BJSM Podcast

Does everyone who has ruptured her/his ACL need a knee reconstruction? Prof Mark Hutchinson

Dr. Mark Hutchinson is professor of orthopaedics and head of the sports medicine services at the University of Illinois College of Medicine. He has been a team physician for the WNBA Chicago Sky, USA gymnastics, USA Field Hockey, USA Basketball and Team USA at two World University Games and the Paralympics Games.
In this second of a two-part set, he discusses management of the patient who presents with recent onset of acute knee pain. You might be surprised by some of what this orthopaedic surgeon says!
Timeline:
1:30m - Does everybody who ruptures an ACL need a knee reconstruction?
2:00m - How do you advise the person who wants to play soccer?
3:00m - How can you tell whether someone will make a good recovery or not with exercise therapy (not surgery)?
4:00m - OK for patients to go through a trial of physio to see if they are going to be stable or not
5:30m - Management of children who rupture their ACL. It’s a hot topic. On the one hand kids may be less compliant with ACL-risky behaviours than adults; on the other hand, operating and crossing growth plates can cause significant problems
7:30m - The key study by Håvard Moksnes and Lars Engebretsen – ACL injuries in kids (http://www.ncbi.nlm.nih.gov/pubmed/26025937) (not open access)
7:45m - How to discuss ACL management options with patients directly – ‘Tell us what you say to the patient Hutch’ (An introduction to shared decision-making)
9:15m - Non-operative, quality physiotherapy for ACL deficient patients
10:15m - Does ACL reconstruction prevent osteoarthritis?
11:15m - The elephant in the room – what about management of the patient whose ACL reconstruction has reruptured?
12:45m - Injuring the other knee – a disaster that occurs all too often!
13:30m - Psychological factors: a neglected part of the equation? http://bjsm.bmj.com/content/48/21/1543.abstract
14:30m - Return to play after reconstruction: the mind matters too! What is the optimal time for collagen healing? Coordination training, functional tests.
16:45m - Return to play with an unoperated knee: with a focus on neuromuscular training exercises
Links:
Previous BJSM podcasts:
Pearls on knee examination: http://ow.ly/UBy3v
Pearls on treating shoulder conditions and one wrist bonus: http://ow.ly/UBym
YouTube videos on Physical Examination have been viewed more than 5 million times! https://www.youtube.com/user/BJSMVideos
YouTube video: 39-minute lecture by Associate Editor Dr Clare Ardern on similar issues – return to play after ACL injury https://youtu.be/P_JJf0h6rhU
Want a replay from last week? (1st podcast in this set) A 40-year old patient presents with an acute exacerbation of knee pain – Professor Hutchinson discusses whether arthroscopy is helpful in the arthritic knee. Which ones need orthopaedic referral?
https://soundcloud.com/bmjpodcasts/mark-hutchinson?in=bmjpodcasts/sets/bjsm-1
Return to Play conference 2016: April 9-11, London (UK). The immensely successful annual Football Medicine Strategies conference focuses on Return to Play for all football injuries – not just ACL. Give this one serious consideration – top programme with over 100 invited speakers, terrific international audience (you will feel at home), friendly atmosphere and convenient venue. All the benefits of London without the need to own an expensive home there! http://www.footballmedicinestrategies.com/en/

How to manage the patient with a degenerative meniscal tear? Prof Mark Hutchinson (USA)

Professor Mark Hutchinson, University of Chicago, Illinois, is an international leader in Orthopaedics and Sports Medicine. He has worked closely with the US Olympic Committee by serving at the Training Centre in Colorado and being part of Team USA at the Pan American Games in Canada (2015).
In this first of two podcasts, he discusses management of the patient who presents with recent onset of acute knee pain. You might be surprised by some of what this orthopaedic surgeon says!
Timeline
1:30m - Importance of a broad clinical workup
2:23m - In the arthritic knee, arthroscopy does not improve patient outcomes.
3:00m - Arthroscopy versus physiotherapy in MRI proven degenerative meniscal tears: no difference
3:30m - What about when there are mechanical symptoms such as ‘locking’ or ‘giving way’? Prof Hutchinson says these may warrant a surgical referral.
4:30m - What would most orthopaedic surgeons do when faced with our clinical scenario?
5:30m - How long should the patient /physiotherapist persist with conservative management? What are the indications for arthroscopy? “Arthroscopy generally doesn’t treat arthritis”.
Links:
Two previous podcasts on BJSM podcasts
Pearls on knee examination: http://ow.ly/UBy3v
Pearls on shoulder examination plus one wrist bonus: http://ow.ly/UBym8
Mark's YouTube videos on Physical Examination have been viewed more than 5 million times! https://www.youtube.com/user/BJSMVideos
Next week: (2nd podcast) a patient presents after rupturing her/his ACL. Does she/he need a knee reconstruction and what are the issues about return to play?

