BJSM Podcast

Do you see football or ice hockey players with persistent pain in the inguinal region? What about players in twisting sports with adductor region pain? Are you still making the diagnosis ‘osteitis pubis’? Are you unsure as to when to order investigations in cases of groin pain? Enough questions – time for answers. Adam Weir, MD, PhD, has more than 10 years’ experience in dedicated clinics treating groin pain in athletes. His sports medicine specialty training was in Netherlands and the past 3 years has seen him work closely with a multidisciplinary team including sports physiotherapists and groin surgeons at the Aspetar Clinic for Groin Pain in Athletes (Doha, Qatar). He discusses the management of the two patients outlined in the two questions above (longstanding pain in the inguinal region, adductor region, in turn). 14 minutes of practical tips – assessment, investigation, specific management. PRP, surgery? No holds barred. What remains unknown. You’ll get the pearls that @AdamWeirSports shared as a keynote speaker at the American Medical Society for Sports Medicine (@TheAMSSM) conference in April 2105. Key resources include: BJSM Issue 12, 2015 – Groin pain in athletes – Table of Contents: http://bjsm.bmj.com/content/49/12.toc 9 systematic reviews most of the Open Access thanks to Aspetar Orthopaedic and Sports Medicine Hosptital, Doha, Qatar – here’s the one on management of groin pain. http://bjsm.bmj.com/content/49/12/813.full (Serner et al., Open Access) Consensus Statement: Doha Agreement Meeting: http://bjsm.bmj.com/content/49/12/768.full (Weir et al - 23 authors, Open Access) Part 2 BJSM podcast with Adam Weir – https://soundcloud.com/bmjpodcasts/take-homes-from-1st-world-conference-on-groin-pain-in-athletes-doha-agreement-part-2 You are encouraged to tweet your podcast questions to @AdamWeirSports or post on the Google + Sports & Exercise Medicine Community page – a great place to write more than a tweet. All you need is a gmail account.

High performance demands heavy workloads but loading increases the risk of ‘overuse’ injury. How can clinicians and strength & conditioning (S&C) coaches find the happy medium? Or is it time to take a different view? Perhaps INCREASING training load will make tissues more resilient and injury LESS likely. Dr Tim Gabbett (www.gabbettperformance.com) bridges sports medicine and S&C as a performance consultant and a recognized applied researcher. In the BJSM spotlight he shares what physiotherapists can learn from S&C coaches and argues for the concept of the ‘performance physiotherapist’. Similarly, he translates S&C secrets for physios – insights to progressing sport specific game demands within the rehabilitation program using a rugby example. We ask him about the high-tech and low-tech equipment to gauge how much players are doing and how to titrate their training dose. The latter part of the podcast focuses on how greater training loads can make players less likely to suffer injury but match demands must be considered. “High training loads are not necessarily the problem, it is how you get there that can damage players”. The internationally-recognized Gabbett closes by outlining the concept of ‘training stress balance’ – the net difference between fitness (long-term training load) and fatigue (short-term training load). When the player is in ‘positive’ balance, (i.e, the short-term load is lower than the longer term level of load the player is adapted to) injury is very unlikely. However, when this pattern is reversed, such as when a player is attempting to rapidly ‘gain fitness’ after a layoff, injury is almost inevitable. Cricket fast bowling data provides compelling evidence for this novel concept. Link to Dr Tim Gabbett’s home page: www.gabbettperformance.com In case you don’t get to check Dr Gabbett’s bio, he is in that rare group of individuals with two PhDs – one in human physiology (2000), the other in the applied science of professional football (2011). He has worked with players in many Olympic Games cycles and published over 150 papers. http://gabbettperformance.com.au/profile/ The BJSM paper relating to ‘training stress balance’: Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Hulin BT, Gabbett TJ, ….Orchard JW. Br J Sports Med. 2014 Apr;48(8):708-12 http://www.ncbi.nlm.nih.gov/pubmed/23962877

