SPNZ BULLETIN PAGE
Issue 4 - August 2017
Feature Mark Plummer Enjoying the Journey SPNZ Symposium and Workshops
FEATURE TOPIC: Rugby
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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
Committee
Monique Baigent Timofei Dovbysh
Visit our website www.spnz.org.nz CHECK OUT THESE LINKS Sports Physiotherapy NZ
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List of Open Access Journals Asics Apparel - how to order
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ASICS EDUCATION FUND A reminder to graduate members that this $1000 fund is available twice a year with application deadlines being 31 August 2017 and 31 March 2018. 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: Rugby
SPNZ MEMBERS PAGE See our page for committee members, links & member information
2
EDITORIAL By SPNZ President Hamish Ashton
4
MEMBERS’ BENEFITS Discounts
5
SYMPOSIUM
In this issue:
SPNZ Symposium and Workshops
6
FEATURE Enjoying the Journey—Mark Plummer
8
MCGRAW HILL BOOK REVIEW Brukner & Khan’s Clinical Sports Medicine 5th Ed
11
SPRINZ How Much is Too Much? Tips for Youth Athletes
12
ASICS REPORT The Science of Midsole Design: Does the Height of the Heel Matter?
15
SPNZ CONCUSSION WORKSHOP REVIEW A Review of the SPNZ Concussion Workshops
17
CLINICAL SECTION- ARTICLE REVIEW Cervicovestibular Rehabilitation in Sport-Related Concussion: a Randomized Controlled Trial
18
RESEARCH PUBLICATIONS BJSM Volume 51, Number 16, August 2017
19
CLASSIFIEDS Classified Advertising
20
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Editorial Hamish Ashton, SPNZ President Greetings all Firstly, I would like to thank all those who gave us feedback via the membership survey. We had about a 40% response rate, which although being a good response for many organisations, is down on some of our previous surveys. We are currently reviewing your responses. The membership surveys are important for the exec in planning and developing new ideas. In case you were sitting waiting for my email or phone call regarding the prize draw to attend the ASICS SMA Sports Medicine Australia conference in Malaysia, I am afraid you are out of luck. The winner was Therese Gray from Invercargill. We look forward to her report on the conference which will be published in a later edition of our bulletin. A big thanks must go out to our key sponsor, ASICS, for providing this prize. The SPNZ Sports Physiotherapy Symposium is rapidly approaching with early bird rates closing in a few days on August 21. There are also three different workshops available at a special rate of only $20 during the early bird period. During this time, they are for SPNZ members only. The workshops will then be opened for all, so get in early and receive this great member benefit. All the symposium information is on our website http://sportsphysiotherapy.org.nz/members/ courses/symposium-2017/ or just click on the picture on the front page. We have an excellent and diverse range of international and local speakers and topics for you this year. This is reflective of the large scope of practice that is sports physiotherapy. As with previous years we pride ourselves in making sure all the talks are of value to you as a practitioner, with key points containing information you can use in your clinic on Monday. The program is 90% finalised and available for you to view on the website. Please note it is still provisional and there may be small changes before the event. As you are all hopefully aware PNZ is currently undergoing a process of change. Though only about 25% of people voted in the first round of decisions in going forward, there was a resounding yes vote. This tells me that you want the organisation to change. For many years I have
heard through comments made, and via social media, the questions - what do PNZ do for us? Or what do we get for our money? Part of the answer to this is they do quite a bit at times but it’s just we don’t hear about it. Personally, I believe this issue of communication is a big one and needs addressing. But on a more productive direction there is now an opportunity for the membership of PNZ to let us know what they want from the organisation. So, to all of you out there, get pen to paper (or drop me an email) and let me know how you would like to see PNZ operate in the future and what they should do or not do. If you know physiotherapists that aren’t members, or are no longer members, ask them what would change their mind. Remember PNZ is all of us, and the different parts of it have different functions, be it the branches and SIGs, the national exec, or the CEO and office. But the one thing I would think most of us would agree on is that when we are talking to groups, especially governmental ones, the bigger and more unanimous the voice the more likely it will be heard. Knowing what you want is vital to us as an organisation going forward. The next stage for the “Changes Group” (I don’t even know if it has an official designation) is to develop a new model of what PNZ should look like and how it should operate. There are ideas, and we as a group have decided on some of the principals, some might say culture, of what we want. The next task however is the nuts and bolts and details. Getting the right model is vital for us going forward as the next vote we have is to go for the new model or not change, and the first vote tells me we want things to change. That’s enough from me for the next couple of months. I look for to seeing hopefully a good number of you at the symposium. Feel free to come and talk to me and let me know your thoughts and ideas. I know many of you via emails so it’s always great to meet you. 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.
DISCOUNTS McGraw Hill Education
25% off Medical books http://sportsphysiotherapy.org.nz/members/reviews/book-order-form/ for details on how to order.
Asics
Members rates on Asics shoes and apparel http://sportsphysiotherapy.org.nz/members/asics-information/ for how to order
SPNZ Member discounts to all SPNZ courses and Symposium http://sportsphysiotherapy.org.nz/courses/ for what is upcoming
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Symposium
WE WOULD LIKE TO WELCOME YOU TO ATTEND:
OUR 4TH BIENNIAL SPNZ SPORTS PHYSIOTHERAPY SYMPOSIUM
Pullman Hotel Auckland October 14-15th 2017 Dr Phil Glasgow Phil was the Chief Physiotherapy Officer for Team GB at the Rio 2016 Olympic Games.
