(Via timesonline.co.uk)

The doctor at the centre of the “Bloodgate” scandal at Harlequins has been suspended from practising medicine pending further investigations into her conduct.

Wendy Chapman, a hospital consultant, has been forbidden by the General Medical Council (GMC) from working as a doctor amid allegations that she deliberately cut the lip of Tom Williams, the Harlequins wing, with a scalpel in order to cover up his attempt to fake an injury using a capsule of red theatrical dye. Read more…

Click here to read the original article.

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My concern with the prophylactic use of NSAIDs occurs in endurance athletes. My anecdotal experience is that endurance runners attempting distances categorised as ultra races (ie longer than a marathon) may regularly take NSAIDs during an event in a misguided attempt to delay muscle fatigue. I have even seen NSAIDs being referred to as “Vitamin I” in some running literature.

Acute renal failure with NSAID therapy is mediated hemodynamically as a result of decreased renal perfusion after inhibition of prostacyclin synthesis. Decreased renal perfusion in ultra distance events can be caused by dehydration. Factor into the equation the muscle breakdown that occurs in these events and possible rhabdomyolysis.

This triple insult to the kidneys can lead to renal failure and dialysis, if not death. I suspect that many ultra endurance athletes, whether this be running or triathlon, are unaware of the possibility of renal failure that may occur when prophylactically taking NSAIDs during an event.

Stephen H. Boyce
Consultant Emergency Medicine
Wishaw General Hospital, North Lanarkshire, Scotland

Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

It’s out! You can stop banging your head against a brick wall in frustration. Hosted by a chapter of editors of various journals, the much-awaited Consensus Statement is out. If you are into concussion, if you treat boxers, football players, heavy metal fans who head bang, then this is for you. Vienna – OUT. Prague – OUT. Passe, done, finished kaput. The equivalent of flares and a brown suede coat for a contemporary wedding.

Zurich – BJSM carries the joint statement but also the excellent key papers that made the event unique and innovative; papers the contributed to the group drawing the conclusions they did. Download the SCAT document and side-line scoring system. Everything you wanted to know about concussion – right here, right now – BJSM Concussion. Comment on the Blog or via eletters – Do these guidelines work for you? What else do you need to take care of your athletes?

Proceedings of the 3rd International Concussion Consensus Conference
HYPERLINK “http://bjsm.bmj.com/content/vol43/Suppl_1/” http://bjsm.bmj.com/content/

By Dr Chris Milne, Sports Physician

1. What is it?

It is a disruption of some of the fibres of the achilles tendon. There may be some minor inflammation, but not as much as previously thought.

2. What causes it?

Overuse, plus some wear and tear disruption of the tendon. Poor alignment through the foot and ankle can play a part.

3. Symptoms – What you notice

• Pain – Usually worse with activity over a 2-3cm length of tendon.
• As the pain progresses you find you are unable to run as far before it comes on, and the pain may stick around for an hour or two after exercise.
• Usually there will be localised swelling at the painful site.

4. Signs – What the doctor finds

• Swelling – usually spread over a 2-3cm length of tendon.
• Tenderness – at the painful site in the tendon.
• Occasionally there may be a small very tender nodule at 0.5cm in size. This may indicate a small partial tear.
• Often associated with flat feet and over-pronation.

5. Investigations

An ultrasound scan may show the amount of fibre disruption. It can also show up a partial tear of the tendon, or associated peritendinitis. If there are significant new vessels, then adjunctive treatment may be required.

6. Treatment

• First aid – ice massage and Voltaren Emulgel are useful. If you are away from home, use some crushed ice or a packet of frozen peas wrapped in a towel.
• Rest from running until the initial soreness subsides. You should be able to continue swimming or cycling, plus gentle walking.
• Once the initial soreness has settled (usually after a week or two) you should start a progressive strengthening programme as below (see recovery sequence Step 3).
• If you have flat feet and have not been supplied with orthotics, a podiatry consultation will probably be arranged.
• If the achilles tendon is not improving despite good adherence to the calf strengthening programme of 90 repetitions per day, adjunctive treatment may be required.
• Surgery is only required if there is a significant partial tear, or if the problem has not settled much over 3-6 months.

7. Recovery time

Average recovery time is 2-4 months.

