Myositis ossificans in a child athlete: a case study.

Background: A 13-year-old female athlete presented with a painful lesion in her right buttock for which she had been receiving physiotherapy. It was keeping her from participating in sports. Aim: To report on a case of traumatic myositis ossificans in a child athlete - including the presentation, investigations, management, and outcome. Findings: Palpation of the right buttock indicated a tender mass. Investigation by musculoskeletal ultrasound detected a large hypoechoic lesion. An MRI revealed patterns of calcification that were inconclusive in differentiating between a malignant or benign lesion. Macroscopic and microscopic histological examination, as well as immunohistochemistry, were consistent with myositis ossificans (MO), a non-malignant condition. The patient improved remarkably within three months of treatment with rest, non-steroidal anti-inflammatory drugs (NSAIDs) and extracorporeal shock wave therapy (ESWT). Implications: Accurate differentiation of myositis ossificans from other benign and malignant soft tissue lesions may require histological evaluation in addition to a comprehensive radiological workup. Successful treatment with the patient being able to return to a pain-free and active state is achievable. Extracorporeal shock-wave therapy can play an important role in the management of this condition and should be considered when presented with a case of MO.

The epidemiology of injury and illness amongst athletes at the Indian Ocean Island Games, Mauritius, 2019.

Background: The Indian Ocean Island Games is a multi-sport event that occurs every four years and includes athletes from seven islands of the Indian Ocean, namely, Comoros, Reunion, Mayotte, Madagascar, Maldives, Seychelles, and Mauritius. Objectives: This study aims to describe the injury and illness epidemiology of the athletes participating during the 2019 Indian Ocean Islands Games. Methods: This prospective cohort study recorded injury and illness cases from athletes who competed in these Games. All medical physicians received detailed instructions and training on data collection using an injury report form. All athletes (minors and adults) who provided consent, or consent given from the minors' guardians, were included in this study. Athletes who did not provide consent for this study were excluded. Results: Athletes (n = 1 521; 531 women and 990 men) reported 160 injuries (injury incidence rate of 11%) and 85 illnesses (illness incidence rate of 6%). The percentage of distribution of injuries were highest in football and basketball. Most injuries occurred during competition, compared with training, joint sprains were the most common type of injury (28%), followed by muscle strains (19%). Men suffered most of the injuries (79% vs. 21% for women). Similarly, men sustained more illnesses than women (57% vs. 43%). Most illnesses affected the respiratory system (67%), and infection was the most common cause of illness (84%) in participating athletes. Conclusion: These findings are similar to previous events in other parts of the world. However, unique ailments, not previously reported on, were discovered. Epidemiological data from this study can be inferred to athletes who compete in similar multi-sport events in the Indian Ocean region.

Sport Concussion Assessment Tool: baseline and clinical reference limits for concussion diagnosis and management in elite Rugby Union.

OBJECTIVES: Rugby Union has adapted the Sports Concussion Assessment Tool (SCAT) into an abridged off-field concussion screen and the complete SCAT is used during diagnostic screens performed after head impact events. No firm guidelines exist as to what should be considered "abnormal" and warrant further evaluation. This study evaluates SCAT performances in 13,479 baseline SCAT assessments, and proposes clear reference limits for each sub-component of the SCAT5. Baseline reference limits are proposed to guide management of baseline testing by identifying abnormal sub-tests, enhancing the clinical validity of baseline screens, while clinical reference limits are identified to support concussion diagnosis when no baseline is available. DESIGN: Cross sectional census sample. METHODS: 13,479 baseline SCATs from 7565 elite male rugby players were evaluated. Baseline reference limits were identified for each sub-test as the sub-test result achieved by approximately 5% of the population, while clinical references limits corresponded to the sub-test score achieved by as close as possible to 50% of the cohort. RESULTS: Players reported symptoms 35% (95% CI 1.29-1.42) more frequently during SCAT5 than SCAT3 baseline assessments (mean 1.4±2.7 vs 1.0±2.4). Ceiling effects were identified for many cognitive sub-tests within the SCAT. Baseline and Clinical reference limits corresponding to the worst performing 5th percentile and 50th percentile were described. CONCLUSIONS: Targeted baseline re-testing should be repeated when abnormal sub-tests are identified according to proposed baseline reference limits, while a more conservative clinical reference limit supports concussion diagnosis during screens in diagnostic settings.

