PB 1

26-27 MAY 2022THE GRAND HOTEL, BRIGHTON

BASEM 2022CONFERENCE

‘Come and meet your Peers at

the Pier’

POSITIVE HEALTH Performance

2022 THEME

ABSTRACTBOOKFurther information available atwww.basemconference2022.co.uk

European Accreditation Council for Continuing Medical Education

(EACCME®)An Institution of the UEMS

2 3

2 3

WELCOMES 4

COMMITTEES 7

PRIZE ORAL PRESENTATIONS 8

ORAL PRESENTATIONS 15

POSTER PRESENTATIONS 59

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

60

MUSCULOSKELETAL PRIZE POSTERS 135

TOM DONALDSON PRIZE POSTERS 148

AUTHOR’S INDEX 173

CO

NT

EN

TS

4 5

Dear Delegates

Welcome to Brighton!

Whether you are joining us in person or virtually, I am delighted to extend you the warmest of greetings. I’m sure I’m not the only one who is grateful for this event after the last two

years; it feels like such a privilege to gather together and learn and catch up with each other.

This event could not come together without the hard work and dedication of the conference team - and they have been working diligently for an extra long time following the postponement of the original conference in 2019. The conference chairs; Professors Nick Webborn and Yannis Pitsiladis, along with the conference programme director; Dr Dora Papadopolou, have never waivered in their enthusiasm and commitment to the event and it is great to see their efforts come to fruition. Their vision has been guided into reality by the excellent BASEM team; Lucy Bateman, Amanda Harwood, Ian Rouse and our new CEO Lynda Phillips. And very much supported by Kay Brennan as BASEM Chair of Education and her education committee.

I would like to say a huge thank you to all our speakers and session chairs who have given of their time to share their wisdom. There are too many to highlight by name, but, suffice to say there is something for everyone! In addition this year it is great to be showcasing an abundance of work from up and coming researchers - do dip into the abstract sessions and review the posters to support them. And I would also like to extend my thanks to the scientific and awards committees for their work judging all the submissions and prizes.

This conference is as much about connection as it is about learning and there are many social opportunities on offer too; which of course includes some physical activity sessions! Do check out the details and sign up at the conference desk. The BASEM non-executive board and I are looking forward to speaking to as many of you as possible and hearing your stories and ideas. If you would like to get involved in BASEM in the future please come and talk to us.

It’s been too long, but here we are, a chance to celebrate the amazing work of so many colleagues and to remind ourselves that we are stronger together. It is our diversity of life and work experiences that make sport and exercise medicine such a special discipline. Over these two days we will applaud the achievements of our fellow workers and use this to strengthen our interdisciplinary relationships going forward.

I wish you a very enjoyable time!

Eleanor

Dr Eleanor Tillett

BASEM Chair

BASEM CHAIR WELCOME ADDRESS

4 5

CHAIRS WELCOME ADDRESSDear Delegates and friends,

We are delighted to welcome you to Brighton for the BASEM Annual Conference 2022.

It is three years since we first began planning this conference which became delayed through 2020 and 2021 by the covid pandemic. Many events, including

sports medicine congresses went ahead around the world in hybrid or fully virtual, but we were not willing to go that route and agreed from the start that we would have a real conference where we could rub shoulders with the best, network, meet old friends and create new friends, and enjoy the atmosphere of one of the most vibrant cities in UK.

This 3-year long delay has allowed us to gain experiences of both summer and winter Olympic and Paralympic Games, which we can bring to the conference. You will note the two key themes of BASEM 2022 are Olympic and Paralympic sports medicine, that celebrates our passion and work of the last few years. Very importantly it will highlight what we have learned in the care of athletes in a global pandemic and the implications of this for future approaches to risk management. In designing the programme, first and foremost we listened to your feedback for Glasgow 2019.

Many of the major topics affecting the health of athletes and the performance outcomes will be covered over the two days - from injury surveillance to optimal preparation for competition, to mental health issues, impact of doping, impact of technology, how we have managed to keep the show on the road despite the pandemic and what impact has it had on all stakeholders from athletes to their support staff. Other public health topics such as how to cope with the biggest threat to mankind - starvation from physical activity made worse by the pandemic. The programme is truly unique and totally up to date on all important issues and combines both renowned international experts with the extraordinary local expertise here in the South East region. We have had near 100% acceptance by our invited speakers to come speak at the Brighton event reflecting also the amazing venue and the much to see and do city of Brighton - the sunshine capital of the UK and much more.

We are also particularly excited that the founders of the Global alliance for the promotion of physical activity will attend the event and outline their roadmap of change. Notably, and for the first time, EFSMA, the European Federation of Sports Medicine Associations, will also attend and enrich our event and use the opportunity to have their meetings/elections at the same time.

We hope this conference will give you an amazing opportunity to network and "fist bump" with the who's who of sport and exercise medicine. The likes of Richard Budgett, Fabio Pigozzi, Wayne Derman, Juergen Steinacker, Peter Weyand, Mats Börjesson, Rob Galloway, Alan Vernec, Evert Verhagen and many more new stars.

Professor Yannis PitsiladisProfessor Nick Webborn

6 7

BASEM PRORAMME DIRECTOR WELCOME ADDRESSDear Delegates, Dear Friends

It is my pleasure to bid you a warm welcome to the Annual BASEM 2022 Conference in Brighton.

What a challenging time it has been. Who could have predicted this?

In November 2019, we were preparing with the Chairs and team BASEM to welcome you to Brighton for the 2020 Annual BASEM Conference. When the first news about COVID struck it was beyond our imagination how it would all play out. Although lots

has changed, we are very proud of the programme for the new 2022 version #basemconf22. We have kept the original speaker line up but have also reflected on the past two and half years, embracing the future with a fresh look.

Inspired by your feedback from our previous conferences we tried to extend the concept this year and we are excited to have created a stream dedicated to the next leaders of SEM for the first time. We are looking forward to seeing you presenting in the podium session.

The conference is the first ever Hybrid BASEM event and as much as we are excited to see you all face to face, we are grateful that we can welcome for the first-time delegates from 46 countries. This far-reaching international audience is un-precedented in BASEM annual conferences.

We are proud and grateful to our speakers, and we hope that you will learn new things from the best in the field. Our national and international experts will be addressing controversial topics, will present the latest evidence on diagnosis and treatment, will give you tips and tricks to take home, but we will also challenge the existing credo. Knowledge, competence, experience, and support is what you can expect from us, and we will do our utmost in that regard. In turn, we anticipate receiving from you a fresh outlook, your critical spirit, your enthusiasm, and we hope to inspire you to debate and interact with the experts and be brave to challenge us and provide us with your valuable feedback. We want to be better for you.

There will be no ‘sitting still’ during the conference as we are injecting ‘ENERGY SHOTS’ for a few minutes in each session providing exercise moves to prime your brain and body for the next session. We also have lots of sports activities coordinated by Dr Kay Brennan so please participate and thank the volunteers who are running them.

This BASEM Conference is a real opportunity! This is the best time for informal social interaction and to build a network with experienced colleagues amongst the faculty and the participants, please take this opportunity and meet your mentors.

Creating such a rich programme and keeping the spirit alive was challenging, but this is not done by one or two people. It is achieved by a big team. Our working group created strong bonds, shared the same values, the same principles, and the same passion for SEM. Hence a sincere ‘thank you’ goes to the two Chairs, Professors Nick Webborn and Yannis Pitsiladis for creating the sessions, the Chair of BASEM Dr Eleanor Tillett and her Scientific Commission for judging the abstracts. I am grateful to the Global Events team for their endless collaboration and our exceptional BASEM office staff for creating the perfect communication with the chairs and myself over the last three years.

Massive thanks go to all our scientific partners and speakers for making the effort to share their knowledge with us, our wonderful volunteers and thank you to you all for attending. It is worth mentioning that without the support of our sponsors we would not be able to hold this event. Please thank them by finding the time to visit their stands during the breaks.

Finally, please let your friends and colleagues know what you have learned during the conference, share your messages via SoMe using #basemconf22 and come and enjoy some relaxing time at our Gala dinner,

A very warm welcome to all of youMiss Dora Papadopoulou

6 7

COMMITTEES

CONFERENCE CHAIRS

Professor Nick Webborn and Professor Yannis Pitsiladis

CONFERENCE PROGRAMME DIRECTOR

Dr Theodora Papadopoulou

SCIENTIFIC/AWARDS COMMITTEE

Chair of the committee: Dr Eleanor Tillett, SEM consultant, Programme Lead MSc at UCL, Chair BASEM

Members: Dr Polly BakerSEM consultant, Research Fellow University of Brighton

Ms Rosy HymanOsteopath, Lecturer at London School of Osteopathy

Professor Amanda IsaacMSK Radiologist, Senior Clinical Lecturer, King’s College London

Dr Simon LackPhysiotherapist, Programme Lead MSc in Sports Medicine, QMUL

Dr Stuart MillerSport & Exercise Scientist, High Performance Lab Manager & Tutor, Queen Mary University of London

Professor Graham SmithPresident Society of Sports Therapists

8 98 9

ORAL PRESENTATIONS

PR

IZE

OR

AL

PR

ES

EN

TA

TIO

NS

8 98 9

PRIZE ORAL PRESENTATIONS

PO01 IS TRAMADOL A PERFORMANCE ENHANCING DRUG? A RANDOMISED CONTROLLED TRIAL

Mauger L., Thomas T., Smith S., Fennell C.University Of Kent, Canterbury, United Kingdom

Introduction: Tramadol is a potent narcotic analgesic that acts on the opioid system. Data from the World Anti-Doping Agency (WADA) Monitoring Programme suggest tramadol is used in several sports to reduce exertional pain and confer a performance advantage. However, it is not included in WADA’s Prohibited List. This study sought to identify whether tramadol enhances performance in time trial cycling.

Methods: Twenty-one highly trained cyclists (Age = 32 ± 10 years; Mass = 79.5 ± 11.7 kg; VO2max = 57 ± 7 mL/kg/min; Peak Power Output = 436 ± 57 W) were screened for tramadol sensitivity through an online interview, and then attended the laboratory across three visits. The first visit identified VO2max, Peak Power Output and Gas Exchange Threshold through a Graded Exercise Test. Between 3-14 days following this visit, participants returned to the laboratory on two further occasions to undertake cycling performance tests following the ingestion of either 100 mg of soluble tramadol (as 2x50 mg Zydol® tablets) or a taste-matched placebo control in a double-blind, randomised, and counter-balanced repeated measures design. The performance tests required participants to complete a 30 min non-exhaustive fixed intensity cycling task at a Heavy exercise intensity, immediately followed by a competitive self-paced 25-mile time trial (TT).

Results: Participants completed the TT significantly faster (t20 = 2.87, p = 0.01) in the tramadol condition (63 min 38 s ± 4 min 39 s) compared to the placebo condition (64 min 30 s ± 5 min 12 s).

Conclusion: In the current group of cyclists, the 1.3% faster time in the tramadol condition could confer a performance advantage sufficient to take a rider with a TT time in the third quartile, into a medalling position. The data from this study suggests that tramadol is a performance enhancing drug in time trial cycling.

10 11

PRIZE ORAL PRESENTATIONS

PO02 5-YEAR SURVIVORSHIP OF REVISION HIP ARTHROSCOPY FOR FEMORO ACETABULAR IMPINGEMENT

Mullins K.1, Filan D. 1, Carton P. 1, 2

1UPMC Sports Medicine Clinic, Whitfield, Co Waterford, Ireland, 2The Hip and Groin Clinic, UPMC Whitfield, Co Waterford, Ireland

Introduction and Purpose: To determine 5-year survivorship of revision arthroscopies for FAI compared to primary hip arthroscopy (HA).

Methods: Cases who had a prior arthroscopy at another institution preceding surgery for FAI at our clinic were reviewed. Cases were excluded if they had a LCEA <25o or Tonnis grade >1. Survival was defined as avoidance of total hip replacement (THR). Survival was compared between the groups using Kaplan-Meier with test of equality of survival distributions between the revision and primary HA cases using log rank (mantel-cox). Differences in re-operation rates were assessed using a chi squared analysis.

Results: 51 revision cases met the inclusion criteria. 88% of the cases were male and 71% presented with a Tonnis grade 0. Age at the time of surgery was 28.8 ± 10.3 years. 82 primary HA cases were included in the analysis and there were no significant differences between the groups for age, alpha angle, LCEA, or gender and Tonnis grade distributions (p>0.05 for all). There was no statistical difference in survival rates between groups (p=0.070). 5 cases (12.2%) in revision group and 3 cases (3.7%) in primary HA converted to THR (Figure 1). 36.6% in revision group compared to 14.6% in primary HA group required repeat surgery. This difference was statistically significant, p=0.002, Effect Size=0.320. The average time of re-operation was 18 ± 11 months in the revision group and 22 ± 11 months in the primary HA group (p>0.05). The reasons for repeat HA in the revision group were capsular plication (29%), bony regrowth (29%), adhesions (21%) instability (7%) and labral excision (7%), and loose body removal (7%).

Conclusion: In the absence of arthritic changes or dysplasia, revision procedures achieve similar survival rates compared to primary HA in the midterm. A higher re-operation may be observed in revision procedures.

10 11

PRIZE ORAL PRESENTATIONS

PO03 CARDIOPULMONARY, FUNCTIONAL, COGNITIVE AND MENTAL HEALTH OUTCOMES POST COVID, ACROSS THE RANGE OF SEVERITY OF ACUTE ILLNESS, IN A PHYSICALLY ACTIVE WORKING AGE POPULATION

O’Sullivan O. 1,3, Holdsworth D. 2,3, Ladlow P. 1,3, Barker-DaviesR. 1,3, Chamley R. 2,3, Houston A. 1,3, May S. 1,3, Dewson D. 1,3, Mills D. 1,3, Pierce K. 1,3, Mitchell J. 1,3, Xie C.

2, Sellon E. 2,3, Naylor J. 3, Mulae J. 3, CranleyM. 1,3, Talbot N. 2, Rider O. 2, Nicol E. 3, Bennett A. 1,3

1DMRC Stanford Hall, Nottingham, United Kingdom, 2Oxford Universities Foundation Hospital Trust, Oxford, United Kingdom, 3Defence Medical Services, United Kingdom

Introduction and Purpose: The medium-long impact of coronavirus disease 2019 (COVID-19) on active populations is yet to be fully understood. The M-COVID study was set up to investigate cardiopulmonary, functional, cognitive, and mental health post-COVID-19 outcomes in a young, physically active working-age population, across the spectrum of acute COVID-19 severity.

Material and Methods: Observational cohort study of 4 groups; hospitalised, community illness with on-going symptoms (community-symptomatic), community illness now recovered (community-recovered) and controls. Participants underwent extensive clinical assessment involving cardiopulmonary imaging, submaximal and maximal exercise testing, pulmonary function, cognitive assessment, blood tests, electrocardiogram and questionnaires on mental health and physical function (Figure 1).

Results: 113 participants (aged 39±9 and 86% male) were recruited into four groups, Hospitalised (n=35), community-symptomatic (n=34), community-recovered (n=18) and control (n=26), at 159±72days following acute illness. Hospitalized and community-symptomatic groups were older, with a higher body mass index, and worse mental health, fatigue, and quality of life scores. Hospitalised and community-symptomatic participants also performed less well on sub-maximal and maximal exercise testing (Figure 2). Hospitalised individuals had impaired ventilatory efficiency (higher VE/VCO2 slope), achieved less work at the anaerobic threshold and at peak than other groups and had a significantly reduced forced vital capacity. Clinically significant abnormal cardiopulmonary imaging findings were present in 6% of hospitalised participants, more lower than seen in other studies. Those who recovered from community-based, mild-moderate COVID-19 had no significant differences when compared with controls.

Conclusion: Recovered individuals who suffered mild-moderate COVID-19 do not differ from an age, sex and job-role matched control population in any study parameter. This is reassuring for the vast majority of individuals who have had acute COVID-19 not requiring hospital management. Individuals who were hospitalised or continue to suffer symptoms require a specific, comprehensive assessment prior to a return to full physical activity.

12 13

PRIZE ORAL PRESENTATIONS

Figure 1. Diagrammatic description of study design.

Abbreviations: ECG, electrocardiogram; PROMS, patient reported outcome measure; CPET, cardiopulmonary exercise test; 6MWT, six-minute walk test; MRI, magnetic resonance imaging ; CMR, cardiac magnetic resonance imaging; HRCT, high-resolution computed tomography; DE CTPA, dual-energy computed tomography pulmonary angiogram.

Figure 2. Cardiopulmonary exercise test (CPET) variables: a) percentage predicted VO2 at VT1 and peak, b) VE/VCO2 slope, c) workload (watts per kilogram) at VT1 and peak, d) resting heart rate.

12 13

PRIZE ORAL PRESENTATIONS

PO04 DO ANATOMICAL DIFFERENCES EXPLAIN THE DISCREPANCY IN PROXIMAL ADDUCTOR AVULSION- PLAC INJURY RATES BETWEEN MALE AND FEMALE ATHLETES?

Schilders E. 1,2, Bharam S. 3,5, Golan E. 4, Cooke C. 2, Johnson R. 1,2

1Fortius Clinic, London, United Kingdom, 2Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom, 3Mount Sinai School of Medicine, New York, USA, 4Northside Orthopedic Specialists, Snellville, USA, 5Orthopaedic Department, Lenox Hill Hospital, NewYork, USA

Introduction and purpose: To date, Proximal Adductor Longus Avulsions and Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC) injuries are reported uniquely in male athletes. This study compared the Symphyseal anatomy of males and females to establish whether anatomical variations could account for the observed sex difference in occurrence of PLAC injuries, and aid MRI image interpretation.

Methods: The anterior Symphyseal area was systematically dissected in six female and eight male fresh-frozen cadavers to examine PLAC and Rectus Abdominis (RA), and their anatomical relationship.The level of agreement for the observers was measured using the Bland and Altman method.

Results: A PLAC was found in all specimens. The RA was found to have both an external and internal tendon (IT) in 100% of male and 66.6 % of female cadavers.

The small bias of -0.17% + 3.58% in the mean of differences in the percentage width of the total RA insertion between the two scorers was not significant (paired t test, P>0.05).

In males the IT of RA decussates with the contralateral tendon and runs deep to the Anterior Pubic ligament (APL), to insert caudally. In females the IT of the RA tendon, when present, by contrast inserts cranial to the deep portion of the APL, and does not interlace with the IT from the contralateral side (Figure 1 and 2).

Conclusions: The PLAC is present in both sexes and therefore does not account for the difference in occurrence of proximal adductor avulsions. However, in males the IT runs deep to the APL forming a pulley system which can be disrupted with forced abduction of the leg. The absence of this pulley system in women and the parallel orientation of the internal tendons of the RA is protective against PLAC injuries, and allows widening of the pubic symphysis during pregnancy and childbirth.

14 15

PRIZE ORAL PRESENTATIONS

14 15

PRIZE ORAL PRESENTATIONS

OR

AL

PR

ES

EN

TA

TIO

NS

16 17

ORAL PRESENTATIONS

O01 INJURY PREVENTION PROGRAMS REDUCE THE INCIDENCE OF SPORT-RELATED HEAD INJURIES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALSAl Attar W.1,2,3

1Department of Physical Therapy, Faculty of Applied Medical Science, Umm Al Qura University, Makkah, Saudi Arabia, 22. Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia, 33. Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland

Introduction and Purpose: Sport-related head injuries, including concussion, are becoming a rising public health and sports medicine issue around the world. To avoid these injuries, it is necessary to investigate the current injury risk reduction measures. Therefore, the purpose of this study was to investigate the effectiveness of injury prevention programs (IPPs) in reducing the incidence of sport-related head injuries among athletes.

Material and Methods: Two investigators independently searched for relevant studies published during the period from 1985-2022 using the following databases: Cochrane Library, PubMed, Web of Science, and PEDro. The keywords used in the search strategy were ‘neuromuscular training’, ‘injury prevention programs’, ‘FIFA’, ‘head injury’, ‘athlete’, and variations of these search terms. Included studies had to be randomized controlled trials using IPPs for athletes with the primary outcome being head injury rate. There were no restrictions of age or playing level. The random-effects model was used in analysing the extracted data by the RevMan Meta-Analysis software version 5.

Results: The pooled results of 10524 athletes showed 34% sport-related head injuries reduction per 1000 hours of exposure compared to the control group with an injury risk ratio [IRR] of 0.66 (95% confidence interval [CI] 0.47-0.92). Figure 1.

Conclusion: This meta-analysis demonstrates that IPPs decreased the risk of sport-related head injuries among athletes and therefore reducing healthcare costs and athletes’ absenteeism.

Figure 1. Forest plot illustrating the effect of IPPs versus controls on head injury rate

16 17

ORAL PRESENTATIONS

O02 THE EFFECTS OF INTERVENTIONS ON LOCAL NEUROMUSCULAR CHARACTERISTICS IN PATELLOFEMORAL PAIN: A SYSTEMATIC REVIEW WITH META-ANALYSISAlsaleh S.2, Bartholomew C.1, Miller S.1, Morrissey D.1, Lack S.1

1Queen Mary University Of London, London, United Kingdom, 2Medical Services Authority, Ministry of Defence, Kuwait

Introduction and purpose: Patellofemoral pain is often recurrent, in part due to incomplete understanding of intervention mechanisms. We aimed to identify the effects of interventions on local neuromuscular deficits found in patellofemoral pain (PFP).

Material and Methods: Five databases were searched for interventional studies of PFP that investigated changes in local neuromuscular characteristics. Cochrane’s risk of bias for randomised (RoB-1) and non-randomised interventional studies (ROBINS-I) were used. Exercise reporting was evaluated using the consensus on exercise reporting template (CERT). Evidence levels were determined by following Van Tulder’s guidelines. Electromyography (EMG), flexibility and muscle performance data of muscles that cross the knee were derived and synthesised according to the length and type of treatment.

Results: Forty-three studies were included. Moderate evidence indicates increases with small effects in knee extensors isometric peak torque, after 6-weeks (SMD [95% CI]; 0.17 [0.00,0.34]) and 3-months (0.33[0.03,0.62]) of strengthening and multimodal programmes, respectively, and extensors concentric peak torque during taping for 1 session (0.21 [0.01, 0.41]). Limited evidence with small effect indicates that extensors endurance increases during 1 session of taping (0.53 [0.08,0.97]) and medium effect suggests that Quadriceps flexibility increases after 4-weeks of multimodal treatment (0.92[0.03,1.81]). Results also showed no changes in Vastus medialis and Vastus lateralis mean EMG excitation amplitude, both during 1 session of taping and bracing, and after 4 weeks of multimodal treatment in knee extensors isometric peak torque (moderate evidence), flexors isometric peak torque, hamstrings, gastrocnemii and iliotibial band flexibility (limited evidence). Very limited evidence showed changes in 21 and no changes in 66 other outcomes. Pain outcomes are poorly reported.

Conclusion: In people with patellofemoral pain, local neuromuscular characteristics can be targeted by short and medium-term interventions comprising of taping, strengthening and multimodal rehabilitation programmes. These effects on local neuromuscular characteristics can be used to identify mechanisms of benefit following treatment.

18 19

ORAL PRESENTATIONS

Figure 1:

Rx: treatment, wks: weeks, multimodal Rx: multiple treatment types in 1 programme (strengthening + stretching or stimulation..etc), Gast: Gastrocnemii, ITB: Iliotibial band, Hams: Hamstrings, Quads: Quadriceps, exc: excitation, amp: amplitude, Ext: extensors, Flex: flexors, p: peak, Av: average, Iso.T: isometric torque, Conc.T: concentric torque, Ecc.T: eccentric torque, end: endurance.

18 19

ORAL PRESENTATIONS

Figure 2:

20 21

ORAL PRESENTATIONS

O03 CAN A TELEHEALTH SERVICE PROMOTE PHYSICAL ACTIVITY AND BEHAVIOUR CHANGE DURING PREGNANCY AND IN THE POST-PARTUM PERIOD? A SYSTEMATIC REVIEW AND META-ANALYSISAndrew D.Queen Mary’s University London, London, United Kingdom

Objective: Physical activity (PA) is beneficial but underperformed during pregnancy and in the post-partum period. Using systematic review and meta-analysis, we aimed to determine whether telehealth methods are effective for the promotion of PA during pregnancy and could be recommended as an alternative to usual care.

Methods: PubMed/Medline, Embase, Ovid and Cochrane Library databases were searched from inception to February 2021 for randomised-controlled trials (RCTs) evaluating the effect of telehealth methods compared to usual care, on PA measures in ante-natal and post-partum periods. Quality was assessed using the PEDro scale and the Risk of Bias-2. Meta-analysis was performed using the standardised mean difference using a random effects model.

Results: Eight studies were identified which included 1920 women. Two of these studies were rated “Excellent” and 6 “Good” using PEDro scoring. Only three of these had statistically significant findings in favour of telehealth services, but a general trend towards telehealth services was seen across the other studies. Meta-analysis of the 5 studies with suitable data and quality, showed telehealth was superior to usual care at 12-16-weeks with small effect (SMD= 0.28) with substantial heterogeneity.

Conclusion: The result of our meta-analysis supports the use of telehealth services for PA promotion in the ante-natal period. With its small effect, but overall general trend in favour of telehealth interventions, we recommend telehealth as an adjunct to usual care. More research, with definitive cost-benefit measures for telehealth intervention, is needed in the ante-natal and post-partum period, to further support and advance the use of this expanding field of healthcare delivery and promotion.

20 21

ORAL PRESENTATIONS

O04 IMPACTS OF THE COVID-19 PANDEMIC ON MENTAL HEALTH PROVISION IN HIGHER EDUCATION SPORT SETTINGS: PERSPECTIVES OF SPORT MANAGEMENT STAKEHOLDERS FROM UNIVERSITIES IN CANADA, THE UNITED STATES, AND THE UNITED KINGDOMSimpson K.1, Grand J.1, Kelly P.1

1University of Edinburgh Academy of Sport, PAHRC, ISPEHS, Edinburgh, United Kingdom

Background: Performance sport athletes in the university ecosystem are a subpopulation of elite athletes known to have unique epidemiological factors for mental health. Elite athletes in higher education environments, often referred to as dual career athletes or student-athletes, experienced the compounded effects of the COVID-19 pandemic athletically, academically, and socially.

Aims: This study aimed to explore how the pandemic affected wellbeing for student-athletes in various environments cross-culturally. The study also aimed to identify emergent opportunities for enhancing student-athlete mental healthcare provision.

Methods: Semi-structured interviews were conducted with student-athlete welfare stakeholders at universities in Canada, the United Kingdom, and the United States. Participants were either Athletic Directors, Coaches, or Student-Athlete Mental Health Practitioners. The results were thematically analyzed.

Results: Multilateral perspectives described experiences that many were undergoing during the pandemic, but within the student-athlete microcosm. The data highlighted the complexity of student-athlete welfare systems. Individually, there were clear institutional and student-athlete differences emphasized by each participant. Collectively, the group of voices underscored an array of shared barriers and limits to student-athlete mental health during the pandemic. Geographical licensure restrictions on mental health practitioners were a major barrier to the delivery of tele-mental healthcare to student-athletes in all three countries during the pandemic. The major findings of the study relate to the unique characteristics of elite student-athletes and opportunities for developing integrated specific care for student-athletes within university and external healthcare systems.

Conclusions: This is the first study to explore perspectives of mental health management across national university sporting associations during the COVID-19 pandemic. Therefore, the findings may help university sport leaders focus their attention post-pandemic and may also encourage stakeholders to work collaboratively to enhance systems and provision of mental healthcare to student-athletes. The results may also offer important insight to inform future debate and action promoting student-athlete wellbeing.

22 23

ORAL PRESENTATIONS

O05 COMMON MENTAL HEALTH DISORDER SYMPTOMS AND WELLBEING IN ELITE BRITISH BASKETBALL PLAYERSChawatama E.1, Kipps C.1, Vishnubala D.2, Kruger P.1, Howarth H.1

1University College London, London, United Kingdom, 2University of Leeds, Leeds, United Kingdom

Introduction and Purpose: Common mental disorder (CMD) symptoms, such as depression and anxiety, are highly prevalent globally. Elite athletes are no different, with these symptoms being associated with poor performance and increased injury risks. The prevalence of CMD symptoms amongst elite basketball players has not previously been studied. Aims: Primary: Establish the prevalence of CMD symptoms and adverse health behaviours amongst elite British basketball players.

Secondary: Investigate the relationships between assumed psychological stressors or protective factors on mental health symptomology and behaviours. Material and Methods: A cross-sectional epidemiological study was conducted via an online questionnaire. Data were provided by 68 elite athletes (males n=33; females n=45) (Mean age: 25 years; Range: 18 to 37). Questioning included validated psychometric tests for CMD symptoms, psychological stressors and assumed protective traits. Results: The prevalence of CMD symptoms ranged from 12% to 75%. Moderate to severe depression was found in 31% (95% CI: 20-43) of athletes, and moderate to severe anxiety in 27% (95% CI: 17-39). 75%(95% CI: 63-85). had a positive screening score for distress. Significant associations were found between the number of severe career injuries and alcohol use. Lower wellbeing scores were also significantly associated with the prevalence of CMD symptoms. Conclusion: To the authors’ knowledge, this is the first study to explore symptoms of CMD in an elite basketball population. Although these results represent estimated values, they reveal a high prevalence of CMD symptoms and adverse health behaviours amongst players, with 3 in 4 players screening positively for psychological distress. CMD prevalence is slightly higher than seen in other sporting populations but may represent the effects of the recent COVID-19 pandemic. This population would benefit from regular mental health screening and wellbeing interventions.

22 23

ORAL PRESENTATIONS

O06 FRACTIONAL EXHALED NITRIC OXIDE IN THE ASSESSMENT OF EXERCISE-INDUCED BRONCHOCONSTRICTION: A MULTICENTRE RETROSPECTIVE ANALYSIS OF UK BASED ELITE ATHLETES

Dickinson J.1, Gowers W.1, Sturridge S.1, Williams N.2, Kippelen P.3, Simpson A.4, Jackson A.5, Hull J.6, Price O.7

1School of Sport and Exercise Sciences, University Of Kent, Canterbury, United Kingdom, 2Sport, Health and Performance Enhancement Research Centre, Nottingham Trent University, Nottingham, Uk, 3Division of Sport, Health and Exercise Sciences, Brunel University, Uxbridge, UK, 4Department for Sport, Health and Exercise Science, Hull University, Hull, UK, 5English Institute of Sport, London, UK, 6Royal Brompton Hospital, London, UK, 7School of Biomedical Sciences, University of Leeds, Leeds, UK

Introduction: Exercise-induced bronchoconstriction (EIB) is a common condition characterised by transient lower airway narrowing that occurs in association with physical activity. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma.

Purpose: To evaluate the predictive value of FeNO to confirm or refute a diagnosis of EIB in a cohort of elite athletes.

Materials and Methods: Multicentre retrospective analysis. Three hundred and twenty-nine elite athletes (male: 79%) performed FeNO and spirometry pre-and-post a eucapnic voluntary hyperpnoea challenge (EVH). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for established FeNO thresholds: (intermediate [≥25ppb] and high [≥40 ppb; ≥50ppb]) and evaluated against objective evidence of EIB: (EVH diagnostic cut-off: -10% ΔFEV1). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC).

Results: All athletes had normal resting lung function (>80% FEV1 pred). Despite this, 39% had a post-EVH FEV1 fall consistent with EIB. FeNO values ≥25ppb, ≥40ppb and ≥50ppb were observed in 38%, 18% and 15% of the cohort, respectively. ROC-AUC for FeNO was 0.591 (95% CI, 0.528-0.665; figure 1). Sensitivity, specificity, PPV and NPV is presented in Table 1.

Conclusions: Our findings indicate that high FeNO (≥40 ppb) provides good specificity (i.e., ability to rule-in a diagnosis of EIB), however, due to the poor sensitivity and predictive values, should not be employed as a replacement for indirect bronchial provocation.

Table 1. FeNO sensitivity, specificity, PPV and NPV for the detection of EIB.FeNO ≥25 ppb FeNO ≥40 ppb FeNO ≥50 ppb

Sensitivity 47% 27% 23%Specificity 65% 87% 88%PPV 45% 57% 53%NPV 66% 65% 64%

24 25

ORAL PRESENTATIONS

Figure 1. Receiver operator characteristic area under the curve

ROC-AUC = 0.591 (95% CI, 0.528-0.665)

(ROC-AUC) to investigate the utility of FeNO to diagnose EIB positive individuals.

24 25

ORAL PRESENTATIONS

O07 CONSUMPTION AND CARDIOVASCULAR SIDE EFFECTS OF NUTRITIONAL SUPPLEMENTS IN ATHLETESFossati C.1,2, Giombini A.1, Di Gianfrancesco A.2, Minganti C.1, Borrione P.1,2, Quaranta F.1, Tomassi G.1, Pigozzi F.1,2

1Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy, 2NADO Italia, Rome, Italy

Introduction and purpose: The use of nutritional supplements (NS) is increasingly frequent in athletes. The potential risks and side effects of these substances are often underestimated. As a matter of fact many organs, including cardiovascular (CV) system, may be affected in sometimes serious ways. The aim of our study was, in a first phase, to assess the prevalence of supplements use in a population of young athletes. In a second phase, the presence of CV side effects of NS was investigated.

Materials and methods: Athletes aged 18-25 who underwent pre-participation screening at “Foro Italico” Centre of Sports Medicine in 2019-2020, were asked to fill-in a survey investigating supplements use and the presence of CV symptoms. Successively, we selected all athletes who reported CV symptoms among NS users (16) and matched them to 3 more groups (16 users with no CV symptoms and 16+16 “non users” with and without CV symptoms, respectively). All subjects underwent dynamic Holter ECG.

Results: 137 athletes aged 21.2±1.4 years completed the survey and were included in the study: 36.5% of the sample reported supplements use with a prevalent motivation of a faster recovery (40.5%). 23,4% of the sample reported CV symptoms. ECG Holter analysis (64 subjects-4 groups) showed supraventricular ectopic beats (11 athletes) with no differences between groups. Ventricular ectopic beats (VEBs) were detected in 14 athletes, with a significant difference (p=0.007) between group 1 (users-CV symptoms) and group 4 (non users-no CV symptoms). In 2 cases VEBs were repetitive and polymorphic with right bundle branch block and left axis deviation QRS morphology.

Conclusions: Considering the uncontrolled use of nutritional supplements, greater attention must be paid to possible health risks, raising awareness among young athletes and their entourage. In the context of an individual susceptibility, the use of supplements can act as a trigger of arrhythmias.

