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Missed the ACPSEM Biennial Young Athlete conference? Not to worry- here are some highlights with links to key resources

25 Nov, 15 | by BJSM

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


By Zachary Spargo (@ZachSpargo)

The Physios in Sport (ACPSEM) Biennial Young Athlete Conference was in no uncertain terms an absolute classic! Great speakers, hot topics, lots of networking and above all – mini burgers for lunch! The focus was on managing the young athlete within all aspects of sport to ensure their development into a robust, resilient and successful adult. This BJSM podcast is a good place to whet your appetite

Here’s some of the educational nuggets that the two days entailed:

Physical Development and Risk

(J Bunce, A Renshaw & P Read)

CLIMBING WALL 4The day opened with a discussion on the optimal training programme for the younger athlete. A balance between resistance and power sessions was suggested to be the best route. The need to make sessions fun for youngsters was keenly stressed, giving examples of Manchester City’s playground and Brighton and Hove Albion’s climbing wall.

Andy Renshaw highlighted one of the key messages of the conference: You simply cannot rely on adult data to predict injuries in younger athletes. Using the Fuller et al. (2006) injury definition consensus statement, Andy was able to expertly illustrate the differences between the populations. His data showed for example that anterior thigh strains were the most commonly occurring injury in the academy teams (18% n=23) compared with a majority of posterior thigh injuries in the adult game. Paul Read went on next to identify some of the main risk factors for injury in adolescent populations including:

  • Previous injury
  • Fatigue
  • Movement skill/neuromuscular skill
  • Growth and Maturation
  • Seasonal Variation (Greatly increased loads pre-season)

Will Abbott (Brighton and Hove FC) also reiterated the importance of load management and monitoring throughout the season, but spoke of the need not to purely focus on velocity of activity.

Hot Topics

(S Parris, M Stewart, T Quantrell, M Hendry, A D’Silva, & J Hanson)

  • Safeguarding: The welfare of the child must always be, the absolute paramount consideration of the healthcare professional.
  • Persistent Pain: Treat the symptoms not the scan (35% of athletes have damage on MRI but no symptoms). ‘Pain is the ideal habitat for worry to flourish’ (Eccleston & Crombez, 2007). Understand our mouths are THREAT MACHINES!
  • Golf: Surprisingly little physical preparation for young golfer currently. Identify physical markers, technical markers and evaluate how your treatment/preparation has effected performance.
  • Sudden Cardiac Death: Exercise is good! However can be a trigger in rare cases for sudden cardiac death (SCD). Some of the conditions causing SCD can be screened in the young athlete.
  • Concussion: If in doubt sit them out! Chronic traumatic encephalopathy has a clinical manifestation of early onset dementia (post mortem findings of repetitive head injury).

Orthopaedic Physiotherapy Management

(P Bennett, I Tak, S Ahamed, Mo Gimpel, P Glasgow, A Wallace, M Allen & A Harris)

  • Gymnastics Adolescent Spine: In a sample of female Olympic gymnasts (12-20 years) 12/19 had degenerative discs and 3/19 had spondylolysis. Our role is to create a robust young athlete, with regular screening and early detection of issues. Must have full fitness before returning to activity after injury! See this podcast from Dr Pippa Bennet for more information:
  • Hip/Groin: Reduced hip range of motion (internal rotation) in athlete with groin pain. Increased anterior pelvic tilt results in decreased range of motion which ultimately affects ball striking power in footballers. Southampton FC’s Mo Gimpel demonstrated a tremendous reduction in hip/groin injuries with a movement dissociation programme. He also noted the need for an iliopsoas/glute activation programme before stepping on the pitch at any time!

Monitoring and Prevention

(N Cameron, J Strickland, A Johnson, W Abbott, L Abnett, J Elphinston & R Brandon)

  • Apophysitis Syndromes: Affects children during secondary growth spurts, especially those involved in physical activity (ages 8-16). Using a self-developed treatment algorithm (including absolute rest, stretching and massage), Jenny Strickland was able to reduce recovery time significantly to an average of 19 days.
  • Screening: Amanda Johnson highlighted the main reasons for screening your youth athletes as follows:
  • Cardiac investigation
  • Growth related injuries
  • Flexibility
  • Strength
  • Load monitoring
  • Endurance and sprint ability

But it was stressed that clinicians should not intervene without evidence and to ensure your protocols are to the highest standard!

Physios in Sport Young Athlete Conference 2015: In Summary

This is really just the tip of the iceberg in relation to what was on offer! I’m really sorry I haven’t been able to include something from all the speakers because they were all absolutely incredible throughout the two days. I urge all readers to look out for where they can find them at other conferences around the world.

If you have any questions then don’t hesitate to comment below!

PLUG ALERT: Look out for the next ACPSEM Biennial conference in 2017! Plus have a nosy at all the brilliant CPD opportunities on the Physios in Sport website.

