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The rise of Brazilian Sports Physiotherapy: one of the legacies of the RIO 2016 Olympics

20 Oct, 16 | by BJSM

By Mario Bizzini (@SportfisioSwiss)

On August 12th, I visited the Polyclinic at the Olympic Village, to meet my Brazilian Sports PT friends Felipe Tadiello and Luciana de Michelis (the current president of Sport Physical Therapy Group in Brasil – SONAFE> www.sonafe.com.br). The purpose of my visit was, on behalf of the  International Federation of Sports Physical Therapy (IFSPT; www.ifspt.org), to officially welcome SONAFE as IFSPT Member Organization, whose application was accepted few weeks prior to the start of the Olympic Games in Rio de Janeiro.

Strong leadership

Felipe Tadiello led the organization of the sports physiotherapy at the Polyclinic of Rio 2016. He tactfully managed more than 800 physiotherapists (the majority were from Brasil, Argentina, Chile; 15% were international). This 800 included those sports PTs working at the training and competition (stadiums, training facilities) and those available in case of emergencies or extra support (medical responders).

Dedicated team

mario-blog-photo

SONAFE lead group at Polyclinic Rio 2016. Left to right: Felipe Ferreira Tadiello, lead manager, Christiane Guerino Macedo, Mario Bizzini (IFSPT), Leonardo Trocoli de Medeiros, and Luciana de Michelis Mendonca, SONAFE president.

All PTs were volunteers, and underwent a rigorous selection process: in total there were almost 3000 interested Brazilians sports PTs who participated at several “pre-olympic” educational courses (organized by SONAFE) across Brazil. SONAFE, the largest sports PT association in South America, thank to the work and dedication of its leaders, has really raised the bar in providing quality education to its members. This process followed the recommendations by Phillips et al, a milestone publication on the preparations for the London 2012 Games (1). According to Luciana (the other important driving force within SONAFE) and Felipe, these 2 years of intensive preparation work toward the Olympics (the story was also featured on the WCPT website http://www.wcpt.org/news/brazil-olympics-August16) and the RIO 2016 experience represent an important legacy for the future of Brazilian sports PT!

Polyclinic services

At the Polyclinic different treatment options were offered to the athletes (from all nations, not only for those nations arriving without their own medical team): sports physiotherapy, electrotherapy, sports massage, cold water immersion, acupuncture, chiropractic, osteopathy, and a department for insoles and braces.

Here’s an example of a working day (August 11) at the Polyclinic: 72 athletes were treated by sports PTs, 62 received sports massage, 22 were seen by osteopaths, 15 by chiropractors and 108 (!) did cold water immersions. Those are some impressive figures underlying the role of sports physiotherapy at the Olympic Games (2), considering that many national teams were present in Rio with their own medical and physio staff.

All illnesses and physical problems, injuries (and subsequently treatments) were systematically recorded in a special online system, which was monitored by Felipe Tadiello and Mary Elaine Grant (Dublin, IOC Physiotherapy responsible). This was part of the comprehensive IOC injury documentation system (Injury Surveillance System) at the Olympic Games, coordinated by a research group with Lars Engebretsen and Roald Bahr (IOC Research and Oslo Sports Trauma & Research Center).

A model of national advancement

Higher quality sports PT means also better protection of health of the athletes, which is also one of the major objectives of the IOC (Engebretsen, Steffen 2015). The leadership of SONAFE before and at RIO 2016 sets an example for those countries hosting future Olympic Games (i.e. Japan in 2020), in terms of preparation and education following international guidelines and through international cooperation. Knowing the mentality and peculiarity of South American physiotherapy (often “isolated” within Portuguese- and Spanish-speaking world), one can only applaud the significant development of SONAFE towards a truly international organization, which will certainly benefit all the sports PTs in Latin America. IFSPT and BJSM have already and will continue to further support and promote sports physiotherapy worldwide, with the ultimate goal to continuously improve athlete’s health globally.

References

  1. Using criteria-based interview models for assessing clinical expertise to select physiotherapists at major multisport games. Phillips N, Grant ME, Booth L, Glasgow P. Br J Sports Med. 2015 Mar;49(5):312-7. doi: 10.1136/bjsports-2014-094176. Epub 2015 Jan 6.
  1. The role of sports physiotherapy at the London 2012 Olympic Games. Grant ME, Steffen K, Glasgow P, Phillips N, Booth L, Galligan M. Br J Sports Med. 2014 Jan;48(1):63-70. doi: 10.1136/bjsports-2013-093169.
  1. Protection of the elite athlete is the responsibility of all of us in sports medicine. Engebretsen L, Steffen K. Br J Sports Med. 2015 Sep;49(17):1089-90. doi: 10.1136/bjsports-2015-095221.

*************************************

Mario Bizzini, PhD, MSc, PT is as a research associate at the Schulthess Clinic in Zürich, Switzerland. He works there for the FIFA Medical Research and Assessment Center (F-MARC), the Swiss Concussion Center and the Human Performance Lab. His research interests focus on prevention and rehabilitation of sports injuries.

Mario is BJSM Deputy Editor, a reviewer for various scientific journals, and also a specialist in sports physiotherapy (committee member of the Swiss and of the International Federation of Sports Physical Therapy).

