SEPNZ June 2018 bulletin

SEPNZ BULLETIN PAGE

Issue 3 June 2018

2019 Symposium

2018 Shoulder Roadshow

Feature Isobel Freeman Physiotherapist Commonwealth Games

FEATURE TOPIC: Commonwealth Games

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SEPNZ Members’ Page Welcome to Sports & Exercise Physiotherapy New Zealand SEPNZ EXECUTIVE COMMITTEE President

Visit our website www.sepnz.org.nz

Blair Jarratt

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Michael Borich

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Monique Baigent

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Committee

Emma Clabburn Rebecca Longhurst Justin Lopes

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Contents FEATURE TOPIC: Commonwealth Games

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

2

EDITORIAL

By SEPNZ Out-going President Hamish Ashton

4

By SEPNZ In-coming President Blair Jarrett

4

MEMBERS’ BENEFITS Discounts

5

FEATURE Isobel Freeman - Physiotherapist Commonwealth Games 2018

6

In this issue:

SITUATIONS VACANT Wanted: Bulletin Editor

9

CONTINUING EDUCATION 2018 Shoulder Roadshow with Dr Ann Cools

10

SEPNZ SYMPOSIUM 5th Biennial SEPNZ Symposium

12

SPRINZ Beating the Heat

13

PLANET OF THE APPS App: SWIBO Tilt

16

ASICS Protection Perfected—Gel-Kayano™ 25

19

CLINICAL SECTION- ARTICLE REVIEW Pain and Fatigue in Sport: Are They So Different?

20

RESEARCH PUBLICATIONS BJSM Volume 52, Number 12, June 2018

21

CLASSIFIEDS Situations Vacant

22

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Editorial Hamish Ashton, Out-Going SEPNZ President Hi all A number of years ago when I wrote the SEPNZ constitution I put a contingency clause in allowing the president to stay longer than the maximum 4 year term in the circumstance that there was no one willing to put their hand up. Earlier this year I was thinking that this clause would be needed. However, what I hadn’t counted on was the commitment of the current committee. Their dedication to the group, which I have never doubted, was shown by several them putting their hand up for new positions, including the presidency.

In this time of change it is great having new leadership taking us forward. All groups benefit from a change at the top. This helps to continue the momentum of the group and bring forward fresh ideas.

As mentioned in previous editorials I have been involved over the last 2 years in the PNZ changes process. What has come from this is a dedication by all SIGs and branches to work together for the better of a profession. Concepts have been developed as a base of a possible organisation, but up to now the model has still lacked specific information especially related to the

exact constitutional formula and costings to members.

We have been told this information is due out shortly.

As Blair mentions below, what is important as this information comes out is to ask, have we got it right? and will this make the difference to the organisation we belong to?

One of the benefits of Blair taking over the leadership is that he comes into things with a fresh pair of eyes.

Though he has been privy to slightly more information than most of the membership, his understanding of the model will be little different than yours. This means questions will be asked when things are not clear or not presented well, so you as members of both SEPNZ and PNZ are clear on where we are going when decisions are made.

A final note from me – a big thanks to all my exec over the last 4 years. I have greatly appreciated the support you have given me.

Hasta la vista – I’ll be back Hamish

Blair Jarratt, In-Coming SEPNZ President Kia ora, Hi. I would like to introduce myself as the new president of SEPNZ. It has been a whirlwind introduction over the last month as Hamish finally found out that an Aussie Super Rugby team can beat a NZ team so has decided to head over the ditch to support them.

The executive would like to thank Hamish for his tireless efforts for this group, and we are glad he is staying on the executive in a different capacity. Hamish has been the president of what was SPNZ and now is SEPNZ over the last 4 years and has been a member of the executive for much longer. Over this time, he has overseen a number of major successes – in 2017 we brought Karim Khan and Jill Cook over for the sell-out roadshows. Off the success of this we ran last year’s concussion road show and workshop as well as a symposium in Auckland. This year starting soon we have the shoulder roadshow in partnership with SMNZ touring seven destinations. If you haven’t seen information on this up and coming roadshow please check out the website but be quick as most venues have sold out. Our level 1 course continues to be very popular and we rolled out a new level 2 earlier this year.

Hamish and now I, along with the rest of our executive, will continue to work hard to give our members value for money. However, if you have any compliments or complaints for us, there are a number of ways you can contact us either through our social media or email, so we can continue to build on what we feel you as our members want from us.

A bit about me. I grew up in Tauranga and was a graduate of Otago University School of Physiotherapy.

