BJSM Podcast

Dr Emma K Stokes (@ekstokes) is the President of the World Confederation of Physical Therapy. This is the second of three podcasts. Karim and Emma continue their discussion and touch on direct access to physiotherapy around the world, the changing role of the physiotherapist in the multi-disciplinary team, and best practice for dealing with social media as a professional.

Wie die Muenchener Klassifikation helfen kann, Athleten mit Muskelverletzungen besser zu behandeln Peter Ueblacker ist ein international renommierter Orthopäde und Sportmediziner, der als einer der Mannschaftsärzte in den Jahren 2009 bis 2015 eine lange und erfolgreiche Karriere beim FC Bayern München hatte . Er arbeitet in eigener Praxis mit Hans-Wilhelm Müller-Wohlfahrt (http://ow.ly/U2mch ). BJSM Redakteur Dr Markus Laupheimer stellt die Fragen in deutscher Sprache. Inhalt (Zeit) 1: 00min - Warum Muskelverletzungen klassifizieren? 3: 00min - Einschränkungen der früheren Klassifikationsverfahren und Notwendigkeit einer neuen Klassifikation - die Entstehungsgeschichte des Münchener Muskelklassifizierungssystems. Hier ist der Link zur Open-Access-Publikation in BJSM (> 55.000 views) http://ow.ly/U2pMG 4: 18min - Was sind die Vorteile für die medizinische Abteilung eines Fussballklubs (Physiotherapeuten, Arzte & Fitnesscoach), die die Münchener Klassifizierungssystem verwenden? Definition und Differenzierung von "direkten" und "indirekten" Muskelverletzungen. 5: 00min - Die Herausforderung der "funktionellen" (nicht-strukturellen) Muskelverletzungen. Keine Pathologie im MRT erkennbar - und doch von hoher Relevanz für Fußballmannschaften, weil diese Verletzungen häufig sind und Spieler nicht spielen können – „time-loss“-Verletzungen. 6: 00min - Verschiedene Typen von Muskelverletzungen ziehen unterschiedliche Fehlzeiten im Sport nach sich. Ist das eine 2-Wochen-oder 6-Wochen-Verletzung? 6: 40min - Der Versuch, die Prognose vorherzusagen - ist das möglich? Was können wir dem Trainer sagen? Hier finden Sie eine Gegenargument http://ow.ly/U2qFJ 7: 10min – Komm auf den Punkt! Strukturelle Muskelverletzungen. Intramuskuläre Sehnenverletzungen sind häufig und relevant (siehe Peter Brukner Papier: http://ow.ly/U2rBc) 8: 15min - Welchen Einfluß die Wirbelsäule auf Muskelverletzungen hat. 10: 00m - Ein praktischer Spaziergang durch das Management der ischiokruralen Muskelverletztungen („hamstrings“). Weiterführende Links: http://ow.ly/U2mUG - Podcast mit Professor Gino Kerkhoffs berücksichtigt auch das Münchener Konsenspapier. Ergänzt den vorliegenden Podcast in seinem größeren Fokus auf die Konsensprozesse und diskutiert die Wertigkeit des MRTs- bei Muskelverletzungen (auf englischer Sprache). http://ow.ly/U2o0Q - Podcast mit Professor Jan Ekstrand Schwerpunkt auf Muskelfaserriss Sie können ohne weiteres zugreifen auf BJSM Podcasts über unser Mobile App (BJSM). Neueste Sportmedizin Updates via Twitter (BJSM_BMJ) und auf der Google+ Community http://ow.ly/U2sNs, wo Sie aufgefordert, Inhalte zu veröffentlichen

