FIFA World Cup 2018 — Will There be Concussion Miscues Again?

FIFA World Cup apperances 1930 – 2018 Picture courtesy of Dufo, from Wikimedia Commons

Ah, the long, lazy days of summer have arrived….or have they?

With a caveat that I must be mindful that fellow colleagues in different parts of the world may be experiencing different workloads right about now, I have been feeling of late both a sense of lassitude and a sense of professional, shall we say, anxiety.

My children’s school year has wrapped up — they certainly are in the mode of being lazy.  The multiple school sports I cover as a pediatric sports medicine physician have largely wrapped their respective seasons too.  There is a bit of a lull in my clinics.

On the other hand, in the larger sporting world, the schedule is most definitely heating up.  I find this to be one of the most interesting times of the year for sport.  In the USA, we are in the midst of the NBA and NHL basketball and hockey finals, and MLB baseball offers multiple games daily.  To our north, the CFL has just started its season.  In Europe, the tennis stars Rafael Nadal, Garbine Muguruza and others are experiencing the joys of Roland Garros.  Golf’s U.S. Open is just around the corner.

And, of course, in less than two weeks, the FIFA World Cup kicks off in Russia. The quadrennial event — alongside the Olympics probably the biggest global sporting event on the planet — opens on June 14 and will continue for a month, until the championship game on July 15.

Like many of my colleagues, I am a fan of sport as well as a physician.  I care about who plays, and find myself cheering on certain teams and certain players [Vamos El Tri!]

Like many of my colleagues as well, however, I am also eyeing this World Cup as a doctor, and I approach the event with concerns over how concussions will be handled in 2018. Read more of this post

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A Twitter Journal Club

casemI want to alert you to a very interesting innovation which was instituted at the end of 2016 and will continue into this new year:  the Canadian Academy of Sport and Exercise Medicine (CASEM) Twitter-based journal club.

You read that right — a journal club, on Twitter.

We’re all familiar with journal clubs.  In fact, the fellowship in which I teach (Nationwide Children’s Hospital Sports Medicine) just completed its monthly journal club yesterday, with the fellow (sports medicine physician in training, Jonathan Napolitano) leading the group of doctors through a study published in our January 2017 CJSM: Reliability Testing of the Balance Error Scoring System in Children Between the Ages of 5 and 14.

I recently wrote of the vital, and increasing, importance social media plays in the dissemination of sports medicine research.  A Twitter journal club is an example of that phenomenon.

The CASEM Journal Club just got off the ground at the end of 2016, and had as its first selection another CJSM study: Physical Exam Risk Factors for Lower Extremity Injuries in High School Athletes:  A Systematic Review. Seems like both CASEM and I found this to be particularly intriguing.  To wit, I cajoled the lead author of that study, Jimmy Onate, into recording a podcast with me.  And then he pulled duty on the CASEM Journal Club as the guest author, interacting on Twitter with folks from around the globe.  What a great opportunity — to get to ask the author directly the questions one has after reading his/her study.

The study for this month’s CASEM journal club is the same one we deconstructed in our fellowship yesterday:  the reliability of the BESS in a pediatric population  It hits close to my heart.   Read more of this post

Dreams of South Africa

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With Wayne Viljoen (@BokSmart), one of the authors of new rugby research in CJSM

It was just a year ago that I was preparing to travel to South Africa on an American Medical Society for Sports Medicine (AMSSM) Travelling Fellowship — dreams of Cape Town and safaris danced in my mind [see post reblogged below].

I haven’t stopped dreaming of South Africa. Should I ever have a mental lapse and not think of the Rainbow Nation for a day or two, I have only to turn to my Twitter feed or my medical journals to be reminded — the country punches well above its weight in both sports and sports medicine. I enjoy reading of the exploits of current South African Sports Medicine Association (SASMA) President Phathokuhle Zondi as she takes care of Paralympic athletes in Rio, for instance — she is a definite follow on Twitter….

