BJSM Podcast

Dr Kieran O’Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips. Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak. Timeline: 1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load 2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one. 4.00 m Should we try to prevent all back pain? Listen to Dr O’Sullivan challenge the belief that it’s important to never have back pain. He likens back pain to conditions like sadness, constipation – not great but not a major problem as long as it doesn’t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Don’t pass on fear (of back pain coming on or persisting) to athletes. 5.00 m Screen for red flags of course, if the clinical picture warrants it – but most long-term back pain is NOT due to something listed as a red flag. 6.00 m Reassurance – being empathetic without inducing fear. 7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model. 9:00 m Don’t just make the diagnosis but be practical. Patient sad? Don’t just say ‘You are sad, your back pain will go away’. Provide specific treatment for the specific threat. 10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems. 11:00 m Don’t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case 12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler). 13:00 m The period at 4-6 weeks of pain can be difficult – patient has not adapted to the contemporary model and may still be on waiting list for imaging. 14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries? Links to previous podcast: 2015 – Dr O’Sullivan on “Effective treatments for back pain: Kieran O'Sullivan’s practical tips within a guiding framework” http://ow.ly/4nepGu BJSM paper: O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers) Manual Therapy paper: Hurley J, …., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111

Eine Frage die Patienten, Therapeuten und Mediziner gleichermaßen beschäftigt. Keller Matthias und Ekaterina Sandakova. Ob Freizeitsportler oder Profiathlet - nach einer Verletzung stellt sich dem Sportler immer die gleiche Fragen. „Wann kann ich wieder zurück zu meinem Sport?“ Auch für Therapeuten und Mediziner ist es schwierig, diese Frage klar zu beantworten. Es zeichnet sich aber ab, dass Tests, welche komplexe Funktionen prüfen und sportartspezifische Belastungen simulieren als Entscheidungshilfe für eine sichere Rückkehr zum Sport dienen. Neben den spezifischen Anforderungen einer Sportart spielt auch das angestrebte Leistungsniveau des Sportlers eine entscheidende Rolle. Die von der Arbeitsgruppe um Matthias Keller beschreibt einen Return to Activity Algorithmus, der eine Rehabilitation messbar und objektivierbar gestalten lässt. Andere BJSM podcasts in Deutsch: 1) Wie können Verletzungen beim Skifahren möglichst vermieden werden? http://ow.ly/4mYqVI 2) Muskelverletzungen im Sport – Interview mit Priv.-Doz. Dr. Peter Ueblacker http://ow.ly/4mYr61 3) Einführung in die Bewegungsmedizin : “Bewegung bringt Heilung” mit Dr Boris Gojanovic http://ow.ly/4mYs2Y

The BJSM community wants practical tips and this podcast earns 10/10 for that feature. The guest, @DarrenBurgess25 is an international leader in working in sports medicine/sports science at the highest level. BJSM Associate Editor Paul Visentini (@PaulVisentini) asks great questions. 1. How do you bring the evidence into your practical job at High Performance Manager at Port Adelaide Football Club (Australian Rules Football) (1 minute in) 2. The art from a master. What are the clinical features you use to determine what the players need? (4 minutes in) 3. How do you reconcile individual differences when you are working with a team? (7 minutes in) 4. Usain Bolt, Luis Suarez – they don’t follow the textbook. What are the minimum requirements for strength? (9 minutes in) 5. Capacity in tissue – and for a whole player. How much can we alter/improve capacity? (See also Jill Cook’s podcast on this and paper, link below) 6. What other features – beyond GPS and data – What do you look for in player welfare? (14 minutes in) Personal note here from Karim Khan: What a great insight into top level sport!! I loved this podcast – the honesty, the specific points. Darren is a master of ‘the sticky message’. Has he read ‘Made to Stick’ or is he just a natural? Wow!! I feel privileged to be part of the BJSM community to learn like this. Next week. Dr Kieran O’Sullivan (Ireland, @KieranOSull) and a German-language podcast where Aspetar’s Ekaterina Sandakova asks the questions of Keller Mattias. #InternationalCommunity Links: 1. Very closely related podcast on load: Dream Team @TimGabbett and colleagues discuss how to manage load to improve performance and minimize injury risk http://ow.ly/4mYQmZ 2. Hear more from Darren Burgess here: Who should lead the sports medicine / high performance team? http://ow.ly/4mYRtm 3. The core concept of ‘tissue capacity’. @ProfJillCook and @SIDocking are the authors and here’s the link: http://ow.ly/4mYUMI 4. One cannot leave a load management chat without making sure you know about Tim Gabbett’s early contender for paper of the year. Open access: The training-injury prevention paradox: should athletes be training smarter and harder? http://ow.ly/4mYSkj

A recent keynote speaker at the Return to Play conference in Bern, the Arsenal FC Sport and Exercise Medicine Conference and the Isokinetic Football Medicine Strategies Return to Play conference in London, Clare Ardern is an emerging voice in sports medicine research. She currently occupies a postdoctoral position in the research department at Aspetar Sports Medicine Hospital, after doing the bulk of her research at La Trobe University in Melbourne, Australia. Her work focuses on the factors influencing return to play, particularly psychological readiness after ACL injury, as well as shared decision making and evidence based medicine. Follow Clare on Twitter @clare_ardern Timeline: 1:35 When can Sarah play again? Should she be playing again? 2:30 Need criteria-based progession through the rehab process , so that the focus shifts from “when” I can play again to “what” I need to achieve for successful return to play. 3:00 Education is key – both the patient and the coach. Motivation is important and can be positive or negative. Young athletes even more important 4:40 Are we moving back to biopsychosocial models, or have we moved on? 5:30 Understand the inherent risks that Sarah is facing, and make sure she understands them! 6:20 Psychological readiness for return to play – the ACL-Return to Sport after Injury (ACL-RSI) scale developed by Dr. Kate Webster and Dr. Julian Feller . It considers: confidence, risk appraisal and the athletes emotions. 12 questions completed in a few minutes. Also available as an Iphone app. It’s sport specific AND IT’S FREE!! 7:45 We should be thinking different for all time-loss injuries. 8:15 Criteria-based rehabilitation – but beware – early return to sport for young athletes increase the risk of re-injury. 9:00 We need to become more systematic to address the psychological/emotional aspects of return to play during our clinical management of these athletes. 12:00 Should we get “informed consent” from the athlete before return to play? 12:50 SUMMARY – When can I play again? 1.Reshape the question – Will I play again? Not all athletes get back, and that doesn’t mean fail. What is the right thing for Sarah? 2.Consider the psychological aspect more systematically! CONSENSUS PAPER on return to sport coming soon! Check out some recent papers from Dr. Ardern: Br J Sports Med 2014;48:1613-1619 doi:10.1136/bjsports-2014-093842The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction http://bjsm.bmj.com/content/48/22/1613.full Br J Sports Med 2014;48:1543-1552 doi:10.1136/bjsports-2013-093398 Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors http://bjsm.bmj.com/content/48/21/1543.full Br J Sports Med 2016;50:506-508 doi:10.1136/bjsports-2015-095475 It is time for consensus on return to play after injury: five key questions http://bjsm.bmj.com/content/50/9/506.full Further listening: Podcast from Adam Gledhill which discusses a case study of ACL return to play considerations and different examples of strategies used to aid return to play experiences - https://soundcloud.com/bmjpodcasts/i-cant-return-to-play-when-fear-of-reinjury-dominates-after-acl-reconstruction-adam-gledhill

Dr Emma K Stokes is the President of the World Confederation of Physical Therapy. The first two parts of her discussion with the BJSM community has already had >9,000 listeners in just two months. In this part she previews the excitement of the IFOMPT Conference (Glasgow, July 2016), opportunities for sports physiotherapist to develop their careers. @EKStokes closes with 3 take-home messages including one slightly quirky one. Thanks to James Walsh (@SportsOsteopath) BJSM podcast podcast associate editor. Links: First of 3 podcasts on BJSM: Physiotherapists in Leadership: https://soundcloud.com/bmjpodcasts/the-face-of-wcpt-dr-emma-k-stokes-unplugged-life-lessons-leadership-physiotherapy-success?in=bmjpodcasts/sets/bjsm-1#t=0:00 2nd of 3 podcasts: Direct Access, social media & more. https://soundcloud.com/bmjpodcasts/the-face-of-wcpt-dr-emma-k-stokes-unplugged-part-2?in=bmjpodcasts/sets/bjsm-1 Profile of President Stokes in the Independent of Ireland: http://www.independent.ie/life/health-wellbeing/health-features/world-leader-dr-emma-stokes-31375045.html Emma’s podcast for the MACP (45 minutes): https://soundcloud.com/macp-3/macp-emma-stokes-podcast Interviewed by social media leader for MACP: Gerard Greene (@gerardgreenephy) . Engage with WCPT here: http://www.wcpt.org/news/WCPT-look-forward

Il dottor Cristiano Eirale è un medico dello sport che lavora ad Aspetar, Qatar Orthopedic and Sport Medicine Center di Doha. In questo podcast interamente in italiano, discute con un misterioso intervistatore, la cui identità verrà rivelata alla fine del podcast stesso, sul congresso mondiale di pubalgia nello sportivo tenutosi nel novembre 2014 e sul Doha consensus sulla terminologia e sulle definizioni nella pubalgia dello sportivo. Links: Entire BJSM Theme Issue: http://bjsm.bmj.com/content/49/12 Groin Consensus Meeting Paper: http://bjsm.bmj.com/content/49/12/768.full

The BJSM community is well aware of the interest in the role of training load on injury. Dr Dr Tim Gabbett, Dr Alex Kountouris and Dr to be Michael Drew share insights into the principles that underpin successful player management. They give specific examples from football codes and cricket at the elite level. They also discuss what clinicians who do not have access to the full raft of data-gathering technology can do to advise players how to monitor load. We thank Sports Physiotherapist Paul Visentini (who invented the VISA score for tendinopathy) for producing the very successful event and for sharing two podcasts with us. (The second will be posted here within a month). (Twitter = @PaulVisentini and @PhysioSports429) The guests: Dr Tim Gabbett, Applied Sports Scientist who consults to elite teams the world over. He is one of only 5 invited Keynote Speakers at the IOC World Congress in Monaco 2017 #IOCPrev2017 @TimGabbett Dr Alex Kountouris, Sports Science and Sports Medicine Director Cricket Australia @Alex_Kountouris Mr Michael Drew Senior Sports Physiotherapist at the Australian Institute of Sport. @_MickDrew Links to related podcasts: Dr Tim Gabbett on how physiotherapists can work well alongside strength & conditioning coaches to prevent injuries and improve performance: http://ow.ly/10aOq2 Dr Alex Kountouris on how to prevent back pain in cricket: http://ow.ly/10aOHX Link to papers on load monitoring: Training – injury prevention paradox. Should athletes be training smarter AND harder (Gabbett) http://bjsm.bmj.com/content/early/2016/01/12/bjsports-2015-095788 Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries. John W Orchard, Peter Blanch2, …, , Alex Kountouris et al, http://bjsm.bmj.com/content/early/2015/03/09/bjsports-2014-093683 And the home page with lots of good background for the conference (March 2016): http://physiosports.com.au/mastering-load-symposium-2016/

