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Society in 1841 which started as a lending Over successive Games which had library so that farmhands could read years the Games been revived in about new agricultural advances, teaching became more Athens by a BASEM PEOPLE them to read when necessary. He was popular and rich merchant, motivated by the plight of the working attracted Evangelos classes, whose knowledge he wanted to competitors Zappas, an improve with lessons and interest groups from as far Albanian or ‘classes’ on a multitude of subjects, as Newcastle by birth but such as reading, writing, botany and art. and of ethnic But he also wanted to improve their health thousands of Greek origin. with physical activity. He admired the spectators, These events ethos of the ancient – that but they were only for ICONS OF SEM they were open to every grade of man, always started Greek speakers. ARTICLE BY GRAHAM HOLLOWAY ideals that were sadly lacking in with the However, in 1858 at that time. One of the classes he set procession. For Brookes sent a up in 1850 was the ‘Olympian class’ “for ease of transport, prize of £10 to be n this mini series we will look at some of the the promotion of the moral, physical and he bought a railway awarded to the winner Dr William Penny Brookes – iconic personalities who played a major part in intellectual improvement of the inhabitants company and had a railway of the Seven Fold Foot Race, the development of the specialty of sport and of the town and neighbourhood of line laid from the mainline to Much and the winner, Petros Velissariou, became Father of British Exercise Medicine? exercise medicine. Wenlock and especially of the working Wenlock with the station adjacent to the the first honorary member of the Wenlock IWe commence with Dr William Penny Brookes classes, by the encouragement of outdoor entrance to the sports field. One problem Olympic Class. By 1860 the Wenlock (1809–1895). Born in the town of Much Wenlock, recreation, and by the award of prizes he faced concerned prizes; the working Games were so successful that Dr Brookes in the heart of , he was the son of the annually at public meetings for skill classes needed prize money, especially founded the Wenlock Olympian Society local doctor and surgeon. Having trained firstly in Athletic exercise and proficiency in if they had to take time off work to and the Games moved around the towns as an apprentice to his father for 5 years from the Intellectual and industrial attainments”. compete, which would attract professional of Shropshire each year. In 1865, he was age of 15, he then studied at St Thomas’ Hospital, athletes country wide. On the other hand, also instrumental in setting up the National London and in hospitals in Paris and Padua, he first games were to take place the the upper classes did not need money and Olympian Association (NOA), based qualifying in 1831. same year and their announcement wanted medals to show off their prowess. in Liverpool, with John Hulley, a gymnast On learning of his father’s death he returned Treceived heavy criticism because and physical education entrepreneur and E to Much Wenlock to take over his father’s large of Brookes’ insistence that the Games THE WENLOCK OLYMPIAN SOCIETY G Ravenstein, the president of the German medical practice. Brookes was convinced of the were open to the working classes. People Dr Brookes so admired the Ancient Gymnastic Society of London. Their first benefits of exercise for children and adults alike for thought there would be a large number of Greek democratic ideals; that all men Olympian Games, a national event, held in the prevention and treatment of many illnesses and scantily-dressed young men performing were equal and able to vote and partake 1866 at The Crystal Palace, London, were a appreciated the link between physical and mental in front of women. It was felt that such an in sport, that he started communicating surprising success and attracted a crowd of

Day 1 strength. By observing men’s posture he could event would cause ‘drunkenness, rioting, with the organisers of a revised Olympic over ten thousand people. overnight camp deduce their occupation and realised that children lewd behaviour, and that men would leave needed to be trained physically from a young age their wives!’ Prize giving in preparation for a life of manual work. He spent Undeterred, on the chosen day, he his life striving to get Physical Exercise included in arranged for his ‘class’ to meet at the the curriculum of all schools, and for this alone he Town Hall and, headed by a band, the should be considered to be the Father of Exercise procession walked a mile through the Medicine in Britain. town and up a hill to the sports field where the competitions were to take WENLOCK AGRICULTURAL READING SOCIETY place, with a celebration in the town at He also realised that many children left school the end. Fortunately, the Games were a at 12 and were ill equipped academically as well huge success and none of the threatened as physically. He was the driving force in the disturbances occurred. The early events development of the Wenlock Agricultural Reading consisted of athletics and traditional country sports such as quoits, football and cricket. The highlight was an equestrian event, ‘Tilting’, where a competitor on horseback had to spear a ring suspended He spent his life striving to get from an overhead beam, the aperture of the ring being only one inch. Later Physical Exercise included in he would include cycling on penny farthings, bowls and swimming. It always the curriculum of all schools, included a fun event such as a blindfolded and for this alone he should be wheelbarrow race. Though the athletic events were mainly contested by adult considered to be the Father of males, there were children’s races and, for women, cookery and haberdashery Dr William Penny Brokes Exercise Medicine in Britain.” competitions and prizes for art, poems and essays, open to all.

