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

CJSM Blog Journal Club — is rESWT an effective therapy for chronic, distal biceps tendinopathy?

I’m pleased to welcome Jason Zaremski MD, one of our junior associate editors, who has contributed our first on-line journal club article.

Dr. Zaremski is a primary care sports medicine specialist who is board certified in Physical Medicine and Rehabilitation. He is an assistant professor at the University of Florida in the Department of Orthopaedics and Rehabilitation.

Dr. Zaremski is also a member of one of our affiliated societies, the American Medical Society for Sports Medicine, and was appointed last year as the AMSSM junior associate editor.  He’s been busy behind the scenes on many CJSM initiatives already; this is his first foray onto the blog, and we’ve been looking forward to his contribution.  Enjoy!

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Clinical Journal of Sports Medicine

Online Journal Club

Jason L Zaremski

Title: Furia JP, et al. Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy. Clin J Sport Med 2017;27:430–437.

Introduction:

This is the first online Journal Club Commentary for the Clinical Journal of Sports Medicine’s new initiative for its Online Journal Club. Furia and colleagues sought to determine the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for chronic distal biceps tendinopathy (cDBT). This is a retrospective case control study with level three evidence. The specific aim of the study is to determine whether rESWT is safe and effective for the management of cDBT.

Methods:

This is a retrospective case control study Read more of this post

It’s July, and the new CJSM issue has published

July is already here and it’s the moment for a new issue of CJSM.

I wanted to take this moment both to share our Editor-in-Chief’s thoughts on the new issue, as well as republish a very popular journal club posting on one of the highlighted studies in the new issue: LIPUS in the treatment of spondylolysis.

Whether it’s summer or winter where you currently live, we at CJSM hope you are well and will enjoy and learn from the July 2019 issue.

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Editor-in-Chief Chris Hughes

It’s difficult to believe that we’re already half-way through the year, but here we are already with our fourth Issue of the Clinical Journal of Sport Medicine in 2019. 

We start this month with an interesting systematic review by DiSilvestro and colleagues examining the outcomes of anterior cruciate ligament (ACL) reconstruction amongst obese and overweight patients, in studies with a minimum of 1-year follow-up data. 

Several factors were examined in this review including mechanism of injury, post-reconstruction rates of arthritis, IKDC scores, risks of requirement for revision surgery, and risks of contralateral ACL tears. A consistent association between overweight status and the subsequent development of arthritis post-ACL reconstruction was found. However, patient-reported outcome measures were similar for both sets of patients apart from IKDC scores, with lower IKDC scores being found amongst the overweight and obese population. The authors conclude that more research is required to be able to appropriately counsel patients undergoing primary ACL reconstruction surgery with specific relation to weight optimisation prior to surgery. 

Tsukada and Colleagues present an interesting case-control study of the effect of low-intensity pulsed ultrasound (LIPUS) for early-stage lumbar spondylolysis amongst a cohort of 82 active sports participants aged between 10-18 years old, with the vast majority of these subjects playing baseball. Time required for return to previous sports activities with standard conservative treatment (including thoracolumbar bracing, activity modification and therapeutic exercises) were compared with a similar group also receiving LIPUS treatment. Amongst this cohort, median time for return to previous sports activities for the conservative treatment plus LIPUS group was 61 days, compared with 167 days for the conservative tretatment-alone group. The authors suggest that LIPUS combined with conservative treatment may be a useful therapy for shortening return to sport times. 

Highlights amongst our other Original Research articles this month include the clinical utility of oculomotor and electrophysiological measures in identifying concussion history, the effects of long-term diving on the morphology and growth of the distal radial epiphyseal plate of young divers as assessed by MRI, and a prospective randomized-controlled trial pilot study comparing conservative treatment with trunk stabilisation exercises to standard hip muscle exercises for treating femoroacetabular impingement. 

We also bring you a Brief Report on the effect of a commercially available footwear insole on biomechanical variables associated with common running injuries, and a Case Report on the clinical outcome following lateral ulnar collateral ligament reconstruction in an adolescent baseball player. 

