Rod Jaques

Position statement on youth resistance training: the 2014 International Consensus

The current manuscript has been adapted from the official position statement of the UK Strength and Conditioning Association on youth resistance training. It has subsequently been reviewed and endorsed by leading professional organisations within the fields of sports medicine, exercise science and paediatrics. The authorship team for this article was selected from the fields of paediatric exercise science, paediatric medicine, physical education, strength and conditioning and sports medicine.

The early management of muscle strains in the elite athlete: best practice in a world with a limited evidence basis.

From 12 to 14 December 2007 UK Sport held a think tank on “muscle strains” in London. This brought together many of UK Sport’s top sports medicine clinicians along with three invited international experts. Many issues of muscle strains were discussed over the three days, but the aspect that attracted the most attention was the early management of strains in the elite athlete. A consensus summary of conclusions on this specific topic from the think tank is presented here. The international experts were chosen by request of the UK clinicians for different reasons. Drs Best (basic science) and Orchard (epidemiology) are recognised internationally by the peer-review system as experts in their fields. Dr Mueller-Wohlfahrt is also recognised internationally as Europe’s premier clinician in the early management of muscle strains. This recognition was initially bestowed on him by his patients, most notably from the thousands of professional football players he has managed over the past 30 years from every country in Europe. Increasingly this recognition has been accorded by the “mainstream” clinicians in the United Kingdom, hence his invitation to the think tank. With the reserve typical of both the British and the scientific community, a common assessment of Dr Mueller-Wohlfahrt’s methods by delegates was “initially I had to be sceptical, but I have seen and heard of so many good results that I am now curious to know why these good outcomes are occurring”. One session of the think tank involved an assessment of our “expert recommendations” for the early management of muscle strains in the elite athlete and a judgement of the evidence base for making the recommendations. The evidence base part was generally easy: almost all of our so-called knowledge has a basis …

Preparticipation examination (screening): practical issues as determined by sport: a United Kingdom perspective.

Objectives:Pre-participation examination, screening and health surveillance are part of the job specification for many roles within Sports Medicine. The type and scope of this activity varies enormously, with little consensus as to best evidence-based practice. The purpose of this work was to explore and understand the practical approaches to pre-participation examination, screening and health surveillance in two contrasting sport scenarios. Data Source:Team physicians for British Triathlon and Manchester United Football Club. Data synthesis/Methods:Information was gathered under the headings: why screen, screening objectives, practical issues and constraints? Results:The systems evolved within these two sports reflect their respective opportunities and constraints. Different systems, each with merit, have evolved with some generalizable concepts across sport. Conclusions:A perfect system for pre-participation examination, screening and health surveillance across all sport does not exist, however, within specific sport scenarios examples of good practice are demonstrated.

Oral health and elite sport performance

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

High-performance sports medicine: an ancient but evolving field

The recognition of Sport and Exercise Medicine (SEM) as a new medical specialty in the UK in 2005 represented a landmark in an area of medicine that began its journey in Greco-Roman times, 2500 years ago. The fathers of our specialty, Herodicus (480 bc), Hippocrates (460–370 bc) and then Galen (ad 129–210), recognised the need to promote and prescribe exercise for health-related benefit, and the need to provide general medical care for the athletic individual.1 2 Such principles form the core components of our specialty today. High-performance sports medicine (HPSM) is a small area of SEM that is specifically focused upon high-performance (‘elite’) athletes—those competing at national or international level, and those involved in professional sports. It is clear from the writings of Hippocrates thatHPSM clearly did exist in Greco-Roman times.1 2 He described the use of medical approaches to optimise the effects of, and recovery from, training, and indeed he dedicated the second volume of his series ‘regimen’ to this subject.2 HPSM subsequently faded until the 19th century, re-emerging when a new era of formal competitive sport began. In those times, there was considerable medical debate relating to the needs of the athlete; there were views that intensive training represented serious adverse physical and physiological consequences. There was negativity towards the pursuit of athletic excellence, resistance to the concept that sports medicine was not ‘real medicine’ and disinterest in understanding the challenges of human physiology at the extremes.3 Some of these views persist in some of the less informed today. Nevertheless, in the modern era, high-performance sport plays a central role in our culture, society and our national identities, and with thatHPSM has an evolving identity and an increasingly prominent and positive profile. In this series of three short articles on HPSM, we aim to describe …

