BJSM Podcast

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

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

Do you provide medical services for athletes or teams that travel nationally or internationally? Are you confident that your travel preparations cover every possible situation? Prav Mathema, the Head of Sports Medicine for the Welsh Rugby Union and physiotherapist to the British & Irish Lions Rugby Team, discusses his top tips for travelling with elite sports teams accrued from his years of experience. Your host is BJSM Senior Associate Editor Dr Liam West (@Liam_West). Related Reading: Derman, W. E. (2008). Medication use by Tea, South Africa during the XXVIIth Olympiad: A model for quantity estimation for multi-coded team events. South African Journal of Sports Medicine, 20(3), 78-84 Hadjichristodoulou, C., et al. (2005). Mass gathering preparedness: the experience of the Athens 2004 Olympic and Paralympic Games. Journal of Environmental Health, 67(9), 52-57 Herring, S. et al (2001). Sideline preparedness for the team physician: a consensus statement. Medicine & Science in Sports & Exercise, 33(5), 846-849 Herxheimer, A., & Petrie, K. J. (2002). Melatonin for the prevention and treatment of jet lag. Cochrane Database Systematic Review, 2, CD001520 Luks, A. M., et al. (2010). Wilderness, Medical Society consensus guidelines for the prevention and treatment of acute altitude sickness. Wilderness Environmental Medicine, 21, 146-155 Milne, C., & Shaw, M. (2008). Travelling to China for the Beijing 2008 Olympic Games. British Journal of Sports Medicine, 42, 321-326 Milne, C., Shaw, M. & Steinweg, J. (1999). Medical issues relating to the Sydney Olympic Games. Sports Medicine, 28, 287-298 Pipe, A. L. (2011). International travel and the elite athlete. Clinical Journal of Sports Medicine, 21, 62-66 Reilly, T. et al. (2007). Coping with jet-lag: A position statement for the European College of Sports Science. European Journal of Sport Science, 7(1), 1-7 Reilly, T., Waterhouse, J., & Edwards, B. (2005). Jet lag and air travel: Implications for performance. Clinics in Sports Medicine, 24, 367-380 Seto, C. K., Way, D., & O’Connor, N. (2005). Environmental illness in athletes. Clinical Sports Medicine, 24, 695-718 Shaw, M. T., & Leggat, P. A. (2000). Traveling to Australia for the Sydney 2000 Olympic and Paralympic Games. Journal of Travel Medicine, 7, 200-204 Shaw, M. T., Leggat, P. A., & Borwein, S. (2007). Travelling to China for the Beijing Olympic and Paralympic games. Travel Medicine and Infectious Diseases, 5, 365-373 Simon, L. M., & Rubin, A. L. (2008). Travelling with the Team. Current Sports Medicine Reports, 7, 138-143 Teichman, P. G., Donchin, Y., & Kot, R. J. (2007). International aeromedical evacuation. New England Journal of Medicine, 356, 262-270 Turbeville, S. D., Cowan, L. D., & Greenfield, R. A. (2006). Infectious disease outbreaks in competitive sports: a review of the literature. American Journal of Sports Medicine, 34, 1860-1865 Walters, A. (2000). Travel medicine advice to UK based international motor sport teams. Journal of Travel Medicine, 7, 267-274 Waterhouse, J., Reilly, T., & Atkinson, G. (1997). Jet-lag. Lancet, 350, 1611-1615 Waterhouse, J., Reilly, T., Atkinson, G., & Edwards, B. (2007). Jet lag: trends and coping strategies. Lancet, 369, 1117-1129 Young, M., Fricker, P., Maughan, R., (1998). The travelling athlete: issues relating to the Commonwealth Games, Malaysia, 1998. British Journal of Sports Medicine, 32, 77-81 BJSM App iTunes - itunes.apple.com/us/app/bjsm/id943071687?mt=8 Google Play - play.google.com/store/apps/detail…m.goodbarber.bjsm

Professor Adrian Bauman is as respected as it gets in the hard core epidemiology world. He advises the World Health Organisation among others and he is receiving an Honor Award at the American College of Sports Medicine meeting in Boston 2016. Here’s a link: http://ow.ly/YTDt300a6wz Focusing an all professionals within the BJSM community, he argues you can make a difference! Timeline: 1:00 m – Every health professional can make a difference to promoting physical activity 3:00 m – You don’t need to do a 16-step intervention to promote your patient’s health 5:00 m – Practical steps that every physiotherapist can do in her/his practice & consultation 7:00 m – Dealing with the main objections, no time! 9:00 m – Do something every day! 11:00 m – Sedentary behavior. In perspective Links: 7 investment document: OPEN ACCESS BJSM - http://bjsm.bmj.com/content/46/10/709.full 2012 podcast with Professor Fiona Bull on the 7 ways that physical activity can be promoted. http://ow.ly/QCgs300a80o