Dr Éanna Falvey appointed World Rugby’s Deputy Chief Medical Officer.

Former Ireland and Munster doctor Dr Éanna Falvey has been appointed to the newly created position of World Rugby’s deputy chief medical officer.

Dr Falvey will take up the role on March 1st, before replacing Dr Martin Raftery as a chief medical officer in January 2020.

Dr Falvey has also worked for the British and Irish Lions and has covered boxing and football. He is a member of World Rugby’s medical commission conference and concussion working group.

On the appointment, World Rugby chairman Bill Beaumont said: “Player welfare is the number one priority for World Rugby and its unions and I believe that we are at the forefront of the sports movement in the important area of injury prevention and management.

“Dr Falvey is an outstanding appointment. He comes with an impressive CV, a great reputation and a deep knowledge of the sport’s approach to medical and player welfare matters, having made strong contributions to various World Rugby medical and concussion working groups and also as team doctor for Ireland and the British and Irish Lions.

“He has an in-depth understanding of wider sports and athlete welfare and we look forward to welcoming him to World Rugby.”

The outgoing Dr Raftery was appointed in 2011, and among the player welfare protocols he helped introduce is the Head Injury Assessment (HIA) process.

On Falvey’s appointment, he said: “As a sport we must and will continue to prioritise player welfare and this appointment underscores that commitment.

“I am delighted that Éanna is joining World Rugby. He is someone I have worked closely with in recent years and not only is he well-regarded within sport, he knows rugby inside out and is perfectly qualified having made strong contributions to our strategies. He is a great addition to the World Rugby team.”

Published in The Irish Times 27th February 2019.

2019 Spring GP Study Day – A selection of photographs.

This event was hosted in UPMC Sports Surgery Clinic’s main hospital and  consisted of workshops with the following SSC Consultants:

Ms Ruth Delaney, Consultant Orthopaedic Surgeon
Mr Michael Donnelly, Consultant Orthopaedic Surgeon
Mr Owen Brady, Consultant Orthopaedic Surgeon

Ms Ann-Maria Byrne, Consultant Orthopaedic Surgeon
Ms Noelle Cassidy, Consultant Orthopaedic Surgeon
Mr Niall Hogan, Consultant Orthopaedic Surgeon

Dr Philip Hu, Pain Management Consultant
Mr Mark Jackson, Consultant Orthopaedic Surgeon
Mr Michael Kelleher, Consultant Neurosurgeon

Mr Gavin McHugh, Consultant Orthopaedic Surgeon
Dr Andy Franklin-Miller, Director of SSC Sports Medicine
Professor Cathal J. Moran, Consultant Orthopaedic Surgeon

Mr Hannan Mullett, Consultant Orthopaedic Surgeon
Mr Jabir Nagaria, Consultant Neurosurgeon
Dr Barry Sheane, Consultant Rheumatologist

Dr Catherine Sullivan, Consultant Rheumatologist
Mr Keith Synnott, Consultant Orthopaedic Surgeon
Dr E. Kathir Tamilmani, Pain Management Consultant

Mr Mihai Vioreanu, Consultant Orthopaedic Surgeon
Neil Welch, Head of Rehabilitation & Knee Stream Lead
Mr Dan Withers, Consultant Orthopaedic Surgeon

Concussion UPMC Sports Surgery Clinic

SSC Sports Medicine-First paper on Concussion in adolescent rugby union players is published in BJSM

SSC Sports Medicine Concussion Study

Introduction Sports-related concussion (SRC) can be challenging to diagnose, assess and manage. Much of the SRC research is conducted on adults. The assessment of SRC should aim to identify deficits using a detailed multimodal assessment; however, most studies investigating the effects of SRC use diagnostic tools in isolation. It is likely that a combination of diagnostic tests will improve diagnostic accuracy. In this study, we aim to investigate how concussion affects adolescent rugby players and how a variety of diagnostic tools interact with each other as participants recover from their injury. The study will also determine the logistics of recording an individual’s concussion history on a virtual ‘Concussion Passport’ that would remain with the individual throughout their sporting career to allow monitoring of long-term health.

