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Imaging in Sports-Specific Musculoskeletal Injuries

29 Sep, 16 | by BJSM

By Karim Khan (@BJSM_BMJ) and Hakim Chalabi

(This blog is based on the published preface for the book – it’s not a new piece of writing. Think of BJSM going green – re-use, refresh, re-edit (a bit)).

Wow!!! Wow!!! Wow!! As experienced sports physicians we have seen most of the injuries, we have listened to very many lectures and we own many books. We have perused a zillion sports medicine books at conferences, academic bookstores and among our friends/colleagues’ collections. So when we heard that Professor Guermazi and Doctors Roemer and Crema were writing a sports medicine radiology book we were pleased but we were not expecting to be surprised.


Comprehensive!! We were not expecting 776 pages. This is encyclopedic but also very friendly to access. With 27 chapters, all the common sports are, of course, included but you can also learn about the imaging of rodeo and climbing sports injuries, for example.

Sporting focus!! The first wave of sports medicine books were anatomically-oriented and very surgical. The next generation was symptom-oriented and much more multidisciplinary. There have been very few ‘sport-focused’ books and no single book springs to mind as a ‘must have’. The International Olympic Committee has published a comprehensive series of encyclopedias and manuals on a sport-by-sport basis and that makes a good collection. But the set is not cheap.

In Imaging in Sports-Specific Musculoskeletal Injuries, the world experts such as Mark Anderson, Philip Robinson, Hollis Potter, Adam Zoga, Ronald Adler, Mario Maas, Anne Cotten and others provide insights sport by sport. Even if one were not interested in radiology J, but just sports medicine, then this book provides remarkable value because it details the mechanisms of sporting injuries and the pathologies that result. The skiing and snowboard chapter is just one example. Twenty years of dogma relating to potential mechanisms has recently been overturned and the new paradigm is captured in this sports imaging book!

We are both very experienced. Despite that, some chapters took us on a steep learning curve. Kudos to the authors. In other chapters, those where we have worked a great deal, we can confirm the quality of the evidence. Which reminds me that the referencing in this book is also outstanding. So it’s also a remarkable guide to the broader sports medicine. There are 2177 references. In chapter 5 alone there are over 260 references! Did we mention ‘comprehensive’?

Images! Just one exclamation mark for the 876 outstanding figures (1690 parts, 104 in color). We had a very, very high bar for images. We expected Professor Guermazi and Doctors Roemer and Crema to provide immaculate images and they did. This sports imaging book has no competitor for the quality and the number of images for sports medicine.

In Imaging in Sports-Specific Musculoskeletal Injuries, the authors provide customized color art (ie, “line drawings” in the older nomenclature) to illustrate anatomy, injury mechanisms, or pathology, where this is complicated. Images from MRI and ultrasound are overdrawn in color to help the reader. Pedagogy applied to help the reader.

One major take home message from this book is that radiologists with a real interest in sports medicine can add great value to the treatment team and ultimately for the patient. This book, although focused on the patient and clinical care, essentially provides a curriculum for the discipline of sports radiology. There is the potential for these authors to now share their knowledge via in person and online channels.

We like it! For the serious clinician who uses imaging – who aims to understand his or her clinical work, this book is a wonderful investment. This is an essential part of the libraries of specialist sport and exercise medicine physicians, sports physiotherapists and sports surgeons.


Karim Khan, MD, PhD, FACSEP, Professor, University of British Columbia; Editor in Chief, BJSM

Hakim Chalabi, MD, Sports Medicine International Expert; Former Medical Doctor of Paris Saint-Germain Football Club

An Illustrated Atlas of Orthopedic MRI: Book review (two thumbs up!)

6 Aug, 15 | by BJSM

BJSM Book Review:
An Illustrated Atlas of Orthopedic MRI
Fischer, Guermazi, Roemer, Carrino, Crema, Grainger, Kijowski, Steinbach

Illustrated atlas MRI

This new sports imaging atlas provides the BJSM community with a wonderful atlas of images (there are 3283 MR case illustrations) and clinically relevant text. Image-based learning is certainly the trend in Radiology, and the authors are to be commended for compiling so many sports medicine images of generally outstanding quality in this volume.


