BJSM Podcast

Lars Engebretsen’s learning points from the 2018 IOC Paediatric ACL consensus statement. Ep #325

Professor Lars Engebretsen, MD, PhD, Head of Medicine & Science at the IOC’s Scientific and Medical Department discusses the massive problem that is ACL injuries in children under 12 years of age.
Kids’ ACL ruptures are becoming more prevalent, the condition seems to affect boys and girls equally, and the management is controversial. There is universal agreement that preserving the meniscus (which can include meniscal suture) is critical. See the full consensus statement here - http://bit.ly/2FwQMF6
Links:
Link to the FREE 2018 consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. http://bjsm.bmj.com/content/early/2018/03/07/bjsports-2018-099060
Editorial by Professor Nick Mohtadi, Dr Clare Ardern and Professor Lars Engebetsen on the need to preserve the meniscus. http://bjsm.bmj.com/content/early/2018/03/09/bjsports-2018-099169
Podcast: Lars Engebretsen on adult knee injuries (2016 podcast, 10K listens) https://soundcloud.com/bmjpodcasts/professor-lars-engebretsen-on-management-of-young-adult-and-older-patients-with-knee-injuries
Podcast: Dr Ben Clarsen on elite athlete screening and monitoring
https://soundcloud.com/bmjpodcasts/nipping-injuries-in-the-bud-practical-tips-for-injuryillness-care-in-elite-athletes
Website: IOC Sports Physiotherapy Diploma – What is it? http://www.sportsoracle.com/Sports+Physical+Therapies/Home/

Explain pain to treat it! Dr. Stanton gives the deep dive on managing osteoarthritis pain #324

Dr. Tasha Stanton’s background in physiotherapy and pain science means her research is very clinically relevant. BJSM’s Liam West discusses with Dr. Stanton the pain experienced by patients with osteoarthritis, how fear and emotions can alter this pain and where the future of osteoarthritis pain management might lie.
Related Articles:
Evidence of central sensitisation, impaired pain inhibition, enhanced pain facilitation in OA:
Edwards et al. BMC Musculoskeletal Disorders 2016; 17:284
Perception of harm influences pain:
Wiech et al J Neurosci 2010; 30:16324-31
What people with OA think about exercise/harm:
Holden MA, et al. Role of exercise for knee pain: what do older adults in the community think? Arthritis Care Res. 2012;64:1554-64.
Somers et al. J Pain Symptom Manage. 2009;37:863-72.
Pouli N, et al. The experience of living with knee OA. Disabil Rehabil. 2014;36:600-7
Modulation of pain by vision:
Longo et al. J Neurosci 2009; 29: 12125-30; Longo et al. J Neurosci 2012; 32: 2601-7
Alterations in body perception in people with OA:
Nishigami et al. PLoS ONE 2017; 12:e0179225
Gilpin et al. Rheumatology 2015; 54:678-82
Body illusions in people with pain:
Bosch et al. PAIN 2016; 157:519-29.
Altering sounds alters feelings of back stiffness:
Stanton et al. Scientific reports 2017; 7: 9861.
Associated Podcasts:
Prof Hunter on OA and exercise - http://bit.ly/2DQAd9z
OA in the spotlight - http://bit.ly/1Frwnxt
Prof Moseley on the brain and mind in chronic pain - http://bit.ly/1u33pPY
Pain coach and first patient contact for pain management - http://bit.ly/2DHCaGa
Am I safe to move? Prof Moseley on understanding pain and focusing on the patient - http://bit.ly/2nmCAqu
Podcast Quotes:
“Give your patient the locus of control”
“Knowledge helps you frame what is happening in your world”
“People with osteoarthritis often hold beliefs that movement is harmful”

Painkillers aren’t the only answer! Simplifying pain science to better manage a patient’s pain #323