 

Methods and analysis All rugby players (n=211) from the Senior Cup Teams of five schools in Dublin, Ireland will be invited to participate in the study. Baseline testing will be performed at the UPMC Sports Surgery Clinic, Dublin (SSC) before the rugby season commences. Participants will be followed up over the course of the rugby season. At baseline and at each postconcussion visit, participants will complete the following: Questionnaire, Sports Concussion Assessment Tool 3, Balance Error Scoring System, Computerised Neurocognitive Testing, Vestibulo-ocular assessment, King Devick test, Graded exercise test, Blood tests, Neck strength, Fitbit.

 

Ethics and dissemination Ethical approval was obtained from the UPMC Sports Surgery Clinic Research Ethics Committee (Approval number: SSC 0020). On completion of the study, further papers will be written and published to present the results of the various tests.

 

Trial registration number NCT03624634.

 


Click on image for the full paper.

A selection of photographs from Educational Evening in Adare

A selection of photographs from our Educational Evening for GP’s, Physiotherapists and S&C Coaches which took place in Adare. Co. Limerick yesterday.

This event consisted of presentations from the following SSC Sports Medicine clinicians:

  • Dr Éanna Falvey,  Consultant Sports & Exercise Medicine Physician.
    • ‘The athletic hip’
  • Dr Andy Franklyn-Miller, Consultant Sports & Exercise Medicine Physician.
    • ‘An update on tendons’
  • Dr James O’Donovan, Consultant Sports & Exercise Medicine Physician.
    • ‘Treatment of patellofemoral pain’
  • Neil Welch, Head of Rehabilitation & Knee Stream Lead.
    • ‘Strength and conditioning for low back pain’

 

 

 

Hannan Mullett Shoulder Specialist Santry

‘Do not shrug off Shoulder Pain’

Rotator Cuff Repair SantryWe use our shoulders a lot, to lift, push, dig. While the shoulder is the most flexible joint in the body, it can be prone to injury precisely because of its flexibility, writes Margaret Hawkins.

Shoulders shattered in accidents, shoulders dislocated during sporting events, rotator cuffs torn by a fall and shoulder joints damaged by arthritis – these are some of the cases that Dublin-based consultant orthopaedic surgeon Hannan Mullett deals with every day.

The youngest shoulder patient Mr Mullett has operated on was 12 – a sports-related shoulder dislocation – and the oldest was 92. This woman had a shoulder joint replaced.

While most of the operations he performs are sports-, arthritis- or rotator-cuff-related, he also works in the national neurosurgical centre in Beaumont Hospital. “We therefore see a fair amount of accident cases as well,” he says. He explains the structure of the shoulder: “The shoulder is made up of two bones and it’s a ball and socket joint, which means that the end of the upper arm bone fits into a socket in the shoulder blade.

“There are also lots of muscles and ligaments surrounding the shoulders connecting the bones and tendons – and connecting the bones to surrounding muscle.”

Is a sprained shoulder a real condition?

No, not really, he says. “People throw the term ‘sprain’ around too loosely to describe any type of shoulder pain,” he says, “but often what they have is rotator cuff tendonitis. That’s inflammation of the rotator cuff. The tendon is inflamed and the top of the tendon may be pinching against a bone in the shoulder called the achromion. That’s as close as you get to ‘sprain’.

“Rotator cuff tendonitis is a very common condition. Probably about 80% of people with it can manage without any surgery – getting physio, taking painkillers or anti-inflammatories or perhaps having steroid injections, which can be very helpful. Keyhole surgery may be necessary in some cases, and it is generally successful when it’s done,” he assures.

Most common condition

The most common operation in middle-aged and older patients is one for rotator cuff repair, he says. These rotator cuff tears and arthritis-related shoulder problems are equally common in men and women.

