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Is it safe to run a marathon after heart surgery (valve replacement)?

26 Mar, 16 | by Karim Khan

Each week students in Professor Ian Shrier’s (@McGillU) Massive Open Online Course (MOOC) ask questions. One questions is answered by our world expert panel on the BJSM blog. This week’s question is from a MOOC student who used to run marathons. (not the person in the photo, left)

MarathonManQ: I used to be a marathon runner currently has 2+ mitral regurgitation and had past heart surgery including tricuspid valve repair. I am not asking your medical opinion (and I appreciate you cannot give me medical advice on a blog) but I wonder what principles underpin a cardiologist’s advice to runners who have had surgery and wonder if it will ever be safe to run a marathon again? (Underscore – this is an example for discussion, it is NOT medical advice for one person.

Answer by Associate Professor André La Gerche, MBBS, PhD, FRACP, FCSANZ, FESC. Sports Cardiologist, Cardiology Department, St Vincent’s Hospital, Melbourne, Australia (Click to read Dr La Gerche’s key paper on right heart problems (members & library access) in high volume exercisers or listen to him chat (free) to Dr Michael Turner).

 

Note: Legal caveat. BJSM underscores that this is not ‘patient advice’ but discussion of a general question.

There are many different ways a heart valve may not be working well. Each has its own particular challenges that would influence recommendations for exercise, as well as personal history of previous heart surgery and other past medical or surgery history. However, there are some basic principles that are usually followed.

First, we want to avoid any factors that may exacerbate the condition and increase the chance of needing re-do surgery. The complexity of re-do surgery is always greater.

An important consideration is the distinction between “structural valve disease” such as problems with the valve leaflets or the papillary muscles that tether the valve in place as opposed to “functional” mitral valve regurgitation where the leakiness arises from dilation of the heart structures around the valve, but the valve itself is ok.  There are some settings in which structural heart disease, such as severe mitral valve prolapse, may be exacerbated by strenuous exercise.

In general, in the absence of significant abnormalities with the valve structure and in the absence of left ventricular dilation or heart failure then it may be possible to exercise at any level and compete in all sports.

The American Heart Association Guidelines (Bonow et al. Circulation 2015) (OPEN ACCESS) suggest:

1.  Patients with mild to moderate mitral regurgitation with normal heart size, function and pressures can participate in all competitive sports at all levels. This would include marathon running.

If there are 1) abnormalities in valve structure or 2) significant left ventricular dilation or dysfunction, then a thorough patient history, physical and investigations are required before advising patients on what might be considered a safe amount of exercise or intensity.

Here is the cover images for 2016 sports cardiology issue edited by @TheAMSSM ‘s Prof Jonathan Drezner

BJSM Journal Cover

A picture IS worth a thousand words: Why healthcare professionals should know (and care) about infographics

19 Feb, 16 | by BJSM

By Chris Oliver @cyclingsurgeon, Hilary Scott @thehilsarealive and Andrew Murray @docandrewmurray

Many industries use infographics: business, politics, food, finance, and healthcare, including physical activity promotion. Statistically, the most successful infographics, in terms of number of ‘shares’ on social media, contain an average of 396 words (1) and a combination of data visualisations (e.g. bar graphs, line graphs, pie charts) and illustrations. 396 words may seem like an inadequate amount of text for many researchers to convey their findings comprehensively, but the saying “a picture tells a thousand words” comes to mind. Three days after learning new information, we are likely to remember up to 6.5 times more through learning from an infographic than reading text alone (2).

However the impact and accuracy of existing infographics is highly variable. Many are published on social media once or twice, then quickly forgotten. Successful infographics should be shared and re-shared again and again on social media to build campaign impact and increase audience reach.  The more people who see an infographic, the more who can talk about and share it’s important message.  As healthcare professionals and researchers we are good at creating content, but perhaps we could gain by making the information engaging, widely seen and sticky, like Dr Mike Evans hit video 23.5 hour (worth a watch it if you haven’t seen it).

Interestingly in the UK we devise and publish physical activity policies and infographics, yet our people are not physically active adults compared with other European countries (3). An infographic designed by the UK’s Chief Medical Officers (CMOs) was launched in 2015 to accompany the physical activity guidelines document ‘Start Active, Stay Active’, first published in 2011 (4).

CMO_Infographic

This infographic is an excellent example of what works: transmitting a message and engaging the reader through a three-step process of ‘raising awareness’, ‘changing and challenging attitudes’ and providing a ‘call to action’ for individuals to change their behaviour and become more physically active (5).

