Guest blog by @CarolineFinch

Cross Fertilising ‘Injury Prevention’ journal (IP) and BJSM

One of the most researched areas in road safety and injury prevention is that of bicyclist safety. In fact, my own initial foray into injury prevention research in the early 1990s was as a member of the team that evaluated the population-level impact of the first mandatory bicycle helmet wearing law (1). The topic of bicycle helmet effectiveness remains a topic of much debate despite much evidence that they are effective if worn correctly. Bicycling is also a major focus of current active transportation and physical activity research.

The February 2011 issue of Injury Prevention includes several papers relating to bicycling injury that are of relevance to anyone interested in increasing this form of physical activity. The first paper, by Poulos et al. presents the protocol of study that aims to describe the incidence of crashes, near-misses and injury rates in relation to bicyclist exposure factors including the time and distance travelled and the type of road infrastructure used. As the authors point out it is not fully obvious which type of bicycling infrastructure provides overall best safety gains and this needs further research. They cite the example that paths that are designed to protect bicyclists from road traffic, but which enable sharing by bicyclists and pedestrians, may in fact increase total injury rates due to collisions with pedestrians in which either type of oath user is injured. The study plans to recruit people who self-identify as active bicyclists and then to conduct two-monthly follow-up surveys with them to collect information about their bicycling habits and injury experiences.

Another paper in the same issue, by Ackery and colleagues, describes a case-control study of bicyclist deaths in the USA e documented as part of the well-established national Fatality Analysis Reporting System. This system includes all fatal crashes involving a motor vehicle on public roadways and so the bicyclist injuries were all the result of a collision with a motor vehicle. The study explored a range of exposure factors such as travel time of day, posted speed limits, and the type of vehicle collided with in both fatal cases and controls who were non-bicyclist road deaths. The most significant finding was that a disproportionately high proportion of the bicyclist deaths, compared to controls, involved larger and more expensive vehicles. The authors concluded that transportation policy should consider strategies to separate bicyclists from other very large road users.

The first French case-control study of helmet wearing and bicyclist injuries is described in a paper by Amoros et al. All study participants were recruited from a road trauma registry, with cases being bicyclists with a head injury and the control being bicyclists without head or neck injuries. Exposure to particular road infrastructure at the time of injury was collected in terms of the crash setting being on an urban or rural road and the type of road (as being major, local, or “off”). Evidence from this study is in support of the protective benefits of helmets.

As with all areas of physical activity promotion, there is a very clear and strong overlap with injury prevention. The bicycling context provides a graphic example of how increased exposure to a given ideal behaviour (e.g. in terms of duration of activity), can also increase the risk of adverse outcomes such as injury. Injury researchers have long known this and have a history of well-developed robust methods for measuring bicyclist exposure (e.g. in (1)). The success of active transportation as a physical activity will depend on there being suitable safe infrastructure and environments for the bicycling to occur in and the amount of bicycling (or exposure to positive physical activity) that ensues will be directly related to this. Conversely, increased exposure to hazards within those same environments, whether due to longer amounts of accumulated time spent bicycling or bicycling in settings with particularly high traffic volumes or poor road conditions, can lead to increased risk of bicycling injury. Active transportation policy developments will need to consider the provision of infrastructure to protect and support the needs of all road users, including those who wish to use it for their physical activity benefits, rather than just as a means of getting from a to b.

Additional reference
(1) Cameron MH, Vulcan PA, Finch CF, Newstead SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia – an evaluation. Accident Analysis and Prevention. 1994, 26:325-337.

Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Centre, Monash University, Australia. She specialises in implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.

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BJSM e-letter by:

Gerhard Ruedl and Wolfgang Schobersberger

E-letter for: Kathrin Steffen, Lars Engebretsen. The Youth Olympic Games and a new awakening for sports and exercise medicine. BJSM. 2011; 45: 1251-1252 (Warm up)

Photo courtesy of IYOGOC

Do we really want to see our young promising talents go through a major injury at one stage into their career?

Definitely no!

