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Young people: Neuromuscular skills for Sport Performance

24 Jul, 17 | by BJSM

 Part-3 (of 3) of the blog mini-series on youth

Dr Nicky Keay nickykeay

Many publications report concerns over low exercise levels in young people. At the other end of the spectrum there are potential pitfalls to be avoided for young athletes. Some aspects have been discussed in my previous blogs: health and fitness in young people and optimising health and fitness for young people, below are some updates.

Supporting previous publications that exercise in young people improves cognitive and academic performance, research found that in boys, delay in reading skills was associated with high levels of sedentary time combined with low levels of exercise. Low muscle tone, associated with lack of exercise is also proposed as potential inhibitor of learning in children. Lack of physical activity, coupled with unfavourable body composition in young people is linked with adverse outcomes for bone development and cardio-metabolic disease in adults. Now there also appears to be long term consequences for cognitive ability and neuromuscular skills.

For young people already involved in sport training, the same principles apply in that this represents the optimal time in life for development of not only physical fitness such as CV fitness, muscular strength and endurance, but also neuromuscular skills. All these factors are important to enhance sport performance and to avoid injury. The risk of injury is more prevalent in early sport specialisation, so any strategies to minimise injury risk is important. For example, periodised strength and conditioning with neuromuscular training to reinforce the acquisition of a diverse range of motor skills. In other words to combine both health related physical fitness (eg. CV fitness) with skill related fitness (eg. co-ordination). The Pilates style body conditioning which I teach for young people, includes developing flexibility, proprioception, core stability, balance and co-ordination which are applicable for all sports.

Collaboration with coaches, sports clubs, physiotherapists and other health care professionals is required to support young people and their families in optimising health and fitness.


Health and fitness in Young People

Optimising Health and Fitness for Young People

Reading skills in sedentary boys

Muscle tone and leaning in children

Factors impacting bone development

Optimal Heath especially for Young athletes! British Association of Sport and Exercise Medicine

The role of Pilates in facilitating sports performance


Announcement of winners! 2017 BJSM PhD Academy Awards

21 Jul, 17 | by BJSM

By Alan McCall

The hard work of PhD candidates and their innovative findings are integral to moving our field forward. They provide evidence based practical recommendations for clinicians and practitioners. The BJSM PhD Academy Awards recognise and celebrate the contribution of younger and emerging leaders.

The ‘People’ and the ‘Editors’ have voted for the inaugural BJSM PhD Oscars! Thanks to all of you who engaged via the BJSM blog – we were delighted to see votes from all over the world for the People’s Choice award.

The People’s Choice Award:

Voted for by the BJSM readership through social media outlets, the winner is…

Dr Ryan Timmins for his thesis entitled: Biceps femoris architecture: the association with injury and response to training. (watch video HERE)

The Editors’ Choice Award:

For the Editors’ Choice Award, each PhD summary was graded based on 6 categories: 1) Novelty, 2) Rationale, 3) Methods, 4) Ambition, 5) Practical applications and 6) Perceived reach. The winner of the BJSM PhD Academy Award is…

Dr James O’Brien for his thesis entitled: Enhancing the implementation of injury prevention exercise programmes in professional football

(watch video HERE)



Here’s our interview with each winner:

Ryan Timmins

Congratulations! How does it feel to hold the People’s Choice ‘Oscar’?
It’s a big shock to be completely honest. I didn’t expect it at all. To be up against some amazing researchers and come out on top, is surprising. The work that Guus Reurink and James O’Brien are doing will have an impact on sports medicine for years to come. It’s a great initiative from BJSM to promote the work of some great PhDs within the field.

What’s the elevator pitch for your thesis?

Hamstring injuries are the most common injury in elite sport and although research in this area is increasing, injury rates aren’t dropping. I identified different factors, mainly muscle structural components, which are associated with an increased risk of injury;   interventions can alter these characteristics of muscle.

What was your most noteworthy finding? 

In elite soccer players, short muscle fascicles (a bundle of fibres – which can be assessed via ultrasound) increases the risk of future hamstring strain injury. This is a previously unidentified risk factor and one which is now being considered within injury prevention and rehabilitation programs.

What was your most significant personal or professional learning that came out of the project?

That research within elite sport medicine isn’t impossible, despite the common view here in Australia that it is. There’s moments where you need to consider all views etc, but being approachable and working well with the sporting clubs enables a mutually beneficial result. Sometimes egos need to be checked at the door and this takes a bit of time to get past for some.

What’s next for you? How can research progress further?

There’s plenty of space now to look at interventions to modify these variables and thus decrease the risk of injury. However, the big leap will be implementing these evidence based interventions within elite populations. It isn’t impossible, but one which will take a bit of massaging to happen. It’s an implementation challenge.

