BJSM Podcast

Joining us for this BJSM podcast is the vastly experienced, Dr Roger Hawkes. We chat to him about a wide range of issues, from his role as CMO to the European Golf Tour - where he has built an incredible service, and provided incredible quality of care to the world’s best golfers – to common golfing injuries, and how to assess them. We also touch on the innovative work being done that is looking into the health benefits of golf, and the challenges of working in such a dynamic, and multi-disciplinary environment. So if you want to get better at assessing & managing the golfers that walk through your clinic door, or want to know more about the benefits of golf (so you can further justify next weekend’s round), look no further! Extra Resources Andrew Murray Golf & Health podcast: https://soundcloud.com/bmjpodcasts/andrew-murray-1 ETPI twitter account: https://twitter.com/ETPI_Physiounit Golf & Health Infographic: http://bjsm.bmj.com/content/51/1/20 The relationships between golf and health: a scoping review: http://bjsm.bmj.com/content/51/1/12 Pictorial review of wrist injuries in the elite golfer: http://bjsm.bmj.com/content/50/17/1053 Hip morphology in elite golfers: asymmetry between lead and trail hips: http://bjsm.bmj.com/content/50/17/1081 The prevalence, variety and impact of wrist problems in elite professional golfers on the European Tour: http://bjsm.bmj.com/content/47/17/1075

Are you confused about healthy nutrition, the role of insulin, this concept of ‘insulin resistance’? Can one largely ignore a macronutrient (i.e. carbohydrates) and not drop dead within a few days? Karim Khan, the Editor in Chief of the BJSM vouches for this podcast personally and describes Dr Hallberg as one of the people that has most influenced his understanding of a key medical concept. In addition to Dr Hallberg’s popular (nearing 2 million views!) TEDx talk https://youtu.be/da1vvigy5tQ Here are her further credentials. https://www.virtahealth.com/about/hallberg When Dr Hallberg refers to blood glucose being ‘100’ she is referring to the US convention – using mg/dL which is 5.6 mmol/L in many countries (Europe, UK, Australia, Canada etc.) Highlights include: Dr Hallberg has great training for exercise prescription from her undergraduate and Master’s degrees in Kinesiology. She’s a medical doctor who runs a clinic for obese patients – that’s a better place to speak from than a lot of theorists in the field. Dr. Sarah Hallberg is the Medical Director at Virta Health, a specialty medical clinic that reverses type 2 diabetes safely and sustainably, without the risks, costs, or side effects of medications or surgery. As a physician and exercise physiologist with a passion for helping people be healthy through diet and exercise, she is responsible for providing medical supervision to Virta’s expert team of physicians and oversees the clinical strategy for Virta Clinic participants. Dr. Hallberg is also the executive director of The Nutrition Coalition, a nonprofit organization that aims to educate the public and policymakers about the need to strengthen national nutrition policy so that it is founded upon a comprehensive body of science. Link to Dr Hallberg’s paper: Recent trial she refers to: http://diabetes.jmir.org/2017/1/e5/ A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes Link to other podcasts on BJSM relating to this topic: Professor Timothy Noakes: “High-fat for health” (11k listens) https://soundcloud.com/bmjpodcasts/high-fat-for-health Professor Stephen Phinney “Science behind lo-carb for performance” (9K listens) https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach Professor Jason Fung: “Diet and obesity and diabetes” (6K listens) https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus Link to Dr Hallberg’s nearly 2 million view TEDx talk: “Reversing Type 2 diabetes starts with ignoring the guidelines” https://youtu.be/da1vvigy5tQ

Whilst at the 2017 IOC Prevention of Injury & Illness Conference, BJSM’s Liam West spoke to a key figure within the concussion research world, Associate Professor Kathryn Schneider. Kathryn is a Clinical Specialist in Musculoskeletal Physiotherapy working at the Sport Injury Prevention Research Centre located at the University of Calgary, Canada. She was the lead author in the landmark RCT look at cervicovestibular rehabilitation in sport-related concussion in 2014 (link below). Her most recent research is discussed in this podcast and formed part of the discussion in the 2016 Berlin Concussion in Sport Meeting. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial (2014) http://bjsm.bmj.com/content/48/17/1294.long Rest and treatment/rehabilitation following sport-related concussion: a systematic review (2017) http://bjsm.bmj.com/content/early/2017/03/24/bjsports-2016-097475 What strategies can be used to effectively reduce the risk of concussion in sport? (2017) http://bjsm.bmj.com/content/early/2017/03/01/bjsports-2016-097452 Remember to check out the literature on the new Sports Concussion Assessment Tool (SCAT5) here: http://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097699 The new tool can be found here: http://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097506SCAT5

Ahead of the Finnish Sports Physiotherapy Congress (June 9 and 10, 2017), BJSM editor in chief Karim Khan, chats with the senior author of a study that proved that partial removal of a degenerative torn meniscus does not alleviate mechanical symptoms when compared with sham surgery. That was Teppo Järvinen (http://bit.ly/2rlfW5I), professor of orthopaedics and traumatology at the University of Helsinki and a speaker at the Finnish Congress in June. Before that study (link below), orthopaedists were confident of the benefits of arthroscopic surgery on patients suffering from mechanical symptoms. However, “scientific proof of the benefits had been based entirely on uncontrolled follow-up studies,” said Dr Raine Sihvonen, specialist in orthopaedics at the Hatanpää Hospital in Tampere and first author of the study. Here is the link to the study in the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1305189#t=article In the podcast we cover: - A bird’s eye view of Bruce Moseley’s seminal sham surgery study – arthroscopy was no more helpful for knee arthroscopy in older people than sham surgery http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article - The fact that MRI is not a good predictor of who will benefit from knee arthroscopy. Here’s Dr Martin Englund’s NEJM paper. http://www.nejm.org/doi/full/10.1056/NEJMoa0800777#t=article - Ewa Roos’ and Nina Kise’s study showing that exercise provides as good results as arthroscopic meniscectomy. Remember – the patients who fail rehab also fail surgery. Look for other solutions – not arthroscopy – to cure that patient. http://www.bmj.com/content/354/bmj.i3740 Links: Here’s a YouTube video summarizing the FIDELITY study in 4 minutes. https://www.youtube.com/watch?v=RaDWkJHmEB0 Here the link to the Finnish Sports Physiotherapy Congress – June 9 & 10, 2017. http://fspa-congress.com/

Doping ist immer ein heisses Thema, besonders in Jahren der Olympischen und Paralympischen Spiele. Dr Markus Laupheimer (London/Zürich) stellt die Fragen in deutscher Sprache an Prof. Dr. Patrick Diel. Patrick ist Professor an der Deutschen Sporthochschule Köln am Institut für Kreislaufforschung und Sportmedizin, Abteilung Molekulare und Zelluläre Sportmedizin. Er hat ein spezielles Interesse an präventiver Dopingforschung und beantwortet uns einige interessante Fragen: - Was ist Doping? - Wo liegen die Nutzen und Risiken von Nahrungsergänzungsmitteln? - Was ist Gen-Doping? - Was ist eine Medizinisch Therapeutische Ausnahmegenehmigung (TUE)? - Wie können wir unsere Athleten vor Doping schützen? Weitere Informationen zum Thema Doping findet Ihr unter: https://www.nada.de/de/nationale-anti-doping-agentur-deutschland/ http://www.doping-prevention.com/ https://www.dshs-koeln.de/visitenkarte/einrichtung/zepraedo/ Für weiter englischsprachige und deutschsprachige Inhalte folgen Sie uns gerne auf Twitter @BJSM_BMJ

