BJSM Podcast

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

Treat the donut, not the hole: What UTC imaging teaches us about tendon pathology. Dr Sean Docking

Most clinicians who manage patients with tendinopathy will have encountered the situation where the clinical picture and imaging findings do not match up.
Sean Docking, researcher at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne, has been using Ultrasound Tissue Characterisation (UTC) to visualise changes associated with tendinopathy in 3D detail. In this podcast he talks to Liam West about how UTC may help us explain this discrepancy between current imaging and clinical pictures in tendinopathy. He also gives the listener an insight into the clinical relevance of UTC and the lessons that have been learnt from his research within the field.
Timeline
0.45 – Current imaging modalities used in tendinopathy
3.45 – Disconnect between imaging findings and clinical picture
4.45 – Place imaging in clinical context
6.00 – Deep dive on UTC
7.55 – Tendon response to pathology
10.45 – Treat the donut, not the hole
Further Reading
 Using UTC to measure game load on tendons in AFL - http://bit.ly/29rSr3k
 Pathological tendons have good amounts of normal structure -
 http://bit.ly/29iCfiG
 Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK
Further Related Podcasts
 Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL
 Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol

A deep dive into hip pain. Professor Damian Griffin makes the complicated clear. (Part 1 of 2)

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 are all around 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 at the BMI Meriden Hospital.
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: http://www.nets.nihr.ac.uk/projects/hta/1310302
You can follow him on Twitter @DamianGriffin and @warwickOrtho or reach him on damian.griffin@warwick.ac.uk, at www.hiparthroscopyclinic.co.uk or +44 1926 403529. BJSM is grateful for his contribution as a Senior Associate Editor.
In this podcast, Damian speaks about Sports Hip 2016, a two day international conference held at St George’s park, the home of English football. The link to conference details:
http://www2.warwick.ac.uk/fac/med/research/csri/orthopaedics/sportsurgery/hip/
Podcast timeline:
0.30 - St George’s Park and the England Football Association Perform Rehabilitation Centre
1.02 - Introduction to Sports Hip 2016: First time for a multidisciplinary meeting on sports hip injuries
1.58 - Instability of the hip
2.47 - Treatment of acute subluxation or dislocation, returning to
3.23 - Deep gluteal space, piriformis syndrome and sciatic nerve entrapment
4.54 - Cartilage repair
6.04 – Workshops in hip arthroscopy, hip replacement techniques suitable for athletes
6.00 - Workshop in hip arthroscopy
6.57 - New techniques in hip replacement suitable for young active people and athletes.
7.24 - World class rehabilitation after hip surgery
7.50 - Round table on challenges in managing elite athletes
8.15 - Femoroacetabular impingement (FAI) syndrome, and the movement towards reaching a consensus statement.
11.00 - Consensus meeting on FAI syndrome

Working with the All Blacks: Peter Gallagher shares his thoughts

Peter Gallagher has been the All Blacks physiotherapist for over 10 years. He discusses how they deal with RTP following ACL injuries and how shared decision-making can be used to set a RTP date. The conversation then branches out onto how changes in training load can be used to recondition players following injury and the need for exercises that provide eccentric muscle training. Finally, we consider alternative exercise programs and the role of functional movement screening for injury prevention.
This open access paper by Dr Tim Gabbett summarizes the theory behind higher training loads and injury rates: http://tinyurl.com/heepexv
Another paper here predicts injury using acute: chronic workload ratios: http://tinyurl.com/z89glpz
An article discussing the limitations of functional screening: http://tinyurl.com/zf5dgpn
Timeline:
0:51- The challenge of RTP in ACL injury.
4:30- How the decision is made to RTP?
5:39-Why lowering a player’s load after injury might be beneficial.
7:11- Some examples of modified training programmes and reconditioning.
13:04- Adapting alternative exercise programs into a training regime.
17:40- The part that functional movement screening could play in the future.

A free online resource in football medicine with Dr Mark Fulcher

F-MARC, the FIFA Medical Association and Research Centre, have recently launched a free online diploma primarily for doctors and other health practitioners who have little or no sports medicine knowledge or experience. There is, however, material that will appeal to anyone with an interest in sports medicine. There are currently 20 modules, which will expand to 42 by the end of the year and completion will lead to being awarded the diploma. Steffan Griffin talks to Dr Mark Fulcher, a sport and exercise medicine physician at the FIFA Medical Centre of Excellence in Auckland, New Zealand.
The online diploma is FREE to do and can be accessed here:
http://f-marc.com/footballdiploma/
Timeline:
0-1.42 What is the diploma?
1.42-3.00 People involved in creating the content.
3.00-3.56-How the website can be used by different specialties.
3.56-4.20 Development and evolution of the diploma.
4.20-6.55 A little bit about Dr Fulcher and his work.

Professor Peter Brukner spotlights a type of hamstring strain that needs special attention

Intramuscular Hamstring Injuries
Professor Peter Brukner is a sports and exercise physician at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. He is Team Doctor for the Australian Cricket Team and formerly worked with Liverpool FC, Australian football in the 2010 World Cup and numerous Olympic Games.
He discusses intramuscular tendon hamstring injuries, a difficult type of hamstring injury, which takes longer to recover than a typical strain. The conversation also branches out to diagnosis, management and rehabilitation of the injury.
Here’s the associated paper with some very helpful figures: http://ow.ly/Hsci301NHpx
Professor Brukner’s thoughts on recurrent hamstring strain can be found here: http://ow.ly/8NeB301NKCw
And more on hamstring strain prevention here: http://ow.ly/PrSL301NLm0
Timeline:
1.00-Why some hamstring injuries are different (and difficult!)
2.30 Diagnosis of intramuscular tendon hamstring injuries.
4.30-Recognition on the MRI
5.30- Management of the injury.
7.50-Rehabilitation and return to play.

Challenging leg pain in the cyclist? Consider iliac artery endofibrosis - not a rare condition

One of the most common complaints of athletes visiting clinicians is leg pain exacerbated by exercise. In this podcast, UK vascular surgeon Rob Hinchliffe explains how iliac artery endofibrosis develops in the sportsperson. He discusses the diagnostic approach for the clinician, potential therapies and gaps in the knowledge about this relatively new pathology, which too often remains undiagnosed for long periods of time. Thanks to BJSM editorial board member and sports physician Dr Yorck Olaf Schumacher from Aspetar, Qatar for having the idea and recording this fascinating podcast.