SEPNZ Bulletin February 2021

PAGE

SEPNZ BULLETIN

ISSUE 19, FEBRUARY 2021

HOWZAT!! p5

BRETT HARROP TALKS ABOUT ALL THINGS CRICKET

p8 BACK TO THE GRAM

p13 CLINICAL REVIEW

p15 UPCOMING SEPNZ COURSES

www.sepnz.org.nz

PAGE 2

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 Visit www.sepnz.org.nz

EDUCATION SUB-COMMITTEE Rebecca Longhurst (Chairperson) Emma Clabburn Justin Lopes Dr Grant Mawston Dr Gisela Sole Lauren Shelley John Love

Join us on Facebook

Follow us on Instagram

Follow us on Twitter

ADDITIONAL USEFUL WEBSITE RESOURCES: List of Open Access Journals Asics Apparel - how to order McGraw-Hill Books and order form Asics Education Fund information

BULLETIN EDITOR Emma Clabburn

Journal of Orthopaedic & Sports Physical Therapy (JOSPT)

International Federation of Sports Physical Therapy (IFSPT)

SPECIAL PROJECTS Karen Carmichael Amanda O’Reilly Pip Sail

BULLETIN ADVERTISING DEADLINES:

February Bulletin: 31st January April Bulletin: 31st March June Bulletin: 31st May August Bulletin: 31st July October Bulletin: 30th September December Bulletin: 30th November Advertising terms & conditions click here.

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

PAGE 3

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

2

EDITORIAL: By SEPNZ President Blair Jarratt

4

FEATURE ARTICLE: HOWZAT! BRETT HARROP GIVES AN INSIGHT INTO WORKING WITH CRICKET

GRAM REVIEW: Back to the Gram!

5

8

MEMBER BENEFITS: Asics Professional Buyers Program

10

ASICS FOOTWEAR REVIEW: CHARCOT FOOT GT-4000 2

11

CLINICAL REVIEW: Is there an association between external workload and lower-back injuries in cricket fast bowlers? A systematic review.

13

UPCOMING SEPNZ COURSES

15

RESEARCH PUBLICATIONS: BJSM November 2020 - Volume 54 - Issue 21

16

MCGRAW HILL MEMBER BENEFITS

25

PAGE 4

EDITORIAL March 2021, here we are - January has passed by with summer and holidays; February school is back and most people are back at work. Let's kick this year off with the intention of a "different" year to 2021. For SEPNZ, there are some significant events this year.

Late last year, we entered our memorandum of understanding with PNZ working on the unity plan's first steps. We will be taking this merger to the vote with our members later this year. This is a crucial vote for you as a member of SEPNZ as it signals either the inclusion to PNZ (such as the majority of branches and special interest groups (SIG) that have merged to date) or to go alone (as the Hands SIG has decided to do).

This year is traditionally our symposium year, and the planning for this is well in the pipeline. This time around, we have changed up how we are going to do this. It is exciting to announce that we will be combining with the NZMPA SIG and running a joint symposium with a combination of live and online presentations and workshops - this will be the best CPD event of the year in NZ. It will be a one-day event and will be cram-packed with leading-edge content. We hope this goes some way to reducing the costs for both SIG's members so you can come along, and as a bonus, it may let you enjoy your night out more after the symposium catching up with old friends and colleagues.

Date: Saturday 25th Sept, Venue: AUT North shore - Watch our social media on Facebook and Instagram for updates in the coming days for presenters and line up.

Thanks to Brett Harrop from Otago Cricket for his feature article in this edition of the bulletin. The pathway that a sports physiotherapist takes always makes for an exciting story. There are usually stories of massive decisions/sacrifices on the personal, social, and vocation front. What doesn't kill us makes us stronger. Brett's story is clinically informative and an excellent read of his time in Bangladesh and then back to Dunedin's pace.

In our last bulletin we featured the Aussie Instagram picks. We head back to the Gram for the app review in this bulletin to pick over the Best of the Brits.

Emma Lattey puts forward her top 3 British Instagrammers so you can get snippets of CPD and opinions whenever you need them.

In association with ASICS, podiatrist Anthony Ng provides insights into "Charcot foot" in diabetic populations with their footwear review on the GT4000. As the prevalence of diabetes increases (rising from 4.7% in 1980 to 8.5% in 2014 https:// www.who.int/news-room/fact-sheets/detail/diabetes),

clinicians should be aware of possible pathologies, appropriate education and care.

