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Sports-Related Concussion in Youth- Improving the Science, Changing the Culture: Book review by Dr. Michael Turner

9 Apr, 14 | by Karim Khan

Book review by Dr. Michael Turner

Sports-Related Concussion in Youth- Improving the Science, Changing the Culture (336 pages)

sports related concussion cover.phpThis is essentially the 2012 Zurich Concussion Consensus process applied to research in youth sport – a great summary of the topic but not an easy read.

For anyone versed in concussion the themes will be familiar:

  • A very high profile topic
  • Very few good quality articles published in the recent literature relating to concussion in youth sport
  • Epidemiology data non-existent for grass roots sport
  • The culture in youth sport is to play down concussion and avoid letting the team down
  • A single definition of concussion is not universally applied so data gathering is a mess
  • Little research has taken place on the molecular changes that occur in the young brain when a concussion occurs
  • Mixed findings on the long term effects of repetitive concussions and sub-concussive episodes
  • Risk factors for post-concussion syndrome and CTE have not been identified
  • No studies on the pre-high school group have tracked the post-concussion changes found in the following activities – physical, cognitive, emotional or sleep
  • There is no data to establish a threshold for concussion in young athletes
  • The is no equipment that can mitigate or prevent concussion, despite the manufacturers claims to the contrary
  • There is currently inadequate information to establish what combination of tests is best to identify and monitor concussion in youth sport (using hospital based or non-hospital based assessment tools)
  • Despite the consensus agreement that concussion should be treated with physical and cognitive, there is little empirical evidence to establish what is the optimal degree and duration of physical rest and if cognitive rest is necessary

The authors explore these problem areas and offer a detailed review of the published literature:

  • Neuroscience, biomechanics and risks of concussion in the developing brain
  • Concussion recognition, diagnosis and acute management
  • Treatment and management of prolonged symptoms and post-concussion syndrome
  • Consequences of repetitive head impacts and multiple concussions
  • Protection and prevention strategies
  • Conclusions and recommendations

 The authors make 6 recommendations:

  1. Surveillance – establish a national surveillance program for children aged 5-21
  2. Evidence based guidelines for concussion diagnosis and management – should be established and research supported
  3. Short and long term consequences of concussion and repetitive head impact – should be evaluated using a controlled, longitudinal, large scale study
  4. Age appropriate rules and playing standards – should be rigorously evaluated by sports associations, schools and national governing bodies of sport
  5. Biomechanics, protective equipment and safety standards – should be evaluated by research funded by the National Institutes of Health and the Department of Defence
  6. Culture change – the NCAA and other organisations should develop, implement and evaluate the effectiveness of the large scale efforts to increase knowledge about concussion and change the culture surrounding concussion (among elementary school through college-age youth, their parents, coaches, sports officials, educators, athletic trainers and health care professionals)

The book costs just US$64-00; the recommended research will cost a great deal more

Sports-Related Concussion in Youth – Improving the Science, Changing the Culture (336 pages)

Institute of Medicine and National Research Council of the National Academies

ISBN – 13: 978-0-309-28800-2

ISBN – 10: 0-309-28800-2

http://0-www.ncbi.nlm.nih.gov.elis.tmu.edu.tw/books/NBK169016/

http://www.nap.edu/catalog.php?record_id=18377

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Dr. Michael Turner, MB BS, FFSEM is the Chief Medical Adviser for the Lawn Tennis Association, London

Listen HERE to the BJSM podcast interview about his time as chief medical adviser of the Lawn Tennis Association, including the medical scandals that have cropped up and the advances he’s seen in the game’s sports medicine.

 

Book Review: “Triathlete’s Training Bible”

25 Oct, 09 | by Karim Khan

The Triathlete’s Training Bible will make triathletes smarter, stronger and faster



Review by Ross Tucker

Joe Friel’s Triathlete’s Training Bible, now in its 3rd edition, has become an indispensable tool for triathletes of all levels wishing to improve their performance using evidence-based methods and principles. Of most credit to the book is that it is very obviously a sound theoretical treatise, heavily based on scientific truths, as well as Friel’s own experience of having worked with triathletes for many years. Yet it does not overplay its hand, forcing technical scientific information on the reader and aspirant improver. Rather, it guides decision-making for all situations, covering topics ranging from motivation (the art) to metabolism (the science), always in a very clear, concise and practical manner. As for scientists who work with athletes, the value is in appreciating how Friel balances the complexity of the science of performance, with the requirement to give athletes tangible, easily implementable advice, and this is something all sports scientists can borrow from.

[Also, click here for a link to Joe Friel’s bloged.]

