BJSM Podcast

Managing the PAINFUL hip and groin in sport – a focus on conservative Rx – Prof Mike Reiman (Part 2)

This podcast logically follows (Part 1) below but it stands alone as well. Painful hip and groin pain requires a careful history looking for aggravating factors and risk factors, as well as targeted physical examination including but not limited to the hip and groin. Duke University’s Associate Prof Mike Reiman shares specific tips for both assessing, and rehabilitating, the patient with hip and groin pain.
See also:
Jo Kemp, Kay Crossley, Ewa Roos. What fooled us in the knee may trip us up in the hip: lessons from arthroscopy: bit.ly/1pifElu
Per Holmich, Kristian Thorborg, Pedersen Nyvold. Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain?: bit.ly/1ic7PPu
UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons: http://bjsm.bmj.com/content/43/13/1036.full
Risk factors for groin/hip injuries in field-based sports: a systematic review: http://bjsm.bmj.com/content/48/14/1089.full
The association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition: http://bjsm.bmj.com/content/44/11/799.full
Hip flexibility and strength measures: reliability and association with athletic groin pain: http://bjsm.bmj.com/content/43/10/739.abstract
Jon Patricios - Hip injuries in sport, in association with SASMA: https://soundcloud.com/bmjpodcasts/hip-injuries-in-sport-in-association-with-sasma
Duke University’s Assoc Prof Mike Reiman on managing the stiff hip in sport – is it FAI? (Part 1): https://soundcloud.com/bmjpodcasts/duke-universitys-assoc-prof-mike-reiman-on-managing-the-stiff-hip-in-sport-is-it-fai-part-1

Duke University’s Assoc Prof Mike Reiman on managing the stiff hip in sport – is it FAI? (Part 1)

Managing the athlete with hip stiffness detected at a physical exam or in a PPE is one of the hottest topics of 2014. Some would argue that nothing needs to be done given that the patient is asymptomatic but on the other hand many orthopaedic papers argue for ‘preventive’ osteotomy. Is this ‘overdiagnosis’ and ‘overtreatment’? Mike Reiman is a highly respected clinician-academic and he has integrated the literature on this topic with his clinical expertise. A ‘must’ podcast for physiotherapists, ATCs and doctors who take care of active people.
See also:
Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis: bit.ly/1inIRfW
Physical examination tests for hip dysfunction and injury: bit.ly/1lHRoVP
Jo Kemp, Kay Crossley, Ewa Roos, What fooled us in the knee may trip us up in the hip: lessons from arthroscopy: bit.ly/1pifElu
Julianne Ryan, Neasa DeBurca, Karen McCreesh, Risk factors for groin/hip injuries in field-based sports: a systematic review: bit.ly/1sq5ip2
Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes: http://bjsm.bmj.com/content/48/14/1102.full
Jon Patricios - Hip injuries in sport, in association with SASMA: https://soundcloud.com/bmjpodcasts/hip-injuries-in-sport-in-association-with-sasma
Managing the PAINFUL hip and groin in sport – a focus on conservative Rx – Prof Mike Reiman (Part 2): https://soundcloud.com/bmjpodcasts/managing-the-painful-hip-and-groin-in-sport-a-focus-on-conservative-rx-mike-reiman-part-2

Jennie Morton - Treating performing artists and musicians

Jennie Morton is a UCL Honorary Lecturer on the MSc in Performing Arts Medicine, and lectures for The British Association for Performing Arts Medicine, Dance UK and many performing arts schools and teaching organisations. She also co-runs a dance school in Tring, Hertfordshire, and is a faculty member of The Wells Summer School with Dancers of the Royal Ballet. She still performs as a professional singer with the Manhattan Music.
She speaks with James Walsh about the challenges of treating performing artists and musicians, her work with the British Association of Performing Arts Medicine(http://www.bapam.org.uk), and the crossover project with the american college of sports medicine (http://athletesandthearts.com/).
See also:
Fitness levels of middle aged martial art practitioners: http://bjsm.bmj.com/content/38/2/143.full
Risk of cervical injuries in mixed martial arts: http://bjsm.bmj.com/content/39/7/444.full
Dance training intensity at 11–14 years is associated with femoral torsion in classical ballet dancers: http://bjsm.bmj.com/content/40/4/299.full
Changes in hip and ankle range of motion and hip muscle strength in 8–11 year old novice female ballet dancers and controls: a 12 month follow up study: http://bjsm.bmj.com/content/35/1/54.full

