TWICKENHAM MATCH DAY PLAYER MEDICAL LEAD - Vacancy RFU

TWICKENHAM MATCH DAY PLAYER MEDICAL LEAD

The Rugby Football Union wishes to appoint a Match Day Player Medical Lead for all matches played at Twickenham Stadium.  

The medical practitioner appointed will personally provide immediate medical care for players and match officials and lead the venue medical team on the c. 22 match days at Twickenham each season. Matches range from Senior England Internationals to finals of County, University and Schools tournaments. Immediate match day medical care will be provided in conjunction with team medical staff, other venue medical room specialists and pitch side Paramedics.

This role is separate to that of medical provision to the crowd.

Candidates must have: 

• Full registration with the General Medical Council  
• Either a JCPTGP Certificate/CCT in GP or a CCT/CESR in SEM or a CCT/CESR in Emergency Medicine 
• Current Evidence of Level 2 (or above) Pre-Hospital Emergency Care Course Competencies (Pitch-side Trauma)
•  Care Course (PSITCC) Certificate/ other RCS ED approved Level 2 Pre-Hospital Emergency Care Course 
• Certificate are accepted as the Standard for Level 2 Competency)
• Evidence of personally providing Pre-Hospital Emergency care in an elite collision sport match day environment(elite rugby union experience preferred)
• Experience of assuring Clinical Governance standards 
• Experience of team leadership

Our commitment to you

The post will be offered initially for the period to 30 June 2012, for c. 22 days per year.  A day rate of £350 to £700 is payable for duty days (depending on the length of the day), plus an annual retainer of £3,500.

To arrange a confidential discussion about this post, please e-mail the RFU Head of Sports Medicine, Simon Kemp, on simonkemp@rfu.com .

For an information pack including a full specification for the position, e-mail recruitment@therfu.com. 

Applicants must submit a current CV, with a covering letter, to Lynn Graco, Human Resources Department, Rugby House, Twickenham Stadium, 200 Whitton Road, Twickenham, TW2 7BA, or via email to recruitment@therfu.com.

The closing date for applications is 23^rd December 2010.  Shortlisted candidates will be notified on 5^th January 201. Interviews will be held at Twickenham Stadium on 13^th January 2011.  The first three games to be played at Twickenham in 2011 are the Six Nations games against Italy on Saturday 12^th February, France on Saturday 26^th February and Scotland on Sunday 13^th March. The successful applicant will be expected to be available for all of these three fixtures.

A full programme of fixtures for the rest of the 2011 season can be downloaded by clicking here:

The Criminal Records Bureau enhanced disclosure process applies to this post.

Infomed MSK US Courses

Infomed Contact Details for MSK Ultrasound Courses

	Company Address: Infomed Research & Training Ltd Lancaster House 7 Elmfield Road Bromley Kent BR1 1LT
	Tel: +44 (0) 20 8123 0021 Fax: +44 (0) 20 8290 6917
	Email: conferences@infomedltd.co.uk

2nd London MSK Ultrasound Course


for Physiotherapists, General Practitioners, Sports Physicians and Sonographers. An intensive and practical day, just what you need, on the use of Ultrasound in assessment, diagnosis and intervention in patients with musculoskeletal injuries on Thursday 9 December 2010 at the Russell Square Conference Centre, Russell Square House, London




The London Foot and Ankle Ultrasound and Interventions Course


For Podiatrists, Sports & Exercise Physicians and General Practitioners on the use of imaging techniques in the assessment and treatment of foot and ankle disorders organised by Infomed Research & Training, on Friday 28 January 2011  at the Russell Square Conference Centre, Russell Square House, London




4th London Musculoskeletal Ultrasound Skills Course


An intensive and practical two day course on the use of Ultrasound in the assessment of musculoskeletal injuries on Monday 4 and Tuesday 5 April 2011 at the Russell Square Conference Centre, 10-12 Russell Square, London


Full details of the Infomed Courses and booking can be found here

The London Foot and Ankle Ultrasound and Interventions Course for Podiatrists, Sports & Exercise Physicians and General Practitioners

The London Foot and Ankle  Ultrasound and Interventions Course for Podiatrists, Sports & Exercise Physicians and General Practitioners
on the use of imaging techniques in the assessment and treatment of foot and ankle disorders. Preparing Clinicians to be Game ready.

organised by Infomed Research & Training, on Friday 28 January 2011,
at the Russell Square House, 10-12 Russell Square, London WC1B 5EH

For the Course programme and online booking options please visit the Course webpage

4th London Musculoskeletal Ultrasound Skills Course

4th London Musculoskeletal
Ultrasound Skills Course


An intensive and practical two day course on the use of Ultrasound in the assessment
of MSK injuries organised by Infomed Research & Training, on Monday 4 and Tuesday 5 April 2011 at the Russell Square Conference Centre, 10-12 Russell Square, London WC1B 5EH

For the Course programme and online booking options please visit the Course webpage

2nd London MSK Ultrasound Course for Physiotherapists, General Practitioners, Sports Physicians and Sonographers

2nd London MSK Ultrasound Course
for Physiotherapists, General Practitioners,
Sports Physicians and Sonographers

An intensive and practical day, just what you need, on the use of Ultrasound in assessment, diagnosis and intervention in patients with musculoskeletal injuries,

organised by Infomed Research & Training, on Thursday 9 December 2010,
at the Russell Square Conference Centre, 10-12 Russell Square, London WC1B 5EH

For the Course programme and online booking options please visit the Course webpage

Sports Shoulder Surgery Monday 8th & Tuesday 9th November 2010 at Scarman House, University of Warwick

Sports Shoulder Surgery

Monday 8th & Tuesday 9th November 2010
at Scarman House, University of Warwick

Damian Griffin, Professor of Trauma & Orthopaedic Surgery at the  
University of Warwick, England, and Mr Steve Drew would like to make  
surgeons, doctors and physiotherapists aware of the forthcoming Sport  
Shoulder meeting on the 8th & 9th November, at the University's  
Scarman House conference centre.

The conference is aimed at Clinicians who treat young patients with  
Sports related shoulder injuries. There will be a strong bias towards  
the surgical treatment of these injuries and will also be exploring  
the most modern thinking on the diagnosis, management and  
rehabilitation of these injuries.

Topics that will be covered include Glenohumeral and AC Joint  
Instability, Rotator Cuff Injuries, Biceps injuries and the management  
of chondral defects in the young athlete.

Convened by Steve Drew & Prof Damian Griffin, Faculty includes: Joe de  
Beer, SA, Giacomo Delle Rose Italy, Len Funk, UK,  Andrew Wallace,  
UK,  Giuseppe Porcellini, Italy,  Matthias Zumstein, Switzerland,  
Nicola Phillips, UK, Steve Corbett, Emilio Calvo, Spain, Julie  
McBirnie UK, Graham Tytherleigh- Strong, UK plus many more.


Prices for the 2-day course including overnight accommodation at the  
conference venue are £295 for Trainees and £495 for Consultants.

Full details and an on line booking form can be found at 

http://www.sportsshouldersurgery.org/ 

Should you require any further details, please do not hesitate to  
contact me on 01476 860759 or email: info@sportsshouldersurgery.org

Medical Indemnity For Sports Medical Specialists

SEMPRIS has been developed specifically in response to the restrictive guidelines, policy endorsements and selective membership criteria recently applied by the medical defence organisations to doctors treating professional sports men and women .

What are the restrictive guidelines, policy endorsements and selective membership criteria?

