SEPNZ Bulletin April 2019

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SEPNZ BULLETIN

ISSUE 8. APRIL 2019

Exercise for Chronic Conditions p13

p17 Effects of Exercise Training on Physical Fitness and Biomarker Levels in Breast Cancer Survivors

p20 Sport Originated Brain Injury: An Update for Physiotherapists

p18 The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects

www.sepnz.org.nz

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SEPNZ EXECUTIVE COMMITTEE

Members Page

President - Blair Jarratt Vice-President - Timofei Dovbysh Secretary - Michael Borich Treasurer - Timofei Dovbysh Website - Hamish Ashton Sponsorship - Bharat Sukha Committee Emma Clabburn Rebecca Longhurst Justin Lopes Emma Lattey

EDUCATION SUB-COMMITTEE Dr Angela Cadogan Emma Clabburn Rebecca Longhurst Justin Lopes Dr Grant Mawston Dr Chris Whatman

Visit www.sepnz.org.nz

Join us on Facebook

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ADDITIONAL USEEFUL WEBSITE RESOURCES: List of Open Access Journals Asics Apparel - how to order McGraw-Hill Books and order form Asics Education Fund information

BULLETIN EDITOR Emma Clabburn

International Federation of Sports Physical Therapy (IFSPT) Journal of Orthopaedic & Sports Physical Therapy (JOSPT)

SPECIAL PROJECTS Karen Carmichael Rose Lampen-Smith Amanda O’Reilly Pip Sail

BULLETIN ADVERTISING DEADLINES: February Bulletin: 31st January April Bulletin: 31st March June Bulletin: 31st May August Bulletin: 31st July October Bulletin: 30th September December Bulletin: 30th November Advertising terms & conditions click here.

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

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CONTENTS

SEPNZ MEMBERS PAGE See our page for committee members, links & member information

2

EDITORIAL: By SEPNZ President Blair Jarratt

4

GET TO KNOW THE TEAM: 2 MINUTES WITH…Justin Lopes

5

APP REVIEW: Metronome Metro Timer

6

MEMBER BENEFITS: Discounts

9

ASICS: Heel counters: what’s all the fuss about?

10

FEATURE ARTICLE: Exercise for Chronic Conditions

13

CLINICAL REVIEW: Effects of Exercise Training on Physical Fitness and Biomarker Levels in Breast Cancer Survivors

17

The Impact of Exercise on Cancer Mortality, Recurrence, and TreatmentRelated Adverse Effects

18

SPRINZ: Sport Originated Brain Injury: An Update for Physiotherapists

20

UPCOMING SEPNZ COURSES

23

RESEARCH PUBLICATIONS: BJSM Volume 53, Number 8, April 2019

25

CLASSIFIEDS

26

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EDITORIAL

Hello, and so we step into the Autumn after a busy start to the year within SEPNZ. With Easter now here, it's hard to think we are already a 1/3 into the way of 2019. Our Symposium is now firmly behind us - all those that made the trip to Tauranga we hope you enjoyed the program. We have had excellent feedback about our speakers; especially it seems that both of Rod Whiteley's Keynote talks were exceptionally well received.

We are also setting some dates out there for our CPD program, and I urge you to look at these sooner rather than later to guarantee places on these courses. Our Level 1 sideline management has already been and gone in Dunedin, and again this was well attended. Keep an eye out on the CPD program on our website and also later in this bulletin there is further information on upcoming courses.

Each bulletin we have been introducing one of the SEPNZ Executive members so you can put a face to the name - this edition we get a quick look into Justin Lopes - SEPNZ stalwart and education committee extraordinaire. Also Emma Lattey our newest executive member picks up the app review for an excellent free app plus she also goes into the many clinical uses for this. You will all be reaching for your phone and heading to the app store after you read her review.

In this Bulletin, we embrace the message of exercise in medicine. Lou James, the Founder and CEO of PINC & STEEL International, takes us through the multiple advantages of prescribed and supervised exercise in cancer care. Like in the many other areas that Physiotherapists work in, our strength is to see the whole patient and not just their presenting issue. Lou discusses six main growing areas of exercise rehab in cancer care.

Pip Sail also backs up this topic with two literature reviews. One on the effects of exercise training on physical fitness and biomarker levels for breast cancer survivors, and the other a systematic review on the impact of exercise on cancer mortality, recurrence and treatment-related adverse effects. I am sure you can guess the conclusions to these papers but it still never ceases to amaze me the power of exercise in the management of many

conditions. Exercise truly is the miracle drug! It's up to us as physiotherapist's to continue to push this message in the community, to our medical professionals and to the people we interact with every day.

In our SPRINZ section physiotherapists are called upon to discuss how in New Zealand we can improve early identification and develop individualised therapy protocols for sports originated brain injury. Concussion is a hugely growing area of interest, and if you want to learn more, then please look into the SEPNZ course on concussion with Dr Stephen Kara scheduled for later this year in Auckland.

Finally Chris Bishop on behalf of ASICS discusses all the fuss around Heel counters in shoes - should you have them yes or no - you will have to read to find out ........

Until next time

Kind Regards Blair Jarratt SEPNZ President

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GET TO KNOW THE TEAM - 2 MINUTES WITH...

Justin Lopes SEPNZ Committee Member

What role do you play on the exec?

I am a general dogsbody on the executive... and am on the Education Committee, I joined 5 years ago.

Life outside of SEPNZ? I enjoy spending time with friends and my family (wife Rachel and Olive and Sam). I try and stay active by playing football, and help coach my children's sports teams.

Favourite tune on a roadtrip?

One in a million by Epsilon Blue Favourite sporting physiotherapy moment?

Coming 3rd at FIFA Club World Cup

Previous teams worked with / sporting background....and present?

I have worked with New Zealand Football teams and a plethora of Auckland based club and national level football teams, Roller Derby teams and cover the West End Cup for the West End Lawn Tennis Club. .

Where do you work & what role?

I am the director of Back To Your Feet Physiotherapy, a boutique physiotherapy clinic based at the Western Springs AFC. Favourite /best or worst destination as touring Physio and why?

Recent tour to Tahiti with NZF MU20 was a really relaxed and enjoyable tour as we were located in resort by the beach, the team and the management group worked well together and the food was great!

The Solomon Islands tour immediately following that was more challenging as the country is a lot poorer and the standard of accommodation was not as great, I ended up with an ear infection (likely from the hotels swimming pool) and had to come home early due to a bereavement in the family.

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APP REVIEW

Back to the App...

