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Top 3 most popular BJSM podcasts of ALL TIME

18 Jan, 16 | by BJSM

The year in BJSM podcasts is off to a good start. “Knowledge translation in sports physiotherapy: moving research into practical use” (with Dr Michael Skovdal Rathleff, Dr Dylan Morrissey and Dr. Christian Barton) had 1000 listens in just 24 hours.

We have lots more to look forward to in 2016. Stay tuned – new podcasts will be posted every Friday. Only time will tell if any of these will beat the ‘reigning champions’ of the most popular podcasts of all time:

podcast listening

  1. Diagnosing and treating acute hamstring injuries

This is a podcast by Dr Robert-Jan de Vos, sports physician in the Erasmus Medical Centre in the Netherlands, with Guustaaf Reurink, who is a registrar in Sports Medicine in the Netherlands and is currently finishing his thesis on diagnosis and treatment of acute hamstring injuries. Recently, he published a paper in the New England Journal of Medicine about the role of Platelet-rich Plasma (PRP) treatment for acute hamstring injuries (www.nejm.org/doi/full/10.1056/NEJMc1402340).

We start with discussing this interesting study, which did not show a benefit of PRP injections in acute hamstring injuries. Dr Reurink expresses the methods and results of this study and possible explanations for these findings are debated.

Dr Reurink also performed a number of studies on the value of clinical tests and Magnetic Resonance Imaging (MRI) in acute hamstring injuries. Previously, he already showed that most MRIs are still abnormal when the athlete already returned to gameplay (bjsm.bmj.com/content/early/2013…92450.abstract?eaf).

We close by discussing the role of MRI and standardised clinical tests as a predictor of time to return to play and re-injury.

  1. Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’

Peter O’Sullivan has two recent BJSM podcasts (see below). In this podcast he shares his thoughts on the recent media attention around Tiger Woods’ obvious back pain while playing in the US PGA.

He discusses what the pathology might be, why the media suggested that Mr Woods’ ‘sacrum went out’. He contends that ‘core strengthening’ may not be the panacea.

The lessons apply to the management of low back pain, and other pain, in a myriad of settings.

See also
Read Professor O’Sullivan’s blog on Tiger Wood’s back pain: bit.ly/1zaISGz

Listen to his podcast on lower back pain: goo.gl/jrQxSe

Listen to his podcast on overtreatment and overdiagnosis in sports medicine: goo.gl/vPZ3g8

  1. Dr Alison Grimaldi with practical physiotherapy tips on treating lateral hip pain

With over twenty years’ experience, accreditation in Sports Physiotherapy, and a recent PhD in the topic of lateral hip pain, Alison Grimaldi (@AlisonGrimaldi) was invited to this podcast by BJSM’s Twitter community.

She is a popular conference speaker internationally. Here she walks you through each step of the assessment and treatment of an older patient with right hip pain. She then shares how to assess and treat a younger sportsperson.

In both cases, Dr Grimaldi emphasizes that compression is bad for tendons that run over bony prominences (trochanter in this case) and indicates how this can be addressed.

Enjoy one of our most practical podcasts. Recorded at the Physiotherapy New Zealand Conference, Auckland (September 2014) with thanks to the NZ Sports Physiotherapy Interest Group (@SportsPhysioNZ).

Links:
1) JL Cook, C Purdam Is compressive load a factor in the development of tendinopathy? Br J Sports Med 46(3):163-8. 2012 bjsm.bmj.com/content/46/3/163.abstract

2) Fearon A, Stephens S, Cook J, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. Br J Sports Med. 2012 bjsm.bmj.com/content/46/12/888.long

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

The 7 most common injuries and illnesses seen at major multisport games

3 Aug, 14 | by Karim Khan

LIVE FROM THE CLOSING CEREMONY!

By Team England Sports Physicians: Paul Dijkstra & Noel Pollock (@DrPaulDijkstra / @DrNoelPollock)

**Podcast with Dr Paul Dykstra sharing the UKAthletics Model for providing integrated (clinicians & coaches/S&C) – click here)

Tonight is the closing ceremony of what has been an amazing 20th Commonwealth Games here in Glasgow; the most successful ever for Team England who topped the medal table with just under 60 gold medals!