Dr Anna Saw is in the Faculty of Health in the School of Exercise & Nut. Sci.at Deakin University’s Burwood Campus. Further reading: Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review - http://ow.ly/ZEkmA

Interview mit Ass.-Prof. Dr. Gerhard Ruedl (Innsbruck) Das Skifahren ist eine beliebte Freizeitsportart bei Groß und Klein, Alt und Jung, Anfänger und Könner und zieht jedes Jahr Millionen von Wintersportlern in die Berge auf die Skipisten. Doch wie groß ist das Verletzungsrisiko auf der Piste? Was sind die häufigsten Verletzungsursachen? Assistenz-Professor Dr. Gerhard Ruedl erörtert diese Fragen und mehr im Gespräch mit Dr. Markus Laupheimer (Associate Editor BJSM). Gerhard ist Experte für Unfallursachen und Verletzungsrisiko beim Alpinen Skifahren, welches er mit seinen Kollegen an der Universität Innsbruck beforscht. Gerhard erläutert uns auch seine neulich im BJSM veröffentlichte Studie, wodurch möglicherweise die große Zahl an Knieverletzungen bei Frauen reduziert werden könnte. Auch werden mögliche Präventivmaßnahmen besprochen, welche uns und unseren Patienten helfen sollen verletzungsfrei durch die Skisaison zu kommen. Dabei sollten wir nicht vergessen “Bewegung bringt Heilung” (https://soundcloud.com/bmjpodcasts/einfuhrung-in-die-bewegungsmedizin-bewegung-bringt-heilung-mit-dr-boris-gojanovic?in=bmjpodcasts/sets/bjsm-1) Euch einen aktiven und bewegungsreichen Tag! Nun viel Spaß mit diesem Ski Podcast des BJSM. Und vergesst nicht uns auf Twitter @BJSM_BMJ, Facebook oder google+ zu folgen. Da gibt es regelmäßig neue updates. Für feedback oder Anregungen für neue Podcasts schreibt mir einfach eine mail [email protected] Links: Skibindung und Knieverletzung Paper 2016: http://bjsm.bmj.com/content/50/1/37.abstract?sid=d457e29b-45f1-4b81-a09b-cfc04d4ae602 Ski Helm Editorial: http://bjsm.bmj.com/content/46/16/1091.extract?sid=d457e29b-45f1-4b81-a09b-cfc04d4ae602

Adam Gledhill (http://www.leedsbeckett.ac.uk/staff/adam-gledhill/) is a Senior Lecturer in Sport and Exercise Therapy at Leeds Beckett University. He has a terrific amount of experience in sport psychology in football at the elite level, particularly among top female football players. Adam (@Gleds13) shares the case of Joanna (pseudonym) who has returned from ACL injury but is losing confidence ahead of a major game. We learn which specific tools can be used to address psychological readiness and how this worked out in real life. We wish Adam the best as he completes his PhD focusing on psychosocial factors associated with talent development in female soccer. Additional resources: Read the systematic review: Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Dale Forsdyke, Andy Smith, Michelle Jones, Adam Gledhill http://bjsm.bmj.com/content/early/2016/02/17/bjsports-2015-094850.abstract Links for sports psychology tools mentioned in the podcast: Evans et al (2008) The development of a measure of psychological responses to injury (paper looking at the development of the psychological responses to sports injury inventory) http://www.ncbi.nlm.nih.gov/pubmed/18270384 Glazer (2009) Development and Preliminary Validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) Scale http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657021/ Smith et al (1990) The psychological effects of sports injuries: Coping (paper for the Emotional Responses of Athletes to Injury Questionnaire)http://link.springer.com/article/10.2165/00007256-199009060-00004 Walker et al. (2010) A preliminary development of the Re-Injury Anxiety Inventory (RIAI). http://www.ncbi.nlm.nih.gov/pubmed/20129120 Another paper that Adam didn't use with this particular client but that he also recommends is: Taylor and May (1996) Threat and coping appraisal as determinants of compliance with sports injury rehabilitation: an application of Protection Motivation Theory (paper for the development of the sports injury rehabilitation beliefs survey) http://www.ncbi.nlm.nih.gov/pubmed/8981286 Further listening: Also check this podcast by Dr Clare Ardern which discusses criteria-based return to play decisions in the case of "Sarah". This complements much of the work conducted with "Joanna" in this podcast. Great food for thought for practical return to play decision-making - https://soundcloud.com/bmjpodcasts/return-to-play

Dr Emma K Stokes (@ekstokes) is the President of the World Confederation of Physical Therapy. This is the second of three podcasts. Karim and Emma continue their discussion and touch on direct access to physiotherapy around the world, the changing role of the physiotherapist in the multi-disciplinary team, and best practice for dealing with social media as a professional.

Wie die Muenchener Klassifikation helfen kann, Athleten mit Muskelverletzungen besser zu behandeln Peter Ueblacker ist ein international renommierter Orthopäde und Sportmediziner, der als einer der Mannschaftsärzte in den Jahren 2009 bis 2015 eine lange und erfolgreiche Karriere beim FC Bayern München hatte . Er arbeitet in eigener Praxis mit Hans-Wilhelm Müller-Wohlfahrt (http://ow.ly/U2mch ). BJSM Redakteur Dr Markus Laupheimer stellt die Fragen in deutscher Sprache. Inhalt (Zeit) 1: 00min - Warum Muskelverletzungen klassifizieren? 3: 00min - Einschränkungen der früheren Klassifikationsverfahren und Notwendigkeit einer neuen Klassifikation - die Entstehungsgeschichte des Münchener Muskelklassifizierungssystems. Hier ist der Link zur Open-Access-Publikation in BJSM (> 55.000 views) http://ow.ly/U2pMG 4: 18min - Was sind die Vorteile für die medizinische Abteilung eines Fussballklubs (Physiotherapeuten, Arzte & Fitnesscoach), die die Münchener Klassifizierungssystem verwenden? Definition und Differenzierung von "direkten" und "indirekten" Muskelverletzungen. 5: 00min - Die Herausforderung der "funktionellen" (nicht-strukturellen) Muskelverletzungen. Keine Pathologie im MRT erkennbar - und doch von hoher Relevanz für Fußballmannschaften, weil diese Verletzungen häufig sind und Spieler nicht spielen können – „time-loss“-Verletzungen. 6: 00min - Verschiedene Typen von Muskelverletzungen ziehen unterschiedliche Fehlzeiten im Sport nach sich. Ist das eine 2-Wochen-oder 6-Wochen-Verletzung? 6: 40min - Der Versuch, die Prognose vorherzusagen - ist das möglich? Was können wir dem Trainer sagen? Hier finden Sie eine Gegenargument http://ow.ly/U2qFJ 7: 10min – Komm auf den Punkt! Strukturelle Muskelverletzungen. Intramuskuläre Sehnenverletzungen sind häufig und relevant (siehe Peter Brukner Papier: http://ow.ly/U2rBc) 8: 15min - Welchen Einfluß die Wirbelsäule auf Muskelverletzungen hat. 10: 00m - Ein praktischer Spaziergang durch das Management der ischiokruralen Muskelverletztungen („hamstrings“). Weiterführende Links: http://ow.ly/U2mUG - Podcast mit Professor Gino Kerkhoffs berücksichtigt auch das Münchener Konsenspapier. Ergänzt den vorliegenden Podcast in seinem größeren Fokus auf die Konsensprozesse und diskutiert die Wertigkeit des MRTs- bei Muskelverletzungen (auf englischer Sprache). http://ow.ly/U2o0Q - Podcast mit Professor Jan Ekstrand Schwerpunkt auf Muskelfaserriss Sie können ohne weiteres zugreifen auf BJSM Podcasts über unser Mobile App (BJSM). Neueste Sportmedizin Updates via Twitter (BJSM_BMJ) und auf der Google+ Community http://ow.ly/U2sNs, wo Sie aufgefordert, Inhalte zu veröffentlichen

Are you or your athletes in control of your ‘chimp’ (emotional, reactive part of your mind) at all times? We hear from Professor Steve Peters -- the brains behind ‘The Chimp Paradox’ and the much-heralded psychiatrist who has worked with the likes of Team Sky Cycling, Liverpool Football Club and the FA to improve athlete performance. Prof Peters explains the rationale for the seemingly simplistic model and shared example of how it can be applied in various sport settings. “The Chimp Paradox” has been among the most popular self-development books in recent years and it will of interest to many BJSM listeners from both a personal and professional standpoint. http://amzn.to/1TNV3Xy If you want to see Prof Peters speak – sign up for the BASEM Spring Conference (Friday April 8th) here! http://bit.ly/1TNV0en Timeline 1:10m: What is the chimp model? 4:15m: How does the ‘chimp’ model work in sport? 5:30m: Is it always an overactive chimp that holds athletes back? 7:45m: What works best with athletes? 9:30m: What can we do about unhelpful behavioural traits? 11:45m: What pitfalls can we avoid when dealing with young elite athletes? 13:30m: How can you talk to athletes about psychological performance? 16:55m: Does the chimp model work when split-second sporting decisions are needed? 18:30m: Mental Health in Sport 21:15m: Any tips for those wanting to work in sport? BJSM Links: 2016’s issue 3 of BJSM was devoted to mental health in sport. Table of contents link: http://bjsm.bmj.com/content/50/3.toc An editorial on the issue of mental health and ‘mental toughness’ : Dr James Bauman: The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport? http://bjsm.bmj.com/content/50/3/135.extract

Dr Emma K Stokes (@ekstokes) is the President of the World Confederation of Physical Therapy. This is the first of 3 podcasts Timeline: 1:00m - A fascinating career journey – from student at Trinity College Dublin to President of the World Confederation. 4:00m - “You have to be yourself but you have to understand yourself. Leadership is about bringing people on a journey. Make sure you understand how other people see, or feel about, that journey” 5:00m - The organisation you work in plays a big role too but you can make a difference from wherever you are. Students and early career physiotherapists are as important as the person on the top of the hierarchy 6:30m - The only constant is change (Emma’s nod to David Bowie but this was recorded before he died). Having a framework for adapting to change 7:50m - Practice change – applying the lessons to a typical health professional practice 10:00m - The role of the IFSPT – International Federation of Sports Physical Therapists – as leaders, advocates. A huge opportunity for leadership. Education, competency definition, congress organisation 12:00m - Physios as entrepreneurs. Social entrepreneurship – physiotherapists’ opportunities to contribute to society 13:30m - Emma’s experience on what makes a successful physiotherapy practice 15:00m - End of Part 1 – part two is scheduled for February 12th, 2016 Thanks to James Walsh (@SportsOsteopath) BJSM podcast podcast associate editor. Links: Drew Dudley "Leading with Lollipops" YouTube Video – helping people become better versions of themselves: https://www.youtube.com/watch?v=hVCBrkrFrBE Profile of President Stokes in the Independent of Ireland: http://www.independent.ie/life/health-wellbeing/health-features/world-leader-dr-emma-stokes-31375045.html Emma’s podcast for the MACP (45 minutes): https://soundcloud.com/macp-3/macp-emma-stokes-podcast Interviewed by social media leader for MACP – Gerard Greene (@gerardgreenephy) Engage with WCPT here: http://www.wcpt.org/news/WCPT-look-forward

