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7 key attributes of Sports Doctors and Physiotherapists at The Commonwealth Games

24 Jul, 14 | by Karim Khan

PhotobombHow can young doctors and physiotherapists get involved?

Paul Dijkstra (@DrPaulDijkstra)

I’m passionate about high performance medical teams and how they work. I used the lead-up to yesterday’s opening ceremony of the 20th Commonwealth Games in Glasgow, Scotland, to chat with participants from different countries here with me in the Village. The excellent sports clinicians are very busy, running around and working long hours to plan and deliver world class medical services to thousands of elite athletes and officials (6500 from 71 nations competing in 17 sports over 11 days!).

I asked “What are the key attributes of Sports Doctors and Physiotherapists working at a major event?”. I asked clinicians and also asked the coaches and management what they expect from good medical teams. Here are top attributes:

  1. Be comfortable to work in an open and collaborative clinical environment (a flat hierarchy) amongst a group of medical, science and coaching professionals where good people do what they’re good at’: Dr Mike Loosemore, Chief Medical Officer of Team England. (@DoctorLoosemore)
  1. Make sure you’re well qualified and experienced for the job’. Easier said than done… It takes 10-12 years of hard work and study to become a specialist Sport and Exercise Medicine Physician and good jobs don’t fall into your lap! Medical students and young doctors in training should not hesitate to get out there and volunteer. ‘Chase knowledge’ said one coach. ‘Build relations with colleagues, physiotherapists, teams, coaches, athletes and sporting officials’. Angela George, Team England physiotherapist agrees: ‘Be prepared to volunteer for every opportunity, get your name known and gain experience in lots of different sports. We all started out in community sport and now have the opportunity to work at the pinnacle of elite sport.’ Really good advice – offer to shadow and assist senior clinicians in the policlinics or next to the fields in smaller local clubs or school events. Be willing to work hard for little or no pay. (@PhysioAnge)

Kudos to Mike Loosemore and Team England management who’ve allowed British marathon runner and Specialty Registrar in Sport and Exercise Medicine (ST5 SEM), Rebecca Robinson to work as part of the Team England medical staff. Market yourself: ‘Blog, write and tweet…’ watch this space: Rebecca will share her experience in a BJSM blog soon! (rjpRobinson)

 

  1. Connect with the athlete’ says Paul Treu, Head Coach to the Kenyan Rugby Sevens team. ‘It is so important for the Team Physician to be able to really understand and appreciate the expectations of each individual athlete’.Dr Stephen Chew, Team England doctor agrees: ‘Attention to detail is important – know the athlete, know the venue and know the sport’. (@paultreu)

 

  1. Be able to adapt to the different environments without compromising on your standards of clinical care’ says Dr Karen Schwabe, here with the South African Team. She added: ‘Be ready to give energy – know how to pace yourself, do some exercise and get down time’. Karen has vast experience in rugby and endurance sport having just published three landmark papers in the BJSM – the SAFER studies.

 

  1. Know your place – the athletes are here to perform. When you’ve seen an injured athlete, don’t keep focusing on that injury or illness by constantly asking the athlete how he / she is doing. They will tell you!’ A valuable lesson I think; our instinct as doctors is to be caring, empathetic and protective. These are all good attributes but should be applied in a sensitive way in a performance focused environment.

 

  1. Laura Hanna is a very experienced physiotherapist and leading Team England’s physiotherapy team: ‘Experience, sound clinical knowledge, flexibility and ability to deal with whatever comes through the door gives physiotherapists working in a multi-sport an advantage. Long hours and putting your hand to anything will help and importantly having a great sense of humor and fun makes anything seem possible.’li>

 

  1. You have to be able to enjoy working in a complex and challenging environment and be passionate about working in sport’, wise words to end this short blog from Dr Bruce Hamilton, leading the New Zealand medical team here.

 

Enjoy the Commonwealth Games!

PS: BJSM Editor’s comment – Follow @DrPaulDijkstra and when he get clearances he’ll keep us informed. Health professionals are part of the TEAM at the Commonwealth Games so they need media clearance of course. He’ll be contributing to the @weRengland twitter feed (Who comes up with those nAmes?)

Paul was too humble to put this in his Blog but his BJSM paper “Managing the Health of the Elite Athlete” has taken off – it’s gone viral as far as journal articles go.  You can read it free tonight here once you turn the TV off.

Exercises to prevent sports injuries – lots of talk, but do they work?

20 Jul, 14 | by BJSM

Letter to the Editor

By Dr. Babette Pluim (@DocPluim)

In response to: Jeppe Bo LauersenDitte Marie Bertelsen, Lars Bo Andersen.

The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trialsBJSM. 201448:11 871-877 .

Strength training was the big winner in a recent BJSM systematic review and meta-analysis of Lauersen et al.1 The authors carefully quantified the preventive effect of several different forms of physical activity programs. They differentiated between the effect on acute and overuse injuries. Previous studies on musculoskeletal injuries, have focused on one particular intervention, one injury type or location, one specific sport, or were narrative reviews. This is a quantum step forward.

The field is relatively mature with 25 RCTs to study, including 26 610 participants with 3464 injuries. The studies were grouped into strength exercises, stretching exercises, proprioception exercises and multiple exposure studies.

Strength training was the most effective intervention and reduced sports injuries to less than one third (RR 0.315 (0.207-0.480). Proprioception exercises were also effective and reduced the number to almost half (RR 0.550 (0.347-0.869). Contrary to my expectations multiple exposure interventions were less effective (RR 0.655 (0.520-0.286) and stretching had no beneficial effect at all (RR 0.963 (0.846-1.095). Outcome analysis showed that both acute (RR 0.647 (0.502-0.836) and overuse injuries (RR 0.527 (0.373-0.746) could be reduced by preventative exercise programs.

exposure plot

Clinical implications

1. There is great potential in strength training — we should utilize this more. The results from the strength training studies were consistent, despite different programmes being used and despite different outcomes of interest, which points towards a strong generalisability of results. This means that many types of strength exercise have the potential to prevent many types of injuries.

2. Was it a nail in the coffin for stretching exercises? Stretching did not prevent injuries, whether done before or after training. However, this analysis included only two studies on army recruits and one internet-based study on the general population, so more data are badly wanted.2-4 Stretching may serve other purposes, and it may still be relevant for the upper extremity, but NOT for injury prevention of lower extremity exercises. It may be helpful in specific cases if there has been a previous injury. But today, there is no evidence supporting stretching for injury prevention.

It makes intuitive sense to combine several interventions to prevent all injuries, and I was therefore surprised that see that multiple intervention studies had smaller effect size that strength training or proprioception alone. However, the authors point out that each component may be reduced quantitatively or qualitatively by designing a program with an array of exposures (the proportion of effective interventions may be smaller, compliance may suffer etc). They therefore suggest these type of programs should be built from well-proven single exposures and they stress the importance of further research into single exposures.

