SEPNZ Bulletin August 2019

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SEPNZ BULLETIN

ISSUE 10. AUGUST 2019

p6 Feature: Sports Specialisation - Jacinta Horan

p20 SEPNZ Sports Certificate Courses

www.sepnz.org.nz

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SEPNZ EXECUTIVE COMMITTEE

Members Page

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

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

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Asics Education Fund information International Federation of Sports Physical Therapy (IFSPT) Journal of Orthopaedic & Sports Physical Therapy (JOSPT)

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

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CONTENTS

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

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EDITORIAL: By SEPNZ President Blair Jarratt

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FEATURE ARTICLE: Specialisation - Our First Sports Specialist

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ASICS ARTICLE with Chris Bishop - Athletic Footwear

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APP REVIEW: 1RM

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GET TO KNOW THE TEAM: 2 MINUTES WITH…Emma Clabburn

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MEMBER BENEFITS

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SPRINZ: Too Serious Too Soon

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CLINICAL REVIEW: Mountain Biking Injuries

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RESEARCH PUBLICATIONS: BJSM Volume 53, Number 11, August 2019

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UPCOMING SEPNZ COURSES

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CLASSIFIEDS

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EDITORIAL

Welcome,

to another jam-packed SEPNZ

bulletin delivered straight to your inbox.

When the Board of Physiotherapy first released the areas of specialisation, sports physiotherapy was left off the list. Some argued that sports physiotherapy should sit under the musculoskeletal specialisation area and there would be no need for it to sit in its stand-alone category. At that time the leaders of this SIG stood up for our Sports Physiotherapists' and argued that Sports Physiotherapy should be recognised as its own area of specialisation. Over the years, we have watched as other categories have gained specialist physiotherapists.

Until two months ago the number was eight specialist physiotherapists in their fields. In August 2019 New Zealand gained our 9th specialist and the first ever sports specialist physiotherapist - Jacinta Horan. The SEPNZ executive is hugely proud of this and therefore we have focused this bulletin on specialisation.

Jacinta - fresh back from her High-Performance Sport New Zealand role to the world university games in Italy, has given us her insights into the process and what this means for her, how she sees it changing her practice and the opportunities this may open up for her. Her application process started two years ago and anyone that is thinking of starting the process - her feature piece is a mustread. Also, now would be a great time to remind our members that SEPNZ is committed to helping the first 5 reach Sports Specialist Physiotherapists status with a grant for the final stages of specialisation. If you are in the process of your submission now, please contact our secretary, so we are aware you are trying to achieve specialist status and possibly to provide you with some guidance.

As per all our bulletins, we focus on an executive member so our members can get an idea of who we are, and it is Emma Clabburn's turn. Emma is the editor of this bulletin and puts out a great resource bi-monthly to our membership. Also, thank you to SEPNZ executive member Emma Lattey with another excellent app review on 1 Rep max testing.

Our executive would also like to take this opportunity to thank long-standing Executive member Bharat Sukha, who is stepping down from our team. Bharat has been on this executive for 13 years (2 instalments) and has maintained the SEPNZ sponsorship relationships, contributing to the growth of this SIG. He has also been well versed in delivering great banter for the executive and helped to keep the seriousness dosed with a

decent dollop of humour. Thank you, Bharat, for all the hard work, you will be hugely missed on our team - we look forward to your 3rd instalment!

We also have an article brought to you by ASICS NZ from Chris Bishop, who is an independent consultant for ASICS Australia. This is an excellent unbiased read in the progression of footwear and what Chris calls his "synergy of performance".

A couple of months ago there was a murmur in the media about injuries for children in sports with ACC quoting some data which sounded like it was breaking news. The concept of specialising too early in our life is not new, and as physiotherapists, we are at the forefront of these questions from our patients and their parents. Dr Simon Walters - head of coaching, health and physical education from AUT contributes to our bulletin with some easy-toremember messages we can give our patients and parents. The public must continue to see exercise and activity as a positive part of our lives, so to have appropriate and well-researched messages to give our clients should be part of all physiotherapists education.

Speaking of activity and exercise, do you love your mountain biking? If not, then maybe you should get to know it better as one of the fastest-growing sports in NZ. With the speed and terrain, this sport is always going to have its fair shares of "offs" and Rose Lampden-Smith reviews an article on the injuries in mountain biking. This is an excellent overview of the most common injuries and with one of the worlds best mountain bike terrains on our doorstep (Rotorua's world-famous redwoods, plus some of those epic rides of Aotearoa such as the west coast old ghost road, Queen charlotte) then expect these mechanisms of injury to grow.

To round off our bulletin - look at the back for some job opportunities in sport and clinic and the SEPNZ upcoming courses. We have one in the South Island and one in the North Island this year and some job opportunities in sport and in clinic.

While you make your way to one of our SEPNZ courses to strengthening your CPD folder, throw your bike on the back of the car and have a look at what NZ has to offer from the saddle. Or slip on your favourite running shoes looking for that "synergy of performance." #Specialistinsportsphysiotherapy - who will be our next?

Thanks for reading.

Kind Regards Blair Jarratt SEPNZ President

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FEATURE ARTICLE

Specialisation Jacinta Horan, (MHPrac (Honours), PG Cert AP, BPhty) Sports Physiotherapy Specialist After almost two years of work it feels hugely satisfying to have achieved the role of Titled Sports Physiotherapy Specialist.

As the first specialist in sports physiotherapy in New Zealand is there any advice you have regarding the process for others thinking of going for specialisation?

