High school athletes require longer recovery following concussions

Press Release:

DETROIT – Young athletes are sidelined for at least one month after suffering a concussion, according to a Henry Ford Hospital study that provides new perspective on concussions and brain injuries.

The study’s results were published ahead of the Michigan High School Athletic Association’s recent announcement that the fall high school sports season will begin as traditionally scheduled, with football practices starting on Aug. 10.

The findings published by Orthopedics, a nationally recognized, peer-reviewed journal for orthopedic surgeons, are from a study conducted between September 2013 and December 2016. The study focused on 357 high school adolescents who sustained one or more concussions by analyzing historical data and then comparing it to more recent findings tied to an increase in reported concussions among young athletes.

The average age of the study’s patients was 15-and-a-half years with nearly 62% being males, the most common sport participated in by these athletes was football, followed by hockey and then soccer. From the study’s participants, 14 % reported suffering from amnesia and 33 % reported a history of concussions. Results of the study include:

  • Athletes with only one concussion required just over 30 days of recovery prior to returning to sport (RTS) while others who reported a second or more concussions required more time.
  • The most common sport of injury was football (27.7%). There was a high incidence of previous concussion (33.1%), and 32 athletes sustained a recurrent concussion.
  • Visual motor speed and reaction time scores decreased with recurrent concussions.
  • Male and female athletes with a previous history of concussion, and those with delayed diagnosis, required increased time to RTS.

The research team also found that athletes who have suffered concussions have a higher incidence of non-contact lower extremity injuries due to balance issues after concussions which may have implications on the performance, safety and well-being of athletes. These findings will be the focus of the next study also led by Toufic Jildeh, M.D., administrative chief resident in Orthopaedic Surgery at Henry Ford Hospital.

One of the earliest studies on concussion data came from the NFL’s mild traumatic brain injury committee and was published in the journal Neurosurgery in January 2004. Based on data collected between 1996 and 2001, researchers found that NFL players were sidelined for six or fewer days after a concussion.

A related 2019 study also led by Dr. Jildeh and published in American Journal of Sports Medicine showed a similar trend with NFL players being sidelined much longer.

“Historically, the literature reported a concussion prevalence of 4-5%, however recent studies have found that nearly 20% of adolescents have suffered at least one concussion, there’s a huge disparity in terms of reporting over time,” says Dr. Jildeh. Previously, it was thought that young age was a protective factor against concussion and that the neuroplasticity offered fast recovery. However, this thinking has been disproven with more recent studies.

Concussions have been a pressing issue. We want to limit the number of concussions and head injuries in a young athlete,” says Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine at Henry Ford and a study co-author, adding that younger athletes who suffer a concussion early in life are much more likely to experience longer term effects if they get repeatedly concussed.

Kelechi Okoroha, M.D., a Henry Ford sports medicine surgeon and study co-author, points to the findings as a baseline for young athletes with a history of concussions, “Depending on the number of concussions, the 30-day mark gives us a baseline for how much time adolescent athletes required before returning to sport,” he says.

The study offers a lot of information to reflect on and build on according to Jeffrey Kutcher, M.D., medical director and sports neurologist at the Henry Ford Concussion and Sports Neurology Clinic, and global director of the Kutcher Clinic.

Concussion diagnosis and management requires an individualized and comprehensive neurological approach to ensure we are accurately diagnosing and managing return to play effectively,” says Dr. Kutcher who also serves as advisor to the players’ associations for the National Football League and National Hockey League.

The study concludes that team physicians must be particularly mindful when evaluating an adolescent athlete due to the short and long-term neurocognitive implications, particularly as it pertains to RTS, and that high school athletes sustaining a concussion require careful attention when determining RTS readiness.

Running Shoe Regulations for Competition Updated

running shoe regulations

Media Release from World Athletics:

World Athletics today announces further revisions to its rules governing shoe technology, which are designed to give certainty to athletes preparing for the postponed Tokyo 2020 Olympic Games and to preserve the integrity of elite competition.

These amendments, approved by the World Athletics Council and introduced further revisions to its rules governing shoe technology, with immediate effect, are based on significant ongoing discussions with the Working Group on Athletic Shoes, established this year, and with the shoe manufacturers.

They include changes to the maximum height of spiked shoes for track and field events and the establishment of an ‘Athletic Shoe Availability Scheme’ for unsponsored elite athletes. The maximum height for road shoes (40mm) remains unchanged.

The purpose of these amendments is to maintain the current technology status quo until the Olympic Games in Tokyo across all events until a newly formed Working Group on Athletic Shoes, which includes representatives from shoe manufacturers and the World Federation of the Sporting Goods Industry (WFSGI), have had the opportunity to set the parameters for achieving the right balance between innovation, competitive advantage and universality and availability.

