SPNZ BULLETIN PAGE
Issue 2 April 2017
Feature Masters Sport, the Next Generation of Athletes SPNZ Course The Lower Limb in Sport Members’ Benefits Find a physiotherapist
FEATURE TOPIC: Masters Games
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SPNZ Members’ Page Welcome to Sports Physiotherapy New Zealand SPNZ EXECUTIVE COMMITTEE President
Hamish Ashton
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Contents FEATURE TOPIC: Education
SPNZ MEMBERS PAGE See our page for committee members, links & member information
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EDITORIAL By SPNZ President Hamish Ashton
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MEMBERS’ BENEFITS Find a Physiotherapist
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FEATURE Masters Sport, the Next Generation of Athletes - a New Challenge for Sports Physiotherapists
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In this issue:
POST-GRAD STUDENT CONTRIBUTION What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a Running Population? PHTY542 Sports Physiotherapy written assignment
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ASICS REPORT Footwear for the Ageing Athlete: Keeping the Masters Bodies Active with the Right Footwear
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HPSNZ CORNER HPSNZ FAQs
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CLINICAL SECTION- ARTICLE REVIEW The Training–Injury Prevention Paradox: Should Athletes be Training Smarter and Harder?
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SPNZ CONTINUING EDUCATION SPNZ Level 2 Course: The Lower Limb in Sport
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RESEARCH PUBLICATIONS BJSM Volume 51, Number 8, April 2017
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CLASSIFIEDS Situations Vacant
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Editorial Hamish Ashton, SPNZ President Greetings all I hope you have all managed to survive the recent weather bombs. Our thoughts go out to those from Edgecumbe and other region affected by the rain. Events like this, Kaikoura and Christchurch continue to remind us that we are at the mercy of nature at times. It provides a reminder to reassess our insurance needs as business owners. How would you manage if something happened to your practice and you couldn’t work there for some time? As you are all aware we recently had our AGM in Christchurch. This was my first visit back there in several years and though there are some still sparse regions it is good to see some positive developments in the city. At our AGM, it was my great pleasure to acknowledge two long standing members with Life Membership awards. Unfortunately, neither could be there on the day, but I hope to be able to catch up with them personally in the near future to thank them for their efforts. The first one was to Graeme Nuttridge. Graeme was the first president of what is now Sports Physiotherapy New Zealand. Back in the mid 90’s when several us were getting together to discuss sports medicine and the physiotherapists role in what was a growing special interest area, Graeme pulled us all together into a national group - the New Zealand Sports and Orthopaedic Physiotherapy Association (NZSOPA). Newsletters went out and courses were held, and it was the start of much more to come. Some years later Tony Schneiders took over the reins. Tony was president for 12 years and really grew the SIG into what we have today. Although he now lives and works in Australia he has been a strong supporter of what is now SPNZ, both locally in New Zealand and around the world. Tony is Vice President of IFSPT, our world sports physiotherapy body, where he continues to promote sports physiotherapy worldwide. While in Christchurch we had the first of a new initiative, the SPNZ concussion workshop. This was run by Dr Deb Robinson (ex All Blacks doctor) and was received enthusiastically by those that were there. Physiotherapists on the side line are often the first on the scene of a concussion. The half day programme covered immediate care and triage of a suspected injury through to the guidelines involved with return to play. Though concussion is seen by many as a medically managed issue there is no doubt that we are often the first contact on the field of play, as well as being heavily involved with
supervising their return to play. The concussion workshop is something we wish to bring to the centres to provide as many physiotherapists as possible with these skills. We are currently sorting out dates for a workshop in Wellington and Auckland. We are also looking for dates in Tauranga and hope to have one in Northland sometime. Due to the practical nature of the course we are restricted to 30 per workshop. If there are any regions who have a group interested, get hold of me at help@spnz.org.nz and we will try to arrange something for you depending on tutor availability. Christchurch sold out in 48 hours, so get in quick when you see the registrations open. As with all courses members will be notified first. Shortly, we will be seeking your opinion on a number of issues as we move forward and further look to develop our SIG. Your opinions are always important to us and though it is not always possible to do everything for everybody straight away, we will do our best to create opportunities for all our members, no matter where they live or play. Look out for these surveys as we have a very exciting prize which will be announced shortly. Finally, from me for this issue is a quick note on our upcoming Sports Physiotherapy Symposium. This year it will be held in Auckland over the weekend of October 14 -15. Like previous symposiums all speakers will provide practical knowledge that you can use in your practice. Two of the exciting speakers already confirmed – Phil Glasgow (Phil was Team GB’s Chief Physiotherapy Officer at the Rio 2016 Olympics. He is also a visiting professor of the Ulster Sports Academy at the University of Ulster and teaches on a number of postgraduate sports medicine programmes at various UK and European universities), and Chris Bishop (Chris is a Podiatrist and Biomechanist based in Adelaide, and a consultant to ASICS Oceania). Following on from the excellent feedback from our recent Roadshow event we will again be showcasing clinical excellence and expertise from our leading local physiotherapists and sports medicine professionals. Put these dates in your diary now as it will be a great weekend of knowledge, comradery, and professional networking. Stay safe over the autumn changes Hamish
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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.
Find a Sports Physiotherapist Are you aware the SPNZ website has a “Find a Sports Physiotherapist” section? This is an opportunity to list and promote yourself as a sports physiotherapist. This site is for athletes and the general population to find a physiotherapist with knowledge or interest in a particular sport. It will be accessed by groups, such as the upcoming Masters Games in Auckland.