Your App Review

By Emma Lattey This edition of our SEPNZ App review is for the more technically-challenged and anti-app physiotherapists out there. The “Metro timer” is a metronome app that is both simple and effective and it’s not so much how it is used but what it can used for, which is ideal for both clinicians and patients.

“If you use a metronome to pace your strength training activity, what you get are the changes that you want at a muscle and tendon level, but you also get the changes to your motor cortex.”

Dr Ebonie Rio – FXNL Podcast 2018 WHAT IS IT? HOW TO USE IT The Metro timer is a timing app that regulates beats at set rates in a consistent tempo. It is as easy as opening the app, setting the required tempo and pressing play. Any musicians out there will be very familiar with the use of a metronome, but recent research in sports medicine circles has recommended the use of a metronome for a wide range of both clinical and training functions, some of which I will mention below. Many other apps in this space over-complicate what is an effective tool for use as clinicians, and I have found “Metro timer” to be the best of the bunch to use in my own clinical practice.

Seller:

ONYX 3

Size:

17.1MB

Category:

Music

Compatibility:

Requires iOS 7.0 or later. Compatible with iPhone, iPad and iPod touch.

Languages:

English

Age rating:

4+

Copyright:

Ó 2015 ONYX Apps

Price:

Free!

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APP REVIEW EXAMPLES OF PRACTICAL APPLICATIONS FOR CLINICIANS AND PATIENTS Vestibular Ocular Motor Screening (VOMS) postconcussion Use the metronome to ensure the speed of head rotation is maintained (Anzalone, et al. 2017) •

Horizontal and Vertical Vestibular Ocular Reflex Tests = set to metronome to 180bpm

•

Visual Motion Sensitivity Test = set metronome to 50bpm

Running retraining for patellofemoral pain (PFP) “Changes in stride rate can be encouraged using a metronome, with increases of 10% or less above an athlete’s preferred rate being adequate to reduce impact loading while maintaining or even reducing oxygen consumption (Warden, et al. 2014)” Recent research by Bonacci et al (2018) has shown that increasing cadence by 10% can reduce PFJ loading during running in people with PFP. Using this easily accessible metronome app, it is effortless to implement this strategy in the clinic and for patients with PFP to use in their own time as part of a returnto-running program. When the most favourable cadence is found and return-to-running is complete, it is worth noting that Spotify have running playlists at specific tempos to help further teach the amended technique.

Tendinopathy Rehabilitation “A metronome may be used to external­ly pace the exercise, introducing a skill­ based element that may improve motor control (Goom, et al. 2016).”

Muscular Endurance Testing

•

Standardisation of Strength Endurance

Heavy Slow Resistance (HSR) = eg. for proximal hamstring tendinopathy rehabilitation, a contraction duration of 3 seconds for each phase (concentric and eccentric) is recommended.

•

Curl up crunch = set metronome to 50bpm and test for 1 minute (Coombes, et al. 2014) Outcome

Measures

for

• Single leg calf raise = set metronome to 60bpm • Single leg glute bridge = set metronome at 60bpm

and bridge ASIS’s up to set bar.

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APP REVIEW Pro’s • User friendly interface is easy to understand • Let’s you set the timer for 1, 2, 3, 5, 10, 15, 20 mins (would be even more useful if you could set timings for return-to-running program…)

• Easy to navigate, solid app, keeps accurate time • Ad free • Sound is loud and high enough to use in a gym/ busy practice • Can change the metronome voice

Con’s • Better if you could adjust it with your device turned off • Needs buttons to save regularly used tempos, however it is quick and easy to adjust

OVERALL RATING = 4.75/5 REFERENCES Anzalone, A. J., Blueitt, D., Case, T., McGuffin, T., Pollard, K., Garrison, J. C., . . . Oliver, J. M. (2017). A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes. Am J Sports Med, 45(2), 474-479. doi:10.1177/0363546516668624 Bonacci, J., Hall, M., Fox, A., Saunders, N., Shipsides, T., & Vicenzino, B. (2018). The influence of cadence and shoes on patellofemoral joint kinetics in runners with patellofemoral pain. Journal of Science and Medicine in Sport, 21(6), 574-578. doi:https://doi.org/10.1016/j.jsams.2017.09.593 Coombes, J., & Skinner, T. (2014). ESSA’s Student Manual for Health, Exercise and Sport Assessment - eBook: Elsevier Health Sciences.

Goom, T. S. H., Malliaras, P., Reiman, M. P., & Purdam, C. R. (2016). Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. Journal of Orthopaedic & Sports Physical Therapy, 46(6), 483-493. doi:10.2519/jospt.2016.5986 Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. British Journal of Sports Medicine, 50(4), 209-215. doi:10.1136/bjsports-2015-095215 Warden, S. J., Davis, I. S., & Fredericson, M. (2014). Management and Prevention of Bone Stress Injuries in Long-Distance Runners. Journal of Orthopaedic & Sports Physical Therapy, 44(10), 749-765. doi:10.2519/jospt.2014.5334

MEMBER BENEFITS

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There are many benefits to be obtained from being an SEPNZ 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.

New Asics Deal: Asics Clothing and Shoes at wholesale rates The ASICS Professional Buyers Programme is designed to enable Sport & Exercise Physiotherapy New Zealand members the opportunity to experience our shoes first hand and to assist in referring the most suitable shoe/s to your patients. By registering for the Professional Buyers Programme, you will:

ASICS Performance Footwear Receive 4 voucher codes per year, 2 every six months.

Each voucher will give you 40% off the retail price of one pair of shoes up to $300 Recommended retail Price.

Vouchers must be redeemed online at www.asics.co.nz

Onitsuka Tiger Casual Footwear Receive 2 voucher codes per year, 2 every six months Each voucher will give you 40% off the retail price of one pair of shoes up to $300 Recommended retail Price Vouchers must be redeemed online at www.onitsukatiger.co.nz We will also keep you up to date with relevant global news relating to bio-mechanics and footwear development. You are also privileged to be able to receive vouchers for the following product portfolio under the Brittain Wynyard brand stable.

Additional Product Offers. Birkenstock Footwear Receive 2 voucher codes per year, 2 every six months Each voucher will give you 30% off the retail price of one pair of shoes up to $200RRP Recommended retail Price. Vouchers must be redeemed online at www.birkenstock.co.nz

Smartwool Socks Receive 2 voucher codes per year, 2 every six months Each voucher will give you 30% off the retail price for your choice of socks (Recommended retail Price) Vouchers must be redeemed online at www.smartwool.co.nz

For further details visit http://sportsphysiotherapy.org.nz

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ASICS

Heel counters: what’s all the fuss about?