With effect from renewal after June 2010:

1. The MDU will not indemnify members for any damages, claimants' costs and/or defence costs which relate to a claim against them by:

• the employer, agent or sponsor of a sports person who is an individual patient;

• any club, team or organisation for, with or under which a sports person who is an individual patient plays a sport; or

• the organiser or owner of any sporting event in or for which a sports person who is an individual patient plays a sport.

2. The MDU cover will not extend to treatment provided outside the UK (for example if the team is touring). Members will need to contact the MDU if they intend to accompany the team abroad, before they travel, and the MDU will then determine whether discretionary assistance might be extended to each trip.

With effect from April 2008:

1. The MPS does not provide indemnity for doctors who are employed by, or contracted to, a Premiership  Football Club.

2. Specialists/consultants should:
• not enter into a written or oral contract with an employer to treat employees for reward

• only accept referrals from other healthcare professionals not from clubs directly

• address any professional fee notes to the patient and not the employer

• review any existing relationship with an employer of a patient very carefully


SEMPRIS has been specifically developed to provide cover in these circumstances and to allow participating members to continue to practice in a manner that is compatible with the unique demands and expectations of professional sport.

For more information please visit http://www.sempris.co.uk/ or  Telephone: +44 (0) 208 770 0333

Case of the Month ?

Dear Docs, I am going to run a case of the month series on the blog and will need your help.

Basically if you have seen something interesting please send details of the case to me either by emailing me direct or via the blog submit clinical case facility. The AMSSM did this some time ago and I really think its a good idea.

In our case however it will be good to include some images too.

Now I understand from speaking to some of you bloggers you may feel a little nervous about interacting with others on this group and feeling others may judge you. Well 99.99% of us on here are very friendly and supportive and yes we all look at each others posts and think OMG sometimes but thats life.

Rather have something to say than hide away :)


Suggested format for case of the month

History:

Physical Exam:

Initial Differential Diagnosis based on the History and Physical:






Diagnostic studies:

Final Diagnosis: Based on imaging and clinical

Treatment and Outcome:

Discussion:

References:

Heres a little bit of something for everyone on the list

1. Osteoarthritis Cartilage. 2010 Aug 3.
Autologous chondrocyte implantation for the treatment of cartilage lesions:

randomized control trials assessed in a systematic review.
Vasiliadis HS, Salanti G.

Orthopaedic Sports Medicine Center, Department of Orthopaedics, School of

Medicine, University of Ioannina, Greece; Molecular Cell Biology and Regenerative

Medicine, Sahlgrenska University Hospital, Gothenburg University, Sweden.


2. Dis Mon. 2010 Jul;56(7):436-42.

Blood-borne infections and the athlete.

Gutierrez RL, Decker CF.
Division of Infectious Diseases, Department of Internal Medicine, National Naval
Medical Center, Bethesda, Maryland, USA.
3. Phys Sportsmed. 2010 Jun;38(2):126-32.
Chronic exertional compartment syndrome of the leg in athletes: evaluation and management.
Gill CS, Halstead ME, Matava MJ.
Chronic exertional compartment syndrome (CECS) is a well-known cause of activity-related lower leg pain in both athletes and nonathletes. In contrast to acute compartment syndrome, CECS is generally not related to trauma, and is often suspected in the outpatient setting by primary care physicians, podiatrists, sports medicine clinicians, and orthopedic surgeons. The diagnosis of CECS is often overlooked because patients avoid or withdraw from exacerbating physical activities instead of seeking treatment for their symptoms from a health care professional. A thorough history and physical examination of an individual with activity-related lower leg pain is necessary for correct diagnosis to occur.
Appropriate diagnostic testing with measurement of intracompartmental pressures reliably confirms the diagnosis of CECS. Nonoperative treatments of CECS rarely leads to complete resolution of symptoms or an individual's ability to return to  previous levels of recreational or athletic activity. Fasciotomy of the involved compartments can reliably lead to resolution of pain and the ability to return to previous activities within 6 weeks.

4. Curr Probl Pediatr Adolesc Health Care. 2010 Aug;40(7):170-83.
Common lower extremity injuries in the skeletally immature athlete.
Grady MF, Goodman A.
Sports Medicine and Performance Center, Children's Hospital of Philadelphia, King of Prussia, PA, USA.

Lower extremity musculoskeletal pain is a common complaint in the adolescent athlete. During rapid growth, several common biomechanical changes occur that may predispose to overuse injury. Unlike fractures, most of these office-based sports medicine complaints are initially evaluated by the primary care provider. This review discusses several of the most common complaints and briefly discusses some clinically significant conditions that masquerade as common injuries. The article discusses only the injuries unique to the growing athlete. The article's goal is to help develop a framework for the pediatric clinician to evaluate common complaints and formulate a plan that includes simple stretches and physical therapy recommendations.

5. Curr Probl Pediatr Adolesc Health Care. 2010 Aug;40(7):154-69.
Concussion in the adolescent athlete.
Grady MF.
Sports Medicine and Performance Center, Children's Hospital of Philadelphia, King of Prussia, PA, USA.

Concussion in the adolescent athlete is a common sports and recreation injury.Traditional management of concussion in this age group has focused on sport return-to-play decisions. However, new research on mild traumatic brain injury has dramatically changed the management of concussion. During the acute healing phase, physical and cognitive rest are crucial for healing. In the school-aged athlete, new concepts, such as complete brain rest, have made school management decisions as important as sport return-to-play decisions. Despite tremendous improvements in the understanding of concussion, most of the research has been done in young adults. The lack of prospective studies in early adolescent student athletes limits definitive management recommendations. This article reviews the current understanding of the epidemiology, pathophysiology, and clinical presentation of concussion and discusses the unique factors involved in clinical  management of concussion in the adolescent student-athlete.

6. Phys Sportsmed. 2010 Jun;38(2):133-45.
Conservative treatment modalities and outcomes for osteoarthritis: the concomitant pyramid of treatment.
Langworthy MJ, Saad A, Langworthy NM. Michael J. Langworthy MD 1 Amira Saad MD 2 Nadia M. Langworthy MD 3 1Battle
Creek Orthopaedics and Sports Medicine Clinic Battle Creek MI 2Michigan State
University East Lansing MI 3University of Michigan Ann Arbor MI Correspondence:
Michael J. Langworthy MD Battle Creek Orthopaedics and Sports Medicine Clinic
6417 N. 39th St. Augusta MI 49012. Tel: 269-209-5066 Fax: 269-969-6283 E-mail: lcdrlang@aol.com.

This article reviews current treatment algorithms for the conservative treatment  of hip and knee osteoarthritis. The available treatment options for osteoarthritis (physical therapy, medical therapeutics, steroid injections, nutraceuticals, hyaluronic acid injections, acupuncture, pulsed electrical stimulation, and topical ointments) are compared to determine efficacy in the treatment of pain and return of function in the osteoarthritic joint. A literature review was conducted to determine combinations of appropriate concomitant therapy. Based on the available literature, we conclude that an early transition to multimodal and concomitant therapy is the most efficacious approach to decrease pain and improve joint function in the osteoarthritic hip and knee.
7. Knee Surg Sports Traumatol Arthrosc. 2010 Jul 22.
Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players.
Boesen AP, Boesen MI, Koenig MJ, Bliddal H, Torp-Pedersen S, Langberg H.
Institute of Sports Medicine, Bispebjerg Hospital and Center for Healthy Aging,
Faculty of Health Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400,

Copenhagen NV, Denmark, boesenanders@hotmail.com.

