This E-letter is in response to The role of the sports and exercise medicine physician in the National Health Service: a questionnaire-based survey Abstract | Full Article

I would like to thank P O’Halloran for conducting this survey. One of the results which strikes clearly is the need for training in Orthopaedics by all the participants ( 85% of all participants) [Figure 1, page 1145 (1)] This is something which I have felt for a long time as most of the injuries are seen by Orthopaedics in UK including tendinosis and their treatments.

The irony is that criteria for SEM Entry does not state or give any preference to those with any or some Orthopaedics experience. One would think that Orthopaedics experience would be handy and mutually symbiotic for SEM as this study proves.

I can tell from my personal experience from earlier this year trying to apply for SEM posts that I did not fulfill the criteria to apply for the SEM posts although I had SEM diploma and vast Orthopaedics experience.

I am pleased to find that Prof Maffuli is an author on this paper. I hope that he will be able to plead the case for those with Orthopaedics experience and SEM Qualifications. Doctors interested in SEM with surgical experience should not be seen as threat and should be encouraged to become part of the SEM fraternity. This will not help make this speciality more interesting.

Turab A. Syed
Registrar Trauma & Orthopaedics cum Sports Doctor
Milton Keynes Foundation Hospital NHS Trust

References

1: The role of the sports and exercise medicine physician in the National Health Service: a questionnaire-based survey: P O Halloran, V Tzortziou Brown, K Morgan, N Maffulli, M Perry, and D Morrissey Br. J. Sports Med. 2009 43:1143-1148; doi:10.1136/bjsm.2009.064972

Conflict of Interest: Orthopaedic Registrar with SEM Diploma hoping to get recognition in SEM Field

The ACSP Clinical Sports Medicine 2010: Tendons

This is a 1-day event, presented by Australian Sports Physicians, which has been designed primarily for General Practitioners, allied health practitioners and specialist trainees.

Event: ACSP Clinical Sports Medicine 2010: Tendons
Date: Sunday 7 March 2010
Time: 8.30 am – 4.30 pm
Cost: Aus$220 (incl GST)
Max delegates: 100
Venue: NSW Institute of Sport, Olympic Park, Sydney
Enquiries: Christine de Villeneuve +61 2 9223 4055
Email: acsp@bigpond.com
Online registration: www.acsp.org.au

25th ACSP Annual Scientific Conference

Date: 24-27 October 2010,
Venue: Couran Cove Island Resort, Queensland, Australia
Enquiries: Christine de Villeneuve +61 2 9223 4055
Email: acsp@bigpond.com
Online registration: www.acsp.org.au

I read your fascinating article with much interest. Do you think that in simple terms that anticipatory regulation may be an aspect of the decision-making the athlete makes before execution of an action. In the instance of longer duration exercise eg a marathon a decision is made then physiological systems amongst others come into action as you have described. Prior learning and adaptation may be involved as well as genetic and environmental factors. The particular learning aspects include; cognition, perception and affection. The knowledge to be gained from this study could have particular importance to injury prevention in sport, notably when fatigue is an issue. Central fatigue and peripheral fatigue.

Henare Broughton
PhD candidate
School of Psychology
Trinity College
Dublin, Ireland.

Shaving may be a daily ritual for most men, but for athletes it is much more open to debate. Some athletes shave with a vengeance : cyclists shave their legs by tradition and to make easier cleaning road rash and massages, swimmers may even shave their entire body (particularly before swimming suits were authorized) to minimize friction, and body builders go for a full body shave for aesthetic reasons (1). Conversely, in boxing, rugby and other sports where high power production is required, many athletes prefer to wait till after the competition before shaving. They do that to avoid any negative effect of shaving on explosive strength (2). Although to our knowledge there is no scientific rationale for this commonplace idea, shaving one’s beard just before a physical performance is said to impair the nervous flux involved in force production (2). This assumption may be linked to the fate of Samson in the Old Testament, who was reported to loose his strength after having his hair cut (3). This possible decrease in muscle force following beard shaving has been largely feared for Sebastien “Caveman” Chabal, a popular rugby player during the 2007 Rugby World cup who sported a long mane and a thick beard. The player did not risk the strength loss and kept his hair and his beard for the following sport seasons. Although science provides advances for a better understanding of sport performance, many commonplace ideas endure in athletes population (4,5). The fear of ending up weakened like Samson still remains widespread and has not been investigated scientifically, to our knowledge, which motivated the present study. We focused on peak power which can be determined from the force-velocity relationship and is an important functional property from a physical performance perspective. Twenty university students (23.4 ± years; 177.6 cm and 74.2 kg), all trained athletes, were included during bench press tests. There were studied in two cross-over sessions undertaken in a random order, assessing force, velocity and power peaks. One session was with beard shaving 2 to 3 hours prior to the test, and the other was with no beard shaving in the preceding 36 hours. After several warm-up sets using light weights of their choice, subjects performed five consecutive bench press lifts (load corresponding to 50-70 % of their own one-repetition maximum ) with pushes at the highest possible velocity. Lifts were performed using an Olympic bar and plates equipped with an inertial dynamometer using accelerometry (Myotest S.A., Switzerland) reported as a valid and reliable method to assess maximal force, velocity and power from loads corresponding to 30-70% of the one-repetition maximum (6). Analysis of variance for repeated measurements were used to detect differences between the sessions. Results from bench press tests described an homogeneous group of subjects trained in this particular movement of strength training with unchanged performances between the first and second tests (P=0.43).

