BJSM Podcast

Dr Russell Hearn has a portfolio career that sees him balance his time between working in general practice in London and Expedition & Wilderness Medicine. He directs and teaches on the Expedition & Wilderness medicine components at Kings College London (KCL) and University College of London (UCL) & is also an Advanced Life Support Instructor. In recognition of providing high-level medical cover for various expeditions and extreme events, Dr Hearn was elected a fellow of the Wilderness Medicine Society in 2013. In this podcast, Dr Liam West (@Liam_West) poses questions that see Dr Hearn take listeners through what it is like to work within these extreme conditions, tips on how to provide optimal medical cover and how to get involved. Useful Resources: Wilderness medicine society of America – consensus documents http://www.ncbi.nlm.nih.gov/pubmed/20591379 - High Altitude Illness http://www.ncbi.nlm.nih.gov/pubmed/25498264 - Hypothermia http://www.ncbi.nlm.nih.gov/pubmed/25498262 - Frist Bite http://www.ncbi.nlm.nih.gov/pubmed/25498263 - Heat Related Illness http://www.ncbi.nlm.nih.gov/pubmed/25498265 - Lightning Injuries http://www.ncbi.nlm.nih.gov/pubmed/25498266 - Acute Pain in Remote Locations http://www.ncbi.nlm.nih.gov/pubmed/25498256 - Spinal Immobilization in Austere Environment http://www.ncbi.nlm.nih.gov/pubmed/25498257 - Wound Management in Austere Environment http://www.ncbi.nlm.nih.gov/pubmed/25498260 - Exercise-Associated Hyponatraemia International World Extreme Medicine Conference & Expo http://www.extrememedicineexpo.com Fellowship Programme of the Academy of Wilderness Medicine (America) http://www.expeditionmedicine.co.uk/index.php/advice/resource/r-0082.html Diploma in Medical Care of Conflict and Catastrophes – Worshipful Society of Apothecaries, London http://www.apothecaries.org/faculty-of-the-conflict-catastrophe-medicine/course-in-conflict-catastrophe-medicine KCL Wilderness Medicine SSC Website http://www.wildernessmedic.org

Podcast titles are limited to 100 characters; the ideal title would have been…”Working as a multidisciplinary team in elite sport – the role of physiotherapy, strength and conditioning teams, medical folks, soft tissue therapists, exercise rehabilitators etc.”. A leading elite team physiotherapist (Andrew Wallis, PT) and a head of sports science/conditioning (Darren Burgess, PhD) provide you the inside view from within two elite teams. And they have international experience before their current jobs. You’ll hear WHO these teams include on the sports medicine payroll. Our hosts (Ebonie Rio, David Opar) ask whose head would be on the chopping block if there was a rash of hamstring strains after a vigorous pre-season training. Is one hamstring injury recurrence among 10 players worth 9 players coming back a week early? What about sending players to the funky treatment’ clinician – flying for the miracle cure? Apologies for a bit of shuffling noise in Andrew’s first two answers but it disappears. Well worth pushing through that distraction (we are working on trying to get sound quality like in Jack Chew’s podcasts!). Confident you’ll love this inside view! Darren Burgess is High Performance Manager at Port Adelaide Football (AFL) Club. Darren was Head of Fitness and Conditioning at Liverpool Football Club. Darren completed his PhD in movement analysis of AFL and Soccer in 2012. http://www.portadelaidefc.com.au/ Andrew Wallis is head physiotherapist at the St Kilda Football Club and has been there for the last 8 years. He has a special interest in Hip and Groin pathology and consults privately at Melbourne Orthopaedic Group and Malvern Sports Medicine Centre. http://www.saints.com.au/ Relevant papers: Seasonal Training Load Quantification in Elite English Premier League Soccer Players. Malone JJ, Di Michele R, Morgans R, Burgess D, Morton JP, Drust B. Int J Sports Physiol Perform. 2014 Nov 13. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/25393111 Countermovement jump performance is not affected during an in-season training microcycle in elite youth soccer players. Malone JJ, Murtagh CF, Morgans R, Burgess DJ, Morton JP, Drust B. J Strength Cond Res. 2015 Mar;29(3):752-7. doi: 10.1519/JSC.0000000000000701. http://www.ncbi.nlm.nih.gov/pubmed/25226317 Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Br J Sports Med. 2014 Jun;48(11):929-38. doi: 10.1136/bjsports-2012-091400. http://bjsm.bmj.com/content/48/11/929.long

You see kids in the clinic and you get most of them better. Do you want to revisit the anatomy and biomechanics that underpin these injuries? Are there novel approaches to treatment? Does early sport specialization cause problems? How can we balance the need for coaches to have time to develop elite juniors’ skills with the risk of overuse injuries. Some kids’ injuries, such as cam deformities at the hip may arise during the growing years and cause problems later in life. Sam Blanchard (@SJBPhysio), sports physiotherapist, shares his career experience which includes four years at the Brighton Hove Albion Football Club Academy (junior development facility). The entry class begins as age eight years! He is a Senior Lecturer in Physiotherapy at the University of Brighton. If this is your area of interest, check out the program at the UK Physios in Sport Annual Conference, “The Young Athlete” October 9,10, 2015. http://bit.ly/1bzGnsl Relevant links include: UK Physios in Sport, Annual Conference: Brighton. http://bit.ly/1bzGnsl Freitag A. Systematic review of rugby injuries in children and adolescents under 21 years. http://bjsm.bmj.com/content/49/8/511.abstract Tak I, Weir A, …, Agricola R. The relationship between the frequency of football practice during skeletal growth and the presence of a cam deformity in adult elite football players. http://bjsm.bmj.com/content/49/9/630.abstract

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