The American Medical Society for Sports Medicine (AMSSM) is the world’s largest primary care sports medicine organisation and one of BJSM’s 23 member societies. It provides authoritative education for the public as well as for athletes and health professionals. BJSM is proud to host AMSSM experts discussing the potentially life-threatening condition that is widely known as ‘The Female Athlete Triad’. Dr Elizabeth Joy (Salt Lake City) and Dr Aurelia Nattiv (UCLA, Los Angeles) are both researchers and clinicians in this field so they provide a great overview as well as practical tips for athletes, parents and health professionals in this 20-minute podcast. (AMSSM’s guest host is Dr Britt Marcussen, U of Iowa). They are two of the lead authors on the 2014 International Consensus Statement on this topic: Br J Sports Med. 2014 Feb;48(4):289. doi: 10.1136/bjsports-2013-093218. http://bjsm.bmj.com/content/48/4/289.long Timeline: 2:00m - What is the ‘Female Athlete Triad’? 4:30m - What type of athletes are at risk? What should I look for? 6:15m - Energy availability, eating disorders, disordered eating. The role of anorexia nervosa, bulimia. Is this an essential element? 8:30m - Practical tips for parents. What to watch out for? 14:20m - If a parent is concerned what is the next step? 16:00m - What is the role of sport restriction in treating this condition? 21:00m - Take home messages: early recognition is key; seek help. An experienced multidisciplinary team (psychologists, nutritionist, sports physician) is key. Links: The definitive ‘Female Athlete Triad’ consensus statement in the BJSM: http://bjsm.bmj.com/content/48/4/289.long A complementary perspective on the issue – the IOC’s consensus statement: http://bjsm.bmj.com/content/48/7/491.long A 2015 podcast by the IOC’s Dr Margo Mountjoy – on the IOC’s perspective: http://ow.ly/XpkYO AMSSM e-learning elements: Podcasts and more! https://www.amssm.org/E-Learning.php

In this 9-minute podcast Zoe Harcombe asks whether dietary guidelines were based on evidence or whether there were other drivers. She summarises what was in the literature at the time the 1977 (US) and 1983 (UK) guidelines were created. Importantly, she highlights that food choices have major implications on the planet. The podcast was recorded in February 2015 – she was a keynote speaker at the Old Mutual 1st International Low Carb High Fat Health Summit 2015 hosted by Prof Tim Noakes & Karen Thomson (Cape Town). https://www.facebook.com/events/880528391966336/ There are plans for a future summit in London in 2016. BJSM senior associate editor Liam West (@Liam_West) led the BJSM team who attended the meeting – including Johann Windt and Ania Tarazi. BJSM has spaced out the recordings from that summit over 12 months and this is the last on the series from that event. Related podcasts were with Dr Stephen Phinney http://ow.ly/X70OP, Dr Jason Fung (http://ow.ly/X70AJ), Dr Aseem Malhotra http://ow.ly/X712D and Professor Timothy Noakes (http://ow.ly/X71rX). All have proven very popular. Timeline: 0m 30s: Why Zoe Harcombe (@ZoeHarcombe) challenges current dietary guidelines 3m 00s: What are the sensible food choices (according to the guest, of course)? 4m 40s: Challenges to supplying calorie-dense low carb foods for the world’s population: “I don’t know if we can feed 7-11 million people on animal based food, I don’t know if we can’t”. Grain requires topsoil and “we are raping the land of nutrients, topsoil, potentially destroying the planet’s ability to house any food”. 5m 50s: Time to revisit the guidelines? 7m 00s: Training doctors – what training do doctors get? (Link to the exercise prescription training module, a template, here: http://bjsm.bmj.com/content/49/4/207.extract Call to action for all health professionals to look at the evidence in an open-minded way. It may need a ‘bottom up’ approach – patients and the public – to draw attention to these issues. Links: The key paper for this podcast: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis http://openheart.bmj.com/content/2/1/e000196 An editorial in the same issue of OpenHeart: http://openheart.bmj.com/content/2/1/e000229.extract (11,000 views as of January 2016) Papers: Challenging beliefs in sports nutrition: are two 'core principles' proving to be myths ripe for busting? Peter Brukner (@PeterBrukner) http://www.ncbi.nlm.nih.gov/pubmed/23603852 Br J Sports Med. 2013 Jul;47(11):663-4. doi: 10.1136/bjsports-2013-092440. Epub 2013 Apr 20. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet Malhotra A, Noakes T, Phinney S. Br J Sports Med. 2015 Aug;49(15):967-8. doi: 10.1136/bjsports-2015-094911. Epub 2015 Apr 22. http://www.ncbi.nlm.nih.gov/pubmed/25904145

Associate Professor Irfan Asif is Vice Chair of Academics and Research at the Greenville Health System and University of South Carolina. This podcast is unashamedly focused on the American Medical Society which we believe is the world’s largest member organisation for primary care sports medicine. For those of you wondering why it needed to be a ‘medical society for sports medicine’ (tautology?/redundancy?) the answer is that sports medicine is a broad field with many disciplines involved, so one could have an ‘orthopedic’ society for sports medicine, for example, or a ‘sports therapists’ society for sports medicine. Timeline: 1m 40s: What is AMSSM? What benefits does it provide primary care sports medicine physicians? 1m 20s: AMSSM President John Devine was at the White House for a national ‘bystanders’ conference – what can the public do to save lives? An initiative to ‘Stop the Bleed’. 1m 50s: Outline of the AMSSM Donjoy travelling fellowships in Australia (2014) and South Africa (2015) as well as the ECOSEP, Spain – providing international leadership. (Editors’ note, these are all BJSM member societies). 3m 20s: Junior NBA programme – NBA players (junior.nba.co) Sports Medicine Today – tips and fact sheets about different injuries for athletes, coaches, parents etc 4m 10s: Collaborative Solutions for Safety in Sport (CSSS): March 2015 meeting at the NFL headquarters (partnership with NATA). Emergency action plans – including Drs Jon Drezner, Kevin Guskiewicz and Doug Casa. Focused on factors such as personnel management, AEDs and prevention of heat stroke. Another example of AMSSM partnering to make changes across the US 5m 15s: Position statements that @theAMSSM is leading (completed and in the pipeline) Viscosupplementation (5:30) – Pros and cons of using Viscosupplementation in osteoarthritis (http://www.ncbi.nlm.nih.gov/pubmed/26729890) Mental Health – Under-recognised ‘silent injury’ – pressures of being an athlete per se Diagnostic ultrasound – building on previous work such as features in BJSM in 2015 (http://bjsm.bmj.com/content/49/3/145.1.long) Cardiovascular issues including ECG interpretation and pre-participation screening (coming out in 2016, ‘next year’ in the podcast because we recorded late in 2015) 6m 30s: Come to the Annual Meeting in Dallas, Texas, April 15-20 - http://ow.ly/X6yKo Hot topics and speakers include: Tendons (Hakan Alfredson), Running Medicine (Blaise Williams – ACSM exchange lecture), Medical issues (e.g. cardiovascular, respiratory) in sports including NBA protocols, pearls for event coverage, low back pain management advances, stress fracture prevention and Rx, emerging technologies in sports medicine. 7m 30s: Opportunities to serve AMSSM on exciting committees (not an oxymoron!) Links: AMSSM conference registration (and programme) http://ow.ly/X6AIx Hakan Alfredson’s classic (code for 2 years old now) BJSM tendon podcast http://ow.ly/X6AWA AMSSM Sports Medcast on injections with guest Matt Gammons (VP, AMSSM) http://ow.ly/X6BkZ Dr Irfan Asif’s recent podcast on HOW to promote lifestyle medicine (‘Exercise is Medicine’) http://ow.ly/X6Bww

Physiotherapist Dr Michael Skovdal Rathleff from the Research Unit for General Practice in Aalborg chats with Dr Dylan Morrissey from Queen Mary University of London and Barts Health NHS trust and Dr. Christian Barton from the new sport and exercise medicine research centre at Latrobe University in Australia. Both Dylan and Christian are clinically active physiotherapists working on moving research from journal papers into the hands of people who can put it to practical use. They discuss the challenges of clinicians being aware of the latest research and the researchers asking relevant questions. They propose to marry quantitative (eg. Systematic review) and qualitative (interviews, patient experience, clinician experience) approaches and they share examples of having already done this. Drs Rathleff, Morrissey & Barton will run a session on this topic at the Danish Sports Medicine and Physiotherapy Conference in Kolding, Denmark on 4-6th February. www.sportskongres.dk They’ll also speak on other topics (including running injuries) in an excellent programme packed with starts. Each speaker has many great papers and you can find two of those discussed in the podcast at these links: The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning. Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. http://bjsm.bmj.com/content/49/14/923.full Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning Rowe V, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D http://www.ncbi.nlm.nih.gov/pubmed/23006143

All clinicians aim to classify muscle injury classifications to guide treatment and predict return – it’s a hot topic. The British Athletics Muscle Injury Classification is one helpful classification system and Dr Noel Pollock explains to Dr Markus Laupheimer (BJSM) how and why the Classification developed, as well as why the (older) Munich classification was not ideal. Listen for tips on how this classification adds something special and is of practical value for treating your athletes with muscle injuries. Timeline: 01:01m – Why a new muscle injury classification? 03:50m – Limitations of the Munich consensus Open access Munich Paper: http://bjsm.bmj.com/content/47/6/342.full.pdf+html 05:18m – British Athletics classification explained Open access British athletics paper: http://bjsm.bmj.com/content/48/18/1347.full 09:15m – Clinical application, follow up papers 12:00m – Discussion: MRI or not? http://bjsm.bmj.com/content/49/24/1579.full 14:05m – Future Development of muscle injury classification Links: British athletics muscle injury classification: a new grading system http://bjsm.bmj.com/content/48/18/1347.long (Open Access) Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification http://bmj.co/1lWvDdy Previous podcast: The Munich muscle classification: Using it for more accurate diagnosis and treatment https://soundcloud.com/bmjpodcasts/the-munich-muscle-classification-using-it-for-more-accurate-diagnosis-and-treatment?in=bmjpodcasts/sets/bjsm-1 Range of BJSM podcast: http://bjsm.bmj.com/site/podcasts/ You can readily access BJSM podcasts via our Mobile App (BJSM). Latest sports medicine updates are posted via Twitter (@BJSM_BMJ)

