August 2016 SPNZ bulletin

SPNZ BULLETIN PAGE

Feature Thinking Safety in Sport

Issue 4 August 2016

Members’ Benefits SPNZ Education Fund

SPNZ Course The Upper Limb in Sport

FEATURE TOPIC: Safety in Sport

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

Hamish Ashton

Secretary

Michael Borich

Treasurer

Timofei Dovbysh

Website

Blair Jarratt

Sponsorship

Bharat Sukha

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Timofei Dovbysh

Committee

Monique Baigent Rebecca Longhurst Justin Lopes

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available twice a year with application deadlines being 31 August 2016 Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing education in the fields of sports and orthopaedic physiotherapy.

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

An application form can be downloaded on the SPNZ website sportsphysiotherapy.org.nz.

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Contents FEATURE TOPIC: Safety in Sport

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

2

EDITORIAL

By SPNZ President Hamish Ashton

4

MEMBERS’ BENEFITS SPNZ Education Fund

5

FEATURE

In this issue:

Thinking Safety in Sport by Peter Cammell

6

SPECIAL REPORT Roadshow Feedback From our Members

10

PLANET OF THE APPS Get Home Safe

12

SPRINZ Gait Retraining… the Evidence is Here

13

CLINICAL SECTION- ARTICLE REVIEW Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in its Management

15

CONTINUING EDUCATION The Upper Limb in Sport - SPNZ Level 2 Course

17

SPNZ Level 1 and 2 Courses

18

Workloads and Injury Workshop

19

RESEARCH PUBLICATIONS JOSPT Volume 46, Number 8, August 2016

20

BJSM Volume 50, Number 16, August 2016

21

CLASSIFIEDS Job Vacancies

22

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Editorial Hamish Ashton, SPNZ President Hi all There have been a number of key things happen in our profession recently that affects us not only as SPNZ members but as PNZ members as well. Firstly, there have been a number of email communications from the Physiotherapy Board in the last few months concerning the increased number of complaints made against physiotherapists. Though a number of these are for competency issues, an increasing number are for conduct or ethical issues. For SPNZ members, especially those working closely with teams or athletes maintaining ethical standards is very important. The Board states …

“You may find it useful to refresh yourself with the expectations of ethical practice in the ‘Physiotherapy Code of Ethics and Professional Conduct’, which is published jointly by the Board and PNZ.” It will also be worthwhile reviewing the SPNZ Sports Physiotherapy Code of Conduct, as it covers areas that are not described in the Physiotherapy Code. Maintaining our standards of practice, both competency and ethical, are vital for the reputation of our profession. Unfortunately, when the public hear of a negative event involving a physiotherapist, it is the profession, not just the individual that is brought into the spotlight.

I would strongly advise you all to approach any colleague that is pushing the ethical boundaries and remind them about what is expected, and not just turn a blind eye thinking it’s not your problem, because ultimately it is.

You have hopefully seen and heard about the PNZ roadshows that are happening at present. Though a number of them have already happened there are more to come in some regions of the country. PNZ is looking at a change of governance structure and that affects us as a SIG, and you as a member of PNZ. I have been to two local ones so far to hear what PNZ have to say, as well as to hear member opinion on the changes, as SPNZ will be petitioning PNZ on the changes. What I find is very disappointing is that at least three so far, there have only been about 20 physiotherapists turn up, and a large majority of those attending were in the older age bracket. To the younger physiotherapists out there, and indeed to all, attend, question and have your say, as this process and possible change will affect you and how you practice.

Finally, I must make comment on the SPNZ BJSM Roadshow that has recently happened. For those of you that didn’t attend you missed quite an event, as the reviews later in the bulletin will attest to. The idea for the Roadshow came from Karim Khan, with his BJSM editor’s hat on. Part of our agreement with BJSM is for them to help promote us as the New Zealand sports physiotherapy group to New Zealand and to the world, and I am sure you would agree he did this, not just with the having him and Jill Cook here but also with his ongoing mentions on Twitter.

By the end of the five lectures and two clinic visits we had over 500 physiotherapists attend. I think that this was a huge achievement by SPNZ and a big thank you must go out to you, our members, as except for Auckland, we had sellouts everywhere we went. We did hear from a number of physiotherapists late in the piece that they had been a bit slow and had missed out. To them, we did try to find bigger venues, but without going to a commercial venue at 10 times the cost we were not able to do so. SPNZ has a strong commitment to affordable, but quality CPD activities and if we had gone commercially, the price for a two hour lecture would have been unacceptable to us. Next time get in a bit quicker so you don’t miss out.

The talks also gave us the opportunity to meet and hear from a number of our NZ High Performance physiotherapists. I was lucky to attend three venues, and listening to them speak, really demonstrated the quality of talent we have in New Zealand, and some of the research that is happening here. From feedback thus far it is something we may do again in the future. If you have any suggestions of who to bring out let us know.

Hamish

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Members’ Benefits

Sports Physiotherapy New Zealand $$$$ EDUCATION FUND $$$$$$ For grants to members of the SPNZ who wish to attend courses or conferences that are relevant to the field of sports physiotherapy for the furtherance of education in sports physiotherapy.

$1000 per half year is available in a contestable fund.

Applications must be received by 5 pm

on the 31st March or 31st August prior to the period when the award is proposed to be taken up.

For details and an application form http://sportsphysiotherapy.org.nz/members/education/

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Feature Thinking Safety in Sport PETER CAMMELL

Ernest Hemingway famously said, “There are only three sports: bullfighting, motor racing, and mountaineering; all the rest are merely games".

Over the past four decades, I have made the latter my passion.

Mihaly Csikszentmihalyi states that we all need to get into a state of flow from time to time. He defines flow as the state of mind where one is able to attain total involvement in something. Time, therefore, vanishes and one is left with a sense of achievement, joy, creativity and satisfaction. Some get there by reading a book or going for a run. I however crave the mountains and other high risk and life-challenging pursuits.

Unfortunately these ‘flow-inducing’ sports are dangerous.

Mountaineering generally makes the news when there is a fatality. Over the years, I have had my fair share of near misses. Survival has taught me a great deal, specifically that luck cannot be relied upon in the mountains. I have therefore developed a system for understanding and assessing risk which I believe can be useful for others.

Mistakes happen in mountaineering

Mistakes happen in mountaineering, healthcare, performance sport, recreation and daily life. In this article I will attempt to explore a systematic approach to improve decision making under extreme circumstances.

Four useful aspects of decision making are System 1 and System 2 thinking, FACETS, Transitions and Checklists.

System 1 and System 2 Thinking In daily life, our brains receive vast amounts of information. Often we take shortcuts when processing this information, and these can lead to errors. Research

by Kahnemann et al proposed two types of thinking and called them System 1 and system 2.