Zachary Spargo MSc Physiotherapy student (pre-registration), BSc (Hons) Sport and Exercise Science (@ZachSpargo). Currently studying at York St John University and is the Yorkshire and Humber CSP Communications Lead for the region. ACPSEM student member.


Hamstring Rehabilitation: Criteria based progression protocol and clinical predictors for return to play

22 Nov, 15 | by BJSM

By Nicol van Dyk, Physiotherapist, Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital and;

Rod Whiteley, Assistant Director, Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital


(presented at the ASICS Sports Medicine Australia conference 2015 – find all the slides here)

“It’s tough to make predictions, especially about the future.” Yogi Berra

It is still one of the most difficult questions clinicians have to answer: “When can I play again?”  Not only the player, but also the coach and/or family members will push you for an answer.  And then we all rub our crystal ball, get out the magic wand, and give them something we feel is sort of close to the mark.  But in reality, we still have very little on which to base our predictions.  Most of the time we’re guessing.  (Educated guessing maybe, but guessing nonetheless.) But before that happens, we first have to get them through the rehab.  Rehabilitation has moved away from time, and grown into criteria-based progression – the paradigm has begun to shift.

There are many excellent rehabilitation protocols of course, and you can find some of them in landmark papers such as Sherry and Best 2004.  Reurink et al published an updated SR investigating different interventions for hamstring strain injury rehabilitation. Not wanting to be left out, we developed a hamstring rehabilitation protocol at the Aspetar Orthopaedic and Sports Medicine Hospital, based on available literature and clinical experience (that magic combination that doesn’t always like each other, but oh how sweet when they do).  Our initial assessment and treatment includes elements that will form part of most protocols.  So I will focus on three critical elements that we were able to identify:

  • The most important measurement is strength, especially outer range strength
  • A running progression protocol that includes volume, intensity, mechanics, and is sport specific
  • Criteria based progression between different stages in the rehabilitation

First things first – measure the strength.

With the use of standardized measurement procedure using hand held dynamometers, we measure inner, mid, and outer range strength of the injured and uninjured hamstring muscles.  The most valuable measurement has been the outer range strength, as this has tracked well with return to play.  In other words, by the time the player was discharged, he had regained his outer range strength fully when compared to the uninjured side.  Mid-range strength was also tracking well, while inner range strength normalized much more quickly – often as fast as a few days, so it was less helpful to measure if your aim was to get a “progress bar” for this athlete’s rehabilitation. (Video of how to do this testing).  We were fortunate to see patients 5 days a week, but if that is not possible, use the outer range strength measurement to keep track of the progression.

figure 1 hamstring 15.11.18
In our experience, nearly all of the hamstring injuries were due to running. If you see dancers (and maybe martial artists) you probably need to take our advice with a grain of salt. We agree with Askling that stretch type injuries are a different beast, but we can’t help you there as we really hardly ever see these. However for our patients, all rehab protocols must include running. Specifically, running as close as you can get to what would be required of the player and their sport.  At our facility, players would typically run from stage 2 and run 3 sets of 4 laps on an indoor track (8 “sprints”) approximating 700m.  We asked the player to rate their running on a scale from  0-100%, and timed their running.  This was also an excellent way to keep track of their progression (another great tip if you don’t have running facilities or can’t see your patient daily).  Finally, in stage 3 we included direction changes by modifying the T-drill a bit (in our version, keep running forwards, but with direction changes to run around the markers).

Modified T-drill to facilitate direction change

Modified T-drill to facilitate direction change

When the player was able to run at 100%, and do direction changes at 100%, he/she was allowed to go out on the field and perform sport specific rehabilitation with our sports rehabilitators.  After they successfully complete 3 sessions, each one harder than the last, we performed some discharge tests (including isokinetic testing) and recommendations to the club to allow a gradual return to play.

Here is our criteria based progression algorithm:

hamstring figure 3 11.18

And now, the magic question – when are they ready?  Considering the outcome reported in the literature, it varies considerably.  One thing we do know is that MRI parameters cannot help us to determine return to play, and adds no value above our clinical assessment.  See this article by Arnlaug Wangensteen, who has contributed enormously to our rehabilitation programme.

So why is the outcome for return to sport so variable? Here’s a thought – perhaps because everyone is employing “conventional rehab” for their control groups, but no one knows what that is?  In a soon to be published article in BJSM by Philipp Jacobsen, with some excellent work by co-author Rod Whiteley, they have investigated the things that we measure, and found some clinical predictors of return to play.  So you will have to wait for the full length version to appear in an upcoming addition of BJSM, but here is the teaser:

Using a regression analysis, a combination of features you can easily measure in your clinical examination on day 1 and day 7 the week 1 examination could predict return to play within a 10 day window, explaining 97% of the variance!  And here are the more important parameters to look out for:

  • Length of pain on palpation
  • Single leg bridge
  • Hamstring strength (compared to the uninjured side) and whether it is painful or not
  • Change in outer range strength over the week

Now, the data is over-fitted (which means it is too good to be true, and won’t stand up when they finish their replication study that’s nearly half way done), but even with that said, how good is a 10 day window?  The coach, the player, the media – they want to know if the player will be ready for the final, and maybe now we can be confident ± 5 days.  That is a pretty specific time point, and the reality is, even when I am using an equation set up to win, the best I can do is “Uh, yes, plus or minus 5 days.”  Is that good enough? I have a sneaky suspicion that it will still not satisfy.  But for now, it’s the best we can do!

