Cannabis and sports

d morgan

Recent tweet from @dmorg91

The intersection of social media and sports medicine has been an interest of mine (and CJSM) for some time. Today, that relationship provides an opportunity to have the blog readers take a poll about a controversial subject: the potential medical benefits of marijuana (cannabis) for active National Football League (NFL) players.

Last week Derrick Morgan (@dmorg91), an NFL player for the Tennessee Titans, tweeted, “It’s time for @NFL to take an HONEST look into the potential medical benefits of Cannabis for its players #CBD #Research.” He and colleague Eurgene Moore were also interviewed by Katie Couric about the issue.  You can see the video here.

The tweet generated a great deal of, er, buzz on social media. In the United States, 25 states and the District of Columbia have legalized marijuana for medicinal purposes, but such legal protection does not contravene employer law — that is, it may be legal to use marijuana for chronic back pain in California, but your employer can still terminate you from your position if they perform drug tests on their employees.  That is, the legal right to avoid criminal prosecution for use of marijuana does not prevent one from the requirement to participate in (and abide by) employer drug testing programs.

There are so many dimensions to this issue including the science itself about the purported benefits of cannabis, and the substance’s listing as a prohibited substance by anti-doping agencies.

But today I wanted to poll you, the readership, on the question somewhat narrowly drawn:  are you in favor of NFL players using marijuana for medicinal purposes?  I don’t intend by this poll to extend the question beyond the NFL (e.g. to Olympians), nor do I intend to enquire about the decriminalization of marijuana for recreational purposes for NFL players.  Like the Brexit vote, you get only two options: yes or no.

Let us know!!!!

And don’t ‘Bregret’ your decision, bro.

p.s. By all means, aside from voting, if you want to comment on the broader issues of marijuana use in sports (is there science behind the claims, should other sports be open to use, etc.) please do so below in the blog comments section.  Thank you!

Concussion: “The Movie”

in the dark

In the dark (not for long, I hope): Concussion has hit the theaters.

I was witness to two big events in the world of professional American Football this weekend:  I watched the movie Concussion and I saw the ugly contest which was the Pittsburgh vs. Cincinnati NFL playoff game.

Of the two events, the more damning, the more worrisome for the league, was the playoff game.

First, let me start with the movie, as I had intended on focusing on that in this blog post….until the playoff game happened.

The movie was well done overall, I thought.  I am no movie critic (I hope that goes without saying) and I rarely see things on the ‘Big Screen’ any more–I think the great movies came and went in the 60’s and 70’s, when I was growing up (Easy Rider, The Deerhunter, Apocalypse Now….).  Concussion (the movie) is largely a heroic story about one man’s personal struggle and vindication:  Dr. Bennet Omalu vs. the NFL, David vs. Goliath.  There are some typical Hollywood moments (e.g. the romancing of his future wife), but largely the film stays on track regarding the story of pathologist Dr. Omalu and his reintroduction of the term ‘chronic traumatic encephalopathy (CTE)’ into the medical lexicon after his autopsy on the brain of the deceased football player, ‘Iron’ Mike Webster.

And Will Smith does an excellent job, I think, with his portrayal of Omalu.

I approached this movie not so much looking for entertainment, but to see if there were anything new in this story I might learn, and to see how the movie might present the science to the general viewing public.  I don’t think I learned anything new regarding the basic story.  This is not so much a criticism of the movie as an endorsement of the PBS documentary, ‘League of Denial,’ which came out two years ago and went into much more depth than a dramatization ever could.  And as for the science?  Once again, you’re better served viewing the documentary.  You won’t have to hear a clunker of a line like this: “Three cases is the scientific burden of evidence.  We have four.”

Now, on to the playoff game.

I don’t think the NFL will be able to survive if the sorts of hits occurring in this game, regardless of their ‘legality,’ continue. Read more of this post

The Controversy Over Grass

madison plains

Where Pigskin Meets Grass

To be clear, my topic today is NOT a survey of what cannabis legalization has wrought in states like Washington or Colorado [as an aside, in our own little corner of the USA the question of legalization will be on the ballot in Ohio this fall].

The grasses we’re discussing are ‘Bermuda,’ ‘Fescue,’ ‘Bluegrass’ and the like.

And the question today is not whether ‘the Dude abides’ [he most certainly does], but is this: which is the safer surface on which to play sport, grass or turf?

