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SEPNZ BULLETIN
ISSUE 15, JUNE 2020
CELBRATING OUR MEMBERS: ROLAND JEFFERY P5
p12 RADIOLOGY: Imaging Utility of the Knee
p16 Achilles tendon rupture treated with surgical repair
p18 UPCOMING SEPNZ COURSES
www.sepnz.org.nz
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SEPNZ EXECUTIVE COMMITTEE
Members Page
President - Blair Jarratt Vice-President - Timofei Dovbysh Secretary - Michael Borich Treasurer - Timofei Dovbysh Website - Hamish Ashton Sponsorship - Emma Lattey Committee Emma Clabburn Rebecca Longhurst Justin Lopes 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
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CONTACT US Michael Borich (Secretary) 26 Vine St, St Marys Bay, Auckland secretary@sepnz.co.nz
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CONTENTS SEPNZ MEMBERS PAGE See our page for committee members, links & member information
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EDITORIAL: By SEPNZ President Blair Jarratt
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FEATURE ARTICLE: CELEBRATING OUR MEMBERS: Roland Jeffery
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APP REVIEW: TeleHab
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MEMBER BENEFITS: Asics Professional Buyers Program
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RADIOLOGY: Imaging Utility of the Knee
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CLINICAL REVIEW: Achilles tendon rupture treated with surgical repair
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UPCOMING SEPNZ COURSES
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RESEARCH PUBLICATIONS: BJSM June 2020 - Volume 54 - Issue 12
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CLASSIFIEDS AND STUDY INVITE
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EDITORIAL It is a pleasure to write this editorial with a different outlook to where we were two months ago. Clinics are open, winter sports have or are about to start, and there is a hum of things returning to some normality or our “new normal”. Hopefully, this Bulletin finds our members in a significantly different position to two months ago. Last week we ran our online Webinar on "Marketing through the levels of COVID" with Nick Thompson from PNZ office - for those of you that were not able to attend we have included Nicks' slides in the member's section of our SEPNZ website. The Webinar was followed by our AGM, where all SEPNZ executive members stayed on in their current positions and we welcomed Dr Gisela Sole, Lauren Shelley and John Love onto out education committee. Documents including the Treasures and Presidents report can be found again on our website in the member's section under "reports." In this SEPNZ bulletin we celebrate 100+ 'A' international games for Team Physiotherapist Roland Jeffery. Executive Member Justin Lopes interviews Roland on how he got to his position, the highlights of his career, and some advice from Roland on how to get involved at an elite level. This is an inspirational interview for any sports physiotherapist to digest plus if you would like to know more, there is a link to a podcast. Thank you Roland for taking the time to be part of this Bulletin, all the best for the coming season.
We have another App review from Emma Lattey - although there may be less demand on Telehealth - it is important that as clinicians we continue to be adaptable for our clients and this golden opportunity to develop our skills in digital medicine should not be wasted. Let's hope we don't have to repeat our sacrifices of earlier this year. Emma reviews TeleHab and its practical application, she has again picked a free APP for our membership, showing there are useful, practical applications which are available for clinicians. Ultrasound imaging of the knee is always a topic that creates discussions as it is reported that clinicians order these too often. Auckland
Radiology group, courtesy of David Dow, have provided an article on when this imaging may be applicable. If you are thinking of referring for an Ultrasound scan, it is recommended that radiographs should accompany this investigation. This short and informative article outlines when an ultrasound may be of clinical use. Thanks again to Pip Sail who rounds out this Bulletin with her clinical review - keeping with the theme of football and the return to play following Achilles tendon repair surgery. Thanks also to Rose Lampen-Smith who is stepping down from our review group — are there any members who would be keen to join this awesome group? Of note to the rest of our members that were not able to make our AGM - the SEPNZ SIG current membership sits at 881 members again making this one of the larger PNZ SIGs. From our reappointed Executive - thank you for continuing to be part of this group, and we look forward to bringing you some CPD options over the coming year. What format they will be in is a work in progress, but please head to page 18 of the Bulletin to see the intended dates for our planned courses. Goodbye until next Bulletin and hopefully a COVID Free NZ once again. Kind Regards Blair Jarratt SEPNZ President
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FEATURE ARTICLE
Celebrating Success: 100+ Roland Jeffery, MHSc (Physio), PGD (Manip), PGC (Acup), MPNZ Consultant Physiotherapist Late last year SEPNZ member Roland Jeffery clocked up 100 'A' Internationals as the Team Physiotherapist with the All Whites (New Zealand Football's Senior Men's team). We wanted to celebrate this achievement as those numbers do not include friendlies, age group games or games covering the Football Ferns (New Zealand Football's Senior Women's team). At the end of 2019, SEPNZ Exec member Justin Lopes caught up with Roland to have a chat about what has made him so successful in the role over the last 15 years. **Disclaimer: Justin worked with Roland at Roland Jeffery Sport Physiotherapy and NZ Football. The following is an abridged version of an interview Justin had with Roland shortly after he was awarded his 100. JL: Roland, congratulations on your 100+ A Internationals. Why did you want to become a Physio? RJ: I had never had Physio but, as a teenager when I was at school, it was something I looked into with the career officer. I looked through manuals and decided to become a Physio because it was dealing with sports, but also dealing with people, and helping people, so I felt that was where I wanted to go. I think I was pretty lucky to fall into the right profession for me! JL: So you studied through AUT? RJ: Yip, went straight from school to AUT, and started just after my 18th birthday. I completed undergraduate study in 1994…we were the first fouryear degree to run. Then I worked in a hospital in Whakatane for 18 months before coming back up to Auckland to work in private practice in Point Chevalier. Then I went overseas for four years, came back and did my Post Graduate study after about seven years.
