SPNZ April 2016 Bulletin by Sports & Exercise Physiotherapy NZ

SPNZ BULLETIN PAGE

Issue 2 April 2016

Feature Injury Prevention: Essential for All Levels of Sport

Password Update

SPNZ Roadshow

FEATURE TOPIC: Injury Prevention SPNZ Bulletin April Edition

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SPNZ Members’ Page Welcome to Sports Physiotherapy New Zealand SPNZ EXECUTIVE COMMITTEE President

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An application form can be downloaded on the SPNZ website sportsphysiotherapy.org.nz.

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Contents FEATURE TOPIC: Injury Prevention SPNZ MEMBERS PAGE See our page for committee members, links & member information

GUEST EDITORIAL Dr Gisela Sole

ROADSHOW SPNZ BJSM Roadshow - coming to a town near you

MEMBERS’ BENEFITS IT Benefits

FEATURE Injury Prevention - Essential for All Levels of Sport by Sharon Kearney

SPECIAL REPORT

In this issue:

High Performance Sport Physiotherapy/Rehabilitation Team

PLANET OF THE APPS ACL Rehab

SPRINZ It’s How You Run That Really Matters

MEMBER PROFILE Isobel Freeman

CLINICAL SECTION- ARTICLE REVIEW FIFA 11+: an Effective Programme to Prevent Football Injuries in Various Player Groups Worldwide – a Narrative Review

Neuromuscular Training Injury Prevention Strategies in Youth Sport: a Systematic Review and Meta-analysis

CONTINUING EDUCATION SPNZ Sports Certificate update

SPNZ Certificate in Sports Physiotherapy Level 1 Course - Expression of Interest

SPNZ Level One Course: Sideline Management

WEBSITE PASSWORDS Important message regarding SPNZ website passwords

RESEARCH PUBLICATIONS JOSPT Volume 46, Number 4, April 2016

BJSM Volume 50, Number 8, April 2016

CLASSIFIEDS Job vacancy and Qualitative Study at the School of Physiotherapy

SPNZ Bulletin April Edition

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Guest Editorial Dr Gisela Sole: Sports physiotherapy in the context of promoting local “heroes” Last weekend, journalist Christopher McDougall (Born to Run and Natural Born Heroes) was in Dunedin on a whirlwind tour organised, not by runners or physiotherapists, but by the Dunedin Writers and Readers Festival (DWRF). I had the privilege of listening to his amazing experiences across the globe over dinner as the writers had asked whether my husband, Chris, and I could host him for an evening. What struck me most was his enthusiasm for life and willingness to explore knowledge deeper than what we have always accepted, and for not being afraid to challenge “long-held” beliefs (meaning, beliefs of the past thirty or forty years). In his talk at the DWRF, he highlighted how important it is to empower the everyday person to be active and really enjoy movement. He suggested that the core of his attention was less about the top athletes that we see continually on television but about bringing back movement joy and freedom to the bulk of the local communities. I suggest that this is a critical part of the role as sports physiotherapists: to ensure that we have a critical and advanced role in the future health needs of our communities, we should also highlight those competencies that are extending beyond the sports field, and that focus on working with the every -day patient. It may be the young adolescent with anterior knee pain who is bullied at school, needing improved self-esteem; the 65-year old living with heart disease and is coming to an exercise class to maintain and improve daily function; or the 55 year-old with subacromial shoulder pain who also has Type 2 diabetes. I contend that getting these people active with exercises and physical activity that motivate and enthuse them should be recognised to be, at least, as important in our role as sports physiotherapists as those that are evident on the sports field dealing with acute injury and helping athletes to return to their sports. I had the opportunity three weeks ago to introduce sports physiotherapy to our new Year 2 students. We all know that sports physiotherapy is what attracts a large proportion of our students to the profession in the first instance – often through experience with their own injury, or seeing a sports physiotherapist on television. However, very few of the new students know the broader competencies included in sports physiotherapy. These competencies were defined in 2004 by the International Federation of Sports Physical Therapy (IFSPT) and I presented these to the students, adding personal experiences and suggesting how the competencies contribute towards health and well-being of our general communities. The first three competencies (Injury prevention, Acute intervention, and Rehabilitation) are well-known and are often taken as the key areas that determine whether or SPNZ Bulletin April Edition

not one can be called a “sports physiotherapist”. We remain experts at dealing with Acute Intervention (IFSPT Competency 2), and Sports Physiotherapy NZ is doing an excellent task of promoting and advocating relevant courses. In terms of Rehabilitation (Competency 3) we usually also feel confident in dealing with our patients’ injuries and getting them back to their chosen sports-, leisureand occupational-related activities. Competencies 4 Performance Enhancement, as applied to athletes, is also well known (and supported by excellent courses by SPNZ). We also know how important team work (Competency 7 Professionalism and Management) and involvement in and dissemination of research (Competencies 8 and 9) and Fair Play (Competency 10) are. But Competency 5 Promotion of an active and safe life-style, as applied to the general population, is less known under the banner of sports physiotherapy. I suggest that the profile and importance of this competency is critical for our long term role in the health of our communities, where people live with obesity, diabetes, hypertension, cancer, asthma, and other health-related conditions. Our life-long learning (Competency 6) should seek to improve our knowledge and skills of all factors impacting on quality of life of our patients, including mental well-being (positive mental skills), current principles of nutrition, and providing patients and communities with information that enhances empowerment and independence. As indicated above, most people know that sports physiotherapists deal with acute injuries, including concussion, facial and abdominal injuries, and we spend many hours in teaching, learning and acquisition of the required skills and knowledge. We also need to promote more clearly that we have experts within sports physiotherapy that use a multi-factorial approach to improving the quality of life for people who are not members of sports teams, of all ages, abilities and all health conditions. I suggest that highlighting those competencies will ensure improved and sustained acknowledgement of our critical role within the wider physiotherapy profession and as a member of the health care team of the future. We will need to focus increasingly on optimising physical activity and general well-being and restoring the joy and freedom of movement to the bulk of our communities. In McDougall’s words, we need to be able to turn everyone, irrespective of age and health conditions, into a local “hero”. Dr Gisela Sole Sports Physiotherapy School of Physiotherapy University of Otago

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Roadshow

SPNZ BJSM Roadshow Coming to a town near you

Karim Khan (Brukner & Khan Sports Medicine Bible) and Jill Cook (All You Need to Know About Tendons) along with some local sports physiotherapists are doing a series of evening lectures. Registrations will be opening soon - Put the dates in your diary now All venues have limited capacity so numbers will be restricted. Register before May 8th and go in the draw for a personal in-service at your clinic with Jill Auckland Sunday June 26th Hamilton Monday June 27th Wellington Tuesday June 28th Christchurch Wednesday June 29th Dunedin Thursday June 30th SPNZ Bulletin April Edition

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Members’ Benefits

There are many benefits to be obtained from being an SPNZ member. For a full list of Members’ Benefits visit http://sportsphysiotherapy.org.nz/benefits/ In each Bulletin we will be highlighting individual member benefits in order to help members best utilise all benefits available.

