Well here we are in May already! The weather is getting cooler, and it is getting harder and harder to get up in the morning to exercise. Remember if you need help with injuries, dietary advice, or which pair of shoes to use we have all the help you need right here. 

This month one of our Exercise Physiologists, Beth Sheehan has written the Blog about the importance of maintaining good core stability. Beth consults every second Friday afternoon at BSEMS adn is happy to take new patients any time.

The abdominal muscles or the core muscles are made up of a number of muscles which include rectus abdominis (6-pack), external and internal obliques (love handles), multifidis, pelvic floor and transversus abdominis.  Most people when working the ‘core’ focus on the visible i.e. the rectus abdominis.  Consequently they perform exercises that increase the musculature but often don’t have an understanding of how to strengthen the deeper core in particular transversus abdominis(TA).  Having a strong TA and deeper core is the pinnacle of good core strength and core control. 

Having good core control has an affect on day to day activities that require good posture (eg computer typing, cleaning & driving) as well as other functional daily activities such as climbing stairs, getting up and down off a bed and gardening. A strong TA enables daily tasks to be performed with minimal risk of new injuries as well as avoiding recurring injuries.  Activation of the TA should become second nature and should be applied during most functional activities performed on a daily basis.  Having a strong TA also assists with good lifting techniques in the gym when utilizing weights as well as performing abdominal exercises.  It also assists with maintaining good balance and stability particularly as we go through the aging process.

When the deeper core is engaged i.e. contracted, the various muscles involved (TA, multifidis, pelvic floor etc) stabilize the spine, pelvis & shoulder girdle and consequently establish a solid basis to build our strength.  We as humans are then able to generate considerable amount of power at our extremities.  If however we are not contracting our core initially and utilizing our larger muscle groups we can sometimes lose this power and consequently recruit our larger muscles. This can often lead to injury and overuse conditions (eg carpal tunnel syndrome, repetitive hamstring tears) and generally cause us physical grief and discomfort.

When we are encouraged to activate the TA many health professionals who know how to instruct the activation will often use a variety of cues.  Some of these include ‘turn your tummy on’, ‘zip up and in’, ‘pelvic tilt’, ‘pull your belly button to your spine’.  All of these are correct cues however sometimes the activation is not achieved by the TA but rather the larger abdominal muscles such as the rectus abdominis is activated instead.

When learning how to strengthen the core it is important that correct activation of the TA is achieved to ensure that the activation of TA can be transferred from daily activities such as house hold duties to manual labour and then to sport and gym based activities.  Core strength is imperative in our daily lives to not only improve our general posture but also our balance and over all well-being.

Pilates is an excellent form of physical activity that encourages correct activation of TA and deep abdominals throughout all exercises.  Exercise physiologists and physiotherapists are also well trained in the activation of TA.  By discussing the importance of TA with these allied health professionals you could change your posture, your current pain discomfort and minimize your risk of injury. 

Want a strong 6 pack?  Activate the TA J

Happy birthday to BSEMS!

April marks 12 months since BSEMS opened its doors. Queenslanders have been through some pretty tumultuous times over this period, but have emerged stronger and more determined. Likewise, the BSEMS practice has grown and added to its core group of practitioners over this time. We are proud of our Multi-disciplinary clinic, and continue to aim to provide Brisbane and South East Queensland with a world class Sport and Exercise Medicine clinic. We are always open to suggestions as to how we can serve you better, so please feel free to leave your comments or thoughts.

This month’s blog topic covers throwing and overhead injuries. Whether you are a weekend warrior throwing around a park, or an elite athlete upper limb problems can result from the repeated action of throwing or using a racquet. Understanding the biomechanics of throwing helps you to appreciate the forces transmitted to the upper limb, and what problems can result from excessive use or poor technique.

Upper Limb Problems in Overhead Athletes

People of all ages are heeding the advice to become more active and participate in sport and recreation. So called ‘over head’ sports activities like throwing and racquet sports for the most part are simple, and require no special training to participate. However tremendous forces are placed though the upper limb during these activities, resulting in a combination of acute, and more commonly over-use injuries, that commonly present to General Practice.  This article explains the biomechanics of common over head activities, which explains the forces placed on the upper limb, and subsequent injury development.

