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“Although an athlete may experience a slow or delayed recovery, there is reason to believe that recovery is achievable with additional time and injury management,” says study author Thomas W. McAllister, MD, of the Indiana University School of Medicine in Indianapolis. “This is an encouraging message that can help remove some of the discouragement athletes may feel when trying to return to their sport. While some athletes took longer than 24 days to return to play, we found that three-quarters of them were able to return to the sport if you were given just a month to recover.”

The study examined 1,751 college athletes diagnosed with a concussion by a team physician. Of the athletes, 63% were male and 37% female. Male athletes mainly competed in football, soccer and basketball. Female athletes mainly competed in football, volleyball and basketball.

Participants were evaluated five times: within six hours of their injury, one to two days later, as soon as they were free of complaints, as soon as they were allowed to play again and after six months.

Participants reported symptoms to medical staff daily for up to 14 days post-injury and then weekly if they had not yet returned to play.

A total of 399 athletes, or 23%, experienced a slow recovery.

Researchers found that among athletes who took longer than 24 days to return to play, more than three-quarters, or 78%, were able to return to play within 60 days of injury, and four-fifths, or 83%, were able to resume. to return to play within 90 days of the injury. Only 11% had not returned to play six months after the injury.

For the slow-recovery group, the average time to return to play was 35 days post-injury, compared to 13 days in the overall group.

“The results of this study provide useful information for athletes and medical teams to consider when evaluating expectations and making difficult decisions about medical disqualification and the value of continuing with their sport,” McAllister said.

A limitation of the study is that the participants were all collegiate varsity athletes and may not be representative of other age groups or sport levels, and the results may not apply to other types of mild brain injuries.

The study was supported by the Grand Alliance Concussion Assessment, Research, and Education Consortium, National Collegiate Athletic Association, and the Department of Defense.

Association for Concussion History and Long-Term Recovery in Youth.

Chizuk HM, Cunningham A, Horn EC, Thapar RS, Willer BS, Leddy JJ, Haider MN. Clin J Sport Med. 2022;32(6):e573-e579. doi:10.1097/JSM.0000000000001044

https://journals.lww.com/cjsportsmed/Abstract/2022/11000/Association_of_Concussion_History_and_Prolonged.19.aspx

Take home message

Athletes with three or more previous concussions were more likely to develop persistent postconcussive symptoms and take longer to recover than peers with fewer previous concussions.

Background

Persistent symptoms after concussion are defined in adults as symptoms lasting more than 10 to 14 days; in children it is defined as taking longer than a month to recover. A history of three or more concussions is associated with a longer recovery in adults. However, it remains unclear whether this also applies to pediatric patients.

Study objectives

The authors examined whether a greater number of previous concussions increased the risk of persistent postconcussive symptoms in pediatric patients.

Methods

The authors prospectively collected patient records from three sports medicine clinics near Buffalo, New York. Patients were between 8 and 18 years of age, diagnosed with a concussion within 14 days of injury, had a documented number of previous concussions, and were treated until clinical recovery. The researchers defined recovery as symptoms returning to normal with rest, a normal physical examination, and the ability to exercise and return to school without worsening symptoms. The researchers calculated recovery time as the difference between the days after the injury and when the participants recovered. Physicians recorded the number of physician-diagnosed concussions or undiagnosed concussions they considered reliable based on a patient’s history.

Results

The authors recruited 284 children, of which 270 were used in the final analysis. Fifteen children had three or more previous concussions. While 32 to 38% of youth with a history of 0 to 2 previous concussions developed persistent symptoms, two-thirds of those with 3 or more concussions developed persistent symptoms. The researchers found that a cutpoint of ≥ 3 or ≥ 4 concussions had the best prediction of who would eventually develop persistent symptoms.

Viewpoints

These results demonstrate that pediatric patients with a history of three or more concussions are more likely to develop persistent symptoms. It will be interesting to see if these findings can be replicated in a study involving more people with three or more concussions. However, these findings may hold up well because they are consistent with previous research among adults who have suffered a concussion.

