BJSM Podcast

Managing stress fractures in any athlete can be difficult. Liam West discussed the topic with international expert Dr. Kathryn Ackerman, to find out clinical management gems. Dr. Ackerman has specialist training in Internal Medicine, Sports Medicine and Endocrinology, Diabetes & Metabolism. This training has cumulated in positions as Medical Director of the Female Athlete Program at Boston Children's Hospital, Associate Director of the Sports Endocrine Research Lab at Massachusetts General Hospital, and Assistant Professor of Medicine at Harvard Medical School. She has focused research efforts on hormonal treatments to improve bone density and fracture healing, as well as various imaging modalities for assessing bone quality. Related Articles Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review. bjsm.bmj.com/content/49/6/370.long IOC Concensus Statement: RED-S - http://bjsm.bmj.com/content/48/7/491 Associated Podcasts Management of difficult stress fractures in sport - http://bit.ly/2EVorIM Margo Mountjoy on the REDS debate - http://bit.ly/1KzYT04 Podcast Quotes “There is a transient osteopenia during adolescenece that predisposes them to stress fractures” “Amenorrhic athletes have wider but weaker bones”

Machine learning. One of the buzz expressions currently being bandied around healthcare. But how can it be applied in sports medicine? In this BJSM podcast, we discuss it with two scientists currently applying machine learning to their practice, Chris Kelly and Dr Tommy Wood from nourishbalancethrive, a US-based performance optimization company. We discuss the applications of machine learning and its potential implications for healthcare. Topics include: - How to go about creating a machine learning model - What have they managed to predict so far - Limitations of using machine learning - Where do they see this technology moving forward to the future? - How can clinicians in sports use machine learning in practice? - How can anyone learn about machine learning? Link to nourishbalancethrive: https://bit.ly/2q3Yyk4 Link to an easy way to getting into coding: https://bit.ly/2EjQM9Y

We all know that exercise is medicine’s polypill. On this podcast, Dr. Blaise Williams discusses how to help older patient’s get active again. BJSM’s Liam West provides the questions that see Dr. Williams cover how the aged runner differs both in biomechanics and physiology, how this effects the forces through various areas of their bodies and finally the top clinical pearls you can use in your office today to help these older patients get moving again. If you haven’t listened to the first BJSM podcast with Blaise on his readiness to run scale, make sure you check that out too! Dr. Williams is an Associate Professor in the Department of Physical Therapy and the Director of the Virginia Commonwealth University (VCU) RUN LAB. Blaise teaches students at VCU within the orthopaedic and sports curriculum. Alongside this, he continues to treat athletes of all levels at the VCU Sports Medicine Clinic. Related Reading Paquette MR, DeVita P, Williams DSB 3rd. Biomechanical Implications of Training Volume and Intensity in Aging Runners. Med Sci Sports Exerc. 2017. Epub ahead of print. Powell DW, Williams DS. Changes in Vertical and Joint Stiffness in Runners with Advancing Age. J Strength Cond Res. 2017. Epub ahead of print. Devita P, Fellin RE, Seay JF, Ip E, Stavro N, Messier SP. The Relationships between Age and Running Biomechanics. Med Sci Sports Exerc. 2016. 48:98-106. Bus SA. Ground reaction forces and kinematics in distance running in older-aged men. Med Sci Sports Exerc. 2003, 35:1167-75. Similar Podcasts ▪From the AMSSM: Drilling down into running injuries – what they don’t teach in medical school http://bit.ly/2EvQbCP ▪From the AMSSM: 3 sports medicine legends on running injuries, illness and footwear http://bit.ly/2mfG7pM ▪Gait retraining to reduce leg pain with Dr Andy Franklyn-Miller http://bit.ly/1iTsOWb ▪Keeping runners running: the secrets of running assessment - advice and exercise progressions http://bit.ly/2EuGrIH Quotes “These changes occur as early as in our 40s, and in females even earlier” “Our physiology changes way before we see changes in our biomechanics”

Retired professional footballers are at a significantly increased risk of several health problems including osteoarthritis, mental health conditions, and difficulties pertaining to suboptimal lifestyle choices. During this podcast, Sean Carmody talks to Dr Vincent Gouttebarge, a retired professional footballer and current Chief Medical Officer of FIFPro (World Players’ Union), about what can be done to reduce the risk of health issues for footballers in retirement. Dr Gouttebarge has led several initiatives to improve outcomes for footballers in retirement, including a pilot ‘exit health examination’ study in collaboration with the Dutch Football Association and Dutch Players’ Union. Related Articles: Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study - http://bjsm.bmj.com/content/early/2017/10/25/bjsports-2017-097503 Perceptions of retired professional soccer players about the provision of support services before and after retirement - http://bjsm.bmj.com/content/bjsports/36/1/33 Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers - https://www.ncbi.nlm.nih.gov/pubmed/27285354 Lower extremity osteoarthritis is associated with lower health-related quality of life among retired professional footballers - https://www.tandfonline.com/doi/abs/10.1080/00913847.2018.1451718

