BJSM Podcast

Sport 1st, disability 2nd. Paralympian Cheri Blauwet discusses SEM in elite disability sport #322

Dr. Cheri Blauwet is a leading and inspiring voice in sport and exercise medicine (SEM). She is a former Paralympic athlete in the sport of wheelchair racing, competing for the United States Team in three Paralypmic Games (Sydney '00, Athens '04, Beijing '08) and bringing home a total of seven Paralympic medals. She is also a two-time winner of the Boston Marathon.
After an elite sporting career, she turned her attentions to medicine. Dr. Blauwet completed her residency training in Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital/Harvard Medical School and followed this by a Sports Medicine Fellowship at the Rehabilitation Institute of Chicago. A successful and influential career in SEM has so far culminated in Cheri acting as the Chairperson of the International Paralympic Committee’s Medical Commission. She also serves on the Board of Directors for the United States Anti-Doping Agency (USADA), promoting clean competition in sports.
BJSM’s Liam West talks to Dr. Blauwet to highlight top learning points from her journey into SEM and the must know topics in disability sport.
You can hear Cheri talk further on this topic at the Canadian Academy of SEM 2018 conference in New Halifax in June - https://bit.ly/2rif5S0
Similar Podcasts;
Cerebral Palsy Soccer - https://soundcloud.com/bmjpodcasts/cerebral-palsy-football-1?in=bmjpodcasts/sets/bjsm-1
Further Reading;
Webborn N, et al. Heads up on concussion in para sport. Br J Sports Med 2017 doi:10.1136/bjsports-2016-097236
Derman W, et al. Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. Br J Sports Med 2017 doi:10.1136/bjsports-2017-097962
Mountjoy M, et al. The IOC Consensus Statement: harassment and abuse (non-accidental violence) in sport. Br J Sports Med 2016 doi:10.1136/bjsports-2016-096121
Derman W, et al. High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days. Br J Sports Med 2017 doi:10.1136/bjsports-2017-098039
Blauwet CA, et al. Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline A Prospective Cohort Study at the London 2012 Paralympic Games. Am J Sports Med 2016;44:6
Blauwet CA, et al. Low Energy Availability, Menstrual Dysfunction, and Low Bone Mineral Density in Individuals with a Disability: Implications for the Para Athlete Population. Sports Med 2017;47(9):1697-1708

Patient’s Voice: It felt like my entire shin had dislocated from the rest of my body. Episode #331

Thanks to Christina Le for providing the first ‘patient voices’ podcast for BJSM. Christina is speaking as a 31-year old patient who is dealing with a common scenario – non-contact ACL rupture while playing soccer. You can follow her patient journey and obtain advice from a top sports physio at @YEGphysio. Christina chatted with BJSM editor-in-chief Karim Khan.
Christina addresses these common questions:
How did the injury occur? Did you feel any pain later? How did you decide whether to opt for surgery or no surgery? What lifestyle changes are you prepared to make after this injury? With whom did you discuss further options? How do you know when to return to sport?
Links: Return to play: 2016 Consensus statement link - http://bjsm.bmj.com/content/50/14/853
Dr Stepanie Filbay on return to sport factors post ACL reconstruction. https://www.ncbi.nlm.nih.gov/pubmed/27167588
Patient voices: Thanks to Osman Ahmed and Tracy Blake for launching the BJSM series. Read the blog here. http://ow.ly/1s4H30jHO1U.

Taking the stress out of stress fractures. Deep dive & clinical tips w/ Dr. Kathryn Ackerman

Managing stress fractures in any athlete can be difficult. Liam West discussed the topic with international expert Dr. Kathryn Ackerman, to find out clinical management gems.
Dr. Ackerman has specialist training 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. She has focused research efforts on hormonal treatments to improve bone density and fracture healing, as well as various imaging modalities for assessing bone quality.
Related Articles
Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review. bjsm.bmj.com/content/49/6/370.long
IOC Concensus Statement: RED-S - http://bjsm.bmj.com/content/48/7/491
Associated Podcasts
Management of difficult stress fractures in sport - http://bit.ly/2EVorIM
Margo Mountjoy on the REDS debate - http://bit.ly/1KzYT04
Podcast Quotes
“There is a transient osteopenia during adolescenece that predisposes them to stress fractures”
“Amenorrhic athletes have wider but weaker bones”

“Dr Skynet will see you now.” Machine learning in sports medicine: Tommy Wood and Chris Kelly #329

