December 2014 bulletin

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BULLETIN

Issue 6 December 2014

Christmas Edition SPNZ MEMBERS PAGE

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

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By SPNZ President Hamish Ashton LATEST NEWS

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Sports Physiotherapy Pathway and Immediate Care and Sports Trauma Management CONTINUING EDUCATION

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SPNZ Level 1 Course—Sideline Management

In this issue:

MEMBER’ BENEFITS

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Join SPNZ and Receive the Following Benefits FEATURE

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Justin Lopes: A Profile CLINICAL SECTION- ARTICLE REVIEW

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Diagnosis and Management of Acute Medial Tibial Stress Syndrome in a 15 Year Old Female Surf Life-Saving Competitor CASE STUDY

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Manikin Shoulder SPRINZ

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Guided Exercise in Order to Attain Your Human Potential ASICS SPNZ EDUCATION FUND REPORT

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by Dr Angela Cadogan PLANET OF THE APPS

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iSpineCare by Human Media Ltd ASICS

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ASICS Shoe Report - Gel Ballarat RESEARCH PUBLICATIONS

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JOSPT Volume 44, Number 12, December 2014 CLASSIFIEDS Job Vacancies

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

Hamish Ashton

Secretary

Michael Borich

Treasurer

Michael Borich

Website & IT

Hamish Ashton

Committee

Timofei Dovbysh Blair Jarratt

Visit our website www.spnz.org.nz CHECK OUT THESE LINKS

Join us on Facebook

List of Open Access Journals

Justin Lopes Dr David Rice Bharat Sukha

Asics Apparel and order form

Follow us on Twitter

Kara Thomas EDUCATION SUB-COMMITTEE Dr David Rice - chair

Sports Physiotherapy NZ

McGraw-Hill Books and order form Asics Education Fund information

Join us on Linkedin Groups

IFSPT and JOSPT

Dr Angela Cadogan Justin Lopes

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Dr Grant Mawston Dr Chris Whatman BULLETIN EDITOR Aveny Moore SPECIAL PROJECTS Monique Baigent Karen Carmichael Deborah Nelson Kate Polson Amanda O’Reilly Pip Sail Louise Turner Greg Usherwood

Deadlines for 2014: February Bulletin: April Bulletin: June Bulletin: August Bulletin: October Bulletin: December Bulletin:

31st January 31st March 31st May 31st July 30th September 30th November

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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 March 2015.

Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing education in the fields of sports and orthopaedic physiotherapy.

An application form can be downloaded on the SPNZ website

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

sportsphysiotherapy.org.nz.

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Editorial Hamish Ashton, SPNZ President Seasons greeting to you all. I hope this year has been a productive one for you all and you get some time for family and friends over the summer.

Since taking over the reins in March I have been busy trying to fill the shoes of Angela and keeping all her good work going. We now have had two of each of our sports physiotherapy level one courses run with good feedback on where we are going. Thanks to David Rice and his committee for their hard work on this.

We look forward to releasing level two next year so look out for these and a new structure for sports physiotherapy training.

A big thanks goes out to Michael Borich, our secretary. Many of you won’t know the tremendous amount of work Michael does for SPNZ. Thanks also to all the other committee members and all those who have contributed to another successful year. For many years SPNZ has only had a small committee running the SIG. With us trying to achieve more for you and better improve what we offer please think about whether there is anything you can do for the organisation. This is not necessarily joining the committee, though we are short on South Island and female representatives. It could be doing an app review, case study or reviewing an article for the bulletin. It may be just some speaker suggestions for courses or our symposium. Every little bit helps and most of it probably counts as CPD in some form.

professional within that team, the sports physiotherapist should consider how their individual actions in a team social setting reflects on themselves and the physiotherapy profession, and impacts on future physiotherapy patient relationships ….” That is not to say that you can’t socialise with the team, but when you do you need to consider them as your patient not just a friend.

That’s been a bit of a ramble but that is how my brain is functioning at this time of year. I am looking forward to a break with my family over Christmas and the New Year. Best wishes to you all and I look forward to you all being part of our wonderful sports group next year Hamish

Over many years now we have tried to provide you as members with an excellent return for your membership. We have kept the subs low and provided an excellent symposium at an affordable rate. We have raised the sub this year, but this was only done after careful consideration and taking your opinion into account. The survey we conducted saw over 400 responses and a 98% + agreement. The reason we did this was to take up an excellent offer we have received from the British Journal of Sports Medicine.

Details will be released next year but in essence we not only get the journal online but also other educational opportunities from them. You just need to look at the benefits page to see the value we have worked tirelessly to bring you.

A highlight of the year has to have been the release of the SPNZ Sports Physiotherapy Code of Conduct.

This is a world first for sports physiotherapy and a great tool to support those of us who work on the sideline. It, and a contract with the team, clarifies who we are and what we do and gives us backing to our decision making. It also helps the team and public know what to expect from us from both a clinical and a professional aspect. One aspect of this is socially. It must be remembered that we have a professional relationship with our athletes even in a social setting. The code states “A sports physiotherapist is part of the team by virtue of their professional role. As a health

Merry Christmas from all of us at SPNZ

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Latest News SPORTS PHYSIOTHERAPY PATHWAY – DR DAVID RICE, CHAIR EDUCATION COMMITTEE SPNZ is developing a series of continuing education courses that are informed by the sports physiotherapy core competencies identified by the International Federation of Sports Physical Therapists http://ifspt.org/competencies/ SPNZ Level 1 courses have already been developed and are for qualified physiotherapists providing sideline management for individuals or sports team at any level. These courses are: 

The Promotion and Prescription of Physical Activity and Exercise

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Sideline Management

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Immediate Care and Sports Trauma Management

SPNZ Level 2 courses are currently under development. These will be available from 2015 and are for qualified physiotherapists with sideline management experience who wish to advance their sports physiotherapy clinical practice skills and/or pursue a career pathway in elite sport. Members who complete all SPNZ Level 1 and Level 2 courses will attain a SPNZ Certificate in Sports Physiotherapy.

In the future, we are planning on developing SPNZ Level 3 courses. These will target sports physiotherapists who work in elite level sport and who wish to gain specialised knowledge and become leaders in the sports physiotherapy profession.

