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Time to bring in pitch-side medical video replays in football – more important than goal line videos?

25 May, 16 | by BJSM

By Andrew Massey @andy_massey

I listened with interest at the 2016 Isokinetic Conference where attendees discussed the importance of a medical team within the football community, and return to play. The event lived up to its reputation of creating a space for cutting edge science and practice innovation.

Discussions of ‘best practices’ made me think about a quandary I am currently facing as Head of Medical Services for liverpool FC. Early in my training I was taught the acronym SALTAPS, which I still commonly use to assess an injury pitch side as a physiotherapist:

See – the mechanism of injury.

Ask – the patient what happened.

Look – at the affected area.

Touch – palpate the affected area.

Active – can the patient move the affected area actively?

Passive – can you take the affected area through its full passive range?

Special tests – to assess the affected area.

It is a crude way of examining a musculoskeletal injury, but served and continues to serve me well.

When looking at resuscitation, everyone is taught airway, breathing, circulation, in that order. My old Emergency Department consultant used to say, “you better have a damn good reason for not following a protocol that someone much cleverer than you has developed.” This advice has encouraged me not to deviate from my simple ABC approach to resuscitation. So why is it OK for me to stray from my SALTAPS approach?

Patient assessments on the pitch often involve very quick decision making on a management approach to any injury, without full access to as much information as possible. Lots can happen in a football match, a doctor or physiotherapist can have their view obscured by a manager, linesman, substitute or combination of all three. Or even if they can see every incident from where they sit, they may simply miss a mechanism. This is not bad practice, it’s just the reality of being a pitchside medic. So what happens when you can’t follow the first step of the SALTAPS approach, when you cannot see the mechanism of injury?

 

fuzzy tvVideo technology exists but we are not allowed to use it!

We are fortunate to have the technology that allows us to view replays of mechanisms of injury pitch side via portable devices, However, medics are constrained by the current laws of the game. The rules prevent us from providing the safest care for players. UEFA have informed me that no official is allowed to view any replays during a match (this is straight from their big book of rules, Match organisation, Rule 14.17. Page 24. Accessed 17th May 2016). FIFA suggests that the rules governed by IFAB do not permit the use of video technology for medical purposes (The Players equipment, Rule 4. Page 42. Accessed 17th May 2016). The FA Premier League have relaxed their rules this season, but request that the viewing of video replays for medical issues must be done in a designated area (often near the changing rooms). A practical implication of this rule is that if there is a serious injury, I either have to follow FIFA and UEFA rules and hope that I had a perfect view past the manager, past the linesman, past the 4th official and past the 6 substitutes warming up, or ask the seriously injured player to wait a moment or two whilst I run down the tunnel to see a replay before running back up the tunnel and administering treatment.

What are the reasons for not allowing such technology to aid medical management? I have been quoted everything from “it gives a performance advantage”, to “it would be a distraction, and take away from your clinical assessment”. My answer is always this, it is a welfare issue. The only performance it gives an advantage to is that of the treating medic. It does not distract. It adds to the initial assessment.

If we are looking to create a level playing field when it comes to medical management, or limit distractions, then perhaps we should insist on all doctors and physiotherapists keeping their eyes closed during a match. How would a radiologist react if we told them they were not allowed to look at the x ray they were reporting on? How would a physiotherapist feel if they were told you can only assess a patient using your left hand? At the moment we are making the best from a bad situation when treating on field injuries. We have the technology now to improve player care and safety, but it is being stifled by rules. From my perspective, if a rule puts a player’s health at risk, then it is wrong. These rules need to be changed and the governing authorities need to press ahead to put the health of the players in the forefront of everyone’s mind.

 

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Andrew Massey @andy_massey is a Doctor, Physiotherapist, and Head of Medical Services Liverpool FC

Step 1 for better manuscripts: acknowledge the wounded writer

21 May, 16 | by BJSM

By Erin Macri, @Erin_Macri

johnny writeWith ease, we can all recall the moments in grad school that brought us to our knees. The red pen all over an assignment, an endless list of reviewer comments, a rejected manuscript, an unsuccessful application for funding. And no matter how successful we are, writing challenges resurface throughout our careers. A theme emerges: being a writer is traumatizing.

I have just been reassured, I am not alone. Professor Anthony Paré, Department Head of Language and Literacy Education at UBC, says we are all wounded writers in some varied and unique way. So as we move into various careers in the academy, without formal education in teaching people to write, how do we support those we mentor? How do we avoid finding ourselves offering so much ‘feedback’ to a student that ‘authorship’ actually becomes ethically complicated? How do we reconcile a student’s short term career metrics with their long term career needs of becoming an independent writer?

At a recent workshop on writing for graduate supervisors, Paré offered some strategies to inspire your grad students to prioritize writing.

  1. Introduce meta-cognition. Students can be taught to develop awareness and skills for planning, reflecting on, and evaluating their own thought processes and writing. Novice writers may approach a manuscript by producing text from start to finish in a linear manner. Metacognition will help students think like an expert writer, producing a manuscript in a more iterative and non-linear process that includes concepts like idea development and contemplation. This approach might look less like a manuscript, and more like the words, circles and arrows seen on the back of a napkin in a moment of eureka.
  1. Move beyond ‘process writing’. The ability to form sentences and paragraphs is foundational on Maslow’s less-well-known hierarchy of writer’s needs. Brainstorming, free form writing, and five paragraph essays are of course basic requisites. For most of us, though, this is where our education ended. As readers we all know: structure and formula do not engage us, and do not tell a persuasive story. Explore with your students how writing and story-telling changes within the context of academia, and how this influences discourse.
  2. Explore your discipline as a unique subculture. What language do you speak in this culture? What thematic values emerge in your field? This can be explored within your department or faculty, and also within the broader national and international context. What can students learn about culture when reading key publications, or when attending meetings or conferences? What do they need to know about what goes into a pitch or a conversation in your discipline? Engage students in cultural contemplation. Every e-mail they send to an investigator is an opportunity to learn about writing for their subculture.
  1. From writer-based to reader-based writing. Most writers begin writing for themselves, according to Linda Flower. What have they learned, what do they think is interesting? This is a good place to start, and Paré encourages this style early in a manuscript. The time to transition to reader-based writing should happen later. Who is the end-user of your work, and how will they interpret what you have said, and use it? Are you writing for policy-makers, researchers, clinicians, or patients? Does the reader know the terminology of your discipline? Do they need an argument to be fleshed out to clearly connect a research finding to a clinical recommendation? Finally, the student needs to think of one additional reader: the reviewer. Mentors, consider advising students to look beyond the ‘author guidelines’ and read the reviewer guidelines so they understand how their manuscript is being evaluated.
  1. Pre-write. Write. Incubate. Re-write. Repeat. Before your student starts to write, have a discussion with them where you develop ideas, key points, and arguments. What is the important story your student wants to share? What is going to change peoples’ minds? Have them write a first ‘draft’. Then have them sit on that draft for a few days. Have them read and edit their own draft again after they’ve set it aside for a while, before submitting to you for feedback. This incubation period may be challenging for you both: in our fast-paced world, it will seem counterproductive to do nothing. Paré insists this time away from the writing will give a fresh perspective and new ideas that will ultimately create stronger arguments and better manuscripts.
  1. Concrete editing. Supervisors, edit for the ‘big picture’ early on – try to avoid correcting grammar and spelling mistakes too soon. Numerous nit-picky corrections early on can traumatize or paralyze a student. Also, try to give concrete feedback and avoid metaphors here. Telling them a paper needs more ‘flow’ or to ‘think outside the box’ may not provide the student with a clear idea of where she has gone astray or what needs changing. If a common theme emerges, give them the ‘rule’ to apply to their writing, rather than making the changes yourself. Accepting tracked changes will not effect change in your student.

