BJSM Podcast

Babette Pluim (BJSM’s deputy editor) talks to Ben Kibler (medical director of the Lexington Clinic Sports Medicine Center, Lexington, Kentucky) about his varied and prolific career in tennis and baseball sports medicine. Dr Kibler discusses his research on the shoulder and also the tennis serve, the importance of considering biomechanics in injury prevention and recovery, and the role of surgery. 0.43 Founding the society for tennis medicine and science 2.34 The increasing focus on the shoulder in sports medicine research 3.45 Dr Kibler interest in the scapula 6.09 The tennis serve as a weapon 9.03 The importance of biomechanics in sports medicine 11.14 The Kibler rehabilitation programme 13.46 The role of surgery 15.02 Basics of the throwing motion conference 16.28 Do we need guidelines on how many serves young tennis players should hit? 19.11 The importance of the rotation of the shoulder and position of the scapula in preventing injury See also: Basics of the throwing motion conference

Tom Best, co-medical director of Ohio State University Sports Medicine and professor of Family Medicine, OSU College of Medicine, talks about his work on the treatment of hamstring injuries. 1.00 - Clinical scenario: acute hamstring injury 4.15 - Recovery time 9.34 - Considerations before returning to sport 17.00 - Recurrence 19.30 - Use of NSAIDs 23.30 - Role of massage in sports medicine injuries 26.20 - American College of Sports Medicine 2012 meeting in San Francisico 30.30 - Other hamstring injury resources See also: Carl Askling’s BJSM podcast on hamstring injuries http://bit.ly/zFjobU BJSM article: Do you consider two types of injury? http://bit.ly/15Dzv8a Feb 2012 issue of BJSM http://bjsm.bmj.com/content/46/2.toc Tom also mentioned: Gisela Sole’s paper http://bit.ly/10aHLnR Jan Ekstrand http://bit.ly/ZMbrHW Tom’s book is Evidence Based Sports Medicine

Pregnancy is hardly an uncommon condition in women, so what are the ins and out of exercise during those nine months? Harriet Vickers (BMJ’s assistant multimedia producer) talks to Bronwyn Bell (consultant obstetrician and gynaecologist) about the benefits and risks of physical activity from conception to postpartum, and how to look after women at different levels of fitness. 0:00 Conception: Getting in shape before becoming a mum and optimising your chances of conception 2:16 BMI and pregnancy 2:40 Benefits of exercise during pregnancy 4:00 Does exercise put the fetus at risk? The role of core temperature. 5:40 Contact sports and preventing injury during pregnancy 6:00 Absolute contraindications to exercise during pregnancy 8:34 Physiological changes - energy balance and body changes 11:30 Case management - initiating an exercise program in the unfit and newly pregnant woman 12:50 Case management - advising the regularly exercising woman to exercise. The ‘talk rule’ and heart rate as guides. 15:44 Case management - the professional athlete and exercise during pregnancy 17:15 Post-natal exercise advice. Breast feeding and breast support. See also: Royal College of Obstetricians and Gynaecologists - Exercise in pregnancy statement http://bit.ly/ZMaYph BMJ editorial - Exercise during pregnancy http://bit.ly/17Um2br

In this podcast, also recorded at UKSEM, Babette Pluim (BJSM deputy editor) interviews Glen Hageman (president of the South African Sports Medicine Association). They discuss the work of SASMA, and plans for the future.

Karim Khan talks to Michael Turner about his career as chief medical advisor for the British Horse Racing Association.

In anther podcast recorded at the UKSEM conference held in London in November, Karim Khan (BJSM editor) talks to Lars Engebretsen (head of science and research for the International Olympic Committee). They discuss the IOC’s work in trauma research, health promotion, and the BJSM-IOC special issues. 2:32: The launch of the IOC’s focus on injury prevention and health promotion (IPHP). 4:00 - Periodic health exam - should athletes be screened prior to major competition? Can we prevent high level athletes from dying on the field? 6:20 - The IOC Centres of Excellence program - advancing applied sports and exercise medicine research 7:43 - Conference opportunities in the field - what is coming up?