We look forward to bringing you further details on this in the first half of next year

IMMEDIATE CARE AND SPORTS TRAUMA MANAGEMENT – TIM DOVBYSH With recent public features of trauma and injury we have all in our own way reflected on the role of the sports physiotherapist. Although serious trauma or emergencies are rare, they can happen and knowing how to react, assess, and manage such a situation will have significant impact. Those of us working on-field often find ourselves the sole health provider covering an event, often unassisted. Given this responsibility it is essential that we be well equipped to respond appropriately when an emergency arises.

SPNZ have been running Immediate Care and Sports Trauma Management Courses for two years. The purpose of the course is to provide knowledge, advice and practical skills to those working in high risk situations with or without immediate medical assistance to the standard recognised by SPNZ and supported by the Sport Physiotherapy Code of Conduct. The latest course in Rotorua featured emergency medicine specialists and intensive care unit consultants Dr Rob Everitt and Dr Duncan Reid, and WDHB clinical skills leader Stephanie Vos. Presentations covered athlete collapse, basic life support, airway assessment and support, anaphylaxis, asthma, diabetes, epilepsy, infectious diseases, various trauma, and spinal injuries. These were supported with thorough closely supervised small group practical sessions detailing their assessment and management approaches in a structured way. Individual assessment and feedback at the conclusion of the course ensured the content was appropriately understood. Successful completion of the course means knowing you have the skill to respond in an emergency situation on-field within the current best practice recommendations.

This course is essential for all those involved with sports teams or events, at any level of experience.

Look out for this course in 2015 in addition to Sideline Management, and Promotion and Prescription of Physical Activity and Exercise, making up the core level 1 competencies of the SPNZ sports physiotherapist pathway.

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Continuing Education SPNZ LEVEL 1 COURSE

SIDELINE MANAGEMENT (2 day course) A course for physiotherapists who work with individual athletes, or on the sideline at sports games or events who want to upskill in the areas of pre-game preparation, first aid, acute injury assessment and management, indications for radiology referral and post-event recovery strategies.

By the end of the course you will have all the tools you need to manage pre-event preparation, post-event recovery and to confidently asses, manage and refer common sporting injuries and wounds.

Date:

Location: Millennium Institute of Sport & Health (click for map) 17 Antares Pl, Mairangi Bay, Auckland

Saturday 14th February 2015 Sunday 15th February 2015 Times: 9am—5pm (both days)

Course Fee: SPNZ Member PNZ Member Non-PNZ Member

$405 $486 $607.50

The Course Will Cover:      

Ethics and Professional Issues in Sports Physiotherapy Pre-event preparation and warm-up Strapping Sports First Aid On-field injury assessment Concussion assessment and management

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Return-to-play decision making Indications for medical and radiology referral Splinting of hand and finger injuries Post-event recovery Anti-doping regulations and banned substances

Presenters:

Dr Deb Robinson (Sports Medicine Physician) Former All Blacks doctor, and Canterbury Crusaders doctor. and: Chelsea Lane & Dr Angela Cadogan (Sports Physiotherapists), Kim Simperingham(Strength & Conditioning) Kelly Davison (Hand Therapist), Drug Free SportNZ.

To Register: Please Note: Places will be strictly limited to 24 participants.

Complete the attached Registration Form and return with payment to:

Physiotherapy New Zealand, PO Box 27 386, Marion Square, Wellington 6141 pnz@physiotherapy.org.nz Fax: 04 801 5571

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Members’ Benefits

Join SPNZ and receive the following benefits

ue l Va

00 3 $

Free: Online JOSPT access for all members of SPNZ Monthly journals plus ‘Clinical Practice Guidelines’ Special reports and more

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Free: Online BJSM access for all members of SPNZ Fortnightly Journals plus Podcasts, Educational Videos, Interactive quizzes PowerPoint presentations and more

$2 80

Great for extra CPD points

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4 times per year copies of the Sports Physio Australia Magazine - Sports Physio

0 $8

4 times per year online copies of the Sports Medicine Australia Magazine - Sport Health

Pr

Va l ice ue les s

Don’t forget to tick SPNZ when you renew your PNZ Membership - All this for just $80  Regular SPNZ Sports Bulletin newsletters by email including clinical updates, latest research, clinical interviews and local case studies

 Up to date information via the SPNZ web site - links to free education opportunities  Education fund available to members only to help with funding for CPD activities (course and conference attendance, research etc)

 Advanced notification of Sports Physiotherapy positions across all levels  ASICS shoes and clothing at Members rates. McGraw Hill 25% medical book discount  Free online “Find a Sports Physio” listing  SPNZ Facebook page and Twitter account to keep you up to date  LinkedIn ‘closed’ Sports Physiotherapy discussion group  Discounted SPNZ courses and much much more...

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Feature Justin Lopes: a Profile Physiotherapist, Auckland City Football Club I was born in South Africa and moved to New Zealand when I was 12, initially living in Wellington for a year before moving to Auckland for secondary school. When I was 15 I realised I wanted to be a sports physiotherapist, specifically (no doubt due to my own love of the “beautiful game”) a football physio. To that end I took subjects at school that helped me to get accepted into AUT’s physiotherapy degree programme. Unfortunately I failed two papers and had to repeat third year (I was a somewhat distracted, and distracting, student). I do believe that this helped incentivise me to try and excel and not fail again. I graduated in 2000. During my final year I completed a sports massage course at the Wellpark School of Massage as I felt I needed to up skill in the more handson techniques I would need to be a sports physiotherapist

During my studies I continued to play football, and to gain experience, I volunteered as a medic for East Coast Bays AFC first team. From there I went to Mt Albert Ponsonby, also playing and working as a medic and, once I graduated, as their first team physiotherapist.

The first job I had was a three month private practice contract at Tawhai Whitewood’s Unitec and Stoddard Rd Clinics – working in isolation as a new graduate at Stoddard Rd proved something of a trial by fire. After finishing my contract, I worked for approximately seven months at the AT & R Ward at Waitakere Hospital before getting another private practice job with Patrick Keating in Mairangi Bay. After working full-time for a year I returned to study at AUT, completing a Post Graduate Certificate in Western Acupuncture (2002) in a Post Graduate Diploma in Musculoskeletal Physiotherapy (2005), and a Masters in Health Science (receiving honours) in 2007. During this time I also got married and now have two wonderfully time consuming kids (a boy, four, and a girl, six).

Since then (and during my postgraduate studies) I worked hard to acquire experience and figure out what it was to be a private practice musculoskeletal physiotherapist. I worked at several clinics on the North Shore including a number of years at Roland Jeffery Physiotherapist (another football physiotherapist clinic). I worked for two years full time at the New Zealand Knights FC – initially by myself and the second year with Craig Neal.