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Erin Macri, @Erin_Macri, is a physical therapist and PhD candidate at UBC.

 

Training fürs Leben – Bewegung ist Medizin

20 May, 16 | by BJSM

von Nash Anderson B.Sc M.Chiro und James Steele, PhD, Dozent für angewandte Sportwissenschaften an der Southampton Solent University

Neulich, in der ärztlichen Praxis, hörte Nash die tolle Aussage eines Patienten, der sagte: „Die Leute fragen mich, warum ich die ganze Zeit ins Fitnessstudio gehe. Sie fragen mich, wofür ich trainiere. Ich trainiere fürs Leben! Quintessenz dieser Unterhaltung war, dass wir, auch wenn wir durch „Wehwehchen“ eingebremst werden, in Schwung und aktiv bleiben müssen, um uns richtig wohl zu fühlen.

Es ist immer schön zu sehen, wenn Patienten verstehen, dass Bewegung fürs Leben ist. Um die Früchte zu ernten muss man kein Profisportler sein, oder sich auf ein bestimmtes Ereignis vorbereiten. Wenn diese Auffassung doch nur weiter verbreitet wäre!

Dieser Artikel wurde durch die o.g. Erfahrung im klinischen Alltag angeregt, sowie durch die Teilnahme am Symposium „Exercise is Medicine“ („Training/Bewegung ist Medizin“) der Royal Society of Medicine in London im Juni 2015.
Der Austausch mit @BJSM_BMJ (Anm.: Account des British Journal of Sports Medicine) auf Twitter spornte mich dazu an, dies niederzuschreiben und die Erkenntnis über die Bedeutung und die Vorteile der körperlichen Bewegung zu teilen.

Verschiebung des Augenmerks weg von ästhetischen Aspekten zugunsten des gesundheitlichen Nutzens eines Trainings

Leider werden körperliche Aktivität und Training von Vielen lediglich als ein Mittel betrachtet auf potenzielle kurzfristige Ziele, in Bezug auf äußerliche Ergebnisse wie Leistungssteigerung oder Verbessern des Aussehens bezüglich der Körperzusammensetzung hin zu arbeiten. All diejenigen die sich durch Training körperlich betätigen, werden eines dieser Ziele auch bis zu einem gewissen Grad erreichen. Allerdings mag das Ergebnis am Ende nicht so aussehen wie erwartet. Dies führt zu Entmutigung und zur Frage nach dem eigentlichen Sinn des Trainings. Es kann frustrierend sein, wenn man zwei Monate lang 4-5 mal pro Woche trainiert mit dem Ziel, dadurch abzunehmen, wenn man am Ende sogar schwerer ist, aufgrund der Tatsache dass begleitend zum Fettabbau die fettfreie Masse ansteigt.

Eine weitere häufig beobachtete Enttäuschung besteht darin, am Ende eines Muskelaufbauprogramms nicht so muskulös zu erscheinen wie ursprünglich beabsichtigt, trotz der lebhaften Vorstellung der nächste Arnold Schwarzenegger zu werden. Es ist leider harte Realität, dass nicht jeder seine anfänglichen Ziele erreichen wird und dass bei vielen solchen Zielen die Aussicht auf Erfolg überbewertet wird. Der Eindruck, prominente Erfolgsgeschichten seien repräsentativ, ist leider ein Trugschluss. Sie stechen lediglich aus der Masse der vielen anonymen Misserfolge hervor. Aber beruht der Erfolg hier wirklich auf einer besonderen Form des Trainings, oder liegt das spezielle Ergebnis in den Genen?

In der Reaktion auf Training und körperliche Aktivität unterliegen wir alle interindividuellen Unterschieden, die vorrangig auf genetische Faktoren zurückzuführen sind (Hubal et al., 2005; Timmons, 2011). Andererseits weiß man, dass Training und körperliche Aktivität solch ein breit gefächertes Spektrum an möglichen positiven Effekten nach sich zieht, dass beinahe jeder in irgendeiner Form davon profitieren kann. Leider ist aber gesundheitlicher Nutzen und damit verbunden eine langfristige Eindämmung von Risikofaktoren schlichtweg nicht so sexy wie ein gut definierter, muskulöser Körper, oder auch das Erreichen eines prägnant hohen Leistungsniveaus.

Wir müssen einen Weg finden wie wir die Wahrnehmung, dass Training primär auf äußerliche, ästhetische Ergebnisse abzielt, aus den Köpfen der breiten Öffentlichkeit verschwinden lassen können. Die Botschaft muss vielmehr lauten, dass auch wenn primäre Trainingsziele nicht erreicht werden, man das Training deswegen nicht aufgeben, sondern fürs Leben trainieren sollte. Es ist bekannt, dass Sport und körperliche Aktivität in einer Dosis-Wirkungs-Beziehung (Lee & Skerret, 2001; Byberg et al., 2009) das allgemeine Sterblichkeitsrisiko senken (Paffenbarger et al., 1986; Nocon et al., 2008). Wird noch etwas intensiver und fleißiger trainiert, werden die positiven Effekte auf die Langlebigkeit sogar noch grösser (Lee et al., 2003; Wisloff et al., 2006; Laukkanen et al., 2010). Sich fit zu halten, basierend auf Training und körperlicher Aktivität, scheint einer der primären Faktoren zu sein, die Langlebigkeit nachhaltig beeinflussen. Kardiorespiratorische Fitness (Kokkinos et al., 2008; Lee et al., 2011; Wen et al., 2011), Kraft (Newman et al., 2006; Ruiz et al., 2008; Leong et al., 2015), Muskelmasse (Srikanthan & Karlamangla, 2014), oder eine Kombination dieser Aspekte (Artero et al., 2011) sind alle in der Lage, multiple Sterblichkeitsrisiken zu reduzieren, mit möglichen lebensverlängernden Folgen. Wir sprechen hier nicht über riesige Verbesserungen hinsichtlich messbarer Fitnesswerte, wie wir sie bei professionellen Sportlern beobachten können, sondern lediglich vom Erreichen der eigenen genetisch vorgegebenen Möglichkeiten aufgrund von Bewegung und körperlicher Aktivität.

Es geht aber nicht nur darum, für ein längeres Leben zu trainieren, sondern auch für verbesserte Körperfunktionen und eine gesündere Lebensqualität. Es existieren reichliche Hinweise, dass Training ein breites Feld an Vorzügen bezüglich gesundheitlicher Aspekte offeriert, einschließlich einiger der unten aufgelisteten Punkte. Mehr noch, mit einem solch breiten Spektrum möglicher positiver Resultate ist es hochgradig wahrscheinlich dass man sich zumindest etwas Gutes tut, selbst wenn man ästhetische oder leistungsbezogene Ziele, die sich leicht beobachten oder messen lassen, nicht erreicht. Tatsächlich schließt eine aktuelle Studie beinahe frech, dass „…es niemanden gibt, der nicht auf irgendeine Weise auf ein widerstandsgestütztes Trainingsprogramm reagiert…“ (Churchward-Venne et al., 2015). Was folgt ist eine kleine Auswahl möglicher Verbesserungen die durch Bewegung und körperliche Aktivität erreicht werden können, sei es mittels ausdauer- oder kraftbasierten Trainings, die im o.g. „Exercise is Medicine“ Symposium der Royal Society of Medicine im Juni angesprochen wurden.

