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4 ‘must attend’ BASEM/FSEM conference sessions on physical activity and young people

6 Sep, 14 | by BJSM

By Beth Cameron, PR & Communications, Faculty of Sport and Exercise Medicine @FSEM_UK

action schools logoThis year’s joint BASEM and FSEM Conference, Walk 500 Miles, will include four, not to be missed, sessions covering paediatric medicine. The session starts at 2pm in Edinburgh’s historic Assembly Rooms, on Thursday 2nd October, with Heather McKay, Professor of the Faculty of Medicine University of British Columbia, opening with A School-Based Physical Activity Success Story – Action Schools! a trial based in British Columbia.

The Action Schools! programme uses a comprehensive health model (socio-ecological approach) to provide children with healthier opportunities for physical activity and healthy eating at school. Professor McKay’s presentation will cover 10 years of practical lessons from school based trials and evidence from efficacy, effectiveness and implementation trials from the inception of Action Schools! in 2004 covering 10 schools, to its scale-up covering 1500 schools.

The second session brings us closer to home with Dr Nicola Crabtree, Principal Clinical Scientist and Research Physicist at Birmingham Children’s Hospital, presenting Physical Activity during Childhood. Dr Crabtree will discuss bone as a living tissue, which responds to local and environmental stimuli and howphysical activity and mechanical loading plays an important role in the development of an optimal skeleton resistant to fracture, both during childhood and later adult life.

Neil Armstrong, Professor of Paediatric Physiology and the Provost of the University of Exeter, will follow this by asking: Young People are Fit and Active – Fact or Fiction? This presentation will provide critical analysis of what we know about young people’s physical activity and aerobic fitness in relation to health and well-being. The dose-response evidence underpinning the health-related benefits of physical activity and aerobic fitness during childhood and adolescence is not as compelling as that during adulthood. How many young people are fit and active enough?

The Paediatric session closes with Dr Karl Johnson, Consultant Paediatric Radiologist at Birmingham Children’s Hospital, talking about Imaging Acute and Chronic Injuries in Children and Adolescents. This talk will highlight the imaging differences between children and adults and illustrate the various imaging modalities available. In many instances, the injuries are specific to the paediatric age group as a consequence of the inherent weakness of the growing skeleton and the different dynamics of the paediatric musculoskeletal system.

To book your place at Walk 500 miles visit the conference web page at

Competing interest: This page was posted directly by @FSEM_UK via the BJSM Blog Editor – it was NOT commissioned by the Editor in Chief of BJSM Karim Khan, nor was it edited in any way by him. (arm’s length)

‘Sacrum went out’…what went wrong? Tiger Woods, media doctors, and collective responsibility

8 Aug, 14 | by Karim Khan

Is there a responsibility for professional bodies such as UK Physios in Sport or the BJSM to comment on sportsmedicine / #sportsphysio media?

I don’t know Tiger Woods although I suspect he is probably an avid BJSM follower. So, everything I mention here is in the public domain. 1. Mr Woods has had back symptoms for some time. 2. On May 5, 2014, he blogged in detail about his progress from microdiscectomy surgery (March 31, 2014). 3. He withdrew from the WGC Bridgestone tournament on Sunday 3rd August. 4. He started in the US PGA on Thursday, August 7th.

When Mr Woods reported on his recovery between the Bridgestone withdrawal and his PGA start, the television coverage cited Mr Wood as saying “My sacrum went out, it pinched the nerve and hence the spasms. Once the bone was put back, it was all good. The spasms went away and I started to get some range of motion. I’m not in any pain. That is the good part”

Photo credit: @RichNorris00 (zero zero - weird number font in word press)

Photo credit: @RichNorris00 (zero zero – weird number font in word press)

Athletes are entitled to their belief systems; no clinician fixes everything/everybody. Humility has to be a foundation of health care. We would laugh if our colleagues in 1914 had the arrogance to say they knew everything; our colleagues in 2114 would laugh would we claim that. However, the scientific method means that we have current ‘best-practice’ and ‘evidence’.