Health infographics are designed to stimulate the following responses from readers – ‘attention, comprehension, recall and adherence’ (6). The design of the CMOs’ infographic was set out in clear terms, allowing members of the public to understand its message without requiring explanation from health professionals as it did not contain complex medical terminology. Easy to understand content is recommended when designing any infographic as this will likely increase the sharing of knowledge among researchers, practitioners and lay people. Infographics have potential to make information more accessible across a diversity of populations.

A successful infographic gets people talking about its message and sharing it more widely

An infographic succeeds if it both attracts people’s attention and they can comprehend the presentation of information. Even better if it encourages them to consider behaviour change themselves, and / or share the messages with their networks. Infographics can build a bridge between lay people and health professionals, and they can clarify important ‘take-home messages’ and provide direction for heal promoting behaviours.

In short, infographics are a powerful tool for communicating key messages clearly, changing attitudes, and even challenging people to change their mindset and/or behaviours. In consideration of research with impact, perhaps each research paper should produce an infographic!

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Chris Oliver @cyclingsurgeon is a Honorary Professor of Physical Activity for Health at the University of Edinburgh, and a Consultant in Trauma and Orthopaedics. 

Hilary Scott (@thehilsarealive) is a third year BSc Applied Sport and Exercise Science student at Robert Gordon University in Aberdeen. She recently completed a six week placement at the Physical Activity for Health Research Centre at the University of Edinburgh and researched the use of infographics in communicating important messages about physical activity.

 Dr Andrew Murray (@docandrewmurray) thinks regular physical activity is the best thing we can do for our, and our children’s health. He is a Sports and Exercise Medicine consultant and PhD student at the University of Edinburgh, amongst other roles

REFERENCES

  1. Ahmad, I. What Makes Infographics Go Viral [Infographic]. [blog]. 2016 Jan 1 [cited 2016 Jan 11]. Available from: http://www.socialmediatoday.com/social-business/what-makes-infographics-go-viral-infographic.
  2. Krum R. Cool Infographics: Effective Communication With Data Visualization and Design. Hoboken, NJ: Wiley; 2013.
  3. Murphy, M. and Cavill, N. Do physical activity infographics, report cards and policies influence behaviour? The Sport and Exercise Scientist, 2015; Winter 2015(46).
  4. Great Britain. Department of Health. Start Active, Stay Active: A report on physical activity from the four home countries’ Chief Medical Officers. London: Department of Health; 2011.
  5. Bauman, A. and Chau, J. The Role of Media in Promoting Physical Activity. Journal of Physical Activity and Health, 2009; 6(Suppl2), S196-S210.
  6. Houts, P.S. et al. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counselling, 2006; 61(2).

Congrats to ECOSEP, MuscleTech Network, and FC Barcelona – the 2015 cover competition winners!

12 Feb, 16 | by BJSM

December 49(24)Congratulations to all of the collaborators and supporters of the ECOSEP/FC Barcelona, December 2015 BJSM issue (#24) for winning the 2015 cover competition by a landslide (honorable runner up goes to Sports Physiotherapy New Zealand 49(issue #14) Strong debut performance!).

We had the pleasure of sharing the news with two of the major contributors: Nikos Malliaropoylos (founding member of ECOSEP), and Gil Rodas (FC Barcelona Doctor):

BJSM: Congratulations! How do you feel about winning “BJSM best cover” for 2015?

We are really impressed with this award. It’s a great example of team work between ECOSEP -MuscleTech -FC Barcelona and BJSM – a genuine collaboration between the scientific community and a football club. The front cover was the tip of the iceberg: a great global sport & exercise medicine event, in the biggest football stadium in Europe (capacity of 99,354 seats that hosted more than 400 international delegates). The stadium was a real feature of the conference of course as the podium was on the hallowed turf and our listners sat in the stadium seats. The big screen hosted the shots! Winning the Best Cover rewarded all our efforts to make this venture successful for the attendees.

BJSM: What in this 24th issue of 2015, stands out for you as exemplary work?

Not easy to answer this as there are so many good articles in this issue – which is usual for the BJSM now. The Exercise-induced leg pain in sport editorial is a very good update regarding this issue in sports. Exercise for osteoarthritis of the knee: a Cochrane systematic review and MRI, does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: A prospective cohort of 180 male athletes, are papers that can really affect practice and benefit patients who attend physiotherapists, doctors and other sports clinicians.

BJSM: In your opinion, where do we head from here?

FC Barcelona knows that a winning team always carries on maintaining the cornerstone partners. Muscle Tech and ECOSEP with BJSM support can add more value to Sports and Exercise Medicine both in Europe and globally. We are dedicated to this exciting field so let’s spread the word of the great evidence we have now and please look out for our conference in Barcelona, October 2016!

BJSM: Thanks Nikos and Gil! 

We will select and contact our 2 individual prize winners within the next two weeks. Stay tuned.

