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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Did you know most calf strains happen in the last 15 minutes of the match? And that old geezers (like me) are at higher risk of injury? So when your veteran player sustains a calf injury in added time, paying attention to soleus is vital! Soleus plays a big role in our lower limb. Not only does it make up 50% of our calf musculature (picture from Seth’s slides), it also contributes 50% of our body’s vertical support force^{5 6}! Seated calf raises FTW!

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

5. Andy Rolls on conservative management for an ACL injury. There has been lots of discussion about research in my previous 4 highlights. But now we turn our attention to a rather interesting case study.

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

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

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

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

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

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

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

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

– Chris

 

References:

1. Cook, J.L. & Docking, S.I. (2015). “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ’tissue capacity’: a core concept for clinicians. British Journal of Sports Medicine, 49, 1484-1485.
2. Gabbett, T.J. (2016). The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine, 0, 1-9.
3. Askling, C.M., Tengwar, M., Tarassova, O., & Thorstensson, A. (2014). Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. British Journal of Sports Medicine, 48, 532-539.
4. Ekstrand, J., Hägglund, M., & Waldén, M. (2011). Epidemiology of muscle injuries in professional football (soccer). The American Journal of Sports Medicine, 39(6), 1226-1232.
5. Albracht, K., Arampatzis, A., & Baltzopolous, V. (2008). Assessment of muscle volume and physiological cross-sectional area of the human triceps surae muscle in vivo. Journal of Biomechanics, 41(10), 2211-2218.
6. Dorn, T.W., Schache, A.G., & Pandy, M.G. (2012). Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. The Journal of Experimental Biology, 215, 1944-1956.

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