John W. O'Kane

Back Pain in Intercollegiate Rowers

Background: Back pain is prevalent among intercollegiate rowers. Purpose: We conducted a large-scale study to determine the rate of and the potential etiologic factors for clearly defined back pain that developed during intercollegiate rowing. Study Design: Survey. Methods: Surveys from 1632 former intercollegiate rowing athletes were analyzed. These surveys concerned training methods and back pain before and during intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week. Results: Five hundred twenty-six subjects reported that back pain developed during intercollegiate rowing. Factors significantly associated with the development of back pain included age at the time of the survey; history of rowing before age 16; use of a hatchet oar blade; training with free weights, weight machines, and an ergometer; midline ergometer cable position; and ergometer training sessions longer than 30 minutes. Back pain while in college also was associated with higher mean college weight and height. Conclusions: Intercollegiate rowers in the last 10 years covered by this study were larger, started rowing at an earlier age, trained more intensely, and developed more back pain during college than their predecessors.

Simple Home Program for Frozen Shoulder to Improve Patients' Assessment of Shoulder Function and Health Status

Background: The purpose of this investigation was to test the hypothesis that a simple home program can improve the self-assessed shoulder function and health status of a group of patients with frozen shoulders. Methods: A case series using a one-group pretest, posttest design analyzing 41 patients from a single orthopedic practice who had a frozen shoulder were included in this study. The patients completed the Simple Shoulder Test (SST) and the Medical Outcomes Study Short-Form Health Survey (SF-36) questionniare at the time of initial consultation, had treatment consisting of education regarding frozen shoulder and home stretching instructions, and were asked to complete the same questionnaires mailed every 6 months. Initial results were compared with previously published control values to establish level of impairment, and follow-up results were compared with the initial results to determine the extent of improvement. Results: Patients initially had serious deficits in the 12 shoulder functions inventoried by the SST and were also compromised in their general health status as reflected by the SF-36 scores. At follow-up, 4 of 10 SST functions were improved (P < 0.001). The SF-36 health status scores of physical function, comfort, and physical role function were also improved (P < 0.001). Conclusion: These data suggest that this home program for frozen shoulder can lead to improved self-assessed shoulder function and health status in patients similar to those in the study population.

Back Pain in Former Intercollegiate Rowers A Long-term Follow-up Study

Background Research has shown that 32% of intercollegiate rowers develop back pain during their college career. Hypothesis Rowers who develop back pain in college are more likely than the general population to have back pain later in life. Study Design Survey. Methods Surveys from 1561 former intercollegiate rowing athletes were analyzed. Subjects who completed the surveys had graduated from college at a mean and median of 13 years previously, with a range of 0 to 20 years between graduation and completion of the survey. The survey was designed to determine the presence of back pain and its severity before, during, and after intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week. Results Age was a significant predictor of back pain after college. Nevertheless, the lifetime prevalence of back pain in former intercollegiate rowers was no different from that of the general population (51.4% versus 60% to 80%). However, rowers who developed back pain in college had more subsequent back pain than rowers who were asymptomatic in college (78.9% versus 37.9%). Rowers who were asymptomatic in college had significantly lower rates of back pain as they aged than did the general population. The mean severity of current back pain was 3.5 ± 1.9 on a scale of 1 to 10. Conclusions Intercollegiate rowers are no more likely than the general population to have back pain later in life.

Concussion among female middle-school soccer players.

IMPORTANCE Despite recent increased awareness about sports concussions, little research has evaluated concussions among middle-school athletes. OBJECTIVES To evaluate the frequency and duration of concussions in female youth soccer players and to determine if concussions result in stopping play and seeking medical care. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study from March 2008 through May 2012 among 4 soccer clubs from the Puget Sound region of Washington State, involving 351 elite female soccer players, aged 11 to 14 years, from 33 randomly selected youth soccer teams. Of the players contacted, 83.1% participated and 92.4% completed the study. MAIN OUTCOMES AND MEASURES Concussion cumulative incidence, incidence rate, and description of the number, type, and duration of symptoms. We inquired weekly about concussion symptoms and, if present, the symptom type and duration, the event resulting in symptom onset, and whether the player sought medical attention or played while symptomatic. RESULTS Among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention. CONCLUSIONS AND RELEVANCE Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms. Heading the ball is a frequent precipitating event. Awareness of recommendations to not play and seek medical attention is lacking for this age group.

Upper respiratory infection: helpful steps for physicians.

IN BRIEF: Upper respiratory infections (URIs) are extremely common in adults. Most adults have multiple URIs each year, with athletes being more or less susceptible, depending on training intensity. Most URIs are viral nasopharyngeal infections that will improve in 7 to 10 days with symptomatic treatment and result in little time lost from athletic participation. Physicians must recognize the symptoms consistent with bacterial pharyngitis, infectious mononucleosis, and sinusitis to provide appropriate diagnostic testing, treatment, and return-to-play recommendations.

