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The 7 most common injuries and illnesses seen at major multisport games

3 Aug, 14 | by Karim Khan

LIVE FROM THE CLOSING CEREMONY!

By Team England Sports Physicians: Paul Dijkstra & Noel Pollock (@DrPaulDijkstra / @DrNoelPollock)

**Podcast with Dr Paul Dykstra sharing the UKAthletics Model for providing integrated (clinicians & coaches/S&C) – click here)

Tonight is the closing ceremony of what has been an amazing 20th Commonwealth Games here in Glasgow; the most successful ever for Team England who topped the medal table with just under 60 gold medals!

The Team England Medical facility was a constant hive of activity with doctors and therapists working side-by-side for very long hours to assist athletes to give their very best. The polyclinic was no exception. On our occasional visits there it was obvious that the excellent facility (sports medicine, pharmacy, 24 hour emergency care, dental, ophthalmology, radiology – including mobile MRI and CT imaging facilities) was being well utilised by all the teams; some more than others…

What were the 7 most common injuries and illnesses seen and how did we manage them?

  1. Upper respiratory symptoms (commonly allergy driven). Asthma and allergy are very common amongst elite athletes. More than 50% of elite athletes have hay fever and a significant percentage will have asthma (up to 25% of elite athletic teams!). Asthma and EIB are more prevalent in swimmers. Hay fever (and especially itchy and watery eyes) has been a problem here brought on by the few very hot and windy days we’ve had in the lead up to the Games. (It was close to 30 degrees on the first day of competitions here on the 24th July.)

Management Tip: Otrivine and a corticosteroid nasal spray are an excellent combination for quick control of nasal congestion and mouth breathing sleep

  1. Viral illness – both respiratory and gastrointestinal. Prevention and early precautionary isolation is key. Travel well-prepared with personal hand gels. Wash hands; everybody was encouraged to use the hand gel provided at the entrance to the dining hall. Paracetamol, and decongestive nasal spray. Martin Schwellnus published an excellent study in the BJSM on the effect of time zone travel on athlete risk of illness. Travelling more than 6 time zones more than doubles the risk of illness while in the foreign environment in professional rugby players.

Gastrointestinal illness is a constant threat when travelling with teams. There was some media attention to an early outbreak of Norovirus among workers here in the village before the start of the games. Due to the excellent work by the Scottish Public Health authorities and others here, the disease has not spread further. It warns us to be ready to manage this kind of problem when travelling with teams to any destination.

Management Tip: Always travel with probiotic capsules. There is some evidence that regular use will shorten the number of days of diarrhoea and also boost the immune system, particularly in endurance athletes.

  1. Emotional stress and sleep problems are common especially in younger athletes competing at a major event for the first time and living in a very big and busy athlete’s village environment. Athletes here are all share rooms and a few have Tweeted their frustration with the noise level!

Management Tip: Encourage athletes to minimise impact to their normal routines and to bring ear plugs and eye masks

  1. Chronic overuse injuries especially affecting lower limb, obviously depending on the type of sport and discipline. The most common of these are Achilles and Patella tendinopathies, plantar fasciosis and stress injuries of tibia and foot / ankle.

Management Tip: One athlete recorded a doubling of daily steps taken while in the village – encourage athletes to limit unnecessary walking and to use appropriate footwear (not flip-flops!)

  1. Acute muscle injuries – especially hamstring and calf muscles. These are common running injuries in sports like track and field, rugby and football.

Management tip: Most sprinting athletes will present with some hamstring symptoms through the rounds of a championships – particularly if they compete in multiple sprints/relays. Team clinicians should be experienced in the management and differentiation of hamstring presentations to assist the coaches and athletes in decision making and performance. As always know your sport!

  1. Acute ankle ligament injuries – especially in contact sports like rugby sevens, netball and hockey. The lateral ankle joint ligament sprains were the most commonly ligament injuries seen here.

Management Tip: Determine the severity of the injury and treat aggressively with immobilisation, cold compression, elevation, rest and strapping / taping for competition. It is important to include the athlete and coach when the relative risk of further competition is being discussed.

  1. Acute (and chronic) hand injuries are more common encounters by medical teams covering the boxing, judo and weightlifting events.

Management Tip: We’ve seen some excellent management of hand injuries by therapists and doctors with a combination of ice-compression, therapy, strapping, injections and anti-inflammatory medication being used.

Conclusion: The overall message is teamwork. Its an easy word to use but there are huge challenges to effective teamwork in a high performance environment (a topic for another blog!). Athletes and coaches usually benefit most when supported by doctors, therapists and management working in synergy towards a common performance goal.

