1
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Abstract
Complaints related to the neck are common following mild pediatric trauma. Although significant cervical spine injuries are most often seen and evaluated in the emergency room or inpatient setting, the primary care provider is faced with the evaluation of lower acuity complaints. We provide a review to assist with the efficient evaluation of these patients to facilitate decisions regarding return to play, the need for imaging, and need for referral to subspecialty providers.
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Affiliation(s)
- Andrew Jea
- Department of Neurosurgery, University of Oklahoma College of Medicine, 1000 North Lincoln Boulevard, Suite 4000, Oklahoma City, OK 73104, USA.
| | - Ahmed Belal
- Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA
| | - Mohamed A Zaazoue
- Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA
| | - Jonathan Martin
- Division of Neurosurgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
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2
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Waltzman D, Daugherty J, Snedaker K, Bouton J, Wang D. Concussion reporting, return to learn, and return to play experiences in a sample of private preparatory high school students. Brain Inj 2020; 34:1193-1201. [PMID: 32697613 DOI: 10.1080/02699052.2020.1793388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of this study is to describe concussion reporting and return to learn and play among high school students. METHODS Self-reported survey data of 1,999 New England private preparatory high school students who played sports or engaged in recreational activities were collected in 2018. Descriptive and bivariate statistics are presented. RESULTS Three in ten respondents (31.4%) reported ever sustaining a concussion and 22.0% did not report at least one concussion to an adult. The most common reasons for not reporting included wanting to keep playing their sport (58.0%) and not thinking the injury was that serious (53.6%). Girls and students in higher grades took longer to return to school and sports. A quarter of students reported pretending to have a faster recovery in order to return to school or sports. CONCLUSION Private school students who play sports or engage in recreational activity may be at risk of sustaining concussions and may not report their symptoms due to a lack of understanding the seriousness of concussion, not wanting to fall behind in school, or out of desire to continue playing their sport. Teachers, coaches, and parents can stress reporting as the first step in recovery.
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Affiliation(s)
- Dana Waltzman
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention , Atlanta, GA, USA
| | - Jill Daugherty
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention , Atlanta, GA, USA
| | | | - Jason Bouton
- PINK Concussions , Norwalk, CT, USA.,King School , Stamford, CT, USA
| | - David Wang
- Elite Sports Medicine, Connecticut Children's Medical Center , Hartford, CT, USA.,Sports Medicine, Quinnipiac University, Hamden, CT, USA
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3
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Abstract
Sports-related injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and second-impact syndrome (SIS). Students who experience multiple brain injuries within a short period of time (hours, days, or weeks) may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice. The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries.
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Affiliation(s)
- Sarah Cobb
- University of South Florida, Tampa, FL, USA
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4
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Sutton M, Chan V, Escobar M, Mollayeva T, Hu Z, Colantonio A. Neck Injury Comorbidity in Concussion-Related Emergency Department Visits: A Population-Based Study of Sex Differences Across the Life Span. J Womens Health (Larchmt) 2018; 28:473-482. [PMID: 30592685 PMCID: PMC6482894 DOI: 10.1089/jwh.2018.7282] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: The cervical spine region can be especially vulnerable to concurrent injury in concussion, with research suggesting that females may be at greater risk due to their weaker and anatomically distinct necks. The main objective of our research was to study sex differences in the rate of neck injury comorbidity across the life span among patients with a concussion diagnosis in the emergency department (ED) setting, by cause of injury (motor vehicle collisions [MVC] and sports). Materials and Methods: All patients with a first concussion-related ED visit between fiscal years 2002/2003 and 2011/2012 (inclusive) in Ontario were identified in population-based health administrative data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) codes. Age-dependent odds ratios of comorbid neck injury for sex were estimated using polynomial multivariable logistic regression models, adjusting for sociodemographic characteristics. Results: Females with a concussion had significantly higher odds of sustaining a comorbid neck injury between the ages of 5–49 years for all concussion-related ED visits, 15–49 years for MVC-related concussion ED visits, and 10–39 years for sports-related concussion ED visits, holding all other covariates in the model constant. Conclusions: These results support the consideration of increased screening for comorbid neck injuries, particularly for females, to allow for early intervention. Furthermore, the increased risk of comorbid neck injury in females with a concussion-related ED visit was age-dependent, with the interaction between sex and age following a nonlinear trend. As such, future studies on concussions should consider linear and nonlinear sex and age interactions.
