April 2015 bulletin

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BULLETIN Issue 2 April 2015

FEATURE TOPIC: Education SPNZ MEMBERS PAGE

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See our page for committee members, links & member information EDITORIAL

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By SPNZ President Hamish Ashton LATEST NEWS

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Latest News from SPNZ CONTINUING EDUCATION

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SPNZ Level 1 Immediate Care and Sports Trauma Management Course MEMBERS’ BENEFITS

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In this issue:

On-line Journals FEATURE

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Physiotherapy Specialisation—My Experience by Dr Angela Cadogan PLANET OF THE APPS

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Physio Logitapp Version 8.0.1 CASE STUDY

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Post Graduate Study in Specialised Area Improves Delivery of Physiotherapy SPRINZ

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Science and Medicine in Endurance Sport Symposium ASICS

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ASICS REPORT—The Foot Soldier of the Professional Sporting Team CLINICAL SECTION- ARTICLE REVIEW

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The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients with Musculoskeletal Conditions CLINICAL SECTION - REVIEW

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Review of the Ottawa Rules for Ankle, Foot and Knee RESEARCH PUBLICATIONS JOSPT Volume 45, Number 4, April 2015

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BJSM Volume 49, Number 48, April 2015

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CONTINUING EDUCATION Local course and APA CPD Event Finder

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CLASSIFIEDS

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

Hamish Ashton

Secretary

Michael Borich

Treasurer

Michael Borich

Website & IT

Hamish Ashton

Committee

Timofei Dovbysh Blair Jarratt

Visit our website www.spnz.org.nz CHECK OUT THESE LINKS

Join us on Facebook

List of Open Access Journals

Justin Lopes Dr David Rice Bharat Sukha

Asics Apparel and order form

Follow us on Twitter

Kara Thomas EDUCATION SUB-COMMITTEE Dr David Rice - chair

Sports Physiotherapy NZ

McGraw-Hill Books and order form Asics Education Fund information

Join us on Linkedin Groups

IFSPT JOSPT BJSM

Dr Angela Cadogan Justin Lopes Dr Grant Mawston Dr Chris Whatman BULLETIN EDITOR Aveny Moore SPECIAL PROJECTS Monique Baigent Karen Carmichael Kate Polson Amanda O’Reilly Pip Sail Louise Turner Greg Usherwood

ADVERTISING Deadlines for 2015: February Bulletin: April Bulletin: June Bulletin: August Bulletin: October Bulletin: December Bulletin:

31st January 31st March 31st May 31st July 30th September 30th November

Advertising terms & conditions click here.

ASICS EDUCATION FUND A reminder to graduate members that this $1000 fund is available twice a year with the next application deadline being 31 August 2015.

Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing education in the fields of sports and orthopaedic physiotherapy.

An application form can be downloaded on the SPNZ website

CONTACT US Michael Borich (Secretary) 26 Vine St, St Marys Bay Auckland mborich@ihug.co.nz

sportsphysiotherapy.org.nz.

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Editorial Hamish Ashton, SPNZ President A warm welcome to all for this our second bulletin for the year. Welcome especially to our new members, and welcome back to those who have remained with us. I just want to remind you to check out our benefits page to see what we have for you as our members.

SPNZ has worked hard over the last few years to bring you world class benefits while at the same time keeping the price affordable to all. This could not have been done without the time put in by our committee.

Our AGM will be in the very near future – keep a look out for the date. As we have no symposium this year it will most likely be in Auckland. Apologies for those out of the region who may not be able to travel up. We however always value your opinion so any ideas on anything please let Michael or me know. One of our committee will be stepping down this year so we need people to put their hand up to help. Being on the committee is neither arduous or a huge demand on your time, but if we don’t have helpers we can’t get things done. If you have things to offer, even if the committee seems too much at present, let me know.

At the moment we are upper North Island and male biased so we are keen to get a more diverse representation of our membership base.

As you can see via the ad we are also keen to have some help with our social media. For those young (not a condition) members out there can you help? Also, if there is anyone who runs a sports based blog we would be interested in linking it to our website and Facebook page. Contact me, Hamish, at help@spnz.org.nz Our big achievement which we are presenting in this bulletin is the release of our SPNZ Certificate in Sports Physiotherapy. Over the last two years we have been running some sports courses but now we have a structure and pathway. These are very practical courses for those who want to gain experience in sports physiotherapy that compliments those who want to undertake a university pathway.

For a number of years the IFSPT has had a document outlining the competencies a sports physiotherapist should have. A large number of these, due to the nature of our “speciality”, aren’t provided in the undergraduate course. Twenty years ago working on the

sideline in a largely unsupported sport I had to learn through trial and error, and with no support, what worked and what didn’t. Our education committee through their dedicated hard work have put together these courses and an excellent panel of presenters to provide you with an opportunity to learn these skills from someone who has been there and done that, rather than by trial and error like I did.

Even if you don’t want to follow the structured certificate at present, a couple of courses that I feel everyone on the side should do are the “Immediate Care and Sports Trauma” and the “Sideline Management Course” . This trauma course goes over those real emergency skills we really should have on the sideline but no one teaches us. The sideline course, amongst other things, covers our Sports Code of Conduct. Keep an eye out for dates for this and the other courses on our CPD pages on the website.

I think some of us out there on the sideline forget at times that when we are working with teams we are still a physiotherapist and as one should act professionally. Any dealings with team members should be like they are your patient. It is vital this is reflected in how we act. My team laughs at me because I won’t have a beer after the game with them.

The standards I set myself mean that until the players have left the club, or arrived back after an away game, they are my responsibility. I therefore can’t be impaired in my judgement if something happens.

I was recently talking to a sports physician. He mentioned a travelling physiotherapist had recently contacted him about medicine for a player – good start. But the medicine was then given before the physician cleared it as appropriate. This is not only dangerous and unethical but also lessens our standing to the medical community, not as the individual concerned, but as a profession.

Well that’s it from me for now Hamish

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Latest News SPNZ is developing a series of continuing education courses that are informed by the sports physiotherapy core competencies identified by the International Federation of Sports Physical Therapists http://ifspt.org/competencies/ SPNZ Level 1 courses have been developed for qualified physiotherapists providing sideline management for individuals or sports team at any level. These courses are:  The Promotion and Prescription of Physical Activity and Exercise  Sideline Management  Immediate Care and Sports Trauma Management SPNZ Level 2 courses are currently under development, with good progress being made. These will be available from early 2016 and are aimed at qualified physiotherapists with sideline management experience who wish to advance their sports physiotherapy clinical practice skills and/or pursue a career pathway in elite sport. Members who complete all SPNZ Level 1 and Level 2 courses within a six year time frame will attain a SPNZ Certificate in Sports Physiotherapy (see attached flyer). For those members who choose not to complete the SPNZ Certificate in Sports Physiotherapy, all courses can be attended on a stand alone basis. All course objectives and outlines are available on our website www.spnz.org.nz/courses.

