BJSM Podcast

Dr Ben Kibler: Clinical assessment of the tennis player with a focus on the shoulder

In part 1 of two podcasts, Dr Ben Kibler, international shoulder authority, shares top tips on examination and diagnosis of the tennis player. (Part 2 will focus on baseball pitchers)
Dr Ben Kibler, orthopaedic surgeon and medical director of Lexington Clinic in Kentucky is a world expert on management of shoulder injuries with a particular focus on the role of the scapula (scapular dyskinesis). He has held regular ‘scapular summit’ meetings of experts in his hometown of Lexington, Kentucky, USA. The most recent summary of that meeting can be read here: http://bjsm.bmj.com/content/47/14/877
In this podcast, we discuss:
• Briefly how Dr Kibler, a surgeon, learned about biomechanics
• Examination of the tennis player’s shoulder including how to perform a biomechanical analysis
• Simple tests to recognize abnormal asymmetry in the tennis player
• Diagnosis of injury in tennis players; search for culprit (the real cause) – don’t just incriminate the victim
• The rise in the double-handed backhand in tennis and how it has increased the incidence of ulnar wrist injuries
• Role of communication within the multidisciplinary team: how much should the physician know about the biomechanics?
• Two tests commonly used to assess shoulder function – the Scapular Assistance Test (SAT) and the Scapular Retraction Test (SRT).
Remember to keep an eye out for Part 2 – management of the overhead throwing athlete. You can meet with Dr Kibler in person at the AMSSM annual conference. May 9-13, 2017, San Diego. It’s a prime spot on the sports medicine calendar. https://www.amssm.org/Content/pdf%20files/BROCHURES/2017_Annual_Meeting.pdf

Professor Graham Smith, Society of Sports Therapists: Return to play and more!

The Society of Sports Therapists was established in the UK in 1990 to address the growing demands from sport and leisure on everyone involved in the management and care of injured participants.
In this 2nd podcast with BJSM, Professor Smith highlights hot topics such as: (i) readiness to return to play and how it differs from return to competition, (ii) training load and contribution of new data in the training-injury field. I summarise the program for the 2017 conference “From Pain to Performance” (May 20th, 2017) that features Peter Brukner, Bill Knowles, and Susan Alexander.
The Society of Sports Therapists is one of 25 member societies that partners with BJSM:
Links:
Home page for the Society of Sport Therapists
http://www.society-of-sports-therapists.org/index.php
Where to study Sports Therapy (BSc Hons)
http://www.society-of-sports-therapists.org/index.php/public/degree_courses_BSc
Where to study Sports Therapy if you already have a relevant degree (MSc)
http://www.society-of-sports-therapists.org/index.php/public/degree_courses_MSc
Previous podcast: 2016
https://soundcloud.com/bmjpodcasts/focus-on-sports-therapists-and-students-considering-sports-therapy-professor-graham-smith