Understanding and managing your patient’s pain can be extremely difficult. Liam West spoke to Dr. Tasha Stanton to tap into her vast expertise in the area of pain science. Dr. Stanton is a Senior Research Fellow for the “Body in Mind” group in Australia and has a background in physiotherapy, spinal biomechanics and pain neuroscience. Her work to date has led to several prestigious pain science awards. In this podcast she explains the disconnect between tissue damage and the pain experience, why people experience different levels of pain to the same stimulus and shares how to explain pain to a patient within a clinic setting.
Related Articles
Discordance between findings on scans (i.e., tissue damage) and pain
Hannan MT, Felson DT, and Pincus T. 2000. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatology 27:1513-1517.
Brinjikji et al American Journal of Neuroradiology 2015;36:811-16
Central sensitisation:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268359/
http://www.noigroup.com/en/Product/EPBII
Things that fire together, wire together:
http://www.noigroup.com/en/Product/EPSB
Explaining the neurobiology of pain:
Moseley GL, Butler DS. Fifteen years of Explaining Pain. J Pain. 2015;16:807-13
Our sensations (including pain) are based on the believable, credible evidence that is available to us:
Expectations of pain can be important: Bingle et al. Sci Transl Med 2011;3:70ra14
Other sensory input can change pain – the stinky smell study: Bartolo et al PAIN 2013
Our sensations are influence by the meaning that we attach to information: Moseley, Arntz. PAIN 2007;133:64-71
People with chronic pain are not good at learning safety (extinguishing fear to what was painful movement):
https://www.ncbi.nlm.nih.gov/pubmed/27776989
A feeling of control and pain:
http://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.90.1.89
Associated Podcasts
Prof Moseley on the brain and mind in chronic pain - http://bit.ly/1u33pPY
Pain coach and first patient contact for pain management - http://bit.ly/2DHCaGa
Am I safe to move? Prof Moseley on understanding pain and focusing on the patient - http://bit.ly/2nmCAqu
Podcast Quotes
“Things that fire together, wire together”
“Things that change the ‘need to protect’ your body changes pain”

Is education more important than exercise in treating patellofemoral pain? Episode #322

Research so often includes ‘education’ in the comparison arm of clinical trials as though it is a universal, standardized, or perhaps even inert component of intervention. But what if education IS a key ingredient in managing patellofemoral pain? Erin Macri met up with Dr. Michael Rathleff after hearing some impressive presentations from him and his team members at the 5th International Patellofemoral Pain Research Retreat in Gold Coast, Australia.
Dr. Rathleff works at the Research Unit for General Practice in Aalborg. He is an associate professor and head of the OptiYouth research group that works towards improving musculoskeletal health in adolescents.
In this podcast, Dr. Rathleff shares some innovative and evidence-based approaches to optimizing outcomes for patellofemoral pain using strategic, targeted education.
Related Articles
Rathleff MS, Roos E, Olesen J, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med 2015;49(6):406-12
Associated Materials for upload
Educational slides for use with patients (attached)

Physio Wisdom 2: How to treat disabling knee and back pain. Profs Crossley and O’Sullivan. #321

Listen to leading physiotherapists continue their conversation on common ground when treating patients with disabling pain. (Link to Part 1 here http://ow.ly/mi3c30iqGSI)
In this episode the focus is treatment - what can you do to provide an all-around programme that respects the biopsychosocial model.
· How to assess the patient given the history you have obtained
· Common ground they have discovered in treating backs and knees – there are many shared experiences and lessons from them
· Exercise is the most powerful treatment – which ones, when, how to promote adherence with a programme.
Links to papers:
1. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. bjsm.bmj.com/content/50/14/839
2. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) bjsm.bmj.com/content/50/14/844
3. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. bjsm.bmj.com/content/51/24/1713.long
The link to Part 1 of the conversation: http://ow.ly/mi3c30iqGSI
The link to previous podcasts by these experts:
Prof Kay Crossley’s previous BJSM podcast on treatment of patellofemoral pain (2015)
http://ow.ly/PnHl30iqNlJ (10,000 listens)
Prof Peter O’Sullivan on treatment of back pain (2014)
http://ow.ly/Ws2Y30iqNyD