Rounding out our first bulletin of the year is another excellent clinical review from Pip Sail correlating to our feature article on Cricket. How can you not be engaged in the New Zealand Cricket scene with a plethora of national games between provinces at present and internationals on our doorstep in New Zealand? This summer on our shores, we have seen: West Indies- Men, Pakistan- Men, England - Women, Australia - Men. We are still to host Australia Women, Bangladesh- Men and later this year, the Black Caps are set to tour England.

The mornings are getting darker; there are a few more rainy days and the occasional crispness in the air, so winter sports are on their way. When writing this, Emirates Team NZ and Luna Rosa Prada Pirelli are locked in with one win each in America's cup.

(Editor’s note: and have now taken the win!) What a fantastic place NZ is to be a sports and exercise physiotherapist.

We will be back in another couple of months with the next bulletin but in the meantime, stay tuned to our social media for details and ticket sales to the 2021 Symposium - From Plinth to Podium.

Kind Regards Blair Jarratt SEPNZ President

PAGE 5

FEATURE ARTICLE

Cricket Edition: HOWZAT!! Brett Harrop Brett Harrop is in his 5th season as physiotherapist for the Otago Volts cricket team in Dunedin. He is an APA Sports & Exercise Physiotherapist, an ASCA Level 2 Strength & Conditioning Coach and a Level 3 Cricket Coach. He has worked exclusively in cricket for the past 8 years, including internationally with Bangladesh and in T20 franchise cricket in the Indian Premier and Pakistan Super Leagues. Brett shares with us some of his experiences along his cricket physiotherapy journey!

How did you come to find yourself working as a physiotherapist in cricket?

I graduated from Melbourne University in 2001 and initially worked in a couple of multidisciplinary private practices in Melbourne. In 2006 and 2007 I travelled overseas and worked for the British Forces on army bases in London and Germany. This was an interesting time to be involved as there were two conflicts going on at the time in Iraq and Afghanistan and I was treating soldiers on pre- or postdeployment. Upon returning to Australia, I had decided that I really wanted a career in professional sport. Over the next 4 years I applied and/or interviewed for dozens of professional sports team jobs, but all of them were unsuccessful. Like many physios, I found it difficult to get a ‘foot in the door’. One of the consistent hurdles I received feedback for was that I didn’t have a masters degree. So, in 2011 and 2012, I completed a Master of Sports Physiotherapy at Melbourne University. I thoroughly enjoyed the course and it greatly helped improve my clinical skills and knowledge. (Obviously, there were a few other confounding variables), but it also helped my career prospects, with my next interview being successful. Some of our family and friends thought we were crazy, but my family and I packed our bags and for the next 3 and a half years we were based in Dhaka, Bangladesh – with me working for Bangladesh Cricket as Rehabilitation Manager. The work, lifestyle, and cultural experience in this vibrant and cricket passionate part of the world was eye-opening, challenging and highly rewarding.

In terms of lifestyle and culture, Bangladesh never ceased to surprise me on a daily basis. Taking my son to a ‘typical’ Bangladeshi 2-year-old birthday party (which was more like a Bollywood wedding), the confronting, uninhibited slaughtering of animals in the streets (and the subsequent rivers of blood) during the religious festival of Eid or enduring the daily exasperating traffic jams. The cricket stadium where I worked was only 6km from my apartment, but it would consistently take between 1-2 hours to get there by car. Running or bike riding to and from work (dodging pedalled and 3-wheeled-auto rickshaws, water buffalo carts and buses overladen with people) became my regular go-to, as it was guaranteed to always be quicker.

What were some of the challenges you faced working in Bangladesh?

Bangladesh is an amazing country with extremely friendly people. The interest in the Bangladesh cricket team in Bangladesh is akin to the All Blacks in New Zealand, but with a fan base of 160 million people as opposed to 5 million. So, there were the obvious pressures and challenges working with high-profile athletes. I was fortunate to work with some world class cricketers, but also alongside a variety of high-quality coaches and support staff, learning lots away the way. It was also a rewarding time with Bangladesh having one of their most successful periods, including making the quarter finals of the 2015 World Cup. CONTINUED ON NEXT PAGE >>

PAGE 6

FEATURE ARTICLE My first assignment when I arrived in Bangladesh was a warm-up match in Khulna in the south-west of the country.