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Affiliation(s)
- Mitchell Sutton
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincy Chan
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tatyana Mollayeva
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Zheng Hu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute–University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Canada
- Address correspondence to: Angela Colantonio, PhD, Rehabilitation Sciences Building, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada
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5
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Caravaggi P, Leardini A, Belvedere C, Siegler S. A novel Cervical Spine Protection device for reducing neck injuries in contact sports: design concepts and preliminary in vivo testing. Sports Biomech 2018; 19:382-394. [PMID: 30004295 DOI: 10.1080/14763141.2018.1481222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Head and neck injuries are common in contact sports such as American football. Different mechanisms can produce such injuries, including compressive impact forces on the crown of the helmet with the neck in a flexed chin-down position. The aim of this paper was developing and testing a novel Cervical Spine Protection Device (CSPD) designed to keep the neck within its safe physiological range. The cervical spine range of motion (ROM) of ten participants was measured under four conditions: free; wearing a football gear; wearing the CSPD; and wearing the CSPD underneath the gear. The CSPD was tested in terms of passive and active restraint of head motion, and for its capability to improve endurance time of the neck extensor muscles. Wearing the CSPD resulted in a significant 40-60% reduction in ROM across the three anatomical planes, and in increased endurance of the neck extensor muscles (FREE: 114 ± 57 s; CSPD: 214 ± 95 s; p = 0.004). In quasi-static loading conditions the CSPD was capable of keeping the neck within its physiological range, thus it may be used to decrease the risk of severe injuries due to dangerous chin-down positions.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
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6
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Abstract
Cervical spine trauma in the athlete is not an insignificant occurrence with possibly catastrophic results. Football remains one of the most common and most well studied sporting activities associated with spine injuries. Transient spinal cord and peripheral nerve injuries may manifest as quadriparesis or burners/stingers with symptoms that resolve completely. More severe spinal cord injuries, typically from axial loading on the cervical spine, will cause bilateral symptoms with residual neurological deficit. Acute Trauma Life Support principles must always be applied to the player with a potential spine injury. Recent positional statements by National Athletic Trainers' Association advocate equipment removal on the field by 3 individuals with appropriate training, a shift from previous recommendations. This recommendation is still under debate, but equipment removal in the field is an option depending on staff training. The use of steroids in acute spinal cord injury remains controversial. Moderate systemic hypothermia has theoretical benefits for reducing spinal cord damage in the setting of an acute injury. Although it has been studied in the laboratory, only a few clinical trials have been performed and further research is necessary before routine implementation of hypothermia protocols.
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Nelson LD, Guskiewicz KM, Barr WB, Hammeke TA, Randolph C, Ahn KW, Wang Y, McCrea MA. Age Differences in Recovery After Sport-Related Concussion: A Comparison of High School and Collegiate Athletes. J Athl Train 2016; 51:142-52. [PMID: 26974186 DOI: 10.4085/1062-6050-51.4.04] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Younger age has been hypothesized to be a risk factor for prolonged recovery after sport-related concussion, yet few studies have directly evaluated age differences in acute recovery. OBJECTIVE To compare clinical recovery patterns for high school and collegiate athletes. DESIGN Prospective cohort study. SETTING Large, multicenter prospective sample collected from 1999-2003 in a sports medicine setting. SUBJECTS Concussed athletes (n = 621; 545 males and 76 females) and uninjured controls (n = 150) participating in high school and collegiate contact and collision sports (79% in football, 15.7% in soccer, and the remainder in lacrosse or ice hockey). MAIN OUTCOME MEASURE(S) Participants underwent evaluation of symptoms (Graded Symptom Checklist), cognition (Standardized Assessment of Concussion, paper-and-pencil neuropsychological tests), and postural stability (Balance Error Scoring System). Athletes were evaluated preinjury and followed serially at several time points after concussive injury: immediately, 3 hours postinjury, and at days 1, 2, 3, 5, 7, and 45 or 90 (with neuropsychological measures administered at baseline and 3 postinjury time points). RESULTS Comparisons of concussed high school and collegiate athletes with uninjured controls suggested that high school athletes took 1 to 2 days longer to recover on a cognitive (Standardized Assessment of Concussion) measure. Comparisons with the control group on other measures (symptoms, balance) as well as direct comparisons between concussed high school and collegiate samples revealed no differences in the recovery courses between the high school and collegiate groups on any measure. Group-level recovery occurred at or before 7 days postinjury on all assessment metrics. CONCLUSIONS The findings suggest no clinically significant age differences exist in recovery after sport-related concussion, and therefore, separate injury-management protocols are not needed for high school and collegiate athletes.
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Affiliation(s)
| | | | | | | | | | | | - Yanzhi Wang
- College of Medicine, University of Illinois at Peoria
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9
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Trends in Sports- and Recreation-Related Traumatic Brain Injuries Treated in US Emergency Departments: The National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001-2012. J Head Trauma Rehabil 2016; 30:185-97. [PMID: 25955705 DOI: 10.1097/htr.0000000000000156] [Citation(s) in RCA: 224] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Sports- and recreation-related traumatic brain injuries (SRR-TBIs) are a growing public health problem affecting persons of all ages in the United States. OBJECTIVE To describe the trends of SRR-TBIs treated in US emergency departments (EDs) from 2001 to 2012 and to identify which sports and recreational activities and demographic groups are at higher risk for these injuries. DESIGN Data on initial ED visits for an SRR-TBI from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for 2001-2012 were analyzed. SETTING NEISS-AIP data are drawn from a nationally representative sample of hospital-based EDs. PARTICIPANTS Cases of TBI were identified from approximately 500,000 annual initial visits for all causes and types of injuries treated in EDs captured by NEISS-AIP. MAIN OUTCOME MEASURE(S) Numbers and rates by age group, sex, and year were estimated. Aggregated numbers and percentages by discharge disposition were produced. RESULTS Approximately 3.42 million ED visits for an SRR-TBI occurred during 2001-2012. During this period, the rates of SRR-TBIs treated in US EDs significantly increased in both males and females regardless of age (all Ps < .001). For males, significant increases ranged from a low of 45.8% (ages 5-9) to a high of 139.8% (ages 10-14), and for females, from 25.1% (ages 0-4) to 211.5% (ages 15-19) (all Ps < .001). Every year males had about twice the rates of SRR-TBIs than females. Approximately 70% of all SRR-TBIs were reported among persons aged 0 to 19 years. The largest number of SRR-TBIs among males occurred during bicycling, football, and basketball. Among females, the largest number of SRR-TBIs occurred during bicycling, playground activities, and horseback riding. Approximately 89% of males and 91% of females with an SRR-TBI were treated and released from EDs. CONCLUSION AND RELEVANCE The rates of ED-treated SRR-TBIs increased during 2001-2012, affecting mainly persons aged 0 to 19 years and males in all age groups. Increases began to appear in 2004 for females and 2006 for males. Activities associated with the largest number of TBIs varied by sex and age. Reasons for the reported increases in ED visits are unknown but may be associated with increased awareness of TBI through increased media exposure and from campaigns, such as the Centers for Disease Control and Prevention's Heads Up. Prevention efforts should be targeted by sports and recreational activity, age, and sex.