In the future, we aim to develop a third level of SPNZ courses. These will target sports physiotherapists who work in elite level sport and who wish to gain specialised knowledge and become leaders in the sports physiotherapy profession. Members who complete all SPNZ level 1, 2 and 3 courses will become SPNZ accredited “Sports Physiotherapists”.

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Latest News

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Continuing Education

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Continuing Education

To register for this course see the form on the website www.spnz.org.nz/courses

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Wanted

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People interested in joining our committee. Join a great bunch of people to keep SPNZ going.

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People who have an interest in social media. Can you help with our Facebook and Twitter accounts?

Contact Hamish: help@spnz.org.nz

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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 highlight individual member benefits in order to help members best utilise all benefits available.

Free full text online access to JOSPT JOSPT is one of the top physiotherapy journals in the world. Scholarly and peer-reviewed, JOSPT features the latest evidence-based research and clinical cases in musculo-skeletal and sports-related health, injury, and rehabilitation, including physical therapy, ortho-paedics, sports medicine, and biomechanics. With 12 issues over the year it strives to offer high-quality research, immediately applicable clinical material, and useful supplemental information in a variety of formats.

Australian Sports Physio Association Magazine - Sports Physio Members receive 4 yearly copies of the Australian Sports Physio Association Magazine – Sports Physio. This is a great magazine with articles by sports physiotherapists and associated practitioners that work on the coal face with athletes. There is always an interesting story either on a sport or on a condition whatever your interest.

British Journal of Sports Medicine British Journal of Sports Medicine (BJSM) is a multimedia portal for authoritative original research, critical reviews and timely debate in sport and exercise medicine (SEM) as well as clinical education and implementation success stories. BJSM’s web, print, video and audio material serves the international sport and exercise medicine community with the journal recognised as a leader in sports medicine social media.

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Feature Physiotherapy Specialisation – My Experience

By Dr Angela Cadogan

Angela is New Zealand’s second physiotherapist to achieve Physiotherapy Specialist Status, and the first of our members to receive this status. Physiotherapy Specialists are expert physiotherapists who have advanced education, knowledge and skills to practise within a specific area of clinical practice. As specialist clinicians they demonstrate leadership in consultancy, education and research. They work collaboratively with the physiotherapy profession and within the wider health team across a range of health and disability settings. Physiotherapy Specialists actively participate and take a leadership role in professional activities, including local and national strategy and policy development. They work in partnership with individuals, whanau, families and communities to optimise health outcomes.

To become a Physiotherapy Specialist there is a detailed process which involves putting together a professional portfolio which is then followed by a panel interview at which a presentation is made and the applicant is questioned on their portfolio and how they see their role as a Physiotherapy Specialist contributing to the profession and to the health and wellbeing of New Zealanders. More information can be found on the NZ Physiotherapy Board website. http://www.physioboard.org.nz/specialisation Angela will give us an insight into her experience of becoming a Physiotherapist Specialist.

How did I get there?

My journey to becoming a Physiotherapy Specialist began as soon as I graduated as a physiotherapist in 1990.

After completing a rotational position at Greenlane/ National Women’s Hospital I spent two years working in the USA before returning to New Zealand and pursuing a career primarily in sports physiotherapy. On a personal level, I was driven by the love of a diagnostic challenge, and the reward of seeing the difference rehabilitation made to patients’ quality of life. On a professional level, I always had the feeling I could ‘do better’ (and still do!), leading me to seek higher levels of knowledge and skill.

This led to completing a Master’s Degree in Sports Physiotherapy at Curtin University (Perth, Western Australia).

I then took on a role with NZ Cricket working as a touring physiotherapist back in the days when many teams didn’t have strength and conditioning personnel. Part of my role while touring was to maintain the strength and conditioning of the touring squad. Feeling well out of my depth, and being a serial-student (geek), I then completed a Post-graduate Certificate in Health Studies (Sport & Exercise) through AUT, including papers in exercise physiology, muscular performance and biomechanics.

Although I had already developed an interest in shoulder pain, this fascination grew after working with “throwing” athletes in cricket and after eight years at NZ Cricket, I

enrolled in a PhD. My topic: the Diagnosis of Shoulder Pain. While my PhD was not specifically in an athletic population, diagnosis is the necessary first step in effective treatment and rehabilitation, and a large scale diagnostic shoulder study had not previously been done.

If I had to summarise my own journey to specialisation it would be:    

Learn, learn and learn some more Strive for excellence Subject yourself to peer review and critique Watch and learn from others.

What is means for me?

Being recognised as a Specialist comes with a huge sense of responsibility to help to set and uphold standards in this new scope of practice. What specialisation means for me, personally, can be summed up as follows:    

Opportunities for more learning Job opportunities Recognition Remuneration

My post-graduate career was primarily in Sports Physiotherapy. In this regard it is disappointing that Sports Physiotherapy is not recognised as an area of Specialist practice, and I believe this is largely due to the relatively ‘young’ career pathway in elite sport in NZ, and

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Feature Physiotherapy Specialisation – My Experience continued...

What it means for the future I believe that future Specialists are able to carve their own niche in their practice area. The opportunities are there for consultancy, advisory and education if you are pro-active and self-motivated and engage well with stakeholders in your area.

the lack of identification of physical activity being a specific competency of sports physiotherapists worldwide. My hope is that this will change in the future.

Following my PhD, my career has followed a less sporting path. Being recognised as a “Physiotherapy Specialist (Musculoskeletal)” has afforded me with an opportunity to take on a role in orthopaedic triage through the Canterbury District Health Board. This role involves triaging referrals made to orthopaedic surgeons through the public system, assessing patients and directing them to an appropriate clinical pathway. I also work with a shoulder surgeon as a clinical assistant in his private practice, performing patient assessments as well as some clinical research.

My private practice patient base now consists almost entirely of direct referrals from other physiotherapists, GPs, sports medicine physicians, or orthopaedic surgeons for patients with complex shoulder conditions, or those who have not responded to conservative measures elsewhere.

I am often asked whether I get paid any more for being a Specialist. Although that was never the primary motivating factor for me, the answer is yes, in that I charge higher surcharges for my services, and patients are happy to pay them. There is no current recognition of Specialist level from the funders of healthcare. This may take time to evolve as more Specialists are identified, and clear roles for them are defined within the health care system.