Tendon-related injuries are a major problem, but the aetiology of tendinopathies  is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate the vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches.The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler >/= grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1st match, tendencies to higher intra-tendinous flow were observed in both the dominant patella tendon and non-dominant quadriceps tendon (P-values n.s.). After 2nd match, intra-tendinous flow was significant increased in the dominant patella tendon (P = 0.009). In all other locations, there was a trend towards a stepwise  increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour Doppler measurement can be used to determine changes in intra-tendinous flow after repetitive loading.


8. Curr Sports Med Rep. 2010 Jul-Aug;9(4):195-201.
Exercise is medicine: a historical perspective.
Berryman JW.
Department of Bioethics and Humanities and Adjunct, Department of Orthopaedics and Sports Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA. berryman@u.washington.edu

Much of the early information about exercise and medicine appeared in the ancient, medieval, and Renaissance medical literature in the context of the "six things nonnatural." These were the things that were under everyone's own control, directly influenced health, and became the central part of the new "physical
education" movement in the early 19 century in the United States. They were known then as the "Laws of Health." Until the early 1900s, "physical education" was dominated by physicians who specialized in health and exercise. However, physical education changed to a games and sports curriculum led by coaches who introduced competition and athletic achievement into the classroom. As that happened, physicians disappeared from the profession. Through the last half of the twentieth century, as exercise became more central to public health, the medical community began to view exercise as part of lifestyle, a concept embracing what was once called the "six things nonnatural."


9. Clin Sports Med. 2010 Jul;29(3):459-76.
Exertional collapse in the runner: evaluation and management in fieldside and office-based settings.
Childress MA, O'Connor FG, Levine BD.
Department of Family and Sports Medicine, DeWitt Army Community Hospital, Fort Belvoir, VA, USA. Marc.childress@amedd.army.mil

Exertional collapse is a commonly encountered phenomenon among runners, particularly in the setting of long distances and extreme environments. Although exertional collapse is generally a benign event occurring in an exhausted finisher at race completion, the multifactorial nature of this disorder creates a broad differential diagnosis. The ability of the sports provider to appropriately recognize and treat these various potential concerns is critical, because collapse may represent several life-threatening conditions. It is especially challenging to determine the appropriate course of evaluation and management of collapse in the context of a mass participation event. This article presents a discussion of the etiology and pathophysiology of collapse as well as strategies for the effective assessment and treatment of collapsed runners, whether in the fieldside setting or in an outpatient office-based environment.


10. J Fam Pract. 2010 Aug;59(8):437-44.
Give your sports physicals a performance boost.
Womack J.
Family Medicine and Community Health, University of Medicine and Dentistry of New
Jersey - Robert Wood Johnson, New Brunswick, NJ, USA. E-mail: womackja@umdnj.edu.

Cover the 12 components of the preparticipation physical evaluation (PPE) recommended by the American Heart Association to screen young athletes for potentially life-threatening cardiovascular disease. Perform a genitourinary exam as part of the PPE for young men; assess young women for the criteria associated with the female athlete triad. Perform auscultation while the patient is squatting and while doing the Valsalva maneuver to determine whether any murmurs you detected on examination are associated with hypertrophic cardiomyopathy.

11. Dis Mon. 2010 Jul;56(7):404-6.
Infectious diseases in the athlete: an overview.
Decker CF.Uniformed Services University of the Health Sciences, Division of Infectious Diseases, Department of Internal Medicine, National Naval Medical Center, Bethesda, Maryland, USA.

12. Curr Sports Med Rep. 2010 Jul-Aug;9(4):191-3.
New innovations in sports medicine: good for the patient or good for the pocketbook?
Johnson RJ.
Department of Family Medicine and Community Health, University of Minnesota,
Minneapolis, MN, USA. johnson1947@gmail.com
13. Sports Med. 2010 Sep 1;40(9):729-46.
A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review.
Quatman CE, Quatman-Yates CC, Hewett TE.
Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics
Center and Human Performance Laboratory, Cincinnati, Ohio, USA.

Although intrinsic and extrinsic risk factors for anterior cruciate ligament (ACL) injury have been explored extensively, the factors surrounding the inciting event and the biomechanical mechanisms underlying ACL injury remain elusive. This systematic review summarizes all the relevant data and clarifies the strengths
and weaknesses of the literature regarding ACL injury mechanisms. The hypothesis is that most ACL injuries do not occur via solely sagittal, frontal or transverse plane mechanisms. Electronic database literature searches of PubMed MEDLINE (1966-2008), CINAHL (1982-2008) and SportDiscus(R) (1985-2008) were used for the systematic review to identify any studies in the literature that examined ACL injury mechanisms. Methodological approaches that describe and evaluate ACL injury mechanisms included athlete interviews, arthroscopic studies, clinical imaging and physical exam tests, video analysis, cadaveric studies, laboratory tests (motion analysis, electromyography) and mathematical modelling studies. One hundred and ninety-eight studies associated with ACL injury mechanisms were identified and provided evidence regarding plane of injury, with evidence supporting sagittal, frontal and/or transverse plane mechanisms of injury. Collectively, the studies indicate that it is highly probable that ACL injuries are more likely to occur during multi-planar rather than single-planar mechanisms of injury.

14. Ann N Y Acad Sci. 2010 Jul;1201:121-8.
Redefining the role of mitochondria in exercise: a dynamic remodeling.
Bo H, Zhang Y, Ji LL.
Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Department of
Health and Exercise Science, Tianjin University of Sport, Tianjin, China.

Exercise induced adaptations in muscle are highly specific and dependent upon the type of exercise, as well as its frequency, intensity, and duration. Mitochondria are highly dynamic organelles. Fusion and fission reactions lead to a continuous  remodeling of the mitochondrial network, which range from reticulum of elongated and branched filaments to collections of individual organelles. Mitochondrial network dynamics are sensitive to various physiological and pathological stimuli,and mitochondrial morphological changes are no epiphenomena, but central to cell function and survival. There is a strong correlation between mitochondrial
network morphology, dynamic-related protein, and energy metabolism. It is expected that alteration in cellular energy status during exercise can also be achieved through mitochondrial network dynamics. In this review, we describe mitochondrial network remodeling response to acute and endurance exercise, which is accompanied by bioenergetics and redox regulation. In addition, potential mechanisms for metabolic and redox signaling involved in mitochondrial dynamic regulation are also reviewed.



15. Dis Mon. 2010 Jul;56(7):407-13.
Respiratory tract infections in athletes.
Lin L, Decker CF.
Infectious Diseases Service, Department of Internal Medicine, Walter Reed Medical Center, Washington, DC, USA.

