BJSM Podcast

Leading sports psychiatrist, Prof Steve Peters, shares secrets of working with the very best

Are you or your athletes in control of your ‘chimp’ (emotional, reactive part of your mind) at all times? We hear from Professor Steve Peters -- the brains behind ‘The Chimp Paradox’ and the much-heralded psychiatrist who has worked with the likes of Team Sky Cycling, Liverpool Football Club and the FA to improve athlete performance. Prof Peters explains the rationale for the seemingly simplistic model and shared example of how it can be applied in various sport settings.
“The Chimp Paradox” has been among the most popular self-development books in recent years and it will of interest to many BJSM listeners from both a personal and professional standpoint. http://amzn.to/1TNV3Xy
If you want to see Prof Peters speak – sign up for the BASEM Spring Conference (Friday April 8th) here! http://bit.ly/1TNV0en
Timeline
1:10m: What is the chimp model?
4:15m: How does the ‘chimp’ model work in sport?
5:30m: Is it always an overactive chimp that holds athletes back?
7:45m: What works best with athletes?
9:30m: What can we do about unhelpful behavioural traits?
11:45m: What pitfalls can we avoid when dealing with young elite athletes?
13:30m: How can you talk to athletes about psychological performance?
16:55m: Does the chimp model work when split-second sporting decisions are needed?
18:30m: Mental Health in Sport
21:15m: Any tips for those wanting to work in sport?
BJSM Links:
2016’s issue 3 of BJSM was devoted to mental health in sport. Table of contents link:
http://bjsm.bmj.com/content/50/3.toc
An editorial on the issue of mental health and ‘mental toughness’ :
Dr James Bauman: The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport?
http://bjsm.bmj.com/content/50/3/135.extract

The face of WCPT: Dr Emma K Stokes unplugged. Life lessons, leadership, physiotherapy success

Dr Emma K Stokes (@ekstokes) is the President of the World Confederation of Physical Therapy. This is the first of 3 podcasts
Timeline:
1:00m - A fascinating career journey – from student at Trinity College Dublin to President of the World Confederation.
4:00m - “You have to be yourself but you have to understand yourself. Leadership is about bringing people on a journey. Make sure you understand how other people see, or feel about, that journey”
5:00m - The organisation you work in plays a big role too but you can make a difference from wherever you are. Students and early career physiotherapists are as important as the person on the top of the hierarchy
6:30m - The only constant is change (Emma’s nod to David Bowie but this was recorded before he died). Having a framework for adapting to change
7:50m - Practice change – applying the lessons to a typical health professional practice
10:00m - The role of the IFSPT – International Federation of Sports Physical Therapists – as leaders, advocates. A huge opportunity for leadership. Education, competency definition, congress organisation
12:00m - Physios as entrepreneurs. Social entrepreneurship – physiotherapists’ opportunities to contribute to society
13:30m - Emma’s experience on what makes a successful physiotherapy practice
15:00m - End of Part 1 – part two is scheduled for February 12th, 2016
Thanks to James Walsh (@SportsOsteopath) BJSM podcast podcast associate editor.
Links:
Drew Dudley "Leading with Lollipops" YouTube Video – helping people become better versions of themselves: https://www.youtube.com/watch?v=hVCBrkrFrBE
Profile of President Stokes in the Independent of Ireland: http://www.independent.ie/life/health-wellbeing/health-features/world-leader-dr-emma-stokes-31375045.html
Emma’s podcast for the MACP (45 minutes): https://soundcloud.com/macp-3/macp-emma-stokes-podcast Interviewed by social media leader for MACP – Gerard Greene (@gerardgreenephy)
Engage with WCPT here: http://www.wcpt.org/news/WCPT-look-forward

Sports Medcast from the AMSSM: A deeper dive into the female athlete triad. Drs Joy and Nattiv