It was during this time that I really learnt my craft. It was great to be able to work with athletes full time, although our results were terrible, and the set up was poor. In all honesty I was probably not experienced enough to do the role justice but travelling with teams every fortnight

you learn on your feet fast.

After the Knights folded I returned to private practice work and came to manage and be senior physiotherapist at Avondale Physiotherapy Clinic. I worked there for a couple of years which allowed me to open the first “Back To Your Feet” Physiotherapy clinic in St Lukes and gave me invaluable experience at running a clinic. Another year at Roland Jeffery’s clinic acted as a springboard for me to open my current” Back To Your Feet” Physiotherapy Clinic at Western Springs AFC in 2013. The “work hard, play hard” environment at Roland Jeffery Physiotherapy, along with the experiences I gained through Roland’s contacts in football, have certainly shaped my style as a physiotherapist, and I owe him a lot.

I have always worked with sports teams and have been fortunate to have had some amazing experiences, the highlights being attending the Beijing Olympics in 2008, the 2011 FIFA U20 World Cup in Colombia and currently the FIFA Club World Cup in Morocco. I have worked with East Coast Bays AFC, Mt Albert Ponsonby AFC, North Shore United, The New Zealand Knights FC, Tahiti U20 World Cup qualifying team, Three Kings United, Waitakere United and Mania Sports Fighting Gym. I continue to work with Western Springs AFC, Auckland Roller Derby League, Pirate City Rollers, New Zealand Roller Derby Team, New Zealand Football and Auckland City FC. I attend as many symposia and conferences as I can, both for valuable networking and the opportunity to further my knowledge - I still feel that I have so much to learn, and our profession is continuing to provide more research into techniques that not only help rehabilitate injuries, but improve our athletes’ performances.

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Feature Justin Lopes: a Profile continued...

I am currently in Marakesh with Auckland City FC and we play the semifinal of the FIFA Club World Cup tonight against San Lorenzo, the CONCACAF club champions, after beating the Morocco champions and the African Champions! This would have to be the pinnacle of my career along with the Olympics and it doesn’t get any better than this...Living the dream!!

ted physiotherapist to cover the large, city fringe club, I approached the board with a full proposal and a partnership was entered into. The clinic is now open 7am to 7pm Monday to Friday, as well as Saturday mornings; operating from within the clubrooms for members of the club and the public. I am also working for Auckland City FC and New Zealand Football.

Please describe your current role and how you ended up there.

What are your specific areas of interest/research?

I started working for NZF by requesting a placement position with Roland Jeffery as he was the All Whites physio and Physiotherapy coordinator for NZF during my Post Grad Diploma. I started working with academies and then fortunately got positions within teams after a couple of years. While in my second tenure at Roland Jeffery Physio, Neil Emblem secured the Director of football position at WSAFC and invited me to be the first team and reserves physiotherapist for the club. After taking on the role and realising there was a wider need for a commit-

I have always been a football physiotherapist, so I see a lot of groin, hip knee and ankle injuries. The last five years I have also specialised in Roller Derby – a high contact, fast paced sport with lots of injuries. The research I undertook during my Master’s degree was in acute ankle sprains, specifically looking at the difference between managing sprains with both RICE and Physiotherapy in the acute phase, compared to RICE in isolation. I am also providing the App review for the SPNZ bulletin and enjoy the way we can use technology to improve the way we work .

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Feature Justin Lopes: a Profile 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?

The physiotherapist’s relationship with the coaches is integral when working with sports teams and, unless you have their support for injury prevention, you will struggle to treat the whole team. I am also fortunate to have a good relationship with some sports physicians who work with the athletes and, when I am in need of a second opinion, a diagnosis, or in depth management plan, I will involve them in the athlete’s care.

What are the types of injuries you commonly see?

Roller Derby injuries are often impact injuries to the knees – PCL and patello-femoral osteochondral injuries are common. As players are up on skates when they fall and twist ankles they can often fracture the fibula at the same time. Footballers frequently injure their groins, knees and ankles, and I see a lot of growth related injuries in the adolescent population due to the load of club football, school football, academies and other sports on the maturing skeletal system. Being based in a large football club I see the full spectrum of age related sports injuries, from growth plate injuries, to treating some of the reconstructed joints of our aging members!

What do you think are the key elements in successfully preventing injury?

Managing training and competitive load is essential in preventing injuries. Communicating with coaches and being involved in planning of sessions to avoid training hard particularly when fatigued. Gradually conditioning players for the loads their chosen sport puts on the body appears to be essential to reduce the incidence of injury.

New Zealand Football in conjunction with ACC and FIFA are pushing the FIFA 11+ programme. It is a freely available injury prevention programme that involves running drills and strength exercises that players do during warm up, in practice and a modified version prior to competing. It combines a combination of progressive running and neuromuscular retraining exercises with strength exercises such as eccentric hamstring exercises to reduce hamstring injuries. (The strength exercises are left out prior to competition but I get our team to do the plank and squats as ‘activation’ exercises.)

Are you involved in performance aspects for your clients?

Indirectly and directly I am involved in the performance of my clients. In the teams where the athletes do not have sports science support I often provide exercise programmes and basic motivational and psychological support for my clients (to the point where I refer on to more appropriate providers).

What are the key attributes you feel are required to work with elite level athletes?

To work with elite athletes you need to be patient, you have to be able to think outside of the square – often they already perform many of the exercises you would usually prescribe to (non athlete) clients and are looking for something extra from you. You need to be able to know the sport you are working with - know the jargon, the main players, and main events as this can help you to build rapport and also give deeper understanding to the client’s goals. You need to know your place…you are the physiotherapist, not their doctor, or the athlete – it is all about the athlete and supporting them to achieve their goal. Often you will get the best out of the athlete when you are doing your rehabilitation if you make it into competition... Elite athlete love winning or competing and I always find I get more buy in to the rehab tasks if there is a competition. When travelling- do research on where you are going – what medical support will be there, local hospitals etc. Never be asked twice for an item – if an athlete needs it once they, or somebody else will ask for it again. I think you need to be able to relate to a wide range of ages, from the young athlete to the older manager as people respond differently when under pressure.

Mostly you need to have a patient partner as you are

Free videos and resource downloads of the FIFA 11+ can be found at http://f-marc.com/11plus/home/ CONTINUED ON NEXT PAGE

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Feature Justin Lopes: a Profile continued...

often away from home, on weekends, birthdays, anniversaries and when they need you!!

