BJSM Podcast

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.

Professor Gwen Jull - Part 1 - Assessment and Management of Neck Pain. First of Two Conversations

Do you treat patients with neck pain? Do you have neck pain? Stop reading and start listening to the podcast. Professor Gwen Jull is one of the most lauded health professionals in the world right now and she shares pearls every minute of this podcast.
Here's the link to the second part of the podcast: https://soundcloud.com/bmjpodcasts/managing-cervicogenic-headache-and-other-pearls-professor-gwen-jull-second-of-two-podcasts?in=bmjpodcasts/sets/bjsm-1
Timeline
0:00m - How do you approach the patient aged in the prime of life who complains of neck pain and bad cervical posture?
2:00m - “Big development in physiotherapy is the assessment /examination which then forms the basis of our treatment” - movement and also how the movement is performed. Facet joint tests, muscle coordination.
3:10m - Detailed specific assessment of posture in the patient with neck pain. Have the patient adopt the work positions. Aim to correct the posture to see if pain changes.
5:10m - How to distinguish the superficial and deep neck extensors
8:30m - 3 trajectories in whiplash patients; folks who get better fairly rapidly (50%), those who suffer persistent mild pain (> 2years, 30%), and ‘the major worry’ of those who have persistent moderate to high levels of pain for many months and sometimes going on for years. What predicts these trajectories? “The last group is a real stumbling block for all professions”.
11:00m - Predictors of the poor outcomes.
12:00m - See the link to the Jull and Sterling booklet for patients - ow.ly/Soyma.
13:00m - Treatment of a patient with uncomplicated whiplash - “Hurry slowly”.
14:00m - Contribution of post-traumatic stress disorder
14:30m - Management of the complicated case of whiplash. Multiprofessional approach. Multimodal care. Instruments to assess severity and to look for particular elements.
16:20m - Providing overall management of the patient. Avoiding the medical merry-go-round
17:00m - Exercise is important (this will appeal to you Adam!)!
17:30m - “My emphasis is on treating multimodally”
18:00m - Manual therapy in the context of multimodal programme
19:00m - Explaining imaging findings to the patient
19:33m - Trigger points and dry needling?
Remember the 2nd part of this conversation (about Headache and more) will be available on the BJSM podcast site on 2nd October, 2015.
Links:
Grieve’s Modern Manual Physiotherapy (4th edition): Book review here http://ow.ly/Sj4cn Gwen Jill is the lead author of this physiotherapy bible
Related podcast: Professor Michele Sterling: ‘Managing Whiplash’ (2013). Very practical management of Whiplash that held up over 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

Keeping runners running: the secrets of running assessment - advice and exercise progressions

Mo Farah has great running technique. You see it, you know it. But what are the elements of Mo Farah’s running style? Can we assess running patients and guide them to improve their technique? Might gait education prove more effective than medication to treat symptoms?
Andy Cornelius has the answers. He’s a Graduate Sport Rehabilitator and head running coach who works in private clinics, premiership football and with high profile clubs and athletes. Posing the questions is Stephen Aspinall, Chairman of the British Association of Sports Rehabilitators and Trainers (BASRaT - http://www.basrat.org) and Lecturer in Sport Rehabilitation at the University of Salford, England.
Timeline
1:20m - What are the key elements of running assessment?
2:45m - What you can learn by watching the runner from behind (frontal plane) and the side (sagittal plane) on the track and on the treadmill.
4:08m - The runner with injuries related to overstriding. What is overstriding? What can the clinician advise?
6:00m - Assessing cadence and helping the athlete to make a change of between 5-10% in cadence.
7:00m - Role of hip extension, angle of trunk lean.
7:40m - Treatment of the runner who over-strides. Exercises for rehabilitation: split stride, triple extension position, mat sliding exercise, TRX device, verbal queues.
10:20m - Stride width: consider this in conditions like ITB friction syndrome, medial tibial stress syndrome (overloading one side).
12:00m - Risk of knee pain with widening stride.
12:20m - Detailed exercise progression to adjust stride width.
14:30m - How to couple pelvic stability with hip mobility – the need to balance stability and mobility.
15:15m - Mo Farah as an example - what he does right.
16:00m - Exercise progressions to address limitations around the hip and pelvis. Strive for Mo Farah’s stride!
17:00m - When to introduce bounding, hopping drills.
17:40m - Learn more at running workshops organised by BASRaT, including at the BASRaT Annual Symposium - Manchester City’s Etihad Stadium, November 20, 2015. http://www.basrat.org/
Links
Paul Hodges on the balance between mobility and stability – http://ow.ly/S4UKE
The Telegraph on Mo Farah in 2013 - http://ow.ly/S4UQh
Andy Franklyn Miller et al. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med. 2014 Mar;48(6):415-6. (OPEN ACCESS) (@AndyFranklynMiller)
http://www.ncbi.nlm.nih.gov/pubmed/22983122
Andy Franklyn Miller’s related podcast - biomechanics and running injuries - http://ow.ly/S4VBF (@AndyFranklynMiller)
Christopher Napier’s Systematic Review gait retraining - http://ow.ly/S4V29 (ONLINE FIRST, live October 1st 2015)
BASRaT Annual Conference – Friday November 20th, Manchester - http://www.basrat.org/
Please feel free to suggest links via @BJSM_BMJ or email karim.khan@ubc.ca