Completing my studies, I worked with SEPNZ life member Graeme Nuttridge before heading on a 5 year UK OE. Returning to Christchurch to work with Graeme, I became the lead physiotherapist for the Canterbury Cricket and Wizards team in the summer and Canterbury Rugby metropolitan and ITM feeder team in the winter which meant a very busy working week all year round. Returning to Tauranga with a small period working closely with NZC for the world cup in Dubai I am now a director of Bureta Physio and enjoy a few more weekends off with my family. Being in the Bay I have stepped into looking after Mount Surf Club which means tirelessly hanging out on the beach…….

I have just returned from the PNZ leadership day in Wellington 25th May. On the list was building advocacy of physiotherapy through PNZ. I hope all of you are aware of the process before us, as part of the vision of the unification model includes unifying all branches and Special Interest Groups (SIG) back into PNZ. As an executive we are working hard to find out the implications of the proposal to unify and its advantages and disadvantages. As a membership I would encourage you to send your questions through to PNZ to get a better understanding of how the proposed changes would positively or negatively affect our members.

We hope you enjoy this latest edition.

Blair

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Members’ 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.

DISCOUNTS McGRAW HILL EDUCATION

25% off Medical books http://sportsphysiotherapy.org.nz/members/reviews/book-order-form/ for details on how to order.

ASICS

Members rates on Asics shoes and apparel http://sportsphysiotherapy.org.nz/members/asics-information/ for how to order

SEPNZ Member discounts to all SEPNZ courses and Symposium http://sportsphysiotherapy.org.nz/courses/ for what is upcoming

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Feature Isobel Freeman PHYSIOTHERAPIST COMMONWEALTH GAMES 2018 What has been your physiotherapy journey so far?

My passion is sport (although I am an average everyday punter myself) and my ambition has always been to work as a full-time physiotherapist with a national sports team. This goal has directed my career and is what continually motivates me and shapes my work and study. I have had a lot of fun and many different roles along the way, but I have remained focused towards what I wanted to achieve.

I graduated from Birmingham University, England, in 1999 with BSc (Hons) Physiotherapy. Immediately I worked with club rugby on top of full-time hospital based employment. In addition to this I volunteered at my local fencing club, which was my university sport. I moved to London to specialise in musculo-skeletal physiotherapy and continued to work with rugby at club and regional levels. I also ‘put my hand up’ for any other opportunities which included volunteer work at large events ie. marathons, badminton tournaments.

It was in a volunteer capacity that I attended my first multi-sport event as a Games physiotherapist at the Athens 2004 Olympics based at the indoor volleyball stadium. This experience gave me a ‘taste’ of the amazing atmosphere which is unique to the pinnacle games and I certainly wanted to be part of this again!

Following Athens, I spread my wings and travelled to the Southern Hemisphere to experience work and travel ‘down under’ which was a great way to expand my knowledge of physiotherapy techniques and make new friends. I returned to Europe and alternated between seasonal physiotherapy in a French ski resort (thoroughly recommended) and London private practices. It was during this period that I became involved with England Hockey at age group level.

I returned to New Zealand in 2009 and I haven’t looked back since. Initially based in Taranaki gaining more sports rugby experience, I then moved to Auckland to complete my Masters in Health Practice in Musculoskeletal Physiotherapy at AUT which opened many doors for me. I was fortunate enough to travel to Samoa with the NZ Youth Commonwealth Games team in 2015 as well as to Europe with Adaptive Snow Sports for World Championships in 2017. Between 2015 -2017 I was the lead physiotherapist for the Black Ferns XV, being with the team and winning the World Cup 2017 was one of my career highlights so far. I am now employed full-time at HPSNZ and am the physiotherapist for men’s hockey.

What was your role at the Gold Coast Commonwealth Games?

Physiotherapist Men’s Hockey

Isobel standing on the turf, Gold Coast Hockey Centre

Career highlight so far: Black ferns winning Women’s Rugby World Cup 2017 Photo courtesy of Sean Willis/NZ Rugby

What type of injuries do you commonly see?

Hockey (men and women) has previously accounted for the highest use of medical services during major games across all sports. This is likely due to a combination of factors which include: a longer competition duration over the games compared to most other sports, injuries resulting from sudden contact and non-contact mechanisms as well as overuse, a large number of athletes (18 per team at this games).

From an injury perspective, this keeps my work interesting, due to a wide variety of presenting conditions. The highest annual time loss injuries are: CONTINUED ON NEXT PAGE

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Feature Isobel Freeman—Physiotherapist Commonwealth Games 2018 continued... hamstring strains, concussion, hip pathologies resulting in surgery and shoulder dislocations. The highest prevalence of underlying ‘niggles’ which do not prevent training but are continually under management are low back pain and hip femoroacetabular impingement.