My number one piece of advice would be instead of just thinking about it get started. I considered going through the process for a couple of years before I finally got around to it. I am not sure it is any different than many things in life where it seems like too big a process to know where to start! Send your application in if you are interested and meet the criteria as at the very worst all that can happen is you don’t progress to stage 2 and the application itself takes very little time. Then put aside some regular time each week/ fortnight or month (whatever you can manage) and ensure that this time is there to “chip away” at each task building your portfolio. This means that over the coming months/year you will gather all the information you require and it will allow you to highlight and target any areas that you don’t have appropriate evidence or history of achieving and therefore you can set targets on how you will then achieve these. One of my concerns was as I am not a researcher and do not have a PhD would I achieve this specialist status being “simply” a clinician. If this is you what I would say is apply! In order to continue to progress our profession physios on the ground need to be the largest group that achieve this status.

Secondly what advice do you have for those thinking about working towards it as a new grad?

Personally as a new grad I think the most important thing is to consolidate all you have learnt over the previous four years, get comfortable in your job, confident in your ability to provide a great service to the public and learn as much as you can from those you work with - not just in their treatment and clinical reasoning but also in the language they use and the way they interact with their patients. Find out what aspect of physiotherapy you love and set goals

around how you are going to progress in that area and what you would love to achieve. If you do that one day you will have the ability to go through the specialist process also if it is something you aspire to achieve.

Have you always wanted to specialise in sports?

I have worked in Sports Physio for almost 20 years. It is why I was interested in studying physiotherapy in the first place and it is the area I am passionate about. I love the challenges that come with sports physio, I love the multidisciplinary nature of it and the challenge of being accountable to not only patients but also a greater management team and I love the sense of achievement when athletes succeed in their goals – whether on a local, national or International stage and the fact that we may have played some part in that.

What has been your worst and best sporting physio moment so far?

This is probably one in the same – Winning a silver medal at the Rio Olympics as part of the Women’s Sevens team but not winning gold. The expectation from the NZ public when involved with rugby in this country is that we win and always win, and even though we knew there was a reasonable chance that we wouldn’t win gold due to a number of factors having worked in the programme for 9 years, it was still heart-breaking watching the girls’ despair when we lost the final. Given a few days to reflect and learn the challenges of winning any medal at the Olympics it certainly became a highlight and is a moment in my career I will never forget.

What do you think are the key attributes and skill sets for a sports physio?

To understand athletes and their desire to return to sport, to be driven by a desire to continually upskill and learn from others, to get very comfortable in a gym environment and push past basic rehab to functional strengthening and sport specific rehab. The ability to clinical reason on the spot, to turn pressure of coaches and players into a challenge rather than CONTINUED ON NEXT PAGE >>

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FEATURE ARTICLE being terrified by it and to be organised from an administrative perspective. Soft skills around understanding athletes – when you need to push them, when you need to pull them back, when you are a “councillor” more than a physio and that none of us know everything but reflection and continual learning is essential in order to achieve.

What do you see as the main differences between being a sports physio and an MSK physio?

I am a firm believer that whilst there is crossover between musculoskeletal physiotherapy and sports physiotherapy they are two very different disciplines.

SEPNZ spent a large amount of time arguing the case that this must be a separate discipline within the specialist scope which is great as otherwise I can honestly say I would not have gone down the specialist path. I believe our scope as sports physiotherapists is much broader than musculoskeletal physiotherapy. Clearly the “hands on”/treatment aspect is very similar but the skills required to be a travelling or sideline sports physiotherapist along with the rehabilitation skills required particularly at an International level are much more advanced than anything I would ever would have learnt within the clinic musculoskeletal space. I think Sports physiotherapists also have a huge amount to offer in a clinic setting as we understand advanced rehab and sports specific training and therefore are able to ensure patients are rehabilitated to the highest level appropriate for them.

What opportunities do you envisage will come from the speciality status?

I hope to continue to work within NZ and overseas in the High Performance space as being a physio for NZ teams on the World stage is something I love being a part of and has been the largest driver in my sports physio career. Alongside this the ability to work more as a consultant in a local sense ensuring that I am able to utilise the skills I have gained over the past 20 years to support local physiotherapists and the sporting public achieve their goals.

Education of the wider public is an area I am particularly passionate about as when you aren’t at the elite level of sport the information available to the general sporting public is often sparse and variable in its quality. I hope to continue to work in this space particularly in the areas of minimising injury risk and the female athlete.

How do you see your practice changing working as a specialist?

Progression from more of the coalface treating to more of a “second opinions”/specialist review role with patients and referring back to their treating therapist to continue with their treatment and rehabilitation is an area I am particularly interested in. I do think there is also a growing opportunity within the NZ. Sporting space to sit alongside Medical Directors within sports and sporting bodies.

With the board removing some of the financial costs of being a Specialist do you see more Sports Physiotherapists becoming titled in the near future?

I don’t think financial barriers are the greatest barrier to becoming a specialist but it is great that financially there is now a benefit to working at this level.

Do you see any other barriers to becoming a sports specialist?

If you meet the criteria the biggest barrier I believe is time particularly in the sports field as if for eg you are full time with a team it would be a pretty large load to add to this work.

One final thing I would say is that the specialist role is an evolving role – both the application, examination and contracting space continues to change and going through this process requires you to be resilient, determined in what you are attempting to achieve and yet forgiving of the fact that not all the answers are out there yet! Most importantly ask questions as now we have a group who have gone through the specialist process and one in sports achieved we are there to help others achieve the same goal.

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ASICS ARTICLE WITH DR CHRIS BISHOP Athletic Footwear: A Synergy of Performance Dr Chris Bishop

Director of Biomechanics—The Biomechanics Lab & Independent consultant for ASICS Australasia.

A lot of people don't give footwear enough credit.

Not only is footwear a powerful manipulator of human movement, but it can also have a drastic effect on human performance.

So what goes into the design of a shoe that can have such an effect? A lot of hard work, innovative thinking, creative design and calculated execution.