So the next time you’re faced with the all impossible question, perhaps you have some better answers.  Not easy answers, but we can say it will take about 3 weeks (give or take 5 days); we have a really good rehabilitation plan, which is measuring what you can do and your progression is based on that; and we will keep track of your progression based on what you need to return to play.

That’s probably as good as it gets!


Winners! – Official 2014/2015 BJSM Systematic Review Awards – Part 2: Walking groups and ACL injury prevention take home the “Intervention SR” title

19 Nov, 15 | by BJSM

By Johann Windt, MS, CSCS, CIHR Doctoral Award Scholar

BJSM has annual awards for the best systematic reviews. The award has two categories:

1) Risk Factor Systematic Reviews

2) Intervention Systematic Reviews

For the judging criteria, as well as the winner of the best risk factor-related systematic review, please look back at Part 1.

What was the best systematic review of an intervention?

The independent assessors of the four top papers could not find a meaningful difference in the excellence of these two systematic reviews:

  1. Sugimoto et al (2015). Specific exercise effects of preventative neuromuscular training intervention on ACL injury risk reduction in young females: meta-analysis and subgroup analysis. 49:282-289
  2. Hanson and Jones (2015). Is there evidence that walking groups have health benefits? A systematic review and meta analysis. 49:710-715

Both reviews adhered to the PRISMA guidelines, and investigated topics that have great public health relevance and interest to BJSM’s 23 member societies.

Dr. Dai Sugimoto and colleagues reviewed 14 clinical trials which utilized neuromuscular training for ACL injury prevention in young females. Through their subgroup analysis they identified that programs that included strengthening exercises, proximal control exercises and multiple exercise interventions were the most effective in reducing ACL injury.

walking in groupSarah Hanson, a PhD student under the supervision of Professor Andy Jones, reviewed 42 studies to determine the health benefits of outdoor walking groups. Her meta-analysis revealed significant improvements in a number of important health outcomes, including blood pressure, % body fat, and physical function (SF-36 physical functioning and 6-minute walk). Furthermore, given that such walking groups experience low attrition and high adherence rates, this review highlights outdoor walking groups as a great referral option for clinicians counselling physically inactive patients.

We congratulate Dr. Sugimoto and Sarah Hanson and co-authors. Congratulations to all authors who contributed over 70 systematic reviews published in BJSM the past 12 months. We expect to publish 4 SRs in each of BJSM’s 24 issues per year.

We welcome submissions to BJSM. Not only can you win a prize but you benefit from the wide reach of BJSM through academic libraries and 23 member societies who provide BJSM online to their members at no extra charge. And BJSM was ranked #1 in Sports Physiotherapy Social Media by the informal awards committee convened at Rylands of Hawthorn (2014).

Can I tell you something? I’m doping…

16 Nov, 15 | by BJSM

By HP Dijkstra¹, N van Dyk², YO Schumacher¹

¹Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

²Rehabilitation Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar


Doping in sport, particularly in track and field, is a reality.[1] [2] The World Anti-Doping Agency (WADA) condemned a rife doping culture in Russian Athletics implicating athletes, coaches, doctors, managers, federations and even the Russian minister of sport. [1] The Council of the International Association of Athletics Federations (IAAF) reacted by provisionally suspending the All-Russia Athletic Federation (ARAF) as an IAAF member. IAAF President, Sebastian Coe commented: “This has been a shameful wake-up call and we are clear that cheating at any level will not be tolerated. To this end, the IAAF, WADA, the member federations and athletes need to look closely at ourselves, our cultures and our processes to identify where failures exist and be tough in our determination to fix them and rebuild trust in our sport.” [3] This was, however, not the only recent doping scandal in athletics.

The prevalence of blood doping ranged from 1-48% for subpopulation samples (country, endurance, non-endurance) of a blood-testing program by the IAAF. [4] In a study on Doping in Elite Sports Assessed by Randomized-Response Surveys, the prevalence of reported past-year doping was 29% at the 13th IAAF World Championships in Athletics in Daegu, South Korea and 45% at the 12th Quadrennial Pan-Arab Games in Doha, Qatar. [2] WADA published a list of 113 coaches, physicians and other support staff, guilty of violating anti-doping rules – athletes are not allowed to associate with any of these individuals. [5]

How easy is it then for athletes to beat the system? What help do they get from team medical staff?


