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November 2020 - Volume 30 - Issue 6

  • Christopher Hughes, MBBS, MSc
  • 1050-642X
  • 1536-3724
  • 6 issues / year
  • Orthopedics 16/82
    Sport Sciences 16/85
    Physiology 22/81
  • 3.165
Other Supplements

Welcome to our November issue of CJSM, our last issue in 2020. 

As the year draws in, I write to you in what continues to be a turbulent time. We remain in the grip of the global COVID-19 pandemic. There have been in excess of 48 million confirmed cases in 219 countries so far, and over 1.2 million deaths.  The World Health Organisation (WHO) has warned that there could be in excess of 2 million deaths worldwide before the pandemic is brought under control. 

Local population health and ripple effects on socioeconomic factors are varied, but there can be no doubt that the overall situation continues to be of great concern. We really are all in this together, and things are far from over with recent resurgences of viral activity in Europe, Canada, North America and Russia. 

It is difficult to see an end in sight. Much hope for the future is focused on the introduction of widespread vaccination. Fortunately, there appears to be some emerging light towards the end of the tunnel. 

As of 3rd November, WHO has highlighted at least 47 candidate vaccines currently in the clinical evaluation phase, with 10 currently undergoing Phase 3 clinical trials and a further 155 candidate vaccines still in preclinical evaluation. This is the result of massive investment and research on a truly global scale, and will hopefully pave the way forward for the introduction of mass vaccination in the near future. 

However, it is still unclear as to when when widespread vaccination will be available, and also how effective this will ultimately prove to be in reducing morbidity and mortality following its introduction. In addition, there is currently much speculation and misinformation about COVID-19 vaccination. Uncertainty leads to fear, and there is much to be worried about for ourselves and for our loved ones in these difficult days. 

Horton writes about the global threat of misinformation about COVID-19 vaccination in the Lancet this month and calls upon politicians and those responsible for policing social media to do more to stop the spread of 'fake news' and scaremongering in relation to issues concerning COVID-19 vaccination. 

I'm sure that we are all hoping that the situation will have changed by the new year, and I hope that we are able to share better news together when our next issue goes live in January 2021. 

In this month's issue, we bring you a host of Original Research articles on a wide variety of topics. 

Dobney and colleagues investigated the safety and accessibility of early active rehabilitation for 9-17 year olds with at least 2-weeks of post-concussion symptoms in a pilot study with a small group (n=20) of participants. Groups were randomized to early active rehabilitation (aerobic exercise, co-ordination drills and education) initiated 2 weeks post-event, or standard active rehabilitation initiated 4 weeks post-event. There was improvement in post-concussion symptom severity scores seen in both groups, with the early group reporting lower frequency, intensity and durations of aerobic exercise compared with the usual care group. Patients in the early group reached 'normal' (ie. Baseline) symptom severity at 4-weeks post-event compared with 6-weeks post-event in the usual care group. The Authors conclude that a larger-scale clinical trial should be feasible to estimate the efficacy of early active rehabilitation. We look forward to hearing again from the Authors when a larger scale study on this topic is conducted. 

In a questionnaire study, Stracciolini and colleagues investigated the association between sports participation and later-life health outcomes plus later-life quality of life measures. They noted that sports participation for female collegiate athletes was mostly associated with positive health outcomes, but also with lower mobility and increased anxiety QoL scores and concluded that increased sports participation amongst young female athletes may result in mainly substantial long-term health benefits. 

The issue of analgesic use amongst current and former athletes is of on-going concern. Dunne and colleagues examined the reasons for prescription opioid use for NFL players as risk factors for current use and misuse amongst former players in a telephone survey, including the administration of the survey of retired NFL football players. Alcohol consumption, prescription sedative and marijuana use, plus use of other drugs for a 30-day period were assessed. Amongst a sample of 336 former NFL players (mean age 47.1yrs), approximately one in four previously exposed to pain medication during their playing career were currently using prescription opioids, with half of those reporting misuse or abuse of prescription drugs. The authors conclude that education and prevention programs related to opioid misuse should be developed, and former players currently misusing opioids or experiencing chronic pain should be referred to evidence-based pain management treatments. 

Our General Review article this issue by Coughlin and colleagues concerns the topic of return to sport after surgical management of proximal hamstring avulsions. This systematic review and meta-analysis of 21 studies with a total of 846 patients who were sports participants in a wide variety of different sports suggests a high rate of return to sport following surgery, but with a lower pre-injury level of sport. There were no major differences in return to sport between partial versus complete, and acute versus chronic hamstring avulsions. 

In our Practical Management article this issue, Sarmiento and colleagues focus on the practical aspects of the CDC guideline on mild traumatic brain injury in children. They highlight important issues related to diagnosis, preparticipation evaluation, neuroimaging, recovery management, symptom monitoring and return to activity related to those participating in sports. They also mention the CDC pediatric mTBI guideline and educational tools which are freely available and well worth a look. 

This issue also includes many other Original Research articles and an interesting Case Report by Finnoff and Johnson on ultrasound-guided fasciotomy for chronic exertional compartment syndrome

We hope that you enjoy our last issue for this year, and we look forward to better times in 2021.

Don't forget to keep up to date with events in the world of sport and exercise medicine on our CJSM Blog, our twitter account on @CJSMonline and on our Facebook account, and check out our ever-growing range of CME articles on the CME Lippincott CME Connection website

In this time of adversity, misinformation and uncertainty, comfort can be found in the words of Marie Curie to whom the following quote is attributed - 'Nothing in life is to be feared, it is only to be understood. Now is the time to understand more so that we may fear less.'​

I wish all of our readers peace, happiness, and safety for you and your loved ones. 

Until next time, with my best wishes for Christmas and the New Year, 



Christopher Hughes MBBS MSc


Feasibility of Early Active Rehabilitation for Concussion Recovery in Youth: A Randomized Trial

Dobney, Danielle M.; Grilli, Lisa; Beaulieu, Christine; More

Clinical Journal of Sport Medicine. 30(6):519-525, November 2020.

Feasibility of early active rehabilitation for concussion recovery in youth

CDC Guideline on Mild Traumatic Brain Injury in Children: Important Practice Takeaways for Sports Medicine Providers

Sarmiento, Kelly; Waltzman, Dana; Lumba-Brown, Angela; More

Clinical Journal of Sport Medicine. 30(6):612-615, November 2020.

CDC guideline on MTBI in children: important practice takeaways for sports medicine providers