BJSM Podcast

Turning up the heat: Julien Périard on heat illness, acclimatisation and cooling strategies

Many athletic events, such as the current Wimbledon Tennis Championships, are staged in hot to very hot environmental conditions. Clinicians should be aware of the risks posed to athletes competing under heat stress and how to mitigate them.
Dr. Julien Périard is a former successful triathlete and now works at Aspetar, Qatar, as a senior research scientist investigating athletic performance under heat stress conditions. BJSM’s Liam West (@Liam_West) poses questions about what heat illness encompasses, what signs and symptoms to look for and how to take care of athletes.
See the 2015 Consensus Statement on Training and Competing in the Heat via BJSM’s Online First http://bit.ly/1CfQLCj The Consensus Statement will be published in BJSM issue 15 which goes live on July 16, 2015 (http://bjsm.bmj.com/)
Primary Link;
Racinais S, ..., & Périard J. (2015). Consensus recommendations on training and competing in the heat (Online First) - http://bjsm.bmj.com/content/early/2015/06/11/bjsports-2015-094915.abstract?sid=4f2f6068-8857-4c4b-ba0e-143084d62ff0
Other reading:
April 2014, Volume 48, Supp 1 – Heat Stress & Tennis Performance - http://bjsm.bmj.com/content/48/Suppl_1.tocBergeron MF. (2008).
Muscle cramps during exercise - Is it fatigue or electrolyte deficit? Curr Sports Med Rep7, S50-S55. Périard JD, Racinais S & Sawka MN. (2015).
Adaptations and mechanisms of human heat acclimation:- Applications for competitive athletes and sports. Scand J Med Sci Sports25, 20-38. Girard O, Brocherie F & Bishop DJ. (2015).
Sprint performance under heat stress: A review. Scand J Med Sci Sports25, 79-89. Sawka MN, Leon LR, Montain SJ & Sonna LA. (2011).
Integrated physiological mechanisms of exercise performance, adaptation, and maladaptation to heat stress. Compr Physiol1, 1883-1928.
Book chapter: Leon, LR and Kenefick, RW (2011). Pathophysiology of Heat-Related Illnesses. In: Wilderness Medicine. Ch 10. Auerbach, PS (Ed) http://www.dtic.mil/dtic/tr/fulltext/u2/a559070.pdf
Blogs:
Thermal perception as a controller of exercise intensity - http://blogs.bmj.com/bjsm/2012/04/28/cool-it-so-is-thermal-perception-a-controller-of-exercise-intensity-during-heat-stress/
Prevention of heat illness – part one - http://blogs.bmj.com/bjsm/2011/03/24/evidence-based-considerations-for-the-prevention-of-heat-related-illness-in-marathon-training-part-1/
Prevention of heat illness – part two - http://blogs.bmj.com/bjsm/2011/03/25/evidence-based-considerations-for-the-prevention-of-heat-related-illness-in-marathon-training-part-2/

Youth Athlete Development (IOC Consensus): Specialisation, Talent Identification, Injury Prevention

Dr Mike Bergeron, Chair of the IOC Consensus Committee on Youth Athletic Development discusses hot topics.
Here’s the link to the Consensus Statement (Open Access): http://bjsm.bmj.com/content/49/13/843.full

Architecture to move

How can we modify the environment we live in to increase physical activity? Steffan Griffin, junior doctor, BJSM editorial team, talks to Simon Allford, one of the UK's most celebrated architects, and the man behind the design of Google's HQ in London, about how buildings can improve health and activity.

Treating the unwell athlete? Practical tips for travelling team clinicians: Prof Martin Schwellnus

Athletes who suffer from illness are more likely to get injured and they are likely to underperform. It’s messy (vomiting, diarrhoea) but there are guidelines for physios and docs in these roles.
Professor. Martin Schwellnus talks to Liam West (@Liam_West) and offers practical tips useful for all members of the medical team. Prof. Schwellnus is director to one of only 8 IOC Research Centres worldwide. He has recently been appointed as Professor Sports & Exercise Medicine by the University of Pretoria, South Africa.
Recorded at the IOC Team Physician Course in Doha, Qatar, so you’ll hear a few sounds in the background. #NotBMJStudio Practical tips from an international icon in sports & exercise medicine, who is a member of the Scientific Committee for the 2016 IOC Team Physician Course in Cape Town, (November).
Further Links:
Prospective monitoring of illness and injury - http://bit.ly/1C2PXLp
Sports Injury & Illness at the Sochi 2014 Games- http://bit.ly/1Fd1aJj
Injury & Illness for Team GB at Sochi 2014 - http://bit.ly/1GyuRKb
Health protection of the Olympic Athlete - http://bit.ly/1BaUhgC
Illness in Super 14 Rugby - http://bit.ly/1SazEp7
Injuries & Illness at the FIFA 2010 World Cup - http://bit.ly/1cPTdmB
Prevention against illness & Injury in Athletics - http://bit.ly/1Iz7hfP
Injuries & Illness at the London 2012 Olympic Games - http://bit.ly/1MvxXyL
Factors associated with illness at London 2012 Games - http://bit.ly/1SazEp7
BJSM App
iTunes - itunes.apple.com/us/app/bjsm/id943071687?mt=8
Google Play - play.google.com/store/apps/detail…m.goodbarber.bjsm