Kopf/Geist

  • Verbesserte Wahrnehmungsfähigkeit und u.a. längere Aufmerksamkeitsspannen, besseres Kurzzeitgedächtnis usw. bei älteren Erwachsenen und bessere Hirnleistung
  • Verlangsamte Abnahme kognitiver Fähigkeiten

Stimmung

  • Verringerter Hang zur Depression
  • Weniger Angst und Beklemmung
  • Mannschaftssportarten fördern die Beteiligung an Gemeinschaftsaktionen und steigern dadurch die allgemeine Gesundheit und Zufriedenheit
  • Verbessertes Selbstwertgefühl

Bewegungsapparat

  • Moderates Training ist gut für Gelenkknorpel
  • Häufig: Gewichtskontrolle
  • Häufig: Kraft, Ausdauer und Energie
  • Häufig: Beweglichkeit und Koordination
  • Erhöhte Knochendichte
  • Verringerte Schmerzen und Gelenkbeschwerden, Bewegung spielt eine wichtige Rolle beim Reduzieren Arthrose-bedingter Symptome
  • Reduzierte Schmerzen und Symptome bei Fibromyalgie
  • Verbesserte Beweglichkeit
  • Verbesserte Leistungsfähigkeit
  • Positive genetische Veränderungen in Bezug auf Alterungsprozesse
  • 30-60% verringertes Risiko einer Schenkelhalsfraktur
  • Positive Trainingseffekte überwiegen gegenüber den Risiken einer Osteoporose

Innere Organe

Herz

  • Verringertes Risiko von Herz-Kreislauf-Erkrankungen
  • Bewegung ist besser als eine perkutane koronare Intervention zur Gewährleistung des Überlebens ohne ein akutes kardiales Ereignis
  • Verringerter Ruheblutdruck
  • Jede Steigerung der körperlichen Aktivität um 200 Schritte pro Tag hilft, das Risiko einer Herz-Kreislauf-Erkrankung um 8-10% zu verringern
  • Regelmäßiges Training ist effektiver als ein Einsetzen von Stents

Verdauungstrakt

  • Verkürzte Zeit der Darmpassage
  • Verbesserte Ergebnisse nach Darmkrebs-Operationen
  • Weniger Nebenwirkungen bei einer Chemotherapie
  • Geringere Sterblichkeitsrate nach einem Jahr
  • Höhere Einjahres-Überlebensrate

Brustkrebs

  • Regelmäßiges Training kann das Brustkrebsrisiko bis zu 20% reduzieren

Diabetesrisiko

  • Verbesserter Glukose-/Insulinstoffwechsel

Allgemein

  • 30-prozentige Verringerung aller Sterblichkeitsursachen, verbunden mit einer höheren Lebenserwartung
  • Verringerter Körperfettanteil
  • Verringerter Bauchfettanteil
  • Verbesserte Blutfettwerte
  • Erhöhter Grundumsatz
  • Verbesserte Schlafqualität

Wir müssen uns vom Blick auf kurzfristige Trainingserwartungen lösen. Training ist viel mehr als nur abzunehmen oder Muskelmasse aufzubauen. Die breite Öffentlichkeit muss ein besseres Verständnis für die umfassenden Vorzüge körperlicher Aktivität erlangen. Jeder der diesbezüglich gefragt wird:

  1. Wenn Du ins Fitness-Studio gehst um Muskulatur aufzubauen, aber Dein Ziel nicht erreichst, warum gehst Du dann überhaupt? Wofür trainierst Du?
  2. Oder, wenn Du ins Fitness-Studio gehst um abzunehmen, aber Dein Ziel nicht erreichst, warum gehst Du dann überhaupt? Wofür trainierst Du?

sollte in der Lage sein zu antworten: “Ich trainiere fürs Leben!”

Daher empfehle ich eindringlich die Verwendung von motivierenden Infografiken bezüglich der Vorteile körperlichen Trainings wie z. B. diese hier in einem kürzlich veröffentlichen BJSM Blog von Andrew Murray et al. in unseren Auftritten in den sozialen Medien, um diese einem breiten Publikum zur Verfügung zu stellen.

Abschließend noch zwei schöne Zitate vom “Exercise is Medicine” Symposium:

“Man ist nie zu alt um etwas Neues anzufangen” – Dr. Charles Eugster (95 Jahre jung!)

“Bewegungsmedizin muss sich vom gängigen medizinischen Modell lösen. Vorbeugen ist besser als Heilen!” Prof. John Buckley.

Sowohl die Quintessenzen und Zitate des “Exercise is Medicine” Symposiums der Royal Society of Medicine in London im Juni 2015, als auch der Austausch mit @BJSM_BMJ auf Twitter haben mich veranlasst, diesen Artikel zu schreiben und die Botschaft zu weiterzuverbreiten.

Die betreffenden Tweets und Informationen sind hier nachzulesen:
http://www.sportmednews.com/blog/category/exercise

Artikel übersetzt aus dem Englischen von:

Isabel Schneider

M.A. Englisch als Fremdsprache

MA Sportwissenschaften

Dozent an der H:G Hochschule für Gesundheit und Sport, Technik und Kunst

Isabel.Schneider@my-campus-berlin.com

Physio-Motion – Beratung und Dienstleistungen rund um Sport, Bewegung und Gesundheit

www.physio-motion.de

www.facebook.de/physi0motion

www.youtube.de/physi0motion

@isi69schneider

Der Artikel wurde im Original auf Englisch publiziert bei BJSM blog (http://blogs.bmj.com/bjsm/). Hier können Sie den Artikel im Original lesen: http://blogs.bmj.com/bjsm/2016/02/23/train-for-life-exercise-is-medicine/

Literatur:

  1. Artero, E.G., et al., 2011. A prospective study of muscular strength and all-cause mortality in men with hypertension. J Am Coll Cardiol. 57(18), pp 1831-1837
  2. Byberg, L., et al., 2009. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. Br J Sports Med. 43(7), pp 482
  3. Churchward-Venne, T.A., et al., 2015. There are no nonresponders to resistance-type exercise training in older men and women. J Am Med Dir Assoc. 16(5), pp 400-411
  4. Hubal, M.J., et al., 2005. Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc. 37(6), pp 964-972
  5. Kokkinos, P., et al., 2008. Exercise capacity and mortality in black and white men. Circulation. 117(5), pp 614-622
  6. Laukkanen, J.A., et al., 2010. Cardiorespiratory fitness, lifestyle factors and cancer risk and mortality in Finnish men. Eur J Cancer. 46(2), pp 355-363
  7. Lee, I., and P. J. Skerrett, 2001. Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc. 33(6), S459 – S471
  8. Lee, I., et al., 2003. Relative intensity of physical activity and risk of coronary heart disease. Circulation. 107(8), pp 1110 – 1116
  9. Lee, D. C., et al., 2011. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Brit J Sports Med. 45, pp 504 – 510
  10. Lee, D.C., et al., 2011. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 124(23), pp 2483-2490
  11. Leong, D. P., et al., 2015. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology Study. Lancet. 386(9990), pp 266-273
  12. Newman, A. B., et al., 2006. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol. 61A(1), pp 72 – 77
  13. Nocon, M., et al., 2008. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 15(3), pp 239 – 246
  14. Paffenbarger, R.S. et al., 1986. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 314(10), pp 605-613
  15. Ruiz, J.R., et al., 2008. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 337, pp a439
  16. Srikanthan, P., & Karlamangla, A.S., 2014. Muscle mass index as a predictor of longevity in older adults. Am J Med. 127(6), 547-553
  17. Timmons, J.A., 2011. Variability in training-induced skeletal muscle adaptation. J Appl Physiol. 110(3), pp 846-853
  18. Wen, C. P, et al., 2011. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet. 378, pp 1244 – 1253
  19. Wisloff, U., et al., 2006. A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? ‘The HUNT study, Norway’. Eur J Cardiovasc Prev Rehabil. 13(5), pp 798 – 804

5 Things I learned from the World Gymnastics Championships

18 May, 16 | by BJSM

 By Rishi Dhand @rishidhand7

Excited, nervous, intrigued… I felt all of these emotions and more when I was asked to help as a doctor at the World Artistic Gymnastics Championships in October, 2015. It was the qualifying event for this year’s Olympic Summer Games in Rio de Janeiro.

