BJSM Podcast

Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus

Dr. Jason Fung is a Consultant Nephrologist who trained and began his medical career at the University of Toronto before heading to the University of California in Los Angeles where he completed his fellowship in nephrology. Since then he has founded the Intensive Dietary Management Program, which provides a unique treatment for Type 2 Diabetes & Obesity.
This BJSM podcast sees @Liam_West pose the questions and Dr. Fung take the listeners through the evidence behind the impact of diet on obesity and Type 2 Diabetes Mellitus (T2DM). Jason explains that, whilst the #LCHF model of “Carbohydrates  Insulin  Obesity” is not wrong, it is incomplete. He reiterates that the main player in the development of obesity and T2DM is INSULIN – not merely high carbohydrates.
Jason believes that the calories in/calories out model that has previously been described is incorrect. He explains the evidence and builds upon the #LCHF model to include the importance of insulin resistance and meal timing. In T2DM, this resistance leads to Beta-cell dysfunction. Evidence exists that this process can be reversed and therefore T2DM should not be considered to be a chronic progressive disease – it is curable with bariatric surgery and caloric prescription.
The take home message for the podcast from Jason is to eat #RealFood, #ConsiderInsulin and #EmpowerPatients to regain control over diabetes.
Literature Discussed in Podcast & Further Reading
INTERMAP Study (2003) - http://www.nature.com/jhh/journal/v17/n9/abs/1001605a.html
KITAVA Study (1995)- http://www.sciencedirect.com/science/article/pii/S0026049599902585
Insulin Resistance - One - http://link.springer.com/article/10.1007/BF00279918
Insulin Resistance - Two - http://www.sciencedirect.com/science/article/pii/S0025712507000983
Insulin Resistance - Three - http://diabetes.diabetesjournals.org/content/56/4/984.short
Lancet Infant Obesity (2010) - http://www.sciencedirect.com/science/article/pii/S0140673610601717
NEWCASTLE Study (2009) - http://www.biomedcentral.com/1471-2458/9/342/
Dietary Fibre reduces Insulin Resistance - http://jama.jamanetwork.com/article.aspx%3FarticleID=192034
Curing Diabetes – Surgical treatment diabetes - http://ajcn.nutrition.org/content/55/2/582S.short
Curing Diabetes - Gastric Banding - http://jama.jamanetwork.com/article.aspx%3Farticleid=1149302
Curing Diabetes - Fasting & Bariatric Surgery - http://care.diabetesjournals.org/content/36/9/2741.short
Curing Diabetes - ACCORD - http://www.nejm.org/doi/full/10.1056/NEJMe0804182
Curing Diabetes - Losing weight doesn’t work - http://www.nejm.org/doi/full/10.1056/NEJMoa033179
Curing Diabetes - Calorie restriction induces restoration of hepatic insulin sensitivity - http://care.diabetesjournals.org/content/36/4/1047.short
Intensive Dietary Management Website - With educational lectures and other content - http://intensivedietarymanagement.com

Complete AC joint dislocation (Grade 3): What’s best management? Bob McCormack (Olympic physician)

Modern surgical techniques can make a traditional treatment obsolete. Think of the Herbert screw for scaphoid fracture. Professor Bob McCormack tested a new hook plate in a Canadian multi-centre trial of management of complete dissociation & dislocation of the AC joint. You have to listen to find out how the story ends!
Enjoy this 3rd of Bob McCormack’s 3 BJSM podcasts.
You can find Bob’s other podcasts here:
1. First time shoulder dislocation: https://soundcloud.com/bmjpodcasts/shoulder-dislocation-to-operate-or-rehabilitate-prof-bob-mccormack-olympic-physician?in=bmjpodcasts/sets/bjsm-1
2. Managing mid-clavicular fractures. https://soundcloud.com/bmjpodcasts/mid-clavicular-fracture-open-surgery-or-collar-cuff-prof-bob-mccormack-olympic-physician?in=bmjpodcasts/sets/bjsm-1