...and in competitive sport

System 1 (fast thinking) allows us to function by making sense of a lot of information quickly. System 1

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Feature Thinking Safety in Sport continued...

decisions are made automatically, for example, driving a car while changing the radio station as well as enjoying the view and not crashing. It’s involuntary, effortless and quick. It is usually correct, adaptive and useful but may be fooled in certain situations.

System 2 (slow thinking) complements, helps and checks System 1. We use it for complex tasks and problems such as reading an exam or calculating mathematical equations. We must consciously choose to activate System 2. Because the task load is high, it is tiring and difficult to sustain. Overuse of System 2 can blind us to other stimuli, for example, being engrossed in a book and ignoring that a tap is running and the sink is overflowing. Our System 2 thinking has attentional capacity limits. The limits are affected by factors such as task load, for example, a cricketer can only hold the fiercest focus for a fraction of time when facing a fast bowler or a tennis player when receiving a serve.

Fatigue, hunger and thirst affect attention as well as distractions and anxiety.

2. FACETS In addition to our System 1 and 2 thinking, we have individual internal bias or the human factor. These make the acronym FACETS which stands for: Familiarity, Acceptance, Expert Halo, First Tracks and Socialisation.

I will use a real experience that I have observed to demonstrate how easy it is to miss key signals when managing human bias or FACETS. The following events unfolded and I eventually intervened before any harm could occur.

A recent snowcraft training course at Mt Ruapehu had 24 novice climbers and 10 instructors, divided into four equal groups. The weather was stable but the snow conditions presented a considerable avalanche hazard (meaning human triggered avalanches were likely and natural avalanches possible).

Familiarity: After the morning briefing and equipment check, the group walked out of the hut and within 500m had entered an avalanche terrain trap (an area where avalanche debri accumulates). When the climber in the lead was challenged as to why this route was chosen, he replied they had been there two weeks ago and it was ‘ok’. However, the snow conditions at this time were different and the hazard had therefore changed. Because the leader was familiar with the terrain he failed to stop and assess the area before entering. There are parallels with driving, for example, approximately 52 percent of all motor vehicle accidents occur within a five-mile radius and 69 percent of all motor vehicle accidents occur within a ten-mile radius of home. This suggests that drivers tend to have a false sense of security when driving close to home, or in familiar areas, and pay less attention to hazards or changes in their surroundings.

Acceptance: The rest of the group, novices and Instructors alike accepted the decision of the leader and followed on into the terrain trap without thought.

Commitment: The snowcraft courses involve a huge financial, time and effort commitment. This group had travelled from Auckland, undergone hard training,

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Feature Thinking Safety in Sport continued... invested in equipment, and were keen to proceed. They were committed to the weekend.

Expert: I arrived late and met the group that morning. I was recognised as having climbed Mt Everest and was therefore deferred to as the ‘expert’. This was irrelevant as I was not leading the group.

Tracks/Scarcity: There was urgency amongst the group to be first onto the new snow. First tracks are scarce but highly prized and when time is short, real risks such as avalanche danger may ignored.

Social: The group were excited that morning, and talked as they walked. They were socially distracted and failed to observe the shift in risk as they approached the avalanche terrain trap.

3. Transitions Transitions represent a crossroad, a moment in time, when circumstances change and should trigger us to stop, look, listen and feel what is occuring that could affect our safety and enjoyment. Some recognise transition zones from experience but novices have no context and may find a checklist helpful.

As the snowcraft group moved from low-angled and low risk terrain to steeper and higher risk terrain, they entered a transition or decision point moment. At this point, I alerted the lead climber to the impending avalanche hazard. After discussion, an alternative safe route was agreed.

We have identified the strengths and limitations of System 1 and 2, the bias of FACETS and the situational awareness of transitions. What solutions do we have to guard against their impact?

The solution that I have found useful is the Shared Mental Model and the conscious activation of System 2 with the use of specific Checklists.

The concept of shared mental model is a tool to get all of the group ‘on the same page’. The process involves verbalising via a pre-activity briefing the decision making process, ensuring everyone knows the plan, discussing goals and incentives, encouraging dissent, identifying concerns and exploring them and group commitment to the process.

So how might the participants have used this model to identify and manage the avalanche hazard that existed?

Still using the example of the snowcraft weekend, the Saturday morning meeting could have used Checklists to

assess and monitor changes in weather, terrain and equipment requirements and hazards. Using the concept of collective responsibility they could have discussed the plan of action, issues within group, goals and objectives and how decisions would be made on the mountain. The plan would have been written and monitored during the journey. Each group member has known that they had an individual responsibility to monitor the group as a whole to make collective decisions. A de-brief of the day would have been helpful for future learning.

In addition, Recognition that fatigue, hunger and thirst affect performance.

Transition events provide opportunities to rest, re-fuel and review the shared mental model and use Checklist prompts to observe and monitor conditions.

I use this model for recreational and professional adventures. I believe these processes are transferable to all walks of life and may be useful for health practitioners. For example, at the forthcoming Rio Olympics, achievement of a gold medal performance will be risky and affected by many variables. A shared mental model and Checklist prompted System 2 slow thinking will enable data gathering and analysis. The decisions made will improve safety, wellbeing and performance.

How can we use this knowledge to prevent injury in our sports men and women?

Understanding how we think and its influence on movement and performance is not a new concept in itself. We have recently seen how the All Blacks have improved their success rate perhaps in some part due to work done around understanding and mastering "red head" and "blue head" thinking.

Physiotherapists are frequently in a position to suggest injury prevention strategies to players and coaches.

Considering the impact of System 1 and System 2 thinking strategies may be useful in accident and injury prevention. Helping athletes recognise the need to be in System 2 thinking to avoid hazards is useful, but also to recognise they may need to stay in System 2 or go back to it after a break in intensity, until all significant hazards are gone. In mountaineering the climber will be in System 2 thinking as he makes a difficult descent and then drop into System 1 as he reunites with his climbing partners with the relief and euphoria of achieving a successful descent. Failure to switch back to System 2 for the final descent may then put him at heightened risk of accident. At this point someone in the team cueing a CONTINUED ON NEXT PAGE

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Feature Thinking Safety in Sport continued... return to System 2 is an accident prevention strategy. The skier who catches an edge on the cat track after a difficult descent is another common example of System 1 thinking giving inadequate protection when significant hazards (although perceived as low), still exist.

It is possible that awareness of these patterns could also influence injury patterns in training where the lower intensity may tend athletes towards a more casual approach and coaches or players becoming aware of the need to cue in System 2 thinking at times of risk could reduce injury. Food for thought and room for research for sure.