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A young 18 year old THE 3 R’S n 1877, Brookes had The Wenlock cricketer, W G Grace He now started requested a prize for his Olympian was playing cricket for canvassing parliament, IGames, from Greece to Society England v Surrey nearby firstly by himself, then mark Queen Victoria’s jubilee. survives and after scoring 224 via his MP. He attracted In response, King George I today and not out in England’s total the interest of many of Greece sent a silver cup its Games of 521 asked his captain senior, high ranking and which was presented at the continue if he could be excused influential people from Shropshire Olympian Games to be held briefly to partake in many walks of life who held that year in Shrewsbury. annually in the games. In spite of supported his pleas to In 1881, Brookes was again the first two all the running he had get gymnastics added in contact with the Greek weeks in July, already done that day, he to the ‘3 R’s’ of reading, government, when he tried though cancelled entered the 440 yards writing and arithmetic. to instigate an Olympic in 2020 due to Covid-19. hurdles event and won His exercise classes Games in Athens open to Its president is Jonathan it in a time of 1 min 10 were included in the international competitors. Edwards, the triple jump world seconds. The Amateur Much Wenlock School Sadly this attempt failed as record holder. Athletic Club, consisting curriculum and as a Greece had many pressing The legacies of William of mainly Oxford and result, the health of the political problems. In 1889, Penny Brookes live on in both Cambridge athletes, pupils visibly improved. Baron physical education and in the objected to competing Neighbouring schools (1863-1937) organised an Modern Olympics Movement. His against lower class were impressed and International Congress remembrance plaque at Much ‘professionals’, so they added the exercises on Physical Education in Wenlock states “His life was subsequently became too. His pleas for Paris, with which Brookes devoted to the kind and skilful a rival organisation to them to be included contributed. Subsequently practice of his noble profession, the National Olympian nationally were listened Brookes invited Coubertin to the welfare of his fellow men, Association, holding to, accepted but he the Wenlock Olympic Games the service of his borough and their championships a was told that the the following year. He stayed county, and to the promotion of month before the NOA. current 3 R’s were several days at Dr Brookes PHYSICAL EDUCATION for the The NOA survived sufficient, to which residence and was greatly development of the manliness of until 1883 as a multisport Brookes responded impressed by the Games. the human race. His character was event and the Amateur that he would gladly On his return to France, Pierre-de-Coubertin remarkable for the high resolve Athletics club, which drop the gymnastics Coubertin gave a glowing steadfast purpose and untiring concentrated on if they included the account of his stay in an energy with which he initiated and events, 3 R’s of running, article, “Les Jeux Olympiques à Much Olympic Games in 1896 modelled on the carried out whatever he believed to be right amalgamated with riding and wrestling! Wenlock”, and referred to his host’s efforts Wenlock Games and was President of the and for the good of others.” other athletic clubs and Dr W G Grace It seemed that other to revive the Olympics. He wrote: “If IOC for the next 6 Games and it is he His contribution to the welfare of the became the Amateur pressing government the Olympic Games that Modern who is remembered as the Father people of all classes surely warrants Athletics Association. business would prevail Greece has not yet been able of the Modern Olympics. Sadly, his recognition as the ‘Father of British Once the Wenlock Games had become until William Gladstone, the Liberal to revive still Brookes died 4 months before Exercise Medicine’. established Brookes pursued his dream of Prime Minister, declared his fondness survives there the first games took place and getting physical education in the school He attracted the for physical exercise. In 1886, his son today, it is his contribution is not so well curriculum. School for under 12 year olds Herbert, also an MP, founded the National due, not to recognised although ‘Wenlock’ only became compulsory in 1870 and he interest of many Physical Recreation Society (NPRS) and a Greek, but was a mascot at the 2012 saw this as an opportunity. The following immediately invited Brookes to become to Dr W P London Olympics. year he attended the local school senior, high ranking a member of its Council. They worked Brookes”. armed with a tape measure and watch, tirelessly, especially after Brookes The following taking physical measurements of the and influential retirement from medical practice at the year Coubertin circumferences of arms, forearms, chest age of 80. sent Brookes and breath holding times of 12 schoolboys. people from many At last, Reginald Brabazon, the 12th a gold medal to 6 of them carried on their lives as normal, Earl of Meath, as president of the NPRS be awarded to the the other 6 doing additional regular walks of life who and a prominent member of the House winner of the Tilting gymnastic training, using a vaulting horse, of Lords, was able to steer a bill through Competition. They horizontal and parallel bars. the upper House of Parliament in 1891 communicated for Six months later he returned and supported his pleas which applied pressure on the House several years and measured them again. Whilst there was of Commons. Coubertin went on to little change in the limb circumferences in to get gymnastics They continued to campaign and set up the International either group, there was a striking increase eventually, in the Education Act of Olympic Committee in in chest circumference and breath holding added to the ‘3 R’s’ 1894, physical education was made 1894, with Dr Brookes ability in the exercised group. They compulsory in elementary schools. as an honorary appeared stronger and had suffered less of reading, writing Brookes, now 85 years old, and after founding member. Wenlock (left) and Mandeville the 2012 London Olympic ill health. He published his results widely more than 40 years of campaigning was Coubertin went on to mascots and added vaulting and horizontal bar and arithmetic.” proclaimed as the ‘Pioneer of Physical organise the first modern competitions to the next Wenlock Games. Activity for the Masses’.