Phil is particularly interested in understanding the factors that influence the development of mastery and effective performance in both sporting and professional environments.
Featuring:
Chris Bishop
Dr Bruce Hamilton
Chris is the founder of The Biomechanics Lab in Adelaide.
Rob Moran
Chris’ research has focussed on the relationship between the foot and shoe, in both how the foot moves inside the shoe and how the shoe design can be optimised to influence the biomechanical function of the foot .
Dr Steve Kara Justin Ralph And many more quality speakers
For further information and to register please see our website: http://sportsphysiotherapy.org.nz/
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Symposium Workshops
4TH BIENNIAL SPNZ SPORTS PHYSIOTHERAPY SYMPOSIUM WORKSHOPS Costs: earlybird with main registration SPNZ Members – $20 (only available to SPNZ) Limited one workshop per person Workshop 1: Sat. 14th October
Jordan Salesa Start 9am
Max. 25 people
Hand held dynamometers Finish 11am approx. Venue: Princesses lounge A
Registration https://pnz.org.nz/Event?Action=View&Event_id=2206 Workshop 2:
Sat. 14th October
Chris Bishop
Start 9am
Max. 25 people
Gait assessment
Finish 11am Venue: Theatre
Registration https://pnz.org.nz/Event?Action=View&Event_id=2205 Workshop 3: Sun. 15th October
Chris Bishop Start 1pm
Max. 25 people
Gait assessment Finish 3pm Venue: Theatre
Registration https://pnz.org.nz/Event?Action=View&Event_id=2207
Workshop 4: Sunday Oct 15
Dr Steven Kara Start 1pm
Max 24 people
Concussion – practical applications Finish 2pm Venue: Princesses lounge A
Registration https://pnz.org.nz/Event?Action=View&Event_id=2204
Costs:
earlybird with main registration SPNZ Members – $20 (only available to SPNZ) After 21st August:
SPNZ members $50 PNZ Members
$80
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Feature Enjoying the Journey
MARK PLUMMER – DIP PHYS, PGD HSC, MHSC I graduated from Auckland back in the 80’s (with an awesome group of people as Lou Johnson mentioned in her June article). At the end of our first year the physiotherapy school moved to AUT on the North Shore – we think we were therefore pioneers, paving the way for the many future intakes. I completed my Post Grad Diploma in 1998, then completed a Masters in 2013. I’ve been married to Jo for 23 years, and we have four kids, ranging in ages from 21 – 11. All the kids are involved in sport and lead very busy lives. We are an incredibly close family, though mum and dad are finding it tough as the older two have flown the coup already. Jo is an ex NZ water polo rep, and recently played in the World Masters games. My three sons play rugby and cricket, and all are doing well– the middle son represented NZ Schools rugby last year which was a thrill. My young daughter loves her netball, and is following mum’s foot-steps into water polo. We live on a few acres in rural Auckland – a few sheep, chickens and cows and plenty of chores when the time allows. I was lucky enough to work with Auckland Rugby in my first year out of physiotherapy school – they hadn’t had a physiotherapist before, so I guess I was a bit of a guinea pig. It was about the start of when physiotherapists were getting into sport in a full-time capacity, and were starting to see that as a genuine career prospect. I do consider myself fortunate, as roles like that now are very competitively sought after, and I was very young and lacked real experience. Thirty years on I still have the role of Auckland Rugby physiotherapist, though I did have some time away from Auckland doing other teams. Auckland Rugby really is part of who I am, and part of our family. NZ Black Caps (1986-1998) I used to play a bit of cricket, and soon after graduating went to play for a season in England, which most young guys try and do at some stage. The NZ Cricket team were touring England that year also. The team physiotherapist had to pull out at late notice and knowing I was in England, asked if I would like to cover the tour. Again, I was very green and inexperienced and found the role very daunting when the team had experienced
pros like Hadlee, Coney, Smith, Snedden, Bracewell, Chatfield etc. So it was sink or swim really. I muddled my way through that tour, and secured a role with NZ Cricket that would last a further 11 years. A wonderful time looking back – many friendships, interesting places I would never have otherwise visited, and touring the world watching my favourite sport. Blues Rugby Team (2009- Present) Once the kids started arriving I finished my cricket commitments and re-joined the rugby world – initially at club level, then with Counties Manukau for 3 years, and finally back to Auckland. This led to also joining the Blues staff in 2009, and these are roles I still have. Other teams I have been involved with have been NZ 7s, NZ U19, NZ U20, NZ U21, NZ Barbarians, CountiesManukau and several club sides. Please describe your current role and how you ended up there. I am a part owner in Physio Rehab Group alongside Jordan Salesa and Karen Sutton. The three of us work CONTINUED ON NEXT PAGE
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Feature Enjoying the Journey continued... really well together, and have different roles within the business. However, I am currently a full time physio with the Blues/Auckland Rugby sides, so am not involved in the practices on a day to day basis. Jordan has a role with HPSNZ, so Karen carries a lot of the can at the moment. We have a wonderful group of staff, physiotherapists and support crew, all working hard to deliver the best physiotherapy services they can. My day to day role with the Blues follows a pretty set routine. The day starts with an injury clinic, followed by meetings with the doctor, coaching staff, strength and conditioning staff, and players themselves. These meetings are generally around the short and long term plans for the athlete, training modifications, treatment and rehab plans etc. These are followed by both classroom and field sessions, numerous amounts of taping, and fitting in treatment sessions. A typical day will have us at Blues HQ 6.30am – 5pm. Weekends generally involve a game Saturday, and recovery sessions / medical clinic again on the Sunday. What are your specific areas of interest/research?
