By: 1 October 2010

The fourth 'Sports & Exercise Medicine for London 2012' meeting in association with DJO Education held at the Royal Society of Medicine in London on September 24th was once again fully booked and attended by leading doctors and SEM practitioners from the UK and Europe.

From left: M Allen N Maffulli J Rompe N Padhiar S Owen Johnstone

Organised by Professor Nicola Maffulli, (Centre Lead and Professor of Sports and Exercise Medicine at Queen Mary University of London Centre for Sports and Exercise Medicine), the September meeting covered Tendinopathies and Compartment Syndrome and Chronic Exertional Compartment Syndrome (CECS).

Six lectures made up the morning's Tendinopathies session. They covered a range of topics from basic science of tendinopathy in human and equine athletes to evidence-based treatments, stimulating robust debates between speakers and delegates.

The first guest speaker, Graham Riley, (Arthritis Research UK Senior Research Fellow at East Anglia University), explained the complexities associated with the diagnosis and management of tendon problems – a basic primer for clinicians. He was followed by Consultant Radiologist, Dr Otto Chan who illustrated advanced imaging techniques for tendon problems. The latest news on tendon pathology and evidence-based conservative management were discussed by Dr Peter Malliaras, (Senior Lecturer on Sports & Exercise Medicine at QMUL), and Professor Jan Rompe, the leading ESWT (Extracorporeal Shock Wave Therapy) researcher, who had travelled from the Ortho Trauma Evaluation Center near Frankfurt in Germany, to make the case for treating tendon problems with ESWT.

Mesenchymal Stem Cell Therapy pioneered to help horses recover from tendon and ligament injuries was next on the agenda with Professor Roger Smith, Professor of Equine Orthopaedics at the Royal Veterinary College in Hertfordshire updated the group on how MSCT could help humans recover from Achilles tendon injuries. The morning ended on a surgical note with Professor Maffulli raising questions from a surgeon's perspective before questions and answers.

One of the delegates, Dr Pete Thomson, SEM Physician at Wimbledon Clinics in London, summarised the morning, pointing out that tendinopathy can still present challenges to both patient and physician. He said: “The patient wishes to know what you are treating and how to plan to get them better. As physicians, we know what we need to treat but we cannot clearly explain the 'how' – apologies if this sounds like a throw-back to the pre-enlightenment age. However, it is exciting to think that in spite of the evidence presented at the meeting, tendinopathy remains a descriptive condition where there is much to learn. Even in the 21st Century it appears that the humble tenocyte is very reluctant to give up its secrets. I personally believe molecular biology probably offers the keys that will unlock the mystery. My sense is that we are at the foot of a mountain from where we can see and describe possible routes to the summit namely the restored healthy tendon. But is there one route or many to the summit? Who knows. We still have a long way to climb.”

Professor Jan Rompe added: “A very instructive and comprehensive lesson on how to diagnose and to treat Achilles tendinopathy, bearing in mind that there still is a tremendous lack of understanding in the most adequate approach to the disease. Clearly, this is not the surgical intervention.”

After lunch, attention turned to Compartment Syndrome and CECS in both lower and upper limbs which opened with a lecture from Dr Nat Padhiar, Consultant Podiatrist and Honorary Senior Lecturer at QMUL, who focused on the foot and the measurement of intra-compartmental pressure (ICP) in diagnosing CECS. He was followed by Mike Allen, Consultant Surgeon – Musculoskeletal Directorate at Leicester General Hospital, who focused on CECS in the lower leg and Simon Owen-Johnstone, consultant orthopaedic surgeon at the Royal London Hospital, who discussed his surgical experience with CECS in the upper limb.

Dr Ali Jawad, Consultant Rheumatologist at Barts & The London, was not able to attend at the last moment, and Dr Padhiar deliberated on whether eosinophilic fasciitis (Shulman's Syndrome) was a cause of EILP (Exercise Induced Leg Pain). Professor Rompe demonstrated how ESWT could be used for the treatment of medial tibial stress syndrome. Professor Maffulli ended the session with a review of surgical management of CECS in the lower limb with time for more debate during the questions and answers. “There is no doubt that surgery remains a mainstay of management of chronic exertional compartment syndrome, and even in this field less invasive techniques are taking hold”, explained Prof Maffulli.

What became clear from the meeting was that the debate provoked as many questions as answers. Indeed, Professor Rompe felt the session was quite frustrating: “Neither diagnosis, nor treatment gave me a clearer picture.”

Dr Dan Roiz de Sa, CMO Environmental Medicine & Sciences at the Institute of Naval Medicine & Hon Senior Lecturer, Dept Sport & Exercise Science at Naval Home Command, was impressed by the quality of the day. “Having only attended the fourth day in this series of high level, multidisciplinary educational days for Sport and Exercise Medicine, I have to say I was disappointed to have missed the first three. This was not a 'sit and be taught the way to do it' session, rather it was very much a presentation of the current scientific and medical knowledge, and at the leading edge of managing these conditions some of this was bound to be controversial. The robust and challenging discussion between the audience and those presenting each session was exceptional. Debate and disagreement is always good for the advancement of both science and medicine; it is not always comfortable but it is in our patients and our future speciality's interest to get it right. The team at CSEM and DJO Education as the backers should be congratulated. Far too many other SEM educational days involve the same old presenters presenting the same old stuff and really add little to the future. This series appears to be very different and I suggest that any senior practitioner working with elite or serious amateur athletes or those involved in rehabilitation of military personnel should add the future DJO Education dates into their calendar.”

The next Meeting is on Friday 10th December where the topics will be Knee Injuries and Anti-Doping. This time, the sessions will take place in parallel in two rooms which means double the number of delegates (100) can be accommodated. For full information and to book, email or visit

For your diary, dates and topics of forthcoming CSEM-DJO Education meetings to be run by Professor Maffulli at Chandos House, RSM, London are:

  • 2010-2011 CSEM-DJO Education Meetings
  • 10/12/10 Anti-doping and Knee Injuries (6 hours CPD awarded by RCSEd)
  • 18/03/11 Head and Neck and Immunology of Exercise
  • 17/06/11 Rotator Cuffs/SLAP Lesions and Exercise Prescription
  • 23/09/11 Women's Soccer and Female Athletes
  • 09/12/11 Foot and Ankle and Core Stability