Dustin Nabhan

Development of the 2012 American Chiropractic Board of Sports Physicians position statement on concussion in athletics

OBJECTIVE The purpose of this article is to provide a summary of the development of the American Chiropractic Board of Sports Physicians (ACBSP) Position Statement on Concussion in Athletics regarding the management of concussion in sport and to offer suggestions to qualifying doctors of chiropractic (DCs) to make return-to-play decisions and clarify common concepts pertaining to evaluating and managing concussion in sport. METHODS A literature review of position statements from sports medicine organizations was performed. The authors reviewed each statement for content. Key issues in the management of concussion in sport were identified with special consideration to concussion management by DCs. A position statement on the management of concussion in sport was drafted by the authors and submitted to the Board of Directors of the ACBSP for review. The Board of Directors called for minor revision; and after all revisions were made, the document was resubmitted. The Board of Directors of the ACBSP accepted the document for publication and presentation. The document was presented and disseminated to certificants by the ACBSP at the 2011 Chiropractic Sports Sciences Symposium. RESULTS The 2012 ACBSP Position Statement on Concussion in Athletics was accepted by the ACBSP Board of Directors. CONCLUSION The Position Statement on Concussion in Athletics has been accepted by the ACBSP. This document offers guidance on the management of concussion in sport and provides qualifying DCs information to make return-to-play decisions.

Chiropractic and concussion in sport: A narrative review of the literature

OBJECTIVE Concussion is a common sporting injury that may be seen by doctors of chiropractic and should be managed following current practice guidelines. The purpose of this abstract is to present a literature review on chiropractic management of concussion in sport and to discuss current guidelines. METHODS A review of the literature was performed using the PubMed search engine. MeSH terms included chiropractic and concussion. Search dates were the beginning of the record through July 30, 2013. All languages and article types were included in the search. Articles found were retrieved and evaluated for the relevance of chiropractic management of concussion in sport. RESULTS Five articles were found (1 prospective study, 1 survey, 3 literature reviews) ranging in publication years from 1993 to 2012. No articles reported a position statement, and none provided a review of current concussion management practices related to chiropractic practice. No articles reported adverse outcomes of chiropractic management of an athlete with concussion. CONCLUSION Research related to the chiropractic management of concussion in sport is a nascent area of investigation. Although there are few published articles, the articles in this review showed that doctors of chiropractic encounter concussed athletes at events and in clinical practice. It is essential for doctors of chiropractic to understand the importance of using standardized concussion assessment tools and current concussion guidelines.

Sports injury and illness epidemiology during the 2014 Youth Olympic Games: United States Olympic Team Surveillance

Background To describe injury and illness incidence from the US Youth Olympic Team during the 2014 Youth Olympic Games (YOG). Methods Electronic health records of Team USA athletes registered for the YOG were reviewed for patient encounters during the 2014 YOG. Medical encounters were defined as all medical services provided by a healthcare provider including evaluation, treatment and prophylactic services. All medical conditions were categorised by IOC Injury and Illness reporting criteria. Results Team USA was comprised of 48 male and 46 female athletes, aged of 14–18 years, representing 20 sports. There were 346 total medical encounters among 54 of the 94 registered athletes for a rate of 3.7 medical encounters per athlete. A total of 40 injuries were recorded (14 time loss injuries, 26 non-time loss) and 20 illnesses. This equates to 43% of athletes sustaining an injury, and 21% sustaining an illness, with a frequency of 426 injuries and 213 illnesses per 1000 registered athletes. The most commonly involved body regions for time loss injuries were the knee (21%) and ankle (12%). Time loss injuries most frequently occurred in competition (71%) and the most common type of injury was a ligament sprain (43%). The most common illnesses were respiratory (35%) and dermatological conditions (30%). Conclusions The rates of injury, illness and medical encounters per athlete were greater than in previous reports of medical service provisions at youth Olympic-level sporting events.

Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification

OBJECTIVE The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. METHODS A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. RESULTS Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). CONCLUSION This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.

Advanced Treatment Monitoring for Olympic-Level Athletes Using Unsupervised Modeling Techniques

CONTEXT Analysis of injury and illness data collected at large international competitions provides the US Olympic Committee and the national governing bodies for each sport with information to best prepare for future competitions. Research in which authors have evaluated medical contacts to provide the expected level of medical care and sports medicine services at international competitions is limited. OBJECTIVE To analyze the medical-contact data for athletes, staff, and coaches who participated in the 2011 Pan American Games in Guadalajara, Mexico, using unsupervised modeling techniques to identify underlying treatment patterns. DESIGN Descriptive epidemiology study. SETTING Pan American Games. PATIENTS OR OTHER PARTICIPANTS A total of 618 U.S. athletes (337 males, 281 females) participated in the 2011 Pan American Games. MAIN OUTCOME MEASURE(S) Medical data were recorded from the injury-evaluation and injury-treatment forms used by clinicians assigned to the central US Olympic Committee Sport Medicine Clinic and satellite locations during the operational 17-day period of the 2011 Pan American Games. We used principal components analysis and agglomerative clustering algorithms to identify and define grouped modalities. Lift statistics were calculated for within-cluster subgroups. RESULTS Principal component analyses identified 3 components, accounting for 72.3% of the variability in datasets. Plots of the principal components showed that individual contacts focused on 4 treatment clusters: massage, paired manipulation and mobilization, soft tissue therapy, and general medical. CONCLUSIONS Unsupervised modeling techniques were useful for visualizing complex treatment data and provided insights for improved treatment modeling in athletes. Given its ability to detect clinically relevant treatment pairings in large datasets, unsupervised modeling should be considered a feasible option for future analyses of medical-contact data from international competitions.