What do you see as the major challenges for Sports Physiotherapy?

Funding for sports physiotherapy is generally poor.

Clubs often rely on the physiotherapist to volunteer or work for very little pay, relying on the ACC payment.

The time the sports physiotherapist puts into team preparation, sideline coverage, and treatment is significant and should be recognised. Securing specialisation status is important for New Zealand Sports Physiotherapy and the SPNZ executive is working hard to ensure that we are recognised under the banner of specialisation.

New Zealand sport physiotherapists have a great reputation overseas, and we have a number of exceptional physiotherapists working with elite teams around the world. I would love to get some of those people home to share their expertise. I think AUT could do better at training student physiotherapists in strapping and sideline trauma as there are often students working as medics on the sideline, and strapping efficiently and correctly is important in any private practice. I do however feel that sports physiotherapy is in a great position to empower our athletes with education on preventing injuries and better ways to rehabilitate from their injuries.

Photos courtesy of Shane Wenzlick, Phototek

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Clinical Section - Article Review Diagnosis and Management of Acute Medial Tibial Stress Syndrome in a 15 Year Old Female Surf Life-Saving Competitor Pietrzak M, (2014). Diagnosis and Management of Acute Medial Tibial Stress Syndrome in a 15 Year Old Female Surf Life-Saving Competitor. The International Journal of Sports Physical Therapy 9(4): 525-539.

ABSTRACT Background and Purpose: As the profound health and cost benefits of physical activity to society are established and participation guidelines implemented, health practitioners are increasingly expected to utilize efficacious and justified injury management and prevention strategies. The complex and multifactorial nature of sports injury makes elucidation of multiple risk factors and how they may subtly and variably interact, difficult. The purpose of this case report is to discuss the differential diagnosis, acute management and rehabilitation of a case of medial tibial stress syndrome (MTSS) in a surf life-saving athlete, in the context of sports injury prevention.

Case Description: The subject of this case study, a 15 year old female surf life-saving competitor, presented to the physiotherapist (PT) with recent onset, first episode, bilateral, diffuse posteromedial shin pain. Differential diagnosis acute management, rehabilitation and preventative strategies for the subject are presented.

Discussion: Emerging injury surveillance research in surf life-saving suggests minor and major trauma as primary causative factors, however, the significance of high-training volumes is likely underestimated. The influence of biomechanical, and subtle arthrokinematic dysfunctions on established risk factors for MTSS injury and prevention of reinjury for this subject, are also discussed. Furthermore, the concept of preventing tibial stress fracture (TSF) by successfully managing acute MTSS, is presented. Lastly, a critical analysis of reliability of clinical assessment methodologies utilised with the subject is provided.

Level of Evidence: Level 5; Single case report ARTICLE REVIEW This article takes a look at the diagnosis and subsequent management of a 15 year old female competitive surf lifesaver in Australia who develops Medial Tibial Stress Syndrome during the competitive season. The article gives an overview of surf life-saving and then discusses the definition of medial tibial stress syndrome (MTSS) as compared to tibial stress fracture (TSF) and bone stress injury (BSI). It then describes the management of the condition along with discussion of possible etiological factors and how they could relate to treatment.

Surf Lifesaving “Surf Lifesaving is an international sport/movement aimed at reducing injury and death around beaches supported by a comprehensive competitive programme.” In Australia (and probably similar in New Zealand) it is a mostly amateur sport, from nippers (5years +) through to Masters level. Through the summer competitive season, carnivals are held at weekends and lead through to National level competitions. Competitors belong to clubs. Events at carnivals include beach and flag sprints, swimming based events, surf craft (surfboard and surf ski), surf boat racing, inflatable rescue boat (IRB) racing or other events such as ironman/woman (swim, ski and board). Many of the events involve short, unshod, beach sprints.

Definition of Medial Tibial Stress Syndrome (MTSS) The definition of MTSS used in the article was “pain along the posteromedial border of the tibia, typically in the distal third, worse during or just after exercise, with tenderness on palpation of at least 5cm and absence of stress fracture or ischaemic symptoms.”

A discussion in the article looked at the difference in possible pathology, comparing Tibial traction periostitis (TTP) a popular inflammatory based pathophysiological theory, to MTSS as a non-focal bony stress injury. They concluded the latter was more likely due to stronger evidence in the literature.

Case Description The subject is a 15 year old female surf lifesaving competitor who was diagnosed with bilateral MTSS. She competed in a number of events potentially competing in up to 20 events in one day. She had quite an intense twice daily training regime, including strength and conditioning and shod and unshod running. She initially presented to physiotherapy during a carnival with bilateral, distal third posteromedial shin pain of two days duration. On assessment CONTINUED ON NEXT PAGE

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Clinical Section - Article Review Diagnosis and Management of Acute Medial Tibial Stress Syndrome in a 15 Year Old Female Surf Life-Saving Competitor continued... there was diffuse tenderness in the distal third of both side tibias. No significant medical history and no red flags.

Stress fracture and ischaemic compartment syndrome were ruled out due to history. A complex ‘decision analyses’ was used to arrive at MTSS as the most likely diagnosis. No radiological tests were ordered as they were deemed to be of limited use in this case.

Intervention and Treatment The article then went on describe the treatment and management of the condition. She was treated weekly over an 8 week period with a follow-up reported at 12 weeks.

Initially she was treated with rest from running, according to a set of staged running guidelines. This seemed quite a useful tool and so is included here.

Table 4:

Level 1: Unrestricted

Unrestricted running at training and competition.

Level 2A: Training restricted

May compete fully but running restricted at training under direction coach/physiotherapist/doctor.

Level 2B: Competition restricted

Restricted sprinting. May compete but effort of sprint restricted under guidance from coach/ physiotherapist/doctor

Level 3: No running with squad

Full weight bearing, no running in competition or squad training. May have separate staged running program under direction of PT separate to squad.

May train other disciplines under guidance, coach/ physiotherapist/doctor.

Level 4: Protected weight bearing

On crutches plus or minus protective orthosis/cast.

Training other disciplines to be discussed with physiotherapist/coach/doctor.

Treatment also consisted of ice initially for pain relief. NSAID’s were not used due to “apparent absence of inflammation, increased side-effect profile, and potential to hinder tissue healing.”