1. When an athlete says ‘sacrum went out’ should we grin and bear it?

From that perspective, ‘sacrum went out’ is not evidence-based. Mr Woods is not a health professional and does not need to be an expert on health care or back pain. He does not need to read Hodges, Vicenzino or O’Sullivan. No need to define central sensitization. So any comments about ‘sacrum went out’ are not criticisms of Mr Woods, they are just comments for naïve readers who may wonder ‘sacrum goes out?’.

Twitter discussion was quick to point out that the health professional may not have said ‘sacrum goes out’. And no-one suggested a health professional had said that. We have all played Chinese whispers. ‘You may have irritated your annulus fibrosis, your facet joints may have jammed up on a drive, or when you fell in that bunker, you have muscle spasm’ can easily turn into ‘sacrum went out’. [And before the back experts put this on Twitter, I appreciate that one is unlikely to make a ’tissue diagnosis’ here and that management requires a careful history, assessment of movement patterns, special physical examination, some trial treatments and expert explanation etc. – and I am not an expert]. [And of course this clinical scenario will not be solved by an MRI miracle – MR imaging post-surgery is even less helpful than it is pre-surgery]. But those clinical issues are a distraction in this blog. The point is to share issues related to the public discourse when a prominent player shares health opinions that run counter to evidence.

I argue that professional bodies have a responsibility to alert the public that ‘sacrum went out’ is an unlikely diagnosis. No value judgement of the athlete, not impugning the health care provider’s skill. Just facts. “Dear member of the public – if you saw TW’s quote that ‘sacrum went out’…please imagine you didn’t. If you have back pain, we suggest you see someone you trust or one of our specialists.

2. When a health professional explains that sacrum can ‘easily come of place’ should we grimace and bear it?

I’m not going to put the links to a video clip from a TV show because the specifics are not important – it’s not personal. A prominent (i.e., comes up near top on Google) golf television show interviewed a medical doctor (‘affiliations and board certifications’ from the American Medical Association and others) about Tiger Woods’ dramatic recovery between the withdrawal (an inability to bend to take shoes off) at Bridgestone and clearing himself for the PGA 72 hours later. (NB: Not Tiger Woods’ MD – a ‘golf’ MD and ‘specialist sports physician’ (among other attributes))

The MD indicated that he had walked some of the PGA holes with Tiger Woods, observed the 2008 US PGA winner moving freely, bending over fully and swinging freely. The MD had spoken to TW’s coach. Great for television. #Credible. The MD explained (with a lovely anatomical drawing) that the sacrum can ‘easily come out of place’ and that one ‘sees it very often in golfers’. In the same clip, he explained that ‘sacrum out’ (1) has a 20-minute fix, (2) benefits from nonsteroidal anti-inflammatory medications (3) has a benign course (my interpretation of ‘good to go’). The MD expressed full confidence that Tiger Woods was cured – sacrum out, sacrum in. ‘Good to go’.

Really? ‘Good to go’? Go where? On which planet? Many real sports physicians and real sports physios were surprised that TW was ‘good to go’. They committed on Twitter ahead of the PGA starting that TW was likely ‘BAD to go’. Imagine it is a final year medical or physio exam…”You are consulted by a 38-year old former World Number 1 who has not won a tournament since 2008. He has had 4 surgeries included microdiscectomy most recently (March 31st, 2014). On his blog on May 5 (3 months ago) he reported filling in the holes on his private golf course so he doesn’t have to bend.

I’ve worked with [son] Charlie on [baseball] hitting and fielding drills and showing him slowly what to do; I can’t do it quickly. We watch a lot of sports on TV, and we try and copy that. We have a lot of putting contests. I can’t bend down to pick up the ball out of the hole, so we sand-filled all the holes so you can still putt to a hole.

…(exam question still going….) The player withdrew on the final day of the most recent tournament on August 3rd. He was reported as being unable to pick up balls, take his shoes off. Today is August 5 and you are assessing and providing advice about his management and specifically playing in the US PGA starting on Thursday August 7. (phew, end of background to question!). Question: What is your advice?”

There are many ways to pass but as a UBC Professor (sticking to scope, shocking at golf), I’d say in my course (KIN 461) ‘sacrum out’ as diagnosis, and ‘sacrum in, good to go’ as treatment, would be a fail.

