Reflections from the Scandinavian Sports Conference: Norefjell 2016

So with a few hours to kill at the airport I thought I’d write down my reflections from the Scandinavian Sports Conference that I was extremely fortunate to attend at the weekend and even more flattered to be asked to speak at.
The setting for this conference was at the Norefjell Ski and Spa about 90 minutes outside of Oslo in Norway. Norefjell is beautiful ski resort up in the mountains and a very picturesque place, or at least it was for about 30 minutes as the rest of the time we were there it was blowing a blizzard and had about a metre of snow dumped.

The 30 mins we could see anything…

Regardless of the conditions outside, the hotel and conference rooms were warm and welcoming, and despite most of us wanting to go out and play in the snow, we just didn’t have the time due to the packed schedule keeping us fully occupied.

Strong start…

The conference was attended by 500 sports doctors, surgeons, physios, and other therapists. It opened with a welcoming ceremony and traditional Norwegian dance called the ‘Halling’ and was an impressive show of grace, strength, and acrobatic skill from the dancer.
After the dancing and introductions, the eminent Norwegian surgeon Lars Engebretsen gave us the first talk of his review of 50 years in sports medicine. It was an interesting to see Lars perspectives on how things have changed and developed over the years, but also how things haven’t, with Lars still calling for caution on the over use of surgery as he has done for many years.
Next up was my colleague, and I think I can now call him a friend, Sigurd Mikkelsen. I have been following Sig’s work on social media for many years and it was a pleasure to finally meet him in person earlier this year and then again at this conference. Sigurd is a experienced physio, but also a deep, deep thinker, having that rare ability to be curious and critical, but also humble and honest. He writes regularly on Facebook and posts loads of useful and challenging information, and he is one of my go to ‘must read’ regularly people. If you don’t follow him, please do now!

Sigurd on stage talking pain…

So Sigurd gave us a great talk on ‘What is pain, and why does it matter’. Explaining pain is a difficult and complex subject at the best of times, let alone trying to do it in 30 minutes to a room full of doctors, surgeons, and therapists, but Sig did a great job.
Sig showed us how pain is a huge global burden and how the healthcare professions are NOT dealing with it well at all. He quoted papers from Artus here and here that show regardless of the treatment given for low back pain it shows a similar rate of improvement or not, suggesting that other factors are at play.
Sigurd then went on to tell us that there is no specific pain neuro-matrix and how we need to understanding and recognise the uniqueness of each persons experience of pain, as well as the uniqueness of their neurophysiology and psychology.
He then finished off by comparing our current situation with the film ‘The Matrix’ and how we all have a choice in accepting the red or blue pill to decide our continued approach on managing pain, he summed up his talk by asking us to be like Kanu Reeves in the matrix and take control of it.

Steady progress…

After lunch there were three streams of talks and workshops, one of which I was running on shoulder rehab which meant I was occupied and could not attend the other talks. However, feedback from others was that Dr Kjaer and Dr Alfredson did some great talks on tendinopathy as usual, and the session on femoro-acetabular impingement of the hip was interesting.
During my workshops I soon realised that 45 minutes to try and discuss, demonstrate, and play around with shoulder rehab ideas is no time at all. Unfortunately, I tried to cram way too much into the sessions and ending up rushing through all of it so don’t think I got my points across as clear as I wanted, apologies to all those who did attend for being very rushed.
After coffee the final session of the day was some short abstract presentations on various topics around sports injury. Lars Haugvad from the Oslo Sports Trauma Research Centre, which is churning out some good quality research and researchers gave us a talk on Ski Jumping injuries. Lars showed us that there is a high prevalence of non traumatic injuries in this sport and this is possibly due to a crazy schedule these athletes have to endure with only 1 day of rest between competitions and there being 47 of them in total.
Lars also briefly talked about a very nice looking mobile phone app called SpartaNova that athletes or anyone can record their activity levels and training times, together with rates of perceived exertion, feelings of fatigue and recovery very simply and easily. This can then be remotely accessed by medical staff and so monitor potential signs and risks of overload and injury.
Next Stig Anderson also from the Oslo Sports Trauma Research Centre discussed injures in hand ball and showed some videos of the how, why and where these injuries occur. If you haven’t heard or seen a game of hand ball I would recommend it, it’s a great sport mainly played in Scandinavia that’s a cross between basket ball, water polo, and rugby.

