BJSM Podcast

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/
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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

Travelling with teams? Practical tips for team clinicians; includes Athlete Management System

Dr Carolyn Broderick, MBBS, FACSP, PhD is staff specialist in Sport and Exercise Medicine at the Children’s Hospital at Westmead, Australia. Dr Carolyn is Team Physician for the Australian Federation Cup Tennis Team.
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 is on injury surveillance in youth sport and physical activity in children with chronic disease.
What are the challenges of being a team physician for tennis players who travel the world continually? Does an athlete management system help to monitor work load and injuries?
Musculoskeletal conditions in children and adolescents managed in Australian primary care. Henschke N, Harrison C, McKay D, Broderick C, Latimer J, Britt H, Maher CG. BMC Musculoskelet Disord. 2014 May 20;15:164.
doi: 10.1186/1471-2474-15-164.
http://www.biomedcentral.com/1471-2474/15/164
Children, sport and the Olympics: Observations from the Games of the XXX Olympiad in London. Broderick C. J Paediatr Child Health. 2013 Sep;49(9):701-3.
doi:10.1111/jpc.12217. http://onlinelibrary.wiley.com/doi/10.1111/jpc.12217/abstract
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. http://bjsm.bmj.com/content/44/7/476.extract
Reducing the risk of injury in young footballers.
Broderick C, McKay D. BMJ. 2009 Mar 18;338:b1050.
doi: 10.1136/bmj.b1050.
http://www.bmj.com/content/338/bmj.b1050

Managing load in young footballer–practical tips to customize treatment and training: Sam Blanchard

Kids as young as 8 years old sign with football clubs and live at Football Club Academies. One website describes the Brighton & Hove Albion FC Academy as “a place where dreams are fired, hopes are heightened and aspirations are raised.” Sam Blanchard (@SJBPhysio_sport) has had 4 years experience in junior development. He’s also a leader among the UK Physios in Sport (@SportsPhysios)
You’ll hear about (i) the typical day for a child/adolescent in this setting, (ii) how to vary training during the adolescent growth period to minimize risk of apophysitis etc. (iii) what to suggest to coaches and how to work with them, as well as (iv) practical tips for assessing maturity. Sam shares strategies for measuring load (including GPS) and uses that to both protect vulnerable athletes from injury as well as ensuring you can add the appropriate type of training as the child matures. A year after the growth spurt the adolescent can benefit from certain dynamic stabilization exercises or heavier resistance loads. In the 2nd half of the podcast Sam includes many practical tips from his vast experience.
Remember the UK Physios in Sport Annual Conference ‘The Younger Athlete’: Brighton, October, 9th & 10th October. http://bit.ly/1cLwHeX
Sam’s first BJSM podcast is on growth-related sport injuries: http://bit.ly/1HqnXsf

Is K-taping effective sports taping? Part 2 with UK Physios In Sport’s Chris McNicholl

K-tape is ubiquitous in top sport. Does it boost performance or prevent injury? In this 2nd podcast about tape, two-time Commonwealth Games and Olympic Games physiotherapist Chris McNicholl shares his clinical wisdom and his scrutiny of the literature.
See below for list of papers that Chris mentions and here’s the link to his other podcast – on regular taping. http://bit.ly/1bUnP5U
Don’t forget to check out the UK Physios Taping courses here: http://www.physiosinsport.org/courses.html
Schiffer T, J Sport Rehabil. 2015 Feb;24(1):47-50. Kinesio taping and jump performance in elite female track and field athletes and jump performance in elite female track and field athletes.
Nunes GS, Effect of kinesio taping on jumping and balance in athletes: a crossover randomized controlled trial. J Strength Cond Res. 2013 Nov;27(11):3183-9.
Poon KY, Kinesiology tape does not facilitate muscle performance: A deceptive controlled trial.Man Ther. 2015 Feb;20(1):130-3. http://www.ncbi.nlm.nih.gov/pubmed/?term=j+strength+cond+res++tape+volleyball+soccer
Parreira P C, Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-specific low back pain: a randomised trial., J Physiother. 2014 Jun;60(2):90-6. http://www.ncbi.nlm.nih.gov/pubmed/24952836
Kachanathu SJ Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain. J Phys Ther Sci. 2014 Aug;26(8):1185-8. http://www.ncbi.nlm.nih.gov/pubmed/25202177
Shaheen AF, Rigid and Elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. J Electromyogr Kinesiol. 2015 Feb;25(1):84-92 http://www.ncbi.nlm.nih.gov/pubmed/25138646
Link to a BJSM paper on K-tape:
Br J Sports Med doi:10.1136/bjsports-2014-094151 Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. http://bjsm.bmj.com/content/early/2015/01/16/bjsports-2014-094151.abstract