www.basem.co.uk www.basem.co.uk 12 13 FINANCE: A PAIN IN THE NECK ARTICLE BY Ms HELEN HOW Innovative neurosurgery and Focus Shockwave intervention takes a severely compromised patient from under a life of pain and drug therapy to the road to recovery…

hen Michael Cornforth felt PREOPERATIVE TREATMENT some pain in his neck, he Mr Fouyas liaised with top Wreacted like most of us colleagues within his unit to ensure would. He rubbed it, put it down to that surgery was justifiable, despite the stresses of work and thought the associated risks. Michael was about taking a few painkillers. It also aware that surgery would not would all be ok in the morning. After provide an immediate solution, and all, what sort of damage can you do post-operative weakness could to yourself, when you’re a financial develop, necessitating lengthy director, who spends his working day rehabilitation. Michael needed at an office screen. Nothing atypical time to prepare for the complex therapy that had helped Michael been ordered to refrain from, at least Left: there, and Michael isn’t the sort of procedure. He would need specialist initially, could help get him fit after for a while. A picture speaks person who neglects his health. help to get ready. So, in a close surgery too. So, over the next volumes, He’s astute enough to balance his collaboration with Helen, Mr Fouyas as he said at the time, it felt like he’d four weeks, Michael made visits BEST CHANCE OF A FULL but doesn’t convey lifestyle with regular workouts in referred Michael back to her for been kicked in the neck by a horse. to her clinic, for a post-operative RECOVERY Michael’s the gym. preoperative Focus Shockwave His left arm felt weak and, suddenly, programme, designed to stimulate Nerve dysfunction does take a long volume of That though wasn’t how it was treatment similar as used in Europe it dawned on him that there may be healing around the neck, coupled time to heal. Mr Fouyas and Helen discomfort expressed working out for Michael. He’d been such as Norway. more to recovery than anyone would with intensive treatment to stimulate both agreed that strenuous activity when asked troubled by the growing discomfort The neurological nature of the have liked. response in Michael’s upper body carries too much risk in the short to raise his forearm. in his neck. Of even more concern, surgery hangs on successful healing, That was when he learned that and arms. term. For would-be gym-bunny he was losing mobility in his left with as little scarring as possible. Mr Fouyas had made a call to his Helen even referred Michael Michael, that’s where Shockwave Above: Balanced hand and arm. Despite seeking Using the specially developed wife, to explain that Michael’s for hyperbaric stimulation to help has been a post-operative boon. physique is professional help, he hadn’t found Focus Shockwave system, of which rehabilitation will be lengthy. further with nerve regeneration. In the same way as cosmetic an easy visual a solution. Helen is the sole practitioner in Although this could be a temporary Both the surgical team and surgeons refer the system, Helen indicator of the depth of Edinburgh, she worked with Michael condition, Michael might have Helen How were convinced that has been using her set-up to Above: his recovery PIONEERING SPECIALIST As a hairstyle, While other consultants had hoped to get his tissues into the best life-changing paralysis. Scar tissue the innovative combination of promote sub-dermal healing, so Michael’s quality of life had been it’ll never that conservative measures would possible readiness for his visit to the around the neck surgery might Shockwave, neuromuscular that the nerves have the best chance catch on, but crashing, he’d been sleeping only the skills of suffice, Helen realised that a more theatre. It’s the sort of preoperative mean that the nerves may not get stimulation, and hyperbaric of a full recovery. a few hours nightly, and his work the surgical radical intervention was needed. treatment that cosmetic surgeons the opportunity to regenerate treatment for the extensive muscle Eighteen months on and Michael team are in performance was as compromised evidence Turning to her long-standing consider, in order to give their successfully, and Michael may have atrophy would be the answer. is, by any measure, a new man. A as his physical wellbeing. That was professional associate, Mr Ioannis patients the best opportunities for a to deal with a pain-free life that resolute and determined patient, when he approached Helen How, Fouyas, she sent Michael across blemish free procedure. comes with considerable cost. n a delightful outcome, that’s coupled with a gradual and closely the Edinburgh based osteopath and Edinburgh to meet with the eminent Bringing together the stellar proving to be the case. Michael monitored clinical programme, and pioneering Shockwave specialist, who consultant neurosurgeon. From that team of surgeons was only going A STRICT REGIME Ihas been attending at Helen the occasional recommendation with a group of other osteopaths, point on, in a rare collaboration, to happen once, so the race was Over the next four weeks, Michael How’s clinic for an extended towards moderation, has curbed physiotherapists, podiatrists, and Helen and the surgical team worked on to get Michael prepped for his was placed under a strict regime of programme of Shockwave therapy, over exertion, and put him well down doctors have regular mentoring and in partnership to change Michael’s procedure. Helen was convinced that recuperation and close observation. and has been showing some the road to recovery. continual professional development life for the better. Shockwave was the only system that Recovery was tough going. Crucially, remarkable improvements. The results Michael has with Storz Medical, Switzerland Even for an experienced would get the results fast enough he was still dependent on drug Critically, he’s been recovering experienced, through Mr Fouyas’s who researched and developed the neurosurgeon, the case presented to make the conjunction of time, therapy and showing poor response movement and use of his left hand, surgical team and Helen How’s equipment and techniques. considerable difficulties. Struggling place and patient all coincide. When to the partial paralysis. Mr Fouyas arm and shoulder to an almost Shockwave and rehabilitation have Over the years, Michael had with debilitating pain and an Michael reached Mr Fouyas’ theatre, wasn’t prepared to accept that as an full extent, even if the road to full convinced him that the journey to developed a severe nerve increasing regime of drug therapy now he was a ready as he could be for the outcome, and to his credit, neither recovery has a way to go yet. recovery was possible, and he’s been entrapment condition. It was including gabapentin, Michael was six hour marathon. was Michael. Michael’s C5 C6 C7 nerve taking every important step, one at apparent to Helen that prolapsed running out of options. Conductivity In a further collaboration, Mr dysfunction meant he has sustained a time. disks were contributing to her tests had shown that three crucial ll surgery carries a risk, and Fouyas referred Michael back to Helen some muscular atrophy. Being a Now with full functionality in his patient’s severe discomfort and neck disks and nerves would need neurosurgery carries as great for a more extensive programme responsible, active man, who doesn’t cervical peripheral nerves, which compromised reflexes. treatment. Specifically the C5, C6 and Aa risk as any. Yet, much to of rehabilitation, based on the take middle age lying down, he’s have regenerated with strength and Helen knew she could help, but C7 locations, all of which carry high his relief and that of the team, when Shockwave therapy that had proved keen to get back to gym fitness as stamina for full daily life activities in she also knew Michael would also risk for the patient. This was going to Michael woke up, he had sensation in so effective in the pre-op stages. soon as possible. Counterintuitively both his arm and shoulder, Michael need something more. be complicated surgery. every part of his body. It’s just that, Helen knew that the Shockwave though, that’s been something he’s can get on with his vigorous life.

