James D. Carson

SPINAL INJURIES IN ICE HOCKEY

SportSmart Canada maintains a registry of spinal injuries in hockey and has documented 214 cases of fracture or dislocation of the spine, occurring mainly in North America since 1966. The current annual incidence is approximately 15 cases per year and may be declining as a result of intense prevention programs. Most of the injuries have been to the cervical spine in players 16 to 20 years of age playing supervised games. Checking from behind causing impact of the head against boards has been an important cause of injury, especially for those injuries resulting in neurological deficit.

New spinal injuries in hockey

ObjectivesIn this study, we wished to examine the nature and incidence of major spinal injuries sustained by ice hockey players and to add reported cases to a permanent registry. DesignThe study was a retrospective review of questionnaires returned by physicians reporting spinal injuries due to ice hockey. SettingCanada primarily, with reported cases from other nations. PatientsTwo hundred forty-one cases of fracture or dislocation of the spine have been reported. Main Outcome MeasuresThe registry includes annual incidence and mortality incidence as well as documentation of sex, age, mechanism of injury, vertebral level of injury, neurologic deficit, type of event, and type of fracture for most cases. ResultsBetween 1982 and 1993, an average of 16.8 ice hockey related major spinal injuries were reported each year. Many of these injuries occurred to the cervical spine of players aged 16–20 years who were playing in supervised games. ConclusionsPrevention programs are beginning to become effective in decreasing the number of severe injuries and the number of injuries caused by a check from behind, although there has not been a significant decrease in the total number of injuries reported annually.

Sport-Related Concussion in Pediatric Athletes

define concussion as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” 2,3 Features used in defining concussion include: (1) trauma including a direct blow to the head, neck or face, or a blow to another part of the body which transmits an impulsive force to the head ; (2) rapid onset of short-lived neurological impairment which spontaneously resolves; (3) acute clinical symptoms of concussion reflecting a functional injury rather than a structural abnormality; (4) a graded set of clinical syndromes, which may or may not involve loss of consciousness and which resolve in a sequential course; and (5) typically normal structural neuroimaging. The majority of concussions do not result in a loss of consciousness or cause only a transient loss of consciousness (less than a minute).

Spinal injuries in Canadian ice hockey: documentation of injuries sustained from 1943-1999.

OBJECTIVES Study objectives were: (a) to examine the causes and incidence of major spinal cord injuries sustained by ice hockey players; and (b) to add recently reported Canadian cases to the Canadian Ice Hockey Spinal Injury Registry to determine the effectiveness of prevention efforts. METHODS The study was a review of questionnaires returned retrospectively by physicians and other sources reporting ice hockey related spinal injuries in Canada. Physicians reported on the mechanism of injury, vertebral level of injury, presence of neurologic deficit, type of event, and type of fracture. RESULTS Between 1943 and 1999, 271 major spinal injuries were reported in Canadian ice hockey players, of which 49.0% occurred to players 16-20 years of age. Ontario has had a disproportionately large number of injuries compared to some provinces, especially Quebec. Of the spinal cord injuries, 65.8% resulted from colliding with the boards, and 36.6% were due to players being pushed or checked from behind. The recent survey shows that there has been a decline in the number of major spinal cord injuries in Canadian ice hockey, especially those causing paralysis due to checking or pushing from behind. CONCLUSIONS Impact of the head with the boards after being checked or pushed from behind was the most common mechanism of spinal cord injury. Injury prevention programs are becoming effective in reducing the overall number of injuries, especially those due to checking from behind. Greater awareness of the occurrence and mechanisms of injury through educational programs and rules changes by organized hockey have reduced the annual incidence of catastrophic spinal injuries in Canadian ice hockey.

The epidemiology of women's rugby injuries.