Wisdom Shared 1: Profs Kay Crossley and Peter O’Sullivan assess knees and backs. Episode #320

Join BJSM editor in chief Karim Khan eavesdropping on Professors Kay Crossley (La Trobe University, Melbourne) and Peter O’Sullivan (Curtin University, Perth) as they discuss the assessment and management of typical patients who present with long-standing knee pain and/or back pain.
In podcast 1 (episode 320), they discuss:
· The context from which to begin the consultation. What is the physio’s goal when taking the history?
· What to ask about
· How to frame the assessment when discussing the patient’s fears
· What NOT to do or say!
Links to papers:
1. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. bjsm.bmj.com/content/50/14/839
2. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) bjsm.bmj.com/content/50/14/844
3. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. bjsm.bmj.com/content/51/24/1713.long
Links to podcasts:
Prof Kay Crossley’s previous BJSM podcast on treatment of patellofemoral pain (2015)
https://soundcloud.com/bmjpodcasts/assoc-prof-kay-crossley-on-procedures-for-patellofemoral-pain
Prof Peter O’Sullivan on treatment of back pain (2014)
https://soundcloud.com/bmjpodcasts/professor-peter-osullivan-curtin-walks-you-through-two-cases-of-low-back-pain

Is your patient ready to run? Blaise Williams shares his 5 minute clinic assessment to help you #319

Dr. Blaise Williams has a passion for helping people to get active and especially to get running. He is an Associate Professor in the Department of Physical Therapy and the Director of the Virginia Commonwealth University (VCU) RUN LAB. Blaise teaches students at VCU within the orthopaedic and sports curriculum. Alongside this, he continues to treat athletes of all levels at the VCU Sports Medicine Clinic. His research interests are in the areas of biomechanics and pathomechanics of running injuries, dynamic balance after injury and limb coordination during functional tasks.
On this podcast he discusses his readiness to run scale with BJSM’s Liam West.
Related Reading
Roelofs EJ, Smith-Ryan AE, Melvin MN, Wingfield HL, Trexler ET, Walker N.
Muscle size, quality, and body composition: characteristics of division I cross-country runners. J Strength Cond Res. 2015, 29:290-6.
Paquette MR, Peel SA, Schilling BK, Melcher DA, Bloomer RJ. Soreness-related changes in three-dimensional running biomechanics following eccentric knee extensor exercise. Eur J Sport Sci. 2017, 17:546-554.
Kuhman D, Melcher D, Paquette MR. Ankle and knee kinetics between strike patterns at common training speeds in competitive male runners. Eur J Sport Sci. 2016;16:433-40.
Raabe ME, Chaudhari AMW. Biomechanical consequences of running with deep core muscle weakness. J Biomech. 2018;67:98-105.
Luedke LE, Heiderscheit BC, Williams DS, Rauh MJ. Influence of Step Rate on Shin Injury and Anterior Knee Pain in High School Runners. Med Sci Sports Exerc. 2016;48:1244-50.
Similar Podcasts
▪ From the AMSSM: Drilling down into running injuries – what they don’t teach in medical school http://bit.ly/2EvQbCP
▪ From the AMSSM: 3 sports medicine legends on running injuries, illness and footwear http://bit.ly/2mfG7pM
▪ Gait retraining to reduce leg pain with Dr Andy Franklyn-Miller http://bit.ly/1iTsOWb
▪ Keeping runners running: the secrets of running assessment - advice and exercise progressions http://bit.ly/2EuGrIH
Quotes
“I always try to get them to work on distance slowly, before they work on speed or intensity”
“Injured athletes need to be able to land before they are able to go back running”

Consider psychological factors in when treating PFP. Prof Bill Vicenzino and Liam McLachlan #318

