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7th Annual London Sports & Exercise Medicine (SEM) Conference: Stand Tall, Talk Small, Play Ball

4 May, 17 | by BJSM

Sport and Exercise Medicine: The UK trainee perspective –A BJSM blog series

By Dr. Robin Chatterjee

Last month, the 7th Annual London Sports & Exercise Medicine Conference took place at the KIA Oval. This yearly event is organised by the Sport and Exercise Medicine registrars who are based in the London area. The event doubles as one of the four National Training Days for Sport and Exercise Medicine trainees. The aim is to showcase a wide variety of topics via experts working throughout the field. This year’s conference, entitled ‘ Stand Tall, Talk Small, Play Ball’, examined the key issues in Sport and Exercise Medicine for all ages and at all levels.

Sport and Exercise Medicine (SEM) is a holistic specialty with various facets that are all equally important in the overall management of a patient, including but not limited to: musculoskeletal (MSK) medicine, exercise medicine, public health and population medicine.  The conference reflected this by having lectures in some of the different fields that make up SEM.

The speakers were comprised of internationally renowned medical, surgical and public health consultants, sports scientists and professors in sports medicine. Their work has ranged from preparing elite athletes for the pinnacle of their sport to strategies to increase activity amongst the general population in order to combat an array of chronic diseases.

The keynote speaker was Dr Ese Stacey who talked about gut dysbiosis causing MSK pain. She spoke about how diet and nutrition were important factors to include in the management of MSK pain as the balance of good and bad gut microorganisms had an impact on joints and tendons and in turn general well being and performance. Other speakers included Dr Justin Varney who discussed the peer-to-peer physical activity ‘Clinical Champions programme’. This is a service created by Public Health England, which provides free structured training, to health professionals by health professionals, to improve the understanding of PA in clinical practice so they can integrate very brief advice into their day-to-day clinical practice. Other highlights included: Dr Roger Wolman who described how short term bisphosphonate treatment may improve healing in selected athletes with stress fractures or bone marrow lesions; Dr. Richard Sylvester who shared his insights into complicated and unusual cases of concussion and Professor John King who spoke about past, present and future management of exercise-induced limb pain. All in all, there was something for everyone in the 170-strong audience, which comprised medical students, doctors, physiotherapists and scientists.

The event allowed networking opportunities for the delegates as well as a chance to learn new information and challenge old beliefs. We are very thankful to the speakers for taking time out of their busy schedules to talk and make the conference a success.

Programme: 7th Annual London Sports & Exercise Medicine (SEM) Conference:

Stand Tall, Talk Small, Play Ball

Sports injuries in the paediatric patient. Dr Matthew Barry (Consultant Orthopaedic Surgeon, Royal London Hospital)

Bisphosphonates in the athlete. Dr Roger Wolman (Consultant Rheumatologist, Royal National Orthopaedic Hospital)

Complicated cases of concussion. Dr Richard Sylvester (Consultant Neurologist, National Hospital of Neurology and Neurosurgery)

Asthma in the athlete. Dr John Dickinson (Head of Exercise Respiratory Clinic and Senior Lecturer, University of Kent)

Exercise induced limb pain. Prof John King (Honorary Chair at the Centre for Sport and Exercise Medicine at Queen Mary University of London)

Gut dysbiosis and MSK problems. Dr Ese Stacey (Consultant in Sports & Exercise Medicine, London West End Bupa Health and Dental centre)

Collapse during endurance training. Dr Courtney Kipps (Consultant in Sports & Exercise Medicine, Consultant to Institute of Sport, medical director of London and Blenheim Triathlons)

Physical activity promotion and the Clinical Champions service. Dr Justin Varney (National Lead for Adult Health and Wellbeing, Public Health England)

Getting people active through sport: overcoming inactivity. Prof Tess Kay (lead for sport, health and well-being research group, Brunel University) & Dr Laura Hills (Lead for Sport, Health and Exercise Sciences, Brunel University)

Safeguarding in sport issues and initiatives. Dr Daniel Rhind (Senior lecturer in social psychology, Brunel University)

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Dr Chatterjee is a Specialist Registrar (ST4) in Sports & Exercise Medicine (SEM), a GP with a Special Interest in SEM and chairperson for the 7th annual London SEM conference . He currently works as a medical officer at the Defence Medical Rehabilitation Centre at Headley Court, London Broncos Rugby League club and Musculoskeletal Interface Clinical Assessment Service (MICAS) at Battersea Health Centre and is a regular contributor for Co-Kinetic Journal.

Twitter: @sportsdocrob

Email: r.chatterjee1@nhs.net

Farrah Jawad is a registrar in Sport and Exercise Medicine and co-ordinates the BJSM Trainee Perspective blog.

‘Dummies’ guide to conferences: undergraduate perspective

28 Dec, 14 | by BJSM

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

By Lysander Gourbault (@lgourbault)

open_door_to_successConferences are a great place to learn, network and they look great on your CV. But it’s often daunting starting a conversation with those consultants and experts that are seemingly so far above you they are out of reach! Here are a few handy tips to make the most of your time at conferences.

