Sport Health Volume 41 Issue 4 by Sports Medicine Australia

Sport

health VOLUME 41 ISSUE 4 2023

FEATURING

• Challenges when researching the menstrual cycle (and why we need to do it anyway) • 2023 ASICS SMA Conference: A Recap • Performance and physiology adaptations of repeatedsprint training with blood flow restriction

Contents REGULARS

FEATURES

From the Chair SMA Board Chair, Dr Kay Copeland, reviews the 2023 ASICS SMA Conference and the 60th Anniversary celebrations.

The Future of Sports Medicine To conclude our 60th Anniversary commemorative series, we spoke with six Conference delegates about the future of sports medicine.

08 Frequently asked questions regarding breast injuries in female athletes

Associate Professor Deirdre McGhee examines common questions about breast injuries experienced by female athletes.

From the CEO Jamie Crain recaps key achievements from the year and announces the 2024 Conference.

12 Performance and physiology adaptations of repeatedsprint training with blood flow function James Mckee reviews the literature regarding the effectiveness of repeatedsprint training with blood flow restriction.

Opinions expressed throughout the magazine are the contributors’ own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made in advertisements nor the quality of goods or services advertised. All materials copyright. On acceptance of an article for publication, copyright passes to the publisher.

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Publisher Sports Medicine Australia Melbourne Sports Centre. 10 Brens Drive Parkville VIC 3052 sma.org.au ISSN No. 2205-1244 PP No. 226480/00028

Copy Editors Archie Veera and Anelia du Plessis Marketing and Member Engagement Manager Sarah Hope Design/Typesetting Perry Watson Design Cover photograph The Image Bank/Donald Miralle Content photographs Author supplied; www.gettyimages.com.au

Volume 41 • ISSUE 4 • 2023

17 2023 ASICS SMA Conference: A Recap

INTERVIEWS

We review session highlights and celebrate the brightest minds in sports medicine and exercise science from this year’s ASICS SMA Conference.

29 5 Mins With: Professor Gordon Waddington

32 21

Sports Medicine Around the World: Argentina

Challenges when researching the menstrual cycle (and why we need to do it anyway) Dr Brianna Larsen shares her assessment of the difficulties with conducting meaningful menstrual cycle research in female athletes.

36 People Who Shaped SMA: Dr Stephanie Hanrahan

26 Supporting Student Athletes at UniSport Nationals 2023 We discuss injury outcomes and the experiences of SMA sports trainers at this year’s UniSport Nationals.

39 Sports Trainer Highlight: Nita Walker

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FROM THE CHAIR

Wrapping up a successful 60th year of Sports Medicine Australia. DR KAY COPELAND, CHAIR OF THE BOARD OF DIRECTORS (SMA), REFLECTS ON THE RECENT SMA CONFERENCE AND 60TH ANNIVERSARY CELEBRATIONS.

elcome to our final edition of Sport Health for 2023.

It has been one year since I was elected as Chair of the Board of Directors for SMA and what a busy year it has been. Our 60th Anniversary celebrations have been a noteworthy feature throughout this year as we’ve acknowledged and reflected on our past as an organisation. These celebrations culminated at the 2023 ASICS SMA Conference with Dr Rodney Whitely delivering the esteemed Refshauge Lecture where he discussed the legacy and future of sports medicine. At the Gala Dinner, I reflected on the history of SMA and the enormous contribution by so many members of our 60-year history. I doubt that the early members could have envisaged the breadth and depth of what SMA is now and the amazing foundation they put in place that has created a legacy for all involved in the broad areas of sports medicine and science. I would like to congratulate all the Award winners who were recognised

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I would like to congratulate all the winners and recipients who were recognised at this year’s Conference.

at this year’s Conference. The calibre of research was exceptional and made deciding the winners an immensely difficult task for our judges. I am also delighted that our Research Foundation Grants were once again presented in 2023. We received several high-quality submissions and are honoured to award grants to five recipients. This year there was a WA Gender Equity Grant that was an outcome of funds raised at a WA event. Congratulations to all these recipients and we look forward to updates on your research.

The ASMF Fellows Dinner at the Conference saw the induction of three new fellows, Kellie Wilkie, Dr Ebonie Rio, and Dr Liam Toohey. I wish to thank the new Fellows for their contributions to SMA over the years and welcome them into the Fellows. Our AGM at the Conference elected two new Board members, Associate Professor Anthony Leicht and Dr Samantha McLeod. I look forward to working alongside the Board and SMA’s staff to ensure the continued implementation of our Strategic Plan in 2024. I hope all SMA Members have enjoyed taking part in our 60th Anniversary celebrations this year and are excited to see what 2024 has to offer. In particular, I eagerly anticipate welcoming you all to the 2024 Conference held jointly with the Australasian College of Sports and Exercise Physicians at the MCG from 16-19 October.

Dr Kay Copeland

FROM THE CEO

Celebrating the 2023 SMA Conference and looking towards the new year. SMA CEO JAMIE CRAIN LOOKS BACK ON THIS YEAR’S CONFERENCE AND SUMMARISES THIS EDITION’S FEATURE ARTICLES.

Recently, we concluded the 2023 ASICS SMA Conference at the Novotel Sunshine Coast Resort. With over 460 delegates in attendance, the event brought together a unique multidisciplinary membership from across the country and globe to listen to the latest research and information in the field of sports medicine. It was a massive success and I thank ASICS for their unwavering support of the event. We at SMA look forward to jointly hosting our 2024 Conference with the Australasian College of Sport and Exercise Physicians (ACSEP) at the Melbourne Cricket Ground from 16 -19 October. It promises to be one of our biggest events in recent years and one that shouldn’t be missed. This quarter saw the release of the 2022/23 Annual Report. We are proud to share that we have hosted 36 professional developments events, symposia and workshops, with almost 2,000 registrations across these events. Our Safer Sport Program maintained a high level of

As we look towards 2024, we are committed to continuing the successful implementation of our strategic plan and improving our performance in all areas.

accreditation with over 10,000 qualified sports trainers nationally, and for the third year running, we delivered a surplus to members. As we look towards 2024, we are committed to continuing the successful implementation of our strategic plan and improving our performance in all areas with additional investments in new membership services.

In our final edition of Sport Health for the year, James Mckee investigates the effect of blood flow restriction on repeated sprint training, and we recap the recent UniSport Nationals held on the Gold Coast. In recognition of our ongoing collaboration series with the AIS Female Performance & Health Initiative (FPHI), we are pleased to have two FPHI experts present articles related to the unique experiences and considerations required for research involving female athletes. Associate Professor Deirdre McGhee answers frequently asked questions about breast injuries, whilst Dr Brianna Larson outlines the difficulties with researching athletes’ menstrual cycles. We thank all our members for your ongoing support in SMA’s 60th year and look forward to many exciting initiatives in the coming years.

Jamie Crain

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SPECIAL FEATURE

The Future of Sports Medicine THIS YEAR MARKS SMA’S 60TH ANNIVERSARY AND THERE’S BEEN MUCH TO CELEBRATE. THROUGHOUT THIS YEAR, WE HAVE LOOKED BACK ON THE PAST 60 YEARS OF SMA’S HISTORY AND REFLECTED ON THE MANY HIGHS AND LOWS THROUGH A SERIES OF ARTICLES IN SPORT HEALTH. IN THIS EDITION, WE SOUGHT TO ACKNOWLEDGE THE IMPORTANCE OF THE PAST WHILST ALSO STARTING TO LOOK TOWARDS THE NEXT 60 YEARS OF SMA. WE SPOKE TO SIX DELEGATES AT THIS YEAR’S 2023 ASICS SMA CONFERENCE TO HEAR WHAT THEY HAD TO SAY ABOUT THE FUTURE OF SPORTS MEDICINE AND EXERCISE SCIENCE.

DR BRADY GREEN What does 60 years of SMA mean to you? It makes me reflect on the history and the legacy supporting and underpinning what we’re doing here. It also provides a context for us to push forward and keep moving, and improving and advancing how we can work together, the research that we can do, and then our clinical practices across all disciplines involved within SMA. What do you think is the future of Sports Medicine? We can consider things like big data and improving how we collect data 4

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to support what we do clinically. Certainly, the utilisation of technology and analytics supporting our ability to do that from a research perspective. Hopefully, that will also support teams being able to share knowledge and work together, and form partnerships with industry and community led groups to improve what we do. But also, not losing sight of implementation, and a clinician’s ability to do that and interpret data and make really good decisions in the management of their patients and prevention of conditions for their patients. I think that’s where the future should hopefully be; marrying up improvements scientifically with the human element of it.

EMERITUS PROFESSOR JULIE STEELE What does 60 years of SMA mean to you? Given that I’ve been involved in SMA for about 40 years, it’s been an integral part of my history as an academic. I still remember in the early to mid80s, I attended one of my first SMA Conferences and I was trained as an exercise science biomechanist. I was sitting and watching the five orthopaedic surgeons on the stage discussing their own techniques to repair an ACL. I’d been involved with biomechanics societies and my biomechanics research was on ACLs, but this was something different because I’m now hearing a surgeon’s perspectives on ACLs, and then I could go listen to a physio’s perspective on rehab. So, it gave me an incredible grounding in the breadth of application of my own research, but also informed my research to be much more critical because previously I was in this little silo. SMA is one of the few professional organisations in Australia and worldwide that really allows you to step outside your discipline and create those connections. I then actually spoke to one of those top orthopaedic surgeons, and I witnessed one of his

SPECIAL FEATURE

surgeries and later did research in his laboratory which gave me access to patients I couldn’t previously get access to. I think that multi-disciplinary ability to go outside your boundaries is crucial and that’s continued from being a junior academic, right through to being senior. What do you think is the future of Sports Medicine? I’ve sat at the conference listening to a couple of keynotes and various free papers, and I’m really hopeful and really positive towards the future because I can see the next generation coming through. I think the whole concept that exercise is medicine across the broad spectrum, not just athletes. I saw papers yesterday on osteoporotic women and we’ve seen lower back pain discussed, and the constant message is how important exercise is. But we need the practitioners here at SMA’s Conference to learn this information, and then to go and train the trainer, so to speak, in terms of educate their colleagues, and educate the public that medicine in the form of tablets isn’t necessarily the best option. That you have this wonderful thing, this prescription, which could be exercise, that can really cure so many ailments or help to. So, I see SMA really driving the education and the research for the general population in trying to come up with a healthier future, in many ways. Additionally, what was thrilling yesterday, I sat there in the afternoon in a whole session on the need for research of women. In the past, if we look at many research studies, it’s all been based on men or there’s a few token women thrown in. I don’t mean that in a derogatory way and the session was positive. The session was about these are the gaps, so how do we address and come up with some fantastic future protocols to ensure that the needs of women are addressed. I thought that was a really positive push. The SMA Conference really looks to the future, really acknowledging that we are made of diverse cultures, age, gender, all these things, and we have to be inclusive. But I can see SMA as inclusive of all these professions, also being inclusive within the research.