I believe the physiotherapy profession is already benefiting from the ability to recognise an advanced level of physiotherapy practice. In Canterbury, the identification of “Specialists” has led directly to physiotherapy being invited to high level discussions within primary health care in the region. The Specialist scope allows immediate identification of those with expertise in various fields and provides the medical profession with a standard that mirrors structures within their own profession with which they can readily identify.

There is no doubt in my mind the future needs to hold separate recognition for advanced levels of physiotherapy as well as Specialists. For this to translate to recognition by, and integration into the sports industry and the healthcare system, this will necessitate robust standards including the assessment of clinical skills and recognition in practice areas that are relevant to current sporting and healthcare services.

Primary care GPs, as well as orthopaedic specialists are crying out for the recognition of advanced practice within physiotherapy, not only as “Specialists” but a level of advanced practice of a proven standard. Healthcare services are also becoming over-burdened and are looking for practitioners with the ability to take on advanced and expanded roles that may require specific training programmes for specific roles e.g orthopaedic triage. I cannot over-estimate the urgency for our profession to identify an additional level of advanced practice and identify potential roles within healthcare that may require separate training/internship programmes.

In terms of sports physiotherapy, sporting organisations, athletes and support structures are now more professional, and there are now literally millions of dollars at stake in terms of an athlete’s health, and performance. As a profession we are accountable for ensuring we produce and identify physiotherapists with the ability to perform in this environment. The physical activity component of sports physiotherapy is often forgotten, and we all know the healthcare cost and individual health consequences of physical inactivity.

Physiotherapy Specialisation is a journey, not a destination, and the journey continues.

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Planet of the Apps Your monthly App review

by Justin Lopes - Back To Your Feet Physiotherapy, SPNZ executive member.

Hi, To follow on from the ‘Education’ theme of this newsletter I have reviewed PNZ’s CPD app ‘ Physio Logitapp’ from LogitApps. PNZ informed me the app was designed by LogitApps who presented it to them and PNZ purchased the rights to the app for their members, which means we all have access for free! You save your CPD activities and then email formats to yourself so you can have a copy for your records and print off to send to the board, in the same format that the board requires for accreditation or auditing.

App: Physio Logitapp Version 8.0.1 Category: Updated: Version: © Logitapp

Medical 25 November 2014 8.0.1

Cost: Requires: What it is used for: Where to find it:

Android or Apple:

Size: Language: Seller: Rated 4+

6.3 MB English Onlinefotos Ltd

Free to all PNZ members as PNZ purchased the rights and license for their members.

Non-member purchase costs $19.95 per year on Apple iPhone and iPad and Android smart phones and tablets.

Storing CPD records of events, time, photos of certificates etc.

Download from Apple store, https://itunes.apple.com/nz/app/physio-logitapp/id689711609?mt=8 Or you can scan a QS code from the website http://logitapps.co.nz/information/ Both

Features:  Set up you own personal CPD Account  Records all your professional development at the click of a button.  Allows you to capture and store a photo of each certificate.  All your personal data is stored safely and securely on the LogitApp server.  All the information can be exported to an excel template with all your activities and with all the evidence.  Very easy to upload and send to the Physiotherapy Board if audited.

Pros: Is affiliated and supported by PNZ and in the format the board requires so if you are audited then you can bring up your CPD evidence, which should be easy and in a format they approve.

Within the app there are links to videos on how to use the app, recertification guidelines, definitions of the four CPD activities, upcoming events, a link to share the app and to contact LogitApps and PNZ. You can view your four CPD activities, back up a file to your server or email, and there is a great summary dashboard of your total hours over the years to date.

Cons: I had been told that there was an access issue with the urls provided in the excel spreadsheets and if the user tried to manipulate them. PNZ and the developers have been made aware of this issue and have assured me that it has been resolved.

How I use the app: I have only started using the app recently, but will continue to use it as I think it will help me keep a more accurate record of my CPD activities.

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Planet of the Apps App: Physio Logitapp Version 8.0.1

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

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Case Study Post Graduate Study in Specialised Area Improves Delivery of Physiotherapy I wanted to be a physiotherapist by the time I was 13, due in no small part to seeing my uncle, Peter Boyle, physiotherapist for the Kiwi league team. Sometime after that I started racing bikes at the age of 16, going on to represent New Zealand at the Junior World Cycling Championships (this was after high school and in a gap year when I wasn’t accepted into physiotherapy school first time around). I was accepted into Otago’s physiotherapy course the following year and continued to ride and race as I studied, including taking a year off in the middle of study to travel overseas racing bikes again.

Once I graduated and began my working life as a physiotherapist, my cycling background led me to see more and more cyclists as patients. I would be doing what I deemed to be the best treatment for the athlete but sometimes I just couldn’t sort out a niggling back or knee pain so I started looking at them, during my appointments, on the bike as well. I could then help more of them with an adjustment here or there to the bike but there was a nagging feeling that I could be doing a better job for them if I knew more.

So I enrolled for my Post Graduate Diploma in Sports Physiotherapy where I was drilled and grilled and educated deeper on injuries and healing and treatments and clinical reasoning. The clinical reasoning aspect of the post grad course was the single most important thing to me that improved my delivery of physiotherapy treatments. Being able to rationalize and sort/order the different structures that could be contributing to the problem for the patient allows me to pick which treatment/intervention or combinations will help my patient the most.

I still wanted to do a better job of understanding “bikefit” so continued on to do my Masters and chose to describe “Lumbar Motion in Cyclists” as my topic. I was lucky to be able to utilise the expensive 12 camera 3D motion capture system that is at Otago Physiotherapy School and I brought cyclists into the lab, stuck reflectorized dots all over them and then captured the cyclists riding on a windtrainer in the lab. From here I was able to play with 3D cyclists on the computer (which was great fun) and spent a lot of time playing with numbers and relearning Pythagoras (which was less fun).

I returned to full time work following the completion of my Masters, moving to Christchurch, and continued to see more and more cyclists and do more bikefits. I started offering bikefits as a specific treatment option and now spend 90 minutes for a bikefit compared to the quick view I used to do during a 20 minute physiotherapy appointment.

Whilst I am still very much a hands on physiotherapist, I now use allen keys, a hacksaw and even occasionally a hammer as tools of my trade and if my clients don’t ride a bike themselves, they probably have a family member or friend who does.