Fortius International Sports Injury Conference (FISIC) – A conference you can’t afford to miss…

11 Jul, 15 | by BJSM

Wimbledon is well underway, cricket season is in full flow, football season is commencing and 20 national rugby squads are preparing to compete in the 2015 Rugby World Cup – needless to say it is another exciting summer of sport.

With the home Rugby World Cup tournament fewer than three months away, the 50-man England squad are in boot camp at Pennyhill Park, then on to high altitude training in the Rocky Mountains, with the aim of being the fittest team in the tournament by the time the action kicks off in September.

The squad will be pushing themselves to their limits, while their medical teams will be working hard to minimise injuries. Perfect timing then for the Fortius International Sports Injury Conference (FISIC) which coincides with a brief interlude in play before the Quarter Finals, and gives team medical personnel a unique opportunity to participate in a world-class, multidisciplinary congress.

fisic june 2015

The full two-day conference, which takes place on October 13th-14th in central London, offers a unique multi-disciplinary approach, and a strong international faculty including many leading experts in Sports Orthopaedics, Elite Sports and Sports Exercise Medicine.

The theme of FISIC ‘15 is Treatment, Recovery and Return to Play, and the programme covers a wide range of key issues and hot topics in sports injury treatment and recovery, as well as specialist sessions from the World Rugby faculty and joint specific presentations.

All sessions will have a multidisciplinary element but are named plenary, surgical, MDT or GP according to their primary target audience. Speakers will emphasise themes of “from science to clinical practice”, “optimising recovery” and “clinical excellence”.

The surgical sessions will involve a series of short lectures with approximately half the session time allowed for debate and discussion. Although some of the MDT sessions will follow this format, others may involve lengthier talks but will still allow ample time for debate.

Some of the programme highlights for Sports Exercise Medicine professionals

The Future of Cell Therapies – Fact or Fiction: covering the current status of stem cell therapies in cartilage repair, bone marrow aspirate and cell therapies, and the PRP debate

Bone Health: covering the biology of bone repair; Bone health in the female athlete; Vitamin D deficiency, supplements & use as a hormone to enhance injury recovery; medical treatments to aid bone repair, and the use of exogen.

Dr Bob Cantu, Dr Caroline Finch, Dr Jon Patricios and Dr Willie Stewart from the World Rugby advisory board discuss the science of concussion, how to recognise and remove it, including management of the difficult case and what we know of the potential long-term consequences.

The science of muscle injuries & repair going on to Acute injuries: Best medical management for successful RTP; imaging acute lower limb muscle injuries: Predicting return to play; best management & optimising RTP following contusion injuries & myositis ossificans; chronic recurrent tears and return to function; surgical indications for hamstring injury.

World Rugby leads a session on player anthropometrics, the demands and current trends in injury in Professional 15 a side Rugby, Community & age-group rugby; skills needed to work pitch-side in rugby union and how practitioners can reduce the risk of injury to a team.

A session on return to play covering: the psychology and nutritional aspects of return to play; RTP post max-fax injuries; the environment needed to facilitate smooth RTP; objective criteria for safe return to play.

A session on disability sport will cover sports science and coaching in sports medicine; performance physiotherapy for disability sport; the athlete/ paralympian perspective; complexity of sports psych in disability sport; Athlete classification and ethical issues in disability sport

The Adolescent Athlete: will cover spinal pain in adolescent sports, strength and conditioning training; apophysitis and soft tissue injuries; CL tears and reconstruction in children & adolescents; Osteochondritis Dissecans and imaging the Adolescent Athlete.

There will also be a wide range of joint specific sessions including: Knee sessions on the Meniscus, Cruciates, Patellofemoral Syndromes In Sport; Foot & ankle sessions on Mid Portion Tendinopathies, Insertional Tendinopathies, The difficult mid- season foot injuries, Ankle & Midfoot Injuries, Ankle Instabilities; Shoulder and elbow sessions on Gleno humeral instability, Spectrum of Shoulder Injuries, Elbow Instability, dislocations, MCL, biceps and triceps injuries and tendonitis; as well as specialist Spine, Hip and Groin and Wrist and Hand sessions

CPD points have been applied for and it’s expected that there will be 6 points for each day of the conference.

You can find out more on the conference website, www.fisic.co.uk.