Get your name listed now!!! To be listed fill out the link https://goo.gl/forms/0a0MOlHCHDYyZcAg2 All listings are in a similar format so look at some examples to know what information is appropriate. If you already have a listing, please check it – any changes email help@spnz.org.nz
Massey University Research Enquiry My name is Lawrence Chu and I am currently a fourth year industrial design student at Massey University Wellington researching post-exercise muscle recovery. As part of my primary research I am looking to meet with some physiotherapists or other experts to have discussions on their experiences and what they know in their respective fields. This is to increase my insight on the topic further than what are already published in books and academic sources. If you are interested in talking about yourself and if you are based in the Wellington region, I would love to meet you face to face and have a chat. Lawrence oahgniyux@gmail.com
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Feature Masters Sport, the Next Generation of Athletes - A New Challenge for Sports Physiotherapists Participation in masters sports has steadily been increasing globally over the past 30 years to the point where, in latter years, it has commonly been described as a “recent boom”. Contributing largely to an exponential rise in participants is a generational aspect – baby boomers are staying active longer and are therefore participating and competing in sport as older adults. An 80-year-old Japanese national successfully climbs Mt Everest at the age of 80 for the third time. Roger Robinson, running for NZ, sets a masters marathon record of 2:18:44 at the age of 41. He continues to run in the over-70’s even following a recent uni-compartmental knee replacement. Maybe this subculture is indeed rewriting the rules of ageing! The sheer numbers of masters athletes may surprise a few of us – the World Masters Games, held every 4 years, and to be held in Auckland this month (April 21-
30) has attracted more than 25,000 registered competitors from 100 countries participating in 28 sports, all of which speaks volumes in terms of continued physical activity for the ageing sector. The goal of these games is encouraging participation in sport throughout life. Locally, the NZ National Masters Hockey tournament regularly attracts 60-70 age-graded provincial teams, a total of more than 1000 competitors. Other sporting codes such as touch, tag, athletics, waka ama and tennis also encompass masters grades for national tournaments, rugby and rugby league have “president’s” grades with altered rule changes for safety, while a number of other sports such as bowls and golf have historically had regular participants in the older age group bracket. The NZ Masters Games also attracts many sports (e.g. swimming, netball, squash) and a high number of participants and its popularity is reflected in this being an annual event. One perceived advantage for
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Feature Masters Sport, the Next Generation of Athletes - A New Challenge for Sports Physiotherapists continued... the older athlete is the availability of time and financial security which act as catalysts for participation. “Second Wind: The Rise of the Ageless Athlete” (by Lee Bergquist, an American masters sports athlete) and “The Masters Athlete” (by Dr Peter Reaburn, sports scientist and masters competitor) are two of a rising number of publications that are indeed a further testament to the boom of interest. However, the infancy of masters sports in comparison to the general sporting population also means that the pace of research has just begun to take hold over recent years. So, masters athletes remain a challenge to researchers world-wide with an open field of investigative topics – injury rates and prevention, hormonal changes, performance limitations, motivational drive and lifestyle benefits to mention a few. Anecdotally, one can assume that as future research provides increased knowledge, the masters athlete will reach as yet an unknown and untapped performance potential. So, what drives the masters athlete? Subjective analysis at various tournaments/events show that motivation is largely driven by personal challenge, passion and achievement, and this can be anything from setting records to experiencing health benefits. Also, a number of athletes have recognised a sporting ability later in life, others have not achieved their goals when young, particularly at provincial and international level, while some seek the challenge of simply keeping fit and healthy. There are also people like Peter Snell, New Zealand’s “Sports Champion of the 20th Century” and who is famous for his 800m and 1500m heroics at the Rome and Tokyo Olympics in the 1960’s where he won three gold medals. He will be competing in the World Masters table tennis event at the age of 78. Deb Reardon, a NZ surf life saver started her sport at the age of 50 and is motivated to keep training and remain fit to help others by patrolling every summer. Seeking opportunities to socialise appeared to be a less important motivator. At the other end of the spectrum from social masters (often called “Golden Oldies”), the older competitive participants represent models of high functional capabilities and they have been shown to have fewer chronic diseases such as diabetes and cardiovascular issues when compared to their nonathletic peers whilst also enjoying higher levels of physical and mental health (1). Further to this, and in my experience, many competitive athletes let ability define their age and not vice-versa. So, what are some of the issues distinct to the masters
athlete? Competitive masters athletes, like the younger sporting population, have high expectations of care including rehabilitation and return to sport. However, as we know, the ageing body predisposes itself to natural changes in physiology, structure and function lending itself to more illness and injury. So, specific considerations are required for the masters athlete predominately due to a reduction in bone density and muscle mass; reduced elasticity of soft tissue; an increase in body fat; reduction in strength, flexibility and coordination; reduced maximal aerobic and anaerobic power; reduced heat and cold tolerance; and degenerative changes. BL Marks (2) showed health benefits in veteran(senior) tennis players – enhanced aerobic capacity (VO2 max), greater bone densities, lower body fat, greater strength and maintenance of reaction time performance in comparison with age matched less active controls. However, Lindsay and Dunn (3) concluded that training induced cardiac hypertrophy of the left ventricle may have associated fibrosis, and Pigozzi et al (4) concluded that the findings of a false ST segment depression, although still not fully understood, may be related to physiological cardiac remodelling induced by regular training. So, these two latter examples of research also illustrate that topics are still very open for investigation, debate and discussion. So, what is the role of the sports physiotherapist? The significant changes with ageing signals that a distinctly more vigilant approach is required by the sports physiotherapist from preparation to sideline and clinical management to rehabilitation. Injuries range from strains and sprains (e.g. calf/TA, groin, hamstring, Lx, patella tendon, rotator cuff) to contusions (e.g. fractures – clavicle, A/C joint, tibial) to medical emergencies. Preparation
• Pre-participation screening/evaluation – be more closely allied to the sports physician to gain more familiarity with medical issues and associated risk factors, e.g. medication (eg. beta blockers, insulin, diuretics, NSAIDs, blood thinners), sudden collapse, exercise induced asthma, head injury, female athlete issues
• Understand pre-existing conditions and take into account that asymptomatic individuals still have natural ageing processes occurring such as degenerative changes to bone and soft tissue e.g. rotator cuff tendons, TA, knee, hip and lumbar OA,
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Feature Masters Sport, the Next Generation of Athletes - A New Challenge for Sports Physiotherapists continued... lumbar stenosis
• Reduced balance and coordination
• A more acute awareness of the types of injuries in a sport
• An awareness of those returning to sport after years of inactivity
• An awareness of performance abilities in climatic extremes of heat and cold: hyper- and hypothermia
• A possible need for more protective equipment • Care with warm up – an extended slow warm up and not introducing any new activity e.g. high leg lifts that, if, foreign to an individual, may cause injury.
• An extended recovery period – training and warm downs
• Care with stretches – number, speed and holding times Sideline
• Take an overall more vigilant approach to action especially for warning signs and symptoms
• Station yourself as close as possible to the field/ event
• Note closest defibrillator( AED) location • Note
any individuals that may predispose themselves to injury due to, for example, poor balance or coordination, lack of skill/technique
Treatment/Rehabilitation Be aware of: • Contraindications e.g. pacemakers, metal implants, medications like blood thinners • Fragility of skin e.g. deep tissue myofascial release, strapping/taping
massage,
• Depth of trigger point release • Slower healing rates • Exercise – appropriate exercise, speed and numbers of repetitions, slower progressions, longer intervals and recovery • Stretching -as mentioned • Mobilisations/manipulations with respect to bone mass/density especially in the female athlete
• Lifestyle needs A recommended reading is “Selected Issues for the Master Athlete and the Team Physician: A Consensus Statement” (5) Finally, to illustrate a couple of experiences on the hockey field:
• A 56-year-old playing for the NZ Men’s Masters 55 age group versus Australia in Hobart in extremely cold conditions who had a complete avulsion of his biceps femoris tendon origin from the ischial tuberosity whilst pivoting and changing direction off that leg. Managed conservatively after considerations of: surgical vs conservative recovery time (approx. equal), work, financial and social factors. Returned to jogging with a shuffle at 9 months. Retired from the sport having played for 48 years. Retired having played for 48 years but continues to be active at the gym and remains heavily involved with the sport. • A 55-year-old playing for North Harbour Men’s Masters endured a collapse via a cardiac event in the second half of the game. CPR administered immediately by an opposition player (a doctor), and one of the referees (a fireman). The player was revived with a defibrillator care of the ambulance staff. Nil past history. Returned to play. An AED is now located at this hockey ground. These examples alert the sports physiotherapist to be prepared for a severe injury that may be more common with the masters athlete. Having said that, my experience in masters hockey over the past 20 years tells me that many participants are now well prepared and an awareness of injury prevention combined with management involving the physiotherapist and allied health professionals has resulted in fewer, overall musculoskeletal injuries. So, there is no question that the older athlete is more prone to injury. The sports physiotherapist, with a sound, meticulous and professional approach, along with future research findings will continue to play a major and defining role in this field. This will assist masters athletes to continue to push the boundaries of their endeavours. Just ask Roger Robinson.