What were the key elements in successfully minimising time loss due to injury at the games?

Fortunately, at the Commonwealth Games every player was fully available for each game and no one was ruled out from an injury perspective once the games began.

Understanding the demands of your sport and the periodisation plan is an integral part of injury management. Gathering injury statistics is essential to be able to identify key areas and therefore focus injury prevention strategies to those resulting in the greatest time loss period. For example, currently we are targeting hamstring injury prevention with an eccentric loading programme which, although it is not decreasing the incidence, it has resulted in a more rapid return to play.

To gain best results return to play planning should be a combined approach between all members of the management team, as well as the player, rather than individual recommendations.

number of occasions to pick up player fatigue and early signs of illness.

At the Games there was also the NZOC core health team which comprised of doctors, physiotherapists and massage therapists to give additional support when required. It was great to have so many of my usual friendly colleagues around to share the experience with.

Other NZ facilities included an extensive recovery suite which housed hot and cold baths as well as spin bikes and a stretching area. This was supervised by an expert physiologist and nutritionist. There was a NZ gym area established in the accommodation basement which was an ideal environment for athletes to continue with their usual routines. Psychologists were also present to provide invaluable support to athletes.

Who else was involved in the support team at the games?

Within men’s hockey we travelled with our strength and conditioner, Scott Logan, who doubled up in the role of manager and led the team through primers, gym sessions, recovery and kept a close eye on load management via GPS. Both Scott and I monitored ‘wellness’ of players through a daily on-line questionnaire consisting of eight questions with both subjective and objective markers. This was useful on a

One of the village recovery pools

Obviously, there were many other NZOC staff forming the ‘wider’ support group ranging from media advisors and uniform fitting specialists through to security staff and project managers all of which added to the seamless running of the New Zealand team.

Were there any challenges at the games?

Celebrating silver with Dr Dan Exeter, Shea McAleese, Isobel and Hugo Inglis

One unexpected challenge that we encountered was the high volume of walking in the village. I had heard that this could be expected but this was my first actual experience of what this meant. The New Zealand accommodation was approximately 700 m from the food hall and 800 m from the transport hub (in the same direction). This high volume of walking was a challenge on already tired legs and could aggravate any underlying niggles. In view of this we adopted several strategies to help lessen the lower limb load which included: combined meals with heading to or from the transport hub, using the closer ‘casual dining’ area, buying and storing breakfast products at our accommodation, allowing time to use the internal shuttle bus which would drop closer to destinations.

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Feature Isobel Freeman—Physiotherapist Commonwealth Games 2018 continued...

Working long days is part of the territory of being support staff for athletes at the Games and it is important to look after yourself and ensure that you are up and ready for each day with a smile and positive energy. My advice to physiotherapists on tour is to plan your day and ensure that you take breaks when possible to have time to yourself. This might mean getting up early for a jog/swim or having a walk and coffee mid-morning or a cup of tea with a colleague at night. Clear communication to your team around allocated treatment times (except in certain acute/emergency situations) will mean that this will minimise everyone wanting to see you at once. Having a cut-off time for treatment (which may vary) in the evening is a good idea to prevent fatigue creeping in.

New Zealand accommodation hub, the village, tournament venues, opening and closing ceremonies.

Everyone is becoming tired at the end as well as this being the business end of the competition so having support staff who remain cheerful and energetic is preferable.

Highlights of the games From a sporting perspective, my highlight was winning our semi-final game versus India, this meant we secured a spot in the final and were guaranteed a medal. After the disappointment of fourth place at the last Commonwealth Games it was a huge relief not to be in the bronze play off again. I was also fortunate enough to have the opportunity to see Sophie Pascoe win her second gold medal of the games which was very special, not only to be amongst the crowd atmosphere and witness a fantastic performance, but also to experience another venue and see the physiotherapy set-up.

From a personal perspective, my highlight was simply being amongst the atmosphere at the games including:

This is a unique environment including people from 71 nations and territories all mixing peacefully together to achieve their sporting dreams. I fully embraced the ‘pin swapping’ rituals, where appropriate, and this was a great opportunity to chat to people from all nations. It was an honour to be part of the New Zealand family and to work alongside support staff and athletes who all excel in what they do.

New Zealand hockey men’s team following the medal ceremony

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Situations Vacant

Wanted: Bulletin Editor The SEPNZ Bulletin is a show piece for physiotherapy publications in New Zealand.

Can you help us???

We are looking for a bulletin editor to help us put together the SEPNZ Bulletin 6 times a year.

Help will be given to get you started in the role.