26 27

ORAL PRESENTATIONS

O08 COMPARING TWO SURGICAL TECHNIQUES WITH SINGLE AND DOUBLE GRAFTS FOR ATHLETES’ ACL RECONSTRUCTION WITH THE USE OF TENSIOMYOGRAPHY AND ARTIFICIAL INTELLIGENCE - RETROSPECTIVE DOUBLE BLINDING STUDY

Gkanias S.1, Fakiris K.1, Koutsojannis C.1

1University οf Patras, Patras, Greece

Purpose: The aim of the present study was to detect if there is any differences between the two surgical techniques in terms of clinical and functional outcomes.

Method: The measurements were performed using the Tensiomyography (TMG) S1 device, to 24 athletes (15 males, 9 females with mean age 32 years), divided in group A (12): knees with double graft (ST - GR) and group B (12): knees with single graft ST. There was only one surgeon who performed all the operations, using the same technique of tunnel positioning. The muscles which were assessed were vastus medialis (VM), vastus laterals (VL), rectus femoris (RF), semitendinosus (ST), biceps femoris (BF). In addition, all the patients were asked to fill the IKDC, Tegner and KOOS scores. It was also used a data-mining algorithm (J48) in order to correlate the type of surgery with the TMG parameters that were affected in the operated limb and to evaluate the effectiveness of each surgery.

Results: According to the performed statistical analysis the Group B has significant lower values in displacement (Dm) of BF (p= 0,039), ST (p=0,014), in construction time (Tc) of ST (p= 0,008) and finally in construction velocity (Vc) of VL (p= 0,033), BF (p= 0,012) compared to Group A. Additionally performing Machine Learning approach, the two types of surgeries significant effect on a combination of TMG parameters was established, separating the two groups with accuracy over 95 %, revealing as the most important parameter VcHT.

Conclusion: In Group B we identified better results regarding the functional behavior of the hamstring construct, and that means that the patient immediately after the operation starts his rehabilitation from a better level in the donor site regarding muscle tonus, muscle power and muscle ability to work effectively when needed. In conclusion, the ST graft is behaving better in ACL reconstructed knees in athletes.

26 27

ORAL PRESENTATIONS

O09 EFFECT OF ACUTE ORAL PREDNISOLONE AND INHALED BECLOMETHASONE DIPROPIONATE ON INFLAMMATORY CYTOKINE RESPONSE FOLLOWING 40-KM CYCLING TIME-TRIALGowers W.1, Loosemore M.1,2, Hopker J.1, Dickinson J.1

1University of Kent, School of Sport and Exercise Sciences, Canterbury, United Kingdom, 2Institute of Sport Exercise & Health, London, United Kingdom

Introduction & Purpose: The World-Anti Doping Agency (WADA) mandate that athletes with asthma-related conditions using glucocorticoid treatment obtain a therapeutic-use-exemption (TUE) during competition periods for orally delivered substances, but not for inhaled substances. Research on the impact of high-dose inhaled glucocorticoids on systemic inflammation following exercise is scarce. Therefore, this study aimed to investigate two glucocorticoid administration routes that differ in WADA legality on inflammatory cytokine response following a 40-km cycling time-trial (TT).

Methods: In a randomised cross-over order, nine-trained male cyclists (VO2max; 59.1 ± 3.8 ml.kg.min-1) completed a 40-km time-trial four-hours after administration of acute oral prednisolone (0.5 mg.kg-1, PRED), inhaled beclomethasone dipropionate (1600 μg, BEC), microcrystalline cellulose capsules (O-PLA), water vapour inhaler (I-PLA) or control (CON). Plasma Interleukin-6 (IL-6) concentration was determined from samples collected at baseline, and immediately after completion of the 40-km TT. Plasma IL-6 concentrations were log-transformed, then statistically analysed using a repeated measures ANOVA with multiple comparisons.

Results: Plasma IL-6 samples were successfully obtained in all conditions and time points from eight participants (n=8). Baseline IL-6 concentration was not significantly different between conditions. The 40-km TT induced a significant increase in IL-6 concentrations in all conditions (p < 0.05). However, PRED administration resulted in significantly lower IL-6 concentrations compared to all other conditions (Table 1, P<0.05).

Conclusion: Acute administration of 0.5 mg.kg-1 oral prednisolone blunted inflammatory cytokine response following a 40-km cycling TT. This effect was not evident in supratherapeutic doses of inhaled glucocorticoids. Oral glucocorticoids [such as prednisolone] should remain controlled by WADA due to the ability to induce systemic anti-inflammatory properties. This study adds evidence that WADA guidelines to allow inhaled glucocorticoids [such as beclomethasone dipropionate] are appropriate.

Table 1. Plasma Interleukin-6 (IL-6) concentrations pre-and-post 40-km cycling time trial (TT).

PRED IN-PLA BEC O-PLA CONBaseline IL-6 [pg/mL]

1.49 ± 1.79 1.54 ± 1.59 1.53 ± 1.74 1.45 ± 1.47 1.48 ± 1.60

Post 40-km IL-6 [pg/mL]

2.76 ± 2.24 *

5.73 ± 5.77 5.32 ± 5.40 5.93 ± 5.39 5.55 ± 5.53

Data presented as mean ± standard deviation. Abbreviations: PRED; oral prednisolone, BEC; inhaled beclomethasone dipropionate, O-PLA; microcrystalline cellulose capsules, I-PLA; wa-ter vapour inhaler, CON; control, IL-6; Interleukin-6.

28 29

ORAL PRESENTATIONS

Figure 1. Mean (± standard deviation) Abbreviations: PRED; oral prednisolone, BEC; inhaled beclomethasone dipropionate, O-PLA; microcrystalline cellulose capsules, I-PLA; water vapour inhaler, CON; control.

28 29

ORAL PRESENTATIONS

O10 EFFECT OF SHORT-TERM HIGH-DOSE INHALED BECLOMETHASONE DIPROPIONATE ADMINISTRATION ON REPEATED BOUT 10-KM CYCLING TIME-TRIAL PERFORMANCEGowers W.1, Loosemore M.2, Hopker J.1, Dickinson J.1

1University of Kent, School of Sport and Exercise Sciences, Canterbury, United Kingdom, 2Institute of Sport Exercise & Health , London, United Kingdom

Introduction & Purpose: The World-Anti Doping Agency (WADA) stipulates that athletes can use inhaled corticosteroids (ICS) for asthma-related conditions at all times, including during competition periods. It remains unclear if ICS provides a competitive advantage for single, or repeated bout exercise. This study aimed to investigate the impact of short-term high-dose ICS administration on 10-km cycling time-trial (TT), and recovery for a subsequent 10-km TT performed on the same day.

Methods: In a randomised cross-over order, eight trained non-asthmatic male cyclists (VO2max; 60.0 ± 4.8 ml.kg.min-1) completed a 10-km TT 14 days post-administration of beclomethasone dipropionate (800 μg, BEC) or water vapour inhaler (PLA). Then, after a one-hour passive recovery, participants completed a further 10-km TT. Before commencing each TT, subjective overall recovery was assessed using Short Recovery Stress Score (SRSS). Plasma Interleukin-6 (IL-6) concentration was determined from samples collected at baseline, and after completion of the subsequent TT (difference between baseline and post-exercise are reported as ΔIL-6). Data was tested for normality, then statistically analysed using Paired Samples T-Test.

Results: No significant difference was seen in completion time for the initial 10-km TT (BEC: 962.1 ± 45.3 s; PLA: 964.7 ± 44.1 s; p=0.50) or the subsequent 10-km TT (BEC: 982.5 ± 48.8 s; PLA: 985.7 ± 54.7 s; p=0.63). Baseline SRSS was not different between conditions (P=1.00), nor prior to the subsequent 10-km bout (P=0.35). Baseline IL-6 was significantly lower in BEC than PLA (0.70 ± 0.47 pg/mL, 0.93 ± 0.54 pg/mL respectively; P=0.05), however ΔIL-6 was not significantly different between conditions (P=0.64).

Conclusion: Short-term high-dose ICS medication did not enhance 10-km TT performance. Furthermore, perceived recovery prior to, or measured performance during subsequent 10-km TT was not different between conditions. Future research should consider the applied significance of ICS related performance and recovery outcomes.

30 31

ORAL PRESENTATIONS

Table 1. Performance and Recovery OutcomesBEC PLA P-Value

Initial TT Completion Time [sec] 962.1 ± 45.3

964.7 ± 44.1

0.50

Subsequent TT Completion Time [sec] 982.5 ± 48.8

986.7 ± 54.7

0.63

Baseline Overall Recovery SRSS [A.U] 5.00 ± 0.53

5.00 ± 0.53

1.00

Pre-Subsequent TT Overall Recovery SRSS [A.U]

3.38 ± 1.41

3.63 ± 1.30

0.35

Baseline IL-6 [pg/mL] 0.70 ± 0.47*

0.93 ± 0.54

0.05

ΔIL-6 [pg/mL] 0.948 ± 0.729

1.035 ± 0.794

0.64

Data presented as mean ± standard deviation. Abbreviations, TT; Time-Trial, SRSS; Short Recovery Stress Score, IL-6; Interleukin-6.

Figure 1. Mean (± standard deviation) and Individual completion time for initial 10-km time-trial. Abbreviations, BEC; beclomethasone dipropionate, PLA; Placebo

30 31

ORAL PRESENTATIONS

O11 A QI PROJECT TO ASSESS AND IMPROVE AWARENESS OF PHYSICAL ACTIVITY GUIDELINES IN A GP SETTINGHawkins K., Munro A.Chilcote GP surgery, Torquay, United Kingdom

Introduction: 63% of the UK adult population are overweight/obese, and physical inactivity (PA) is one of the most significant modifiable risk factors for disease/disability in England1. One in four patients have said they would be more active if encouraged by a healthcare professional. Despite this few GPs discuss guidelines with patients during consultations1.

Purpose: To assess patient knowledge of the PA guidelines and determine levels of PA undertaken. To increase patient knowledge of guidelines via information distribution and to develop a sustainable intervention for use in primary care.

Methods: Assessment was made via questionnaire of all attending patients over a one week period (175). Questionnaires were distributed to subjectively assess PA levels and knowledge of guidelines. Public Health England (PHE) guidelines were then distributed to patients via text message (including guidelines for adults, children, pregnant/postpartum women and patients with a disability). Patients were followed up to determine whether this information distribution was effective.

Results: There were 175 participants in this project. The majority of participants were adults (86%). 59% of participants (n=101) believed they knew the PHE guidelines. 64% of participants (n=108) believed their activity levels were sufficient. 47% of patients thought they both knew the guidelines and had activity levels in line with PHE recommendations. A majority of responders (68%) wanted information regarding PHE guidelines, irrespective of baseline knowledge. Upon follow-up, one in seven claimed to change their behaviour as a result.

Conclusion: Evidence suggests that one in four patients would be more active if encouraged by a healthcare professional. Our project has identified reasonable patient knowledge of guidelines and physical activity levels in the community setting but there remains significant room for improvement. We have identified that people want information regarding physical activity and we have developed a sustainable intervention for physical activity guideline distribution in primary care.

32 33

ORAL PRESENTATIONS

Appendix

Figure 1: questionnaire distributed to patients.

Figure 2: distribution system of physical activity guidelines using QR codes.

32 33

ORAL PRESENTATIONS

O12 MANAGING SERIOUS PATHOLOGY IN LOW BACK PAIN: DEVELOPMENT AND VALIDATION OF A BAYESIAN NETWORK DECISION SUPPORT TOOLHill A.1, Joyner C.1, Yet B.2, Keith-Jopp C.1, Tuncer-Sakar C.3, Marsh W.1, Morrissey D.1

1Queen Mary University Of London, London, United Kingdom, 2Middle East Technical University, Ankara, Turkey, 3Hacettepe University, Ankara, Turkey

Introduction and Purpose: A key decision for assessment of Low back pain (LBP) is identifying serious underlying conditions such as Cauda Equina Syndrome, infection, fracture or space-occupying lesions. Previous decision support tools for LBP deployed rule-based recommendations, yet Artificial Intelligence has enabled ‘intelligent’ decision support tools, with Bayesian Networks particularly suitable for complex conditions such as LBP. This study aimed to test whether clinical knowledge could be elicited to construct a Bayesian Network to support clinicians’ detection of serious pathology masquerading as LBP. Material and Methods: A modified-RAND appropriateness procedure elicited knowledge from 16 domain experts from General Practice, Rheumatology and Musculoskeletal specialties. The first three stages of the study used bespoke online tools interleaved with face-to-face meetings to elicit: 1) Variables, 2) Structure, 3) Probabilities. In the fourth stage, validation of the prototype Bayesian network took place with independent experts in spinal pathology. Gwet’s AC2 test for agreement was used to compare the study output with the spinal experts’ opinion, interpreted with Landis and Koch criteria. Results: The tool includes background risk factors (e.g. trauma, age), signs and symptoms (e.g. bladder disturbance, inflammatory symptoms) and derived judgement factors (e.g. cord compression, fracture). The tool has an interactive online interface, requiring real-time patient inputs from the subjective assessment, then gives a judgement comparing baseline to the current patient. Agreement between participants and spinal experts was almost perfect for all but two judgement factors (Table 1).

Node Agreement

Space occupying lesion1Almost perfect

Cauda Equina Syndrome0.85Almost perfect

Infective condition0.86Almost perfect

Fracture0.34Fair

Cord compression1Almost perfect

Inflammatory condition0.91Almost perfect

Nerve Root0.93Almost perfect

34 35

ORAL PRESENTATIONS

Irritability of pain0.68Substantial

Depression1Almost perfect

Stress1Almost perfect

Anxiety0.95Almost perfect

Table 1: Agreement of Spinal experts with study participants

Conclusion: The structured elicitation method yielded a reasoning model using expert clinician knowledge, establishing consensus amongst participants about its content. A lack of consensus on fracture risk factors and signs and symptoms was reflected in the validation. The node ‘irritability of pain’ highlighted issues with the definition of pain and how that is interpreted. Further iterations to expand the model to common LBP presentations should follow.

34 35

ORAL PRESENTATIONS

O13 ACCURACY OF A DEDICATED MRI GROIN STUDY PROTOCOL TO DIAGNOSE AND DIFFERENTIATE BETWEEN DIFFERENT TYPES OF PLAC INJURIES ASSOCIATED WITH ADDUCTOR LONGUS AVULSIONS, AND THE CORRELATION WITH SURGICAL FINDINGS.Johnson R.1,2, Mitchell A.1, Lee J.1, Kartsonaki C.3, Cooke C.2, Schilders E.1,2

1Fortius Clinic, London, United Kingdom, 2Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom, 3MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom

Introduction and Purpose: An imaging classification for Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC) injuries has recently been described. The objective of this study was to assess intra-and inter-observer agreement on MRI PLAC injury classification and make comparisons with surgical findings.

Methods: Retrospective study The PLAC injury database in our institution was interrogated using the following inclusion criteria: Acute post-traumatic PLAC injury, dedicated MRI protocol, complete Adductor Longus (AL) Avulsion, surgical PLAC repair 2017-2020.

Two expert musculoskeletal radiologists, blinded for demographic and clinical data, scored the MRI scans twice in a 6-week interval. Both MRI and surgical findings were scored for type of PLAC injury (1-5), injury to Pectineus and Lacunar Ligament (LL).

Cohen’s weighted and unweighted Kappa were used to calculate intra- and inter-rater agreement for scoring the MRI scan and to calculate agreement between each radiologist with the surgical findings.

Results: 80 athletes fulfilled the inclusion criteria. Main sports were Football (n=36, 45%), Rugby (n=21, 26%), Other (n=23, 29%).

Surgical findings: The Pyramidalis was present in (n=76, 95%). AL was separated from Pyramidalis (n=44, 55.0%), in continuity (n=35, 43.8%). The AL was displaced in (n=55, 68.8%) and in situ in (n=25, 31.2%). LL injury (n=41, 51.2%). Partial Pectineus Avulsion (n=39, 48.8%).

Scoring PLAC injury type, the intraobserver weighted Kappa score was 1 for both radiologists, the interobserver weighted Kappa score 0.98.

The weighted Kappa score for MRI/Surgical correlation for PLAC injury type was 0.96 for first scorer and 0.98 for the second.

Conclusion: This original study established excellent correlations between MRI and surgical findings in AL/PLAC injuries. There was an almost perfect intra- and inter-observer agreement on the PLAC injury type diagnosis. A dedicated MRI groin study protocol is a reliable method to accurately diagnose PLAC injury, assess the different anatomical structures and facilitate effective planning for surgical treatment.

36 37

ORAL PRESENTATIONS

Type 1 Complete fibrocartilage (FC) avulsion-Pyramidalis separated from Adductor Longus-intact Pectineus

Type 2 Complete FC avulsion-Pyramidalis separated from Adductor Lon-gus-partial Pectineus tear

Type 3 Complete FC avulsion-Pyramidalis connected to Adductor Lon-gus-intact Pectineus

Type 4 Complete FC avulsion-Pyramidalis connected to Adductor Lon-gus-partial Pectineus tear

Type 5 Complete FC avulsion-Pyramidalis partially separated from Ad-ductor Longus-partial Pectineus tear

Type 6 Partial FC avulsion-Pyramidalis connected to Adductor Longus-in-tact Pectineus

Table 1 Types of PLAC injuries

Interobserver agreement Kappa unweighted Kappa weighted

lower estimate upper lower estimate upperType of PLAC 0.95 0.98 1.00 0.98 0.98 0.98Pyramidalis 1 1 1 1 1 1Pyramidalis oedema 0.74 0.85 0.96 0.73 0.73 0.73

Pyramidalis-AL separation 1 1 1 1 1 1

Partially/complete 0.9 0.96 1.0 0.9 0.9 0.9

Lacunar ligament injury 0.75 0.87 0.98 0.75 0.87 0.98

Partial pectineus avulsion

1 1 1 1 1 1

Table 2: interobserver agreement between radiologist for the first score

36 37

ORAL PRESENTATIONS

O14 BONE STRUCTURAL PARAMETERS AND SKELETO-MUSCULAR ROBUSTICITY OF YOUNG ATHLETES BY THE TYPE OF SPORTSKalabiska I.1, Annár D.2, Zsákai A.2, Malina R.3

1Hungarian University of Sport Science, Research Center for Sport Physiology, Hungary, 2Eotvos Lorand University, Department of Biological Anthropology, Hungary, 3Department of Kinesiology and Health Education, University of Texas at Austin, United States

BONE STRUCTURAL PARAMETERS AND SKELETO-MUSCULAR ROBUSTICITY OF YOUNG ATHLETES BY THE TYPE OF SPORTS

Introduction and Purpose. In DEXA analytical practice, it is important to use athlete references to estimate bone development in athlete children and adolescents. In 2020, our research team introduced new bone mineral reference values about young athletes. Our aim of the study was to construct bone mineral density (BMD) and bone mineral content (BMC) references of athletes by the type of sports.

Material and Methods. DEXA was used in 1793 elite athletes aged between 11 and 20 years. The bone structural parameters of each athlete were converted to z-scores relative to age- and sex-specific reference values specified by the DEXA software. Z-profile analysis and principal component analysis were used to identify body structural components in young athletes and to evaluate the associations between the identified component and the type of sport.

. The total BMD of male athletes is considerably higher than the age-specific references for males (p<0.001 in each age-group). An outstanding skeleto-muscular robusticity of male wrestlers, pentathletes and cyclers could be observed in the studied sports: wrestlers had significantly more developed skeleto-muscular robusticity and BMD than the age-group average among elite athletes, while pentathletes and cyclers had worse bone structural parameters than the reference level for their age-group among elite athletes. The corresponding trends in the BMC of female athletes are significantly higher than the references (p<0.001 in every age-group, with the exception of 13 years, p= 0.04). In case of female athletes, the rhythmic gymnasts’ and pentathletes’ bone structural parameters differed significantly from the players’ average parameters of the studied elite athletes: their average skeletal robusticity both in the trunk and the extremities lagged behind the age-group mean values for elite athletes.

Conclusion. Compared to reference values for the general population, BMD and BMC of the youth athletes were better developed. The skeletal development of cyclers, pentathletes and rhythmic gymnasts should be monitored more frequently, since their bone development lags behind not only their age-peer elite athletes’ bone development but also the population-based reference values.

38 39

ORAL PRESENTATIONS

O15 THE EFFECTS OF VIBRATION AS AN EXERCISE MODALITY ON SHOULDER GIRDLE MUSCLE ACTIVATION AND TIMING

Khaiyat O.1, Hawkes D.1, Horsley I.2

1Liverpool Hope University, Liverpool, United Kingdom, 2English Institute of Sport, UK

Introduction and Purpose: There is an interest within elite sport in understanding the impact of a vibrating platform as an adjunct to exercise in the training and rehabilitation of throwing athletes. However, there has been no comprehensive evaluation of its impact on the rotator cuff muscles and the timing of shoulder muscle recruitment.

Materials and Methods: Twenty healthy participants were recruited with EMG recorded from 15 shoulder girdle muscles. Isometric shoulder flexion at 25% maximal voluntary contraction was performed in three testing scenarios [no vibration; whole body vibration (WBV); and arm vibration (AV)]. A press up and triceps dips with and without vibration were also performed. Muscular recruitment was assessed pre- and post-vibration exposure.

Results: Activation of the anterior deltoid (p = 0.002), serratus anterior (p = 0.004), and rotator cuff muscles (p = 0.004-0.022) occurred significantly earlier following exposure to vibration. Significantly greater activation was seen in the anterior, middle and posterior deltoid, upper, middle and lower trapezius, serratus anterior, teres major, latissimus dorsi, supraspinatus, and infraspinatus when the isometric contraction was performed with either WBV and/or AV (p = < 0.001-0.040). Similarly, increased activation was also demonstrated during the press up and triceps dips when performed with vibration.

Conclusion: The use of vibration as an adjunct to exercise provokes a near global increase in shoulder muscle activation. Furthermore, exposure to vibration alters muscular recruitment improving readiness for movement. This has potential implications within elite sport for both training and game preparation.

38 39

ORAL PRESENTATIONS

O16 A MULTIDISCIPLINARY INVESTIGATION OF THE MUSCULOSKELETAL HEALTH BENEFITS OF TENNIS

Khaiyat O.1, Jackson M.1, Roche D.1

1Liverpool Hope University, Liverpool, United Kingdom

Introduction: The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study investigated impact of regular tennis participation in enhancing MSK function.

Materials and Methods: Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness.

Results: Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, −0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, −0.16 ± 1.70; P < 0.05).

Conclusion: The study supports improved MSK functionality in tennis players possibly due to the hybrid high-intensity interval training nature of tennis. The findings suggest tennis as an excellent activity mode to promote MSK health and a viable alternative to existing physical activity guidelines.

40 41

ORAL PRESENTATIONS

O17 THE EFFECTS OF THE NEW KAATSU-CYCLE BLOOD FLOW RESTRICTION PROTOCOL ON METABOLISM, AND PERCEPTUAL, MOOD AND COGNITIVE RESPONSES TO RESISTANCE EXERCISEKotopoulea Nikolaidi M.1,2, Giannopoulou I.1,2, Guppy F.2,3, Comeras-Chueca C.4, Collins A.1, Wright G.1, Angeloudis K.1,2, Muniz-Pardos B.4, Pitsiladis Y.1,2

1School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom, 2Centre for Stress and Age Related Disease, University of Brighton, Brighton, United Kingdom, 3School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, United Kingdom, 4GENUD Research group, Faculty of Health and Sport Sciences, University of Zaragoza, Brighton, United Kingdom

Introduction: Continuous KAATSU blood flow restriction (KAATSU-CON) during resistance exercise (RE) is being considered as an alternative mode of exercise to high intensity RE for muscle strength and hypertrophy. Recently, a new intermittent blood flow restriction (BFR) protocol has demonstrated similar hypertrophic muscular adaptations, with lower perceived of exertion (RPE) and pain compared to continuous BFR mode.

Purpose: To compare the psychophysiological and perceptual responses of a new intermittent KAATSU protocol (KAATSU-Cycle) to the more established KAATSU-CON during low load RE in healthy adults.

Material and Methods: Eleven recreationally active, healthy adults (age:22.55±5.01y; BMI:23.59±2.47kg/m2) performed low-load (30% 1RM) RE consisting of 4 sets leg press (30-15-15-15 repetitions) under 3 experimental conditions (Control, KAATSU-CON, KAATSU-Cycle). Capillary blood lactate, cognitive function (Stroop test), and mood (Profile of Mood State questionnaire: POMS) tests were conducted before and after exercise, while RPE and pain were assessed at the end of each RE set.

Results: Post RE blood lactate values were significantly higher following KAATSU-Cycle (Mean±SD;4.84±1.14[mmol/l], t(23)=2.91, pbonf=0.024) and KAATSU-CON (5.26±1.22[mmol/l], t(23)=3.57, pbonf=0.005) compared to control (3.96±0.85[mmol/l]), with no difference between the two KAATSU conditions (t(23)=0.329, pbonf=1.00). Sessional (median of all sets) RPE was significantly lower in KAATSU-Cycle (Median±IQR; 3±2) compared to KAATSU-CON (4±2, z=-3.549, p<0.001) but not compared to the control condition (3±3, z=-1.853, p=0.064), with no difference between KAATSU-CON and control (z=-1.549, p=0.121). Sessional pain was significantly higher in the KAATSU-CON (Median ± IQR; 3±2) compared to both KAATSU-Cycle (1±2, z=4.700, p<0.001) and Control (0±2, z=5.833, p<0.001), with no difference between KAATSU-Cycle and control (z=1.939, p=0.052). No significant differences were found in mood (p>0.05) or cognitive function (p>0.05).

Conclusions: KAATSU-Cycle, appears to evoke similar lactate concentrations but with significantly lower rating of perception and pain compared to KAATSU-CON. The full metabolic profile of the KAATSU-Cycle remains however to be determined.

40 41

ORAL PRESENTATIONS

42 43

ORAL PRESENTATIONS

42 43

ORAL PRESENTATIONS

O18 USABILITY TESTING OF A DIGITAL ASSESSMENT ROUTING TOOL FOR MUSCULOSKELETAL CONDITIONS: AN ITERATIVE CONVERGENT MIXED METHODS STUDY

Lowe C.1, Browne M.1, Marsh W.2, Morrissey D.1,3

1Sports & Exercise Medicine, WHRI, Queen Mary University of London, London, United Kingdom, 2Risk and Information Systems Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London, London, United Kingdom, 3Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom

Introduction and purpose: Digital technologies improving clinical outcomes and efficiency across the musculoskeletal pathway are prioritized for development, however rigorous evaluation must be completed to ensure efficacy. This study examined a musculoskeletal Digital Assessment Routing Tool (DART) to allow mitigation of all serious usability issues and optimize system performance to create positive user experience and system adoption.

Materials and Methods: An iterative-convergent mixed-methods design with 22 adult participants using 50 different clinical presentations over 5 testing rounds across 4 DART iterations. Recruitment used a purposive sampling matrix with quotas for age, habitual internet use and English language ability. Quantitative data collection was defined by the constructs with the ISO 9241-210-2019 standard, with user satisfaction measured by the system usability scale. Study endpoints were the mitigation of all Grade 1 and 2 usability problems and a mean system usability scale score of 80 or over across a minimum of 3 user group sessions.

Results: Every assessment resulted in a recommendation with no DART system errors and a mean completion time of 5.2 minutes (SD 4.44, range 1-18). Usability problems reduced from 12 to zero, with trust and intention to act improving during the study. The relationship between electronic health literacy and age was explored with Pearson correlation coefficient r (19)= -0.23, with no meaningful relationship found. The mean score across all groups was 84.3 (84.3, SD 12.73, CL 90% 4.67, corresponding to an “excellent” system, with qualitative data from all participants confirming DART was simple to use.

Conclusions: Participants found DART easy to use and would trust and act on the recommendation given, allowing progression to further validation studies. The iterative convergent mixed methods design proved highly effective in fully evaluating DART from a user perspective and could provide a blueprint for other researchers of mHealth systems.

44 45

ORAL PRESENTATIONS

O19 PREVALENCE AND BURDEN OF MENSTRUAL DISORDERS IN ATHLETES: A QUESTIONNAIRE STUDYLydon K.1,2, Madigan S.1, Rankin A.3,4

1Sport Ireland Institute, Dublin, Ireland, 2Irish College of General Practitioners, Dublin, Ireland, 3Sports Medicine NI, Belfast, United Kingdom, 4Sports Institute, Jordanstown, United Kingdom

Introduction: Menstrual disorders including amenorrhea and oligomenorrhea are well-documented issues for female athletes. There are many menstrual disorders that may affect the female athlete. These include conditions such as premenstrual syndrome, dysmenorrhea and menorrhagia. Evidence of the prevalence and burden of these conditions is less common in the published literature. Purpose: To assess prevalence and burden of menstrual disorders in athletes. Materials and Methods: Females, 18 years and older, engaged in competitive sport or regular physical activity were invited to participate in this cross-sectional study. Participants completed an online questionnaire incorporating demographic details, validated questionnaire assessment of menstrual function and performance related sections. Results: 533 physically active females completed the online questionnaire. 28.5% competed at national or international level with 66.8% competing regularly in their chosen sport. 35.1% reported concern about their menstrual cycle, with 27.2% overall reporting that these concerns were significant. 35.27% reported current or previous amenorrhea, 48.2% reported symptoms of premenstrual syndrome with 65.7% reporting analgesic use for dysmenorrhea. 82.3% of those studied have sought medical advice and were prescribed medication. Other sources of advice included; friends (68.9%), family (63.2%) and coach/trainer (15.8%). 78.85% have used the oral contraceptive pill, most commonly for contraception (49.64%), dysmenorrhea (18.71%) and menorrhagia (7.91%). Common symptoms associated with exercise included prolonged duration of menses (16.6%) and increased bleeding (2.9%). Conclusions: Disorders of menstruation are common in athletes and include premenstrual syndrome, dysmenorrhea and menorrhagia. Although less well studied in athletes, these menstrual disorders can affect quality of life, training and athletic performance in the female athlete. Ideally, these conditions should be identified at pre-participation screening and pro-actively managed in the competitive athlete.

44 45

ORAL PRESENTATIONS

O20 CREATING A SPORT AND EXERCISE MEDICINE MASTERS SYLLABUS FOR DOCTORS: A DELPHI STUDYVishnubala D.1,2, Iqbal A.2, Marino K.3, Salman D.4, Pringle A.5, Nykjaer C.2, Bazira P.1, Finn G.6

1Hull York Medical School, York, United Kingdom, 2University of Leeds, Leeds, United Kingdom, 3Royal Stoke University Hospital, Stoke on Trent, United Kingdom, 4Imperial College Hospital, London, United Kingdom, 5School of Human Sciences, Derby, United Kingdom, 6University of Manchester, Manchester, United Kingdom

Introduction and Purpose: Sport and Exercise Medicine (SEM) Masters curricula vary. This Delphi study aimed to create a consensus curriculum for doctors undertaking SEM Masters courses.

Material and Methods: A modified Delphi survey was utilised. An expert panel was established of individuals deemed to have adequate knowledge of the field. The research group developed the initial draft of the curriculum by collating and reviewing previously published United Kingdom-based postgraduate SEM-related curricula. There were 2 phases. In phase 1 the expert group either accepted, rejected or modified each learning objective (LO). During phase 2 the expert group were asked to accept or reject each LO that did not get accepted outright previously. The research group analysed the levels of agreements and the comments given by the expert panel after each phase.

Results: The expert panel consisted of 45 individuals, with 35 completing phase 2 (78% retention rate). Of the 136 LOs initially collated: 71 (52%) were accepted outright, 60 (44%) were altered in some way and re-included in phase 2, and 5 (4%) were removed after phase 1. The research group added 2 (1%) new LOs upon reflection over comments made by the expert panel. The final curriculum contained 133 LOs, divided into 11 sub-themes (Table 1).

Sub-Theme Number of objectives in sub-theme1. Physical Activity and Human Health 132. Medical Issues Related to Exercise 163. Injuries Related to SEM 224. Basic Science in SEM 185. Clinical Pharmacology 66. Antidoping 47. Sports Team and Event Management 288. Physical Activity in Challenging Environments 1

9. Specific Groups in SEM 1110. Intrinsic Skills of an SEM Clinician 311. Extrinsic Skills of an SEM Clinician 11Total 133

Table 1. The finalised sub-themes and number of LOs within each sub-theme.

Conclusion: The findings will better inform educators when developing SEM Masters curricula and inform students what they should look for when considering an SEM Masters. This consensus curriculum is an important step in standardizing postgraduate SEM education.

46 47

ORAL PRESENTATIONS

O21 SPORTS-RELATED CONCUSSION RISK IN UNIVERSITY PERFORMANCE ATHLETES Olatigbe O.1, Cooper D.2, Lodge S.3, O’Hanlon M.3,4

1University Hospital of Wales, Cardiff, United Kingdom, 2School of Allied Health Professions, Keele University, Keele, United Kingdom, 3David Ross Sports Village, Department of Sport, University of Nottingham, Nottingham, United Kingdom, 4Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom

Introduction: Sports-related concussion (SRC) is common in all athletes and can lead to short- and long-term health consequences. The Sport Concussion Assessment Tool-5th Edition (SCAT-5) is a useful tool in concussion evaluation, with an increase in clinical value when post-concussive results are compared to pre-season baseline scores. Athletes participating in collision/contact sports are most at risk to sustain an SRC. A previous concussion history has also been demonstrated to increase the SRC risk; however, the evidence, particularly in females and University performance athletes, is limited.

Purpose: To examine the sports-related concussion risk in University performance athletes.

Methods: This was a retrospective cohort study. Performance athletes from the University of Nottingham who had completed pre-season baseline SCAT-5 testing were recruited and those who sustained a SRC during the season were further analysed. The SRC risk in female and male athletes was investigated, as were established risk factors elucidated from the SCAT-5. Ethical approval was obtained from the University of Nottingham Research Ethics Committee.

Results: A total of 399 University performance athletes (172 female, 227 male) met the eligibility criteria and were included in this study (see Table 1). There was a SRC incidence rate of 18% (72 athletes; 38 female, 34 male) during the season (see Table 2). Female athletes were approximately 1.5 times more likely to sustain an SRC than male participants during the season (RR 1.47, CI 1.03-2.23). However, when adjusted for established SRC risk factors, the risk was lower in females (OR<1). Participation in a collision sport and a previous concussion history were the two most common factors amongst the concussed cohort (see Table 2).

Conclusion: This study illustrates the high rates of SRC amongst University-aged athletes. The increased SRC risk in female athletes necessitates the need for further research into potential emerging gender specific SRC risk factors.

