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Will whole grains make you live longer?

22 Jul, 16 | by BJSM

Nutrition – a BJSM blog series

The mission of BJSM is to share quality content and promote debate relating to how physical activity, exercise and sport influence health. With this mission in mind, BJSM has at least 3 strong reasons to engage with content related to nutrition:

  1.  Sports medicine has long been closely associated with nutrition – nutrition for performance in sport.
  2. Most people conflate physical inactivity and nutrition as joint causes of obesity – another link between BJSM’s focus and food.
  3. The traditional ‘nutrition channels’ such as many academic journals in the field, receive substantial funding from major food corporations. And many of the Editorial board members also receive such funding. As BJSM does not receive funding from food corporations, we are ideally placed to share content in the domain.

WE encourage readers to make up their own minds. Enjoy this blog – dare we say it – ‘Food for thought’.

Originally posted on: http://www.zoeharcombe.com/

ZoeHead1Three! journal articles were published on whole grains in the past couple of weeks; not sure how that happened. Zong et al had this article published in Circulation: “Whole Grain Intake and Mortality From All Causes, Cardiovascular Disease, and Cancer. A Meta-Analysis of Prospective Cohort Studies.” Aune et al had this article published in the BMJ: “Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies.” Chen et al had this one published in the AJCN “Whole-grain intake and total, cardiovascular, and cancer mortality: a systematic review and meta-analysis of prospective studies.”

The US Circulation/Harvard team study was the one that dominated the media headlines, not only in the US, but also in the UK, where we were misinformed: “Three slices of wholemeal bread a day slash risk of dying from heart disease by 25%”.

All three studies were meta-analyses of prospective cohort studies. Just to make sense of this – a meta-analysis is generally seen as the highest level of evidence possible. It is a statistical technique to pool together many similar studies, working on the principle that looking at several studies together is more powerful than looking at just one. Prospective cohort studies are also called population studies, or epidemiological studies. These types of studies follow populations over a period of time. At the start of the study they record as many things as possible about the participants’ lifestyle (smoking/alcohol/diet/exercise etc) and they record as many things as possible about the participants’ characteristics (age/gender/education etc) and then they see what happens to the people over the following years. The goal with prospective cohort studies is simply to spot patterns (associations) – do people who drink alcohol get liver disease? Do people who do yoga get fewer diagnoses of stress?

The standard issues

Every time a study hits the headline – e.g. “wearing red socks will reduce your risk of dying from boredom by 25%” – there are two standard issues: association is not causation and relative risk is not absolute risk…

1) Association is not causation.

Observational studies can only establish associations. They cannot say that A causes B. They can only say that A and B are associated. For example, observational studies are good ways of establishing that smoking and getting lung cancer are associated. The next question to ask is – does this have a plausible mechanism? The answer is yes – we have evidence of the ways in which substances in cigarettes damage lungs. We could then test the hypothesis “Smoking causes lung cancer” by conducting a randomised controlled trial where the intervention is smoking vs. not smoking and nothing else changes.

The two studies from last week have shown an association between consuming whole grains and mortality and that’s it. Is there a plausible mechanism? The BMJ article tries to suggest a few (are people who eat whole grains slimmer? Are whole grains anti-inflammatory? Read Dr William Davis’s Wheat Belly book and you’ll conclude the opposite.) There is nothing intrinsically healthy about whole grains, so there is no obvious plausible mechanism. I will suggest below an explanation for the observed association – the marker vs. maker argument.

2) Relative risk is not absolute risk.

I don’t blame the media for this one – I blame the press releases from the journals. These should know better than to put “25% reduced risk” in a press release – knowing that this is misleading relative risk hysteria and not scientific absolute risk information.

European heart data tell us that 33 in every 100,000 men died from coronary heart disease in 2009 and 8 in every 100,000 women died from CHD in 2009. IF eating whole grains were causal and IF eating whole grains could reduce this by 25%, then – taking the women – approximately 7 in 100,000 women in the top whole grain consumption category would be likely to die from CHD and 9 in 100,000 women in the never/hardly ever eat whole grains category would be likely to die from CHD (the difference between 7.1 and 8.9 being just over 25%, while maintaining 8 as the average/mean).

7 vs. 9 in 100,000. Hardly hold the front page now is it?!

The other key points

1) Dietary advice to eat whole grains is not evidence based.

For something to be evidence based, it needs to be based in evidence, If something is based in evidence, the evidence comes first. Advice to consume whole grains dates back to the 1980 Dietary Guidelines for Americans (if not earlier). If you can see the full BMJ article you will notice that only one study that appears in all the meta-analysis results even comes from the last century. This one study, Liu et al, dates back to 1999. All other studies used as evidence are from the year 2000 onwards (a high proportion are from the past couple of years).

Dietary Guidelines have been under serious attack from real food proponents for the past few years. I can understand wanting to try to find retrospective evidence for guidelines in this climate, but it will never make the guidelines evidence based. The evidence didn’t come first and it never will.

2) The comparator group is Jekyll & Hyde.

These studies claim to have found an association between whole grain consumption and reduced mortality (i.e. living longer). The groups that they compared were those in the highest intake of whole grain consumption (more than 3oz per day) vs. those in the lowest intake group. People in the lowest intake group were those who (self) reported “rarely or never” eating whole grains.

The 2010 Dietary Guidelines for Americans tell us: “Less than 5 percent of Americans consume the minimum recommended amount of whole grains, which for many is about 3 ounce-equivalents per day. On average, Americans eat less than 1 ounce-equivalent of whole grains per day.” (p.36)[1]

Hence – both studies have used a very small section of the population as the comparator group (<5%). There are two polarised groups of people in the “never/rare consumers of whole grains”: i) people who avoid all grains and ii) people who eat refined grains instead of whole grains. I would expect whole grain eaters to be healthier than refined grain eaters. The comparison that has not been done is the whole grain eaters vs. the no grains-at-all eaters (the latter, virtually guaranteed, also avoid sugar).

3) Whole grain consumption is a marker, not maker, of a healthy lifestyle.

I would expect people who consume whole grains regularly (the <5%) to: not smoke; not drink; be affluent; do yoga; be slim; shop at Whole Foods/Waitrose; eat at restaurants, not takeaways; have children called Olivia and Tarquin and so on. The whole grain consumption is a marker of good health, not the maker of good health.

The BMJ study noted this as one of the limitations of their research: “People with a high intake of whole grains might have different lifestyles, diets, or socioeconomic status than those with a low intake, thus confounding by other lifestyle factors is a potential source of bias.”

