SPNZ August 2015 bulletin by Sports & Exercise Physiotherapy NZ

SPNZ BULLETIN PAGE

Issue 4 August 2015

SPNZ Course Side-line Management Feature Kia Magic Physiotherapist Membersâ&#x20AC;&#x2122; Benefits IT Benefits FEATURE TOPIC: Netball

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

Hamish Ashton

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Michael Borich

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Michael Borich

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Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing education in the fields of sports and orthopaedic physiotherapy. An application form can be downloaded on the SPNZ website

sportsphysiotherapy.org.nz.

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Contents FEATURE TOPIC: Netball

SPNZ MEMBERS PAGE

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

By SPNZ President Hamish Ashton MEMBERS’ BENEFITS

IT Benefits FEATURE

Roger Athy-Knibbs—Physiotherapist for Kia Magic PLANET OF THE APPS

App: Ankle

In this issue:

SPRINZ

In Sickness and in Health - Making Exercise a Lifetime Partner ASICS GRANTS

Winners of the Asics Education Award and the SMA Conference Grant CLINICAL SECTION- ARTICLE REVIEW

Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains CONTINUING EDUCATION SPNZ Level 1 Sideline Management

Local course and APA CPD Event Finder

RESEARCH PUBLICATIONS JOSPT Volume 45, Number 8, August 2015

BJSM Volume 49, Number 16, August 2015

CLASSIFIEDS

Vacancies

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Editorial Hamish Ashton, SPNZ President Hi to all. I was procrastinating on writing this as I couldn’t think on what to say when social media came to my rescue. Yet again the medical personnel for sports teams are in the news. This time it’s a coach taking his frustrations out on them. For those who have no idea what I am talking about, Jose Mourinho, the Chelsea Football team manager, has accused the team doctor and physio of not understanding the game and thereby putting the result of the game at risk. Earlier in the game the Chelsea keeper was sent off meaning they played most the game with 10 men. Late in the game with the teams locked in a draw a Chelsea player went down. For those not familiar with football, for a medical person to attend a player we need to be called on to the field by the referee. However, after we attend to them the player has to leave the field until the referee calls them back on. This left Chelsea with only nine men on the field for a short period of time. Did this affect the result – no. The keeper being sent off probably had a much greater effect on the game. Should they have gone on? More recent footage shows the referee calling them twice before they went on. They obviously weren’t entering the field of play without forethought. Did they do the right thing – yes. A player was down injured asking for assistance and the referee called them on to assess the player. Mourinho has stated that the doctor’s and physiotherapist’s positions are now at risk and they are likely to be stood down from sideline duties. Is this a permanent or temporary situation? We will no doubt find out in time. This brings up a couple of points for us to consider if working on the sideline. The first is know your sport. Know when are you allowed to enter the field of play and what happens afterwards with respect to assessing the player and their return (if fit) to the game. Get to know the personality of your players. I have a player who tends to fall over readily when an opposition player makes contact with him. Over the two years working with him he has gained us a number of penalties. Though I am always aware of what is going on I am overall slower to prepare myself to go out onto the field when he goes down. Finally build a relationship with your coaching staff. I find it best when working with a new coach to explain your thought processes to them – “based on my experience if this player misses training this week they are 95% likely to be able to play this weekend, but if they train they may be out of action for the next week”. Distinguish between if

it is dangerous to play them e.g. they are concussed, or they will just be sore. If you are working in a tournament situation with multiple games per day over consecutive days then this is a challenge. It can become a case of if we rest them today they will be OK for the final, but if don’t do well today we won’t make the final. However the health of the athlete is always your primary concern and not the season result. This is where our view point differs from the coaching staff. Player welfare is also the area I sometimes have discussions with the referees and their assistants. As mentioned in football, with which I am involved, we have to be called on by the referee. They then want the player moved off the pitch as soon as possible to allow play to continue. However letting us on the field sometimes takes longer than it could. I have talked with a senior doctor about this to see if there is anything in the rules that can help us, but my understanding is that there is nothing. Remembering that player welfare is paramount, my view and recommendation is that if you are concerned about the welfare of the player just go. This especially is the case for suspected head injuries. In saying this choose wisely if you do. Removing a player from the field is all about good communication. Letting the referee know you just need to assess them first and stabilise the situation generally results in a positive response. Well that’s my ramble for another issue. Remember to look out for our sideline management and acute trauma courses to improve your skills in this area.