The American Medical Society for Sports Medicine (AMSSM) is the world’s largest primary care sports medicine organisation and one of BJSM’s 23 member societies. It provides authoritative education for the public as well as for athletes and health professionals.
BJSM is proud to host AMSSM experts discussing the potentially life-threatening condition that is widely known as ‘The Female Athlete Triad’. Dr Elizabeth Joy (Salt Lake City) and Dr Aurelia Nattiv (UCLA, Los Angeles) are both researchers and clinicians in this field so they provide a great overview as well as practical tips for athletes, parents and health professionals in this 20-minute podcast. (AMSSM’s guest host is Dr Britt Marcussen, U of Iowa).
They are two of the lead authors on the 2014 International Consensus Statement on this topic: Br J Sports Med. 2014 Feb;48(4):289. doi: 10.1136/bjsports-2013-093218. http://bjsm.bmj.com/content/48/4/289.long
Timeline:
2:00m - What is the ‘Female Athlete Triad’?
4:30m - What type of athletes are at risk? What should I look for?
6:15m - Energy availability, eating disorders, disordered eating. The role of anorexia nervosa, bulimia. Is this an essential element?
8:30m - Practical tips for parents. What to watch out for?
14:20m - If a parent is concerned what is the next step?
16:00m - What is the role of sport restriction in treating this condition?
21:00m - Take home messages: early recognition is key; seek help. An experienced multidisciplinary team (psychologists, nutritionist, sports physician) is key.
Links:
The definitive ‘Female Athlete Triad’ consensus statement in the BJSM: http://bjsm.bmj.com/content/48/4/289.long
A complementary perspective on the issue – the IOC’s consensus statement: http://bjsm.bmj.com/content/48/7/491.long
A 2015 podcast by the IOC’s Dr Margo Mountjoy – on the IOC’s perspective: http://ow.ly/XpkYO
AMSSM e-learning elements: Podcasts and more! https://www.amssm.org/E-Learning.php

Were the US and UK dietary guidelines wrong? Zoe Harcombe on what has driven diet for 30 years

In this 9-minute podcast Zoe Harcombe asks whether dietary guidelines were based on evidence or whether there were other drivers. She summarises what was in the literature at the time the 1977 (US) and 1983 (UK) guidelines were created. Importantly, she highlights that food choices have major implications on the planet. The podcast was recorded in February 2015 – she was a keynote speaker at the Old Mutual 1st International Low Carb High Fat Health Summit 2015 hosted by Prof Tim Noakes & Karen Thomson (Cape Town).
https://www.facebook.com/events/880528391966336/
There are plans for a future summit in London in 2016.
BJSM senior associate editor Liam West (@Liam_West) led the BJSM team who attended the meeting – including Johann Windt and Ania Tarazi. BJSM has spaced out the recordings from that summit over 12 months and this is the last on the series from that event.
Related podcasts were with Dr Stephen Phinney http://ow.ly/X70OP, Dr Jason Fung (http://ow.ly/X70AJ), Dr Aseem Malhotra http://ow.ly/X712D and Professor Timothy Noakes (http://ow.ly/X71rX). All have proven very popular.
Timeline:
0m 30s: Why Zoe Harcombe (@ZoeHarcombe) challenges current dietary guidelines
3m 00s: What are the sensible food choices (according to the guest, of course)?
4m 40s: Challenges to supplying calorie-dense low carb foods for the world’s population: “I don’t know if we can feed 7-11 million people on animal based food, I don’t know if we can’t”. Grain requires topsoil and “we are raping the land of nutrients, topsoil, potentially destroying the planet’s ability to house any food”.
5m 50s: Time to revisit the guidelines?
7m 00s: Training doctors – what training do doctors get? (Link to the exercise prescription training module, a template, here: http://bjsm.bmj.com/content/49/4/207.extract
Call to action for all health professionals to look at the evidence in an open-minded way. It may need a ‘bottom up’ approach – patients and the public – to draw attention to these issues.
Links:
The key paper for this podcast: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
http://openheart.bmj.com/content/2/1/e000196
An editorial in the same issue of OpenHeart: http://openheart.bmj.com/content/2/1/e000229.extract (11,000 views as of January 2016)
Papers:
Challenging beliefs in sports nutrition: are two 'core principles' proving to be myths ripe for busting?
Peter Brukner (@PeterBrukner) http://www.ncbi.nlm.nih.gov/pubmed/23603852 Br J Sports Med. 2013 Jul;47(11):663-4. doi: 10.1136/bjsports-2013-092440. Epub 2013 Apr 20.
It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet
Malhotra A, Noakes T, Phinney S.
Br J Sports Med. 2015 Aug;49(15):967-8. doi: 10.1136/bjsports-2015-094911. Epub 2015 Apr 22.
http://www.ncbi.nlm.nih.gov/pubmed/25904145

Spotlight: American Medical Society for Sports Medicine (AMSSM): Associate Professor Irfan Asif