Every two years, the footwear biomechanics symposium brings together the best footwear scientists around the world, from both industry and academia, to share a mutual love of footwear for 3 days. What I often find frustrating about scientific meetings is when companies or individuals get on stage, share 5% of the story and leave you hanging. But sometimes I am left amazed, inspired and proud of the innovative work being performed to positively influence human performance.

So I want to share with you my experience from FBG, and how some of the research that was presented (namely Prof Roger Kram’s keyone address) can be translated directly into practice. And to do that, I am going to use a framework that was presented called the synergy of performance (Credit to Emma Farina from NIKE for the term).

There are three ways in which footwear can influence human performance (through a surrogate measure of running economy): Shoe mass Longitudinal bending stiffness Cushioning Maximizing all three creates what a 'Synergy of Performance."

So is light mass all the rage?

Firstly, we know light shoes influence performance. This was originally proposed by Ned Frederick back in the 1980s, with the finding of increasing shoe mass by 100g had a negative effect on running economy in the order of magnitude of 1%. Roger Kram and his lab have validated this finding (see Franz et al. 2012), which makes Ned's experimental findings even more impressive given the lack of equipment and knowledge 30 years ago compared to now.

Figure extracted from Franz et al. (2012)

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ASICS ARTICLE WITH DR CHRIS BISHOP But is there a point (of explicit mass) by which just putting a shoe on will result in improvements in Running economy? A colleague of mine (Dr Joel Fuller who is now at Macquarie Uni) wrote a great review that identified a US size 9 shoe that weighed < 220g would instantaneously result in an improvement in running economy.

Yet there was one comment from Kram’s keynote that really resonated with me…

“The design of competition shoes for road racing on paved surfaces should not overemphasize weight minimization at the expense of cushioning… (Tung et al. 2014) So is light weight really better…In pursuit of light weight, what do we compromise? Durability? Energy return?

Im not sure im willing to sacrifice both…

So moving on…is a stiff forefoot a good idea?

We know from the early work out of Calgary by Roy and Stefanyshyn that longitudinal bending stiffness has a benefit to the physiological cost of running, as long as it is tuned to the individual . To stiff (or not stiff enough) and the runner will receive a negative benefit. This was recently put into context by Oh and Park whom identified increasing longitudinal bending stiffness was ok as long as it does not interfere with natural 1st MTP joint motion.

Figure extracted form from ROY & STEFANYSHYN, D. J. (2006).

Enter the team at NIKE. And their innovative and game changing concept to a plate through the shoe will be discussed later as another highlight of the conference.

Emma Farina leads the running team at NIKE. And an impressive team it is. And with the budget NIKE has, I would expect nothing less! There is no doubt that the Vaporfly 4% has changed the landscape of running. I can't, in my time in footwear, remember a shoe that has had a bigger impact on the footwear industry as this shoe. And haven't they copped a fair bit of negative press about the shoe. Media outlets are calling it to be banned as it’s a spring. But when you look at it closely, and understand the mechanics, it isn't a spring. It is simply a lever to optimise the mechanical advantage of the foot.

The vaporfly works in two ways: The proprietary cushioning (see section on cushioning) The carbon fibre plate.

With the respect to the latter, Farina took us through the design and development of the plate, and how NIKE developed the unique design. It started with four prototypes: A baseline shoe, same cu the restored after a loading shioning and no plate Prototype 1 which have a stiff plate with no curvature (same cushioning as baseline shoe) Prototype 2 which have a stiff plate with mild curvature through the forefoot (same cushioning as baseline shoe) Prototype 3 which have a stiff plate with extreme curvature through the forefoot (same cushioning as baseline shoe) So what did they find?

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ASICS ARTICLE WITH DR CHRIS BISHOP The curvature of the plate had a large effect, with the more severe curvature prototype having the greatest effect on reducing the negative effect of increasing bending stiffness (see Figure 1 below from Abstract). What one would normally expect is that a result of increasing forefoot longitudinal bending stiffness you would get net energy loss at the MTP and a net external increase in the ankle plantarflexor moment but this wasn’t the case.

It’s like the runner receives the best of both worlds; maximise power around the MTP whilst not making the calf work harder.

Extracted from Farina et al. (2019). Footwear Science.

And how is this done?

Through the shoe of course! Roger Kram, who oversaw the external validation work of the shoe at University of Colorado Boulder, presented data to support the fact that the shoe itself was doing some of the work. This is likely the holy grail, reducing the work at the MTP without increasing it at the ankle, knee or hip.

But remember this is fast running. Elite runners (sub 30 min 10 km runners), running at 18km/h. Whether this data stacks up to recreational runners at paces more attributable to say a 4 hr marathon remains to be seen.

So what about cushioning?

In short, cushioning has a big impact on both the perception of comfort, as well as the vibrations applied to the body. However, what a lot of people fail to understand about cushioning is what influences it?

There are two distinct factors Compliance Resilience The compliance of a shoe has formed the traditional view of cushioning. Soft bouncy midsoles like BOOST, Everrun etc have entered the market with large applause. The immediate perception of a comfortable ride has sold many a millions of pairs of shoes (irrespective of durability). Interestingly, research has suggested that regardless of whether you run on hard or soft materials, the magnitude of load applied to the body is the same.

However the perception of the load can be different, and likely explains why some people prefer different materials to others.

So if it isn’t compliance that makes cushioning so good, then what is it?

