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Australian Football League considers Concussion Consensus Statement

12 Mar, 13 | by Karim Khan

Interesting take on the Consensus statement from the Zurich 2012 Conference on Concussion In Sport. This paper is Open Access on BJSM and BJSM is the exclusive publisher of the 12 systematic reviews that underpin the Consensus statement. This special issue of BJSM is an Injury Prevention and Health Protection (IPHP) issue of BJSM – supported by the International Olympic Committee.

Click here for the full AFL blog:



BJSM podcasts speak for themselves – 6,738 downloads in the last 30 days!

14 Oct, 12 | by Karim Khan

Are you an app developer? If you want to create the BJSM podcast app please ‘call me maybe’.  Granted BJSM podcasts are marginally less popular than Carly Rae Jepsen’s hit (300 million views) but I am optimistic that sports medicine will truimph over time. Right now we are only 300 million views behind (with rounding). Many in the BJSM community commented on the value of  the 5 most popular BJSM Podcasts in 2011.

Here is a 2012 update on our ‘platinum podcasts’:

5 most popular in the last 30 days (average over 1000 listens per podcast):

Acute ankle injuries, with Gino Kerkhoffs  Based on the very rigorous review of management published in the August issue of BJSM (VSG member society – theme issue).

Five clinical tips for shoulder assessment and Rx, with Professor Mark Hutchinson  Comes with linked video material – a multi-media overview that even experienced clinicians can learn from.

Darren Burgess – Head of Fitness and Conditioning at Liverpool FC   How can clinicians and fitness and conditioning professionals can work together to improve team performance. Yes they can!

Professor Mark Hutchinson’s pearls on knee examination: Do the simple things extraordinarily well  Don’t be fooled by the word ‘simple’ in this one. Later in the podcast (and you can go straight there using the timeline under the link) Hutch discusses complex management issues. He’s a great instructor. (As his >3 million YouTube views attest.)

Prof Jeremy Lewis: Rotator cuff tendinopathies You get the best of BJSM’s Deputy Ed Prof Jill Cook (interviewing) and Prof Jeremy Lewis on controversial issues topics related to the painful shoulder. Where does the pain come from? Should I succumb to SAD? (subacromial decompression). A rare opportunity to be a fly on the wall while two of the most popular clinical educators chat.

Most popular ever (all with > 2000 listens):

Biomechanical overload and lower limb injuries, with Andrew Franklyn-Miller Expert commentary on leg pain (not ‘shin splints’ but roughly in that part of the body 🙂 ), barefoot running, and how to modify your running technique to reduce injury risk.

Hamstring injuries with Carl Askling In a short podcast, Swedish physiotherapist Askling shares the take-home messages from over a decade of both treating hamstring strains in athletes/dancers and from completing a brilliant PhD on the subject. This is revolution – not just evolution – in managing hamstring tears. If your hamstring strain is not differentiated into Askling’s Type 1 or Type 2 you are at a disadvantage in knowing your prognosis and perhaps even optimum treatment. A hot commodity on the sports medicine conference circuit Dr Askling provides valuable guidance here.

Groin injuries, with Per Holmich One of the most challenging areas of sports medicine – from a world-renowned surgeon with rare appreciation of conservative management.  Learn how to differentiate the entities that contribute to groin pain and how that should influence management. Don’t have FAI surgery before listening to this!

Treating tendinopathy with Professor Håkan Alfredson A very practical podcast on the distinction between mid-portion and insertional Achilles problems. How to manage each condition. Current management controversies. From the clinician who invented the modern heel-drop program – one of the top 10 downloaded and cited papers of all time in the Am J Sports Med (1998).

The shoulder in sport, with Ben Kibler  Dr Scapula – Ben Kibler – is guaranteed to fill a room at any conference. Tennis doctor and BJSM deputy editor Babette Pluim (@DocPluim) poses the challenging clinical scenarios so we can all learn!

BJSM welcomes your suggestions for podcast guests. Email or Tweet to the BJSM at @BJSM_BMJ or post to our facebook page.

The legality of Pistorius: why ethics is more relevant than biomechanics. Guest blog @DrJohnOrchard

5 Aug, 12 | by Karim Khan

by @DrJohnOrchard

I’m pleased to see Professor Lippi’s opinion piece on Oscar Pistorius in BJSM’s Online first [1], as it is a very important topic and the BJSM is a very appropriate forum to publish on this debate. Much of the article is a good neutral overview of the parameters of this debate. However I disagree very strongly with some of the conclusions made. In particular this section:

“If we all agree—as we do, indeed—that whatever artificial addition on athlete’s body shall be considered unfair or even illicit (the ban of the bathing suits that enhanced swimmers performance is a paradigmatic case), then, prosthetic technology should follow the same route. Beside the fact that Pistorious’s running performance may be higher, the basic dynamics has been definitely proven to be grossly different from that of intact-limb sprinters, and he should not be allowed to race in the Olympics, whereby his natural field remains the Paralympics.” [1]

