Exercise medicine

Karim Khan calls mechanotherapy “the most important fundamental concept that underpins rehabilitation exercises”. 

Listen to Karim explain that all exercise-based rehabilitation relies on the cells of the injured tissue sensing the exercise stimulus, converting that signal to protein synthesis, and repairing tissue. He explains why ‘rest doesn’t work’ and argues that mechanotherapy has substantial evidence in its favour. The process applies to all body tissues – to injuries / pathology in bone, muscle, tendon and cartilage. 

Read the review article, which has had over 32,000 full-page views since 2009:

Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair -  http://bjsm.bmj.com/content/43/4/247.full


“Mechanotherapy” and why it’s important for clinicians with Karim Khan

Here’s the podcast that over 12,000 listeners have been demanding – physiotherapist Adam Meakins (@TheSportsPhysio)on a number of controversial topics, including:
Is diagnostic palpation accurate?
Can the sacroiliac joint really be ‘unstable’?
How does ‘touch’ in physiotherapy have its therapeutic effect? 

Adam provides great value on Twitter and on his blog – here you can listen to him in your favourite podcast setting. 

Adam shares his way of explaining neural pain to patients and that alone is worth the price. 

He also discusses his popular blogs on ‘5 Least Favourite Shoulder Rehab Exercises’ as well as ‘Top 5 Shoulder Rehab Exercises’. 

He argues that the key to managing some knee conditions is to manage load and he refers to Scott Dye’s classic ‘envelope of function’ concept. 

And we close by discussing a couple of  figures that have gained great traction in the Twittersphere. You might find them useful in your clinical practice. But it’s a risk on radio – I get that! Enjoy and comment via @BJSM_BMJ or on Facebook.

See also:

Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain: http://bjsm.bmj.com/content/47/17/1095.full

Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis: http://bjsm.bmj.com/content/48/16/1216.full

Rehabilitation for shoulder instability: http://bjsm.bmj.com/content/44/5/333.full

Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury: http://bjsm.bmj.com/content/45/4/245.full

Adam Meakins' practical physio tips – explaining neural pain, shoulder rehab and managing knee load

Dr David Opar joins us for this BJSM podcast. David is a lecturer at the Australian Catholic University in Melbourne and one of the emerging voices in the field of hamstring strain injuries, having done work on the possible mechanism of injury as well as prospective studies aimed at better understanding eccentric strength as a risk factor for these injuries. 

His work also investigates the Nordic Hamstring Device, developed by the Queensland University of Technology Hamstring Group, looking into the potential of this device in prevention, treatment and rehabilitation of hamstring injuries. 

Nicol van Dyk, a physiotherapist in the Rehabilitation Department at Aspetar Sports Medicine & Orthopaedic Hospital in Qatar, leads the discussion around nordic hamstring exercises, the role of eccentric strength in hamstring strain injuries and the seeing the big picture in prevention and rehabilitation.

With hamstring strain injuries continuing to receive much attention in the literature and mainstream media, David Opar elucidates some significant features of this common injury.

Eccentric hamstring exercises – they work in practice but not in theory?

What causes tendon breakdown? What are the stages of tendinopathy, and how do they effect your treatment? Is treatment just about eccentric training? When should NSAID’s be used?

This is part of the great discussion I had with Jill Cook about tendons and tendinopathy. We also chatted about some other aspects of tendinopathy, including

Factors that contribute to tendinopathy beyond biomechanics
Eccentrics – what is the future of training to rebuild tendons
Return to sport or running after tendinopathy
Avoiding tendinopathy
Treatment at each stage of tendinopathy
Rehabing achilles tendinopathy
Rehab for hamstring tendinopathy
plus we related all of these to clinical scenarios. Enjoy!

PE #005  Tendons And Tendinopathy With Jill Cook

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)

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

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

What is tissue ‘capacity’? How does it help successful rehabilitation? Prof Jill Cook (2nd of 2)

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

Professor David Hunter is a leading rheumatologist and researcher working at the University of Sydney. David has over 350 publications in rheumatology and has co-authored several books providing self-management strategies for patients with osteoarthritis. In this podcast, we discuss:

• Treatments of OA, what does and doesn’t work
• How to take a detailed history and examination from a patient with OA
• Cornerstones of patient care: behavioral change, self management and weight loss 
• Weight loss strategies and how to maintain it
• Physiology behind how exercise improves symptoms
• Pharmacological and surgical treatments for OA

David caught up with Karim Khan after the 2017 Australasian College of Sport and Exercise Physicians (ACSEP) conference in the Gold Coast.  The next event is February 2018 and is sure to be a huge success! http://ow.ly/t20j3093yZq

Professor David Hunter talks osteoarthritis exercise therapies: better outcomes

It’s been called “the universal panacea” - exercise has a positive effect on almost all health measures, and governments are actively campaigning for us to do more. But at the opposite end of the scale, the realisation that some people may be addicted to exercise is gaining traction.

