William P. Meehan III, M.D. guests on “5 questions with CJSM”

September 14, 2013 by

bill m stanley cup

Bill Meehan & The Stanley Cup
One of the few awards he has
not garnered in his career.

Readers of the blog will remember in August I was able to interview Dr. Jason Mihalik, University of North Carolina, about his work while using the ‘5 questions with CJSM’ format.  I’m happy to say I have another willing victim for this format.

I have known William P. Meehan III, M.D. for several years; we both did our sports medicine training in Boston under the illustrious doctors Lyle Micheli, M.D. and Pierre d’Hemecourt, M.D., authors whose names will be familiar to readers of the journal as they have both been published in CJSM numerous times.

Bill, as I know him, is likewise establishing his own enviable track record in the clinical management and study of sport-related concussions.    I have mentioned some of the work he has done in a recent blog post, and so in the spirit of brevity let’s get right to the interview.

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Five Questions with CJSM

WM:  Thanks so much for inviting me to be part of your blog, Jim.  You do great work here at the Clinical Journal Sports Medicine I appreciate your including me.

1)    CJSM:  Thanks for those kind words Bill, and congratulations on your receipt of the first AMSSM-ACSM Foundation’s Clinical Research Grant for your project titled “A Randomized, Double-Blind, Placebo-Controlled Trial of Transcranial Light Emitting Diode Therapy for the Treatment of Chronic Concussive Brain Injury.”  Can you tell us what potential you see for LED therapy in this arena

WM:  The idea of using light emitting diodes (LEDs) to treat concussive brain injury was brought to my attention by Margaret Naeser, PhD, who works at the VA Boston Healthcare System and Boston University School of Medicine. Dr. Naeser approached me one day after a lecture and suggested that perhaps LED therapy could help people suffering from concussive brain injury. To be honest, I was a bit skeptical at first. But she was passionate and convincing about it.  After reading some of the previous medical and scientific literature about light therapy, my mentor in the laboratory, Michael Whalen, MD at Massachusetts General Hospital conducted some experiments on mice that had suffered a traumatic brain injury.  The results were promising.  So the three of us, together with Rebekah Mannix, MD, MPH, Alex Taylor, PsyD, and Ross Zafonte, DO set out to conduct the study.

As you know, the current hypothesis of concussion is that a rapid rotational acceleration of the brain leads to changes in the ionic gradients across the axonal membrane. Those ionic gradients are restored to homeostasis by the action of the sodium-potassium pump. The sodium-potassium pump operates on adenosine triphosphate (ATP). It turns out that light in the red and near infrared spectrum when applied to cells in culture increases the activity of cytochrome C oxidase. This results in further ATP synthesis. Thus, some very astute researchers hypothesized that shining light in the red/near infrared spectrum on the brain would result in an increase in ATP production and perhaps decrease the healing times after certain brain injuries, including traumatic brain injury.

Dr. Whalen was nice enough to conduct an experiment in his laboratory using mice that had sustained brain injuries when we first heard about this.  Those experiments showed that treatment with laser in the red/near infrared spectrum resulted in better outcomes on measures of cognitive functioning, specifically the Morris water maze. After considering all of the evidence I followed up with Dr. Naeser. She informed me that she had an ongoing trial of light emitting diode therapy for people suffering from chronic traumatic brain injury. She had also published a case series of two patients who sustained concussions during motor vehicle collisions, athletic participation, and military service, who showed improvements of their cognitive functions after LED therapy. So we decided to conduct a randomized, double-blinded, placebo-controlled trial of LED as treatment for concussion.  Thus far, we have recruited half of our estimated sample size of 48 patients.

2) CJSM:  Congratulations as well for becoming Director for the Micheli Center.  If you had to compose a 140 character tweet to tell the world about the work you expect to accomplish there, what would it say?

WM:  Thank you.  I was delighted to become director of the Micheli Center for Sports Injury Prevention. We believe we are the first center in the world where athletes can come and learn which injuries they are at highest risk of sustaining, and what steps they can take to reduce the risk of those injuries.  The full Injury Prevention Evaluation takes about 3-3.5 hours.  It starts by collecting historical information, such as what sports the athletes play, what injuries the athletes have previously suffered, how many hours per week the athletes train, etc.   Then the athletes move out to the assessment floor where we measure bony angles, flexibility at the joints, strength in various muscle groups, speed, power, agility, and many other factors that are associated with the risk of injury.  The full evaluation includes over 300 data points, all based on the available medical and scientific evidence.  At the end of the evaluation, athletes are given a list of the injuries for which they are at highest risk, and an individualized prescription that outlines the steps they can take to reduce their risk of sustaining those injuries.

Our goal is to encourage safe participation in athletics while simultaneously decreasing the risk of injuries sustained during sports.

Although I don’t have twitter account, if I had to put out a 140 character tweet to the world I would say, “Our goal is to reduce the risk of sustaining sports injuries while simultaneously encouraging athletic participation.”

(CJSM:  21 characters to spare with that tweet!  Hey, Bill, with a name like yours, you can imitate RG3 and see if the twitter handle WM3 is available.  You can make the Micheli Center go viral!) Read more of this post

Filed under Concussion in Sport, Evidence-based Medicine in SEM, General Interest, Injury Prevention, Technology in Sports Medicine, Youth Sport Tagged with

Exertional Rhabdomyolysis

September 11, 2013 by

I hope the blog readership has had a chance to take a look at the most recent issue of CJSM.  The September 2013 edition of the Journal has studies looking at conditions from concussion to osteoporosis and at sports from football to ballet.  It is a varied mix, and a testament to the wide range of conditions primary care sports clinicians treat and study.