IT Benefits Facebook - facebook.com/SportsPhysiotherapyNZ

Sports Physiotherapy New Zealand has a Facebook page to help keep our members up to date with the latest news and articles out there on the web. “Like us” and receive regular news and information.

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Follow us and join in the conversations. Follow links through to interesting articles and hear titbits from conferences as they happen.

Podcasts - SPNZ Members Section

In the Members Resources Section of the website there are links to some free podcasts. These are a great way to listen to world renowned experts from your home in your own time and credit some CPD at the same time.

SPNZ Bulletin April Edition

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Feature Injury Prevention - Essential for All Levels of Sport SHARON KEARNEY DIP PHTY, DIP GRAD PE, PGD SPORTS MED, MPHTY I live in Akaroa in Canterbury with my partner Kevin. We have three children (19, 16 and 10). I played a lot of sport at school and whilst physical education was my initial career choice, thankfully an open day at the Auckland Physiotherapy School at Grafton made a huge impression, and my career in physiotherapy started in 1983. Graduating in 1985, I did the mandatory year in a hospital and then headed to Christchurch and secured a job with Brian McKenzie, at the Canterbury Institute of Sport. The job was fantastic and moulded how I work as a physiotherapist. The staff were a real “go get bunch” and included Prof. Pete O’Sullivan (he was not a professor then), Marg Lay (NZ Women’s Cricket and NZ Women’s Softball physiotherapist), Barry Donaldson (All Black physiotherapist), and Kev Dysart (my partner). Brian was a physiotherapist ahead of his time and in the late eighties introduced us to the principles of Shirley Sahrmann. The basis of our approach was observing movement patterns, assessing movement and muscle imbalances, and developing clinically reasoned treatments based on what we saw. The work environment was very collaborative, problem solving and stimulating. How I learnt to assess, reason and treat I transferred into the sporting setting. After a mandatory OE I headed to Dunedin to study PE at a graduate level (Graduate Diploma – 1990- 1991) to enable me to access a Master’s programme. Whilst my colleagues were heading down the specialist physiotherapist route (manips courses) I chose to broaden – I felt that understanding exercise physiology and biomechanics was fundamental to how I treated patients and supported where I wanted to go – sports physiotherapy. My Masters route was very long and tortuous finally getting there in 2014 as well as picking up a Post Grad Diploma in Sports Medicine (2002) along the way. In Dunedin Kevin and I opened a clinic and this opened up opportunities in sports. I approached a number of sporting codes and offered my physiotherapy services. Learning on the side line is a massive part of being a sports physiotherapist. Observing, assessing, clinically reasoning under pressure and treating acute injuries on the side line cannot be replicated in an academic setting. On Saturday mornings I was at netball, Saturday afternoon at rugby and Sundays at football. Great way to learn practical sports physiotherapy and earn a clientele base for my clinic. Netball involvement at a club level lead to becoming the physiotherapist of the Otago netball team. Being in the right place at the right time was pivotal – however you have to put yourself out there to be in that right place! In addition, in the early 90’s, I brought something new to sports physiotherapy in netball. The Otago netball coach (Georgina Salter) was an inspirational coach and was interested in my approach. Whilst I was interested in assessing movement patterns, movement efficiency, muscle imbalances and their relationship to netball and minimising injury risk (jumping and landing technique, lower limb alignment control) the coach was interested in

movement efficiency and its relationship to performance. Working with the coach and fitness consultant (Tracey Paterson) we collectively developed an individualised approach to performance enhancement, injury prevention, and grew a successful and formidable team. The Otago coach was the NZ U21 netball coach at the time and in November 1992 I was appointed the NZ U21 netball physiotherapist and headed to my first netball World Youth Cup (WYC). A Dunedin colleague of mine, (the late) Peter Boyle, was the NZ Rugby League physiotherapist. He was fantastic source of touring knowledge and gave me great advice and tips to quickly develop my international physiotherapist touring capability. From 1993 – 95 I was the Silver Fern physiotherapist. I returned to the U21 development level from 1996 – 2000 attending two more WYC. In 2002 I began my second stint with the Silver Ferns and worked with them for 13 years until I recently resigned. The Silver Fern physiotherapy role is challenging and not dissimilar to the All Black role (but on a far smaller scale). The Silver Ferns spend little time collectively together and spend far more time playing in their ANZ Championship franchises. CONTINUED ON NEXT PAGE

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Feature Injury Prevention - Essential for All Levels of Sport continued... Working closely with the five franchise physiotherapists is fundamental. They work daily/weekly with the Silver Ferns based in the franchise setting from December through to July. Whilst the franchise physiotherapists do the day to day physiotherapy delivery, it is important NNZ have a clear understanding of pathology, treatment and rehabilitation plans, return to play (RTP) plans and potential impact any injury or illness will have on an impending Silver Ferns campaign. Please describe your current role and how you ended up there. After resigning from the Silver Ferns role I have continued to maintain involvement with netball. I am the NNZ Injury prevention (IP) consultant on a part time basis. I work with ACC and the NNZ coaching team to develop the IP philosophies, frame work, and resources. I worked in a similar role back in 2005 when ACC first developed its relationship with key sports. It is an area I am very passionate about and very keen to develop further. In addition, I am the Tactix physiotherapist for 2016. I am loving this role because unlike the Silver

Ferns role I am centralised with the athletes for 6 months and work with them on a daily basis. Challenging and rewarding. What are your specific areas of interest/research? ACL injury prevention is my absolute passion. Netball is a high risk ACL sport. It is a power strength based sport played predominantly by females and has very restrictive foot work rules leading to large deceleration forces. All three contributing factors to ACL injury. There are 400 netball ACL reconstructions per year â&#x20AC;&#x201C; netball needs to do a better job to decrease ACL risk. NNZ in conjunction with ACC have developed a sports specific NetballSmart Dynamic Warm up. The warm up is based on the FIFA 11+ warm up which is validated and evidence based. I have developed many levels to the warm up ranging from year 1 (5 years of age) through to the full NetballSmart Dynamic Warm up. It is part of NNZ coaching resources and will shortly be released on the ACC and NNZ websites. NNZâ&#x20AC;&#x2122;s aim is the netball population are using the NetballSmart Dynamic Warm up and engaging in IP.