That’s journal speak for “Whole grain consumption is a marker, not maker, of a healthy lifestyle.”

The headlines imply that people just need to up their intake of whole grains and they will “slash their risk of dying from heart disease by 25%!” This could not be further from the truth. It’s not causal, the absolute difference is tiny and it’s a whole lifestyle being depicted in these studies – not a whole grain.

To prove me wrong, the authors of these studies need to give 3oz of whole grains daily to the smoking, drinking, obese, sedentary, aimless, fourth generation unemployed, living-on-benefits, deprived populations in the Welsh valleys and change nothing else. Do you think that will “slash their risk of dying from heart disease by 25%”?!

Me neither.

Surprisingly great interest for an MCL sprain – Cristiano Ronaldo and the 2016 UEFA Euro Final

20 Jul, 16 | by BJSM

By Markus Waldén @MarkusWalden

In just the 8th minute of the final between Portugal and France (hosts of the UEFA Euro 2016), Portugal’s star player and 3-time winner of Ballon d’Or, with jersey number 7, Cristiano Ronaldo @Cristiano, was tackled and suffered an apparent MCL injury of his left knee. Partial and total tears of the MCL occur usually as a consequence of direct contact and MCL injury is the most frequent knee injury in professional players as previously shown by us in the so-called UEFA elite Club Injury Study (http://bjsm.bmj.com/content/47/12/759.abstract).1

Interestingly, the incident of #CR7 resulted in instant interest in different social media (#SoMe) fora, including Twitter. For example, we were immediately able to see pictures and videoclips of the injury event. There were numerous speculations about the extent of his injury. I posted a couple of tweets myself including one about the possible injury mechanism.

My tweet was rapidly (and surprisingly) shared directly and indirectly by many people –before the match had even finished. In the week after the final, it was re-tweeted more than 700 times and watched more than 121,500 times.

knee tweet 2

So, what can we learn from this?

First, I must admit that I had not – until now – really realized the cascading impact of #SoMe even if I use Twitter professionally on a daily basis. Obviously, with these figures the potential for information, promotion, knowledge dissemination and other educational activities is enormous (See: How BJSM embraces the power of social media to disseminate research).2 All in all, #SoMe as a natural source of interaction and knowledge transfer for medical practitioners, journals, congresses and stakeholders, etc. in sports medicine are probably under-utilised in broader terms even if many nice exceptions exist. It will be interesting to see how its use develops over the next few years.

Second, when watching the incident frame-by-frame back and forth, it is quite clear that the injury mechanism could have resulted in more than “just an MCL” injury. For example, it is well-known that very little valgus is actually needed to tear the ACL if there is concomitant tibial rotation. In #CR7’s injury there was a knee-to-knee clash with anterolateral impact on his left knee with the tibia in external rotation. The knee then moved inwards (= valgus) and into extension, but probably without any significant internal rotation and no hyperextension. Interestingly, one of the six direct contact ACL injuries in our systematic video analysis study (http://bjsm.bmj.com/content/47/12/759.abstract (OPEN ACCESS)),3 had exactly this injury mechanism except for the externally rotated tibia before the clash. It could thus be speculated that the absence of internal rotation probably saved his ACL, since internal rotation has been shown to be deleterious for the ACL with concomitant knee valgus.4

So, why did he go back to the pitch twice?

We know from the concussion experiences of the World Cup in 2014 that the medical team, sitting on the bench far from the action, often has difficulties in seeing what really happens on the pitch during the injury incident. We also know that the players are pumped up with adrenaline and that they always want to continue playing; in the case of #CR7, the immediate clinical impression was a simple knee contusion. A similar 3-minute stop by the referee, as recently decided on by FIFA and UEFA for the evaluation of head injuries, to let the medical team watch the replays. This strategy is to assist the medical-teams decision making, and protect player welfare, by taking the player off before he can continue playing with serious injury. This issue was recently thoroughly argued for by Dr. Andrew Massey in another BJSM blog and I can from a medical perspective support his idea.

So, what is the take-away?

The knee injury of #CR7 drew much attention on Twitter which illustrates the power of #SoMe for communication and message sharing in the sports medicine community. I encourage those of you who not yet have created accounts to do so. In addition, it seems that the injury was “just an MCL”, but the injury mechanism initially suggested that other intra-articular structures may have also been damaged. Fortunately, this was not the case and we can therefore welcome #CR7 back to the pitch already within a couple of weeks.

References

  1. Lundblad M, Waldén M, Magnusson H, et al. The UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play. Br J Sports Med 2013:47:759-62.
  2. Verhagen E, Bower C, Khan KM. How BJSM embraces the power of social media to disseminate research. Br J Sports Med 2014;48:680-81.
  3. Waldén M, Krosshaug T, Bjørneboe J, et al. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med 2015;49:1452-60.
  4. Koga H, Bahr R, Myklebust G, et al. Estimating anterior tibial translation from model-based image-matching of a noncontact anterior cruciate ligament injury in professional football: a case report. Clin J Sport Med 2011;21:271-4

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Markus Waldén @MarkusWalden, MD, PhD, is an orthopaedic surgeon, football doctor, and a member of the Football Research Group in Linköping, Sweden.

Footnotes

The Football Research Group has been established in Linköping, Sweden, under the leadership of Prof. Jan Ekstrand in collaboration with Linköping University and through grants from the Union of European Football Associations, the Swedish Football Association, the Football Association Premier League Limited, and the Swedish National Centre for Research in Sports.

Consent was obtained from Dr. Jesus Enrique Olmo Navas of Real Madrid CF to report on the injury mechanism of #CR7’s knee injury as has been done in the current blog.

Return to Play – BJSM Virtual Conference

15 Jul, 16 | by BJSM

A monthly round-up of podcasts and articles

By Zach Spargo (@ZachSpargo) & Steffan Griffin (@lifestylemedic)

Can’t keep up with what the latest research on return-to-play is saying? Need direction on where to find all the up-to-date literature and podcasts? This is your place! We’ve put together the greatest and latest RTP work from BJSM into this Virtual Conference to create ease of access – you can read or listen to all material via clicking the links or downloading the BJSM app.

So if you’re on your summer holidays at the moment (or wishing you were!) then get stuck into all your RTP goodness here!

  1. 2016 Consensus statement on Return to Sport

http://bjsm.bmj.com/co

First up – This is the big one. Brand new consensus statement on return to play or ‘return to sport’ (RTS) as is used in the paper. It contains discussion on the definition of RTS and proposes a framework that incorporates the StARRT 3 step model (http://bjsm.bmj.com) and the Biopsychosocial model with appropriate load management. Great stride forward for return to play!

