Undergraduate perspective on Sports & Exercise Medicine – a BJSM blog series

By Jonathan Shurlock (@J_Shurlock)

Reading the recent BJSM blog on the 6^th annual London Deanery Sports and Exercise Medicine (SEM) Conference written by the event organisers, inspired me to give the delegate view of the important lessons learnt by those in attendance, and add in some links to related BJSM material.

Tales from the ballet: common problems encountered with performing athletes and dancers – Dr Roger Wolman

• Dancers are often lumped as a single group, however movement patterns vary significantly between forms of dance
• Injury risk factors – Poor nutrition. The movements desired by dance coaches require demanding biomechanics. Aesthetic requirements of low body weight and knee hyper-flexion
• Demands – Highly competitive environment means that dancers do not reveal injuries for fear of being held back. Tours are often long, with inadequate rest
• Support – Limited financial resources, therefore there is inadequate medical and scientific support. The first NHS specialist dance injury clinics were set up in 2012. There is often an on-going battle between dance teachers and sports therapists and a balance must be met to ensure protection of athlete’s health and performance capability

Mental health in sport – Dr Justin Yeoh

• The true incidence of depression in sport is uncertain, due to limited research. There is a higher incidence in aesthetic sports (e.g. dance, gymnastics)
• If exercise is effective in the treatment of depression, so why do athletes get depressed? à Athletes are perceived to be superhuman. However, they have the same risk factors as the general population, and a long list of additional risk factors (e.g. recurrent injuries)
• Athletes will not necessarily discuss their symptoms, so awareness is needed of the common signs, including:
• Consistent poor or inconsistent performance (reduced work rate, poor motivation)
• Increased apathy or irritability
• Medical issues (recurrent illness or injury, excessive fatigue)
• Stigma and lack of education are still prevalent issues. Good examples of schemes to improve awareness and reduce stigma from PFA, Rugby Union, and Rugby League
• See recent BJSM blog

Rehabilitation considerations in the older athlete – Mr Bruce Paton

• Increasing age impacts on oxygen transfer (reduced V0₂ max), maximum heart rate and muscle physiology (reduced number and size of muscle fibres, and change in muscle fibre types)
• The V0₂ max requirement to retain independence is thought to be above 15-18 litres/min/kg
• A substantial drop in performance is seen with most sports at around 70 years of age, event with chronic exercise
• Eccentric or isometric loading is very useful for older athletes
• See previous BJSM blog

The challenges of managing an athlete with a disability – Dr Richard Weiler

• The general level of evidence for the implementation and effectiveness of prevention strategies and treatments in disability sport is poor
• “You must unlearn what you have learned” à observe and understand the different abilities that these athletes possess
• Humour can be critical when working with individuals in disability sport

Keynote; How to increase exercise in sedentary people – Dr William Bird

• Low cardiorespiratory fitness has a much greater impact on all cause mortality than obesity. (See evidence here)
• A huge number of deaths from disease such as breast and bowel cancer are attributable to physical inactivity (See evidence here)
• You cannot isolate physical activity and throw it on top of a busy, stressful life. To promote physical activity, we need to identify patient values and end goals, to provide a gateway to a better life
• Promotion of physical activity requires changes to infrastructure and strong partnerships and leadership from the health sector
• See open access article and BJSM podcast

To delivery and beyond: Exercise in pregnancy – Dr Eleanor Tillet

• Physical activity guidelines are modified during pregnancy (See here)
• Exercise in pregnancy should be encouraged, as long as you ensure your patient is aware of the following:

–   Contraindications to physical activity during pregnancy

–   Injury risk with increased ROM

–   Avoidance of exercise where there is risk of abdominal trauma

–   The aim during pregnancy is not to gain fitness, but to maintain

• See previous BJSM Blog and BJSM Podcast

Paediatric sports medicine: Top tips for managing the child and adolescent athlete – Dr GB Ajayi

• Children are not little adults! Their injury risks are not the same as the adult population
• Increasing height = modified centre of mass = reduced muscular control = increased injury risk (Testosterone mitigates against this)
• Ossification centres are areas of weakness therefore children can get injuries not often seen in adults (e.g. supracondylar fractures)
• You need to be aware of the increased risk of acute avulsion injuries and chronic overuse osteochondroses
• See these systematic reviews (1 & 2) for a good summary of injury considerations in children

How the medical team prepares for an international tournament – Dr Ian Beasley

• The multidisciplinary team (MDT) is central in tournament preparation. The team must agree realistic aims and plan logistics
• An emergency action plan is needed at every stage
• Where is your defibrillator? This should always be immediately accessible, not ‘under the bus’
• When traveling for competition endemic problems need to be assessed, such as local communicable disease, temperature and humidity
• During international competition, the host country hosts a meeting of all team medical officers to discuss specifics. This is vital to ensure effective medical care throughout the competition

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Jonathan Shurlock, BSc (Hons), is a fourth year medical student. He sits on the european College of Sport & Exercise Physicians (ECOSEP) student committee, in addition to the London Sports and Exercise Medicine Committee. He has a passion for clean sport, and as such works as a research assistant at The Centre for Sport and Exercise Science and Medicine (SESAME) in Eastbourne, working on various WADA funded anti-doping projects. His twitter handle is @J_Shurlock.

Dr. Liam West BSc (Hons) MBBCh PGCert SEM (@Liam_West) is a graduate of Cardiff Medical School and now works as a junior doctor at the John Radcliffe Hospital, Oxford. In addition to his role as an associate editor for BJSM he also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.