You can’t outrun a bad diet: @DrAseemMalhotra on weight loss strategies

You or your patient wants to lose weight. What gives you the best bang for your buck? BJSM editor Karim Khan puts London cardiologist and physical activity champion Dr Aseem Malhotra under the glaring lights. This podcast follows up the free BJSM editorial 'It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet'
Here’s the link to the related BJSM editorial: http://bjsm.bmj.com/content/early/2015/05/07/bjsports-2015-094911.full
You can also listen to Dr Malhotra discuss the role of diet and cardiovascular risk factors here: https://soundcloud.com/bmjpodcasts/aseem-malhotra-dont-fear-the-fat?in=bmjpodcasts/sets/bjsm-1

Why patients and docs make poor decisions. Challenge of evidence in practice. Steve Stovitz (AMSSM)

Steven Stovitz, MD, MS, directs the University of Minnesota’s Program in Primary Care Sports Medicine and is the associate director of the University of Minnesota’s Sports Medicine Fellowship. His clinical work is divided between the University of Minnesota’s Sports Medicine clinic and Orthopedic clinic along with the athletics department, where he is a team physician for University’s athletes.
Dr. Stovitz’s research involves the intersection of clinical medicine and epidemiology, as well as a variety of issues related to the study of obesity. He is a fellow of the American College of Sports Medicine and a senior associate editor with the BJSM.
He has a special interest in evidence informed medicine and he challenges us with specific clinical settings where patients and doctors commonly make ‘inferior’ choices. Why does this happen? A thought-provoking podcast that may be best enjoyed at home with focus rather than driving on a windy coastal road!
See also:
Stovitz SD, Shrier I. Sickle cell trait, exertion-related death and confounded estimates.
http://bjsm.bmj.com/content/48/4/285.long
Stovitz SD, Shrier I. Medical decision making and the importance of baseline risk.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809433/
Stovitz SD. Confusion surrounding false-positive rates: distinguishing the definition from the important clinical question. Curr Sports Med Rep. 2014
Mar-Apr;13(2):69-70. doi: 10.1249/JSR.0000000000000032. PubMed PMID: 24614417.
Stovitz SD, Shrier I. Injury rates in team sport events: tackling challenges in assessing exposure time.
http://bjsm.bmj.com/content/46/14/960.long

