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After a patient has undergone ACL surgery, rehabilitation is bread and butter in many physiotherapy/sports medicine clinics. Many BJSM podcast listeners will be expert in this role. If you are less expert and wondering if there is an ‘optimum’ way to guide the patient back to sport, Dr Andy Franklyn-Miller provides some food for thought. 

He discusses some novel ways of assessing a patient’s progress after ACL reconstruction, advocates for the use of video in the clinic, and shares the dynamic tests he uses before allowing a player to return to sport. He shares exercises that both test, and help rehabilitate athletes in this setting.
 
Dr Franklyn-Miller is a sports physician at the Sports Surgery Clinic in Dublin, Ireland. He has published widely in sports medicine and his book, Clinical Sports Anatomy (2011), co-authored with Eanna Falvey and Peter Brukner, is an international best-seller. You can follow him on Twitter @AFranklynMiller and his blog provides great resources (www.drAndyFranklyMiller.com) including a further series of podcasts.
 
See also:
His previous podcasts on BJSM relating to running injuries (http://bit.ly/1bqMh8C) and groin pain (http://bit.ly/1fo2TAW).

Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation: http://bjsm.bmj.com/content/early/2013/07/23/bjsports-2013-092299.full

Lower extremity performance following ACL rehabilitation in the KANON-trial: impact of reconstruction and predictive value at 2 and 5 years: http://bjsm.bmj.com/content/47/15/980.full
 

Andy Franklyn-Miller - Tuning up rehabilitation after ACL reconstruction

Dr Alex Kountouris is the physiotherapist or the Australian men’s cricket team, a position he has held for 8 years. He has just completed his PhD on the relationship between quadratus lumborum and lumbar stress fractures. 

In this podcast he discusses strategies for the prevention and treatment of lumbar spine injuries in cricket. The interesting questions posed to him come from our twitter followers, so hear his responses to your questions!

See also:

Biomechanics of lumbar spine injury in young Australian fast bowlers: http://bjsm.bmj.com/content/44/Suppl_1/i4.3.abstract

MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players: http://bjsm.bmj.com/content/41/11/836.full

A stress fracture of the lumbar spine in a professional rugby player: http://bjsm.bmj.com/content/41/5/337.full

Injuries in West Indies cricket 2003–2004: http://bjsm.bmj.com/content/40/2/119.full

@PeterBrukner discusses today’s major headline: Successful antibiotic treatment in a subset of people with chronic low back pain: http://blogs.bmj.com/bjsm/2013/05/08/peterbrukner-discusses-todays-major-headline-successful-antibiotic-treatment-in-a-subset-of-people-with-chronic-low-back-pain/

Book Review: Clinical anatomy of the lumbar spine and sacrum: http://blogs.bmj.com/bjsm/2008/10/16/book-review-clinical-anatomy-of-the-lumbar-spine-and-sacrum/



Lower back injuries in cricket players, with Alex Kountouris

Welcome to the Sports Medcast, brought to you in association with the American Medical Society for Sports Medicine.

In this episode, AMSSM members discuss the recently published 'Overuse Injuries and Burnout in Youth Sports: A Position Statement from the AMSSM' with statement authors Dr John DiFiori, Dr Joel S Brenner and Dr Neeru Jayanthi.

Read the statement: http://goo.gl/lczEHo

Please feel free to contact us at thesportsmedcast@gmail.com regarding this or any other Sports Medcast.

AMSSM Sports Medcast: Overuse injuries and burnout

Professor Philippe Neyret from Lyon, France, is a renowned sports orthopaedic surgeon. Following from his talk at the Isokinetic Football Medicine Conference in Milan, BJSM editor Karim Khan reached him via mobile phone. 

Prof Neyret discusses patellar dislocation in the setting of football and explains that certain anatomic variations (including trochlea dysplasia) make the condition more likely to occur. For players who have suffered patellar dislocation, next steps are not straightforward. Professor Neyret explains which players he would recommend have surgery.  

See also:

Injuries of the sporting knee: http://bjsm.bmj.com/content/34/6/467.1.full

Patient Information Sheet: Patellar Instabilities (dislocation or subluxation of the kneecap): http://blogs.bmj.com/bjsm/2008/10/16/patient-information-sheet-patellar-instability-dislocation-or-subluxation-of-the-kneecap/

Patellar dislocation in football, with Professor Philippe Neyret, France

Hip dysplasia is a commonly missed cause of hip and groin pain. In this podcast, which is part 2 in the 3 part series with Tom Goom (Running Physio), you’ll discover three types of hip dysplasia that will cause different symptoms and need different treatment (based on Wilkins et al. 2017), how to identify each type, and common exercises and a treatment approach that may be stirring up your patients hip and groin pain.

156. 3 types of hip dysplasia and how to identify them with Tom Goom

Bob Sallis is a family physician and sports medicine expert who encourages his patients to take charge of their health by exercising. 

With a passion for prevention, he lends his voice to the Every Body Walk Campaign and is an avid supporter and advocate of the Exercise is Medicine initiative of the ACSM. And Bob literally "walks the walk": he walks (or runs) every day! 