our best to limit soft tissue injuries with our preparation and prehab prescriptions. Contact injuries are part and parcel of the game. The hardest injuries to deal with are those that may end a player’s season - the significant lower limb muscle tear, the shoulder or knee instability episodes, high ankle sprains which take longer than other ankle sprains to settle. The issue with significant injury is it often means players relinquish positions which can also have effect on contracts. What do you think are the key elements in successfully preventing injury? We screen our players pre-season and have used different screens over the years. I think screening has to be relevant to the demands of the sport. When we screen we also use the tests as a chance to get some baseline numbers that we can refer back to. Hop tests for example can be a useful baseline for any player returning from a lower limb injury. I have started using some validated upper limb tests that I have pinched from other sports, so we can start to get some “norms” for rugby players at baseline. Plenty has been written
I have an obvious interest in rugby injuries, naturally. I am learning more now than I ever have – I probably appreciate, as I get older and keep reading, the need for us all to keep learning, keep abreast, keep an open mind, listen to other ideas, treat what we see and not use prescriptive generic protocols, stay holistic, experiment …… My master’s thesis was looking at patella tendinopathy in rugby players, which came about on account of this being a big problem for rugby players in the pre-season period especially. Duncan Reid and Wayne Hing from AUT assisted me hugely as my supervisors. Shoulders have been of particular interest in recent years. One of my sons has had two shoulder reconstructions as a result of rugby – both before age of 18. The second of these was a bony block (Latarjet procedure). There has not been much literature around the rehabilitation and return to play protocol for rugby players following these procedures, so together we have used him as a bit of a case study in terms of how we progress through to contact and ultimately returning to the field. He has successfully just completed a full season of club rugby, and we have started using the same protocol for a couple of other young rugby players. What are the types of injuries you commonly see?
recently about objective testing before return to play for ACL reconstructed knees, but we don’t have as much information on other areas, so we’re trying to develop some of our own. The other really important area not to overlook is the players mental state with regard to their injury, and return to play. There are many simple return to sport psychological assessment tools available, which are really valuable, and which I put a lot of effort in to understanding. The player MUST be ready and confident to return psychologically, as much as physically. I sit down with the player and we review these questionnaires together as a final tick box before full RTP.
Injuries are really varied, as in any contact sport. We do CONTINUED ON NEXT PAGE
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Feature Enjoying the Journey continued... Who else is involved in the “support” team that you communicate with and how do you integrate with them to optimise injury prevention and rehabilitation? At Super Rugby level we are incredibly lucky in that we have a big multi-disciplinary support staff for players. Our medical staff consists two physiotherapists and a doctor, and we work very closely with the S&C. A holistic approach is used in dealing with each individual and where necessary we have “round table” discussions which may involve several departments – medical, S&C, coaching, nutrition, mental skills, professional development, high performance, commercial and sponsorship, along with the athlete himself and his partner/parents. Are you involved in performance aspects for your clients? Again we run a very holistic approach to all athletes with their performance being at the centre of all discussion. What are the key attributes you feel are required to work with elite level athletes? Being a good listener is important – hear what your athlete is really saying. They generally know their body better than you, and often let you know what they feel is the best approach to treatment/rehabilitation. It is sometimes important to filter out the “noise” – coach’s needs, partner/family/ agent, contracts, team selections, overseas offers. All have the ability to sway decision making and ultimately let a player down when they perhaps need you most. Listen, discuss, educate, involve all that need to be involved and exclude those that aren’t needed, make a
plan, review the plan regularly, communicate. Be prepared, and prepare for eventualities. We practise a lot of scenarios regularly – particularly situations we may come across pitch side e.g. removing a suspected cervical spine injured player safely from the field of play. Each person has a role, and practice gives us clarity and confidence we will manage these types of situations well. Communication with athlete and support staff is crucial. What do you see as the major challenges for sports physiotherapy? What is important is keeping abreast of best practice. There is more literature and research than ever before with regard to treatment protocols and rehabilitation regimes. Whilst experience is useful in being able to draw on clinical situations, use everything at your disposal. Use a holistic, multi-disciplinary approach where possible – dealing with elite athletes alone can be a difficult task. Sports physiotherapy can be a very rewarding line of work, however it is not all beer and skittles. There are long hours and you have to give more of yourself than you initially anticipate. You ride the highs and lows of both team and individuals, and often there is little thanks. I have thoroughly enjoyed my journey and am continuing to do so. I would encourage any physiotherapist with an interest in following the sports pathway to have a plan, speak to those that may help you, be prepared to start at a school or club level, and at each stage be the best you can be. Learn from others along the way – you will never know it all. Sport is to be enjoyed, so most of all ensure you enjoy your journey as well.