What are the odds? Understanding Risk and Uncertainty

What are the odds? Understanding Risk and Uncertainty.
Today we welcome Dr. Rod Whiteley for the first time ever to the BJSM podcast. Rod has done a bunch of work in shoulder injuries (measuring load and strength long before it got sexy). And the rumour is he’s still got a pretty good curve ball. A clinician for well over 20 years, He is the current assistant director of the Rehab department here at Aspetar Orthopaedic and Sports Medicine Hospital, and he has also contributed heavily in the area of hamstring rehabilitation and groin injuries. Look out for him on twitter @RodWhiteley, where’s he’s happy to be unpopular to point out the obvious.
Rod is a clinical researcher, interested in how practitioners can understand statistics better, and integrate that in their daily practice. In this podcast, Rod and I talk about how we understand risk, in particular percentages and odds. And no, they’re not the same thing.
2:45 The difference between odds, ratios, and percentages.
3:20 An example: ACL and hamstring injuries as an example, looking at the base rate for how often these injuries happen (ACL infrequently, and hamstrings quite frequent), and then adding a likelihood ratio and how does that change the odds.
5:20 Chad Cook and Erik Hegedus really turned our ideas around interpreting risk around. Clinicians need to understand pre- and post-test odds. Find the related articles here (http://bmj.co/2m65v43) and in the links below.
6:30 Mladen Jovanovic (@Physical_Prep) - heuristics and uncertainty, published recently here (http://bmj.co/2nrRUUX) in the Aspetar journal. We have to get more comfortable with the uncertainty of these tests.
7:46 Understand base rates, and using tests that have large likelihood ratios in our clinical assessment. Pre-test odds will influence how you interpret your clinical test, which then changes your post-test odds.
10:14 Can we do the same for prevention, and identifying risk? IOC world conference prevention of injury and illness in sport (http://bmj.co/2m64AR8) in Monaco will focus this year on the value of screening. Screening allows us to identify modifiers and change potential interventions at a group level.
10:31 The importance of population level studies, looking for associations with subsequent injury. Screening is useful for injury prevention. “But if you’re doing a test to tell someone they are or aren’t gonna get injuried, you’re gonna make a monkey of yourself in open court pretty quickly.”
12:27 WHO report on risk of cancer risk associated with eating bacon/processed meat. If we ignore the base rate, we might be fooled by the actual change in risk. And then you still need to interpret that for the individual.
14:00 Absolute vs Relative risk, and what is the actual event happening. We don’t think of delayed onset of muscle soreness (DOMS) and sudden cardiac death the same.
14:15 Two players with the same risk of injury, but totally different interpretation of their result.
15:12 Predicting vs Forecasting - “An experiment that only happens once.” You only get one season and and you either get an injury or you don’t. We have to be more comfortable with that kind of uncertainty.
16:35 Predicting return to play with clinical outcome measures.
18:30 How do we interpret and incorporate percentages and odds into our clinical setting.
Links:
IOC world conference prevention injury and illness in sport (http://bmj.co/2m64AR8)
Available for FREE from BJSM (http://bjsm.bmj.com/)
Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests (http://bmj.co/2mwMP90)
A combination of initial and follow-up physiotherapist examination predicts physician-determined time to return to play after hamstring injury, with no added value of MRI (http://bmj.co/2mx0r3Z)

Player Medicals and Screening at Arsenal FC - Part Two

Screening is one of the hottest topics in Sports Medicine, and a topic which is constantly evolving. The BJSM has provided a platform for much of the academic literature concerning screening, but what actually happens at the coalface? In part one of this special podcast with Arsenal FC giants Colin Lewin, and Dr Gary O’Driscoll, we heard about the role of screening in professional sport, and how it ties in with player medicals, which is further elaborated on in this podcast. Other topics that are touched upon include the role of technology in predicting injury, the pressure of the jobs, and some tips for anyone working in football medicine/hoping to do so one day!
This podcast is bound to generate some deal of controversy, and if you’re looking for a platform to voice your opinion, you shouldn’t miss the Arsenal SEMS conference, with insights from the likes of Professor Roald Bahr, Adam Meakins, and Des Ryan amongst other influential names. The link to the event can be found at http://www.arsenal.com/semsconference - it’s bound to be one of the most insightful conferences of 2017!

Professor Bruce Forster: Using ultrasound imaging in the physiotherapy clinic. Pearls, pitfalls.

Bruce Forster is the Head of Radiology at the University of British Columbia. He was previously the director of diagnostic imaging at the Vancouver Winter Olympics and has authored over 80 peer-reviewed publications. In this podcast, we discuss:
- The role of MSK ultrasound in sports medicine and how to learn
- Structures that can be imaged and their challenges
- What to look for when purchasing an ultrasound machine?
- Ultrasound guided injections, including evidence behind PRP, stem cells and cortisone
- Pain science and the role of radiology in treating chronic pain
- Imaging for prognosis and RTP -when to image?
Bruce is presenting a workshop at the IOC Prevention Conference- details can be found here : http://ow.ly/SFcJ309KUve

Player Medicals and Screening at Arsenal FC - Part One

Screening is one of the hottest topics in Sports Medicine, and a topic which is constantly evolving. The BJSM has provided a platform for much of the academic literature concerning screening, but what actually happens at the coalface? BJSM Associate Editor Steffan Griffin chats to two giants of the football (and sports) medicine world – Colin Lewin, and Dr Gary O’Driscoll, who both head up the medical department at Arsenal Football Club – about the practical aspect of screening, and what role it plays in elite sport.
This podcast serves as a little taster to the Arsenal SEMS conference, which this year focuses on the role of screening, with insights from the likes of Professor Roald Bahr, Adam Meakins, and Des Ryan amongst other influential names. The link to the event can be found at http://www.arsenal.com/semsconference
Topics covered in this part one include:
What is involved with a player ‘medical’?
Who is involved with a player’s ‘medical’?
Is there a role for screening in elite sport?
Look out for the upcoming Part Two – where screening and player medicals are discussed in further detail.

Do platelet-rich plasma and stem cells have a role in sports medicine? Genetic testing?