DR RYAN TIMMINS What does 60 years of SMA mean to you? I think it’s a professional body that represents a whole range of disciplines. SMA has helped advance not just sports medicine but exercise science, dietetics and a range of other things that we’ve taken for granted, and I think having that professional body to do that has been pretty good. What do you think is the future of Sports Medicine? I think integrative AI and how AI actually works into the whole space. I believe we’re still going to have athletes that want to run faster and jump higher and they’re still going to get injured. I think we need to find better ways to manage and monitor them without being intrusive. So, how do we integrate technology to do that, without having to do 15 questionnaires a day? I think that’s where we might end up. Maybe we’ll swallow a pill one day and it will give us all the metrics in one. So, I think there’s going to be a bit more technological advancements than we have previously had.

SIMONE MUSCAT What does 60 years of SMA mean to you? 60 years of SMA for me means 60 years of collaborative, multidisciplinary care with a closely connected community that is so supportive in the goals and bettering of health of our patients and furthering the profession effectively. So, for me it’s 60 years of advancements, policymaking and progress within the sports medicine community. What do you think is the future of Sports Medicine? I reflect on Rod’s Refshauge Lecture as to the future of physio and sports medicine, and I hope the field

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SPECIAL FEATURE

The Future of Sports Medicine continues to evolve. I’m looking forward to the next 60 years of SMA and also to contributing and watching the community grow. In terms of the next 60 years for sports medicine, I hope it’s what we’ve done for the past 60 years but even more effectively. I want to see further patient-oriented research for injury prevention and for performance enhancement with collaborative care at the core of it.

DANIEL PATTERSON What does 60 years of SMA mean to you? I would say it shows the dedication to research and developing continually by providing that knowledge to a wide range of health professionals. It’s so good to see world leading experts here at the Conference and that shows how each year it’s gotten better and better and more respected. So, I’d say it’s a pretty big feat. What do you think is the future of Sports Medicine? I would say the future is more collaborative, especially between allied health and the medical field. I would say allied health need to understand the role of sports physicians, surgeons, and the medical side of things and then vice versa. I think a lot of the talks we’ve had here at the Conference have been from surgeons, physios and the like, all on the one talk, and they share the symposium so I would say the future is mainly collaboration. But also, more evidence based because we’ve come a long way. I’m a physio and it’s more and more evidence driven. So, I would say this Conference is feeding into that.

DR TANIA PIZZARI What does 60 years of SMA mean to you? I think it shows what a robust organisation it is that it’s survived over those years and obviously grown immensely over that time, as well. I’ve been involved for the last 20 years, and certainly for me, it’s been an organisation that’s provided a lot of support, a lot of education, a lot of networking opportunities, and the potential for career progression opportunities. So, to be able to contribute all of that over 60 years for so many individuals is a fantastic achievement. What do you think is the future of Sports Medicine? At this point in time, the massive explosion in technology and particularly artificial intelligence will be

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a massive part of sports medicine, as it will be throughout every other industry. It’s going to be important as to how we utilise that to ensure that it works for us and is a positive thing rather than a negative consequence. I think sports medicine will continue to develop in terms of evidence. After coming to conferences over 20 years, I’ve seen the change in the evidence and the change in participation in research and the continued focus on ensuring that we’re coming from a very evidence-based background, but also not losing the art of sports medicine as well. I think that’s really important too. So, continuing to do what everyone at this conference does really well, and continuing to foster new people coming through as well as continuing to advocate for the entire profession so that everybody is valued. I think that’s a really important thing in sports medicine.

FEATURE

Frequently asked questions regarding

breast injuries in female athletes ASSOCIATE PROFESSOR DEIRDRE MCGHEE

What is a breast injury? A breast injury is the result of a blow or impact to the breast that causes breast pain, swelling and bruising. It is a newly identified female-specific sports injury.

Photo: Nerthuz/ gettyImages

How common are breast injuries in female athletes? Because they have only recently been identified, only lifelong prevalence and prevalence/per season data have been collected. Robyn Tyler (Breast Research Australia (BRA), University of Wollongong) presented her research on breast injuries in women’s rugby league at our SMA National Conference in October. Of the 255 rugby league players surveyed, 35% had sustained a breast injury in the previous season, and 80% had more than one injury. Research conducted by BRA of 504 elite female athletes from 46 different sports found the lifelong prevalence of breast injuries in contact and combat sports (44%) was higher compared to non-contact sports (26%). From this research, we know breast injuries occur. We are currently investigating the incidence of breast injuries across several contact sports to provide evidence of how frequently these breast injuries occur. This research will enable us to guide sporting organisations and female athletes on the relative risk of sustaining a breast injury within each sport. 8

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Photo: sutlafk/ gettyImages

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How do breast injuries occur? We also have minimal data on the mechanism of breast injuries. Within the football codes, rugby union, rugby league and Australian football, the most common mechanism reported was impact with another athlete2. The other common causes were impact with the ball and the ground2. Variation was found in the percentage of each mechanism amongst these codes2, suggesting the mechanism is sportspecific. In sports such as cricket and softball, most breast injuries were caused by impact with the ball during batting or wicketkeeping. How severe are breast injuries? Most female athletes report that they continued to play their sport despite their breast injury. This suggests that most breast injuries are not severe enough to cause an athlete to miss training or competition. A high percentage of athletes, however, reported that their breast injury negatively affected their performance by limiting their ability to run, perform forceful movements of their arms and mentally focus on the game. It also made them reluctant to dive and tackle. The negative impact on performance is not surprising, considering the pain intensity associated with breast injuries. In community rugby union players, research presented by Ruby Dang (BRA) at our SMA National

Breast injuries should be managed like any other sports injury, with global, evidence-based prevention strategies.

Conference in October reported the mode pain intensity of breast injuries was a moderate level, which for approximately half the players lasted one to seven days. Breast bruising and swelling were associated with 65% of injuries and lasted one to seven days. Are there any long-term consequences of breast injuries? For breast injuries sustained in women’s sports, there is minimal data on the long-term consequences of these injuries. Robyn Tyler’s data on rugby league players reported that 7% had long-term consequences. There is more research on breast trauma sustained

during motor vehicle accidents from impact with a seat belt of a car. The most common long-term consequence reported in this research is breast fat necrosis, which causes scarring within the breast, resulting in fibrous or calcified lumps. These lumps are not breast cancer, and previous breast trauma is not a risk factor for breast cancer. Breast fat necrosis, however, can present like breast cancer in clinical imaging and clinical examination. Dr Bronwyn Kennedy, a Sydney-based breast physician, spoke about this in the SMA webinar on breast injuries (March 29th, 2023). A medical review and additional investigations are required to differentiate breast fat necrosis and breast cancer. It is, therefore, important that breast injuries are reviewed and monitored by a doctor to ensure complete breast tissue recovery. There is also case-study evidence of breast trauma causing breast deformities due to the halting of breast development during puberty and the bursting of implants, and damage to the milk ducts and breastfeeding mechanism in lactating breasts. It is essential for female athletes to be aware of these potential consequences of breast injuries but also understand that these consequences are rare (i.e., are case study data only). Sports clinicians and women’s sporting organisations need to ensure VOLUME 41 • ISSUE 4 2023

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Frequently asked questions regarding

breast injuries in female athletes female athletes are educated about breast injuries to ensure they report them to enable these injuries to be treated and monitored for breast tissue recovery and to prevent longterm consequences. Education will also enable female athletes to make informed decisions to protect their breasts during sports. Why is it important that female athletes understand breast cancer awareness? Dr Bronwyn Kennedy, during the SMA webinar on breast injuries (March 29th, 2023) reinforced the importance for female athletes to be familiar with the “normal” look and feel of their breasts to enable breast tissue recovery to be monitored after a breast injury. Bronwyn stated: “Every woman needs

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to know the “normal look and feel” of their breasts because women’s breasts do not all look and feel the same”. Indeed, our research (Breast Research Australia) of female athletes involved in cricket, rugby league and rugby union has found they have poor knowledge and understanding of breast cancer awareness. The AIS Female Performance and Health Initiative Breast Health Module (www. ais.gov.au/fphi/education) provides simple instructions on breast cancer awareness and self-examination. Bronwyn also stated: “It is vital for all women to be familiar with the “normal look and feel” of their breasts because early detection and treatment of breast cancer is essential for effective management”. Why have breast injuries have only recently been identified? Breast injuries have been called “silent” sports injuries because most breast injuries (~90%) are not reported to coaching or medical staff 1. The lack of reporting has been attributed to:

1 Sensitivity of female athletes discussing breast-related issues with male coaches and medical staff. 2 Injury surveillance systems in women’s sports that do not enable breast injuries to be recorded. 3 Lack of awareness amongst female athletes that breast injuries can be treated and have long-term consequences1, 2. The recent explosion of female participation in sports that have been traditionally for males only, such as rugby league, rugby union, and Australian football, has also provided greater exposure and opportunity for women to sustain impact injuries to their breasts. Can breast injuries be treated? Yes, breast injuries can be treated! The benefit for a female athlete to report a breast injury immediately after it occurs is that the pain can be relieved, and the acute soft tissue injury (bruising and swelling) can be treated with physiotherapy. This will enhance

FEATURE

The negative impact on performance is not surprising, considering the pain intensity associated with breast injuries.

and speed up breast tissue recovery time and limit the risk of long-term consequences, and the negative impact breast injuries are known to have on athletic performance. Women who play on with these breast injuries are true warriors! If they report their injuries, however, we can help them immediately so they can continue to play with a higher level of performance and with less pain, more confidence and protection. They need to let their sports trainers, physiotherapists and doctors help them to perform at their best and look after their breasts. Robyn Tyler’s research will educate sports trainers in the QRL to manage breast injuries, and I have been training physiotherapists and sports doctors. I have written assessment and treatment protocols accessible in a review article on breast injuries (doi. org/10.1016/j.clinbiomech.2023.106031). Assessment and Treatment guidelines will also be in a new chapter on breastrelated issues in female athletes in the 6th edition of Brukner and Khan’s Clinical Sports Medicine. To view a recording of the SMA and FPHI Webinar on Breast Injuries (March 29th, 2023), scan the QR code below.