The magic in these new smart materials we are seeing (i.e. Zoom X in the Vaporfly 4%) seems to be the resilience of the material. Resilience of foam is defined as the energy restored from the material after a load has been applied. This is commonly referred to energy return. In presenting loading data of the 4%, Kram eloquently demonstrated that just because you have a compliant midsole, does not mean that has a negative effect on energy return. Infact, high compliance, couple with high resilience, results in a material that loses minimal energy through the loading cycle. Where the Zoom Streak returned 65.5 % energy and the Adidas adios boost 2 (the shoe Denis Kimetto broke the world record in) returned 75.9%, Zoom X was recorded a staggering CONTINUED ON NEXT PAGE >>

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ASICS ARTICLE WITH DR CHRIS BISHOP 87.0% of energy. According to Martyn Shorten who tests shoes for Runners World, this is the highest recording of energy return ever recorded by a shoe. What ultimately results is less energy lost in the midsole, and therefore more returned to the runner to assist with propelling forward momentum.

Impressive huh…YEP Despite these three factors combining together to create a synergy of performance, I am going to take the opportunity to discuss some of the findings we presented at FBG on midsole density. Yes I will at this point declare a conflict of interest given my consultancy role with ASICS, but I do feel our results suggest the dual density midsole design can also contribute to this synergy of performance.

DuoMAX - ASICS dual density midsole system. What does it do?

There has been a staple in the ASICS footwear range since Kayano 1 (yes that it 26 years!). And that is duomax. ASICS' patented dual density midsole system.

Now I want to address the elephant in the room of the role of dual density midsoles. I honestly feel they have been harshly dealt with on the online stratosphere. There are many individuals calling for the extinction of this technology. I routinely read 'they are heavy', 'they don't control pronation' so why include them in the shoe. Yet I am yet to ready a really good study showing these shoes don't work (and yes tehre are multiple ways to define 'work'). In fact, there is a range of really good studies that show benefits of medial posted shoes. This makes it all the more surprising that companies are deviating away from this technology (despite anecdotal feedback from consumer that some find these type of shoes more comfortable) given the lack of conclusive evidence to support their lack of effect.

I also want to highlight that not all dual density systems are the same So what did we do…

We built two versions of the Kayano 23, with the only difference between the shoes being the presence (or lack of) DUOMAXTM design. We then got people to run both fresh and in the presence of fatigue (with fatigue created throughr unning back-to-back 3km time trials as quick as they could). What we found was instantaneously, there was a physiological benefit (2%) running in the DuoMAX shoe regardless of foot posture, with the benefit increasing to 3% when running in the presence of fatigue. This also translated into a performance benefit, with the dual density shoe assisting in maintaining performance (i.e. faster time trial performance in the dual density shoe) in the presence of fatigue. This was measured as a 6.8s improvement in 3km time trial performance, equating to an improvement of some 24 m. This is a clear and substantial benefit of this design feature. And something that should be considered in a lot of recreational runners…fatigue influences performance!

So to summarise, of course there is a desire for every runner to find the perfect shoe. And at the moment, we don't know what that is. But we do know that when we get footwear right, different components combine to create a synergy of performance.

So what contributes to this synergy?

A shoe that is durable. If it can be light, that is even better!

A forefoot stiffness that is tuned to the individual needs, one that doesn't restrict MTP ROM and one that doesn’t increase the moments acting around the ankle A shoe that is resilient and returns energy stride after stride after repeated loading And if running in the presence of fatigue, perhaps considering a shoe with DuoMax might help too!

References • • • • •

Bishop, Chris (2019) Dual density midsole design improves running economy and performance when fatigued, Footwear Science, 11:sup1, S136-S137, Farina, Emily M, Haigh, Derek & Luo, Geng 2019, ‘Creating footwear for performance running’, Footwear Science., vol. 11, no. sup1, pp. S134–S135.

FRANZ, J. R. , WIERZBINSKI, C. M. & KRAM, R. (2012). Metabolic Cost of Running Barefoot versus Shod. Medicine & Science in Sports & Exercise, 44(8), 1519–1525. doi: 10.1249/MSS.0b013e3182514a88.

Roy J and Stefanyshyn DJ. (2006) Shoe midsole longitudinal bending stiffness and running economy, joint energy, and EMG. Med Sci Sports Exerc. 38(3):562-9.

TUNG, K. D. , FRANZ, J. R. & KRAM, R. (2014). A Test of the Metabolic Cost of Cushioning Hypothesis during Unshod and Shod Running. Medicine & Science in Sports & Exercise, 46(2), 324–329. doi: 10.1249/MSS.0b013e3182a63b81.

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APP REVIEW

Back to the App...

Your App Review

One Rep Max Calculator-1RM Lift Log - Your App review by Emma Lattey from CAPE Physio App: One Rep Max Calculator-1RM Lift Log Seller: Charles Vanderhoff Category: Health & Fitness Version: 1.1 Uses Epley formula compared to other 1RM Size: 13.5 MB apps which were less accurate.

Language: English Family Sharing: Yes Cons: https://apps.apple.com/nz/app/one-rep-max-calculatorRegular ads and constant pop-ups to upgrade.

1rm-lift-log/id950621710 Price: Free, $6.99 to upgrade to Pro version How I use the app: Compatibility: Requires iOS 9.0 or later. ComIt is as simple as entering the weight and reps to patible with iPhone, iPad, and iPod touch. determine a good estimate of your patientâ&#x20AC;&#x2122;s one rep What it is used for: Calculating your one rep maximum max lift using the Epley formula.

Overall Rating: 4/5 Where to find it: Download from Apple store.

Android or Apple or both: Apple Pros: Very simple, clean and easy to use interface.

Relevance to clinical practice for Sports Physios: Despite this app being designed for power athletes rather than for clinicians, the relevance of measured and progressive rehabilitation and loading for our patients is extremely important. This app makes it very easy to calculate an estimated 1RM and the below table is a good tool to reassess what you are trying to achieve with each patientâ&#x20AC;&#x2122;s rehabilitation once 1RM has been measured.

