Training & Exercise

David Pope (@DavidKPope) is a practicing physiotherapist in Australia and a pioneer in social media for physio education. His podcasts via ClinicalEdge (www.clinicaledge.com.au/pages/podcast) with stellar guests such as David Butler and Jill Cook have had many tens of thousands of listeners. 

In this podcast, BJSM turns the microphone around and asks him to share the secrets of contemporary clinical teaching methods and clinical reasoning.

Physio education, with David Pope

Adam Weir talks to Ben Kibler from the Shoulder Center of Kentucky about the 2013 consensus statement on scapular dyskinesis in shoulder injury.

Read the editor's choice article for free online: http://bjsm.bmj.com/content/47/14/877.full

The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. 

Scapular summit 2013 with Ben Kibler

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

The debut AISTS MSA Sports Medicine podcast by Michael DeCastro and Milena Schötzer gives listeners a humourous insight into recovery methods, equating recovery from training to brushing your teeth: “you know you have to do it, but you don’t”.  

Sports Medicine: Recovery Methods by Michael DeCastro & Milena Schötzer

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

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

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

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

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

http://everybodywalk.org/

http://www.exerciseismedicine.org/

Bob Sallis on exercise as medicine

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

Sports rehabilitators and trainers specialise in exercise and sports rehabilitation and managing musculoskeletal conditions. They also promote exercise and healthy lifestyles. Listen here to BASRaT Chairman, Steve Aspinall from the University of Salford, and Continuing Professional Development Officer, Allan Munroe, University of Bradford. In addition to painting the picture of the profession, and the training pathway, our guests highlight BASRaT’s clinical contribution to Team True Spirit (rehabilitation of seriously injured servicemen ) and the Rugby Football Union (concussion information and management).

British Association of Sport Rehabilitators and Trainers (UK and Ireland)

Podcast titles are limited to 100 characters; the ideal title would have been…”Working as a multidisciplinary team in elite sport – the role of physiotherapy, strength and conditioning teams, medical folks, soft tissue therapists, exercise rehabilitators etc.”.
  
A leading elite team physiotherapist (Andrew Wallis, PT) and a head of sports science/conditioning (Darren Burgess, PhD) provide you the inside view from within two elite teams. And they have international experience before their current jobs. 

You’ll hear WHO these teams include on the sports medicine payroll. Our hosts (Ebonie Rio, David Opar) ask whose head would be on the chopping block if there was a rash of hamstring strains after a vigorous pre-season training. Is one hamstring injury recurrence among 10 players worth 9 players coming back a week early? What about sending players to the funky treatment’ clinician – flying for the miracle cure?

Apologies for a bit of shuffling noise in Andrew’s first two answers but it disappears. Well worth pushing through that distraction (we are working on trying to get sound quality like in Jack Chew’s podcasts!). 

Confident you’ll love this inside view! 

Darren Burgess is High Performance Manager at Port Adelaide Football (AFL) Club. Darren was Head of Fitness and Conditioning at Liverpool Football Club. Darren completed his PhD in movement analysis of AFL and Soccer in 2012.  http://www.portadelaidefc.com.au/

Andrew Wallis is head physiotherapist at the St Kilda Football Club and has been there for the last 8 years. He has a special interest in Hip and Groin pathology and consults privately at Melbourne Orthopaedic Group and Malvern Sports Medicine Centre. http://www.saints.com.au/

Relevant papers: 

Seasonal Training Load Quantification in Elite English Premier League Soccer Players.
Malone JJ, Di Michele R, Morgans R, Burgess D, Morton JP, Drust B.
Int J Sports Physiol Perform. 2014 Nov 13. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/25393111

Countermovement jump performance is not affected during an in-season training microcycle in elite youth soccer players.
Malone JJ, Murtagh CF, Morgans R, Burgess DJ, Morton JP, Drust B.
J Strength Cond Res. 2015 Mar;29(3):752-7. doi: 10.1519/JSC.0000000000000701.
http://www.ncbi.nlm.nih.gov/pubmed/25226317

Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme.
Brukner P, Nealon A, Morgan C, Burgess D, Dunn A.
Br J Sports Med. 2014 Jun;48(11):929-38. doi: 10.1136/bjsports-2012-091400. http://bjsm.bmj.com/content/48/11/929.long


An inside view: Who should lead rehabilitation in elite teams? Sports physios or rehab?

Dr Mike Bergeron, Chair of the IOC Consensus Committee on Youth Athletic Development discusses hot topics.

Here’s the link to the Consensus Statement (Open Access): http://bjsm.bmj.com/content/49/13/843.full

Youth Athlete Development (IOC Consensus): Specialisation, Talent Identification, Injury Prevention

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

In this episode of the AISTS Sports Medicine podcast, AISTS MSA 2015 participants, Mauricio Matos and Ignasi Vendrell, takes a look at the quantity ad quality of sleep and its impact on athletes' memory, performance, focus, decision-making and moods. 

To learn more about the AISTS Master of Sports Administration, visit www.aists.org/msa.

Sleep for Athletes: Impact on Performance & Recovery

Debating the theory of nature vs nurture, AISTS MSA 2015 participants, Anthony Gardner and Cindy Qiu packs this podcast with the wisdom of Homer Simpson, the studies of Malcom Gladwell, the theories of Gagne and analogies by Matt Damon's Will Hunting. 

