Posts Tagged ‘medicine’

It’s that time of year again, when the International Motorcycle Show returns to town and I remember I still haven’t shared photos from the previous year (I promise I’ll be better).  I’m not going this year due to a busy schedule.  Honestly, last year’s show didn’t catch my interest.

Even the FMX demo felt low in energy.  To be fair, Fitz Army had two members injured, one in Dallas specifically.  I talked to the guys, and they mentioned the ceiling being too low for their set-up, hence the lack of variation on tricks.  This is probably a reason contributing to their absence for 2019.  Nevertheless, Anthony Murray and Cal Vallone did their best to put on a good show, and Matt Buyten wasn’t too bad as a newbie on the mic.
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There were some cool motorcycles on display, including ones from the 1940s and World Superbike champ Jonathan Rea’s Kawasaki Ninja.
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One of my faves was a custom painted bike that was a tribute to a kid with mastocytosis, a condition where mast cells (which are responsible for triggering an allergic reaction) accumulate in various organs.  The disease is rare and not well-studied.  The bike design is based on the mast cells.  It’s an unusual look, and I appreciate the efforts in raising awareness.
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Click here for more photos

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A couple weeks ago, I attended the ConTex Kickoff Brunch.  It was mostly an introduction to the program, which aims to study mild, sports-related traumatic brain injury in patients ages 12-20 and get an idea of how TBI is being treated in the Dallas-Fort Worth Metroplex.  I was able to get some important information that I didn’t cover in a previous post about TBI in relation to action sports.

There I am in the blue and green shirt.  Photo from UTSW Dept of Neurology and Neurotherapeutics

There I am in the blue and green shirt. Photo from UTSW Dept of Neurology and Neurotherapeutics

There’s between 1.6 and 3.8 million reported concussions every year.  Many experts believe that there is a significant amount of under-reporting due to lack of knowledge of symptoms (you don’t have to lose consciousness and CAT scans can be negative) and a strong desire to not get sidelined, whether you’re playing football or skating.  Much of the focus has been on football because that’s where the funding comes from and it is America’s beloved pastime.  However, you can get a concussion from any sport so it’s important to have safe practices and be aware, regardless of what you’re doing.

Women actually have an increase incidence of concussion.  Some of it is due to more reporting, and some of it is due to head size and neck strength.  Thus even if the female athletes are doing fewer spins at a lower height, the risk they face is nothing to overlook.

So what can the action sports community do? (That was a question I asked.)  Learn about concussions and its various symptoms.  Have our friends and family study them up too.  Go to your annual physicals so that you and your doctor have an idea of what is “normal” for you; that will allow them to spot something out of the ordinary that could be a long-term side effect.

Football players have the Maddocks Questions to check up on an athlete who has been hit.  I propose an action sports version:
1. What’s the name of the park?
2. What trick were you doing?
3. What’s the last trick you landed?
4. Who are you skating/riding with?
5. [for contests] Who’s in the lead?

Although there have been interesting developments in TBI research related to biomarkers (proteins that the body produces in response to a concussion) and genetics, lack of resources and funding have produced a need for better statistics on injured groups and long-term studies.  We have no idea why some people develop chronic traumatic encephalopathy (degeneration of the brain) and others don’t.  Moreover, a lot of the focus remains on treatment rather than prevention.  This is why it’s important for everybody to do their part in staying safe.  Even though action sports has prided itself on pushing forward against all odds, sometimes it’s better to sit out.

This past spring, Mat Hoffman told the story of how in 1999, he tore his ACL underwent surgery without anesthesia to receive a synthetic ligament.  Because the LARS™ ligament was banned in the U.S., he had to go to Canada.  The video, illustrated by Taj Mihelic, described why there was no anesthesia and what made it so revolutionary for him.  It piqued my interest in the LARS™ ligament so I did a little digging about its history and current studies.

The Ligament Advanced Reinforcement System, or LARS™, was developed in 1992 with hopes of solving problems with synthetic ligaments in the past decade (Corin).  Those often failed or caused inflammation in the synovial membrane that lines the joints (Machotka et al. 2010).  The LARS™ ligament was made from terephthalic polyethylene polyester fibers that are twisted for increased durability.

1595 From Corin

When Mat received his LARS™ ligament, the procedure was still relatively new.  It made headlines in Australia around 2010, as more professional athletes got LARS™ ligaments and enjoyed the speedy recovery.  That’s not to say there weren’t critics. Moreover, the FDA has yet to approve it.

Reviews of clinical studies thus far lean towards positive outcomes. Batty et al. and Chen at al. have compared the efficacy of many types of synthetic ligaments, and the LARS ligament produced the lowest rate of failure. The results reinforces the idea that this could be a solution to the severe side effects experienced with its predecessors. One issue appears to be the long-term durability. A study by Tiefenboeck et al. published this year examined patients who had their ACL reconstructed with the ligament with at least a ten-year follow-up reveals that re-rupturing does occur. They do not recommend the LARS™ ligament for primary ACL reconstruction. This is, however, just one study. As more results are published and more patients are observed in the long run, a better idea of the uses and limitations of the LARS™ ligament will be known. In Mat’s case, it appears to be a great success.