 

Medical Provision in English Professional Football: the Good, the Bad and the Ugly

2 Jun, 15 | by BJSM

By Dominic Malcolm, Andrea Scott, Ivan Waddington

Imagine you run a business in which employees are routinely paid hundreds of thousands of pounds per week. You have restricted periods when you can ‘buy’ these employees, often for millions of pounds. Yet your industry has a workplace injury rate 2000 times higher than the UK average. How important would medical care be to you? The obvious answer to this hypothetical question is that it should be of primary concern. At many football clubs, sadly, this is not the reality.

soccer siloetteMedical provision in football briefly hit the headlines about 15 years ago when the Professional Footballers Association sponsored Waddington and colleagues to conduct research which was subsequently published in the British Journal of Sports Medicine. The authors argued that selection and appointment procedures represented a ‘catalogue of poor employment practice’. Club doctors rarely had relevant occupational experience or specialist sports medicine qualifications. Most had no formal contract and received little remuneration, and often worked in a semi-voluntary capacity simply because they were fans of the team. The report also revealed that a half of all ‘physiotherapists’ were not chartered, holding only the FA Diploma in the Treatment of Injuries. Many had no experience of working in healthcare settings outside of football and their position depended directly on their personal relationship with the club manager. This occupational insecurity sometimes made it difficult to resist threats to their clinical autonomy (for example in return to play decisions) or to maintain the highest standards of ethical practice.

The world has changed significantly since that report was published. The record transfer involving a British club has risen from £22.5m (paid by Arsenal for Nicolas Anelka in 1999) to over £85m (paid for Gareth Bale), sport and exercise medicine has become a formally recognized medical speciality in Britain, and the Football Association (FA) has bolstered its medical regulations. But can we therefore assume that the problems with medical care in professional football have been resolved?

To find out, researchers from Loughborough, Chichester and Chester/Oslo universities sought to refine and repeat the earlier study. In January 2014 a short questionnaire was mailed to a named club doctor and physiotherapist at each of the 92 clubs in the English Premier and Football Leagues. 33 and 42 were returned, giving response rates of 35.8% and 45.6% respectively. The results reveal the good, the bad and the ugly of medical provision in English professional football.

The Good

There have been a number of significant improvements. In particular, many more club doctors now have specialist qualifications in sports medicine and relevant occupational experience. Amongst physiotherapists, reliance on the FA Diploma for the Treatment of Injuries is now a thing of the past and many more have a good range of relevant occupational experience.

There is also evidence of the development of sports medicine as a career path. Formal contracts are issued more frequently and football provides more doctors with their primary employment. While the earlier study found that the club doctor was typically a ‘one sport, one club doctor’ and that their ‘commitment is typically not to sports medicine in general but to their local club’, many current doctors had worked for multiple clubs and/or in multiple sports, and relatively few identified ‘support for the team’ as a primary motivation to become club doctor. Payment of doctors is more widespread than in the past. In sum, clubs have moved towards a more professional provision of medical support and the personnel employed show a greater commitment to sports medicine as a specialism.

These changes are likely to have had a qualitative impact on medical care. While we do not have directly comparable data from the earlier survey, it seems clear that clubs currently employ more doctors, physiotherapists and other sports science/healthcare staff than was the case 15 years ago. There has also been a marked increase in the number of hours doctors spend on football club work, and consequently it appears probable that players are receiving better ongoing treatment of injuries. The significant number of physiotherapists who had been in post for over three years suggests that many enjoy greater job security than in the past. The improved qualifications and experience, the greater contractual security, and the more extensive network of healthcare colleagues are also likely to increase clinical autonomy and so enhance medical provision.

The Bad

However it is also clear that many aspects of the appointment process still fall short of good employment practice. The vast majority of club doctor posts are still not publicly advertised. The majority of doctors still obtain their posts as a result of personal contact with either the former doctor or someone else at the club. And although interview panels are now more likely to contain a medically-qualified person, this is not universal. Indeed the proportion of doctors interviewed for their post has actually fallen.

It is a similar tale for physiotherapists. The earlier research found that most had been recruited through an ‘old boy’s network’, and that positions were often ‘in the gift of the manager’. The present study indicates that there has been some, but limited, progress in this regard with around a third recruited as a result of responding to a public advertisement. However, more than half obtained their posts as a result of personal contact with either a member of the club’s medical team or a coach or committee member and only about half had been interviewed by a panel that included the club doctor.

The Ugly

Two findings are of particular concern because they indicate that some clubs are not meeting FA medical regulations. First, while FA regulations are unclear/inconsistent regarding continuing  professional development (CPD) requirements, one physiotherapist and two doctors indicated that they had attended no such training in the past year. A further five physiotherapists (11.9%) cited a single event (most usually the one-day FA Advanced Resuscitation and Emergency Aid course). This suggests that minimum thresholds of CPD are not being upheld which means that many football healthcare staff are not accessing the state-of-the art knowledge and skills that CPD provides.

Second, and most worryingly, the research revealed three doctors – 9% of our sample – whose qualifications to work in professional football were questionable. Contrary to FA medical regulations, the three had been appointed since 2003 but did not possess a Diploma in Sports Medicine or equivalent. One of these had worked at another Football League club so may satisfy FA regulations, but the other two had not and thus must have been in breach of FA regulations. While dealing with small numbers here, it is a sobering thought that doctors who were aware of their ineligibility under FA regulations would almost certainly have been less likely to respond to the survey. The actual percentage of inadequately qualified doctors is therefore likely to be higher.