Take homes from 1st World Conference on Groin Pain in Athletes: Doha Agreement (Part 2)

23 international experts in groin pain were sent two specific cases – one on inguinal region pain, the other – you guessed it – adductor region pain. The heavyweights in groin pain including Holmich, Muschaweck, Ekstrand, Meyers, Tyler, Silvers, Schilders, Thoborg, Brukner, Paajanen, Philippon, Weir, Griffen, Orchard +++. Physiotherapists, sports physicians, surgeons – unique for the diversity of opinions sought.
The experts were asked to (i) write down their diagnosis and (ii) suggest initial treatment. How many diagnoses were presented? (Really? 22!! You are kidding, surely). These folks were also invited to work on focused systematic reviews and share their thoughts in person in Doha, Qatar. So far so good.
But there’s always a catch! They were then locked in a room with just #LCHF not to come out until there was useful product for clinicians. Adam Weir, MD, PhD, was the driving force behind this effort and he shares what was achieved and how this can help your practice. He also guides you to hours of additional resource material including the Aspetar YouTube channel for the entire World Conference (some links below). If you see patients with groin pain this is a must!
Key resources include:
BJSM Issue 12, 2015 – Groin pain in athletes: http://bjsm.bmj.com/content/49/12.toc
Consensus Statement: Doha Agreement Meeting: http://bjsm.bmj.com/content/49/12/768.full (Weir et al - 23 authors, Open Access)
Aspetar YouTube Channel (Google Aspetar, Groin Pain, YouTube for a full list)
Adam Weir BJSM podcast part 1 on BJSM (and follow @AdamWeirSports).
You are encouraged to tweet your podcast questions to @AdamWeirSports or post on the Google + Sports & Exercise Medicine Community page – a great place to write more than a tweet. All you need is a gmail account.

Managing groin pain in athletes: Adam Weir’s pointers for two very common presentations (Part 1)

Do you see football or ice hockey players with persistent pain in the inguinal region? What about players in twisting sports with adductor region pain? Are you still making the diagnosis ‘osteitis pubis’? Are you unsure as to when to order investigations in cases of groin pain? Enough questions – time for answers.
Adam Weir, MD, PhD, has more than 10 years’ experience in dedicated clinics treating groin pain in athletes. His sports medicine specialty training was in Netherlands and the past 3 years has seen him work closely with a multidisciplinary team including sports physiotherapists and groin surgeons at the Aspetar Clinic for Groin Pain in Athletes (Doha, Qatar).
He discusses the management of the two patients outlined in the two questions above (longstanding pain in the inguinal region, adductor region, in turn). 14 minutes of practical tips – assessment, investigation, specific management. PRP, surgery? No holds barred. What remains unknown. You’ll get the pearls that @AdamWeirSports shared as a keynote speaker at the American Medical Society for Sports Medicine (@TheAMSSM) conference in April 2105.
Key resources include:
BJSM Issue 12, 2015 – Groin pain in athletes – Table of Contents: http://bjsm.bmj.com/content/49/12.toc
9 systematic reviews most of the Open Access thanks to Aspetar Orthopaedic and Sports Medicine Hosptital, Doha, Qatar – here’s the one on management of groin pain. http://bjsm.bmj.com/content/49/12/813.full (Serner et al., Open Access)
Consensus Statement: Doha Agreement Meeting: http://bjsm.bmj.com/content/49/12/768.full (Weir et al - 23 authors, Open Access)
Part 2 BJSM podcast with Adam Weir – https://soundcloud.com/bmjpodcasts/take-homes-from-1st-world-conference-on-groin-pain-in-athletes-doha-agreement-part-2
You are encouraged to tweet your podcast questions to @AdamWeirSports or post on the Google + Sports & Exercise Medicine Community page – a great place to write more than a tweet. All you need is a gmail account.