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Feature Masters Sport, the Next Generation of Athletes - New Challenge for Sports Physiotherapists continued... Bharat Sukha A physiotherapist of 26 years, predominantly in private practice (owner, Physiosport) . I started my academic life with a BSc in Biosciences at Auckland University, worked in agriculture for 5 years, had a 4-year OE (backpacking Americas, UK, Europe, Africa and Asia) and then returned to study physio in Auckland with a PGD in Sports Medicine some years later. An SPNZ executive committee member for several years. A tennis player in younger days who then became a hockey player and coach for 34 years (and still going!!) at the Roskill Eden Hockey club; Auckland and NZ Masters hockey rep. Experiences include: Lecturer: Human physiology and anatomy, Dept of Sport and Recreation, AUT; “Cultural Awareness for Physiotherapists”, AUT Physio: International experience includes: Canadian Cycling team, Commonwealth Games; NZ Hockey, 7 years (NZ Juniors, Junior and Senior Academies, NZ Men); Other – Ironman, Oceania Veteran Games. Eden Park Stomp, Feb 2017
REFERENCES 1. Wright V J and Perricelli BC 2008 “Age related rates of decline in performance among elite senior athletes” AJSM 36(3) 443-50 2. Marks BL “Health benefits for veteran tennis players)” BJSM 40 (5) http://dx.doi.org/10.1136/ bjsm.2005.024877 3. Lindsay M and Dunn F “Biochemical evidence of myocardial fibrosis in veteran endurance athletes” BJSM 41(7) http://dx.doi.org/10.1136/ bjsm.2006.031534 4. Pigozzi et al “Role of exercise stress test in master athletes” BJSM 39(8) http://dx.doi.org/10.1136/ bjsm.2004.014340
5. “Selected Issues for the Master Athlete and the Team Physician: A Consensus Statement”. Medicine and Science in Sports and Exercise: April 2010 42 (4) pp820-833. (/acsm-msse/ toc/2010/04000) 6. “Coaching Masters Association of Canada
Athletes”,
Coaching
ACKNOWLEDGEMENT Coaching Association of Canada (and Kona Hawaii 2011 Ironman) for their kind permission to reproduce the front cover.
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Post-Grad Student Contribution What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a Running Population? PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT
INTRODUCTION Gluteal tendinopathy (GT) is described as one of the most prevalent lower limb tendinopathies, and refers to debilitating pain or symptoms over the greater trochanter of the hip. It presents commonly in sedentary populations and is most prevalent in females over the age of 40 (Grimaldi et al., 2015; Mellor et al., 2016). The syndrome is also abundant in runners with numbers proposed to further increase, particularly with expanding running and fitness communities (Grimaldi et al., 2015; Mellor et al., 2016). Unfavourable effects on well-being, quality of life and degrading general health are characteristic to this condition, thus the desire for timely identification and return to physical activity is strong (Mellor et al., 2016). The literature around the management of GT is broad and encompasses a range of moderately supported treatment strategies, with gold standard management for the active population remaining unclear (Grimaldi et al., 2015; Mellor et al., 2016). Although gluteus medius/minimus tendinopathy are frequently to blame, the complexity of the multifactorial pathology that may be associated with GT is often overlooked, resulting in poor management alongside premature return to sport and further risk of injury. This report will briefly explore the appropriate assessment of GT, followed by a focus on the multivariate supply of risk factors and the selection of management options reported in the literature, with the aim of highlighting favourable sports specific treatment strategies and their role in successfully allowing return to pain free running. Assessment Dysfunction of the gluteal tendons is a result of catabolic degenerative and interstitial cell response to load. This is combined with accumulative lateral compression and high tensile stress during eccentric contractions (Mulligan et al., 2015), with excessive hip adduction and internal rotation during static and dynamic postures mostly to blame (Grimaldi et al., 2015). Video analysis during assessment of sports specific tasks or the use of a single leg squat proves to be beneficial in identification of these faulty movement patterns (Brukner and Kahn, 2012). A consistent diagnostic hallmark of GT is tenderness on palpation over the lateral greater trochanter (Woodley et al., 2008; Brukner and Kahn, 2012). The patient may also report pain at night or when lying on the affected side, sitting with their legs crossed, prolonged weight bearing on the affected limb and a reduced tolerance for physical activity. There may also be lateral thigh or buttock pain referral. (Woodley et al., 2008; Brukner and Kahn, 2012). Special orthopaedic tests of the hip appear to possess weak diagnostic properties for GT, therefore a battery of tests may be used to strengthen examination findings (Grimaldi et al., 2015). Superior tests in the literature include pain with resisted hip abduction, resisted de-rotation from external rotation in
90 degrees of flexion and single leg stance for 30 seconds (Lequesne et al., 2008; Woodley et al., 2008). The Patrick and Ober tests have conflicting evidence regarding their overall validity in GT (Woodley et al., 2008) and although they are commonly used this should not be in isolation. The Trendelenburg sign has been shown to have relative validity when assessing for gluteal pathology, particularly in runners where the practitioner must distinguish between pain inhibition or true weakness (Brukner and Kahn, 2012; Mulligan et al., 2015). Radiology, preferably radiography, ultrasound of magnetic resonance imaging (MRI), in acute episodes may be necessary to rule out bony or significant soft tissue injury. It is agreed however, that findings on imaging do not always correlate with the clinical picture. (Woodley et al., 2008; Grimaldi et al., 2015). The trochanteric bursa may also be implicated, although radiological and surgical studies have shown it is rarely the culprit of symptom manifestation and is often over diagnosed in lateral hip pain (Mulligan et al., 2015; Mellor et al., 2016). Further differential diagnosis should include intra-articular hip disorders, muscle tears, iliotibial band (ITB) disorders, lumbar or sacroiliac dysfunction, inguinal hernia and snapping hip (Mulligan et al., 2015).
