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Paraceta-MORE: The increasing over-reliance on painkillers in sport

7 Oct, 17 | by BJSM

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

By Adil Iqbal 

Rugby World magazine ran an article back in April which really got me thinking. The article focused on painkiller use in rugby featuring a prominent ex-professional player’s first-hand account of frequent painkiller use and all the issues he was now suffering from(1). I came to realise how often I had seen team-mates and opposition players rely on painkillers to get them through a game and the week that followed. Not long after this article the wider media coverage of the issue began, on a drive home I ended up catching a BBC Radio 4 documentary focusing on whether painkillers were a career necessity or a serious long term health risk(2).

This all got me thinking, it’s one of those things that isn’t really apparent until you look deeper into it, in fact 60% of us amateur ‘athletes’ take them once a week(3), but have you ever stopped to ask yourself the consequences of something so seemingly trivial?

A fear of failure seems the main instigator in professional sport when it comes to painkillers. Often their use seems to be linked to being replaced(1), that is after all the way the modern professional sporting world works. You are only an ‘asset’ for as long as you are performing well and with a vast number of teammates and competitors vying for your position it’s easy to see why individuals choose to compete through the pain, but at what cost?

In Amateur Sport

Unlike professional sport where most painkiller use seems to stem from the fear of losing your place in the team(1) or withdrawing from a competition, from my own experience, in amateur sport it arises from the fact there is often a lack of replacements. This leads to individuals choosing to ‘pop’ pills to either make up the numbers or when the numbers fall keep playing on despite injury. Playing student rugby myself, I’ve often been on the wrong side of not being able to put out a full team and starting the game with 14 men on the pitch. As injuries start to strike we have been left with 13 or even 12 players on the pitch. There have been times where I have unwisely stayed on the pitch knowing I would have left if there had been someone to replace me, and I’m sure I’m not the only one.

Instigating change

In my mind it seems that the way to combat this increasing overuse and, in some cases, dependency on painkillers in all areas of sports is widespread education. Only through effective education can we hope to prevent long-term overuse of analgesia.

With various testimonies from players citing how readily available stronger painkillers were to them(1), on a professional level there must be an onus on healthcare professionals to see the individual they are treating as a patient primarily and the fact they are a sportsperson should in theory have little influence. However in reality this is often difficult, saying no to any patient can be difficult especially when there is an actual medical issue, and in the realm of elite sport it can be even harder with there often being increased pressure and scrutiny from a manager and often the player themselves. This is of course if the player reveals themselves to be injured. Studies on concussion which mainly focus on high school and college level athletes in America found there to be a ‘culture of resistance’ (4) and often less than 40% of concussion events are actually reported often in the days and weeks after the actual event (5)(6)

On a more day to day level it is everyone’s responsibility to take care of their own health, there is by no means anything wrong about having to take painkillers but having to rely on them in the long-term and at increasing doses is a completely different matter. It should be the case that minimising dosage and duration are a priority when painkillers are used(7).

Athletes, especially at an elite level inherently understand and accept the risks that come with playing sport(8). Psychological studies point towards an assumption by athletes that playing through pain and injury is a step towards success(9) and it has been found that this assumption causes a shift in attitude to using painkillers leading to a culture of their overuse to facilitate this step(10).

Perhaps there would be a rethink to people’s approach if they knew some of the side effects of longer term painkiller use, not with the intention of being a scare tactic but to make them think of the effects they will be having during the prolonged period over which they are taken. Things such as renal impairment, stomach ulcers, haemorrhages and even an increased risk of MI and strokes(11)(12).

IT’S OKAY TO NOT BE OKAY

From a young age children everywhere are taught pain is just weakness and to fight through it. Sportspeople need to understand the limits of their own bodies rather than be under this illusion of pain being weakness, more often than not pain is the later stages of your body telling you you’ve had enough.

Showing weakness is nothing to be ashamed of, individuals who stay on after having suffered substantial injuries tend to get praise whilst those who are replaced after taking a little knock often get jeered. Surely there should be a comfortable middle ground where if injured an individual isn’t praised for staying on and torn into for deciding they can’t carry on. After all only you know the limits of your own body. How many of us will be regretting the fact we didn’t give ourselves enough time to recover, or playing on through the pain later on in our lives.

Everyone is always looking for a quick fix an easy way to get or feel better and in the context of sport this more often than not falls to the use of painkillers. However next time you reach for the painkillers in the lead up to competing whatever the level may be, think to yourself ‘do I really need those’ and no matter what the answer consider sitting on the sidelines and cheering your team on instead.

References:

  1. Playing through the pain: an investigation into painkiller use in rugby. Rugby World Magazine
  2. Gain Without the Pain: Legal Drugs in Sport. File on 4. BBC Radio 4.
  3. Gain Without the Pain: Legal Drugs in Sport. BBC Sport.
  4. Culture of resistance: self-reporting concussions in youth sports
  5. Knowledge, Attitude, and Concussion-Reporting Behaviors
  6. Reports of head injury and symptom knowledge among college athletes
  7. Guidelines for sensible NSAID use. BJSM
  8. Sage dictionary of sports studies: Risk. Page 218
  9. Sage dictionary of sports studies: Risk-Pain-Injury Paradox
  10. Painkilling drugs in collegiate athletics: knowledge, attitudes, and use of student athletes
  11. Non Steroidal Anti-Inflammatory Drugs. British National Formulary 2017. [online].
  12. Painkiller Side Effects. Cancer Research UK

Adil Iqbal  is a 3rd medical student at Leeds University, where he is President of the Medical School Representative Council. He has an interest in all things related to sports and exercise and orthopaedics.

Jonathan Shurlock is an academic foundation year 2 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series. If you would like to contribute to the blog series please email jhshurlock@gmail.com.

Inspiring the next generation in sports medicine: Utilising the USEMS e-publication to bridge the knowledge gap between student and clinician

18 Sep, 17 | by BJSM

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

By Liam Newton @newton_liam  and Sean Carmody @seancarmody1 

Today’s sports medicine clinicians have a wealth of quality educational resources on tap. The British Journal of Sports Medicine blog series, podcasts and original articles are easy examples to cite. They are also complimented nicely by many others including the Aspetar Sports Medicine Journal, Yann Le Meur infographics and Physio Edge Podcasts. However, back in 2016 we recognised that the extent of resources tailored specifically to undergraduates didn’t reflect the burgeoning interest among that population. Thus, the Undergraduate Sport and Exercise Medicine Society (USEMS) eMagazine was created to serve students who are passionate about SEM.

The aim of the publication is to inspire the next generation of sports medicine professionals by providing expert analysis, insight and comment from prominent figures within the field in a modern, easy-to-read format. Similarly, it allows a platform for undergraduate students to write and contribute their unique perspective on key issues within the specialty. We want to produce content which generates debate, raises contentious issues and is as equally appealing to established clinicians as to students.

