BJSM Podcast

CrossFit: dangerous fad or fitness panacea? Episode #392

CrossFit: dangerous fad or fitness panacea? The AMSSM talks safety with Drs Sean Rockett and Robert Oh.
Few topics in sports draw such universally strong opinions from medical providers as that of CrossFit. Most seem to love or hate it, but are their strong opinions justified? Does current data back-up the concerns many of us have regarding the safety of this sport? What are the common injury patterns that are found? Host Dr. Devin McFadden, MD is joined by Dr. Sean Rockett, MD and Dr. Robert Oh, MD to explore these topics and more on the AMSSM Sports Medcast.
Dr. Sean Rockett is an Associate Professor of Orthopedic Surgery at Tufts University School of Medicine, president of Orthopedics New England and author of 321GoMD.com an injury prevention website for CrossFitters. He is head of the Orthopedic division for the Medical team for The CrossFit Games.
Dr. Robert Oh, Sports Medicine physician and CrossFitter for 12 years. He’s the Chief of the Family Medicine Dept at Madigan Army Medical Center and Fellowship director for the Leader and Faculty Development at Madigan.
References:
1. Sport Med - open. 2018;4(1):11. doi:10.1186/s40798-018-0124-5.
2. J Sports Med Phys Fitness. 2017;57(9):1147-1153. doi:10.23736/S0022-4707.16.06827-4
3. Orthop J Sport Med. 2018;6(10):2325967118803100. doi:10.1177/2325967118803100
4. J Sport Rehabil. 2018;27(3):295-299. doi:10.1123/jsr.2016-0040.
5. Sport Med. 2017;47(3):479-501. doi:10.1007/s40279-016-0575-0
6. Annals of epidemiology 2006; 16(9):712-719.)
7. Work Heal Saf. 2017. doi:10.1177/2165079916685568.
8. Mil Med. 2016;181(7):627-637. doi:10.7205/MILMED-D-15-00273
9. US Army Med Dep J.:36-47. http://www.ncbi.nlm.nih.gov/pubmed/24146241. Accessed August 5, 2018.

Preventing harassment and abuse in sport: Professor Margo Mountjoy, MD, PhD (2019 update). #391

“Only by speaking out can we create lasting change”
On this week’s BJSM podcast, Prof Margo Mountjoy (T:@margomountjoy) joins BJSM’s Daniel Friedman (T:@ddfriedman) to discuss harassment and abuse in sport. Prof Mountjoy is an Associate Clinical Professor in the Department of Family Medicine at McMaster University Medical School and Regional Assistant Dean of the Michael G. DeGroote School of Medicine, McMaster University. She is also a clinician scientist – sports medicine physician practicing at the Health + Performance Centre at the University of Guelph, as the Clinical + Academic Director. Prof Mountjoy works for several International Sports organizations in the field of sports medicine including the International Olympic Committee (Games Group), the International Federation for aquatics (FINA), the Association of Summer Olympic International Federations and for the World Anti-Doping Agency.
In this episode, Prof Mountjoy discusses:
· The Larry Nassar case
· Sexual abuse in sport
· MeToo movement’s impact on sport
· Types of abuse and harassment and the impact on the athlete vs organisation
· The Olympic Athlete Welfare Programme
· Tips for clinicians to help prevent abuse and harassment in sport
Mentioned in this podcast:
Mountjoy M ‘Only by speaking out can we create lasting change’: what can we learn from the Dr Larry Nassar tragedy? British Journal of Sports Medicine 2019;53:57-60. https://bjsm.bmj.com/content/53/1/57
The Larry Nasser Tragey – BMJ https://blogs.bmj.com/bmj/2018/03/29/margo-mountjoy-on-the-larry-nassar-tragedy-never-again/
Reardon CL, Hainline B, Aron CM, et al Mental health in elite athletes: International Olympic Committee consensus statement (2019) British Journal of Sports Medicine 2019;53:667-699. https://bjsm.bmj.com/content/53/11/667
Safeguarding athletes from harassment and abuse in sport IOC toolkit https://www.iwf.net/wp-content/uploads/downloads/2018/10/IOC_Safeguarding_Toolkit_ENG.pdf
You can find two of Professor Mountjoy’s previous podcasts here:
Relative energy deficiency syndrome (RED-S): http://ow.ly/VCZK50v2A7f
Psychological abuse in sport (2017) http://ow.ly/ljJt50v2Amt (Harrassment, abuse, bullying)