Clinical Reasoning in Exercise and Performance Rehab: 24/25 Sept and 15/16 Oct 2016

25 Aug, 16 | by BJSM

NRC2016 flier (3)

To register and for more information: http://www.physiosinsport.org/courses.html

Geeking Out at the Football Medicine Strategies Conference (BJSM’s 2015 Cover competition winner shares the story of her prize, and 5 take home messages)

30 May, 16 | by BJSM

What a bloody brilliant week I had in London. I remember starting this blog while enjoying a warm cup of tea at The Wolseley. I fondly recall staring blankly at my computer and an expensive basket of assorted croissants for a solid 15 minutes. But before I get ahead of myself, let’s backtrack to the very beginning. I was born a cute bundle of joy to a loving mum and dad. One day, a mean old wizard killed my parents in front of me and I became a really popular and powerful witch who saved the world… JK! Sounds like a good book idea though, someone should write it.

How about we start with the two things that brought me to London: Twitter and the British Journal of Sports Medicine (BJSM).

Screen Shot 2016-04-24 at 11.15.42 PMBefore I start rambling on, I should warn the general public that I am a huge nerd. Fact: every third tweet of mine includes the hashtag “#nerdtweet”. Usually, the only people who read my blog are my family (when relentlessly encouraged) and friends (n=4). So forgive me for any upcoming corny jokes.

Oh Twitter. Everyone who knows me is completely aware of my addiction to this social media app. I spend far too much time on my mobile reading sports headlines, laughing at Simpsons quotes, and trying to keep up with current physiotherapy research.

One wintery day in Edmonton, I came across a BJSM contest on my beloved Twitter. They were giving away free registration to the Football Medicine Strategies Conference in London (as in London, England for all the Canadians who asked me if I was going to London, Ontario… C’mon mate!). My coworker and I entered and proceeded to immediately practice our English accents in the off chance one of us would win. Then a few minutes went by and my small hamster brain forgot about the whole thing.

Then with a lot of luck and zero talent or skill, I received an email from the BJSM… I had won the contest! I was pretty much the living and breathing version of Charlie with his golden ticket to the chocolate factory. Except replace chocolate with lectures by sport medicine experts. Which is a thousand times better than chocolate, am I right?!Screen Shot 2016-04-23 at 12.13.42 AM

Full disclaimer: this was my first big conference (and my first time in London). What a rookie! I knew it would be amazing but I wasn’t aware of the degree of its amazingness. (Feel free to use that as a direct quote when sharing this on social media.)

Screen Shot 2016-04-23 at 2.44.48 PMI was ridiculously excited from day one. So excited that I took the wrong bus and ended up walking 20 minutes to the Queen Elizabeth II Centre. Pro: I got to see Big Ben and Westminster Abbey without a million tourists around. Con: I would have been kicked out if it were the Amazing Race.

Fortunately, I still got there with a few minutes to spare and parked myself in a seat with a good view for some live tweeting. For all the poor chaps who were unable to attend, you can relive the weekend by checking out Twitter (my feed or the official conference feed) or Adam Meakins’ review. Alternatively, you can just keep reading this blog..

On to the main act! Without further ado, here are my top 5 take home messages:

  1. Jill Cook on loading tendons. Wow. What an innovative way of dealing with tendon injuries, eh? To load them! Evidence it works in treating tendon injuries! It’s a modern day miracle. This one shouldn’t be Screen Shot 2016-04-23 at 4.28.18 PMearth shattering to anyone but it never hurts to really hammer home an important message.

@ProfJillCook focused on progressive loading as the key to victory when treating tendon injuries. Rest is detrimental. It causes detraining and weakens tendons. And on the other end of the spectrum, excessive loading is not the solution either. Overloading can cause bleeding, inflammation, structural changes, and eventually tendon thickening.

When loading a tendon (and the person to whom that tendon belongs), find the optimal load and slowly increase that over time. Heavy loads can take a few days for a tendon to recover from. The ultimate goal is to safely increase tissue capacity. Don’t listen to anyone who says they have a quick fix for tendon injuries. Toss the ultrasound, injections, and PRP. Be patient and load!

  1. Tim Gabbett on training load. I was gutted to have missed this talk. It was definitely my biggest regret of the conference, if not my life. But I was lucky to have fellow Twitterati kept me up to date. Even better, Aspire Academy uploaded a presentation Tim gave at their training load conference in March. @TimGabbett ‘s  research on training smarter and harder isn’t rocket science which is perfect for muppets like me!

Screen Shot 2016-04-28 at 12.10.04 AMTrain at low loads? Higher injury risk. Train at very high loads? Higher injury risk. We have to find that “sweet spot” where optimal training loads improve fitness and performance yet the odds of sustaining a non-contact soft tissue injury are minimized.

It’s important to train your athletes at safe (i.e. smart) but demanding levels (i.e. hard). If you can get them to these high loads on a consistent basis, they can develop a resistance to soft tissue injuries. Chronic high workloads should be the target of training programs.

Alright, makes sense so far but how do we get our athlete to that consistent high load without putting them at risk of injury? Enter the acute:chronic workload ratio. If your athlete’s acute workload (e.g. hours of training in one week) is much higher than his/her chronic workload (e.g. hours of training over the average of the last 4 weeks), then this athlete is more susceptible to injury.

In rugby players, the magic ratio number was 1.5 (i.e. acute load greater than chronic load by 1.5 times)2. A spike in training in one week greater than the 1.5 workload ratio puts players at risk of injury. The lesson here is to avoid these spikes in training load. Spikes are bad. Almost as bad as your favourite pub running out of fish and chips and lagers.Screen Shot 2016-04-23 at 4.42.45 PM

  1. Carl Askling @CAskling on hamstring injuries. I found this talk particularly great because there was lots of practical information. Stuff you can take home with you and try straight away. There was heavy emphasis on the long head of biceps femoris (the most commonly affected hamstring muscle) and even heavier emphasis on loading it eccentrically.

