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Sports Medicine Research Featured at National Meeting

Sports Medicine Research Featured at National Meeting

by | May 24, 2023 | Research & Innovation

Several of our physicians and trainees attended the American Medical Society for Sports Medicine (AMSSM) annual meeting recently. At this event, individuals are selected to share progress and results on projects that impact the care of athletes of all ages. Our team shared several pediatric-focused studies. Additionally, Jane S. Chung, M.D., served as faculty for a pre-conference event teaching participants how to transform a clinical question into a successful research project. Each of these activities reflects our organization’s commitment to provide the best care, continued learning and teaching through research and academic endeavors. Here are several projects our Center for Excellence in Sports Medicine research team, and trainees, extensions of our team, presented at this meeting.

AMSSM Grant-Funded Project Presented by Lead Investigator
Jane S. Chung, M.D., is conducting a study with the Movement Science Lab team to evaluate movement in pediatric ballet dancers. The larger project includes evaluating demographics, surveys and movement data to determine how ballet dancers respond to training demands of the art. The project presented at this event is titled, “Athletic identity and Injury Patterns in Pediatric Ballet Dancers,” and began to explain how ballet dancers think about their identity as an athlete and found that pediatric ballet dancers, particularly those who trained more and reported a prior history of injury strongly identify with their sport.

 

The purpose of the AMSSM Foundation Research Grant Award program is to foster original scientific investigations by members of AMSSM. Research proposals that investigate issues within the broad discipline of sports medicine will be considered, including clinical practice, injury prevention and rehabilitation, basic science, epidemiology and education. – 

Sport-Related Concussion Projects Presented by Trainees
David Mikhail, B.S., is a medical student at UT Southwestern Medical Center who presented “A Longitudinal Evaluation of Differences Between First and Second Concussion Among Pediatric Patients.” In collaboration with faculty mentor Shane M. Miller, M.D., David reviewed 31 pediatric cases in The North Texas Concussion Registry (ConTex).

A man is giving a presentation at a conference called rising to the challenge | CAMS RISING THE CHALLENGE A Longitudinal Evaluation of Differences in Presentation Between First and Second Concussions in Pediatric Patients UT Southwester SCOTTISH RITE ConTex SAMSS

Comparing variables between sport-related concussions within and between patients, the study aimed to identify the effects of a second concussion on young athletes. Findings included:

  • Pediatric patients presented similarly following first and second concussion and demonstrated similar time to return-to-play.
  • Neurocognitive abilities were not shown to be negatively impacted by a subsequent concussion.

Also representing data from the ConTex registry, Joshua A. Beitchman, M.D., M.B.S., UT Southwestern Medical School second-year resident in pediatric neurology, presented “Endophenotype presentation of athletes with concussion contingent upon sex and time since injury.” Working closely with his mentor and pediatric sports neurologist, Mathew Stokes, M.D., Dr. Beitchman, used a complex system called phenotyping to begin to explain the very difficult task of identifying treatment strategies earlier in the care of concussions. He says, “since concussed athletes experience symptoms differently based on sex and time since injury, predicting outcomes or the prognosis is challenging.” This study is making progress on these challenges in treating athletes with a concussion. A specific direction coming out of this effort is to further evaluate how mood and sleep affect recovery and learn interventions that will address these successfully in this population.

SM EDICINE Annual Meeting SAMESH Co-Authors RISING THE CHALLENGE. A man stands at a podium at an annual meeting

Pediatric Musculoskeletal Ultrasound Expert Shares Results of Novel Study
Sports medicine physician Jacob C. Jones, M.D., RMSK, presented “Increased Ultrasonographic Humeral Retrotorsion in Young Overhead Athletes with Little League Shoulder or Elbow.” This study adds to a small, but growing volume of evidence in the use of musculoskeletal ultrasound in the evaluation and research of pediatric sport-related conditions.

Comparing the shoulders of throwing athletes with and without shoulder or elbow pain with similar athletes in other overhead sports such as gymnastics, the study aimed to describe how the bone is remodeled, or changed, with a high volume of throwing. This study will aid in the understanding of growth-related, training-related and sport-related changes in the shoulder with sports that have a high volume of throwing such as baseball. In particular, studies like this will help to understand why some athletes develop pain with these activities and some do not.

Common Youth Ice Hockey Injuries and How to Avoid Them

Common Youth Ice Hockey Injuries and How to Avoid Them

by | Oct 17, 2022 | Sports Medicine

Ice hockey is a contact sport that carries a higher risk of injury as the skill and competition level increase. Though ice hockey may not be as prevalent in North Texas as it is in other regions, Scottish Rite’s Sports Medicine team still takes care of injuries from this fast-paced and fast-growing sport.

Rules, such as delaying body checking, change an athlete’s risk of injury. We asked Jacob C. Jones, M.D., RMSK, and Madelyn White, P.T., D.P.T., to answer a few questions about pediatric sports medicine and physical therapy as it relates to ice hockey. Here’s what they had to say.

