BJSM Podcast

Secrets for clinicians caring for elite and recreational youth athletes: Dr Boris Gojanovic

Dr Boris Gojanovic (@DrSportSante) is a specialist sports medicine physician and a board member of the Swiss Sports Medicine Society. In addition to his Sports Medicine training, he is certified in Internal Medicine (General Medicine).
In this chat about paediatric sports development, training and injuries he shares tips on interdisciplinary management of concussion, knee injuries. He tackles hip pain including that related to femoroacetabular impingement. He reveals his lessons from working as the lead doctor for national teams in the sports of gymnastics and youth triathlon.
The Young Athletes Forum conference is in Montreux, September 21, 22, 2017. http://yaf2017.org/, Twitter @YAFfoundation
Links to related podcasts:
Lars Engebretsen on whether or not to reconstruct the ACL in children: http://ow.ly/1Hzr30e9Fu6
Ben Clarsen on monitoring workload in team settings: http://ow.ly/q6iL30e9FDw

What is golf fitness? Andy Nicholettos talks through sports medicine in golf.

Andy Nicholettos @sportinjuryandy is co-founder and head of sports medicine at Prevail Golf Performance, a specialist academy that blends golf coaching, sports medicine and strength and conditioning practice. Andy is also the author of “a movement in golf performance”.
Aside from golf, Andy is the clinical lead at the Pain Clinic Oxford. He has lectured nationally and internationally on the application of pain science to sports performance, and has contributed to literature spanning exercise physiology, and orthopedics
The discussion includes:
• The Tiger Woods effect
• What is golf fitness?
• Marrying research and clinical practice.
• Back pain in the golfer
• How to get patients off the treatment merry-go-round
• Myths in golf practice

When should we tape? Dr Marie-Elaine Grant, PT. IOC World Congress, Monaco. Host Dr Karen Litzy

New York physiotherapist Dr Karen Litzy @KarenLitzyNYC, host of physio podcast 'Healthy Wealth and Smart' poses the practical questions to Dublin’s Dr Marie-Elaine Grant. Dr Grant has been Ireland’s Olympic Team Chief Physiotherapist since 1992 and Chief Physiotherapist with the IOC Medical Commission for the London 2012 Games.
The discussion includes:
• Whether to tape or brace or not
• For how long should an athlete use tape or brace?
• If the athlete is superstitious? Is it OK to keep taping for luck
• The K-tape question
• Tape falling off – re-tape or not?
• Any adverse events? Contraindications
• How long do the properties of the tape last?
• Bracing vs. neuromuscular training
Download the ‘BJSM’ mobile app to your phone, tablet or desktop computer if you want to benefit from over 200 experts sharing their tips.

Screening for Injury doesn’t work and probably never will, Prof. Roald Bahr.

Prof. Roald Bahr is the Head of the Aspetar Sports Injury & Illness Prevention Programme, Chair of the Oslo Sports Trauma Research Center and a member of the IOC medical committee. Prof. Bahr’s main research area is the prevention of injury and illness in athletes, and has published more than 200 papers and book chapters.
In this podcast he talks to BJSM's Dr. Liam West about his views on musculoskeletal screening - why it doesn't work and probably never will.
You can access his review paper on this topic using the link below:
Bahr - Why screening tests to predict do not work - http://bjsm.bmj.com/content/50/13/776
Clarsen - Screening is dead. Long live screening! - http://bit.ly/2tPJ5Hu
If you want to catch Prof. Bahr and other keynote speakers get along to the Dutch annual sports medicine scientific conference in Holland on the 23rd and 24th November 2017.
http://www.sportmedischwetenschappelijkjaarcongres.nl/pg-31582-7-113164/pagina/home.html

How to rehabilitate the athlete after shoulder surgery. Top physio Jo Gibson on shoulder and mind

Jo Gibson is a Clinical Physiotherapy Specialist at the Liverpool Upper Limb Unit based at the Royal Liverpool Hospital, UK. She lectures both nationally and internationally about rehabilitation of the shoulder. Her research interests are shoulder instability and motor learning. Jo is currently Squad Physiotherapist for the Great Britain Endurance riding Team.

Dr Jeremy Lewis clarifies shoulder confusion: Common pitfalls and how to avoid them