Britain's leading anti-sugar campaigner and one of the most prolific doctors in the world influencing obesity thinking and highlighting the harms of too much medicine. In addition to being a Consultant Cardiologist, Dr Malhotra is a member of the board of trustees of UK health think tank, The King’s Fund and a member of the Academy of Medical Royal Colleges Choosing Wisely Steering Group Here’s the link to his website: http://doctoraseem.com/biography/ Topics covered include: No association of saturated fats and heart disease in primary or secondary prevention studies. Focus on sugar - •CVD mortality has come via reduction in smoking & trans fats with better acute AMI management. •Statins have a number needed to treat of 1 in 83 for mortality in secondary prevention in men •Stents save lives during heart attacks but not for 'stable' coronary disease •PREDIMED and Lyon heart study •Cholesterol is not the mechanism of action of how diet studies work •Practical explanation-of frying vegetable oils and dangerous omega 6 (high omega 6 to omega 3 is bad) •Butter and coconut oils have saturated fatty acids and are stable in cooking. •Criticism from the Centre for evidence based medicine (Oxford). Here is the editorial (Free) in BJSM: http://bjsm.bmj.com/content/early/2017/03/31/bjsports-2016-097285

What is rhabdomyolysis? Can it sneak under a clincian’s radar? What the key clinical features? When to be alert for rhabdomyolysis Problems when coaches are too aggressive with a new load Two cases – clinical scenarios When sickle cell trait complicates matters Which athlete with sickle cell trait is at increased risk? Can clinicians identify the athlete with sickle cell trait who is at risk of death? To screen or not to screen. Ethics and science. Who is ready to return to play? Who is at risk of recurrence? It applies to athletes and war fighters. Role of genetics – the genetic markers that clinicians can test for in a tertiary care centre Links to a previous podcast by Fran O’Connor – Exertional leg pain http://ow.ly/j9IU30bs1oe Links to papers: Sickle Cell paper in Medicine and Science in Sports and Exercise: https://www.ncbi.nlm.nih.gov/pubmed/?term=harmon+and+Med+Sci+Sports+Exerc Pathophysiology of exertional death associated with sickle cell trait: can we make a parallel with vaso-occlusion mechanisms in sickle cell disease? Connes P, Harmon KG, Bergeron MF. http://bjsm.bmj.com/content/47/4/190.long Sickle cell trait associated with a RR of death of 37 times in National Collegiate Athletic Association football athletes: a database with 2 million athlete-years as the denominator. Harmon KG, Drezner JA, Klossner D, Asif IM. http://bjsm.bmj.com/content/46/5/325.long To screen or not to screen for sickle cell trait in American football? Harmon KG, Drezner JA, Casa DJ. http://bjsm.bmj.com/content/46/3/158.long Return to Physical Activity After Exertional Rhabdomyolysis O'Connor FG; Brennan FH, et al. http://journals.lww.com/acsm-csmr/Fulltext/2008/11000/Return_to_Physical_Activity_After_Exertional.8.aspx

Dr Jonathan Finnoff, DO, is the Medical Director for Mayo Clinic Square, Sports Medicine Center, Minneapolis, Minnesota. He is a specialist in Physical Medicine and Rehabilitation and Sports Medicine. He benefits from his experience as a former professional athlete in his work as the Team Physician for professional basketball teams -- the Minnesota Timberwolves and Lynx. Dr Finnoff addresses the case of a 24 year old basketball player who has calf pain that stops her from playing but responds relatively quickly when she stops running. Timeline •The differential diagnoses include chronic exertional compartment syndrome, vascular problems such as popliteal artery entrapment, as well as neurological causes •Physical examination is critical and there are some key tests to distinguish those different pathologies •The role of investigations including imaging •How does one make the compartment pressure diagnosis? •Treatment for chronic exertional compartment syndrome including gait retraining •More aggressive treatment including use of the meniscotome, botox injection and surgery •Outcomes of treatment including botox and surgery Link to previous podcasts: This podcast is complemented by one with Professor Francis O’Connor: https://soundcloud.com/bmjpodcasts/professor-francis-oconnor-from-the-amssm-challenging-leg-paincalf-pain-and-military-injuries?in=bmjpodcasts/sets/bjsm-1 Andy Franklin-Miller’s BJSM podcast on exertional compartment syndrome and gait retraining: https://soundcloud.com/bmjpodcasts/running-injuries-with-andy Andy Cornelius on how to assess a runner and what to do when you see abnormalities: https://soundcloud.com/bmjpodcasts/keeping-runnners-running-the-secrets-of-running-assessment-advice-and-exercise-progressions

BJSM’s good friend Fran O’Connor is Director of Emergency Medicine and Sports Medicine at Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland. He is a former President of the American Medical Society for Sports Medicine (AMSSM, @theAMSSM). He also held leadership positions in the American College of Sports Medicine and the American Medical Athletic Association. He is a prolific researcher with more than 60 scientific journal publications, 25 book chapters and numerous national and international presentations. In the podcast he addresses the following questions: •What are the main challenges seen by clinicians who work in military settings? •What is the differential diagnosis to consider in the patient with calf pain, leg pain? •How does one make the compartment pressure diagnosis? •What are the challenges of measuring compartment syndrome? •What is the conservative management for compartment syndrome? (Prof O’Connor touches on gait retraining first and foremost, Pose running technique, botox injection) •Is there a role for surgery, and if so, which surgery? What are the outcomes? •What is the role of orthoses? Link to previous podcasts: This podcast is complemented by one with Dr Jonathan Finnoff: https://soundcloud.com/bmjpodcasts/mayo-clinic-and-amssm-sports-medicine-specialist-dr-jon-finnoff-on-managing-leg-pain-in-sport?in=bmjpodcasts/sets/bjsm-1 Andy Franklin-Miller’s BJSM podcast on exertional compartment syndrome and gait retraining: https://soundcloud.com/bmjpodcasts/running-injuries-with-andy Andy Cornelius on how to assess a runner and what to do when you see abnormalities: https://soundcloud.com/bmjpodcasts/keeping-runnners-running-the-secrets-of-running-assessment-advice-and-exercise-progressions

How has football medicine changed in the past 10 years? What is its future? Mike Davison, managing director of Isokinetic Medical Group in London, one of the FIFA medical centers of excellence, gives us an excellent overview of football medicine: past, present and future. In this hard-hitting podcast we also preview the upcoming Isokinetic Conference in Barcelona, where representatives from over 88 countries are attending. Topics discussed in this podcast include: -Where has football medicine come from? What is the state of play now? -The challenges in managing re-injury and long-term rehab -Is there too much over medicine in sport? How has this come about? -What can we expect from the Isokinetic Conference? -Practical tips to break into the field for aspiring clinicians For articles on this topic, visit http://bjsm.bmj.com/

The American Medical Society for Sports Medicine (AMSSM) has its Annual Meeting come up (May 8-13, 2017) so we celebrate with this podcast. Dr Devin McFadden (Sports Medicine Fellow, Washington D.C) is your host. He chats with Dr Bert Fields (Sports Medicine Physician, North Carolina), Dr Robert Oh (Sports medicine, Fort Benning, Georgia) and Dr Chad Asplund (Athletic Sports Medicine, Georgia Southern University) Topics discussed include: •Common mistakes made by amateur running athletes – training errors and hip abduction weakness get a mention •Is one type of exercise best for reducing the risk of cardiovascular disease? The trade-off between health benefits and injury risk. •Non-MSK running injuries- which ones do we need to think about? •Biomechanics of running and types of shoes •Minimalist and barefoot running- evidence supporting a different running style? Link to JAMA study that mentioned the ‘weekend warrior’ promoting health: https://www.ncbi.nlm.nih.gov/pubmed/?term=JAMA+internal+medicine+and+weekend+warriors and the BJSM editorial commenting on it (FREE this weekend!) http://bjsm.bmj.com/content/early/2017/02/23/bjsports-2017-097538 Link to BJSM paper suggesting you can’t run to your way to health weight http://bjsm.bmj.com/content/49/15/967.long (FREE) Link to 2016 BJSM paper where 1 in 13 runners had illness in the lead up to an event http://bjsm.bmj.com/content/50/15/939.long Link to BJSM RED-S consensus statement: Relative Energy Deficiency (Sport) http://bjsm.bmj.com/content/48/7/491.long (FREE)