AMSSM has a series of podcasts (https://www.amssm.org/E-Learning.php) and here experts highlight the management of shoulder, elbow and knee pain with a focus on the declining role of corticosteroid injections. The sports physicians discuss other injection treatment options – PRP, prolotherapy and viscosupplementation where relevant. Keep the AMSSM’s 2016 Annual Meeting in mind – Registration opens on January 8th. It will be in Dallas, Texas, April 15-20, 2016. And the special AMSSM issue of BJSM appears online first on January 18th, 2016.(Mental health theme). The experienced and popular hosts are Dr Blair Becker and Dr Scott Young, with special guest AMSSM Vice-President, Dr Matt Gammons. Timeline: 2:00 m Shoulder pain and subacromial corticosteroid injection – what is the level 1 evidence? 4:05 m What about corticosteroid for frozen shoulder? Does distention add benefits? 5:30 m Dr Gammons in his experience with adhesive capsulitis and shared decision making. 6:30 m The severity of symptoms may influence the decision. What would make it worth it for the patient to have an injection? 7:30 m PRP – platelet rich plasma. Again, as usually the case with PRP, no therapeutic benefit. What about prolotherapy? 8:30 m The AMSSM position statement on ultrasound guidance for shoulder injection. 12:30 m The elbow – an area where corticosteroids are becoming less popular. 15:30 m Is there support for long-term benefit of PRP? Nothing in the short term but a benefit at 2 years? 16:00 m Dr Gammons provides an overview. “Tools to add to the toolbox”, “Reasonable discussions to have with the patient”. Remember that the natural history is toward resolution. 17:00 m Shared decision making is key 17:30 m Moving on to the knee. Osteoarthritis and corticosteroid – short term benefit. Dealing with the acute flare-up. 18:40 m Viscosupplementation. See also the AMSSM scientific statement – (http://ow.ly/VKUxC ) and its recommendation for use in patients aged >60 years with grade 2 or 3 Kellgren-Lawrence. 20:00 m Dextrose prolotherapy for knee osteoarthritis (University of Wisconsin). 21:00 m Intra-articular PRP for knee osteoarthritis 23:30 m Other targets around the knee. Iliotibial band, pes anserinus as well as the patellar tendon. 25:30 m Summary of clinical practice – putting it all into perspective. Other links Clinical Journal of Sport Medicine blog and link to AMSSM Viscosupplementation position statement http://ow.ly/VKUxC Evidence against elbow PRP via Dr Robert-Jan de Vos: http://bjsm.bmj.com/content/48/12/952.long

The American Medical Society for Sports Medicine (AMSSM) is strongly committed to embedding Exercise is Medicine in the health of Americans. A member of the AMSSM’s leadership group is Associate Professor Irfan Asif, the Director of the Sports Medicine Fellowship within the Department of Family Medicine at the University of South Carolina Greenville. Our chat focuses on the practical aspects of Lifestyle Medicine – which is more than exercise medicine alone. You’ll hear about: (i) the patient’s journey through a 6-week clinical service, (ii) exercise being embedded in all 4 years of the medical curriculum, (iii) how medical students are engaging with high school students in very practical ways and with some surprising outcomes. We discuss the challenges of rolling out a lifestyle medicine programme in rural areas with minimal resources and the devil’s advocate asks the hard question: ‘Are doctors really the right persons in health care teams to prescribe exercise?’. Timeline: 00:47m - What is the Lifestyle Medicine clinic? Who is involved, what are the goals? 02:00m - The diet part – modifying the DASH diet with a Southern Flavour (Dietary Approaches to Stop Hypertension (http://ow.ly/VtPSR)) 04:00m - An example: walking through the patient’s journey – such as a patient with COPD. The role of partners such at the YMCA 05:30m - What the patient finds important – health or weight loss? 06:00m - How the curriculum embraces Lifestyle Medicine. See the link to Dr Jennifer Trilk’s work below (BJSM paper) 08:00m - Practical experiences of medical students within their communities. From given practical cooking advice to engaging high school students who are at risk of gang-related behaviour. Leadership concepts and team dynamic training – beyond the traditional medical model 10:00m - Physicians encouraging 7th & 8th grade children to ‘get your 30’ (minutes). Teaching CPR to children at this level. Encouraging young students to be open about concussion symptoms. Practical stuff 11:00m - Exercise Vital Sign: how many minutes do you exercise and how often do you exercise? Integrated into the Electronic Medical Record of the 13th largest health system in the US (with credit to Kaiser-Permanent as well). Flipping the health care system upside down from its focus on fee-for-service to prioritising prevention. 13:00m - Rural roll out: how to make this happen outside of major centres: ‘Think big but start small – practical first steps that will bring partners on board’ 14:45m - Taking a broader view – 'If we rely only on medical professionals to provide care our system is bound to sink'. 'There is plenty of pathology to go around'. The role of various health professionals in a team that provides excellence: 'Everyone plays a vital role' 15:30m - Dr Asif answers the hard question: 'What if an exercise professional feels he or she knows more about exercise prescription than the doctor?' Links: Incorporating ‘Exercise is Medicine’ into the University of South Carolina School of Medicine and Greenville Health System (Editorial, BJSM, 2014) - http://ow.ly/VtWv4 Check out the 2015 Physical Activity Issue of BJSM - http://bjsm.bmj.com/content/49/4.toc 2014 Physical Activity Issue of BJSM - http://bjsm.bmj.com/content/48/3.toc

In this 2nd of 2 podcasts for 2015 (link to previous one here http://ow.ly/V8h97) Professor Jill Cook from the La Trobe University Centre for Sports and Exercise Medicine Research (Australia) introduces the term ‘capacity’ for physical therapy / physiotherapy. ‘Capacity’ is a very practical concept that underpins successful tendon rehabilitation. Prof. Cook discusses how to use the figure from the linked paper to list exercises a patient should do. Practical stuff. 13 minutes of gold! Timeline: 1:00m - Why do we need the term ‘capacity’ in clinical practice? 1:30m - Definition – What is tissue ‘capacity’? 2:15m - The difference between ‘capacity’ and ‘function’ – capacity is tissue-specific 3:15m - Practical example: Hamstring muscle strain 5:30m - How to use this in the clinical setting – sitting with a patient and explaining the rehab programme 7:00m - The ‘Capacity’ figure – how to use it with patients to get buy-in to their rehabilitation 8:30m - ‘Building a bridge’ from what patients can do now to what they want to return to 9:00m - Practical tips including examples of (i) strength, (ii) energy storage, (iii) energy storage & release exercises 12:00m - Summary (30 seconds!) Previous podcast: How tendons fail, how to treat in season/out of season http://ow.ly/V8h97 Related papers: The Continuum model of tendinopathy http://ow.ly/V8hLr The challenge of managing tendinopathy during the season http://ow.ly/V8oTl Capacity – the paper (with Figure!) that underpins this podcast! http://bmj.co/1MIaBrx

Dr. Mark Hutchinson is professor of orthopaedics and head of the sports medicine services at the University of Illinois College of Medicine. He has been a team physician for the WNBA Chicago Sky, USA gymnastics, USA Field Hockey, USA Basketball and Team USA at two World University Games and the Paralympics Games. In this second of a two-part set, he discusses management of the patient who presents with recent onset of acute knee pain. You might be surprised by some of what this orthopaedic surgeon says! Timeline: 1:30m - Does everybody who ruptures an ACL need a knee reconstruction? 2:00m - How do you advise the person who wants to play soccer? 3:00m - How can you tell whether someone will make a good recovery or not with exercise therapy (not surgery)? 4:00m - OK for patients to go through a trial of physio to see if they are going to be stable or not 5:30m - Management of children who rupture their ACL. It’s a hot topic. On the one hand kids may be less compliant with ACL-risky behaviours than adults; on the other hand, operating and crossing growth plates can cause significant problems 7:30m - The key study by Håvard Moksnes and Lars Engebretsen – ACL injuries in kids (http://www.ncbi.nlm.nih.gov/pubmed/26025937) (not open access) 7:45m - How to discuss ACL management options with patients directly – ‘Tell us what you say to the patient Hutch’ (An introduction to shared decision-making) 9:15m - Non-operative, quality physiotherapy for ACL deficient patients 10:15m - Does ACL reconstruction prevent osteoarthritis? 11:15m - The elephant in the room – what about management of the patient whose ACL reconstruction has reruptured? 12:45m - Injuring the other knee – a disaster that occurs all too often! 13:30m - Psychological factors: a neglected part of the equation? http://bjsm.bmj.com/content/48/21/1543.abstract 14:30m - Return to play after reconstruction: the mind matters too! What is the optimal time for collagen healing? Coordination training, functional tests. 16:45m - Return to play with an unoperated knee: with a focus on neuromuscular training exercises Links: Previous BJSM podcasts: Pearls on knee examination: http://ow.ly/UBy3v Pearls on treating shoulder conditions and one wrist bonus: http://ow.ly/UBym YouTube videos on Physical Examination have been viewed more than 5 million times! https://www.youtube.com/user/BJSMVideos YouTube video: 39-minute lecture by Associate Editor Dr Clare Ardern on similar issues – return to play after ACL injury https://youtu.be/P_JJf0h6rhU Want a replay from last week? (1st podcast in this set) A 40-year old patient presents with an acute exacerbation of knee pain – Professor Hutchinson discusses whether arthroscopy is helpful in the arthritic knee. Which ones need orthopaedic referral? https://soundcloud.com/bmjpodcasts/mark-hutchinson?in=bmjpodcasts/sets/bjsm-1 Return to Play conference 2016: April 9-11, London (UK). The immensely successful annual Football Medicine Strategies conference focuses on Return to Play for all football injuries – not just ACL. Give this one serious consideration – top programme with over 100 invited speakers, terrific international audience (you will feel at home), friendly atmosphere and convenient venue. All the benefits of London without the need to own an expensive home there! http://www.footballmedicinestrategies.com/en/

Professor Mark Hutchinson, University of Chicago, Illinois, is an international leader in Orthopaedics and Sports Medicine. He has worked closely with the US Olympic Committee by serving at the Training Centre in Colorado and being part of Team USA at the Pan American Games in Canada (2015). In this first of two podcasts, he discusses management of the patient who presents with recent onset of acute knee pain. You might be surprised by some of what this orthopaedic surgeon says! Timeline 1:30m - Importance of a broad clinical workup 2:23m - In the arthritic knee, arthroscopy does not improve patient outcomes. 3:00m - Arthroscopy versus physiotherapy in MRI proven degenerative meniscal tears: no difference 3:30m - What about when there are mechanical symptoms such as ‘locking’ or ‘giving way’? Prof Hutchinson says these may warrant a surgical referral. 4:30m - What would most orthopaedic surgeons do when faced with our clinical scenario? 5:30m - How long should the patient /physiotherapist persist with conservative management? What are the indications for arthroscopy? “Arthroscopy generally doesn’t treat arthritis”. Links: Two previous podcasts on BJSM podcasts Pearls on knee examination: http://ow.ly/UBy3v Pearls on shoulder examination plus one wrist bonus: http://ow.ly/UBym8 Mark's YouTube videos on Physical Examination have been viewed more than 5 million times! https://www.youtube.com/user/BJSMVideos Next week: (2nd podcast) a patient presents after rupturing her/his ACL. Does she/he need a knee reconstruction and what are the issues about return to play?