In this podcast we're joined by Heather Hausenblas - professor of kinesiology at Jacksonville University, James Smoliga - associate professor of physiology at highpoint University, and Katherine Schreiber - who’s experienced exercise addiction, and written about her experience.

They describe the condition, and what drives people to become addicted to exercise. They also outline the key indicators of the addiction, and what options there are for treatment.


Read their article:
http://www.bmj.com/content/357/bmj.j1745

“I had two herniated discs in my back, and I was still running” - addicted to exercise

There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy. How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with&nbsp;Dr Peter Malliaras&nbsp;in episode 68 of the Physio Edge podcast. We also explore:  Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas? How will you identify tendinopathy or other structures that may be contributing to your patients symptoms? Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement How can you measure your patients load tolerance? What categories of tendinopathy patients can you use to help differentiate your treatment? How can you rehabilitate patients with tendinopathy? What role does biomechanics have? What advice can you provide to your patients about load management, symptoms and flareups? When is it ok for your patients to continue or return to running? What strength tests should your patients be able to complete before returning to running? If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration? When are isometrics useful in your treatment? When can you start isotonic and plyometric exercises? How can you incorporate tendon neuroplastic training (TNT)?  Links associated with this episode   Download your podcast handout Dr Peter Malliaras on Twitter Tendinopathy rehab blog with Dr Peter Malliaras Get your free trial Clinical Edge membership David Pope on Twitter Clinical Edge on Facebook  Other episodes of interest:   PE 046 - Proximal hamstring tendinopathy with Tom Goom  PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O’Neil  PE 023 – Lower limb tendinopathies with Dr Pete Malliaras  Articles associated with this episode:    Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia   Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy   Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.   Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.

Physio Edge 068 Lower limb tendinopathy loading, running and rehab with Dr Peter Malliaras

On this episode of the Healthy Wealthy and Smart Podcast, Nick Tumminello joins me to discuss exercise prescription. Nick Tumminello is the 2016 NSCA Personal Trainer of the Year, and the Editor-in-chief of the NSCA Personal Training Quarterly journal. He's the author of three books: Building Muscle and Performance, StrengthTraining for Fat Loss, and Your Workout PERFECTED. He's been a trainer for over 20 years, is the former strength coach for team Ground Control MMA and has trained professional athletes in field, court, combat and physique sports. In this episode, we discuss: -How to apply the 4 principles of strength and conditioning to program design -Progressive and regressive load management -Why the Socratic Method should be used when discussing training philosophies -Nick’s approach to new fitness fads -And so much more! &nbsp; Nick has found that trainers train their clients with trendy methods and neglect to tailor a program to meet the clients’ unique goals. When designing a program, Nick stresses, “The approach is determined by the goal… It’s not determined by my bias as a trainer or my favorite pet exercise.” A client must always be the driver of their own success, but Nick sees an important role for strength and conditioning coaches to enable their client’s full potential. He believes, “A facilitator gives people what they need to achieve what they want.” &nbsp; A solid training and rehab regime is built on adhering to these four principles: goal specificity, individuality, progressive overload and variability. Nick has found that, “If you focus your training or your rehabilitation approaches on principles and you go from principles up not methods down, your training or your rehab approach will never go out of date.” &nbsp; Nick’s experience with members of the health and fitness community has led him to believe that an open approach to communication rather than a divisive or pedagogical one will lead to more success in promoting your message. Nick advises, “Ask more questions and genuinely listen.” &nbsp; For more information on Nick: “A bit of an outsider…” That’s how Nick Tumminello describes himself in the fitness industry. He’s an independent thinker who avoids falling in line with the crowd. His goal is to provide practical solutions that deliver specific results. Nick’s hybrid approach to training allows him to leverage the tools, knowledge and skills of many disciplines and methods to help his clients and to educate other trainers how to deliver results. As early as his teenage years Nick knew that he wanted to be a trainer. His early influence came from his mother, growing up in a gym watching her prepare for bodybuilding competitions. She’ll tell you that “Nick grew up on iron and sweat.” As a way to connect Nick and his mother attended fitness events and conferences from the time he was 16 years old. Personal training is the only ‘real job’ nick’s ever known. But, his story isn’t common. Not being one to fall in line with the crowd Nick never attended college or got a degree. He graduated high school as an average student. He worked hard to accumulate a lot of on the job experience and despite his distaste for structured education Nick was very interested in learning. After being fired from his first two personal training jobs due to his independent thinking and lack of needing to ‘fit in’ he went off on his own to start a business. Training and fitness aren’t a hobby to Nick. This is a profession that he’s very passionate about. It would be easy to confuse Nick as a ‘science guy’ due to his ability to challenge thoughts and ideas, the way he respects the scientific process and critical thinking. However, he’s most excited by the application and end results that the information he learns and the ideas he creates can produce.&nbsp;&nbsp; “Studies and research are great, but if there is no practical application there is no need”...

