BJSM Podcast

ACL injuries are some of the most common and debilitating injuries in athletes. In this podcast, Tim Hewett and Kate Webster talk about the biomechanical risk factors for ACL injury, the role and potential of screening, and the use of ACL prevention programmes. Tim Hewett is an expert in biomedical engineering work at the Mayo Clinic and Kate Webster is an associate professor at La Trobe University. They are both speaking at the upcoming Sports Medicine Australia Conference-more details can be found here-http://tinyurl.com/h4ndfy2 Timeline: 0.40 - What is the biggest risk factor for ACL injury? 2.10 - How are ACL injuries preventable? 4.10 - Can we screen for injury risk? 6.00 - Key criteria for RTS. 9:40 - The high risk of re-injury following ACL damage. 13.00 - Are we returning athletes too soon post injury?

Often tendinopathy will be resistant to even the best traditional rehabilitation methods. Liam West chats to Dr Ebonie Rio, a PostDoctoral Fellow at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. Dr Rio’s research aims to explain the role of the primary motor cortex in tendinopathy. She discusses tendon neuroplastic training (TNT) and how it might help your tendinopathy patients regain pain free function in the clinic. Timeline 0.40 – Why traditional rehabilitation for tendinopathy might be unsuccessful 1.40 - Changes in primary motor cortex and motor control in tendinopathy 2.35 – What is TNT & how to utilise it? 5.30 – How long does it take for TNT to help patients? 6.30 – Cross education for tendinopathy Further Reading Tendon neuroplastic training: changing the way we think about tendon rehabilitation – OPEN ACCESS - http://bit.ly/29ergE3 Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK Related Podcasts Prof Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL Prof Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol Defining tissue capacity - http://bit.ly/29iVSKc

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

Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School. Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults. His clinical practice and research are all around joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes at the BMI Meriden Hospital. Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation: http://www.nets.nihr.ac.uk/projects/hta/1310302 You can follow him on Twitter @DamianGriffin and @warwickOrtho or reach him on damian.griffin@warwick.ac.uk, at www.hiparthroscopyclinic.co.uk or +44 1926 403529. BJSM is grateful for his contribution as a Senior Associate Editor. In this podcast, Damian speaks about Sports Hip 2016, a two day international conference held at St George’s park, the home of English football. The link to conference details: http://www2.warwick.ac.uk/fac/med/research/csri/orthopaedics/sportsurgery/hip/ Podcast timeline: 0.30 - St George’s Park and the England Football Association Perform Rehabilitation Centre 1.02 - Introduction to Sports Hip 2016: First time for a multidisciplinary meeting on sports hip injuries 1.58 - Instability of the hip 2.47 - Treatment of acute subluxation or dislocation, returning to 3.23 - Deep gluteal space, piriformis syndrome and sciatic nerve entrapment 4.54 - Cartilage repair 6.04 – Workshops in hip arthroscopy, hip replacement techniques suitable for athletes 6.00 - Workshop in hip arthroscopy 6.57 - New techniques in hip replacement suitable for young active people and athletes. 7.24 - World class rehabilitation after hip surgery 7.50 - Round table on challenges in managing elite athletes 8.15 - Femoroacetabular impingement (FAI) syndrome, and the movement towards reaching a consensus statement. 11.00 - Consensus meeting on FAI syndrome

Peter Gallagher has been the All Blacks physiotherapist for over 10 years. He discusses how they deal with RTP following ACL injuries and how shared decision-making can be used to set a RTP date. The conversation then branches out onto how changes in training load can be used to recondition players following injury and the need for exercises that provide eccentric muscle training. Finally, we consider alternative exercise programs and the role of functional movement screening for injury prevention. This open access paper by Dr Tim Gabbett summarizes the theory behind higher training loads and injury rates: http://tinyurl.com/heepexv Another paper here predicts injury using acute: chronic workload ratios: http://tinyurl.com/z89glpz An article discussing the limitations of functional screening: http://tinyurl.com/zf5dgpn Timeline: 0:51- The challenge of RTP in ACL injury. 4:30- How the decision is made to RTP? 5:39-Why lowering a player’s load after injury might be beneficial. 7:11- Some examples of modified training programmes and reconditioning. 13:04- Adapting alternative exercise programs into a training regime. 17:40- The part that functional movement screening could play in the future.

