Training & Exercise

Physio

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

Zoe Russell discusses ankle sprain assessment and treatment, and how to return your patients to sport. You’ll discover how to help your ankle sprain patients fully recover as quickly as possible, and avoid long term issues, such as chronic ankle instability, osteoarthritis or other lower limb injuries. 

Zoe is a Specialist Sports Physiotherapist (FACP), APA Titled Musculoskeletal and Sports Physio, as well as a Clinical Edge Senior Educator and Presenter, and in this Physio Edge podcast hosted by David Pope, we discuss the latest evidence and practical strategies for ankle sprains.

148. How to assess ankle sprains & start rehab with Zoe Russell

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

CrossFit is a very popular form of improving strength and fitness, and CrossFit athletes have a variety of common injuries. Training errors and the athlete’s biomechanics often contribute to these injuries, and identifying incorrect biomechanics and other contributing elements in their training is often the key to helping your patients recover from injury, train pain free and importantly for your patients, ultimately get stronger and fitter.
In episode 30 of the Physio Edge podcast, David Pope discusses CrossFit injuries, training, biomechanics and injury recovery with Antony Lo. Antony is a Musculoskeletal Physiotherapist with a number of clinics within CrossFit gyms across Sydney, and a large proportion of his patient population are CrossFit athletes.
In this podcast Antony and David explore:
	•	The most common injuries in CrossFit
	•	Factors that contribute to injuries in the Shoulders, Neck, Back, Knees, and lower limb
	•	Specific exercises performed in CrossFit
	◦	Squats
	◦	Pullups/Chinups
	◦	Pushups
	◦	Overhead exercises
	◦	Double unders
	◦	Overhead squats
	◦	Snatch
	◦	Running
	•	Ideal biomechanics for each of these movement
	•	Common movement errors and ways to assess each movement
	•	Rest from training vs continue training
	•	Manual therapy on cross fit athletes
	•	Modifying training loads
	•	Rhabdomyolisis
	•	Urinary continence while training
	•	Advice for Physios treating CrossFit athletes
Links of Interest
Subscribe to the podcast in iTunes
Review the podcast in iTunes
Listen to the podcast on Soundcloud
Antony Lo
Antony’s Website - physiodetective.com
Antony on Twitter
CrossFit


PE #030 CrossFit Injuries With Antony Lo

Dr Jeppe Bo Lauersen, currently working as a medical doctor in Copenhagen, investigated exercise intervention and its effects during a pre-graduate scholarship year at the Institute of Sport Science in Copenhagen with co-authors Ditte Bertelsen and Lars Bo Andersen.  Prof Andersen, who is the head of the Centre for Research in Childhood Health at the University of Southern Denmark and a professor the Norwegian School of Sport Sciences, joins him on this podcast.  They discuss their systematic review and meta-analysis of randomized control trials investigating exercise interventions for sports injuries.

In this podcast they share with us their interesting results, why some of the findings surprised them, and what conclusions we could take away from their work.  Prof Andersen also shares some thoughts on the statistics and methods surrounding systematic reviews.

With exercise and its effect on health receiving much attention in the wide stream media currently, the authors discuss the effectiveness of exercise interventions, and what we should focus on when considering treatment of sports injuries.

Find their article here: http://bjsm.bmj.com/content/48/11/871.full


Exercise interventions to prevent sports injuries – what you need to know

The Society of Sports Therapists was established in the UK in 1990 to address the growing demands from sport and leisure on everyone involved in the management and care of injured participants. Professor Graham Smith, Chairman of the Society of Sports Therapists, discusses the past, present, and future of sports therapy. 

The first two minutes cover the rationale for this health care profession.

3:00m - you can hear what a student learns through the 3 years of the course. 

4:20m - The Master’s in Sports Therapy (with eligibility for membership) – the course for folks who already have a sports science degree and want to become clinicians. 

5:50m - Final year student perspective - “students are the future of the profession” - useful tips for deciding whether sports therapy is for you or not. 

9:00m - A discussion of the roles that sports therapists are filling in a wide range of sports settings. “82% of the members are self-employed” - clearly sports therapists are well suited to work in the large sports club setting or in smaller clubs. 