Blues medical and S&C staff cooking BBQ for the team
Photo at beginning of the feature is of the family following son Harry’s game vs Australia for NZ Secondary Schools last season
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McGraw Hill Book Review BRUKNER & KHAN’S CLINICAL SPORTS MEDICINE 5TH ED Part C (Ch. 44-48) includes conditions specific to paediatric and adolescent athlete, military personnel, medical screening, team care (working as a health team and travel), and career progression. What to like: Every chapter has been updated and re-written by internationally renowned physiotherapists and physicians. All regional conditions have been updated to include current evidence-based principles of diagnosis and treatment while still retaining clinically informed practical evidence. Content for each regional condition chapter has been meticulously sourced and provides unrivalled summary and detail with extensive clinical application. What not to like: As this edition is comprised of two volumes, volume one lacks a dedicated segment to the management of medical conditions in sport such as cardiovascular, respiratory, and gastrointestinal symptoms. Although, these conditions are indirectly referenced in regional conditions where appropriate. Printed references are no longer included at the ends of each chapter*.
The bible of sports medicine has gone through an overhaul for its 5th edition. This new edition has been split into two volumes with the first published and available either in hardcopy or an eBook. Volume 1 is titled “Injuries” and features the more familiar parts of Fundamental Principles, Regional Problems, and Practical Sports medicine that the former editions are known for. More than 550 new full-colour figures have been added. New chapters include return to play, exercise prescription, diagnostics, as well as others. Part A (Ch. 1-19) provides insight into various fundamental sports medicine principles such as acute and overuse injury pathophysiology, clinical biomechanics, exercise prescription, assessment and diagnosis, treatment and rehabilitation, and return to play. Part B (Ch. 20-43) retains its familiar overview of conditions organised by region. The content has been updated to include current evidence-based practice principles. There are numerous new tables which clearly summarise features of differential diagnoses, updated epidemiological data, diagnostic test metrics (specificity, sensitivity), new anatomy illustrations and imaging, and updated practice pearls not in previous editions. Treatment pathways have been updated where possible and have been supported by supporting literature.
*Instead a link is provided to where the reference can be accessed in .pdf form. This allows you to copy and paste the link into a web browser to retrieve articles rather than manually typing them out, which is arguably very useful. Overall: Each new edition of Clinical Sports Medicine features updated clinically relevant information. The previous edition was published in 2011 and significant new research has emerged within the last 5 years. Owning a copy of this edition is critical in ensuring you have access to current informed practise. The second volume, Clinical Sports Medicine: Exercise Medicine, is scheduled for release in 2018.
Reviewed by SPNZ Executive
Brukner & Khan’s Clinical Sports Medicine 5th Ed is published by McGraw Hill Education. SPNZ members are entitled to a discount when ordering online from McGraw Hill.
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SPRINZ
How Much is Too Much? Tips for Youth Athletes
By Kelly Sheerin and Scott Brown In last month’s bulletin we wrote about the emerging concerns regarding early specialization in youth athletes. This month the focus is on training intensity and load management in youth athletes. Below is a piece originally published at http://news.autmillennium.org.nz/athlete-development/ which provides some great practical advice to youth athletes interested in understanding their load exposure. We have republished it here with the kind permission of the blog’s author, Dr Craig Harrison, who leads the Athlete Development programme at AUT Millennium. How do you know how much sport is too much? How do you know that all the training you’re doing isn’t doing more harm than good? It’s easy to think that more is better. That because you’re out there working hard on your endurance, you must be getting fitter. Or that because you’re putting so much time in practicing your shooting skills, you’re improving”. Unfortunately, it’s not that simple. Think back to your last early morning training. Did you battle to drag yourself out of bed when your alarm went off? When you finally turned up, late, could you not stop yawning? And how was your mood? Did you get frustrated easily? Did you find yourself giving up when and extra bit of effort was called for? You know, that extra 10% we know makes all the difference in training. Adaptation is the change your body makes in response to training stress. It’s the driving force
behind you getting better. A healthy body (i.e. one that isn’t tired, or hungry, or sore) is one that maintains homeostasis – I know it’s a big word but stay with me. You can think of homeostasis as the body’s normal range in which is stays healthy and functions optimally. Training is a form of physiological load that puts stress on the body. Think about the thumping sensation you get in your chest when your heart rate responds to a hardout fitness session. Or that burning feeling in your legs when your sprint as fast as you can up a steep hill. Despite feeling uncomfortable at the time, physiological stress is vital in your training. It’s what forces your body to adapt to get fitter, stronger, or more skilled. It puts you into a fatigued state, which signals a repair response from the body and the start of recovery process.
Figure 1. The Super-Compensation Model CONTINUED ON NEXT PAGE
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SPRINZ How Much is Too Much? Tips for Youth Athletes continued... To produce the outcome you’re after, the right kind of training stress is required.
Score
Perceived Effort
If your goal is to maintain a high intensity throughout the entire game, you need to stress the cardiovascular system using appropriate duration and frequency. If you goal is to jump higher, your muscular system requires stress. And if you want to become more skilful, then your sensorimotor system must be stressed through deliberate practice.
0
Rest – nothing at all, like you’re sitting on the couch
1
Super easy, like a slow walk
2
Easy – you can have go on for a long time
3
Moderate
All going well, the body adapts and ‘super compensates’ to a higher point of homeostasis – your body’s normal range in increased and you get better.
4
Somewhat hard – you’re a bit stuff at the end
5–6
Hard – you were keeping up but feeling it
But it’s not all about training stress.