From one of his recent papers, Carl showed us the benefit of eccentric exercises over conventional exercises. Using the “diver” and “glider” lengthening exercises, elite sprinters were able to return to sport faster than their mates doing conventional exercises – on average, 37 days faster to be exact3! That’s almost a whole month and a fortnight!

He also implemented the use of the Askling H-test. When a sprinter had no positive signs of injury on clinical exam, they underwent the H-test (see video below and guess which is the injured side). The athlete is instructed to perform a straight leg raise as fast as possible. If the athlete reports any insecurity during the test, then the return to full training was delayed 3 to 5 days. This test of confidence likely prevents the risk of reinjury which has been shown to be an issue with hamstring strains3.

  1. Seth O’Neill on calf injuries. @Seth0Neill Calf injuries are the 4th most common musculoskeletal injury in soccer! Seth’s calf talk is also known as a public service announcement for soleus. Yes, soleus! The unsung hero in the posterior chain.

Screen Shot 2016-04-24 at 10.27.42 PMDid you know most calf strains happen in the last 15 minutes of the match? And that old geezers (like me) are at higher risk of injury? So when your veteran player sustains a calf injury in added time, paying attention to soleus is vital! Soleus plays a big role in our lower limb. Not only does it make up 50% of our calf musculature (picture from Seth’s slides), it also contributes 50% of our body’s vertical support force5 6! Seated calf raises FTW!

The trick for strengthening soleus – and the calf in general – is heavy loading. The long term goal is 1.5 times body weight for calf strengthening! Elite athletes aim for 2 to 3 times! Essentially, if you can do a calf raise with an elephant on your back, you’re set. Like I said, heavy.

  1. Andy Rolls on conservative management for an ACL injury. There has been lots of discussion about research in my previous 4 highlights. Screen Shot 2016-04-24 at 10.35.19 PMBut now we turn our attention to a rather interesting case study.

Andy is a first-team physio that works for (my favourite club) Arsenal. He presented a case of a professional soccer player who tore his ACL and made an informed decision to decline surgery. Andy was very honest about the medical team’s apprehension about the player choosing conservative treatment. If it failed, would they be scrutinized for not encouraging surgery? In a weekend filled with science this and science that, it was refreshing to hear about personal experience and emotion. All the feels!

Using a criteria-based return to play model (hooray!), the athlete gradually regained strength and control of his knee. Subjectively, he was asked the simple question, “Do you trust your knee?” following different exercises and graded this answer on a Likert scale. Objectively, he performed hop tests every 3 days. Using these simple measures, the staff was able to appropriately guide his progressions in rehab.

Screen Shot 2016-04-24 at 11.57.31 PMThe best part of this story is that it has a happy ending. The player returned to training at 8 weeks post-injury and played 60 minutes in a reserve match at 9 weeks! Furthermore, he has been fully fit for over 2 years now and has started 26 games in the Premier League!

Pretty amazing considering our immediate instinct is to refer athletes in high demanding pivot and twisting sports, like soccer, for surgery. Can all players do this? No. So how do we identify copers from the non-copers? That is the million dollar question, folks.

And there you have it! Five solid messages from Isokinetics Football Medicine Strategies Conference to chew on, spit out, chew on some more, and then perhaps implement in practice. At the very least, I hope they get your wheels turning.

Screen Shot 2016-04-24 at 10.54.52 PMThe weekend was jam packed with great presentations and exhibits. I even got to fulfill my dream of testing out a NordBord and then walk around for the rest of the day with hamstring soreness! But my absolute favourite aspect of the conference was having the opportunity to chat with these wonderful speakers. Everyone I spoke to was top class. All very friendly and, thankfully, irrespective of my obvious fangirling.

I even made a few new friends (n=9)! Colleagues who share the same passion and desire to learn more about sport medicine and become better practitioners. It’s nice knowing I’m not the only geek out there!

Massive thanks to Isokinetic and FIFA putting on such an incredible conference. And a huge shout out to BJSM for sending me to it! I’ve already started saving for Barcelona in May 2017. (Picture below with the Conference President – Dr Stefano Della Villa)

Screen Shot 2016-04-24 at 11.23.04 PM

– Chris

 

 

 

 

 

 

 

References:

  1. Cook, J.L. & Docking, S.I. (2015). “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ’tissue capacity’: a core concept for clinicians. British Journal of Sports Medicine49, 1484-1485.
  2. Gabbett, T.J. (2016). The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine, 0, 1-9.
  3. Askling, C.M., Tengwar, M., Tarassova, O., & Thorstensson, A. (2014). Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. British Journal of Sports Medicine48, 532-539.
  4. Ekstrand, J., Hägglund, M., & Waldén, M. (2011). Epidemiology of muscle injuries in professional football (soccer). The American Journal of Sports Medicine39(6), 1226-1232.
  5. Albracht, K., Arampatzis, A., & Baltzopolous, V. (2008). Assessment of muscle volume and physiological cross-sectional area of the human triceps surae muscle in vivo. Journal of Biomechanics41(10), 2211-2218.
  6. Dorn, T.W., Schache, A.G., & Pandy, M.G. (2012). Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. The Journal of Experimental Biology215, 1944-1956.

********************************************

Christina Le @yegphysio is a Physiotherapist at the Glen Sather Sports Medicine Clinic in Edmonton, Canada

Clinical Reasoning in Exercise and Performance Rehabilitation (February and March 2016), registrar now!