46 47

ORAL PRESENTATIONS

Table 1: Demographics and Participant Information

Female Male TotalNumber of participants (%): 172 (43.1%) 227 (56.9%) 399

Mean age in years ± SD (range):

19.5 ± 1.5 (18-29)

19.8 ± 1.7 (18-30)

19.7 ± 1.6 (18-30)

Years of education completed (± SD): 15.0 ± 1.5 15.4 ± 1.9 15.3 ± 1.7

Sporting discipline:Rugby Union (%) 83 (48.3%) 62 (27.3%) 145 (36.3%)American Football (%) 0 (-) 60 (26.4%) 60 (15.0%)Lacrosse (%) 36 (20.9%) 17 (7.5%) 53 (13.3%)Hockey (%) 35 (20.3%) 17 (7.5%) 52 (13.0%)Rugby League (%) 0 (-) 40 (17.6%) 40 (10.0%)Football (%) 13 (7.6%) 25 (11.0%) 38 (9.5%)Water Polo (%) 5 (2.9%) 6 (2.6%) 11 (2.8%)

Total 399History:Previously suffered a sports-related concus-sion

120 (69.8%) 146 (64.3%) 266 (66.7%)

Previous hospitalisation for head injury 10 (5.8%) 42 (18.5%) 52 (13.0%)

Diagnosed/treated for headache or migraine 18 (10.5%) 12 (5.3%) 30 (7.5%)

Diagnosed with a learn-ing disability/dyslexia 17 (9.9%) 19 (8.4%) 36 (9.0%)

Diagnosed with ADHD/ADD 1 (0.6%) 5 (2.2%) 6 (1.5%)

Diagnosed with a men-tal health disorder 12 (7.0%) 7 (3.1%) 19 (4.8%)

48 49

ORAL PRESENTATIONS

Table 2 - Sports- Related Concussion Incidence Rates

Female Male Total Sports-related concus-sions during the season (%)

38 (52.8%) 34 (47.2%) 72

Sporting discipline:Rugby Union 23 (60.5%) 9 (26.5%) 32 (44.4%)American Football 0 (-) 11 (32.4%) 11 (15.3%)Lacrosse 7 (18.4%) 3 (3.8%) 10 (13.9%)Hockey 5 (13.2%) 1 (2.9%) 6 (8.3%)Rugby League 0 (-) 6 (17.6%) 6 (8.3%)Football 1 (2.6%) 4 (11.8%) 5 (6.9%)Water Polo 2 (5.3%) 0 (-) 2 (2.85)History:Previously suffered a sports-related concussion 26 (68.4%) 21 (61.8%) 47 (65.3%)

Previous hospitalisation for head injury 0 (-) 6 (17.6%) 6 (8.3%)

Diagnosed/treated for headache or migraine 3 (7.9%) 4 (11.8%) 7 (9.7%)

Diagnosed with a learning disability/dyslexia 7 (18.4%) 7 (20.6%) 14 (19.4%)

Diagnosed with ADHD/ADD 0 (-) 1 (2.9%) 2 (2.8%)

Diagnosed with a mental health disorder 6 (15.8%) 3 (8.8%) 9 (12.5%

48 49

ORAL PRESENTATIONS

O22 DISCUSSING THE MENSTRUAL CYCLE IN THE SPORTS MEDICINE CLINIC: PERSPECTIVES OF ORTHOPAEDIC SURGEONS, PHYSIOTHERAPISTS, ATHLETES, AND PATIENTS.O’Loughlin E.1, 2, Reid D.1, Sims S.1, 3

1The Sports Performance Research Institute New Zealand (SPRINZ), Auckland University Of Technology, New Zealand, 2Department of Surgery and Anaesthesia, University of Otago, New Zealand, 3WHISPA Group, High Performance Sport New Zealand, New Zealand

Introduction and Purpose: Recently, there has been an increase in female oriented sports medicine research related to physiological aspects of the menstrual cycle. However, it is unclear if this topic is routinely and openly discussed in the sports medicine clinic. In addition, sports medicine health professionals’ knowledge, perceptions, and comfort in discussing the menstrual cycle in the sports medicine clinic are unknown.

Material and Methods: This study explored members of the sports medicine community’s knowledge, perceptions of, and comfort discussing the endogenous menstrual cycle. Five semi-structured focus group sessions were conducted with 18 participants (2 orthopaedic surgeons, 9 sports physiotherapists, 3 patients, and 4 athletes) in Wellington, New Zealand.

Results: An inductive and semantic approach of reflexive thematic analysis revealed a number of themes that described the menstrual cycle as a pertinent and evolving topic in the sports medicine clinic. The first theme ‘A dearth of education and discussion has given rise to a perceived lack of menstrual cycle knowledge’ reflects the participants’ consensus regarding a lack of knowledge of the menstrual cycle. In contrast, ‘Different (mismatched) concerns of health professionals and non-health professionals’ describes contrasting menstrual cycle-related concerns reported by health professionals and non-health professionals. The third theme ‘Health professionals have specific strategies to enable comfortable menstrual cycle conversations’ describes the common barriers to in-clinic menstrual cycle discussions, and pragmatic approaches health professionals take to tackle these barriers. Finally, ‘The menstrual cycle is a gendered topic’ reflects participants’ descriptions of the menstrual cycle as a gendered topic within the sports medicine environment.

Conclusion: While many participants described general comfort discussing the menstrual cycle, participants identified several factors affecting this, including health professional and non-health professional age, culture, sex, and/or gender. This study highlights the importance of developing trust, giving context, and being aware of each patient’s concerns and sociocultural status when discussing the menstrual cycle in the sports medicine clinic.

50 51

ORAL PRESENTATIONS

O23 ARE PREGNANT WOMEN MEETING THE NATIONAL PHYSICAL ACTIVITY RECOMMENDATIONS AT THEIR BOOKING APPOINTMENT?Ridout A.1, Smith R.1, Scanlan S.2, Reid H.1, Lee C.1, Mackillop L.2

1Department of Sport & Exercise Medicine, Nuffield Orthopedic Centre, Oxford, United Kingdom, 2Women’s Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

Introduction and Purpose: National recommendations advise that pregnant women should perform an aerobic component of at least 150 minutes per week of physical activity (PA), and the benefits of PA in pregnancy are well recognised. Despite this, many women do not meet the recommended guidance, and activity levels decline during pregnancy. This study was done to evaluate physical activity levels at 10-12 weeks of pregnancy, measured with the exercise vital sign (EVS), which is a validated and quick to use physical activity reporting tool.

Materials and Methods: A modified version of the EVS was incorporated into the electronic record system used at the Oxford University Hospitals NHS Foundation Trust booking appointment. EVS was self-reported, recorded by midwives and coded into three categories - green (more than 150 minutes/week), amber (30-150 minutes/week) and red (less than 30 minutes/week). A very brief advice intervention was then given to women, depending on their physical activity levels. Body mass index (BMI) was compared with PA levels using Pearson’s chi-squared test.

Results: 32,570 women were assessed between April 2018-January 2022. Mean age was 31.2y (14-55y), mean booking weight 75.5kg (21-187.9kg) and mean BMI 26.5 kg/m2 (12.4-66.3 kg/m2). 19,459 (59.7%) were coded green, 9151 (28.1%) amber and 3960 (12.2%) red. 14.5% of women (n=953) with BMI ≥30kg/m2 were in the lowest PA category compared to 11.5% women (n=2993) with BMI < 30kg/m2 (p<0.05).

Conclusion: This tool has successfully been introduced at scale, demonstrating less than two-thirds of women met the recommended PA levels and 1 in 8 were very inactive. A significant association was found between raised BMI and lowest category of PA levels. This information is used to guide and target PA advice, supporting women to increase their activity levels. Future work should address the effectiveness of interventions to support women to increase their physical activity levels during pregnancy.

50 51

ORAL PRESENTATIONS

O24 THE ASSOCIATION BETWEEN ASTHMA AND LIFETIME PHYSICAL ACTIVITY: A SECONDARY DATA ANALYSISSeth S.1, Edwards K.1

1Orthopaedics, Trauma And Sports Medicine, School Of Medicine, Faculty of Medicine and Health Sciences, University Of Nottingham, Nottingham, United Kingdom

Introduction and Purpose: Asthma affects 12% of the United Kingdom’s (UK) population and is characterised by reversible airway obstruction with remodelling. Physical activity (PA) decreases obesity and cardiovascular disease risk, alongside improving asthma control and symptoms. Individuals affected by asthma notice breathlessness and wheezing during PA, thus lowering activity levels. Running is a form of PA; decreased participation levels are observed in this group. Our study aimed to explore the association between asthma and lifetime PA. Secondly, we aimed to investigate running differences between the asthma and asthma-free population. Material and Methods: Secondary data analysis was conducted on the Health of Adults’ Longitudinal Observational Study cohort: it is an epidemiological study with participants from the UK and Australia. Baseline data was recorded between 2016 and 2020; participant demographics, disability, illness, injury, and PA levels. Lifetime PA was measured using Lifetime Physical Activity Questionnaire (L-PAQ): weekly PA hours and weekly MET-Hours were calculated. Information on running training patterns, distances and times were collected retrospectively. The L-PAQ data analysis occurred through Linear Regression, Multiple Regression and K-Meloid clustering; running data was analysed through Chi-squared and Mann-Whitney U.

Results: There was no association between asthma and weekly PA hours and weekly MET-Hours (p=0.340; p=0.384). Significant associations were seen between higher L-PAQ outcomes and females (p<0.001), older age (p<0.001) and number of injuries (p=0.01). Three clusters based on sex, age, BMI, ethnicity, education, occupational PA, smoking status, asthma, injuries and L-PAQ outcomes were formed, with all variables contributing significantly to the model (p<0.05). Longest monthly and annual run, recorded in miles and minutes, were similar across study groups (p>0.05). The asthma-free group ran quicker than the asthma group (p<0.001).

Conclusion: There were no associations between PA levels or running measures with asthma. Further research should understand the relationship between asthma control and symptoms.

52 53

ORAL PRESENTATIONS

O25 PHYSICAL ACTIVITY PROMOTION IN EMERGENCY DEPARTMENTS: CAN SPORTS AND EXERCISE MEDICINE HELP? Shaikh F.1, MacMullen H.1, Speers C.1

1Oxford University Hospitals, Oxford, United Kingdom

Background: Physical Activity (PA) can significantly impact global health. The World Health Organisation have indicated that all health service providers should engage in Health and PA Promotion, including Emergency Departments (ED). EDs have recognised this need and there is drive to encourage health promotion despite barriers and challenges. Sports and Exercise Medicine (SEM) clinicians can help ED promote PA.

Aim: We propose and pilot an interdisciplinary project where SEM supports PA Promotion in ED using Behaviour Change Theory principles.

Methods: A SEM and an ED Registrar conducted a variety of interventions over 9 months including transtheoretical and COM-B based individual/group motivations and educational sessions, staff surveys, informal multidisciplinary engagement; empowering early-adopters, and resource provision. These were aimed at embedding PA promotion (‘active conversations’) in ED culture.Results: We saw increase in referrals to local health-promotion service (n=39;11 referrers). Referrals continued after direct SEM intervention stopped. Informally, culture change was observed. Our staff survey (n=43) showed that 79% rated PA Promotion ≥7/10 in importance; but 46% rated personal confidence of ≥7/10 in delivering interventions. 34% had PA Promotion training, 63% welcomed it. Time and lack of training were stated as important challenges. Discussion: SEM collaboration with ED can sustainably increase PA Promotion. Focussed intervention aimed at educating and motivating staff is effective for behaviour change. Opportunity identification and involvement of PA promotion enthusiasts can increase stakeholder involvement. Our model can be adopted at other centres nationwide for population health benefits.

52 53

ORAL PRESENTATIONS

O26 THE ASSOCIATION OF TFAM (RS1937), MB (S7293) AND GDF5 (RS143383) POLYMORPHISMS WITH ENDURANCE STATUS IN LITHUANIAN ATHLETESBortkevič A., Anikevičiūtė G., Ginevičienė V., Sivačiova M.Vilnius University, Vilnius, Lithuania

Introduction: The mitochondrial transcription factor A (encoded by the TFAM gene) is a mitochondrial DNA binding protein essential for mitochondrial biogenesis. Myoglobin (encoded by MB gene) is a cytoplasmic hemoprotein that supply oxygen to myocytes, and expressed primarily in oxidative skeletal muscle fibers. Growth Differentiation Factor 5 (encodes GDF5 gene) is involved in tissue growth, bone and cartilage formation. We hypothesized that TFAM rs1937 (c.35G>C, p.Ser12Thr), MB rs7293 (c.174G>A, p.Ala58=) and GDF5 rs143383 (g.375G>A; c.-275C>T) genetic variants might be associated with physical performance traits. Therefore, the aim of this case-control study was to investigate the association of TFAM rs1937, MB rs7293 and GDF5 rs143383 polymorphisms with athlete status in Lithuanians.

Material and methods: A total of 180 elite athletes (endurance n=81, sprint/power n=44, and mixed n=55 groups) and 255 non-athlete controls (healthy unrelated Lithuanian citizens) were genotyped for TFAM rs1937 (G/C) and MB rs7293 (G/A) variants by restriction fragment length polymorphism methods, and GDF5 (G/A) - by real-time polymerase chain reaction.

Results: The phenotype of Lithuanian athletes corresponds to skills of high elite level. The TFAM rs1937 CC genotype was higher in endurance-oriented athletes (4.9%) compared to sprint/power-oriented athletes (0%) and controls (4.9%) (p<0.05). The TFAM rare C allele was more frequent in the endurance-oriented group compared to sprint/power-oriented (18.3% vs 7.1%, p=0.02). Regarding the MB variant, genotypes distribution significant differed between endurance-oriented athletes and controls (GG/GA/AA: 38.3/58/3.7% vs 27.5/45.1/27%; p<0.0001). The MB G allele frequency was higher in endurance-oriented athletes (67.3%) compared to sprint/power-oriented athletes (56.8%), mixed (37.3%) and controls (50%) (p<0.05). Moreover, significant differences in GDF5 allele distribution were observed between endurance athletes and controls (G/A: 55.3/44.7% vs 40.5/59.5%, p=0.037).

Conclusions: Our findings provide support for an association of TFAM rs1937 (C allele), MB rs7293 (G allele) and GDF5 rs143383 (G allele) with endurance status in Lithuanian athletes.

54 55

ORAL PRESENTATIONS

O27 EVER SINCE MY INJURY, I FEEL LIKE EVERY DAY IS LEG DAY’: A QUALITATIVE STUDY ON PATIENTS’ EXPERIENCES OF NEUROMUSCULAR CHANGES AFTER KNEE INJURIESTayfur B., Morrissey D., Miller S.1Queen Mary University of London, London, United Kingdom

Introduction and Purpose: Neuromuscular deficits following knee injuries are common, and may persist and contribute to post-traumatic osteoarthritis. Our aim was to provide a deeper understanding of peoples’ experiences of neuromuscular changes after knee injuries.

Material and Methods: A qualitative semi-structured interview study was conducted using an interpretative phenomenological approach. Nineteen people with a history of knee injury were recruited with purposive maximum variation based on injury type (ligament, meniscus, cartilage), time since injury (1-30 years), activity level (sedentary-professional athlete) and symptoms. Questions focused around neuromuscular changes experienced since injury and their current knee function. Data were analysed using an inductive thematic approach.

Results: Following injury, participants described an unloading period with reduced movement, which was accompanied by neuromuscular changes such as visible atrophy, muscle weakness and inhibition. Different expectations and concerns about neuromuscular recovery were expressed. During the recovery period, many experienced a certain amount of neuromuscular recovery, although ongoing deficits were common. Attitudes towards exercise and muscle strength, and access to healthcare and guidance affected movement and exercise choices. Progression was a facilitator of neuromuscular recovery, while barriers were mainly symptomatic reactions and safety concerns, affecting how much a person would load their leg. Long-term physical activity modifications were common and affected neuromuscular recovery. Many were satisfied with these changes, even though the neuromuscular function was not at pre-injury level. People had lower expectations from their knees, with changed feelings and perceptions. Ongoing management was required for keeping at a certain physical activity level.

Conclusion: Individual expectations and needs should be prioritized while focusing on neuromuscular recovery, since many people expressed satisfaction with modified physical activity levels, hence lowered neuromuscular capacity, while many people struggled during recovery and management in long-term due to lack of healthcare access and guidance.

54 55

ORAL PRESENTATIONS

O28 FEASIBILITY OF ROUTINELY ASSESSING PATIENTS’ EXERCISE LEVELS IN IRISH GENERAL PRACTICE: A MIXED METHODS STUDYWall N.1,2, Frizelle J.3, Brady J.2, Buckingham A.1, McKay C.1

1University of Bath, Bath, United Kingdom, 2Blessington Family Practice, Blessington, Ireland, 3Castleknock Medical Centre, Dublin, Ireland

Introduction and Purpose: Physical activity promotion has been highlighted as a priority for healthcare professionals by the World Health Organisation. Yet, assessment of exercise levels is not frequently performed in general practice, with time being a key barrier. Previous research has demonstrated higher rates of exercise assessment by healthcare professionals, plus subsequent improved patient health outcomes, when exercise assessment tools are completed prior to doctor consultations. This study aims to investigate the feasibility of integrating routine assessment of patients’ exercise levels into a general practice setting in the Republic of Ireland.

Material and Methods: Three general practices completed a one-week intervention, in which all patients attending consultations were asked to complete an Exercise Vital Sign (EVS) questionnaire prior to their consultation. Researchers collected quantitative data on rates of assessment and recording. Focus group interviews were conducted to investigate the views of participating general practitioners (GPs), practice nurses and reception staff, regarding the feasibility of integrating routine exercise assessment into normal practice.

Results: Of 527 eligible consultations, 133 EVS questionnaires were completed (25.2% assessment rate). Outcomes were recorded to healthcare records in 48.9% of assessments. The intervention added less than one minute in 94% of consultations. However, qualitative data demonstrated that the cumulative time added across multiple consultations was perceived by GPs as a barrier to performing routine assessment of exercise levels. Most GPs expressed a preference for targeting exercise assessment to specific consultations.

Conclusion: Pre-consultation assessment facilitated high rates of structured exercise assessment, compared to standard practice. However, GPs have concerns about the feasibility of routine assessment, due to additional workload requirements. Targeting structured assessment to specific consultations may be more feasible for GPs; further exploration of this is needed within general practice.

56 57

ORAL PRESENTATIONS

O29 A SYSTEMATIC REVIEW AND META-ANALYSIS OF PREVALENCE AND RISK FACTORS FOR LOW BACK PAIN AMONG ADOLESCENT ATHLETESWall J.1, Meehan W.2, Trompeter K.3, Trompeter K.4, Gissane C.1, Mockler D.5, van Dyk N.6, van Dyk N.7, Wilson F.1

1Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland, 2The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children’s Hospital, Harvard Medical School, Waltham,, USA, 3Department of Sports Medicine and Sports Nutrition Ruhr-University Bochum, Bochum, Germany, 4Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany, 5John Stearne Library, Trinity College Dublin, Dublin, Ireland, 6High Performance Unit, Irish Rugby Football Union, Dublin, Ireland, 7Section Sports Medicine, University of Pretoria, Pretoria, South Africa

Introduction and Purpose: Although low back pain (LBP) is common in adolescent athletes, there is no published synthesis characterising LBP in adolescent sport. This systematic review aimed to investigate prevalence, incidence, risk factors, and common pathological presentations of LBP in this population.

Material and Methods: Five sources were searched from inception to September 2021 for studies evaluating incidence and/or prevalence of LBP in adolescent athletes. Data synthesis calculated weighted mean prevalence and incidence proportion of LBP for each time period used. Meta-regression analyses (mixed-effects model) were conducted. Quality was assessed using a tool developed by Lebeouf-Yde and Lauritsen.

Results: There were 80 studies included. Mean weighted prevalence of LBP in adolescent athletes was 50% (95% CI 41 to 59, I2=99%) for lifetime, 42% (95% CI 30 to 54, I2=96%) for 12-month, and 15% (95% CI 10 to 21, I2=98%) for point prevalence (Figure 1). Mean weighted 12-month incidence of LBP in adolescent athletes was 33% (95% CI 7 to 67, I2=99%) (Figure 2). Spondylolysis was the most common pathology reported (13 studies). Factors associated with LBP reported in high quality cross-sectional studies (mean weighted OR) were sports participation (OR=1.6, 95% CI 1.1 to 2.4) and concurrent lower extremity pain (OR=8.3, 95% CI 4.8 to 14.4). In meta-regression analyses, differences in methodological quality and LBP definition accounted for most heterogeneity in studies of cohort design.

Conclusion: LBP is as common among adolescent athletes as in the general adolescent population (ranging from 12-33% annual incidence and 3-39% point prevalence), with spondylolysis the most reported diagnosis. Concurrent lower limb pain may be associated with LBP in adolescent athletes. Sport participation may increase risk of developing LBP when compared to a non-sporting control group. This increase in risk may be too heavily attributed to sport in adolescents, since the general adolescent population does not engage in sufficient physical activity and still reports a high prevalence of LBP.

56 57

ORAL PRESENTATIONS

Figure 1. Forest (left) and funnel (right) plot of weighted pooled means of studies reporting point prevalence of LBP.

Figure 2. Forest (left) and funnel (right) plot of weighted pooled means of studies reporting 12-month incidence of LBP.

58 5958 59

ORAL PRESENTATIONS

O30 THE 700 MILE CYCLE TO SOCIAL HEALTH ON HAEMODIALYSIS

Weekes C.1, Ruck S.2

1Swansea Bay University Health Board, Swansea, Wales, UK, 2B Braun Avitum UK, Llantrissant Dialysis Unit, Pontyclun, Wales, UK, 3Paul Popham Fund, Swansea, Wales, UK

Introduction and Purpose: Physical Inactivity (PI) has been characterised as a global pandemic. Evidence shows 45% of renal patients receiving Haemodialysis (HD) do no exercise: The benefits (reducing the risk of adverse health conditions, increasing life expectancy and quality of life (QoL)) are well documented, however there are considerable barriers when distributing exercise programs as routine treatment.

The purpose of this study was to re-introduce an Intra-Dialytic Cycling (IDC) program post COVID lockdown, to promote team work, and measure how this affected QoL measurements.

Material and Methods: In April 2021 the IDC program was re-introduced (n = 8, age: 66 ± 14.3 years). Baseline measurements were also taken from a sample of historic IDCs at this time (n=10, age: 64.5 ± 12.6 years).QoL measurements included: Medical Outcomes Short Form 36 (SF-36) and General Practice Physical Activity Questionnaire (GPAQ). IDC was conducted on a MOTOMedLetto2 cycle ergometer during the first hour of dialysis treatment. Patients cycled for a target time of 20 minutes at individualised moderate intensities supervised by a physiotherapist. Mileage was recorded each session.

Results: Initial QoL results show improvements ranging from 12-34% in five SF36 domains (Physical Role, Body Pain, General Health, Social Functioning, and Mental Health) and reductions ranging from 6-20% in 3 domains (Physical Function, Vitality and Emotional Role). GPAQ results revealed 5 patients moving from “Inactive” to “Moderately Inactive” categories. Over 6 months patients collectively cycled 668.72 miles.

Conclusion: Evidence from this study has shown that moderate intensity IDC increases general health, and improves social functioning.The collection of mileage has had the effect of encouraging teamwork and initiating social conversation.The NHS generally focuses on a medical model of care, however this cannot “fix” QoL. By running routine IDC we can reduce inactivity, promote positive, social interactions and non-medical, relatable conversations.

58 5958 59

PO

ST

ER

PR

ES

EN

TA

TIO

NS

60 6160 61

TH

E A

SS

OC

IAT

ION

AN

D I

NS

TIT

UT

EP

RIZ

E P

OS

TE

RS

60 61

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

60 61

P01 IMPROVING THE USE OF THE FIRST CONTACT PHYSIOTHERAPY SERVICE AT IDLE MEDICAL CENTRE IN TERMS OF APPOINTMENT UPTAKE AND GENERAL PRACTITIONER SATISFACTIONKataria S., Kataria K.Bradford Teaching Hospital Foundation Trust, Bradford, United Kingdom

Introduction: On average, 30% of General Practitioner (GP) appointments address musculoskeletal (MSK) problems (Department of Health (2006)). First Contact Physiotherapy (FCP) is service placing MSK physiotherapists directly in GP practices to get patients seen quicker and recovering faster. Additionally, they aim to reduce GP workload to ease pressure. This QIP aimed to optimise use of FCP at Idle Medical Centre and thus streamline care for patients with MSK presentations. The endpoints were uptake of FCP appointments and GP satisfaction with the FCPs role in managing MSK problems at the practice.

Methods: Two changes were implemented. Firstly, FCP were lobbied to provide face to face appointments. Secondly, administration staff were educated regarding FCP appointment criteria via a talk and posters.

The proportion of unused FCP appointments in the 273 appointments before and after the changes was calculated. Questionnaires were disseminated among GPs to assess satisfaction with the FCP service before and after changes.

Results: 8 GPs completed questionnaires before and after changes. After changes:There was a large decrease in unused FCP appointments (35% to 4.3%). Fewer GPs reported that the majority of MSK cases they had seen recently would have been more appropriate for FCP appointments (7 to 1).There was an increase in GPs reporting to be satisfied with the service FCP were providing (12.5% to 87.5%)

Discussion: There was a vast improvement in both uptake of FCP appointments and GP satisfaction. As a result, the FCP will continue to provide face to face appointments. There will be annual teaching for the reception staff regarding the FCP service and it will form part of the induction for new staff. Informational posters remain in place for reference. There is a collective understanding amongst the reception staff regarding how best to navigate care of MSK presentations and streamline the patient’s journeys.

62 63

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P02 Withdrawn

62 63

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P03 A SYSTEMATIC REVIEW OF LONG-DISTANCE TRIATHLON MUSCULOSKELETAL INJURIESRhind J.1, Dass D.2, Barnett A.2, Carmont M.3

1St Georges University Hospital, London, United Kingdom, 2Robert Jones Agnes Hunt Hospital, Oswestry, United Kingdom, 3Shrewsbury & Telford Hospitals NHS Trust, Telford, United Kingdom

Introduction: The distribution of injuries affecting long-distance triathletes is yet to be fully understood. A systematic review was performed of the clinical literature to determine the epidemiology of musculoskeletal injuries affecting long-distance triathletes. Method: Searched databases in Feb 2020 were PubMed, Medline, EMBASE, EMCARE, and CINHAL databases. Published observational research articles related to the incidence or prevalence of musculoskeletal injuries in long-distance triathletes (competing at “Ironman” full distance or greater), written in the English language and not restricted by age or gender or date were eligible.

Results: Of the 975 studies identified on the initial search, six studies met the inclusion criteria for analysis. The mean age (SD) of the long-distance triathletes in these studies was 35.1 (2.7) and the range was 21-68 years. Overuse injuries were most frequent with the incidence range of 37-91%, and acute injury incidence range was 24-27%. The knee and spine were the most frequent location of injury. Running was the most frequently affected discipline. Elite athletes had a lower incidence of overuse injury (37%). The highest acute injury incidence (27%) was recorded in non-elite athletes. The quality of the studies was relatively poor with only one study satisfying >50% of the quality assessment tool questions and only two studies were prospective, the rest were retrospective cross-sectional studies.

Conclusion: Overall, there is a lack of literature reporting on musculoskeletal injuries in long-distance triathletes. Overuse injuries, particularly in the knee, are the most frequently reported, running and cycling are the most frequent disciplines associated. Long-distance triathletes may have a lower incidence of both overuse and acute injuries.

Table 2 - Types of InjuryLead Author Definition of Injury Time Period

of StudyAcute Inju-ries

Over-use Injuries

Overall Injuries

Other Injuries

Hiller et al. (1987)bi cycling, and running

Presentation to Medical Tent

2 IM Events Not report-ed

Not re-ported

Not re-ported

22% IM Quali-fier 198413% IM World Championships 1985 "Trauma/Orthopaedic Complaints"

64 65

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

O’Toole et al. (1989)but may be even more important to those pursuing ultraen-durance exercise. The purposes of this study were to report the type and incidence of overuse injuries in ultraendurance triathletes and to relate training practices to injury occurrence. Data was gathered from the responses of 95 competitors (75 men, 20 women

Left to the judge-ment of each athlete

One year Not report-ed

91% Not re-ported

Not reported

Egermann et al. (2003)

Injury was defined as an event taking place during train-ing or competition since starting tri-athlon, which forced the athlete to stop the current training session or race

6.7 years Fractures 11% Contusions/Abrasions 51% Muscle/Ten-don 33% Capsule/Liga-ment29%

76% 75% Not reported

Vleck et al. (2010)question-naire-based, ret-rospective analysis of training and injury in British National Squad Olympic distance (OD

Any musculoskeletal problem causing cessation of training for at least one day, a reduction in training mileage, or taking of medicineAcute injury: “That caused by a hazard encounter”

5 years Not report-ed

37% Not re-ported

18% orthopae-dic problems

Rimmer and Co-niglione (2012)

Any competitor who sought assessment and/or treatment by race medical staff was recorded

1 IM Event 27% Not re-ported

Not re-ported

37% presented to the medical tent for atten-tion

Andersen et al. (2013)

Acute injuries: all physical complaints over a 2-week period. Overuse injuries: reported using OS-TRC methodology

26 weeks 24% 56% Not re-ported

Not reported

IM = Ironman, IM 70.3 = Half Ironman, OD = Olympic distance, IQ = Ironman Qualifier

64 65

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Table 4 - A Heatmap Representing Injury Variables From Each Study

66 67

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P04 THE MMAAS PROJECT: AN OBSERVATIONAL HUMAN STUDY INVESTIGATING THE EFFECT OF ANABOLIC ANDROGENIC STEROID USE ON GENE EXPRESSION AND THE MOLECULAR MECHANISM OF MUSCLE MEMORYKolliari-Turner A.1, Lima G.1,2, Wang G.1, Ho P.3, Meehan L.3, Roeszler K.3, Seto J.3, Malinsky F.1, Karanikolou A.1, Eichhorn G.1,4, Tanisawa K.5, Betancurt J.6, Hamilton B.1,7,8,9, Kumi P.10, Shurlock J.11, Skiadas V.12, Twycross-Lewis R.13, Kilduff L.14, Guppy F.7,8, North K.3, Pitsiladis Y.1,2,8, Fossati C.2, Pigozzi F.2, Borrione P.2

1School of Sport and Health Sciences, University Of Brighton, Eastbourne, United Kingdom, 2Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy, 3Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia, 4Environmental Extremes Laboratory, University of Brighton, Eastbourne, United Kingdom, 5Faculty of Sport Sciences, Waseda University, Tokyo, Japan, 6Faculty of Sport Science, Universidad Europea de Madrid, Madrid, Spain, 7School of Applied Science, University of Brighton, Brighton, United Kingdom, 8Centre for Stress and Age-related Disease, University of Brighton, Brighton, United Kingdom, 9The Gender Identity Clinic Tavistock and Portman NHS Foundation Trust, London, United Kingdom, 10Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom, 11Somerset NHS Foundation Trust, Taunton, United Kingdom, 12University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, 13School of Engineering and Materials Science, Queen Mary University of London, London, United Kingdom, 14Applied Sports, Technology, Exercise, and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, Swansea

Introduction and Purpose: It remains unknown if myonuclei accumulated from Anabolic Androgenic Steroid (AAS) usage are permanent, potentially giving long-lasting benefits. Limited data exists on AAS influence on gene expression and Fat Free Mass (FFM) losses post exposure.

Material and Methods: Males aged 20-42 were recruited within the following: Non-resistance trained (C) or resistance trained (RT), RT-currently using AAS (RT-AS), of which if AAS usage ceased for ≥18 weeks re-sampled as Returning Participants (RP) or RT-previously using AAS (PREV). Whole blood and a trapezius muscle sample was collected for gene expression analysis, with a separate muscle sample collected for immunohistochemical (IHC) analysis. FFM was measured via Bioelectrical impedance. IHC data between groups were compared by a Generalized Linear Model with an alpha of 0.05.

Results: FFM of four of five RP (RP2-5), who ceased AAS usage ≤2 weeks prior to visit one and had 19-28 weeks between visits, decreased by 3.9-4.7kg. RP1’s first visit was 34 weeks after AAS exposure, his second visit was 28 weeks later and FFM decreased 0.9kg. Fibre CSA decreased for RP1 and RP2 between visits (7566 vs 6629 µm²; 7854 vs 5677 µm²) whilst myonuclei per fibre remained similar (3.5 vs 3.4; 2.5 vs 2.6). Respectively these values increased for RP3 between visits (7167 vs 7889 µm²; 2.6 vs 3.3). There were no significant differences between C (n=5), RT (n=15), RT-AS (n=17) and PREV (n=6) for myonuclei per fibre. Whole blood (C=7, RT=22, RT-AS=19, RP=5, PREV=7) and muscle (C=7, RT=19, RT-AS=19, RP=4, PREV=7) is preserved for gene expression analysis.

Conclusion: This cohort of past AAS users did not have elevated myonuclei per fibre values, unlike previous research. Comparable myonuclei per fibre numbers despite decrements in fibre CSA post AAS potentially adheres with myonuclei being long-lasting, but there is variation in usage relative to sampling date.

66 67

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P05 KNOWLEDGE OF MEDICAL AND PHARMACY STUDENTS IN MALTA REGARDINGPERFORMANCE ENHANCING DRUGS IN SPORT IN MALTAMifsud D., Borg N.1, Testa L.1, Mifsud J.1, Attard L.1, Sammut F.1

1University of Malta, Msida, Malta

Background: Central to the work of medical and pharmacy practitioners is the provision of support with respect to medical preparations and products, including performance enhancing drugs, for patients, who may also be competitive athletes. This study had the aim to assess the knowledge of medical and pharmacy students at the University of Malta with respect to the World Anti-Doping Code and the Prohibited List. This subject had never been investigated locally before.

Methods: A sample of 242 medical and pharmacy students from an eligible cohort of 665 students completed an online questionnaire which assessed knowledge regarding the prohibited status of 19 substances, as well as knowledge regarding therapeutic use exemptions. A pass mark of 14 (just over 50%) was agreed upon by the research group. Performance of medical and pharmacy students and athletes and non-athletes were compared using the Mann-Whitney U Test.

Results: Participants showed limited knowledge on the subject, with 79% of participants failing to obtain the pass mark. Pharmacy students had better knowledge when compared to medical students (p-value = 0.034). Athletes did not have more knowledge than non-athletes (p-value = 0.659).

Conclusion: Medical and Pharmacy students have poor knowledge about performance enhancing drugs in sport. The use of medicines and performance enhancing drugs in sports should be included as part of the undergraduate and postgraduate curricula for both medicine and pharmacy.