Preparations

  • Do your homework (part one) – Research conferences months in advance to get the early bird discounts and to submit abstracts.
  • Look for funding – As a student, there may be hidden bags of gold at the end of the university, college or departmental rainbow. Speak to your personal tutor or university financial advisor and see what is available to you. Learn to play the game; in your application show how attending this conference will allow you to gain knowledge you can transfer back into university or your clinical care.
  • Submit an abstract – Very useful for the CV and can get you extra points for your junior doctor application. If, like me, you aren’t exactly sure how best to put together an abstract, ask for advice from your tutor or members of your college.
  • Do your homework (part two)! Research the speakers at the conference – Now you’ve got everything sorted and you’re just making those final preparations before you go, take a look at who the speakers are and some of their published works. This will allow you to firstly, ask a question after the lectures, and secondly provide that all-important conversation starter when speaking to people in the breaks.
  • Research a current topical issue – the best place to look these up is on BLOGS. Blogs are a great place to see what’s going on in the world in your specialty and are much easier reading than normal articles. So go on, get reading…oh wait, you already are!

At the conference

  1. Don’t be afraid to ask a question from the audience.
  2. During the breaks DO approach people and introduce yourself. People love enthusiasm and people love speaking about THEMSELVES. So introduce yourself, ask them who they are and then that topical question you prepared the night before!
  3. Be tactical! Wait until that person you want to speak to is in a conversation with at least two other people. When you go over to say hi, they will introduce you to whoever they are talking to. It’s like branches on a tree, every person you meet leads you to two more people and so forth.
  4. Now you’ve had the chat, don’t leave without their email address – you never know when it might come in handy! They might be able to give you placements or suggest people for you to get in contact with instead. Just like followers on twitter, you can never have too many friends.

After the conference

  1. Make sure you email all the people you spoke to thank them for the chat. Include something about the topic you discussed or where you spoke to them so that they remember you.
  2. Sometime in the future you may wish to speak to them again. You can then just reply on the back of your email. This is really important because these people will be getting 100s of emails. So the fact that they know you might mean they bother reading it!
  3. Make sure you upload the conference certificate on to your e-portfolio if you have one or keep it somewhere safe until you do.

And finally keep going to as many as you can! Conferences are great fun, a superb way to dodge lectures and an even better place to make those contacts that might well give you your break into the world of Sport & Exercise Medicine.

Good luck!!!

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Lysander Gourbault is a third year medical student at Newcastle University. He is the joint founder of Durham Sport and Exercise Medicine Society (DSEMS) and has a passion for sports medicine and orthopaedics. You can contact him on Twitter @Lgourbault. Find out more about DSEMS @DSEMS1, on our facebook page or by contacting durhamsems1@gmail.com

Dr. Liam West BSc (Hons) MBBCh PGCert SEM (@Liam_West) is a Cardiff Medical School graduate and now a junior doctor at the John Radcliffe Hospital, Oxford. He is an Associate Editor for BJSM and also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

Not just about the knee! Return to Play Conference “The ACL”, Melbourne July 26, 2014

18 Jul, 14 | by BJSM

Copeland_Theatre

 

The return to sport following an ACL reconstruction is often discussed in the media in terms of timelines, often with little regard to the athlete or an understanding of the process not being all about the knee. The ability to withstand multi joint, multi directional movement is vital at high load in a linear then multi planar movements. This requires the integrated care of surgeon, physiotherapists and physical trainers alongside strength and conditioning staff.

Programs around the world are addressing ACL injury risk using 3D motion capture technology to quantify these movements accurately and with joint moment and angular vector, The Sports Surgery Clinic, Dublin are utilising this technology to map individualised rehabilitation programs to expediate return safely with increased performance goals. As part of this initiative the clinic are launching a Global Research Foundation later in 2014. The aims of the foundation are to conduct original research with Global Centres focussing initially on 3D Biomechanics return to Play rehabiliation and the  rapid translation of original research, and as part of the goals education is a strong one.

To highlight the process of return to play rather than the injury itself the Foundation are holding a Conference in conjunction with The Centre for Health Exercise and Sports Medicine in University of Melbourne bringing together expertise in injury prevention, the psychology of injury and also the techniques of surgery but a focus on the strength, rate of force development, linear and multidirectional running resilience required to safely return to play. The Conference will be discussing much of the evidence behind 3D Biomechanics and also  concurrent injury with Professor Julian Feller from Melbourne and Bert Mandelbaum from the US from a surgical perspective. Dr Kate Webster will speak on the Psychological challenges and impact of rehabilitation and Dr Andrew Jowett will speak on the financial and emotional costs to clubs.

Prof Martin Schwellnus from Cape Town will talk on the Risk factors including genetics for ACL injury and Dr Eanna Falvey on ACL injury Prevention and Dr Andy Franklyn-Miller on the 3D Biomechanics of multi directional sport performance. Rehabilitation and linear and multi directional return will be discussed by Enda King from SSC, and Suki Hobson and Mike Snelling from Australia.