Dr. Jeremy Lewis is a Consultant Physiotherapist and Professor of Musculoskeletal Research (University of Limerick, Ireland). Originally born in New Zealand, he trained in Australia before moving to England where he now works in both the Public (NHS) and Private sectors.
Dr. Lewis has distinguished himself and become a globally respected voice in the area complex shoulder issues in both clinical and research capacities.
This podcast has been adapted from one originally published by our friends Kinetic Labs (https://kineticlabs.ca/ - where you can find the full version). Dr. Lewis shares his thoughts with the listeners on;
• Shoulder Impingement
• Rotator Cuff tears
• Shoulder special tests and why they aren't that special
• Shoulder Surgery
• Shoulder Symptom Modification Procedures and how they help treat patients
• What mistakes we commonly make when treating shoulder pain
For extra podcast resources on shoulder issues in SEM, check out;
• Practical Clinical Shoulder Pearls with Adam Meakins - https://soundcloud.com/bmjpodcasts/shoulder-focus-with-leading-sports-physiotherapist-adam-meakins-practical-clinical-pearls?in=bmjpodcasts/sets/bjsm-1
• Prof McCormack on whether to operate on Shoulder Dislocations - https://soundcloud.com/bmjpodcasts/shoulder-dislocation-to-operate-or-rehabilitate-prof-bob-mccormack-olympic-physician?in=bmjpodcasts/sets/bjsm-1
• Scapular Summit with Ben Kibler - https://soundcloud.com/bmjpodcasts/scapular-summit-2013?in=bmjpodcasts/sets/bjsm-1
• 5 Clinical shoulder tips with Dr. Mark Hutchinson - https://soundcloud.com/bmjpodcasts/five-clinical-tips-for?in=bmjpodcasts/sets/bjsm-1
• Prof Jeremy Lewis on Rotator Cuff Tendinopathy - https://soundcloud.com/bmjpodcasts/prof-jeremy-lewis-rotator-cuff?in=bmjpodcasts/sets/bjsm-1
• Shoulder Injuries with Ann Cools - https://soundcloud.com/bmjpodcasts/shoulder-injuries-with-ann?in=bmjpodcasts/sets/bjsm-1
• The Shoulder in Sport with Ben Kibler - https://soundcloud.com/bmjpodcasts/the-shoulder-in-sport-with-ben?in=bmjpodcasts/sets/bjsm-1
• Clinical assessment of the Tennis Shoulder with Ben Kibler - https://soundcloud.com/bmjpodcasts/dr-ben-kibler-examination-and-diagnosis-of-the-tennis-player-part-one?in=bmjpodcasts/sets/bjsm-1

Treating low back pain in sport—Dr Fiona Wilson. 15 pearls from vast rowing experience

Assistant Professor Dr Fiona Wilson is a Chartered Physiotherapist in the discipline of Physiotherapy, Trinity College, Ireland. She has over 25 years of clinical experience in the UK, South Africa and Ireland. She has worked with elite and international athletes throughout her career and was Lead Physiotherapist for Rowing Ireland for 10 years.
Her research has focused on sport and exercise medicine with a special focus on rowing and back pain and recently in rugby and concussion. She is editorial board member for BJSM and was awarded the prestigious Cochrane Fellowship in 2012.
In this podcast Dr Wilson shares wisdom on topics such as:
• Managing back pain in the mature rower
• 3 common pitfalls / stroke issues to assess
• How to assess the rowing athlete
• How rowers monitor load / or not
• How you can use technology and apps to monitor rowers
• How to apply lessons from rowing to managing back pain in all sports and among the general public
• Debate on stability and mobility – are planks associated with increased incidence of back pain?
3 previous BJSM podcasts on back pain in sport include the very popular:
• Tiger Woods – soon after his 2014 spinal surgery, @PeteOSullivanPT (Prof Peter O’Sullivan) feared for the worst. Was surgery a good idea? Remember this conversation predated Tiger Woods’ plunging down the world ranking. https://soundcloud.com/bmjpodcasts/professor-peter-osullivan-peteosullivanpt-on-tiger-woods-back-and-core-strength
• Tiger Woods – 2015 update. With @PeteOSullivanPT after a 2nd operation a year later. How helpful is the postoperative MRI scan? https://soundcloud.com/bmjpodcasts/test
• Dr Kieran O’Sullivan (no relation to Peter above) shares 7 habits of highly effective clinicians who manage back pain. It’s had 23K listens! https://soundcloud.com/bmjpodcasts/dr-kieran-osullivan-on-managing-back-pain-7-habits-of-highly-effective-clinicians-part-2-2016