www.basem.co.uk www.basem.co.uk 14 BASEM PEOPLENEWS BASEM PEOPLE 15 STAYING ON TRACK THROUGH A PANDEMIC: A REPORT ON MEASURES TAKEN TO REDUCE RISK OF COVID IN FORMULA 1 A TEAM DOCTOR’S PERSPECTIVE… Places where Covid-19 could enter the F1 bubble ARTICLE BY DR ALEXANDER MCFARQUHAR - FORMULA MEDICINE Below, we focus on measures to prevent the virus The tests use PCR analysis of material from the upper entering, and measures to limit the spread of the virus. respiratory tract to screen for covid antigens and this is Covid-19 has proven difficult to contain with numbers still rising in many places in particularly useful in the early detection of covid-19 in asymptomatic patients. This screening method, far from the world. With the global pandemic set to continue into the winter, the question Measures to prevent the virus getting ideal, is one of the only measures that can be used to into F1 bubble identify coronavirus and reduce the chance of its entry of how we keep a covid-free environment in Formula 1 is crucial in order to protect • Face masks at all times (FFP3 / N95) provide and spread through the paddock. This means that as a greatest protection). Changed daily procedure, it is likely to continue for the year. people’s health and livelihoods, and those of their colleagues too. Whilst the procedure has its clear upsides, the down • 3-5 daily swab testing with results sent to teams in sides are now starting to become more apparent. order to isolate positive tests at hotel rather than Swab testing is an invasive procedure with NHS fter several months track to reduce transmission guidelines suggesting nasopharangeal testing should of lock down, The F1 be used in combination with oropharyngeal testing (2.) season restarted in July • Alcohol gel after breakfast on getting into van for the most accurate result. This method, however, with a European ‘triple can have a significant impact on people’s work. The Aheader’! But things were different. • Cleaning of steering wheel dread and disruption to daily work is clear. In several Fewer crowds, fewer press, fewer cases, nasopharyngeal testing is so uncomfortable corporate personnel, and a feeling • Temp check on entering the van that oropharyngeal testing is the only appropriate of apprehension. The glitz was on alternative. Whilst some studies suggest oropharyngeal hold, but it was still time to get • Travel with windows open (and no air con) to testing is an inferior method of testing (3), other studies (4) down to the business of racing! The maximize ventilation with van have suggested the superiority of oropharyngeal swabs covid pandemic has meant changes for certain virus detection e.g. adenovirus and 2009 to the way many teams operate in • Clean change of clothes daily to reduce H1N1. In the same study (4) oropharyngeal testing was the paddock this year. Measures transmissions on fomites deemed inferior (vs nasopharyngeal swabbing) in the have been put in place to curb the detection of influenza B and parainfluenza virus. spread of the infection and are being For this reason, a combination of NP and OP swabbing rigorously implemented by the FIA Measures to prevent the virus entering is considered the only safe option. this season. With small improvements the paddock: Owing to the need for compliance with continued being constantly made by each testing, urgent further research in the area will be individual team, the sharing of best Temperature checks required in order to understand if OP swabs can practices in a secretive environment Vietnam, often held up as a makes Formula 1 a high risk sport Temperature checks are carried out daily on entry to produce as reliable a result as NP swab testing, in the where hundredths of a second often ‘shining light’ for its low infection for spread of the virus. Here we the paddock area. One of several measures brought context of covid-19. A large research study (including count, is vital. rates, has used a combination of examine how the virus may enter in to pick up symptoms and reduce the chances of detection of positive cases using NP Vs OP methods) After a positive covid case in symptom checks (temperature), the paddock, and measures taken to contamination and transmission of the virus. The will reliably guide swab testing methodology and Melbourne brought the season to an mass masking, regular testing, limit its spread. surface temp checks are carried out with an infrared allow optimisation of comfort whilst not compromising abrupt pause, July saw a tentative isolation, contract tracing and lock thermometer pointed towards the forehead. reliability of testing in a world where progress and restart to the F1 season. Regular downs (1). F1 has shared many of A TYPICAL DAY IN FORMULA 1 efficiency is key. swab testing, face mask use and the problems experienced in other A typical day in formula 1 involves Regular Swabs testing sub grouping are just some of the countries in terms of outbreaks travel from the hotel to the track in One of the main measures brought in by the FIA in a Hand washing measures brought in by the FIA to and spread of the virus. In fact, groups, followed by a day’s work at bid to screen for covid cases is swab testing. With a It is proposed by Jayaweera et al (6), that there are 3 reduce the risk from SARS-COV-2. the movement of the teams across the track and then travel back to the mandatory requirement of swab testing every 5 days, modes of transmission of covid-19. Droplets transmitted Lessons can be learned from borders and through multiple team hotel in the evening. some teams have further stretched their screening on ‘fomites’ (clothes, utensils, furniture), aerosol/ several countries in their approach countries together with consistent This is the routine from Tuesday program to 3 daily in a bid to pick up any asymptomatic air borne droplets, and self-inoculation (of the nasal to stemming the spread of covid-19. travel within enclosed environments, up until Sunday’s race. cases earlier. mucosa by contaminated hands).

