IOC Concussion Conference Amsterdam 2022

The podium at CISG meeting in Amsterdam — Dr. Jacklyn Caccese of Ohio State University presenting

What is the definition of a concussion?

If you are wondering whether this is a rhetorical question, would it confuse you still more to know this is how the IOC Concussion in Sport Group (CISG) Consensus Conference in Concussion began in Amsterdam?

Would it concern you that this is still an open question for one of the more vexing problems we deal with in sports medicine? Even among the panel of world experts gathered to bring together the most recent update of consensus statement for concussion in sport?

I think the answer is — yes. Yes to the confusion, yes to the concern.

I had never been to an IOC CISG meeting. As many of the journal’s readers will know, there have heretofore been several meetings with a consensus statement as their output: 2001 Vienna was the first, 2016 Berlin was the most recent.

CISG was set for a meeting to take place in Paris in the autumn of 2020, but we all know what occurred in that year’s spring.  And so the 6th meeting was rescheduled for 2022 and for a new venue: Amsterdam.

I have just returned home from Amsterdam and wanted to collect my thoughts to give you the reader a brief rundown.

These meetings have become huge, and I am not merely referring to the number of participants (hundreds).  The worldwide press recognizes the importance of the CISG and its influence on global sports.  Over the past year the press has been following closely the story of the previous leader, and now discredited academician, Paul McCrory. And……..immediately prior to the gathering in Amsterdam, the news broke that America’s NIH formally acknowledges the causal link between concussion and chronic traumatic encephalopathy (CTE). 

That’s a lot. Read more of this post

Head guards in boxing — the podcast

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Dr. Mike Loosemore, lead author of new CJSM boxing study

We open 2017 with a new podcast on the new (non)-intervention in Olympic-style boxing:  head guards, or the lack thereof.

Our guest is Dr. Mike Loosemore MBBS MSc PhD FFSEM(UK), a consultant in sport and exercise medicine at the Institute of Sport, Exercise and Health, University College London.  Dr. Loosemore is currently the doctor to the British Olympic Boxing team, and a well known figure in the boxing medicine world.

He is, as well, the lead author of a highlighted study in our January 2017 issue: The Use of Head Guards in AIBA Boxing Tournaments — A Cross-Sectional Observational Study.  The team of researchers included Julian Bailes, whose name will be familiar to most people who study and treat sport-related concussions [or familiar to those who watched the movie Concussion in 2016].

Rio 2016 was the first Olympic competition since the 1984 games in Los Angeles where male boxers did not wear head guards , a rules change which generated a lot of controversy. Research like Dr. Loosemore’s was instrumental in making the determination to stop 52 years of practice.jsm-podcast-bg-1

Just before Christmas, we chatted with Dr. Loosemore, and he shared what he and his team found in their study and the back story behind the use, and now discontinuation, of headguards in Olympic-style boxing.

Be sure to listen to the podcast here and read the study (free access currently) here…..and, as ever, let us know what you think, or give Dr. Loosemore a shout out on Twitter @doctorloosemore

 

5 Questions with Dr. Jane Thornton — what is the physical activity prescription?

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Jane Thornton MD, PhD (2nd from left) — Canadian Olympian and Lead Author of CASEM Position Statement

We are having a sit down with Jane Thornton, MD PhD today as part of our recurring  blog offering, ‘5 Questions with CJSM.’  Among many other things, Dr. Thornton is the lead author of the new Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the ‘Physical Activity Prescription.’  This article, published in our July 2016 issue, has already drawn an immense amount of interest — it is currently free, so do not hesitate to check it out and print out/download the PDF to fully appreciate its contents.

Dr. Thornton is an extraordinarily accomplished individual who is finishing up her family medicine/sport medicine training at the University of Western Ontario.  Besides a medical degree, she has earned a Masters and PhD, doing her studies CJSM Associate Editor Connie Lebrun while at the Fowler Kennedy Sports Medicine Clinic.

With the Rio Olympics set to begin in a few days, it is perfect timing to conduct this interview with Dr. Thornton.  While doing all of that academic work noted previously, she was also training for the Canadian national rowing team. She rowed in the 2008 Olympics in Beijing with the Canadian women’s eight.  She knows a thing or two about physical activity, no doubt. In addition to her authorship of the CJSM manuscript, Dr. Thornton has co-created along with Dr. Mike Evans a website about how to #MakeYourDayHarder, advancing the notion that our every day activities offer abundant opportunity to get in meaningful levels of physical activity.