A first year sports physiotherapist is taught about ‘progression’ of exercises and return to play. You have to pass one level to get the text. Example answer might list progressions like this…Putting with kids. Short irons, longer irons. Drivers (easy swing, not too many). More of above…greater volume, greater intensity. 9 holes. 18 holes. Days on, days off of 18 holes. Two days in a row and then an easy day. Three days in a row. Four days in a row, but taking it easy. Later tournament but not hitting for maximum length (many options, just an example). //

Breaking down in Bridgestone is not how you pass the ‘return to tournaments at lower pressure than Majors’ level. That’s why the media was awash with predictions (just one of many snips, below) that TW’s PGA would be the train wreck that it proved to be. No need for Nostradamus.


Note date stamp (prior to PGA tee-offs): Contrasting with GolfTV doc 'good to go', back experts such as @PeteOSullivanPT and even aged, out-of -touch editors (i.e. not expert) predicted TW back would not hold out for 72 holes (to say nothing of likely poor scoring which will precede frank pain)

Note date stamp (Aug 7, prior to PGA tee-offs): Contrasting with GolfTV doc ‘good to go’, back experts such as @PeteOSullivanPT and even aged, out-of-touch editors (i.e. not expert) predicted TW back would not hold out for 72 holes (to say nothing of likely poor scoring which will precede frank pain)


3. What to do? On the one hand we don’t like to be critical of colleagues.

It’s not easy being interviewed on TV. As a viewer, I don’t have the clinical information about Tiger Woods. On the other hand, the interview can be analysed merely on the facts. Analysis is not personal. NONE of the discussion from commentators related to Tiger Woods’ actual condition.

We were discussing (i) Tiger Woods’ public explanation of his understanding of what is going on and (ii) an MD’s TV (and web clip) explanation. The MD’s website lists ‘Golf Medicine’ under an ‘Expertise’ tag. The MD’s website says he is ‘…sports medicine physician and doctor to some of the top golfers in the world….and a pioneer in the field of golf medicine’. Humbly, he shares that he learns from every patient including from ‘one of my golfers with a major tournament on the line.’ His website includes golfers describing the MD as eminent – ‘the best in the business’.

An MD going on TV with those ‘credentials’ also carries responsibility. A responsibility to fellow MDs, fellow sports physicians and to golf medicine experts. If the TV interview says that the sacrum ‘easily comes out of place‘, this will reflect badly on MDs, real sports physicians and golf medicine experts who base their practice on evidence. If, on surfing the MD’s website one finds claims of ‘4 simple saliva tests’ that allow this MD to quantify the patient’s level of inflammation it raises flags. Immunology expert as well as golf, sports medicine, emergency medicine and surgery…oops I digress… [Editor’s note – take that out]

Des Spence has already labelled ‘sports medicine’ as ‘Bad Medicine’ in theBMJ. As sports physicians, we don’t want to provide a chapter for Ben Goldacre’s BAD SCIENCE. @BenGoldacre

4. Don’t top players like Tiger Woods have the best clinicians caring for them?

First, I am not commenting on TW’s medical team. That’s way out of my scope. But speaking of elite athletes generally, some make better choices than others. That’s my opinion (level V evidence). Top players, particularly in individual sports, can have a very sheltered life. They might need a GP from time to time. How can they know who the best golf doctor is!

You know how tournament doctors are chosen! Did you see ‘Sportsmedicine Team’ advertised for the US Open in the BJSM, AJSM, JOSPT and other reputable journals? Did you hear that a committee recommended by the AMSSM (@TheAMSSM) reviewed applications? Did you hear PGA organisers commit an appropriate budget for Tournament Physician, Physiotherapist, Massage therapist etc? [How could the PGA possibly pay expert health professionals properly? Its 2009 tax form (#990) revealed the revenue for this non-profit organization was only $973,000,000].* And the players being taken care of by those health professionals share $10 million.

Or do you imagine that a friend of the tournament organizer with an MD degree might have picked up the odd tournament gig? Can you imagine that the price was right? ($0.00? + 3 autographs + one photo). That’s why saying you were the doctor for James Dean, Marlon Brando, Elvis Presley (OK, maybe not a great example) shouldn’t carry weight. #RightPlaceRightTime.