Knee MRI

The book is well-organized by anatomic location, including spine which is unusual in sports imaging textbooks,  preceded by introductory chapters on examination technique (includes the most appropriate MR sequences for structural assessment of joints), and the most common bone, cartilage, tumor and muscle pathologies.  Diagnostic pitfalls are marked with exclamation marks, and differential diagnoses are highlighted, although the latter could be used more extensively.  Normal anatomy is illustrated at the beginning of each chapter, although the level of detail would not obviate the need for an anatomic atlas.  The numerous color line drawings are superb, and add further clarity to the text.

Using the shoulder as an example, this 637 page volume covers not only the more common clinical scenarios in sports medicine (eg rotator cuff tears), but also the more recent and controversial topics (eg microinstability/glenohumeral Internal Rotation Deficit or GIRD).  One of the discriminatory features of this image-rich text  is its evidence-based approach, as following each chapter there is a moderately comprehensive but not exhaustive list of references. is overall a superb addition to the sports imaging literature, and strikes the right balance between text, drawings, images, and reference material.  This book with be much-used companion for radiologists, sports medicine physicians, orthopedic surgeons, physiotherapists, and indeed any practitioner who uses imaging in managing patients. BJSM has a clear commitment to imaging research (1,2) and education and this book will be a valuable addition to many BJSM readers’ reference libraries.


  1. Orchard J. What role for MRI in hamstring strains? An argument for a difference between recreational and professional athletes. Br J Sports Med. 2014 Sep;48(18):1337-8.
  2. Forster BB. The game has changed… but it still needs to be played: the role of imaging tests using ionising radiation in the practice of sports medicine. Br J Sports Med. 2014 Apr;48(8):679.

Sports-Related Concussion in Youth- Improving the Science, Changing the Culture: Book review by Dr. Michael Turner

9 Apr, 14 | by Karim Khan

Book review by Dr. Michael Turner

Sports-Related Concussion in Youth- Improving the Science, Changing the Culture (336 pages)

sports related concussion cover.phpThis is essentially the 2012 Zurich Concussion Consensus process applied to research in youth sport – a great summary of the topic but not an easy read.

For anyone versed in concussion the themes will be familiar:

  • A very high profile topic
  • Very few good quality articles published in the recent literature relating to concussion in youth sport
  • Epidemiology data non-existent for grass roots sport
  • The culture in youth sport is to play down concussion and avoid letting the team down
  • A single definition of concussion is not universally applied so data gathering is a mess
  • Little research has taken place on the molecular changes that occur in the young brain when a concussion occurs
  • Mixed findings on the long term effects of repetitive concussions and sub-concussive episodes
  • Risk factors for post-concussion syndrome and CTE have not been identified
  • No studies on the pre-high school group have tracked the post-concussion changes found in the following activities – physical, cognitive, emotional or sleep
  • There is no data to establish a threshold for concussion in young athletes
  • The is no equipment that can mitigate or prevent concussion, despite the manufacturers claims to the contrary
  • There is currently inadequate information to establish what combination of tests is best to identify and monitor concussion in youth sport (using hospital based or non-hospital based assessment tools)
  • Despite the consensus agreement that concussion should be treated with physical and cognitive, there is little empirical evidence to establish what is the optimal degree and duration of physical rest and if cognitive rest is necessary

The authors explore these problem areas and offer a detailed review of the published literature:

  • Neuroscience, biomechanics and risks of concussion in the developing brain
  • Concussion recognition, diagnosis and acute management
  • Treatment and management of prolonged symptoms and post-concussion syndrome
  • Consequences of repetitive head impacts and multiple concussions
  • Protection and prevention strategies
  • Conclusions and recommendations

 The authors make 6 recommendations:

  1. Surveillance – establish a national surveillance program for children aged 5-21
  2. Evidence based guidelines for concussion diagnosis and management – should be established and research supported
  3. Short and long term consequences of concussion and repetitive head impact – should be evaluated using a controlled, longitudinal, large scale study
  4. Age appropriate rules and playing standards – should be rigorously evaluated by sports associations, schools and national governing bodies of sport
  5. Biomechanics, protective equipment and safety standards – should be evaluated by research funded by the National Institutes of Health and the Department of Defence
  6. Culture change – the NCAA and other organisations should develop, implement and evaluate the effectiveness of the large scale efforts to increase knowledge about concussion and change the culture surrounding concussion (among elementary school through college-age youth, their parents, coaches, sports officials, educators, athletic trainers and health care professionals)

The book costs just US$64-00; the recommended research will cost a great deal more

Sports-Related Concussion in Youth – Improving the Science, Changing the Culture (336 pages)

Institute of Medicine and National Research Council of the National Academies

ISBN – 13: 978-0-309-28800-2

ISBN – 10: 0-309-28800-2


Dr. Michael Turner, MB BS, FFSEM is the Chief Medical Adviser for the Lawn Tennis Association, London

Listen HERE to the BJSM podcast interview about his time as chief medical adviser of the Lawn Tennis Association, including the medical scandals that have cropped up and the advances he’s seen in the game’s sports medicine.


Book Review: “Triathlete’s Training Bible”

25 Oct, 09 | by Karim Khan

The Triathlete’s Training Bible will make triathletes smarter, stronger and faster

Review by Ross Tucker

Joe Friel’s Triathlete’s Training Bible, now in its 3rd edition, has become an indispensable tool for triathletes of all levels wishing to improve their performance using evidence-based methods and principles. Of most credit to the book is that it is very obviously a sound theoretical treatise, heavily based on scientific truths, as well as Friel’s own experience of having worked with triathletes for many years. Yet it does not overplay its hand, forcing technical scientific information on the reader and aspirant improver. Rather, it guides decision-making for all situations, covering topics ranging from motivation (the art) to metabolism (the science), always in a very clear, concise and practical manner. As for scientists who work with athletes, the value is in appreciating how Friel balances the complexity of the science of performance, with the requirement to give athletes tangible, easily implementable advice, and this is something all sports scientists can borrow from.

[Also, click here for a link to Joe Friel’s bloged.]

Book Review: Essential Sports Medicine

7 Nov, 08 | by Karim Khan


Essential Sports Medicine
Edited by Richard Higgins, Peter Brukner and Bryan English.
Published by Blackwell, pp 160, £24.99.
ISBN: 9-78140-5114387

This is primarily a UK written sports medicine book whose primary audience is intended to be at an undergraduate level. With the expansion of the speciality as a whole it is always a difficult task to be comprehensive, but the major fundamentals have been covered in a very clear and concise manner. The book is well laid out and presented with a generous number of illustrations. Colour would have been nice but I guess budget constraints did not permit this or is it meant to reflect the murky British weather?

There is a good balance between musculoskeletal injuries and medical based problems. Basic nutrition and exercise physiology have also been included.

The book has been well researched, as you would expect from the quality of the contributors, and each chapter finishes with a short list of further reference material for those interested. I found the information to be very current and up-to-date. Even an ageing sports physician such as myself was able to learn an extra thing or two!

I was particularly interested in the sports specific injury section; secretly I was hoping that there may have been a medical explanation or two in there from one of the co-editors as to why Chelsea had a trophyless season—never mind!

Overall this book has very few weaknesses, certainly nothing worth mentioning. I feel it has more than achieved its aim of reaching the intended target audience and I can see this material becoming a good source reference book in the years to come, with further revisions, especially when sports medicine finally becomes a part of the undergraduate UK medical curriculum. No doubt it will encourage a few undergraduate physiotherapy and medical students to enter a sports medicine career path.