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Post-Grad Student Contribution What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a Running Population? continued... PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT
Risk Factors for GT in runners The workload-injury aetiology model from Windt and Gabbett (2016) summarises the complex interplay of external and internal risk factors that contribute to injury, with those that are modifiable being a focus throughout rehabilitation.
(2012) describing a two-fold increase in lower limb injury risk in a runner who adopts a rear foot strike pattern versus a forefoot pattern. It must be noted that normal levels of hip adduction will result due to gravitational and acceleration loads, along with the ground reaction force falling medial to the hip (Novacheck, 1998; Niemuth et al., 2005).
Intrinsic
Extrinsic
Modifiable intrinsic risk factors associated with the development of GT include previous injury, proximal strength deficits, faulty foot loading patterns and functional leg length discrepancies (Niemuth et al., 2005; Mulligan et al., 2015; Barton et al., 2016; Windt and Gabbett, 2016).
Extrinsic risk factors include training load, level of competition and changes in terrain such as a cambered ground or running in the same direction around a track (Niemuth et al., 2005; Mulligan et al., 2015; Barton et al., 2016). Spikes in workload are strongly associated with injury risk as a result of increased exposure and fatigue, and may serve to alter the effect of modifiable risk factors (Windt and Gabbett, 2016).
Proximal strength is vital when referring to the closed kinetic chain theory, where adequate control of distal segments is necessary to prevent injury. This is particularly important in runners where balanced biomechanical forces at the hip are required in order to reduce detrimental lower limb movement patterns (Niemuth et al., 2005). Niemuth et al. (2005) demonstrate significant strength deficits in the affected hips of injured runners, with the abductors and flexors both proving to be weaker than the hip adductors. This may be associated with the work by Rio et al. (2015a) who recognise the contradicting evidence around the relationship between pain and altered motor control in patellar tendinopathy. They suggest that altered corticospinal control involving an imbalance of excitability and inhibition, combined with changes in strength and tendon capacity is as a result of a protective adaptation to pain. Previous injury along with non-resolution of the above factors may therefore increase the likelihood of symptom reoccurrence. Running technique is also recognised in the literature as a contributor in the development of GT, although research quality shows room for improvement. The repetitive nature of running places the lower limb under loads up to eight times body weight (Anderson et al., 2001). Inadequate cadence, stride length and foot strike patterns have been associated as modifiable risk factors contributing to a lack of hip control (Heiderscheit et al., 2011; Chumanov et al., 2012), with Daoud et al.
Although the majority of movement in running is in the sagittal plane, it is reported that 18.9% of total running energy is devoted to control of frontal plane movements (Niemuth et al., 2005). It is thus apparent that protocols focusing on correcting the cause of these reported movement and training faults play an important role in the prevention and management of GT in runners. Management Gait retraining There is substantial evidence to support the immediate biomechanical effects of running technique re-training in uninjured populations. Strong evidence for those that are injured is lacking, although it should be recognised that alterations in a runners’ kinematics can significantly affect how external and internal forces are generated through the pelvis (Daoud et al., 2012). An increase in a runners preferred cadence by 10% has been shown to reduce peak adduction moments, stride length, impact loading and energy absorption of the hip (Heiderscheit et al., 2011; Chumanov et al., 2012). Chumanov et al. (2012) report an increase in gluteus medius and maximus contraction during the late swing phase of the gait cycle with an increased cadence, thus benefiting motor control during the subsequent foot contact. They report no significant increase in contraction during
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Post-Grad Student Contribution What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a Running Population? continued... PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT stance phase, although this may be beneficial as it results in improved lateral pelvic control without increased energy use. Alteration in foot strike patterns and footwear choice have also been associated with injury risk and although the literature is conflicting, results are promising. A runner who develops more of a forefoot rather than rear foot strike pattern, preferably in minimalist shoes, demonstrates reduced ground reaction forces (Daoud et al., 2012; Rice et al., 2016) as well as increased cadence and subsequent reduction in stride length, both of which have been linked with minimising adductor angles (Heiderscheit et al., 2011; Daoud et al., 2012; Altman and Davis, 2016). Real-time feedback is supported, with external cues such as metronomes, music and verbal instructions being the most valued among experts in the field (Heiderscheit et al., 2011; Barton et al., 2016). It is important to note that an individualised adaptation period for these alterations is required, with McCarthy et al. (2015) suggesting 12 weeks as an appropriate timeframe for changes in motor patterns. This should aid in the reduction of injuries such as stress reactions in the metatarsals of which have been associated with prompt transitions to forefoot running (Rice et al., 2016). Pain management and adjunct treatments When comparing the effects of shock wave therapy (SWT), corticosteroid injection (CSI) and a home exercise programme (HEP) for lateral hip pain, Rompe et al. (2009) report that although CSI has very favourable short term results, after one month this was significantly reduced. After four months’ SWT was the superior treatment and after 15 months’ SWT and HEP were equally successful. It must be noted however that the HEP included ITB stretching which may have slowed response due to the known compressive properties of tensor fascia lata (TFL) and gluteus maximus at the greater trochanter (Mulligan et al., 2015; Mellor et al., 2016). Non-steroidal antiinflammatory drugs, ice, heat and ultrasound have also been reported in the literature as early pain management options, although their long term efficacy is questioned (Cook et al., 2016; Mellor et al., 2016). Rio et al. (2015a) also argue that these unimodal treatments do not address local or central deficits in tendon capacity, muscle strength or corticospinal
control across the kinetic chain when compared to exercise. Surgery is reserved for if conservative management fails, although if the athlete is managed appropriately this can be avoided (Mellor et al., 2016). Strength and neuromotor control It is evident that strength imbalances in the hip that exist in the frontal plane may play a significant role in the development of GT in runners. Exercises should therefore focus on targeted strengthening of the hip abductors and dynamic control of adduction and internal rotation during functional tasks. It is vital to initially restore controlled strength in the deep hip stabilisers through various degrees of instability (Brukner and Khan, 2012). Following this, focused gluteal strengthening can commence, ensuring that throughout progressions the athletes pain is monitored and they demonstrate adequate deep hip control as well as lumbo-pelvic stability (Brukner and Khan, 2012). Exercises may include but are not limited to hip rotation, bridging, squats, side stepping, balance training and resistance work. Sports specific training including gait retraining for runners should be incorporated. Large hip adduction angles as well as active hip abduction through range should be avoided in the very acute phases if painful (Brukner and Khan, 2012; Mellor et al., 2016). Snyder et al. (2009) have researched the effect of closed chain hip abduction and external rotation exercises on hip motions during running and have demonstrated reduced internal rotation moments following a six-week progressive strength programme. Leung et al. (2015) discuss the benefit of externally paced strength exercises with a metronome and their superior effect on increasing excitability and reducing inhibition when compared to commonly prescribed self-paced exercises. This ability to address altered corticospinal control is important in the adequate correction of faulty movement patterns and although further research is required for its use in GT, it should be considered where possible during strength programmes. It should be noted that there is no strong evidence available for the use of eccentric exercises in GT specifically. Load Management Although complete rest is catabolic for tendons, it is important to initially identify and correct deficits in CONTINUED ON NEXT PAGE
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Post-Grad Student Contribution What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a Running Population? continued... PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT training load (Barton et al., 2016; Cook et al., 2016). Load management may aid in acute tendon regeneration and is fundamental in the prevention and treatment of injury (Grimaldi et al., 2015; Cook et al., 2016; Drew et al., 2016). Initially, reducing activities that involve high eccentric efforts of the gluteals is necessary, including hopping and bounding and may include overall running distance (Grimaldi et al., 2015). Spikes in workload are strongly associated with injury and with reference to the work by Windt and Gabbett (2016), high chronic workloads must not increase by more than 10% week to week and the acute: chronic work load ratio should be kept moderate. Educating the athlete on these risk factors is important during the rehabilitation phase of an injury. Athlete education Further education on reducing compression forces and pain include applying a donut shaped relief pad to the affected side when sleeping and avoiding unilateral stance or sitting with crossed legs. The treating physiotherapist may choose to include lateral distractions and posterior glides of the hip (Mulligan et al., 2015), as well as friction massage of the tendon (Cook and Purdam, 2009).