Perhaps the most valuable aspect of producing the eMag has been the opportunity to engage with and build relationships with influential clinicians and researchers in sports medicine. Their willingness to volunteer their time to create quality content to advance student knowledge of sports medicine is a huge testament to the spirit of collaboration and sharing within the specialty. In addition to their efforts, this simply wouldn’t have been possible without the design genius of Dr Fadi Hassan (and my architect sister Rachel Carmody for the 2nd edition!).

To wet the appetite, below we have list 10 important quotes taken from the editions published to date:

  1. “I think it is vital to build a rapport with all the players and develop an open and trusting relationship. When I took over as the Lead Doctor my first objective was to build my relationship with the players. I ensured I made time to speak to them on medical and not medical matters to help build that bond. I have learnt from working in sport over the years that unless the players trust you there is no point in being there.” – Dr Ritan Mehta, England Women’s Performance Doctor, shares his experiences of looking after an international team in our first edition here.
  2. “There has been much debate and controversy regarding the effects of the menstrual cycle on athletic performance. Paula Radcliffe is quoted as saying that “Sport has not learned how to deal with elite athletes’ periods” and that this was attributable to a “lack of learning” and understanding often from male doctors.” – Dr Kirsty Elliot-Sale delves into the effects of menstruation on sports performance in our edition on The Female Athlete published here.
  3. “Feedback from all 20 teams and team doctors has confirmed that the medical logistics and support provided during RWC 2015 was the best ever. All medical scenarios had been analysed, dissected and planned for efficient management at all stadia. Back up medical services for teams away from competition were also excellent with designated area medical officers and priority access to key medical support services being available.” – Chief Medical Officer of World Rugby Dr Martin Raftery reflects on the successful medical provision at the Rugby World Cup in our second edition.
  4. “Tournament competition is always high-pressured. Regardless of whether you are a player or member of the management team, personal and public expectation always weighs heavily on every team. Everyone is looking to compete at the highest level and to give the best account of themselves and their country they represent.” – In our second edition, Prav Mathema, National Medical Manager of the Welsh Rugby Union, records the challenges faced by his medical team during a week at the Rugby World Cup.
  5. “Managers, Chief Executives and fans alike demand the opportunity to see the best players in the team pitted against the opposition. Prevention is much more ethical, sustainable and cost-effective than treatment and cure. The issue is how do we better prevent injuries, or more so, how to we avoid many of the injuries, especially the non-contact, that often blight the game ?” – Mike Davison, of the Isokinetic Medical Group, sets out his vision of the future of football medicine in our third edition.
  6. “For those of you looking to work in SEM, I can strongly recommend spending some time working in disability sport. Although it may be perceived to be less glamorous or “sexy” than other forms of elite sport medicine, the athletes you are working with will provide you with clinical reasoning challenges that will be far more complex (and in my opinion more interesting!) than working with mainstream athletes.” – In the third edition, Osman Ahmed lays out the unique challenges faced in looking after the Great Britain Cerebral Palsy Football Squad.
  7. “We do, however, have to acknowledge that injuries and illness occur, and contingency planning has occupied much of our thoughts – what if our main medal hopes get injured? How do we ensure they receive speedy access to the best medical care when they train on the other side of the country to our base in Lilleshall? Each potential Olympic Team member has a contingency plan in place so that all eventualities are covered.” – In our fourth edition themed Lessons from Rio: Reflecting on the Olympic Games , Chief Medical Officer for British Gymnastics, Dr Chris Tomlinson spoke about the challenges of preparing for a major event. Team GB gymnasts subsequently finished the Rio Olympic Games with seven medals across all three gymnastics disciplines, making it their most successful Olympic performance in history.
  8. “As the competition draws to a close on Sunday, most players make their way straight from the locker room to the airport as they head on to the next event. The tour schedule, in particular the European Tour, can be relentless and this high volume of flights, temporary time zones and often new/foreign cuisines all increase the risk of illness for the players and caddies” – Top sports nutritionist David Dunne dissects the nutritional requirements of elite golfers in our most recent edition here.
  9. “Any sport worth its salt has a joint or body part to claim as its own. Football has claimed the knee, rugby has claimed the brain, and the wrist belongs to golf. In the past, there was a poor understanding of the wrist among sports physicians, and we were referring cases that weren’t particularly complicated to specialist wrist surgeons, when in truth, they didn’t really require a surgical input. As a consequence, I have tried to foster better knowledge among trainees and doctors that work on the Tour in the clinical assessment of the wrist.” – Chief Medical Officer of the European Tour Dr Roger Hawkes shares key lessons for young clinicians hoping to work in professional golf here.
  10. “Sports medicine professionals are imperative to upholding integrity in sport. Clinicians need to be conscious of the wider personnel influencing the decisions of golfers – it is equally important that the anti-doping messages reach them too. It is a difficult environment to work in, because golfers are on the road so often, and getting messages to them is not always easy.” – Michele Verroken, Anti-Doping advisor to the PGA European Tour, demands change in how we tackle anti-doping issues here.

All editions are available through this link: http://www.basem.co.uk/usems/usems-emagazine/

If you would like a .pdf copy of any edition, please email seanocearmaide@gmail.com

Liam Newton works as a musculoskeletal physiotherapist in the NHS as well as AFC Bournemouth Academy. You can find him on Twitter @newton_liam.

Sean Carmody is a junior doctor working in London. He tweets regularly on topics related to sports medicine, health and high performance @seancarmody1.

Jonathan Shurlock is an academic foundation year 2 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series. If you would like to contribute to the blog series please email jhshurlock@gmail.com.

 

 

 

 

Premier league injury watch – same old story?

18 Aug, 17 | by BJSM

Undergraduate perspective on Sport & Exercise Medicine  a BJSM blog series

By Jonathan Shurlock (@J_Shurlock)

A new football season is upon us, with the premier league back in action alongside the lower divisions which recently kicked off. Already much of the focus is on who is going to be contending for the premier league title this year, with pundits everywhere adding their two cents. Sporting commentary is filled with often repeated; supposedly insightful phrases. One such adage, which remains true is that to win the league you need to win games. One of the most important undertakings in this process is keeping players healthy, as was nicely explored by Michael Davison recently.[1] In this vein, and inspired by the injury tracking work at the PhysioRoom website, we thought it pertinent to carry out a semi-regular review of premier league injuries. We will aim to give a brief overview of recent injury profiles, and which teams are struggling with injury burden, followed by a more in-depth look at specific injury types.

A review of the weekend’s premier league action indicates seven new injuries picked up by players from five different teams. Before reading ahead, we challenge you to have a go at predicting which injury type was most prevalent amongst these seven. Are you at all surprised that the most frequent injury type seen in the opening weekend is of the hamstring muscles? Simon Francis of Bournemouth, Isaiah Brown of Brighton & Hove Albion, and Paul Dummet of Newcastle all picked up new hamstring injuries; the most common single injury seen in football (More on this topic in this past blog).[2] It certainly seems to be a relevant time to discuss hamstring injury, off the back of watching Usain Bolt bow out from his track career with a potential hamstring injury.