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Feature Injury Prevention - Essential for All Levels of Sport continued... Silvers-Granelli et al, (2015 DOI: 10.1177/0363546515602009) have shown that a FIFA 11+ programme performed weekly significantly decreased injury rate in male collegiate football players. In addition showed 4.25-fold reduction in the likelihood of sustaining an ACL injury. Saleh at el (2015 DOI: 10.1007/s40279-015-0404-x) support FIFA 11+ decreases the risk of injuries among football players. Emery et al (2015 DOI:1136/bjsports-2015-094639) suggests efficacy of NMT programmes in reducing knee injuries in youth team sports. However also highlights the challenges in implementation, the importance of the coach as the implementation tool, and the need for comprehensive coach workshops to support coach-lead delivering strategies. What are the types of injuries you commonly see? In netball, ankle injuries are the most common, ACL injuries are rare but devastating and ACL injury is increasing in netball. At an international level, netball has changed significantly. It is faster and significantly more physical. The international netballer needs to be stronger to tolerate forces, move efficiently to optimise landing and cutting techniques to minimise ACL risk, and fitter to tolerate a more physical and fast game for 60 minutes. The young netball population is attempting to replicate their Silver Ferns role models – play harder, faster and more physical. This increases injury risk. What do you think are the key elements in successfully preventing injury? Injury prevention implementation is really challenging. Developing an IP strategy/programme is merely the start. Empowering and educating coaches is vital. A coaching frame work (in underfunded sport) is imperative, linking IP with performance enhancement has a positive effect on adherence, on-going reinforcement and education are critical. Athletes need to be engaged and understand importance and IP needs to be integrated in all aspects of netball training (gym, warm up, home programmes, coaching, game play). At a high performance level there are more opportunities to screen, identify risk, and implement individual strategies, educate coaches and athletes. However, at this level athlete load identification and management is often the most important IP strategy - and often the most challenging to do. Who else is involved in the “support” team that you communicate with and how do you integrate with them to optimise injury prevention and rehabilitation? SPNZ Bulletin April Edition

Integration and communication with the support team is important in all aspects of injury prevention, treatment and rehabilitation. The coach is integral, the sports medicine director is involved in all injury management, the strength and conditioning coach is advised on limitation of training and rehabilitation strategies developed, the psychologist is advised and engagement may vary depending on degree of injury (major injury), recurrence of chronic injury, the nutritionist is engaged to discuss dietary needs if necessary (i.e. if a major injury there will be a significant change in energy output and therefore changes in energy input necessary). Injury prevention at a high performance level involves the entire support team. The coach drives the overall culture, the physiotherapist in conjunction with S and C develop the strategies, the athlete adheres to the strategies to ensure efficacy. Adherence (in all aspects of HP) is often facilitated by the psychologist. Are you involved in performance aspects for your clients? My involvement in performance is to maximise the athlete’s ability to train in order to maximise their performance. Whether that be identifying risk factors, optimising movement efficiency relevant to netball, diminishing any muscle imbalances that would impact on injury/performance, load management, assessing and treating injuries that do occur and minimising impact where possible. What are the key attributes you feel are required to work with elite level athletes? Injury knowledge – theoretical and practical, game knowledge, communication, integration, being “part of a team”. Ability to optimise performance whilst minimising injury risk (OP & MIR). What do you see as the major challenges for sports physiotherapy? In NZ we live in a reactive physiotherapy mind-set driven by our reliance on ACC. There is evidence to support efficacy of proactive IP strategies in sport. However, there is a deficiency in funding, inadequate sound IP models and implementation strategies, and coaches, athletes and parents lack knowledge on IP. Physiotherapists have the skill set to drive IP strategies in all sport. We need knowledge, frame works, funding and resources. Within netball we are trying to develop an IP model to take to the netball community. Watch this space!

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Special Report High Performance Sport Physiotherapy/Rehabilitation Team BY DUNCAN REID AND FIONA MATHER For many physiotherapists working in the sports arena, an appointment to an elite or high performance sports team is the pinnacle of one’s career. However there are only a small number of those positions available and they are highly competitive and sought after. The downside of having only a small number of positions available is the ability for sports and organisations that may employ these people to build capacity and manage succession planning. The purpose of this paper is to outline the current philosophy of High Performance Sport New Zealand (HPSNZ) with respect to it model of service delivery to elite athletes and outline some ways in which physiotherapists who aspire to work in this arena to be better prepared when applying for roles when they are advertised. The mission of the HPSNZ medical service is to deliver an internationally respected, sustainable and pre-eminent medical service. This is done under the umbrella of the overall HPSNZ goal of having more athletes win on the world stage. The strategic direction of the HPSNZ medical service is embodied in the Five Plus Performance Health Model (see figure 1)

Research Figure 1 The 5 plus performance health model The reason for starting with this model is that it provides a fundamental change from the previous expectations of the skills required to work in high performance sport (HPS). The main driver for the health team to show value in this arena is the ability to influence performance. This is arguably different than the perception that to work in HPS you need exceptional skills in the injury and illness end of the model. This may have been so in years gone by but the scope of the work has now expanded considerably. Those who have worked in HPS soon find that treating injuries of athletes becomes overwhelming and seemingly endless. The performance “cost” of injury to an athlete can be significant and there is pressure on the modern physiotherapist working in sport to minimise the time lost, hence the emphasis on Injury prevention. This is far more effective and allows more athletes to be able to train and compete more of the time. However there are aspects of the injury prevention area that also need growing skills. Without good injury surveillance and load monitoring one may not get a good sense of why injuries are occurring (see Figure 2 over page).

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Special Report High Performance Sport Physiotherapy/Rehabilitation Team continued...