Conclusion This report has discussed the identification and variable management options of GT in the active running population. Risk factors including altered running technique, poor motor control and training load were explored and serve to appropriately direct the focus of treatment strategies. Although addressing pain is critical in the early stages of tendinopathy management, efforts at rehabilitation are more likely to be successful when the focus is on restoring balanced function of the hip and the kinetic chain. For a runner with GT, running technique interventions, targeted neuromotor control exercise and load management should be included in the treatment process. If work rates exceed an athletes’ limits or compressive and tensile loads at the lateral hip are poorly addressed, treatment outcomes and risk of future injury are compromised. Although further research is required for its role in GT, adopting this active approach may not only aid in the treatment and prevention of injury but also enhance wellbeing and performance of the runner. References
Click here for a full list of references.
Questionnaires Gabbett (2016) also acknowledges the importance of athlete well-being monitoring through the use of questionnaires to allow coaches and physiotherapists to alter an athletes training if need be. The stress response model adapted from (Williams and Scherzer, 2010) supports this and is a useful way to familiarise practitioners on the multiple stresses that athletes may encounter. The VISA-G questionnaire has been shown to have good reliability and validity as a way of measuring the severity of disability associated with GT. It is also useful in determining the effectiveness of treatment, although it must be acknowledged that the questions are not aimed at athletes and are only mildly sports specific as sedentary populations are currently the most prevalent group affected (Fearon et al., 2015).
By Grace Fursdon Bachelor of Physiotherapy (Otago) and Post Grad Diploma on Sports and Exercise Medicine (Otago).
This review was completed as part of the Sports Physiotherapy paper, University of Otago. Grace was undertaking this paper towards a Postgraduate Diploma in Sports Medicine.
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ASICS Report Footwear for the Ageing Athlete: Keeping the Masters Bodies Active with the Right Footwear They say a good red wine gets better with age…BUT ONLY if you look after it and cellar it in the right conditions. It is the extra TLC that makes the difference. This is no different to managing our older patients. Ageing is associated with numerous structural and functional changes to the body. These changes in turn influence the adaptive capacity of our soft tissues, meaning that our body cannot handle the load that it once use to without experiencing pain and symptoms. So, what is different about these statesmen/women of our generation and how they walk:
•
•
•
They walk slower than young adults with a decline of approximately 0.1-1.2% per year from 20 years of age (Arnold 2016). This is likely due to changes in muscle strength, fear of falls and altered sensation/proprioception. This reduction in walking speed directly shortens stride and step length. A less propulsive gait pattern (Boyer at al. 2012). This can be explained by the above variables, as well as the resultant changes in reduced pressure noted under the heels and balls of the foot, as well as reduced ankle power generation and strength. In terms of joint movement, there is less range of motion (Arnold et al. 2015). Mobility of the joints is desirable to allow efficient function of the foot, yet it is likely that older feet are in fact stiffer.
So in those older individuals who want to stay active, what can we do to help them stay fit and injury free? Well finding them the right shoe is a good start. But that matriarch of the family, the active retiree or the masters athlete, how do we help them select their perfect shoe? I think as health professionals we can follow five key criteria to assist in this process 1. Understand any age-related changes that are occurring in their body. This can be a sensitive question, but the information generated in any investigation is pivotal to selecting the right shoe. Therapists need to take the time to conduct a thorough movement analysis profile of their patient. Combined with a detailed subjective history about past injury and any age-related
pathological processes at play, the information about joint structure and function greatly assists in identifying the type of shoe the individual may need. 2. Provide the required information to assist retail to find the right shoe…but DON’T suggest just one shoe! Are you the therapist that does not send in a letter with your patient to the shoe store to assist in the selection of shoes, but then complain they have been provided the wrong shoe when they present back in your clinic? Yes absolutely…too often in clinic I see the wrong shoe prescribed to the wrong individual. But whose fault is that? It’s not always the retail attendant. Shoe prescription is an art, but it is also a treatment. Retail attendants may be experts in footwear, but they are not trained health practitioners, and we cannot simply expect them to understand age-related pathological processes (although some do try…). Perhaps with a bit of effort, we could actually assist them in choosing the right shoe… Ask any retail attendant about what their number one reason for returns is (outside of material failure) and it would certainly relate to their medical team disapproving of the shoe choice made. Let’s remove this possibility and send our patients in-store with information to help the retail attendant do their job, just as if we were referring our patient to another therapist or surgeon. But don’t just suggest one shoe…give the retail attendant the details of what you want from a shoe and allow them to match the best shoe to your patient’s foot type and needs. 3. Educate your patient Never has their been more choice in the market. More choice though generally means more confusion. In my experience, those individuals that know what is wrong with them, what they need and what their practitioners is asking for are those that generally get the best results. Purchasing footwear is no different. Given we often wont be in the shoe shop with them, it is important that we provide our patients with criteria to evaluate whether the shoe is correct for them. Clearly CONTINUED ON NEXT PAGE
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ASICS Report Footwear for the Ageing Athlete: Keeping the Masters Bodies Active with the Right Footwear explaining what makes a shoe comfortable, what type of support they need from a shoe (and where it should be positioned) and why it is important to get properly fitted will all go a long way to your patients choosing the best shoe. 4.