Professor Lorimer Moseley on the brain and mind in chronic pain

Professor Lorimer Moseley holds the Inaugural Chair in Physiotherapy at the University of South Australia as well as being a Professor of Neurosciences. He completed his PhD in 2002 and has both learned and shared wisdom at the Universities of Queensland, Sydney and Oxford before settling in Adelaide. He leads the Body in Mind Research Group and coauthored the best-selling ‘Explain Pain’.
In this podcast he answers questions from Ebonie Rio, Department of Physiotherapy, Monash University, covering the important difference between pain and nociception, and sharing thoughts on how pain science can help clinicians working in sports medicine.
You’ll hear him share the best, and worst, ways to explain pain to patients. He predicts how low back pain management will look in 100 years’ time. As always with Lorimer Moseley. expect thoughtful reflections shared with big dob of humour and humility.
See also:
TEDx talk ‘Why things hurt’: http://www.youtube.com/watch?v=gwd-wLdIHjs
Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment http://goo.gl/zaNX8s
Are children who play a sport or a musical instrument better at motor imagery than children who do not? http://goo.gl/Xv9Qum
Exercise is medicine, for the body and the brain: http://bjsm.bmj.com/content/48/12/943.full
Chronic traumatic encephalopathy in sport: a systematic review: http://bjsm.bmj.com/content/48/2/84.full

Matthieu Sailly - Apophyseal injury in children and adolescents

Apophyseal injury in children and adolescents are common and usually respond to simple unloading interventions. But what is the underlying pathology and why do some children succumb and others not? And why do some apophyses become painful and others fail completely with a complete avulsion? Despite these questions it is an area that is under-researched and few people have a specific interest in this area.
Listen to the insights of Dr Matthieu Sailly, who is a French sports physician who has expertise and research interest in injuries in young athlete. He was the head of the Aspire Academy medical centre where he worked extensively with highly trained adolescent athletes and developed experience on growth related injuries and long term development strategies for immature athletes in various sports.
See also:
Physeal injuries in children’s and youth sports: reasons for concern?: http://bjsm.bmj.com/content/40/9/749.full
Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis: http://bjsm.bmj.com/content/41/11/827.full
“Goalkeeper’s hip”: acute haematogenous osteomyelitis secondary to apophyseal fractures: http://bjsm.bmj.com/content/40/9/808.full

‘Overdiagnosis’ in sports medicine? FAI for example? The great Ray Moynihan (‘Selling sickness’)