The player perspective is most important and  will be represented by the high profile Geelong player Daniel Menzel who has had 4 ACL reconstructions including a LARS reconstruction and will be interviewed by Dr Peter Brukner on his challenges, thoughts and rehab experiences. It is not just about the knee.

Few places remain – join us in Melbourne www.returntoplayconference.com

The Dublin SSC team will also be delivering a 1/2 day workshop for those working with Elite athletes on the 3D Athletic Groin Pain  Rehabilitation program via Olympic Park Sports Medicine Centre on Sunday 27th July.

Isokinetic “Football Medicine Strategies” Conference – Bringing the Football Medicine Family Together

26 Jun, 14 | by BJSM

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

By Daniel Broman (@Daniel_Broman)

The Isokinetic Medical Group is an internationally recognised leader in the fields of sports injury treatment, orthopaedic rehabilitation and medical research. The Education and Research Department at Isokinetic, led by Dr. Sergio Roi, is well known and respected world-wide. In the past few years, interest in the 20-year-old football medicine conference has really exploded. Some consider it the premier football medicine event in the world.

THE 2015 CONFERENCE WILL BE IN LONDON – APRIL 11 & 12 (confirmed dates)

Conference 'comes home' to  Italy - MiCo Conference Centre Milan

Conference ‘comes home’ to Italy – MiCo Conference Centre Milan

In review, the 2014 conference, “Football Medicine Strategies for Joint and Ligament Injuries,” attracted an impressive 2,259 delegates from 73 countries worldwide, including an outstanding selection of internationally recognised experts in Football Medicine. Football is the biggest participation sport in the world and it needs a medical force to cope with this – the “football medicine family” as the Isokinetic Group warmly call it – and the global football medicine community were all certainly in Milan for one weekend. Not even ‘El Clasico’ in Spain could keep the Real Madrid & Barcelona doctors away!

For me, a good conference is about many things. Obviously, scientific content and opportunity to learn new things from experts is extremely important. However, good events are also about sharing experiences more informally – catching up with old friends, making new connections, and enjoying yourself around like-minded individuals. The Isokinetic conference ticked all these boxes.

It was great to see so many young people (the average age was just over 30 years old) attend the event. We all go to conferences to listen to world experts, but the Isokinetic Group are also very passionate about providing opportunities to aspirational young professionals and bringing through the next generation of experts in the field.

Isokinetic are also fantastic at doing all the little things well and have a large team behind the scenes making sure everything runs to plan. This attention to detail gave the conference a really good ‘feel’ about it and ensured that delegates focus on enjoyment and making the most of their time.

From a scientific point of view, some personal conference highlights include:

  • picture 2 footballThe ‘Grassroots and Recreational Football’ session because, for me, this is the true footballing population. It is exciting to manage professional/elite athletes, but caring for the millions of “weekend warriors” over the world is of particular importance, to ensure that football promotes long-term health benefits.
  • The Science of Football summit which focused on initiatives to prevent injuries in football, as we all know that preventing problems is always preferential to treating them after they occur.
  • The ‘Management of Early and Late Osteoarthritis’ in football because, observationally, I feel this is a major long-term risk associated with football, which merits more research. We don’t want to get to a stage where the millions of footballers in the world suffer from pre-mature OA.

Next year the conference returns to London with the title “Football Medicine Strategies for Player Care”. Looking ahead to the conference in 2015 and being a junior doctor working in London, I would love to see more British medical students and junior doctors attend, especially with the growing interest in SEM at Undergraduate level in the UK.

london 2015With the title of the conference, in 2015, focusing on ‘player care’ as a topic and being a physician, I would also like to see symposia/workshops on the various medical problems that exist in football. We know that cardiology, mental health, concussion, heat and travel related problems etc., play a large role in the health of a footballer and next years’ conference may provide the opportunity to learn more about these topics.

Finally, credit and thanks must go to Stefano Della Villa and Sergio Roi for their continued passion in education, research and the development of football medicine. They really do bring the football medicine family together for one weekend every year and long may that continue!

For more information on next year’s conference, keep an eye on www.footballmedicinestrategies.com or by following @footballmed on Twitter.

 

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Dr. Daniel Broman (@Daniel_Broman) is a Core Medical Trainee in London, currently working in the Neurology department at the Royal London Hospital, Barts Health NHS Trust. He also acts as head of medical services for Maccabi Great Britain and is passionate about pursuing career in Sport & Exercise Medicine whilst helping improving the health of the nation.

Dr. Liam West BSc (Hons) MBBCh is a graduate of Cardiff Medical School and now works as a junior doctor at the John Radcliffe Hospital, Oxford. In addition to his role as an associate editor for BJSM he also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

Call for abstracts: First, world conference on groin pain in athletes, Aspetar, Qatar

5 May, 14 | by BJSM

groin aspetar blog

Dear Colleagues,

We are pleased to announce that Aspetar will host the 1st World Conference on Groin Pain in Athletes. This major conference will be held at the Academy Auditorium, from 1st to 3rd November 2014.

The scientific committee is currently accepting Abstract and Poster submissions in the topics related to the Groin Pain.