13 Dec, 15 | by BJSM

ACPSEM Course – Clinical Reasoning in Exercise & Performance Rehabilitation

 

Part 1- 6th & 7th February 2016

Part 2- 12th & 13th March 2016

  • This course is open to qualified physiotherapists
  • The tutor team will be: Dr Nicola Phillips, Tim Sharp, Lynn Booth, Dr Phil Glasgow, Chris McNicholl and Caryl Becker. Each of our tutors have many years of elite sports experience and teaching practice.

See more details on poster below and/or check out:  www.physiosinsport.org

Registration open now!
aspem

BJSM Podcasts – a year in review

9 Dec, 15 | by BJSM

joint-inflammation

Fridays are good days. We hope BJSM podcasts add to that feeling.

2015 marked an exciting year for sports physio / sports medicine podcasts. We loved listening to our colleagues’ podcasts – Jack Chew Physio Matters, Adam Meakins (@AdamMeakins), James MacDonald, the MACP, the Naked Physio and Dr Andy Frankyn-Miller. @BJSM_BMJ will feature on Karen Litzy’s New York-based physiotherapy podcast in 2016.

We tried to continually improve our podcasts for our listeners. Feel free to provide feedback. One BJSM goal was more consistent production quality and we feel we made progress over 2014. Thanks a lot to the very patient & dedicated James Walsh, sound engineer and @SportsOsteopath.  The field has progressed very well from the inception of regular sports physio / sportsmedicine podcasts in 2009.

Big, big thanks to our guests – they ARE the podcasts! http://bjsm.bmj.com/site/podcasts/. These guests are now drawing 10,000 listens per week to the > 200 podcasts on the BJSM channel alone!! We love reading tweets about your favourite episodes, and any pearls you learned while riding the tube or bus to work, so keep them coming! (Is cycling and listening to BJSM podcasts safe?). Big shout out to social media specialist Ania Tarazi for creating the BJSM app on top of everything else.

We welcome your suggestions for 2016: email karim.khan@ubc.ca or tweet @BJSM_BMJ

(you can also check out the mid-year podcast review in this BJSM print article: http://bjsm.bmj.com/content/early/2015/07/06/bjsports-2015-095140)

Below we highlight the 3 most popular podcasts in the last 2 months (Yep, they launched on Fridays). Stay tuned for part two of this series where we profile the most popular podcasts of ALL TIME.

#1. Gold Medal Professor Gwen Jull – Part 1 – Assessment and Management of Neck Pain. First of Two Conversations

Do you treat patients with neck pain? Do you have neck pain? Stop reading and start listening to the podcast. Professor Gwen Jull is one of the most lauded health professionals in the world right now and she shares pearls every minute of this podcast.

Timeline
0:00m – How do you approach the patient aged in the prime of life who complains of neck pain and bad cervical posture?

2:00m – “Big development in physiotherapy is the assessment /examination which then forms the basis of our treatment” – movement and also how the movement is performed. Facet joint tests, muscle coordination.

3:10m – Detailed specific assessment of posture in the patient with neck pain. Have the patient adopt the work positions. Aim to correct the posture to see if pain changes.

5:10m – How to distinguish the superficial and deep neck extensors

8:30m – 3 trajectories in whiplash patients; folks who get better fairly rapidly (50%), those who suffer persistent mild pain (> 2years, 30%), and ‘the major worry’ of those who have persistent moderate to high levels of pain for many months and sometimes going on for years. What predicts these trajectories? “The last group is a real stumbling block for all professions”.

11:00m – Predictors of the poor outcomes.

Follow THIS LINK for the complete timeline.

#2. Silver Medal Keeping runners running: the secrets of running assessment – advice and exercise progressions

Mo Farah has great running technique. You see it, you know it. But what are the elements of Mo Farah’s running style? Can we assess running patients and guide them to improve their technique? Might gait education prove more effective than medication to treat symptoms? Andy Cornelius has the answers. He’s a Graduate Sport Rehabilitator and head running coach who works in private clinics, premiership football and with high profile clubs and athletes. Posing the questions is Stephen Aspinall, Chairman of the British Association of Sports Rehabilitators and Trainers (BASRaT – www.basrat.org) and Lecturer in Sport Rehabilitation at the University of Salford, England.

Timeline
1:20m – What are the key elements of running assessment?

2:45m – What you can learn by watching the runner from behind (frontal plane) and the side (sagittal plane) on the track and on the treadmill.

4:08m – The runner with injuries related to overstriding. What is overstriding? What can the clinician advise?

6:00m – Assessing cadence and helping the athlete to make a change of between 5-10% in cadence.

Follow THIS LINK for a complete timeline

#3. Bronze Medal Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach

Consider the classic understanding that high carbohydrate intakes are necessary for optimal endurance performance. What if that failed to take into account the physiological changes that occur with adaptation to low carbohydrate diets? In this podcast, @JohannWindt interviews physician-researcher Dr. Stephen Phinney about his last 30 years of research into low-carb ketogenic diets. Highlights include the previously undocumented levels of during exercise fat oxidation seen in endurance athletes adapted to a low carbohydrate diet. He also touches on ketogenic diets’ potential benefits in other sporting contexts, addresses common criticisms, and looks ahead to future research questions in the field.

Further reading and papers discussed in the podcast are included below.