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10
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Abd-El-Barr MM, Proctor MR. Chiari Malformations and Other Anomalies. HEAD AND NECK INJURIES IN YOUNG ATHLETES 2016:105-118. [DOI: 10.1007/978-3-319-23549-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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11
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Siegler S, Caravaggi P, Tangorra J, Milone M, Namani R, Marchetto PA. The envelope of motion of the cervical spine and its influence on the maximum torque generating capability of the neck muscles. J Biomech 2015; 48:3650-5. [PMID: 26338098 DOI: 10.1016/j.jbiomech.2015.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022]
Abstract
The posture of the head and neck is critical for predicting and assessing the risk of injury during high accelerations, such as those arising during motor accidents or in collision sports. Current knowledge suggests that the head's range-of-motion (ROM) and the torque-generating capability of neck muscles are both dependent and affected by head posture. A deeper understanding of the relationship between head posture, ROM and maximum torque-generating capability of neck muscles may help assess the risk of injury and develop means to reduce such risks. The aim of this study was to use a previously-validated device, known as Neck Flexibility Tester, to quantify the effects of head's posture on the available ROM and torque-generating capability of neck muscles. Ten young asymptomatic volunteers were enrolled in the study. The tri-axial orientation of the subjects' head was controlled via the Neck Flexibility Tester device. The head ROM was measured for each flexed, extended, axially rotated, and laterally bent head's orientation and compared to that in unconstrained neutral posture. Similarly, the torque applied about the three anatomical axes during Isometric Maximum Voluntary Contraction (IMVC) of the neck muscles was measured in six head's postures and compared to that in fully-constrained neutral posture. The further from neutral the neck posture was the larger the decrease in ROM and IMVC. Head extension and combined two-plane rotations postures, such as extension with lateral bending, produced the largest decreases in ROM and IMVC, thus suggesting that these postures pose the highest potential risk for injury.
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Affiliation(s)
- Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - James Tangorra
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Mary Milone
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Ramya Namani
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Paul A Marchetto
- The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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12
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Miyashita TL, Diakogeorgiou E, Hellstrom B, Kuchwara N, Tafoya E, Young L. High School Athletes' Perceptions of Concussion. Orthop J Sports Med 2014; 2:2325967114554549. [PMID: 26535279 PMCID: PMC4555556 DOI: 10.1177/2325967114554549] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The perception high school athletes have regarding concussions may influence their injury-reporting behavior, and if their perceptions are based on incorrect or incomplete information, they may be at risk for subsequent head injuries. PURPOSE To determine whether the recent influx of concussion information has had a positive impact on high school athletes' knowledge of concussions, to determine their perceptions regarding the severity of a concussion injury, and to determine whether receiving correct information will potentially alter their future reporting behavior. STUDY DESIGN Cross-sectional study; Level of evidence, 4. METHODS A total of 454 high school athletes (212 females, 242 males; mean age, 15.7 ± 1.15 years) from 6 different schools participated in an anonymous survey. The researchers met with teams individually at their high schools to collect data and provide an educational intervention regarding sports-related concussions. The survey questions assessed the athletes' personal injury histories and perceptions and knowledge of the severity of concussion injuries. RESULTS There was a difference in the number of athletes who reported having their "bell rung" (n = 297) versus the number of athletes reporting at least 1 concussion (n = 172) (t (453) = -11.60, P = .000, d = -0.54). There was also a difference in the number of athletes who reported a history of at least 1 concussion at the beginning of the study session (n = 172) versus the number of athletes who reported at least 1 concussion at the end of the session (n = 292) (t (453) = -12.018, P = .000, d = 0.732). Fifty percent of athletes also stated that the importance of a game/event should dictate when they return to play. CONCLUSION High school athletes continue to fail to realize when they have sustained a concussion. Additionally, athletes lack understanding regarding the severity and seriousness of a concussion. A better effort at formalized education must be made if the culture of sports is to change. CLINICAL RELEVANCE Allied health care professionals need to continue to put forth a great effort in educating all student athletes on what a concussion is and the dangers of a concussion injury. Preseason meetings should be used as an opportunity to provide formalized education to all student athletes.
