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SEPNZ BULLETIN
ISSUE 16, AUGUST2020
CELEBRATING OUR MEMBERS: P5 Jacinta Horan Sports Specialist Physiotherapist & Registered IFSPT Specialist
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RADIOLOGY:
Ultrasound of the Hindfoot
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Reliability of a Shoulder Arm UPCOMING SEPNZ Return to Sport Test Battery COURSES
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 - Emma Lattey Committee Emma Clabburn Rebecca Longhurst Justin Lopes Visit www.sepnz.org.nz
EDUCATION SUB-COMMITTEE Rebecca Longhurst (Chairperson) Emma Clabburn Justin Lopes Dr Grant Mawston Dr Gisela Sole Lauren Shelley John Love
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BULLETIN EDITOR Emma Clabburn
Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
International Federation of Sports Physical Therapy (IFSPT)
SPECIAL PROJECTS Karen Carmichael Amanda O’Reilly Pip Sail
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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
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EDITORIAL: By SEPNZ President Blair Jarratt
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FEATURE ARTICLE: CELEBRATING OUR MEMBERS: JACINTA HORAN
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APP REVIEW: Mentemia
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MEMBER BENEFITS: Asics Professional Buyers Program
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RADIOLOGY: Ultrasound of the hindfoot
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CLINICAL REVIEW: Reliability of a Shoulder Arm Return to Sport Test Battery
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UPCOMING SEPNZ COURSES
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RESEARCH PUBLICATIONS: BJSM September 2020 - Volume 54 - Issue 17
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CLASSIFIEDS AND STUDY INVITE
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EDITORIAL As we head into spring, we are now at the tail end of the winter sports season. Back in March, I didn't think we were going to get any winter sport so it been fantastic that we can keep the activity going in the community with what was a shortened winter season in most sports. The saga is not over unfortunately so again, more adaptation, and resilience is required as we rapidly move through 2020. Reading international news makes me feel very lucky to have this freedom in NZ at this point. Maybe this is an excellent time to get some extra study in with one of our SEPNZ courses or those of you interested in starting the pathway way to specialisation. On page 14 of this bulletin, we have our upcoming SEPNZ education program for the end of the year. I will renew our SEPNZ obligation to assisting the first five sports specialist physiotherapist through the Physiotherapy board process with financial backing from SEPNZ. We have 4 grants left. If you are interested, please contact our secretary for information on where SEPNZ can assist you, and don't forget our ASICS education grants which you can read about on our website! Talking about specialisation - In this edition, we take another look at the pathway being set out by our own Sports Specialist Jacinta Horan who was the first recipient of our SEPNZ Specialist grant. Jacinta has recently been accepted as registered by the International Federation of Sports Physiotherapist (IFSPT). Justin Lopes, our SEPNZ executive member provides a Q&A session with Jacinta on how this has changed her clinical practice and what the future holds for her. This is an inspiring read for not only those just starting their sports physiotherapy career but also those with experience and possibly thinking of taking on a higher level of clinical practice. We have another FREE App review this time looking at wellbeing and mental health. Obviously, with our current levels of restrictions, it does make some sporting events challenging to manage and organise. It's an excellent time to refine some of those soft skills we have with our clients. Many people and athletes are finding this a
difficult time. In the sporting world, major events are being cancelled or postponed. In the community, financial, personal, and work pressures may be compounding on people. The majority of people we see are now back to work, so maybe there is less time then they may have had in full lockdown. Motivation may be dwindling, and if you also throw in an injury, then there can be an extra mental load on clients/athletes. A simple APP or subtle recommendation during consultation might go a long way. Also, it is worth noting that these effects are not only client-centric - clinicians may be feeling the pressure, so make sure that you are looking after yourselves so you can be at your best for others. Using an APP as per our review or using resources for clinicians such as PNZ recently sent out via email can point you in the right direction. Every musculoskeletal physiotherapist should have a good understanding of appropriate imaging, and we continue this section with the assistance of the Auckland Radiology Group. In this edition, we look at the hindfoot; this is a quick read but has high clinical relevance on appropriate imaging - its strengths and weaknesses. There are also some excellent clinical pearls at the end of this article on when not to use ultrasound. We round out this bulletin with a clinical review from Pip Sail on the reliability of a shoulder arm return to sport test battery (SARTS). Any clinician involved in a sport with upper limb involvement will be interested in the clinical relevance of this testing protocol when trying to make a decision on return to sport. Behind the scenes, SEPNZ has been working away with PNZ and have finally got to the point of a signed MoU as of the 1st of September 2020. We are looking forward to this making a more streamlined joining process, with PNZ taking over the new memberships and welcome letters to all our new and rejoining members. Also, we are looking forward to the trial unity plan with PNZ to strengthen our value proposition to members. Stay well, and be kind to each other while we work our way through.
