The surf was up at ACSEP 2017

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Let the koalas sleep — you won’t be doing much of that if you attend an ACSEP conference

One of the highlights of my 2016 was my first visit to the Australasian College of Sport and Exercise Physicians (ACSEP) annual meeting.  I wrote about the experience in several of these CJSM blog posts.

ACSEP is one of CJSM’s affiliated societies, and we greatly value our relationship with the college.  Two of our Associate Editors are members of the college: Hamish Osborne (NZ) and Steve Reid (AUS).

On a personal note, I also greatly valued the experience of attending the meeting. The venue (Surfer’s Paradise) was stunning — just the ticket for someone muddling through a Northern Hemisphere winter.  And the proceedings themselves — well, they were little short of perfect.  From the educational sessions to the food and social events — first class, all the way.

ACSEP 2016 was, without a doubt, one of the best sports medicine conferences I have ever attended.

I couldn’t make the 2017 edition, which also took place in Surfer’s Paradise. What was my misfortune turned out to have a pleasant side-effect, as Dr. Osborne was in attendance, and he graciously penned this letter giving an overview of the proceedings:

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ACSEP has been and gone and my promised blog post is now a thank you to all those who attended clearly our biggest but also our best-ever annual scientific conference. I arrived early, actually before most registrars as it turned out, to meet and greet and enjoy the excellent presentations from our new intake of trainees. The bar is going up and up. Looking forward to increasing research contributions from this group as they come through.

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Hi hon, really busy at the ACSEP meeting

The first afternoon of the conference was up there with perhaps the best series of 4 keynotes on SEM that I have ever heard. Read more of this post

Six Nations — a hymn to rugby

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In the President’s Box, watching South African Rugby — photo: A Brooks

One of Rugby Union’s big, international events – The Six Nations Championship – kicked off this weekend, and we’re looking forward to the great sport the event will offer through mid-March (the last competitions take place March 18).

I have a soft spot for rugby (union and league), though it is a sport I never played myself (a middle- and long-distance track runner, I would have been eaten up and spit out on the rugby pitch). I’ve lived at different times in southern Africa and New Zealand, where I was exposed to the glorious traditions of both Springbok and All Blacks rugby.  And I did my sports medicine training under Dr. Lyle Micheli, whom many know played rugby well into his sixties.  Inevitably, one gets to take care of plenty of rugby athletes when spending some time with Dr. Micheli.

Rugby is a sport that combines collision with endurance, fierce play with fluid movement.  It is also a sport about which it has been written:  “Rugby is a game for barbarians played by gentlemen. Football is a game for gentlemen played by barbarians.”  I don’t intend on offending fans of soccer/football, but I do want to emphasize the special character of so many of the players, coaches, referees and others I see in the sport of rugby.

“Building character since 1886”:  that’s how World Rugby, the sport’s international governing body states their mission.

Consequently I have become, over time, increasingly involved with USA Rugby and have written several of these CJSM blog posts on various issues related to the sport.  My interest continues to grow.

This personal interest parallels the interest CJSM has in publishing research related to the sport. Read more of this post

PRiSM 2017 — Dallas

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Dr. Jim Andrews, one of the pioneers of pediatric sports medicine, gives the keynote address at PRiSM 2017, Dallas photo: Kevin Ford

The last time we wrote about the Pediatric Research in Sports Medicine Society (PRiSM) we were in sunny San Diego.  This year’s annual meeting took place in another sunny, albeit slightly cooler, locale:  Dallas.

PRiSM is a relatively young society, but one which is up and coming.  There were 250+ attendees at this year’s meeting, the 4th annual gathering.  What makes this organization special is its focus and membership:  1) its focus is pediatric sports medicine research; 2) its membership is multidisciplinary, drawing from physicians, surgeons, physical therapists, athletic trainers and radiologists.  One of the speakers this year, in fact, came from the world of veterinary medicine: Cathy Carlson of the Univ. of Minnesota gave several interesting talks on aspects of osteochondritis dissecans (OCD), focusing on the animal models (swine, caprine) she uses in her research.  Her insights into the early development of OCD were among the most powerful, I thought, of the conference.

The keynote conference was delivered by a true pioneer in the field:  the world-renowned Dr. Jim Andrews, from the Andrews Sports Institute.  He bemoaned the epidemic of pediatric sports injuries and spent time identifying many of the factors contributing to this important public health issue.  At the same time, he described some of the success stories out there — models for how we can improve injury prevention in our young athletes.  These include the @safekids initiative he is involved with.  I would add MomsTeam Institute to any list of such safety initiatives.  This is the non-profit youth sports safety group I am involved with.

[on a side note — I am presenting research that MomsTeam has done, along with Executive Director Brooke de Lench, at the IOC World Conference on Prevention of Injury & Illness in Sport in Monaco in March — expect posts a plenty coming from that conference]

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David Howell, of Boston Children’s Sports Medicine, wins the best scientific poster of PRiSM 2017. Photo: Greg Myer

The faculty at PRiSM 2017 was simply stellar, including several who have graced the pages of our journal and our blog: Read more of this post

Isometric Contractions for In-Season Treatment of Patellar Tendinopathy

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Guest blogger Dr. Napolitano grinding it out on the water.

One of the great features of modern medical journals like CJSM is the ability to publish studies ahead of print – we call it “Published Online First.”

With the flexibility  allowed by the internet and emerging media, we are able to get studies that have gone through peer review and are in the queue for printing out to the reading public months before they otherwise would see the light of day.

We have one of our “Published Online First” studies burning things up on emerging media.  At CJSM we follow the Altmetrics on the studies in our pages, and this new one — Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial — currently has a very hot rating of 107 (and climbing).

The treatment of such a common condition will be of inherent interest to those who practice sports medicine. Moreover, managing this nagging condition in mid-season can prove to be a Sisyphean task for the athlete and clinician.  This study has great promise to make a significant impact on your care of the athletes you see.

I asked the physician fellow working with me at NCH sports medicine, Jonathan Napolitano, MD, to do a guest post on this study authored by Rio et al.  Dr. Napolitano’s commentary, forthwith:

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Basketball season is upon us and our clinics have begun to fill with athletes ailing from patellar tendinopathy, seeking pain relief and a quick return to the hardwood.  As a sports medicine fellow with a residency background in physical medicine and rehabilitation I have used this time to step back and review the therapeutic exercises we prescribe for tendinopathies.  I have always paired the concept of eccentric strengthening with tendon repair.  However, various other types of muscle contraction and strengthening exercises can (and perhaps should be) prescribed as well.

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In between isotonic beer curls at World Series 2017 game (L – R): Drs. Stephen Cuff, Reno Ravindran, Jonathan Napolitano

As an educational exercise I would like to take a moment to review the types of muscle contractions.  Isometric contraction occurs without any movement of the joint on which the muscle acts.  Isokinetic contraction occurs at a constant speed across a joint range of motion with variable resistance.  Finally, isotonic exercises are performed through normal joint range of motion with a consistent resistance at variable speed.  Isotonic contractions are further divided into concentric (muscle shortening) and eccentric (muscle lengthening).

Tendon pain is a factor that limits participation and performance in athletes.  Eccentric strengthening has shown good clinical outcomes in the long-term; however, this intervention can lead to increased pain in the short-term, and in 2005 Visnes et al showed eccentric strengthening to be of no benefit for in-season athletes.

Recent research by Dr. Rio et al [including senior author Dr. Jill Cook] compared rehabilitation programs for in-season athletes with patellar tendon pain.  Read more of this post

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