Vermont and MIT Study Dr. Phinney’s original two studies on low carbohydrate performance. Original two low carb performance studies.
www.metabolismjournal.com/article/0026…5-1/abstract
www.ncbi.nlm.nih.gov/pmc/articles/PMC371554/

Phinney SD et al. The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation. Metabolism 1983;32:757-68.
www.metabolismjournal.com/article/0026…5-1/abstract

Phinney SD et al. capacity for moderate exercise in obese subjects after adaptation to a hypocaloric, ketogenic diet. J Clin Invest 1980;66:1152-61.
www.ncbi.nlm.nih.gov/pmc/articles/PMC371554/

The gymnast study mentioned in the podcast: Paoli et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts.
J Int Soc Sports Nutr 2012; 9: 34.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3411406/

Significant decrease in inflammation shown in low carb diets by Forsythe, Phinney, et al.Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 2008;43:65-77.
link.springer.com/article/10.1007/…7?no-access=true

Prof Phinney’s recent BJSM Editorial: Noakes T, Volek JS, Phinney SD. Low-carbohydrate diet for athletes: what evidence? Br J Sports Med 2014
bjsm.bmj.com/content/early/2014…014-093824.extract

Prof Phinney and Volek’s website– Art and Science of Low Carbohydrate Living/Performance www.artandscienceoflowcarb.com/

In the August 2015 issue of BJSM you’ll find a series of paper on weight loss and physical activity: bjsm.bmj.com/content/49/14.toc

Dr Aseem Malhotra’s paper: It’s time to bust the myth of physical inactivity and obesity: you can’t outrun a bad diet (if you want to be thin) bjsm.bmj.com/content/49/15/967.full (OPEN ACCESS) Coauthors are Professor Phinney and Professor Timothy Noakes (@ProfTimNoakes).

Professor Stephen Blair’s rebuttal: Physical inactivity and obesity is not a myth: Dr Steven Blair comments on Dr Aseem Malhotra’s editorial bjsm.bmj.com/content/49/15.toc

Professor Kamal Mahtani’s editorial: Physical activity and obesity editorial: is exercise pointless or was it a pointless exercise? bjsm.bmj.com/content/49/15/969.extract

Two relevant BJSM podcasts include:

1) Professor Tim Noakes interviewed by Professor Peter Brukner ow.ly/PQlld
2) Dr Aseem Malhotra discussing the debate around his editorial above ow.ly/PQlNL

BJSM editors appreciate that nutrition is a controversial issue (not sure why, but that’s OK) so please note the Prof Phinney’s competing interests are listed in bjsm.bmj.com/content/49/15/967.full BJSM revels in debate and publishes quality material. Hence, you can see divergent views represented above and we have commissioned an editorial from respected scientists who feel that protein, or carbohydrate, deserves greater prominence. Your submissions are welcome via the BJSM’s various channels – ‘print’, rapid response, blog, Google plus community, twitter, Facebook. Or email karim.khan@ubc.ca

Missed the ACPSEM Biennial Young Athlete conference? Not to worry- here are some highlights with links to key resources

25 Nov, 15 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

CONFERENCE REPORT

By Zachary Spargo (@ZachSpargo)

The Physios in Sport (ACPSEM) Biennial Young Athlete Conference was in no uncertain terms an absolute classic! Great speakers, hot topics, lots of networking and above all – mini burgers for lunch! The focus was on managing the young athlete within all aspects of sport to ensure their development into a robust, resilient and successful adult. This BJSM podcast is a good place to whet your appetite https://soundcloud.com/bmjpodcasts/managing-load-in-young-footballer-practical-tips-to-customize-treatment-training-sam-blanchard

Here’s some of the educational nuggets that the two days entailed:

Physical Development and Risk

(J Bunce, A Renshaw & P Read)

CLIMBING WALL 4The day opened with a discussion on the optimal training programme for the younger athlete. A balance between resistance and power sessions was suggested to be the best route. The need to make sessions fun for youngsters was keenly stressed, giving examples of Manchester City’s playground and Brighton and Hove Albion’s climbing wall.

Andy Renshaw highlighted one of the key messages of the conference: You simply cannot rely on adult data to predict injuries in younger athletes. Using the Fuller et al. (2006) injury definition consensus statement http://bjsm.bmj.com/content/40/3/193, Andy was able to expertly illustrate the differences between the populations. His data showed for example that anterior thigh strains were the most commonly occurring injury in the academy teams (18% n=23) compared with a majority of posterior thigh injuries in the adult game. Paul Read went on next to identify some of the main risk factors for injury in adolescent populations including:

  • Previous injury
  • Fatigue
  • Movement skill/neuromuscular skill
  • Growth and Maturation
  • Seasonal Variation (Greatly increased loads pre-season)

Will Abbott (Brighton and Hove FC) also reiterated the importance of load management and monitoring throughout the season, but spoke of the need not to purely focus on velocity of activity.