References/Useful Links National Highway Traffic Safety Administration Survey Coaching a Cricket Team, NZ Cricket 2004 Flow: Mihaly Csikszentmihalyi Intro to cognitive biases: http://en.wikipedia.org/wiki/List_of_cognitive_biases (just look into some of the ones in this presentation) More on system 1 and system 2: http://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman/dp/0374533555 Kahneman (and his colleague) was the psychologist that first came up with cognitive biases (and has Nobel prize for his effort). This is a relatively recent book that talks about system 1 and 2. It’s great, but relatively heavy going for many.

Matthew Harrison, Organisational Psychologist https://www.linkedin.com/in/nzmattharrison Peter Cammell Biography: https://www.linkedin.com/in/peter-cammell

My professional career is in the pharmaceutical, and health and safety adventure activity sectors. For many years I owned and operated pharmacies in Queen St, Auckland where client and staff health, safety and wellbeing often presented challenges and hazards requiring careful management.

Currently, I am a safety auditor for the adventure activity sector. I audit and consult on the Adventure Activity Regulations and Health and Safety at Work Act 2015. I am a rock, avalanche and alpine instructor, lead the NZ Alpine Club Climbing committee and Auckland instruction courses.

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Special Report Roadshow Feedback From our members During this session Jill imparted many gold nuggets but the main theme was around the introduction of isometric heavy slow loads into early tendon rehabilitation as well as the importance of reducing the compression loads on the tendon. Jill also took us through her rehabilitation progressions for the treatment of achilles and patella tendinopathies which we all found especially useful, as this population group can be tricky to treat at times.

Hands On Rehabilitation was lucky enough to win an hour with Jill Cook following her excellent presentation on the road show. She commenced the session saying that she 'didn't do anything above the waist', however the team managed to draw on her extensive global knowledge of tendonopathy to create a fun, informative and valuable hour.

Some key messages included:  Ensure that you question patients for relevant comorbidities ie insulin resistance, menopause, hypercholeresteremia, thyroid function.  Diagnostic accuracy - the importance of differentiating between tendon and peritendon  Progressive loading is essential for successful long term tendon function  Consider other anatomical structures involved in start of pathology ie hormones and retinacular thickening in De Quervains  Consider the role of medications for different pathologies ie heparinoid and topical antiinflammatory poultice for peritendonitis or poly pill for reactive tendonopathy We look forward to Jill’s future clinical advances based on the research that investigates the interplay between structure, pain, function.

Donna Hickmott

Our physio team at SportsRehab were lucky to have the opportunity to meet with Jill Cook for one hour, as a prize in the Sports Physiotherapy New Zealand roadshow. It was an hour of laughs and non-stop banter as Jill answered all our burning questions about tendons and rehabilitation of patients with tricky tendon pathologies.

Overall we all gained new knowledge and understanding of tendonopathies as well as clinically applicable ideas to use in out treatment of this patient group.

Thanks again for the unique opportunity.

All the team at SportsRehab - Phillippa Horne

"A huge thank you to Hamish and SPNZ for organizing a great roadshow event in Hamilton filled with clinical "pearls and nuggets" that we could incorporate into our daily practice from the next day.

Jill Cook's informative and easily digestible talk around tendons gave some useful insights into the benefits of isometrics as a pain relieving modality and also challenged us to focus on our assessment and clinical reasoning and question "Is this really a tendonopathy- or are there other factors at play?".

Karim Khan's discussion raised a number of interesting topics including mechnotherapy and acute:chronic workload ratio which again were off clinical value for our rehabilitative client populations that we see on a daily basis. His insights into the BJSM and the use of podcasts were valuable learnings to take away and utilize.

Craig did a fantastic job of giving us an overview of elite level rowing in New Zealand and the challenges involved, his talk tied nicely into both Jill and Karim's content in regards to workload ratio and loading of the athletes. A tough gig to talk in between two speakers with the international profile of Jill and Karim but he did the Waikato/BOP region proud with his talk and content.

Thanks also to the panel team for the Q and A session at the end of the talk, which helped provide some further clarity around some of the night's key discussion points.

Given the scope and relevance of the content and the wit and good humor it was mixed with it was well worth the trip over the Kaimais- justifiably a “sell out" Scott Illingworth CONTINUED ON NEXT PAGE

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Special Report Roadshow Feedback From our members Helen Littleworth, physiotherapist for the NZ White Ferns cricket team and NZ Para Athletics team, was our first speaker. She discussed the Functional Movement screening and training principles she uses with her athletes. We learnt about the differences in movement quality and improvements in performance following changes in training that Helen had implemented.

Pete Gallagher then discussed the integrated approach to injury prevention within the All Blacks camp. We had a day-in-the-life view of the planning and management involved in an international test series. This involves many components - players coming in from the middle of a Super Rugby campaign, previous or current injuries, planning gym and rehab sessions, managing playing and training load and returning the players back to their franchise teams.

Our last speaker was Karim Khan, presenting Jill Cook’s ‘tendon clinical pearls and nuggets’ talk. These were very helpful tips – including the cardinal signs of tendinopathies during assessment, and a quick glimpse into her treatment plan for those with the condition. Karim then discussed some research that has recently been published in the BJSM. We were all very lucky to have the opportunity to listen to such well-respected and successful physiotherapists, I’m sure everyone took a lot away from the talk and used these ideas in their own practice and in their clinics around Otago.

Jessica McCormick

Student Feedback It was great to get the opportunity to listen and learn from a world class physio leader : Jill Cook. I found her isometric exercise in standing most useful as is super easy to give to patients and they can start using it straight away anywhere for lateral hip tendonopathies. It was interesting to hear her view on the conventional "clam" exercises for PGM. My last assignment was on hip strengthening in terms of correlating with knee alignment and stability and all the papers I found made use of either variations of the clam or dynoband exercises or side lie position which she was opposed to. Either the research hasn't caught up yet or there are different schools of thought.

Sarah-Anne Jackson

I found the evening to be very informative and interesting.

The physiotherapy course at AUT is based on utilising current literature and integrating this information into both the academic part of our course and our practical skills. Being able to listen to Jill Cook and Karim Khan provided an insight, not just into recent research, but the sharp end of the research spectrum. They both presented interesting and cutting edge information, using humour and in a way that was easy to listen to and understand even with my lack of clinical experience.

Jill's descriptions of the current thinking regarding diagnosis of tendinopathy was very interesting, with the move away from the use of ultrasound for diagnosis and towards a set of rules differing from what is currently considered to be the standard method. Karim's discussion around ACL knee rehabilitation reinforced current course content surrounding physiotherapy lead rehabilitation protocols vs. surgery, but took it a step further with the discussion around the sham vs. actual surgery rehabilitation findings for the meniscectomy, we hadn't discussed that in our course as of yet.

The evening provided a snap shot of what is required for parts of our CPD as a physiotherapist in New Zealand. It is a shame that more students did not take the opportunity to come along, being so close to our exams and with tighter finances this may have been the reasons there. My partner and I are both pleased we made the effort to come along though as we both enjoyed the night.