In short…(??really!!)

1) Tiger – we all wish you the best. Real sports physicians hate giving advice that a player needs to miss any tournament, let alone a Major. We became sports physicians to allow folks like you to share your talents. And folks like my neighbor, Dr Targett who hacks around. And to promote exercise in 86-year olds like my Mum before she died. Unfortunately Tiger, pathologies exist, rehabilitation can take time. Things may not look good for you at the very top level.  Your PGA wins may be done at 14; a writer way more expert at golf than me has suggested.

Sports physiotherapists and sports physicians are big on exercise for rehabilitation. Exercise is a proven therapy. It works via the process of mechanotherapy. But the compression forces alone (not to mention shear etc.) on your lumbar discs from top golf are 6 times bodyweight (see below). That’s a serious Bear you are carrying (!, sorry). Body structures have remarkable capacity to repair with appropriate loading (=rehab exercises and progression) but at the very top you also need high volume practice (not an expert on golf, just guessing).

So, the combination of forces you create, and volume you need to sustain to be competitive on weekends, may not be compatible with another PGA win. This link provides a useful starting place on the biology. Noteworthy, it includes scientific data – ‘studies’. No financial competing interest for surgery or implants. There’s no way to tell your future precisely, you need to work at rehab progressively. I’m just painting a ‘worst-case’ scenario that I hope you have discussed with your expert team. Understand that microdiscectomy is not a guarantee of return to sport at the previous level (i.e., in your case winning Majors, not just showing up). Your player colleagues also need to know that in randomized trials, outcome of surgery has not bettered outcome of physio rehabilitation. As Adam Meakins @TheSportsPhysio tweeted “The best don’t have any miracle fixes”

2) Discussion of Tiger’s public explanation of his problem are just discussions – they are not meant to reflect any insider knowledge. They are like a ‘theoretical case’ or a movie where they say ‘any likeness to real people is accidental’. Because of the media focus on top athletes, authorities need to discuss comments such as ‘sacrum went out’. To help the public and to help athletes who want to be part of the discussion.

3) Collegial responsibility and self-promotion on TV. If you find a website that seems rather ‘self-aggrandising’ it might be worth adding a pinch of salt. I’m not referring to any specific website here – so no-one should take offence. And media doctors are important – consider the excellent educational work of Dr Peter Larkins (@DocLarkins), a fully certified real specialist in sports medicine. His expertise is based on formal external certification (Australasian College of Sports Physicians) (not ‘self-certification’ or ‘cereal packet certification’).

Speaking of real sportsmedicine/#sportsphysio experts, I see that Roald Bahr (@RoaldBahr) doesn’t have a personal website telling the world he’s a pioneer or leader in anything. Neither does Jill Cook (@ProfJillCook). They don’t have a *6-part miracle cure for everything*. Their universities, their hospitals, and the IOC may refer to them but they don’t self-market. Remember that the very best don’t need make self-promoting videos with guarantees and background music of a certain genre. And if a physician’s greatest claim to fame is ‘who I’ve treated’ there is reason to think twice. Medicine can be treated as a business.

4) Players – are you sure you have a quality physician and physiotherapist? How do you tell? Don’t ask other folks in the same industry – there is likely to be ‘group think’ in your sport. Speak with folks from different sports who are experienced and who don’t have a commercial interest in being your doctor. I’m not convinced that a golfer (lumbar compression force = 6 times bodyweight per swing x 72 swings per round x 4 rounds) can compare his loads with that of a Cowboys’ quarterback but that’s an aside.

I can see the challenge though. In the US, the American Medical Society for Sports Medicine (@theAMSSM) is an internationally recognized accrediting body for real sports medicine physicians. Has your doctor done an accredited AMSSM fellowship (specialist training)? Who were your doctor’s mentors? Does your doctor encourage you to get different opinions as needed? Does your doctor work closely with sports physiotherapist or experienced athletic therapist? Does your doctor use the word ‘evidence’ (not watertight but a start!)?