Associate Professor Irfan Asif is Vice Chair of Academics and Research at the Greenville Health System and University of South Carolina. This podcast is unashamedly focused on the American Medical Society which we believe is the world’s largest member organisation for primary care sports medicine. For those of you wondering why it needed to be a ‘medical society for sports medicine’ (tautology?/redundancy?) the answer is that sports medicine is a broad field with many disciplines involved, so one could have an ‘orthopedic’ society for sports medicine, for example, or a ‘sports therapists’ society for sports medicine.
Timeline:
1m 40s: What is AMSSM? What benefits does it provide primary care sports medicine physicians?
1m 20s: AMSSM President John Devine was at the White House for a national ‘bystanders’ conference – what can the public do to save lives? An initiative to ‘Stop the Bleed’.
1m 50s: Outline of the AMSSM Donjoy travelling fellowships in Australia (2014) and South Africa (2015) as well as the ECOSEP, Spain – providing international leadership. (Editors’ note, these are all BJSM member societies).
3m 20s: Junior NBA programme – NBA players (junior.nba.co) Sports Medicine Today – tips and fact sheets about different injuries for athletes, coaches, parents etc
4m 10s: Collaborative Solutions for Safety in Sport (CSSS): March 2015 meeting at the NFL headquarters (partnership with NATA). Emergency action plans – including Drs Jon Drezner, Kevin Guskiewicz and Doug Casa. Focused on factors such as personnel management, AEDs and prevention of heat stroke. Another example of AMSSM partnering to make changes across the US
5m 15s: Position statements that @theAMSSM is leading (completed and in the pipeline)
Viscosupplementation (5:30) – Pros and cons of using Viscosupplementation in osteoarthritis (http://www.ncbi.nlm.nih.gov/pubmed/26729890)
Mental Health – Under-recognised ‘silent injury’ – pressures of being an athlete per se
Diagnostic ultrasound – building on previous work such as features in BJSM in 2015 (http://bjsm.bmj.com/content/49/3/145.1.long)
Cardiovascular issues including ECG interpretation and pre-participation screening (coming out in 2016, ‘next year’ in the podcast because we recorded late in 2015)
6m 30s: Come to the Annual Meeting in Dallas, Texas, April 15-20 - http://ow.ly/X6yKo
Hot topics and speakers include: Tendons (Hakan Alfredson), Running Medicine (Blaise Williams – ACSM exchange lecture), Medical issues (e.g. cardiovascular, respiratory) in sports including NBA protocols, pearls for event coverage, low back pain management advances, stress fracture prevention and Rx, emerging technologies in sports medicine.
7m 30s: Opportunities to serve AMSSM on exciting committees (not an oxymoron!)
Links:
AMSSM conference registration (and programme) http://ow.ly/X6AIx
Hakan Alfredson’s classic (code for 2 years old now) BJSM tendon podcast http://ow.ly/X6AWA
AMSSM Sports Medcast on injections with guest Matt Gammons (VP, AMSSM) http://ow.ly/X6BkZ
Dr Irfan Asif’s recent podcast on HOW to promote lifestyle medicine (‘Exercise is Medicine’) http://ow.ly/X6Bww

Knowledge translation in sports physiotherapy: moving research into practical use

Physiotherapist Dr Michael Skovdal Rathleff from the Research Unit for General Practice in Aalborg chats with Dr Dylan Morrissey from Queen Mary University of London and Barts Health NHS trust and Dr. Christian Barton from the new sport and exercise medicine research centre at Latrobe University in Australia. Both Dylan and Christian are clinically active physiotherapists working on moving research from journal papers into the hands of people who can put it to practical use.
They discuss the challenges of clinicians being aware of the latest research and the researchers asking relevant questions. They propose to marry quantitative (eg. Systematic review) and qualitative (interviews, patient experience, clinician experience) approaches and they share examples of having already done this.
Drs Rathleff, Morrissey & Barton will run a session on this topic at the Danish Sports Medicine and Physiotherapy Conference in Kolding, Denmark on 4-6th February. www.sportskongres.dk They’ll also speak on other topics (including running injuries) in an excellent programme packed with starts.
Each speaker has many great papers and you can find two of those discussed in the podcast at these links:
The 'Best Practice Guide to Conservative Management of Patellofemoral Pain': incorporating level 1 evidence with expert clinical reasoning.
Barton CJ, Lack S, Hemmings S, Tufail S, Morrissey D.
http://bjsm.bmj.com/content/49/14/923.full
Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning
Rowe V, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D
http://www.ncbi.nlm.nih.gov/pubmed/23006143

Managing muscle injuries better: Tips from Dr Noel Pollock (British Athletics)

