BJSM Podcast

Transparency and innovative thinking: how rugby is tackling concussion (Part One)

Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law & policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (CMO), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. This is Part 1: in the build up to the Berlin Consensus Conference.
Timeline:
01:15: Can you give us some insight into the scale of concussion in Rugby Union?
04:00: Are the rising rates due to increased incidence or due to people being more likely to recognise and report it nowadays?
06:45: What is the RFU’s general approach to the management of Concussion?
08:45: Can you tell us a little about the ‘recognise, remove, recover and return’ campaign?
14:00: So the aim is to remove as many concussed players from the pitch as soon as possible: what else is the RFU doing to try and ensure this?
19:15: you have published a number of papers in the BJSM – one of which showed a relationship between concussion and subsequent musculoskeletal injuries – could you please elaborate?
21:50: What does this mean about the return to sport following concussion? How could this influence practice?
Links
Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015 http://bjsm.bmj.com/content/early/2016/09/01/bjsports-2016-096461.abstract
The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby http://www.jsams.org/article/S1440-2440(16)30142-6/abstract
Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes http://bjsm.bmj.com/content/early/2015/12/01/bjsports-2015-094982.full
BJSM Podcast with the Heath Brothers & Mike Evans: https://soundcloud.com/bmjpodcasts/23-5-hours-to-switch-behaviour?in=bmjpodcasts/sets/bjsm-1

Phil Glasgow talks all things around the hip and treatment

Phil Glasgow is the head of sports medicine at the Sports Institute, Northern Ireland. A vastly experienced physiotherapist, he has worked at 3 Olympic Games, and has just returned from Rio. In this podcast, we discuss a case history of a football player with hip pain, from assessment to RTP. We look at the sensitivity vs. specificity of various tests, how to explain the symptoms to patients, and any co-existing pathologies there may be in the athlete. Finally, the discussion moves to treatment, the role of manual therapy, and exercises the patients can do to increase strength in the tissue.
The 2nd World Conference of Sports Physiotherapy will be held in Belfast, 2017- details can be found here: http://bit.ly/2dP2HjH
Timeline
0.40 - Hip pain: a case history and when is it reported to the physio?
3.08 - Ruling things out in the hip is easy: how do we rule things in?
7.30 - Things to consider when treating the hip
10.30 - Prescribing exercise for the patient - how do we go about it?
13.00 - How to increase the load in the injured athlete
18.26 - Bridging exercises for the hip
22.50 - Building a model for the pain and tips from the top

Professor Peter Brukner on food as medicine. No industry funding.

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely.
Relevant links:
Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes: https://soundcloud.com/bmjpodcasts/high-fat-for-health
Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus
Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach:
https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1
If you think that BJSM is only sharing one side of the story please use our various channels to contribute. Papers, blogs, podcasts, Twitter, Facebook - we’d love to hear from you. We haven’t rejected any papers saying that hi-carb is good for you!

Dr Andrew Murray on golf and its effects on health

In this podcast, Steffan Griffin of the BJSM speaks to Dr Andrew Murray – SEM consultant & adventurer (amongst other things!), who is currently undertaking a PhD looking into ‘Golf and Health’. We talk about how the Golf and Health project was born, and some of the notable findings from his recently published scoping review. This is a must-listen for any SEM professional/student, not only due to some of the clinical pearls, but due to the fact that this is a shining light of what other sports could also be doing!
Contents
1.00: Andrew tells us about the Golf and Health project
2.30: What are the main findings from the scoping review?
5.30: Deeper dive into the potential benefits
6.45: What about mental health?
7.30: Could spectators also be reaping some of the health rewards associated with playing?
9.45: What lessons are there for other sports?
Links
Scoping Review http://bjsm.bmj.com/content/early/2016/09/26/bjsports-2016-096625.full
Infographic http://bjsm.bmj.com/content/early/2016/09/20/bjsports-2016-096866.full.pdf+html
Golf and Health website http://www.golfandhealth.org/
Golf and Health twitter https://twitter.com/GolfAndHealth
Golf and Health facebook https://www.facebook.com/GolfAndHealth/?fref=ts

