Impacts of the Early COVID-19 Pandemic on Depressive Symptoms and Mental Health Among Student-Athletes.

Objective: Social distancing protocols due to the COVID-19 pandemic resulted in premature ending of athletic seasons and cancellation of upcoming seasons, placing significant stress on young athletes. Inability to play or forced early retirement has significant consequences on athlete's mental health, as demonstrated by an extensive body of injury literature. We hypothesize that premature suspension and cancellation of athletic events due to the COVID-19 pandemic leads to higher incidence of depressive symptoms among high-school and collegiate athletes. Further, athletes who strongly derive their sense of self-worth centered around athletics would have higher rates of depressive symptoms. Methods: High school and collegiate athletes were evaluated for depressive symptoms, emotional health and athletic identity measures through validated assessment instruments from May 2020 through July 2020. The Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test (PROMIS-10 Depression CAT), Veterans RAND-12 (VR-12), which comprises both a physical and mental health component, and Athletic Identity Measurement Scale (AIMS) were utilized. Results: Mental health assessments were completed by 515 athletes (52.4% male, 47.6% female; .84.5% collegiate, 15.5% high school). Female athletes scored significantly worse than males on VR-12 mental health assessments, as well as PROMIS-10 Depression scores; however, males scored significantly lower than females on VR-12 physical health assessments, irrespective of education level. Athletes who had strong associations with athletics as central to their personal identity exhibited worse psychologic impact on VR-12 mental health and PROMIS-10 Depression measures and female athletes in this cohort reported greater depressive symptoms than males. Conclusion: Social distancing protocols due to the COVID-19 pandemic have limited athlete's ability to participate in sports at the training and competition level. Higher rates of depressive symptoms in high school and college athletes have resulted among female athletes and those who identify strongly as an athlete.

Targeting Rule Implementation Decreases Concussions in High School Football: A National Concussion Surveillance Study.

BACKGROUND: Concussions occur at higher rates in high school football as compared with all other high school sports. In 2014, the National Federation of State High School Associations implemented rules defining illegal contact against a defenseless player above the shoulders to reduce concussions in football players in the United States. To the best of our knowledge, rates of emergency department (ED)-diagnosed concussions of high school football players before and after the 2014 rule implementation have not been compared. HYPOTHESIS: It was hypothesized that (1) there would be lower rates of helmet-to-helmet and helmet-to-body-part concussions after rule implementation and (2) alternative mechanisms of concussion would not differ, as these would be less influenced by rule implementation. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data from the National Electronic Injury Surveillance System (NEISS) were analyzed for high school football players 14 to 18 years old sustaining a concussion from January 1, 2009, to December 31, 2019. Data were collected on mechanism of injury, setting, and loss of consciousness. Raw data were used to calculate national estimates based on the assigned statistical sample weight of each hospital by the NEISS. RESULTS: A total of 4983 (national estimate = 154,221) high school football concussions were diagnosed in US EDs; 58.8% of concussions occurred during competition and 41.2% during practice. Between 2009 and 2013 the rate of concussions diagnosed in EDs rose 10.7% as compared with a 6.2% decrease between 2015 and 2019 (P = .04). Between 2009 and 2013, the rate of helmet-to-helmet concussions rose 17.6% as compared with a 5.6% decrease between 2015 and 2019 (P = .03). There were no significant changes between other mechanisms of concussion before and after the 2014 rule implementation. CONCLUSION: We identified a decreased trend in overall and helmet-to-helmet high school football concussions diagnosed in the ED after implementation of the targeting rule. This study adds to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related concussions.

Concussion-Reporting Behavior in Rugby: A National Survey of Rugby Union Players in the United States.