Where are you working now?

I’m at Australian Catholic University in Melbourne, still working closely with Dr David Opar (my PhD supervisor) in the area of hamstring injury prevention and rehabilitation. I also hold a position at the Melbourne Victory Football Club, which helps in understanding some of the limitations with implementing research within the sporting sphere.

Any special thank-yous / shout outs?

As always this is never an individual effort. This whole PhD and awards process wouldn’t have happened without a great team of people:

Anthony (Das) Shield: now an Associate Professor who always provided great insight and direction and is always a wealth of knowledge. Without him, a lot of the people in this thank you list wouldn’t even be in research (myself included); David Opar: one of the greats and one who will continue to change sports medicine research now and into the future; Morgan Williams: the magic man responsible for anything interesting in our papers. We have him to thank for his tireless hours with JMP and trying to bash our stats into something understandable. Also thank you to all my other co authors and ripper blokes (and Casey) from our research group: Christian Lorenzen; Nirav Maniar; Joshua Ruddy; Jack Hickey; Joel Presland; Matthew Bourne; Chris Pollard; Dan Messer; Steven Duhig; Casey Sims; Argell San Jose.

James O’Brien

Congratulations! How does it feel to be the Editors’ Choice? (for the grammar pundits, it’s Editors’ choice because there are 3 Editors of the BJSM)…

I’m really honoured to have my work recognised in this way, especially considering the strength of all the nominees’ projects. The positive feedback I’ve received this past week from both researchers and clinicians also means a lot.

What’s the elevator pitch summary of your thesis?

Football is the world’s most popular sport, but injuries are common. Specific exercise programs can drastically reduce the number of injuries, but a lot of teams choose not to use these programs, or don’t perform them correctly. I asked “Why is this?”, with the aim of improving use of these exercise programs, and hence preventing more football injuries.

What did you discover? 

The most important finding was the wide range of barriers and facilitators to implementing injury prevention programs. This is important because these factors directly influence the ultimate success of these programs, when teams employ them under real world conditions.

What was your most significant personal or professional lesson? 

As I come from a clinical background, the biggest lesson for me was that conducting and reporting high quality research is really hard work. I developed huge respect for top-level researchers in sport and exercise medicine, especially those few who manage to combine both research and clinical work at a high level.

What’s next for you? 

Important steps are understanding what components of injury prevention exercise programs are crucial to their success, along with the required dosage. There’s also a need for innovative ways of harmonising injury prevention with other important goals in the football environment, especially performance goals. Future injury prevention requires multi-faceted strategies that embrace the complexity of the environments in which they are delivered.

What are you doing now?

I’m extremely fortunate to be working in one of the world’s leading football academies at Red Bull Salzburg. My work involves a combination of injury prevention research and practice, along with physiotherapy treatments and supervision. In the academy, I’ve been able to directly apply the important lessons I’ve learnt from my PhD. We’ve enjoyed big injury reductions, along with significant sporting success, including winning the UEFA Youth League.

Any special thank-yous/shout outs?

Most of all I want to thank my wife and children  for supporting me through my PhD. The trials and sufferings of PhD students are well known, but those of their partners and families often go unheard. A huge thank you to my supervisors Professor Caroline Finch and Associate Professor Warren Young, along with the whole team at ACRISP, Federation University Australia, who are all conducting very important research. I also want to thank my colleagues in the medical team at the Red Bull Academy; I cannot imagine a finer group of people to work with. Finally, thanks to BJSM for drawing attention to the contribution PhD students make to sport and exercise medicine

Editors’ notes: Big thanks to BJSM Senior Associate Editor Dr Alan McCall who runs this part of the BJSM. Every element of BJSM takes a ton of work and we have sportsmedicine’s best team – by a mile!  Kudos to all whose work is published in this monthly BJSM feature, part of the new-look colour BJSM which launches in January 2018. 

Professor Jill Cook to present workshops in Vancouver for Physios and RMTs

19 Jul, 17 | by BJSM

Don’t miss this rare opportunity!

One of the world’s leading experts on tendons and tendinopathy is coming to Vancouver to run symposia and workshops for physiotherapists and registered massage therapists.

Fresh from her sold-out workshops and lectures in France, Spain and the UK, Professor Jill Cook will run two 1-day symposia with accompanying masterclasses on two consecutive weekends in August.

For physiotherapists: August 12th and 13th

For registered massage therapists: August 19th and 20th

Check out for more info!