Know your product
As we age gracefully, our body loses some of the natural dampening process that help our body attenuate impact forces. The fat pads underneath the foot thin out, the foot gets stiffer and our joints just don’t seem to be moving as much as they used to… We are talking about fitting footwear to an age demographic that are likely experiencing some form of degenerative arthritis or change in the mechanical/ structural properties of the soft tissues in the body. Their bodies just don’t function he way they used to. So how could this all be assisted with footwear technology? Think cushioning system, trustic designs, last designs, upper materials, toe springs and shoe geometry…shoes are powerful manipulators of human movement, yet there is a wide range of products our there between the big manufacturers. The only way to stay atop of this is to organise visits with each of the major companies you use every six months to spend the time understand their product and what is new/ changed since the last model. Ensure that you then make the effort to understand what products are going to be stocked by your local store so that you can refer appropriately.
You never know, the referrals may in fact even be reciprocated and come back to you!
So in summary…is the ageing foot different to the young foot? Yes it is. Do shoe companies make shoes for the older athlete to account for the changes in foot function? Not really. Should we expect the retail attendant to select the perfect shoe for our patients without any background history? No we shouldn’t. But as health practitioners, if we take on some more responsibility, educate our patients and provide a detailed referral for shoes, I think we will go a long way to improving the prescription of shoes to our matersaged patients.
By Dr Chris Bishop PhD Director of Biomechanics - The Biomechanics Lab Post-doctoral research fellow - UniSA
Chris Bishop content provided through the support from our SPNZ sponsor
5.
Have a great relationship with your local store
Just as we invest time in developing medical relationships with potential referrers, so should we be with our local shoe store. After all, it is in the best interests of your patients. Go in and meet them. Provide your contact detail. Tell them to call you if they have any concerns about the shoes for a particular patient. I for one would much rather get the 5-10 phone calls a day from my local store clarifying a small question to ensure my patient can be provided with the right shoe there and then, rather than having to come back to me for approval or recommendation of another shoe. They are the shoe experts…respect their knowledge…but be n hand when they need yours.
– ASICS
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HPSNZ Corner Welcome to the High Performance Sport New Zealand (HPSNZ) corner. Each bulletin we are looking to supply content from physiotherapists working in high performance sport. This bulletin we posed questions that we are regularly asked by members to Jennifer Sayer, Megan Munro and Fiona Mather from HPSNZ.
1) What qualities and attributes do you think make a good sports physiotherapist? Fiona Mather: Flexibility in approach; the ability to adapt to a variety of coaching styles, training environments and personalities whilst maintaining a high quality and professional manner Jennifer Sayer: Level headed and calm under pressure. Assertive enough to present difficult information to coaches and management in “underpressure” environments, even when it is not what they want to hear. Need to be able to laugh at yourself – take what you do seriously but not yourself. Need to be able to prioritise and manage your time and work effectively and efficiently as part of the team. Understand the boundaries between yourself and the athletes – which sometimes seem to be more “blurred” within the sporting environment but which are equally, if not more important than they are in private practice – to protect both yourself and the athletes. Megan Munro: I think the ability to communicate, work as a team, appreciate and compliment other disciplines within your team and to understand performance and what it takes to make an impact on performance. You need to have the ability to see the bigger picture, and to understand your place in that picture. 2) How do I get into a High Performance Physiotherapy role, or how did you get into your High Performance Physiotherapy role? Fiona Mather: Experience and understanding of the broader aspects of the role, be prepared to demonstrate where you have been effective in the following areas within a performance environment; injury management (understanding the coach and athlete perspective and pressure of competition calendar and the impact upon return to play decisions) Injury prevention (apply a critical approach, injury surveillance/interventions whilst demonstrating efficacy of any intervention programme – a post graduate qualification helps show a critical approach can be applied to the practical situation), experience at national and international competition and understand the vagaries of the role of in the domestic and touring environment. Jennifer Sayer: Pay your due diligence – put in the hours in grassroots sports first, building up your foundation of experience – be this initially unpaid or low paid eg club rugby/ netball/ football. Align yourself with well-respected clinics who have a good development
programmes. Attend regular SMNZ and sports SIG learning opportunities to start networking. Post graduate courses eg Masters in health practice/ SPNZ courses/ sports first aid courses. Remember – that the physio world is small - everybody you meet within the discipline has the potential to “make or break” your career – so treat people with the respect that you want them to extend to you. Work hard – anything worth having requires you to put the effort in. Megan Munro: I volunteered as a physio at the London 2012 Olympics and Paralympics. Best summer of my life! The rest is history, it opened huge doors for me and I've never looked back. 3) What other skills, aside from manual therapy and on-field physio intervention do I need to work as a physiotherapist in a High Performance environment? Fiona Mather: Critical thinking; elite sport often presents quite unique challenges to the sports physiotherapist. A successful outcome demands an enquiring mind and a robust rationale for interventions which must focus on performance without compromising the long term health and wellbeing of the athlete. The practitioner who displays a balance of confidence within his/her scope and an honesty when the picture is less certain will build trust with athlete, coach and wider Multi-disciplinary team. Jennifer Sayer: Sense of humour. Sense of the “bigger picture” rather than the day to day “fixing” of injuries – need to look at preventative strategies and management strategies rather than just standing at the bottom of the cliff when things go wrong. Good communication skills – in person and through other means. Respect – for the athletes, for the coaches and for the processes of HP sport. Megan Munro: I work in Para sport and I think it's important to be able to think outside the box/laterally and have a good imagination. I think working in Para sport really improves your clinical reasoning as very little is 'normal' and you are constantly challenging yourself to come up with unique, unconventional ways of achieving a performance outcome or injury prevention strategy. If you have any questions that you would like answered in the HPSNZ corner, please email them to Rebecca Longhurst: Rebecca.Longhurst@hpsnz.org.nz
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Clinical Section - Article Review The Training–Injury Prevention Paradox: Should Athletes be Training Smarter and Harder? Reference: Gabbett, T.J. (2016). The training – injury paradox: should athletes be training smarter and harder? Br J Sports Med, 50: 273-280
INTRODUCTION The relationship between training load, injury, fitness and performance is critical to practitioners who work with athletes and teams (physiotherapists, sports scientists, strength and conditioning coaches). Dr. John Orchard reported in a British Journal of Sports Medicine blog that both inadequate and excessive loads would result in increased injuries, reduced fitness and poor team performance. Any injuries that are considered “training-load-related” are also considered “preventable”. Strength and conditioning coaches aim to develop resilience by exposing players to intense physical training in lines with the competition demands. Medical practitioners on the other hand usually advocate for reducing training loads to reduce the risk of “load-related” injuries. In terms of performance; several studies have shown an improved performance after a greater training volume and intensity. One study looked at fifty-six runners, cyclists and speed skaters of whom undertook twelve weeks of training. A ten percent performance improvement was associated with a ten-fold training load volume increase.