Despite increasing knowledge of the mechanism of hamstring injury, and ongoing research outputs on diagnosis, management and re-injury, the burden of hamstring injury has actually increased in recent years.[3] Perhaps this is due to increased work load, or perhaps due to clubs not utilising evidence based prevention programmes.[4] One thing appears clear, we’re still not getting it right.

The BJSM team have covered hamstring injury in almost every multi-media format, including one of their most popular podcasts with Gustaaf Reurink (http://bit.ly/1zsDDDS). It’s certainly worth checking out the various outputs from Gus’ PhD as they give some great insight into topical areas of hamstring injury including Platelet-rich-plasma use and role of MRI.

Struggling to remember useful hamstring exercises? Have a watch of the following videos for a refresher:

https://www.youtube.com/watch?v=TO47AQuYphE

https://www.youtube.com/watch?v=McvuPAInukY&feature=youtu.be

There’s plenty more BJSM hamstring to get into get stuck into via blog posts, podcasts and editorials (just click on the “Hamstring” tag to the right). We’ll revisit in a few weeks and keep an eye on which teams are struggling with injuries, and whether hamstring remains the most common injury type. Additionally we will develop a more in-depth look at the diagnosis, management and return-to-play decisions for some of these injuries.

References

  1. Davison M. Extra workload will disrupt rhythm of the champions. The Telegraph. 2017;
  2. Askling C. Types of hamstring injuries in sports. Br J Sports Med. 2011 Feb 1;45(2):e2–e2.
  3. Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016 Jun;50(12):731–7.
  4. Bahr R, Thorborg K, Ekstrand J. Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J Sports Med. 2015 Nov;49(22):1466–71.

*********

Jonathan Shurlock is an academic foundation year 2 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series. If you would like to contribute to the blog series please email jhshurlock@gmail.com.

Mental health of elite young athletes: spot and support them before it’s too late

14 Aug, 17 | by BJSM

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

By Johnson Pok-Him Tam (@tamph4) and Manroy Sahni (@manroysahni)

Image credit: http://www.rightbluelabs.com/blog/mental-health/who-is-the-most-vulnerable-group-to-mental-illness/

Elite sport is results driven. Each generation of new athletes is pushing themselves to new limits, to reach new heights and eclipse records set by their predecessors. But what impact can this constant cauldron of pressure and expectation have on the mental health of a young athlete? Are young athletes speaking out when they need help? And what help is available?

Elite young athletes have daily gruelling training regimes to help reach the potential suggested by their outstanding natural talent. To achieve these goals, they are usually guided by an expert coach, medical team and close family and friends[i]. This network is intended to be a support system in both a sporting and an emotional sense. However, at times it can contribute to a high level of expectation placed on the shoulders of young sports stars.

Determining the burden of mental health issues in sport can be difficult. Especially considering the (1) stigma associated with speaking out given the sporting culture in which professional athletes are enmeshed (read past blog in link for more), as well as (2) the research suggesting a positive association of physical activity on the prevention and treatment of mental health issues.[ii]An American study found 21.4% of elite athletes, compared to 29.2% of the general public of the same age (18-25 years old) reported clinical symptoms of depression[iii]. This is in stark contrast to other reports indicating similar or higher levels of mental health issues in young elite athletes when compared to the general population[iv]. To help shed light on the important issue of young athletes and mental health, this blog identifies:

  • common risk factors for young athletes developing mental health issues,
  • coping strategies, and;
  • potential barriers when seeking professional help.

Common risk factors

Common risk factors for developing mental health problems can be categorised into intrinsic and extrinsic factors. Some elite young athletes have an exclusively athletic identity of self-worth, which is often dependent on their performance. If they perform below expectation, their perception of self-worth and esteem can decrease and lead to potential mental health issues[v]. It is common for an elite young athlete to develop a perfectionist personality due to the constant pursuit of superior performance both at training and competition, which often leads to extra anxiety, stress, depression and fatigue[vi],[vii]. These “optimum” levels of physical activity can improve mental health, however, at an elite level can also compromise mental health due to overtraining, injuries and excessive pressure on the athlete[viii].

Parents and coaches have a fundamental impact on a young athlete’s well-being[ix]. Dunn et al.[x] concludes that parental pressure increased negative stress and decreased motivation for their child athlete. Almost one-third of parents reported to give negative verbal comments to their young athletes, thus increasing the possibility of psychological stress and burnout[xi],[xii]. Alexander et al.[xiii] found that more than one third of young elite athletes reported emotional harm due to their coaches, from actions such as shouting, negative comments about their performance and attempts to intimidate.

Coping strategies

Methods do exist to potentially reduce mental health problems in elite young athletes. For example, athletes should develop a coping mechanism for stress with their coaches and parents. This can include (1) thought control, (2) relaxation, (3) mental development and (4) help seeking— all of which positively improve objective and subjective achievement, whilst decreasing the risk of mental health injury[xiv],[xv]. Parents and coaches are encouraged to comment on the athlete’s attitude and effort, rather than performance[xvi].

Barriers to seeking help

Negative attitude and stigma are two of the biggest barriers faced by young athletes when looking for help. Young people in general are reluctant to admit their mental health issues and studies have shown young athletes have a bigger reluctance than non-athletes when seeking help[xvii],[xviii]. In a survey[xix] of top college athletes, the most common reason for not seeking help was to avoid any ‘personal discomfort’ and others felt there was ‘no need’ for professional help.

In conclusion, mental health issues in elite young athletes are common. Maintaining an athlete’s “super human” identity as well as pressure from parents and coaches are all contributing factors. Steps for the future are to ensure that all young athletes have personalised coping mechanisms to deal with stress and feel confident and comfortable to ask for help.

References

[i] Caine DJ. Are kids having a rough time of it in sports? Br J Sports Med. 2010;44:1-3.

[ii] Rosenbaum S, Tiedemann A, Sherrington C. Physical Activity Interventions for People with Mental Illness: A Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry. 2014;75(9): 964-974

[iii] Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med. 2011

[iv] Junge A, Feddermann-Demont N Prevalence of depression and anxiety in top-level male and female football players BMJ Open Sport & Exercise Medicine 2016;2:e000087.

[v] Maffulli N, Longo UG, Gougoulias N, Loppini M, Denaro V. Long-term health outcomes of youth sports injuries. Br J Sports Med. 2010;44(1):21–25.

[vi] Appleton PR, Hill AP. Perfectionism and athlete burnout in junior elite athletes: the mediating role of motivation regulations. J Clin Sport Psychol. 2012;6(2):129–145.

[vii] Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016 Feb 1;50(3):145-8.

[viii] Hamer M, Stamatakis E, Steptoe A. Dose-response relationship between physical activity and mental health: the Scottish health survey. Br J Sports Med. 2009:43(14):1111–1114.