Throwing Biomechanics

Throwing is a ‘whole body activity’ that commences with drive from the large leg muscles and hip rotation and progresses through segmental trunk and shoulder girdle rotation. It continues with a ‘whip-like’ transfer of momentum through elbow extension and through the small muscles of the forearm and hand, transferring propulsive force to the ball. Movement of the trunk and contact with the ground allow for maximal transfer of energy to the ball. (Water polo players can throw at only half the velocity of baseball pitchers.) The forces transmitted to the shoulder are lower during serving in tennis as the racquet dissipates much of the impact force, allowing a greater intensity of serving compared with throwing.

Throwing can be divided into 4 phases.

1) Preparation and wind up:

The major forces arise in the lower half of the body and develop a forward moving ‘controlled fall’. The weight is shifted back on the ipsilateral leg and the body rotates so that the hip and shoulders are at 90º to the target. During this phase lasting 500-1000 milliseconds, the shoulder muscles are relatively inactive.

Problems in any part of the ‘kinetic chain’ (e.g. injured hamstring) could impact on the eventual position of the upper limb, and precipitate injury.

2) Cocking:

The shoulder moves into abduction through horizontal extension and then into maximal external rotation (ER). In this position, the shoulder is ‘loaded’ with the anterior capsule coiled tightly in the apprehension position, storing elastic energy, and the internal rotators (IR’s) are stretched.

Toward the end of cocking the anterior shoulder restraints (inferior glenohumeral ligament and capsule) are under the greatest strain- with repetition these structures can become attenuated leading to subtle instability.

The cocking phase, which also lasts 500-1000 milliseconds, ends with the planting of the lead leg, with the body positioned for energy transfer through the legs, trunk and arms to the ball. Together, the first two phases constitute 80% of throwing duration.

3) Acceleration:

This consists of the rapid release of two forces: the stored elastic force of the tightly bound capsular fibrous tissue, and forceful contraction from the internal rotator muscles.

This generates excessive forces at the shoulder articulation, and the cuff muscles are highly active to hold the humeral head into the socket. Muscle fatigue can lead to loss of coordinated rotator cuff motion and decreased support. There are enormous valgus forces placed on the elbow, which tends to lag behind the inwardly rotating shoulder. A large degree of torque present on the elbow joint causes shearing forces to the articular cartilage.

This phase lasts 50 milliseconds, 2% of the overall time. It concludes with ball release at approximately the ear level.

4) Deceleration/follow through:

Not all of the momentum is transferred to the ball and very high forces pull forward on the glenohumeral joint following ball release, with a distraction force of 80% of body weight. The forces that must be countered are: humeral IR, glenohumeral distraction and elbow extension. This places large stresses on the posterior shoulder structures and elbow flexors.

Both the intrinsic and extrinsic muscles fire at near their maximum, in an attempt to develop >500N to slow the arm down. The spine and its associated musculature have a significant role as a force attenuator. Toward the end of the throwing motion, the torso begins to rotate forward, thus acquiring some of the kinetic energy of the arm, helping reduce the burden on the shoulder stabilizers which are attempting to stabilize the scapula and hold the humeral head within the glenoid. This phase lasts 350 milliseconds (18% of the total time).

Changes in throwing arm with repeated throwing:

At the shoulder, long term throwing athletes have an increased range of ER, because of repeated stress to the anterior capsule in the cocking phase, and stretch or breakdown of the inferior glenohumeral ligaments. This may lead to anterior instability of the shoulder and secondary impingement. Throwers often have more lax shoulders than non-throwers.

The normal strength of IR: ER is approximately 3:2, but in throwers this is exaggerated and over time lack of ER strength may increase vulnerability to injury.

At the elbow, repeated valgus stress could lead to a breakdown of the medial stabilizing structures (collateral ligament, joint capsule, and flexor muscles). This leads to an increased carrying-angle at the elbow. Less frequently, there may be anterior capsular strains, posterior impingement, or forearm flexor strains and a subsequent fixed flexion deformity.

