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Special Issue of BJSM

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

3 Aug, 14 | by Karim Khan


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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



‘Care of the Female Athlete’ special theme issue: AMSSM call for manuscripts

25 Jul, 13 | by Karim Khan

The American Medical Society for Sports Medicine (AMSSM) is soliciting submissions for publication in the February 2014 issue of the BJSM. This AMSSM themed issue will focus on the broad topic of “Care of the Female Athlete”. (See the cover of the 2013 AMSSM special issue of BJSM at right). 


Manuscript submissions can be in any area of sports medicine as it pertains to women in sport. Submission ideas can include but are not limited to those manuscripts that are cutting edge, highlight current areas of significant clinical interest or debate, focus on a novel treatment or training regimen.

Deadline for original manuscripts  is  September 15, 2013

They must be submitted to the BJSM Editorial office by this date to be considered. Instructions to authors can be found HERE . Submissions should be sent to

In your cover letter, reference that the paper is being submitted for the AMSSMease also send an email with the title of the paper you’re submitting to both Dr. Joy ( and Dr. Logan (, and copy BJSM Editor Karim Khan, MD, PhD (

Submission of a manuscript for the themed issue does not guarantee acceptance. All manuscripts will be peer-reviewed.

The AMSSM (@TheAMSSM), one of BJSM’s 13 member societies, is excited to have this opportunity to highlight “Care of the Female Athlete” in this BJSM issue. We are confident that we can have exceptional representation from our AMSSM membership and from other contributors.

Yours in sport and exercise medicine,

Elizabeth Joy, MD, MPH

Kelsey Logan, MD

Call for papers – The ECOSEP BJSM Judo and Martial Arts Issue 2013

2 Apr, 13 | by Karim Khan

ECOSEP  Invites  Submissions for December BJSM Issue (open to authors from all countries)

JudoWe are putting together articles for an ECOSEP Judo and Martial Arts issue which will be published by the BJSM in December, 2013. We are particularly interested in articles that may influence the current practice of sports medicine and welcome submissions on a broad range of topics. Our main focus will be on Judo, but we are also interested in the other martial arts, and hope to cover sports injuries, as well as nutritional and weight management issues in these sports.

However, we also encourage any sports scientists who have done research in this area to submit articles for consideration. 

Original research involving Judo, as well as reviews and educational pieces relevant to other martial arts are welcome.  All authors will have to comply with the normal BJSM online submission process and all articles will be subject to peer review.

If you have a paper you would like to submit (or are in the process of completing relevant research) please contact Nikos Malliaropoulos (

NB. All articles must to be submitted online via the BJSM website by July 1st 2013 –  (click the ‘Submit a paper’ tab)

We look forward to hearing from you and to an excellent ECOSEP Judo and Martial Arts issue!

Nikos Malliaropoulos – ECOSEP Secretary

ECOSEP label

BJSM cover competition – round 2 (Vote now!)

21 Dec, 12 | by Karim Khan

The winner of round 1!

Thanks to everyone who voted in round 1 of our second annual BJSM cover competition. Perhaps due to flexibility envy, BJSM’s issue #2 (ECOSEP special issue) goes through to the final.

See the four awesome covers in this second round. To recap: You (and your friends) vote below for your favourite cover. One click and you would make Abe Lincoln proud. The winner of the remaining preliminary rounds joins the Hamstring Issue in the final.

We will have prizes (a draw from those who vote) in the final. Right now, vote for your favourite cover from April – June 2012. (There were 16 issues of BJSM in 2012 – because of our links with the IOC and their 4 issues dedicated to Injury Prevention and Health Promotion – see the Olympic Rings on those issue covers, e.g, Cover 7, below). If you want to vote along ‘party lines’ remember that issue 5 and 8 were guided by the AMSSM (US) and SASMA (South Africa) respectively. BJSM has 12 actively engaged member societies.

Cover 5

Cover 5

Cover 6

Cover 6













Cover 7

Cover 7


Cover 8

Advances in Sports Cardiology supplement: 17 terrific open access articles!

30 Oct, 12 | by Karim Khan

17 fantastic articles from leading experts comprise BJSM’s Advances in Sports Cardiology supplement. From:

…Hot debates in US vs European approaches…

Ventricular arrhythmias, stress, and adaptations associated with endurance sports athletes …

To… Peripheral vascular structure and function in hypertrophic cardiomyopathy…

This supplement is packed with variety and quality.