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Affiliation(s)
| | | | - Brian Hellstrom
- Metropolitan State University of Denver, Denver, Colorado, USA
| | - Nick Kuchwara
- Metropolitan State University of Denver, Denver, Colorado, USA
| | - Erica Tafoya
- Metropolitan State University of Denver, Denver, Colorado, USA
| | - Lori Young
- Metropolitan State University of Denver, Denver, Colorado, USA
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Nelson LD, Janecek JK, McCrea MA. Acute clinical recovery from sport-related concussion. Neuropsychol Rev 2013; 23:285-99. [PMID: 24248943 DOI: 10.1007/s11065-013-9240-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
Abstract
Concussion is a highly prevalent injury in contact and collision sports that has historically been poorly understood. An influx of sport-concussion research in recent years has led to a dramatic improvement in our understanding of the injury's defining characteristics and natural history of recovery. In this review, we discuss the current state of knowledge regarding the characteristic features of concussion and typical acute course of recovery, with an emphasis on the aspects of functioning most commonly assessed by clinicians and researchers (e.g., symptoms, cognitive deficits, postural stability). While prototypical clinical recovery is becoming better understood, questions remain regarding what factors (e.g., injury severity, demographic variables, history of prior concussions, psychological factors) may explain individual variability in recovery. Although research concerning individual differences in response to concussion is relatively new, and in many cases limited methodologically, we discuss the evidence about several potential moderators of concussion recovery and point out areas for future research. Finally, we describe how increased knowledge about the negative effects of and recovery following concussion has been translated into clinical guidelines for managing concussed athletes.
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Affiliation(s)
- Lindsay D Nelson
- Department of Neurology, Division of Neuropsychology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA,
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14
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Abstract
Hockey is one of the most popular sports for Canadian children and youth. While the health benefits of physical activity and sport participation are well recognized, there is increasing concern around the frequency and severity of hockey-related injuries, particularly concussion. Studies consistently identify bodychecking as the primary mechanism associated with youth hockey injuries, including concussion. Policy to delay bodychecking until bantam league play (when participants are 13 to 14 years of age) will reduce the risks of injury and concussion in young ice hockey players. Bodychecking should be eliminated from non-elite youth ice hockey. The age at which bodychecking is introduced in competitive hockey leagues must be reconsidered. Both initiatives require policy change in many provinces/territories, and must be re-evaluated prospectively in light of emerging research.
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Abstract
Spinal cord injuries are uncommon in sports. Planning and practice for their occurrence, however, remains an essential component of Sideline Medical Team preparedness. Evaluation of cervical nerve injury, cervical cord injury, and cervical disc disease can be complex. Medical management, diagnostic imaging techniques and surgical recommendations in this setting continue to evolve. Most published guidance offers occasionally opposed expert opinion with sport participation after Cervical Cord Neuropraxia in the setting of Cervical Spinal Stenosis appearing particularly polarizing. Such conflicts can present challenges to clinicians in forming management and Return to Play decisions for the health of their athletes.
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16
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Abstract
Closed head injuries vary from the very minor to the catastrophic. It is often difficult to differentiate the severity at initial presentation. Serial assessment is very valuable. Awareness of facial injuries is aided by familiarity with facial bone anatomy and the clinical presentation of orbital, zygomatic, maxillary, and mandibular fracture. Functional injury such as concussion may coexist with other injuries. This article will discuss closed head trauma and outline specific injuries to the face, brain, skull, and its surroundings.
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Affiliation(s)
- Hamish A Kerr
- Primary Care Sports Medicine Fellowship, Division Internal Medicine/Pediatrics, Albany Medical College, Latham, NY 12110, USA.
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17
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Houghton KM, Emery CA. La mise en échec chez les jeunes hockeyeurs. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.9.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Many types of spinal abnormalities can have an impact on an athlete’s ability to participate in sports. One of the challenges in the current era is distinguishing the clinically relevant lesions from the incidental. Almost without exception, a Chiarimal formation, significant syringomyelia or other cyst compressing the spinal cord or nerve roots, tethered spinal cord, or spinal tumor should prompt referral to a neurosurgeon. However, tonsillar ectopia (descent of the cerebellum less than 5 mm beyond the foramen magnum) and small dilatations of the central canal, are very commonly seen and appear to represent normal anatomic variants that place athletes at no increased risk of spinal injury, and should not be considered a contraindication to play. The recommendations made in this article are largely based on consensus and experience, but as we gain more clinical experience to correlate with the increasingly sophisticated imaging findings, we hope that these recommendations can be refined further.
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Affiliation(s)
- Mark R Proctor
- Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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Petschauer MA, Schmitz R, Gill DL. Helmet fit and cervical spine motion in collegiate men's lacrosse athletes secured to a spine board. J Athl Train 2011; 45:215-21. [PMID: 20446833 DOI: 10.4085/1062-6050-45.3.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Proper management of cervical spine injuries in men's lacrosse players depends in part upon the ability of the helmet to immobilize the head. OBJECTIVE To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete. DESIGN Crossover study. SETTING Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS Eighteen healthy collegiate men's lacrosse players. INTERVENTION(S) Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions. MAIN OUTCOME MEASURE(S) Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet). RESULTS Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the no-helmet condition (P < .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P < .0001). CONCLUSIONS Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.
