bjsm 2

Are you wondering how to best manage sports-related groin pain? In this 2nd of two podcasts by, Dr Andrew Franklyn-Miller focuses on groin pain – particularly in football sports. He advocates a fresh look at the treatment and diagnosis of groin pain. In particular, he argues that the patient’s biomechanics can be best analysed using dynamic video capture systems. 

Dr Franklyn-Miller has published widely in sports medicine and his book, Clinical Sports Anatomy (2011), coauthored with Eanna Falvey and Peter Brukner, is an international best-seller.

Listen to his first podcast, on running injuries, here: http://bit.ly/187BA9b

Managing groin pain, with Andrew Franklyn-Miller

Julien Périard is a Canadian research scientist. After racing on the International Triathlon Union Circuit, he completed a PhD at the University of Sydney, investigating the mechanisms that limit prolonged exercise in the heat. He continues to be intrigued by the mechanisms that mediate performance and fatigue in adverse conditions and is now based in Qatar, an ideal place conduct heat studies in athletes. 

In this podcast he talks about a study he led with tennis players competing in both hot (37ºC) and cool (22ºC) conditions. He discusses the thermal, physiological and perceptual strain associated with match-play tennis in these conditions, as well as fatigue from a physical and neuromuscular performance perspective. He further discusses the impact of playing in the heat on oxidative stress, and the role of an individualized hydration regimen on performance under heat stress. 

He gives several important take home messages for coaches and players who plan to compete in the heat.

See also:

Heat stress does not exacerbate tennis-induced alterations in physical performance: http://bjsm.bmj.com/content/48/Suppl_1/i39.full

Coping with heat stress during match-play tennis: Does an individualised hydration regimen enhance performance and recovery?: http://bjsm.bmj.com/content/48/Suppl_1/i64.full

Increase in tennis injuries at the Australian Open – media hype or evidence based: http://blogs.bmj.com/bjsm/2014/01/28/increase-in-tennis-injuries-at-the-australian-open-media-hype-or-evidence-based/

Australian Open – Hot Tennis. To play or not to play? That is the question: http://blogs.bmj.com/bjsm/2014/01/18/australian-open-hot-tennis-to-play-or-not-to-play-that-is-the-question/

Thermal, physiological and perceptual strain mediate alterations in match-play tennis under heat stress: http://bjsm.bmj.com/content/48/Suppl_1/i32.full

Hydration and thermal strain during tennis in the heat: http://bjsm.bmj.com/content/48/Suppl_1/i12.full

Core body temperature during competition in the heat: national boys’ 14s junior tennis championships: http://bjsm.bmj.com/content/41/11/779.full

An integrated physiological and performance profile of professional tennis: http://bjsm.bmj.com/content/41/8/531.full

The impact of match-play tennis in a hot environment on indirect markers of oxidative stress and antioxidant status: http://bjsm.bmj.com/content/48/Suppl_1/i59.full

Neuromuscular adjustments of the knee extensors and plantar flexors following match-play tennis in the heat: http://bjsm.bmj.com/content/48/Suppl_1/i45.full


Julien Périard Tennis in the heat

Dr Bert Mandelbaum is the team doctor for Team USA (soccer), the LA Galaxy, and Director of Research for Major League Baseball. He shares his optimism about the role of PRP in various injuries, while cautioning that stem cells, despite their promise, may still be like a ‘Ferrari without a steering wheel’. 

He was a pioneer in ACL prevention research and believes that programs successful in women may well translate across to men in sport such as NFL football. 

He takes 2 questions from @BJSM_BMJ Twitter followers. You can catch him next at the 23rd Isokinetic Football Medicine Conference in Milan, March 22-23, 2014 www.footballmedicinestrategies.com/en/
 
Read two of Dr Mandelbaum's prominent papers:

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players bit.ly/1fWWCfu

Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes bit.ly/1lwfzt8

See also:

Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial bit.ly/1iXJRmS

Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial bit.ly/LSeWgb

Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial bit.ly/1fWWjRF

Growth factor delivery methods in the management of sports injuries: the state of play: http://bjsm.bmj.com/content/42/5/314.full

The PRP debate: http://blogs.bmj.com/bjsm/2010/11/15/the-prp-debate/

IOC consensus paper on the use of platelet-rich plasma in sports medicine: http://bjsm.bmj.com/content/44/15/1072.full

