BJSM Podcast

How many push-ups can you do? Assessing cardiovascular risk with Dr Alex Hutchinson PhD. #376

Drop and give us 20.
On this week’s BJSM podcast, Dr Alex Hutchinson PhD (T:@sweatscience) joins BJSM’s Daniel Friedman (T: @ddfriedman) to make sense of all of the click-bait headlines and explore whether push-up prowess is the secret to long life.
Alex writes Outside’s Sweat Science column, about the science of endurance and adventure. He started out as a Cambridge-trained physicist and long-distance runner on the Canadian national team. As a journalist, he earned a National Magazine Award for his energy reporting with Popular Mechanics, covered adventure travel for The New York Times, and wrote a training column for Runner’s World. His latest book, out in February 2018, is ENDURE: Mind, Body, and the Curiously Elastic Limits of Human Performance. He lives in Toronto, where he runs fast, climbs poorly, and gets outside as much as possible with his wife and daughters.
In this 17-minute conversation, Alex discusses:
· If push-ups can predict your likelihood of future cardiovascular events
· What we can learn from functional tests that aim to assess different health outcomes
· New data on the cardio vs weights debate
Further reading:
Yang J, Christophi CA, Farioli A, Baur DM, Moffatt S, Zollinger TW, Kales SN. Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men. JAMA network open. 2019 Feb 1;2(2):e188341-. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724778
Stamatakis E, Williamson C, Kelly P, Strain T, Murtagh EM, Ding D, Murphy MH. Infographic. Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts. Br J Sports Med. 2019 Mar 1:bjsports-2018. https://bjsm.bmj.com/content/early/2019/03/01/bjsports-2018-100468.abstract
Harb SC, Cremer PC, Wu Y, Xu B, Cho L, Menon V, Jaber WA. Estimated age based on exercise stress testing performance outperforms chronological age in predicting mortality. European journal of preventive cardiology. 2019 Feb 13:2047487319826400. https://journals.sagepub.com/doi/10.1177/2047487319826400

Talking Tendinopathies & Solving the Soleus Conundrum with Seth O’Neil. Episode #375

Seth is a physiotherapy lecturer at the University of Leicester with a special interest in calf & Achilles injuries, having completed his PhD on Achilles Tendinopathy. He joins us to answer some of these questions
· What are the biggest risk factors for Achilles tendinopathy (AT)?
· What would be your biggest bang-for-buck treatments for AT?
· What would you say were the most useful markers for progression?
· Where do you think people are going wrong in the treatment of AT in general – what are the most common misconceptions/mistakes?
· How important is the role of the soleus in ankle/calf function, and sporting performance in general?
· In terms of managing soleus injuries, what tips would you have for clinicians out there?

In pursuit of the unbreakable athlete with Tim Gabbett. Episode #374

What comes first—the robust athlete or the high training load? What is the role of moderating factors in training load? And is the ‘10% rule’ a myth?
On this episode, Dr. Tim Gabbett PhD x2 (T: @TimGabbett) joins BJSM’s Daniel Friedman (T: @ddfriedman) to discuss all things training load and debunk some common misconceptions.
Tim has over 20 years of experience working as an applied sport scientist with elite athletes, coaches, and high performance teams from around the world. He holds a PhD in Human Physiology (2000) and has completed a second PhD in the Applied Science of Professional Football (2011), with special reference to physical demands, injury prevention, and skill acquisition. www.gabbettperformance.com
In this 20 minute conversation, Tim discusses:
· The definition of training load and its different components
· The Acute:Chronic Workload Ratio (ACWR) and its limitations
· What separates robust from fragile athletes
· The 10% rule ‘myth’
· How to design a rehabilitation training program for an injured athlete
Further reading:
Gabbett TJ, Nielsen RO, Bertelsen ML, Bittencourt NF, Fonseca ST, Malone S, Møller M, Oetter E, Verhagen E, Windt J. In pursuit of the ‘Unbreakable’Athlete: what is the role of moderating factors and circular causation? https://bjsm.bmj.com/content/early/2018/11/13/bjsports-2018-099995
Gabbett TJ. Debunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners. Br J Sports Med. 2018 Oct 26:bjsports-2018. https://bjsm.bmj.com/content/early/2018/10/26/bjsports-2018-099784
Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder?. Br J Sports Med. 2016 Mar 1;50(5):273-80. https://bjsm.bmj.com/content/50/5/273
Hulin BT, Gabbett TJ, Lawson DW, Caputi P, Sampson JA. The acute: chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med. 2016 Feb 1;50(4):231-6. https://bjsm.bmj.com/content/50/4/231
Soligard T, Schwellnus M, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, Gabbett T, Gleeson M, Hägglund M, Hutchinson MR, Van Rensburg CJ. How much is too much?(Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med. 2016 Sep 1;50(17):1030-41. https://bjsm.bmj.com/content/50/17/1030