Injuries associated with overhead activities

Shoulder

Typically overhead athletes will complain of pain during the throwing action. Repeated throwing often results in impingement, which can be superior or posterior; apprehension or subtle instability (typically anterior); and over time wear and tear changes to the rotator cuff and/or labral cartilage.

Pain during the wind up and cocking phase may be associated with lax anterior restraints, subtle instability and over time cuff tendinopathy.

Pain during the acceleration phase may be due to an internal rotation deficit, tight posterior cuff and internal impingement. Over time this could be associated with the development of a SLAP (Superior labral anterior-to-posterior) lesion.

A thorough biomechanical assessment, including analysis of throwing action, can determine problems with shoulder mechanics, and allow a targeted rehabilitation process. Often weakness in the ‘stabilizing’ rotator cuff muscles needs to be improved, along with scapulohumeral dysrhythm. A Sports Physician is ideally suited to examine such patients and coordinate rehabilitation. Investigations like ultrasound or MRI are occasionally warranted, and rarely operative intervention will be indicated. 

Elbow

The primary forces delivered to the elbow during throwing are a valgus and extension opening force. This produces:

Continued valgus and extension forces may produce olecranon tip osteophytes, loose bodies in the posterior or radio-capitellar compartment, and a kissing lesion (articular damage on the posteromedial trochlea caused by the olecranon osteophyte.  Subtle laxity may cause excessive soft tissue stretch with flexor-pronator mass tendinopathy, and ulnar neuritis)

Treatment typically involves a period of avoidance of aggravating activities, correction of biomechanics, appropriate strengthening rehabilitation, and a graded return to the provocative activity, monitoring for a return of symptoms.

Problems specific to young athletes:

Younger athletes are especially vulnerable to over head over-use injuries. Whilst they are exposed to the same forces as adults, growth plates remain open and are susceptible to stress related injuries, and may lead to long term deformity.

Problems in the shoulder include:

Traction apophysitis at the attachments of deltoid and pectoralis major

Rotational bone stress or stress fractures in the humerus

Shoulder impingement

Problems at the elbow include:

Medial epicondyle apophysitis

Lateral compartment osteochondritis dissecans

Traction apophysitis at the triceps attachment to the olecranon

In the sport of baseball, strict regulations apply specific to age, regarding the types of pitch allowed, as well as the number of pitches and innings permitted. This has been effective in reducing ‘little league’ shoulder and elbow pain. Most other sports rely on common sense in relation to appropriate training load. Unfortunately in this day of elite sport and high training volume at a young age, unrestricted load often results in over-use injury.

Elbow pain in Racquet sports:

Elbow pain is common in racquet sports, and may be due to dominant activity of the wrist extensors. The impact between the ball and racquet produces a significant amount of force, and the ‘shock’ transmitted to the arm depends on how hard the swing is; the speed of the incoming ball; where on the racquet face the ball hits; the quality of the racquet; the string tension; and the stroke mechanics. The ‘sweet spot’ is the area on the tennis racquet where the initial shock is at a minimum- if the ball misses the sweet spot there is increased shock transmitted to the hand, wrist and elbow.

Tennis elbow or lateral epicondylosis, is an overuse tendinopathy of the common extensor origin. Golfers elbow is the same pathology at the common flexor origin. Ways to reduce the shock at impact include:

Lower the string tension

Increase the flexibility of the racquet

Increase the size of the racquet head

Increase the weight (lead tape to the head and handle)

Increase the grip size

Grip higher on the handle

A larger grip size prevents the player from gripping the handle too tightly. It is only necessary to squeeze firmly on the grip during the acceleration phase of the stroke. Over time an eccentric strengthening programme has been shown to improve strength and function, and reduce pain. Adjunctive treatments such as corticosteroid injection, autologous blood injection or shock wave lithotripsy may have a role in recalcitrant cases.

An understanding of the biomechanics of over head sports allows the astute physician to determine injury likelihood, accelerate diagnosis, and to commence appropriate treatment and rehabilitation.