Figure 2 Injury Monitoring and Review Model This requires the modern sports physiotherapist to have good reporting mechanisms on injuries and the incidence and prevalence. Working with the coaching staff and strength and conditioning staff to look at load is vital to understand the relevant contribution and impact upon performance. The practitioner who can offer consistent and reliable data presented in a meaningful way has tremendous ability to impact performance. Recent papers by Newlands et al (2015) show that high volumes of training load in rowing for example, are directly correlated with increasing amounts of low back pain, the number one injury in rowing. Recent research by Raysmith and Drew (2016) has shown load increases and missed training sessions have an impact on performance. In essence it is not good enough now just to be good at treating the injuries you need to be good at identifying key causes, reducing these where possible so that performance can be enhanced. Performance enhancement also looks at things like biomechanical assessment, Physical benchmarking for movement competency and working closely with coaches to enhance movements that improve technique and movement efficacy. Planning and coordination requires the skills of working in an interprofessional sports team environment This requires competencies around athlete centred care, interprofessional communication, team functioning, collaborative practice, role clarification, conflict resolution and collaborative leadership (Reid and Flood, 2011). One of the best examples of where this must work well is in the area of return to play. Recent research by Shrier et al (2014) demonstrates that all the professions that are involved the RTP decisions are best placed to make the final decision on when the athlete is able to RTP. Clearly this is a challenge and those sport and disciplines that find a way to do this in a collaborative way in the best interest of the athlete do this well. Without these skills it is hard to survive in the HPS. The reason we are outlining these key ways of working is that when physiotherapists apply to work in HPSNZ they often have focused on the treatment skill set and have not been able to demonstrate how they can influence performance and the wider issues outlined in the model above. Another obstacle is how the work is actually delivered. The Accident Compensation Corporation (ACC) private practice model of care and remuneration is poorly aligned with the High Performance environment. Yes, time is needed for specific treatment when injuries occur, but CONTINUED ON NEXT PAGE SPNZ Bulletin April Edition

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Special Report High Performance Sport Physiotherapy/Rehabilitation Team even more time needs be allocated to athlete monitoring and injury recording, injury prevention strategies, effective warm drills, time in the field observing athletes and working with coaches on performance enhancement. Fortunately, the service delivery models at HPSNZ are trending this way and we are now appointing more full time staff to meet these needs. So back to the conundrum, you aspire to work in this area but there are only a small number of places available, how can I get these skills? We would suggest the following steps. 1.

A sound post graduate education is essential. Courses run by NZ Manipulative Physiotherapists Association and Sports Physiotherapy NZ are a great starting point to gain extra knowledge. The SPNZ are aligned to the International Federation of Sports Physical Therapy (IFSPT) pathway. These can lead to post graduate diplomas and Masters degrees offered by AUT and Otago University. These post graduate degrees are the minimum entry requirement for working at HPSNZ and are currently accredited by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT).

Get involved with key Olympic and elite sports at a junior development level so you can gain the requisite skills with athletes that are also up and coming.

Put in place the above models so that the athletes and coaches get used to the 5 plus model.

Try to get a mentor in teams that are further up the ladder in the sports. Most key Olympics Sports have a designated physiotherapist. They often look for assistance at a junior development level. This can leads to opportunities to tour and work with these athletes.

Look constantly for ways you can enhance performance and talk to the coaches and athletes about these.

Come and visit HPSNZ training facilities so you get a sense of how it all works.

Duncan Reid Associate Professor and Physiotherapy Advisor to HPSNZ Fiona Mather (Lead Manager Physiotherapy & Rehabilitation HPSNZ)

References Newlands, C, Reid, D and Parmar, P. The prevalence, incidence and severity of low back pain among international-level rowers British Journal of Sports Medicine (2015) 49: 951â&#x20AC;&#x201C;956. Raysmith, B and Drew, M Performance success or failure is influenced by weeks lost to injury and illness in elite Australian Track and Field athletes: a 5-year prospective study. Journal of Science and Medicine in Sport (2016), http://dx.doi.org/10.1016/j.jsams.2015.12.515 Reid, D, and Flood, B (2011) Interprofessional Education in Health and Environment in Aotearoa/New Zealand. 2nd ed Oxford University Press. Shrier I, Safai P, Charland L. Return to play following injury: whose decision should it be? British Journal of Sports Medicine 2014;48:394â&#x20AC;&#x201C;401.

SPNZ Bulletin April Edition

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Planet of the Apps Your monthly App review by Justin Lopes - Back To Your Feet Physiotherapy, SPNZ executive member.

App: ACL Rehab Hi team, One of my clients who unfortunately has suffered an Anterior Cruciate Ligament rupture and the subsequent trauma of an ACL reconstruction (ACLR) introduced me to this month’s App and it highlighted the fact that I am not the only one trawling the ‘interweb’ for Apps that can provide information and advice for our clients – they are doing it too! I liked the way this App presented the information, and how it allowed some basic prescription abilities around the exercises at each phase of the rehabilitation. However it is a generic App that is based in America, so care needs to be taken when using it. The ACL Rehab app has three main sections on the front page: Information, Anatomy and References. Below this it has the Home Page, Stages of Rehab, Exercises and My Workout. The Stages of Rehab are divided up in to Prehabilitation, and then Stage 1 (Acute Post-op through to Stage VII (Return to Sport). Each stage has timeframes associated with them, along with descriptions about what to expect at each stage. The exercises component is broken down into Strength, Flexibility, Balance and Agility and within each of these subgroups there are a selection of exercises to choose from. Category:

Medical

Released:

14 August 2015

Version:

1.0.4

Size:

65.5 MB

Language:

English

Seller:

Rated 12+ for the following: Infrequent/Mild Medical/Treatment Information Cost:

$5.99 incl GST

What it is used for:

Patient information and exercise prescription app.

Pros:  Has some basic anatomical diagrams of muscles and ligaments around the knee and a description of current commonly used techniques for ACLR (hamstring and patellae grafts).  The client (or the physio) can choose exercises from a limited selection to add to the My Workout section.  The App has a list of recent references that it draws its information from which are listed in the references section.  The App is very pro physiotherapy with encouragement to see their physio to help manage their rehab. Cons:  The prescription for the exercises are set (generally Repeat 10 times, 2-3 sets as tolerated). These are obviously generic and may not suit all clients.  The exercises are model diagrams and could have been videos. This does mean that the App is not as large as it could have been though. You are able to slide sideways to change the photo from starting position to mid position to finishing position

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Planet of the Apps App: ACL Rehab continued...  

The App was written for an American audience and so some of the protocol information is not necessarily how New Zealand surgeons or physios manage patella tendon reconstructions. It is not very clear what exercises are supposed to be in each phase and clients could misconstrue that box jumps are in the early post op phase for instance – not a good idea.