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Regular hand washing using tried and tested methods (7) isolation and re-testing, as well as early identification of Sub grouping It remains to be seen what further impact coronavirus is crucial in reducing the chances of the virus particles contacts. Vigilance from medical personnel for common Sub grouping is a crucial part of limiting the spread of will have on this (and next) season’s Formula 1 calendar. initially breaking into the F1 bubble. Hand washing is also symptoms (fever, cough, shortness of breath, fatigue, any virus outbreak in F1. But with subgrouping, swab testing, social distancing, necessary to protect the individual from spreading the headache, rhinitis, sore throat, anosmia, ageusia, skin contact tracing, risk assessments, early isolation, early virus particles from fomites to their own mucosal surfaces rash, peripheral cyanosis) is also key in the process of detection measures, screening for early symptoms and (mouth and eyes). Together with hand washing, 24 early testing and isolation of potential cases. facemask use, we can see the implementation of robust hourly washing of clothes will be essential to reduce the measures to battle the virus and keep the race season potential for picking up and transmitting virus particles. Suspected cases on track. It is clear that the aforementioned symptoms are wide Face masks ranging and therefore an efficient, robust process is There is a multitude of guidance on the use of required in order to rapidly test (or retest) patients with References: facemasks. Currently, WHO recommends masks to symptoms or inconclusive test results. This reduces their limit the transmission of SARS-CoV-2 (5). In the context risk of transmission by immediate isolation and limits 1. Vietnam’s response to COVID-19: prompt and of aerosol generating procedures (ENT examinations, isolation time, returning individuals to work asap, in the proactive actions. Dinh et al intubation, CPR), masks including N95, FFP2 or FFP3 event of a negative repeat swab test. are suggested. In all other cases, medical masks are Having seen this method tested at several times 2. https://www.england.nhs.uk/coronavirus/ recommended by the WHO, as they have 95 % droplet during the season, the process of isolation and re-testing wp-content/uploads/sites/52/2020/03/ filtration.(5) The FIA has suggested a medical face mask is pivotal to reducing risk of transmission with any guidance-and-sop-covid-19-virus-testing-in-nhs- of the level: EN14683:2019+AC:2019 as a minimum suspected case or positive test result. Any suspected A team’s ability to manage a positive case has been laboratories-v1.pdf requirement for use (9). cases should be managed with full PPE (medical mask, pivotal this season. With accurate subgrouping, it Further research into mask use (6) shows that FFP3 or gown, gloves, eye protection) with an escalation to N95 is possible to segregate groups in the event of any 3. https://www.cebm.net/covid-19/comparative- N95 masks are best at limiting the spread of infection. or FFP3 in order to limit the spread of infection. outbreak and thus limit spread. This allows for isolation accuracy-of-oropharyngeal-and-nasopharyngeal- Their routine use, whilst not crucial according to of small groups during which time, repeat testing can swabs-for-diagnosis-of-covid-19/ the world health organisation (if a medical mask is Isolation be carried out to check for viral spread and confirm available), is best in order to reduce infection rates in As formula 1 teams move through countries, local negative swabs and therefore fitness to work. 4. Comparison of Nasopharyngeal and enclosed environments like those seen in transport vans, guidelines take precedent over FIA code of conduct. Oropharyngeal Swabs for the Diagnosis of airplanes and garages throughout the paddock. In Austria, local guidelines allowed for teams to leave Early contact tracing Eight Respiratory Viruses by Real-Time Reverse It must be noted that any mask containing material their hotels and enter their local environments to eat, Early contact tracing has been essential in order to Transcription-PCR Assays. Kim et al coverings introduces the concept of mask maintenance. drink and exercise. In Hungary, a ‘lock down’ meant reduce the risk of transmission in the event of symptoms Fabric must be cleaned 24 hourly and wet or soiled that teams were unable to leave their ‘bubble’(the or a positive swab test. It is hoped that sub groups 5. Advice on the use of masks in the context of masks should be