BJSM Podcast

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

Are you responsible for pre-season screening and injury prevention in a football setting?

Rob Swire has had 22 years of experience at Manchester United. BJSM asked him ‘How do you screen a professional football team pre-season?’
He shares how it’s done, as well as the challenges of being a team clinician and struggling to keep up with continuing education. In the most recent season, Manchester United have moved to include a software package to simplify their screening data entry, risk calculation and the offer of advice as to what might be appropriate exercises in specific settings.
‘I’m a pragmatic (physio) surfing on a wave of science’ was how Steyn Van der Bruggen described his role. Previously at West Ham and more recently at Moscow Dynamo, he shares his approach on how to evaluate players’ functional capacity and then address limitations with targeted exercise.
See also:
Impact energy attenuation performance of football headgear: http://bjsm.bmj.com/content/34/5/337.full
Dehydration of football referees during a match: http://bjsm.bmj.com/content/37/6/502.full
Reductions in pre-season training loads reduce training injury rates in rugby league players: http://bjsm.bmj.com/content/38/6/743.full
The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study: http://bjsm.bmj.com/content/38/2/148.full
Community football players’ attitudes towards protective equipment—a pre-season measure: http://bjsm.bmj.com/content/38/4/426.full
Concussion, risk assessment, and practical steps to reform: Learning from the Hugo Lloris example: http://blogs.bmj.com/bjsm/2013/11/21/concussion-risk-assessment-and-steps-to-reform-learning-from-the-lloris-example/

Dr Mike Loosemore on ‘Exercise is Medicine’ – technology & behaviour change

Are you an exercise advocate? Dr Mike Loosemore, leader of the ‘Exercise is Medicine’ task force in the UK shares recent advances in this field. He spearheaded a most successful conference in that topic in 2013 and shares highlights with BJSM Editor Karim Khan.
He previews the 2014 Exercise Medicine conference which you can catch at the Royal Society of Medicine in London on Friday June 20 and Saturday June 21. Keynote speakers include Professors Steven Blair and Greg Whyte. Here is the link for the meeting; themes include the role of technology, digital health and influencing behaviour change. http://www.rsm.ac.uk/academ/spe02.php
BJSM’s special 2014 issue on Exercise is Medicine, edited by Professors Steven Blair and Stewart Trost can be found here: http://bjsm.bmj.com/content/48/3.toc
See also:
Developing a strategic research framework for Sport and Exercise Medicine: http://bjsm.bmj.com/content/48/14/1120.full
Developing learning outcomes for an ideal MSc course in sports and exercise medicine: http://bjsm.bmj.com/content/39/1/20.full
Leisure-time aerobic physical activity, muscle-strengthening activity and mortality risks among US adults: the NHANES linked mortality study: http://bjsm.bmj.com/content/48/3/244.full
Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects: http://bjsm.bmj.com/content/42/8/636.full
Intensity of leisure-time physical activity and cancer mortality in men: http://bjsm.bmj.com/content/45/2/125.full
CT scans and X-rays increase risk of cancer – changing the goal posts in sports medicine: http://blogs.bmj.com/bjsm/2012/09/19/ct-scans-and-x-rays-increase-risk-of-cancer-changing-the-goal-posts-in-sports-medicine/
Physical activity more likely to prevent breast cancer in certain groups: http://blogs.bmj.com/bjsm/2008/05/18/physical-activity-more-likely-to-prevent-breast-cancer-in-certain-groups/

Prof Jiri Dvorak on anti-doping in sports; Athlete Biological Passport and 10 years in a freezer.

This 12-minute podcast relates to a special 2013 Consensus Meeting on Anti-Doping in Sports & its summary in BJSM’s Special Issue on Anti-Doping (May 2014).
On November 29, 2013, FIFA hosted a meeting of representatives from key Anti-Doping stakeholders. Represented were sports physicians, athletes, legal experts, biomedical scientists, as well as leadership of international sports federations, the IOC and the Word Anti-Doping Agency. To take a ‘giant leap' forward in the battle to ensure a level playing field in sport the group addressed two key questions. (1) ‘Are we doing the right thing?’ and (2) ‘What contemporary methods can move beyond the simple testing strategy that was begun in the 1960s?’
Listen to the ebullient Professor Dvorak analyse anti-doping options and share with you the reasons drug-cheats are either stopping or very nervous.
Read the full consensus statement:
http://bjsm.bmj.com/content/48/10/801.full
See also:
Monitoring of biological markers indicative of doping: the athlete biological passport: http://bjsm.bmj.com/content/48/10/827.full
FIFA’s approach to doping in football: http://bjsm.bmj.com/content/40/suppl_1/i3.full
Gene doping: an overview and current implications for athletes: http://bjsm.bmj.com/content/47/11/670.full
Anti-doping programme and physicians: http://bjsm.bmj.com/content/45/2/e2.2.abstract
Do drug cheats ever prosper?: http://bjsm.bmj.com/content/36/2/79.2.full
A doping sinner is not always a cheat: http://bjsm.bmj.com/content/42/7/549.full
Super athletes or gene cheats?:http://bjsm.bmj.com/content/37/3/192.full
Why we should allow performance enhancing drugs in sport: http://bjsm.bmj.com/content/38/6/666.full
FIFA’s future activities in the fight against doping: http://bjsm.bmj.com/content/40/suppl_1/i58.full
Ruling from the Court of Arbitration for Sport brings consistency, but anti-doping debate will rumble on: http://blogs.bmj.com/bjsm/2012/04/30/ruling-from-the-court-of-arbitration-for-sport-brings-consistency-but-anti-doping-debate-will-rumble-on-2/
Hot Topic: The Truth Behind Doping Scandals: https://soundcloud.com/bmjpodcasts/jiri-dvorak-on-the-future-of/edit
Hot Topic: Current Anti-Doping Policies: http://blogs.bmj.com/bjsm/2008/08/07/hot-topic-current-anti-doping-policies/
Guest Blog: Peter Brukner on Drugs and the London Olympics: http://blogs.bmj.com/bjsm/2012/08/20/guest-blog-peter-brukner-on-drugs-and-the-london-olympics/