Sports Medicine Australia 2022 Conference Recap

If you have been on social media over the last week, you may have seen a few posts from various people from the 2022 Sports Medicine Australia (SMA) Conference on the Gold Coast, Australia.

For me, it was the first time since 2016 that I attended the SMA conference, and hand on heart, this was the best Conference that I have attended to date.

I generally come away from Conferences with my head full and spinning from the new research shared. But this one was different. Sure, my head was spinning still, but this one I've come back to work more confident than ever before, and highly motivated to improve outcomes in not only my ACL patients, but all of my patients with other pathologies.

For 4 days straight, the conference proceedings and presentations were world-class, and there was not a single session over the 4 days where I thought "there's nothing here that doesn't interest me; or isn't clinically relevant to me."

In fact, there were many occasions, where I wish I had a clone that could attend 2 sessions at the same time!

Having a strong clinical interest in ACL injury prevention and rehabilitation, there was a ton of brand new research presented that I lapped up - including the potential game-changing research from the Cross Bracing Protocol trial for ACL healing.

On top of this amazing ACL research shared, there were incredible presentations delivered on tendons, hips, hamstrings, osteoarthritis and physical activity and I wanted to put all my highlights over the 4 days into 1 very easy to read document for you all to read and benefit from

So without further ado, here are the best bits (from my perspective anyway) from SMA conference 2022!

ACL Research

As mentioned above, there was so much up to date ACL research shared including a brilliant session and executive summary of the 7 OptiKnee ACL papers from each of the lead authors of each individual paper.

If you are interested in reading about these 7 papers, they are available here:

If you want a very brief overview of the session - here are my main takeaways:

💥 initial acute ACL tear management must feature education; that includes different treatment options and exercise rehab

💥 Delay surgery until knee is quiet

💥 Financial cost for ACLR higher than rehab alone

💥 KOOS-QOL patient reported outcome measure we should be using consistently

💥 Single leg hop test and triple crossover are key functional tests we should be using

Steph Filbay shared some of the preliminary findings from the much talked about Cross Bracing Trial. Steph presented data that showed 90% acutely injured ACL patients (full ruptures) managed with a 12 week bracing protocol (commenced within 4 weeks of injury - earlier the better - and medically supervised) showed evidence of varying degrees of healing of the native ACL. Note the varying grades of healing on MRI on the pic below, but 50% had grade 1 healing (ACLOAS grading system) at 3 months.

This presentation got people really talking both at SMA and online and its such a fascinating sub-topic of ACL injury management and I cant wait for the full paper to be published soon and longer term follow-up papers in the future.

I've put my thoughts on the prospect of the ACL healing into a separate blog, and if you're interest you can read it here:

Tom West is doing his PhD in the ACL field and is part of the OptiKnee research group, and his research showed that in the event that you don't have access to isokinetic testing or HHD, the single leg rise test can be used as a reliable measure of quads strength in ACLR patients.

Up to a certain point though.

Those who can do 22 or more, should have formalised quad strength testing via isokinetic or HHD.

Adam Culvenor featured quite heavily throughout the SMA conference and was the winner of the best Clinical Sports Medicine paper award. One key takeaway from his paper were that those that attended >10 physio rehab sessions were nearly 3x more likely to return to pre-injury level of sport - Caveat: 10 high quality rehab sessions > 10 low quality rehab sessions.

Adam is also one of the lead investigators of the SUPERknee trial, where they are looking to see if people 9-36 months post-op with poor knee health and function (<80 KOOS) can turn things around with supervised / semi-supervised structured and progressive rehabilitation. You can read more about the SUPERknee trial here

Jay Ebert is a prolific ACL researcher from Western Australia and has lead a great research project on an accelerated ACL rehab program compared to a "standard" rehab program. Note: this was not an "accelerated return to sport" protocol, but rather the typical rehab exercises and drills you'd see in a rehab plan were started earlier in comparison.

They showed that an accelerated ACLR rehab program compared to a "standard" resulted in significantly better strength and performance outcome measures at 6/9/12/24 months post op - without compromising graft laxity. They also showed superior return to level 1&2 sports at 12 months was higher in "accelerated" rehab group vs "standard" group - 77 vs 59%. Check out the paper here

Argell San Jose is a young researcher from Melbourne and showed once again that although strength is often restored nicely within 6 months post-op ACLR, rate of force development (RFD) is not.

In his subjects, at 12 months post-op, hamstrings RFD in males and females (hams grafts) had not restored to acceptable levels. Furthermore, by 6 and 12 months post-op, quads strength and RFD in females not restored to acceptable levels

Adam Bryant has done a ton of work in the ACL biomechanics space and showed that sagittal plane loading is far more dominant to ACL loading than frontal or transverse planes - making another strong argument to make sure quad dominant exercises are regularly done to help protect ACL.