Clinical implications

Doctors should use this information to educate patients, especially those who have suffered multiple concussions, that their recovery will likely take longer than their previous concussions. It may be helpful to inform school physicians and administrators that a patient has a history of multiple concussions and may require a longer recovery time and additional academic accommodations.

Questions for discussion

1. Do other factors from a patient’s history influence the risk of a concussion?

Written by Mitchell Barnhart
Reviewed by Jeffrey Driban

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History of concussion is associated with poor perception
Structural brain changes associated with concussion history and cognition
Snoozy athletes report more signs and symptoms of concussions

Researchers hypothesized that the physical and cognitive demands of orienteering, which integrates exercise and navigation, may stimulate parts of the brain that our ancient ancestors used for hunting and gathering. The brain evolved thousands of years ago to adapt to the harsh environment by creating new neural pathways.

Those same brain functions are no longer as necessary for survival today due to modern conveniences like GPS apps and readily available food. Researchers suggest it’s a matter of ‘use it or lose it’.

“Modern life may lack the specific cognitive and physical challenges the brain needs to thrive,” said Jennifer Heisz, Canada Research Chair in Brain Health and Aging at McMaster University, who oversaw the study. “In the absence of active navigation, we risk losing that neural architecture.”

Heisz points to Alzheimer’s disease, where the loss of the ability to find one’s way is one of the earliest symptoms, affecting half of all affected individuals, even in the mildest stages of the disease.

In the study, published today in the journal PLoS ONEresearchers examined healthy adults, ranging in age from 18 to 87 years, with varying levels of orienteering expertise (none, intermediate, advanced and elite).

People who participate in orienteering reported better spatial navigation and memory, suggesting that adding elements of wayfinding to regular training could be beneficial across the lifespan.

“When it comes to brain training, the physical and cognitive demands of orienteering have the potential to give you more bang for your buck compared to training alone,” said lead author Emma Waddington, a graduate student in the Department of Kinesiology who designed the study. and is a coach and member of the national orienteering team.

The goal of orienteering is to navigate by running as quickly as possible over unknown terrain and finding a series of checkpoints using only a map and compass. The most skilled athletes must switch efficiently between different mental tasks, making quick decisions while moving around the terrain at a fast pace.

The sport is unique in that it requires active navigation while making rapid transitions between parts of the brain that process spatial information in different ways. For example, reading a map relies on a third-person perspective of the environment. Orienteers must quickly translate that information in relation to their own position in the environment, in real time, as they navigate the course.

It’s a skill GPS systems have taken from modern life, researchers say. This can affect not only our ability to navigate, but also our spatial processing and memory in general, because these cognitive functions depend on overlapping neural structures.

Researchers suggest there are two simple ways to integrate more orienteering into everyday life: turn off the GPS and use a map to find your way while traveling and challenge yourself – spatially – by using a new route for your run -, walking or cycling tour.

“Orienteering is a sport for life. You often see participants between the ages of 6 and 86 participating in orienteering,” says Waddington. “My long-term involvement in this sport has allowed me to understand the process behind learning navigation skills and has inspired me to explore the uniqueness of orienteering and the scientific significance this sport can have for an aging population,” says Waddington.

Student-athlete preferences for reporting sexual violence: A discrete-choice experimental patient

Ellyson AM, Adhia A, Kroshus E, Wright DR. Patient. 2022. https://doi.org/10.1007/s40271-022-00600-z.

Full text not freely available

Take home message

Student-athletes may be more likely to formally report sexual assault if there is a drug amnesty policy in place and students who commit sexual assault are more likely to be caught in violation of a school’s code of conduct.

Background

Sexual violence – defined as any sexual activity without consent or performed under duress – is common on American college campuses. Unfortunately, after sexual assault, someone rarely formally reports these events on college campuses. There are many reasons why someone might not want to report (stigma, fear of retaliation, not being believed). However, student-athletes may face unique sports-related barriers if their perpetrator is a fellow athlete, coach, or sports mentor. We know little about the features of reporting systems that would encourage a student-athlete who has experienced sexual violence to increase the likelihood of reporting.

