William J. Moreau

Is physical activity contraindicated for individuals with scoliosis? A systematic literature review ☆ ☆☆ ★

OBJECTIVE The purpose of this study was to perform a systematic review of the literature and other authoritative sources for recommendations regarding the appropriateness of physical and sporting activity for those with scoliosis. METHODS The literature was systematically searched in PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Index to Chiropractic Literature, and the National Guidelines Clearinghouse from the earliest date of each database through July 2008. All languages and research designs were included. Web sites of respected organizations were searched for position/white papers on scoliosis and physical activity. Included articles were rated using the Oxford Centre for Evidence-Based Medicine criteria, and recommendations for physical activity were made using the Oxford Centres criteria for grades of recommendation. RESULTS Of 42 articles retrieved, 11 met the inclusion criteria. The Internet review of 18 organizations yielded no previous guidelines or position papers for physical activity and scoliosis. Recommendations were made from 3 level 3b studies and 8 level 5 studies; they include the following: (1) brace-treated and surgically treated scoliosis patients have demonstrated that they can physically participate in physical activities at the same level as nonsurgical patients (grade C recommendation); (2) nonsurgically treated patients are encouraged to participate in sports and physical activity and (3) scoliosis is not a contraindication to participation in most sports (grade D recommendation); (4) brace-treated scoliosis patients are encouraged to exercise with their brace on; however, exercise may also be done outside of the brace (grade D recommendation); and (5) physical activity may be commenced after surgery for scoliosis; however, no high-quality evidence exists that guides the timing of return to physical activity (grade D recommendation). A potential association between elite-level competition in specific sports at an early age and an increased prevalence of scoliosis has been reported (grade C recommendation). CONCLUSION This article offers evidence-based guidance to health care providers and to patients with scoliosis when making decisions to participate in physical and sporting activities.

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.

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.

The American Chiropractic Board of Sports Physicians supports the Journal of Chiropractic Medicine

It is with great pleasure that the American Chiropractic Board of Sports Physicians (ACBSP) and our 2000 certificants join in announcing that we have selected the Journal of Chiropractic Medicine (JCM) as the official journal of the ACBSP. Now, through a collaborative effort with the existing JCM partners and societies such as the American Academy of Chiropractic Physicians, the ACBSP certificants will be able to explore and stimulate intellectual discourse through reading and contributing to the peer-reviewed literature. Each of our active certificants will receive a subscription to the JCM as a benefit. For readers who are not familiar with the ACBSP, the ACBSP is a certifying organization for doctors of chiropractic who are interested in the fields of sports medicine and physical fitness. The ACBSP mission statement is “Promoting the highest standards of excellence and clinical competence for chiropractors specializing in sports medicine and physical fitness.” There are 2 levels of certification available through the ACBSP: the Diplomate of the American Chiropractic Board of Sports Physicians and the Certified Chiropractic Sports Physician/Practitioner. Several chiropractic colleges offer programs directed toward these credentials. The ACBSP stands committed to the expansion and development of scientific literature related to sports chiropractic and physical fitness. This year is a hallmark year for the ACBSP because it received approval for ACBSP certification processes from the National Commission for Competency Assurance (NCCA). This rigid review by the NCCA included a peer review process to recognize the ACBSPs work in establishing accreditation standards. The NCCA helps ensure the health, welfare, and safety of the public through the accreditation of a variety of certification programs/organizations that assess professional competency. Research that investigates the science and art of chiropractic has been a consistent thread woven through the many years of past ACBSP and American Chiropractic Association Sports Council leadership. By banding together with other supporters of JCM, we can all work together to carry out the ongoing mission of advancing the discipline of chiropractic through research literature. There are several reasons the ACBSP board of directors has decided to select JCM as the official journal of the ACBSP. The editor and assistant editor are sports chiropractors and proven researchers. Drs Johnson and Green will work diligently toward the goal of advancing the quality and breadth of chiropractic literature. In the sports medicine arena and in general practice, there is confusion regarding the scope of knowledge and the practice skills of doctors of chiropractic. One method of addressing concerns is to expand the body of work that defines the science of chiropractic. There is a substantial need for doctors of chiropractic from all walks of life to assist in the exploration of what it is that they do. To accomplish this goal, a steady expansion of the literature related to chiropractic is required. When researchers from other professions search for information on a topic, the field of chiropractic is defined for them through the results of their literature search. The JCM is not currently incorporated into all search indexes, but work is under way to move JCM in the direction needed to accomplish this goal. Others within our profession need to participate if by no other means than becoming lifetime learners of the profession that they practice. The ACBSP also believes the chiropractic specialties should provide meaningful and thought-provoking scientific discourse related to their specialty field and chiropractic in general. Before a doctor can become a Diplomate of the American Chiropractic Board of Sports Physicians, he or she must produce an original work that contributes to the body of chiropractic literature. Each ACBSP Sports Science Symposium includes abstract and poster presentations from the field of sports chiropractic. We hope to have selected abstracts and papers published in future issues of JCM. The ACBSP encourages other chiropractic specialties to make a similar commitment. A position paper is one type of publication the ACBSP is interested in developing. The goal of a position paper is to provide the reader with an opinion that is both valid and worth reviewing. These documents provide substantiated documentation about an important issue. This is especially important for the sport chiropractic field because few people know what sport chiropractors and doctors of chiropractic are capable of doing. This is why chiropractors need to steadily build a base of information on topics that demonstrate the scope and knowledge of the profession. For example, the ACBSP has 4 original position papers that include information regarding preparticipation examination (athletic physical), weight loss in wrestling, exercise and athletic participation during pregnancy, and bloodborne pathogens. These positions will be revisited on a regular basis. Although the ACBSP is proud of what we have developed, we also recognize that these are not enough to provide substantial broad-based support to the chiropractic profession as a whole. Therefore, the ACBSP has committed resources that are necessary to develop quality research-based position papers on a variety of essential topics related to sports chiropractic. New projects are already under way, with a projected completion within a year. It is reasonable to consider that the future direction of chiropractic will be decided in part by the literature related to chiropractic. In an age where immediate electronic access to literature is available, it is imperative that the individuals interested in chiropractic band together. By working together, we can advance the literature that defines chiropractic. The ACBSP invites you to join us in accepting the challenge and resultant opportunity to contribute to the profession through ongoing education, support of research, and expansion of the body of chiropractic literature.

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.