7–8
Very hard – you were struggling to up
9
Very, very hard – almost as hard as you could possibly go
10
Maximal – as hard as you’ve ever gone in your life
Other types of stress must also be accounted for, such as the stress of exams and assessments at school, the stress of family and social relationships, and the stress of a part time job, if you want to improve. Crucially, stress is cumulative. Stress at home, school, work and training add up and contribute to overall fatigue. And the more fatigued you are, the more time you need to recover from training, adapt, and ultimately, super compensate. So, how do you get it right? Measure Your Training Load Measuring training load gives you a sense for how ready you are to train and compete. It also helps you change something that isn’t working.
Table 1. Scale of Perceived Effort 3) Calculate your session training load Your session training load is training duration X your effort score. For example, if you train for 60 minutes at an effort of 5, your training load for that session will be 300. Do this for every session you complete during the week. 4) Calculate your daily training load points
Here’s how to measure your training load, and use it to modify your training appropriately, in 6 easy steps.
Your daily training load is the total of your session training load scores. Do this for each day of the week.
1) Record how long you train
5) Compute you weekly training load points
Record the duration of each training or game in minutes.
Your weekly training load is the total of your daily training load scores.
2) Score your training effort How much effort are you giving in training? The second step is to monitor your effort after a session. The scale of perceived effort (table 1) describes a range of exercise intensities, from nothing at all, to as hard as you can go, and assigns a score to them. For example, if scoring the game you played last weekend during which you were struggling to keep up with the pace, you’d give it an 8.
CONTINUED ON NEXT PAGE
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SPRINZ How Much is Too Much? Tips for Youth Athletes continued... Monday Training session/ game duration and effort score
Run – 45 x 7 = 315
Total points for the day
315
Total points for the week
2, 075
Tuesday
hockey training – 90 x 6 = 540
540
Wednesday
swimming training – 60 x 5 = 300
300
Thursday
Friday
Run – 30 x 6 = 180 hockey training – 45 x 4 = 180
360
Rest
Saturday
Sunday
water polo hockey game – game – 60 x 8 = 480 20 x 4 = 80
480
80
Table 2. Example weekly training load for a 14-year-old hockey player 6) Monitor how you feel Now that you’ve quantified how much you are doing as an arbitrary number per week, you must interpret it with a view to changing anything that’s not working. You can accomplish this by sitting down on a Sunday afternoon and reflecting on the past week by asking yourself five simple questions.
• • • •
How have I been feeling mentally? How have I been feeling physically? How am I sleeping? How hungry am I?
Answering these questions will give you a sense of the volume of training that is right for you.
For instance, if you are mentally drained, or physically sore a lot, you may need to dial down your training and make room for more recovery. If you’re struggling to get out of bed in the morning, try and schedule more sleep. And if you are battling with sleep quality (i.e., you find it hard to get to sleep at night and/or wake up a lot), or you’re constantly low on appetite, it’s highly likely you’re over doing it. Download your FREE Training Load Monitoring Template here Do this for every week you train. Over time, and based on where you’re at in your season, you’ll experience a range of weekly training loads you can use to learn about yourself. You may also find it helps you answer important questions, like “how much is too much?”
Dr Craig Harrison is the Director of Athlete Development at AUT Millennium and a Research Fellow at AUT University. Craig has a PhD in youth athlete development and focuses on uncovering best practice and inspiring change in the area. He leads a team of coaches to create the best possible learning and improving environments for athletes to achieve their best. Before working at AUT Millennium, Craig held sport science and athlete conditioning roles in high performance sport. https://sprinz.aut.ac.nz/areas-of-expertise/strength-and-conditioning/staff-profiles/craig-harrison
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ASICS ASICS Report The Science of Midsole Design: Does the Height of the Heel Matter? The world of athletic footwear changes at a rapid rate. Every year there are new technologies or trends that emerge. Some are disbanded at the R&D phase. Some make it to market and then are squashed. Some return and rear their ugly head. Some linger too long. Some last the test of time. As a footwear biomechanist, whenever a new trend in footwear emerges I ask myself three key questions: 1. Does the trend and/or new technology address an important concept or issue in footwear? 2. Is the trend/technology emerging supported by research evidence (not just brand R&D findings)? 3. Do I believe that the trend/technology will help reduce injury or improve performance? So what is the trend in question? Heel raises, heel gradients, differentials, drops, pitches…whatever you want to call it. Let’s dispel the myths and investigate what they do and don’t do, and whether there is such thing as a perfect dropped shoe! So, does changing the drop of a running shoe address an important concept or issue in footwear? Firstly – what is drop? The true meaning is in the detail. So many terms are thrown around - Heel height, stack height, heel height differential, drop, Pitch...they are used interchangeably so let’s put it straight: • Stack height is different in the rearfoot and forefoot and is not the same as heel pitch or drop • Heel height differential, pitch and drop are the same thing – the differential in the heights of the heel height and forefoot height. Secondly, what is the ‘hypothesis’ for changing drop? How many times have we hear that running in minimalist shoes will make you more ‘natural’, run faster and more efficient and therefore perform better. There are so many theories out there in the blogosphere re: drop and what is right and wrong, many with absolutely no evidence to support their claims. Let’s take a look at the evidence. Does changing a shoes ‘drop’ actually change the biomechanics of how we run? Here are the two clear messages sent by the literature on this topic: 1. There is no conclusive evidence that increasing shoe drop will reduce the passive tension in the