Study aim

The authors surveyed collegiate athletes to determine how features of the reporting system influence decisions to formally report their sexual assault to their institution.

Methods

The authors surveyed 1,004 student-athletes from 10 NCAA Division I member institutions. The student-athletes answered questions about prior sexual violence and reported experiences and sociodemographic data (e.g., age, race/ethnicity, gender, team status, academic status). Participants also completed a discrete choice survey. This type of survey asks whether they would report sexual assault in a series of hypothetical situations that varied aspects of a facility’s reporting system. With this study, the researchers were able to determine which aspects are most likely to lead to someone formally reporting sexual violence.

Results

Overall, ~29% (n=288) reported a history of sexual violence. Overall, student-athletes reported that they would be more likely to report sexual assault if students who committed sexual assault were more likely to be caught violating the code of conduct. Furthermore, reporting would be higher if an institution had a substance use amnesty policy. Unfortunately, the aspects likely to influence reporting behavior varied widely among student-athletes and may be influenced by history of sexual assault, sport (male versus female), and competitive status. For example, students who reported a history of sexual violence were less likely to report formally and value aspects of the reporting system less than their peers. Students with a history of sexual violence reported greater interest in substance use amnesty policies, anonymous reporting, and survivor-initiated investigations than their peers without a history of sexual violence. Students at higher competitive levels reported that the most important characteristics were the likelihood of finding policy violations, survivor-initiated investigations, and amnesty for substance use.

Viewpoints

The authors found that overall substance abuse amnesty policies could potentially lead to higher reporting rates. Sexual violence is often associated with substance use (Foubert et al.). Therefore, providing amnesty policies for substance use could remove this barrier to reporting sexual violence. It was interesting to note the differences when considering the history of sexual violence, sports team contexts, and competitive status. This highlights the need for further research into these dynamics to better understand the preferences of this population and to generalize to the non-student-athlete population.

Clinical implications

This work emphasizes that student preferences should guide policies aimed at supporting students who experience sexual violence. Furthermore, physicians and administration must inform athletes of the policy to ensure everyone understands it and that there is full transparency about the policy and follow-up processes.

Questions for discussion

How does your school deal with reporting sexual violence? Does implement your school similar features to encourage reporting?

related posts

1. Sexual violence in sports: Position statement of the American Medical Society for Sports Medicine
2. It’s Not Boys Being Boys on College Campuses: Men in Fraternities and Sports Clubs Commit Sexual Violence at More Rates than Their Peers
3. It’s not just happening in Hollywood, rape myths are becoming accepted on college campuses

Written by: Jane McDevitt
Review by: Jeffrey Driban

The study – the largest of its kind – also found that having just one moderate to severe concussion or traumatic brain injury (TBI) can have a long-lasting impact on brain function, including memory.

Led by teams from the University of Oxford and the University of Exeter, the research included data from more than 15,000 participants in the online PROTECT study, who were aged between 50 and 90 and based in Britain. They reported the severity and frequency of concussions they had experienced throughout their lives, and administered annual computerized tests of brain function.

Published in the Journal of NeurotraumaThe study found that people who reported three or more concussions had significantly worse cognitive function, which became successively worse with each subsequent concussion after that. Attention and completion of complex tasks were particularly affected.

Researchers say people who have suffered a concussion should be warned about the dangers of continuing with risky sports or work.

Lead researcher Dr Vanessa Raymont, from the University of Oxford, said: ‘We know that head injury is a major risk factor for dementia, and this large-scale study provides the greatest detail yet on a stark finding: the more often you damages your brain, your brain function may deteriorate as you get older.

“Our research indicates that people who have experienced three or more, even mild, concussions should be given advice on whether to continue with high-risk activities. We should also include organizations operating in areas where it is more likely to the head is affected, encourage them to think about how to protect their heads.” athletes or employees.”

The team found that participants who reported three episodes of even mild concussions over their lifetime had significantly worse attention and ability to perform complex tasks. Those who had four or more mild concussions also showed worse processing speed and working memory. Each additional concussion reported was associated with increasingly poorer cognitive function.