Hot Topics

(S Parris, M Stewart, T Quantrell, M Hendry, A D’Silva, & J Hanson)

  • Safeguarding: The welfare of the child must always be, the absolute paramount consideration of the healthcare professional.
  • Persistent Pain: Treat the symptoms not the scan (35% of athletes have damage on MRI but no symptoms). ‘Pain is the ideal habitat for worry to flourish’ (Eccleston & Crombez, 2007). Understand our mouths are THREAT MACHINES!
  • Golf: Surprisingly little physical preparation for young golfer currently. Identify physical markers, technical markers and evaluate how your treatment/preparation has effected performance.
  • Sudden Cardiac Death: Exercise is good! However can be a trigger in rare cases for sudden cardiac death (SCD). Some of the conditions causing SCD can be screened in the young athlete. http://blogs.bmj.com/bjsm/tag/sudden-cardiac-death/
  • Concussion: If in doubt sit them out! Chronic traumatic encephalopathy has a clinical manifestation of early onset dementia (post mortem findings of repetitive head injury). http://bjsm.bmj.com/content/47/5/250.full

Orthopaedic Physiotherapy Management

(P Bennett, I Tak, S Ahamed, Mo Gimpel, P Glasgow, A Wallace, M Allen & A Harris)

  • Gymnastics Adolescent Spine: In a sample of female Olympic gymnasts (12-20 years) 12/19 had degenerative discs and 3/19 had spondylolysis. Our role is to create a robust young athlete, with regular screening and early detection of issues. Must have full fitness before returning to activity after injury! See this podcast from Dr Pippa Bennet for more information: https://soundcloud.com/bmjpodcasts/legendary-england-football-chief-medical-officer-on-acl-injuries-red-s-and-sport-team-culture
  • Hip/Groin: Reduced hip range of motion (internal rotation) in athlete with groin pain. Increased anterior pelvic tilt results in decreased range of motion which ultimately affects ball striking power in footballers. Southampton FC’s Mo Gimpel demonstrated a tremendous reduction in hip/groin injuries with a movement dissociation programme. He also noted the need for an iliopsoas/glute activation programme before stepping on the pitch at any time!

Monitoring and Prevention

(N Cameron, J Strickland, A Johnson, W Abbott, L Abnett, J Elphinston & R Brandon)

  • Apophysitis Syndromes: Affects children during secondary growth spurts, especially those involved in physical activity (ages 8-16). Using a self-developed treatment algorithm (including absolute rest, stretching and massage), Jenny Strickland was able to reduce recovery time significantly to an average of 19 days.
  • Screening: Amanda Johnson highlighted the main reasons for screening your youth athletes as follows:
  • Cardiac investigation
  • Growth related injuries
  • Flexibility
  • Strength
  • Load monitoring
  • Endurance and sprint ability

But it was stressed that clinicians should not intervene without evidence and to ensure your protocols are to the highest standard!

Physios in Sport Young Athlete Conference 2015: In Summary

This is really just the tip of the iceberg in relation to what was on offer! I’m really sorry I haven’t been able to include something from all the speakers because they were all absolutely incredible throughout the two days. I urge all readers to look out for where they can find them at other conferences around the world.

If you have any questions then don’t hesitate to comment below!

PLUG ALERT: Look out for the next ACPSEM Biennial conference in 2017! Plus have a nosy at all the brilliant CPD opportunities on the Physios in Sport website.

Zachary Spargo MSc Physiotherapy student (pre-registration), BSc (Hons) Sport and Exercise Science (@ZachSpargo). Currently studying at York St John University and is the Yorkshire and Humber CSP Communications Lead for the region. ACPSEM student member.

 

Undergraduate Physiotherapists at Sheffield Hallam University use Interdisciplinary Exercise Medicine Resources

14 Nov, 15 | by BJSM

By Anna Lowe

In 2014 Exercise Works! (an organisation that promotes the prevention and treatment of non-communicable diseases) made huge steps forward to enhance the exercise-related content of medical undergraduate curricula. The project “Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients” (Tomorrow’s Doctors), funded by Public Health England, led to the development of exercise medicine and chronic disease resources for all UK undergraduate medical degrees.

sheffald

Following on from the success of “Tomorrow’s Doctors”, these resources have been revised and made available for all undergraduate nursing, midwifery and Allied Health Professions courses internationally.

At Sheffield Hallam University we have approximately 300 undergraduate physiotherapy students and we are delighted to be using the resources to support our training of “Tomorrow’s Physiotherapists”.  Our physiotherapy approaches must evolve to keep up with a changing and growing population.  Exercise medicine is a core part of our undergraduate curriculum, in view of the rise of long-term conditions and the ageing population, the need for exercise prescription skills is greater than ever before.  The resources are a selection of PowerPoint presentations on subjects ranging from “Mental Health & Exercise” to “Physical Activity Leadership”.  We will evaluate staff and student perspectives and promote the resources to other health courses within the University.

Sheffield has a rich history of physical activity and it has recently claimed the title of The Outdoor City.  It borders the Peak District and benefits from an abundance of green space and beautiful landscape; something that brings many students to the city and keeps them here long after their studies finish.  With the help of Olympic Legacy projects such as Move More (a city-wide physical activity strategy) and the National Centre for Sports and Exercise Medicine the physical activity infrastructure continues to grow and physical activity is becoming firmly embedded in the personality of the city.

Despite this, Sheffield is a city of contrast with large geographic variations in health and disability. Contemporary health education requires a deep understanding of the wider determinants of health, particularly in relation to health behaviours.  Every patient contact is an opportunity to impact, not only on the presenting complaint, but also on overall health & wellbeing.  A physiotherapist may see up to half a million patients in their career, many of these patients will have long-term conditions and will therefore be at risk of disability and early death.  As a profession we must ensure that we keep exercise at the heart of everything we do and that no opportunity is wasted!

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Anna Lowe is a Senior Lecturer in Physiotherapy at Sheffield Hallam University

@annalowephysio a.lowe@shu.ac.uk

Ann B Gates is founder of Exercise Works!

@exerciseworks  ann@exercise-works.org

Physiotherapy’s role in an adolescent multi-sports environment: what’s tape got to do with it?