What constitutes the safe use of PRP in sports injuries? Continuing the PRP debate: http://blogs.bmj.com/bjsm/2010/11/25/what-constitutes-the-safe-use-of-prp-in-sports-injuries-continuing-the-prp-debate/

No magical therapeutic benefit of PRP in Achilles tendinopathy — JAMA paper follow-up and BJSM podcast: http://blogs.bmj.com/bjsm/2011/10/18/no-magical-therapeutic-benefit-of-prp-in-achilles-tendinopathy-jama-paper-follow-up-and-bjsm-podcast/

Platelet-rich plasma: a ‘feeling' and ‘hope' ailing athletes: http://bjsm.bmj.com/content/44/Suppl_1/i1.2.abstract

Airway injury during high-level exercise: http://bjsm.bmj.com/content/46/6/385.full

PRP within the wider context of regenerative medicine: http://blogs.bmj.com/bjsm/2010/12/07/prp-within-the-wider-context-of-regenerative-medicine/

Dr Bert Mandelbaum on PRP and stem cells for treatment / exercises for injury prevention

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

Managing the athlete with hip stiffness detected at a physical exam or in a PPE is one of the hottest topics of 2014. Some would argue that nothing needs to be done given that the patient is asymptomatic but on the other hand many orthopaedic papers argue for ‘preventive’ osteotomy. Is this ‘overdiagnosis’ and ‘overtreatment’? Mike Reiman is a highly respected clinician-academic and he has integrated the literature on this topic with his clinical expertise. A ‘must’ podcast for physiotherapists, ATCs and doctors who take care of active people. 

See also: 

Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis: bit.ly/1inIRfW 

Physical examination tests for hip dysfunction and injury: bit.ly/1lHRoVP

Jo Kemp, Kay Crossley, Ewa Roos, What fooled us in the knee may trip us up in the hip: lessons from arthroscopy: bit.ly/1pifElu

Julianne Ryan, Neasa DeBurca, Karen McCreesh, Risk factors for groin/hip injuries in field-based sports: a systematic review: bit.ly/1sq5ip2

Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes: http://bjsm.bmj.com/content/48/14/1102.full

Jon Patricios - Hip injuries in sport, in association with SASMA: https://soundcloud.com/bmjpodcasts/hip-injuries-in-sport-in-association-with-sasma

Managing the PAINFUL hip and groin in sport – a focus on conservative Rx – Prof Mike Reiman (Part 2): https://soundcloud.com/bmjpodcasts/managing-the-painful-hip-and-groin-in-sport-a-focus-on-conservative-rx-mike-reiman-part-2

Duke University’s Assoc Prof Mike Reiman on managing the stiff hip in sport – is it FAI? (Part 1)

Associate Professor Grethe Myklebust, physiotherapist and PhD from the Olympic Training Centre in Norway, was one of the pioneers to investigate the role of exercise for ACL prevention.  

To discuss her research with her is Jodie McClelland from La Trobe University. Jodie’s experience is in the biomechanics of the knee in the normal and injured state, and she has the knowledge to extract the best information from Grethe about her research and its impact on the clinical management of those with, and at risk of, ACL injury.


Management and prevention of ACL injuries, with Assoc Prof Grethe Myklebust

Chris McNicholl brings the experience of the Olympic Games and two Commonwealth Games to his sports taping courses for UK Physios in Sport. In this podcast we dig below the surface. Does taping really prevent injuries and if so, how? We cover lower limb, upper limb, joints & muscles. Football and rugby. But we keep the issue of Kinesio-tape for a separate podcast. 

You’ll hear Chris refer to the following papers: 

Tricia J. Hubbard, et al. Effect of Ankle Taping on Mechanical Laxity in Chronic Ankle Instability Foot & Ankle International/Vol. 31, No. 6/June 2010

Heather Miller et al. Role of External Prophylactic Support in Restricting Accessory Ankle Motion after Exercise Foot Ankle Int 2012 33: 862

Karl Stoffel et al. Effect of Ankle Taping on Knee and Ankle. Joint Biomechanics in Sporting Tasks. MEDICINE & SCIENCE IN SPORTS & EXERCISE 2010

Eamonn Delahut et al. Altered Neuromuscular Control and Ankle Joint Kinematics During Walking in Subjects With Functional Instability of the Ankle Joint. The American Journal of Sports Medicine, Vol. 34, No. 12 2006

Effective ankle taping: Mechanisms, myths and more….(Part 1)

Modern surgical techniques can make a traditional treatment obsolete. Think of the Herbert screw for scaphoid fracture. Professor Bob McCormack tested a new hook plate in a Canadian multi-centre trial of management of complete dissociation & dislocation of the AC joint. You have to listen to find out how the story ends!   