Publishing knowledge is not needed

• • • •

Duties include: Contacting people to supply articles Proof reading articles to make sure they make sense Reminding people to send things in on time Choosing an article to be reviewed for publication

Skills needed are basic time management and a computer Further details on request Contact Michael Borich - mborich@gmail.com

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Continuing Education

2018 Shoulder Roadshow with Dr Ann Cools

Registrations are now open for the 2018 Shoulder Roadshow. We are very fortunate to have Professor Ann Cools from Ghent University in Belgium touring the country, doing workshops and leading the Mini Symposiums.

All venues will be holding both a Mini Symposium and a Workshop – with the exception of Napier and Queenstown, where only the Mini Symposium will take place.

The Mini Symposium will involve a presentation by Dr Ann Cools, along with presentations from invited guests who also have a special interest in the shoulder region, followed by a panel discussion.

You can purchase tickets to either both events, or Mini Symposium or Workshop alone.

The Workshop will be a practical workshop focusing on treating the injured shoulder. Assessment and exercise based approach to rehab. The Mini Symposium will be a presentation from Dr Ann Cools, followed by a couple of invited speakers on the theory behind the injured shoulder from assessment to investigations to treatment options and will be followed by a panel discussion

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Continuing Education Dr Ann Cools is a physiotherapist, working as an associate professor at the Department of Rehabilitation Sciences and Physiotherapy at the Ghent University, Belgium, and as senior researcher at the Dept of Occupational and Physical Therapy and the Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen, Denmark. Her topic of research and teaching expertise, as well as her clinical work is shoulder rehabilitation in general, and sport specific approach and scapular involvement in particular. She finished her PhD in 2003, debating scapular involvement in sports related shoulder pain in the overhead athlete, and she has published numerous papers in peer-reviewed international journals, wrote contributions and chapters in several international recognized books, and gives several courses on a national and international level. She was head of the Physical Therapy Education at the Ghent University 2008-2016, and founding member and president of the European Society of Shoulder and Elbow Rehabilitation (EUSSER) 2008-2012. She is currently a member of the Board of the International Congress of Shoulder and Elbow Therapists.

2018 SEPNZ and SMNZ Shoulder Roadshow

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SEPNZ Symposium

5th Biennial SEPNZ Symposium Tauranga March 9/10th 2019 - Save the date

Key Note Speaker: Rob Whiteley Assistant Director of Clinical Projects & Quality Aspetar Rod Whiteley is a specialist sports physiotherapist, who was awarded a fellowship in the first cohort in Australia. He subsequently spent time on the College of Sports Physiotherapy’s board as chief examiner and has worked with a number of professional and international teams and individuals in rugby league, rugby union, baseball, football, squash, and athletics.

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SPRINZ Beating the Heat

by Associate Professor Andrew Kilding, AUT Sports Performance Research Institute New Zealand Several pinnacle sporting events are held in hot and humid conditions that provide a challenge to the body’s thermoregulatory abilities. The men’s marathon at the recent Commonwealth Games highlighting once more that the combination of heat and prolonged intense exercise require special consideration both in terms of the preparation of athletes, but also treatment plans should an athlete suffer from heat illness during or after competition.

Heat-related illnesses are a potential adverse event that can occur when individuals exercise in hot environments. Indeed, the combination of intense exercise and environmental heat stress is often called the greatest challenge to human thermoregulatory and cardiovascular function (González-Alonso, 2012).

Manifestations of heat illness include heat rash, heat exhaustion, heat syncope, heat cramps, and heat stroke (Howe and Boden, 2007). In field settings the best way to prevent heat illnesses is quick detection followed by immediate treatment (Howe and Boden, 2007). If heat illnesses are detected quickly and acted upon then they very rarely have any prolonged effects.

While humans can tolerate core temperatures of up to 42°C, there are risks when core temperature exceeds 40°C and heat illness can still occur with core temperatures below 40°C, though this is only associated with injury in field settings where there is insufficient immediate medical help, or the diagnosis takes too long (Casa et al. 2012). The best‑practice guidelines for heat injury management set out by Casa et al. (2015) are a must read for practitioners supporting athletes competing in hot environments.

Whilst combining exercise and environmental heat poses particular risks, the ability to perform prolonged exercise in hot, arid environments was critical for the survival of our hunter-gatherer ancestors. As such, through evolution we have developed a number of key characteristics that allow us to effectively cope with heat stress during exercise, such as relatively hairless, narrow frames, bipedal gaits, and an unparalled capacity for evaporative sweat loss and therefore heat dissipation (Bramble & Lieberman 2004). Therefore, with appropriate preparation, athletes and exercisers can remain healthy and successful without completely avoiding environmental heat stress in their training and competition.