“Just because it’s difficult doesn’t mean it’s impossible” says Norway’s Ben Clarsen (PT, PhD) (@BenClarsen). We all say the words – ‘injury prevention is important’, ‘we want to catch injuries early’ but how do you do it? What about if your nation’s athletes are spread all around the globe? Can a systematic, yet simple, process of asking athletes questions by text messaging work? Norway punch above their weight in elite sport and Ben Clarsen is one of the team at the engine room of Norwegian Sports Medicine & Sports Science ‘Olympiatoppen’ (ie. ‘EliteSport’). He shares with @Liam_West HOW Norway keeps in touch with athletes weekly, responds to early warning signals, and initiates appropriate treatment in a financially prudent manner (oil price down right now). Links include: For athletes’ health problems: http://bjsm.bmj.com/content/48/9/754.abstract - The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. By Clarsen B, Rønsen O, Myklebust G, Flørenes TW, Bahr R. Br J Sports Med. 2014 May;48(9):754-60. doi: 10.1136/bjsports-2012-092087. Epub 2013 Feb 21. For sports injury problems: http://bjsm.bmj.com/content/47/8/495.abstract Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. By Clarsen B, Myklebust G, Bahr R. Br J Sports Med. 2013 May;47(8):495-502. doi: 10.1136/bjsports-2012-091524. Epub 2012 Oct 4.

Prof. Roald Bahr is a world-renowned name in Sports Medicine. He is a member of the IOC medical committee and a Professor in Sports Medicine. He acts as the Head of the Aspetar Sports Injury & Illness Prevention Programme and also Chair of the Oslo Sports Trauma Research Center at the Norwegian School of Sports Sciences. Prof. Bahr’s main research area is the prevention of injury and illness in athletes, and has published more than 200 papers and book chapters. He was speaking at the IOC Advanced Team Physician Course in Doha, Qatar when BJSM caught up with him. In this podcast, Dr Liam West (@Liam_West) poses questions that see Prof. Bahr take listeners through various Return To Play (RTP) frameworks and how we should be willing to accept risk during the RTP period. Relevant Reading: Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med 2010;20:379–85. http://journals.lww.com/cjsportsmed/Abstract/2010/09000/Return_to_Play_in_Sport__A_Decision_based_Model.12.aspx Herring SA, Kibler WB, Putukian M. The team physician and the return-to-play decision: a consensus statement-2012 update. Med Sci Sports Exerc 2012;44:2446–8. http://europepmc.org/abstract/med/23160348 Shrier I, Safai P, Charland L. Return to play following injury: whose decision should it be? Br J Sports Med 2014:48:394-401 http://bjsm.bmj.com/search?submit=yes&y=0&fulltext=risk%20management&x=0&FIRSTINDEX=10 IOC Sports Medicine Diploma – http://www.iocsportsmedicine.com/ IOC Sports Nutrition Diploma - http://www.sportsoracle.com/Nutrition/Home/ https://twitter.com/bjsm_bmj https://www.facebook.com/BJSM.BMJ https://plus.google.com/+BJSMVideos/posts BJSM App iTunes - https://itunes.apple.com/us/app/bjsm/id943071687?mt=8 Google Play - https://play.google.com/store/apps/details?id=com.goodbarber.bjsm