16. J Bone Joint Surg Am. 2010 Aug 4;92(9):1842-50.
The rising incidence of acromioplasty.
Vitale MA, Arons RR, Hurwitz S, Ahmad CS, Levine WN.
Center for Shoulder, Elbow and Sports Medicine, Department of Orthopaedic Surgery, New York-Presbyterian Medical Center, Columbia University, 622 West 168th Street, PH-1117, New York, NY 10032, USA. wnl1@columbia.edu

BACKGROUND: Acromioplasty is considered a technically simple procedure but has become controversial with regard to its indications and therapeutic value.
METHODS: Two complementary databases were used to ascertain the frequency of acromioplasty over a recent span of time. In Part A, the New York Statewide Planning and Research Cooperative System (SPARCS) ambulatory surgery database was searched from 1996 to 2006 to identify all ambulatory surgery acromioplasties as well as all orthopaedic ambulatory surgery procedures. In Part B, the American Board of Orthopaedic Surgery (ABOS) database was searched from 1999 to 2008 to identify all arthroscopic acromioplasties as well as all orthopaedic procedures.
RESULTS: Part A revealed that in 1996 there were 5571 acromioplasties in New York
State, representing a population incidence of 30.0 per 100,000. In 2006 there were 19,743 acromioplasties, representing a population incidence of 101.9 per 100,000. Over these eleven years, the volume of acromioplasties increased by 254.4%, compared with only a 78.3% increase in the volume of all orthopaedic
ambulatory surgery procedures. In 2006, as compared with 1996, patients were 2.4  times more likely to have an acromioplasty compared with all other orthopaedic ambulatory procedures (p < 0.0001). Part B revealed that, in 1999, a mean of 2.6  arthroscopic acromioplasties were reported per candidate for Board certification. In 2008 a mean of 6.3 arthroscopic acromioplasties per candidate were reported. Over these ten years, the mean number of arthroscopic acromioplasties reported increased by 142.3%, compared with only a 13.0% increase in the mean number of all orthopaedic surgery procedures. In 2008, as compared with 1999, candidates were 2.2 times more likely to report an arthroscopic acromioplasty compared with all other orthopaedic procedures (p < 0.0001). CONCLUSIONS: There has been a substantial increase in the overall volume and the population-based incidence of  acromioplasties in recent years on both the state and national levels in theUnited States. The reasons for this increase have yet to be determined and are likely multifactorial, with patient-based, surgeon-based, and systems-based factors all playing a role.

17. Scand J Med Sci Sports. 2010 Jul 29.
Sever's injury; treat it with a heel cup: a randomized, crossover study with two  insole alternatives.
Perhamre S, Lundin F, Norlin R, Klässbo M.
Centre of Sports Medicine in Värmland, Karlstad, Sweden.

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children. Common advice is to reduce physical activity. However, our previous study showed that application of insoles reduced pain in Sever's injury without having to reduce physical activity. The purpose of this study was to test which of the two insoles, the heel wedge or the heel cup, provided best pain relief during sport activity in boys with Sever's injury (n=51). There was crossover design in the first randomized part of the study. In the second part,the boys, 9-14 years, chose which insole they preferred. There was a reduction in
odds score for pain to a fifth (a reduction of 80%) for the cup compared with the wedge (P<0.001). When an active choice was made, the heel cup was preferred by >75% of the boys. All boys maintained their high level of physical activity throughout. At 1-year follow-up, 22 boys still used an insole and 19 of them reported its effect on pain as excellent or good (n=41).


18. Phys Ther Sport. 2010 Aug;11(3):99-103. Epub 2010 Jul 24.
Short and mid-term results of a comprehensive treatment program for longstanding  adductor-related groin pain in athletes: a case series.
Weir A, Jansen J, van Keulen J, Mens J, Backx F, Stam H.
The Hague Medical Centre (MCH), Department of Sports Medicine, Burg Banninglaan
1, 2262 BA, Leidschendam, The Netherlands. a.weir@mchaaglanden.nl

OBJECTIVE: To evaluate short and mid-term results of active physical therapy in athletes with longstanding groin pain. DESIGN: Case series. SETTING: Primary care physical therapy practice. PARTICIPANTS: A total of 44 athletes suffering longstanding adductor-related groin pain. INTERVENTION: A combination of passive (joint mobilization) and active (exercises) physical therapy interventions. MAIN  OUTCOME MEASUREMENTS: Return to (the same level of) sports, restriction in sports, and recurrence. RESULTS: Directly after treatment, return to the same level and type of sport was successful in 38 athletes (86%), and without symptoms in 34 athletes (77%). At 6.5-51 months follow up, 10/38 (26%) of those that returned to sports had experienced a relapse; 22 (50%) athletes were able to participate in sports without any restrictions at the mid-term follow-up.
CONCLUSIONS: For athletes with longstanding groin pain, short term results of physical therapy seem positive, whereas mid-term results are moderately positive. The risk for recurrence is high.

19. Dis Mon. 2010 Jul;56(7):414-21.
Skin and soft tissue infections in the athlete.
Decker CF.
Uniformed Services University of the Health Sciences, Division of Infectious
Diseases, Department of Internal Medicine, National Naval Medical Center, Bethesda, Maryland, USA.


20. Br Med Bull. 2010 Aug 14.
Sport injuries: a review of outcomes.
Maffulli N, Longo UG, Gougoulias N, Caine D, Denaro V.
Centre for Sports and Exercise Medicine, Barts and The London School of
Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.

Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.


21. J Sci Med Sport. 2010 Sep;13(5):471-2. Epub 2010 Jul 31.
What's popular in sports medicine and sports science research?
Kolt GS.

2nd Congress of European College of Sport & Exercise - London

2nd Congress of European College of Sport & Exercise

Physicians&12th Scientific Conference in SEM,
Centre for Sports and Exercise Medicine
Queen Mary University of London

Date: 9th - 11th September 2010

Venue: Bancroft Building, Queen Mary
University of London

Topics:


Scientific Presentations by MSc Students inSport and Exercise Medicine
Ultrasound Scanning in Sports Medicine
Gene, Stem Cells and Sports Medicine
Guidelines on Anti-Doping
2012 London Olympic and Paralympic Games
Exercise Induced Leg Pain in Sport
Muscle and Tendon Injuries in Sports
Knee Problems in Sports Medicine
Sports Nutrition
Academic Programmes in Sports Medicine
Biological Therapies in Sports Medicine
Sports Cardiology and Pre-Participation
Cardiovascular Evaluation


Social Events: th September 2010 - Pub crawl followed y curry

10th September 2010 - Black tie dinner at the House of Lords

academia.bbmuk@bbraun.com

www.aesculap-academia.co.uk

(MSK CATS) - MSK or Sports Physician Required

Vale Health Ltd. is seeking to recruit additional fully-qualified and experienced musculoskeletal physicians to join its existing clinical team on a part-time, sessional and self-employed basis.
The Company is a business partner of Buckinghamshire PCT and holds a rolling contract to provide musculoskeletal clinics to NHS patients at ten venues throughout Buckinghamshire, the principal objective being to offer patients the most appropriate treatment to meet their needs as close as possible to their home.


The service has been running extremely successfully for the past two years and the Company now needs to recruit additional physicians to meet increasing demand.

Candidates must be medically qualified, possess a post-graduate degree in musculoskeletal/sports medicine and, ideally, have a proven track-record of relevant experience. Exceptionally, newly qualified (MSK) graduates could be offered a period of mentoring by our MSK Clinical Lead.

We believe this is an exciting opportunity for GPs to develop their skills in this specialised field of medicine to meet the anticipated high demand in the future.


Further information can be obtained by contacting:


John Butler
Commercial Director
Vale Health Ltd.
John.butler2@nhs.net
07831 395602

BASEM + ASICS Congress November

Formerly the BASEM Conference, this year has taken on a new direction with the aim



to become, in conjunction with our partner ASICS, the European equivalent to ACSM by


2012. 2010 offers a 4 day programme from 24th -27th November 2010 with dual stream


recorded presentations, 30 speakers from 6 countries and joined by the Defence


Medical Services Rehabilitation Conference on the 26th, themes including Performance


Physiology, Exercise immunology, Sports Injury, The Spine, Stem Cell technology,


Innovations, Functional Rehabilitation following injury and Physical Competencies.


We have 6 abstract prizes of £1000 each and an overall expenses paid trip to ACSM


for the best submission. A fantastic location in the UK's most advanced Conference


venue the ICC at ExCeL.