The Injury/Illness Performance Project (IIPP): A Novel Epidemiological Approach for Recording the Consequences of Sports Injuries and Illnesses

Background. Describing the frequency, severity, and causes of sports injuries and illnesses reliably is important for quantifying the risk to athletes and providing direction for prevention initiatives. Methods. Time-loss and/or medical-attention definitions have long been used in sports injury/illness epidemiology research, but the limitations to these definitions mean that some events are incorrectly classified or omitted completely, where athletes continue to train and compete at high levels but experience restrictions in their performance. Introducing a graded definition of performance-restriction may provide a solution to this issue. Results. Results from the Great Britain injury/illness performance project (IIPP) are presented using a performance-restriction adaptation of the accepted surveillance consensus methodologies. The IIPP involved 322 Olympic athletes (males: 172; female: 150) from 10 Great Britain Olympic sports between September 2009 and August 2012. Of all injuries (n = 565), 216 were classified as causing time-loss, 346 as causing performance-restriction, and 3 were unclassified. For athlete illnesses (n = 378), the majority (P < 0.01) resulted in time-loss (270) compared with performance-restriction (101) (7 unclassified). Conclusions. Successful implementation of prevention strategies relies on the correct characterisation of injury/illness risk factors. Including a performance-restriction classification could provide a deeper understanding of injuries/illnesses and better informed prevention initiatives.

Observations on the “Lausanne Recommendations” on sudden cardiovascular death in sport

As Directors of Medical Services to UK Athletics, the English Institute of Sport and the British Olympic Association, we were pleased to receive the Lausanne Recommendations on Preparticipation Cardiovascular Screening for Sudden Cardiovascular Death in Sport.1 We fully support the goals and motivations behind this document, but having carefully read the document, there are a number of areas that may warrant open discussion. The following dissertation outlines those areas of the recommendations that we, as practising sports physicians charged with their implementation, believe require further delineation and clarity. Our hope is that further discussion will result in enhanced clarity and help on the implementation of these recommendations. 1. We applaud the document’s goals, which are to “identify, as accurately as possible, athletes at risk in order to advise them accordingly”. Although not stated, it is important to be reminded that this is referring to sudden cardiac death in sport and not other causes of sudden death. 2. Despite its goals, it is unclear exactly which sporting group the recommendations are intended for: elite sport, mass participation or the health and fitness industry? This lack of clarity results in interpretation difficulties and makes the subsequent implementation of detail found in the document more uncertain. We believe that this warrants clarification. 3. Although appropriately altruistic in its intent, it is clear that “to …

Consensus statement: Oral health and elite sport performance

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

A Delphi developed syllabus for the medical specialty of sport and exercise medicine

Training in the medical specialty of sport and exercise medicine is now available in many, but not all countries. Lack of resources may be a barrier to the development of this important specialty field and the International Syllabus in Sport and Exercise Medicine Group was convened to reduce one potential barrier, the need to develop a syllabus. The group is composed of 17 sport and exercise medicine specialists residing in 12 countries (Australia, Canada, India, Ireland, Malaysia, the Netherlands, Qatar, South Africa, Sweden, Switzerland, the UK and USA). This paper presents the first phase of this project covering the domains and general learning areas of a specialist training syllabus in sport and exercise medicine.

Revalidation in Sport and Exercise Medicine: a UK perspective

The era of professional self regulation in medicine is over. In 2006, it was recognised in the UK Chief Medical Officers report, ‘Good doctors, Safer patients,’ that an enhanced system of quality assurance and performance management of doctors was required, not only for the profession but to protect the safety of patients.1 From this developed a proposal for five-yearly revalidation of doctors, which is to have two elements, relicensing and recertification. The former, relicensing, began in November 2009. Doctors in the UK are required to hold a licence to practise, which sits alongside their General Medical Council (GMC) registration. Licensure is required by all doctors currently undertaking those professional activities that were previously restricted by law to doctors registered with the GMC.2 Relicensing is the process set up to demonstrate that doctors are practising in accordance with generic standards of practice broadly based upon the guidance provided by the GMC in Good Medical Practice.3 The purpose of this editorial is to bring into focus the requirements for recertification of those doctors practising Sport and Exercise Medicine in the UK. Before considering the specific requirements, it is important to understand that the purpose of revalidation is to ensure that doctors who are registered and have a licence to practise are up to …