Myles Murphy

Head Impact Exposure in Junior and Adult Australian Football Players

This study measured and compared the frequency, magnitude, and distribution of head impacts sustained by junior and adult Australian football players, respectively, and between player positions over a season of games. Twelve junior and twelve adult players were tracked using a skin-mounted impact sensor. Head impact exposure, including frequency, magnitude, and location of impacts, was quantified using previously established methods. Over the collection period, there were no significant differences in the impact frequency between junior and adult players. However, there was a significant increase in the frequency of head impacts for midfielders in both grades once we accounted for player position. A comparable amount of head impacts in both junior and adult players has implications for Australian football regarding player safety and medical coverage as younger players sustained similar impact levels as adult players. The other implication of a higher impact profile within midfielders is that, by targeting education and prevention strategies, a decrease in the incidence of sports-related concussion may result.

The King–Devick test is a valid and reliable tool for assessing sport-related concussion in Australian football: A prospective cohort study

OBJECTIVES Sport-related concussion (SRC) research has focused on impaired oculomotor function. The King-Devick (K-D) test measures oculomotor performance and is reported to identify suboptimal brain function. The use of the K-D test in Australian football (AF), a sport involving body contact and tackling, has not been documented. Therefore, the objective of this study was to determine the test-retest reliability and diagnostic accuracy of the K-D test on a sub-elite AF team. DESIGN Prospective cohort study METHODS: In total, 22 male players (19.6+2.3 years) were tested and re-tested on the K-D test. Those suspected of having a SRC secondary to a significant head impact were tested. Randomly selected additional players without SRC were assessed for comparison. RESULTS There were observable learning effects between the first and second baseline testing (48 vs. 46s). The ICC for the first and second baseline tests was 0.91. Post-match test times were longer than the baseline times for players with SRC (n=7) (-1.9s; z=-5.08; p<0.0001). Players tested with no signs of SRC (n=13) had an improvement in time when compared with their baseline score (3.0s; z=-4.38; p<0.0001). The overall sensitivity was 0.98, specificity 0.96, and a kappa of κ=0.94. The positive likelihood ratio was 11.6 and the positive predictive value was 89.0%. CONCLUSIONS This study supports the use of the K-D test due to its test-retest reliability, high sensitivity and specificity, and fast and simple use that is ideal for sports medicine professionals to make quick judgement on management and playability.

In situ use of the King-Devick eye tracking test and changes seen with sport-related concussion: saccadic and blinks counts

ABSTRACT Objectives: Sport-related concussion (SRC) can result in impaired oculomotor function. Oculomotor performance, measured utilizing the King-Devick/Eye Tracking test (K-D/ET), is reported to be able to identify sub-optimal brain function. The objectives of the study were to determine the diagnostic accuracy of the K-D/ET in identifying SRC occurring from game participation and to perform a comparative analysis on saccade and blink counts for each K-D card individually and total counts between baseline and post-concussion. Methods: Nineteen male Australian Football players were assessed on the K-D/ET test. Those suspected of having SRC secondary to a head impact were also tested. Results: Participants recorded a slower time on the third (20.2 ± 4.6 s) screen when compared with the first (p = 0.0424) and second (p = 0.0150) screens. The number of blinks was higher on the third (2.9 ± 2.9) when compared with the second (p = 0.0057) screen. There was decrease of the K-D/ET total times between pre- and post-game (p = 0.1769). Participants who sustained a head impact recorded slower mean total K-D time (p = 0.7322), fewer mean total saccades (p = 0.0112), and more mean blinks (p = 0.8678) compared with their baseline scores. The assessment of blinks was the most sensitive measure for potential SRC (0.67). The K-D/ET duration was the most specific measure for potential SRC (0.88). An increase in the number of blinks had a fair specificity of 0.69. Conclusion: The rapid number-naming component of the K-D test is an assessment tool which quantifies impairment to oculomotor function and has been validated as a diagnostic tool for SRC. The clinical usefulness of the eye tracking component of the K-D/ET test is that it may be an effective method to assess concussions with the eye tracking component serving as a measure of progression and return to play. However, more research is required at the adult and youth level.

The effects of Botulinum Toxin injection in an elite sportsman with Functional Popliteal Artery Entrapment Syndrome: A case report

BACKGROUND Botulinum Toxin-A (BoNT-A) is an effective intervention for Functional Popliteal Artery Entrapment Syndrome (FPAES) however, concerns with this intervention include reductions in strength and performance. CASE REPORT This case presents an elite male athlete with FPAES who underwent BoNT-A injection and the results of testing before and after injection. The athlete experienced a decrease in strength and performance at one week post-injection however, he returned to baseline levels within four weeks. When comparing sprint distance during games, before and after injection, the athlete had an increase in his sprint distance per game post-injection. Finally on ultrasound he had visible medial gastrocnemius denervation atrophy with a decrease in arterial flow velocity at four weeks post-injection. CONCLUSION BoNT-A may be an effective minimally invasive treatment option for FPAES however, athletes may experience a transient decrease in function following BoNT-A injection and consequently caution must be taken with regard to treatment timing.

Pediatric Lateral Patellar Retinacular Sleeve Avulsion

A 10-year-old girl presented to the physical therapist with acute left knee pain, after sprinting that morning. She reported a pop and lateral knee pain, which caused her to stop her run. The physical therapist referred the patient for radiographs that day, which showed a possible lateral patellar avulsion. Magnetic resonance imaging was performed the following day, given the poor accuracy of radiographs in patellar avulsions, which confirmed a lateral patellar retinacular sleeve avulsion. J Orthop Sports Phys Ther 2017;47(10):815. doi:10.2519/jospt.2017.6616.