BJSM Podcast

Screening is one of the hottest topics in Sports Medicine, and a topic which is constantly evolving. The BJSM has provided a platform for much of the academic literature concerning screening, but what actually happens at the coalface? BJSM Associate Editor Steffan Griffin chats to two giants of the football (and sports) medicine world – Colin Lewin, and Dr Gary O’Driscoll, who both head up the medical department at Arsenal Football Club – about the practical aspect of screening, and what role it plays in elite sport. This podcast serves as a little taster to the Arsenal SEMS conference, which this year focuses on the role of screening, with insights from the likes of Professor Roald Bahr, Adam Meakins, and Des Ryan amongst other influential names. The link to the event can be found at http://www.arsenal.com/semsconference Topics covered in this part one include: What is involved with a player ‘medical’? Who is involved with a player’s ‘medical’? Is there a role for screening in elite sport? Look out for the upcoming Part Two – where screening and player medicals are discussed in further detail.

Professor Tim Caulfield (@CaulfieldTim) is a best-selling author in the health and popular science domain. He has published over 300 articles into the ethical, legal and health policy of a broad range of topics including stem cell therapies, genetic testing, obesity treatment and the prevention of chronic disease. In this podcast, we discuss: • Genetic testing and its predictive value- what place does it have in sports medicine? • Stem cell therapies- evidence behind it and how it is portrayed by the media • PRP- therapeutic benefits or another health fad? • The role of athletes as celebrities in advocating new treatments • 6 simple ways to maintain a healthy lifestyle. Links to Tim’s hugely successful books can be found here http://ow.ly/TEfJ309ise8 David Epstein (@DavidEpstein) book The Sports Gene here: http://thesportsgene.com/

Professor David Hunter, a leading rheumatologist, discusses osteoarthritis treatments, importance of behavioral interventions, detailed patient assessments, weight loss strategies, exercise physiology, and pharmacological/surgical treatments. The podcast explores personalized exercise therapies, challenges of weight loss, controversies in knee arthroscopy, and the benefits of conservative approaches over surgery.

Eamonn is a wonderful clinician-scientist who graduated with a 1st Class Honours Degree from the University College Dublin (UCD) School of Physiotherapy in 2003 placing first in his class. Eamonn received a prestigious Irish Research Council for Science Engineering and Technology (IRCSET) post-graduate research scholarship. He was awarded his PhD from the UCD School of Physiotherapy and Performance Science in 2006, In this podcast that combines science with clinical application topics include: • The high prevalence of ankle injuries and the high risk of the development of chronic residual symptoms. • The characteristic features of CAI. • How to manage the young soccer player who sustains an ankle injury. • Detailed discussion of (1) modified Ottawa Ankle Rules; (2) determination of lateral ligament laxity; (3) syndesmosis assessment. • How to assess for chronic ankle instability • Mechanical insufficiencies including: (1) pathological laxity; (2) arthrokinematic restrictions; (3) synovial changes; (4) degenerative changes. • Functional insufficiencies including: (1) impaired proprioception; (2) impaired neuromuscular control; (3) impaired postural control/postural balance; (4) impaired strength. • Assessment of laxity and the use of taping and bracing. • Patient-reported outcome measures clinicians can use including the FAAM, CAIT & idFAI Associated papers and tools: Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis http://bjsm.bmj.com/content/early/2016/11/24/bjsports-2016-096858.long Cumberland ankle instability tool ( 11 – chronic ankle instability (>11) Foot and ankle ability scale: FAN ADL(21 items) and FAN sport (8 minutes) Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. http://bjsm.bmj.com/content/48/13/1014 2016 consensus statement the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. http://bjsm.bmj.com/content/50/24/1493.long

