Sport Health Volume 37 Issue 4: COVID-19 and the impact on Sport by Sports Medicine Australia

Sport

health VOLUME 37 ISSUE 4 2020

COVID-19 and the impact on Sport PLUS • AIS Return to Sport in a COVID-19 Environment - Dr David Hughes et al

• The role of testing in management of COVID-19 in Sport – Dr Matthew Mooney et al

• Why Community Sport must come • Adapt and Overcome – How Olympic and back on Track – Prof Rochelle Eime, Paralympic athletes have adapted to the Prof Hans Westerbeek, and Patrick Walker. postponement of the 2020 games – Jaryd Clifford, Anabelle Smith

Contents REGULARS

FEATURES

In our Stride – Overcoming COVID-19 restrictions, lockdown and returning to play.

From the Chairman: Remaining nimble in challenging and new times

In this feature Manly Sea Eagles High Performance Manager Donny Singe, discusses the impact of COVID-19 restrictions, maintaining operations, challenges during lockdown and the process to returning to play in the National Rugby League (NRL) competition.

Prof. Gregory Kolt discusses the challenges faced by sport in a pandemic environment, and how organisations have had to reimagine their role in moving to recovery. Professor Gregory Kolt

Donny Singe

From the CEO: Safer Sport in our new reality

Adapt and Overcome – How Olympic and Paralympic Athletes have adapted to the postponement of the 2020 games.

CEO Craig Knox talks about the new reality presented by COVID19 and the important role SMA is playing in supporting its members and the community at this challenging time. Craig Knox

04 Return to Sport in a COVID-19 Environment – the Australian Institute of Sport

The role of testing in management of COVID-19 in sport – the Australian Institute of Sport and University of Canberra Research Institute for Sport and Exercise Sport is an integral part of Australian society, and this has been reflected in the transition back to normality after the initial wave of COVID-19. The want to return to sport has meant that the role of testing in management of COVID-19 in sport plays a critical role and we explore the new positions required such as the COVID-19 Safety Coordinator and go into detail about the required COVID-19 Safety Plan.

Australian Olympic Diving Bronze medalist Anabelle Smith and Paralympic vision impaired middle distance athlete Jaryd Clifford share how they have been impacted since the rescheduling of the 2020 games.

Dr Mathew Mooney, Dr Nirmala Perera, Dr David Hughes

Jaryd Clifford, Anabelle Smith

Hawthorn Football Club Physiotherapist, Bruce Connor shared an insight into how COVID-19 has impacted the AFL environment for staff, players, club resources and how this could change the future of elite and recreational football across Australia.

Australian sporting organisations are attempting to function under what are arguably, the most difficult conditions in history. This piece reflects on articles written around this topic over the past six months and the stunning rapid acceleration of cases diagnosed around the world and what that means for sport and its return.

26 The impact of COVID-19 in the AFL environment

Bruce Connor

Dr David Hughes, Dr Matthew Mooney, Dr Nirmala Perera, Dr Richard Saw

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.

Publisher Sports Medicine Australia Sports House, 375 Albert Rd Albert Park VIC 3206 sma.org.au ISSN No. 1032-5662 PP No. 226480/00028

PR, Communications and Marketing Manager Cohen McElroy

Copy Editor Cohen McElroy

Content photographs Author supplied; www.gettyimages.com.au

Design/Typesetting Perry Watson Design Cover photograph gettyimages/wavebreakmedia

CONTENTS

Volume 37 • Issue 4 • 2020

NEWS

The Recovery of Sport – A Sport Nutrition Perspective

54 Sports Medicine Community News

Accredited Sports Dietitian Jess Rothwell shared a Sport Nutrition perspective about the recovery of sport and the issues that could arise with athletes when they are are away from their usual routines. Jess Rothwell

32 Medical servicing considerations for professional and high performance sport – the Australian Institute of Sport Medical servicing is an essential and key component in elite and high performance sports. Manual therapy which comes with inherent risks due to COVID-19 and we must realise it can’t be just business as usual as we return to sport. Jennifer Cooke, Dr Nirmala Perera, Dr Richard Saw, Dr David Hughes, Dr Matthew Mooney

40 Why community sport must come back on track COVID-19 has hit community sport for six and in this piece, we delve into the importance of community sport returning and how this will impact community clubs, associations and the general population.

Sport Health shares all the latest news from leading Sports Medicine associations including Australian College of Sport and Exercise Physicians (ACSEP), Australian Physiotherapy Association (APA), Exercise & Sports Science Australia (ESSA), Sports Dietitians Australia (SDA), Australian Academy of Podiatric Sports Medicine (AAPSM), Australian Institute of Chiropractic Education (AICE) and the Australian Psychological Society (APS)

56 People Who Shaped SMA – Dr Robert Reid AM

Prof Rochelle Eime, Prof Hans Westerbeek, Patrick Walker

This issue we pay tribute to Robert Reid AM for his significant service and contribution to SMA.

Dr Robert Reid

Recap of SMA’s Telehealth in Sports Medicine Beyond COVID-19 Dr Adam Castricum recaps the SMA Webinar, Telehealth in Sports Medicine: Beyond COVID19 and shares the future of Telehealth for Sports Medicine with all the benefits, limitations and further opportunities. Dr Adam Castricum

48 COVID-19 impact on a State Sporting Organisation

36 The COVID-19 Impact on healthy and active communities Whilst traditional community sport has been severely impacted by COVID-19, outdoor recreation levels have increased significantly with people having to forgo the gym and fitness centres in favour of running, cycling and walking in their local parks and community spaces. Bruce Fordham

With traditional community sport so heavily impacted by COVID-19, Sport Health sat down with Gymnastics Victoria to discuss the impacts on a State Sporting Organisation. Alan Mackinnon

INTERVIEWS

60 Sports Trainer Spotlight – Phil Driscoll Phil Driscoll has over 30 years’ of experience as a Sports Trainer. Read about Phil Driscoll’s career in Sports Medicine. Phil Driscoll

5 minutes with… Luke Nelson Sport Health spent 5 minutes with Luke Nelson, Sports and Exercise Chiropractor and Director of Health and High Performance Luke Nelson VOLUME 37 • ISSUE 4 2020

FROM THE CHAIRMAN

Remaining nimble in challenging and new times SMA BOARD CHAIR, PROFESSOR GREGORY KOLT DISCUSSES THE CHALLENGES FACED BY SPORT IN A PANDEMIC ENVIRONMENT, AND HOW ORGANISATIONS HAVE HAD TO REIMAGINE THEIR ROLE IN MOVING TO RECOVERY.

elcome to this issue of Sport Health. We know that our members look to Sport Health for information and guidance on contemporary practice and research, and this issue is no exception. As we move into an altered environment for sport and our organisation, the challenges that already exist, and that will continue to emerge during the ongoing COVID-19 pandemic, will require a new and fresh methodology and adaptability. Most organisations globally, including all of those involved in sport, will be reflecting on their best-laid plans at the start of this year, and how they have had to reimagine their role, moving from the crisis of a pandemic to the recovery stage and consideration of new ways of operating. In this vein, the SMA Board has met frequently over the course of this year to assess and monitor the

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In this vein, the SMA Board has met frequently over the course of this year to assess and monitor the changing landscape for our members and services, and how we as an organisation can provide the best service possible. changing landscape for our members and services, and how we as an organisation can provide the best service possible. The strategic priorities that have emerged from this process have included a need to focus even more heavily on our membership value

proposition, the need to move quickly to the online environment for delivery of our events and services, a required focus on creating greater efficiencies, and developments to maintain our role as a leading source for sports medicine information and advice. The work undertaken in these past weeks by our administration has served our refocussed objectives and will enable the organisation to remain nimble in the months and years ahead. This issue of Sport Health is a testament to our focus on the very real issues at hand, both for our members and the community at large. We present a range of articles related directly to sport (and return to sport) within the pandemic environment. Enjoy this issue, and ensure the safety of yourself and others in your practice and research pursuits. Professor Gregory Kolt

FROM THE CEO

Safer Sport in our new reality MANY LONGER TERM SMA MEMBERS DESCRIBE OUR ORGANISATION AS AN ORGANISATION FOR GIVERS, THOSE WHO CONTRIBUTE TO SOMETHING THAT IS BIGGER THAN THEMSELVES. DURING THIS DIFFICULT TIME, THIS CHARACTERISTIC HAS COME TO THE FORE AGAIN WITH CRITICAL VOLUNTEER SUPPORT ENABLING US TO NAVIGATE THE CIRCUMSTANCES PRESENTED BY COVID-19 IN A PROACTIVE WAY.

rom the formation of a specific medical advisory group for relevant guidelines and course development, to the work of our Conference committee members in creating the energy and themes for our recent live online events and the input from state council and committee members to help maintain our normal activities, these contributions have been so important at this time. Our new reality is that sport will look and feel somewhat different in the coming months and years ahead however, the historic role of SMA in connecting and informing our members is more important than ever and we will continue to produce the resources and events that will serve this purpose. Our recent collaboration with the AIS and Sport Australia to produce the ‘Sports Trainer Practices in a COVIDSAFE Australia’ guideline and our online events on Telehealth and ‘Returning to Sport; Lessons Learned’ will be built upon in the coming months. There is also little doubt that our long-term name and intent of our grass roots community education program ‘Safer Sport’ has

Remaining informed and connected is so important for our members during these difficult times and we hope that this issue of Sport Health provides further valuable insights and inspires new ideas and opportunities for the near future. never had more relevance. Globally and locally, we will need to play our role in engaging our communities in a safer version of sport. This very different issue of Sport Health is true to our purpose. It profiles our member and stakeholder perspectives on Sport in the COVID-19 environment and the actions and initiatives that are most useful at this challenging time. This includes the impact of the pandemic from the elite sporting environments of the AFL and NRL, testing and management practices in high performance sport, the postponement of the Tokyo Olympics and Para Olympic perspectives and the influence COVID-19 is having on our use of open space for recreational activities. We feature the AIS framework for the rebooting of sport in a COVID-19 environment as well as innovative

research exploring the impact of sport on health and wellbeing pre, during and post COVID-19. In maintaining our SMA member focus, we interview and honour the contribution and career of long term SMA member and former Board Director, Dr Rob Reid, the extensive career of experienced Sports Trainer and course presenter, Phil Driscoll and we spend five minutes with Victorian State Council member Luke Nelson. Remaining informed and connected is so important for our members during these difficult times and we hope that this issue of Sport Health provides further valuable insights and inspires new ideas and opportunities for the near future. Craig Knox craig.knox@sma.org.au VOLUME 37 • ISSUE 4 2020

RETURN TO SPORT IN A COVID-19 ENVIRONMENT

Return to sport COVID-19 envir THE AUSTRALIAN INSTITUTE OF SPORT AUSTRALIAN SPORTING ORGANISATIONS ARE ATTEMPTING TO FUNCTION UNDER WHAT ARE ARGUABLY, THE MOST DIFFICULT OPERATIONAL CONDITIONS IN HISTORY. REFLECTING ON THE ARTICLES WE HAVE WRITTEN ON THIS TOPIC OVER THE PAST SIX MONTHS, WE ARE STUNNED BY THE RAPID ACCELERATION OF CASES DIAGNOSED AROUND THE WORLD. IN MID-MARCH WHEN THE WORLD HEALTH ORGANISATION DECLARED A PANDEMIC, THERE WERE APPROXIMATELY 120,000 COVID-19 CASES AND 4000 DEATHS GLOBALLY. BY LATE APRIL THERE WERE OVER 3 MILLION CONFIRMED COVID-19 CASES AND MORE THAN 220,000 DEATHS. NOW IN MID-JULY, THERE ARE ALMOST 13 MILLION CASES AND APPROACHING 600,000 DEATHS WORLDWIDE.

he USA is now the global epicentre of COVID-19, currently exceeding 65,000 cases per day. Cases in Brazil, Russia and India are increasing at a rate that suggests the world is far from seeing the worst of this pandemic. There are many countries in Africa, South America and the Middle East where the COVID-19 journey is in its infancy. Australia, having brought the initial COVID-19 outbreak of March/April under control, is currently experiencing a significant and worrying increase in infections. The major difference between the current outbreak and the peak of March/April is that the initial wave was overwhelmingly linked to infections imported from overseas, whereas the current cases are largely

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Every respiratory infection in an athlete must be treated as COVID-19 until proven otherwise.

RETURN TO SPORT IN A COVID-19 ENVIRONMENT

in a ronment

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RETURN TO SPORT IN A COVID-19 ENVIRONMENT

Return to sport in a COVID-19 environment driven by community transmission. Community transmission is much more difficult to control. Most recent community transmission has occurred in Victoria with concerning evidence of community transmission spilling over into other States and Territories. The coming weeks to months will be critical in determining whether Australia can bring this outbreak under control and drive down the daily number of infections into a manageable caseload. What is it about the SARS-CoV-2 virus (the virus which causes COVID-19) that has made this the worst pandemic since the Spanish flu of 1918? Firstly, SARS-CoV-2 has a higher basic reproductive rate (R0) than influenza or other epidemicassociated coronaviruses (Severe Acute Respiratory Syndrome [SARS] and Middle Eastern Respiratory Syndrome [MERS]), meaning that COVID-19 is much more easily transmitted through the population than these viruses. COVID-19 causes minimal or no symptoms in a high proportion of cases which allows transmission to occur through a population who can unknowingly spread the virus. In those patients who do develop symptoms, they are often maximally infective by the time the symptoms develop. This means that the virus has already been transmitted by the time the diagnosis is confirmed. The proportion of patients requiring ICU admission is much higher for COVID-19, compared to influenza. The high rate of ICU admission means that a COVID-19 outbreak places a significant strain upon healthcare resources. The challenge for the individual clinician is that it is not possible to differentiate COVID-19 from other upper respiratory tract infections, based on history and clinical examination alone. The way that sporting organisations deal with respiratory infections therefore has 6

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Australia, having brought the initial COVID-19 outbreak of March/April under control, is currently experiencing a significant and worrying increase in infections. The major difference between the current outbreak and the peak of March/April is that the initial wave was overwhelmingly linked to infections imported from overseas, whereas the current cases are largely driven by community transmission.

profoundly changed. Every respiratory infection in an athlete must be treated as COVID-19 until proven otherwise. Any athlete with relevant symptoms should be provided with a facemask to wear and should be isolated from others. The athlete must be tested for COVID-19 and remain in strict isolation until they have been medically

cleared. Even once COVID-19 has been excluded, the unwell athlete with another form of respiratory infection should be managed conservatively to avoid spreading their infection which would result in their team-mates requiring COVID-19 testing and significant disruption. Management should include hand

RETURN TO SPORT IN A COVID-19 ENVIRONMENT

has been documented in some young individuals who have had relatively minor COVID-19 symptoms. Therefore, any individual who has had a confirmed case of COVID-19 and who is intending to return to high intensity exercise, must be thoroughly assessed by a medical practitioner to ensure that it is safe for them to resume high intensity exercise. Anecdotally, there are high performance athletes from other nations that have had significant difficulty returning to high intensity exercise following COVID-19 infection. Currently however, there is little knowledge of the long term performance aspects of COVID-19.

hygiene and respiratory etiquette plus should not be returned to the group sporting environment until they have been medically cleared to do so. The necessity for such aggressive standing-down of athletes with minor respiratory symptoms is new for sport, and understandably frustrating for athletes, coaches and administrators.