By Dr. Chris Bishop PhD Shoe design is a difficult task.

With the common goal to reduce mass of a shoe, how can designers include all of the technology they desire without the shoe feeling like a brick? The argument is often that shoes have been over engineered, and it is often questioned what technical design features can be removed without compromising the function, structure and support that a technical running shoe provides. One of the main design features in the spot light is the heel counter.

Do we need it…at least in its rigid form? If yes, is it internal or external?

Walk into most shoe shops and you will get the standard line that a firm heel counter will support the foot during gait. But really, is this true? Do we know this? What is its role? Does it control foot pronation?

Does it aid in stability as the foot is loaded? Does it simple provide structure and shape to the shoe?

Despite the often quoted conceptions about what a heel counter actually does, the reality is that little is known from a scientific point of view.

Firstly lets look at its intended role and then we can explore the supporting science. The shape (construction) of a heel counter can have a significant impact the overall fit and feel of the shoe. We know that heel fit is a really important consideration in the overall comfort of a shoe. Surprisingly, differences in the shape, degree of padding, depth, how well the shape of the heel matches the shape of the back of the heel counter can be overlooked, particularly in a retail environment. It is then sometimes overcome by different lacing techniques, when really the 'openess' or design of the heel counter doesn't match the individuals heel shape. This can cause significant issues with internal heel wear or rubbing on the posterior aspect of the calcaneus (especially if a haglunds deformity is present). The suggestion that an external heel counter is 'better' because it allow for

the natural movement of the foot during midsole compression and reduce wear is also largely unsubstantiated and simply a belief. However the greatest misconception is that it somehow ‘guides’ the heel as the foot touches the ground and helps 'control' the heel from excessively pronating.

When we delve through the literature and look at the science underpinning rearfoot shoe design, apart from the work of Nigg and Butler in the late 1980’s, minimal work has been done substantiating the presence of a heel counter in the modern athletic shoe. This doesn’t say that many of the shoe companies haven’t done their own R&D and simply haven’t published their work which I’m sure they have. But lets look at some of the findings out there with respect to motion control, fit and variability in response: In 2000, the late Alex Stacoff and co-authors compared hindfoot biomechanics during running both barefoot and in shoes. There findings contrast the previous findings in the literature that showed substantial and significant reduction of hindfoot eversion, identifying that the differences in calcaneal eversion between barefoot running and running with normal shoes were small and not systematic. Given these authors used more accurate methods by attaching markers directly to the bone rather than on the skin, it is likely that previous studies identifying a reduction in hindfoot eversion were measuring the movement of the shoe and/or skin, and not the true movement of the underlying bone. This indicates no motion-control benefits were identified.

In 2007, Irene Davis and co-workers published their findings on the contribution of a heel counter to internal stresses of the heel pad during static standing. When comparing the results of a finite element model of the heel inside the shoe with and without a heel counter, the heel counter provided CONTINUED ON NEXT PAGE >>

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ASICS inwards directed pressure on the skin which counteracted the internal pressures within the fat pad pushing outwards when loaded. This reduces stress in the heel pad. Despite the research occurring in static standing and isolated to one subject, the insights provided in this study have plenty of implications for running - a well-fitted heel counter may actually be an effective reducer of heel pad stress…think of all those runners with heel pain, or maybe we have an answer to the increased magnitude of vertical force when heel striking?

Regardless of whether you understand the methods used in this paper, it indicates that an appropriately fitting shoe is extremely important in the overall effect of the shoe.

At the 2013 SMA conference in Phuket, I presented data from our lab at the University of South Australia.

Using our in-shoe foot model, and based on the existing literature, we thought that during running, shoes would not reduce either the amount of hindfoot eversion, nor the velocity of the movement. Based on data from 18 runners, very small and non significant differences were identified between the barefoot and shoe conditions. However, what was interesting was when we broke down our analysis to look at the variability of how each person responded to the shoe condition. Nine of the runners actually everted more, and nine runners everted less, with the net effect of the increase in eversion balanced by the decrease in eversion to result in no identified difference at all. This indicates based on pooled or average data, researchers can be quick to jump to conclusions about the net effect of a design feature, when in reality, individuals are likely to respond to different things in different ways.

So in my opinion, what is the fuss about the heel counter and is it required…simply yes. I think it improves comfort and fit of a shoe, and retailers need to be appropriately skilled in assessing rearfoot width and fit, not just whether there is enough room in the forefoot across the toes. Appropriately fitting shoes in the rearfoot will reduce heel slippage which is a common complaint amongst runners, resulting in a reduction in the amount of blisters and the break down of the shoe upper material behind the heel.

Does it control motion – well yes and no and it depends on the individual. However it shouldn’t be classified as a motion control feature of the shoe.

Rather a heel counter should be viewed as a design feature that improves the fit of the shoe around the heel of the foot, and in a properly fitted shoe, the runner’s heel should feel supported (and not slip) the whole time the foot is in contact with the ground. It should be a smooth ride. And look, if we can get the same fit benefits from an external shoe counter and drop 3-4 grams from the shoe, then this is going to be a great result as well!

Is this saying that a shoe without a heel counter is also no good…no not at all. Every shoe has some structure. And some people may like this. There will be a slight reduction of mass, less issues with material friction yet may also result in shoe structure compensations.

So is it internal, external or none at all? How do you choose the right counter or what should you recommend patients?

Go with what the individual feels is ideal, what they feel fits best and what they prefer. The individual perception of what is most ideal for them is highly likely going to end up being the most comfortable.

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FEATURE ARTICLE

Lou James (MNZM), Founder and CEO Pinc & Steel International I was passionate about becoming a Physiotherapist from the age of 15. I was seriously into sports and represented New Zealand at the Triathlon World Champs for the first time when I was 17. I really wanted to work with athletes to help them rehabilitate and become active again after injury. I started my own Physiotherapy & Pilates studio in Ponsonby when I was 25. However, it wasn't until I started helping people facing cancer that I really felt I was making the valuable difference to people's lives that had originally inspired me to become a Physiotherapist.

Now in my forties I continue to be hugely motivated to help people affected by cancer and to teach other Physiotherapists how to use their skills to make a difference too. I founded Pinc & Steel International in 2008 and now our cancer rehabilitation education programs are being accessed by Physiotherapist’s in 11 countries.

One of the most rewarding aspects of my work is hearing from the Physios we train about how our programs have sparked their passion for working in this rewarding field.