Machine learning. One of the buzz expressions currently being bandied around healthcare. But how can it be applied in sports medicine? In this BJSM podcast, we discuss it with two scientists currently applying machine learning to their practice, Chris Kelly and Dr Tommy Wood from nourishbalancethrive, a US-based performance optimization company. We discuss the applications of machine learning and its potential implications for healthcare.
Topics include:
- How to go about creating a machine learning model
- What have they managed to predict so far
- Limitations of using machine learning
- Where do they see this technology moving forward to the future?
- How can clinicians in sports use machine learning in practice?
- How can anyone learn about machine learning?
Link to nourishbalancethrive: https://bit.ly/2q3Yyk4
Link to an easy way to getting into coding: https://bit.ly/2EjQM9Y

Movement is Medicine – Clinical secrets to keep your older patients running from Dr. Blaise Williams

We all know that exercise is medicine’s polypill. On this podcast, Dr. Blaise Williams discusses how to help older patient’s get active again. BJSM’s Liam West provides the questions that see Dr. Williams cover how the aged runner differs both in biomechanics and physiology, how this effects the forces through various areas of their bodies and finally the top clinical pearls you can use in your office today to help these older patients get moving again. If you haven’t listened to the first BJSM podcast with Blaise on his readiness to run scale, make sure you check that out too!
Dr. Williams 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.
Related Reading
Paquette MR, DeVita P, Williams DSB 3rd. Biomechanical Implications of Training Volume and Intensity in Aging Runners. Med Sci Sports Exerc. 2017. Epub ahead of print.
Powell DW, Williams DS. Changes in Vertical and Joint Stiffness in Runners with Advancing Age. J Strength Cond Res. 2017. Epub ahead of print.
Devita P, Fellin RE, Seay JF, Ip E, Stavro N, Messier SP. The Relationships between Age and Running Biomechanics. Med Sci Sports Exerc. 2016. 48:98-106.
Bus SA. Ground reaction forces and kinematics in distance running in older-aged men. Med Sci Sports Exerc. 2003, 35:1167-75.
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
“These changes occur as early as in our 40s, and in females even earlier”
“Our physiology changes way before we see changes in our biomechanics”

Put out to Pasture - What is our Duty of Care to the Retired Professional Footballer? Episode #327

Retired professional footballers are at a significantly increased risk of several health problems including osteoarthritis, mental health conditions, and difficulties pertaining to suboptimal lifestyle choices. During this podcast, Sean Carmody talks to Dr Vincent Gouttebarge, a retired professional footballer and current Chief Medical Officer of FIFPro (World Players’ Union), about what can be done to reduce the risk of health issues for footballers in retirement. Dr Gouttebarge has led several initiatives to improve outcomes for footballers in retirement, including a pilot ‘exit health examination’ study in collaboration with the Dutch Football Association and Dutch Players’ Union.
Related Articles:
Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study - http://bjsm.bmj.com/content/early/2017/10/25/bjsports-2017-097503
Perceptions of retired professional soccer players about the provision of support services before and after retirement - http://bjsm.bmj.com/content/bjsports/36/1/33
Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers - https://www.ncbi.nlm.nih.gov/pubmed/27285354
Lower extremity osteoarthritis is associated with lower health-related quality of life among retired professional footballers - https://www.tandfonline.com/doi/abs/10.1080/00913847.2018.1451718

Achilles and patellar tendinopathy loading principles with Dr. Peter Malliaras. Episode #326

“There is no real optimal exercise program. There’s no such thing it doesn’t really exist.”
LIVE from Copenhagen at the 14th Scandinavian Congress of Medicine & Science in Sports, Dr. Karen Litzy, PT, DPT, with the Healthy, Wealthy and Smart Podcast, interviews Dr. Peter Malliaras about exercise principles for patellar and Achilles tendinopathy. Peter Malliaras is an Associate Professor at Monash University in the Department of Physiotherapy. His research focus is musculoskeletal disorders, sports medicine and tendinopathy. In 2006 he completed his PhD in tendinopathy identifying novel risk factors, and since has undertaken post-doctoral research in the UK and Australia. Peter maintains a strong clinical focus, specializing in difficult tendinopathy cases and delivering clinical postgraduate education for clinicians in Australia and internationally. In this podcast, Peter discusses different loading programs, pain responses and the value of imaging for patellar and Achilles tendinopathy.
Resources
Peter Malliaras Twitter - http://bit.ly/2ESwPch
Scandinavian Congress of Medicine & Science in Sports - http://bit.ly/2nHdZ0h
Peter Malliaras Research Gate Profile - http://bit.ly/2G3K61c
Tendinopathy Rehabilitation - http://bit.ly/2C94T0H
Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness - http://bit.ly/2Bn2d34
Monash University Peter Malliaras Profile - http://bit.ly/2Ey1sGg

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”