Objective details

  • Targeted to an undergraduate audience.
  • Peter Bruckner is a well known author and has written arguably one of the finest books in sports medicine, Clinical sports medicine, with Karim Khan (McGraw Hill Publications).

Subjective details

  • The easy reading style along with the illustrations was appealing although JK Rowling need not worry about the competition!
  • Not useful to me at this point in my career; certainly would have been valuable when I was starting out.

Arjun Rao
Maylands, Washington State, USA

Presentation 16
Comprehensiveness 15
Readability 16
Relevance 15
Evidence basis 15

Book Review: Clinical anatomy of the lumbar spine and sacrum

16 Oct, 08 | by Karim Khan


Clinical anatomy of the lumbar spine and sacrum (2005)
By Nikolai Bogduk
Published by Churchill Livingstone
pp 324, US$90. ISBN: 0-443-10119-1

This publication can be considered a classic for those clinicians involved in the care of patients with lower back problems. The purpose of the book is given in the foreword and the first paragraph of the author’s preface to the 4th edition: “There have been no changes in the anatomy of the lumbar spine in the past 20 years, but our understanding of some of the controversial issues has. Among them the presence of new data on zygoapophyseal joint pain, suggesting that it is not as frequent as once thought, whereas discogenic pain seems to be on the up once more, with better knowledge of the process of internal disc disruption.”

The book covers comprehensively the expected topics: bones, joints, ligaments, muscles and fascia, blood and nerve supply in various chapters, as well as embryology and development. There is a separate chapter for the sacroiliac joint.

The book has been written as a text book for the International Spine Intervention Society (ISIS): it is required reading for students and a key reference to instructors to review before teaching the Society’s anatomy courses.

As a clinician with an interest in low back and pelvis patients (but not involved in intervention procedures) I found the “extra” chapters particularly interesting. In the chapter “Age changes in the lumbar spine” Professor Bogduk stresses in his own emphatic style that many changes observed in imaging studies are nothing more than the result of the normal ageing process, not pathological findings.

From a clinician’s point of view the last three chapters on low back pain, instability and radiographic anatomy are of particular interest. The author addresses controversial topics as is his custom: with thoroughly researched references, available clinical evidence and very definite opinions. A number of the references are obviously form the first edition (1987), but still valid. The instability chapter has an excellent biomechanical basis, and is presented in a very logical fashion, that makes understanding of the issues easier. There is no reference, however, to the available literature on the link between low back pain and changes in muscle recruitment patterns, which is clinically significant. I also would have liked to see the last chapter on the radiographic anatomy expanded to cover other imaging modalities, rather than limited to simple x ray films. In fairness to the author, he indicates that further material is covered in the instructional CD of the ISIS.

These criticisms are not sufficient to change my opinion of this book: it is an excellent resource for all those who have an interest in the lumbar spine, from surgeons to interventionists, anatomists, physiotherapists, chiropractors and osteopaths.

M F Cusi
University of Notre Dame
Sydney School of Medicine
Darlinghurst, NSW

Presentation 15
Comprehensiveness 18
Relevance 20
Evidence bass 18

Book Review: Science and football V: the proceedings of the 5th World Congress on Science and Football

3 Oct, 08 | by Karim Khan


Science and football V: the proceedings of the 5th World Congress on Science and Football.

Edited by Thomas Reilly, Jan Cabri and Duarte Araújo.
Published by Routledge, 2005, pp 634.
ISBN: 978-0-415-48480-0 (paperback); 978-0-415-33337-5 (hardback); 978-0-203-41299-2 (electronic)

Target: Football elite and sub-elite sport science support

Appeal: Broad coverage necessary components sport science. As a sports physician it is not primarily targeted for me and so although it had components of interest, I would not personally purchase

In recent years, sport has by necessity evolved in many facets. Financial rewards have boomed. Information systems have fuelled intense exposure and scrutiny. Doping issues have come under intense publicity and accountability. All this intensifies need for sports to seek ethical advantage with evidence based front line measures.