Subspine Hip Impingement: An Unusual Cause of Hip Pain in an Elite Weightlifter.

Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury.

Laboratory tests ordered by a chiropractic sports physician on elite athletes over a 1-year period

OBJECTIVE The purpose of this study is to describe and discuss laboratory tests ordered on elite athletes in an interdisciplinary sports medicine clinic by a doctor of chiropractic over 1 calendar year. METHODS A retrospective review of laboratory tests ordered during routine clinical practice as standard screening and diagnostic tests from November 1, 2009, to November 1, 2010 was performed. Data were collected during clinical encounters at one sports medicine clinic and entered into a database for analysis. Descriptive and frequency statistics were used to describe the tests ordered and the frequency of abnormal findings. RESULTS Five hundred and thirty-nine studies were ordered for diagnostic and routine screenings on 137 athlete patients (86 males, 51 females), representing 49 types of tests. Sample sources included blood, urine, skin lesions, and fecal matter. The most commonly ordered tests were complete blood count, comprehensive metabolic panel, serum ferritin, creatine kinase, serum iron and total iron binding capacity, total cortisol, thyroid stimulating hormone, and lipid panels. There were 217 studies (40%) flagged as abnormal by the reporting laboratory. CONCLUSION This report provides greater insight into the diverse array of laboratory studies ordered over a 1-year period for diagnosis and screening of elite athletes. A high percentage of the results were flagged as abnormal by the laboratory. These findings show that the unique physiology of the elite athlete must be considered when interpreting laboratory findings in this population.

Organization and multidisciplinary work in an olympic high performance centers in USA

Resumen The organization and methodology of providing services to athletes through Olympic high performance centers varies among the National Olympic Committees (NOC). Between NOCs, provider composition and methodology for the delivery of services differs. Services provided typically include sports medicine and sports performance. NOCs may provide service through a university-based system or high performance centers. The United States Olympic Committee (USOC) provides services using multiple approaches through a hybrid model that includes three Olympic Training Centers, National Governing Bodies (NGB) high performance centers and independent specialty care centers. Some highly developed National Governing Bodies have dedicated high performance training centers that serve only their sport. The model of sports medicine and sports performance programming utilized by the USOC Olympic Training Centers is described in this manuscript.

Organización y trabajo multidisciplinario en un centro olímpico de alto rendimiento en los estados unidos

Resumen La organizacion y metodologia para proporcionar servicios a atletas a traves de centros olimpicos de alto rendimiento varia entre los Comites Olimpicos Nacionales (NOC, por su sigla en ingles). Entre los NOCs hay diferencias en la composicion y metodologia de la entrega de servicios. Entre los servicios que se entregan habitualmente, estan la medicina del deporte y el rendimiento en los deportes. Los NOCs pueden proporcionar servicios a traves de un sistema centralizado en las universidades o en los centros de alto rendimiento. El Comite Olimpico de los Estados Unidos (USOC, por su sigla en ingles) proporciona servicios valiendose de multiples metodos a traves de un modelo hibrido que incluye tres Centros de Entrenamiento Olimpico, Entidades de Gobernacion Nacional (NGB, por su sigla en ingles), centros de alto rendimiento y centros de cuidado independientes de diversas especialidades. Algunas Entidades de Gobernacion Nacional muy desarrolladas han hecho que ciertos centros de alto rendimiento se dediquen solo al deporte elegido por ellos. En este manuscrito se describe la programacion del modelo de medicina del deporte y de rendimientos del deporte utilizada por los Centros de Entrenamiento Olimpico del USOC.

Defining the elite: normative values for scat major components in healthy elite athletes

Objective Describe normative baseline SCAT 2 and 3 (SCAT) performance in elite athletes. Design Retrospective cohort. Setting United States Olympic Committee Sports Medicine Clinics. Participants Six hundred and forty-one SCAT baseline evaluations were performed on a population of 565 elite athletes (291 women and 350 men, mean age 24.9±5.2 years) representing 23 Summer and Winter Olympic sports as part of a multimodal concussion management program. Intervention No intervention was applied. The SCAT evaluations were administered as a component of baseline testing on healthy athletes. Main Outcome Measurements Baseline SCAT performance on major components is described. T-tests were used to compare differences in baseline performance by sex. Results During baseline evaluation elite athletes reported a mean of 2.1 (1.8–2.4) symptoms with average symptom severity scores of 3.4 (3.0–3.9). Mean scores on SCAT 3 components in this population were; orientation 4.9 (4.8–4.9), immediate memory 14.5 (14.4–14.5), concentration 3.9 (3.8–4.0), tandem gait 11.7 (11.4–12.0), delayed recall 3.7 (3.6–3.8), balance 2.83 (2.2–3.4), SAC total 26.9 (26.8–27.1). This population reported historys of 1.19 (1.0–1.4) previous concussions. Females reported significantly more symptoms (3.9 vs 3.0, P=0.04), and scored significantly higher on the orientation (4.9 vs. 4.8, P=0.004), immediate memory (14.6 vs. 14.4, P=0.003), concentration (4.1 vs 3.8, P=0.0013) SAC total score (27.3 vs. 26.6, P<0.01) Conclusions Population specific normative values for baseline SCAT performance in a population of elite athletes are presented in this case series. Clinical relevance Clinicians are encouraged to reference population specific normative values when interpreting SCAT performance. Acknowledgements None. Competing interests None.