• Newsletter Summer 2017

    Sports Doctors Australia Newsletter No:9

    Summer 2017

    We are approaching the end of a summer that has been one of superlatives in Orange- hottest January and possibly February on record, the hottest day ever in Orange, and a short but severe drought after one of the wettest years on record. This has had an effect on local sport with regular cancellations of junior sport due to heat, after frequent cancellations last year due to wet grounds.

    Locally, we are approaching the Orange Running Festival next Sunday with the possibility of cancellations. Having been a victim of heat stroke myself in last year’s marathon, I have been lobbying organisers to take heat and humidity into account and cancel if necessary.Although the effect of climate change appears hard to predict and quantify, it would be hard to deny its impact.

    National sport has seen women’s sport growing in prominence with the Women’s AFL, soccer, as well as netball in the near future gaining airtime on television. Crowd numbers have been impressive. Concurrently, Sheffield Shield is largely unreported and attendances poor, though BBL goes from strength to strength (for those with very short attention spans!). The impending Test tour of India appears to be a foregone conclusion, with a “competitive loss” the most hopeful outcome.

    2016 SMA Conference

    Dr Gill Cowen provided the following report:

    Mid-October brought the Sports Medicine Australia Annual Conference with attendance at the MCG for this 4 days event including Medical Professionals, Scientific Researchers and Allied Health Professionals, all with one common desire – to improve exercise participation, whilst ensuring the health of the athlete.

    Dr Andre le Gerche (Cardiologist) provided a particularly interesting and informative presentation “Palpitations in athletes; which are important?” Important take home messages from this presentation were:

    In general, arrhythmias in structurally normal hearts are benign, but what is a normal heart in an athlete? In athletes it can be difficult to sort out what a “normal” heart is on ECHO; MRI (with gad) can be used to show scarring in the heart but its clinical significance is uncertain.

    SCD occurs in 1/50-100000; always ask about presyncopic episodes and epilepsy in the athlete, and their family history.

    If an athlete reports an arrhythmia try to record it – there are now phone apps which in conjunction with finger sensors can be used by athletes to help with this.

    Mr Jason Harvey (Orthopaedic Hand, Wrist and Elbow Surgeon) presented a useful talk on hand injury. Key messages included:

    Stiffness is the enemy

    Restore function

    Err on the side of a longer recovery

    He also emphasised that important factors when taking a history and examining a patient with hand injury are:

    Mechanism of action

    Direction and force of trauma


    Is the injury acute, or acute on chronic?

    Localised point tenderness.

    ASADA reported that Globaldro is the new “check your substances” website link. The ASADA website provides a list of who require advanced TUE, and further information was given regarding issuing of retroactive TUE in circumstances such as medical emergency in an elite athlete.

    Dr Tim Low and I presented 2 workshops on Concussion Management for the Allied Health Professional, on behalf of Sports Doctors Australia. This was well received and emphasis was placed on return to learn before return to play in the child and adolescent population, as well as emphasising the need to look out for the updated Consensus Statement on Concussion which is expected in the BJSM early next year following Berlin 2016.

    The highlight of my conference was a fabulous presentation from Glenn Gaesser, Healthy Lifestyle Research Centre, Arizona University, entitled Fitness v Fatness. It was concluded that cardiorespiratory fitness attenuates much of the risk associated with obesity but that moving away from the weight loss paradigm in a shift towards increasing the cardiorespiratory fitness of the bottom 20% of the unfit population significantly reduces morbidity in this group, and that despite a strong genetic component to cardiorespiratory fitness, the reduced risk of mortality with improved fitness is likely to be related to the physical activity induced change in fitness itself.

    Weight/ Diet

    From my earliest GP days I have keenly followed research and debate on the interaction between dietary fat and carbohydrates, blood lipids, lipid fractions, weight, insulin resistance, and cardiovascular risk. My experience in general practice, though anecdotal, has been that there is no obvious link between total cholesterol and cardiovascular events. The link between “healthy diets”, as espoused by the Heart Foundation and multiple agencies and weight/ diabetes/ cardiovascular risk has always seemed tenuous. Food pyramids have changed little over the decades since their introduction, yet seemed to be based on very poor or limited evidence.

    Recent BJSM reviews by Tim Noakes (British Journal of Sports MedicineJan 2017,51(2)133-139;DOI:10.1136/bjsports-2016-096491) and Zoe Harcombe (British Journal of Sports MedicineOct 2016,bjsports-2016-096734;DOI:10.1136/bjsports-2016-096734) have examined research in detail and questioned the basis for public health food guidelines. The Heart Foundation website fails to differentiate between dairy-sourced saturated fats and trans-fats in its list of unhealthy foods. In “The Big Fat Surprise” (Simon and Schuster Paperbacks; 2014) Nina Teicholz conducts a detailed history of the development of the “Low fat High carbohydrate” mantra and examines the research behind it. Sadly, teaching at an undergraduate and postgraduate level in medical schools and specialist colleges seems reluctant to question of update the simple message that “fat is bad, animal fat is the worst, complex and simple carbohydrates (e.g. fruit) are good”. The PBS still accepts a total cholesterol level of 7.5 in non-Aboriginal men above 35 years of age with no significant family history of coronary artery disease or diabetes as an indication for statin therapy, regardless of HDL, LDL, or LDL sub fractions. A brief reading of the evidence would suggest this is a gross oversimplification.

    Concurrently, there is a plethora of excellent research showing the benefits of regular exercise on cardiovascular disease, with no clear evidence of an effect on total cholesterol (HDL often increases with LDL decreasing), yet cardiovascular health is not factored into public health equations determining degree of risk, or suitability for statin prescriptions.

    I am hopeful with more and more good quality research being performed, public health recommendations may eventually reflect our changing understanding.


    NSW- New Horizons in Sports Medicine; Thursday 11 May 2017, Novotel Sydney Brighton Beach; http://sma.org.au/conferences-events/professional-development-calendar

    2017 ASICS Sports Medicine Australia Conference; Wednesday 25 October, 2017; The Weston, Langkawi; http://sma.org.au/conferences-events/professional-development-calendar


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