Gastrocnemius was found to be tight, limiting talocrural dorsiflexion, which was postulated to cause excessive compensatory pronation and a possible risk factor of MTSS. She also showed a tendency towards dynamic knee valgus (DKV), which is also a possible risk factor and may or may not be associated with the excessive foot pronation as well. “DKV likely potentiates MTSS through excessive tibial rotation resulting from excessive pronation and torque conversion at the sub-talar joint.”

Therefore in light of those two biomechanical findings, treatment also consisted of gastrocnemius stretches, core strengthening and gluteal strengthening which were progressed over time, along with local soft tissue work.

At around the 4 week mark (difficult to tell exactly when from article), the athlete was allowed to return to competition, but remained on level 2A of the staged running protocol. She was given strict guidelines for return to competition, and had to report if symptoms failed to continue to improve. At 8 weeks after initial onset she reported that symptoms were fully resolved. At 12 weeks post injury she was allowed to go to Level 1 of the staged running guidelines. The rest of the season was pain free.

Discussion Proposed risk factors for MTSS identified were female sex and excessive foot pronation. The author also feels that decreased talocrural dorsiflexion in sub-talar neutral and dynamic knee valgus were relevant to the injury onset.

Certainly management of these factors had a good outcome in what can be a condition that is notoriously difficult to rehabilitate. The author felt that measuring whole foot dorsiflexion may not fully evaluate all factors, which is why he looked at it in sub-talar neutral. There are still many questions to be asked regarding MTSS. Including how it is likely to progress onto Tibial Stress Fracture and how we can intervene effectively in that continuum between diffuse bony stress injury to stress fracture. Stress responses vary with age, loading, gender, bone structure, nutrition, biomechanics, training, footwear and pain perceptions, it is therefore difficult to predict what will happen to an individual, however resolution and prevention of stress fracture is important to try and achieve.

By Karen Carmichael BSc, BPhty, M(SportsPhysio)

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Case Study Manikin Shoulder A 24 year old elite female swimmer and surf lifesaving athlete presented to physiotherapy with left sided anterior shoulder pain. The athlete reported the pain had become noticeable over the past month as she transitioned from the Common Wealth Games swimming campaign into surf lifesaving. During the surf lifesaving build up to the world cup her training had changed with a focus on the surf lifesaving pool events which involved training with a 53kg plastic manikin.

This athlete reported having a history of sub acromial impingement in both shoulders at various times over her swimming career especially affecting her R). However with the appropriate strengthening, stretches and treatment this had not been a problem for the past 3-4 months. After a manikin session she reported having increased anterior shoulder pain during and after. It also ached at night which was noticeable but did not keep her awake. She denied any neural symptoms and had no medical conditions of concern.

Objectively the athlete had full range of movement in both her shoulders with slight anterior pain when she reached behind her back. She had obvious lifting off of her L) inferior scapular angle and increased internal rotation and protraction of her L) shoulder. Resisted internal rotation (inner and outer range) and resisted flexion at her elbow and shoulder provoked her anterior pain but she had full power in all. Both impingement tests and the lift off test were positive for pain only.

Speeds test was positive for pain but no weakness.

She had increased tone in her L) biceps, upper trapezius and latissimus dorsi. Her thoracic mobility was significantly reduced to the R) and there was general tightness of her anterior shoulder and chest muscles.

Management involved a one week rest from manikin sessions and in this time a sports doctor was consulted.

Technique analysis was under taken to identify and eliminated any unnecessary load and stress on the carrying shoulder. Going forward there was special attention to load management through monitoring the amount of time the athlete used the manikin within a training session and the allowance of adequate recovery.

Physiotherapy consisted of manual treatment involving myofascial and trigger point release and stretches of biceps, posterior capsule, latissimus dorsi, subscap and triceps. Mobilisation of her thoracic spine was also performed. She also had specific strengthening and stretching exercises to complement the above treatment.

Background The manikin is carried beside the athlete by the back of its head and the manikin’s mouth and nose must stay out of the water. The athletes carrying shoulder is internally rotated in slight extension and abduction with the elbow and

wrist flexed. Careful management is required to reduce the severe stress that the manikin creates on the carrying shoulder complex and surrounding capsule, muscles, and tendons. The opposite shoulder is free style stroking at high revolutions with the athlete breathing to the stroking side.

Outcome Four weeks later this athlete went on to compete at the World Surf Lifesaving Championships in France.

Through careful management and the input from the teams sports doctor this athlete was a key pool competitor who managed to come away with a number of individual world records and helped the New Zealand team bring back the cup for a second time in a row.

Discussion Over the past two world cup campaigns we have developed a comprehensive pre-screening assessment that helps identify the potential risk factors for “Manikin shoulder�. The pre-screening identifies; pre-existing bursitis/tendinopathy, tightness of the internal rotators, scapula humeral dysfunction, thoracic hypo mobility, poor technique and increased anterior translation of the humeral head. All of these are not unlike the general risk factors for your classic sub acromial shoulder impingement (swimmers shoulder).

It is stated across the research that as high as 70 percent of elite swimmers will have some form of shoulder pain. Supraspinatus tendinopathy and thickened bursa as a result of repetitive micro trauma are said to be the most common causes of impingement resulting in shoulder pain in elite swimmers. Considering that over half our team come from an elite swimming background they all have varying degrees of pre-existing shoulder problems. Identifying and managing potential risk factors to help minimise shoulder pain and dysfunction is a vital part of my role as the New Zealand Surf Lifesaving Physiotherapist.

By Susan Pirret MHSc

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SPRINZ

Guided Exercise in Order to Attain Your Human Potential

By Matt Wood and Kelly Sheerin It is commonplace for clients presenting with musculoskeletal issues (especially older adults) to also present with other high-risk chronic conditions and/or cardiovascular disease risk factors. Historically both exercise prehab/rehab options have been limited by guidelines for low-moderate intensity exercise guidelines (normally below “anaerobic” threshold). This approach will typically result in some basic health improvements, followed by a plateau. However, there is clear research to suggest if exercise is progressed to an intensity above an individual’s training-sensitive threshold, there are potentially much greater health gains to be made.

Gary, a recent client at the Human Potential Clinic at AUT Millennium, is a prime example of how what appears to be a ‘typical’ patient can benefit from more specific exercise guidelines.

Gary is a 57-year-old male who presented to his physiotherapist after tripping down the steps and twisting his knee. Through the course of his rehabilitation it was recommended that he begin cycling to help strengthen his knee. However, Gary was a little reluctant as he’d experienced shortness of breath and some heart palpitations on the last couple of attempts at cycling. He’d previously had a coronary stent inserted, and was provided with the same cycling recommendation, but it had gone unheeded. Now faced with ongoing hypertension, high cholesterol, and borderline insulin resistance, he was a little more determined.