Kind Regards Blair Jarratt SEPNZ President
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FEATURE ARTICLE
Celebrating Success: SPECIALISATION! Jacinta Horan PBNZ REGISTERED PHYSIOTHERAPY SPECIALIST MHPrac (Honours), PG Cert AP, BPhty High Performance Sport NZ Physiotherapist Jacinta Horan has been trailblazing the way for sports physiotherapists in New Zealand for the last few years The following is an abridged version of an interview by SEPNZ Exec member Justin Lopes with Jacinta who has recently been accepted into the International Federation of Sports Physiotherapists (IFSPT) as a RIFSPT (Registered IFSPT Specialist) She is still the only Sports Specialist Physiotherapist in the country, and now is the first RIFSPT from New Zealand. JL: Tell us about the road to being the first Sports Specialist Physiotherapist in New Zealand? JH: When I finished up full time with New Zealand Sevens I made the decision that it was now or never to do my specialist qualification so I slowly chipped away, a day a week. I worked on it for a 12-18 month period and maybe I could have been done in a quicker time period but it allowed me to work it around the rest of my life, but making sure I was slowly progressing without having a large period of time set aside for it. I developed a portfolio and once I had got through that phase I did the examination phase, and achieved Specialisation status. JL: How has being a Specialist changed your practice?
JH: It has certainly changed my practice. I now do about 50% normal work and 50% Specialist work, which is working more in a consultancy role, largely second opinions, majority sent by Sports Docs and Physicians and a select group of physiotherapists which is starting to evolve a little bit more as those therapists understand the benefits of it and that it is not about trying to take over the care of their patients but casting a fresh set of eyes over complex or non-resolving cases and giving opinions, recommendations and options. I am fortunate to have access to technology that most don’t have access to. This allows me to provide objective data to identify impairments and design a rehabilitation plan related to this. Going forward I hope that a greater percentage of referrals come from physiotherapists versus specialists, and that physios see the benefit from a CPD perspective in coming along to appointments with their patients as they are interested. I can probably do full time Specialist work almost now but I really enjoy my normal sports patients and not a lot of the Specialist work is treatment, rather it is high level assessment and rehab planning. A combination of specialist and non-specialist work is currently working well for me, which is great. JL: What do you do for Specialist appointments? JH: Initial appointments are an hour and that leaves an hour of reporting time, there is quite a lot of work post appointment that goes into those reports. Still trying to master that from a time perspective at this point! Where possible, in the sporting population it is using technology to give a lot of objective data. I am aware there are not a CONTINUED ON NEXT PAGE >>
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FEATURE ARTICLE lot of practices that have hand held dynamometers or force plates and being able to utilise that to give people real numbers can be extremely useful – to both patients and clinicians alike. I am doing most of my work in the area of chronic hip and groin pain in the athletic population, which is very widespread from elite to the weekend warrior that has had the issue for a long period of time. I think that technology and objective measures can be really useful and that’s one area where I can see the physio Specialist referral to be hugely beneficial. People can refer to me, get all the testing done, they can get the results back and work on the rehab programme with some fresh ideas and guidelines and then I review them for a check up to see if those identified impairments are progressing. That’s how it works, and follow up appointments are generally half-an-hour and there are maximum five appointments. For the majority of people that are seeing other physios I will see them usually two or three times but if they are under me and I am running their rehab then I will utilise four or five appointments as needed over a six month period and have another physio working in with them as appropriate..
Women in Sport: A performance advantage) work, and some concussion stuff as well. I guess a mix of the practical plus some research group based work which keeps me at the forefront
JL: You are based in Tauranga. Are you getting referrals from all over the country at the moment given you are the only Sport Specialist?
Please ensure in your referral letter it states “For Specialist referral”
JH: Up until now that hasn’t necessarily been possible until Telehealth has became more available, but that has opened the door a little bit, so I am seeing a couple of patients from outside of the Bay. I have found Telehealth really useful for that and so it will be interesting to see moving forward if that continues. At this stage it is and I know other Specialists who do see people from outside of the regions have found it really useful for that reason also. It definitely is an opportunity for the future. JL: You were the first Sports Specialist Physio in New Zealand and the first recognised RIFSPT registered Physiotherapist from NZ… What is next for Jac’s? JH: Well, I think a growing combination of stuff which is what I am really enjoying is working in the Specialist role as well as doing some standard sports physio work as well as working in some working groups in the moment which I certainly enjoy. I am on the National ACL Project at the moment and then continuing on with the WHISPA (Healthy
JL: SEPNZ is really proud of you, we love watching what you are doing, so keep doing what you do and flying the flag for females and kiwi physiotherapists around the world! JH: Thanks! If you would like a second opinion, or some support from Jacinta on any sports related injury, particularly in the areas of athletic hip/groin pain, sporting shoulder or non-resolving tendinopathy then please refer your clients by sending a referral letter to jacinta@optimisephysio.nz If you have any questions regarding whether a patient is appropriate or not you can call her on 021623627.