Adherence with ethical standards This study has been reviewed by the University Faculty Research Ethics Committee. All data was collected anonymously and voluntarily, with the right to withdraw at any point without penalty or impact on students’ academic evaluation. No deceit, deception or coercion was employed to recruit participants. Disclosure On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding No funding was granted

68 69

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P06 WHAT IS THE RELATIONSHIP BETWEEN EXERCISE TYPE, EXERCISE INTENSITY AND COGNITIVE PERFORMANCE?Jackson M.1,2, Burgess P.1, Fletcher A.1, Ronca F.1

1University College London (UCL), London, United Kingdom, 2NHS, London, United Kingdom

Introduction and Purpose: Current literature suggests that a single bout of exercise can improve cognitive performance; however, the effects of exercise type and intensity on cognition are less well-understood. This study compared changes in executive function following an acute bout of running or strength training and investigated the effect of exercise intensity on these changes using heart rate (HR). Material and Methods: Participants completed four cognitive tasks immediately before and after running (n=55), strength training (n=111) or resting as control (n=25). Tasks measured simple reaction time (SRT), choice reaction time (CRT), analogical reasoning (APS) and stimulus oriented/stimulus independent attending behaviour (XNA-SO/XNA-SI). Differences between pre- and post-exercise reaction time (RT) were analysed using three-way repeated measures ANOVAs. Numerical scores representing low, moderate, and high intensity exercise for each training session were created from HR data through Factor Analysis. Multiple linear regression models were developed for predicting cognitive changes based on HR-derived exercise intensity scores.

Results: Overall, all participants (including the control group) had a faster post-exercise RT across all tasks. The improvement in post-exercise RT was statistically significant for CRT (p=0.02), APS (p<0.01) and XNA-SI (p<0.01). There were significant improvements in RT after running and strength training, but not after rest, for CRT (p<0.01) and XNA-SI (p<0.01). Regression analysis of effects of exercise intensity using HR demonstrated a positive association between higher intensity running on SRT (p<0.01), whereas higher intensity strength training was associated with a negative effect on CRT (p<0.01). Conclusion: This study demonstrates statistically significant benefits of running and strength exercise on executive function (CRT and XNA-SI). A ‘learning effect’ was also observed, where participants (including those who rested) performed all tasks faster after the intervention. Results also suggest that exercise intensity (according to HR measurements) may alter the effects of running and strength training on different cognitive tasks.

68 69

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P07 MOVING MEDICINE - DEVELOPMENT OF THE HOSPITAL ASSOCIATED DECONDITIONING RESOURCE Gould R.1, Roy S.2, Speers C.1

1Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom, 2Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom

Introduction and Purpose: Hospital associated deconditioning (HAD), a loss of independence in activities of daily living during hospital admission, affects 30% of over 65-year-olds admitted to hospital and is associated with increased re-admissions, increased risk of being discharged to a residential or nursing home and increased mortality. Physical inactivity is thought to be one of the main drivers of HAD, patients acutely admitted to hospital can spend as much as 89-99% of their time lying or sitting down. We developed a Moving Medicine online resource to support healthcare professionals working in hospital settings to have person-centred conversations about physical activity.

Material and Methods: We performed a rapid evidence review of the effects and harms of physical activity interventions in adults acutely admitted to hospital. The main outcomes were physical performance, functional performance, cognitive function, and adverse events. We also performed a qualitative literature review exploring the motivators, facilitators, and barriers to physical activity in patients, and health-care professionals working in hospitals. The findings of the literature reviews, along with input from over 20 healthcare professionals and patients at an online workshop, were then used to develop the Moving Medicine online resources.

Results: We found that physical activity during hospital admissions was safe, improves walking and movement, the ability to do everyday activities and keeps the brain and mind working well. Physical activity may also reduce length of hospital stay and the risk of delirium and urinary incontinence. We produced online consultation guides for health-care professionals, resources which signposted to other support organisations and patient information leaflets (figures 1 & 2).To date, the online Moving Medicine HAD resources have been accessed from 15 different countries.

70 71

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 1. Patient information leaflet page 1

70 71

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 2. Patient information leaflet page 2

ConclusionHAD is an important issue in healthcare. The Moving Medicine HAD resources were developed using a collaborative, evidence-based, approach to support health care professionals to have person-centred conversations about physical activity.

72 73

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P08 EXPLORING THE ASSOCIATION BETWEEN CARDIORESPIRATORY FITNESS, VIGOROUS PHYSICAL ACTIVITY AND MENTAL HEALTH, A CROSS-SECTIONAL STUDY OF 84,000 PARTICIPANTSAlifrangis A., Kipps C., Hamer M.ISEH / University College London, London, United Kingdom

Background: Mental health disorders (MHD) are prevalent worldwide, with growing interest in the use of exercise-based therapy in their prevention and management. The aims of this study were to 1) Investigate the effect of cardiorespiratory fitness levels on anxiety and depression, 2) to ascertain if vigorous physical activity (VPA) worsen anxiety symptoms and 3) explore any gender-associated differences.

Methods: Data was analysed from 84,581 adults presenting for an annual health assessment. PHQ-9 and GAD7 questionnaires were used to assess for depression and anxiety symptoms respectively, and fitness testing via Cycle ergometer was performed. Binary logistic regression models were used to obtain odds ratios of depressive or anxiety symptoms in low fitness, low-medium fitness, medium-high fitness, and high fitness groups. Models were adjusted for potential confounding factors (age, gender, body mass index, smoking), and sub-categorised to look for gender differences. This method was also used to analyse VPA and anxiety symptoms.

Results: A linear reduction in depressive symptoms was seen with increasing fitness levels (confidence intervals 95%); odds ratios of reporting depressive symptoms were 0.58 and 0.51 in the medium-high fitness and high fitness groups respectively, when compared with the low fitness group. The odds ratios of reporting anxiety symptoms were 0.84 in the medium-high fitness group and 0.71 in the high fitness group. Female participants displayed lower anxiety scores only in the high fitness group (odds ratio 0.72). Vigorous activity analyses showed inverse relationship with anxiety as levels of activity increased.

Discussion and conclusions: This study demonstrates a clear negative association of fitness levels with depressive symptoms, that is irrespective of age, body mass index, gender and smoking. In women, anxiety scores were significantly lower only in the higher fitness groups. Furthermore, VPA has a dose-dependent negative association with anxiety and depression, inferring that high intensity exercises be incorporated into exercise- based programmes in the treatment of these conditions.

72 73

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P09 HOW TO MONITOR ELITE ROAD CYCLISTS FOR RELATIVE ENERGY DEFICIENCY IN SPORT(RED-S) AND THEN APPLY THE RESULTS TO PREPARING CYCLISTS FOR THE TOUR DE FRANCE: A SCOPING REVIEW Heron N.1, 2, McIntosh N.1

1Centre for Public Health Research, Queen’s University, Belfast, United Kingdom, 2Dept of Medicine, Keele University, Staffordshire, England

Introduction: Relative Energy Deficiency in Sport (RED-S) is a syndrome caused by low energy availability, involving impairment of various aspects of health and performance in male and female athletes. Central to avoiding negative effects of RED-S and ensuring maximal performance is monitoring and early detection, although the best monitoring approach has not yet been identified. Road cycling is a ‘leanness’ sport, putting cyclists at an increased risk for RED-S, especially pre-Grand Tour when they ‘make-weight’ for optimal performance.Objective: Summarise the evidence relating to RED-S monitoring methods in athletes, using these findings to develop a protocol to identify and monitor RED-S in elite road cyclists pre-Tour de France (TdF).

Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews guidelines. Searches were conducted across four databases and screened using a priori eligibility criteria. Data was extracted to form a numerical analysis and narrative synthesis.

Results and discussion: 76 potential records were identified, 19 met the inclusion criteria. Included studies covered three main areas: biochemical markers, physical markers, and questionnaires. Testosterone and T3 were the most sensitive markers for RED-S and responded to management of the energy imbalance within one-week. Combining quantitative and qualitative screening tools, with a multi-disciplinary (MDT) approach, provides a sensitive assessment of RED-S risk.

Conclusions: A MDT approach is recommended for RED-S monitoring, including a regular medical evaluation, physical examination, and blood monitoring at six-, three-, and one-week pre-TdF. Further research is needed to understand marker’s response to treatment, and markers across diverse sporting cohorts.

74 75

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 1: Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow diagram

74 75

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 2: Proposed RED-S monitoring plan for road cyclists preparing for the Tour de France. GT, Grand Tour; BMI, Body Mass Index

76 77

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P10 A SYSTEMATIC REVIEW: ASSESSING MUSCLE STRENGTH IN PARA-ATHLETESHeron N.1, 10, O’Connor S.1, Fagher K.2, Williamson S.3, Pluim B.4,5,6, Ardern C.7,8, C Janse van Rensburg D.5,9

1Queen’s University Belfast And Keele University, Belfast, United Kingdom, 2Lund University Dept of Health Sciences, Lund, Sweden, 3English Institute of Sport, Manchester, United Kingdom, 4Royal Netherlands Lawn Tennis Association, Amstelveen, Netherlands, 5University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa, 6IOC Research Center of Excellence, ACHSS, Amsterdam, Netherlands, 7University of British Columbia, Dept of Family Practise, Vancouver, Canada, 8La Trobe University, Sport & Exercise Medicine Research Center, Melbourne, Australia, 9World Netball -Medical Board, Manchester, United Kingdom, 10Keele University - School of Medicine, Staffordshire, United Kingdom

Introduction: Evaluating muscle strength in Para-athletes in an accurate and reliable way is essential for monitoring the effects of strength training and/or rehabilitation programmes, and for sport classification.

Objective: This systematic review aimed to synthesise evidence related to assessing the muscle strength of Para-athletes.

Design and Data Sources: Four databases were searched from January 1990 to July 2021 for observational studies focusing on strength assessment. Article screening, data extraction and quality assessment were completed by two independent reviewers.

Results: A total of 1764 potential studies were identified. Thirty met the inclusion criteria and were included for review. The mean age of participants was 30.7 years (SD: 2.4). The majority were men (88%) participating in wheelchair sports including basketball, rugby and tennis (23/30: 76%). Study quality varied; more than half of studies failed to identify strategies for dealing with confounding variables such as level of impairment or modified testing methods. Despite manual muscle testing being a common component of para-sport classification systems, evidence examining strength characteristics in Para-athletes is derived primarily from isometric and isokinetic testing. In studies that included comparative strength data, findings were mixed. Some studies found strength values were similar to, or lower than able-bodied athletic controls. However, an important observation was that others reported higher shoulder strength in Para-athletes who were participating in wheelchair sports compared to both able-bodied and disabled non-athletes.

Summary/Conclusion: Further studies are needed to develop accessible, standardised strength testing methods that account for training influence, and to establish normative strength values in Para-athletes. There is also a need for additional studies including female Para-athletes and those with greater functional impairments.

76 77

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 1. Flowchart showing study selection process during the review

Identification

References from database searches [n=1721]

Total [n=1764]

References from other sources [n=43]

- Grey literature search [n=43]

ScreeningTitles screened based on titles and descriptions [n=1764]

Papers excluded [n=1699]

- Not directly relevant to m/s assessment [879] - Duplicate publication [n=192]- m/s assessment only as part of rehabilitation [n=156] - Non-athletic population [n=251]- Non-disabled population only [n=179]- Unpublished data (conference papers, thesis, report) [n=24] - Single case study / commentary / review paper [n=18]

Eligibility Papers assessed in full [n=65]

Excluded after full review [n=35]- m/s assessment only as part of rehabilitation [n=6]- seperate m/s data not available [n=11] - Non-athletic population [n=5]- Non-disabled population only [n=9]- Unpublished data (conference papers, thesis, report) [n=2] - Single case study / commentary / review paper [n=2]

m/s = muscle strength

Included Studies included in review [n=30]

78 79

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P11 HOW DO SYMPTOMS AT DIFFERENT PHASES OF THE MENSTRUAL CYCLE AFFECT TRAINING AND PERFORMANCE OF FEMALE FOOTBALL PLAYERS?Shiel-rankin S.University College London, United Kingdom

Introduction: The phase related effects of the menstrual cycle on training and performance in female football players is not well understood despite the growing popularity of the sport. The Menstrual Symptom index (MSi) is a novel metric to capture the occurrence and frequency of menstrual cycle relate symptoms (MCRS) in female athletes. This study aimed to compare MSi between different phases of the menstrual cycle and assess the impact of symptoms on training and perceived performance in female football players.

Methods: A survey about menstrual cycle characteristics was completed by collegiate female football players. The MSi for athletes not using hormonal contraceptive (n=87) was compared at three stages; before menstruation, during menstruation and mid-cycle. Logistic regression analyses were used to assess MSi with the impact of MCRS on missing training, adapting training and perceived performance.

Results: There was no significant difference between MSi before menstruation (18.3 ±11.8) and MSi during menstruation (19.4 ±11.3) but both stages were significantly greater than MSi at mid-cycle (7.3 ±10.2). The likelihood of missing and adapting training increased by 1.18 and 1.27 respectively with MSi before menstruation. 68% of athletes reported perceived impairment in performance due to MCRS.

Conclusion: The frequency and timing of MCRS varies between athletes but symptoms were significantly more prevalent before and during menstruation compared to mid-cycle. The MSi may predict the likelihood of an athlete missing or adapting training. Addressing the impact of menstrual cycle symptoms on participation and performance in women’s football should be a matter of interest to performance teams.

78 79

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P12 LET’S GET MOVING: REDUCING SEDENTARY BEHAVIOUR IN PRIMARY CARE WAITING ROOMSBoalch A.

Royal United Hospital , Bath, United Kingdom

Introduction: Physical inactivity affects a third of the population and is the fourth leading cause of death globally. Increasing activity by just thirty minutes a week can extend life expectancy by four years. The number needed to treat for physical activity is 12, thus the role of clinicians in promoting physical activity is immensely valuable. We implemented a project promoting movement in waiting rooms and assessed the impact on staff and patient activity levels.

Methods: A poster demonstrating chair-based exercises, physical activity recommendations, and a QR-link to additional exercises was created. The poster was displayed in waiting rooms, text to patients before appointments and featured on the practice website. Educational sessions were provided to staff and a physical activity display created for patients. A survey was distributed to staff and patients both pre- and post-intervention. Results: Pre-intervention only 31.00% of staff and 39.47% of patients met the recommended 150 minutes of physical activity in the previous week. Interestingly 65.52% of staff and 71.79% of patients believed regular exercise could extend life expectancy by over five years. The aerobic component of the physical activity guidelines was correctly identified by 27.59% of staff and 20.51% of patients and the strength component by 33.33% of staff and 28.21% of patients. Importantly, 65% of patients reported they would be ‘likely’ or ‘very likely’ to engage in more physical activity if recommended by a clinician. Post-intervention results are awaited.

Conclusion: Despite the strong belief in the benefits of physical activity to health and longevity, there is a lack of understanding of the guidelines by both clinicians and the public. Patients respond positively to exercise recommendations from professionals therefore efforts should focus on improving clinician awareness of guidelines and promoting movement at a practice-wide level.

80 81

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P13 ROSETTA STONE TRANSLATION PROJECT FOR SPORTS MEDICINEO’ Leary F.1, Aliefri A.2, Yoon J.2, Krassioukov-Enns D.2, Theodoropoulos T.2, Alshabanah H.3, Leung M.2,4, Marekic M.4, Ormonde S.4, Miyauchi S.5, Abo-Arisha M.6, Asem K.7, Clayden W.8, Constantini N.9,10, Hegazy Y.11, Jang R.11, Omar P.11, Niu J.12, Klett M.12, Gonzalez-Lomas G.13, Masroori Z.14, Meijlander-Evjensvold M.15, O’ Giollagain C.16, Shalhav T.17, Sugrue R.18, Wawrzyniak S.19, Cichy B.20, Gallagher C.21, Mahagevan V.8, Ruban T.2, Tourvas V.2, Dilworth N.2,3,4,5

1Imperial College Healthcare NHS Trust, London, United Kingdom, 2University of Toronto, Toronto, Canada, 3Halton Healthcare, Georgetown, Canada, 4Cleveland Clinic Canada, Toronto, Canada, 5Toronto Football Club, Toronto, Canada, 6Hillel Yafe Medical Center, University of Tel-aviv, Hadera , Israel, 7Western University, London, Canada, 8McMaster University, Hamilton, Canada, 9Hebrew University of Jerusalem, Jerusalem, Israel, 10Heidi Rothberg Sport Medicine Center, Jerusalem, Israel, 11York University, Toronto, Canada, 12University of Ottawa, Ottawa, Canada, 13Department of Orthopedic Surgery, New York University, Langone Medical Centre, New York, USA, 14Shiraz University of Medical Science, Shiraz, Iran, 15Oslo University Hospital, Oslo, Norway, 16University College Dublin, Dublin, Ireland, 17Maccabi Health Services, Tel-Aviv, Israel, 18Harvard University, Cambridge, USA, 19Northrhine-Westfalia, , Germany, 20Dept of Trauma and Orthopaedics, Zeromski Hospital, Krakow, Poland, 21Football Association of Ireland, Dublin, Ireland

Introduction and Purpose: Effective communication is essential to the health and wellbeing of elite athletes, yet language barriers remain an issue even at major international sporting events. The difficulty with an online translation service is its poor accuracy for translating medical terminology (anatomical or condition-related terms). Translation guides to improve medical-care communication with non-English speaking athletes at sporting events were created.

Material and Methods: This was a qualitative study. Invited international sports physicians were consulted online or in person. Interviews (electronically or in person) took place with practicing sports medicine physicians to determine, by saturation, essential medical terms and phrases deemed to be essential so to develop a field-side consultation with a non-English speaking athlete. These recommended terms and phrases were then assembled into a user-friendly template by healthcare professionals with linguistic expertise. The main outcome was to create a defined list of medical terms and phrases necessary for a sports physician to communicate effectively with a non-English speaking athlete.

Results: Six international sports medicine physicians were interviewed. Fifty nine terms and twenty six medical phrases were generated. A translational template guide was subsequently developed in different nineteen languages including: Arabic, Farsi, French, German, Greek, Hebrew, Irish, Italian, Korean, Japanese, Mandarin, Norwegian, Polish, Portuguese, Russian, Serbian, Spanish, Swahili, and Tamil.

Conclusion: Linguistic competence remains crucial for effective communication in the medical setting with non-English speaking athletes. A shortfall of readily available medical terms exist. This qualitative study established such terms and phrases which subsequently developed nineteen quick reference linguistic guides designed for the sports medicine environment. Future studies could include testing the use of the guide in the field and collecting feedback from users as well as development of a smartphone application for practical field-side translation.

80 81

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 1: Body Map English:Mandarin

82 83

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Sprain - 扭傷 niu shangCramp - 抽筋 chou jinLabrum - 唇 chunHip labrum - 髖關節唇 Kuan guanjie chunFemoralacetabular impingement - 股骨髖臼撞擊 Gugu kuan jiu zhuangjiFracture - 骨折 gu zhe Tendon - 筋 jin Ligament - 韌帶 ren daiMuscle - 肌肉 ji rouRotator cuff - 旋轉肌袖 xuan zhuan ji xiuOsteoarthritis - 關節炎 guan jie yanTendinitis - 肌腱炎 ji jian yanMeniscus - 半月板 ban yue banFrozen shoulder -五十肩 wu shi jianAdhesive capsulitis -粘黏性肩關節囊炎 zhan nian xing jian guan jie nang yanImpingement syndrome -夾擠症候群 jia ji zheng hou qunContusion/bruise - 瘀青 yu qingSubluxation - 半脫位 ban tuo wei Dislocation-脫臼 tuo jiu Joint 關節 guan jieCartilage 軟骨 ruan guBone 骨頭 gu touConcussion 腦震盪 nao zhen dangLoose body 游離體 you li ti (medical)，關節鼠 guan jie shu (colloquial) Swelling 腫 zhong Instability 不穩定性 bu wen ding xing Numbness 沒知覺 mei zhi jue Tingling/paresthesias 麻 maWeakness 無力 wu liBone spur/osteophyte 骨刺 gu cimild, moderate, severe 輕度 qing du，中度 zhong du，重度 zhong du partial, complete 部分 bu fen，完全 wan quan sharp, dull 刺痛 ci tong，鈍痛 dun tong

82 83

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P14 CLINICAL APPLICATION OF MONITORING INDICATORS OF PROFESSIONAL DANCER HEALTH, INCLUDING ARTIFICIAL INTELLIGENCE IN FEMALE HORMONE NETWORKS Keay N.1, Lanfear M.2, Francis G.3

1Durham University, Durham, United Kingdom, 2Scottish Ballet, Glasgow, UK, 3Science4performance, London, UK

Introduction: Imbalances in training load and nutrition can result in low energy availability in dancers. Low energy availability can have the adverse health and performance consequences of relative energy deficiency in sport (RED-S).

Purpose: The aim of this study was to assess the clinical effectiveness of a variety of modalities to monitor dance health.

Methods: With institutional ethics approval, 14 professional female dancers completed a published dance specific health questionnaire and tracked wellbeing, training load and menstrual cycles over a year. For those not on hormonal contraception, 2 capillary blood samples on day 14 and 21 of a menstrual cycle were taken and individual characteristics on cycle length, and wellbeing metrics were reported. Artificial intelligence (AI) techniques were applied to plot the most likely variation of each the measured hormones follicle stimulating hormone (FSH), luteinising hormone (LH), oestradiol and progesterone over the entire menstrual cycle to detect the early effects of low energy availability and to monitor recovery of female hormone networks from those who had experienced disruption. Each dancer received personal clinical discussions.

Results: Applying this combined clinical approach, subclinical menstrual cycle hormone disfunction was identified and advice promptly provided regarding training load and nutrition. Subsequent restoration of full endocrine network function was monitored with repeat testing on subsequence cycles.

Conclusion: This study indicates that a combination of clinical approaches supported by AI can be applied to menstrual cycle hormone networks to identify early, subtle disruption caused by low energy availability. This enables early intervention and prevention of the adverse clinical consequences of RED-S. Similarly, this clinical approach allows close monitoring of restoration of endocrine function from low energy availability. This clinical approach could be applied for female athletes, including age group athletes to distinguish between perimenopause and low energy availability.

84 85

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P15 WHAT BENEFITS MIGHT BE ASSOCIATED WITH INCREASED PARTICIPATION IN WOMEN’S RUGBY, AS SET OUT AS PART OF THE RUGBY FOOTBALL UNION’S BID TO HOST THE 2025 WOMEN’S RUGBY WORLD CUP?Griffin S.1,2, Wooding J.3, Girdlestone H.4, Faull-Brown R.2, Hornby K.2, Kemp S.2,5

1University Of Edinburgh, London, United Kingdom, 2Rugby Football Union, London, United Kingdom, 3University of Birmingham, Birmingham, United Kingdom, 4Basildon University Hospitals, Basildon, United Kingdom, 5London School of Hygiene and Tropical Medicine, London, United Kingdom

Introduction: Women’s rugby is one of the world’s fastest growing sports. Much of the current narrative around risk in rugby focuses on the negative health impacts of participation, though it has been established that rugby can provide health-enhancing moderate-to-vigorous physical activity. As outlined in their bid to host the 2025 Women’s Rugby World Cup in England, the Rugby Football Union aims to use the competition to encourage 60,000 more women to play rugby. The potential associated health benefits are currently unknown.

Material and Methods: A hypothetical rugby programme engaging 60,000 women with a low level of current physical activity in England (aged 16-30) was modelled using Sport England’s MOVES tool. Using a programme’s expected engagement, intensiy, frequency, and duration, it provides outcomes including: the expected incidence of several long-term conditions in populations with and without the intervention; the cost per quality-adjusted life-year (QALY) gained; and overall reduction in health expenditure (over 25-years). The data that were used in the projection (Table 1) were based on a combination of publicly available data, as well as data from governing bodies and industry.

Table 1. Hypothetical programme-specific data used in MOVES projection

DemographicsSex FemaleAge Group 16-30 yearsStarting Activity Level Low activity

Activity

Type RugbyIntensity LeisureDuration 1.25 hoursFrequency 2 sessions per week

Scale

Beginning Participants 60000Ends with 25,440 (42.4%)Median years of ongoing partici-pation 2

Costs

Programme cost per participant to provider £42 per year

One-time or ongoing cost One-timeWillingness-to-pay per QALY £20,000

Results: This hypothetical programme could lead to a reduction in National Health Service expenditure of over £900,000 over 25-years (Table 2). During this period, over 333 QALYs would be gained, at a projected cost of £5088 per QALY gained. As per the thresholds set by the National Institute for Health and Care Excellence, this would be considered cost-effective.

84 85

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Table 2. Health and economic outcomes (economic values adjusted for inflation using the Bank of England inflation calculator)

Return on Investment (over a 25-year time-frame)

Reduction in NHS expenditure £934,619.49

QALYs gained 333.2Disability Adjusted Life Years (DALYs) avoided 358.9

Total value of QALYs gained £6,664,954

Cases Avoided (over a 25-year timeframe)

Type 2 Diabetes 7Coronary Heart Disease 1Stroke 1Breast Cancer 2Colorectal Cancer 0Dementia 1Depression 48Hip Fracture 0

Numbers Needed to Treat (over a 25-year time-frame)

To avoid 1 event 984Gain 1 QALY 181Avoid 1 DALY 168

Conclusion: A rugby programme initially engaging 60,000 relatively inactive women aged 16-30 would likely provide a range of population and public health benefits over a 25-year timeframe. These findings should be balanced against potential injury costs but could be used to inform conversations policy around how rugby might be able to contribute to population health and wellbeing.

86 87

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P16 IDENTIFYING BARRIERS, FACILITATORS, AND MOTIVATORS FOR EXERCISE IN PATIENTS WITH ANXIETYPreston B.1, Willoughby R.1, Wynter Bee W.2, Shahid F.3, Lester C.4

1Imperial College London School of Medicine, London, United Kingdom, 2Imperial College Healthcare NHS trust, London, United Kingdom, 3The Institute of Sport, Exercise and Health (ISEH), London, United Kingdom, 4Moving Medicine, United Kingdom

Introduction and purpose: Physical activity can reduce anxiety and may be useful in its management. Moving Medicine is an initiative by the Faculty of Sport and Exercise Medicine that provides research, education, and tools to help improve conversations between health care providers and patients with long term health conditions. This literature review aims to identify the qualitative evidence for exercise as a treatment for anxiety, including reviewing barriers, facilitators and motivators for physical activity in those with anxiety.

Materials and methods: A literature search of the online databases PubMed and Ovid Medline was conducted using the keywords (Anxiety*) AND (Motivators* OR Facilitators* OR Barriers*) AND (Physical activity* OR Exercise*). This search yielded 155 papers which were then screened for relevance. Studies looking at co-morbid health problems in addition to anxiety were excluded with 4 studies being included in the review. Papers were reviewed to identify barriers, facilitators, and motivators to physical activity.

Results: Time constraints were commonly identified as a barrier to engaging in exercise. Other barriers included a lack of willpower as well as a changing schedule that prevented patients from planning when to partake in exercise. Facilitators included incorporating exercise into a routine as well as having peer support from others with anxiety diagnoses. Motivators identified were receiving advice from a healthcare professional to engage in physical activity as well as patients being able to feel like they were connecting with nature.

Conclusions: Future treatment for anxiety should focus on encouraging patients to engage in physical activity and informing them of the potential benefits that exercise may have on their condition. During consultations, clinicians should address any potential barriers that patients may have to performing exercise and aim to identify solutions to overcome these with the patient.

86 87

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P17 CREATINE SUPPLEMENTATION AND HAIR LOSS: A SYSTEMATIC REVIEW ON THE EFFECT OF CREATINE ON ANDROGEN AND CORTISOL LEVELSAlam B.1, Akbari A.2, Alali B.3, Awodiya A.2

1Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom, 2King’s Mill Hospital, Derby, United Kingdom, 3Mubarak Al Kabeer Hospital, Kuwait

Introduction and purpose: Creatine monohydrate (Cr) is one of the most popular nutritional ergogenic aids due to its athletic enhancements. Despite these benefits, there is conflicting information on the long-term health effects and the association with hair loss remains a commonly held belief. Hair loss can occur through an androgenic mechanism or cortisol-induced growth disruption, with androgenic alopecia being identified as the most common cause. This systematic review investigates the relationship between Cr supplementation and hair loss by analysing the effect of Cr on androgen and cortisol levels.

Material and Method: A literature search was conducted using online libraries to identify clinical trials investigating the impact of Cr on hair loss and associated hormones; testosterone, dihydrotestosterone (DHT) and cortisol. All studies were screened, quality assessed and stratified into groups based off the outcome analysed.

Results: A total of 11 studies in total were identified. 9 of these assessed testosterone, with 5 studies suggesting Cr has no impact on testosterone levels and 4 demonstrating a significant increase. Only 1 study investigated DHT, showing Cr caused an increase. 9 studies measured cortisol levels; when Cr was given to volunteers 1 study showed a decrease in cortisol, 3 observed an increase and 5 illustrated no effect. No studies directly assessing hair loss were identified.

Conclusion: Current literature indicates a possible association between Cr and hair loss through an increase in levels of DHT. However, literature for this association is sparse and limited. For a distinct association to be proven further research must be conducted, particularly assessing hair loss directly or measuring DHT. Further studies would enable users to make an informed decision prior to initiating Cr supplementation.

88 89

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P18 THE IMPACT OF UNSAFE SPORT PLAYGROUND ON THE PARTICIPATION OF STUDENTS IN EXTRACURRICULAR SPORT ACTIVITY IN SOME SELECTED PRIMARY SCHOOLS IN ADDIS KETEMA SUB CITY OF ADDIS ABABASentie W.Bahir Dar University, Bahir Dar, Ethiopia

Introduction: Despite, sport is one of extracurricular school program in Addis Ababa; many students weren’t engaged in extracurricular sporting activities. The aim of this study was to assess the impact of unsafe sport field on the participation of students in extracurricular sport activity in some selected primary schools.

Materials and Methods: The study was employed a descriptive survey research method. From 1810 students, 311 samples were selected using stratified sampling technique. The data was collected through questionnaire and thus, analyzed using IBM SPSS Version 23, both quantitative and qualitative methods by describing statements and frequency counts and percentages.

Results: The age of participants were (13.13±2.82), their grade level was (5.66±1.84). Participants home to school distance in kilometers were (1.94±1.48). Out of the entire extracurricular sport activities offer to students, most respondents (61.1%) prefer football. Nevertheless, on the suitability of playground & infrastructure, nearly 90% were totally disagreed. Thus, 68% weren’t participated. Indeed, the parents’ education level was more than high school complete, they (58.2%) weren’t encourages kids to participate.

Conclusion: Engaging in extracurricular sport activities has an advantage for health, improving skills, for entertainment, and boost socialization. Nevertheless, as a result of insecure playground & parents’ unwillingness; students display a disturbingly high rate of inactivity. Thus, need to plan a new playground or upgrading an existing playground is an important issue for the operation of all play spaces. Awareness should provide for parents that their active participation in encouraging sporting habits among their children is indispensable.

88 89

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P19 PUPILLARY LIGHT REFLEX AS AN OBJECTIVE BIOMARKER FOR SPORT-RELATED CONCUSSION IN ELITE FEMALE HOCKEY PLAYERS

Murphy R.1, Rankin A.3, McGuigan P.1, Archbold P.4, Bleakly C.2

1University of Bath, Bath, United Kingdom, 2University of Ulster, Belfast, N.Ireland, 3SportNI Sports Institute , Belfast, N.Ireland, 4Department of Orthopaedic surgery, Musgrave Park Hospital, Belfast, N.Ireland

Introduction: Concussion diagnosisis based on subjective assessment of non specific clinical signs and symptoms with no definitive, objective diagnostictest. The pupillary system can be assessed via observation of the pupillary light reflex (PLR). Changes to the PLR have been demonstrated intraumatic brain injury and inadolescents with a history of concussion. Assessment of changes to the PLR following concussion has been proposed as a potential biomarker.

Purpose:Assessment of the reliability of PLR measurement in a cohort of elite female athletes.Determination of normative PLR data for female athletes with and without a history of concussionDeterminationofthediscriminantvalidityofPLRmetricsinathleteswithandwithoutahistoryofconcussion.

Material and methods: Across-sectional cohort study of 33 international female field hockey athletes were voluntarily recruited. Three valid pupil ometerreadings of each eye were obtained using the Neuroptics PLR 000. Measurements of eight PLR metrics were obtained; maximum and minimum pupil diameter, percentage of pupil constriction, constriction latency (CL), average constriction velocity (ACV), peak constriction velocity (PCV), average dilatation velocity (ADV) and T75%. Reliability was determined through intraclass coefficients with standard error of measurement and minimum detectable change calculated. Between group differences were analysed using non-parametric tests.

Results: Neuroptics PLR-3000 demonstrated good-to-excellent reliability for all PLR metrics. No statistically significant differences (p>0.05) were demonstrated between those with and without a history of concussion. Trends towards lower PLR metrics (CL,ACV,PCVandADV) were not edin athletes with a recent concussion (<three months) and athletes with three or more concussions.

Conclusion: In this limited pilot study, PLR shave promise asa rapid,r eproducible and objective physiological biomarker for concussion. Further validation is required inl argercohorts along sdeinvestigation of the responsiveness of PLR metrics during acute concussion.

90 91

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P20 CHANGES IN VOLUMETRIC VARIABILITY OF SPONTANEOUS RESPIRATION UNDER THE INFLUENCE OF TRAINING LOADRomanchuk O.1, Guzii O.1, Mahlovanyi A.2

1Ivan Boberskyj Lviv State University of Physical Culture, Lviv, Ukraine, 2Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Introduction and Purpose: The equivalent of the body’s needs in different states is the minute volume respiration (MVR), which is calculated as the product of respiratory rate and tidal volume. To assess the state of the respiratory system, we proposed to use indicators of volumetric variability of respiration (VVR), which are associate with the MVR and there are derivatives of the volumetric inspiratory and expiratory velocities. They also take into account the rhythmic and frequency characteristics of respiration.The purpose of this study was to analyze changes in VVR indicators under the influence of the training load of highly qualified athletes.

Material and Methods: 202 highly qualified athletes were examined in the pre-competition training period. Measurements were performed before, after and the next morning after training. A spiroarteriocardiorhythmograph was used, which simultaneously records the ECG, pulse wave and airflows on inhalation and exhalation. According to the measurement of air flows, VVR indicators were calculated in the ranges similar to heart rate variability - the total power (TPR (l/min)2), the very low frequency range power (VLFR (l/min)2), the low frequency range power (LFR (l/min)2), the high-frequency range power (HFR (l/min)2).