In her first podcast since being recruited to the La Trobe University Centre for Sports and Exercise Medicine Research (Australia), Professor Jill Cook explains: (i) how tendons break down, (ii) how to assess painful tendons, (iii) how to manage tendon pain DURING a season, and (iv) how to rehabilitate a tendon properly after a season has finished. She explains what a ‘reactive’ tendon is and what a ‘degenerative’ tendon is as well as what sort of loads should be prescribed for patients who have tendon with these pathologies. A practical masterclass. Even if you have heard Jill speak before, there will be something new for you here. Sneak peek – Part 2 focuses on the concept of ‘capacity’ and why it’s an important concept. Further reading Classic paper: Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy http://bjsm.bmj.com/content/43/6/409.abstract

Peter Ueblacker is an internationally renowned orthopaedic surgeon and sports medicine doctor who had a long and very successful career with Bayern Munich from 2009 – 2015. He works in private practice with Hans-Wilhelm Mueller-Wohlfahrt (http://ow.ly/U2mch). BJSM editor Markus Laupheimer asked the questions (English language). Timeline 1:00m - Why classify muscle injuries? 3:00m - Limitations of previous classification methods and the need for a comprehensive one – the genesis of the Munich Muscle Injury Classification system. Here is the link to this Open Access paper in BJSM (>55,000 views) http://ow.ly/U2pMG 4:18m - What are the benefits for the health professional who uses the Munich classification system? Definition of ‘direct’ and ‘indirect’ muscle injuries. 5:00m - The challenge of ‘functional’ muscle injuries. No pathology on MR imaging yet a major burden for football teams because players cannot play – time loss injuries. 6:00m - Different muscle injuries lead to different periods of time out of sport. Is this a 2-week or 5-week injury? 6:40m - Trying to predict prognosis – is it possible? What can we tell coaches? You’ll find a counter-argument here http://ow.ly/U2qFJ (not discussed in this podcast). 7:10m - Drilling down on structural muscle injuries. Tendinous injuries within the muscle are important (See @PeterBrukner paper on that here http://ow.ly/U2rBc) 8:15m - How the spine is contributing to muscle injuries. Under-rated? Clinical implications. 10:00m - A practical walk through the management of hamstring muscle injuries Additional links: http://ow.ly/U2mUG - Previous podcast with Professor Gino Kerkhoffs also considers the Munich Consensus paper. It complements the present podcast in its greater focus on the consensus process and argues of the usefulness of MR imaging in muscle injury diagnosis. http://ow.ly/U2o0Q - Previous podcast with Professor Jan Ekstrand focusing on hamstring injuries. Which of the hamstring muscles is most likely injured? How long will such an injury keep a player out of sport? Also comments on the Munich Consensus http://ow.ly/U2ova - Hamstring ‘virtual conference’ BJSM blog by Steffan Griffin (@Lifestylemedic), BJSM editor responsible for Facebook among other things. You can readily access BJSM podcasts via our Mobile App (BJSM). Latest sports medicine updates are posted via Twitter (@BJSM_BMJ) and on the Google+ community http://ow.ly/U2sNs where you are encouraged to post content too.

Sports physiotherapists provide evidence-based treatment for back pain. Unfortunately surgery for back pain has rather poor outomes. Tiger Woods has spinal surgery on March 31, 2014 and did not return to his previous level of play. He went under the knife again on September 16, 2015. In this podcast, Curtin University’s Professor Peter O’Sullivan comments on the risks and possible benefits of surgery in an elite golfer. Previous podcast (>10,000 listens): Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’ http://ow.ly/TK6uo

Wenn Dir jemand sagen würde da gibt es eine Pille die bei Beschwerden aller Art hilft mit fast keinen Nebenwirkungen und evetuell das menschliche Leben verlängern kann --- was würdest du sagen? Wo kann ich diese Pille kaufen? Die Bewegungsmedizin ist ein anerkanntes Therapiekonzept für viele Erkrankungen des Bewegungsapparates wie Rückenschmerzen, Tendinopathien und Gelenksarthrose. Aber auch bei vielen Internistische Indikationen wie Herzertkrankung, Diabetes usw. Dr Boris Gojanovic gibt uns eine EInführung. In Diskussion mit Dr Markus Laupheimer (BJSM) werden degenerative Meiskusrisse und Bluthochdruck Therapie besprochen, als Beispiel wie die Bewegungstherapie Therapie der Wahl ist. Weitere Links zur Bewegungsmedizin: Schweizerische Gesellschaft für Sportmedizin (SGSM): http://www.sgsm.ch/ Swiss French SEM network http://www.rrms.ch/cms/index.php Blog Deutsche Verband für Gesundheitssport und Sporttherapie (DVGS): http://www.dvgs.de/blog Bedeutung und Evidenz der körperlichen Aktivität zur Prävention und Therapie von Erkrankungen: http://www.dgsp.de/_downloads/allgemein/RfB-DMW-Loellgen2013-ub-323.pdf Therapie von degenerativen Meniskusrissen: http://bjsm.bmj.com/content/49/19/1229.full http://blogs.bmj.com/bjsm/2014/06/15/time-to-stop-meniscectomies-for-degenerative-tears-practice-must-catch-up-with-evidence/ Twitter: British Journal of Sports Medicine @BJSM_BMJ Dr Markus Laupheimer @swisssportscare Dr Boris Gojanovic @DrSportsSante

Dr Nigel Jones is the England Rugby Senior Team Doctor, and a hugely respected figure in the UK Sport and Exercise Medicine scene. In this podcast with Steffan Griffin, you will hear about everything from being involved as part of the home team at a major sporting event, to the state-of-play in UK Sport and Exercise Medicine training. Timeline: 00:45m – Working at the 2015 Rugby World Cup 01:30m – Preparing an elite team for competition 03:05m – Conditioning vs collapse – how to avoid the latter! 05:15m – Player monitoring at the top table 06:30m – Getting coaches to buy-in to player monitoring/injury prevention – TOP TIPS 08:30m – Concussion – what’s in place to ensure gold-standard care? World Rugby Online Concussion Resources http://playerwelfare.worldrugby.org/concussion 12:00m – Sport and Exercise Medicine Training Pathway in the UK – where’s it heading? 16:20m – British Association of Sport and Exercise Medicine & the Faculty of Sport and Exercise Medicine - What can we expect at the BASEM/FSEM 2015 Conference? Find out more about the BASEM/FSEM 2015 Annual Conference – November 12/13 http://bit.ly/1Woxmpn

Professor Gwen Jull, from the University of Queensland, is one of the most lauded health professionals in the world. She discusses the assessment and management of the patient with neck pain. In the second half of the podcast BJSM asks her a couple of broader questions. What does it take to be a great clinician? Timings 1:30m - A case of headache – what elements to consider in the subjective/history 3:00m - What differentiates the expert clinician from learners who are treating neck pain? 4:00m - How to identify those headaches that respond to physiotherapy and which ones don’t respond well. 7:00m - What does it take to be a good clinician? 8:00m - Perspectives on the physiotherapy/physical therapy profession. Importance of being first contact practitioners. 9:45m - Physiotherapists as leaders in large health organisations and pioneers in heath service changes. 11:45m - Professor Jull shares the highlights of the new issue of Grieve’s Modern Musculoskeletal Physiotherapy here http://ow.ly/Sj4cn 15:00m - The biopsychosocial model – avoid biases towards one domain in this model. Advocating for the multimodal approach to physiotherapy/physical therapy. Links: Grieve’s Modern Musculoskeletal Physiotherapy (4th edition): Book review here http://ow.ly/Sj4cn Gwen Jill is the lead author of this physiotherapy Bible. First of Professor Jull’s two podcasts: Assessment and Management of Neck Pain. First of Two conversations http://ow.ly/TcVtr Related podcast: Professor Michele Sterling: ‘Managing Whiplash’ (2013). Very practical management of Whiplash that held up of the 2 years. http://ow.ly/Sj4Jz Is the neck pain related to concussion? A related paper in BJSM: Schneider KJ, et al. Br J Sports Med. 2014 Sep;48(17):1294-8. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial - http://bjsm.bmj.com/content/48/17/1294.abstract

Avoiding catastrophic injuries at the Rugby World Cup. We explore effective injury prevention strategies and what other sports can learn from rugby with Dr James Brown and Dr Sharief Hendricks from South Africa. Dr James Brown (@jamesbrown06) and Dr Sharief Hendricks (@Sharief_H), Post-Doctoral researchers from the division for Exercise Science and Sports Medicine (ESSM) at the University of Cape Town (UCT), share their expertise in rugby science in our “Emerging Voices” series led by BJSM editor Nicol van Dyk (@NicolVanDyk). Dr Brown focuses on rugby injury prevention for both BokSmart (www.boksmart.com) and the Chris Burger Petro Jackson Players’ Fund (www.playersfund.org.za). James’ PhD thesis evaluated the effectiveness of South Africa Rugby Union’s BokSmart programme (www.boksmart.com). Dr Sharief Hendricks holds an NRF Innovation Post-Doctoral Research Fellowship at the University of Cape Town. He has investigated the tackle in Rugby Union and he examines how training and match behaviour data can help coaches improve players’ performance, and minimise injury risk. Sharief has also contributed substantially to national strategic documents for his country’s rugby union (SARU). Both speakers contributed to the inaugural World Rugby Science Network Conference (http://rsnlive15.com), co-hosted between University of Bath and the University of Cape Town. They utilised a multi-media online platform and had an excellent line up of speakers just days before the Rugby World Cup kicked off. You can hear both speakers in the “Rugby Medicine” track upcoming Transact South African Sports Medicine Association (SASMA) Conference 2015 (http://www.sasma2015.co.za), Johannesburg South Africa, 16-22 October 2015 (@SASMA2015). This bi-ennial conference has an excellent line up of international speakers, and a clinically driven programme under the leadership of Dr. Jon Patricios (@jonpatricios) is set to deliver a great week of learning and fun. Find a list of publications from James and Sharief on their website www.rugbyscientists.com. Here are two favourites from BJSM: Are we currently underestimating the risk of scrum-related neck injuries in rugby union front-row players? http://bjsm.bmj.com/content/48/14/1127.extract An evidence-driven approach to scrum law modifications in amateur rugby played in South Africa http://bjsm.bmj.com/content/48/14/1115.abstract

“Physical Therapists are the best suited clinicians to assess and treat the movement system” says Washington University (School of Medicine in St. Louis) Department of Physical Therapy Professor Shirley Sahrmann. Physical therapist and Assistant Professor, Dr Sylvia Czuppon (@czuppons), asks the questions. Timeline 0:30 mins - What differentiates elite athletes’ movement patterns from that of ‘normal’ people and of those with abnormalities? 2:00 mins - Why physical therapists are best suited to keeping the movement system functioning optimally 3:08m - The concepts of relative stiffness, relative flexibility – Professor Sahrmann’s Movement System Impairment approach 4:30m - How to perform muscle length assessment 5:45m - The spring-like behavior of muscles – a key contributor to abnormal movement patterns 6:40m - Hypertrophy of muscles increasing the stiffness of muscles and thus increasing passive stiffness: “It’s not just about muscle shortness” 8:00m - The role of microinstability and abnormal accessory movements contributing to pain. Practical examples including a case of tight Tensor Fascia Lata illustrating the concept that the body takes the path of least resistance 10:30m - Clinical reasoning in a patient with groin pain. Are there abnormal accessory movements? 13:00m - Practical tips on the assessment of a patient with FAI – femoroacetabular impingement 14:30m - Common musculoskeletal exam errors by young clinicians – what NOT to do 16:00m - The difference between the novice and expert in movement pattern examination 18:00m - Physical therapists as lifespan practitioners – and movement is critical to health across the lifespan. Physical therapists – optimising movement to enhance the life experience 19:00m - A call for physical therapists to “take back exercise”. Of course this is much more powerful than passive therapies Other links Professor Sahrmann’s Movement System Impairment Syndromes Courses: http://ow.ly/SFnWl Professor Gwen Jull on managing neck pain - http://ow.ly/SFooy Professor Paul Hodges on the balance between mobility and stability – http://ow.ly/S4UKE Please feel free to suggest links via @BJSM_BMJ or email [email protected] The Movement System Impairment (MSI) syndromes were developed by Shirley Sahrmann, PT PhD and her colleagues at Washington University Program in Physical Therapy. These syndromes are described in her books, Diagnosis and Treatment of Movement Impairment Syndromes and Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spine.