RTP infographic

  1. Criteria based return to play. Psychological readiness. How? Whose call? With Clare Ardern

https://soundcloud.com/bmj

This podcast is a close sibling of the consensus statement above! Clare Ardern explains and answers questions in regard to how fear and anxiety can affect return to play and how we as clinicians can become desensitised to the psychological stresses on an athlete post injury. There is a specific ACL example used to illustrate how we can examine a player’s psychological readiness.

  1. To risk, or not to risk: the return to play dilemma, with Roald Bahr

https://soundcloud.com/bmjpodcasts/

Where is the traditional RTP model letting athletes down? How can we be more holistic in our approach? Prof Roald Bahr explains by focusing on physical deficits and the danger of not customising your rehab to individual sport/position requirements. Finally the discussion dives into why sport and health are sometimes opposing entities. Not to be missed!

  1. “I can’t return to play” – When fear of re-injury dominates after ACL reconstruction, with Adam Gledhill

https://soundcloud.com/bmjpodcasts/

Now let’s get sport specific. Adam Gledhill brings his knowledge of sport psychology (particularly among top female football players) to the forefront in discussing the ACL injury example of ‘Joanna’. We hear about specific tools that address psychological readiness and their application and success in real life! Best results achieved with combined reading of this paper bjsm.bmj.com/content.

  1. MRI findings and return to play in football: Hamstring injuries

http://bjsm.bmj.com

Big paper here. Prospective analysis of 255 hamstring injuries within elite football was completed by Jan Ekstrand et al. (2016). Some interesting findings! Combine with this podcast if possible! https://soundcloud.com/bmjpodcasts

  1. ACL injuries in men’s professional football: a 15 year prospective study

http://bjsm.bmj.com/

Another ACL source here. This time it’s the work of Markus Walden et al. 2016 with their paper on return to play rates after ACL injury. This is currently a very popular paper and shows the startling finding that only 65% of players still play top level football 3 years post rupture. Vital information here.

  1. The brain and mind in chronic pain, with Lorimer Moseley

https://soundcloud.com/

And finally we’ll tie up all the above with some pain science from the master – Lorimer Moseley. It’s a BJSM classic. As discussed in all of the RTP work in this virtual conference, one cannot underestimate the factor of psychological readiness. You’ll hear how Lorimer proposes clinicians working in sport can use pain science to further inform their athletes.

So that’s it. Another virtual conference with all the ingredients to make a RTP soufflé. As always, let us know your thoughts via our various social media channels – Twitter (@BJSM_BMJ), Facebook (BJSM) and Google + (https://plus.google.com/u/0/com). We value and appreciate Feedback!

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Zachary Spargo (@ZachSpargo) MSc Physiotherapist working within NHS Betsi Cadwaladr, BSc (Hons) Sport and Exercise Science. BJSM Editorial Team and ACPSEM member.

Wimbledon! A day in the life of an All England Club SEM Physician – BJSM trainee perspective blog

13 Jul, 16 | by BJSM

Sport and Exercise Medicine: The UK trainee perspective –A BJSM blog series

By Dr. Ajai Seth

Sports and Exercise Medicine Trainee, MBBS, BSc, MSc, MRCS, MRCGP, MFSEM

Wimbledon 2016 image 2As a life-long avid tennis fan, I was thrilled at the opportunity to spend some time with the medical team at The Championships, Wimbledon. Wimbledon is the oldest, perhaps most prestigious tennis tournament in the world. Held at the All England Lawn Tennis Club (AELTC) since 1877 and currently the only Grand Slam tennis tournament to be played on grass.

Context

Wimbledon is a mass spectator event. Up to 39,000 people can be in the grounds at once. St John’s Ambulance provides medical cover for the crowd and most non-player staff members. For player medical care, the The All England Lawn Tennis & Croquet Club Limited (AELTC) employs a medical team for the duration of the Championships. The medical team at the All England club consists of 3 sports medicine physicians, 1 radiology consultant and a general practitioner who works with the AELTC full time (the Club doctor). In addition to this, there is a strikingly large number of other personnel employed by a variety of tennis organisations. For example, LTA, ATP, WTA and the AELTC. They may include physiotherapy, strength and conditioning, podiatry and massage therapy. Furthermore, top players may have their own entourage of coaching and fitness teams. All this adds up to an extremely busy working environment!

As you may expect, the medical team at Wimbledon hold a wide range of responsibilities. The Wimbledon qualifying event takes place the preceding week at the Bank of England sports ground in Roehampton. A whole host of other housekeeping tasks are associated with this event including: communications, dealings with the press, anti-doping and ensuring adequate medical staffing and equipment.

Pre-competition screenings

A change was made to the tennis calendar in 2015, pushing back The Championships by one week. This allows players more recovery time and transition after The French Open, the second grand slam of the year. Players therefore have an opportunity to use The All England Training club facilities prior to the tournament as well as during. These facilities include the use of 2 separate gyms, 22 practice courts, physiotherapy, massage services and 3 hydrotherapy baths, all at different temperatures. There is also offers a pre-competition opportunity for players to present injuries and seek advice from the medical staff. A sports physician may encounter: flares of chronic musculoskeletal injury, acute musculoskeletal injury and management medical conditions.  The majority of injuries presenting at Wimbledon are pre-existing or recurrent.1 Muscle and ligament injuries are the predominant type of acute injury in professional grass court tennis, with ligament and articular surface injuries being less common.1 Often, the player’s coach/team will attend the consultation and adjustments can be made to their training schedule. Occasionally players will want advice on whether they are fit to play or need to be rested.

Comprehensive AELTC player care

The vast majority of players rely on the medical expertise and diagnostic skills provided at tournaments as much of their year is spent abroad on tour. Therefore when they know good medical services are available, players may seek medical help for more chronic injuries. At the AELTC, they are able to get onsite ultrasound assessment by a sports physician with and offsite MRI assessment, interpreted by an experienced MSK radiologist. All members of the medical team have a vast experience of tennis medicine and years of medical experience at the Championships.