Jared Faulkner

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Planet of the Apps Your monthly App review

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

Hi team, Given the outdoorsy them of this bulletin I was given the challenge of finding an app that would benefit mountaineers of all technical abilities. I figured there wouldn’t be too many for rock climbers as their hands would be pretty full just hanging on, and as some of the best mountaineering locations are outside of the reach of the Teleco’s strongest transmitters the only use a smartphone would be in those situations would be as a camera or torch… but boy was I wrong…There were a couple of Apps that I took a cursory glance at such as the ones that you can enter your route, estimated return time and or and then there is ‘Avanet’ which is the first global crowdsourced platform of mountain safety information where users upload photos, info of trails. Most of these were for the overseas (US and Europe) markets but there is a New Zealand version (created by a Queenstownian in 2013)– Get Home Safe App– is “an independent personal safety app that alerts your Emergency Contacts when things don’t go as planned.”

App: Get Home Safe Category:

Lifestyle

Updated:

Apr 14, 2016

Version:

1.1.6

Size:

3.7 MB

Language:

English

Seller:

Get Home Safe Limited © 2013 GetHomeSafe

Website:

www.gethomesafe.com https://itunes.apple.com/us/app/gethomesafe-personal-safety/id654865653?mt=8

Cost:

FREE (offers in app text packages) 10x SMS alerts & invites $1.99, 30x SMS alerts & invites $4.99, 70x SMS alerts & invites $9.99

Requires:

IOS 8.0 or later. Compatible with iPhone, iPad, and iPod touch, Available on Google Play.

What it is used for: Alerting people as to your location or safety. When the app is activated, GPS information is uploaded to an external server, which means alerts can be sent even if a smartphone battery dies, is out of reception range or breaks.

Users can also opt to have their location tracked in real-time. A URL with a tracking map that gets updated every 10 minutes can be emailed to someone for monitoring.

Where to find it:

Download from Apple Store, or Google Play (GetHomeSafe-Personal Safety)

Android or Apple or both:

Both

Pros: A good way to ensure people know your location when heading out into the great outdoors, or going into situations where you feel unsafe and you want people to know where you are.

There is a Duress Pin alert which can be used to trigger an emergency alert to your contacts… just need to remember which pin you set for your unlock and cancellation pin!

Easy to use, set up info that can be stored is versatile and it has some pre-entered basic info.

Cons: Could be a source of ‘false’ alarms if you don’t clear and check in when you get to your destination. There is a small charge for text alerts, however email alerts are free The app’s providers promise they have taken prudent steps to protect users information but server protection is never fail-proof and people should be careful about revealing where they lived or their daily movements. Keeping your GPS location set to off and only switching it on when needed is one way to minimise this risk.

How I use the app: I have not yet used the app in situations where I was concerned for my safety, however on trial in the mean streets of Westmere and Western Springs the location accuracy was within 10m and the email I received to notify that I had arrived home safely certainly put my mind at ease…

Overall Rating: 4/5

As always if you have a great app you would like to share, or one that you would like reviewed please send me through the details.

Cheers, Justin

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SPRINZ

Gait Retraining… the Evidence is Here

By Kelly Sheerin Abnormal biomechanics have long been proposed as a potential risk factor for running-related injuries, and over this time many interventions have been aimed at modifying these biomechanical risk factors through such approaches as the varied use of orthotics, shoes, the absences of shoes, strengthening or various combinations. Not until more recently has the potentially more logical approach of gait retraining gained traction clinically.

While there has been increasing support for this approach over the last 5-6 years, many published studies may not translate well to clinical practice due to issues with practicality, by using interventions such as real-time 3D motion analysis feedback, etc. Additionally, many have adopted a ‘one size fits all’ approach whereby all participants’ transition from a rearfoot to forefoot strike. While such approaches may have been successful for some patients, or some conditions, it’s unlikely to work for all runners, and may have in fact led to the development of new injuries.

A recent mixed-methods review published in BJSM has provided clearer evidence of running retraining for specific running-related injuries.

Barton, C. J. (2016). Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion, 1–17. http:// doi.org/10.1136/bjsports-2015-095278 Now this is not your run of the mill systematic review that’s all about statistical significance and effect sizes.

While it does include a review of 46 research studies that implemented any cue or strategy to alter an individual’s running technique, this is also supplemented by expert opinion from 16 international clinicians experienced in prescribing running retraining. The result being 20+ pages of really useful information for clinicians working in this area.

Below I will briefly examine several running-related injuries that have been proven to benefit from gait retraining; anterior exertional lower leg pain and patellofemoral pain syndrome (PFPS).

Anterior exertional lower leg pain Four studies investigating the clinical outcomes related to transitioning from rearfoot strike to either a midfoot or forefoot strike, and increased step rate, have

demonstrated a reduction in pain and compartmental pressures in runners suffering anterior exertional lower leg pain.

The experts suggest the success of this approach relates to engaging the calf muscle, which in turn assists to absorb and transfer load away from the anterior muscles of the leg. Additionally, runners who run with a lower step rate typically overstride, which promotes a rearfoot strike landing pattern.

For some runners, a successful change in foot strike pattern can be a simple focused adjustment, but this is probably the minority. Many of the experts have suggested that having runners focus on increasing their stride rate or cadence can be a more successful intervention. This can be supported via the use of adjuncts like up-beat music or digital metronomes. For others these changes can be facilitated by cuing quicker, lighter steps and increasing hip and knee flexion, if these are lacking.

Patello-femoral pain syndrome There has been long-standing evidence that increased hip adduction and internal rotation are closely linked to the development of PFPS in runners. Therefore it makes sense that re-aligning the lower limb will reduce the symptoms of PFFS, however the in practice this is not quite as simple. Many therapists adopted a strengthening intervention approach, and with good rationale, however this rarely resulted in changes to mechanics. This recent review has not only added support to the notion of changing biomechanics, but it has also highlighted that these changes can be achieved via gait retraining alone.

The experts have suggested that cuing glute engagement by having runners squeeze their glutes can successfully reduce hip adduction and in turn increase the distance between their knees. Others however suggest that taking an external focus by having runners imagine their knees are headlights, and keep them pointed straight ahead, can lead to even more positive changes. Again, real-time feedback, this time in the form of a simple mirror can fast track these changes for some. Interesting the experts agreed that transitioning from a rearfoot to a mid-foot or forefoot strike for the treatment of PFPS.

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SPRINZ

Gait Retraining… the Evidence is Here continued

By Kelly Sheerin While this review undoubtedly adds evidence and guidance for clinicians working with injured runners, what it does pay little attention to is the fact that gait retraining is actually the ‘re-learning’ of a highly complex ingrained task, and therefore is inherently linked to the principles of motor learning. To truly impact on longterm behaviour, rather than just a change in immediate

performance we need to factor in the ‘learning’, which is a whole other article in itself. Additionally, it is worth noting that much of the evidence in drawn from studies that have used healthy populations, rather than injured runners, and much of the research is ‘biomechanically’ focussed, and pays little attention to clinical application.