Book Review: Essential Sports Medicine

7 Nov, 08 | by Karim Khan

essentialsportsmedicine

Essential Sports Medicine
Edited by Richard Higgins, Peter Brukner and Bryan English.
Published by Blackwell, pp 160, £24.99.
ISBN: 9-78140-5114387

This is primarily a UK written sports medicine book whose primary audience is intended to be at an undergraduate level. With the expansion of the speciality as a whole it is always a difficult task to be comprehensive, but the major fundamentals have been covered in a very clear and concise manner. The book is well laid out and presented with a generous number of illustrations. Colour would have been nice but I guess budget constraints did not permit this or is it meant to reflect the murky British weather?

There is a good balance between musculoskeletal injuries and medical based problems. Basic nutrition and exercise physiology have also been included.

The book has been well researched, as you would expect from the quality of the contributors, and each chapter finishes with a short list of further reference material for those interested. I found the information to be very current and up-to-date. Even an ageing sports physician such as myself was able to learn an extra thing or two!

I was particularly interested in the sports specific injury section; secretly I was hoping that there may have been a medical explanation or two in there from one of the co-editors as to why Chelsea had a trophyless season—never mind!

Overall this book has very few weaknesses, certainly nothing worth mentioning. I feel it has more than achieved its aim of reaching the intended target audience and I can see this material becoming a good source reference book in the years to come, with further revisions, especially when sports medicine finally becomes a part of the undergraduate UK medical curriculum. No doubt it will encourage a few undergraduate physiotherapy and medical students to enter a sports medicine career path.

Objective details

  • Targeted to an undergraduate audience.
  • Peter Bruckner is a well known author and has written arguably one of the finest books in sports medicine, Clinical sports medicine, with Karim Khan (McGraw Hill Publications).


Subjective details

  • The easy reading style along with the illustrations was appealing although JK Rowling need not worry about the competition!
  • Not useful to me at this point in my career; certainly would have been valuable when I was starting out.

Reviewer
Arjun Rao
Maylands, Washington State, USA

Analysis
Presentation 16
Comprehensiveness 15
Readability 16
Relevance 15
Evidence basis 15

Book Review: Clinical anatomy of the lumbar spine and sacrum

16 Oct, 08 | by Karim Khan

clinicalanatomyofthespinebjsm

Clinical anatomy of the lumbar spine and sacrum (2005)
By Nikolai Bogduk
Published by Churchill Livingstone
pp 324, US$90. ISBN: 0-443-10119-1

This publication can be considered a classic for those clinicians involved in the care of patients with lower back problems. The purpose of the book is given in the foreword and the first paragraph of the author’s preface to the 4th edition: “There have been no changes in the anatomy of the lumbar spine in the past 20 years, but our understanding of some of the controversial issues has. Among them the presence of new data on zygoapophyseal joint pain, suggesting that it is not as frequent as once thought, whereas discogenic pain seems to be on the up once more, with better knowledge of the process of internal disc disruption.”

The book covers comprehensively the expected topics: bones, joints, ligaments, muscles and fascia, blood and nerve supply in various chapters, as well as embryology and development. There is a separate chapter for the sacroiliac joint.

The book has been written as a text book for the International Spine Intervention Society (ISIS): it is required reading for students and a key reference to instructors to review before teaching the Society’s anatomy courses.

As a clinician with an interest in low back and pelvis patients (but not involved in intervention procedures) I found the “extra” chapters particularly interesting. In the chapter “Age changes in the lumbar spine” Professor Bogduk stresses in his own emphatic style that many changes observed in imaging studies are nothing more than the result of the normal ageing process, not pathological findings.

From a clinician’s point of view the last three chapters on low back pain, instability and radiographic anatomy are of particular interest. The author addresses controversial topics as is his custom: with thoroughly researched references, available clinical evidence and very definite opinions. A number of the references are obviously form the first edition (1987), but still valid. The instability chapter has an excellent biomechanical basis, and is presented in a very logical fashion, that makes understanding of the issues easier. There is no reference, however, to the available literature on the link between low back pain and changes in muscle recruitment patterns, which is clinically significant. I also would have liked to see the last chapter on the radiographic anatomy expanded to cover other imaging modalities, rather than limited to simple x ray films. In fairness to the author, he indicates that further material is covered in the instructional CD of the ISIS.

These criticisms are not sufficient to change my opinion of this book: it is an excellent resource for all those who have an interest in the lumbar spine, from surgeons to interventionists, anatomists, physiotherapists, chiropractors and osteopaths.

Reviewer
M F Cusi
University of Notre Dame
Sydney School of Medicine
Darlinghurst, NSW
Australia

Analysis
Presentation 15
Comprehensiveness 18
Relevance 20
Evidence bass 18

Book Review: Science and football V: the proceedings of the 5th World Congress on Science and Football

3 Oct, 08 | by Karim Khan

scienceandfootballbjsm

Science and football V: the proceedings of the 5th World Congress on Science and Football.