All clinicians aim to classify muscle injury classifications to guide treatment and predict return – it’s a hot topic. The British Athletics Muscle Injury Classification is one helpful classification system and Dr Noel Pollock explains to Dr Markus Laupheimer (BJSM) how and why the Classification developed, as well as why the (older) Munich classification was not ideal. Listen for tips on how this classification adds something special and is of practical value for treating your athletes with muscle injuries.
Timeline:
01:01m – Why a new muscle injury classification?
03:50m – Limitations of the Munich consensus
Open access Munich Paper: http://bjsm.bmj.com/content/47/6/342.full.pdf+html
05:18m – British Athletics classification explained
Open access British athletics paper: http://bjsm.bmj.com/content/48/18/1347.full
09:15m – Clinical application, follow up papers
12:00m – Discussion: MRI or not?
http://bjsm.bmj.com/content/49/24/1579.full
14:05m – Future Development of muscle injury classification
Links:
British athletics muscle injury classification: a new grading system
http://bjsm.bmj.com/content/48/18/1347.long (Open Access)
Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification
http://bmj.co/1lWvDdy
Previous podcast:
The Munich muscle classification: Using it for more accurate diagnosis and treatment
https://soundcloud.com/bmjpodcasts/the-munich-muscle-classification-using-it-for-more-accurate-diagnosis-and-treatment?in=bmjpodcasts/sets/bjsm-1
Range of BJSM podcast: http://bjsm.bmj.com/site/podcasts/
You can readily access BJSM podcasts via our Mobile App (BJSM). Latest sports medicine updates are posted via Twitter (@BJSM_BMJ)

AMSSM Sports Medcast - The Evidence Behind Injection Therapy in Sports Medicine

AMSSM has a series of podcasts (https://www.amssm.org/E-Learning.php) and here experts highlight the management of shoulder, elbow and knee pain with a focus on the declining role of corticosteroid injections. The sports physicians discuss other injection treatment options – PRP, prolotherapy and viscosupplementation where relevant. Keep the AMSSM’s 2016 Annual Meeting in mind – Registration opens on January 8th. It will be in Dallas, Texas, April 15-20, 2016. And the special AMSSM issue of BJSM appears online first on January 18th, 2016.(Mental health theme).
The experienced and popular hosts are Dr Blair Becker and Dr Scott Young, with special guest AMSSM Vice-President, Dr Matt Gammons.
Timeline:
2:00 m Shoulder pain and subacromial corticosteroid injection – what is the level 1 evidence?
4:05 m What about corticosteroid for frozen shoulder? Does distention add benefits?
5:30 m Dr Gammons in his experience with adhesive capsulitis and shared decision making.
6:30 m The severity of symptoms may influence the decision. What would make it worth it for the patient to have an injection?
7:30 m PRP – platelet rich plasma. Again, as usually the case with PRP, no therapeutic benefit. What about prolotherapy?
8:30 m The AMSSM position statement on ultrasound guidance for shoulder injection.
12:30 m The elbow – an area where corticosteroids are becoming less popular.
15:30 m Is there support for long-term benefit of PRP? Nothing in the short term but a benefit at 2 years?
16:00 m Dr Gammons provides an overview. “Tools to add to the toolbox”, “Reasonable discussions to have with the patient”. Remember that the natural history is toward resolution.
17:00 m Shared decision making is key
17:30 m Moving on to the knee. Osteoarthritis and corticosteroid – short term benefit. Dealing with the acute flare-up.
18:40 m Viscosupplementation. See also the AMSSM scientific statement – (http://ow.ly/VKUxC ) and its recommendation for use in patients aged >60 years with grade 2 or 3 Kellgren-Lawrence.
20:00 m Dextrose prolotherapy for knee osteoarthritis (University of Wisconsin).
21:00 m Intra-articular PRP for knee osteoarthritis
23:30 m Other targets around the knee. Iliotibial band, pes anserinus as well as the patellar tendon.
25:30 m Summary of clinical practice – putting it all into perspective.
Other links
Clinical Journal of Sport Medicine blog and link to AMSSM Viscosupplementation position statement
http://ow.ly/VKUxC
Evidence against elbow PRP via Dr Robert-Jan de Vos: http://bjsm.bmj.com/content/48/12/952.long

How to promote Lifestyle Medicine in the Clinic, Curriculum, Community: Assoc Prof Irfan Asif

