BJSM Podcast

Prof Mario Maas on what sports clinicians need to know about radiology

Prof Mario Maas is professor of radiology, in particular musculoskeletal radiology, at the Academic Medical Centre in Amsterdam. His focus of research includes joint and tendon disorders, muscle pathology and sports imaging and he is a regular contributor to the BJSM I-test series.
Mario Maas explains the essence of sports imaging and what information a sports physician should include to make his referral note even more useful. He describes what he wants his students, fellows and young doctors to learn about sports medicine and what makes a good teacher.
Finally, he shares with us the aims and mission of ACES, the Academic Centre for Evidence Based Sports Medicine.
See also:
Predicting return to play after hamstring injuries
http://goo.gl/9uvlVf
MRI observations at return to play of clinically recovered hamstring injuries
http://bjsm.bmj.com/content/48/18/1370.long
I-test: a gymnast with anterior knee pain: not a typical case of jumper's knee
http://bjsm.bmj.com/content/48/6/476.extract
An 11-year-old high-level competitive gymnast with back pain
http://bjsm.bmj.com/content/47/14/929.extract
A long-distance runner with lateral knee pain
http://bjsm.bmj.com/content/44/16/1209.1.extract
Imaging techniques in sports medicine
http://www.ncbi.nlm.nih.gov/pubmed/19785847

Osteopath Rosi Sexton on mixed martial arts

In this podcast James Walsh talks with professional mixed martial artist (MMA) and osteopath Rosi Sexton.
They discuss performance enhancing drug use within MMA, the challenges of promoting a new sport to the public, and training and injury within MMA.

Dr Shabaaz Mughal (Tottenham) and Dr Ian Beasley Medical (FA) on new concussion protocols/rules

In this podcast James Walsh talks with Dr Shabaaz Mughal Tottenham Hotspurs team docor and Dr Ian Beasley Medical director of the FA about head injuries in football.
They discuss the new concussion protocols that have come in this season, rule changes and the FA’s “Use your head campaign”.
http://www.thefa.com/news/2014/aug/head-injuries-in-football

Dr Alison Grimaldi with practical physiotherapy tips on treating lateral hip pain

With over twenty years' experience, accreditation in Sports Physiotherapy, and a recent PhD in the topic of lateral hip pain, Alison Grimaldi (@AlisonGrimaldi) was invited to this podcast by BJSM’s Twitter community.
She is a popular conference speaker internationally. Here she walks you through each step of the assessment and treatment of an older patient with right hip pain. She then shares how to assess and treat a younger sportsperson.
In both cases, Dr Grimaldi emphasizes that compression is bad for tendons that run over bony prominences (trochanter in this case) and indicates how this can be addressed.
Enjoy one of our most practical podcasts. Recorded at the Physiotherapy New Zealand Conference, Auckland (September 2014) with thanks to the NZ Sports Physiotherapy Interest Group (@SportsPhysioNZ).
Links:
1) JL Cook, C Purdam Is compressive load a factor in the development of tendinopathy? Br J Sports Med 46(3):163-8. 2012 http://bjsm.bmj.com/content/46/3/163.abstract
2) Fearon A, Stephens S, Cook J, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. Br J Sports Med. 2012 http://bjsm.bmj.com/content/46/12/888.long

Diagnosing and treating acute hamstring injuries

This is a podcast by Dr Robert-Jan de Vos, sports physician in the Erasmus Medical Centre in the Netherlands, with Guustaaf Reurink, who is a registrar in Sports medicine in the Netherlands and is currently finishing his thesis on diagnosis and treatment of acute hamstring injuries. Recently, he published a paper in the New England Journal of Medicine about the role of Platelet-rich Plasma (PRP) treatment for acute hamstring injuries (http://www.nejm.org/doi/full/10.1056/NEJMc1402340).
We start with discussing this interesting study, which did not show a benefit of PRP injections in acute hamstring injuries. Dr Reurink expresses the methods and results of this study and possible explanations for these findings are debated.
Dr Reurink also performed a number of studies on the value of clinical tests and Magnetic Resonance Imaging (MRI) in acute hamstring injuries. Previously, he already showed that most MRIs are still abnormal when the athlete already returned to gameplay (http://bjsm.bmj.com/content/early/2013/11/19/bjsports-2013-092450.abstract?eaf).
We close by discussing the role of MRI and standardised clinical tests as a predictor of time to return to play and re-injury.