What do we know about ice hockey injuries?
Injuries occur quite frequently. Even though much of youth hockey prohibits checking and overt contact, that doesn’t entirely eliminate all contact in the sport. Both acute and chronic musculoskeletal injuries happen to hockey players. Concussions are also common in ice hockey players.

Are there different injuries in different age groups or skill levels?
Although many injuries are similar, younger hockey players may have more frequent injuries involving their growth plates since older adolescents may be near completion of growth. As a result, providers should be aware of how any injury may affect a growth plate. This can help provide the best treatment and avoid future complications.

Are there certain considerations when a player returns to the ice after an injury and rehabilitation?
It’s important to allow a gradual return to full participation in on-ice and off-ice training after injury. Be sure to warm up adequately prior to practice and games and avoid playing through pain.

Are ice hockey injuries preventable?
Yes, some of them may be preventable, especially the chronic injuries. Different youth leagues around the world have implemented rules changes regarding checking to help reduce the incidence of acute injuries.

What are tips for a skater to help prevent injuries?
Wearing proper gear, continuing to build flexibility and core strength. Some common injuries include ankle and shoulder injuries. Focusing regularly on exercises that help with the strength and mobility of these areas could help prevent injuries. Many overuse injuries and burnout can be prevented by trying to find at least three months out of the year to do a non-hockey sport or activity.

What should parents know about concussions in ice hockey?
Like other contact sports, these happen even with appropriate protective equipment and rules to avoid contact. Given the unique nature of the sport of hockey compared to other field sports, a treatment plan and return to play program should be tailored to hockey players. Seeing a medical provider familiar with sport-related concussions and hockey can help determine when it is safe to return to the ice, then safe to return to full hockey participation.

Are there exercises to help prevent back pain in ice hockey skaters?
Exercises to maintain hip mobility can help maintain good skating form and avoid back pain during hockey. It’s also important to build up abdominal and glutes strength. Exercises such as planks, banded side steps and crab walks can help prevent low back pain.

Concussion Balance Study

Concussion Balance Study

by | Oct 10, 2022 | Sports Medicine

Learn how we use our Movement Science Lab to evaluate balance testing in sport-related concussion management.

Balance testing is commonly used to assess impairment and recovery after a sport-related concussion in the clinic setting. Measuring imbalances while going through various stances combined with both a firm and foam surface can provide valuable information in the evaluation of a concussion. Scottish Rite’s study, recently published in Brain Injury, was designed to look at how balance performance differed from diagnosis to return-to-play among athletes recovering from a concussion. A standardized test called the Balance Error Scoring System (BESS) is easy to perform in a clinic setting, but it may not provide the level of detail needed for a research study evaluating balance after sustaining a sport-related concussion. By conducting balance testing using the Movement Science Lab’s force plates, or special areas built into the flooring that are sensitive to the weight and force applied, researchers could correlate the BESS results with a highly objective center-of-pressure (COP) measure.

Principal investigator and director of movement science Sophia Ulman, Ph.D., explains the differences between these tests. “The BESS is a subjective test that requires clinical training and practice,” she says. “Alternatively, the force plate used to assess COP provides very specific, multidimensional measures that allow for discrimination of small differences in balance performance.”

It has been well established that there is an increased risk of prolonged symptoms as well as potential for compounding injuries if an athlete returns to play too soon after a sport-related concussion. Although balance is not the only measure used to determine readiness for sport, the proper assessment of balance is an important factor in this decision making. After reviewing data for these two tests in 40 patient-subjects, our team noted that the commonly used BESS test may not provide the information needed to assist with balance assessment as symptoms improved.

What does this mean for providers managing sport-related concussions?

Despite the volume of studies on the topic, the Sports Medicine team is continuing to learn about managing sport-related concussions in young and growing athletes. Pediatric sports medicine physician Shane M. Miller, M.D., says, “Until there is a better test to use in the clinical setting, we will continue to use tests like the BESS to do our best to assess balance improvement and identify the right time to return athletes to their sport. I suspect this will be a conversation for many years.”

The study, “Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures,” was published in July 2022 in Brain Injury, the journal of the International Brain Injury Association.

Sports Medicine Team Presents Latest Studies at National Meeting for Clinical Research Professionals

Sports Medicine Team Presents Latest Studies at National Meeting for Clinical Research Professionals