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APP REVIEW

For Android Users 1 Rep Max Calculator and Log on Google Play Similar set-up to above Apple version with option to the choose 1RM formula (including Epley) which suits you.

(Bird, Tarpenning, & Marino, 2005) RECAP ON REPETITION MAXIMUM TESTING Repetition maximum (RM) testing is used to identify the maximum weight that can be lifted for a particular exercise a given number of repetitions with satisfactory technique i.e.

3RM tests measure the max weight that can be lifted for 3 complete reps. A 1RM can be derived from an athlete performing multiple repetitions to fatigue with a lighter weight, using a prediction equation. Several prediction equations have been proposed and have been found to have high correlation with 1RM performance (r . 0.95) (Mayhew, Johnson, Lamonte, Lauber, & Kemmler, 2008).

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APP REVIEW Direct Measurement of 1RM = Do a 1RM Indirect Measurement of 1RM = Use Epley formula (or app)

or the NSCA table

1RM = ((weight*reps)/30) + weight eg. ((10kg*10reps)/30) + 10kg 1RM = 13.3kg Purpose:

To assess muscular strength. This information can be used to monitor improvements in strength, to identify weaknesses in muscle groups or imbalances between muscle groups (e.g. bench press vs bench pull), talent ID or to evaluate the effectiveness of a period of training. Known RM values for various exercises can be used to prescribe strength training intensities and direct exercise prescription.

References Bird, S. P., Tarpenning, K. M., & Marino, F. E. (2005). Designing resistance training programmes to enhance muscular fitness: a review of the acute programme variables. Sports Med, 35(10), 841-851. doi:10.2165/00007256-200535100-00002 Mayhew, J. L., Johnson, B. D., Lamonte, M. J., Lauber, D., & Kemmler, W. (2008). Accuracy of prediction equations for determining one repetition maximum bench press in women before and after resistance training. J Strength Cond Res, 22(5), 1570-1577. doi:10.1519/JSC.0b013e31817b02ad Reynolds, J. M., Gordon, T. J., & Robergs, R. A. (2006). Prediction of one repetition maximum strength from multiple repetition maximum testing and anthropometry. J Strength Cond Res, 20(3), 584-592. doi:10.1519/R-15304.1 Lecture material from Masters of Sports Physiotherapy â&#x20AC;&#x201C; University of Queensland 2017/18.

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

Emma Clabburn SEPNZ Committee Member What role do you play on the exec?

Currently Bulletin Editor and also on Education Committee. ....and how long on the exec: 4 years Life outside of SEPNZ I live in Wellington with my husband James, daughter Maya and son Theo. I have a varied sporting background personally but am mainly limited to mum's and bubâ&#x20AC;&#x2122;s activities now!

Previous teams worked with / sporting background Before moving to New Zealand I worked with various rugby teams including Bahrain, Birmingham and Solihull Bees, Esher and the Nigerian national rugby 7s and 15s sides. I also work with Samurai international and did a season with Surrey Storm netball team.

...and present?

I currently work with Marist St Pats Rugby Club in Wellington.

Favourite tune on a road-trip Big fan of the new Lion King soundtrack at present!

Favourite sporting physiotherapy moment Qualifying for the Commonwealth games with Nigeria 7s - we didn't end up going but that's another story!

Work - where, what, role I work for Habit Physiotherapy in Wellington as a lead physio. (Currently on maternity leave) Favourite /best or worst destination as touring physio and why e.g. temperature, medical facilities etc A close call between Kenya and Dubai - both amazing locations with equal challenges and rewards - the crowds in Dubai and the people and scenery in Kenya were amazing!

MEMBER BENEFITS

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

For a full list of Members’ Benefits visit http://sportsphysiotherapy.org.nz/benefits/

In each bulletin we will be highlighting individual member benefits in order to help members best utilise all benefits available.

issuu Our newsletters are available as a flip book online on ISSUU http://issuu.com/sportsphysiotherapynz There are also heaps of other resources on the site and a number of them have been grouped for your benefit. Click the “Stacks” button to find copies of sports related magazines for free. These include: Football Medic, Journal of Physiotherapy and Sports Medicine, Sports Performance and Technology and more.

Podcasts

Podcasts are recorded interviews or talks that are made available for access anytime.

A number of sports medicine related podcasts are available which have been linked to our website. http://sportsphysiotherapy.org.nz/members/resources/freepodcasts

Journals

Not studying at present and miss the library at physio school?

There are a number of journals that are available online for free.

This list is increasing as more companies are developing free access journals, but please let Hamish know if you are aware of ones not on the list.

We currently have a list of sports medicine, orthopaedic related and sports science. http://sportsphysiotherapy.org.nz/members/resources/journal/

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SPRINZ

Too Serious, Too Soon? A Complex Issue But There are Some Easy-to-Remember Messages We Can Give Parents Dr Simon Walters Head of Coaching, Health and Physical Education (HPE) School of Sport and Recreation, AUT Overview: Simon leads the Sports Coaching and HPE teams in the School of Sport and Recreation at AUT, with his main area of applied research focused on enhancing young people’s experiences of organised sport and enhancing parent and coach awareness of the benefits of ‘free play’. Initially interested in areas that promoted coach and parent awareness of how to create optimal experiences for young people in sport, his more recent research interests have focused on some of the issues associated with ‘early specialisation’. Simon completed his PhD in 2012, and is currently supervising 10 postgraduate students all studying under the broad umbrella of youth development. He is a member of the International Play Association, and sat on the Steering Group for the Sport NZ funded project Good Sports, implemented by Aktive Auckland Sport and Recreation.

