Bulletin Board

January 29, 2015

More Rest Needed After Concussion
Researchers at the University of Gothenburg in Sweden have conducted a number of studies that show cerebrospinal fluid can be used to determine the extent of brain injury. Their most recent findings reveal that the biological effects of concussion can last longer than previously thought.

To conduct this investigation, researchers examined the cerebrospinal fluid of 30 amateur boxers one to six days following a bout and found significantly higher levels of several brain injury biomarkers compared to a control group of 25 non-boxers. Levels of three biomarkers--neurofilament light (NFL), phosphorylated neurofilament heavy, and glial fibrillary acidic protein--remained elevated in the boxers after a rest period of at least 14 days.

Additional medical, neurological, and neuropsychological evaluations were also conducted on both the boxers and the control group. Boxers who had higher NFL levels two weeks after a match performed significantly poorer on two evaluations--the Trail Making A Test, which measures visual attention and task switching, and the Simple Reaction Test, an examination of psychomotor speed.

The study included a more detailed account of one boxer who was knocked unconscious during a bout. This athlete's NFL levels two weeks following the fight were four times higher than those of boxers who weren't knocked out. In addition, although the boxer reported no concussion symptoms, the NFL level did not return to pre-bout values until 36 weeks after the knockout, which is longer than previously expected.

"Assessment today is often based on physical symptoms, neuropsychological tests, and the neurological examination of the athlete," lead researcher Sanna Neselius, MD, Specialist in Orthopedic Surgery and PhD student at Gothenburg, said in a press release announcing her findings. "Our studies show that these tests are not sensitive enough, nor can we rely on the athletes' self-reported lack of symptoms. Concussion symptoms usually pass after a few days, but the neurological damage may still be present. I hope that brain injury markers in the cerebrospinal fluid, and hopefully also later in blood, can be used at all levels in all sports ... to plan and guarantee safe rehabilitation."

A link to the study, "Diagnosis and Monitoring of Sport-Related Concussion," can be found at: bit.ly/TCConcStudy.

Technology to Prevent Tommy John
It seems like not a day goes by without news of a baseball pitcher undergoing season-ending ulnar collateral ligament reconstruction, better known as Tommy John surgery. This recent spike has caught the eye of baseball and sports medicine experts alike.

In response, renowned orthopedic surgeon James Andrews, MD, a founder of both the Andrews Sports Medicine and Orthopedic Center in Birmingham, Ala., and the American Sports Medicine Institute (ASMI), and Kevin Wilk, PT, DPT, ASMI Director of Rehabilitative Research, have developed a smartphone app designed to educate players, parents, and coaches about ways to prevent pitching injuries that can lead to surgery. Called "Throw Like a Pro," the app was released in June and addresses preseason preparation, in-season recommendations, warm-up guidelines, and overuse injury prevention.

The preseason and in-season components include stretching and strengthening exercises athletes can use to reduce the risk of injury, with Wilk appearing in videos to offer instruction for each activity. The overuse injury prevention section includes a pitch counter as well as age-based pitch count guidelines. It also has a rest calculator that recommends how long pitchers should wait before returning to the mound based on the number of pitches thrown in their last outing. In addition to these interactive features, the app lists ASMI guidelines for pitchers, such as learning and using proper mechanics and avoiding the use of radar guns, which can promote overthrowing.

Andrews, who has long emphasized the importance of reducing overuse injuries in baseball pitchers, hopes the app will reduce the number of Tommy John surgeries in the future. "For the first time, kids and parents everywhere will have access to the information and routines that we hope will put an end to this epidemic," he said in a press release announcing the app.

The Throw Like a Pro app costs $9.99. It is available in the Apple app store and can only be used on iOS devices, such as iPhones and iPads.

Myofascial Increases Flexibility
For many strength coaches and athletic trainers, myofascial release tools have replaced static stretching in their efforts to prepare athletes' muscles and ligaments prior to physical activity. According to researchers from DeSales University, science also supports this approach for attaining short-term flexibility gains.

In a study presented at the 2014 American College of Sports Medicine's annual meeting in May, researchers looked at the effects of myofascial release on flexibility in 11 male and 12 female physically active college students and compared the massage technique's range of motion (ROM) benefits to those of static stretching. Following a baseline sit-and-reach flexibility assessment, each subject was instructed to perform one of three different protocols for 14 minutes: either static stretching consisting of seven unilateral movements, the same seven movements performed using a foam roller, or sitting still. Sit-and-reach ROM for each subject was reassessed three, 10, and 14 minutes afterward.

At the three- and 10-minute marks, both static stretching and myofascial release showed significantly greater ROM than sitting still. Furthermore, myofascial release proved much more effective at improving ROM after three minutes than static stretching. However, results for static stretching and myofascial release both waned at the 10-minute mark, with the corresponding groups experiencing decreased ROM from what was seen at the three-minute interval.

Researcher Rebecca Kudrna, MS, told Medscape Medical News that, "at least in terms of a single day, myofascial release was as effective as static stretching." However, the benefits are fleeting. "Usually between 10 and 15 minutes, all of your effects go away," she added.

Kudrna's findings have been touted as the first evidence that myofascial release could be a valid tool for improving flexibility. Next up for Kudrna will be a study comparing the effects of myofascial release on long-term muscle lengthening to those attained through static stretching.

To read an abstract for "Acute Effects of Myofascial Release and Static Stretching on Flexibility," go to: digitalcommons.wku.edu/ijesab and search "myofascial release."

Pac-12 Expands Health Initiative
At the conclusion of the 2014 Pac-12 Conference's summer meetings, the league announced that it would expand aspects of its Student-Athlete Health Initiative, which was launched in 2013. Most notable is their plan to extend funding of a research grant program for the next three years at an annual cost of $3.6 million.

Part of the grant money will go to creating a data repository that will allow schools in the league to share recent studies from their faculty, as well as injury data from practices and games. This information will then be analyzed by athletic trainers and team physicians looking to spot trends and improve treatment of student-athletes.

The Pac-12 will also start a Head Trauma Task Force made up of conference physicians and athletic trainers. Its aim will be to collect data on the effectiveness of the league's existing football contact limitations, recommending potential changes when necessary.

As an additional facet of the grant program, each school in the conference can submit research proposals to a 12-person review board made up of Pac-12 athletic trainers, physicians, and research specialists. The board will be responsible for approving proposals for funding, with an eye toward those that can provide best practices for student-athlete health and safety conference-wide.
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