For Physiotherapists

Clinical Tendon Symposium for Physiotherapists with Professor Jill Cook


  • August 12 Symposium (lecture-style); 9 am – 4:30 pm
  • August 13 exclusive 25-spot masterclass (must also register for August 12 symposium); 9 am – 4:30pm

About the Symposium:
The course will focus on management of clinical cases and you will be encouraged to contribute clinical scenarios ahead of the symposium.
The learning objectives of the symposium will mean that after the course you will:

  • Be able to confidently distinguish tendon pain from other causes of patient pain
  • Know when to ignore/downplay imaging (Ultrasound, MRI) information about patients in relation to tendon pain
  • Assess the patient’s capacity and devise a treatment program to address specific limitations in capacity that are relevant for that patient’s goals
  •  Be aware of the rationale for the 4-stage treatment approach that includes isometric strengthening, isotonic exercises, energy storage exercises and sport-specific rehabilitation

Symposium Fee: PABC members and SPC members $215; non-members $250. This course is restricted to physiotherapists.

Location:  2111 LT – Chan Lecture Theatre @ BC Children’s Hospital Research Institute

About the Masterclass:
Professor Cook is also holding an additional 1-day masterclass on Sunday, August 13th. This will include a round-table discussion of topics from the Saturday in further detail as well as clinical assessment of cases in the areas of…

  • In-season treatment of tendon pain
  • Insertional tendon problems
  • The patient who has seen everyone
  • More detailed exercise demonstration for the 4-step program.

Masterclass Fee: $335 (+ Cost of symposium)

LocationThe Centre for Hip Health and Mobility at the Robert H.N. Ho Research Centre, 2635 Laurel St., Vancouver

Registration and attendance at the symposium is the pre-requisite for the masterclass. This masterclass is only open to PABC and SPC members; the total fee for both days is $550. Only 25 spots available for this exclusive masterclass.

For Registered Massage Therapists

Clinical Treatment Symposium for Registered Massage Therapists


  • August 19 Symposium (lecture-style); 9 am – 4:30 pm
  • August 20 exclusive 25-spot masterclass (must also register for August 19 symposium); 9 am – 4:30pm

About the Symposium:

After the course you will…

  • Know how to assess the patient with lower limb pain
  • Understand the red flags that should result in referral
  • Know the scientific underpinning of exercise-based treatment
  • Be aware of the evidence for remedial massage therapy in tendon injury
  • Have an Introduction to Cook-Purdam continuum model to approach treatment and the 4-step treatment model
  • Gain insight into building your private RMT business- MBA tips without doing an MBA!

Course Fee:

  • RMTBC members and SPC members: $215
  • Non-members: $250

Location:  2111 LT – Chan Lecture Theatre @ BC Children’s Hospital Research Institute

N.B. This course is for Registered Massage Therapists. 

About the Masterclass
Professor Cook is also holding an additional 1-day masterclass on Sunday, August 20th. This will include a round-table discussion of topics from the Saturday in further detail as well as…

  • Clinical cases applying the Cook-Purdam continuum model to approach treatment
  • Clinical cases applying the 4-step treatment model in practice
  • Marketing principles for your private practice – ethical ways to generate referrals

Course Fee: $335 (+ Cost of symposium)

Location: The Centre for Hip Health and Mobility at the Robert H.N. Ho Research Centre, 2635 Laurel St., Vancouver
Registration and attendance at the symposium is the pre-requisite for the masterclass.

Mental health in professional football: compromised care and strategies for change

17 Jul, 17 | by BJSM

By Andrea Scott-Bell

Aaron Lennon’s Sectioning under the Mental Health Act on May 2nd is the latest addition to the list of professional footballers experiencing mental health difficulties.

Photo by Tom Pennington/Getty Images

The day after news broke of Lennon’s detention, the PFA claimed that mental health issues among footballers were on the rise, with 160 reported cases in the previous year. Unlike broader contexts where we have seen a decline in mental health services (1), professional football can afford the best healthcare resources, and yet, mental health concerns continue to increase. Why is the reporting of mental health on the increase within this sport and how are doctors and healthcare professionals able to respond to this?

The Culture of Professional Football

There is considerable research that emphasises the role sport and physical activity can play in the prevention and treatment of mental health conditions such as mild to moderate depression (2). However, this relationship is not entirely straightforward or unproblematic. Studies also show how everyday demands and workplace practices in professional sport can contribute to mental health conditions in athletes. This research delves beyond popular, simplistic representations of professional sports as arenas characterised by fit, highly skilled bodies and minds, huge financial rewards, luxurious treatment and public adoration. Indeed, Lennon’s story highlights that mental health issues do not discriminate against background, profession, or wealth.

