Here we are with our July issue, following a thoroughly enjoyable and successful annual symposium of our founder Society, the Canadian Academy of Sport and Exercise Medicine (CASEM), in Quebec at the end of April.
In the grand venue of the Fairmont Château Frontenac, there was a packed program of events for delegates to enjoy. Particular highlights for me included Laurent Duvernay-Tardif's insightful and self-reflective account of his time as an elite athlete in the NFL and medical school graduate, the practice changing articles section in sport medicine with Professors Ian Shrier and Pierre Fremont, and the Sandy Kirkley research sessions. For those of you who missed out, you can view all of the podium and poster presentation abstracts in our last issue of the Journal.
This month's Editorial by Dr Laura Purcell and colleagues highlights the 'Choosing Widely Canada' initiative, and CASEM's contribution to this via it's list of eight pediatric SEM recommendations. These evidence-based recommendations have been made in order to minimise unnecessary investigations and to optimize child and youth athlete care.
Find out more about the recommendations by reading the Editorial together with the links to the recommendations on the Choosing Wisely Canada website, and by listening to our forthcoming podcast interview where Deputy Editor James MacDonald interviews Dr Purcell on the CASEM recommendations. This podcast will be available on the media section of our website as part of our podcast collection.
Amongst our Original Research offerings this week, Congeni and colleagues present an interesting pilot study of head and neck cooling following concussion in adolescent athletes. In this prospective, randomized non-blinded study, eligible adolescents aged 12-17 yrs who had been diagnosed with concussion within 1 week of injury were randomized to 'standard brain rest' (n=27) versus head and neck cooling treatment, at both post-injury assessment and 72 hrs post -injury (n=28). Study outcomes showed that the cooling intervention group had a significant reduction in total symptom severity score at each assessment over 28 days compared with the control group. Whilst promising, the nature of the study and number of participants make it difficult to make any firm conclusions and a forthcoming multi-centre study using a larger sample size will be eagerly awaited to see if the trends seen are reproduced amongst a larger group.
There is plenty of evidence for the effectiveness of anterior cruciate ligament injury prevention programmes in the literature. However, in practice some of these programs seem to be less effective than we would like. Ling and colleagues explore the relationship between coach education workshops and adherence to neuromuscular training (NMT) amongst high-school coaches in a variety of different sports (basketball, volleyball, baseball, softball, track and field and lacrosse). In this prospective study over 2 seasons, coaches were randomized to either take part in a 60-minute educational workshop teaching a NMT programme, including the provision of printed materials, or solely to receive the same printed materials without attending the workshop. Data collection observers were used to observe weekly team practice and games, completing study questionnaires regarding coach adherence to the program. Of 399 practises or games, the intervention group showed a significantly higher proportion of coaches providing alignment cues and completing full NMT training routines compared with the control group. The Authors concluded that coach education can improve adherence and alignment cue delivery to an NMT program, and argue for the importance of in-person coach training. They advocate for prospective injury surveillance to assess clinical outcomes from these interventions.
Other Original Research this issue includes the measurement of recovery with ecological momentary assessment after sport-related concussion, characteristics of second-line investigations of middle-aged athletes who failed preparticipation examinations, and the prevalence of female and male athlete triad risk factors in ultramarathon runners amongst much more content both in-print and in our online-only content.
We bring you two General Review articles this issue. Our first by Toomey and colleagues is a systematic review on adiposity as a risk factor for youth sport injury. There were 38 articles included with 17 deemed eligible for meta-analyses, with results showing an association betwen higher BMI in youth with any sports-related injury and lower BMI in those developing a bone stress injury compared with controls. The Authors conclude that Level 2b evidence suggests high BMI is associated with a greater risk of youth sport (age < 21yrs) injury, and in particular lower-extremity injury and excluding bone stress injury or fracture.
Gazendam and colleagues present a systematic review and network meta-analysis of randomised controlled trials comparing the efficacy of nonoperative treatments for greater trochanteric pain syndrome. Of 13 RCTs included with a total of 1034 patients, the authors found that platelet-rich plasma injections and shockwave therapy showed significantly better short-term (1-3 months) pain relief compared with controls, and that structured exercise leads to improved short-term functional outcomes. However, it should be noted that most interventions also reached minimally clinically important difference at 1-3 months follow-up, including placebo and no treatments.
In our Practical Management article this issue, Trease and colleagues present hydration strategies for those pursuing physical activity and endurance events at high altitude (>2500m). Readers will be aware that altitude may complicate hydration strategies as a result of physiological adaptations which need to be taken into account by those competing at altitude and those advising them. The article discusses the impact of acclimatisation on hydration status and the physiological changes taking place, with an in depth discussion of suggested hydration strategies with a focus on a risk-averse approach.
There is lots more in this issue to enjoy including Brief Reports on cardiocirculatory stress in professional football (soccer) coaches and the use of Botulinum toxin A for chronic exertional compartment syndrome, a Critical Review describing frequencies of lower-limb apophyseal injuries in children and adolescents, and a Case Report on the treatment of Pellegrini-Stieda syndrome with percutaneous lavage and platelet-rich plasma infiltration.
Once again, a reminder that CJSM is now on Instagram as well as our other social media outlets including Twitter and Facebook, so keep an eye out for us on these sites as well as on the CJSM Blog to keep up to date with what's going on in the world of Sports Medicine.
Check out our CME articles on the Lippincott CME Connection website with new topics being added regularly, and don't forget to have fun testing your clinical reasoning skills with our clinical case studies, produced in association with AMSSM and AOASM and available for free on our website.
Enjoy the summer months, and we'll see you again in September.
All the best,
Christopher Hughes MBBS MSc