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Abstract
Acute spinal injuries are fortunately rare in pediatric sports but can be catastrophic. Imaging is integral to the diagnosis and care of spinal trauma. Plain radiographs and CT are critical for detecting vertebral fracture, and MR imaging is an essential adjunct for evaluating muscular, ligamentous, and spinal cord injury. Back pain is a common complaint among athletes of all ages. The growing spine has unique weaknesses that result in a higher rate of detectable radiologic abnormalities. Disk pathology is less common in children, and is often uniquely associated with fracture of the ring apophyses. Spondylolysis is far more prevalent in youth athletes than in their adult counterparts, requiring a different approach to imaging for assessment of adolescent back pain.
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Affiliation(s)
- Bradley A Maxfield
- Section of Pediatric Radiology, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Clinical Science Center MC 3552, 600 Highland Avenue, Madison, WI 53792-3252, USA.
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21
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Abstract
Head injury occurs frequently in childhood and results in approximately 500,000 emergency department visits and over $1 billion in costs annually. Nearly 75% of these children are ultimately diagnosed with mild traumatic brain injury (MTBI), a misnomer because many will have radiographically identified intracranial injuries and long-term consequences. Identification of the brain at risk and prevention of secondary injury is associated with the largest reduction in head trauma morbidity and mortality. This article reviews the current literature to discuss the initial evaluation, management, and long-term outcomes in children sustaining MTBI.
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Affiliation(s)
- Nicholas A Hamilton
- Saint Louis Children’s Hospital, One Children’s Place, St. Louis, MO 63110, USA
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22
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Abstract
A 17-year-old male soccer player presented with numbness in the upper- and lower-left extremities of 6 months' duration. He had no apparent history of trauma but experienced neck pain during heading of the ball 5 years prior. A high-signal intensity area was seen on T2-weighted magnetic resonance imaging (MRI) of the cervical spine. No muscle weakness was observed. Hypoesthesia was observed in bilateral forearms, hands, and extremities below the inguinal region. Plain radiographs in the neutral position showed local kyphosis at C3/4. A small protrusion of the C3/4 disk was observed on T1-weighted MRI. A high-signal area in the spinal cord at the C3/4 level was observed on T2-weighted MRI, but this was not enhanced by gadolinium. Multiple sclerosis, intramedullary spinal cord tumor, sarcoidosis and malignant lymphoma, and spinal cord injury were all considered in the differential diagnosis. However, in view of the clinical, laboratory, and radiological investigations, we concluded that repeated impacts to the neck caused by heading of the ball during soccer induced a chronic, minor spinal cord injury. This contributed to the high-signal intensity change of the spinal cord in T2-weighted MRI. The present case demonstrates that repeated impact may cause chronic spinal cord injury. Soccer, American football, or rugby players presenting with neck or extremity symptoms should not be overlooked for the possibility of latent spinal cord injury, as this could present later development of more severe or unrecoverable spinal cord injuries.
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Affiliation(s)
- Yoshihiko Kato
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
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23
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Shields BJ, Fernandez SA, Smith GA. Epidemiology of cheerleading stunt-related injuries in the United States. J Athl Train 2010; 44:586-94. [PMID: 19911084 DOI: 10.4085/1062-6050-44.6.586] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Cheerleading-related injuries are on the rise. To date, no epidemiologic studies of cheerleading stunt-related injuries have been published. OBJECTIVE To describe and compare cheerleading stunt-related injuries by type of cheerleading team (All Star, college, high school, middle school, or recreation league) and event (practice, pep rally, athletic event, or cheerleading competition). DESIGN Prospective injury surveillance study. SETTING Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) surveillance tool. PATIENTS OR OTHER PARTICIPANTS Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. MAIN OUTCOME MEASURE(S) The numbers, types, and rates of cheerleading stunt-related injuries during a 1-year period (2006-2007) are reported. RESULTS Stunt-related injuries accounted for 60% (338/567) of the injuries sustained by US cheerleaders who participated in the study and 96% (22/23) of the concussions and closed head injuries (CHIs) reported during the study. Collegiate cheerleaders were more likely to sustain a concussion or CHI than were cheerleaders on other types of teams (P = .02, odds ratio = 3.10, 95% confidence interval = 1.20, 8.06). Most injuries occurred while the cheerleader was spotting or basing another cheerleader (34%, 115/338), and these injuries comprised 32% (51/161) of all stunt-related strains and sprains. Four cheerleaders (1.2%, 4/335) were admitted to the hospital, and 9 cheerleaders (2.7%, 9/335) required surgery. CONCLUSIONS Cheerleading stunts pose an increased risk for injury, especially in terms of sustaining a concussion or CHI. Spotters and bases were most likely to be injured during the performance of cheerleading stunts and were at risk for sustaining strain and sprain injuries. The ankle, lower back, and wrist were the sites most likely to be reinjured while performing cheerleading stunts.