Professor Tim Caulfield (@CaulfieldTim) is a best-selling author in the health and popular science domain. He has published over 300 articles into the ethical, legal and health policy of a broad range of topics including stem cell therapies, genetic testing, obesity treatment and the prevention of chronic disease. In this podcast, we discuss:
• Genetic testing and its predictive value- what place does it have in sports medicine?
• Stem cell therapies- evidence behind it and how it is portrayed by the media
• PRP- therapeutic benefits or another health fad?
• The role of athletes as celebrities in advocating new treatments
• 6 simple ways to maintain a healthy lifestyle.
Links to Tim’s hugely successful books can be found here http://ow.ly/TEfJ309ise8
David Epstein (@DavidEpstein) book The Sports Gene here: http://thesportsgene.com/

Professor David Hunter talks osteoarthritis exercise therapies: better outcomes

Professor David Hunter is a leading rheumatologist and researcher working at the University of Sydney. David has over 350 publications in rheumatology and has co-authored several books providing self-management strategies for patients with osteoarthritis. In this podcast, we discuss:
• Treatments of OA, what does and doesn’t work
• How to take a detailed history and examination from a patient with OA
• Cornerstones of patient care: behavioral change, self management and weight loss
• Weight loss strategies and how to maintain it
• Physiology behind how exercise improves symptoms
• Pharmacological and surgical treatments for OA
David caught up with Karim Khan after the 2017 Australasian College of Sport and Exercise Physicians (ACSEP) conference in the Gold Coast. The next event is February 2018 and is sure to be a huge success! http://ow.ly/t20j3093yZq

Dr Eammon Delahunt, international authority: Ankle sprain management and chronic instability

Eamonn is a wonderful clinician-scientist who graduated with a 1st Class Honours Degree from the University College Dublin (UCD) School of Physiotherapy in 2003 placing first in his class. Eamonn received a prestigious Irish Research Council for Science Engineering and Technology (IRCSET) post-graduate research scholarship. He was awarded his PhD from the UCD School of Physiotherapy and Performance Science in 2006, In this podcast that combines science with clinical application topics include:
• The high prevalence of ankle injuries and the high risk of the development of chronic residual symptoms.
• The characteristic features of CAI.
• How to manage the young soccer player who sustains an ankle injury.
• Detailed discussion of (1) modified Ottawa Ankle Rules; (2) determination of lateral ligament laxity; (3) syndesmosis assessment.
• How to assess for chronic ankle instability
• Mechanical insufficiencies including: (1) pathological laxity; (2) arthrokinematic restrictions; (3) synovial changes; (4) degenerative changes.
• Functional insufficiencies including: (1) impaired proprioception; (2) impaired neuromuscular control; (3) impaired postural control/postural balance; (4) impaired strength.
• Assessment of laxity and the use of taping and bracing.
• Patient-reported outcome measures clinicians can use including the FAAM, CAIT & idFAI
Associated papers and tools:
Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis
http://bjsm.bmj.com/content/early/2016/11/24/bjsports-2016-096858.long
Cumberland ankle instability tool ( 11 – chronic ankle instability (>11)
Foot and ankle ability scale: FAN ADL(21 items) and FAN sport (8 minutes)
Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.
http://bjsm.bmj.com/content/48/13/1014
2016 consensus statement the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains.
http://bjsm.bmj.com/content/50/24/1493.long

Nutrition pearls for sport performance: Professor Graeme Close provides 27 practical tips

You want the big names on BJSM podcasts and Twitter asked for Dr Graeme Close. Fresh from the UK undergraduate student conference, Graeme shares pearl after pearl on this top podcast. What do you do in a first consultation? How does nutrition in team sport vary from individual sport? What’s the key to a successful pre-game routine? How should nutrition change when an athlete is injured? Supplements? Coffee? Sleep? Take home tips – all in this 16 minute gem.
Graeme has a great CV for his role in top sport. He is (i) a former professional rugby league player (clips here https://youtu.be/1mHljSGlQwA) (ii) a sports science PhD and now faculty at Liverpool John Moores University (iii) rumored to be the only person in the UK accredited with the official bodies for sports science (BASES), sports nutrition (SENr) and strength & conditioning (UKSCA). We call that the ‘triple crown’.
Kudos to medical student Tej Pandya for organizing the conference and for a great debut as a podcast host. BJSM’s podcasts have been hosted by 23 different interviewers and there are podcasts in 5 languages. Feel free to submit a podcast for our consideration. (info.bjsm@bmj.com)