About the Author: Kelly Sheerin Kelly is a registered physiotherapist and biomechanist who leads the AUT Millennium Sports Performance Clinics. He has a clinical interest and expertise in running injuries and biomechanics. Kelly has a Masters degree in musculoskeletal physiotherapy, including research in 3D running biomechanics. He is currently completing his PhD in the area of real-time feedback in runners at risk of tibial stress fracture.

If you have questions on running biomechanics or the treatment of specific running injuries, feel free to e-mail me .

About the Sports Performance Clinics The Sports Performance Clinics, based at AUT Millennium, have world class facilities teamed with a highly skilled and knowledgeable team, to provide the best sports science support, irrespective of your requirements whether it be rehabilitating from injury, improving your strength and power, honing your cardiovascular fitness, or acclimatising to heat. The services on offer are grounded in research, and underpinned by the principles of AUT’s Sports Performance Research Institute New Zealand (SPRINZ). The overall paradigm is that all of the athletes and clients seen at the SPC can potentially be research subjects through various on-going studies. Thus, our research is facilitated through the services we provide, and the services are in turn improved through research.

Further information on the Sports Performance Clinics can be found here .

Physiotherapy New Zealand Conference – Pre-conference Workshop The Science and Medicine of Running Injuries Kelly will be partnering with Dr. Andrius Ramonas to run a pre-conference workshop on The Science and Medicine of Running Injuries, specifically looking at prevention strategies and a practical approach to technique assessment.

Andrius is a qualified Sports Medicine Doctor and Exercise Physiologist who is also a talented ultra-endurance runner. The workshop will cover fundamental running biomechanics, common running injuries and how they link to technique. It will also include a practical assessment guide for a range of running athletes.

There will be very limited numbers for this workshop, so if you’re interested, check out the details on the Physiotherapy NZ website.

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Clinical Section - Article Review Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in its Management Journal of Orthopaedic and Sports Physical Therapy. 45(11): 910-922.

Alison Grimaldi and Angela Feardon Synopsis Gluteal tendinopathy is now believed to be the primary local source of lateral hip pain, or greater trochanteric pain syndrome, previously referred to as trochanteric bursitis. This condition is prevalent, particularly among postmenopausal women, and has a considerable negative influence on quality of life. Improved prognosis and outcomes in the future for those with gluteal tendinopathy will be underpinned by advances in diagnostic testing, a clearer understanding of risk factors and comorbidities, and evidence-based management programs. High-quality studies that meet these requirements are still lacking. his clinical commentary provides direction to assist the clinician with assessment and management of the patient with gluteal tendinopathy, based on currently limited available evidence on this condition and the wider tendon literature and on the combined clinical experience of the authors.

ARTICLE REVIEW

Imaging

This was a timely article to review given the recent roadshow with Jill Cook. Many of the points covered were also noted by Jill Cook in her Pearls and Nuggets discussion.

“Signs of local soft tissue pathology at the greater trochanter are common in imaging of those without lateral hip pain” (as noted by Jill Cook in her roadshow presentation, you commonly have signs of tendinopathy on imaging, but this doesn’t mean it is the source of pain). Therefore diagnosis should not just be dependent on imaging. Imaging is mostly useful in excluding other causes such as lesions, or when the condition is not responding to an appropriate management programme.

Lateral hip pain is a common condition, particularly in postmenopausal women, previously it was described as Trochanteric Bursitis; gluteus medius and/or minimus tendinopathy is now accepted as the most prevalent pathology in those with pain and tenderness over the greater trochanter. The tendinopathy and in severe cases tendon tears most commonly occur in the deep and anterior portions of the gluteus medius tendon. The tendon changes seen are consistent with degenerative changes seen in other tendinopathies.

Risk Factors Few risk factors have been validated. The main two are: Female over 40 years old, and increased duration of low back pain (possibly due to possible gluteal dysfunction or poor lateral stability of the pelvis). Importantly treating the tendon-related pain has been shown to improve the function of those with low back pain.

Other factors such as anthroprometric measures are inconclusive.

Diagnosis Making the diagnosis can be difficult. Symptomatic local pathology may coexist with more distant sources. The paper includes a useful table for Differential Diagnosis in relation to lateral hip pain. Diagnoses to consider include: bony metastasis, neck of femur fracture, hip joint pathlogy (osteoarthritis, FAI, avascular necrosis), lumbar spine referral, inflammatory diseases, and extra-articular pathology (ischiofemoral impingement/quadratus femoris tear, piriformis and related sciatic nerve entrapment syndromes.

In trying to differentiate different sources the history and site of the pain are very important, especially as many orthopaedic hip tests can be used for diagnostic purposes for more than one condition. The site of pain reproduction allows site-specific evaluation.

The type of imaging most useful was up for debate, with MRI or Ultrasound both being useful, however MRI did show a number of false positives.

Pathomechanics Most commonly the gluteus medius tendon develops deep, undersurface tears. This has been hypothesized to be due to compressive loads and relative shielding from tensile loads.

(Similar to pathology in the supraspinatus tendon). “During normal daily weight-bearing function, the hip is used in low ranges of abduction, with single-leg function normally performed in slight hip adduction. The deep fibres of the gluteus medius and minimus tendons are likely to carry less tensile load in these ranges than the more superficial tendons.”

The authors looked at some recent studies trying to elucidate why it is more prevalent in women, two possible reasons were; a smaller insertion on the femur across which tensile load can be dissipated and a shorter moment arm, along with possibly a less efficient gluteus medius, thereby using increased adduction during function to provide a mechanical advantage for the abductors.

These strategies in females may increase compressive load.

The iliotibial band also has a role in compressing the muscles against the underlying bone. The pressure

increases as the hip is adducted. “Activity of the iliotibial band tensioners in a position of hip adduction may result in higher levels of compressive loading at the greater trochanter than a passively adopted position of adduction.”

Another key finding is fatty atrophy of the gluteus medius CONTINUED ON NEXT PAGE

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Clinical Section - Article Review Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in its Management continued... and minimus in those with lateral hip pain. The tensor fasica lata (TFL) was shown to be commonly hypertrophied compared to the healthy side. This suggests that changes within the abductor muscle synergy may be associated with tendon pathology.

Observably deficits present as excessive lateral pelvic tilt and/or lateral pelvic shift, often accompanied by excessive hip internal rotation. The combination of trochanteric abductor insufficiency, increased iliotibial band tensioners (e.g. TFL) and excessive use of functional adduction may represent a mechanical risk factor for the gluteal tendons.

(This is a theory only).

Findings from clinical trials.

“The best approach for clinical management of gluteal tendinopathy has yet to be elucidated.”