 The deadline for submissions is June 20th, 2014. 

 

For further information on abstract and poster submissions, please click here.

For further information about the conference, please go to the website.

IOC World Conference – Prevention of Injury & Illness in Sport: On the ground recap

24 Apr, 14 | by BJSM

By Liam West (@Liam_West)

IOC conference

For 3 years this conference has been firmly on my “SEM Bucket List” and it did not disappoint. Firstly, Monaco in the sun is a sight to behold and secondly to walk into a coffee break to see the “who’s who” of global sports medicine was simply inspirational. The numbers for the event were equally impressive;

  • 24 symposia
  • 5 keynotes
  • 34 workshops
  • 73 free communications
  • 233 poster presentations (unopposed in the time table)

The only downside was that I could not attend all of the sessions, although I guess that speaks volumes of the quality of presentations on offer. Below is a summary of the 3 days and some take home messages from the sessions I attended.

Dr. Richard Budgett, IOC Medical Director, reminded all the delegates at the opening ceremony that “It’s all about the athlete” and as a former Olympic gold medalist he knows this more than most! The next day the opening keynote lecture showcased a vigorous debate between Karim Khan (@BJSM_BMJ) and Dominic MacAuley (@DMacA) as to whether sports injury & illness prevention research has delivered. The answer? Yes in certain areas (e.g. ACL prevention), but there is much work to be done (or optimistically to be read as opportunities for research!!).

Using the #IOCprev2014, the interactivity between delegates and speakers both in attendance and across the globe was terrific. Perhaps this was triggered by the excellent symposium about “the power of social media” chaired by @CarolineFinch. Learning points? You can to use social media as a platform to market your message. It is now one of the best ways to signpost readers to scientific content and can improve citation rates although @DrJohnOrchard warned about the perils of engaging in non-academic discussions online. @clairebower explained the three top rules of twitter [slides can be accessed here]. 1) Know your audience, 2) keep it simple & 3) image is everything (use photos). @EvertVerghagen explained that using social media can increase subject recruitment for research and apps may be the future of sports injury prevention – you can find his talk here.

Sudden cardiac death (SCD) was an integral theme at the last IOC conference in 2011 and 2014 was no different – read the open access BJSM issue on Advances on Sports Cardiology here. After the overview by @Prof­_MatWilson, the issue of the optimum screening protocol for SCD was tackled – future efforts lie in detecting subclinical disease in older athletes. No guaranteed protocols were given by the experts but Michael Papadakis provided pro-ECG evidence and then educated delegates to the normal ECG changes associated with age, sex and ethnicity – read the Seattle Criteria here and do the online BMJ ECG interpretation module here. Shanjay Sharma (@SSharmacardio) talked about the importance of maintenance of left ventricular cavity size in the athlete’s heart that is lost in cardiomyopathy and that it isn’t the size of the heart that matters but the function. Screening will never pick up all athletes at risk of SCD – Jonathan Drezner (@AMSSM) preached the importance of sideline preparation and the role of the automated external defibrillator (AED) in preventing SCD. The big take home message – “A seizure or loss of consciousness should be assumed to be sudden cardiac arrest until proven otherwise”

Concussion is the current vogue in SEM and the keynote by Neurologist/Sports Physician & PhD Paul McCrory was well attended. He described that whilst technology has improved enabling us to measure impact & biomechanical forces, these show little correlation to rates and severity of concussion. The most recent Zurich guidelines were emphasized to be just that – guidelines. There are no definite answers so far in concussion and currently we are only looking into neurocognitive athletic function but McCrory explained that concussion is a complex systemic pathology with many components; consider mood, sleep, hormonal disturbances etc. – listen to his 4 recent BJSM podcasts on the topic here – 1,2,3, & 4. It is important to note that Chronic Traumatic Encephalopathy is a separate entity to concussion and as clinicians we must not let the media dictate the course of science – education in this area is key! You can access the BJSM journal dedicated to concussion and the 4th International Conference on Concussion in Sport (Zurich, 2012) here.

The recent IOC Consensus Statement “Beyond the Female Athlete Triad – Relative Energy Deficiency Sydrome (RED-S)” was presented and discussed in a fantastic stream led by @margomountjoy – this work has moved on from the Female Athlete Triad and the journal can be read here. RED-S acknowledges this condition affects both genders and has multisystem involvement with more complex pathophysiology than previously described. It’s all about the energy. RED-S describes the imbalance between training load and recovery as the imbalance between energy availability and expenditure. With low energy availability comes susceptibility to short term risks to illness, infection, fatigue etc and long term risks such as decrease in performance and overall health. The paper proposes a traffic light system to RTP issues for athletes with this condition – useful for clinicians.

Some other short take home messages;

  • The legend of running biomechanics, Benno Nigg, spoke on the evolution of footwear and the prevention of running injuries. He concluded from his years of research that the only thing that actually confers injury protection is the ability of athletes to use a “comfort filter” to choose the shoe/insole that works for them.
  • Injury prevention – @benclarsen presented on the difficulty with recording overuse injuries. He stated that we need to move away from the trend of only measuring time loss injuries and look to include injuries that can lead to overuse pathologies.