In the second half of the podcast Professor Smith also highlights hot topics such as: (i) the interaction with physiotherapists “to complement physiotherapy and to protect the people who play sport and exercise”, (ii) the 2016 scientific meeting “From Pain to Performance” (May 14th, 2016) featuring the great US knee surgeon Don Shelbourne, and (iii) the Society being a partner with BJSM: “We are pleased to be part of a global sports medicine community and appreciated as such”.

Links:

Home page for the Society of Sport Therapists 
http://www.society-of-sports-therapists.org/index.php/public_information/what-is-sports-therapy 

Where to study Sports Therapy (BSc Hons) 
http://www.society-of-sports-therapists.org/index.php/public/degree_courses_BSc

Where to study Sports Therapy if you already have a relevant degree (MSc)
http://www.society-of-sports-therapists.org/index.php/public/degree_courses_MSc


Focus on Sports Therapists and students considering Sports Therapy: Professor Graham Smith

The American Medical Society for Sports Medicine (AMSSM) is strongly committed to embedding Exercise is Medicine in the health of Americans. A member of the AMSSM’s leadership group is Associate Professor Irfan Asif, the Director of the Sports Medicine Fellowship within the Department of Family Medicine at the University of South Carolina Greenville. 

Our chat focuses on the practical aspects of Lifestyle Medicine – which is more than exercise medicine alone. You’ll hear about: (i) the patient’s journey through a 6-week clinical service, (ii) exercise being embedded in all 4 years of the medical curriculum, (iii) how medical students are engaging with high school students in very practical ways and with some surprising outcomes. 

We discuss the challenges of rolling out a lifestyle medicine programme in rural areas with minimal resources and the devil’s advocate asks the hard question: ‘Are doctors really the right persons in health care teams to prescribe exercise?’.

 Timeline: 
00:47m - What is the Lifestyle Medicine clinic? Who is involved, what are the goals? 

02:00m - The diet part – modifying the DASH diet with a Southern Flavour (Dietary Approaches to Stop Hypertension (http://ow.ly/VtPSR))

04:00m - An example: walking through the patient’s journey – such as a patient with COPD. The role of partners such at the YMCA

05:30m - What the patient finds important – health or weight loss?

06:00m - How the curriculum embraces Lifestyle Medicine. See the link to Dr Jennifer Trilk’s work below (BJSM paper)

08:00m - Practical experiences of medical students within their communities. From given practical cooking advice to engaging high school students who are at risk of gang-related behaviour. Leadership concepts and team dynamic training – beyond the traditional medical model 

10:00m - Physicians encouraging 7th & 8th grade children to ‘get your 30’ (minutes). Teaching CPR to children at this level. Encouraging young students to be open about concussion symptoms. Practical stuff

11:00m - Exercise Vital Sign: how many minutes do you exercise and how often do you exercise? Integrated into the Electronic Medical Record of the 13th largest health system in the US (with credit to Kaiser-Permanent as well). Flipping the health care system upside down from its focus on fee-for-service to prioritising prevention. 

13:00m - Rural roll out: how to make this happen outside of major centres: ‘Think big but start small – practical first steps that will bring partners on board’ 

14:45m - Taking a broader view – 'If we rely only on medical professionals to provide care our system is bound to sink'. 'There is plenty of pathology to go around'. The role of various health professionals in a team that provides excellence: 'Everyone plays a vital role'

15:30m - Dr Asif answers the hard question: 'What if an exercise professional feels he or she knows more about exercise prescription than the doctor?'

Links: 
Incorporating ‘Exercise is Medicine’ into the University of South Carolina School of Medicine and Greenville Health System (Editorial, BJSM, 2014) - http://ow.ly/VtWv4

Check out the 2015 Physical Activity Issue of BJSM - http://bjsm.bmj.com/content/49/4.toc 

2014 Physical Activity Issue of BJSM - http://bjsm.bmj.com/content/48/3.toc

How to promote Lifestyle Medicine in the Clinic, Curriculum, Community: Assoc Prof Irfan Asif

Welcome to the Latrobe Sports and Exercise Medicine Research Centre podcast,  Dr Joanne Kemp is an APA titled Sports Physiotherapist and is current a research fellow at Federation University in Ballarat.  Dr Kemp is an emerging name in the area of hip pain research and is currently involved in a number of research projects investing surgical and non-surgical management for hip pain both here in Australia and around the world.  Dr Kemp provides listeners with some great insights into the current status of hip research and some clinic ready skills for those of who treat patients with hip pain..

148. How to assess ankle sprains & start rehab with Zoe Russell

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