Dr. John Orchard on pain management in elite athletes: The CJSM Podcast

Dr. John Orchard, Chief Medical Officer of Cricket Australia (and so much more)

The September 2018 CJSM is a thematic issue on an issue of central importance in sport and exercise medicine:  the management of pain in the athletes we serve.

Many authors contributed to this special issue, with only a few more prolific than our guest on today’s podcast: John Orchard MBBS BA PhD MD.  Dr. Orchard was a contributing author on three of the original articles included in this issue:

Dr. Orchard is a wonderful interview, and so I hope you get to listen in — as ever you can go to our journal website to find all of our podcasts or to iTunes. We covered a lot of ground in a short time during our conversation.  Among the stories Dr. Orchard shared with me was one of immediate relevance:  that of Cooper Cronk, rugby league player in the NRL played in that league’s Grand Finale with a fractured scapula (and a local anesthetic injection).

The readers of this blog and the listeners of the podcast should all know that Dr. Orchard is also a wonderful tweeter — one of our profession’s most important ‘follows’ I think. I you don’t already have him on your Twitter list, please find him @DrJohnOrchard and remedy that situation!

Thanks for following us here on the blog, on the podcast, and on our journal’s website.  As ever we appreciate your feedback, and we’d ask you specifically to comment on the podcast on iTunes if you are willing.  We are always interested in improving our content.

“got pain?” Get the new issue of CJSM

A tibial spine avulsion fracture — an injury requiring surgery, and significant pain management.

The new academic year has begun in North America, and with it a new set of sporting seasons and a surge in sports’ injuries in our clinics.  Youth and school soccer and football provide many of the injured patients I manage.  For instance, a few days ago, on a Friday, I saw a 12-year-old boy who described a twisting injury to his knee, with immediate disability and an effusion.  I saw him in my clinic the day after his injury and discovered he had sustained a tibial spine avulsion fracture.

These injuries typically occur in skeletally immature patients aged 8 to 14 who sustain twisting or valgus moments to a hyperextended knee.  Though relatively uncommon, a tibial spine avulsion fracture is seen rather often in a specialty center like mine that focuses on the care of the pediatric and adolescent athlete.

In the USA (perhaps everywhere?), these will almost always require surgical fixation.  Since I am a primary care sports medicine physician, this means I was on the phone immediately with my orthopedic surgical colleague, and the child was booked for the OR on Monday.

What remained for me to deal with were the important issues of splinting and pain management over the weekend.

Pain management in the injured athlete — a broad topic which challenges a clinician on an almost daily basis.  I would add that I have found the issue has become increasingly challenging with the opioid epidemic that has ravaged the USA, most especially in states like Ohio, where I practice.

Over the nearly 25 years I have been a physician, I have seen the conversation about analgesia change from one putting an emphasis on ‘pain as a vital sign’ to one asking the question:  in the physician’s efforts to alleviate pain, has patient safety been compromised?

(L to R) Three greats from South Africa: Martin Schwellnus, Wayne Derman, Pierre Viviers

It is an ever-timely contribution, then, that our September 2018 issue is a thematic issue devoted to the topic of pain management in the athlete.  I am delighted to add that our Guest Editor this month is Professor Wayne Derman who is Director and Chair of the Institute of Sport and Exercise Medicine at the Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa.

I count Wayne as a friend, and I am happy to let you know I plan to conduct a podcast with him in the next month so you can hear directly from our guest editor how he brought this issue together.

In the meantime I urge you to go to this issue  and check out the many interesting articles, ranging from the excellent editorial about ‘deromanticising’ the image of athletic pain authored by Prof. Derman to the open access study on Cannabis and the Health and Performance of the Elite Athlete.

 

Five Questions with Dr. Nick Peirce: The Role of Physical Activity and Sport in Mental Health

Dr. Nick Peirce, lead on the FSEM team producing recent exercise and mental health position statement.

Reduce depression and cognitive decline by up to 30% with regular exercise?  Can this be so?

For those of us ‘in the know’ in this field of sport and exercise medicine, that statement may seem understood.  But medical research translating to broadly held knowledge which then may lead to meaningful change:  well, we ALL know how rare that situation can be.  The management of recent concussion events in the FIFA World Cup reminds us of the difficulty of knowledge translation: there were instances where it seemed as if we were ‘partying like it’s 1999’ so to speak.

