Tag Archives: injury

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


You step off the podium into an abyss. And, that’s if you have been a success. For everyone who competes at top level, medallist or not, the transition is dramatic. If your sporting career has come to a sudden end due to injury, poor performance, or you are unexpectedly dropped from the team, there can be an overwhelming sense of failure or unfulfilled ambition. No one sees what happens when you leave the stage. Adjusting to the real world can create huge challenges for former athletes and often, the greater the success, the more difficult to readjustment.

Gearoid Towey, a four-time Olympic rower and former World Champion, founded an organisation called 'Crossing the Line' to help athletes deal with retirement. ...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


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.


From Domhnall MacAuley, CMAJ Associate editor, in Monaco

Dr Richard Budgett, IOC Medical Director and former Olympic gold medalist, pointed out in his introduction to the IOC World Conference that “It’s about the athlete”. Raymond Verheijen , the straight talking Dutch Director of the World Football Academy, underlined this message in his talk aimed at coaches of elite level soccer. Although it’s all about winning (and money), if you want to win, you have to keep the players on the pitch- injury free. The goal is performance. But only healthy athletes can perform.

Sports injuries feature daily in the back pages of the newspapers and often make prime time headlines.  This conference had the inside track on the latest pioneering research, controversies and innovations.

Cruciate ligament injury can cost your career. In sports that require athletes to make sudden changes in direction, anterior cruciate rupture is devastating. Yet there are now preventive strategies, supported by good evidence based on high quality randomised controlled trials. Implementation has been especially successful in soccer. Research findings have been integrated into the FIFA11+ programme and rolled out across the world. Could we screen athletes, to identify those most prone to cruciate injury? Yes, according to Tim Hewett (USA), who showed how those with valgus movement on a vertical jump create a rotatory movement-effectively treating their knee hinge almost as a ball and socket joint. But, will it predict injury?

Ankle injury prevention, based on equally robust evidence hasn’t had the same penetration and uptake. Evert Verhagen and team (The Netherlands), developed a primary prevention programme based on sound evidence built from empirical work, observational studies, and systematic reviews, and ultimately evaluated in randomised controlled trials. They also developed an “app”, available on iTunes, which they are currently testing in a randomised controlled trial. Verhagen, who is particularly interested in the use of modern electronic media, in a keynote address, showed how to use online technology to recruit research participants; explored the potential of twitter; demonstrated the value of online data collecting; and described how some of his students even use twitter to take and share lecture notes. He also told us scary stuff about the data we generate on our smart phones- someone somewhere knows where you are, what you are interested in and, from a physical activity perspective, knows how far you have walked, run or cycled, just from data collected by your phone.

Sudden death in the sports arena always make headlines. Medicine has been searching for the optimum screening protocol- including questionnaires, clinical examination, ECG and echocardiography - that could help us reduce sports related cardiac events. Again, the experts had few conclusive answers. We follow families after a sudden death, and underline the importance of taking symptoms such as dizziness and syncope more seriously. But, Lucy Free (UK), a rowing doctor, pointed out to the expert panel, that almost every athlete she knows feels a little dizzy after an ergometer test!  A reality check from the sharp end by a team clinician. It’s not easy for the specialists either: Michael Papadakis (UK) discussed variations in 12 lead ECG findings in black and white athletes and at different stages in the transition from adolescent to senior athlete making interpretation especially complex in national squads with a large ethnic mix. Sanjay Sharma (UK) pointed out the difficulties in differentiating cardiomyopathy from physiological hypertrophy where it’s not just the size of the ventricular wall that counts but left ventricular cavity size too. And, if all the tests are equivocal, the ultimate diagnostic indicator is if the echocardiographic changes reverse on de-training- but try asking a top athlete to ease off on training! Sanjay left immediately for London as he is also medical director for the London marathon where, sadly, they had an event related death yesterday. Jon Drezner (USA), a team doctor with the Superbowl winning Seattle Seahawks, emphasised the importance of sideline doctors being prepared for sudden cardiac events. He showed some stark videos of sudden cardiac events- tough viewing for our non-medical colleagues. But it was effective. Be prepared and think “What if”.  An entirely appropriate message coming from Monaco- where it seemed there was an AED at every bus stop.