The take home message for me as a sports physician is that I will take strengthening exercises to prevent injuries even more seriously than I already did:

- hip abduction, lunges, squats, step ups and step downs to prevent ACL injuries and anterior knee pain
- leg curls and Nordic hamstring exercise to prevent hamstring injuries
- proprioception exercises for the ankle (the ankle app!)5 to prevent ankle injuries

The recent data of Clarsen et al. on the shoulder are promising,6 and as a tennis doctor, I would love to see an RCT on the effect of external rotator cuff strengthening as a follow up to their cohort study :-).

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

Dr Babette Pluim is a Sports Physician with particular expertise in Tennis Medicine (Chief Medical officer – Netherlands. She is Deputy Editor of BJSM. Follow her on twitter @DocPluim

References

1. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2014:48:871-7.

2. Jamtvedt G, Herbert RD, Flottorp S, et al. A pragmatic randomised trial of stretching before and after physical activity to prevent injury and soreness. Br J Sports Med 2010;44:1002–9. LaBella CR, Huxford

3. Pope R, Herbert R, Kirwan J. Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Aust J Physiother 1998;44:65–72.

4. Pope RP, Herbert RD, Kirwan JD, et al. A randomized trial of preexercise stretching for prevention of lower-limb injury. Med Sci Sports Exerc 2000;32:271–7.

5. Verhagen E. Easy to use mobile app for ankle sprains prevention and rehabilitation. http://blogs.bmj.com/bjsm/2014/04/07/easy-to-use-mobile-app-for-ankle-sprains-prevention-and-rehabilitation/

6. Clarsen B, Bahr R, Andersson SH, et al. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. Br J Sports Med 2014. Published Online First 19 June 2014.

 

 

Not just about the knee! Return to Play Conference “The ACL”, Melbourne July 26, 2014

18 Jul, 14 | by BJSM

Copeland_Theatre

 

The return to sport following an ACL reconstruction is often discussed in the media in terms of timelines, often with little regard to the athlete or an understanding of the process not being all about the knee. The ability to withstand multi joint, multi directional movement is vital at high load in a linear then multi planar movements. This requires the integrated care of surgeon, physiotherapists and physical trainers alongside strength and conditioning staff.

Programs around the world are addressing ACL injury risk using 3D motion capture technology to quantify these movements accurately and with joint moment and angular vector, The Sports Surgery Clinic, Dublin are utilising this technology to map individualised rehabilitation programs to expediate return safely with increased performance goals. As part of this initiative the clinic are launching a Global Research Foundation later in 2014. The aims of the foundation are to conduct original research with Global Centres focussing initially on 3D Biomechanics return to Play rehabiliation and the  rapid translation of original research, and as part of the goals education is a strong one.

To highlight the process of return to play rather than the injury itself the Foundation are holding a Conference in conjunction with The Centre for Health Exercise and Sports Medicine in University of Melbourne bringing together expertise in injury prevention, the psychology of injury and also the techniques of surgery but a focus on the strength, rate of force development, linear and multidirectional running resilience required to safely return to play. The Conference will be discussing much of the evidence behind 3D Biomechanics and also  concurrent injury with Professor Julian Feller from Melbourne and Bert Mandelbaum from the US from a surgical perspective. Dr Kate Webster will speak on the Psychological challenges and impact of rehabilitation and Dr Andrew Jowett will speak on the financial and emotional costs to clubs.

Prof Martin Schwellnus from Cape Town will talk on the Risk factors including genetics for ACL injury and Dr Eanna Falvey on ACL injury Prevention and Dr Andy Franklyn-Miller on the 3D Biomechanics of multi directional sport performance. Rehabilitation and linear and multi directional return will be discussed by Enda King from SSC, and Suki Hobson and Mike Snelling from Australia.

The player perspective is most important and  will be represented by the high profile Geelong player Daniel Menzel who has had 4 ACL reconstructions including a LARS reconstruction and will be interviewed by Dr Peter Brukner on his challenges, thoughts and rehab experiences. It is not just about the knee.

Few places remain – join us in Melbourne www.returntoplayconference.com

The Dublin SSC team will also be delivering a 1/2 day workshop for those working with Elite athletes on the 3D Athletic Groin Pain  Rehabilitation program via Olympic Park Sports Medicine Centre on Sunday 27th July.

Michael Owen: An interview with England’s most feared footballer of his generation

16 Jul, 14 | by BJSM

This interview was originally published in 2013 in the Aspetar Sports Medicine Journal and is reproduced with the kind permission of Aspetar – Orthopaedic and Sports Medicine Hospital

Interview by Dr Ian McGuiness

photo: www.mirror.co.uk

photo: www.mirror.co.uk

The most feared English player of his generation and the youngest to be capped by his country in 100 years, Michael Owen played for 3 of the world’s biggest clubs in Liverpool, Real Madrid and Manchester United, and starred for England at 5 major tournaments, including 3 World Cups. He was also the last British winner of the Ballon d’Or in 2001-the coveted award given to the best player in Europe.

Blessed with electric pace and an incredible eye for goal, he burst onto the international scene as an 18-year old, with the best goal of the 1998 World Cup in France-an amazing solo effort against Argentina.

Rated among the top strikers his country has ever produced, by the age of 24 he had played 316 games for club and country.

Playing so many games as a youngster ultimately took its toll, and a succession of major injuries reduced his speed and curtailed his career, but he remained an instinctive goal scorer, which led Sir Alex Ferguson to say,

“His positional play, his first touch and his finish were absolutely magnificent. They were world class. There’s no-one better than Michael Owen”

A confirmed family man, since retirement Michael has become a successful racehorse owner, with his own Manor House Stables, and continues to work in the game he loves, as a football analyst for BT Sport in the UK.

You had a glittering career at the very highest level, winning many major team and individual honours. What was your personal highlight, and how would you best like your football career to be remembered?

I was really fortunate to have a career at the top level. To be still playing at a team like Manchester United at the end of that career was particularly gratifying. To stay at the top when you have been compromised with the injuries I sustained is not easy. The early part of my career at Liverpool is where I was at my best. I reached the top of my profession in those years, and playing for a great team like Liverpool as well as England were the years I remember fondly. Winning honours and trophies are great highlights, but I think my personal highlight would be winning the European player of the year award. At the time I wasn’t aware of what a great honour it was, but looking back at the past winners and the names of the English players that are on that list, it certainly was a huge accolade. If I had to pick out three main highlights of my career it would be the goal in the 1998 World Cup against Argentina in France, the hat trick in Munich against Germany in World Cup qualification and the two goals in the FA Cup final to beat Arsenal in the last few minutes.

You made your 1st Team debut for Liverpool in the Premier League at 17 – how difficult was it to play against experienced professionals, who were, in some cases, twice your age?