Hamish

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Members’ Benefits

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

IT Benefits Facebook - facebook.com/SportsPhysiotherapyNZ

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

Twitter - twitter.com

@SportsPhysioNZ

We have recently added a Twitter account to our list of ways of keeping contacted with the world. Follow us and join in the conversations. Follow links through to interesting articles and hear titbits from conferences as they happen.

Podcasts - SPNZ Members Section

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

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Feature Roger Athy-Knibbs Physiotherapist for Kia Magic BSc ( Hons ) Physiotherapy Roger graduated from the University of Southampton in 1998. He has 16 years experience working in sports physiotherapy with three years in his current position with the Kia Magic. Roger took the position of team physiotherapist for London Wasps U21 in 1999 and in 2002 was elevated to head physiotherapist/medical coordinator for the senior team. Over the next five years he established one of the primary rugby medical teams at one of English rugby’s premier clubs. He also worked closely with the England rugby and British and Irish Lions medical teams. Leaving the UK in 2007 Roger moved to New Zealand with his Kiwi wife and their two children (the youngest being just 10 days old) and settled in Tauranga. He took a position as principal physiotherapist in a private practice, which gave him the opportunity to work with the BOP Steamers, BOP Cricket and BOP Netball. Roger also currently works with New Zealand Cricket, Waikato ITM rugby team, Northern Districts Cricket and Bay of Plenty Cricket.

ANZ Netball and Kia Magic The ANZ Championship launched in 2008 with 10 teams (five from Australia and five from New Zealand). It succeeded two national leagues: Australia's Commonwealth Bank Trophy (1997-2007), and New Zealand's National Bank Cup (1998-2007). Netball has the highest participation rate of any women's sport in both countries. Australia and New Zealand have dominated the international history of netball, between them winning every World Championship title since 1963. The ANZ Championship is the first professional netball competition in Australasia and the world's best netball league. The Waikato/Bay of Plenty Kia Magic are the most successful New Zealand team to play in the competition. They are the only team in the league to have made the finals every year since the competition’s inception, and are the only New Zealand team to have won the Championship - in 2012. Under a revised finals format this season the Kia Magic won the inaugural NZ Conference trophy.

the opportunity to work with the Bay of Plenty Gold team during the Lion Foundation championship, which consisted of members of the Magic team. Over the next few years I continued my involvement with BOP Netball and Magic, covering the incumbent physiotherapist for training sessions and some games during the season. In 2013 I was invited by Noeline Taurua to take the full time physiotherapy position for the forthcoming ANZ campaign. The role involved attending two to three training sessions per week with the team as well as all games both around NZ and in Australia. Over the three years that I have been with the team my role has developed considerably. What are your roles with the team? When I first became involved with the team my role was to manage player injuries and court-side cover at training and game day. My role has grown since then to: 

Game day physiotherapy including court-side cover, pre- and post-game treatment

How did you become involved in your current role?



Post-game and training recovery sessions

During the inaugural ANZ championship campaign one of the Tauranga based players picked up a significant ankle injury. She came to me for treatment and rehabilitation, and despite being initially told that the injury would end her season, she returned to play in the finals series. This introduced me to the Magic environment and netball. Later during the year I then got



Liaise with the strength & conditioning trainer on player management through the week



Management of medical provisions



Injury management and rehabilitation of all franchise players from time of injury to return to playing CONTINUED ON NEXT PAGE

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Feature Roger Athy-Knibbs Physiotherapist for Kia Magic continued... 

Liaise with coaching and fitness staff to ensure players are in peak condition for championship games

 Weekly management meeting  Perform pre-signing medicals  Carrying out pre-season screening  Develop and maintain close relationships with consultants and other medical experts  Make referrals to consultants and other medical professionals  Preparation of end of season medical report  Communicate with the Silver Ferns medical team for international squad members