Studies that have been done did not show great improvement and exercise studies could probably have selected better exercises, based on more recent theories on tendon management.

A single dose of shockwave therapy seemed to have the best results at 12 month follow-up, corticosteroid was no better at 12 months than usual conservative treatment.

Proposed Physical Therapy Management Strategies.

It is important to note that these are proposed and not yet evidence based, although based on clinical experience.

The authors’ broke their management up into 3 areas: Load management, exercise therapy and management of modifiable risk factors and comorbities.

Load Management Avoid hip-adduction positions (e.g. standing hanging on 1 hip, sitting or standing crossed legged or with knees together)

provided the most provocative aspects are minimized.

Exercise Therapy Start on restorative loading in positions of minimal hip adduction. (Reduce pain and improve the tendon’s loadbearing capacity) Isometric Exercises: Isometric exercises are commonly used to manage tendon pain by activating segmental and extra segmental descending pain inhibitory pathways. The optimal loading is yet to be determined. At this stage, a low -intensity effort focused on trochanteric abductor recruitment is recommended. (See full article for detailed exercise descriptions).

Low-velocity, high tensile strengthening of the trochanteric abductors to minimize tendon compression.

Weight- bearing exercise promotes higher levels of gluteus medius activation than non-weight bearing. Moving into inner range abduction will reduce compressive load on the tendon and disadvantage the ITB tensioners.

High tensile load exercise should only be performed 3 times/week (allowing soft-tissue recovery and adaptation).

It is safest to start with a moderate level of effort and low repetitions and monitor for 24 hours, until the tendon response to loading is established. (Especially note increases in night pain).

Targeted hip abductor strengthening should be accompanied by movement retraining from basic through to higher level functions, as individually required.

As pain eases control of hip adduction under higher loads, increased speed and more complex actions can be retrained.

Management of modifiable risk morbidities

factors

and co-

Night time postures (lying supine with pillow under knees, to unload antero-lateral hip and spine, avoid side-lying or try softer overlay, pillow between knees.)

Bony morphology cannot be modified, improving function of the lumbar spine, hip and knee may all be necessary to improve control of the hip and pelvis.

Avoid hip adduction stretches (massage and needling techniques could be used instead)

Functional exercises such as bridging, squatting and steptype exercises can serve multiple purposes in improving function through the lower kinetic chain and reducing load at the hip.

Movement patterns evaluated and addressed.

Recreational of sporting activity can usually be maintained,

CONCLUSION This was an interesting article on a very topical subject. It is a condition that many of us will come across frequently and I am sure treat with varying degrees of success. The article was a useful review of what is known about lateral hip pain, and also identified the many gaps in our knowledge around the exact pathomechanics and the optimal treatment. The proposed management strategies gave good examples of exercises that can be done without any need for special equipment, which makes them clinically relevant for most of us. Hopefully someone will follow this up with some good quality clinical trials which back up the suggested exercises and advice.

In summary clinically, look for lateral hip pain and rule out any red flags. Most prevalent in females over 40 years old. Advice should centre on reducing compressive loads and altering (if necessary), but not stopping activity.

Exercise should look at isometric loading for pain-relief and then low-velocity, high tensile loading to improve muscle strength (in positions avoiding hip adduction), before moving to functional retraining and gradually moving into adducted positions. Mechanics of the lumbar spine, hip and knee may all need to be addressed to reduce compressive loads at the greater trochanter and constant monitoring of exercises to avoid aggravating the problem is important.

by Karen Carmichael, BSc, BPhty, M(SportsPhysio)

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Continuing Education The Upper Limb in Sport (SPNZ LEVEL 2 COURSE) This course is for registered physiotherapists who work with individual athletes or teams in which upper 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 upper limb conditions.

By the end of the course you will understand the pathoaetiology of common upper limb injuries, be able to perform key clinical and functional tests, rehabilitate upper limb injury in a number of sporting contexts including swimming, throwing, racket and contact sports, and develop individualised return-to-sport programmes.

Course Pre-requisite: This is an advanced rehabilitation course. As such, it is a pre-requisite for this course that all attendees have previously completed training in exercise prescription. Evidence in the form of CPD certificate or student course record is required.

Please see information regarding this on next page.

Location:

Date:

AUT North Campus (AA building)

Saturday 15th October 2016

90 Akoranga Drive, Northcote, Auckland

8.30am – 5pm

Click for Google map Click for AUT North Campus map

Sunday 16th October 2016

Course Fee: SPNZ Member

$405.00

PNZ Member

$486.00

Non-PNZ Member

$607.50

9am – 4.00pm

The course will cover: 

Pathomechanics of upper limb injury in collision sports, swimming, throwing & racquet sports



Performance-related functional tests for the upper limb



Diagnostic tests and imaging investigations for common sporting pathologies of the upper limb



Design and implementation of rehabilitation programmes and processes



Integration with coaching and biomechanics for technique modifications



Return-to-sport decision planning and processes



Injury prevention including conditioning, pacing and workload management

Presenters: Dr Angela Cadogan Margie Olds Mandy Gumbly

Physiotherapy Specialist (Musculoskeletal) Sports Physiotherapist, Clinical Educator & PhD Candidate AUT University Registered Hand Therapist

To Register: Registration will be limited to the first 26 paid registrants

Details here

Registrations - http://pnz.org.nz/Event?Action=View&Event_id=2007

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Continuing Education

Level 2 SPNZ Sports Certificate Courses These are advanced rehabilitation course. As such, it is a pre-requisite for this course that all attendees have previously completed training in exercise prescription.

Evidence in the form of CPD certificate or student course record is required - see below 1.

2.

3.

SPNZ Level 1 Promotion and Prescription of Physical Activity and Exercise A post graduate exercise paper run by a university – a copy of your academic records is required.

A 2-day course covering the principles of exercise prescription – a copy of the course objectives and outcomes along with the name of the course presenter should be provided for approval.

Any enquiries about course pre-requisite, please contact SPNZ to help@spnz.org.nz

The Upper Limb in Sport (SPNZ LEVEL 2 COURSE) This course is for registered physiotherapists who work with individual athletes or teams in which upper 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 upper limb conditions.

By the end of the course you will understand the pathoaetiology of common upper limb injuries, be able to perform key clinical and functional tests, rehabilitate upper limb injury in a number of sporting contexts including swimming, throwing, racket and contact sports, and develop individualised return-to-sport programmes.

Saturday 15th October - Sunday 16th October 2016 AUT Auckland

Sports Physiotherapy in Specific Athletic Populations (SPNZ LEVEL 2 COURSE) This course provides you with the skills to practice effective sports physiotherapy in challenging populations. It will cover key considerations in injury prevention, performance enhancement and the assessment and rehabilitation of injury in a variety of special populations including children and adolescents, older athletes, athletes with metabolic and respiratory disorders and the disabled athlete.