Nile_Kinnick

The great Nile Kinnick,
University of Iowa
1939 Heisman trophy winner,
World War II hero

I spent a good amount of time in August talking about concussions, and I could easily continue this thread throughout September.  I started off the month, in fact, with a look at my friend Bill Meehan’s recent work on the “The Presence of Undiagnosed Concussions in Athletes.”  I thought I’d take a break from that topic, and look at a less common but also potentially dangerous condition:  exertional rhabdomyolysis.  It’s a particularly relevant topic at this moment, as exertional rhabdo often times strikes untrained athletes working out in hot and humid environmental conditions, and it’s an unseasonable 95 in Columbus Ohio today, where I am writing this post.

A Cluster of Rhabdomyolysis Affecting a Division I Football Team,” a study by Smoot, MK, Amendola, A, Cramer, E et al., looks at an ‘outbreak’ of the condition in January 2011 at the University of Iowa’s football (american) team after some intense off-season lifting workouts.  Ironically, we had a cluster of our own in Columbus, Ohio, home to Iowa’s Big Ten rival Ohio State, just this spring, in the women’s sport of lacrosse.  The LAX players were hospitalized after team members performed a new 20 minute workout involving repetitive pushups, situps and chin ups, without break.  Six female athletes were hospitalized for as much as a week.  The local newspaper reported,  “Five returned to play last season, all except sophomore Kelly Becker of Dublin…..who has since transferred to Michigan.”

mo squared at michigan

The author’s son,
letting it all hang out
in the ‘Big House’
Ann Arbor, MI

Ok, stop!!  If that doesn’t suggest to you the gravity of the situation, nothing will.  As a consequence of her experience as an athlete who developed exertional rhabdo, a young woman traded in being a Buckeye for a Wolverine.  The ultimate protest!!!!

Returning to the study…..The authors set out to look for what might be risk factors for exertional rhabdo (ER) in collegiate football players.  They begin by doing a brief and excellent overview of the signs and symptoms, defining characteristics, and known risk factors for ER.  They proceed then to describe the workout the 16 football players did (e.g. 100 back squats at 50% of one rep maximum) and how the young men presented with ER.  Thirteen players were hospitalized for ER after this workout.

The authors were given permission to look at the medical records of 10 of the 13 cases. Nine of the 10 had urine screens negative for drugs (one had a positive opiate screen, but his urine had been collected after being administered narcotic analgesics); one of the 10 had sickle cell trait; and two of the 10 had consumed creatine before the workout.

Read more of this post

Filed under Exercise Medicine, General Interest, Injury Prevention, Safeguarding in Sport Tagged with

The New Issue of CJSM

September 8, 2013 by 4 Comments

friday night lights

Under the lights, on the gridiron:
the site of a lot of concussions.

I was very excited to find the eTOC (electronic table of contents) for the September 2013 CJSM in my email inbox this morning.

As an associate editor, I am privy to this sort of information prior to launch, so to speak, but it’s usually all I can do on these blog pages not to talk about the contents prior to publication.  The offerings are always so varied, so interesting.  Well, the ‘horse is out of the barn now,’ the new CJSM is travelling over the ether, and I can at last discuss an article or two!

Before I forget, let me remind you that you, too, can get the CJSM eTOC and find out the lineup when it’s hot off the press, so I encourage you to go to the home page and sign up, the link is near the top of the masthead.

I wanted to write briefly this morning about one of the new studies in the September CJSM, “The Prevalence of Undiagnosed Concussions in Athletes,” Meehan et al.

William P. Meehan III, M.D. is a friend of mine.  To paraphrase a line that has had a lot of currency recently here in the states, the arc of Bill’s career bends towards success.  It is really hard to keep track of all the work he is doing in the field of concussion.  In fact, in an attempt to do so, I have asked him to participate in a “Five Questions with CJSM” blog post interview, like the one I did with Dr. Jason Mihalik last month.   Keep your eyes posted here, because I’m hoping Bill can sit for a few minutes between attending to his multiple, other commitments and I’ll write up his thoughts in a blog post  before the end of the month, I hope.

The new study was conducted at Boston Children’s Hospital and the University of Pittsburgh.   Read more of this post

Filed under General Interest

Anyone for Tennis? U.S. Open Tennis Championships in Full Swing

September 4, 2013 by

From the archives: with the U.S. Open in full swing, our Excecutive Editor Chris Hughes gives a thorough review on evidence-based treatments for lateral epicondylitis/’tennis elbow’ from the 2011 CJSM blog.

Chris Hughes's avatarClinical Journal of Sport Medicine Blog

And so to the gloriously British Grand Slam Premier Tennis event that is Wimbledon which is currently in full swing. Well – full swing insomuch as the British weather is currently allowing, but at least with the Centre Court’s retractable roof, installed in time for the 2009 Championships, we are guaranteed to get through at least some of the scheduled games every day. As I write in London not more than a few miles away from the courts, the rain is currently pouring down – a not so welcome tradition of the Championships, together with the more desirable traditions such as strawberries and cream, ‘Henman Hill,’ and the inevitable tireless British banter about why we haven’t managed to produce a Men’s Champion since the legendary Fred Perry way back in 1936 when he won for a third time.

A total of 128 players take part over the fortnight in the single tournaments…

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Filed under General Interest

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