Professor Jill Cook (La Trobe University) revisits BJSM podcasts after two years: First of Two

In her first podcast since being recruited to the La Trobe University Centre for Sports and Exercise Medicine Research (Australia), Professor Jill Cook explains: (i) how tendons break down, (ii) how to assess painful tendons, (iii) how to manage tendon pain DURING a season, and (iv) how to rehabilitate a tendon properly after a season has finished.
She explains what a ‘reactive’ tendon is and what a ‘degenerative’ tendon is as well as what sort of loads should be prescribed for patients who have tendon with these pathologies.
A practical masterclass. Even if you have heard Jill speak before, there will be something new for you here. Sneak peek – Part 2 focuses on the concept of ‘capacity’ and why it’s an important concept.
Further reading
Classic paper: Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy
http://bjsm.bmj.com/content/43/6/409.abstract

The Munich muscle classification: Using it for more accurate diagnosis and treatment

Peter Ueblacker is an internationally renowned orthopaedic surgeon and sports medicine doctor who had a long and very successful career with Bayern Munich from 2009 – 2015. He works in private practice with Hans-Wilhelm Mueller-Wohlfahrt (http://ow.ly/U2mch). BJSM editor Markus Laupheimer asked the questions (English language).
Timeline
1:00m - Why classify muscle injuries?
3:00m - Limitations of previous classification methods and the need for a comprehensive one – the genesis of the Munich Muscle Injury Classification system. Here is the link to this Open Access paper in BJSM (>55,000 views) http://ow.ly/U2pMG
4:18m - What are the benefits for the health professional who uses the Munich classification system? Definition of ‘direct’ and ‘indirect’ muscle injuries.
5:00m - The challenge of ‘functional’ muscle injuries. No pathology on MR imaging yet a major burden for football teams because players cannot play – time loss injuries.
6:00m - Different muscle injuries lead to different periods of time out of sport. Is this a 2-week or 5-week injury?
6:40m - Trying to predict prognosis – is it possible? What can we tell coaches? You’ll find a counter-argument here http://ow.ly/U2qFJ (not discussed in this podcast).
7:10m - Drilling down on structural muscle injuries. Tendinous injuries within the muscle are important (See @PeterBrukner paper on that here http://ow.ly/U2rBc)
8:15m - How the spine is contributing to muscle injuries. Under-rated? Clinical implications.
10:00m - A practical walk through the management of hamstring muscle injuries
Additional links:
http://ow.ly/U2mUG - Previous podcast with Professor Gino Kerkhoffs also considers the Munich Consensus paper. It complements the present podcast in its greater focus on the consensus process and argues of the usefulness of MR imaging in muscle injury diagnosis.
http://ow.ly/U2o0Q - Previous podcast with Professor Jan Ekstrand focusing on hamstring injuries. Which of the hamstring muscles is most likely injured? How long will such an injury keep a player out of sport? Also comments on the Munich Consensus
http://ow.ly/U2ova - Hamstring ‘virtual conference’ BJSM blog by Steffan Griffin (@Lifestylemedic), BJSM editor responsible for Facebook among other things.
You can readily access BJSM podcasts via our Mobile App (BJSM). Latest sports medicine updates are posted via Twitter (@BJSM_BMJ) and on the Google+ community http://ow.ly/U2sNs where you are encouraged to post content too.

Prof Peter O’Sullivan considers surgery for back pain: Tiger Woods’ 2015 re-operation

Sports physiotherapists provide evidence-based treatment for back pain. Unfortunately surgery for back pain has rather poor outomes. Tiger Woods has spinal surgery on March 31, 2014 and did not return to his previous level of play. He went under the knife again on September 16, 2015. In this podcast, Curtin University’s Professor Peter O’Sullivan comments on the risks and possible benefits of surgery in an elite golfer.
Previous podcast (>10,000 listens): Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’ http://ow.ly/TK6uo

Einführung in die Bewegungsmedizin : “Bewegung bringt Heilung” mit Dr Boris Gojanovic