Additionally, the researchers found that reporting even one moderate to severe concussion was associated with worse attention, complex task completion, and processing speed.

In the online PROTECT study, participants share detailed lifestyle information and complete a battery of cognitive tests every year for up to 25 years. This rich trove of data helps researchers understand how the brain ages and what factors are involved in maintaining a healthier brain in later life.

Dr. Helen Brooker, co-author of the study from the University of Exeter, said: “As our population ages, we urgently need new ways to enable people to live healthier lives in later life. This article emphasizes the importance of detailed long-term studies. such as PROTECT in better assessing head injury and its impact on long-term cognitive function, especially as concussion has also been linked to dementia. We are learning that life events that may seem insignificant, life experiencing a mild concussion, can have an impact on the Our findings indicate that cognitive rehabilitation should focus on key functions such as attention and completion of complex tasks, which we have found to predispose are for long-term damage.’

Dr. Susan Kohlhaas, research director at Alzheimer’s Research UK, said: “Studies like this are so important in unraveling the long-term risks of traumatic brain injury, including their effect on the risk of dementia. These findings should send a clear message to policymakers and sports organizations , which must implement robust guidelines that minimize the risk of head injury.”

The research involved collaboration with the University of New South Wales, Australia, Kings College London and University College London, UK, Stavanger University Hospital in Norway and Harvard Medical School, in the US. The. article entitled ‘Lifetime TBI and Cognitive Domain Deficits in Late Life: The PROTECT-TBI cohort study’, published in the Journal of Neurotrauma.

Evidence of ACL healing on MRI after ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON study.

Filbay SR, Roemer FW, Lohmander LS, et. already. Br J Sports Med. Doi 2022:10.1136/bjsports-2022-105473. E-publishing prior to printing.

Full text freely available

Take home message

Nearly one in three participants offered supervised exercise therapy with optional delayed anterior cruciate ligament (ACL) reconstruction had MRI evidence of spontaneous ACL healing two years after ACL rupture. Those who are healed are more likely to report better patient-reported outcomes than participants without healing or who underwent early or delayed ACL reconstruction.

Background

Many assume that a torn ACL cannot heal spontaneously. If we better understood how often a torn ACL heals and how ACL healing relates to patient-reported outcomes, we could identify the best treatment options for certain patients.

Study aim

Filbay and colleagues completed a secondary analysis of data from the KANON study to report how often the ACL heals within the first five years after an ACL injury and to compare 2- and 5-year outcomes among those who do and do not heal are.

Methods

The KANON randomized controlled trial compared results between 62 participants who received early reconstruction and 59 participants who received supervised exercise therapy with optional delayed ACL reconstruction. A blinded radiologist assessed each knee 2 and 5 years after injury for ACL healing (on MRI) and osteoarthritis. The primary outcomes of interest were ACL healing, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, measures of passive knee laxity, and osteoarthritis at 2 and 5 years postinjury.

Results

Two years after injury, 30% (16 of 54) of participants assigned to rehabilitation with the option of delayed ACL reconstruction had evidence of ACL healing. More specifically, 53% of participants (16 of 30) treated with rehabilitation alone had evidence of ACL healing. Participants who demonstrated ACL healing reported better KOOS scores at the two-year follow-up than the nonunion, delayed ACL reconstruction, and early ACL reconstruction groups. At the five-year follow-up, KOOS scores were more comparable between groups.

Viewpoints

The results of this study show that spontaneous ACL healing occurs in approximately 30% of people with ACL rupture. This finding of spontaneous healing is consistent with previous research. Participants with ACL healing reported better knee symptoms than peers who did not heal or received ACL reconstruction (early or delayed). Hopefully, this study will lead to new research with larger cohorts to help us identify who will experience and benefit from spontaneous ACL healing.

Questions for discussion

Do you feel that this research will have an impact on your clinical practice regarding ACL ruptures and their treatment?