References

  • Batty LM, Norsworthy CJ, Lash NJ, Wasiak J, Richmond AK, Feller JA. 2015. Synthetic devices for reconstructive surgery of the cruciate ligaments: a systematic review. Arthroscopy. 31(5):957-68.
  • Chen J, Xu J, Wang A, Zheng M. 2009 Scaffolds for tendon and ligament repair: review of the efficacy of commercial products. Expert Review of Medical Devices. 6(1):61-73.
  • Corin – “LARS™ (Medical professionals)”
  • Machotka Z, Scarborough I, Duncan W, Kumar S, Perraton L. 2010. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2:29.
  • Tiefenboeck TM, Thurmaier E, Tiefenboeck MM, Ostermann RC, Joestl J, Winnisch M, Schurz M, Hajdu S, Hofbauer M. 2015. Clinical and functional outcome after anterior cruciate ligament reconstruction using the LARS™ system at a minimum follow-up of 10years. Knee. pii: S0968-0160(15)00131-3.

Around the time I began my new job in the Department of Neuroscience, BMX rider Brett Banasiewicz sustained traumatic brain injury (TBI) from a crash. That was when I started to connect the dots between science and action sports with the realization that not only could action sports make science more interested, but science could help action sports. Too many action sports athletes were sustaining terrible injuries that they couldn’t just bounce back from. The impact of TBI on football players had generated a lot of buzz, but what about the other sports?

Last February, I went to the 2014 Paul M. Bass Neurosurgery Symposium on Traumatic Brain Injury to learn about the latest treatments and prevention methods and to find a way to pass this onto the action sports community. We don’t have a single governing body like the NHL or NFL even though medical staff at events have been doing a wonderful job. Worse is that kids aren’t doing this at school or in a club so the environment can’t be controlled. Sure we have Camp Woodward, but you also have kids who go to the parks on their own or just hit the streets. The action sports community has to educate itself, as well as the doctors who don’t know what someone was doing to have wound up with an injury or the rationale behind wanting to recover ASAP (I’m reminded of the scene in The Crash Reel where Kevin Pearce argues with his family and doctor about hitting the slopes again).
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The Crash Reel and Kevin’s story also helped spark my interest in neuroscience research related to TBI.

Probably the most relevant fact I learned from the symposium was that helmets don’t prevent concussions. But don’t ditch your helmet just yet! They do help against head injuries as a whole by preventing skull fractures and hemorrhaging, but they do nothing to keep the brain from getting jostled inside the skull. Therefore, we need to start examining other ways to minimize TBI in addition to promoting helmet use.

In the case of football, the best proposed solution was modified behavior. Players are learning the proper technique to tackle and block while coaches keep an eye on risky habits that need correction. Now action sports outside of the Olympics generally don’t utilize coaches, but newcomers have to learn from somebody (or something). It is important to pass along knowledge of how to fall in a way that minimizes injury and to know the techniques behind moves like the double cork which bring the head close to another object. Although it’s fun to see people hucking big tricks, a little bit of planning could save a life.

Scientists and doctors are working to better address when injuries do happen. The 4th International Conference on Concussion in Sport has released definitions and guidelines for proper diagnosis, treatment, and management. Less than 10% of TBIs result in loss of consciousness so I recommend looking at their list of symptoms to know whether your friend should go to the hospital.

The symposium also introduced ways scientists have been studying TBI. Most of the research has focused on football players and military veterans even though the majority of TBI actually results from falls and car crashes. I decided to look up any possible studies involving action sports, and to my surprise, I found that Weber State University students used Dew Tour competitors for their subjects last year. The linked article discusses looking at the athletes’ blood for biomarkers, which can be anything from genes, enzymes, cells, or even a measurement (think blood pressure). TBI, or any sort of injury, triggers cell death so scientists can look at neurons for damage or check for the contents that dead cells release.

This past season, the students also employed the Shockbox, helmet sensors that detect head acceleration upon impact. The results could be used to determine course changes that would keep athletes from hitting their heads as hard. The takehome message is that we all have to work together to make action sports safer without having to compromise the fun of pushing the human body.

I was planning on catching up on entries, but then I learned that Josh Perry (you may have seen him on America’s Got Talent as a member of the American BMX Stunt Team) is undergoing radiation treatment. Two and a half years ago, he had a benign tumor removed from his brain. He recovered after a couple of months, but the tumor recently grew back. Since his surgeon recommended against another operation, Josh underwent Gamma Knife® radiation therapy.

In an interview with Eastern Bikes, he describes the non-invasive procedure as having “200 beams of radiation generated by radioactive cobalt that unlike normal radiation are not powerful enough to damage surrounding tissue but once they meet at the pinpointed location they are strong enough to help control/destroy the tumors growth.” Also called Cobalt-60 therapy (for the isotope used), the treatment is known for its precision and reduced side effects. Last month marked its 61st anniversary.

News of Josh’s treatment hits close to home for me, as I have people in my life who have dealt/are dealing with brain tumors. Josh’s positivity is inspiring (definitely read the Eastern Bikes interview), and he is doing well after the procedure. I wish him the best.