Consider this: you’re a team physiotherapist at an IAAF World Championships. While treating an athlete with Achilles pain he or she asks: “Can I tell you something? I’m doping… Please don’t tell anyone.” What do you do? Is this ‘patient confidential information’ or is it your ethical responsibility to report this?

This confession may be confidential in certain settings but in many countries (UK, Germany, Australia etc.) you are protected by the athlete’s contract and senior management, and must report this. Athletes who use performance enhancing substances do not generally involve their team physician, but carefully choose to operate outside organized structures. How can healthcare professionals protect themselves and athletes from getting involved or accused of doping?


Healthcare professionals in sport should lead and implement change to protect athletes and themselves. Here are four elements promoting best practice:

  1. A comprehensive anti-doping education program warning athletes against taking supplements that might contain prohibited substances, and educating coaches and support staff (figure 1).
  2. An effective out of competition testing program based on athlete where-about registration. There is huge discrepancy in the operational efficiency of many National Anti-Doping Organisations (NADOs) especially in countries where doping is more prevalent. The recent WADA report on doping in Russian Athletics is a clear indication of this. [1]
  3. ‘Zero-tolerance’ athlete contracts. Many elite athletes in “non-professional” sports are funded by governmental programs, such as lottery funds or employed by the armed forces. These funded athletes sign a contract, relinquishing their right to medical confidentiality related to doping. All athletes competing at major events sign an athlete’s contract after team selection. These contracts underpin a zero-tolerance approach to illegal practices, including doping, and ‘patient confidentiality’ does not apply.
  4. A well-structured, professional and transparent coaching, training and medical support system.

We reported on the Integrated Performance Health Management and Coaching Model implemented by UK Athletics. [6] Athletes, coaches and support staff work together in an integrated and transparent model of shared decision-making and mutual accountability.

Medical Team: Medical support staff should undergo annual clinical appraisals. They provide evidence of regular peer reviewed clinical activities, patient log books, reflective continuing professional development (CPD) diaries and performance-feedback by colleagues and patients. UK medical staff, including Sport and Exercise Medicine (SEM) physicians is already subject to a robust peer review and annual appraisal system that informs General Medical Council (GMC) revalidation. [7] Although not impossible, it is difficult for a physician in such a program to engage in illegal practices without drawing suspicion.

Athletes: Athletes should live in the official team hotel or athlete’s village before and during major championships. These environments are not conducive to ‘easy doping’ – medical teams operate in designated ‘open medical spaces’ where peers observe and comment. Athletes and support staff, eat, train, rest and sleep (more often than not 2-4 in one room) in an environment where secret doping practices will be difficult. Athletes should be encouraged to embrace this type of organised team environment with appropriate performance measures (single rooms) to support individual medal-potential athletes.


UK Athletics poster used at training venues before the London Olympic Games


There is a systemic failure of certain countries to curb doping practices. Prudent federations, managers, coaches and medical staff would invest in robust systems of professional and ethical athlete coaching and support. National and international governing bodies should prioritize these systems, creating educational platforms and mandatory practices that hold individuals and teams accountable at all levels. This will not only serve to protect the vast majority of ethical athletes, coaches and support staff, but also safeguard sport from becoming a pharmacological spectacle. It is fundamentally about fairness and the integrity of true competition – “play true”!


Correspondence to:

H Paul Dijkstra MBChB, BSc (Hons) (Pharmacology), MPhil (Sports Medicine), FFSEM (UK); Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar; TEL: +974 4413 2000; e-mail:

Contributions of each author:

Dijkstra HP: First author, substantial contribution to conception and design, coordination of authors, drafting and revising the manuscript and approval of the final version to be published

Van Dyk, Nicol: Contribution to drafting and revising the manuscript and approval of final version to be published

Schumacher YO: Contribution to drafting and revising the manuscript and approval of final version to be published

Competing Interest: All authors are prominent in sport and exercise medicine. Drs Dijkstra and Schumacher have practical experience as physicians working with athletes who have undergone drug testing. Dr Schumacher provides expert advice for various Anti-Doping Agencies including WADA. (See publications as well).