While COVID-19 was initially viewed as a respiratory disease, there is growing evidence that it is in fact a persisting multi-organ disease causing a range of pathologies including cardiac injury, respiratory compromise, microthrombosis, large vessel stroke, renal pathology, neurological and hepatic dysfunction. Serious organ damage

The transmission of COVID-19 does not happen in a uniform fashion across a community. That is, not all of those with COVID-19 will pass on the virus to a similar number of others. There are individuals who are ‘super-spreaders’ and there are environments that are ‘super-spreading environments’. Research has indicated that between 10% and 20% of infected people are responsible for 80% of the spread of COVID-19. Several factors contribute to a particular environment having super-spreading capacity. Indoor environments are far higher risk than outdoor environments, particularly where there is poor ventilation. Confined indoor environments, where there tend to be high concentrations of individuals in a relatively small space are particularly problematic. Large clusters have been identified within nursing homes, churches, food processing plants, choirs, schools, shopping centres, worker dormitories, prisons, gymnasiums and cruise ships. Duration of contact is important. Contact tracing has demonstrated that those that are in contact with an infected individual for greater than 10-15 minutes are far more likely to contract the virus than those who have a fleeting contact. VOLUME 37 • ISSUE 4 2020

RETURN TO SPORT IN A COVID-19 ENVIRONMENT

Return to sport in a COVID-19 environment What individuals are doing in enclosed spaces is also important. Transmission of infection occurs via respiratory droplet, aerosol generation and touching contaminated surfaces. When individuals are talking, singing, or exercising, they generate far more respiratory droplets and aerosols than they do when at rest and not talking. Indoor fitness classes have therefore been associated with clusters in several countries. Nightclubs and pubs, where individuals tend to talk loudly in close proximity for prolonged periods of time, have also been identified as high-risk environments. How does this information translate to the sporting environment? Firstly, we have to ensure that we do not make inaccurate assumptions about transmission risk in certain sports. It is a common presumption that contact football codes would be high risk environments for transmission of COVID-19. While transmission of COVID-19 is certainly possible in such environments, it is important to remember that contact football codes are generally played outdoors (lower risk) and contact between

individuals is usually very brief (lower risk). To illustrate this point, letâ&#x20AC;&#x2122;s presume that I was told that I had to share an environment with a COVID-19 positive person for the next 60 minutes. I am given a choice of 4 different environments to share with the infected individual: 1. playing AFL football against them, 2. singing in a church choir with them, 3. undertaking a cycling spin class with them or 4. playing chess against them in indoors. Personally, from what I understand of this disease, I would consider the order of least risk to highest risk would be: 1. AFL 2. Chess 3. Singing in a church choir 4. Cycling spin class Out of this list, I believe AFL would be the least risky activity because it is conducted outdoors and any contact with the infected individual would be fleeting. Chess would be higher risk because it is indoors and I am sitting in close proximity with the infected person for a prolonged period of time. That person however is probably not saying much and therefore they are

not likely to be secreting large amounts of droplets or aerosols. Singing in a church choir with an infected individual has been shown to be a very highrisk activity because of the increased secretion of respiratory droplets in an enclosed space. A cycling spin class in an indoor environment is going to result in greatly elevated secretion of respiratory droplets and aerosols in an enclosed environment with individuals inhaling deeply and therefore having a high likelihood of inhaling viral particles. While there is no scientific literature comparing the infective potential of these activities, the next best decision making process involves a thorough understanding of the first principals and context of the virus transmission. 8

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RETURN TO SPORT IN A COVID-19 ENVIRONMENT

Transmission of infection occurs via respiratory droplet, aerosol generation and touching contaminated surfaces.

Across Australia, sporting organisations at both the grassroots and the high performance level have worked with governments in adopting an evidencebased approach to the resumption of sport. The AIS Framework for the reboot of sport in a COVID-19 environment (the AIS Framework) was released on 1 May 2020, as the first wave of infections decreased around Australia. The AIS Framework divides sporting activity into three levels (A, B, C). Level A is the most restrictive level of training, including; ✔ Exercise only individually or in pairs (thereby decreasing potential infectious contact points),

✔ Maintaining distance of at least 1.5 meters between a pair of individuals (thereby decreasing risk of droplet/aerosol transmission), ✔ No exercise with others indoors (thereby avoiding the inherent risk of indoor transmission), and ✔ No sharing of equipment (thereby decreasing the risk of transmission by touching of infected surfaces). Levels B and C gradually introduce larger numbers of participants and the possibility of indoor and contact exercise. The AIS Framework is available as an open source document in the Journal of Science and Medicine

in Sport. While the AIS Framework provided guidance to sport about the nature of activities that could be undertaken at Levels A, B and C, the pace at which sporting organisations could move towards a resumption of sporting activity was largely dictated by the Directives of the Australian State and Territory governments. While Australia has challenges ahead with the current increase in COVID-19 infections, on the whole, we have relatively low COVID-19 case numbers and deaths, per head of population, compared to most other countries. At the time of writing, international borders are closed and individuals gaining an exemption to enter must undergo 14 days of supervised quarantine, upon arrival into Australia. Given the deteriorating situation globally, it is unlikely that international borders will be open anytime soon. This has a significant impact upon sporting organisations wishing to participate in international competition or wishing to qualify athletes for the 2021 Tokyo Paralympic/Olympics. There have been many key learnings regarding the conduct of sport in a COVID-19 environment, over the past six months. Until an effective vaccine becomes available, sporting organisations need to adapt to a new way of operating, which incorporates fundamental safety measures to minimise the risk of COVID-19 being transmitted within the sporting environment. Individuals who are unwell should not come into the sporting environment. Any individual with symptoms of COVID-19 (fever, cough, headache, sore throat, shortness of breath) or potential symptoms not explained by another cause (fatigue, myalgia, loss of taste or smell, gastrointestinal symptoms) should isolate themselves AND should be tested for COVID-19. High performance sport athletes are monitored via daily VOLUME 37 • ISSUE 4 2020

RETURN TO SPORT IN A COVID-19 ENVIRONMENT

Return to sport in a COVID-19 environment symptom checks for COVID-19 and daily temperature checks. Athletes and staff need to be educated about social distancing of 1.5 meters wherever possible, washing hands on entering and leaving the training environment, spending as little time as possible in communal spaces such as change rooms, showers etc. and practising appropriate respiratory hygiene. Reinforcing these personal behaviours is crucial. Individuals and sporting organisations cannot control the decisions of Federal, State or Territory governments. Every individual can

however control their own behaviours and can call out any inappropriate behaviours of others within their teams/training environment. The current increase in COVID-19 infections can be attributed at least in part, to a breakdown in protocols/ procedures designed to limit the spread of COVID-19 and a complacency regarding the possibility of COVID-19 infection, by members of the public. All Australians, whether involved in sport or not, need to understand that the SARS-CoV-2 virus will remain

All Australians, whether involved in sport or not, need to understand that the SARS-CoV-2 virus will remain in the Australian community for the foreseeable future.

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in the Australian community for the foreseeable future. These safety measures therefore have to become and continue to be the new normal for operating in both the community and high-performance sport environments. The AIS and Sport Australia have made a range of resources freely available to assist community and highperformance sporting organisations in their planning for the safe resumption and continuation of sporting activity in a COVID-19 environment.

RETURN TO SPORT IN A COVID-19 ENVIRONMENT

These resources can be found at https:// www.ais.gov.au/health-wellbeing/ covid-19. Sports Medicine Australia with the AIS and Sport Australia, has recently released a guidance document on Sports Trainer Practices in a COVIDSAFE Australia (https:// www.sportaus.gov.au/__data/assets/ pdf_file/0008/756764/Sports-TrainingPractice-in-COVID19-Environment.pdf).

About the Authors Dr David Hughes is a Sport & Exercise Medicine Physician with over 25 years experience working in high performance sport. He is currently Chief Medical Officer of the AIS and Medical Director for the Australian Olympic Team for Tokyo 2020/2021. Experience includes Super Rugby, the NRL and English Premier League football. He attended London 2012 as Team Physician for the

Sports Trainers are frequently the frontline personnel overseeing the safety and wellbeing of athletes and spectators at community sporting events. Supporting Sports Trainers and other personnel at sporting events is crucial to ensuring the safety of athletes, staff and the community in this new and challenging environment.

Opals and Rio 2016 as Olympic Team Medical Director. He is a former President of the Australasian College of Sport and Exercise Physicians (ACSEP). Dr Hughes’ current work focus is on systemwide protocols to optimise athlete health and safety, concussion and ethical/integrity challenges in high performance sport. Dr Mathew Mooney is a medical practitioner who is completing an industry funded PhD scholarship at the AIS and University of Canberra investigating infectious diseases in high performance athletes. Prior to commencing medical

The world of sport has changed fundamentally since the start of COVID-19 in early 2020. While there are many resources directed at the search for an effective vaccine, it remains unclear if and when such a vaccine will be available. It is crucial that all support staff working with athletes are educated and kept up to date with the latest information available about how to function in sport in a way that optimises safety. While we must all continue to listen to the experts about what is and is not permitted in various jurisdictions, the main contribution that we can all make is to ensure that our own personal behaviours and the protocols and procedures of our organisations are aligned with best practice.

training, he completed undergraduate and honours degrees in sport science with an interest in strength and conditioning. Following residency, he completed post graduate studies in Infectious Disease Intelligence. Dr Mooney’s main research interest is in the application of field epidemiology to understand infectious disease in a high performance sporting context. Dr Nirmala Perera is the Clinical Research Project Officer at the Australian Institute of Sport. She previously held Post Doctoral Research Fellowships at the University of Oxford and University of Linköping, Sweden and a member of Sport Without Injury Programme (SWIPE). Her research focuses on a range of sports medicine and injury prevention projects. She is an Associate Editor for the Journal of Science and Medicine in Sport, alongside serving on several committees including as a former Sport Medicine Australia Executive Board Member. Dr Perera is passionate about knowledge translation and is the Social Media Coordinator for the International Olympic Committee World Conference on Prevention of Injury and Illness in Sport. Dr Richard Saw is a Sport and Exercise Medicine Physician, currently appointed as the Lead Physician at the Australian Institute of Sport. He has previously worked with the Australian Men’s Cricket Team, North Melbourne Football Club and the AFL Umpires.

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IN OUR STRIDE

In Our Stride Overcoming COVID-19 restrictions, lockdown and returning to play.

IN THIS FEATURE, MANLY WARRINGAH SEA EAGLES HIGH PERFORMANCE MANAGER, DONNY SINGE, SHARES HIS INSIDE SCOOP ON THE IMPACT OF COVID-19 RESTRICTIONS, MAINTAINING OPERATIONS, CHALLENGES DURING LOCKDOWN AND RETURNING TO PLAY.

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IN OUR STRIDE

OVID-19 felt like it struck the sporting world in the blink of an eye. Whilst the effects for the players out on the field were instantaneously seen by all, what remained unknown was how this pandemic would impact the hidden teams off the field, that underpinned the players’ elite level performance. The high-performance team for the Manly Sea Eagles in the National Rugby League (NRL) had to act swiftly and make sure all of their departments – Strength and Conditioning, Sport Scientists, Sports Trainers, Sport Psychologists, Masseuses and Nutritionists – were well equipped to adapt to the ever changing landscape. Weeks before the eventual season was postponed on March 23 by the NRL, High Performance Manager for the Manly Sea Eagles, Donny Singe, said the Club had started to implement changes to the usual routine with training, gym work and even player attendance. “We were already starting to incorporate changes in hygiene, changes in access, even changes to the point of social distancing in terms of who wasn’t training with the squad. All the squads were starting to practice that so we were already aware of the fact that somebody could contract COVID-19 whether it was a coach, administrator or player. During that time, we started putting things in practice. We were getting a lot of good information from the house services around us, from our own medical teams and contacts through the performance units, other clubs, the NRL itself and obviously our SMA contacts,” said Singe. With the changes in place and the club playing the first two games of the season, Singe firmly believed that the game could continue although the 2020 season would look different, but still able to operate week to week. “We were aware that we were heading towards a “situation” – little did we know then that the whole game would be stopped – and we firmly believed that we would be able to maintain the game at that time, until the government said everyone was to stand down until we could all get our heads around it all.”

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IN OUR STRIDE

In our Stride

Once the game had been stopped, the attention turned to the welfare of all those in Singe’s team alongside the playing group. It was important to put people first in front of the game as at the end of the day it is just a game. “From higher up we were told that we would have to shut the entire program down for the sake of putting people first, which is how we should always be.” The immediate turnaround from there to player performance was next on the agenda for Singe and

the High Performance team. This required all areas to pull together and help transform the program to be successfully applied in remote settings. “I’m really fortunate because I boast a very knowledgeable and extensive performance and medical crew, so I can literally say everyone just steped up. Connor who handles all our strength work was very quickly able, through the periodization process he had already built, to isolate players and dish out exactly what they needed to get through six weeks of training.

We were aware that we were heading towards a “situation” – little did we know then that the whole game would be stopped – and we firmly believed that we would be able to maintain the game at that time, until the government said everyone was to stand down until we could all get our heads around it all.

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All my sports science crew were able to pull out numbers – dietitians and skin folds – and how we were going to maintain those levels. I had my conditioning staff, Des and I isolating individuals and giving them the appropriate equipment, whether it was anaerobic or a lactic load. We broke everything down to its smallest component and then we were able to use each modality, continuing to take measurements and wellness markers daily, so we just continued with that.” An interesting component of this process was applying the program for

IN OUR STRIDE

our injury rehabilitation players. As this is usually quite a hands-on approach the club had to seek permission from the NRL and the New South Wales government to maintain this process. “Obviously we had injuries from the first two rounds and these players would still have to be rehabilitated so we worked with the NRL, medical bodies and with the NSW government, and we were able to maintain a process where they were able to be treated in line with government and health guidelines.”