cleaned/changed immediately. vicinity of the hotel) except to travel to and from the will form the majority of close contacts. Mask use and COVID-19. WHO. June 2020 track in subgroups. These local variations appear to social distancing ensures that individuals travelling to Measures to limit the spread of infection: reflect each country’s capacity for risk, with the risk of and from the track together are the most likely to be 6. Transmission of COVID-19 virus by droplets and F1 to the country deemed greater than the risk of the spending >15minutes in close proximity to one another, aerosols: A critical review on the unresolved Travel to and from the track country to F1. This appears to be somewhat accurate for thus being recorded as ‘close contacts’. dichotomy. Jayaweera et al Another potential place where covid 19 virus particles some of the European races where covid-19 numbers may be spread is during travel to and from the track. within the country are particularly low. As the season Social distancing 7. https://www.who.int/gpsc/clean_hands_ After research conducted by Jayaweera et a (6) into has progressed to Grand Prix in the more ‘high risk’ Of crucial importance in disrupting the spread of protection/en/ ventilation in confined spaces (cars, airplanes and health countries (those where covid-19 is more prevalent), infection is two meter social distancing. The FIA has care settings), it seems that keeping ventilation as careful vigilance has been paid to current corona virus produced guidelines to suggest that a 2m gap should be 8. Mitigation plan for 2020 Austrian grand prix. high as possible in these environments is best in order cases in that country, population densities and proximity maintained at all times. This is difficult given the work Return to motor sport in the context of the to reduce the risk of transmission and remove virus of team residents to in-country outbreaks. pressures within the garages and where safety could be covid-19 Pandemic particles from enclosed environments. Since ventilation compromised by maintaining this gap. within airplanes is an uncontrollable, ventilation in cars Risk assessments In this case, masks are recommended to curb the 9. FIA code of conduct can be more heavily focussed on. Better ventilation Risk assessments of countries hosting F1 events can spread of infection.Outside of the track (team hotels), is achieved by keeping the windows open and the air investigate population densities, location of in-country a 2 meter distance should be maintained at all times conditioning/ fan off. This reduces transmission(6) . outbreaks of the virus, current corona virus trends and (particularly between members of different teams and Jayaweera et al (6) do also mention that there may be location of tracks in relation to highly populated areas: different subgroups). a better chance of virus droplets being spread more in As Formula 1 continues to navigate through the temperate climates in E.Asia, Europe and N.America stormy seas of a global pandemic, adherence to the (humidity <50%, temp <25, ACH>60) than in tropical above guidelines is crucial in order to prevent the climates like SE Asia, Africa and S.America where virus penetrating the F1 bubble. With several positive humidity and temperature are higher. This concept is test results this season, the speedy and effective important in calculating the risk of virus spread during identification and isolation of affected individuals is travel to each individual host country. a credit to the processes put in place to manage the pandemic, reducing the impact of coronavirus on the Early identification of positive case sport and the Formula 1 community. As previously mentioned, swab testing is at the heart of early detection of covid-19. If a positive sample is received, information is relayed to the teams so that the individual in question does not leave the team hotel in

the morning, limiting their contact with others, and risk Reference: WHO daily coronavirus cases- of spreading infection. This event will trigger immediate https://covid19.who.int/region/euro/country/hu

www.basem.co.uk www.basem.co.uk 18 DO YOU WANT TO ENHANCE YOUR MSK SKILLS? ARTICLE BY DR MARTYN SPEIGHT FFSEM Are You feeling frustrated/limited in your skill set, when faced with a complex MSK case load? Are you weary of seeing another MRI scan of a low back pain patient that does not offer any clear structural explanations? Have you thought of post graduate training in Osteopathic/ Manual neuromusculoskeletal Medicine at the London College of Osteopathic Medicine?