Wenn Dir jemand sagen würde da gibt es eine Pille die bei Beschwerden aller Art hilft mit fast keinen Nebenwirkungen und evetuell das menschliche Leben verlängern kann --- was würdest du sagen? Wo kann ich diese Pille kaufen?
Die Bewegungsmedizin ist ein anerkanntes Therapiekonzept für viele Erkrankungen des Bewegungsapparates wie Rückenschmerzen, Tendinopathien und Gelenksarthrose. Aber auch bei vielen Internistische Indikationen wie Herzertkrankung, Diabetes usw.
Dr Boris Gojanovic gibt uns eine EInführung. In Diskussion mit Dr Markus Laupheimer (BJSM) werden degenerative Meiskusrisse und Bluthochdruck Therapie besprochen, als Beispiel wie die Bewegungstherapie Therapie der Wahl ist.
Weitere Links zur Bewegungsmedizin:
Schweizerische Gesellschaft für Sportmedizin (SGSM): http://www.sgsm.ch/
Swiss French SEM network
http://www.rrms.ch/cms/index.php
Blog Deutsche Verband für Gesundheitssport und Sporttherapie (DVGS): http://www.dvgs.de/blog
Bedeutung und Evidenz der körperlichen Aktivität zur Prävention und Therapie von Erkrankungen: http://www.dgsp.de/_downloads/allgemein/RfB-DMW-Loellgen2013-ub-323.pdf
Therapie von degenerativen Meniskusrissen:
http://bjsm.bmj.com/content/49/19/1229.full
http://blogs.bmj.com/bjsm/2014/06/15/time-to-stop-meniscectomies-for-degenerative-tears-practice-must-catch-up-with-evidence/
Twitter:
British Journal of Sports Medicine @BJSM_BMJ
Dr Markus Laupheimer @swisssportscare
Dr Boris Gojanovic @DrSportsSante

Rugby: Player Preparation and Monitoring with Nigel Jones

Dr Nigel Jones is the England Rugby Senior Team Doctor, and a hugely respected figure in the UK Sport and Exercise Medicine scene. In this podcast with Steffan Griffin, you will hear about everything from being involved as part of the home team at a major sporting event, to the state-of-play in UK Sport and Exercise Medicine training.
Timeline:
00:45m – Working at the 2015 Rugby World Cup
01:30m – Preparing an elite team for competition
03:05m – Conditioning vs collapse – how to avoid the latter!
05:15m – Player monitoring at the top table
06:30m – Getting coaches to buy-in to player monitoring/injury
prevention – TOP TIPS
08:30m – Concussion – what’s in place to ensure gold-standard care?
World Rugby Online Concussion Resources http://playerwelfare.worldrugby.org/concussion
12:00m – Sport and Exercise Medicine Training Pathway in the UK – where’s it heading?
16:20m – British Association of Sport and Exercise Medicine & the Faculty of Sport and Exercise Medicine - What can we expect at the BASEM/FSEM 2015 Conference?
Find out more about the BASEM/FSEM 2015 Annual Conference – November 12/13 http://bit.ly/1Woxmpn

Managing Cervicogenic Headache and Other Pearls: Professor Gwen Jull. Second of two podcasts

Professor Gwen Jull, from the University of Queensland, is one of the most lauded health professionals in the world. She discusses the assessment and management of the patient with neck pain. In the second half of the podcast BJSM asks her a couple of broader questions. What does it take to be a great clinician?
Timings
1:30m - A case of headache – what elements to consider in the subjective/history
3:00m - What differentiates the expert clinician from learners who are treating neck pain?
4:00m - How to identify those headaches that respond to physiotherapy and which ones don’t respond well.
7:00m - What does it take to be a good clinician?
8:00m - Perspectives on the physiotherapy/physical therapy profession. Importance of being first contact practitioners.
9:45m - Physiotherapists as leaders in large health organisations and pioneers in heath service changes.
11:45m - Professor Jull shares the highlights of the new issue of Grieve’s Modern Musculoskeletal Physiotherapy here http://ow.ly/Sj4cn
15:00m - The biopsychosocial model – avoid biases towards one domain in this model. Advocating for the multimodal approach to physiotherapy/physical therapy.
Links:
Grieve’s Modern Musculoskeletal Physiotherapy (4th edition): Book review here http://ow.ly/Sj4cn Gwen Jill is the lead author of this physiotherapy Bible.
First of Professor Jull’s two podcasts: Assessment and Management of Neck Pain. First of Two conversations http://ow.ly/TcVtr
Related podcast: Professor Michele Sterling: ‘Managing Whiplash’ (2013). Very practical management of Whiplash that held up of the 2 years. http://ow.ly/Sj4Jz
Is the neck pain related to concussion? A related paper in BJSM: Schneider KJ, et al. Br J Sports Med. 2014 Sep;48(17):1294-8. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial - http://bjsm.bmj.com/content/48/17/1294.abstract