What are your specific areas of interest/research? I am currently in the process of completing my Masters of Health Rehabilitation and writing my thesis on tibialis posterior assessment. The function of this muscle has been widely recognised to provide mid-foot stability and maintain the medial longitudinal arch of the foot. Dysfunction has been demonstrated to lead to acquired adult flat foot or Pes Planus, however in recent years its role in medial ankle stability and function though the gait cycle has also been acknowledged. With ankle and foot injuries being commonly seen in netball, the role of this muscle is important to understand in both prevention and rehabilitation. What are the types of injuries you commonly see? ANZ netball has brought new challenges for all the

players, from young up and coming players to seasoned internationals. The demands placed on each player have increased significantly, and the pace and physicality of the game has meant that all the girls involved with each franchise now undertake regular weights and speed and agility sessions. Players are therefore fitter, faster and stronger, and consequently injuries are now often more traumatic in their nature. Jumping related injuries are most commonly seen. Ankles are often the most affected, but we have also seen a significant increase in the number of ACL injuries. The physical nature of the modern game has increased the close contact of the players throughout the court, so it is not uncommon for a player to step on an opponent’s foot, and it is under these situations that inversion injuries occur. Include the extra pace that the game is played at and these injuries become significantly traumatic. Whilst lateral ligament injuries are the most common we are certainly seeing more episodes of high ankle sprains (anterior inferior tibiofibular ligament), and posterior impingement problems. We have also seen a rise in the number of achillies tendon injuries ranging from tendonopathy to rupture. The change of loading through the knee joint has seen an increase in injuries such as ACL ruptures, patella tendonopathy and MCL injuries. A major factor in these injuries is the increase of speed and agility of the players. The most important skill any netball player has to master is the ability to stop within one step once the ball is received. With the modern evolution of the game and the players’ ability to move faster over a smaller area, the physical demands that are being placed on knee and ankle joints are significant, especially when having to decelerate from such high speeds so quickly. Upper limb injuries are not commonly seen in netball, but we are seeing players going into games with strapping applied to their shoulders and wearing supportive garments for elbows and wrists, again demonstrating that the physical demands of the game are resulting in injuries that have not been a part of the game previously. What do you think are the key elements in successfully preventing and managing injury? Pre-season screening is a tool that is useful for gaining an appreciation of the current status of each player. It allows me time with the player to evaluate any dysfunctions or weaknesses present. From this information the trainer and I will put together prehab programmes to address these issues. CONTINUED ON NEXT PAGE

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Feature Roger Athy-Knibbs Physiotherapist for Kia Magic continued... Understanding the demands that are required for each player is equally important and in some ways contributes more greatly to how we prevent and manage any injury. With the demands that are placed on the players both on and off the court, understanding and having a handle on their ongoing physical and mental status is a major factor in preventing injury. Players often pick up injuries when both physically and mentally tired, so if we can limit this by managing their training loads and court time, it means we get the best out of them as well as limiting risks of picking up injuries. Injury education, management and intervention are other important tools that we use. My approach to injury management is to be proactive and not reactive where at all possible. We can never account for those one off events that cause injury such as an achillies or ACL rupture, but if a player pulls up with a lower back spasm or a tight calf due to compensatory actions of joint restrictions, then their problem has not been managed well. All players who play for the Kia Magic are educated to identify and discuss any stiffness, soreness or pain and not to assume that it will heal itself. From this, treatment intervention and management can be planned, to keep them playing and preventing deterioration into a more serious issue. Who else is involved in the â&#x20AC;&#x153;supportâ&#x20AC;? team that you communicate with and how do you integrate with them to optimise injury prevention and rehabilitation? One of the areas that we pride ourselves on as a management team, is our communication and how we manage to get the best out of all the players. Regular contact with our trainer allows us to modify programmes to suit injury status, and withdraw players from programmes and training if required. We discuss week prehab programmes ensuring that we are progressing their development and limiting the risk of injury. I regularly talk to our head coach reporting on player

injury/health status. We discuss their wellbeing, training schedule, work load for the next week, and demands of travel, especially when going to Australia. This not only ensures the players are peaking each week for games but also minimising the risk of injury. What are the key attributes you feel are required to work with elite level athletes? Understanding, knowledge and hard work. It is obviously important to understand the sport you are working in but as a physiotherapist it is equally important to understand the players you are working with. How do they manage themselves, their injuries, their time? How do they prepare for a game, do they have any special requirements such as stretching, strapping in a certain way, is there any medication that they are reliant on such as asthma inhalers? These are important aspects that help them to perform at their best. Injured players will always want to be back playing the next day. They will test your knowledge of the anatomy of the injury, they will demand a progressive rehabilitation programme and as they draw closer to full fitness, they will push to return to playing. Without knowledge of the injury and the rehabilitation process you risk returning a player to play too early and re-injury. Knowledge and understanding of the sport allows the physiotherapist to deliver injury management more proficiently. Be prepared to work hard and long hours, being the physiotherapist for an elite netball team requires many hours of travel, to training and games. There is also planning and implementing treatment and rehabilitation programmes, attending team and management meetings and all of the administration requirements, such as writing notes and letters to doctors. For most physiotherapists this is done as well as working in their normal day jobs. But the buzz from coming together as a team and winning in a tough professional sporting environment makes it well worth it.