Dr Clare Ardern (Sweden) shares the latest on Return to Play – World Congress Consensus Statement

Dr Clare Ardern is a sports physiotherapy researcher at Linkoping University in Sweden. She carries Australia’s prestigious NHMRC’s top scholarship for clinician researchers – the 4-year Fellowship Award. You may know of her publications that highlight the relatively low return to play rates after ACL reconstruction. In this podcast, she addresses return to play more broadly. From 12-15th October this year she will be a keynote speaker at Sports Medicine Australia’s conference. You can follow that via BJSM Twitter #SMAConf16 and Facebook.
She was interviewed by Dr Christian Barton, who is a well-published physiotherapist PhD as well. He serves as BJSM Deputy Editor and the Editor responsible for Social Media (small job! easy!).
Timeline:
1:00m - Where did the Return To Play Consensus come from?
2:00m - Defining Return to Play; what does it mean in different settings
3:00m - The difference in RTP for o/c acute – removal from play?
4: 10 - Decision making – how should the return to play decision be made?
3:30m - Return to Play is a continuum that requires meticulous planning
4:00m - When can the athlete return to a pre-injury (or better) level of performance?
4:30m - What is the evidence for return to play decisions? Spoiler alert! – It’s limited.
5:20m - Taking the emphasis of the ‘one day’ that players focus on to be back at sport. The concept of a continuum (from when you first see the athlete).
6:45 - Return to play and returning to perform at the previous level. Are there important differences? What can clinicians do to help players get back to that level?
8:30m - Does ‘Return to Play’ end? It’s very different for different athletes.
10:10m - Should athletes have ACL reconstruction after ACL injury? What does the research show?
11:40 - Clare’s perspective on the return to play data after ACL reconstruction in the non-elite players.
12:15 - An example of a player in the English Premier League who was ACL deficient.

Prof Peter O’Sullivan’s sneak peek of Refshauge Lecture on Back Pain: Sports Medicine Australia 2016

Professor Peter O’Sullivan is among the top 3 most popular physiotherapy voices on podcasts and here he focuses on myths and harmful beliefs about back pain. He takes a swing at clinicians who rely excessively on imaging findings to attempt to explain the source of pain. He shares the story of a clinician who told a patient his spine was ‘shredded’.
Prof O’Sullivan emphasizes the importance of history taking, finding factors that can sensitize neural tissue and gives an overview of treatment. He will be the keynote Refshauge Lecturer at Sports Medicine Australia’s 2016 Conference (#SMAConf16, @SMA_Events).
Timeline:
0.35 m - A sneak preview of the Refshaughe lecture plan – back pain is a big problem and those in sport can learn from what is known in back pain in the general population
2.17 m - Patients respond well to a combination of explanation, being shown ways they can get back to the things they love to do, and appropriate progressive exercises
4.21 m - A case where a patient could have been treated with early investigation, aggressive medical intervention, potentially surgery. An alternative approach to management
6.48 m - How junior clinicians can approach the patient who presents with a bag of images or a medical note that may not reflect current best practice for managing back pain
9.45 m - The biology of how neural tissue can be sensitized by lack of sleep, stress. Fascinating neuroimmunology
10.55 m - You do treat the back don’t you? It’s not just explaining pain, counseling?
12.30 m - Parallels with work of other physiotherapists such as Prof Jill Cook (@ProfJillCook) and Dr Alison Grimaldi (@alisongrimaldi) who advocate for progressive loading as a stimulus for healing. “Backs love movement”
13.55 m - A 30-second summary!
Related podcasts:
Please consider downloading the mobile app “BJSM’ from iStore or GooglePlay. There are over 250 to choose from and the 10 most recent are very easy to get via the app.
1. Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’
http://ow.ly/uNgj304udUI
2. Dr Kieran O’Sullivan (@KieranOSull) on how top clinicians approach back pain
http://ow.ly/18Ru304ue96

The Warwick Agreement on the management of femoroacetabular impingement syndrome with Damian Griffin