1          Wada commission wants Russia ban. BBC Sport. (accessed 9 Nov2015).

2          Committee publishes “blocked” study on doping – News from Parliament – UK Parliament. (accessed 18 Sep2015).

3          IAAF provisionally suspends Russian Member Federation ARAF | (accessed 14 Nov2015).

4          Sottas P-E, Robinson N, Fischetto G, et al. Prevalence of Blood Doping in Samples Collected from Elite Track and Field Athletes. Clin Chem 2011;57:762–9. doi:10.1373/clinchem.2010.156067

5          WADA Bans 114 Support Staff Banned For Doping Violations. (accessed 21 Sep2015).

6          Dijkstra HP, Pollock N, Chakraverty R, et al. Managing the health of the elite athlete: a new integrated performance health management and coaching model. Br J Sports Med 2014;48:523–31. doi:10.1136/bjsports-2013-093222

7          GMP Framework for appraisal and revalidation. (accessed 21 Sep2015).

Figure 1: UK Athletics poster used at training venues before the London Olympic Games

Undergraduate Physiotherapists at Sheffield Hallam University use Interdisciplinary Exercise Medicine Resources

14 Nov, 15 | by BJSM

By Anna Lowe

In 2014 Exercise Works! (an organisation that promotes the prevention and treatment of non-communicable diseases) made huge steps forward to enhance the exercise-related content of medical undergraduate curricula. The project “Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients” (Tomorrow’s Doctors), funded by Public Health England, led to the development of exercise medicine and chronic disease resources for all UK undergraduate medical degrees.


Following on from the success of “Tomorrow’s Doctors”, these resources have been revised and made available for all undergraduate nursing, midwifery and Allied Health Professions courses internationally.

At Sheffield Hallam University we have approximately 300 undergraduate physiotherapy students and we are delighted to be using the resources to support our training of “Tomorrow’s Physiotherapists”.  Our physiotherapy approaches must evolve to keep up with a changing and growing population.  Exercise medicine is a core part of our undergraduate curriculum, in view of the rise of long-term conditions and the ageing population, the need for exercise prescription skills is greater than ever before.  The resources are a selection of PowerPoint presentations on subjects ranging from “Mental Health & Exercise” to “Physical Activity Leadership”.  We will evaluate staff and student perspectives and promote the resources to other health courses within the University.

Sheffield has a rich history of physical activity and it has recently claimed the title of The Outdoor City.  It borders the Peak District and benefits from an abundance of green space and beautiful landscape; something that brings many students to the city and keeps them here long after their studies finish.  With the help of Olympic Legacy projects such as Move More (a city-wide physical activity strategy) and the National Centre for Sports and Exercise Medicine the physical activity infrastructure continues to grow and physical activity is becoming firmly embedded in the personality of the city.

Despite this, Sheffield is a city of contrast with large geographic variations in health and disability. Contemporary health education requires a deep understanding of the wider determinants of health, particularly in relation to health behaviours.  Every patient contact is an opportunity to impact, not only on the presenting complaint, but also on overall health & wellbeing.  A physiotherapist may see up to half a million patients in their career, many of these patients will have long-term conditions and will therefore be at risk of disability and early death.  As a profession we must ensure that we keep exercise at the heart of everything we do and that no opportunity is wasted!


Anna Lowe is a Senior Lecturer in Physiotherapy at Sheffield Hallam University


Ann B Gates is founder of Exercise Works!


Vote now! Round 3 of the 2015 BJSM cover competition

11 Nov, 15 | by BJSM

Welcome to the second last preliminary round of the 2015 cover competition.

Win a prize! We will reveal this year’s prizes (voters in the final round get entered in a draw, and profiled on the blog) next round. See last years winners HERE.  There is a rumor winners may get entered into a very small group who will be in the running to gain free registration to a BJSM sponsored conference of choice (1 winner!) (For example the Football Medicine Strategies Conference, London, April 9-11 2016) (Just a rumor for now…)

BJSM is the only sports clinicians’ journal with new content twice-monthly. This helps us to address hot topics while they are fresh. In the Impact Factor ratings, BJSM ranked #1 of 81 in Sports Sciences for ‘Immediacy’ – papers cited within a year of publication.

Our 19 member societies guide us to hot topics. Did you miss an issue? Here’s a quick way to scan this year’s archive:

Check-out the issues we feature in this round (below).

  1. ASICS Sports Medicine Australia Conference (SMA)
  2. Active Norwegians live longer But can we overdo it? (Norwegian Physios and Sports Doctors)
  3. Groin pain: Doha Agreement Meeting (International consensus)
  4. Youth Athletic Development Aiming high while keeping it healthy, balanced and fun! (IOC)
  5. Sports Physiotherapy New Zealand (SPNZ)
  6. Learners to Leaders: Learning from African cycling, Leading with physical activity (SASMA)
BJSM Journal Cover

May 49 (10)

November 49 (11)

June 49 (11)









BJSM Journal Cover

June 49 (12)


July 49 (13)

July 49 (13)










July 49 (14)

July 49 (14)

August 49 (15)

August 49 (15)








poll here








Running Virtual Conference: all the hot topics and resource links in one blog!