The burden of cancer in our communities is enormous and for many, cancer is a chronic illness, with echoes that last long after treatment ends. It is exciting to see the advances in research over the past decade, particularly supporting the use of exercise training for this patient population. Emerging literature has addressed the effects of exercise-based rehabilitation programs along the continuum of the disease and this has rapidly progressed the role of physiotherapy in cancer.

Photo credit: Lou James (PINC & STEEL Founder) running with breast cancer survivor Judith Ansell.

The primary focus of oncology medical professionals is to eliminate or control disease by suppressing cancer cell growth (chemo, radiation, targeted therapies or directly removing the tumour (surgery). These treatments are increasingly successful but they also damage ‘normal’ tissue. While oncology specialists seek the best possible outcomes, i.e. the absence of any residual cancer – this does not mean genuine, meaningful recovery is complete. The Cancer Rehab Physiotherapists’ focus is on supporting the whole patient, not just addressing their cancer.

Exercise medicine is an emerging field in oncology with evidence demonstrating its use before treatment, during treatment and after treatment.

CONTINUED ON NEXT PAGE >>

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FEATURE ARTICLE Physical activity and exercise are vital components targeting three main aspects of the cancer continuum: prevention, morbidity and mortality. Exercise rehab in cancer care is a growing area of practice and has the potential to: 1. HELP PREVENT UNNECESSARY DISABILITY - The number of people living longer and surviving cancer is growing, however these people may be living with long-term side effects of the disease and treatment (both physical and emotional), which make them feel they haven’t ‘beaten’ cancer at all. Side effects may be visible during or very soon after treatment, or they may take months and years to be seen. Many of these side effects can significantly affect quality of life. Exercise prescription tailored to the individual can help minimise the risk of short and long-term side effects and help prevent unnecessary disability.

2. RESTORE MOVEMENT AND FUNCTION Cancer rehabilitation physiotherapists are experts in restoring movement and function to people affected by cancer. However, it doesn't stop there. There is also strong evidence supporting exercise rehabiliation not only helping people physically but also emotionally, vocationally and socially.

3. HELP MANAGE FATIGUE, DURING AND AFTER TREATMENT - There is an abundance of evidence that regular moderate exercise can decrease feelings of tiredness, lack of energy and fatigue. During cancer treatment it is often possible to continue exercising if it is carefully prescribed by a Cancer Rehab Physiotherapist.

4. ASSIST THE PSYCHOLOGICAL RECOVERY There is an emotional toll that cancer survivors face in addition to the physical one. A cancer diagnosis can cause depression, anger, anxiety, fear and stress.

Exercise rehabilitation, reassurance and education can help improve psychological recovery.

5. PREVENT FURTHER DEGENERATION OF HEALTH - If symptoms are not managed throughout treatment there is a greater risk a patient will have problems coping. The combined burden from treatments and lack of physical activity can cause de-conditioning, which can further exacerbate fatigue and lead to a longer road to recovery. Cancer Rehab Physiotherapists can help patients overcome the significant physical and functional impairments suffered after cancer surgery and treatments that act as major barriers to resuming physical activity.

6. REDUCE AND DECELERATE THE IMPACT OF A RANGE OF SYMPTOMS - There is evidence that exercise can help in symptom control, reduction of treatment toxicity and ability to improve the tolerance of and recovery from intensive cancer treatment regimens. Exercise rehabilitation can help patients: • maintain their independence; • increase their strength, range of motion, functional status, and physical activity levels; • manage their fatigue, and pain; • restore bowel and bladder function, and • help people return to work, sport and activities they love.

The thought of exercise can be overwhelming to people affected cancer, but a well-designed exercise program may help them feel better physically and mentally, and it may also decrease the risk of further disease. Recent insights are beginning to illustrate the progression and plausibly extending overall survival, largely through preclinical studies or epidemiological associations. Exercise is a dose-dependent mechanical stimulant (with evidence of dose-response) that can be safely prescribed to patients with advanced cancer and sclerotic metastases. Patients are at increased risk of osteoporosis, cardio-vascular disease, diabetes, functional decline and cancer recurrence. My work with this population, as well as published research, confirms that exercise helps to mitigate the side effects of cancer treatment and surgery.

CONTINUED ON NEXT PAGE >>

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FEATURE ARTCLE Cancer Rehabilitation is very rewarding work for physiotherapists to be involved in and you can truly make a big difference to peoples’ lives.

Cancer patients endure a huge amount and their journey is long and uncertain. I have been privileged to meet many inspiring people thorough my work and observe their strength and uncommon wisdom. It is not simply that they see the big picture, if you spend long enough with them they help you see it too.

To find out more about Cancer Rehabilitation Education for Physiotherapists visit www.pincandsteelphysios.com

Lou James (MNZM) has dedicated the last 15 years to helping improve the lives of people affected by cancer in New Zealand and overseas. Lou graduated with a Bachelor of Health Science in Physiotherapy from AUT in 1997. She is responsible for the introduction of the PINC & STEEL, Next Steps and PaddleOn Cancer Rehabilitation Programmes, which focus on the physical and mental wellbeing of people affected by cancer. The programmes are now available in 11 counties and have supported thousands of people. In New Zealand the programmes are supported by a number of charities including Breast Cancer Foundation New Zealand, CanTeen, The Bowel Cancer Foundation Trust, Look Good Feel Better, Leukemia & Blood Cancer NZ and the Prostate Foundation.

In 2006, Lou founded the PINC & STEEL cancer rehabilitation Trust to help make rehabilitation more accessible and affordable for New Zealanders. Lou has been recognised for her pioneering work in this field, most recently being appointed a Member of the New Zealand Order of Merit in the 2017 Queens New Years Honours List for services to people with cancer.

References: Ref: Hart NH, Galvão DA, Newton RU. Exercise medicine for advanced prostate cancer. Curr Opin Support Palliat Care. 2017;11(3):247–57.

Ref: Friedenreich CM, Neilson HK, Farris MS, Courney KS. Physical Activity and Cancer Outcomes: A Precision Medicine Approach. Clin Cancer Res. 2016. Oct 1;22(19):4766-4775 Ref: Cormie P, Zopf EM, Zhang X, Schmitz KH. et al. The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects.

Epidemiol Rev. 2017. Jan1:39 (1): 71-92 Ref: Hamer J, Warner E. Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health. CMAJ. 2017 Feb 21;189 (7):E268-E274 Ref: Jones LW, Habel LA, Weltzien E, Castillo A, Gupta D, Kroenke CH, et al. Exercise and risk of cardiovascular events in women with no metastatic breast cancer. J Clin Oncol. 2016;34(23):2743.

Ref: Kim TH, Chang JS, Kong ID. Effects of exercise training on physical fitness and biomarker levels in breast cancer survivors. J Lifestyle Med. 2017;7 (2):55–62.

