Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law and policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (Chief Medical Officer), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. Here is Part 2!

Timeline:

0.35: Is there a relationship between when players are removed & their subsequent recovery?

5.13: What else is the RFU doing around concussion?

8.36: Will we ever prevent concussions in rugby?

Professor Lars Engebretsen is the Head of Scientific Activities in the Department of Medicine and Science at the International Olympic Committee. An orthopaedic surgeon, he is a strong advocate of the multidisciplinary approach to patient care. Among his many awards are the Nordic Prize in Medicine and the American Orthopaedic Society of Sports Medicine Hall of Fame. He is the Editor of the BJSM’s Olympic-supported issues (4 per year, usually numbers 1, 7, 11 and 17).

Timeline:

0:40 mins - Surgical management of the patient with the acute ACL rupture – emphasis on early rehabilitation

1.44 mins - Prehabilitation – a definite focus

5.54 mins - The locked knee – what is it and how does finding one affect management?

8.00 mins - Is surgery indicated for meniscal injuries or not?

9.12 mins - The paediatric ACL (age 8-12 years). What’s the best management?

Do you consider the first 10 seconds of a consultation to be important? Have you looked at your clinic space and how that might affect your patients? In this podcast Steve Aspinall (BASRaT) speaks to Richmond Stace @painphysio about the importance of compassion and active listening in the treatment of pain.

Richmond is presenting at the BASRaT symposium on the 18th of November in London.

Our Symposium this year will focus on pain; with unmissable keynote speeches from experts in the field and presentations and workshops that will enrich your knowledge.

Focussing exclusively on pain and all its forms and manifestations it will be vital for practitioners to help manage and manipulate pain and help people from all walks of life.

Our unmissable range of speakers includes Richmond Stace who is leading advances in understanding and treating pain and has created the pain coach programme.

Richmond will look into the importance of the first point of contact, how we can gain information from the first few words.

We have a range of workshops including "Gold from Rio"- BASRaT Sport Rehabilitator, Hannah Crowley helped Ed Clancy on his road to recovery from a back injury and to his gold medal win at Rio.

Our closing keynote "Pain, the Brain and a little bit of Magic" will be presented by Professor Anthony Jones. Professor Jones is an MSK pain specialist and leads the Human Pain Research Group.

This one day event on Friday 18th November will be packed full of essential speeches, presentations and seminars, enriching your knowledge and aiding your work.

BOOK NOW. Visit basrat.eventbrite.co.uk.

Timeline:

1:03 How big is the problem of pain?

2:39 What does good communication mean?

8:00 What are the key points in an interview about pain?

12:11 How to pain the patients journey?

16:44 Is neuroscience education important?

18:59 Key messages for the clinician

Links:

http://basrat.org/

Over the last 20 years across the western world the increasing toll of sedentary behaviour on young peoples physical and mental wellbeing is a well-documented phenomenon. Many different piecemeal policy initiatives have failed to tackle the problem. In this podcast Steve Aspinall (BASRAT) speaks to head teacher Elaine Wyllie about the daily mile initiative. This simple game changing initiative provides massive public health benefits though a simple philosophy of non-competitive outdoor fun that is accessible to all children regardless of age, gender, ability or socioeconomic background.

Listen to Steve and Elaine discuss this inspirational initiative and find out how you can get involved:

Timeline:

1:03 What is the daily mile?

1:49 How is the daily mile implemented in schools what are examples of best practice?

4:54 Does the daily mile work for all children?

8:56 How does the weather impact participation?

11:43 Local and national level support

15:04 Preliminary results of a large scale study

17:00 How to get involved

Links:

http://thedailymile.co.uk/

http://basrat.org/

Rugby is often maligned in the press for its inevitable relationship with concussion, with numerous high-profile incidents only compounding the issue. If your reading is restricted to the newspapers, you’d be forgiven for thinking that a culture of denial is in place, however when you delve deeper, there are numerous examples of innovative and powerful research, all of which is already leading to law & policy changes. One leading light in the sport is the Rugby Football Union (RFU), who are actively conducting policy-informing research, and using this to shape the game in order to maximise player welfare. Steffan Griffin, of the BJSM, caught up with Dr Simon Kemp (CMO), Dr Matt Cross (Professional Rugby Medical Research Officer), and Dr Mike England (RFU’s Community Rugby Medical Director), who provide an insight into their work, which is not only shaping the way the game is played, but provides a fantastic blueprint for other sports to follow. This is Part 1: in the build up to the Berlin Consensus Conference.

Timeline:

01:15: Can you give us some insight into the scale of concussion in Rugby Union?

04:00: Are the rising rates due to increased incidence or due to people being more likely to recognise and report it nowadays?

06:45: What is the RFU’s general approach to the management of Concussion?

08:45: Can you tell us a little about the ‘recognise, remove, recover and return’ campaign?

14:00: So the aim is to remove as many concussed players from the pitch as soon as possible: what else is the RFU doing to try and ensure this?

19:15: you have published a number of papers in the BJSM – one of which showed a relationship between concussion and subsequent musculoskeletal injuries – could you please elaborate?

21:50: What does this mean about the return to sport following concussion? How could this influence practice?

Links

Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015 http://bjsm.bmj.com/content/early/2016/09/01/bjsports-2016-096461.abstract

The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby http://www.jsams.org/article/S1440-2440(16)30142-6/abstract

Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes http://bjsm.bmj.com/content/early/2015/12/01/bjsports-2015-094982.full

Phil Glasgow is the head of sports medicine at the Sports Institute, Northern Ireland. A vastly experienced physiotherapist, he has worked at 3 Olympic Games, and has just returned from Rio. In this podcast, we discuss a case history of a football player with hip pain, from assessment to RTP. We look at the sensitivity vs. specificity of various tests, how to explain the symptoms to patients, and any co-existing pathologies there may be in the athlete. Finally, the discussion moves to treatment, the role of manual therapy, and exercises the patients can do to increase strength in the tissue.