But what exactly is a rotator cuff injury? “The rotator cuff is a group of internal muscles of the shoulder that power it. It can tear, however, and it’s probably the most common shoulder condition. It can either be a traumatic tear, where somebody has an accident, for example, they trip over the dog and land on their shoulder and tear the tendon; or, over time, the tendon just becomes frayed. That is, to some extent, due to age, but there can be a genetic component as well.

“Some people are more genetically predisposed to rotator-cuff tears, just as some people are more genetically disposed to heart disease. It is not particularly related to occupations that involve a lot of heavy lifting,” he says.

Shoulder dislocation

The most common sports shoulder injury he deals with are shoulder dislocations, and these happen to two groups of people: younger males, who play contact sports, and those who have had accidents.

“The sports involved include Gaelic football and hurling, rugby and, to a lesser extent, soccer. Those who need surgery because of an accident could just have fallen off their bike,” he explains.

Hannan Mullett treats athlete patients from school age to international level. “It is always a great pleasure to see a player return to the same level [after surger]). In younger patients, stabilisation surgery for shoulder dislocations is the most common kind of surgery I do.”

In older patients, dislocation of the shoulder can be due to a tear of the rotator cuff. “If you’re over the age of 40, it’s probable that dislocation is due to this tear, rather than a sports injury.”

Dislocation sometimes needs intervention, he states. “These days we would generally operate after the second dislocation for recreational-level players, but more and more we operate after one dislocation in high- level players – inter-county, high-level rugby players – but for school-boy soccer players we would probably allow them to dislocate a second time [before deciding to do shoulder stabilisation surgery on them].”

Is that because they are such valuable players? “If you are a contact player and playing for your county in the senior squad and dislocate your shoulder, the chance of re-dislocating it is so high that you are probably just better off getting it fixed when it happens the first time,” he says.

Shoulder replacement

Shoulder replacement surgery is becoming more common now too, he adds and can be very reliable in eliminating pain and restoring function. If he was a hip or knee surgeon, joint replacements would be the bulk of his practice, he says, but replacements are only a small part of his workload at present.

“I probably do about 80 to 100 shoulder replacements a year, but it is becoming more common. The technology and material science advances in shoulder replacement have progressed, particularly over the last five to 10 years, so it is a lot more successful than it used to be.”

Improved anaesthesia has help

“It’s easier now to give older patients anaesthesia for surgery, so people who would have been turned down for surgery 10 to 15 years ago are not being turned down now,” says the surgeon.

Shoulder replacement involves replacing the joint surfaces with metal and plastic components. “With modern techniques, this can now be done in minimally invasive fashion, using smaller incisions and by removing less bone (surface replacement).

“There are also now replacements available for patients who have both arthritis in combination with a bad rotator-cuff repair (reverse geometry shoulder replacement), which work very well in reducing pain and restoring function, often in quite elderly patients,” he explains.

Farmers with rotator-cuff tears

He treats a lot of farmers at his clinics, including Cappagh hospital. “I often tell my trainees that if I only treated sportspeople and farmers I would be a very happy man! They are generally very easy to deal with and eager to get back to work – maybe sometimes a little too early.

“The most frequent injuries that I see in farmers are rotator-cuff tears, which are often a combination of wear and tear and an injury; for example, being pulled by an animal or a farmer falling on his land.

“One small point about farmers, though: they are often very stoical by nature and tend to put injuries on the long finger. They sometimes present with conditions such as rotator cuff tears that have been left so long that they are either beyond repair or the results are not as good as they would have been if they had sought medical attention earlier,” the surgeon warns.

What causes frozen shoulders?

Many people experience what’s called a “frozen shoulder”, involving shoulder pain when moving the arm backwards, for example. So why exactly does this happen?

“The answer is that we don’t know. Frozen shoulders are more common in women than men and between the ages of four and 60. Some conditions predispose you to it, like diabetes or hypothyroidism (underactive thyroid), but there is no reason for the vast majority of frozen shoulders; they just happen,” says Mr Mullett.