Over-diagnosis, over-treatment and industry influence. Surely not in sports medicine?
Ray Moynihan is an internationally renowned contributor in the battle to limit any inappropriate influence of pharmaceutical, diagnostic, and technology companies on good clinical practice.
He shares his concerns about the role of drug/implant companies but also argues that clinicians may well be contributing to suboptimal care – almost subconsciously. This is relevant for conditions such as femoroacetabular impingement (FAI). The issue of ‘preventive’ surgery to prevent future arthritis in currently pain-free hips is a massive issue in sports medicine of course. How do we know which patients need this treatment?
Enjoy this podcast from a voice outside BJSM’s traditional network of physiotherapists, physicians, massage therapists, clinicians working with active people.
When we planned the podcast, Ray Moynihan said he didn’t know about sport but I think you’ll agree that what he offers is hugely relevant to sport and exercise medicine. Thanks Ray!
And the 2nd ‘Preventing Overdiagosis’ conference is at Oxford from September 15-17 – just google ‘overdiagnosis conference’. Share your thoughts to @BJSM_BMJ - is this a problem in sports medicine?
See also:
Online First editorial about FAI: http://goo.gl/ziOLNz
In the June issue of BJSM we carry a review of PRP suggesting it isn’t helpful: http://goo.gl/xARb44
The authors of one of the key papers respond here:
http://goo.gl/B1hxqc
You can read several of Ray Moynihan’s papers in the BMJ including this one that summarises his thoughts on overdiagnosis:
http://goo.gl/8uxcGS
Repudiation of the ‘magic bullet’ approach to health improvement: a call to empower people to get moving and take charge: http://bjsm.bmj.com/content/46/5/303.full
‘Overdiagnosis’ / ‘overtreating’– relevant in sportsphysio/medicine? Professor Peter O’Sullivan: https://soundcloud.com/bmjpodcasts/overdiagnosis-overtreating-relevant-in-sportsphysiomedicine-peter-osullivan

Adam Meakins’ practical physio tips – explaining neural pain, shoulder rehab and managing knee load

Here’s the podcast that over 12,000 listeners have been demanding – physiotherapist Adam Meakins (@TheSportsPhysio)on a number of controversial topics, including:
Is diagnostic palpation accurate?
Can the sacroiliac joint really be ‘unstable’?
How does ‘touch’ in physiotherapy have its therapeutic effect?
Adam provides great value on Twitter and on his blog – here you can listen to him in your favourite podcast setting.
Adam shares his way of explaining neural pain to patients and that alone is worth the price.
He also discusses his popular blogs on ‘5 Least Favourite Shoulder Rehab Exercises’ as well as ‘Top 5 Shoulder Rehab Exercises’.
He argues that the key to managing some knee conditions is to manage load and he refers to Scott Dye’s classic ‘envelope of function’ concept.
And we close by discussing a couple of figures that have gained great traction in the Twittersphere. You might find them useful in your clinical practice. But it’s a risk on radio – I get that! Enjoy and comment via @BJSM_BMJ or on Facebook.
See also:
Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain: http://bjsm.bmj.com/content/47/17/1095.full
Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis: http://bjsm.bmj.com/content/48/16/1216.full
Rehabilitation for shoulder instability: http://bjsm.bmj.com/content/44/5/333.full
Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury: http://bjsm.bmj.com/content/45/4/245.full

Paul Dijkstra - Time for a different way to deliver care to high level athletes

Integrating athlete care – ‘one stop shop’ to optimize athlete care - sports medicine with a focus on PERFORMANCE.
Dr Paul Dijkstra has vast experience in elite track and field athlete care. He shares his experience from UK Athletics – the team won 4 gold medals at the London Olympic Games. What’s new in this approach? This model of athlete care emphasises the partnership among not only the health professionals, but also with the strength and conditioning team and the coach(es). Also emphasised is performance – too often clinicians tend to focus exclusively on health whereas the athlete’s focus is performance.
Dr Dijkstra provides case scenarios -- how the management model works in real life. He shares the public domain case of UK heptathlete Jessica Ennis who forewent the Beijing Olympic Games (2008) because of a navicular stress fracture, but chose full healing and a longer future over ‘patch up’ to get to the 2008 Olympic Games.
The paper outlining this approach was featured in the April issue of BJSM supported by the IOC (Injury Prevention, Health Protection). You can read the Open Access paper here: http://bjsm.bmj.com/content/48/7/523.full
See also:
Seeing you through London 2012: eye care at the Olympics: http://bjsm.bmj.com/content/47/7/463.full
The role of sports physiotherapy at the London 2012 Olympic Games: http://bjsm.bmj.com/content/48/1/63.full
The London 2012 Summer Olympic Games: an analysis of usage of the Olympic Village ‘Polyclinic’ by competing athletes: http://bjsm.bmj.com/content/47/7/415.full
Fit and healthy Paralympians—medical care guidelines for disabled athletes: a study of the injuries and illnesses incurred by the Polish Paralympic team in Beijing 2008 and London 2012: http://bjsm.bmj.com/content/47/13/844.full
Massage provision by physiotherapists at major athletics events between 1987 and 1998: http://bjsm.bmj.com/content/38/2/235.full
Care of the multisport athlete: lessons from Goldilocks: http://bjsm.bmj.com/content/45/14/1086.full
Public health implications of establishing a national programme to screen young athletes in the UK: http://bjsm.bmj.com/content/45/7/576.full
Suicide, sport and medicine: more education and awareness needed for athletes’ mental health: http://blogs.bmj.com/bjsm/2012/12/10/suicide-sport-and-medicine-more-education-and-awareness-needed-for-athletes-mental-health/
“How does a clinician know what’s in the athlete’s best interest?” An Olympic experience: http://blogs.bmj.com/bjsm/2012/08/24/what-defines-an-athletes-best-interest-an-olympic-experience/