In closing, I offer this blogpost with humility.  I know there are flaws in BJSM articles. I am open to correcting them and to highlighting that I have made mistakes. My personal scientific articles have wrongs, please let me know. Not all my patients got better. I made clinical errors.

But our compelling goal as real sports physicians and athletes and active people is to share accurate information. To acknowledge what we don’t know, and to be athlete focused in an evidence-based manner. Marketing voodoo/snakeoil/funky treatments has no place among real sports physicians and real sports physiotherapists who are working hard to master the art.

There has be room to point out, and draw attention to, statements that don’t have evidence.

And Tiger, if you can’t get through the PGA tournament because of your back (as I suspect you won’t) I’d respectfully suggest you listen to Dr Peter O’Sullivan’s podcast (link here). He’s a physiotherapist with specialised training in back assessment and treatment, a ton of experience with ‘difficult backs’. And a PhD. Just like a top golfer will have a range of qualities, those qualities belong to a top back clinician. There are a few like him around the world – just as there are a top 10 in golf. Encourage your sportsmedicine/#sportsphysio team to be honest with you – not to tell you what they think you want to hear. Reward those who have courage – to make it part of your team’s culture.

Which brings me to my last book recommendation – The 5 dysfunctions of a team. Patrick Lencioni emphasises that ‘artificial harmony — fear of conflict is cancer in a team. (A similar theme to the ‘GroupThink’ point above). Disagreement is not disloyalty, it’s evidence of loyalty. Your on-course team, your Tiger Jam team, your golf design project teams – encourage them to be honest. An honest, even remotely qualified, itsy bitsy teeny weenie experienced #sportsphysio would have suggested you were not ready on Thursday. You failed the progression (Bridgestone).

I wish you every success, as I do every player. And every 86-year old who knows what’s best for her.

*Above – PGA donate $130 million to charity (much directly from sponsors).


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

24 Jul, 14 | by Karim Khan

PhotobombHow can young doctors and physiotherapists get involved?

Paul Dijkstra (@DrPaulDijkstra)

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

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

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

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


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


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


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


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


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


Enjoy the Commonwealth Games!

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

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

Not everything in sport is black and white: #addsomecolour…….Part 2 The Association of Chartered Physiotherapists in Sport and Exercise Medicine Biennial Conference

26 Dec, 13 | by Karim Khan

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series

Click HERE for part 1.

add_colour__tst_by_hairycheesecake-d390j9fConference sessions

Continuing on the theme #addsomecolour, Alison Rose, a Physiotherapist who has worked with Jessica Ennis and the Brownlee brothers, discussed her success using visceral manipulation as a treatment with athletes (an unusual concept for most physios). She highlighted the importance of effective breathing patterns and the influence on the diaphragm. Perhaps as musculoskeletal physios we should not be plagued by bad memories of respiratory on-calls, and consider how respiratory mechanics influence athletes. Cara Lewis discussed Femoroacetabular Impingement (FAI) and whether the common structural changes found are part of hip structure adaptation over time.  She suggested that FAI was a conflict between movement patterning and structure.  Activity modification, such as not running on narrow paths or treadmills, may help with symptoms.

Conference Dinner

The conference dinner was an opportunity to meet old friends and colleagues, make new acquaintances and discuss hot topics of the day. Steph Brennan, a physiotherapist and name familiar to many in the sports medicine world, for mixed reasons, delivered the after dinner speech.  He spoke of his involvement in the ‘Bloodgate’ scandal at Harlequins RFC that shocked and divided opinion across sports medicine. He discussed his difficult journey, his return to the profession he loves and the challenging questions he’d been asked along the way.  In a world where money increasingly talks the loudest in sport, and decisions are made based on potential for financial gain, clinicians are under increasing pressure to act in the club’s interest, not necessarily the players’ interests.  Sport is a high-pressure environment, often with overbearing characters in influential positions. It can be hard to remember that you are an independent practitioner, not just ‘one of the team’. As professionals working in accordance with a code of conduct, we have worked hard to get Physiotherapy recognized, protected and respected. Would we all stand our ground when placed under pressure to act in a way that could bring that profession into disrepute?