[ix] Mountjoy M, Rhind DJ, Tilvas A, Leglise M. Safeguarding the child athlete in sport: a review, a framework and recommendations for the IOC youth athlete development model. Br J Sports Med. 2015;49(13):883–886.

[x] Dunn JGH, Dunn JC, Gotwals JK, et al. Establishing construct validity evidence for the Sport Multidimensional Perfectionism Scale. Psychol Sport Exerc. 2006;7:57–59.

[xi] Shields DL, Bredemeir BL, LaVoi NM, Power FC. The sport behaviour of youth, parents, and coaches: the good, the bad, and the ugly. J Res Character Educ. 2007;3(1):43–59.

[xii] Gould D, Lauer L, Rolo C, Jannes C, Pennisi N. Understanding the role parents play in tennis success: a national survey of junior tennis coaches. Br J Sports Med. 2006;40(7):632–636.

[xiii] Alexander K, Stafford A, Lewis R. The experiences of children participating in organized sport in the UK, Edinburgh: University of Edinburgh/NSPCC. 2011.

[xiv] Nicolas M, Gaudreau P, Franche V. Perception of coaching behaviors, coping, and achievement in a sport competition. J Sport Exerc Psychol. 2011;33(3):460–468.

[xv] Emery CA, Roy TO, Whittaker JL, Nettel-Aquirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015;49:865–870

[xvi] Carter CW, Micheli LJ. Training the child athlete: physical fitness, health and injury. Br J Sports Med.. 2011 Sep 1;45(11):880-5.

[xvii] Schwenk TL. The stigmatisation and denial of mental illness in athletes. Br J Sports Med. 2000 Feb 1;34(1):4-5.

[xviii] Ekeland E, Heian F, Hagen KB. Can exercise improve self-esteem in children and young people? A systematic review of randomised controlled trials. Br J Sports Med. 2005 Nov 1;39(11):792-8.

[xix] Watson J: Student-athletes and counseling: factors influencing the decision to seek counseling services. Coll Stud J 2006, 40(1):35–42.

Johnson Pok-Him Tam (@tamph4) is a Foundation Year 1 Doctor in the West Midlands with an interest in Orthopaedics Surgery and SEM. He was previously the President for University of Bristol Sports & Exercise Medicine society and has written articles for the student BMJ.

Manroy Sahni (@manroysahni) is an Academic Foundation Year 1 Doctor in the West Midlands with a passion for SEM. He also co-coordinates the BJSM Undergraduate Perspective blog series. Please send your blog feedback and ideas to: manroysahni@gmail.com

 

Duty of care and the relevance of occupational health in professional sport

28 Jul, 17 | by BJSM

Undergraduate perspective on Sport & Exercise Medicine  a BJSM blog series

By Manroy Sahni (@manroysahni)

Image credit: http://www.korbuild.co.uk/csr/occupational-health/

 

Performance vs Safety

Team success, winning and performance are undoubtedly at the heart of elite sport. The concept of “marginal gains” and the pursuit of miniscule improvements that ultimately tip the balance between winning and losing mean that “performance” is a growing theme within sports medicine. However, performance and safety should never compete. Elite sport will never be 100% safe- that is an unrealistic expectation given the intrinsic risk associated with high-level physical competition. However, it is reasonable to expect that we should take steps to reduce the likelihood of harm, whether this be through modifying the playing environment, optimising technique or analysing and learning from previous incidents. This begs the question, who is responsible for the care of an athlete?

Who is responsible for the care of the athlete?

Within the hospital environment, doctors and the multidisciplinary health care team have a duty of care for patients on their wards. Things are not so clear cut within the sporting arena. Sports doctors of course still have a duty of care for their players but this duty of care is shared with the Employer. For example, football players will be employed by a club, whether that be at Premier League level or in the lower leagues, and player safety is therefore also the responsibility of the club. This is written in law under the Health and Safety at Work Act (1974). Consequently, within a sporting context the duty of care of the player falls on both the Doctor and the Employer. The Doctor must be competent and work within their “scope of practice” and the Employer must take reasonable steps to mitigate the risk to their employees through operating safely.

A Sports Physician’s Scope of Practice

It is of fundamental importance for all doctors to recognise their limitations and only work within their scope of practice. This remains true for doctors working within the dynamic and unpredictable world of professional sport. There are various routes into SEM so the training background for sports doctors can vary considerably. Typically, team doctors will have a General Practice background with a Postgraduate SEM qualification or have completed the SEM specialty pathway (http://blogs.bmj.com/bjsm/2017/04/24/postgraduate-perspective-sem-training-programme-undergraduates/).

For football, the Premier league and football league also require all team doctors to have a postgraduate qualification in SEM, up-to-date ATLS training in the form of Advanced Trauma Medical Management in Football (ATMMIF) and appropriate ultrasound accreditation if necessary. On top of this, a multitude of skills are required from the knowledge and capacity to travel with teams, the flexibility to work within a specialist MDT and the character required to cope with the very particular demands of the competitive environment . An appreciation for occupational health is often overlooked within this varied skill set.

Relevance of Occupational Health

In professional sport, the doctor is working for both an athlete and an employer. This means that the role of a sports medicine doctor has striking similarities with occupational medicine. The doctor must respect the fundamental importance of patient / athlete confidentiality whilst at the same time communicating pertinent information to the employer that may impact on an employee’s capability to work. Furthermore, sports doctors will often find themselves communicating player’s health reports to non-medical staff- whether this be members of the coaching team or club management. It is vital that in these scenarios, the team doctor understands the limits of what they can and cannot disclose.

Additionally, a team doctor may be asked to provide a medical opinion during a discussion regarding termination of a player’s contract, fitness to return to sport following serious injury or to advise on the impact of a mental or physical disability. These tasks come under the realm of occupational health and require the consent of the employee who has a right to see any report submitted.

What I hope to highlight in this short blog, is that doctors and employers have a shared interest in the wellbeing of athletes. Also, that the role of a sports doctor is evolving to fit in line with health, safety and employment law. These key messages are important to underline to an undergraduate audience, namely the representatives of the future of SEM.

For further detail and background on the points raised in this blog please read the following resources:

  1. Duty of Care in Professional Football, Dr Matt Perry, BASEM Today Issue 38, Spring 2017
  2. The Occupational Health of Sports Medicine, Dr John Ballard, BASEM Today Issue 38, Spring 2017
  3. A Doctor’s Duty of Care When Attending a Football Game, BASEM Position Statement
  4. Ethics Guidance for Occupational Health Practice; The Faculty of Occupational Medicine December 2011

Manroy Sahni (@manroysahni) coordinates the BJSM Undergraduate Perspective blog series. He is an academic foundation doctor in the West Midlands and serves as Education Officer for the Undergraduate Sports and Exercise Medicine Society (USEMS) committee.