Dr Carolyn Broderick provides practical examples of the type of physical exercise that is feasible in children with chronic diseases, such as diabetes, mitochondrial myopathy, haemophilia, or after an organ transplantation. She also discusses the risk of injury during the growth spurt and how to best avoid these injuries. Dr Broderick, MBBS, FACSP, PhD, is a staff specialist in Sport and Exercise Medicine at the Children’s Hospital at Westmead, Australia. She was Medical Director of the Australian Team for the Youth Olympic Games in 2014 and Team Physician for the Australian Team at the Sydney 2000 and London 2012 Olympic Games. She is a member of the Australian Olympic Committee Medical Commission and Deputy Medical Director for the Australian Olympic Team in Rio 2016. Her research interests include injury surveillance in youth sport and physical activity in children with chronic disease. Further Reading: Fundamental movement skills, physical fitness and physical activity among Australian children with juvenile idiopathic arthritis. Hulsegge G, Henschke N, …Broderick C, et al. J Paediatr Child Health. 2015 Apr;51(4):425-32. doi: 10.1111/jpc.12733. http://www.jsams.org/article/S1440-2440%2812%2900661-5/abstract Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative interventions. Michaleff ZA, Kamper SJ, Maher CG, Evans R, Broderick C, Henschke N. Eur Spine J. 2014 Oct;23(10):2046-58. doi: 10.1007/s00586-014-3461-1. http://link.springer.com/article/10.1007%2Fs00586-014-3461-1 A feasibility study of the effect of intra-articular corticosteroid injection on isokinetic muscle strength in children with juvenile idiopathic arthritis. McKay D, Ostring G, Broderick C, Chaitow J, Singh-Grewal D. Pediatr Exerc Sci. 2013 May;25(2):221-37. Epub 2013 Mar 15. http://www.ncbi.nlm.nih.gov/pubmed/23504857 Evaluation and management of bleeding risks with athletic activities in children with hemophilia. Broderick C. Clin Adv Hematol Oncol. 2013 Jan;11(1):46-7. No abstract available. Mol Cancer. 2013 Feb 1;12:7. doi: 10.1186/1476-4598-12-7. http://www.ncbi.nlm.nih.gov/pubmed/23416863 Association between physical activity and risk of bleeding in children with hemophilia. Broderick CR, Herbert RD, Latimer J, Barnes C, Curtin JA, Mathieu E, Monagle P, Brown SA. JAMA. 2012 Oct 10;308(14):1452-9. doi: 10.1001/jama.2012.12727. http://jama.jamanetwork.com/article.aspx?articleid=1377921 Patterns of physical activity in children with haemophilia. Broderick CR, Herbert RD, Latimer J, van Doorn N. Haemophilia. 2013 Jan;19(1):59-64. doi: 10.1111/j.1365-2516.2012.02904.x. The International Olympic Committee Consensus statement on age determination in high-level young athletes. Engebretsen L, Steffen K, Bahr R, et al. Br J Sports Med. 2010 Jun;44(7):476-84. doi: 10.1136/bjsm.2010.073122. No abstract available. Erratum in: Br J Sports Med. 2010 Aug;44(10):770. http://bjsm.bmj.com/content/44/7/476.extract

Dr Carolyn Broderick, MBBS, FACSP, PhD is staff specialist in Sport and Exercise Medicine at the Children’s Hospital at Westmead, Australia. Dr Carolyn is Team Physician for the Australian Federation Cup Tennis Team. She was Medical Director of the Australian Team for the Youth Olympic Games in 2014 and Team Physician for the Australian Team at the Sydney 2000 and London 2012 Olympic Games. She is a member of the Australian Olympic Committee Medical Commission and Deputy Medical Director for the Australian Olympic Team in Rio 2016. Her research is on injury surveillance in youth sport and physical activity in children with chronic disease. What are the challenges of being a team physician for tennis players who travel the world continually? Does an athlete management system help to monitor work load and injuries? Musculoskeletal conditions in children and adolescents managed in Australian primary care. Henschke N, Harrison C, McKay D, Broderick C, Latimer J, Britt H, Maher CG. BMC Musculoskelet Disord. 2014 May 20;15:164. doi: 10.1186/1471-2474-15-164. http://www.biomedcentral.com/1471-2474/15/164 Children, sport and the Olympics: Observations from the Games of the XXX Olympiad in London. Broderick C. J Paediatr Child Health. 2013 Sep;49(9):701-3. doi:10.1111/jpc.12217. http://onlinelibrary.wiley.com/doi/10.1111/jpc.12217/abstract The International Olympic Committee Consensus statement on age determination in high-level young athletes. Engebretsen L, Steffen K, Bahr R, et al. Br J Sports Med. 2010 Jun;44(7):476-84. doi: 10.1136/bjsm.2010.073122. http://bjsm.bmj.com/content/44/7/476.extract Reducing the risk of injury in young footballers. Broderick C, McKay D. BMJ. 2009 Mar 18;338:b1050. doi: 10.1136/bmj.b1050. http://www.bmj.com/content/338/bmj.b1050

Kids as young as 8 years old sign with football clubs and live at Football Club Academies. One website describes the Brighton & Hove Albion FC Academy as “a place where dreams are fired, hopes are heightened and aspirations are raised.” Sam Blanchard (@SJBPhysio_sport) has had 4 years experience in junior development. He’s also a leader among the UK Physios in Sport (@SportsPhysios) You’ll hear about (i) the typical day for a child/adolescent in this setting, (ii) how to vary training during the adolescent growth period to minimize risk of apophysitis etc. (iii) what to suggest to coaches and how to work with them, as well as (iv) practical tips for assessing maturity. Sam shares strategies for measuring load (including GPS) and uses that to both protect vulnerable athletes from injury as well as ensuring you can add the appropriate type of training as the child matures. A year after the growth spurt the adolescent can benefit from certain dynamic stabilization exercises or heavier resistance loads. In the 2nd half of the podcast Sam includes many practical tips from his vast experience. Remember the UK Physios in Sport Annual Conference ‘The Younger Athlete’: Brighton, October, 9th & 10th October. http://bit.ly/1cLwHeX Sam’s first BJSM podcast is on growth-related sport injuries: http://bit.ly/1HqnXsf