The Team England Medical facility was a constant hive of activity with doctors and therapists working side-by-side for very long hours to assist athletes to give their very best. The polyclinic was no exception. On our occasional visits there it was obvious that the excellent facility (sports medicine, pharmacy, 24 hour emergency care, dental, ophthalmology, radiology – including mobile MRI and CT imaging facilities) was being well utilised by all the teams; some more than others…

What were the 7 most common injuries and illnesses seen and how did we manage them?

  1. Upper respiratory symptoms (commonly allergy driven). Asthma and allergy are very common amongst elite athletes. More than 50% of elite athletes have hay fever and a significant percentage will have asthma (up to 25% of elite athletic teams!). Asthma and EIB are more prevalent in swimmers. Hay fever (and especially itchy and watery eyes) has been a problem here brought on by the few very hot and windy days we’ve had in the lead up to the Games. (It was close to 30 degrees on the first day of competitions here on the 24th July.)

Management Tip: Otrivine and a corticosteroid nasal spray are an excellent combination for quick control of nasal congestion and mouth breathing sleep

  1. Viral illness – both respiratory and gastrointestinal. Prevention and early precautionary isolation is key. Travel well-prepared with personal hand gels. Wash hands; everybody was encouraged to use the hand gel provided at the entrance to the dining hall. Paracetamol, and decongestive nasal spray. Martin Schwellnus published an excellent study in the BJSM on the effect of time zone travel on athlete risk of illness. Travelling more than 6 time zones more than doubles the risk of illness while in the foreign environment in professional rugby players.

Gastrointestinal illness is a constant threat when travelling with teams. There was some media attention to an early outbreak of Norovirus among workers here in the village before the start of the games. Due to the excellent work by the Scottish Public Health authorities and others here, the disease has not spread further. It warns us to be ready to manage this kind of problem when travelling with teams to any destination.

Management Tip: Always travel with probiotic capsules. There is some evidence that regular use will shorten the number of days of diarrhoea and also boost the immune system, particularly in endurance athletes.

  1. Emotional stress and sleep problems are common especially in younger athletes competing at a major event for the first time and living in a very big and busy athlete’s village environment. Athletes here are all share rooms and a few have Tweeted their frustration with the noise level!

Management Tip: Encourage athletes to minimise impact to their normal routines and to bring ear plugs and eye masks

  1. Chronic overuse injuries especially affecting lower limb, obviously depending on the type of sport and discipline. The most common of these are Achilles and Patella tendinopathies, plantar fasciosis and stress injuries of tibia and foot / ankle.

Management Tip: One athlete recorded a doubling of daily steps taken while in the village – encourage athletes to limit unnecessary walking and to use appropriate footwear (not flip-flops!)

  1. Acute muscle injuries – especially hamstring and calf muscles. These are common running injuries in sports like track and field, rugby and football.

Management tip: Most sprinting athletes will present with some hamstring symptoms through the rounds of a championships – particularly if they compete in multiple sprints/relays. Team clinicians should be experienced in the management and differentiation of hamstring presentations to assist the coaches and athletes in decision making and performance. As always know your sport!

  1. Acute ankle ligament injuries – especially in contact sports like rugby sevens, netball and hockey. The lateral ankle joint ligament sprains were the most commonly ligament injuries seen here.

Management Tip: Determine the severity of the injury and treat aggressively with immobilisation, cold compression, elevation, rest and strapping / taping for competition. It is important to include the athlete and coach when the relative risk of further competition is being discussed.

  1. Acute (and chronic) hand injuries are more common encounters by medical teams covering the boxing, judo and weightlifting events.

Management Tip: We’ve seen some excellent management of hand injuries by therapists and doctors with a combination of ice-compression, therapy, strapping, injections and anti-inflammatory medication being used.

Conclusion: The overall message is teamwork. Its an easy word to use but there are huge challenges to effective teamwork in a high performance environment (a topic for another blog!). Athletes and coaches usually benefit most when supported by doctors, therapists and management working in synergy towards a common performance goal.