I’d like to thank the organisers for putting on such a fantastic event that enabled delegates to meet old friends whilst making new connections that will hopefully last for many years to come. I look forward to seeing many of you at the next IOC Conference in 2017!

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Dr. Liam West BSc (Hons) MBBCh is a junior doctor at the John Radcliffe Hospital, Oxford. He is a founder and current President of USEMS and is also the founder of Cardiff Sports & Exercise Medicine Society (CSEMS). In addition to his role as an associate editor for BJSM he also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series. He has a passion for developing the SEM movement amongst undergraduates and sits on the Council of Sports Medicine for the Royal Society of Medicine as Editorial Representative and on the Educational Advisory Board for the British Association of Sport and Exercise Medicine. His Twitter handle (as above) is @Liam_West and you can find Liam on Facebook as well.

Science of Cycling, Injury Prevention: 20 to 22 June 2014 Australian Institute of Sport, European Training Centre. Varese, North Italy.

11 Apr, 14 | by Karim Khan

science of cycling jpeg

A three day conference involving a Friday evening Masterclass, Saturday Symposium and Sunday Practical workshops. The content is focused towards Cycling Related Injury Management, with a detailed analysis of the theory and practice of Bike Set-Up and Body Assessment of the cyclist. Muscle Activation in Cycling and the Biomechanics of Cycling will be discussed, within a clinical reasoning framework, especially in relation to injury presentation and fatigue/high workload states.

Other topics include (but are not limited to) the aetiology and management of major cycling injuries, as well as their epidemiology. The conference will take place at the Australian Institute of Sport (AIS) European Training Centre (ETC) in Varese, Northern Italy, with accommodation available on-site.

Take your Cycling Injury Prevention and Management knowledge to a new level, visit the AIS ETC and enjoy the wonders of Northern Italy!

For more information: http://www.scienceofcycling.com.au/

 

USEMS 2014 National Conference – Tickets going fast, register now!

26 Mar, 14 | by BJSM

Undergraduate perspective on Sports & Exercise Medicine  a BJSM blog series

By Steffan Griffin (@lifestylemedic)

USEMS are proud to announce the second annual student Sports & Exercise Medicine (SEM) conference, hosted in 2014 by the Birmingham University Sports & Exercise Medicine Society (BUSEMS).

SEM career aspirations?…then don’t miss this event

This conference features engaging and informative talks by: BJSM Editor Prof. Karim Khan, Dr. Peter Brukner, Dr. Aseem Malhotra and Prof. Lennard Funk, and many more. It promises to be a great educational experience AND a chance to network with some of the biggest names in the SEM world. You will be able to create opportunities to get that SEM dream job.

For less than you’d spend at the local curry-house (and with lunch & refreshments provided) you can attend one of the biggest SEM events in the UK this year!

Sign-up here www.usems2014.eventbrite.co.uk.

Tickets are going fast and the deadline is on the 25th of April. Get your tickets today so you don’t miss out!

The conference is aimed primarily at juniors. Both undergraduate and postgraduate students qualify for the £15 ticket. If you are not a student but still interested in coming, please contact the organiser at steffangriffin@gmail.com.

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Steffan Griffin is a third year medical student at the University of Birmingham. As an ambassador for Move.Eat.Treat and the president of the Birmingham University Sport and Exercise Medicine Society (BUSEMS), he is passionate about the role of exercise as a proactive healthcare tool. He combines a passion for all things SEM related with an avid interest in sport, and tries to live as active a life as possible.

Liam West BSc (Hons) is a final year medical undergraduate student at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.

Not everything in sport is black and white: #Addsomecolour…….Part 1 The Association of Chartered Physiotherapists in Sport and Exercise Medicine Biennial Conference

4 Dec, 13 | by Karim Khan

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series

By Charlie McCall

With a healthy dose of intrigue, I set off from Bristol for Glasgow and the Association of Chartered Physiotherapists in Sport and Exercise Medicine (ACPSEM) Biennial conference in late October.  The high calibre international speakers and diverse topics in the conference programme had sparked my enthusiasm.

The conference venue was the University of Glasgow. Delegates could be forgiven for thinking they had been transported to Hogwarts, while Glasgow’s West End provided a plethora of amazing architecture, culture and restaurants.

Alison Rose ACPSEMA conference entitled “Not everything in sport is Black & White” with the tag line ‘#add some colour’.  Surely this is why we attend conferences: to learn new ideas, to have our preconceptions challenged. The first day kicked-off with short lectures based around ‘The Profile of The Modern Day Athlete”.  Discussions covered topics including how our ability to sweat enables us to outrun our prey and why humans make lousy athletes. The question of whether champions were born or built was discussed, and our interaction with our environment explored. I wonder if, in the western world,    we have lost some of the patience we had in chasing our prey for so long.  Five minutes in a supermarket queue for convenience food seems to equate to ‘stress’ these days.