I had a 40 year old Ironwoman, who was referred by her tri coach, last year who emailed me: “Hi there… I had previously done 12 Ironmans and biking was always my strength. I had a break for five years and had two children, then started from scratch...new bike, new shoes, different person to set it up and had nothing but sore shoulders and a numb right foot. I did Ironman Melbourne this year and had to stop three times on the bike due to neck and shoulder pain, then had to stop through the run with a numb foot....so it’s time to get it sorted” I saw her for a bikefit and recommended a change in saddles (to take weight on her pelvic bones better), shoes (wider to stop her metatarsals from being squashed together) and stem length (shorter in this case to bring handlebars back and her elbows closer to under

her shoulders so she was more balanced). With my physiotherapy knowledge and education I am able to look at the rider on the bike and see what the body is doing and with my knowledge of cycling from years of turning the pedals I know what it should look and feel like for them on the bike. Once she had made the purchases she returned for a follow up and we tweaked the bike position to suit her better both from a comfort and a performance perspective.

She reported an immediate benefit to her riding and trained well leading up to IM Canada over the next six months. She made contact a week out from the event.

Her bike had been damaged a little on the plane trip over and on her first ride she was stuck in a big gear and developed posterior knee pain and in her back on the same side. She was worried that her bikefit may

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Case Study Post Graduate Study in Specialised Area Improves Delivery of Physiotherapy continued... have been changed when she repacked her bike (although her seatpost had been marked by her husband). I reassured her of the fit and advised that the combo of long haul flight and overload with big gears was a likely culprit. I also advised back extensions, quad and hip flexor and hamstring stretches, to alleviate the tightness I associated with extended sitting on a plane, as well as seeing a physiotherapist over there.

Following the race I heard from her again: “I did loads of stretching and saw a great physiotherapist up in Whistler for two one hour sessions prior to the race which really helped.

I had a fantastic swim and came out in the top quarter of the field then got onto my bike and for the first time in a race since 2006, my bike felt a part of me. It was a really hilly 180km and the hardest of the 14 Ironman races I have done. There were so many big climbs and I had been warned to be patient for the first 150km as there was a 30km climb. I was overtaken quite a bit between 60km and 90km which was a bit demoralising but I stuck to my plan. At 90km there was a flattish out and back 50km stretch and I was cruising on 31km and overtaking everyone. The last 90km was 37 degrees and the climb back up had no wind, so an hour 20ish of scorching heat.

The thing that struck me about this ride was that mentally I was bright the whole way, I felt stronger the last 90km and there were only a few people who overtook me on the last 30km home. That hasn't happened for a really long time...like ten years! I was 20 minutes faster than the flat course in Melbourne last year and in a whole difference space in terms of my head and comfort. The whole ride I was so comfortable.

You have no idea how amazing that felt. For a mountainous ride...that was amazing.

My running off the bike felt fantastic and after the first normal 5km of hurt, I ran feeling like I hadn't ridden! I

ran well till 25km when I started getting incredibly dizzy.

It was about this time that a bear poked its head out at me and I just about had heart failure :). I was pulled off the course at 30km, given a silver blanket and some soup till I stopped shaking (it was still 30 degrees), and somehow managed to walk back to the finish where I collapsed and spent three hours in the medical area and had two Iv's....Apparently my electrolytes were too low and I was really dehydrated. Silly, silly mistake but I had no idea it would be that hot! Funnily enough it’s the race I am most proud of because I honestly didn't think I was going to finish I felt so unwell.

So in terms of time, it was my slowest ever Ironman, but there was only one other race where I felt so good and so comfortable on the bike and that was my personal best race in 2003 so thank you so very very much for that!”

So whilst this was not the perfect ending for her race, she was held back by nutrition rather than injury and we were able to relieve all her symptoms that had held her back from completing her previous event.

I never intended to become a bikefitter but thanks to my post graduate studies I was able to shape my job and round out my work as a sports physiotherapist to help my main client group to a higher degree and there is no way I would be working quite the way I do now if I hadn’t returned to study.

By Anthony Chapman Sports Physiotherapist & Bikefitter BPhty, PGDipPhty (Sports), MPhty (Sports) Optimal Performance www.optimalperformance.co.nz www.bikefitter.co.nz

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SPRINZ

Science and Medicine in Endurance Sport Symposium June 27th, 2015 On June 27th 2015 SPRINZ will be hosting the Science and Medicine in Endurance Sport Symposium.

The Science and Medicine in Endurance Sport Symposium will be a day of talks and discussion led by top athletes, coaches, scientists and practitioners sharing their knowledge and experience on a whole host of topics. And of course, it’s a day to meet fellow coaches, scientists and health practitioners.

Hosted by SPRINZ, the day is all about elevating endurance: integrating and connecting science to the real world. The content will be relevant for those working with elite athletes, as well as those developing emerging talent, or working with age-group athletes.

The Symposium will take place at AUT Millennium, on Auckland’s North Shore.

Speakers Dylan McNeice | Rob Creasy | Kaytee Boyd | Dr. Grant Schofield | Bevan McKinnon | Kelly Sheerin | Dr. Andrew Kilding | Dr. Mikki Williden Topics Strength training for endurance sport | Integration of science on race day | Running gait re-training | Low carb high fat for performance | Adrenal fatigue | Adaptation to training and environmental stress | Real food and recovery WATCH THIS SPACE FOR FURTHER INFO AND REGISTRATION DETAILS

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ASICS ASICS Report The Foot Soldier of the Professional Sporting Team

THE FOOT SOLDIER OF THE PROFESSIONAL SPORTING TEAM

DR MICHAEL A. KINCHINGTON PHD M.Pod; Grad Dip Sports Med.; Ms Ex & Sp Sc; FAAPSM; FSMA Musculoskeletal Injury & Sports Medicine Podiatric Consultant Research Fellow Australian Catholic University Injury statistics in running-based team sports (the rugby codes, soccer, Australian rules for example) indicate that a high proportion of injuries occur to the lower limbs, so much so that they are estimated to cost in excess of $2billion annually. Lower extremity injuries not only result in significant financial and social impact on players but can also be extensive and debilitating to the athlete both physically and mentally. Ultimately, they can significantly impact on player welfare, career longevity and team performance.

One thing common to all football codes is the high volumes of running undertaken in any given game.

Distances recorded in the various codes have shown footballers running upwards of 7 kilometres (km) per game in the rugby codes, 12 km in football-soccer and 17km per game in Australian Rules Football. As such, certain pre-emptive measures to monitor lower extremity well –being during these periods of high musculoskeletal demand have become a requirement for best practice.

Furthermore, the role of podiatry in lower limb injury prevention has become an integral working component of any successful medical program within professional sporting teams.

It is the podiatrist’s responsibility to interact with the physiotherapy department as well as the medical and rehabilitation teams. Sports podiatrists offer programs aimed at improving lower extremity comfort, calculate ground hardness and choose footwear appropriateness for players.

FORERUNNER AUGUST 2014

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ASICS ASICS Report continued...

They need to consider what is best suited for pre-season training, inseason training as well as making match day boot recommendations (based upon environmental conditions, player soreness and performance based criteria), develop shoe rotation policies and monitor player lower limb comfort data to assist with determining training and rehabilitation.