Thanks to all our colleagues in Team England and to the coaches & athletes; as ever, its a privilege to work with such talented people. ————–

 

—————————–

@DrPaulDijkstra’s paper on the Integrated Performance Health Management & Coaching model here (please see podcast note at top of blog too).

integratedMOdel

 

The 5 most popular BJSM Podcasts in 2011

8 Feb, 12 | by Karim Khan

Courtesy of Boston Public Library, Flickr CC

ACL injuries, lower limb injuries, neck pain, tendons and ultrasound in sports medicine practice were the chart busters in the 2nd half of 2011. Over 4000 listeners monthly enjoy the 35 BJSM podcasts available now. And we continue to add to the list.

We are very open to your suggestions as to whom to interview – feel free to email, post a message on twitter (include @BJSM_BMJ of course) or call 1 800 BJSM.

That’s all for this blog – take the time to listen to a BJSM podcast and provide feedback via ’email or your favourite social media site

karim.khan@ubc.ca

@BJSM_BMJ

http://www.facebook.com/BJSM.BMJ

The 5 most popular BJSM Podcasts in 2011 were…

5. Treating tendinopathy with Professor Håkan Alfredson

4. Musculoskeletal ultrasound with Kim Harmon and Sean Martin

3. Managing whiplash with Michele Sterling

2. Biomechanical overload and lower limb injuries with Andrew Franklyn-Miller

…drum roll please for most popular podcast of the year…

1. The JUMP-ACL study with Anthony Beutler

Is the global movement ‘tipping’? Exercise IS medicine

2 Feb, 12 | by Karim Khan

Three exciting updates from the frontlines of health promotion through physical activity.


Illustration by Liisa Sorsa, 23.5 hours video

First, congratulations to Professor Steven Blair for winning the Bloomberg Manulife Prize for the Promotion of Active Health. This international competition celebrates a researcher whose work promises to broaden understanding of how physical activity, nutrition or psychosocial factors influence personal health and well-being.

Professor Blair has tirelessly raised awareness of the burden of low fitness. His dedicated data gathering and adroit analysis has allowed him to deduce that physical inactivity is the biggest public health problem of the 21st century. His 2009 editorial in BJSM shares this title and has been downloaded more than 20,000 times (available free online).

To read more about the award, follow this link to the Globe and Mail.

Secondly, after garnering global attention, Mike Evan’s videos 23.1/2 hours is being translated into multiple languages. Sports Medicine colleagues will ensure the video can be enjoyed by speakers of Arabic, Spanish, Chinese, and Italian. And there will likely be more offers to come.

This will further enable the first physical activity ‘YouTube sensation’ – 23 1/2  – to promote behaviour change, while recognizing the physical activity challenges in a wide range of countries.

While 1.6 million hits demonstrates 23.1/2’s current success, translation into multiple languages may take this video to the ‘next level’ with a goal of 10 million views!

The video has already gained international traction as shown by the breakdown of views per country: US 844, 664, Canada 320, 000, UK 61, 345, Australia 49, 100, India 32,000, Netherlands 14, 977, Singapore 13,761, Germany 13, 345, Malaysia 11, 986, Sweden 11,589, Israel 11, 387, Saudi Arabia 10, 786, Mexico 10, 607…and the list goes on.

If you haven’t watched the video yet, check it out here (and note Steve Blair’s fun cameo at around 2 minutes 50).


And a third exciting sign of progess was Scotland appointing a physician to head their campaign against physical inactivity.

Doctor Andrew Murray (@docAndrewMurray) – who clearly has to differentiate himself from his colleague “Andy Murray” (@andy_murray).

The more important of the two, although seemingly not by # of Twitter followers, Doctor Murray, makes the point that having a low level of fitness is equivalent in risk to having diabetes, smoking, and being obese combined”. BJSM likes that emphasis – amazing but true. All the best in the job DocAndy – we look forward to interviewing you for a BJSM podcast (with subtitles).

For more information on this check out the BBC article: GP runner Andrew Murray given sports education role

So – things are moving in the right direction – let’s all take up the cudgels and promote, promote, promote. Remember that Kotter said transformational changes takes 10 times as much communication as you expect it will need (plus 7 other things: see BJSM article on Kotter’s eight-step programme for transformational change).

