Tag Archives: sports medicine

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

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

The newspaper story about our research focused on the proportion of older people without sufficient leg strength to stand up unaided from sitting in a chair. At the time, it irritated me. We had just completed a major country wide health and activity survey with superb data on fitness at all ages....and they picked this one component. It was a huge piece of work. Our team had interviewed 1800 adults up to the age of 70 years old, measured VO2max together with ECGs on a treadmill, undertaken various strength tests in a mobile exercise laboratory that we transported to 14 different hospital sites, and taken fasting blood tests in peoples’ homes. My main interest in sport and exercise medicine was in promoting physical activity and - at the time - I thought I was a bit of an exercise guru. It wasn’t the headline I had hoped for and, furthermore, I was teased for weeks by friends and relatives. Everyone wanted to show me how they could all stand up unaided from sitting in their armchairs!

But, with a bit of hindsight, I can now say that perhaps the journalists were right. ...continue reading

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Sport, the focus of so many dreams, hopes and ambitions is a part of life where we were encouraged to believe that ability, dedication and commitment would triumph over all adversity. Who hasn’t imagined a winning performance, making that critical score or crossing the finish line to the applause of the crowd: Daydreams of the young and not so young.

We could dismiss the occasional cheat, vilify the greed of a professional team, criticise the incompetence of a governing body but the systematic, structured and organised doping, bribery and cover up associated with recent scandals in athletics is staggering. First it was the Kenyans who betrayed our beliefs. Their distance runners, world leaders and role models, whose easy loping style, lightness of foot, and incredible pace suggested an awesome natural ability, winning almost all the major city marathons. Allegations of doping, while persuasive, seemed to suggest small scale, ad hoc involvement. Until the recent story of doping by Russian athletes, that is. This evolving story is much more dramatic than what we've come to expect as the norm; doping in Russian athletics is widespread, structured and systematic. Every day reveals another layer. And doctors were complicit. ...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

Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK, and recently in Edinburgh for the British Association of Sport and Exercise Medicine conference 2014

 

Why are the Jamaicans so dominant in world sprinting? And, it’s not just Jamaicans, but those of Jamaican origin representing other countries such as Canada and the UK. Is there a genetic component? Yannis Pitsiladis, a world expert with access to the world’s largest biobank, found no unique genetic trait. Jamaicans’ believe that this dominance is from the eugenic effects of the slave trade - only the fittest and strongest survived ...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

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

 

Taking your nine year old to climb Mont Blanc (altitude 4810m), seeking the record for the youngest ascent, is high risk on a mountain where about 100 people die each year. At what point on the scale of encouragement-to-achieve do we stray into the red zone? Take a look at this clip from ABC News in the US showing Paul Sweeney and his two children aged eleven and nine climbing in the snow and, watch as one child, then another, slip off the mountain. The children were unhurt but the mayor of St Gervais les Bains, which includes Mont Blanc, was highly critical. While there are non-medical questions about who controls the wilderness and when we should intervene when adult behaviour puts others, such as the rescue services, at risk, there are other deeper ethical questions when children are involved.

An underage athlete was also one of the main medical stories at the Commonwealth Games. Chika Amalaha, a 16year old female Nigerian weight lifter was stripped of her gold medal when, according to the BBC, amiloride and hydrochlorothiazide, both prohibited as diuretics and masking agents, were identified in her urine sample.

While this clearly transgresses the ethical and legal boundaries, and is particularly serious when it involves a minor, other sporting situations involving children are less clear. To achieve excellence in sport requires immense commitment with intensive skills training from a young age. Children are vulnerable and may well not be making informed decisions for themselves so, although we are generally impressed by outstanding underage performance, we might also sometimes feel uncomfortable.

Other random Commonwealth Games medical thoughts- while I marvelled at English diving sensations Victoria Vincent (13) and Matthew Dixon (14), on the 10m board, I wondered if repetitive diving risks damaging the developing brain. I have no idea if there is significant impact on striking the water. (Perhaps someone might respond.)
In boxing, blood streaming from cuts made dramatic, if rather unsavoury, television. Amateur boxing has shed head protection making head clashes more likely. Head gear may not reduce repetitive impact but it will reduce potential blood injury. Medicine struggles with boxing. It is difficult to defend a sport where the ultimate aim is to inflict direct injury but the sport is generally well regulated and undoubtedly benefits many young men and women. There is no body contact in squash but the ball is a perfect fit for the orbit and I was impressed with the eye protection worn by squash players in those amazing externally transparent courts. Good sports medicine should be in the background. If it is makes headlines, it usually means there is something wrong so we should acknowledge the outstanding work of the host medical team since among the non-stories were a well contained potential outbreak of gastroenteritis and an Ebola virus scare.

On Monday, as the athletes left the airport in a swirl of bagpipes, we gathered in another part of Glasgow for a memorial service celebrating the life of Professor Stewart Hillis, a cardiologist and one of pioneers of Sport and Exercise Medicine. Long-time Scotland Team doctor, he contributed much to soccer, including introducing cardiovascular screening of referees, worked enthusiastically with UEFA and FIFA medical committees, and was a close friend and confidante of many soccer legends, including Sir Alex Ferguson who gave one of the eulogies. In his academic role, he was a key to introducing the BSc and MSc in sport and exercise medicine to the University, and educating a generation in sport and exercise medicine, many of whom worked on the Games and some of whom came in their team kit. His was a life spent in the service of others – a witty, inspirational, and incredibly committed professional, and a wonderful colleague and friend.

Domhnall MacAuleyIts not just the football. Sports docs watch the World Cup medical stories with great interest—which players are injured, what happened and how they are managed. Luis Suárez, suddenly infamous, scored two goals, effectively eliminating England, just weeks after an arthroscopy. And, with the current controversy over concussion and possible long term chronic traumatic encephalopathy, we are especially aware of head injuries. In 2010, team doctors of the 32 finalist teams reported 125 injuries in 64 matches with 104 injuries during training. Most of these injuries were not serious and the incidence of match injuries was lower than in the three preceding World Cups. So far, this year looks even better. The World Cup only offers a short window on acute soccer injuries, however, and it may be more important to look at the long term sequelae and, in particular, if soccer might lead to long term osteoarthritis. There is some evidence that it does but we await the findings of what may be the definitive study, Osteoarthritis Risk of Professional Footballers, undertaken by the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis—a major UK and international collaboration. The World Cup is also likely to generate other tangential papers such as to how it might influence the number of ER admissions or myocardial infarctions.

Exercise in treating arthritis initially seemed counter intuitive. Rob Petrella, now at University of Western Ontario, first brought this to my attention in a poster at a medical conference, and it led to his systematic review in 2000 asking if exercise was an effective treatment for osteoarthritis of the knee. At that time there were few sufficiently powered randomised controlled trials but, overall, the evidence seemed in favour. Last year, a similar systematic review showed overwhelming evidence in favour of exercise for lower limb osteoarthritis. This was a sequential meta analysis and, what was particularly important, was that there was sufficient evidence to show physical activity was beneficial as early as 2002. It can take a long time to change our minds and integrate evidence into practice.

Evidence in treating arthritis is not always what one might expect. Just a few weeks ago, Kim Bennell and her colleagues published a high quality randomized controlled trial on the effect of physical therapy in hip osteoarthritis. Patients had 10 treatments over 12 weeks comprising education and advice, manual therapy, home exercise, and gait aid if appropriate. There was, perhaps unexpectedly, no difference in pain or function compared with sham treatment. I cannot imagine that the findings of this study were welcomed by Kim’s physiotherapy colleagues. Its not just in football where the results can be surprising, unexpected and disappointing for the supporters.