7 Nov, 15 | by BJSM

A monthly round-up of podcasts and articles 

By Steffan Griffin (@lifestylemedic)

LONDON, UNITED KINGDOM - APRIL 26:  A runner dressed in a naked suit in the mass start during the Virgin Money London Marathon on April 26, 2015 in London, England. (Photo by Stephen Pond/Getty Images)

LONDON, UNITED KINGDOM – APRIL 26: A runner dressed in a naked suit in the mass start during the Virgin Money London Marathon on April 26, 2015 in London, England. (Photo by Stephen Pond/Getty Images)

In the penultimate virtual conference of 2015, the topic is one that becomes increasingly relevant at the turn of the year, likely featuring on a lot of people’s New Year’s resolutions – running. In the same format as its predecessors on the hamstring, shoulder, and tendons (among others) – here’s a list of BJSM resources so you’re clued up to treat any runners that come limping your way!

Running Injuries – an overview

Don’t know where to start? This may be the best place, an overview of running injuries with Andy Franklyn-Miller, with secrets from 15 years of experience in treating runners and running injuries.

Running shoes and running injuries: mythbusting and a proposal for two new paradigms 

A recent and hugely popular paper – mainly concerning whether or not running shoes (or sport shoes in general) influence the frequency of running injuries at all. Contains two new paradigms which are likely to stick around for the considerable future. A must read!

Biomechanical overload and lower limb injuries

Sticking with one of the BJSM’s most popular podcast guests (Andy Franklyn-Miller), this podcast delves into the issue of chronic exertional compartment syndrome and the potential role of running re-education in managing the pathology. The podcast also touches on the historically hot topic of barefoot running.

Barefoot running: an evaluation of current hypothesis, future research and clinical applications

The podcast leads nicely on to this fantastic review by the great team in Cape Town, looking into the factors driving the prescription of barefoot running, whilst also examining which of these factors may have merit, what the collected evidence suggests about the suitability of barefoot running for its purported uses and describe the necessary future research to confirm or refute the barefoot running hypotheses.

Keeping runners running – the secrets of running assessment and advice

Following on from Andy Franklyn-Miller’s podcast, this discussion with Andy Cornelius asks if we can assess running patients and guide them to improve their technique. Might gait education prove more effective than medication to treat symptoms?

Overuse injuries – what to consider

Moving on slightly to an issue that most serious runners have to deal with at some stage – burnout. Although not quite specific to running, there are still some good nuggets to take home from this.

Patellofemoral pain – a masterclass

Likewise, not strictly unique to running is the issue of patellofemoral pain – but this chat with the world-renowned Kay Crossley is 100% worth a listen on the way to work – covering the best PFP treatments and evidence for them as well as new insights into knee pain after ACL reconstruction.

The foot core system: a new paradigm for understanding intrinsic foot muscle function

The final resource on the list is another game-changing paper proposing a new paradigm, shifting the goalposts in regard to how we regard the intrinsic muscles of the foot. The authors draw the parallels between the small muscles of the trunk region that make up the lumbopelvic core and the intrinsic foot muscles, introducing the concept of the ‘foot core’, before then integrating the concept of the foot core into the assessment and treatment of the foot.

And that’s it! Hope you enjoyed trawling through the resources from some hugely influential names – please do let the BJSM know your thoughts/questions on twitter, Facebook and the Google+ SEM community, we are always open to suggestions for improvement!

Highlights from the BASEM Exercise in Health and Disease Course

4 Nov, 15 | by BJSM

By Manroy Sahni (@manroysahni)

Unfortunately, the vast majority of medical schools dedicate very little teaching time to the health benefits of physical activity and how to deliver lifestyle advice to patients that would profit. As such, this course stood out as an opportunity to gain some background knowledge and learn practical tips from the experts on how to get patients MOVING MORE and SITTING LESS- and it definitely didn’t disappoint!

The course provided a solid base of underpinning evidence for promoting exercise in patients suffering from a multitude of chronic illnesses including diabetes, cardiovascular disease, arthritis, osteoporosis and cancer. Especially interesting for me were the talks outlining practical strategies to get patients moving. Topics included brief interventions during consultations, tips to motivate patients in general practice and breaking down common barriers. We even had a chance to try Nordic walking!

I learned valuable points and tips that I will use to encourage physical activity and lifestyle optimisation when talking with patients.

gear shiftFor example an interesting analogy was that getting people motivated and doing more physical activity is like driving. When you’ve been stationary and want to get the car moving what gear do you go in to? First gear. So people who have been inactive should initially go into first gear by trying something easy- like standing more instead of sitting. If they try to go straight into 4th gear (e.g. a marathon) they will stall. Therefore when promoting physical activity we should encourage patients to take it slowly and go through the gears- this way they will be less likely to stall.

Health care professionals are now very good at smoking cessation advice, with many aware of the ASK, ADVISE and ACT intervention to identify patients at risk and point them in the right direction for help. Similar brief interventions were outlined to promote the benefits of physical activity and motivate patients to make lifestyle changes. Utilising these strategies, we as health care professionals can make every patient contact count.

prev medicineThe importance of working an exercise history into each standard medical history was also reinforced. This is a topic that is again relatively neglected in undergraduate training and something that should be stressed considering the increasing burden of (potentially preventable) chronic disease gripping the nation. After all it’s easier to turn off the tap than to mop the floor.