BACKGROUND: Rugby is the fastest growing team sport in the United States for male and female athletes. It is a contact/collision sport with an injury risk profile that includes concussions. PURPOSE: To examine the prevalence of concussions in male and female rugby players in the United States and to characterize behaviors around reporting concussions that could be a target for prevention and treatment efforts. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: An online survey distributed to active members on the USA Rugby membership list was used to examine self-reported concussions in male and female athletes. Concussion-reporting behaviors and return to play after a concussion were also explored. Statistical analysis was used to compare male with female athletes and report differences, with years of experience as a dependent variable. RESULTS: The proportion of athletes with a history of at least 1 concussion was 61.9% in all respondents. Of those who reported a concussion, 50.8% reported the concussion during the game or practice in which it occurred, and 57.6% reported at least 1 concussion to a qualified medical provider. Overall, 27.7% of participants who reported ≥1 rugby-related concussion in our survey noted that at least 1 of these concussions was not formally reported. The most commonly cited reasons for not reporting a concussion included not thinking that it was a serious injury, not knowing that it was a concussion at the time, and not wanting to be pulled out of the game or practice. Additionally, 61.0% of athletes did not engage in recommended return-to-play protocols after their most recent rugby-related concussion. CONCLUSION: US rugby union athletes may not report concussions to medical personnel or follow return-to-play protocols guided by medical advice. This could result from a lack of education on concussion recognition and the risks associated with continued play after a concussion as well as limited access to health care. Further education efforts focusing on the identification of concussions, removal from play, and return-to-play protocols are necessary in the US rugby union population.

The Psychological Burden of Retirement from Sport.

Participation in sport is associated with numerous physical and psychological health benefits, but also can have negative consequences, such as career ending injuries, which may have long-term effects on mental health. Recent research suggests that involuntary retirement, due to injury, illness, or being cut from a sport, can be particularly detrimental. As such, this review focuses on the impact athletic retirement has on the psychological well-being of collegiate athletes. We provide an algorithm to inform clinical decision making regarding involuntary retirement, as well as recommendations for the development of support programs and educational resources for athletes struggling with career transition. Our aim is that in developing retirement algorithms, support programs, and educational resources for athletes who are retired from sport, we can intervene early thus reducing the potential long-term psychological burden they may experience.

Post-Traumatic Epilepsy after Sports-Related Concussion: A Case Report.

Sports-related concussions (SRCs) are a public health concern across the United States, and they lead to neurological sequelae that can last long after the event itself. Concussive convulsions at the time of injury are common and rarely require additional workup or treatment. Post-traumatic epilepsy (PTE), however, is a rare phenomenon that can develop after traumatic brain injury and must be managed with adequate medical therapy. Herein we present the case of a 15-year-old football player who developed PTE after an SRC. This condition must be identified through proper education of sports clinicians and those involved in care and management of athletes.

Change in Heart Rate Variability after Concussion in a Collegiate Soccer Player.

Athletes are known to under-report concussion symptoms due to competitive disincentives to report and conflation of concussion symptoms with other conditions associated with rigorous participation in sports. A quantitative biomarker for concussion has the potential to decrease the reliance on inconsistent patient-reported symptoms for the diagnosis of concussion. The objective of this project was to monitor heart rate variability (HRV) patterns of in-season athletes as a potential biomarker for concussion. Twenty in-season National Collegiate Athletic Association (NCAA) Division 2 collegiate soccer players were given a wristband heart rate sensor with instructions to wear the band full time (24/7) for the entire fall season (approximately 3 months). The athletes were prompted by email to complete a weekly survey on the severity and frequency of any concussion symptoms. The survey and HRV data were de-identified for confidentiality, and to increase the likelihood of accurate reporting the athletes were told their responses would not be used to disqualify them from athletics. Our hypothesis was that HRV would be diminished in those with recent concussion. One athlete (5% of the cohort) sustained a concussion during the study period. A marked decrease in HRV was identified 7 days following the concussion, which eventually returned to baseline. This normalization of HRV followed the timing of resolution of concussion symptoms. Participants who did not sustain a concussion exhibited minimal variance in HRV over time. This preliminary study shows that HRV has potential as a biomarker for symptom resolution after clinically apparent concussion. HRV is unlikely to serve as a concussion diagnostic due to the 7-day lag in HRV change after concussion.

Ultrasound-Guided Hip Injections.

