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Sport Medicine, Injured Athletes and Norbert Elias’s Sociology of Knowledge

Dominic Malcolm

This paper seeks to develop understanding of both clinician-patient encounters within sport and Elias’s sociology of knowledge. Premised on a belief that there is a relatively high degree of consensus between figurational and “non-figurational” research on the social organization of sport medicine, and that such a consensus contrasts with the rather acrimonious relations which have characterized similar perspectival relations in the past, a review of literature is undertaken to highlight aspects of implicit agreement. Using a range of Elias’s concepts, this paper argues that there is broad agreement between researchers that clinician-patient relations are fundamentally structured according to mutually coexisting bodies of knowledge, and that there is cross-theoretical acceptance that such bodies of knowledge are shaped by, and make sense within, the distinct social context in which the respective parties are located. In examining aspects of Elias’s theoretical perspective which have hitherto received relatively little attention in the sociology of sport, this paper invites a revision of readings of this theoretical approach within the subdiscipline.

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Healing the Body in the “Culture of Risk”: Examining the Negotiation of Treatment between Sport Medicine Clinicians and Injured Athletes in Canadian Intercollegiate Sport

Parissa Safai

This case study examines the relationship between the “culture of risk” and the negotiation of treatment between sport medicine clinicians and student-athletes at a large Canadian university. The evidence acknowledges that a “culture of risk” was reinforced under certain circumstances during negotiation, but was also tempered by the existence of a “culture of precaution” that worked to resist those influences. The dialectic between the cultures of risk and precaution reveals some of the tensions inherent in negotiations between clinicians and patient-athletes, and helps to complicate the notion of a “culture of risk.” Another aspect (one that has rarely if ever been examined) of the negotiation of treatment is also considered—the promotion of “sensible risks” by clinicians to injured athletes.

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Product Liability in Sport Medicine

Lisa Gorman

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The Demise of the Sport Medicine and Science Council of Canada

Parissa Safai

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Investigating the Nexus of Paralympic Bodies With Medicine

Nancy Quinn and Laura Misener

The nexus of athleticism and bodily impairment persists as an uneasy site of interrogation in contemporary scholarship, in the sporting media and within the practice of sport medicine ( Brittain et al., 2020 ; Howe, 2018 ; Pullen et al., 2020 ). Lupton ( 2012 ) and Malcolm and Safai ( 2012

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Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis

Rafel Cirer-Sastre, Alejandro Legaz-Arrese, Francisco Corbi, Keith George, Jinlei Nie, Luis Enrique Carranza-García, and Joaquim Reverter-Masià

Purpose: The authors evaluated the impact of acute exercise and 24-hour recovery on serum concentration of cardiac troponins T and I (cTnT and cTnI) and N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) in healthy children and adolescents. The authors also determined the proportion of participants exceeding the upper reference limits and acute myocardial infarction cutoff for each assay. Method: Web of Science, SPORTDiscus, MEDLINE, ScienceDirect, and Scopus databases were systematically searched up to November 2017. Studies were screened and quality-assessed; the data was systematically extracted and analyzed. Results: From 751 studies initially identified, 14 met the inclusion criteria for data extraction. All 3 biomarkers were increased significantly after exercise. A decrease from postexercise to 24 hours was noted in cTnT and cTnI, although this decrease was only statistically significant for cTnT. The upper reference limit was exceeded by 76% of participants for cTnT, a 51% for cTnI, and a 13% for NT-proBNP. Furthermore, the cutoff value for acute myocardial infarction was exceeded by 39% for cTnT and a 11% for cTnI. Postexercise peak values of cTnT were associated with duration and intensity (Q (3) = 28.3, P < .001) while NT-proBNP peak values were associated with duration (Q (2) = 11.9, P = .003). Conclusion: Exercise results in the appearance of elevated levels of cTnT, cTnI, and NT-proBNP in children and adolescents. Postexercise elevations of cTnT and NT-proBNP are associated with exercise duration and intensity.

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The Effect of Growth Hormone Treatment on Physical Performance Indices in Children With Idiopathic Short Stature

Adi Weinberg, Nitzan Dror, Katya Motin, Michal Pantanowitz, Dan Nemet, and Alon Eliakim

Purpose: To examine the effect of growth hormone (GH) treatment on physical performance in children with idiopathic short stature and normal GH secretion. Materials and Methods : A total of 24 children participated in the study (13 GH-treated, 11 non-treated, aged 8–13 y, 11 males and 13 females, Tanner stage 1–2). Participants performed a battery of motor skill performance tests (Eurofit), as well as the Wingate anaerobic test. Results: No statistically significant differences in any of the Eurofit physical fitness test results (eg, 20-m shuttle run 33.0 [15.1] vs 25.1 [21.0] laps in treated and nontreated participants, respectively, P = .25) or the Wingate anaerobic test were found between the groups (eg, peak power 5.0 [2.9] vs 3.9 [2.6] watts/kg in treated and nontreated participants, respectively, P = .2). Conclusions: Therapeutic usage of exogenous GH for pre and early pubertal children with idiopathic short stature and normal GH secretion was not associated with beneficial effects on physical performance indices. This suggests that the use of GH as a potential performance enhancing agent, in this age group, at least at commonly used doses, is not advantageous.