“They tend to be more common in patients who are active, rather than those who are sedentary and overweight. The patient generally presents with a painful shoulder and a restricted range of motion. Over nine to 12 months, on average, the pain resolves and the movement comes back.

“Steroid injections work very well for getting rid of pain for that. The injection is into the shoulder joint and the space above the tendon.

For some people, the pain doesn’t go away, or they may remain very stiff. In those cases, there is an option to do keyhole surgery as well, but that’s generally about 10% of those who get frozen shoulders,” he says.

Motorbike victims

Hannan Mullett finds some severe trauma cases, such as motorbike injuries, very challenging.

“If the injuries are life-threatening or if they have nerve damage and are paralysed or if they have an injury that’s going to be life changing – if their shoulder is shattered and they are working as a painter/decorator, perhaps, and now their shoulder is going to be very stiff and they have to change career or sport – that can be very difficult to deal with.

“Most of the time though, with a surgical team working together, it is possible to put them back together again. This kind of surgery can also be very satisfying, as it is a challenge to sometimes come up with custom solutions to a particular problem,” he explains.

Genetic illnesses

While arthritis and rheumatoid arthritis (RA) do affect shoulder joints, surgeons no longer do as many operations on those with RA, because the medication has improved.

“Treatment for rheumatoid arthritis has improved dramatically over the last 10 to 20 years,” he says. “A lot of patients would have needed hip, knee and elbow replacement in the past but, because of modern medicine and various types of biological treatment, the impact of the disease on joints has been greatly reduced. If you have RA at the age of 20 now, you can go on to have a relatively normal life.”

Being mechanically-minded helps

He likes this kind of work because it is a practical area of medicine, he says. “Orthopaedics is a great speciality, as most patients get better and the results are seen quickly. Someone comes in with a torn rotator cuff, for example, and you fix it, so for the patient and the doctor, it’s a kind of satisfying thing.

Orthopaedic surgery suits people who are mechanically-minded. There’s a good blend of medicine, fine engineering and material science in what we do, and you also get to deal with a wide variety of patients, which is good.”

Hannan also specialised in shoulder surgery, he says, as it was a field that was advancing rapidly, particularly with the development of arthroscopic (keyhole) surgery. “Approximately 80% of operations can now be performed by this method,” he says.

For further information on shoulder injuries please contact info@sportssurgeryclinic.com
UPMC Sports Surgery Clinic Orthopaedic Hospital

SSC Research Ethics Committee meeting 10th September

The date for the next Research Ethics meeting is Monday 10th September 2018 at 18:00

All submissions must be made by 17: 00, August 20th for distribution to the Board members. Applications should be sent to emeragnew@sportssurgeryclinic.com

Please use the existing HREC submission form including Plain Language statement and it is expected that all trials conducted at SSC will be registered at clinicaltrials.gov.

The Principal Researcher with any submission will be expected to be present at the meeting to answer any questions arising from the submission and reviewers comments.

Emer Agnew
Quality, Clinical Risk & Patient Safety Manager
UPMC Sports Surgery Clinic

1st: L-R Dr Josh Keaveny, CEO; Dr Peter Marshall; Mr Cliff Beirne; Dr Aidan Kelleher and Dr Rory O'Donoghue.

GP Golf Day 2018

1st: L-R Dr Josh Keaveny, CEO; Dr Peter Marshall; Mr Cliff Beirne; Dr Aidan Kelleher and Dr Rory O'Donoghue.

UPMC Sports Surgery Clinic hosted its fifth annual GP Golf Day last week in Powerscourt Golf Club.

The weather was fantastic in Enniskerry and the East Course was in tremendous condition.

Spirits were high and this was reflected in the exceptional scorecards returned on the day!

Thank you to everybody who attended, we hope you enjoyed it as much as we did.

For more images click below.

 

Athletes halve their hip and groin injury time with new facility at Dublin’s UPMC Sports Surgery Clinic

Sports Medicine Facility, UPMC Sports Surgery Clinic, Santry, Dublin, Ireland

Patients suffering from Athletic Groin Pain are returning to their sport almost 50% quicker after rehabilitating at a new biomechanical facility at Dublin’s UPMC Sports Surgery Clinic.