March is here and the football season is well and truly upon us. The Reds are off to a good start and the Broncos, Titans, Lions and GC Suns kick off their season soon. Of course best wishes to the Brisbane Roar for their impending Grand Final.

With all this excitement it is a good inspiration to dust off your sporting gear and get out amongst it. This month, our renowned Sports Dietitian, Lauren Nugent provides a fact sheet about the benefits of a Nutrition check-up. Lauren consults at BSEMS and is available for appointments on alternating Wednesday afternoons.

Have you had your nutrition check-up?

March is often the month where athletes, whether recreational, elite or simply a weekly participant; start getting serious about their training.  The pre-season is starting for footy codes, triathlon clubs are ramping up, running clubs are in full swing, rowing teams are in the water again, basketball and netball teams begin their competitive season and winter sports are raring to go. 

A full training load is not only a challenge to your physical body but also to your nutritional intake.  Many active people will keep their muscles and joints in top form with massage, physio treatment, a medical check, a podiatry review and a stretch regime, but have you considered your nutritional needs?  Do you need a nutrition check-up?

What is a nutrition check-up?

Your Eat Smart Dietitian will begin by questioning you about your sporting, life and medical goals.  Do you want to lose body fat, gain muscle, become fitter or lower your blood pressure?  Your Dietitian will then assess your current dietary intake in relation to your training habits.   You will then be given a list of goals to improve your nutritional intake and a complete nutrition plan to help you reach your potential.

I’m not an athlete, do I need a nutrition check-up?

Everyone can improve their diet to achieve better energy levels, improve body composition, improve sporting performance or simply get more out of life! 

I train once per week and play a game once per week, what can a nutrition check-up do for me?

Many things! Do you know how to prepare yourself on the day of the game?  Are you fuelling your body adequately on your training day?  Do you have adequate recovery fuel to maximize adaptations to training?  Are you confused on what you should eat and drink at half-time?  Or do you simply need to eat better every day to manage your weight? 

I’m just a general exerciser, could a nutrition check-up help me?

Absolutely!  Would you like to advance your fitness, step-up and do a fun run, increase your strength in the gym or simply feel better during and after exercise?  Then let one of the Eat Smart Dietitians assess your individual needs for the exercise you do and see what you can achieve!

Ear Smart Nutrition Consultants has 6 experienced Sports Dieititians who can give you a nutrition check-up to achieve your training, exercise and competition goals.

BSEMS February Blog

Well January certainly was a trying time for Queenslanders. Many of the staff and specialists at BSEMS were themselves directly affected by the Brisbane floods, or have close friends or family who were. The destruction caused by Cyclone Yasi was equally troubling to see, but we know the Far North Queenslanders are made of stern stuff. We hope everyone is finding their feet again after such a troubling start to the year.

Football Season

It is that time of year again (already!) where the football season gets up and running again. Trial games have already begun for the Reds, and Dr Matt Hislop will be busy covering games for the Reds Academy team, and soon after that the Broncos. After seeing the damage caused to Suncorp Stadium, it will be truly awesome to see it up and running again so quickly. Dr Daelyn Vivers will busy herself with club Rugby games, and hopes to step up to being the Reds full time doctor in the not too distant future. Our new Registrar Dr Tom Gan will be involved in game coverage for the new Gold Coast Suns AFL development team.

Welcome to Beth Sheehan

We are pleased to welcome our newest practitioner Beth Sheehan. Beth is an Exercise Physiologist who adds her wealth of experience to the BSEMS clinic. She has recently returned from overseas work and has re-settled back in Brisbane. Beth specializes in exercise programs for individuals who suffer from chronic pain as well as rehabilitation programs for sporting and work related injuries.

Our resident Podiatrist, Mr Craig Page has provided the latest timely fact sheet. Craig now undertakes sessions at BSEMS every Friday afternoon. Craig will assess your foot type, gait pattern and foot function, as well as offer advice on appropriate footwear for your particular foot type and chosen sport.  Please contact our staff for more details.