320: Nick Tumminello: Exercise Prescription

In this week’s BJSM podcast, BJSM deputy editor Dr Jane Thornton (T: @JaneSThornton) joins Daniel Friedman (T: @ddfriedman) to discuss physical activity counselling.
Dr Jane Thornton MD PhD is a sports medicine physician and researcher currently based in London, Canada, and is an international advocate for physical activity. She has a wealth of international experience in the field of preventative medicine, with a particular passion for promoting physical activity as both prevention and treatment of chronic disease. Alongside a super impressive medical career, Dr Thornton is also a World Champion and former Olympic rower for Canada.
In Part 1 of this 2-part podcast, Dr Thornton discusses:
·        Why physical activity is the single best thing we can do for our health
·        The evidence for physical activity prescription in primary care
·        The shared decision making of how to prescribe physical activity to patients
·        How to talk about physical activity intensity with patients
 
Mentioned in this podcast:
23 and a half hours YouTube video:  https://www.youtube.com/watch?v=aUaInS6HIGo
Make Your Day Harder http://www.makeyourdayharder.com/
PA Prescription Position Statement https://bjsm.bmj.com/content/50/18/1109
Naci et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. BJSM 2019. https://bjsm.bmj.com/content/53/14/859

Prescribing physical activity with Dr Jane Thornton (Part 1). Episode #388

CrossFit: dangerous fad or fitness panacea? The AMSSM talks safety with Drs Sean Rockett and Robert Oh.

Few topics in sports draw such universally strong opinions from medical providers as that of CrossFit. Most seem to love or hate it, but are their strong opinions justified? Does current data back-up the concerns many of us have regarding the safety of this sport? What are the common injury patterns that are found? Host Dr. Devin McFadden, MD is joined by Dr. Sean Rockett, MD and Dr. Robert Oh, MD to explore these topics and more on the AMSSM Sports Medcast.

Dr. Sean Rockett is an Associate Professor of Orthopedic Surgery at Tufts University School of Medicine, president of Orthopedics New England and author of 321GoMD.com an injury prevention website for CrossFitters. He is head of the Orthopedic division for the Medical team for The CrossFit Games. 
Dr. Robert Oh, Sports Medicine physician and CrossFitter for 12 years. He’s the Chief of the Family Medicine Dept at Madigan Army Medical Center and Fellowship director for the Leader and Faculty Development at Madigan. 

References:
1. Sport Med - open. 2018;4(1):11. doi:10.1186/s40798-018-0124-5.
2. J Sports Med Phys Fitness. 2017;57(9):1147-1153. doi:10.23736/S0022-4707.16.06827-4
3. Orthop J Sport Med. 2018;6(10):2325967118803100. doi:10.1177/2325967118803100
4. J Sport Rehabil. 2018;27(3):295-299. doi:10.1123/jsr.2016-0040.
5. Sport Med. 2017;47(3):479-501. doi:10.1007/s40279-016-0575-0
6. Annals of epidemiology 2006; 16(9):712-719.)
7.  Work Heal Saf. 2017. doi:10.1177/2165079916685568.
8. Mil Med. 2016;181(7):627-637. doi:10.7205/MILMED-D-15-00273
9. US Army Med Dep J.:36-47. http://www.ncbi.nlm.nih.gov/pubmed/24146241. Accessed August 5, 2018.

CrossFit: dangerous fad or fitness panacea? Episode #392

Nanette Mutrie (@NanetteMutrie) has been Chair of Physical Activity for Health at the University of Edinburgh since July 2012. She directs the Physical Activity for Health Research Centre (PAHRC) in the Institute for Sport, Physical Education and Health Sciences. In January 2015 Nanette was awarded an MBE in the New Year's Honours list for services to physical activity for health in Scotland.
Nanette is a Chartered Psychologist and a Fellow of the British Association of Sport and Exercise Sciences—hence the expertise in behavioural interventions. She took a break from writing the 4th edition of ‘Psychology of physical activity” to speak with BJSM Editor in Chief Karim Khan (@BJSM_BMJ)
This podcast (part 1 of 2) will help you; appreciate the power for walking for health and mental health even more than previously, realise why ‘brisk’ may not be the ideal adverb to associate with walking for certain populations. The chat swings from practical tips about which technology to consider to capture walking, to tips for physios in the clinic and to Prof Mutrie explaining that walking is one factor that can contribute to addressing the Climate Crisis. 
 
