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Concussions associated with cognitive, behavioral, and emotional consequences for students

Concussions can have a compounding effect on children, leading to long-term cognitive, behavioral, and emotional health consequences, according to researchers at The University of Texas Health Science Center at Houston (UTHealth), who published their findings in the American Journal of Sports Medicine.

In 2017, approximately 2.5 million high school students in the United States reported suffering at least one concussion related to sports or physical activity in the last 12 months, according to information from the U.S. Centers for Disease Control and Prevention (CDC).

The UTHealth researchers analyzed survey data from more than 13,000 high school students in the United States. According to the authors, it is the first study to report on the association between sports-related concussions and negative health implications based on a representative sample of U.S. high school students.

“We have previously speculated that children who suffer a concussion have more behavioral problems, so this study was able to provide a more comprehensive analysis on the various cognitive and behavioral health issues that this population faces in connection with this type of brain injury,” said Gregory Knell, PhD, the study’s first and corresponding author. Knell is an assistant professor at UTHealth School of Public Health in Dallas and is research faculty at Children’s Health Andrews Institute for Orthopaedics and Sports Medicine.

A concussion is the most common form of traumatic brain injury, caused by a mild blow to the head. Common symptoms include a headache, ringing in the ears, nausea, vomiting, fatigue, drowsiness, and blurry vision.

Participants were asked how many times they had suffered a concussion from playing a sport or during physical activity in the last 12 months. Students were also surveyed on relevant cognitive, emotional, and behavioral factors and related health outcomes, including questions on topics such as academics, suicidal ideation, and substance abuse.

The study revealed that 14.5% of female high school athletes and 18.1% of male high school athletes reported experiencing at least one concussion the previous year. These students also reported at least one factor associated to their behavioral, cognitive, and emotional health. The questions covered topics such as difficulty concentrating, poor grades, drinking and driving, carrying a weapon, getting into a physical altercation, using tobacco or marijuana, binge drinking, feeling depressed, and having suicidal thoughts or actions.

Of the male participants who suffered at least one concussion, 33.8% reported they drank and drove in the last 30 days. For the female athletes who reported suffering more than one concussion, 19% stated they had used marijuana at least once in the last 30 days. Both male and female participants who answered that they had been in at least one physical fight in the last year were significantly more likely to have reported having at least one concussion in that same timeframe.

Other associated factors that were significantly more likely in male students who reported a prior concussion included difficulty concentrating, tobacco/e-cigarette use, and binge drinking. Female students who reported prior concussions were more likely to ride in a car with a driver who had been drinking, and have suicidal thoughts or actions.

“Parents need to understand that a concussion is a very serious brain injury, one which requires treatment every time a concussion is sustained. This study has revealed this type of traumatic brain injury can have a compounding effect on children that could lead to more aggressive behavior, academic problems, and social issues,” said study co-author Scott Burkhart, PsyD, a neuropsychologist at Children’s Health Andrews Institute for Orthopaedics and Sports Medicine.

The research team encourages future studies to continue the surveillance on the prevalence of concussions among student athletes, as well as the severity of these injuries.

Press Release from UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON

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What is metatarsalgia?

Metatarsalgia is a bad term for a foot problem that is common in athlete. It is a phrase that unfortunately gets used often but is quite a meaningless term and diagnosis. The term is like, for example, saying you have a sore hip. That sore hip could be due to any one of many different things. Metatarsalgia means pain in the metatarsals or ball of the forefoot, so it can be due to multiple different things. That is why the term is a bad term.

The cause of the pain could be a corn on the skin under the ball of the foot; it could be a pinched nerve that causes radiating type pains; it could be an atrophy of the fat pad that causes problems only when weight bearing; or it could be osteoarthritis type symptoms inside the metatarsophalangeal joints in the ball of the foot. Each of these possible reasons for metatarsalgia are extremely different to each other with different set of symptoms and different causes which just serves to illustrate just what a bad term it is to use.

Probably the most frequent cause for pain under the ball of the foot is a condition called a plantar plate tear. This is a sprain of the ligament under the joints in the ball of the foot that can progress to a minor tear. The symptoms are typically over the joint on the bottom of the foot and just in front of the joint. Typically it is the second metatarsophalangeal joint, but it can affect all or any of the joints in the ball of the foot. It is more common in those who exercise more and are more active. It starts as a small ache which is often ignored, but it can progress unless there is a therapy started since it does not heal on its own.

Usually the treatment of a plantar plate tear is to make use of strapping to hold the toe in a plantarflexed or pointing downward position to prevent it from bending up so the strain is given a rest. A rocker sole footwear or a shoe that is more rigid can also help do this. If this helps, it can take a long time and patience is needed to get better. If this approach not help, then some plantar plate tears need a surgical treatment.