Are you or your athletes in control of your ‘chimp’ (emotional, reactive part of your mind) at all times? We hear from Professor Steve Peters -- the brains behind ‘The Chimp Paradox’ and the much-heralded psychiatrist who has worked with the likes of Team Sky Cycling, Liverpool Football Club and the FA to improve athlete performance. Prof Peters explains the rationale for the seemingly simplistic model and shared example of how it can be applied in various sport settings. “The Chimp Paradox” has been among the most popular self-development books in recent years and it will of interest to many BJSM listeners from both a personal and professional standpoint. http://amzn.to/1TNV3Xy If you want to see Prof Peters speak – sign up for the BASEM Spring Conference (Friday April 8th) here! http://bit.ly/1TNV0en Timeline 1:10m: What is the chimp model? 4:15m: How does the ‘chimp’ model work in sport? 5:30m: Is it always an overactive chimp that holds athletes back? 7:45m: What works best with athletes? 9:30m: What can we do about unhelpful behavioural traits? 11:45m: What pitfalls can we avoid when dealing with young elite athletes? 13:30m: How can you talk to athletes about psychological performance? 16:55m: Does the chimp model work when split-second sporting decisions are needed? 18:30m: Mental Health in Sport 21:15m: Any tips for those wanting to work in sport? BJSM Links: 2016’s issue 3 of BJSM was devoted to mental health in sport. Table of contents link: http://bjsm.bmj.com/content/50/3.toc An editorial on the issue of mental health and ‘mental toughness’ : Dr James Bauman: The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport? http://bjsm.bmj.com/content/50/3/135.extract

Dr Emma K Stokes (@ekstokes) is the President of the World Confederation of Physical Therapy. This is the first of 3 podcasts Timeline: 1:00m - A fascinating career journey – from student at Trinity College Dublin to President of the World Confederation. 4:00m - “You have to be yourself but you have to understand yourself. Leadership is about bringing people on a journey. Make sure you understand how other people see, or feel about, that journey” 5:00m - The organisation you work in plays a big role too but you can make a difference from wherever you are. Students and early career physiotherapists are as important as the person on the top of the hierarchy 6:30m - The only constant is change (Emma’s nod to David Bowie but this was recorded before he died). Having a framework for adapting to change 7:50m - Practice change – applying the lessons to a typical health professional practice 10:00m - The role of the IFSPT – International Federation of Sports Physical Therapists – as leaders, advocates. A huge opportunity for leadership. Education, competency definition, congress organisation 12:00m - Physios as entrepreneurs. Social entrepreneurship – physiotherapists’ opportunities to contribute to society 13:30m - Emma’s experience on what makes a successful physiotherapy practice 15:00m - End of Part 1 – part two is scheduled for February 12th, 2016 Thanks to James Walsh (@SportsOsteopath) BJSM podcast podcast associate editor. Links: Drew Dudley "Leading with Lollipops" YouTube Video – helping people become better versions of themselves: https://www.youtube.com/watch?v=hVCBrkrFrBE 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

The American Medical Society for Sports Medicine (AMSSM) is the world’s largest primary care sports medicine organisation and one of BJSM’s 23 member societies. It provides authoritative education for the public as well as for athletes and health professionals. BJSM is proud to host AMSSM experts discussing the potentially life-threatening condition that is widely known as ‘The Female Athlete Triad’. Dr Elizabeth Joy (Salt Lake City) and Dr Aurelia Nattiv (UCLA, Los Angeles) are both researchers and clinicians in this field so they provide a great overview as well as practical tips for athletes, parents and health professionals in this 20-minute podcast. (AMSSM’s guest host is Dr Britt Marcussen, U of Iowa). They are two of the lead authors on the 2014 International Consensus Statement on this topic: Br J Sports Med. 2014 Feb;48(4):289. doi: 10.1136/bjsports-2013-093218. http://bjsm.bmj.com/content/48/4/289.long Timeline: 2:00m - What is the ‘Female Athlete Triad’? 4:30m - What type of athletes are at risk? What should I look for? 6:15m - Energy availability, eating disorders, disordered eating. The role of anorexia nervosa, bulimia. Is this an essential element? 8:30m - Practical tips for parents. What to watch out for? 14:20m - If a parent is concerned what is the next step? 16:00m - What is the role of sport restriction in treating this condition? 21:00m - Take home messages: early recognition is key; seek help. An experienced multidisciplinary team (psychologists, nutritionist, sports physician) is key. Links: The definitive ‘Female Athlete Triad’ consensus statement in the BJSM: http://bjsm.bmj.com/content/48/4/289.long A complementary perspective on the issue – the IOC’s consensus statement: http://bjsm.bmj.com/content/48/7/491.long A 2015 podcast by the IOC’s Dr Margo Mountjoy – on the IOC’s perspective: http://ow.ly/XpkYO AMSSM e-learning elements: Podcasts and more! https://www.amssm.org/E-Learning.php