So, what are some of the reasons that contribute to the increase in mental health issues within professional football? Evidence suggests that problems stem from the sporting culture in which players are enmeshed. For example, studies have shown that professional footballers’ work is characterised by uncertainty (contracts, injuries, and relocation), paranoia, loneliness, superficial working relationships and mistrust of others. These issues are connected to certain forms of occupational masculinity, which discourage players from revealing and discussing weakness with others. Indeed, players fear that the disclosure of mental health issues could lead to their stigmatisation; one that will endanger their continued employment in this highly competitive industry.  Arguably then, it is these deeply embedded subcultural norms that lead players to both experience and hide mental health difficulties from those who are responsible for their welfare and well-being. These include coaches, managers, and, importantly, medical professionals employed by football clubs.

Mental Health Support for Active Footballers

In order to remedy this situation, the PFA have initiated a series of support services including access to a 24-hour counselling helpline, a self-help publication, and affiliation to A Sporting Chance (a respite clinic set up by former footballer Tony Adams). Notwithstanding this support, it is not surprising that 98 of the 160 calls to the PFA’s counselling helpline were from former footballers no longer hampered by the parameters of football industry. The minority of current players who have contacted the PFA’s services is bound to represent the tip of the iceberg and tells us a great deal about the constraints of the social setting that footballers are enmeshed and why effective management of mental health difficulties is limited during footballers’ playing careers. Explicitly, the specificities of medical support in football raise a series of further problems:

1) Footballers often rely on the services of club doctors rather than being registered an independent GP, compromising what they may wish to disclose in this context.

2) Despite the PFA’s recommendation that players first seek support from club doctors (4), most are appointed on part-time contracts, and are therefore less able to provide regular support in a confidential environment.

3) The physical environment of the football club comprises shared medical facilities that limit chances for players to access private spaces when medical staff are in attendance

3) Treatment is often sourced on the basis of trust (usually the physiotherapist) rather than medical expertise (medical doctor) and physiotherapists are less certain of the appropriate referral procedures and available treatments

4) Conflicts of interest between physiotherapists and managers are well documented, and this may lead to breaches to the ethical conventions of patient confidentiality

5) Where specialist services are available within clubs (e.g. sports psychologists) their remit is skewed toward performance-enhancement over player wellbeing.

These compromises to the make-up of medical care for current footballers, combined with the subcultural constraints of football clubs, are fundamental to the barriers footballers face in reporting mental health problems while actively playing. Mental health continues to be particularly well hidden within sport and this context poses particular challenges. Nevertheless, if elite athletes are enabled to speak about mental health more openly, mental health services/charities will be able to better challenge the prevailing stigma. Concomitantly, without substantial improvements in the training needs of sports clinicians related to mental health, satisfactory reporting mechanisms, appropriate physical location and autonomy of medical staff vis-à-vis others in clubs, we are bound to see more athletes only reaching out when they hit crisis point or, most worryingly, when it is too late.


(1) Lancet Global Mental Health Group. Scale Up Services for Mental Disorders: A Call to Action. The Lancet. 2007;370 (9594): 1195-1197

(2) Rosenbaum S, Tiedemann A, Sherrington C. Physical Activity Interventions for People with Mental Illness: A Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry. 2014;75(9): 964-974

(3) Roderick M. The Work of Professional Football: A Labour of Love? Oxon: Routledge; 2006

(4)The Professional Footballers Association. Available from: [Accessed 15th May 2017]


Andrea Scott-Bell PhD, FHEA, Senior Lecturer Sociology of Sport/Sport Development, Department of Sport, Exercise and Rehabilitation

Exercise and fitness in young people – what factors contribute to long term health?

14 Jul, 17 | by BJSM

Part-2 of the blog mini-series on youth

By Dr Nicky Keay

Recent reports reveal that children in Britain are amongst the least active in the world. At the other end of the spectrum there have been a cluster of articles outlining the pitfalls of early specialisation in a single sport.

Regarding the reports of lack of physical activity amongst young people in Britain, this is of concern not only for their current physical and cognitive ability, but has repercussions for health in adult life. Research demonstrates that young people with low cardiovascular fitness have an increased risk of developing cardiovascular disease in adult life. Conversely, the beneficial effects of weight bearing exercise in prepubescent girls has been shown to enhance bone mineral density accumulation, which will have beneficial impact on peak bone mass. However, as I found in my longitudinal studies, the level of exercise has to be in conjunction with an appropriate, well-balanced diet to avoid relative energy deficiency deficiency in sport (RED-S), which can compromise bone mineral density accumulation.

At the other end of the scale, early specialisation in a single sport does not necessarily guarantee long term success. Rather, this can increase the risk of overuse injury in developing bodies, which in turn has long term consequences. Ensuring that all elements of fitness are considered may be an injury prevention strategy. I agree that injury prevention can be viewed as part of optimising sports performance, especially in young athletes for both the present and in the long term.

