Tag Archives: concussion

mike loosemore by clare parkMike Loosemore is Lead Consultant Sports Physician at the English Institute of Sport, Exercise and Health; he is currently at the Rio 2016 Olympics

 

Have you noticed that the male competitors in Boxing don’t have to wear head guards at the Rio 2016 Olympics? This may seem odd, perhaps. However, the requirement to wear head protection has been removed for the first time since it was introduced in 1984 at the Los Angeles games. In the lead up to the 1984 Olympics, concerns about brain damage as result of boxing led to a strong anti-boxing feeling within the medical profession. It was under pressure from the medical profession to make boxing safer that head guards were introduced. ...continue reading

Version 2Laura Zuccaro
University of Ottawa
Class of 2017

 

 

 

 

 

I weave the ball through an intimidating defense,
An elite player, striving to improve my game,
I perceive, I predict, and I react – effortlessly
One tournament: suddenly
Grounded – concussed.
But I am strong, invincible, and bounce back quickly: ready to play. ...continue reading

Girl in the DarkPatricia Lightfoot is Associate Director, Online Physician Learning, at the new CMA subsidiary "8872147 Canada Inc."

 

I read Girl in the Dark a few months after escaping from a darkened room, where I had lain blind-folded and ear-plugged, the prisoner of an implacable captor, with whom no negotiation was possible. My time spent in darkness was the consequence of a concussion, sustained following a severe fall when cycling down a hill on my regular Saturday ride. A full recovery eluded me for months, in spite of my intense desire to be well and active. Once I had served my sentence ...continue reading

DMacA_ski_resizeDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK, recently returned from attending CASEM-OMA Sports Medicine symposium in Ottawa.

 

Myth busters could be a regular session at any medical conference. But sports medicine seems particularly susceptible to suggestion, quackery or placebo as everyone looks for an easy answer. Jamie Kissick took us on an entertaining trip around the dubious evidence base surrounding interventions such as functional movement prediction of injury; managing muscle soreness; glucosamine and chondroitin; ice baths in recovery and many others. I was delighted to hear praise for my colleague Chris Bleakley’s work. And, indeed, mention of the POLICE acronym.

Should my child play contact sports? It is a question asked by many parents following the discussions about trauma in professional sport. J. Scott Delaney outlined many of the arguments, focusing on the short and long term risks associated with concussion. My view of Delaney's talk is that the evidence is unclear- and it can be difficult, even for you as the doctor, to be objective. ...continue reading

DMacA_ski_resizeDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. This week he is attending the CASEM-OMA Sports Medicine symposium in Ottawa.

 

Edu-tainment is how we need engage audiences, according to Andrew Pipe, chair of the opening session of the CASEM-OMA 2015 meeting in Ottawa. And what a superb opening session. Ian Shrier and Pierre Frémont introduced their five key sports medicine papers and debates of the last year. From a CMAJ perspective, it was great to hear Ian cite our systematic review on arthroscopic surgery for degenerative tears of the meniscus as a key paper. He made a very important point that the outcome was the minimally important difference to patients. The authors had used the average but, looking at the minimally important difference distribution, this may not be entirely reflective, and some people may have had a benefit in the short term although, in the long term, there was no effect.

Concussion is a major issue and Pierre reminded us of a paper emphasising that concussion management protocols should include cervicovestibular evaluation ...continue reading

Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Concussion is in the news again. In the first of the Six Nations Championship matches, George North of Wales suffered two blows to the head during the game against England. Peter Robinson, whose son Ben died in 2011 at age 14 after a schools match in Northern Ireland, was quoted in the Times “We are using these players as guinea pigs. I thought Ben’s death was the tipping point when they realised they had to do something, but I don’t think anything drastic will happen until there is a tragedy involving a famous star live on TV. We need a culture change.” Since the weekend, the medics, the coaching team, the concussion protocols and the rugby hierarchy have all been criticized. ...continue reading

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Matt_HockeyMatt Eagles is a medical student at Memorial University, Newfoundland and Labrador (Class of 2017) and a former Major Junior and University hockey player. He is a founding member of Concussion-U

 

On Saturday November 19, 2011 I took the ice for warm-up against the UPEI Panthers. It was just another night at the rink. My routine felt no different than it had for any of the other 300 or so games I played in my Major Junior and University Careers. What I did not know at the time was that this would be the last game of competitive hockey I would ever play.