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Affiliation(s)
- Brenda J Shields
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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24
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Shields BJ, Smith GA. Cheerleading-related injuries in the United States: a prospective surveillance study. J Athl Train 2010; 44:567-77. [PMID: 19911082 DOI: 10.4085/1062-6050-44.6.567] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Cheerleading injuries are on the rise and are a significant source of injury to females. No published studies have described the epidemiology of cheerleading injuries by type of cheerleading team and event. OBJECTIVE To describe the epidemiology of cheerleading injuries and to calculate injury rates by type of cheerleading team and event. DESIGN Prospective injury surveillance study. SETTING Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) online surveillance tool. PATIENTS OR OTHER PARTICIPANTS Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. MAIN OUTCOME MEASURE(S) The numbers and rates of cheerleading injuries during a 1-year period (2006-2007) are reported by team type and event type. RESULTS A cohort of 9022 cheerleaders on 412 US cheerleading teams participated in the study. During the 1-year period, 567 cheerleading injuries were reported; 83% (467/565) occurred during practice, 52% (296/565) occurred while the cheerleader was attempting a stunt, and 24% (132/563) occurred while the cheerleader was basing or spotting 1 or more cheerleaders. Lower extremity injuries (30%, 168/565) and strains and sprains (53%, 302/565) were most common. Collegiate cheerleaders were more likely to sustain a concussion (P = .01, rate ratio [RR] = 2.98, 95% confidence interval [CI] = 1.34, 6.59), and All Star cheerleaders were more likely to sustain a fracture or dislocation (P = .01, RR = 1.76, 95% CI = 1.16, 2.66) than were cheerleaders on other types of teams. Overall injury rates for practices, pep rallies, athletic events, and cheerleading competitions were 1.0, 0.6, 0.6, and 1.4 injuries per 1000 athlete-exposures, respectively. CONCLUSIONS We are the first to report cheerleading injury rates based on actual exposure data by type of team and event. These injury rates are lower than those reported for other high school and collegiate sports; however, many cheerleading injuries are preventable.
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Affiliation(s)
- Brenda J Shields
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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25
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Singh GD, Maher GJ, Padilla RR. Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study. Dent Traumatol 2009; 25:515-21. [PMID: 19614931 DOI: 10.1111/j.1600-9657.2009.00808.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM It is accepted that sports mouthguards decrease the incidence of dental injuries in athletes, but the value of oral orthotics in the prevention of concussion/mild traumatic brain injuries in footballers remains contentious. However, previous investigations have primarily studied non-customized mouthguards without dental/temporo-mandibular joint examinations of the subjects. Therefore, the aim of this study is to determine whether the use of a customized mandibular orthotic after temporo-mandibular joint assessment reduces the incidence of concussion/mild traumatic brain injuries in high-school football players. MATERIALS AND METHODS Using a longitudinal, retrospective design, data were collected from a cohort of football players (n = 28) over three seasons using a questionnaire. The mean age of the sample prior to the use of the customized mandibular orthotic was 17.3 years +/- 1.9. Prior to deployment, dental records and temporo-mandibular joint evaluations were undertaken, as well as neurocognitive assessment, including history of concussion/mild traumatic brain injuries. After establishing optimal jaw position, a customized mandibular orthotic was fabricated to the new spatial relations. RESULTS The mean age of the sample after three seasons was 19.7 years +/- 2.0. Prior to the use of the customized mandibular orthotic, the mean self-reported incidence of concussion/mild traumatic brain injuries was 2.1 +/- 1.4 concussive events. After the deployment of the customized mandibular orthotic the number of concussive events fell to 0.11 +/- 0.3 with an odds ratio of 38.33 (95% CI 8.2-178.6), P < 0.05. CONCLUSION The preliminary results of this study suggest that a customized mandibular orthotic may decrease the incidence of concussion/mild traumatic brain injuries in high- school football athletes, but a comprehensive study is required to confirm these initial findings. Furthermore, additional research is necessary to indicate the possible mode(s) of action of a customized mandibular orthotic in the prevention of concussion/mild traumatic brain injuries.
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Affiliation(s)
- G Dave Singh
- Director of Continuing Education, SMILE Foundation, Chatsworth, CA 91311, USA.
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26
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Abstract
We administered neurocognitive batteries to 49 youth soccer athletes (9–15 yr), who were selected from competitive soccer teams in Central Florida. We collected observational data on soccer heading, self-reported soccer heading, as well as demographics, including school, medical, and soccer history. Both the frequency and intensity of heading the ball in soccer was low in comparison with adolescents and adults. In our sample, the vast majority of soccer headings were of low to moderate intensity and direct (i.e., the incoming flight of the ball was perpendicular to the forehead). Age significantly correlated with frequent heading. Parents were reliable observers of their children’s soccer heading behavior and other at-risk behaviors during games. The majority of soccer headings were direct rather than flicks. Almost half of our participants reported headache and one-fourth reported dizziness after instances of heading the ball. Frequency of soccer heading was not related to neuropsychological score data.