However, in competitive alpine skiing, snowboarding and freestyle, the risk to get major head and anterior cruciate ligament injuries is indeed high [1-4]. Therefore, training focussing on injury prevention should start at an early age and should go along with the athletes’ career. To implement evidence based preventive measures, however, it is of utmost importance to investigate first of all data on occurrence and severity of injuries according to the 4-step model of injury prevention research [5].

At this point of time, there is little data available concerning the injury risk of youth elite athletes competing in winter sports [6, 7]. Therefore, we will conduct a systematic injury and illness surveillance on young elite athletes participating in the 1st Winter Youth Olympic Games in Innsbruck/Austria in January 2012.  Let us work together to get meaningful data as a basis for further research on injury risk factors and injury mechanisms and finally on injury prevention strategies among young elite winter sport athletes.

We are glad to welcome you in Innsbruck!

References
(1) Pujol N, Blanchi MP, Chambat P. The incidence of anterior cruciate ligament injuries among competitive alpine skiers.  Am J Sports Med 2007; 35: 1070-4.
(2) Florenes TW, Bere T, Nordsletten L et al. Injuries among male and female World Cup alpine skiers. Br J Sports Med 2009; 43: 973-8.
(3) Florenes TW, Nordsletten L, Heir S et al. Injuries among World Cup freestyle skiers. Br J Sports Med 2010; 44: 803-8.
(4) Florenes TW, Nordsletten L, Heir S et al. Injuries among World Cup ski and snowboard atlethes. Scand J Med Sci Sports. 2010 Jun 18 [Epub ahead of print].
(5) Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med 2005; 39: 324-9.
(6) Steffen K, Engebretsen L. The Youth Olympic Games and a new awakening for sports and exercise medicine. Br J Sports Med 2011; 45: 1251-52.
(7) Steffen K, Engebretsen L. More data needed on injury risk among young elite athletes. Br J Sports Med 2010; 44: 485-9.

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Gerhard Ruedl is a Senior Researcher at the Department of Sport Science, University of Innsbruck, Austria

Wolfgang Schobersberger is the Chief Medical Officer of Winter Youth Olympic Games in Innsbruck; Institute for Sports Medicine, Alpine Medicine & Health Tourism Innsbruck/Austria

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!!

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:

• Platelet-rich plasma: Debate. Jul 2010, (44)9
• IOC consensus paper on the use of platelet-rich plasma in sports medicine. Dec 2010, (44)15

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.

Conclusions?

– No clinical benefit in 6 months:

• de Vos, R, Weir, A et al. 2010. Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy. JAMA, 303(2)

-  No ultrasound evidence of benefit:

• de Vos, R, Weir, A et al. 2010. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. BJSM, Online first November, 2010

- and now no benefit at 12 months:

• de Jonge, S, de Vos, R., Weir, A et al. 2011. One-Year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy: A Double-Blind Randomized Placebo-Controlled Trial. AJSM. August  39.

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?

Image source: www.spotflick.com

The August 2011 issue of Injury Prevention (sister journal to the BJSM ) included an editorial from me with my views on an apparent unfortunate divide between sports medicine and injury prevention researchers.   The two groups rarely meet at the same conferences or read the same journals and so there is somewhat of a lack of knowledge about relevant research across the two sectors. I have vowed to help reduce this gap by establishing cross-journal Blog posts to directly alert readers of one journal about relevant research in the other, and vice versa.  Of course, my hope is that this will not be necessary in the long-term and that cross-fertilisation of ideas becomes the norm.

In this first IP to BJSM  cross-Blog, I’d like to alert injury researchers to several papers describing methodological issues of relevance, also published in the August IP issue.

One paper by Lawrence discusses the use of the controlled vocabularies of the commonly-used literature search engines PubMed/MEDLINE and PsycINFO for finding articles on injury prevention and safety promotion.  It highlights specific indexing problems that could impact on the quality of literature search strategies that rely solely on those methods to identify papers to include in reviews.

Another paper by Khan et al focuses on the statistical issue of how to best model injury count data, when there are excess zeroes. This is a common occurrence in injury studies where most people sustain no injuries, many only one or two injuries and fewer people sustain more injuries.  Such data should not be analysed by traditional Poisson counts and more appropriate statistical modelling applied instead.