Hamstring injuries are the most prevalent muscle injuries in sport. Symptoms can be particularly prolonged, healing response poor, and the risk of re-injury high. Carl Askling (Karolinska Institute, Stockholm) has been trialling a new way of categorising these injuries, thinking about them as high-speed running or stretching types. He explains to Karim Khan how these types can be diagnosed and the different treatment and monitoring they require. He also describes how to assess athletes post hamstring injury for return to sport. See also: High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis http://bit.ly/15Dzv8a Hamstring strain injuries: are we heading in the right direction? http://bit.ly/LfwK2I Hamstring issues in sports: still a major clinical and research challenge http://bit.ly/JTzgb7 February’s BJSM has a special focus on hamstring injuries, so there’s even more related content in the issue and on the website.

BJSM editor Karim Khan talks to Michael Turner about his time as chief medical adviser of the Lawn Tennis Association, including the medical scandals that have cropped up and the advances he’s seen in the game’s sports medicine. Dr Turner is also chief medical adviser for the British Horseracing Authority, but more of that in a future podcast…

We’re well down the road to London 2012, but getting here has taken a herculean feat of organisation. In this BJSM podcast Richard Budgett, Chief Medical Officer British Olympic Association, explains how LOCOG has prepared to meet the medical needs of the olympians, their entourage, and their fans.

Coming together at the UKSEM conference in London, Professor Lars Engebretsen (Oslo Sports Trauma Research Center and IOC medical commission) talks to Dr Richard Frobell (Lund University, Malmo, Sweden) about his work on return to exercise after ACL (anterior cruciate ligament) injury. Dr Frobell describes the evidence already on this issue, and his recently published randomized trial on whether surgery or rehabilitation improves pain, symptoms, function in sports and recreation, and knee-related quality of life post-injury See also: A randomized trial of treatment for acute anterior cruciate ligament tears http://bit.ly/rrS51Y The BJSM Warm up about this injury http://bit.ly/tBNdiu Our 2010 interview with Richard Frobell and coauthors of the NEJM paper above http://bit.ly/99leZd

Diagnosing chronic exertional compartment syndrome relies on measuring intramuscular pressure, however Andrew Franklyn-Miller (Sports Surgery Clinic, Dublin; education director at BASEM) has shown the criteria for this are flawed (2.51). He talks to BJSM editor Karim Khan about what clinicians can do to get round this, his theory the condition is caused by biomechanical overload and his work looking at running re-education to alleviate symptoms (6.13). He also gives us his views on barefoot running (10.44) and talks about his research on orthotics (17.57). Finally, as UKsem’s director, Dr Franklyn-Miller gives us an update on the speakers and programme of the upcoming conference (21.04). See also: Foot Orthoses in the Prevention of Injury in Initial Military Training http://ajs.sagepub.com/content/39/1/30.abstract The validity of the diagnostic criteria used in chronic exertional compartment syndrome: A systematic review http://bit.ly/10aEvc9 Chronic exertional compartment syndrome testing: a minimalist approach http://bit.ly/ZkXNBc Chronic exertional compartment syndrome http://bit.ly/oNUhJE BJSM podcast: July’s BJSM and the UKsem Congress, with Andrew Franklyn-Miller UKsem http://bit.ly/13rUCpJ