I believe that when I was younger I was mentally very strong and ahead of my time in many ways, nothing fazed me. I went into games with a supreme confidence, knowing that I was one of the best players on the pitch. Mentally and physically I certainly felt ready. It didn’t matter who we were playing against, I would expect to score, because I had never experienced anything else. I never had any feelings of failure and I just expected to be the star man in every game. When you get a little bit older and wiser and start worrying about what the opposition’s strengths are and whether you are going to beat them, that is when your performance starts slipping a bit and you can over analyse things.

You once said you were “born to score goals” – to succeed in football, how much is down to natural ability and talent, and how much is hard work, allied with the right coaching?

There is no doubt it is a mixture of them all. You have to be born with a certain amount of natural ability. Physically you have to have a body that is going to withstand the rigours of the game and if you are fortunate enough to be born with a body that can move quickly, like I was, then you have a head start. But the mental side of the sport also plays a part. There was never any doubt that I would be a football player. My dad was a professional footballer and I used to go on the pitch feeling as if I had scored before I had even kicked a ball. You also need to be coached well. You need to be in the right place at the right time, natural ability is one thing, but if you do not have that hard work and dedication to the game, and if you don’t have people around you that are creating an environment for you to flourish, that talent might disappear. So certainly to get to the top you need a combination of them all.

You also said, “As a youngster, I was considered exceptional, and in many ways that was to my detriment” – can you explain what you meant by that?

The only lingering question mark in my mind is; did I play too many games as a youngster when I was not fully developed? I was playing in the national team from under 15s right the way through to the under 21s and the senior team. I was in the Liverpool team at 17 and everyone wanted me in their team. I was playing virtually every game open for me to play in and I wonder if that was that to my detriment? I picked up a huge injury when I was 19 playing away at Leeds and I ruptured my hamstring. Liverpool at the time weren’t the best team in the league and they needed me to play. In defence of the manager who was picking me at the time, I wanted to play every game.

By the age of 24, you had played 316 games for club and country, as opposed to Ryan Giggs (112), Paul Scholes (123) and David Beckham (184) – do you think that affected you in your later career, and do clubs have a duty to protect their young players more?

It’s a huge number and it goes to prove that my body could stand the rigour as I had played thousands of youth games as well. But because the hamstring injury I suffered was so big, I think that left me compromised for the rest of my career. It wasn’t rehabilitated properly and that isn’t any criticism to the medical staff at the time, but sports medicine has moved on since then. I was running with half the power on one leg than I had on the other, which then creates problems in other areas. It went from hamstrings to groins, to thighs, and it almost took a cycle around my body. I am quite confident in saying that there was a chain reaction of injuries from that initial one.

How does the doctor earn the respect of the players?

I think medics in general, can’t get through life at the top of their profession without having a great knowledge of their profession. Immediately you are presented as a doctor of a football team with many different injuries, so you need a fantastic base of knowledge. Football is quite unique in that you need to be a certain character to survive in a team environment. If you get rumours of misdiagnosis spreading through a dressing room, it can be very powerful. I think as a team doctor or physio you earn the respect of players by the way you handle them and by the way that you talk to them. Footballers like to build a good affinity and a good relationship with their medical team and they need to earn that respect and vice versa.

What advice would you give to physios and doctors who want to work in football?

You need to know your stuff and be at the top of your game but not stop there. You need to have the experience of being at different football clubs, learning the culture and learning how people react at different clubs. There is a lot of pressure on medics at football clubs. The managers want their key players to be fit tomorrow, the players want to be fit tomorrow and sometimes you have to manage expectations. It’s not just about learning how long an injury takes. Every situation is different and the pressure that comes from outside is great. Having a qualification to be a sports doctor is not enough.

How much of an influence was sports science on your career?

I think sports science is the fastest growing area of football, no doubt about it. When I first came into the game, in terms of sports science, we employed someone part-time just to do an hour or so in the warm up, maybe twice a week. When I left Manchester United there must have been about five or six full-time sports scientists. That is the area that’s developing most quickly at the moment. How do you run faster, how do you run for longer, how do you cover more ground, how do you do all of these things? And basically it is down to these sports scientists to provide you with not only the answers, but to put on the sessions and to advise you the right way to do them.

If you were 18 again now, do you think sports medicine and science would have changed your career?

Certainly, the injury that I sustained early on would have been dealt with differently and I have no doubts that I would have been at the top of my profession for far longer than I actually was. I think they detect a lot of injury and illness before it actually happens these days, which is obviously to the benefit of the players. I think my career would have been a better one, maybe not a better player, but certainly a better player for longer.

Did you feel nervous before big games?

I don’t think I suffered with nerves too much. I was really comfortable going into games; I felt I belonged on the pitch and that I could affect the game. Nerves didn’t play a huge part during my pre-match preparation. What I did do, was focus in on the game the days before, I was very irritable before a game and often my wife knew that a game was approaching just by my mood swings. Afterwards I was back to normal and I suppose it was just my way of preparing – but nerves, not really, they didn’t do it for me.

How did you cope with disappointments in your career?

It has to do with mental strength. You need a good team of people around you, not just the medical team if you’re injured, but at home with your family and an understanding manager is always helpful. Of course everyone will at some point have a dip in form, a bad injury, a family problem or a problem off the pitch during their career. It is how you get over those disappointments and how you come back from them that define a lot of people. I was always really disappointed when I got injured, but I had a good ability to re-focus my mind on the target of getting back to fitness and how I was going to get there; how I was going to put the disappointment behind me and re-focus on how I was going to get back out on to the football pitch.

Other than the injuries you have suffered, do you have any regrets in your career?

Regret is possibly the wrong word. There are certainly times I have wondered ‘what if’. The ‘what if’ is what would have happened if I had stayed at Liverpool the rest of my career. I always saw myself as a one club man, but I got offered the chance to play for Real Madrid. I didn’t want to leave Liverpool, but I felt that I would regret not playing for one of the greatest teams of all time. It was just an opportunity that I didn’t want to pass up and I thought saying no to it might be a bigger regret than leaving Liverpool in the first place. I have had a rounded career and played for some of the great teams, but there is something about being at the same team for your entire career, there is something pretty special about that, and that’s one of the things I had to sacrifice when I decided to move to Madrid.

What game from your career would you want to play again?

It would certainly be a bad one. I would probably go for the World Cup in Japan in 2002, when we played against Brazil in the quarter-finals. The feeling around the camp at that time was if we can get past this, then we can win the World Cup. But it was a disappointing game; I was half fit with a hamstring tear from the game before against Denmark. I scored in the game, but I didn’t feel right and the team didn’t play right. If we could rewind the clock, I would love to play in that game being fit and healthy again, we never had a better chance. We lost 2-1, after leading 1-0.

How did you switch off after games?