Achilles tendon. But running in minimalist shoes does result in a redistribution of work done from the knee to the ankle (Fuller et al. 2016) 2. Lower drop footwear is associated with a more midfoot strike (lower foot angle at ground contact), which in turn is associated to increased leg stiffness (Horvais & Samozino 2013) Ok so a few key changes. What do they mean? In search of the holy grail, does changing drop reduce injury risk or improve running economy and performance? Let’s start with injury to runners. Laurent Malisoux is a big player in this space and demonstrated in his paper last year that injury risk is not modified by changing the drop (10, 6 and 0) of standard cushioned runners. However, two key points to acknowledge here: A. Malisoux also identified that low-drop shoes could be more hazardous for regular runners and should be an occasional choice (Malisoux et al. 2016). This may be explained by Fuller et al. (2016s) findings of increased work at the ankle in minimalist shoes. Surely this supports varying the input into the body and the benefits of a multi-shoe footwear program. B. Speaking of Fuller et al. – a separate paper by Joel and his colleagues has shed light on the influence of body mass. A colleague of mine Joel Fuller showed that heavier runners (> 85.7 kg) are at increased risk of injury Whilst we are talking about injury, perhaps we point out a big interest of mine in terms of kids and specifically football boots and casual trainers. Why you ask? Well sever’s is a big problem in kids. Between the ages of 8 and 15, a high proportion of kids will experience exercise induced posterior heel pain at the level of the calcaneal apohphysis. How do we treat it? Often with a heel raise right? To reduce the passive tension in the calf? Well this got me thinking…Put simply a heel raise (say of 10mm) in a zero drop shoe is the same as a 10mm drop shoe isn’t it? Food for thought in the prescription of shoes for kids sports in this age bracket perhaps… Now for the big one…improved performance. Do we need to lower the drop to actually run faster? The evidence is strong that reduced shoe mass can help improve running economy and performance:
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ASICS ASICS Report continued... The Science of Midsole Design: Does the Height of the Heel Matter? 1. Reduced oxygen cost associated with running in lighter shoes (Fuller et al. 2015; Bonacci et al.2013; Franz et al. Rothschild, 2012) a. Note for every 100g added per foot/shoe, energy cost increases by approximately 1% (Franz et al. 2012).
partners, I get asked all the time what the perfect drop is. Is one better than the other? My answer is often ‘how long is a piece of string’. Let me explain: •
Traditionally this has been thought to be a result of lower drop or dare I say it more ‘minimalist shoes’.
The ‘actual drop’ of a shoe can vary by as much as 10-15%. Take a random selection of 3 shoes in five different sizes, grab a set of digital (and calibrated) calipers and measure the rearfoot and forefoot stack heights of each, and then calculate the differential. There will be variability between all 15 shoes and this is natural. Manufacturing techniques in terms of compression moulding foam midsoles naturally have to allow for some expansion out of the moulds once they have cooled. There is a natural tolerance of 5%. This can be the difference between a 8.6, 10.3, 9.7 and 11.3 mm drop result in the same 10 mm targeted drop shoe model.
•
Enter NIKE. With Breaking2, they have completely dispelled the myth of a low drop racing flat as being the only option for runners wanting to encounter a bit of speed work. Marketing hype aside (and how good was it!), I respect the guys at NIKE. Not only does their data claim a MINIMUM 4% effect by putting the VaporFly4% shoe on, independent testing by Rodger Kram from the University of Colorado support their 4% improvements and energy saving claims. All on a rear foot stack height > 30 mm, a forefoot stack height > 20mm and a drop of 10mm in a shoe weighing just 184 g (6.5 Oz US Size 10)!
The heel height differential (or ‘drop’) actually has a different interpretation across shoe size; a 10 mm drop in a US women’s Size 7 is completely different to that existing in a Male US Size 13 shoe. Let’s call this the angle of pitch, and simple trigonometry tells us pitch of the shoe will change by approx. 1 deg per increase in US sizing.
•
Foams compress under load. Therefore the heel height differential or ‘drop’ is going to depend on the mass of the individual running in it. Put a 100 kg male in the same drop shoe as a 55 kg female (assuming the same cushioning) and I bet you my house that the shoe has compressed underload and therefore reduced its actual drop. The softer and less dense the midsole, the worse it’s going to be!
b. 220G is a critical threshold for shoe mass, below of which results in improvements in running economy (Fuller et al. 2015) 2. In addition to running economy, Fuller et al. (2015) demonstrated that compared to running in a 10mm drop shoe, running in minimalist shoes (4mm drop) also improves 5-km running performance So how do we make shoes lighter?
What is the lesson from this? Drop isn’t the be all and end all. The influence of smart materials, the mass of the shoe and the geometry of the shoe are likely to be far more important. So in conclusion, where are we at with drop? Quite simply, shoes need to be prescribed to the individual, based on their anthropometry, their medical and running history, their running program and performance goals. There is no such thing as the perfect shoe. And this same principle applies to drop 10mm, 12 mm, 8mm, 4mm…they all work for someone. There is no such thing as a perfect drop for all individuals! So where does this leave us? Can we possibly predict those individuals who needs a higher vs lower drop?
