BJSM Podcast

Is it safe for this athlete to exercise? Are ultraendurance events and training for them leading to reversible cardiac fatigue to frank damage and fibrosis? How should one investigate the athlete who may be in the ‘grey zone’ between benign ‘athletes heart’ and potentially fatal cardiomyopathy? Dr Andre La Gerche, an internationally renowned sports cardiologist with experience in Europe and Australia took time out from his keynote role at the American Medical Society for Sports Medicine conference (2015) to answer those questions with BJSM’s Dr Michael Turner. Relevant links include: The right ventricle following prolonged endurance exercise: are we overlooking the more important side of the heart? A meta-analysis – this was discussed on the podcast. http://goo.gl/TWgpnr Ventricular arrhythmias associated with long-term endurance sports: what is the evidence? By Dr La Gerche and colleagues. http://goo.gl/TuF4mQ ECG interpretation in athletes – free (minor signing in, takes Jon Drezner from the archive - Jon Drezner and the 2012 sudden cardiac death update: two new key messages http://bit.ly/1aYmnyX

Meryl Wheeler goes by the name of “non-physician expert” and she explains that after an injury a patient books online, sees an athletic therapist especially trained for this setting, before closing with a sports physician consultation. Patients who needed a surgeon got an operation 5 months earlier in this system than in Canada’s regular publicly funded one. Food for thought? Link: http://www.theglobeandmail.com/life/health-and-fitness/calgary-knee-clinic-delivers-quicker-cheaper-elite-level-care/article4180511/ The Canadian Academy of Sport & Exercise Medicine is a BJSM member society - casem-acmse.org/

Dr. Jason Fung is a Consultant Nephrologist who trained and began his medical career at the University of Toronto before heading to the University of California in Los Angeles where he completed his fellowship in nephrology. Since then he has founded the Intensive Dietary Management Program, which provides a unique treatment for Type 2 Diabetes & Obesity. This BJSM podcast sees @Liam_West pose the questions and Dr. Fung take the listeners through the evidence behind the impact of diet on obesity and Type 2 Diabetes Mellitus (T2DM). Jason explains that, whilst the #LCHF model of “Carbohydrates  Insulin  Obesity” is not wrong, it is incomplete. He reiterates that the main player in the development of obesity and T2DM is INSULIN – not merely high carbohydrates. Jason believes that the calories in/calories out model that has previously been described is incorrect. He explains the evidence and builds upon the #LCHF model to include the importance of insulin resistance and meal timing. In T2DM, this resistance leads to Beta-cell dysfunction. Evidence exists that this process can be reversed and therefore T2DM should not be considered to be a chronic progressive disease – it is curable with bariatric surgery and caloric prescription. The take home message for the podcast from Jason is to eat #RealFood, #ConsiderInsulin and #EmpowerPatients to regain control over diabetes. Literature Discussed in Podcast & Further Reading INTERMAP Study (2003) - http://www.nature.com/jhh/journal/v17/n9/abs/1001605a.html KITAVA Study (1995)- http://www.sciencedirect.com/science/article/pii/S0026049599902585 Insulin Resistance - One - http://link.springer.com/article/10.1007/BF00279918 Insulin Resistance - Two - http://www.sciencedirect.com/science/article/pii/S0025712507000983 Insulin Resistance - Three - http://diabetes.diabetesjournals.org/content/56/4/984.short Lancet Infant Obesity (2010) - http://www.sciencedirect.com/science/article/pii/S0140673610601717 NEWCASTLE Study (2009) - http://www.biomedcentral.com/1471-2458/9/342/ Dietary Fibre reduces Insulin Resistance - http://jama.jamanetwork.com/article.aspx%3FarticleID=192034 Curing Diabetes – Surgical treatment diabetes - http://ajcn.nutrition.org/content/55/2/582S.short Curing Diabetes - Gastric Banding - http://jama.jamanetwork.com/article.aspx%3Farticleid=1149302 Curing Diabetes - Fasting & Bariatric Surgery - http://care.diabetesjournals.org/content/36/9/2741.short Curing Diabetes - ACCORD - http://www.nejm.org/doi/full/10.1056/NEJMe0804182 Curing Diabetes - Losing weight doesn’t work - http://www.nejm.org/doi/full/10.1056/NEJMoa033179 Curing Diabetes - Calorie restriction induces restoration of hepatic insulin sensitivity - http://care.diabetesjournals.org/content/36/4/1047.short Intensive Dietary Management Website - With educational lectures and other content - http://intensivedietarymanagement.com