With the physical side of preparation sorted, the wellbeing and checking in of players was a major focus for Singe and his team. This was especially critical with players facing uncertainty and a new environment. “Our wellness program was implemented straight away and included in their daily schedule. All players knew they had to have that completed by 10 am. On a normal day we were looking at around 6:307:00am because that’s when they usually get to training. Knowing that they had this extra time we could allow them a little bit of living time at home, as it’s a different environment and we understood that. Monitoring included using a wellness app and ratings of perceived exertion (RPE) every single session so we could see what was happening. After that we placed players into four different groups. We assigned a coach to each of these groups and also assigned the players to skills groups. This meant that the tactical coaches

were able to speak to them just to keep their mind ticking over from a playing positional perspective. It was imperative that we continued to connect with the players and give them information on what was happening. As you know yourself, SMA can boast a very vigilant and knowledgeable stream of access to information. Unfortunately, the general public will get information thrown at them from all different areas, not all of that information is valid. We would continuously update our playing group and staff on what the facts were, where we were at as a nation and as a sport with COVID-19. That was to give them peace of mind but also to help them to talk to their families about what was going on and give them a sense of security. There was a tremendous amount of mental support from the club to ensure channels of communication were kept open.” As the season postponement carried on over six weeks, the High VOLUME 37 • ISSUE 4 2020

IN OUR STRIDE

In our Stride Performance Team remained busy, continually updating the players’ programs as they completed their weekly check ins. “Programs had to change over the course of time because we haven’t had the luxury of a measured game over this period. If you look at any statistics from a game you can see how many meters they run per minute, you can see the form they have to reach in terms of high speed or top speed. There is a tremendous amount of load and volume of intensity that’s missing, and we haven’t been able to reach that because you only really get those types of levels when your competing. So, what we had to do was put testing protocols in place that tell us the capacity and volume we’re getting back. This would tell us the size of the gas tank and what we can work with in terms of capacity. What’s missing are tendons, ligaments, joints and the mechanics. They haven’t been extended frequently enough to those values that you’d reach in a game. Also, we haven’t had any contact so it doesn’t matter when you’re working internally, you can strengthen that area through explosive movement. You can do the mechanics and anatomical exercises of weightlifting and you can get that adaption phase occurring. What you can’t get is that external impact or collision training. It is very different. So, we had to prioritize their football – moving within the scope of the football, moving and executing at the speed of the game and those types of drills. The second thing you’re going to have to get is that contact and that repeat effort contact movement back into your training.” A challenge over this period for Singe was working with the Medical team, his High Performance team and of course the Coaching team at the club. All these areas have a certain part of the game they need 16

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I really believe that whether you follow rugby or not, to bring something communal back to the screens that has a sense of normality about it, then I’m very proud of the fact that we are leading the way to do it, but I’ll be even prouder if I can feel that true sense that the NRL choose to do this so society, the community and the country as a whole can benefit from stepping forward and from not only watching the sport but seeing what can be done when we come together.

to focus on, but it was imperative that they worked together to achieve the right program for each player. “Medical, High Performance and Coaching units come from different stand points. The medical view has a focus on the injury risk of the high training load; the performance and coaching focus is training hard enough to build the tenacity of muscle fibre

that is required. We had to prioritize the elements we could get the most out of which is definitely football and then build a football program and re-introduce the other aspects which would normally have a big part (weight training, isolated energy systems) in different ways.” Successfully managing the players during the lockdown period set

IN OUR STRIDE

About the Author Donny Singe has had great success as a strength and conditioning coach in both Australia and New Zealand, having worked in professional Rugby Union, Australia Tennis also worked with the New Zealand Z National Side, Maori side, the Cook Islands National Team and Samoa National Rugby League teams. Don completed his Masters of Education in Sports Coaching at Sydney University in 2019 and regularly presents and speaks for international sporting companies, commercial business/corporate and government law enforcement agencies for both general duty officers and the nation’s elite. These presentations range from Leadership/Team Building/Workplace Culture to Healthy Lifestyle Choices for daily performance. The latter around mindfulness, nutrition and mental well-being of employees. Most recently Don has joined the team at Well College Global as the Principal Conveyor for The Sports Professionals Certificate of Wellbeing Coaching & Mentoring, and is utilizing his expertise and extensive hands on experience to forge strong partnerships for Well College Global in the health, corporate health, and wellbeing sector. Don currently lives life on the beautiful Northern Beaches of Sydney with his wife and two sons, and he is the Head of Performance with the Manly Warringah Sea Eagles.

the NRL up to be the first professional sport ready for return to play, in a new look competition with certain protocols in place. Singe said it was quite a proud moment to be involved in the NRL and lead the way for the rest of the world to return during COVID-19. “The NRL in particular has the frame of mind that everything we are doing is a showcase for everyone else to follow

suit. With any challenge you adapt and overcome. There’s only one way you can move and that’s forward. I really believe that whether you follow rugby or not, to bring something communal back to the screens that has a sense of normality about it, then I’m very proud of the fact that we are leading the way to do it, but I’ll be even prouder if I can feel that true sense that the NRL choose to do this

so society, the community and the country as a whole can benefit from stepping forward and from not only watching the sport but seeing what can be done when we come together. I think it’s a massive achievement and I really do believe that there is a strong sense of achievement if we can learn from each stage, move forward and if we can do it correctly, I’ll be very happy with that outcome.” VOLUME 37 • ISSUE 4 2020

ADAPT AND OVERCOME

Adapt and Overco How Olympic and Paralympic Athletes have adapted to postponement of the 2020 games.

THE POSTPONEMENT OF THE 2020 TOKYO SUMMER OLYMPIC AND PARALYMPIC GAMES DUE TO COVID-19 HAS HAD A SIGNIFICANT IMPACT FOR AUSTRALIAN ATHLETES. WE SPOKE WITH OLYMPIC AND COMMONWEALTH GAMES DIVING BRONZE MEDALLIST ANABELLE SMITH AND PARALYMPIC VISION IMPAIRED MIDDLE DISTANCE ATHLETE JARYD CLIFFORD ABOUT HOW THEY’VE BEEN IMPACTED SINCE THE RESCHEDULING OF THE 2020 GAMES.

How was lock down for you? What were some of the positives and negatives? Jaryd: Lockdown restrictions had little impact on my training. As a runner, I am lucky that I can train from my front door. My training partner (guide runner) Tim Logan and I live in the Diamond Valley area on the outskirts of Melbourne, which served us well during this crisis. We have been able to explore some local trails and train in a more creative way, rather than sticking to our tried and trusted regimes. Anabelle: I went through a few waves during lockdown! Initially I was really devastated by the cancellation of all my upcoming international competitions and the eventual postponement of the Olympics. It took me a few weeks to accept everything, and then look forward towards setting new goals for 2021. The middle part of lock down I really found my groove and settled into ‘home life’. My days consisted of zoom meetings, home workouts and sleep ins! Coming out the other end

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ADAPT AND OVERCOME

come now, I am excited to get back into the gym and start slowly training again. I was also so excited when we were allowed to visit family and friends again. It has been tough staying at home, but I am never usually in Melbourne at this time of the year, so I have been very grateful to be at home. Talk us through how you felt back in March when the 2020 Olympic and Paralympic Games, scheduled to be held in Japan, were postponed until 2021. Jaryd: I thought I was ready for the announcement. I wasn’t. By the time the Games were officially postponed, I knew it was the right decision. That didn’t stop me feeling empty and hollow. Frankly, I felt completely shattered. Since the age of 12, I have grown up in a highperformance environment that was geared towards Tokyo 2020. It was everything. My life has revolved around one question: Will I win in Tokyo? To obsess about something, and then for it to disappear, that was tough. VOLUME 37 • ISSUE 4 2020

ADAPT AND OVERCOME

Adapt and Overcome Anabelle: I was really shocked initially. There had been about three weeks leading up to the official postponement when everyone was just focused on our qualifying events possibly being cancelled. We were still assuming the Games would go ahead. So, when the decision was made, I realised it was the only possible decision considering the rapid spread of the virus, but I also needed time to wrap my head around it. I had been working towards Tokyo for 4 years, so to have to keep powering forward for another year was a tough reality to accept.

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How has your training changed during COVID-19 restrictions? Jaryd: The biggest daily impact on my training throughout this crisis was most definitely missing my guide Tim from my training sessions. He lives nearby, so travelling was not the issue. As a qualified electrician, Tim was called upon to prepare extra hospital capacity in anticipation for COVID-19, some weeks working nearly 70 hours. This meant I had to train alone a lot of the time, and for my safety this required a lot of running on a treadmill or around an oval â&#x20AC;&#x201C; both can drive me crazy!

I think the biggest challenge is working out what our timeline looks for the next year, with so much uncertainty still around training and travel for competitions.

ADAPT AND OVERCOME

Anabelle: My training certainly reduced. I went from training almost five hours a day, to about one hour. Obviously, without access to a pool, the majority of our training can’t happen. So, my home training sessions rotated between a prescribed home gym session, a bike interval session, yoga and some dance cardio workouts I found on YouTube! I definitely enjoyed mixing up my workouts and trying out new online classes like shadow boxing, but I wasn’t able to do much diving specific training. I bought a soft mat to try somersaults on in my lounge room, but it’s not ideal! In terms of qualifying for the Olympics and Paralympics, how has COVID-19 impacted your timeline? Were you working towards peaking at certain times this year to maximise your chances of being selected? Jaryd: My selection for Tokyo 2020 was all but confirmed. Our focus was on peaking for the Games, and we were on track to achieve this. Now, we will implement the same plan intended for this year, next year. And, at the age of 20, if I continue to train the way I do, then another year should only help my chances of winning gold. Anabelle: It severely impacted our training timeline. We had just returned home from our first World Series event in Canada, with three more competitions to come before April. Mid-April we were working towards peaking for the World Cup in Tokyo, which was our last chance to qualify in Australian places for the Olympics. One by one all the competitions were cancelled and have yet to be secured for next year. What do you think the biggest challenge for Olympic and Paralympic athletes, who were anticipating competing this year, are facing now? Jaryd: I think a major challenge is resetting psychologically. A lot of us have been pushing our bodies for a long time, with September 2020 serving as the finish line in our minds. Now, we have to extend that mindset by one year, which is an exhausting prospect. Nevertheless, this lockdown period could define the results in 2021. The athlete that navigates this challenge the best will most likely perform better in 2021. Perhaps, the gold medal will be determined by how we approach these next few months.

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ADAPT AND OVERCOME

About the Authors Jaryd Clifford is a visually impaired distance runner. He made his Australian senior debut in 2015 at the World Para Athletics Championships aged 16. In 2016, he ran in the Paralympic Games, placing 7th in both the 1500m and 5000m. The following year, he won bronze over 1500m at the world championships. Two years later, in 2019, he became double world champion over 1500m and 5000m. He has also won a national ablebodied title and competed at the World U20 Championships for able-bodied athletes, the first Paralympian to achieve this honour. Anabelle Smith is an Olympic and Commonwealth Games diving bronze medallist. She describes herself as a hardworking and determined elite athlete, striving to be the best she can be in her sport and in life. She puts a lot of hard effort and passion into any task she is given, and she loves sharing her experience and passion for sport, health and fitness with other people. She is a self-driven and confident public speaker and an approachable leader. Her goal is to win an Olympic gold medal and leave a positive legacy in Australian sport. She won

Anabelle: I think the biggest challenge is working out what our timeline looks for the next year, with so much uncertainty still around training and travel for competitions. It’s hard to plan training schedules and to find peak motivation, when you are unsure what you are actually working towards. Also, my 3m synchronization partner trains in Brisbane, so working out our training plan is challenging with different states opening facilities at different times and quarantine rules.

bronze at the 2016 Rio Olympic Games and placed 5th at the 2012 London Olympics. She has won bronze at three Commonwealth Games (2010, 2014 & 2018) and been an Australian national squad member for the past seven years. Anabelle is a recipient of the 2019 Olympians Club of Victoria John Landy Scholarship, 2019 AMP ‘Tomorrow Maker’, 2017 Australian of the Year nominee, 2016 Victorian Institute of Sport ‘Spirit’

What are you now most looking forward to about the 2021 Olympics and Paralympics?

award winner, Sports Australia Hall of Fame Scholarship recipient 2008, 9 x Diving Victoria Athlete of the year and 3x Layne Beachley

Jaryd: The 2021 Paralympic Games will be historic. I believe that there is an opportunity for sport to play a powerful role in the post-pandemic healing process. For me, winning a gold medal has been a lifelong dream. I have always dreamt that this would happen in Tokyo. Anabelle: I am most looking forward to the celebration of sport and of unity. The Olympics in 2021 really will be a special time for the world to come together in the spirit of Olympism. It has been such a challenging time to navigate for the whole world, and I have never felt more disconnected. The Olympics next year will represent unity more than ever.

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‘Aim for the Stars’ scholarship recipient.

THE ROLE OF TESTING IN MANAGEMENT OF COVID-19 IN SPORT

The role of testing in management of COVID-19 in sport AUSTRALIAN INSTITUTE OF SPORT AND UNIVERSITY OF CANBERRA RESEARCH INSTITUTE FOR SPORT AND EXERCISE

port is an important part of society, as is reflected by its transition back to some normality after the initial wave of COVID-19. In Australia, each sport has been required to appoint a COVID-19 Safety Coordinator and have a proactive risk management strategy (COVID-19 Safety Plan) to reduce the risk of transmission of COVID-19 in their training environment. Key components of the COVID-19 Safety Plan include: education, physical distancing among athletes and support staff, enhanced hygiene including cleaning of equipment, facilities and safe waste disposal, use of personal protective equipment (PPE), health checks, symptom monitoring, not allowing anyone with symptoms (i.e., fever, cough, sore throat or shortness of breath) to attend, record keeping for attendance and possible contact tracing, notification and ensuring the appropriate medical review of illness prior to return.

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THE ROLE OF TESTING IN MANAGEMENT OF COVID-19 IN SPORT

Observing these protocols has resulted in the relative success of Australiaâ&#x20AC;&#x2122;s COVID-19 response in the sport setting as well as in the community. It is important to acknowledge unique and intrinsic characteristics of participation in some sport environments. These include sharing of facilities and equipment, close and prolonged physical contact between teammates and opponents, indoor exercise and high levels of physical exertion, which likely increase respiratory droplet and aerosol generation. These factors are difficult to modify while maintaining usual competitive sporting activities. Such conditions increase the risk of transmission of infectious disease,

necessitating a high level of vigilance with risk mitigation interventions.

A key aspect of SARSCoV-2 (the virus that causes COVID-19) is the role of asymptomatic transmission. Approximately one of every two infections are transmitted from individuals without symptoms.

A key aspect of SARS-CoV-2 (the virus that causes COVID-19) is the role of asymptomatic transmission. Approximately one of every two infections are transmitted from individuals without symptoms. Asymptomatic individuals can therefore unknowingly transmit COVID-19 to others and preventing symptomatic persons from attending training or a sporting event does not in itself eliminate risk. It is but one measure in what must be a multipronged risk mitigation approach. Addressing SARS-CoV-2 transmission risk is challenging for public health experts. Health advice is evolving in accordance with emerging evidence of how the disease is transmitted (droplet vs aerosol), local transmission rates, health care capacity, availability of personal and protective equipment (PPE), resources for testing and the economic imperative. Sporting organisations need to remain up to date with the current recommendations for hygiene, social distancing, mask use and group gathering size, all of which mitigate transmission risk should an asymptomatic but infectious individual attend training or competition. One means of identifying asymptomatic but potentially infectious individuals is molecular testing (i.e., Polymerase Chain Reaction, or PCR testing) for COVID-19. PCR testing is the preferred method of testing used globally to diagnose COVID-19. It has the potential to identify an infected individual, prior to the development of symptoms. While there have been significant advances in molecular testing techniques (portability, usability and accuracy) it must be acknowledged that molecular COVID-19 testing

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THE ROLE OF TESTING IN MANAGEMENT OF COVID-19 IN SPORT

is a finite resource that is in global short supply. There is also a possibility that PCR testing may result in a false negative, if conducted soon after transmission. Therefore, it is generally accepted that it is not appropriate to perform untargeted largescale blanket testing on asymptomatic persons.

