CJSM and concussions — in the news

As 2020 rolls on and COVID dominates, quite rightly, much of the conversation in sports medicine, important research continues on topics of concern that have been present a lot longer than the novel SARS-CoV-2 virus.

CJSM prides itself on publishing a large number of primary research articles, which often get considerable media buzz. I wanted to share with you today two recent CJSM publications that have caught the attention of the lay press and are likely to have a significant and transformative impact on sports medicine practice.  The two research articles both address a long-standing concern of sports medicine — concussion in sport.

The first such article was published in our March 2020 edition: Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football, a study whose team of authors primarily comes from Purdue University in the United States.  This pilot study contributes to the literature of risk mitigation in contact sport — how might we lower the incidence of concussion in a sport like North American football?  The findings were interesting enough to command the attention of Forbes magazine.

John Miller of the Buffalo Bills demonstrating a ‘2-point’ or ‘up’ stance. Photo Erik Drost, Wikimedia

This study evaluated the number of head acceleration events (HAEs) based on position, play type, and starting stance.  The most significant outcomes were reported for offensive linemen.  Offensive linemen in North American football have typically begun plays in a ‘down’, or what is known as a 3- or 4- point stance, as opposed to an ‘up’ or a 2-point stance. The position taken at the start of the play is sometimes dictated by what type of play, run vs. pass, may be run. Read more of this post

CJSM Podcast with Kim Barber Foss and Greg Myer

We’re excited to ring in 2020 (and our 30th year of the journal) with both the publication of our January issue and a podcast with two special guests:  Kim Barber Foss MS, ATC and Greg Myer PhD from Cincinnati Children’s hospital, the lead and senior author on a study published in our November 2019 issue, Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football.

Kim Barber Foss MS, ATC

Kim and Greg are prolific researchers and have published widely. For instance, Kim published one of the seminal papers on youth sports concussion over 20 years ago in JAMA: Traumatic Brain Injury in High School Athletes. Do you remember those hoary days of the late 90’s, a prelapsarian world before iTunes and Twitter????  And Greg has published widely on subjects from ACL injury to concussion.  He has been a frequent contributor to CJSM and a major force in advancing evidence-based sports medicine.

With good friend and frequent CJSM contributor, Greg Myer PhD

I hope you get the chance both to read the study and listen to the podcast.  As ever, the podcast conversation can be an illuminating way to understand the author’s interpretation of their own work — conclusions which can be quite different from those which an individual reader may draw from the same study.  This is most especially true when the underlying subject — brain injury in youth contact sports — is such a controversial one.

As ever, you can find and subscribe to our podcasts on iTunes or at the CJSM website. If you have feedback to give us about the podcasts in general, please take the time to rate CJSM at iTunes.  And if you want to comment on this particular podcast and this particular study, please do so on this blog’s moderated comment section.

Enjoy the January 2020 issue and Happy New Year!

CJSM Blog Journal Club — Brain Changes After a Single Season in Youth vs. High School Football

Attending to injured player, High School Football

The November 2019 Clinical Journal of Sport Medicine has just published, and as always the new edition is full of interesting and original research.

One of the studies that already is getting some buzz is one by a team of researchers (full disclosure: including myself) headed by Dr. Kim Barber-Foss entitled Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football.

This is a perfect study for a journal club, as the subject of cumulative exposure to head impacts, most especially in our youngest athletes, has been a hot, hot topic in sports medicine for several years. The sport in question here is American gridiron football.

Our intrepid Blog Journal Club author and Junior Associate Editor Jason Zaremski MD leads the charge, as ever, in his most recent post.  Thanks Dr. Zaremski for your insightful analysis of this new research.

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Title: Barber Foss KD, et al. Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football. Clin J Sport Med 2019;29:442–450.

Jr. Assoc. Editor and Blog Journal Club author Dr. Jason Zaremski (L) and CJSM Editor-in-Chief Dr. Chris Hughes (R)

Introduction:  The pre-holiday CJSM journal club brings you an innovative new study from expert researchers related to potential white matter changes in the brain in adolescent football players. As has been discussed in the CJSM journal club as well as throughout the media, there are many consequences to sustaining a sport related concussion (SRC). One question yet to be answered, with advances in neuroimaging techniques, can structural alterations of the brain be observed using magnetic resonance diffusion tensor imaging (DTI)? According to the authors, DTI can evaluate microscale white matter (WM) changes. This is potentially important as WM changes may be detected even without clinical signs of a SRC. More specifically, the measurable metrics include fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD), and mean diffusivity (MD). According to prior research, RD, AD, and MD are sensitive to detect WM changes in athletes participating in contact sports. Hence, we present “Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football.”

Purpose: To determine preseason to postseason changes in WM integrity from repetitive head impacts for youth football (YFB) players compared with HS football players during a competitive football season.

Hypothesis(es): The magnitude of WM changes would be greater for YFB than for HS football players.

Methods/Design:  Prospective study with IRB approval and consent and assent obtained. Read more of this post

What to do about heading?

Heading the ball — photo courtesy of Wikimedia

I have been meaning to write a blog post for over a week, since a bit of breaking sports medicine news occurred with the publication of some research in the New England Journal of Medicine (NEJM).

It took a Tweet this morning to rouse me to action.  I promise it hasn’t been sloth on my part that has slowed my hand, but pleading “I’m busy” to the group of folks who usually will be reading CJSM media is not going to gain much sympathy.

And yes, with fall sports, I sure have been busy.  But I am sure you have too.

I hope, however, not too busy to have missed this piece of research from NEJM: “Neurodegenerative Disease Mortality Among Former Professional Soccer Players.”  There was an accompanying editorial to this study, a piece that is most definitely worth a read too. “Soccer and Mortality — Good News and Bad News”

The published research was a large retrospective cohort study looking at former professional Scottish football (soccer) players: 7676 cases were identified from databases of Scottish football players and 23,028 controls (3:1) from the ‘general population’ were identified using a Scottish ‘Community Health Index.’ Controls were matched to players on the basis of sex, age, and degree of social deprivation.  Of note, all the participants in this study were male.The researchers looked at two dependent outcome variables:  i) cause of death as noted on death certificates and ii) dispensed medications, information for which was obtained from the Scottish national Prescribing Information System.  Follow up information for study participants was for a median of 18 years (for each individual, “Age was used as the time covariate, with follow-up from age 40 years to the date of data censoring, which was either the date of death or the end of the follow up (December 31, 2016), whichever occurred first).”

The researchers report several important findings in this study, to note just a few:

Read more of this post

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