Going viral with key SEM messages

11 Jul, 17 | by BJSM

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

By Jonathan Shurlock (@J_Shurlock)

Image: http://marketbusinessonline.com/profitable-viral-internet-marketing-tips-for-businesses/

This blog looks at ‘viral’ spread. No, not the relationship between viral infections and athletes that have been explored previously, 1,2 but rather viral SEM messages in social media. The term ‘viral media’ was first used by Douglas Rushkoff to describe the mass circulation of content amongst the population. The term is spreading fast, with every day seeming to bring a new ‘viral video’ to our attention on every available social media platform.

We do not need to revisit the statistics in great detail here, even a cursory search shows an increase in our time spent online, and that an ever larger portion of this time is devoted to social media. In addition, there is much debate regarding the human attention span, and whether it is indeed shrinking in part due to rapid exposure to sound bites and memes generated by social media.

Looking at videos specifically, where else to look but YouTube. At the time of writing the 3 most viewed videos on YouTube have 2.882, 2.860 and 2.608 billion views respectively. Inevitably, these include a video from the pop star that everyone hates to love, Justin Bieber. Searching for ‘Sport and Exercise Medicine’ brings up around 1,610,000 hits. The 3 videos with the most views have 25,000 – 60,000 views. While not quite reaching a view count of over a third of the world population, the target audience is admittedly smaller. Expanding our search slightly further, we come across a few videos relevant to the world of SEM which have managed to have an even greater impact:

In an entertaining TEDx talk, Charles Eugster explores the topic of increasing obesity in a video titled: ‘Why bodybuilding at age 93 is a great idea’. Charles identifies the increasing problems seen as a result of increased levels of physical inactivity. Have a watch and see what you think of his reflections:

(insert: )

We couldn’t talk about SEM videos without a mention of Dr Mike Evans incredible 23 and ½ hours’ video; which has seen a surge in views of late (apparently due to a feature in the Netflix show ‘Orange is the New Black’). Currently sat at over 5.3 million views, Dr Evans’ video seems to encapsulate all the aspects of a successful video with significant impact. Relatively short at just over 9 minutes, long enough to be worth watching, but short enough to maintain our apparently waning attention spans.  Dr Evans explores a vital topic of sedentary behaviour with some engaging animation. The 23 and ½ hours video has been explored before on the BJSM blog here and here, so lets refresh your memory:

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Dr Evans has plenty of other equally informative videos that are well worth a watch, and can be found HERE.

We know that brief interventions can be beneficial and cost effective4, so is there a place for videos such as these to be used as tools in our everyday clinical practice?

Anecdotally I often hear ‘my patient is too unwell to exercise’ as a reason for not discussing physical activity in the inpatient setting. Obviously there are limitations on the role of physical activity in the setting of acute illness, but the reality remains that physical activity is simply not a priority topic for many practicing clinicians.

As Professor Dame Sally Davies announces her plan to utilise genomics in order to continue to shape cancer treatment and personalise medicine, are we not missing an opportunity to be discussing the fact that physical activity is associated with a 20% RISK REDUCTION IN BOWEL CANCER5 or how about a 14% RISK REDUCTION IN BREAST CANCER?5 While genomics and personalised cancer treatment have their important roles in effective healthcare provision, are we at risk of overlooking the importance of physical activity in the pursuit of ever more complex and (at times) expensive treatments?

Once again, we revisit the importance of physical activity and the difficulty with encouraging those with sedentary lifestyles to engage with it. What insights do these videos give us into successful attempts to capture the interest of the general population with these important health messages? Is it all in the design or does the message matter the most? Thoughts welcome!

References

  1. Roberts JA, Wilson JA, Clements GB Virus infections and sports performance a prospective study. British Journal of Sports Medicine 1988;22:161-162.
  2. De Araujo, Maíta Poli et al. “Prevalence of Sexually Transmitted Diseases in Female Athletes in São Paulo, Brazil.” Einstein1 (2014): 31–35.
  3. Jenkins, Henry; Ford, Sam; Green, Joshua (2013). Spreadable Media: Creating Value and Meaning in a Networked Culture. New York: NYU Press.
  4. GC V, Wilson EC, Suhrcke M, et al. Are brief interventions to increase physical activity cost-effective? A systematic review. Br J Sports Med Published Online First: 05 October 2015.
  5. Kyu H, Bachman V, Alexander L, Mumford John, Afshin A, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013 BMJ 2016; 354

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Jonathan Shurlock is an academic foundation year 1 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series.

A (resource packed!) overview of Sports and Exercise Medicine (SEM) intercalated degree courses

14 Jun, 17 | by BJSM

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

By James Murphy

This blog follows up my previous post where I broadly discussed intercalation FAQs (READ IT HERE). Here, I intend to give medical students interested in intercalating in SEM an overview of their different options. I provide, to the best of my ability, a comprehensive list and basic description of the SEM and closely related courses offered in the UK. The information is from course web pages and from my own contact with course directors. My own observations on the courses are shown in bold italics.

Sports and Exercise Medicine courses

Sports and Exercise Medicine MSc, Nottingham University

All students on the MSc course complete compulsory modules as well as a research project.

The compulsory modules include anatomy and the assessment of sports injury. The ‘Pitch side Care of the Injured Athlete’ compulsory module is a great opportunity for students to get hands on experience in pitch side care. As part of this module students study and attend an “advanced emergency care course”(1) and also provide first aid cover at some University sports pitches. The other compulsory modules are: ‘Physical Activity in Health and Disease’ and ‘Research Methods’. The optional modules are listed on the course page.

https://www.nottingham.ac.uk/pgstudy/courses/medicine/medical-sciences/sports-and-exercise-medicine-msc.aspx

Despite the stated entry requirements, the course directors are open to applications from intercalating students.

BSc Sports and Exercise Medicine, Queen Mary, University of London

On this course students complete 120 credits, organised in to six modules. The modules are: ‘Research Methods’, ‘Injuries and medical problems in sport’, ‘Literature reviewing’, ‘Research project’, ‘Biomechanics and rehabilitation’ and ‘Exercise as a Health tool’. The breakdown of the modules is on the below website.

http://www.smd.qmul.ac.uk/undergraduate/courses/intercalated/sem/index.html

The taught research methods and literature reviewing modules prepare students to carry out research and critically appraise papers. Relating research skills to sports and exercise medicine literature allows students to appreciate the importance and application of the skills. As part of the degree students undertake a systematic review and a full research project, many students work towards, and succeed in having their work published.

BSc (Med Sci) Clinical Medicine, Glasgow University

Students can apply to undertake the Sport and Exercise Medicine subject and research project within this Clinical Medicine Degree. The degree is split into four different areas:  the ‘Core Course’ (which aims to provide students with “transferable research skills”(3)), the ‘Specialist subject’, ‘Medical Statistics’, and a ‘Research project’. For their specialist subject students can apply to take the SEM course. The SEM course aims to cover “exercise in health promotion, disease prevention and treatment of disease states”.(3)

Students undertake three modules: ’Clinical Sports Injuries’, ‘Sports Medicine in Practice’ and ‘Exercise in Clinical Populations’.