The American Medical Society for Sports Medicine (AMSSM) is strongly committed to embedding Exercise is Medicine in the health of Americans. A member of the AMSSM’s leadership group is Associate Professor Irfan Asif, the Director of the Sports Medicine Fellowship within the Department of Family Medicine at the University of South Carolina Greenville.
Our chat focuses on the practical aspects of Lifestyle Medicine – which is more than exercise medicine alone. You’ll hear about: (i) the patient’s journey through a 6-week clinical service, (ii) exercise being embedded in all 4 years of the medical curriculum, (iii) how medical students are engaging with high school students in very practical ways and with some surprising outcomes.
We discuss the challenges of rolling out a lifestyle medicine programme in rural areas with minimal resources and the devil’s advocate asks the hard question: ‘Are doctors really the right persons in health care teams to prescribe exercise?’.
Timeline:
00:47m - What is the Lifestyle Medicine clinic? Who is involved, what are the goals?
02:00m - The diet part – modifying the DASH diet with a Southern Flavour (Dietary Approaches to Stop Hypertension (http://ow.ly/VtPSR))
04:00m - An example: walking through the patient’s journey – such as a patient with COPD. The role of partners such at the YMCA
05:30m - What the patient finds important – health or weight loss?
06:00m - How the curriculum embraces Lifestyle Medicine. See the link to Dr Jennifer Trilk’s work below (BJSM paper)
08:00m - Practical experiences of medical students within their communities. From given practical cooking advice to engaging high school students who are at risk of gang-related behaviour. Leadership concepts and team dynamic training – beyond the traditional medical model
10:00m - Physicians encouraging 7th & 8th grade children to ‘get your 30’ (minutes). Teaching CPR to children at this level. Encouraging young students to be open about concussion symptoms. Practical stuff
11:00m - Exercise Vital Sign: how many minutes do you exercise and how often do you exercise? Integrated into the Electronic Medical Record of the 13th largest health system in the US (with credit to Kaiser-Permanent as well). Flipping the health care system upside down from its focus on fee-for-service to prioritising prevention.
13:00m - Rural roll out: how to make this happen outside of major centres: ‘Think big but start small – practical first steps that will bring partners on board’
14:45m - Taking a broader view – 'If we rely only on medical professionals to provide care our system is bound to sink'. 'There is plenty of pathology to go around'. The role of various health professionals in a team that provides excellence: 'Everyone plays a vital role'
15:30m - Dr Asif answers the hard question: 'What if an exercise professional feels he or she knows more about exercise prescription than the doctor?'
Links:
Incorporating ‘Exercise is Medicine’ into the University of South Carolina School of Medicine and Greenville Health System (Editorial, BJSM, 2014) - http://ow.ly/VtWv4
Check out the 2015 Physical Activity Issue of BJSM - http://bjsm.bmj.com/content/49/4.toc
2014 Physical Activity Issue of BJSM - http://bjsm.bmj.com/content/48/3.toc

What is tissue ‘capacity’? How does it help successful rehabilitation? Prof Jill Cook (2nd of 2)

In this 2nd of 2 podcasts for 2015 (link to previous one here http://ow.ly/V8h97) Professor Jill Cook from the La Trobe University Centre for Sports and Exercise Medicine Research (Australia) introduces the term ‘capacity’ for physical therapy / physiotherapy.
‘Capacity’ is a very practical concept that underpins successful tendon rehabilitation. Prof. Cook discusses how to use the figure from the linked paper to list exercises a patient should do. Practical stuff. 13 minutes of gold!
Timeline:
1:00m - Why do we need the term ‘capacity’ in clinical practice?
1:30m - Definition – What is tissue ‘capacity’?
2:15m - The difference between ‘capacity’ and ‘function’ – capacity is tissue-specific
3:15m - Practical example: Hamstring muscle strain
5:30m - How to use this in the clinical setting – sitting with a patient and explaining the rehab programme
7:00m - The ‘Capacity’ figure – how to use it with patients to get buy-in to their rehabilitation
8:30m - ‘Building a bridge’ from what patients can do now to what they want to return to
9:00m - Practical tips including examples of (i) strength, (ii) energy storage, (iii) energy storage & release exercises
12:00m - Summary (30 seconds!)
Previous podcast:
How tendons fail, how to treat in season/out of season http://ow.ly/V8h97
Related papers:
The Continuum model of tendinopathy http://ow.ly/V8hLr
The challenge of managing tendinopathy during the season http://ow.ly/V8oTl
Capacity – the paper (with Figure!) that underpins this podcast! http://bmj.co/1MIaBrx