Can breast injuries be prevented? Female-specific breast protective equipment is currently available for women to wear as a preventative measure; however, there is currently no evidence that any product on the market can attenuate the force that a breast experiences during a breast injury. Our research (BRA) found only a minority of female athletes in the football codes wear breast protective equipment. Although most perceived it increased their confidence, there were issues with fit and wearability. High-support sports bras that hold the breasts firmly to the chest wall are also perceived in multiple contact and combat sports to protect from breast injuries. Breast injuries should be managed like any other sports injury, with global, evidence-based prevention strategies. World Rugby is currently funding us to research breast injuries in the Australian Women’s Rugby Union to provide them with evidence-based prevention strategies. We are using a similar approach in several other women’s contact sports to guide these sporting organisations on sport-specific prevention strategies and assist them in developing guidelines and recommendations about breast protection.

Moving forward, how can we improve the management of breast injuries in female athletes? 1. Raise awareness that breast injuries occur in women’s sports to encourage the reporting of breast injuries. 2. Include in player welfare programs education about high-support sports bras, breast injuries and breast cancer awareness to inform athletes how to protect their breasts, manage breast injuries, enable breast tissue recovery to be monitored and minimise any adverse effect of breast injuries on athletic performance. 2. Upskill doctors, physiotherapists, and sports trainers to assess and treat acute breast injuries and coaches to develop female-specific skill-training strategies to prevent breast injuries. 3. Modify injury surveillance systems in women’s sports to enable ongoing surveillance of breast injuries. 4. Continue research into breast injuries to develop sport-specific evidencebased prevention strategies. For article references, please email info@sma.org.au

Author Bio Associate Professor Deirdre McGhee is a Fellow of the Australian Sports Medicine Federation, an APA Titled Sports and Exercise Physiotherapist and Director of Breast Research Australia, University of Wollongong. She is a world leading researcher in breast pain, breast injuries and breast protective equipment for female athletes. She also teaches musculoskeletal anatomy and pathology in Graduate Medicine and the School of Medical, Indigenous and Health Sciences at the University of Wollongong.

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FEATURE

Repeated-Sprint Training with Blood Flow Restriction Innovation or Madness?

Photo: jacoblund/ gettyImages

JAMES R. MCKEE (2023 ASICS SMA Conference Best Poster Winner – Sports and Exercise Science)

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epeated-sprint training with blood flow restriction (BFR) may sound like a modern form of torture for athletes. However, the fine margins in high-level sport demand that players pursue innovative training strategies to gain potential performance advantages over their competitors. This novel training method is designed to improve repeated-sprint ability, which reflects the best average performance that can be sustained across a series of short-duration sprints (≤ 10 seconds), separated by incomplete recovery periods (≤ 60 seconds). Not only do team-sport players perform a considerable volume of sprint bursts in-game (~20 to 60 sprints of approximately 2 to 3 seconds mean duration), but sprinting is reported to be one of the most common actions completed prior to crucial match moments, such as scoring a goal. Indeed, many standout players are often defined by their speed, power, or agility capabilities, thus, developing the ability to resist fatigue and sustain sprint performance is highly relevant. Typically, right before the start of pre-season, every coach in the world will tell their high-performance staff; “this year I want us to be faster”. These words are uttered at under-14’s level all the way through to senior sporting grades. Coaches don’t care how you plan to get it done (as long as it is legal and doesn’t interfere with their drills), or what you actually do to achieve it (considering you don’t injure anyone). Therefore, developing repeatedsprint ability is of significant interest to athletes and practitioners alike.

that few methods allow you to induce such a large ‘metabolic stress’ during training to challenge your body in a different way to the norm. Indeed, low-, high-, and maximal-intensity exercise under hypoxic conditions increase the relative internal load (i.e., metabolic stress) and reduce external loads (i.e., mechanical power output) when compared to traditional exercise at equivalent intensities. To train with system hypoxia, teams may venture on a pre-season camp at a location of high altitude, but typically sessions are performed in elaborate laboratory environments that are capable of simulating extreme elevations. Research has shown that completing repeated sprints at moderate simulated elevations of 2000-3000m may provide the optimal ‘trade-off’ between inducing a potent physiological stimulus for adaptation and minimising acute decrements in performance. A majority of studies applying moderate systemic hypoxia during repeated-sprint training report further improvements in repeated-sprint ability compared to equivalent training performed at sea-level. Interestingly, performance and physiology improvements with systemic hypoxia commonly occur despite reductions in absolute training quality (i.e., lower

A majority of studies applying moderate systemic hypoxia during repeated-sprint training report further improvements in repeatedsprint ability compared to equivalent training performed at sea-level. power outputs produced during training itself). Therefore, training with hypoxic methods may also be suitable for athletes that cannot tolerate high external loads including those rehabilitating an injury. However, if you haven’t heard of many teams training with systemic hypoxia, then that is probably because it can be expensive, with just a single hypoxic generator often costing > USD 2000. Like many sporting teams, if your staff are fighting for scraps or begging the manager to pay out for an extra roll

Studies have investigated the inclusion of systemic (i.e., altitude exposure) and localised (i.e., BFR) hypoxia during repeated-sprints, as strategies to lower oxygen availability and provide a large stimulus for physical adaptation. The beauty of implementing hypoxia is VOLUME 41 • ISSUE 4 2023

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Repeated-Sprint Training with Blood Flow Restriction Innovation or Madness?

of rigid strapping tape, then utilising this beneficial training method is not exactly realistic. Therefore, much of my research focuses on exploring more accessible and cheaper alternative hypoxia strategies that can potentially mimic the success established by incorporating systemic hypoxia during repeated-sprint training. Traditionally applied during resistance training, BFR induces localised hypoxia with inflatable cuffs worn around the top of the legs that reduce blood flow to and from the limb. As illustrated below, we recently proposed a theoretical framework outlining how BFR training may promote key physiological adaptations to improve repeated-sprint ability. Specifically, repeated-sprint ability can be improved by eliciting adaptations which target the physiological factors limiting performance. This includes the ability to rapidly supply energy or produce force during sprints. Phosphocreatine must be recuperated to fuel sprints,

and its partial restoration during recovery periods is strongly influenced by an athlete’s aerobic fitness and their capabilities to deliver oxygen. Furthermore, waste products (e.g., lactate and hydrogen ions) accumulate during sprints and are detrimental to muscle function, so enhancing their removal during recovery periods will better sustain force production during subsequent sprints. Surprisingly however, no published research has currently investigated whether repeated-sprint training with BFR can further improve repeatedsprint ability compared to unrestricted training, thereby supporting our proposed framework. Our research group recently conducted a training study with semi-professional and amateur team-sport players to answer this very question. This series of studies are currently under journal review, so unfortunately, we are not able to share the specifics yet. Therefore, this article will outline key insights from my PhD research for implementing BFR during repeated sprints. Firstly, we have to understand how to best apply BFR during repeated-sprints to optimise the physiological stimulus and ensure safe implementation. Typically, cuffs applied during low-

Figure 1: Reused with permission from Wolters Kluwer Health, Inc.: Mckee et al. Repeated-sprint training with blood flow restriction: A novel approach to improving repeated-sprint ability? Strength Cond J, 2023;45(5):598-07. DOI: 10.1519/SSC.0000000000000771 ATP adenosine triphosphate, PCr phosphocreatine

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moderate intensity resistance training are inflated to 60-80% of the pressure required to completely occlude blood flow, or to a 7 out of 10 ‘tightness’ using elastic wraps. But I and many of my participants have discovered that repeated-sprint training can hurt, physically, mentally, and/or emotionally, so we suggest that cuffs (10-cm wide) should only be inflated to 40-60% of the total cut-off pressure to balance for the maximalintensity sprint demands. Partial restriction has been recommended to be implemented for a maximum of 20 minutes during exercise before releasing cuff pressure to allow for the safe reperfusion of blood. But importantly, considering that BFR must be balanced with the maximal intensity demands, continuous occlusive durations exceeding 5-10 minutes are unlikely to be necessary during repeated-sprints. Furthermore, most repeated-sprint exercise protocols can be easily completed within 15 minutes (excluding the non-occluded warmup period), as illustrated in Figure 2. Within the sample repeated-sprint session, you may notice that BFR is applied continuously during the sets. Alternatively, cuffs can be intermittently inflated just during the sprints or recovery periods alone. Considering that manually inflatable cuffs can take ~5-10 seconds each to pump up, continuous BFR is the most practical application method to implement during repeated sprints. However, automatically inflatable cuffs do exist at a substantially greater cost to easily manipulate the restriction form and subsequent physiological stimulus induced. Recently, we examined which BFR application method (continuous vs. intermittent) elicits the largest physiological stimulus for a given power output during repeated-

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Figure 2: Repeated-sprint exercise sample session

sprint exercise. Similar to research comparing the impact of differing elevations for systemic hypoxia implementation (2000-4000m), we report that the BFR application form can dictate the internal:external load ratio during repeated-sprint exercise. The pursuit of an optimal physiological stimulus during repeated-sprints with BFR may sound appealing on paper, but how do team-sport players actually perceive this exercise? Simply put, if the repeated-sprint BFR session is too difficult or painful, athletes are less likely to adhere to consistent training. In fact, repeatedsprint exercise alone can be nauseainducing for some individuals at the best of times (yours truly included). Therefore, recommended guidelines for cuff implementation should be closely adhered to. However, the overwhelming majority of participants undertaking a repeated-sprint BFR protocol similar to the above sample session comfortably completed the exercise, without reporting a deteriorated recovery. Therefore, the sample repeated-sprint session could serve as a good ‘tolerance test’ to ensure that participants can initially handle BFR. We actually suspect that high-performing amateur athletes or semi-professionals may benefit from more difficult repeated-sprint BFR protocols, which may include either longer sprints (~10 seconds), reduced work:rest ratios (1:2 or 1:3), or greater sprinting volume (20-25 total bouts).