Firstly, I don’t think that there is universal agreement that “all artificial aids should be illicit”. What is a running shoe other than an artificial aid? It is simply an artificial aid that everyone is allowed to use (although different brands, which surely have different biomechanics, are allowed and chosen). Equestrians are allowed saddles, cyclists are allowed helmets that reduce drag and footballers can wear studs on their boots to improve grip on grass. Artificial aids are available in many sports and we debate and regulate depending on a combination of scientific argument and consensus opinion. We also debate whether caffeine, pseudoephedrine and salbutamol should be on the banned substances list and sometimes change our minds. Lippi points out that the decision was made to ban ‘fast swimsuits’ as if this was the only decision available, when of course it is easy to envisage a scenario where this decision could have been determined with the opposite outcome and we all just accepted better technology. We accept that modern golf balls and clubs allow the ball to be hit further than previous versions, even though many have made the argument to limit this technology. These are all decisions on artificial aids, not automatic choices where we have only had one option.

I don’t think it is an established ‘fact’ that Pistorius has biomechanical advantages over able-bodied runners which outweigh his disadvantages. Obviously there are respected biomechanics experts who have quantified advantages that he does have, but there remain multiple unknowns with respect to the disadvantages. The counter-argument that Pistorius and his supporters (including myself) make is: you can have as much ‘in vitro’ science as you like, but why do able-bodied runners post faster times in every discipline than amputees using artificial limbs over the same distance? In vitro science is fallible. I imagine that a motivated biomechanist could present an in vitro study suggesting that a running shoe would make you run slower compared to bare feet or a physiologist similarly that women had a theoretical advantage in the marathon than men. You wouldn’t need better science to mount a powerful counter-argument – why don’t barefeet athletes (since Abebe Bakila) win running events or women beat men? If amputee runners were consistently beating able-bodied runners then the science alleging an unfair advantage to Pistorius would have a lot more weight. Let’s face it, science can’t yet tell us whether Nike shoes lead to more injuries than Asics shoes or even lead to faster running (even though we could actually do RCTs on these hypotheses, which is not available in the case of amputee athletes) and we need to be humble about what the limits of scientific analysis are.

If the jury is still out on whether Pistorius has an unfair advantage then he deserves the benefit of the doubt. If he was a completely crazy second tier able-bodied athlete who had cut off his own legs in order to try to improve his times, then you could mount a very good ethical argument that he should be excluded (in order to discourage others from following suit). He is in fact the opposite – one of the most inspirational athletes of all time. Where biomechanics can’t give us a foolproof answer, we need to judge this based on our ethical preferences, just as it was decided to ban fast swimsuits, but to keep caffeine legal. Just as the golf authorities will decide whether or not long putters stay legal or become illicit. Just as we decide whether drug cheats should get a 1, 2, 4 year or life suspension. The key question is “what do we want the Olympics to look like?” We decide that you can’t compete in the Olympic marathon in a wheelchair because we don’t want the Gold, Silver and Bronze medals all going to wheelchair athletes. That is a value judgement. If amputee runners were winning every medal at the Olympics, I would be comfortable with a decision that banned them from the events before we did start to get lunatics chopping their legs off to compete. At the moment we have a single amputee runner (Oscar Pistorius) who is internationally competitive in the able-bodied 400m but nowhere near as fast as Michael Johnson, the world record holder. Do we want this sort of athlete in the Olympics? I can’t comprehend an ethical world where it could be determined, ethically, that LaShawn Merritt could return from a drug suspension in time to compete in the 400m at the Olympics, but that we decided to exclude Pistorius from the same event because we thought he had an unfair advantage that we weren’t comfortable with. I am very relieved that the IOC didn’t exclude him. It has already been shown, however, in the Pistorius case, that it is possible to change the rules (from Pistorius being ineligible in Beijing to eligible in London). The “thin edge of the wedge” argument can be countered with the obvious – if Pistorius, or any other amputee athlete, starts beating world records by huge margins, there is every opportunity to change the rules once again.

Personally I would rank Oscar Pistorius amongst the most significant Olympic athletes of all time, alongside Paavo Nurmi, Jesse Owens, Dawn Fraser, Abebe Bakila, Bob Beamon, Mark Spitz, Nadia Comanici, Cathy Freeman, Steven Redgrave, Michael Phelps and Usain Bolt.

All of these athletes make the list because of the Gold medals performance that they have put in. Pistorius is possibly the only non-Gold medallist who belongs in such an esteemed list. Most importantly I believe he will have a greater impact on the world than any of the other legends, in that he may lead to a completely different vision we have of ‘disability’. I will explore this possibility in my upcoming Dr J. column in Sport Medicine Australia’s magazine Sport Health and co-publish it on the BJSM Blog in the near future.