Final reflections

Sports medicine/physiotherapy is increasingly competitive.  As new graduates looking for work drift more towards lone club work, there is an increase in risk of people trying to do ‘all they can’ to keep getting work.  It’s important that we make ethically sound decisions when under pressure, even if that means losing our dream job. Dr Barry O’Driscoll’s resignation from the IRB over concussion guidelines and practices shows that a stance can be made. There also needs to be a supportive environment in our profession, with a more open forum for people to ask for guidance and help, without fear.

With the exceptional recent, current and future global sporting events in the UK, and much has been made of the ‘legacy’ for future generations. Dr Yannis Pitsalidis, in his provocatively entitled talk “White Men Can’t Run”, discussed the success of Jamaican sprinting, in country with the same population as Wales. He talked of Kingston’s annual children’s sprint Championships, with over 2000 participants and 33 000 cheering spectators.  Surely providing such opportunities is going to inspire young people to take up an activity and keep trying their hardest.  As children, we move and we challenge our body in all three dimensions through play and activity, loading the fascia, training it to cope, training the movement patterns, stimulating central and peripheral pathways. Maybe there’s a place for us all to encourage, support and give attention to all age groups and all levels of sport and physical activity, not just be ‘wowed’ by the elite.

Professor Karim Khan closed the conference with a general overview of proceedings. Noting the high quality of content, and discussed how sports physios are open to new ideas, and experts at turning movement into musculo-skeletal repair.

After a mentally stimulating 3 days of learning, I was inclined to adopt Dean Benton’s philosophy that sleep is one of the most important aspects of recovery for the athlete.  This conference delivered what it promised: high calibre, intellectual learning and discussion.  For Sports Physiotherapy in the UK and for recognition of the profession across the wider medical professions, such gatherings of minds are really important.  I congratulate the ACPSEM in organising such a fantastic event.  It certainly is true that not everything in sport is black and white………colour always makes things more interesting!


Charlie McCall is a Sport and Exercise Physiotherapist at the University of Bristol Sports Medicine Clinic.



Not everything in sport is black and white: #Addsomecolour…….Part 1 The Association of Chartered Physiotherapists in Sport and Exercise Medicine Biennial Conference

4 Dec, 13 | by Karim Khan

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series

By Charlie McCall

With a healthy dose of intrigue, I set off from Bristol for Glasgow and the Association of Chartered Physiotherapists in Sport and Exercise Medicine (ACPSEM) Biennial conference in late October.  The high calibre international speakers and diverse topics in the conference programme had sparked my enthusiasm.

The conference venue was the University of Glasgow. Delegates could be forgiven for thinking they had been transported to Hogwarts, while Glasgow’s West End provided a plethora of amazing architecture, culture and restaurants.

Alison Rose ACPSEMA conference entitled “Not everything in sport is Black & White” with the tag line ‘#add some colour’.  Surely this is why we attend conferences: to learn new ideas, to have our preconceptions challenged. The first day kicked-off with short lectures based around ‘The Profile of The Modern Day Athlete”.  Discussions covered topics including how our ability to sweat enables us to outrun our prey and why humans make lousy athletes. The question of whether champions were born or built was discussed, and our interaction with our environment explored. I wonder if, in the western world,    we have lost some of the patience we had in chasing our prey for so long.  Five minutes in a supermarket queue for convenience food seems to equate to ‘stress’ these days.

Topics were pertinent, with Dr Barry O’Driscoll speaking about concussion and current issues around the Pitchside Concussion Assessment (PSCA) in rugby. Recent events in the nation’s first sporting love, football, have highlighted the issue of concussion in sport to the masses.  Hopefully this platform will help those campaigning for better and safer procedures for decision making about return to play get their message across.  This needs to be heard: not just by medical professionals, but by coaches, trainers, players and parents of young players.

The first full conference day started with Dr Antonio Stecco talking about fascia.  The idea that up to 30% of muscle fibres do not reach the tendon or bony interfaces, instead blending into the deep fascia, means we need to rethink the traditional anatomical model.  The fascial system as a whole has a huge role in proprioception, so changes in elements of fascia, such as ‘densification’, a term Stecco used to describe increased viscosity of the fascia, is likely to impact proprioception and, ultimately how we move.