Finally this month, we pay tribute in respect of the passing of our esteemed Editorial Board Member, Dr Bill Garrett Jr, on May 4th, 2019. As Director of Duke Health, Bill was a much-loved and valued member of the Orthopedic team there for over 40 years. As a Specialist in Sports Medicine, he worked as the Medical Director for the US Soccer Federation and as Team Physician for the US National Men and Women’s Teams, as well as for many Duke teams. A consummate clinician, researcher and teacher, he served as former President of the American Orthopaedic Society for Sports Medicine and the Herodicus Society, and was also a Board Member of the American Board of Orthopaedic Surgeons, the American Academy of Orthopaedic Surgeons, and the American College of Sports Medicine. 

Bill will be sadly missed by all of us at the Clinical Journal of Sport Medicine, and by the many colleagues, juniors, and patients who owe their thanks to him for his contribution to Medicine in his many roles over the years. 

Best Wishes, 

Chris

Christopher Hughes MBBS MSc

Editor-in-Chief 

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Clinical Journal of Sport Medicine Blog

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…

View original post 1,161 more words

Gender Bias in Medicine — the CJSM podcast with Dr. Esther Choo

@choo_ek (a.k.a. Dr. Esther Choo) — a definite follow on Twitter!

We are excited to share the first CJSM podcast of 2019 with you.  Special guest Esther Choo M.D., M.P.H. joins us to discuss issues of gender bias in medicine:  “From Mansplaining to Bromotion — How We Can Move the Needle on Gender Bias in Sports Medicine.” 

For those not familiar with Dr. Choo’s work, I would direct you to a CJSM blog post from December 2018 where I shared with you some of my thoughts about one of her more recent commentaries published in the British Medical Journal (BMJ): “A Lexcion for Gender Bias in Academic Medicine.”

I would also direct you to her Twitter feed and heartily encourage you to follow her @choo_ek to continually learn from her, as I do on a nearly daily basis.  She argues strongly that issues of equality inform all our attempts to deliver high quality medicine; that issues of bias should be of interest to us all, because they affect not only our fellow professionals, but the patients we serve.

She also does this typically with a sense of humor, which has often put me in mind of Mark Twain’s quotation, “Against the assault of laughter nothing can stand.”  This work and this tone can be hard to achieve, because many of the issues Dr. Choo and others are tilting against can be dark.  In thinking of our own word of sports medicine, the complicated and horrific story of Larry Nassar and USA Gymnastics comes to mind.  I’m also mindful of stories like that of Eva Carneiro, former team physician of an English Premiership Club, whose summary dismissal was entwined with these issues of sexism.  Or the exceedingly common phenomenon of attending a sports medicine conference only to find that all the keynote speakers are male

The world we serve is rife with issues of gender bias.  On his recent retirement, Andy Murray was lauded as an all too rare light in men’s sport — a man who would publicly stand up for women’s issues, a #HeForShe.  Or what to make of the arena of NCAA Division I coaching, where the sight of a man coaching a women’s team is common (think Gino Auriemma of UConn Women’s Bball), but the reverse is an exceedingly uncommon phenomenon.

There is light in this darkness.  Dr. Choo and groups like Feminem.org are doing great work.  I am also mindful of the lead that the IOC 2020 Prevention Conference has taken on this — the organizers publicly stated their intention to assemble a gender balanced planning committee, and they got it right, I think, including many luminaries in our field including Margo Mountjoy, Kate Ackerman, Caroline Finch, and Christa Janse van Rensburg, among others. Bravo!

I hope you go to our podcast page on our main website, or subscribe to the podcast on iTunes, to listen to our conversation with Dr. Choo and sample all of our podcasts.  Please let us know what you think. Take the time if you can on our iTunes feed to give us your opinion on the podcast in general, as we always take feedback seriously and use it to ‘tweak’ our media to make it ever better for you.

 

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