About the Authors Dr Mathew Mooney is a medical practitioner who is completing an industry funded PhD

Point of care molecular testing has become available to doctors in the previous 10-15 years and represents one means of mitigating some of the increased risk associated with sport. The primary benefits of point of care testing are in a more rapid turn-around time for test result, permitting expanded (but still targeted) indications for testing, addressing the unique epidemiological risk factors in the sporting context, and for a team travelling internationally. Point of care molecular testing requires a significant initial investment, with medical oversight from a practitioner with appropriate training and skills. This may limit its practical application to some high performance and professional sports with adequate resources and full time medical staff. Despite these limitations, molecular point of care testing offers a useful adjunct to robust and comprehensive infection control procedures in some sport settings.

scholarship at the AIS and University of Canberra investigating infectious diseases in high performance athletes. Prior to commencing medical training, he completed undergraduate and honours degrees in sport science with an interest in strength and conditioning. Following residency, he completed post graduate studies in Infectious Disease Intelligence. Dr Mooney’s main research interest is in the application of field epidemiology to understand infectious disease in a high performance sporting context. Dr Nirmala Perera is the Clinical Research Project Officer at the Australian Institute of Sport. She previously held Post Doctoral Research Fellowships at the University of Oxford and University of Linköping, Sweden and a member of Sport Without Injury Programme (SWIPE). Her research focuses on a range of sports medicine and injury prevention

There has been interest in other forms of testing that could be used at the point of care. Lateral flow antigen or antibody testing is currently under development. Antibody testing aims to ascertain if a person has developed antibodies in response to viral exposure. Currently, there are no antigen tests available in Australia and their diagnostic utility is limited due to poor sensitivity. Moreover, point of care antibody testing does not provide information on infectivity and is not clinically superior to PCR testing in the sporting context.

projects. She is an Associate Editor for the Journal of Science and Medicine in Sport, alongside serving on several committees including as a former Sport Medicine Australia Executive Board Member. Dr Perera is passionate about knowledge translation and is the Social Media Coordinator for the International Olympic Committee World Conference on Prevention of Injury and Illness in Sport. Dr David Hughes is a Sport & Exercise Medicine Physician with over 25 years’ experience working

While point of care molecular testing has a potential role in risk mitigation in the sport setting, it is imperative to do the non-technical fundamentals of infection control well and consistently. Avoiding training and competition venues with the presence of any symptoms, social distancing and enhanced hygiene measures form the basis of a COVID-19 Safety Plan which reduce the risk of disease transmission. The priority at all times must be to preserve public health and minimise the risk of community transmission.

in high performance sport. He is currently Chief Medical Officer of the AIS and Medical Director for the Australian Olympic Team for Tokyo 2020/2021. Experience includes Super Rugby, the NRL and English Premier League football. He attended London 2012 as Team Physician for the Opals and Rio 2016 as Olympic Team Medical Director. He is a former President of the Australasian College of Sport and Exercise Physicians (ACSEP). Dr Hughes’ current work focus is on system-wide protocols to optimise athlete health and safety, concussion and ethical/

To read more about testing and management please refer to Mooney et al., A deep dive into testing and management of COVID-19 for Australian high performance and professional sport.

integrity challenges in high performance sport

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THE IMPACT OF COVID-19 IN THE AFL ENVIRONMENT

The impact of COVID-19

in the AFL environment

HAWTHORN FOOTBALL CLUB PHYSIOTHERAPIST, BRUCE CONNOR SHARED AN INSIGHT INTO HOW COVID-19 IMPACTED THE AFL ENVIRONMENT BACK IN APRIL FOR STAFF, PLAYERS AND CLUB RESOURCES AFTER THE AFL SEASON WAS SHUT DOWN AND HOW THIS COULD CHANGE THE FUTURE OF ELITE AND RECREATIONAL FOOTBALL ACROSS AUSTRALIA.

You’ve been in the AFL industry for a long time with your work with Essendon Football Club and now Hawthorn Football Club. How does the pandemic compare to other changes you have seen in AFL in your time? All the changes that have happened throughout my career were of slow evolution. There were a couple of big jumps in the curve at various stages like the introduction of the national competition which meant more teams and more travel. Once they began to schedule games later than Saturday afternoon the scheduling had to change around that. We evolved through the mid to late 1990’s from being part time sports clubs if you like into full time sports business. So, there was an exponential growth in staff and responsibilities and then player availability because the players were becoming professionals. All of

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those were major changes in that significant period but in terms of a one of episode we haven’t seen anything like this since the World Wars. That’s the only thing that’s stopped the world like this and hopefully we won’t experience too often again. Thinking back to round one. You were scheduled to play on the Sunday and the round got called off halfway through. What was the impact of that? If you recall during that period, the general knowledge and perception of impact in Australia was not that great. In terms of business as usual from about two or three weeks out it became clear that we were going to have to do things a little differently to continue to function in line with general society. As various restriction levels ramped up, we had to do the same with the football club. Within

THE IMPACT OF COVID-19 IN THE AFL ENVIRONMENT

the clinic we were probably ahead of the football club – in terms of hygiene measures, distancing, screening people – it was starting to change the way we were operating which flowed back into the football club. The football club is a higher density environment and its harder to stagger your contact with people there. Medical rooms are social hubs as much as health administration areas, there are always people around. Our response to COVID-19 required a pretty quick culture change which we had already initiated. It started with reducing the administration staff, and then the numbers of staff within the football department were reduced to what we call essentials. We got to the point leading into the first game it was a very modified environment anyway and we all had to start multitasking in a sense and filling in gaps. I finished up being a trainer, along with our

radiologist, our rehabilitation physio and our normal head trainer. The last time I was a trainer was in 1983 so the rules around being a trainer have changed enormously in that time. We had to do a briefing about being a trainer and just do the job. I enjoyed it because I was on the ground a lot more than I normally would be. I heard a lot of banter with no crowd noise as well! We all met up the day after that match and had a formal discussion with the CEO about how we would manage the squad. At that point the AFL announced a one-month total shut down with no contact at all with the club, and two-month postponement from matches. It was the initial view to reassemble through May and resume play at the end of May. That was later pushed back, with players programs modified accordingly. Having an understanding from a

medical perspective about what a virus is, what it was doing and how the authorities were trying to get it under control, my feeling was that two months wasn’t going to be enough. The bigger issue has been the relationships with the staff and the club. I expected that final post-match meeting would be my last formal get together with that group of staff. It was an odd feeling because I was acutely aware that if I were to return in some capacity, it would almost certainly be to a very different environment. So, though the “good bye” at the end of that morning was pretty casual, it was very much unknown what the immediate future held. The club has had to reduce the number of staff down to a bare minimum because what they’re essentially doing is setting up programs and running from a distance.

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THE IMPACT OF COVID-19 IN THE AFL ENVIRONMENT

What does sports medical team resourcing look like going forward? If in the virus flares up again and the games are further limited or suspended, and next year we’re still playing in front of empty grandstands, the available resources will be very small. I’m pretty sure that the football department will look very different and that will be driven by the soft cap which is a limitation set on the amount each football club can spend in their football departments. That was set a few years ago by the AFL to curb escalating expenditure so the need to think seriously about what we were spending money on was already present. The reality is there will be most likely be reduced resources with it being at each club’s discretion as to how those resources are allocated. Even with reduced resources and staffing, our future approach will leverage what we’ve learnt over the last 15 years. 15 years ago we didn’t have a great handle on what the demands of football were. We had a lot of people who had analysed the game and were speculating on the sports in terms of physical demands. In the last 10-15 years we’ve developed a greater understanding of that because we’ve had greater tools and resources

to analyse it. Future sports medical teams, even if there are less people, will have a much greater grasp of what the physical demands and the recovery profiles are to be an AFL Footballer. They’re coming from a much better base than what we had 15 years ago. It’s not just about numbers of people,

it’s about their level of knowledge as well. If we have less resources, a multidisciplinary and collaborative approach will be more important because you’ll have less people to support the players. We are better placed and equipped now to handle a situation like this than we were 15 years ago. What is your experience of the clinical side of the COVID-19 response? It’s been interesting. Everybody was in shock about what it meant for them. You had people being sacked, stood down, put into hibernation and working from home. So, you had these people scrambling for technology knowledge – how to work zoom – all that stuff was going on. For the first week or so things dropped off quickly. I don’t think physio treatments were at the forefront of people’s minds. In the last 4-8 weeks we’ve really settle into a new normal. Our workload whilst reduced, has bounced back to a reasonable level. Partially that is

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THE IMPACT OF COVID-19 IN THE AFL ENVIRONMENT

The reality is there will most likely be reduced resources in the future, with it being at each club’s discretion as to how those resources are allocated.

About the Author Bruce Connor received his Bachelor of Applied Science in Physiotherapy in 1982 and became a titled Sports Physiotherapist with the Australian Physiotherapist Association (APA) in 1999. Along with Paul Wise and Paul Lew, Bruce established the Windy Hill Sports and Spinal Physiotherapy Clinic (WHSSPC) in 1994. Initially he shared his clinical time with the role as head physiotherapist at Essendon Football Club, a role he continued in until the end of season 2005. From 2006 Bruce changed roles, with Paul Wise taking over as Essendon Football Club (EFC) head physio with Bruce remaining as a member of the EFC physiotherapy team until early 2012. This has allowed him to increase his WHSSPC clinic time and take up the position as clinic manager. Bruce brings more than 25 years of sports physiotherapy experience to WHSSPC and very much enjoyed overseeing the development of its new facilities through 2007 and 2008. He has been working with the Hawthorn Football Club as a physiotherapist since 2012.

because the health minister and the advisors to him have said they want allied health to stay open, and it’s not a high risk environment to still see people face to face if you’re doing the right thing which we’ve been doing from the start. Things like screening our patients before they come in thoroughly, social distancing, higher hygiene levels and just being sensible about how we interact. Telehealth has its limitations of course, but in terms of exercise prescription, you can cover a lot of things that gives people some sort of value for their interaction. The big thing that’s hit us is that we can run classes. We run a considerable number of rehab and preventative condition classes which we’ve had to trim down from six-to-one to one-toone. We’re quite accepting that this is how we must operate. That’s had a fair impact on the amount of people who’ve had access to that. We’ve had to be quite innovative in terms of setting up exercises online and ways of communicating with people without

being face-to-face. But by in large, things at the clinic have exceeded my expectations. We’ve settled into a rhythm that’s a new normal. Do you think you’ll keep some of these measures you brought in when restrictions ease further? I think the hygiene measures are a good idea. I think we’ll keep up a higher level of hygiene. The big one is communication. I now have confidence that if someone I was treating went on holidays or overseas, I could happily communicate with them via telehealth. Generally, people have gotten so quickly used to online communication that if you said let’s do a zoom consultation people would take it up and it would work. That’s something we’ll keep in the back of our minds. People have also become more self-sufficient with their exercise. Tapping into people’s desire and ability to exercise at home will be a positive for us. It’s been a real eye opener for me to see how people have coped.

What are the priorities for supporting a safe return to play the recreational AFL level? Everyone involved in a recreational sports team will have a role to play in making that environment safe and compliant to enable people to play. That will involve similar things to that at Hawthorn: heightened levels of hygiene, distancing where possible given that the field of play doesn’t seem to be a high-risk environment in terms of transmitting this. It will impact on the social elements of sport, but for the sake of getting sport going again, how clubs are set up and the guidelines that are involved are a really important area they’ll have to fill. Things are changing so quickly so what’s a recommendation this week may not work next week. Somebody within each club will have to be the go-to person who is absorbing this information and implementing it into the U’15’s football team, or whoever it is. That will be the key role, as well as all the things we normally do.

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THE RECOVERY OF SPORT - A SPORTS NUTRITION PERSPECTIVE

The Recovery of Sport A Sports Nutrition Perspective

s Australia and the rest of the world enter into their respective phases of returning to a new normal; the recovery of sport and implications for all stakeholders is significant and no simple task. The AIS Framework for Rebooting Sport in a COVID-19 Environment highlights this challenge and describes baseline standards for sport to prioritise preserving public health and minimising at all times, the risk of community transmission. Albeit an enormous task, the return and recovery of sport will undoubtedly be a fulfilling time for our communities and their networks. During the peak of COVID-19 in Australia, as high performance and community sport was shut down, organisations were thrown into obvious chaos. From a nutrition perspective and working across multiple organisations, it has been fascinating and rewarding to be part of workplaces who band together to create, share, inspire and do everything in their power to look after the safety, health and wellbeing of their athletes, clients, colleagues, employees and businesses – which ultimately support our sporting communities. It has been incredibly important to listen, acknowledge, initiate and plan strategies to support and assist individuals and teams through the challenging and unknown territory. The 30

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effort and energy has been huge – from team cooking masterclasses, webinars, recipe book creations and inspiration, to virtual nutrition education sessions, telehealth consultations, athlete reviews and the development of resources to accommodate potential effects of isolation. It’s been important to provide reassurance and recognise the need to not overwhelm, but to be proactive in planning and providing the relevant tools and support as required. As we are all hopeful for a smooth exit to stable ground, far away from the slippery slope and outcomes of COVID-19, it’s important to be aware and prepared for the recovery and return to sport as well as the potential longer term ramifications that may have impacted our active communities. Metabolic health/dieting Unfortunately, the negative effects of isolation, including altered sleep, reduced physical activity, changes to regular eating behaviours such as non – hungry / boredom eating or poor food choices, can increase the negative health risk for individuals quite quickly. King et al, 2020 share these insights in a great opinion piece exposing the outcomes of disrupting usual circadian rhythms, as well as practical solutions to minimise the risk of adverse health outcomes. I received an email from a client recently, depicting exactly this – “I need your help, we’re all going

to come out of COVID-19 a chunk, hunk or a drunk.“ This statement quite bluntly summarises some of the personal effects of COVID -19, but also, opens an opportunity for all allied health to continue providing support to empower and inspire individuals within our communities to support their health. Prioritising and ensuring credible nutrition education and exercise support, as well as psychological support when relevant, will hopefully help discourage engagement or buy in to dietary fads or diabolic weight loss regimes, and address further challenges that may arise. Isolation and effects of body image or Disordered Eating The AIS in collaboration with the National Eating Disorders Collaboration (NEDC) have recently released a fantastic set of resources for athletes, coaches and the high performance team that address some of these challenges individuals can experience. These resources were developed to highlight the challenges that result from isolation that may affect even the most resilient of athletes, including mental health, body image and disordered eating. If such challenges and or symptoms are presented by athletes that you work with please encourage them, where appropriate, to check in or reach out to a Sports Physician, Sports Psychologist or

THE RECOVERY OF SPORT - A SPORTS NUTRITION PERSPECTIVE

Accredited Sports Dietitian. It’s also worth raising the question: ‘Is it imperative for all athletes to have their body composition assessed as soon as they recommence training, or could this trigger further issues if they have experienced body changes?’ These are very important considerations and may require specific management to ensure we don’t create harm, particularly for those individuals who may be more vulnerable or at greater risk of experiencing a challenging relationship with food or their body. Periodised Nutrition/RED-S With the recovery of sport, continued periodised nutrition and helping athletes adjust their nutritional intake to the demands and changes of training or activity levels is important to ensure adequate nutrition. For some, this may have been providing education to accommodate a reduction in energy and for others, this could mean increasing the energy available relative to the type/ modification of training, or with the return to usual high volume training loads which helps to minimise the risk of relative energy deficiency in sport. Communication among the high performance team is imperative to understand the overarching goals for the athlete now and when these may change, which is not straightforward for sports with unknown future competitions or qualification events.

The SDA community Keep your eyes peeled on the SDA website and your inboxes for the promotion of our new Coaches Toolkit – this has been designed to support coaches with the foundations of nutrition. SDA has a range of resources including factsheets, a blog, recipes and a community sporting eMagazine called ReFuel that is free to subscribe to. It’s important our education extends not only to the athlete, but also to their supporting network.