In my own 20 odd years as a sports medicine/sports podiatry consultant I have had some great opportunities to prepare, manage and conduct research with professional athletes in a variety of sporting bodies including several football codes. This includes past and current stints with NRL teams, NSW and Cricket Australia, Super Rugby Competition, Football Federation Australia, A-League Football, AFL and the International Olympic Committee.

Particularly in football, footwear is the only form of player apparel that acts as a filter between the playing surface and the body during weight bearing. That means it will directly influence movement patterns on a variety of surfaces (soft, hard, wet, dry and undulating), and therefore contribute to a number of football outcomes (slipping, performance, traction, comfort and injury). However, it is surprising that up until only recently no footwear profiling studies had been published that documented the potential associations between footwear, injury and comfort within the football codes and subsequently provided objective guidance with regards to footwear selection decisions. This lack of data eventually led to the development of a novel lower limb comfort index which simultaneously measures anatomical regions of the lower extremity to determine the physical preparedness of an athlete. This index can be used to rate comfort, predict injury, monitor the severity of existing injury and offer clear guidelines on footwear usage. A major theme to emerge from research conducted on more than 180 professional footballers was that the use of a tailored footwear program could act as a viable intervention to prevent lower limb injury. Furthermore, a lower limb monitoring program that tiers individual comfort levels can provide an important snapshot of a football player’s physical preparedness to train and play.

The focus on lower limb comfort is a relatively new frontier in professional football and I have been at the forefront of this science for close to a decade. The scientific, peered reviewed data and the weekly practical-clinical data indicates that comfort changes are relevant to football; that comfort zones can be either predictive of an injury or used to monitor lower extremity well-being. The interpretation of the data shows that high comfort scores may be a protective mechanism against lower limb injury.

For elite performances, it is generally accepted that a range of shoesshould be made available to suit varying ground (hard vs. soft), environmental conditions (dry vs wet), and training routines (running vs. skills). However, footwear styles across a spectrum of sports are associated with comfort effects, injury and performance.

Therefore, the monitoring of variables like what footwear is worn on any given surface, the environmental conditions (playing surfaces), movement patterns (distances covered) and physical biomechanical profiling are all critical to managing musculoskeletal loads. It is these variables that are analysed on a weekly basis.

Surprisingly, footwear is commonly neglected in professional sport and left to the individual athlete to determine. It is probably the only area of professional football that a club, apart from lip service, does not particularly control. This is despite the vast science indicating footwear can positively influence joint and muscle load, improve oxygen expenditure, improve comfort, enhance performance and minimize injury.

Prospectively recorded data and footwear research that I have conducted found a tailored footwear program consisting of player education, prescription of footwear, monitoring of footwear and footwear modification can substantially reduce lower extremity injury and improve comfort levels. We now have enough of this data both from a science and clinical perspective to indicate that the results achieved within professional sport is applicable to sports other than football‌why?... Footwear and running related activities requires shoes, there are more than 150 football boots on the market and over 400 running shoes to choose‌ are you confident of getting it right?

In conclusion it has been suggested that firstly a designated training shoe may have protective qualities for the lower extremity and has the capacity as an instrument of a tailored footwear program to aid the lower extremity comfort of footballers. Secondly, that coordinated footwear program can be beneficial in the injury management paradigm. Optimal footwear selection based on player comfort guidelines is recommended for development to assist injury prevention programs and finally that lower limb comfort can be affected by footwear with important consequences for injury management and player welfare. This research provided evidence that the football boot when worn for extended periods contributes to poor lower limb comfort and that a dedicated training shoe may offer protection to players over the course of the season. A platform to develop clinical footwear guidelines and educative programs to footballers, coaching staff and medical personnel is therefore recommended.

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Clinical Section - Article Review The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients with Musculoskeletal Conditions Jason Rodeghero,PT,PhD1,2,5 * Ying-Chih Wang,OT,PhD3,4 * Timothy Flynn,PT,PhD1,5 Joshua A Cleland, PT,PhD6 * Robert S. Wainner, PT,PhD5,7,8 * Julie M Whitman, PT,DSc5,8 Journal of Orthopaedic & Sports Physical Therapy February 2015, Volume 45, Number 2 As the physical therapy profession has advanced to a doctoral-level profession, there has been greater emphasis on autonomous practice and on physical therapists achieving recognition as the musculoskeletal provider of choice.

There is an increasing focus on specialisation through post-professional education in physical therapy residency and fellowship programs. Scant evidence exists that evaluates the influence of post-professional clinical education on actual patient outcomes.

ARTICLE REVIEW A retrospective cohort design was conducted using data from an electronic survey and an existing commercial outcomes database. The objective was to compare the clinical outcomes of patients with musculoskeletal conditions treated by physical therapists who had completed residency or fellowship programs versus those who had not.

Clinical experience and post-professional education are dimensions of expertise in physical therapy. Knowledge and clinical reasoning have been identified as critical elements of clinical expertise. Knowledge can be obtained through many formats whereas clinical reasoning is a dimension of expertise that may require some degree of mentored clinical practice.

There has been very little investigation on the effect of continuing education, post-professional fellowship or residency on the actual clinical outcomes.

Two studies have investigated the impact of continuing education on patient outcomes.

Brennan et al6 investigated a two day continuing education course of education and laboratory skills practice. A subset participated in a six month clinical improvement project. There was no difference between attendees and non -attendees however better outcomes were achieved from those who participated in the clinical project compared to those who did not. The conclusion was that passive continuing education does not influence practice patterns to a level to benefit patients unless there is a formal process for reinforcement into clinical practice.

Cleland et al10 investigated a two day continuing education course focused on assessment and treatment. The group split between ongoing follow-up and mentoring and no further follow-up or mentoring. The physiotherapists that followed up with mentorship and/or ongoing education achieved significantly greater improvements.

These studies suggest that traditional post-professional continuing education may not improve clinical practice compared with programs that include clinical oversight and formalised reinforcement.

Resnik and Hart36 examined the difference in outcomes for patients with low back pain treated by physical therapists with and without post-professional certification. Results suggested that physical therapists with certified manual therapy credentials achieved better outcomes.

Residency programs have been shown to offer perceived benefits but there is lack of evidence addressing the impact of such programs on outcomes. There is potential that a standardised program with mentorship may have positive results on patient outcomes. Formal clinical residency and fellowship programs are potential mechanisms to provide this educational experience.

There is increasing focus on matriculation through formal residency and fellowship training but there is minimal evidence to support the impact on patient outcomes.

A retrospective cohort design study was used to determine the level of post-professional education and clinical outcomes. It was extracted from a database and analysed to identify differences in outcomes achieved and clinical efficiency.