You want the big names on BJSM podcasts and Twitter asked for Dr Graeme Close. Fresh from the UK undergraduate student conference, Graeme shares pearl after pearl on this top podcast. What do you do in a first consultation? How does nutrition in team sport vary from individual sport? What’s the key to a successful pre-game routine? How should nutrition change when an athlete is injured? Supplements? Coffee? Sleep? Take home tips – all in this 16 minute gem. Graeme has a great CV for his role in top sport. He is (i) a former professional rugby league player (clips here https://youtu.be/1mHljSGlQwA) (ii) a sports science PhD and now faculty at Liverpool John Moores University (iii) rumored to be the only person in the UK accredited with the official bodies for sports science (BASES), sports nutrition (SENr) and strength & conditioning (UKSCA). We call that the ‘triple crown’. Kudos to medical student Tej Pandya for organizing the conference and for a great debut as a podcast host. BJSM’s podcasts have been hosted by 23 different interviewers and there are podcasts in 5 languages. Feel free to submit a podcast for our consideration. (info.bjsm@bmj.com)

A world leader in sportsphysiotherapy, Associate Professor Dr Kristian Thorborg is from Copenhagen University. He is renowned for his studies and clinical workshops related to patients with hip, groin, hamstring and knee related injuries. Here he outlines: - the paradigm shift for the use of exercise to treat conditions such as tendinopathy and hamstring strains. He addresses questions such as ‘What is the ideal type of exercise?’ and ‘Does the body know if the exercise is concentric or eccentric?’ - cheap technology that can be used to help patients measure the load they are using and to check compliance - the challenge of treating patients in season - the concept of progression and the different stage of rehab that is preparation for ‘return to play’ - prevention – it needs monitoring of the players – waiting until they show up with pain is too late

How does a leading shoulder physiotherapist approach patients in the clinic? What are 3 fundamental principles that guide every consultation? Hear from extended scope practitioner Adam Meakins on how his approach to the patient with shoulder pain has changed over the past years. Learn how you can provide exercises for your patient without needing sophisticated video equipment or cameras. Listen to tips on how to tell if the patient is fearful, perhaps at greater risk for a central contribution to pain. Timeline 0:40 - Adam makes the case for 3 principles that guide every consultation 2:30 - Encouraging movement – both for health and to exercise injured parts (e.g. the shoulder) 4:00 - The need for patient education and advice. And how to do it. 8:35 - How much pain is OK? 10:30 - Treating the patient as an individual – the whole patient 12:40 - Is there a central component of pain? 13:19 - Which exercises to choose

The Berlin Concussion in Sport Consensus Meeting was held in October 2016 and the experts are currently writing the systematic reviews and agreeing on the final statement from this event. In the meantime, various panel members are sharing some key messages the world over. The knowledge translation needed from event such as this is extensive. The experts are Dr Jon Patricios, sports physician and former President of the South African Sports Medicine Association (SASMA) and Paul McCrory, Associate Professor and neurologist at the Florey Institute of Neuroscience and Mental Health, Australia. Both attended the Berlin meeting. Timeline: 0:45 Immediate management of concussion 2:54 Differences and common ground from elite level competition to the community setting 5:00 Balance and visual disturbances 8:26 Concussion in the developing brain 14:34 The update on CTE – chronic traumatic encephalopathy 16:40 Take home messages

Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law and policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (Chief Medical Officer), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. Here is Part 2! Timeline: 0.35: Is there a relationship between when players are removed & their subsequent recovery? 5.13: What else is the RFU doing around concussion? 8.36: Will we ever prevent concussions in rugby? 16.45: What are we hoping to hear about at the Berlin Consensus Conference?

Professor Lars Engebretsen is the Head of Scientific Activities in the Department of Medicine and Science at the International Olympic Committee. An orthopaedic surgeon, he is a strong advocate of the multidisciplinary approach to patient care. Among his many awards are the Nordic Prize in Medicine and the American Orthopaedic Society of Sports Medicine Hall of Fame. He is the Editor of the BJSM’s Olympic-supported issues (4 per year, usually numbers 1, 7, 11 and 17). Timeline: 0:40 mins - Surgical management of the patient with the acute ACL rupture – emphasis on early rehabilitation 1.44 mins - Prehabilitation – a definite focus 5.54 mins - The locked knee – what is it and how does finding one affect management? 8.00 mins - Is surgery indicated for meniscal injuries or not? 9.12 mins - The paediatric ACL (age 8-12 years). What’s the best management? 13.50 mins - IOC education courses with a focus on the 2-year online diploma.