Data from low-intensity resistance training indicates that BFR does not increase muscle damage or adverse blood clotting risk compared to unrestricted exercise. indicates that BFR does not increase muscle damage or adverse blood clotting risk compared to unrestricted exercise. Our research group received funding to further investigate the haematological safety of BFR during repeated sprints, and early data are

encouraging, but currently there is no conclusive answer. However, readers are highly encouraged to utilise the published risk assessment tool to determine if BFR exercise is safe or contraindicated for certain individuals. Abiding by appropriate BFR screening and application recommendations as suggested, and monitoring exercise (e.g., terminating the exercise if the athlete is dizzy or nauseous) is believed to support the safety of this intervention during repeated-sprint sessions. So… innovation or madness? Similar to the pioneer study first incorporating systemic hypoxia in 2013, it may take another 5-10 years’ worth of evidence to truly establish whether repeated-sprint training with BFR is innovative or not, but us researchers may very well drive ourselves to madness trying to figure that out. I would like to acknowledge Olivier Girard, Jeremiah J. Peiffer and Brendan R. Scott for their contributions in helping design my PhD projects and interpreting the study findings. Additionally, Daniel J. Hiscock, Kirsten Smedley, Kristen De Marco, and Alasdair R. Dempsey provided invaluable assistance with this research, which of course would not be possible without the efforts and commitment of my participants. For article references, please email info@sma.org.au

Author Bio James R. Mckee is a PhD candidate nearing completion from the discipline of Exercise Science at Murdoch University, Western Australia. He currently works as a strength and rehabilitation coach with Western Australian Football League players and teaches introduction to exercise science units for undergraduate students and registered training organisations. His research interests focus on developing conditioning strategies for athletes. This includes optimising high-intensity interval training to

Lastly, our research begs the question; is the application of BFR during repeated-sprint exercise safe? Data from low-intensity resistance training

maximise benefits in aerobic endurance and developing repeated-sprint ability in team-sport players.

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SPECIAL FEATURE

2023 ASICS SMA Conference A Recap O

ur annual Conference returned to the picturesque Novotel Sunshine Coast Resort in October, with over 450 delegates attending. The continued support from ASICS helped us deliver yet another successful event with a focus on research, innovation and excellence. We hosted seven exceptional keynotes, two invited speakers, eight workshops and nine symposia. Early and senior career researchers presented cuttingedge work, unveiling findings which prompted debate and discussion. A vibrant social calendar allowed delegates to connect and network. Day One kicked off with the coveted Refshauge Lecture delivered by Dr Rodney Whiteley. Rod reflected on his passion for the field and the

legacy we’re handing over to the next generation. This was followed by beach-side Welcome Cocktails, sponsored by SMA’s supporting partner, Mentholatum. Our Trade exhibitors also set-up to showcase their products and brand to industry leaders, decision makers and stakeholders within the sports medicine industry. Day Two commenced with an early morning run around Novotel’s lagoon and landscaped gardens, followed by workshops on ankle osteoarthritis and taping for the sporting back. Prof Margo Mountjoy delivered the day’s first keynote presentation on Relative Energy Deficiency in Sport (RED-S) and the new IOC RED-S Consensus Statement. Margo’s lecture attracted a massive attendance and media coverage with 7News Sunshine Coast

on-site. The proceeding presentations looked at pelvic health, foot function, bone strength and injury prevention. Keynote speakers Dr Andrea Mosler and Prof Paulo Ferreira presented on hip/groin pain and low back pain respectively. The day concluded with the ASMF Fellows Dinner at which we welcomed our new Fellows – Dr Ebonie Rio, Dr Liam Toohey and Kellie Wilkie – and celebrated SMA’s 60th Anniversary. Day Three featured morning workshops on hip and groin pain, ACL rehabilitation and an ASMF/ SMA Fellows mentoring session. Prof Margo Mountjoy and Dr Andrea Mosler delivered a popular presentation on female athlete injury prevention, followed by symposia covering concussion, exercise podiatry, ACL injury prevention

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2023 ASICS SMA Conference A Recap and hamstring muscle injury management. The afternoon focused on paper presentations and a special symposium where delegates heard from experienced athletes about their journey in elite sport, ups and downs, and how and where their Performance Team has added value. The day ended with the Scientific Poster session where the best posters were recognised and awarded. Huge thanks to Heal with Laser for sponsoring this session. Day Four saw the last of our clinical workshops on shoulder injuries, calf endurance and video-analysis in sport. Keynote speakers, Prof Julien Périard, Prof Cristina Caperchione and Prof Anne Tiedemann presented on the impact of heat on health and performance, culturally appropriate physical activity for priority populations and physical activity for healthy ageing. The afternoon’s Best of the Best Awards celebrated the Best Paper winners across clinical sports medicine, sports and exercise science, sports injury prevention, physical activity and health promotion, and women in sport. The Conference concluded

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with the Gala Dinner where A/Prof Joanne Kemp won the esteemed ASICS Medal for Best Paper Overall, presented by Sam Chew, General Manager Product at ASICS. Our sincere thanks to all Conference partners, supporters, sponsors and exhibitors – ASICS, Sunshine State Council, Visit Sunshine Coast, Deep Heat Mentholatum, JSAMS/Elsevier, Strapit, Gallagher, BJSM, SEPA, Bared Footwear, VALD, Heal with Laser, Health Smartz Online, Clarius, Emily Braidwood, Ascent Footwear, fisiocrem, The University of Queensland, Australian Catholic University, Whiteley

Medical Supplies and MGC Diagnostics. We thank everyone who attended and made the Conference what it was - an environment of collegiality, warmth and knowledge sharing in the multidisciplinary field of sports medicine. We’re delighted to announce that the 2024 Conference will be a joint effort between SMA and the Australasian College of Sport and Exercise Physicians (ACSEP). See you at the Melbourne Cricket Ground from 16-19 October 2024.

SPECIAL FEATURE

Award Winners ASICS MEDAL FOR BEST PAPER OVERALL A/Prof Joanne Kemp

WENDY EY AWARD FOR BEST PAPER (WOMEN IN SPORT) Jodie Dakic

EARLY CAREER RESEARCH AWARDS Ken Maguire Award for Best Paper (Clinical Sports Medicine) Dr Rachael McMillan

SENIOR CAREER RESEARCH AWARDS ASICS Best Paper (Clinical Sports Medicine) A/Prof Joanne Kemp

John Sutton Award for Best Paper (Sports & Exercise Science) Maddison Kirk

ASICS Best Paper (Sports & Exercise Science) Dr Shelley Keating

ASICS Best Paper (Sports Injury Prevention) Vanessa Sutton

ASICS Best Paper (Sports Injury Prevention) Prof Kay Crossley

ASICS Best Paper (Physical Activity & Health Promotion) Free Coulston POSTER AWARDS ASICS Best Poster (Clinical Sports Medicine) Frédérique Dupuis

ASICS Best Poster (Sports Injury Prevention) Theresa Heering

ASICS Best Poster (Sports & Exercise Science) James Mckee

ASICS Best Poster (Physical Activity & Health Promotion) Boden Tighe

People’s Choice Award for Best Poster Dr Samual Kayll

My highlight was catching up with colleagues and visiting the Sunshine Coast. I like the small nature of the Conference; not too large that you run into others multiple times over the days. It was great! – Conference delegate VOLUME 41 • ISSUE 4 2023

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2023 ASICS SMA Conference

Honour Board – SMA Annual Conferences List of SMA’s National Conferences since the first Conference was held in 1965.

2023

Novotel Sunshine Coast Resort, Sunshine Coast

1993

Melbourne

2022

RACV Royal Pines Resort, Gold Coast

1992

Perth

2021

e-Conference

1991

Canberra

2019

Twin Waters Resort, Sunshine Coast

1990

Alice Springs

2018

Perth Convention Centre, Perth

1989

Melbourne

2017

The Westin Hotel Langkawi, Malaysia

1988

Sydney

2016

Melbourne Cricket Ground, Melbourne

1987

Adelaide

2015

Sanctuary Cove, Gold Coast

1986

Brisbane

2014

National Convention Centre, Canberra

1985

Ballarat

2013

Hilton Phuket Arcadia Resort and Spa, Thailand

1984

Perth

2012

Sydney Convention and Exhibition Centre, Sydney

1983

Canberra

2011

The Esplanade Hotel Fremantle, Fremantle

1982

Surfers Paradise

2010

The Sheraton Mirage, Port Douglas

1981

Sydney

2009

Convention and Exhibition Centre, Brisbane

1980

Hobart

2008

Hamilton Island Convention Centre, Hamilton Island

1979

Hawaii

2007

Adelaide Convention Centre, Adelaide

1978

Adelaide

2006

Shangri-la’s Fijian Resort, Fiji

1977

Singapore

2005

Melbourne Convention & Exhibition Centre, Melbourne

1976

Broadbeach

2004

Alice Springs Convention Centre, Alice Springs

1975

Perth

2003

Canberra Convention Centre, Canberra

1974

Melbourne

2002

Carlton Crest Hotel, Melbourne

1973

Hobart

2001

Burswood Casino, Perth

1972

Adelaide

2000

2000 IOC Pre-Olympic Congress, Convention & Exhibition Centre, Brisbane

1971

Surfers Paradise

1999

5th IOC World Congress, Sydney Convention & Exhibition Centre, Sydney

1970

Melbourne

1998

Adelaide Convention Centre, Adelaide

1969

Perth

1997

Canberra Convention Centre, Canberra

1968

Sydney

1996

Canberra Convention Centre, Canberra

1967

Adelaide

1995

Hobart

1966

Melbourne

1994

Brisbane

1965

Adelaide

VOLUME 41 • ISSUE 4 2023

FEATURE

Challenges when researching the menstrual cycle (and why we need to do it anyway)

Photo: Jomkwan/ gettyImages

DR BRIANNA LARSEN

ith the Matildas FIFA Women’s World Cup campaign that captured the nation, the Diamonds impressive victory at the Netball World Cup, and the Australian women’s cricket team winning the ICC Women’s T20 World Cup, there is no doubt that 2023 has been a golden year for Australian women’s sport. Not only on the world stage: we’re witnessing

a growth in participation numbers amongst women and girls in sports typically dominated by men, such as Australian rules football, soccer, and cricket, and attendance and viewership for women’s sporting events are reaching all-time highs locally and across the globe. Following the Matildas recent success, the Australian federal government pledged $200 million to go towards increasing media visibility,

improving equipment/facilities, and promoting initiatives to improve grassroots participation in girls and women’s sport. However, this long overdue increase in the promotion of women’s sport and investment in our sportswomen (and future generations of sportswomen) has put a spotlight on an issue that many in the sporting world have long been aware of – sports science research disproportionately favours men. VOLUME 41 • ISSUE 4 2023

FEATURE

Challenges when researching the menstrual cycle (and why we need to do it anyway)

Several recent reviews have highlighted the fact that women are significantly underrepresented in exercise and sport science research. Only ~34% of research participants in studies published in top sport and exercise journals are women, and only ~6% of published articles have a women-only participant cohort (compared to ~31% of studies that focus solely on men). This is important, as the results from studies that utilise male participant groups may not be directly applicable to female athletes, who experience menstrual-cycle related hormonal fluctuations that influence factors like fuel metabolism, cognition,

Photo: gorodenkoff/ gettyImages

Results from studies that utilise male participant groups may not be directly applicable to female athletes, who experience menstrualcycle related hormonal fluctuations.