How to measure training loads: Training loads are measured via external training loads (i.e. physical work) accompanied by an internal training load (i.e. physiological or perceptual). Individual characteristics of an athlete (i.e. training age, injury history) combined with the external and internal training loads determine the training outcome. External training loads are commonly measured using a global positioning system (GPS). These can measure speed and distance as well as non-locomotor sportsspecific activities (e.g. collisions in rugby). Internal training loads are commonly measured using a session-rating perceived exertion (RPE) multiplied by the session duration. These are normally referred to as arbitrary units or exertional minutes. Well-being is also a common monitored measure in high performance sport. These subjective questionnaires are normally rated on a simple five, seven or ten-point Likert scale and question athletes on items such as their mood, stress levels, energy, sleep and muscle soreness.
The relationship between training loads and injury: Numerous studies have looked at the external training load of an athlete in their given sport and correlated it to an injury risk. For example, fast bowlers in cricket who bowled more than 50 overs in a match were at increased risk of injury. Internal training loads research has shown correlation with external load. For example, in professional rugby union players, higher one-week arbitrary units and fourweek cumulative loads were associated with higher risk of injury. In rugby league, there has been shown to be no significant relationship between field training loads and incidence of strength and power injuries. However, strength and power training loads have significant association with the incidence of contact and noncontact field training injuries. To minimize trainingrelated injuries, scheduling of field and gymnasium sessions should be carefully considered to reduce residual fatigue between sessions.
CONTINUED ON NEXT PAGE
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Clinical Section - Article Review The Training–Injury Prevention Paradox: Should Athletes be Training Smarter and Harder? continued... Training adaptations between younger and older athletes:
Acute and chronic training load:
The chronological and training age of an athlete influences adaptations and injury risk to training. Both older and younger rugby league athletes improve in muscular power and maximal aerobic power; however the improvements are greater in the younger athletes.
Using acute and chronic training load ratio provides an index of athlete preparedness. Chronic determines the state of ‘fitness’ and acute determines the state of ‘fatigue’ for an athlete. The ratio considers the training load that the athlete has performed relative to the load the athlete has been prepared for.
A study on Australian Football League players showed that at a given training load older and more experienced players were at greater risk than younger and less experienced players. This may be confounded by the older players having previous injury history which is a major risk factor for a new injury.
Data from cricket, Australian Football and rugby league has established a guide to interpreting and applying acute: chronic workload ratio. A ratio range of 0.8-1.3 could be considered the training ‘sweet spot’, while a ratio of equal or greater than 1.5 represents the ‘danger zone’.
Given the above research, it is suggested that training programmes should be modified to accommodate differences in training age.
As this data relates to the above sports, caution is recommended when applying these ratios to other sports.
Training load – injury relationship and predicting injury:
CONCLUSION
Over a two year period, Gabbett used the session-RPE load monitoring to determine the relationship between load and likelihood of injury in elite rugby league players. Players were fifty to eighty percent more likely to sustain a preseason injury within the weekly training load range of 3000 to 5000 arbitrary units. This arbitrary unit was considerably lower in competition phase. Injury data was recorded prospectively for a further two years and an injury prediction model was developed based on planned and actual training loads. If a player exceeded the weekly training load threshold, they were seventy times more likely to test positive for noncontact, soft tissue injury compared to players that did not succeed the threshold, of whom were 1/10 as likely to test positive. Week to week changes in training loads: A study on Australian Football players has shown that a rapid change of greater than ten percent training load was associated with a forty percent increase likelihood of injuries. Large week to week changes of 1069 arbitrary units has also been shown to increase risk of injury in professional rugby union players. To minimize the risk of injury, practitioners should limit weekly training loads increases to less than ten percent.
There is a strong relationship between high training loads and injury. The problem with high training load appears to be more related to the inappropriate training prescribed such as excessive and rapid changes in load. This paper highlights the importance of monitoring training load preferably via an acute: chronic training workload ratio to assist with long-term reduction in training-related injuries. Implications for practice:
• Scheduling of field and gymnasium sessions should be carefully considered to reduce residual fatigue between sessions.
• Training programmes should be modified to accommodate differences in training age.
• To minimize the risk of injury, practitioners should limit weekly training load increases to less than ten percent.
• An acute: chronic training load ratio range of 0.81.3 could be considered the training ‘sweet spot’, while a ratio of equal or greater than 1.5 represents the ‘danger zone’.
By Amanda O’Reilly BPhty (Otago)
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SPNZ Continuing Education
The Lower Limb in Sport (SPNZ LEVEL 2 COURSE) This course is for registered physiotherapists who work with individual athletes or teams in which lower limb injury is common. The focus of the course is on pathomechanics and kinetic chain deficits as they relate to injury prevention and performance, diagnosis and advanced rehabilitation of lower limb conditions. By the end of the course you will understand the pathoaetiology of common lower limb injuries, be able to perform key clinical and functional tests, rehabilitate lower limb injury in a number of sporting contexts including football, running and contact sports, and develop individualised return-to-sport programmes. Course Pre-requisite: This is an advanced rehabilitation course. As such, it is a pre-requisite for this course that all attendees have previously completed training in exercise prescription (The SPNZ Level 1 Promotion & Prescription of Physical Exercise or equivalent). We however understand that the timing of the courses sometimes does not suit, and people have undertaken previous courses that may cover the same information. We therefore have developed a quiz based on the level one course that if passed will enable you to undertake the level two courses. You only have one opportunity at doing the quiz for each course. To access the quiz follow the link. To make the registration process smoother please don’t register until you have been confirmed as passing this course. To attain the Certificate in Sports Physiotherapy ALL level one and two courses must be undertaken.