Some time ago, my colleague Chris Whatman asked me to write a guest editorial talking about some of the research I and my colleagues have been doing in the kids’ sport space. It has been on my ‘to do’ list for a while but I was prompted to put pen to paper after a recent visit to my local physiotherapist. As I walked into his treatment room he appeared really down. He told me he was devastated that he had for the first time just encountered an ACL injury in an 11 year old. This was probably the lowest point for him over a period of time in which he had regularly expressed his concern regarding the increasing number of sports injuries he was seeing in children and adolescents.

So if there has been an increase, and recent ACC media releases show there has been a 60% surge in general injuries in the 10-14 year old age group (1), what are some of the factors possibly contributing to this? We are conducting a programme of youth development research at AUT, with a team of people with expertise in coaching, sports parenting, physical activity, exercise science and sport injury prevention. I think that what we have witnessed over the last couple of decades is an increasingly serious focus on young people’s organised sport, and this is occurring at increasingly younger ages. Cognisant of these worrying developments, Sport New Zealand funded a youth sport ‘culture change’ project in 2015. The project – ‘Good Sports’(2) – was designed and implemented in the Greater Auckland area by Aktive Auckland Sport and Recreation working closely with researchers from AUT and Massey University. The resources utilised in Good Sports workshops were sourced by the research team and were drawn from the latest international research and NZ based research we were conducting. To date, over 2,000 parents/ coaches/teachers have attended Good Sports workshops,

and over 300 people nationwide representing over 100 sports organisations (NSOs, RSOs. RSTs, Schools etc) have been trained up as Good Sports ‘developers’, qualified to run the programme in their own communities.

Based on the latest research, Good Sports advocates for young people’s sporting experiences to be conducted in a ‘Climate of Development’ as opposed to a ‘Climate of Performance’. A Climate of Performance is characterised as one that focuses on outcomes (winning) as opposed to development; is usually accompanied by pressure (from coaches or parents); and leads to earlier and earlier specialisation. Evidence we are uncovering here in NZ and internationally suggests that a ‘climate of performance’ can result in elite performance, but comes at a cost for the vast majority, these costs including burnout, dropout and overuse injuries. Conversely, a ‘climate of development’ creates an environment that supports early diversification in a range of sports; lots of ‘free’ and ‘risky’ play outside of the organised sport setting; is accompanied by parental support and a lack of pressure from coaches; and if specialising in one sport, then that happens later (15yrs plus) and only if the child wants to and is ready. Evidence we are discovering here in New Zealand shows that this developmental pathway is also a pathway to elite performance, but more importantly can also result in kids staying with sport as they transition into adulthood. It also reduces the risk of overuse injuries in the adolescent age group.

As we now know, there are some simple guidelines that we can give parents based on recent evidence (3). These easy-to-remember guidelines basically state that children: should not participate in organised sport for more hours CONTINUED ON NEXT PAGE >>

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SPRINZ per week than years of age; should not exceed a 2:1 ratio of organised sport to free play; and not participate in one sport for more than 8 months of the year. Physiotherapists and other sports medicine practitioners are ideally placed to communicate these messages to parents. Most importantly, let parents know that sport should be fun and should not be overly serious too soon. The more their kids enjoy sport, the more likely they are to stay with it as they get older.

However, parents are only one stakeholder – no matter how well informed parents and coaches are, it is the competitive structures put in place by sporting organisations that can drive behaviour. Acknowledging this, Good Sports conversations are also happening at the sport organisational level. Partly in response to these conversation a number of provincial rugby unions, supported by the New Zealand Rugby Union and Sport NZ, have removed junior representative rugby competitions (4). These changes reflect a move away from a ‘climate of performance’ and support a more developmental approach to children’s sport. Structures can shape attitudes and drive the behaviour of not only adults but of children themselves. The Theory of Planned Behaviour (TPB) suggests that behaviours can be driven by: attitudes (beliefs related to the likely consequences of the behaviour); norms (the expectations of significant others e.g. parents, coaches); and perceived behavioural control (perceptions about external factors that will control behavioural performance) (5). A number of years ago I interviewed three injured female athletes (two netball players, one hockey player). They had similar stories about playing on through injury, but I repeat an extract from the interview with the hockey player here: Player: “Hockey is like rugby, you need to appear tough and take a knock. I had compartment syndrome – knew what it was – but told nobody as my age group trials were coming up for national selection. I got picked but injury got worse and I ended up missing much of the next season.”

SW: “If you could go back in time, would you make same decision to disguise the injury?”

Player: “Yes.” SW: “What would make you consider telling your coaches about an injury?”

Player: “Reassurance that you are not forgotten just because you are injured – but that wouldn’t happen.”

The issues we face are complex. We need to have informative conversations with parents and coaches, organisations need to have a deeper understanding of the implications of their athlete development structures and processes (as evidenced by the attitude of the hockey player interviewed here). It is time in New Zealand for a ‘think tank’ involving representatives from key stakeholders involved with the delivery and support of sport for young people. There have been moves in the right direction, as evidenced by Rugby organisations recently. But if we want to see a decline in the injury trends reported by ACC, that will require a multi-disciplinary approach. As researchers we have worked in silos for too long (Sports Medicine, Exercise Science, Coaching, Sport Management), we have often ignored the knowledge and experiences of those at the ‘coal face’ (physiotherapists, coaches, teachers). We need to work together to enhance the ongoing delivery of sport for young people in our country. As a relatively small country, with a history of innovation, collaboration should be easy and we could lead the way in this area.

References ACC Media Release (2019). Retrieved from https:// www.acc.co.nz/newsroom/stories/significant-surge-in-kiwikids-side-lined-by-sports-injuries/ Aktive Auckland. (2019). Good Sports. Retrieved from: http://aktive.org.nz/good-sports/McGowan, J. (2018). Early specialisation, sport participation volume and musculoskeletal injury in early adolescent New Zealand children. Unpublished Masters Thesis. Retrieved from: https://openrepository.aut.ac.nz/handle/10292/11754 :AUT Cleaver, D. New Zealand Herald. (2019). Exclusive: North Harbour kicks junior rep rugby to touch in shock move.

