Bulletin Board

January 29, 2015

Genetics and Concussions
It's now understood that the time it takes an athlete to return to play following a concussion is a process governed by a number of information-yielding variables. New research suggests adding one more to the list: an individual's genetic makeup.

Presented at the American Orthopaedic Society for Sports Medicine's annual meeting in July, the study followed 51 concussed athletes at the Temple University School of Medicine's Concussion Center from the time they underwent standardized concussion assessments until they fully recovered. Subjects were classified into one of two groups: normal or prolonged recovery. Normal recovery time was defined as 20 days or less, and prolonged recovery was considered more than 20 days. Researchers also collected saliva for DNA analysis.

"We identified that patients with a long allele in the (GT)n genotype were four times more likely to have a prolonged concussion recovery," the study's lead author, Jane McDevitt, MS, Clinical and Research Coordinator at Temple's Concussion and Athletic Neurotrauma Program, said during the presentation. "Because genes determine the structure and function of proteins involved in the cell's resistance and response to mechanical stress, it's not surprising there could be a connection to recovery from a traumatic event like a head injury.

"Making the genetic connection in this data is an exciting step for concussion injury research," McDevitt added. "Knowing this information could help improve monitoring and management of athletes who experience concussion and may also aid in the development of genetic counseling in athletes exposed to concussive head impacts."

An abstract of the study can be found by searching its title, "Supporting the Concept of Genetic Predisposition to Prolonged Recovery Following a Concussion," at: www.sportsmed.org/apps/aossm_2014/index.html.

Caffeine May Prevent Weight Gain
It's common for athletes to start their day with a cup of coffee. But new research claims that athletes who are trying to gain weight should avoid drinking too many beverages with high amounts of caffeine in them prior to physical activity.

According to a study currently in press in the International Journal of Sport Nutrition and Exercise Metabolism, trained athletes who ingested 4.5 mg of caffeine per kilogram of bodyweight before a workout burned 15 percent more calories during the three hours after exercise than those who took a placebo. For a 150-pound athlete, that's equivalent to the amount in a 12-ounce cup of coffee.

In the study, researchers from the Exercise Physiology Laboratory at the University of Castilla-La Mancha, in Toledo, Spain, had twelve subjects cycle for one hour at 75 percent of their VO2 max on five separate occasions. The cyclists either took a placebo or 0.5, 1.5, 3.0, or 4.5 mg of caffeine per kilogram of bodyweight before each session, and then had their heart rate, blood pressure, glucose, lactate, and fatty acid levels analyzed for three hours post-exercise.

The study authors noted no differences in any of the variables for the subjects who consumed the placebo and 0.5, 1.5, and 3.0 mg of caffeine. Researchers believe the higher post-exercise energy expenditures for the cyclists who took 4.5 mg was likely due to the increased energy cost of breathing.

An abstract of the study can be found by searching its title, "Ingestion of a Moderately-High Caffeine Dose Before Exercise Increases Post-Exercise Energy Expenditure," in the PubMed database at: www.ncbi.nlm.nih.gov.

D-I Strength Coaches Need Certification
With an eye toward student-athlete safety, the NCAA Division I Board of Directors recently took a page from the Division III rulebook. As a result of recent legislation, all D-I strength and conditioning coaches will be required to hold a nationally accredited strength and conditioning certification. D-III schools have operated under similar rules since 2012, and D-II schools have considered the legislation but have tabled it for now.

Currently, only the certifications offered by the National Strength and Conditioning Association and the Collegiate Strength and Conditioning Coaches Association meet the NCAA's nationally accredited standard. Uncertified coaches employed by D-I schools have been granted until August 2015 to obtain the updated qualifications.

For D-I programs, certification will only be required for employees holding the title of strength and conditioning coach. Athletic trainers and sport assistant coaches who also supervise strength programs will need to obtain certification at the discretion of their school. Additionally, individual institutions will decide the role of coaches who do not become certified prior to August 2015.

Quick Returns Not Always Ideal
The good news for college athletes who suffer an in-season shoulder instability injury, such as subluxation or dislocation, is that most can expect to return to play within one week. The bad news, however, is that more than half of those returnees are likely to develop recurring shoulder instability issues as the season goes on, according to the results of a new study.

These findings were presented at the July American Orthopaedic Society for Sports Medicine's annual meeting, and the data was gleaned from college athletes at three institutions over a two-year period. Researchers examined 45 contact-sport athletes who experienced anterior shoulder instability. Each individual's sport, previous instability events, direction of instability, and type of instability were recorded. The players were also subjected to the Western Ontario Shoulder Instability Test (WOSI) and Simple Shoulder Test (SST).

Every patient then participated in a standardized accelerated rehab program. Upon its completion, researchers found that 33 athletes (73 percent) returned to play for at least part of the season after a median of five days. Of these, 21 (63 percent) experienced recurrent instability.

In addition, the study's results showed a correlation between the WOSI and SST examinations and lost time. For every one point higher the WOSI scale score was when the injury occurred, the athlete increased their chances of returning to play that season by five percent. Similarly, for every 10 points higher on the SST scale score, the player returned roughly one day earlier.

Despite the small sample size, investigators hope their findings provide team physicians and athletic trainers with a helpful resource for determining return-to-play plans for shoulder instability. "More research is needed to determine the effect of multiple recurrent instability events on long-term outcomes, and this study will hopefully be a first good step in understanding this relationship," the study's lead author, Jonathan Dickens, MD, an orthopaedic surgeon at the Keller Army Hospital in West Point, N.Y., told Science Daily.

An abstract of the study can be found by searching its title, "Return to Play Following In-season Anterior Shoulder Instability: A Prospective Multicenter Study," at: www.sportsmed.org/apps/aossm_2014/index.html.
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