Human Factors in Sports Medicine – Unconsciously Unaware? Episode #390

Jonathan Hanson is a Sports Medicine consultant with a background in emergency medicine. He works as team doctor for the Glasgow Warriors rugby union team, has worked as an Emergency care advisor to the FA and worked on Head injury systems and immediate care with the Senior men at the 2018 FIFA World Cup. Given his background, he has a particular interest in the human factors associated with working in SEM, especially in a pitch-side/pre-hospital setting.
In this podcast, we discuss:
 What is meant by the term ‘human factors’?
 How do we develop these? Can they be developed at an individual level, or do they need to be embraced more broadly by a team/department as a whole?
 Examples of how human factors have affected practice
 Getting people to ‘buy-in’ to the importance of human factors?
For listeners, you can follow Jonathan @SportsDocSkye – and the links to the resources we
mentioned can be found below:
BJSM Three-Part Blog Series:
https://blogs.bmj.com/bjsm/2019/04/30/human-factors-in-sports-medicine-part-1/
https://blogs.bmj.com/bjsm/2019/05/17/human-factors-in-sports-medicine-part-2/
https://blogs.bmj.com/bjsm/2019/05/25/human-factors-part-3/
Just a routine operation: https://www.youtube.com/watch?v=JzlvgtPIof4
13 minutes to the moon: https://www.bbc.co.uk/programmes/w27vq4km

Prescribing physical activity with Dr Jane Thornton (Part 2). Episode #389

On this week’s BJSM podcast, BJSM deputy editor Dr Jane Thornton (T: @JaneSThornton) joins Daniel Friedman (T: @ddfriedman) to discuss physical activity counselling.
Dr Jane Thornton MD PhD is a sports medicine physician and researcher currently based in London, Canada, and is an international advocate for physical activity. She has a wealth of international experience in the field of preventative medicine, with a particular passion for promoting physical activity as both prevention and treatment of chronic disease. Alongside a super impressive medical career, Dr Thornton is also a World Champion and former Olympic rower for Canada.
In Part 2 of this 2-part podcast, Dr Thornton discusses:
· Her efforts leading the Canadian Medical Education Strategy
· Physical activity resources for clinicians and patients
· Examples for successful physical activity counselling initiatives around the world
· What SEM clinicians can start doing today to help their patients become more physically active
Mentioned in this podcast:
Make Your Day Harder http://www.makeyourdayharder.com/
PAPRICA (Switzerland) https://www.paprica.ch/
WHO Global Action Plan on Physical Activity https://www.who.int/ncds/prevention/physical-activity/gappa
In-bed cycling for patients https://www.cbc.ca/news/canada/hamilton/biking-in-bed-is-good-for-icu-patients-says-new-mcmaster-study-1.3915472
Park Run https://www.parkrun.com/
PA prescription in Luxembourg http://www.sport-sante.lu/

Prescribing physical activity with Dr Jane Thornton (Part 1). Episode #388

In this week’s BJSM podcast, BJSM deputy editor Dr Jane Thornton (T: @JaneSThornton) joins Daniel Friedman (T: @ddfriedman) to discuss physical activity counselling.
Dr Jane Thornton MD PhD is a sports medicine physician and researcher currently based in London, Canada, and is an international advocate for physical activity. She has a wealth of international experience in the field of preventative medicine, with a particular passion for promoting physical activity as both prevention and treatment of chronic disease. Alongside a super impressive medical career, Dr Thornton is also a World Champion and former Olympic rower for Canada.
In Part 1 of this 2-part podcast, Dr Thornton discusses:
· Why physical activity is the single best thing we can do for our health
· The evidence for physical activity prescription in primary care
· The shared decision making of how to prescribe physical activity to patients
· How to talk about physical activity intensity with patients
Mentioned in this podcast:
23 and a half hours YouTube video: https://www.youtube.com/watch?v=aUaInS6HIGo
Make Your Day Harder http://www.makeyourdayharder.com/
PA Prescription Position Statement https://bjsm.bmj.com/content/50/18/1109
Naci et al. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. BJSM 2019. https://bjsm.bmj.com/content/53/14/859