And I most certainly enjoyed reading some recent rugby research just published in our September 2016 CJSM: Incidence and Factors Associated With Concussion Injuries at the 2011 to 2014 South African Rugby Union Youth Week Tournaments.  It was a delight to read this epidemiological study, whose authors include good friends Sharief Hendricks, Clint Redhead, and Wayne Viljoen — researchers all of whom most definitely have made their mark internationally.

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Partying with Sharief Hendricks (@Sharief_H), author of new rugby research in CJSM, in Johannesburg

In the authors’ words, the “….study provides the first published incidence of concussion, per player-match-hours, in South African youth rugby union and falls well within what was previously published elsewhere for youth rugby.”  They found the incidence of concussion in youth rugby to be 6.8/1000 player match-hours.  Importantly, and what for me was new information, was that under-13s and under-16s had higher incidence rates than under-18s.  The younger kids were at greater risk for concussion.  This may have important implications for rules and policy making in youth rugby.

For anyone with an interest in rugby, or South African sports and sports medicine, the study, in our newest edition of CJSM, is a definite read.  And it’s never too early to start dreaming of the 2017 SASMA biennial congress, which will take place in Cape Town 2017.  To stay ‘in the know’ for the timing and details of that pre-eminent conference, follow President Phathokuhle Zondi and SASMA itself on Twitter.

Clinical Journal of Sport Medicine Blog

IMG_1630Every so often, sports takes a back seat to other world events. So too for sports medicine.

We all know this, whether in our personal lives or in our interactions with the world at large.  There is the NFL player who is torn between performance on Sunday and ‘being there’ for his young daughter with leukemia.  There are cases where the athlete him- or herself is felled with illness–think of Lou Gehrig and amyotrophic sclerosis.  The issues of who won the last game, the intricacies of a salary negotiation, or the season missed from a knee injury pale in comparison with such ‘real world’ contingencies.

In sports medicine we sometimes experience directly the intersection between serious illness and athletics.  I think immediately of the young gymnast I saw with anterior knee pain that turned out not to be Osgood-Schlatter’s but osteogenic sarcoma of the tibia…….a ‘game changing’ event…

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Rugby’s Big Year(s)

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Sam Boyd Stadium, Las Vegas Nevada, site of the annual Rugby 7s tournament.

It’s amazing how time flies.  How is it already March?

It’s almost 7 p.m. and I’m writing by the light of a sun that is still above the horizon, thanks to one of my favorite inventions of the modern world: daylight savings time, which arrived last night.

This realization is a personal reminder, however, that I have been delinquent: meaning to write a blog post about an event that took place three weeks ago…..but, my oh my, business has just swamped me, I guess.

As the swallows return annually to San Juan Capistrano, so do the Rugby 7 squads of Kenya, South Africa, New Zealand and other countries come each February to the desert:  Las Vegas hosted the USA leg of the HSBC Sevens Series Feb 13 – 15.  It is the largest annual rugby tournament held in North America. and Las Vegas has been its host since 2010.

As followers of the blog will know, USA Rugby conducts an outstanding medical symposium every year just prior to the tournament, and I was out for some education as well as sport.  It was a fabulous conference, and I do hope you all get a chance to attend some day.

Tim Hewett, who is well known to readers of this blog, gave a great talk on original research of the difference in injury rates between collegiate rugby and American football players.  We are most definitely looking forward to seeing that research published.  Hey, Tim, if you’re looking for a place to send that manuscript for peer review, send it our way.

His colleague from Ohio State, the orthopaedic surgeon and OSU Team Doc Chris Kaeding, gave a great talk as well, regarding data on knee outcomes coming out of the ‘Multicenter Othopaedic Outcomes Network,’ or MOON group, some of whose research we have published in CJSM.

With the George North story on everyone’s mind, we were all eager to hear what concussion experts such as Chris Nowinski of the Sports Legacy Institute had to say about minimizing injury risk in rugby.  Nowinski presented one of the best and most nuanced talks I have heard on the ‘concussion crisis’ in sports. I enjoyed it so much I caught up with him after the conference, and the interview I had with him is now available as a podcast. Read more of this post

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