Sport and Exercise Medicine Indemnity Scheme

SEMPRIS is the Sports and Exercise Medicine Professional Indemnity Scheme – a new and comprehensive indemnity scheme for all doctors involved in the treatment and care of professional sportsmen and women.

In addition to standard medical defence organisation membership benefits. SEMPRIS also provides the most comprehensive medico-legal support and indemnity available from any insurer or medical defence organisation in the UK.

SEMPRIS brings together a wealth of experience including medico-legal advisers, insurers and sports governing bodies, and has been developed to overcome the gaps in indemnity provided by the medical defence organisations for doctors involved in the treatment of professional sports persons.

All GMC registered medical practitioners can apply for membership of SEMPRIS.

SEMPRIS has been developed to cover all aspects of your practice not just sports related work. It includes non-sport related independent practice and professional issues not covered by NHS indemnity.

Further information about SEMPRIS, membership, medico-legal advisory services, and the indemnity insurance policy is available on the pages of this website or by contacting us directly.

Telephone: +44 (0) 208 770 0333
Email: info@sempris.co.uk
www.sempris.co.uk

Dry needling for spinal stenosis

Not sports medicine however a number of us do see spinal patients too on this group. I thought this article was of interest.

Please take a look here at the article and figures and feedback to the group your thoughts. Needle position simiar to TFESI however more lateral approach.

Provisional PDF

Sports Medicine Physician Required Dublin

Sports & Exercise Medicine Physician

In 2007 Sports Surgery Clinic (SSC) in Dublin was founded to cater for athletes and the active public of all ages. The purpose-built hospital boasts state of the art diagnostic, surgical and rehabilitation facilities.

The Sports Medicine department at SSC provides a secondary referral service to General Practitioners and allied health professionals as well as a tertiary referral service to other specialist services such as Orthopaedics, Respiratory Medicine and Cardiology. The successful applicant will be required to work within the department as an independent Sports Physician.

Clinical Responsibilities:

1. Provision of clinical sessions to Sports Surgery Clinic in the disciplines of:

• Acute Sports Injury including management of acute fracture

• Chronic Sports Injury

• Musculoskeletal assessment

• Sports and general health screening clinics

• Exercise Prescription and performance optimisation

2. Injury investigation (including radiological interpretation), management and rehabilitation.

3. Participation in regular in-service, research, audit and journal club meetings.

4. Participation in educational symposia arranged by SSC for other health professionals and the general public.

The frequency of such sessional input to be agreed with the Medical Director, but could be expected to amount to at least eight clinical sessions (morning, and or afternoon) per week.


The position requires the individual to work in close conjunction within an interdisciplinary team including Orthopaedics, Radiology, Physiotherapy, Cardiology and Respiratory Medicine.

Applicants must be of good standing on the IMC Medical Register. While Speciality recognition in SEM would be viewed favourably, previous experience working with a professional or elite sport is essential. A minimum requirement would be that the applicant:

• Hold a Postgraduate Diploma or MSc in Sport and Exercise Medicine

• Be a Member or Fellow of the Faculty of Sport and Exercise Medicine

• Able to show evidence of ongoing CPD in SEM

• Hold appropriate medical indemnity insurance including Sport and Exercise Medicine

• Possess excellent communication as well as personal organisational skills.

Excellent remuneration package available for suitable candidate.

If you are interested in this position please send your CV to eannafalvey@sportssurgeryclinic.com

http://www.sportssurgeryclinic.com/

England RFU U 18 Team Physician

ENGLAND U18 TEAM DOCTOR

The Rugby Football Union is looking to appoint a new team doctor to lead the medical care for the England U18 Rugby team. 

The person appointed will have full responsibility for the medical care of the U18 England side during all training camps, tours and tournaments.  A significant part of this role is to liaise with rugby and medical staff within the rugby academies and rugby playing schools to monitor the welfare of the England squad on a regular basis, for which excellent communication and personal organisation skills are essential.

Candidates must have:


    * Full registration with the General Medical Council


    * MSc or Diploma in Sport and Exercise Medicine


    * Either JCPTGP Certificate/CCT in GP or CCT/CESR in SEM


    * Fellowship of the Faculty of Sports and Exercise Medicine (FFSEM) preferred


    *  Minimum 3 years substantial part-time or full time experience within elite level rugby union as a team doctor


    * A reputation for clinical excellence in the field of rugby medicine


    * Excellent communication and relationship building skills as a team leader


Our commitment to you:  This is a fixed term, self-employed position for the period to 30 June 2012.  The day rate for England duty is £395 and the post attracts an annual retainer of £10,000.

To apply:  To arrange a confidential discussion about this post, please e-mail the RFU Head of Sports Medicine, Simon Kemp on simonkemp@rfu.com.  For an information pack, e-mail recruitment@therfu.com.

Applicants must submit your CV, with a covering letter, to Lynn Graco, Human Resources Department, Rugby House, Rugby Road, Twickenham, TW1 1DS, or email recruitment@therfu.com.

Closing date for applications is 27 August 2010.  Short- listed candidates will be notified no later than 4 September and interviews will be held on the morning of 13 September 2010 at Rugby House, Twickenham.  The successful candidate would be expected to be available for …...    

The Criminal Records Bureau enhanced disclosure process applies to this post.

International Association for Dance Medicine and Science (IADMS)

20th Annual Meeting



Thursday – Saturday, 28 – 30 October 2010


Birmingham, UK

Overview

The 20th Annual Meeting of the International Association for Dance Medicine and Science (IADMS) will be held Thursday-Saturday, 28 - 30 October 2010 in Birmingham, UK. The 20th Annual Meeting will be followed by workshops on Sunday, 31 October 2010. The venue will be the Birmingham Hippodrome. The meeting will be hosted by the University of Wolverhampton and the Birmingham Royal Ballet. The Annual Meeting and workshops are open to both IADMS members and non-members.

http://www.iadms.org/associations/2991/files/info/IADMS_2010_Conference_Schedule.pdf

Aldershot Town Football Club (Coca-Cola League Division 2) - 1ST Team SEM Physician

Aldershot Town Football Club is seeking an experienced sports and exercise physician for a part-time position as Team Physician.


The successful applicant will be required to provide SEM support to the 1ST Team, Reserves and Academy players, have excellent clinical assessment and treatment skills, communication skills, and a strong work ethic.



Previous experience working with a professional Football team would be advantageous. The position requires the individual to work in close conjunction within an inter-disciplinary team including an excellent experienced Physiotherapist and ‘Strength and Conditioning’ Coach.



Responsibilities will include:

a. Regular interaction with the medical team members and communication with CEO and 1st Team Manager.

b. To provide Emergency Pitch-side cover for all Home Games

c. Diagnose and treat injuries.

d. Liaise with External Medical agencies.

e. Perform Pre-signing Medicals.

f. Health Screening of Players.

g. Instrumental in developing Medical Policy and procedures.



The successful applicant must:



1. Be of good standing on the GMC GP Register, or the GMC Specialist Register



2. Hold a Postgraduate Diploma or MSc in Sport and Exercise Medicine




3. Be a Member or Fellow of the Faculty of Sport and Exercise Medicine



4. Have previous experience as a team doctor within Professional sport, preferably football.



5. Able to show evidence of ongoing CPD, in accordance with the FA Rules, and annual medical appraisal in the major speciality of their work portfolio



6. To be in-date for a pitch-side immediate trauma care course (FA Resuscitation + Emergency Aid Certification or equivalent)



7. Hold appropriate medical indemnity insurance including Sport and Exercise Medicine



8. Possess excellent communication as well as personal organisational

skills.