Choosing the Right Football Boots

The start of the football season often means new boots. Finding the right boot is important for both comfort and injury prevention.  The following information will help you decide on the boot that is best for you.

Features to look for:

Upper – In recent times much research has gone into developing the optimal combination of materials for use in the upper. For instance there are uppers which are designed to enable the player to add spin to the ball and there are uppers that incorporate chemical coatings to provide additional grip. The upper needs to be strong enough to support your foot during rapid changes in direction and when kicking.  Combination leather and synthetic uppers are the strongest particularly when reinforced with ample stitching. Kangaroo leather is becoming particularly popular due to its strength and ability to mould well to the foot, whilst remaining very light.

Heel counter – The heel counter or heel cup needs to be very rigid to support your rear foot during swerving & stepping. A sturdy deep heel cup can prevent injuries especially in young footballers.

Midsole – More and more boots today have midsoles or wedges under the heel and even the forefoot much like a touch football boot (hybrid between joggers and a conventional boot). A boot with a midsole provides cushioning and support which is desirable for injury prevention. These are particularly good for young footballers that suffer from heel pain or ‘severs’(growth plate inflammation) or any player that suffers from lower limb injuries such as shin splints, Achilles tendonopathy and chronic knee pain. The extra bulk in this type of boot is the only downside and serious players often prefer to use them for training only whilst staying with the traditional style boot for game day.

Outsole – The outsole must be rigid and match the width of the foot. A narrow outsole will cause the foot to hang over the edge of the sole and place more pressure on the upper, which decreases the stability of the boot. The outsole should only flex at the forefoot in the position that the toes bend, all other movement in the outsole should be minimal.

Moulded Vs Screw-in studs – Football and rugby in Queensland is generally played on very hard surfaces, therefore, a moulded boot is far more suitable and a lot safer. It is important to make sure there are no studs positioned directly under the big toe joint and that the studs do not stop the boot flexing where it is suppose to – under the ball of the foot. Many footwear companies are using cleats/blades rather than the traditional circular stud shape. The advantage of a cleat system is the ability to provide greater grip without increasing the weight of the boot. Anyone who has had a knee reconstruction or suffers from instability in the knee joint should be careful not to use an aggressive cleat design as the increased grip may cause the foot to remain stuck in the turf whilst the upper leg rotates, potentially leading to excessive twisting through the knee.

Fit – a correctly fitted boot is an important factor in prevention and treatment of foot injuries. There should always be a thumb nail width from the longest toe to the end of the boot. There should also be adequate depth to ensure your foot sits securely in the boot.

At Brisbane Sports and Exercise Medicine Specialists, our Podiatrist Craig will assess your foot type, gait pattern and foot function, as well as offer advice on appropriate footwear for your particular foot type and chosen sport.

Happy New Year to all of our BSEMS patients, staff and friends.

We hope that 2011 proves successful in maintaining health and fitness. If you are struggling than feel very welcome to come and see one of our specialists- at BSEMS there is someone who can help get you back on track.

Welcome to Dr Thomas Gan

In mid January Dr Tom Gan will be commencing sessions at BSEMS. Tom is a senior registrar, meaning he is nearing completion of his Sport and Exercise Medicine specialty training. Tom has worked as a team physician for various elite sporting teams and has also been medical director for world class sporting events such as the Brisbane International Tennis tournament.

He has many professional interests including lower limb stress fractures, tennis injuries, cricket injuries, and trigger-point acupuncture.  He is available to provide consultations for a variety of paediatric and adult sports medicine conditions.

Tom will be working Tuesday mornings between 8am-12pm in the BSEMS rooms.

This year we are aiming to include a fact sheet from one of our practitioners to each blog. The fact sheets will be catalogued in our “Patient Info” webpage, under appropriately enough “Factsheets”.

For January we have provided an information sheet for patients and referrers regarding the appropriate preparation needed before a compartment pressure test is performed. This can help ensure that the test is performed correctly the first time and to reduce the chance of a false negative investigation.