He tells us about the Exercise is Medicine initiative, talks about dosing (and overdosing!) of exercise, discusses the role of the physician and the fitness industry in getting people to exercise, and gives some practical tips on how to prescribe exercises to someone who is injured or has a chronic disease. 

See also:
Sallis RE. Exercise is medicine and physicians need to prescribe it! Br J Sports Med 2009;43:3-4. 
http://bjsm.bmj.com/content/43/1/3.full

Sallis RE. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med 2011;45:473-474.
http://bjsm.bmj.com/content/45/6/473.full

http://everybodywalk.org/

http://www.exerciseismedicine.org/

Bob Sallis on exercise as medicine

Cerebral Palsy (CP) Football in the UK gives players the opportunity to develop individual skills within a team environment, encased in an impairment competitive structure. The football programme contributes to the development of the England Cerebral Palsy Regional and National Squads, through talent identification with the goal to provide player performance pathway for elite performers, and also to provide participation opportunities for players of all abilities.

Dr Osman Ahmed (@osmanhahmed) has a PhD in concussion & social media where his research was focused on the use of Social Networking Sites (specifically Facebook) in assisting the recovery from sports concussion. Since 2003 he has been involved with providing physiotherapy services to a range of disability football teams for the Football Association including CP, Learning Disability, Blind, Partially sighted and Amputee squads.

Jordan Raynes (@jraynes32) has been involved with England CP Football team for many years now as a goalkeeper and has travelled with the squad to various competitions around the globe (including the Paralympic Games in Beijing in 2008).

To discuss CP football and the medical issues involved with the sport with Osman and Jordan is Dr Liam West (@Liam_West). Liam is a Senior Associate Editor of the BJSM and a junior doctor in Oxford, UK. He also runs the “Undergraduate Perspective on SEM” blog series for BJSM, building on his passion for increasing awareness and opportunities in SEM for undergraduates.

See also:
http://www.thefa.com/my-football/player/disability-football/play

http://www.thefa.com/news/england/development/2014/mar/cps-world-cup-at-sgp-200314

http://www.bbc.co.uk/sport/0/get-inspired/26545892

Enhancing performance and sport injury prevention in disability sport: moving forwards in the field of football
http://goo.gl/l8sFs2

Cerebral palsy football

Blood transfusions have been identified as one of the most overused therapies both in the United States and the UK. 

In this podcast Lawrence Tim Goodnough, from Stanford University Medical Center's Transfusion Service, and Michael Murphy, from NHS Blood and Transplant, explain the physiological reasons why
liberal blood transfusion will not benefit patients, and can potentially harm them.

Read their full analysis:
http://www.bmj.com/content/349/bmj.g6897


Too much blood: when transfusions do more harm than good

With Ann Gates and Ian Ritchie (@ExerciseWorks and Royal College of Surgeons of Edinburgh, respectively). 

The ebullient Ann Gates, physical activity champion and social media phenomenon, explains that the campaign to train physicians to prescribe exercise is not squarely in the medical curriculum. In this joint podcast with Mr Ian Ritchie, we learn that surgeons are also taking up the cudgel to encourage physical activity before surgery, in hospital, and after surgery. Surgeons themselves need to be role models – to undertake 150 minutes of physical activity per week.  Listen to the practical suggestions, share the free Nottingham University Medical School learning module at your institution. 

See Ann Gates’ full editorial at http://bjsm.bmj.com/content/early/2015/01/01/bjsports-2014-094442.extract  

The BJSM special issue on Physical Activity (2015) is issue #4 (Online first from January 30th, 2015)

Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients

Shoulder dislocation is common in sports, and management for the active athlete who dislocates for the first time remains controversial. Canada’s Olympic Medical Committee Medical Director, Prof Bob McCormack, explains the ways to assess patients to help decide whether to trial rehabilitation first or to opt for reconstruction. 

Bob has vast experience as an Olympic team doctor (beginning with Sydney) and as a team physician in the Canadian Football League and Major League Soccer. 

This is the first of 3 podcasts; he discusses management of AC joint separation and clavicle fracture in the others. BJSM welcomes the Canadian Academy of Sport & Exercise Medicine (CASEM) as one of 17 member societies (Full access to all content).   


Shoulder dislocation: to operate or rehabilitate? Prof Bob McCormack (Olympic physician)

Philipe de Souto Barreto argues that, to reduce premature mortality, policies should focus on getting fully inactive people to do a little physical activity rather than strive for the entire population to meet current physical activity recommendations.

Read the full analysis paper:
http://www.bmj.com/content/350/bmj.h23

WHO needs exercise?

In this episode we talk with PhD(c) Bret Contreras aka 'The Glute Guy' aka 'Buttman'.  We talk with him about what inspired him to research... well butts and how he got known as the creator of awesome backsides.  We talk about his research and his training as well as general science topics.  

Physique Science Radio Episode 14 - Bret Contreras 'The Glute Guy' Interview

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 karim.khan@ubc.ca

Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach

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


Hamstring injuries: A 10-min evidence based update on optimal treatment (H Pas and H Tol)

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