Allison Ezzat showed us all that on top of common ACL specific patient reported outcomes such as ACL-RSI, IKDC, KOOS and TSK-11, we should also consider using Knee Self Efficacy Scale (K-SES) in mid-late stage ACLR rehab as significant differences exist between ACLR athletes and healthy controls for present and future self efficacy.

Hot tip: Beware the athlete who had high self efficacy early.

Using the K-SES also important to identify those with low self efficacy and implement strategies to achieve a great outcome.

Tendons

Prof Jill Cook spoke on each of the last 3 days of SMA conference and I held on to every word that she had to say. There was also a bucket-load of other really interesting research shared from other presenters too; and here are my main takeaways:

💥 Watch the sneaky compression during squats, lunges etc in symptomatic insertional AT patients. Aim to keep tibia straight during calf & kinetic chain exercises.

💥 0/10 pain during rehab is often unrealistic. We want stable pain. Low levels of pain and steady over time is ok

💥 Beware the funky treatments for tendon pain (eg. PRP, laser, ESWT etc) - they don't change the tendon pathology and it doesn't improve function. Exercise and progressive overload needs to be central to your management.

💥 Return to running goals in achilles tendon pain:

🦵 30x single leg heel raises (calf endurance)

💪 4-6reps straight leg single leg heel raises of person's body weight (on top of their body weight)

💥 Not all tendons behave the same. Progressive rehab tends to work better for thickening tendons like Achilles, Patellar and Hams rather than thinning (Glut Medius and Supraspinatus)

💥 We can't predict Achilles (or Patellar) rupture - and probably never will.

💥 Imaging not really helpful for most tendons - costly and can create kinesiophobia.

💥 Be active early, with multiple COD sports + resistance training key to early tendon (and bone) health - may also reduce risk of pathology development in tendons.

Hip and Knee OA

Joanne Kemp really brought to our attention the disproportionate hip pain and symptoms and loss of hip function that women go through - especially in middle ages - compared to men.

💥 Women have disproportionate hip pain than men across lifespan with the peri-menopause period of life (approx 35-51yrs) being a time of hormonal chaos and work/life chaos

💥 Common presentations in this period are Hip OA and GTPS

💥 Comprehensive treatment required including GP input, dietary changes, physical activity, heavy resistance training and make sure their concerns are being listened to and not dismissed!

Christian Barton showed us all for the first time a wonderful free online resource for Knee OA patients (and clinicians) called My Knee. Check it out here.

He also showed that a GLAD exercise program delivered via telehealth was non-inferior to an in-person GLAD program for Knee OA patients.

There was also a tremendous Knee OA presentation from Andrew Hislop (PhD candidate). He showed the following from his clinical trial.

💥 Quads strength 32% weaker in knee OA patients vs healthy controls

💥 Hip add strength also 34% weaker vs healthy controls

💥 Balance 16-24% weaker vs healthy controls on SEBT

💥 look to target these in rehab

💥 Quad strength had direct relationship on 40m walking speed, 30sec sit to stand test, stair climb test and SEBT balance test

💥 Outside of targeting quads in knee OA patients, don't sleep on hip ext, add & abd strength 💪

Physical Activity

High Intensity Interval Training (HIIT) featured a fair bit during the 4 days at SMA conference and there were 2 talks that were clear standouts from me.

The first from Prof John Hawley with the following being the main takeaways:

💥 HIIT is never worse than moderate intensity continuous training compared to many diff outcomes - often superior.

💥 If you question - is it safe to do HIIT? You should ask yourself, is it safe not to do HIIT - Very low risk of cardiac events.

💥 Optimal dose of HIIT per week is 50-57mins per week, but benefits seen with as little as 10mins per week

💥 General population also benefits from 2-3x sessions per week

The second talk I really enjoyed was from Dr Belinda Brown on HIIT and cognitive health with the following being the main takeaways:

💥 Current medications to treat/manage Dementia and Alzheimer's not great and don't change disease course.

💥 Intensity of exercise and physical activity important with higher intensities of exercise (HIIT) showing stable cognitive ability over 10yrs compared to lower intensities

💥 Resistance training 2x per week also recommended to improve cognitive health and memory function

So there you have it! A summary of the best bits of SMA 2022 - well at least I thought that these were the best anyway. Of course there were so many other topics and presentations to SMA conference 2022 , but I just wanted to share with you all the key takeaways that can help improve your clinical practice as much as it has helped mine!

If you ever find yourself wondering in the future - "should I go to SMA conference?"

The answer is always YES.

If you're looking to learn more about ACLs, Tendons, Hips, Knees, Shoulder, Lumbar Spine, Thoracic Spine, Feet, Ankles, Hamstrings.. you name it... head to www.learn.physio and check out our collection of online Masterclasses from world leading experts to help you become the best clinician that you can be!