Concussion Alters Neuromuscular Function in Collegiate Athletes

Despite being cleared to return to play following a concussion, research has suggested that athletes may be at a greater risk for other kinds of injuries – namely, those affecting the lower extremities. However, the mechanism for this increased risk of a lower extremity injury after a concussion is unclear. Neuromuscular changes following concussion that persist beyond return to play may contribute to this increased injury risk.


In this study, the investigators identified altered lower extremity stiffness in the hip, knee and leg stiffness in a jump-landing task – finding this increased stiffness in athletes who had sustained a concussion when compared to uninjured matched teammates.


Changes in lower extremity stiffness have been shown to be a risk factor for lower extremity injury. Clinicians may need to include neuromuscular measures during concussion treatment programs. This may improve patient outcomes and decrease risk of lower extremity injury when these individuals return to sports activity.

For more information, view the abstract

HIP POINTERS

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • The term “hip pointer” refers to a bruise of the muscles and soft tissue attachments to the top of the pelvis bone, near the area where your shorts or pants would be
  • A hip pointer occurs from direct contact, such as from an opponent’s knee or fall to the court
  • Most hip pointers heal very well, with full recovery typically expected at about 3 weeks

In the last few weeks there have been several prominent NBA players sidelined for an Rockets v Clippersinjury called a “hip pointer”. We’ll see a fair number of these at all levels of basketball, including at the youth level.

What’s A “Hip Pointer”?

The term “hip pointer” has been used by sports medicine specialists for many decades, and in 1967 Dr. Martin E. Blazina from UCLA specifically noted that the phrase “hip pointer” should be used to describe a deep bruise to an area of the pelvis called the iliac crest (bone on the side of the body roughly near the top of your shorts or pants). So in actuality a hip pointer doesn’t really involve the hip, but the pelvis. Still we use the term somewhat broadly today. A hip pointer is an injury that occurs when there is direct contact to the iliac crest. This can occur by getting hit or falling onto your side and landing on a hard surface.

How the Injury Happens

The pelvic bone can see trauma during basketball if there is a direct blow from an opponent’s knee, or from a fall directly on to the basketball floor.

What’s The Story?

Hip pointers typically result in immediate, intense pain and localized tenderness over the iliac crest or pelvic bone. There will usually be significant bruising and swelling around the front, outside and inside of the hip. Due to the bleeding and swelling, movement of the hip will usually be limited and painful. Decreased range of motion and weakness are also typically seen. In young athletes I’ll typically get an x-ray to look for a fracture around the pelvis. One area particularly vulnerable in the growing athlete is the upper edge of the bone, where growth is still occurring.

Typical Treatment

Treatment starts with a proper diagnosis from a skilled sports medicine professional. These injures can be very uncomfortable, so crutches may be needed for the first several days, along with “RICE”: rest, ice, compression, and elevation. This will help to reduce inflammation and control the swelling. After the initial healing, the focus will shift to soft tissue mobilization. Soft tissue massage can help improve range of motion of the hip joint, further reduce swelling and prevent scar tissue. The athlete can then be progressed to range of motion, flexibility, strengthening, and sport specific exercises. For many young athletes I’ll prescribe physical therapy.

Time To Return To Play

Once pain free gait has been resumed sports specific training can be initiated. Fullssd.banner return to competition usually takes about 1-3 weeks for older teenagers, but may take longer in younger athletes, and longer still if there’s a fracture to the bone. After full healing, you should expect to be able to participate in full activity without restrictions.

ACL Bracing by DonJoy

HELPING WITH PREVENTION, PROTECTION & HEALING

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DonJoy pioneered the concept of functional knee bracing more than 30 years ago. Our first prototypes were simple neoprene sleeves sewn together in the Carlsbad, Calif. garage of our founders, Philadelphia Eagles Offensive Line Captain Mark Nordquist and local lawyer Ken Reed. Those first braces came from a deep understanding of the need for prevention, protection and healing, and DonJoy has led the profession of performance ever since by studying the body, listening to athletes, consulting physicians and pushing the envelope of innovation.

