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Prof. Roald Bahr is a world-renowned name in Sports Medicine. He is a member of the IOC medical committee and a Professor in Sports Medicine. He acts as the Head of the Aspetar Sports Injury & Illness Prevention Programme and also Chair of the Oslo Sports Trauma Research Center at the Norwegian School of Sports Sciences.

Prof. Bahr’s main research area is the prevention of injury and illness in athletes, and has published more than 200 papers and book chapters. He was speaking at the IOC Advanced Team Physician Course in Doha, Qatar when BJSM caught up with him.


In this podcast, Dr Liam West (@Liam_West) poses questions that see Prof. Bahr take listeners through various Return To Play (RTP) frameworks and how we should be willing to accept risk during the RTP period.

Relevant Reading:

Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med 2010;20:379–85.
http://journals.lww.com/cjsportsmed/Abstract/2010/09000/Return_to_Play_in_Sport__A_Decision_based_Model.12.aspx
Herring SA, Kibler WB, Putukian M. The team physician and the return-to-play decision: a consensus statement-2012 update. Med Sci Sports Exerc 2012;44:2446–8.
http://europepmc.org/abstract/med/23160348

Shrier I, Safai P, Charland L. Return to play following injury: whose decision should it be? Br J Sports Med 2014:48:394-401
http://bjsm.bmj.com/search?submit=yes&y=0&fulltext=risk%20management&x=0&FIRSTINDEX=10

IOC Sports Medicine Diploma – http://www.iocsportsmedicine.com/
IOC Sports Nutrition Diploma - http://www.sportsoracle.com/Nutrition/Home/

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BJSM App 
iTunes - https://itunes.apple.com/us/app/bjsm/id943071687?mt=8
Google Play - https://play.google.com/store/apps/details?id=com.goodbarber.bjsm 


To risk, or not to risk: the return to play dilemma - Prof. Roald Bahr

“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.

Practical tips in preventing sports injuries in teams. Secrets from Norway’s surveillance methods

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.

Managing groin pain in athletes: Adam Weir’s pointers for two very common presentations (Part 1)

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. 
 

Take homes from 1st World Conference on Groin Pain in Athletes: Doha Agreement (Part 2)

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


Treating the unwell athlete? Practical tips for travelling team clinicians: Prof Martin Schwellnus

Eckhart Tolle is reading from his book: Practicing the Power of Now

01 Practicing The Power of NOW -

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


Dr Kieran O’Sullivan on managing back pain: 7 habits of highly effective clinicians. Part 2, 2016

Dan Nicholls discusses hypermobility spectrum disorders with Dr Jane Simmonds

Hypermobility with Dr Jane Simmonds

Lorimer Moseley's presentation from IFOMPT 2016. Video recording of this presentation is available FREE on the MACP website. www.macpweb.org

Expanding Our Understanding of Pain Biology into Patient Care With Lorimer Moseley

two part podcast, the first half of the podcast is an interview with a cauda equine syndrome sufferer discussing her story, followed by the second half of the podcast reflecting on this case and discussing current  research and frameworks in identifying and managing cauda equina syndrome with Sue Greenhalgh, Laura Finucane and Chris Mercer.

Cauda Equina Syndrome

At the 6 th International Patellofemoral Pain Research Retreat held in Milwaukee in October 2019, Erin Macri pulled four clinician-scientists (Dr. Simon Lack, Dr. David M. Bazett-Jones, Dr. Gretchen Salsich,
Dr. Christian Barton) into the ring, with a goal of teasing out key concepts and providing guidance on how to incorporate dynamic knee valgus into the evaluation and treatment of individuals with
patellofemoral pain. Should dynamic knee valgus always be treated? Find out in this episode.

Dynamic knee valgus and patellofemoral pain – what gives? Episode #411

Dr Steven Roberts discusses his personal experiences being diagnosed with an osteosarcoma with consultant physiotherapist Laura Finucane. Primary bone tumours often mimic MSK pathology, Improving early sign and symptom recognition is recommended as a key way to reduce diagnostic delay. 