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Planet of the Apps Your monthly App review by Justin Lopes - Back To Your Feet Physiotherapy, SPNZ executive member. Hi, This month’s newsletter has a focus on netball injuries and I was tasked to find an app which would help injured netballers… Challenge accepted! Fortunately, whilst scrolling through my twitter feed, a tweet from BJSM popped up describing just such an app: ANKLE; an app designed by a research group within the Department of Public and Occupational Health at the VU University Medical Center in Amsterdam. The Ankle app is a research based proprioception retraining programme which patients can download that will prescribe them an eight week set of exercises. The exercises do include a wobbledisc but the app says you can find another suitable unstable surface (such as a pillow). You set up a reminder for your three sessions per week, and the app gives you the progressions, along with animated figures demonstrating how to do the exercises.

App: Ankle Seller:

VU Medisch Centrum Divisie VI Beheer BV

Category:

Health & Fitness

Updated:

16/03/2014

Version:

2.0

Size:

30.2 MB

Language:

English, German, Northern Sami or Spanish

Website:

http://slhamsterdam.com/ankleapp-2/Rated 4+

Cost:

$1.29

Requires:

IOS 5.0 or later. Compatible with iP{hone, iPad, and iPod touch. This app is optimized for iPhone 5

What it is used for:

Preventing ankle sprains

Where to find it:

Download from Apple store

Android or Apple or both:

Apple

Pros: 

Researched based programme: you can tell your clients there is evidence that if they do the exercises their ankle will get stronger…



You set the reminder time around your schedule, and the researchers believe compliance is increased as you need to click through each exercise to demonstrate you have completed it.

Cons: 

The animated figures are a bit basic, but do demonstrate the exercises well enough. You would be able to go over technique with your clients as necessary.

How I use the app: I have given the details for the app to be downloaded along with basic instructions as a home exercise programme. We review the exercises at next session and correct any technique faults, and modify if they are getting pain. I recommend it to clients as a prevention programme, but also as a rehab programme post injury. Overall Rating:

4/5 For further discussion on this App check the SPNZ LinkedIn forum page Click here

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Planet of the Apps App: Ankle continued...

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SPRINZ

In Sickness and in Health – Making Exercise a Lifetime Partner Matt Wood measures a client’s oxygen consumption during a consultation at the Human Potential Clinic

Visitors to a special corner of AUT Millennium are using a powerful combination of medical and fitness expertise to help maximise their health in the face of serious medical conditions. The team at AUT’s Human Potential Clinic works with clients to prevent, treat and manage serious illnesses such as cancer, cardiovascular disease, diabetes and stroke. Exercise is a key focus of the holistic service, which facilitates long-term lifestyle changes and supports people in adopting health promoting habits. Research shows physical activity is clearly linked to better outcomes for those with ill health, or classic precursors such as elevated blood pressure. Physically active cancer survivors, for example, have been found to experience 50% lower mortality than survivors who don’t regularly exercise. Research also points to the value of individually tailored exercise programmes. Evidence shows that following a bespoke exercise plan, based on advanced fitness assessments, offers vastly better health benefits than the generic, low to moderate intensity programmes typically prescribed to patients with health concerns. Clients visiting the Human Potential Clinic undergo labbased exercise assessments, before having a safe exercise level identified, discussing their exercise preferences and obstacles, and receiving a bespoke fitness plan. They then work with expert staff on an ongoing basis, to help stay on track towards achieving and maintaining their health goals.

By using a sophisticated suite of testing and equipment, and working closely with referring medical practitioners, the team gains a clear picture of each client’s health risks and is able to develop fitness programmes offering maximum health benefits. This assessment approach leapfrogs the rough gauges people often revert to without specialist help, such as Body Mass Index (BMI) and waist circumference as indicators of health risk and progress. “These measures are a country mile off the insights we gain through specialised testing methods,” says Matt Wood – Exercise Physiologist and Manager of the Human Potential Clinic. “Cardiovascular fitness has profound predictive ability. We’re able to test this at safe levels – without pushing clients to their maximum limit – using respiratory gas analysis equipment,” he says. With cardiovascular fitness the single greatest modifiable risk factor in achieving longevity, the Human Potential Clinic hopes to make a significant difference to the lives of clients and their families. The Clinic team currently works with clients on an individual basis, but is in the process of developing a new group service. Clients will benefit from individual assessment and consultation, with the addition of group exercise classes – a move that will allow Clinic staff to reach more people, without sacrificing the level of service they receive. The new group classes are expected to launch later this year.