Ref: Thomas GA, Cartmel B, Harrigan M, Fiellin M, Capozza S, Zhou Y, et al. The effect of exercise on body composition and bone mineral density in breast cancer survivors taking aromatase inhibitors. Obesity. 2017;25(2):346–51.

Ref: Kirkham AA, Davis MK. Exercise prevention of cardiovascular disease in breast cancer survivors. J Oncol. 2015;2015(917606):1–13.

Ref: Scott JM, Khakoo A, Mackey JR, Haykowsky MJ, Douglas PS, Jones LW. Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer: current evidence and underlying mechanisms. Circulation. 2011;124(5):642–50.

Ref: Lynch ME, Brooks D, Mohanan S, Lee MJ, Polamraju P, Dent K, et al. In vivo tibial compression decreases osteolysis and tumor formation in a human metastatic breast cancer model. J Bone Miner Res. 2013;28(11): 2357–67.

Ref: Hart NH, Newton RU, Spry NA, Taaffe DR, Chambers SK, Feeney KT, et al. Can exercise suppress tumour growth in advanced prostate cancer patients with sclerotic bone metastases? A randomised, controlled study protocol examining feasibility, safety and efficacy. BMJ Open. 2017;7 (5):e014458.

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FEATURE ARTCLE Ref: Hojman P, Gehl J, Christensen JF, Pedersen BK. Molecular mechanisms linking exercise to cancer prevention and treatment. Cell Metab. 2018;27 (1):10–21.

Ref: Newton RU, Kenfield SA, Hart NH, Chan JM, Courneya KS, Catto J, et al. Intense exercise for survival among men with metastatic castrate-resistant prostate cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol. BMJ Open. 2018;8(5):e022899.

Ref: Glass OK, Inman BA, Broadwater G, Courneya KS, Mackey JR, Goruk S, et al. Effect of aerobic training on the host systemic milieu in patients with solid tumours: an exploratory correlative study. Br J Cancer. 2015;112(5):825.

Ref: Semenza GL. The hypoxic tumor microenvironment: a driving force for breast cancer progression. Biochimica et Biophysica Acta (BBA)-Molecular.

Cell Res. 2016;1863(3):382–91.

Ref: Ashcraft KA, Peace RM, Betof AS, Dewhirst MW, Jones LW. Efficacy and mechanisms of aerobic exercise on cancer initiation, progression, and metastasis: a critical systematic review of in vivo preclinical data. Cancer Res. 2016;76(14):4032–50.

Ref: Dethlefsen C, Pedersen KS, Hojman P. Every exercise bout matters: linking systemic exercise responses to breast cancer control. Breast Cancer Res Treat. 2017;162(3):399–408.

Ref: Ergun M, Eyigor S, Karaca B, Kisim A, Uslu R. Effects of exercise on angiogenesis and apoptosis-related molecules, quality of life, fatigue and depression in breast cancer patients. Eur J Cancer Care. 2013;22 Ref: Pedersen L, Christensen JF, Hojman P. Effects of exercise on tumor physiology and metabolism. Cancer J. 2015;21(2):111–6.

Ref: Pudkasam S, Tangalakis K, Chinlumprasert N, Apostolopoulos V, Stojanovska L. Breast cancer and exercise: the role of adiposity and immune markers. Maturitas. 2017;105:16–22.

Ref: Thomas RJ, Kenfield SA, Jimenez A. Exercise-induced biochemical changes and their potential influence on cancer: a scientific review. Br J Sports Med. 2016;51(8):640–4.

Ref: Ruiz-Casado A, Martín-Ruiz A, Pérez LM, Provencio M, Fiuza-Luces C, Lucia A. Exercise and the hallmarks of cancer. Trends Cancer. 2017;3 (6):423–41.

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CLINICAL REVIEW

Tae Ho Kim, Jae Seung Chang, In Deok Kong Journal of Lifestyle Medicine Vol.7. No2, 55-62 https://doi.org/10.15280/jlm.2017.7.7.2.55

By Pip Sail

Abstract Exercise has been identified as a beneficial intervention to enhance quality of life in breast cancer survivors.

Several noteworthy studies have emerged, this one investigated the effects of different types of exercise (aerobic, resistance, combined) on breast cancer survivors, with changes in physical fitness and biomarker levels as the primary outcome.

Breast cancer is the most common type and second leading cause of death of women worldwide. However, with improvement and development in drugs, surgical intervention, radiotherapy, chemotherapy, and hormone therapy, 90% of breast cancer patients survive at least 5 years after diagnosis.

The rates of breast cancer incidence and mortality have decreased. Exercise and physical activity are vital to reduce risk factors and improve physical fitness, psychological controls, and quality of life in breast cancer survivors [5,6]. Exercise promotes social interaction during and after treatment and can considerably enhance the ability of cancer patients and survivors to cope with fatigue, lymphedema, and bone metastasis [7].

The results from this study showed that: 1.

2.

3.

aerobic exercise was significant in reducing body fat, improving VO2max, grip strength, 6-min walk test and 1-mile running test and reduced the serum level of HMGB-1. resistance exercise improved strength in chest, hip, arm and leg and 2 trials reported improved serum IL 6 and TNF-a (tumor necrosis factor) levels combined exercise improved the chest, hip, arm and leg strength; functional walking performance; and predicted VO2max. and 2 trials reported improved leptin, cholesterol, cutaneous T-cell attracting chemokine levels

.

Discussion It is necessary to continue studies to identify guidelines for exercise prescription for breast cancer survivors, especially the types, localisation and side effects associated with exercise [42].

To date, available guidelines suggest participating in moderate aerobic exercise with flexibility and intermittent resistance exercise [43,44]

Conclusion Combined exercise improves body composition and adipokine levels and musculoskeletal strength. It also increases the levels of biomarkers associated with bone mineral density [14,19,21,23]. Research suggests that combined exercise should be considered a beneficial and effective exercise type for breast cancer survivors.

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CLINICAL REVIEW

The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects Prue Cormie, Eva M Zopf, Xiaochen Zhang, and Kathryn H Schmitz Epidermiologic Reviews Vol.39 2017 DOI:10.1093/epirev/mxx007

By Pip Sail ABSTRACT Increasing numbers of new cancer cases and improving survival rates have unique health-care requirements. A growing body of research has identified the importance of incorporating exercise in cancer care. This systematic review summarises the literature searches focused on determining the potential impact of exercise on 1. cancer mortality and recurrence and 2. Adverse effects of cancer and its treatment. Compared with patients who did little or no exercise, patients who engaged in exercise following a diagnosis of cancer were noted to have lower relative risk of cancer mortality and recurrence and experienced fewer and/or less severe adverse effects.