Olympic physician Bob McCormack discusses new surgical techniques for AC joint dislocation, comparing surgical vs. non-operative management, surprising results showing non-operative treatment with faster recovery, and the importance of engaging with the Canadian Academy of Sport and Exercise Medicine.

Drs. M.P. (Rien) Heijboer, orthopedic surgeon, works at the Dept at Orthopedic at the Erasamus Medical Centre in Rotterdam. He has extensive experience with sports-related injuries and has worked for more than 30 years as medical adviser of football club Feijenoord in Rotterdam. He is a member of the medical staff of the Dutch National Soccer Team and visited the world soccer championships in Brasil in 2014, which he describes as a "life-time experience"! He is president of the Dutch Orthopedic Society (NOV). He has a great interest in sports-related injuries and today Rien discusses his lifetime experience of managing difficult stress fractures in sport. Further reading: Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review. http://bjsm.bmj.com/content/49/6/370.long Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW. Br J Sports Med. 2015 Mar;49(6):370-376. doi: 10.1136/bjsports-2013-093246. Epub 2014 Aug 19. Review. Ultrasonography of fractures in sports medicine. http://bjsm.bmj.com/content/49/3/152.long Hoffman DF, Adams E, Bianchi S. Br J Sports Med. 2015 Feb;49(3):152-60. doi: 10.1136/bjsports-2014-094217. Epub 2014 Dec 24. Fifth metatarsal fractures among male professional footballers: a potential career-ending disease. http://bjsm.bmj.com/content/47/12/754.long Ekstrand J, van Dijk CN. Br J Sports Med. 2013 Aug;47(12):754-8. doi: 10.1136/bjsports-2012-092096. Epub 2013 Apr 9.

Chris McNicholl brings the experience of the Olympic Games and two Commonwealth Games to his sports taping courses for UK Physios in Sport. In this podcast we dig below the surface. Does taping really prevent injuries and if so, how? We cover lower limb, upper limb, joints & muscles. Football and rugby. But we keep the issue of Kinesio-tape for a separate podcast. You’ll hear Chris refer to the following papers: Tricia J. Hubbard, et al. Effect of Ankle Taping on Mechanical Laxity in Chronic Ankle Instability Foot & Ankle International/Vol. 31, No. 6/June 2010 Heather Miller et al. Role of External Prophylactic Support in Restricting Accessory Ankle Motion after Exercise Foot Ankle Int 2012 33: 862 Karl Stoffel et al. Effect of Ankle Taping on Knee and Ankle. Joint Biomechanics in Sporting Tasks. MEDICINE & SCIENCE IN SPORTS & EXERCISE 2010 Eamonn Delahut et al. Altered Neuromuscular Control and Ankle Joint Kinematics During Walking in Subjects With Functional Instability of the Ankle Joint. The American Journal of Sports Medicine, Vol. 34, No. 12 2006

‘Relative energy deficiency in sport’ (RED-S) refers to impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. You will hear McMaster University’s Dr Margo Mountjoy clarify the IOC’s consensus statement on this condition. Why it was needed. What the controversies are. And what clinicians can do in the clinic. Dr Mountjoy walks you through the new clinical tool the RED-S Clinical Assessment Tool (CAT) that uses a simple ‘green’, ‘orange’ and ‘red’ traffic light system for clinicians managing athletes who may be suffering the effects of insufficient energy intake. The original 2014 consensus statement is here: http://bjsm.bmj.com/content/48/7/491 The 2015 update/extension is here: http://bjsm.bmj.com/content/49/7/417.full And the clinical assessment tool (CAT) is here: http://bjsm.bmj.com/content/49/7/421.full.pdf+html