I checked into the hotel and upon entering my room on the 5th floor, something did not feel quite right. Something was askew in the room. I picked up the round ashtray from the coffee table and placed it upright on the floor. I let it go and it started rolling, accelerating faster and faster across the floor, crashing into the far wall. The building was leaning! Being on the 5th floor of a ‘moderately’ tilted building with metal bars blocking any window exits, my first night’s stay in a Bangladesh hotel was a little uneasy!

In terms of professional development, there were few opportunities in Bangladesh, so I made the most of things by completing a predominantly online masters degree in Exercise Science (Strength & Conditioning) through Edith Cowan University in Perth. I was able to slowly work my way through the course, one paper per semester. It certainly helped with improving my end-stage rehabilitation and physical performance management of elite athletes.

How did you end up in Dunedin with the Otago Volts and what is your current role?

Unfortunately, in 2015 and 2016 there were a couple of terrorist events in Dhaka and subsequent security changes meant it was time for my family and I to move on.

Luckily for me, the Otago Volts were going through a restructuring phase and the team physiotherapist role opened up.

The change was one of extreme contrast – coming from Dhaka with its high population density, congested traffic, hot tropical climate, and high levels of pollution/smog to ‘remote’ Dunedin with its relatively low population, ease of traffic, refreshing ‘temperate’ climate and clean environs! It was the perfect location for bringing up two little kiwi kids!

Ironically, we joked at the time that Dunedin would be the perfect place to be if there was ever an unprecedented global crisis, catastrophe or pandemic!

My current role with Otago Volts is team physiotherapist which is full time during the summer months. We have had a great group of coaches and support staff over the 5 seasons I have been involved, and the players are extremely professional – working the hardest and most purposefully of any in the country (some potential bias here). It has been great to see a number of them progress into the New Zealand A and Blackcaps setup this season (Duffy, Rae, Smith, Rippon).

What are the types of injuries you commonly see?

Typically, the most common injuries seen in cricket are hamstring strains, side strains, traumatic hand and finger injuries and lumbar stress fractures (with these resulting in the longest periods out of the game).

The types of injuries I have encountered though, have varied across the different demographic groups, geographical locations, and cricket formats I have worked in. One constant, however, is that the fast bowlers are consistently the most injured.

Interestingly, in Bangladesh there are fewer fast bowlers overall than we see in New Zealand or Australia. This is due to various reasons but includes (1) the conditions/ wickets are generally more conducive to spin bowling, (2) the shorter average height of the athletes (3) the youngsters role modelling themselves on successful Bangladesh international spinners. As a result, the overall number of lumbar stress injuries was less than what we tend to see here.

The cricket program in Bangladesh was centralised in Dhaka. A lot of the players would return to their village when a series/tour finished where they may not have access to training facilities. Upon their return to Dhaka, there would be a spike in training volume and intensity, and we would often see intensity-related soft tissue injuries (hamstring strains, side strains etc). Furthermore, the domestic schedule in Bangladesh could suddenly change at short notice (often due to the international fixture suddenly changing). There were a couple of instances where the first-class competition (long format / 4 -day cricket) was announced with only a couple of weeks’ notice. This made it impossible to appropriately load the fast bowlers for competition. The players were therefore more often exposed to sudden spikes in volume and intensity than what we tend to see here (where the preparation for Plunket Shield, Ford Trophy and Super Smash can be planned well in advance).

The Otago Volts injury profile over the past 5 seasons has been a little atypical for cricketers – with no hamstring injuries and no lumbar stress injuries to our fast bowlers.

We are fortunate to have a core group of fast bowlers who are relatively resilient, have good training ages and have exposed their bodies to consistent and uninterrupted bowling workloads over several seasons (Duffy, Rae, Smith, Bacon, and previously Wagner). What we have tended to see the most in our squad are traumatic hand and finger injuries. However, a particular recent focus on high volume, foundational catching technique drills and protective handwear for training has helped reduce these injuries.

What is it like working in T20 cricket leagues such as the IPL and PSL? What are the common injuries you see there?

