Concussions: The “Injury of 2018”

December 11, 2018 by 2 Comments

Concussions remain a dominant subject in the sport medicine literature and media at large — Photo: PET Scan Brain, Wikimedia

As 2018 winds down, the Clinical Journal of Sport Medicine, like so many of its sister media, finds itself in a reflective mood.

Time magazine, for instance, has just named its “Person of the Year”: a group of journalists the magazine notes has been ‘targeted’ for the work they do pursuing the truth.  Time calls them The Guardians. It is an interesting selection:  a media outlet honoring other professionals in its own line of work.

I thought it time that CJSM do its own version of “Person of the Year,” but with a sport medicine twist — Injury of the Year.

I’m naming “Concussion” the Injury of the Year.  In 2019, I’ll have my ‘act together’ and put out a Twitter poll in late November for reader contributions; but in 2018, I’ll have to play judge and jury, given that it’s nearly mid-December. Thanks for indulging me!

Like LeBron James of the NBA, who could probably be named MVP in any year he has played in the league, concussion is a sports injury which could probably earn this distinction in any year over the last decade or more.

In truth, 2018 was a red banner year for the injury, so to speak.  As an example, nearly our entire March 2018 issue was devoted to original research on various aspects of the subject, including a systematic review on the long-term consequences of traumatic brain injury in professional football players.  Continuing this line of reasoning, I would draw your attention to another noteworthy systematic review just published in our last issue of 2018 (November).   This one looks at the utility of blood biomarkers in the assessment of sports-related concussions (spoiler alert:  we have a long way to go in developing these for ‘prime time’).

The dominant theme of our 2018 podcasts was, again, concussion.  Read more of this post

Filed under CJSM Podcasts, Concussion in Sport, Elite sport, General Interest

Pain Management in Athletes: A Conversation with South Africa’s Wayne Derman

November 26, 2018 by

Wayne E. Derman MBChB BSc (Med)(Hon) PhD, of Stellenbosch University, South Africa

Our guest for our newest podcast is Wayne E. Derman MBChB BSc (Med)(Hon) PhD.

Dr. Derman was the Guest Editor of our September 2018 CJSM, which was a thematic issue focusing on pain management in athletes.  He hails from South Africa, where he is Director and Chair of the Institute of Sport and Exercise Medicine, at the Division of Orthopaedic Surgery, Stellenbosch University. Dr. Derman does research in Sports Medicine, Rehabilitation Medicine and Cardiology and lectures widely around the world.

If you have not heard him speak, now is your chance. We had an exciting discussion about the challenges of pain management (and the challenges of guest editorship) which we have entitled:

No pain no gain? NO WAY!

Take a listen to this episode, and all of our podcasts, at the CJSM link on iTunes or on the journal’s home page on the web.  Then consider reading Dr. Derman’s lead editorial, or any number of the published studies in the thematic issue, and share your thoughts which him or us on Twitter: @wderman @cjsmonline.

Filed under CJSM Podcasts, Drugs and Doping in Sport, Elite sport, Ethics and probity in SEM, General Interest

CJSM Blog Journal Club — Can Cold IV Saline Mitigate the Effects of Exertional Heat Illness?

November 21, 2018 by 1 Comment

Can cooling this down prevent the sequelae of EHI? Photo courtesy of Wikimedia, NIAID

It’s November, and our sixth and final edition of 2018 has just published.  One of the original research articles in this edition is: Effects of Intravenous Cold Saline on Hyperthermic Athletes Representative of Large Football Players and Small Endurance Runners. 

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 and the blog post below.  As ever, we love your comments:  you may give them here on the blog or Tweet them to us at @cjsmonline.

We’re nearing the end of 2018.  As the Journal publishing crew gets ready to celebrate Thanksgiving, we want to thank you for visiting us on this blog and reading and contributing to CJSM.

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Jason Zaremski, MD

Introduction:  The winter Journal Club commentary for the Clinical Journal of Sports Medicine (CJSM) will be a review of an original research manuscript highlighting an alternative method for treating exertional heat illness (EHI). As many of us in the sports medicine community are fully aware, EHI is a potentially devastating pathophysiological process that is treatable if timely and efficient action is taken.  Speed is of the essence. Heat stroke, a type of EHI where core body temperature is greater than 40°C/104°F, can result in significant central nervous system morbidity, and even death, if not treated immediately.

Morrison and colleagues performed a novel study assessing the effects of intravenous cold saline (IVCS) on hyperthermic collegiate football players and cross country runners. As the authors note, the use of cold saline infusion has not been studied for its effects on hyperthermic athletes, though it has been studied for rapid cooling for patients who have had cardiovascular and/or neurological insults in order to induce “therapeutic hypothermia.”