Figure 1 : Peaks for force, velocity and power in subjects not shaved (A) and recently shaved (B). Means are in bold black lines, forces are expressed in N, velocity in cm/s, power in W.

The performances in maximal power, velocity and force appeared unchanged by the shaving status (P=0.39). Beard shaving shortly before exercise did not appear to affect muscle force production although our results did not assess a possible influence on nervous flux. Our results suggest that the “Samson negative effect” of beard shaving is truly a myth. However, modifying their routine and beliefs could influence their psychological disposition for optimal performance, and change the image they want to project. Therefore, athletes may not be shaved before competing, but from now on they should invoke a better reason than optimization of force production.

Desgorces FD, Trémion M, Noirez P

Université Paris Descartes, UFR STAPS, Paris, France

References

1 R.L. Sharp, D.L. Costill, Med Sci Sports Exerc 21,576-80 (1989)

2 A. Saouter, Terrain n°25, revue d’ethnologie de l’europe, Eds (French culture ministry and foundation of Paris home of Human sciences, Paris 1995).

3 The Old Testament, Book of Judges 16

4 N. Yang, D.G. MacArthur, J.P. Gulbin, A.G. Hahn, A.H. Beggs, S. Easteal, K. North, Am J Hum Genet 73,627-31 (2003)

5 F.D. Desgorces, G. Berthelot, N. El Helou, V. Thibault, M. Guillaume, M. Tafflet, O. Hermine, J.F. Toussaint, PLoS One 3, e3653 (2008)

6 B. Jidovtseff, J.M. Crielaard, S. Cauchy, J.L. Croisier, Sci Sports 23, 94-97 (2008)

Congratulations to one of BJSM’s member societies, the Australasian College of Sports Physicians, for reaching another landmark in the road toward specialization. Below is the announcement by the Australian Medical Council. At BJSM, we appreciate that all countries aim to learn from each others’ efforts so this news is not just of significance in Australia. Congratulations to the ACSP!

Coincidentally, the upcoming December issue of BJSM (issue 14 for 2009) focuses on sports medicine specialization! That issue should be on the website mid-December after the early December issue of BJSM (issue 13, Injury Prevention Health Protection, IPHP, together with the IOC) that focuses on the Winter Olympics.

MEDIA RELEASE

Recognition of Sport and Exercise Medicine as a Medical Specialty

13 November 2009

In November 2009, following on the advice received from the Australian Medical Council (AMC), the Commonwealth Minister for Health and Ageing announced that she has decided to recognise sport and exercise medicine as a medical specialty for the purpose of inclusion in the AMC List of Australian Recognised Medical Specialties.

The Minister’s decision does not automatically lead to the inclusion of this specialty on Schedule 4 of the Health Insurance Regulations 1975, which would grant patients access to rebates through Medicare Australia.

The education and training programs of the Australasian College of Sports Physicians were assessed by the AMC in November 2008. The AMC then advised the Minister for Health and Ageing that the education and training programs of the College met the criteria for AMC accreditation, thereby completing Stage 2 of the recognition procedure. The AMC assessment of specialist education and training programs is a collegial process for quality assurance and continuous quality improvement of specialist medical education and training programs. Listing on the AMC List of Australian Recognised Medical Specialties allows training providers to participate in the AMC’s accreditation of specialist medical education, training and professional development programs.

In 2002, in response to an invitation of the Commonwealth Minister for Health and Ageing, the AMC took on the responsibility for advising the Minister on which disciplines of medical practice should be recognised as medical specialties in Australia. The AMC manages a two-stage process that assesses applications for recognition against specific criteria and standards. In Stage 1, an application is assessed against specific recognition criteria. In Stage 2, the standards of the specialist education, training programs and continuing professional development programs available for the proposed medical specialty are assessed.