Whether to opt for exercise treatment, new ‘biological therapies’ like platelet-rich plasma (PRP), or surgery is a clinical challenge. Sweden’s Professor Håkan Alfredson has unique experience in considering these options for patients with Achilles pain. He has 15 years experience as an international leader in sports and exercise medicine. In this podcast, he tells BJSM’s editor Karim Khan how to manage both straightforward (0.37) and complicated (7.34) Achilles tendinopathy. He shares novel insights into the contribution of the aberrant plantaris tendon to chronic medial leg pain (12.40). Prof Alfredson also provides a memorable clinical story to underscore the effectiveness of heavy loading eccentric training in one particularly stubborn patient (3.49). He argues against the use of PRP (17.37) and considers cortisone to be a short-term fix but long-term liability (15.24). The podcast concludes with discussion of both jumper’s knee (19.35) and lateral elbow tendinopathy (24.44). Related paper: Midportion Achilles tendinosis and the plantaris tendon http://bit.ly/11y79bc Related podcasts: Robert Jan de Vos and Adam Weir on platelet rich plasma injections http://bit.ly/JdmFkJ Professor Jill Cook on managing tendinopathies in 2011 http://bit.ly/15DM8Qp

Zoals u weet heeft de VSG deze zomer een samenwerking gesloten met de British Journal of Sports Medicine. Door de samenwerking heeft sportarts Adam Weir een podcast opgenomen met directeur Anja Bruinsma van de Vereniging voor Sportgeneeskunde. Anja Bruinsma gaat in op: Samenwerking VSG en BJSM, erkenning sportgeneeskunde, wetenschapsdomein, centraal stellen van de sporter en de toekomst van de sportgeneeskunde. Voor meer informatie zie ook www.sportzorg.nl, www.sportgeneeskunde.com.

VSG’s (the sports medicine society of the Netherlands) editor-in-chief Hans Tol and congress committee member Adam Weir highlight the October issue of BJSM and preview the VSG Annual Meeting on 1-2 December 2011. The first paper highlighted is from Collard et al [http://bit.ly/ZFQS3U], who have calculated the economic costs of organised sports, leisure time physical activities and physical education classes of 10-12 year old Dutch children (1.26). The outcomes are intriguing! A second paper of interest is from Malliaras and Cook [http://bit.ly/ZkULNj], who contend that the longitudinal changes in antero-posterior patellar diameter support a continuum of pathological changes (2.02). Two new theories on Achilles tendinopathy are presented in this issue. Firstly, Alfredson proposes [http://bit.ly/qyxi2W] there is an important role for the plantaris tendon (2.45). The second paper, presented by Andersson et al [http://bit.ly/15DwlRQ], highlights the role that substance P plays in tendinopathy (3.25). A must-read for those interested in tendon pathology and food for thought for all sport physicians! Visiting the VSG Annual Meeting in Kaatsheuvel, Netherlands, is a decision you won’t regret. Hans Tol and Adam Weir explain in their warm-up why this is a must-visit for sports medicine enthusiasts. However, the conference language is Dutch, so make sure you master this in time! Dr Weir discusses the main topics of interest in the second half of the podcast (5.44).

Ultrasound is rapidly revolutionising point-of-care medicine in many specialties. The last few years have seen technological advances make musculoskeletal ultrasound more practical, opening up opportunities for diagnostic and therapeutic interventions. In this podcast, BJSM’s editor Karim Khan investigates the value of musculoskeletal ultrasound and how to integrate it into practice, with Kim Harmon, director of the Sports Medicine Fellowship at the University of Washington, US, and Sean Martin, Clinical Faculty at Eglin Airforce Base, US. They discuss their experiences of the technique in clinical practice (0.44), which procedures it’s useful for (4.22), how to get started (12.03), using musculoskeletal ultrasound in the training room (13.33), the value of collaborating with radiologists and orthopaedics (15.58) and credentialing (17.46). See also: Musculoskeletal ultrasound education for sports medicine fellows: a suggested/potential curriculum by AMSSM http://bit.ly/XSYhwi American Institute of Ultrasound in Medicine (AIUM) http://www.aium.org/ BJSM podcast: What is the future in sports imaging? Bruce Forster, David Hancock and John Orchard http://bit.ly/ZM6Q8C