Working in T20 competitions in the subcontinent is a fullon experience. The electric atmosphere at the grounds, the elaborate hotels and extravagant team functions, the CONTINUED ON NEXT PAGE >>

PAGE 7

FEATURE ARTICLE high demands of your time and high quality/quantity work output expected of you, along with the pressures of dealing with big name players and owners, is both an awesome challenge as well as complete sensory overload.

between formats is one of the great challenges and balancing acts for physiotherapists, coaches and performance staff working in cricket. Load management for both injury prevention and performance is an important aspect of these transitions. Fast bowlers may need to bowl more (↑volume) at trainings during short format competitions (T20) to prepare themselves appropriately for upcoming long format matches. Conversely, during long format competitions, some players may not be adequately exposed to high intensity activities (e.g. sprinting) and may need additional speed exposure training (for both an injury prevention and performance perspective) to prepare themselves appropriately for upcoming short format matches.

Cricket also involves multiple disciplines (‘positions’) that are vastly different in physical requirements.

Physiotherapists working for cricket teams should be aware that the fast bowlers are the group that is the most injury prone. An emphasis should therefore be made towards this group regarding preparation and recovery strategies and injury prevention and management.

What are some tips for physiotherapists treating cricketers in their clinic?

In the subjective assessment it is important we identify certain physical information regarding the athlete such as limb dominance, primary and secondary skills, and the level and format of cricket being played. This information will influence the treatment and management.

It is important to identify limb dominance for batting, bowling (if applicable), and throwing. There is a lot of ambidexterity in cricket. Sometimes a left-arm spin bowler may actually throw right-handed. By identifying limb dominance for each skill, you can more accurately prescribe activity restrictions, allow unprovocative activities to be continued, and apply appropriate progressions throughout the rehabilitation process.

In terms of injuries, in most of the T20 competitions I have been involved in (regardless of country), fielding coaches and new coaches (despite their best intentions) tend to get overly zealous about “being the best fielding team in the competition”. In the days leading up to the first match of the tournament, there is a big focus on fielding training.

The number and intensity of throws ‘spike’ and as a result, there tends to be an increase in the presentation of shoulder and elbow pain in the physio room. Often several of the players may not have thrown at such high intensities, distances, volumes, or frequencies for a number of weeks prior to the team assembling. To help reduce this issue, I now prescribe the players a throwing program 6-8 weeks prior to the start of a tournament to progressively load their shoulder/elbow.

What do you think are key aspects in successfully managing or preventing injury in cricketers?

Load management would be a big one. Cricket is a unique sport in that it has 3 different formats (multi-day, one-day, T20). Each format has unique workload demands related to intensity and duration. Successfully transitioning players

Most cricketers will have a primary and secondary skill (e.g. wicketkeeper and middle-order batter, or, opening batter and pace bowler etc.). They may be able to continue training or playing with one or the other of their skills during the rehabilitation process. It is important we are focused on what they can do, as opposed to simply what they cannot do – to minimise the deleterious effects of detraining.

It is also crucial to understand which teams (frequency), level (intensity) and format (volume and intensity) of cricket they are playing – including previously, currently, and upcoming. This information is important for differential diagnosis (e.g. identifying likelihood of stress related injury), guiding treatment progressions and for devising appropriate return to play plans (team, level, format). .

PAGE 8

APP REVIEW

Back to the Gram ...

The Best of the Brits

by Emma Lattey Carrying on from my Aussie Instagram picks last bulletin, this edition is the best of the Brits. Three big personalities in the social media world showcase the passion there is out there in sports physiotherapy and sports medicine insta space.

Whether or not you always agree with what some of them say, they sure get you thinking…

adammeakins

Adam Meakins aka The Sports Physio is a Physiotherapist, a strength and conditioning specialist, and an extended scope practitioner in both the National Health Service and private practice in Hertfordshire, England.

Throughout his career Adam has worked in many roles including professional sport and has been fortunate to work with and learn from some of the world’s leading shoulder authorities and experts. Adam’s instagram account conveys his beliefs of a no-nonsense, simple, practical and evidence-based approach to therapy and the physiotherapy profession. His updates are very regular (every 12 days usually), always inciteful, and very honest.

Quotes: “You can’t go wrong getting strong.”

“100 body weight squats per day.”

“Classification of Loose shoulder injuries by Adam Meakins” 1. Torn Loose – most common, Traumatic Injury 2. Worn Loose – no history of trauma in the background

3. Born Loose CONTINUED ON NEXT PAGE >>

PAGE 9

APP REVIEW

•

running.physio

Tom Goom is known in the sport and exercise medicine community as the “Running Physio”. Tom has a slightly different social media approach compared to Adam, but has very good educational content – mostly running focused - on his regular (every 1-2 weeks) postings.