Professor Mark Batt graduated from Cambridge University Medical School in 1984 and trained in Family Medicine. He obtained a Diploma in Sports Medicine from the University of London in 1991 and completed a fellowship in Sports Medicine at the University of California, Davis in 1993. Since 1995, he has been in Nottingham, United Kingdom, as a consultant/senior lecturer in Sport and Exercise Medicine at the Nottingham University Hospitals where he was appointed Special Professor in 2004. He serves or served as a consultant for The England and Wales Cricket Board, The Rugby Football League, British Gymnastics, The English Institute of Sport, The Wimbledon Tennis Championships, ATP and the WTA. He is immediate past-president of the Faculty of Sport & Exercise Medicine and past Chairman of the Specialist Advisory Committee in SEM. He chaired the work-group which produced the successful case for SEM as a specialty of medicine (2005). He is director of the Arthritis Research UK (ARUK) Centre for Sport, Exercise and Osteoarthritis: a consortium of Nottingham, Oxford, Southampton, Bath, Loughborough, UCL and Leeds Universities investigating the relationship between acute and overuse injury and subsequent Osteoarthritis. In this podcast, Dr. Liam West (@Liam_West) poses questions that see Prof Batt take listeners through the objectives and aims of the ARUK centre and the research it is currently working on. Prof Batt also gives his views on how to ensure that research remains clinically relevant before finishing the podcast discussion the future avenues for the treatment of osteoarthritis. Further Reading ARUK Centre for Sport, Exercise and Osteoarthritis - http://www.sportsarthritisresearchuk.org/seoa/index.aspx ARUK Research Projects - http://www.sportsarthritisresearchuk.org/seoa/research-projects/index.aspx ARUK Work Packages - http://www.sportsarthritisresearchuk.org/seoa/work-packages/workpackages.aspx ARUK Centre Publications - http://www.sportsarthritisresearchuk.org/seoa/publications/index.aspx Isokinetic Football Medicine Conference, 11-12th April 2015, QEII Conference Centre, London http://www.footballmedicinestrategies.com/en/ Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis http://bjsm.bmj.com/content/48/21/1579.abstract  Optimal types of exercise for lower limb osteoarthritis http://bjsm.bmj.com/content/early/2014/02/18/bjsports-2013-093384.full  No benefit of surgery over physiotherapy for meniscal tears in adults with knee osteoarthritis http://bjsm.bmj.com/content/48/9/797 Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective http://bjsm.bmj.com/content/early/2011/02/17/bjsm.2010.081984 Osteoarthritis in football: FIFA/F-MARC approach http://bjsm.bmj.com/content/45/8/673.extract

Sports rehabilitators and trainers specialise in exercise and sports rehabilitation and managing musculoskeletal conditions. They also promote exercise and healthy lifestyles. Listen here to BASRaT Chairman, Steve Aspinall from the University of Salford, and Continuing Professional Development Officer, Allan Munroe, University of Bradford. In addition to painting the picture of the profession, and the training pathway, our guests highlight BASRaT’s clinical contribution to Team True Spirit (rehabilitation of seriously injured servicemen ) and the Rugby Football Union (concussion information and management).

Chris Swier is a sports physiotherapist and has a Masters degree in Business Administration. As a physiotherapist, he has specialised in dry needling and myofascial release techniques. In 2006, he joined the ATP Medical Services Committee as one of their Sports Medicine Therapists on the ATP Wold Tour, traveling from tournament to tournament. He continues to work in clinical practice, mainly for Manual Fysion in Amsterdam. Chris has also worked with Dutch women's volleyball, Dutch Beach Volleyball and even the Argentinian Davis Cup team! His main interests include sports and orthopaedic rehabilitation of the ankle, knee, hip and shoulder. At the ATP World Tennis Tournament in Rotterdam he talks about his life and work on the ATP World Tour.