I think football is like any other sport. You can be as dedicated to it as anyone, but it does help to switch off. Whether you have got family that take you mind off things for a bit, play golf or enjoy other pastimes. I have four children, who occupy most of my time. I would suggest to young players coming through to try to find something outside football that appeals to you, mainly for the times that you’re low. I think if you’re injured for a month and you’re thinking about football constantly, it can drive you mad.

You had some traumatic injuries during your career – what was the most difficult to recover from?

I think at the time injuring my knee at the World Cup in Germany in 2006 was probably the worst. I suffered a cruciate knee ligament injury and also had some meniscal damage – that was the hardest injury to get over. Before the World Cup I was absolutely flying at Newcastle, with Alan Shearer banging in goals and then I broke my foot playing against Tottenham at White Hart Lane. A fractured metatarsal meant that I was in a plaster cast for a few months. I came out of that plaster cast, played one game and declared myself fit to go to the World Cup for England- then I got the cruciate injury. Looking back it was the same leg that I had injured with my hamstring earlier in my career. I had a real weakness on that side and I was basically not strong enough. I put it down to being deconditioned and I probably shouldn’t have gone to the World Cup. So that injury and that game put me out for a year and really hurt my career at Newcastle.

In Aspetar, we have a “state of the art” rehabilitation facility, used by many of the world’s top athletes. Did you ever visit such a place and what do you see the benefits of it being, over working only at the club?

Football clubs have their own physiotherapists and doctors, but any specialised problems thereafter, are outsourced to some of the great people and great surgeons around the world. It is also the same for anybody who has a long-term injury, as a different environment and a great facility with different people can freshen your mind. It is very hard to plough on through months of injury and so sometimes it is good to use another facility. I have been at clubs where this has been used quite lot. I have flown all over the world seeing leading specialists, going to some great facilities to try to improve the rate of your comeback from injury and other times just to have a change of environment. Facilities like this, with state of the art equipment and great people running them, are beneficial to everyone in the sporting industry.

At one point in your career, you had an on-going groin issue. What symptoms did you have and how did it affect your performance?

Hamstrings were my curse, but I did have a time at Newcastle when I had some groin issues and it transpired that I needed hernia surgery. It didn’t feel like I had a problem in the actual muscle, but when I was using it, when I didn’t feel sure of my footing or I was on a slippery surface, I felt it was recruiting my groin a little bit too much and I was getting a lot of referred pain. I went to see a specialist in Germany and they picked up straight away that I needed a hernia operation. Later I had some mesh put in during a second operation as the first operation only worked for about a year, and I didn’t look back. I had another groin strain at some point in my career, basically cutting across the ball doing too much shooting practice and I tore my groin, but that only kept me out a couple of weeks.

In Aspetar, we have a Sports Groin Pain Centre, which is working to advance the field of knowledge in these injuries. Why do you think groin problems prove so difficult to diagnose and treat, and what issues do you think the Centre should look at?

I am no medical expert, but I have had many injuries in my time and I am always keen to understand the injuries and listen to the doctor and the diagnosis. The groin is a complex area and has a lot of different uses when you’re playing football; running, twisting and turning. It is sometimes easy for medics to look at the affected area and to concentrate on the injury and treat the injury instead of the actual cause for the pain. In my experience the cause of groin pain can come from a variety of different areas, and centres like this should be looking at these different areas that could cause groin problems. Groin pain is a debilitating type of injury, if you have a groin problem it is very difficult to continue playing so you need to get the diagnosis right straight away.

You starred for England in three World Cup Tournaments – what were the differences at this level, compared to league and Champions League football?

I felt it was more of a mental challenge than anything else. When you go into a World Cup, a lot of the time you play with some weaker nations, so I don’t think the standard is far greater than Champions League football or domestic Premier League football. The biggest difference is the pressure. You realise there are millions of people watching you and cheering you on, but you also realise if you make a mistake, cost a goal or miss a penalty that sends your team home, you’re going to be scarred with that for life. Some people can’t take that expectation and basically buckle under the pressure.

What expectations do you have from the World Cup in Qatar in 2022?

Well I don’t think there is any doubt in anybody’s mind that it will be a fabulous World Cup. You only have to look at the plans and the stadiums that are being built. It is a fantastic country and I have been lucky enough to visit on a couple of occasions. Obviously the weather is one thing which might be a little bit different to what some people are used to, but I am sure once that issue is solved, Qatar is going to host a wonderful world cup. It should bring great things to the country, with a huge amount of people travelling over and I am sure the facilities will be second to none and I can’t wait for it to come around.

You achieved 10 GCSEs at School, despite playing for Liverpool at the same time – how important is it for young athletes to maintain their studies?

Well it is obviously very important as you never know whether you are going to make it or not. I was fortunate that I always wanted to be a footballer and I turned out to be a footballer, but you really don’t know where your career is going to take you so I think it’s very important to continue with your studies. I think study and playing football all comes under the same bracket. You are either a disciplined person who likes working hard or you’re not and for me I loved football, loved training hard, loved playing, but also when I was doing something else like an exam or revision, I wanted to do it to the best of my ability – that’s just the type of person I am.

At the Aspire Academy, we have a vehicle for many of our promising young athletes to enhance their development and learn their skills. What piece of advice would you give them, and in particular to the young footballers?

Having academies like this is fantastic and I was fortunate enough to go to the Aspire Academy when I was at Manchester United and again recently; it is a world class facility. Having facilities like this encourages people to get to the top of their profession. Creating that environment for people to thrive is what it is all about. Not everybody is going to make it, but what you don’t want is a really talented youngster not having the opportunity, coaching and the know how to take them to that final level and an academy like Aspire can provided that. My advice to anyone, particularly young footballers, is to make use of facilities like this and make use of the qualified people that work in these facilities. As long as you have got the right attitude and dedication to work and you want to perform to the highest of your ability, then academies like this are going to help you along the way, so there really is a great opportunity to make a name for yourself.

Get Up, Get Movn: A Novel Approach to get Patients Moving

14 Jul, 14 | by BJSM

By Harsh Vathsangam and Ade Adesanya

Who would have thought that one of the biggest killers of the 21st century would be your couch?

Physical inactivity is one of the biggest silent killers of our time and an important factor in weight loss, heart disease and stroke and diabetes. Given such dire consequences, health practitioners are increasingly incorporating physical activity regimens as part of standard practice to combat chronic diseases.

unnamedThe most common issues faced by care providers in increasing physical activity are compliance, engagement and scaling. If care providers prescribe 30 minutes of walking every day, they have limited means to ascertain if patients actually follow through. It is often challenging to engage and motivate patients, especially considering that providers are often pressed for time, sometimes seeing more than 10 patients an hour. Given these constraints, how can they ensure that all their patients are motivated to become active without sacrificing on speed and quality of care?

For the past 5 years, we at Moving Analytics have been tackling this problem. We created Movn, a mobile health platform for physical activity engagement. While developing Movn, we interviewed over 150 patients and discovered that reasons for sedentary lifestyles can be distilled to lack of awareness, ability or motivation to be active. In this post, we’re going to share our approach on how care providers can leverage cutting-edge mobile tracking technologies to tackle these issues and engage patients to become active.