24 Sep, 15 | by BJSM

Association of Chartered Physiotherapists in Sports & Exercise Medicine blog series @PhysiosinSport

By James Boyd

physio 2 2015 Well, what a fantastic few days I’ve had recently. I’ve not long returned from working at the 2015 Sainsbury’s School Games, and am proud to have shared company with a wonderful plethora of athletes, coaches, doctors and physiotherapists. This was my second year at the games and this time around, I found myself working with fellow physio and frequent blogger for the BJSM, Sam Blanchard (@sjbphysio_sport). Whilst there isn’t much down time in this environment, there is always time for discussion. One such chat between Sam, myself and the rest of the team got me thinking: what is the physiotherapist’s role in an environment such as the School Games?

physio sep 2015The annual School Games event sees approximately 1600 athletes aged 13-18 years of age, competing across various sporting disciplines, over a three-day period. For the medical team this is a busy 72 hours, with plenty of assessments being undertaken and lots of new faces, each with their own complex histories and idiosyncrasies. So how can we be the most effective?

Well, for starters we need to ensure that we are performing the basics to a high standard. Thorough subjective and objective assessments need to take place with our detective’s hats on, so we can wean out any possible ‘nasties’ or serious pathologies. These could range from osteosarcomas to a previously undiagnosed stress response. It is also worth taking note of the possibility of apophyseal avulsions in the adolescent athlete. But let’s assume that we’ve managed the basics well and we are left with those generalized aches and pains that any athlete will present with. Those that are not life or limb threatening, but are a day to day issue with athletes who train and compete for many hours each week.

Here’s an example from this year’s games: A 14 year old male athlete entered the make-shift medical clinic (the changing rooms), complaining of vague soreness in his knees. This had been ongoing for a couple of weeks and had been linked with an increase in training load in prep for the competition. Upon observation he was covered in tape from top-to-toe. He assured me that he was not sponsored by a leading kinesiology tape brand, but I was dubious. Three strips around each knee, lines up and down his ITBs, and some obscure technique running across his lower back. When asked who had implemented the taping he confessed that he had self-applied, but had based what he’d done on the techniques he had been shown by physios in the past.

“Do you think you need all that tape on?” I asked.

“Umm, I think so?” He replied with a questioning inclination.

“Do you think it helps?” My second line of inquisition.

“Umm, I think so” His response came with a pondering pause prior.

“Do you think it will help your pain or performance?” My third line of questioning.

“Umm, maybe” He replied.

I can’t promise that this was verbatim, but that was the gist of the conversation, and with it I aim to highlight the impact that previous physiotherapy input has had. At this stage I hasten to acknowledge that there are, of course, other contributing factors, such as the influence of peers and role-models who are seen sporting the same tapes, the effect of marketing strategies of the tape companies, and many more. But he has been shown how to perform these techniques by other physios and they have been remembered, to the point where he is applying the tape with no known knowledge as to what it does, or why he’s even using it. He just feels that he needs it, and has become reliant on wearing the tape. I am not questioning the role of taping (that’s a new blog topic altogether), neither am I questioning the quality of the previous physio input (as any athlete will come away with only a few key messages from a session and in this case, it may have been the tape that stuck – excuse the pun!). However, by contributing in such a way, are we helping to build strong, robust athletes or those reliant on external factors?

Predictably enough, this athlete was a repeat user of the physiotherapy service during the 3 days of games. Each time presenting with fatigue based aches and pains – expected after four to four and half hours of repeated jumping and landing per day. He frequently asked for rub downs and taping to help him get through the tournament and with time restraints as they are in such an environment, it would be very easy to slip into auto pilot and give him some therapeutic hands on work. However, what followed was a dose of education and reassurance that his own body and mind were resilient structures that could withstand the rigors of the sport and perform at a high level. Whilst he may have left unsatisfied without his rub down, he went on to medal with his team at the games, and I can only hope that this experience went some way to reassuring him that he could still perform, even without his taping/soft-tissue work.

As a team we pondered if there was something underlying that we were missing, but we realized that this 14 year old athlete had simply been institutionalized into the world of physiotherapy. He had become reliant on his tape and massages, with very little education as to how he can self-manage some of the rigors of training independently. I would argue that the child/adolescent athlete should be empowered to manage their own bodies, as opposed to feeling dependent on techniques that they may not always be able to access. I pose that if we are not considerate with our wording and actions as physiotherapists, we will nurture a generation of athletes (and on a bigger picture, adults) who are reliant as opposed to resilient, and may not be able to self-manage.

As elite programs for the young athletes develop and a greater number of kids are exposed to the pressures of high level sport, the medical profession must identify that we are not working with young adults. This completely different client group requires a different skill set. It is my belief that as part of our practice to the developing athlete, we need to instill good habits, educate and most importantly, empower them to become the best that they can be.

physio three

Signing out,

James Boyd

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James is a Physiotherapist at the University of Bath and acts as the Lead Physiotherapist for the Southampton FC Satellite Academy and the University Badminton set-up. He is currently setting up the Team Bath Physiotherapy and Sports Science Podcast, so watch this space!! Follow him on Twitter @jimmypboyd

Physiotherapy and ‘The Young Athlete’: Education, advocacy, and the upcoming ACPSEM biennial conference

28 May, 15 | by BJSM

Association of Chartered Physiotherapists in Sports & Exercise Medicine blog series @PhysiosinSport

By Claire Treen @ClaireTreen

biennel conferenceIn recent months, politicians in the UK have – quite rightly – talked a lot about the NHS. However, perhaps because many teens don’t vote, we don’t hear as much about the challenges of bone growth, adolescent and young adult mental health, eating disorders and adapting to change in academic and social environments. My colleague Dr Dominique Thompson, University of Bristol Director of Student Health, recently highlighted this in a 3 minute BMJ podcast.

