Controversy or Hard Evidence?

The topics we deal with in sport medicine run the gamut from traumatic head injury to turf toe. It is the goal of the Clinical Journal of Sport Medicine to provide objective evidence to guide the physician in treating the active patient. In this young field, controversy abounds in areas such as concussion management, while others (e.g., the treatment of the ACL injured knee) are more “mature” in their science. In this age of medicine we, as clinicians, are accustomed to taking an objective, scientific approach to decision making. Experiments and their clinical equivalents (randomized clinical trials) guide our practice. We have been educated that our choices in treatment should be based on such evidence, be it an original study or a critical appraisal of a body of research literature. Yet, the scientific approach is often found lacking in many respects. Not all the problems we face can be studied with such a rigorous approach. Often, “prescientific” case reports and consensus statements, while fallible, provide us with useful guidance. There are still areas of medicine where we rely more on opinion, experience, and consensus. It is only later that the objective, scientific evidence comes forth to support, fine-tune, or change our decision-making process. The practicing sport medicine clinician must assess and treat their patients on an ongoing basis. Regardless of the state of science, we still see a spectrum of problems—all of which require our management. In this issue of the Journal, we bring you a range of articles that span the spectrum from the art to the science of sport medicine. The Clinical Investigations section provides the scientific perspective with original research on a variety of topics ranging from injury risk, to surgical outcomes, to creatine supplementation. The Critical Review section focuses on the specific topic of magnesium supplementation. In addition, the Journal Club continues to deliver a succinct highlight of sport medicine research published elsewhere, along with an original clinical commentary. The Case Reports, on the other hand, provide insightful clinical perspectives on rare conditions. Head injuries are one of the most controversial areas in sport medicine and are perhaps the best example of our need to manage a problem in the face of less-than-perfect evidence. In this issue, we feature both a position statement and a guideline prepared by the Canadian Academy of Sport Medicine (CASM). The “Use of Facial Protection in Ice Hockey” position statement tackles an area of heated debate within the hockey community. It was developed by the CASM Sport Safety Committee after a thorough review of the scientific literature. The clinicians who participated in its development also provided their interpretation of this body of knowledge. The position statement that resulted was therefore a blending of scientific evidence and practical perspective. The “Guidelines for Assessment and Management of Sport-Related Concussion” addresses an even more controversial area. In this area, the scientific literature is less conclusive, and a definitive position statement was therefore not feasible. Upon careful consideration by the CASM Concussion Committee, the guidelines were developed on the basis of consensus. These guidelines were written with the intention of providing clinicians, athletes, parents, and coaches with a simple, practical approach to managing mild head injury in sport. In each case, it is the blend of hard science evidence and practical experience that permit an organization to issue a practical guide for clinicians. CASM is to be applauded for their willingness to take a bold step forward in these areas. The controversy versus hard evidence issue in medical literature is, in many ways, a direct reflection of the art versus science dichotomy of medicine. Even in times of modern medicine and high technology, striking a balance between these two extremes will continue to be the hallmark of wise clinical decision making and good patient care. It is the goal of the Clinical Journal of Sport Medicine to strike this balance. With the spectrum of articles we have published in this issue, we hope we have found a happy medium for the sport medicine clinician.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.