In this BJSM podcast, Karim Khan talks to Anthony Beutler (Injury Prevention Research Lab, Uniformed Services University, Bethesda, Maryland) about the JUMP-ACL study http://www.iprc.unc.edu/jumpacl/. It is a large prospective cohort study which investigates risk factors for ACL injury - results will be published soon. They discuss the mechanism of ACL injury in different athletes, the risk of recurrence, and plans to turn the results into practical steps to prevent this injury. Related articles in BJSM include: the IOC current concepts statement on ACL injuries http://bit.ly/ZkTHJ4 Roald Bahr’s editorial - ACL injuries - problem solved? http://bit.ly/13TDrBm as well as previous podcasts if you missed them - Tim Hewett and Lars Engebretsen/Liza Arendt. Topic timecodes Main findings - 02.35 Frequency of occurrence - 07.45 Prevention - 11.30 Link with BMI - 18.00

Karim Khan catches up with associate professor Michele Sterling (Centre for National Research on Disability and Rehabilitation Medicine (CONROD), University of Queenstown, Australia) at the Canadian Physiotherapy Association Congress. As an international expert on neck pain, Michele explains what we currently do and don’t know about whiplash, and advises on managing the condition. She talks us through the importance of early pain management, the link with post traumatic stress disorder and what to do if you suspect this, manual and physical therapies, and treating chronic pain. Resources: Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury http://bit.ly/Mod4oo CONROD’s whiplash evidence based information resource http://bit.ly/11A6xkg

Dr Mike Loosemore is a consultant in sports and exercise medicine who works at the English Institute of Sport and the University College London Hospital. In this podcast he emphasises the importance of clinicians taking an exercise/activity history. (See link Developing healthcare systems to support exercise: exercise as the fifth vital sign http://bit.ly/17Uhlyc). He provides practical tips for clinicians and highlights major health benefits from physical activity in a wide range of settings as diverse as patients with mental illness, breast cancer [2 links below], and those undergoing renal dialysis. See also: Physical activity interventions for cancer survivors http://bit.ly/ZFQ5jD Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects http://bit.ly/ZJHPfb

Professor Jiri Dvorak, one of BJSM’s senior associate editors, shares his 17 years experience as the FIFA chief medical officer. He discusses How FIFA have reduced injuries in football [1], The evidence for football being a great medicine [2 a ,b] ‘Football for Health’ – FIFA’s successful foray into public health education in schools [3]. This is a terrific story of research turning into action – improved health for football players and football players contributing to improve the health of their society. See also: [1] Injuries and illness of football players during the 2010 FIFA world Cup http://bit.ly/11gDgdG [2a] Executive summary: The health and fitness benefits of regular participation in small-sided football games http://bit.ly/17Mntpu [2b] Give Hippocrates a jersey: promoting health through football/sport http://bit.ly/15DIc21 [3] ‘11 for Health’, a football-based health education programme for children: a two-cohort study in Mauritius and Zimbabwe http://bit.ly/13rSMVR

Jon Drezner, BJSM’s senior associate editor for sports cardiology, discusses prevention of sudden cardiac death. Jon discusses where ECG fits into screening, training sport physicians to confidently interpret ECGs, and the utility of automated external defibrillators. Jon is also president-elect of the American Medical Society of Sports Medicine, and he gives us a preview of the 2012 annual meeting in Atlanta (April 21-25). To listen to Jon Drezner’s opening keynote presentation at the IOC’s 3rd World Congress on Prevention of Injury and Illness in Sport (a joint lecture with Professor Antonio Pellucia), follow this link [http://www.ioc-preventionconference.org/] and see the ‘Online Presentations’ tab on the top right of the screen.

BASEM’s chair of education, Dr Andrew Franklyn-Miller, highlights the July issue of BJSM and previews the UKsem Congress in November 2011. Listen to an introduction to Marije T Elferink-Gemser’s paper [http://bit.ly/15DGYDR] on what it takes to be an elite athlete. Another paper of particular interest [http://bit.ly/mLoMpk] highlights the role of proximal stabilisers (eg hip) in patellofemoral pain. Considering the UKsem conference in London, November 23-26? You won’t regret it. Dr AFM discusses the key activities in the second half of the podcast.