University of Glasgow B.Sc. (Med. Sci.) Clinical Medicine Sport and Exercise Medicine – Course information

http://www.gla.ac.uk/schools/medicine/undergraduate/intercalateddegrees/clinicalmedicine/

Sports and Exercise Science courses

Sports and Exercise Science (intercalated), Loughborough University

Students taking the Intercalated degree study alongside the final year Sport and Exercise Science BSc students. Intercalated students take 120 credits worth of modules from a great variety of options (the list can be found on the website below). Alongside their modules students complete a research project and have the opportunity to observe sports medicine practitioners in NHS clinics in Leicester.

http://www.lboro.ac.uk/departments/ssehs/undergraduate/courses/ses-intercalated/

In my opinion the list of modules offered on the Loughborough course is the most varied amongst all the SEM or SEM-related courses in the UK. With no compulsory modules this course provides students complete control over what modules make up their degree.

BSc in Medical Sciences (Sports Health and Exercise Science), University of Hull.

This degree offers students the “opportunity to engage with the theories and methods related to the bio-scientific study of sport and exercise, including sports injury.”(7) Students choose 120 credits, 40 of which are the dissertation module. Students choose at least two of ‘Human Locomotive Systems’, ‘Ageing, Obesity and Health’, ‘Fitness and Injury Prevention’. Furthermore students choose another two from ‘Environmental Physiology’, ‘Performance Enhancement and Injury Prevention’, ‘Psychology in Sport Rehabilitation’, ‘Sport and Exercise Nutrition’, ‘Exercise Physiology’.

The general areas students can undertake their research project in are: psychology, exercise physiology, biomechanics and sport rehabilitation.

http://www.hyms.ac.uk/undergraduate/intercalated-degrees/intercalation

University of Hull, Sports Health and Exercise Science 2016 programme description

Sport and Exercise Science (intercalated) BSc (Hons), Cardiff Metropolitan University

Here intercalating students study ‘Biomechanics of Sport and Exercise’ and “an independent project in one or more of Biomechanics, Physiology or Psychology”(8) and then choose three optional modules.

The optional Modules are: ‘Exercise Physiology for Sport Performance’, ‘Exercise Physiology for Health’, ‘Sport Psychology’, ‘Exercise Psychology’.

http://www.cardiffmet.ac.uk/schoolofsport/courses/Pages/Sport-and-Exercise-Science-(Intercalated)-BSc-(Hons).aspx

BSc in Sport and Exercise Science, Brighton and Sussex Medical School

Intercalating students join the final year of the BSc Sport and Exercise Science course at the University of Brighton. However, students are also given the chance to attend second year lectures and laboratory sessions if they wish. On the course students develop research method skills and complete a dissertation. Final and second year modules can be found in the “Course in detail”(9) section on the below webpage.

https://www.brighton.ac.uk/courses/study/sport-and-exercise-science-bsc-hons.aspx

Students hoping to gain hands on experience are able to complete a placement at a sports medicine practice on campus (numbers permitting).

BMedSci Sports Science Medicine, University of Edinburgh

This course combines SEM with the sports performance and exercise sciences (biomechanics, physiology, psychology and skill acquisition). Students can gain an “understanding of sports injuries and the health, performance and rehabilitation role that exercise can play in active sports people, specific patient groups and the wider population”.(11) The connection with the university’s SEM centre allows students to shadow members of the multidisciplinary SEM clinics. Students also acquire transferable skills such as literature appraisal, and how to plan and execute a research project.

https://media.ed.ac.uk/media/Intercalated+Honours+in+Sports+Science+Medicine/1_8iujw34v/42261371

http://www.ed.ac.uk/medicine-vet-medicine/undergraduate/medicine/mbchb/intercalated-honours

B.Sc. Sport Science in Relation to Medicine, University of Leeds

This flyer explained that on the course students have the chance to develop “research, analytical and critical evaluation skills,” and learn about “the major sport science disciplines – biomechanics, exercise physiology, psychology and motor control.”(12) The course also provides students the chance to study “the links between exercise and health from a scientific perspective”.

As part of the course students undertake a research project and compulsory modules in ‘Interdisciplinary issues in Sport and Exercise Sciences’, ‘Advanced Exercise Physiology’ and ‘Sports Medicine, Health and Nutrition’. Students also complete 40 credits of optional modules.

Information was obtained from B.Sc. Sport Science in Relation to Medicine course flyer, kindly sent to me by Stuart Egginton, Professor of Exercise Science at the University of Leeds.

List of References

  1. https://www.nottingham.ac.uk/pgstudy/courses/medicine/medical-sciences/sports-and-exercise-medicine-msc.aspx
  2. http://www.smd.qmul.ac.uk/undergraduate/courses/intercalated/sem/index.html
  3. http://www.gla.ac.uk/schools/medicine/undergraduate/intercalateddegrees/clinicalmedicine/
  4. University of Glasgow B.Sc. (Med. Sci.) Clinical Medicine Sport and Exercise Medicine – Course information
  5. http://www.lboro.ac.uk/departments/ssehs/undergraduate/courses/ses-intercalated/
  6. http://www.hyms.ac.uk/undergraduate/intercalated-degrees/intercalation
  7. University of Hull, Sports Health and Exercise Science 2016 programme description
  8. http://www.cardiffmet.ac.uk/schoolofsport/courses/Pages/Sport-and-Exercise-Science-(Intercalated)-BSc-(Hons).aspx
  9. https://www.brighton.ac.uk/courses/study/sport-and-exercise-science-bsc-hons.aspx
  10. http://www.ed.ac.uk/medicine-vet-medicine/undergraduate/medicine/mbchb/intercalated-honours
  11. https://media.ed.ac.uk/media/Intercalated+Honours+in+Sports+Science+Medicine/1_8iujw34v/42261371
  12. Sc. Sport Science in Relation to Medicine course flyer.

Other Resources

USEMS website

http://www.thestudentroom.co.uk/wiki/A_Brief_Guide_to_Intercalated_Degrees

Acknowledgements

Much of the information in this article is taken from course webpages and handbooks with the permission of the Universities. My thanks go to the course directors and leaders who gave me permission to include the courses in this article. Their help and support was much appreciated.

About the author:

James Murphy has completed four years of medicine at Newcastle University and is currently intercalating on the MSc Sports and Exercise Medicine course at the University of Nottingham.

Manroy Sahni (@manroysahni) co-coordinates the BJSM Undergraduate Perspective blog series. Please send your blog feedback and ideas to: manroysahni@gmail.com

A postgraduate perspective of a SEM training programme for undergraduates

24 Apr, 17 | by BJSM

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

By Andrew Shafik (@aaashafik), Guy Evans (@drguyevans) and Ajai Seth (@ajaiseth)

Are you a doctor interested in specialty training that incorporates physical activity, exercise, sport and medicine?

