BJSM Podcast

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

Dr Kieran O’Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips. Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak. Timeline: 1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load 2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one. 4.00 m Should we try to prevent all back pain? Listen to Dr O’Sullivan challenge the belief that it’s important to never have back pain. He likens back pain to conditions like sadness, constipation – not great but not a major problem as long as it doesn’t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Don’t pass on fear (of back pain coming on or persisting) to athletes. 5.00 m Screen for red flags of course, if the clinical picture warrants it – but most long-term back pain is NOT due to something listed as a red flag. 6.00 m Reassurance – being empathetic without inducing fear. 7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model. 9:00 m Don’t just make the diagnosis but be practical. Patient sad? Don’t just say ‘You are sad, your back pain will go away’. Provide specific treatment for the specific threat. 10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems. 11:00 m Don’t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case 12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler). 13:00 m The period at 4-6 weeks of pain can be difficult – patient has not adapted to the contemporary model and may still be on waiting list for imaging. 14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries? Links to previous podcast: 2015 – Dr O’Sullivan on “Effective treatments for back pain: Kieran O'Sullivan’s practical tips within a guiding framework” http://ow.ly/4nepGu BJSM paper: O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers) Manual Therapy paper: Hurley J, …., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111

Eine Frage die Patienten, Therapeuten und Mediziner gleichermaßen beschäftigt. Keller Matthias und Ekaterina Sandakova. Ob Freizeitsportler oder Profiathlet - nach einer Verletzung stellt sich dem Sportler immer die gleiche Fragen. „Wann kann ich wieder zurück zu meinem Sport?“ Auch für Therapeuten und Mediziner ist es schwierig, diese Frage klar zu beantworten. Es zeichnet sich aber ab, dass Tests, welche komplexe Funktionen prüfen und sportartspezifische Belastungen simulieren als Entscheidungshilfe für eine sichere Rückkehr zum Sport dienen. Neben den spezifischen Anforderungen einer Sportart spielt auch das angestrebte Leistungsniveau des Sportlers eine entscheidende Rolle. Die von der Arbeitsgruppe um Matthias Keller beschreibt einen Return to Activity Algorithmus, der eine Rehabilitation messbar und objektivierbar gestalten lässt. Andere BJSM podcasts in Deutsch: 1) Wie können Verletzungen beim Skifahren möglichst vermieden werden? http://ow.ly/4mYqVI 2) Muskelverletzungen im Sport – Interview mit Priv.-Doz. Dr. Peter Ueblacker http://ow.ly/4mYr61 3) Einführung in die Bewegungsmedizin : “Bewegung bringt Heilung” mit Dr Boris Gojanovic http://ow.ly/4mYs2Y

The BJSM community wants practical tips and this podcast earns 10/10 for that feature. The guest, @DarrenBurgess25 is an international leader in working in sports medicine/sports science at the highest level. BJSM Associate Editor Paul Visentini (@PaulVisentini) asks great questions. 1. How do you bring the evidence into your practical job at High Performance Manager at Port Adelaide Football Club (Australian Rules Football) (1 minute in) 2. The art from a master. What are the clinical features you use to determine what the players need? (4 minutes in) 3. How do you reconcile individual differences when you are working with a team? (7 minutes in) 4. Usain Bolt, Luis Suarez – they don’t follow the textbook. What are the minimum requirements for strength? (9 minutes in) 5. Capacity in tissue – and for a whole player. How much can we alter/improve capacity? (See also Jill Cook’s podcast on this and paper, link below) 6. What other features – beyond GPS and data – What do you look for in player welfare? (14 minutes in) Personal note here from Karim Khan: What a great insight into top level sport!! I loved this podcast – the honesty, the specific points. Darren is a master of ‘the sticky message’. Has he read ‘Made to Stick’ or is he just a natural? Wow!! I feel privileged to be part of the BJSM community to learn like this. Next week. Dr Kieran O’Sullivan (Ireland, @KieranOSull) and a German-language podcast where Aspetar’s Ekaterina Sandakova asks the questions of Keller Mattias. #InternationalCommunity Links: 1. Very closely related podcast on load: Dream Team @TimGabbett and colleagues discuss how to manage load to improve performance and minimize injury risk http://ow.ly/4mYQmZ 2. Hear more from Darren Burgess here: Who should lead the sports medicine / high performance team? http://ow.ly/4mYRtm 3. The core concept of ‘tissue capacity’. @ProfJillCook and @SIDocking are the authors and here’s the link: http://ow.ly/4mYUMI 4. One cannot leave a load management chat without making sure you know about Tim Gabbett’s early contender for paper of the year. Open access: The training-injury prevention paradox: should athletes be training smarter and harder? http://ow.ly/4mYSkj

