Background:Concussion injuries have been highlighted to the American public through media and research. While recent studies have shown increased traumatic brain injuries (TBIs) diagnosed in emergency departments across the United States, no studies have evaluated trends in concussion diagnoses across the general US population in various age groups.Purpose:To evaluate the current incidence and trends in concussions diagnosed across varying age groups and health care settings in a large cross-sectional population.Study Design:Descriptive epidemiological study.Methods:Administrative health records of 8,828,248 members of a large private-payer insurance group in the United States were queried. Patients diagnosed with concussion from years 2007 through 2014 were stratified by year of diagnosis, age group, sex, classification of concussion, and health care setting of diagnosis (eg, emergency department vs physician’s office). Chi-square testing was used for statistical analysis.Results:From a cohort of 8,828,248 patients, 43,884 patients were diagnosed with a concussion. Of these patients, 55% were male and over 32% were in the adolescent age group (10-19 years old). The highest incidence of concussion was seen in patients aged 15 to 19 years (16.5/1000 patients), followed by those aged 10 to 14 years (10.5/1000 patients), 20 to 24 years (5.2/1000 patients), and 5 to 9 years (3.5/1000 patients). Overall, there was a 60% increase in concussion incidence from 2007 to 2014. The largest increases were in the 10- to 14-year (143%) and 15- to 19-year (87%) age groups. Based on International Classification of Disease–9th Revision classification, 29% of concussions were associated with some form of loss of consciousness. Finally, 56% of concussions were diagnosed in the emergency department and 29% in a physician’s office, with the remainder in urgent care clinics or inpatient settings.Conclusion:The incidence of concussion diagnosed in the general US population is increasing, driven largely by a substantial rise in the adolescent age group. The youth population should be prioritized for ongoing work in concussion education, diagnosis, treatment, and prevention.Clinical Relevance:The rise of concussions in the adolescent age group across the general population is concerning, and clinical efforts to prevent these injuries are needed.

Knee injuries are common in sports activities. Understanding the mechanisms of injury allows for better treatment of these injuries and for the development of effective prevention programmes. Tibial torque and knee flexion angle have been associated with several mechanisms of injury in the knee. This article focuses on the injury to the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL) and the meniscus of the knee as they relate to knee flexion angle and tibial torque. Hyperflexion and hyperextension with the application of tibial torque have both been implicated in the mechanism of ACL injury. A combination of anterior tibial force and internal tibial torque near full extension puts the ACL at high risk for injury. Hyperflexion also increases ACL force; however, in this position, internal and external tibial torque only minimally increase ACL force. Several successful prevention programmes have been based on these biomechanical factors. Injury to the PCL typically occurs in a flexed or hyperflexed knee position. The effects of application of a tibial torque, both internally and externally, remains controversial. Biomechanical studies have shown an increase in PCL force with knee flexion and the application of internal tibial torque, while others have shown that PCL-deficient knees have greater external tibial rotation. The meniscus must endure greater compressive loads at higher flexion angles of the knee and, as a result, are more prone to injury in these positions. In addition, ACL deficiency puts the meniscus at greater risk for injury. Reducing the forces on the ACL, PCL and meniscus during athletic activity through training, the use of appropriate equipment and safe surfaces will help to reduce injury to these structures.

Objectives:Concussion injuries have been correlated with significant long-term deleterious effects on patients. While recent studies have shown increased traumatic brain injuries (TBI) diagnosed in U.S. emergency departments, no studies have evaluated trends in concussion diagnoses across the general U.S. population in various age groups. The objective of this study is to evaluate the current incidence and trends in concussions diagnosed across varying age groups and healthcare settings in a large cross-sectional population.Methods:Administrative health records of 8,828,248 members of a large private payer insurance group in the United States were queried. Patients diagnosed with concussion from years 2007 through 2014 were stratified by year of diagnosis, age group, gender, classification of concussion, and healthcare setting of diagnosis (e.g. ED vs. physician’s office). Chi-square testing was used to for statistical analysis.Results:From a cohort of 8,828,248 patients, 43,884 patients were diagnosed with a concussion. Fifty-five percent of concussion patients were male and over 32% were in the adolescent age group (10-19 years old). The highest incidence of concussion was seen in the 15-19 age group (16.5 cases per 1000 patients) followed by the 10-14 (10.5 per 1000), 20-24 (5.2 per 1000) and 5-9 (3.5 per 1000) age groups. Overall there was a 160% increase in concussion incidence from 2007 to 2014. The largest increases were in the 10-14 (243%) and 15-19 (187%) age groups. Based on ICD-9 classification, 29% of concussions were associated with some form of loss of consciousness. Finally, 56% of concussions were diagnosed in the ED and 29% in a physician’s office, with the remainder in urgent cares or inpatient settings.Conclusion:The incidence of concussion diagnosed in the general population in the United States is increasing, driven largely by a substantial rise in the adolescent age group. The youth population should be prioritized for ongoing work in concussion education, diagnosis, treatment and prevention.

Purpose of Review The exponential growth of women participating in competitive sports throughout the years was made possible through several initiatives by the International Olympic Committee and the passage and implementation of Title IX as a federal law in the United States. However, this positive trend towards gender equity in sports has not transpired for women in medicine, especially in fields that care for elite athletes. This current review will discuss specific areas that can be tailored to help female athletes prevent injuries and optimize their athletic performance. We will also highlight how increased female team physician representation in sports may help optimize care for female athletes. Recent Findings Female athletes are considered high risk for certain conditions such as ACL tears, patellofemoral pain syndrome, bone stress injuries, sport-related concussions, and sexual violence in sport. Addressing factors specific to female athletes has been found to be valuable in preventing injuries. Strength and conditioning can optimize athletic performance but remains underutilized among female athletes. Although diversity in healthcare workforce has been found to be beneficial for multiple reasons, women remain underrepresented in sports medicine. Increasing female team physician representation may positively impact care for female athletes. Summary Team physicians must understand the physiologic, biomechanical, and anatomic factors that are unique to female athletes in order to tailor injury prevention programs and optimize their athletic performance. Advocating for gender equity in sports medicine to advance representation of women in the field will increase workforce diversity and promote excellence in sports medicine care.

Purpose of Review Here, we summarize the current scientific literature on the management of sports-related concussion (SRC) in the acute period (< 6 weeks post-injury) with a focus on rest, return to learn, return to play, and emerging treatments. Recent Findings While relative rest is recommended for the first 24-48 h following acute SRC, the most recent guidelines highlight the lack of evidence for complete rest and in fact show that prolonged cognitive and physical rest can be detrimental. Gradual return to learn and play is recommended. Return to sport should only occur once the patient is symptom free. While there are no FDA-approved medications for acute treatment of concussion, there is preclinical data for the benefit of omega 3 fatty acids. Evidence is limited around the benefits of treating sleep disorders, vestibular-ocular dysfunction, and neck pain in the acute period. Summary After 24-48 h of rest, SRC patients may gradually resume cognitive and physical activity. More research is needed to determine if any supplements, medications, and/or physical therapy are indicated in the management in acute SRC. Keywords Sports-related concussion (SRC) . Return to learn . Return to play . Concussion treatmentThis article is part of the Topical Collection on Concussion