CJSM Blog Journal Club — NMT to prevent ankle sprains in youth soccer and basketball athletes

Our Jr. Assoc Editor Dr Zaremski — already awarded an AMSSM Travelling Fellowship. Is there something bigger in his future?

It’s July, and our fourth edition of 2018 has just published.  One of the headlining pieces of original research we have in this edition is new work from the Sport Injury Prevention Centre in Calgary, Alberta Canada (chaired by Caroline Emery, the well-known researcher and author): Prevention of Ankle Sprain Injuries in Youth Soccer Cland Basketball: Effectiveness of a Neuromuscular Training Program

Our Jr. Assoc. Editor Jason L Zaremski, MD  is today reprising his role as guest author for the CJSM blog journal club  and will take us through his read of the study.  Join in the conversation over this important new, original research by reading the article, the journal club post below, and sharing your thoughts in the ‘reply’ section below this post, or on Twitter at @cjsmonline 

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Clinical Journal of Sport Medicine Blog Journal Club

Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR

Title: Owoeye OBA, Palacios-Derflingher LM, Emery CA. Prevention of Ankle Sprain Injuries in Youth Soccer and Basketball: Effectiveness of a Neuromuscular Training Program and Examining Risk Factors.

Introduction:  The summer Journal Club commentary for the Clinical Journal of Sports Medicine will be an analysis of the new research examining the effects of injury reduction of ankle sprains in soccer and basketball using neuromuscular training (NMT) program in youth athletes. The secondary objective of this study included the evaluation of risk factors for Ankle Sprain Injury (ASI).

Methods:  This study was a secondary data analysis from 3 cohort studies and 2 randomized control trials (RCTs) over the course of 1 season of player in soccer and basketball from 2005-2011. There were a total of 2265 patients aged 11-18 years that play soccer and basketball in Alberta, Canada. Player characteristics (sex, age, weight, height, BMI, sport exposure time, previous ASI, previous lower extremity injury with and without ASI) were divided based upon if a player participated in a NMT program or did not. Frequency between all variables was very similar except for No NMT between females (n=952) and males (n=439) and sport participation without exposure to NMT (soccer = 965, basketball = 426). Average age, weight, height, and BMI were all similar. Exposure time for the NMT group was 72.56 (70.98-74.15) hours versus 62.92 (61.48-64.37) hours for No NMT group.

Secondary Data Analysis Studies: Read more of this post

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CJSM Blog Journal Club — is Low-intensity Pulsed Ultrasound an Effective Treatment in Spondylolysis?

Spondylolysis in the adolescent athlete — what to do?

Symptomatic isthmic spondylolysis in the adolescent athlete — for many of us in the world of primary care sports medicine who have a large pediatric/adolescent patient base, this is one of the more common clinical entities we treat.

I’ve written previously about some of the controversies surrounding this condition, and I have had the pleasure of seeing some of the spondylolysis research I’ve conducted published in the pages of CJSM.

Recently published “On Line first” in CJSM is research coming from a Japanese center renowned for its work in this area:  Low-intensity Pulsed Ultrasound (LIPUS)for Early-stage Lumbar Spondylolysis in Young Athletes.

I’m delighted to introduce again our Junior Associate Editor, Jason Zaremski, M.D., who is pioneering our on-line CJSM journal club.  He’ll take us through this new study and help us decide:  LIPUS — should we be using it in our clinical practice when treating an adolescent-athlete with early-stage, or ‘acute,’ isthmic spondylolysis?

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Clinical Journal of Sports Medicine

Online Journal Club

Jason Zaremski, M.D.

Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR

Title: Tsukada M, Takiuchi T, and Watanabe K. Low-Intensity Pulsed Ultrasound for Early-Stage Lumbar Spondylolysis in Young Athletes. Clin J Sport Med. Published Ahead of Print October 10, 2017. doi: 10.1097/JSM.0000000000000531.