http://www.autmillennium.org.nz/health-and-fitness/clinics/hpc

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ASICS Grants Asics Education Award - Winning Recipient The winning recipient of the above award for March 2015 is Dr Gisela Sole, Senior Physiotherapy Lecturer from the University of Otago. This recipient has satisfied the Education Committee of the criteria for application as per the SPNZ Education Awards Terms and References. Gisela is attending the Australian Physiotherapy Association (APA) conference on the Gold Coast, Australia, in October 2015. An abstract has been accepted for presentation by Gisela on behalf of an Honours student, Arlene von Aesch, entitled “Management of Anterior Cruciate Ligament (ACL) injuries: physiotherapist’s perspectives”. The project was awarded the 2014 SPNZ award for the best undergraduate research study at the University of Otago and the paper is currently under review at “Physical Therapy in Sport”. The conference will also allow networking opportunities in related fields and updating current clinical and research trends. We will look forward to the report on this conference which will be published in the SPNZ bulletin. The next round of applications closes on 31 August 2015. All members are encouraged to view the Terms and Conditions of this award available on our website at sportsphysiotherapy.org.nz.

SMA Conference Grant - Winner

Congratulations to Adam Letts Winner SMA Conference Grant

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Clinical Section - Article Review Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains Robray L Martin,PT,PhD; Todd E Davenport,DP; Stephen Paulseth,DPT,MS; Dane K Wukich,MD; Joseph J Godges, DPT,MA Journal of Orthopaedic and Sports Physical Therapy September 2013/Vol 43 (9) A1-A40 Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of The American Physical Therapy Association The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments. The purpose of these clinical guidelines is to: 1. Describe evidence-based physical therapy practice 2. Classify and define common musculoskeletal conditions using World Health Organisations terminology 3. Identify interventions supported by current best evidence Content experts were given the task to identify impairments of body function and structure, activity limitations, and participation restrictions described using International classification of Functioning, Disability and Health (ICF) that could; (a) categorise patients into mutually exclusive impairment patterns on which to base intervention and (b) serve as measures of changes in function over a course of treatment. The second task was to describe the supporting evidence for the classification. Individual clinical research articles were graded according to criteria described by The Centre for Evidence-based Medicine, Oxford, UK198 (Table of Levels of Evidence Page A5) The strength of the evidence supporting recommendations made in the guidelines were graded (Table of Grades of Evidence Page A5) The Orthopaedic Section, APTP, selected consultants to review these clinical practice guidelines which were then edited utilising the reviewers comments. This guideline has chosen to classify lateral ankle sprain into two categories: 1. acute lateral ankle sprains (within 72 hours post injury or pain/swelling/limited weight bearing/overt gait disturbance) 2. ankle instability (post- acute or instability/weakness/limited balance responses/swelling) Uniformly applied criteria to diagnose chronic ankle instability has not yet been developed. IMPAIRMENT/FUNCTION-BASED DIAGNOSIS Incidence Physically active individuals, particularly those who participate in court and team sports 86, are at higher risk than the general population. The overall incidence of lateral ankle sprain may be underestimated as approximately 50% do not seek medical attention after injury12,177,224 Pathoanatomical Features The lateral ligaments of the ankle complex are potentially injured with an inversion or supination mechanism. Structures other than the ligaments can be injured and may contribute to chronic instability. These include subtalar ligaments, peroneal tendon, nerve injury, retinaculum, inferior tib/fib ligament, osteochondral lesions and neuromuscular elements. CONTINUED ON NEXT PAGE

