SIRC at the JCSMS!

2011 Joint Commission on Sports Medicine & Science Annual Meeting
by Nancy Rebel, Director of Library Services, SIRC

SIRC is pleased to be a member organization of the Joint Commission on Sports Medicine and Science (JCSMS) and attend the annual meetings. The Commission gathers together the executives from over 60 organizations that are leaders in the area of sport and physical activity. This year’s meeting is taking place in Philadelphia and SIRC’s Director of Library Services, Nancy Rebel, is in attendance.

Today’s discussions focused on two features:

US National Physical Activity Plan: From Plan to Implementation to Progress
The Plan is a comprehensive set of policies, programs, and initiatives that aim to increase physical activity in all segments of the American population. The intent of the Plan is to be inclusive and across all sectors and industries. The Plan focuses on the power of collaboration. The National Coalition for Promoting Physical Activity (NCPPA) has taken a leadership role to move forward on the implementation of the plan. Goals are for the Plan to be very active, to create measurable change, setting annual strategies to forge forward on multi-year plan.

Latest resource for the Plan:
Make the Move report (digital report - interactive viral publication)

Wii-Hab to Wii Fit and Beyond
Bryce Taylor, MS, PT.
Using Wii in clinical practice for rehabilitation. He mainly uses games compatible with the WIi Balance Board (use Wii Fit & Wii Fit Plus).
This presentation was done by one of the self-proclaimed pioneers of this “Wiihabilitation”. A large percentage of physical therapists are currently using it for some of the following: Injury prevention, analysis, corrective exercise, research, athletic conditioning. Applications can be used for stroke patients through to athletes with modifications to make it easier or harder depending on the needs of the individual. Modifications can be made by using different equipment (Swiss ball, bosu, stability trainers, tilt board etc.) in conjunction with the Wii balance board. The balance board acts as a force plate. For example a plank can be done using Halo bars on a stability ball on the Wii balance board.
Benefits: Affordable, Advantageous, Affable (fun), Available
Targets: Stability, neuromuscular control, functional training, core strengthening

SIRC at the JCSMS - Day 2

Tackling Sport Concussion
by Nancy Rebel, SIRC

Did you know

• 58% of all concussions occur in practice (high school & college football)
• 140,000 concussions a year in US high school sport (football #1, girls’ soccer #2)

Presenter: Dr. Robert Cantu, MD
A lot of research has been done in concussion management, but it has really taken off since 2001. There is still much to be done. The best treatment for concussion, other than prevention, is physical and cognitive rest. It takes 5-10 days to recover from the symptoms of concussion, but in actual fact it takes the brain 3-4 weeks to really approach recovery. The length of time that symptoms occur is key in determining how serious the concussion is. The longer the symptoms last, the more severe the concussion is. For many injuries you can still play safely depending on the severity. However with spinal or head injury there is no such thing as playing hurt. The athlete should not participate while exhibiting any symptoms of spinal injury or concussion. It is about repetitive brain trauma, not just about the number of concussions.

“If in doubt, sit them out!”

Youth Concussion Management
Presenter: Gerard Gioia, PhD

• Lack of education & awareness
• Under-identification & under-recognition
• Poor/incomplete management

Whereas in the professional leagues you see team physicians on the sidelines to deal with diagnosis and management, on the youth level there are parents and coaches. It is important that they are aware that it is not just concussion that they should be aware of, but any trauma to the head that may contribute to the build up of brain trauma. “If in doubt, sit them out” Again, not just physical rest , but cognitive rest. As an athlete they sit out, as a student they should also be “benched”.

Online Resources:
Centers for Disease Control and Prevention: Concussion & Traumatic Brain Injury
SportsConcussions.org
NCAA Guidelines and Best Practices (multimedia resources)
Consensus Statement On Concussion in Sport (international Medical Associations)

For more information on sports concussion contact SIRC

Returning to play? Who decides?

So you lose your star player to injury. If you are a professional team, this may affect gate receipts. If you are in the hunt for a championship, this may cost you the title. So no matter the motivation to get your player back on the field of play, star of the team or not, how is the decision made and who makes it?

