Sportfisio Symposium 2023 – Bern, November 24th

Boris Gojanovic, SEMS president

The annual Swiss Sports Physiotherapy Association Symposium (SSPA) is always a highlight for the year. Our dear friends at SSPA have made the decision many years ago to organize their symposium in English only, in order to invite some of the best international researchers and clinicians in the field of sport medicine rehabilitation and training.

An important annual event on the international stage

Every year, some 500 practitioners attend the November one-day event at Bernexpo, mostly physiotherapists involved or interested in the sports sector, but also many sports medicine doctors and other professionals involved in the care of athletes and active people of all levels. Here some of the highlights, in my opinion, in the history of the Sportfisio Symposium:

• In 2015, SSPA hosted the First World Congress in Sports Physical Therapy on the topic of Return-to-Play. Over 2 days, the best in the field presented the current state of knowledge on RTP and the meeting was followed by the publication of one of the most cited papers in the field: the 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. [1]
• In 2018, we joined forces to organize the 1st SEMS-SSPA conference, addressing hip problems, and recovery in sports. 750 participants benefited from the fact that… «Together Everyone Achieves More (TEAM)». We dedicated a special issue of SEMS-journal (issue 4, 2018). [2] This conference was followed up by 4 consensus publications on hip-related pain in sports. [3-6]
• In 2019, the Shoulder & Sports symposium led to another important scientific collaboration, materialized in the “2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes” publication. [7]

2023 Muscle & Sports Symposium

This year, a strong line-up of international speakers tackled the complexities of muscle injuries in sports. Here are some of the highlights and key messages:

1. Complex does not mean complicated

A Nigerian born and trained, Oluwatoyosi (Olu) Owoeye pursued his career in Calgary (Canada) and now at Saint Louis University (USA). His presentation – Prevention of muscle injuries in team sports: A complex but pragmatic approach – touched on multiple aspects of injury prevention. It brought some light on the necessity to move away from linear causality concepts, in order to embrace the complex systems approach: we need to “see the whole system”, understand the circularity of causes, the inter-relationships of the system’s parts, and the whole environment around the athlete. Not an easy task! I invite you to read one his papers on the importance of dissemination and implementation. [8] Olu on X (@owoeye_oba).

2. Muscle repair takes longer than we think

Carles Pedret (www.carlespedret.com) is a Spanish sports medicine and orthopedics physician. His work focusses on muscle and tendon injuries and he works with multiple elite football and basketball teams, including in the NBA. His brilliant overview of the pitfalls and pearls of imaging – The role of imaging in muscle injuries diagnosis and prognosis – reminded the audience that muscle healing takes a long time. Typically the phase around 15 to 20 days is fragile and sensitive to too much loading.
Also, he presented a very clear overview of the main different types of muscle lesions, to move beyond any current classification systems (which we know are insufficient). It is essential to categorize the lesion according to location within the muscle structure: it can be a tendon, a myotendinous junction, a muscle fiber or a myofascial lesion. These have different prognoses and management strategies. Hence Dr Pedret’s strong emphasis on an adequate diagnosis of the initial injury. Make sure to follow him on X (@carlespedret).

3. How a simple Aussie rehabs hamstrings

Australia had to be part of the festivities, and who else but Rod Whiteley to present on hamstring muscle injuries (HMI). Rod is a physiotherapist and researcher working at Aspetar in Qatar, where multiple studies on HMI have been conducted and led to a comprehensive rehabilitation guide (free online). [9]
Rod likes to say he is a simple guy and he presented some simple rules that he follows – Clinical examination of muscle injuries. If a patient is better after the previous day’s loading, then load some more. If he feels the same, load the same. If he is worse, reduce the load.
Also, he is adamant about the importance of running early and increasing the speed as soon as possible. Running, and especially running fast is by far the most intense load you can put on hamstrings, especially the biceps femoris. One of his favourite toys: the curve treadmill. Instant speed control! Follow Rod on X (@RodWhiteley).

4. Biomechanics – the missing pieces in a mysterious puzzle?

The task of decrypting the biomechanics of sprinting and their relationship to injury risk or rehabilitation was given to French scientist, researcher and track & field coach Jean-Benoît Morin (www.jbmorin.net) – Hamstring injury management: why and how to include sprint mechanics to the puzzle. In a recent opinion piece in BJSM, he (and our good friends physiotherapist from Switzerland, Caroline Prince and Kenny Guex) make the case for the importance of sprinting in rehabilitation and training. [11] But JB also pointed to specific sprinting kinematics that he analyzes (pelvic tilt, lateral trunk motion), as they have identified an increased risk of HMI linked to these. Although still controversial and challenging to analyze accurately in 2D (even in 3D if you listen to Rod Whiteley), it certainly raises important questions. It feels like we are trying to build a puzzle, whilst not knowing how many pieces we will need and what the final shape will be. Jean-Benoît on X (@jb_morin).