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Clinical Section - Article Review Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains cont... Clinical Course Acute lateral ankle sprains can vary greatly in their presentation with respect to the amount of oedema, pain, range of movement (ROM), and loss of function, +/- sensorimotor deficiency (proprioception, reflex reactions, postural control, alpha-motor neuron excitability, strength). Sub-acute phases often present with stiffness, swelling, decreased function and instability. Post-acute is characterised as mechanical instability (increased joint motion of the talar or sub-talar joint) or functional instabiblity (normal joint motion with perceived instability due to sensorimotor or neuromuscular deficits). The factors that determine prognosis following acute lateral ligament sprain have largely been unidentified. However, having high levels of activity (3 times or more per week) and not receiving appropriate treatment after injury may be related to increased likelihood of residual symptoms 11,63,128,175,184,261,268. Surgical intervention may be indicated if conservative treatment is ineffective. There was insufficient evidence to recommend surgical or conservative treatment, however, surgery appeared to decrease the prevalence of re-injury potentially at the expense of increased risk to developing osteoarthritis. Risk Factors Risk factors for acute lateral ankle sprain are categorised as being intrinsic or extrinsic and may be different from ankle instability. Clinicians should recognise the increased risk of acute lateral ankle sprain in patients who: 1.

Have a history of previous ankle sprain

Do not use an external support

Do not warm up properly with static stretching and dynamic movement

Have reduced ankle dorsiflexion range

Do not participate in a balance/proprioceptive prevention

Clinicians should recognise the increased risk for developing ankle instability in patients who: 1.

Have increased talar curvature

Are not using external support

Did not perform balance or proprioception exercises following acute lateral ligament sprain

Risk factors predicting ankle instability are not well documented. Classification Traditionally, ankle sprains are graded I,II, and III to represent the extent and severity of ligament damage. 163 Clinicians should use the clinical findings of level of function, ligamentous laxity, haemorrhaging, point tenderness, total ankle motion, swelling, and pain to classify a patient with acute lateral ankle sprain into the ICD category of sprain and the associated ICF impairment-based category of ankle instability and movement impairments. Clinicians may incorporate a discriminative instrument, such as the Cumberland Ankle Instability Tool 116 to assist in identifying the presence and severity associated with the ICD category of instability. Differential Diagnosis There are many structures that may be traumatised with an inversion force depending on the magnitude of force, direction of the force and lower limb position. Chronic ankle instability diagnosis is generally different from that of acute lateral ligament sprain. Clinicians should use diagnostic classifications other than acute lateral ligament sprain when the patient reported acitivity limitations or impairments of body function and structure are not consistent with those in the diagnosis/ classification section of the guidelines. The Ottawa231 and Bernese74 ankle rules should be used to determine whether a radiograph is required. CONTINUED ON NEXT PAGE

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Clinical Section - Article Review Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains cont... Clinicians should use diagnostic classifications other than ankle instability when the patient reported activity, limitations of impairment of function and structure are not consistent with those presented in the Diagnosis/ Classification section of this guideline. History and clinical examination are usually sufficient to diagnose acute lateral ankle sprain. For those with persistent problems, imaging is recommended. Examination Clinicians should incorporate validated functional outcome measures such as The Foot and Ankle Ability Measure (FAAM)168 and the Lower extremity Functional Scale (LEFS) 21 as part of a standard clinical examination. These should be utilised before and after interventions intended to alleviate the impairments of function and structure, activity limitations and participation restriction associated with ankle sprain and instability. When evaluating a patient in the post-acute period following recent or recurring lateral ankle sprain, assessment of activity limitation, participation restriction and symptom reproduction should include objective reproducible measures. Assessment of impairment should include objective and reproducible measures of ankle swelling, ankle ROM, talar translation and inversion and single-leg balance. Intervention Clinical Guidelines for intervention are divided in to two parts: 1. Protected motion phase (generally associated with the acute tissue healing) 2. Progressive loading and sensorimotor training phase (post-acute) Protected motion/acute phase use external support to progressively weight-bear based on severity of injury, phase of tissue healing, required level of protection, extent of pain and, patient preference. Clinicians should use manual therapy procedures within pain free movement to reduce swelling, increase pain free mobility and normalise gait patterns75,97 in treatment of acute lateral ankle sprains. There is moderate evidence both for and against the use of electrotherapy for management of acute ankle sprains. Clinicians should implement rehabilitation programs inclusive of therapeutic exercises for patients with acute lateral ligament sprain24,258,123,16 Clinicians should include manual therapy procedures such as graded joint mobilisation, manipulation, and mobilisation with movement, to improve ankle dorsiflexion, proprioception and weight-bearing tolerance in acute lateral ankle sprain252,271,41,196 In individuals with functional instability, hip muscle recruitment patterns are altered 18,29,30 Clinicians may include therapeutic exercises and activities for getting hip and trunk muscle coordination, strength and endurance in the post-acute period in comprehensive rehabilitation programs. Clinicians can implement balance and sports-related activity training to reduce the risk for recurring sprains but there is no significant difference in ankle sprain incidence between groups receiving balance training 11,243 and sports related activity training and subsequent sprains.