What is abuse and how does it manifest itself in sport? In this hard-hitting podcast, Karen Litzy hosts Dr Margo Mountjoy, IOC medical commission, FINA executive board member, and associate clinical professor at McMaster University. Dr Mountjoy explores the various types of harassment, how it can occur, and what safeguards can be put in place to help athletes report abuse. Highlights include: -What does it mean when we talk about abuse and harassment? -Youth sport and why we need to be especially careful in our younger athlete - Top tips to recognizing abuse: when is the athlete trying to tell us something? -Putting in safeguarding mechanisms to protect athletes and report abuse -The impact of social media in sport especially among “millennials” -Take home messages for working in practice Dr Mountjoy is a Senior Associate Editor at BJSM and here’s the link for her previous podcast about energy deficiency among sportspeople (RED-S) http://ow.ly/w6w430aBmKJ Link to the open access (FREE) IOC consensus statement on non-accidental violence in sport: http://ow.ly/YzMd30aBmA2

In part 1 of two podcasts, Dr Ben Kibler, international shoulder authority, shares top tips on examination and diagnosis of the tennis player. (Part 2 will focus on baseball pitchers) Dr Ben Kibler, orthopaedic surgeon and medical director of Lexington Clinic in Kentucky is a world expert on management of shoulder injuries with a particular focus on the role of the scapula (scapular dyskinesis). He has held regular ‘scapular summit’ meetings of experts in his hometown of Lexington, Kentucky, USA. The most recent summary of that meeting can be read here: http://bjsm.bmj.com/content/47/14/877 In this podcast, we discuss: •Briefly how Dr Kibler, a surgeon, learned about biomechanics •Examination of the tennis player’s shoulder including how to perform a biomechanical analysis •Simple tests to recognize abnormal asymmetry in the tennis player •Diagnosis of injury in tennis players; search for culprit (the real cause) – don’t just incriminate the victim •The rise in the double-handed backhand in tennis and how it has increased the incidence of ulnar wrist injuries •Role of communication within the multidisciplinary team: how much should the physician know about the biomechanics? •Two tests commonly used to assess shoulder function – the Scapular Assistance Test (SAT) and the Scapular Retraction Test (SRT). Remember to keep an eye out for Part 2 – management of the overhead throwing athlete. You can meet with Dr Kibler in person at the AMSSM annual conference. May 9-13, 2017, San Diego. It’s a prime spot on the sports medicine calendar. https://www.amssm.org/Content/pdf%20files/BROCHURES/2017_Annual_Meeting.pdf

The Society of Sports Therapists was established in the UK in 1990 to address the growing demands from sport and leisure on everyone involved in the management and care of injured participants. In this 2nd podcast with BJSM, Professor Smith highlights hot topics such as: (i) readiness to return to play and how it differs from return to competition, (ii) training load and contribution of new data in the training-injury field. I summarise the program for the 2017 conference “From Pain to Performance” (May 20th, 2017) that features Peter Brukner, Bill Knowles, and Susan Alexander. The Society of Sports Therapists is one of 25 member societies that partners with BJSM: Links: Home page for the Society of Sport Therapists http://www.society-of-sports-therapists.org/index.php Where to study Sports Therapy (BSc Hons) http://www.society-of-sports-therapists.org/index.php/public/degree_courses_BSc Where to study Sports Therapy if you already have a relevant degree (MSc) http://www.society-of-sports-therapists.org/index.php/public/degree_courses_MSc Previous podcast: 2016 https://soundcloud.com/bmjpodcasts/focus-on-sports-therapists-and-students-considering-sports-therapy-professor-graham-smith

What are the odds? Understanding Risk and Uncertainty. Today we welcome Dr. Rod Whiteley for the first time ever to the BJSM podcast. Rod has done a bunch of work in shoulder injuries (measuring load and strength long before it got sexy). And the rumour is he’s still got a pretty good curve ball. A clinician for well over 20 years, He is the current assistant director of the Rehab department here at Aspetar Orthopaedic and Sports Medicine Hospital, and he has also contributed heavily in the area of hamstring rehabilitation and groin injuries. Look out for him on twitter @RodWhiteley, where’s he’s happy to be unpopular to point out the obvious. Rod is a clinical researcher, interested in how practitioners can understand statistics better, and integrate that in their daily practice. In this podcast, Rod and I talk about how we understand risk, in particular percentages and odds. And no, they’re not the same thing. 2:45 The difference between odds, ratios, and percentages. 3:20 An example: ACL and hamstring injuries as an example, looking at the base rate for how often these injuries happen (ACL infrequently, and hamstrings quite frequent), and then adding a likelihood ratio and how does that change the odds. 5:20 Chad Cook and Erik Hegedus really turned our ideas around interpreting risk around. Clinicians need to understand pre- and post-test odds. Find the related articles here (http://bmj.co/2m65v43) and in the links below. 6:30 Mladen Jovanovic (@Physical_Prep) - heuristics and uncertainty, published recently here (http://bmj.co/2nrRUUX) in the Aspetar journal. We have to get more comfortable with the uncertainty of these tests. 7:46 Understand base rates, and using tests that have large likelihood ratios in our clinical assessment. Pre-test odds will influence how you interpret your clinical test, which then changes your post-test odds. 10:14 Can we do the same for prevention, and identifying risk? IOC world conference prevention of injury and illness in sport (http://bmj.co/2m64AR8) in Monaco will focus this year on the value of screening. Screening allows us to identify modifiers and change potential interventions at a group level. 10:31 The importance of population level studies, looking for associations with subsequent injury. Screening is useful for injury prevention. “But if you’re doing a test to tell someone they are or aren’t gonna get injuried, you’re gonna make a monkey of yourself in open court pretty quickly.” 12:27 WHO report on risk of cancer risk associated with eating bacon/processed meat. If we ignore the base rate, we might be fooled by the actual change in risk. And then you still need to interpret that for the individual. 14:00 Absolute vs Relative risk, and what is the actual event happening. We don’t think of delayed onset of muscle soreness (DOMS) and sudden cardiac death the same. 14:15 Two players with the same risk of injury, but totally different interpretation of their result. 15:12 Predicting vs Forecasting - “An experiment that only happens once.” You only get one season and and you either get an injury or you don’t. We have to be more comfortable with that kind of uncertainty. 16:35 Predicting return to play with clinical outcome measures. 18:30 How do we interpret and incorporate percentages and odds into our clinical setting. Links: IOC world conference prevention injury and illness in sport (http://bmj.co/2m64AR8) Available for FREE from BJSM (http://bjsm.bmj.com/) Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests (http://bmj.co/2mwMP90) A combination of initial and follow-up physiotherapist examination predicts physician-determined time to return to play after hamstring injury, with no added value of MRI (http://bmj.co/2mx0r3Z)

Screening is one of the hottest topics in Sports Medicine, and a topic which is constantly evolving. The BJSM has provided a platform for much of the academic literature concerning screening, but what actually happens at the coalface? In part one of this special podcast with Arsenal FC giants Colin Lewin, and Dr Gary O’Driscoll, we heard about the role of screening in professional sport, and how it ties in with player medicals, which is further elaborated on in this podcast. Other topics that are touched upon include the role of technology in predicting injury, the pressure of the jobs, and some tips for anyone working in football medicine/hoping to do so one day! This podcast is bound to generate some deal of controversy, and if you’re looking for a platform to voice your opinion, you shouldn’t miss the Arsenal SEMS conference, with insights from the likes of Professor Roald Bahr, Adam Meakins, and Des Ryan amongst other influential names. The link to the event can be found at http://www.arsenal.com/semsconference - it’s bound to be one of the most insightful conferences of 2017!

