{"id":6409,"date":"2015-08-21T07:12:27","date_gmt":"2015-08-21T06:12:27","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bjsm\/?p=6409"},"modified":"2015-08-31T02:58:29","modified_gmt":"2015-08-31T01:58:29","slug":"conference-highlights-from-the-concussion-in-sport-conference-at-the-sports-surgery-clinic-in-dublin","status":"publish","type":"post","link":"http:\/\/stg-blogs.bmj.com\/bjsm\/2015\/08\/21\/conference-highlights-from-the-concussion-in-sport-conference-at-the-sports-surgery-clinic-in-dublin\/","title":{"rendered":"Conference Highlights from the Concussion in Sport conference at the Sports Surgery Clinic in Dublin"},"content":{"rendered":"<p><b>By Steffan Griffin<\/b><b> (<a href=\"https:\/\/twitter.com\/lifestylemedic\" target=\"_blank\">@lifestylemedic<\/a><\/b><b>) and Dr.\u00a0Sean Carmody (<a href=\"https:\/\/twitter.com\/seancarmody1\" target=\"_blank\">@seancarmody1<\/a>)<\/b><\/p>\n<p>You may have seen <a href=\"https:\/\/twitter.com\/BJSMPlus\">@BJSMPlus<\/a> &#8211; our conference twitter handle feeding various clinical pearls from events around the world \u2013 going into overdrive at the recent \u2018Concussion: Diagnosis and Rehabilitation\u2019 conference at the Sports Surgery Clinic in Dublin early last month #sscConcussion<\/p>\n<p>This fantastic event, expertly organised by Colm Fuller and the rest of the team at SSC not only provided teaching from some of the world\u2019s premier concussion experts, but also raised some intriguing questions and stimulated some great debate. Additionally, the conference provided an ideal opportunity to launch the innovative <a href=\"http:\/\/www.sportssurgeryclinic.com\/news-events\/latest-news\/new-research-programme-for-treatment-of-concussion-presented-at-sports-surgery-clinic-sports-medicine-conference\/540\">Post Concussion Rehabilitation Pathway<\/a> that aims to improve the recovery process in concussed athletes.<\/p>\n<p>In case you missed out \u2013 below are some highlights and impactful tweets \u2013 enjoy! All of the day\u2019s stats are easily accessible via the 2012 Zurich Consensus Document, a must-read: <a href=\"http:\/\/bjsm.bmj.com\/content\/47\/5\/250.full\">http:\/\/bjsm.bmj.com\/content\/47\/5\/250.full<\/a><\/p>\n<p><strong>The Athlete\u2019s Perspective<\/strong> Ruby Walsh<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6411\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-11.png\" alt=\"concussion 1\" width=\"505\" height=\"168\" srcset=\"http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-11.png 526w, http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-11-300x100.png 300w\" sizes=\"auto, (max-width: 505px) 100vw, 505px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p>It was, perhaps, appropriate that a conference on Concussion was opened by horse-racing legend, Ruby Walsh. As Prof Paul McCrory and Dr Michael Turner later informed us, horse racing is the most high risk sport for developing concussions. During his talk, Ruby ignited a theme which was to recur throughout the day \u2013 \u201cConcussion is not a new story and the media storm does not mean it&#8217;s a new issue, it\u2019s simply in the news more often\u201d.<\/p>\n<p><strong>Concussion Management \u2013 New Ideas and Global Consensus<\/strong> Professor Paul McCrory PhD<\/p>\n<ul>\n<li>We need to resort to scientific evidence and not media speculation when considering all aspects of a concussion \u2013 a culture of fear exists which may be unfounded.<\/li>\n<li>An example of this is the issue of suicide amongst NFL footballers in the USA \u2013 \u201cRate of suicide in 3049 retired NFL footballers (who played &gt; 5 seasons) is 40% of age-matched non-footballers\u201d \u2013 meaning that sport may confer a protective effect!<\/li>\n<li>At the moment &#8211; scans don&#8217;t rule in concussion, only rule out more serious pathologies<\/li>\n<li>Second Impact Syndrome should be called Single Impact Syndrome- there doesn\u2019t have to be a second impact<\/li>\n<li>Examples of how concussions can be prevented include: coaching (eg tackle technique in collision sports), neck muscle strengthening, and rule changes (eg NFL rule banning hits with the crown of the helmet).<\/li>\n<li>Mouth guards have no role in preventing concussion.<\/li>\n<li>Our understanding of the pathogenesis of concussion is still very rudimentary. Do we know all of the causative pathways? Do NSAIDs put you at increased risk?<\/li>\n<li>The Mild\/Moderate\/Severe classification of concussion is inadequate in comparison to most other conditions. Breast cancer, for example, is classified according to clinical features, histological findings, hormonal receptor status and evidence of metastases- concussion has a long way to go.<\/li>\n<li>Concussion has a wide and varied profile, with aspects stretching across many different clinical realms \u2013 it means that there is unlikely to be a single diagnostic test.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6413\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-21.png\" alt=\"concussion 2\" width=\"424\" height=\"330\" srcset=\"http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-21.png 536w, http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-21-300x233.png 300w\" sizes=\"auto, (max-width: 424px) 100vw, 424px\" \/><\/p>\n<p><strong>Taking a Targeted Approach to Concussion Rehabilitation<\/strong> Professor Willem Meeuwisse MD, PhD<\/p>\n<ul>\n<li>Normal recovery is dependent on age &#8211; an important factor to consider with young athletes.<\/li>\n<li>Much of the early management of concussion features reassurance and education.<\/li>\n<li>What comprises the \u2018difficult\u2019 concussion patient?