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

By Liam West (@Liam_West)

Students looking to get into Sport and Exercise Medicine (SEM) should attend as many conferences as possible – many examples from the Undergraduate perspective blog series support this statement. London School of Sport & Exercise Medicine’s 5th Annual School Conference, provides another ‘case in point’.

This year’s conference theme was: “How can SEM help the endurance athlete?”

In addition to the numerous networking opportunities during the day, the presentations offered valuable insights to the opportunities that await students in a career in SEM. A great strategy for students wanting to excel is to always take away two main points from a talk and read up on them later.

For those students unable to attend, below are two interesting points of education / discussion from each presentation:

Exercise Induced Collapse (EIC) – Dr. C. Kipps

• Majority of EIC and cardiac arrests occur in the last mile of both half and full marathons. If you are involved in medical provision for endurance events it is important to ensure these lengths of the race are fully staffed with medical personnel and equipment.
• Hyponatraemia – due to fluid shifts, if an athlete drinks too much it doesn’t matter if this has sodium in or not. Look for neurological signs (confusion, seizure etc), which will be absent in the assessment of an athlete suffering from dehydration. Treat the athlete with 100ml hypertonic saline bolus, repeat as needed.

Female Athlete Triad – Dr. Cath Spencer-Smith

• Only need one or more factors of FAT to have morbidity. Ask yourself is the athlete getting enough energy? The main cause of FAT is insufficient energy availability. It is documented that athletes need 30calories/kg lean mass/day (for at least 5days in a row) but optimal amounts are more likely to be >45calories/kg lean mass/day.
• You must council patients that they should not try to train and lose weight simultaneously. These should be done at separate times to reduce the risks of poor bone health and subsequent injuries.

An insight into altitude Medicine – Extreme Everest – Dr. Dan Martin

• More fit individuals fare worse at altitude – larger drops in VO2 max in these subjects. Don’t train to climb large mountains!!! Hypoxia can be considered to be a drug and therefore as such has variable effects on variable people.
• Unlike the philosophy of “live high, train low”, training at high altitude has no high-level evidence as simply can’t train as hard. The future lies in individualised, dose-response hypoxic training with athletes that have been genetically profiled beforehand.

How to optimise the performance of the endurance athlete? – Prof. Greg Whyte

• The heart is not immune to fatigue. During ultra distance events, evidence suggests that the heart can be a limiting factor to performance.
• There is no such thing as a “performance gene” or gene to predict performance instead we should concentrate efforts on optimising the individual.

The management of anterior knee pain – Present, past and future – Mr. Sam Church

• With each possible pathology – always physiotherapy as the first treatment modality. You need to teach the muscles how to work properly.
• ITB friction syndrome – send the patient into the MRI scanner with symptoms to get the best images.

Plantar fasciitis – Assessment and management – Mr. Trevor Prior

• Inflammatory signs often absent but chronic degeneration signs present – use MRI to stage rather than USS so you get bony detail. Think as a syndrome rather than a distinct pathology.
• As this is a chronic pathology it will take time to get over (6 months). Treat in a step wise manner – 1) Biomechanical issues, 2) symptomatic relief – NSAIDs, steroid injection, shock wave, 3) surgery.

Imaging of lower limb overuse injuries – Dr. Justin Lee

• Stress fractures – MRI must be the first line Imaging modality
• The ultrasound probe is the new stethoscope for Sports Medicine Physicians.

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

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