Results: It was found that after training there was a significant increase in TPR from 283.9 (176.9; 515.3) to 384.2 (222.0; 595.4), p <0.05, VLFR from 2.0 (1.2; 3.6) to 2.6 (1.6; 5.3), p <0.01, HFR from 223.5 (122.1; 374.5) to 289.0 (147.7; 504.0), p <0.05. The next morning after training, these indicators returned to baseline: TPR to 278.9 (179.6; 445.2), p >0.05, VLFR to 2.3 (1.4; 4.0), p >0.05 and HFR to 204.5 (116.6; 346.0), p >0.05.

Conclusion: The dynamics of changes in VVR indicators shows their informativeness about the impact of training loads. The results obtained may be significant in the further processing of data in combination with other parameters.

90 91

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P21 SPORTS-RELATED CONCUSSION (SRC) ASSESSMENT IN ELITE ROADCYCLING: INTRODUCING THE CONCUSSION POCKET ASSESSMENT TOOL FOR CYCLING

Elliott J.1, Heron N.2,3,4

1Royal Victoria Hospital, Belfast, United Kingdom, 2Dept of General Practice and Primary Care, Queen’s University Belfast, Belfast, 3Centre for Public Health Research, Queen’s University, Belfast, 4School of Medicine, Keele University, Staffordshire, England, United Kingdom

Introduction and Purpose: Sports related concussion (SRC) is a common injury within elite road cycling and a recognised global public health concern. It is typically assessed and managed in elite sport using the SCAT5 tool. The Union Cycliste Internationale (UCI) have recently published new SRC guidelines although the guidelines lack practical applicability within the different cycling disciplines. We would therefore like to propose the creation of a Concussion Pocket Assessment Tool for cycling (C-PATc) for health practitioners to use to help diagnose SRC during cycling events.

Material and Methods: The C-PATc is based on an initial systematic review detailing the need for a cycling-specific SRC assessment tool and an overarching recognition and assessment process published as an editorial published by the authors, as well as findings from the Harrogate Consensus Statement. Results: The purpose of this C-PATc is to provide an easily accessible framework for all race medical staff to recognise an agreed set of red flag and observable signs that facilitate the removal of the rider from the field of play for the duration of the event. Specifically trained medical staff can then assess those riders who are absent of any of these signs using a modified version of the SCAT5, the C-PATc using the features of assessment detailed below.

92 93

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

92 93

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Conclusion: We hope that discussion of the RIDE protocol and C-PATc can begin to build on the steps taken by the UCI through the recent Harrogate Consensus agreement. We hope application of this tool can be trialled and learning tabled for discussion during the upcoming Amsterdam Concussion Conference later this year, informing future iterations of the SCAT. We acknowledge the progress made on SRC assessment and management in recent years and hope to update the tool as new evidence emerges.

94 95

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P22 IN VIVO LOADING IN ACHILLES TENDON: A SYSTEMATIC REVIEW OF OUTCOME MEASURESMifsud T.1, Gatt A.1, Padhiar N.2, Chockalingam N.3, Micallef Stafrace K.4, Wearing S.5

1Faculty of Health Sciences, University Of Malta, Msida, Malta, 2Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK, 3Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University,, Stoke on Trent, Staffordshire, UK, 4Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, Msida, Malta, 5School of Clinical Sciences & Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland , Australia

Introduction and Purpose: Achilles tendinopathy causes weakness and altered force patterns within the tendon. Current quantification of an individual’s strength may be suboptimal leading to persistent deficits and recurrent injuries. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO number - CRD42021219722). This was undertaken to identify the measurement instruments used to quantify the in vivo force within the Achilles tendon and investigate the measurement properties of these instruments, thus identifying the sufficiently robust methodology to be used for research and in clinical practice.

Method: CINAHL, PubMed, Cochrane, MEDLINE Complete and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Both reviewers independently assessed the methodological quality of these studies using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology. A modified Grading of Recommendations Assessment Development and Evaluation approach was applied to the evidence synthesis.

Results: Twenty-eight articles were included for the qualitative analysis. Objective outcome measures identified for quantifying internal forces included clinician based outcomes using ultrasonography, elastography, myotone, tensiometers; and performance based outcomes using isokinetic dynamometry. Low to moderate-quality evidence was found for reliability. Moderate-quality evidence was found for measurement error when using continuous shear wave elastography while evidence for the other tools was indeterminate. Validity had high-quality evidence for axial shear wave elastography while the other instruments had insufficient quality to be graded for evidence. Level of evidence for responsiveness was not graded due to mixed quality ratings.

Conclusions: It is recommended that the quality of instruments used is improved and reported in detail so in vivo force measurements can be used by clinicians during the rehabilitation to monitor return to sport.

94 95

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 1 - Prisma flow diagram

96 97

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P23 A SYSTEMATIC REVIEW OF THE KNOWLEDGE, ATTITUDES AND EXPERIENCES OF CONCUSSION AMONG FOOTBALL (SOCCER) STAKEHOLDERSMontgomery C.1, Hurley E.2, McCullough C.3, Fahy C.4

1Tallaght University Hospital , Dublin, Ireland, 2Mater Misericordiae Hospital, Dublin, Ireland, 3University College Dublin, Dublin, Ireland, 4University of South Wales, Treforest, United Kingdom

Introduction: Football has one of the highest rates of concussion in sport, with concussion noted to occur at a high incidence rate at all standards of play.

Purpose: To systematically review the literature to assess the experiences, knowledge and attitudes of concussion in the stakeholders of football.

Methods: A literature search was performed based on PRISMA guidelines, utilising the MEDLINE, EMBASE, Web of Science, CINAHL, SPORTDiscus and PsycINFO databases.

Results: 1319 studies were identified, from which 17 studies across five different countries were included in the review. There were 14 cross sectional studies and three prospective cohort studies. There were 13203 respondents from football stakeholders or prospectively enrolled athletes, of whom 10467 were youth athletes, 1205 professional athletes, 1116 parents, 105 coaches, 293 medical professionals and 17 referees. At least one prior concussion was reported by 14.9% (n=1546/10387) of youth athletes and 32.9% (n=377/1146) of professional athletes. Only 47% (n=188/400) of professional athletes sought medical attention following concussion, while 34.2% (n=114/333) continued to play in their practice or match at the time of their concussion. 10% (n=39/391) of respondents incorrectly chose distractor symptoms such as believing concussion to be associated with myocardial infarction (MI). 41% (n=168/411) of parents have considered not allowing their child to participate in any youth sport due to concerns of concussion.

Conclusion: While general acceptance of concussion severity and health consequences was identified, a number of misunderstandings and concerning attitudes towards concussion still exist. Athletes recognise the severity and associated dangers of playing with a concussion. Yet, a large proportion of both youth and professional athletes admit to, or report the belief that they would continue to play while suffering symptoms of concussion. Further education is required among football stakeholders, particularly with the less frequently recognised symptoms of concussion and misconceptions about concussion management and prevention.

96 97

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P24 AN EXPLORATION OF RESPIRATORY CONDITIONS WITHIN SCOTTISH SWIMMINGOswald F.1, McCrea C.2,3, Hall A.4,5

1NHS Greater Glasgow and Clyde, Glasgow, United Kingdom, 2Sport Scotland Institute of Sport, Stirling , United Kingdom, 3Scottish Swimming, Stirling, United Kingdom, 4Edinburgh Orthopaedics, Edinburgh, United Kingdom, 5Golden Jubilee National Hospital, Glasgow, United Kingdom

Introduction: Dyspnoea is an extremely common presentation in young athletes, particularly participants of endurance, aquatic, and winter-based sports. Accurate diagnosis of respiratory presentations can present challenges but is necessary to ensure optimal clinical care is given and adherence to anti-doping responsibilities are met.

Purpose: The study aimed to review incidence, aetiology, diagnosis, and management of respiratory conditions within the elite swimming cohort in Scotland. Further aims were to identify knowledge gaps and support evidence for governance to optimise management of respiratory dysfunction in elite swimmers.

Methods: Athletes within the following Scottish Swimming squads were eligible for participation: Senior Gold, Senior Silver, Youth Squad and Youth Development. The study was conducted in two parts: Part 1 was a scoping survey that explored prevalence and aetiology of respiratory conditions within Scottish Swimming. Part 2 examined the impact and athletes’ understanding of these conditions. Both explored diagnostic methodology and management.

Results: Results identified 22.9% of athletes within Scottish Swimming had a respiratory condition: 57.1% asthma, 39.3% exercise-induced bronchoconstriction and 3.6% dysfunctional-breathing. Only 7.1% of athletes with a respiratory condition reported moderate or very-significant impact on their swimming. While management was generally in accordance with current national guidelines, there was discrepancy with diagnostic methodology and support felt by athletes.

Conclusion: Findings highlight that future education of athletes should encourage greater ownership for their healthcare, including clearer guidance on athlete-specific diagnosis and management of respiratory presentations. Scottish Swimming has a robust anti-doping education strategy which incorporates these topics, but future information may be best shared in a multimodal way, with agreed communication tools to members of the multi-disciplinary team, especially GPs, coaches, and parents. It is hoped this research will enhance clarity of the ‘Therapeutic Use Exemption’ process. Findings from this report have generalisability and may overlap with other endurance sports e.g., triathlon and skiing.

98 99

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P25 CAN A MOTIVATIONAL INTERVIEW-BASED TELEMEDICINE SERVICE IMPROVE PHYSICAL ACTIVITY IN PEOPLE WITH RHEUMATOID ARTHRITIS? A 6-WEEK PILOT STUDYAndrew D.Queen Mary’s University London, London, United Kingdom

Introduction: Physical activity (PA) can improve rheumatoid arthritis (RA) symptoms and sequelae but is underperformed. This study aimed to assess a pilot study and effect of a motivation interview-based (MI) telemedicine service for PA promotion in RA.

Methods: Four participants were assessed for self-reported PA, leg strength and endurance, and RA disease severity at baseline and 6-weeks following MI on a telemedicine platform.

Results: No statistically significant changes were observed in International Physical Activity Questionnaire-Short Form (IPAQ-SF), 30-Chair-Stand Test (30-CST) or Multi-Dimensional Health Assessment Questionnaire (MDHAQ) scores at 6-weeks. Improved mean differences were seen for combined PA 1020-Metabolic Equivalence of Task-minutes/week(p=0,21) (MET-mins/wk) and moderate PA 1390(p=0.13) with medium(-0.79) and large(-1.03) Cohen d’s effect sizes respectively. However, MDHAQ scores showed marginal worsening in function, psychological, pain, RAPID3 and the 30-CST. Statistically insignificant Pearson’s r correlations were observed across all IPAQ-SF measures and MDHAQ scores

Discussion: This study because of poor social media recruitment, was unable to assess the feasibility of the study protocol. Changes to recruitment strategy, PA and strength/endurance measurement and staffing would be required if the trial was to proceed. PA and MDHAQ scores were affected by small sample size, participant, and environmental issues, e.g., acute-on-chronic RA changes and COVID-19-related isolation. Improved reliability and validity of results and feasibility assessment would result from increased sample sizes.

Conclusion: This underpowered study shows the potential of an amended protocol to assess the effects of MI-based telemedicine interventions for PA promotion in RA. Although statistically insignificant, this study suggests MI-based telemedicine as part of a multifaceted, tailored and participant-lead intervention for PA promotion.

98 99

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P26 RISK ASSESSMENT AND IMPLEMENTATION OF RISK REDUCTION MEASURES IS NOT ASSOCIATED WITH INCREASED TRANSMISSION OF SARS-COV-2 COMPARED TO STANDARD ISOLATION AT PROFESSIONAL GOLF EVENTSRobinson P.1,2, Murray A.1,2,3, Watson M.2,3, Close G.2,3,4, Kinane D.5,6

1University of Edinburgh, Edinburgh, United Kingdom, 2European Tour Performance Institute, Virginia Water, UK, 3Medical and Scientific Department, R&A, St. Andrews, UK, 4Research Institute for Sport and Exercise Sciences, Liverpool John Moores University,UK, 5School of Dental Medicine, University of Berne, Switzerland, 6Medical and Scientific Department, Cignpost Diagnostics, UK

Objectives: The purpose of this prospective study was to report incidence and transmission of SARS-CoV-2, amongst professional golfers and essential support staff undergoing risk assessment and enhanced risk reduction measures when considered a close contact as opposed to standard isolation while competing on the DP World Tour during the 2021 season.

Methods: This prospective cohort study included all players and essential support staff participating in 26 DP World Tour events from 18th April to 21st November 2021. High risk contacts were isolated for 10 days. Moderate risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with RT-PCR day 5, mandated mask use, and access to outside space for work purposes only. Low risk contacts typically received rapid antigen testing every 48 hours and PCR testing on day 5.

Results: The total study cohort compromised 13,394 person-weeks of exposure. There were a total of 30 positive cases over the study period. Eleven contacts were stratified as ‘high risk’. Two of these subsequently tested positive for SARS-CoV-2. There were 79 moderate risk contact and 73 low risk contacts. One moderate risk contact subsequently tested positive for SARS-CoV-2 but did not transmit the virus. All other contacts, remained negative and asymptomatic to the end of the tournament week.

Conclusions: A risk assessment and risk reduction based approach to contact tracing was safe in this professional golf event setting when Alpha and Delta were the predominant variants. It enabled professional golfers and essential support staff to work.

100 101

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P27 ASSESSING THE RISK OF SARS-COV-2 TRANSMISSION IN INTERNATIONAL PROFESSIONAL GOLFRobinson P.1,2, Murray A.1,2,3, Watson M.2,3, Close G.2,3,4, Kinane D.5,6

1University of Edinburgh, Edinburgh, United Kingdom, 2European Tour Performance Institute, Virginia Water, Uk, 3Medical and Scientific Department, R&A, St. Andrews, UK, 4Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK, 5School of Dental Medicine, University of Berne, Switzerland, 6Medical and Scientific Department, Cignpost Diagnostics, UK

Introduction: There is no published data on the incidence or risk of SARS-CoV-2 virus transmission when playing golf, a sport played outdoors where social distancing is possible. The purpose of this prospective study was to report incidence and transmission regarding SARS-CoV-2, of professional golfers competing on the PGA European Tour across 23 events in 11 countries.

Methods: Daily symptom and temperature checks, and weekly Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) screening were performed to determine potential carriage of SARS-CoV-2 (Figure 1). Onset and type of symptomology were analysed. Gene expression and Cycle Thresholds were reviewed for all positive cases. Repeat PCR testing was performed on all positive players. RT-PCR analysis included human house-keeping genes, and various RNA genes specific for SARS-CoV-2.

Results: During the study period, there were 2900 RT-PCR tests performed on 195 professional golfers competing on the European Tour. Four players tested positive on-site during the study period (0.14% of tests; positive results were declared with Ct <40.). Two positive tests were returned as part of routine protocols while two reported a history of close contact with an individual who had tested positive for SARS-CoV-2 and were isolated and target tested. All were asymptomatic at time of testing, with three developing symptoms subsequently. None required hospital admission. There was no transmission from player to player.

Conclusions: Golf is an outdoor sport, where social distancing is possible, meaning risks can be low if guidance is followed by participants. This report can also provide reassurance for participants and policy makers regarding community golf, which can be encouraged for the health benefits it provides, in a relatively low risk environment, with minimal risk of transmission by observing sensible viral hygiene protocols.

100 101

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 1. PGA European Tour COVID-19 pathway for competing players

102 103

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P28 AN ANALYSIS OF BURNOUT AND AVAILABILITY OF WELLBEING AND MENTAL HEALTH SUPPORT AMONG HEALTHCARE PROFESSIONALS WORKING IN THE SPORTING ENVIRONMENT - A CROSS SECTIONAL SURVEY STUDYRademaker K.1, Phillips N.1

1Cardiff University, Cardiff, United Kingdom

Introduction: Burnout commonly occurs among acute healthcare professionals, and sports coaches and trainers. Healthcare professionals that work in sport are known to be exposed to stressful working conditions, but there is a limited body of literature exploring burnout among healthcare professionals working in sport. Therefore this study set out to explore burnout and mental wellbeing among healthcare professionals working in sport.

Methods: A cross-sectional survey study. Electronic questionnaire sent out to healthcare professionals working in the sport• Data exploring workplace supervision and one-to-one support and wellbeing and mental

health resources.Maslach Burnout Inventory- human services survey (MBI)Demographic data; age, gender, profession, governing body, years qualified in profession, years working in sport, working environment/sport working with, employment type and hours of clinical contact. Descriptive analysis was completed using percentage, mean and standard deviations.

Results: 55 results were obtained (table 1 for demographic summary). Results showed that in general healthcare professionals working in sport demonstrated low levels of occupational burnout (table 2), 43.64% scored a ‘Low Degree’ of emotional exhaustion, 70.91% scored a ‘Low Degree’ of depersonalisation, and 50.91% scored a ‘High Degree’ of personal accomplishment.

When exploring MBI scores and subgroups it highlighted that there was a significant lack of supervision and wellbeing/mental health support provided to healthcare professionals working in sport, with 56;36% of the population not receiving regular supervision and 63.64% not receiving any mental health and wellbeing training. Those who had more regular supervision and dedicated time for wellbeing had lower scores of emotional exhaustion.

Table 1- demographic data summary

102 103

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Gender Male - 29 (52.73%)Female - 26 (47.72%)

Sport Working With

Rugby - 27 (47.36%)Futsal - 1 (1.75%)Football - 7 (12.28%)Athletics - 2 (3.52%)Swimming - 2 (3.52%)American Football - 1 (1.75%)Netball - 2 (3.52%)Wrestling - 1 (1.75%)Aussie Rules - 1 (1.75%)Multi-Sports - 4 (7.03%)Volleyball - 1 (1.75%)Tennis - 2 (3.52%)F1 -1 (1.75%)MMA - 1 (1.75%)Cricket - 1 (1.75%)Hockey - 1 (1.75%)Skiing - 1 (1.75%)Gymnastics - 1 (1.75%)

104 105

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Age 20-25 - 3 (5.45%)26-30 - 16 (29.09%)31-35 - 7 (12.73%)36-40 - 12 (21.82%)41-45 - 6 (10.91%)46-50 - 2 (3.64%)51-55 - 4 (7.27%)56-60 - 4 (7.27%)61-65 - 0 (0%)65-70 - 1 (1.82%)

Mean= 37.64Range= 24-69

Profession Physiotherapist - 41 (74.54%)Sports Therapist - 6 (10.91%)Doctor - 4 (7.27%)Sports Rehabilitator - 2 (3.64%)Chiropractor - 1 (1.82%)Soft Tissue Therapist - 1 (1.82%)

Employment Type

Full-time - 35 (63.64%)Part-time - 19 (34.54%)Both - 1 (1.82%)

Employed - 35 (63.64%)Self-employed - 15 (27.27%)Both - 5 (9.09%)

104 105

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Years Qualified

1-5 - 10 (18.18%)6-10 - 15 (27.27%)11-15 - 12 (21.82%)16-20 - 8 (14.54%)21-25 - 2 (3.64%)26-30 - 2 (3.64%)31-35 - 3 (5.45%)36-40 - 2 (3.64%)41-45 - 1 (1.82%)

Mean= 13.89Range= 2-45

Years Working with Sport

1-5 - 17 (30.91%)6-10 - 16 (29.09%)11-15 - 8 (14.54%)16-20 - 6 (10.91%)21-25 - 2 (3.64%)26-30 - 4 (7.27%)31-35 - 1 (1.82%)36-40 - 1 (1.82%)41-45 - 0 (0%)

Mean= 11.54Range= 1-37

Working Hours per Week

0-5 - 5 (9.09%)5-10 - 7 (12.73%)10-15 - 2 (3.64%)15-20 - 8 (14.54%)20-25 - 3 (5.45%)25-30 - 0 (0%)30-35 - 1 (1.82%)35-40 - 5 (9.09%)40 + - 24 (43.64%)

Clinical Hours per Week

0-5 - 5 (9.09%)5-10 - 10 (18.18%)10-15 - 5 (9.09%)15-20 - 9 (16.37%)20-25 - 6 (10.91%)25-30 - 1 (1.82%)30-35 - 6 (10.91%)35-40 - 3 (5.45%)40 + - 10 (18.18%)

106 107

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Hours Travelling for Work per Week

<1 - 7 (12.73%)1-2 - 5 (9.09%)2-3 - 7 (12.73%)3-4 - 6 (10.91%)4-5 - 9 (16.37%)6-7 - 6 (10.91%)8-9 - 4 (7.27%)9-10 - 3 (5.45%)10-11 - 2 (3.64%)11-12 - 1 (1.82%)12-13 - 1 (1.82%)13-14 - 2 (3.64%)15+ - 2 (3.64%)

Work based in the UK, Inter-national or Both

UK - 38 (69.09%)International - 9 (16.37%)Both - 8 (14.54%)

Table 2- MBI resultsEmotional Exhaustion Personal Accomplishment Depersonalisation

Low (total)

Moder-ate

(total)

High (total)

Low (total)

Moder-ate

(total)

High (total)

Low (total)

Moder-ate

(total)

High (total)

Total (n/55) 24 14 17 7 20 28 39 10 6

% 43.64 25.45 30.91 12.73 36.36 50.91 70.91 18.18 10.91

Mean 8.375 21.357 38.588 23.714 34.4 43.179 2.564 9.2 15.833

SD 4.137 3.433 7.550 5.992 2.062 2.310 2.075 2.150 1.602

Conclusion: Low levels of burnout found among healthcare professionals working in sport, despite poor provision of wellbeing support. However the small sample and disproportionate representation of different professions limited these results. Further studies setting obtaining a larger sample are needed to further explore this important topic.

106 107

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P29 INJURY PATTERNS TO THE PYRAMIDALIS-ANTERIOR PUBIC LIGAMENT-ADDUCTOR LONGUS COMPLEX (PLAC) FOLLOWING ADDUCTOR LONGUS AVULSIONS ARE SPORT-SPECIFICJohnson R.1,2, Cooke C.2, Schilders E.1,2

1Fortius Clinic, London, United Kingdom, 2Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom

Introduction and Purpose: A recent MRI study defined the different types of PLAC injuries (Table 1) and noted that Adductor Longus Avulsions are seldom isolated, being most commonly associated with injuries to the Pyramidalis and Pectineus. Mechanisms of injury of the Adductor Longus and PLAC differ between different sports.The aim of the study was to examine the hypothesis that the prevalence of the type of PLAC injury is dependent on the type of sport.

Materials and Methods: Retrospective study. The PLAC injury database in our institution was interrogated using the following inclusion criteria: acute post traumatic PLAC injury; PLAC injury score (type 1-6); type of sport, n>3 per sport.The distribution of PLAC injury types across sports was examined alongside the incidence of associated partial Pectineus tears. Hypotheses were tested using Chi-square test, effect size using Cramer’s V.

Results: 257 athletes fulfilled the inclusion criteria.

The experimental hypothesis, that the type of PLAC injury is dependent on the type of sport is accepted and is significant across all sports. (X2 (30, 257) = 63.7 (LR), p = 0.0003; small effect size (Cramer’s V = 0.232)).Football (n=188, 73%) with (n=128, 50%) professional, Rugby (n=43, 17%), Racket sports (n=11, 4%), professional Ice Hockey (n=5, 2%), Martial Arts (n=6, 2%), Water Skiing (n=4, 2%). The occurrence of a partial Pectineus Avulsion is also significant across all sports (X2 (3, 192) = 10.2, p = 0.017;small effect size (Cramer’s V = 0.230)). Associated Pectineus Avulsions were: Football (24%), Rugby (44%), Martial Arts and Water Skiing (100%).

Conclusion: The study confirms different PLAC injury patterns across different sports, including a considerable variation in the prevalence of associated Pectineus injuries.This is clinically relevant and important knowledge to facilitate accurate MRI assessment of these injuries, and appropriate planning of surgical treatment.

Type 1 Complete fibrocartilage (FC) avulsion-Pyramidalis separated from Adductor Longus-intact Pectineus

Type 2 Complete FC avulsion-Pyramidalis separated from Adductor Longus-partial Pectineus tear

Type 3 Complete FC avulsion-Pyramidalis connected to Adductor Longus-intact Pec-tineus

Type 4 Complete FC avulsion-Pyramidalis connected to Adductor Longus-partial Pectineus tear

Type 5 Complete FC avulsion-Pyramidalis partially separated from Adductor Lon-gus-partial Pectineus tear

Type 6 Partial FC avulsion-Pyramidalis connected to Adductor Longus-intact Pectine-us

Table 1: Types of PLAC injuries

108 109

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

PLACTYPE

Total Football Professional Football

Rugby Racket Sports

Ice Hockey

Martial Arts

Water Skiing

Type 1 67(25) 8(14) 40(31) 12(28) 7(64) 0 0 0Type 2 45(18) 12(20) 19(15) 7(16) 0 0 4(66) 3(75)Type 3 63 (24) 15(25) 36(28) 8(19) 2(18) 2(40) 0 0Type 4 21 (8) 2(3) 9(7) 7(16) 0 1(20) 1(17) 1(25)Type 5 9(4) 1(2) 2(2) 5(12) 0 0 1(17) 0Type 6 52 (21) 22(36) 22(17) 4(9) 2(18) 2(40) 0 0Total 257 60 128 43 11 5 6 4

Table 2: Frequency of PLAC type by sport (integers in brackets are percentages)

108 109

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P30 CASE SERIES OF TRIATHLETES WITH TAKOTSUBO CARDIOMYOPATHY PRESENTING WITH SWIMMING INDUCED PULMONARY OEDEMA Rigler C.2, Menon G.2, Lipworth S.1, Langrish J.3, Kipps C.4, Shanmuganathan M.2, Smith R.2

1Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom, 2Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust. Oxford., Oxford, United Kingdom, 3Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust. Oxford., Oxford, United Kingdom, 4Institute of Sport, Exercise and Health, Division of Surgery and Interventional Sciences, University College London, London, United Kingdom

Introduction and purpose: Swimming-induced pulmonary oedema (SIPE) is a rare cause of life-threatening acute breathlessness occurring during a water-based event, characterized by symptoms and signs of pulmonary oedema following water immersion. Here we report three cases of triathletes who presented with SIPE following water immersion and were subsequently diagnosed with Takotsubo Cardiomyopathy (TCM).

Methods: Patients were initially managed by the event medical team and subsequently at the local tertiary level hospital from where clinical details were acquired via a manual review of the notes. Written consent was gained from all subjects.

Results: The three recreational triathletes were aged between 50 and 60 years, two were females and all presented with acute dyspnoea on exiting the water following a mass participation trialthlon between June 2018-2019. Two also presented with chest pain and haemoptysis. A diagnosis of SIPE was suspected by the medical event team on initial presentation of low oxygen saturations and clinical signs of pulmonary oedema. All were transferred to the local emergency department and had signs of pulmonary oedema on chest radiographs. Further investigations led to a diagnosis of TCM with findings of T wave inversion in anterolateral electrocardiogram leads, and apical hypokinesia on transthoracic echocardiogram and unobstructed coronary arteries.

Conclusions: This case series presents triathletes diagnosed with SIPE and TCM following the open water swim phase. It is unclear whether the myocardial dysfunction contributed to causation of SIPE or was the result of SIPE. Mass participation race organizers must be prepared that both SIPE and TCM can present in this population. Those presenting with an episode of SIPE require prompt evaluation of their cardiac and pulmonary physiology. Further research is required to ascertain the exact nature of the relationship between TCM and SIPE.

110 111

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P31 IS NEUROPATHIC-LIKE PAIN A FEATURE IN PATIENTS WITH FEMORAL ACETABULAR IMPINGEMENT SYNDROME ? A SECONDARY ANALYSES OF THE FAIT TRIALWood S.1,2, Coxon L.3, Glyn Jones S.2, Barker K.1,2

1Physiotherapy Research Unit, Oxford, , United Kingdom, 2Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, 3Nuffield Depatment of Women’s and Reproductive Health, Medical Science division, Oxford, United Kingdom

Introduction: Femoral acetabular impingement syndrome (FAIS) is a recognised cause of hip pain triggered by abutment of the femoral head against the acetabulum. Traditionally thought to be nociceptive, pain phenotypes e.g., burning, numbness, slight pressure pain are reported, mimicking neuropathic pain. Although no lesion to the somatosensory system is identified, does the presence of neuropathic-like pain (NeLP) explain why nociceptive-focussed treatments are not always successful?

Purpose: To identify NeLP in patients with FAIS and investigate if it is related to poorer outcomes.

Methods: A secondary analysis of the FAIT trial published in 2019: https://www.bmj.com/content/364/bmj.l185. The primary outcome measure, PainDETECT questionnaire (PD-Q); a validated screening tool for neuropathic pain and secondary outcome measures; iHOT33, HADS and ‘average pain over a month’, collected at baseline awaiting randomisation and 8 months follow-up. Both treatments arms (surgery or physiotherapy) were pooled. All outcome measures were non-normally distributed. Non-parametric statistical analyses were performed.

Results: Baseline 173 complete data sets with 131 at 8 months follow-up. Baseline PD-Q identified 69% nociceptive, 19% mixed and 12% neuropathic pain phenotypes. Post intervention, nociceptive 74%, mixed 16% and neuropathic 10%. Baseline group analyses showed significantly higher anxiety (p=0.005), depression (p=0.008), and average pain (p=0.01) and lower iHOT33 (p=<0.01) in the neuropathic compared to nociceptive group. Post intervention, a significant improvement in the iHOT33 (p=<0.01, r=0.60) average pain (p=0.003, r=0.30) in the neuropathic group and group comparison showed no difference between nociceptive and neuropathic in these outcomes. No change was shown in anxiety or depression in the neuropathic group.

Conclusion: NeLP exists in symptomatic patients with FAIS and is associated with increased levels of anxiety, depression, average pain and functional limitations. Nociceptive-targeted treatment improves hip function and pain but with less improvement in the NeLP group.Tailoring treatment to pain phenotype prior to intervention may further improve outcomes.

110 111

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P32 AN EVALUATION OF PHYSIOTHERAPISTS’ KNOWLEDGE REGARDING THE CLINICAL ASSESSMENT OF AN ACUTE ANKLE SPRAIN AND CHRONIC ANKLE INSTABILITYCurran L.1, Meehan C.1, Delahunt E.1

1University College Dublin, Dublin, Ireland

Rationale for Study & Background: Lateral ankle sprains are the most commonly sustained lower limb musculoskeletal injury amongst individuals who engage in recreational physical activities (Gribble et al., 2016). Lateral ankle sprains have the highest reinjury rates of all lower limb MSK injuries (Anandacoomarasamy and Barnsley, 2005). Up to 40% of these individuals progress to develop Chronic Ankle Instability (CAI), within 12 months of sustaining an ankle injury (Doherty et al., 2016).According to Delahunt et al (Delahunt et al., 2010) the defining characteristics of CAI are (1) the regular occurrence of “giving way” of the ankle joint; (2) self-reported feelings of ankle joint instability; (3) recurrent injury. Traditionally, CAI has been attributed to two causes : mechanical instability and functional instability. However this approach does not sufficiently grasp the wide range of complex impairments that interact to produce CAI. In a seminal article, Hertel (Hertel, 2002) discusses the pathomechanics and pathophysiology of CAI and outlines a particular set of mechanical and functional impairments which are associated with CAI. Previous research has highlighted that physiotherapist do not have a comprehensive understanding of these impairments (Kerin.F and Delahunt). Hence physiotherapists may not be delivering high standards of care to their patients. International guidelines have been published in terms of clinical ankle assessments, in order to comprehensively assess for these associated impairments of CAI. Identification of these impairments is imperative to be able to create impairment orientated rehabilitation programmes (Delahunt et al., 2018). Without this, incidence of CAI will remain high. The aim of this study was to evaluate Irish physiotherapist’s competencies in conducting a comprehensive clinical ankle assessment, their knowledge of CAI and their self-rated confidence in treating and assessing an ankle injury.

Methods & Measures: - The Irish Society of Charted Physiotherapist sent an anonymous survey to physiotherapists via email. 263 physiotherapists agreed to participate and 87 physiotherapists completed it.- The survey contained questions in order to assess participant’s competencies in conducting a comprehensive clinical ankle assessment and their knowledge of CAI as measured by their ability to identify the associated mechanical and functional impairments. The participants were also asked to self-rate their own proficiency in conducting an ankle assessment out of ten.

Results:- The results demonstrated that the majority of participants did in fact include most of the recommended assessment components in their own clinical exams with the exceptions of ankle joint arthrokinematics (44% did not include) and patient-reported outcome measures (60% did not include).- 49% of participants could not identify any mechanical impairments. 0% could identify all four.- 47% of participants could not identify any functional impairments. 3% could identify all four.- 75 participants (86%) rated themselves as either 6 or greater out of ten in the clinical assessment of an ankle injury

112 113

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Conclusions: The majority of Irish physiotherapists appear to conduct comprehensive ankle joint assessments, with the exceptions of not assessing for arthrokinematics and using patient reported outcome measures in their assessments. Despite this, Irish physiotherapists regarded themselves to be highly proficient in conducting an ankle injury assessment. Irish physiotherapists also exhibited a poor understanding of CAI and its associated impairments. Without this knowledge, evidence based practice cannot be adhered to, and incidence of CAI will continue to remain high.

Poster

112 113

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P33 INJURIES IN QUIDDITCH: A PROSPECTIVE STUDY FROM A COMPLETE UK SEASON Pennington R.1, Cooper A.2, Faulkner A.3, Macinnes A.3, Greensmith T.4, Mayne A.5, Davies P.3

1St Andrews University, St Andrews, United Kingdom, 2Pennine Care NHS Foundation Trust, UK, Manchester, United kingdom, 3NHS Tayisde, Dundee, United Kingdom, 4County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom, 5Belfast Health and Social Care Trust, Belfast, United Kingdom

Introduction and purpose: Quidditch is a mixed-gender, full-contact sport founded in the USA in 2005, played worldwide by an estimated 25,000 players. It is one of the few mixed-gender full-contact sports, yet there remain few published studies regarding injury rates and patterns. A previous study suggested that the overall rate of injury in quidditch is in line with other contact sports, however raised concerns that female players were sustaining a higher rate of concussion when compared to male players. The purpose of this study is to examine injury rates and injury patterns in UK quidditch athletes over the course of a single season.

Material and methods: Data were prospectively collected by professional first aid staff over the course of a season spanning all major UK tournaments, involving 699 athletes. Anonymised player demographics were collected by an online survey. Time loss injury rates were measured per 1000 athletic exposures (AEs) and hours of play.

Results: The overall time loss injury rate was 20.5 per 1000 hours or 8.0 per 1000 AEs. The combined rate of concussion was 7.3 per 1000 hours or 2.8 per 1000 AEs. There was no statistical difference between time loss injuries in males (20.9/1000 hours and 8.1/1000 AEs) and females (13.9/1000 hours and 5.4/1000 AEs) (p=0.30) and no statistical difference between concussion rates in males (n=7) and females (n=4) (p=0.60).