Solid performances…

That wrapped up day one and it was time for a quick workout, play in the snow, or relax in the sauna before we all met up for a little bit of fun before dinner. Seven researchers having just 2 minutes to ‘pitch’ or ‘sell’ their current studies to us in the audience. We then had to use our phones to score them online as to which one we thought was best.
The one that won for me, but unfortunately not the night, was again from Stig Anderson. He presented his research on predictors of over use shoulder injury in hand ball players, and found that Scapula dyskinesis nor loss of total shoulder rotation were risk factors, but INCREASED shoulder internal rotation and lack of shoulder external rotation strength where.
After this it was off for some hot dogs, burgers, and beer, and then the ski shots and dancing started as I made my lame excuses and slipped away quietly for an early night due to having an early start tomorrow.

Shoulders of course…

Day two started bright and early with three separate symposiums. I was presenting in the shoulder one together with sports medicine doctors Niels Gunnar Juel and Jen Ivar Brox, and shoulder surgeon Stefan Moosemeyer.
We had 20 minutes each to discuss the challenges in assessing and treating non traumatic shoulder pain. Niels did a great talk on how we need to simplify our assessments and classifications of non-traumatic shoulder pain which was like music to my ears. He asked us all to consider using simply stiff or not stiff. I like this approach as it fits very well with my own simplification model I use and teach but I do think we also need to consider the unstable shoulder as well.
Next Jens discussed the challenges in identifying yellow and red flags in shoulder pain. I found this a good review but I think some things were lost in translation from Norwegian to English and found it didn’t flow quite right.
I then talked about the issues and uncertainty surrounding our assessments when we assess painful shoulders and highlighted how we can never rely on one test or sign alone. I also tried to emphasise that we need to recognise the complexity and uncertainty of humans when we are assessing them, and how we don’t assess shoulders, we assess people with shoulders.

On stage trying to put the person back into painful shoulders…

Stefan finished off the symposium with a good review of rotator cuff calcific deposits, the why, where and how to deal with them. I found this a useful talk as he demonstrated a really nice pain free barbotage technique which the evidence and their clinical experience shows can be quite effective for some recalcitrant calcific deposits.

Sedentary stats…

After coffee, there again was three separate streams running. I attended the physical activity and sedentary time session and found it really interesting, especially in light of our recent editorial on creating a movement for movement just published in BJSM here.
Key points from this session was that Norway has seen a slight increase in the number of people meeting the recommended amounts of 150 minutes of moderate to intense physical activity a week, but this is still only just over 30% of the population. They also showed if they could just get some to do just an extra 10 minutes more physical activity a week then that figure would rise to nearly 50%.
Another key point made in this session is that measuring levels of physical activity accurately and reliably is difficult, really difficult. Most population measures of physical activity are done with self reported questionnaires, but it seems that when these are compared to actual objective measurements using wearable devices such as accelerometers, we see a marked difference in rates with individuals often over estimating how much physical activity they do by around 20-25%.

Superb finish…

After coffee the last session of the day saw Clare Ardern previously from Aspetar and now based in Sweden giving a great over view of her consensus paper on return to play (RTP) after injury which is actually freely available here. She expertly went through the four key points…

• RTP starts from the moment of injury, and is not a phase just done at the end of rehab for a week or two.
• RTP success is unique to each RTP situation, so different injuries, sports, individuals will have different outcomes
• RTP should be a shared decision making process, between medical staff, player, and coaches… however there are times when player safety means that at time the medical staff do have more responsibility, eg concusion.
• We have big gaps in the evidence base in many sports and injuries to guide us on criterion for RTP, therefore good quality clinical reasoning is needed often.

Clare also briefly discussed the role of psychological factors that we need to recognise more when considering RTP after injury, things like fear of re-injury need to be assessed and managed as best as possible.