Tom specialises in running injuries and is based in Brighton, England. He is the clinical lead at The Physio Rooms and has over 15 years of clinical experience. He has previously worked in semi-professional sport, lower-limb and spinal rehab, and has run chronic pain programmes. In 2012, Tom started his website www.runningphysio.com to share his knowledge and offer free advice to clinicians and runners on injury prevention and treatment. His specialist areas of interest include running gait analysis and managing tendinopathy.

Below is a podcast interviewing Tom from BJSM from last month :-

https://podcasts.apple.com/nz/podcast/bjsm/ id330966919?i=1000462926230

•

bjsm_bmj

Speaking of the BJSM, my last choice is the official British Journal of Sports Medicine Instagram account.

The BJSM is a twice-monthly peer-reviewed medical journal covering sports science and sports medicine by the BMJ Group. It was established in 1964 and the editor-in-chief from 2008-2020 was Professor Karim Kahn.

This Insta account is a must follow with educational content every 2-3 days with links to “hot off the press” research plus excellent infographics.

PAGE 10

MEMBER BENEFITS

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.

The ASICS Professional Buyers Programme is designed to enable Sport & Exercise Physiotherapy New Zealand members the opportunity to experience our shoes first hand and to assist in referring the most suitable shoe/s to your patients. By registering for the Professional Buyers Programme, you will: ASICS Performance Footwear/ASICS Sportstyle Footwear Receive 4 voucher codes per year, 2 every six months.

Each voucher will give you 40% off the retail price of one pair of shoes up to $300 Recommended Retail Price.

Vouchers must be redeemed online at www.asics.co.nz Additional Product Offers: Birkenstock Footwear Receive 2 voucher codes per year, 1 every six months.

Each voucher will give you 30% off the retail price of one pair of shoes up to $200 Recommended Retail Price.

Vouchers must be redeemed online at www.birkenstock.co.nz Smartwool Socks Receive 2 voucher codes per year, 1 every six months.

Each voucher will give you 30% off the retail price for your choice of socks (Recommended Retail Price).

Vouchers must be redeemed online at www.smartwool.co.nz

Register Here Full terms and conditions can be found on the Professional Buyers Programme registration page.

If you are already a member of the Professional Buyers Programme you will receive your vouchers in July and February.

For first time registered member, we run a report at the end of each month which picks up the newly registered members. You should then receive your vouchers by the middle of the following month.

REGISTER HERE

PAGE 11

Asics

Charcot Foot GT-4000 2

Thanks to Asics for this latest footwear review from Anthony Ng.

Charcot foot is a significant foot complication of Diabetes which involves a direct inflammatory response affecting bones, soft tissues and joints of the foot and ankle.

The pathophysiology is unknown however, Charcot’s tends to develop from trauma, increased weight bearing along with neuropathy.

Charcot foot is a significant foot complication of Diabetes which involves a direct inflammatory response affecting bones, soft tissues and joints of the foot and ankle. The pathophysiology is unknown however, Charcot’s tends to develop from trauma, increased weight bearing along with neuropathy.

If healthcare professionals are unable to identify the condition at the acute phase to prevent the foot changes, it will result in significant deformation primarily occurring at the Lisfranc joints, STJ or mid tarsal region of the foot. The damage to the foot skeletal shape can be of a gross foot deformity, resulting in vast valgus malalignment, notably arch collapse with a rocker bottom appearance. This often results in increased stiffening of the foot, along with associated ligament changes altering the natural forces of gait which will lead to further lower limb complications.

The best strategy is to avoid this condition from occurring and diagnose early for prophylaxis. If Charcot’s foot has already occurred and settled, the deformity of the foot structures will need to be continually supported. If you have any suspicion of a patient whom you deem will develop this condition, the treatment is more therapeutic to stop, prevent or preserve the foot from deteriorating. Surgical intervention is recommended for the most serve foot disfigurements where all other non-surgical options are exhausted.

As the deformity mainly occurs at the Lisfranc joints, STJ and MTJ there will be the tendency for the foot to move medially. ASICS has engineered the new GT-4000 version 2, which provides the stiffening strength required at the rear and midportion of the shoe to help support those foot structures during the forces of plantar loading.

