Domhnall MacAuley: Sports medicine awards and research opportunity

Domhnall MacauleyThe Lord Speaker’s chambers at the House of Lords seemed an appropriate setting for the presentation of the Duke of Edinburgh prize for sport and exercise medicine. And, it seems, it would have taken place at Buckingham Palace had Prince Phillip not had a prior engagement. Among those honoured were the legendary Swedish orthopaedic surgeons Lars Peterson and Per Renström, authors of, probably, the most influential textbook for this generation in sport and exercise medicine. Preceding  a conference entitled “Tackling osteoarthritis in sport,” it also heralded a new partnership between the Arthritis Research UK and the Institute of Sports and Exercise Medicine, the research arm of the Faculty of Sport and Exercise Medicine.

Sport and exercise medicine research in the UK is relatively underdeveloped despite the considerable advances in education.  It would be unfair to chide a professional group that includes many volunteers who provide medical care to clubs and organisations throughout the country at their own cost; others who have worked voluntarily tirelessly to create an academic structure and, consequently, the Faculty of Sport and Exercise Medicine; nor even the current generation of specialist registrars who will complete training with little hope of employment.  For those committed to researching the causes, treatment, and prevention of sports injury, it is a difficult path. Sport and exercise medicine is rarely prioritised by medical research bodies and there is no Pharma godmother. The few academic departments that exist lack the funding necessary to build critical mass and a research infrastructure. They create a pathway from masters to doctorate, and ultimately post doctoral work. Judged by the success of previous Arthritis Research UK initiatives,  however, we should be optimistic and need only look to the primary care research unit at University of Keele, for a model of achievement. Under the inspirational leadership of Professor Peter Croft, it has become one of the leading world centres of musculoskeletal research. Professor Alan Silman, medical director of Arthritis Research UK in his introduction made a firm commitment to funding sport and exercise medicine research- an unprecedented opportunity. Never in my professional lifetime have I heard such a commitment.  It is up to the sport and exercise medicine community in the UK to respond.

The speakers list was a galaxy of stars. Chosen deliberately so we could learn from these world leaders, one of the purposes of the meeting was to create a research agenda for the UK. For me, one of the key messages was the need to seek out new areas where we can make rapid gains. With a vast unexplored landscape in sport and exercise medicine, we would be wise to avoid the fields of expertise cultured by our international colleagues. Dr Richard Steadman (USA) showed a graph of the exponential increase in research publications on the anterior cruciate ligament- incredible that such a small piece of tissue could create such a volume of work- which  made me wonder if we really need any more replication of previous work.  In the moderated discussion, Roald Bahr (Norway), suggested that we need to concentrate our expertise in key areas which I interpret as a need to develop centres of excellence if not physically, then virtually. The way forward, a view echoed by many, is for multidisciplinary collaboration building  from basic science through to  clinical practice.

There were some useful clinical nuggets: Steve Blair (US), reflected wittily that colleagues in other disciplines say he never needs to make any new slides — and, as he demonstrated the evolving research evidence showing a dose response benefit for physical activity in every age group, in every condition, and with almost any form of exercise, all the graphs looked almost identical. Phillip Conaghan (UK) spoke about how effective analgesia may inadvertently increase the severity of osteoarthritis as it enables people with mild and early joint pain to continue to exercise, perhaps inappropriately, and thus increase joint damage. And, David Hunter (Aus) reflected that MRI can reveal asymptomatic pathology that we do not yet know if it is abnormal. A number of speakers spoke of autologus chondrocyte transplantation, perhaps with a matrix, and the potential of stem cells, so there may be a future in cartilage repair. But Denis Caine made a memorable comment when talking of children’s sport —“What will they have longer- their trophies or their injuries?”

But, for me, the most exciting message was Alan Silman’s declaration that Arthritis Research was committed to funding sport and exercise medicine. We have had the talk. Let’s see the walk. Time to deliver.

Domhnall Macauley is primary care editor, BMJ