Summary Creating evidence-based practice guidelines for orthopaedic physical therapy management of patients with acute lateral ligament sprain and ankle instability set a standard of medical care. The ultimate clinical procedure or treatment plan is dependent on the clinical data presented by the patient, the diagnostic and treatment options available and the patientâ&#x20AC;&#x2122;s expectations, values and preferences. A full summary of the recommendations of these clinical practice guidelines can be found on Pages A29-30.

Reviewed by Pip Sail, Physiotherapist

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Continuing Education

SIDELINE MANAGEMENT (SPNZ LEVEL 1 COURSE) This course is for registered physiotherapists who work with individual athletes, or on the sideline at sports games or events who want to upskill in the areas of pre-game preparation, first aid, acute injury assessment and management, and post-event recovery strategies. By the end of the course you will have all the tools you need to manage pre-event preparation, post-event recovery and to confidently assess, manage and refer common sporting injuries and wounds. Location: Physiotherapy Department Burwood Hospital Click for Google map 255 Mairehau Road Christchurch

Date: Saturday 3rd October 2015 9am – 5pm

Course Fee: SPNZ Member $405.00 PNZ Member

$486.00

Sunday 4th October 2015 8am – 4.30pm

Non-PNZ Member

$607.50

The course will cover:  Ethics and professional issues in sports Physiotherapy

 Splinting of hand and finger injuries

 Pre-event preparation and warm-up

 Indications for medical and radiology referral

 Strapping

 Return-to-play decision making

 Sports First Aid

 Post-event recovery

 On-field injury assessment

 Anti-doping regulations and banned substances

 Concussion assessment and management

Presenters: Dr Deb Robinson (Sports Medicine Physician – former All Blacks doctor & current Crusaders doctor) Angela Cadogan (Physiotherapy Specialist – Musculoskeletal) Kim Simperingham (Strength & Conditioning) John Roche (Physiotherapist Canterbury Crusaders & ITM cup) Craig Hawkyard (Hand Therapist) Drug Free Sport NZ

To Register: Registration will be limited to the first 25 paid registrants Complete the attached Registration Form and return to Physiotherapy New Zealand Fax 04-801 5571 or Email: pnz@physiotherapy.org.nz

PAGE 17

Continuing Education Upcoming courses and conferences in New Zealand and overseas in 2015. For a full list of local courses visit the PNZ Events Calendar For a list of international courses visit http://ifspt.org/education/conferences/

LOCAL COURSES & CONFERENCES When?

What?

Where?

27 September 2015

Stability Plus Pilates - Foam Roller

Auckland

28 September 2015

PhysioScholar - Examination of the Hip and Groin

Nationwide

17-18 October 2015

NZMPA - Mulligan Concept Part B

Auckland

13-15 November 2015

Otago Branch - Southern Physiotherapy Symposium 7

Queenstown

14-15 November 2015

Clinical Gait Assessment - A step in the right direction

Auckland

21-22 November 2015

NZMPA - Mulligan Concept Part B

Wellington

APA CPD EVENT FINDER SPNZ members can now attend APA SPA (Sports Physiotherapy Australia) courses and conferences at APA member rates. This includes all webinars and podcasts (no travel required!). To see a full list visit the APA and SPA Events Calendar

APA SPA COURSES & CONFERENCES When?

What?

Where?