Introduction:

The spring Journal Club commentary for the Clinical Journal of Sports Medicine will be a review of new research examining the effects of pulsed ultrasound for early-stage lumbar spondylolysis in young athletes. This is a retrospective case control therapeutic study with level three evidence. The specific aims of the study were 1) to determine differences in median time to return to previous sports activity with and without the use of low intensity pulses ultrasound (LIPUS); and 2) to determine if healing rates are improved with LIPUS. Read more of this post

“Primary Care for Sweaty People”

Dr. Carl Stanitski with wife & equestrian athlete, Debbie

I am fortunate to be spending my weekend in Ft. Lauderdale, Florida, where I am attending the 5th Annual Meeting of the Pediatric Research in Sports Medicine (PRiSM) Society Meeting.  This meeting is becoming a major fixture on the pediatric sports medicine calendar, and I have gained so much by joining this organization and attending the proceedings over the last few years.  If you specialize in pediatric sports medicine, the dates January 24 – 26 2019 (next PRISM meeting in Atlanta, Georgia) should be circled on your calendar.

Among the highlights of the meeting was a keynote talk by Dr. Carl Stanitski, Emeritus Professor of Orthopaedic Surgery and Pediatrics at the Medical University of South Carolina.  He, along with other legends like Dr. Lyle Micheli and Dr. Jim Andrews, was a pioneer in pediatric sports medicine in the 1970’s when, as he described it, the initial work being done in this field was derided as ‘primary care for sweaty people.’

My, how this field has grown.  In the USA, the advanced, fellowship training in this discipline has exploded in both the primary care and orthopaedic surgery worlds.In the primary care world alone, there are > 200 programs in operation

Twenty-five years ago, when the field was a lot smaller, Dr. Stanitski and others were already sending up the alarms over increasing sports injury rates seen in young athletes — check out this vintage New York Times article from 1992. The article notes:  “They attribute the rise in such so-called overuse injuries to intensive sports training programs for young children, longer playing seasons and specialty sports camps in which children may spend hours lobbing balls on a tennis court or throwing hundreds of pitches each day.”

Plus ça change….the more things change, they more they stay the same.  These are precisely the issues we still face, 25+ years down the road.  That same sentence in the NY Times could be written today.

CJSM and other journals (JATA, BJSM, AJSM, Sports Health) play major roles in publishing and disseminating the research on the diagnosis, management, treatment and prevention of pediatric sports injuries.  A cursory review of the pages of CJSM over the last few years reveals publications related to pediatric concussions , overuse injuries, and training.

What I walk away from this meeting with, more than ever, is the awareness of how much more we need to go in terms of knowledge translation.  If 25 years ago the leaders in this field were already noting a skyrocketing injury rate, and if there has been a wealth of increasing research in this area, why has the problem only seemed to worsen?

The issue of knowledge translation — of taking the information we researchers produce and we journals publish — is near and dear to the collective hearts of the CJSM editorial board.  As professionals we have to start getting the rubber to meet the road.  One of the reasons why we are so passionate at CJSM about using social media is our goal to spread knowledge widely, to get it in front of the people who can put this into practice.

Join us in this quest by following us on Twitter and Facebook and subscribing to our iTunes podcast feed.

Disparities in sports medicine health care

Most days of the week I see my pediatric sports medicine patients in two very different clinics:  one is within the inner city of Columbus, Ohio itself; and one is in the foothills of Appalachia, a region described in the recent bestseller, Hillbilly Elegy.  Among the patients I frequently see, I have many who could be described as urban poor (the former location), and many as rural poor (the latter).

In my care of these patients, I frequently see them (and their families) struggle with several barriers to excellent care — these range from financial issues, to issues of transportation and distance traveled, to issues of understanding related to educational levels, to a relative lack of resources at their home schools or clubs (e.g. no certified athletic trainers).  I feel at a great loss, at times, in trying to help them achieve the same results I would want for any of my patients.

I read with great interest then, in the November 2017 CJSM, a newly published, original research study: Disparities in Athletic Training Staffing in Secondary School Sport: Implications for Concussion Identification.  I found it so impactful, that I wanted to talk with the author — and so I tracked down Emily Kroshus ScD, MPH for this episode of the CJSM podcast.

Dr. Kroshus is a Research Assistant Professor of Pediatrics at the University of Washington, who is developing a body of academic work that focuses on “….identifying social and contextual determinants of help seeking behaviors, with an overarching interest in addressing disparities related to gender, race, sexual orientation, and socioeconomic status.”(1)

I hope you are as interested in this sort of research as much as I am.  So take a listen to the podcast on iTunes or go to the CJSM website for the podcast (look for the radio button) and the study itself.

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(1) Dr. Kroshus’ biography can be found at the University of Washington faculty page:  https://depts.washington.edu/uwgenped/directory/emilykroshus

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