Dr Quentin Fogg further challenged ideas about anatomy basics through discussion on how muscle attachments actually work.  For example, the continuity between semitendinosus and anterior tibial fascia could have implications for anterior tibial pain. Dr Jay Shah gave really interesting lectures on the pathophysiology of myofascial pain, trigger points and the physiological findings around trigger points. With growing evidence, we can more adequately explain to patients why the problem may be somewhere other than where they feel the pain.

Coaches Frans Bosch and Vern Gambetta played their part in ‘adding colour’.  Bosch suggested that for highly skilled movement at speed, we need to move away from the idea of the hierarchical model i.e. cue the brain and it will tell everything in the body what to do.  He championed the idea of a ‘decentralised model’ with multiple ‘substations’ throughout the system that can adjust our control of movement.  Gambetta warned against confirmation bias, i.e. only seeing what you are looking for.

Bosch and Gambetta both urged us to rehabilitate  the entire movement, to go straight to the end point and move beyond just rehabing the muscle.  They also suggested that we should stop ‘over-coaching’ in rehab and allow the body to regain movement patterns independently.  Physiotherapist Dr Dylan Morrissey agreed there is a tendency to over coach, but cautioned against just allowing the body to work it out with the question ‘what if the body keeps getting it wrong?’  There was collective agreement on the need to ensure we move past low level rehab and challenge the body and movement patterns in relation to forces it will undergo.  Physiotherapist James Moore followed this idea through, suggesting that returning to running early in hamstrings rehab is important, while Johnson McEvoy discussed how the ability to resist fatigue is critical to reducing key risk factors to shoulder and upper limb injury.

To be continued (Part 1 of  the synopsis of The Association of Chartered Physiotherapists in Sport and Exercise Medicine Biennial Conference )…


Charlie McCall is a Sport and Exercise Physiotherapist at the University of Bristol Sports Medicine Clinic.

ECOSEP Student Congress: two weeks away – still time to register!

28 Sep, 13 | by Karim Khan

This student organised Sports and Exercise Medicine conference (Oct 12th-13th) is suitable for all medical students from first to final year. The Sunday examination session, will be of particular interest (and practical use) for final year students.

For more information and to register go HERE

Stay connected on Facebook HERE

ECOSEP congress


ECOSEP Second Student Congress – an event not to be missed…

7 Sep, 13 | by Karim Khan

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

By Paul Jones (@PaulRemyJones)

conc3 aussie


The second ECOSEP Student’s Congress will take place at Imperial College on the 12th and 13th of October.

This meeting is aimed at medical students with an interest in Sport and Exercise Medicine and those wanting to get involved in a traditionally under-represented (in terms of teaching) medical school specialty.

ECOSEP have arranged an exciting and varied programme of lectures and workshops over the 2-day timetable.  Sessions will include lectures on career paths in Sport and Exercise Medicine, the prescription of exercise and exercise physiology.  A full day’s worth of workshops are also available to give students a chance to hone their examination skills in a sport-specific way and to give a flavour of the pressures of working in the pitch-side environment.

There will also be a poster competition:

  • £100 for the winner,
  • £50 for second, and;
  • £25 third place.

All accepted posters will be displayed for the duration of the congress.

The programme is packed with some fascinating and vastly experienced speakers and promises to be both educational and enjoyable.  In addition, the Saturday night social promises to be a night not to be missed and difficult to remember.

Tickets are priced at £10 for one day, £15 for the weekend, and are available HERE 

For more information on the congress and poster competition, please visit our Facebook page


Dr. Paul Jones is a junior doctor who trained at Kings College London whilst also intercalating in Sport & Exercise Medicine at UCL. He is extremely passionate about exercise medicine and has helped to develop a physical activity education strand during his time at KCL. He leads the student committee for ECOSEP.

Dr. Liam West MBBCh BSc (Hons) is a now a junior doctor working in Oxford after completing his medical degree at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.