Upper extremity issues in the adolescent overhead throwing athlete. Episode #373

What common injury patterns do adolescent overhead throwing athletes face? What are the current pitch count recommendations and evidence for their use? How can we best monitor and encourage compliance with these recommendations? Host Dr. Devin McFadden, MD is joined by Dr. Jason Zaremski to explore these topics and more on the AMSSM Sports Medcast.
Dr. Zaremski is an assistant professor from the Division of Physical Medicine and Research, Department of Orthopaedics and Rehabilitation and Co-Medical Director of the Adolescent and High School Outreach Program at the University of Florida College of Medicine in Gainesville, Florida. He is also a past participant in the AMSSM International Travelling Fellowship program, having recently travelled to Scandinavia where he shared insights on the above topics and learned how the Scandinavians deal with similar injuries.
In this 30 minute conversation Dr. Zaremski addressed the following topics:
What are common injury patterns in adolescent overhead throwing athletes?
What injury prevention strategies have been enacted and what is the evidence for their use?
When to consider operative rather than conservative treatments.
Mechanisms and Treatment of Throwing Injuries- https://journals.lww.com/acsm-csmr/fulltext/2017/05000/Mechanisms_and_Treatments_for_Shoulder_Injuries_in.17.aspx
Zaremski ZL, Wasser JG, Vincent HK. Mechanisms and Treatments for Shoulder Injury in Overhead Throwing Athletes. Current Sports Medicine Reports. 2017;16(3):179-188
Unaccounted Workload in Pitch Counts- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894908/
Zaremski JL, Zeppieri G, Jones DL, et al. Unaccounted workload factor: game-day pitch counts in high school baseball pitchers- an observational study. Orthop J Sports Med. 2018;6(4):1-7
The Thrower’s Ten Exercises- https://insights.ovid.com/pubmed?pmid=28498227
Wilke KE, Yenchak AJ, Arrigo CA, et al. The advanced throwers ten exercise program: a new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. Phys Sportsmed. 2011;39(4):90-97.

In the driver’s seat with Formula One physio Kim Keedle. Episode #372

Breakneck speeds. Scorching heat. Extreme g-forces. Motor racing is one of the most challenging of all sports - not only for drivers themselves, but also for the teams that play an integral role in the performance of the driver and car.
As the 2019 Formula One World Championship Season launches into action this weekend in Melbourne, F1 physiotherapist Kim Keedle takes a pit stop with BJSM’s Daniel Friedman (T: @ddfriedman) to share insights into the physically and mentally demanding world of motor racing.
Kim graduated from Melbourne University in 2012 with a Bachelors of Physiotherapy, and completed a Masters in Strength & Conditioning at Edith Cowan University in 2016. He is currently working full time as a physiotherapist and high performance coach for the Haas F1 Team, based in Geneva.
In this 17 minute conversation, Kim explains:
· His pathway into F1
· The role of the physiotherapist within the broader F1 medical team
· The physical and mental demands of F1 racing
· The importance of neck and trunk strength for drivers
· Cervical loading programs and conditioning during the off season
Further reading:
https://blogs.bmj.com/bjsm/2013/03/26/the-fast-and-the-furiousand-physiotherapy-training-for-extreme-g-force-loads-on-the-neck/
Contact Kim: kkeedle@gmail.com

The use of force plates in return-to-play following shoulder injuries. Episode #371

Following their recent editorial (https://bjsm.bmj.com/content/early/2018/11/09/bjsports-2018-099457) in the BJSM, and the publication of the reliability paper in the #BMJOpenSEM https://t.co/lCFcZNi5Tu - we managed to get this international team of collaborators around the table at BMA House, to discuss the applicability of the ASH test in guiding the return to play process following shoulder injuries.
Steffan Griffin had the pleasure of hosting Ben Ashworth, Laura Tulloch, Nav Singh & Daniel Cohen, who take us through the journey behind the test, and how it can be used within the clinical setting. Some great examples & case-studies for anyone who sees upper limb injuries in sport!
If you’re interested in the paper & the group’s work, you can follow them here:
https://twitter.com/AthleteShoulder
https://twitter.com/benashworth
https://twitter.com/lt_physio
https://twitter.com/paddhog
https://twitter.com/danielcohen1971
https://twitter.com/i/status/1021381112378155009

Cardiac Screening Outcomes in Young Footballers - Dr Aneil Malhotra. Episode #370

Since 1996, the Football Association has mandated that every young professional footballer in England undergoes cardiac screening. In this podcast, Dr Aneil Malhotra, lead author on the recent NEJM paper which reported the outcomes of the FA’s screening programme, discusses the implications of the research and what it means for screening in the future. In this conversation with Dr Sean Carmody, he also discusses other measures support staff can take to minimise the risk of sudden cardiac deaths in athletes.
Related Articles:
Outcomes of Cardiac Screening in Adolescent Soccer Players
Emergency response facilities including primary and secondary prevention strategies across 79 professional football clubs in England

