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September 2020 - Volume 30 - Issue 5

  • Christopher Hughes, MBBS, MSc
  • 1050-642X
  • 1536-3724
  • 6 issues / year
  • Orthopedics 16/82
    Sport Sciences 16/85
    Physiology 22/81
  • 3.165
Concussion in Sport
Published March 2020

We have reached September, in what has been one of the most challenging years most of us have faced in our lives. 

Looking back towards the start of 2020, it seems almost surreal to imagine that the world would be in the position we find ourselves in today. 

The global COVID-19 pandemic has resulted in adversity on many different levels, both for our patients and for those of us who strive to look after them. Whilst mortality and morbidity figures directly due to COVID-19 infection are hugely significant, it is also important to consider the ripple effects of the pandemic on global health. 

The World Health Organisation (WHO) recently produced an interim report regarding their survey on the impact of COVID-19 on health systems . Based on data from 105 countries, the vast majority (90%) reported disruption to local health services. Predictably, low and middle-income countries reported the greatest problems. The global effects seen on vaccination, emergency service provision, and access to ambulatory health care services including primary care and mental health services, have caused problems for many patients in our societies and will likely continue to do so for some considerable time. The effects on global and local economies are of huge concern. 

Whilst the situation is far from over, it is heartening to see the amazing efforts contributed by the medical fraternity around the world in attempting to mitigate both direct and indirect effects of the pandemic. I have heard many stories of heroism, devotion, selflessness, and kindness which make me both proud and humble to stand alongside colleagues who go about their everyday business of caring for our communities. 

In the sphere of primary care sports medicine, many practitioners have gone to extraordinary lengths to try to continue to care for their patients involved in sports and exercise pursuits. You may already have had the chance to listen to our special series of CJSM podcast interviews with several sports medicine physicians from around the world, who have offered insights into how their lives and practice have been affected by the pandemic.

Fortunately, those working in sports medicine have been admirably supported in their activities by our affiliate societies, who have produced a number of excellent resources aimed to assist clinicians in caring for their patients. 

The American Society for Sports Medicine (AMSSM) have links to some useful information on their website for healthcare professionals, athletic programs, coaches, parents and athletes dealing with COVID-19-related issues. 

CJSM is pleased to have recently published AMSSM's latest Interim Guidance on the Preparticipation Physical Exam for Athletes During the SARS-CoV-2 Pandemic online-first here.  

Our Founder Society, the Canadian Academy of Sport and Exercise Medicine (CASEM), lists a wide range of COVID-19 resources on their website, including return to SEM practice, return to sport, team physician and other resources. There is also a link to a great podcast interview with TV and radio host Christine Blanchett and Dr Jack Taunton reminding us of the importance of exercise during the pandemic. 

The American Osteopathic Academy of Sports Medicine have produced a special communication on Return to Training: Management of the Athlete from the COVID-19 Pandemic here, together with other relevant information links. 

Last but by no means least, the Australasian College of Sport and Exercise Medicine offer a support and resource page with a focus towards clinicians based in Australasia, with general links to useful information. 

Alongside clinicians, researchers have also been very busy this year and we continue to enjoy a large number of manuscript submissions to the Journal. 

This Issue, Gauvin-Lepage and Colleagues present a multi-center prospective study evaluating the effectiveness of an exercise-based intervention on youths aged 8-17 yrs with self-reported post-concussion symptoms 4 weeks after the original injury, compared with standard rest-based symptom-limited activity recommendations. In this non-randomized study, the Authors found that both groups (n=49) reported decreased symptoms over time, with youths in the experimental group reporting higher quality of life and less anger after 6 weeks. They conclude that active rehabilitation does not affect recovery of post-concussion symptoms beyond usual management at 6 weeks, but that it increases quality of life, decreases anger, and may increase energy level and balance. 

There are two articles on the subject of eye tracking, with Bin Zahid and Colleagues presenting a study on eye tarcking as a biomarker for concussion in children, and Howell and Colleagues offering a study on the reliability of eye tracking measures amongst health adolescent athletes, and also two different articles on issues related to the use of the sway balance system. Other Original Research articles this Issue include an exploratory study on quality-of-life amongst those with symptomatic achilles tendinopathy, the effectiveness of field-based resistance training protocols on hip muscle strength among youth elite football players, and the evaluation of allergic diseases, symptom control, and relation to infections amongst a group of Italian elite mountain bikers. 

Haider and Colleagues present a Practical Management article on a suggested brief, focused physical examination for sport-related concussion in the outpatient setting, the Buffalo Concussion Physical Examination. This combines parts of the SCAT5 and VOMS tests, with greater emphasis on assessing autonomic and vestibular function. Practising clinicians will no doubt find this article of interest, and we would be interested to hear your views on the assessment suggested by the Authors. 

Readers of the Journal online will be delighted to see a total of 10 Brief Reports on a variety of topics, and 7 interesting Case Reports this Issue. 

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

Stay safe, until next time, 

Best Wishes, 

Chris

 

Christopher Hughes MBBS MSc

Editor-in-Chief 




Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion

Gauvin-Lepage, Jérôme; Friedman, Debbie; Grilli, Lisa; More

Clinical Journal of Sport Medicine. 30(5):423-432, September 2020.

Effectiveness of an exercise-based active rehabilitation intervention for youth who are slow to recover after concussion

Practical Management: Brief Physical Examination for Sport-Related Concussion in the Outpatient Setting

Haider, Mohammad N.; Leddy, John J.; Du, William; More

Clinical Journal of Sport Medicine. 30(5):513-517, September 2020.

Brief physical examination for sport-related concussion in the outpatient setting