CJSM Podcast 4: Concussions and the World Cup

jsm-podcast-bg-1In this podcast we had the chance to talk with physicians Cindy Chang and Matthew Gammons about the concussion incidents in the recent FIFA World Cup.  Drs. Chang and Gammons are distinguished members of one of our affiliated societies, the American Medical Society for Sports Medicine:  Dr. Chang is a past president and Dr. Gammons is a current vice-president of the organization.

Our Concussion Collection on our main web page contains several valuable research studies on the subject of concussion, and several of the articles are free.  The collection also includes the important Zurich Consensus Guidelines from 2012, which is one of the subjects up for discussion in the podcast.

At CJSM, we employ various media to ‘spread the word.’  You can get a quick taste of what the Zurich guidelines are about by watching our video of past Editor-in-Chief Willem Meeuwisse.  And all of our podcasts can be found here.

Enjoy this, our fourth one,  and let us know what you think!

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Concussion management in professional soccer: an opinion piece

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Dr. Luis Rodriguez, demonstrating his skills.

The 2014 World Cup is getting smaller in the rear-view mirror day by day, and the sporting world’s collective attention is turning to other events.  The Commonwealth Games is about to open in Glasgow; the 2016 Olympics are not far off and will, of course, occur in Brazil (Rio); and another World Cup is coming around the corner:  in a little more than a year the Rugby World Cup will kick off in England.

And for the Americans in the on-line crowd, there is the little matter of NFL preseason training camps opening at the end of this week; my beloved Packers start up this Saturday!

On the other hand, the discussion about the management of concussion at the Brazil World Cup is not diminishing.   From media like the Washington Post to social media such as Twitter–which, frankly, remains all ‘atwitter’ over the issue–the dissection of the events and the discussion of what to do next continues.  The New York Times has captured the ‘zeitgeist’ I think with its headline:  FIFA’s Dazed and Dated Attitude.

We have had several posts on this issue already.  I offer you yet another today.  I take part in a LISTSERV which includes members of one of our affiliated societies, the American Medical Society of Sports Medicine (AMSSM).  Last week, I joined in on a robust and wide-ranging discussion about issues of concussion management in soccer (apologies to some readers, since this on-line football discussion mostly involved Americans, the word that was kicked around was, indeed, soccer).  The LISTSERV discussion was so intriguing that I reached out to the participants and asked if anyone was interested in doing a guest post on this blog.  I got a volunteer!

Dr. Luis Rodriguez is an AMSSM member, a clinician and teacher, and an avid soccer player and fan.  He is the Assistant Program Director – UHS Wilson Memorial Hospital Primary Care Sports Medicine Fellowship Program, Johnson City, NY, and is a Clinical Assistant Professor at SUNY Upstate Medical University, Binghamton Campus.  He is, as well, the Team Physician for the Binghamton University Bearcats, the SUNY Broome Hornets, and the Davis College Falcons.

And he has graciously shared with us his opinions.  Thanks Dr. Rodriguez!
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Concussion Management in Professional Soccer–Dr. Luis Rodriguez

According to the Nielsen company, an estimated 26.5 million people in the United States watched Germany’s extra-time win over Argentina in the final game of the FIFA World Cup on Sunday July 13, 2014. Being a huge soccer fan, I played my small part in making this the most watched soccer match in U.S. history, even though I was not rooting for anyone in particular. I also knew I was not the only Sports Medicine doctor watching of course, and this fact became pretty obvious early into the first half of an excellent soccer match (although I prefer the term “futbol” myself).

It was the 16th minute, German midfielder Christoph Kramer was fighting for possession deep into Argentinian territory and received what was surely an unintentional (and perhaps most importantly unexpected) hit to the left side of his head and face from the shoulder of defender Ezequiel Garay. Kramer went to the ground immediately, and the ball was put out of play by Germany after a brief delay. During this time, ESPN’s English commentators mentioned he had tried to get up but went back down. Germany’s medical personnel got to him when the game clock showed 17 minutes, 10 seconds and began evaluation. 30 seconds later he was given the famous “pat in the back” that all of those who cover sports as team physicians are probably familiar with as the universal sign for: “you’re ok, now get back in there!”.

The referee did not let Kramer back in immediately, as per official FIFA rules, he had to leave the pitch since medical personnel came in to provide care. I must say, he looked quite dazed and confused to me as he was making his slow walk around the pitch waiting for permission to come back into the match.

Read more of this post

The World Cup Final and More

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Maracana Stadium, site of the 2014 final….and site of more medical controversy?