For patients to move more and/or determine if they are achieving their daily physical activity goals, they have to be aware how much they are currently moving. With Movn, users can set daily movement goals and the app will track their physical activities (such as walking, running, dancing etc.) using just the sensors on their smartphones, no extra hardware/tracker required. Users can also manually log activities they do without their phones such as swimming or yoga.

Despite, knowing that physical activity is good, many people think they don’t have enough time to stay active due to demands from work, family and friends. However, there are ample opportunities to incorporate physical activity into daily routines and stay active without hitting the gym. Movn uses this concept and helps build tiny habits of activity in a user’s day. Movn uses location, calendar, call status, weather and time of day, to recommend in-the-moment things they can do to stay active, such as; take the stairs instead of the elevator (location), walk around while taking a call (call status), schedule a walking meeting (calendar). If the user is sitting for too long, Movn will remind them to get up and move. If they are regularly active, Movn will congratulate them. By doing so, Movn aims to increase one’s ability to stay active.

Personalization is a key issue. Since people have different personalities there’s no cookie cutter approach to motivating individuals to move more. From our experience we’ve observed that people are either goal oriented, data driven, or socially motivated. As users interact with Movn it builds a model of their personality and uses that model to personalize notifications accordingly. For individuals who seek social support, Movn enables sharing of achievements and feedback from friends. For individuals who are goal oriented, Movn lets them set personal activity targets and prompts them to increase those targets if they regularly achieve them. Movn also provides historical information and insights to motivate data driven individuals.

We’re sure by now, some of you are wondering how Movn will integrate into the current healthcare system. Our research shows that most general practitioners don’t have enough time to care for patients let alone request or look at their activity data. However in cases where patients are at risk for chronic diseases the doctor usually refers them to a lifestyle management program such as a diabetes prevention, weight loss or cardiac rehabilitation program. Within these programs, care providers pay more attention to patients and educate them on healthy food choices and the importance of physical activity. Currently, these programs require patients to log their physical activity on a paper report. From our research, these reports are usually inaccurate due to poor patient recall.

Movn helps simplify this process by aggregating data using just patients’ phones and converting it to actionable information for the provider. Movn provides a web dashboard that care-providers can use to track the physical activities of their clients and provide better-informed coaching. Movn captures information about activity behavioral patterns, when users are most engaged, what types of motivation are most effective etc. Care providers can see trends, identify at-risk patients and track long term progress of individuals under their care. No paper work necessary.

Smartphone-based technologies represent a unique way to support delivery of physical activity interventions by leveraging hardware that is increasingly ubiquitous in daily life. Our aim with Movn is make it easier for patients and providers to better manage this process. After all, we need to beat that couch!

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Competing interests: Ade and Harsh are researchers at the University of Southern California and are co-founders of Moving Analytics Inc. They would love to get your feedback on the app and how to get patients moving. Please send them a note at info@movinganalytics.com

Excellent BASEM Education Exercise in Health and Disease Course: From Dialysis to Nordic Walking

10 Jul, 14 | by BJSM

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

By Dr Catherine Lester

obesity

This was the first education day of its kind and masterminded by SEM consultant Dr Kate Hutchings. The course covered a wide variety of topics in a subject often poorly taught, both in undergraduate and postgraduate training.

Tutors included several SEM practitioners, exercise physiologists, a PhD health economics research fellow and the director of British Nordic walking.

The day consisted of thirteen sessions. It is difficult to summarise the day’s events in a single blog. However, personal highlights included:

  • Mr Gould’s research, within the Leicester Kidney Exercise Team, which has shown promising clinical results and had excellent demonstrations of Dialysis patients on custom made cycles during their dialysis sessions.
  • Ms Ann Gates, Founder and Director of Exercise Works, who discussed ‘The Paradigm Shift in Physical Activity Interventions’ and;
  • Dr John Buckley who encouraged the attendees to “practice what we preach” and made us stand for the second half of his presentation on physical activity (PA) in CVD rehabilitation. The day concluded with high quality research presented by Dr Pascale Kippelen on Exercise in Asthma.

Keeping to the theme of exercise and strength training, I have organised the key elements of the day’s education into 3 sets of 4 reps:

Set 1: 4 Numbers

  1. 0% – The number of 65+ year old women meeting modest PA recommendations (The Health survey for England 2008)
  2. 12 weeks- The number of weeks that funding is provided for exercise prescription. Imagine prescribing a proven life changing medication for a chronic condition and then removing it after 3 months.
  3. 58% of men and 78% of women, by age 74, can’t walk 30min or more (BHF 2012 statistics)
  4. 672,973 the number of daily clinical opportunities to encourage PA in the NHS

Set 2: 4 Great Resources and References

  1. Let’s get moving: commissioning guidance
  2. Exercise works
  3. Generation games 
  4. The Cochrane meta-analyses: Physical training for Asthma [1]

Set 3: 4 Take Home Points for myself

  1. Apply the brief intervention to every consult
  2. Exercise as the 5th ‘vital sign’ [2]
  3. Inactivity and obesity trigger persistent, low-grade systemic inflammation [3]
  4. I am NOT naturally proficient at Nordic Walking, despite excellent tutoring.

I would highly recommend the course to those interested in exercise medicine and PA.

References 

[1] Carson KV, Chandratilleke MG, Picot J, Brinn MP, Esterman AJ, Smith BJ. Physical training for asthma. Cochrane Database Syst Rev. 2013;9:CD001116.

[2] Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011;45(6):473-4.

[3] Handschin C, Spiegelman BM. The role of exercise and PGC1alpha in inflammation and chronic disease. Nature. 2008;454(7203):463-9.

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Dr Catherine Lester graduated from the University of the Witwatersrand in 2004, She completed her MSc at QMUL in 2011 and is currently in a SEM research post at Charing Cross.   She worked at the Olympics and Paralympics during London 2012, and has worked with England Women’s Hockey, Australian rowing and is the team doctor for the junior GB Ultimate Disc teams.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

 

 

Eat, drink, and win? Diet lessons from Novak Djokovic, the 2014 Wimbledon Champion

7 Jul, 14 | by BJSM

By Dr. Babette Pluim (@DocPluim)

Ever since Novak Djokovic wrote his book “Serve to Win”, a hot debate surrounds tennis players diets. Should they all eat gluten-free foods? Will that bring them instant fame and fortune?

Gluten-free?