THE PERCEPTION

The overall perception of knee bracing technology available to most patients today is that “everyday” knee braces can be unsightly, bulky, heavy, minimally effective, restrictive and uncomfortable. These misconceptions combine to produce “brace anxiety” among many patients, often preventing mainstream adoption and compliance of braces that can help prevent injuries, allow people to remain active while healing, and protect the knee from future injury.

THE REALITY

Patients are looking for quick, effective and economic options for maintaining or regaining their life activities; most want to delay expensive, invasive surgeries. While some patients are turning to the use of prescription narcotics (which can lead to addiction) and cortisone shots to manage their pain, these treatment options do not provide stability to the knee.

THE FACTS

Young people between the ages of 15-25 account for half of all ACL injuries.

A person who has torn their ACL has a 15 times greater risk of a second ACL injury during the initial 12 months after ACL reconstruction, and risk of ACL injury to the opposite knee is two times that of the restructured knee.

Many athletes don’t return to sport after ACL reconstruction due to fear of re-injury.

BRACING FOR PREVENTION

Given the physicality of football, it’s easy to understand why collegiate and professional linemen wear braces on both knees. The line of scrimmage is an environment prone to knee injuries, so team doctors, athletic trainers and coaches don’t hesitate to equip their players with bilateral (both knees) custom braces.

As with helmets and shoulder pads, knee braces have become standard equipment to assist in preventing season-ending knee injuries. And the same logic holds true with skiing, snowboarding, soccer, basketball, volleyball, professional rodeo, water sports and others. An ounce of prevention is worth a pound of cure.

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BRACING POST INJURY

Why brace after ACL reconstruction? Clinicians will typically prescribe a functional knee brace after the patient has regained full range of motion—that’s usually between three to five months after surgery. Graft strength of the new ACL is considerably weaker than the native (original) ACL during the first 12 months, so a brace during this early period helps protect it from harmful forces that occur in everyday life or in sport.defiance-300x250

Bracing also elevates a patient’s confidence, allowing them to return to their previous or enhanced level of activity. Just look to athletes including Robert Griffin III, Tiger Woods, Adrian Peterson, Tom Brady, Lindsey Vonn, Matt Ryan and Peyton Manning just to name a few. Another important reason? Peace of mind. A functional knee brace provides not only confidence for the patient, but confidence for the surgeon, knowing that their patient’s knee is protected.

NFL Films Presents: Carson Palmer’s Doner

An incredible story about the woman whose tendon went on to help NFL quarterback Carson Palmer and the amazing bond donation created between these two families!

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QB Carson Palmer’s ACL Injury in the past resulted in a unique connection with his donor’s family.

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Reward Yourself at CEO Challenges; Complex Knee Injuries in Pro Athletes; NBA vs NFL Injuries

Episode 16.34 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

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Segment One:  The President of CEO Challenges, Ted Kennedy talks about the Camaraderie, Experience & Opportunity provided by CEO Challenges. Meet and compete with fellow C-suite executives that share your passion and interests. You’ll start out as strangers and finish as lifelong friends.

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Ted’s background is unique in the fitness industry and includes the following highlights:

  • 20 years in sales and marketing with packaged goods companies (Quaker Oats / Best Foods)
  • One of the original founders of IRONMAN North America (launching IRONMAN races in the USA)
  • Hosted the first ever CEO IRONMAN Challenge in Lake Placid in 2001
  • Started CEO Challenges with an exclusive license deal from IRONMAN in 2005
  • Sold his company to $1.4 billion Life Time Fitness in 2012 with the agreement to run it for five years

Ted has been interviewed by most major business news and fitness publications for hisCEO Challenges knowledge and relationship with CEOs that have a passion for endurance events. The CEO Challenge database includes 1,900 opt-in subscribers who receive monthly newsletters with race results and announcing new CEO Challenge events around the world. CEO Challenges enjoys an 83% post-event rating of ‘exceeded’ or ‘far exceeded’ expectations from some of the world’s most discerning customers.


nfl-knee-injurySegment Two: Dr. Brian Cole discusses the prevalence and his experience with
cartilage and complex knee issues in professional athletes; new techniques in dealing with the long recovery times; load related activity & pain management.


