BJSM Podcast

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.

How to keep athletes healthy when travelling. David Dunne explains the best strategies

For the 2nd time on the BJSM podcast, Sean Carmody is joined by David Dunne to discuss practical considerations for the travelling athlete. During his time with Orreco, David has worked closely with athletes from professional golf and the NBA, most of whom face gruelling travel demands during competition.
David and Sean delve into the strategies the practitioner can employ to help reduce the risk of illness, minimise the effects of jet lag, improve sleep and optimise performance. These strategies are complimented by lessons David has learnt during his PhD in Behaviour Change at Liverpool John Moores University.
Key research linked below:
Elite athletes travelling to international destinations >5 time zone differences from their home country have a 2–3-fold increased risk of illness: http://bjsm.bmj.com/content/46/11/816.

Preventing and managing hamstring strain injuries: the Holy Grail of football medicine

In this podcast, Dr Sean Carmody speaks to Dr Nick van der Horst, who has recently published a paper on decision-making and medical criteria for return to play following hamstring strain injuries. Nick, who is First team physiotherapist at the Go Ahead Eagles in the Dutch Eerst Divisie and holds a PhD in football medicine, provides his thoughts on the controversies around the role of MRI and eccentric strength in determining return to play, and also shares his beliefs about why hamstring strain injuries continue to rise. Finally, Nick closes the podcast with his key tips for clinicians managing hamstring strain injuries.
There is lots of research referred to during the podcast, and these are linked below:
Return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making:
http://bjsm.bmj.com/content/early/2017/03/30/bjsports-2016-097206
Hamstring injuries have increased by 4% annually in men's professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study:
http://bjsm.bmj.com/content/early/2016/01/08/bjsports-2015-095359
Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey:
http://bjsm.bmj.com/content/early/2015/05/20/bjsports-2015-094826
Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making:
http://bjsm.bmj.com/content/early/2015/06/02/bjsports-2014-094569.short?rss=1
Hamstring injuries and predicting return to play: ‘bye-bye MRI?’
http://bjsm.bmj.com/content/49/18/1162
MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes:
http://bjsm.bmj.com/content/early/2015/08/24/bjsports-2015-094892

Rugby’s journey to improving player welfare – with Dr Martin Raftery & Dr Ross Tucker

Over the last few years, rugby medicine has been somewhat mired with controversy. From ‘Bloodgate’, to concussion, there have been many back-page features in the press, often calling for quite sensationalist measures.
Against this backdrop, and away from the gaze of the press, World Rugby have been busy synthesising an evidence base, and adapting the game to try and maximise player welfare. Such efforts have often flown under the radar, and today on the podcast we hear from its Chief Medical Officer & Senior Scientific Advisor, who address a variety of topics including:
-The process behind the recent law changes
-Trying to optimise the prevention and management of concussion
-Injury prevention
-Trying to build an evidence-informed player welfare initiative
Some resources that you may find useful, and are mentioned in the podcast include:
-World Rugby Medical website http://playerwelfare.worldrugby.org/
-The evidence underpinning the tackle laws
-Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies http://bjsm.bmj.com/content/51/15/1152
-Injury risk and a tackle ban in youth Rugby Union: reviewing the evidence and searching for targeted, effective interventions. A critical review http://bjsm.bmj.com/content/50/15/921
-Tackle technique and body position of the tackler and ball carrier significantly influences head injury risk in rugby union http://bjsm.bmj.com/content/51/11/A70.2
-Berlin Concussion Consensus http://bjsm.bmj.com/content/51/11/838
Let us know your thoughts on what is discussed via the normal social media channels – we look forward to hearing from you!