K-tape is ubiquitous in top sport. Does it boost performance or prevent injury? In this 2nd podcast about tape, two-time Commonwealth Games and Olympic Games physiotherapist Chris McNicholl shares his clinical wisdom and his scrutiny of the literature. See below for list of papers that Chris mentions and here’s the link to his other podcast – on regular taping. http://bit.ly/1bUnP5U Don’t forget to check out the UK Physios Taping courses here: http://www.physiosinsport.org/courses.html Schiffer T, J Sport Rehabil. 2015 Feb;24(1):47-50. Kinesio taping and jump performance in elite female track and field athletes and jump performance in elite female track and field athletes. Nunes GS, Effect of kinesio taping on jumping and balance in athletes: a crossover randomized controlled trial. J Strength Cond Res. 2013 Nov;27(11):3183-9. Poon KY, Kinesiology tape does not facilitate muscle performance: A deceptive controlled trial.Man Ther. 2015 Feb;20(1):130-3. http://www.ncbi.nlm.nih.gov/pubmed/?term=j+strength+cond+res++tape+volleyball+soccer Parreira P C, Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial., J Physiother. 2014 Jun;60(2):90-6. http://www.ncbi.nlm.nih.gov/pubmed/24952836 Kachanathu SJ Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain. J Phys Ther Sci. 2014 Aug;26(8):1185-8. http://www.ncbi.nlm.nih.gov/pubmed/25202177 Shaheen AF, Rigid and Elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. J Electromyogr Kinesiol. 2015 Feb;25(1):84-92 http://www.ncbi.nlm.nih.gov/pubmed/25138646 Link to a BJSM paper on K-tape: Br J Sports Med doi:10.1136/bjsports-2014-094151 Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. http://bjsm.bmj.com/content/early/2015/01/16/bjsports-2014-094151.abstract

You or your patient wants to lose weight. What gives you the best bang for your buck? BJSM editor Karim Khan puts London cardiologist and physical activity champion Dr Aseem Malhotra under the glaring lights. This podcast follows up the free BJSM editorial 'It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet' Here’s the link to the related BJSM editorial: http://bjsm.bmj.com/content/early/2015/05/07/bjsports-2015-094911.full You can also listen to Dr Malhotra discuss the role of diet and cardiovascular risk factors here: https://soundcloud.com/bmjpodcasts/aseem-malhotra-dont-fear-the-fat?in=bmjpodcasts/sets/bjsm-1

Steven Stovitz, MD, MS, directs the University of Minnesota’s Program in Primary Care Sports Medicine and is the associate director of the University of Minnesota’s Sports Medicine Fellowship. His clinical work is divided between the University of Minnesota’s Sports Medicine clinic and Orthopedic clinic along with the athletics department, where he is a team physician for University’s athletes. Dr. Stovitz’s research involves the intersection of clinical medicine and epidemiology, as well as a variety of issues related to the study of obesity. He is a fellow of the American College of Sports Medicine and a senior associate editor with the BJSM. He has a special interest in evidence informed medicine and he challenges us with specific clinical settings where patients and doctors commonly make ‘inferior’ choices. Why does this happen? A thought-provoking podcast that may be best enjoyed at home with focus rather than driving on a windy coastal road! See also: Stovitz SD, Shrier I. Sickle cell trait, exertion-related death and confounded estimates. http://bjsm.bmj.com/content/48/4/285.long Stovitz SD, Shrier I. Medical decision making and the importance of baseline risk. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809433/ Stovitz SD. Confusion surrounding false-positive rates: distinguishing the definition from the important clinical question. Curr Sports Med Rep. 2014 Mar-Apr;13(2):69-70. doi: 10.1249/JSR.0000000000000032. PubMed PMID: 24614417. Stovitz SD, Shrier I. Injury rates in team sport events: tackling challenges in assessing exposure time. http://bjsm.bmj.com/content/46/14/960.long