At CJSM, we have had an abiding interest in research on various aspects of physical activity (e.g. check out our recent post on #PEPA16 and Ann Gates, another mentor of Dr. Thornton’s), and so it is with great pleasure that we share with you our ‘chat’ with Jane Thornton.

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1) CJSM: How effective is an ‘exercise prescription’?  What is the evidence for this intervention?

JT: It may sound like common sense that physical activity is good for us, but it has taken us a long time to understand just how important it really is as a component of treatment. When we understand that it can lead to improved clinical outcomes in over 30 different chronic diseases, and can be as effective as medication in many instances (hypertension, stroke, and mild-to-moderate depression, to name a few), then we can’t ignore the fact that it should be something we talk about with our patients.

To best illustrate its effectiveness, though, let’s compare exercise prescription with smoking cessation counseling.  When we examine the number needed to treat (NNT), studies tell us that we need to counsel 50-120 patients to see one patient successfully quit smoking. When it comes to getting one patient to meet the globally agreed upon physical activity guidelines (150 minutes per week of moderate-to-vigorous physical activity), however, that number drops to 12 – meaning we have an incredible opportunity to help patients make a life-changing adjustment in their lives. No one, including me, would argue that smoking cessation counseling is not incredibly important. But given the recent findings that being inactive is almost as bad for you as smoking, we really should be expanding the conversation at each clinical encounter to include exercise.

2) CJSM: What are the barriers to its use?  Why aren’t more physicians actively engaged in giving their patients an exercise prescription?

JT: The most oft-cited barriers are time constraints, lack of education and training, complex comorbidities… and the most honest among us will also bring up the point that we just don’t think patients are motivated enough or willing to change. Interestingly, if we demonstrate a belief in patients, they will usually rise to the challenge. It may also come as no surprise that doctors who are active themselves are also more likely to counsel their patients to be active. A big obstacle in many countries is, of course, remuneration. It’s hard for some to justify time spent counseling on exercise if there is no billing code they can tack on. That one is a tougher nut to crack. Policy makers should take comfort in the fact that the practice of exercise prescription is also cost-effective.

3) CJSM: You are active on Twitter – if you could compose a 140 character Tweet for the CASEM position statement, what would it be?  Read more of this post

Open Water Swimming

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Sunrise over Lac St. Jean, site of FINA 10K and 32K open water swimming events

Amazing to think that the Rio Olympics opening ceremony takes place a mere week from now.

I am, currently, enjoying the good fortune of mixing with Olympians from several countries who will be headed there for the open water swim events.  This weekend I am in Roberval, Canada (3 hours north of Quebec City), at Lac St. Jean — where the FINA/HOSA 10K marathon World Cup and 32K Gran Prix events are taking place.

I am a FINA medical delegate at these events.  I have written about this experience before in a 2013 blog post:  the 32K Gran Prix event coincides with an historic open water swim that has been done for decades on this lake, the Traversee internationale du lac St-Jean.

It is a great pleasure to be involved in an international sporting event like this one.  The local organizing committee does fabulous work.  I am privileged to work with fellow FINA representatives from New Zealand and France. Outside of the work hours, we get to socialize some and partake in the hospitality of the Roberval community.

I also greatly enjoy working for the athletes, watching out for their health and safety.  I genuinely enjoy getting to know them and experience vicariously the thrill of their competition. The joy and challenges of sport are a special dimension of human culture —  I am sure this is what leads many of us to sports medicine.

I think it is those broader, aspirational aspects of sport that lead many of us in the sport medicine community to push back on efforts toIMG_2210 cheat, such as doping.  And it’s no surprise that for an elite, international event like this one FINA has doping surveillance as part of its core mission.  One of the roles I play during my time on site is to supervise the excellent work done by representatives of the Canadian Centre for Ethics in Sport, which conducts post-race testing on select individuals many of whom, as I have indicated, will be swimming soon in Rio, where we already have had headline-making doping news before the games have even begun!

We have published frequently on the issue of doping in the pages of CJSM and these blog pages.  We hope you take this chance to click on those links and look at some of that work, in advance of the upcoming Olympics.  And, since it’s Friday, it’s time to follow something new — I would suggest the Facebook page of FINA, which is so well done, and will be hopping with information about this weekend’s Traversee and next month’s Olympics.

Enjoy the Games!  Let them be competitive, safe, and clean.

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