Professor Damian Griffin talks about the Warwick Agreement, an international consensus on the management of femoroacetabular impingement syndrome. This podcast brings you right up to date on the most current thinking about hip impingement or FAI.
0.38 Aim of the consensus
1.36 Consensus methodology
2.26 What is FAI syndrome? Symptoms, clinical signs, and imaging findings.
3.40 How should FAI syndrome be diagnosed?
6.26 What is the appropriate treatment for FAI syndrome?
8.26 What is the prognosis of FAI syndrome?
10.23 How should someone with an asymptomatic hip, with cam or pincer morphology, be managed?
11.53 What research is now needed?
14.15 How is this new definition of FAI syndrome going to influence clinical care?
@DamianGriffin #WarwickAgreement
Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School.
Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults. His clinical practice and research focus on joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes in London and Coventry (www.hiparthroscopyclinic.co.uk).
Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation:www.nets.nihr.ac.uk/projects/hta/1310302
You can follow Damian on Twitter @DamianGriffin and @WarwickOrtho or reach him on damian.griffin@warwick.ac.uk

Secrets behind Leicester City’s title win - team work and culture to avoid the medical room

Leicester City’s league title was widely seen as one of the biggest upsets in sporting history. But was it really that surprising? Christian Barton (La Trobe University) talks to Dr Paul Balsom, the Head of Sports Science at Leicester City and analyst with the Swedish National Football Team.
In this podcast, Paul explains how teamwork and culture led to players avoiding the medical room. We then go on to discuss the role of evidence-based medicine in sports, and how the ideas employed by Leicester can be transitioned between sports. Lastly, the conversation moves on to the ongoing season, which will see an increased number of matches for the team and how to manage this load.
Link to the upcoming SMA Conference where you can see Dr Balsom: http://tinyurl.com/jx739en
And a podcast with one of the other keynote speakers: http://tinyurl.com/zaoncqq
Timeline:
0.40 - The key factors behind the success of Leicester.
2.00 - How do you achieve good communication in a football club?
3.55 - Keeping all the players fit - by putting responsibility onto them!
5.40 - Optimising performance - what role does EBM have in sport?
7.22 - What medical teams can learn from each other.
9.02 - How to manage an injury free rate with increased load - looking at the new season.
10.45 - The principles behind measuring load in players.

What predicts ACL rupture? What prevents it? Tim Hewett (Mayo Clinic) and Kate Webster (La Trobe)

ACL injuries are some of the most common and debilitating injuries in athletes. In this podcast, Tim Hewett and Kate Webster talk about the biomechanical risk factors for ACL injury, the role and potential of screening, and the use of ACL prevention programmes.
Tim Hewett is an expert in biomedical engineering work at the Mayo Clinic and Kate Webster is an associate professor at La Trobe University. They are both speaking at the upcoming Sports Medicine Australia Conference-more details can be found here-http://tinyurl.com/h4ndfy2
Timeline:
0.40 - What is the biggest risk factor for ACL injury?
2.10 - How are ACL injuries preventable?
4.10 - Can we screen for injury risk?
6.00 - Key criteria for RTS.
9:40 - The high risk of re-injury following ACL damage.
13.00 - Are we returning athletes too soon post injury?

Could TNT blast a hole in treatment barriers in tendinopathy? Ebonie Rio discusses

Often tendinopathy will be resistant to even the best traditional rehabilitation methods. Liam West chats to Dr Ebonie Rio, a PostDoctoral Fellow at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. Dr Rio’s research aims to explain the role of the primary motor cortex in tendinopathy. She discusses tendon neuroplastic training (TNT) and how it might help your tendinopathy patients regain pain free function in the clinic.
Timeline
0.40 – Why traditional rehabilitation for tendinopathy might be unsuccessful
1.40 - Changes in primary motor cortex and motor control in tendinopathy
2.35 – What is TNT & how to utilise it?
5.30 – How long does it take for TNT to help patients?
6.30 – Cross education for tendinopathy
Further Reading
Tendon neuroplastic training: changing the way we think about tendon rehabilitation – OPEN ACCESS - http://bit.ly/29ergE3
Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK
Related Podcasts
Prof Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL
Prof Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol
Defining tissue capacity - http://bit.ly/29iVSKc