If you know of successful SEPNZ members we would love to celebrate them; please email Justin@sepnz.org.nz to let us know who we should be interviewing!
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APP REVIEW
Back to the App... Your App Review Mentemia—by Emma Lattey These are crazy old times. And in these crazy old times we need apps to help us and our patients feel better, physically and mentally. Mentemia is an app that coaches mental wellbeing.
Seller: Size: Category: Version: Compatibility: Languages: Age rating: Copyright: Cost: Family Sharing:
What it is used for?
Who would benefit from this App?
Mentemia Limited 68.4 MB Health & Fitness 0.12.0 Requires iOS 9.3 or later. Apple and Android English 12+ Ó Mentemia Limited 2019 Free Yes
Mentemia means “My Mind” in Italian. It has been developed both for individuals and businesses, to help to build a daily mental wellbeing plan which is specific to each person. Mentemia was created by Sir John Kirwan, who has shared his battle with depression, along with tech entrepreneur Adam Clark and medical advisers. It provides practical tips and techniques to help users take control of their mental health and wellbeing. Anyone. At. All.
PRACTICAL APPLICATION For ourselves, our loved ones, and our patients in this current climate this is a free app that could be very helpful for anyone in need of a little extra mental health help right now. Throughout the app there is a strong emphasis on exercise and diet, with many “short reads” and “easy listens” from athletes and people involved in elite sport. Other popular mental health wellbeing apps such as Headspace and Insight Timer mostly focus on meditation and mindfulness. However, Mentemia is very different and quirky with mostly short articles to read and quick tasks like a “mood tracker” and “worry map” to complete every day.
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APP REVIEW
Pros: • • • • •
It is fun and free and there is a lot of new content every day Easy features which are clear to use The activities are short and doable which avoids one of the downfalls of similar type apps where the information or exercises can become overwhelming The wheel of kindness is my personal fav where you spin the wheel to find a task which will make another person happy, eg. reconnect with a friend, let someone go first, write a comment. It’s like having a personalised mental health coach in your pocket!
Cons: • •
All poor reviews online are due to technical app issues with account/log in information, I haven’t had any problems. Doesn’t replace the need for professional help if indicated.
OVERALL RATING = 4.8 / 5
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.
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/ASICS Sportstyle 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 Additional Product Offers: Birkenstock Footwear Receive 2 voucher codes per year, 1 every six months. Each voucher will give you 30% off the retail price of one pair of shoes up to $200 Recommended Retail Price. Vouchers must be redeemed online at www.birkenstock.co.nz Smartwool Socks Receive 2 voucher codes per year, 1 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
Register Here Full terms and conditions can be found on the Professional Buyers Programme registration page. If you are already a member of the Professional Buyers Programme you will receive your vouchers in July and February. For first time registered member, we run a report at the end of each month which picks up the newly registered members. You should then receive your vouchers by the middle of the following month. REGISTER HERE
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RADIOLOGY
Ultrasound of the Hindfoot Auckland Radiology Group Thanks to Auckland Radiology Group for the content which in this edition is provided by Dr Neal Stewart. The strengths of ultrasound are: • • • • • • •
Comparing symptomatic and asymptomatic sides Its high resolution for superficial structures, particularly tendons and nerves It can evaluate long segments of superficial tendons and nerves better than MRI Dynamic assessment of peroneal tendons for subluxation and dislocation Differentiating between cystic and solid masses Assessing veins and arteries Ability to detect neovascularity which may be seen with tendinopathy, synovitis and bursitis.
Figure 2 Medial ankle region: Short axis image in region of tarsal tunnel shows a ganglion (arrows) deep to the posterior tibial vessels (shown in colour). This is compressing the tibial nerve. It is not possible to do justice to evaluating all of the structures about the ankle in an allocated 30-minute examination time. Ultrasound of the foot is most useful when targeted at a specific region. When requesting an ultrasound of the hindfoot please indicate clearly which region of the hindfoot you would like examined. 1. Medial Figure 1 Medial ankle region: Short axis image shows enlarged tibialis posterior tendon (arrow) with distended tendon sheath (arrow heads) and neovascularity (colour), indicating tenosynovitis.