Finally, Cryer et al present a new theoretical definition of injury death, which should overcome the short falls of current surveillance systems which are known to under-enumerate injury deaths.  Even though deaths in sport are rare compared to those in other settings, these new definitions are relevant to anyone who uses routine mortality data to monitor injuries.

Caroline Finch is an injury prevention researcher specialising in implementation and dissemination science applications for sports injury prevention.  She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group.  Caroline can be followed on Twitter @CarolineFinch

Should 12-lead ECG be part of the pre-participation examination of athletes? Those in favor of ECG screening argue that it reduces the risk of sudden cardiovascular death;  those against screening point out the low cost-effectiveness, the low disease prevalence resulting in a low positive predictive value, the difficulties in distinguishing abnormal electrocardiographic changes indicative of cardiac pathology from normal, training-induced alterations and the inconsistencies in the definition of ECG abnormalities.

New perspective

In a recent edition of Circulation, Uberoi et al. tackled this obstacle of the varying definition of ECG abnormalities and have written a good, educational article that focuses on the interpretation of the electrocardiogram of athletes (Interpretation of the electrocardiogram of young athletes, Circulation 2011;124:746-757)

The European Society of Cardiology recently published new recommendations for the interpretation of the ECG in athletes. The strength of this current article by Uberoi et al. is that it builds on the guidelines of the European Society of Cardiology, but elaborates this even further, refines the recommendations, and includes excellent figures to illustrate the various examples.

Uberoi’s article discusses specific aspects of interpretation, presents the author’s commendations and then critiques the document of the European Society of Cardiology. The following aspects of the ECG are discussed: Increased QRS voltage, early repolarization, Q waves, conduction delay, QRS axis deviation, right ventricular hypertrophy, atrial abnormalities, T-wave inversion, ST depression, QT abnormalities (long and short), Brugada-like abnormalities and ARVD, ventricular preexitation, and ventricular extrasystoles and supraventricular arrhythmia.

The main conclusions and recommendations of the article are summarized in one clear table (Table 5 – split between two pages, 753-4).

A very useful and educational for anyone who is involved in the ECG screening of athletes! Read this great article in Circulation. And remember, sports cardiology is a major focus of BJSM – see the September 2009 issue (still highly topical), read the WarmUp for that issue, and listen to Senior Associate Editor Jon Drezner’s recent podcast of updates on sports cardiology. Previous blogs too!  Hot hot hot!!

Figure 5 (part 1, p. 753)

Figure 5. Summary of recommendations for screening PPE ECG. PPE indicates preparticipation examination; RAA, right atrial abnormality; LAA, left atrial abnormality; RVH, right ventricular hypertrophy; RAD, right axis deviation; RBBB, right bundle branch block; TWI, T-wave inversion; and QTc, heart-rate correction of the QT interval. (part 2, p. 754)

Image source: www.fullissue.com

Recent press coverage of BJSM article: Television viewing time and reduced life expectancy: a life table analysis, has sparked debate in popular media. David Aaronovich, from the UK Times, writes: “On Tuesday morning many people in Britain woke up to the news that their televisions were killing them… A curious person would want to know how this transmission of death works…Is it some kind of death ray, emitted by the billions of nasty little pixels on the screen?”

His main issue wasn’t with the credibility of research findings but rather the news coverage’s muddled distinction between causal and associated behaviour risks.

The sensationalist response to Veerman, Healy, and Cobiac et al’s article is not confined to the UK. News headlines from around the globe include:

TV can kill, just like smoking

It’s the threat in the corner of every living room

TV And Lifespan: One Hour’s Viewing Shortens Life By 22 Minutes

New Study Says “Jersey Shore” Can Shorten Life Span (Not Really)

Reporting accuracy aside, as they say in the business – any press is good press. The news coverage successfully calls attention to the risks associated with coming home from your desk job (remember a few weeks ago – we were told that desk jobs are a serious health risk), and sitting for hours in front of the TV.