I recognize my fortune to participate at an event of this magnitude whilst my SEM career is so young.  Although a doctor for over 2 years, with experience shadowing and providing support at smaller scale sporting events, this was by far my biggest SEM opportunity to date.

rishi team

Five things that I learned, and hope to pass on to early career sports medicine doctors:

1) Concentrate

Obviously a vital attribute of any medical professional covering a sporting event. However, it would have been easy to lose concentration whilst watching any of these world-class athletes on their apparatus. Even as someone who hadn’t watched much live gymnastics, after a few hours I found myself instinctively recognising when a gymnast was about to land awkwardly whilst they were still in mid air.

2) Learn from the physios.

For each shift, I was paired with a physiotherapist. Many of the physios had years and years of experience. They had worked at Olympics, World Championships, private sports clinics and elite football too. Some of their tips on taping techniques, common injuries and rehabilitation was invaluable and possibly the most educational part of the Championships for me. Not to mention the whole variety of interesting stories to keep us entertained in our quieter moments!!

3) Preparation is key.

Something that you may not realize when you watch an event on TV is the amount of work that is done behind the scenes. 7 am run-throughs in the Arena on the Field of Play, allowing the doctors, physios and paramedics to work in sync. I acted as the ‘injured athlete’ for a couple of these!

We had morning and evening handovers. This allowed us to discuss injured and/or treated athletes as well as those who were struggling on a particular apparatus. This was vital information for our medical team as it gave us direction of when and where to have heightened awareness.

One example of this was an athlete who had been struggling with an upper limb injury. In his transition from training hall to warm up hall and into the arena, he was identified to each medical team as an athlete at risk. During his main routine, he under rotated on an apparatus and sustained a nasty lower limb injury.  The heightened awareness allowed the medical team to be on their toes on the field of play to promptly treat him.

4) Athletes’ passion to compete may outweigh medical advice.

Gymnasts are a set of athletes that are truly dedicated to their sport and they seem to be immune to the threat of danger as they throw themselves over various bars! They were picking up injuries that should have ruled them out, but such was their desire to compete, some ignored medical advice. One athlete had a suspected ACL rupture. He so adamantly wanted to complete his routine that he opted to finish it landing on one leg!

5) Soak up the atmosphere.

I took any chance I had to go into the arena, either in quiet moments during the day or after our shifts.

It was amazing to witness world class athletes on show, watch GB women win their first ever world team medal, GB men win their first ever world team medal, and Max Whitlock become the first man to win gold for GB in a world championship. As you could guess, the atmosphere was electric. It really spurred the medical team to achieve even greater heights and made the experience even more of a privilege.

One of the gymnasts from the USA Olympic medal winning team from 2008 said, “Competing in gymnastics is the greatest reminder of being alive as a human being.”   After my experience in Glasgow, I think I’ve caught that particular bug and I’d urge you to catch it too.

Related BJSM Articles

Daly, Bass, and Finch. (2001). Balancing the risk of injury to gymnasts: how effective are the counter measures? A classic from the archives. Over 20,000 views

Surviving 30 years on the road as a team physician (2013). Peter Brukner. (Members only, not open access)

Same paper as a free blog here.

 

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Dr Rishi Dhand is a Teaching Fellow at Sunderland Royal Hospital. He wants to pursue a career in Sports Medicine

Financial impact of injury, biometrics, and communication: Lessons from MIT Sloan Sports Analytics Conference 2016

14 May, 16 | by BJSM

By Sean Carmody (@seancarmody1)

“We can’t win like everyone else, we have to do something different”

moneyball

Those are the words of Dr David Martin, Director of Performance and Research at the Philadelphia 76ers, who featured on the Sport Science panel at the 2016 MIT Sloan Sports Analytics Conference (SSAC). The sentiment related to the 76ers’ current struggle for improvement from last position on the NBA Eastern Conference ladder, but it could easily represent what the conference as a whole stands for; the continuous search for an edge in the cut-throat industry of elite sport.

Ten years into its existence, the influence of SSAC permeates American sports. Take Daryl Morey for example, a computer science graduate and co-founder of the conference, who has been appointed General Manager of the Houston Rockets and has earned plaudits for his use of analytics to drive improvement in the Rockets’ performance and recruitment. The traditional focus of the conference has been on this ‘Moneyball’ approach to player recruitment, or in real terms: “looking for players whose surface appearance is deceiving the market place about their value”. However, with the recent success of teams such as the Golden State Warriors, who have pioneered the strategic sleep and rest of players, there has been a palpable shift towards exploring the use of analytics in optimising athlete health and preventing injuries.

With that in mind, here are some insights from the 2016 Conference which may be of use to the sports medicine community:

The Impact of Injury

Those in sports medicine often quote the financial impact of injury to demonstrate their value, and it’s difficult to argue against them. In US sports alone, $700 million per season is lost in injured player salaries in Major League Baseball, $358 million in the NBA, while NFL starters miss 1600 games a season through injury. This monetary incentive to prevent injury is now coupled with an emerging wealth of research examining the effect of injury on overall team performance- Hagglund et al’s UEFA Champions League study being a classic example.

One of the most interesting research presentations at the conference applied advanced machine learning techniques to predict the probability of injury for an NBA player. The researchers presented a model that offered a quantitative and systematic approach to injury prevention which allowed teams to forecast the likelihood that any given player will succumb to injury during the course of an upcoming game. Applying this model successfully to other sports will be game-changing.

Ray Hensberger of Booz Allen Hamilton sought to know how an injury to one player may directly affect the on-field performance of another. To illustrate his point he referred to the Baltimore Ravens’ linebacker combination of Elvis Dumervil and Terrell Suggs. In 2014, Suggs (12) and Dumervil (17) led the number of sacks in the NFL with a combined total of 29. However, following a season-ending injury to Suggs in week 1, Dumervil only managed 6 sacks for the entire 2015 season. Of course there are many confounding factors in this, but it makes for an intriguing line of research. To consider an example closer to home, when Leicester City’s N’Golo Kanté touches the ball in the middle or back of the pitch, shots on the subsequent attack are 70% likelier to yield a goal than when he isn’t involved– how might an injury to his ever-present midfield partner Danny Drinkwater affect this (and Leicester’s chances of securing the Premier League)? Answers to these questions may contribute to a greater understanding of the fascinating concept of team cohesion and winning.