Tim Gabbett: Heavy training versus injury risk: Can physiotherapy and conditioning work together?

High performance demands heavy workloads but loading increases the risk of ‘overuse’ injury. How can clinicians and strength & conditioning (S&C) coaches find the happy medium? Or is it time to take a different view? Perhaps INCREASING training load will make tissues more resilient and injury LESS likely.
Dr Tim Gabbett (www.gabbettperformance.com) bridges sports medicine and S&C as a performance consultant and a recognized applied researcher. In the BJSM spotlight he shares what physiotherapists can learn from S&C coaches and argues for the concept of the ‘performance physiotherapist’. Similarly, he translates S&C secrets for physios – insights to progressing sport specific game demands within the rehabilitation program using a rugby example. We ask him about the high-tech and low-tech equipment to gauge how much players are doing and how to titrate their training dose.
The latter part of the podcast focuses on how greater training loads can make players less likely to suffer injury but match demands must be considered. “High training loads are not necessarily the problem, it is how you get there that can damage players”. The internationally-recognized Gabbett closes by outlining the concept of ‘training stress balance’ – the net difference between fitness (long-term training load) and fatigue (short-term training load). When the player is in ‘positive’ balance, (i.e, the short-term load is lower than the longer term level of load the player is adapted to) injury is very unlikely. However, when this pattern is reversed, such as when a player is attempting to rapidly ‘gain fitness’ after a layoff, injury is almost inevitable. Cricket fast bowling data provides compelling evidence for this novel concept.
Link to Dr Tim Gabbett’s home page: www.gabbettperformance.com
In case you don’t get to check Dr Gabbett’s bio, he is in that rare group of individuals with two PhDs – one in human physiology (2000), the other in the applied science of professional football (2011). He has worked with players in many Olympic Games cycles and published over 150 papers. http://gabbettperformance.com.au/profile/
The BJSM paper relating to ‘training stress balance’: Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Hulin BT, Gabbett TJ, ….Orchard JW. Br J Sports Med. 2014 Apr;48(8):708-12
http://www.ncbi.nlm.nih.gov/pubmed/23962877

Practical tips in preventing sports injuries in teams. Secrets from Norway’s surveillance methods

“Just because it’s difficult doesn’t mean it’s impossible” says Norway’s Ben Clarsen (PT, PhD) (@BenClarsen). We all say the words – ‘injury prevention is important’, ‘we want to catch injuries early’ but how do you do it? What about if your nation’s athletes are spread all around the globe? Can a systematic, yet simple, process of asking athletes questions by text messaging work?
Norway punch above their weight in elite sport and Ben Clarsen is one of the team at the engine room of Norwegian Sports Medicine & Sports Science ‘Olympiatoppen’ (ie. ‘EliteSport’).
He shares with @Liam_West HOW Norway keeps in touch with athletes weekly, responds to early warning signals, and initiates appropriate treatment in a financially prudent manner (oil price down right now).
Links include:
For athletes’ health problems: http://bjsm.bmj.com/content/48/9/754.abstract - The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. By Clarsen B, Rønsen O, Myklebust G, Flørenes TW, Bahr R. Br J Sports Med. 2014 May;48(9):754-60. doi: 10.1136/bjsports-2012-092087. Epub 2013 Feb 21.
For sports injury problems: http://bjsm.bmj.com/content/47/8/495.abstract Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. By Clarsen B, Myklebust G, Bahr R. Br J Sports Med. 2013 May;47(8):495-502. doi: 10.1136/bjsports-2012-091524. Epub 2012 Oct 4.