On the Edge: Expedition and Wilderness Medicine with Russell Hearn

Dr Russell Hearn has a portfolio career that sees him balance his time between working in general practice in London and Expedition & Wilderness Medicine. He directs and teaches on the Expedition & Wilderness medicine components at Kings College London (KCL) and University College of London (UCL) & is also an Advanced Life Support Instructor.
In recognition of providing high-level medical cover for various expeditions and extreme events, Dr Hearn was elected a fellow of the Wilderness Medicine Society in 2013.
In this podcast, Dr Liam West (@Liam_West) poses questions that see Dr Hearn take listeners through what it is like to work within these extreme conditions, tips on how to provide optimal medical cover and how to get involved.
Useful Resources:
Wilderness medicine society of America – consensus documents
http://www.ncbi.nlm.nih.gov/pubmed/20591379 - High Altitude Illness
http://www.ncbi.nlm.nih.gov/pubmed/25498264 - Hypothermia
http://www.ncbi.nlm.nih.gov/pubmed/25498262 - Frist Bite
http://www.ncbi.nlm.nih.gov/pubmed/25498263 - Heat Related Illness
http://www.ncbi.nlm.nih.gov/pubmed/25498265 - Lightning Injuries
http://www.ncbi.nlm.nih.gov/pubmed/25498266 - Acute Pain in Remote Locations
http://www.ncbi.nlm.nih.gov/pubmed/25498256 - Spinal Immobilization in Austere Environment
http://www.ncbi.nlm.nih.gov/pubmed/25498257 - Wound Management in Austere Environment
http://www.ncbi.nlm.nih.gov/pubmed/25498260 - Exercise-Associated Hyponatraemia
International World Extreme Medicine Conference & Expo
http://www.extrememedicineexpo.com
Fellowship Programme of the Academy of Wilderness Medicine (America)
http://www.expeditionmedicine.co.uk/index.php/advice/resource/r-0082.html
Diploma in Medical Care of Conflict and Catastrophes – Worshipful Society of Apothecaries, London
http://www.apothecaries.org/faculty-of-the-conflict-catastrophe-medicine/course-in-conflict-catastrophe-medicine
KCL Wilderness Medicine SSC Website
http://www.wildernessmedic.org

An inside view: Who should lead rehabilitation in elite teams? Sports physios or rehab?

Podcast titles are limited to 100 characters; the ideal title would have been…”Working as a multidisciplinary team in elite sport – the role of physiotherapy, strength and conditioning teams, medical folks, soft tissue therapists, exercise rehabilitators etc.”.

A leading elite team physiotherapist (Andrew Wallis, PT) and a head of sports science/conditioning (Darren Burgess, PhD) provide you the inside view from within two elite teams. And they have international experience before their current jobs.
You’ll hear WHO these teams include on the sports medicine payroll. Our hosts (Ebonie Rio, David Opar) ask whose head would be on the chopping block if there was a rash of hamstring strains after a vigorous pre-season training. Is one hamstring injury recurrence among 10 players worth 9 players coming back a week early? What about sending players to the funky treatment’ clinician – flying for the miracle cure?
Apologies for a bit of shuffling noise in Andrew’s first two answers but it disappears. Well worth pushing through that distraction (we are working on trying to get sound quality like in Jack Chew’s podcasts!).
Confident you’ll love this inside view!
Darren Burgess is High Performance Manager at Port Adelaide Football (AFL) Club. Darren was Head of Fitness and Conditioning at Liverpool Football Club. Darren completed his PhD in movement analysis of AFL and Soccer in 2012. http://www.portadelaidefc.com.au/
Andrew Wallis is head physiotherapist at the St Kilda Football Club and has been there for the last 8 years. He has a special interest in Hip and Groin pathology and consults privately at Melbourne Orthopaedic Group and Malvern Sports Medicine Centre. http://www.saints.com.au/
Relevant papers:
Seasonal Training Load Quantification in Elite English Premier League Soccer Players.
Malone JJ, Di Michele R, Morgans R, Burgess D, Morton JP, Drust B.
Int J Sports Physiol Perform. 2014 Nov 13. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/25393111
Countermovement jump performance is not affected during an in-season training microcycle in elite youth soccer players.
Malone JJ, Murtagh CF, Morgans R, Burgess DJ, Morton JP, Drust B.
J Strength Cond Res. 2015 Mar;29(3):752-7. doi: 10.1519/JSC.0000000000000701.
http://www.ncbi.nlm.nih.gov/pubmed/25226317
Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme.
Brukner P, Nealon A, Morgan C, Burgess D, Dunn A.
Br J Sports Med. 2014 Jun;48(11):929-38. doi: 10.1136/bjsports-2012-091400. http://bjsm.bmj.com/content/48/11/929.long