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

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Medial Knee Ligament Injury

A medial ligament sprain or MCL injury is a tear of the ligament on the inside of the knee, usually a result of twisting or direct impact. Medial ligament injuries are common in contact sports such as football and rugby, as well as martial arts. They can also occur in daily life through falls and twists of the knee joint.

Anatomy: The medial collateral ligament or MCL for short connects the thigh bone (or femur) to the shin bone (or tibia) on the inside of the knee and prevents the knee joint from moving sideways, particularly from forces on the outside of the knee.

The medial knee ligament itself has two parts to it; a deep inner section which attaches to the cartilage meniscus at the top of the shin bone, and a superficial band that originates higher up on the femur to an area lower down on the inner surface of the tibia.

Causes: Injury to the MCL often occurs after an impact to the outside of the knee when the knee is slightly bent. The ligament on the inside of the knee becomes stretched and if the force is great enough, some or even all of the fibres will tear. The deep part of ligament is prone to becoming damaged first and this may lead to a medial cartilage meniscus injury.

Twisting the knee can also cause a medial ligament sprain as well as the possibility of an ACL tear. If the foot is planted and the player tries to turn quickly this can also lead to stressing the joint causing the inside of the joint to open and tear the ligament. Whilst repetitive valgus forces can gradually over time lead to a MCL sprain, pain on the inside of the knee which does not occur after a sudden injury, should be considered for pes anserine tendinopathy or bursitis.

Symptoms: Graded 1, 2 or 3 depend on on severity of the injury.

Grade 1 symptoms: For a grade 1 MCL injury there may be mild tenderness on the inside of the knee over the ligament. There is usually no swelling. When the knee is bent to 30 degrees and an outward force applied to the lower leg to stress the medial ligament, pain is felt but there is no joint laxity (play valgus stress test video). A grade one tear consists of fewer than 10% of the fibres being torn.

Grade 2 symptoms: Significant tenderness will be felt on the inside of the knee along the medial ligament. Some swelling may seen over the ligament. When the valgus stress test is applied there is pain with mild to moderate laxity in the joint, although there is a definite end point (the knee cannot be bent sideways completely).

Grade 3 symptoms: This is a complete tear of the ligament. Pain can vary and is sometimes not as bad as that of a grade 2 MCL sprain. The valgus stress test will reveal significant joint laxity and the patient may complain of having a very wobbly or unstable knee.

Treatment for medial ligament sprains: Treatment can be divided into immediate first aid during the acute stage and longer term rehabilitation.

Immediate first aid

  • Apply P.R.I.C.E. principles (Rest, Ice, Compression, Elevation) to the injured knee.
  • Rest from training or any activities or movements which are painful to allow healing to take place
  • Apply ice or cold therapy wrap for 10 to 15 minutes every hour initially reducing frequency as symptoms allow. Ice should not be applied directly to the skin but use a wet tea towel or similar. Specialist cold therapy knee wraps are convenient to use and will apply compression as well.
  • Wear a compression bandage or knee support to help reduce any swelling and protect the joint. A hinged knee brace is best particularly for grade 2 and 3 injuries.

Wear a hinged knee brace: A hinged knee brace is a strong knee support which has solid metal supports down the sides to prevent sideways movement of the joint and protect the knee ligaments while healing. More severe grade 2 and full grade 3 injuries may require a limited motion hinged knee brace which restricts the amount of movement or knee bend in the joint whilst healing.

Electrotherapy: Ultrasound treatment involves applying high frequency sound waves to the injured tissues. A professional therapist may do this in the early more acute stages to help control swelling and pain. Interferential or tens involves applying electric currents to the tissue around the injury which can also help with pain and swelling.

Knee tapingTaping: Taping the knee joint can also provide a high level of support and protection. It can be done in the early stages as well as later on when returning to full training. A good taping technique can provide excellent support and often more support than some of the cheaper hinged knee braces, but the effectiveness of tape will reduce over time as the tape stretches slightly. It will need to be re-applied to maintain good support for the joint, particularly during competitive sport.

Knee rehabilitationExercises: A full rehabilitation program consisting of mobility and strengthening exercises should begin as soon as pain allows. Initially range of motion mobility exercises are done to restore full pain free range of movement. In the early stages isometric strengthening exercises (static muscle conractions) can be done to help maintain muscle strength and prevent muscle wasting whilst the ligament heals.

As the ligament heals strengthening exercises such as mini squats, leg press and step ups can be done but movements involving change of direction or sideways stresses should be avoided until much later in the rehabilitation program. A hinged knee brace should be worn to protect the ligament whilst exercising.

Massage: Manual therapy techniques including massage may be used as part of a rehabilitation program. Massage to the injured tissues should be avoided in the early acute stages. Later as the ligament starts to heel then light cross friction massage may be used and in particular if there is persistant pain in the later stages of rehabilitation then cross friction massage may be beneficial.

Do I need surgery? Most medial ligament injuries do not require surgical treatment. If there is additional damage to the joint for example an ACL tear as well then surgery may be considered. However, it is thought there is no advantage even with grade 3 injuries to treating them surgically as opposed to bracing and rehabilitation exercises.