Bruce Forster is the Head of Radiology at the University of British Columbia. He was previously the director of diagnostic imaging at the Vancouver Winter Olympics and has authored over 80 peer-reviewed publications. In this podcast, we discuss: -The role of MSK ultrasound in sports medicine and how to learn -Structures that can be imaged and their challenges -What to look for when purchasing an ultrasound machine? -Ultrasound guided injections, including evidence behind PRP, stem cells and cortisone -Pain science and the role of radiology in treating chronic pain -Imaging for prognosis and RTP -when to image? Bruce is presenting a workshop at the IOC Prevention Conference- details can be found here : http://ow.ly/SFcJ309KUve

Screening is one of the hottest topics in Sports Medicine, and a topic which is constantly evolving. The BJSM has provided a platform for much of the academic literature concerning screening, but what actually happens at the coalface? BJSM Associate Editor Steffan Griffin chats to two giants of the football (and sports) medicine world – Colin Lewin, and Dr Gary O’Driscoll, who both head up the medical department at Arsenal Football Club – about the practical aspect of screening, and what role it plays in elite sport. This podcast serves as a little taster to the Arsenal SEMS conference, which this year focuses on the role of screening, with insights from the likes of Professor Roald Bahr, Adam Meakins, and Des Ryan amongst other influential names. The link to the event can be found at http://www.arsenal.com/semsconference Topics covered in this part one include: What is involved with a player ‘medical’? Who is involved with a player’s ‘medical’? Is there a role for screening in elite sport? Look out for the upcoming Part Two – where screening and player medicals are discussed in further detail.

Professor Tim Caulfield (@CaulfieldTim) is a best-selling author in the health and popular science domain. He has published over 300 articles into the ethical, legal and health policy of a broad range of topics including stem cell therapies, genetic testing, obesity treatment and the prevention of chronic disease. In this podcast, we discuss: • Genetic testing and its predictive value- what place does it have in sports medicine? • Stem cell therapies- evidence behind it and how it is portrayed by the media • PRP- therapeutic benefits or another health fad? • The role of athletes as celebrities in advocating new treatments • 6 simple ways to maintain a healthy lifestyle. Links to Tim’s hugely successful books can be found here http://ow.ly/TEfJ309ise8 David Epstein (@DavidEpstein) book The Sports Gene here: http://thesportsgene.com/

Professor David Hunter is a leading rheumatologist and researcher working at the University of Sydney. David has over 350 publications in rheumatology and has co-authored several books providing self-management strategies for patients with osteoarthritis. In this podcast, we discuss: • Treatments of OA, what does and doesn’t work • How to take a detailed history and examination from a patient with OA • Cornerstones of patient care: behavioral change, self management and weight loss • Weight loss strategies and how to maintain it • Physiology behind how exercise improves symptoms • Pharmacological and surgical treatments for OA David caught up with Karim Khan after the 2017 Australasian College of Sport and Exercise Physicians (ACSEP) conference in the Gold Coast. The next event is February 2018 and is sure to be a huge success! http://ow.ly/t20j3093yZq

Eamonn is a wonderful clinician-scientist who graduated with a 1st Class Honours Degree from the University College Dublin (UCD) School of Physiotherapy in 2003 placing first in his class. Eamonn received a prestigious Irish Research Council for Science Engineering and Technology (IRCSET) post-graduate research scholarship. He was awarded his PhD from the UCD School of Physiotherapy and Performance Science in 2006, In this podcast that combines science with clinical application topics include: • The high prevalence of ankle injuries and the high risk of the development of chronic residual symptoms. • The characteristic features of CAI. • How to manage the young soccer player who sustains an ankle injury. • Detailed discussion of (1) modified Ottawa Ankle Rules; (2) determination of lateral ligament laxity; (3) syndesmosis assessment. • How to assess for chronic ankle instability • Mechanical insufficiencies including: (1) pathological laxity; (2) arthrokinematic restrictions; (3) synovial changes; (4) degenerative changes. • Functional insufficiencies including: (1) impaired proprioception; (2) impaired neuromuscular control; (3) impaired postural control/postural balance; (4) impaired strength. • Assessment of laxity and the use of taping and bracing. • Patient-reported outcome measures clinicians can use including the FAAM, CAIT & idFAI Associated papers and tools: Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis http://bjsm.bmj.com/content/early/2016/11/24/bjsports-2016-096858.long Cumberland ankle instability tool ( 11 – chronic ankle instability (>11) Foot and ankle ability scale: FAN ADL(21 items) and FAN sport (8 minutes) Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. http://bjsm.bmj.com/content/48/13/1014 2016 consensus statement the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. http://bjsm.bmj.com/content/50/24/1493.long

You want the big names on BJSM podcasts and Twitter asked for Dr Graeme Close. Fresh from the UK undergraduate student conference, Graeme shares pearl after pearl on this top podcast. What do you do in a first consultation? How does nutrition in team sport vary from individual sport? What’s the key to a successful pre-game routine? How should nutrition change when an athlete is injured? Supplements? Coffee? Sleep? Take home tips – all in this 16 minute gem. Graeme has a great CV for his role in top sport. He is (i) a former professional rugby league player (clips here https://youtu.be/1mHljSGlQwA) (ii) a sports science PhD and now faculty at Liverpool John Moores University (iii) rumored to be the only person in the UK accredited with the official bodies for sports science (BASES), sports nutrition (SENr) and strength & conditioning (UKSCA). We call that the ‘triple crown’. Kudos to medical student Tej Pandya for organizing the conference and for a great debut as a podcast host. BJSM’s podcasts have been hosted by 23 different interviewers and there are podcasts in 5 languages. Feel free to submit a podcast for our consideration. ([email protected])

A world leader in sportsphysiotherapy, Associate Professor Dr Kristian Thorborg is from Copenhagen University. He is renowned for his studies and clinical workshops related to patients with hip, groin, hamstring and knee related injuries. Here he outlines: - the paradigm shift for the use of exercise to treat conditions such as tendinopathy and hamstring strains. He addresses questions such as ‘What is the ideal type of exercise?’ and ‘Does the body know if the exercise is concentric or eccentric?’ - cheap technology that can be used to help patients measure the load they are using and to check compliance - the challenge of treating patients in season - the concept of progression and the different stage of rehab that is preparation for ‘return to play’ - prevention – it needs monitoring of the players – waiting until they show up with pain is too late

How does a leading shoulder physiotherapist approach patients in the clinic? What are 3 fundamental principles that guide every consultation? Hear from extended scope practitioner Adam Meakins on how his approach to the patient with shoulder pain has changed over the past years. Learn how you can provide exercises for your patient without needing sophisticated video equipment or cameras. Listen to tips on how to tell if the patient is fearful, perhaps at greater risk for a central contribution to pain. Timeline 0:40 - Adam makes the case for 3 principles that guide every consultation 2:30 - Encouraging movement – both for health and to exercise injured parts (e.g. the shoulder) 4:00 - The need for patient education and advice. And how to do it. 8:35 - How much pain is OK? 10:30 - Treating the patient as an individual – the whole patient 12:40 - Is there a central component of pain? 13:19 - Which exercises to choose

The Berlin Concussion in Sport Consensus Meeting was held in October 2016 and the experts are currently writing the systematic reviews and agreeing on the final statement from this event. In the meantime, various panel members are sharing some key messages the world over. The knowledge translation needed from event such as this is extensive. The experts are Dr Jon Patricios, sports physician and former President of the South African Sports Medicine Association (SASMA) and Paul McCrory, Associate Professor and neurologist at the Florey Institute of Neuroscience and Mental Health, Australia. Both attended the Berlin meeting. Timeline: 0:45 Immediate management of concussion 2:54 Differences and common ground from elite level competition to the community setting 5:00 Balance and visual disturbances 8:26 Concussion in the developing brain 14:34 The update on CTE – chronic traumatic encephalopathy 16:40 Take home messages

Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law and policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (Chief Medical Officer), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. Here is Part 2! Timeline: 0.35: Is there a relationship between when players are removed & their subsequent recovery? 5.13: What else is the RFU doing around concussion? 8.36: Will we ever prevent concussions in rugby? 16.45: What are we hoping to hear about at the Berlin Consensus Conference?