Exercise is an important adjunct in the management of cancer.

Improvements in screening, diagnosis and treatment of cancer has resulted in an exponential increase in the number of cancer survivors. Within this growing population there are 2 major areas of health concerns, 1. Cancer recurrence and mortality and 2.

Persistent adverse effects of cancer treatment. Trials have been undertaken to evaluate the potential efficacy of exercise training to improve outcomes of these concerns.

In this study 2 separate literature searches were conducted to evaluate the impact of exercise following a diagnosis of cancer on 1.cancer mortality and recurrence (review 1) and 2.the adverse effects of cancer and its treatments (review 2).

and all-cause mortality in patients who have superior exercise behaviours. Studies reported a significant statistical association in patients with breast (11,12,19,23,24,26), colorectal (9,22,29,31-33,35,40) and prostrate (28), cancer. It is unclear from this review if there is any variation in the magnitude of protective effect against cancer-specific mortality, cancer recurrence, and/or all-cause mortality according to the type of cancer or the exercise dosage (modality, volume, intensity, frequency). It is unclear if the timing of the assessment influenced the relationship between exercise and cancer progression.

Review 2 suggests variability in the efficacy of exercise to improve adverse treatment effects by adverse effect, tumor site, intervention and timing of the intervention with regard to treatment. Statistically, significant improvements in treatment related symptoms were noted both with breast cancer survivors and conducted during chemotherapy (46,50). Significant effects were also noted in comparing lower with higher intensity exercises with significant effect on women doing higher intensity aerobic exercise or higher intensity aerobic exercise combined with resistance training (50).

The outcomes explored in meta-analysis included fatigue, quality of life, psychosocial distress, body image, sleep, physical function, physical health, lymphedema and shoulder dysfunction. Conclusions of these meta-analysis are that exercise does have a significant positive effect on these outcomes.

Review 1 suggests a consistent trend for reduced risk of cancer specific mortality, cancer recurrence CONTINUED ON NEXT PAGE >>

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CLINICAL REVIEW DISCUSSION Findings from this review support the view that exercise is an important adjunct therapy in the management of cancer. Specifically it confirms that cancer patients involved in greater levels of exercise have a lower relative risk of cancer mortality and a lower relative risk of cancer recurrence, and they experience fewer and/or less severe treatment-related adverse effects.

CONCLUSIONS This comprehensive review supports the view that exercise is an important adjunct therapy for the management of cancer. The review of scientific evidence on the effectiveness of exercise interventions to prevent recurrence and to improve adverse effects of cancer treatments has implications for policy and practice. Exercise guidelines largely mirror general exercise guidelines for healthy adults, recommending the people with cancer engage in regular moderate-intensity aerobic and resistance exercise (133-135, 137, 138). There is great potential to improve outcomes for patients and potentially to reduce health system expenditure through improved implementation of exercise in cancer care.

A full list of references is available on request.

PAGE 20

SPRINZ

Joshua McGeown1, Patria Hume1,2 Natalie Hardaker3,1 Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand; 2 National Institute for Stroke and Applied Neuroscience Research, Auckland University of Technology, Auckland, New Zealand; 3Accident Compensation Corporation

1

Sport originated brain injury (SOBI) is a growing area of concern to the public, media, clinicians and researchers. Approximately 30% of athletes who sustain a SOBI will experience protracted symptom resolution characterised by one or more post-concussion disorders. A proportion of patients with SOBI require attention from physiotherapists with specialty training in the identification and treatment of cervical and/or vestibulo-ocular pathologies. Physiotherapists play a crucial role in the management of SOBI. We call upon physiotherapists and sports physicians to discuss how we can improve early identification of the predominant symptom cluster and develop therapy protocols that can be individualised for SOBI patients.

KEYWORDS: concussion, mild traumatic brain injury, assessment, rehabilitation, return to play, return to learn.

Severity of traumatic brain injury (TBI) can range from mild concussion to a severe penetrating injury resulting in coma or death [1]. In New Zealand, approximately 21% of all reported TBIs were sustained while playing sport or during physical activity [2]. Of these TBIs 98% were considered mild TBIs, and 51% of these were sustained by youth under the age of 18 years old [2]. Sport Related Concussion (SRC) and mild Traumatic Brain Injury (mTBI) are often used interchangeably both in the literature and in clinical practice. It is important to understand that concussion is a subset of mTBI and therefore not all mTBIs are necessarily concussion [3].

To improve the understanding of the seriousness of any brain injury that can result from sport, and to improve clarity surrounding the implications of mTBI and SRC resulting from sporting activities, we have

coined the easily remembered abbreviation SOBI for sport originated brain injury. SOBI describes the mechanical loading and deformation of brain tissue [1] that occurs as a result of impacts to the head or body and transmitted to the head that can occur during sport participation. This loading results in the brain colliding with the inside of the skull, and triggers a complex pathophysiological process causing disruption to normal brain function and metabolism which manifests clinically with somatic, cognitive, and emotional symptoms[5, 6] reported by the patient, and signs observed by clinicians [3-5].

Following SOBI, approximately 70% of individuals will experience spontaneous resolution of their symptoms within 10-14 days after the initial mechanical injury took place [6]. Conversely, other evidence indicates that 20-40% of individuals sustaining SOBI may continue to experience *CONTINUED >>

PAGE 21

SPRINZ persistent symptoms for weeks, months, or years after the initial injury [7, 8]. It was hypothesised that persistent symptoms beyond the acute period of SOBI were a result of unresolved global physiological dysfunction due to the initial forces applied to the brain [9].

A classification system for persistent symptoms was proposed to stratify individuals into one of three predominant symptom cluster (PSC) subgroups [912].

1.

Vestibulo-ocular PSC includes persistent symptoms such as dizziness, postural instability, or blurry vision caused by dysfunction of the vestibulo-ocular system due to the initial SOBI [9].

1.

1.

Cervicogenic PSC includes persistent concussion symptoms such as neck pain, lightheadedness, or occipital headaches caused by injury and dysfunction of the cervical spine somatosensory system due to the initial forces causing SOBI [9].

Physiologic PSC includes persistent symptoms such as difficulty concentrating, memory loss, fatigue, or exercise intolerance and is associated with impaired brain metabolism and autonomic function [9].