Since researchers excluded those individuals that exercised in front of the TV, the underlying issue here is the negative health impacts of sedentary behaviour. This is nothing new for our fellow physical activity advocates (see related BJSM warm up on smokadiabesity).

The blast of news coverage also suggests that creative research angles on behavioral health impacts are useful in grabbing the public imagination. It may be considered a less dramatic version of when activists take off their clothes to promote reduction of fossil fuel dependency or anti-fur campaigns (see World Naked Bike Ride and I’d Rather Go Naked Than Wear Fur).

As commendable as this level of commitment to promoting behavior change is, one of our aims at BJSM is to keep our clothes on and let the science speak for itself.

Post script: One news headline DID hit on the crux of the issue:

Want to live longer? Try less TV and more exercise

By Professor Evert Verhagen

In reaction to the guest blog by professor Caroline Finch (May 9th), it is really good to see that the important topic of implementation gets the attention it needs. I’ve heard many times, in relation to van Mechelen’s sequence of prevention [1], that we need more intervention studies. This is whilst most studies focus on the first two steps of the four step prevention sequence; counting injuries and describing causal factors.

However, positive intervention outcomes do not necessarily imply prevention of injuries. In fact, I hardly ever see positive study outcomes being implemented and adopted by associations, coaches or athletes. I have no idea whether it is practice that does not want to bow for the evidence, or whether it is evidence that does not fit practice. My opinion hangs to the latter. Nevertheless, fact remains that we are facing an important gap in our knowledge.

Consider the hierarchy in research questions. Efficacy questions being on the fundamental side, effectiveness questions in the middle, and implementation questions on the practical end of the spectrum. I would argue that just as with the sequence of prevention we are stuck somewhere halfway. The field has a solid foundation with efficacious evidence, but hasn’t progressed past the effectiveness questions.

However, this progression is not easy. Our research group has done a fair bit of implementation research, not only in the field of sports injury prevention, and we continuously face the difficulty in publishing the outcomes of such studies. In relation to effectiveness studies implementation research has no standard approach, study design and methodology. In addition, the outcome measures are different and less objective.

Yes, implementation research is a field in progress and we are still refining our methods. And yes, the outcomes seem a bit fuzzy and cloudy. But…implementation research is needed in order to move our knowledge to practice and really mean something for the athlete.

I hope this short blog by professor Caroline Finch is a sign of things to come.

[1] Van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med 1992; 14(2): 82-99.

Evert Verhagen is an Assistant Professor at the EMGO Institute for Health and Care Research at the VU University Medical Center, Amsterdam, the Netherlands.  You can follow him on Twitter @EvertVerhagen

By Dr. Kjetil K. Haugen[1][2][3]

April 1, 2011

Abstract

In this short note, I enhance the discussion of legalizing performance enhancing drugs brought up by Savulescu, Foddy and Clayton through applying some simple economic theoretic arguments. I claim that Savulesu et al. fail to see some evident economic arguments, and hence very well may reach an erroneous conclusion.

1 My intention

Oxford Professor J. Savulescu and colleagues B. Foddy and M. Clayton, published a paper titled Why we should allow performance enhancing drugs in sport [3]  (BJSM 2004). The authors argued strongly, not surprisingly taking the title into account, for legalizing performance enhancing drugs (PEDs).

I remember after reading their article, back in 2004, a somewhat awkward feeling to the contents in general, and my personal role in particular. I thought about writing a comment back then, but due to more urgent creative projects, I did not pursue the idea. However, after witnessing professor Savulescu on national Norwegian TV and other media [2] arguing strongly for his case, I have decided to open my mouth on the matter.

Previous work of mine seems to play a certain part in Savulescu et al.’s arguments in their article. My article, The performance-enhancing drug game [1] published in Journal of Sports Economics in 2004, and cited by Savuelscu et al., may to some extent be perceived as a support for the conclusion of Savulescu et al. I agree on the fact that my article predicts problems in fighting PED-use among professional athletes. However, problems in fighting do not equate legalizing.

My main point in writing The performance-enhancing drug game was actually to help fight drug abuse, not legalize it. So, in order to not be associated with Savulescu’s personal international vendetta (at least that is what it seems like observed from outside), I use this opportunity to state that I do not agree that we should legalized PEDs in sport. If my previous work [1] has led Savulescu and others to believe so, I hereby declare the opposite.