Tibialis posterior tendon; only a limited segment of the flexor digitorum longus and flexor hallucis longus tendons can be visualised at the ankle because they lie deep in the plantar aspect of the mid foot Tarsal tunnel which includes the above tendons, tibial nerve, artery and veins Deltoid ligament
2. Lateral
Peroneal tendons' Anterior talofibular, calcaneofibular and anterior tibiofibular ligaments CONTINUED ON NEXT PAGE >>
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RADIOLOGY 3. Anterior
Joint effusion Tibialis anterior, extensor hallucis longus and extensor digitorum longus tendons Branches of the superficial and deep peroneal nerves
4. Posterior Achilles tendon Retrocalcaneal and superficial calcaneal bursae 5. Plantar
Plantar fascia
Ultrasound should not be used to diagnose an acute ankle sprain - this is a clinical diagnosis! Ultrasound cannot see the calcaneocuboid, posterior talofibular or deep component of the deltoid ligaments very well; it cannot accurately distinguish between acute and chronic ligament changes and cannot grade (the stability/severity) of ligament injuries any better than clinical examination.
6. Assessment of a soft tissue lump
Common pathology about the hindfoot which is well imaged with ultrasound includes tendinopathy, plantar fasciitis and soft tissue lumps which commonly turn out to be ganglia, tenosynovitis or bursitis.
Figure 4 Anterior ankle region: Long axis of the tibialis anterior tendon (white arrows) with a laceration in the tendon (blue arrow) and fluid in tendon sheath (yellow arrow heads).
Figure 3 Lateral ankle region: Short axis comparison images of left and right peroneus longus tendons at lateral malleolus. On the left the peroneus longus tendon (white arrow) is subluxed lateral to lateral malleolus (arrow heads). On the right the peroneus longus tendon is normally positioned posterior to lateral malleolus (yellow arrow heads). A= anterior. P = posterior.
Author Dr Neal Stewart
Musculoskeletal Radiologist
Auckland Radiology Group
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CLINICAL REVIEW
Reliability of a Shoulder Arm Return to Sport Test Battery. Margie Olds, Cadre Coulter, Dan Marrant, Tim Uhl Physical Therapy in Sport 39 (2019) 16-22
By Pip Sail ABSTRACT To establish the intra and inter-rater reliability and responsiveness of a clinical test battery developed to determine readiness to return to sport after an upper extremity injury and to examine the limb symmetry in single limb tests. It is hypothesised that there will be significant familiarisation between day 1 and 2 while reliability of day 2 and 3 will be good to excellent. Decision-making regarding return to sport after a shoulder injury is difficult for clinicians and the lack of reliable and valid performance tests exacerbates this problem. Shoulder injuries which result in lengthy time away from sport can be expensive for professional athletes and can limit career opportunities. Rates of recurrent shoulder instability after a shoulder dislocation can be higher than 50% whether conservative or surgically managed, thus indicating that improvements in decision-making are required to ensure athletes are safe to return to sport after a shoulder injury. Physical performance tests to facilitate decision-making regarding whether athletes are ready to return to sport are critical in helping reduce recurrent shoulder injuries. These tests must be easy and inexpensive to perform in the clinic, demonstrate good psychometric properties and have normative data and cut-off values established before clinical use. Clinical tests should be representative of the demands of the sport to which the athlete is returning and consider endurance capability. Single on-off testing is unlikely to accurately measure an athletes readiness for return to play thus, a battery of tests safe, valid and reliable physical performance tests which measure different aspects such as power, strength, range of movement and neuromuscular control may be more beneficial.
assigned for a participant. The participant alternated between open and closed chain tests for their session. All tests were performed for a minute with a rest period between each test of 1-2 minutes. The total number of repetitions performed was recorded as the score. The open chain tests included Ball Abduction Eternal Rotation (BABER), Drop catches, Ball Taps and Overhead Snatch. Closed chain tests included Push Up Claps, Line Hops, Modified Closed Kinetic Chain Upper Extremity Shoulder Test (MCKCUEST), and Side Hold Rotations. All participants were evaluated in a test-retest design of three tests , one week apart. CONCLUSION The SARTS test battery contains reliable physical performance tests that may assist clinicians with clinical decision making with respect to return to sport and compares favourably with other shoulder physical performance measures. One of the strengths of this study is the utilisation of tests which examine performance over an extended time period and may more closely replicate sporting requirements and provide a clearer indication of readiness for return to sport.
