BJSM Podcast

Kathryn Schneider talks concussion: primary, secondary and tertiary prevention

Whilst at the 2017 IOC Prevention of Injury & Illness Conference, BJSM’s Liam West spoke to a key figure within the concussion research world, Associate Professor Kathryn Schneider. Kathryn is a Clinical Specialist in Musculoskeletal Physiotherapy working at the Sport Injury Prevention Research Centre located at the University of Calgary, Canada.
She was the lead author in the landmark RCT look at cervicovestibular rehabilitation in sport-related concussion in 2014 (link below). Her most recent research is discussed in this podcast and formed part of the discussion in the 2016 Berlin Concussion in Sport Meeting.
Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial (2014)
http://bjsm.bmj.com/content/48/17/1294.long
Rest and treatment/rehabilitation following sport-related concussion: a systematic review (2017)
http://bjsm.bmj.com/content/early/2017/03/24/bjsports-2016-097475
What strategies can be used to effectively reduce the risk of concussion in sport? (2017)
http://bjsm.bmj.com/content/early/2017/03/01/bjsports-2016-097452
Remember to check out the literature on the new Sports Concussion Assessment Tool (SCAT5) here: http://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097699
The new tool can be found here: http://bjsm.bmj.com/content/early/2017/04/28/bjsports-2017-097506SCAT5

Sham surgery for meniscal knee pain – Boom! Boom! Boom! Prof Teppo Järvinen rocks the boat

Ahead of the Finnish Sports Physiotherapy Congress (June 9 and 10, 2017), BJSM editor in chief Karim Khan, chats with the senior author of a study that proved that partial removal of a degenerative torn meniscus does not alleviate mechanical symptoms when compared with sham surgery. That was Teppo Järvinen (http://bit.ly/2rlfW5I), professor of orthopaedics and traumatology at the University of Helsinki and a speaker at the Finnish Congress in June.
Before that study (link below), orthopaedists were confident of the benefits of arthroscopic surgery on patients suffering from mechanical symptoms. However, “scientific proof of the benefits had been based entirely on uncontrolled follow-up studies,” said Dr Raine Sihvonen, specialist in orthopaedics at the Hatanpää Hospital in Tampere and first author of the study.
Here is the link to the study in the New England Journal of Medicine:
http://www.nejm.org/doi/full/10.1056/NEJMoa1305189#t=article
In the podcast we cover:
- A bird’s eye view of Bruce Moseley’s seminal sham surgery study – arthroscopy was no more helpful for knee arthroscopy in older people than sham surgery http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article
- The fact that MRI is not a good predictor of who will benefit from knee arthroscopy. Here’s Dr Martin Englund’s NEJM paper. http://www.nejm.org/doi/full/10.1056/NEJMoa0800777#t=article
- Ewa Roos’ and Nina Kise’s study showing that exercise provides as good results as arthroscopic meniscectomy. Remember – the patients who fail rehab also fail surgery. Look for other solutions – not arthroscopy – to cure that patient. http://www.bmj.com/content/354/bmj.i3740
Links:
Here’s a YouTube video summarizing the FIDELITY study in 4 minutes. https://www.youtube.com/watch?v=RaDWkJHmEB0
Here the link to the Finnish Sports Physiotherapy Congress – June 9 & 10, 2017.
http://fspa-congress.com/

Doping mit Prof Dr Patrick Diel

Doping ist immer ein heisses Thema, besonders in Jahren der Olympischen und Paralympischen Spiele.
Dr Markus Laupheimer (London/Zürich) stellt die Fragen in deutscher Sprache an Prof. Dr. Patrick Diel. Patrick ist Professor an der Deutschen Sporthochschule Köln am Institut für Kreislaufforschung und Sportmedizin, Abteilung Molekulare und Zelluläre Sportmedizin. Er hat ein spezielles Interesse an präventiver Dopingforschung und beantwortet uns einige interessante Fragen:
- Was ist Doping?
- Wo liegen die Nutzen und Risiken von Nahrungsergänzungsmitteln?
- Was ist Gen-Doping?
- Was ist eine Medizinisch Therapeutische Ausnahmegenehmigung (TUE)?
- Wie können wir unsere Athleten vor Doping schützen?
Weitere Informationen zum Thema Doping findet Ihr unter:
https://www.nada.de/de/nationale-anti-doping-agentur-deutschland/
http://www.doping-prevention.com/
https://www.dshs-koeln.de/visitenkarte/einrichtung/zepraedo/
Für weiter englischsprachige und deutschsprachige Inhalte folgen Sie uns gerne auf Twitter @BJSM_BMJ

Time to reset: What causes coronary artery disease? Dr Aseem Malhotra.