After consultation with the Gary’s medical providers, a submaximal (85% upper limit) cardiopulmonary exercise assessment was performed using 12-lead ECG, respiratory gas analysis, pre-post blood glucose and other haemodynamic and symptom monitoring. Gary’s threshold was achieved one stage prior to decision to stop the test and is relatively low compared to normal values. Following further medical consultation and approval, Gary was introduced to a monitored 12-week exercise programme eventually progressing to an intensity just above his anaerobic threshold without significant symptoms.

Gary underwent a 12-week follow-up assessment, and this time completed the full test protocol without significant ischaemic changes or angina symptoms. A substantial improvement in both threshold (+8.5ml.kg.min) and predicted exercise capacity (+ 7.5ml.kg.min) were observed. This translates into improved function and a predicted 25-30% risk reduction. As an added bonus Gary lost weight, is no longer borderline insulin resistant, has improved his lipid profile and is now on a reduced dosage of some of his medications. Furthermore, Gary is now equipped with the skills to maintain his health and fitness improvements and understands how to self-monitor when exercising in a nonsupervised environment. Gary has now joined his local gym.

In order to optimise health and fitness benefits, an individual’s threshold is normally quantified by measuring respiratory gas analysis responses to an incremental exercise protocol. This is normally accompanied by a number of exercise-based (condition specific) safety measures used to check for normal responses and eventually guide exercise prescription. This method of exercise prescription results in a combination of unique and substantially greater health improvements, whilst minimising risk. More recently, specialised Clinical Exercise Physiology services have become readily available to the public, such as those offered by the Human Potential Clinic at AUT Millennium.

The Human Potential Clinic specialises in providing advanced exercise assessment and prescription for people with a wide range of medical conditions and risk factors such as hypertension, diabetes, cardiovascular disease and cancer. This unique clinic works closely with referring medical practitioners, specialists and allied-health professionals to provide comprehensive prevention, treatment and management of chronic health conditions. Services are centred on the principles of progressive self-management and long-term changes in health-behaviours, ranging from intensely supervised (one-to-one) to home-based (independent) programmes.

CONTINUED ON NEXT PAGE

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SPRINZ

Guided Exercise in Order to Attain Your Human Potential cont...

By Matt Wood and Kelly Sheerin

For more information on the services on offer at the Human Potential Clinic at AUT Millennium check out their website: http://autmillennium.org.nz/health-and-fitness/clinics/hpc Matt Wood - MHSc (Exercise Science & Rehabilitation) Matt is an Exercise Physiologist and Manager of the HPC. He has a wide variety of experience in clinical, occupational, and sports physiology. Matt received his exercise science and rehabilitation training at AUT University and the University of Auckland.

He is currently involved in several research projects including the effects of progressive exercise training on prognosis and function in cancer patients, and is also working towards his PhD with the aim of optimizing exercise prescription for people living with chronic disease. Matt works as a lecturer in the School of Sport and Recreation where he teaches courses in exercise science, exercise prescription and athletic conditioning.

PAGE 16

ASICS SPNZ Education Fund Report

By Dr Angela Cadogan I am extremely grateful to SPNZ for the funding they provided in support of my attendance at “The Sporting Hip, Groin and Hamstring: A Complete Picture” conference, held at the Healix Centre, Dublin City University, Dublin from 4 th – 6th September 2014.

This was the first combined conference of the Faculty of Sports and Exercise Medicine and the World Federation of Athletic Training and Therapy and featured a number of world experts in the area of sporting hip, groin and hamstring injury. Conference content included pathoaetiology, biomechanics, diagnostic classification, clinical examination, rehabilitation, surgical management and injury prevention for common hip, groin and hamstring injuries complemented by workshops focusing on practical aspects of clinical examination and rehabilitation.

The conference also included an update on key aspects of sports medicine including anti-doping, psychology in sport and concussion.

The opening conference address was one of the highlights of the conference. Paul Kimmage, a former professional road cyclist turned sports journalist who represented Ireland at LA Olympics in 1984 provided a moving account of his journey through the professional ranks of cycling where he competed against Lance Armstrong in the Tour de France, a journey that culminated in him exposing the use of performance enhancing substances and doping in the sport in his book “Rough Ride” that won Sports Book of the Year in 1990.

This, combined with his subsequent, much-publicised 7hour interview with Floyd Landis fuelled the investigation that ultimately led to Lance Armstrong being forced to admit he used performance enhancing substances despite years of denial, creating one of the biggest sports stories of the century.

Paul spoke of his initial exposure and good experiences with Sports Medicine staff as an amateur cyclist prior to LA Olympics. One year after turning professional his team appointed a doctor. He talked about the trust he had in the medical profession and his assumption that

the team would be well cared for under the eye of a medical professional. One night prior to a race he was called to doctors’ room and told he should take testosterone to enhance his performance in the upcoming race. He refused, and realised at that point that his days in professional cycling were numbered. He left the sport in 1990 after hearing that a fellow rider had died under suspicious circumstances (later found to be related to EPO use) and reported that 30 more riders died ‘under suspicious circumstances’ in subsequent years.

Paul went on to explain that Armstrong’s doctor, Michele Ferrari was equally to blame given his duty of care as a doctor. He explained the almost incomprehensible conflict of interest that existed in the contractual arrangement with doctors at the time whereby they were paid a percentage of the teams’ earnings. He concluded his address with a heartfelt plea for the sports medicine community in the UK and Ireland to consider including content relating to ethical issues in sport in future conferences. In this regard SPNZ can consider themselves ahead of the game and should be congratulated on the development of the Sports Physiotherapy Code of Conduct and for the attention that ethical issues in sport receive in their biennial symposia.

Other conference highlights for me were the podium presentations and workshops presented by Dr Phil Glasgow on biomechanics of human movement as they relate to injury and to optimising performance, and to hear Dr Geoff Verrall (Australia) and Per Holmich’s views on the diagnostic categories for hip and CONTINUED ON NEXT PAGE

PAGE 17

ASICS SPNZ Education Fund Report

By Dr Angela Cadogan continued... groin pain. It was pleasing to hear I am not the only one confused by the diverse terminology currently used to describe these injuries. They both provided their preferred diagnostic criteria and terminology but emphasised that more work is needed to reach consensus in this area before we can move forward with an evidencebased approach to management of these conditions.