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inflammation, and thermoregulation – all of which can influence exercise capacity. It should also be noted here that there is a lack of sports science research within trans and gender diverse athlete communities, as almost all existing research categorises participants according to the binary man/woman or male/female (though this does not automatically mean verification of sex was performed). While the majority of sport and exercise publications (63%) include mixed male and female participant cohorts, many of these studies (and indeed, some studies including female athletes only) do not appropriately ‘control’ for participants’ menstrual cycle status, which may draw into question the validity of the results. The outcome of this research imbalance? Most of the training practices we see in sport today are based on data from men. When we consider the recent success of our women’s sports teams, not to mention the almost

equal percentage of men (51%) and women (49%) competing at the most recent Olympics in Tokyo, it is important to question why men are still considered the ‘baseline’ in sport and exercise science research. The lack of research centering sportswomen has been noted not only by the scientific community, but by athletes themselves. Several recent media articles have quoted elite female athletes calling for more research to better inform their training and competition practices, such as the 2022 articles ‘Female athletes are calling for more research into periods. Here’s why’ (SBS) and ‘Research ‘gaps’ about periods, the pill and female physiology affecting women in sport’ (ABC). In particular, athletes have noted a lack of research and resources surrounding the menstrual cycle and how it may influence performance, despite the majority of female athletes reporting adverse performance effects associated with their menstrual cycle. As former Scottish swimmer and Olympian Hannah Miley said: “More research needs to be done, to help maximise potential with menstruation. This can future proof the health and wellbeing for many female athletes. Certainly from when I started swimming many years ago the information and support was just not there, currently it is a lot better - but it still needs to keep growing. This is not just for elite athletes, but for anyone taking part in sport”. Encouragingly, there are many signs that things are moving in a more positive direction in addition to the Government’s $200 million investment. More and more athletes are speaking about their menstrual cycle as it relates to their sports performance, a subject that was formally considered ‘taboo’. The Australian Institute of Sport established the Female Performance and Health Initiative in 2019, which provides evidence-based resources on a range of performance and health considerations for sportswomen and their coaches, such as the menstrual cycle and hormonal contraception, pregnancy, breastfeeding, and more. The all-white Wimbledon dress code was relaxed this year to accommodate women players who wished to wear

Photo: microgen/ gettyImages

FEATURE

Hormonal contraceptive users have a different hormonal profile when compared to women who have a ‘natural’ menstrual cycle.

coloured undergarments due to ‘period anxiety’. Finally, there is exciting sport science research currently happening in this space, with groups across the world now working to comprehensively answer the question: how does the menstrual cycle really impact sports performance? Unfortunately, this seemingly simple question is quite difficult to answer. Conducting research that appropriately accounts for the hormonal fluctuations that occur across the menstrual cycle can be challenging. There are two distinct phases that make up the menstrual cycle, the follicular and luteal phase (separated by ovulation); however, when looking at hormone concentrations across the cycle, there is substantial variation in the concentration of the female sex hormones, oestrogen and progesterone, within each of these phases. For example, during the early follicular phase (i.e., during a period), both hormones are very low

in concentration, whereas in the late follicular phase progesterone remains low but oestrogen concentrations rise significantly prior to ovulation. Similar hormonal variability is observed within the luteal phase. Moreover, the magnitude of these hormonal fluctuations vary even amongst eumenorrheic women. Given oestrogen and progesterone play a role in modulating many physiological pathways beyond reproduction, it’s important to consider, and in many cases ‘control’, the phase of the menstrual cycle in which testing is conducted when performing research with female athletes. If this is not done, it can be difficult to determine whether the research findings are due to the intervention being investigated or variability in female sex hormone concentrations within the participant group. Hormonal contraceptive users also have a different hormonal profile when compared to women who have a ‘natural’ menstrual cycle, as do women with menstrual cycle

dysfunction such as luteal phase defects or anovulatory cycles. Even within hormonal contraceptive users, there will be many different hormonal profiles displayed depending on the type of contraceptive used (e.g., one of the 30+ oral contraceptives available in Australia, contraceptive implants, injections, intra-uterine devices etc.) and the synthetic hormone(s) it contains (i.e., a synthetic oestrogen and progesterone, or a progesterone only). When you consider the high rate of hormonal contraceptive use (~50% of elite Australian female athletes) and menstrual cycle dysfunction amongst athletes relative to the general population, it becomes clear that there is likely to be substantial hormonal variability within any team or group of sportswomen. In practical terms, this can mean significantly longer and more expensive data collection, as the timing of research testing may need to be individually tailored to the menstrual VOLUME 41 • ISSUE 4 2023

FEATURE

Challenges when researching the menstrual cycle (and why we need to do it anyway) cycle (or hormonal contraceptive schedule) of each participant. This can limit or complicate the ability to do group research testing with a sports team, which may render recruitment and testing more time consuming than if the same study were conducted within men’s sport. Accounting for the menstrual cycle also relies on collecting menstrual cycle data from research participants, most commonly via daily menstrual cycle monitoring – this is often required for multiple menstrual cycles before research testing commences to ensure participants’ have a eumenorrheic (regular) cycle and to determine their cycle length, which can again extend the data collection period. Capturing menstrual cycle phase data can be done in several ways, the gold standard being the objective analysis of hormone data via blood collection. This can prove costly and can add to participant burden if they are required to attend commercial

pathology clinics at multiple timepoints across the menstrual cycle in addition to partaking in research testing. Given many sport science researchers have limited funding and feel pressure to maintain a high level of research productivity, it is perhaps unsurprising that more research has historically been performed with men, where testing may be able to be performed more quickly and cost-efficiently. Unfortunately, the research challenges presented mean that many of the studies that do focus on women have a small participant cohort and are statistically underpowered, use highly variable methodologies, and/ or have significant limitations in their study design (such as a lack of objective verification of menstrual cycle phase via hormone analysis). This makes it difficult to compare between studies and provide female athletes and their performance support staff with evidence-based recommendations to inform training. We also cannot ignore the role of sexism. It is not unreasonable to suggest that the lack of emphasis on understanding the role of the menstrual cycle in sport and the fact that ‘period talk’ remained taboo within

Photo: Robert Daly/ gettyImages

Giving our women’s sports stars the tools they need to keep winning and shattering records will continue to inspire younger generations of athletes.

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sport for so long (and arguably still does in some forms), is likely exacerbated by the fact that most sportswomen are coached by men. Historically, priority has also been given to boys and men’s sports in terms of participation opportunities, media attention, pay rates, sponsorship prospects, and funding for equipment and facilities. For instance, many women athletes hold down part-time or full-time jobs in addition to their sporting careers to supplement their income. The Australian Bureau of Statistics reports a median annual income of $67,652 for men classified as a sportsperson in Australia compared to $42,900 for women in the same category. These figures may also overestimate the income of many sportswomen as they are expressed as annual incomes, when many athletes in professional sports are actually on shorter-term contracts (e.g., 3-6 months). Having to work on top of sustaining their training and competition schedules means that many sportswomen are time-poor, leaving less opportunities to participate in research. My hope is that while there is a spotlight on women’s sport, we will continue to address some of these imbalances between men and women athletes and ultimately provide

FEATURE

sportswomen with equal participation opportunities, media attention, and renumeration for their efforts. While the task can be daunting, the sport science community (myself included) clearly need to conduct more high-quality research studies to understand the extent to which the menstrual cycle influences performance. To not do so would be doing our sportswomen a disservice, as currently there is very little consensus within the research to provide evidence-based recommendation as to how – or if – the menstrual cycle (or hormonal contraceptive use) will impact exercise performance. There are studies that have shown menstrual cycle phase or hormonal contraceptivebased differences in key performance parameters such as aerobic capacity and maximal strength. However, many other studies have shown no differences. The timing and magnitude of the performance changes that have been reported also vary from study to study, so synthesising the literature into useable recommendations that apply to all female athletes can be near impossible. What does seem clear is that there is a lot of individual variability in terms of how athletes experience their menstrual cycle and therefore there is unlikely to be a neat ‘one size fits all’ approach.

ahead of their competitors, whether that is through tweaking training or recovery protocols, nutritional strategies, or psychological approaches. And yet, when I conduct menstrual cycle educational sessions for athletes and coaches, too often I have to answer their performance questions with “it depends” or “we don’t really know yet”. I would like that to change. Firstly, in the spirit of fairness, because currently the specificity with which we can use research to guide our male athletes is substantially greater than what we can provide for our women and girls. Secondly – simply because I like to win! Australia is a proud sporting nation, and we often punch above our weight in terms of our performance in international competition, and as a sports scientist one of my passions is finding ways to give our athletes an even better chance of success. Finally, this isn’t just about elite sportswomen - one of the best parts of our women’s teams doing so well this year has been

the effect it has had on inspiring young girls to take up or continue pursuing sports (most probably dreaming of being the next Sam Kerr). Giving our women’s sports stars the tools they need to keep winning and shattering records will continue to inspire younger generations of athletes. Moreover, having accurate information about the role of the menstrual cycle in sport can benefit anyone with a period who engages in physical activity – sports science research in women can even be used as a launching pad to better understand the experiences of women performing physically demanding occupational roles, such as firefighting, police, or military work. So, while I have presented many reasons throughout this article as to why conducting research with women participants may be challenging, I firmly believe that the outcomes will be worth it. For article references, please email info@sma.org.au

Author Bio Dr Brianna Larsen is a Senior Lecturer of Sport & Exercise at the University of Southern

To help focus future research endeavours, there have been recent reviews published that provide guidelines for conducting rigorous research in female athletes that appropriately accounts for the menstrual cycle and/or hormonal contraceptive use, such as the 2021 review published in the journal Sports Medicine titled ‘Methodological considerations for studies in sport and exercise science with women as participants: A working guide for standards of practice for research on women’. Hopefully, the increased funding and participation opportunities we are seeing for girl and women athletes will also translate into more opportunities to conduct impactful research with these athletes. Elite sport is all about finding the ‘one percenters’ that may be able to nudge athletes

Queensland. She has an established track record conducting research and publishing journal articles on the menstrual cycle and hormonal contraceptive use in female athletes and currently leads the Australian Institute of Sport (AIS) funded project: ‘What do female athletes know about the menstrual cycle and hormonal contraception?’ (2023, $34,816). Dr Larsen has led educational workshops on the menstrual cycle/hormonal contraception for key industry stakeholders such as the AIS, Queensland Academy of Sport, and Swimming Australia, and has designed several education pieces surrounding reproductive health for stakeholders within sport (such as two infographic educational tools for Basketball New Zealand; 2021, 2022). She has supervised 5 Honours and 2 Masters students to completion, with 6 of those projects related to the menstrual cycle and/or hormonal contraceptive use in elite female athletes. She has gained national media attention as a subject matter expert on the menstrual cycle and exercise performance, including national televised interviews on ABC News Breakfast and ABC News 24.