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27
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Byard RW, Vink R. The second impact syndrome. Forensic Sci Med Pathol 2009; 5:36-8. [DOI: 10.1007/s12024-008-9063-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 09/26/2008] [Indexed: 11/28/2022]
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28
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Finnoff JT, Peterson VJ, Hollman JH, Smith J. Intrarater and Interrater Reliability of the Balance Error Scoring System (BESS). PM R 2008; 1:50-4. [PMID: 19627872 DOI: 10.1016/j.pmrj.2008.06.002] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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29
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Olivier PE, Du Toit DE. Isokinetic neck strength profile of senior elite rugby union players. J Sci Med Sport 2008; 11:96-105. [PMID: 17560830 DOI: 10.1016/j.jsams.2007.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 12/24/2006] [Accepted: 01/09/2007] [Indexed: 11/29/2022]
Abstract
To delineate and compare the isokinetic neck strength profile of senior elite rugby players. One hundred and eighty-nine rugby players (mean; 95% confidence intervals: 24.31; 23.87-24.75 years) were sampled from South African provincial teams and assessed anthropometrically and isokinetically according to a set protocol. Specially designed equipment was used to perform the isokinetic assessment and gathered data were analysed according to positional categories (front, second, back row and backline players). Second row forwards performed the best in the measure of peak flexion (44.04; 40.41-47.67Nm) and lateral flexion right (69.42; 63.36-75.48Nm) and left (66.31; 61.21-71.41Nm) torque, while the front row forwards performed best in peak extension torque (65.60; 62.12-69.08Nm). Few significant differences (p<0.05) existed between the forward positional categories. However, they all proved to be significantly (p<0.05) stronger and more powerful than the backline players. Peak torque values relative to body weight indicated much less variability between all positional categories. Cervical flexor to extensor ratios showed that front row forwards (65; 61.94-68.06%) had significantly (p<0.05) lower ratios than the other positional categories. Absolute peak torque is an important positional prerequisite, especially among the front row forwards. Isokinetic neck strength data presented here provides a benchmark for the effective and quantified comparison of neck strength variables, assisting with preparticipation screening and the effective rehabilitation of injured senior rugby union players.
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Affiliation(s)
- Pierre E Olivier
- Nelson Mandela Metropolitan University, Department of Human Movement Science, South Africa.
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30
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Affiliation(s)
- Laura Purcell
- Division of Emergency Medicine, University of Western Ontario, London, ON.
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31
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Abstract
PURPOSE OF REVIEW The purpose of this review is to present an overview of sport-related concussion in the young athlete and review recent publications of clinical and scientific importance. RECENT FINDINGS Recent findings show that young athletes are more susceptible to concussions than older athletes and more likely to develop second impact syndrome, as well as long-term negative cumulative consequences. Further, ongoing research suggests a more prolonged disturbance of brain function following a concussion than previously believed. SUMMARY Given the increased vulnerability of the young athlete, current research suggests conservative management of concussion and return-to-play decisions. A decision tree diagram to assist the practitioner in making return-to-play recommendations for the young athlete is included in this review.
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Affiliation(s)
- Sergio R Russo Buzzini
- Department of Pediatrics and Orthopaedic Surgery, Division of Adolescent Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
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32
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Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics 2006; 117:1359-71. [PMID: 16585334 DOI: 10.1542/peds.2005-0994] [Citation(s) in RCA: 234] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Athletic concussion is a growing focus of attention for pediatricians. Although numerous literature reviews and clinical guidelines are now available pertaining to athletic concussion, few have focused on the pediatric athlete in particular. Sport-related concussions occur relatively frequently in children and adolescents, and primary health care providers are often responsible for coordinating clinical management. Here we summarize the scientific literature pertinent to the care of young athletes. We examine how concussion affects younger and older athletes differently at biomechanical, pathophysiological, neurobehavioral, and contextual levels. We also discuss important issues in clinical management, including preparticipation assessment, concussion evaluation and recovery tracking, and when and how to return pediatric athletes to play sports. We also briefly cover non-sport-related interventions (eg, school support). With proper management, most children and adolescents sustaining a sport-related concussion can be expected to recover fully.
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Affiliation(s)
- Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, Children's Hospital, Denver, Colorado, USA.
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33
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Mulder K, Cassis F, Seuser DRA, Narayan P, Dalzell R, Poulsen W. Risks and benefits of sports and fitness activities for people with haemophilia. Haemophilia 2004; 10 Suppl 4:161-3. [PMID: 15479391 DOI: 10.1111/j.1365-2516.2004.01000.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Physical activity is a key component of a healthy lifestyle. Exercise and physical activity have been shown to help maintain a healthy body weight, reduce stress, increase self-esteem and feelings of wellbeing, control blood pressure, and prevent heart disease and diabetes. Children with haemophilia may feel restricted from competing in sports through parental concern or pain and difficulty in moving, or they may rebel against such restrictions, thus leaving themselves open to serious injury. Several groups have attempted to classify sports activities with regard to the level of risk involved; however, these are not consistent. It is important to match the child's abilities with the sport in which they want to take part, and suggest alternatives if this is not possible. Prevention of injury should not depend solely on use of factor concentrates.
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Affiliation(s)
- K Mulder
- Children's Hospital, Winnipeg Canada.
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34
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Affiliation(s)
- Andrea Stracciolini
- Division of Emergency Medicine & Division of Sports Medicine, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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35
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Asthagiri AR, Dumont AS, Sheehan JM. Acute and long-term management of sports-related closed head injuries. Clin Sports Med 2003; 22:559-76. [PMID: 12852686 DOI: 10.1016/s0278-5919(02)00111-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aggressive participation in athletics is rewarded in many ways in our society. As long as there is such strong impetus for participation in athletics, the risks of head injuries for participants will remain. Important strides made in understanding of the pathophysiology of head injuries may lead to improved treatment strategies in the future. In light of the current lack of effective therapies, however, the best options remain injury prevention, early and appropriate recognition, and limitation of subsequent, further injury. Frequently the medical staff is encouraged to allow the athlete to return to play based on the desires of the coach, team, fans, parents, and even the athlete himself. A thorough understanding of the potentially serious risks of repetitive injury, however, mandates that only a proper conservative period of observation and evaluation will best serve the competitor.
