Bulletin Board

January 29, 2015

Concussion Education Not Enough
Most high school athletic departments take numerous steps to educate their student-athletes about the dangers of concussions. Changing student-athlete behavior continues to be elusive, however, according to a study presented at the Pediatrics Academic Societies annual meeting in May.

In the summer of 2012, researchers from Cincinnati Children's Hospital Medical Center gave surveys to 120 Cincinnati-area high school football players. The questions asked about their knowledge of concussion symptoms and gauged their attitudes regarding return to play.

The respondents scored well on symptom recognition, especially headaches (93.3 percent), dizziness (89.2 percent), difficulty remembering (78.3 percent), sensitivity to light and sound (78.3 percent), and difficulty concentrating (75.8 percent). Over 90 percent understood that they risked serious injury by returning to play too soon following a head injury.

Despite this knowledge, 91.4 percent of players surveyed said they believed it was acceptable for athletes to play with a concussion. In addition, only 40.6 percent said they would immediately tell their coach if they had experienced concussion symptoms. Some players felt that concussed athletes have a responsibility to take part in important games.

"It is possible that concussion education alone may not be enough to promote safe concussion behaviors in high school football players," Brit Anderson, MD, Pediatric Emergency Medicine Fellow at Cincinnati Children's Hospital Medical Center and one of the study's co-authors, said in a news release. "These attitudes could leave young athletes vulnerable to injury from sports-related concussions."

To view an abstract of the study, "'I Can't Miss the Big Game': High School Football Players' Knowledge and Attitudes about Concussions," go to www.aap.org and search "High School Athletes Say Concussions Won't Sideline Them." The link to the abstract will be in the article.

New Guidelines for EIB
In an effort to provide sports medicine professionals with accurate, up-to-date information on exercise-induced bronchoconstriction (EIB), the American Thoracic Society recently released a new set of clinical practice guidelines. Published in the May issue of the American Journal of Respiratory and Critical Care Medicine, the recommendations cover both diagnosing and managing the syndrome.

EIB is an acute airway narrowing that can occur during or after exercise. Compounding factors include cold or dry air, ambient ozone, and airborne particles. Up to 20 percent of the general population is expected to experience EIB at some point during their lifetime, with a prevalence rate of up to 70 percent for Olympic and elite athletes and 90 percent for individuals with asthma.

The new guidelines advise basing a diagnosis of EIB on post-exercise lung function rather than peak expiratory flow rate or symptoms of coughing, wheezing, and chest tightness. Lung function can be determined by measuring the forced expiratory volume (FEV1)--the maximum amount of air that can be exhaled in one second--before and after five, 10, 15, and 30 minutes of exercise.

The percentage difference between the pre-exercise FEV1 value and the lowest level recorded within 30 minutes of exercise should be used to determine the level of EIB severity. Mild EIB is diagnosed when the FEV1 drops by more than 10 percent but less than 25. When the decline is between 25 and 50 percent, EIB is considered moderate, and any reduction exceeding 50 percent signifies severe EIB.

The newly released guidelines also outline appropriate treatment options. These include a thorough warm-up and use of an inhaled short-acting beta-agonist 15 minutes prior to exercising. Athletes requiring additional care should add a daily dose of an inhaled corticosteroid or a leukotriene receptor antagonist. In addition, a long-acting beta-agonist (LABA) may be used provided it is limited to no more than three times per week since one study found that those taking LABAs build up a tolerance.

Sink or Swim
Not many athletic trainers have a collegiate coaching victory, let alone a championship win, on their resume. However, in April, Daniel Siopa, MS, ATC, a first-year Assistant Athletic Trainer at Connecticut College, pulled off just such a feat.

With 5:44 left in the Collegiate Water Polo Association (CWPA) Division III women's championship game, Siopa found himself summoned to the pool deck after Connecticut Head Coach JJ Addison was issued a red card and ejected from the game with his team leading 4-1. Because Assistant Coach Ryan Pryor was serving a one-game suspension for being ejected from the team's previous game, the Camels were left without a coach. This presented a problem as NCAA rules, which govern the CWPA, dictate that if a declared coach is not present on the bench once the clock restarts, the team must forfeit.

"I was sitting in the stands and the PA announcer said that our team needed an administrator present to continue the game," Siopa says. "A few seconds later, one of the officials asked me if I was an administrator, and I told him I was an athletic trainer for the school. He said that satisfied the criteria and pulled me down to the pool deck where I stood until the match was over."

Siopa had attended only one or two water polo matches previously. "I really don't know anything about water polo, so I relied on the athletes to guide me," he says. "But I wasn't nervous. They were playing so well to that point, I was confident that no matter what I did, the team would pull it out."

During his time on the sideline, Siopa called a timeout and at his team's request inserted a senior reserve goalie into the line-up so she could finish out her career in style. He also watched the squad net two more goals to ice the championship--the program's first. Per NCAA and CWPA standards, Siopa was the coach of record for the game.

When the final buzzer sounded, Siopa found himself in yet one more unusual situation. "The girls told me that if I had a cell phone in my pocket, I should take it out because I was about to go for a swim," Siopa says. "Luckily, JJ came running out before that could happen and they threw him in the pool instead."

Revealing Suspect Shoulders
A new motion measurement system can help identify baseball pitchers who are at greatest risk for shoulders injuries, according to a study published in a supplement to the April 2013 issue of Musculoskeletal Surgery. Using a portable 3-D-motion measurement machine, researchers were able to detect small changes in the pitchers' scapulo-humeral rhythm (SHR), which may indicate a deterioration in the coordinated movement of the upper arm and shoulder.

The study's authors attached sensors to 13 college-age pitchers' bodies (at the thorax, scapula, humerus, and forearm), including 3-D gyroscopes, magnetometers, and accelerometers. Using the Xbus kit from Xsens, this allowed them to track the motion of both the shoulder and upper arm in greater detail than is possible through video. The researchers evaluated flexion-extension and abduction-adduction movements before pitching, immediately after throwing 60 pitches, and 24 hours after throwing the 60 pitches.

Three of the pitchers (23 percent) showed deterioration in their SHR after pitching that did not improve in the following 24 hours. Three other pitchers with reduced SHR results immediately after pitching showed some improvement after 24 hours, but had not completely recovered. Five pitchers showed complete recovery of their deteriorated SHR scores after 24 hours and two pitchers showed no change in their SHR through all three measurement stages. Since deterioration of the SHR can lead to shoulder injuries, the study's authors recommend that pitchers flagged with sustained deteriorated SHR measurements should consider shoulder strengthening exercises and physical therapy.

An abstract for the study, "Motion Analysis Assessment of Alterations in the Scapulo-Humeral Rhythm After Throwing in Baseball Pitchers," can be found by typing the title in the search window at: www.springer.com.
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