Do you treat patients with neck pain? Do you have neck pain? Stop reading and start listening to the podcast. Professor Gwen Jull is one of the most lauded health professionals in the world right now and she shares pearls every minute of this podcast. Here's the link to the second part of the podcast: https://soundcloud.com/bmjpodcasts/managing-cervicogenic-headache-and-other-pearls-professor-gwen-jull-second-of-two-podcasts?in=bmjpodcasts/sets/bjsm-1 Timeline 0:00m - How do you approach the patient aged in the prime of life who complains of neck pain and bad cervical posture? 2:00m - “Big development in physiotherapy is the assessment /examination which then forms the basis of our treatment” - movement and also how the movement is performed. Facet joint tests, muscle coordination. 3:10m - Detailed specific assessment of posture in the patient with neck pain. Have the patient adopt the work positions. Aim to correct the posture to see if pain changes. 5:10m - How to distinguish the superficial and deep neck extensors 8:30m - 3 trajectories in whiplash patients; folks who get better fairly rapidly (50%), those who suffer persistent mild pain (> 2years, 30%), and ‘the major worry’ of those who have persistent moderate to high levels of pain for many months and sometimes going on for years. What predicts these trajectories? “The last group is a real stumbling block for all professions”. 11:00m - Predictors of the poor outcomes. 12:00m - See the link to the Jull and Sterling booklet for patients - ow.ly/Soyma. 13:00m - Treatment of a patient with uncomplicated whiplash - “Hurry slowly”. 14:00m - Contribution of post-traumatic stress disorder 14:30m - Management of the complicated case of whiplash. Multiprofessional approach. Multimodal care. Instruments to assess severity and to look for particular elements. 16:20m - Providing overall management of the patient. Avoiding the medical merry-go-round 17:00m - Exercise is important (this will appeal to you Adam!)! 17:30m - “My emphasis is on treating multimodally” 18:00m - Manual therapy in the context of multimodal programme 19:00m - Explaining imaging findings to the patient 19:33m - Trigger points and dry needling? Remember the 2nd part of this conversation (about Headache and more) will be available on the BJSM podcast site on 2nd October, 2015. Links: Grieve’s Modern Manual Physiotherapy (4th edition): Book review here http://ow.ly/Sj4cn Gwen Jill is the lead author of this physiotherapy bible Related podcast: Professor Michele Sterling: ‘Managing Whiplash’ (2013). Very practical management of Whiplash that held up over the 2 years. http://ow.ly/Sj4Jz Is the neck pain related to concussion? A related paper in BJSM: Schneider KJ, et al. Br J Sports Med. 2014 Sep;48(17):1294-8. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. http://bjsm.bmj.com/content/48/17/1294.abstract

Mo Farah has great running technique. You see it, you know it. But what are the elements of Mo Farah’s running style? Can we assess running patients and guide them to improve their technique? Might gait education prove more effective than medication to treat symptoms? Andy Cornelius has the answers. He’s a Graduate Sport Rehabilitator and head running coach who works in private clinics, premiership football and with high profile clubs and athletes. Posing the questions is Stephen Aspinall, Chairman of the British Association of Sports Rehabilitators and Trainers (BASRaT - http://www.basrat.org) and Lecturer in Sport Rehabilitation at the University of Salford, England. Timeline 1:20m - What are the key elements of running assessment? 2:45m - What you can learn by watching the runner from behind (frontal plane) and the side (sagittal plane) on the track and on the treadmill. 4:08m - The runner with injuries related to overstriding. What is overstriding? What can the clinician advise? 6:00m - Assessing cadence and helping the athlete to make a change of between 5-10% in cadence. 7:00m - Role of hip extension, angle of trunk lean. 7:40m - Treatment of the runner who over-strides. Exercises for rehabilitation: split stride, triple extension position, mat sliding exercise, TRX device, verbal queues. 10:20m - Stride width: consider this in conditions like ITB friction syndrome, medial tibial stress syndrome (overloading one side). 12:00m - Risk of knee pain with widening stride. 12:20m - Detailed exercise progression to adjust stride width. 14:30m - How to couple pelvic stability with hip mobility – the need to balance stability and mobility. 15:15m - Mo Farah as an example - what he does right. 16:00m - Exercise progressions to address limitations around the hip and pelvis. Strive for Mo Farah’s stride! 17:00m - When to introduce bounding, hopping drills. 17:40m - Learn more at running workshops organised by BASRaT, including at the BASRaT Annual Symposium - Manchester City’s Etihad Stadium, November 20, 2015. http://www.basrat.org/ Links Paul Hodges on the balance between mobility and stability – http://ow.ly/S4UKE The Telegraph on Mo Farah in 2013 - http://ow.ly/S4UQh Andy Franklyn Miller et al. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med. 2014 Mar;48(6):415-6. (OPEN ACCESS) (@AndyFranklynMiller) http://www.ncbi.nlm.nih.gov/pubmed/22983122 Andy Franklyn Miller’s related podcast - biomechanics and running injuries - http://ow.ly/S4VBF (@AndyFranklynMiller) Christopher Napier’s Systematic Review gait retraining - http://ow.ly/S4V29 (ONLINE FIRST, live October 1st 2015) BASRaT Annual Conference – Friday November 20th, Manchester - http://www.basrat.org/ Please feel free to suggest links via @BJSM_BMJ or email [email protected]

Dr Pippa Bennett has the CV and life experience that aspiring sport and exercise medicine doctors dream about. How’s this for a short version: Chief Medical Officer (CMO) for England Women’s Football Teams (15 years) including UEFA European Championships x 4 and FIFA World Cups x 2; CMO to British Gymnastics working at World and European events; World University Games x 3, Commonwealth Games, Olympic Games x 2 including Team GB Women’s Football in London 2012. English Institute of Sport including archery, athletics, swimming, hockey and wheelchair basketball. She completed a Masters in Sport and Exercise Medicine at Bath University. Describes herself as a keen football player who hung up her boots “due to old age and injury.“ In conversation with Dr Markus Laupheimer, they cover (i) ACL injuries and their prevention, (ii) the medical issues formerly known as the Female Athlete Triad which the IOC Consensus Group prefers to consider as the Relative Energy Deficiency Syndrome in Sport (RED-S) and (iii) Dr Bennett’s tips for junior clinicians – secrets from 15 years in the locker rooms in leading women’s and men’s sporting teams. TIMELINE 1:30m - Why are women more prone to ACL injuries? Addressing movement patterns for prevention; making players more robust. 4:00m - Prevention strategies - Dr Bennett’s experience in screening at schools and providing customised programmes for individual athletes to prevent injury. 5:20m - Relative Energy Deficiency in Sport (RED-S) - “a more rounded concept” focusing on the real culprit – energy deficiency - “Making sure your athlete is putting enough energy into the body”. 6:20m - Menstruation (in the context of amenorrhea) as well as in relation to performance and taboos. 7:00m - A case of a bone stress injury with an unusual underlying cause - “Treat the whole athlete”. 9:15m - Moving to Team Dynamics - Pippa shares her wide experience and contrasts men's and women's events in the same sport (e.g. gymnastics). 11:15m - The FIFA World Cup experience 13:20m - Advice for women clinicians considering applying for position in men’s teams: “Apply” Podcast and paper links (podcasts OPEN, most papers OPEN too): RED-S podcast with Dr Margot Mountjoy Major debate about energy deficiency among sportspeople: http://ow.ly/RMYRq RED-S consensus statement (2014) Mountjoy M1, Sundgot-Borgen J, Burke L, et al The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 48(7):491-7. doi: 10.1136/bjsports-2014-093502. Hyperlink - http://ow.ly/RN0II RED-S Clinical Assessment Tool: Mountjoy M, Sundgot-Borgen J, Burke L, et al. RED-S CAT. Relative Energy Deficiency in Sport (RED-S) Clinical Assessment Tool (CAT). Br J Sports Med. 2015 Apr;49(7):421-3. Hyperlink - http://ow.ly/RN171 Female Athlete Triad consensus statement (2014): De Souza MJ1, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Br J Sports Med. 2014 Feb;48(4):289. doi: 10.1136/bjsports-2013-093218. hyperlink - http://ow.ly/RN0Ae ACL mechanisms – Martin Hagglund -- Which 3 on-field football scenarios precede ACL rupture? http://ow.ly/RMYw5 Management and prevention of ACL injuries: Associate Prof Grethe Myklebust http://ow.ly/RMZcX ACL prevention paper – Norwegian experience: Myklebust G et al. Skjølberg A, Bahr R ACL injury incidence in female handball 10 years after the Norwegian ACL prevention study: important lessons learned. Br J Sports Med. 2013 May; 47(8):476-9. doi: 10.1136/bjsports-2012-091862. Epub 2013 Feb 12. hyperlink - http://ow.ly/RN1jj

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. Professor Graham Smith, Chairman of the Society of Sports Therapists, discusses the past, present, and future of sports therapy. The first two minutes cover the rationale for this health care profession. 3:00m - you can hear what a student learns through the 3 years of the course. 4:20m - The Master’s in Sports Therapy (with eligibility for membership) – the course for folks who already have a sports science degree and want to become clinicians. 5:50m - Final year student perspective - “students are the future of the profession” - useful tips for deciding whether sports therapy is for you or not. 9:00m - A discussion of the roles that sports therapists are filling in a wide range of sports settings. “82% of the members are self-employed” - clearly sports therapists are well suited to work in the large sports club setting or in smaller clubs. In the second half of the podcast Professor Smith also highlights hot topics such as: (i) the interaction with physiotherapists “to complement physiotherapy and to protect the people who play sport and exercise”, (ii) the 2016 scientific meeting “From Pain to Performance” (May 14th, 2016) featuring the great US knee surgeon Don Shelbourne, and (iii) the Society being a partner with BJSM: “We are pleased to be part of a global sports medicine community and appreciated as such”. Links: Home page for the Society of Sport Therapists http://www.society-of-sports-therapists.org/index.php/public_information/what-is-sports-therapy 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