Women’s football medicine in 2019 with Dr Celeste Geertsema. Episode #387

On this week’s BJSM podcast, Dr Celeste Geertsema joins BJSM’s Daniel Friedman (T: @ddfriedman) to discuss the imbalance between men’s and women’s football medicine research and what needs to be done to move towards equality.
Dr Geertsema is is a Sports Medicine Physician at Aspetar with her main interests being in football, skiing, snowboarding and athletes traveling. She has extensive experience working alongside FIFA in various World Cups. She was the first ever female Team Physician at the FIFA world Cup (in South Africa 2010) and also worked as FIFA Medical Officer at the Women’s Football World Cup and U17 Women’s World Cup, as well as Medical Officer at the Winter Olympic Games and Commonwealth Games. https://www.aspetar.com/person-profile.aspx?id=12〈=en
In this 20-minute conversation, Dr Geertsema discusses:
• Her current role at the Women’s FIFA World Cup in France
• The medical requirements of men vs women at the World Cup
• Why men and women footballers should be studied separately
• The gaps in women’s football medicine research
• What the SEM community can do to help out
*Disclaimer: This is a personal interview for BJSM. Dr Geertsema is not speaking on the behalf of FIFA.*

Pele in a skirt: https://www.cbc.ca/sports/2.720/marta-pele-in-skirts-1.731293
Germany Women’s FIFA World Cup Ad: https://www.youtube.com/watch?v=layoVXL5mnw

Tennis Medicine – there’s more than meets the eye! Episode #386

It has been another big year for tennis, and for British Tennis in particular with further successes in the Fed Cup and a number of exciting juniors making an impact on the world stage. In the run up to Wimbledon, we thought we’d catch up with some of the practitioners
tasked with not only caring for these athletes, but responsible for the medical provision at some of the biggest sporting events in the international calendar.
In this podcast we hear from Dr Jo Larkin and Dr Wing Chu. Jo is a Sport & Exercise Medicine consultant and Lead Doctor for British Tennis, with Wing an SEM registrar and qualified GP who works with Jo at the Lawn Tennis Association. In this podcast, you can hear about everything from the challenges of working in tennis, to some of the often under-appreciated public health benefits linked to the sport.
 Patients needing advice & input across multiple continents at the same time
 Policy-making as well as ‘pitch-side’ care
 Population health – what role does tennis have?
Do you know someone who could benefit from a healthier heart, reduced stress and a leaner body? Or, does this sound like a personal target for you? We would implore the #SEM community to share the podcast, infographics, papers and animations widely in order to try and spread the knowledge not only of #TennisMedicine, but tennis AS medicine
https://www.youtube.com/watch?v=X4UHmZ6PL30
Seminal Papers
Health Benefits of tennis infographics: https://bjsm.bmj.com/content/52/3/201
Health Benefits of tennis paper: https://bjsm.bmj.com/content/41/11/760
Associations of specific types of sports and exercise with all-cause and cardiovascular-
disease mortality https://bjsm.bmj.com/content/51/10/812.long
Leisure-Time Physical Activity & Life-Expectancy
https://www.mayoclinicproceedings.org/article/S0025-6196(18)30538-X/fulltext

More important than life and death? Liverpool FCs Dr Andy Massey’s view of football medicine. Ep#385

What is like working at one of the biggest clubs in the world? How do you manage the intense workload of the English premier league? What happens when players retire? In this hard hitting BJSM podcast, we are joined by Dr Andy Massey, physiotherapist and doctor who currently works as head of medical services at Liverpool FC. Topics discussed include:
● Managing the load of the premier league footballer
● Looking at the whole squad; substitutes and non-playing members
● The £177 million conundrum; the cost of injured players to the league
● Managing a rectus femoris injury; how to approach it?
● 1%ers- what is their place in football?
● Transitioning into retirement- do we do enough?
● Top tips for early career professionals wanting to work in football
Links to some of the papers mentioned:
Bye Bye MRI? https://bit.ly/2KfChKQ
POLICE principle for treating injuries : https://bit.ly/2EHcS9C