Related BJSM publications

Rhodes RE and Dickau L. 2011. Moderators of the intention-behaviour relationship in the physical activity domain: a systematic review . BJSM. Published Online First: 25 Jan, 2012.

Burton NW, Khan A, and Brown WJ. How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. BJSM. Published Online First: 20 Jan, 2012.

Bauman A, Titze S, Rissel Cand Oja P. 2011. Changing gears: bicycling as the panacea for physical inactivity? BJSM 45:761-762. (Free online!)

Khan, KM. 2009. Mid-year review: physical inactivity universally accepted as the biggest public health problem of the 21st century, shoulder exam challenges, and progress against the scourges of anterior knee pain and ACL injuries. BJSM, 43:469-470. (Free online!)

Summit on Electrocardiogram (ECG) Interpretation in Athletes – Seattle, Feb 13-14, 2012

26 Jan, 12 | by Karim Khan

Guest blog by Jon Drezner, Sports Cardiology Senior Associate Editor

Photo by Andrew E. Larsen, Flickr cc

A Summit on Electrocardiogram (ECG) Interpretation in Athletes is being held in Seattle on February 13-14, 2012.  The meeting is sponsored by the American Medical Society for Sports Medicine (AMSSM) in partnership with the Pediatric & Congenital Electrophysiology Society (PACES), European Society of Cardiology Sports Cardiology Subsection, the British Journal of Sports Medicine, and the FIFA Medical Assessment and Research Center (F-MARC).  Seattle will host experts on ECG interpretation in athletes from the U.S., Italy, Sweden, U.K., Belgium, Switzerland, Qatar and Brazil.

Summit participants aim to:

  1. Define ECG interpretation standards in athletes and;
  2. Develop a comprehensive, freely-available online training module for physicians to gain a common foundation in ECG interpretation in athletes.

This educational resource will help physicians distinguish normal ECG variants in athletes from ECG patterns that suggest an underlying cardiac disorder.

This state of the art E-learning program will be hosted by BMJ Learning and will be accessible to any physician in the world with the aim of improving the cardiovascular care of athletes.

Participants include:

AMMSM:

Jonathan Drezner, MD  (Chair)

Jeff Anderson, MD

Chad Asplund, MD

John DiFiori, MD

Kim Harmon, MD

Stephen Paul, MD

ESC Sports Cardiology Section:

Mats Borjesson, MD

Domenico Corrado, MD, PhD

Hein Heidbuchel, MD

Antonio Pelliccia, MD

Sanjay Sharma, MD

PACES

Michael Ackerman, MD, PhD

Bryan Cannon, MD

Peter Fischbach, MD

Jack Salerno, MD

Other U.S. Cardiologists

Euan Ashley, MD

Aaron Baggish, MD

Vic Froelicher, MD

Joseph Marek, MD

David Owens, MD

Jordan Prutkin, MD

Victoria Vetter, MD

F-MARC (FIFA Medical Assessment and Research Centre)

Christian Schmied, MD

Qatar (Aspetar)

Mathew Wilson, PhD

Brazil

Ricardo Stein, MD, ScD


Related Publications:

Podcast:

Blogs:

Fit is not actually ‘vs.’ Fat – Guest Blog by Professor Timothy Noakes

30 Nov, 11 | by Karim Khan

On Monday the Guardian published It’s not obesity that’s killing us – it’s the lack of exercise. Inspired by research presented at UKSEM (see also Blair Physical inactivity: the biggest public health problem of the 21st century, and BJSM Warmup 2011; 45), the Guardian exhorted us to focus less on obesity and more on physical activity. With 191 comments, 1000 Facebook likes, and 71 tweets (in 48 hours) it doesn’t take a social media expert to figure that this topic is hot.

A critical question is whether exercise is THE primary tool for weight loss (rather than just as part of a healthy lifestyle).

Does exercise promote weight loss?

King, Horner et. al’s have a great article – Exercise, appetite and weight managementin BJSM Online first.