Prof. Kay Crossley on treatment for patellofemoral pain

Are you old enough to remember the storm when Jenny McConnell first proposed new exercise and taping procedures for patellofemoral pain (PFP)? It revolutionised rehabilitation for the many sufferers of the condition and it promoted much-needed research. So do we still need to tape and focus on the vastus medialis?
Professor Kay Crossley of La Trobe University is a present-day expert in PFP, having completed several key RCTs on patellofemoral pain. She discusses (i) the outcomes of the 3rd International Patellofemoral Retreat (BJSM 2014, see below), (ii) the best PFP treatments and evidence for them as well as (iii) new insights into knee pain after ACL reconstruction.
See also the following papers:
Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial http://goo.gl/yhPfxp
Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013 http://goo.gl/CxgClm
Is patellofemoral osteoarthritis a common sequela of patellofemoral pain? http://goo.gl/Z8Aw1Y

Managing muscle injuries – Does the Munich Consensus Statement help? Part 2 of 2

Dr G.M.M.J. (Gino) Kerkhoffs is professor of Orthopaedics at the Faculty of Medicine of the University of Amsterdam (AMC-UvA), with a special emphasis on sports traumatology.
Grading of muscle injuries should have a big influence on time to return to sport but it’s not so easy!
Babette Pluim asks Prof Kerkhoffs how the Munich Consensus Statement of terminology and classification of muscle injuries in sport was developed. And what are the practical implications for clinicians?
Prof Kerkhoffs also shares his dream about the development of a centre of expertise for the advancement of care for injured athletes, with integrated diagnostics, customised treatment and monitoring of treatment results in Amsterdam, and the steps that have already been taken.
See also:
Terminology and classification of muscle injuries in sport: the Munich consensus statement http://goo.gl/7tM2PF
https://www.amc.nl/web/Het-AMC/Afdelingen/Medische-afdelingen/Orthopedie/Orthopedie/Afdeling.htm
Amsterdam Institute of Sports Sciences: http://aiss.nl/

Managing the difficult ankle and foot with Prof Gino Kerkhoffs - Part 1 of 2

Dr Gino Kerkhoffs is professor of Orthopaedics at the Faculty of Medicine of the University of Amsterdam (AMC-UvA), with a special emphasis on sports traumatology.
He shares his expertise on ankle injuries with Dr Babette Pluim, and discusses evidence based treatment options of ankle impingement, ligament injuries and osteochondral lesions.
Prof Kerkhoffs also discusses treatment of the slow healing metatarsal V stress fractures.
See also:
Economic evaluations of diagnostic tests: treatment and prevention for lateral ankle sprains: a systematic review
http://goo.gl/Pn9FMp
A twist on the athlete's ankle twist: some ankles are more equal than others http://goo.gl/3FhGBT
Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline http://goo.gl/7ITP7S
Treatment of proximal metatarsal V fractures in athletes and non-athletes http://goo.gl/fKaib6

Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’

Peter O’Sullivan has two recent BJSM podcasts (see below). In this podcast he shares his thoughts on the recent media attention around Tiger Woods' obvious back pain while playing in the US PGA.
He discusses what the pathology might be, why the media suggested that Mr Woods’ ‘sacrum went out’. He contends that ‘core strengthening’ may not be the panacea.
The lessons apply to the management of low back pain, and other pain, in a myriad of settings.
See also
Read Professor O'Sullivan's blog on Tiger Wood's back pain: http://bit.ly/1zaISGz
Listen to his podcast on lower back pain: http://goo.gl/jrQxSe
Listen to his podcast on overtreatment and overdiagnosis in sports medicine: http://goo.gl/vPZ3g8

Michael Kjaer on the pathogenesis of tendinopathy and tendon healing

Professor Michael Kjaer is Professor in Sports Medicine at the Institute of Sports Medicine and Centre for Healthy Ageing in Copenhagen, Denmark. He has published articles in the areas of Sports Medicine and muscle and tendon adaptation at the structural and mechanical levels as well as at the cellular and molecular level. Michael is interested in mechanisms of adaptations to muscle and tendon following exercise, disuse, disease and ageing.
In this podcast on tendon and tendon pathology he gives a synthesis of seven models of tendinopathy, explains the difference between mid-tendon and insertional tendinopathy, presents his views on the healing capacity of tendons, talks about the (absence of a) link between tendinopathy and tendon rupture, and discusses the various interventions that are used in an attempt to promote tendon healing, including eccentric and concentric exercises.
Links to articles:
Heinemeier KM, Schjerling P, Heinemeier J, Magnusson SP, and Kjaer M. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb 14C. FASEB Journal 2013;27:2074–9. http://goo.gl/MRmulq
Kjaer M. Role of extracellular matrix in adaptation of tendon and skeletal muscle to machanical loading. Physiol Rev 2004;84:649-8. http://goo.gl/tEiirg
Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol 2010;6:262-8. http://goo.gl/s1dpDc