Osgood Schlatter – not the self-limiting condition we once thought. Episode #384

Have we been thinking about Osgood Schlatter Disease (OSD) all wrong? To answer this question, Dr. Erin Macri interviewed Prof. Jens Lykkegaard Oleson and Dr. Sinead Holden from Aalborg University on a recent visit to Denmark.
Prof. Olesen is a rheumatologist and sports medicine physician, currently located at the Center for Almen Medicine at Aalborg University. His research focuses on tendon and fascia tissue adaption to loading, and the use of ultrasound examination in tendon and fascia pathology. Dr. Holden is a Senior Researcher at the Center for General Practice in Aalborg, where she is co-founder and research co-ordinator for the OptiYouth Research Group focused on ‘optimising physical health in youth’. Her research aims to increase understanding of musculoskeletal injuries and pain in youth, to identify those at increased risk for developing chronic MSK problems.
In this episode, we delve into some recent evidence suggesting the OSD may not be the self-limiting condition we have typically believed it to be. In fact, OSD may be more akin to a tendonopathy in its presentation, which lends itself to exploring some novel treatment approaches that may change OSD management in clinical practice.
Related Articles and Links
OSD table: http://bjsm.bmj.com/pages/wp-content/uploads/sites/17/2019/06/OSD-table.pdf
Cairns G, Owen T, Kluzek S, Thurley N, Holden S, Rathleff MS, Dean BJ. Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ Open Sport Exerc Med. 2018 Aug 13;4(1):e000383. doi: 10.1136/bmjsem-2018-000383
https://bmjopensem.bmj.com/content/4/1/e000383
Holden S, Winiarski L, Krommes K, Thorborg K, Olesen JL, Hölmich P & Rathleff MS. Prognosis of Osgood-Schlatter - poorer than anticipated? A prospective cohort study with 24-month follow-up. Presented at the Scandinavian Sports Medicine Conference 2019, Copenhagen, Denmark.
Vad, CG; Rathleff, MS; Jensen, HP; Holden S. Osgood Schlatter is associated with significant impairments in knee function and quality of life 4 years after diagnosis: a retrospective study. Presented at the Scandinavian Sports Medicine Conference 2019, Copenhagen, Denmark.
Lyng K, Rathleff MS, Dean B, Kluzek S, Holden S. Current Management Strategies in Osgood Schlatter: A quantitative study. Presented at the Scandinavian Sports Medicine Conference 2019, Copenhagen, Denmark.
Kaya DO, Toprak U, Baltaci G, et al. Long-term functional and sonographic outcomes in Osgood-Schlatter disease. Knee Surg Sports Traumatol Arthrosc 2013;21(5):1131-9.
Krause BL, Williams JP, Catterall A. Natural history of Osgood-Schlatter disease. J Pediatr Orthop 1990;10(1):65-8.

Returning to play in 2019 with Dr Clare Ardern. Episode #383

On this week’s BJSM podcast, the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) EIC elect Dr Clare Ardern PhD (T: @clare_ardern) joins BJSM EIC Prof Karim Khan to answer the difficult questions about return to play.
Dr Clare Ardern is a physiotherapist and clinical researcher who completed her award-winning PhD on return to play in 2013. Since then, Clare has worked as a clinical researcher at the Aspetar Orthopaedic & Sports Medicine Hospital (Qatar) and Linköping University (Sweden). Clare led the 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. She has a particular interest in the psychological aspect of returning to play and how the return to play transition can be improved with specific clinical interventions and superior clinical decision making.
We here at BJSM would like to thank Clare for her tireless work as BJSM Deputy Editor and wish her all the best for her upcoming role as EIC at JOSPT!
In this 30-minute conversation, Clare discusses:
· Tips for clinicians when approaching RTP with athletes
· The psychological aspects of RTP and the importance of shared decision making
· Athletes’ biggest fears when RTP
· Non-operative management of ACL injuries
· Paediatric ACL injuries
On Oct 4-5, Clare will be speaking at the The IFSPT Third World Congress of Sports Physical Therapy in Vancouver, Canada. She will be presenting alongside a world-class line up of local and international experts exploring the theme “High performance to clinical practice”. https://www.sportphysio.ca/calendar-of-upcoming-events/spc2019/
Mentioned in this episode:
Ardern CL, Ekås G, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med 2018;doi:10.1136/bjsports-2018-099060 (article co-published by Knee Surgery Sports Traumatology Arthroscopy, Journal of ISAKOS and Orthopaedic Journal of Sports Medicine).
https://bjsm.bmj.com/content/52/7/422
Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 2016;50:853-864. https://bjsm.bmj.com/content/50/14/853
Ardern CL, Taylor NF, Feller JA, Webster KE. 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. Br J Sports Med 2014;48:1543-1552.
Grindem H, Snyder-Mackler L, Moksnes H, et al Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study British Journal of Sports Medicine 2016;50:804-808. https://bjsm.bmj.com/content/50/13/804
Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. New England Journal of Medicine. 2010 Jul 22;363(4):331-42.
Headspace App: https://www.headspace.com/headspace-meditation-app