f some of the above sounds familiar the neuromusculoskeletal system and b) offering post graduate osteopathic to you, spend a little longer to reflect the functional (pathophysiological) and medicine training to qualified medical on what you can do to enhance your structural (pathomorphological) basis of practitioners. It has it’s foundations in skill set for managing MSK cases. With dysfunction of the neuromusculoskeletal American medical osteopaths from 1911, Excellence in postgraduate osteopathic training for doctors since 1937 I the relatively recent introduction of “ system. Pathophysiological disturbances entitled British osteopathic association, Experts in musculoskeletal medicine”, into are classified using the accepted later establishing the osteopathic the SEM title, this may well be the case international term “somatic (or association clinic in Westminster in 1927, for the structuralist/pathoanatomical segmental when applied to the spine) then moving to its current location in DO YOU WANT TO reductionist approach to patient care. dysfunction.” The recognition, diagnosis Boston place (which at the time had a But what about dysfunction of the and management of these reversible connection to Dorset square). After world neuromusculoskeletal system? dysfunctional states, manifest clinically war two In 1945, the second generation of BROADEN YOUR PRACTICE Do you feel equipped to recognise, as reduced joint mobility, tight muscles, American medical osteopaths founded the diagnose and manage such a disorder? disturbances of the autonomic nervous London college of Osteopathic medicine, Whichever practitioner in an MDT setting system and abnormal neurodynamics, with a charter of holistically treating WITH ENHANCED MSK SKILLS? is managing these cases, it behoves all differentiate the discipline of MSK soldiers injured in the war. team players to have an understanding medicine form rheumatology and Osteopathy in the UK is regulated of the key diagnostic feature, to ensure orthopaedic surgery. (Hutson M, like Medicine and Dentistry. The LCOM that the most appropriate management Fundamentals of MSK medicine, Oxford course operates part time over 84 weeks. Gain more practical skills and the ability to diagnose & treat is implemented. Whether you work in textbook of MSK medicine, 2nd ed, 2016, The course is delivered as 4 modules: 1) an NHS MSK clinic, elite sports team/ with permission). Foundations of osteopathic medicine, a MSK conditions in our 18-month medical osteopathy course club setting, or in your own independent So what could you do to enhance your distance learning section, over 12 weeks, private practice, a clear and detailed skills? You could consider sitting in a clinic requiring 3 hours learning per week. 2) understanding of neuromusculoskeletal with a medical practitioner who is trained Introduction to clinical osteopathy, an medicine, is a key foundation to optimal in neuromusculoskeletal manual diagnostic intensive block of two 6 day periods of management of MSK cases. / treatment skills to gain insights into their clinical work at the LCOM. 3) & 4) Two work, as well as attending modular courses Clinical apprenticeship periods, each UNDERLYING CONCEPTS on such skills (these are widely available covering a period of 39 weeks, attending MSK medicine has emerged from a on the web). A more clearly structured/ Fridays and Saturdays at the LCOM. background of orthopaedic medicine, systematic approach, would be to attend Total number of hours are: Contact (non manual medicine and osteopathic attend the 18 month part-time osteopathic -clinical) 384, Contact (clinical) 780, Central London Small Groups Professional Recognition manipulative medicine. The distinctive medicine course at the London college of Non-Contact: 360. TOTAL: 1524 hours. and underlying concepts of MSK Osteopathic Medicine. Further information/course fees etc, is LCOM is located in Marylebone Teaching is via small group LCOM is approved to medicine are: a) the scientific basis of The college is unique in the world, available at lcom.org.uk/studywithus London & our clinical course and interactive learning teach osteopathy by GOSC runs 2 days a week (on Fridays with highly trained & & has Recognised Dr Matteo Bernardotto o give some useful insights into the MSK skills needed to broaden. I was growing & Saturdays) over 18 months. experienced faculty. Qualification RQ status. experience of a Sports and Exercise frustrated by the over-reliance of on diagnostic TMed icine doctor who has recently imaging at the expense of clinical skills. I was also (completion 2019) trained at the LCOM impressed by the ability of many physiotherapists and just two months ago, was appointed and osteopaths to provide “hands on” treatment What our graduates say: as Consultant in Sports & Musculoskeletal to athletes to complement their structured Medicine at the London Hospital for rehabilitation programme. I therefore felt that “My skills in diagnosing & managing MSK “I realised it would add a valuable dimension integrated medicine, I asked Dr Matteo manual medicine should be an essential skill set conditions has improved immeasurably as a result to my work as a sport & musculoskeletal Bernardotto the following questions: for all SEM physicians and I explored how to attain of the LCOM course. I now have an understanding (MSK) doctor, particularly the ability to better such training. My search led me to find LCOM, & a skillset which allows me to treat these conditions assess MSK problems and provide manual 1) At what stage in your postgraduate which provides the world’s only osteopathic directly & successfully in NHS general practice.” treatment during consultations.” training did you decide to do the LCOM course specifically for medical doctors. After training and why? a discussion with the course director, I knew it Half way through my SEM training I felt my would be a good professional investment. For more information, contact course director Tracy Davies [email protected] and visit our website www.lcom.org.uk www.basem.co.uk 20 BASEM PEOPLE 21