Written by: Kyle Harris
Review by: Jeffrey Driban

related posts

Why patients treated nonoperatively after an ACL injury decide to undergo surgery
Treatment after acute injury of the anterior cruciate ligament (ACL), part 2: treatment of the patient with an ACL injury
Coach the coach, make ACL injury prevention programs stick!
BEAR: a bridge to better psychological preparedness after ACL injury
Do patients check all the boxes after ACL reconstruction?

Cambridge scientists gave newborn rats, which are naturally born prematurely, a combination of glucocorticoid steroids and statin therapy. The results, published today in Hypertension, show that the combined treatment led to the elimination of the negative effects of steroids on the cardiovascular system, while maintaining their positive effects on the developing respiratory system.

Premature birth (before 37 weeks) is one of the leading causes of death in perinatal medicine today. In high-income countries, one in ten babies are born prematurely; this can rise to almost 40% in low- and middle-income countries.

Premature babies are extremely vulnerable because they miss a crucial final stage of development in which the hormone cortisol is exponentially produced and released into the unborn baby’s blood. Cortisol is essential for the maturation of organs and systems necessary to keep the baby alive after birth.

In the lungs, for example, cortisol ensures that they become more elastic. This allows the lungs to expand so that the baby can take his first breath. Without cortisol, newborns’ lungs would be too stiff, which leads to Respiratory Distress Syndrome (RDS) and can be fatal.

The established clinical treatment for any pregnancy at risk of preterm delivery is glucocorticoid therapy, administered via the mother before the birth of the baby and/or directly to the baby after birth. These synthetic steroids mimic natural cortisol by accelerating the development of organs – including the lungs – meaning the premature baby has a much greater chance of survival.

Lead author Professor Dino Giussani from the Department of Physiology, Development and Neuroscience at the University of Cambridge said: “Glucocorticoids are clearly a lifesaver, but the problem with steroids is that they accelerate steroid maturation. all organs. This is beneficial for the baby’s lungs, but it can be harmful to the heart and circulatory system; it looks like accelerated aging.”

An earlier clinical study by Professor Paul Leeson’s laboratory at the University of Oxford found that people exposed to glucocorticoid therapy as unborn babies, through their mothers, showed measures of cardiovascular health typical of people ten years older.

Cambridge researcher Dr. Andrew Kane, involved in the rat research, thought that this accelerated aging could be the result of steroids causing oxidative stress. Steroids lead to an imbalance of molecules known as free radicals, resulting in a reduction in nitric oxide. Nitric oxide is very beneficial for the cardiovascular system: it increases blood flow and has antioxidant and anti-inflammatory properties.

To test whether a nitric oxide deficiency could be the cause of the adverse cardiovascular side effects associated with glucocorticoid therapy, the researchers combined steroid treatment with statins, which are commonly used to lower cholesterol and are known to increase nitric oxide.

Researchers gave the synthetic steroid dexamethasone, combined with the statin pravastatin, to rat pups. There were three other groups: one received only dexamethasone, one received only pravastatin, and a control group received saline. Measurements of respiratory and cardiovascular function were then taken when the rats had grown into ‘infancy’.

The Cambridge scientists found that steroids had adverse effects on the heart and blood vessels, and on molecular indices linked to cardiovascular problems. But when statins were given at the same time, the rats were protected from these effects. Crucially, the statins had no effect whatsoever on the beneficial effects of steroids on the respiratory system.

“Our discovery suggests that combined treatment with glucocorticoids and statins may be safer than glucocorticoids alone for the treatment of premature infants,” said Professor Giussani.

“Goods not say to stop using glucocorticoids because they are clearly a life-saving treatment. We say against that improve this therapy – to refine it — we could combine it with statins. This gives us the best of both worlds: we can retain the benefits of steroids on the developing lungs, but eliminate the adverse side effects on the developing heart and circulatory system, making therapy much safer for the treatment of preterm labor. .”

The team plans to replicate the experiment in sheep, which have similar physiology to humans, before conducting clinical trials on humans.

The research was funded by the British Heart Foundation and the Research Council for Biotechnology and Biological Sciences (BBSRC). Dr. Andrew Kane was supported by the Frank Edward Elmore Fund and the James Baird Fund.