The amendments include:

  1. Clarification of the position for new shoes that have been approved to date;
  2. As an ongoing obligation, athletes, their authorised representative or their shoe manufacturer must continue to submit shoe specifications and, if requested, new shoes for examination by our independent expert;
  3. Approved shoes to be made available prior to an international competition for distribution to any uncontracted elite athlete via an Athletic Shoe Availability Scheme. The Working Group on Athletic Shoes will develop this scheme including timelines, elite athlete criteria, numbers of pairs of shoes required and method of distribution.
  4. Confirmation that the manufacturer commits to making the new shoe available via a scheme to provide shoes to unsponsored elite athletes for free and/or for purchase depending on whether they are qualified or an unqualified athlete who benefits from a place at World Athletics Series events or Olympic Games;
  5. Provision of information concerning the availability of the shoe for other unsponsored elite athletes who need a pair of shoes prior to competition. This is in keeping with the principle of shoes being reasonably available to athletes. As a priority item, in its forthcoming meeting we will work with the working group and World Federation of Sports Goods Industry to design an ‘Athletic Shoe Availability Scheme’ to deliver this. The scheme will cover process, criteria, numbers of pairs of shoes required, method of distribution and when the shoe needs to be available from (our position, which has been generally accepted by manufacturers, is for one month prior to international competition). 


The maximum height of the track spike shoes have been amended as set out in the table below:

EventMaximum thickness of the sole (As per rule 5.5, notes (i), (ii), (iii) and figures (a) & (b) to rule 5.5, and rule 5.13.3).Further rule requirement
Field events (except triple jump)20mmApplies to all throwing events, and vertical and horizontal jumping events except the triple jump. For all field events, the sole at the centre of the athlete’s forefoot must not be higher than the sole at centre of the athlete’s heel.
Triple jump25mmThe sole at the centre of the athlete’s forefoot must not be higher than the sole at centre of the athlete’s heel.
Track events (including hurdle events) up to but not including 800m20mmFor relays the rule applies to the distance of the leg being run by each athlete.
Track events from 800m and above (including steeplechase events)25mmFor relays the rule applies to the distance of the leg being run by each athlete. For race walking events the maximum thickness of the sole is the same as that for road events.
Cross country25mm 
Road events (running and race walking events)40mm 
Events under rule 57 of the technical rulesAny thickness 

World Athletics CEO Jon Ridgeon said the previous rule changes, announced in late January, were designed to give the athletes clarity before the Tokyo Olympic Games, which were originally due to take place in July-August this year.

However the later postponement of the Olympic Games for a full year, due to the global pandemic, had given the governing body more time to consult with stakeholders and experts and develop amended rules that will guide the sport through until late 2021.

“We have a better understanding now of what technology is already in the market and where we need to draw the line to maintain the status quo until after the Tokyo Olympic Games,” Ridgeon said. 

“In developing these rules we have been mindful of the principles of fair play and universality, maintaining the health and safety of athletes, reflecting the existing shoe market in these challenging economic times, and achieving a broad consensus with the shoe manufacturers who are major investors in our sport.

“These transitional rules give us more time to develop a set of working rules for the long term, which will be introduced after the Olympic Games next year, with the aim of achieving the right balance between innovation, competitive advantage and universality.”

Working Group on Athletic Shoes

The new Working Group on Athletic Shoes (WGAS) met for their first meeting last Wednesday (22 July). It is tasked with scoping and overseeing studies around shoe technology, exploring definitions to provide clarity to athletes about the shoes they are able to compete in, creating a robust certification and control process and providing expert advice and recommendations to the World Athletics Competition Commission on the future direction of World Athletics’ Rules and Regulations concerning elite athlete shoes for the long-term which may or may not be different to the current rules. The structure and composition of the WGAS can be found here.

Running in Tarahumara culture

Press Release:

“Running in Tarahumara (Rarámuri) Culture,” just published in Current Anthropology (v61, no. 3 (June 2020): 356-379) studies the Tarahumara Native Americans of northern Mexico. For over a century, the Tarahumara have been famous for their long distance running traditions and abilities, with many accounts claiming they have superhuman athletic abilities that partly result from being uncontaminated by westernization. Now an international team of researchers (including a champion Tarahumara runner) combine their own observations with detailed interviews of elderly Tarahumara runners to dispel these stereotypical myths, which they term the “fallacy of the athletic savage.” Lieberman and colleagues use accounts by Tarahumara runners to detail the various ways Tarahumara used to run for hours to hunt animals, and they describe how the Tarahumara still run traditional long distance races that, for men, involve chasing a small wooden ball and, for women, a hoop. While these many different kinds of running have important social dimensions, running is also a spiritually vital form of prayer for the Tarahumara. Further, contrary to the fallacy of the athletic savage, Tarahumara runners –both men and women– struggle just as much as runners from other cultures to run long distances, and instead of being the natural “superathletes” that some journalists have claimed, they develop their endurance from regular hard work and other endurance physical activities such as lots of walking and dancing.