Overall this was an extremely well organised conference, a fantastic venue with excellent speakers and a good combination of podium presentations and practical workshop sessions. The Sports Physiotherapy Group in Ireland is similar in its evolutionary phase to SPNZ, and it was interesting to see that, in contrast to New Zealand where we have frequently held combined sports medicine and sports science conferences until recent years, that this was the first ever combined conference for these two faculties in Ireland. It will be interesting to watch this relationship develop.

In accordance with the funding award terms, I have prepared the following report summarising the conference content and hope that it may be of benefit to SPNZ members. Thanks once again to SPNZ for their funding support of my attendance at this conference.

Key Conference Messages ________________________________________ 1. Need to establish ‘clinical entities’ for groin pain  We need to all start using same terminology  FAI is morphological, not pathological – unless it becomes symptomatic.  ‘Osteitis pubis’ is not a diagnosis in the sporting population i.

Should be replaced by “pubic bony stress injury”

 ‘Sports hernia’ is very contentious as a diagnosis/ imaging is of no value 2. Diagnosis is made primarily based upon clinical examination

 History 80%  Physical examination 19%  Investigations 1% i.

MRI value debatable (sees too much)

ii. Diagnostic injections of local anaesthetic are of value for hip pain 3. Management  TIME!! Be patient  Identify secondary problems/contributing factors  Monitor using HAGOS  Specific conditions: i.

Hip labral tears – trial of conservative management

ii. Pubic bony stress injury – treat as bony stress reaction/fracture iii. Other groin conditions – address kinetic chain and specific muscle deficits 4. Hamstring Injuries  In rehabilitation – ‘rate of force development’ is an important strength variable  In elite sport – return to sport often occurs when the hamstring is ‘functionally fit’ but not ‘fit’ enough to prevent recurrence.

5. Injury Prevention and Performance Enhancement  Individual assessment of movement efficiency is required to identify where deficiencies exist that may alter tissue loading leading to injury, and reduce performance. Component assessment should include: i.

Range of motion

ii. Motor control iii. Strength and strength sub-qualities iv. Kinetic chain influences

For further details and a copy of the full report click here.

PAGE 18

Planet of the Apps Back to the App… Your monthly app review by

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

Hi, Continuing to look at apps that can benefit both the therapist and the client this month’s app is iSpineCare - an app that has animated educational videos with voice over descriptions.

App: iSpineCare by Human Media Ltd This App has been around for a little while and has been updated again recently.

Requires: IOS 7.0 or later IOS8 compatibility has been added.

What it is used for: Self education for clinicians and great for educating clients Where to find it: Download from Apple store, https://itunes.apple.com/us/app/ispinecare/id348144361?mt=8 or just search for it in the App store!

Category: Medical Updated: Dec 04, 2014 Version: 1.5.2 Size: 1.81 GB Seller: Human Media Pty Ltd Compatibility: Requires iOS 8.0 or later. Compatible with iPhone, iPad, and iPod touch. This app is optimized for iPhone 5, iPhone 6, and iPhone 6 Plus.

Android or Apple: Apple Features: Videos for spine anatomy, pathology and care for practitioners and educational videos for clients. Cervical spine, lumbar spine anatomy movement and pathology videos. Pelvic muscles anatomy, conservative care and exercise library with flexibility for cervical, hip, shoulder and some strength exercises for the back and core. For each muscle there is a video with audio, key images and notes on the description, origin, insertion, innervation, blood supply and action which can be printed. There is medical imaging section including MRI and CT pictures and the ability to add to a ‘Favourites’ menu.

Pros: Great selection of normal anatomy and for and pathological anatomy and conditions for the spine. Educational videos for clients.

Cons: Large amount of data due to the number of videos (1.8G). The American voice may not be for everyone and the schematics and animations are basic. I usually turn the volume down so I can discuss the important or appropriate points with my clients. At just under $60.00 it is an expensive app but as I do use it every day I feel it has some value.

Compatibility: Requires iOS 8.0 or later. Compatible with iPhone, iPad, and iPod touch. This app is optimized for iPhone 5, iPhone 6, and iPhone 6 Plus.

Overall Rating: 4/5

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

PAGE 19

ASICS ASICS Shoe Report Gel Ballarat

The GEL Ballarat is relatively new to the ASICS range and functions as a walking based cross trainer. That is, it is ideally suited to consumers who want to engage in walking based activity 3-4 times per week but also want to participate in some cross lateral activities, kicking a ball with the kids or the occasional social game of tennis for example. Because of this the GEL Ballarat is designed predominantly with anterior-posterior motion in mind but realizes that extra durability, in the form of outsole wrapping, and support may be required.

There are of course some significant biomechanical differences between running and walking. Walking does not produce the same level of gained momentum as running which means that stance phase is a greater percentage of the overall gait cycle. Not only are you in contact with the ground for longer per step but more steps are required over any given distance which in turn produces greater shearing forces at the ground-shoe interface. These demands require a shoe to be lightweight, have a stronger more durable outsole to resist wear as well as adequately allowing movement from heel to toe with less effort (as a means to reduce muscle fatigue and decrease the possible likelihood of injury occurring).

With these goals in mind the Ballarat has been developed with a completely new midsole/outsole configuration. A durable non marking rubber outsole with multiple flex grooves provides effortless forward movement from heel to toe. The shoe is kept light and cushioned via the incorporation of a dual layered SpEva midsole with a soft top layer for maximum cushioning and a firmer bottom layer for durability. Forefoot and Rearfoot GEL units assist with load dispersion and a Clutch Counter rearfoot fitting system allows the rear of the shoe to customise itself to the individual heel shape of the wearer. Furthermore, a stitched toe cap and protector provide additional protection when playing court based sports. All these combine to produce a tidy package that has a cushioned underfoot feel with the freedom to move forward with minimal resistance.

Ultimately, the Ballarat will suit the casual walker looking to do a few 30-60 minute walks during the week who is also looking for multi-purpose shoe capable to withstanding the wear and tear associated with cross lateral activities.

FORERUNNER August 2014

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Research Publications JOSPT www.jospt.org JOSPT ACCESS All SPNZ members would have been sent advice directly from JOSPT with regards to accessing the new JOSPT website.

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

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

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

Only current financial SPNZ members will have JOSPT online access.