Ground-breaking research reveals that 73% of patients with Athletic Groin Pain return to play at an average of 9 weeks with biomechanical rehabilitation at the clinic. This work, part of a series of 3 papers published by SSC’s Groin Group in the prestigious British Journal of Sports Medicine shows the fastest published rehabilitation of groin pain patients to date.

This compares with previously published rehabilitation figures of 18.5 weeks return to play for non-surgical, and 14-18 weeks following surgical intervention. SSC’s Sports & Exercise Medicine Department have pioneered the use of 3D Biomechanics (VICON motion capture technology) when treating patients suffering from Athletic Groin Pain since they established the laboratory in 2013.

This technology digitises an athlete’s movement, clearly defines forces through the body and provides new insights into understanding rehabilitation interventions. Data captured in the testing is used by clinicians in their assessment of the patient’s injury and the development of a rehabilitation programme.

SSC Sports Medicine clinicians consist of highly experienced Sports Physicians, Physiotherapists, Strength & Conditioning coaches and Biomechanists who treat over 700 patients suffering from Athletic Groin Pain every year.

They have developed a research database of over 4,000 people affected by Athletic Groin Pain and have collaborated with the University of Roehampton in London, Dublin City University, Science Foundation Ireland and Insight to develop this highly effective new non-surgical rehabilitation pathway.

SSC’s latest research paper ‘Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients’ was published by the British Journal of Sports Medicine in March 2018.

What is Athletic Groin Pain?

Athletic Groin pain refers to a group of conditions that present as pain in the hip and groin. They are commonly referred to as Sportsman’s Hernia, Gilmore’s Groin, Adductor Tendinopathy, Athletic Pubalgia and Osteitis Pubis. It is commonly seen in male athletes, especially those involved in multidirectional sports such as soccer (20%), Australian rules (49%), Gaelic football (38%), and Rugby (60%) annually.

Symptoms often develop gradually. Initially, athletes see a decrease in performance with running, cutting, kicking and pain after training. Symptoms gradually worsen until athletes are no longer able to compete.

A current trend is to blame the hip joint and symptoms of femoral acetabular impingement (FAI) for all groin pain – however latest research indicates that is present in almost all footballers, and in many cases, it is the body’s natural response to training load in pre-adolescent years.

Issues around the hip are therefore more often problems we should be attempting to prevent rather than correct once they have occurred. The Groin Lab at SSC has been developing innovative methods of assessment and rehabilitation to improve outcomes of return to play without surgery in this large group of athletes.

SSC Sports medicine

Key Results of SSC Research

73% of athletes undergoing biomechanical rehabilitation at SSC’s Groin Lab return to play after 9 weeks with a biomechanical rather than anatomical approach to rehabilitation.

Current time in GroinLab Rehabilitation is 9.9 weeks (6.2 through 12.6 weeks) before full return to play. This compares to previously published rehabilitation protocols of Hölmich et al (68% RTP, 18.5 weeks) and Weir et al (48% RTP, 17.3 weeks)

It also compares well to the surgical approach for adductor (63%–76% RTP, 14–18 weeks) and pubic pathology (100% RTP, 13–28 weeks) as well as hip arthroscopy (O’Connor et al).

Additional Information

The Groin Lab at SSC is available for all sportsmen and women both in Ireland and internationally. At present, it is treating on average 2 to 3 referrals of high profile international athletes every week.

Anyone suffering from Athletic Groin Pain wishing to avail of the facilities at UPMC Sports Surgery Clinic can do so by making an appointment by contacting sportsmedicine@sportssurgeryclinic.com

Three landmark papers published in the British Journal of Sports Medicine with the highest Impact factor of any Sport Science, Medicine, and Orthopaedic Journal.