From a performance perspective, researchers at AUT’s Sports Performance Research Institution New Zealand (SPRINZ) have long been interested in how heat stress impacts human physical function and performance, especially in athletes. Prior to both the 2016 Rio Olympics and the recent 2018 Commonwealth Games we replicated the types of activities and environments that an individual would be exposed to in their sport using our environmental chamber, and developed preexercise cooling (Schulze et al. 2015), cooling during exercise (Maunder et al. 2017), and periodised short duration heat acclimation strategies (Casadio et al.

2016) to help athletes cope better with the heat.

We are currently interested in how heat acutely modifies substrate metabolism during prolonged exercise and how these effects might need to be considered when planning nutritional strategies, both pre- and during competition, with a view to reducing the incidence of ‘bonking’ or depletion of the body’s carbohydrate energy stores during endurance exercise.

It has been shown previously that when prolonged exercise is performed in the heat, the rate at which these finite carbohydrate stores are utilised is accelerated (Febbraio et al. 1994), which is an important consideration given carbohydrates stored in muscle can become depleted to very low concentrations during intense endurance exercise of sufficient duration, and that this depletion is a possible cause of fatigue (Ørtenblad et al. 2013). However, the precise combinations of endurance exercise and environmental heat stress under which these effects are seen is not currently known. As such, we are exploring how this effect is mediated by both exercise intensity and the magnitude of the environmental temperature to provide athletes and practitioners with improved understanding of how a given combination of environmental heat and endurance exercise will impact their substrate metabolism, and therefore allow them to plan their nutritional strategies accordingly.

It is also possible that training in hot environments may improve the adaptive response to exercise through heightened stress at the cellular level (Hawley et al.

2018), a suggestion no doubt supported anecdotally by the many endurance athletes who engage in this practice through ‘heat stress training camps’. However, whilst promising, the research in this field is very much

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SPRINZ Beating the Heat continued...

by Associate Professor Andrew Kilding, AUT Sports Performance Research Institute New Zealand in its infancy and has primarily been conducted in cells exposed to high incubator temperatures (Liu & Brooks, 2012). We have started to explore physiological and biochemical responses to training in the heat in strength and power athletes (Casadio et al. 2017b) but ongoing research interest at SPRINZ is to establish the adaptive response to exercise training performed under environmental heat stress in other athletes. Exploring this effect is expected to help athletes and practitioners better understand how to use environmental heat stress as part of training to achieve optimal performance for NZ athletes in a range of sports performed in temperate and hot environments.

Practical recommendations and conclusions

• The combination of intense exercise and a hot environment is a huge stress on thermoregulatory and cardiovascular function, although humans are uniquely adapted to cope with such stresses.

• Rapid diagnosis and appropriate treatment is essential in minimising the consequences of heat illness.

• Pre- and during exercise cooling, as well as specific heat acclimation, are well-supported strategies for reducing the risk of heat illness and maximising exercise performance in hot environments (see Casadio et al. 2017).

• Performing endurance exercise in hot conditions alters substrate metabolism, which might have implications for the nutritional strategies adopted by athletes.

• The effects of purposely performing training in hot environments to augment an adaptive response are not completely understood and warrant further investigation.

References Bramble, D.M. & Lieberman, D.E. Endurance running and the evolution of Homo. Nature 432(7015), 345-352, 2004.

Casa, D.J. Armstrong, L.E, Kenny, G.P, O'Connor, F.G, Huggins, R.A. Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep 11(3): p. 115-23, 2012.

Casa, D.J, et al., National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. J Athl Train 50(9): p. 986-1000, 2015.

Casadio J.R, Kilding A.E, Siegel R, Cotter J.D, Laursen P.B. Periodizing heat acclimation in elite Laser sailors preparing for a world championship event in hot conditions.

Temp, 4;3(3):437-443, 2016.

Casadio J.R, Kilding, A.E, Cotter, J.D, Laursen P.B. From Lab to Real World: Heat Acclimation Considerations for Elite Athletes. Sports Med 47 (8):1467-1476, 2017 Casadio J.R, Storey A.G., Merien F, Kilding A.E, Cotter J.D, Laursen P.B. Acute effects of heated resistance exercise in female and male power athletes. Eur J Appl Physiol 117(10):1965-1976, 2017b.

Febbraio, M.A, Snow, R.J, Stathis, C.G, Hargreaves, M, Carey, M,F. Effect of heat stress on muscle energy metabolism during exercise. J Appl Phys 77(6), 28272831, 1994.

González-Alonso, J. Human thermoregulation and the cardiovascular system. Exp Phys 97(3), 340-346, 2012.