Implications of COVID-19 for resumption of sport in South Africa: A South African Sports Medicine Association (SASMA) position statement - Part 1.

The significant impact of the coronavirus disease 2019 (COVID-19) pandemic has extended to sport with the cessation of nearly all professional and non-professional events globally. Recreational parks and fitness centres have also closed. A challenge remains to get athletes back to participation in the safest way, balancing the protection of their health while curbing the societal transmission of the virus. With this Position Statement, the South African Sports Medicine Association (SASMA) aims to guide return-to-sport as safely as possible, in an evidence-based manner, given that COVID-19 is a new illness and new information from experts in various fields continues to emerge. Clinical considerations are briefly described, focusing on a return-to-sport strategy, including education, preparation of the environment, risk stratification of sports and participants, and the practical implementation of these guidelines. The management of the potentially exposed or infected athlete is further highlighted. It is important that persons charged with managing athletes' return-to-sport in any environment must be up-to-date with local and international trends, transmission rates, regulations and sport-specific rule changes that might develop as sport resumes. Additionally, such information should be applied in a sports-specific manner, considering individual athlete's and team needs and be consistent with national legislation.

Implications of COVID-19 for resumption of sport in South Africa: A South African Sports Medicine Association (SASMA) position statement - Part 2.

The lockdown regulations due to the coronavirus pandemic (COVID-19) that broke out towards the end of 2019 and continued to spread throughout most countries in the world had a negative effect on the sporting community. The South African government eased the lockdown rules to Level 1 from 21 September 2020. In Part 2 of this Position Statement of the South African Sports Medicine Association (SASMA), the authors address the position regarding the safe return to sports for athletes who were infected by the virus. An update on clinical manifestations and multi-organ involvement, testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), prolonged positive real time polymerase chain reaction (RT-PCR) and the role of quantitative real time polymerase chain reaction (RT-qPCR) in informing return to sports, grading of disease severity, individualised management of infected athletes and graduated return to play guidelines (GRTP) is provided. The authors also share thoughts on athletes with disabilities, immunisation, the using of masks during exercise and utilising biologically safe environments (BSE). Finally the SASMA Guidelines for Safe RTP in Level 1 lockdown during SARS-Cov-2 are introduced.

'Make exercise the elixir across an economic divide': A message to COVID-19 decision makers.

South Africa, like other countries around the world, has used a lockdown strategy to address the initial phases of the COVID-19 epidemic. The significant restrictions on population movement have included initially limiting exercise to the home. There is substantial evidence for the many benefits of exercise. This study specifically emphasises the benefits of exercise to the immune system, particularly for those most vulnerable to the effects of the SARS-CoV-2 virus and proposes measures to improve access to exercise in a demographically diverse and economically disparate society.

South African professional Super Rugby players' lived experiences of career-related traumatic injuries: A descriptive phenomenological analysis.

Background: Historically, non-career-ending traumatic rugby injury (TRI) has been viewed from a predominantly biological perspective. However, dimensional perspectives, such as the biopsychosocial model, have highlighted the need to incorporate psychosocial understandings of TRI into treatment plans. Aim: To describe the lived experiences of a cohort of traumatically injured South African Super Rugby players in order to add to the body of literature on the subject of TRI experience. Methods: The employment of a qualitative, descriptive phenomenological method was used to achieve the research outcome. Discussion: Common descriptive themes indicated that TRI seems to exist within three stages: the initial, emotional and subsequent reactions to the traumatic injury. Sub-themes described within each stage included attempts at remaining positive and appraising the severity of the injury during onset, fear responses and concomitant feelings of loss related to foregone career opportunities during the emotional reactions stage, the employment of coping mechanisms, and relying on specific support structures during subsequent reactions. Two novel experiences revealed within this study and not reported in the international literature included the injured players' reliance on compartmentalisation and positive religious belief structures as coping strategies. All themes were reduced to descriptive phenomenological essences that describe a lifeworld or biopsychosocial experience of TRI. Conclusion: Themes drawn from this study can be applied in the future design and implementation of expanded studies and psychological interventions aimed at assisting traumatically injured rugby players during their recovery process. The identified themes affirm aspects from the international literature while highlighting some uniquely South African outcomes.

Addressing negative psychosocial factors linked to severe injury in professional rugby players: An introduction to a group psychotherapy approach.