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SPECIAL FEATURE

Supporting Student Athletes at

UniSport Nationals F

rom September 23rd to 29th, over 6,000 student-athletes representing 41 universities across Australia took part in the 2023 UniSport Nationals. Returning to the Gold Coast, Queensland for the first time since 2019, UniSport Nationals saw students compete across 31 different sports including water polo, hockey, basketball, and badminton. This year saw the addition of new sports AFL 9s, oztag, and rugby league 9s. SMA was proud to again be the official supplier of sports trainers for the event. Across the seven-day schedule, a total of 39 trainers took part with some travelling from as far as Tasmania and Western Australia to participate. This culminated in 1,637.25 hours worked over the entirety of the event. A wide variety of injury presentations

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were seen from minor bruises and sprains to hard tissue injuries. In total, 1,702 presentations were made to SMA’s sports trainers with the most common presentations including ankles (333), knee (312), foot (129) and shoulder (100). Throughout the weeklong event, sports trainers removed 45 athletes from play as they were suspected of sustaining a concussion. For many trainers, the 2023 event was their first time being involved with UniSport Nationals. When asked why he wanted to attend, Robert Ferguson said, “This is the first time that I’ve been to this type of event. I did not know what it was like or what to expect which is why I wanted to take part. It’s been quite an enjoyable experience.” For Howard Tam, he revealed that he was excited to take

SPECIAL FEATURE

2023

My expectation was that there was going to be a lot more injuries than what there has been. The reality is the players are quite good, so it hasn’t been too bad. - Renae Morrisey

part in UniSport Nationals because it was the first time he had gotten to attend a large national event and he was able to gain new experience. UniSport Nationals provided some trainers with an opportunity to continue engaging with sports they had previously participated in themselves. Howard shared that he had previously taken part in badminton and was now covering the sport at UniSport Nationals. He stated, “I really enjoy the game, so it’s been fun to be here and see such an amazing competition.” Trainers also appreciated the chance to assist at sports they hadn’t previously covered. Robert has been a sports trainer since 1995 and has primarily looked after

boxers. At the UniSport Nationals he provided coverage for basketball and volleyball. When asked about his experience he said, “This is completely different to boxing and I’m finding it very interesting. It’s a totally different type of sport for me.” Across the board, all trainers shared a positive sentiment about the

experience and highly recommended for others to take part in the 2024 edition. In particular they highlighted the opportunity to take part in an event held on a national scale, the ability to connect with and learn from other experienced sports trainers, and the chance to get experience across various sporting codes and exposure to different injury presentations. VOLUME 41 • ISSUE 4 2023

Did you know that JSAMS has launched a new series of interviews with published authors? Asking the JSAMS Author Introducing a new series of interviews hosted by the Journal of Science and Medicine in Sport (JSAMS) Social Media Editor DR DANILO DE OLIVEIRA SILVA

Listen to interviews with DR TODD LECKIE Corresponding author of Marathon running and cell-cycle arrest biomarkers of acute kidney injury, Vol 26, p 14 (2023) DR JAROSŁAW KRZYWAŃSKI First author of Vaccine versus infection – Covid-19-related loss of training time in elite athletes, Vol 2, pp 950 (2022) This paper was also voted Best Paper JSAMS 2022 by the JSAMS editorial board.

Visit jsams.org to Access JSAMS past, present and in press papers (including SMA conference abstracts) Access Editors Choice highlighted once a month Check out Featured this month highlighting initiatives which include Dr Danilo de Oliveira Silva’s interviews and Virtual Special Issues Meet the Editorial team Read the Most Read (last 30 days) and Most Cited papers (last 3 years)

5 MINS WITH

5 minutes with

Prof Gordon Waddington What made you decide on a career in sports medicine? My first qualification is as a physio and I had started practice in that space and was obviously seeing a lot of young people with sports injuries, which was impacting on their continuing progression with physical activity. At the time, Sports Medicine Australia was really the only alternative if you wanted to look at going down the track of building into a sports medicine area and that was really attractive. It was one of those things at the time that was of interest to me and that’s how I ended up joining Sports Medicine Australia. In fact, I think that’s almost the longest association that I’ve been a member of, of all the professional associations that I’m part of. Can you tell us about your educational and research background? I did a bachelor of physiotherapy and then I did master’s degrees in exercise and sports science and sports physiotherapy. I was progressing down that track, doing more and more clinical work in that space, having more and more interest in trying to answer some of the questions that we were coming across. Particularly one that interested me at the time was, when I came on board, there have been almost no change over the preceding 20 years of time and literature in the effectiveness of ankle injury rehabilitation, and lower limb in general. That encouraged me then to head down the research track and

into the PhD. I had a slightly unusual track at the time, because as a physio my supervisors, one was a neurologist, and one was a psychologist. This was for two reasons. One, it was hard to get physios as supervisors because there weren’t many with PhDs at that stage. And the second was, I was really interested not just in the mechanical aspects of what was happening in injury, but what changes happened in the brain in injury. So, I ended up with a PhD around about 2000.

medicine and the physical medicine space in the community have come from research and development in the high performance space. The research space that I work in is the sensorimotor space. That’s the space where we have the uncharted territory as yet.

As the AIS Professor of Sports Medicine Research at the University of Canberra, is there a particular part of your research that stands out to you? We do a broad range of things looking at trying to help answer questions that are relevant to the high performance athletes. One of my colleagues at the AIS has a wonderful quote in relation to that, he looks at us as being like Formula One to the family car. Many of the things in the performance space that we can do there end up trickling down to the broader picture in the community. Many of the improvements that have happened in the sports

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5 MINS WITH

5 minutes with

Prof Gordon Waddington That’s only just opening up as another potential for improving performance, particularly following injury. Can you talk about your work regarding the assessment of human somatosensory function? What led you to researching this function? The first thing was we’ve got this problem with ankle injury and lower limb in general and we weren’t actually doing any better. People are still getting lots of injury. The terrible

thing is, it’s actually not a hell of a lot different now all these years later. It makes me more and more convinced that we need to look at the broader picture of how the body functions here. Almost all of our training and rehab type processes focus on what we call the efferent side of the system. So, you’ve got the input side, which is the afferent side of the nervous system, which is getting information from all your senses, your vision, your vestibular information, which gives your brain information and this is combined with a memory of what the movement is. And then you’ve got the efferent stuff, which drives out the exercise, the strength, the speed, all of that stuff comes out of that process. Just about everything that’s been done, when you drill down over those many years, has focused on the effector side. You’ve

got to get stronger, you’ve got to get more flexible, these sorts of things. But very little has been able to effectively look at the neural control side. One of the problems in modern day medicine, across the board, is unless you can see it or test it or get a result that shows something in the chemistry, it tends to get ignored. That’s the big problem with the afferent side. It’s basically been ignored, because people can’t measure it, so they keep focusing on other things. Our biomechanics systems and so on have gotten better and better and better, getting better at looking at differences in movement and performance, but we still actually haven’t gotten any better in terms of the overall process around rehab. So that led me then to be involved in developing testing systems in this space. Currently even MRI doesn’t really tell us anything about afferent function. As a result, we’ve developed some other testing systems of afferent ability, which are now being utilized internationally. They’re being used at MIT with the astronaut programs in the US to evaluate performance there. The long-term plan with MIT is to build more and more capability into the technology and allow us to actually do testing in space. I think you’ll find, the movement towards looking at the afferent side of the control of movement is going to be a huge changeover in how we determine performance, because even talent ID is strongly linked to this afferent capability. Indicating how you get information from the world that then drives out how you can use that

I was really interested not just in the mechanical aspects of what was happening in injury, but what changes happened in the brain during injury.

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5 MINS WITH

information for movement. Again, using lovely metaphors I’ve heard, you can buy a wonderfully expensive sports car, a big Porsche with big motors, and all that beautiful technology in there. But if you’ve got a dirty windscreen, you can’t get information effectively about the environment. So, you can have all the power and all the agility in the world, but if you’re getting poor information coming in, it doesn’t matter. What inspired you to establish Prism Neuro? We had to develop a new test system and there’s two ways of doing things in the technical world in science. One is, you write a grant, you get some money, you build whatever it is you want to build. And if you do that, then to do anything more, you have to write another grant then make the changes you need to make. However, the other way to do it is once it gets to a certain level, see if you can get somebody else to pay to do that for you and do that commercial process. That can speed things up quite dramatically. So, we first got a Space Agency grant a couple of years back, and that money was spent to get two machines that can only do a certain amount. But as soon as you do that testing, you realize, we can actually do this if we change this and

so on and so forth. Paying for all that out of grants is very hard and very slow, and very hit and miss. But that was the reality. We knew we had something that was a validated tool and it’s quite different from what most people are used to in any of these spaces. And so, to do that, I then had to get more opportunities to use more of these systems and work with partners with more of the systems. The easiest way to do that was the commercial pathway, which actually is not the easiest way to do it. But it’s a different way of doing it from the grants path. Where we are now project wise has just rocketed up because we’ve got 20 systems that became available in the last 12 months, whereas before that I’d be lucky to get two. So it’s had a multiplier effect.