About the Author Jessica Rothwell is an Accredited Sports Dietitian currently consulting at the Victorian Institute of Sport, Olympic Park Sports Medicine Centre and is the High Performance Nutrition Lead for Athletics Australia and in-house Sports Dietitians at Sports Dietitians Australia.

Now is a great time to connect with your local Accredited Sports Dietitian. Get them involved in your local community or elite level individual or team-based sports and help to empower your communities with the skills to confidently manoeuvre through this time and as we all move forward. VOLUME 37 • ISSUE 4 2020

MEDICAL SERVICING CONSIDERATIONS FOR PROFESSIONAL AND HIGH PERFORMANCE SPORT

Medical servicing considerations for professional and high performance sport by the Australian Institute of Sport REPORTS OF COVID-19 OUTBREAKS AMONG COMMUNITIES AND WITHIN SPORTING COMPETITIONS AS SPORT BEGINS TO RETURN ARE A REMINDER THAT IN A PANDEMIC, SMALL NUMBERS CAN QUICKLY BECOME BIG CLUSTERS. THE FIGURE BELOW ILLUSTRATES HOW ONE INFECTED PERSON IN ANY ENVIRONMENT CAN POTENTIALLY INFECT 400 PEOPLE WITH COVID-19 IN ONE MONTH.

edical servicing is an essential and key component in high performance sport. The medical team is comprised of sports physicians, sports physiotherapists, soft tissue therapists, sports trainers, sports dietitians and psychologists. This article relates mainly to sports physiotherapists and soft tissue therapists but is applicable to all personnel delivering manual therapy services. There are inherent risks in delivery of manual therapy services that need to be managed and we need to recognise that it is not “business as usual” as we return to full sport.

players, staff, officials and fans from COVID-19 is a concern for many sporting organisations. In this article we discuss safe and considered ways to provide medical servicing in the unique context of professional and high performance sport based on the AIS Framework for Rebooting Sport in a COVID-19 Environment (the AIS Framework) which is available as an open source document in the Journal of Science and Medicine in Sport. The principles discussed herein are also applicable to other settings.

Decisions on how best to provide medical servicing (physiotherapy and manual therapy) whilst protecting

We recommend mandatory completion of the freely available Australian Government COVID-19

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infection control training module is recommended for all staff involved in medical service provision prior to any contact with athletes. The approach to medical servicing should focus on ‘get in, get out’, minimising unnecessary contact in treatment rooms and common areas. General principles for medical service provision include keeping the number of individuals in the treatment area to a minimum in accordance with the social distance guidelines. Sporting treatment

MEDICAL SERVICING CONSIDERATIONS FOR PROFESSIONAL AND HIGH PERFORMANCE SPORT

unwell (even if mild) with symptoms of COVID-19 (fever, cough, sore throat, shortness of breath) or potential symptoms not explained by another cause (fatigue, myalgia, loss of taste or smell, gastrointestinal symptoms) or had contact with a known or suspected case of COVID-19 in the past 14 days, they must not join the training environment or manual therapy treatments until cleared to do so by a medical doctor.

areas can often morph into informal social gatherings, but in a pandemic environment this is no longer safe, so all non-essential athletes and staff should stay away from treatment areas. To minimise the transmission between practitioner and the athlete, five moments of hand hygiene must always be used: ٚ Where possible do not share equipment and clean all

equipment thoroughly after use. ٚ Single use towels/bedsheets and thorough cleaning of treatment beds and key contact surfaces before and after every athlete should be part of routine hygiene practice. ٚ It is recommended that the athlete and therapist wear a face mask during manual therapy treatment or massage. ٚ Athletes should shower before and after the treatment where possible. ٚ If the therapist or athlete has been

The AIS Framework divides sporting activity into three levels (A, B, C) Level A is the most restrictive level of training. Core principles for medical servicing specific to Level A, B, C sporting activities are discussed below. Level A ٚ All consultations should be conducted via telehealth where possible. Telehealth consults must be conducted over end to end encrypted apps to ensure appropriate level of privacy is maintained. ٚ Consults should only proceed to face to face where essential and when all indirect management techniques have been exhausted, for example VOLUME 37 • ISSUE 4 2020

MEDICAL SERVICING CONSIDERATIONS FOR PROFESSIONAL AND HIGH PERFORMANCE SPORT

where the diagnosis cannot clearly be made without some differential physical assessment or where equipment / technique is required to support physical wellbeing. ٚ If face to face consults are essential, public health advice on use of face masks should be followed and 1.5 m distancing should be maintained wherever practical. ٚ All routine and non-essential manual therapy should be avoided. Level B: Hygiene measures from Level A must continue. In line with the AIS Framework principles, all routine management consults should continue via telehealth where possible.

Considerations before arranging a face-to-face non-hands-on consult

Before considering face to face consults the therapist should consider whether they have exhausted all remote means of managing the athlete’s clinical presentation. After applying strong clinical reasoning and in consultation with key stakeholders it may be established that a face to face consult would be beneficial. Considerations for follow up face-to-face hands-on consults Stakeholders must establish what the triggers are that support moving to the next level of servicing – for example, the clinical presentation has plateaued and would benefit from an intervention from a therapist. Where possible, face-to-face consults should be conducted observing social distance rules (i.e. from 1.5m apart) and hands on treatment should be for essential techniques only. A single source of therapist is recommended – it is recommended that sports seek to keep their manual therapists and sports trainers as part of their ‘biosecurity bubble’ to limit cross contact between sports and social groups. Face masks are recommended for the athlete and practitioner during any essential manual therapy in line with public health advice. 34

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Level C: Routine hygiene measures from Levels A and B must be maintained with thorough cleaning of surfaces and equipment after each use.

Use of a mask should be considered where the athlete is supine or sitting and the therapist and athlete will be within 1.5m for more than a brief assessment.

Social distancing guidelines should be continued wherever practical.

Rigorous reasoning should be applied to the necessity of face to face consults, which require use of

MEDICAL SERVICING CONSIDERATIONS FOR PROFESSIONAL AND HIGH PERFORMANCE SPORT

hands on techniques, throughout all levels of the AIS Framework to reduce the risk of infection. We can demonstrate to athletes and coaches the significant benefits of evidenced based approaches to exercise-based treatment at this time. We have the opportunity to demonstrate the diverse skill set manual therapists possess to support athletes and coaches to achieve optimal performance outcomes.

About the Authors Jennifer Cooke is a Titled Sports and Exercise Physiotherapist with over 30 years’ experience working in high performance sport. Jennifer is currently the AIS Physical Therapies Lead. She has extensive experience in hockey having worked with Australian national hockey teams from 1996 to 2015. She attended the Melbourne 2006, Delhi 2010 and Glasgow 2014 Commonwealth Games and Beijing 2008 and London 2012

Although the pandemic has disrupted sport across the world, as sports start to return to full training it is an opportunity to reflect on the practices that have been created by the necessity of lockdowns. What are the opportunities that have arisen from these learnings? How can we continue to employ new methods of working that will enhance our service to athletes in the “new normal” world of sport?

Olympic Games as team physiotherapist for the Australian Women’s Hockey team. She also represented Australia at Athens 2004 as an Australian Team Headquarters Physiotherapist. Jennifer’s current focus of work is to support world class sports physiotherapy services in the high performance system with a particular interest in developing systems that support health and injury prevention in the pre-elite population. Dr Nirmala Perera is the Clinical Research Project Officer at the Australian Institute of Sport. She previously held Post

The lockdown required therapists to become more efficient in supporting athletes to undertake guided self-management. This creates an increased self-sufficiency and ownership of the programs that athletes are advised to follow. Return to past practices, that remove this self-sufficiency with a return to non-evidenced based practise, could negate the benefits that have been made.

Doctoral Research Fellowships at the University of Oxford and University of Linköping, Sweden and a member of Sport Without Injury Programme (SWIPE). Her research focuses on a range of sports medicine and injury prevention projects. She is an Associate Editor for the Journal of Science and Medicine in Sport, alongside serving on several committees including as a former Sport Medicine Australia Executive Board Member. Dr Perera is passionate about knowledge translation and is the Social Media Coordinator for the International Olympic Committee

An emphasis on prevention and the opportunity to address aspects of athlete development has also presented itself. This focus on prevention has seen good coach support and again the opportunity is created to continue with prevention strategies.

World Conference on Prevention of Injury and Illness in Sport. Dr Richard Saw is a Sport and Exercise Medicine Physician, currently appointed as the Lead Physician at the Australian Institute of Sport. He has previously worked with the Australian Men’s Cricket Team, North

The lockdown has opened windows of opportunity for athletes to address ongoing issues that impact on training and performance but where the timing had not been ideal to modify loads for various reasons. Opportunities to address these issues will enable an athlete to optimise their performance potential.

Melbourne Football Club and the AFL Umpires. Dr David Hughes is a Sport & Exercise Medicine Physician with over 25 years experience working in high performance sport. He is currently Chief Medical Officer of the AIS and Medical Director for the Australian Olympic Team for Tokyo 2020/2021. Experience includes Super Rugby, the NRL and English Premier League football. He attended London 2012 as Team Physician for the

Remaining agile and responsive to the needs of stakeholders as well as the public health position is essential. The ability to develop practices that support moving in and out of possible future lockdowns will facilitate continuity of care for sports.

Opals and Rio 2016 as Olympic Team Medical Director. He is a

Owing to inherent risks in delivery of manual therapy services, it is vital to follow key hygiene principles and social distancing wherever possible by all practitioners to minimise the risk of COVID-19 spread. It is important to be vigilant and recognise that it is not “business as usual” as we return to sport. Medical services are a key component of athlete performance and have a significant responsibility to minimise risk by supporting and advocating for COVID-19 safe practices in the sports environment.

Dr Mathew Mooney is a medical practitioner who is

former President of the Australasian College of Sport and Exercise Physicians (ACSEP). Dr Hughes’ current work focus is on systemwide protocols to optimise athlete health and safety, concussion and ethical/integrity challenges in high performance sport

completing an industry funded PhD scholarship at the AIS and University of Canberra investigating infectious diseases in high performance athletes. Prior to commencing medical training, he completed undergraduate and honours degrees in sport science with an interest in strength and conditioning. Following residency, he completed post graduate studies in Infectious Disease Intelligence. Dr Mooney's main research interest is in the application of field epidemiology to understand infectious disease in a high performance sporting context.

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THE COVID-19 IMPACT ON HEALTHY AND ACTIVE COMMUNITIES

The COVID-19 on healthy and active communities

WHILST COMMUNITY SPORT HAS BEEN SEVERELY IMPACTED BY COVID-19, OUTDOOR RECREATION LEVELS HAVE INCREASED AS MANY INDIVIDUALS HAVE BEEN FORCED TO FORGO THE TRADITIONAL GYM AND FITNESS CENTERS AS A MEANS OF PHYSICAL ACTIVITY IN FAVOR OF RUNNING, CYCLING AND WALKING WITHIN OUTDOOR COMMUNITY SPACES. PARKS AND LEISURE AUSTRALIA (PLA) PRESENTS THE OPEN SPACE AND RECREATION PERSPECTIVE ON HEALTHY AND ACTIVE COMMUNITIES.

arks and Leisure Australia (PLA) represent the people behind the places that encourage healthy and active communities. The planners, architects and custodians of Australia’s parks, bushlands, gardens, sports facilities, leisure centres and trails.

That said, we have found new ways to communicate and continue to deliver projects as opposed to operating facilities and delivering programs. Our use of Zoom and Teams together with Local Government engagement has increased and will impact the way we work together into the future.

The impact of coronavirus (COVID-19) restrictions on our industry and membership has been significant. We have seen many job losses and staff stood down across peak sports bodies, local government and private operators across our sports facilities and aquatic and leisure centres. The impacts are being felt by volunteers at the grass roots level to the administrators of elite sports competitions.

We are encouraged to see people walking, exercising and riding in our parks, on our tracks and trails and within our natural places. During lockdown, we have placed a high value on our parks and bushland. These wonderful places have helped people escape the isolation in our houses, keep healthy and provided the mental break needed under stressful times. Our parks have also been a place where the whole family have exercised together.

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We have also seen enthusiasm by our urban planners and leaders to put people movement at the heart of our urban planning response to COVID-19. As restrictions ease, we are seeing car free zones to enable pedestrian use at a safe social distance, car parks being closed in our CBDs to encourage commuter bike riding and new parks being constructed in built up areas with a low level of open space per capita. This is an opportunity for Australia to rethink our design of our places to

THE COVID-19 IMPACT ON HEALTHY AND ACTIVE COMMUNITIES

Impact By Bruce Fordham – Manager of Leisure Centre and Sport, Hume City Council, Melbourne. (Contribution on behalf of Parks and Leisure Australia)

address a national crisis – the poor health of our nation. 8 in 10 Australian children do not meet national guidelines for 60 minutes of physical activity per day. 1 in 3 Australians aged 15 and over do very little or no exercise at all. 70% of Australian men and 56% of Australian women are overweight or obese. 1 in 5 Australian experience a mental illness. It is critical in our response to COVID-19 that our metropolitan and regional cities develop urban health

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THE COVID-19 IMPACT ON HEALTHY AND ACTIVE COMMUNITIES

infrastructure plans that build on the natural attributes of our coasts, rivers, parks and bushland, extend our open space networks and reimagine our cities as healthy and active living places. PLA also supports the AIS Framework for Rebooting Sport in a COVID-19 Environment and looks forward to these steps being followed in line with State and Territorial Governments public health advice. This will be welcomed by our membership, particularly those waiting to return to work. In recent years sports facilities, aquatic and leisure centres have been evolving to welcome and invite all members of our community to participate, employing universal design principle to create accessfor-all, gender inclusive facilities. Our response to COVID-19 needs to fast track these developments. We will need to consider the impact of COVID-19, rethink and redesign our spaces for the ‘new normal’. This will require a management response in the short term and a design response in the long term. Issues around the 38

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Through the period of COVID-19 to date, whilst there has been closures of a range of large public spaces and facilities, there has been an overwhelming increase in people engaging in more local community spaces and places to seek leisure and recreation (fitness) opportunities. This has included increased dog walking and families spending time walking, running and cycling together.

type of sport and capacity of change spaces will need to be addressed as most community level facilities cater for a number of sports with varying participation numbers e.g., football (soccer), Australian Rules football, rugby union, rugby league , cricket, netball. This will take time as most facilities are long lived assets and as such are in place for over 15 – 20 years before renovations or replacement that would allow such changes. These facilities are mostly funded by Local Government. COVID-19 is impacted the financial capacity of Local Government to invest in this response and therefore partnership funding with State and Federal Government is critical. With the approach at present being the sports needing to manage this for their sports with team mangers and officials needing to monitor restrictions and ensure compliance, this will add further compliance requirements onto community clubs, who rely heavily on volunteers who already have a number of obligations. Volunteers at present require training and certification to be involved in these sports, particularly if it involves children and new compliance