Background: Negative psychosocial sequelae of severe rugby injury (SRI) in professional rugby players are well documented. Unaddressed, these issues can leave players vulnerable to persistent common mental disorders (CMD) and negatively affect injury recovery processes. Objective: To introduce a psychotherapeutic group intervention aimed at addressing negative psychosocial sequelae linked to SRI in professional rugby player cohorts. Methods: Literature aimed at clarifying the potential efficacy of an integrative group therapy model, the Recovery Mastery Group (RMG), is discussed after which component parts of the intervention are presented. Case illustration: A case illustration is presented comprising examples of how the RMG framework addressed psychosocial recovery issues in a professional South African rugby team during 2019. Conclusion: The proposed Recovery Mastery Group (RMG) is presented as a cost- and time- effective psychotherapeutic intervention that integrates well-researched psychotherapeutic techniques. The RMG appears able to address multiple facets of psychosocial injury recovery, while possibly offering protection from the onset of CMD. This introduction to the RMG can be a forerunner of similar research across larger cohorts, in different team sports, to determine wider therapeutic intervention efficacy.

Eye tracking technology in sports-related concussion: a systematic review and meta-analysis.

OBJECTIVE: The development of objective quantitative tools for the assessment and monitoring of sports-related concussion is critical. Eye tracking is a novel tool that may provide suitable metrics. The aim of this review was to appraise current evidence for the use of eye tracking technology in sports-related concussion assessment and monitoring. APPROACH: A systematic literature review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A search was run using Google Scholar, Microsoft Academic and PubMed for literature published between January 1980 and May 2018. Included were empirical research studies in English where at least 50% of the research participants were athletes, the participants were individuals with a diagnosis of concussion, and eye movements were measured using an eye tracking device. MAIN RESULTS: This systematic review integrates 21 publications on sports-related concussion and eye tracking technology, nine of which also qualified for the meta-analysis. Overall, the literature reported significant findings for variables in each of the four classes of eye tracking measurements (movement, position, count, and latency). Meta-comparison was made for seven variables for the acute concussions (the difference between the concussed and the control groups was significant for all of them) and one variable for the latent concussions (the difference was not significant). SIGNIFICANCE: Most saccadic and pursuit deficits may be missed during clinical examination, and therefore eye tracking technology may be a useful and sensitive screening and monitoring tool for sports-related concussions. The inconsistencies between the eye movement metrics and methodology still make inferences challenging; however, using tasks that are closely related to brain areas involved in executive functions (such as memory-based saccade or antisaccade tasks) in the acute injury phase holds promise in differentiating between athletes who have a concussion compared to those who do not.

Concussion knowledge and attitudes among amateur South African rugby players

Background: The South African Rugby Union's BokSmart programme currently educates coaches and referees on concussion. Rugby players are often more familiar with their teammates than the coach or referee. Therefore they are well-positioned to play a pivotal role in rugby safety if they have adequate knowledge to identify subtle signs and abnormal behaviour displayed by a concussed teammate. However, no programme focuses on concussion education among South African rugby players and there is a dearth of literature on concussion education programmes among rugby players which could lead to safer return to play (RTP) habits.Objectives: To evaluate South African rugby players' concussion knowledge and attitudes/behaviours regarding RTP following a concussion.Methods: A descriptive, cross-sectional study was used. Participants (n=294) were divided into junior amateur high school (JAHS) (n=216) and senior amateur club (SAC) (n=78) players. The modified RoCKAS-ST questionnaire was used to evaluate their concussion knowledge index (CKI) and concussion attitudes/behaviours index (CAI) regarding RTP.Results: On average, 62% (JAHS) and 60% (SAC) of the CKI questions were answered correctly. JAHS participants correctly identified 66% of concussion symptoms, similarly to the SAC participants (63%), rendering similar (p=0.37) overall CKI scores when comparing the two groups. The CAI questions yielded similar (p=0.98) results between the groups, reporting safe responses in 66% (JAHS) and 67% (SAC) of the items.Discussion and conclusion: Junior and senior South African amateur rugby players lacked approximately one-third of essential concussion knowledge, which may lead to a display of unsafe attitudes/ behaviours to concussion and RTP. Further research is warranted to inform educational programmes on concussion among rugby players

Uterine actinomycosis associated with an enterocutaneous fistula. A case report.

A postmenopausal woman with suppurative actinomycotic uterine infection complicated by an enterocutaneous fistula is reported. It occurred against a background of prolonged use of an intra-uterine contraceptive device.