Location:
Date: th
AUT North Campus (AA119 building)
Saturday 20 May 2017
90 Akoranga Drive, Northcote, Auckland
8.30am – 4pm
Click for Google map Click for AUT North Campus map
Course Fee: SPNZ Member
$450.00
PNZ Member
$520.00
Non-PNZ Member
$650.00
Sunday 21st May 2017 9am – 4pm
The course will cover: • • • • • • •
Pathomechanics of lower limb injury in running sports, football and other lower limb sports Performance-related functional tests for the lower limb Diagnostic tests and imaging investigations for common sporting pathologies of the lower limb Design and implementation of rehabilitation programmes including post-surgical rehabilitation Integration with coaching and biomechanics for technique modifications Return-to-sport decision planning and processes Assessment and management of challenging lower limb conditions
Presenters: Dr Peter McNair
Professor of Physiotherapy
Geoff Potts
Sports Physiotherapist, Clinical Educator & DHSc Student
Justin Lopes
Sports Physiotherapist
To register: Registration will be limited to the first 26 paid registrants Complete online registration via Physiotherapy New Zealand
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Research Publications British Journal of Sports Medicine www.bjsm.bjm.com
Volume 51, Number 8, April 2017 REVIEWS Personalising exercise recommendations for brain health: considerations and future directions Cindy K Barha, Liisa A Galea, Lindsay S Nagamatsu, Kirk I Erickson, Teresa Liu-Ambrose http://bjsm.bmj.com/content/ β-alanine supplementation to improve exercise capacity and performance: a systematic review and meta-analysis Bryan Saunders, Kirsty Elliott-Sale, Guilherme G Artioli, Paul A Swinton, Eimear Dolan, Hamilton Roschel, Craig Sale, Bruno Gualano http://bjsm.bmj.com/content/ Resistance training interventions across the cancer control continuum: a systematic review of the implementation of resistance training principles C M Fairman, P N Hyde, B C Focht http://bjsm.bmj.com/content/
ORIGINAL ARTICLES Training load--injury paradox: is greater preseason participation associated with lower in-season injury risk in elite rugby league players? Johann Windt, Tim J Gabbett, Daniel Ferris, Karim M Khan http://bjsm.bmj.com/content/ EDITORIAL Paradoxes and personalised medicine: from preseason to post-diagnosis Jane S Thornton http://bjsm.bmj.com/content/
EDUCATION A higher sport-related reinjury risk does not mean inadequate rehabilitation: the methodological challenge of choosing the correct comparison group Ian Shrier, Meng Zhao, Alexandre PichĂŠ, Pavel Slavchev, Russell J Steele http://bjsm.bmj.com/content/
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Classifieds CAMBRIDGE Body Performance Clinic Full or Part Time Physiotherapist We are offering a unique opportunity to work in a brand-new physiotherapy and rehabilitation clinic with exposure to emerging talent and the high performance environment. We are located in the heart of Cambridge, the “town of champions” and hub for high performance sport in New Zealand, and have close links to Rowing NZ, Cycling NZ, as well as local sports medicine doctors and specialists. We are looking for physiotherapists, both full time and part time, starting in early 2017. This is an exciting opportunity to work alongside a highly experienced, motivated and high energy team. Our principal physiotherapist is Masters qualified and a two times Olympic Games physio. You can expect on-going support as part of our strong mentoring program along with an allowance for CPD to assist with post-graduate study, courses and conferences. We provide generous appointment times. Our wellequipped exercise therapy area allows for exercise prescription and rehabilitation of clients onsite. Team fit is incredibly important to us – we are team led, family centered and strongly connected to our community. We are firm advocates of the enormous health benefits of movement and activity, and are looking for like-minded people to join our team. If you have an active interest in wellness and gym based rehab, a strong desire to learn and enhance your clinical skills, and a drive to work as part of a high performing team then we want to hear from you. If this sounds like you please send your CV and cover letter to: jobs@bodyperformance.co.nz
TAURANGA Foundation Clinic Sports Physiotherapy Position All of us at Foundation really love our job. We pride ourselves on being a strong, dynamic, and effective team working together to ensure the best benefits for our patients. Due to an ever expanding patient load Foundation is in need of another high quality sports physiotherapist. Foundation is one of Tauranga’s leading sports physiotherapy and rehab clinics. Work along-side a clinical team that consists of highly qualified physiotherapists, massage therapists, sports physician, dietician, mental skills coach, strength and conditioning coaches and full time reception. The position will involve working in the Bay of Plenty’s leading health club “Aspire Health and Sports” as well as Mt Manganui’s newest athlete training facility “THE ATHLETE FACTORY NZ.” Generous appointment times allow for an emphasis on manual/manipulative physiotherapy and exercise prescription encompassing full rehabilitation in the onsite rehabilitation gym. The position is permanent full time, however part time options will be considered for the right person. Start date negotiable. Remuneration package to be discussed, with various options available, including allowance for CPD. We are looking for a fun, competent, hard-working individual with high work ethic, excellent communication and enthusiasm who is keen to learn and enhance their clinical skills. At least 3-5 years experience working in sports or private practice preferred, however applicants with any sports physio experience will be considered. All applications will be treated with utmost confidentiality. For more information check out our website www.foundationclinic.co.nz For expressions of interest forward your CV and covering letter to: Craig Newland: craig@foundationclinic.co.nz
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Classifieds HAMILTON Sports Med Physiotherapy Musculoskeletal Physiotherapist Sports Med Physiotherapy has an exciting opportunity for an enthusiastic musculoskeletal physiotherapist to work as part of our friendly team. Due to the increasing demand for treatment in our busy private practice in Hamilton, we have a physiotherapy position coming available in June. Sports Med Physiotherapy is a long established clinic and is well equipped having private consultation rooms and a fully equipped gymnasium. Our clinical treatment philosophy is one of providing clinically pertinent manual therapy coupled with quality gym based rehabilitation exercises. Our current physiotherapist’s are post-graduate trained and our principal has just finished a 6 year stint with the Chiefs Super Rugby Team. We have also previously had a long association with the Paralympic Cycling Team, Magic Netball Team and the New Zealand Triathlon Team. We aim to maintain a very supportive work environment for our staff and provide monthly onsite CPD and funding for external courses. The length of our patient appointment times are flexible, giving you the ability to individually tailor treatment to benefit your patient. Private practice work experience would be ideal, but we are also very open to working with, and mentoring, new graduates in our clinic. This fulltime position will begin as a 9 month contract, but has the potential to become permanent. The clinic uses Gensolve and an understanding of this would be advantageous but not necessary. Candidates must be eligible to work in New Zealand, have an annual practicing certificate and registered with the Physiotherapy board of New Zealand. Remuneration will be based on experience. Please send a CV with covering letter to malovell@me.com.
TARANAKI Taranaki Physiotherapy Physiotherapist Are you a physiotherapist looking for an amazing place to work that offers flexibility, friendly staff and patients who genuinely value your service? Want to live in a beautiful part of the country that offers incredible outdoor opportunities, great beaches and a stress free way of life? Taranaki is that place and Taranaki Physiotherapy is offering that job. Due to our continued growth we are looking for an enthusiastic, motivated physiotherapist to join our fantastic team, ideally in a full-time capacity, however we are open to negotiation around work hours. The right candidate will be adaptable, have excellent communication skills and have high standards of professional clinical service. Competitive remuneration is offered. We are a general practice with a supportive work environment. We offer opportunities in sports physiotherapy and our staff are members of both PNZ and SPNZ. We are committed to further education and offer ongoing clinical supervision, along with opportunities and support for training in your areas of interest. Applications from all levels of experience will be considered. If you wish to apply for this position please provide your CV and covering letter to: tim@taranakiphysiotherapy.co.nz Any enquiries can be directed to Tim Connole on 0274637307.