Sleep is a vital element in optimising health and fitness, especially in young people who may be tempted to look at mobiles or screens of other mobile devices which delays falling asleep by decreasing melatonin production. Sleep promotes mental freshness and physical elements such as boosting immunity and endogenous release of growth hormone. As Macbeth put it, sleep is the “chief nourisher in life’s great feast”.

A balanced approach to health and fitness should be promoted, with young people encouraged to take part in a range of sporting activities.


Young athletes’ optimal health: Part 3 Consequences of Relative Energy Deficiency in sports Dr N. Keay, British Association Sport and Exercise Medicine, 13/4/17

Sleep for health and sports performance Dr N. Keay, British Journal Sport Medicine, 7/2/17

Optimising health, fitness and sports performance for young people

Telegraph article

Active Healthy Kids global alliance

Poor cardiovascular fitness in young people risk for developing cardiovascular disease 

Sports Specialization in Young Athletes

IOC consensus statement on youth athletic development British Journal Sport Medicine






Going viral with key SEM messages

11 Jul, 17 | by BJSM

Undergraduate perspective on Sport & Exercise Medicine – a BJSM blog series

By Jonathan Shurlock (@J_Shurlock)


This blog looks at ‘viral’ spread. No, not the relationship between viral infections and athletes that have been explored previously, 1,2 but rather viral SEM messages in social media. The term ‘viral media’ was first used by Douglas Rushkoff to describe the mass circulation of content amongst the population. The term is spreading fast, with every day seeming to bring a new ‘viral video’ to our attention on every available social media platform.

We do not need to revisit the statistics in great detail here, even a cursory search shows an increase in our time spent online, and that an ever larger portion of this time is devoted to social media. In addition, there is much debate regarding the human attention span, and whether it is indeed shrinking in part due to rapid exposure to sound bites and memes generated by social media.

Looking at videos specifically, where else to look but YouTube. At the time of writing the 3 most viewed videos on YouTube have 2.882, 2.860 and 2.608 billion views respectively. Inevitably, these include a video from the pop star that everyone hates to love, Justin Bieber. Searching for ‘Sport and Exercise Medicine’ brings up around 1,610,000 hits. The 3 videos with the most views have 25,000 – 60,000 views. While not quite reaching a view count of over a third of the world population, the target audience is admittedly smaller. Expanding our search slightly further, we come across a few videos relevant to the world of SEM which have managed to have an even greater impact:

In an entertaining TEDx talk, Charles Eugster explores the topic of increasing obesity in a video titled: ‘Why bodybuilding at age 93 is a great idea’. Charles identifies the increasing problems seen as a result of increased levels of physical inactivity. Have a watch and see what you think of his reflections:

(insert: )

We couldn’t talk about SEM videos without a mention of Dr Mike Evans incredible 23 and ½ hours’ video; which has seen a surge in views of late (apparently due to a feature in the Netflix show ‘Orange is the New Black’). Currently sat at over 5.3 million views, Dr Evans’ video seems to encapsulate all the aspects of a successful video with significant impact. Relatively short at just over 9 minutes, long enough to be worth watching, but short enough to maintain our apparently waning attention spans.  Dr Evans explores a vital topic of sedentary behaviour with some engaging animation. The 23 and ½ hours video has been explored before on the BJSM blog here and here, so lets refresh your memory:

(insert )

Dr Evans has plenty of other equally informative videos that are well worth a watch, and can be found HERE.

We know that brief interventions can be beneficial and cost effective4, so is there a place for videos such as these to be used as tools in our everyday clinical practice?

Anecdotally I often hear ‘my patient is too unwell to exercise’ as a reason for not discussing physical activity in the inpatient setting. Obviously there are limitations on the role of physical activity in the setting of acute illness, but the reality remains that physical activity is simply not a priority topic for many practicing clinicians.

As Professor Dame Sally Davies announces her plan to utilise genomics in order to continue to shape cancer treatment and personalise medicine, are we not missing an opportunity to be discussing the fact that physical activity is associated with a 20% RISK REDUCTION IN BOWEL CANCER5 or how about a 14% RISK REDUCTION IN BREAST CANCER?5 While genomics and personalised cancer treatment have their important roles in effective healthcare provision, are we at risk of overlooking the importance of physical activity in the pursuit of ever more complex and (at times) expensive treatments?

Once again, we revisit the importance of physical activity and the difficulty with encouraging those with sedentary lifestyles to engage with it. What insights do these videos give us into successful attempts to capture the interest of the general population with these important health messages? Is it all in the design or does the message matter the most? Thoughts welcome!