The GT-4000 uppers and correct midsole shore densities helps correct alignment and influences the pressure distribution to prevent subsequent disorganization of the foot from further deformity and provide those at risk with supportive footwear before this condition can eventuate.

The strong midfoot truss offers reduced torsional twisting to increase stabilization and strength occurring around the mid tarsal region. This will provide the desirable control and help support those associated with a rocker bottom deformity.

This condition is associated with a lack of absorbency. Shock attenuation is required to provide comfort for those interlocking joints and bones throughout the gait cycle. The chosen foam offers durability and effective energy return providing comfort.

The ideal pitch profile will not create additional trans ferred forces as the unstable foot moves through gait. The 2E width fit adds extra depth and girth to accommodate structural changes that may have occurred or provide the space for any accommodative custom fabricated devices.

CONTINUED ON NEXT PAGE >>

PAGE 12

Asics

Finding the correct footwear can be difficult, the GT-4000 provides some of the ideal requirements for this condition. GT-4000: Solid rigid constructed rear, with a durable dual-density midsole offers the desirable support thought out the medial and lateral longitudinal arch which extends through to the propulsive phase. Other conditions that this shoe may be benefit include: Amputation to hallux: is associated with the structures of the midfoot to move medially. Altered pressure distribution occurs during the initial phase of propulsion causing the foot to move in a valgus direction, ultimately affect the timing of the gait cycle. The GT-4000 encompasses a strong extended midfoot component which improves sagittal alignment.

Flexible flatfoot with hallux Valgus: Notable weakening of foot muscles, causes ineffective transfer of energy which alters the timing of the foot during dynamic gait; this often makes normal push-off impossible.

Ineffective sagittal plane motion causes increase foot deformity resulting in Hallux Valgus (HAV). Support required from distal midfoot to proximal forefoot.

Posterior Tibial Dysfunction: Normally related to adults with an acquired flat foot deformity. resulting in tendon degeneration/ elongation changes.

The presentation of a valgus deformity will require a supportive constructive shoe to improve foot alignment in providing a more positive ergonomic ride.

Pronation: Able to effectively control kinematics of pronation and reducing tibial rotation. Capable of replacing the need for orthotic therapy.

STJ Ligament Injury : Usually associated with a major traumatic sprain. Irritation occurs over the anterior ankle, with loss of strength in dorsiflexion. Supportive footwear to regain ankle hold and control.

Anthony Ng B.Sc (Pod), B.Ed, Dip Tch

Survey Request

Physios - we need your help to understand how you manage middle-aged and older adults with chronic hip pain. We value your perspective as a physio working in clinical practice.

We want to know what you think is most important when managing patients with chronic hip pain. Your views can inform the design of clinically relevant studies that aim to improve the health of people with chronic hip pain.

This is a one-off online survey that will take approximately 20 to 40minutes to complete. By completing this survey you can enter the draw to win an Apple iPad Air. Follow this link https:// melbourneuni.au1.qualtrics.com/jfe/form/SV_8iCXMECS5Z8HsYR to participate.

This study is being Co-ordinated by Mr Travis Haber and Dr Michelle Hall at the Centre for Health, Exercise and Sports Medicine (CHESM) at the University of Melbourne, email Travis thaber@student.unimelb.edu.au if you have any questions.

PAGE 13

CLINICAL REVIEW

Is there an association between external workload and lower-back injuries in cricket fast bowlers?

A systematic review.

Corey Perrett, Peter Lamb, Melanie Bussey, PhD Physical Therapy in Sport https://doi.org/10.1016/j.ptsp.2019.11.007

By Pip Sail Introduction: The prevalence of injuries to fast bowlers is over 20% compared with the next most commonly injured position, batsmen7.4%, (Orchard, Kountouris, and Sims). During each delivery bowlers exert significant vertical and horizontal ground reaction forces (Bayne, Elliot, Campbell & Alderson 2016) and experience substantial shear force through the lumbo-pelvic region (Crewe, Campbell, Elliot & Alderson 2013).

The repetitive nature of this substantial load combination has been associated with this prevalence, particularly in the lower-back and more significantly for the sport, lower-back injuries have been associated with the highest number of playing days lost (Frost & Chalmers 2012).