Professor Lars Engebretsen is the Head of Scientific Activities in the Department of Medicine and Science at the International Olympic Committee. An orthopaedic surgeon, he is a strong advocate of the multidisciplinary approach to patient care. Among his many awards are the Nordic Prize in Medicine and the American Orthopaedic Society of Sports Medicine Hall of Fame. He is the Editor of the BJSM’s Olympic-supported issues (4 per year, usually numbers 1, 7, 11 and 17). Timeline: 0:40 mins - Surgical management of the patient with the acute ACL rupture – emphasis on early rehabilitation 1.44 mins - Prehabilitation – a definite focus 5.54 mins - The locked knee – what is it and how does finding one affect management? 8.00 mins - Is surgery indicated for meniscal injuries or not? 9.12 mins - The paediatric ACL (age 8-12 years). What’s the best management? 13.50 mins - IOC education courses with a focus on the 2-year online diploma.

Do you consider the first 10 seconds of a consultation to be important? Have you looked at your clinic space and how that might affect your patients? In this podcast Steve Aspinall (BASRaT) speaks to Richmond Stace @painphysio about the importance of compassion and active listening in the treatment of pain. Richmond is presenting at the BASRaT symposium on the 18th of November in London. Our Symposium this year will focus on pain; with unmissable keynote speeches from experts in the field and presentations and workshops that will enrich your knowledge. Focussing exclusively on pain and all its forms and manifestations it will be vital for practitioners to help manage and manipulate pain and help people from all walks of life. Our unmissable range of speakers includes Richmond Stace who is leading advances in understanding and treating pain and has created the pain coach programme. Richmond will look into the importance of the first point of contact, how we can gain information from the first few words. We have a range of workshops including "Gold from Rio"- BASRaT Sport Rehabilitator, Hannah Crowley helped Ed Clancy on his road to recovery from a back injury and to his gold medal win at Rio. Our closing keynote "Pain, the Brain and a little bit of Magic" will be presented by Professor Anthony Jones. Professor Jones is an MSK pain specialist and leads the Human Pain Research Group. This one day event on Friday 18th November will be packed full of essential speeches, presentations and seminars, enriching your knowledge and aiding your work. BOOK NOW. Visit basrat.eventbrite.co.uk. Timeline: 1:03 How big is the problem of pain? 2:39 What does good communication mean? 8:00 What are the key points in an interview about pain? 12:11 How to pain the patients journey? 16:44 Is neuroscience education important? 18:59 Key messages for the clinician Links: http://basrat.org/ http://www.eventbrite.co.uk/o/british-association-of-sport-rehabilitators-and-trainers-6930299875

Over the last 20 years across the western world the increasing toll of sedentary behaviour on young peoples physical and mental wellbeing is a well-documented phenomenon. Many different piecemeal policy initiatives have failed to tackle the problem. In this podcast Steve Aspinall (BASRAT) speaks to head teacher Elaine Wyllie about the daily mile initiative. This simple game changing initiative provides massive public health benefits though a simple philosophy of non-competitive outdoor fun that is accessible to all children regardless of age, gender, ability or socioeconomic background. Listen to Steve and Elaine discuss this inspirational initiative and find out how you can get involved: Timeline: 1:03 What is the daily mile? 1:49 How is the daily mile implemented in schools what are examples of best practice? 4:54 Does the daily mile work for all children? 8:56 How does the weather impact participation? 11:43 Local and national level support 15:04 Preliminary results of a large scale study 17:00 How to get involved Links: http://thedailymile.co.uk/ http://basrat.org/ http://www.eventbrite.co.uk/o/british-association-of-sport-rehabilitators-and-trainers-6930299875

Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law & policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (CMO), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. This is Part 1: in the build up to the Berlin Consensus Conference. Timeline: 01:15: Can you give us some insight into the scale of concussion in Rugby Union? 04:00: Are the rising rates due to increased incidence or due to people being more likely to recognise and report it nowadays? 06:45: What is the RFU’s general approach to the management of Concussion? 08:45: Can you tell us a little about the ‘recognise, remove, recover and return’ campaign? 14:00: So the aim is to remove as many concussed players from the pitch as soon as possible: what else is the RFU doing to try and ensure this? 19:15: you have published a number of papers in the BJSM – one of which showed a relationship between concussion and subsequent musculoskeletal injuries – could you please elaborate? 21:50: What does this mean about the return to sport following concussion? How could this influence practice? Links Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015 http://bjsm.bmj.com/content/early/2016/09/01/bjsports-2016-096461.abstract The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby http://www.jsams.org/article/S1440-2440(16)30142-6/abstract Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes http://bjsm.bmj.com/content/early/2015/12/01/bjsports-2015-094982.full BJSM Podcast with the Heath Brothers & Mike Evans: https://soundcloud.com/bmjpodcasts/23-5-hours-to-switch-behaviour?in=bmjpodcasts/sets/bjsm-1

Phil Glasgow is the head of sports medicine at the Sports Institute, Northern Ireland. A vastly experienced physiotherapist, he has worked at 3 Olympic Games, and has just returned from Rio. In this podcast, we discuss a case history of a football player with hip pain, from assessment to RTP. We look at the sensitivity vs. specificity of various tests, how to explain the symptoms to patients, and any co-existing pathologies there may be in the athlete. Finally, the discussion moves to treatment, the role of manual therapy, and exercises the patients can do to increase strength in the tissue. The 2nd World Conference of Sports Physiotherapy will be held in Belfast, 2017- details can be found here: http://bit.ly/2dP2HjH Timeline 0.40 - Hip pain: a case history and when is it reported to the physio? 3.08 - Ruling things out in the hip is easy: how do we rule things in? 7.30 - Things to consider when treating the hip 10.30 - Prescribing exercise for the patient - how do we go about it? 13.00 - How to increase the load in the injured athlete 18.26 - Bridging exercises for the hip 22.50 - Building a model for the pain and tips from the top

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely. Relevant links: Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes: https://soundcloud.com/bmjpodcasts/high-fat-for-health Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach: https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1 If you think that BJSM is only sharing one side of the story please use our various channels to contribute. Papers, blogs, podcasts, Twitter, Facebook - we’d love to hear from you. We haven’t rejected any papers saying that hi-carb is good for you!