In the second period, I suffered my third concussion in a ten-month span. I had gone through the recovery process in the past, and I figured that I would be fine in no time. Unfortunately, that wasn’t the case. When I tried to return to the classroom about a week later, I could not focus. If I tried to sit down and read, I would get headaches. By this point in my life I had shifted my dream from playing in the NHL to attending medical school. I quickly realized that my playing days might be numbered, and I sought expert advice. Both physicians and psychologists advised that I should walk away from the game. They said that continuing to play hockey would be putting my brain at risk for long-term impairment. Reluctantly, I heeded their counsel. My hockey career was over. ...continue reading

DMacA_ski_resize

by Domhnall MacAuley, CMAJ Associate editor, in Monaco.

Concussion is the current big story. Football, Hockey, Boxing and even Cricket have their own internal debates addressing issues including, helmets, rules on return to play, and the use of substitutes. The major worry is Chronic Traumatic Encephalopathy.  CMAJ recently published a practice primer based on the Zurich Consensus guidelines, which sparked some spirited responses. Controversial stuff. I had hoped Paul McRory, an international expert on concussion, would give us some answers in his keynote. He described advances in technology that allow us to measure impact from sensors in helmets and how telemetrics and video allow us to calculate the biomechnical forces in head deceleration, but there was little correlation between these various parameters and concussion.  Even highly sophisticated MRI examination tells us little. McRory reminded us that current guidance on return to play focuses mostly on the neurocognitive function, but that concussion is a systemic complex with many components. Even the pathological findings in deceased ex athletes are difficult to interpret. There is no direct correlation between impact and the concussive response and, individuals appear to react differently in different circumstances. The only strong risk factors for concussion that have been identified appear to be previous injury, gender and a history of migraine-so there is not a lot we can do. Like many in the audience, I had hoped for a simple solution. There isn’t one.

The most recent Zurich guidelines created lots of discussion but McCrory pointed out that these guidelines are work in progress rather than the definitive answer. Research has produced lots of new information in recent years but, he concluded, we probably know less now than before.

I discussed this with Peter Larkins, a doctor and media analyst for Aussie Rules Football, who provides on the spot television analysis of injuries during games. He told me about changes to the rules of Aussie Rules football, which allow players to leave the pitch for 20 minutes for concussion assessment. It’s amazing that a governing body was prepared sanction such a long time out period; it’s a rule that should perhaps be adopted by other sports.

Showing data from the UEFA study of top European football clubs, Jan Eksrand (Sweden) shared some interesting findings on injury patterns in soccer. He showed how more injuries occur during matches than in training and how more injuries occur during matches lost than won. Each player has an average 1.8 injuries per season with 12% of a playing squad unavailable at any one time. It’s remarkable that clubs are prepared to share these data but, of course, sharing knowledge about injuries could help them all.  Many sessions on injury management focused on accelerating return to play. But, before we could get carried away with rapid rehabilitation, one audience member reminded us that the role of collagen hadn’t altered in the 30 plus years since he was at medical school.  We might have the best intentions but biology hasn’t changed.

On a lifelong journey from runner, through jogger, to shuffler, I’ve worn many of the shoes that Benno Nigg (Canada and Switzerland), a legend in the science of shoes, gait, and running biomechanics, used as examples of running shoe development in his keynote address. His talk fascinated me. With shoe design changes, pressure was unpredictable, insoles caused variable pronation and supination and almost all parameters were subject specific. Comfort, however, was the common factor - athletes seemed able to choose their own shoe. We still haven’t found the answer to the perfect running shoe and his penultimate slide called for increasing collaboration between epidemiology and functional science. A fitting conference epilogue.