Bulletin Board

January 29, 2015

Recovery Studies Making Headway
Though current and retired professional athletes in high-profile sports generate most of today's news about concussions, researchers are working hard to uncover optimal concussion management strategies for those not in the limelight. Two recently published studies focus on recovery predictors.

In the first, researchers looked to identify factors predicting that post-concussion symptoms would last 28 days or longer. Published in the October 2013 Journal of Pediatrics, the study included 182 children ages 12 to 18 reporting sport-related concussions lasting at least four weeks.

Based on their findings, researchers concluded that age, loss of consciousness, and amnesia could not be tied to the duration of symptoms. Instead, a higher Post-Concussion Symptom Scale score and lower performance on neurocognitive testing soon after the injury were better predictors of whether recovery would take longer than 28 days.

In another study, researchers at the University of Rochester School of Medicine and Dentistry found that women who suffer a concussion in the two weeks leading up to their menstrual period heal more slowly than those whose injury occurred outside that time frame. Jeffrey Bazarian, MD, one of the study's authors, believes this difference in recovery time is related to a woman's level of progesterone, a brain-protecting hormone produced most abundantly in the two weeks before menstruation.

In the study, published in November 2013 on the Journal of Head Trauma Rehabilitation website, follow-up evaluations revealed that of the 144 women treated for a concussion, those who suffered the injury within two weeks of their period were more likely to experience headaches and dizziness. On the other hand, Bazarian said, women who sustained the concussion in the two weeks after menstruating or women on birth-control pills, which prevent a drop in progesterone, reported less extreme symptoms.

To learn more, type "Symptom Severity Predicts Prolonged Recovery after Sport-Related Concussion, but Age and Amnesia Do Not" into the search window at: www.jpeds.com and "Menstrual Phase as Predictor of Outcome After Mild Traumatic Brain Injury in Women," into the search window at journals.lww.com.

New-Look Performance Training
Could practicing a sport while wearing glasses with lenses that alternate between transparent and opaque states improve an athlete's performance? A new pilot study provides the first evidence that stroboscopic eyewear can directly impact sports performance in positive ways.

Appearing in the November/December 2013 issue of Athletic Training and Sports Health, the study tested the glasses on 11 NHL players from the Carolina Hurricanes during the team's 2013 preseason training camp. Constructed of curved, plastic LCD lenses, the glasses alternately block and disrupt the athletes' vision through a strobe or flicker effect. By switching between clear and obstructed vision, the eyewear trains the athlete's brain to anticipate what's coming when the eyes are blocked, which in theory improves their processing of visual information, timing, and ability to pick up on subtle motion cues.

Designed and conducted by the team's athletic training staff, the testing of the technology began with a baseline evaluation of the skill levels of seven forwards and four defensemen. The forwards completed a drill that demonstrated their skating and shooting proficiency, while the defensemen were tested on skating acumen and long pass precision.

Next, four forwards and two defensemen in the group wore stroboscopic glasses for a minimum of 10 minutes per day over a 16-day period, performing typical on-ice drills. The five other players made up the control group, participating in the same workouts without wearing the eyewear.

On the final day of training camp, all 11 players were retested using the same drill they completed for the baseline assessment. The group that had worn the stroboscopic eyewear averaged an 18 percent improvement in performance compared to their baseline score, whereas the control group showed no improvement.

To read an abstract of the study, "Enhancing Ice Hockey Skills Through Stroboscopic Visual Training: A Pilot Study," type "stroboscopic" into the search window at: www.healio.com.

Athletes at Risk for Medication Misuse
The nature of participating on an athletic team often means sustaining sports-related injuries, which sometimes necessitate the use of prescription painkillers. A recent study indicates this puts male youth athletes at a heightened risk for medication misuse and abuse.

In the study, 1,540 students ages 11 to 17 volunteered to take the Secondary Student Life Survey once a year from 2009 to 2012. The survey consisted of a series of questions about the students' exposure to and use of prescription medications during the preceding 12 months, with a focus on opioids. Sixty-three percent of the participants were involved in organized sports over the course of the study.

Published online in the Journal of Adolescent Health, the results showed that male athletes within the study group were 10.5 times more likely to take too much of an opioid medication and 4.01 times more likely to use it to get high. However, female athletes in the study were not more likely to misuse opioids than female non-athletes.

The researchers believe this problem is lessened through open communication. They encourage health care providers involved in the treatment and management of sports-related injuries to talk with athletes and their parents about the risks of medication misuse and abuse.

"These drugs are being treated, or viewed, by adolescents [and parents] as something 'safer' than street drugs," lead researcher Philip Veliz, PhD, told dailyRx News. "Although these drugs serve an important function to manage pain, they still have a high abuse potential."

To view the abstract of the study, "Painfully Obvious: A Longitudinal Examination of Medical Use and Misuse of Opioid Medication Among Adolescent Sports Participants," search the study title at: www.pubmed.gov.

Back Injuries Are Third Most Common
The lower back is the third most commonly injured area in athletes younger than 18, new research has found. The study was presented at the American Academy of Pediatrics' National Conference on Oct. 28, 2013. Researchers looked at 859 injuries suffered by 837 athletes aged eight to 18 who underwent sports physicals or injury treatment at Lurie Children's between 2010 and 2013. A group of 360 uninjured athletes in the same age group made up the control group.

Just over 15 percent, or 127, of the injuries observed in the study were of the lower back. Only knee (31 percent) and ankle (16 percent) injuries were more common. Of the lower-back injuries, nearly 40 percent were considered "serious," such as stress fractures and the complications that can arise from them, like spondyloysis.

The biggest contributing factor to lower-back injuries may be overuse, the study authors wrote. Athletes in the study with lower-back injuries spent an average of 12.7 hours a week playing sports, compared to an overall average of 11.3 hours among the injured athletes. Researchers recommend avoiding specialization in one sport before late adolescence and ensuring athletes spend fewer hours a week playing sports than their age number.

To read an abstract of the study, "Risks of Specialized Training and Growth for Injury in Young Athletes: A Prospective Clinical Cohort Study," go to: https://aap.confex.com/aap/2013/webprogram/Paper21503.html.
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