THE COVID-19 IMPACT ON HEALTHY AND ACTIVE COMMUNITIES

directions in response to COVID-19 will add to regulatory priorities and challenges. Volunteers will need our support to continue the enormous contribution and value they make to our social community fabric. Local Government has been looked to as the monitoring force to ensure community compliance with social distancing and this may be extended to policing the use of the facilities they manage, which community clubs use. Equally, Local Government will rely on clubs to ensure compliance with public health advice and other guidance such as the AIS Framework to Reboot Sport in a COVID-19 Environment and Sport Australia’s Return to Sport Toolkit. Parks and Leisure Australia will continue to support its members through this challenging time. We look forward to all levels of Government supporting the rebooting of our parks and leisure industry as COVID-19 restrictions ease. Parks and Leisure Australia commentary on impact of COVID-19 Kevin Lowe (Executive Manager Economic Development & Innovation, Campbelltown City Council) and Ben Bainbridge (Associate, Otium Planning Group Pty Ltd) The shutdown of community sport has had an immediate impact, not the least being the personal health

impact on many individuals and families not being able to exercise regularly, the loss of social interaction (not only for the players but also for families) that occur as a result of engagement in community sport and further the impact on the viability of a number of community sporting clubs into the future. Community sport facilitates activity from the early years in junior development programs through to seniors who participate regularly in modified sporting activity. Many community sporting clubs have been able to engage with their players/ members via a range of social media outlets and this has included “keeping in touch messaging” through to clubs offering at home training drills and motivational advice during these unprecedented times. The impact for community sporting clubs and associations is the direct financial impact on their viability with many small business supporters/ sponsors unable to continue their support in the immediate future due to the financial impact on businesses. There has been a range of responses to this issue from Governments at all levels including small grants to assist clubs and associations. A significant challenge currently facing clubs and associations is the rebuild, but as has been witnessed through times of community hardship (fire, floods and other environmental

impacts) there is clear evidence of community support, strength and resilience in the face of adversity. The health benefits (both physical and mental) delivered through community sporting clubs and associations are often understated and not well understood within the broader community. Investment by all levels of Government will be repayed through positive community health outcomes and initiatives. Local playgrounds, skate parks and fitness stations have not been available for use but cycle paths, walking paths and community open spaces have, and in many cases have been discovered for the first time. Whilst organised sport caters for a particular cohort in our society there are significant opportunities for great community engagement in passive recreational pursuits to enhance both physical and mental health outcomes via access to well designed and planned community spaces and places. We implore all levels of Government to enhance their promotion of these opportunities, and in particular the “no cost“ benefit of being able to engage in these places and spaces at times that suit individuals or families. If there is to be a take away as we move to the relaxing of COVID-19 restrictions, it is that through participation in community sport (either as a player, parent or supporter) or being able to access well planned and provided community spaces and places we as a society need to continue to focus on the positive health outcomes that are able to be delivered. Funding at all levels for both organised community sport and the development of our community spaces and places needs to continue to be a priority and enhanced to ensure long term health benefits. Bruce Fordham – Manager of Leisure Centre and Sport, Hume City Council, Melbourne. On behalf of Parks and Leisure Australia.

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COMMUNIT Y SPORT MUST COME BACK ON TRACK

Why community sport

must come back on track N COVID-19 SMASHED COMMUNITY SPORT FOR SIX. YET WHILE COMMUNITY SPORT CLUBS WERE FORCED TO SHUT DOWN TRAINING SESSIONS AND COMPETITIONS DURING ISOLATION, MANY AUSTRALIANS RECOGNISED THEY STILL NEEDED TO REMAIN ACTIVE. THEY BOUGHT BIKES, LYCRA AND HOME GYM EQUIPMENT, WALKED AND CYCLED, AND EXPLORED THEIR COMMUNITIES. IN THIS FEATURE, WE DELVE INTO THE IMPORTANCE OF COMMUNITY SPORT RETURNING AND HOW THIS WILL IMPACT COMMUNITY CLUBS, ASSOCIATIONS AND THE GENERAL POPULATION.

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ow that restrictions are easing, it will be up to the leagues, associations and local community clubs to decide how Australians return to active play. Recently, junior sport competitions were allowed to re-start, but some winter sport leagues and clubs are questioning whether they will return for a shortened 2020 season or cancel their season altogether for cost and other reasons. This means that for some sports, if even one club does not return to competition, the green light could turn red for everyone. More than a dozen Victorian country football and netball leagues have already abandoned their 2020 seasons. A study currently underway by Victoria University, Federation University, and Flinders University has surveyed over 6000 sport-playing Australians to investigate the contribution of sport to the health and wellbeing of individuals and communities before, during, and after COVID-19. When study participants rated their health during COVID-19 lockdown restrictions

COMMUNIT Y SPORT MUST COME BACK ON TRACK

compared to a year earlier, one quarter reported their general health was worse than the year before, 29% reported worse physical health, and 31% reported worse mental health. Further, within the past two weeks, during COVID-19, 28% reported feeling downhearted and depressed and 30% were losing sleep due to worry. We will be able to see any changes to individuals’ health once they have returned to play, as we will survey the respondents once again (post COVID-19). This shows that the absence of community sport has a clear detrimental effect on physical and mental health. When we survey these participants again once they return to play, we expect to see improvements in all these health measures. So, it is particularly concerning, therefore, that the sustainability of thousands of community sport clubs across Australia is currently under threat. A study being undertaken by the Australian Sports Foundation is assessing the financial impact of COVID-19, as well as the impact on membership and the crucial aspect of volunteering – essential to the functioning of community sport. Interim results from over 4,000 community clubs paint a bleak picture: revenue from membership, sponsorship and fundraising has virtually ceased, while costs such as utilities, insurance and maintenance remain. And the return to sport – while welcome – brings with it additional pressures. Over 70% of clubs project reduced revenue from local sponsors and fundraising, while 68% forecast a reduction in membership revenue. Even worse, clubs will face increased costs – 91% of clubs say new hygiene measures will increase costs, while around 50% face additional costs from staggered training and additional equipment requirements caused by COVID-19.

the sport clubs are intimately woven into the social fabric of the communities and where local retail and hospitality trade delivers significant economic value in its association with a connection to sport. These studies highlight not only the physical and mental health benefits that community sport brings, and which COVID-19 consequences have clearly exposed, but they also point to a major reason that many Australians play sport – for fun and enjoyment. Most children do not care about how many matches they get to play, nor winning the premiership. In the end they just want to play with their friends even if this means that the season is shorter than normal. These findings should move an Australia-wide ‘Return to Community Sport’ to the top of the priority list for those who make that call.

About the Authors Professor Rochelle Eime is a Behavioural Epidemiologist who has over 15 years of research experience specifically relating to the sport and recreation sectors relating to both public health and sport management. Rochelle is the Director of the Sport and Recreation Spatial program of research which focuses on investigating sport and recreation participation, facilities and health for evidence based decision making. Professor Hans Westerbeek is Professor of International Sport Business and Head of the Sport Business Insights Group, and came to Victoria University (VU0) 10 years ago as the founding Director of the Institute of Sport, Exercise and Active Living (ISEAL) (now Institute for Health &

COVID-19 also means that clubs will need more volunteers – yet nearly half of all respondents project a decline in volunteers, through a combination of health fears and the additional workload required by new hygiene measures.

Sport). He then took on the role of Dean of the College of Sport and Exercise Science followed by heading up the VU-wide sport strategy as Pro-Vice Chancellor Sport. He is a member of the team at Track – VU’s human

Against this background, communities, politicians, sport decision-makers, and highly valued sport volunteers will need to develop a consolidated and coordinated approach to get community sport clubs back to training and competing.

performance tracking business – and also holds

As a start, the Australian Sports Foundation will use the findings from its study to launch a nationwide campaign to raise funds for clubs in need so they can help them survive the next crucial six to 18 months. While no single body is expected to write a cheque large enough to ensure the survival of community sport clubs – many of which are small, volunteer-dependent organisations – the philanthropic community, charities, corporate Australia, and governments at every level can play a part in ensuring the sustainability of such a vital part of Australian community life.

Hans has written 25 books and in excess of 200 refereed and

Professorial appointments at the Free University of Brussels, the Real Madrid Graduate School and the Central University of Finance and Economics in Beijing, China.

popular scientific articles. He is frequently contributing to the media and holds various expert appointments around the world including positions with the Dutch Sports Council in the Netherlands, with fanbase marketing company Sports Cloud International and with the Ingesport Group in Spain. Patrick Walker is the CEO of the Australian Sports Foundation. The Sports Foundation is a not for profit charity whose purpose is to raise money for sport via the philanthropic and community donations. It believes

The physical, mental and social health of individuals, clubs and the whole of sporting system will suffer if we don’t maximise the time that we can play. This especially applies to regional and rural regions where

that sports plays a unique role in Australia and that all Australians should be able to enjoy the benefits of sports, irrespective of social, cultural and other circumstances.

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TELEHEALTH IN SPORTS MEDICINE

Recap of SMA’s Telehealth in Sports

Beyond COVID-19

with

WITHOUT SPORT THERE IS NO SPORTS MEDICINE. WHEN THE COVID-19 PANDEMIC HIT OUR SHORES IN MARCH EARLIER THIS YEAR, SPORTS MEDICINE WAS SIGNIFICANTLY IMPACTED WITH ALL SPORT CANCELLED AS THE COUNTRY WENT INTO HIBERNATION FOR A FEW LONG MONTHS. TRAINING STOPPED, POOLS, GYMS AND BOOT CAMPS WERE ALSO CLOSED. FORTUNATELY, OUR FEDERAL GOVERNMENT KEPT EXERCISE AS ONE OF ONLY FOUR REASONS TO LEAVE HOME. THEY ALSO MOVED RAPIDLY TO IMPLEMENT FEDERALLY AND SOON AFTER PRIVATE HEALTH FUNDED MODELS FOR TELEHEALTH CONSULTATIONS. THIS PROVIDED A WELCOME ALTERNATIVE FOR MANY SPORT AND EXERCISE MEDICINE PRACTICES, WHO SAW THEIR PATIENT AND REVENUE NUMBERS SUDDENLY DECREASE FOR VARIOUS PANDEMIC RELATED HEALTH AND SAFETY REASONS, AS WELL AS THE DROP OFF IN SPORTS PARTICIPATION. THANKFULLY, TELEHEALTH SERVICES ALLOWED THE SPORTS AND EXERCISE MEDICINE (SEM) COMMUNITY TO STAY CONNECTED WITH THEIR PATIENT BASE PROVIDING ESSENTIAL CARE AND SUPPORT WHILST ALSO PROVIDING A WONDERFUL PLATFORM FOR EXERCISE PRESCRIPTION AND ITS MANY BENEFITS. 42

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TELEHEALTH IN SPORTS MEDICINE

I Medicine Dr Adam Castricum

n lockdown, the community was suddenly socially distanced and disconnected. With this came many mental and physical issues – anxiety, depression, inactivity, loss of confidence, pain and dysfunction. If anything, COVID-19 has highlighted the importance of exercise to address all of these issues and more. Telehealth has and will continue to be an important enabler for our isolated, disrupted and disconnected community as the pandemic continues to affect all aspects of health. It is important that we all embrace the wonderful opportunities both exercise and telehealth mutually support and offer. It is equally important that we address its limitations and strive to improve these to ensure the highest quality service, so that it can continue to be funded and be accessible and effective for all.

I was invited to be part of a multidisciplinary Sport and Exercise Medicine panel for the SMA Telehealth in Sports Medicine: Beyond COVID-19 on June 2, 2020, at a time when Australia and New Zealand had successfully beaten off the coronavirus to low levels and elimination was on the radar for both countries. The mood was buoyant and much was shared by the panel about the benefits of telehealth in the Sport and Exercise Medicine field (or TeleSEM field), in an interactive webinar wonderfully chaired by Sport and Exercise Physiotherapist,

Ebonie Rio from Latrobe University Sport and Exercise Medicine and Research Centre. The webinar featured Sport and Exercise Physicians, Carolyn Broderick from Westmead Children’s Hospital in Western Sydney, Viran DeSilva from Territory Sports Medicine in Darwin, and myself, as well as Exercise Physiologist, Matthew Ternes from Pindara Physiotherapy on the Gold Coast and Orthopaedic Surgeon, Patrick Weirauch, from the Brisbane Hip Clinic. With a third of the 180 attendees logging in from all the continents across the globe (except Antarctica), this was a truly worldwide event, in keeping with the spread of the COVID-19 pandemic worldwide and the disruption to the global sport and exercise medicine community. Benefits All practitioners had enthusiastically embraced telehealth with many using the medium prior to the pandemic as this allowed them to maintain contact with their remote and regional patients, both for follow up and indeed helping with surgical planning, as well as with their travelling athletes, whether domestically or internationally. With the COVID-19 pandemic, telehealth had allowed practitioners to maintain consultations with unwell, elderly and vulnerable members of the community and for some, allowed them to continue practice if they were unwell and self-isolating or quarantined. It was VOLUME 37 • ISSUE 4 2020

TELEHEALTH IN SPORTS MEDICINE

Recap of SMA’s Telehealth in Sports Medicine

Beyond COVID-19 also found to be invaluable for families who were both working and schooling from home during the lockdown. Where possible, video consultation was considered essential to ensure a better experience for both the practitioner and the patient as one could get excellent insights into the home environment as well as make a better social connection than more distant and impersonal phone consultations, or indeed the “facing the screen typing” of face to face consultations. Secure end to end encrypted video conferencing services such as Zoom, GoTo meeting, Skype and Doxy.me were utilised as well as the updated Physitrack and Vald platforms. Preferred platforms allow sharing of screens online resources and work-through management plans to educate and set goals with shared decision making, just as one would in a face to face consultation. Many panel members found initial consultations challenging as clinical examination was limited and required adaptation of physical examination to be more functional. Indeed, all agreed that taking a thorough and complete history was even more crucial, as in the overall majority of cases, it could help elicit the diagnosis and subsequent management. Telehealth helped all clinicians to sharpen their exercise prescription skills and video to help with demonstration of exercises and correct technique. I feel that this is the domain of all in the Sport and Exercise medical community, from Sport and Exercise Physicians, Orthopaedic Surgeons, Sports General Practitioners, Physiotherapists, Exercise Physiologists, Podiatrists, Osteopaths and Chiropractors. Exercise is the best and one of the most important medicines we can give our patients, not just during COVID-19 or any future pandemic, but at all times. It is vital we 44

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are all proficient in prescribing exercise, and if not, know who to refer to for this. Some practices had made the switch to paperless for much of their imaging, pathology and practitioner referrals, letters and management plans, including online patient reported outcome measures (PROMS) which was extremely satisfying for practitioner, patient and management. The Federal Government at the time of writing was still fine tuning the transition from paper to e-prescriptions which we all hope will spell the end of the archaic fax machine! Importantly, this can then all be linked to the patients e-health record, allowing better clinical auditing and monitoring of outcomes – all of which can help to support further research and lobbying for better funding of Sport and Exercise medicine services for the community. Limitations and opportunities Limitations to the telehealth experience were communicated by the panel members. Not all patients are suitable for telehealth consultations and must be identified to ensure the therapeutic relationship is not compromised. It should be the choice of the patient and both formats should be offered, where possible. Children should be accompanied by a parent or guardian for at least some of the telehealth consultation. All panel members felt that it was imperative to gain a greater understanding of the patient to confirm their condition, and that a face to face consultation was necessary at some stage in the patient-practitioner encounter. For many this would be the initial face to face consultation which could then be followed up via telehealth should there not be any uncertainty of the diagnosis or should an intervention be planned. For some, especially remote, isolated

or quarantined patients, the initial appointment could be via telehealth essentially as a triage, allowing planning or further imaging with a face to face follow up straight after, making the whole experience more efficient and cost effective for the patient and economy, with less missed days of work, and thus increased productivity – even more crucial as we move through the pandemic. Many communities, where there is restriction on travel or remote indigenous community

TELEHEALTH IN SPORTS MEDICINE

Telehealth has and will continue to be an important enabler for our isolated, disrupted and disconnected community as the pandemic continues to affect all aspects of health.

health services, may need to look at telehealth consultations for their patients with a local practitioner in the session, in communication with the practitioner remotely in a larger centre. This may be the most culturally safe avenue for many patients, again enhancing the therapeutic relationship and optimising outcomes. For many panel members, there have been issues with connectivity by patients, which may include a

technology literacy issue or an internet quality issue, and all agreed that the sooner the Federal Government and private health insurers committed to telehealth permanently beyond September 30, 2020 when the rebates are set to be reviewed, the better. Only then will health start to embed telehealth platforms into practice software and consumer interfaces which will lead to a more satisfying and rewarding therapeutic relationship for the practitioner and patient. To ensure quality control and continuity of care, funded telehealth services must also be limited to appropriately registered practitioners with a physical practice where they can have face to face consultations and examine patients as required. It must also be remembered that telehealth is a service and not a technology and so, it must retain the integrity of the patient-doctor relationship and not be replaced by automated artificial intelligence services, which lack the human touch that is so important to effective Sport and Exercise medical care.