But are all injuries bad? The cliché injury is an opportunity to get better is well worn, but there is anecdotal evidence pointing to its truth. Hensberger used the story of San Antonio Spurs’ Kawhi Leonard who used his time injured to develop into an all-round better athlete, while an article in ESPN Magazine’s Analytics Edition suggested that for the Golden State Warriors: “A Steph Curry who has never injured his ankles would be less preferable than the Steph Curry we actually have today”. It bodes the question, is the experience of overcoming injury key to developing the resilience of a champion? Would Jonny Wilkinson have kicked Toulon to back-to-back European Cups in the twilight of his career if he hadn’t spent several seasons before in the rehab room?

Perhaps the impact of player availability can be summed up by the vignette offered by Andy Glockner, author of Chasing Perfection, who spoke at the conference. While researching for his book, Glockner asked Keke Lyles, Director of Performance at the Golden State Warriors: “If you could guarantee Andre Iguodala was available for 75 games this season, would anything else matter?”Lyles responded with an emphatic “No”. That season, Iguodala played in 77 games and the Golden State Warriors were crowned champions.

Biometrics – The Next and Biggest Analytics Frontier?

During his talk, Glockner argued that the use of biometry represents the most significant opportunity for teams to gain an edge over their competitors. Biometrics refers to biological data which may be important for keeping an athlete healthy. Examples include the data input into personal apps by athletes (including sleep quality, soreness etc) and those collected by global positioning systems (including indicators of workload). Glockner proposed that figuring out which data is most helpful in predicting injury will be a major discussion point in the future. In light of this revelation, recent research published in the British Journal of Sports Medicine cites the acute: chronic workload ratio as a strong predictor of subsequent injury.

Big data collecting systems are now essentially ubiquitous in professional sport but as Brian Kopp of Catapult Sports suggests, “the advantage is never going to be merely in having access to the data. It will be in what you do with it”. With such widespread data available, there has inevitably been inappropriate use of technology in sport. Stephen Smith, founder and CEO of Kitman Labs, feels that the availability of such data has wrongly led to a tendency to hold athletes back – stating during the Sport Science panel at SSAC that: “Every time we hold an athlete back we limit their potential. It shouldn’t automatically be ‘we should stop the athlete from participating’, instead we should consider how else we can train and treat them, how can we do something incredibly intelligent with the data to improve the outcome”.

In sports such as basketball, with multiple games in quick succession, and large amounts of time spent on airplanes, it’s easy to see how biometrics can provide an advantage. It was reported during the conference that basket-ballers lose up to 25% of their flexibility at the end of each game, and often have to jump straight on a flight traveling across time zones which limits their opportunity to recover. Add to that the risk of being tall and flying frequently, and you have a recipe for illness and injury.

Old Lessons Die Hard

Despite the promise of expensive technology and sophisticated analytics, a recurring theme throughout the conference was the importance of good communication. The information gleaned from big data is irrelevant if it can’t be presented to coaches and athletes in a way that is understandable and specific to them (“coach speak”). This topic was touched on during the Soccer Analytics panel where it was suggested that footballers tend to be visual learners, and that insights should be packaged in a style that reflects this.

Conclusion

Conferences such as SSAC are inspiring days out, never lacking in insightful soundbites. But the cynic in me often wonders if in an industry as ruthless and secretive as sport, if what’s really worth knowing is not being told.

Nevertheless, it appears that we’re living in an exciting time for sports medicine with the impact analytics can have on protecting athlete health and extending sporting careers. With this in mind, we return to Daryl Morey, the man who started SSAC. During a panel session he was asked which profession he feels will play an increasingly important role in the front office of sporting organisations in the future. His response? Doctors.

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Sean Carmody (@seancarmody1) is a junior doctor working in the South Thames Deanery.

Rat Races, Referrals and Randomised Trials: Exercise Medicine Updates from Ireland

12 May, 16 | by BJSM

Undergraduate perspective on Sports & Exercise Medicine  a BJSM blog series

By Fiachra Maguire (@Fiachrama)

The annual Spring Study Day forms part of the Faculty of Sports Medicine in Ireland’s (@FSEM_IRL) educational series. Now in its third successive year, the event aims to provide a mix of sports related pathologies and more clinically applicable exercise medicine.

The standard was high in both presentation and content. For those at preliminary stages, the short feedback sessions provided some additional insight on study design. The abstract booklet, with details on each talk is available to view here.

Take-home messages of the 3rd Annual FSEM Ireland Spring Study Day:

An Introduction to the MedEx Program  — Dr. Brona Furlong

  • MedEx is a chronic illness rehabilitation programme utilising exercise with parallel educational and related supports.
  • Primarily consultant led referrals from local hospitals due to specialisation for chronic illnesses.
  • HSE (NHS equivalent) evaluation of the programme, for feasibility of a national implementation is underway.
  • 12-Month duration Single Arm Observational Trial. Non-Controlled due to ethical consideration of withholding treatment to ill populations where evidence shows exercise to be of benefit.

Experiences with Exercise in Cancer Patients  — Dr. Lisa Loughney

  • Treatment for Cancer, Chemotherapy and Surgery, are both significant risk factors for mortality and post-operative complications. Resulting in an increased risk of death pertinent at 3 years.
  • Stratification based on CardioPulmonary Exercise Testing allows a more accurate (patient specific) assessment of risk.
  • Facilitates a collaborative decision making process.
  • The role that Exercise Training can play in “dual hit” neoadjuvant cancer treatment and surgery; safe and feasible but a need for more controlled trials.
    (Read more here — Loughney et al., 2016)
  • Read a systematic review of how exercise is beneficial to cancer patient’s quality of life here

Exercise and Nutrition – Interplay in Chronic Illness  — Mr. Conor Kerley

  • Significant interplay between some of the top risk factors for morbidity and mortality worldwide.
  • Nutrition related risk factors have risen to prominence in the last ten year period, versus physical inactivity, which has remained relatively static.

Exercise and the Brain; Applications in Neurodegeneration Professor Tim Lynch

exercise brain

  • Prevailing theory that exercise results in increased connectivity for reserve & resilience
  • Investigations in rat models of Parkinson’s Disease utilising forced exercise demonstrate that the ‘lazy’ rats pathological findings were consistent with PD, versus the running rat.
  • Structural change in the connectivity in the basal ganglia of the exercised PD rats; more efficient in processing dopamine than the unexercised.
  • Read more here — Petzinger et al., 2015
  • Fascinating case report on Exercise and Progressive Multiple Sclerosis.
    • Combined with pharmacological management, the patient initiated a physiotherapist prescribed exercise intervention.
    • Stringent adherence to the regime and augmentation with a wearable activity monitor has precipitated significant & rare improvements in symptomatic scoring.
  • Read an editorial piece on the cognitive effects of exercise here or click the following link to read about the effects of aerobic exercise on neural plasticity here

Hypertension and Exercise  — Dr Eamonn Dolan

Exercise and Pulmonary Arterial Hypertension  — Professor Paul McLoughlin

  • Exercise training improves exercise tolerance in PAH.
  • Magnitude of improvement on 6-Minute Walk Test in line with pharmacological intervention.
  • Improves Quality of Life scores.
  • Accompanied by significant incidence of transient adverse effects [10 – 15%], such as syncope, which necessitates medical supervision.

There will be plenty more to listen to and learn from at @FSEM_IRL’s next event, which is the Annual Scientific Meeting (@FSEM_ASC2016) taking place from the 15th to 17th of September. The special topic is the Female Athlete and the scope will be similarly broad, from performance to clinical medicine.

More information is available here.
Note that both *Student Discount* and *Early Bird Pricing* exists, making the invitation increasingly difficult to decline.