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New Insights Into Accelerometer-Measured Habitual Physical Activity and Sedentary Time During Early Recovery in Pediatric Concussion

Bhanu Sharma, Joyce Obeid, Carol DeMatteo, Michael D. Noseworthy, and Brian W. Timmons

Purpose: Concussion management is shifting away from a rest-is-best approach, as data now suggest that exercise-is-medicine for this mild brain injury. Despite this, we have limited data on habitual physical activity following concussion. Therefore, our objective was to quantify accelerometer-measured physical activity and sedentary time in children with concussion (within the first month of injury) and healthy controls. We hypothesized that children with concussion would be less active than their healthy peers. Methods: We performed a secondary analysis of prospectively collected accelerometer data. Our sample included children with concussion (n = 60, 31 females) and historical controls (n = 60) matched for age, sex, and season of accelerometer wear. Results: Children with concussion were significantly more sedentary than controls (mean difference [MD], 38.3 min/d, P = .006), and spent less time performing light physical activity (MD, −19.5 min/d, P = .008), moderate physical activity (MD, −9.8 min/d, P < .001), and vigorous physical activity (MD, −12.0 min/d, P < .001); these differences were observed from 8:00 AM to 9:00 PM. Sex-specific analyses identified that girls with concussion were less active and more sedentary than both boys with concussion (P = .010) and healthy girls (P < .010). Conclusion: There is an activity deficit observed within the first month of pediatric concussion. Physical activity guidelines should address this while considering sex effects.

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Effects of Self-Massage Using a Foam Roller on Ankle Range of Motion and Gastrocnemius Fascicle Length and Muscle Hardness: A Pilot Study

Akane Yoshimura, Robert Schleip, and Norikazu Hirose

Context: Several studies have reported that self-massage using a foam roller (FR) increased joint range of motion (ROM) immediately. However, the mechanism of increasing ROM by the FR intervention has not been elucidated. Objective: To clarify the mechanism by investigating properties and morphological changes of muscles targeted by the FR intervention. Design: An interventional study. Setting: An athletic training laboratory. Participants: Ten male college volunteers with no injuries in their lower limbs (mean [SD]: age 23.8 [3.2] y, height 173.2 [4.9] cm, weight 69.5 [8.6] kg). Intervention: The FR intervention on the right plantar flexors for 3 minutes. Main Outcome Measures: Maximum ankle ROM, muscle hardness, and fascicle length of the gastrocnemius muscle at the neutral (0°), maximum dorsiflexion, and maximum plantar flexion positions. All measurements were conducted before (PRE) and after (POST) the FR intervention. Results: Dorsiflexion ROM increased significantly at POST (PRE: 13.6° [8.0°], POST: 16.6° [8.4°]; P < .001), although plantar flexion ROM did not change significantly between PRE and POST (PRE: 40.0° [6.1°], POST: 41.1° [4.9°]). There was no significant difference in muscle hardness and fascicle length between PRE and POST in any of the angles. Conclusions: Dorsiflexion ROM increased significantly by the FR intervention in the present study; however, muscle hardness and fascicle length did not change. FR may affect not only the muscle but also the fascia, tendon, and muscle-tendon unit. The FR protocol of the present study can be applied in clinical situations, because it was found to be effective to increase ROM.

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Effectiveness of PRP Injection in Reducing Recovery Time of Acute Hamstring Injury: A Critically Appraised Topic

Mary Lynn Manduca and Stephen J. Straub

Clinical Scenario: Hamstring strains are common athletic injuries, with a high-recurrence rate (34%). Recently, platelet-rich plasma (PRP) injections have gained popularity as a potential treatment option to accelerate healing of hamstring injury. Focused Clinical Question: Does the combination of PRP injection and rehabilitation decrease recovery time of acute hamstring injury as compared to rehabilitation alone in college athletes? Summary of Key Findings: A literature search resulted in 3 randomized controlled trials. One study showed benefits in various outcome measures with PRP, compared to rehabilitation alone, while 2 showed no benefits. One study reported improved pain, ultrasonography regenerative indications, and recovery time with PRP injection following acute hamstring injury; however, larger studies have shown no benefits. The literature demonstrates conflicting evidence regarding benefits of PRP injections in hamstring injuries. Clinical Bottom Line: At this time, PRP injections cannot be recommended as having value for hamstring injuries, compared to rehabilitation alone. Strength of Recommendation: Due to inconsistent or limited quality patient-oriented evidence in existing literature, the strength of this recommendation is grade B, based on the strength of recommendation taxonomy.