Wimbledon 2016 selfie

Wimbledon 2016 selfie with Professor Mark Batt, Medical Officer at Wimbledon

On the ground at Wimbledon

Perhaps one of the biggest challenges at the AELTC is navigation. Anyone who has been lucky enough to visit Wimbledon as a spectator, will have an appreciation for the complexity of the site layout, which includes 41 courts and a multitude of shops, restaurants and bars. Behind closed doors, there is a vast array of corridors, staircases, walkways and underground connections between the buildings. In order to provide effective medical and emergency treatment for players, it is vital that the medical team are aware of how to respond quickly and efficiently to incidents across the whole site with some courts being relatively difficult to access. It is also important to know how best to evacuate an injured athlete. This may not be as simple as it seems with many obstacles to negotiate. For higher profile matches with more media presence, it is not unusual for the doctor to be courtside, for example Finals Day.

Spending time at the AELTC with the medical team provided fascinating insight into what is involved in supporting athletes in perhaps the highest profile tennis tournament in the world. I would like to thank Professor Mark Batt and Dr. Ian McCurdie for this opportunity.

References

  1. Tennis injury data from The Championships, Wimbledon, from 2003 to 2012. I McCurdie, S Smith, P H Bell and M E Batt. Br J Sports Med January 11, 2016

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Ajai Seth is a Sport and Exercise medicine Registrar and General Practitioner in the West Midlands Deanery. His sporting interests include racket sports, football, athletics and expedition medicine. He is currently Birmingham City Academy and GB para-archery doctor.

Farrah Jawad is a sport and exercise medicine registrar in London and co-ordinates the BJSM Trainee Perspective blog.

The Eva Carneiro case and gender inequality in SEM: Why it matters for the SEM community

8 Jul, 16 | by BJSM

By Sheree Bekker @shereebekker and Tracy Blake @tracyablake

“Women want to be leaders, we just put them off as we go along. I think in every program I have ever watched in my life the woman, the female doctor [unclear] is either hyper-sexualised…or she is not present….This is what young girls, what I, grew up with as the perception of what a female doctor was. This needs to change.” ~ Dr Carneiro, Swedish Football Association Conference 2014

What the Eva Carneiro case tells us about gender discrimination in sport

As the BJSM blog “Team doctors have the authority over managers to make medical decisions #PlayerSafety1st” pointed out, the Mourinho/Carneiro case has highlighted two critical issues: 1) gender discrimination in sport, and 2) a team doctor’s authority to make medical decisions, not the manager.

The second issue has rightly seen widespread outcry from the SEM community, and opened up much-needed conversation around scope of practice, and player safety. This included Lisa O’Neil’s excellent editorial “No way Jose! Clinicians have authority over patient care: The manager’s scope of practice does not cover medical decisions”.

Yet discrimination – specifically gender discrimination – the deeper underlying issue, has seen little to no commentary from within the SEM community. Whilst – as the recent BJSM blog post stated – “we applaud and celebrate all SEM practitioners who have a commitment to player welfare” – there has been limited outcry over the sexist treatment to which Dr Carneiro has been subjected, both in this case, and in the larger pattern of insidious and benevolent sexism which she has endured over her career.

The statement put out by Chelsea FC following the settlement of this case is perhaps the most telling sign of what it takes to be successful as a woman within SEM at the professional sports level:

“We wish to place on record that in running onto the pitch Dr Carneiro was following both the rules of the game and fulfilling her responsibility to the players as a doctor, putting their safety first. Dr Carneiro has always put the interests of the club’s players first.  Dr Carneiro is a highly competent and professional sports doctor. She was a valued member of the club’s medical team and we wish her every success in her future career.” ~ Chelsea Football Club Announcement, June 2016

For those in the SEM community, these statements may be self-evident. But we also need to address the perceptions of those with hiring power. The comments of Chelsea’s former manager explicitly questioned Dr Carneiro’s professional knowledge and her ability to fulfil her role field side at a professional event. These sentiments have the potential to not only follow the individual, but become attached to other women in SEM professions.

The under representation of women in professional SEM roles

Women in SEM roles in professional sport organizations are rare. A look at the 25 Canadian professional franchises in hockey, basketball, baseball, soccer, football and lacrosse, for example, shows that women comprise only 11 of the 219 listed sport medicine and sport science personnel. Negative comments that reference traits associated with being ‘female’ can implicitly or explicitly damage not only an individual’s future opportunities, but the opportunities for other women clinicians to work with the top professional athletes in the world. The impact of these comments hold even more weight in the modern era, where the globalization of information means that publicly-stated opinions can be accessed with the ease of opening a search engine. This has not been shown to be the case for men in the same situation, if for no other reason than there are simply too many men in these roles for such generalizations to be tenable. The inclusion of the club’s public statement as part of Dr Carneiro’s settlement clearly exonerates her professionally. However, until it is no longer required in order to justify the work of women SEM professionals, in the face of non-expert opinions, we collectively (men and women in the SEM community) have work to do.

In this way, women in this industry are shown time and time again – both intentionally and unintentionally, explicitly and implicitly – that they do not yet have an equal place in the sporting world. Men in SEM simply do not experience these same underlying messages.

Sport is often seen as ‘inherently good’ and put on a pedestal by our society. However, sport is not experienced as exclusively positive by those who are discriminated against. Discrimination exists at the intersection of gender, race, class, and economic disparities. This means that where gender issues are present, intersectional issues such as racism, and discrimination against people who identify as GLTBQIA – amongst others – exist. When these exist, even highly qualified and experienced women like Dr Carneiro are hindered or excluded from doing their jobs.

Where is our commitment to the safety of our women (and those who identify as women) and other underrepresented minority SEM practitioners, researchers, patients, and research participants? Just because discrimination is not recognised, does not mean that it does not exist. Agile moves around this issue, and careful sidestepping, only add to the unease that our community has with this very issue.

Let’s unpack this pattern with some recent examples from our research and context:

  • Right here in BJSM an editorial pointed out that the female body is consistently underrepresented in SEM research.
  • It was shown that sportsmen’s views on race, sex, masculinity, and sexual preference have meant the attrition of Indigenous players in the Australian Football League.
  • Other recent instances of gendered discrimination and attack that come to mind are Raymond Moore’s sexist comments of women tennis players, Muirfield Golf club’s exclusion of women, and Brock Turner’s sexual assault of a woman (yes Turner’s sports participation is an important factor in his case).
  • The gender pay gap persists – both in sport, and in academia.

Further, if we look at the people who make up our SEM practitioner and research community, there is a clear lack of diversity:

Call to action, for broader inclusion in the SEM Community

To those who occupy discriminated spaces, and who are discriminated against, this is the threat to safety. What happened to Dr Carneiro is not merely a player safety issue, this is part of a broader SEM community safety issue that we have failed to recognise, acknowledge, and counteract.