\n<ul>\n<li>Persistent symptoms<\/li>\n<li>Multiple concussions<\/li>\n<li>Concussions with diminishing force<\/li>\n<li>Seizures<\/li>\n<li>Structural brain injury<\/li>\n<li>Paediatric injury<\/li>\n<li>Multiple co-morbidities<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6414\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-3.png\" alt=\"concussion 3\" width=\"444\" height=\"197\" srcset=\"http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-3.png 536w, http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-3-300x133.png 300w\" sizes=\"auto, (max-width: 444px) 100vw, 444px\" \/><\/p>\n<ul>\n<li>Dix-Hallpike test &amp; Walk-whilst-talk test can be used to assess the potentially concussed athlete \u2013 whilst the latter may be used as a management tool <a href=\"http:\/\/t.co\/ppIEWIeSRJ\">http:\/\/t.co\/ppIEWIeSRJ<\/a><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6416\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concus.png\" alt=\"concus\" width=\"427\" height=\"113\" srcset=\"http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concus.png 529w, http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concus-300x79.png 300w\" sizes=\"auto, (max-width: 427px) 100vw, 427px\" \/><\/p>\n<p><strong>Long Term Monitoring of the Retired Athlete<\/strong> Dr Michael Turner<\/p>\n<ul>\n<li>Consensus statements must be taken with a pinch of salt \u2013 evidence constantly evolving and many of the recommendations are based on the \u2018I just know\u2019 principle.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6417\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-5.png\" alt=\"concussion 5\" width=\"462\" height=\"293\" srcset=\"http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-5.png 783w, http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-5-300x190.png 300w\" sizes=\"auto, (max-width: 462px) 100vw, 462px\" \/><\/p>\n<ul>\n<li>Jockeys are the athletes at greatest risk of developing a concussion. In professional racing a jockey falls off a horse in 1 out of 16 rides, compared to amateur racing where jockeys fall off once every 8 rides. The difference relates to skill level. One jockey dies every 250,000 rides.<\/li>\n<\/ul>\n<p><strong>Analysis of CSF Biomarkers in Concussion<\/strong> Dr Sanna Neselius MD, PhD<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-6418\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-61.png\" alt=\"concussion 6\" width=\"485\" height=\"348\" srcset=\"http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-61.png 534w, http:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/08\/concussion-61-300x215.png 300w\" sizes=\"auto, (max-width: 485px) 100vw, 485px\" \/><\/p>\n<ul>\n<li>Concussions may lead to an increased risk for chronic injuries.<\/li>\n<li>Several concussions will lead to delayed recovery.<\/li>\n<li>Neurofilament light (NFL) which although varies with time-of-day may correlate with amount of head trauma.<\/li>\n<li>NFL may have more of a role to play in delayed recovery than in the initial assessment period.<\/li>\n<li>Subdural haematoma is the most common sports-related intracranial bleeding.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>A Physiological Approach to Assessment and Treatment of Concussion and mTBI<\/strong> Professor Barry Willer PhD<\/p>\n<ul>\n<li>Return to Play can happen when the athlete can exercise fully without exacerbation of symptoms.<\/li>\n<li>Issue with return-to-play (RTP) guidelines \u2013 return when &#8216;asymptomatic&#8217; &#8211; but when are athletes, let alone controls, fully without symptoms?<\/li>\n<li>No evidence to support &#8216;radical rest&#8217;, simply academic suggestion &#8211; deconditioning may even confer risks to the athlete.<\/li>\n<li>Role for exercise testing followed by graded exercise protocol (%HR<sub>max<\/sub>) in getting athletes asymptomatic faster, thus potentially accelerating RTP?<\/li>\n<li>Poor exercise tolerance in the acute phase post concussion may be a marker of poor prognosis.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>All papers available at <a href=\"http:\/\/t.co\/NzRDDn9aKO\">http:\/\/t.co\/NzRDDn9aKO<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>***********************************<\/p>\n<p><em><strong>Dr Sean Carmody<\/strong> is a junior doctor working in the South Thames deanery. He tweets regularly on topics related to sports medicine and performance\u00a0<a href=\"https:\/\/twitter.com\/seancarmody1\" target=\"_blank\">@seancarmody1<\/a>.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Steffan Griffin (@lifestylemedic) and Dr.\u00a0Sean Carmody (@seancarmody1) You may have seen @BJSMPlus &#8211; our conference twitter handle feeding various clinical pearls from events around the world \u2013 going into overdrive at the recent \u2018Concussion: Diagnosis and Rehabilitation\u2019 conference at the Sports Surgery Clinic in Dublin early last month #sscConcussion This fantastic event, expertly organised [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"http:\/\/stg-blogs.bmj.com\/bjsm\/2015\/08\/21\/conference-highlights-from-the-concussion-in-sport-conference-at-the-sports-surgery-clinic-in-dublin\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[8271,8258],"class_list":["post-6409","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-concussion","tag-conferences"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/6409","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/comments?post=6409"}],"version-history":[{"count":0,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/6409\/revisions"}],"wp:attachment":[{"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media?parent=6409"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/categories?post=6409"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/tags?post=6409"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}