Conclusion

Over the last 15 years, medical provision in English professional football has become increasingly professional, with healthcare practitioners better qualified, more likely to have relevant occupational experience and more oriented towards the sport and exercise medicine specialisation than in the past. However, appointment procedures continue to fall below best practice. Positions are rarely advertised, frequently filled via personal contacts, and interviews are frequently not held, or not conducted by someone qualified to judge medical expertise. FA medical regulations are not being universally adhered to.

What should be done? FA regulations should be clarified, specifically in relation to CPD requirements, but also more generally. They should also be revised to enhance the procedures governing the recruitment and appointment of football club medical staff. Implementing the recommendations of the 1999 report – e.g. that all candidates are interviewed by someone qualified to assess their medical expertise – would help improve medical provision across English professional football. The FA also need to monitor the implementation of their policies more effectively.

But it is surely also time to insist that all club doctors have a Diploma in Sport and Exercise Medicine and that the level of resources clubs devote to the healthcare of players in this extremely dangerous industry reaches a specified minimum. Despite what seems like obvious economic sense, it is clear that the clubs – and indeed the FA – still have some way to go if they are to properly safeguard the health of players.

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Dominic Malcolm is Reader in sociology of sport at Loughborough University. His research focuses on the intersection of sport, health and medicine, including various aspects of the work of sports clinicians, the patient experience of sporting injury, and various interventions like cardiac screening and the management of concussion.

Andrea Scott is a senior lecturer in the Department of Sport Development and Management at the University of Chichester. Her research interests are broadly focused on athlete healthcare in sport. Andrea has published qualitative and quantitative work on the organisation and professionalisation of sport and exercise medicine, practitioner boundaries in MDTs and the contextual factors that both enable and constrain healthcare professionals’ management of illness and injury among athletes. 

Ivan Waddington is Visiting Professor at the Norwegian School of Sport Sciences, Oslo and the University of Chester, UK. He is an internationally recognised expert on drugs in sport and has also written extensively about sports medicine and pain and injury in sport. His work has been translated into German, French, Italian, Spanish, Portuguese, Flemish and Japanese.

References

Drawer, S. Fuller, C. Evaluating the level of injury in English professional football using a risk based assessment process. Br Jo Sports Med 2002;36: 446-451.

Roderick M, Waddington I, Parker, G. Playing hurt: managing injuries in English professional football. Int Rev for the Soc of Sport 2000;35: 165-180.

Waddington I, Roderick M, Naik R. Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues. Br Jo Sports Med 2001;35: 48-53.

Waddington I, Roderick M, Parker G. Managing Injuries in Professional Football: the Roles of the Club Doctor and Physiotherapist. Centre for Research into Sport and Society, University of Leicester, 1999.

Waddington I, Roderick, M. The management of medical confidentiality in English professional football clubs: some ethical problems and issues. Br Jo Sports Med 2002;36: 118-123.

Winner announcement: BJSM 2014 cover competition

18 Mar, 15 | by BJSM

The Dutch Association of Sports Medicine theme issue that focused on muscle injuries won the Oscar for BJSM’s 2014 cover.  The clear winner broke the The South African Sports Medicine Association’s  3-year stranglehold on the coveted trophy; no other nation had captured this ultimate among sports awards. Congratulations to all 17 BJSM member societies and particularly to those who created BJSM’s September 2014 issue 18 that focused on muscle injuries.

Canadian sidenote: there are no ‘loser’ covers at BJSM – excellent quality all-round for 2014.

We shared the good news with Drs Babette Pluim and Robert-Jan de Vos, the issue’s Editors, and here’s what they said during the crazy all-night celebration in Amsterdam’s Vondelpark which was orange-bedecked in anticipation of this announcement.

“We are delighted to win this cover competition with the Dutch Sports Medicine (VSG) special issue. Sports medicine was recognized as a medical specialty in the Netherlands last year, and we are now gaining a permanent position in the Dutch healthcare system. Our partnership with BJSM is a positive stimulus for Dutch sports medicine, and the support for our 2014 issue adds to our momentum.”