Enjoy this 3rd of Bob McCormack’s 3 BJSM podcasts. 

You can find Bob’s other podcasts here: 
1.	First time shoulder dislocation: https://soundcloud.com/bmjpodcasts/shoulder-dislocation-to-operate-or-rehabilitate-prof-bob-mccormack-olympic-physician?in=bmjpodcasts/sets/bjsm-1

2.	Managing mid-clavicular fractures. https://soundcloud.com/bmjpodcasts/mid-clavicular-fracture-open-surgery-or-collar-cuff-prof-bob-mccormack-olympic-physician?in=bmjpodcasts/sets/bjsm-1


Complete AC joint dislocation (Grade 3): What’s best management? Bob McCormack (Olympic physician)

Meryl Wheeler goes by the name of “non-physician expert” and she explains that after an injury a patient books online, sees an athletic therapist especially trained for this setting, before closing with a sports physician consultation. Patients who needed a surgeon got an operation 5 months earlier in this system than in Canada’s regular publicly funded one. Food for thought? 

Link:  http://www.theglobeandmail.com/life/health-and-fitness/calgary-knee-clinic-delivers-quicker-cheaper-elite-level-care/article4180511/
 
The Canadian Academy of Sport & Exercise Medicine is a BJSM member society - casem-acmse.org/


A radical clinic for care of patients with knee injuries

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)

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

Are you or your athletes in control of your ‘chimp’ (emotional, reactive part of your mind) at all times? We hear from Professor Steve Peters -- the brains behind ‘The Chimp Paradox’ and the much-heralded psychiatrist who has worked with the likes of Team Sky Cycling, Liverpool Football Club and the FA to improve athlete performance. Prof Peters explains the rationale for the seemingly simplistic model and shared example of how it can be applied in various sport settings. 

“The Chimp Paradox” has been among the most popular self-development books in recent years and it will of interest to many BJSM listeners from both a personal and professional standpoint.  http://amzn.to/1TNV3Xy

If you want to see Prof Peters speak – sign up for the BASEM Spring Conference (Friday April 8th) here! http://bit.ly/1TNV0en 

Timeline

1:10m: What is the chimp model?

4:15m: How does the ‘chimp’ model work in sport?

5:30m: Is it always an overactive chimp that holds athletes back?

7:45m: What works best with athletes?

9:30m: What can we do about unhelpful behavioural traits?

11:45m: What pitfalls can we avoid when dealing with young elite athletes?

13:30m: How can you talk to athletes about psychological performance?

16:55m: Does the chimp model work when split-second sporting decisions are needed?

18:30m: Mental Health in Sport

21:15m: Any tips for those wanting to work in sport?

BJSM Links: 

2016’s issue 3 of BJSM was devoted to mental health in sport. Table of contents link: 
http://bjsm.bmj.com/content/50/3.toc

An editorial on the issue of mental health and ‘mental toughness’ : 
Dr James Bauman: The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport?
http://bjsm.bmj.com/content/50/3/135.extract



Leading sports psychiatrist, Prof Steve Peters, shares secrets of working with the very best

F-MARC, the FIFA Medical Association and Research Centre, have recently launched a free online diploma primarily for doctors and other health practitioners who have little or no sports medicine knowledge or experience. There is, however, material that will appeal to anyone with an interest in sports medicine. There are currently 20 modules, which will expand to 42 by the end of the year and completion will lead to being awarded the diploma. Steffan Griffin talks to Dr Mark Fulcher, a sport and exercise medicine physician at the FIFA Medical Centre of Excellence in Auckland, New Zealand.

The online diploma is FREE to do and can be accessed here: 
http://f-marc.com/footballdiploma/ 

Timeline:
0-1.42 What is the diploma?
1.42-3.00 People involved in creating the content.
3.00-3.56-How the website can be used by different specialties.
3.56-4.20 Development and evolution of the diploma.
4.20-6.55 A little bit about Dr Fulcher and his work.


A free online resource in football medicine with Dr Mark Fulcher

Most clinicians who manage patients with tendinopathy will have encountered the situation where the clinical picture and imaging findings do not match up. 