SEM Training Programme

Although BASEM was formed in 1952, SEM was only first recognised as a medical specialty in 2005. This was closely followed by the launch of the Faculty of SEM (FSEM) in 2006 and the first cohort of SEM trainees in 2007.

The SEM training program is a four-year training program (ST3-6), which starts after completing speciality-training year 2 (ST2). Applicants wishing to apply for SEM training (starting at ST3 level) must complete two years of core medical training (CMT), acute care common stem (ACCS) or the three/four year general practice (GP) speciality-training programme. Trainees undertaking CMT or ACCS as their core training programme are required to obtain full MRCP (UK) before entry into SEM ST3. All trainees must pass the FSEM Membership exam before the end of ST5 consisting of two parts: written and practical clinical assessments1.

The SEM training programme is varied but most trainees rotate in the following specialties:

  • Emergency Medicine
  • Acute Medicine
  • Trauma and Orthopaedics
  • Musculoskeletal Medicine
  • General Practice
  • Rehabilitation Medicine
  • Public Health
  • Other: Respiratory, Cardiology, Rheumatology, Radiology
  • Military
  • Elite Sport

Trainees have exposure to SEM clinics throughout the training and spend part of ST6 working with elite athletes.

Although the FSEM is looking at ways to increase the number of training places across the UK, there are currently no training programmes in Scotland or Wales and are only in certain deaneries around the UK e.g. no posts in south or south east England.

SEM Career

SEM consultants are often portfolio doctors working in several different settings that provide flexibility and security such as: NHS consultant post, elite sports teams/athletes, private SEM/MSK clinics as well as research, education or public health activities.

Standard working hours are usually between 8am and 6pm although commitments with professional sports team can fall outside these hours. Due to the little or no on-call commitments, SEM posts do not usually include banding. Working with clubs/teams is classed as private work and can be paid or voluntary.

The shape of training final report published in 2013 has set out a new broad framework for the future of postgraduate medical education and training2. This aims to make sure doctors are trained to the highest standards whereby a doctor is less specialist and therefore broader and more adaptable to meet changing patient needs for the years to come. The shift of the FSEM Diploma Exam to the new FSEM Membership Exam in recent months is one that now allows professional recognition in Sport and Exercise Medicine to all doctors3.

The future of the speciality is to continue to incorporate SEM services within primary and secondary care, by treating MSK pain, treating and preventing chronic and non-communicable disease and doing so by increasing physical activity within the general population. Whilst funding for training posts remain uncertain, there is a need for SEM physicians to ‘bridge the gap’ between primary care and orthopaedic services. This ultimately improves the patient’s journey across the system.

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Andrew Shafik, BSc (Hons), is a 4th year medical student at the University of Aberdeen with a keen interest in SEM. He has an intercalated degree in Sports & Exercise Science and is a keen footballer playing for Aberdeen University Men’s Football Club 1st XI. He is also Co-Founder & Co-President @aberdeen_sems, an Ambassador for Move.Eat.Treat and a new undergraduate representative for the Scottish branch of the FMA.

Dr Guy Evans is a newly qualified Sport and Exercise Medicine Consultant having completed SEM specialist Training in the West Midlands. He is currently the Lead Sports Physician with British Swimming and works with Bath Rugby Club. He held the role of FSEM trainee representative until completion of his Specialist Training and continues to be involved with the training and education of SEM trainees and MSc students.

Dr Ajai Seth is a Sport and Exercise Medicine Registrar and General Practitioner in the West Midlands Deanery. His sporting interests include racket sports, football, athletics and expedition medicine. He is currently Birmingham City Academy and GB para-archery doctor.

References:

  1. Evans G. A Career In Sport and exercise medicine. Student BMJ. 2016; 24: j4336
  2. General Medical Council. (2013). Shape of Training Final Report.Available: http://www.shapeoftraining.co.uk/. Last accessed 5th Mar 2017.
  3. (2017). Professional Recognition in Sport and Exercise Medicine Now Available to all Doctors.Available: http://www.fsem.ac.uk/news/faculty-news/2017/february/professional-recognition-in-sem-available-to-all-doctors.aspx . Last accessed 5th Mar 2017.

Manroy Sahni (@manroysahni) coordinates the BJSM Undergraduate Perspective blog series. He also serves as Education Officer for the Undergraduate Sports and Exercise Medicine Society (USEMS) committee and Co-President of Birmingham University Sports and Exercise Medicine Society (BUSEMS).

 

(USEMS) Q and A with Sam Blanchard: An insight into working in elite sport

20 Feb, 17 | by BJSM

Undergraduate perspective on Sport & Exercise Medicine

By Sam Blanchard, Liam Newton, and Jonathan Shurlock

Undergraduate Sports and Exercise Medicine Society (USEMS) recently hosted an online Q&A session, via Twitter with Sam Blanchard (@SJBPhysio_sport) – Academy Clinical Lead & International Women’s Lead Physiotherapist for Scottish Rugby Union (SRU). For those who missed it we’ve highlighted the key interactions, and some of our personal insight into working in elite sport. We’ve taken some of Sam’s answers directly from his replies to some of the questions he received throughout the Q&A evening.

Q: How did you make your first steps into professional sport?

SB: “Putting in the hours. Continuously wanting to learn, being open to criticism, reflecting and reacting. A key moment (of realisation) was lone working and feeling out of my depth. So I looked for supported opportunities.”

The idea of working in a supportive environment is essential for safe practice and your ability to learn from your experience. As a student or new graduate working full-time within a professional sports medicine team can be difficult to achieve, however semi-professional sport often provides a great stepping stone. As Sam mentioned, it’s important to seek out a club that has qualified staff to work under to help develop your clinical decision making and ensure your work tasks are suited to your current scope of practice.

Sam and the SRU recently advertised for 2 Junior positions to address this very issue and offer a structured development plan for those wanting to make the step into elite sport. First Aid/trauma course certification and basic insight into sports tapping and massage are essential. Having these extra skills will make you more valuable to a club. When contacting them it’s important to highlight what YOU can offer them!

Sam highlighted the importance of not working from an isolated and vulnerable position, in his answer to a later question:

Q: What do you think are the most important practical skills to learn in order to be a successful practitioner?

SB: “regardless of method, clinical reasoning underpins everything. Continually ask “why” to yourself and colleagues. Clinical reasoning for exercise rehabilitation provides you with tools not ‘answers’.”

Regardless of your experience, expose yourself to different practitioners and schools of thought. It’s important to find ways of thinking that suit you and your personality, to back this up, where possible, with evidence based research and slowly become your own clinician. Organise continuous professional development  (CPD) visits to different organisations and even different sports, as medical care very often transposes athletic demands.

 

Q: How often does your advice conflict with that from the medic? How do you deal with that?