Cover art by Vicky Scott; Cover athlete: Sven Kramer, Dutch speed skater winner of an all-time record seven World Allround Champion,  record holder of seven European All round Championships and Olympic Champion of the 5000 meters and the current world record holder in the 5000 m, 10,000 m, and the team pursuits

Cover art by award winning medical illustrator Vicky Earlehttp://vearlemedicalart.com/ Cover athlete: Sven Kramer, Dutch speed skater winner of an all-time record seven World Allround Championships, record holder of seven European All round Championships and 3 x Olympic Champion. Current world record holder in the 5000 m, 10,000 m, and team pursuits

BJSM is grateful for Vicky Earle’s cover designs and here the depiction of Dutch great Sven Kramer You can contact Vicky for that special powerpoint slide or paper/book illustration at http://vearlemedicalart.com/

To read articles from this issue, please click HERE. And you can check all BJSM content conveniently via the free BJSM mobile app (Android/AppStore)

The Warm-up (Free) for the issue is called, Knowledge is only rumour until it is in the muscle by Robert-Jan de Vos.

The most downloaded article from the issue is by Noel Pollock and the team from UK athletics: British Athletics Muscle Injury Classification: A injury grading system  This Open Access paper moves us past the historic Grades 1, 2 and 3 muscle strain classification to take more account of the extent of damage that can now be assessed by MRI.

A great complementary piece in that issue (also Open Access, as Editors’ Choice) is from the Dutch group (Maarten Moen, Gustaaf Reurink, Adam Weir et al) who found that passive straight leg raise deficit, and the player’s own estimate of time to return to play, were both better predictors of ultimate return to sport than MRI appearance at the time of injury! Food for thought. Predicting Return to Play after Hamstring Injuries – click here

On the subject of Return To Play, remember the first World Sports Physical Therapy Congress that will focus on Return To Play – Bern, Switzerland, November 21-22, 2015

Stay tuned to the blog (and your emails) for our announcement of the book prize winners. And share news of the free BJSM mobile app with your friends.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professor Karim Khan Awarded Honorary Fellowship of the Faculty of Sport and Exercise Medicine UK

6 Nov, 14 | by BJSM

 By Beth Cameron, PR & Communications, Faculty of Sport and Exercise Medicine @FSEM_UK

Prof Karim Khan and Dr Roderick JaquesProfessor Karim Khan was awarded Honorary Fellowship of the Faculty of Sport and Exercise Medicine at the BASEM/FSEM joint Annual Conference, Walk 500 Miles, on Thursday 2 October 2014. Professor Khan received the award in recognition of his international career in Sport and Exercise Medicine.

Professor Khan is a truly international sports physician. He was educated in Australia, and studied Medicine and Medical Research at the University of Melbourne. He was awarded a PhD in Medicine by the University of Melbourne with a thesis titled “The effect of mechanical loading on the musculoskeletal system: clinical and laboratory studies”.  More recently he has studied and completed an MBA from the University of British Columbia, Canada.

His career spans the globe. Starting in Australia, he moved to Canada and is currently working in Qatar as the Director of Research and Education at Aspetar Orthopaedic and Sports Medicine Hospital. He is in his 7th year as Editor in Chief of the British Journal of Sports Medicine, which has become the leading international academic journal and digital media hub for the speciality.

Professor Khan is authorised as a Sports Medicine Physician by the Canadian Academy of Sports Medicine (CASEM) and the Australasian College of Sports Physicians (ACSP). He is a Fellow of the American College of Sports Medicine and Sports Medicine Australia. He served as Sports Physician to several teams, from a range of disciplines from Ballet to Basketball. His main research areas are in exercise promotion for health (including bone health and falls prevention) and pathogenesis and imaging of tendinopathies. He has published over 250 original research articles in addition to 3 books. He is a co-author of Brukner and Khan’s Clinical Sports Medicine, which has been published in three languages and is in its 4th edition. In 2001, Professor Khan was awarded the Australian Prime Minister’s Medal for service to sports medicine. In 2012, he was profiled in ‘The Lancet” with a biography titled ‘Good Sports’.

The FSEM awards up to two Honorary Fellows per year via its Members and Fellows Committee. The award of Honorary Fellow is made where there is an outstanding contribution to the specialty of Sport and Exercise Medicine throughout an individual’s professional career.

Should trainee sports physician’s always be remunerated to provide medical cover at sports events?

20 Aug, 13 | by Karim Khan

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

By Dr Bhavesh Kumar

 

Background

pig bankThere has been recent debate on appropriate remuneration for the provision of medical services at sports events by junior doctors involved in Sport & Exercise Medicine (SEM). This has in part been prompted by a reduction in tariffs offered by some sports in this era of financial pressure. In certain cases, this results in a change in the prioritisation of sports within which doctors would prefer to work.

Historically most, if not all budding sports physicians and doctors with a special interest in SEM have provided pitchside sports medicine cover pro bono, at least in the early part of their careers. In some instances, medics have retrospectively discovered that they were the only unpaid member of the entire team of support staff. Indeed in the USA some doctors themselves will pay top clubs to be their physician as a form of self-marketing to help boost private practice.