The diagnosis of hip pain can be difficult to isolate because the discomfort can originate from several locations and compensatory pain patterns. Pain generators can include the intra- and extra-articular hip structures, the lumbar spine, the pelvic floor, or a combination of these. It can also be referred as pain from the bowel, bladder, or reproductive organs. Injections into and around the hip have become an important part of both diagnostic and nonsurgical treatment algorithm for hip pain. The proximity of the hip to important neurovascular structures, lack of palpable anatomic landmarks, and deep location of targets can make use of ultrasonography-guided injections ideal. These injections have been growing in popularity in the orthopedic community because ultrasonography allows for a real-time visualization of dynamic anatomy without any radiation exposure to the patient and physician. The use of ultrasonography has allowed for in-office image guidance with improved accuracy for more targeted and advanced procedures. The patient's response to these injections can help guide patient selection for surgery and allow for better pain control of the soft-tissue pathology that often accompanies intra-articular pathology. This article highlights the diagnostic and therapeutic value of ultrasonography-guided hip injections for an orthopedic practice. The focus is on sonographic anatomy, introduction to technique, common indications, and pearls and pitfalls of these procedures.

High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies.

BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a relatively common diagnosis among the general population. OBJECTIVE: We aim to determine the prevalence of GTPS among patients who presented to the spine clinic. METHODS: Medical records of patients who were evaluated in the spine clinic were reviewed over a 12-month period (4/1/2016 to 3/31/2017). Patient demographics, presenting symptomatology, physical examination findings, presence or absence of GTPS, medical imaging findings, and interventions were recorded analyzed. Statistical analysis was performed using SPSS Statistics 23.0 (Chicago, IL). Statistical significance is defined as p < 0.05. RESULTS: A total of 273 consecutive patients (145 women, 128 men) were evaluated for degenerative lumbar pathologies by a single spine surgeon over the study period. The average patient age was 61.9 years. Overall, there were 138/273 patients (50.5%) with GTPS (Group I), while 135/273 patients (49.5%) did not have GTPS (Group II). There were 73 patients in Group I received trochanteric injection for GTPS treatment and subsequently returned to clinic for follow-up, and there were 36/73 (49.3%) patients reporting improvement in their symptoms after trochanteric injection. There was a statistically significant predilection for presence of GTPS in the female gender (60% vs 32.8%, p = <0.01). There was no statistically significant difference in the prevalence of low back pain, buttock, thigh or groin pain between the two groups. CONCLUSION: GTPS is a very common but often unrecognized or misdiagnosed condition. Accurate diagnosis and differentiation of GTPS from lumbar spinal pathologies are essential in avoiding potential unnecessary spinal procedures.

Medical retirement from sport after concussions: A practical guide for a difficult discussion.

PURPOSE OF REVIEW: In patients with a considerable history of sports-related concussion, the decision of when to discontinue participation in sports due to medical concerns including neurologic disorders has potentially life-altering consequences, especially for young athletes, and merits a comprehensive evaluation involving nuanced discussion. Few resources exist to aid the sports medicine provider. RECENT FINDINGS: In this narrative review, we describe 10 prototypical vignettes based upon the authors' collective experience in concussion management and propose an algorithm to help clinicians navigate retirement discussions. Issues for consideration include absolute and relative contraindications to return to sport, ranging from clinical or radiographic evidence of lasting neurologic injury to prolonged concussion recovery periods or reduced injury threshold to patient-centered factors including personal identity through sport, financial motivations, and navigating uncertainty in the context of long-term risks. SUMMARY: The authors propose a novel treatment algorithm based on real patient cases to guide medical retirement decisions after concussion in sport.

Evaluation, management and prevention of lower extremity youth ice hockey injuries.

Ice hockey is a fast-paced sport played by increasing numbers of children and adolescents in North America and around the world. Requiring a unique blend of skill, finesse, power and teamwork, ice hockey can become a lifelong recreational activity. Despite the rising popularity of the sport, there is ongoing concern about the high frequency of musculoskeletal injury associated with participation in ice hockey. Injury rates in ice hockey are among the highest in all competitive sports. Numerous research studies have been implemented to better understand the risks of injury. As a result, rule changes were adopted by the USA Hockey and Hockey Canada to raise the minimum age at which body checking is permitted to 13-14 years (Bantam level) from 11-12 years (Pee Wee). Continuing the education of coaches, parents and players on rules of safe play, and emphasizing the standards for proper equipment use are other strategies being implemented to make the game safer to play. The objective of this article was to review the evaluation, management and prevention of common lower extremity youth hockey injuries.