Great that @CJSMonline has made our Systematic Review of the safety and use of local anaesthetic injections in sport a free view and download…
Limited data, but we did find 1970 injections in 540 athletes from 10 studies in the Sports Medicine literature. Only from football codes at elite level - nothing at amateur level or outside football (where hopefully use is uncommon anyway)
Data on safety best for A/C joints injections, iliac crest, some finger injuries. However safety data not generally verified by independent study methodology
A/C joint pathology has good rationale for safety in that A/C OA not a long term likely cause of morbidity, so with some long term data to back up this theory it can be given soft ✔️in pro football
There might be a real phenomenon of rupture of the plantar fascia origin under local block “curing” the condition although much more work needed to prove this
Very little data on whether ultrasound guidance is useful, but for rib injuries it would almost seem essential given that pneumothorax is a possible complication
Given how common knee osteoarthritis is post football career, you’d need to be very very judicious about ever injecting knee to play, as the connection highly likely to get made 20+ years down the track
But....if you are talking Superbowls, Champion’s League finals, AFL Grand Finals, State of Origin games or the Olympics, maybe consider? That is why Sports Medicine is not a trivial specialty. Doing this in front of millions who will watch, as well
Knowing nerve anatomy also critical. Don’t go near lateral popliteal nerve, sciatic nerve, femoral nerve etc or you might get a player who can’t run. The risk of injection without the benefit of playing
Not an area with much published literature but a critical one. Important that (1) Sport and exercise medicine is recognised as the specialty it is and (2) the “don’t ask don’t tell” culture on injecting players to player becomes one of publication to define when it’s safe
A reminder: what it’s like to work in pro sport on TV every week....…
A one metre putt in golf is easy, but when it’s to win the US Masters, it is the most difficult putt of your life. Sports medicine (and injecting an A/C joint with local) is easy, but on international TV, much more difficult 😳😅🏃‍♀️🧑‍⚕️⚽️🏈🏟🏉
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More from @DrJohnOrchard

5 May 20
Thread: If the Australian Medical Association (AMA) wants to have some input on safe return to sport during the pandemic, their first step should be to recognise Sport & Exercise Medicine (SEM) as a specialty.
AMA and their President Tony Bartone made a media release earlier this week cautioning the NRL against an early return to play and said that the NRL should heed “expert medical advice”…. I have comments!
Unfortunately, Tony and the AMA are speaking from a position of ignorance about the level of expert medical advice that the professional sports are receiving. There is plenty of expert medical advice going to the NRL and all other pro sports
Read 19 tweets
29 Mar 20
The specialty of Sport & Exercise Medicine (SEM) in Australia and Telehealth. Thread spoiler: SEM physicians have effectively not (yet) been included. For SEM Telehealth, the patient will have to pay the full fee with no rebate.
It is already know that SEM specialists do long consults with few procedures – a very detailed MBS Review document (via SCPCCC) proved this in 2019
SEM is therefore a specialty with good potential to do Telehealth consults, as Exercise Prescription/loading is our signature treatment and can safely be done over Telehealth.
Read 15 tweets
25 Mar 20
@ACSEP_ @ESSA_NEWS media release - Boot Camp groups of 10 are not recommended as safe during the Coronavirus Pandemic. Alternate safer exercise options are advised in this media release
Outdoor exercise in groups up to 10 people (such as with “boot camp”) is permitted under Australian Stage 2 restrictions, however, there are good reasons why we should NOT be participating in such activities.
Exercise, indoors or outdoors, remains safe and beneficial during the COVID-19 pandemic unless you are subject to quarantine. Keep a distance of 4 metres between people when walking, running or doing activity where you are puffing hard
Read 12 tweets
24 Mar 20
Thread on Sport & Exercise Medicine (SEM) specialists in Australia and Telehealth. SEM physicians need to be included in Greg Hunt's plan for Telehealth and I'll explain why..... 1/thread
Example: Low back pain accounts for 2% of all Australian Emergency Dept visits… that is 160,000 ED visits annually or 400 per day; back pain is the 5th most common ED diagnosis…
Far too many ED patients get medications and scans (although some need these) and far too few get prescribed exercise……… but in the current climate the worst thing about LBP is unnecessary clogging of EDs
Read 12 tweets
12 Feb 20
One of these muscle strains is not like the others, out of hamstring quadriceps, calf and groin. Read through this short thread to find out which from our latest @BJSM_BMJ paper.....
But pre-poll (no peeking below) which of the “Big 4” has the most differences from the other 3 from an Epidemiology perspective? [be brave and have a guess....]
....if you answered “groin” it was the best incorrect answer, as you can argue that diagnostically it is the least pure and therefore perhaps the most polluted dataset of the 4. But actually the correct answer is “Calf strains” - behave differently from the others
Read 9 tweets
11 Feb 20
This is a reprised thread to celebrate some of the outstanding female Sport & Exercise medicine physicians in Australia who are on Twitter, as part of
@WomenScienceDay #WomenInScience #WomenInSTEM @ACSEP_ @womenandmed
@WomenScienceDay @ACSEP_ @womenandmed @ACSEP_ now has a female President
@DrLouiseTulloh who is providing terrific leadership. As well as ♀️ President, ACSEP has female CEO @hoover22
, 50% board representation… >50% office staff and Gender dashboard to try to increase equity on other metrics
@WomenScienceDay @ACSEP_ @womenandmed @DrLouiseTulloh @hoover22 @DrLouiseTulloh will leave a legacy of actively increasing the female representation across leadership of all levels of the College and making sure prospective ♀️ SEM physicians have visible role models
Read 15 tweets

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