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Clinical Section - Article Review The Impact of Physical Therapy Residency or Fellowship Education on Clinical Outcomes for Patients with Musculoskeletal Conditions continued...

The results of this preliminary study suggest that physical therapists with fellowship training may provide better patient outcomes in fewer treatment sessions compared with others and this challenges the clinical benefit of completing a residency program. Patients treated by residency trained physical therapists did not achieve greater outcomes than groups without residency training. Physical therapists without residency training achieved equivalent outcomes to residency trained therapists but did so more efficiently.

Limited previous research has demonstrated the lack of impact the weekend continuing education courses have on patient outcomes. Available literature has shown increased individual perception of clinical skills among graduates, however, it is unknown whether the perception of improved skills translates into meaningful benefit for patients.

CONCLUSION Results of this study and existing literature appear to support the positive influence of postgraduate education in the form of fellowship training on clinical practice. That influence may include greater improvements in outcome statistics and greater efficiency of care.

In the changing environment of healthcare, achieving better outcomes in fewer visits or demonstrating the efficiency of additional visits will be important for physical therapists to demonstrate the value of treatment for care of musculoskeletal conditions. Data analysed to date indicates that there may be benefit from manual physical therapy fellowship training to achieve this but this is not reflected similarly in continuing education or residency training without ongoing mentorship.

By Pip Sail Dip Sports Med., BSc, Cert Acupuncture (PANZ)

Clinical Section - Review A Review of the Ottawa Rules for Ankle, Foot and Knee The Ottawa ankle, foot and knee rules were developed by Stiell and colleagues to determine the indications for radiology of these areas. This was to try and rule out unnecessary radiology in patients presenting with acute ankle and knee injuries. The ankle rules appear to have been more widely adopted especially in countries with lower rates of litigation such as the United Kingdom. The knee rule appears to be less widely used and this is in part due to the complexities of presenting knee injuries. Both the knee and ankle rules have been shown to be extremely sensitive in all studies, but specificity is mixed. However using the rules has shown to be effective in reducing unnecessary radiology where it has been implemented as protocol. The ankle rule has been shown to be effective in children down to the age of 2 years and the knee rule to children as young as 5 years.

The Ottawa Ankle Rules for Ankle Injury Radiology (Stiell et al, 1993)

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Clinical Section - Review A Review of the Ottawa Rules for Ankle, Foot and Knee continued...

An ankle x-ray series is only required if there is any pain in the malleolar zone and any of these findings: 1) Bone tenderness at A OR 2) Inability to bear weight both immediately and in the ED A foot x-ray series is only required if there is any pain in the mid-foot zone and any of these findings: 1) Bone tenderness at C OR 2) Bone tenderness at D OR 3) Inability to bear weight both immediately and in the ED Wynn-Thomas et al, 2002, did a survey of New Zealand GP’s to find their awareness of the Ottawa ankle rules.

Ankle injury guidelines data was collected from 2 after hours medical centres.

Results: Awareness of the Ottawa Ankle Rules was low. The sensitivity of the Ottawa Ankle Rules for diagnosis of fractures was 100% (Sensitivity refers to the ability of the test to correctly identify those patients with fracture), and the specificity was 47%. (Specificity refers to the ability of the test to correctly identify those without fractures. So a test with high sensitivity but low specificity results in many patients who have no fracture being told of the possibility that they have a fracture and subject to unnecessary radiology) The sensitivity of GP’s clinical judgement was 100% and the specificity was 37%, so implementing the OAR would reduce X-ray utilisation by 16%, this would be a significant saving in both monetary cost and also in reduction of radiation to the patient along with time savings, as often ED waits for radiology can be significant.

Bachmann et al, 2003 did a systematic review and found that less than 2% of patients in most subgroups (including children) presenting to emergency departments with an acute ankle sprain, who were negative for fracture according to the Ottawa ankle rules actually had a fracture. Sensitivity ranged in the studies reviewed from 99.6% to 96.4% However they found that the specificity across studies varied from 10% to 79%, (that is the number of unnecessary radiographs that may be avoided with this decision rule). It would therefore be difficult to quantify how much unnecessary radiography is actually being reduced when the rule is applied, although it would be fair to say that in most of the studies there was a reduction in unnecessary radiography.

Cameron and Naylor, 1999, found that even after education sessions that were positively received about the Ottawa ankle rules, there was no reduction in the use of radiology. Their interpretation of this was that “Even when a dissemination strategy is well received and involves a widely accepted clinical guideline, the impact on behaviour in clinical practice may be small”.

The Ottawa clinical prediction rules for knee fractures. (Stiell et al, 1995) The Ottawa rules recommend plain radiography if any of the following features are present in a patient:     

Age over 55 years (because of the risk of osteoporosis) Tenderness over the fibular head Discomfort confined to the patellar upon palpation Inability to flex the knee to 90 degrees Inability to bear weight, immediately and in the emergency department, for at least four steps.

Meta-analysis has shown that the Ottawa knee rule accurately excludes fractures in adult patients presenting with an acute knee injury. A negative result on the Ottawa knee rule test is associated with a fracture probability of <1.5%.

Bachmann et al, 2004 showed the Ottawa knee rule was 99% sensitive and 49% specific for knee fracture. It has also been shown that the rules are 99-100% sensitive and 43-46% specific in children over 5 years old.

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Clinical Section - Article Review A Review of the Ottawa Rules for Ankle, Foot and Knee continued...

Beutel et al, 2012 found that although sensitivity was good and knowledge of the rule was fairly high, again as with the ankle rules adherence amongst clinicians was poor, reasons for poor use was varied, but cited were “patient expectations” and system issues such as “orthopaedics referral requirement”.

In another article it was stated that:  Plain radiographs often show no fractures after acute knee injuries; even serious internal derangements of the knee may be occult on radiographs.  The Ottawa rule is recommended for deciding whether to do radiography after knee injuries  MRI is the technique of choice for evaluating internal derangement of the knee.  CT has an important role in evaluating fractures shown on radiographs, and for delineating fractures before surgery.

(Teh et al, 2012) Therefore the use of plain radiographs in knees is a more complicated diagnostic challenge than that of ankles, with plain radiographs often not picking up many of the internal derangements that may be presenting in the knee. Use of the rule however will help to rationalise what imaging tests should be ordered.