Hawley, J.A., Lundby, C, Cotter, J.D, Burke, L.M. Maximizing cellular adaptation to endurance exercise in skeletal muscle. Cell Metab 27(5), 962-976, 2018.

Howe, A.S. and Boden, B.P. Heat-related illness in athletes. Am J Sports Med 35(8): p. 1384-95, 2007.

Liu, C.T. & Brooks, G.A. Mild heat stress induces mitochondrial biogenesis in C2C12 myotubes. J Appl Phys 112(3), 354-361, 2012.

Maunder, E., Laursen P.B, Kilding A.E. Effect of ad libitum ice-slurry and cold-fluid ingestion on cycling time -trial performance in the heat. Int J Sp Phys Perf 12(1), 99-105, 2017.

CONTINUED ON NEXT PAGE

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SPRINZ Beating the Heat continued...

by Associate Professor Andrew Kilding, AUT Sports Performance Research Institute New Zealand Ă˜rtenblad, N., Westerblad, H,. Nielsen, J. Muscle glycogen stores and fatigue. J Physiol 591(18), 44054413, 2013.

Schulze, E,. Daanen, H.A,. Levels, K,. Casadio, J.R, Plews, D.J, Kilding, A.E, Siegel R, Laursen P.B. Effect of thermal state and thermal comfort on cycling performance in the heat. Int J Sports Physiol Perform, 10(5):655-63, 2015.

Associate Professor Andrew Kilding leads the SPRINZ (Sports Performance Research Institute New Zealand) Sports Physiology and Nutrition Research Group. His research interests focus on developing and assessing novel ways to enhance endurance (aerobic) performance – both in individual sports such as running, cycling and triathlon, but also in team sports. https://sprinz.aut.ac.nz/our-people/sports-physiologyand-nutrition-research-group/andrew-kilding

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Planet of the Apps Back to the App… Your App Review

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

Hey team, It has been a little while since I have come across any good apps that I felt I needed to share, but on a flight down to Wellington recently I saw a small piece on a Wellington Victoria University entrepreneurial company that had released SWIBO Tilt and I decided to get in touch and give it a go. SWIBO Tilt was created to help improve the compliance of proprioception training. This is achieved by creating games that can be played on a wobbleboard (or bosu) that are viewed on a screen. Basically, you are using the accelerometer and gyroscope in your phone as your joystick, which connects via Bluetooth to your computer screen. You need to download the SWIBO programme onto your computer. This is not a new concept, there have been some similar concepts used in neuro rehab before, but it was the first New Zealand version that I am aware of. Through SWIBO Tilt not only are you gameifying exercise which may increase compliance, you can also measure balance, and track your clients progress. You can purchase a SWIBO Tilt board which has been designed to hold your smartphone, or use ones you already own (putting down an antislip mat on the bosu or wobbleboard helps to keep your phone in place).

App: SWIBO Tilt Seller:

SWIBO Ltd

Category:

Health & Fitness

Version:

3.7

Size:

1.3MB

Language:

English

Website:

https://swibo.co.nz/ Demo videos are available at: https://www.youtube.com/watch?v=pSOtfETRCMQ

Cost:

Varies from NZ$19.99 per month for personal to $NZ99.00 for the full professional account which allows you to create up to 10 clients accounts.

There is a Limited Professional account for $49.99 that you can use that allows you to access the balance tests but you can’t track clients’ activity.

Personal:

Allow you to play Tilt from home and automatically collect data.

• Can play Tilt games Professional:

Are used to measure client's balance and assign game exercises,

• Can play Tilt games

• Can do balance tests • Has client activity tracking • Can create client accounts CONTINUED ON NEXT PAGE

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Planet of the Apps You can also purchase a SWIBO Tilt board for $150.00 each or 10 boards for $400.00.

The app is free to download Requires:

You will need to download SWIBO Tilt on your computer onto either Windows (Windows 8 or Higher, Dual Core Processor, 4GB RAM) and Mac OSX platforms (OSX 10.10 Yosemite, or newer, Dual Core Processor, 4GB RAM and onto a phone Android version 4.1 Jellybean or higher or iO6 version 6 or higher.

What it is used for: Gamefying proprioception training, increasing compliance Where to find it:

Download from Apple store, or Android Play, check https://swibo.co.nz for details

Android or Apple or both: Both Pros:

• This makes wobbleboarding more fun! Exercising your senses and • • • • • •

Cons:

engaging in a bit of fun could produce a positive proprioceptive outcome.