  1. Roberts JA, Wilson JA, Clements GB Virus infections and sports performance a prospective study. British Journal of Sports Medicine 1988;22:161-162.
  2. De Araujo, Maíta Poli et al. “Prevalence of Sexually Transmitted Diseases in Female Athletes in São Paulo, Brazil.” Einstein1 (2014): 31–35.
  3. Jenkins, Henry; Ford, Sam; Green, Joshua (2013). Spreadable Media: Creating Value and Meaning in a Networked Culture. New York: NYU Press.
  4. GC V, Wilson EC, Suhrcke M, et al. Are brief interventions to increase physical activity cost-effective? A systematic review. Br J Sports Med Published Online First: 05 October 2015.
  5. Kyu H, Bachman V, Alexander L, Mumford John, Afshin A, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 BMJ 2016; 354


Jonathan Shurlock is an academic foundation year 1 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series.

Synthetics ligaments in the knee: Deja vu or innovation ?

6 Jul, 17 | by BJSM

By Lars Engebretsen MD, PhD.

Are you old enough to remember these orthopedic implants: GoreTex, Dacron, Polyester, Polypropylen, or carbon fibers? Let me remind you that these were not raincoats, mountaineering apparel or shoelaces— they were knee ligament substitutes!

I am old enough to have tried these as substitutes for torn ACL or PCL, or augmentations for knee and ankle ligaments. The promise? Speedy return to sports. However, invariably it resulted in a shortened sports career.  The synthetic ligament had two end points: either early synovitis due to the knees reactions to the foreign body or worse, material failure of the synthetics and spreading of intraarticular particles resulting in catastrophic cartilage damage, bony erosions and eventually premature osteoarthritis

Why a blog about this now? I just returned from the ISAKOS (International Society of Knee Surgery and Orthopedic Sports Medicine) congress in Shanghai. 5000 surgeons from all over the world witnessed news in sports traumatology. Unfortunately they also listened and watched new talks, symposia and poster sessions on synthetics as ligament substitutes. In fact, the very first video demonstration – a highlight lecture – featured synthetics.

As in the late 70s and early 80s, the basic science evidence for graft substitutes is flimsy. The industry data is proprietary — unavailable for scientific discussions. The industry does not want to share among competitors. It goes beyond my understanding how the FDA and EU regulators can approve products without what I believe to be valid basic science. Very few, if any academic groups are doing research in this area. My anxiety is that we are repeating the mistakes of the 70s and 80s in our quest to achieve an early return to sports and prolonging some veteran careers veterans.

Perhaps there is a need for synthetic augmentation in some cases of multiligament injuries, but this use must be based on solid basic science. Biomechanical and molecular biology materials testing, small and large animal trials, and controlled, pilot studies for new materials are needed. Industry has a large responsibility for this if they are promoting synthetics ligament implants.

Remember, as sport medicine physicians our prime task is: Do No Harm! And I can tell you from personal experience — synthetic ligament substitutes have resulted in much harm and sorrow for our patients. Our task is to challenge industry to invest and publish basic science research in this field. Stay far away from synthetic ligament substitutes until this is accomplished!


Professor Lars Engebretsen has published over 400 articles and book chapters, with a citation index (H-index) of 56. He is among the world’s most productive researchers. He uses clinical, epidemiological and basic science methods to address questions in the areas of general sports medicine, knee ligaments, cartilage as well as the prevention of sports injuries and illnesses.

He was inducted into the AOSSM Hall of Fame in July 2015 and became an ESSKA Honorary member in 2016 and an ISAKOS Honorary member in June 2017 . He received the Nordic Prize in Medicine in 2016.

Inaugural BJSM PhD Academy Awards 2016-17: Vote for the “People’s Choice Award” NOW

3 Jul, 17 | by BJSM

By Alan McCall

Welcome to the inaugural 2016/17 PhD Academy Awards. We put out a call for recently completed PhD candidates to submit a summary of their thesis. We asked them to highlight 4 key points:

  1. What did I do?
  2. Why did I do it?
  3. What did I find? And;
  4. What are the most important clinical/practical applications?

At the BJSM, we greatly value the contribution innovation brings to clinical and practical settings. Research ensures that our knowledge and practice is continually advanced through scientifically robust ways and ultimately improves our decision making and care given to patients, athletes, players and clients.

The purpose of the PhD Academy Awards is to recognise and celebrate the individuals undertaking such integral and meaningful work in the sports medicine and science industry.


We have had a fantastic response and influx of submissions since launching with the call  in summer 2016. To date we have peer reviewed, accepted and published (online first or in print edition) 10 nominees’ PhD summaries.

The official voting period for the class of 2016/17 begins NOW and you can cast your vote on the poll at the end of this blog.

