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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

What makes a happy hip? Understanding FAI, arthroscopy and treatment outcomes

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

Professor Gwen Jull - Part 1 - Assessment and Management of Neck Pain. First of Two Conversations

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. 

The Munich muscle classification: Using it for more accurate diagnosis and treatment

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


Professor Jill Cook (La Trobe University) revisits BJSM podcasts after two years: First of Two

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/


Dream Team of training load management: How training influences injury and performance

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

Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School.

Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults.  His clinical practice and research are all around joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes at the BMI Meriden Hospital.

Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation: http://www.nets.nihr.ac.uk/projects/hta/1310302

You can follow him on Twitter @DamianGriffin and @warwickOrtho or reach him on damian.griffin@warwick.ac.uk, at www.hiparthroscopyclinic.co.uk or +44 1926 403529. BJSM is grateful for his contribution as a Senior Associate Editor. 

In this podcast, Damian speaks about Sports Hip 2016, a two day international conference held at St George’s park, the home of English football.  The link to conference details:
http://www2.warwick.ac.uk/fac/med/research/csri/orthopaedics/sportsurgery/hip/

Podcast timeline:
0.30 - St George’s Park and the England Football Association Perform Rehabilitation Centre
1.02 - Introduction to Sports Hip 2016: First time for a multidisciplinary meeting on sports hip injuries
1.58 - Instability of the hip
2.47 - Treatment of acute subluxation or dislocation, returning to 
3.23 - Deep gluteal space, piriformis syndrome and sciatic nerve entrapment
4.54 - Cartilage repair
6.04 – Workshops in hip arthroscopy, hip replacement techniques suitable for athletes
6.00 - Workshop in hip arthroscopy
6.57 - New techniques in hip replacement suitable for young active people and athletes.
7.24 - World class rehabilitation after hip surgery
7.50 - Round table on challenges in managing elite athletes
8.15 - Femoroacetabular impingement (FAI) syndrome, and the movement towards reaching a consensus statement.
11.00 - Consensus meeting on FAI syndrome


A deep dive into hip pain. Professor Damian Griffin makes the complicated clear. (Part 1 of 2)

Often tendinopathy will be resistant to even the best traditional rehabilitation methods. Liam West chats to Dr Ebonie Rio, a PostDoctoral Fellow at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. Dr Rio’s research aims to explain the role of the primary motor cortex in tendinopathy. She discusses tendon neuroplastic training (TNT) and how it might help your tendinopathy patients regain pain free function in the clinic.

Timeline
0.40 – Why traditional rehabilitation for tendinopathy might be unsuccessful
1.40 - Changes in primary motor cortex and motor control in tendinopathy
2.35 – What is TNT & how to utilise it?
5.30 – How long does it take for TNT to help patients?
6.30 – Cross education for tendinopathy

Further Reading
Tendon neuroplastic training: changing the way we think about tendon rehabilitation – OPEN ACCESS - http://bit.ly/29ergE3 

Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK 


Related Podcasts
Prof Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL 

Prof Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol 

Defining tissue capacity - http://bit.ly/29iVSKc 



Could TNT blast a hole in treatment barriers in tendinopathy? Ebonie Rio discusses

ACL injuries are some of the most common and debilitating injuries in athletes. In this podcast, Tim Hewett and Kate Webster talk about the biomechanical risk factors for ACL injury, the role and potential of screening, and the use of ACL prevention programmes. 

Tim Hewett is an expert in biomedical engineering work at the Mayo Clinic and Kate Webster is an associate professor at La Trobe University. They are both speaking at the upcoming Sports Medicine Australia Conference-more details can be found here-http://tinyurl.com/h4ndfy2 

Timeline:
0.40 - What is the biggest risk factor for ACL injury?
2.10 - How are ACL injuries preventable?
4.10 - Can we screen for injury risk?
6.00 - Key criteria for RTS.
9:40 - The high risk of re-injury following ACL damage.
13.00 - Are we returning athletes too soon post injury?
     