All interested parties should submit a cover letter briefly explaining

their suitability for this position and return electronically along

with an electronic copy of your CV by 30 June 2010 to:



bgreen@theshots.co.uk



Aldershot Town Football Club

The Recreation Ground
High Street
Aldershot
Hampshire
GU11 1TW

Club Telephone: 01252 320211
Fax 01252 324347

Aldershot Town Football Club is an Equal Opportunities Employer and is

committed to safeguarding and promoting the welfare of children. The

club expects all staff to share this commitment.

Opportunity for MSK / SEM Physicians - Buckinghamshire

MUSCULOSKELETAL COMMUNITY ASSESSMENT AND TREATMENT SERVICE

(MSK CATS)



Vale Health Ltd. is seeking to recruit additional fully-qualified and experienced musculoskeletal physicians to join its existing clinical team on a part-time, sessional and self-employed basis.



The Company is a business partner of Buckinghamshire PCT and holds a rolling contract to provide musculoskeletal clinics to NHS patients at ten venues throughout Buckinghamshire, the principal objective being to offer patients the most appropriate treatment to meet their needs as close as possible to their home.



The service has been running extremely successfully for the past two years and the Company now needs to recruit additional physicians to meet increasing demand.



Candidates must be medically qualified, possess a post-graduate degree in musculoskeletal/sports medicine and, ideally, have a proven track-record of relevant experience. Exceptionally, newly qualified (MSK) graduates could be offered a period of mentoring by our MSK Clinical Lead.



We believe this is an exciting opportunity for GPs to develop their skills in this specialised field of medicine to meet the anticipated high demand in the future.



Further information can be obtained by contacting:



John Butler

Commercial Director

Vale Health Ltd.

John.butler2@nhs.net

07831 395602

Sports Medicine Physician Everton Football Club - Apply Now

SPORTS MEDICINE PHYSICIAN

Everton Football Club is looking for an experienced Sports Medicine Physician to support the First Team playing squad on a part-time basis. As part of a skilled and experienced medical team the successful candidate will play a vital role in all medical matters associated with its professional players.



Main responsibilities for the role include:


Daily interaction with medical and sport science support staff, as well as regular communication with senior football management on all medical matters


Attend training sessions and all First Team games to provide emergency cover, home and away


Diagnosis and treatment of injuries


Liaison with external medical agencies


Medical pre-signing


Health screening of players


Instrumental in developing medial policies and procedures


As well as possessing exceptional injury diagnosis and treatment skills the candidate must be prepared to integrate and become part of a hard working and dedicated inter-disciplinary support team.


The successful candidate must have first class medical and sports medicine qualifications and significant experience of working as a sports physician within elite team sports, ideally professional football.



To apply for this role, please forward your CV and an accompanying cover letter


to vacancies@evertonfc.com


Closing date: Monday 5 July 2010

International Sports Medicine 20 -21 July 2010, The Rose Bowl, Leeds

International Sports Medicine, Science and Performance Conference
highlighting Innovations in elite sport and the Commonwealth Games
20 -21 July 2010, The Rose Bowl, Leeds


Please contact Mr Barry Hill for a booking form
E: barryghill@hotmail.com M: 07968 586 855

International Sports Medicine, Science and Performance Conference 20 -21 July 2010, The Rose Bowl, Leeds

To deliver a high level International Sports Medicine, Science and Performance Conference with a programme that will bring together national and international experts, alongside those who work in the world of elite sport – highlighting Innovations in Elite Sport and the build up to the 2010 Commonwealth Games and beyond


Current Conference Schedule:

Day One Tuesday 20 July 2010

0815Commercial Exhibition Open

Refreshments & Registration

0845 Welcome Address : Dr Lisa Hodgson

0900Keynote Address : Prof Alan Hodson Leeds Met Uni

0930Keynote : Dr Mike Turner “The sports medicine & science Team”

1015Refreshments

1045Risk management in team sports Dr Colin Fuller

Fingers & Fears: Injury & the role of self efficacy in performance rock climbing

Mr Gareth Jones (LMU)

Physical competencies & player development - Background and Rationale Mr Kelvin Giles (LMU)

1125Change over rooms

1130Keynote : Sportsmen’s Groin-Diagnosis and Therapy “minimal repair technique”

Dr Ulrike Muschaweck, Hernia Centre, Munich Football

1200Q&A Dr Ulrike Muschaweck

1215Change over rooms

1220Posterior Ankle Impingement Dr Nick Peirce Cricket

Biomechanics, Fatigue & Injury Carlton Cooke TBC (LMU)

1300Lunch

1400Practical Workshops - 45 minutes each

Practical Kinesiotaping Company Demonstration

Hip pathology & rehabilitation Prof Ernest Schilders (LMU)

Illustrations of Assessment Mr Kelvin Giles

1445Change over rooms

1450Practical Kinesiotaping Company Demonstration

The sporting hip and groin Mr Mark Young ECB

Illustrations of Exercise Progression Mr Kelvin Giles

1535 Refreshments

1605Keynote: Medico legal aspects and doping in Cricket Mr Iain Higgins , Company Lawyer ICC, Dubai

1645 Keynote: Injury Audits in Elite Professional Football Prof Jan Ekstrand, Sweden

1725 Panel Q&A Mr Iain Higgins and Prof Jan Ekstrand

1745 Day 1 Close

1830 Conference Dinner at Rose Bowl




Day Two Wednesday July 21st 2010


0830Commercial Exhibition Open

Refreshments & Registration

0900Keynote Mr Glenn Hunter “Innovations in Team Sports Performance – exploring possibilities”

0950Change over rooms

1000Workshop Innovations in Sport - making it happen Mr Glenn Hunter

Workshop Innovations in Sport – making it happen Mr Paul Francis

1100Refreshments

Practical commercial innovations or time to visit exhibition

1130Commercial innovation 1Commercial innovation 2Commercial innovation 3

1230Lunch

1330Keynote Dr Mike Loosemore “The Commonwealth Games”

1425Change over rooms

1430CW Science Topic 1 tbc Prof Greg Whyte

CW Medical Topic 1 tbc Dr Eleanor Tillott

CW Performance Topic 1 tbc Don Parker

1515Refreshments

1545CW sport 1 – Performance Dr Rob Chakraverty

CW sport 2 – Cycling Dr Roger Palfreeman

CW sport 3 – Gymnastics Julie Sparrow

1630 Change over rooms

1635 Closing Address: Mr Chris Hudson, Prof Alan Hodson and Dr Lisa Hodgson

1645 Conference Close

Chief Medical Officer - Archery

Chief Medical Officer (CMO) Archery GB
Remuneration  TBC (*approx 5 days per annum)


Location - Home Based


Occasional visits- Lilleshall National Sport Centre UK
Job Description

 Working toward British success at the London 2012 Olympic Games, there has never been a more exciting time to work in British sport.


Based at the Lilleshall National Sports Archery Centre, Nr Telford, Archery GB is the National Governing Body for the Olympic and Paralympic sport of archery and is going through nothing short of a revolutionary change as we embark on one of the most exciting times in the history of our sport. The GB programme, preparing Britain’s Olympic and Paralympic Archery team, is managed by Archery GB through the Archery Performance Unit.


As a critical part of the continued growth, we are inviting applications for the role of CMO. The position is a part time post dedicated to supporting and monitoring Britain’s archers toward international success in the short and long term.


The Grand National Archery Society (“GNAS”), which trades under the Archery GB name, is the governing body for the sport of archery in Great Britain and Northern Ireland. The national governing body serves eight Regional Societies, 1200 Clubs, and approximately 31,000 members.