In this 9-minute podcast Zoe Harcombe asks whether dietary guidelines were based on evidence or whether there were other drivers. She summarises what was in the literature at the time the 1977 (US) and 1983 (UK) guidelines were created. Importantly, she highlights that food choices have major implications on the planet. The podcast was recorded in February 2015 – she was a keynote speaker at the Old Mutual 1st International Low Carb High Fat Health Summit 2015 hosted by Prof Tim Noakes & Karen Thomson (Cape Town). https://www.facebook.com/events/880528391966336/ There are plans for a future summit in London in 2016. BJSM senior associate editor Liam West (@Liam_West) led the BJSM team who attended the meeting – including Johann Windt and Ania Tarazi. BJSM has spaced out the recordings from that summit over 12 months and this is the last on the series from that event. Related podcasts were with Dr Stephen Phinney http://ow.ly/X70OP, Dr Jason Fung (http://ow.ly/X70AJ), Dr Aseem Malhotra http://ow.ly/X712D and Professor Timothy Noakes (http://ow.ly/X71rX). All have proven very popular. Timeline: 0m 30s: Why Zoe Harcombe (@ZoeHarcombe) challenges current dietary guidelines 3m 00s: What are the sensible food choices (according to the guest, of course)? 4m 40s: Challenges to supplying calorie-dense low carb foods for the world’s population: “I don’t know if we can feed 7-11 million people on animal based food, I don’t know if we can’t”. Grain requires topsoil and “we are raping the land of nutrients, topsoil, potentially destroying the planet’s ability to house any food”. 5m 50s: Time to revisit the guidelines? 7m 00s: Training doctors – what training do doctors get? (Link to the exercise prescription training module, a template, here: http://bjsm.bmj.com/content/49/4/207.extract Call to action for all health professionals to look at the evidence in an open-minded way. It may need a ‘bottom up’ approach – patients and the public – to draw attention to these issues. Links: The key paper for this podcast: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis http://openheart.bmj.com/content/2/1/e000196 An editorial in the same issue of OpenHeart: http://openheart.bmj.com/content/2/1/e000229.extract (11,000 views as of January 2016) Papers: Challenging beliefs in sports nutrition: are two 'core principles' proving to be myths ripe for busting? Peter Brukner (@PeterBrukner) http://www.ncbi.nlm.nih.gov/pubmed/23603852 Br J Sports Med. 2013 Jul;47(11):663-4. doi: 10.1136/bjsports-2013-092440. Epub 2013 Apr 20. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet Malhotra A, Noakes T, Phinney S. Br J Sports Med. 2015 Aug;49(15):967-8. doi: 10.1136/bjsports-2015-094911. Epub 2015 Apr 22. http://www.ncbi.nlm.nih.gov/pubmed/25904145