Overall I would recommend the App to clients, with some caveats. Make it clear that this is a generic App and that not all information may be accurate for them. I update the exercises that I think are appropriate for the stage and phase of their rehabilitation. You can delete the exercises that they have progressed from. Not all exercises are in the App so you will need to augment them with some of your own. Overall rating:

3/5

Another useful App for your ACL injured clients that can give you some information on how the client is progressing is the ACL RSI. This App was designed and validated by La Trobe University, to measure athletes’ emotions, confidence in performance, and risk appraisal in relation to returning to sport after an ACL injury. Your client can answer 12 questions using a slider, and the summary of their results can be emailed to yourself or your GP. Of course there are more comprehensive Outcome Measures post ACLR but this is an easy way to assess your client’s confidence re their return to sport. Happy Apping… Cheers, Justin

For further discussion on this App check the SPNZ LinkedIn forum page Click here SPNZ Bulletin April Edition

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SPRINZ

It’s how you run that really matters By Kelly Sheerin Running related injuries are some of the most prevalent that physiotherapists treat, but they can also be equal parts challenging and frustrating, with an astonishingly high recurrence rate. There is a substantial bulk of research that can help provide guidance for practitioners treating running injuries, but it is often difficult to access, and even when you can get your hands on it, the results can be confusing and occasionally conflicting. To help combat some of these problems, a recent large systematic review published in Gait & Posture has honed in on patellofemoral pain (PFPS) in runners, and serves to provide a good, un-biased summary, of the effectiveness of treatment interventions from 28 individual research papers*. One of the key findings of the review is that specific biomechanics are an important factor in runners sustaining PFPS. The condition appears to have strong links with those who run with increased hip adduction and dynamic knee valgus, which are often teamed with dropping of the contralateral pelvis. Personally, I don’t think this finding on its own is particularly ground breaking, we’ve known this for some time now. However, where this paper really comes into it’s own is that it may have finally shone a light on the reasons why some interventions are more successful that others. The interventions assessed have largely been grouped into ‘exercise’ and ‘gait re-training’, where the exercise interventions largely constitute proximal glute strengthening. This is where I think this review gets interesting… While it was identified that both of these treatment approaches can result in reduced PFPS pain, only running retraining was found to also reduce peak hip adduction; An established risk factor for PFPS development. While this paper doesn’t delve into the nitty gritty of the clinical world, I’ve seen many PFPS cases where intensive proximal glute strengthening has seemingly resolved patients knee pain in the short term, only to have it come back with a vengeance at a later date. Conversely, those who have made an attempt to change their running mechanics have been a lot more successful in remaining injury free. While I don’t have any evidence, I suspect the improved muscle strength on its own, simply acts to buffer the condition for a periSPNZ Bulletin April Edition

od. Inevitably, as the demands go up, the symptoms return. While none of these findings are a new-found cure, this review does provide a clear message to show that specifically addressing faulty mechanics, and not just assuming they are resolved, is essential especially if you’re interested in long-term success for your running patients with PFPS. Does this mean that you should forget about the strengthening altogether? In my opinion, not at all… It’s critical you establish a stable base before changing biomechanics, otherwise you’re just asking for bigger problems. We need to start thinking of running much more like a skill. If we want a better golf swing or tennis serve, we practice the skills required to do so. Running requires the same level of focus: If runners want to run better, they need to practice the skill of running in the right way. How do you retrain someone’s running I hear you ask? Well that’s a whole other topic! Stay tuned for that later in the year. Key points  Running biomechanics (especially hip adduction and dynamic knee valgus) are closely linked to PFPS.  If you’re treating runners for conditions such as PFPS and you think there could be links to faulty mechanics, it’s important you assess their running biomechanics.  Both strengthening and gait retraining can successfully reduce PFPS pain.  Only gait retraining is successful in improving faulty biomechanics linked to PFPS.

* Neal, B. S., Barton, C. J., Gallie, R., O’Halloran, P., & Morrissey, D. (2016). Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: A systematic review and meta-analysis. Gait & Posture, 45, 69–82.

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SPRINZ

Itâ&#x20AC;&#x2122;s how you run that really matters continued...

About the author: Kelly Sheerin Kelly is the Manager of the Sports Performance Clinics, based at AUT Millennium in Auckland. He has a clinical interest and expertise in running injuries and biomechanics. Kelly has a BHSc in Physiotherapy and a BSc in Sport and Exercise Science. He has gone on to complete an MHSc in musculoskeletal physiotherapy, including research in 3D running biomechanics. Kelly is currently completing his PhD in the area of real-time feedback in runners at risk of tibial stress fracture. If you have questions on running biomechanics or the treatment of specific running injuries, feel free to e-mail me ksheerin@autmillennium.org.nz) . About the Sports Performance Clinics The Sports Performance Clinics, based at AUT Millennium, have world class facilities teamed with a highly skilled and knowledgeable team, to provide the best sports science support, irrespective of your requirements whether it be rehabilitating from injury, improving your strength and power, honing your cardiovascular fitness, or acclimatising to heat. The services on offer are grounded in research, and underpinned by the principles of AUTâ&#x20AC;&#x2122;s Sports Performance Research Institute New Zealand (SPRINZ). The overall paradigm is that all of the athletes and clients seen at the SPC can potentially be research subjects through various on-going studies. Thus, our research is facilitated through the services we provide, and the services are in turn improved through research. Further information on the Sports Performance Clinics can be found here .

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Member Profile Sports physiotherapist mixes it up with a little sports science for good measure

When sports physiotherapist Isobel Freeman completed her postgraduate studies at AUT she decided to broaden her experience by including papers from the sports science programme. Isobel is currently working as the point of contact physiotherapist for the Men's Black Sticks based at High Performance Sport NZ and also at Unisports Sports Medicine Clinic. Additionally in the winter she is the physiotherapist for North Harbour 'B' rugby team. She was kind enough to answer a few questions we threw at her regarding her postgraduate experience at AUT. How did you hear about the sports science papers? Due to my particular interest in sports rehabilitation I investigated papers on-line (through the AUT website) to see what sports papers were available to incorporate within my Masters of Health Practice in musculoskeletal physiotherapy. I also found a physiotherapist who had previously enrolled in these papers and he highly recommended them to me. I was very keen to complete the practicum of physical conditioning and in order to do this I also needed to complete enhancing muscular performance and exercise physiology. What made you choose papers from the sports science programme? I knew I wanted to work as a physiotherapist with elite athletes. I hoped that choosing papers from the sports science programme would enhance my knowledge of athletic training/exercise prescription for all levels of sports participants. I also saw this as an ideal opportunity to gain knowledge/exchange ideas with other professionals completing the course (e.g. strength and conditioning coaches and sports scientists). I was enthused by the practicum which consolidated all the theoretical knowledge gained into a practical environment with the other course participants. How did you find the mix of the sports science papers and the papers from rehabilitation? Two of the papers were completed solely on-line, so study could be done in my own time and this was useful to be able to work around other papers and employment. The final paper was a practicum of physical conditioning which included a week on campus at AUT Millennium. This paper was particularly beneficial due to the practical content and mixing with all the other course participants. The sports science papers complemented the papers from rehabilitation by adding to my clinical reasoning skills. I found that the knowledge gained enabled me to explain in greater depth the physiological changes occurring due to a prescribed exercise regime. How have the sports science papers influenced/helped your sports physiotherapy work? I currently work with elite athletes alongside strength and conditioning coaches and the papers have been invaluable in understanding periodisation programs towards pinnacle events and the demands expected of an athlete. They have also aided me in rehabilitation exercise prescription. Any other comments? Sports science papers are not only beneficial for physiotherapists working in sport, but also in regards to exercise prescription for all patients.