Management of difficult stress fractures in sport

Drs. M.P. (Rien) Heijboer, orthopedic surgeon, works at the Dept at Orthopedic at the Erasamus Medical Centre in Rotterdam.
He has extensive experience with sports-related injuries and has worked for more than 30 years as medical adviser of football club Feijenoord in Rotterdam. He is a member of the medical staff of the Dutch National Soccer Team and visited the world soccer championships in Brasil in 2014, which he describes as a "life-time experience"!
He is president of the Dutch Orthopedic Society (NOV).
He has a great interest in sports-related injuries and today Rien discusses his lifetime experience of managing difficult stress fractures in sport.
Further reading:
Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review.
http://bjsm.bmj.com/content/49/6/370.long
Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW.
Br J Sports Med. 2015 Mar;49(6):370-376. doi: 10.1136/bjsports-2013-093246. Epub 2014 Aug 19. Review.
Ultrasonography of fractures in sports medicine.
http://bjsm.bmj.com/content/49/3/152.long
Hoffman DF, Adams E, Bianchi S.
Br J Sports Med. 2015 Feb;49(3):152-60. doi: 10.1136/bjsports-2014-094217. Epub 2014 Dec 24.
Fifth metatarsal fractures among male professional footballers: a potential career-ending disease.
http://bjsm.bmj.com/content/47/12/754.long
Ekstrand J, van Dijk CN.
Br J Sports Med. 2013 Aug;47(12):754-8. doi: 10.1136/bjsports-2012-092096. Epub 2013 Apr 9.

Effective ankle taping: Mechanisms, myths and more….(Part 1)

Chris McNicholl brings the experience of the Olympic Games and two Commonwealth Games to his sports taping courses for UK Physios in Sport. In this podcast we dig below the surface. Does taping really prevent injuries and if so, how? We cover lower limb, upper limb, joints & muscles. Football and rugby. But we keep the issue of Kinesio-tape for a separate podcast.
You’ll hear Chris refer to the following papers:
Tricia J. Hubbard, et al. Effect of Ankle Taping on Mechanical Laxity in Chronic Ankle Instability Foot & Ankle International/Vol. 31, No. 6/June 2010
Heather Miller et al. Role of External Prophylactic Support in Restricting Accessory Ankle Motion after Exercise Foot Ankle Int 2012 33: 862
Karl Stoffel et al. Effect of Ankle Taping on Knee and Ankle. Joint Biomechanics in Sporting Tasks. MEDICINE & SCIENCE IN SPORTS & EXERCISE 2010
Eamonn Delahut et al. Altered Neuromuscular Control and Ankle Joint Kinematics During Walking in Subjects With Functional Instability of the Ankle Joint. The American Journal of Sports Medicine, Vol. 34, No. 12 2006

Major debate about energy deficiency among sportspeople: New ‘RED-S’ by Dr Margo Mountjoy

‘Relative energy deficiency in sport’ (RED-S) refers to impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. You will hear McMaster University’s Dr Margo Mountjoy clarify the IOC’s consensus statement on this condition. Why it was needed. What the controversies are. And what clinicians can do in the clinic. Dr Mountjoy walks you through the new clinical tool the RED-S Clinical Assessment Tool (CAT) that uses a simple ‘green’, ‘orange’ and ‘red’ traffic light system for clinicians managing athletes who may be suffering the effects of insufficient energy intake.
The original 2014 consensus statement is here: http://bjsm.bmj.com/content/48/7/491
The 2015 update/extension is here: http://bjsm.bmj.com/content/49/7/417.full
And the clinical assessment tool (CAT) is here: http://bjsm.bmj.com/content/49/7/421.full.pdf+html

Arthritis Research UK Centre: Putting osteoarthritis in the spotlight

Professor Mark Batt graduated from Cambridge University Medical School in 1984 and trained in Family Medicine. He obtained a Diploma in Sports Medicine from the University of
London in 1991 and completed a fellowship in Sports Medicine at the University of California, Davis in 1993. Since 1995, he has been in Nottingham, United Kingdom, as a consultant/senior lecturer in Sport and Exercise Medicine at the Nottingham University Hospitals where he was appointed Special Professor in 2004.
He serves or served as a consultant for The England and Wales Cricket Board, The Rugby Football League, British Gymnastics, The English Institute of Sport, The Wimbledon Tennis Championships, ATP and the WTA.
He is immediate past-president of the Faculty of Sport & Exercise Medicine and past Chairman of the Specialist Advisory Committee in SEM. He chaired the work-group which produced the successful case for SEM as a specialty of medicine (2005). He is director of the Arthritis Research UK (ARUK) Centre for Sport, Exercise and Osteoarthritis: a consortium of Nottingham, Oxford, Southampton, Bath, Loughborough, UCL and Leeds Universities investigating the relationship between acute and overuse injury and subsequent Osteoarthritis.
In this podcast, Dr. Liam West (@Liam_West) poses questions that see Prof Batt take listeners through the objectives and aims of the ARUK centre and the research it is currently
working on. Prof Batt also gives his views on how to ensure that research remains clinically relevant before finishing the podcast discussion the future avenues for the treatment of
osteoarthritis.
Further Reading
ARUK Centre for Sport, Exercise and Osteoarthritis -
http://www.sportsarthritisresearchuk.org/seoa/index.aspx
ARUK Research Projects - http://www.sportsarthritisresearchuk.org/seoa/research-projects/index.aspx
ARUK Work Packages - http://www.sportsarthritisresearchuk.org/seoa/work-packages/workpackages.aspx
ARUK Centre Publications - http://www.sportsarthritisresearchuk.org/seoa/publications/index.aspx
Isokinetic Football Medicine Conference, 11-12th April 2015, QEII Conference Centre, London
http://www.footballmedicinestrategies.com/en/
Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis http://bjsm.bmj.com/content/48/21/1579.abstract

