Concussions take time — CJSM Blog Post Journal Club

Our Jr. Assoc. Editor Jason Zaremski MD looking for some help from a friend with the newest CJSM Blog Post Journal Club

Our March 2020 issue has just published, and right out of the gate one of the studies that has received the most buzz is one from a team of researchers in New Zealand demonstrating that less than 50% of concussed individuals recover within two weeks of a sports-related concussion.

Jason Zaremski, MD, CJSM’s Jr. Assoc. Editor, explores this new study today in our most recent CJSM Blog post Journal Club.  It is a two year prospective study with some revealing findings. We’re sure you will enjoy the blog post and the study itself!

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Jason Zaremski MD

Kara S, et al. Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study. Clin J Sport Med 2020;30:96–101. doi.org/10.1097/JSM.0000000000000811.

Introduction:  Sports related concussion (SRC) is a common and significant concern, challenging not only sports medicine practitioners, but also athletes, coaches, family members, and all sports performance team members. While diagnostic skills and research in this area have dramatically improved in the past 10 years, our patients still have several questions, including: How long until I can go back and play? Some data has suggested the majority of SRC patients recover in approximately a 2-4 week recovery time frame. According to the consensus statement in concussion in sport (5th iteration) held in Berlin, Germany, in October 2016—“the expected duration of symptoms in children with SRC is up to 4 weeks.” (McCrory, et al. BJSM 2017).  Kara and colleagues  have looked into the validity of this stated time frame.

Purpose: To describe clinical recovery time and factors that could impact recovery after a sports-related mild traumatic brain injury (SR-mTBI, aka “concussion”).

Methods/Design:  This is a prospective cohort study with level IV evidence. Read more of this post

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).

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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.

The 2019 AMSSM Position Statement on Concussion — a Podcast with Dr. Kim Harmon

How to manage concussion in sport in 2019: The AMSSM Position Statement, and the new CJSM podcast

As one of our partner societies, the American Medical Society for Sports Medicine (AMSSM) contributes significantly and regularly to the global sports medicine discussion.  When the AMSSM authors a position statement, it’s a document that should be read by the active sports medicine clinician

Prof. Kim Harmon, past-president of the AMSSM

Hence, the publication of the AMSSM Position Statement on Concussion in Sport is news we want to make sure you all know about.  And if you haven’t had the chance to read it yet, you can now take the opportunity to hear about it from the publication’s lead author, Dr. Kimberly Harmon of the University of Washington.

For the new statement, Dr. Harmon notes that she and a panel of expert authors adopted a very specific focus: what does the practicing clinician need to be current when diagnosing and managing a concussion in 2019. This is a document for the sideline, the training room, the clinic.  A document for ‘now.’

It is evidence-based, but also ready to assist clinicians in the areas of concussion where evidence is currently limited.  That is, the statement makes suggestions for needed future research directions, but also reports current best practices informed by consensus or expert opinion.

After reading it, I found myself immediately referencing the statement when conversing with patients and families, whose questions might range from whether their child should take fish oil after their concussion (no, unless your child is a rat, as Dr Harmon may say….) to whether they are ready to drive (well, that depends….).

Take a listen to all of our podcasts on our main website or on iTunes.

If you want especially to hear interviews we’ve had with authors of previous AMSSM Position Statements, check out as well our podcasts with Dr. Jonathan Drezner (cardiovascular screening) and this one with Dr. Irfan Asif  (best practices for a sports medicine fellowship).

As ever give us feedback on these podcasts at the iTunes page, or in the comment section here!

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