Care of the Medically Disqualified Athlete with Pierre Rouzier. Episode #369

NCAA athletes face the realization of career ending injuries, whether they are acute/catastrophic or cumulative. As team physicians and athletic trainers it is imperative that we have our athletes' long-
term health as a priority in their care. Presenters of this podcast are Pierre Rouzier, MD, head team physician of the University of Massachusetts, Jennifer Brodeur, ATC, director of Sports Medicine and Jeff Smith, ATC, senior associate Athletic Director for Internal Operations at UMass.
This presentation will discuss various medical categories considered career ending and disqualifying; some of these are clear-cut, some may be more nebulous. Athletes facing 'retirement due to injury'
are known to have significant psycho-social issues in their transition; we will discuss important institutional resources to help our athletes. We will present cases and outcomes from data collected at the University of Massachusetts.
At the conclusion of the podcast, listeners will have learned various NCAA definitions, such as 'medical disqualification', 'medical hardship', 'medical red-shirt' and changes new to 2018.
Program participants will know the consequences and implications of being 'medically disqualified' from an NCAA sport, and the impact on the athletes' financial assistance and what this means to their team's scholarship numbers. Listeners will be able to learn the process of medically disqualifying an athlete and how to provide the support and care they need to transition out of their sport.
Hayley Marks, Daniel R. Czech, Brandonn S. Harris, Trey Burdette, David D. Biber, An Examination of
Coping with Career Ending Injuries: An NCAA Division I and NCAA Division III Comparison, International Journal of Sports Science, Vol. 5 No. 2, 2015, pp. 87-92.
https://doi.org/10.5923/j.sports.20150502.07
Leena Ristolainen, Jyrki A. Kettunen, Urho M. Kujala & Ari Heinonen (2011): Sport injuries as the
main cause of sport career termination among Finnish top-level athletes, European Journal of Sport
Science, https://doi.org/10.1080/17461391.2011.566365
2017-18 NCAA Division 1 Manual
https://www.ncaapublications.com/p-4511-2017-2018-ncaa-division-i-manual-august-version-
available-august-2017.aspx
2014-15 NCAA Sports Medicine Handbook
https://www.ncaapublications.com/p-4374-2014-15-ncaa-sports-medicine-handbook.aspx

Physical inactivity: a global public health problem. Prof Fiona Bull, WHO Episode #368

Did you know that worldwide, more than one in four adults (28% or 1.4 billion) are physically inactive? In some countries, it’s as high as one in three! How many more times do we need to be reminded that physical inactivity is one of the leading risk factors for global mortality before we finally decide to get off the couch?
On this week’s episode, Prof Fiona Bull MBE (T: @fiona_bull) joins BJSM’s Daniel Friedman (T: @ddfriedman) to discuss the latest physical activity trend data and explain how clinicians can play their part to increase levels of physical activity for a more active world.
Prof Bull is the Programme Manager in the Department of Prevention of Noncommunicable Diseases (NCD) at the World Health Organization based in Geneva, Switzerland. She leads the WHO’s global work on physical inactivity, healthy eating and the prevention of obesity, and provides leadership for global monitoring and surveillance of NCDs and their risk factors. Bull joined WHO in 2017 after 25 years in applied research in Australia, the UK and the USA. Her recent positions include Professor of Public Health and Director of the Centre for Built Environment and Health at the University of Western Australia and Professor of Sports Science and Director of National Centre of Physical Activity at Loughborough University in the UK.
Bull has co-authored over 180 scientific publications and reports. Her interest is in bridging the knowledge-policy-practice gap, and she has been actively involved in civil society. She is immediate past President of the International Society of Physical Activity. In 2014, Bull was awarded a Member of the British Empire (MBE) for her services to public health.
In this 15 minute conversation, Prof Bull addresses:
· Physical inactivity trends over the past 16 years
· The causes of physical inactivity
· What the WHO is doing to support countries increase physical activity
· What clinicians can do to play their part
Further reading:
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1· 9 million participants. The Lancet Global Health. 2018 Oct 1;6(10):e1077-86. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30357-7/fulltext
World Health Organization. (‎2018)‎. ACTIVE: a technical package for increasing physical activity. World Health Organization. http://www.who.int/iris/handle/10665/275415
Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization; 2018. http://apps.who.int/iris/bitstream/handle/10665/272722/9789241514187-eng.pdf
Global action plan on physical activity 2018-2030: At a glance http://apps.who.int/iris/bitstream/handle/10665/272721/WHO-NMH-PND-18.5-eng.pdf

Physical activity in pregnancy—what, when, how and why to be active: Prof Greg Whyte, OBE. #367

Our guest for this podcast is Professor Greg Whyte, one of the world’s most respected and renowned Sport & Exercise Scientists. Greg combines his academic position at Liverpool John Moores University with both public & private work around the UK, and is a hugely respected scientist and voice, with expertise in a wide range of domains. Not content with overseeing breathtaking Sport Relief challenges and helping to raise >£30m for charity, he has recently published a book titled ‘Bump It Up’, focused on advice for pregnant women.
In this podcast, Greg covers:
- The current consensus
- Common misconceptions
- Common barriers and how to overcome them
- Safety & contraindications
- The importance of physical activity at every life-stage
Further resources:
Greg’s Book: https://www.penguin.co.uk/books/111/1111959/bump-it-up/9780593077481.html
BJSM Special Edition on Pregnancy: https://bjsm.bmj.com/content/52/21
2019 Canadian guideline for physical activity throughout pregnancy https://bjsm.bmj.com/content/52/21/1339