In his book, Djokovic describes his diagnosis of a strong intolerance for wheat and dairy, and a mild sensitivity to tomatoes. Cutting out gluten from his diet resolved his gastrointestinal complaints, his asthma symptoms (possibly the so called “baker’s asthma”?) and restored his energy levels. While reviewing literature to write this blog, I was actually surprised to read that sensitivity to wheat in the general population (assessed by IgE) is around 1% (Fasano 2003). This percentage is much higher than I remembered from my textbooks (0.01%). So if a player has vague gastro-intestinal symptoms that you can’t pin down, it may well be useful to test for gluten sensitivity. However, we may assume that the current rush by tennis players to embrace a gluten-free diet is not based on a tidal wave of positive jejunal biopsies!

Djorvak takes a drink webWhole foods and protein?

In his book, Djokovic touches on a number of issues worth copying. They are useful tips for anyone, not just tennis players. If you ignore the more eccentric parts, it is actually good sport science (Rodriguez 2009). He places an emphasis on a good, healthy breakfast with plenty of carbohydrates with a low glycemic index – the ones that take a bit longer to digest. This means that he will not simply eat “empty” carbohydrates, but that his breakfast will include fruits, nuts, seeds, grains and quinoa (full of fibre, vitamins, minerals, and other micronutrients).

He likes a protein drink after play and recommends proteins (white meat and fish) and vegetables in the evenings, to enhance recovery. I would personally recommend that you throw some carbs in there as well, to restore the depleted glycogen stores of the muscles and liver; weight gain will not be an issue if you have another heavy work out scheduled for the next day! Timing the protein intake (during and immediately after exercise and at night) is something that has gained more credibility lately for adequate muscle restoration and buildup.

Sports drinks?

When it comes to drinks, Djokovic does not seem to have a single preference. He recommends water in the morning, energy drinks with fructose and hydration drinks during workouts, and protein drinks after play. Professional tennis players usually drink both water and sports drinks during a match. Other players have their own particular preferences and you can see Rafael Nadal shouting out for his recuperation drink on YouTube (see https://www.youtube.com/watch?v=twL0bz6saqs). Players should always start a match well hydrated, and drink enough during a match to balance fluid losses. The advantage of tennis is that players have ample opportunity to drink during changeovers. This is in contrast to football, for example, where extra drinking opportunities had to be created during the World Cup. Tennis players can take a few sips every time they change ends and simply drink to thirst, without the need to force fluid intake. In addition to water, sports beverages also contain the carbohydrates and electrolytes that are recommended to help maintain blood glucose concentration, provide fuel to the muscles, and decrease the risk of dehydration and hyponatraemia (Périard 2014; Kovacs 2006). However, energy drinks with very high concentrations of sugar and caffeine are generally not recommended during play.

A bite to eat?

Another advantage that tennis has over other sports is that players can graze during change overs – the most popular products being bananas, sport bars, energy gels and sweets. Djokovic admits that he sometimes uses a power gel with 25 mg of caffeine before matches if he really wants to be fired up.

Low carb – high fat (LCHF)?

The LCHF debate does not seem to have hit the tennis scene (yet), so I will stay out of that minefield and reduce the Twitter dialogue from South Africa (https://soundcloud.com/bmjpodcasts/high-fat-for-health) !

Does the 2014 Wimbledon Champion play so well just because he eats well?

No, it’s far more complicated than that – growing up and playing tennis in a war zone, exercising up to 8 hours a day, doing lots of mental exercises, having a fantastic team around him, taking care of his body with stretching, strengthening and massage are just a few of the factors that have moulded a tennis superstar.

On what it takes to be a top level tennis player, the man himself says: “I would say 10% is talent, 85% is hard work and 5% is luck.” Novak simply fails to mention his diet!

References

Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med 2003; 163:286-92.

Rodriguez NR, DiMarco NM, Langley S. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J Am Diet Assoc 2009; 109:509-27.

Périard JD, Racinais S, Knez WL et al. Coping with heat stress during match-play tennis: does an individualised hydration regimen enhance performance and recovery? Br J Sports Med 2014 (suppl 1); 48:64-70.

Kovacs MS. Carbohydrate intake and tennis: are there benefits? Br J Sports Med 2006; 40:e13.

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Dr Babette Pluim is a Sports Physician with particular expertise in Tennis Medicine. She is Deputy Editor of BJSM. Follow her on twitter @DocPluim

 

How physios working in sport can solve clinical problems with research. Practical tips.

2 Jul, 14 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Simon Rice

For recently graduated physiotherapists or those working in private practice, research can intimidate and appear as something that just happens behind closed laboratory doors. Often, physiotherapists working in private clinics would like to get involved in research, but think…’I don’t have time’ or ‘I don’t have money’. Do you hold the view that research is strictly for academics? If that were the case it would really limit our discipline. And remember there are many examples of physios in private and active clinical practice who have made major research contributions – Jenny McConnell is a classic example from the 1980s. Many more since then (see below).

Benefits for research project involvement range from individual to global:

  • It encourages you to read articles that relate to your interests.
  • Your name on a paper in your area of interest or specialty may help advance your career
  • Patients may have greater confidence in your ability knowing you have an active research interest in their injury area and the related treatment techniques and prognostic variables
  • Physiotherapists working day to day with athletes and non-professional activity enthusiasts, will likely orient research questions to those of practical use in the ‘real world’
  • Physiotherapists with different case loads and experience are likely to ask a higher volume and variety of research questions
  • A lot of modalities physiotherapists use on a day-to-day level are not supported by high levels of evidence. Contributing to this evidence base strengthens the community of sport and exercise professionals as a whole to ultimately improve patient care and set the discipline apart from complementary therapies with little or no evidence.
  • If you are skeptical about physio research read the articles about PEDro in the BJSM and go to the PEDro website.

Getting involved in research is often easier then people think. You don’t need to have a large volume of clinical experience before you start on a research project. Conducting a systematic review or managing a small part of an interventional study often does not impose large time pressures and can be managed well in the private sector.

Here are a couple tips to get you started:

  1. Find a research mentor. This is really important as they can walk you through the step-by-step process and mitigate the intimidation.
  2. Get involved with someone doing a systematic review in an area of interest to you.
  3. Jump on the opportunity to be a second or third author on a review as it allows you to dip your toes in the research water and get a feel for the process, while maintaining a smaller time commitment to not interfere with your clinical load.
  4. Still unsure? Some additional resources can be found here: http://www.csp.org.uk/professional-union/research/doing-research and here: http://www.completesportscare.com.au/research-2/research-resources/
  5. Ready to get started? Learn about grants and funding opportunities here: (http://www.csp.org.uk/professional-union/research/funding/csp-research-funding) and here: http://www.csp.org.uk/professional-union/research/research-funding/finding-funding). Also, the CSP lists the topics that are considered priority areas: http://www.csp.org.uk/documents/physiotherapy-research-priority-project-2010-prioritised-research-topic-musculoskeletal

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Simon Rice is a Musculoskeletal Physiotherapist and Research Lead at Pure Sports Medicine in London. He has background working in strength and conditioning with elite athletes and has a particular interest in end stage rehabilitation and injury prevention. He is currently completing research in neuromuscular warm ups for injury prevention and the effect of maximal strength training on running economy.