We will grant awards to two PhD summaries:

  1. One will be voted for internally by the BJSM Editorial group – ‘The BJSM Editors Choice’ and;
  2. Our readers (that means you)will vote for the second via the poll at the bottom of this blog – ‘The People’s Choice Award’.

Voting for the People’s Choice Award will open on Monday 3rd July and will close on Sunday 9th July (BST).

We will announce the Editors’ Choice and the People’s Choice Award on the blog the following week.

We ask that you consider the novelty/originality of the PhD thesis, the ambitiousness, the robustness of scientific methods and your perceived overall clinical/practical impact.


The winner of the Editors’ Choice Award will receive registration to the 2018 Football Medicine Strategies Conference in Barcelona in addition to a place on the scientific program.


The People’s Choice Award winner will be able to choose from a selection of top Sports Medicine/Science books including Brukner and Khan’s Clinical Sports Medicine and Bahr and Engebretsen’s International Olympic Committee Sports Injury Prevention handbook.


Below, you will find the list of nominees and a link to 1) their PhD Academy Award manuscript and 2) a link to a ‘why vote for my PhD’ video (for those nominees submitting a video).

We look forward to celebrating the contributions made by all of the nominees and welcome submissions from the new class of 2017/18.

2016/2017 PhD Academy Awards nominees

Anna E Saw (watch video HERE)

Self-report measures in athletic preparation

Anne Fältström (watch video HERE)

One ACL injury is enough! Focus on female football players

Eric J Hegedus (watch video HERE)

The association of physical performance tests with injury in collegiate athletes

Gustaaf Reurink (watch video HERE)

Managing acute hamstring injuries in athletes

Jaclyn B Caccese (watch video HERE)

Head accelerations across collegiate, high school and youth female and male soccer players

James O’Brien (watch video HERE)

Enhancing the implementation of injury prevention exercise programmes in professional football

Matthew J Cross

Dr Matthew Cross: epidemiology and risk factors for injury in professional rugby union

Ryan Timmins (watch video HERE)

Biceps femoris architecture: the association with injury and response to training

Stephanie R Filbay (watch video HERE)

Longer-term quality of life following ACL injury and reconstruction

VOTE NOW: By clicking on your choice below 

POLL NOW CLOSED (votes no longer count)

Optimising Health, Fitness and Sports Performance for young people

30 Jun, 17 | by BJSM

Part-1 of the blog mini-series on youth

By Dr Nicky Keay

Young people need information in order to make life decisions on their health, fitness and sport training with the support of their families, teachers and coaches.

As discussed in my previous blog anima sana in corpore sano, exercise has a positive effect on all aspects of health: physical, mental and social. The beneficial impact of exercise is particularly important during adolescence where bodies and minds are changing. This time period presents a window of opportunity for young people to optimise health and fitness, both in the short term and long term.

The physical benefits of exercise for young people include development of peak bone mass, body composition and enhanced cardio-metabolic health. Exercise in young people has also been shown to support cognitive ability and psychological wellbeing.

Optimising health and all aspects of fitness in young athletes is especially important in order to train and compete successfully. During this phase of growth and development, any imbalances in training, combined with changes in proportions and unfused growth plates can render young athletes more susceptible to overuse injuries. A training strategy for injury prevention in this age group includes development of neuromuscular skills when neuroplasticity is available. Pilates is an excellent form of exercise to support sport performance.

In athletes where low body weight is an advantage for aesthetic reasons or where this confers a competitive advantage, this can lead to relative energy deficiency in sport (RED-S). Previously known as the female athlete triad, this was renamed as male athletes can also be effected. The consequences of this relative energy deficiency state are negative effects on metabolic rate, menstrual function, bone health, protein synthesis and immunity. If this situation arises in young athletes, then this is of concern for current health and may have consequences for health moving into adulthood.

A well informed young person can make decisions to optimise health, fitness and sports performance.

Link to Workshops


Optimal Health: Especially Young Athletes! Part 3 – Consequences of Relative Energy Deficiency in Sports Dr N. Keay, British Association Sport and Exercise Medicine 13/4/17

Report from Chief Medical Officer

Cognitive benefits of exercise

Injuries in young athletes

Young people: neuromuscular skills for sports performance

IOC consensus statement

Health and fitness in young people



Australian Sports Anti-Doping Authority (ASADA) – Level 1 Anti-doping E-Learning course. A free online anti-doping course everyone should do.

26 Jun, 17 | by BJSM

By Nat Sharp and Nash Anderson @sportmednews

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” – Hippocrates.

To ensure clean, fair and safe sport, anti-doping measures are essential.