Segment Three:  Captain Matthew T. Provencher, MD MC USN with the Steadman Philippon Research Institute and Head Team Physician with the New England Patriots during their 2014 Super Bowl Championship Season. Dr. Provencher talks with Steve and Dr. Cole about his work in research; NBA vs NFL injuries and experience in setting up the Navy Seal Special Forces Tactical Athlete program.

Matthew T. ProvencherDr. Provencher graduated in 1993 with highest honors from the United States Naval Academy and was the Secretary of the Navy Distinguished Graduate, where he was an all-American rower. He earned his medical degree with Honors from Dartmouth Medical School in 1998.

He has served as Chief of Sports Medicine at The Massachusetts General since April 2013 and has been with the Patriots for the last two seasons. He also serves as a Professor of Surgery and Orthopaedics at the Uniformed Services University of the Health Sciences (USUHS) and is a Visiting Professor at The Harvard Medical School.

Dr. Provencher completed his orthopaedic residency at the Naval Medical Center San Diego and his orthopaedic shoulder knee and sports surgery fellowship at Rush University in Chicago. A prolific researcher, he has received numerous academic and research awards including the American Orthopaedic Society for Sports Medicine (AOSSM) Aircast Award, The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Science Award.

He was also selected for several prestigious traveling fellowships, including the AOSSM Asia-Pacific, the American Orthopaedic Association (AOA) John Fahey North American Traveling Fellowship, and the American-British-Canadian (ABC) Fellowship. In addition, he has received multiple peer-reviewed research grants totaling over $1.5M to study topics such as shoulder instability, rotator cuff injuries, and ACL tears from funding agencies including, OREF, PRORP, and The Department of the Army and Navy.

The World’s Leading Custom Knee Brace: Defiance by Donjoy

Defiance Knee BraceThe custom Defiance is DonJoy’s flagship knee brace. With clinically-proven technology including the 4-Points-of-Leverage System™ plus innovative, high-tech materials and design, this lightweight brace provides durable support for moderate-to-severe ACL, PCL, MCL and LCL instabilities. Plus, the low-profile design fits comfortably underneath clothing and sports uniforms, including hockey and football.

As the strongest of DonJoy’s functional braces, the custom, carbon composite Defiance is recommended for high-collision sports, while its featherweight materials and custom fit also make it the brace of choice for activities of daily living. Available with the LoPro FourcePoint Hinge, the only hinge clinically-proven to protect the ACL.

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Defiance technology is on the field, on the court, on the slopes and in the water protecting knees and providing confidence to those who wear it. First introduced in 1992, DonJoy has produced more than a million braces; in college football alone, 22 of the Associated Press Top 25 teams use the Defiance knee brace.

FEATURES & BENEFITS

  • Backed by DonJoy’s Knee Guarantee Program™
  • Custom-made craftsmanship
  • Lifetime warranty on frame and hinges
  • Clinically-proven 4-Points-of-Leverage System™
  • Custom fabricated
  • Swooping Thigh Cuff for inner thigh clearance and bilateral brace use
  • Strong, lightweight carbon composite frame
  • ACL, PCL, or Combined Instability (CI) strap configurations
  • 24-hour turnaround time

Options

  • Patented, clinically  proven FourcePoint™ hinge technology (stop kit not included)
  • Over 40 custom frame colors and graphics
  • Defiance Extra includes reinforced carbon composite frame
  • Metal Caps – PowerCaps, metal strap tab caps (recommended for contact sports)
  • High strength stainless steel gears (recommended for contact sports)
  • Standard Low Profile Hinge
  • DropLock Hinge

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