Many matches or tournaments take place in evenings and weekends, outside of usual clinic times for which doctors are remunerated by their training program. Therefore doctors for this ‘out-of-hours’ work usually seek pay. Exceptions have included, but are not limited to, work at amateur mass participation events, such as annual triathlons, marathons or charity events. One could argue that such events employ many staff to enable the smooth and safe operation of the event, and so why shouldn’t the medical staff be paid as well?

Some sports will pay doctors a standard sessional or daily tariff regardless of their seniority or the level of competition. Others appear to operate within pay bands, determined by factors that may include seniority, urgency, negotiating skills, and level of interest in the role.

Issues for training doctors

Most work timetables allow a registrar to take one session (a morning or afternoon) per week to attain pitchside or club sports medicine experience and the associated curriculum competencies. If further time is required, for example to cover a camp or competition, then registrars will usually have to resort to using annual leave or unpaid leave, and therefore invariably seek adequate remuneration.

Pressures, standards and the necessary medical training are quite rightly becoming increasingly stringent and professional, at least in elite sport, and therefore registrars invariably pay to attend training courses and accredit to be a team physician, as well as subscribe with an appropriate indemnifier. These costs need to be covered.

Some doctors feel that they have provided plenty of pro bono sports medicine cover, and feel they cannot continue to justify their time without remuneration, particularly whilst trying to balance sports work during anti-social hours with family commitments. They feel that their considerable training and experience deserves some financial recognition. Individual registrars will have their own ideas of what they personally deem as fair pay. This can result in fragmentation amongst the pool of junior doctors, because as long there are enough medics prepared to work for less or free, then tariffs can potentially be kept low or lowered.

Personal opinion

In an ideal world, the hourly or daily rate for medics covering any professional sport would be the same, or very similar. Clearly, differing budgets will always preclude this. There is no simple solution to overcoming relatively large variations in pay.

My own feeling is that as trainees, we should be taking opportunities to learn and attain experience in a variety of sports covering different age groups, gender and abilities. On occasions, this will invariably involve working for little or no money. Also see two BJSM blogs for junior doctors and physios wanting to moving their career forward. Here is one…..by Karim Khan  Here is the other…by Liam West

At the end of the day, it is up to the individual registrar to decide the opportunity cost for them. Factors will likely include the duration of the event, whether it involves out-of-hours work or 24 hour cover, the intensity of the work, geographical proximity and desirability, potential liability and indemnity cover necessary, and of course their previous experiences, personal interests and future aspirations.

If the next generation of registrars all chose not to take up opportunities for picthside work unless a certain threshold of remuneration is met, particularly as far as elite or professional sport is concerned, then this could either prove a catalyst for better remuneration, or Chief Medical Officers may look elsewhere for willing practitioners from different specialties or allied professions where appropriate.

Remuneration will most likely continue to evolve, as changes occur to sports budgets, the perceptions of registrars, Training Program Directors and Chief Medical Officers, and potentially the funding of SEM registrar training. If recent history is anything to go by, then notable increases in pay are unlikely to ensue anytime soon.

A final thought

I wonder what proportion of registrars who have worked pro bono at very high profile events such as the Olympic Games and London Marathon for example will choose to work unpaid at similar but less high profile and perhaps geographically less convenient events such as the next Commonwealth Games or regional half-marathons, particularly if travel and accommodation costs have to be personally met.

 

Your opinions

It would be interesting to hear the experiences and strategies of sports medicine consultants and registrars from home and abroad! Just send an email to karim.khan@ubc.ca with “BJSM BLOG” in the subject line.

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Dr Bhavesh Kumar is a General Practitioner and senior registrar in Sport & Exercise Medicine in London, currently working at DMRC Headley Court.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

Injury prevention, advances and challenges of the international paralympic committee, and countdown to the next games

7 Aug, 13 | by Karim Khan

Mr. Bean on the pianoIt has been 12 months since Rowan Atkinson plonked the piano with his umbrella to Chariots of Fire in the London Olympic Games Opening Ceremony. Wikipedia says he is worth 85 million pounds, loves cars, has retired ‘Mr Bean’ and has been married to Sunetra Sastry for 23 years. But I digress already.

Now, Professor Lars Engebretsen and Dr Kathrin Steffen, the Injury Prevention and Health Protection (IPHP) editorial team, provide you valuable Olympic content. In 2013’s June and September (forthcoming) issues, you can discover how to prevent and identify injuries, and also learn more about the personpower needed to service major events.

Photo courtesy of Nick Webborn

Photo courtesy of Nick Webborn

In the June 2013 issue, the inspiring and redoubtable Dr Nick Webborn grabbed my attention with his evocative description of his London Paralympic experience. ‘The wall of sound that resonated around the stadium literally made the hairs on the back of my neck stand up.’ Equally importantly he highlights advances in the field and the challenges that face the International Paralympic Commitee (Read Nick’s article HERE).