Early bird registration ends soon, register now: ASICS Conference of Science & Medicine in Sport, October 22 – 25 2013, Phuket Thailand

11 Jul, 13 | by Karim Khan


October 22 – 25 2013, Hilton Phuket Arcadia Resort and Spa, Phuket Thailand

Don’t miss this opportunity to get the latest on sports medicine, sports science, physical activity and injury prevention whilst enjoying Asia’s premier beach holiday destination! A preliminary conference program is now available HERE.

Make the most of early bird prices and register for the 2013 ACSMS now! Early bird registration closes 5pm July 31st 2013.

You will be able to engage with the internationally renowned:

·         Refshauge Lecturer Mr Craig Purdam (AIS) Head of Physical Therapies, Australian Institute of Sport and multiple Olympic Games clinician, tendinopathies expert.

·         Professor Jiri Dvorak (FIFA) Professor at University of Zurich, Senior Consultant in Neurology at Schulthess Spine Centre & Chief Medical Officer to FIFA

·         Professor Per Aagaard (University of Southern Denmark) Head of Muscle Physiology & Biomechanics Research Unit, Institute of Sports Science & Clinical Biomechanics, University of Southern Denmark

Dr Matthieu Sailly (Centre Biologie et Medicine du Sport at Pau) Sports Physician, Centre Biologie et Medicine du Sport at Pau, France

·         Dr Charlotte Suetta (University of Copenhagen) Centre of Internal Medicine, Institute of Sports Medicine, Copenhagen, Bispebjerg Hospital, University of Copenhagen

·         Professor Kim Bennell (University of Melbourne) Professor of Physiotherapy and Director of the Centre for Health, Exercise and Sports Medicine, University of Melbourne

Please visit the ACSMS website for more information.

BASEM Congress 2013 – St George’s Park, 31st October & 1st November

25 Jun, 13 | by Karim Khan


BASEM 2013 is a ‘not-to-miss’ event for clinicians interested in sport and exercise medicine & physiotherapy. A great forum for physiotherapists, sports therapists and doctors, the packed program is full of practical sessions and opportunities for networking and discussion. See full program details HERE. What’s more, it will be at the impressive new venue of St. Georges Park.

“The theme of the conference is focused on a new era for BASEM and the specialty of SEM with ‘an expanding field of practice’. The programme contains scientific evidence based material as well as empirical data, experience and anecdotes. Time keeping will be strict to ensure that the discussion sessions are respected and lead to constructive interaction and debate.”

Check out the BASEM website for more details.

Final 4 days for Abstract Submission ~ Patellofemoral Pain Research Retreat, Sept 18-20, 2013, Vancouver BC

26 Apr, 13 | by Karim Khan

In relation to its size, the patellofemoral joint (PFJ) is one of the most described joints of the human body. This may be partly attributed to the high prevalence of patellofemoral pain (PFP) in active people, the controversies concerning the underlying aetiological mechanisms, and the recalcitrant nature of the symptoms. The natural history of this syndrome and the chance for developing patellofemoral osteoarthritis later in life are still enigmatic.

PFP experts plan to tackle this problem head on when they meet for the third annual Patellofemoral Pain Research Retreat and Clinical Symposium, Sept 18-21st, 2013, in Vancouver, British Columbia Canada.


The Patellofemoral Research Retreat (September 18-20) provides researchers and clinicians an opportunity to learn, network, and present.

Keynote speakers will include Professor Irene Davis, a world expert in patellofemoral pain and running bio-mechanics, and Professor Paul Hodges, Director of the NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury, and Health at the University of Queensland in Brisbane, Australia.

Abstracts for presentation at the research retreat will be accepted until April 30.

As in previous years, this gathering will be intimate and intense. It will culminate with the creation of a consensus statement that summarizes the current state of the science and suggests future directions.

Clinicians will also not want to miss the first-ever one-day International Patellofemoral Pain Clinical Symposium (September 21) at the same location. Speakers include renowned experts such as Irene Davis, Paul Hodges, Jenny McConnell, Kay Crossley, Christopher Powers, and Erik Witvrouw. Topics will include innovations in the understanding of PFP, proximal vs distal contributions to PFP, and specific or local exercises for management of PFP.

For more information:

visit or contact Erin Macri at


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