“There is no real optimal exercise program. There’s no such thing it doesn’t really exist.” LIVE from Copenhagen at the 14th Scandinavian Congress of Medicine & Science in Sports, Dr. Karen Litzy, PT, DPT, with the Healthy, Wealthy and Smart Podcast, interviews Dr. Peter Malliaras about exercise principles for patellar and Achilles tendinopathy. Peter Malliaras is an Associate Professor at Monash University in the Department of Physiotherapy. His research focus is musculoskeletal disorders, sports medicine and tendinopathy. In 2006 he completed his PhD in tendinopathy identifying novel risk factors, and since has undertaken post-doctoral research in the UK and Australia. Peter maintains a strong clinical focus, specializing in difficult tendinopathy cases and delivering clinical postgraduate education for clinicians in Australia and internationally. In this podcast, Peter discusses different loading programs, pain responses and the value of imaging for patellar and Achilles tendinopathy. Resources Peter Malliaras Twitter - http://bit.ly/2ESwPch Scandinavian Congress of Medicine & Science in Sports - http://bit.ly/2nHdZ0h Peter Malliaras Research Gate Profile - http://bit.ly/2G3K61c Tendinopathy Rehabilitation - http://bit.ly/2C94T0H Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness - http://bit.ly/2Bn2d34 Monash University Peter Malliaras Profile - http://bit.ly/2Ey1sGg

Professor Lars Engebretsen, MD, PhD, Head of Medicine & Science at the IOC’s Scientific and Medical Department discusses the massive problem that is ACL injuries in children under 12 years of age. Kids’ ACL ruptures are becoming more prevalent, the condition seems to affect boys and girls equally, and the management is controversial. There is universal agreement that preserving the meniscus (which can include meniscal suture) is critical. See the full consensus statement here - http://bit.ly/2FwQMF6 Links: Link to the FREE 2018 consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. http://bjsm.bmj.com/content/early/2018/03/07/bjsports-2018-099060 Editorial by Professor Nick Mohtadi, Dr Clare Ardern and Professor Lars Engebetsen on the need to preserve the meniscus. http://bjsm.bmj.com/content/early/2018/03/09/bjsports-2018-099169 Podcast: Lars Engebretsen on adult knee injuries (2016 podcast, 10K listens) https://soundcloud.com/bmjpodcasts/professor-lars-engebretsen-on-management-of-young-adult-and-older-patients-with-knee-injuries Podcast: Dr Ben Clarsen on elite athlete screening and monitoring https://soundcloud.com/bmjpodcasts/nipping-injuries-in-the-bud-practical-tips-for-injuryillness-care-in-elite-athletes Website: IOC Sports Physiotherapy Diploma – What is it? http://www.sportsoracle.com/Sports+Physical+Therapies/Home/

Dr. Tasha Stanton’s background in physiotherapy and pain science means her research is very clinically relevant. BJSM’s Liam West discusses with Dr. Stanton the pain experienced by patients with osteoarthritis, how fear and emotions can alter this pain and where the future of osteoarthritis pain management might lie. Related Articles: Evidence of central sensitisation, impaired pain inhibition, enhanced pain facilitation in OA: Edwards et al. BMC Musculoskeletal Disorders 2016; 17:284 Perception of harm influences pain: Wiech et al J Neurosci 2010; 30:16324-31 What people with OA think about exercise/harm: Holden MA, et al. Role of exercise for knee pain: what do older adults in the community think? Arthritis Care Res. 2012;64:1554-64. Somers et al. J Pain Symptom Manage. 2009;37:863-72. Pouli N, et al. The experience of living with knee OA. Disabil Rehabil. 2014;36:600-7 Modulation of pain by vision: Longo et al. J Neurosci 2009; 29: 12125-30; Longo et al. J Neurosci 2012; 32: 2601-7 Alterations in body perception in people with OA: Nishigami et al. PLoS ONE 2017; 12:e0179225 Gilpin et al. Rheumatology 2015; 54:678-82 Body illusions in people with pain: Bosch et al. PAIN 2016; 157:519-29. Altering sounds alters feelings of back stiffness: Stanton et al. Scientific reports 2017; 7: 9861. Associated Podcasts: Prof Hunter on OA and exercise - http://bit.ly/2DQAd9z OA in the spotlight - http://bit.ly/1Frwnxt Prof Moseley on the brain and mind in chronic pain - http://bit.ly/1u33pPY Pain coach and first patient contact for pain management - http://bit.ly/2DHCaGa Am I safe to move? Prof Moseley on understanding pain and focusing on the patient - http://bit.ly/2nmCAqu Podcast Quotes: “Give your patient the locus of control” “Knowledge helps you frame what is happening in your world” “People with osteoarthritis often hold beliefs that movement is harmful”