SB: “In my experience, very rare! Understanding of roles & level of knowledge crucial. Recognise your own limitations & others’ strengths.”

Q: How would you recommend medical students learn about the basic principles of rehabilitation?

SB: “Try the exercises before prescribing. And be prepared to steal ideas from Twitter…”

Sam has written a really interesting piece on exercise rehabilitation, which can be found here. Improving your rehabilitation skills takes time and is as much an art as a science. Thus it is important to try out ideas, reflect on what has or hasn’t worked and learn from that. Setting an identity or purpose to a rehabilitation session ensures meeting the correct physiological adaptations. There is a great paper here on bridging the gap between training and rehabilitation, here on how to apply the principles of strength and conditioning into rehabilitation as well as how optimal loading can be used in the rehabilitation process.

Q: What qualities do you look for when interviewing/shortlisting a young Physio?

SB: “awareness of own limitations, humility, social skills, work ethic… and tea making ability”

Q: What do you think about increased ACL/knee damage post ankle injury?

SB: “GRF’s feed up so loss of range or proprioception or ability to decelerate would make sense for increased risk.”

Although it’s from a few years back, there’s a great literature review on this topic, which highlights some of the clear evidence for an increased risk of re-injury, particularly with inadequate rehabilitation. You can find that review here.

Q: Any courses or conferences you’d recommend to students or new grads?

SB: “Don’t just stick to your own professional courses. Explore S&C/sports science/coaching”.

Although a light-hearted tweet to finish on, extracurricular courses and CPD are a really important consideration throughout your training and post-graduation. And they often come with a hefty price tag. There are a number of student discounts available to courses such as Isokinetic Football Medicine Conference as well as through BASEM and our very own USEMS student conference – so look out for these. As rich an education resource these courses may be, it is important that you are working with a patient population that allows you to apply the newly acquired knowledge, making the money spent, a wise investment.

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Sam Blanchard is Academy Clinical Lead & International Womens Lead Physiotherapist for Scottish Rugby Union. You can find him on twitter @SJBPhysio_sport

Liam Newton works as a musculoskeletal physiotherapist in the NHS as well as AFC Bournemouth Academy. You can find him on twitter @newton_liam

Jonathan Shurlock is an academic foundation year 1 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series. Please send your blog feedback and ideas to: jhshurlock@gmail.com ; or Tweet @J_Shurlock

 

 

Hey undergrads, research doesn’t bite! Reflections from recent Tom Donaldson Award Winners

30 Jan, 17 | by BJSM

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

By Manroy Sahni and Esther Wright

Manroy and Esther, both final year medical students, reflect on why they were motivated to get involved in SEM research and show how far you can take your work. Manroy was the recent winner of the Tom Donaldson Research award (http://www.basem.co.uk/awards/tom-donaldson-poster-prize/) for his project “Anxiety, Depression and Perceived Sporting Performance amongst Professional Cricket Players”. Esther was runner up with her project “The Risk Factors for Patellar Tendinopathy in Adolescent Athletes: A Systematic Review”.

From left to right: Joey Fong (3rd), Manroy Sahni (1st) and Esther Wright (2nd). Tom Donaldson 2016 Prize Winners

What are some of the benefits for undergraduates that get involved in research?

To a medical student, the word ‘research’ is a daunting one. Although medical school prepares us for work within a clinical environment, the same cannot always be said for academic medicine. Despite being taught the basics of reading and appraising a paper, as students, we rarely get the chance to actively participate in research and are required to seek out our own opportunities. Those of us willing to put in a few extra hours of work will reap the rewards, even at an undergraduate level. Opportunities to explore areas of interest can help with refining career choices, whilst developing contacts and finding suitable mentors.  Publications, presentations and posters are useful additions to any portfolio, whilst demonstrating ambition and a commitment to learning.

How do you get involved with research within SEM?

As a relatively new and rapidly advancing specialty, research within SEM provides numerous opportunities for student participation. Many hospitals will not have dedicated SEM physicians, but due to the large overlap with other specialties such as orthopaedics and general practice, finding a supervisor with an interest in SEM is surprisingly easy. To date 15 UK universities have a SEM society, providing opportunities to attend lectures and discuss research ideas with speakers. If there is no SEM society are your university, don’t fret! The National Undergraduate Sports and Exercise Medicine Society (USEMS) holds an annual conference, inviting prominent figures within the sports medicine field to discuss their job roles and research interests. Conferences such as this create a platform to approach potential mentors and gain guidance on how to go about research as an undergraduate. USEMS also has a Facebook page, making it even easier to stay up to date with events and developments within SEM.

It’s all well and good taking part in research, but where can you present your findings at an undergraduate level?

As students we have the common misconception that research is only presented at conferences. When not developed with undergraduate attendees in mind, these are often pitched at the wrong level and may be very costly to attend. There are several other platforms which are easy to access as students and much less daunting places to develop presentations skills. Grand rounds occur regularly within most teaching hospitals, these allow a more informal approach to presentation and offer good opportunities for feedback. Regional SEM meetings also encourage student presentations within a supportive environment, not to mention the opportunities for peer education and development of teaching skills. Manchester SEM society runs an annual poster competition for undergraduate SEM projects; the Tom Donaldson Prize. This is a great starting point and shortlisted applicants will present their posters at the British Association of Sport and Exercise Medicine (BASEM) annual conference.  If you’re still looking further afield, some universities and research centres will provide grants to enable students to attend international conferences, it’s always worth submitting an abstract, you never know where it may take you!

You participated in the 2016 Tom Donaldson poster competition, how did you find the experience?

Participating in the competition enabled me to present my work at the BASEM conference; a prestigious event attended by leading club and national team doctors and expert physicians within the field of SEM.  Whilst presenting my work to individuals of this calibre was challenging it allowed me to establish relationships with professionals who may vitally assist me with future research and career advice. The conference itself featured a vast number of speakers covering a variety of topics from their role in the Olympic games, to development in the treatment of particular musculoskeletal conditions. I also met a number of SEM trainees, who shed more light on the available training pathways and gave me tips to further develop my portfolio. Overall the experience was very rewarding, both educationally and as a networking opportunity. As a final year medical student, I can’t really complain about the prize money either!

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Manroy Sahni (@manroysahni) coordinates the BJSM Undergraduate Perspective blog series. He also serves as Education Officer for the Undergraduate Sports and Exercise Medicine Society (USEMS) committee and Co-President of Birmingham University Sports and Exercise Medicine Society (BUSEMS).

Esther Wright is a final year medical student at Birmingham University and a senior committee member of Birmingham University Sports and Exercise Medicine Society (BUSEMS). She has further demonstrated her interest by completing an intercalated BSc in Sport and Exercise Medicine (SEM) at Barts and the London, graduating with First Class honours. Her interest in SEM stems from her own sporting experiences, both as a competitive swimmer and horse rider. She hopes to pursue a career in orthopaedic surgery, whilst maintaining an interest in SEM.

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