8. Recovery sequence

• Step 1 Ice packs, Voltaren Emulgel.
• Step 2 Physiotherapy – advice regarding stretching and strengthening exercises. Ultrasound therapy may be useful in some cases.
• Step 3 Progressive strengthening exercises (calf raises). Start with both legs together, and build up progressively until you can manage 3 sets of 15 single leg calf raises twice a day (90 calf raises a day). Do these off the back steps of your house.
• Step 4 Continue swimming and cycling as much as the pain will allow.
• Step 5 Restart running, beginning slowly on grass for 5-10 minutes, and build up your normal training over the next 2-3 months.

22-25 October 2008, Melbourne: 23rd ACSP Annual Conference / Football Australasia
Website: www.footballaustralasia2008.com.au/

30 October 2008, Zurich: 3rd International Conference on Concussion in Sport
Website: www.fifa.com/medical

13-15 November 2008, Dunedin: Sports Medicine New Zealand Annual Conference
Website: http://www.sportsmedicine.co.nz/

5-8 November 2008, Madeira, Portugal: 2nd International Congress of Complex Systems and 10th European Workshop of Ecological Psychology.
Website: http://www.idram.pt/2ccss/welcome/to_2ccss.html

18-13 November 2008, Barcelona: XXX FIMS World Congress of Sports Medicine
Website: http://www.fims.org/default.asp?pageID=688035705

13-14 December 2008, Thessaloniki: 1st E.C.O.S.E.P. Congress, Guidelines in Sports Medicine. When to return to play.
Website: www.ecosep.eu/1st_ecosep_congress/

28 February – 1 March 2009, Sydney: ACSP Clinical Sports Medicine
Website: www.acsp.org.au

3-7 June 2009, Vancouver: The Road to 2010 begins in Vancouver in 2009
Website: http://www.casm-acms.org/documents/PreliminaryProgramVancouver2009.pdf

14-17 October 2009, Brisbane: be active ’09 Australian Conference of Science and Medicine in Sport
Website: www.sma.org.au/acsms/2009

18-22 October 2009, Couran Cove, South Stradbroke Island : 24th ACSP Annual Scientific Conference
Website: www.acsp.org.au

12-28 February 2010, Vancouver: XXI Olympic Winter Games
Website: http://www.olympic.org/uk/games/vancouver/index_uk.asp

14-26 August 2010, Singapore: 1st Summer Youth Olympics
Website: http://www.singapore2010.sg/day/index.htm

12-27 November 2010, Guangzhou: 16th Asian Games
Website: http://www.ocasia.org/16AG.asp

27 July – 12 August 2012, London: Games of the XXX Olympiad
Website: http://www.olympic.org/uk/games/london/index_uk.asp

7-23 February 2014, Sochi: XXII Olympic Winter Games
Website: http://www.olympic.org/uk/games/sochi/index_uk.asp

BJSM Associate Editor Ron Zernicke (centre), with his wife Kathy, pictured receiving an honorary degree at Canada’s University of Waterloo.

The BJSM Blog is an ideal place to capture some of the wisdom of our wonderful cadre of Editorial Board members. We can acknowledge their pre-eminence in the field and we can learn from their advice. In the link, Ron Zernicke, one of the giants of biomechanics and sports medicine, shares a lifetime of wisdom. ‘Keep your fork’ is a wonderful symbol of his optimistic outlook on life.

“Keep your fork.” It would seem an odd thing to say to approximately 600 graduands at a university convocation, but that was exactly part of the advice that commencement speaker Ronald Zernicke gave UW’s morning graduation ceremony on Saturday.

“My mother always told me, ‘keep your fork’, because the best is yet to come,” Zernicke said smiling. “She meant dessert.”

Read More.

Dr Chris Milne, Sports Physician

1. What is it?

It is an overuse injury of the origin of the tibialis posterior muscles. There is micro-bleeding at the junction between the bone cover (periosteum) and muscle origin.

2. What causes it?

It is an overuse injury usually caused by excessive running in the presence of faulty alignment in the lower leg.

3. Symptoms – what you notice

• Pain – usually on the inside of the shin bone (tibia) extending over a length of 10-20cm. The pain is usually of gradual onset, and worst with running.
• If you have focal pain (i.e. all the pain is over a 1-2cm area) then it is possible you have a stress fracture, rather than periostitis.
• If your pain is concentrated in the muscles rather than the bone-muscle junction, then it is possible you have compartment syndrome.

4. Signs – what the doctor finds

• Tenderness – along a 10-20cm length of the inner border of the tibia if it is periostitis. Focal tenderness where the doctor can put one finger on the sore spot is suggestive of a stress fracture. Diffuse muscle tenderness is present in the case of compartment syndrome.
• Hopping on the injured leg is relatively pain free in the case of periostitis, but is very painful if a stress fracture is present.
• Over-pronating flat feet are commonly seen in those who complain of shin splint pain.

