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light-hearted (for some)

Participation, prevention, and treatment at the North Pole Marathon (a guest blog from this year’s winner!)

14 May, 12 | by Karim Khan

Sport and Exercise Medicine: The UK trainee perspective (A monthly series on the BJSM blog)

 

By Dr. Andrew Murray

Increasing Physical Activity is the biggest public health challenge of the 21st century.  Steven Blair’s message is so powerful that it is worth taking to the ends of the earth. I’m currently working for our CMO Harry Burns in the Scottish Government, promoting physical activity for health as part of their Sport and Physical Activity policy team.  Sir Harry is a fantastic advocate for this important form of medicine and enjoys running himself.

In March I received a late call up to take part in the North Pole Marathon. The race itself takes place at the Geographical Pole.  I’d be helping provide medical cover whilst competitors readied themselves and went husky racing etc. in Spitsbergen – 79 degrees North.  The North Pole is only “inhabited” for 3 weeks of the year, as for the rest of the year it is either permanently dark or the ice starts to break up.  Russians sky-dive in and set up an ice runway each year.  The video footage of tractors floating down on parachutes over the pole is bizarre.  The base doctors take care of competitors during the race itself, with a full medical kit that included a gun. Race director Richard Donovan explained that if a polar bear did turn up that it would be disqualified for failure to enter the race and could be discouraged from hanging around by firing a few shots in the air.

The old medical idiom that “prevention is better than cure” holds true in the Arctic, and of frostbite and hypothermia in particular. We advised competitors on clothing strategy (basically to cover every inch of the body), and when to seek medical attention. The risk assessment ensured that a lapped course kept competitors visible to staff, and avoided any leads/breaks in the ice. A warm tent was available to stock food and water for runners and to ward off any impending hypothermia.  Warm areas had been assigned for self-treat i.e. blisters, as well as for minors and majors.

The race itself is like no other, run not on land but on the frozen Arctic Ocean. Some competitors wear snowshoes with their Gore-Tex trainers to traverse the white world of this beautiful natural freezer.  The 9th of April brought perfect conditions of -26 Celsius and light winds.  The full medical kits were cross checked and the race began.

Amazingly all 41 competitors, from 18 different countries finished with the event even featuring a marriage proposal. Spectator numbers were low, although a seal did pop up occasionally.  I ran round in 4hrs 17 mins, whilst the final competitor took over 11 hours.  There were only a few relatively minor cases of frostbite (much to the disappointment of the documentary makers), in addition to the common expected musculoskeletal injuries.  Anterior knee pain was especially common probably due to the wide gait adopted to chew through the deep snow by most runners, whilst other injuries seen included Achilles tendinopathy, ankle dorsiflexor tendinopathy, and a hip flexor injury. I helped patch runners up once I had finished, and advised the few that were injured on appropriate treatment, including what to tell their doctor in Mauritius who presumably doesn’t see much frostbite.

I think we all have the opportunity to promote physical activity for health.  Steven Blair, Karim Khan, Mike Evans, Richard Weiler and others have done much to produce data, and frame it imaginatively. 23 and a half hours is a must share resource, and sticky messages like “Smokadiabesity” seem to resonate with the public and policy makers.   Additionally, sporting events like the North Pole Marathon offer the chance to put forward a health message.

On a personal level, I’m looking forward to running seven ultra-marathons on seven continents in seven days in November this year, with the sole aim of promoting physical activity as the single best thing that we can do for our health.

 

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

Follow Andrew on twitter at @docandrewmurray

Andrew Murray is a Sport and Exercise Medicine Registrar in Scotland.  His book is called “Running Beyond Limits” Mountain Media.  He failed to mention in his blog that he won the North Pole Marathon 2012!

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

 

 

Voltaire as a proponent of soccer therapy

11 May, 12 | by Karim Khan

By  Francois Trudeau and Roy J. Shephard

 

Soccer has recently been commended as a means of enhancing health in adults with cardiac risk factors [1, 2]. However, a re-reading of the “Book of Fate” [3] suggests that this approach was not exactly news to the French satirical author Voltaire (1694-1778). In this story, Zadig is a Babylonian philosopher who, in his travels, stumbles upon a group of women who are seeking a basilisk, a rare and legendary beast that is king of the serpents. The local physician has suggested this animal can cure Ogul, their Lord and Master. Zadig offers Ogul an alternative remedy, in return for the freedom of the beautiful Astarte:

 

“Zadig, again addressing himself to Ogul, said; my Basilisk, Sir… is not to be drest or eaten; but all its Virtues must penetrate your whole Fabrick, thro’ your Pores; I have inclos’d my never-failing Sudorific in a Bladder, full-blown and carefully cover’d with the softest Leather. You must kick this Bladder, Sir, once a Day about your Hall for a whole Hour together, with all the Vigour and Activity you possibly can. This Medicine must be repeated every Morning…., Upon your due Observance of the Regimen I shall put you under, I doubt not, but with the Blessing of Heav’n on my honest Endeavours, I shall give you ample Demonstration of my being an Adept in Physick. Ogul, upon making the first Experiment, was ready to expire for want of Breath, and thought he should die with the Fatigue. The second Day did not prove altogether so irksome, and he slept much better at Night than he had done before. In short, our Doctor in about eight Days Time, perform’d an absolute Cure. His Patient was as brisk, active and gay, as One in the Bloom of his Youth.

 

Now, Sir, said Zadig, I’ll…. disclose to you the important Secret. You have play’d at Foot-ball these eight Days successively; and you have liv’d all that Time, within the Bounds of Sobriety and Moderation. Know, Sir, that there is no such Animal in Nature as a Basilisk; that Health is to be secur’d by Temperance and Exercise…

 

Ogul’s physician was very reluctant to let such an “anti-medicinale” cure eclipse his own reputation. He plotted with “a set of petty doctors and apothecaries” to poison Zadig, but the latter avoided his planned death with a “rendez-vous gallant.”

 

Voltaire is known for a less than stellar opinion of the Enlightenment physician, described as one who [4]:

«pours drugs of which he knows little into a body of which he knows less.”

 

However, Voltaire himself seems to have grasped the health value of 60 minutes of vigorous physical activity per day.

 

REFERENCES

1. Krustrup P, Aagaard P, Nybo L et al.  Recreational football as a health promoting activity: a topical review. Scand J Med Sci Sports. 2010; 20 Suppl 1:1-13.

2. Randers MB, Petersen J, Andersen LJ et al.  Short-term street soccer improves fitness and cardiovascular health status of homeless men. Eur J Appl Physiol. 2011; Sep 29. [Epub ahead of print]

3. de Voltaire, F-MA. Zadig, ou la destinée (Zadig, or the Book of Fate, an Oriental history). 1747/2008, Chapter XV, The Basilisk. (English translation). Boston, Mass : MobileReference.

4. Editor. Medicine a science. Eclectic  Medical Journal (Ohio State Medical Association, Worthington, Ohio) 1871; 31 : 140-141.

 

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

Prof Francois Trudeau – Department of Physical Activity Sciences, Université du Québec à Trois-Rivières Trois-Rivières , P.Q., Canada.

 Prof Roy J. Shephard - Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON.

BJSM Cover 2nd Semi-Final…Vote and win!

8 May, 12 | by Karim Khan

VOTE HERE (CLICK) NOW! (until May 15th)

The first semi-final of the cover competition was tight! The winner advanced to the final with a one vote margin!  Still a secret though! Now we have the 2nd semi-final.

Rules refresher!

1. Semi Final 2 goes until midnight Oslo time: May 15th 2012.

2. You can vote in each round [more chances to win the prize!]. Takes you 20 seconds to vote and win!

3. Each Semi Finals include 3 covers each.

4.Next week is the Grand Final / World Cup / Superbowl!…. where readers choose the BJSM cover of the year (2011) from the Semi winners!

4. Voters (from all rounds) will be entered into a draw for PRIZE of $133 gift certificate to amazon.com. We need your email to know if you won – we delete them all after the competition.

VOTE HERE (CLICK) NOW! (until May 15th)

Guest post: Exercise is Medicine’s Bob Sallis. Every Body Walk campaign. Fun videos!

4 May, 12 | by Karim Khan

 

Thought you might be interested in seeing our latest edition to the Every Body Walk campaign.  This PSA features the cast from The West Wing TV show.

We are releasing this virally, and its had over 300,000 hits in 3 days.

http://www.funnyordie.com/videos/3dc51a407a/walk-talk
Behind-the-scenes
http://www.youtube.com/watch?v=MCZQqu2Xlms

See also Bob Sallis’ compelling case for doctors including exercise as the 5th vital sign – every consultation. This has had over 4,000 views.