Is Heading in Youth Soccer Dangerous Play

ABSTRACT Background: Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. Methods: Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. Results: Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain’s susceptibility to injury. Conclusions: There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.

Evaluation of the Zachery Lystedt Law Among Female Youth Soccer Players

Abstract Background: Despite recent increased awareness about sports concussions, few studies have evaluated the effect of concussion laws on concussion outcomes among young athletes. The purpose of our study was to evaluate the effect of the Washington State Zachery Lystedt Concussion Law on playing with concussion symptoms and being evaluated by a health care provider. Methods: We performed a prospective cohort study of 351 elite female soccer players, aged 12 to 15 years, from 33 randomly selected youth soccer teams in the Puget Sound region of Washington State from 2008 to 2012. The Washington State Zachery Lystedt Concussion Law went into effect on July 1, 2009. Among concussed players (N = 59), we assessed the risk of playing with symptoms, the evaluation by a health care professional, and receiving a concussion diagnosis before and after the law was passed using logistic regression to estimate odds ratios and 95% CIs. Results: The majority of concussed players (59.3%) continued to play with symptoms, and we found no statistically significant difference in the proportion of players who played with symptoms before and after the law was passed. Only 44.1% of concussed players were evaluated by a health care provider, with no difference before and after the law was passed. Among those evaluated by a health care professional, players were 2.1-fold (95% CI, 1.0–10.1) more likely to receive a concussion diagnosis after the law was passed. Conclusion: The majority of concussed female youth soccer players report playing with symptoms. Legislation mandating concussion education and evaluation prior to returning to play was not associated with an increase in concussion evaluations by health care providers.

Strength and Jump Biomechanics of Elite and Recreational Female Youth Soccer Players

CONTEXT Most researchers investigating soccer injuries have studied elite athletes because they have greater athletic-exposure hours than other athletes, but most youth participate at the recreational level. If risk factors for injury vary by soccer level, then recommendations generated using research with elite youth soccer players might not generalize to recreational players. OBJECTIVE To examine injury risk factors of strength and jump biomechanics by soccer level in female youth athletes and to determine whether research recommendations based on elite youth athletes could be generalized to recreational players. DESIGN Cross-sectional study. SETTING Seattle Youth Soccer Association. PATIENTS OR OTHER PARTICIPANTS Female soccer players (N = 92) aged 11 to 14 years were recruited from 4 randomly selected elite (n = 50; age = 12.5 years, 95% confidence interval [95% CI]) = 12.3, 12.8 years; height = 157.8 cm, 95% CI = 155.2, 160.3 cm; mass = 49.9 kg, 95% CI = 47.3, 52.6 kg) and 4 randomly selected recreational (n = 42; age = 13.2 years, 95% CI = 13.0, 13.5 years; height = 161.1 cm, 95% CI = 159.2, 163.1 cm; mass = 50.6 kg, 95% CI = 48.3, 53.0 kg) soccer teams. MAIN OUTCOME MEASURE(S) Players completed a questionnaire about demographics, history of previous injury, and soccer experience. Physical therapists used dynamometry to measure hip strength (abduction, adduction, extension, flexion) and knee strength (flexion, extension) and Sportsmetrics to measure vertical jump height and jump biomechanics. We compared all measurements by soccer level using linear regression to adjust for age and mass. RESULTS Elite players were similar to recreational players in all measures of hip and knee strength, vertical jump height, and normalized knee separation (a valgus estimate generated using Sportsmetrics). CONCLUSIONS Female elite youth players and recreational players had similar lower extremity strength and jump biomechanics. This suggests that recommendations generated from research with elite youth soccer players could be generalized to recreational players.

Cerebral microhemorrhages in a collegiate football player: clinical implications in the management of sports concussion

Most concussions in sports medicine are managed without advanced neurological imaging. However, computed tomography and magnetic resonance imaging are sometimes used in the management of complex sports concussions to identify acute/delayed intracranial bleeding or other associated pathology. Advances in imaging techniques have led to greater resolution and the identification of pathology of uncertain clinical significance. This report describes the presence of persistent cerebral microhemorrhages identified on magnetic resonance imaging in a collegiate football player who suffered a concussion. The associated risks and clinical significance of cerebral microhemorrhages have not been determined in the young athletic population. This case highlights provocative issues in the management of sports concussions as related to findings on modern neurological imaging and their potential implication on to return-to-play considerations.

Allergen-mediated disease : Keeping patients active

A nasal corticosteroid is the most effective treatment for allergic rhinitis, but delayed improvement can reduce compliance. Topical vasoconstrictors, cromolyn, and NSAIDs are recommended for allergic conjunctivitis. Some athletes who have exercise-induced or exercise-exacerbated asthma may have a refractory period, which, along with short- and long-term beta-2 agonists, inhaled corticosteroids, and leukotriene antagonists, may be used to manage symptoms. Topical steroids are the main treatment for atopic dermatitis. Drug restrictions by sports governing bodies can limit therapies for competitive athletes.