CJSM highlights emerging issues in sport medicine

Should electrocardiograms be included in cardiovascular screening of athletes? What's the current status of research into long-term effects of concussions? These and other hot topics are the focus of the January Clinical Journal of Sport Medicine, a special issue on "Emerging Issues in Sport Medicine." The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Marking the 20th anniversary of publication for CJSM, the special issue reflects the development of sport medicine into a "widely inclusive" specialty involving clinicians and researchers from many different backgrounds. "In this thematic issue, we have tried to capture a variety of issues that are relevant to those involved in sport medicine in 2011," writes Guest Editor Dr. James R. Birchers of The Ohio State University, Columbus. The Editor-in-Chief of CJSM is Dr. Willem Meeuwisse of University of Calgary.

Cardiovascular Screening, Concussions, 'Exercise as Medicine,' and More…
The January issue includes ten invited articles by renowned experts, highlighting some of the most important issues facing sport medicine in the coming decade. The topics covered reflect a focus not just on athletic injuries, but on the many ways sport and physical activity influence health throughout the population.

Two papers cover the contentious issue of whether cardiovascular screening for young athletes should include an electrocardiogram (ECG). Current European guidelines recommend ECG screening as part of the sport pre-participation evaluation, while U.S. guidelines do not. One article concludes that the current evidence supports mandatory ECG screening. However, the other points out that "feasibility and practical concerns" will need to be overcome before ECG screening is widely implemented.

Recent years have seen an intense focus on the possible long-term consequences of concussions, with high-profile media reports describing serious mental and physical health effects in athletes with a history of repeated concussions. However, a new paper points out, "[T]he scientific evidence to support these views is limited, with only a handful of cases reported." More research is needed to determine which athletes are at highest risk. Meanwhile, following the existing 'Zurich guidelines'—which call for gradual return to sport activity after concussion—is "likely to be the safest option," the authors write.

Another article examines the emerging concept of 'Exercise as Medicine'—a new approach to managing chronic diseases in an "increasingly sedentary" society. Sport medicine physicians have a unique role to play in making exercise recommendations for patients with almost any type of health problem, and in promoting physical activity to maintain health and reduce disease risks. "From home to the workplace and from children to the elderly, we have a role enabling societal and environmental change," the authors write.

Other emerging issues highlighted in the special issue are:
•The potential use of asthma medications as 'doping' agents to enhance sport performance. The current international guideline permitting some medications but prohibiting others "has no foundation in pharmacological science or in clinical practice."
•The increasing use of platelet-rich plasma to treat a wide range of sport injuries—despite continued questions about the safety and effectiveness of this treatment approach.
•The growing role of ultrasound as a useful and cost-effective imaging technology for in-office evaluation of ligament and tendon injuries and other types of athletic injuries.
•Health and safety issues associated with international athletic competitions—not only travel-related concerns for athletes, but also public health issues related to such large-scale events as the 2010 Olympic Games in Vancouver.
•A condition called femoroacetabular impingement—increasingly recognized as a cause of hip pain in young athletes.
•The ongoing debate over decisions regarding return to play after athletic injuries. A new paper points out that only a few research papers have addressed all key factors that need to be considered in making these important decisions.

Including contributions from a "star-studded author list," the special issue is a fitting start to the CJSM's 20th anniversary year, Dr. Borchers believes. "The hope is these reviews will provide excellent data and a stimulus for continued research and advancement in clinical practice for the topics presented."