To risk, or not to risk: the return to play dilemma - Prof. Roald Bahr

Prof. Roald Bahr is a world-renowned name in Sports Medicine. He is a member of the IOC medical committee and a Professor in Sports Medicine. He acts as the Head of the Aspetar Sports Injury & Illness Prevention Programme and also Chair of the Oslo Sports Trauma Research Center at the Norwegian School of Sports Sciences.
Prof. Bahr’s main research area is the prevention of injury and illness in athletes, and has published more than 200 papers and book chapters. He was speaking at the IOC Advanced Team Physician Course in Doha, Qatar when BJSM caught up with him.
In this podcast, Dr Liam West (@Liam_West) poses questions that see Prof. Bahr take listeners through various Return To Play (RTP) frameworks and how we should be willing to accept risk during the RTP period.
Relevant Reading:
Creighton DW, Shrier I, Shultz R, et al. Return-to-play in sport: a decision-based model. Clin J Sport Med 2010;20:379–85.
http://journals.lww.com/cjsportsmed/Abstract/2010/09000/Return_to_Play_in_Sport__A_Decision_based_Model.12.aspx
Herring SA, Kibler WB, Putukian M. The team physician and the return-to-play decision: a consensus statement-2012 update. Med Sci Sports Exerc 2012;44:2446–8.
http://europepmc.org/abstract/med/23160348
Shrier I, Safai P, Charland L. Return to play following injury: whose decision should it be? Br J Sports Med 2014:48:394-401
http://bjsm.bmj.com/search?submit=yes&y=0&fulltext=risk%20management&x=0&FIRSTINDEX=10
IOC Sports Medicine Diploma – http://www.iocsportsmedicine.com/
IOC Sports Nutrition Diploma - http://www.sportsoracle.com/Nutrition/Home/
https://twitter.com/bjsm_bmj
https://www.facebook.com/BJSM.BMJ
https://plus.google.com/+BJSMVideos/posts
BJSM App
iTunes - https://itunes.apple.com/us/app/bjsm/id943071687?mt=8
Google Play - https://play.google.com/store/apps/details?id=com.goodbarber.bjsm

Children with chronic diseases can exercise too! Diabetes to organ transplant – Ex is medicine!

Dr Carolyn Broderick provides practical examples of the type of physical exercise that is feasible in children with chronic diseases, such as diabetes, mitochondrial myopathy, haemophilia, or after an organ transplantation. She also discusses the risk of injury during the growth spurt and how to best avoid these injuries.
Dr Broderick, MBBS, FACSP, PhD, is a staff specialist in Sport and Exercise Medicine at the Children’s Hospital at Westmead, Australia. She was Medical Director of the Australian Team for the Youth Olympic Games in 2014 and Team Physician for the Australian Team at the Sydney 2000 and London 2012 Olympic Games. She is a member of the Australian Olympic Committee Medical Commission and Deputy Medical Director for the Australian Olympic Team in Rio 2016. Her research interests include injury surveillance in youth sport and physical activity in children with chronic disease.
Further Reading:
Fundamental movement skills, physical fitness and physical activity among Australian children with juvenile idiopathic arthritis.
Hulsegge G, Henschke N, …Broderick C, et al.
J Paediatr Child Health. 2015 Apr;51(4):425-32. doi: 10.1111/jpc.12733.
http://www.jsams.org/article/S1440-2440%2812%2900661-5/abstract
Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative interventions.
Michaleff ZA, Kamper SJ, Maher CG, Evans R, Broderick C, Henschke N.
Eur Spine J. 2014 Oct;23(10):2046-58. doi: 10.1007/s00586-014-3461-1.
http://link.springer.com/article/10.1007%2Fs00586-014-3461-1
A feasibility study of the effect of intra-articular corticosteroid injection on isokinetic muscle strength in children with juvenile idiopathic arthritis.
McKay D, Ostring G, Broderick C, Chaitow J, Singh-Grewal D.
Pediatr Exerc Sci. 2013 May;25(2):221-37. Epub 2013 Mar 15.
http://www.ncbi.nlm.nih.gov/pubmed/23504857
Evaluation and management of bleeding risks with athletic activities in children with hemophilia.
Broderick C.
Clin Adv Hematol Oncol. 2013 Jan;11(1):46-7. No abstract available.
Mol Cancer. 2013 Feb 1;12:7. doi: 10.1186/1476-4598-12-7.
http://www.ncbi.nlm.nih.gov/pubmed/23416863
Association between physical activity and risk of bleeding in children with hemophilia.
Broderick CR, Herbert RD, Latimer J, Barnes C, Curtin JA, Mathieu E, Monagle P, Brown SA.
JAMA. 2012 Oct 10;308(14):1452-9. doi: 10.1001/jama.2012.12727.
http://jama.jamanetwork.com/article.aspx?articleid=1377921
Patterns of physical activity in children with haemophilia.
Broderick CR, Herbert RD, Latimer J, van Doorn N.
Haemophilia. 2013 Jan;19(1):59-64. doi: 10.1111/j.1365-2516.2012.02904.x.
The International Olympic Committee Consensus statement on age determination in high-level young athletes.
Engebretsen L, Steffen K, Bahr R, et al. Br J Sports Med. 2010 Jun;44(7):476-84. doi: 10.1136/bjsm.2010.073122. No abstract available. Erratum in: Br J Sports Med. 2010 Aug;44(10):770. http://bjsm.bmj.com/content/44/7/476.extract