Picture of Domhnall MacAuley cross-country skiing

From Domhnall MacAuley, CMAJ Associate editor, in Monaco

Dr Richard Budgett, IOC Medical Director and former Olympic gold medalist, pointed out in his introduction to the IOC World Conference that “It’s about the athlete”. Raymond Verheijen , the straight talking Dutch Director of the World Football Academy, underlined this message in his talk aimed at coaches of elite level soccer. Although it’s all about winning (and money), if you want to win, you have to keep the players on the pitch- injury free. The goal is performance. But only healthy athletes can perform.

Sports injuries feature daily in the back pages of the newspapers and often make prime time headlines.  This conference had the inside track on the latest pioneering research, controversies and innovations.

Cruciate ligament injury can cost your career. In sports that require athletes to make sudden changes in direction, anterior cruciate rupture is devastating. Yet there are now preventive strategies, supported by good evidence based on high quality randomised controlled trials. Implementation has been especially successful in soccer. Research findings have been integrated into the FIFA11+ programme and rolled out across the world. Could we screen athletes, to identify those most prone to cruciate injury? Yes, according to Tim Hewett (USA), who showed how those with valgus movement on a vertical jump create a rotatory movement-effectively treating their knee hinge almost as a ball and socket joint. But, will it predict injury?

Ankle injury prevention, based on equally robust evidence hasn’t had the same penetration and uptake. Evert Verhagen and team (The Netherlands), developed a primary prevention programme based on sound evidence built from empirical work, observational studies, and systematic reviews, and ultimately evaluated in randomised controlled trials. They also developed an “app”, available on iTunes, which they are currently testing in a randomised controlled trial. Verhagen, who is particularly interested in the use of modern electronic media, in a keynote address, showed how to use online technology to recruit research participants; explored the potential of twitter; demonstrated the value of online data collecting; and described how some of his students even use twitter to take and share lecture notes. He also told us scary stuff about the data we generate on our smart phones- someone somewhere knows where you are, what you are interested in and, from a physical activity perspective, knows how far you have walked, run or cycled, just from data collected by your phone.

Sudden death in the sports arena always make headlines. Medicine has been searching for the optimum screening protocol- including questionnaires, clinical examination, ECG and echocardiography – that could help us reduce sports related cardiac events. Again, the experts had few conclusive answers. We follow families after a sudden death, and underline the importance of taking symptoms such as dizziness and syncope more seriously. But, Lucy Free (UK), a rowing doctor, pointed out to the expert panel, that almost every athlete she knows feels a little dizzy after an ergometer test!  A reality check from the sharp end by a team clinician. It’s not easy for the specialists either: Michael Papadakis (UK) discussed variations in 12 lead ECG findings in black and white athletes and at different stages in the transition from adolescent to senior athlete making interpretation especially complex in national squads with a large ethnic mix. Sanjay Sharma (UK) pointed out the difficulties in differentiating cardiomyopathy from physiological hypertrophy where it’s not just the size of the ventricular wall that counts but left ventricular cavity size too. And, if all the tests are equivocal, the ultimate diagnostic indicator is if the echocardiographic changes reverse on de-training- but try asking a top athlete to ease off on training! Sanjay left immediately for London as he is also medical director for the London marathon where, sadly, they had an event related death yesterday. Jon Drezner (USA), a team doctor with the Superbowl winning Seattle Seahawks, emphasised the importance of sideline doctors being prepared for sudden cardiac events. He showed some stark videos of sudden cardiac events- tough viewing for our non-medical colleagues. But it was effective. Be prepared and think “What if”.  An entirely appropriate message coming from Monaco- where it seemed there was an AED at every bus stop.