It is not only women and underrepresented groups who are missing out when we discriminate against half of our population; everyone misses out. When we only hear the opinions of – or do the research of and on – one privileged group, we are missing the opportunity to be enriched by the knowledge, experiences, capabilities, and insights of women within the SEM community.

We owe it to our SEM community to: (i) as a start, open up this conversation, and; (ii) consider our individual roles and areas of influence and the ways in which we are both implicated in the issue, and can take small or large actions to be part of the solution.

We can, and should, do more.

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Sheree Bekker, Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia

Twitter: @shereebekker

Tracy Blake, Physiotherapist. PhD candidate, eSport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta

Twitter: @tracyablake

Hört endlich auf degenerative Meniskusrisse zu operieren: Es wird Zeit, dass sich die gängige Praxis an der Evidenz orientiert.

6 Jul, 16 | by BJSM

meniscus german

Translation by: @drfrankweinert

Von Kay M Crossley, Joanne L Kemp, Charles Ratzlaff und Ewa M Roos übersetzt aus dem Englischen

To read blog in English: http://blogs.bmj.com/bjsm/2014/06/15/time-to-stop-meniscectomies-for-degenerative-tears-practice-must-catch-up-with-evidence/

Im Jahr 2002 wurde im New England Journal of Medicine eine randomisierte kontrollierte Studie veröffentlicht, die uns alle aufhorchen ließ. Das wirklich bemerkenswerte an dieser Studie war, dass alle Teilnehmer randomisiert drei Gruppen zugewiesen wurden:

  1. Arthroskopisches Debridement, inklusive Chondroplastie, Lavage und Meniskusteilresektion
  2. Arthroskopische Lavage oder
  3. Placebo-Operation (nur Hautinzision)

Das Ergebnis:

Arthroskopischer Eingriff nicht besser als Schein-OP

Die Patienten in der Interventionsgruppe (arthroskopische Behandlung) zeigten zu keinem Zeitpunkt im Follow-up weniger Schmerzen oder eine bessere Funktion als die Patienten in der Placebogruppe. Das steht in komplettem Widerspruch zur gängigen Praxis arthroskopischer Eingriffe mit Debridement, sowohl bei Patienten mit Gonarthrose als auch bei jüngeren Patienten oder im sportmedizinischen Bereich.

In sportmedizinischen und orthopädischen Kreisen wird die Kniearthroskopie weiterhin propagiert, wobei das Hauptaugenmerk von Eingriffen bei Gonarthrose auf die transarthroskopische Teilmeniskusentfernung verlagert wurde. Da aber degenerative Meniskusläsionen Teil des Arthroseprozesses im Kniegelenk sind, erlaubt dieses Re-branding (Meniskusresektion statt Gelenktoilette oder Debridement) Chirurgen mit der im Kern gleichen Art von Operation fortzufahren, nur unter einer anderen Bezeichnung.

In den letzten 12 Jahren wurde in fünf weiteren randomisierten und kontrollierten Studien die Kniearthroskopie ausgewertet. Eine dieser Studien untersuchte  das Gelenkdebridement, die anderen vier konzentrierten sich auf die transarthroskopische Meniskektomie. Von diesen zeigte die Arbeit von Sihvonen und Kollegen keine Vorteile einer Meniskusteilresektion im Vergleich zur Scheinoperation. Hervorzuheben ist, dass die Studienteilnehmer Patienten waren, von denen angenommen wurde, dass Sie besonders von einer Operation profitieren würden (z.B. Patienten mit degenerativer Meniskusläsion ohne radiologische Zeichen einer Arthrose).

Trotz der Schwierigkeiten, die bei der Durchführung von randomisierten kontrollierten Studien (RCTs) bei chirurgischen Therapieverfahren bestehen, blieben sechs RCTs von hoher Qualität ohne Evidenz für zusätzliche Effekte bezüglich Schmerzlinderung oder Funktionsverbesserung bei transarthroskopischer Meniskusresektion im Vergleich mit Placebo/Schein-OP oder konservativer Therapie, wie z.B. physikalischer Therapie. Die Ergebnisse sind stabil, egal ob eine Gelenktoilette durchgeführt wurde oder nicht.

Diese Evidenz hoher Qualität sticht die positiven Resultate unkontrollierter Fallstudien aus und zeigt, dass die Meniskusresektion keine effektive Therapiemaßnahme bei symptomatischen degenerativ bedingten Meniskusrissen ist.

Obwohl degenerative Meniskusrisse das Risiko für eine beginnende Arthrose erhöhen, zeigen Studien bei Meniskektomie in der Langzeitbeobachtung kein besseres Bild: Patienten, die sich einer Meniskusresektion unterziehen, haben im Vergleich zur Kontrollgruppe ein zehnfach erhöhtes Arthroserisiko 10-20 Jahre nach dem Eingriff.

Die Arthroskopie bei degenerativen Meniskusläsionen wird nicht weiter unterstützt.

Die zunehmende Evidenz die gegen Meniskusresektionen spricht, findet sich auch in aktuellen Leitlinien wieder: Die NICE Leitlinien in Großbritannien konstatieren »Do not refer« Überweisen Sie keinen Patienten zur arthroskopischen Spülung und Gelenktoilette als Teil einer Arthrosetherapie, solange das Kniegelenk dieser Person nicht eine eindeutige Vorgeschichte mechanischer Einklemmungserscheinungen aufweist (im Gegensatz zu Symptomen wie Morgensteifigkeit, giving-way, oder radiologische Hinweise auf freie Gelenkkörper).

Allerdings ist das Einordnen von Meniskusrissen innerhalb des Arthroseprozesses

eine Herausforderung. Subgruppen-Analysen der oben genannten RCTs zeigen ebenfalls keinen Unterschied im Therapieergebnis bei Patienten mit mechanischen Problemen.

Sogar das führende Organ für Chirurgen, die American Academy of Orthopedic Surgeons, konstatiert: »Wir sind nicht in der Lage klare Empfehlungen für oder gegen eine arthroskopische Meniskusteilresektion bei Gonarthrosepatienten mit einer Meniskusläsion abzugeben.«

Warum werden dann immer noch so viele Patienten diesem Eingriff unterzogen?

Obwohl keine Vorteile gegenüber einer Schein-OP, einem Placebo-Eingriff oder konservativer Therapiemaßnahmen bestehen, werden Millionen von Patienten weltweit bei degenerativen Meniskusrissen operiert. Dabei werden sie unnötigen und nicht unerheblichen Risiken und Kosten ausgesetzt. Während die Zahlen für Eingriffe bei Gonarthrose im letzten Jahrzehnt gesunken sind, zeigte sich im selben Zeitraum ein Anstieg bei den Meniskuseingriffen. Auffällig ist, dass sich die Eingriffshäufigkeit in der Gruppe der 35-45 jährigen verdoppelt hat. Bei den über 55jährigen zeigte sich sogar ein 2,7 facher Anstieg.