Enjoy the June 2013 issue, and anticipate the September offerings (which BJSM’s 13 member societies can enjoy via OnlineFirst). For those who insist on reminsicing, the June 2012 issue broke all records for IPHP downloads.

The good news is that there are only 192 days until the next Olympic Games – BJSM will preview the sports medicine of the Sochi Olympic Winter Games in a future IPHP issue. Keep a track of injury prevention and athlete health protection via BJSM – and our special quarterly IPHP issues supported by the International Olympic Committee.

And while we are on things Olympic, injury prevention and memorably occasions – remember the 2014 IOC World Conference on Prevention of Illness and Injury in Sport. Follow @RoaldBahr for regular updates but hold the dates right now. The biggest collection of experts in sports medicine and physio in the one venue for the year – and perhaps years on either side. This 2014 Conference is April 10-12 in Monaco; there is an exclusive post-conference advanced team physician course for just 80 clinicians April 14-16 in Mandelieu. France. Explain it as onnce in a lifetime – cutting-edge education & fun with immediate clinical application. The conference of 2014.

What my 13-flight & 4-country sports medicine elective taught me: 5 lessons for success in sports & exercise medicine

5 Aug, 13 | by Karim Khan

Undergraduate perspective on Sports & Exercise Medicine  a BJSM blog series

By Liam West (@Liam_West)

13 flights. 4 countries. One very battered and bruised suitcase. The most incredible 3 months of my life.

Liam travelsMy medical elective enabled me to experience sport and exercise medicine (SEM) outside of the United Kingdom for the first time. A privilege to meet and witness in action many inspirational SEM professionals. I spent eight weeks experiencing front line SEM in three prestigious and internationally renowned centres; the Olympic Park Sports Medicine Centre in Melbourne, Australia, the Stadium Orthopaedic and Sports Medicine Centre in Sydney, Australia and Aspetar – The Qatar Orthopaedic & Sports Medicine Hospital in Doha.

Here are  my “top five lessons learnt” for students looking to create a successful career in SEM.

1.    Create your own luck

You have to put yourself out there to gain experience. You don’t want to be sitting back in five years time thinking – if only I had asked to join in… For instance, getting involved with sports teams:

  • First step – I always read up on the physicians / physiotherapists I have the opportunity to work or come into contact with working with to find out their interests and which sports teams they work for.
  • Second step – when it’s appropriate, start a conversation with them about their sports role and how you would love to, if at all possible, attend a training session / match with them to see on-field sports medicine.
  • Third step – Repeat first and second steps.

Don’t expect to get paid, but volunteering as a spare pair of hands is always appreciated and can give you invaluable experience. This helped me see the role of the sports physician in Rugby League (Sydney Roosters), Rugby Union (NSW Waratahs and British & Irish Lions), Australian Rules (St. Kilda Saints) and the Trauma Team for the Motor Cross Australia. This leads nicely to the second lesson…

2.    Step out of your comfort zone

Most of us have at least one sport that we consider to know pretty well. Challenge yourself to gain experience outside of these sports, the further afield the better. To be a good sports physician you need to be able to deal with any injury that comes into the clinic. By only covering a single sport you will not have the breadth of knowledge to confidently deal with presentations. You might also enjoy it along the way…

3.    Broaden your horizons – physiotherapists are awesome sports medicine teachers…

As well as covering a variety of sports, try to gain experience with as many different SEM health professionals as possible. I found that the experiences and conversations I had with physiotherapists, coaches, sports psychologists etc. were invaluable as they provided diverse perspectives. As a sports doctor you need to be aware of all these inputs and opinions to create the optimal management plan for the injured athlete.

4. Network

Possibly the most important lesson – the more people you know, the more opportunities will come your way. Social media is making this more accessible than ever before so if you haven’t thought about things such as twitter to market your interest in SEM, why not start today? My advice would be that you should be yourself when ‘networking’ and prove you are just a normal person with a passionate interest in the field – people employ people they will enjoy working with, not just someone with a good CV. The more homework you have done – reading about sports medicine, attending conferences (by volunteering to work there to save money), building on your existing connections – the more opportunities you will generate.

 5.    Be confident and enthusiastic

Your lack of specialist expertise can sometimes be of benefit – you may come up with the simple diagnosis that the physician may have ignored whilst for a more complicated one (I am talking from personal experience here!). Having the confidence to question things you don’t understand is very important. Also remember that enthusiasm is infectious – it will make others want to spend that extra five minutes per patient teaching you.

 

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. He is a founder and current President of USEMS and is also the founder of Cardiff Sports and 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 Student 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.

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