Domhnall MacAuley: World Congress on Sports Injury Prevention

Domhnall Macauley Far out. About as far away as you can get; 300 km above the Arctic circle in Tromso, Norway, at the World Congress on Sports Injury Prevention.

Indeed, geography is a useful metaphor as sport and exercise medicine often finds itself on the margins. Seldom taken seriously by mainstream medicine, who see sport as play, and scoff at academic standards. Maybe it is time to learn from other disciplines.

The big debate on Thursday was about research methods, a debate long consigned to history in other specialties. Other disciplines have moved on; recognising the primacy of the RCT in assessing interventions, the value of large cohort studies and the limitations of less rigorous methods.

Randomised controlled trials are not easy. Individual athletes, clubs and organisations have their own agendas and resist being treated as an experiment. Funding is difficult and there are no dedicated charities, research councils or drug companies with a particular interest. But, emotive arguments don’t make much impression on scientific colleagues, universities or journal editors.

Search the BMJ website for papers on sport and exercise medicine, and there is quality research on cancer, asthma, falls prevention and other patient focused topics. As sports medicine struggles with yesterday’s arguments, other medical specialties have adapted the principles of physiological testing, training and rehabilitation. No self respecting cardiology or respiratory investigation centre would be without a treadmill or oxygen uptake analyser.

The great strength of sports medicine has been in the large epidemiological research on the benefits of physical activity. But, it needs to move on. For that reason, it was entirely appropriate that this conference was hosted by the Norwegians, undoubted the international leaders in pioneering quality injury based research.

But they did not have it all their own way. While our Norwegian colleagues, led by the charismatic Roald Bahr, have performed some superb prevention studies, their Danish neighbours, under Michael Kjaer’s guidance, are the clear leaders in tendon research. This conference was a triumph for the Scandinavians.

Conferences have their own character and atmosphere. And we bring our own expectations – Perhaps we should not be surprised to see Tromso in a murky drizzle. Even when the organisers had helpfully suggested we bring warm clothes and rainwear, I confess I still expected sunshine at mid summer in the land of the midnight sun. I never saw the sun, but 24 hour daylight is very strange. Winter must be dreary, however, when the sun sets towards the end of November and doesn’t reappear above the horizon until mid January.

This conference was different in many other ways; it was lively, exciting, energetic, with coffee breaks buzzing, and the discussion dynamic. Kicked off, to use an appropriate sporting analogy, by a virtual Jaques Rogge, who took time out from his Olympic preparations to send us a video clip. The atmosphere almost euphoric, perhaps boosted by the 24 hour melatonin surge. Even the delegates were a different shape. The mass transformation of delegates to early evening joggers was in marked contrast to the usual podgy cohorts shepherded to post conference pharma sponsored hospitality at many events. So, lets not mimic everything in mainstream medicine.

Domhnall MacAuley is Primary Care Editor, BMJ