Alleine in den USA werden etwa eine halbe Million transarthroskopischer Meniskuseingriffe durchgeführt. Das ist möglicherweise der Tatsache geschuldet, dass die Kosten für den Eingriff von Medicare übernommen werden.  Dagegen wird das Debridement bei Gonarthrose, egal ob mit oder ohne Meniskusteilresektion, nicht bezahlt.

Dies zeigt entweder, dass die gängige Praxis nicht mit der vorhandenen Evidenz Schritt hält, oder es deutet, wie ein Editorial im Journal »Arthroscopy« vor kurzem konstatierte, auf die gängige Meinung hin, dass als Studienobjekte (in placebokontrollierten chirurgischen Studien) Patienten ausgewählt wurden, die möglicherweise nicht mehr ganz bei Verstand seien. Demnach sind die Ergebnisse dieser Studien nicht übertragbar auf solche, deren Probanden im Vollbesitz ihrer geistigen Kräfte waren.

Die Autoren argumentieren zudem, dass die Durchführung von Schein-OPs (Eingriffe ohne therapeutische Intervention) unethisch sind. Wie auch immer: Arthroskopie (z.B. mit Teilmeniskusentfernung oder Gelenkdebridement) bietet keinen zusätzlichen positiven Effekt und ist somit auch keine Therapie. Ihre eigene Argumentation lässt daher eher den Schluß zu, dass arthroskopische Eingriffe mit Debridement oder Meniskusresektion als unethisch zu bewerten sind.

Allen die im Bereich der klinischen Sportmedizin tätig sind (Ärzte, Chirurgen, Physiotherapeuten und alle anderen Heilmittelerbringer) kommt eine wichtige Rolle zu, klinische Praxis auf Höhe der aktuellen Evidenz zu halten.

Aktuelle RCTs von hoher Qualität, klinische Leitlinien und Editorials zeigen uns, dass die Entfernung degenerativer Meniskusläsionen keine besseren Ergebnisse zeigt, als Placebo- oder Schein-OPs oder physikalische Therapiemaßnahmen.

Ausgestattet mit diesen Informationen müssen wir gut informierte, evidenzbasierte Entscheidungen treffen bezüglich optimaler Patientenversorgung und die fortbestehende Praxis arthroskopischer Meniskusoperationen hinterfragen.

Anmerkung des Übersetzers:

Ab Frühjahr 2016 gelten in Deutschland bei der Versorgung von GKV-Versicherten mit Gonarthrose deutliche Einschränkungen. Arthroskopien dürfen dann nur noch bei Patienten mit Traumata, akuten Gelenkblockaden und meniskusbezogenen Indikationen, bei denen die bestehende Gonarthrose lediglich als Begleiterkrankung anzusehen ist, als GKV-Leistung erbracht und über den EBM abgerechnet werden.

Für alle anderen Fälle hat der Gemeinsame Bundesausschuss (GBA) den Eingriff aus dem Leistungskatalog der gesetzlichen Krankenversicherung gestrichen.

Übersetzt von:

Dr. med. Frank Weinert, Facharzt für Allgemeinmedizin – Sportmedizin – Chirotherapie, Sportmedizinische Untersuchung- und Beratungsstelle des Bayerischen Sportärzteverbandes (BSÄV) und des Bayerischen Landes-Sportverbandes (BLSV)

Wohnhaft in Bayern, dem Bundesland mit den höchsten Raten an arthroskopischen Eingriffen und Knieprothesenimplantationen (Quelle: Faktencheck Gesundheit).

Webseite: www.drfrankweinert.de

Email: hilfe@drfrankweinert.de

Facebook: facebook.com/praxisdrweinert

Twitter: @drfrankweinert

#IOCprev2017 social media campaign: What it’s all about, and why YOU should be a part of it

4 Jul, 16 | by BJSM

 

twitter nirmalaHello! My name is Nirmala Perera (@nim_perera) and I coordinate the #socialmedia (#SoMe) campaign for @IOCprev2017 on twitter and LinkedIn (http://www.linkedin.com/groups/10306029).  My role is to develop and facilitate an integrated and sophisticated approach to the #IOCprev2017 campaign – to benefit both individuals and society as a whole.

Background

We know conferences are a great way to disseminate latest research, but many existing conference social media strategies fail to harness the full potential of engagement. Conference twitter accounts mostly consist of announcements and conference updates to drive abstract submissions and registrations. Inevitably these accounts are somewhat active leading up to a conference, highly active during the conference and usually dormant post-conference. The @IOCprev2017 team aims to go beyond being simply a promotion tool for the #IOCprev2017 conference and engage you all in a conversation, and provide a legacy of networks that reaches beyond the event itself. This is an ambitious strategy. However our organic growth of the twitter follower base (approximately 50+ tweeps a week),  and many retweets are indications that the #IOCprev2017conferences has a strong #SoMe strategy that works.

http://www.ioc-preventionconference.org/

http://www.ioc-preventionconference.org/

Our approach

Scoping out our target audience of the #SportsMed and #BJSM community, I realised that most of you are clinicians and/or researchers with an interest in sports #injuryprevention. We all advocate for sports safety. We are time-poor and often use twitter and social media to keep up with the latest news in the field and connect with the #SportsMed community.

With this in mind, the @IOCPrev2017 account serves three distinct audiences:

  • those hoping to attend the conference
  • those unable to attend the conference
  • ‘influencers’ (which in reality is all of you who engage in the community) who can help us gain momentum

Figuratively, the @IOCprev2017 twitter account is a virtual water cooler, a place where followers can go to exchange ideas, be part of the team, have some fun…

We use  our dedicated LinkedIn group to expand on and compliment what can be achieved by our tweeps. We can continue conversations started on Twitter in more depth, and post more comprehensive content in relation to a single subtopic. Additionally, LinkedIn allows you to gain a perspective of others in the #IOCprev2017 group, their background and their work.

Curating – finding the best for you at one convenient site

Our team is committed to curating content across social media platforms that is relevant and engaging. Links to journal articles, photos, podcasts and videos that enhance the knowledge base of conference sessions.  As an aside, you may be interested to know that Tweets with a link AND an image lead to 70% more link clicks and retweets than a tweet with just a link.