Edited by Thomas Reilly, Jan Cabri and Duarte Araújo.
Published by Routledge, 2005, pp 634.
ISBN: 978-0-415-48480-0 (paperback); 978-0-415-33337-5 (hardback); 978-0-203-41299-2 (electronic)

Target: Football elite and sub-elite sport science support

Appeal: Broad coverage necessary components sport science. As a sports physician it is not primarily targeted for me and so although it had components of interest, I would not personally purchase

In recent years, sport has by necessity evolved in many facets. Financial rewards have boomed. Information systems have fuelled intense exposure and scrutiny. Doping issues have come under intense publicity and accountability. All this intensifies need for sports to seek ethical advantage with evidence based front line measures.

To fulfill these demands is the immense expectation in sport science seeking that gain an edge in coaching, conditioning and medicine. To achieve this requires sport support services to be reliably informed. This is critical at the elite level to ensure peer parity and at the sub-elite level to provide exposure to elite concepts and portability to sub-elite programs as is practicable.

“Science and Football V: the proceedings of the 5th World Congress on Science and Football” is geared for sports science (conditioning and skill acquisition) rather than primarily sports medicine. It is ideal for coaching staff and strength and conditioning staff. Content is of sound background content for football medical support staff.

Authors are from a wide range of geographic national backgrounds, with strong emphasis on university sport science departments with particular interest in soccer reflecting its international predominance—but representing all codes. Content includes sections on biomechanics, fitness profiling, performance analysis, a small section on medical aspects, football conditioning, physiology and nutrition, paediatric issues and behavioural science.

Topics include coverage of those perennial “footballs”—stretching modes and benefits and relation to injury, warm-up, micronutrient levels and effect of diet and supplementation.

I believe this publication does deliver sound depth and a range of contemporary football sport science for coaching and conditioning support staff, as a summary for those fortunate enough to attend the conference, and as a reference for those particularly involved at the elite level of conditioning for high level teams. For those involved in sub-elite levels it provides an excellent insight into elite performance as a means of extracting ideas into the non-professional level.

Reviewer
P Baquie
Olympic Park Sports Medicine Centre,
Melbourne
Victoria
Australia

Analysis
Presentation 5
Comprehensiveness 5
Readability 5
Relevance 4
Evidence base 4

Book Review: Martindale’s Drugs Restricted in Sport

10 Sep, 08 | by Karim Khan

Martindale35_l bjsm

Martindale’s Drugs Restricted in Sport, Pocket Companion, 2008
Sean C. Sweetman (editor)
Publisher: Pharmaceutical Press, 2008
ISBN 978-0-85369-825-8
416 pages

“Martindale’s Drugs Restricted in Sport” is unique in its kind. It is the first pharmacopia that lists all the drugs that are on the WADA list of prohibited substances, drawing on the wealth of information and clinical expertise in the full reference work: “Martindale, the complete drug refeerence”. This is a great resource for sports medicine physicians, general practitioners and all other health care professionals working with athletes. It contains over 450 monograhs pertaining to individual drug substances that may be restricted in some or all sports, either in or out of competition.

The book is arranged alphabetically by drug substance. The international nonproprietary name or generic name is used, where one exists.

Other synonyms listed include British approved names, the French, Latin, Spanish, and Russian variants of generic names, names used in other European, Baltic, and Scandinavian countries, comon synonyms, and maufacturer codes.

The clinical profile is based on the full text of “Martindale: the complete drug reference” and describes the basis action and uses of the substance.

The WADA status indicates whether the substance is prohobited in or out of competition.

The WADA class gives an indication of the reason for the prohibition and gives more information about the range of substances covered in that class, plus any special circumstances. It is a great asset of the book that this is repeated with every substance, so you don’t need to go somewhere else to read all the information of the particular substances you are interested in. All the information is given right there where you need it.

A comprehensive index of over 15200 entries is to be found at the back of the book, and includes all names, synonyms, and proprietary (trade) names found in he tex. Even Cyrillic names are listed!

This is a great book for those of us who have been in the awkward situation where our athlete phones us, while away on a trip in Norway, Egypt or Russia, have gotten sick and are not sure of the medication the doctor has given him, and can only provide you, let’s say, the Russian trade name. What do you do?

The player is “strictly liable”, but is depending on you. And it is your name who will appear in the court case on internet for many years to go when you make a mistake. And there is no way you will find that Russian trade name on the WADA doping list!

So now there is a solution to all of these problems: Martindale’s Drugs Restricted in Sport Pocket Companion! The only thing missing is a short summary of the categories of the WADA list of prohibited substances and methods – it would be really helpful is that would be included at the front of the book as well.

Babette Pluim,
Sports physician

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