Lippi G. Pistorious at the Olympics: the saga continues. Br J Sports Med doi:10.1136/bjsports-2012-091545

See also medical student Abhishek Chitnis’ BJSM Blog on this topic. (Retweeted 21 times in first hour it was up)


John Orchard is an Australian sports physician who has worked with numerous professional team sports. His sometimes controversial views are personal and not necessarily representative of organisations he is affiliated with. You can read more at and/or follow @DrJohnOrchard on Twitter


Professor Lippi whose article in Italian can be found here

Practical Guidance for Exercise and Pregnancy: 10 Take home messages from the BMJ Podcast

30 Mar, 12 | by Karim Khan

Photo by Serge Melki, Flickr CC

Exercise  during pregnancy provides many benefits to the mother and baby. Fortunately, clinicians and mothers have moved well beyond the view that women should be confined, or cannot initiate activity and be active at any stage of pregnancy. Here are 10 ‘take home messages’ for both clinicians and mums from a recent BMJ podcast with Dr. Browyn Bell.

1. Consider type, frequency and duration; a combination of different types of exercise is important to:

  • Reap the different rewards of different types of exercise (pre, during, and post-partum)
  • Prepare women for the physical demands of pregnancy and motherhood
  • Maintain a healthy bodyweight which decreases likelihood of pregnancy complications

2. There are multiple benefits to exercise during pregnancy such as:

  • Prevention of Gestational Diabetes
  • Reduction of stress and fatigue

3. Keep core body temperature below 38.5 degrees Celsius (especially in the first trimester)

4. Avoid contact sports, scuba diving, and supine exercises during later pregnancy (listen to the podcast for specifics/details)

5. Consider pre-existing health conditions that may become more pronounced during pregnancy

6. For sedentary pregnant woman who want to start exercising, guidelines are the same as for non-pregnant women (gradual increase in activity)

7. One way to ensure a safe exercise intensity is by maintaining a conversation during exercise

8. Women are encouraged to continue exercise during all stages of pregnancy (even if performance ability is reduced)

9. As always, make healthy food choices

10. Everyone has different (pre-existing and unique) health and physical needs. Common sense activities such as walking are always a good idea. Consult a physician or physiotherapist to develop an individualized approach to exercise.

Follow this link to listen to the complete podcast

Related Articles

Artal, R and O’Toole, M. 2003. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003;37:6-12 . (FREE ONLINE!)

Ruben Barakat, R, Cordero Y, and CoteronJ et al. 2011. Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial. Br J Sports Med Published Online First: 26 September 2011.



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


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

Don’t miss Richard Budgett’s Olympics podcast…

20 Dec, 11 | by Karim Khan

Just a quick alert that Richard Budgett, the Chief Medical Office for the London Olympics, shares his very special insights.

He was an Olympic Gold medal winner in Los Angeles before serving the UK and now the world!

Click here for the podcast

And remember, the IOC, through its Medical Commission, supports the 4 of the 16 issues of British Journal of Sports Medicine (BJSM) annually. See recent editorial about Youth Olympic Games here. The BJSM is the leading clinical source of sports and exercise medicine.

Day 2 UKsem…bare feet, public health crisis and tennis elbows. Oh my!

25 Nov, 11 | by Karim Khan

I learned that about 12% of high fit 80+ year olds die annually. Seems a bit unfair. But 27% of low fit 60-69 year olds die annually! No typo. High fit 80-yr olds are HALF AS LIKELY TO DIE as low fit 60-yr olds. Are we talking about 80-yr old Olympians? Nope. High fit is top 40%. Low fit = bottom 20%. Not too hard.

Prof Steve Blair (giving the audience both barrels of evidence, below) provided the data and reminded us that 150 minutes of moderately vigorous activity weekly (walking to and from the fridge) will leave the low fitness group in the dust. Alternatively, 70 minutes of vigorous walking to the fridge will do it. Not a big ask. As he said, the folks who are ‘too busy’ to do this generally have 3-4 hours a day to watch TV. And I guess there’ll be a few who have 10-20 years in the grave to think about it. Sounds non-PC but is actually just a fact.

Prof Dan Lieberman, ‘the Barefoot Professor’ wore black slipper type shoes to remind us not to polarize the debate into ‘barefoot’ vs ‘shod’ running. He highlighted the evolutionary advantage that humans have to run down game in the heat. 9-15 km daily, daily, daily back in the day. He really argued for the benfits of forefoot strike to prevent injuries. He’s doing an interview with the BMJ team tomorrow and there’ll be a session on running shoes/orthoses/etc. with Benno Nigg too. In the meantime see orthotics and patellofemoral pain in the BMJ.