How long will it take to recover?

  • A mild MCL injury or grade one sprain should take 3 to 6 weeks to make a full recover.
  • A more severe grade 2 or grade 3 injury may take 8 to 12 weeks.

Contributed by: Sports Injury Clinic


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

Key Points:

  • The spleen is the most commonly injured abdominal organ during sports
  • An enlarged spleen, such as from mononucleosis, places an athlete at additional risk of injury to the spleen
  • Emergency treatment is critical to ensure the health of the athlete after a possible spleen injury

This week I was working with a college lacrosse player who was seeing me for ongoing lacrosse stick checkissues with groin pain. Unrelated to that he indicated to me that in the past season he was hospitalized for a week due to a laceration of his spleen. The laceration occurred during a lacrosse game when he was diving for a ball and an opposing player’s stick hit him just underneath his left rib cage. My patient was fortunate in that he has made a full recovery and should go on to have normal function of his spleen. But others have not been quite so lucky.

A young man named Evan Murray, a 17-year-old three-sport athlete at Warren Hills Regional High School in New Jersey took a hit in the backfield during a football game in 2015. According to witnesses who spoke to the media, Murray walked off under his own power but later collapsed. As he was placed on a stretcher to be taken to a local hospital, he told his teammates he would be fine and gave them the thumbs-up sign.

But tragically, Evan Murray didn’t make it.

According to the County Coroner’s Office, the cause of death was a lacerated spleen that caused massive internal bleeding. Dr. Ronald Suarez found that Murray’s spleen was abnormally enlarged, making it more susceptible to injury.

What is the spleen?

The spleen is an organ in the upper far left part of the abdomen, to the left of the stomach. The spleen plays multiple supporting roles in the body. It acts as a filter for blood as part of the immune system. Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. The spleen also helps fight certain kinds of bacteria that cause pneumonia and meningitis.

Some medical conditions can result in an enlarged spleen, and an enlarged spleen is a risk for rupture. One of these conditions commonly seen in young athletes is mononucleosis, otherwise known as “mono”. For this reason, most physicians will require an athlete to rest for several days after mono before return to sports. This gives the spleen a chance to return to normal size.

Mechanism of spleen injuries

While death from spleen injuries is thankfully rare, the spleen is actually the most frequently injured abdominal organ in sports. A direct blow to the left side of the upper abdomen in contact or collision sports like football, lacrosse, or hockey, can injure the spleen in a healthy athlete.

Recognition of spleen injuries

A huge amount of blood travels through the spleen. Laceration or rupture can lead to massive bleeding into the abdomen that can be catastrophic.

Spleen injuries can be hard to diagnose at the time of injury. A player might have upper left abdominal pain after a hard tackle to the body, or being hit by the backend of a stick. He might complain of left shoulder pain from blood irritating the diaphragm. A doctor or athletic trainer might find tenderness when feeling the abdomen or ribs over the spleen.

Recognition and treatment of athletes with spleen injuries

Immediately after the injury, the athlete may have very few complaints and the exam could look nearly normal. It’s incredibly important therefore to pay close attention and act quickly if the young athlete develops any signs of abdominal pain. Evaluation of the athlete at a hospital is critical if there is any question of a serious injury.

SideLineSportsDocMany athletes with ruptured spleens require surgery and sometimes removal of the spleen. Some types of spleen injuries can be successfully treated without surgery. My young patient required a week in the hospital. These athletes usually do well and lead healthy lives, often returning to sports.

Evan Murray’s death was devastating for his hometown. Maybe one positive outcome will result from this tragedy. Parents, coaches and athletes can become more aware of these injuries so that no more athletes die from them in the future.

Nutrition for the Brain; Throwing Injuries in MLB and Little League Athletes.

Episode 15.28 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.


Segment One:  How ‘Re:Mind Recover’ Supplement Supports Healthy Brain Function

Mike Harriett, Luke Thiem and Dr. Michael Lewis discuss the nutritional approach to brain health using ‘Re:Mind Recover’ Supplement especially for contact sport athletes.

Re:Mind Recover – Perform Today, Think Tomorrow

Leaders in providing athletes with access to innovative, safe, simple and effective nutritional products that support healthy brain function

  • As athletes ourselves, we were driven to create the most effective product possibleremindrecover to help our teammates recover from the hits that they take on the field
  • Research shows that it is Best Practice to take an Omega-3 supplement after every practice and game*
  • Re:Mind Recover™ contains no banned substances and all ingredients are considered safe by sports governing bodies
  • Research from the U.S. Military shows that proper nutrition may help support healthy brain function

Mike Harriett – Co-Founder

  • Chicago Lions Rugby Football Club
  • 2007 Captain of the University of Chicago Football Team
  • 2007 American Football Coaches Association Good Works Team

Luke Thiem – Co-Founder

  • Chicago Lions Rugby Football Club – Captain of the 7’s Team
  • 2011-2012 USA 7’s National Team Player Pool
  • 2008 Collegiate All American for the University of Minnesota

Dr.  Michael Lewis, President of the Brain Health Education and Research Institute

  • Experience developing programs for the military on the use of Omega-3’s
  • Ran the primary care and flight medicine clinics at the Pentagon
  • Board-certified in General Preventive Medicine and Public Health
  • Graduate of US Military Academy at West Point & the Tulane University School of Medicine in New Orleans
  • Postgraduate training at the Walter Reed Army Medical Center, Johns Hopkins University School of Public Health, & the Walter Reed Army Institute of Research

Re:Mind Recover™ has been independently tested by Senior Staff Scientist Dr. Pam Maher at the Salk Institute for Biological Studies in California.  Her research showed that nerve cells survive stress up to 5X better with Re:Mind Recover™.