What is the best piece of advice you have received in your career? This sounds like a cliche, but that process of believing in yourself, but also do a hell of a lot of listening. Sometimes you believe in yourself, and you’re actually way out on the end of a limb and you need people to give you frank and fearless advice. But listen, listen, listen. Listen to everybody. I get tremendous input from my PhD students. We try and keep a very flat structure so that everybody’s got the opportunity to put their advice in and doesn’t feel in any way threatened by that. It’s listen, listen, listen, but still believe in yourself. Where we are now, I did have some advice early on that this will never get going. It’s the usual story, it’s all too hard. At that stage, it was too hard, because we were doing hand repetitions of tests and it took 40 minutes to do a single test that now takes two minutes to do. And yes, fair enough, it would never have gone on unless you stick with it yourself and drive those processes and share that information as much as possible. Get advice and listen to people. So many people are so happy to talk, talk, talk the ear off somebody and then say well, you didn’t listen to anything I said! So, listen, listen, listen, is the most useful thing I could say. VOLUME 41 • ISSUE 4 2023

SPORTS MEDICINE AROUND THE WORLD

Photo: Armando Oliveira/ gettyImages

Sports Medicine In Argentina

Argentinian Sports Medicine through history September 25th is considered the Sports Physicians Day in Argentina due to Dr Enrique J. Romero Brest’s birth. He is considered the first sports physician and also the founder of physical education teaching in Argentina. He created the National Institute of Physical Education (INEF) in 1912, where physical education had its own institutional space in schools for the first time. During 1920 to 1930, Dr Gofredo Grasso was the first national physician who applied his scientific knowledge in athletes. He became Vice-President of the International Union of Sports Physicians (UIMD), which was founded in 1934. Later in the same year, he became adviser of the Argentinian Olympic Committee (COA). By that time, the socio-political situation in Argentina allowed for the expansion of 32

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sports institutions and sports in general, which permitted the dissemination of his proposal. This “recreational revolution” can be seen in the emergence of specialized publications, creation of athletic entities, construction of sports facilities and the participation of Argentinian athletes in international competitions. Dr Grasso “mathematized bodies of elite athletes contributing to produce sports champions” in swimming, athletics, fencing, and boxing, among other sports. He insisted on the need of a qualified medical service to carry out athlete’s follow up, which in addition should be mandatory for all recreational institutions. Medical Education in Argentina Buenos Aires is the most popular city for any training instance of academic excellence, but there are many other cities where you can study: Rosario, La Plata, Cordoba, Mendoza, among others.

At the Buenos Aires University (UBA), the Medicine School follows an eightyear path. Before entering, all students must carry out one year of academic levelling where the subjects studied involve a Common Basic Course (CBC). At the end, those who have passed get into Medicine School. Once you are in Medicine School, the whole college career is divided into two stages: 1. Biomedical stage or preclinical training, where students get the basis for their clinical training. It is divided into: a. First year, where you study Anatomy, Genetics, Biology, Embryology & Histology, Mental Health, Bioethics I and Family Medicine I. b. Second year, where you study Biochemistry and Physiology & Biophysics.

SPORTS MEDICINE AROUND THE WORLD

practice that is carried out in rotations in the various departments of the University Hospitals. After that, you get your MD degree as a physician! It must be emphasised that students commencing the 2nd year have only two weeks where they learn about exercise physiology. That means their studies involve only a “quick look” at the extensive chapter of Sports Medicine. They do not even get the idea of sports as a treatment related to noncommunicable diseases (NCDs). Sports Medicine in Argentina Training specialization programs or internships (called residency/ concurrency in South America) in Argentina typically lasts 4 years and takes place at University Hospitals or affiliated clinics and includes fulltime practical training of 12 hours per day at least. Sports Medicine is not a training you can take by this method.

c. Third year, where you study Immunology, Microbiology & Parasitology I and II, Pathology I and Pharmacology I. 2. Clinical stage, which involves the last two years of study and students aim to acquire knowledge and skills in diagnostics and treatment. Students must meet Internal Medicine I and II, Nutrition, Diagnostic Imaging, Dermatology, Infectious Disease, Pneumonology, Neurology, General Surgery, Urology, Orthopaedics, Neurosurgery, Otorhinolaryngology, Gynaecology & Obstetrics, Paediatrics, Pathology II, Pharmacology II, Public Health I & II, Psychiatry, Medicine & Law, Toxicology and Bioethics II. Once you finish both stages, you must then undertake the final year through the Annual Rotating Internship (IAR), where you have a pre-graduation

Almost all universities offer postgraduate medical study programs. After the medical degree, there are different options to earn the Sports Medicine specialty and become a sports physician all throughout the country. There are many private universities where you can find the Sports Medicine course: Catholic (UCA), Maimónides (UMAI), Favaloro, Austral and some others. Public University of La Plata (UNLAP) also offers the Sports Medicine specialty. The most recommended and prestigious Sports Medicine degree involves a two-year path at UBA. Sports Medicine is a postgraduate speciality. This means you need to be a physician and demonstrate at least one year of training/experience in orthopaedics, paediatrics, general surgery, internal medicine, or cardiology. Once you apply, chair managers interview the applicants. UBA is the home of the first Sports Medicine department in Argentina. There are 3 offered chairs. We will refer to the one led by Dr Luis V. Parrilla, which has more than 30 years of experience training Sports Physicians. The main objectives of this training

program are to train physicians in injury & illness prevention and to promote and encourage a healthy and physically active lifestyle in general population. This training includes classes in field of play at CeNARD (National Centre for High-Performance Sports), where students might have contact with elite athletes from all of Argentina’s sports teams. Indeed, most athletes train and get tested (strength, speed, coordination, balance, VO2max, etc.) at CeNARD. Students also attend classes at UBA’s Medicine School. There are 16 hours of classes per week during the entire training (45 weeks per year) divided into four modules: 1. Introduction to sports medicine (sports physiology) 2. Human performance (training, body composition, doping and antidoping regulation, biomechanics, recovery, etc.) 3. Physical activity in health & sports (cardiology, infectious disease, ophthalmology, traumatology, emergency, physical therapy, nutrition, etc.) 4. Special situations/conditions (transplanted and para-athletes, diabetes, cancer, pregnancy, etc). During the second year, students will carry out internships at various institutions, clubs, medical services, and national or international competitions if available. AMDARG (Argentinian Sports Physician’s Association) emerged from the chair led by Dr Parrilla with graduates and teachers of this same institution. It was founded during the pandemic and is a national multidisciplinary organisation committed to enhancing the health of all Argentinians through safe participation in sport and physical activity. The association’s members wish to generate and disseminate scientific knowledge and also want to highlight the Sports Physician’s role of providing expert information and advice, with the ultimate purpose of supporting the health and living standards of the entire population where sports medicine and related VOLUME 41 • ISSUE 4 2023

SPORTS MEDICINE AROUND THE WORLD

issues are involved. The main vision of AMDARG’s proposal is “the continuous training of sports physicians even after graduating. This situation will allow development and growth of sports medicine in the medical community and general population”. Nowadays, it is difficult to define “sports physician’s dos and don’ts” because sports physicians still do not have their own identity, at least in Argentina. Strengthening ties with other associations such as AATD (Argentinian Sports & Orthopaedics Association), ISEF N 1 Dr Romero Brest, FAA (Argentinian Soccer Players Union), APDA (Sports Psychology Argentinian Association), Hospital M. Rocca, FAMEDEP (Argentinian Sports Medicine Federation), and others is a good start on this path. Almost all sports physicians are encouraging Argentinian Schools of Medicine to include SEM in their curricula. Medical students need to be taught topics such as healthy habits and exercise counselling. They should be familiar with the American College of Sports Medicine’s guidelines on physical activity for health. It is a matter of public health. Recently, the Covid-19 pandemic put topics such as sedentary lifestyles under the spotlight. Sedentary behaviour is a real health problem in Argentina. In 2009, 54.9% of the population did not exercise, and 61.6% of the Argentinian population was overweight or obese. In 2018, Argentina still had the most sedentary behaviour in Latin America. However, in September 2021, the National Institute of Statistics and Census reported that sedentary behaviour is now decreasing for the first time. Unfortunately, noncommunicable diseases are still responsible for 73.4% of deaths in this country. AlI members from AMDARG wish that the entire population could have access to SEM physicians to achieve continued improvements for public health. Promoting and encouraging a healthy and physically active lifestyle is indeed our duty!

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Photo: Armando Oliveira/ gettyImages

Sports Medicine In Argentina

As Dr Luis V. Parrilla, AMDARG’s President, said in the last XXI Argentinian Sports Physician’s Congress 2021: “The responsibilities of Sports Physician & Sports Medicine are endless. The object of study is precisely the whole population. It is therefore proposed to “redefine” the title of this specialty to “medicine of physical activity/exercise and sport”. In other words: SEM - Sport & Exercise Medicine; so as not to restrict it only to a group that practices it with rules. Sports Physicians ideal training should be similar to an internship (hour load, dedication, etc.), not just a postgraduate specialty. In order to perform this change, it would be necessary to establish a standard in teaching & learning process, determining competences and responsibilities of the specialists in order to define the sports physician’s identity so they can also be recognized

and valued. Academic training processes should not culminate when graduated, but rather should start! This situation gives sustainability to Sports Medicine and sports physicians”. Nowadays, AMDARG is trying to conduct a census of Sports Physicians all over the country with some difficulties, but we are on our way! We do not have solid institutes which combine multidisciplinary work in amateur practice. CeNARD is the only place where you can find these collaborative interactions for highperformance athletes. Some National Federations aim to implement more interdisciplinary work, but they do not have enough financial resources to support it. Obviously, some sports do not have these financial issues. Indeed, most known soccer, hockey and rugby teams have a well-organized Sports Medicine Department. We still need more interdisciplinary work on this area in order to have the best staff for athletes. Some private Hospitals do have a Sports Medicine Department and there is only one institution in the Public Health Care System, but this situation is exceptional. There is a lack of standardized development in this area of health. That is why these kinds of services are generally not included in our healthcare system. Amateur athletes are usually excluded from Sports Medicine Departments and do not have the same opportunities that high-performance athletes do.

Author Bio Rodrigo A. Martínez Stenger Staff Orthopaedic Surgeon in Hospital Dr. A. Zubizarreta (Buenos Aires – Argentina) Co-founder & Member of the Executive Board in AMDARG (Argentinian Sports Physician’s Association) Member of the World Skate Medicine Commission (Lausanne – Switzerland) Sports Physician of the Argentinian Female Wheelchair Basketball Team

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PEOPLE WHO SHAPED SMA

People Who Shaped SMA

Dr Stephanie Hanrahan Can you tell us about your educational background and what inspired you to pursue a career in sports psychology? Originally, I was going to go into clinical psychology. I started as an undergrad in psychology, and I worked in a mental institution full time while I was studying my undergrad full time. In the US you also have a minor, so my minor was coaching. In my very last term of uni as an undergrad, I had a sport psychology class and I just went “that’s me,” and I immediately ripped up my applications for graduate school for clinical psych and applied for sport

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psych programs instead. At the time, there were only a few universities that offered sport psychology, it was a really new thing. Working at the mental institution, I thought I’d be nuts myself by the time I was 30 if I kept working in clinical psych. I’ve always been really into sport, so it married really well for me and I’ve been in it ever since. I ended up doing a Master’s in sport psych and then doing a PhD in sport psych. My undergrad and my Master’s were in the US and when it came time to do my PhD, I wanted to go somewhere outside the US and I had always wanted to go to Australia.