Novak Djokovic shares his sportsmedicine secrets for success

28 Jun, 14 | by BJSM

This interview was originally published in 2013 in the Aspetar Sports Medicine Journal and is reproduced with the kind permission of Aspetar – Orthopaedic and Sports Medicine Hospital

You can subscribe for free and have the Aspetar Sports Medicine Journal delivered to your door – yes, full colour, hard copy to your door. Google ‘Aspetar Sports Medicine Journal’ and enter your address. Easy. No spam. Just good quality sports medicine content.

DvorskyInterview by Dr Bane Krivokapic

Whether he’s on court or off, Novak Djokovic gives 100% of himself. His fitness and flexibility have helped him climb to the World No. 1 ranking. His humanitarian projects and on-court antics have made him a crowd favourite. Not only can he play and win the longest matches the game has ever seen (remember the 2012 Australian Open Final? Or Wimbledon 2013?), but he can play up to an international audience across dozens of media channels. And then return to do it all again in the next tournament in a different country, on a different surface.

The 26-year-old Serbian has taken the art of recovery to a whole new level, but the secret to his success, he says, is his team and family. They are the ones who have helped him become a 6-time Grand Slam Champ. Well, that, and eliminating gluten and sugar from his diet, as he tells us here.

How do you feel after playing a match that lasts for many hours? E.g. Australian Open final against Nadal

If you win the match, then you feel fantastic, no matter the amount of hours spent on court. But if you lose, then you can feel really bad, which is normal – you know you gave it all, you fought to the last drop of strength on court, and you lost. That is not easy to handle every time, especially in Grand Slams. But, this is a sport where you can always get another chance, every week there is a new tournament, new challenge. So, you learn from what happened, and turn to what’s coming.

How much time do you need to recover from such an extreme effort?

Tennis trains your body and mind to recover fast from a very early age. Because the season is so long and we play week after week, we don’t really have time to recover our energy to its fullest. You have to factor in different time zones, different climate, food, courts, balls… So your body is always adjusting to something and recovering from something. Not to mention your mind – you have to be able to resist the temptation to just stay in bed and give in to laziness after a long flight, training or match. You have to resist the urge to give up when you lose a point, a game or a set because in tennis, you always get another chance. If not in this game, then in next one; if not in this set, then in the next one. If not this week, then there is the next one. So we get one or two times per year to fully recover. Everything else is just grinding, and not giving up when going gets tough.

What is your recovery routine?

I have a great team of people around me that do the best they can with their expertise to make me feel physically, mentally and emotionally ready for every match and every challenge, and they then help me to recover later on. We have a standard routine after the matches which I don’t like to talk about, but it’s not a big secret. We do the stretching part, ice-baths, massage and similar things that are common in our sport. The main thing is to find the right balance and to understand the true limits of your body.

You give the impression that you are always physically prepared. What advice can you give to other athletes about fitness?

Every player is different, and there is no unique rule or advice. My team and I, as an example, love to be in nature so most of the things I do, I try to do out of the gym if I can. I bike ride, swim, run, play football, basketball. Every day we focus on different parts of the body. My advantage is my flexibility. My muscles are elastic and I spend a lot of time on stretching because that prevents injuries and keeps my body fresh.

How do you personally maintain your health?

I have to thank my diet for that. Eating healthy food helps me stay energised, healthy, pain free and injury free. I talked a lot about this in my book Serve to Win. We are all different and one rule cannot apply to all of us, but I did give some advice on how to find the right formula for your body that will help you stay healthy and happy.

What motivates you?

Love. Love is what keeps me going every day. Love for life, for this beautiful sport, for my family and fiancé and my team. I enjoy playing tennis and love competing. The fact that I am successful at what I do gives me an incredible opportunity to help others less fortunate than I am. I am never lacking motivation to go out there and give my best.

What is the mental game of tennis like? How do you prepare yourself in terms of psychology?

I have certain techniques that help me such as visualisation, meditation, relaxation or quite simple things like walking through a park which does miracles sometimes, I must say.

You often joke around on court – does this help your mental game?

One of my mottos is to be who I am and not pretend to be somebody else. I think that kind of thinking got me to where I am. Apart from being very serious and business-like when I go out on court to play, at the same time I really enjoy those moments and sometimes I like to show it and share it with the crowd.

Who makes up your medical staff?

I don’t really have a medical staff. I mainly visit doctors who have high expertise in working with professional athletes and I’ve been very fortunate not to need any medical assistance in the past few years.

Who do you travel with? A physiotherapist? A doctor?

I don’t travel with a doctor. We do all the necessary tests several times a year, so there is no need for him to be with me at tournaments. On the other hand, a physiotherapist is a crucial part of my team. I work with Miljan Amanovic, my close friend. We have been working together since 2007, when I was number three in the world. He helps me to recover, to prevent injuries and to get my physical condition in the best possible shape. He knows exactly what I need in every moment, which is not an easy task. But, he does it in a magnificent manner, as you can see. We are together for 9 months of the year, and when Miljan is not able to travel with us because of his family, I work with another physio, Saša Jezdic, a great professional and expert. I also travel with Marijan Vajda, my tennis coach, and Gebhard Phil-Gritsch, a fitness coach. We are a team with a capital T.

Who makes the decisions when it comes to your health, you, your doctor or your coach?

I never try to make decisions on my own because even though it’s an individual sport, it’s a team effort in the end that really counts. So the whole team discusses everything that is affecting my game and career, including health.

How much do you believe in the doctors you see?

I am very fortunate to be surrounded by great people who are excellent at what they do. I am certain that doctors I meet during the tournaments and between tennis events are all professionals, therefore there is no reason for me not to trust them. Thank God I am still healthy and young so I don’t need their assistance that much. But I am definitely not the person who will take ‘a pill for every ill’. I strongly believe that our body is able to heal itself if we give it time, and if we eat the right food. On top of that, I observe my body as a whole and don’t think that a headache is just a headache. I always try to understand and respond to the signals my body is sending to me.

You are obviously very close to your team. How does that contribute to your playing?

Without their support I would never be so successful. They mean the world to me. Each member of my team has its own obligations, but we work best as a team. We talk about everything, listen to what everyone has to say and we respect each other. It is a co-operation based on trust, hard work and professionalism, which is a winning formula in my opinion.

What is your relationship like with your coach?

My coach, Marian Vajda, is like my second father. We are more than a coach and a player. He is a very emotional guy and we have a lot of fun off the court which is very important to me. Marian is a good spirit of the team who brings positive energy.

He has contributed a lot in my career. Since we started working together I have won every singles title with him. We have gone through highs and lows, not just in my tennis career but also in my private life. He is the person I can talk to and he is like a part of my family.

Now that you eat gluten free, how do you keep your energy up without large carbohydrate loads?