Thanks to all our colleagues in Team England and to the coaches & athletes; as ever, its a privilege to work with such talented people. ————–

 

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@DrPaulDijkstra’s paper on the Integrated Performance Health Management & Coaching model here (please see podcast note at top of blog too).

integratedMOdel

 

Live from Glasgow’s Sports Medicine Tent – 5 tips from #Games Doctor

29 Jul, 14 | by Karim Khan

By Doctor Rebecca Robinson @RjpRobinson

In July 2014, I was fortunate enough to be offered the opportunity of a registrar’s lifetime. Working with Team England in medical headquarters for the Glasgow Commonwealth Games. Here are my Top 5 Tips:

Glasgow1. Preparation, preparation, organisation

Games time comes and goes fast, so do your homework. Arriving a week before the Opening Ceremony in Glasgow provided a great opportunity to set up an efficient medical room. Check out competition schedules, venues and transport systems now to deliver care smoothly.

Medically screening the majority of the 600 Team England competitors as they arrived was invaluable to avoid last-minute concerns, with additional benefits in establishing athlete-doctor relations.

Familiarise yourself with the arena and its rules: can you see the athlete in the mixed zone? Where is the defibrillator and can you switch it on? Who can treat a blood injury in a boxing ring? With a grasp of the basics, immersing yourself in the squash court, judo hall, velodrome and track adds immeasurably to theoretical knowledge.

2. Work with the best to become better

A multisport games is a unique melting pot. The world’s best athletes supported by expertise in sports medicine, physiology and management garnished by multinational cultures.

Working alongside a wealth of experience in Team England Headquarters revealed a group of individuals every bit as dedicated as the podium athletes with their indefatiguable work-ethic.

Simply existing in this environment is a unique learning experience. Be observant.

Key to Team England was a cohesive, supportive team environment across medics, physios and HQ staff, in which all members views were valued.

There will be times to take initiative, but recognise the expertise around you. With hard work, you’ll be back for future games, but your athlete may not. If in doubt or if you think you know the answer: ask. Remember there’s no such thing as a stupid question. Do not work in isolation or outside your competency.

3. Pace Yourself

It’s a marathon. And a sprint, rugby sevens, a triathlon and track cycling: and that’s just day 1!

With a 3-week stay in the Village bubble, it was imperative to sustain energy to respond safely to medical emergencies, meet last-minute needs of anxious athletes calmly and keep a ready smile for every single volunteer, physio, cleaner and policeman (yes, they really do smile at you at Games time!)

Everyone making the games happen faces challenges and will be both exhilarated and exhausted at times. Remembering to eat, sleep, communicate with loved ones outside are essentials. Turn around to make sure your colleagues do this too. A smile, a coffee run or a supportive shoulder can make a world of difference.

4. Primum non nocere

The first rule of medicine generates ethical debate in the elite sporting arena, where medals define careers.

What is your role: to help win the medals or protect the athlete’s health? Injuries in competition demand precise evaluation: how will they impact performance now and what are the longer-term health outcomes your focused athlete cannot visualise?

The depth of senior medical experience contributing to Team England meant athletes were able to make informed decisions with their team.

Sometimes dreams are shattered in the field of play. A sensitive approach to the injured athlete, with a clear team-based management plan will not lessen the pain but can help ensure healing starts in the Village.

Management in Glasgow was facilitated by good venue medical facilities and safe field-of-play retrieval, followed by accessible Polyclinic resources including 24-hour on-site clinics and onsite radiology.

5. ‘Be Kind’ (Dr Mike Loosemore, CMO Team England)

The Commonwealth ‘Friendly Games’ is a microcosm in which tiny countries can produce sporting greatness alongside larger, expectant nations. Like all major Games, it is also a hotbed of ambition, where 7000 dreams shimmer on the cusp of reality.

An 11-day Games represents the pinnacle of careers, dreams and sheer sweat, blood and determination. Be mindful that this will alter over the course of a games as winners and losers emerge. Be on hand in triumph or disaster but don’t intrude. Resist the urge to take that selfie or add pressure to the expectations of an athlete. On the flip side, you can be well-placed to advise the hurt, anxious or unwell athlete who approaches you. Be sensitive. Be kind.

With special thanks to:

Dr Mike Loosemore, Dr Pippa Bennett, Dr Paul Dijkstra, Dr Graeme Wilkes, Dr Mike Rossiter, Dr Abosede ‘GB’ Ajayi, Dr Stephen Chew, Dr Greg Whyte, Chef de Mission Jan Patterson and Team for all their support.

Editor’s question: Is Chessboxing in the Commonwealth Games?

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Benefits and barriers: Sport & Exercise Medicine (SEM) conferences through the eyes of a student

19 Dec, 12 | by Karim Khan

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

By Holly Weaver

lecture hallThe consensus amongst my peers was that being a team doctor in the Olympics would make a ‘Top 5 jobs in the world’ list. You may therefore be surprised to hear then that it is relatively easy to progress through undergraduate studies without encountering Sports & Exercise Medicine (SEM). Keen to remedy this, I set up a SEM society in my clinical school last year with the aim of encouraging interest in the speciality. Since then, to keep my finger on the pulse, I have made it my mission to attend as many conferences as allowed by my schedule (and bank account). So here is my level 5 evidence for SEM conferences –  through the eyes of a medical student.