Compartment Pressure Testing

Pre-test Preparation

Chronic exertional compartment syndrome is a cause for leg pain with exercise. The usual pattern is a gradual increase in pain during continuous exercise to a point when the athlete has to stop. Pain then takes between minutes to hours to go. Patients describe a feeling of hardness or fullness in their legs, and occasionally will notice lumps in the muscles. The condition is diagnosed by performing a compartment pressure test (CPT).

During a CPT the patient must be able to reproduce their leg pain as bad as they can get it. This means that in the days to weeks before the test is done, the patient should perform moderate level exercise (and not rest) so that they can reliably reproduce their symptoms on the day of the test. The patient will also guide the Sport and Exercise Medicine (SEM) Physician as to which compartments need testing, and they must pay attention to where they develop their pain (i.e. front of the leg, side, behind the shin bone, or more than one area).

The CPT involves injecting a small amount of local anaesthetic into the skin at the sites where the pressures will be tested. The patient will then jog/run/whatever needs to be done to bring on their symptoms, usually for 10-15 minutes. They then return to the room, and the SEM Physician performs the test, which involves inserting pressure manometer needles into the relevant muscles. One special needle has a catheter inside it, and this remains in the leg while the patient does specific exercises, whilst the pressure in the leg is monitored.

The test is very safe, but complications can occur- listed below. The test takes one hour. Typically the patient can drive or fly after the test is completed.

The SEM Physician always prefers to see the patient before arranging a time for the test, to ensure the test is done correctly right the first time, reducing the risk of getting a false negative result. If the diagnosis is confirmed, then the only real treatment is surgery (a procedure called fasciotomy, performed by an orthopaedic surgeon).

Complications

Compartment pressure testing is a relatively safe procedure, but is an invasive intervention, and some complications may result including (but not limited to):

Infection

Bleeding and bruising at the puncture sights

Possible (permanent) damage to underlying blood vessels

Possible (permanent) damage to underlying nerves, resulting in sensory or motor disturbance

Failure of the procedure

Risk of development of acute compartment syndrome requiring and urgent operation

Risk of development of a complex regional pain syndrome

Please feel free to discuss any questions or concerns you may have with the BSEMS staff and specialists.

A big thank you!

BSEMS practitioners and staff would like to thank everyone for their fantastic support in 2010. Over the past 8 months the multidisciplinary clinic has grown, and we still strive to be your ‘one stop shop’ for Sport and Exercise Medicine needs. We would like to wish all of our patients and clients a safe and happy festive break, and look forward to working with you to keep you fit and active through 2011.

Welcome to Christina Harwood

BSEMS would like to welcome the newest member of our team, Christina Harwood. Chris is an Occupational Therapist and works with the well known and respected EKCO clinic.

Chris’ work will complement that of our Upper limb surgeon, Dr Darren Marchant, particularly benefitting his post-operative patients, and helping them with their rehabilitation. Chris is more than happy to see new patients or see referrals for any patients requiring aid with upper limb rehabilitation or needing elbow/wrist/hand splints.

Christmas Opening Hours

The BSEMS clinic will be shut for Christmas from the 20th December until the 2nd January 2011. If you have an emergency that requires urgent attention in this period please present to your closest Accident and Emergency centre. The rooms will re-open with business as usual from the 3rd January 2011.

Important Announcement

Sports and Exercise Medicine has recently been accepted as one of Australias new Medical Specialist groups. Whilst this is more of a bureaucratic decision, it has important implications on patients seeing Sports Physicians.

From the 1st November 2010, patients seeing Sports Physicians will require a current letter of referral from either a GP or other Medical Specialist, if they are to be eligible for a Medicare rebate. Patients without a Doctor's referral can of course be seen, but the consultation will not attract a rebate from Medicare.

The BSEMS staff will be able to tell you whether you have a current letter of referral when you book or confirm your appointment. If you require any aid or a letter to your GP explaining the need for referral, we will be happy to forward this to you. We apologize for any inconvenience this abrupt change may cause in the short term.