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Daniel E. Lieberman, Mickey Mahaffey, Silvino Cubesare Quimare, Nicholas B. Holowka, Ian J. Wallace, and Aaron L. Baggish, “Running in Tarahumara (Rarámuri) Culture: Persistence Hunting, Footracing, Dancing, Work, and the Fallacy of the Athletic Savage,” Current Anthropology 61, no. 3 (June 2020): 356-379.

Study reveals long-term impact of rugby injuries

Press Release:

Rugby players continue to suffer from their high ‘injury load’ after retirement from the sport, according to the first independent study looking at the health of retired rugby players.

The researchers, led by Durham University’s sport and exercise scientists, are calling for governing bodies to step up efforts to prevent, in particular, recurrent injuries and ensure players are supported post-retirement.

Both elite and amateur rugby union and league players report suffering back pain and severe and regular joint pain which they attribute to the long-term impacts of their cumulative injuries post-retirement.

Concussion was the most common injury amongst rugby players with most suffering at least one concussion during their career and with this injury most associated with reported longer term impact.

Around half of all players had sustained a knee ligament injury with 25 per cent experiencing on-going problems.

Osteoarthritis – a condition that causes joints to become painful and stiff – was twice as common amongst elite rugby players compared to non-contact athletes and was associated with previous injuries and surgery.

The findings, published in the academic journal Sports Medicine, come after the Rugby World Cup in Japan saw a number of issues with high tackles and dangerous play leading to injuries.

Lead for the project, Dr Karen Hind from the Department of Sport and Exercise Sciences at Durham University, said: “It is clear from these findings that playing rugby union or rugby league is associated with lasting impacts in terms of injury and pain. Although there have been initiatives and rule changes to try and make the game safer, the rates of injury across a player’s entire career are still very high. The game is now also faster and players are bigger than they used to be so the impacts are greater.

“Many of the ex-players who took part in this study competed in rugby football over a decade ago when the sport was more about evasion. The injury levels for these individuals are up to nine-fold higher than for former non-contact athletes of a similar age.

“What we need to consider is that the game today is more about players running through opponents rather than evading – this is inevitably going to increase injury risk.”

The study was led by Durham University in collaboration with colleagues from Auckland University of Technology in New Zealand as part of the Global Rugby Health Research Network and the UK Rugby Health Project which built on the original New Zealand Rugby Health Study.

It compared the types and number of injuries suffered by 254 male elite rugby code players, amateur rugby code players and non-contact athletes, such as cricketers. The retired athletes ranged in age from 21 to 82 years.

Dr Hind added: “Our study looked at the total number of injuries across a player’s career and our findings suggest a need for better injury recovery given the reported frequency of recurrent injuries.

“A case could be argued for less players on the pitch and providing more opportunity for evasion. Medics also have a role to play in encouraging sensible injury recovery times which clubs need to support.

“Importantly, our findings highlight a need for programmes to support professional players post-retirement, in managing the long term impacts of injuries sustained during their career.”

Jon Sleightholme is a former international rugby player who represented England 12 times at senior level scoring four tries and was part of the team that won the Five Nations Championship in 1996. He also played for England Sevens and at club level for Wakefield, Bath and Northampton, retiring in 2004 after 13 seasons playing at the top level.

He commented: “The long term effects of playing contact sports especially at the elite level clearly have implications for players after their careers have finished. Sometimes those symptoms don’t appear until several years post-retirement.

“What the study highlights for me is the need for long term support and education for ex-players to help them manage these conditions as they get older.”

Dr Fraser Birrell, Consultant & Senior Lecturer in Rheumatology and Director of Science & Research for the British Society of Lifestyle Medicine (who was not involved in this research project), commented: “This is an important study that provides injury data on professional and amateur rugby players compared to non-contact athletes across an entire sporting career.

“We know how beneficial exercise is, but understanding the risks of high-intensity sport and especially the most frequent injury being concussion, helps inform playing guidelines and safety practices.

“It was striking to see that this high burden of injuries was associated with osteoarthritis at more than double the prevalence in professional rugby players (affecting half) compared to non-contact athletes, despite being younger.”

Professor Patria Hume, collaborator on the UK study and lead of the New Zealand study, commented: “The independent UK study has supported preliminary findings from our study in New Zealand, which was part funded by World Rugby, regarding increased concussions and injury during playing years and later osteoarthritis during retirement from sport.”

The UK Rugby Health Project includes ongoing studies investigating blood biomarkers, inflammation, head impacts, concussion and sub-concussions.