Conclusions: Total time loss injury rates in quidditch appear to be comparable with other full-contact sports such as football. The rate of concussions for both males and females appear higher when compared to other contact sports.

114 115

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P34 UK PHYSIOTHERAPISTS DELIVERING PHYSICAL ACTIVITY ADVICE: WHAT ARE THE CHALLENGES AND POSSIBLE SOLUTIONS? A QUALITATIVE STUDYStead A.1, Nykjaer C.1, Marino K.2, Iqbal A.3, Vishnubala D.1

1School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK, Leeds, United Kingdom, 2Royal Stoke University Hospital, Stoke-on-Trent, UK, Stoke-on-Trent, United Kingdom, 3Calderdale and Huddersfield NHS Foundation Trust, Lindley, Huddersfield, United Kingdom

Introduction and Purpose: Despite the benefits of physical activity (PA), including reducing non-communicable diseases such as cardiovascular disease, PA levels are in decline. Healthcare professionals (HCPs), including physiotherapists, have been identified as ideal conduits to promote PA, yet their knowledge and awareness of PA guidelines are poor. The aims of this study were to evaluate the current PA knowledge of physiotherapists and identify barriers and possible solutions to delivering PA advice.

Materials and Methods: Eighteen United Kingdom (UK) based physiotherapists (11 working in outpatients, five working in inpatients and two working in both) who managed National Health Service (NHS) patients, were recruited through volunteer sampling. Semi-structured audio-recorded virtual interviews took place using Zoom and an inductive thematic analysis was conducted on the transcriptions using Braun and Clarke’s six steps: data familiarisation; coding; theme identification; revision of themes; defining and naming themes; and writing up.

Results: Five themes and 16 sub-themes were identified, separated according to barriers and solutions to delivering PA advice. Barriers consisted of physiotherapist intrinsic barriers (knowledge, fear/ confidence); patient barriers (compliance, expectations and fear of doing PA); and lack of emphasis and priority given to PA (time constraints, minimal educational and staff training). Solutions consisted of increasing awareness (staff training, signposting awareness, use of social media and television campaigns) and optimising delivery (use of visual resources, good communication and approaches involving being individualised and gradual for patients with chronic conditions).

Conclusion: Physiotherapists knowledge on PA guidelines remains limited and are faced with barriers previously reported in the literature. Solutions suggested should be implemented to support physiotherapists delivering PA advice. Further research is needed to evaluate the efficiency of any implemented solutions supporting the delivery of PA advice.

114 115

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P35 PRACTICAL APPLICATION OF THE UCI HARROGATE CONSENSUS AGREEMENT CYCLING- SPECIFIC SPORTS RELATED CONCUSSION AT THE 2021 WOMENS TOUR & MENS TOUR OF BRITAINChapman P., Gray M., Thompson F.Medical Team Women’s Tour/Tour of Britain, United Kingdom

Introduction and Purpose: Taking advantage of the drawing together of many of the experts in cycling medicine in Harrogate, Great Britain, in September 2019 for the UCI road cycling world championships a conference and agreement meeting was held leading to the publication of the UCI Harrogate Consensus agreement cycling- specific sports related concussion. Following this the UK based Mens and Womens tour of Britain did not happen in 2020 due to the Covid Pandemic. However in 2021 both events were again held in close succession.

Material and Methods: Practical discussion and reflection by the race medical team of both the 2021 Womens Tour & Mens Tour of Britain about the utility of applying the UCI Harrogate Consensus agreement including the challenges faced and how it provides a practical framework for decision making..The UCI Harrogate Consensus agreement is a helpful and practical approach to a difficult problem. It can be difficult to practically apply all the principles in the pressured & dynamic environment of an elite road race. The authors discuss the strengths & difficulties encountered in applying these principles on the UK’s 2 major UCI multistage road races in 2021.

Conclusion: The UCI Harrogate Consensus agreement offers a concise tool to aid and improve decision making and assessment of riders with head injuries yet this remains practically challenging to apply in the dynamic environment of road cycling.

116 117

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P36 PLAC INJURY TYPES ASSOCIATED WITH ADDUCTOR LONGUS AVULSIONS IN PROFESSIONAL ATHLETES ARE DISTRIBUTED DIFFERENTLY BETWEEN GROUPS WITH FAILED CONSERVATIVE TREATMENT AND THOSE WITH SUCCESSFUL NON-OPERATIVE OR SURGICAL TREATMENT

Schilders E.1,2, Cooke C.2, Johnson R.1,2

1Fortius Clinic, London, United Kingdom, 2Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom

Introduction and Purpose: Currently there is no consensus on the most appropriate management of Adductor Longus Avulsions and selection of athletes for operative or non-operative treatment. An MRI study identified 6 types of injury to the Pyramidalis-Anterior Pubic Ligament- Adductor Longus Complex (PLAC) following Adductor Longus Avulsions, often associated with partial Pectineus Avulsions.Alternate hypothesis: the distribution of PLAC injuries associated with Adductor Avulsions is different in athletes with failed conservative treatment compared to athletes with successful conservative or surgical treatment.

Methods: The PLAC injury database was examined at our institution for the following inclusion criteria:High level or Professional Athletes, PLAC injury score type 1-6 (Table 1), with further division into:Group A: Failure of non-operative treatment (> 44 days after index injury), completion of structured rehabilitation program Group B: Successful non-operative or surgical treatment (<20 days of the index injury).Hypotheses were tested using Chi-square, effect size Cramer’s V and post hoc cell differences using Bonferroni adjustment (p< 0.004).

Results: Group A (n=120), Group B (n=109)Most common PLAC types found in group A were type 3 and 6 (Table1), n=39 (33%) and n=40 (33%) respectively.Most common types found in group B were type 1 and 3, n=37 (34%) and n=21 (19%) respectively.Overall, PLAC type distribution and groups were dependent (X2 (5, 229) = 26, p = 0.00009; moderate effect size (Cramer’s V = 0.304)). The variation between frequency of type 1 and 6 injuries between the groups reflected the significant cell differences between observed and expected values (p=0.0002 and p=0.0001 respectively).

Conclusion: Variability exists in PLAC injury patterns between athletes who had successful conservative or surgical management compared to athletes who had failed conservative treatment. This original study can help to select the appropriate treatment for PLAC injuries associated with Adductor Avulsions.

116 117

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Type 1 Complete fibrocartilage (FC) avulsion-Pyramidalis separated from Adductor Longus-intact Pectineus

Type 2 Complete FC avulsion-Pyramidalis separated from Adductor Longus - partial Pectineus tear

Type 3 Complete FC avulsion-Pyramidalis connected to Adductor Longus - intact Pectineus

Type 4 Complete FC avulsion-Pyramidalis connected to Adductor Longus - partial Pectineus tear

Type 5 Complete FC avulsion-Pyramidalis partially separated from Adductor Longus - partial Pectineus tear

Type 6 Partial FC avulsion-Pyramidalis connected to Adductor Longus-intact Pectineus

Table 1: Types of PLAC injuries

Type 1 2 3 4 5 6Group A 120

16 (13%)

16 (13%)

39 (33%)

6(5%)

3 (3%)

40 (33%)

Group B82+27

30 +7 (34%)

18 +1(18%)

15+6 (19%)

8+1 (8%)

5+2 (6%)

6+10 (15%)

Table 2: Distribution of PLAC injury types between Group A (failed non-operative treatment) and Group B (successful surgical or non-operative treatment)

118 119

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P37 LITERATURE REVIEW ON THE EFFECTS OF ACUTE, REPEAT AND LONG-TERM CONCUSSIVE INJURIES IN SPORTS PLAYERS AND ITS ASSOCIATION TO DEPRESSIONGiacci L., New K.University of South Wales, Cardiff, United Kingdom

There is immense curiosity in identifying the potential long-term effects of sports related concussions sustained during an athlete’s career. Depression is a well-known acute response to concussion, but there is little research done into the long-term effects of depression following a head injury.The aims of this literature review are:To review the impact of playing contact sports on the increased risk of concussion and ergo, depression later in life.To review if a history of concussion and mental health issues worsen post-concussion syndrome risk.To investigate the short and long-term effects of concussion on the executive function of players.To investigate any provisions available to support depression in post-concussion.A literature search using PubMed and Cochrane will focus on adult studies written from 2016. The following MESH terms will be used: concussion, head injury, or traumatic brain injury; as well as sport and depression. The database search identified 237 articles and once screened, 22 articles from various sports were included.The literature review found that in the absence of concussion, playing contact sports does not increase your risk of depression later in life. However, with concussion as the independent variable, each sport related concussion increased the risk of future mental health symptoms by 7-11%. Players with a history of ≥3 concussions were more likely to be diagnosed with depression. Contact sport athletes may feel they have poorer executive function compared to the general public but in the absence of concussion, there was no significant difference. The perceived dysfunction may be due to normal ageing and the current media attention on head injuries and mental health.No direct provisions were identified that could support athletes with acute or chronic post-concussive depression, but a healthy lifestyle could suppress some of the somatic symptoms.

118 119

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P38 DOES INCREASING PHYSICAL ACTIVITY IMPROVE COGNITIVE FUNCTION OF PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD)? A PILOT FEASIBILITY STUDYJames C.1, Ward K.2, Bradshaw E.2, Rossetti G.3, Macdonald J.3

1Cardiff and Vale University Health Board, , UK, 2Betsi Cadwaladr University Health Board, UK, 3Bangor University, UK

Introduction and Purpose: Patients with chronic kidney disease (CKD) have a considerably higher risk of developing cognitive impairment compared to the general population. Cerebrovascular disease is more likely to cause their cognitive impairment than Alzheimer’s disease. In other populations, the vascular risk factors that contribute to the development of cognitive impairment can be improved by exercise interventions. However, no studies have directly investigated the effect of an exercise intervention on cognitive function in patients with pre-dialysis CKD. The main aim of this study was to determine if it is feasible to recruit, test and retain CKD patients, with mild to moderate cognitive impairment, in an exercise intervention, which could potentially lead to an improvement in cognitive function.

Material and Methods: For this feasibility study, 10 patients with stage 3 or 4 CKD AND mild to moderate cognitive impairment were to be recruited. The procedure to be followed during the study is outlined in Figure 1. Feasibility was determined using 4 feasibility outcome measures relating to the methodological process, resources, management, and treatment effects.

Figure 1. Diagram outlining the procedure to be followed during the study

Results: Only 1 participant was recruited before dropping out as outlined in Figure 2. Researchers could successfully complete the baseline testing for the 1 participant, and it took as long as expected with minimal delays. The participant had MCI, however, their scores for the cognitive tests were not consistent with a diagnosis of MCI.

120 121

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 2. Diagram to demonstrate patient recruitment

Conclusion: This pilot feasibility study investigating the effects of exercise on cognition in patients with CKD is not feasible and therefore unsuitable for progression to a full randomised controlled trial. If the study were to continue, serious modifications would need to be made to improve recruitment rates.

120 121

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P39 THE IMPACTS OF SOCIAL RESTRICTIONS DURING THE COVID-19 PANDEMIC ON THE PHYSICAL ACTIVITY LEVELS OF ADULTS AGED 50-92 YEARS: THE CHARIOT COVID-19 RAPID RESPONSE (CCRR) COHORT STUDYGreen C.1, Salman D.1, Beaney T.1, Robb C.2

1Imperial College London, London, United Kingdom, 2Monash University, Monash, Australia

Introduction and Purpose: In the past 2 years, necessary social restriction measures to limit the spread of COVID-19 in the UK meant older adults limiting social interaction. Associations have previously been found between social isolation, loneliness, and reduced physical activity (PA). Therefore, this study aimed to quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, with PA levels over the duration.

Materials and Methods: 7,748 cognitively healthy adults aged ≥ 50 years, residing in London completed a baseline survey in April 2020. Questions asked about demographic, lifestyle, social isolation, and loneliness characteristics, as well as PA (using the International Physical Activity Questionnaire - IPAQ). Participants were followed up with up to 5 surveys over 11 months. Associations between shielding status, loneliness, and PA were then investigated using linear mixed models.

Results: In univariable models, participants reporting feeling often lonely at the outset of the pandemic completed an average of 522 fewer metabolic equivalent of task (MET) minutes/ week than those reporting they were never lonely (95% CI: -809, -236; p<0.001). Participants who were shielding at the outset of the pandemic completed an average of 352 fewer MET minutes/ week than those who were not (95% CI: -432, -273; p<0.001). After adjusting for demographic and lifestyle factors no statistically significant associations were found.

Conclusion: Those who were shielding or lonely at the outset of the COVID-19 pandemic were likely to have lower levels of physical activity than those who were not. However, these associations were not seen in adjusted models, suggesting these relationships are partly explained by socio-demographic and lifestyle factors. Individuals who were shielding or lonely at the outset of the pandemic may be at risk of poor health due to prolonged physical inactivity. Targeted PA interventions for socially isolated groups and people who are lonely should be considered.

122 123

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P40 THE 2021 BRIGHTON MARATHON MEDICAL TEAM EXPERIENCELeckie T.3, Long T.1, Fitzpatrick D.4, Hodgson L.3, Weller C.3, Grimaldi R.5, Richardson A.6, Galloway R.3, Stacey M.7

1Brighton and Sussex Medical School, Brighton, United Kingdom, 2Brighton Marathon Research Group, Brighton, United Kingdom, 3University Hospitals Sussex NHS Trust, United Kingdom, 4St George’s University Hospitals NHS Trust, , United Kingdom, 5Great Ormond Street Hospital NHS Trust, United Kingdom, 6School of Sport and Health Sciences, University of Brighton, Brighton, United Kingdom, 7Imperial College Healthcare NHS Trust, United Kingdom

Introduction: the 2021 Brighton Marathon took place on the 12/09/2021. Medical provision for the marathon runners is provided by a unified system combining St John Ambulance staff and health care professional volunteers in both clinical and non-clinical roles.

Methodology: a retrospective case note review of all runners presenting to the 2021 Brighton Marathon Medical Team and requiring advanced medical care during, or upon finishing, the marathon. Medical documentation was completed on proforma case report forms with a combination of categorical and free text data entry.

Results: over 8000 runners started the marathon, and 34 cases (0.4%) met the inclusion criteria for review. Mean age was 37.6 yrs (standard deviation ± 11.4) with gender of cases; 16 males, 6 females and 12 undocumented. Mean duration of treatment by the medical team was 2 hr 14 min ± 1 hr 23 min with 85% (29) of runners discharged home and the remainder conveyed to the local acute hospital for ongoing care. Of these, 3 had persisting neurological symptoms and 2 had ongoing cardiac symptoms. Point of care (POC) blood tests were performed as part of protocolised initial assessment, serum sodium range was 140-151 mmol/L. Figure 1 lists initial diagnosis made by the attending clinician. Nineteen cases had an initial temperature of >38 oC, with a mean of 39.4 ± 0.9 oC. The magnitude of initial temperature and POC tests were not associated with duration of treatment. Environmental conditions were consistent with average UK September conditions (minimum 11oC, peak 21 oC).

Conclusion: our data is consistent with recent data demonstrating the falling incidence of significant electrolyte derangement. This series contributes to the characterising of acute endurance running associated illnesses, highlighting its heterogeneity and the challenge of identifying patients at risk of developing persistent illness and requiring ongoing treatment beyond the medical tent environment.

122 123

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P41 METHODS TO INCREASE PHYSICAL ACTIVITY DISCUSSION IN A PRIMARY CARE CONSULTATION: THE IMPACT OF EDUCATION AND RESOURCES, A QUALITY IMPROVEMENT PROJECT Wan C., Wormall S. , Prasad V.

Kings Mill Hospital, Mansfield, United Kingdom

Introduction: The United Kingdom (UK) Chief Medical Officer recommends adults in the UK engage in 150 minutes of exercise per week. High levels of obesity -(body mass index >30kg/m2) affects 26% of men and 29% of women. Physical inactivity - (less than 30 minutes of moderate or vigorous exercise) affects 27% of adults. The role of the General Practitioner (GP) in increasing levels of physical activity (PA) is important. Brierley Park medical centre serves a population of 9,305 people and uses Read codes on SystmOne to track key consultation interventions and AccuRx to send messages to patients.

Aims: This project aims to test the efficacy of an educational intervention and introduction of a text template on AccuRX to improve PA discussion and referral.

Methods: The frequency of PA discussion/prescription in consultations for two months was calculated using Read codes and AccuRx text numbers before and after the educational intervention. The intervention consisted of a lecture style session aiming to raise awareness of the benefits of exercise, methods of introducing physical activity discussion into consultations and a newly designed AccuRX text template signposting patient to the ParkRun.

Results: In the two months prior to the intervention there was 8,977 consultations with a total of 4,250 patients seen at least once. Of these patients 27 (3 per thousand) were prescribed exercise or had exercise discussed with them. Post intervention 4,615 patients were seen at least once over a total of 10,418 consultations with 95 (10 per thousand) prescribed exercise or having exercise discussed. One text was sent using the AccuRX template post intervention compared to none before.

Conclusion: The educational intervention increased the number of exercise discussions and prescriptions and could be used in similar primary care settings to increase PA discussion. The AccuRX template showed little uptake.

124 125

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P42 DEVELOPMENT OF AN EVIDENCE AND CONSENSUS-BASED GUIDE TO DIFFERENTIAL DIAGNOSIS OF EXERCISE-INDUCED LEG PAIN (EILP): A SCOPING REVIEWBosnina F., Padhiar N., Miller S., Massoura C., Girotra K., Morrissey D.Sports & Exercise Medicine, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London., London, United Kingdom

Introduction: Numerous conditions are grouped under the generic Exercise-Induced-Leg-Pain (EILP) category yet definitive diagnostic guidelines are lacking. We aimed to provide a clear guidance about the diagnostic criteria of EILP patients from a comprehensive review of the literature.

Methods: Five online databases were searched from inception to September 2021 for any study identifying, describing, or assessing the clinical presentation and diagnostic criteria of EILP. Coded data extraction included condition definition, history, pain mapping, signs, diagnostic criteria, and investigative tools. Methodological quality was assessed using the Mixed Methods Appraisal Tool.

Results: 127 retained manuscripts with a median quality range of 2/5 (IQR=1) included data on chronic-exertional-compartment-syndrome (CECS, n=47), stress fractures (n=30), popliteal-artery-entrapment-syndrome (n=12), medial-tibial-stress-syndrome (MTSS, n=11), superficial-peroneal-nerve-entrapment-syndrome (SPNES, n=7), lumbar-radiculopathy (n=4), McArdle’s disease and other myopathies (n=6), accessory/low-lying-soleus-muscles-syndrome (n=4) and other common conditions (n=6). Those conditions are recognised as the most common, and 25 identified diagnostic criteria distinguished them, organised into 4 main categories (symptoms, physical findings, history, and investigations). There were 22 identified investigative tools, sub-categorized as invasive and non-invasive (e.g., dynamic-intra-compartment-pressure (DICP) testing and imaging, respectively). Elevated DICP was the most used diagnostic criteria for CECS, whereas the diffuse tenderness and the usage of imaging modalities were the most common criteria to diagnose MTSS. Imaging was the dominant diagnostic criterion to diagnose stress fractures while SPNES diagnosis was underpinned by neurological testing. As an example, the MTSS diagnostic framework was gradual onset exercise-related-diffuse-pain (history) along the posteromedial tibial border (location), which might persist for a few hours to 3 days; is reproducible by palpation (sign) while exclusion of other conditions requires imaging confirmation (investigations).

Conclusion: Initial diagnostic frameworks have been developed for each common EILP sub-condition suitable for consensus confirmation. The patient history, pain mapping, and physical findings represent the crucial diagnostic elements.

124 125

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 3: The most reported diagnostic criteria for each condition, CECS= Chronic exertional compartment syndrome, MTSS= Medial tibial stress syndrome, Tibial SF= Tibial stress fracture, SPNE= Superficial peroneal nerve entrapment syndrome, PAES= Popliteal artery entrapment syndrome, ASMS= Accessory soleus muscle syndrome

126 127

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

This figure represents the proportion percentage VS the most reported physical findings for each condition

The vertical axis represents the most reported physical findingsThe horizonal axis represents the proportion percentage

The colored bars represent the proportion percentage for each of these physical findings for each conditionNumbers of reported papers for each condition are outlined next to each condition

Figure 4: The most reported physical findings for each condition, CECS= Chronic exertional compartment syndrome, MTSS= Medial tibial stress syndrome, Tibial SF= Tibial stress fracture, SPNE= Superficial peroneal nerve entrapment syndrome, PAES= Popliteal artery entrapment syndrome, ASMS= Accessory soleus muscle syndrome

126 127

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P43 CLINICAL OUTCOME AND RETURN TO SPORT FOLLOWING FINGER FLEXOR PULLEY INJURY IN CLIMBING: A SYSTEMATIC REVIEW AND META-ANALYSISNorth D.

Queen Mary, University of London, United Kingdom Introduction and Purpose:The sport of climbing is a new Olympic discipline with a relatively young research field. It is well established that the most common injuries in climbing are to the finger flexor pulleys. Several small cohort studies have shown generally good clinical and return-to-sport outcomes following both conservatively and surgically treated pulley injuries, but to date there are no large-scale studies or systematic reviews assessing outcomes following pulley injury, nor a consensus on how these should be measured. This purpose of this review is to describe the clinical outcomes and return-to-sport success following pulley injury from the available literature. A secondary aim is to describe the common post-injury complications that impact these outcomes. Material and Methods: A search was carried out across 5 databases and results were screened for eligibility. Inter-reviewer reliability was assessed using percentage agreement and Cohen’s k statistic. Risk of bias was assessed using the Risk Of Bias in Non-randomized Studies - of Interventions (ROBINS-I) ‘Robvis’ tool. A meta-analysis of proportions was conducted using a random-effects model to estimate the return-to-sport performance level of surgically and conservatively treated pulley injuries. Remaining outcome measures and complications were qualitatively assessed.

Results: Inter-reviewer reliability was 94% with a Cohen’s k of 0.747. 12 studies were included (8 in meta-analysis). 86% of surgically treated pulley injuries and 97% of conservatively treated injuries regained their pre-injury climbing level. Sport-specific activity was resumed within 5 months (surgical treatment) or 8 months (conservative treatment). Other reported outcome measures included pain, patient experience, proximal interphalangeal joint range of motion (PIPJ-ROM), tendon-bone distance (TBD), finger strength and return-to-sport time. Conclusion: Clinical outcomes and return-to-sport success are good following both surgically and conservatively treated pulley injuries. An international consensus is required on the optimal outcome measures used to predict injury outcome in athletes.

128 129

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Example figure 1: PRISMA flow chart for identification, screening, eligibility assessment and inclusion of studies for systematic review and meta-analysis.

Example figure 2: estimated proportion of climbers regain-ing pre-injury return-to-sport performance level (matched or progressed) following surgically treated (above) and conservatively treated (below) finger flexor pulley injuries.

128 129

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P44 CUSTOM MADE MOUTHGUARDS; HELP TO IMPROVE COMFORT DURINGAEROBIC EXERCISEFine P.1, Ahmed I.2

1UCL Eastman Dental Institute, London, United Kingdom, 2Homerton Hospital, London, United Kingdom

Introduction & Purpose: Despite sports mouthguards significantly reducing the risk of orofacial trauma, in at risk sports; many athletes do not universally use them due to discomfort when exercising or talking. Over The Counter (OTC) varieties (Stock and Boil & Bite), are available but only dentally made custom made varieties, are fully fitted to improve comfort and efficacy. The advent of laminate technology has allowed new custom-made sports mouthguards that can improve compliance and breathing during exercise, but few studies have looked into the impact of this during exercise

To determine if a (3 laminate design) custom made mouthguard can improve comfort during exercise for athletes compared to Boil and Bite (OTC) mouthguards

Materials & Methods: 13 athletes (amatuer boxers) were provided with a dentally made custom made mouthguard to use. After an acclimatisation period - they were asked to self-report rating of perceived comfort (0-10) in control, Boil and Bite and Custom made mouthguard conditions at rest, during speech and whilst exercising.

Results: 13 participants took part in the study. Mean levels of comfort were reported as 9.9; 9.9 & 9.5 for the control mouthguard at rest, during speech and whilst training respectively. The participants reported a comfort level of 9; 7.5 & 7.7 with the Custom-made mouthguard, at rest, during speech and whilst training respectively. Finally comfort whilst wearing the Boil and Bite mouthguard was reported as 6.3; 4.4 & 4.9 at rest, during speech and whilst training respectively. Whilst at rest there is minimal difference in the comfort levels of a Custom-made mouthguard and the control group.

Conclusion: Despite the small number of athletes participating in this study it is clear that Custom-made mouthguards are more comfortable than a boil & bite mouthguard. Evidence supports the Custom-made mouthguard as being more effective against oro-facial trauma; therefore, these devices should be encouraged for all contact sports.

130 131

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P45 BONY DEFORMITY REDUCES RANGE OF HIP MOTION IN ATHLETES WITH SYMPTOMATIC FEMORO-ACETABULAR IMPINGEMENTFilan D.1, Mullins K.1, Carton P.1,2

1UPMC Whitfield, Waterford, Ireland, 2The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland

Introduction: Cam and pincer bony deformities may act as a mechanical block to end range of hip movement (ROM). Objective ROM assessment forms an important element of the diagnostic work-up when screening athletic hips.

Aim:(1) evaluate the association between abnormal bony hip morphology on hip-ROM, in a series of athletes diagnosed with symptomatic Femoro-Acetabular Impingement (FAI) and (2) evaluate the impact of arthroscopic correction of FAI, on improving post-operative ROM.

Methods: Prospective institutional registry of male athletic hips undergoing primary HA between 2018-2021 was reviewed. Exclusion criteria: dysplasia, coxa profunda, Tonnis>1, <16 years,>35 years, non-field-based athletes. Hip-ROM was objectively measured in the supine position (flexion and abduction), with a hand-held goniometer using a two-operator technique; internal/external rotation and adduction measured supine with 90o hip flexion. Standardised radiological assessment of hip morphology was quantified with continuous and categorical scales, measuring alpha angle (cam>55o Dunn, >65o AP-view), lateral centre-edge angle (LCEA) (pincer>30o AP-view). Pearson’s correlation and analysis-of-variance tested for differences between continuous and categorical variables respectively (SPSS (v.28.0)).

Results:226 cases were included. Mean age 24.6+/-4.7 years. Main sport GAA hurling (37.2%), Gaelic football (45.6%), soccer (17.3%). Statistically significant inverse correlation was observed at baseline between LCEA and flexion (r=-0.134, p=0.004), adduction (r=-0.264, p<0.001), ER(r=-0.222,p<0.001), IR(-0.255,p<0.001) and total ROM (tROM) (r=-0.271,p<0.001). Moderate inverse correlation was observed between alpha angle and flexion (-0.328, p<0.001), adduction(r=-0.403,p<0.001), IR(r=-0.397,p<0.001) and tROM(r=-0.441,p<0.001). Mixed FAI had significantly reduced flexion(109 vs 113 vs 117), adduction(12 vs 17 vs 19), IR(13 vs 20 vs 21), tROM(215 vs 235 vs 247) compared to isolated cam/pincer and absence of bony deformities respectively (p<0.001). Larger pincer resection was associated with a significant increase in IR post-op(p=0.019,r=0.176). Larger cam resection was associated with a significant increase in IR (Dunn: p=0.012,r=0.188), and abduction(AP p=0.022,r=0.172).

Conclusion: Bony deformities of both acetabulum(pincer) and femur(cam) result in significant reduction in hip ROM for symptomatic male athletes. Arthroscopic correction of abnormal bony deformities is associated with significant increases in hip-ROM post-operatively.

130 131

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P46 CORTICOSTEROID INJECTION FOR PLANTAR FASCIITIS: AN AUDIT OF FINDINGSOlivelle J.1, Olivelle A.2

1Foot and Ankle Centre, London, United Kingdom, 2University of Nicosia, Nicosia,

Introduction: Plantar fasciitis commonly seen in the musculoskeletal clinic and accounts for around 8% of running injuries. BMJ best practice advises that primary treatment should be rest and reducing the precipitating factors with corticosteroid injections used if primary treatment fails to improve symptoms. The National Institute of Health and Care Excellence guidance of 2019 recommended corticosteroid injections for patients whose “symptoms are having a significant impact on the person” however, they also feel that this treatment will only provide short term relief. Methylprednisolone is a medium duration corticosteroid which may improve patient satisfaction however there is limited research on its effectiveness.

Material and Methods: 93 patients were included in this audit. All patients received 1ml of 40mg depomedrone (methylprednisolone)

Inclusion criteria: All patients who had clinically diagnosed plantar fasciitis foot 8 weeks and had received the first line treatments of stretching and orthotics.

Exclusion criteria: Patients yet to begin a stretching program or had alternative treatments (e.g. shockwave), had systemic disease or previous surgery were excluded.Outcome measures: A patient assessed (Visual analogue scale) and a physician assessed (Heel tenderness index) outcome measure was used.

Results: 93 patients with ages ranging from 42.5 to 58.4 years were assessed.

VAS80 (86.02%) reported an improvement in symptoms at the 4 week follow up, 62 (66.67%) of whom reported to be pain free. The remaining 18 patients advised their symptoms had improved by 50%. 13 patients (13.98%) reported no improvement.

HTI

Heel Tenderness Index

Number of patients prior to corticosteroid injection

Number of patients at the 4 week follow up

0 0 831 27 32 47 73 18 0

83 (89.25%) patients had no pain on palpation of the heel post injection, whilst prior to the injection all patients had pain in differing degrees. 18 patients (19.35%) had severe pain prior to the injection, post injection no patient had severe pain. 90 (96.77%) of patients had improved HTI scores.

Conclusion: Corticosteroid injections are an effective second line treatment for the treatment of plantar fasciitis.

132 133

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P47 THE EFFECT OF TECHNOLOGICALLY AUGMENTED VISUAL FEEDBACK ON ATHLETES’ PERFORMANCE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED AND NON-RANDOMIZED CONTROL TRIALSVikatou T.1,2, Sinha P.1, Welsh E.1, Angioi M.1, Morrissey D.1,2

1Queen Mary University of London, London, United Kingdom, 2Barts Health NHS Trust, London, United Kingdom

Introduction and Purpose: Technologically augmented visual feedback (TAVF) is a potentially beneficial application to enhance motor control and is routinely used in athletic training. This systematic review aims to identify the effects of TAVF, through electronic devices, on athletes’ and dancers’ individual skills, training and technique.

Materials and Methods: Four databases were searched (Pubmed, Web of Science, Scopus and Cochrane library) for peer reviewed randomised and non-randomised controlled trials evaluating the effects of TAVF in healthy skilled athletes’ and dancers’ performance, from inception to March of 2021. Quality was judged by applying a modified version of the Downs and Black quality assessment tool by three independent reviewers. Kinetic and kinematic data were reported descriptively and meta-analysed where possible.

Results: A total of 8 studies (with fair and good quality) with a total of 174 participants were retained. The level of athletes varied, including amateurs to professionals among different sports, but no studies of dancers. TAVF was delivered via electronic devices such as smartphones, tablets and displays in real time. Five main subgroups of outcome measures were identified; Velocity, Sprint time, Jump-height, Power, and sports-related skills, divided into two subcategories (Pre- versus Post-intervention in figure 2, and between control and intervention groups in figure 1). Moderate to large effect sizes were found for power and small to moderate effect sizes for all the subgroups except the specific skills group, in which conflicting findings were found. Pooled data revealed moderate effect sizes for Sprint Time (ST) and Countermovement Jump (CMJ) (control-intervention ST d=0,48 95% CI=-2,24 to 3,21, CMJ d=0,60 95%CI=- 14,07 to 15,28; pre-post ST d=0,59 95% CI=0,14 to 1,05, CMJ d=0,55, 95%CI=-0,28 to 1,38).

Conclusion: Despite the clinical and methodological heterogeneity of included studies, moderate evidence was found, suggesting that the incorporation of TAVF in sports training can benefit athletes’ performance while also yielding lessons for injury rehabilitation.

132 133

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

Figure 5: Between group effect sizes, positive values favouring the intervention.

Figure 6: pre-post intervention effect sizes, positive values favouring post- intervention.

134 135134 135

THE ASSOCIATION AND INSTITUTE PRIZE POSTERS

P48 IMPACT OF THREE DIFFERENT PHASES OF UK COVID-19 LOCKDOWN RESTRICTIONS, COVID INFECTIONS AND COVID VACCINATION STATUS ON RUNNERS TRAINING DISTANCE AND PACEStocks J.1, Bullock G.2, Feakins B.3, Gayer De Mena L.1, Tahir D.1, Zheng J.1, Wang S.1, Huang X.1, Bestwick-Stevenson T.1, Jumbu N.1, Simpkins D.1, Kluzek S.1

1University Of Nottingham, Nottingham, United Kingdom, 2Wake Forest School of Medicine, Winston-Salem, USA, 3University of Oxford, Oxford, United Kingdom

Introduction and Purpose: The Covid-19 pandemic changed physical activity levels. Running participation became more popular to help maintain a healthy body weight and reduce the risk of severe Covid-19 symptoms, whilst improving overall physical and mental health. Lockdown restrictions and ‘Work From Home’ directive also facilitated time availability for fitness activity participation. This study aimed to compare the impact on running activities of the third Covid-19 lockdown period in the UK, during the phased exit from lockdown and once all restrictions ended. Material and Methods: Baseline data from 1671 participants of ‘Running Through’, a prospective cohort study of community runners, joggers and Nordic walkers were collected via electronic survey between February - December 2021. Lockdown categories chosen were determined based on UK Covid restrictions. Mean distance (km/week) and running pace (min/km) were analysed and adjusted for injury status, covid infection and covid vaccination. Results:

Overall

Full Lockdown

Pre March 8 2021

Tiered/Phased Lockdown

Mar 8 - Jul 19 2021

No Restrictions

Post Jul 19 2021

Total person weeks 31568 1905 17965 11221

Distance, km/week 22.1 (9.3, 35.0) 28.7 (14.2,

43.2)22.5 (10.0,

35.0) 20 (8.3, 33.3)

Pace, min/km 6.2 (1.4) 6.00 (1.9) 6.21 (1.7) 6.21 (1.5)Distance run per week was also significantly reduced when adjusted for recent injured -9.61 (95% CI- 10.19, -9.04) and covid infection -3.12 (95% CI -4.36,-1.88) but not covid vaccination. During lockdown the mean pace was significantly faster than when restrictions ended. However, when adjusted for covid infection, covid injection status and recent injury only injury influenced mean running pace 0.15 (95% CI 0.11, 0.20).

Conclusion: Mean distance ran was greater during the winter lockdown rather than during the restriction-free summer. However, covid cases increased as restrictions ended and covid infections significantly influenced reduced weekly distance. Covid vaccinations did not significant impact running pace or distance.