Stop swimming upstream - a new model for swimmer’s shoulder

Struggling with swimmers and their shoulders? It’s something we clinicians struggle with, and have been for a long time. Today we’re gonna take this head on, how we can move the model from external impingement to anterior superior internal impingement (ASII).
We are joined on this BJSM podcast with Andrew Delbridge and Craig Boetcher from Australia. Craig completed his PhD through Sydney University examining shoulder EMG back in 2010. He’s been the physiotherapist for the Australian swim team for the last 8 years, and offers a unique perspective to this issue, having been an elite swimmer himself.
Craig is currently supervising Kylie Holt who is completing her PhD on Shoulder pain and pathology in elite swimmers. Kylie is a senior sport physio at the Australian institute of sport, and has been looking after the swimming programme since 2009.
Our second guest is Andrew Delbridge, who has been working with Craig at Regent St Physiotherapy for the last 17 years. Andrew has been working in elite sport with throwing athletes, and has found a fresh way of looking at the swimmer’s shoulder.
1:25 What is swimmer’s shoulder? External impingement model from the 70s outdated
2:00 Difference between primary and secondary impingement
3:40 We’ve got swimmer’s shoulder wrong. Andrew explains some of the reasons.
5:10 Spoiler alert - you guessed it, its internal impingement.
ASII- Anterior superior internal impingement
6:00 Clinical background that initially drove the reason for the new ASII approach
8:20 What can baseball teach us about swimming? The loads don’t make sense!
Buhrkart influenced throwing shoulder which led to applying that in swimmers
9:25 3 questions to understand the swimmer’s shoulder:
1) What is the unique position for swimmers in their stroke,
2) what is the anatomical relations in that position,
3) can we reconcile pathology we see?
10:00 Unique position for the demands of swimming - elevation and internal rotation while in large amount of elevation
10:30 Literature also looks at this position (classic Hawkins & Kennedy) investigating the anatomy in this position.
11:30 Position vs load - which causes the pain? It’s mix of tensile and compressive load
12:00 ASSI explained
Swimmers are super overhead workers
13:15 The data are building, but it’s still early. 60 swimmers included in large MRI study
15:00 Does this only apply to elite swimmers? No.
16:25 Key differences in ASII model:
Internal not external, tendinopathy (anterior or posterior).
Mix loading (compressive load in ASII) which might apply to the whole cuff,
Broad term of swimmer’s shoulder to vague, sub-classification needed to differentiate treatment
18:15 3 practical tips for the clinician:
1) Shift in thinking, apply your tendinopathy theory
2) Use dynamometry to assess cuff health
3) Monitor training load.
Full text now available here: https://goo.gl/rQ4EMF

Do you see golfers in your clinic? Golf as a public health panacea? Dr Roger Hawkes explains all

Joining us for this BJSM podcast is the vastly experienced, Dr Roger Hawkes. We chat to him about a wide range of issues, from his role as CMO to the European Golf Tour - where he has built an incredible service, and provided incredible quality of care to the world’s best golfers – to common golfing injuries, and how to assess them.
We also touch on the innovative work being done that is looking into the health benefits of golf, and the challenges of working in such a dynamic, and multi-disciplinary environment. So if you want to get better at assessing & managing the golfers that walk through your clinic door, or want to know more about the benefits of golf (so you can further justify next weekend’s round), look no further!
Extra Resources
Andrew Murray Golf & Health podcast: https://soundcloud.com/bmjpodcasts/andrew-murray-1
ETPI twitter account: https://twitter.com/ETPI_Physiounit
Golf & Health Infographic: http://bjsm.bmj.com/content/51/1/20
The relationships between golf and health: a scoping review: http://bjsm.bmj.com/content/51/1/12
Pictorial review of wrist injuries in the elite golfer: http://bjsm.bmj.com/content/50/17/1053
Hip morphology in elite golfers: asymmetry between lead and trail hips: http://bjsm.bmj.com/content/50/17/1081
The prevalence, variety and impact of wrist problems in elite professional golfers on the European Tour: http://bjsm.bmj.com/content/47/17/1075

Why we get fat. Insulin is a fat-storing hormone: Dr Sarah Hallberg, renowned obesity doctor

Are you confused about healthy nutrition, the role of insulin, this concept of ‘insulin resistance’? Can one largely ignore a macronutrient (i.e. carbohydrates) and not drop dead within a few days?
Karim Khan, the Editor in Chief of the BJSM vouches for this podcast personally and describes Dr Hallberg as one of the people that has most influenced his understanding of a key medical concept.
In addition to Dr Hallberg’s popular (nearing 2 million views!) TEDx talk https://youtu.be/da1vvigy5tQ
Here are her further credentials. https://www.virtahealth.com/about/hallberg
When Dr Hallberg refers to blood glucose being ‘100’ she is referring to the US convention – using mg/dL which is 5.6 mmol/L in many countries (Europe, UK, Australia, Canada etc.)
Highlights include:
Dr Hallberg has great training for exercise prescription from her undergraduate and Master’s degrees in Kinesiology. She’s a medical doctor who runs a clinic for obese patients – that’s a better place to speak from than a lot of theorists in the field.
Dr. Sarah Hallberg is the Medical Director at Virta Health, a specialty medical clinic that reverses type 2 diabetes safely and sustainably, without the risks, costs, or side effects of medications or surgery.
As a physician and exercise physiologist with a passion for helping people be healthy through diet and exercise, she is responsible for providing medical supervision to Virta’s expert team of physicians and oversees the clinical strategy for Virta Clinic participants.
Dr. Hallberg is also the executive director of The Nutrition Coalition, a nonprofit organization that aims to educate the public and policymakers about the need to strengthen national nutrition policy so that it is founded upon a comprehensive body of science.
Link to Dr Hallberg’s paper:
Recent trial she refers to: http://diabetes.jmir.org/2017/1/e5/ A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
Link to other podcasts on BJSM relating to this topic:
Professor Timothy Noakes: “High-fat for health” (11k listens) https://soundcloud.com/bmjpodcasts/high-fat-for-health
Professor Stephen Phinney “Science behind lo-carb for performance” (9K listens) https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach
Professor Jason Fung: “Diet and obesity and diabetes” (6K listens) https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus
Link to Dr Hallberg’s nearly 2 million view TEDx talk: “Reversing Type 2 diabetes starts with ignoring the guidelines” https://youtu.be/da1vvigy5tQ