Many thanks to Isobel for taking the time to respond to our questions. For those interested the postgraduate sport and exercise study options at AUT include a range of papers including Exercise Physiology, Enhancing Muscular Performance, Applied Human Movement Studies, Applied Sport Psychology, Practicum in Physical Conditioning and others, many of these can be completed online as Isobel mentioned. For more details go to www.aut.ac.nz/pgsportexercise.

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Clinical Section - Article Review FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide – a narrative review Bizzini M, Dvorak J. (2015) British Journal of Sports Medicine 49:577-579

ABSTRACT FIFA 11+ is an injury prevention programme that has been promoted and disseminated throughout the 209 Member Associations (MAs) of FIFA. The programme was originally developed in 2006 as a group of warm up exercises to be completed a couple of times a week to prevent injuries (non-contact) in amateur football players. Since the official launch in 2009, the effectiveness of undertaking the programme has been evaluated in a number of countries, as well as the issues of implementing the programme at all levels of the amateur game. Positive outcomes have been found in female and male amateur football players with a reported decrease in the incidence of non-contact injuries occurring. Specific note is being made of the programme in respect to children and referees.

Article Review INTRODUCTION FIFA11+ is a programme designed to reduce the risk of non-contact injuries in amateur football players. It is comprised of 15 exercises that in total take 15-20minutes to complete. The Coach has been identified as the key implementer of the programme. RCT’s that have been undertaken since 2008 show that team members performing the programme at least twice a week will significantly reduce the incidence of injury. The article reviewed the recent evidence from the MAs of FIFA regarding the implementation and successfulness of introducing this programme. METHODOLOGY Peer-reviewed journal articles published from the time of the first published review on FIFA11+ in 2008 up until January 2015 were assessed. A total of 25 papers were included which looked at the effectiveness of injury prevention, impact on performance and effectiveness of implementation strategies. FINDINGS Effectiveness of Injury prevention: Since the outset of implementing this programme, effectiveness of reducing injury has been reported as being between 40-50% (ref 2,3,4,5) in both male and female amateur footballers. The issue of compliance was deemed integrally related to the ultimate success of the programme. Of those RCT with good outcomes, the programme was performed at least two times a week. In assessing the effectiveness of injury prevention in children (under 14 years of age) and referees – there has been little research done to date. FIFA is currently piloting more specific programmes for these subgroups. With respect to professional footballers there has been no publication relating directly to the FIFA 11+ programme. However, in review of 44 teams’ prevention strategies, there was a close correlation of the exercises they included in their warm up protocols to the exercises from the FIFA 11+ programme. IMPACT ON PERFORMANCE A common goal that players, and their coaches, strive for – is improvement in performance. As a medical professional we wish for maximum performance with optimum player health and a reduction to the risk of injury. Compliance to perform an activity/exercise programme will increase if there is a correlation to performance goals. RCTs (23) found significantly better neuromuscular control following 9 weeks of FIFA 11+ practice. Further studies (5,24-28,30,31) highlighted beneficial physiological changes after having integrated the FIFA 11+ programme in to CONTINUED ON NEXT PAGE SPNZ Bulletin April Edition

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Clinical Section - Article Review FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide – a narrative review continued... their training. This included improved functional balance, and agility skills, improvement in core and hip neuro-muscular control affecting jumping ability and quicker stabilisation times of the lower extremity. Interestingly it is noted that the FIFA 11+ programme showed similar physiological effects as other warm-up protocols (29). Perhaps the point is not necessarily the FIFA 11+ protocol but in fact that the team has taken the time to warm up properly and regularly, involving sports specific drills. EFFECTIVENESS OF IMPLEMENTATION STRATEGIES It is currently still a challenge to correctly implement a programme such as FIFA 11+ across the footballing world. The National Associations rely on coaches at grassroots to get involved. The most successful outcomes have occurred when specific training and certification of coaches to the programme have occurred. As a physiotherapist involved in a sports team and treating sports players, this article offers clear support to our argument that an injury prevention programme is worthwhile. The effectiveness of FIFA 11+ has been shown to reduce the risk of non-contact injury to footballers and potentially enhance performance through neuro-muscular changes. We can continue to educate the coaches, parents and players on the importance of these programmes with support from organisations including NZ Football. Physiotherapists can get alongside coaches and help educate them and get involved with implementing the FIFA 11+ programme which is both simple and effective. Spending time on injury prevention can only be beneficial to all involved. This article discusses football’s approach to injury prevention, but by no means are they the only sporting association to do this. Development injury prevention programmes in netball is occurring both here and in Australia. . Relevant links of interest: http://f-marc.com/11plus/home/; http://www.nzfootball.co.nz/fifa-11/ http://netball.com.au/netball-launches-program-to-eliminate-knee-injuries/ http://www.mynetball.co.nz/netball-smart/fitness-injury-prevention.html References can be provided on request By Rose Lampen-Smith Dip Phys; PGD HSc (Phty)

Foot Science International Academy presents: “Entering the FootZone 2016” – a one-day accredited course about the patient’s foot and lower limb function and pathology

offered in six NZ locations May 14-21 More information & sign up with EventBrite: http://bit.ly/footscience Enquiries at 0800 60 30 10 or info@footscienceinternational.co.nz SPNZ Bulletin April Edition

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Clinical Section - Article Review Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis Carolyn A Emery, Thierry-Olivier Roy, Jackie L Whittaker, Alberto Nettel-Aquirre, Willem van Mechelen. British Journal of Sports Medicine 49 (13): 865-870

ABSTRACT Sport is the leading cause of injury in youth. This meta-analysis revealed a combined preventative effect of neuromuscular training in reducing the risk of lower extremity injury however a lack of uptake and maintenance of such programmes is an ongoing issue.