The COVID-19 pandemic has impacted health significantly, but equally it has smashed our economy and the financial operations of many Sport and Exercise medicine practices, with some closing their doors during the initial lockdown. In New Zealand, practices were closed to patients for six weeks of their hard lockdown and telehealth was the only means of staying connected with patients and ensuring they were continuing the very best of care. Most practices had experienced significant downturns in patient numbers and with this revenue, some as low as a 70% drop in patients and revenue. Telehealth helped practitioners and practices stay connected and financial during the initial lockdown with 30% of the revenue at my practice, Olympic Park Sports Medicine Clinic (OPSMC), coming from telehealth consultations at the nadir of the initial lockdown, and 100% for our colleagues across the ditch. Telehealth consultations were the same length as face to face consultations and patients certainly appreciated the reassurance and advice in uncertain times, with mental health issues occasionally presenting, requiring at times referral on for additional expert advice. Patients were generally comfortable paying the same fees as face to face consultations, helped by the fact the MBS rebates for face to face and telehealth consultations were eventually matched by the Federal Government. The Federal Health Minister, Greg Hunt, the Commonwealth Chief Medical Officer, Dr. Brendan Murphy and the Federal Health Department are to be applauded for their outstanding work delivering 10 years of change to the medical service delivery model in 10 days, which was then tweaked over the following four weeks to make it workable for all. These changes have also improved access to VOLUME 37 â&#x20AC;˘ ISSUE 4 2020

TELEHEALTH IN SPORTS MEDICINE

Recap of SMA’s Telehealth in Sports Medicine

Beyond COVID-19 Sport and Exercise medicine services for all members of the community, including those most socially and economically disadvantaged, and it is hoped that the rebates and private health funding for allied health services will continue past September 30, 2020. Lockdown 2.0 This is even more pressing as I sit here reflecting and writing this piece on a cold mid wintery night, in early July, where my hometown, Melbourne, has just started lockdown 2.0. With the rising cases in the community and hospital admissions building, the realisation that we must all learn to live with this virus through this pandemic is daunting. Whilst going back into lockdown will be tough mentally, socially, financially and physically for all concerned again, I am coping better with this transition to hibernation as I know I have the tools to help keep myself, my family and my clinic going and staying connected with my patients. As we came out of the initial Lockdown 1.0, my face to face sessions filled up again and by the end of June as junior sport was about to go back I was back to full clinics, but kept two telehealth sessions open, one late on a Tuesday evening and a morning session on Friday. Friday is my day at home to help my wife with my three young kids and do telehealth consulting from home. I hope to be able to retain this day working from home ongoing to also improve my work life balance, allowing my wife to further pursue her career. As the numbers of cases in Melbourne rose, our clinic started pivoting patients to telehealth reviews and opened up longer telehealth sessions. In the week prior to Lockdown 2.0, our clinic saw telehealth revenue rise from the low of 3% when we were almost back to normal after Lockdown 1.0 back up to 7% and continuing to increase 46

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into Lockdown 2.0. At the time of writing my telehealth consults were up to 23% of all consultations in the week of the lockdown and many were grateful, especially patients in regional centres not under lockdown, that this service was available. Most of us will still continue to consult face to face but in limited sessions, and with community spread of the SARS-COV2 virus, this will be with surgical masks to ensure we can continue these consultations with the confidence of our community. Many of our clinic practitioners also fled Victoria for the AFL isolation hubs up north, and with this had to cancel all face to face consultations for an unknown time. They were easily able

to pivot their patients to telehealth and refer patients that needed a face to face consultation and examination to those remaining behind in the clinic. The implementation and support of telehealth into the health community has been a lifesaver for many in the Sport and Exercise Medicine community. It has spawned TeleSEM and e-SEM, now referenced in the recent British Journal of Sport Medicine (BJSM) article “Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic” by Paul Dijsktra and his team at Aspetar in UAE, one of the countries that joined our Telehealth webinar in early June. I hope that you can read their excellent summary of the teleSEM process and

TELEHEALTH IN SPORTS MEDICINE

learn how we can make this exciting, innovative new platform work for our patients and our SEM community. Telehealth delivered optimally, and with funding support equivalent to our face to face consultations, will provide Sport and Exercise medicine practitioners with another important patient centred tool, to continue to deliver expert care to our patients and athletes, keeping them active throughout this pandemic, so that when sport resumes in the community they will be mentally and physically fit and ready to perform at their best.

About the Author Dr Adam Castricum has been a Fellow of the Australasian College of Sport and Exercise Physicians (ACSEP) since 2008 and works clinically, heading up the Medical Department at Olympic Park Sports Medicine Centre, Melbourne. Adam was President of ACSEP from early 2016 to early 2019 and during this time sat on the Council of Presidents of Medical Colleges (CPMC) where he strongly advocated for equality and diversity in medicine.

Take care all, stay safe and stay active.

Adam is an official mentor to indigenous doctors and actively involved in teaching ACSEP Registrars.

Dr. Adam Castricum Sport and Exercise Physician Olympic Park Sports Medicine Centre Melbourne

Adam is a member of the Health Male Champions of Change advocating for gender equality in the medical specialities and in health leadership positions. From 2008-2016, Adam was the Chief Medical Officer for Athletics Australia including the 2012 London

Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic

and 2016 Rio Olympic Games, and also worked with the Hawthorn Football Club from 2014-2017. Adam is passionate about improving indigenous, regional, and remote health outcomes, doctors’ mental health, and

Dijkstra HP, et al. Br J Sports Med 2020;0:1–7. doi:10.1136/bjsports-2020-102650

ensuring that specialist Sport and Exercise Medical care is accessible to all members of the community.

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COVID-19 IMPACT ON A STATE SPORTING ORGANISATION

COVID-19 impact on a State Sporting Organisation IN THIS FEATURE WE SAT DOWN WITH GYMNASTICS VICTORIA TO DISCUSS HOW COVID-19 HAS IMPACTED COMMUNITY SPORT FROM A STATE SPORTING ORGANISATION PERSPECTIVE.

tate Sporting Organisations (SSOs) are relied upon by all levels of sport, from elite through to community clubs, from coaches, trainers and other personnel to volunteers, parents and of course athletes and players. SSOs provide pathways, funding, structure and overarching guidance for their particular sport. COVID-19 left many organisations in a tough position on both a financial and participation fronts.. In Victoria, Gymnastics Victoria (GV) watched every gymnastics club in the state close its doors on March 23 and to date, those doors have remained shut. This has meant over three months of no gymnastics and over 1 million plus hours of structured physical activity for participants postponed. This was only the beginning of the challenges for Gymnastics Victoria Interim CEO Alan Mackinnon as gymnastics clubs were left with no avenue to produce income and the likely hood of standing down coaches. “The biggest challenge 48

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during this time has been to support our clubs who are no longer able to operate including assisting many of our community members who rely on gymnastics for their livelihood. With clubs unable to operate it has meant being faced with many hurdles including no incoming revenue, the requirement to stand down or terminate coaches, the ongoing need to pay rent and much more”. With the above challenges coming thick and fast, GV quickly developed a COVID-19 Recovery Action Plan that was designed to help their staff, members, volunteers and clubs during the difficult lockdown period. “To support our clubs and our community we put in place a whole series of measures, including: Waiving Term 2 member fees, relaxing payment terms, creating and releasing multiple free online webinars (including about JobKeeper and HR issues for staff), passing on information about government grants that are available, providing gymnastics-specific JobKeeper

webinars and keeping communication frequent with all of the information and updates from the government. We’ve been really deliberate in promoting great initiatives by clubs during lockdown and making sure that people knew that there were reasons to stay positive.” Participants still had a hunger for Gymnastics and as the State Governing Body, GV teamed up with Gymnastics Australia to create an online platform with national guidelines and rules. “Our clubs have moved to training athletes online, but there still have been lots of gymnasts training, including both recreational and competitive athletes. We spoke with our insurers and shared examples of suitable online training from clubs; our national body, Gymnastics Australia, liaised with our insurance brokers to come up with national guidelines and rules for online training that would apply to all States and Territories, including ensuring no aerial work was to be practiced-meaning one hand or one

COVID-19 IMPACT ON A STATE SPORTING ORGANISATION

foot was to remain on the ground at all times.”, said Mackinnon.

About the Author

“Equipment was not to be used unless the athlete was at an elite level, with permission granted to use their own apparatus equipment and understanding the risks involved. We reviewed our Child Safe policies and emphasised online safety for athletes and it was also an opportunity for us to establish a workshop policy to ensure that any webinars and presentations that we make available are consistent and adhere to child safe and member protection standards.” The transition to online programming has received quite positive feedback from participants, community clubs and coaches. But there is no doubt that everyone is really looking forward to getting back into the gym.

Alan Mackinnon, Gymnastics Victoria Interim CEO Alan was the interim CEO at Gymnastics Victoria at the time of the interview, as GV were going through the recruiting process. He was a leader for the organisation throughout the

“There is definitely a sense of excitement about having a date and a timeline for when gymnastics clubs can re-open. It has been excellent to see so many of our clubs adapt to the changing circumstances and shift programs and training online.”

COVID-19 pandemic and the development of the Return to Gymnastics Plan. Alan has been at GV for over five years and is now General Manager – Finance & Administration.

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5 MINUTES WITH

IN THIS ISSUE OF SPORT HEALTH WE SPENT 5 MINUTES WITH LUKE NELSON, SPORTS & EXERCISE CHIROPRACTOR AND DIRECTOR OF HEALTH AND HIGH PERFORMANCE.

5 minutes with

Luke Nelson Tell us a little about your professional experience in sports medicine? After graduating from my chiropractic studies at RMIT, Melbourne in 2003 I began work in private practice. I had always been involved in a number of sports growing up, and whilst not excelling in any, I just loved the competition and being involved in a team! During my studies I worked as a massage therapist for the Collingwood Football club and continued in this role after graduating for a few years. 50

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I learned a lot in my time there and enjoyed working with a team that made four grand finals and eventually won a premiership in 2010! Wanting to quench my thirst for further knowledge in sports medicine, I continued my studies, completing a Postgraduate Diploma in Sports Chiropractic in 2009 through Murdoch University, before completing my Masters in Sports Science in 2013. One of the things I

5 MINUTES WITH

Much like I continually strive to better myself, I enjoy educating others to do the same. It’s always satisfying to play a role in helping an individual achieve their goal or attaining a personal best!

love about sports medicine is there is always so much to learn, and I’m very passionate about continued learning and bettering oneself! I feel very fortunate to have pursued a career in sports medicine; meeting some incredible people and visiting some amazing places all around the world through seminars, organisations, and sporting events. A recent highlight of mine was working at the World Games in Poland in 2017, as part of

the FICS chiropractic delegation. I worked with a phenomenal bunch of people, collaborating with other members of the sports medicine team from all over the world. I was honored last year to be recognized as part of the inaugural cohort of Fellow Sports & Exercise Chiropractors. What does a typical day or week consist of for you? After 12 years of private practice I established my clinic, Health & High Performance, in Melbourne. Our mission is to help active individuals achieve their health and performance goals through comprehensive assessment and individualised management plans. I’m very fortunate to work in a modern building that has gym space, and access to specialized testing equipment that has previously only been available to elite sporting clubs (the AxIT system). I work with another chiropractor, Phoebe Henry, and the majority of my role is clinical, with all the other “running of the business” activities that go along with owning a private practice taking up the rest of my day. I enjoy the variety of patients that I see ranging from your weekend warrior to your elite athlete vying for Olympic selection! As a keen runner

myself, and it being something I’m pretty passionate about, a large proportion of my caseload are runners. I run most days of the week to keep myself physically and mentally in check. Then it’s family time with my wife and two beautiful young kids (ages 7 and 3), and finally squeezing in the duties for all my various roles I volunteer for. I’d say I’m a pretty organised person and have needed to be to fulfil all that I’ve taken on! How has COVID-19 impacted the business operations of your clinic? It hasn’t had a significant impact on us in terms of patient volume thankfully. We ceased face to face treatments for three weeks for most of April, shifting to telehealth consultations via Zoom, with face to face consultations recommencing after that. We have been very proactive in enforcing strict hygiene procedures including enforcing social distancing in the waiting room (or patients waiting in their cars), frequent cleaning of all touch surfaces and cleaning rooms in between consultations. What has the impact of COVID-19 been on your patients? A large proportion of my patients play some level of organised sport or VOLUME 37 • ISSUE 4 2020

5 MINUTES WITH

5 minutes with

Luke Nelson train in a gym so it’s certainly been disruptive! For those without gym access, we’ve had to get creative in finding ways to continue exercising.

having access to testing equipment (i.e., force plates, gym equipment) and also for those patients that receive manual therapy as part of their care.

How do you think your operations will change once COVID-19 restrictions are lifted? The COVID-19 situation has provided an opportunity to re-set and assess procedures. Going forward I will be using Telehealth more frequently for those patients it is suitable for, as I have become quite comfortable with using it! I had previously performed telehealth consultations only occasionally and through this period of higher usage we have seen positive results, , especially for those patients traveling long distances. The main challenges faced were not

A lot of clinics will look to return to “business as usual”, but others will have used this opportunity to pivot the way in which they provide services. Telehealth will be here to stay, and I expect we see a number of practitioners continue to utilise this method of treatment delivery. How did you become involved with SMA? I remember first attending one of SMA’s Scientific Conferences in Victoria not long after graduating from University, and just loved being in a room with a wide variety of

other professions all there to learn. Sometimes in our studies we can all get caught up in our own silos, and I feel that being involved in sports and Sports Medicine Australia has been a fantastic opportunity to break down those silos and meet lots of different people across the different sports medical disciplines. There is a saying that if you are “the smartest person in the room, then you are in the wrong room”, and attending an SMA conference makes me feel I’m in the right room! What is great about SMA events is that regardless of an individual’s status, everyone is so approachable and humble. Wanting to get more involved in Sports Medicine Australia, I joined SMA’s Victorian Regional Council in 2015, and have continued to serve on this committee with an amazing group of people. I have also held volunteer roles with Sports Chiro Australia (since 2014), now President, and served as the Finance Chair for the International Federation of Sports Chiropractic (FICS) from 2015-2018. How have you maintained connection with your professional networks during this period? There has been a multitude of online continuing education in the last few months which has been great! I’m also part of a number of online Facebook groups that have been incredibly supportive. Plus there has been plenty of phone conversations with colleagues throughout this time. Who has been a mentor to you? I’ve been fortunate to receive a lot of mentoring over the years, and a special mention needs to go to Pete Garbutt (chiropractor, past SMA ACT chair and SMA Fellow) for all of his guidance that has helped shape me as the sports chiropractor and leader I am today. Thank you, Pete!