Professor Timothy Noakes (and @GaryTaubes) add these insights to the discussion in this guest blog:

Photo courtesy of Gavin Clarke, Flickr cc

What astonishes me is the continuing failure of so many people, my medical colleagues included, to realize that the solution to personal obesity is so simple. The cause for most people is exactly as Gary Taubes described it – a diet too low in fat and protein and too high in carbohydrate especially sugar. If you are over forty, overweight, personally motivated, and not eating a high fat/high protein/low carbohydrate diet, then you are missing out – your life is passing you by.

The second key is also as Taubes describes it – obesity begets inactivity whereas leanness promotes activity. Trying to get lean by exercising whilst continuing to eat the “healthy” high carbohydrate diet will be unhelpful for most with an elevated BMI (and who are are therefore by definition, carbohydrate intolerant/resistant). You need first to lose the weight by changing to a high fat/high protein/low carbohydrate diet. As the weight falls of (as it does very dramatically at rates that most will not believe), the desire to exercise becomes increasingly overwhelming. In time the desire to exercise becomes addictive.

Trying to encourage overweight people to exercise without first changing their habitual eating patterns (not diet, please note) will never produce the same outcome as will one in which the initial focus is on changing to a high fat/high protein/low carbohydrate diet.

As Gary Taubes describes, this has been known since 1861 but was written out of the medical and popular literature after 1970 when Dr Ancel Keys essentially single handedly developed the global fear of fatty foods that mislead the world and led directly to the epidemic of obesity and diabetes that began to engulf especially people in the developed world especially after about 1977.

Until we rid ourselves of the ridiculous idea that carbohydrate foods are somehow “healthy” (for all) and fatty foods are unhealthy, and as long as we allow our eating patterns to be dictated by industries that aim remorselessly to increase global consumption of sugar and refined carbohydrates, then we cannot solve the global problem of obesity and diabetes.

But at an individual level we can take control by realizing that obesity is a genetic/nutritional disorder caused by excessive carbohydrate consumption in those who are carbohydrate-resistant (and who are therefore unable to metabolize carbohydrates especially fructose, appropriately but who will store the excess calories in fat, rather than expend them in physical endeavor).

Dr. Timothy Noakes is a Sports Physician, Exercise Physiologist and Discovery Health Professor of Exercise and Sports Science at the University of Cape Town and Sports Science Institute of South Africa.

via New York Times – the challenge of patients demanding inappropriate MRIs

29 Oct, 11 | by Karim Khan

The New York Times is a great source of sports medicine news and Gina Kolata‘s article about inappropriate use of MR requires little editorializing.

My feeling is that although some doctors diagnose by MR instead of via cognitive processes, that is NOT the problem in sports and exercise medicine. See Chris Milne’s recent lucid description of what happens in the sports medicine setting. However, we are in a phase where PATIENTS are DEMANDING MRs — as this article highlights toward the end.

So the next implementation/knowledge translation challenge is to education patients to value a careful history and physical exam. That won’t be easy in a time where technology is valued – at times to excess.

Don’t forget the BJSM podcasts on imaging – with a particular emphasis on ultrasound’s increasing relevance in the clinic and on the sideline. For those clinicians looking at ways of training in US – click on the podcast with Sean Martin and Kim Harmon from AMSSM.

BJSM priortizes ‘hot topics’ such as sports imaging, US in imaging. You can sign up for free Table of Contents (TOC) via email and over 2000 folks follow us on Twitter (@BJSM_BMJ) where we post alerts to this blog and other useful sport and exercise medicine links.

Have an active weekend and remember that low fitness kills more Americans than smoking, diabetes, and obesity combined (smokadiabesity). If you have any trouble accessing the paper there see also the blog post.

Rapid return to activity after ankle injury

11 Nov, 10 | by Karim Khan

The topic of a new BJSM podcast is Ankle sprains and rehabilitation, with human movement specialist Evert Verhagen.

He addresses accurate diagnosis, whether to tape or brace (and when), principles of return to sport, and issues of cost-effectiveness. This podcast is geared to clinicians treating patients after ankle sprain  — and preventing these injuries in the first place. See Evert’s e-learning module at the BMJ [link http://learning.bmj.com.] and his editorial on injury prevention with Professor van Mechelen.

If you haven’t checked out our podcasts, go there now. Feel free to post your comments below.

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