OBJECTIVE The purpose of this study was to identify all injuries to members of an elite womens rugby team and to compare these injuries with published data on injuries in other womens contact and collision sports. DESIGN This was a prospective cohort observational study conducted using a monthly log completed by the teams certified athletic therapist to closely monitor attendance at practices and games along with the type and severity of injuries. SETTING Rugby games and practices held in Ontario, Quebec, and the Netherlands. PARTICIPANTS Forty members of the Ontario Womens Senior Provincial Rugby Team over the 1997 season and the 1998 World Championships. MAIN OUTCOME MEASURES An injury was defined as a rugby-related event that kept a player out of practice or competition for >24 hours or required the attention of a physician (e.g., suturing lacerations) and in addition included all dental, eye, and nerve injuries and concussions. RESULTS There were a total of 35 injuries in 4,958 player-hours and 2,926 athletic exposures. This resulted in a rugby injury rate of 7.1+/-0.4 per 1,000 player-hours and 12.0+/-2 per 1,000 athletic exposures. CONCLUSION The incidence of injuries in womens rugby is comparable with that in other womens contact and collision sports, indicating that the sport may be safer than stated in the literature and media.

CanadianAcademyofSportandExerciseMedicinePosition Statement: Neuromuscular Training Programs Can Decrease Anterior Cruciate Ligament Injuries in Youth Soccer Players

Cathy J. Campbell, BPE, MSc, MD, Dip Sport Med,* James D. Carson, MD, Dip Sport Med,* Elena D. Diaconescu, MD,† Rick Celebrini, PT, PhD,‡ Marc R. Rizzardo, Dip Sports Physio, BScPT, MPE, BPE,‡ Veronique Godbout, MD, Dip Sport Med, MA, MedEd, BSc,§ Jennifer A. Fletcher, MD, Dip Sport Med,¶ Robert McCormack, MD,k Ross Outerbridge, MD, Dip Sport Med,** Taryn Taylor, MSc, MD, Dip Sport Med,†† Naama Constantini, MD, DFM, Dip Sport Med,‡‡ and Manon Cote, MD, Dip Sport Med, BScPT§§

A workshop for educators on concussion led directly to the user-centredcentered design of a school board approved return to learn protocol

Objective To improve the educators’ knowledge and implementation of academic accommodations for optimal return to learn (RTL) after a sport-related concussion (SRC). Design Initially designed as a pre- post- intervention study, this qualitative report describes an unexpected but most relevant outcome of an educational intervention regarding SRC management in a school-based setting. Setting A sport-focused Ontario (Canada) secondary school. Participants 94 educational staff, including teachers, administrators and psychologists. Intervention A workshop where educators learned about SRC management and reflected on their own experiences with some of the 63 cases of SRC managed at theirschool over the preceding 3.5 years. Participants were asked to develop RTLprotocols adapted for their environment. Outcome measures Capacity to develop RTL protocols to improve concussionmanagement in school-based settings. main results Working in small groups, participants were able to independently construct RTL protocols. As an unexpected outcome of this session, the educators formed a committee, which formalised a user-centred (teacher accepted and student focused) eight-stage post-SRCRTL protocol. In 2015 their school board accepted this protocol for use at over 200 schools. The index school initiated a daily accommodations update RTL passport. Conclusions Working in small groups, participants were able to independently construct RTL protocols. As an unexpected outcome of this session, the educators formed a committee, which formalised a user-centred (teacher accepted and student focused) eight-stage post-SRCRTL protocol. In 2015 their school board accepted this protocol for use at over 200 schools. The index school initiated a daily accommodations update RTL passport. Competing interests None.

Investigation of knowledge and attitude about concussion diagnosis and management among family medicine residents

Objective To assess knowledge, attitude and learning needs about concussion among family medicine residents Design A web-based prospective survey Setting Toronto, Canada. Participants Family medicine residents at the University of Toronto. Intervention A link to the survey was disseminated via e-mail by the Department of Family and Community Medicine post-graduate office at the University of Toronto. Data collection occurred over 5 weeks from January to March 2015 with reminder emails sent out to all 348 family medicine residents at 2 weeks and 4 weeks of the study period. Outcome measures Survey answers to assess knowledge and attitude about concussion. Main results The residents who responded (n=73/348, response rate 21%) scored an average of 5.2 correct answers out of 9 (57.8%) questions regarding the diagnosis and management of concussion. Seventy-one percent of residents who responded did not recognise chronic traumatic encephalopathy and only 63% recognised second impact syndrome as consequences of repetitive concussions. Moreover, 32% of residents did not think that “every concussed individual should see a physician” as part of management. Conclusions We found significant gaps in knowledge surrounding concussion diagnosis and management among family medicine residents. This lack of knowledge should be addressed at both the undergraduate medical education and residency training levels to improve concussion-related care and patient outcomes. Competing interests None.