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5 MINUTES WITH

Favourites Travel destination: Italy! Had an incredible time on my honeymoon there and would love to go back at some stage! Sport to play/watch: I love watching all sports, but AFL is number one. Go Pies! Beverage: Alcoholic – Stone & Wood Pacific Ale. Non-alcoholic – coffee (amazingly only started drinking coffee 16 months ago!) Cuisine: Italian food. Movie: Close call between Shawshank Redemption and The Power of One. TV program: Seinfeld and Game of Thrones.

About the Author Luke Nelson is a Sports & Exercise Chiropractor (AICE), President of Sports Chiro Australia and Director of Health & High Performance. After graduating from RMIT in 2003, Luke has worked in private practice

Song: “Charlie” by the Red Hot Chili Peppers (according to my iTunes I’ve listened to it 202 times!) Book: Pretty much all the reading I do these days is research articles (nerd!!), but the only book I’ve ever read more than once was Lord of the Rings.

for 16 years, and recently founded Health & High Performance in Mont Albert North, in Melbourne. His vision is to provide high quality healthcare to help keep active individuals and athletes doing what they love! Luke’s special interest is treating

Gadget: I love my gadgets! At work this includes my AxIT system and from more of a recreational point, my trusty Garmin Forerunner 235.

sporting injuries and in particular, running injuries. In 2016, Luke was awarded the Australian Chiropractic Association’s “Sports Chiropractor of the Year” for his contributions to the field of Sports Chiropractic. In 2019 Luke was awarded his Fellowship in Sports and Exercise Chiropractor by Australasian Institute of Chiropractic Education (AICE) . A keen fitness enthusiast himself, Luke has competed in a variety

Name four people, living or not, you would invite for a dinner party? Eliud Kipchoge, Michael Jordan and Roger Federer so I could pick the brains of the greatest athletes of all time in their respective sports, and then Anthony Kiedis (Red Hot Chili Peppers) for some entertainment!

of different sports throughout his life, but his current number one love is running! Luke has completed 5 marathons, an ultra-marathon and 2 Iron Man triathlons. VOLUME 37 • ISSUE 4 2020

SPORTS MEDICINE COMMUNIT Y NEWS

Sports Medicine @SMA_News sma.org.au • SMA Annual Scientific Conference postponed to 2021 • Safer Sport courses online only from 19th March • SMA extends Sports Trainer Accreditation dates - March to September 2020 • SMA forms a Community Sport Medical Advisory Working Group • SMA online event & content library– Webinars, Podcast, Videos • New COVIDSAFE Guidelines for Sports Trainers, July 2020

@ACSEP_ acsep.org.au • ACSEP Conference Save the Date – Adelaide February 2021 • May 2020: Interview with ACSEP President Dr Louise Tulloh highlights of the ACSEP Annual Conference and how COVID has changed things for Sport and Exercise Medicine in Australia • New e-learning tutorial content released

@SportsDietAus sportsdietitians.com.au • Release of SDA COACHES TOOLKIT, June 2020 • What’s new in the SDA Nutrition Kitchen? • ReFuel Magazine - Winter 2020 • Latest Factsheets

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SPORTS MEDICINE COMMUNIT Y NEWS

Community News @APAPhysio australian.physio • Latest Media Releases • Physitrack: The Australian Physiotherapy Association Launches World-first Data Pilot to Digitally Collect Patient Outcomes in Real-time, May 2020 • Talking Physio Podcast: Back pain imaging and overdiagnosis, June 2020 • Return to face to face PD, July 2020 • Online learning options available

@ESSA_News essa.org.au • Latest Media Releases • Exercise Right Week, May 2020 • Telepractice resources, May 2020 • Joint position statement on the Screening and Management of Prediabetes in Adults in Primary Care in Australia, May 2020 • Webinar: Returning to sport in a COVID19 World, June 2020 • Telehealth webinar, July 2020

@AICE Sports & Exercise www.chiro.org.au/membership/aice/sport (formerly Sports Chiro Australia) • Interest Groups now part of The Australasian Institute of Chiropractic Education (AICE), July 2020 • Sports Symposium for Students, 23 July 2020 • Updates to the 2020 Sports Chiropractic Symposium • HPSS employment award finalised, May 2020 • COVID19 support for Chiropractors, April 2020

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PEOPLE WHO SHAPED SMA

People Who Shaped SMA

Dr Robert Reid AM

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PEOPLE WHO SHAPED SMA

What made you decide on a career in sports medicine? There were a number of things that came together to lead me to make this decision. I joined Surf Life Saving Australia when I was 17-years-old as at that time it was the earliest I could complete the Surf Life Saving Bronze Medallion. I completed my Bronze Medallion prior to starting my medical education and was a surf lifesaver from 1973 to 1979. After a couple of years working at Geelong Hospital, I worked in Switzerland as a ski instructor and then moved to West Germany to work with the Canadian Armed Forces. At that time, as a civilian, I was looking after a fairly young community of families of the military staff, and I was also part of the Canadian Ski Patrol system, eventually becoming President of the Schwarzwald Zone. During this time I became more and more interested in looking after sports injuries better, and there was a small group of us who started looking at this issue between 1982 and 1985. I had a knee injury whilst working as ski patroller for the Canadians in 1982, and this really changed my attitude. I did not know at that time whether I would be able to run or play any sport after I injured my knee so rehabilitation became the focus. This cemented my desire to look after athletes and treat them properly and this set me on my path to sports medicine. You mentioned you were an athlete. What’s sport or sports did you play? During my time at school, I played AFL, rugby union, rowing, cricket, athletics (including pole vault), body surfing, field hockey, beach sprints and beach flags. I was fairly active! As I mentioned above, I was also a ski patrol ski instructor in West Germany.

Can you describe your educational background? I went to school and college in Melbourne, where I learned how to play sport for sport’s sake, mostly at school. Monash University was where I undertook my medical training and my student colleagues and I organised the initial First Aid course for a medical school at the time. This is now pretty much an every-day measure. After I left Monash, following my time in Geelong Hospital and then in West Germany, I moved to London and did the London Hospital Diploma in Sports Medicine course (half exercise physiology and half orthopaedic surgery). I found the course excellent and fascinating. After that I learned a great deal more by working in exercise physiology for three years in London I undertook corporate health testing, including exercise stress testing (to maximum), lung function testing, and muscle testing. How and when did you first start working in sports medicine? During my time in West Germany, I was exposed to more and more sports medicine even though I was a General Practitioner (GP) during that time. Once I completed the Diploma of Sports Medicine in London, through my work at City Healthcare in London I looked after clientele which included elite level soccer players and hockey players. During that time I was very involved in teaching a “sports trainers” course at London Polytechnic, in addition to looking after field hockey, (eventually winding up as the doctor for the Hockey Association in England), and also being a member of the British Association of Sports and Exercise Medicine (BASEM), and the British Association of Sports and Exercise Sciences (BASES).

My most significant contribution has been my involvement and leadership on the ACT Board and now the State Council, aswell as my involvement and membership of the National Board.

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PEOPLE WHO SHAPED SMA

How and when did you first join SMA? What was your initial role? I joined SMA as soon as I returned to Australia from London, but I cannot remember whether I was a member when I was in England. I became involved very quickly, and was seconded to the committee in early 1989 and began lecturing on sports trainers courses around that time. Within the committee structures I progressed very quickly from committee member to secretary and then finally, president of the Australian Capital Territory (ACT) branch for many years. After your initial period at SMA what other positions position did you hold? I was on the committee for the ACT for many years holding various positions. I was also a member on the National Council from 1990/1991 for an extended period. I was later a National Board Member and am still a member of the ACT Regional Council. I’ve always been interested and involved with sports trainers and teaching sports trainers and also held the position of coordinator of SMA’s National Working Group of Community Education and Training. How did being part of SMA help you in your career? The most wonderful thing about SMA is working with like-minded people and being able to connect with them

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all over Australia and around the world. SMA committee and council members are all voluntary, and they do what they do for altruistic reasons. I have a great respect for people who put that much back into the community, which many members of SMA have done. I’ve been able to meet great mentors and great teachers through SMA and this goes from Sports Trainers to Medical Specialists, and Sports Scientists, Physiotherapists and Psychologists. The range of those involved and interested in sports medicine is staggering!

The most wonderful thing about SMA is working with likeminded people and being able to connect with them all over Australia and around the world.

What has your biggest contribution to SMA been? My most significant contribution has been my involvement and leadership on the ACT Board and now the State Council, aswell as my involvement and membership of the National Board. I am passionately interested in sports trainers and their training and practice needs. Involvement in these has allowed me to, I hope to , be the voice of reason where needed, and be a good role model of someone involved in sports medicine. Involvement with sports trainers as a lecturer, teacher, and assisting in writing the Sports Trainers Manual (various editions) has made me very proud. Dr Rob Reid AM Specialist Sport and Exercise Physician Canberra Sports Medicine Former SMA National Board Member.

PEOPLE WHO SHAPED SMA

A Moment with Dr Robert Reid (AM) What has been your career highlight? This is a difficult one as so many highlights come to mind, but I guess my greatest highlight is receiving an AM for my contribution to administrative and volunteer services to sport. I see this as a “representative” AM as I believe that it represents all of those who have assisted me over the years, most of whom are members of SMA. It represents my being able to teach and assist others to be better in whatever area that they are in. Do you have any career regrets? I don’t think I have any true career regrets, apart from the lack of appropriate recognition of Sports Physicians. This limits how seriously the contribution sports medicine is taken by the some of the rest of the medical community. One of the regrets that I have for SMA is that as the peak bodies under the umbrella of SMA (e.g. Sports Physicians, Exercise Scientists, & Exercise Physiologists) often do not realise the value of SMA during their maturation periods, although they later

develop a better relationship with SMA which is the only multidisciplinary organisation in sports medicine. What do you believe is your most important contribution to your industry? I think my philosophy is probably my greatest contribution, and I believe it that “you do it because it’s the right thing to do”. I believe myself to be a teacher, healer, coach, student and dream weaver. I believe that giving kudos to all those who have touched and helped me is extremely important as none of us do these things by ourselves. What is your advice to those starting out on their career? Stay humble, stay curious, and know that you can do it. Follow your dreams. Learn from everyone, as you can learn something from every interaction with every person at whatever level. Don’t look at this as something that you do to make you rich, but something to do because it is the right thing to do.

About the Author Dr Robert Reid (AM) completed his medical degree in Melbourne and completed a Diploma in Sports Medicine at the London Hospital Medical College. This was followed by three years in corporate health and exercise physiology at City Health Care in London. He was also Chief Medical Officer for the Hockey Association. In 1989-1990 he was a Sports Physician at the Australian Institute of Sport, during which time he worked with elite and Olympic athletes and the team of doctors, physiotherapists, strength and conditioning specialists, exercise physiologists, psychologists, and biomechanists. He has a successful private practice now and continues to work with elite and Olympic athletes as well as the active general public. He has been Chief Medical Officer for Ice Hockey Australia (10 years), Chief Medical Officer of the Rally of Canberra (17 years), and Chief Medical Officer of Tuggeranong Valley Rugby Union Football Club (18 years). He is Immediate Past President of Sports Medicine Australia (ACT Branch) and a Fellow of SMA (Australian Sports Medicine Federation). Rob has always worked extremely closely with professionals of all disciplines: from soft tissue therapists to orthopaedic surgeons; from osteopaths to strength and conditioning coaches; from physiotherapists to exercise physiologists; from acupuncturists to chiropractors. Rob was inaugurated as a Member of the Order of Australia (AM) for services to sports medicine in 2015.

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SPORTS TRAINER SPOTLIGHT

Sports Trainer Spotlight

Phil Driscoll How long have you been an SMA Sports Trainer? I have been an SMA Sports Trainer since 1984, so that’s over 36 years (you get less for murder haha!). How did you get first involved with SMA? I completed my first Level 1 Sports Trainer Certificate in 1984, back when the process to receive the accreditation took a lot longer and over several weekends. I then completed my level 2 Sports Trainer Accreditation one year later in 1985. I was a TAFE teacher at the time and SMA needed educators to cope with the growing demand of people requiring a Level 1 Sports Trainer certification. During this time, I was completing a Sports Science degree from the University of Wollongong, which was the first tertiary institution to run the course in all of Australia! I had a love of sport and sports medicine and was also involved with the National Basketball League (NBL) Illawarra Hawks. What’s been the highlight of your journey as a Sports Trainer so far? I’ve had many highlights working as a Sports Trainer. Some of my highlights include working with the Australian men’s national basketball team (the Boomers), Under 23 Australian Rugby League men’s team (the Junior Kangaroo’s and the Kangaroo’s), the Sydney Olympics, the 2010

VOLUME 37 • ISSUE 4 2020

SPORTS TRAINER SPOTLIGHT

NRL premiership team Illawarra Cutters, the NSW Cup premiership team the Mackay Cutters in 2015 and imparting knowledge to countless people as an SMA course presenter. What do you love most about being a Sports Trainer? These days I enjoy being able to impart knowledge to trainers and immersing myself within sport, around sports people and the like. I still work with the Illawarra Hawks basketball team and the St George Illawarra Dragons National Rugby League (NRL) team so as you can see, I love sport, helping out teams and officials whenever I can. What tips/advice do you have for any new Sports Trainers who are just starting out? Time and communication skills are important. It takes time to build your career – it’s a long road for most and you need to learn to communicate well. Every day I learn something new in sports medicine and about athletes, coaches and support staff. Do what you do well and not fast because that’s where mistakes are made and don’t over complicate matters. How has COVID-19 impacted your operations as a sports trainer? It’s been good to have some time off and recharge the batteries but not being involved with other likeminded people – especially the athletes and staff you see every day – has been really hard. Being on the older side as a Sports Trainer

I’ve self-isolated myself from a lot of what I do, not only to protect myself and family but also the athletes. Have you been able to incorporate technology into your work as a sports trainer during this period? And if so, what opportunities and challenges have you encountered? I’ve had lots of Zoom meetings and have been able to use zoom to minimise face to face contact time in course delivery. This has helped me maintain work relationships and income opportunities; the only challenge is you’re not face to face with people.

Moving forward, how do you think COVID-19 will change the way sports trainers need to work? This COVID-19 pandemic may have a lot of positive outcomes for community sport, despite the many challenges. Elite teams already practice high levels of hygiene and are well resourced from a medical perspective whereas community sport is heavily volunteer driven. Increased awareness of infection control and safety standards within the role of a sports trainer will be a positive outcome but the fundamentals are already well within the scope of the trainer’s role. I hope these issues can increase the recognition of the importance of ongoing education and training. VOLUME 37 • ISSUE 4 2020

Publisher Sports Medicine Australia Sports House 375 Albert Road, Albert Park 3206 ISSN No. 1032-5662 PP No. 226480/00028