Associate Professor Irfan Asif is Vice Chair of Academics and Research at the Greenville Health System and University of South Carolina. This podcast is unashamedly focused on the American Medical Society which we believe is the world’s largest member organisation for primary care sports medicine. For those of you wondering why it needed to be a ‘medical society for sports medicine’ (tautology?/redundancy?) the answer is that sports medicine is a broad field with many disciplines involved, so one could have an ‘orthopedic’ society for sports medicine, for example, or a ‘sports therapists’ society for sports medicine. Timeline: 1m 40s: What is AMSSM? What benefits does it provide primary care sports medicine physicians? 1m 20s: AMSSM President John Devine was at the White House for a national ‘bystanders’ conference – what can the public do to save lives? An initiative to ‘Stop the Bleed’. 1m 50s: Outline of the AMSSM Donjoy travelling fellowships in Australia (2014) and South Africa (2015) as well as the ECOSEP, Spain – providing international leadership. (Editors’ note, these are all BJSM member societies). 3m 20s: Junior NBA programme – NBA players (junior.nba.co) Sports Medicine Today – tips and fact sheets about different injuries for athletes, coaches, parents etc 4m 10s: Collaborative Solutions for Safety in Sport (CSSS): March 2015 meeting at the NFL headquarters (partnership with NATA). Emergency action plans – including Drs Jon Drezner, Kevin Guskiewicz and Doug Casa. Focused on factors such as personnel management, AEDs and prevention of heat stroke. Another example of AMSSM partnering to make changes across the US 5m 15s: Position statements that @theAMSSM is leading (completed and in the pipeline) Viscosupplementation (5:30) – Pros and cons of using Viscosupplementation in osteoarthritis (http://www.ncbi.nlm.nih.gov/pubmed/26729890) Mental Health – Under-recognised ‘silent injury’ – pressures of being an athlete per se Diagnostic ultrasound – building on previous work such as features in BJSM in 2015 (http://bjsm.bmj.com/content/49/3/145.1.long) Cardiovascular issues including ECG interpretation and pre-participation screening (coming out in 2016, ‘next year’ in the podcast because we recorded late in 2015) 6m 30s: Come to the Annual Meeting in Dallas, Texas, April 15-20 - http://ow.ly/X6yKo Hot topics and speakers include: Tendons (Hakan Alfredson), Running Medicine (Blaise Williams – ACSM exchange lecture), Medical issues (e.g. cardiovascular, respiratory) in sports including NBA protocols, pearls for event coverage, low back pain management advances, stress fracture prevention and Rx, emerging technologies in sports medicine. 7m 30s: Opportunities to serve AMSSM on exciting committees (not an oxymoron!) Links: AMSSM conference registration (and programme) http://ow.ly/X6AIx Hakan Alfredson’s classic (code for 2 years old now) BJSM tendon podcast http://ow.ly/X6AWA AMSSM Sports Medcast on injections with guest Matt Gammons (VP, AMSSM) http://ow.ly/X6BkZ Dr Irfan Asif’s recent podcast on HOW to promote lifestyle medicine (‘Exercise is Medicine’) http://ow.ly/X6Bww

Physiotherapist Dr Michael Skovdal Rathleff from the Research Unit for General Practice in Aalborg chats with Dr Dylan Morrissey from Queen Mary University of London and Barts Health NHS trust and Dr. Christian Barton from the new sport and exercise medicine research centre at Latrobe University in Australia. Both Dylan and Christian are clinically active physiotherapists working on moving research from journal papers into the hands of people who can put it to practical use. They discuss the challenges of clinicians being aware of the latest research and the researchers asking relevant questions. They propose to marry quantitative (eg. Systematic review) and qualitative (interviews, patient experience, clinician experience) approaches and they share examples of having already done this. Drs Rathleff, Morrissey & Barton will run a session on this topic at the Danish Sports Medicine and Physiotherapy Conference in Kolding, Denmark on 4-6th February. www.sportskongres.dk They’ll also speak on other topics (including running injuries) in an excellent programme packed with starts. Each speaker has many great papers and you can find two of those discussed in the podcast at these links: The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning. Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D. http://bjsm.bmj.com/content/49/14/923.full Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning Rowe V, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D http://www.ncbi.nlm.nih.gov/pubmed/23006143