Sports Psychology

Allira Rogers is our Sports Psychologist consulting at BSEMS every Tuesday afternoon. Allira has been closely watching the Delhi Commonwealth Games, and has seen how the difficult conditions can play on an athletes mind. Please enjoy her contribution below:

One of the key skills that elite athletes have is the ability to create a consistent mindset for every performance.  You would have heard terms like the ‘zone’, ‘bubble’, or ‘ideal performance state’ or what we at Mental Notes Consulting call ‘A game’.  An athlete’s ‘A game’ is when their mind and body are working together to produce optimal performance on a consistent basis. In short, elite athletes know how they want to think, feel and behave to achieve peak performance consistently and they know what makes them compete to their best.  Having this understanding and identifying what you want to be thinking, feelings and behaving for peak performance is what the team of sport psychologists at Mental Notes help those they work with no matter what level, age and sport through the use of various mental skills.

In addition to having a good understanding of what you think, feel and behave when you perform well it is valuable to consider what factors can affect your performance and take you away from your ‘A game’. Athletes constantly face an array of stressors relating to both the competitive and noncompetitive nature of the sporting environment which subsequently place them under intense psychological and physical strains. That is, athletes of all levels and ability are not immune to the impact stressful events within their sport have on their psychological functioning (e.g., increased anxiety, concentration issues, negative self-talk, lack of confidence).

The 2010 Commonwealth Games have been rich in demonstrating the many demands and setbacks elite athletes from across the world have had to face and deal with so as to limit the impact they have on their performance. Some of these demands and events are controllable and some are uncontrollable. The most important thing that elite athletes can do is realise what is in their control and focus their energy and attention on this; their thoughts, feelings and behaviours. That is, their reaction to an event in is their control. For example, swimmers at the games have had to deal with debris in the pool, delays in the starting of events, loud crowd noise as they have taken the blocks to start a race and false starts. For example, the swimmers in the 200m Men’s Relay Final, had to deal with a delay in starting due to debris in the pool.  South African sprinter Roland Schoeman, had to reset his focus after a mishap in the Men’s 50m freestyle event to progress into the final.

However, what elite athletes possess is the ability to deal with these demands and setbacks more effectively to help get them back into their ‘A game’ to help perform the way they want to. How is this? Well, elite athletes have trained all aspects of their sporting performance; physical, technical, tactical and MENTAL. At this level, these athletes know that their competitors have probably done similar types of training for similar amounts of time. That is, the physical difference between them is smaller and what sets them apart is their ability to deal with setbacks, pre-competitive nerves; their MENTAL performance. A good example of this ability to bounce back after a setback will be Sally Pearson in the 100m hurdle at the Games. She was stripped of her gold medal in the 100m women’s sprint final after a contested false start. However, as Sally mentioned "I am in this sport as a competitor and as an athlete just like anyone else. This is our career, this is our job. This is what we train for. To run the race [and] do the victory lap and then be told; 'Oh no you can't have your medal now' is horrible. But I have to deal with it because that's just the way sport is." Through the use of mental skills, athletes can deal with setbacks and demands of their sport so as to recreate and maintain their ‘A game’ on a consistent basis. We can all learn from the elite athletes no matter what age, ability level and sport as we all want to perform at our best consistently.

For more information, contact MNC consultant Allira Rogers by email at allira@mentalnotesconsulting.com.au. Allira works at the Brisbane Sport & Exercise Medicine Specialists at Hawthorne.  Alternatively, visit our website www.mentalnotesconsulting.com.au.

Welcome to the BSEMS September Blog

Platelet-rich Plasma and Autologous Blood Injections

The Sports Physicians at BSEMS are pleased to offer Platelet-rich Plasma (PRP) and Autologous Blood Injections (ABI) to our patients. Please refer to our fact sheet for more information. This intervention should be considered an adjunct to a detailed strengthening programme, and is typically used for recalcitrant tendinopathies.

Welcome to Dr Peter Myers

BSEMS would like to welcome Dr Peter Myers, world renowned Orthopaedic Surgeon to the clinic. Dr Myers has long been the preferred knee surgeon for The Brisbane Broncos and Queensland Reds, and is a world leader in meniscal repair, and transplantation. Dr Myers expertise only adds to the wealth of Specialists consulting at BSEMS, and we are happy to have him on board.