Being gluten free today is so much easier than couple of years ago. Everywhere you turn you can find gluten free products so I am not really missing out on carbs. My diet is thoroughly explained in my book, so I definitely encourage you to read it.

How do you feel now that you’ve given up gluten?

I feel great. I feel more relaxed, more focused and more in control of my life in general. I’ve learned to sync food with my body’s needs, giving it exactly what it wants, when it wants it. It probably sounds strange to say I feel more relaxed and at balance but it’s true. I am at one with my body – I feed it with the right energy and in return I get a healthy and energised body. My mind and body are now more focused on performance than on masking or fighting pain.

Are you strict about any other foods? Have you cut out anything else?

I am strict about being healthy. I don’t enjoy feeding my body with junk food. It’s funny how after a while of eating right, your body immediately detects the wrong food and rejects it. In the past, every time I ate something ‘sinful’ and took something that was not a ‘healthy’ choice, my body reacted immediately and I would regret going that way. So, I cut out gluten from my life and it was the best decision ever! I also cut sugar and dairy to certain extent. The bottom line is that I am not missing anything, I am replacing junk with good and that cannot feel bad to me or my body.

How tough is it to be a high level tennis player?

It is not easy, I can tell you that. It has its ups and downs. You have to sacrifice a lot in life to be on top. High level tennis players are like Spartans, in a way. From early morning till evening we have a strict schedule of things we must do – four to five hours of practice each day, no matter if it’s 50 degrees outside. Fitness work, gym, running, ice-baths and a controlled diet are just a small part of it. Not to mention commitments to sponsors and tournaments. We travel so much, that sometimes we wake up not knowing which city or country we are in. When you are a top player, there is enormous pressure that you must win every single tournament and beat every opponent. But, I guess that’s the case with every job. If you want to be the best at something, you have to work hard; pressure is a privilege that we must earn. I enjoy tennis – it’s my life and it has given me everything. I breathe tennis and I must say it’s the best thing that has happened to me, so far. So all these things I mentioned I accept as a toll on the road and I keep going straight.

To be a high level tennis player, what percent is talent and how much is hard work?

It depends a lot from person to person, but I would say 10% is talent, 85% is hard work and 5% is luck.

The ATP tour is played on many surfaces. As an athlete, is changing surfaces good or bad for you?

It is always a challenge to change surface in a very short period of time. You have to adapt to different conditions, which is not easy, both physically and mentally. But tennis-wise, I guess the game would be quite boring if we constantly play on clay, for example. Different surfaces give opportunities to different players to show what they know, and this variety is always a good thing in sport.

When are we going to see you in Doha?

I play in Abu Dhabi every year in the Mubadala World Tennis Championship. If I find free time, I would be more than happy to visit Qatar, too. I respect all that the Al Thani family is doing for the country, and I have heard great things about Doha and its marvels. I am sure I will visit Qatar much before the FIFA World Cup in 2022.

Isokinetic “Football Medicine Strategies” Conference – Bringing the Football Medicine Family Together

26 Jun, 14 | by BJSM

Undergraduate perspective on Sports & Exercise Medicine - a BJSM blog series

By Daniel Broman (@Daniel_Broman)

The Isokinetic Medical Group is an internationally recognised leader in the fields of sports injury treatment, orthopaedic rehabilitation and medical research. The Education and Research Department at Isokinetic, led by Dr. Sergio Roi, is well known and respected world-wide. In the past few years, interest in the 20-year-old football medicine conference has really exploded. Some consider it the premier football medicine event in the world.

THE 2015 CONFERENCE WILL BE IN LONDON – APRIL 11 & 12 (confirmed dates)

Conference 'comes home' to  Italy - MiCo Conference Centre Milan

Conference ‘comes home’ to Italy – MiCo Conference Centre Milan

In review, the 2014 conference, “Football Medicine Strategies for Joint and Ligament Injuries,” attracted an impressive 2,259 delegates from 73 countries worldwide, including an outstanding selection of internationally recognised experts in Football Medicine. Football is the biggest participation sport in the world and it needs a medical force to cope with this – the “football medicine family” as the Isokinetic Group warmly call it – and the global football medicine community were all certainly in Milan for one weekend. Not even ‘El Clasico’ in Spain could keep the Real Madrid & Barcelona doctors away!

For me, a good conference is about many things. Obviously, scientific content and opportunity to learn new things from experts is extremely important. However, good events are also about sharing experiences more informally – catching up with old friends, making new connections, and enjoying yourself around like-minded individuals. The Isokinetic conference ticked all these boxes.

It was great to see so many young people (the average age was just over 30 years old) attend the event. We all go to conferences to listen to world experts, but the Isokinetic Group are also very passionate about providing opportunities to aspirational young professionals and bringing through the next generation of experts in the field.

Isokinetic are also fantastic at doing all the little things well and have a large team behind the scenes making sure everything runs to plan. This attention to detail gave the conference a really good ‘feel’ about it and ensured that delegates focus on enjoyment and making the most of their time.

From a scientific point of view, some personal conference highlights include:

  • picture 2 footballThe ‘Grassroots and Recreational Football’ session because, for me, this is the true footballing population. It is exciting to manage professional/elite athletes, but caring for the millions of “weekend warriors” over the world is of particular importance, to ensure that football promotes long-term health benefits.
  • The Science of Football summit which focused on initiatives to prevent injuries in football, as we all know that preventing problems is always preferential to treating them after they occur.
  • The ‘Management of Early and Late Osteoarthritis’ in football because, observationally, I feel this is a major long-term risk associated with football, which merits more research. We don’t want to get to a stage where the millions of footballers in the world suffer from pre-mature OA.

Next year the conference returns to London with the title “Football Medicine Strategies for Player Care”. Looking ahead to the conference in 2015 and being a junior doctor working in London, I would love to see more British medical students and junior doctors attend, especially with the growing interest in SEM at Undergraduate level in the UK.

london 2015With the title of the conference, in 2015, focusing on ‘player care’ as a topic and being a physician, I would also like to see symposia/workshops on the various medical problems that exist in football. We know that cardiology, mental health, concussion, heat and travel related problems etc., play a large role in the health of a footballer and next years’ conference may provide the opportunity to learn more about these topics.

Finally, credit and thanks must go to Stefano Della Villa and Sergio Roi for their continued passion in education, research and the development of football medicine. They really do bring the football medicine family together for one weekend every year and long may that continue!

For more information on next year’s conference, keep an eye on www.footballmedicinestrategies.com or by following @footballmed on Twitter.

 

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Dr. Daniel Broman (@Daniel_Broman) is a Core Medical Trainee in London, currently working in the Neurology department at the Royal London Hospital, Barts Health NHS Trust. He also acts as head of medical services for Maccabi Great Britain and is passionate about pursuing career in Sport & Exercise Medicine whilst helping improving the health of the nation.

Dr. Liam West BSc (Hons) MBBCh 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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