Retrieved from: https://www.nzherald.co.nz/sport/news/ article.cfm?c_id=4&objectid=12206300 Murphy, A.M., Askew, K.L., Sumner, K.E. (2017). Parents’ intentions to allow youth football participation: Perceived concussion risk and the theory of planned behaviour.

Sport, Exercise and Performance Psychology, 6(3), 230242

Republished with the permission of the New Zealand Journal of Sports Medicine.

Dr Simon Walters Head of Coaching, Health and Physical Education (HPE) School of Sport and Recreation, AUT Qualifications: PhD (AUT), MSc (University of Leicester), Further and Adult Education Teaching Certificate (University of Wales), B.Hum (Joint Hons) (University of London) University links: http://www.aut.ac.nz/profiles/sport-recreation/senior-lectures/simon-walters

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CLINICAL REVIEW

Mountain Biking Injuries Current Sports Medicine Reports Ansari, M; Nourian, R; Khodaee, M.

American College of Sports Medicine Nov/Dec 2017 16(6)4:404-412

https://journals.lww.com/acsm-csmr/Fulltext/2017/11000/Mountain_Biking_Injuries.10.aspx

By Rose Lampen-Smith The authors have provided a summary of Mountain Biking Injuries (MBI) following a review of literature over the last 20 years.

There has been a definite increase in numbers of mountain bike riders (MBR) over this period of time, and so concurrently with an increase in the popularity of the sport there has been an increase in the number of injuries reported. A 2016 study undertaken in Colorado, USA reported 50% and 80% of recreational and professional MBR have reported at least one major injury directly related to the sport. Meanwhile a study in 2015 reported overuse injuries in over half of MBR. Therefore the prevention of MBI requires recognition of both traumatic and overuse mechanisms.

There are differing types of mountain bikes with associated injuries, for example Cross Country(XC), Downhill (DH) and Freeride bikes, with terrains, environmental factors, riding at Mountain bike Parks, competing in events and overall expertise of the riders creating a multitude of scenarios where injuries can occur. In general DH riders have a greater incidence of traumatic injures than XC and males are more likely to get injured than females.

‘Bike Fit’ is the process of making the cyclist and bicycle geometry compatible to minimise the risk of injury and optimise performance. It is widely acknowledged that poor bike fit can lead to overuse injuries. Assessment needs to be made of each component of the bike to rider interface, including but not limited to, saddle height, saddle positioning (setback), foot/shoe/pedal interface, assessment of the riders ‘reach’, and choice and height of handlebars.

Due to the repetitive action of pedalling, length of time of events and training loads, there is risk of overuse injuries that occur across all proficiency levels of riders. The average MBR will rotate the pedals between 3600 to 6000 times per hour and endurance events can last for many hours and even days. Overuse injuries can be related to poor bike fit, or changes with load and types of training.

The knee is commonly overloaded causing patellar femoral pain, ITB friction and patellar tendinopathies.

Higher training volumes and intensity, with low or anterior seat positions are risk factors for anterior knee pain, and conversely, positioning the seat too high and/or posteriorly can cause ITB friction pain.

Cervicalgia is another common complaint among MBR. Weakness and fatigue of cervical stabilisers with an

associated postural mechanical disadvantage on the bike can lead to pain. Assessment of scapular stabilisers, maintenance of thoracic and cervical mobility and ensuring a good bike fit are essential. There is a similar incidence of low back pain (LBP), reported in up to 40% of riders, however, there is a paucity of research on the precipitating factors linking LBP to MBR. The general consensus is that poor bike fit, training methods and riding techniques with anatomical imbalances will lead to LBP. Other overuse injuries include ulnar (cyclists palsy), median nerve neuropathies and genital area injuries.

With respect to acute injuries, the occurrence of fractures has been reported at over 74% of all MBI reported, with over two thirds of the fractures reported in the upper extremities. Head injuries resulting in concussions, dental trauma and facial fractures accounted for a high percentage of injuries too with severe spine injuries less common. Chest and abdominal injuries were also reported with blunt trauma received from bicycle handlebars.

Interestingly at the time of the review, the authors comment that helmet use in MB has not been fully investigated as to its use in respect to the incidence of brain injuries. The above types of injuries – due to their severity are reported however more minor injuries of lacerations, blisters, chafing and abrasions are also very common.

Due to the nature of the sport the rider needs to be prepared for many conditions and what injuries they will be prone to especially with endurance events. The rider will be faced with scenarios where they could be at risk of altitude illness, sunburns, heat stroke or conversely hypothermia. Therefore Race Directors need to develop medical protocols specific for each Mountain biking event.

Overall, predictive factors for MBI from crashes included a prior history of crashing, riding in a group or in the dark.

Further influencers were riders error, fatigue, trail and environmental conditions, speed and riding unfamiliar bikes. However, it is generally felt that the potential risks of cycling are outweighed by the health and social related benefits of bike riding.

The authors summarise that there is a paucity of high quality research looking at the pathogenesis, prevention and treatment of overuse and traumatic injuries sustained

by MBR. References available by following the link.

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RESEARCH PUBLICATIONS

British Journal of Sports Medicine August 2019; Vol. 53, No. 15 EDITORIAL Vastus medialis obliquus (VMO) retraining or graduated loading programme for patellofemoral pain: different paradigm with similar results?