The 1-tweet-conference pitch was a challenge to our conference speakers, and it is a great way to give you a sneak peak of some of the symposia/keynote content (https://storify.com/Nim_Perera/iocprev2017-1-tweet-pitch).

It engaged the speakers and the wider audience, and generated some more social buzz.  By continuing to cater to those who can, and those who cannot physically attend the event (watch out for future live tweets and broadcasting) and by showcasing the presenters/delegates, before during and after the conference, this is a conversation that CAN and WILL continue.

Being a #SoMe coordinator is much like being a stand-up comedian.

It is vital to promptly understand the audience. So, in real time, I need to know if the audience is laughing at my jokes and then adjust accordingly to keep them engaged.  I need to have my finger on the pulse, so I can tactfully capitalise on what’s trending, key hashtags and identify new stories to reach and connect with a global audience. A constant re-evaluation of every aspect of this campaign and the social network it generates forms the very cornerstone of what we hope will be a very successful social media campaign.

I have a pretty cool toolbox too, including Hootsuite (https://hootsuite.com/), TweetDeck (https://tweetdeck.twitter.com/), TweepsMap (https://tweepsmap.com/), Netlytic (netlytic.org/), SocioViz (Socioviz.net) and Mytweeps (https://mytweeps.com/) to name a few. These are all vital in gaining insight into what you, my audience, find interesting and what is going down like a lead balloon. Currently, we have tweep-of-the-week to acknowledge those who actively contribute to the campaign and encourage participation.

Have you joined us yet?  We have so many exciting plans coming up over the next few months so #WatchThisSpace.

At the end of the day success of the @IOCprev2017 campaign depends on the active contributions of you, the #IOCprev2017 community. So, from myself and all those involved, a BIG THANK YOU once again to each and every one of you for your active contribution to the success of the 2017 IOC World Conference: http://www.ioc-preventionconference.org/ !!!

******************************

Nirmala Perera (@nim_perera) has a background in health promotion and social marketing and is a PhD scholar at the Australian Centre for Research into Injury in Sport and its Prevention (@ACRISPFedUni), following in the footsteps of @CarolineFinch. She has always been an enthusiastic advocate of twitter, winning the #IOCprev2014 twitter competition for the most retweets by an individual. She is currently the #IOCprev2017 #SoMe campaign coordinator (And send thanks to @RoaldBhar and @fbendiks for the opportunity).

Cutting sporting Australians to their knees: time for more investment in sports injury prevention

29 Jun, 16 | by BJSM

By David Hunter, Florance and Cope Professor of Rheumatology

Australia flagAustralians’ passion for their favourite sporting pursuits is almost unmatched by any other country throughout the world. We pride ourselves on our sporting heritage and the records that our minnow sized population has been able to achieve in an ever expanding sporting world. Not detracting from the importance of physical activity, our love for sport is counterposed by the risks inherent in not practising sport safely.

How common is this problem?

Every year approximately 20,000 Australians tear the main ligament in their knee and about half of those require reconstruction. The major burden of these injuries is amongst our young adults (15 to 25-year-olds) and this appears to be rising at about 5 to 6% each year. These injuries appear to be more common in females potentially as a consequence of anatomical and physiological differences. They are so common they now lead to five times more hospital admissions than road injuries.

What are the consequences?

Separate from the pain and diminished sports participation, knee injuries can also lead to reconstructive surgery, osteoarthritis and potentially, joint replacement. Thirty to forty per cent of participants experiencing a major sports-related injury will discontinue playing sport and/or will significantly reduce their physical activity levels. Approximately 60% of young persons who sustain a knee injury will develop osteoarthritis within 10 to 15 years.

This can be prevented

Robust evidence supports that over half of these injuries could be prevented if young people received appropriate balance and agility training. This training teaches them how to land properly on their knee and move so that the potential for injury is not sustained. A preventive training program should include exercises that are done 2-3 times a week over the course of the entire season, take no more than 15 minutes to complete, and can be incorporated by coaches into regular training sessions. Many forward thinking countries around the world have implemented such training programs with great success. An Australian sports injury prevention program targeting all 12 to 17-year-olds and high risk 17 to 25 – year -olds would cost $1 million per year and cut future public health costs by $120 million over four years.

An effective response to sports injury prevention is now needed in order to make sport safe for all participants and reduce the later community burden of osteoarthritis. Sport has many salutary benefits and we strongly encourage increased “safe” participation in sport. The major sporting codes are all on board and we need funding to ensure the Australian sports commission can train coaches and trainers properly in implementing these sports injury prevention programs. Discussions have been had with the respective federal sports/health ministers of successive Labor and conservative governments without success. Will Smith’s recent movie appropriately highlighted concerns related to concussion and the threat of litigation for the NFL. Young sporting Australians deserve the right to practice sport safely-our mutual love for sport supports that wish.

 

Regular Consumption of Sports Drinks are a Risk to Children’s Health

29 Jun, 16 | by BJSM

FSEM PRESS RELEASE

Water or milk is sufficient quote

Regular consumption of sports drinks by children, for social reasons, could be having a detrimental effect on their health concludes the Faculty of Sport and Exercise Medicine (FSEM) UK. A survey by Cardiff University School of Dentistry[i], published in the British Dental Journal, showed a high proportion of 12-14 year olds are regularly consuming, high sugar, sports drinks unnecessarily:

  • 89% of school children are consuming sports drinks with 68% drinking them regularly (1-7 times per week)
  • Half claimed to drink sports drinks for social reasons
  • The high sugar content and low pH of sports drinks increases the risk of obesity, type 2 diabetes, heart disease and the erosion of tooth enamel
  • Most sports drinks are purchased by children in local shops at value prices

The survey looked at 160 children in four schools across South Wales and uncovers that children are attracted to sports drinks because of their sweet taste, low price and availability.  The research highlights the fact that parents and children are not aware that sports drinks are not intended for consumption by children. The FSEM recommends that water and milk is sufficient enough to hydrate children and adults before during and after exercise, there is no evidence of beneficial effects of sports drinks in non-elite athletes or children. However, there is evidence that an increasing consumption of sugar sweetened drinks in the UK increases cardiometabolic risks[ii] and contributes to tooth decay.

Half of the children surveyed claimed to drink them socially and most (80%) purchased sports drinks in local shops, whilst 90% claimed that taste was a factor and only (18%) claiming to drink them because of the perceived performance enhancing effect. The FSEM is calling for tighter regulation around the, price, availability and marketing of sports drinks to children, especially surrounding the school area, to safeguard general and dental health:

Dr Paul D Jackson, President of the FSEM UK comments: “The proportion of children in this study who consume high carbohydrate drinks, which are designed for sport, in a recreational non-sporting context is of concern.