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Affiliation(s)
- Ashok R Asthagiri
- Department of Neurological Surgery, University of Virginia School of Medicine, Box 212, Charlottesville, VA 22908, USA
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36
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Abstract
In this article, we review the available data on sporting injuries to the head and neck and discuss sport-specific injury risk and prevention strategies, as well as the costs of head and neck injuries.
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Affiliation(s)
- Minton Truitt Cooper
- University of Virginia School of Medicine, P.O. Box 800739, Charlottesville, VA 22908-0739, USA
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37
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Weinberg J, Rokito S, Silber JS. Etiology, treatment, and prevention of athletic "stingers". Clin Sports Med 2003; 22:493-500, viii. [PMID: 12852682 DOI: 10.1016/s0278-5919(02)00057-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Stingers or burners are common in athletes, especially football players. They represent a traction, compression, or direct blow to the upper roots of the brachial plexus. They are usually transient and resolve quickly. Cervical canal stenosis with concurrent degenerative disc disease may predispose an athlete to this injury. Return-to-play criteria are largely based on the number of previous episodes and the duration of symptoms. These criteria also require appropriate consideration of any underlying pathological conditions. Appropriate counseling, including modification of tackling and addition of protective gear, in conjunction with complete rehabilitation, may be effective in preventing this condition or decreasing the rate of recurrence. The athlete, family, and coaches need to understand that recurrence remains unpredictable.
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Affiliation(s)
- Jacob Weinberg
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, 70-05 76th Avenue, Room 250, New Hyde Park, NY 11040, USA
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38
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Abstract
The continued development of the sport environment as a laboratory for clinical investigation of mild head injury has greatly advanced the use of neuropsychological assessment in evaluating brain-injured athletes, and tracking their symptoms and recovery in an objective manner. The use of neurocognitive baseline measures has become critical in determining whether a brain-injured athlete has recovered function sufficiently to return to play. The rapid growth of computerized and web-based neurocognitive assessment measures provides an efficient, valid technology to put such testing within the reach of most institutions and organizations that field sport teams. Moreover, the knowledge of the recovery curve following mild head injury in the sport environment can be generalized to the management of MTBI in general clinical environments where baseline measures are unlikely. What we know today is that sideline assessments of severity are not predictive of which athletes will show the most typical 5- to 10-day recovery period and which will report persistent PCS complaints and exhibit impaired neurocognitive performance for an extended time. The research on mechanisms of brain injury in MTBI suggests that unpredictable, diffuse white-matter damage may control much of the variability in functional impairments and recovery duration.
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Affiliation(s)
- Frank M Webbe
- School of Psychology, Florida Institute of Technology, Melbourne, FL 32901, USA
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39
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Ghiselli G, Schaadt G, McAllister DR. On-the-field evaluation of an athlete with a head or neck injury. Clin Sports Med 2003; 22:445-65. [PMID: 12852679 DOI: 10.1016/s0278-5919(02)00109-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Head and cervical spine sports-related injuries are intimately associated. The on-field evaluation and management of the athlete with these injuries is of paramount importance to stabilize the athlete and prevent further injury. Clinicians need to be aware of the differential diagnoses and consider each possibility based on the mechanism of injury. Although recognition of head and cervical spine injuries has resulted in significant reductions of catastrophic neurological injuries, especially in the cervical spine, further advances to decrease the incidence and long-term sequelae of head and neck injuries are needed. The first step is education of the athlete and the individuals involved in the care of that athlete.
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Affiliation(s)
- Gary Ghiselli
- Department of Orthopaedic Surgery, UCLA School of Medicine, Box 956902, Los Angeles, CA 90095, USA
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40
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Bowen AP. Second impact syndrome: a rare, catastrophic, preventable complication of concussion in young athletes. J Emerg Nurs 2003; 29:287-9. [PMID: 12776088 DOI: 10.1067/men.2003.90] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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41
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Tuggy ML, Breuner CC. Athletic Injuries. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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SHARP DAVIDS, ROSS JONATHANH, KAY ROBERT. Attitudes Of Pediatric Urologists Regarding Sports Participation By Children With A Solitary Kidney. J Urol 2002. [DOI: 10.1097/00005392-200210020-00038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Abstract
The high school sports of wrestling, gymnastics, ice hockey, baseball, track, and cheerleading should receive closer attention to prevent injury. Safer equipment and sport-specific conditioning should be provided and injuries strictly monitored. Greater attention must also be paid to swimming and diving techniques, and continued observation is needed for heat stroke and heat intolerance in sports such as football, wrestling, basketball, track and field, and cross-country. An increased awareness of commotio cordis in sports other than baseball should include ice hockey, football, track field events, and lacrosse. American football because of the sheer numbers and associated catastrophic injury potential must continue to be monitored at the highest medical levels!
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Affiliation(s)
- Eugene F Luckstead
- Pediatric Medicine Department, Texas Tech Medical School-Amarillo, 1400 Coulter Drive, Amarillo, TX 79160, USA.
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