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Fiachra Maguire (@Fiachrama) is a medical student of Trinity College Dublin, Ireland. He has a healthy interest in sports and exercise medicine and is currently undertaking an MSc research project on gait & cognitive impairment.

Dr. Liam West  (@Liam_West) 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.

Zurück zum Sport nach Verletzungen an der unteren Extremität  

10 May, 16 | by BJSM

By Keller Matthias

Ob Freizeitsportler oder Profiathlet – nach einer Verletzung stellt sich dem Sportler immer die gleiche Fragen. “Wann kann ich wieder zurück zu meinem Sport?”

Auch für Therapeuten ist es schwierig, diese Frage klar zu beantworten. Es zeichnet sich aber ab, dass Tests, welche Funktionen prüfen und sportartspezifische Belastungen simulieren als Entscheidungshilfe für eine sichere Rückkehr zum Sport dienen (1,2). Um die richtigen Assessments zu wählen muss das Ziel des Patienten definiert werden. Neben den spezifischen Anforderungen einer Sportart spielt auch das angestrebte Leistungsniveau des Sportlers eine entscheidende Rolle. Die Post Injury-Pyramide soll dabei helfen das angestrebte Leistungsniveau eines verletzten Sportlers zu bestimmen. Gleichzeitig stellt es ein Stufensystem dar, welches zur Steuerung der Rehabilitation bis zur Wettkampffähigkeit eingesetzt werden kann (2,3).

Post-Injury-Pyramide

Verschiedene Experten haben zum Thema “Zurück zum Sport” Begrifflichkeiten eingeführt. Eine einheitliche Darstellung existiert nicht. Grundsätzlich lassen sich die verwendeten Begrifflichkeiten hierarchisch als Pyramide darstellen (Abbildung 1).

Return to Activity

Unter “Return to Activity” versteht man das Wiedererlangen von Basisfunktionen oder grundlegenden Bewegungsmustern, wie beispielsweise dem Einbeinstand, einem Ausfallschritt oder einem Sprung. Das Beherrschen dieser Muster kann als minimale Voraussetzung für alle (dynamischen) Sportarten angesehen werden.

Return to Sport

Kann der Patient wieder beginnen sportartspezifisch zu trainieren, dann kann dies als “Return to Sport” bezeichnet werden. Dabei finden Teile des Trainings in der gewohnten Trainingsumgebung statt. Das volle Leistungsniveau ist noch nicht erreicht.

Return to Play

Als “Return to Play” bezeichnet man das Wiederlangen der vollen Sportfähigkeit. Der Athlet hat keine posttraumatischen Einschränkungen mehr und kann als gesund bezeichnet werden. In Teamsportarten bedeutet dies die uneingeschränkte Teilnahme am Mannschaftstraining.

Return to Competition

Wenn ein Sportler wieder über die gesamte Dauer oder den gesamten Umfang am Wettkampf teilnehmen kann, wird dies als “Return to Competition” bezeichnet. Ob der Athlet die physische und psychische Leistung erbringen kann um einem Wettkampf erfolgreich standzuhalten, obliegt meist der Entscheidung des Trainers oder des Trainerstabs.

 

german pyramid

Abbildung 1: Post Injury-Pyramide

 

 

  1. Keller M, Kotkowski P, Hochleitner E, Kurz E. Der Return to Activity Algorithmus für die untere Extremität – ein Fallbeispiel. manuelletherapie 2016; 20: 19–29
  1. Keller M, Kurz E, Schmidtlein O, Welsch G, Anders C. Interdisziplinäre Beurteilungskriterien für die Rehabilitation nach Verletzungen an der unteren Extremität: Ein funktionsbasierter Return-To-Activity Algorithmus. Sportverletzung Sportschaden 2016; 30 ( 01 ): 38-49
  1. Keller M, Kurz E. Zurück zum Pre Injury Level nach Verletzungen der unteren Extremität – eine Einteilung funktioneller Assessments. manuelletherapie 2016; 20: 16–18

 

Distance Running Part II: Landmark Research Projects and Science-Based Books

7 May, 16 | by BJSM

By Phillip B. Sparling

In part I of my retrospective, I featured pioneer researchers in distance running. In part II, I’ll first flashback to two notable projects on elite runners, and then share thoughts about books on the science of running.

Men's_Study_1975 (1)

40 Years Ago – Elite Men’s Project: In 1975, Michael Pollock, director of the Institute for Aerobics Research in Dallas, Texas, led a group of researchers in a multi-day study of 20 elite distance runners. Frank Shorter and Steve Prefontaine led the all-star ensemble of the best runners in America. Previous research had been limited by a small number of test variables or few subjects. This project was unique in incorporating a research team, a large sample and a more comprehensive test battery administered by experts in different domains: for example, muscle biopsies and fiber typing by David Costill (Ball State University), biomechanical analysis by Peter Cavanagh (Penn State University), psychological characterization by William Morgan (University of Wisconsin), and cardiorespiratory, metabolic and body composition measures by M. Pollock. The next year (1976) in New York City, findings from this project along with a host of other papers by notable investigators from far and wide were presented at a conference on the marathon runner. Sponsored by the New York Academy of Sciences, the published proceedings, a large volume at over 1,000 pages, has become a classic reference (1).

Dallas_study

Caption: Elite Men’s Study, Dallas, 1975. Back row, from left to right – Michael Pollock, Kenny Moore, Steve Prefontaine; Kenneth Cooper is at far right. Front row – Frank Shorter is at far right.

30 Years Ago – Elite Women’s Project: In 1985, I organized a study on elite women distance runners modeled after the 1975 study on men. My friend Russ Pate (University of South Carolina) was co-director of the project. Interestingly, as a 2:15 marathoner, he had been a subject in the men’s study. Key investigators from the project a decade before – Drs. Cavanagh, Costill, Morgan, and Pollock – joined us at Georgia Tech in Atlanta for 3 days of testing. Among our elite group of women runners (n=16), Canadian Jacqueline Gareau and Brit Priscilla Welch, both marathoners, were perhaps the best known. Three of the athletes were 1984 Olympians, 6 were USA national champions, and all were nationally ranked (top-10). At the time of this study, it had been 13 years since the passage of Title IX and the Boston Marathon’s acceptance of women competitors, and one year since the first Olympic Marathon for women. Papers from this project were published as a set in a special issue of the International Journal of Sports Medicine (2). Many papers from the 1975 and 1985 projects allow direct comparisons between measurements in elite men and women as well as with those of good runners (well-trained men and women but not elite) (see examples, 3-14).

Women's_Study_1985

Looking Back, Moving Forward: Many people beyond those mentioned – other researchers, clinicians, graduate students, lab assistants and support staff – were instrumental in making these multidisciplinary projects possible. The primary scientists who formed the core teams went on to conduct research in other areas. Except for Michael Pollock who died in 1998, the main players are still around. Our experiences during these projects were uplifting and rewarding. With a synergy among investigators and with the runners, it was a special opportunity to combine passion, curiosity and science in the quest to learn more about distance running. Olympic marathoner and journalist Kenny Moore recounted his experiences as a subject in the Dallas study in a Sports Illustrated article (15). Findings from the women’s project, along with studies of researchers worldwide, clearly dispelled the lingering notion that “the fairer sex” is unsuited to the rigors of strenuous training and intense competition. Mary Decker (Slaney), Grete Waitz, Joan Benoit and their contemporaries blazed the trail; scientists simply confirmed their capabilities. Investigators today – using research tools from molecular biology, genomics and neuroscience – continue to probe deeper. The search continues to better understand what combinations of factors contribute to the success of the world’s best distance runners.