From the University of Queensland, Australia, physiotherapist and PhD candidate Liam McLachlan and Professor of Sports Physiotherapy Bill Vicenzino share clinical pearls relating to the patient with patellofemoral pain.
Dr Erin Macri, physiotherapist and BJSM editorial board member doing her postdoctoral studies at the University of Delaware leads the conversation.
• Why is it important to consider psychological factors in patellofemoral pain?
• Which instruments should I use in the clinic (clue, google “Startback tool”)
• Which comes first, the psychological distress or the pain?
• Can explanation and reassurance contribute to reducing pain and improving function?
• Bottom line – time to rethink from the narrow mechanical (only) perspective.
Here are some key links:
*Systematic review: The psychological features of patellofemoral pain: a systematic review. First author: Liam Maclachlan. http://bjsm.bmj.com/content/51/9/732 FREE
*Be sure to check the 3 BJSM Patellofemoral consensus statements (all free):
1. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. http://bjsm.bmj.com/content/50/14/839
2. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) http://bjsm.bmj.com/content/50/14/844
3. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. http://bjsm.bmj.com/content/51/24/1713.long
*The STarT Back Screening Tool (SBST): Home page. https://www.keele.ac.uk/sbst/startbacktool/
Twitter: @Bill_Vicenzino: https://twitter.com/Bill_Vicenzino
@PaulWHodges: https://twitter.com/PaulWHodges (coauthor)

Olive oil, sunshine and a half hour walk - a conversation with Dr. Aseem Malhotra – Episode #317

In this Podcast, Heart Digital Media Editor Dr. James Rudd is joined by Dr. Aseem Malhotra from Lister Hospital, Stevenage, UK. They discuss what we should tell our patients about diet and exercise - high fat, low fat or something else?
Link to published paper: bjsm.bmj.com/content/51/15/1111
Further Listening
Management of mature athletes with cardiovascular conditions - https://soundcloud.com/bmjpodcasts/management-of-mature-athletes-with-cardiovascular-conditions?in=bmjpodcasts/sets/heart-podcast
Physical activity for the prevention of heart disease - https://soundcloud.com/bmjpodcasts/physical-activity-in-the-prevention-of-coronary-heart-disease-implications-for-the-clinician?in=bmjpodcasts/sets/heart-podcast
Aseem Malhotra on the impact of diet on heart disease https://soundcloud.com/bmjpodcasts/aseem-malhotra-dont-fear-the-fat
Fearless cardiologist author, Dr Aseem Malhotra, busts myths and shares Pioppi health secrets https://soundcloud.com/bmjpodcasts/fearless-cardiologist-author-dr-aseem-malhotra-busts-myths-and-shares-pioppi-health-secrets

Clinical tips from Dr. Kathryn Ackerman on how to manage athletes with low energy availability

Dr. Kathryn Ackerman talks in this podcast to Dr. Liam West about the hot topic of energy availability in sport giving us clinical tips to manage athletes we suspect might be at risk of the consequences of low energy availability.
Dr. Ackerman has undertaken board certification in Internal Medicine, Sports Medicine and Endocrinology, Diabetes & Metabolism. This training has cumulated in positions as Medical Director of the Female Athlete Program at Boston Children's Hospital, Associate Director of the Sports Endocrine Research Lab at Massachusetts General Hospital, and Assistant Professor of Medicine at Harvard Medical School. Kathryn’s research focuses on the Female Athlete Triad and the various aspects of Relative Energy in Deficiency in Sport.
Related Articles
IOC Concensus Statement: RED-S - http://bjsm.bmj.com/content/48/7/491
Misunderstanding the FAT - http://bjsm.bmj.com/content/48/20/1461
IOC RED-S Clinical Assessment Tool - http://bjsm.bmj.com/content/49/21/1354
Associated Podcasts
AMSSM Sports Medcast- Female Athlete triad - http://bit.ly/2lBP7WJ
Thoughts from the England Football CMO - http://bit.ly/2CpV6Zp
Margo Mountjoy on the REDS debate - http://bit.ly/1KzYT04
Podcast Quote
Low energy availability happens to others, it can happen to men, it can happen to disabled athletes.