Vincent J. Lacroix

Concussions among university football and soccer players

ObjectiveA study to examine the incidence and characteristics of concussions among Canadian university athletes during 1 full year of football and soccer participation. DesignRetrospective survey. ParticipantsThree hundred eighty Canadian university football and 240 Canadian university soccer players reporting to 1999 fall training camp. Of these, 328 football and 201 soccer players returned a completed questionnaire. Main Outcome MeasuresBased on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous full year of football or soccer participation, the duration of symptoms, the time for return to play, and any associated risk factors for concussions. ResultsOf all the athletes who returned completed questionnaires, 70.4% of the football players and 62.7% of the soccer players had experienced symptoms of a concussion during the previous year. Only 23.4% of the concussed football players and 19.8% of the concussed soccer players realized they had suffered a concussion. More than one concussion was experienced by 84.6% of the concussed football players and 81.7% of the concussed soccer players. Examining symptom duration, 27.6% of all concussed football players and 18.8% of all concussed soccer players experienced symptoms for at least 1 day or longer. Tight end and defensive lineman were the positions most commonly affected in football, while goalies were the players most commonly affected in soccer. Variables that increased the odds of suffering a concussion during the previous year for football players included a history of a traumatic loss of consciousness or a recognized concussion in the past. Variables that increased the odds of suffering a concussion during the previous year for soccer players included a past history of a recognized concussion while playing soccer and being female. ConclusionsUniversity football and soccer players seem to be experiencing a significant amount of concussions while participating in their respective sports. Variables that seem to increase the odds of suffering a concussion during the previous year for football and soccer players include a history of a recognized concussion. Despite being relatively common, symptoms of concussion may not be recognized by many players.

Concussions during the 1997 Canadian Football League season

ObjectiveTo examine the incidence and characteristics of concussions for one season in the Canadian Football League (CFL). Design Retrospective survey. Participants 289 players reporting to CFL training camp. Of these, 154 players had played in the CFL during the 1997 season. Main Outcome MeasuresBased on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play after concussion, and any associated risk factors for concussions. ResultsOf all the athletes who played during the 1997 season, 44.8% experienced symptoms of a concussion. Only 18.8% of these concussed players recognized they had suffered a concussion. 69.6% of all concussed players experienced more than one episode. Symptoms lasted at least 1 day in 25.8% of cases. The odds of experiencing a concussion increased 13% with each game played. A past history of a loss of consciousness while playing football and a recognized concussion while playing football were both associated with increased odds of experiencing a concussion during the 1997 season. ConclusionMany players experienced a concussion during the 1997 CFL season, but the majority of these players may not have recognized that fact. Players need to be better informed about the symptoms and effects of concussions.

Recommendations for Grading of Concussion in Athletes

AbstractMild sports-related concussions, in which there is no loss of consciousness, account for >[75% of all sports-related brain injury. Universal agreement on concussion definition and severity grading does not exist. Grading systems represent expertise of clinicians and researchers yet scientific evidence is lacking. Most used loss of consciousness and post-traumatic amnesia as markers for grading concussion. Although in severe head injury these parameters may have been proven important for prognosis, no study has done the same for sport-related concussion. Post-concussion symptoms are often the main features to help in the diagnosis of concussion in sport. Neuropsychological testing is meant to help physicians and health professionals to have objective indices of some of the neurocognitive symptoms. It is the challenge of physicians, therapists and coaches involved in the care of athletes to know the symptoms of concussion, recognise them when they occur and apply basic neuropsychological testing to help detect this injury. It is, therefore, recommended to be familiar with one grading system and use it consistently, even though it may not be scientifically validated. Then good clinical judgement and the ability to recognise post-concussion signs and symptoms will assure that an athlete never returns to play while symptomatic.

Concussions among university football and soccer players: a pilot study.

ObjectiveA pilot study to examine the incidence and characteristics of concussions for one season of university football and soccer. DesignRetrospective survey. Participants60 football and 70 soccer players reporting to 1998 fall training camp. Of these, 44 football and 52 soccer players returned a completed questionnaire. Main Outcome MeasuresBased on self-reported symptoms, calculations were made to determine the number of concussions experienced during the previous season, the duration of symptoms, the time for return to play and any associated risk factors for concussions. ResultsOf all the athletes who returned completed questionnaires, 34.1% of the football players and 46.2% of the soccer players had experienced symptoms of a concussion during the previous season. Only 16.7% of the concussed football players and 29.2% of the concussed soccer players realized they had suffered a concussion. All of the concussed football players and 75.0% of the concussed soccer players experienced more than one concussion during the season. The symptoms from the concussion lasted for at least 1 day in 28.6% of the football players and 18.1% of the soccer players. Variables that increased the odds of suffering a concussion during the previous season for football and soccer players included a past history of a recognized concussion. ConclusionMore university soccer players than football players may be experiencing sport related concussions. Variables that seem to increase the odds of suffering a concussion during the previous season for football and soccer players include a history of a recognized concussion. Despite being relatively common, many players may not recognize the symptoms of a concussion.