HowTheyTrain

Applying the Science: Introspective and analytical, distance runners have always sought answers. A half-century ago, athletes and coaches were primarily empiricists. In 1959, Fred Wilt published How They Train, a detailed compilation of training programs of the world’s best distance runners. Updated and retitled Run, Run, Run in 1964, his books set a new standard. A two-time Olympian (1948, 1952), Sullivan Award Winner, and prominent coach, he believed runners should study widely and through careful trial and error determine what training suits them individually. Today, after decades of research studies, an ongoing question is: What can science tell us about how to train better and run faster? Translating research findings into sound, practical advice, a seemingly simple task, is in fact difficult. Many books have tried to fill the gap but few have met the mark with lasting success. Among the top-tier books of perhaps a dozen in the USA, I’ll mention three: The Lore of Running by Tim Noakes (16), Daniels’ Running Formula by Jack Daniels (17), and Running Science by Owen Anderson (18). These authors, all venerated authorities, share an uncommon blend of attributes. Each is a highly-regarded scientist, accomplished athlete, sought-after coach/adviser, and superb writer for professional and general audiences alike. These books connect the dots between science, training and performance, with sage advice and fascinating stories of runners and races.

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Phil Sparling is a Professor Emeritus of applied physiology at the Georgia Institute of Technology (Georgia Tech) in Atlanta, Georgia, USA. Decades ago he was a competitive distance runner and marathoner. He still runs several days a week. phil.sparling@gatech.edu

References

(1) Milvy P (ed) The Marathon: Physiological, Medical, Epidemiological, and Psychological Studies. Ann NY Acad Sci 301: 1–1046, 1977 http://onlinelibrary.wiley.com/doi/10.1111/nyas.1977.301.issue-1/issuetoc

(2) Sparling PB (ed). A Comprehensive Profile of Elite Women Distance Runners. Int J Sports Med 8 (suppl 2): 71-136, 1987 www.thieme-connect.com/products/ejournals/issue/10.1055/s-002-9118

(3) Pollock ML. Characteristics of elite class distance runners – overview. Ann NY Acad Sci 301: 278-282, 1977

(4) Sparling PB, Wilson GE, Pate RR. Project overview and description of performance, training and physical characteristics in elite women distance runners. Int J Sports Med 8 (suppl 2): 73-76, 1987

(5) Pollock ML. Submaximal and maximal working capacity of elite distance runners: cardiorespiratory aspects. Ann NY Acad Sci 301: 310–322, 1977

(6) Pate RR, Sparling PB, Wilson GE et al. Cardiorespiratory and metabolic responses to submaximal and maximal exercise in elite women distance runners. Int J Sports Med 8 (suppl 2): 91-95, 1987

(7) Costill DL, Fink WJ, Pollock ML. Muscle fiber composition and enzyme activities of elite distance runners. Med Sci Sports 8: 96–100, 1976

(8) Costill DL, Fink WJ, Flynn M et al. Muscle fiber composition and enzyme activities in elite female distance runners. Int J Sports Med 8 (suppl 2): 103-106, 1987

(9) Pollock ML, Gettman LR, Jackson A et al. Body composition of elite class distance runners. Ann NY Acad Sci 301: 361-370, 1977

(10) Graves JE, Pollock ML, Sparling PB. Body composition of elite female distance runners. Int J Sports Med 8 (suppl 2): 96-102, 1987

(11) Cavanagh PR, Pollock ML, Landa J. A biomechanical comparison of elite and good distance runners. Ann NY Acad Sci 301: 328-345, 1977

(12) Williams KR, Cavanagh PR, Ziff JL. Biomechanical studies of elite female distance runners. Int J Sports Med 8 (suppl 2): 107-118, 1987

(13) Morgan WP, Pollock ML. Psychologic characterization of the elite distance runner. Ann NY Acad Sci 301: 382-403, 1977

(14) Morgan WP, O’Connor PJ, Sparling PB. Psychologic characterization of the elite female distance runner. Int J Sports Med 8 (suppl 2): 124-131, 1987

(15) Moore K. Watching their steps. Sports Illustrated May 3, 1976 www.si.com/vault/issue/43339/75/2

(16) Noakes T. The Lore of Running (4th ed). Human Kinetics, 2002

(17) Daniels J. Daniels’ Running Formula (3rd ed). Human Kinetics, 2013

(18) Anderson O. Running Science. Human Kinetics, 2014

Beating the odds: How the ACPSEM CPD pathway can help physios who want to work in sport

4 May, 16 | by BJSM

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

By Nikki McLaughlin @Nikkimacphysio

Having just read @sianknott‘s recent blog on behalf of @sport_wales, I am inspired to give a brief synopsis of how to use current and existing infrastructures of governing and professional bodies to progress through your career as a sport physio – being an Olympic year, what better time to share the info.

Rabbit in headlights

Where do I go from here???

Now when you first start out it’s a bit like a rabbit in the head lights – you don’t know where to go or what to do…so my main aim for this blog is to give some advice and personal experience on where you can go as a newly graduated physio who wants to work in sport, or for those looking for more exposure in multi sport events.

I wouldn’t say I am the most experienced sports physiotherapist out there but if I didn’t have the help and support from some key figures in the sports physio world (you know who you are), I would never have worked with some of the teams I have, or travelled to the farthest corners of the world. Therefore, I am merely just trying to return the favour by  “Paying it forward”.

CPD Pathway and Education-Going for gold.

Firstly, I have found and continually use the Association of Chartered Physiotherapists in Sport and Exercise Medicine (ACPSEM) as a great resource for  professional development and networking. The organisation has a clear and structured CPD and educational pathway. The process is straight forward and the “pathway provides a road map to help sports physiotherapists to plan, implement and reflect upon their learning”.

The ACPSEM accreditation levels are internationally recognised by the International Federation of Sports Physiotherapists, theBritish Olympic Association and Sports National Governing Bodies. Evermore, employers are using the CPD levels as essential criteria on their job descriptions to ensure that they can be confident in the physiotherapists sporting experience. With more competition in the marketplace from other sports practitioners, the pathway can add value to your professional credibility.

Secondly, the organisation clearly has some influence within the market place. It’s members regularly liaise with Health Professions Council and Chartered Society of Physiotherapy to inform them of any changes and/or updates of working practices of physiotherapists working in sport medicine.

To volunteer or not????

As you enter into the sporting world it is very easy to get caught up in the volunteering process.  Now I for one feel strongly about this and speak from experience. All too often you hear of physios covering or volunteering for sports to gain experience but quite often end up working alone or exposed, and I’m not against volunteering but what I will say and question is what are you getting from it?

Perhaps an example would help better here? – If you a covering a social sporting side to gain experience and you are the sole practitioner and responsible for trauma cover, question are you really going to benefit from it or are you just exposing yourself to a potentially vulnerable situation?

working alone pitchside

Exposure pitch side the need for team support is essential

If however, you are involved within a team there is no reason why you cannot volunteer and access the previously mentioned ACPSEM pathway documentation and mentoring system. This will support you to clearly define objectives and learning outcomes from within your role making the experience more worthwhile.

If you really seek a structured experience, with exposure within multi sport events then BUCS as an organisation is a  great place to start.  Throughout my career I have been heavily involved and still am. The cohort of physio and medics are so varied in their professional and sporting backgrounds that the information or learning you can gain is invaluable regardless of experience. Is it costly? simple answer no, all you have to do is give your time and be willing to work the hours and in environments your not used to.