In this podcast, Steffan Griffin of the BJSM speaks to Dr Andrew Murray – SEM consultant & adventurer (amongst other things!), who is currently undertaking a PhD looking into ‘Golf and Health’. We talk about how the Golf and Health project was born, and some of the notable findings from his recently published scoping review. This is a must-listen for any SEM professional/student, not only due to some of the clinical pearls, but due to the fact that this is a shining light of what other sports could also be doing! Contents 1.00: Andrew tells us about the Golf and Health project 2.30: What are the main findings from the scoping review? 5.30: Deeper dive into the potential benefits 6.45: What about mental health? 7.30: Could spectators also be reaping some of the health rewards associated with playing? 9.45: What lessons are there for other sports? Links Scoping Review http://bjsm.bmj.com/content/early/2016/09/26/bjsports-2016-096625.full Infographic http://bjsm.bmj.com/content/early/2016/09/20/bjsports-2016-096866.full.pdf+html Golf and Health website http://www.golfandhealth.org/ Golf and Health twitter https://twitter.com/GolfAndHealth Golf and Health facebook https://www.facebook.com/GolfAndHealth/?fref=ts

Dr Clare Ardern is a sports physiotherapy researcher at Linkoping University in Sweden. She carries Australia’s prestigious NHMRC’s top scholarship for clinician researchers – the 4-year Fellowship Award. You may know of her publications that highlight the relatively low return to play rates after ACL reconstruction. In this podcast, she addresses return to play more broadly. From 12-15th October this year she will be a keynote speaker at Sports Medicine Australia’s conference. You can follow that via BJSM Twitter #SMAConf16 and Facebook. She was interviewed by Dr Christian Barton, who is a well-published physiotherapist PhD as well. He serves as BJSM Deputy Editor and the Editor responsible for Social Media (small job! easy!). Timeline: 1:00m - Where did the Return To Play Consensus come from? 2:00m - Defining Return to Play; what does it mean in different settings 3:00m - The difference in RTP for o/c acute – removal from play? 4: 10 - Decision making – how should the return to play decision be made? 3:30m - Return to Play is a continuum that requires meticulous planning 4:00m - When can the athlete return to a pre-injury (or better) level of performance? 4:30m - What is the evidence for return to play decisions? Spoiler alert! – It’s limited. 5:20m - Taking the emphasis of the ‘one day’ that players focus on to be back at sport. The concept of a continuum (from when you first see the athlete). 6:45 - Return to play and returning to perform at the previous level. Are there important differences? What can clinicians do to help players get back to that level? 8:30m - Does ‘Return to Play’ end? It’s very different for different athletes. 10:10m - Should athletes have ACL reconstruction after ACL injury? What does the research show? 11:40 - Clare’s perspective on the return to play data after ACL reconstruction in the non-elite players. 12:15 - An example of a player in the English Premier League who was ACL deficient.

Professor Peter O’Sullivan is among the top 3 most popular physiotherapy voices on podcasts and here he focuses on myths and harmful beliefs about back pain. He takes a swing at clinicians who rely excessively on imaging findings to attempt to explain the source of pain. He shares the story of a clinician who told a patient his spine was ‘shredded’. Prof O’Sullivan emphasizes the importance of history taking, finding factors that can sensitize neural tissue and gives an overview of treatment. He will be the keynote Refshauge Lecturer at Sports Medicine Australia’s 2016 Conference (#SMAConf16, @SMA_Events). Timeline: 0.35 m - A sneak preview of the Refshaughe lecture plan – back pain is a big problem and those in sport can learn from what is known in back pain in the general population 2.17 m - Patients respond well to a combination of explanation, being shown ways they can get back to the things they love to do, and appropriate progressive exercises 4.21 m - A case where a patient could have been treated with early investigation, aggressive medical intervention, potentially surgery. An alternative approach to management 6.48 m - How junior clinicians can approach the patient who presents with a bag of images or a medical note that may not reflect current best practice for managing back pain 9.45 m - The biology of how neural tissue can be sensitized by lack of sleep, stress. Fascinating neuroimmunology 10.55 m - You do treat the back don’t you? It’s not just explaining pain, counseling? 12.30 m - Parallels with work of other physiotherapists such as Prof Jill Cook (@ProfJillCook) and Dr Alison Grimaldi (@alisongrimaldi) who advocate for progressive loading as a stimulus for healing. “Backs love movement” 13.55 m - A 30-second summary! Related podcasts: Please consider downloading the mobile app “BJSM’ from iStore or GooglePlay. There are over 250 to choose from and the 10 most recent are very easy to get via the app. 1. Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’ http://ow.ly/uNgj304udUI 2. Dr Kieran O’Sullivan (@KieranOSull) on how top clinicians approach back pain http://ow.ly/18Ru304ue96

Professor Damian Griffin talks about the Warwick Agreement, an international consensus on the management of femoroacetabular impingement syndrome. This podcast brings you right up to date on the most current thinking about hip impingement or FAI. 0.38 Aim of the consensus 1.36 Consensus methodology 2.26 What is FAI syndrome? Symptoms, clinical signs, and imaging findings. 3.40 How should FAI syndrome be diagnosed? 6.26 What is the appropriate treatment for FAI syndrome? 8.26 What is the prognosis of FAI syndrome? 10.23 How should someone with an asymptomatic hip, with cam or pincer morphology, be managed? 11.53 What research is now needed? 14.15 How is this new definition of FAI syndrome going to influence clinical care? @DamianGriffin #WarwickAgreement Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School. Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults. His clinical practice and research focus on joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes in London and Coventry (www.hiparthroscopyclinic.co.uk). Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation:www.nets.nihr.ac.uk/projects/hta/1310302 You can follow Damian on Twitter @DamianGriffin and @WarwickOrtho or reach him on [email protected]

Leicester City’s league title was widely seen as one of the biggest upsets in sporting history. But was it really that surprising? Christian Barton (La Trobe University) talks to Dr Paul Balsom, the Head of Sports Science at Leicester City and analyst with the Swedish National Football Team. In this podcast, Paul explains how teamwork and culture led to players avoiding the medical room. We then go on to discuss the role of evidence-based medicine in sports, and how the ideas employed by Leicester can be transitioned between sports. Lastly, the conversation moves on to the ongoing season, which will see an increased number of matches for the team and how to manage this load. Link to the upcoming SMA Conference where you can see Dr Balsom: http://tinyurl.com/jx739en And a podcast with one of the other keynote speakers: http://tinyurl.com/zaoncqq Timeline: 0.40 - The key factors behind the success of Leicester. 2.00 - How do you achieve good communication in a football club? 3.55 - Keeping all the players fit - by putting responsibility onto them! 5.40 - Optimising performance - what role does EBM have in sport? 7.22 - What medical teams can learn from each other. 9.02 - How to manage an injury free rate with increased load - looking at the new season. 10.45 - The principles behind measuring load in players.

ACL injuries are some of the most common and debilitating injuries in athletes. In this podcast, Tim Hewett and Kate Webster talk about the biomechanical risk factors for ACL injury, the role and potential of screening, and the use of ACL prevention programmes. Tim Hewett is an expert in biomedical engineering work at the Mayo Clinic and Kate Webster is an associate professor at La Trobe University. They are both speaking at the upcoming Sports Medicine Australia Conference-more details can be found here-http://tinyurl.com/h4ndfy2 Timeline: 0.40 - What is the biggest risk factor for ACL injury? 2.10 - How are ACL injuries preventable? 4.10 - Can we screen for injury risk? 6.00 - Key criteria for RTS. 9:40 - The high risk of re-injury following ACL damage. 13.00 - Are we returning athletes too soon post injury?