Provisional dates Saturday 26th - Sunday 27th November 2016 Auckland Details here Registrations opening later this year

Promotion and Prescription of Physical Activity and Exercise (SPNZ LEVEL 1 COURSE) This course provides you with the skills to practice effective sports physiotherapy in challenging populations. It will cover key considerations in injury prevention, performance enhancement and the assessment and rehabilitation of injury in a variety of special populations including children and adolescents, older athletes, athletes with metabolic and respiratory disorders and the disabled athlete.

Provisional dates: Saturday 19th - Sunday 20th November 2016 Wellington if venue can be confirmed Details here Registrations opening soon

PAGE 19

Continuing Education

Workloads & Injury Workshop An interactive and practical course for coaches, teachers, strength & conditioning coaches and physiotherapists.

The Foundation Workloads & Injury Workshop course is designed to develop a higher understanding of load management, how to prescribe and monitor athlete training loads to help prevent injuries and ultimately improve athletic performance.

A day full of cutting-edge and evidence-based practice presented by one of the world's leading strength and conditioning coaches, Dr Tim Gabbett.

DR TIM GABBETT Dr Tim Gabbett has 20 years experience working as an applied sport scientist with athletes and coaches from a wide range of sports. He has worked with elite international athletes over several Commonwealth and Olympic Games. He currently works as a sport science consultant and advisor for several high performance teams around the world, including most recently with European Football teams and NFL and NBA teams in America.

He holds two PhDs - the second specialising in physical demands, injury prevention, and skill acquisition in football. Tim has published over 200 peer-reviewed articles and has presented at over 200 national and international conferences.

8:30 - 9AM:

MEET & GREET / REGISTRATION

 T I M E TA B L E 

9AM - 12PM A BEST PRACTICE APPROACH TO TRAINING MONITORING: 

Load is Not the Problem - It's the Load that You're Prepared For...



HIGH PERFORMANCE COMMUNICATION: 



1- 5PM

MONITORING TRAINING LOADS FOR INJURY PREVENTION & PERFORMANCE:  Should We be Training Smarter & Harder?

WHAT ARE WE TRAINING FOR: 

Date: Venue: Cost:

Coach, Strength & Conditioning, & Physiotherapy Relationships...

The Training-Injury Prevention Paradox... More Evidence that Training Smarter & Harder Reduces Injuries

Saturday 12 November 2016, 8.30am – 5pm Trinity Wharf, 51 Dive Crescent, Tauranga $200 For course registration & further detail: Craig Newland, e: craig@foundationclinic.co.nz Hot beverages & lunch provided. For any special dietary requirements, please let us know at time of registration time

PAGE 20

Research Publications JOSPT www.jospt.org

JOSPT ACCESS

All SPNZ members would have been sent advice directly from JOSPT with regards to accessing the new JOSPT website.

You will have needed to have followed the information within that email in order to create your own password.

If you did not follow this advice, have lost the email, have any further questions or require more information then please email JOSPT directly at jospt@jospt.org in order to resolve any access problems that you may have.

If you have just forgotten your password then first please click on the “Forgotten your password” link found on the JOSPT sign on page in order to either retrieve or reset your own password.

Only current financial SPNZ members will have JOSPT online access.

Volume 46, Number 8, August 2016 EDITORIAL Growth and Consequences MUSCULOSKELETAL IMAGING Rotator Cuff Tear Consequent to Glenohumeral Dislocation Long-Lever-Arm Manipulation Under Anesthesia With Resultant Traumatic Anterior Shoulder Dislocation RESEARCH REPORT Cervicothoracic Manual Therapy Plus Exercise Therapy Versus Exercise Therapy Alone in the Management of Individuals With Shoulder Pain: A Multicenter Randomized Controlled Trial Hip Strength Deficits in People With Symptomatic Knee Osteoarthritis: A Systematic Review With Meta-analysis Satisfaction With the Outcome of Physical Therapist–Prescribed Exercise in Chronic Whiplash–Associated Disorders: Secondary Analysis of a Randomized Clinical Trial Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk Pain During Prolonged Sitting Is a Common Problem in Persons With Patellofemoral Pain Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running The Accuracy of the VISA-P Questionnaire, Single-Leg Decline Squat, and Tendon Pain History to Identify Patellar Tendon Abnormalities in Adult Athletes Impaired Foot Plantar Flexor Muscle Performance in Individuals With Plantar Heel Pain and Association With Foot Orthosis Use Strength Measurements in Acute Hamstring Injuries: Intertester Reliability and Prognostic Value of Handheld Dynamometry CASE REPORT Rehabilitation and Return to Sport Following Surgical Repair of the Rectus Abdominis and Adductor Longus in a Professional Basketball Player: A Case Report

PAGE 21

Research Publications British Journal of Sports Medicine www.bjsm.bjm.com

Volume 50, Number 16, August 2016 REVIEWS Physiotherapy for pain: a meta-epidemiological study of randomised trials Elisabeth Ginnerup-Nielsen, Robin Christensen, Kristian Thorborg, Simon Tarp, Marius Henriksen http://bjsm.bmj.com/content/ Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors K D B van Leeuwen, J Rogers, T Winzenberg, M van Middelkoop http://bjsm.bmj.com/content/ Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis Tom A Ranger, Andrea M Y Wong, Jill L Cook, Jamie E Gaida http://bjsm.bmj.com/content/ Neural representations and the cortical body matrix: implications for sports medicine and future directions Sarah B Wallwork, Valeria Bellan, Mark J Catley, G Lorimer Moseley http://bjsm.bmj.com/content/ Risk factors for musculoskeletal injury in preprofessional dancers: a systematic review Sarah J Kenny, Jackie L Whittaker, Carolyn A Emery http://bjsm.bmj.com/content/

ORIGINAL ARTICLES Central pain processing is altered in people with Achilles tendinopathy Nefeli Tompra, Jaap H van Dieën, Michel W Coppieters http://bjsm.bmj.com/content/ Low chronic workload and the acute:chronic workload ratio are more predictive of injury than between-match recovery time: a two-season prospective cohort study in elite rugby league players Billy T Hulin, Tim J Gabbett, Peter Caputi, Daniel W Lawson, John A Sampson http://bjsm.bmj.com/content/

PAGE 22

Classifieds CHRISTCHURCH Avonhead Physiotherapy and Pilates Full or Part-time Physiotherapist This is the opportunity you have been waiting for!

Avonhead Physiotherapy and Pilates is on the lookout for an enthusiastic and energetic physiotherapist to join our friendly team. We are an industry-leading practice in the north west of Christchurch city, offering a range of services including musculoskeletal physiotherapy, Pilates (equipment and mat) and vocational rehabilitation programs.