What’s more — all articles are open access (thanks to Aspetar Hospital, Doha, Qatar).

and they are available online now.

Check it out here, or via the links below.




Advancing sports cardiology: blue sky thinking in Qatar. Bruce Hamilton, Mathew G Wilson, Hakim Chalabi. Br J Sports Med 2012;46 i1 Open Access

Sports cardiology: current updates and new directions. Mathew G Wilson, Jonathan A Drezner. Br J Sports Med 2012;46 i2-i4 Open Access

Cardiac screening: time to move forward! Mats Borjesson, Jonathan Drezner. Br J Sports Med 2012;46 i4-i6 Open Access

Standardised criteria for ECG interpretation in athletes: a practical tool. Jonathan A Drezner. Br J Sports Med 2012;46 i6-i8 Open Access


Current updates


Debate: challenges in sports cardiology; US versus European approaches. Bruce Hamilton, Benjamin D Levine, Paul D Thompson, Gregory P Whyte, Mathew G Wilson Br J Sports Med 2012;46 i9-i14 Open Access

Aetiology of sudden cardiac death in sport: a histopathologist’s perspective. Mary N Sheppard Br J Sports Med 2012;46 i15-i21 Open Access

Impact of ethnicity upon cardiovascular adaptation in competitive athletes: relevance to preparticipation screening. Michael Papadakis, Mathew G Wilson, Saqib Ghani, Gaelle Kervio, Francois Carre, Sanjay Sharma. Br J Sports Med 2012;46 i22-i28 Open Access

The endurance athletes heart: acute stress and chronic adaptation. Keith George, Greg P Whyte, Danny J Green, David Oxborough, Rob E Shave, David Gaze, John Somauroo Br J Sports Med 2012;46 i29-i36 Open Access

Atrial fibrillation and atrial flutter in athletes. Naiara Calvo, Josep Brugada, Marta Sitges, Lluis MontBr J Sports Med 2012;46 i37-i43 Open Access

Ventricular arrhythmias associated with long-term endurance sports: what is the evidence? Hein Heidbuchel, David L Prior, Andre La Gerche. Br J Sports Med 2012;46 i44-i50 Open Access


New directions


Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum. M G Wilson, S Sharma, F Carre, P Charron, P Richard, R O’Hanlon, S KPrasad, H Heidbuchel, J Brugada, O Salah, M Sheppard, K P George, G Whyte, B Hamilton, H Chalabi. Br J Sports Med 2012;46 i51-i58 Open Access

Advising a cardiac disease gene positive yet phenotype negative or borderline abnormal athlete: Is sporting disqualification really necessary? Pascale Richard, Isabelle Denjoy, Veronique Fressart, Mathew G. Wilson, Francois Carre, Philippe Charron Br J Sports Med 2012;46 i59-i68 Open Access

Imaging focal and interstitial fibrosis with cardiovascular magnetic resonance in athletes with left ventricular hypertrophy: implications for sporting participation. Deirdre F Waterhouse, Tevfik F Ismail, Sanjay K Prasad, Mathew G Wilson, Rory O’Hanlon. Br J Sports Med 2012;46 i69-i77 Open Access

Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician. Peter J Angell, Neil Chester, Nick Sculthorpe, Greg Whyte, Keith George, John Somauroo. Br J Sports Med 2012;46 i78-i84 Open Access

Emergency cardiac care in the athletic setting: from schools to the Olympics. Brett Toresdahl, Ron Courson, Mats Borjesson, Sanjay Sharma, Jonathan Drezner. Br J Sports Med 2012;46 i85-i89 Open Access


Original articles


Do big athletes have big hearts? Impact of extreme anthropometry upon cardiac hypertrophy in professional male athletes. Nathan R Riding, Othman Salah, Sanjay Sharma, Francois Carre, Rory O’Hanlon, Keith P George, Bruce Hamilton, Hakim Chalabi, Gregory P Whyte, Mathew G Wilson. Br J Sports Med 2012;46 i90-i97 Open Access

Peripheral vascular structure and function in hypertrophic cardiomyopathy. Nicola Jayne Rowley, Daniel J Green, Keith George, Dick H J Thijssen, David Oxborough, Sanjay Sharma, John D Somauroo, Julia Jones, Nabeel Sheikh, Greg Whyte Br J Sports Med 2012;46 i98-i103 Open Access


Mechanisms, persistence, and prevention of airway dysfunction in swimmers

25 Jul, 12 | by Karim Khan

Swimming is consistently one of the most popular Olympic sports.

