By Jonny Elliott (@jelliott1989)

On 14^th September the Faculty of Sports and Exercise Medicine (FSEM) Ireland hosted it’s widely anticipated 16th Annual Scientific Conference (ASC) at the prestigious Royal College of Surgeons Ireland. The event itself, entitled “Movement is Therapy”, showcased some of the best and brightest from across Medical and Allied Health Professions and gave space to reflect on how effective prescription of loading and various interventions can cause positive adaptations. This fantastic event was organised by Co-Chairs Dr James O’Donovan (FSEM) and Prof Phil Glasgow (ISCP) and had a world class line up of researchers and clinicians.

The core principles discussed at the ASC are summarised below, along with a selection of the top tweets:

Radiology: Stress related bone injury. Prof Steve Eustace

• Radiological distinction of a bone bruise verses fracture; with cortical disruption visible in fractures only and trabecular disruption appearing in both.
• Bone oedema has four causes: vasogenic, congestive, tumourogenic and traumatic; with traumatic oedema pattern being dictated by the mechanism of injury and the associated soft tissue injury.

Optimal Loading: Considerations around loading specificity and optimisation of tissue adaptation within rehabilitation. Prof Craig Purdam

• Reinforced the need to expand the current knowledge base on tissue demands in sport, healing processes, mechanotherapy approaches and appropriate assessment tools.
• Made particular mention of how we consider loading rates in returning athletes to running sports; citing the key elements of loads progression and examples of higher-level drills.
• Offered a word of caution to those who harness the use of Alter G rehabilitation; highlighting the importance of the horizontal braking force to rehabilitation which the technique uses, as well as the need to further understand how the playing surface can affect tissue loads.

Bone Healing. Return to Sport after Surgical Intervention. Prof Justin Cobb

• Gave a dynamic overview of bone healing and return to sport following surgical intervention through the story of one of his patients who suffered a bisphosphonate associated femoral fracture.
• Summarised how his department, based at Imperial College London, are using mathematical modelling to visualise the ideal hip in patients with hip pathology and map the surgical intervention that can be offered to achieve this.

Move on – it’s just pain: physical activity in youth with musculoskeletal pain. Dr Sinead Holden

• Discussed the challenge of managing MSK pain in adolescents, and particularly those with persisting pain with Osgood Schlatter’s disease.
• Highlighted the importance of viewing the patient as a whole through the Biopsychosocial lens and tailoring the intervention to the patient – “You can have the best intervention but if the kid doesn’t enjoy it, it won’t succeed.”

Tendon injuries in sports: what, when, why and what should we do? Dr Seth O’Neill

• Discussed the structural changes associated with tendinopathy: alterations to tendon cell population, disorganisation of collagen, ground substance changes and neovascularisation.
• Demonstrated why exercise can be a trigger for tendinopathy and that modification of load, particularly loading high and being progressive, is the only conservative treatment with good evidence and that rehab must focus on being longer and heavier. 

Sleep and Recovery: Implications for Athletes. Ronan Doherty

• Reinforced the importance of how recovery prescription should consider both the phase of the season and the resultant training stress.

Microbes in Sport – The Potential Role of the gut microbiota in athlete health and performance. Dr Sharon Madigan

• Provided a deep-dive summary of how species, pathways and metabolites show distinction between different sports and how this may lead to the identification of an optimal gut microbiome unique to the sport the individual partakes in.

Obesity and impact on physical function. Dr Donal O’Shea

• “Should obesity by classified as a disease, or a disability?”
• “We as healthcare professionals should be creating a culture where talking to a patient about their weight becomes an accepted norm. “

Holistic Athlete Care: Maximising Health, Optimising Performance. Ashleigh Wallace

• Discussed the performance opportunity of athlete health and how coaches are integral to co-creating optimal health for the athlete.
• Highlighted the association between athlete health and soft tissue injury.

To load or not to load: stress fractures, tendon, ligamentous injuries and post operatively. Johny McKenna

• Provided a surgical overview of how we go about loading stress fractures, tendon, ligamentous injuries, as well as during the post-operative period.

Optimising Loading to Maximise Treatment Outcomes. Prof Phil Glasgow

• Provided a stimulating overview on what successful rehab looks like and how understanding the impact of load on various tissues can guide effective rehabilitation through the interconnectedness of load adaption on injury prevention and performance enhancement.

Psychological challenge of returning to play after injury. Jessie Barr

• Harnessed her position as an ex-athlete turned Performance Psychologist to highlight factors influencing response to injury and qualitative approaches to assessing an athlete’s cognitive approach of returning to performance.

The conference featured a diverse array of research, with the best five abstracts competing for the Professor Moira O’Brien Medal through a series of oral presentations in the main scientific session. The winner was University College Cork medical student Darek Randell for his novel research on ‘Characteristics and Assessment of Potential Concussive Events in Gaelic Football Association Players’ through observational review of video.  This year also featured a significant number of poster presentations competing for prizes selected by both delegates and the research review committee. Craig Coffee won the poster prized judged by the conference research review committee for his comparative study on the fitness levels of Irish children with Autism Spectrum Disorder compared to neurotypical individuals. Whilst Paul Carragher won the delegate choice poster award for his prospective study of illness and, acute and overuse injuries in elite youth and junior athletics.

In summary: movement can be utilised to maximise tissue adaption, recovery of tissue injury and indeed return to return to activity. Congratulations to FSEM Ireland and The Conference Committee for organising a world-class event.

Acknowledgements

Sincere thanks to ASC Co-Chairs Dr James O’Donovan (FSEM) and Prof Phil Glasgow (ISCP) for their input to this blog.

***

Jonny Elliott (@jelliott1989) is a final year medical student at Queen’s University Belfast. He is actively interested in concussion management, human factors and rugby medicine. Email: jonnyelliott4@gmail.com