134 135134 135

MU

SC

ULO

SK

EL

ETA

L

PR

IZE

PO

ST

ER

S

136 137

MUSCULOSKELETAL PRIZE POSTERS

P49 THE TYPE, AND THE EFFECT OF THERAPEUTIC EXERCISE ON QUALITY OF LIFE AND FATIGUE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN GREECE: A CROSS-SECTIONAL STUDYBonia D., Sourvinos S., Siaperas P.Institute of Occupational Science and Rehabilitation, , Greece

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with severe symptoms, such as fatigue and has a high impact on patient’s quality of life.

Purpose: The aim of this study was to determine the rate, the type, and the effect of therapeutic exercise in patients with SLE on quality of life and fatigue in Greece.

Method: Three questionnaires were used to measure quality of life, fatigue, and physical activity and 101 patients with SLE answered about their personal choices.

Statistics: For the statistical analysis, the statistical program (IBM) SPSS 25 Statistics was used, while for the analysis of the data Kolmogorov-Smirnov, ANOVA, Pearson Correlations were used.

Results: The results showed that the sample average for quality of life was 48.3, for fatigue 41.73 and the total score of physical activity was 1603.79. Furthermore, for vigorous exercise the average was 557.79 of gym training, 30 minutes per day, twice a week, for moderate exercise 824,65, of housework and cleaning, 1 hour per day, twice a week, and for low exercise 239,87, for 30 minutes, three times per week. A high average (50.5) of the sample was presented by patients who chose to remain seated during a day. Correlation between exercise and QoL and Fatigue was found (p<,01).

Conclusion: The conclusions were that the patients with SLE in Greece do not perform systematically exercise. The main choice was housekeeping and cleaning, while choosing a sedentary lifestyle brings further problems to their health, although exercise was found to have positive results.

136 137

MUSCULOSKELETAL PRIZE POSTERS

P50 EARLY REDUCTION OF ACUTE ANTERIOR SHOULDER DISLOCATIONS IN A SKI FIELD SETTING: A RETROSPECTIVE DESCRIPTIVE CASE SERIESFraser C.1, Pellatt R.2, 3, 4, 5, Shirran M.1,2,5,6, McKay G.1, Smith M.1,7

1NHS, Edinburgh, United Kingdom, 2Emergency Department, Gold Coast University Hospital, Queensland, Australia, 3LifeFlight Retrieval Medicine, Queensland, Australia, 4Bond University, Queensland, Australia, 5Griffith University, Parklands Drive, Queensland, Australia, 6Queensland Ambulance Service, Queensland, Australia, 7Queensland University of Technology, Queensland, Australia

Introduction and Purpose: Shoulder dislocations are commonly sustained during snow sports. These injuries can be significant and often benefit from early management. This study analysed the effectiveness and outcomes of anterior shoulder reductions performed in a ski field clinic prior to hospital transfer.

Methods: This was a retrospective case series of patients with shoulder dislocations presenting to two ski field clinics in Queenstown, New Zealand in the winter season of 2019. The management of patients presenting with suspected anterior glenohumeral joint dislocations without associated significant fractures was analysed. The data collected included age, sex, successful/failed reductions, and post reduction imaging results. The primary outcome of interest was the possibility of early reductions prior to hospitalization. Patients with suspected associated fractures did not have reductions attempted.

Results: Over the 2019 season, 243 patients presented to the ski field clinics with shoulder injuries, 71 of which were suspected dislocations. Forty nine patients were deemed appropriate for early reduction. Forty four (90%) of these patients had successful reductions prior to hospital transfer. Thirty-three (66%) of these patients went on to have post reduction imaging. None of the patients had injuries on post reduction imaging that required surgical intervention and 22 (67%) had unremarkable findings on x-ray.

Conclusions: This case series suggests it is possible to perform reductions of selective anterior shoulder dislocations safely and effectively, prior to imaging, in a non-hospital setting.

138 139

MUSCULOSKELETAL PRIZE POSTERS

Table 1 Characteristics of patients that had attempted reductions

Total (n=49) Percentage

Gender

Female 9 18%

Male 40 82%

Activity

Ski 19 39%

Board 30 61%

Other 0 0%

Age groups no.

<17 1 2%

17-25 19 39%

26-40 19 39%

>40 10 20%

Age - mean (SD) 31.7 (12.6)

Side of Injury

Right 20 41%

Left 29 59%

Table 2 Attempted reductions

Total (n=49) Percentage

Failed Reductions 5 10%

Successful Reductions 44 90%

Available post reduction X-rays 33

Normal 21 64% of available x-rays

Reported injuries† 12 36% of available x-rays

† 5 Bankart lesions, 6 Hill-Sachs lesions, 3 Greater Tuberosity fractures, 1 coracoid frac-ture)

138 139

MUSCULOSKELETAL PRIZE POSTERS

P51 USE OF GOOGLE LOCATION HISTORY (GLH) TO ASSESS PHYSICALACTIVITY (PA) PROFILESHashmi A., Hopkins M., Salman DImperial College London, London , United Kingdom

Introduction and Purpose: Physical activity (PA) is a major contributor to global non-communicable disease prevention. However, current methods of measuring PA (subjective questionnaires or objective accelerometer measures) do not allow for objective, large scale and retrospective analysis at a granular level. Google Location History (GLH), which uses location data from smartphones, is an unexplored potential tool for measuring PA which could overcome some of these issues. We aimed to determine if GLH could be used and interrogated to measure PA levels and produce summary activity profiles.

Material and Methods: GLH data of 5 healthy UK participants (mean ± SD age: 30.4±7.5 years) were downloaded as a JSON file with a Portable Operating System Interface (POSIX) timestamp, latitude and longitude, and a confidence level of the most likely activity that a user was performing (on foot, on bicycle, in vehicle). R statistical software was used to convert POSIX data to Greenwich Mean Time (GMT); individual days and weeks were grouped together by activity; and activity duration calculated using time data between changes in activity. Data were then assessed for normality using histograms and the Shapiro-Wilk test. Median time for each activity was used to create 24-hour clock profiles for each participant.

Results: The timescales of recorded activity ranged from 23 to 2790 days. Median (IQR) minutes per week spent on-foot ranged from 28.65(8.21) to 487.24 (267.76) mins, on-bicycle 2.08 (1.1) to 49.08(84.41) mins and combined 29.1(8.38) to 509.93 (261.88) mins. 24-hour clock profiles showed peaks in activity starting between 06:30-07:30 and 17:30-19:30.

Conclusion: GLH can be used to create objective PA profiles covering considerable timescales, and at a daily, granular level. This suggests it could be a useful tool to assess patterns of PA.

Figure 1: Median (IQR) minutes per week spent on foot, cycling and combined

140 141

MUSCULOSKELETAL PRIZE POSTERS

P52 USE OF ULTRASOUND TO GUIDE RETURN TO PLAY (RTP) DECISIONS FOLLOWING HAMSTRING MUSCLE INJURIES: A SCOPING REVIEWSalman D.1, Patel J.2, O’Leary F.2, Jones R.1, Korgaonkar J.2

1Imperial College London, , United Kingdom, 2Imperial College NHS Trust, London, United Kingdom

Introduction and Purpose: Hamstring muscle injuries are very common in sport and cause significant absence from training and competition for athletes. To date, Magnetic Resonance Imaging (MRI) has been used to grade hamstring injuries and guide rehabilitation but is financially costly. Ultrasound (USS) imaging is currently used for diagnosis, but guidance is lacking on its use for rehabilitation. This systematic scoping review aims to map the available evidence to ascertain if: (i) USS can guide Return To Play (RTP) decisions following hamstring muscle injuries; (ii) how USS has been used to guide RTP decisions in other lower-limb muscle groups; and (iii) what forms of ultrasound have been tried to guide RTP decisions following muscle injury?

Material and Methods: The Joanna Briggs Institute (JBI) methodological framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to guide the development and reporting of this systematic scoping review respectively. MEDLINE, EMBASE and CINAHL databases were searched using the key concepts of population (athletes, hamstring or other lower limb muscles), intervention (ultrasound) and outcome (RTP). Any study or review of human participants, using non-interventional ultrasound were included and limited to English language studies only. Studies exclusively on tendon and not involving muscle were excluded.

Results: A total of 464 studies were found, and 421 removed at the first stage due to lack of relevance or duplication. 22 studies were excluded at the second stage (figure 1). Remaining studies included different USS modalities, for example fascicle length and shear wave elastography measurements across hamstring, quadriceps and gastrocnemius muscle injuries.

Conclusion: USS is under-investigated and under-used in rehabilitation or RTP decisions following muscle injury, and shows promise as an accessible tool to aid clinical decision making.

Figure 1: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of the scoping review process

140 141

MUSCULOSKELETAL PRIZE POSTERS

P53 EFFECT OF THE COVID-19 UK LOCKDOWN ON LOWER LIMB TENDON RUPTURES Yasen Z., Islam S., Hasnain A., Ali S., Raja H., Tsitskaris K.Barts Health NHS Trust, London, United Kingdom

Objectives: Achilles tendon ruptures are known to be prevalent in the ‘weekend warrior’, individuals who are intermittently active on a background of sedentary behaviour. There is minimal literature that looks at whether this impacts the incidence of rupture of other tendons. In the spring of 2020, a ‘lockdown’ was announced in the UK in response to the COVID-19 pandemic. In this study we aim to assess whether the incidence of lower limb tendon rupture had increased compared to other years, and whether the incidence changed as exercise allowance was increased.

Methods: A retrospective study was performed at a London district general hospital assessing the incidence of Achilles, patellar and quadricep tendon rupture presenting during the lockdown period, and the corresponding periods in 2019 and 2021.

Results: In 2020 there was a significant increase in incidence of Achilles (2021: 16, 2020: 14, 2019: 8) and patellar (2021: 2, 2020: 7, 2019: 1) tendon ruptures, whereas quadricep (2021: 0, 2020: 2, 2019: 0) tendon ruptures did not differ significantly. There was an increase in the incidence of Achilles tendon rupture as exercise allowance was increased.

Conclusion: This study reinforces the necessity of stepwise return to play protocol for deconditioned athletes as well as the advantages of an active lifestyle for the general population. The results also indicate that patellar rupture may be influenced by the same lifestyle factors as Achilles rupture, and should prompt larger studies across multiple sites to confirm this.

142 143

MUSCULOSKELETAL PRIZE POSTERS

P54 GENETIC MARKERS FOR SOFT-TISSUE INJURY RISK IN LITHUANIAN ATHLETESGineviciene V., Utkus A.Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

Introduction: Studies have reported the association of the COL1A1 Sp1 binding site variant (rs1800012, c.104-441G>T) and promoter variant (rs1107946, c.-2116G>T) with the risk of musculoskeletal soft tissue injuries. The ACTN3 variant (rs1815739, c.1729C>T, p.Arg577Ter) has also been proposed to modulate injury risk. Therefore, this study aimed to support the contribution of the COL1A1 rs1107946 and rs1800012, and ACTN3 rs1815739 variants to the profile predisposing for musculoskeletal soft tissue injuries.

Material and Methods: In total, Lithuanian 123 control (injury-free) athletes and 62 athletes with injuries (experienced during sport: Achilles tendon and anterior cruciate ligament ruptures, and shoulder dislocations) were genotyped (using Real-time polymerase chain reaction) for the prioritized variants (rs1800012, rs1107946, rs1815739). Statistical analysis was performed using Rv3.2.

Results: The genotype and allele frequency distributions of the ACTN3 rs1815739 variant did not differ significantly between the controls and injury athletes’ group (P = 0.458). Significant differences in COL1A1 genotypes distribution were observed between injury athletes and controls (rs1800012: case GG/GT/TT: 44/32/24% vs controls GG/GT/TT: 89/10/1%; P<0.0001; rs1107946: case GG/GT/TT: 60/29/11% vs controls GG/GT/TT: 64/33/3%; P = 0.042). The COL1A1 rs1800012 T allele was higher in injury athletes (40%) compared to controls (6%) (P<0.0001). The rare rs1800012 TT genotype (OR: 38.9, 95% CI: 5 - 303.1, P = 0.0005) and rs1107946 TT (OR: 5.09, 95% CI: 1.3 - 20.4, P =0.022) of COL1A1 gene were associated with decreased injury risk.

Conclusion: These results support previous observations (for an association of the COL1A1 variants (rs1800012 and rs1107946) with the risk of acute soft tissue injuries) and reiterate the heterogeneity of musculoskeletal phenotypes whereby certain markers may be common to the predisposing profiles while others may be unique. In future, specific genotypes associated with increased risk of soft tissue injury can prevent these injuries by identifying individuals at higher risk.

142 143

MUSCULOSKELETAL PRIZE POSTERS

P55 THE FIFA INJURY PREVENTION PROGRAMS REDUCE THE INCIDENCE OF GROIN INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALSAl Attar W.1, 2, 3

1Department of Physical Therapy, Faculty of Applied Medical Science, Umm Al Qura University, Makkah, Saudi Arabia, 2Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia, 33. Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland

Introduction and Purpose: Groin injuries are among the most common and time-consuming injuries in sports. Justifying the implementation of sports injury prevention program (IPPs) such as the Fédération Internationale de Football Association (FIFA) 11, 11+ and modified 11+. Therefore, the purpose of this study was to investigate the effectiveness of IPPs such as 11, 11+ and modified 11+ in reducing the incidence of groin injuries among athletes.

Material and Methods: This meta-analysis was based on the PRISMA protocol. Two investigators independently searched for relevant studies published during the period from 1985-2022 using the following databases: Cochrane Library, PubMed, Web of Science, and PEDro. The keywords used in the search strategy were ‘neuromuscular training’, ‘injury prevention programs’, ‘FIFA’, ‘Groin injury’, ‘athlete’, and variations of these search terms. Included studies had to be randomized controlled trials using the 11, 11+ and modified 11+ IPPs. The random-effects model was used in analysing the extracted data by the RevMan Meta-Analysis software version 5.

Results: The pooled results of 9322 athletes showed 35 % groin injuries reduction per 1000 h of exposure compared to the control group with an injury risk ratio [IRR] of 0.65 (95% confidence interval [CI] 0.49-0.85). Figure 1.

Conclusion: This meta-analysis demonstrates that the 11, 11+ and modified 11+ IPPs decreased the risk of groin injuries among athletes.

Figure 1. Forest plot illustrating the effect of IPPs versus controls on groin injury rate

144 145

MUSCULOSKELETAL PRIZE POSTERS

P56 PREVALENCE AND EPIDEMIOLOGY OF SPORTS INJURIES PRE - AND POST-COVID-19 LOCKDOWN AMONG SOCCER PLAYERS IN SAUDI ARABIA: A PROSPECTIVE STUDYAl Attar W.1, 2, 3

1Department of Physical Therapy, Faculty of Applied Medical Science, Umm Al Qura University, Makkah, Saudi Arabia, 22. Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia, 33. Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Australia

Introduction and Purpose: The Coronavirus disease (COVID-19) caused a global lockdown, followed by the Ministry of Sports announcing suspension of all sports activities, which has forced soccer players to train indoor or stop training. Therefore, the purpose of this study was to evaluate the consequences of COVID-19 lockdown on the injury rate among soccer players.

Material and Methods: A total of 45 soccer teams (630 players) competing in the amateur leagues, were followed for two seasons (pre- and post-COVID-19 lockdown). The medical staff of participating teams were requested to report all injuries during matches and/or training. Exposure during all matches and training were calculated.

Results: The incidence of sport-related injuries (initial, recurrent), (mild, sever) significantly increased by 47.25% post COVID-19 lockdown among amateur soccer players. Figure 1.

Conclusion: This study indicates that COVID-19 lockdown has an impact on the overall injuries among soccer players.

Figure 1. Injury rate pre- and post-COVID-19 lockdown among amateur soccer players

144 145

MUSCULOSKELETAL PRIZE POSTERS

P57 MANAGEMENT OF SUBACROMIAL SHOULDER PAIN IN THE COMMUNITY MUSCULOSKELETAL SERVICETaylor C., Baltsezak S.ESNEFT NHS Community Musculoskeletal Service, Colchester,, United Kingdom

Introduction and purpose: Subacromial pain (SAP) is a major cause of shoulder pathology. The treatment is largely conservative and includes analgesia, self-management advice, exercises, and corticosteroid injections.The purpose of this study was to assess whether current management of patients presenting with SAP to North East Essex (NEE) community MSK service is effective in reducing number of referrals to secondary and orthopaedic care.

Material & Methods: All patients who had subacromial steroid injection between June and November 2020 had retrospective review of electronic notes at 12-18 months after last consultation. Presence or absence of secondary care referral was recorded. Patients demographics, referral to physiotherapy, type and dose of injection were analysed.

Results: Overall, 134 patients were analysed. The average age was 58 years old (21-83). 61% (82) of patients were female, 39% (52) male. The main diagnoses were subacromial pain syndrome (SAPS)/impingement, calcific tendinopathy, and rotator cuff tears. 70.9% of patients had 40mg Kenalog injection in the subacromial space, 20.9% had 20mg, 7.46% had 30mg and 1 (0.74%) had 10mg. Only 51% of patient had documented physiotherapy rehabilitation after injection. 24% (32) of patients were referred to Orthopaedics for further management: 6 patients had calcific tendinopathy, 8 patients had rotator cuff tear, 6 patients had acromioclavicular joint osteoarthritis, and 23 patients had SAPS. 4% of patients were referred to other secondary services. Of those patients requiring referral, 66% did not have documented exercise therapy after injection.

Conclusion: Exercise based, physiotherapist led rehabilitation is the accepted management for SAP. Steroid injection is used to facilitate pain free recovery. Majority of patients (72%) presenting to NEE community MSK clinics did not require subsequent referral to secondary care. However, low number of physiotherapy referrals after injection leaves room for further improvement.

146 147

MUSCULOSKELETAL PRIZE POSTERS

P58 MANAGEMENT OF GLUTEAL TENDINOPATHY: A SYSTEMATIC REVIEW WITH META-ANALYSIS OF ALL INTERVENTIONSBremer T.1, Nicklen P.2, Fearon A.3, Morrisey D.1

1Sports and Exercise Medicine, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London, United Kingdom, 2Monash University, Department of Physiotherapy PO Box 527, Frankston, Vic, 3199 , Australia, 3University of Canberra, 1 Kirinari St, Bruce ACT 2617, Australia, Australia

Introduction: Gluteal tendinopathy (GT) is a common source of hip pain with reported pain, function, quality of life being equivalent to end stage hip osteoarthritis. This systematic review aims to clarify the best management for people with GT.Materials and Methods: 9 electronic databases and the grey literature were searched from inception to March 2021. 20 high-quality, randomised controlled trials of any intervention for GT were included. The PEDro scale was used for quality assessment, with risk of bias assessed using the Cochrane Risk of Bias tool 2.0.

Intervention Outcome domain

Short term(0-3 months)

Medium term(3-6 months)

Long term(6-12 months)

Primary proof of efficacyExercise and education

Pain: Effects

0.95 [0.58, 1.33]Mellor (2018)Moderate strength evidenceLarge effect size

0.60 [0.23, 0.96]Mellor (2018)Moderate strength evidenceMedium effect size

0.46 [0.10, 0.81]Mellor (2018)Moderate strength evidenceSmall effect size

Pain: Outcomes

1.12 [-1.09, 3.34]Mellor (2018), Rompe (2009)

0.69 [0.42, 0.97]Clifford (2019), Ganderton (2018)

3.00 [2.47, 3.53]Mellor (2018)

1.31 [0.79, 1.83]Mellor (2018), Rompe (2009)

0.90 [0.58, 1.21]Ganderton (2018)

Function: Effects

0.91 [0.53, 1.28]Mellor (2018)Moderate strength evidenceLarge effect size

0.79 [0.42, 1.16]Mellor (2018)Moderate strength evidenceMedium effect size

0.41 [0.05, 0.76]Mellor (2018)Moderate strength evidenceSmall effect size

Function: Outcomes

0.87 [0.33,1.40]Clifford (2019), Ganderton (2018), Mellor (2018)

1.34 [0.96, 1.72]Mellor (2018)

1.02 [0.73, 1.31]Ganderton (2018), Mellor (2018)

KeyEffect size: small = 0.20 - 0.49, medium = 0.50 - 0.79, large= 0.80 or above. Strength of evidence: strong moderate no data available

Strength of evidence and efficacy of intervention (Table 1):

146 147

MUSCULOSKELETAL PRIZE POSTERS

Results: Meta-analysis of four studies of exercise and education (EDX) for pain and function demonstrated that EDX has a large effect on pain outcomes in the short term (SMD 0.95, 95% CI 0.58, 1.33), medium effect in the medium term (SMD 0.60, 95% CI 0.23, 0.96) and a small effect on in the long term (SMD 0.46, 95% CI 0.10, 0.81). EDX has a large effect on functional outcomes in the short term (SMD 0.91, 95% CI 0.53, 1.28), medium effect in the medium term (SMD 0.79, 95% CI 0.42, 1.16) and a small effect in the long term (SMD 0.41, 95% CI 0.05, 0.76).

Conclusion: Education and exercise has a positive impact on pain levels and function at every time point. Education and exercise interventions should form part of GT management. Clinical decision making should incorporate the findings.

148 149

TOM DONALDSON PRIZE POSTERS

TO

M D

ON

AL

DS

ON

P

RIZ

E P

OS

TE

RS

148 149

TOM DONALDSON PRIZE POSTERS

P59 RELATIVE ENERGY DEFICIENCY IN SPORT: CREATION OF A PUBLIC HEALTH ENGAGEMENT VIDEOZouvani A.1, Keay N., Andronikou S., Stewart K.1Glasgow School of Medicine, University Of Glasgow, Glasgow, UK, 2Durham University, Durham, UK, 3Perelman School of Medicine, University of Pennsylvania, USA, 4Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK

Introduction and Purpose: The project aimed to create a short film in order to raise awareness about Relative Energy Deficiency in Sport (RED-S), assist viewers in recognising common signs and symptoms and encourage those affected to pursue treatment from appropriate avenues.

Methods: Video format was chosen as it has been proven effective in educating viewers while simultaneously possessing the element of emotional contagion. Video creation was achieved through an extensive literature search, pre-production planning, writing, animating and filming. A purposive sample provided feedback on an initial draft in order to amend defects.

Results: The content of the video was extracted after an extensive systematic literature search. The final 4 minute and 26 second piece comprises three parts: a) Education on RED-S, b) Timeline of events preceding and following LEA and c) Recovery. Throughout the whole piece a voiceover facilitates the understanding of the visual display. A combination of animated and live action clips was utilised. Animation simplifies complicated information facilitating the learning process. Live action is more appropriate for scenes whose aim is conveying emotion.

Conclusion: Creation of a visual engagement piece was achieved for the purpose of raising awareness by clarifying the nature of RED-S holistically and bridging barriers towards recovery. In an attempt to direct athletes towards appropriate support, the video suggests convenient sources of information and help for RED-S. The digital form of the video facilitates its distribution among communities; however, further data must be collected in order to determine the film’s true impact in the population. barriers towards recovery. In an attempt to direct athletes towards appropriate support, the video suggests convenient sources of information and help for RED-S. The digital form of the video facilitates its distribution among communities; however, further data must be collected in order to determine the film’s true impact in the population.

150 151

TOM DONALDSON PRIZE POSTERS

P60 A SERVICE EVALUATION OF THE UTILISATION OF MRI SCANS AT BIRMINGHAM SPORTS CONCUSSION CLINICBadesha H.1, Nijran K.2, O’Halloran .P3

1University of Birmingham, Birmingham, United Kingdom, 2University of Birmingham, Birmingham, United Kingdom, 3Marker Diagnostics UK Ltd, Birmingham, United Kingdom

Introduction and Purpose: The purpose of this study was to describe the utilisation of and incidence of abnormal findings on MRI brain scans at the NHS Birmingham Sports Concussion Clinic (BSCC), to enable clinicians to use MRI more effectively for the management of patients with sports-related concussion (SRC).

Material and Methods: A service evaluation was conducted via a retrospective review of patient data, clinical encounter notes, imaging requests and reports. 98 patients (86 male, 12 female, aged 13-32) presented to the BSCC with a new concussive episode from August 2019 to January 2020 inclusive. Patient demographic details as well as the outcomes of recorded assessments such as the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) and Vestibular-Ocular Motor Screening (VOMS) were explored to describe associations with MRI utilisation and abnormal findings.

Results: Of the 98 patients presenting to the clinic, 48(49%) received an MRI scan. Of the MRI scans conducted, 18(38%) reported abnormalities. There were no differences in the patient demographics amongst those who received or did not receive an MRI scan. 23/88(26%) patients had abnormal ImPACT scores. 13/41(32%) patients receiving an MRI scan had abnormal ImPACT scores and 6/15(40%) patients with abnormalities on their MRI scan had abnormal ImPACT scores. 29/71(41%) patients had abnormal VOMS scores. For patients receiving an MRI scan, 18/33(55%) had abnormal VOMS scores and 8/13(62%) patients with MRI scan abnormalities had abnormal VOMS scores.

The most common abnormality was ‘hyperintense white matter foci’ which was recorded in 15/18(83%) abnormal MRI scans.

Conclusions: Abnormal findings on MRI scans appears to be associated with an increased proportion of abnormal performance on ImPACT and VOMS tests. The systematic use of these tests could be of value in designing clinical pathways to maximise the efficiency of MRI use at BSCC.

150 151

TOM DONALDSON PRIZE POSTERS

P61 EXTRACORPOREAL SHOCKWAVE THERAPY FOR RESISTANT HEEL PAIN: A PROSPECTIVE STUDYNezhentsev A.1, Gould R.2, Baldock J.2, Smith R.2, Wood S.2, Botchey S.2, Latif S.2

1University of Oxford Medical School, John Radcliffe, Oxford, United Kingdom, 2Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford , United Kingdom

Introduction and Purpose: Extracorporeal Shockwave Therapy (ESWT) is a novel treatment for refractory Achilles Tendinopathy (AT) and Plantar Fasciitis (PF). NICE Guidance (2016) states ESWT must be used with arrangements for governance, consent, audit, and review of outcomes. In October 2020, the Oxford University Hospital NHS Sports and Exercise Medicine (SEM) service initiated a treatment pathway to deliver ESWT for patients with refractory AT/PF. We prospectively evaluated this service’s practice using the NICE audit tool and ESWT effectiveness through Patient Reported Outcome Measures (PROMs).

Material and Methods: A 9-month prospective analysis of ESWT in a single tertiary SEM clinic was performed. Patients with persistent symptoms despite physiotherapy, with radiologically confirmed AT/PF, underwent weekly ESWT for three consecutive weeks. Completion of ESWT training, documentation, and pre/post treatment PROMs was evaluated. The following PROMs were collected at baseline and 3-months post-ESWT: VAS recorded pain, EQ-5D-5L measured health-related quality of life, and VISA-A and MOXFQ for AT and PF, respectively.

Results: 37 patients received ESWT. Mean age was 50 years old. 62% were female. 51% had AT and 49% had PF. All documentation, consent, and staff training standards were met (Table 1). 50% of AT and 40% of PF patients experienced transient pain post-procedure. Mean VAS pain score improved from baseline to 3-month follow-up (57.3 to 43.4, p<0.01). 30.8% experienced clinical improvement in EQ-5D-5L health-related quality of life. 69.2% of AT patients showed clinical improvement in VISA-A scores. Overall, 38% improved sufficiently to be discharged, 32% showed a partial response and were referred for a second course of ESWT, and 19% were referred for radiological intervention.

152 153

TOM DONALDSON PRIZE POSTERS

Pre-Procedure Standard OutcomeCompletion of referral forms 100% 100%

Completion and documentation of baseline PROMs 80% 95%

Documentation of patients having received written infor-mation about the procedure, its safety and efficacy 100% 100%

Staff training - did those providing treatment receive ade-quate training in use of the machine and protocols 100% 100%

At Procedure

Documentation of a discussion with the patient regarding the safety and efficacy of ESWT 100% 100%

Completion of informed consent forms 100% 100%

Documentation of treatment 100% 100%

Post-Procedure

Completion and documentation of follow up PROMs 80% 65%

Completion of follow-up within 3.5 months after final ap-pointment N/A 68%

Table 1: Audit targets. Green cells mark where audit targets were met, and red cells mark where the audit target was not met.

Conclusion: ESWT for AT/PF was practiced successfully in our SEM clinics according to NICE audit criteria, with improved PROM scores for patient symptoms and quality of life. This expands upon the sparse yet growing evidence base of ESWT for treatment of AT and PF.

152 153

TOM DONALDSON PRIZE POSTERS

P62 VARIATION IN INDICES OF GLUCOCORTICOID ACTIVITY IN BLOOD ANDSALIVA WITH PEAK AND SUBMAXIMAL EXERCISE BOUTS IN THE HEATBarden A.1,2,3, Barden A.1, House C.3, Gifford R.2,3, Parsons I.2,3, Hill N.1, Woods D.2,3

1Imperial College London, London, United Kingdom, 2Leeds Beckett University, Leeds, United Kingdom, 3Ministry of Defence, London, United Kingdom

Introduction and Purpose: The glucocorticoid hormone cortisol presents an appealing window onto metabolic and immune function in athletes. At rest, partial inactivation of cortisol in serum (cortisolserum), by protein-binding, is mirrored in saliva by enhanced conversion of the free form (cortisolsal) to cortisone (cortisonesal). However exercise and heat stress may reduce serum binding, increase diffusion into tissues and shift cortisolsal: cortisonesal. As it was unclear which effects would predominate in health, we investigated these relationships during standardised exercise performance in the heat.

Material and Methods: During morning hours, sixteen trained male soldiers were assessed in a climatic chamber (34 °C ambient heat, 44% relative humidity) by VO2peak (incremental running to exhaustion) followed by treadmill walking (60% relative intensity). Heart rate (HR) and rectal temperature (Tc, °C) were recorded and activity continued until thermal equilibrium was demonstrated. Biochemical sampling was performed at rested baseline and following both VO2peak and submaximal assessments. Results: VO2peak was 53.9 ± 6.1 ml.kg.-1min-1. With submaximal exercise (duration 60 [60,65] min), HR and Tc increased to 161 ± 14 beats.min-1 (85 ± 5 % of HRpeak) and 38.9 ± 0.3 °C. Across exercise bouts, only cortisonesal varied significantly (Figure 1). Overall, cortisolserum correlated both with cortisolsal (r2=0.80) and cortisonesal (r2=0.62). As cortisolserum increased, cortisolsal incremented at a greater rate than cortisonesal (Figure 2). A positive linear tendency (r=0.48, P=0.0587) was apparent for cortisolsal:cortisonesal versus Tc at end-exercise. Conclusion: With increasing salivary accumulation, graded inactivation to cortisone appeared to conserve a close overall relationship for cortisolsal versus cortisolserum. This was despite an opposing tendency favouring a shift towards cortisolsal at higher levels of cortisolserum and physiological strain. As the potential for real-time monitoring with wearable sensors matures, scope for differential variation in indices relating to glucocorticoid activity must be considered.

154 155

TOM DONALDSON PRIZE POSTERS

Figure 1. Variation in glucocorticoid markers (median, range) with successive exercise-heat stress bouts. **significant linear trend, P=0.0035 (overall treatment effect P=0.0302).

Figure 2. Variation of cortisolsal and cortisonesal with cortisolserum from pooled data (rested, post-VO2peak, post-submaximal exercise. Significant difference by slope, F=16.1, P=0.0001.

154 155

TOM DONALDSON PRIZE POSTERS

P63 A REPEAT MEASURES INVESTIGATION INTO THE EFFECTS OF COMPRESSION GARMENTS AND A FLEXIBILITY PROGRAMME ON DYNAMIC POSTURAL CONTROLPatel N., Thawley P.Institute of Sports and Exercise Health (ISEH), University College London, London, United Kingdom

Introduction: It is widely accepted that DPC is crucial for performing the SBET. The effects of a flexibility programme and CGs on SEBT performance are unknown. This study combined CGs and a series of static stretched to address this issue.

Purpose: This study aimed to discover the effects CGs and a 6-week flexibility programme could have on SEBT reach distance and DPC.

Material and Method: Thirty-five participants were instructed to attend 3 testing sessions (BASE, PRE and POSTINT). The POSTINT session followed 6-weeks of flexibility training. Maximum reach distance on the SEBT was used as the primary outcome measure. Participants were tested twice for each limb, once with and once without CGs.

Results: CGs significantly increased SEBT composite score for the right limb (4.14% and 2.45% at BASE and PRE respectively (p<0.001)). SEBT composite score for the RL after the flexibility programme when wearing CGs increased by 5.2% (p<0.001), whilst composite score for the LL with CGs increased by 3.19% (p<0.001). Significant increases in RL MAXD% in the ANT (5.65%), AL (3.03%), LAT (5.72%), PL (4.50%) and POST (5.91%) directions were noted when wearing CGs after the flexibility programme. Significant increases in LL MAXD% in the ANT (5.09%), AL (4.99%), LAT (4.56%) and PL (4.12%) directions were found when wearing CGs post-intervention.

Conclusion: CGs immediately increased SEBT reach distance. Significant increases in reach distance were also seen when CGs and a 6-week flexibility programme were combined. These findings show flexibility training and CGs can improve DPC in a healthy population.

156 157

TOM DONALDSON PRIZE POSTERS

P64 ULTRA-LOW VELOCITY MULTI-LIGAMENT KNEE INJURIES IN OBESE PATIENTS: A SYSTEMATIC REVIEWGray J.1, Akhtar M.2, Esland J.3

1The University of Edinburgh, Edinburgh, United Kingdom, 2NHS Fife, Kirkcaldy, United Kingdom, 3NHS Lothian, Edinburgh, United Kingdom

Introduction: Multiple ligament knee injuries (MLKIs) represent damage to two or more of the four primary ligaments of the knee and reports are available in the literature discussing these injuries in the context of ultra-low velocity (ULV) trauma in obese patients. This systematic review was performed to determine the role of bodty mass index (BMI) in these ULV mechanisms of injury.

Aims: This review article set out to investigate the following - prevalence of obesity in ULV MLKI patients; primary mechanisms of injury associated with MLKIs in the obese; preferred treatment modalities associated with ULV MLKIs in the obese and finally the complications most commonly associated with ULV MLKIs in the obese.

Methods: A literature search was completed in line with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (including Medline); Embase; Web of Science Core Collection; SPORTDiscus were searched and returned 7 results discussing MLKIs in obese patients following ULV trauma.