So what are my clinical tips of how to differentiate who may and may not be able to handle a lower drop shoe: 1. Any individual with a history of Achilles tendon or calf pain should proceed with caution in lowering the drop of their running shoe and consult the opinion of a health professional. 2. Heavier runners ( body mass > 85 kg) should avoid a low heel drop (≤ 4 mm) 3. Those with poor soleus strength may cause increased load in the Achilles in a low drop shoe. 4. Forefoot strikers who run with a toe-heel-toe gait pattern may cause an increase in eccentric lengthening of the Achilles in a low drop shoe.
Whether it is in the clinic, the lab or even by my retail CONTINUED ON NEXT PAGE
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ASICS ASICS Report continued... The Science of Midsole Design: Does the Height of the Heel Matter? I will leave you with these statements re drop: A. There is little published scientific evidence that underpins each companies go to drop. B. Is the drop of your shoe perfect? Perhaps…for you.
By Dr Chris Bishop PhD Director of Biomechanics - The Biomechanics Lab Post-doctoral research fellow - UniSA
C. Is it the right drop? Maybe D. Should you change your drop? Maybe – but first ask why and what are the ramifications if you do? For some runners, an increased drop will be beneficial and for others it won’t and could cause pain. Vice versa with lowering the drop. Do yourself a favour and get the right advice before you make the change.
Chris Bishop content provided through the support from our SPNZ sponsor – ASICS
E. If you are experiencing pain, could it be the drop of your shoe? Perhaps. Get it checked out by a health professional. Until next time Chris
SPNZ Concussion Workshop Review As we all are aware concussion and its management has been a hot topic over the last couple of years and one that has certainly garnered a lot of media interest in 2017. We were lucky to be offered the opportunity as physios and on-field medics to attend the SPNZ Concussion Workshop in Tauranga to further our concussion management knowledge. Run by the passionate former All Blacks doctor Deb Robinson, the group of attendees with varying degrees of prior knowledge were treated to a night of the latest evidence based learning, great practical components and case studies along with some robust discussion. The full spectrum was covered in brief; from immediate pitchside management to end stage rehabilitation fuelled by our enthusiasm and of course pizza. As a physio for a club rugby team with one major concussive event prior this year my main reason for attending the course was to improve my pitch-side management. This was covered off with a great practical session in line with the standardized approach to an injured player: anterior approach, ABC’s, MILS, clearing Cx spine, log rolling and immediate referral if required. For those of us out there that look after any sports side I cannot recommend more highly that you familiarise yourself with this standardised approach or
partake in further training so that you are prepared in the event of an on-field injury or emergency. I was personally able to vouch for this training two weekends later in a club rugby accident. The more robust discussions of the night were reserved for the management of the concussed athlete/patient as there is sensibly no set-in-stone protocol for a return to normal life/sport. A common-sense approach based on reliable objective measures/markers and individual patient circumstances mean we as physiotherapists can take a lead role in the management of a successful return to sport for these patients. Deb provided us with some excellent case scenarios that we were able to work through as groups that illustrated the flexibility required to manage concussion in its many varied presentations. We as physiotherapists are in a unique position in healthcare where we can play a large part in concussion management and this workshop helped give the confidence to do so. A big thank you to Deb Robinson and SPNZ for this well worthwhile workshop. By Tim Perrin Physiotherapist
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Clinical Section - Article Review Cervicovestibular Rehabilitation in Sport-Related Concussion: a Randomized Controlled Trial Schneider, K.J.; Meeuwisse, W.H.; Nettel-Aguirre, A.; Barlow, K.; Boyd, L.; Kang, J. & Emery C.A. (2014). Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med, 48: 1294-1298
Introduction After a concussion, the majority of symptoms resolve within seven to ten days however in approximately thirty percent of athletes they persist. Headache post-concussion has been reported as a predictor of longer time loss. It is well acknowledged that the cervical spine is a source of pain in individuals with whiplash so it is understandable that the cervical spine may also be injured in athletes with concussion due to the forces transmitted to the head at the time of the incident. Other symptoms commonly reported after a concussion are dizziness and balance dysfunction which may be due to problems of the vestibular, proprioceptive or central mechanisms. The aim of this randomized controlled trial was to examine whether a combination of vestibular rehabilitation and physiotherapy treatment for the cervical spine (manual therapy and strengthening) decreased the time until medical clearance to return to play in individuals with prolonged post-concussion symptoms. Intervention The primary outcome measure used in this study was time to medical clearance to return to sport (days). The clearance was given by a blinded medical physician. Other measures used were general demographics, sport and injury details, and numerical pain rating scale, activities-specific balance confidence scale, dizziness handicap index, SCAT2, dynamic visual acuity, head thrust test, modified motion sensitivity test, functional gait assessment, cervical flexor endurance and joint position error test. Participants were seen once weekly by the study treatment physiotherapist for eight weeks or until medical clearance was given. Both groups were given range of movement exercises, stretching and postural education and followed the standard care protocol for concussion (rest until symptom free followed by graded exertion).
repositioning manoeuvres. All individualized for the individual.