2 Savulescu et al.’s (missing) arguments

Now, after stating what I mean on this matter, let me also spend a tiny bit of time trying to argue why. In spite of the fact that I (and others) have shown the immense difficulty in fighting doping, there are – in my opinion – certain reasons for not legalizing it. Unfortunately, these reasons are not even mentioned by Savulescu et al., and I sincerely feel that they need to be.

In my opinion, general sports economic theory may prove handy as a tool to enhance the arguments used by Savulescu et al. In (sports) economic theory, the concept of markets plays a vital role. In order to have a market, both buyers (demanders) and sellers (suppliers) are needed for transactions. According to Savulescu et al.’s argumentation, which contains no reference to supply or demand, it is easy to assume that these topics are either uninteresting or unaffected by legalization of PED. I do not believe so.

Firstly, let me focus on the demand side. The question to ask then seems obvious. How and in what way may demand be affected by legalizing PEDs? Surely, this question is hard to answer, but it should be asked and at least discussed in order to judge such a radical proposition. Personally, I do not believe that demand is unaffected. On the contrary I think demand will be affected, and perhaps adversely. Savulesu et al. argue for fairness, safety and to some extent (as a consequence) more uncertainty of outcome. (quote: «By allowing everyone to take performance enhancing drugs, we level the playing field. We remove the effects of genetic inequality». After all, if all athletes are able to equate genetic differences by individually optimal PED use, a reasonable outcome should be more even competition. And yes, more even competition (or higher uncertainty of outcome as sports economists like to name it) has a positive demand effect. Fans like to watch sports competitions where at least some probability of the underdog winning exists. However, and this is perhaps the main point, sports fans also demand more than uncertainty of outcome. They demand excellence. 90.000 people at Nou Camp also come to watch Barcelona play wonderful football, not necessarily only the uncertainty related to the match outcome. Some fans might even state that the outcome of the match is subordinate to the beauty of Barcelona’s passing. Excellence is a relative measure. If everybody plays like Barcelona, Barcelona is no longer excellent. Hence, maximizing uncertainty of outcome does not (necessarily) maximize total sports demand. Then, it may very well be that a more even playing field attracts some fans but then also repels other. The question then boils down to the total effect which very well may be negative. After all, most sports economic experts recognize uncertainty of outcome as a positive demand effect, but most would probably agree on the fact that other effects, including excellence, may be far more significant.

Furthermore, the difference between knowing and expecting is not at all discussed. If PEDs are legalized, fans know that all athletes use certain (now) legal substances in order to enhance performance. Today, I might expect that all 8 runners in the Olympic 100 meters final have used steroids. However, there is a difference between expecting and knowing. Personally, I would definitely not find this information to be a demand booster. Obviously, this argument is relatively unscientific, but still, I believe it to be of some importance.

Secondly, and in my opinion, of greater importance is the supply side. Sports suppliers are of course athletes and teams, producing the sports products. However, the supply chain is a bit more complex than that. Efficient supply of the sports product also involves parents, coaches and volunteers and to some extent public subsidies as necessary production input. In this chain of production input, I believe that parents are the really vital part. If parents become reluctant in allowing their kids to do sport activities, in the long run a possible sports market collapse should be the outcome[4]. No supply of talent leads to no demand, and hence no professional sports markets. Frankly, I might be skeptical today of sending my kids to sprint training, but with legalized PEDs, any reasonable parent would never even judge recommending such activities for their kids knowing that success in the long run would lead to PED use. Obviously there are unreasonable parents out there, but hopefully still in minority.

Finally, it seems plausible just to mention that most professional sports activity to a great extent also generates revenues through both public and private sponsors. I will not dive into the private sponsor market here, but mainly mention that the classical argument for public sports financing is related to positive external effects — typically health-wise. Still, even if professional sports are considered unhealthy, youth non-professional sporting activities are considered healthy and hence obliged to receive public money. I must say I am very pessimistic on keeping this stream of money running at the same speed into sports given legalized use of PEDs.

