Warm up

Preventing ACL injuries, turning research into practice and avoiding media ambush

Karim M Khan

Correspondence to:
Karim M Khan

Finland is famous for many things including its haunting national anthem (creatively called 'Finlandia') and a universal love of lakes and saunas. I'll stay away from memorable Eurovision winners Lordiⁱ!

In this issue of BJSM, you can read the report of the Finnish randomised controlled trial (RCT) that showed a tremendous reduction of lower limb injuries with a simple warm-up programme (see page 802).¹ Although not powered for that holy grail of sports medicine research — reduced anterior cruciate ligament injuries – the study provides a very clear message. If you have a daughter who is playing basketball, soccer, handball or floorball, then it is crazy if her team isn’t undertaking one of the evidence-based warm-ups targeting lower limb injury prevention. You’ll find exercises illustrated in the links here as well as in papers previously published in Europe and the US. There is now incontrovertible evidence that a series of warm-up programmes that encourage neuromuscular training and balance activities have more benefits than risks. We owe a great deal to pioneers including Caraffa, Myklebust, Maendelbaum and Silvers.² If you missed the special IOC knee consensus statement in June,³ you can download it from the BJSM home page (click on "Browse by Issues" on the right-hand side).

How can we "interface" with the target audience who reads neither BMJ nor BJSM? What will it take so that every school, every club is downloading exercise sheets onto coaches' iPods and iPhones; when will more people download these videos in preference to watching George Bush's bloopers on YouTube? (you have to check that one out). Groups who have committed to address this problem include the Oslo Sports Trauma Research Centre site (http://www.ostrc.nih.no) and the international football association, FIFA (http://www.FIFA.com). We’d also love to hear about how you have implemented programmes that work, protocols to share, ways that you have adopted research into practice. The BJSM website and blog lend themselves to information-sharing, so not everything that comes to BJSM has to be in the form of a narrowly defined research paper. BJSM is already renowned for its breadth of clinical commentaries, commissioned editorials and web support for papers. The time has come for sports medicine therapy to come out of the page and into active sports – help us with your advice as to how this can happen.

Unfortunately, knee injuries do still occur, so sports medicine trainees need to learn to be expert knee examiners. Declaring my conflict of interest (see below), I alert you to Mark Hutchinson's series of knee exams on YouTube (the first can be found at http://www.youtube.com/watch?v = MgdkcX7koAg&feature = related). Dr Hutchinson, one of the foremost clinical mentors of the American College of Sports Medicine (ACSM), shows how its done — all free, no conference fee or travel expenses. Over 30 000 of his clips have been downloaded since April and his shoulder exam is being edited by the Coen brothers as I write this piece (that would be Noel and Bethan Coen, just so I don't get sued). Check out the BJSM meta-analysis of shoulder examination and learn medicine using Web 2.0. I hope that Hutchinson’s clips will be on the BJSM website soon too. If you are a print copy subscriber, remember to check the web for added links to the papers you read, a shortcut to the blog as well as PowerPoint presentations. The e-journal is the journal, so there will be more and more added value on the web as time goes by.

At least three more clinically relevant issues can be found inside! Sports medicine seems to garner a disproportionate amount of media attention compared with dermatology and occupational medicine so it behoves clinicians to know what to do when the media calls. And as London launches 2012, it is timely that UK clinicians have developed very practical guidelines. A combined wisdom of 360 years of clinical expertise is distilled into 4 pages (see page 785). Check it out and avoid being pilloried on YouTube for the wrong reasons.

And I can’t leave you without mentioning the groin pain paper (see page 851).⁴ This UK-based team evaluated the prevalence of the clinical groups and it will help you with your diagnosis and insights. BJSM’s 2007 groin pain paper by Holmich⁵ has been widely read and cited. This paper builds on that and BJSM will cover various elements of groin pain over the next few issues — think of it as a "theme issue" that crosses months!

My personal favourite paper this month was from Germany – it provides a way of explaining how exercise cleans those cardiac pipes (see page 839).⁶ Don’t you just love that feeling of your heart thumping in your chest when you are free to exercise again after a few days of being way too sedentary? There is a visceral joy about being alive that has to be almost as good as the feeling of removing an annoying bit of dental plaque that has been there for days when you can't find the floss. I digress – the paper sheds light on the physiological process that probably makes the difference between longevity and an early grave for many, many folk. Read about it and then turn research into practice. Please.

And a "heads up" for January (and Online First anytime). Guest editor Stephen Blair has cajoled and corralled a quintessential cabal of critics to provide BJSM readers with perspective relating to the multisystem benefits of physical activity. A benefit of this set of papers is that you can turn that into practical clinical advice. Time to turn research into practice! You won't want to miss that issue in print, online or Online First. Enjoy this issue and please do provide feedback on the BJSM editorial team’s efforts to bring you clinically relevant valuable information monthly. Please send feedback to me at karim.khan@ubc.ca, to the blog (http://blogs.BMJ.com/BJSM/), or to the editorial office.

Competing interests: KK is a co-author with M Hutchinson on the University of British Columbia and University of Illinois (Chicago) knee examination project, which was funded by the Teaching and Learning Enhancement Fund at UBC. The project aims to provide a free resource for those wishing to learn knee examination. KK and M Hutchinson are both contributors to the text Clinical Sports Medicine (Brukner P, Khan K), 3rd edn, 2007. New York, London: McGraw-Hill.

ⁱ Lordi, a unique, memorable heavy metal band who won Eurovision (http://www.youtube.com/watch?v = 2FYGcHyZSEA)

1. Pasanen K, Parkkari J, Pasanen M. Neuromuscular training and the risk of leg injuries in female floorball players: cluster randomised controlled study. BMJ 2008;337:a295.[Abstract/Free Full Text]
2. Silvers HJ, Mandelbaum BR. Prevention of anterior cruciate ligament injury in the female athlete. Br J Sports Med 2007;41(suppl):i52–9.[Abstract/Free Full Text]
3. Renstrom P, Ljungqvist A, Arendt E, et al.. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 2008;42:394–412.[Abstract/Free Full Text]
4. Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med 2008;42:551–4.[Free Full Text]
5. Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns - a 'clinical entity' approach: Prospective study of 207 patients. Br J Sports Med 2007;41:247–52.[Free Full Text]
6. Sandrock M, Schulze C, Schmitz D, et al.. Physical activity throughout life reduces the atherosclerotic wall process in the carotid artery. Br J Sports Med 2007;42:539–44.[CrossRef]

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