However, at BJSM we don’t care about Twitter gossip on Australian swimmer Stephanie Rice, nor are we particularly concerned if US Champion Michael Phelps wins more medals. We, of course, are interested in noteworthy research on swimmers’ health.


We focus today on Valérie Bougault and Louis-Philippe Boulet’s BJSM publication: Airway dysfunction in swimmers (May 2012). The authors discuss “upper and lower airway disorders in swimmers, underlying mechanisms of development and persistence, their general management and the future research needed to help understand their clinical significance in order to prevent potential long term damage to the airways.” Over 5,000 readers have accessed this paper – it’s on the way to being a landmark in the field.


Read the full article to learn more about the diagnosis, treatment and prevention of: the effects of chlorine, mechanisms of rhinitis, pulmonary/airway function changes, and their impact on athletic performance.


Bougault and Boulet’s insightful article is (free!) online here.


Want more on respiratory health in elite and amateur athletes?



BJSM special issue on intensive exercise and respiratory health (May 2012). Including:

Now the Wall Street Journal chimes in on athlete’s heart

24 Aug, 11 | by Karim Khan

Today a short link to the Wall Street Journal. [this link is to a free, shorter version of the paper – subscription version highlighted below].
BJSM Senior Associate Editor Jon Drezner is quoted liberally – all good stuff for sports medicine and for his University of Washington. Sports cardiology is a hot topic when it makes the mainstream media. We ran a sports cardiology blog yesterday — interpreting athletes’ ECG/EKG and now WSJ adds interesting new issues! Mandatory exclusion is clearly a tricky issue.

Next thing the editorial team will get accused for making this the BJSC – British Journal of Sports Cardiology!

See the links in yesterday’s guest blog (by Dr Babette Pluim – her PhD was in sports cardiology!). Also, Jon Drezner did a nice job explaining all this in his podcast!
There are key papers Online first and a couple of very interesting ones in the pipeline! Keep an eye out in the BJSC, oops, I mean BJSM for the latest in Sports Cardiology.

BJSM blogs are flagged for you on Twitter (@BJSM_BMJ). We also send other interesting links using that medium (one to two tweets per day).

Don’t forget our current home page – great IOC-supported theme issue on sport in young people and health.

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’

Osteoarthritis Prevention: Important for the Young and Old

5 Mar, 11 | by Karim Khan

In April, our special issue of BJSM reminds athletes, clinicians, and coaches that prevention of osteoarthritis is important for both younger and older athletes. Check these papers online first if you have BJSM access – otherwise they’ll be up on April 1st.

Dennis Caine and Yvonne Golightly review  the epidemiology of OA, the effect of acute injury, epiphysial growth plate injury as well as the link between level of sports participation and OA during childhood. They suggest a link between youth sports injuries (most notably in the knee or ankle) and OA. Thus, efforts to prevent sport-related early-onset OA should begin during the childhood years. (Read full article here)

On the other side of the age spectrum, Jiri Dvorak’s review stems from Klunder et al’s seminal investigation that OA of the hip was significantly more frequent in retired football players than controls.  Dvorak assesses FIFA data on injury prevention programs and injury related drug use. The team found a problem of excessive medication use in top-level female and male international football players. “Research into the early onset of osteoarthritis in sports and in particular the most popular sport, football, should include an early diagnosis of small cartilage lesions in the joints which might be treated and reduce the later onset of osteoarthritis.” (Read full article here)

Hideki Takeda et al. offer a review of OA treatments (in both athletes and non-athletes). Unfortunately, surgical or physical rehabilitation does not preclude OA in the knee, and injury prevention is therefore imperative. (Read full article here)

Thanks to Arthritis Research who sponsored the Arthritis in Sport Conference in London in October 2010 (link to BJSM October 2010)

Thanks to the IOC for their support of 4 IPHP Issues annually – see the April 2011 theme issue for the full set of key papers. This issue will be given free to all the attendees of the IOC World Conference on Prevention of Injury and Illness Prevention in Sport (Monaco, 7-9 April).

Sudden death in sport – still not sorted

12 Jan, 11 | by Karim Khan

Just a quick post getting back into the year – highlighting that the issue of managing cardiac risk factors in sports is not easy.

I was reading about various deaths in athletes when I came across this older, but interesting post.

Remember also the September 2009 BJSM which dealt specifically with cardiac issues in the athlete.

BJSM blog homepage


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