Sean Docking, researcher at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne, has been using Ultrasound Tissue Characterisation (UTC) to visualise changes associated with tendinopathy in 3D detail.  In this podcast he talks to Liam West about how UTC may help us explain this discrepancy between current imaging and clinical pictures in tendinopathy. He also gives the listener an insight into the clinical relevance of UTC and the lessons that have been learnt from his research within the field.

Timeline
0.45 – Current imaging modalities used in tendinopathy
3.45 – Disconnect between imaging findings and clinical picture
4.45 – Place imaging in clinical context
6.00 – Deep dive on UTC
7.55 – Tendon response to pathology
10.45 – Treat the donut, not the hole 

Further Reading
	Using UTC to measure game load on tendons in AFL - http://bit.ly/29rSr3k 
	Pathological tendons have good amounts of normal structure - 
	http://bit.ly/29iCfiG 
	Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK 

Further Related Podcasts
	Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL 
	Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol 


Treat the donut, not the hole: What UTC imaging teaches us about tendon pathology. Dr Sean Docking

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

Coming together at the UKSEM conference in London, Professor Lars Engebretsen (Oslo Sports Trauma Research Center and IOC medical commission) talks to Dr Richard Frobell (Lund University, Malmo, Sweden) about his work on return to exercise after ACL (anterior cruciate ligament) injury.

Dr Frobell describes the evidence already on this issue, and his recently published randomized trial on whether surgery or rehabilitation improves pain, symptoms, function in sports and recreation, and knee-related quality of life post-injury

See also:
A randomized trial of treatment for acute anterior cruciate ligament tears http://bit.ly/rrS51Y
The BJSM Warm up about this injury http://bit.ly/tBNdiu
Our 2010 interview with Richard Frobell and coauthors of the NEJM paper above http://bit.ly/99leZd

Return to exercise after ACL (anterior cruciate ligament) injury, with Dr Richard Frobell

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

Dr Mark Hutchinson, professor of Orthopaedics and Sports Medicine at the University of Illinois Medical Centre, and star of the three million times viewed BJSM physical examination videos [http://bit.ly/17UykR2], gives Karim Khan an update on examination and management of shoulder injuries.

In this podcast Dr Hutchinson covers (i) Common pitfalls and what to do instead (ii) How to diagnose overuse in the throwing shoulder (iii) ‘Labral tears’ vs ‘SLAP’ tears nomenclature (iv) Shoulder dislocation – when is surgery appropriate? and (v) Scaphoid fracture - has screw fixation become first line treatment?

If you missed Dr Hutchinson’s knee podcast listen here http://bit.ly/O2rRe2.

Another popular shoulder podcast is by Professor Jeremy Lewis on rotator cuff tendinopathy http://bit.ly/11yxbel.

4 bread-and-butter shoulder problems + special bonus with Prof Mark Hutchinson?

This short podcast is directed to patients - specifically active sportspeople who have recently rupture an anterior cruciate ligament (ACL). Associate Professor Richard Frobell is the lead of the team that has addressed a key question with the most rigorous research study to date. Is there any benefit to immediate knee reconstruction? Will waiting for a knee reconstruction lead to more injury or arthritis?

See also:
Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial bit.ly/Yqr25b
A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears bit.ly/cgTUfO
Renström PA. Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: recent evidence and a personal reflection. Br J Sports Med. 2012 Aug 31 1.usa.gov/14M4mzO
G Myklebust, R Bahr, Return to play guidelines after anterior cruciate ligament surgery bit.ly/ZK5pZk

Professor Richard Frobell - Do I need an immediate knee reconstruction?

We are talking tendons again in this podcast because the next International Scientific Tendinopathy Symposium has been scheduled for September 5 and 6 in Oxford, UK. This exciting event follows on from two successful conferences in Vancouver in 2012 and Umea in 2010. The consensus paper from the Vancouver conference is open access in the June 2013 edition of BJSM [http://bit.ly/13fLIN1].

In this podcast I am talking to with Dr Mark Thompson, a biomedical engineer from Oxford University, who leads the Oxford Mechanobiology Group. Amongst other things he is working with Prof Andy Carr, who has a large number of publications particularly on the rotator cuff tendon.

Mark discusses the mechanics of tendon and tendinopathy, and how mechanics contribute to the clinical perspectives of the condition.

bjsm 2

Ivan Kirov