Does the athlete decide when they are ready? Should the coach make the final decision? Is it the team doctor, the athletic trainer, the parents or the family doctor? Whether the injury is a head concussion, sprained ankle, stress fracture or leg contusion, return to play protocols are a critical part of a physicians guidelines and they should be given the power and responsibility to abide by them for the sake of the athlete.

Conflicts of interest with players themselves, as well as with team management, are widespread. Because of the pressures associated from bringing together all the decision-making stakeholders involved in an athlete’s career, the decisions made by a physician or athletic trainer regarding an injured athlete’s return to play can occasionally have over-riding ethical dilemmas. Using a moral compass and doing the ‘right thing’ for the athlete, embraces the basic principles of ethical decision making.

And while the decisions need not be perfect, they should reinforce the medical practitioner’s responsibilities to the athlete. Decisions should focus solely on the athlete's welfare and not on the effect those decisions will have on the outcome of a sporting event.

Additional Resources:

• Stovitz, S. D., & Satin, D. J. (2006). Professionalism and the Ethics of the Sideline Physician. Current Sports Medicine Reports, 5(3), 120-124.
• Dunn, W. R., George, M. S., Churchill, L., & Spindler, K. P. (2007). Ethics in Sports Medicine. American Journal of Sports Medicine, 35(5), 840-844.
• International Federation of Sports Medicine / Fédération Internationale de Médécine du Sport – Code of Ethics
• Swisher, L., Nyland, J., Klossner, D., & Beckstead, J. (2009). Ethical Issues in Athletic Training: A Foundational Descriptive Investigation. Athletic Therapy Today, 14(2), 3-9. Available in the SIRC Collection.
• Borowski, Bill, Pack, Cory & Powell, David (2007). Ethical Issues in Sport Medicine. Unpublished. Retrieved from the Internet March 17, 2011.

The Achilles Heel of the Achilles Tendon

The Achilles tendon is the large fibrous tissue that connects the heel to the muscles of the lower leg.  Named after Achilles, the ancient Greek hero of the Trojan War who was invulnerable except for one spot on his heel, it is the thickest and strongest tendon in the body, so that it can connect with the most powerful muscle group in the body - the calf muscles (plantaris, gastrocnemius and soleus muscles) to the heel bone (calcaneus).  The tendon is vital to such activities as walking, running and jumping, and it’s the sudden explosive starts in sports such as basketball, tennis and racquetball that does the most damage to a tendon that is weak and thinned with age or under-use. An acute rupture of the Achilles tendon can happen to any level of athlete whether world class or recreational. However, research indicates that typically it is the “weekend warrior” male athlete between ages 30 and 50 with no previous tendon issues and is intermittently active, who suffers from this type of injury. 

Diagnosis of a ruptured Achilles tendon is made in a variety of ways.

• Typically the patient will say that it felt like they were kicked or shot behind the ankle.
• Presence of a gap in the tendon. However swelling can disguise the gap in acute ruptures.
• Conduct a Thompson test. With the patient lying face down and feet hanging off the edge of the examination table, the test is positive if there is no plantar flexion of the foot when the adjacent calf is squeezed. Likewise, the test is negative if the foot moves in a plantar flexion direction signifying that the muscles that the tendon is still attached.

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches and among the medical profession, opinions are divided as to which is preferred.

A few ways to possible prevent Achilles tendon injuries are:

• Begin any new physical activity programs slowly over time.
• Do not use equipment you are not familiar with.
• Wear appropriate footwear.
• Don’t be the “weekend warrior.” Exercise regularly.
• Try to limit the amount of time exercising on hard surfaces, such as concrete.

For more information on sports medicine injuries, please contact SIRC.

SIRC at the CASEM Conference!

The SIRC virtual resource centre is on the road this week in Kelowna, BC attending the Canadian Academy of Sport and Exercise Medicine (CASEM) conference. It is great talking to the sports medicine community and helping them out with their questions in the area of sport medicine and preventive health interventions.

Some of the topics being discussed include:

• Exercise as a modality for chronic disease prevention 
• Exercise as disease management 
• Concussion research, prevention and management (including adaptations for women and youth) 
• Ethics for team physicians 
• Anterior Cruciate Ligament (ACL) research 
• Advocating for healthy lifestyles 

SIRC is pleased to be in partnership with CASEM to support medical professionals working in the area of sport and active living through SIRC membership.

Great conference CASEM!!