5. Investigations

Usually none are required. If a stress fracture is suspected, then an x-ray may confirm this if symptoms have been present for longer than a month. Otherwise, a bone scan is needed. Compartment pressure studies can help confirm a diagnosis of compartment syndrome.

6. Treatment

• First aid – an ice pack or ice massage can be helpful after painful activity.
• Mechanical correction of over-pronating feet is essential. A podiatry referral is recommended.
• Physiotherapy, including myofascial release and a muscle rehabilitation problem is useful.
• Surgery is only required for confirmed compartment syndrome or very severe cases of periostitis lasting many months.

7. Recovery time

Average recovery time is 2-4 weeks for periostitis, 6-8 weeks for stress fracture and several months for compartment syndrome.

8. Recovery sequence

• Step 1 Ice packs, pain relief, felt or orthotic footwear correction.
• Step 2 Myofascial release and muscle rehabilitation.
• Step 3 Continue swimming and cycling, and only restart running after at least two weeks when symptoms have settled. Start on grass initially.
• Step 4 Build up pace and add stop-start routines.
• Step 5 Run figure eights.
• Step 6 Perform cutting and turning exercises.
• Step 7 Team training and skill sessions.
• Step 8 Resume playing, half a game at first.

By Dr. Chris Milne, Sports Physician

1. What is it?

It is a disruption of the posterior cruciate ligament. This one of the main supporting and stabilising ligaments of the knee joint.

2. What causes it?

It is usually caused by a hyperextension or forced flexion injury to the knee.

3. Symptoms – what you notice

• Pain – in the middle or back of the knee which is worse with running.
• Inability to accelerate rapidly.
• Instability – if there is damage to the posterolateral complex, you may also experience instability.
• Such an injury is rare on the football field, but may occur in motocross or other high speed accidents.

4. Signs – what the doctor finds

• A positive posterior sag test – this test is performed with both knees flexed to 90°.
• A positive posterior drawer test – this test is performed by pushing the tibia (shin bone) backwards and is positive is there is pain or increased movement compared with the other knee.

5. Investigations

• X-rays are important to exclude any bony problem in the knee. It is often necessary to perform an
• MRI scan to assess any damage to other structures that may be injured in association with the posterior cruciate ligament.

6. Treatment

• First aid – an ice pack applied to the back of the knee may be helpful. Take Panadol or anti-inflammatory tablets.
• This injury is difficult to diagnose and it is often necessary to get specialist review to be sure of the nature of the problem.
• Most posterior cruciate injuries can be managed via a standard rehabilitation programme (see below).
• If there is evidence of associated damage to the posterolateral complex, surgical reconstruction should be considered.

7. Recovery time

Average recovery time is 4-12 weeks. It is about 6 months if surgical reconstruction is undertaken.

8. Recovery sequence

• Step 1 Ice packs, pain relief.
• Step 2 Regain full extension in the knee.
• Step 3 Physiotherapy supervised rehabilitation to build up quadriceps and hamstring function. This
• includes daily exercise such as stair climbing.
• Step 4 Cycling and swimming.
• Step 5 Restart gentle running and progress to stop-start then multidirectional activity.
• Step 7 Team training and skill sessions.
• Step 8 Resume playing, half game at first.

By Dr Chris Milne, Sports Physician

What is it?
It occurs when the patella moves out of its usual groove in front of the knee.

What causes it?
It is caused by a variety of factors including muscle imbalance, a small or high riding patella, a shallow groove for it to track in, plus excess joint mobility and flat feet.

Symptoms – what you notice

• Pain – usually along the inner border of the patella as the muscle attachments are torn away from the bone. The pain may be very severe.
• Deformity – the patella may appear as a lump on the outside of the knee. It usually pops back into its usual groove when you straighten your knee.
• Instability – you may lack confidence in the knee, and feel it is about to give way.
• Swelling – this usually comes on virtually immediately and is related to bleeding into the knee joint.

Signs – what the doctor finds

• Effusion – usually there is a tense swelling in the knee that will last for a week or two after the injury.
• Tenderness – usually down the inner border of the patella, related to tearing of muscle attachments as above.
• A positive apprehension sign – this occurs when the doctor tries to push your patella towards the outside of your knee.
• There may be associated flat feet, or generalised hypermobility of many joints in the body.