Volume 44, Number 12, December 2014 MUSCULOSKELETAL IMAGING Stress Reaction of the Humerus in a High School Baseball Player PERSPECTIVES FOR PATIENTS Return to Sport: When to Resume Full Activity After an ACL Surgery RESEARCH REPORT Implications of Practice Setting on Clinical Outcomes and Efficiency of Care in the Delivery of Physical Therapy Services Physical Activity and Spatial Differences in Medial Knee T1rho and T2 Relaxation Times in Knee Osteoarthritis Observational Ratings of Frontal Plane Knee Position Are Related to the Frontal Plane Projection Angle but Not the Knee Abduction Angle During a Step-down Task Interrater and Intrarater Reliability of Transverse Abdominal and Lumbar Multifidus Muscle Thickness in Subjects With and Without Low Back Pain Translation, Cross-cultural Adaptation, and Psychometric Properties of the German Version of the Hip Disability and Osteoarthritis Outcome Score Self-Reported Knee Function Can Identify Athletes Who Fail Return-to-Activity Criteria up to 1 Year After Anterior Cruciate Ligament Reconstruction: A Delaware-Oslo ACL Cohort Study Physical Therapists' Level of McKenzie Education, Functional Outcomes, and Utilization in Patients With Low Back Pain Factors Associated With Visually Assessed Quality of Movement During a Lateral Step-down Test Among Individuals With Patellofemoral Pain EDITORIAL A Special Thanks to 2014 JOSPT Contributors

PAGE 21

Classifieds Palmerston North Churchyard Physiotherapy Lead Sports Physiotherapist This is an exciting new role in our busy and expanding practice. We are looking for a dynamic motivated therapist keen to take the next step in their Sports Physiotherapy career and at the same time work in a clinic that has a diverse range of clients and conditions and so maintain a broad base of skills. You will work with two experienced sports and manipulative therapists and help them guide and mentor 2-3 junior staff. This role is vacant as the current therapist is leaving us after two seasons to return home to Scotland to further her career there.

Key Roles 



Physiotherapist to Manawatu Rugby Union (MRU) Turbos Rugby team. Our Premiership team for 2015, recently promoted to the top level of provincial rugby in New Zealand. 

Full time role with the team July – October when they are in full time training and during ITM Cup season



Responsible for development and implementation of injury management, injury prevention, return to sport (RTS) and recovery protocols



Communicate with coaches, team doctor and other management staff regarding player availability.

Lead Sports Physiotherapist Churchyard Physiotherapy Clinics 

Development and implementation of injury management, injury prevention and recovery protocols for all teams that clinic staff are involved with and educating staff on their implementation



Supervision and mentoring of junior staff involved with other sports teams



Developing a culture of current best practice and evidence based treatment and management of sports injuries

Key Skills/Qualities 

Excellent communication skills



An ability to work in a team environment



Able to motivate and educate other staff



Sound knowledge of Sports Physiotherapy principles, ethics and relevant sports guidelines and protocols

Required Qualifications/Knowledge 

NZ Registered Physiotherapist



Post-graduate (or in the process of gaining) qualification in Manual/Manipulative Therapy and/or Sports Physiotherapy



Current First Aid and CPR Certification



Sound knowledge of IRB guidelines on the management of concussion

Experience 

5 years+ post graduate experience 



Preferably mainly in manual therapy/sports therapy

Previous experience working with sports teams 

As the main part of this role is with the Turbos we would prefer this experience to be with rugby



Preferably at a representative level – ITM Cup, Heartland, U20, U18, Development teams etc

Package 

Competitive salary



CPD and APC allowances



Regular inservices For full job description please contact Fiona O’Connor, fiona@churchyardphysio.co.nz For more information on the clinic please see our website www.churchyardphysio.co.nz All correspondence will be treated in confidence.

PAGE 22

Classifieds Palmerston North Churchyard Physiotherapy Staff Physiotherapist We have an exciting opportunity for the right person who is passionate about Musculoskeletal and Sports Physiotherapy.

Churchyard Physiotherapy has a reputation for quality Physiotherapy and attracts a wide variety of clients from all age groups and abilities upto and including elite athletes.

There are two clinics – one in central Palmerston North that was completely rebuilt and expanded in 2014 and is now a superb facility with spacious rooms, exercise area and with podiatrists and hand therapists on site. The other clinic is the recently acquired Massey University Student Health Physiotherapy clinic, situated on campus and adjacent to the medical facility there.

There are opportunities to work in one or both clinics.

We have the contract for Manawatu Rugby and the clinic principal has extensive experience working with sporting teams at provincial, national and international levels including the 2010 Delhi Commonwealth Games and 2012 London Olympics. But it isn’t just about sports injuries – we treat a diverse range of clients, including post-op orthopaedic conditions, shoulders, knees and back surgery ensuring a good variety of work.

We are looking for someone with lots of energy, who is keen to learn and be the best they can be. You will need to have excellent communication skills, be organised and professional and of course have NZ Physiotherapy Board Registration.

You will be working in a supportive environment, with up to 5 other therapists and a great admin team. Senior staff have post grad qualifications in Manipulative Therapy and are willing to share their knowledge and experience. You will be part of our regular in-service education programmeme and receive assistance with CPD. Check us out at www.churchyardphysio.co.nz.

This role is suitable for either recently graduated or more experienced therapists Please send applications with current CV to fiona@churchyardphysio.co.nz

Whangarei Physiotherapist wanted for full-time position Whangarei Treatment Providers (WTP) is looking for a skilled physiotherapist with a passion for sports medicine and a track record in providing pitchside and rehabilitation services to representative teams and elite athletes. At present we have a particular focus on rugby and are major service providers in Northland.

Are you looking for an opportunity to work in an environment where you can advance your clinical skills and gain management experience whilst establishing an elite service? We are seeking to grow this area of our business and you would contribute to the development of the team delivering a quality sports injury service:  Position would suit a dynamic early career physiotherapist (min 3 years experience).  You would assist with the development and implementation of injury prevention & management strategies, recovery, and return to sport protocols  Communicate with coaches, team doctors and other staff regarding player availability  Supervise and mentor junior WTP staff involved in sports injury management services This is a full time salaried position, package includes:  Starting salary up to $70,000 (dependent on experience & qualifications)  Support for ongoing training & skills development. Generous employer contribution towards external PD courses (including PD leave)  Structured career progression with annual salary review  Mentoring & a great work–life balance In the first instance please contact: Stiofán Mac Suibhne (Clinical Resources Manager) stiofan@wtp.co.nz www.wtp.co.nz