Delhi Commonwealth Games

BSEMS would like to wish all the Australian Athletes all the best for the Commonwealth Games competition in New Delhi! After a bit of a rough start, we are sure now the competition has started that India will have its chance to shine as host. A few of the athletes experienced some last minute hiccups before departing andDr Hislop and Dr Vivers were happy to do their part for Queensland based competitors.

Team Coverage

The long NRL and AFL seasons have finally come to an end for 2010, and not without much drama. The Brisbane Broncos are enjoying a well earned break, but the Reds and Academy players will start their preseason over the next few weeks. Dr Hislop was also privileged to help out with some game coverage for the Brisbane Roar football team in September.

Feedback

Please let us know how we are doing. BSEMS strive to offer a world class service to Queenslanders and if you think of ways we can do better please let us know.

Until next time, stay fit, healthy and active.

The BSEMS team.

Welcome to the first blog from BSEMS.  We hope to make this a regular occurrence, and a chance to pass on information on what is happening behind the scenes at BSEMS, as well as to provide information on topics provided by our specialists.

Since opening on the 7th April 2010, we have seen hundreds of patients from southeast Queensland with Sports and Exercise medicine issues. The first 5 months have been great, and we look forward to growing and providing a one-stop-shop for Sports Medicine. We have a multidisciplinary team waiting to help wherever we can. Every 1-2 months, we will endeavour to provide a topic of interest on the blog from one of our specialists.

Team coverage

Dr Matt Hislop is joint team physician for the Brisbane Broncos, and looks after the Reds Rugby Academy. The past few months have been a busy time with team cover.

Rugby League:

Dr Hislop was also happy to help with the screening and coverage of the two Queensland teams that played the curtain raisers for State of Origin game 2 held at Suncorp. Of course the real achievement of the night was when Queensland won the series for an historic fifth time.

The last few months have been interesting with the Broncos unfortunately falling short and out of finals contention for the first time in 17 years. Darren Lockyer's rib injury was quite significant, and it is a testament to him that he came close to returning to play. The timing of his injury was incredibly bad for the Broncos, but that is the nature of any sport. The Broncos no doubt are looking forward to some time off, before starting up again for the preseason.

Rugby Union:

The club rugby finals are on at the moment. It has been good to see many past Reds Rugby Academy members progressing to play Super 14 for the Reds- Poutasi Luafutu, Quade Cooper, Scott Higginbotham, Luke Morahan, and Ben Lucas to name a few. Dr Hislop is proud to be part of the team that helps young and upcoming rugby players in the best Academy programme in the country. His Academy role helps with screening, injury prevention, and management of injuries when they do occur.

Soccer:

Dr Hislop was privileged to be invited to help with medical cover for Everton FC when they completed their successful tour of Down Under in July. Thankfully the game was completed injury free, as the team had to board a flight back to the UK later that evening!

Dr Daelyn Vivers

BSEMS have been happy to welcome Dr Daelyn Vivers who has arrived from Perth recently.

She is settling in well and developing a dedicated patient following.

Dr Vivers is the newly appointed QAS Swimming doctor, and also looks after Water Polo.

She was involved in the coverage of National Short Course Championships at the Sleeman Centre, Chandler in July. Many of the well known Queensland swimmers have gone on to do well at the Pan Pacs Championship recently held in the USA, including Jessica Schipper, Sophie Eddington and Emily Seebohm.

Dr Vivers has recently undertaken a thorough review of exercise induced asthma and its management and is happy to manage any musculoskeletal problem.

Feedback

At BSEMS we are proud of our world class new rooms, great website, and our multidisciplinary team of specialists. We want to make life easy for our patients, by offering a one-stop shop for Sports and Exercise Medicine. (We do not have physiotherapy on site, but work closely with many of the excellent sports physiotherapists in our area.) Please peruse our website for more information on what each practitioner does. We welcome and value your feedback, both positive and negative.

Best regards until next blog!

Dr Matt Hislop

Practice Principal