And in the Steve Blair-edited Special Exercise is Medicine theme issue (Jan 2009), Bob included an argument for the doctor’s role in prescribing - share this with your colleagues!

Finally – for those who haven’t seen Mike Evans’ viral video ’23.5 hours’ - it fits beautifully with ‘Everybody Walk’. Click on this link to the BJSM blog and watch it for 9 minutes! It has had nearly 3 million views!

 

The 5 most popular BJSM Podcasts in 2011

8 Feb, 12 | by Karim Khan

Courtesy of Boston Public Library, Flickr CC

ACL injuries, lower limb injuries, neck pain, tendons and ultrasound in sports medicine practice were the chart busters in the 2nd half of 2011. Over 4000 listeners monthly enjoy the 35 BJSM podcasts available now. And we continue to add to the list.

We are very open to your suggestions as to whom to interview – feel free to email, post a message on twitter (include @BJSM_BMJ of course) or call 1 800 BJSM.

That’s all for this blog – take the time to listen to a BJSM podcast and provide feedback via ‘email or your favourite social media site

karim.khan@ubc.ca

@BJSM_BMJ

http://www.facebook.com/BJSM.BMJ

The 5 most popular BJSM Podcasts in 2011 were…

5. Treating tendinopathy with Professor Håkan Alfredson

4. Musculoskeletal ultrasound with Kim Harmon and Sean Martin

3. Managing whiplash with Michele Sterling

2. Biomechanical overload and lower limb injuries with Andrew Franklyn-Miller

…drum roll please for most popular podcast of the year…

1. The JUMP-ACL study with Anthony Beutler

Cast your Nomination for the BMJ Award for Sport and Exercise Team of the Year (February 28th Deadline!)

18 Jan, 12 | by Karim Khan

Are you aware of (or part of!) an outstanding team project or initiative in the UK that promotes physical activity and the improved care of athletes?

We want to know about it.

Photos of 2011 award winners courtesy of BMJ

The 2012 BMJ Group Improving Health Awards has a new category geared at Sports Medicine Practitioners. The award for Sport and Exercise Team of the Year “recognizes teams making a valuable contribution to promoting physical activity, improving the care of athletes or medical services to the sporting community.” The wide acceptance criterion includes projects focused on the elite, disabled, and/or the amateur athlete. It also welcomes initiatives geared at public health promotion through physical activity.

With over 643 nominations received last year, the BMJ Awards is a high profile event. It draws a diverse nominee group and audience. Fiona Godlee, editor in chief of the BMJ, characterizes the event as great opportunity to celebrate ‘unsung heroes,’ acknowledge the importance of partnerships, and to share in excellence.

Judging Criteria

The panel of expert judges will be looking for the team project or initiative that most demonstrates;

  • A clear strategy.
  • Measurable improvement in physical activity participation, health care in athletes or management of illness or injury in the sporting community.
  • These teams should demonstrate a commitment beyond what would normally be expected in their role.

For more information on categories, judges, and tickets go to the BMJ Improving Health Awards website.

Or submit your nomination NOW (the deadline is only one month away).

Let’s all take this opportunity to celebrate leaders in the field and raise the profile of Sports and Exercise Medicine.

23 and a half hours video passes 2 million views!

12 Dec, 11 | by Karim Khan

Mike Evans circulated this to his hockey team of kids early in December 2011.  #1 educational video on YouTube. Remember that low fitness (<30 mins of physical activity daily) kills more Americans that smoking, diabetes, and obesity combined (smokadiabesity).

Click on this link. Watch it, share it. Do it yourself.

Encourage patients to watch it and start today! Great ‘sticky’ message capturing Steve Blair’s evidence that this treatment will save more American’s lives than a cure for smoking, diabetes and obesity put together. That’s a fact!

It passed 2 million views in February, 2012. Wow!!

Perfect time to commit to UKsem London…Nov 23 thru 26 or part thereof…

10 Nov, 11 | by Karim Khan

Looking for a world class conference bringing together sport and exercise medicine, conditioning and science with nutrition, rehabilitation and high performance coaching?. This conference will provide new knowledge for those working with elite sport and recreational athletes as well as those presenting to all clinicians for exercise prescription. See the UKsem home page including the concise video (and Andy Franklin-Miller’s very modish shirt)…Will you be there?