The benefits of video gaming have been shown to improve spatial skills, attention capacity, and proprioception (SWIBO is undergoing testing at the moment to see the effect of their games) With the pro version you can check clients compliance, test their balance ability Great for those that enjoy gaming, Those that have played it have enjoyed it and enjoyed challenging themselves to beat their high score The interface for testing looked professional Being able to track compliance of patients is great – and allows them to see their progress too

• I really wanted to like this product but….This seems ridiculously •

expensive for what it is. The games appear very basic.

If you are using iOS you need to have a good WiFi setup (ours isn’t)

How I use the app: I have not continued my subscription after the 14 day trial. I will forward the link to the website for those that I think will enjoy the app and use it. I found it was a lot more challenging using a bosu flipped onto the air filled end. If we were to purchase the Professional version the SBIBO team suggested we could pass the cost onto my clients.

I am going to keep watching the website though as the SWIBO team have told me there are some better games in the pipeline.

Bring the price down and improve the games and think that SWIBO could be onto a winner. I CONTINUED ON NEXT PAGE

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Planet of the Apps know that some of you would love it so if it is something that you are interested in please get in touch with the SWIBO team.

Don’t just take my opinion on this product though…I gave it to Techsavvy Tim to give it a go…

This is what he said….

Techsavvy Tim’s Two cents worth: Thanks Justin, We had the team at SWIBO come in and give our team an overview and demonstration.

What we liked:

•

There are three different games which will be appealing to a different age range of patient.

One is an obstacle course you negotiate, another is a race-type game, and the last is a shooting-style game.

•

The software uses the gyroscope and accelerometer in your phone and can display metrics and trends at the end of a game. This allows you to track movement on a sagittal, coronal, and transverse planes to compare errors or similarities between sides. This can be monitored over a period of time.

•

As the all the SWIBO needs is a flat surface for a smartphone, you are able to look beyond lower limb rehab – we trialed controlling the board with our arms in a press up position so there is utility in upper limb and trunk rehab exercises or testing.

What we didn’t like as much:

•

You have to set up clients as users and there is a limit to how many client accounts you can create per subscription. Clinics will have to work out a subscription structure that fits.

•

An internet connection is required to play – great if you have no connectivity issues, not great if you do.

•

It can take a bit of time to set up the client’s account and show them how to use the game so each clinic will have to figure out how this fits within their appointment time structures.

Take home message: While this concept isn’t new, it is great to see a New Zealand company get involved. The SWIBO team are great communicators if you have any questions/issues and may be able to provide a demonstration if they are in your area if you get in touch. This was the first time we trialed a product like this and it was interesting to see how it could fit into a clinical setting as an assessment and/or rehabilitation tool.

Overall Rating: 3/5

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

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ASICS

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Clinical Section - Article Review Pain and Fatigue in Sport: Are They So Different?

Kieran O’Sullivan,1,2 Peter B O’Sullivan,3,4Tim J Gabbett5,6 British Journal of Sports Medicine May 2018 Vol 52 No 9

Athletes will often avoid or reduce their training and/or sporting participation for pain and fatigue. Paradoxically, that ‘relative’ rest means that they avoid the very essence of what keeps them healthy, fit and resilient. Coaches sometimes see pain and fatigue as a ‘weakness’ and when medical staff have an opposing view this can place the athlete in a conflicted state. (see link for figure 1)

Both pain and fatigue are potentially important signals that the body perceives danger.

However, in the absence of pathology or signs of maladaptation,1 these can be misinterpreted as injury or illness. Fatigue is unavoidable2 if physiological adaptation is to be achieved.

Interpretation of fatigue and pain may be influenced by the central nervous system (CNS) and this may play a large part in determining a person’s pain experience.4 Listen carefully to the athlete: Athlete responses are completely individual and their fatigue or pain may coincide with other factors creating anxiety.

Educate and reassure through behavioural learning: Pain and fatigue can create fear about the safety of training and lead to load avoidance. Conversely, fear of appearing ‘weak’ can exacerbate symptoms. Identify the contributing factors and develop strategies so activity can be maintained while building physical and psychological resilience (figure 1). Use positive and reflective communication

to help athletes understand that pain and fatigue are multi-factorial and they need not be barriers to achieving their goals.

Team environment: Develop good relationships with athletes to identify what makes them vulnerable to their interpretation of sensations and help them achieve an understanding of resilience to achieve athletecentred goals.

In conclusion, once serious pathology has been ruled out, identification and management of the relevant factors can be used within a decision-making framework7,8 to enable athletes to continue training without provoking symptoms or unnecessarily avoiding training.

This editorial reminds clinicians that athletes are individuals and that good communication and education are paramount in providing complete athlete management of injury.

A full list of references is available on request.