5. Do not forget the anterior thigh muscles

Nicol van Dyk is the Medical research lead at Irish rugby. A physiotherapist from Cape Town (South Africa), he spent 7 years at Aspetar and worked mostly on HMI. They tricked him into a 180 degrees pirouette to look at the front part of the thigh – Forget me – forget me not: muscle injuries to the anterior thigh. Tough challenge, as the research is scarce. A recent review identified the following risk factors: previous quadriceps injury (really??), dominant kicking leg, recent hamstring injury, competitive match play. [10] Whilst there is no clear protocol for the quads, he emphasized a few key points: trust a systematic rehab approach, where we move from early movement skills, to mid-stage technical skills, before getting to late-stage performance skills. This moves along a continuum from essential “structural” to more “neural” stimulations. Additionally, Nicol insisted on the importance of communication and teamwork, along with the understanding that success is always context-dependant and person-dependant. Although Irish Rugby was a favourite for the recent World Cup, it appears that performance can also be hard to predict….just the same for the occurrence of muscle injuries. Follow Nicol on X (@NicolvanDyk).

6. Injury prevention is complex, so is performance

The last speaker was Natalia Bittencourt from Brazil, addressing the audience through Zoom. Her current position as Head of Health and Performance at Cruzeiro Football Club (Salvador de Bahia) prevented her from making the trip. You most likely know her from a blockbuster study on injury determinants and complex systems approach for sports injuries. [12]
Her presentation revolved around the challenges of setting up interdisciplinary health and performance teams – Balancing performance and health in elite football. She also introduced an App-based tool to help guiding rehabilitation in sport (www.phast.com.br).
Whilst their current set-up has helped the team be the healthiest (aka least injured) in the current championship, the team is facing relegation in the second division. Performance is also a complex system! Follow Natalia on X (@bittencourt_nfn).

To summarize, here are some of my thoughts (yes, this is my opinion, here). When it comes to muscle injuries, we learned a lot about hamstrings, due to the numerous studies over the last 10-15 years. What also learned that there are different types of HMI, and that rehabilitation and timelines differ according to diagnosis. In addition, when looking at other muscle groups (calves, anterior thigh, adductors), we have a long way to go to define lesion types and lesion-specific + muscle-specific protocols.
As for HMI, the literature tells us that despite all the good prevention programs, we still see an increase or certainly not decrease in incidence in elite sports (football, sprinting). Implementation, dissemination and buy-in might be involved, for sure. My key take-away on hamstring injuries at the conference was this: if you want to really prevent them, don’t run fast. If your goal really is to run fast, you have to run really fast. See, I am also simple guy, Rod…
What an event. It was an absolute pleasure to listen to these brilliant speakers from almost all continents and the audience was very much engaged, asking questions on a digital crowd-interaction platform. Congratulations for yet another successful symposium, the 21^st of the (young) Swiss Sports Physiotherapy Association.
We look forward to starting our discussions soon for the organization of the 2^nd joint SEMS-SSPA congress, which will be held in Lausanne on October 30^th and 31^st, 2025. Save the date.

Corresponding author

Boris Gojanovic
editor@sems.ch

References

1.  Ardern CL et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 2016; 0: 1–12. doi:10.1136/bjsports-2016-096278.
2. Sport & Exercise Medicine Switzerland Journal, Issue 4, 2018: https://sems-journal.ch/6911.
3. Kemp JL et al. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med. 2020 May; 54(9): 504-511. doi: 10.1136/bjsports-
   2019-101458.
4. Mosler AB, et al. Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. Br J Sports Med. 2020 Jun; 54(12): 702-710. doi : http://dx.doi.org/10.1136/bjsports-2019-101457.
5. Reiman MP et al. Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2020 Jan 20. doi: 10.1136/bjsports-2019-101453.
6. Impellizzeri FM et al. Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med. 2020. Feb 17. doi: 10.1136/bjsports-2019-101456.
7. Schwank A et al. 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther 2021; 52(1): 11-28. Doi. https://www.jospt.org/doi/10.2519/jospt.2022.10952.
8. Owoeye OBA, Rauvola RS and Brownson RC. Dissemination and implementation research in sports and exercise medicine and sports physical therapy: translating evidence to practice and policy. BMJ Open Sport Exerc Med 2020. Nov 13; 6(1): e000974. doi: 10.1136/bmjsem-2020-000974.
9. Aspetar hamstring protocol. https://www.aspetar.com/en/professionals/aspetar-clinical-guidelines/aspetar-hamstring-protocol. Accessed on November 27th, 2023.
10. Pietsch S and Pizzari T. Risk Factors for Quadriceps Muscle Strain Injuries in Sport: A Systematic Review. J Orthop Sports Phys Ther 2022 Jun; 52(6): 389-400. doi: 10.2519/jospt.2022.10870.
11. Edouard P et al. Sprinting: a key piece of the hamstring injury risk management puzzle. Br J Sports Med 2023 Jan; 57(1): 4-6. doi: 10.1136/bjsports-2022-105532.
12. Bittencourt NFN et al. Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med 2016 Nov; 50(21): 1309-1314. doi: 10.1136/bjsports-2015-095850.