In conclusion, although the Ottawa rules for Ankle, foot and knee have been shown in many studies and reviews to be very effective at reducing unnecessary radiology, especially in the ankle and foot, its use is not as widespread as it could be. In NZ where we are not faced with the same litigation problems as in other countries such as the United States it would be prudent to use these rules to avoid unnecessary radiation and cost to our clients. They are simple to implement and their high sensitivity means that we as clinicians should be using them on a regular basis as best evidence based practice. Particularly in regards to the ankle it is also a relatively straight forward assessment that can be done on a sports field side line in making a decision as to whether that player requires x-ray or not. Maybe it would be an interesting survey to see how many physiotherapists in New Zealand use these clinical prediction rules and how easy and effective they are found to be.

References Bachmann LM et al, Accuracy or Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003; 326:417 Bachmann L et al. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004:121-7.

Beutel BG et al. The Ottawa knee rule: Examining the use in an academic emergency department. West J Emerg Med. 2012 13 (4): 366-372.

Cameron C and Naylor C: No impact from active dissemination of the Ottawa Ankle Rules: further evidence of the need for local implementation of practice guidelines. CMAJ: 1999, Vol 160 (8) 1165-1186.

Stiell IG et al. Decision Rules for the use of radiography in acute ankle injuries: refinement and prospective validation.

JAMA 1993:269: 1127-1133.

Stiell IG et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995.

26(4): 405-13.

Teh J et.al. Investigation of acute knee injury. BMJ 2012; 344:e3167 Wynn-Thomas S et.al. The Ottawa ankle rules for the use of diagnostic X-ray in after hours medical centres in New Zealand. N Z Med J, 2002 Sep 27:115(1162):U184.

By Karen Carmichael BSc, BPhty, M(SportsPhysio)

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Research Publications JOSPT www.jospt.org JOSPT ACCESS 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 “Forgotten your password” 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 45, Number 4, April 2015 EDITORIAL Improving Long-Term Outcomes for Chronic Low Back Pain: Time for a New Paradigm?

MUSCULOSKELETAL IMAGING Osseous Fragment in a Patient With Knee Pain PERSPECTIVES FOR PATIENTS Whiplash: Are You at Risk for Ongoing Pain or Disability?

RESEARCH REPORT External Validation of a Clinical Prediction Rule to Predict Full Recovery and Ongoing Moderate/Severe Disability Following Acute Whiplash Injury The Comparative Effects of Spinal and Peripheral Thrust Manipulation and Exercise on Pain Sensitivity and the Relation to Clinical Outcome: A Mechanistic Trial Using a Shoulder Pain Model The Effect of Additional Ankle and Midfoot Mobilizations on Plantar Fasciitis: A Randomized Controlled Trial Changes in Quadriceps and Hamstring Cocontraction Following Landing Instruction in Patients With Anterior Cruciate Ligament Reconstruction The Geography of Fatty Infiltrates Within the Cervical Multifidus and Semispinalis Cervicis in Individuals With Chronic Whiplash-Associated Disorders A Systematic Review of the Measurement Properties of the Patient-Rated Wrist Evaluation Cumulative Loads Increase at the Knee Joint With Slow-Speed Running Compared to Faster Running: A Biomechanical Study RESIDENT’S CASE PROBLEM Suprascapular Neuropathy After Distal Clavicle Resection and Coracoclavicular Ligament Reconstruction: A Resident's Case Problem Pelvic Osteomyelitis Presenting as Groin and Medial Thigh Pain: A Resident's Case Problem

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Research Publications British Journal of Sports Medicine www.bjsm.bjm.com Volume 49, Number 48, April 2015 EDITORIALS Dizziness after sports-related concussion: Can physiotherapists offer better treatment than just â&#x20AC;&#x2DC;physical and cognitive restâ&#x20AC;&#x2122;?

Jennifer C Reneker, Chad E Cook http://bjsm.bmj.com/content/ REVIEWS A systematic review of concussion in rugby league Andrew Gardner, Grant L Iverson, Christopher R Levi, Peter W Schofield, Frances Kay-Lambkin, Ryan M N Kohler, Peter Stanwell http://bjsm.bmj.com/content/ Smartphone and tablet apps for concussion road warriors (team clinicians): a systematic review for practical users Hopin Lee, S John Sullivan, Anthony G Schneiders, Osman Hassan Ahmed, Arun Prasad Balasundaram, David Williams, Willem H Meeuwisse, Paul McCrory http://bjsm.bmj.com/content/ Concussion in youth rugby union and rugby league: a systematic review Graham Kirkwood, Nikesh Parekh, Richard Ofori-Asenso, Allyson M Pollock http://bjsm.bmj.com/content/ Systematic review of rugby injuries in children and adolescents under 21 years Andreas Freitag, Graham Kirkwood, Sebastian Scharer, Richard Ofori-Asenso, Allyson M Pollock http://bjsm.bmj.com/content/ ORIGINAL ARTICLES The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study Gordon Ward Fuller, Simon P T Kemp, Philippe Decq http://bjsm.bmj.com/content/ Collapsed scrums and collision tackles: what is the injury risk?

Simon P Roberts, Grant Trewartha, Mike England, Keith A Stokes http://bjsm.bmj.com/content/ A systematic video analysis of National Hockey League (NHL) concussions, part I: who, when, where and what?

Michael G Hutchison, Paul Comper, Willem H Meeuwisse, Ruben J Echemendia http://bjsm.bmj.com/content/ A systematic video analysis of National Hockey League (NHL) concussions, part II: how concussions occur in the NHL Michael G Hutchison, Paul Comper, Willem H Meeuwisse, Ruben J Echemendia http://bjsm.bmj.com/content/

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Continuing Education Upcoming courses and conferences in New Zealand and overseas in 2015.

For a full list of local courses visit the PNZ Events Calendar For a list of international courses visit http://ifspt.org/education/conferences/ LOCAL COURSES & CONFERENCES When?

What?

Where?

9-10 May 2015

Assessment & Rehabilitation of Chronic Shoulder Conditions

Christchurch

9 May 2015

RockTape (Kinesiology) Taping 1 day Seminar

Mt Maunganui

9 May 2015

RockTape (Kinesiology) Taping 1 day Seminar

Wellington

15 May 2015

PhysioScholar - Dr Annelise Pool - Specialist Manipulative Therapist

Nationwide

15-16 May 2015

Myofascial Release Therapy Training Courses - The Fundamentals

Auckland

16 May 2015

RockTape (Kinesiology) Taping 1 day Seminar

Dunedin

17-18 May 2015

Myofascial Release Therapy Training Courses - The Fundamentals

Auckland

23 May 2015

RockTape (Kinesiology) Taping 1 day Seminar

Christchurch

23-24 May 2015

Kinesio Taping Course - KT 1 & 2

Hamilton

23-24 May 2015

Motor Control and Sensorimotor Training for Pain and Injury in the Sacroiliac Joint and Pelvis

Wellington

24 May 2015

SPNZ Level 1 Immediate Care and Sports Trauma Management Course

Auckland

29-30 May 2015

Myofascial Release Therapy Training Courses - The Fundamentals

Tauranga

4-5 July 2015

SPNZ Level 1 Promotion and Prescription of Physical Activity and Exercise

Hamilton

APA CPD EVENT FINDER SPNZ members can now attend APA SPA (Sports Physiotherapy Australia) courses and conferences at APA member rates. This includes all webinars and podcasts (no travel required!).