Britain's leading anti-sugar campaigner and one of the most prolific doctors in the world influencing obesity thinking and highlighting the harms of too much medicine.
In addition to being a Consultant Cardiologist, Dr Malhotra is a member of the board of trustees of UK health think tank, The King’s Fund and a member of the Academy of Medical Royal Colleges Choosing Wisely Steering Group
Here’s the link to his website: http://doctoraseem.com/biography/
Topics covered include:
No association of saturated fats and heart disease in primary or secondary prevention studies.
Focus on sugar -
• CVD mortality has come via reduction in smoking & trans fats with better acute AMI management.
• Statins have a number needed to treat of 1 in 83 for mortality in secondary prevention in men
• Stents save lives during heart attacks but not for 'stable' coronary disease
• PREDIMED and Lyon heart study
• Cholesterol is not the mechanism of action of how diet studies work
• Practical explanation-of frying vegetable oils and dangerous omega 6 (high omega 6 to omega 3 is bad)
• Butter and coconut oils have saturated fatty acids and are stable in cooking.
• Criticism from the Centre for evidence based medicine (Oxford).
Here is the editorial (Free) in BJSM:
http://bjsm.bmj.com/content/early/2017/03/31/bjsports-2016-097285

Exertional Rhabdomyolysis: What you don’t diagnose may kill a patient. Prof Francis O’Connor

What is rhabdomyolysis?
Can it sneak under a clincian’s radar?
What the key clinical features?
When to be alert for rhabdomyolysis
Problems when coaches are too aggressive with a new load
Two cases – clinical scenarios
When sickle cell trait complicates matters
Which athlete with sickle cell trait is at increased risk?
Can clinicians identify the athlete with sickle cell trait who is at risk of death?
To screen or not to screen. Ethics and science.
Who is ready to return to play?
Who is at risk of recurrence? It applies to athletes and war fighters.
Role of genetics – the genetic markers that clinicians can test for in a tertiary care centre
Links to a previous podcast by Fran O’Connor – Exertional leg pain http://ow.ly/j9IU30bs1oe
Links to papers:
Sickle Cell paper in Medicine and Science in Sports and Exercise: https://www.ncbi.nlm.nih.gov/pubmed/?term=harmon+and+Med+Sci+Sports+Exerc
Pathophysiology of exertional death associated with sickle cell trait: can we make a parallel with vaso-occlusion mechanisms in sickle cell disease?
Connes P, Harmon KG, Bergeron MF.
http://bjsm.bmj.com/content/47/4/190.long
Sickle cell trait associated with a RR of death of 37 times in National Collegiate Athletic Association football athletes: a database with 2 million athlete-years as the denominator.
Harmon KG, Drezner JA, Klossner D, Asif IM.
http://bjsm.bmj.com/content/46/5/325.long
To screen or not to screen for sickle cell trait in American football?
Harmon KG, Drezner JA, Casa DJ.
http://bjsm.bmj.com/content/46/3/158.long
Return to Physical Activity After Exertional Rhabdomyolysis
O'Connor FG; Brennan FH, et al.
http://journals.lww.com/acsm-csmr/Fulltext/2008/11000/Return_to_Physical_Activity_After_Exertional.8.aspx

Mayo Clinic and AMSSM sports medicine specialist, Dr Jon Finnoff, on managing leg pain in sport.

Dr Jonathan Finnoff, DO, is the Medical Director for Mayo Clinic Square, Sports Medicine Center, Minneapolis, Minnesota. He is a specialist in Physical Medicine and Rehabilitation and Sports Medicine. He benefits from his experience as a former professional athlete in his work as the Team Physician for professional basketball teams -- the Minnesota Timberwolves and Lynx.
Dr Finnoff addresses the case of a 24 year old basketball player who has calf pain that stops her from playing but responds relatively quickly when she stops running.
Timeline
• The differential diagnoses include chronic exertional compartment syndrome, vascular problems such as popliteal artery entrapment, as well as neurological causes
• Physical examination is critical and there are some key tests to distinguish those different pathologies
• The role of investigations including imaging
• How does one make the compartment pressure diagnosis?
• Treatment for chronic exertional compartment syndrome including gait retraining
• More aggressive treatment including use of the meniscotome, botox injection and surgery
• Outcomes of treatment including botox and surgery
Link to previous podcasts:
This podcast is complemented by one with Professor Francis O’Connor: https://soundcloud.com/bmjpodcasts/professor-francis-oconnor-from-the-amssm-challenging-leg-paincalf-pain-and-military-injuries?in=bmjpodcasts/sets/bjsm-1
Andy Franklin-Miller’s BJSM podcast on exertional compartment syndrome and gait retraining: https://soundcloud.com/bmjpodcasts/running-injuries-with-andy
Andy Cornelius on how to assess a runner and what to do when you see abnormalities:
https://soundcloud.com/bmjpodcasts/keeping-runnners-running-the-secrets-of-running-assessment-advice-and-exercise-progressions

Professor Francis O’Connor, from the AMSSM: Challenging leg pain/calf pain and military injuries