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.

Intramuscular Hamstring Injuries Professor Peter Brukner is a sports and exercise physician at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. He is Team Doctor for the Australian Cricket Team and formerly worked with Liverpool FC, Australian football in the 2010 World Cup and numerous Olympic Games. He discusses intramuscular tendon hamstring injuries, a difficult type of hamstring injury, which takes longer to recover than a typical strain. The conversation also branches out to diagnosis, management and rehabilitation of the injury. Here’s the associated paper with some very helpful figures: http://ow.ly/Hsci301NHpx Professor Brukner’s thoughts on recurrent hamstring strain can be found here: http://ow.ly/8NeB301NKCw And more on hamstring strain prevention here: http://ow.ly/PrSL301NLm0 Timeline: 1.00-Why some hamstring injuries are different (and difficult!) 2.30 Diagnosis of intramuscular tendon hamstring injuries. 4.30-Recognition on the MRI 5.30- Management of the injury. 7.50-Rehabilitation and return to play.

One of the most common complaints of athletes visiting clinicians is leg pain exacerbated by exercise. In this podcast, UK vascular surgeon Rob Hinchliffe explains how iliac artery endofibrosis develops in the sportsperson. He discusses the diagnostic approach for the clinician, potential therapies and gaps in the knowledge about this relatively new pathology, which too often remains undiagnosed for long periods of time. Thanks to BJSM editorial board member and sports physician Dr Yorck Olaf Schumacher from Aspetar, Qatar for having the idea and recording this fascinating podcast.

Whilst injuries will undoubtedly dominate the headlines at the Olympics, we shouldn't ignore the competitors' increased susceptibility to illnesses - which can cause just as much heartbreak. BJSM’s popular podcast host, Steffan Griffin (@lifestylemedic), speaks to Athletics New Zealand team sports and exercise medicine physician Dan Exeter. Dr Exeter will be in Rio in August for the 2016 Summer Games and he shares New Zealand’s secrets for prevention illness in individuals and across the New Zealand squad. Remember that the Australian College of Sports and Exercise Physicians (@ACSP_SportsDocs ) and Sports Physiotherapy New Zealand (@SportsPhysioNZ) are both BJSM member societies. If you belong to one of these (or BJSM’s other 21 member societies) you can access all BJSM content for free via your member organisation’s website. Not a member country yet? Email karim.khan@ubc.ca Links: Great podcast last week: How Rugby 7s are approaching their Olympic Games preparation and the demands of this new Olympic Sport. http://ow.ly/EfCY3017Z2B Norway’s very experienced team physiotherapist, @BenClarsen (PT, PhD) on a systematic approach to monitoring elite athletes on a regular basis even when they are on the road for long periods of time. http://ow.ly/6GHV3017VMX Professor Roald Bahr (@RoaldBahr) on the challenges of a team clinician making Return To Play decisions: http://ow.ly/TrSz3017Ycn BJSM publishes 4 Injury Prevention and Health Protection (IPHP) issue annually. Check them all out here: http://bjsm.bmj.com/content/by/year The paper (OPEN) on Illness and Injury at the London Olympic Games: http://ow.ly/gORM3017ZRT

Want to know more about one of the new Olympic sports, or perhaps want an insight into how to best manage jetlag in athletes? Dr James McGarvey, a sport and exercise medicine physician to the New Zealand Rugby Sevens team in Rio talks to Steffan Griffin (@LifestyleMedic) about everything 7s related - although something for all to take away! Related content: Podcast on travel with teams; This time 15s Rugby – Rugby World Cup by Prav Mathema: http://ow.ly/n1Nz300PRw5 Podcast on how Dr Nigel Jones worked with the England World Cup Rugby team (2015). http://ow.ly/2MbG300Q4bz Open access paper: A new model for managing athletes health and performance in partnership with coaches: http://ow.ly/Pzz1300QSxV BJSM App iTunes - itunes.apple.com/us/app/bjsm/id943071687?mt=8 Google Play - play.google.com/store/apps/detail…m.goodbarber.bjsm