Serum ferritin distribution in elite athletes.

OBJECTIVES: It is not uncommon for athletes to be diagnosed with iron deficiency, yet there remains uncertainty whether the prevalence of suboptimal iron status in elite athletes differs from the normal population or warrants routine screening. The purpose of this study is to describe the distribution of serum ferritin (SF) in a cohort of elite athletes. DESIGN: Retrospective cohort study. METHODS: Electronic health records of 1085 elite adult athletes (570 women, 515 men) from 2012-2017 were examined retrospectively. SF values were compared to published normal population data. The proportion of athletes meeting criterion values for iron deficiency or initiation of treatment was examined. RESULTS: SF distributions in male athletes were significantly lower than normal males aged 20 to <24yrs. (χ2 28.8, p<0.001) and aged 24 to <28yrs. (χ2 91.9, p<0.001). SF status was similar in female athletes and normal women aged 20 to <24yrs. (χ2 9.5, p>0.05) or aged 24 to <28yrs. (χ2 11.5, p>0.05). Using 35ng/ml as the criterion value for stage one iron deficiency, 15% of male athletes and 52% of female athletes displayed suboptimal iron status. CONCLUSIONS: Male athletes have a significantly lower population distribution of SF values as compared to normative data on healthy males, with 15% of male athletes having suboptimal SF status. The distribution of SF values in elite female athletes did not differ from population values, however approximately half women athletes were iron deficient. These data suggest that iron screening should be considered in both male and female athlete populations.

Survey of Income Comparison: General Practice and Sports Certified Doctors of Chiropractic.

OBJECTIVE: The purpose of this study was to determine whether there are differences in reported gross billings and collections between doctors of chiropractic who have obtained a certificate of additional qualification (CAQ) in sports medicine compared with those without a CAQ in sports medicine. METHODS: A cross-sectional study was conducted. An e-mail invitation to participate in an anonymous survey was sent to doctors of chiropractic who hold active certifications with the American Chiropractic Board of Sports Physicians. The respondents were provided a link to a web-based survey that was constructed with similar questions to a national chiropractic survey issued by Chiropractic Economics (CE) for the same year (2015). RESULTS: Three hundred forty-nine sports medicine CAQ doctors of chiropractic responded (23.8% response rate) in comparison to 719 CE respondents. The CAQ respondents averaged $722 983 in gross billings (9.8% response rate) compared with $539 046 by CE respondents. Sports medicine CAQ doctors of chiropractic averaged $452 376 in gross collections (10.4% response rate) compared with $348 773 by CE respondents. CONCLUSION: An analysis of these 2 surveys illustrates that CAQ respondents report higher total annual gross billings and collections than the CE respondents. Improving study methodology may improve response rates and garner a more accurate representation of any differences between doctors of chiropractic with and without CAQs.

Detection of Persisting Concussion Effects on Neuromechanical Responsiveness.

PURPOSE: Assessment of various indices of neuromechanical responsiveness for association with concussion history. METHODS: An observational cohort study included 48 elite athletes (34 males: 23.8 ± 4.4 yr; 14 females: 25.4 ± 4.5 yr) who performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included two dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT+ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT+FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. RESULTS: Concussion occurrence at 2.0 ± 2.3 yr before testing was reported by 21 athletes. Strong univariable associations were found for VMRT+FT left minus right difference ≥15 ms (odds ratio [OR], 7.14), VMRT+ST outer two-ring to inner three-ring ratio ≥1.28 (OR, 4.58), and WBRA speed asymmetry ≥7.7% (OR, 4.67). A large VMRT+FT by VMRT+ST interaction effect was identified (OR, 25.00). Recursive partitioning identified a three-way VMRT+FT by VMRT+ST by WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all three factors had 90% negative predictive value. CONCLUSIONS: Performance on dual-task VMRT tests and the WBRA test identified neuromechanical responsiveness deficiencies among elite athletes who reported a history of concussion.

Subspine Hip Impingement: An Unusual Cause of Hip Pain in an Elite Weightlifter.

Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury.

Laboratory Tests Ordered By a Chiropractic Sports Physician on Elite Athletes Over a 1-Year Period.

OBJECTIVE: The purpose of this study is to describe and discuss laboratory tests ordered on elite athletes in an interdisciplinary sports medicine clinic by a doctor of chiropractic over 1 calendar year. METHODS: A retrospective review of laboratory tests ordered during routine clinical practice as standard screening and diagnostic tests from November 1, 2009, to November 1, 2010 was performed. Data were collected during clinical encounters at one sports medicine clinic and entered into a database for analysis. Descriptive and frequency statistics were used to describe the tests ordered and the frequency of abnormal findings. RESULTS: Five hundred and thirty-nine studies were ordered for diagnostic and routine screenings on 137 athlete patients (86 males, 51 females), representing 49 types of tests. Sample sources included blood, urine, skin lesions, and fecal matter. The most commonly ordered tests were complete blood count, comprehensive metabolic panel, serum ferritin, creatine kinase, serum iron and total iron binding capacity, total cortisol, thyroid stimulating hormone, and lipid panels. There were 217 studies (40%) flagged as abnormal by the reporting laboratory. CONCLUSION: This report provides greater insight into the diverse array of laboratory studies ordered over a 1-year period for diagnosis and screening of elite athletes. A high percentage of the results were flagged as abnormal by the laboratory. These findings show that the unique physiology of the elite athlete must be considered when interpreting laboratory findings in this population.

Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification.

OBJECTIVE: The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. METHODS: A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. RESULTS: Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). CONCLUSION: This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.

The American Chiropractic Board of Sports Physicians Position Statement on Pre-Participation Examinations: An Expert Consensus.

OBJECTIVE: The purpose of this paper is to present a position statement of best practices for the provision of a safe and high-quality pre-participation examination (PPE) and to provide recommendations on education requirements for doctors of chiropractic providing the PPE. METHODS: In 2014, the American Chiropractic Board of Sports Physicians (ACBSP) Board of Directors identified a need to review and update the ACBSP position statements and practice guidelines in order to be current with evolving best practices. Twelve ACBSP certificants, 10 Diplomates of the ACBSP, and 2 Certified Chiropractic Sports Physicians, met in April 2015 to author a pre-participation position statement using an expert consensus process. Panel members excluded anyone with commercial conflicts of interest and included individuals with expertise in clinical sports medicine and the performance of PPEs. A literature review was performed and circulated in advance for use by the panel in addressing the topic. The position statement was written through a consensus process and accepted by the ACBSP Board of Directors in May of 2015. RESULTS: The ACBSP Position Statement on Pre-participation Examinations identifies the qualifications and best practices for doctors of chiropractic to perform a PPE. CONCLUSION: This position statement states that doctors of chiropractic with post graduate education and current Diplomates of the ACBSP or Certified Chiropractic Sports Physicians certification have the prerequisite education and qualifying skills to perform PPEs.

Development of the 2012 American Chiropractic Board of Sports Physicians position statement on concussion in athletics.

OBJECTIVE: The purpose of this article is to provide a summary of the development of the American Chiropractic Board of Sports Physicians (ACBSP) Position Statement on Concussion in Athletics regarding the management of concussion in sport and to offer suggestions to qualifying doctors of chiropractic (DCs) to make return-to-play decisions and clarify common concepts pertaining to evaluating and managing concussion in sport. METHODS: A literature review of position statements from sports medicine organizations was performed. The authors reviewed each statement for content. Key issues in the management of concussion in sport were identified with special consideration to concussion management by DCs. A position statement on the management of concussion in sport was drafted by the authors and submitted to the Board of Directors of the ACBSP for review. The Board of Directors called for minor revision; and after all revisions were made, the document was resubmitted. The Board of Directors of the ACBSP accepted the document for publication and presentation. The document was presented and disseminated to certificants by the ACBSP at the 2011 Chiropractic Sports Sciences Symposium. RESULTS: The 2012 ACBSP Position Statement on Concussion in Athletics was accepted by the ACBSP Board of Directors. CONCLUSION: The Position Statement on Concussion in Athletics has been accepted by the ACBSP. This document offers guidance on the management of concussion in sport and provides qualifying DCs information to make return-to-play decisions.

Organization and multidisciplinary work in an olympic high performance centers in USA

The organization and methodology of providing services to athletes through Olympic high performance centers varies among the National Olympic Committees (NOC). Between NOCs, provider composition and methodology for the delivery of services differs. Services provided typically include sports medicine and sports performance. NOCs may provide service through a university-based system or high performance centers. The United States Olympic Committee (USOC) provides services using multiple approaches through a hybrid model that includes three Olympic Training Centers, National Governing Bodies (NGB) high performance centers and independent specialty care centers. Some highly developed National Governing Bodies have dedicated high performance training centers that serve only their sport. The model of sports medicine and sports performance programming utilized by the USOC Olympic Training Centers is described in this manuscript.

Organización y trabajo multidisciplinario en un centro olímpico de alto rendimiento en los Estados Unidos / Organization and multidisciplinary work in an olympic high performance centers in USA

La organización y metodología para proporcionar servicios a atletas a través de centros olímpicos de alto rendimiento varía entre los Comités Olímpicos Nacionales (NOC, por su sigla en inglés). Entre los NOCs hay diferencias en la composición y metodología de la entrega de servicios. Entre los servicios que se entregan habitualmente, están la medicina del deporte y el rendimiento en los deportes. Los NOCs pueden proporcionar servicios a través de un sistema centralizado en las universidades o en los centros de alto rendimiento. El Comité Olímpico de los Estados Unidos (USOC, por su sigla en inglés) proporciona servicios valiéndose de múltiples métodos a través de un modelo híbrido que incluye tres Centros de Entrenamiento Olímpico, Entidades de Gobernación Nacional (NGB, por su sigla en inglés), centros de alto rendimiento y centros de cuidado independientes de diversas especialidades. Algunas Entidades de Gobernación Nacional muy desarrolladas han hecho que ciertos centros de alto rendimiento se dediquen sólo al deporte elegido por ellos. En este manuscrito se describe la programación del modelo de medicina del deporte y de rendimientos del deporte utilizada por los Centros de Entrenamiento Olímpico del USOC.