Lower-back pain injury in cricketers has been associated with both intrinsic and extrinsic risk factors (Olivier et al.,2016). Intrinsic factors are diverse, including, but not limited to:mixed action (Portus, Mason, Elliott, Pfitzner & Done,2004), trunk muscle asymmetries (Engstrom, Walker, Kippers, & Mehnert, 2007), and reduced lumbar proprioception (Olivier, Stewart, & McKinon, 2014).

Workload is reported as the primary extrinsic factor for injury (Olivier et al.,2016) in fast bowlers. The association between workload and injury is complex: high workload may increase Injury risk by 2.1x (Hulin et al., 2013) and low workload by 1.4x (Dennis, Farhar, Goumas, & Orchard,2003). Workload is said to have a dual risk threshold. This dual risk threshold indicates that bowlers need to have a workload high enough to facilitate positive training adaptations compatible to the demands of the task but low enough to minimise the risk of stress related injuries (Hulin et al.,2013) Workload has been defined in terms of internal and external load. Internal workload refers to the perceived effort or physiological demand of each delivery on the internal structures of the body (Hulin

et al.,2013). External is defined by the total bowling volume (Hulin et al., 2013). The product of these represents the total workload.

Because of the ‘dual’ risk threshold the timeframe of the workload becomes important. The ratio between an acute workload (about a week) and a chronic workload (on average, 4 weeks) becomes a potential risk factor for injury (Hulin et al., 2013; McNamara et al.,2017;Windt & Gabbett, 2018)

Since there is plausible mechanism for workloads causing injury, the hypothesis for this paper is, that external workloads are associated with lower-back injuries in cricket fast bowlers.

Method: Literature search using 4 sets of key words: (1)

cricket;

(2)

bowl,bowler,fast,pace,seam,medium;

(3)

spine, lumbar, lower-back, disc, fracture, stress, spondylosis, spondylolisthesis;

(4)

workload, work, load, effort, demand, overuse, internal, external.

Inclusion: Type of study-cohort or cross-sectional that included a measure of external workload AND an outcome measure of lower-back injury in cricket fast-bowlers Type of participants-cricket fast bowlers; no restriction in terms of age, sex,skill level or handedness

CONTINUED ON NEXT PAGE >>

PAGE 14

CLINICAL REVIEW Results: Only eight were found to meet the inclusion criteria: Four of these were a mixture of retrospective and prospective cohort studies, (Alway et al., 2019 Orchard et al.,2002, 2015;Orchard and James 2003) each reflecting on some previously recorded data. The other four were entirely prospective cohorts (Bayne et al., 2016; Davies et al,.2008; Dennis et al., 2005,2008) which followed participants for a period of time. The study follow-up ranged from 6 months to the length of the season in the prospective cohort studies. The retrospective cohorts examine data from multiple seasons. The diagnostic pathway also differed with 2 utilising MRI and 4 using clinical diagnosis via physical examination.

In general, the risk of bias across the studies was high. Only those studies that used imaging to validate the injury diagnosis (Bayne et al., 2016;Dennis et al., 2005) could be said to be clear of measurement bias in terms of the injury diagnosis; however, neither of these studies used a valid, reliable method of workload measure, so the risk of measurement bias was high in all the studies.

would be considered gold standard, and thus reduce the risk of bias in the study.

Had the examined studies used valid measures for injury and/or workload, their strength of evidence would have been greater, improving effectiveness of the study.

The review highlights a need for valid and reliable methods for measuring both workload and lowerback injuries in order to be able to link the two.

Although imaging is expensive, time consuming and to an extent less practical than a physio or doctor, it is the best way to determine whether an injury exists and if so to what extent. Knowing this for certain is essential to determine the cause of injury.

Designing studies to improve the measurement of workload remains a significant challenge. While it has been recognised that workload can be categorised as either acute, chronic, or both as well as internal or external (Hulin et al 2013), understanding what these workloads are and how to measure them remains unclear.

Conclusion: Table 3

Discussion: Based on the existing quality of evidence the hypothesis can not be supported.

The risk bias scores across 8 studies was 6-11 from 15 and consequently, the level of evidence to determine whether external workload could accurately predict lower-back injuries in cricket fast bowlers was low.

One problematic issue across studies was the risk measurement bias when diagnosing lower back injuries. A validation of initial diagnosis through MRI

This review found that there is very little strength to any association between external workload and lower -back injury in fast bowlers, due to biases within the injury and workload measurements in the existent literature.