There is a very high participation rate in youth sport which has important health implications including psychosocial benefits. However, sport is also the leading cause of injury in adolescents. The estimated annual incidence across many countries is 35 injuries per 100 youth requiring medical attention. Lower limb injuries account for 60 percent of the overall injury burden. This systematic review and meta-analysis looked at randomized controlled trials, quasi-experimental or cohort studies published prior to September 2014. All studies were reviewed using the Downs and Black quality assessment tool. Twenty-five studies were used for final evaluation. All studies showed a significant overall protective effect of 36 percent in lower limb injury risk. The studies also showed a potential reduction in knee injuries however this was not significant. The majority of the studies examined neuromuscular training strategies including multiple components (strength, balance, agility) hence it is difficult to assess the contribution of each component. Some studies did show a greater protective effect when programmes included jumping and/or plyometric training compared to those without. There were reported limitations to the studies reviewed. A lot had poor reporting of losses to follow up, lack of control for potential confounding factors and exposure to risk was not considered. The studies also only reviewed ages 11 to 18 years and elite sports so results cannot be generalizable to paediatric and non-elite sport populations. While there is growing evidence that injury prevention training programmes work, there is also evidence to support the lack of programme uptake and ongoing maintenance. There is a need to focus on the ongoing and sustainable implementation of effective injury prevention strategies in youth sport. Some sports have shown greater adherence when the programmes are sport-specific with a focus on coach training.

By Amanda Oâ&#x20AC;&#x2122;Reilly, Physiotherapist, BPhty, PGDipSEM

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Continuing Education

SPNZ Sports Certificate Update As mentioned in the article by Duncan and Fiona, High Performance Sport New Zealand has a pathway or model for progressing into the realm of treating high performance athletes which includes the courses we run as part of the Sports Physiotherapy Certificate. These courses are based on competencies the IFSPT considers necessary to be a sports physiotherapist. Though the numbers of top jobs are limited, this pathway or principal is also very relevant to anyone working with sports or athletes, be it weekend warriors or club and provincial players. When I started working with sports teams many years ago there werenâ&#x20AC;&#x2122;t any courses in New Zealand, be it weekend courses like the certificate, or post graduate sports courses. Knowledge was gained through trail and error, or if you were lucky, you worked beside an experienced sports doctor. Over many years we have looked at how to provide NZ physiotherapists with this knowledge. Finally, the hard work and dedication of the SPNZ executive and education committee has now enabled us to provide for you a top programme for sports physiotherapy in NZ. Over the last few years level one courses have proven very popular, so it is pleasing that this year we are releasing the first of our level two courses. Hamish

We aim to have all three level one courses twice a year.

Level One: We aim to have 2 of each of the 3 level one courses yearly

Trauma Course

April 16 & 17thâ&#x20AC;&#x201D;both full

Sideline Management Course

Exercise Prescription Course

May 21st-22nd Auckland - see advertisement page 26

Expression of interest for Wellington in November - see page 24 for details

Level Two: Looking at 12 to 18 months depending on demand Upper Limb Course July 16-17th Auckland -more details soon

Lower Limb Course Provisional date: February 2017 Spine and Pelvis Course

Specific Athletic Populations Course Provisional date: mid 2017 Provisional date: November 2016 Auckland

Prevention and Performance Course Provisional date: second half of 2017

SPNZ Members always get first notification for the courses so keep an eye out for an email and in the bulletin SPNZ Bulletin April Edition

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Continuing Education

Expression of Interest Promotion and Prescription of Physical Activity and Exercise SPNZ Certificate in Sports Physiotherapy Level 1 Course Physical inactivity is responsible for the growing epidemic of obesity and health-related conditions. Physiotherapists play a critical role in promoting and prescribing physical activity in all age groups and are ideally placed to prescribe exercise for those with chronic health conditions, and to those wanting to return to recreational activity or competitive sport following injury. A course covering the promotion and assessment of physical activity levels, exercise testing and ways to effectively prescribe physical activity and exercise for individuals ranging from inactive to those involved in competitive sports. Presented by:

Dr Grant Mawston and Dr Peter McNair

Expression of Interest in Wellington Course November 2016 Likely Cost: SPNZ members $450 Cost includes morning and afternoon teas and course manual.

Please note: At this time this is an expression of interest only. If we do not get sufficient interest to cover course costs, the course will not be run in Wellington. Please indicate your interest by emailing Hamish Ashton ( help@spnz.org.nz )

This course is suitable for: Physiotherapists wanting to improve their knowledge and skills in assessment and prescription of physical activity and exercise to use with patients on a daily basis. This course provides a bridge to Level 2 SPNZ courses and important background information for those considering university postgraduate study.

What the course will cover: The course will provide a combination of lectures, practical demonstrations, practical assessments and

case studies and will cover the following topics:        

SPNZ Bulletin April Edition

Principles of exercise prescription Promotion and assessment of physical activity Assessment of neuromuscular performance Aerobic and functional capacity testing Strategies to enhance exercise adherence Screening for return to sport Exercise risk screening and goal setting Physiological effects of disuse and ageing

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Continuing Education

SIDELINE MANAGEMENT (SPNZ LEVEL 1 COURSE) This course is for registered physiotherapists who work with individual athletes, or on the sideline at sports games or events who want to upskill in the areas of pre-game preparation, first aid, acute injury assessment and management, and post-event recovery strategies. By the end of the course you will have all the tools you need to manage pre-event preparation, post-event recovery and to confidently assess, manage and refer common sporting injuries and wounds. Location: AUT Millennium Click for Google map

Date: Saturday 21st May 2016 9am – 5pm

Course Fee: SPNZ Member $405.00 PNZ Member

$486.00

17 Antares Place, Mairangi Bay Auckland

Sunday 22nd May 2016 8am – 4.30pm

Non-PNZ Member

$607.50

The course will cover:  Ethics and Professional Issues in Sports     

Physiotherapy Pre-event preparation and warm-up Strapping Sports First Aid On-field injury assessment Concussion assessment and management

 Splinting of hand and finger injuries  Indications for medical and radiology referral  Return-to-play decision making  Post-event recovery  Anti-doping regulations and banned substances