The FIFA research team (F-MARC) including Philippe Tscholl, Mario Bizzini and Jiri Dvorak (photo above) shared the facts that 2010 World Cup football players used medication including NSAIDs and cortisone at a remarkable rate – comparable to that of osteoarthritic octogenarians in a care facility.  A concern. Doctors must do better. No lessons learned from previous World Cups in Germany and France. In a nutshell – FIFA 11+ prevents lower limb injuries and is being rolled out around the world. Football for Health — health messages with players as ambassadors and school children as the target is proving effective and electric. Great uptake – a lesson in implementation which is the theme of January’s BJSM issue (2012). No hyperlink there just yet. BJSM Blog gives you today’s news but not tomorrow’s!

We are hours away from freshening up the podcast page with a suite of interviews. Just need to get the switch at BMA house. We’ll tweet you when it’s ready (@BJSM_BMJ).

And if you add a question for any conference speaker below we’ll try to get it answered. No promises though! Or via Twitter.

PS: Thanks to our terrific team from BMJ for being at UKsem 2011. I am sure you have earned a spot for 2012!

No magical therapeutic benefit of PRP in Achilles tendinopathy — JAMA paper follow-up and BJSM podcast

18 Oct, 11 | by Karim Khan

My sense is that the popularity of platelet-rich plasma (PRP) is increasing independent of research in this field. BJSM has covered this with front cover attention:

Of most interest to blog readers will be the Podcast on PRP with Robert Jan de Vos and Adam Weir. These authors have arguably the highest quality study testing PRP to date. We congratulate the Dutch researchers on their quality study design and comprehensive investigations.


– No clinical benefit in 6 months:

–  No ultrasound evidence of benefit:

– and now no benefit at 12 months:

No benefit at 12 months is not a surprise given previous findings. The proposed mechanism for PRP therapy is accelerated early healing. Nevertheless, these data are important as some evangelical PRP providers may be tempted to discount the 6-month results and argue for a ‘delayed benefit’. This is not the last word on PRP and BJSM Associate Editor Kim Harmon (see: Musculoskeletal ultrasound: taking sports medicine to the next level) has pointed out reasons for this series of Dutch studies having ‘no effect’. BJSM is one of the leading venues for rational debate on PRP and we look forward to adding to your knowledge about the clinical utility of this ‘hot’ therapy that is gaining clinical popularity. Time for a quality randomized trial of PRP versus the Alfredson program for Achilles tendinopathy?

Consussion podcast still timely – McCrory on Consensus Statement

12 Mar, 11 | by Karim Khan

Concussion, concussion, concussion – has dominated the media over the past months. Major injuries to kids, research suggesting long-term problems, even the American Neurology Association updating their guidelines, now Sidney Crosby sits on the sidelines at millions of dollars 🙂 a day.

BJSM afficionados will be aware but as we get new readers and blog followers daily, I don’t apologize for reminding you of free value in the following links:

The special issue of BJSM that followed the Zurich Concussion Consensus Meeting – this is the meeting that is driving the science – this was the evidence behind all the current change.

Particularly useful is Paul McCrory’s explanation of how to interpret the guidelines – via BJSM’s masterclass podcast.

Here’s the intro that goes with that podcast…

Part 3: You are the expert – you teach concussion to fellows and you can recite the SCAT2 even if you have profound headache and retrograde amnesia. Professor McCrory provides tips from the Consensus Statement that have you on the same page as the 27 experts in Zurich. And maybe you were one of them. Listen anyway, send any additional tips to the BJSM blog ( and share the news of this practical podcast.

And then there is consensus statement itself – copublished in about 14 journals – a remarkable achievement in turning knowledge to action or ‘knowledge exchange’

As well as the practical forms to use on the sideline – the unfortunately named ‘SCAT2’ and ‘Pocket SCAT2’

Congratulations Sweden!

17 Feb, 11 | by Karim Khan

No apologies for plugging the Swedish National Institute for Public Health who have produced an amazing medical tool – evidence based exercise prescription for many, many, medical conditions. If you are in the UK you will be familar with the BNF – this should accompany every BNF and be used more often!

In Australia the equivalent is MIMS and in Canada CPS.  Clinicians should be reaching for this instrument more often than the stethoscope – it would have more impact as an intervention by any measure!
The great thing is that it can be downloaded for free! No excuses!

The link to the downloadable PDF version is in the subject line of this blog. You can read the authors’ brief editorial in this month’s BJSM for free.

We had planned to have the BJSM podcast done by March 1st and we still may – but the issue busted to the home page ahead of schedule so please bear with us if you are looking for the podcast. Lots of great podcasts up on the home page for free (the one with Steven Blair is very relevant) but nothing about this Bible of Physical Activity Prescription yet. I’ll update on the podcast here and via Twitter (@BJSM_BMJ).

BJSM blog homepage


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