ASADA (The Australian Sports Anti-Doping Authority) is an Australian Government statutory authority tasked to eliminate sports doping and to protect Australia’s Sporting integrity. ASADA works with National Sporting Organisations to implement its policies, and has now created a free course to help educate the public. It is not only athletes who need to understand these policies. All support staff are required to not only understand, but to also follow anti-doping regulations. Support staff have a major role over not only what athletes are eating and drinking, but what supplements and medications are being taken.

Doping infringements are very serious with ineligibility periods ranging from 1-4 years. A sanction means that you are banned from competing in any sport sanctioned by a National Federation, coaching, working in sport and even training with your team. As anti-doping guidelines are constantly changing, so it is imperative that all of the athlete’s network are aware of not only what is allowed or prohibited, but also how to check these substances before the athlete uses them.

The ASADA Level 1 anti-doping course is a free e-learning initiative designed to educate athletes, support staff and the public. Although this course is for an Australian audience, the content is universal. The home page for the course is designed around the “Australian National Training Centre” with eight destinations to visit, representative of eight sections to complete. To participate in the course, the participant navigates through each of these destinations is a module where a different anti-doping topic is explored with information, videos, examples and revision questions. The final destination is the main stadium where a final quiz on all topics is to be completed. The course takes around 60-80 minutes to complete, and progress is saved automatically. You do not need to complete the course in one sitting.

The modules that are covered in the course include:

  • Anti-Doping Overview
  • Prohibited Substances and Methods – Learning about the prohibited list and how to ensure the medications you are taking are not prohibited
  • Therapeutic Use Exemptions
  • Supplements
  • Doping Control – Learning about what you can expect to encounter during the doping control process, and the rights and responsibilities of the athletes.
  • Intelligence and Investigation of anti-doping agencies

As feedback we found the course very practical. In some of the assessments we were required to use GlobalDro to check whether a substance was allowed to be used in different scenarios. For example;

 “You’re a male sprinter competing in your first meet since having knee surgery three months ago. Your knee has been sore since your warm up and you consider taking something to relieve the pain before your event starts in an hour. You looked in your bag and found some left over Endone tablets that you used to relieve the pain after the knee surgery. Use GlobalDro – link opens in new window, to confirm whether you can take this substance.”

This helps you to become practiced at using antidoping resources to solve real life problems.

Assessments are spread throughout the modules. In each section, there are a number of questions that you need to answer correctly in order to be able to progress to the final quiz.

We found that the questions tested knowledge of the content well.

In a world where athletes are the ones who are ultimately responsible for what drugs and supplements they are taking, they would benefit from completing this course. This course explains not only the steps involved for checking their substances, but their rights and responsibilities so that they can be fully prepared for any testing they will face during their career. It also emphasises the power of anti-doping community and real life consequences from inadvertent and deliberate doping to ensure they do not make foolhardy or innocent mistakes. Although this course is designed for an Australian audience, we would however recommend that anyone involved in sport complete this course. Sanctions for anti-doping violations are catastrophic for a career in sport.

ASADA have created a fantastic online course in the Level 1 module. To extend your understanding after completing the ASADA eLearning, further courses are offered including: Level 2 Anti-Doping Course, Ethics in Sports regarding match fixing, Medical Practitioner and Athlete Support Personnel course, as well as Integrity and Anti-doping, a module for secondary teachers. These modules are brief but helpful.

For more information visit:

Recommended Follow Up Anti-Doping Resources

WADA Prohibited list

Check your substances – Globaldro


Report doping confidentially (Australian website

Recommended follow up BJSM Resources

Gaehwiler, R. (2017). “Anti-doping and the physician’s role: how do we overcome the challenges in elite sport?” BJSM Blogs. FREE Link here –

Stuart, M. Schneider, C.; Steinbach, K. (2016). “Meldonium use by athletes at the Baku 2015 European Games. Adding data to Ms Maria Sharapova’s failed drug test case” BJSM Blogs. FREE Link here –

HP Dijkstra, HP; Van Dyk, N; Schumacher, YO (2015). “Can I tell you something? I’m doping…” BJSM Blogs. FREE Link here –

“The World Anti-Doping Agency, and blood passports, with Alan Vernec” (2013).  BJSM podcasts. FREE Link here –


Nash Anderson has a special interest in sideline care and the SEM community. Nash has created, an open access health and sports medicine resource for clinicians and the public. He also assists in the management of Social Media for Sports Chiropractic Australia. You can follow him on Twitter (@sportmednews).

A former Australian representative in both Beach and Indoor Volleyball, Nat Sharp has a special interest in sideline care, volleyball and sports chiropractic. She has recently returned from working as medical director of the Beach Volleyball World Tour in Sydney. You can’t follow her on Twitter unfortunately! Nash and Nat are Chiropractors at Enhance Healthcare, a multidisciplinary practice in Mitchell​, Canberra.

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