At last. we have reached the final game of the 2014 FIFA World Cup.  Who will be crowned the victor, Argentina or Germany?  We will soon find out.

There has been plenty to write about and talk about in this tournament, which began back on June 12 at Arena Corinthians in Sao Paulo.  On the sport medicine front, we have seen issues ranging from Neymar’s fractured vertebra to the concussion seen ’round the world:  Uruguay’s Alvaro Pereira and his return to the pitch immediately after his injury were the focus of our post a few weeks back.

I haven’t yet had the chance to discuss with you all the incident which occurred in the semi-final between Argentina and the Netherlands, involving Javier Mascherano.  Since he’ll be playing for Argentina in today’s final, I thought it high time to discuss his injury and the further implications such events have for sports medicine clinicians covering sports around the world.

Like many of you I was watching the semi-final live.  [Full disclosure:  I was rooting for Argentina (I still am….hoping for a triumph of faith over reason in today’s final!)].  For those who were watching you will remember, that Mascherano went down toward the end of the game after colliding with an opponent’s head while the two were attempting to head the ball.  The medical staff worked on him for several minutes.  While this was going on, my son correctly worried that should he not be able to return to the pitch, Argentina would have to play a man down, as they had already used their limit of three substitutions for the match.

Like a lot of sports medicine folks watching, I was surprised to see Mascherano make it back to the pitch; it seemed clear that he had possibly suffered a concussion, and should probably have been removed.  The field-side decision-making was roundly criticized subsequently.  The player himself went on to perform a possibly game-saving tackle on Arjen Robbens after returning to the field.

The complexity of decision-making in these settings is immense.  I re-posted a blog post from our Executive Editor Chris Hughes in the wake of the Perreira incident exploring precisely this issue of same-day return-to-play clearance.  The most immediate consequence of proceeding with what was arguably the correct medical call would have been to consign Argentina to playing a man down the rest of the match.  It’s not difficult to start imagining parallel renderings of what ‘might have been’ for the Netherlands had Argentina finished the match a man down……without Mascherano on the field, who is there to block Robbens’ shot?

All of us clinicians who manage sideline medical care face such decisions.  Regarding concussions, the information is readily available, albeit still up for debate!  You can go to our pages to access the 2012 Zurich Consensus Statement on Concussion in Sport, which argues against same-day return to play and argues for “Sufficient time for assessment and (that) adequate facilities should be provided for the appropriate medical assessment both on and off the field for all injured athletes” (my itals).  You can go to our freely available ‘Concussion Collection,’ which contains some of the research published in our pages on this rapidly evolving field.  You can even listen to our Podcast, with Canadian authors Drs. Oliver Leslie and Neil Craton, who provide a powerful critique of the Zurich statement. Read more of this post

Ramadan and the World Cup

The Islamic holy month of Ramadan begins today and will affect athletes and sporting fans around the globe until the fast is broken with the feast of Eid al-Fitr on July 28.

The World Cup may be like a religion, and is currently affecting the lives of many…..but throughout the next month Ramadan will have possibly the bigger impact on over a billion people on the planet.

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Hassan Yabda, one of the players on the Algerian national team.

How, for instance, will the fast affect Algerian athletes who play their World Cup knock out match against Germany in two days?  How will it affect, for that matter, the millions of the faithful, Algerian fans who will be watching?

We revisit a blog post from last year, and an excellent study published in our pages on this very issue:  Does Ramadan Affect the Risk of Injury in Professional Football?

How topical:  The World Cup, the very pinnacle of professional soccer–it’s happening!  Ramadan–it has begun!

Good luck to the teams playing in the knock-out stages of the World Cup, and Ramadan Mubarak!

Clinical Journal of Sport Medicine Blog

Crescent_Moon_(2558144570) The Crescent Moon rising at sunset, marking the start of the month of Ramadan

The month of Ramadan begins tomorrow, July 9, and lasts until August 7.  As many of this blog’s readers will know, observant Muslims will fast from dawn until sunset:  no food, no liquids…..no sports drinks or power bars.  The questions of ‘carb loading’ or ‘gluten free’, (‘should i drink some chocolate milk after my workout?‘) can all be put on the table until the evening.  The diet is one of pure abstinence, morning until night.

Muslim athletes are not unique in observing a fast: Catholic Christians will consume much less than usual if observing the prescribed tenets of Lent on Ash Wednesday and Good Friday, and Jewish athletes will go a full 25 hours consuming nothing on Yom Kippur:  friends have told me they will be loath to brush their teeth or even shower, lest…

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