To see a full list visit the APA and SPA Events Calendar

APA SPA COURSES & CONFERENCES When?

What?

Where?

9-10 May 2015

Advanced Knee Course - Diagnoses and Rehabilitation

Deakin, ACT

23-24 May 2015

The Sporting Spine

Silverwater, NSW

30-31 May 2015

The Sporting Hip

QLD

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Continuing Education Formthotics Medical New Zealand Roadshow ENTERING THE FOOTZONE: A one-day hands-on training course Confidently assess your patient’s foot and lower limb function and pathology. Rationalise and justify patient treatment including the appropriate prescription of Formthotics.

Learn new clinical methods with the revised 6 Tests, 6 Steps™ a patient centric process of assessment, selection and fitting of Formthotics.

Entering the FootZone is a multidisciplinary, intensive one-day course for medical professionals who want to increase their knowledge of the foot and lower limb, and treatment options. This course will combine theory and a practical, hands-on workshop to maximise your learning experience.

2015 COURSE DATES:     

Queenstown: Christchurch: Rotorua: Palmerston North: Auckland:

Wednesday 13 May Thursday 14 May Friday 15 May Saturday 16 May Sunday 17 May

For booking and more information go to: www.formthotics.com/medical-roadshow-nz or down load the brochure here

Classifieds

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Classifieds HAMILTON Active Plus Physio Clinic Lead physiotherapistâ&#x20AC;&#x201D;full time position 40 hrs per week An exciting new lead physio role is available in the new Active Plus Physio Clinic in Hamilton. We are looking for a dynamic, motivated and experienced physiotherapist who is keen to make an exciting career progression into a leadership position within a large and dynamic multidisciplinary team.

If you are a hard-working team player with a sense of fun and are looking to work for a premier NZ physiotherapy group, then this is the role for you.

Active Plus provides a supportive and widely varied environment to grow and use your skills. You will be working within a large team of highly experienced, post graduate qualified physiotherapists, occupational therapists and psychologists providing musculoskeletal, vocational and pain management services to a wide ranging caseload.

You will hold a lead clinician position with the physiotherapy musculo-skeletal services at our Hamilton based clinic.

An excellent remuneration package including salary, phone and laptop, use of vehicle, continuing education programme PLUS performance bonuses for clinic growth; make this a highly desirable position for any physiotherapist looking to further their career yet maintain a work/life balance on salaried hours.

Applicants for this position should have NZ residency or a valid NZ work permit, a current New Zealand Annual Practicing Certificate and a current NZ driverâ&#x20AC;&#x2122;s licence. Preference given for Post-graduate qualification in Manual therapy, and/or a proven record of relevant professional development in this scope of work.

Please send your CV and cover letter to martyn.parkes@enrichplus.org.nz

TAURANGA AND MOUNT MAUNGANUI Back In Action Physio Part time physiotherapist EXCITING OPPORTUNITY Are you passionate about physiotherapy and helping people? Do you need hours that fit in with your lifestyle?

Email us NOW at Back In Action Physio.

Come to sunny Tauranga and work in practices where we have longer treatment sessions, associations with gym and doctors, regular in-services and a manageable patient load. We are looking for a part time physio to work with our fun team from mid-May with potential for full time work or to remain part time.

Start Date: Mid-May

Deadline: none

Hours of employment are negotiable. We have an extensive mentoring programme and are continually sharing our knowledge and tips and tricks.

Check out our website www.biaphysio.com for more information on our clinic and email Leanna at leanna@biaphysio.com .

Come and join us for some fun and adventures in the Bay of Plenty.

Contact Details: leanna@biaphysio.com

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Classifieds AUCKLAND - NORTH SHORE Forrest Hill Physiotherapy Ltd Physiotherapist—part time position A part time role with immediate start is available with Forrest Hill Physiotherapy. This position might ideally suit an experienced physiotherapist undergoing post-graduate studies.

Our musculoskeletal practice is a certified community based clinic, with NZ representative team providers amongst the six post-graduate and Masters qualified physiotherapists. Established over 25 years ago, the clinic has a loyal patient and GP referral base and an excellent reputation within the community.

Our clinic has a strong manual therapy and exercise rehabilitation focus, facilitated by a fully equipped Clinical Pilates studio, rehab gym and real time ultrasound Imaging service. In addition to fortnightly in-service education, the successful applicant will work alongside Clinical Pilates instructors, a continence physiotherapist and massage therapists. All staff are supported by a skilled and experienced administration team and practice manager. A competitive financial package is offered including support of on-going education, conferences, courses and work in special interest areas, e.g. sports teams.

Post-graduate qualifications are desirable but PGD students with private practice experience will be considered.

If you fit these criteria and are motivated to work in a dynamic post-graduate environment, then please e-mail CV to Chris McCullough at info@forresthillphysio.co.nz.

All replies received in the strictest confidence.

MOUNT MAUNGANUI – NZ’S SLICE OF PARADISE! Body in Motion Physio & Rehab Surf, sand, sun and a great physio job too? Why wouldn’t you?

The Life: Watch the sunrise over the ocean before work; watch it set over the harbour afterwards. Walk through shops; enjoy the café lifestyle over lunch or dinner. Lounge at the beach at the weekend…

The Person: Are you a solutions focused physiotherapist keen on continuous improvement? Do you enjoy working in a team where people really matter? Yes? Body in Motion Physio & Rehab has “The Job” for you!

The Job: You will enjoy a fulltime varied caseload including acute musculoskeletal clients, pain management services, and physical / vocational rehabilitation programming. Opportunities also exist to work alongside HPSNZ accredited physios with the region’s elite sportspeople.

The Skills: You will have 4 years clinical experience and a NZ Physiotherapy Practicing Certificate. You will use excellent communication and organizational skills to deliver exceptional service. Your attention to detail and ability to manage time and tasks effectively will also be of value. You will also have both the desire and the ability to have fun, and to enjoy your work.

The Company: Body In Motion Physio & Rehab is a reputable company with 6 locations Tauranga wide. Our greatest strength is the quality of our people. Our expertise and dedication are the foundations of our success.

Get in touch with us now by sending your CV and cover letter to mal.shivnan@bodyinmotionphysio.co.nz , and find out more about your dream work / life balance in the sunny Bay of Plenty!