The 2nd World Conference of Sports Physiotherapy will be held in Belfast, 2017- details can be found here: http://bit.ly/2dP2HjH

Timeline

0.40 - Hip pain: a case history and when is it reported to the physio?

3.08 - Ruling things out in the hip is easy: how do we rule things in?

7.30 - Things to consider when treating the hip

10.30 - Prescribing exercise for the patient - how do we go about it?

13.00 - How to increase the load in the injured athlete

18.26 - Bridging exercises for the hip

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely.

Relevant links:

Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes: https://soundcloud.com/bmjpodcasts/high-fat-for-health

Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus

Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach:

https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1

In this podcast, Steffan Griffin of the BJSM speaks to Dr Andrew Murray – SEM consultant & adventurer (amongst other things!), who is currently undertaking a PhD looking into ‘Golf and Health’. We talk about how the Golf and Health project was born, and some of the notable findings from his recently published scoping review. This is a must-listen for any SEM professional/student, not only due to some of the clinical pearls, but due to the fact that this is a shining light of what other sports could also be doing!

Contents

1.00: Andrew tells us about the Golf and Health project

2.30: What are the main findings from the scoping review?

5.30: Deeper dive into the potential benefits

6.45: What about mental health?

7.30: Could spectators also be reaping some of the health rewards associated with playing?

9.45: What lessons are there for other sports?

Links

Scoping Review http://bjsm.bmj.com/content/early/2016/09/26/bjsports-2016-096625.full

Infographic http://bjsm.bmj.com/content/early/2016/09/20/bjsports-2016-096866.full.pdf+html

Golf and Health website http://www.golfandhealth.org/

Golf and Health twitter https://twitter.com/GolfAndHealth

Dr Clare Ardern is a sports physiotherapy researcher at Linkoping University in Sweden. She carries Australia’s prestigious NHMRC’s top scholarship for clinician researchers – the 4-year Fellowship Award. You may know of her publications that highlight the relatively low return to play rates after ACL reconstruction. In this podcast, she addresses return to play more broadly. From 12-15th October this year she will be a keynote speaker at Sports Medicine Australia’s conference. You can follow that via BJSM Twitter #SMAConf16 and Facebook.

She was interviewed by Dr Christian Barton, who is a well-published physiotherapist PhD as well. He serves as BJSM Deputy Editor and the Editor responsible for Social Media (small job! easy!).

Timeline:

1:00m - Where did the Return To Play Consensus come from?

2:00m - Defining Return to Play; what does it mean in different settings

3:00m - The difference in RTP for o/c acute – removal from play?

4: 10 - Decision making – how should the return to play decision be made?

3:30m - Return to Play is a continuum that requires meticulous planning

4:00m - When can the athlete return to a pre-injury (or better) level of performance?

4:30m - What is the evidence for return to play decisions? Spoiler alert! – It’s limited.

5:20m - Taking the emphasis of the ‘one day’ that players focus on to be back at sport. The concept of a continuum (from when you first see the athlete).

6:45 - Return to play and returning to perform at the previous level. Are there important differences? What can clinicians do to help players get back to that level?

8:30m - Does ‘Return to Play’ end? It’s very different for different athletes.

10:10m - Should athletes have ACL reconstruction after ACL injury? What does the research show?

11:40 - Clare’s perspective on the return to play data after ACL reconstruction in the non-elite players.

Professor Peter O’Sullivan is among the top 3 most popular physiotherapy voices on podcasts and here he focuses on myths and harmful beliefs about back pain. He takes a swing at clinicians who rely excessively on imaging findings to attempt to explain the source of pain. He shares the story of a clinician who told a patient his spine was ‘shredded’.

Prof O’Sullivan emphasizes the importance of history taking, finding factors that can sensitize neural tissue and gives an overview of treatment. He will be the keynote Refshauge Lecturer at Sports Medicine Australia’s 2016 Conference (#SMAConf16, @SMA_Events).

Timeline:

0.35 m - A sneak preview of the Refshaughe lecture plan – back pain is a big problem and those in sport can learn from what is known in back pain in the general population

2.17 m - Patients respond well to a combination of explanation, being shown ways they can get back to the things they love to do, and appropriate progressive exercises

4.21 m - A case where a patient could have been treated with early investigation, aggressive medical intervention, potentially surgery. An alternative approach to management

6.48 m - How junior clinicians can approach the patient who presents with a bag of images or a medical note that may not reflect current best practice for managing back pain

9.45 m - The biology of how neural tissue can be sensitized by lack of sleep, stress. Fascinating neuroimmunology

10.55 m - You do treat the back don’t you? It’s not just explaining pain, counseling?

12.30 m - Parallels with work of other physiotherapists such as Prof Jill Cook (@ProfJillCook) and Dr Alison Grimaldi (@alisongrimaldi) who advocate for progressive loading as a stimulus for healing. “Backs love movement”

13.55 m - A 30-second summary!

Related podcasts:

Please consider downloading the mobile app “BJSM’ from iStore or GooglePlay. There are over 250 to choose from and the 10 most recent are very easy to get via the app.

1. Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’

http://ow.ly/uNgj304udUI

2. Dr Kieran O’Sullivan (@KieranOSull) on how top clinicians approach back pain

http://ow.ly/18Ru304ue96