Six of the eight tests in the SARTS battery of tests are reliable measures. Some tests (BARBER, Side Hold Rotations and Push-Up Claps) require practice before clinical testing while two tests (Drop Catches and Ball Taps) showed continued learning across three tests. Further examination of the tests in sports-specific populations is required to develop normative guidelines.
The tests were developed to replicate the shoulder demands of athletes engaged in sport and designed to assess readiness to return to sport.
The test battery was comprised of four open chain tests and four closed chain tests that were randomly
A full set of references are available on request
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UPCOMING SEPNZ COURSES Please note these are the proposed courses for 2020. With the current COVID-19 situation this could also change. Once we are confirmed to go ahead registrations will be open via PNZ. Student night 28th of September 2020 SEPNZ is excited to announce the launch of our Inaugural Student night. This event is an informal get together for undergraduate Physiotherapy students across the country who are interested in the field of Sports and Exercise Physiotherapy. We have a fantastic line up of speakers who can share experiences and stories to help broaden the understanding of what a career in Sports and Exercise Physiotherapy might look like. More info and venues below
Otago: https://pnz.org.nz/Event?Action=View&Event_id=2976 AUT: https://pnz.org.nz/Event?Action=View&Event_id=2975 Zoom: https://pnz.org.nz/Event?Action=View&Event_id=2977
The Lower Limb in Sport Day 1 & 2 Via Zoom September 28th 2020 & October 3rd 2020 Day 3 at the Christchurch Apollo Centre October 4th 2020 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. Register here: https://pnz.org.nz/Event?Action=View&Event_id=2978
Injury Prevention and performance enhancement Auckland November/December Date TBC 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
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RESEARCH PUBLICATIONS
British Journal of Sports Medicine September 2020; Vol. 54, Issue 17 ller-Riemenschneider
ORIGINAL RESEARCH
REVIEW Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12–17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial (28 January, 2020)
Preseason shoulder range of motion screening and inseason risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis (14 January, 2020)
Ida Åkerlund, Markus Waldén, Sofi Sonesson, Martin Hägg lund
Federico Pozzi, Hillary A Plummer, Ellen Shanley, Charles A Thigpen, Chase Bauer, Melissa L Wilson, Lori A Michener
Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players (30 January, 2020)
WARM UP
Haiko Ivo Maria Franciscus Lodewijk Pas, Babette M Pluim, Ozgur Kilic, Evert Verhagen, Vincent Gouttebarg e, Rebecca Holman, Maarten H Moen, Gino M Kerkhoffs, Johannes L Tol Preventing injuries in alpine skiing giant slalom by shortening the vertical distance between the gates rather than increasing the horizontal gate offset to control speed (27 April, 2020 Matthias Gilgien, Philip Crivelli, Josef S Luteberget, Erich Müller, Jörg Spörri
Kröll,
Live
Let us spend time pitchside for our athletes’ benefit: a call to broaden collaboration by Sport and Exercise Medicine Switzerland (SEMS) (19 August, 2020) Philippe Matthias Tscholl
http://bjsm.bmj.com/content/54/7 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/
EDITORIALS Undergraduate examination and assessment of knowledge and skills is crucial in capacity planning for the future healthcare workforce in physical activity interventions (14 January, 2020) Ann Bernadette Gates, Michelle Grace Swainson, Fiona Moffatt, Roger Kerry, George S Metsios, Ian Ritchie Mouthguards should be worn in contact sports (27 March, 2020)
Paul Allison, Faleh Tamimi Ski racers’ understanding of sports-related concussion and its management: are contemporary findings and clinical recommendations reaching the target audience, the racers themselves? (26 March, 2020) Natalie Maxwell, Lucy Redhead, Evert Verhagen, Jörg Spö rri BRIGHT SPOTS Bright spots, physical activity investments that work: National Steps Challenge, Singapore: a nationwide Health physical activity programme (19 December, 2019)
Jiali Yao, Chuen Seng Tan, Cynthia Chen, Jeremy Tan, Nicole Lim, Falk Mü
The Foot and Ankle Show is the UK's newest and most exciting FREE digital event for all health professionals with a focus on the lower limb! As the principal event sponsor, Formthotics are making the conference content available to all New Zealand health professionals. The Foot and Ankle Show Digital event is on the 16th and 17th of October (UK time), and sessions are available for 48 hours post-event allowing you to watch the sessions at your convenience. Register at www.footandankleshow.com to reserve your tickets for the Foot and Ankle Show Digital this October.
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ADVERTISING