Helping clinicians to turn evidence into practice – software for injury prevention and rehab

Isabel van Obergen and Hannes Cleppe discuss their prevention platform for sports: a software program (SpartaNova) that is in the ‘e-Health’ category for physiotherapy and sports medicine.
We begin with an obvious competing interest disclaimer. BJSM has no financial interest or association with SpartaNova. Because clinicians use specific products, such as ‘Theraband’ ® for example, BJSM will report on the utility of such products while being open about any competing interests. Have you considered using software in your practice? Feel free to suggest what we should assess. We love to share ‘success stories’ – and if a commercial product adds value for you we’d report that information.
Our guests in this podcast are the CEO of SpartaNova, (IvO) who was attending London’s ‘Leaders in Performance’ conference in 2013, and Hannes Cleppe, who trained as a physiotherapist in Belgium and the US before focusing on developing the injury prevention module for this product. The team includes active clinical advisors as well as experts in computer sciences and maths and closely co-operates with science partners from its founding universities and a broader network of researchers.
See also:
Developing an injury tracking software system specific for volleyball: a case example: http://bjsm.bmj.com/content/45/6/545.3.abstract
Visual or computer-based measurements: important for interpretation of athletes’ ECG: http://bjsm.bmj.com/content/48/9/761.full

Practical tips for in-season injury prevention and monitoring professional football players

With Rob Swire (Manchester United) and Stijn Vandenbroucke (Moscow Dynamo).
‘You always start off the season with a masterplan of what you are wanting to do but we’ve never had a master plan that works or goes anywhere near where it is supposed to, but you just try your best’. Given this validation of what you are doing, listen and see how you CAN make prevent injuries and improve team performance by working as a team with your other health professional as well as strength and conditioning colleagues.
It’s all about load monitoring and here you can hear from two very experienced physios in the field. What role GPS? What role other software? This is a scenario where ‘e-Health’ or ‘M-health’ meets performance.
Our guests speak about how to customise training and monitor players’ adaptation – What are the things to watch out for? When can a player return to training after an injury spell? Is the coach the greatest risk factor – and can the GPS help communicate load messages to the coach?
See also:
General practitioners’ perceptions and practices of physical activity counselling: changes over the past 10 years: http://bjsm.bmj.com/content/43/14/1149.full
Technology in Paralympic sport: performance enhancement or essential for performance?: http://bjsm.bmj.com/content/44/3/215.full
Planning and implementing a nationwide football-based health-education programme: http://bjsm.bmj.com/content/46/1/6.full
Monitoring stress and recovery: new insights for the prevention of injuries and illnesses in elite youth soccer players: http://bjsm.bmj.com/content/44/11/809.full
Reproducibility of computer based neuropsychological testing among Norwegian elite football players: http://bjsm.bmj.com/content/39/suppl_1/i64.full