South african sports medicine has advanced rapidly in recent years. In this podcast, president of the South African Sports Medicine Association (SASMA) Jon Patricios, and University of Cape Town professor Tim Noakes, share their views on the past, present and future of sports medicine in Africa. Patricios and Noakes review the influence of the 2011 FIFA World Cup on african sports medicine, and highlight the ‘Football For Health’ program which is underpinned by research published in BJSM in 2010 and 2011. Professor Noakes also discusses the Central Governor Model of performance and the role of industry in excessively promoting over-drinking in endurance events. Lastly, a preview of the 2011 SASMA Congress.

Exercise on prescription in Sweden started in the 1980s, and has now become widespread in the country. To help primary care clinicians navigate the evidence on prescribing exercise, the Swedish Institute of Public Health have produced the book Physical Activity in the Prevention and Treatment of Disease (available for personal use from http://www.fyss.se) In this podcast Mai-Lis Hellénius and Carl Johan Sundberg, two of the authors of the book, share their experience of exercise on prescription in Sweden, and give some tips for clinicians thinking of following their model.

This podcast focuses on recent advances in sports imaging – particularly side-line ultrasound and the use of MR imaging at sporting venues where teams are based. It adds to the discussion raised in several papers in the December 2010 issues of BJSM (#16) The print issue has editorials by Kim Harmon and Fran O’Connor (AMSSM) [http://bit.ly/Y1bIfQ], as well by the head of Olympic radiology at Vancouver 2010 – Bruce Forster [http://bit.ly/10aB8lt]. One of the papers discussed in the podcast [http://bit.ly/10aB8lt] relates to use of ultrasound at the sporting venue to undertake injections pre- and post-game.

Treating tendinopathies remains a challenge, despite many advances in the past decade. Listen to practical tips and a tip to consider the time course of tendon injury when making treatment decisions. More information can be found in Professor Cook’s paper Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy http://bit.ly/R0PDbT See also: Jeremy Lewis on shoulder tendinopathy http://bit.ly/mm3C1f Tendon-focussed issue, BJSM #5, April 2011http://bit.ly/11A4rRb

In this edition of the BJSM podcast, Robert Jan de Vos and Adam Weir discuss their research on the efficacy of platelet rich plasma injections for the treatment of tendon injury.

In this edition of the BJSM podcast, human movement specialist Evert Verhagen discusses ankle sprains and rehabilitation.

Everything you wanted to know about the Zurich International Conference on Concussion The Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008 is BJSM’s top download and this podcast takes you behind the scenes. Professor Paul McCrory shares the reasons behind recent changes in management of concussion and provides practical tips for you to prevent concussion and treat it where necessary. Part 3: You are the expert – you teach concussion to fellows and you can recite the SCAT2 even if you have profound headache and retrograde amnesia. Professor McCrory provides tips from the Consensus Statement that have you on the same page as the 27 experts in Zurich. And maybe you were one of them. Listen anyway, send any additional tips to the BJSM blog (http://blogs.bmj.com/bjsm/) and share the news of this practical podcast. Related articles: http://bjsm.bmj.com/content/vol43/Suppl_1/ (Contents page for the Concussion Supplement) http://bjsm.bmj.com/cgi/content/full/43/Suppl_1/i76 (Main Consensus Statement) http://bjsm.bmj.com/cgi/reprint/43/Suppl_1/i85 (SCAT2) http://bjsm.bmj.com/cgi/reprint/43/Suppl_1/i89 (Pocket SCAT2)