2) Do you feel that the LCOM 5) Do you have any advice for an MSK CASE HISTORY AND QUIZ training fulfilled your training SEM doctor who wants to expand ARTICLE BY DR JOHN TANNER MSK AND SEM PHYSICIAN needs and expectations? on their MSK assessment and The 18-month training was intense but treatment skills? I would like to describe 3 cases of rewarding. The small group tutorials, I would strongly recommend the 1-to-1 supervision and the large volume LCOM course to any SEM doctor that shoulder pain and dysfunction… of patients seen in the teaching clinic wants to expand their MSK expertise. proved to be an excellent platform The combination of osteopathic and to nurture my MSK diagnostic and SEM principles is a strong synergy to treatment skills. I felt my clinical improve clinical examinations assessments were more functional and diagnosis. and holistic, complementing well the In addition, the ability to deliver biomechanical model typically used in hands on treatments such as SEM. Over time my manual dexterity, manipulations makes clinical practice or “manual literacy”, improved more interesting and satisfying, for dramatically, allowing me to deliver both the doctor and the patient. osteopathic manipulations safely Osteopathy or manual medicine and effectively. Once I completed is sometimes unfairly seen as the exit exams, I was also able to complementary medicine, despite register with the General Osteopathic Dr Matteo Bernardotto being supported by a large body Council and practice these new skills of evidence, studies and clinical independently and to a high standard guidelines. as a recognised professional. However, my experience of learning Image 1: T2 weighted MRI oblique R shoulder Image 2: Ultrasound posterior shoulder Looking back at my training at these skills has been thoroughly 3) What would you say was the positive, and I would heartily CASE 1 CASE 2 Image 3: Ultrasound of the posterior shoulder most useful part of your overall LCOM, what stands out is the recommend it to those with the A 42-year-old man who was a squash A 19-year-old tennis player presented experience at the LCOM and what intellectual curiosity to look at the player competing at club level with persistent pain in his right shoulder CASE 3 impact has this had on your day to dedication of the clinical whole spectrum of opportunities presented with the complaint of on overhead actions such as serving A 69-year-old male golfer presented with day clinical work? tutors, who provided support within SEM and MSK medicine. weakness on back hand strokes and and smashes. He had had physiotherapy moderate discomfort in the right deltoid A pivotal learning from the LCOM mild discomfort in the shoulder region. focussed on strengthening his rotator region during the windup and follow course was the ability to perform a and guidance throughout the 6) Any other comments about your It had become progressively worse over cuff, improving thoracic rotation and through phases of the swing. He could more comprehensive and detailed programme. ” LCOM experience? the previous few months. posture and scapular positioning, which manage a full round and the symptoms MSK assessment for patients. This Looking back at my training at LCOM, Examination revealed wasting of had not helped. Examination indicated tended to fade within a few hours. He strengthened my diagnostic acumen what stands out is the dedication the infrascapular muscle mass, a some posterior shoulder discomfort had intermittent pain during dependent and allowed me to embrace a truly of the clinical tutors, who provided full passive range of motion of the at full active elevation, absent painful arm swing when walking. Examination integrative and holistic approach, addressing all the different support and guidance throughout the programme. glenohumeral joint, full active elevation arc, full range of passive glenohumeral revealed discomfort towards the end factors underpinning a patient’s condition more effectively. I am also very thankful to the school directors, who allowed of the shoulder in the scapular plane movement and full power on isometric of passive range of both rotations and From a treatment perspective it has been refreshing to me the flexibility to continue the course without impacting my with no painful arc, and normal power testing. An ultrasound scan (image glenohumeral abduction and some provide focused and effective point-of-care manual treatment SEM training rotations. I have developed good friendships with on resisted isometric abduction with 2, above) was performed showing a loss of power only external rotation, to patients during consultations, complementing well the students I trained with and I continue to feel part of the arm by his side but weak on resisted normal rotator cuff but an unexpected absent impingement signs, and positive standard SEM interventions such as exercise prescription and school with their regular post-graduate masterclasses and isometric external rotation. Other finding in the posterior region which O’Brien’s test in the thumbs up position. rehabilitation advice. This has greatly benefited the therapeutic CPD activities. isometric tests showed full power. led to MRI investigation. A subsequent An Ultrasound scan showed the cause relationship with my patients, who have generally shown An MRI was arranged (Image 1, above) sonographically guided procedure close to the spinoglenoid notch (image better understanding of their condition, engagement with Thanks to Matteo for the above insight. I would just like to which revealed the cause and he was performed in the clinic resulted in 3, above), and a simple image guided rehabilitation, treatment satisfaction and clinical outcomes. expand on the reference in part 4 above, to the ESSOMM, referred to a shoulder surgeon. resolution of his symptoms. procedure resolved his symptoms. who in September 2018 issued the following; European 4) What opportunities have you had as a result of doing core curriculum “manual Medicine” methodological the LCOM course? recommendations and contents for the european postgraduate Completing the LCOM course opened many opportunities. training and qualification for the additional competence manual QUESTIONS: I developed a strong interest in back pain, and I was able to take medicine for european specialists. up a position in the MSK and manual medicine department at (http://doi.org/10.1007/s00337-018-0453-y). 1) What is most likely diagnosis common to all three cases? the Royal London Hospital for Integrated Medicine (RLHIM). 2) Describe the types of pathology associated with this abnormality and their usual locations. I am now not only more confident in managing a challenging group of patients with complex and chronic MSK pain, but I also Anyone wishing to discuss any of the above, please contact me 3) Name the nerves that can be involved and their muscle innervation. enjoy it more. This was a great platform to continue practicing at the details below; my osteopathic skills and help develop a new SEM consultant 4) Describe the image guided procedure performed in an outpatient setting. post in the NHS. In addition, I have been involved with the Dr Martyn Speight, MSK/Sports Physician, Osteopath. 5) What is the risk of recurrence following the US guided procedure unless the underlying pathology is addressed. European Scientific Society of Manual Medicine (ESSOMM), The Wharfedale Clinic, Barden House, to establish an Europe-wide training framework in manual 50-52 Park Road, Guiseley Leeds, LS20 8AN. medicine and help it become a recognised subspeciality. www.thewharfedaleclinic.co.uk In fact, whereas manual medicine or physiatry is already a [email protected] Please send yours answers to Nicky Birkinshaw - [email protected] recognised speciality in many western countries, the UK does 01943 850950 not yet have a recognised training pathway for doctors. 07947367302 The winner will receive a £50 Amazon voucher from BASEM

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