Dr. Joanne Kemp, research fellow at ACRISP (Australian Centre for Research into Injury in Sport and its Prevention) Federation University Australia, discusses Femoral Acetabular Impingement (FAI) and the overall health of the hip joint. Dr. Kemp completed her PhD at the University of Queensland in 2013. She remains very much involved in clinical physio practice as an APA sports physiotherapist and director of Bodysystem®. (@JoanneLKemp) An emerging voice in sports medicine, she explores some of the difficult questions regarding hip pathology. Do we know when surgery is appropriate for FAI, or when to opt for conservative treatment? Which outcomes should guide our clinical decision to treat patients with hip pathology? What are the long term implications for joint health after sports-related hip injury? Links to 3 of Dr Kemp’s papers here: Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty - http://bjsm.bmj.com/content/46/9/632.abstract Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes - http://bjsm.bmj.com/content/48/14/1102.abstract What fooled us in the knee may trip us up in the hip: lessons from arthroscopy - http://bjsm.bmj.com/content/48/16/1200.extract Follow @JoanneLKemp on Twitter

In-game video analysis of 39 ACL injuries provides new insight into when male football players are most at risk of ‘non-contact’ ACL rupture. At 4 mins into this podcast, Dr Markus Waldén (@MarkusWalden, Football Research Group, Linkoping, Sweden) shares the gold. The 3 key scenarios when professional male players rupture their ACLs include (i) a defender pressing and side-stepping suddenly to either stop the attacking player getting by or to reach the ball, (ii) a player regaining balance after kicking, and (iii) a player landing awkwardly after a heading duel. This differs from ‘contact’ ACL injury which was mostly caused by illegal tackles from the side that caused a forceful lateral impact and valgus collapse at the knee. These need to earn red cards. At 7m 40s Dr Waldén shares the controversy about ‘valgus collapse’. Has this ‘mechanism’ been oversold? Is it more of an immediate result of imbalance rather than a direct cause? To close around 8m 40s, Nicol van Dyk from the BJSM asks what clinicians can do to prevent ACL injuries in professional male football players. What exercise programs can be brought in now? Links: Yann Le Meur's (@YLMSportScience) popular infographic is here: http://ow.ly/QUdY3 The full paper in BJSM (free) is here: http://ow.ly/QUezQ Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Waldén M, et al. Br J Sports Med. 2015 Apr 23. The special UEFA football issue of BJSM in 2013 - http://bjsm.bmj.com/content/47/12.toc

The medico-legal spotlight is shining brightly on individuals who provide medical services for athletes. With high profile lawsuits in the USA and the UK, practitioners need to be aware of how to protect themselves from any litigation pitfalls. Mr Majid Hassan is a lawyer expert in giving advice to sports clinicians. The podcast begins by explaining how the field has changed just recently – there is much more pressure on us to explain ALL risks to patients. The key cases were not in sports medicine, but their outcomes are critical for sports medicine practice. The first specific sports case is discussed at 5 mins 30 secs. It’s about the high-profile and most unfortunate case of Radwan Hamed and Tottenham Hotspur. What’s the role of the team physician, or the cardiologist? Does reading an ECG provide a duty of care? As we take the time to analyse what happened in order to try to avoid such events, our thoughts are with all involved in this tragic case. At 12.18 @Liam_West asks whether having an athlete sign a waiver can provide the clinician with protection against future legal action. At 14:22, to close, Mr Hassan shares 4 vital tips for all clinicians: minimize risk, communicate well, have detailed notes and more, but I better not give it away here. Our thanks to Mr Hassan, Partner in the Clinical Law Team at Capsticks Law Firm.

Kelly Starrett is a coach-physical therapist whose 2013 book, Becoming a Supple Leopard, is a New York Times and Wall Street Journal bestseller. He received his Doctor of Physical Therapy (DPT) degree in 2007 from Samuel Merritt College in California. He runs his own physical therapy practice that emphasises returning athletes to elite level sport and performance. In the podcast, Kelly enthusiastically draws on his background as an elite athlete and national level coach to suggest that sport physiotherapists should consider being very well trained in the practical aspects of strength and conditioning coaching. He argues that including the ‘coach’ element in the physiotherapist’s scope of practice will provide better results for patients. He calls for physios to be able to understand, and communicate, in ‘actionable language’ for customers – potentially elite athletes. He refers to the physio-coach as someone who is ideally poised to treat musculoskeletal conditions. Plenty of practical tips on how to get there. Primary link to Kelly’s resources: MobilityWOD.com Jump on to the Google+ Sports Clinicians Community page to add your comment: https://plus.google.com/u/0/communities/101520200531074507996 Become a Supple Leopard on Amazon: http://www.amazon.com/Becoming-Supple-Leopard-Preventing-Performance/dp/1936608588 Competing interest: Neither BJSM nor Karim Khan has any financial interest in the MobilityWOD company. Kelly Starrett’s role in MobilityWOD and ‘Becoming a supple leopard’ is self-evident.

Do you want to get your athletes with an acute hamstring injury back to play as quickly as possible, without the risk of a recurrence? Should you include lengthening exercises, trunk stabilisation, Nordic curls or PRP injections? Are you searching for a comprehensive, evidence-based update? This 10-minute podcast will answer all your questions. BOOM! Eminent sports physician Johannes Tol asks the hard questions. Sports physician Haiko Pas provides answers based on his recent systematic review & meta-analysis on hamstring rehab programs and PRP injections. Time codes: Optimal treatment for a quick return to play (2.30 min), re-injury reduction (3.50min) and the added value of PRP injections (6.20min). The podcast finishes with three evidence based take home messages for the clinician dealing with acute hamstring injuries (8.20 min). Links: Pas H, Reurink G, Tol JL, Weir A, Winters M, Moen M. Br J Sports Med 2015 (BJSM issue 18) Efficacy of rehabilitation (lengthening) exercises, platelet rich plasma injections and other conservative interventions in acute hamstring injuries: An updated systematic review and meta-analysis. http://bjsm.bmj.com/content/early/2015/07/21/bjsports-2015-094879.abstract Brukner P. Hamstring injuries: prevention and treatment—an update. Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094427. doi: 10.1136/bjsports-2014-094427. [Epub ahead of print] http://bjsm.bmj.com/content/early/2015/06/23/bjsports-2014-094427.long Hamilton B, Tol JL, Almusa E, Boukarroum S, Eirale C, Farooq A, Whiteley R, Chalabi H. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015 Jul;49(14):943-50. doi: 10.1136/bjsports-2015-094603. http://bjsm.bmj.com/content/49/14/943.long Bahr R, Thorborg K, Ekstrand J. Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J Sports Med. 2015 May 20. pii: bjsports-2015-094826. doi: 10.1136/bjsports-2015-094826. [online first and issue 22] http://bjsm.bmj.com/content/early/2015/05/20/bjsports-2015-094826.long Reurink G, Goudswaard GJ, Moen MH, Weir A, Verhaar JA, Bierma-Zeinstra SM, Maas M, Tol JL; Dutch HIT-study Investigators. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study. Br J Sports Med. 2015 May 4. pii: bjsports-2014-094250. doi: 10.1136/bjsports-2014-094250. [Epub ahead of print] http://bjsm.bmj.com/content/early/2015/05/03/bjsports-2014-094250.long

Consider the classic understanding that high carbohydrate intakes are necessary for optimal endurance performance. What if that failed to take into account the physiological changes that occur with adaptation to low carbohydrate diets? In this podcast, @JohannWindt interviews physician-researcher Dr. Stephen Phinney about his last 30 years of research into low-carb ketogenic diets. Highlights include the previously undocumented levels of during exercise fat oxidation seen in endurance athletes adapted to a low carbohydrate diet. He also touches on ketogenic diets’ potential benefits in other sporting contexts, addresses common criticisms, and looks ahead to future research questions in the field. Further reading and papers discussed in the podcast are included below. Vermont and MIT Study Dr. Phinney’s original two studies on low carbohydrate performance. Original two low carb performance studies. http://www.metabolismjournal.com/article/0026-0495%2883%2990105-1/abstract http://www.ncbi.nlm.nih.gov/pmc/articles/PMC371554/ Phinney SD et al. The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation. Metabolism 1983;32:757-68. http://www.metabolismjournal.com/article/0026-0495%2883%2990105-1/abstract Phinney SD et al. capacity for moderate exercise in obese subjects after adaptation to a hypocaloric, ketogenic diet. J Clin Invest 1980;66:1152-61. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC371554/ The gymnast study mentioned in the podcast: Paoli et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. J Int Soc Sports Nutr 2012; 9: 34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411406/ Significant decrease in inflammation shown in low carb diets by Forsythe, Phinney, et al.Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 2008;43:65-77. http://link.springer.com/article/10.1007/s11745-007-3132-7?no-access=true Prof Phinney’s recent BJSM Editorial: Noakes T, Volek JS, Phinney SD. Low-carbohydrate diet for athletes: what evidence? Br J Sports Med 2014 http://bjsm.bmj.com/content/early/2014/05/26/bjsports-2014-093824.extract Prof Phinney and Volek’s website– Art and Science of Low Carbohydrate Living/Performance http://www.artandscienceoflowcarb.com/ In the August 2015 issue of BJSM you’ll find a series of paper on weight loss and physical activity: http://bjsm.bmj.com/content/49/14.toc Dr Aseem Malhotra’s paper: It’s time to bust the myth of physical inactivity and obesity: you can’t outrun a bad diet (if you want to be thin) http://bjsm.bmj.com/content/49/15/967.full (OPEN ACCESS) Coauthors are Professor Phinney and Professor Timothy Noakes. Professor Stephen Blair’s rebuttal: Physical inactivity and obesity is not a myth: Dr Steven Blair comments on Dr Aseem Malhotra's editorial http://bjsm.bmj.com/content/49/15.toc Professor Kamal Mahtani’s editorial: Physical activity and obesity editorial: is exercise pointless or was it a pointless exercise? http://bjsm.bmj.com/content/49/15/969.extract Two relevant BJSM podcasts include: 1) Professor Tim Noakes interviewed by Professor Peter Brukner http://ow.ly/PQlld 2) Dr Aseem Malhotra discussing the debate around his editorial above http://ow.ly/PQlNL BJSM editors appreciate that nutrition is a controversial issue (not sure why, but that’s OK) so please note the Prof Phinney’s competing interests are listed in http://bjsm.bmj.com/content/49/15/967.full BJSM revels in debate and publishes quality material. Hence, you can see divergent views represented above and we have commissioned an editorial from respected scientists who feel that protein, or carbohydrate, deserves greater prominence. You submissions are welcome via the BJSM’s various channels – ‘print’, rapid response, blog, Google plus community, twitter, Facebook. Or email [email protected]