Understanding and managing your patient’s pain can be extremely difficult. Liam West spoke to Dr. Tasha Stanton to tap into her vast expertise in the area of pain science. Dr. Stanton is a Senior Research Fellow for the “Body in Mind” group in Australia and has a background in physiotherapy, spinal biomechanics and pain neuroscience. Her work to date has led to several prestigious pain science awards. In this podcast she explains the disconnect between tissue damage and the pain experience, why people experience different levels of pain to the same stimulus and shares how to explain pain to a patient within a clinic setting. Related Articles Discordance between findings on scans (i.e., tissue damage) and pain Hannan MT, Felson DT, and Pincus T. 2000. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatology 27:1513-1517. Brinjikji et al American Journal of Neuroradiology 2015;36:811-16 Central sensitisation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268359/ http://www.noigroup.com/en/Product/EPBII Things that fire together, wire together: http://www.noigroup.com/en/Product/EPSB Explaining the neurobiology of pain: Moseley GL, Butler DS. Fifteen years of Explaining Pain. J Pain. 2015;16:807-13 Our sensations (including pain) are based on the believable, credible evidence that is available to us: Expectations of pain can be important: Bingle et al. Sci Transl Med 2011;3:70ra14 Other sensory input can change pain – the stinky smell study: Bartolo et al PAIN 2013 Our sensations are influence by the meaning that we attach to information: Moseley, Arntz. PAIN 2007;133:64-71 People with chronic pain are not good at learning safety (extinguishing fear to what was painful movement): https://www.ncbi.nlm.nih.gov/pubmed/27776989 A feeling of control and pain: http://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.90.1.89 Associated Podcasts Prof Moseley on the brain and mind in chronic pain - http://bit.ly/1u33pPY Pain coach and first patient contact for pain management - http://bit.ly/2DHCaGa Am I safe to move? Prof Moseley on understanding pain and focusing on the patient - http://bit.ly/2nmCAqu Podcast Quotes “Things that fire together, wire together” “Things that change the ‘need to protect’ your body changes pain”

Research so often includes ‘education’ in the comparison arm of clinical trials as though it is a universal, standardized, or perhaps even inert component of intervention. But what if education IS a key ingredient in managing patellofemoral pain? Erin Macri met up with Dr. Michael Rathleff after hearing some impressive presentations from him and his team members at the 5th International Patellofemoral Pain Research Retreat in Gold Coast, Australia. Dr. Rathleff works at the Research Unit for General Practice in Aalborg. He is an associate professor and head of the OptiYouth research group that works towards improving musculoskeletal health in adolescents. In this podcast, Dr. Rathleff shares some innovative and evidence-based approaches to optimizing outcomes for patellofemoral pain using strategic, targeted education. Related Articles Rathleff MS, Roos E, Olesen J, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med 2015;49(6):406-12 Associated Materials for upload Educational slides for use with patients (attached)

Listen to leading physiotherapists continue their conversation on common ground when treating patients with disabling pain. (Link to Part 1 here http://ow.ly/mi3c30iqGSI) In this episode the focus is treatment - what can you do to provide an all-around programme that respects the biopsychosocial model. · How to assess the patient given the history you have obtained · Common ground they have discovered in treating backs and knees – there are many shared experiences and lessons from them · Exercise is the most powerful treatment – which ones, when, how to promote adherence with a programme. Links to papers: 1. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. bjsm.bmj.com/content/50/14/839 2. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) bjsm.bmj.com/content/50/14/844 3. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. bjsm.bmj.com/content/51/24/1713.long The link to Part 1 of the conversation: http://ow.ly/mi3c30iqGSI The link to previous podcasts by these experts: Prof Kay Crossley’s previous BJSM podcast on treatment of patellofemoral pain (2015) http://ow.ly/PnHl30iqNlJ (10,000 listens) Prof Peter O’Sullivan on treatment of back pain (2014) http://ow.ly/Ws2Y30iqNyD