To fulfill these demands is the immense expectation in sport science seeking that gain an edge in coaching, conditioning and medicine. To achieve this requires sport support services to be reliably informed. This is critical at the elite level to ensure peer parity and at the sub-elite level to provide exposure to elite concepts and portability to sub-elite programs as is practicable.

“Science and Football V: the proceedings of the 5th World Congress on Science and Football” is geared for sports science (conditioning and skill acquisition) rather than primarily sports medicine. It is ideal for coaching staff and strength and conditioning staff. Content is of sound background content for football medical support staff.

Authors are from a wide range of geographic national backgrounds, with strong emphasis on university sport science departments with particular interest in soccer reflecting its international predominance—but representing all codes. Content includes sections on biomechanics, fitness profiling, performance analysis, a small section on medical aspects, football conditioning, physiology and nutrition, paediatric issues and behavioural science.

Topics include coverage of those perennial “footballs”—stretching modes and benefits and relation to injury, warm-up, micronutrient levels and effect of diet and supplementation.

I believe this publication does deliver sound depth and a range of contemporary football sport science for coaching and conditioning support staff, as a summary for those fortunate enough to attend the conference, and as a reference for those particularly involved at the elite level of conditioning for high level teams. For those involved in sub-elite levels it provides an excellent insight into elite performance as a means of extracting ideas into the non-professional level.

P Baquie
Olympic Park Sports Medicine Centre,

Presentation 5
Comprehensiveness 5
Readability 5
Relevance 4
Evidence base 4

Book Review: Martindale’s Drugs Restricted in Sport

10 Sep, 08 | by Karim Khan

Martindale35_l bjsm

Martindale’s Drugs Restricted in Sport, Pocket Companion, 2008
Sean C. Sweetman (editor)
Publisher: Pharmaceutical Press, 2008
ISBN 978-0-85369-825-8
416 pages

“Martindale’s Drugs Restricted in Sport” is unique in its kind. It is the first pharmacopia that lists all the drugs that are on the WADA list of prohibited substances, drawing on the wealth of information and clinical expertise in the full reference work: “Martindale, the complete drug refeerence”. This is a great resource for sports medicine physicians, general practitioners and all other health care professionals working with athletes. It contains over 450 monograhs pertaining to individual drug substances that may be restricted in some or all sports, either in or out of competition.

The book is arranged alphabetically by drug substance. The international nonproprietary name or generic name is used, where one exists.

Other synonyms listed include British approved names, the French, Latin, Spanish, and Russian variants of generic names, names used in other European, Baltic, and Scandinavian countries, comon synonyms, and maufacturer codes.

The clinical profile is based on the full text of “Martindale: the complete drug reference” and describes the basis action and uses of the substance.

The WADA status indicates whether the substance is prohobited in or out of competition.

The WADA class gives an indication of the reason for the prohibition and gives more information about the range of substances covered in that class, plus any special circumstances. It is a great asset of the book that this is repeated with every substance, so you don’t need to go somewhere else to read all the information of the particular substances you are interested in. All the information is given right there where you need it.

A comprehensive index of over 15200 entries is to be found at the back of the book, and includes all names, synonyms, and proprietary (trade) names found in he tex. Even Cyrillic names are listed!

This is a great book for those of us who have been in the awkward situation where our athlete phones us, while away on a trip in Norway, Egypt or Russia, have gotten sick and are not sure of the medication the doctor has given him, and can only provide you, let’s say, the Russian trade name. What do you do?

The player is “strictly liable”, but is depending on you. And it is your name who will appear in the court case on internet for many years to go when you make a mistake. And there is no way you will find that Russian trade name on the WADA doping list!

So now there is a solution to all of these problems: Martindale’s Drugs Restricted in Sport Pocket Companion! The only thing missing is a short summary of the categories of the WADA list of prohibited substances and methods – it would be really helpful is that would be included at the front of the book as well.

Babette Pluim,
Sports physician

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