Purpose/Specific Aim(s):  To evaluate the cooling effects of IVCS (4°C/39°F) on hyperthermic athletes and compare to the effects of room temperature normal saline (RTNS) (22°C). A secondary aim was to assess if body composition had an effect on IVCS cooling rates.

Methods/Design: Read more of this post

Filed under General Interest, Journal Club Tagged with ,

Musings Post Sports Medicine New Zealand 2018 Conference

November 15, 2018 by

Dr. Hamish Osborne (standing, far left) at Pan Pacific Masters Games

Our Associate Editor Hamish Osborne MB ChB FACSP is a member of the Australasian College of Sport and Exercise Physicians (ACSEP).  CJSM relies on Dr. Osborne for a lot!  He has been a lead author on important studies CJSM has published, been a guest on our podcast series, and plays an invaluable role keeping the journal and its readers abreast of sport medicine developments in New Zealand and Australia.

We asked him to share his thoughts about the recent Sports Medicine New Zealand Conference that took place at the end of October.  He would have filed this report sooner, we’re sure, except for the fact he had to jet off right after the conference to participate in the Pan Pacific Masters Games which just wrapped.

So, we share with you our ever-intrepid editor, physician, athlete and Tweeter, Dr. Hamish Osborne:

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So I’m sitting @DunedinAirport in the @FlyAirNZ lounge on my way to the Gold Coast for the @PanPacMasters Games to put into action some of the swim skills @Karlynswim Pipes taught me in Kona a few weeks ago at the @IRONMANtri Sports Medicine Conference. My wife Jules Osborne, who coaches @HPSportNZ Allied health medical staff in motivational interviewing, is already there playing basketball with @ACSEP_ CEO Kate SImkovic (@hoover22). Hoove is great on the rebounds hence the handle. They are 2/2 so far so keep going team.

This morning I got to use what we learned at last week’s @Sportsmednz Conference. It has been a challenge for several years counselling young athletes with fresh ACL tears – you know the stuff – only 60% actually return to pivoting sport and the operation is no better than no operation just we don’t know how to decide whether you should have an operation – the consultation all goes well and they come back next time saying their coach/friend/sister/dog walker had an ACL recon and so they want one. Well – I had never heard of Prof Lynn Snyder-Mackler @doclsmack or her work. A decade of worldwide literature shows the return to sport rates after ACLR are not much better than the chance of predicting a US election* really no matter what sport, what level or country it’s from. Lynn’s research is more than 10% better than that AND she has published it. Not only does she have a pre op pathway that improves outcomes, she has a post op pathway that smashes everyone else’s results and makes us look like amateurs. I got to use it this morning and I must say it made for a much better consultation than what I used pre conference. #Loveaconferencethatchangesmypractice!!

It was also great to see my Canadian friend Dr Alan Vernec again.  I met him for the first time (but felt like I knew him from Prof David Gerrard talking about him) at Mt Tremblant @CASEMACMSE Conference in 2017. What a debate we had with him, David ( who is chair @wada_ama TUE Committee), A/Prof @LynleyAnderson  (author @ACSEP_ code of conduct) and Dr Peter Burt who is doing his PhD on the ethically challenging situations sports docs end up in @Otago University.

So back to my preparations; I stopped cramming my fitness Monday and tapered this morning. I’m rehydrating on a small glass of world famous New Zealand Sauvignon Blanc and they just called my flight.

Hope to see you all #DownUnder in New Zealand next year. You have a great choice – the ACSEP_ conference is in Queenstown in February 2019 and the next Sports Medicine New Zealand Conference is in Dunedin 1-2 November 2019 to coincide with the 150th Anniversary Celebrations  of Otago University

Swim fast, advise well, don’t dope and vote!

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Thank you Dr. Osborne.  Regarding several of the important points you brought up:

  1. Definitely circle the ACSEP conference on your calendars for 8 -10 February 2019 in Queenstown!
  2. Dr. Lynne-Sackler’s work on post-ACL injury rehab (for conservative or surgical treatment) is among the programs evaluated in this review of ACL Rehab Programs.
  3. * And regarding this point:  the quoted ‘odds’ of the Democrats’ winning the 2016 USA election were 85%, those facing an NFL goal-kicker kicking from the 37-yard line. Did anyone else watch Mason Crosby’s cringe-worthy kicking performance a few weeks ago?  As a Packers’ fan, I, for one, will never again take a 37 yard field goal for granted (or, for that matter, put much stock in election predictions!).

Filed under Medical Conferences Tagged with

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