SOBI patient. There is potential to expand the role of physiotherapists in the management of SOBI. Emerging evidence indicates that early identification of vestibulo-ocular abnormalities following SOBI is predictive of complicated clinical recovery >14 days [11]. SOBI patient’s presenting with vestibulo-ocular dysfunction may benefit from early referral to a specialised physiotherapist who can initiate an individualised treatment plan. Patients may develop vestibulo-ocular compensations if treatment is not promptly initiated.

Assessment of cervical spine/whiplash and disorders comorbid with SOBI may also be conducted by physiotherapists resulting in earlier recognition and initiation of treatment. The increased use of physiotherapists trained specifically in SOBI related assessment and rehabilitation may reduce the proportion of patients who experience complicated outcomes.

We call upon physiotherapists and sports physicians to discuss how in New Zealand we can improve early identification of the predominant symptom cluster and develop therapy protocols that can be individualised for SOBI patients.

This method of classification provides clinicians and researchers a means to assess and differentiate between which PSC is underlying the majority of symptoms. Individuals with SOBI would be expected to present with symptoms attributed to more than one PSC. Nevertheless, there is still limited evidence regarding the ideal clinical model for the management of SOBI. Physiotherapists play a crucial role in the multidisciplinary management of mTBI. Currently, physicians are required to make diagnosis and clearance decisions for injured athletes before they can return to training, and eventually competition.

Physicians have stated they lack the time to provide detailed and individualised therapy directly to the CONTINUED ON NEXT PAGE >>

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SPRINZ

References 1. Kent, T.A., et al., Novel carbon nanoparticles are catalytic antioxidants and improve outcome after experimental traumatic brain injury at a clinically relevant time point. Journal of Cerebral Blood Flow and Metabolism, 2016. 36: p. 296-296.

2. Theadom, A., et al., Sports-related brain injury in the general population: An epidemiological study. Journal of Science and Medicine in Sport, 2014.

3. McCrory, P., et al., Consensus Statement on Concussion in Sport: The 4th International Conference on Concussion in Sport, Zurich, November 2012.

Journal of Athletic Training (Allen Press), 2013. 48(4): p. 554-575.

4. Giza, C.C. and D.A. Hovda, The Neurometabolic Cascade of Concussion. Journal Of Athletic Training, 2001. 36(3): p. 228-235.

5. Giza, C.C. and D.A. Hovda, The new neurometabolic cascade of concussion. Neurosurgery, 2014. 75: p. S24-S33.

6. McCrory, P., et al., Consensus Statement on Concussion in Sport: The 4(th) International Conference on Concussion in Sport Held in Zurich, November 2012. Journal of the American College of Surgeons, 2013. 216(5): p. e55-71.

7. Belanger, H.G., et al., Postconcussive symptom complaints and potentially malleable positive predictors. The Clinical Neuropsychologist, 2013. 27(3): p. 343-355.

8. Theadom, A., et al., Sleep difficulties and their impact on recovery following mild traumatic brain injury in children. Brain Injury, 2016. 30(10): p. 12431248.

9. Ellis, M.J., J.J. Leddy, and B. Willer, Physiological, vestibulo-ocular and cervicogenic post-concussion disorders: an evidence-based classification system with directions for treatment. Brain Injury, 2015. 29(2): p. 238-248.

10. Ellis, M.J., et al., Vestibulo-ocular dysfunction in pediatric sports-related concussion. Journal of Neurosurgery: Pediatrics, 2015. 16(3): p. 248-255.

11. Ellis, M.J., et al., Multidisciplinary management of pediatric sports-related concussion. The Canadian Journal of Neurological Sciences, 2017. 44(1): p.

24-34.

12. Leddy, J., et al. A randomized controlled trial of assessment of exercise tolerance in adolescents with acute Sport-Related Concussion (SRC). Clinical Journal of Sport Medicine., 2015. 25, 216 DOI: 10.1097/JSM.0000000000000199.

Josh McGeown HBK, MscKine, PhD Student Josh McGeown is a PhD student at Auckland University of Technology’s Sport Performance Research Institute New Zealand (SPRINZ). Josh’s research focuses on optimizing rehabilitation and return to play strategies for athletes injured during training and competition. For his PhD project, Josh will be working with athletes who have suffered a concussion during sport, and will evaluate the effectiveness of exercise based rehabilitation techniques on a wide variety of subjective and objective outcome measures of symptom recovery. The findings of Josh’s PhD will aid in improving postconcussion rehabilitation guidelines, and provide a better understanding of safe return to play practices.

Patria Hume is Professor of Human Performance at Auckland University of Technology’s Sport Performance Research Institute New Zealand (SPRINZ). She has an international reputation in sports biomechanics, kinanthropometry and sports injury prevention. Her work has been recognised with national and international awards, including the most prestigious award in her field – the International Society of Biomechanics in Sports Geoffrey Dyson Award 2016. She was the 2016 AUT University Medalist for her outstanding contribution to research and sustained and exceptional academic achievement. With over 600 scholarly publications her work has been cited over 5000 times.

Natalie Hardaker has 15 years of mixed clinical and research experience in the area of Sports Injury Prevention and Rehabilitation. She currently has a role at ACC as a Senior Injury Prevention Specialist and is a PhD Candidate at AUT, Auckland, New Zealand. Her research area is the effect of the female sex hormones on the risk for and recovery from Sports Related Concussion. Natalie leads the Sports Collaboration Group (cross code group to address injury issues and management in sport) and has been actively involved in the development of the ACC National Guideline for Concussion in Sport.

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UPCOMING SEPNZ COURSES - Save the Dates -

A concussion Workshop in Auckland Upcoming in June/July, stay tuned for dates and locations Presented by Dr Stephen Kara (Sports Doctor - Axis Sports Concussion Clinic ) (The South Island Concussion Workshop dates TBC) In this workshop you will learn the Basic physiology and current understanding of concussion. Pitch side management of the concussed athlete, Initial Assessment and referral guidelines, Follow up assessment, graduated return to play protocols including use of SCAT, SAC and neurocognitive tests (just description of the latter) and this course is a Combination of lectures, case studies and practical workshops.

Lower Limb The Lower Limb in Sport (SEPNZ LEVEL 2 COURSE) Auckland October 5th & 6th Presenters: Dr Peter McNair Professor of Physiotherapy Geoff Potts Sports Physiotherapist, Clinical Educator & DHSc Student Justin Lopes Sports Physiotherapist 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.

Injury Prevention & Performance Enhancement.(SEPNZ LEVEL 2 COURSE) Auckland 12th & 13th of October We will be running both day one and day 2 of the injury prevention and performance enhancement course.

We have only run day one previously.