As Sport and Exercise Physiotherapists, youth and parents often confide in us. It is therefore especially important to both be informed about key youth health issues and advocate for their importance.

I’ve worked with many teens, particularly young runners and tennis players, in a university environment over the last 10 years. My colleagues and I have noted recurrent challenges around screening and safeguarding young athletes.

Questions we have raised in our continuing professional development  sessions include:

What do we understand about adolescent growth and its influence on musculo-skeletal development and injury?

How do we prevent today’s star first XV rugby player from being tomorrow’s persistent pain sufferer?

What are the implications of applying high load to areas such as the spine, hip and groin during adolescence?

We are constantly challenged in our work to support young people as they transition from developing or elite junior athletes into an elite senior environment. How can we best do this, and who should be involved?

How can the ACPSEM biennial conference strengthen our capabilities?

With a focus on ‘the young athlete,’ the upcoming ACPSEM biennial conference (this October in Brighton) aims to help answer some of these questions.

Conferences not only provide presentations on ‘hot-topics’ from leaders in the field, but also a chance to interact with others facing similar clinical scenarios, and discuss these – and more – multifaceted questions.

What are the benefits of being an ACPSEM member?

Being an ACPSEM member gives you a discount, and helps you become part of a group of skilled physio professionals. You can also access continuing professional development through journal subscriptions and an organised and well mentored pathway.

The early bird catches the worm…everyone who books before May 31st gets a discounted price and a free (unfilled) Vivomed kit bag and entry into raffle prizes.

Register today! Hope to see you there!

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Claire Treen @ClaireTreen is a Physiotherapist at University of Bristol Sports Medicine Clinic, Coombe Dingle Sports Complex

Announcement of the BJSM 2014 Cover Competition prize winners, drum roll please…

9 Apr, 15 | by BJSM

A huge thank-you to everyone who voted in this year’s cover competition. Thanks to the record number of voters in all rounds. And thanks for your comments on the BJSM covers – which you may use in your presentations and social media to illustrate key points. Read the interesting career development stories from the a new sports medicine book prize winners below.

1. Dr. Eamonn Delahunt (@EamonnDelahunt)

Eamonn 1Tell us about your educational background and current involvement in Sports Medicine.

I graduated with a BSc Physiotherapy in 2003 from University College Dublin. Upon graduation, I received a PhD scholarship from the Irish Research Council for Science, Engineering and Technology. Whilst completing my PhD, I worked part-time in a Sports Medicine and Physiotherapy clinic. I am currently a senior lecturer at UCD and teach in under-graduate and post-graduate physiotherapy and sports science programmes, and also supervise PhD and research MSc students. I recently received the honorary title Specialist Member of the Irish Society for Chartered Physiotherapists (discipline Sports Medicine).

What has been your inspiration? 

I developed a keen interest in sports physiotherapy clinical practice following a placement in 2nd year of my undergraduate education. After this placement I began to study Brukner & Khan’s Clinical Sports Medicine. I still have my original copy of the 2nd edition- it is just about holding together. From reading this book, I developed an interest in sports medicine and physiotherapy research by mainly consulting the bibliographic reference list at the end of each chapter. During the summer period between 3rd and 4th year of my under-graduate education I sourced an “extra” placement in a Sports Medicine and Physiotherapy clinic and this solidified my interest. After this there was no other option for me; I wanted to practice and research in the areas of sports medicine and sports physiotherapy.

Why you are excited to have won a new sports medicine book?

I currently have a strong interest in teaching and learning pedagogy. I am a strong believer in the principle of research-aligned teaching. I also try to practice the principle of research-enriched learning and teaching. The IOC Manual of Sports Injuries will provide an excellent supplementary resource to my current teaching, particularly for a final year module that I teach called Sports Injury Management.

What’s your favourite thing about the BJSM blog?

I love the utility of the blog as a learning resource for undergraduate students. We regularly use it to launch discussions in class. I have to say that the BJSM mobile app works well — great to reach the blog, download and listen to podcasts!

When not teaching or practicing Sports Medicine we will likely find you…

Watching UCI World Tour races on Eurosport.

2. Suzan de Jonge @Suus_DJ

Suzan de jongeECOSEP_photos_4
Tell us about your educational background and current involvements

I’m a clinical registrar and research trainee in Sports Medicine in Medical Center The Hague in the Netherlands. I combine the clinical training for sports physician with a PhD-project on Achilles tendon injuries at the Orthopaedic Department of the Erasmus University Medical Center in Rotterdam. I’m a member of the national board of the Netherlands Association of Sports Medicine (VSG), as well as national chairperson of the board of registrars in Sports Medicine in the Netherlands. Last year I won the ECOSEP travelling fellowship and visited several sports medicine centres in five European countries. I hope to finish both my PhD-thesis and the specialist training for sports medicine this year.

What inspired you to become involved in Sports Medicine?

What attracted me to sports medicine, and continues to fuel my interest is the great diversity of problems (and solutions).

Why you are excited to have won a new sports medicine book?

The focus of training for sports medicine in the Netherlands lies more on exercise therapy than manual therapy. So I would love to receive Orthopedic Manual Therapy by Chad Cook to help me learn more about this field.

What’s your favourite thing about the BJSM blog?

While I do enjoy the diversity of topics on the BJSM blog, I have to admit I like the BJSM podcasts the most.

 

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