Reviews of the current state of evidence-based knowledge about medically important findings continue to be of vital importance in ‘getting the word out’.  In that spirit, we couldn’t be happier to see the recent position statement released by one of our partner societies, the Faculty of Sport and Exercise Medicine (UK) : The Role of Physical Activity and Sport in Mental Health.

The lead on the team of authors which produced this FSEM UK Position Statement is Dr. Nick Peirce, Chief Medical Officer of the England and Wales Cricket Board.  We wanted to pick his brain to get a bit more of the background work which resulted in this statement.  The summer Cricket season has kept Dr. Peirce occupied above and beyond his usual level of busyness.  During a gap between competitions, CJSM caught up with him — the results of our interview can be found here.

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1. CJSM: We want to discuss the new FSEM statement on the role of physical activity and sport in mental health, but first can you tell us a bit about yourself: your background as a sports medicine clinician and your involvement with FSEM?

NP: I have been involved in Sports and Exercise medicine for over 20 years having worked across a large number of Olympic and Professional sports, including Leading Sports Medicine for English Institute of Sport (EIS) at the busiest site in the country at Loughborough University, the Davis Cup team and the football team Nottingham Forest. I am a Hospital Consultant in Sport and Exercise Medicine in the NHS and have been Chief Medical Officer for the England Cricket for the more than 10 years. I have been involved in many of the Sports Societies and for 3 years have sat on the Faculty (FSEM), although professional sport commitments make this challenging.

2. CJSM: How did you become involved with this particular FSEM project on mental health – was there a large team involved in the production of this project? Was FSEM the only organization involved in the drafting of this document? Read more of this post

An opportunity of a lifetime: The AMSSM Traveling Fellowship

Drs. Leonardo Oliveira, Jason Zaremski, and John Lombardo (L to R), enjoying the long evenings in Scandinavia.

In 2015 I became a very lucky man:  I was chosen, along with Doug McKeag and Alison Brooks to be one of the American Medical Society for Sports Medicine (AMSSM) Traveling Fellows.  That year, we visited South Africa, and AMSSM/USA enjoyed a reciprocal visit from Jon Patricios, one of the pre-eminent sports medicine practitioners in the land of the Springboks.

The journey I shared with Doug and Alison and so many South African colleagues was a trip of a lifetime.

The AMSSM, one of CJSM’s affiliated societies, awards the Traveling Fellowship annually. This year’s worthy (and lucky) recipients were the Americans John Lombardo (past-president of AMSSM), Leonardo Oliveira and CJSM’s Jr. Associate Editor, Jason Zaremski.  Their journey took them to Scandinavia, where they were hosted by Norway’s Hilde Moseby Berge (Chief Medical Officer of her country’s Paralympic team) and others.

I reached out to the American team to ask them how their trip went. They couldn’t have been happier to share a bit of their wonderful experience.

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AMSSM Traveling Fellowship — Scandinavia 2018

By: Leonardo Oliveira, John Lombardo, and Jason Zaremski

Drs. John Lombardo, Hilde Moseby Berge, Leonardo Oliveira, and Jason Zaremski (L to R)

As sports medicine physicians in the United States, we (Leonardo Oliveira and Jason Zaremski) had the opportunity of a lifetime—to travel to Scandinavia under the direction of one of the AMSSM founders, Dr. John Lombardo (known as “the Godfather” to our Scandinavian Colleagues 🙂 as the AMSSM Junior Traveling Fellows for 2018. The traveling fellowship is an educational international experience designed to provide a unique global academic learning opportunity to interact with sports medicine leaders from around the world. The Traveling Fellowship program is also a two-way exchange. Each year AMSSM selects a sports medicine physician from a partnering country to serve as the International Visiting Fellow. This year it was Dr. Hilde Berge, Chief Medical Officer for the Norway Paralympics. Dr. Berge, in addition to attending and presenting at the AMSSM Meeting in Orlando, FL, also lectured and visited sports medicine centers in Greenville, SC, Richmond, VA, and Boston, MA.

We have been asked multiple times since we have returned to the States:  what were the highlights of your trip?. Read more of this post

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