 “Sports drinks are intended for athletes taking part in endurance and intense sporting events, they are also connected with tooth decay in athletes[iii] and should be used following the advice of dental and healthcare teams dedicated to looking after athletes. Water or milk is sufficient enough to hydrate active children, high sugar sports drinks are unnecessary for children and most adults.”    

Russ Ladwa, chair of the British Dental Association’s Health and Science Committee said: “The rise of sports drinks as just another soft drink option among children is a real cause for concern, and both parents and government must take note. They are laden with acids and sugars, and could be behind the decay problems we’re now seeing among top footballers[iv]

“Sports drinks are rarely a healthy choice, and marketing them to the general population, and young people in particular, is grossly irresponsible. Elite athletes might have reason to use them, but for almost everyone else they represent a real risk to both their oral and their general health.”

The FSEM is concerned about an increasing UK trend for the consumption of sports drinks[v] and this schools survey uncovers social reasons, availability and price as having a large influencing factor. Price was one of the top three recorded reasons for purchase and, of particular concern, 26% of children also cited leisure centres as purchase sources.

The survey also addresses the fact that there is particular confusion over the definition of a sports versus an energy drink. However from a dental and wider health perspective, these two drinks have similar detrimental effects due to their high sugar content and low pH.

In supermarkets and shops, sports drinks are sold alongside other sugar sweetened beverages. This is misleading children and parents by indicating that they are meant for use by everyone.

Related BSJM Material:

Tim Noakes, Open Letter: Lobbyists for the sports drink industry: an example of the rise of “contrarianism” in modern scientific debate (BJSM, 2007, OPEN ACCESS).

References:

[i] A survey of sports drinks consumption amongst adolescents. Br Dent J 2016; 220: 639-643, D Broughton BDS (Hons) , RM Fairchild BSc (Hons), PhD, MZ Morgan BSc (Hons), PGCE, MPH, MPhil, FFPH.  Applied Clinical Research and Public Health, College of Biomedical and Life Sciences, Cardiff University, School of Dentistry, Cardiff Metropolitan University, Department of Healthcare and Food.

[ii] Sweetening of the Global Diet, particularly beverages: patterns, trends, and policy responses. The Lancet Diabetes and Endocrinology volume 4, No.2 p174-186, February 2016, Prof Barry M Popkin, PhD, Prof Corinna Hawkes, PhD.

[iii] Faculty of Sport and Exercise Medicine UK, Position Statement, Oral Health in Sport, October 2014, Professor Ian Needleman

[iv] UCL Eastman Centre for Oral Health and Performance Better Oral Health for Footballers Needed, statement published 3 November 2015. Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists, Br J Sports Med 2016;50:41-44 doi:10.1136/bjsports-2015-094953, Professor Ian Needleman et al.

[v]  Sales of beverages 2009-2014 in selected countries, data from Euromonitor Passport International, obtained from nutrition fact panels and websites of sugar-sweetened beverage companies kcal = kilocalories, source The Lancet Diabetes & Endocrinology, 2016 4, 174-186DOI: (10.1016/S2213-8587(15)00419-2)

 

Primary care sports med to ‘pitchside’ gymnastics: Travelling across the pond to dip my toes in the USA SEM scene

26 Jun, 16 | by BJSM

Undergraduate perspective on Sports & Exercise Medicine a BJSM blog series

By Michael Akadiri

texas orthaepedic hospitalThis Spring, I travelled across the pond from the UK to the USA to take the fortuitous opportunity of a 6-week study elective. In line with the country’s nickname as ‘The Land of Opportunity’, I viewed this trip as my opportunity to delve further into the ever growing speciality of Sports and Exercise Medicine (SEM).

Primary Care Sports Medicine

The setting for my first three weeks was the Orthopedic Specialty Institute (OSI) in Orange, California shadowing Dr Kruse, a primary care sports physician (most akin to a SEM consultant in the UK). Primary care sports physicians in the US typically undertake three years of Family Medicine Residency (training), followed by a one year Sports Medicine Fellowship.

Know Your Sport!

Dr Kruse is one of the USA Gymnastics’ Team Physicians. Therefore I observed the management of various gymnastic injuries in clinic. Among the great insight I gleaned was the very useful lesson: Know your sport! History taking is a much smoother process when the clinician understands the sport specific terms used by the historian to describe their mechanism of injury. What is a Tumble Track? High Bar?

These upcoming Olympic Games should be watched for education as well as entertainment!

No screening? No participation!

Outside of the clinic, I observed two High School Pre Participation Physical Examinations (PPE). All athletes from Junior High School (c. 12 years old) and above must undergo and pass an annual PPE in order to participate in any sport. The PPEs were held in May to permit adequate treatment time for those who had ‘failed’ over the summer break. Is this a concept that we should introduce on our shores to provide better holistic care for our Secondary School athletes?

Sports Orthopaedics

I spent the latter three weeks in Houston at the Texas Orthopedic Hospital (TOH) to observe the experienced Sports Orthopaedist, Dr Elkousy. He specialises in arthroscopic surgery of the knee and the shoulder. Sports Orthopaedists typically spend five years undertaking an Orthopaedic Residency followed by a One Year Sports Medicine Fellowship.

Taking the long term view

A footballer tears his/her ACL. It’s reconstructed and the player successfully returns to play? Success right?

What about the long-term sequelae?

A handful of former college (American) Football and Basketball players with previous ACL tears presented the clinic with moderate to severe OA as early as 37 years old! Whilst we await further research on the risk factors for early OA in athletes, should more consideration be given to the long-term effects of participating in elite sport?

Final thoughts

What an educational and thought provoking six weeks! Amongst all the teachings, I feel the most important lesson is that there’s a lot more to sports medicine than the pitchside care of athletes. The bread and butter of our practice is the clinical care of the active population.

Mr Michael Akadiri is a final year medical student at the University of Nottingham. He is set to graduate in the summer of 2016 and commence work as a junior doctor in the South Thames Deanery. As an undergraduate, he co founded and led Nottingham’s University SEM Society as President for two years.  

Dr. Liam West BSc (Hons) MBBCh (@Liam_West) is a graduate of Cardiff Medical School and now works as a junior doctor at the John Radcliffe Hospital, Oxford. In addition to his role as an associate editor for BJSM he also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

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