The Student-orientated Conferences (aka ‘cheap as chips’):

  • Imperial Sports Medicine Conference – 14th May 2011 – Cost: £7

At a price even a student finds cheap, this was a great introduction to the world of SEM. It taught me the value of ‘networking’ as I made contact with other student societies which got the ball rolling.

  • ECOSEP SEM Student Congress – 18th-19th August 2012 – Cost £10

The excitement in the wake of the Olympics ensured a strong group of delegates at this inaugural ECOSEP conference aimed at students. My verdict? Definitely a success – I would recommend attending its next instalment. Integrating delegates from a variety of backgrounds demonstrated the importance of a multi-disciplinary team approach to SEM. My highlight was the seminar on exercise prescription; in my opinion this should be covered in all medical school curriculums.

  • Cardiff SEMS Olympic Conference – 15th December 2012 – Cost £10

After the hugely successful first conference held by the Cardiff Sports & Exercise Medicine Society (CSEMS), I made sure I took full advantage of the impressive programme on offer at the Cardiff SEMS Olympic conference. The opportunity to attend different workshops, in addition to inspiring key note lectures, enabled me tailor the programme to my personal preference.

The Professional Approach (aka ‘big names, big money’):

  • UKSEM International Conference 2011 – 23rd-26th November 2011

I attended UKSEM for free as an undergraduate representative for the Manchester SEM Society. It was a grand affair at the Excel centre in London, attracting an international roster of leading SEM professionals. Many expressed interest in the student society, however the scale of the conference venue and the lecture programme precluded people from spending much time in the exhibition hall.

  • World Sports Trauma Congress – 17th-20th October 2012 – Cost: £150 for 2 days

Thanks go out to my college for providing the financial support for this conference; the price, even with the ‘early bird’ price discounted for training grade, would have stopped me from going otherwise. I was keen to go as the emphasis was on sports orthopaedics. This combined with the ticket price meant that I had high expectations. The scope was huge, and in terms of organisation, venue and sponsors they ticked every box. All of the speakers were fascinating and I learnt a lot about a subject matter I was never exposed to previously. However, I didn’t leave buzzing with excitement. I realised that this was because it was pitched at people at the stage in their careers where the cutting-edge topics weren’t just cool, it was what they needed to keep their skills up to date. This conference simply wasn’t aimed at me. In fact, few conferences are aimed at individuals in the early stages of their career.  However, students should still attempt to attend conferences, placing a higher priority on networking & getting a foot into the ‘SEM door.’

Taken together, my experiences and conversations with peers suggest that medical students must use their initiative to fill our current ‘SEM knowledge gap.’ There is little benefit from just waiting for SEM to feature in the undergraduate curriculum!!

7 tips for students attending SEM conferences:

  1. Sign up early as many have early bird ticket prices (and buy train tickets early too)
  2. Get sponsorship, some of them are overpriced for a student budget – ask about funds at your university or relevant student society
  3. On the same note…take advantage of the cheap ones! Don’t assume because a conference costs a tenner it will be inferior to the pricey one with all the big sponsors
  4. Plan the sessions you will attend and research the speakers; it enables you to pinpoint which topics interest you so that you can read a relevant paper or two
  5. If you achieve No. 4, remember that if you’ve got a good question, ask it!
  6. Get stuck in at practical workshops, it’s easier to chat over a model knee than at formal ‘networking breaks’; at least it’s an ice breaker if you can’t tell your PCL from your ACL!
  7. Choose a conference that is happening now and put it in your calendar for next year; plan to enter the poster competition or submit an abstract and keep your eyes peeled for the submission deadline! Voila, extra CV points!

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

Holly Weaver is a final year medical student at the University of Cambridge Clinical School. She is the founder and president of the Cambridge Sports and Exercise Medicine Society (Cambridge SEMS).

Liam West BSc (Hons) is a final year medical undergraduate student at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.

Final Round! – BJSM’s Best Cover of 2011 Competition

21 May, 12 | by Karim Khan

 

Thanks to everyone who voted in rounds 1 & 2. Here are the finalists:

A. South African Sports Medicine Association (SASMA) Congress issue (June 2011)

vs.

B. BASEM’s Sport and Exercise Medicine Conference issue (July 2011)

Who will be the champion?

While you can only vote once – get your friends to vote too (maybe they will even split the prize with you!). You get bonus notoriety points if you vote for the winner AND win the prize.

Remember: Voters (from all rounds) will be entered into a draw for PRIZE of $133 gift certificate to amazon.com. Takes 20 seconds to complete! Your email address is just for us to contact you if you win – we delete them all after the competition.

Click here to vote NOW!  (until May 28th)

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