Dig into the impact of hard work, intrinsic motivation and "going with the flow" when it comes to athlete development. 

To learn more about the AISTS Master of Sports Administration, visit www.aists.org/msa.

Debating the 10,000 hour rule

Dr Donald Shelbourne is an orthopedic surgeon at The Shelbourne Clinic in Indianapolis, Indiana. He has performed more than 6,000 ACL reconstructions since 1982 and he is credited with developing the ‘accelerated rehabilitation program’. He discusses the history of the field and how he contributed to eliminating the big problem of the ‘stiff stable’ knee. He does NOT detail the rehabilitation method itself. He has an interesting thought on the role of ACL reconstruction in young people who suffer ACL tears. 

See the timeline below that includes a paper referred to in the discussion and two additional BJSM resources. If I had to create a short slogan for the podcast I would go with ‘Symmetric Motion is Key’.  

1:00 How Dr Shelbourne discovered accelerated rehabilitation  
3:00 The problem of knees that were too stiff after ACL surgery in the 1980s. 
4:00 The problem of excessively large ACL grafts and graft hypertrophy blocking knee extension
4:40 Casts contributing to knees becoming ‘stiff-stable’. Knees not returning to full extension (1980s)
6:00 Moving patients from plaster to one hour a day of a limited motion brace
6:50 Dr Shelbourne comments on augmented lateral procedures today. Discusses hamstring grafts and allografts in this context. His rationale for ipsilateral patellar tendon grafts. 
9:40 Patellar tendon donor site problems – the role of physiotherapy in solving the problem
9:10 A comment on Dr Leo Pinzewski’s 20 year post-ACL surgery followup study. (Hamstring graft) Paper in American Journal of Sports Medicine (http://ow.ly/hcRx300Eb58). See also Professors Hutchinson and McCormack discuss that paper in BJSM (http://ow.ly/f1JM300EcQ0). They also have a new editorial on ACL outcomes online first as this podcast goes live (http://ow.ly/gqdk300Edm7). 
10:50 Stiffness is not acceptable. Patients prefer a bit of instability with full range of motion than a stiff stable knee. Stiff knee is a time bomb for osteoarthritis.
12:00 Who should have an ACL reconstruction? About half of patients who have ACL injuries are not getting back to sport at the previous level. “In a way you are much better off having non-operative treatment….”
13:00 If you are wondering whether to have surgery or not after ACL injury – go for conservative management first. “Nothing to lose”. “A stiff knee is a time bomb for osteoarthritis later on.”
13:45 Osteoarthritis. Patients who don’t get all their movement back have a high risk of osteoarthritis moving forward. Many surgeons overlook the loss of motion as a risk factor. 

Related podcasts: 
Dr Mark Hutchinson on ACL reconstruction: https://soundcloud.com/bmjpodcasts/markhutchinson2?in=bmjpodcasts/sets/bjsm-1
Dr Mark Hutchinson on meniscectomy for symptoms of painful locking and clicking: https://soundcloud.com/bmjpodcasts/mark-hutchinson?in=bmjpodcasts/sets/bjsm-1


The father of accelerated rehabilitation, Dr Don Shelbourne, on history and managing ACL injuries

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

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..

Latrobe Sports and Exercise Medicine Research Centre podcast featuring Dr Joanne Kemp

With athletes increasingly using social media to engage their fanbase and support sponsor activities, AISTS participants Jeffrey Aylen and Annie O'Shea asks the question: "how does such constant connectivity affect athlete mental health?" 

This podcast touches on the impact of cyber bullying, how negative interactions online may amplify existing depression, anxiety, insecurity and pressures and what sports administrators can do to help athletes. 

The Impact of Social Media on Athletes' Well Being

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely.

Relevant links: 
Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes:  https://soundcloud.com/bmjpodcasts/high-fat-for-health

Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus

Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach:
https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1

If you think that BJSM is only sharing one side of the story please use our various channels to contribute. Papers, blogs, podcasts, Twitter, Facebook -  we’d love to hear from you. We haven’t rejected any papers saying that hi-carb is good for you!

Professor Peter Brukner on food as medicine. No industry funding.

Phil Glasgow is the head of sports medicine at the Sports Institute, Northern Ireland. A vastly experienced physiotherapist, he has worked at 3 Olympic Games, and has just returned from Rio. In this podcast, we discuss a case history of a football player with hip pain, from assessment to RTP. We look at the sensitivity vs. specificity of various tests, how to explain the symptoms to patients, and any co-existing pathologies there may be in the athlete. Finally, the discussion moves to treatment, the role of manual therapy, and exercises the patients can do to increase strength in the tissue.

The 2nd World Conference of Sports Physiotherapy will be held in Belfast, 2017- details can be found here: http://bit.ly/2dP2HjH

Timeline
0.40 - Hip pain: a case history and when is it reported to the physio?
3.08 - Ruling things out in the hip is easy: how do we rule things in?
7.30 - Things to consider when treating the hip
10.30 - Prescribing exercise for the patient - how do we go about it?
13.00 - How to increase the load in the injured athlete
18.26 - Bridging exercises for the hip
22.50 - Building a model for the pain and tips from the top

Phil Glasgow talks all things around the hip and treatment

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

Training & Exercise

Robert Vignoli