Prescribed Exercise for Managing Concussions — the CJSM Blog Journal Club

Our Editor-in-Chief Chris Hughes (R) and Jr. Assoc. Editor Jason Zaremski (L) taking a brief spell from their busy lives.

Our fifth edition of the year went live at the beginning of September, and it’s a special one:  we have devoted the entire issue to the theme of pediatric athletes.

Our guest editor Alison Brooks M.D., M.P.H. has assembled an impressive line up of authors, including John Leddy M.D. of SUNY Buffalo who is the lead on an interesting new study demonstrating the benefits of prescribed aerobic exercise in the recovery of adolescent males from sport-related concussion.

Our Jr. Assoc. Editor Jason Zaremski M.D. has submitted another insightful journal club piece looking at the details of Dr. Leddy’s study.

As fall approaches in the Northern Hemisphere, and spring in the Southern, sports-related concussions will continue to show up in a variety of sports our young athletes play.  This work from Dr. Leddy et al. (including both this new study and his CJSM 2018 study) will be transformative in the way we manage our athletes.

Enjoy the original research paper itself (here) and the journal club article (below).

________________________________________________________________________________

Jason Zaremski M.D., Junior Associate Editor CJSM

Title:

Leddy JJ, et al. A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males. Clin J Sport Med 2019 29(5):353-360.

Introduction:  

As the temperature begins to change and we enter the fall season, millions of student-athletes have returned to school and sport. With such large participation numbers in sport inevitably comes a rise in injury. One of these injuries is sports related concussions (SRC). In recent years, our overall knowledge of how to diagnose, manage, and treat SRC has improved thanks to the ever-growing research in this area. However, one aspect that is continuing to evolve is the timing and intensity of physical activity after sustaining a SRC. While rest (cognitive and physical) has been a mainstay of treatment in the past, there is a growing body of research that indicates physical activity may accelerate recovery versus physical rest only. Thus, it is our pleasure to provide this month’s CJSM Journal Club by reviewing Leddy and colleagues’ new work on the effects of early aerobic exercise as a potential treatment for SRC in adolescent males.

Purpose/Hypothesis(es):

The primary purposes of this research is to compare early subthreshold aerobic exercise (STAE) versus prescribed rest and days to recovery from concussion for adolescent males. The authors hypothesized that STAE would reduce the days to recovery after treatment prescription. Read more of this post

The CJSM Podcast with Dr. Tamara McLeod — Pediatric & Adolescent Concussions

Our guest for the newest CJSM podcast is a friend and colleague I see in a variety of professional settings, and it’s always a pleasure when our paths cross.  Tamara Valovich McLeod PhD, ATC is a busy clinician and researcher at A.T. Still University in Arizona, USA, where she is J.P. Wood, D.O., Chair for Sports Medicine and Professor as well as Director of the Athletic Training Program.

Dr. McLeod is the lead author of an original research paper in our July 2019 CJSM: Patient, Injury, Assessment and Treatment Characteristics & Return-to-play Timelines After Sport-Related Concussion.

Dr. McLeod does it all — from teaching to research to racing.

In our podcast, Dr. McLeod describes how her team did a deep-dive into data from a growing practice-based research network (now encompassing 37 states in the USA) to uncover some of the finer points associated with the presentation, management and outcomes seen in pediatric and adolescent sport-related concussion.

The Athletic Training Practice Based Research Network (AT-PBRN) is centered at A.T. Still University and is a valuable resource for the profession of athletic trainers  (ATs) and sports medicine clinicians in general.  You’ll be sure to see more research coming out of this database in the coming years.

If you’re listening from outside of the USA, you may not be so familiar with ATCs and their central role to the care of athletes, most especially at the secondary school and university levels.  You’ll learn more about the profession if you listen in on the conversation I had with Dr. McLeod.

As ever, you can find this podcast episode (and all of our episodes) on both iTunes and on the CJSM main website.

Remember to subscribe to the podcasts via iTunes so you can access an episode as soon as it is released, and while you are visiting the iTunes site be sure to rate and comment on the good and the bad after listening.  We’re always seeking to improve our media at CJSM.

Summer Reading, Continued

It’s hard to believe. August is here.

In the USA, this is prime time for my field of pediatric sports medicine.  Two-a-day practices have started in high school.  Contact in American football practices will soon begin.  This training is all taking place in the heat.  We’ve got a lot of injuries coming our way.

And yet….it is still summer, and that means vacation for a lot of us.

In the last CJSM blog post, I shared with you a book that I would consider a ‘must read’ for anyone in our profession who cares for young athletes or is interested in the mental health of athletes, especially elite ones:  What Made Maddy Run?

In this post, I want to commend to you another read, David Epstein’s new book, Range: Why Generalists Triumph in a Specialized World.

Mr. Epstein is likely well known to at least American readers of CJSM.  He was a keynote speaker at the AMSSM annual meeting several years ago, and was a focus of a CJSM blog post published at the time his last book came out (another ‘must read’ for our profession): The Sports Gene: Inside the Science of Extraordinary Athletic Ability. 

The Epstein book I am currently reading, Range, is a great book for summer travels.  It was a compelling read that I could pick up on a plane, on the beach, or from my nightstand.  Mr. Epstein’s prose flows as he, er, ranges over a variety of topics centered on the theme of generalists vs. specialists.

The book’s most obvious connection to our world is via the increasingly hot topic in sports medicine of sport specialization, most notably early specialization in youth sports, increasingly recognized as a possible contributor to a high incidence of overuse injuries and burnout. Mr. Epstein explodes the modern dominant paradigm of the so-called 10,000 hour rule, making an argument that specialization may be a crucial piece for excelling only in a limited range of sports (e.g. golf, gymnastics).  That youth who start off as generalists go on to  thrive instead in most sports.

He divides the sports world (and the world in general) into ‘kind’ and ‘wicked’ environments.  Read more of this post

Summer Reading

What are you reading this summer?

Summer can be a time when the pace of work and life slow just a bit, affording us a chance to pick up that book we’ve had sitting on our nightstand or follow through on someone’s suggestion for a ‘must read.’

I have a vacation coming up, during which time I plan to catch up a bit on my pleasure reading. The titles in that reading list are not particularly relevant to our world of sports medicine.  However, I did find the time this past week to read a book I have been ‘meaning to’ for a while, and it’s one I would certainly recommend to all my colleagues in the world of sports medicine.

It is:  “What Made Maddy Run”

I found myself engaging with this book on so many levels — as a human being (mental health issues can affect us all), as a former Ivy League athlete, as a consumer and producer of social media, as a father of teenage athletes, and yes, as a sports medicine clinician.  It was a powerful read, a ‘page turner’ — one that has left me thinking long after I turned the last page, the hallmark of a good book, I think.

Madison (Maddy) Holleran was a high level track runner attending Penn, one of her dream schools, as a freshman.  She came from a supporting, loving family, and was endowed with so many gifts. She was the person who ‘had it all.’ Her social media favorite — Instagram — provided the visuals and narrative confirming that.

But.

But, Maddy struggled with anxiety and depression, and she took her life early in the second semester of her first year at university, leaving so many people mourning the loss and full of questions.

The author Kate Fagan stepped into this story and has written such an insightful book on the nexus of youth sports, mental health, and social media.  Ms. Fagan herself is a former NCAA athlete who poignantly discusses her own struggles with mental health in this book.  Indeed, the story is first and foremost’s Maddy’s; but we come to know the struggles of two athletes as we read this book: the author’s and the subject’s. Read more of this post

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