Often tendinopathy will be resistant to even the best traditional rehabilitation methods. Liam West chats to Dr Ebonie Rio, a PostDoctoral Fellow at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. Dr Rio’s research aims to explain the role of the primary motor cortex in tendinopathy. She discusses tendon neuroplastic training (TNT) and how it might help your tendinopathy patients regain pain free function in the clinic. Timeline 0.40 – Why traditional rehabilitation for tendinopathy might be unsuccessful 1.40 - Changes in primary motor cortex and motor control in tendinopathy 2.35 – What is TNT & how to utilise it? 5.30 – How long does it take for TNT to help patients? 6.30 – Cross education for tendinopathy Further Reading Tendon neuroplastic training: changing the way we think about tendon rehabilitation – OPEN ACCESS - http://bit.ly/29ergE3 Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK Related Podcasts Prof Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL Prof Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol Defining tissue capacity - http://bit.ly/29iVSKc

Most clinicians who manage patients with tendinopathy will have encountered the situation where the clinical picture and imaging findings do not match up. Sean Docking, researcher at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne, has been using Ultrasound Tissue Characterisation (UTC) to visualise changes associated with tendinopathy in 3D detail. In this podcast he talks to Liam West about how UTC may help us explain this discrepancy between current imaging and clinical pictures in tendinopathy. He also gives the listener an insight into the clinical relevance of UTC and the lessons that have been learnt from his research within the field. Timeline 0.45 – Current imaging modalities used in tendinopathy 3.45 – Disconnect between imaging findings and clinical picture 4.45 – Place imaging in clinical context 6.00 – Deep dive on UTC 7.55 – Tendon response to pathology 10.45 – Treat the donut, not the hole Further Reading Using UTC to measure game load on tendons in AFL - http://bit.ly/29rSr3k Pathological tendons have good amounts of normal structure - http://bit.ly/29iCfiG Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK Further Related Podcasts Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol

Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School. Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults. His clinical practice and research are all around joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes at the BMI Meriden Hospital. Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation: http://www.nets.nihr.ac.uk/projects/hta/1310302 You can follow him on Twitter @DamianGriffin and @warwickOrtho or reach him on [email protected], at www.hiparthroscopyclinic.co.uk or +44 1926 403529. BJSM is grateful for his contribution as a Senior Associate Editor. In this podcast, Damian speaks about Sports Hip 2016, a two day international conference held at St George’s park, the home of English football. The link to conference details: http://www2.warwick.ac.uk/fac/med/research/csri/orthopaedics/sportsurgery/hip/ Podcast timeline: 0.30 - St George’s Park and the England Football Association Perform Rehabilitation Centre 1.02 - Introduction to Sports Hip 2016: First time for a multidisciplinary meeting on sports hip injuries 1.58 - Instability of the hip 2.47 - Treatment of acute subluxation or dislocation, returning to 3.23 - Deep gluteal space, piriformis syndrome and sciatic nerve entrapment 4.54 - Cartilage repair 6.04 – Workshops in hip arthroscopy, hip replacement techniques suitable for athletes 6.00 - Workshop in hip arthroscopy 6.57 - New techniques in hip replacement suitable for young active people and athletes. 7.24 - World class rehabilitation after hip surgery 7.50 - Round table on challenges in managing elite athletes 8.15 - Femoroacetabular impingement (FAI) syndrome, and the movement towards reaching a consensus statement. 11.00 - Consensus meeting on FAI syndrome

Peter Gallagher has been the All Blacks physiotherapist for over 10 years. He discusses how they deal with RTP following ACL injuries and how shared decision-making can be used to set a RTP date. The conversation then branches out onto how changes in training load can be used to recondition players following injury and the need for exercises that provide eccentric muscle training. Finally, we consider alternative exercise programs and the role of functional movement screening for injury prevention. This open access paper by Dr Tim Gabbett summarizes the theory behind higher training loads and injury rates: http://tinyurl.com/heepexv Another paper here predicts injury using acute: chronic workload ratios: http://tinyurl.com/z89glpz An article discussing the limitations of functional screening: http://tinyurl.com/zf5dgpn Timeline: 0:51- The challenge of RTP in ACL injury. 4:30- How the decision is made to RTP? 5:39-Why lowering a player’s load after injury might be beneficial. 7:11- Some examples of modified training programmes and reconditioning. 13:04- Adapting alternative exercise programs into a training regime. 17:40- The part that functional movement screening could play in the future.

F-MARC, the FIFA Medical Association and Research Centre, have recently launched a free online diploma primarily for doctors and other health practitioners who have little or no sports medicine knowledge or experience. There is, however, material that will appeal to anyone with an interest in sports medicine. There are currently 20 modules, which will expand to 42 by the end of the year and completion will lead to being awarded the diploma. Steffan Griffin talks to Dr Mark Fulcher, a sport and exercise medicine physician at the FIFA Medical Centre of Excellence in Auckland, New Zealand. The online diploma is FREE to do and can be accessed here: http://f-marc.com/footballdiploma/ Timeline: 0-1.42 What is the diploma? 1.42-3.00 People involved in creating the content. 3.00-3.56-How the website can be used by different specialties. 3.56-4.20 Development and evolution of the diploma. 4.20-6.55 A little bit about Dr Fulcher and his work.

Intramuscular Hamstring Injuries Professor Peter Brukner is a sports and exercise physician at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. He is Team Doctor for the Australian Cricket Team and formerly worked with Liverpool FC, Australian football in the 2010 World Cup and numerous Olympic Games. He discusses intramuscular tendon hamstring injuries, a difficult type of hamstring injury, which takes longer to recover than a typical strain. The conversation also branches out to diagnosis, management and rehabilitation of the injury. Here’s the associated paper with some very helpful figures: http://ow.ly/Hsci301NHpx Professor Brukner’s thoughts on recurrent hamstring strain can be found here: http://ow.ly/8NeB301NKCw And more on hamstring strain prevention here: http://ow.ly/PrSL301NLm0 Timeline: 1.00-Why some hamstring injuries are different (and difficult!) 2.30 Diagnosis of intramuscular tendon hamstring injuries. 4.30-Recognition on the MRI 5.30- Management of the injury. 7.50-Rehabilitation and return to play.

One of the most common complaints of athletes visiting clinicians is leg pain exacerbated by exercise. In this podcast, UK vascular surgeon Rob Hinchliffe explains how iliac artery endofibrosis develops in the sportsperson. He discusses the diagnostic approach for the clinician, potential therapies and gaps in the knowledge about this relatively new pathology, which too often remains undiagnosed for long periods of time. Thanks to BJSM editorial board member and sports physician Dr Yorck Olaf Schumacher from Aspetar, Qatar for having the idea and recording this fascinating podcast.

Whilst injuries will undoubtedly dominate the headlines at the Olympics, we shouldn't ignore the competitors' increased susceptibility to illnesses - which can cause just as much heartbreak. BJSM’s popular podcast host, Steffan Griffin (@lifestylemedic), speaks to Athletics New Zealand team sports and exercise medicine physician Dan Exeter. Dr Exeter will be in Rio in August for the 2016 Summer Games and he shares New Zealand’s secrets for prevention illness in individuals and across the New Zealand squad. Remember that the Australian College of Sports and Exercise Physicians (@ACSP_SportsDocs ) and Sports Physiotherapy New Zealand (@SportsPhysioNZ) are both BJSM member societies. If you belong to one of these (or BJSM’s other 21 member societies) you can access all BJSM content for free via your member organisation’s website. Not a member country yet? Email [email protected] Links: Great podcast last week: How Rugby 7s are approaching their Olympic Games preparation and the demands of this new Olympic Sport. http://ow.ly/EfCY3017Z2B Norway’s very experienced team physiotherapist, @BenClarsen (PT, PhD) on a systematic approach to monitoring elite athletes on a regular basis even when they are on the road for long periods of time. http://ow.ly/6GHV3017VMX Professor Roald Bahr (@RoaldBahr) on the challenges of a team clinician making Return To Play decisions: http://ow.ly/TrSz3017Ycn BJSM publishes 4 Injury Prevention and Health Protection (IPHP) issue annually. Check them all out here: http://bjsm.bmj.com/content/by/year The paper (OPEN) on Illness and Injury at the London Olympic Games: http://ow.ly/gORM3017ZRT

Want to know more about one of the new Olympic sports, or perhaps want an insight into how to best manage jetlag in athletes? Dr James McGarvey, a sport and exercise medicine physician to the New Zealand Rugby Sevens team in Rio talks to Steffan Griffin (@LifestyleMedic) about everything 7s related - although something for all to take away! Related content: Podcast on travel with teams; This time 15s Rugby – Rugby World Cup by Prav Mathema: http://ow.ly/n1Nz300PRw5 Podcast on how Dr Nigel Jones worked with the England World Cup Rugby team (2015). http://ow.ly/2MbG300Q4bz Open access paper: A new model for managing athletes health and performance in partnership with coaches: http://ow.ly/Pzz1300QSxV BJSM App iTunes - itunes.apple.com/us/app/bjsm/id943071687?mt=8 Google Play - play.google.com/store/apps/detail…m.goodbarber.bjsm