Topics were pertinent, with Dr Barry O’Driscoll speaking about concussion and current issues around the Pitchside Concussion Assessment (PSCA) in rugby. Recent events in the nation’s first sporting love, football, have highlighted the issue of concussion in sport to the masses.  Hopefully this platform will help those campaigning for better and safer procedures for decision making about return to play get their message across.  This needs to be heard: not just by medical professionals, but by coaches, trainers, players and parents of young players.

The first full conference day started with Dr Antonio Stecco talking about fascia.  The idea that up to 30% of muscle fibres do not reach the tendon or bony interfaces, instead blending into the deep fascia, means we need to rethink the traditional anatomical model.  The fascial system as a whole has a huge role in proprioception, so changes in elements of fascia, such as ‘densification’, a term Stecco used to describe increased viscosity of the fascia, is likely to impact proprioception and, ultimately how we move.

Dr Quentin Fogg further challenged ideas about anatomy basics through discussion on how muscle attachments actually work.  For example, the continuity between semitendinosus and anterior tibial fascia could have implications for anterior tibial pain. Dr Jay Shah gave really interesting lectures on the pathophysiology of myofascial pain, trigger points and the physiological findings around trigger points. With growing evidence, we can more adequately explain to patients why the problem may be somewhere other than where they feel the pain.

Coaches Frans Bosch and Vern Gambetta played their part in ‘adding colour’.  Bosch suggested that for highly skilled movement at speed, we need to move away from the idea of the hierarchical model i.e. cue the brain and it will tell everything in the body what to do.  He championed the idea of a ‘decentralised model’ with multiple ‘substations’ throughout the system that can adjust our control of movement.  Gambetta warned against confirmation bias, i.e. only seeing what you are looking for.

Bosch and Gambetta both urged us to rehabilitate  the entire movement, to go straight to the end point and move beyond just rehabing the muscle.  They also suggested that we should stop ‘over-coaching’ in rehab and allow the body to regain movement patterns independently.  Physiotherapist Dr Dylan Morrissey agreed there is a tendency to over coach, but cautioned against just allowing the body to work it out with the question ‘what if the body keeps getting it wrong?’  There was collective agreement on the need to ensure we move past low level rehab and challenge the body and movement patterns in relation to forces it will undergo.  Physiotherapist James Moore followed this idea through, suggesting that returning to running early in hamstrings rehab is important, while Johnson McEvoy discussed how the ability to resist fatigue is critical to reducing key risk factors to shoulder and upper limb injury.

To be continued (Part 1 of  the synopsis of The Association of Chartered Physiotherapists in Sport and Exercise Medicine Biennial Conference )…

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Charlie McCall is a Sport and Exercise Physiotherapist at the University of Bristol Sports Medicine Clinic. http://www.bris.ac.uk/sport/sportsmedicine

Guest blog: Do athletes with prosthetic limbs have an unfair advantage over able-bodied athletes?

5 Aug, 12 | by Karim Khan


 

 

Abhishek Chitnis

3rd Year Medical Student

Keele University

Email: v0z55@students.keele.ac.uk

The use of prosthetic limbs in medicine has helped many patients over millennia lead a more comfortable life, enabling them to continue their activities of daily living as well as to compete in sport. In developing countries, prosthetic limbs are mainly used because of amputation due to trauma related injuries such as those suffered in conflict or road traffic injuries.[1] By contrast, in developed countries, the main cause of lower limb amputation is atherosclerosis, which may be affiliated with diabetes.[2] In the UK alone there are about 5000 new major amputations yearly, usually occurring in those who are sixty years old (or above),[1] making the use and development of prosthetics vital in the 21st century.

For athletes, this may be especially important as it could help them lead a normal life having being born with congenital limb problems. Other athletes who have suffered major trauma related injuries may want to continue competing in sports, and the development of prosthesis helps them achieve their goals. However, technological developments in sport can be controversial and this article aims to review any discrepancies as to whether or not technology creates an unfair advantage for the Paralympian, when competing against able-bodied Olympic athletes.

The history and development of prosthetics

Prosthetics have been used for over 3000 years, from the Egyptians where a prosthetic toe made of wood and leather has been discovered, to armoured knights who used prosthetic arms and legs in battle. In the sixteenth century Ambroise Paré invented prosthetics with joints, allowing prosthesis to become more functional.[3] And its not only humans who use prosthesis; elephants and horses that have been injured in accidents have also been given prostheses to help them move around!

Prosthetic limbs have evolved over time to use more advanced materials such as plastics and carbon-fibre composites. These materials make the prosthesis lighter, stronger and more realistic enabling the patient to engage in a full range of normal activities.[3]

Prostheses for athletes; the Flex-Foot

For athletes, possibly the most important development in prosthetic limbs has been the development of the energy-storing Flex-Foot, a carbon-fibre prosthesis with a heel component. Studies have shown the Flex-Foot provides amputees with a natural ankle motion and gives up to 84% of energy return rate to every step taken,[4] resulting in lower energy expenditure and an enhanced gait efficiency.[4] This value may seem high, but in comparison, the energy return rate of a natural limb is about three times higher at 241%.[4]

The Flex-Foot however only conserves energy at higher walking velocities and it does not seem to provide any major advantages for less active amputees. In a recent study to find the benefits of the Flex-Foot when compared with a conventional prosthesis, results showed that amputees had a lower induced disability when walking in a variety of different situations with the Flex-Foot than with conventional prostheses.[5]

Another study showed that amputees walking with the Flex-Foot had a lower heart rate and a lower VO2 (maximal oxygen uptake) than amputees walking with normal prosthesis[4], enabling them to walk for longer distances before tiring.