Presenters: Dr Deb Robinson (Sports Medicine Physician – former All Blacks doctor & current Crusaders doctor) Dr Angela Cadogan (Physiotherapy Specialist – Musculoskeletal) Kim Simperingham (Strength & Conditioning) Emma Mark (Physiotherapist Marist St Pats and Habit physiotherapy, previously Nigerian national rugby federation and championship level UK) Kelly Davison (Hand Therapist) Drug Free Sport NZ

To Register:

Registration will be limited to the first 25 paid registrants Registration Form - : https://sideline-management-spnz-level-1-course.lilregie.com/ Fax 04-801 5571 or Email: pnz@physiotherapy.org.nz

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Continuing Education

Website Passwords

Please note:

SPNZ Website Passwords

We are about to do an update of our database for accessing the website. *** Unfortunately this will delete your current password. *** A new one will be issued and this will be: your mobile number minus the first 0 e.g. mobile = 0211234567 password = 211234567 If this doesnâ&#x20AC;&#x2122;t work just reset it. (This could be because we have no number or an incorrect number) See the FAQ page if you donâ&#x20AC;&#x2122;t know how. Our apologies for this Hamish SPNZ Bulletin April Edition

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Research Publications JOSPT JOSPT ACCESS

www.jospt.org

All SPNZ members would have been sent advice directly from JOSPT with regards to accessing the new JOSPT website. You will have needed to have followed the information within that email in order to create your own password. If you did not follow this advice, have lost the email, have any further questions or require more information then please email JOSPT directly at jospt@jospt.org in order to resolve any access problems that you may have. If you have just forgotten your password then first please click on the â&#x20AC;&#x153;Forgotten your passwordâ&#x20AC;? link found on the JOSPT sign on page in order to either retrieve or reset your own password. Only current financial SPNZ members will have JOSPT online access.

Volume 46, Number 4, April 2016

EDITORIAL 2015 JOSPT Awards: Back Pain and Anterior Cruciate Ligament Injuries Are a Continued Focus of Research and Clinical Attention in Physical Therapy CLINICAL COMMENTARY Shedding Light on the Etiology of Sports Injuries: A Look Behind the Scenes of Time-to-Event Analyses MUSCULOSKELETAL IMAGING Cauda Equina Compression in the Absence of Neurologic Signs RESEARCH REPORT Reduced Physical Activity in People Following Ankle Fractures: A Longitudinal Study A Prescriptively Selected Nonthrust Manipulation Versus a Therapist-Selected Nonthrust Manipulation for Treatment of Individuals With Low Back Pain: A Randomized Clinical Trial Cervico-occipital Posture in Women With Migraine: A Case-Control Study The Influence of Centralization and Directional Preference on Spinal Control in Patients With Nonspecific Low Back Pain Plantar Cutaneous Sensitivity With and Without Cognitive Loading in People With Chronic Ankle Instability, Copers, and Uninjured Controls M-Mode Ultrasound Reveals Earlier Gluteus Minimus Activity in Individuals With Chronic Hip Pain During a Step-down Task Abdominal Bracing Increases Ground Reaction Forces and Reduces Knee and Hip Flexion During Landing Postural Cueing to Increase Lumbar Lordosis Increases Lumbar Multifidus Activation During Trunk Stabilization Exercises: Electromyographic Assessment Using Intramuscular Electrodes

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Research Publications British Journal of Sports Medicine www.bjsm.bjm.com Volume 50, Number 8, April 2016 REVIEWS Do runners who suffer injuries have higher vertical ground reaction forces than those who remain injury-free? A systematic review and meta-analysis Henk van der Worp, Jelte W Vrielink, Steef W Bredeweg http://bjsm.bmj.com/content/ Effects of exercise and manual therapy on pain associated with hip osteoarthritis: a systematic review and meta-analysis Lucy Beumer, Jennie Wong, Stuart J Warden, Joanne L Kemp, Paul Foster, Kay M Crossley http://bjsm.bmj.com/content/ Measurement of physical activity in older adult interventions: a systematic review Ryan S Falck, Samantha M McDonald, Michael W Beets, Keith Brazendale, Teresa Liu-Ambrose http://bjsm.bmj.com/content/ CLINICAL ANALYSIS Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury Peter Blanch, Tim J Gabbett http://bjsm.bmj.com/content/ ORIGINAL ARTICLES Prospective comparison of running injuries between shod and barefoot runners Allison R Altman, Irene S Davis http://bjsm.bmj.com/content/ Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding Laurent Malisoux, Nicolas Chambon, Nicolas Delattre, Nils Gueguen, Axel Urhausen, Daniel Theisen http://bjsm.bmj.com/content/ â&#x20AC;&#x153;Physical Activity 4 Everyoneâ&#x20AC;? school-based intervention to prevent decline in adolescent physical activity levels: 12 month (mid-intervention) report on a cluster randomised trial Rachel Sutherland, Elizabeth Campbell, David R Lubans, Philip J Morgan, Anthony D Okely, Nicole Nathan, Luke Wolfenden, Jarrod Wiese, Karen Gillham, Jenna Hollis, John Wiggers http://bjsm.bmj.com/content/

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Classifieds PALMERSTON NORTH Rehab Physio Centre Physiotherapist â&#x20AC;&#x201C; start early May Itâ&#x20AC;&#x2122;s time for her big OE and with Shannon leaving we have big shoes to fill!! Are you an enthusiastic, energetic team player wanting to join an experienced team of five physiotherapists working with a variety of sports, spinal and work related injuries? We are looking for someone who will value the opportunity to learn and develop professionally. You will be working independently in a friendly supportive environment. Along with providing expertise in manual therapy, therapeutic exercise and acupuncture, our practice has a fully equipped rehab gym. To apply, or for more information, please contact Mike Harnett, Managing Director, Rehab Physio Centre (PN) Ltd at: mike@rehabphysiocentre.co.nz or phone 021 473 422, or visit our website www.rehabphysiocentre.co.nz

Qualitative Study at the School of Physiotherapy Current perspectives on the assessment and prescriptions of footwear for overuse running knee injuries Physiotherapists and podiatrists are sought for a focus group discussion or individual interviews on the perceptions and opinions of the assessment and overall treatment of running-related overuse knee injuries, including approaches to prescription of footwear. This study will clarify current trends in clinical practice and inform teaching and future research studies. The discussion will be maximally one hour and can be conducted individually with the researchers via Zoom (a web-based programme similar to Skype). For further information, please contact Codi Ramsey (PhD candidate) at codi.ramsey@otago.ac.nz

SPNZ Bulletin April Edition