Legendary England Football Chief Medical Officer on ACL injuries, RED-S and sport team culture

Dr Pippa Bennett has the CV and life experience that aspiring sport and exercise medicine doctors dream about. How’s this for a short version: Chief Medical Officer (CMO) for England Women’s Football Teams (15 years) including UEFA European Championships x 4 and FIFA World Cups x 2; CMO to British Gymnastics working at World and European events; World University Games x 3, Commonwealth Games, Olympic Games x 2 including Team GB Women’s Football in London 2012. English Institute of Sport including archery, athletics, swimming, hockey and wheelchair basketball. She completed a Masters in Sport and Exercise Medicine at Bath University. Describes herself as a keen football player who hung up her boots “due to old age and injury.“
In conversation with Dr Markus Laupheimer, they cover (i) ACL injuries and their prevention, (ii) the medical issues formerly known as the Female Athlete Triad which the IOC Consensus Group prefers to consider as the Relative Energy Deficiency Syndrome in Sport (RED-S) and (iii) Dr Bennett’s tips for junior clinicians – secrets from 15 years in the locker rooms in leading women’s and men’s sporting teams.
TIMELINE
1:30m - Why are women more prone to ACL injuries? Addressing movement patterns for prevention; making players more robust.
4:00m - Prevention strategies - Dr Bennett’s experience in screening at schools and providing customised programmes for individual athletes to prevent injury.
5:20m - Relative Energy Deficiency in Sport (RED-S) - “a more rounded concept” focusing on the real culprit – energy deficiency - “Making sure your athlete is putting enough energy into the body”.
6:20m - Menstruation (in the context of amenorrhea) as well as in relation to performance and taboos.
7:00m - A case of a bone stress injury with an unusual underlying cause - “Treat the whole athlete”.
9:15m - Moving to Team Dynamics - Pippa shares her wide experience and contrasts men's and women's events in the same sport (e.g. gymnastics).
11:15m - The FIFA World Cup experience
13:20m - Advice for women clinicians considering applying for position in men’s teams: “Apply”
Podcast and paper links (podcasts OPEN, most papers OPEN too):
RED-S podcast with Dr Margot Mountjoy Major debate about energy deficiency among sportspeople: http://ow.ly/RMYRq
RED-S consensus statement (2014) Mountjoy M1, Sundgot-Borgen J, Burke L, et al
The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 48(7):491-7. doi: 10.1136/bjsports-2014-093502.
Hyperlink - http://ow.ly/RN0II
RED-S Clinical Assessment Tool: Mountjoy M, Sundgot-Borgen J, Burke L, et al.
RED-S CAT. Relative Energy Deficiency in Sport (RED-S) Clinical Assessment Tool (CAT). Br J Sports Med. 2015 Apr;49(7):421-3.
Hyperlink - http://ow.ly/RN171
Female Athlete Triad consensus statement (2014): De Souza MJ1, Nattiv A, Joy E, et al.
2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Br J Sports Med. 2014 Feb;48(4):289. doi: 10.1136/bjsports-2013-093218.
hyperlink - http://ow.ly/RN0Ae
ACL mechanisms – Martin Hagglund -- Which 3 on-field football scenarios precede ACL rupture?
http://ow.ly/RMYw5
Management and prevention of ACL injuries: Associate Prof Grethe Myklebust
http://ow.ly/RMZcX
ACL prevention paper – Norwegian experience: Myklebust G et al. Skjølberg A, Bahr R ACL injury incidence in female handball 10 years after the Norwegian ACL prevention study: important lessons learned. Br J Sports Med. 2013 May; 47(8):476-9. doi: 10.1136/bjsports-2012-091862. Epub 2013 Feb 12.
hyperlink - http://ow.ly/RN1jj