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Physicians for Motion
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Physicians for Motion
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Midwest
Sports Medicine News
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News from the American College of Sports Medicine 54th
Annual Meeting by Erik Adams MD, PhD One person's experience of the ACSM annual meeting will undoubtedly be different than another's, because there are so many concurrent sessions from which to choose. An exception to this rule would be the lecture by Robert Cantu, MD, because the schedule was arranged so that no other session would conflict with his. Dr. Cantu has been a leader in the field of concussions, especially as they relate to sports participation. From a personal point of view, I found it helpful to hear his perspective, as there are so many different voices on this topic. Here are some of Dr. Cantu's points that I found notable: 1. He emphasized that permanent neurologic sequellae to multiple concussions are seen in a wide variety of sports, so recent contentions that football is somehow immune to such an effect do not make sense. He highlighted three recent high-profile cases in former NFL players, which resulted in early death, two by suicide. These athletes were afflicted by depression and cognitive dysfunction. 2. Having said this, there seem to be substantial inter-individual differences in the cumulative effects of concussion. Some tolerate 8 or 10 in a career without difficulty, and some are showing effects much earlier. An individualized approach is needed for return to play (RTP) issues. 3. He stated that, in his practice, he does not see a trend towards increasing severity and duration of post-concussion symptoms, with increasing cumulative number of concussions, as long as the athlete is allowed to fully recover prior to RTP. He did also mention that this trend is seen in the literature, but he did not highlight this apparent dichotomy. Perhaps he is saying that we are returning athletes prior to complete symptom resolution? 4. Dr. Cantu stated that second impact syndrome does exist, but it is rare. This highlights the need to ensure that symptoms have completely resolved, both without and with exertion, prior to RTP. I have heard a number of assertions from other sports medicine physicians that second impact syndrome does not exist, but here we're hearing it from Dr. Cantu. Consider the implications of possibly being wrong about the non-existence of second impact syndrome and sending an athlete back too play too early. ____________________ I also attended a discussion session on the continuing medical education aspects of the ACSM meeting, where participants made some important points: 1. One of ACSM's greatest strengths is its mixture of researchers and clinicians, but many of the presentations do not attempt to bridge the divide between these two worlds. One participant stated that a clinician should be able to state why their topic would be useful or interesting to a researcher, and vice versa. 2. All of us find the annual meeting to be a great learning experience and a good opportunity to see what's new in the field, so that when we get home, we apply these new ideas to what we are doing every day. 3. There needs to be attention to maintaining the quality of the presentations, and we need to discuss whether we need such a large volume of talks. Lower Extremity Injuries I had the opportunity to moderate a session of lower extremity injury research presentations, which ended up focusing primarily on the ankle. In this field, there appears to be a new questioning of the current "gold standard" of treatment for lateral ankle sprains, in which patients are not immobilized and are returned rapidly to activity. However, some of these researchers cited an incidence of over 35% for residual subjective instability after ankle sprain, and one of the presenters showed in an original study that this is associated with persistent ATF ligament laxity with arthrometer testing. In the literature, there has been great variability in duration and type of immobilization in studies of ankle sprains, and in preparing for the session, I was dismayed to see one paper quote only one article from 1965 in their admonition to avoid immobilization after ankle sprain! Certainly, it appears that persistent laxity is a concern, so I am glad to see this being investigated, with old assumptions re-investigated.
___________________________________________________________________________ SUMMER ACTIVITIES at Midwest Sports Medicine
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Don't forget the July 14, 2007 We'll have the
grill going (brats, chicken, Boca |
The Summer
Extravaganza will be followed by This will pit
PT clinics against each other in a battle Physicians
are welcome to compete in the Smaller PT clinics
are welcome, but you may need |
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Our rain date for these events is July 21, 2007
- same time, same place.
Copyright © 2007 Midwest Sports Medicine Institute, S.C.
Midwest Sports Medicine
Institute, S.C. |
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