Results: The review found that obese patients made up 36% of all of those who had suffered ULV MLKIs. Additionally, it was found that 39% of obese patients studied suffered a MLKI through an ULV mechanism. Surgical reconstruction was found to be the most commonly opted for surgical approach in obese ULV MLKI patients where data was available. Finally, nerve injuries were found to be more common than vascular injuries in obese ULV MLKI patients.

Conclusions: Conclusions from this review were challenging to draw due to the lack of data available on the subject. However, it appears that there is a link between BMI and ULV mechanisms of injury. We are aware the ULV MLKIs represent a growing problem and one that will only place further burden on healthcare systems in years to come as obesity rates continue to increase.

156 157

TOM DONALDSON PRIZE POSTERS

P65 UNDERSTANDING THE BURDEN OF CHRONIC BACK PAIN: A SPATIAL MICROSIMULATION OF CHRONIC BACK PAIN AT SMALL AREA LEVEL ACROSS ENGLANDSmalley H., Edwards K.School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom

Introduction and purpose: Chronic back pain (CBP) carries a significant burden. Understanding how and why CBP prevalence varies spatially, as well as the potential impact of policies to decrease CBP, would prove valuable for public health planning. This study aims to simulate the prevalence of CBP at ward-level across England, identify associations which may explain variation, and explore ‘what-if’ scenarios for the impact of policies to increase physical activity on CBP.

Material and methods: A two-stage static spatial microsimulation approach was used. The simulation ‘combined’ national CBP and physical activity data from the Health Survey for England with spatially disaggregated demographic data from the 2011 Census. The output was validated, mapped, and analysed using geographically weighted regression (GWR). ‘What-if’ analysis altered individuals moderate-to-vigorous physical activity (MVPA) levels and repeated the simulations.

Results: Significant clusters of high CBP prevalence were found predominantly in coastal areas and low prevalence in cities (Figure 1). Univariate GWR found a strong positive correlation between physical inactivity and CBP prevalence at ward-level, strongest in/around cities (R2=0.815; Coefficient: Mean=0.833, SD=0.234, Range=0.073-2.623). This relationship was largely explained in the multivariate multiscale-GWR model by confounders, the proportion of residents that are: >60, in low skilled jobs, female, obese, smokers, white/black, disabled (R2=0.924; Coefficient: Mean=0.070, SD=0.001, Range=0.069-0.072). ‘What-if’ analysis showed a detectable reduction in CBP prevalence for increases in MVPA of 30 and 60 minutes (-2.71%).

Conclusion: CBP prevalence varies across England. At ward-level physical inactivity is highly positively correlated with CBP. This relationship is largely explained by geographic variation in confounders. Policies to increase physical activity will likely result in a significant reduction in CBP prevalence. To maximise their impact, policies could be tailored to high prevalence areas.

158 159

TOM DONALDSON PRIZE POSTERS

Figure. CBP prevalence in England

158 159

TOM DONALDSON PRIZE POSTERS

P66 BODYWEIGHT RESISTANCE TRAINING UNDER LOCKDOWN: ONE WEEKLY SESSION IS ENOUGH TO IMPROVE MUSCULAR ENDURANCE IN UNTRAINED INDIVIDUALSKenda A.1,2, Ronca F.1,2

1University College London Division of Surgery and Interventional Science, London, United Kingdom, 2Institute of Sport, Exercise and Health (ISEH), London, United Kingdom

Introduction and Purpose: Limited literature exists assessing bodyweight resistance training responses in healthy adults. Such training may effectively address widespread non-compliance to muscle-strengthening guidelines where time and facility access prevent engagement. COVID-19 lockdowns and changing physical activity behaviours presented an opportune moment to investigate home-based bodyweight exercise. Consequently, this study aimed to determine the effects of eight-week exercise interventions (control, high and low dose) on field-based measures of lower limb power, upper limb muscular endurance and trunk muscular endurance in healthy adults using a randomised controlled design.

Material and Methods: Recruited participants (aged 27 ± 12 years) were divided into control (N=7), high (N=36) and low (N=35) dose groups. The high (3 sessions/week) and low (1 session/week) dose groups completed the same strength endurance programme comprised exclusively of bodyweight exercises covering all major muscle groups. High repetition ranges (≥15) and short rest periods (<90s) were utilised targeting muscular endurance. Controls did not train. Participants undertook timed isometric prone plank, countermovement jump, standing long jump and one-minute push-up tests before and after their interventions.

Results: Plank time, push-ups in one minute, and countermovement jump height (measured using MyJump2) increased significantly (p ≤ 0.05) in both training groups, but not in the controls. Although mean increases in trunk/upper limb muscular endurance suggested a dose-response relationship, significant intergroup response was only found in push-up performance between the high dose and control groups (p = 0.036). Compliance was 96% and 100% in the high and low dose groups respectively.

160 161

TOM DONALDSON PRIZE POSTERS

Figure 2 mean push-up repetitions completed in one minute. * p<0.001; Δ p=0.036

Conclusion: Bodyweight resistance training improves strength endurance, even at frequencies below government guidelines, and therefore should be promoted as an accessible exercise modality.

160 161

TOM DONALDSON PRIZE POSTERS

P67 A COHORT STUDY ON THE PREVALENCE OF SKIN CANCER IN CURRENT AND FORMER CRICKETERSThomas A., Bullock G., Silman A., Arden N.University Of Oxford, Oxford, United Kingdom

Aim: To assess risk between duration of cricket career and skin cancer.

Methods: 2276 current and former male English cricketers surveyed and provided details of their playing career and relevant exposures. Outcomes reported included self-reported skin cancer. We analysed the risk of reported skin cancer per 1,000 cricketers, by seasons played, stratified into thirds, adjusted for age.

Results: In all 83 (36/1000) reported a past diagnosis of skin cancer. The prevalence rate ratio was compared between thirds of the number of seasons played and expressed as a risk compared to the lowest third. Those in cumulative prevalence in those with the lowest third of years played (range 1-20 seasons) was 11/1000. This increased to 38/1000 in the middle range group (20-36 seasons): prevalence ratio (95% CI) 3.6 (1.6-7.9) and to 66/1000 in the longest duration group (36-68 seasons); prevalence ratio 6.2 (2.9-13.2). Adjusting for age attenuated these increases but there was still a doubling in risk in those with over 20 seasons played.

Conclusion: There are a number of important cautions in interpreting these results. Diagnosis was based on self-reported cases. Our approval to access the survey data did not permit further validation of the diagnosis, the date, and the type of cancer. However, it is unlikely that there were any systematic biases why those with a longer duration of cricket playing reported more skin cancers. These are the first data we could find on the risk of a skin cancer in a national unselected cohort of cricketers. Skin cancer, as result of sun exposure, inevitably has a long latency and behavioural change can take decades to show itself in changes in cancer occurrence. These data do suggest that cricketer with their unique long periods of sun exposure still need to be an occupation group of concern.

162 163

TOM DONALDSON PRIZE POSTERS

P68 A RETROSPECTIVE ANALYSIS OF A NATIONAL MEDICAL SCREENING PROGRAMME IN ACADEMY FOOTBALLERSSinclair J.1, Connelly S.2, Martin R.2

1Cardiff University, Cardiff, United Kingdom, 2Football Association of Wales, Pontyclun, United Kingdom

Introduction and Purpose: Medical screening of athletes is conducted throughout elite sport with the aim of supporting athlete health, well-being and performance. The Football Association of Wales (FAW) has implemented a nationwide medical screening programme for Welsh Premier League (WPL) academy footballers with players receiving individual feedback on areas both health and performance. A retrospective analysis of all responses was conducted, to help understand the burden of injuries and illness on these athletes.

Material and Methods: Each consented WPL academy player within U14, U16 and U19 age groups were sent a secure online medical screening questionnaire in December 2019. 545 players completed the questionnaire, including questions concerning footballing injuries, illness and mental wellbeing. Anonymised data was analysed using ‘Benchmark 54’ medical record software.

Results: 44% of players missed training or competition in the past year due to injury. More than 30 days were missed by 16% of U19s, compared to 10% of U14s. Overuse injuries were most prevalent in U16s with anterior knee pain reported by 1 in 4 players.36% of players reported absence due to illness over the previous year, most prevalent in U16s.The mean score for all ages on the Warwick-Edinburgh Mental Wellbeing Scale (WEMWS) was 52.6 out of 70.

Conclusion: This is the first data describing the burden of injury and illness in youth academy footballers in Wales. This data suggests that injury and illness significantly impact playing time, with overuse injuries highlighted to be more common than previously reported in literature. WEWMS score was higher than the teenage population mean, suggesting mental wellbeing among these young footballers to be better than average. Findings have resulted in change to coach education regarding injury and illness prevention, as well as recommendations for ongoing screening and analysis to assess impact of these changes.

162 163

TOM DONALDSON PRIZE POSTERS

P69 THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY, WAIST CIRCUMFERENCE-TO-HEIGHT RATIO (WTHR) AND COGNITIVE PERFORMANCE IN 9-11-YEAR-OLDS IN THE UKBoulton H.1,2, Burgess P.3, Mohd Habib S.1,2, Loosemore M.2, Ronca F.1,2

1University College London, London, United Kingdom, 2Institute of Sport, Exercise and Health, London, United Kingdom, 3Institute of Cognitive Neuroscience, University College London, London, United Kingdom

Introduction and purpose: Increasing obesity, and decreasing physical activity (PA) levels in children prompted research into neuro-cognitive effects. Some literature suggests improvements in obesity indicators and increases in activity are associated with improved cognition; however, there are inconsistencies and further research is needed. This research aimed to establish relationships between waist-to-height ratio (WtHR), PA and reaction times (RT) for inhibition and simple reaction time (SRT) in children.

Material and methods: 87 children (75 female, 12 male) in school years 5-6 completed a PA questionnaire, including height and waist circumference, and completed online SRT and inhibition tasks, which measured time taken to press the spacebar in response to two stimuli. Means and Pearson correlations were calculated, with the significance level set at p<0.05.

Results: SRT mean RT was 337.96±194.01ms and inhibition mean RT was 470.78±93.7ms. Year 6 had significantly faster SRT (P<0.001) and inhibition (P<0.001) mean RTs than Year 5. Females had significantly faster SRT (P=0.041) and inhibition (P=0.003) RTs than males. WtHR positively correlated with SRT (r=0.23, P=0.032) and inhibition (r=0.31, P=0.004)

RTs (Figure 1). PA positively correlated with the inhibition factor (r=0.22, P=0.046).

Conclusion: Children with decreased WtHR had faster RTs, but those with higher PA performed worse with regards to the inhibition factor, which was affected by error rates. There were significant differences in RTs between school years, which are expected, in addition to significant gender differences, which may have been affected by the small male sample size. Improvements in cognition with reduced WtHR may

support obesity interventions in schools, however, further longitudinal research is needed.

164 165

TOM DONALDSON PRIZE POSTERS

P70 THE EFFECT OF BIOLOGICAL SEX ON CARDIOVASCULAR RESPONSE TO ACUTE HYPOXIASingh J.1, Oliver S.2

1School of Medicine and Bangor University School of Human and Behavioural Sciences, Cardiff University , Cardiff and Bangor, United Kingdom, 2School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom

Introduction and Purpose: Hypoxic conditions are found extensively worldwide. To preserve cardiac output in acute hypoxia, alterations in cardiovascular (CV) physiology are required, including an elevation in heart rate (HR). These changes have been explored in males, but despite literature indicating physiological sex differences, little research compares the sexes. The aim of this research was to examine whether changes to HR and mean arterial pressure (MAP) under hypoxia differ with sex.

Material and Methods: Ten individuals (mean age 21.7 years, 50% female) were exposed to fractions of inspired oxygen (FiO2) of 20.9% (normoxia) and 12.0% (hypoxia), both lasting 90 minutes. Under each respective condition, blood oxygen saturations (SpO2%), resting HR and MAP were assessed at four timepoints per participant, with data averaged into one datapoint for comparison. Data were analysed using 2-factor 2-level mixed model ANOVAs.

Results: No significant interaction effects between ‘FiO2%’ ‘sex’ on SpO2 (p = .211), HR (p = .337) or MAP (p = .280) were observed. Significant main effects for FiO2 on SpO2 and HR were observed (p = < .001 and .003 respectively), with hypoxia causing a significant decrease in SpO2 but a significant increase in resting HR. Neither a significant main effect for FiO2 on MAP (p = .164) nor for sex on SpO2 (p = .086), HR (p = .418) or MAP (p = .693) were observed.

Conclusion: This project revealed that in a convenience sample of 10 participants, resting HR significantly increased under hypoxic stress whilst SpO2 significantly decreased, with no significant change to MAP. Despite established differences in CV physiology between the sexes, no significant variations in resting HR, MAP or SpO2 under hypoxic challenge were observed. Future studies might examine the changes in these parameters under hypoxia in a broader sample.

164 165

TOM DONALDSON PRIZE POSTERS

P71 ASSOCIATION OF LATERALITY AND SPORTS SPECIFIC ROTATIONAL PREFERENCE WITH THE NUMBER OF INJURIES IN ARTISTIC GYMNASTSJoshi T.Royal National Orthopaedic Hospital, Pinner, United Kingdom

Introduction: Laterality has shown to play a role in performance as well as injuries especially in unilateral sports disciplines. Uniquely, Artistic Gymnastics involves combination of unilateral, bilateral and complex multi-planer elements as well as gymnastics specific rotational preference. Therefore, this study was conducted to explore if any such preferences are associated with number of injuries in artistic gymnasts.

Purpose: To explore the association between lateral preferences, rotational preferences and injuries incidence in artistic gymnastics.

Methods: Artistic gymnasts above 16 years of age, were invited to participate in an online survey. The survey included consent, lateral preference inventory, injury data collection according to anatomical locations and rotational preference for selected gymnastics elements performed on the floor exercise. SPSS version 24 was used to analyse Non-parametric data using Kruskal-Wallis (K- independent test) test. Multiple regression was performed to identify the predictor for injuries and their side in gymnasts.

Results: Total number of injuries per gymnast were associated with handedness (p value-0.049) and no significant association was noted for footdness (p value-0.207), eyedness (p value-0.491) and eardness (p value-0.798). Additionally, rotational preferences did not influence number of injuries (p value-0.521). In multiple regression, eyedness was identified as a predicting factor to determine the number of injuries. Rotational preferences were neither determined as a national strategy nor a product of lateral preference.

Conclusions: Handedness and eyedness can be predictors for a higher number of injuries in artistic gymnasts. Rotational preference is independent of laterality and nationality.

166 167

TOM DONALDSON PRIZE POSTERS

P72 FACE MASKS WHILST EXERCISING TRIAL (MERIT): A CROSSOVER RANDOMISED CONTROLLED STUDY Jones N.1, Marsh S.2, Oke J.1, Nikbin K.3, Bowley J.4, Hobbs F.1, Greenhalgh T.1

1Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom, 2University of Oxford, Oxford, United Kingdom, 3Kings College London, London, United Kingdom, 4University of Nottingham, Nottingham, United Kingdom

Introduction and purpose: Physical exertion is a high-risk activity for emission of aerosols, but there is controversy around whether facemasks are safe and acceptable when exercising. We aimed to determine the safety and tolerability of healthy young adults wearing different types of facemask during moderate-to-high intensity exercise.

Methods: Crossover randomised controlled study, comparing a surgical, cloth and FFP3 mask to no mask during 15 minutes of exercise separated by 5 minutes rest. In a non-inferiority analysis, the primary outcome was changes in oxygen saturations (non-inferiority margin=2%) and secondary outcomes included changes in heart rate (non-inferiority margin=7bpm).

Results: 72 individuals aged 18-35 (mean 23.1 years) completed the study. Changes in oxygen saturations and heart rate did not exceed the pre-specified non-inferiority margin with any mask type compared to no mask. At the end of exercise the estimated average difference in oxygen saturations for the cloth mask was -0.07% (95%CI -0.39 to 0.25), for the surgical 0.28% (95%CI -0.04 to 0.60) and for the FFP3 -0.21% (95%CI -0.53 to 0.11). The corresponding estimated average difference in heart rate for the cloth mask was -1.20bpm (95%CI -4.56 to 2.15), for the surgical 0.36bpm (95%CI -3.01 to 3.73) and for the FFP3 0.52bpm (95%CI -2.85 to 3.89). The cloth mask was felt to be most difficult to exercise in by 56.3% of participants (n-=40) and the FFP3 by 38% (n=27). Wearing a facemask caused additional symptoms such as breathlessness (n=13, 18.1%) and dizziness (n=7, 9.7%). 33 participants broadly supported facemask wearing during exercise, particularly indoors, 18 would agree to this if it were mandated and 22 were opposed. Conclusions: Exercising at moderate-to-high intensity wearing a facemask appears to be safe in healthy, young adults. There was most support for wearing a surgical facemask during indoor exercise if needed to reduce the spread of COVID-19.

166 167

TOM DONALDSON PRIZE POSTERS

P73 FAST EFFECTIVE PAIN RELIEF: ANALGESIA OPTIONS AT THE PITCH SIDE Joslin L.1, Ahmed I.2, Awan S.3

1University College London, London, United Kingdom , 2Homerton Hospital, London, United Kingdom, 3University College London Hospital, London, United Kingdom

Introduction: Chronic and acute musculoskeletal injuries at the pitch side, are a common occurrence during matchdays and often require medical teams to acutely prescribe and administer analgesic medications. The exact mechanism, and pharmacokinetics of analgesics in the prehospital setting, detail how fast a drug acts and how fast it is cleared. These parameters are crucial in selecting the most effective analgesic strategy. Clinicians’ choice of analgesia is often based on empirical evidence, and experience of acute hospital or community prescribing in non-athletes. Sports pharmacology is an exciting, area of sports medicine, where data on individual drug pharmacokinetics and pharmacodynamics - can be used to design optimal drug strategies that provide fast effective pain relief whilst limiting drug side effects (renal, hepatic, and metabolic).

Method: 14 Analgesic mediations were found in a premier league pitch side emergency bag, (green bag). A structured review was performed on all 14 medications, using the electronic medicine compendium database, renal drug database and drug bank to assess the following for each medication: 1) time to peak concentration (Tmax) 2) half-life 3) maximum dosage in 24 hours.

Results:Four class of medications were audited: NSAID (7), weak opioids (2), anaesthetic agents/gases (3) and anti-pyrexic (2).The inhaled gases had the fastest (Tmax) : Entonox 3 mins & Penthrox 5 mins.Oral analgesia medication had a range of Tmax ; 60-120 minutes. The fastest oral medications were codeine and diclofenac potassium (60 mins).Naproxen and Celecoxib has the longest time to clearance (half life >10 hours), leading to the longest duration of sustained action post administration.Results

Drug name Route

Time to peak concentra-tion (Tmax)

minutes

Half-life (hours)

Maximum dosing in 24 hours

Paracetamol PO 90 1-4 4g daily Paracetamol IV 15 2.7 If <50Kg, dose

is 15mg/Kg Ibuprofen PO 60-120 2 Naproxen

PO 60-120 12-15 1.25g in 24 hours (in divid-ed doses)

Diclofenac Sodium PO (tab) 120 2

150mg in divided doses

Diclofenac potassium PO (tab) 60 1.9

168 169

TOM DONALDSON PRIZE POSTERS

Celecoxib PO 180 8-12 400mg in divided doses

Ketorolac Trometamol IV 30-50

2.5-9.2

*

>50KG: 90mg/daily <50KG: 60mg/dailyIM 45-50

Codeine PO 60 2.5 -4 240mg in divided doses

Morphine (Oramorph 10mg/5mL solution)

PO 120-180 2-3 120mg in divided doses /24 hours

Lidocaine 1% /2% IV Local acting N/A N/AEntonox (nitrous oxide and oxygen) Inhaled 0.5-5 5

Penthrox (methoxyflurane 99.9%) Inhaled 5-15 7

minutes 6mL in a single day

Conclusion: The inhaled gases (Penthrox & Entonox) had the fastest time to therapeutic concentration with short half lifes (rapid clearance). Oral analgesic medications, have a long (Tmax), (>60 mins) which has implication for pre games dosing and timing of medication administration.

168 169

TOM DONALDSON PRIZE POSTERS

P74 ISOLATED ANTERIOR PUBIC LIGAMENT TEARS IN PROFESSIONAL FOOTBALL: A PREVIOUSLY UNRECOGNISED CAUSE OF POST TRAUMATIC PUBIC RELATED GROIN PAINSchilders A.1, Johnson R.2,3, Cooke C.3, Schilders E.2,3

1University Of Bristol, Bristol, United Kingdom, 2Fortius Clinic, London, United Kingdom, 3Carnegie School of Sport, Leeds Becket University, Leeds, United Kingdom

The Anterior Pubic ligament spans the Symphyseal joint and forms part of the Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC). A recent MRI study demonstrated that anterior Pubic ligament (APL) tears of the bridging part are often associated with PLAC injuries and Pectineus injuries.

No cases have previously been reported of isolated APL tears in professional football.The aim of this study is to describe this new entity, detail the clinical symptoms and MRI findings.

Material and Methods: Our PLAC database was interrogated for APL tears.Adductor Longus avulsions, partial or complete, were excluded.Demographics, type of sport and level were recorded.The mechanism of injury, clinical presentation and MRI findings were evaluated. All athletes in our clinic presenting with acute groin pain are imaged using a specific MRI protocol.

Results: Four professional Football players fulfilled the inclusion criteria (average age 24 years (21-28)). Injury occurred when two players did the splits and two were taking a penalty. All players felt a pop and developed severe immediate pubic related groin pain. None of the players could continue playing. Clinically there was exquisite pain on palpation of the Symphyseal joint. One player had a feeling of unstable pubic bones. All had reduced adductor strength bilaterally (Table 1).

The MRI showed a typical APL ligament tear where it bridges the Symphyseal joint (Figure 1).Three of the four players had previous MRI imaging which did not demonstrate the APL tear. Time between injury and diagnosis was 28-388 days.

Conclusion: Isolated APL tears are a newly reported cause of Pubic-related groin pain. Players who feel a pop and develop severe post traumatic Pubic pain should routinely have a dedicated MRI groin protocol. Axial oblique images through the Symphyseal area, thinly sliced, are essential to diagnose this condition which is easily missed with incorrect MRI protocols.

Age injury mechanism Pain location ADD R ABD R ADD L ABD

LADD/ABD R

ADD/ABD L

28 split Pubis/Perineal 13 36 11 30 0.36 0.3625 split Pubis/Adductor 19 33 21 27 0.57 0.7725 Penalty kick Pubis/Adductor 12 18 15 23 0.66 0.6521 Penalty kick Pubis/Adductor 26 34 27 33 0.76 0.82

Table 1: Clinical presentation of anterior pubic ligament tear. Strength measurements of Adductors and Abductors in pounds (Microfet) and as a ratio (ADD = adduction; ABD = abduction).

170 171

TOM DONALDSON PRIZE POSTERS

Figure 1: T2 axial oblique: yellow arrow demonstrates anterior pubic ligament tear.

170 171

TOM DONALDSON PRIZE POSTERS

P75 THE FASTING FOOTBALLER: WHAT ARE THE CURRENT RECOMMENDATIONS FOR OPTIMISING PERFORMANCE WHILST FASTING Rehman H.1, Ahmed I.2

1University Of Leeds, Leeds, United Kingdom, 2Homerton University Hospital, Hackney, United Kingdom

Introduction: Football remains the number one professional sport globally, with roughly 128,000 professional players competing across 201 countries. For Muslim footballers, who fast during the holy month of Ramadan - the need to compete at the highest level requires specific guidance on nutrition, sleep, hydration, and recovery to maximise performance and avoid adverse health consequences. This can be achieved by enhancing key variables in order to optimise performance.

Purpose: To perform a PubMed literature review, on current guidelines specific to fasting footballers during Ramadan.

Material and Methods: A systematic review was performed on PubMed. The search terms that were included were:• Football AND Fasting OR Ramadan NOT American Football

Titles, abstract and article were screened for athlete specific advice in four categories.

Setting Published studies available on PubMed relevant to footballers during Ramadan.

Patients Footballers competing during Ramadan whilst fasting.

Main Outcome Measurements Articles were screened and were included if they offered advice on any of the following:1). Carbohydrate intake2). Protein intake 3). Hydration advice4). Sleep advice

Results: Out of the 28 studies found via PubMed only five studies met the screening criteria. General advice was available on 24 hour/ daily intake of carbohydrates (2) protein (1) and water (2) in (5 studies). No studies offered advice on specific nutrition advice regarding initiating the fast (suhoor) or fast breaking (iftar) meals. In addition, no studies offered advice relevant to elite athletes or sleep adjustment.

Conclusion: Despite being a globalised sport, there is a lack of specific published guidance to direct safe nutritional intake and sleep advice for fasting footballers. A football specific pre-participation screening questionnaire (Figure 1) would help teams to highlight key recommendations for athlete health. Also identify specific safety criteria and nutritional advice in this patient group. This will also promote athlete health and inclusivity.

172 173172 173

TOM DONALDSON PRIZE POSTERS

172 173172 173

AU

TH

OR

S’ IN

DE

X

174 175

AUTHOR’S INDEX

AAbo-Arisha M P13 Andrew D O03, P25Ahmed I P44, P75 Andronikou S P59Ahmed I P73 Angeloudis K O17Akbari A P17 Angioi M P47Akhtar M P64 Anikevičiūtė G O26Al Attar W O01, P55, P56 Annár D O14Alali B P17 Archbold P P19Alam B P17 Arden N P67Ali S P53 Ardern C P10Aliefri A P13 Asem K P13Alifrangis A P08 Attard L P05Alsaleh S O02 Aujla RAlshabanah H P13 Awan S P73

Awodiya A P17

BBadesha H P60 Bonia D P49Baldock J P61 Borg N P05Baltsezak S P57 Borrione P O07, P04Barden A P62 Bortkevič A O26Barker K P31 Bosnina F P42Barker-Davies R PO03 Botchey S P61Barnett A P03 Boulton H P69Bartholomew C O02 Bowley J P72Bazira P O20 Bradshaw E P38Beaney T P39 Brady J O28Bennett A PO03 Bremer T P58Bestwick-Stevenson T. P48 Browne M O18Betancurt J P04 Buckingham A O28Bharam S PO04 Bullock G P48Bleakly C P19 Bullock G P67Boalch A P12 Burgess P P06, P69

CC Janse van Rensburg D P10 Coen SCahill R Collins A , O17Carmont M P03 Comeras-Chueca C , O17Carton P , P45 Connelly S P68Carton P PO02 Constantini N P13

Chamley R PO03 Cooke CO13, PO04,

P29, P36, P74Chapman P , P35 Cooper A P33

174 175

AUTHOR’S INDEX

Chawatama E O05 Cooper D O21Chockalingam N P22 Coxon L P31Cichy B P13 Cranley M PO03Clayden W P13 Curran L P32Close G P26, P27

DDass D P03 Dewson D PO03Davies P P33 Di Gianfrancesco A O07

Delahunt E P32 Dickinson JO06, O09,

O10, Dilworth N P13

EEdwards K , O24, P65 Elliott J , P21Eichhorn G P04 Esland J P64

FFagher K P10 Filan D , PO02, P45Fahy C P23 Fine P P44Fakiris K O08 Finn G O20Faulkner A , P33 Fitzpatrick D P40Faull-Brown R P15 Fletcher A P06Feakins B P48 Fossati C O07, P04Fearon A P58 Francis G P14Fennell C PO01 Fraser C P50

Frizelle J O28

GGallagher C P13 Golan E PO04Galloway R P40 Gould R P07Gatt A P22 Gould R P61Gayer De Mena L P48 Gowers W O09, O10, Giacci L P37 Gowers W O06Giannopoulou I , O17 Grand J Ο04Gifford R P62 Gray J P64Gineviciene V P54 Gray M P35Ginevičienė V O26 Green C P39Giombini A O07 Greenhalgh T P72Girdlestone H P15 Greensmith T , P33Girotra K P42 Griffin S P15Gissane C O29 Grimaldi R P40Gkanias S O08 Guppy F O17, P04Glyn Jones S P31 Guzii O , P20

176 177

AUTHOR’S INDEX

HHall A P24 Hobbs F P72Hamer M P08 Hodgson L P40Hamilton B P04 Holdsworth D PO03Hashmi A P51 Hopker J O09, O10Hasnain A P53 Hopkins M P51Hawkes D O15 Hornby K P15Hawkins K O11 Horsley I O15Hegazy Y P13 House C P62Heron N P09, P10, P21 Houston A PO03Heron N P02 Howarth H O05Hill A O12 Huang X P48Hill N P62 Hull J O06Ho P P04 Hurley E P23

IIqbal A O20, P34 Islam S P53

JJackson A O06 Jones N P72Jackson M O16 Jones R P52Jackson M P06 Joshi T P71James C P38 Joslin L P73Jang R P13 Joyner C O12

Johnson RO13, PO04,

P29, P36, P74 Jumbu N P48

KKalabiska I O14 Kippelen P O06Karanikolou A P04 Kipps C O05, P30Kartsonaki C O13 Kipps C P08Kataria K P01 Klett M P13Kataria S P01 Kluzek S , P48Keay N P14, P59 Kolliari-Turner A P04Keith-Jopp C O12 Korgaonkar J P52Kelly P Ο04 Kotopoulea Nikolaidi M O17Kemp S P15 Koutsojannis C O08Kenda A P66 Krassioukov-Enns D P13Khaiyat O O15, O16 Kruger P O05Kilduff L P04 Kumi P P04Kinane D P26, P27

176 177

AUTHOR’S INDEX

LLack S , O02 Lester C P16Ladlow P PO03 Leung M P13Lanfear M , P14 Lima G P04Langrish J P30 Lipworth S P30Latif S Lodge S O21Latif S P61 Long T P40Leckie T P40 Loosemore M O09, O10, P69Lee C O23 Lowe C O18Lee J O13 Lydon K O19Lennon D

MM Alsalamah N Meehan C P32Macdonald J P38 Meehan L P04Macinnes A , P33 Meehan W O29

Mackillop L O23Meijlander-Evjensvold M P13

MacMullen H O25 Menon G P30Madigan S O19 Micallef Stafrace K P22Mahagevan V P13 Mifsud D P05Mahlovanyi A P20 Mifsud J P05Malina R O14 Mifsud T P22Malinsky F P04 Miller S O02, P42Mannan F Miller S O27Marekic M P13 Mills D PO03Marino K O20, P34 Minganti C O07Marsh S P72 Mitchell A O13Marsh W O18 Mitchell J PO03Marsh W O12 Miyauchi S P13Martin R P68 Mockler D O29Masroori Z P13 Mohd Habib S P69Massoura C P42 Montgomery C P23Mauger L PO01 Morrisey D P58

May S PO03 Morrissey D, O02, O18,

O27, P42Mayne A , P33 Morrissey D O12McCrea C P24 Morrissey D P47McCullough C P23 Mulae J PO03McGuigan P P19 Mullins K PO02, P45McIntosh N P09 Muniz-Pardos B , O17McKay C O28 Munro A O11McKay G P50 Murphy R P19McPherson L Murray A , P26, P27

178 179

AUTHOR’S INDEX

NNaylor, J PO03 Nijran, K P60New, K P37 Nikbin, K P72Nezhentsev, A P61 Niu, J P13Nicklen, P P58 North, D P43Nicol, E PO03 North, K P04

Nykjaer, C O20, P34

OO' Leary, F P13 Olivelle, J P46O’ Giollagain , C P13 Oliver, S P70O’Halloran, P P60 O'Loughlin, E O22O'Connor , S P10 Omar, P P13O'Hanlon , M O21 Ormonde, S P13Oke, J P72 O'Sullivan, O PO03Olatigbe, O O21 Oswald, F P24O'Leary, F P52Olivelle, A P46

PPadhiar, N P42 Pierce, K PO03Padhiar, N P22 Pigozzi, F O07, P04Parsons, I P62 Pitsiladis, Y , O17, P04Patel, J P52 Pluim, B P10Patel, N P63 Prasad, V P41Pellatt, R P50 Preston, B P16Pennington, R , P33 Price, O O06Phillips, N P28 Pringle, A O20

QQuaranta, F O07

RRademaker, K P28 Rigler, C P30Raja, H P53 Robb, C P39Rankin, A O19 Robinson, P P26, P27Rankin, A P19 Roche, D O16Rehman, H P75 Roeszler, K P04Reid, H O23 Romanchuk, O P20Reid , D O22 Ronca, F P06, P66, P69Rhind, J P03 Rooney, D P02Richardson, A P40 Rossetti, G P38

178 179

AUTHOR’S INDEX

Rider, O PO03 Roy, S P07Ridout, A O23 Ruban, T P13

Ruck, S O30

SSalman, D O20, P51, P52 Silman, A P67Salman, D P39 Simpkins, D P48

Simpson, A O06Sammut, F P05 Simpson, K Ο04Sarregui , I P02 Sims, S O22

Sinclair, J P68Scanlan, S O23 Singh, J P70Schilders, A P74 Sinha, P P47

Schilders, EO13, PO04,

P29, P36 Sivačiova, M O26Schilders, E P74 Skiadas, V P04Sellon, E PO03 Smalley, H P65Sentie, W P18 Smith, M P50Seth, S O24 Smith, R O23, , P30Seto, J P04 Smith, R P61Shahid, F P16 Smith, S PO01Shaikh, F O25 Sourvinos, S P49Shalhav, T P13 Speers, C O25, P07Shanmuganathan, M P30 Stacey, M P40Shiel-rankin, S P11 Stead, A P34Shirran, M P50 Stewart, K P59Shurlock, J P04 Stocks, J P48Siaperas, P P49 Sturridge, S O06

Sugrue , R P13

TTahir, D P48 Thomas, T PO01Talbot, N PO03 Thompson, F , P35Tanisawa, K P04 Tomassi, G O07Tayfur, B O27 Tourvas , V P13Taylor, C P57 Trompeter, K O29Testa, L P05 Trompeter, K O29Thawley , P P63 Tsitskaris, K P53Theodoropoulos , T P13 Tuncer-Sakar, C O12Thomas, A P67 Twycross-Lewis, R P04

180 181

UUtkus, A P54

Vvan Dyk, N O29 Vishnubala, D O05, O20, P34Vikatou, T P47

WWall, J O29 Welsh, E P47Wall, N O28 Williams, N O06Wan, C P41 Williamson , S P10Wang, G P04 Willoughby, R P16Wang, S P48 Wilson, F O29Ward, K P38 Wood, S , P31, P61Watson, M P26, P27 Wooding, J P15Wawrzyniak , S P13 Woods, D P62Wearing, S P22 Wormall, S P41Weekes, C O30 Wright, G O17Weller, C P40 Wynter Bee, W P16

XXie, C PO03

YYasen, Z P53 Yoon, J P13Yet, B O12

ZZheng, J P48 Zsákai, A O14Zouvani, A P59

180 181

182 PB