Optimal types of exercise for lower limb osteoarthritis http://bjsm.bmj.com/content/early/2014/02/18/bjsports-2013-093384.full

No benefit of surgery over physiotherapy for meniscal tears in adults with knee osteoarthritis http://bjsm.bmj.com/content/48/9/797
Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective http://bjsm.bmj.com/content/early/2011/02/17/bjsm.2010.081984
Osteoarthritis in football: FIFA/F-MARC approach http://bjsm.bmj.com/content/45/8/673.extract

British Association of Sport Rehabilitators and Trainers (UK and Ireland)

Sports rehabilitators and trainers specialise in exercise and sports rehabilitation and managing musculoskeletal conditions. They also promote exercise and healthy lifestyles. Listen here to BASRaT Chairman, Steve Aspinall from the University of Salford, and Continuing Professional Development Officer, Allan Munroe, University of Bradford. In addition to painting the picture of the profession, and the training pathway, our guests highlight BASRaT’s clinical contribution to Team True Spirit (rehabilitation of seriously injured servicemen ) and the Rugby Football Union (concussion information and management).

Physiotherapist Chris Swier on the ATP World Tour

Chris Swier is a sports physiotherapist and has a Masters degree in Business Administration. As a physiotherapist, he has specialised in dry needling and myofascial release techniques.
In 2006, he joined the ATP Medical Services Committee as one of their Sports Medicine Therapists on the ATP Wold Tour, traveling from tournament to tournament.
He continues to work in clinical practice, mainly for Manual Fysion in Amsterdam. Chris has also worked with Dutch women's volleyball, Dutch Beach Volleyball and even the Argentinian Davis Cup team!
His main interests include sports and orthopaedic rehabilitation of the ankle, knee, hip and shoulder.
At the ATP World Tennis Tournament in Rotterdam he talks about his life and work on the ATP World Tour.

Effective treatments for back pain: Kieran O’Sullivan’s practical tips within a guiding framework

Physical rehab (physiotherapy), behavioural rehab and combinations of these have been mainstays of back pain treatment. Dr Kieran O’Sullivan shares his expertise on what to do and what not to do – lessons from 15 years of providing specialised clinical care and engaging in top level research.
Specifically, what is the role of patient advice, targeted exercises, and novel therapies including injections?
You can link to Dr O’Sullivan’s home page at the University of Limerick here: http://www.ul.ie/clinicaltherapies/node/443
Interested in back pain? Related resources:
Editorial: Common misconceptions about back pain in sport: Tiger Woods’ case brings five fundamental questions into sharp focus
http://bjsm.bmj.com/content/early/2015/02/08/bjsports-2014-094542.extract
Podcast: Professor Peter O’Sullivan on Tiger Woods’ back and ‘core strength’
https://soundcloud.com/bmjpodcasts/professor-peter-osullivan-peteosullivanpt-on-tiger-woods-back-and-core-strength?in=bmjpodcasts/sets/bjsm-1

Improving day-to-day physiotherapy practice

Professor Chad Cook is a clinical researcher, physical therapist, and profession advocate with a long history of clinical care excellence and service.
In this podcast he shares his passion for refining and improving the patient examination process and validating tools used in day-to-day physical therapist practice. His books, including Orthopaedic Manual Therapy, are game changers.
For shoulder examination, Professor Cook refers to this paper in Physical Therapy in Sport. 2014 Aug 10. Combining orthopedic special tests to improve diagnosis of shoulder pathology: http://goo.gl/5wJzDe