Manroy Sahni is a fourth year medical student at the University of Birmingham. He is co-president of the Birmingham University Sports and Exercise Medicine Society and involved in promoting healthy living and lifestyle change. 

Winner, winner – Official 2014/2015 BJSM Systematic Review Awards (Part 1): Weak Hips – The Cause or Result of Unhappy Knees?

2 Nov, 15 | by BJSM

By Johann Windt, MS, CSCS, PhD Student

Gold Badge with red ribbon (vector)Systematic reviews are the gold standard for critically appraising clinically-relevant literature. BJSM rewards the authors of the best systematic review(s) published each year. What’s the ‘best’ systematic review? What is good art? To address this challenge we used similar criteria to judge the reviews as in past years.

All systematic reviews published from July 2014 – June 2015 were eligible fand were evaluated based on:

  1. Clinical Relevance – How relevant is the topic to BJSM’s readers? Does the review have the potential to influence how clinicians tackle clinical challenges?
  1. PRISMA Adherence – Have the authors careful designed their study and adhered to best practice systematic review methods, following internationally recommended reporting guidelines (PRISMA)?
  1. Intriguing & Informative Introduction – Do the introductions provide an accurate background description while being structurally sound and engaging? ‘Why we did it?’
  1. Descriptive & Detailed Discussion – Did the authors skillfully analyse and interpret their results and synthesize them into a discussion that links both to the 1) study’s objectives and 2) the existing knowledge/literature?
  1. Conclusion Clarity and Conciseness – Are the conclusions:
  • Plausible? Authors should accurately reflect the study findings while considering limitations.
  • Succinct and concrete? Authors should provide a take home message that can be feasibly incorporated into clinical practice.

As a result of the increased quantity and improved quality of SRs submitted to BJSM, we divided this year’s contest into two categories – 1) Prevention/Risk Factor Systematic Reviews, and 2) Intervention Systematic Reviews.

Through the initial iterative process we narrowed the contest to the top 4 reviews in both of these 2 categories. In no particular order, these reviews were:

Risk factor systematic reviews

  • Whittaker et al (2015). Risk Factors for groin injury in sport, an updated systematic review
  • Mosler et. al (2015). Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis
  • Rathleff et al (2014) Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis
  • Hamstra-Wright et al. (2015). Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis

Intervention systematic reviews

  • Sugimoto et al (2014). Specific exercise effects of preventative neuromuscular training intervention on ACL injury risk reduction in young females: meta-analysis and subgroup analysis
  • Hanson et al (2015). Is there evidence that walking groups have health benefits? A systematic review and meta analysis
  • Hegedus et al (2015). Clinician friendly lower extremity performance measures in athletes: a systematic review of measurement properties and correlation with injury, Part 1, and Part 2.
  • Weston et al (2014). High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis

Finally, two independent reviewers then very carefully assessed these papers using the PRISMA reporting checklist to evaluate the study design and reporting, then compared their assessments to determine this year’s winning reviews.

The winner for the best risk factor-based review of 2014-2015 is:

Rathleff et al (2014). Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. 48:1088

Dr. Michael Rathleff and his colleagues reviewed the relationship between hip strength and patellofemoral pain (PFP). Most notably, the authors contribute to the field by identifying a discrepancy between prospective and cross-sectional research findings – while cross-sectional studies identify reduced hip strength in PFP, prospective investigations fail to find any association. Even though both men and women with PFP possess hip strength deficits, these deficits appears to be a result, not cause, of their patellofemoral pain. The authors note that these findings come from a small number of heterogeneous trials, but identify this as a key area for future investigation in the attempt to better understand how patellofemoral pain and hip strength are related.

We congratulate Dr. Rathleff and coauthors. Furthermore, congratulations to all authors who had systematic reviews published in BJSM, which receives over 100 submissions per month!

Stay tuned for the upcoming announcement of the best intervention-based review!

Athlete Monitoring in Sport- Key Principles and Practical Tips By Jason Laird (@PhysioReel)

29 Oct, 15 | by BJSM

By Jason Laird (@PhysioReel)

Photo from:

Photo from:

Within elite sport the use of data and  technology is now commonplace. In particular, the use of athlete monitoring tools is now the norm for many sports looking to prevent injury. These tools are primarily aimed at monitoring training load (exposure) and an individual’s response to this exposure. The link between this monitoring data and injury incidence is now being closely analysed.

Prevention of Injury

In order to fully understand the role of athlete monitoring in the prevention of injuries we first need to delve a little deeper into the types of prevention available in sports medicine.

Within epidemiology research there are examples of different types of prevention; primary, secondary, and tertiary (1, Health Knowledge Link). In the context of elite sport, primary prevention is aimed at removing or controlling the exposure to risk factors. Screening for these risk factors (most commonly in pre-season) often leads to targeted prevention strategies (2, 3). For more information on other types of risk factors in sport see Bahr and Holmes’ paper (4).