All clinicians aim to classify muscle injury classifications to guide treatment and predict return – it’s a hot topic. The British Athletics Muscle Injury Classification is one helpful classification system and Dr Noel Pollock explains to Dr Markus Laupheimer (BJSM) how and why the Classification developed, as well as why the (older) Munich classification was not ideal. Listen for tips on how this classification adds something special and is of practical value for treating your athletes with muscle injuries. Timeline: 01:01m – Why a new muscle injury classification? 03:50m – Limitations of the Munich consensus Open access Munich Paper: http://bjsm.bmj.com/content/47/6/342.full.pdf+html 05:18m – British Athletics classification explained Open access British athletics paper: http://bjsm.bmj.com/content/48/18/1347.full 09:15m – Clinical application, follow up papers 12:00m – Discussion: MRI or not? http://bjsm.bmj.com/content/49/24/1579.full 14:05m – Future Development of muscle injury classification Links: British athletics muscle injury classification: a new grading system http://bjsm.bmj.com/content/48/18/1347.long (Open Access) Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification http://bmj.co/1lWvDdy Previous podcast: The Munich muscle classification: Using it for more accurate diagnosis and treatment https://soundcloud.com/bmjpodcasts/the-munich-muscle-classification-using-it-for-more-accurate-diagnosis-and-treatment?in=bmjpodcasts/sets/bjsm-1 Range of BJSM podcast: http://bjsm.bmj.com/site/podcasts/ You can readily access BJSM podcasts via our Mobile App (BJSM). Latest sports medicine updates are posted via Twitter (@BJSM_BMJ)

AMSSM has a series of podcasts (https://www.amssm.org/E-Learning.php) and here experts highlight the management of shoulder, elbow and knee pain with a focus on the declining role of corticosteroid injections. The sports physicians discuss other injection treatment options – PRP, prolotherapy and viscosupplementation where relevant. Keep the AMSSM’s 2016 Annual Meeting in mind – Registration opens on January 8th. It will be in Dallas, Texas, April 15-20, 2016. And the special AMSSM issue of BJSM appears online first on January 18th, 2016.(Mental health theme). The experienced and popular hosts are Dr Blair Becker and Dr Scott Young, with special guest AMSSM Vice-President, Dr Matt Gammons. Timeline: 2:00 m Shoulder pain and subacromial corticosteroid injection – what is the level 1 evidence? 4:05 m What about corticosteroid for frozen shoulder? Does distention add benefits? 5:30 m Dr Gammons in his experience with adhesive capsulitis and shared decision making. 6:30 m The severity of symptoms may influence the decision. What would make it worth it for the patient to have an injection? 7:30 m PRP – platelet rich plasma. Again, as usually the case with PRP, no therapeutic benefit. What about prolotherapy? 8:30 m The AMSSM position statement on ultrasound guidance for shoulder injection. 12:30 m The elbow – an area where corticosteroids are becoming less popular. 15:30 m Is there support for long-term benefit of PRP? Nothing in the short term but a benefit at 2 years? 16:00 m Dr Gammons provides an overview. “Tools to add to the toolbox”, “Reasonable discussions to have with the patient”. Remember that the natural history is toward resolution. 17:00 m Shared decision making is key 17:30 m Moving on to the knee. Osteoarthritis and corticosteroid – short term benefit. Dealing with the acute flare-up. 18:40 m Viscosupplementation. See also the AMSSM scientific statement – (http://ow.ly/VKUxC ) and its recommendation for use in patients aged >60 years with grade 2 or 3 Kellgren-Lawrence. 20:00 m Dextrose prolotherapy for knee osteoarthritis (University of Wisconsin). 21:00 m Intra-articular PRP for knee osteoarthritis 23:30 m Other targets around the knee. Iliotibial band, pes anserinus as well as the patellar tendon. 25:30 m Summary of clinical practice – putting it all into perspective. Other links Clinical Journal of Sport Medicine blog and link to AMSSM Viscosupplementation position statement http://ow.ly/VKUxC Evidence against elbow PRP via Dr Robert-Jan de Vos: http://bjsm.bmj.com/content/48/12/952.long