Many athletic events, such as the current Wimbledon Tennis Championships, are staged in hot to very hot environmental conditions. Clinicians should be aware of the risks posed to athletes competing under heat stress and how to mitigate them. Dr. Julien Périard is a former successful triathlete and now works at Aspetar, Qatar, as a senior research scientist investigating athletic performance under heat stress conditions. BJSM’s Liam West (@Liam_West) poses questions about what heat illness encompasses, what signs and symptoms to look for and how to take care of athletes. See the 2015 Consensus Statement on Training and Competing in the Heat via BJSM’s Online First http://bit.ly/1CfQLCj The Consensus Statement will be published in BJSM issue 15 which goes live on July 16, 2015 (http://bjsm.bmj.com/) Primary Link; Racinais S, ..., & Périard J. (2015). Consensus recommendations on training and competing in the heat (Online First) - http://bjsm.bmj.com/content/early/2015/06/11/bjsports-2015-094915.abstract?sid=4f2f6068-8857-4c4b-ba0e-143084d62ff0 Other reading: April 2014, Volume 48, Supp 1 – Heat Stress & Tennis Performance - http://bjsm.bmj.com/content/48/Suppl_1.tocBergeron MF. (2008). Muscle cramps during exercise - Is it fatigue or electrolyte deficit? Curr Sports Med Rep7, S50-S55. Périard JD, Racinais S & Sawka MN. (2015). Adaptations and mechanisms of human heat acclimation:- Applications for competitive athletes and sports. Scand J Med Sci Sports25, 20-38. Girard O, Brocherie F & Bishop DJ. (2015). Sprint performance under heat stress: A review. Scand J Med Sci Sports25, 79-89. Sawka MN, Leon LR, Montain SJ & Sonna LA. (2011). Integrated physiological mechanisms of exercise performance, adaptation, and maladaptation to heat stress. Compr Physiol1, 1883-1928. Book chapter: Leon, LR and Kenefick, RW (2011). Pathophysiology of Heat-Related Illnesses. In: Wilderness Medicine. Ch 10. Auerbach, PS (Ed) http://www.dtic.mil/dtic/tr/fulltext/u2/a559070.pdf Blogs: Thermal perception as a controller of exercise intensity - http://blogs.bmj.com/bjsm/2012/04/28/cool-it-so-is-thermal-perception-a-controller-of-exercise-intensity-during-heat-stress/ Prevention of heat illness – part one - http://blogs.bmj.com/bjsm/2011/03/24/evidence-based-considerations-for-the-prevention-of-heat-related-illness-in-marathon-training-part-1/ Prevention of heat illness – part two - http://blogs.bmj.com/bjsm/2011/03/25/evidence-based-considerations-for-the-prevention-of-heat-related-illness-in-marathon-training-part-2/

Dr Mike Bergeron, Chair of the IOC Consensus Committee on Youth Athletic Development discusses hot topics. Here’s the link to the Consensus Statement (Open Access): http://bjsm.bmj.com/content/49/13/843.full

How can we modify the environment we live in to increase physical activity? Steffan Griffin, junior doctor, BJSM editorial team, talks to Simon Allford, one of the UK's most celebrated architects, and the man behind the design of Google's HQ in London, about how buildings can improve health and activity.

Athletes who suffer from illness are more likely to get injured and they are likely to underperform. It’s messy (vomiting, diarrhoea) but there are guidelines for physios and docs in these roles. Professor. Martin Schwellnus talks to Liam West (@Liam_West) and offers practical tips useful for all members of the medical team. Prof. Schwellnus is director to one of only 8 IOC Research Centres worldwide. He has recently been appointed as Professor Sports & Exercise Medicine by the University of Pretoria, South Africa. Recorded at the IOC Team Physician Course in Doha, Qatar, so you’ll hear a few sounds in the background. #NotBMJStudio Practical tips from an international icon in sports & exercise medicine, who is a member of the Scientific Committee for the 2016 IOC Team Physician Course in Cape Town, (November). Further Links: Prospective monitoring of illness and injury - http://bit.ly/1C2PXLp Sports Injury & Illness at the Sochi 2014 Games- http://bit.ly/1Fd1aJj Injury & Illness for Team GB at Sochi 2014 - http://bit.ly/1GyuRKb Health protection of the Olympic Athlete - http://bit.ly/1BaUhgC Illness in Super 14 Rugby - http://bit.ly/1SazEp7 Injuries & Illness at the FIFA 2010 World Cup - http://bit.ly/1cPTdmB Prevention against illness & Injury in Athletics - http://bit.ly/1Iz7hfP Injuries & Illness at the London 2012 Olympic Games - http://bit.ly/1MvxXyL Factors associated with illness at London 2012 Games - http://bit.ly/1SazEp7 BJSM App iTunes - itunes.apple.com/us/app/bjsm/id943071687?mt=8 Google Play - play.google.com/store/apps/detail…m.goodbarber.bjsm

23 international experts in groin pain were sent two specific cases – one on inguinal region pain, the other – you guessed it – adductor region pain. The heavyweights in groin pain including Holmich, Muschaweck, Ekstrand, Meyers, Tyler, Silvers, Schilders, Thoborg, Brukner, Paajanen, Philippon, Weir, Griffen, Orchard +++. Physiotherapists, sports physicians, surgeons – unique for the diversity of opinions sought. The experts were asked to (i) write down their diagnosis and (ii) suggest initial treatment. How many diagnoses were presented? (Really? 22!! You are kidding, surely). These folks were also invited to work on focused systematic reviews and share their thoughts in person in Doha, Qatar. So far so good. But there’s always a catch! They were then locked in a room with just #LCHF not to come out until there was useful product for clinicians. Adam Weir, MD, PhD, was the driving force behind this effort and he shares what was achieved and how this can help your practice. He also guides you to hours of additional resource material including the Aspetar YouTube channel for the entire World Conference (some links below). If you see patients with groin pain this is a must! Key resources include: BJSM Issue 12, 2015 – Groin pain in athletes: http://bjsm.bmj.com/content/49/12.toc Consensus Statement: Doha Agreement Meeting: http://bjsm.bmj.com/content/49/12/768.full (Weir et al - 23 authors, Open Access) Aspetar YouTube Channel (Google Aspetar, Groin Pain, YouTube for a full list) Adam Weir BJSM podcast part 1 on BJSM (and follow @AdamWeirSports). You are encouraged to tweet your podcast questions to @AdamWeirSports or post on the Google + Sports & Exercise Medicine Community page – a great place to write more than a tweet. All you need is a gmail account.

Do you see football or ice hockey players with persistent pain in the inguinal region? What about players in twisting sports with adductor region pain? Are you still making the diagnosis ‘osteitis pubis’? Are you unsure as to when to order investigations in cases of groin pain? Enough questions – time for answers. Adam Weir, MD, PhD, has more than 10 years’ experience in dedicated clinics treating groin pain in athletes. His sports medicine specialty training was in Netherlands and the past 3 years has seen him work closely with a multidisciplinary team including sports physiotherapists and groin surgeons at the Aspetar Clinic for Groin Pain in Athletes (Doha, Qatar). He discusses the management of the two patients outlined in the two questions above (longstanding pain in the inguinal region, adductor region, in turn). 14 minutes of practical tips – assessment, investigation, specific management. PRP, surgery? No holds barred. What remains unknown. You’ll get the pearls that @AdamWeirSports shared as a keynote speaker at the American Medical Society for Sports Medicine (@TheAMSSM) conference in April 2105. Key resources include: BJSM Issue 12, 2015 – Groin pain in athletes – Table of Contents: http://bjsm.bmj.com/content/49/12.toc 9 systematic reviews most of the Open Access thanks to Aspetar Orthopaedic and Sports Medicine Hosptital, Doha, Qatar – here’s the one on management of groin pain. http://bjsm.bmj.com/content/49/12/813.full (Serner et al., Open Access) Consensus Statement: Doha Agreement Meeting: http://bjsm.bmj.com/content/49/12/768.full (Weir et al - 23 authors, Open Access) Part 2 BJSM podcast with Adam Weir – https://soundcloud.com/bmjpodcasts/take-homes-from-1st-world-conference-on-groin-pain-in-athletes-doha-agreement-part-2 You are encouraged to tweet your podcast questions to @AdamWeirSports or post on the Google + Sports & Exercise Medicine Community page – a great place to write more than a tweet. All you need is a gmail account.

High performance demands heavy workloads but loading increases the risk of ‘overuse’ injury. How can clinicians and strength & conditioning (S&C) coaches find the happy medium? Or is it time to take a different view? Perhaps INCREASING training load will make tissues more resilient and injury LESS likely. Dr Tim Gabbett (www.gabbettperformance.com) bridges sports medicine and S&C as a performance consultant and a recognized applied researcher. In the BJSM spotlight he shares what physiotherapists can learn from S&C coaches and argues for the concept of the ‘performance physiotherapist’. Similarly, he translates S&C secrets for physios – insights to progressing sport specific game demands within the rehabilitation program using a rugby example. We ask him about the high-tech and low-tech equipment to gauge how much players are doing and how to titrate their training dose. The latter part of the podcast focuses on how greater training loads can make players less likely to suffer injury but match demands must be considered. “High training loads are not necessarily the problem, it is how you get there that can damage players”. The internationally-recognized Gabbett closes by outlining the concept of ‘training stress balance’ – the net difference between fitness (long-term training load) and fatigue (short-term training load). When the player is in ‘positive’ balance, (i.e, the short-term load is lower than the longer term level of load the player is adapted to) injury is very unlikely. However, when this pattern is reversed, such as when a player is attempting to rapidly ‘gain fitness’ after a layoff, injury is almost inevitable. Cricket fast bowling data provides compelling evidence for this novel concept. Link to Dr Tim Gabbett’s home page: www.gabbettperformance.com In case you don’t get to check Dr Gabbett’s bio, he is in that rare group of individuals with two PhDs – one in human physiology (2000), the other in the applied science of professional football (2011). He has worked with players in many Olympic Games cycles and published over 150 papers. http://gabbettperformance.com.au/profile/ The BJSM paper relating to ‘training stress balance’: Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Hulin BT, Gabbett TJ, ….Orchard JW. Br J Sports Med. 2014 Apr;48(8):708-12 http://www.ncbi.nlm.nih.gov/pubmed/23962877

“Just because it’s difficult doesn’t mean it’s impossible” says Norway’s Ben Clarsen (PT, PhD) (@BenClarsen). We all say the words – ‘injury prevention is important’, ‘we want to catch injuries early’ but how do you do it? What about if your nation’s athletes are spread all around the globe? Can a systematic, yet simple, process of asking athletes questions by text messaging work? Norway punch above their weight in elite sport and Ben Clarsen is one of the team at the engine room of Norwegian Sports Medicine & Sports Science ‘Olympiatoppen’ (ie. ‘EliteSport’). He shares with @Liam_West HOW Norway keeps in touch with athletes weekly, responds to early warning signals, and initiates appropriate treatment in a financially prudent manner (oil price down right now). Links include: For athletes’ health problems: http://bjsm.bmj.com/content/48/9/754.abstract - The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. By Clarsen B, Rønsen O, Myklebust G, Flørenes TW, Bahr R. Br J Sports Med. 2014 May;48(9):754-60. doi: 10.1136/bjsports-2012-092087. Epub 2013 Feb 21. For sports injury problems: http://bjsm.bmj.com/content/47/8/495.abstract Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. By Clarsen B, Myklebust G, Bahr R. Br J Sports Med. 2013 May;47(8):495-502. doi: 10.1136/bjsports-2012-091524. Epub 2012 Oct 4.