3 Conclusions

Failing to consider obvious economic effects both on demand and perhaps especially on the supply side makes Savulescu et al.’s arguments somewhat too simplified. I might agree that legalizing PEDs may prove both fairer and safer, but it may very well be that aiming for fairness and safety may lead to a total breakdown of professional sports markets as we see them today. I would not sit still observing this. So my medicine would be to do what I tried to state in previous work. Increase penalties for drug-taking behavior, make prize-functions less progressive and of course; increase quality of drug tests.

References

[1] K. K. Haugen. The performance-enhancing drug game. Journal of Sports

Economics, 5:67-86, Feb. 2004.

[2] J. Rasmussen. Oxford-professor vil legalisere doping. Dagbladet

(Norwegian Newspaper), Retrieved from the Internet – April 2011

http://www.dagbladet.no/2011/03/17/sport/doping/gendoping/15845005/, 2011.

[3] J. Savulescu, B. Foddy, and M. Clayton. Why we should allow performance enhancing drugs in sport. British Journal of Sports Medicine, 38:666-670,2004.

[2] Molde University College, Specialized University in Logistics, Box 2110, 6402, Molde,NORWAY

[3] Thanks to Prof. H. Gammelseter at Molde University College for  valuable comments, discussion and reading through the

manuscript.

[4] Being a true sports fan, I would definitely not like that to happen.

Guest blog by Dr. Malachy McHugh

If the purpose of  Des Spence’s article Bad Medicine: Sports Medicine (British Medical Journal, March 30 2011)  is to strike a chord with sports medicine professionals then it has probably done its job. However, as a piece of scientific writing this lacks objectivity to put it mildly. The sports medicine literature is relatively clear on many of the issues raised in the article. The literature indicates that more expensive running shoes do not confer any benefit when compared to less expensive shoes. The literature is very clear that excessive consumption of water during endurance activities (especially in the slower athletes) imposes a serious risk of hyponatremia. The literature is also quite clear on the benefits of sports drinks, the types of activities for which they may be indicated and the correct timing of consumption and dosage. Of course controversies exist such as surgical vs. nonsurgical treatment of rotator cuff tears or the long term outcome of ACL reconstruction. This is the same in all areas of medicine; try to get a bypass surgeon to agree with an interventional cardiologist on the best treatment for their patients.

As the evidence-based medicine movement has taken hold the quality of the sports medicine literature has improved. There are many more good randomized clinical trials and injury prevention studies in the literature than just 20 years ago. Sports medicine is a relatively new discipline compared to many other medical specialties and we are learning on our feet . For clinicians, there is nothing more humbling than data. Bold and confident opinions are still just opinions. For example, the statement in regard to the efficacy of massage, “it is illogical that external forces could affect a molecular physiological healing process” should maybe be reconsidered in the light of research from Tom Best’s lab (Butterfield et al 2008: Cyclic compressive loading facilitates recovery after eccentric exercise). Two lines from the abstract are quite clear on the effect of “external forces” on healing:

“We found that commencing 30 min of cyclic compressive loading to the muscle, immediately after a bout of eccentric exercise, facilitated recovery of function and attenuated leukocyte infiltration. In addition, fiber necrosis and wet weight of the tissue were also reduced by compressive loading.”

I am far from being an advocate for sport massage but hard data can temper one’s opinions.

In my opinion Bad Medicine: Sports Medicine does a disservice to sports medicine and the title is inflammatory and not appropriate for a medical journal. But I suppose that is just another opinion.

Mal

Dr. Malachy McHugh is the Director of Research at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT) at Lenox Hill Hospital in New York City. He leads a multidisciplinary research team including orthopaedic surgeons, physical therapists, exercise physiologists, nutritionists, biomechanists, medical engineers and athletic trainers.  Dr McHugh is a fellow of the American College of Sports Medicine, an associate Member of the American Orthopaedic Society for Sports Medicine, and a member of the Orthopaedic Research Society.  He has more than 100 publications in the sports medicine and exercise science literature.

What are your thoughts on this subject? Please leave your comments below.