Secondary prevention aims to detect changes from a normal baseline (usually via a screening tool) in order to intervene and stop a problem from progressing. A good example of this in the medical world is screening for cervical cancer, that well establishes the link between screening findings and the disease (5, WHO link).

Athlete monitoring is a type of secondary prevention that analyses subjective and objective data in order to detect a change in the athlete. This information gives us a real-time snapshot of how the individual is responding to their current exposure level and shows any occurrence of trends.

Linking monitoring findings to prevention

Identifying a causal link between monitoring findings and injury incidence in order to prevent injuries before they happen is perhaps the ‘holy grail’ in this field. This requires plenty of ongoing research, particularly in the areas of validity and reliability of tests and their possible combinations. See this great blog on ‘Diagnostic Validity’ by Andrew Cuff via Tom Goom (6) for more information on how to understand validity and reliability within physiotherapy research.

There is now a huge selection of tools at our disposal to collect subjective and objective data from athletes. Some of these require relatively expensive equipment and bespoke analytical programs whereas others need just a pen and paper and a chat with the athlete and coach. A great video to use as an introduction is one from Dr Bryan Mann (7) and shows how simple and effective monitoring can be in a busy sports environment.

Some further examples of athlete monitoring in elite sport can be seen here in Rugby Union (8) and the NFL (9). With these types of tools having the potential to keep players fit and available for longer, some sports teams are placing serious investment into staff and technologies aimed directly at collecting monitoring data and researching the output.

There are some recent studies investigating how factors such as hamstring strength (10) and increases in training load (11,12) can link to injury risk in elite level sport and the evidence base surrounding athlete monitoring and injury is sure to grow. In the meantime, different types of monitoring continues to be commonplace in elite sport. There is a whole host of technology companies and equipment manufacturers being used across the world and fully integrated into sports teams.

Practical tips for athlete monitoring

Finally, here are a few practical tips:

  • Pick tests relevant to your sport

The tests you choose should relate well to your sport and look to target your key time loss injuries, as well as being valid and reliable tests for your athlete group. It may also be useful to look into the minimal detectable change and standard error of measurement of the tools you are going to use (13, Rehab Measures link).

  • Start simple and small

Don’t make the tests too extravagant or time consuming from the outset. Start small and simple and add more as required. An easy start point for athletes is the use of subjective wellbeing data, with recent evidence indicating that this type of ‘self-report’ data may be of more use in detecting changes than objective tests (14).

  • Create ‘Buy-In’ with the athlete and coaching team

Bringing the athlete and coaches on the journey with you regarding what you aim to achieve by collecting the data is perhaps the most important part of the whole process. As everyone begins to understand what the tests are showing and what the trends look like it will allow you to have more impactful contextual discussions around the data.

  • Quick feedback of data

The faster you can feedback the data to athletes and coaches the better; this will help massively with buy-in and also provide an opportunity to have discussions on live data, rather than just what happened last week.

Happy monitoring!

Reference List

1: Health Knowledge ‘Epidemiological basis for preventive strategies ‘:

2: Pappas, E., Nightingale, E.J., Simic, M., Ford, K.R., Hewett, T.E., Myer, G.D. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. British Journal of Sports Medicine. 2015, 49 (10), 673:680.

3: Clarsen, B., Bahr, R., Andersson, S.H., Munk, R., Myklebust, G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. British Journal of Sports Medicine. 2014, 48 (17), 1327-1333.

4: Bahr, R., and Holme, I. Risk factors for sports injuries–a methodological approach. British Journal of Sports Medicine. 2003, 37 (5), 384-392.

5: WHO- Human papillomavirus (HPV) and cervical cancer:

6: Diagnostic validity:

7: Monitoring Fatigue from A-Z, Dr Bryan Mann:

8: ‘Kitman Labs Provides ‘Invaluable Tool’ For IRFU- Irish Rugby’:

9: ‘Dolphins aim to prevent injuries with futuristic performance program’:

10: Freckleton, G., Cook, J., Pizzari, T. The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players. British Journal of Sports Medicine. 2014, 48 (8), 713-717.

11: Hulin, B.T., Gabbett, T.J., Blanch, P., Chapman, P., Bailey, D., Orchard, J.W. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. . British Journal of Sports Medicine. 2014, 48 (8), 708-712.

12: Cross, M.J., Williams, S., Trewartha, G., Kemp, S.P.T., Stokes, K. The Influence of In-Season Training Loads on Injury Risk in Professional Rugby Union. International Journal of Sports Physiology and Performance. 2015, in press.

13: Rehab Measures Database:

14: Saw, A.E., Main, L.C., Gastin, P.B. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine. In press.


Jason Laird (@PhysioReel) works for the English Institute of Sport as Lead Physiotherapist for British Judo.

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