This course will provide you with the key skills used in the enhancement of sporting performance and prevention of injury. It covers the analysis of physical, biomechanical and technical needs of sport, identifying key factors affecting performance and injury prevention.

You will learn how to assess athletes and implement an individualised programme designed to optimise movement efficiency, performance and minimise injury risk. You will learn how to develop a sport–�specific screening assessment, how to monitor injury rates and target injury prevention strategies within different sporting contexts.

Registrations will be open soon via www.pnz.co.nz Dates are subject to change.

Limited spots available

PAGE 24

The new Volume 2 will be out in May. If any members are interested in reviewing, please contact hamish@p2pphysio.nz

PAGE 25

RESEARCH PUBLICATIONS

British Journal of Sports Medicine April 2019; Vol. 53, No. 8 Warm Up

Editorials

Focus on the ‘E’ in SEM: Sports Medicine Australia invites you to the Sunshine Coast on 23–26 October 2019 (29 March, 2019) Free Michelle Bergeron, Mitch J Duncan, Liam Richard West

Early ACL reconstruction is required to prevent additional knee injury: a misconception not supported by high-quality evidence (30 October, 2018) Stephanie Rose Filbay

Original Articles

Is it time to give population health surveillance a late fitness test? (2 February, 2018) Gavin Sandercock, Ben Jones

Depression and anxiety symptoms in 17 teams of female football players including 10 German first league teams (2 February, 2018) Astrid Junge, Birgit Prinz

It’s time we paved a healthier path of least resistance (7 March, 2018) Jessica A Renzella, Alessandro R Demaio Meridith Sones, Daniel Fuller, Yan Kestens, Meghan Winters

Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 highincome and upper middle-income countries between 1981 and 2014 (30 October, 2017) Grant R Tomkinson, Justin J Lang, Mark S Tremblay

Infographic

Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport: population-level trends in hospitaltreated injuries (14 September, 2018) Caroline F Finch, Shannon E Gray, Muhammad Akram, Alex Donaldson, David G Lloyd, Jill L Cook

Reviews

Infographic: The ‘weekend warrior’ physical activity pattern and mortality (7 March, 2018) Gary O’Donovan, I-Min Lee, Mark Hamer, Emmanuel Stamatakis

Research Letter Provider attitudes and management regarding returning to drive after concussion (12 March, 2018) John A Lucas, Justin B Moore, Stephen Davis, Johnell O Brooks, Christopher Miles

Change in physical activity from adolescence to early adulthood: a systematic review and meta-analysis of longitudinal cohort studies (24 July, 2017) Kirsten Corder, Eleanor Winpenny, Rebecca Love, Helen Elizabeth Brown, Martin White, Esther van Sluijs Updated systematic review of exercise studies in breast cancer survivors: attention to the principles of exercise training (21 November, 2017) Free Sarah E Neil-Sztramko, Kerri M Winters-Stone, Kelcey A Bland, Kristin L Campbell Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis (14 September, 2018) Free Spencer Stuart Haines Roberts, Wei-Peng Teo, Stuart Anthony Warmington

http://bjsm.bmj.com/content/52/15 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/

PAGE 26

CLASSIFIEDS Physiotherapy Innovation, Mount Maunganui DMA Clinical Pilates Bundle for sale $7,500 ono Currently consulting in Australia so not required.

This is your opportunity to join an excellent physiotherapy team in an inspiring practice, treating a wide variety of clients. Manual therapy, exercise prescription and rehabilitation are the hallmarks of our practice.

The principal is an experienced physiotherapist who enjoys mentoring and passing on his knowledge to his staff, and undergraduate and postgraduate physiotherapy students from the Auckland University of Technology. He has postgraduate qualifications in both Manipulative Therapy and Sports Medicine. He also has extensive experience with high performance sport athletes, having been involved with two New Zealand National Men’s Sports Teams (Hockey and Football), and also attending three Olympic Games and three Commonwealth Games, as a Team Physiotherapist, over a ten year period.

Opportunities to be involved with local sports teams are available. In-service training and professional support is provided regularly. The Morrinsville Physiotherapy Clinic is an accredited practice. New graduates welcome.

Mentoring provided.

Morrinsville is a provincial town in the Waikato region of New Zealand's North Island, with a population of approximately 7,000. The town has excellent facilities and is an easy 25 minute commute to Hamilton, with a population of 161,000.

The Waikato region is easily accessible to both East and West coast beaches, bush walks, mountain biking, water sports, fishing and snow sports, so you can optimise your weekend activities and down time. Travel to Auckland by car from Hamilton or Morrinsville is only 1 hour 40 minutes.

If this opportunity interests you, I would love to hear from you. A full time physiotherapy position is available to start immediately, although there is a degree of flexibility with a starting date if required. Applications close 31st July 2019.

Please email your CV with a cover letter – in confidence to Gavin at: gavin@morrinsvillephysio.co.nz or contact Gavin if you have any questions regarding the position via email or phone 07 889 7474 All applicants must have a current New Zealand Annual Practicing Certificate.

Check out our website: www.morrinsvillephysio.co.nz

Purchased 2014 for $14,500 DMA clinical reformer/accessories, clinical trapeze/ accessories, jump board, barrel, wobble board, foam wedge, seat, balance poles Contact: andrea@physioinnovation.co.nz or +61436312922

PAGE 27

CLASSIFIEDS

SEPNZ EDUCATION COMMITTEE Expressions of Interest Expressions of Interest to join the Education Committee are now open.

SEPNZ BULLETIN EDITOR

SEPNZ

SEPNZ is committed to providing sustainable, quality, robust Sports Physiotherapy Education Pathway that aligns with, and stands up to assessment against, the International Federation Sports Physiotherapy (IFSPT) competencies.

If education in Sports Physiotherapy is a passion of yours and you believe that you have something to offer the SEPNZ Education Committee that could help us to overcome barriers in the delivery of quality Sports Physiotherapy Education with our courses, please send your CV and letter outlining; why you wish to apply, what you offer and how you would look to implement your ideas to help the ongoing review and improvements that we are committed to making within the SEPNZ Education Committee to:

The SEPNZ Bulletin is a show piece for publications for physiotherapy in New Zealand Can you help us???

We are looking for a bulletin editor to help us put together the SEPNZ Bulletin 6 times a year.

• Help will be given to get you started in the role • Publishing knowledge is not needed

Duties include: • Contacting people to supply articles • Proof reading articles to make sure they make

sense

• Reminding people to send things in on time • Choose an article to be reviewed for publication • Skills needed are basic time management and a

computer

becsvw@hotmail.com.

Further details on request Contact Michael Borich mborich@gmail.com