The decision to recognise a medical specialty rests with the Commonwealth Minister for Health and Ageing. Recognition as a specialty is conditional upon successful completion of both stages of this process and on the Minister having made a decision to recognise a specialty.

The overall objective of the College’s training is ‘to set and maintain a specialist standard of excellence in the training and practice of sport and exercise medicine’. To be granted College Fellowship, which leads to independent practice as a sports physician, medical practitioners must successfully complete the College’s four-year training program.

The AMC expert team’s assessment included visits to clinics; a review of College documents and interviews with College representatives; surveys of doctors completing sport and exercise medicine training and their supervisors; and submissions from external stakeholders such as health departments, other health professional bodies and university medical schools.

The report identifies and commends the significant strengths of the College’s training. The AMC found that while the College is small, it is active and produces competent specialists capable of practising independently. The report makes recommendations to improve the ACSP programs and plans, and to monitor the implementation of the changes. The report recognises the primary strength of ACSP training to be the development and implementation of a comprehensive and well documented training program with considerable multi-disciplinary input to training; regular formalised cycle of formative assessment; an active program of review for all aspects of the training curriculum; and a clear commitment to provide ongoing professional development for Fellows.

The team’s report also recommends the College develop more explicit learning objectives, a curriculum map and linked assessment blueprint for the training program. The team found that the College could develop policies to improve the involvement of consumers, registrars and other health practitioners in governance and review and assessment processes.

The Executive Summary of the accreditation report of the education and training programs of the Australasian College of Sports Physicians is available on the AMC website.

This e-letter is in response to Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Abstract | Full Article

This outstanding body of research is a watershed in the fight against ACL-injuries.  This group should be richly commended for this excellent work.

The work points to (a priori) how, in the case of alpine skiing, excessive abduction loading / valgus torque of the lower leg structure relative to the upper leg (about the knee) can be truncated by ”detaching” the imposing load from the point of load application at the playing surface in the direction of the applied load.  E.G., if the medial load that applies abduction to the lower leg can be “released” from the lower leg — the abduction / valgus loading will dissipate.  An alpine ski-binding with this capability (via lateral heel release) will provide this capability when the applied load is “released” (when the applied abduction load approaches a pre-determined level that is well below the elastic limit of the acl but which level is above that which is needed to provide “controlled” skiing maneuvers).  Such a binding exists, today, and a prospective intervention study should be considered to study its merits for skiers.

Rick Howell
Dipl. Eng.
Stowe, Vermont, USA

Conflict of Interest: Inventor of alpine ski-binding with independently adjustable, non-inadvertant abduction release in response to excessive valgus loading, but am presently cut-off from financial gain in this IP due to on-going litigation re: ownership rights.

Evolutionist Dan Lieberman raised the question of barefoot running in the ACSM’s Wolfe Memorial Lecture in 2009. Here the New York Times enters the debate by interviewing renowned biomechanist Benno Nigg (University of Calgary) and weaving in data from a recent BJSM paper on what happens as shoes wear out over time.

BJSM aims to be relevant to clinicians and to influence practice. It has been pleasing to see BJSM quoted in the New York Times, the Financial Post, and other major international news outlets. Our September issue (PDF), in partnership with the IOC continues to have an impact the world over. This link is to the widely read US News. To read the editorial about sudden cardiac death for athletes in the September issue click here.

The Triathlete’s Training Bible will make triathletes smarter, stronger and faster

Review by Ross Tucker

Joe Friel’s Triathlete’s Training Bible, now in its 3rd edition, has become an indispensable tool for triathletes of all levels wishing to improve their performance using evidence-based methods and principles. Of most credit to the book is that it is very obviously a sound theoretical treatise, heavily based on scientific truths, as well as Friel’s own experience of having worked with triathletes for many years. Yet it does not overplay its hand, forcing technical scientific information on the reader and aspirant improver. Rather, it guides decision-making for all situations, covering topics ranging from motivation (the art) to metabolism (the science), always in a very clear, concise and practical manner. As for scientists who work with athletes, the value is in appreciating how Friel balances the complexity of the science of performance, with the requirement to give athletes tangible, easily implementable advice, and this is something all sports scientists can borrow from.

[Also, click here for a link to Joe Friel's blog - ed.]

Cold Water Immersion is one of the latest trends in encouraging recovery. At the Olympics several swim teams set up immersion tanks on the warm-up pool deck for “recovery”.

What are your thoughts? Do you have evidence that they help? Please do share your thoughts on Cold Water Immersion with us at the BJSM.