treatment
was
Results The sample size of this study was small with only thirty one individuals randomly allocated, four of which withdrew. Eleven of the fifteen individuals in the treatment group were cleared within the eight weeks compared to one in fourteen of the control group. The treatment group was 10.27 times (95% CI 1.51 to 69.56) more likely to be medically cleared to return to sport within eight weeks than the individuals in the control group. Conclusion
This study shows that individuals with persistent post-concussion symptoms treated with a combination of vestibular rehabilitation and cervical spine physiotherapy treatment were ten times more likely to be cleared to return to sport by eight weeks than individuals who continue with rest instead. The The intervention group received cervical spine optimal time of when to initiate this treatment is not physiotherapy which included cervical and thoracic currently known. Future research with a larger spine joint mobilisations and cervical neuromotor sample size is needed to review this aspect. retraining exercises (craniovertebral flexor and extensor retraining) and sensorimotor retraining Implications for practice exercises. Typically this treatment was initiated • Initiating vestibular rehabilitation and cervical before adding vestibular rehabilitation exercises. spine physiotherapy treatment is warranted in Vestibular rehabilitation included habitual gaze individuals with persistent post-concussion stabilisation, adaption exercises, standing balance symptoms alongside the standard care protocol. exercises, dynamic balance exercises and canalith By Amanda O’Reilly BPhty (Otago)
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Research Publications British Journal of Sports Medicine www.bjsm.bjm.com Volume 51, Number 16, August 2017 EDITORIALS
Biopsychosocial model of disease: 40 years on. Which way is the pendulum swinging? Gwendolen Jull http://bjsm.bmj.com/content/
MRI investigation for groin pain in athletes: is radiological terminology clarifying or confusing? Adam Weir, Philip Robinson, Brian Hogan, Andrew Franklyn-Miller http://bjsm.bmj.com/content/
Towards the reduction of injury and illness in athletes: defining our research priorities Caroline F Finch, Roald Bahr, Jonathan A Drezner, Jiri Dvorak, Lars Engebretsen, Timothy Hewett, Astrid Junge, Karim M Khan, Domhnall MacAuley, Gordon O Matheson, Paul McCrory, Evert Verhagen http://bjsm.bmj.com/content/
Misinterpretations of the ‘p value’: a brief primer for academic sports medicine Steven D Stovitz, Evert Verhagen, Ian Shrier http://bjsm.bmj.com/content/ REVIEWS
Review: Injuries impair the chance of successful performance by sportspeople: a systematic review Michael K Drew, Ben P Raysmith, Paula C Charlton http://bjsm.bmj.com/content/ The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology: a system-
atic review and meta-analysis
Harvi F Hart, Joshua J Stefanik, Narelle Wyndow, Zuzana Machotka, Kay M Crossley
http://bjsm.bmj.com/content/
Calf muscle strain injuries in sport: a systematic review of risk factors for injury Brady Green, Tania Pizzari http://bjsm.bmj.com/content/ ORIGINAL ARTICLES
Training loads and injury risk in Australian football—differing acute: chronic workload ratios influence match injury risk David L Carey, Peter Blanch, Kok-Leong Ong, Kay M Crossley, Justin Crow, Meg E Morris http://bjsm.bmj.com/content/
Return to play criteria after hamstring muscle injury in professional football: a Delphi consensus study Mattia Zambaldi, Ian Beasley, Alison Rushton http://bjsm.bmj.com/content/
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Classifieds DEVONPORT—NORTH SHORE—AUCKLAND Devonport Physiotherapy and Pilates Musculoskeletal Physiotherapist Our clinic has a manual therapy, education and exercise-rehabilitation focus, facilitated by our Pilates studio and regular class schedule. We have dynamic community, and a strong referral base from our local GPs. You will be included in our regular in -service programme and have the opportunity to attend Pilates classes. Flexible hours: part or full time. Working with three experienced physiotherapists, podiatrist, Pilates instructors and experienced and supportive full time reception staff. Competitive remuneration. Salary or contract employment options available. Mentoring available. The successful candidate will also have the opportunity to learn how to teach and apply Pilates to their practice. CONTACT DETAILS:
Sarah Metcalfe 021 0283 9550 sarah@devonportphysio.co.nz
CLOSING DATE:
31st August 2017
TAURANGA Back In Action Physio Part time or full time physiotherapist Start date: now Full or part time position available to start immediately. We are looking for an active, fun, passionate physiotherapist to join our Tauranga team. You must have an interest in sports physiotherapy for this role. We are a small team of experienced clinicians who all have extra qualifications and specialities. Our clinics are set up with your own treatment rooms, longer treatment sessions, easy access to physios for clinical reasoning, extensive CPD both one-on-one and in a small group, associations with gym and doctors and a manageable patient load. The hours of employment are negotiable and flexible so you can fit in all you want outside of work too. Remuneration is competitive. Go on - check out our website www.biaphysio.com or drop Leanna an email leanna@biaphysio so you can learn more about the role.
Contact: Leanna Veal leanna@biaphysio.com 0211282614 Deadline: once position is filled
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Classifieds
CLINIC FOR SALE - CANTERBURY PhysioSteps Ashburton is an established and accredited practice on EPN contract in central Ashburton with a great reputation, a high number of new patients and is the perfect for you! The owners are have made a lifestyle choice to sell the clinic and focus on family and other business and so have made the tough decision to sell this profitable and well-run clinic. If you are wanting to get into clinic ownership without the stress of setting up, establishing a client base and becoming accredited or want to expand your portfolio then get in touch.
For more information please email Shaun at sclark@physiosteps.co.nz or call on 0273208916