Genetic Testing for Sports Injuries

The recent NFC championship game proved, I think, this truth: a true champion is not dead until the final whistle blows. The Seahawks  won in dramatic fashion over the Packers, my favorite team.  As many commentators noted, Seattle played horribly for 58 minutes, but were stellar for the last two; and that was all that mattered in the end.

As a fan, my initial reaction is to think “we gave it away.”  But that is a disservice to the champions.  The Seahawks never lay down, and they seized the moment when it presented itself.

Still…..as a fan, I wonder–if Aaron Rodgers’ calf were 100%, would we have pulled away more decisively earlier in the game?  The field goals in the red zone: would they have been touchdowns instead if our quarterback had his usual mobility?

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Does Rodgers carry a valuable SNP in the genes of his gastrocnemius? I hope so!

Well, we Packer fans have an offseason to think about ‘what ifs,’ and the Packers medical staff has an offseason to rehab Rodgers’ injury and think about secondary prevention.  Perhaps the Packers will want to think about doing some genetic testing as part of their assessment. Management and the medical staff may want, at least, to take a look at our lead editorial for the January 2015 issue:  “The Dawning Age of Genetic Testing for Sports Injuries.”

We have written about ‘genes’ and sports in the pages of this blog:  a very popular post last year was “The Sports Gene:  how Olympians are made (or born),” a review of David Epstein’s excellent book, The Sports Gene:  Inside the Science of Extraordinary Athletic Performance. As those titles would indicate, the focus on the sports/gene intersection in those pieces was more on sports performance than sports injury.

The ‘intersection’ of sports injury and genes has come up in the pages of the CJSM journal itself:  Genetics:  Does it Play a Role in Tendinopathy? and an investigation into genotypes and the risk for concussion in college athletes  are among the offerings we’ve had on this subject in recent years.

In the January lead editorial, Gabrielle Goodlin and her co-authors from Stanford do an excellent job in a short space of reviewing a great deal of what evidence already exists in this world, as well as pointing out directions where this work may be headed. Read more of this post

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Return to Play Decisions

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Though a beautiful time of year, fall is not
the most idyllic for a sports medicine clinician

Like many of the readers out there, my colleagues and I are deep in a football season, where we are managing various teams and their mounting injuries.  For a sports medicine physician, fall in America must be a bit like early spring for an accountant (tax day = April 15):  it’s the time to buckle down and crank through patients, the time, from a certain perspective, to see the volume of patients that will sustain the business through leaner times of the year.

When I’m out of the clinic and on the sidelines, I’m also doing one of the parts of my job that is the most fun, and I’m sure my colleagues out in the blog sphere will agree.  But I wouldn’t describe the work as an idyll.  I can be enjoying my team’s performance, and then called in three directions at once, treating players and making decisions on whether they can get back into the game:  decisions that can have significant consequences for the player and the team.

I thought I would write somewhat extemporaneously today, and in sharing some of the more interesting cases I have seen of late think in a more structured way about how we primary care sports medicine physicians make return to play (RTP) decisions.

RTP decisions make the headlines all the time.  In the professional leagues of North American sports, in just the last two weeks, we have seen discussions about Kobe Bryant’s return to the NBA from late spring Achilles tendon surgery; Rob Grownkowski’s ‘delayed’ return from a surgically treated forearm fracture; the much anticipated return of Derrick Rose more than a year after his ACL reconstruction; debate over RGIII and whether he has come back too soon from his own multi-ligamentous knee injury…….the list goes on!

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The end of a season?

In my own practice, I have been trying to return players back to American football while they have recovered from a kidney contusion, a posterior elbow dislocation, a complete rupture of the ulnar collateral ligament, and a demyelination injury of the axillary nerve.  Of the four, two are back playing; the elbow dislocation is still rehabbing, and i hope to return in a hinged knee brace before the end of the year; and the axillary nerve injury continues to have pain and profound weakness of his deltoid, and his recovery will extend beyond the end of this season (much to the coach’s dismay).

Despite being one of the more important aspects of our job, there is very little in the way of evidence-based medicine to guide a clinician in these decisions. Read more of this post

Achilles Tendon Ruptures and Kobe Bryant’s Injury

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Kobe Bryant, Joe Johnson Wikimedia

I woke up this morning to hear very sad news that occurred in the NBA last night:  Kobe Bryant has ruptured his Achilles tendon.

Kobe, who turns 35 this year, is one of the most recognized athletes in the world (maybe one of the few things that China and the USA can agree on). He had been leading his team to crucial victories as they were making a playoff run when he succumbed to this not uncommon injury in the middle aged athlete.

As he is quoted saying, he made a move he had executed a ‘million times’ when he felt like someone had kicked him in the leg, and he subsequently crumpled to the ground.  This is the classic history one might obtain when caring for an athlete with such an injury.  If you watch the video, you’ll see Kobe perform a classic move which can result in a ruptured tendon:   his left leg  pushes back  while he powerfully tries  to accelerate around the defensive player; this eccentric contraction is followed by a step and immediate inability to bear weight, and he falls to the ground. Read more of this post

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