What predicts ACL rupture? What prevents it? Tim Hewett (Mayo Clinic) and Kate Webster (La Trobe)

Professor Damian Griffin talks about the Warwick Agreement, an international consensus on the management of femoroacetabular impingement syndrome. This podcast brings you right up to date on the most current thinking about hip impingement or FAI.

0.38 Aim of the consensus
1.36 Consensus methodology
2.26 What is FAI syndrome? Symptoms, clinical signs, and imaging findings.
3.40 How should FAI syndrome be diagnosed?
6.26 What is the appropriate treatment for FAI syndrome?
8.26 What is the prognosis of FAI syndrome?
10.23 How should someone with an asymptomatic hip, with cam or pincer morphology, be managed?
11.53 What research is now needed?
14.15 How is this new definition of FAI syndrome going to influence clinical care?

@DamianGriffin #WarwickAgreement

Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School.

Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults. His clinical practice and research focus on joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes in London and Coventry (www.hiparthroscopyclinic.co.uk).

Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation:www.nets.nihr.ac.uk/projects/hta/1310302

You can follow Damian on Twitter @DamianGriffin and @WarwickOrtho or reach him on damian.griffin@warwick.ac.uk



The Warwick Agreement on the management of femoroacetabular impingement syndrome with Damian Griffin

Have we been thinking about Osgood Schlatter Disease (OSD) all wrong? To answer this question, Dr. Erin Macri interviewed Prof. Jens Lykkegaard Oleson and Dr. Sinead Holden from Aalborg University on a recent visit to Denmark. 
Prof. Olesen is a rheumatologist and sports medicine physician, currently located at the Center for Almen Medicine at Aalborg University. His research focuses on tendon and fascia tissue adaption to loading, and the use of ultrasound examination in tendon and fascia pathology. Dr. Holden is a Senior Researcher at the Center for General Practice in Aalborg, where she is co-founder and research co-ordinator for the OptiYouth Research Group focused on ‘optimising physical health in youth’. Her research aims to increase understanding of musculoskeletal injuries and pain in youth, to identify those at increased risk for developing chronic MSK problems.
In this episode, we delve into some recent evidence suggesting the OSD may not be the self-limiting condition we have typically believed it to be. In fact, OSD may be more akin to a tendonopathy in its presentation, which lends itself to exploring some novel treatment approaches that may change OSD management in clinical practice.

Related Articles and Links
OSD table: http://bjsm.bmj.com/pages/wp-content/uploads/sites/17/2019/06/OSD-table.pdf
Cairns G, Owen T, Kluzek S, Thurley N, Holden S, Rathleff MS, Dean BJ. Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ Open Sport Exerc Med. 2018 Aug 13;4(1):e000383. doi: 10.1136/bmjsem-2018-000383
https://bmjopensem.bmj.com/content/4/1/e000383
Holden S, Winiarski L, Krommes K, Thorborg K, Olesen JL, Hölmich P  & Rathleff MS. Prognosis of Osgood-Schlatter - poorer than anticipated? A prospective cohort study with 24-month follow-up. Presented at the Scandinavian Sports Medicine Conference 2019, Copenhagen, Denmark. 
Vad, CG; Rathleff, MS; Jensen, HP; Holden S. Osgood Schlatter is associated with significant impairments in knee function and quality of life 4 years after diagnosis: a retrospective study. Presented at the Scandinavian Sports Medicine Conference 2019, Copenhagen, Denmark. 
Lyng K, Rathleff MS, Dean B, Kluzek S, Holden S. Current Management Strategies in Osgood Schlatter: A quantitative study. Presented at the Scandinavian Sports Medicine Conference 2019, Copenhagen, Denmark. 
Kaya DO, Toprak U, Baltaci G, et al. Long-term functional and sonographic outcomes in Osgood-Schlatter disease. Knee Surg Sports Traumatol Arthrosc 2013;21(5):1131-9.
Krause BL, Williams JP, Catterall A. Natural history of Osgood-Schlatter disease. J Pediatr Orthop 1990;10(1):65-8.

Osgood Schlatter – not the self-limiting condition we once thought. Episode #384

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