Preventing catastrophic injuries at the Rugby World Cup: Drs Brown and Hendricks

Avoiding catastrophic injuries at the Rugby World Cup. We explore effective injury prevention strategies and what other sports can learn from rugby with Dr James Brown and Dr Sharief Hendricks from South Africa.
Dr James Brown (@jamesbrown06) and Dr Sharief Hendricks (@Sharief_H), Post-Doctoral researchers from the division for Exercise Science and Sports Medicine (ESSM) at the University of Cape Town (UCT), share their expertise in rugby science in our “Emerging Voices” series led by BJSM editor Nicol van Dyk (@NicolVanDyk).
Dr Brown focuses on rugby injury prevention for both BokSmart (www.boksmart.com) and the Chris Burger Petro Jackson Players’ Fund (www.playersfund.org.za). James’ PhD thesis evaluated the effectiveness of South Africa Rugby Union’s BokSmart programme (www.boksmart.com).
Dr Sharief Hendricks holds an NRF Innovation Post-Doctoral Research Fellowship at the University of Cape Town. He has investigated the tackle in Rugby Union and he examines how training and match behaviour data can help coaches improve players’ performance, and minimise injury risk. Sharief has also contributed substantially to national strategic documents for his country’s rugby union (SARU).
Both speakers contributed to the inaugural World Rugby Science Network Conference (http://rsnlive15.com), co-hosted between University of Bath and the University of Cape Town. They utilised a multi-media online platform and had an excellent line up of speakers just days before the Rugby World Cup kicked off.
You can hear both speakers in the “Rugby Medicine” track upcoming Transact South African Sports Medicine Association (SASMA) Conference 2015 (http://www.sasma2015.co.za), Johannesburg South Africa, 16-22 October 2015 (@SASMA2015). This bi-ennial conference has an excellent line up of international speakers, and a clinically driven programme under the leadership of Dr. Jon Patricios (@jonpatricios) is set to deliver a great week of learning and fun.
Find a list of publications from James and Sharief on their website www.rugbyscientists.com. Here are two favourites from BJSM:
Are we currently underestimating the risk of scrum-related neck injuries in rugby union front-row players?
http://bjsm.bmj.com/content/48/14/1127.extract
An evidence-driven approach to scrum law modifications in amateur rugby played in South Africa
http://bjsm.bmj.com/content/48/14/1115.abstract

Professor Shirley Sahrmann (PT, PhD) outlines the Movement System Impairment Approach

“Physical Therapists are the best suited clinicians to assess and treat the movement system” says Washington University (School of Medicine in St. Louis) Department of Physical Therapy Professor Shirley Sahrmann. Physical therapist and Assistant Professor, Dr Sylvia Czuppon (@czuppons), asks the questions.
Timeline
0:30 mins - What differentiates elite athletes’ movement patterns from that of ‘normal’ people and of those with abnormalities?
2:00 mins - Why physical therapists are best suited to keeping the movement system functioning optimally
3:08m - The concepts of relative stiffness, relative flexibility – Professor Sahrmann’s Movement System Impairment approach
4:30m - How to perform muscle length assessment
5:45m - The spring-like behavior of muscles – a key contributor to abnormal movement patterns
6:40m - Hypertrophy of muscles increasing the stiffness of muscles and thus increasing passive stiffness: “It’s not just about muscle shortness”
8:00m - The role of microinstability and abnormal accessory movements contributing to pain. Practical examples including a case of tight Tensor Fascia Lata illustrating the concept that the body takes the path of least resistance
10:30m - Clinical reasoning in a patient with groin pain. Are there abnormal accessory movements?
13:00m - Practical tips on the assessment of a patient with FAI – femoroacetabular impingement
14:30m - Common musculoskeletal exam errors by young clinicians – what NOT to do
16:00m - The difference between the novice and expert in movement pattern examination
18:00m - Physical therapists as lifespan practitioners – and movement is critical to health across the lifespan. Physical therapists – optimising movement to enhance the life experience
19:00m - A call for physical therapists to “take back exercise”. Of course this is much more powerful than passive therapies
Other links
Professor Sahrmann’s Movement System Impairment Syndromes Courses: http://ow.ly/SFnWl
Professor Gwen Jull on managing neck pain - http://ow.ly/SFooy
Professor Paul Hodges on the balance between mobility and stability – http://ow.ly/S4UKE
Please feel free to suggest links via @BJSM_BMJ or email karim.khan@ubc.ca
The Movement System Impairment (MSI) syndromes were developed by Shirley Sahrmann, PT PhD and her colleagues at Washington University Program in Physical Therapy. These syndromes are described in her books, Diagnosis and Treatment of Movement Impairment Syndromes and Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spine.