BUCS volunteer

BUCS events, particularly the larger ones, provide an excellent opportunity for doctors and physiotherapists looking to enhance their sporting experience. BUCS currently operate two multi-sport events where are large number of doctors and physiotherapists come together to work and share knowledge and skills.  Involvement in the domestic programme can additionally lead to a variety of international opportunities. I can say that these have been some of the best working trips I have been on and made some real life-long friends.

For domestic events, BUCS provides expenses and daily rates for ACPSEM qualified physiotherapists and doctors. Students and newly qualified individuals are also able to be involved in a shadowing capacity. Interested in volunteering click here

If after reading this blog your keen to progress further in the Sport and Exercise Medicine world, then volunteer and get involved because who knows, you may be attending the next World University Games, Commonwealth Games or  Olympics Games………………………

See you there😉

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 Nikki McLaughlin @Nikkimacphysio works at Baseline Physiotherapy in Cardiff and Caerphilly, http://www.baselinephysiotherapy.co.uk/

 

Getting the best out of athletes: Load, Injuries and Determination

2 May, 16 | by BJSM

By Rory Heath (@roryjheath) and Xanni von Guionneau

The Arsenal SEMS Conference “Marginal Gains in Sports Medicine” provided deep insight into attaining and maintaining the highest level of sporting performance in professional athletes. As the elite athletic population becomes more homogenous, the value of “marginal gains” in achieving podium finishes and championship titles is more important than ever.

Below are our takeaway points focusing on Load, Injuries and Determination; we hope they provide a competitive edge to your practice!

Load”

  • One way to objectify ‘performance’ is to measure “load”; the stressors that affect a player’s physical and mental homeostasis. “Load” can be separated into “external”; the demands placed on an athlete through training and competition, or “internal” factors of psychological stress from the sport or other life events. (Halson, 2014)
  • “External” load is sport specific. Cyclists may calculate load by analysing power output for time duration, whilst Rugby players must factor in collisional, metabolic and mechanical load. E.g. Load = ((Duration X RPE ) +( X Number of collisions ))
  • Load is unique to the individual and their playing position – a tight head prop will experience larger mechanical and collisional loads than a scrumhalf, requiring individualised parameters
  • Monitoring “load” allows tailoring of future sessions and tapering/peaking approaches to match days
  • Be aware of OED and MEDs! The Optimum Effective Dose (OED) has its place in the preseason, building strength and speed. When load increases in-season, the Minimal Effective Dose (MED) is adequate to maintain or further training adaptations
  • “You can collect as much data as you want, but without conversations, data is meaningless” Nigel Jones
  • Success with metrics such as HRV require communication and understanding amongst the entire team, from medical staff to players
  • Understand the demands of your player to provide focused training and treatment – “Don’t put square pegs in round holes” Shad Forsythe

Injuries” 

  • Although data is only a small part of the decision, “load” can predict injury risk – “The majority of our players have an injury – it is our job to help them decide whether this will stop them playing” Nigel Jones
  • The management aim for >90% player availability by optimising load management, recovery and player resilience
  • If an injury occurs, Dr Jones’ team will reflect on its aetiology.
  • Shad’s athletes focus on hip extension and thoracic mobility in their recovery work

Return to Play”

  • The injury doesn’t leave just a physical toll. Psychological effects (doubt, insecurity, fear) change the athletes view towards injury, subsequently effecting recovery and return to play
  • Returning to play comprises physical, psychological and contextual factors
  • Recovery is not a linear path and is not predictable!
  • A tailor made programme can address stressors and psychological barriers unique to the individual
  • Communication between all members of the medical team, the athlete and the family is needed to maintain steady progress
  • “Visualisation” of RTP is a useful tool to speed recovery
  • Pair a newly injured athlete with someone further down the road to recovery: positive mentoring potentiates a positive outlook

Recovery”

  • Although athletes may perform with injuries or in pain, they should not participate if there is a significant risk of further injury.
    • Imagine player recovery as a battery; a full battery of green bars shows adequate recovery, whilst a power level fading into a red zone implies poor recovery, accompanied by the risk of illness, injury and burnout. Effective recovery serves to recharge the battery and prevent the athlete going into the red
  • It is important to promote player understanding and ownership of their recovery. England Rugby use a “points based” system to incentivise recovery, providing players with quantifiable targets of positive actions
    • For example; a player is required to total 100 points in a day, selecting activities from broad headings of food, sleep, “headspace” and more specific methods such as cryotherapy or contrast hydrotherapies

Determination”

  • Approach athletes through both a team and an individual approach. Shad’s approach at Arsenal for ‘Off pitch support’ is 80% team (Positive lifestyle changes, mobility maintenance and muscle activation sessions) and 20% individual (focused physiotherapy, individual dietary prescription)
  • Athletes can be “admired for talent but respected for work ethic” – Richard Moore
  • “I worried I hadn’t suffered enough” is a common thought of elite athletes pertaining their preparation for competition.
  • “Hunger” stems from early enjoyment and positive experiences of sport during childhood, with a subsequent feed-forward mechanism of further training to improve winning. On the contrary, “Hunger’ is brought by a fear of losing
  • Determination can be genetic, illustrated by the products of selective breeding of huskies. However, this genetic role is difficult to isolate in humans – “Performance in sport is highly multifactorial”Nigel Jones
  • There is no ‘cookie cutter’ approach to talent ID. Jamie and Andy Murray have very different character traits and personalities, yet both have succeeded in their sport
  • The first thing to look at in Talent ID is the parents – the environment shapes athletic potential.

We’d like to thank Arsenal SEMS for holding such an exciting and informative conference! See you there on March 21st next year!

You can find Dr Nigel Jones (@theboxingdoctor), Shad Forsythe (@ShadForsythe), Dr Clare Arden (@clare_ardern) and Mr Richard Moore (@RichardMoore73) on Twitter.

Interested to find out more? Check out related BJSM material:

Articles

J Windt, T J Gabbett, D Ferris, and K M Khan. 2016.Training load–injury paradox: is greater preseason participation associated with lower in-season injury risk in elite rugby league players? 

JL Cook, C Purdam. 2012. Compressive load a factor in the development of tendinopathy?

Blogs

http://blogs.bmj.com/bjsm/2015/10/29/athlete-monitoring-in-sport-key-principles-and-practical-tips-by-jason-laird-physioreel

http://blogs.bmj.com/bjsm/2015/04/14/supporting-young-athletes-to-stay-and-excel-in-sport-whats-the-role-of-the-medical-team-and-what-does-expanding-our-view-of-maturation-have-to-do-with-it/

http://blogs.bmj.com/bjsm/2015/03/05/game-changing-in-mental-health-tackling-stigma-building-resilience-in-elite-sport/

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Rory Heath (@roryjheath) is a fourth year medical student at King’s College London with a keen interest in SEM and elite performance. He has played county rugby and rugby league for London and South and enjoys blogging. He is currently Secretary for the nationwide Undergraduate Sports and Exercise Medicine Society (USEMS), an Ambassador for Move.Eat.Treat and organises SEM-focused events in the London area. 

Xanni von Guionneau is a second year medical student at King’s College London. She has a background in multiple sports including rowing and swimming, currently representing the KCL Cycling and Triathlon teams! She has a growing interest in Sports Medicine, especially Orthopaedic injuries. 

References

Halson SL. Monitoring Training Load to Understand Fatigue in Athletes. Sports Medicine (Auckland, N.z). 2014;44(Suppl 2):139-147. doi:10.1007/s40279-014-0253-z.

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