The UKsem site is the best place to find the conference program. Names I am looking forward to hearing from include Roald Bahr (sports injury prevention-always great value), Dan Lieberman (the ‘barefoot doctor’), Damien Comolli (the secret to Liverpool’s success), Vern Gambetta (the art and science of coaching).Vern has over 4000 followers as @coachGambetta on Twitter so you know he’s doing something right.

‘Sleepers’ for many will be Carl Askling on hamstring rehabilitation and Richard Frobell on conservative management of ACLs. The former has terrific programs for both prevention and treatment. He discovered the difference between ‘type I’ (sprinters/football players) and ‘type II’ (stretching/dancer’s) hamstring strains and their very different prognoses. Great teaching videos for both rehab and determining return to play.

Dr Frobell headed up the New England Journal of Medicine RCT which randomized ACL patients to rehab or surgery. Not every conference presenter can open up with that claim…’Thanks for coming and if you doze off during my talk you can read all about in the NEJM….’. Good one. 10 years of hard work to become the overnight sensation. BJSM comments on that paper are here in a WarmUp and here in a podcast with Dr Frobell and his research team. Do your homework and then ask him the stumper at UKsem. Or buy him beer for the great effort!

I’ll stop there as I want you to use your coffee break to go to the UKsem site, not to read this. And by ‘sleepers’ – I meant – ‘under the radar’ — not lectures to sleep in. I would reserve sleeping for Friday morning 9:35 – 10:05. Something about how Mad Men, the Marlboro Man and Freakonomics have the answer to ‘smokadiabesity‘? Weird!

The UKsem site is great but if you insist on only following BJSM pages you can see Andy Franklin-Miller’s WarmUp about the conference here and listen to two interviews with the mellifluous BBC-trained sports physician and fashionista.

July podcast – his conference highlights

October podcast – lower limb biomechanics plus a sneaky conference plug in the last 3 minutes of this 24 minute file.

Nice shirt….

Two related blog posts – Clinicians and scientists crazy to ignore social media

29 Sep, 11 | by Karim Khan

Image source: http://econversemedia.com/

Last weekend I spoke for our local Sport and Exercise Medicine coordinating body – SportMedBC. Its mandate is to coordinate education and advocate for all the various professions that make up our diverse community. Interestingly, they chose to focus on the role of social media in sports medicine.

Then on Tuesday I was alerted to Scientific American’s take on the issue. How did I come across the article? via Twitter. Thanks @NerdyChristie and good luck with your PhD studies in Hawaii.

The tweet immediately after reinforced the emergence of social media. It was provocatively titled ‘to those still in denial…

The significance of social media for clinicians and healthcare practitioners is both a timely and ongoing topic of interest. In April, BMJ’s Fiona Pathiraja wrote, Twitter – the medium and the message? an informative and practical article on using Twitter for healthcare purposes (follow her @Dr_Fiona). The public conversation about social media and science is hotting up and is going to get a lot hotter – this train is not slowing down!

You can find highlights from the SportMedBC Annual General Meeting and Conference here. Similar topics may be relevant for workshops at other sports medicine conferences that have small group breakouts/workshops. For example,

  • Room 1 – shoulder exam.
  • Room 2 – practical ultrasound skills in the office.
  • Room 3 – how to get the most from social media.

Getting back to Scientific American/NerdyChristie  [interesting how those two sides of the same coin have different 'brand associations'] – here’s her terrific closing quote from Alan Alda (M*A*S*H fame)…

Alan Alda said it perfectly when he asked,

“if scientists could communicate more in their own voices—in a familiar tone, with a less specialized vocabulary—would a wide range of people understand them better? Would their work be better understood by the general public, policy-makers, funders, and, even in some cases, other scientists?”

That’s a rhetorical question!

Case Report: Unusual cause of fibular fracture in a golfer

9 Jul, 11 | by Karim Khan

BJSM extends sympathies to golfer Thomas Levet, who seems likely to miss the British Open due to a ‘celebration injury’ after his French Open win (see him immediately pre-injury, left).

He clearly doesn’t spend as much time in the water hazards as some of us. The hazards are usually incredibly wide and powerfully ball-sucking but they are not that deep.  Quelle dommage.

Interestingly, there have been papers published on score-celebration injuries in soccer! Injuries included ankle, clavicle and rib fractures and the mean time to recover was 6.2 weeks.

If this is an area of your sports medicine expertise here the original link:


Enjoy the weekend – celebrate safely!
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