by | Sep 27, 2021 | Research & Innovation

The Society of Clinical Research Associates (SOCRA) is an organization committed to the education and certification of people involved in clinical research. Scottish Rite for Children has many research coordinators who participate in SOCRA and its activities. “We are fortunate to have individuals who are committed to ethical and meaningful research,” says Henry B. Ellis, M.D., pediatric orthopedic surgeon and associate director of clinical research. “Their membership and active participation in professional organizations like SOCRA bring value to our teams and work products.” While collaborating with others in study development and enrollment, data collection and manuscript preparation, research coordinators at Scottish Rite are encouraged to perform original research, publish and seek opportunities to share with appropriate audiences. This month, two research coordinators from our Sports Medicine team shared their work at the SOCRA annual meeting. Clinical research personnel from across the country participated in virtual continuing education opportunities, including digital poster presentations. “Posters are a traditional way of sharing an overview of a project and stimulating conversations among peers,” explains research coordinator Hannah M. Worrall, M.P.H., CCRP. “Even before the pandemic, we saw a shift to sharing them digitally, in place of or in addition to a traditional poster exhibit in a large hall.” All three posters were selected as finalists for the top clinical trial posters. Soccer-Related Concussions and Position Played The prospective study, “Differences in Concussion-Related Characteristics and Return-to-Play in Soccer Positions,” addresses a question about the influence of position-played on injury-related details and outcomes after a sport-related concussion. The data was prospectively collected from participants enrolled in the North Texas Concussion Registry (ConTex) from August 2015 to April 2021. This data has strong representation from patients seen in the Scottish Rite sports medicine clinic, so it is helpful to our team to continually improve care for this population. “In this study of almost 300 soccer players, goalkeepers showed higher rates of depression, disproportionately suffered more concussions and experienced a different mechanism of injury as well as had the lowest rate of returning-to-play three months after their injury,” says Worrall. This information may aid providers in educating players, their families and their coaches about the risks of concussion with different soccer positions and may play a future role in injury prevention. Investigators of this study include Hannah M. Worrall, M.P.H., CCRP, Claire E. Althoff, BA, Shane M. Miller, M.D., Jane S. Chung, M.D., Mathew A. Stokes, M.D., Stephanie Tow, M.D., C. Munro Cullum, Ph.D., and Jacob C. Jones, M.D.
Early Specialization The prospective study, “Sport Participation and Specialization Characteristics in a Pediatric Sports Medicine Clinic,” evaluated sport-related variables of more than 10,000 patients seen in our sports medicine clinic (2016-2021) with a specific set of questions in mind. The concepts of overuse and overtraining in youth sports have gained a lot of attention over the past decade because they lead to an increased risk of injuries.

SURVEY OF 10,000 PATIENTS MORE hours/week than age in years 15%. A pie chart that says survey of 10,000 patients more hours / week than age in years

A guideline has been proposed to reduce the risk of injury by limiting the number of training hours per week to the athlete’s age in years. For example, a 7 year old should not train more than seven hours/week in organized sports. The study found that 15% of athletes seen in the clinic did participate in more hours per week than their age. These athletes were more likely to report they are single-sport athletes, which is also known to increase their risk of injury. 

“The results support a growing body of evidence describing the risk of early specialization and overuse in youth sports,” says research coordinator Savannah Cooper, M.S., CCRP. “The effort should help guide continued education efforts for coaches, parents, administrators for youth sports and medical professionals.”

Investigators of this study include Hannah M. Worrall, M.P.H., CCRP, Savannah Cooper, M.S., CCRP, Jacob C. Jones, M.D., Shane M. Miller, M.D., and Jane S. Chung, M.D.

Standardized Postoperative Pain Management Opioid prescriptions following surgery in the adolescent population contribute to the use and abuse of addictive drugs in this age group. The purpose of this prospective study is to evaluate pain and opioid use following standardized surgeries in our patient population. The Scottish Rite for Children pediatric orthopedic surgery teams who care for joint-related injuries collaborated with pediatric anesthesiologists to implement a standardized pain management protocol for common surgical procedures with the goal of decreasing the number of opioid pills prescribed.

Plan Do Act Check. A diagram showing the steps of plan do act and check

“By using questionnaires to monitor pain level and pill usage, we are evaluating the effectiveness of the multidisciplinary and multi-modal protocol and looking at factors such as procedure type to determine areas for future study,” says Cooper. The team expects to continually adjust the study and the model based on the findings. Investigators of this study include Savannah Cooper, M.S., CCRP, Hannah M. Worrall, M.P.H., CCRP, Benjamin L. Johnson, MPAS, P.A-C., Charles Wyatt, M.S., CPNP, Philip L. Wilson, M.D., and Henry B. Ellis, M.D. “Evidence-based sports injury prevention efforts must be grounded in studies like these,” says Ellis. “Our sports medicine team is passionate about contributing to the growing data that help to focus efforts and future controlled trials.” Keeping young athletes safe requires a collaborative effort. This is why all of our Centers for Excellence include clinical research professionals like Worrall and Cooper. Learn more about our sports medicine research.
FOX 4: Coppell High School invests in high-tech mouthguards for football players

FOX 4: Coppell High School invests in high-tech mouthguards for football players

by | Oct 18, 2019 | Press Coverage, Sports Medicine

New technology may be able to help coaches keep North Texas high school football players safer when it comes to head injuries. Our sports medicine expert, Dr. Shane Miller weighed in on the topic with FOX 4 News.

He says there is still a lot to learn about using sensor technology in high-tech mouthguards to monitor players, but believes it is a step in the right direction.

“I don’t want parents to have a false sense of security,” he said. “This is not a concussion detection device. You still need to rely on trainers and medical personnel to help identify this. But the technology does have the potential to impact player safety if used correctly.”

Watch FOX 4’s feature