Accurate measurement and a better understanding of workload will help uncover whether there is an association between workload and lower-back injuries.

A full set of references is available on request.

PAGE 15

UPCOMING SEPNZ COURSES Please note these are the proposed courses for 2021. With the current COVID-19 situation this could also change. Once we are confirmed to go ahead registrations will be open via PNZ. Promotion and Prescription of Physical Activity and Exercise 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

This course is TBC for August 2021 The Sporting Lower Limb 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.

This course is TBC for Oct 2021 Injury Prevention & Performance Enhancement.

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.

This course is TBC for November 2021

PAGE 16

RESEARCH PUBLICATIONS

British Journal of Sports Medicine December 2020; Vol. 54, Issue 24 WARM UP SEPNZ warm UP BJSM tendinopathy, back pain and OA: sorting the evidence (18 February, 2021) Blair Jarratt

Riitta-Maija Hämäläinen, João Breda, Fabio da Silva Gomes, Gyanendra Gongal, Wasiq Khan, Romeu Mendes , Leo Nederveen, Nivo Ramanandraibe, Binta Sako, Steph en Whiting

ORIGINAL RESEARCH Estimating the global economic benefits of physically active populations over 30 years 2020–2050) Marco Hafner, Erez Yerushalmi, Martin Stepanek, William Phillips, Jack Pollard, Advait Deshpande, Michael Whitm ore, Francois Millard, Shaun Subel, Christian van Stolk Levels of domain-specific physical activity at work, in the household, for travel and for leisure among 327 789 adults from 104 countries Tessa Strain, Katrien Wijndaele, Leandro Garcia, Melanie Cowan, Regina Guthol, Soren Brage, Fiona C Bull Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middleaged and older individuals Ulf Ekelund, Jakob Tarp, Morten W Fagerland, Jostein Steene Johannessen, Bjørge H Hansen, Barbara J Jefferis, Peter H Whincup, Keith M Diaz, Steven Hooker, Virginia J Howard, Ariel Chernofsky, Martin G Larson, Nicole Spartano, Ramachandran S Vasan, IngMari Dohrn, Maria Hagströmer, Charlotte Edwardson, Tho mas Yates, Eric J Shiroma, Paddy Dempsey, Katrien Wijndaele, Sigmund A Anderssen, I-Min Lee

GUIDELINES World Health Organization 2020 guidelines on physical activity and sedentary behaviour Fiona C Bull, Salih S AlAnsari, Stuart Biddle, Katja Borodulin, Matthew P Buman, Greet Cardon, Catherine Carty, JeanPhilippe Chaput, Sebastien Chastin, Roger Chou, Paddy C Dempsey, Loretta DiPietro, Ulf Ekelund, Joseph Firth, C hristine M Friedenreich, Leandro Garcia, Muthoni Gichu, Russell J ago, Peter T Katzmarzyk, Estelle Lambert, Michael Leitzmann, Karen Milton, Francisco B Ortega, Chathuranga Ranasinghe, Emmanuel Stamatak is, Anne Tiedemann, Richard P Troiano, Hidde P van der Ploeg, Vicky Wari, Juana F Willumsen REVIEWS Maximising the impact of global and national physical activity guidelines: the critical role of communication strategies Karen Milton, Adrian E Bauman, Guy Faulkner, Gerard Hastings, William Belle w, Chloë Williamson, Paul Kelly

EDITORIALS

How can global physical activity surveillance adapt to evolving physical activity guidelines? Needs, challenges and future directions

Putting physical activity in the ‘must-do’ list of the global agenda

Richard P Troiano, Emmanuel Stamatakis, Fiona C Bull

Emmanuel Stamatakis, Fiona C Bull

How does occupational physical activity influence health?

An umbrella review of 23 health outcomes across 158 observational studies

Making the case for ‘physical activity security’: the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective Estelle

Victoria

Lambert,

Tracy

Kolbe-

Bart Cillekens, Matthias Lang, Willem van Mechelen, Evert Verhagen, Maaike

Alexander, Deepti Adlakha, Adewale Oyeyemi, Nana Kwame Anokye, Shifalika Goenka, Patricia Mogrovejo, De borah Salvo New global physical activity guidelines for a more active and healthier world: the WHO Regional Offices perspective

http://bjsm.bmj.com/content/55/5 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/

ADVERTISEMENT

PAGE 17