Everything you wanted to know about the Zurich International Conference on Concussion The Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008 is BJSM’s top download and this podcast takes you behind the scenes. Professor Paul McCrory shares the reasons behind recent changes in management of concussion and provides practical tips for you to prevent concussion and treat it where necessary. Part 2:Professor McCrory provides advice based on the Consensus Statement for the more junior clinician. You can’t remember whether the previous Consensus meeting was in Vienna or Prague (why do they get to go to all the cool places), you may have only learned about concussion in your university training (eek!) or you may not have worked in sports where concussion is prevalent. Now you are about to cover boxing or Australian Rules Football. Whack this podcast on your iPod and listen to it ringside (that team applies to Australian Football, don’t worry). Related articles: http://bjsm.bmj.com/content/vol43/Suppl_1/ (Contents page for the Concussion Supplement) http://bjsm.bmj.com/cgi/content/full/43/Suppl_1/i76 (Main Consensus Statement) http://bjsm.bmj.com/cgi/reprint/43/Suppl_1/i85 (SCAT2) http://bjsm.bmj.com/cgi/reprint/43/Suppl_1/i89 (Pocket SCAT2)

Everything you wanted to know about the Zurich International Conference on Concussion The Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008 is BJSM’s top download and this podcast takes you behind the scenes. Professor Paul McCrory shares the reasons behind recent changes in management of concussion and provides practical tips for you to prevent concussion and treat it where necessary. Part 1: An overview of the conference process and the highlights of the specific conference papers that you can find in the May supplement of BJSM. What is new in definitions of concussion, concussion in children, return to play guidelines, the role of neuroimaging and biomarkers and advances in protection. Related articles: http://bjsm.bmj.com/content/vol43/Suppl_1/ (Contents page for the Concussion Supplement) http://bjsm.bmj.com/cgi/content/full/43/Suppl_1/i76 (Main Consensus Statement) http://bjsm.bmj.com/cgi/reprint/43/Suppl_1/i85 (SCAT2) http://bjsm.bmj.com/cgi/reprint/43/Suppl_1/i89 (Pocket SCAT2)

Which type of ACL reconstruction is best? How does one decide? What are the rehabilitation implications of each? In this podcast, US and Norwegian knee specialists Elizabeth Arendt and Lars Engebretsen share their experiences from operations that have allowed thousands to return to sport at the highest level. But they also raise the question, “Does everyone who ruptures their ACL need an operation?” Related articles http://bjsm.bmj.com/cgi/content/abstract/bjsm.2009.058156v1 http://bjsm.bmj.com/cgi/content/abstract/bjsm.2009.058024v1 Other relevant links Oslo Sports Trauma Research Center http://www.ostrc.no/en IOC statement http://bjsm.bmj.com/cgi/content/abstract/42/6/394

Dr Robert Sallis serves as the chairman for the Exercise is Medicine initiative and previously served as president of the American College of Sports Medicine.He discusses how clinicians can assess current physical activity levels and motivate patients to meet guideline levels. He also discusses the implications of the May 2010 release of the National Physical Activity Plan in the US.

Dr Genevieve Healy, from the University of Queensland, discusses the recently-recognised phenomenon of ‘sitting’ being a risk factor for cardiac events and mortality independently of ‘physical activity’. She reports that a single 30-minute bout of physical activity does not guarantee cardiac health. The practical implications are that there should be more ‘standing meetings’, ‘standing breaks’ and remote controls being kept out of reach while watching TV.

Steven N. Blair is a Professor in the Departments of Exercise Science and Epidemiology/Biostatistics at the Arnold School of Public Health at the University of South Carolina. His research focuses on the associations between lifestyle and health. He has published over 480 scientific papers. Here he discusses a range of issues relating to fitness and health with BJSM editor Karim Khan. He addresses the question ‘Should health policy focus on physical activity rather than obesity?’ which was the subject of a BMJ ‘Head to Head’ http://bit.ly/VadRke

In this podcast Karim Khan, BJSM Editor, talks to the team behind the NEJM paper - A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears. They discuss their research and the implications for clinicians. See the full article on the NEJM website http://bit.ly/rrS51Y

Paediatric exercise specialist Dennis Caine discusses hot topics relating to kids in sport. How much is too much? What are the major risks? See also: BJSM January issue - Kids in sport http://bit.ly/129d46L