28 August 2015

Rehabilitation in Elite Sport

Richmond, VIC

3-6 October 2015

Australian Physiotherapy Association - Connect Conference 2015

Gold Coast

21-24 October 2015

Sports Medicine Australia Conference

Sanctuary Cove

21 October 2015

Load Management in Lower Limb Bony Stress Reaction/Fractures

Eight Mile Plains, QLD

PAGE 18

Research Publications JOSPT www.jospt.org

JOSPT ACCESS

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

Volume 45, Number 8, August 2015

MUSCULOSKELETAL IMAGING Fracture of the Scaphoid During a Bench-Press PERSPECTIVES FOR PATIENTS Running: Improving Form to Reduce Injuries RESEARCH REPORT Gait Retraining for Injured and Healthy Runners Using Augmented Feedback: A Systematic Literature Review Lumbar Traction for Managing Low Back Pain: A Survey of Physical Therapists in the United States Diagnostic Accuracy of the Slump Test for Identifying Neuropathic Pain in the Lower Limb Baseline Examination Factors Associated With Clinical Improvement After Dry Needling in Individuals With Low Back Pain Atrophy of the Quadriceps Is Not Isolated to the Vastus Medialis Oblique in Individuals With Patellofemoral Pain Dynamic Balance Deficits 6 Months Following First-Time Acute Lateral Ankle Sprain: A Laboratory Analysis Impact of Varying the Parameters of Stimulation of 2 Commonly Used Waveforms on Muscle Force Production and Fatigue BRIEF REPORT Responsiveness and Minimal Clinically Important Change: A Comparison Between 2 Shoulder Outcome Measures

PAGE 19

Research Publications British Journal of Sports Medicine www.bjsm.bjm.com Volume 49, Number 16, August 2015 WARM UP Comprehending concussion: evolving and expanding our clinical insight Michael Makdissi, Jon Patricios http://bjsm.bmj.com/content/ Is tendinopathy research at a crossroads? Lorenzo Masci http://bjsm.bmj.com/content/ REVIEWS Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis S R Filbay, A G Culvenor, I N Ackerman, T G Russell, K M Crossley http://bjsm.bmj.com/content/ Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: a systematic review Andrew J Gardner, Can Ozan Tan, Philip N Ainslie, Paul van Donkelaar, Peter Stanwell, Christopher R Levi, Grant L Iverson http://bjsm.bmj.com/content/ Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis Anne Martin, Claire Fitzsimons, Ruth Jepson, David H Saunders, Hidde P van der Ploeg, Pedro J Teixeira, Cindy M Gray, Nanette Mutrie http://bjsm.bmj.com/content/ ORIGINAL ARTICLES Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries John W Orchard, Peter Blanch, Justin Paoloni, Alex Kountouris, Kevin Sims, Jessica J Orchard, Peter Brukner http://bjsm.bmj.com/content/ Current hydration guidelines are erroneous: dehydration does not impair exercise performance in the heat Bradley A Wall, Greig Watson, Jeremiah J Peiffer, Chris R Abbiss, Rodney Siegel, Paul B Laursen http://bjsm.bmj.com/content/ Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced change evident using the Finnish registry study Ville M Mattila, Tuomas T Huttunen, Heidi Haapasalo, Petri Sillanp채채, Antti Malmivaara, Harri Pihlajam채ki http://bjsm.bmj.com/content/ The effect of eccentric exercise in improving function or reducing pain in lateral epicondylitis is unclear Irene L C Heijnders, Chung-Wei Christine Lin http://bjsm.bmj.com/content/

PAGE 20

Classifieds LINCOLN SportsMed Lincoln Physiotherapist – Full Time As part of the MOTUS Health Network, SportsMed Lincoln is a clinic doing things a bit differently and we’re looking for a physiotherapist with a strong commitment to customer focused care to join our team. We believe great outcomes for our customers start with great teams of well supported professionals, and that’s why we put a lot of work into making sure you have the resources, mentoring, development opportunities, and clinical exposure to make every day just that little bit easier. We’re confident that our guaranteed base salary, generous ongoing professional development allowance, access to our incentive scheme, comprehensive in service program, along with access to colleagues with post-graduate qualifications and experience as mentors offers a unique experience for physiotherapists looking for that something extra. As well as the usual busy and varied workload, the multidisciplinary capabilities within the MOTUS Health Network enhance customer care, as well as offering a fantastic learning environment for our clinicians. We are looking for a person with a positive, ‘can do’ attitude, a great sense of humour and the ability to work with a wide ranging customer base, offered by a semi-rural environment. If this sounds like you, then we would love to have you on our team! Please enquire in complete confidence to Amy Bourne abourne@pmg.management

TAURANGA / BAY OF PLENTY Back In Action Physio Full Time Physiotherapist Immediate start EXCITING OPPORTUNITY Are you passionate about physiotherapy and helping people? Email or call us NOW at Back In Action Physio. Come to sunny Tauranga and work in practices where we have longer treatment sessions, associations with gym and doctors, regular in-services and a manageable patient load. We need a full time physio to work with our team. Hours of employment are negotiable. We have an extensive mentoring programme and are continually sharing our knowledge. Check out our website www.biaphysio.com for more information and email Leanna at leanna@biaphysio.com . Come and join us for some fun and adventures in the Bay of Plenty.

Contact Details: leanna@biaphysio.com Deadline: none