Re:Mind Recover: Impact Recovery Drink

Segment Two: MLB Throwing Injuries; Advice to Little League Parents.

white-soxHead Team Physician for the Chicago White Sox, Dr. Charles Bush-Joseph from Midwest Orthopaedics at Rush, talks with Steve Kashul and Dr. Cole about throwing injuries; causes, symptoms, pitch counts, post-game therapy treatment, importance of icing, use of compression devices, measuring shoulder-elbow range of motion; the importance of off-season rest and recovery for Little League players to avoid the over-throwing injuries, using good delivery technique and watch for range of motion signs of injury.

A graduate of the University of Michigan Medical School in 1983, he is currently a Professor at Rush University Medical Center and the Associate Director of the Rush Orthopaedic Sports Medicine Fellowship Program. Dr. Bush-Joseph is a respected educator of medical students, residents, fellows, and practicing orthopedic surgeons lecturing at numerous national educational meetings. He serves on the editorial board ofCharles A. Bush-Joseph, M.D. several national orthopedic journals (including the prestigiousAmerican Journal of Sports Medicine) and holds committee responsibilities with several national orthopedic societies including the American Academy of Orthopaedics Surgeons and the American Orthopaedic Society Sports Medicine. Dr. Bush-Joseph has been a member of the American Board of Orthopaedic Surgery Sports Medicine Examination Committee formulating the board exam for orthopedic surgeons and sports medicine physicians.

ACL Injuries

What is an ACL?

Simply put, an anterior cruciate ligament (ACL) connects the bottom of the femur (thighbone) to the top of the tibia (shinbone). It is one of four ligaments in the knee and is responsible for stability, forward movement of the lower leg and preventing rotational stress. Not only is the ACL the weakest of the four ligaments in the knee, too much stress can cause it to tear.

Prevention Programs

How does the ACL get injured?

Direct contact ACL injuries occur from an on-field or on-court collision. Non-contact ACL injuries are usually the result of a quick pivot, unbalanced landing or acceleration of speed followed by a sudden stop. Sometimes, the non-contact ACL injury can be exacerbated by overuse, when an athlete continues to play one sport year round without a break. Experts are most concerned about the rising number of non-contact ACL injuries, which account for nearly 70 percent of all ACL injuries.
Who gets an ACL injury?

Anyone can get an ACL injury, but the most susceptible are those involved in sports that require pivoting, jumping, decelerating and turning quickly, such as skiing, basketball, football, lacrosse, volleyball, cheerleading, soccer and gymnastics.

Females are at greater risk than males. The American Academy of Orthopaedic Surgeons (AAOS) reports that female athletes are up to 10 times more likely to sustain an ACL tear than their male counterparts. This is because higher levels of estrogen in women actually weaken the tendons by relaxing the fibers, making them more susceptible to tears. Since girls typically have wider hips than boys, there is a smaller notch for the ligament to connect to the femur, which restricts movement. Girls are also more likely to land on their feet with knees straight, as opposed to bent, which increases pressure on the joints. With more girls playing sports since the inception of Title IX in 1972, there has been at least a 10-fold increase in the number of injuries sustained by females.

What are the symptoms of an ACL injury?

Many patients are only too aware of their injury. There is usually intense pain, a telltale pop or snap, a loose feeling in the joint and an inability to put weight on the affected limb. However, there are instances in which the extent of the injury is less severe. Some ball players have been known to play with a damaged ACL, but that is an exceptional situation. Any lack of stability in the knee should be followed up with an MRI to assess damage. The risk of permanent injury, arthritis and total knee replacement is too great not to check for signs of a torn ligament.

How prevalent is it?

ACL injuries are extremely common among both professional and amateur athletes.

About 400,000 people in the U.S. are treated for ACL injuries every year. Medical professionals nationwide are seeing a significant uptick in the number of ACL injuries every year. Physicians in Philadelphia documented a 400 percent increase in ACL patients in a 10-year time period. From 2009 to 2013, the number of MOR patients with ACL injuries doubled. The number of ACL injuries in young people under age 25 tripled in that same five-year period. That’s why Midwest Orthopaedics at Rush (MOR) physicians are concerned about what they call an epidemic of ACL injuries.

With more emphasis on competitive sports and more young people engaged in these activities year-round, the numbers are going up.

To counter these accelerated rates of injury and to reduce stress on the joints, more cross training should be emphasized. Longer breaks between activities and exercises to improve balance and core strength around the knee joints can further lessen the likelihood of an ACL tear in people involved in rigorous competition.


Midwest Orthopaedics