Clare doing a great talk on RTP…

Next up was me… again… For my last talk I gave a slightly provocative review on some myths around manual therapy, and tried to answer if it is a skill, and art, or just an illusion. I also had some fun by taking the micky out of some of the crazy shit that surrounds manual therapy which I think went down fairly well.
Finally to close day two Ingrid Eitzen who is a formidable physio and ex Phd who actually quit research to, in her own words ‘avoid potential pompousness’ in my opinion gave the best talk of the conference, but also for me the most uncomfortable one.
Ingrid’s talk was on ‘Research fraud, deceit and social media rock stars in sports physio, who do you trust?’. She started of by reminding us of some of the big publicised cases of research fraud and deceit, but also showed us that it is a much bigger problem than what is seen publicly, with suspected high rates of publication bias, data amending, figure fiddling or even just making shit up.
However Ingrid didn’t stop with the critique of fraud in research, she went on to highlight another type of fraud in our profession, the gurus, or the rock stars as she calls them. The talkers of a good game, but doers of very little, usually full of arrogance and bravado, lacking in humility and uncertainty.
Ingrid highlighted how they they manipulate their followers and fans with their blogs and social media posts and by cherry picking research, or generally bull shitting, convincing others that this is great, and that is bad based on nothing more than their opinions. As Ingrid talked I felt myself becoming more and more uncomfortable as I recognised a lot of these criticisms directed at my own current situation.
But its good to feel uncomfortable now and then and I do accept this criticism from Ingrid towards me and all the other social media bloggers in our profession. I am acutely aware that over the last few years my profile has grown thanks to social media. Very few people had heard of a physio from North London called Adam Meakins, however, now I am asked for my advice and opinion on various issues and topics, and of course I am asked to do presentations, courses and conference talks.
This means I am extremely fortunate and privileged to travel, meet some awesome people, and make some extra income, and I would be bull shitting you all if I didn’t say that I thoroughly enjoy it, it’s lot of fun, and a tad ego boosting.
But I am also acutely aware that I am at risk of turning into everything I loathe and hate, a god damn fucking guru. I have no desire to be one, at all.
I am passionate about trying to highlight how, in my opinion, there is lots of misinformation, myths and general time wasting on ineffective assessments and treatments. I am passionate about promoting a more simpler, more open, more honest way of working. But remember these are my passions and my opinions, and I do try and get this across before I start my courses.

 

Me controversial…never!!!

So although feeling uncomfortable I totally agree with Ingrid’s closing remarks, that everyone is entitled to their opinions, and it is great that there are lots of different views out there, but lets not be sheep, lets not forget to think critically, lets not forget to consider the evidence base as a whole, lets not follow or accept all that’s said on just one blog, by one guru, by one rock star, or by one research paper…
But in saying this please, please all go an follow Ingrid on twitter here as she will hate it, but I secretly think she wants a bit of rock star in her life too… ;o)

Shoes, booze, and snus…

So after a little bit of squirming on my chair it was good to get up, get dressed up, and attend the conference gala dinner. And let me tell you the Norwegians know how to put on one hell of an evening, with everyone dressed up to the nines, looking absolutely fabulous, and the evening was a blast and rolled on to the early hours of the morning with lots of booze, some amazing dancing shoes, and some good awful snus (pronounced snooze to all the English reading).
Snus is really popular in Scandinavia and I thought I would give it a go when offered it for about the 12th time that night, but instantly wish I hadn’t. Snus is a tabacco pouch that you slip under your top lip to get a hit of nicotine, think smoking without smoking. However, what I got was a burning sensation on my gums, a taste of stale damp wood in my mouth, and even more dizzy than I already was.

Summary…

So that was my first experience of the Scandinavian Sports Conference, there was a third day but due to a rock star sized hang over and a plane to catch I had to leave early so I couldn’t make those talks.
However, I will say that I had a great time, and was made to feel really welcomed by everyone. I would personally like to thank everyone who I spoke too for all the kind comments and the discussions we had, especially Einar Svindland for the tips on improving my handstands. I would also like to thank the organising committee for inviting me, especially Camilla Sahlin Pettersen, as well as Angelita ‘the seaweed’ Eriksen for being my chaperone and having to put up with me at the social events, you both deserve a medal, and Angelita… Take the leap!