  1. ‘Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: a prospective cohort of 205 patients’
    King E, Franklyn-Miller A, Richter C, O’Reilly E, Doolan M, Moran K, Strike S, Falvey É.
    Br J Sports Med. 2018 Mar 17
  2. ‘Athletic groin pain (part 2): a prospective cohort study on the biomechanical evaluation of change of direction identifies three clusters of movement patterns.’ Franklyn-Miller A, Richter C, King E, Gore S, Moran K, Strike S, Falvey EC.  Br J Sports Med. 2017 Mar; 51(5):460-468
  3. ‘Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients–clinical findings, MRI findings and patient-reported outcome measures at baseline.’ Falvey ÉC, King E, Kinsella S, Franklyn-Miller A.  Br J Sports Med. 2016 Apr;50(7):423-30.
Colin Griffin Run Lab SSC

‘The Appliance of Science’ an interview with Colin Griffin

Colin Griffin Run Lab SSCIf you’re serious about training and competition, then at some point you’re sure to have asked yourself ‘Am I doing this right?’

We all follow general principles; don’t over-train, get plenty of rest, eat well, stay properly hydrated – but eventually we reach a point where something more tailored to us as individuals is needed, and the value of objective, science-based approach.

At UPMC Sports Surgery Clinic’s Run Lab, Strength and Conditioning Coach Colin Griffin explains the role of their services in improving performance and reaching goals.

Griffin, who represented Ireland as a 50km race walker in two Olympics and has coached other athletes to that level, and has recently run a marathon in 2.29.15, is an accredited strength and conditioning coach who is leading Run Lab’s superbly-appointed service in Gulliver’s Retail Park in Santry, north Dublin.

“Endurance performance is multi-factorial and while aerobic endurance is very important, there are other trainable variables that can contribute to further performance improvements or at least more consistent training. The Run Lab service provides comprehensive profiling of the athlete and can identify areas of limitation for people who are ambitious to improve their performance”

The aim is to optimise performance in a real-world setting, so when we recommend areas of training on which to focus, we’re taking into account the lifestyle factors which may make some changes difficult; for instance the type of work you do, the hours you keep, your access to facilities and so on. These factors influence how your body can recover and adapt to training.

This isn’t a once-off process; ideally, we like to follow-up after, say, 8-10 weeks to review progress and if necessary make changes to our recommendations. It is a consultation service and we also welcome interaction with the athlete’s coach. Essentially, we’re offering ongoing support for athlete and coach.

There’s also the injury-prevention aspect to our service; by talking to the athlete about their injury history and training profile, in combination with physiological tests, we can identify any areas of weakness or imbalance that could either explain past injuries or help forestall future problems.

There is a greater need to train smarter; the ‘traditional’ approach to endurance running emphasises mileage, with 100 miles per week the gold standard. However, athletes can reach a ceiling where increasing mileage further may not yield any further benefits and training needs to be more creative. For some athletes, they may not be able to tolerate that mileage without breaking down regularly. With Run Lab, we can help identify more efficient and effective methods to optimise endurance by training at the right intensities together with developing power and elasticity to complement their running.

We use a wide range of technology, including force plates and 3D motion analysis. The 2-hour consultation begins with a strength and conditioning coach who will discuss your training background and performance goals. You will be measured for height and weight. Then you will have your ankle and hip mobility assessed, as well as your balance during a single leg squat.

After a brief warm-up, you will perform a series of jumping and hopping tests on the force plate. The results of these tests will tell us whether you need to develop more strength or power, and your tendons’ ability to absorb and return elastic energy – an important determinant of running economy and performance.

We perform a gait assessment using video analysis, looking at posture, how you strike the ground and how you absorb impact, noting any asymmetries between left and right side. We can then advise if you would benefit from making some changes to your running technique to improve performance or reduce your risk of injury.

A treadmill test then measures the lactate threshold, running economy; indicators of aerobic efficiency. We will then be able to advise you on what zones you should train at for long runs and interval training. The athlete receives a dashboard report which they can discuss with their coach to help them devise a more effective training programme.

For more information  or to book an appointment at SSC’s Run Lab service please contact 01 526 2040