Case study; Oscar Pistorius

The above studies show that the Flex-Foot was the best type of prosthesis for athletes but the application of this technology has been controversial, as demonstrated by the much-heralded Oscar Pistorius or ‘Blade Runner’. The double amputee Paralympic runner who uses the “Cheetah” Flex-Foot (Figure. 2), a sprinting variant of the Flex-Foot without the heel, was eligible to qualify in the men’s 400 m sprint in both the 2008 Olympic and Paralympic Games. This begged the question; do Pistorius’ Cheetahs provide him with any advantage over biological limbs?  Or are they needed to maximise his performance and to overcome any compensatory consequences his disability creates?

Pistorius was born with absent fibulas in both legs due to a congenital condition and at the age of 11 months he had a transtibial (below-knee) amputation to remove both legs. During his time at school, Pistorius competed in a number of different sports, including rugby, water polo, tennis and wrestling. At 17 he discovered athletics and he went on to win gold in the men’s 200m during the 2004 Paralympic games.

However in 2007, the International Association of Athletics Federation (IAAF) asked for an assessment to be carried out to find out whether the prostheses Pistorius used gave him any undue advantage. The study[6] found that at a given speed, the Cheetahs he used consumed 25% less energy than the runners he was compared to. This would mean Pistorius would have a much lower muscular demand, enabling him to run faster and for longer periods of time before he got tired.

Interestingly, as the normal Flex-Foot was found to give an 84% energy return compared to 241% of a natural limb, it was found that the Cheetahs energy return was three times higher than of a natural limb. The consequence of this would mean that Pistorius would be able to run at the speed with much lower energy expenditure.

The study also found Pistorius displayed a much lower vertical motion than able-bodied runners, meaning he lost less energy during the landing and take-off phase of running. This lead to the finding that the Cheetahs only lost 9.3% of energy during the stance phase of running compared to 41.4% in the biological leg. This meant that Pistorius had a much lower physiological and metabolic workload, giving him a large mechanical advantage over a biological leg. Pistorius argued the case stating the disadvantages he faced with his prostheses including running in the rain (giving him lower traction on the track), wind (which blew his prostheses sideways) and the fact that he needed more energy to start running than other competitors. However, the IAAF found him to breach rule 144.2 “any technical device … that provides a user with an advantage over another athlete not using such a device”,[6] subsequently barring him from competing in any IAAF events including the 2008 Olympic games.

He consequently appealed and in May 2008 just before the Olympics, the Court of Arbitration for Sport (CAS) overturned the IAAF’s ban stating that there was insufficient evidence that Pistorious’ prostheses provided him with any sort of metabolic advantage over able-bodied competitors. It also concluded that the IAAF did not consider Pistorius’ disadvantages through the race.  This allowed Pistorius to try and qualify for the Olympics, but however in the end he could not meet the required qualifying time.

However in November 2009, a new study[7] concluded that athletes with a Flex-Foot, similar to one Pistorius used had no advantage over able-bodied competitors. The running mechanics of a number of athletes was tested as they sprinted on a treadmill and the results showed that prosthetic limbs didn’t generate as much force against the ground as biological legs.

Only single amputees were tested so that their prosthetic and biological limbs could easily be compared. The treadmill that the athletes ran on measured the force, called ground reaction force (GRF), each limb generated as it struck the belt; the greater the force, the higher the speed. It was found that at all speeds, athletes produced a 9% lower GFR in their prosthetic limb than their biological limb. In an able-bodied competitor this would mean a 9% drop in their top speed. It was also found that there is no difference in swing times between the prosthetic and biological limbs, meaning that even though prostheses are lighter than biological legs, amputee sprinters don’t move their legs any faster than able-bodied sprinters. To back up this data, the men’s 100m Olympic and Paralympic finals were analysed and again no significant difference in the swing times of their legs was found.

Pistorius argues that thousands of other runners also use the same prosthetic legs as him, without getting anywhere near his times, and that his times have been steadily improving since 2004 since he first got his Cheetahs blades not because of advances in technology, but due to his relentless training and improved technique. His sporting motto is “You’re not disabled by the disabilities you have, you are able by the abilities you have”. This tells us Pistorius feels his impairment does not affect his physical functioning and that to him; competition is as much mind, as it is matter.

In 2011 Pistorius qualified for the world athletics champions in South Korea with a time that would have placed him in fifth place the 400-metre final at the Beijing Olympics. He is currently contesting for a place in the South African sprinting team that will compete in London 2012 Olympics.