By Pip Sail Physiotherapist

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

Volume 52, Number 12, June 2018 EDITORIALS What Hippocrates called ‘Man’s best medicine’: walking is humanity’s path to a better world Emmanuel Stamatakis, Mark Hamer, Marie H Murphy Walking: a best buy for public and planetary health Fiona C Bull, Adrianne E Hardman Socially awkward: how can we better promote walking as a social behaviour?

Ruth F Hunter, Kylie Ball, Olga L Sarmiento REVIEWS How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review Catrine Tudor-Locke, Ho Han, Elroy J Aguiar, Tiago V Barreira, John M Schuna Jr, Minsoo Kang, David A Rowe Moving to an active lifestyle? A systematic review of the effects of residential relocation on walking, physical activity and travel behaviour Ding Ding, Binh Nguyen, Vincent Learnihan, Adrian E Bauman, Rachel Davey, Bin Jalaludin, Klaus Gebel Walking on sunshine: scoping review of the evidence for walking and mental health Paul Kelly, Chloë Williamson, Ailsa G Niven, Ruth Hunter, Nanette Mutrie, Justin Richards What works to promote walking at the population level? A systematic review Charlie Foster, Paul Kelly, Hamish A B Reid, Nia Roberts, Elaine M Murtagh, David K Humphreys, Jenna Panter, Karen Milton ORIGINAL ARTICLES Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50 225 walkers from 11 population British cohorts Emmanuel Stamatakis, Paul Kelly, Tessa Strain, Elaine M Murtagh, Ding Ding, Marie H Murphy Effects of frequency, intensity, duration and volume of walking interventions on CVD risk factors: a systematic review and meta-regression analysis of randomised controlled trials among inactive healthy adults Pekka Oja, Paul Kelly, Elaine M Murtagh, Marie H Murphy, Charlie Foster, Sylvia Titze

http://bjsm.bmj.com/content/

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Classifieds TAURANGA Back in Action Physiotherapy Physiotherapist We have found a great therapist to join our team but due to expansion we are still looking for another one, which could be you!

If you had to list all the things you want in a job ‌.. here is your list AND that is what we are offering!! * Flexibility with hours * Weekly planned CPD * Longer sessions * Fun staff * Lots of sports teams * Autonomous * Full list * Easy location to get to * Varied workload * Great patients * Great coffee down the road * Senior support * Lots of laughs * Competitive remuneration * Work-life balance * Learning * Fab beaches * Redecorated clinic * Your own room * Awesome admin support * Cool city to explore * Part or full time * Sports team opportunities * Focus on patient care * Clinical reasoning sessions Go and check us out at www.biaphysio.com.

Then it's easy – if you want to know more then drop me an email with some questions or if you are already keen then send me your CV and we can have a chat. info@biaphysio.com Look forward to hearing from you soon.

Leanna Veal Position Requirements: NZ Work Visa Annual Practising Certificate

TAURANGA Bureta Physiotherapy Physiotherapist We need another team member. Our busy physiotherapy clinic is looking for another like minded physio to join us in a varied job role of most clinical physiotherapy, rehabilitation and some ACC contract work.

This is an exciting opportunity to work in an established sports physiotherapy and rehabilitation clinic and the ability to learn and be exposed to the world of emerging talent and high performance sport. For over thirteen years Bureta Physiotherapy has been providing the highest quality physiotherapy to a wide variety of "everyday" patients to elite athletes with a focus on overall health and wellness. As well as working with sports teams our clinic holds major contracts with APM for vocational, functional, and pain management contracts.

Generous appointment times allow for an emphasis on manual/manipulative physiotherapy and exercise prescription encompassing full rehabilitation in the onsite rehabilitation gym or one of our partnered gyms in Tauranga. Work alongside experienced post graduate and Masters qualified physiotherapists, a therapeutic massage therapist, a great reception team along with close links to local sports medicine doctors and specialists. The successful applicant will receive ongoing support as part of our strong mentoring program along with an allowance for CPD to assist with post graduate study/courses and conferences.

Start date is July 2018. We are looking for an enthusiastic, hard-working physiotherapist with excellent communication skills, an interest in gym based rehabilitation and a strong desire to learn and enhance their clinical skills as well as build their reputation as a high quality physiotherapist. The position has the ability to involve primarily musculoskeletal and sports physiotherapy or a mix of clinical work with contract work under the ACC pain contract as a key worker and vocational rehabilitation. If contract work option is desired experience is these areas is preferred although not essential as training will be provided.

Come see why our clinic won the Bay of Plenty Westpac Business Awards for Customer service in 2017 and be the best physiotherapist you can be. The ability to think outside the box and go 'above and beyond' is a must to work in this dynamic and energetic team.

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