The subject came to mind after reading about a recent kerfuffle in the NFL.  The Houston Texans have played on a specially designed grass surface over the years. This season, they are switching to turf in response to concerns voiced about the field quality by opponents such as the Kansas City Chiefs.  In the NFL, in this season for this stadium, there’s a push toward turf.

On the other hand, readers may remember the controversy that raged much of this year regarding the use of turf [as opposed to grass] for the FIFA Women’s World Cup. And that ‘other’ world cup, Rugby World Cup 2015, is taking place right now in England, with  Twickenham Stadium and its grass pitch as that event’s centerpiece.

Grass vs. turf?  The perennial question.  Looking at it solely from the perspective of injury prevention [as opposed to factors such as sports performance or maintenance costs], we have looked at this question from time to time in the blog and in the journal.

For instance, this summer, in the July 2015 CJSM, O’Kane et al. published their timely findings looking into shoe wear and surface type on injury rates in female youth soccer players.  They found that a grass surface and wearing cleats on grass raised rates of lower extremity injuries; they concluded: “When considering playing surfaces for training, communities and soccer organizations should consider the third-generation artificial turf a safe alternative to grass.” Something to consider in this population and this sport and a countervailing argument to the push for grass in future iterations of the Women’s World Cup? Perhaps.  Or might that be too great of a generalization, extrapolating from the youth to the elite sport level?  Very likely.

What about you: your thoughts on this matter?  Taken purely from the perspective of sporting safety and injury prevention, what are your thoughts, your read of the medical literature?  Grass vs. Turf:  which is safer?  Does the sport matter?  Does the level of play matter?

Tell us in the poll!

 

Super Bowl Aftermath

Julian_Edelman_2014

Julian Edelman, New England Patriots pic: Jeffrey Beall

It’s a Tuesday as I write, so literally (and figuratively) I do not propose to do any “Monday Morning Quarterbacking.”  I’ll leave it to others to deconstruct Pete Carroll’s decision at the end of the game (though I don’t think it was that crazy of a call, and was in keeping with other contrarian decisions he has made that actually got the Seahawks into the Super Bowl–like the fake field goal call against Green Bay in the NFC Championships).

The Russell Wilson interception obviously turned out badly for Seattle, and sent all of New England into a frenzied state of joy (though a snowstorm in the region is causing the fans there to hold off one more day from a celebratory parade through Boston).

No, I’m here to focus on sports medicine–specifically the management of Julian Edelman’s apparent concussion in the big game–and encourage you, the reader, to take a poll to stimulate conversation about the issue.

I’m sure a lot of us in the sports medicine world had a sense of deja vu when we saw Edelman stay in the game after what many viewers thought was a concussion:  in the 2014 FIFA World Cup there were several similar incidents, when several players had suspicious head injuries whose management was questionable.  In the aftermath of that tournament, we had a podcast with guests Matthew Gammons and Cindy Chang , physicians of the American Medical Society of Sports Medicine (AMSSM), exploring the issues involved with management of possible concussions in real time, in the setting of a highly visible sporting event…like the Super Bowl.

The NFL has, in the wake of much criticism, introduced new concussion protocols.  It is my understanding that “….. the NFL assigns an independent physician to each team to monitor head injuries, and there is another independent ‘spotter’ who watches players on both teams from a booth above the field and can radio to the sidelines if there is evidence of an on-field concussion.” [1] Additionally, each team has its own medical personnel to monitor the situation as well as do any necessary evaluations.

It is not clear to me, however, that there is an independent physician who is empowered to remove a player from the field of play; to mandate removal if necessary, and not just ‘monitor.’  Should there be a clinician who i) has no conflict of interest [as exists intrinsically in any dynamic that involves medical personnel employed by a team:  player safety comes first, but there are, inarguably, biases that can creep into our decisions when player performance, especially in the setting of the World Cup or the Super Bowl, is at a premium]; and ii) who has the power, and the backing from the league, to disregard the player’s opinion, the coaches’ opinions, etc. and can mandate even the removal of a key player like, say, Tom Brady, for suspicion of a concussion, on the biggest stage of their sport.

And so, today’s poll:

 

References

[1] The Super Bowl’s Concussion Calculation, The New Yorker, Ian Crouch.

http://www.newyorker.com/news/sporting-scene/super-bowls-concussion-calculation, accessed 2/3/15

 

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