Further reading 
Gosling & Rushton (2106)Identification of adult knee primary bone tumour symptoms presentation: A qualitative study https://www.mskscienceandpractice.com/article/S1356-689X(16)30682-8/pdf

Anthony Pilcher Bone Cancer Trust
http://www.apbct.org.uk/contact.shtml

Osteosarcoma

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Dr. Andrea Mosler is a specialist sports physiotherapist and research fellow at La Trobe University, Melbourne. In this podcast, Liam West poses the questions that see Dr. Mosler explain how you should approach the prevention and management of hip and groin pain in athletes. She describes findings from her PhD and gives you the listener some clinical pearls to add to your “hip and groin” treatment toolbox!

What actually works? Hip and Groin masterclass with Dr. Andrea Mosler. Episode #437

There has been a huge shift in golfers over the last 10 to 15 years with many more golfers at the top of the game such as Tiger Woods, Rory Mcllroy and Brooks Koepka focusing on Strength and Conditioning (S&C) to improve performance.
COVID-19 has stopped many sporting events and has provided some a unique opportunity to focus on S&C. Bryson DeChambeau took full advantage of this putting on large amounts of muscle and is the latest golfer to demonstrate the benefits of S&C in golf performance. In this podcast Dan Coughlan explains to Will Wynter Bee the shift in S&C in golf and how the different S&C programmes used by tour players can improve performance while minimising injury risk. He also discusses the S&C set up on the European tour.
Additional information.
https://bjsm.bmj.com/content/bjsports/53/1/13.full.pdf?casa_token=SP73J6k2B4AAAAAA:EmiTi99T9da2ALJWIbVB350UmxsyeNLtkCz43HLNyVAGaDqzP9F1bJZC6_ReinWhYHzI8TLCTvA

https://shapeamerica.tandfonline.com/doi/abs/10.1080/02640414.2018.1559972#.Xw8soZNKhTY

https://sportperfsci.com/strength-and-conditioning-in-golf-probability-of-performance-impact/

Dan’s Twitter and Instagram accounts

https://twitter.com/etpi?lang=en

https://www.instagram.com/etpi_performanceunit/

Strength and Conditioning in Golf – How did Bryson get so big? Dan Coughlan discusses. Episode #440

Dr. Harvi Hart is a postdoctoral researcher at Western University in London, Ontario, funded by the Canadian Institutes of Health Research. Dr. Hart’s research focuses on identifying risk factors for knee osteoarthritis, both non-traumatic and post-traumatic osteoarthritis. Through better understanding these risk factors, Dr. Hart aims to develop new treatment approaches for managing knee OA. In this episode, Dr. Erin Macri asks Dr. Hart about her most recent studies looking at cadence and its possible role in joint loading and knee osteoarthritis. 
 
Twitter:
@HarviHart
@Erin_Macri
 
Resources and references
Hart HF, Birmingham TB, Primeau CA, et al. Associations between cadence and knee loading in patients with knee osteoarthritis. Arthritis Care Res (Hoboken) 2020. Published online first doi:10.1002/acr.24400
Hart HF, Gross KD, Crossley KM, et al. Is step rate associated with worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men? The Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2019. Published online first doi: 10.1002/acr.23864
Lenhart RL, Thelen DG, Wille CM, Chumanov ES, Heiderscheit BC. Increasing running step rate reduces patellofemoral joint forces. Med Sci Sports Exerc 2014; 46: 557-564. 
Willy RW, Meardon SA, Schmidt A, Blaylock NR, Hadding SA, Willson JD. Changes in tibiofemoral contact forces during running in response to in-field gait retraining. J Sports Sci 2016; 34: 1602-1611.
Bramah C, Preece SJ, Gill N, Herrington L. A 10% increase in step rate improves running kinematics and clinical outcomes in runners with patellofemoral pain at 4 weeks and 3 months. Am J Sports Med 2019 7:3406-3413.

Cadence: Steps to manage joint load in knee OA? An interview with Dr. Harvi Hart. Episode #447

As a three-time Major winner and the current European Ryder Cup team captain, Padraig Harrington is uniquely placed to consider the cultural changes in golf with respect to medicine and performance.

During this two-part conversation with Dr Sean Carmody and Padraig's longtime fitness coach, Dr Liam Hennessey, Padraig provides an insight into his experiences of injury, what he believes contributes to injury, and how a willingness to innovate has helped him to continue playing at the highest level over so many years.

Cadence: Steps to manage joint load in knee OA? An interview with Dr. Harvi Hart. Episode #447

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