A recent keynote speaker at the Return to Play conference in Bern, the Arsenal FC Sport and Exercise Medicine Conference and the Isokinetic Football Medicine Strategies Return to Play conference in London, Clare Ardern is an emerging voice in sports medicine research. She currently occupies a postdoctoral position in the research department at Aspetar Sports Medicine Hospital, after doing the bulk of her research at La Trobe University in Melbourne, Australia. Her work focuses on the factors influencing return to play, particularly psychological readiness after ACL injury, as well as shared decision making and evidence based medicine. Follow Clare on Twitter @clare_ardern Timeline: 1:35 When can Sarah play again? Should she be playing again? 2:30 Need criteria-based progession through the rehab process , so that the focus shifts from “when” I can play again to “what” I need to achieve for successful return to play. 3:00 Education is key – both the patient and the coach. Motivation is important and can be positive or negative. Young athletes even more important 4:40 Are we moving back to biopsychosocial models, or have we moved on? 5:30 Understand the inherent risks that Sarah is facing, and make sure she understands them! 6:20 Psychological readiness for return to play – the ACL-Return to Sport after Injury (ACL-RSI) scale developed by Dr. Kate Webster and Dr. Julian Feller . It considers: confidence, risk appraisal and the athletes emotions. 12 questions completed in a few minutes. Also available as an Iphone app. It’s sport specific AND IT’S FREE!! 7:45 We should be thinking different for all time-loss injuries. 8:15 Criteria-based rehabilitation – but beware – early return to sport for young athletes increase the risk of re-injury. 9:00 We need to become more systematic to address the psychological/emotional aspects of return to play during our clinical management of these athletes. 12:00 Should we get “informed consent” from the athlete before return to play? 12:50 SUMMARY – When can I play again? 1.Reshape the question – Will I play again? Not all athletes get back, and that doesn’t mean fail. What is the right thing for Sarah? 2.Consider the psychological aspect more systematically! CONSENSUS PAPER on return to sport coming soon! Check out some recent papers from Dr. Ardern: Br J Sports Med 2014;48:1613-1619 doi:10.1136/bjsports-2014-093842The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction http://bjsm.bmj.com/content/48/22/1613.full Br J Sports Med 2014;48:1543-1552 doi:10.1136/bjsports-2013-093398 Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors http://bjsm.bmj.com/content/48/21/1543.full Br J Sports Med 2016;50:506-508 doi:10.1136/bjsports-2015-095475 It is time for consensus on return to play after injury: five key questions http://bjsm.bmj.com/content/50/9/506.full Further listening: Podcast from Adam Gledhill which discusses a case study of ACL return to play considerations and different examples of strategies used to aid return to play experiences - https://soundcloud.com/bmjpodcasts/i-cant-return-to-play-when-fear-of-reinjury-dominates-after-acl-reconstruction-adam-gledhill

Dr Emma K Stokes is the President of the World Confederation of Physical Therapy. The first two parts of her discussion with the BJSM community has already had >9,000 listeners in just two months. In this part she previews the excitement of the IFOMPT Conference (Glasgow, July 2016), opportunities for sports physiotherapist to develop their careers. @EKStokes closes with 3 take-home messages including one slightly quirky one. Thanks to James Walsh (@SportsOsteopath) BJSM podcast podcast associate editor. Links: First of 3 podcasts on BJSM: Physiotherapists in Leadership: https://soundcloud.com/bmjpodcasts/the-face-of-wcpt-dr-emma-k-stokes-unplugged-life-lessons-leadership-physiotherapy-success?in=bmjpodcasts/sets/bjsm-1#t=0:00 2nd of 3 podcasts: Direct Access, social media & more. https://soundcloud.com/bmjpodcasts/the-face-of-wcpt-dr-emma-k-stokes-unplugged-part-2?in=bmjpodcasts/sets/bjsm-1 Profile of President Stokes in the Independent of Ireland: http://www.independent.ie/life/health-wellbeing/health-features/world-leader-dr-emma-stokes-31375045.html Emma’s podcast for the MACP (45 minutes): https://soundcloud.com/macp-3/macp-emma-stokes-podcast Interviewed by social media leader for MACP: Gerard Greene (@gerardgreenephy) . Engage with WCPT here: http://www.wcpt.org/news/WCPT-look-forward

Il dottor Cristiano Eirale è un medico dello sport che lavora ad Aspetar, Qatar Orthopedic and Sport Medicine Center di Doha. In questo podcast interamente in italiano, discute con un misterioso intervistatore, la cui identità verrà rivelata alla fine del podcast stesso, sul congresso mondiale di pubalgia nello sportivo tenutosi nel novembre 2014 e sul Doha consensus sulla terminologia e sulle definizioni nella pubalgia dello sportivo. Links: Entire BJSM Theme Issue: http://bjsm.bmj.com/content/49/12 Groin Consensus Meeting Paper: http://bjsm.bmj.com/content/49/12/768.full

The BJSM community is well aware of the interest in the role of training load on injury. Dr Dr Tim Gabbett, Dr Alex Kountouris and Dr to be Michael Drew share insights into the principles that underpin successful player management. They give specific examples from football codes and cricket at the elite level. They also discuss what clinicians who do not have access to the full raft of data-gathering technology can do to advise players how to monitor load. We thank Sports Physiotherapist Paul Visentini (who invented the VISA score for tendinopathy) for producing the very successful event and for sharing two podcasts with us. (The second will be posted here within a month). (Twitter = @PaulVisentini and @PhysioSports429) The guests: Dr Tim Gabbett, Applied Sports Scientist who consults to elite teams the world over. He is one of only 5 invited Keynote Speakers at the IOC World Congress in Monaco 2017 #IOCPrev2017 @TimGabbett Dr Alex Kountouris, Sports Science and Sports Medicine Director Cricket Australia @Alex_Kountouris Mr Michael Drew Senior Sports Physiotherapist at the Australian Institute of Sport. @_MickDrew Links to related podcasts: Dr Tim Gabbett on how physiotherapists can work well alongside strength & conditioning coaches to prevent injuries and improve performance: http://ow.ly/10aOq2 Dr Alex Kountouris on how to prevent back pain in cricket: http://ow.ly/10aOHX Link to papers on load monitoring: Training – injury prevention paradox. Should athletes be training smarter AND harder (Gabbett) http://bjsm.bmj.com/content/early/2016/01/12/bjsports-2015-095788 Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries. John W Orchard, Peter Blanch2, …, , Alex Kountouris et al, http://bjsm.bmj.com/content/early/2015/03/09/bjsports-2014-093683 And the home page with lots of good background for the conference (March 2016): http://physiosports.com.au/mastering-load-symposium-2016/