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Managing pain after sports medicine surgery

DETROIT -A Henry Ford Hospital study published in the Journal of Arthroscopic and Related Surgery, has found that patients who underwent knee surgery and other types of sports medicine procedures could manage their pain without opioids or a minimal dosage.

knee sugery

“This is a large prospective study and our hope is that non-opioid use will gain momentum and that others may tweak our protocol and use it throughout orthopedics, from joint surgery to spine surgery and other surgeries” says Vasilios (Bill) Moutzouros, M.D., chief of Sports Medicine, a division of the Department of Orthopedic Surgery and the study’s lead author, “We hope that we are helping to change practices not just in sports medicine surgery but in all surgery.”

The purpose of the prospective study was to determine whether postsurgical pain following common sports medicine procedures could be managed effectively with a nonopioid multimodal analgesic protocol that relies more on non-steroid and anti-inflammatory medicine. It included 141 patients who underwent surgery between May and December 2018 for ACL reconstruction, shoulder and rotator cuff repairs or a torn knee meniscus. The study is the first in a series by Henry Ford researchers examining the issue.

Researchers found that 45 percent of patients had low levels of pain that was effectively managed by the regimen. Drowsiness was the only side effect reported by patients. All 141 patients were satisfied with how their post-surgery pain was managed by their doctor.

Even though patients were prescribed oxycodone as part of their regimen, none used it for pain control. Researchers say the regimen appeared to be essentially multiplicative, alleviating the need for patients to take the oxycodone.

Patients who required opioids were more likely to have a history of anxiety/depression and reported higher pain scores than those who didn’t need to take them.

“This kind of research has the potential to decrease opioid use in the general population as we find that many patients who abuse opioids started using them after a surgery and got hooked on them. It starts with the more common surgeries. By eliminating surgical opioid use, we are contributing to the reduction in opioids, which helps decrease dependence,” says Kelechi Okoroha, M.D., a Henry Ford sports medicine physician and a study co-author.

Dr. Toufic Jildeh, a study co-author and administrative chief resident in orthopedics at Henry Ford, says sports medicine physicians can “play a direct role in improving pain management and decreasing opioid prescribing.”

“There are currently no protocols that completely eliminate opioid use,” he says. “This study strongly suggests that eliminating opioids postoperatively is actually possible.”

Prior Henry Ford studies that focused on perioperative pain control and minimizing post-operative pain and opioid consumption after sports surgery led researchers to better understand risk factors that contribute to postoperative pain.

“It’s a practice changing study,” Dr. Moutzouros says. “This type of research allows physicians to look at how we manage pain differently in the post-surgical environment. It allows us to change our practices and become safer. What we’re trying to do is support each individual patient and reassure them that we are going to prescribe little if any opioids for their pain control to mitigate or eliminate a potential for addiction.”

Press release from Henry Ford Health System

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What can a podiatrist do for a cyclist?

The foot is a pretty vital structure in cycling, especially if you are a competitive cycler. We depend on the foot to transfer all the load and forces to the pedal to work harder. The structure, integrity and comfort is vital to that process. Any problems are going to lessen performance if you are a competitive athlete and be a source of discomfort if you are a recreational cyclist.

podiatry cycling

Podiatrists diagnose and treat problems of the foot and often are very involved in cycling issues from the pain that can occur in the foot, to the set up of the bike, footwear and pedal and also the alignment issues of the foot for optimum performance and injury treatment and prevention. They will give advice on cycling footwear and the correct fit. Typically that footwear has to be quite tight fitting, which can result in a range of problems from pinched nerves and numb feet. Podiatry often use cycling orthotics to help these types of problems and to improve foot alignment. There was a good discussion on Podiatry Arena between podiatrists on foot othoses and cycling that is worth browsing if you want to follow this topic. In addition, they have these threads on cycling.

PodChatLive has this episode on Podiatry and cycling and this explain more about foot orthotics and what podiatrists can do to help the foot problems in cyclists.

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Is Overpronation a problem in runners?

If you read in many places, you would think that this thing of “overpronation” is evil and something that runners must do about if they have it. Overpronation is when the rearfoot rolls inwards at the ankle and the arch collapses. Foot orthotics and motion control running shoes are widely advocated to treat this. It is quite common to see this advanced as quite a problem in running magazine and running shoe websites. This has been linked to injuries such as plantar fasciitis, medial tibial stress syndrome and runners knee.

On the other hand, you have this video of Haille Gebrselassie running and very severely overpronation. Yet he was at the top of his game and never had any problems with his overpronation. This has led to lots of debates in professional circles and social media about this overpronation.

The reality is that if you read the actual scientific evidence (summarized here), yes overpronation is a problem, but a small problem, though statistically significant. It does increase the risk for a range of injuries in runners, but only a small amount.

The whole area is subject to many myths and to see clearly through it is that you need to stick to what the actual data and evidence shows. The above video of Haille Gebrselassie is an anecdote and not scientific evidence. As pointed out here, you can’t bring anecdotes to debates about data. There is really no debate, the evidence is quite clear on this.