At the time I only spoke English, so it had to be an English-speaking country and the University of Western Australia gave me a scholarship. It turns out, I was the first person to get a PhD in sport psychology in Australia. There were Australians who’d gone to Canada or the US and gotten PhDs, but I’ve been told I was the first person to get one in Australia. You have recently retired from your career as a psychology practitioner, researcher, and professor. What has been the highlight of your career? I used to do a lot of work in elite sport,

PEOPLE WHO SHAPED SMA

but I got sick of the entitlement issues of some athletes. Back in 2005, I came home grumpy after working with a professional men’s team who were really up themselves and, in the moment, I felt they didn’t appreciate a thing. I’d received a newsletter from an orphanage in Mexico and I thought “they’d appreciate what I do.” So, I wrote a two or three page proposal and sent it to them. I didn’t hear anything for three months and then I got an email saying, please come, and I went. That eventually turned into a 10-session program called Life Matters that I’ve now done in a bunch of countries. It’s based on the mental skills I used to teach elite athletes combined with physically active games that are fun but also teach, via stealth, skills like trust, communication, and problem solving. My most single satisfying thing in my career was when I ran the program with gang members in Mexico. They were thirsty little sponges who really wanted to change their lives, but didn’t have a clue how to do it. I really felt like I made a huge difference. Helping

people to change their lives seemed to suddenly mean a lot more than helping athletes win another game.

Sport Psychology which became the bestselling Routledge Handbook. I don’t know if that’s still the case, but it was a few years ago. It became the goto thing for applied sport psychologists in some countries, which I thought was cool. In terms of research, it goes back to the Life Matters program - having gotten that published in journals that want randomized control trials and lab-based studies, and I’m doing a real-world thing. It felt like a real win to have journals recognize there’s enough value to publish my research even though it wasn’t as structured as what they typically publish. Although, one of my Master’s students did complete a randomized controlled trial with Life Matters at a school here in Queensland for students who’d been kicked out of regular school, often for drug related issues and such.

Do you have any research outputs that you are particularly proud of? It’s not really a research output but a publication. I was a co-editor for the Routledge Handbook of Applied

How and when did you first get involved with SMA? I honestly don’t remember. When I got to the University of Queensland, it was the early 90s and I’m sure it

You could have all the knowledge in the world as a practitioner but if patients aren’t motivated to do what’s going to help them, your knowledge is wasted.

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PEOPLE WHO SHAPED SMA

People Who Shaped SMA

Dr Stephanie Hanrahan was somebody within the School of Human Movement Studies who talked about it. SMA has been part of what I’ve done for over 30 years. How did being part of SMA help you in your career and research? It was good from a lot of perspectives. First of all teaching. I was training sport psychologists through the UQ Master’s program, and being able to do so somewhat holistically in terms of helping them become more aware of all the other professionals who work with the same clients and how what we do affects other people and what other people do affects us. SMA helped me to get well versed or at least somewhat familiar with a lot of areas of sports science and sports medicine that I might not have had a clue of otherwise. Also, through SMA I think I was able to help people in other

professions to become more aware of the role of psychology. For example, through SMA I was an invited speaker at a sports podiatry conference. It looks so weird on my resume, but I spoke at a podiatry conference. It was about how to get your patients to actually do what you’ve asked them to do, because you could have all the knowledge in the world as a practitioner but if they’re not motivated to do what’s going to help them, then your knowledge is wasted. Do you have any advice for people starting out their career in sports medicine? Related to what I previously said, remembering that you’re just one piece of the pie. By that I mean you often get so caught up in your area, whether that’s biomechanics or sport podiatry or physio or sport psychology or whatever, that you start thinking

what you do is the most important thing. You’re just one small piece of the pie and athletes require all pieces of the pie. Also, that you shouldn’t take credit for your clients’ successes, nor should you take responsibility for their failures.

SPORTS TRAINER HIGHLIGHT

Sports Trainer Highlight

Nita Walker What motivated you to become a sports trainer? I’ve always been interested in injuries. Working in personal training you see lots of different injuries and personal trainers legally can’t address anyone that has a pre-existing injury, or they can’t train them unless they’ve got GP clearance. So, unless the person is actually healthy, which usually isn’t why they’re at personal training, you’re actually not supposed to deal with them. And I thought there’s got to be a better way. I was living on a remote island, which I still visit quite often, and watching the football there. On King Island, we’ve got three football teams and they’re down to 12 players aside. The common thought amongst the players is, “We don’t train because if we get injured at training, we can’t play the game”, but if you don’t train, you’re 80% more likely to get injured. Looking at the age and the fitness levels of these guys going out on the field I thought, how can we make it so that football on King Island survives? So that people can still actively play and go to work and reduce injury risks and injuries. To make a long-term impactful difference, you’ve got to get on the ground to do it. I sit back quite often and think if only we could educate a bit more on a community level, then imagine the return to play rates. VOLUME 41 • ISSUE 4 2023

SPORTS TRAINER HIGHLIGHT

Sports Trainer Highlight

Nita Walker I’ve found it’s tough when you’re the person on the field that’s making the difficult call. By doing things at a sports trainer level, that gives you that confidence to say I cannot allow you to return to play, which is also really hard to do at a professional level, because you want them to be able to play and continue and get back on the field. But you also want them to go home, and you want them to be able to play next year, and you want them to be able to recover. People get emotional about sport. At that moment, it is the most important thing in their world to get back on the field. Whereas the next day, the most important thing is actually going to work so that you can afford to live. I became a sports trainer to make a difference, and to make a difference with other trainers too. To be a sports trainer, you only really need a couple of hours of courses. It’s really simple and really easy. SMA are fantastic

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at providing the resources and the upskilling and education if you want to, but there’s no requirement to do that. It’s all well and good to just receive all the papers and the books and have access to the internet, but when you can work next to someone who can explain it differently, or can make you think a bit differently or ask questions, I think that has the chance to make a difference on the ground. Coming from my background and having the injuries that I have also influenced me. I was 135 kilos at one point, which is a significant amount of weight, and I dropped 60 kilos through diet and exercise. The more that I did, the more that I loved it. But also, the more that I did, the more my body was like, I can’t move that way suddenly. I was fat and unfit and uninjured, and now I’m fit and permanently injured. So, I also wanted to be able to mitigate my risks of injuries through learning and developing my understanding.

How long have you been an SMA sports trainer? I’ve been a sports trainer for about 3 years. What has been a highlight of your journey as sports trainer so far? I get to do some pretty incredible things. I get to travel the country as a sports trainer, I can work anywhere in Australia, in multiple sports so that’s a huge highlight for me. UniSports was awesome. A lot of those athletes are going to go on to represent their

SPORTS TRAINER HIGHLIGHT

state or the country, so having that experience was fantastic. My NPL boys won their 2023 season, and my biggest highlight was that I got a medal the same as the Strikers players did at the end of it. They were so inclusive and said, you were part of it and we’re here because of you. They really see me as part of the team. I get to do epic things and I never thought that I would be doing the stuff that I’m doing now at all. I did it to make a local difference initially and now I get to travel across the country working in elite sports which is incredible. Having that sports trainer certificate opened up so much more in terms of career development in sports medicine. Suddenly I’m working with the AFL, the NPL, and I’m actually ducking into the NRL next season. I never pictured where I would be now. I don’t come from a sporting background. For me, especially being someone that was 135 kilos and doing my shoe lace up was a workout, to now where I’m running across football fields, it’s been very special. Also, the relationships that I’ve built along the way. Having the experience that I have and being able to give other sports trainers support and advice has been so rewarding. I’ve had other sports trainers tell me, “I didn’t know you can say no to strapping” and “That’s a really good question, I never would have thought to ask that”. Stuff like that comes second nature to me because I’m doing it all the time, not just every now and then on the weekend. When you look at things like AFL, for example, putting players on the field, we want them to have as little strapping on them as possible. If they’re constantly strapped, that indicates that they’re not recovering from injury, which indicates we’ve got a problem. And it should be the same in lower levels of sport, but it doesn’t get picked up. So, sharing that knowledge has been important. How has being part of SMA helped your career so far? You get to build links and you get to build opportunities. Sports training is such a sought-after little niche but it’s not something that you could do as a

full-time job all the time. But by being able to duck into little bits and pieces, I get to do some really interesting things. Without SMA, I never would have gone up to the Gold Coast for 10 days, and I never would have gone and seen fencing. Those kids were epic. When they’re competing at something like UniSport, they are the elite of their sport at a university level. It was great being able to provide support and educate on that level as well. One guy said to me he hadn’t had any water, he was absolutely dehydrated, and I told him your problem is that you’re not eating and drinking. He thought I wouldn’t understand the pressures of competition, but I explained to him that at any level, if any of my athletes hadn’t ate or drank before a big game, there would be some serious concerns and the coaches wouldn’t put them on at all. It’s just basics that some of them don’t think about at all. The other awesome part about it as well is linking in with physios. There are physios all across Australia that I work with, and they’re physios that I’ve built a relationship with, and I’ve been to their facilities, and I’ve worked there, or I’ve worked out there, or I’ve trained with them. So, depending on where the athlete is, I know that when I’m referring people to them, that they’re getting that extra care that they need.

With SMA, I’m about to move into education as well which I think is where you can make a real difference on a community level. That’s what I’m most looking forward to in terms of moving forward with sports training and SMA, stepping into that educator role and getting out there and helping make that bit more of a difference at another level. What is your advice to people thinking about starting sports training? Do it! At the end of the day, it is such a little cost for something that can, one, help you give back to your community, and two, keep people involved in the clubs. A lot of sports trainers now I’ve noticed at a community level are older, but they still have some really good techniques and hints because they’ve been doing it for so long. Looking back it’s something that I wish I had done a very long time ago. I’d tell anyone to have a go because what have you got to lose. You only lose the opportunities that you don’t take. So, if you get up and you take it and grab it and run with it, you could end up anywhere. At the end of the day, it’s just another qualification, even if it only helps out your kids when they go to play sport, it’s super helpful and it’s a really good little way to give back.

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