Dr Donald Shelbourne is an orthopedic surgeon at The Shelbourne Clinic in Indianapolis, Indiana. He has performed more than 6,000 ACL reconstructions since 1982 and he is credited with developing the ‘accelerated rehabilitation program’. He discusses the history of the field and how he contributed to eliminating the big problem of the ‘stiff stable’ knee. He does NOT detail the rehabilitation method itself. He has an interesting thought on the role of ACL reconstruction in young people who suffer ACL tears. See the timeline below that includes a paper referred to in the discussion and two additional BJSM resources. If I had to create a short slogan for the podcast I would go with ‘Symmetric Motion is Key’. 1:00 How Dr Shelbourne discovered accelerated rehabilitation 3:00 The problem of knees that were too stiff after ACL surgery in the 1980s. 4:00 The problem of excessively large ACL grafts and graft hypertrophy blocking knee extension 4:40 Casts contributing to knees becoming ‘stiff-stable’. Knees not returning to full extension (1980s) 6:00 Moving patients from plaster to one hour a day of a limited motion brace 6:50 Dr Shelbourne comments on augmented lateral procedures today. Discusses hamstring grafts and allografts in this context. His rationale for ipsilateral patellar tendon grafts. 9:40 Patellar tendon donor site problems – the role of physiotherapy in solving the problem 9:10 A comment on Dr Leo Pinzewski’s 20 year post-ACL surgery followup study. (Hamstring graft) Paper in American Journal of Sports Medicine (http://ow.ly/hcRx300Eb58). See also Professors Hutchinson and McCormack discuss that paper in BJSM (http://ow.ly/f1JM300EcQ0). They also have a new editorial on ACL outcomes online first as this podcast goes live (http://ow.ly/gqdk300Edm7). 10:50 Stiffness is not acceptable. Patients prefer a bit of instability with full range of motion than a stiff stable knee. Stiff knee is a time bomb for osteoarthritis. 12:00 Who should have an ACL reconstruction? About half of patients who have ACL injuries are not getting back to sport at the previous level. “In a way you are much better off having non-operative treatment….” 13:00 If you are wondering whether to have surgery or not after ACL injury – go for conservative management first. “Nothing to lose”. “A stiff knee is a time bomb for osteoarthritis later on.” 13:45 Osteoarthritis. Patients who don’t get all their movement back have a high risk of osteoarthritis moving forward. Many surgeons overlook the loss of motion as a risk factor. Related podcasts: Dr Mark Hutchinson on ACL reconstruction: https://soundcloud.com/bmjpodcasts/markhutchinson2?in=bmjpodcasts/sets/bjsm-1 Dr Mark Hutchinson on meniscectomy for symptoms of painful locking and clicking: https://soundcloud.com/bmjpodcasts/mark-hutchinson?in=bmjpodcasts/sets/bjsm-1

Do you provide medical services for athletes or teams that travel nationally or internationally? Are you confident that your travel preparations cover every possible situation? Prav Mathema, the Head of Sports Medicine for the Welsh Rugby Union and physiotherapist to the British & Irish Lions Rugby Team, discusses his top tips for travelling with elite sports teams accrued from his years of experience. Your host is BJSM Senior Associate Editor Dr Liam West (@Liam_West). Related Reading: Derman, W. E. (2008). Medication use by Tea, South Africa during the XXVIIth Olympiad: A model for quantity estimation for multi-coded team events. South African Journal of Sports Medicine, 20(3), 78-84 Hadjichristodoulou, C., et al. (2005). Mass gathering preparedness: the experience of the Athens 2004 Olympic and Paralympic Games. Journal of Environmental Health, 67(9), 52-57 Herring, S. et al (2001). Sideline preparedness for the team physician: a consensus statement. Medicine & Science in Sports & Exercise, 33(5), 846-849 Herxheimer, A., & Petrie, K. J. (2002). Melatonin for the prevention and treatment of jet lag. Cochrane Database Systematic Review, 2, CD001520 Luks, A. M., et al. (2010). Wilderness, Medical Society consensus guidelines for the prevention and treatment of acute altitude sickness. Wilderness Environmental Medicine, 21, 146-155 Milne, C., & Shaw, M. (2008). Travelling to China for the Beijing 2008 Olympic Games. British Journal of Sports Medicine, 42, 321-326 Milne, C., Shaw, M. & Steinweg, J. (1999). Medical issues relating to the Sydney Olympic Games. Sports Medicine, 28, 287-298 Pipe, A. L. (2011). International travel and the elite athlete. Clinical Journal of Sports Medicine, 21, 62-66 Reilly, T. et al. (2007). Coping with jet-lag: A position statement for the European College of Sports Science. European Journal of Sport Science, 7(1), 1-7 Reilly, T., Waterhouse, J., & Edwards, B. (2005). Jet lag and air travel: Implications for performance. Clinics in Sports Medicine, 24, 367-380 Seto, C. K., Way, D., & O’Connor, N. (2005). Environmental illness in athletes. Clinical Sports Medicine, 24, 695-718 Shaw, M. T., & Leggat, P. A. (2000). Traveling to Australia for the Sydney 2000 Olympic and Paralympic Games. Journal of Travel Medicine, 7, 200-204 Shaw, M. T., Leggat, P. A., & Borwein, S. (2007). Travelling to China for the Beijing Olympic and Paralympic games. Travel Medicine and Infectious Diseases, 5, 365-373 Simon, L. M., & Rubin, A. L. (2008). Travelling with the Team. Current Sports Medicine Reports, 7, 138-143 Teichman, P. G., Donchin, Y., & Kot, R. J. (2007). International aeromedical evacuation. New England Journal of Medicine, 356, 262-270 Turbeville, S. D., Cowan, L. D., & Greenfield, R. A. (2006). Infectious disease outbreaks in competitive sports: a review of the literature. American Journal of Sports Medicine, 34, 1860-1865 Walters, A. (2000). Travel medicine advice to UK based international motor sport teams. Journal of Travel Medicine, 7, 267-274 Waterhouse, J., Reilly, T., & Atkinson, G. (1997). Jet-lag. Lancet, 350, 1611-1615 Waterhouse, J., Reilly, T., Atkinson, G., & Edwards, B. (2007). Jet lag: trends and coping strategies. Lancet, 369, 1117-1129 Young, M., Fricker, P., Maughan, R., (1998). The travelling athlete: issues relating to the Commonwealth Games, Malaysia, 1998. British Journal of Sports Medicine, 32, 77-81 BJSM App iTunes - itunes.apple.com/us/app/bjsm/id943071687?mt=8 Google Play - play.google.com/store/apps/detail…m.goodbarber.bjsm

Professor Adrian Bauman is as respected as it gets in the hard core epidemiology world. He advises the World Health Organisation among others and he is receiving an Honor Award at the American College of Sports Medicine meeting in Boston 2016. Here’s a link: http://ow.ly/YTDt300a6wz Focusing an all professionals within the BJSM community, he argues you can make a difference! Timeline: 1:00 m – Every health professional can make a difference to promoting physical activity 3:00 m – You don’t need to do a 16-step intervention to promote your patient’s health 5:00 m – Practical steps that every physiotherapist can do in her/his practice & consultation 7:00 m – Dealing with the main objections, no time! 9:00 m – Do something every day! 11:00 m – Sedentary behavior. In perspective Links: 7 investment document: OPEN ACCESS BJSM - http://bjsm.bmj.com/content/46/10/709.full 2012 podcast with Professor Fiona Bull on the 7 ways that physical activity can be promoted. http://ow.ly/QCgs300a80o