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Sports medicine highlights from other journals
  1. Angela Gisselman1,
  2. Ronan Kearney2,
  3. Christina Le3,
  4. Brady Desmond Green4
  1. 1University of Otago, Dunedin, New Zealand
  2. 2Royal College of Surgeons in Ireland, Dublin, Ireland
  3. 3Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada
  4. 4Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia
  1. Correspondence to Dr Ronan Kearney; ronankearney{at}

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Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football

JAMA 2017; 318:360-370

You may have already seen the results of this paper through a media outlet. Let’s take a closer look. This study represents the largest case series of deceased American football players who donated their brains for research. At first glance the results appear shocking but further consideration is needed.

Chronic traumatic encephalopathy (CTE) was diagnosed in 177 of 202 (87%) deceased players, including a subgroup of NFL players in which CTE was identified in 99% of cases. Suicide was the most common cause of death in mild CTE, and dementia or parkinsonian-related disease in severe CTE.

The majority of players in this study were at the elite level, so caution must be taken when generalising results to other football players. The authors also acknowledged that the cohort was a ‘conveniently’ selected sample and had an ascertainment bias due to athletes’ participation in the brain donation programme. Furthermore, without a control group in this study, we cannot definitively say that CTE is caused by prior sporting participation, despite what the headlines tried to tell us.

On our quest to find answers to the questions that CTE raise, let us not forget the many proven health benefits of sporting participation.

Preseason anxiety and depressive symptoms and prospective injury risk in collegiate athletes

The American Journal of Sports Medicine 2017; 45: 2148-2155

Concussions are one example of how brain health can impact athletes’ quality of life and overall health. Mental health is another factor with significant health implications, and its effects can be seen in collegiate athletes who face the challenge of balancing academic and social demands with sport responsibilities and injury setbacks. Some athletes may fly through college without any major bumps or bruises; however, anxiety and depression can be a stumbling block for many.

This prospective cohort study of 958 American collegiate athletes identified those with self-reported anxiety or depressive symptoms during preseason. Remarkably, 29% of athletes reported anxiety symptoms and 22% reported depressive symptoms. Compared with those without any symptoms, athletes with anxiety symptoms had significantly higher injury rates of 2.5 and 1.9 times for both males and females, respectively. Strangely, depressive symptoms did not have any statistical impact on injury rate.

Considering one-quarter of collegiate athletes in this study reported anxiety or depressive symptoms, more effort should be dedicated to mental health screening and management. Oscar de la Hoya, Kelly Holmes and Terry Bradshaw are great examples of athletes who overcame their mental health burden. Let’s not allow mental health prevent young athletes from reaching their potential!

Individual and combined effects of acute and chronic running loads on injury risk in elite Australian footballers

Scandinavian Journal of Medicine & Science in Sports. 2017; 27:990–998

As was illustrated in the previous article, monitoring mental health among athletes should become part and parcel of athlete care. Alongside this, monitoring training load parameters and interactions with injury risk are gaining increasing attention. In this study, the utility of monitoring the acute:chronic workload (ACWR) is investigated in a cohort of footballers. ACWR measures an athlete’s current workload versus workload from the previous four weeks.

Total distance, player load and distances at key velocity bandwidths were collected and analysed from 59 elite Australian footballers across two seasons. An in-season ACWR >2.0 for total distance and high-speed distance was associated with a greater injury risk for current and subsequent training weeks. Very high in-season ratios also increased the risk of soft-tissue injury up to eight fold in the week the loading occurred.

However, players completing higher chronic workloads had a reduced risk of future injury. The results support the protective effects of building load capacity for injury resilience.

Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries

Bone Joint Journal 2017; 99-B: 774–8

Unfortunately injuries still occur despite effective athlete load management. Returning athletes to previous level of sport after knee injuries and surgeries remains challenging. Although surgery may be appropriate in some cases, conservative management is commonly first line for many knee injuries. Does this hold true for posterior cruciate ligament (PCL) injuries?

Forty-six athletes who sustained an isolated, acute (<4 weeks) grade II or III PCL injury completed the study.

Athletes performed a supervised, graded physiotherapy programme for 10 to 16+ weeks. Off-the-shelf bracing was used and knee motion, progressive strengthening and a graduated running programme were advanced per each athlete’s tolerance. Isolated hamstring exercises were avoided until 6 weeks post injury.

The results? Excellent return to play time (mean 4 months) regardless of injury severity. Impressively, 91% of the athletes maintained or increased their level of play at 2 years post injury!

These outcomes highlight the importance of an early physiotherapy-guided programme following PCL injury and the value of athlete compliance to rehabilitation during the return to play process.


  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.