BJSM’s good friend Fran O’Connor is Director of Emergency Medicine and Sports Medicine at Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland. He is a former President of the American Medical Society for Sports Medicine (AMSSM, @theAMSSM). He also held leadership positions in the American College of Sports Medicine and the American Medical Athletic Association. He is a prolific researcher with more than 60 scientific journal publications, 25 book chapters and numerous national and international presentations.
In the podcast he addresses the following questions:
• What are the main challenges seen by clinicians who work in military settings?
• What is the differential diagnosis to consider in the patient with calf pain, leg pain?
• How does one make the compartment pressure diagnosis?
• What are the challenges of measuring compartment syndrome?
• What is the conservative management for compartment syndrome? (Prof O’Connor touches on gait retraining first and foremost, Pose running technique, botox injection)
• Is there a role for surgery, and if so, which surgery? What are the outcomes?
• What is the role of orthoses?
Link to previous podcasts:
This podcast is complemented by one with Dr Jonathan Finnoff: https://soundcloud.com/bmjpodcasts/mayo-clinic-and-amssm-sports-medicine-specialist-dr-jon-finnoff-on-managing-leg-pain-in-sport?in=bmjpodcasts/sets/bjsm-1
Andy Franklin-Miller’s BJSM podcast on exertional compartment syndrome and gait retraining:
https://soundcloud.com/bmjpodcasts/running-injuries-with-andy
Andy Cornelius on how to assess a runner and what to do when you see abnormalities:
https://soundcloud.com/bmjpodcasts/keeping-runnners-running-the-secrets-of-running-assessment-advice-and-exercise-progressions

Football Medicine Supremo Mike Davison: A decade of dramatic change in sportsmedicine/sportsphysio

How has football medicine changed in the past 10 years? What is its future?
Mike Davison, managing director of Isokinetic Medical Group in London, one of the FIFA medical centers of excellence, gives us an excellent overview of football medicine: past, present and future. In this hard-hitting podcast we also preview the upcoming Isokinetic Conference in Barcelona, where representatives from over 88 countries are attending.
Topics discussed in this podcast include:
-Where has football medicine come from? What is the state of play now?
-The challenges in managing re-injury and long-term rehab
-Is there too much over medicine in sport? How has this come about?
-What can we expect from the Isokinetic Conference?
-Practical tips to break into the field for aspiring clinicians
For articles on this topic, visit http://bjsm.bmj.com/

From the AMSSM: 3 sports medicine legends on running injuries, illness and footwear

The American Medical Society for Sports Medicine (AMSSM) has its Annual Meeting come up (May 8-13, 2017) so we celebrate with this podcast. Dr Devin McFadden (Sports Medicine Fellow, Washington D.C) is your host. He chats with Dr Bert Fields (Sports Medicine Physician, North Carolina), Dr Robert Oh (Sports medicine, Fort Benning, Georgia) and Dr Chad Asplund (Athletic Sports Medicine, Georgia Southern University)
Topics discussed include:
• Common mistakes made by amateur running athletes – training errors and hip abduction weakness get a mention
• Is one type of exercise best for reducing the risk of cardiovascular disease? The trade-off between health benefits and injury risk.
• Non-MSK running injuries- which ones do we need to think about?
• Biomechanics of running and types of shoes
• Minimalist and barefoot running- evidence supporting a different running style?
Link to JAMA study that mentioned the ‘weekend warrior’ promoting health: https://www.ncbi.nlm.nih.gov/pubmed/?term=JAMA+internal+medicine+and+weekend+warriors and the BJSM editorial commenting on it (FREE this weekend!) http://bjsm.bmj.com/content/early/2017/02/23/bjsports-2017-097538
Link to BJSM paper suggesting you can’t run to your way to health weight http://bjsm.bmj.com/content/49/15/967.long (FREE)
Link to 2016 BJSM paper where 1 in 13 runners had illness in the lead up to an event http://bjsm.bmj.com/content/50/15/939.long
Link to BJSM RED-S consensus statement: Relative Energy Deficiency (Sport) http://bjsm.bmj.com/content/48/7/491.long (FREE)

Dark underbelly of competitive sport - Harassment and abuse. Dr Margo Mountjoy. Host Dr Karen Litzy

What is abuse and how does it manifest itself in sport? In this hard-hitting podcast, Karen Litzy hosts Dr Margo Mountjoy, IOC medical commission, FINA executive board member, and associate clinical professor at McMaster University. Dr Mountjoy explores the various types of harassment, how it can occur, and what safeguards can be put in place to help athletes report abuse.
Highlights include:
-What does it mean when we talk about abuse and harassment?
-Youth sport and why we need to be especially careful in our younger athlete
- Top tips to recognizing abuse: when is the athlete trying to tell us something?
-Putting in safeguarding mechanisms to protect athletes and report abuse
-The impact of social media in sport especially among “millennials”
-Take home messages for working in practice
Dr Mountjoy is a Senior Associate Editor at BJSM and here’s the link for her previous podcast about energy deficiency among sportspeople (RED-S) http://ow.ly/w6w430aBmKJ
Link to the open access (FREE) IOC consensus statement on non-accidental violence in sport: http://ow.ly/YzMd30aBmA2