Avonhead Physiotherapy and Pilates has operated in Avonhead for over 20 years. As a well-established clinic, we have a loyal patient base and a reputation for excellence. We share the building with other allied health workers, a great mix for sharing knowledge and expertise. The clinic is located next to Avonhead Mall, a busy suburban shopping centre, making it a very handy location for running errands over lunch or after work. We have great people, a social and fun work environment, and we are excited to welcome you to our clinic!

We offer:  The opportunity to work in a variety of roles within the clinic  30 minute follow up appointments and a generous allocation of administration time daily  Financial support contributed to profession development annually  Access to an onsite Pilates studio and rehabilitation gym for use with each patient  Senior physiotherapist support  An atmosphere that encourages growth and a positive work-life balance The successful applicant must be NZ registered and will ideally have the following attributes:  A minimum of 3 years experience working in private practice  Experience teaching mat or equipment Pilates.  Excellent communication skills  A passion for helping people lead a healthy and active life  An ability to work in a collaborative team environment If this sounds like you but you are not sure if you have the right skills, please get in touch and we can chat about options. We are looking for a part time or full time physiotherapist.

The position is currently available so please get in touch today!

Please send your application and CV to office@avonheadphysio.co.nz. We look forward to meeting you. www.avonheadphysioandpilates.co.nz

TAURANGA Bureta Physio Full-time physiotherapist Travel and increasing workloads means we are on the look out for another full time physiotherapist.

Our young, dynamic, enthusiastic team require a motivated full time physiotherapist for our busy centrally located clinic with a great reputation for sports, manual therapy, dry needling, gym rehabilitation and workcare. Great team atmosphere with fantastic reception staff. We are strongly committed to professional development with a regular inservice and training programme along with support and assistance towards further education. Sports medicine opportunities are available and encouraged. Experienced physiotherapists with post graduate qualifications/Masters to work alongside.

We are looking for an energetic, passionate physio with good communication skills, a keen interest in sports physiotherapy (and the flexibility this requires) along with a dedicated approach to overall health and wellness.

For further information please contact Jacinta Horan on jacinta@buretaphysio.co.nz or 021623627

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Classifieds WELLINGTON Wellington Phoenix Football Club Assistant Physiotherapist Position The Wellington Phoenix are looking for expressions of interest for the role of Assistant Team Physiotherapist.

The contract is full time running on a season by season basis. Starting as soon as possible through until 1 st May 2017. The position is based in Wellington, although you may be required to travel nationally and internationally for team camps and away games.

The successful applicant will work alongside the head physiotherapist and club coaching staff.

The physiotherapist will be expected to:  Be available and attend first team trainings and home games around the Wellington region.  Cover for the reserve team physiotherapist at games and trainings in Wellington region as required.  Coordinate and manage first and reserve team players alongside head physiotherapist and Strength & conditioning staff at the club.  Liaise with club coaches, sports science and medical staff over player injury issues.

The ideal applicant will:  Be a NZ Registered Physiotherapist  Have previous experience working with sports organisations or teams  Have strong communication and administration skills A great opportunity to experience physiotherapy within a professional sports environment working with leading national and international representative athletes.

If you are a good team player, ambitious and interested in working alongside a great team of coaches and staff please email your CV and covering letter to brento@wellingtonphoenix.com.

TAURANGA Avenues Physio-Fitness Physiotherapist required An exciting new opportunity exists for a registered Physiotherapist to join our contemporary, independent physiotherapy practice located in the heart of Tauranga.

We are in search of a dynamic Physiotherapist to join our team of five physiotherapists and exercise consultants.

The staff at Avenues Physio-Fitness are undoubtedly our best asset. All staff have Post Graduate qualifications and are dedicated to optimizing each client’s physical rehabilitation, mobility, and return to sporting pursuits.

While the majority of patients are musculoskeletal and sports injury cases, we also offer clinics specialising in paediatrics, hydrotherapy, gym-based rehabilitation, clinical Pilates and vocational rehabilitation.

While senior therapists with manual therapy, Pilates, acupuncture and exercise based rehabilitation skills are preferred, we would also welcome a junior therapist who is keen to up skill and learn. All applicants must have a current APC and appropriate work visas.

For further details please contact Claire on: 07 579 0421 www.avenuesphysiofitness.co.nz for more information about the clinic.

Please email your application that includes a cover letter and CV to avenuesphysiofitness@xtra.co.nz

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Classifieds INVERCARGILL Windsor Street Physiotherapy Awesome opportunity for the right physiotherapist.

We're looking for an enthusiastic physiotherapist(s) and/or hand therapist to grab it with both hands. Based in Southland, New Zealand, just 2 hours from Queenstown/Central Otago- why wouldn't you! Our patient base is predominantly musculoskeletal, but we highlight the importance of providing treatment to a wide range of patient needs, including hand therapy, occupational rehabilitation, acupuncture and rehabilitation in our onsite fully equipped gym. Applicants need to be able to work independently, to work as part of a dynamic team, have confidence and a can-do attitude. We have a very strong hands-on approach so good manual therapy skills are essential, along with an enthusiasm to learn and participate in ongoing education and professional development. The hand therapy position is open to any registered hand therapist or a physiotherapist training towards their hand therapy registration.

We are committed to:  Providing ongoing education through weekly in-services.  Financial contributions towards professional development, annual practicing certificate, and professional memberships.  A mentoring programme to support any new graduate physiotherapist.  Regular training and clinical/ professional supervision.  A supportive team of experienced physiotherapists you can work alongside, be supported by and learn from.  Private fully equipped treatment rooms with laptops with Gensolve, the patient management system which can be accessed from anywhere.  A clinic with the equipment needed for rehabilitation.  Opportunities to work with local sports teams.  An expansive referral network, having been operating for over 30 years.

We can offer the right person(s) a relocation allowance to help you settle in Invercargill, New Zealand.

No matter where you are in your career, if you are motivated to make a difference to other people's lives and be a part of an expanding practice, then we would love to hear from you!

So apply directly to Ian via ian@windsorphysio.co.nz or (03) 2174983.

Applicants for these positions should have NZ residency or a valid NZ work permit.

Applicants need to be able to register as a physiotherapist in New Zealand.

Case Study and Feature Article Contributors Wanted We all enjoy immensely reading the contributions from our members and guests. Without exception when we ask these people to share their stories with us, they fit this into an already packed schedule. We know there are many other physiotherapists who have interesting ideas and information to share. If you would like to contribute a case study, or would like to be our feature physiotherapist I would love to hear from you. You may be working with weekend warriors or elite sports people, or you may be helping people with chronic long term conditions improve their activity levels. You may be working with national sporting bodies or helping people become active after cancer treatment. Hearing a variety of physiotherapy stories is inspirational for our members.

Case studies on any topics are needed for the bulletin. If you have an idea but need help putting it together let us know.

Please contact our editor Aveny Moore if you are interested in any of the above.