Pistorius is not the first disabled athlete who attempted to compete in both the Olympic and Paralympic Games; several have done so before. Natalia Partyka, a table tennis player, was born without a right hand and forearm and competed in the 2008 Olympics and Paralympic games in Beijing and the wheelchair archer, Neroli Fairhall, the first ever paraplegic competitor, participated in the 1984 Olympic Games in Los Angeles and has also competed in several Paralympic Games.

When debating technological developments in sport, it is also important to consider equal access to the technology. For example, Abebe Bikila, an athlete from Ethiopia who ran barefoot, won the Olympic marathon in 1960. How much faster could he have run with the technology to absorb the ground reaction forces and improve friction? Similarly, who knows how much faster other amputees could run if they had access to Pistorius’ Cheetahs, of which access is limited due to their expense. This situation is more problematic for athletes in developing countries, where the funding for new technology is hard to obtain.

Another issue to consider is have the technological development of Pistorius’ Cheetahs lead to his steadily improving times, or it down to his sheer grit and determination as he so claims. If this is due to the former, one can argue: ‘Who’s going to win the gold medal, the athlete or the scientists who have developed and improved the prosthesis?’

Some have reasoned that historical continuity is crucial, so current athletes can be compared to past athletes and achievements can be understood in context. Allowing Pistorius to compete with his existing Cheetahs does not allow this, as he cannot be compared to past sprinters, which represents a break in historical tradition. Others have made the point that “Natural” athleticism should be exhibited, to preserve the essence of a sport. Using a prosthesis represents a much more significant change than using contact lenses or improving your diet.

Psychological issues must also be contemplated; amputees have often gone through stressful and life changing events, often at an early age, which may put a strain on their psychological well being. For example, they may have issues surrounding their body image, self-pity and frustration. Does the use of a prosthesis help amputees overcome any disadvantage that they have suffered psychologically?

Final thoughts

The evolution of prosthetics has led to specialised limbs being developed for athletes, causing controversy to develop as amputees strive to compete against able-bodied athletes with their specialised limbs. Despite the debate, the ruling regarding Oscar Pistorius’ case was the right one. The prosthesis was primarily developed to attempt to restore loss of function in the Paralympian and there have been both studies for and against whether this prosthesis provides him with any advantage over able-bodied athletes. The fact that studies have not shown irrefutable evidence that Pistorius’ Cheetahs give him an advantage, allowing Pistorius to compete in able-bodied competition would constitute providing him fair opportunity to compete. Because of this uncertainty, Pistorius has rightly been given the sporting ‘benefit of the doubt’ and has been eligible to compete in the Olympic Games, given that he meets the required qualifying time. However, more research is required before any conclusive evidence is drawn as to whether prostheses do in fact give amputees an advantage or not. Until then, the question as to whether Pistorius is disabled, or too abled, remains.

The technological development of prosthesis has had a far-reaching impact worldwide, including in war stuck Sierra Leone where people regularly play amputee football. As prosthesis get more functional and advanced, it can be questioned as to whether or not using a prosthesis completely removes an amputees disability, as they now provide the opportunity for amputees to perform activities to the normal range (or even to a greater range), than a normal human being. This can be debated, but one thing is clear; prosthesis are bridging the gap between the disabled and able bodied.

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Abhishek Chitnis is a 3rd Year Medical Student at Keele University. He has a keen interest in Sports and Exercise Medicine and hopes to pursue it as a future career. Abhishek can be contacted via email at v0z55@students.keele.ac.uk

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

References

  1. Marks LJ, Michael JW. Science, medicine, and the future – Artificial limbs. BMJ 2001;323:732-735.
  1. Kelly BM, Pangilinan PH, Rodriguez GM, et al. (2009) Lower Limb Prosthetics <http://emedicine.medscape.com/article/317358-overview> (Accessed 04.05.2012).
  1. Thurston A. Pare and Prosthetics: The Early History of Artificial Limbs. ANZ Journal of Surgery 2007;77:1114-1119.
  1. Nolan L. Carbon fibre prostheses and running in amputees: a review. Foot and Ankle Surgery 2008;14:125-129.
  1. Alaranta H, Kinnunen A, Karkkainen M, et al. Practical Benefits of Flex-Foot(TM) in Below-Knee Amputees. JPO 1991;3:179-181.
  1. IAAF. Oscar Pistorius – Independent Scientific study concludes that cheetah prosthetics offer clear mechanical advantages. 2008.  <http://www.iaaf.org/news/printer,newsid=42896.htmx>  (Accessed 04.05.2012)
  1. Grabowski AM, McGowan CP, McDermott WJ, et al. Running-specific prostheses limit ground-force during sprinting. Biology Letters 2010;6:201-204.

Figure 1. Oscar Pistorius running against able-bodied athletes at the Norwich Union British Grand Prix 2007. Adapted from http://www.foxnews.com/story/0,2933,289450,00.html, 2012.

See also BJSM Online First paper by Professor Lippi – click here

See @ScienceofSport on Twitter and blog: TheScienceofSport for detailed discussion

See website ‘Only a Game’ discuss the topic: Argues for Pistorius running.

 

 

 

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