Enjoy!

Is walking the best buy for public health? What should physios do? Prof Nanette Mutrie. Episode #415

In this edition of the BJSM podcast, human movement specialist Evert Verhagen discusses ankle sprains and rehabilitation.

Evert Verhagen on ankle sprains and rehabilitation

Exercise on prescription in Sweden started in the 1980s, and has now become widespread in the country. To help primary care clinicians navigate the evidence on prescribing exercise, the Swedish Institute of Public Health have produced the book Physical Activity in the Prevention and Treatment of Disease (available for personal use from http://www.fyss.se)

In this podcast Mai-Lis Hellénius and Carl Johan Sundberg, two of the authors of the book, share their experience of exercise on prescription in Sweden, and give some tips for clinicians thinking of following their model.

Exercise on prescription, Mai-Lis Hellénius and Carl Johan Sundberg

Dr Mike Loosemore  is a consultant in sports and exercise medicine who works at the English Institute of Sport and the University College London Hospital.

In this podcast he emphasises the importance of clinicians taking an exercise/activity history. (See link Developing healthcare systems to support exercise: exercise as the ﬁfth vital sign http://bit.ly/17Uhlyc). He provides practical tips for clinicians and highlights major health benefits from physical activity in a wide range of settings as diverse as patients with mental illness, breast cancer [2 links below], and those undergoing renal dialysis.

See also:
Physical activity interventions for cancer survivors http://bit.ly/ZFQ5jD
Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects http://bit.ly/ZJHPfb

Mike Loosemore - how to prescribe exercise

Pregnancy is hardly an uncommon condition in women, so what are the ins and out of exercise during those nine months? Harriet Vickers (BMJ’s assistant multimedia producer) talks to Bronwyn Bell (consultant obstetrician and gynaecologist) about the benefits and risks of physical activity from conception to postpartum, and how to look after women at different levels of fitness.

0:00 Conception: Getting in shape before becoming a mum and optimising your chances of conception

2:16 BMI and pregnancy

2:40 Benefits of exercise during pregnancy

4:00 Does exercise put the fetus at risk? The role of core temperature.

5:40 Contact sports and preventing injury during pregnancy

6:00 Absolute contraindications to exercise during pregnancy

8:34 Physiological changes - energy balance and body changes

11:30 Case management - initiating an exercise program in the unfit and newly pregnant woman

12:50 Case management - advising the regularly exercising woman to exercise. The ‘talk rule’ and heart rate as guides.

15:44 Case management - the professional athlete and exercise during pregnancy

17:15 Post-natal exercise advice. Breast feeding and breast support.

See also:
Royal College of Obstetricians and Gynaecologists - Exercise in pregnancy statement http://bit.ly/ZMaYph
BMJ editorial - Exercise during pregnancy http://bit.ly/17Um2br

Exercise in pregnancy

In this podcast we look at what sports and exercise medicine around the world can learn from Australia, just one of the countries where the area is thriving.

Scott Gardner is an Australian sports scientist currently working in the UK, recently with British Cycling, and he describes what’s going on at the Australian Institute of Sport, and why he thinks they’re so good at training clinicians (0.45).

Sports medicine in football is where John Orchard, associate professor at the University of Sydney and sports physician for Australian cricket and the Sydney Roosters, thinks the country is getting it right. He argues that politics in the English Premier League can prevent clinicians from doing their job properly, whereas those working in Australia face a much more open culture (5.24).

And Peter Brukner, previously head of Sports Medicine & Sports Science at Liverpool FC and media commentator, talks about how the media and public down under are very interested in, and hence knowledgeable about, sports injuries, and how this has a positive impact for clinicians. He also gives us a round up of what other countries are doing particularly well in sports and exercise medicine (13.11).

Future BJSM podcasts will put other nations under the spotlight; Phil Glasgow will share Team GB’s Olympic success story in the next installment in this series.

Drs Gardner, Orchard and Brukner spoke about sports and exercise medicine in Australia at a meeting organised by the Sporting Health Group, where Harriet Vickers (BMJ’s assistant multimedia editor) recorded this podcast.

See also:
Who is to blame for all the football inuries? http://bit.ly/NOJQF5
On the value of team medical staff: can the “Moneyball” approach be applied to injuries in professional football? http://bit.ly/10aYJSY

Peter Brukner, Scott Gardner and John Orchard on lessons from Australia

Critical thinker, curious, eclectic and genuinely interested in knowledge in every field, mostly in science and writing. Sports physio as first profession, involved in bringing high quality clinical and sport science education with Novavia Project in Italy, Switzerland and Slovenia.

Exercise medicine

SalviatiSPT