Investigations
X-rays can show an associated fracture of the inner border of the patella. A ‘skyline’ view is most useful for this. X-rays can also show a small or high riding patella, plus a shallow groove for the patella to track in. MRI scans are rarely needed but may show bone bruising, which is an additional clue in tricky cases; patellar instability is often quite subtle and may be overlooked by less experienced doctors. CT scans are usually only ordered if surgical stabilisation is being considered.

Treatment

• First aid – try to push the knee out straight, as this will often be enough for the patella to clunk back into its proper place. Apply an ice pack.
• Whether or not your patella is back in place, you need to go to an A & M Clinic to get the knee immobilised in a brace in full extension (out straight). Leave the brace on for 6 weeks.
• You should take painkillers or anti-inflammatory tablets regularly for the first few days after injury.
• If the blood in the joint is causing lots of pain, this can be sucked out of the joint by a doctor.
  Perform quadriceps exercises to strengthen the muscles in front of the thigh.
• If you have flat feet, orthotics can help correct the faulty alignment in your legs.
  In severe cases of recurrent patellar instability, surgery to stabilise the patella may be required.

Recovery time
Average recovery time is 4-6 weeks, but recurrences are common.

Recovery sequence
Step 1 Get the knee out straight and the patella back in position. Ice packs, pain relief.
Step 2 Immobilise the knee in a brace for six weeks.
Step 3 Perform quadriceps exercises every day.
Step 4 Physiotherapy supervised exercises when you come out of the brace.
Step 5 Cycling and swimming.
Step 6 Restart gentle running and progress to stop-start then multidirectional activity.
Step 7 Team training and skill sessions.
Step 8 Resume playing, half game at first.

Human body size and the laws of scaling: physiological, performance, growth, longevity and ecological ramifications
Edited by Thomas T Samaras
Nova Biomedicals
ISBN-10: 1600214088

Is the substantial increase in human height and weight over the last century a positive development for society and individuals within society in terms of physical performance, health and longevity? If this question generates a personal interest then this book on human body size is worth finding. The content and material in this book are primarily directed towards clinicians and researchers interested in the area of scaling in biology and medicine, and general readers who find these questions a welcome diversion from their own activities.

Among the topics and questions explored are the advantages and disadvantages of greater human height; relationships between body height and weight and chronic disease and longevity; the obesity epidemic related to birthweight; the evolutionary ecology of humans with reference to body size; and the impact of body size on social, political and economics issues such as resources, pollution and the environment.

This is unashamedly a quantitative and experimental book. However, the authors wisely devote an early chapter to introducing the mathematical concepts of human scaling, allometry and isometry. The methods for estimating changes in parameters representing human size (including height, weight, volume, surface area, strength, and acceleration) based on the laws of scaling, geometry and physics are well-described. There is detailed treatment of the Body Mass Index (BMI), which retains popularity in medical and industry circles despite some of its shortcomings highlighted in the peer-reviewed literature.

The reference period of the work covered in this book is generally years to decades, which makes a change for the busy sports medicine practitioner whose timeframe is often days to weeks. The discussion of changes over the last 100♣years provides a longer-term frame of reference for evaluating the impact of the substantial increases in stature, mass, body mass index and longevity. There are also useful insights into the obesity epidemic that now challenges practitioners and policymakers around the world. This public health issue has seemingly arisen quickly over the last decade or two and the underlying experimental and epidemiological work discussed in the book is pertinent and well-received.

Much of the book is directed toward health, longevity, lifestyle and disease issues rather than sports medicine per se. In terms of sports medicine there is little of direct interest to the sports medicine practitioner or sports performance researcher. However, there is only limited treatment of scaling of physiological measures (such as maximal oxygen uptake, and muscular strength and power) that influence sports performance.

The format of the book consists of 14 individual chapters and a useful appendix detailing symbols, acronyms and abbreviations used throughout the book. There is liberal use of informative sub-headings in most chapters, which makes it a bit easier for the general reader to access the information. One or two of the chapters examining the research on gene knockout and transgenic mice are a little more challenging and best left to the specialist reader. The book is extensively referenced with a small selection of illustrative material.

Only three authors contributed to the book, so it is not overtly a broad-scale collaborative effort. In fact, two of the three authors contribute 13 of the 14 chapters, so it is really a two-handed effort. Nonetheless, this book is worth a read for those with an interest in the evolutionary issues of human size and the impact of longevity, health and physiology. Familiarity with a quantitative rather than a qualitative approach will be useful for readers wishing to tackle this book.

Review by David Pyne
Department of Physiology, Australian Institute of Sport