GNAS is a company limited by guarantee which operates as a members’ association on sound business principles. It trades as Archery GB and is affiliated to the International Archery Federation (“FITA”).


Role Requirements The role of Chief Medical Officer will involve:


• Overseeing identified archers medical care and in accordance with patient confidentiality report on their health and fitness status


• Work in close collaboration with key medical staff to monitor, co-ordinate and track all referrals through the Athlete Medical Care Scheme, EIS or BUPA system


• Integrate medical services into the multi disciplinary science and medicine team


• Educate archers and coaches on prevention of injury/illness, anti-doping and drug-related issues


• Work with the Performance Unit on anti-doping in line with UK Sport, WADA and FITA requirements/practices


• Work with colleagues to develop an understanding of good medical practice and preparation for performance


Meetings will be held at least once a quarter and more frequently if required.

*Conference Calls may supplement face to face meetings.


*Time commitment: approximately 5 days per annum


Personal Skills


To meet the service requirements interested parties should be able to demonstrate:


• Knowledge and experience in elite athlete care/high performance sports, ideally archery


• Current certificate of registration of the GMC and current membership of a medical defence organisation


• Membership/Fellowship of the Faculty of Sports and Exercise Medicine, Diploma/MSc in Sports/Exercise Medicine, and evidence of continuing medical education in sport and exercise medicine


• Detailed knowledge/experience of doping rules and procedures, emergency skills (CPR, ALS), and delivery of musculo-skeletal medicine


• Previous experience of working with children and young people.

How to apply


Please send your CV and letter of application to: Hollie Jones
hollie.jones@archerygb.org


For informal/confidential discussions surrounding this position please contact

Sara Symington, Performance Director of Archery GB via email sara.symington@archerygb.org
or mobile 07809863549


Closing Date
Monday 14th June 2010
Interview Date    tbc

Pubic Inguinal Pain Syndrome - Sports Hernia ?

G. Campanelli


Received: 28 September 2009 / Accepted: 4 December 2009 / Published online: 6 January 2010
 
 

Sports hernia (SH) is a controversial condition which presents


itself as chronic groin pain. It is responsible for signiWcant

time away from work and sports competition, with

an incidence of between 0.5 and 6.2% [1–3]. Groin injury is

common in soccer and ice hockey players, but SH can be

encountered in a variety of sports, and even in normally

physically active people [1, 3]. For this reason, we think

that it is more appropriate to speak of pubic inguinal pain

syndrome (PIPS).

Over the past decade, the number of sports-related

injuries has increased as a function of increased athletic

activities, and the demand for an early return to work and

competitive sports puts pressure on the doctor for immediate

diagnosis and treatment [1–3].

The anatomy involved, diagnostic criteria and treatment

modalities are inconsistently described in the medical,

surgical and orthopaedic literature. In fact, there is no

evidence-based consensus available to guide the decisionmaking,

and most of the studies are level IV investigations

[1, 3, 4].
 
 
Click on the enclosure link for article

The groin triangle: a patho-anatomical approach to the diagnosis of chronic groin pain in athletes.

Br J Sports Med. 2009 Mar;43(3):213-20. Epub 2008 Nov 19.


Falvey EC, Franklyn-Miller A, McCrory PR.

Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia. e.falvey@mac.com

Abstract

Chronic groin pain is a common presentation in sports medicine. It is most often a problem in those sports that involve kicking and twisting movements while running. The morbidity of groin pain should not be underestimated, ranking behind only fracture and anterior cruciate ligament reconstruction in terms of time out of training and play. Due to the insidious onset and course of pathology in the groin region it commonly presents with well-established pathology. Without a clear clinical/pathological diagnosis, the subsequent management of chronic groin pain is difficult. The combination of complex anatomy, variability of presentation and the non-specific nature of the signs and symptoms make the diagnostic process problematical. This paper proposes a novel educational model based on patho-anatomical concepts. Anatomical reference points were selected to form a triangle, which provides the discriminative power to restrict the differential diagnosis and form the basis of ensuing investigation. This paper forms part of a series addressing the three-dimensional nature of proximal lower limb pathology. The 3G approach (groin, gluteal and greater trochanter triangles) acknowledges this, permitting the clinician to move throughout the region, considering pathologies appropriately.

A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes.

Sports Med Arthrosc Rehabil Ther Technol. 2009 Mar 31;1(1):5.



Machotka Z, Kumar S, Perraton LG.

Centre for Allied Health Evidence, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia. saravana.kumar@unisa.edu.au.

Abstract

ABSTRACT: BACKGROUND: Athletes competing in sports that require running, changes in direction, repetitive kicking and physical contact are at a relatively higher risk of experiencing episodes of athletic groin pain. To date, there has been no systematic review that aims to inform clinicians about the best available evidence on features of exercise interventions for groin pain in athletes. The primary aim of this systematic review was to evaluate the available evidence on the effectiveness of exercise therapy for groin pain in athletes. The secondary aim of this review was to identify the key features of exercise interventions used in the management of groin pain in an athletic population. METHODS: MEDLINE, CINAHL, PubMed, SPORTSDiscus, Embase, AMED, Ovid, PEDro, Cochrane Controlled Trials Register and Google Scholar databases were electronically searched. Data relating to research design, sample population, type of sport and exercise intervention was extracted. The methodological evaluation of included studies was conducted by using a modified quantitative critical appraisal tool. RESULTS: The search strategy identified 468 studies, 12 of which were potentially relevant. Ultimately five studies were included in this review. Overall the quality of primary research literature was moderate, with only one randomised controlled trial identified. All included studies provided evidence that an exercise intervention may lead to favourable outcomes in terms of return to sport. Four of the five studies reviewed included a strengthening component and most utilised functional, standing positions similar to those required by their sport. No study appropriately reported the intensity of their exercise interventions. Duration of intervention ranged from 3.8 weeks to 16 weeks. All five studies reported the use of one or more co-intervention. CONCLUSION: Best available evidence to date, with its limitations, continues to support common clinical practice of exercise therapy as a key component of rehabilitation for groin pain in athletes. Overall, the available evidence suggests that exercise, particularly strengthening exercise of the hip and abdominal musculature could be an effective intervention for athletes with groin pain. Literature provides foundational evidence that this may need to be in the form of progressive exercises (static to functional) and performed through range. There is currently no clear evidence regarding the most effective intensity and frequency of exercise, because of a lack of reporting in the primary literature.

The inguinal release procedure for groin pain: initial experience in 73 sportsmen/women.

Br J Sports Med. 2009 Aug;43(8):579-83. Epub 2009 Jan 21.



Mann CD, Sutton CD, Garcea G, Lloyd DM.

Department of Surgery, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK. chris.mann@doctors.org.uk


Abstract

OBJECTIVE: To assess the impact of the laparoscopic inguinal release procedure with mesh reinforcement on athletes with groin pain. DESIGN: Prospective cohort study. SETTING: Private sector. PATIENTS: Professional and amateur sportsmen/women undergoing the inguinal release for groin pain. MAIN OUTCOME MEASUREMENTS: Change in patient's symptoms, functional limitation and time to resuming sporting activity following surgery. RESULTS: 73 sportsmen/women underwent laparoscopic inguinal release in the study period, 37 (51%) of whom were professionals. 95% were male with a median age of 30 years. Following operation, patients returned to light training at a median of 1 week, full training at 3 weeks (professionals-2 weeks) and playing competitively at 4 weeks (professionals-3 weeks). 74% considered themselves match-fit by 4 weeks (84% of professionals). Following surgery, there was a highly significant improvement in frequency of pain, severity of pain and functional limitation in both the whole cohort and professional group. 88% reported a return to full fitness at follow-up, with 73% reporting complete absence of symptoms. 97% of the cohort thought the operation had improved their symptoms. CONCLUSIONS: This study shows that the laparoscopic inguinal release procedure may be effective in the treatment of a subgroup of athletes with groin pain.

Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.

J Bone Joint Surg Am. 2009 Oct;91(10):2455-60.



Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q.

Department of Orthopaedics, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, England. e.schilders@btopenworld.com


Abstract

BACKGROUND: Adductor dysfunction can cause groin pain in athletes and may emanate from the adductor enthesis. Adductor enthesopathy may be visualized with magnetic resonance imaging and may be treated with entheseal pubic cleft injections. We have previously reported that pubic cleft injections can provide predictable pain relief at one year in competitive athletes who have no evidence of enthesopathy on magnetic resonance imaging and immediate relief only in patients with findings of enthesopathy on magnetic resonance imaging. In this follow-up study, we attempted to determine if the same holds true for recreational athletes. METHODS: We reviewed a consecutive case series of twenty-eight recreational athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. A period of conservative treatment had failed for all of these athletes. The adductor longus origin was assessed with magnetic resonance imaging for the presence or absence of enthesopathy. All patients were treated with a single pubic cleft injection of a local anesthetic and corticosteroid into the adductor enthesis. The patients were assessed for recurrence of symptoms at one year after treatment. RESULTS: On clinical reassessment five minutes after the injection, all twenty-eight athletes reported resolution of the groin pain. Fifteen patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and thirteen patients (Group 2) had findings of enthesopathy on magnetic resonance imaging. At one year after the injection, five of the fifteen patients in Group 1 had experienced a recurrence; these recurrences were noted at a mean of fourteen weeks (range, seven to twenty weeks) after the injection. Four of the thirteen patients in Group 2 had experienced a recurrence of the symptoms at one year, and these recurrences were noted at a mean of eight weeks (range, two to nineteen weeks) after the injection. Overall, nineteen (68%) of the twenty-eight athletes had a good result following the injection. Of the remaining nine athletes, two were treated successfully with repeat injection; therefore, overall, twenty-one (75%) of the twenty-eight athletes had a good result after entheseal pubic cleft injection. CONCLUSIONS: Most recreational athletes with adductor enthesopathy have pain relief at one year after entheseal pubic cleft injection, regardless of the findings on magnetic resonance imaging. There were similarities between this group of recreational athletes and the competitive athletes in our previous study, in that the adductor enthesis was the source of pain and entheseal pubic cleft injection was a valuable treatment option. The main difference was that, in this group of recreational athletes, magnetic resonance imaging evidence of adductor enthesopathy did not correlate with the outcome of the injection.

Adductor tenotomy: its role in the management of sports-related chronic groin pain.

Arch Orthop Trauma Surg. 2009 Dec 24.



Atkinson HD, Johal P, Falworth MS, Ranawat VS, Dala-Ali B, Martin DK.

Department of Trauma and Orthopaedics, University College London Medical School, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK, dusch1@gmail.com.



Abstract

PATIENTS AND METHODS: Chronic adductor-related groin pain in athletes is debilitating and is often challenging to treat. Little is published on the surgical treatment when conservative measures fail. This single center study reviews the outcomes of 48 patients (68 groins) who underwent percutaneous adductor tenotomy for sports-related chronic groin pain. Questionnaire assessments were made preoperatively and at a minimum follow-up of 25 months. RESULTS: Mean pre-injury Tegner activity scores of 8.8 reduced to 6.1 post-injury and these improved to 7.7 following surgery (p < 0.001). Sixty percent of patients regained or bettered their pre-injury Tegner activity scores after the adductor surgery; however, mean post-surgical Tegner scores still remained lower than pre-injury scores (p < 0.001). No patient had been able to engage in their chosen sport at their full ability pre-operatively, and 40% had been unable to participate in any sporting activity. The mean return to sports was at 18.5 weeks postoperatively, with 54% returning to their pre-injury activity levels, and only 8% still unable to perform athletic activities at latest follow-up. Seventy-three percent patients rated the outcome of their surgery as excellent or very satisfactory, and only three patients would not have wished to undergo the procedure again if symptoms recurred or developed on the opposite side. No patients reported their outcome as worse. A 78.1% mean improvement in function and an 86.5% mean improvement in pain were reported, and these two measures showed statistically significant correlation (p = 0.01). Groin disability scores improved from a mean of 11.8 to 3.9, post-operatively (p < 0.001). Bruising was seen in 37% of procedures, 3 patients developed a scrotal hematoma and 1 patient had a superficial wound infection. One patient developed recurrent symptoms following re-injury 26 months post-surgery, and fully recovered following a further adductor tenotomy. CONCLUSIONS: Adductor tenotomy provides good symptomatic and functional improvement in chronic adductor-related groin pain refractory to conservative treatment.

Minimal Repair technique of sportsmen's groin: an innovative open-suture repair to treat chronic inguinal pain.

Hernia. 2010 Feb;14(1):27-33.


Muschaweck U, Berger L.

Hernia Center Dr. Muschaweck, München, Germany. UM@hernien.de


Abstract

BACKGROUND: Sportsmen's groin, also known as sportsman's hernia, sports hernia, (athletic) pubalgia or athletic hernia, especially in professional sportsmen, is a difficult clinical problem, and may place an athlete's career at risk. It presents with acute or chronic inguinal pain exacerbated with physical activity. So far, the diagnostic criteria and treatment modalities are inconsistently described and there is no evidence-based consensus available to guide decision-making. OBJECTIVES: We developed an innovative open suture repair, called the "Minimal Repair" technique. With this technique, the defect of the posterior wall of the inguinal canal is not enlarged, the suture is nearly tension-free and the patient can, therefore, return to full training and athletic activity within the shortest time. METHODS: In September 2008, we started a prospective cohort study to evaluate the outcome of patients undergoing operations under the Minimal Repair technique for sportsmen's groin. Between September 2008 and May 2009, 129 patients were included in the study and were questioned at entry and 4 weeks after the operation. The primary endpoints were time to complete freedom of pain and time to resumption of exercise and sport. Here, we present the results observed 4 weeks after operation under the Minimal Repair technique. RESULTS: At enrollment, all but three patients reported a significant restriction of physical activities due to severe groin pain (median duration of pain 142 days, interquartile range [IQR] 57-330 days). Four weeks after operation under the Minimal Repair technique, 96.1% had resumed training (median 7 days, IQR 5-14 days). At this time, there was a full return to pre-injury sports activity levels in 75.8% (median 18.5 days, IQR 11.75-28 days). Focusing on the group of professional athletes, 83.7% had returned to unrestricted sports activities (median 14 days, IQR 10-28 days). In this subgroup, the median time to complete pain relief was 14 days (IQR 6-28 days). DISCUSSION: The surgical treatment of sportsmen's groin is common practice when non-surgical treatment has failed over a period of 6 weeks or more. However, there is no evidence-based data on the type of treatment. A wide variety of techniques with and without mesh are being performed. So far, laparoscopic repair is believed to enable a faster recovery and return to unrestricted sports activities. Our results, however, show that the outcome after operation under the Minimal Repair technique is very fast, without exposing the patient to possible risks related to mesh insertion or laparoscopic procedures. CONCLUSION: The Minimal Repair technique is an effective and safe way to treat sportsmen's groin.