Kay M Crossley, Sallie M Cowan Mathematical coupling causes spurious correlation within the conventional acute-to-chronic workload ratio calculations Lorenzo Lolli, Alan Batterham, Richard Hawkins, David M Kelly, Anthony J Strudwick, Robin Thorpe, Warren Gregson, Greg Atkinson Is live high–train low altitude training relevant for elite athletes? Flawed analysis from inaccurate data Gregoire P Millet, F Chapman, Olivier Girard, Franck Brocherie

Robert

Zombie reviews taking over the PROSPERO systematic review registry. It’s time to fight back!

Renato Andrade, Rogério Pereira, Adam Weir, Clare L Ardern, João Espregueira-Mendes SYSTEMATIC REVIEWS Broad-spectrum physical fitness benefits of recreational football: a systematic review and meta-analysis Zoran Milanović, Saša Pantelić, Nedim Čović, Goran Spori š, Magni Mohr, Peter Krustrup

Recreational and ergogenic substance use and substance use disorders in elite athletes: a narrative review David McDuff, Todd Stull, João Mauricio Castaldelli-Maia, Mary E Hitchcock, Brian Hainline, Claudia L Reardon Epidemiology and return to play following isolated syndesmotic injuries of the ankle: a prospective cohort study of 3677 male professional footballers in the UEFA Elite Club Injury Study Bart Lubberts, Pieter D’Hooghe, Håkan Bengtsson, Christopher DiGiovanni, James Calder, Jan Ekstrand ACL and meniscal injuries increase the risk of primary total knee replacement for osteoarthritis: a matched case– control study using the Clinical Practice Research Datalink (CPRD) Tanvir Khan, Abtin Alvand, Daniel Prieto-Alhambra, David J Culliford, Andrew Judge, William F Jackson, Brigitte E Scammell, Nigel K Arden, Andrew James Price On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches James Rafferty, Craig Ranson, Giles Oatley, Mohamed Mo stafa, Prabhat Mathema, Tom Crick, Isabel S Moore DISCUSSION Is unintentional doping real, or just an excuse?

Derwin King Chung Chan, Tracy Chor Wai Tang, Patrick Shu-Hang Yung, Daniel F Gucciardi, Martin S Hagger

Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials Alessio Bricca, Carsten Juhl, Martijn Steultjens, Wolfgang Wirth, Ewa M Roos ORIGINAL ARTICLES Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card) Florian Beaudouin, Karen aus Fünten, Tobias Tröß, Claus Reinsberger, Tim Meyer

der

Review of criterion-referenced standards for cardiorespiratory fitness: what percentage of 1 142 026 international children and youth are apparently healthy?

Justin J Lang, Mark S Tremblay, B Ortega, Jonatan R Ruiz, Grant R Tomkinson

Francisco

http://bjsm.bmj.com/content/53/15 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/

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

This course is for registered physiotherapists who work with individual athletes or teams in which lower limb injury is common. The focus of the course is on pathomechanics and kinetic chain deficits as they relate to injury prevention and performance, diagnosis and advanced rehabilitation of lower limb conditions.

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

Promotion and Prescription of Physical Activity and Exercise (SEPNZ LEVEL 1 COURSE) Dunedin October 12-13th This course is suitable for physiotherapists wanting to improve their knowledge and skills in assessment and prescription of physical activity and exercise to use with patients on a daily basis. This course provides a bridge to Level 2 SPNZ courses and important background information for those considering university postgraduate study.

The course will provide a combination of lectures, practical demonstrations, practical assessments and case studies and will cover the following topics: Principles of exercise prescription, Promotion and assessment of physical activity, Assessment of neuromuscular performance, Aerobic and functional capacity testing ,Strategies to enhance exercise adherence, Screening for return to sport, Exercise risk screening and goal setting, Physiological effects of disuse and ageing

Injury Prevention & Performance Enhancement (SEPNZ LEVEL 2 COURSE) Auckland Nov 30—Dec 1st This course will provide you with the key skills used in the enhancement of sporting performance and prevention of injury. It covers the analysis of physical, biomechanical and technical needs of sport, identifying key factors affecting performance and injury prevention.

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

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

All SEPNZ members get a discounted rate on our courses.

If you don’t know the discount code click here ***There are no prerequisites to level 2 courses***

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CLASSIFIEDS Canterbury Cricket Physiotherapist (7.5 Months Fixed Term) From the BLACKCAPS and WHITE FERNS on the international stage, to backyard cricket with friends in the holidays. New Zealand Cricket are behind it all, promoting and supporting our number one summer sport.

We’re a passionate and enthusiastic team, focused on ensuring that cricket is a game without barriers, and committed to living and breathing our vision of cricket being a game for all New Zealanders; a game for life.

We’re looking for a Physiotherapist to work with Canterbury Cricket, based in Christchurch, but with the ability to travel for the entire upcoming season. This role is a key part of the Association and will be responsible for the diagnosis and management of injury and illness for the men’s team, including clinical reasoning and complete and comprehensive player rehabilitation plans related to short and long-term injuries on an individual basis.

Ideally, you’ll have a host of relevant experience, covering the following: A NZ registered physiotherapist with experience in musculoskeletal physiotherapy Prior experience with high-performance athletes or sporting organisations Sound knowledge and experience of strength and conditioning programmes You’ll also have some amazing personal skills and attributes such as: Effective communication to help you work with athletes, Canterbury Cricket and NZC Excellent coordination and management to support all player treatment and monitoring Collaboration to help you work with the wider management group for overall player wellbeing We are a high-performance organization who are proud of our values of inclusivity, optimism, tenacity, fun and respect. To be successful you’ll share our focus on achieving the very best and bring the same value-based approach in what you do. There’s a lot to enjoy about working for New Zealand Cricket and being part of the team behind the teams that represent the best of New Zealand.

If this sounds like you, apply here.