Ocular injuries occur at a high rate in the United States and are a common complaint in the emergency department (ED). The CDC estimates that the annual rate for all-cause ocular injuries presenting to the ED is approximately 37.6 per 10,000 (1). The personal impact of ocular injury is an obvious one which necessitates urgent evaluation and possibly emergent ophthalmologic evaluation for vision preserving intervention. Specific sports and recreational activities increase the risk of injury; these include sports involving projectiles (i.e., target shooting, racquet sports, hockey pucks, lacrosse) as well as combat sports (i.e., martial arts, boxing, wrestling). Sideline physicians should be aware of the sports setting and be prepared for ocular injuries with the proper sideline equipment. Prompt recognition, management, and referral can lead to decreased morbidity in this select population.

Injuries resulting from facial trauma are common in all sports. Athlete-to-athlete contact, falls, and blows from equipment account for the majority of these events. Appropriate knowledge of basic science, relevant anatomy, and clinical skills is required to provide the correct medical care. While true medical emergencies are infrequent, a prompt accurate diagnosis is essential in developing targeted management and return to play options.

Cerebral palsy (CP) is a group of debilitating motor disorders that carries a wide array of clinical presentations ranging from isolated physical or cognitive impairment to global loss of function. Despite the prevalence of CP, recommendations and benefits of physical activity/exercise have historically not been clearly defined. The research on the subject has several limitations, including small sample size, power, standardized measures/outcomes, and poor classification regarding severity of the disease. Nonetheless, the general consensus and new research shows that individuals with CP who participate in sports and exercise regimens, even at reduced frequency and intensity, exhibit improvements in health care benefits, including cardiorespiratory endurance, gross motor function, gait stability, and reduction in pain. These regimens can be prescribed safely and individualized by health care providers to improve morbidity and mortality in patients suffering from CP.

The effectiveness of osteopathic manipulative treatment (OMT) in the modification of various hormones has been studied; however, there is still a need for quantitative measurements to determine how large of an influence exists. The goal of this meta-analysis is to investigate the implications OMT has on cortisol levels. A systematic literature search restricted to English was performed from October 2022 to November 2022 using Google Scholar, OSTMED.DR, and PubMed and included articles from 2000 onward. Articles were excluded if they did not include a measurement for the control group in their study. We identified 4120 studies for potential inclusion. Of these, a total of four studies met the inclusion criteria, with a total of 135 participants (N= 68 OMT, N= 67 control). Out of the 135 participants, 126 participants (N= 62 OMT, N= 64 control) made up the salivary cortisol studies, and the remaining nine participants made up the serum cortisol studies (OMT N= 6, control N= 3). The National Institutes of Health (NIH) bias assessment tool was utilized to measure the risk of bias. Standard mean differences were calculated for effect size. A mean difference in cortisol of 0.10μg/dl (-10μg/dl, 95%CI -0.15, -0.04) was found when comparing all pre-versus post-cortisol levels with OMT versus sham control groups. OMT demonstrated a 0.10μg/dl larger decrease in cortisol than sham control treatments. The standard mean difference was found to be -0.46 (95%CI -1.40, 0.48) making this finding a medium effect size without significance. Heterogeneity for the salivary analysis measured by I 2 was 0% indicating no significant heterogeneity across studies. When serum cortisol was included, heterogeneity stayed at 0%. A larger number of high-quality studies, especially those specific to serum cortisol, are recommended, to elucidate the relationship between OMT and cortisol. This research suggests OMT reduces cortisol more than sham treatment before versus after OMT treatment, and though the change is small when comparing after one treatment, it may have clinical usage if multiple OMT sessions are performed.

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