The Controversy Over Grass

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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!

 

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Ebola and the Athlete

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The South African Minister of Sport has tweeted a ‘no, thank you’ to being host.

The biennial Africa Cup of Nations (AFCON) is set to begin in January 2015. Organizers are still looking for a host.

Morocco was set to host the tournament but has pulled out because of the fears over Ebola contagion. The Republic of South Africa has already served notice that they will not volunteer to be alternative hosts:  the country’s Minister of Sport has tweeted that the RSA is “…not the Big Brother of Africa….” and will not be standing in as host for the Cup. As I understand it, the Confederation of African Football organizers are meeting November 2 to discuss solutions for what seems to be an impasse.

If sports is indeed a mirror of the culture, then it stands to reason that concerns regarding the Ebola virus would show up in sporting venues, training rooms, sport talk shows, and athletes’ twitter feeds.  The current outbreak of the virus is still largely confined to certain nations in W. Africa, but it  is the largest and most deadly one in history.  Sport, like society at large, is concerned.  How might teams handle potential exposures?  Must consideration be given to quarantining? Is it reasonable to target only those countries at the epicenter in W. Africa?  Is ‘quarantine-lite’ the way to go? Is it wise to consider having large numbers of people travel to and from one country, as in the case of hosting AFCON?

Carrier_of_diphtheria_keep_out_of_this_house_by_order_of_board_of_health.

A sign of things to come?

A generation or two ago–most especially in the pre-vaccine and pre-antibiotic era–the quarantine was a standard measure for handling outbreaks of contagious diseases in communities.  My mother describes how she and her whole family were quarantined after she developed strep throat as a young girl in the 1930’s.   In the modern world, however, the quarantine as a response to controlling Ebola has already come under heavy fire, at least here in the United States.

The intersection of public health, international sporting events, and an infectious virus is not unique to this moment in time, of course.  In 2010 CJSM published a thematic issue on “Emerging Issues in Sport Medicine,” and included among the many offerings an article on International Travel and the Elite Athlete as well as an article on Public Health Recommendations for Athletes Attending Sporting Events.The 2009 CJSM published original research on a novel, web-based approach to more carefully monitor illnesses in professional rugby union players.  These documents are potentially useful resources to help teams and sporting federations formulate responses to this newest challenge.

But I want to acknowledge that the Ebola virus raises issues which require a great deal more work to determine appropriate, evidence-based interventions.  Winter is coming in the Northern Hemisphere, and we know we should be offering our athletes influenza vaccinations. We have a ‘system’ to handle the flu.  What to do with a disease like Ebola for which there is no current vaccine let alone an established treatment?  Likewise, what to do in the case of a virus which does not pose an airborne exposure risk like the flu, but has a much higher case fatality rate when the virus is contracted?

Already, popular sentiment has begun ‘making’ decisions of a sort.   Read more of this post

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!

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

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