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Sports Doctors Australia is proud to be in its fourth year as one of BJSM's 23 member societies. This issue will touch a chord—pleasant or unpleasant—with most primary care practitioners. Clinicians are well aware of the inability to change the course of chronic low back pain in many people. When yet another patient comes in with persisting back pain, it may trigger a heart-sinking response or be seen as a challenge.
Back pain—are we making progress?
For a long time, we clinicians have tried to attack this problem through the reductionist model, believing that the more we understand about the cause of the pain, the more likely we were to improve the outcomes. Jørgen Jevne (see page 198) editorialises where we have gone wrong in our approach to finding a structural cause to treat to help these people. It is time for us to stand back and take a more holistic approach to managing back pain.
Fleshing out this point—that some long-held recommendations may not be based on solid evidence—the editorial by Kieran O’Sullivan (see page 197) cuts across what we have learned—paracetamol is ineffective in low back pain. He puts forward a range of options to enhance management.
Other articles report what works and does not work in the management of chronic low back pain. Jon J Ford (see page 237) presents a good reason to include individualised physiotherapy plus individualised advice in care. In BJSM's popular ‘PEDro’ systematic review synthesis series,1 Alessandra Garcia (see page 247) presents a systematic review and meta-analysis of a multidisciplinary biopsychosocial approach to care. A similar PEDro systematic review and meta-analysis by Nolwenn Poquet (see page 253) outlines the pros and cons of treatment strategies for sciatica. Finally, BJSM Editorial Board member and physiotherapist Michael Reiman (see page 221) completed a high-quality systematic review and meta-analysis and found no difference in time to return to sport after microdiscectomy for radicular pain compared with conservative care. This is why Tiger Woods is on the cover of this issue—and you can listen to Peter O'Sullivan discuss the challenges of golf and back pain in two of BJSM's most listened podcasts via this link (http://ow.ly/W9aT5).
Tendons and the inflammation debate
Where would we be if we did not have a good, ongoing debate about tendons? Ben Dean (see page 216) presents a review of the evidence in chronic tendon pain and finds inflammatory cells are present in chronic tendinopathy. Jonathan Rees (see page 201) drills into the issue. Ebonie Rio (see page 209) celebrates her successful 2015 PhD completion and graduation by sharing concepts of tendinopathy management. It's an engaging and in-depth look at the reasons to add in motor control training along with strengthening and isometric contraction to the developing concept of tendon treatment.
Closely related to the tendon is the intramuscular tendon injuries that delay and complicate efforts to return athletes to play. Former Liverpool and now Australian Cricket medical officer, Peter Brukner (see page 205), highlights the need to identify if there is tendon damage in what seem on the surface as hamstring and quadriceps ‘muscle’ strains. This Open Access paper climbed to BJSM's top two papers for November while still ‘Online First’. That not all ‘muscle’ injuries involve just ‘muscle’ tissue (ie, beware tendon involvement) is a key element of the British athletics classification of muscle injuries.2 That is influencing clinical care widely—it is worth tracking down. You can also listen to first author and Olympic doctor, Noel Pollock, explain it at this link to the BJSM podcast which shot past 4000 listens in its first month (http://ow.ly/W9evw).
Closing out this issue are thought-provoking articles covering workload predictors for injury in Rugby League players (see page 231), bariatric surgery in obesity management (see page 246), a wonderful overview of femoroacetabular impingement (see page 196), education tips, mobile apps user guides and a lot more. (Speaking of apps—remember the BJSM app is very useful for tracking everything, BJSM Apple and Android.)
Sports Doctors Australia
Sports Doctors Australia exists to support and educate primary care sports doctors in Australia. We provide a collegiate environment for our members and have a significant input into the medical aspects of the annual Sports Medicine Australia (SMA) conference.
The group provides an exciting and very well run course to improve emergency care of doctors and others with our On-Field Emergency Care Course. This was presented at the 2015 SMA national conference and was extremely well received.
The 2016 annual SMA conference (12–15 October 2016) at the historic Melbourne Cricket Ground (MCG) is a guarantee of excellent sports science, exercise medicine and clinical aspects of sport. http://sma.org.au/conferences-events/2016-sports-medicine-australia-conference/. It is relevant to all disciplines in our field. Bringing this editorial full circle, the first keynote speaker has been announced—Professor Peter O'Sullivan. Together with my Sports Doctors Australia colleagues, and all of SMA I look forward to seeing you in marvellous Melbourne.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.