An 18-year review of sports groin injuries in the elite hockey player: clinical presentation, new diagnostic imaging, treatment, and results.

Objective:This is a retrospective study of 98 hockey players who underwent 107 surgical explorations for refractory lower abdominal and groin pain that prevented them from playing hockey at an elite level. Design:Retrospective chart review combined with a complete follow-up examination and questionnaire. Setting:The players were treated in an ambulatory care university tertiary care centre. Patients:A total of 98 elite hockey players underwent 107 surgical groin explorations for intractable groin pain preventing their play. Follow-up was 100%. Intervention:Each player had repair of a tear of the external oblique muscle and fascia reinforced by a Goretex mesh. The ilioinguinal nerve was resected in each patient. Outcome Measures:There was absence of groin pain on the return to play hockey at an elite level. Results:In all, 97 of 98 players returned to play after the surgical procedures. No morbidity was attributed to division of the ilioinguinal nerve. Conclusions:Surgical exploration of the involved groin with repair of the torn external oblique muscle and division of the ilioinguinal nerve has resulted in resolution of refractory groin pain and return to play in the elite hockey player. The surgical procedure is associated with a low morbidity. Recent observations on dynamic ultrasound show promise in accurately diagnosing this injury.

Lower abdominal pain syndrome in national hockey league players: a report of 11 cases

PURPOSE Groin injuries are a major diagnostic and therapeutic challenge in sports medicine. The aim of this review is to describe the clinical and surgical findings associated with an atypical lower abdominal pain syndrome occurring in elite ice hockey players. CASE SUMMARIES Eleven professional ice hockey players from various National Hockey League teams were referred to the Montreal General Hospital between 1989 and 1996, suffering from atypical refractory pain and paraesthesia in the lower abdomen. Despite the use of conventional investigative procedures such as physical examination, ultrasound, bone scan, computed tomography scan, and magnetic resonance imaging scan, preoperative findings were consistently negative. Operative findings revealed varying degrees of tearing of the external oblique aponeurosis and external oblique muscle associated with ilioinguinal nerve entrapment. Repair of the external oblique tear, ablation of the ilioinguinal nerve, followed by a 12-week planned course of physiotherapy allowed all to return to professional ice hockey careers. DISCUSSION While soft tissue injuries are the most common cause of groin pain in the athlete, tears of the external oblique aponeurosis and superficial inguinal ring have rarely been cited as a consistent cause of lower abdominal pain in athletes. Inguinal nerve entrapment is also rare in patients without a history of previous lower abdominal surgery. RELEVANCE These 11 cases emphasize the importance of including another diagnostic possibility in the differential diagnosis of chronic overuse injuries of the lower abdomen.

A complete approach to groin pain.

IN BRIEF: Focused history questions and physical exam maneuvers are especially important with groin pain because symptoms can arise from any of numerous causes, sports related or not Questions for the patient should attempt to rule out systemic symptoms and clarify the pain pattern. Some of the most possible causes of groin pain include stress fracture of the femoral neck or pubic ramus, Legg-Calvé Perthes disease, slipped capital femoral epiphysis, acetabular labral tears, iliopectineal bursitis, avulsion fracture, osteitis pubis, strain of the thigh muscles or rectus abdominis, inguinal hernia, ilioinguinal neuralgia, and the ‘sports hernia.’ Depending on the diagnosis, conservative treatment is often effective.

Exercise-Induced Asthma

Exercise-induced asthma (EIA) is a common condition that can impede physical activity, particularly for children, adolescents, and young adults. A detailed patient history can help the physician identify subtle EIA clues such as fatigue or poorer performance than training would predict. A careful physical exam can help rule out conditions that mimic EIA such as respiratory infections or cardiac conditions. Pulmonary function testing is often useful for assessing severity and establishing a baseline for assessing treatment efficacy. Treatment options include nonpharmacologic measures that address the exercise environment and warm-up routines. Several medication options and combinations can help patients avoid symptoms and participate fully in fitness and sports activities.