JL: Had you been working in football at that stage or with other sports? RJ: When I was in private practice, I had been working with rugby league and rugby, but I had played football as a young boy and had a passion for it. I had coached football while I was playing rugby and had done a few games here and there for football. When I returned from England to Auckland in 2000, I was approached by my local football club (Glenfield Rovers) to provide services for their club and First Team, and that's when I fell into it. JL: Had you started your clinic (Roland Jeffery Sport Physiotherapy) at that time? RJ: I had started my clinic at that time, and I contracted to Glenfield Rovers, it all started at once…73 Chartwell in 2001 and moved to 22 Chartwell in 2004. I think you came on board in 2004/2005! JL: Good times! How did you get involved with New Zealand Football? RJ: I had worked at Glenfield Rovers with their First Team and through the Chairman of the club (Glen Read), United Soccer 1 which is now Northern Football Federation (NFF). Keith Pritchett needed a CONTINUED ON NEXT PAGE >>
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FEATURE ARTICLE Physiotherapist for a game. I literally got rung up last minute, the afternoon of the game. It was a senior game, the NFF Team vs the All Whites…(The All Whites were preparing for the Nations Cup in 2002). I went up there and did a good job. Keith then used me for US1 as much as he could. We both support a club called Watford, he played for Watford, so there was a little link there. From there Keith recommended me to NZF when they had their Academies during the school holidays. I got involved from that level and worked my up from there. JL: So how long from when you started with NZF until you got your first All White’s cap? And was that the first team that you worked with or did you work with other NZF teams? RJ: I worked with the (NZF) Academies for about six months, went away with Ricky Herbert with the NZF MU17 Team for some World Cup Qualifiers…We didn't qualify, Australia was in the group then. I then got selected for a U22 team which went over to Japan with Paul Smalley and then an opportunity with the All Whites came up in 2003, so this is all in the same calendar year. That was a one-off away game against Iran. The Director and Coach Paul Smalley asked if I could come along with the Doctor as a one-off game and from there…
good because that's what I love. JL: There have been a lot of tours. What would you say is the highlight of your Physio career so far? RJ: I think football-wise the two highlights, were the South Africa 2010 World Cup and the London 2012 Olympics. Pretty special memories. That’s probably the football side of it. Perhaps the two best memories I've got is being on the stage for the Halberg Awards in 2011 winning the Sports Team of the Year. It's not often a Physio gets to go up on stage with a team. Usually, it is an athlete like a shotputter or kayaker that gets to do that, and we got to do that which is pretty impressive. The other time would be the closing ceremony of the 2012 Olympics, just walking around that with all the other athletes and the actual show with all the British music was pretty special. Two memories that are football-related but not directly on the pitch. JL: And the best home series? RJ: The best game would be the Bahrain game at home, that was pretty awesome…surreal, a real night, a bit of tension and everyone who was there that night can remember it pretty well. A pretty special memory that one!
JL: Never looked back! So you have been going since 2003 to present, 100 ‘A’ Internationals plus a whole lot of other friendlies and other games including the Olympics? RJ: Went to the London 2012 Olympics, that’s the only Olympics I have been to JL: And on the team for next years Olympics? RJ: Hopefully, yes. JL: FIFA World Cup? RJ: Yip 2010 JL: FIFA Women's World Cup? RJ: 2007 JL: Any other age group World Cups? RJ: Never been to any age group World Cups but have Qualified teams for the World Cups, but never been to age-group World Cup's myself. JL: Any other pinnacle events… World Masters Games? Have you done other sports? RJ: Yip, World Masters Games and I went to Azerbaijan, Baku, worked at the European Games. That was a pretty big event. I looked after Beach Soccer and Beach Volleyball for three weeks. I have done other sports like badminton, softball and things but it has been 99% football since 2001, which is
Mark Fulcher, Wade Irvine and Roland Jeffery at Azteca Stadium, Mexico (2013)
JL: You tour frequently and are really organised. I know you have a comprehensive kit that goes with you. What is some essential things you have in your Physio kit, or something people may not have thought of, or are invaluable to you? RJ: Well, I think the two things that spring to mind are my own pair of hands. A lot of my players, well most of my players are professional now, so they look after themselves a lot better than what they did 15 years ago. We have foam rollers, massage balls, Normatec, Game Ready's – all these things that when I started 15 years ago, we didn't have. So I
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FEATURE ARTICLE think the players are in a lot better shape and a lot of work I do is just maintenance work so my hands would be the most important thing. I think technology like Game Ready's and Normatec make my job a lot easier now for recovery, looking after injuries. When we were in Nashville a couple of years ago, me and Mark (Palmer) were sitting on our tables in a huge medical room. There were literally 20 players on Normatec’s Game Ready’s, foam rollers, massage balls and they were all looking after themselves, and we were doing nothing while music played in the background! I think every Physio has their own special kit or apparatus, but for me, I think if you do everything inside the square savagely well, then I don't think you need to think too much outside the square. Keep it nice and simple, and if you do that, then you can refine things as you get to know your players and team. JL: How does the medical structure for the All Whites work? RJ: It's a really different environment from most teams because all our players are either based overseas, or there are half a dozen players based in Wellington when we pick our top 23 man squad. So we don't get together like the All Blacks, netball team or hockey team. We don't tend to have camps or train together, so my job is just networking, or email, phone calling players, particularly if they are having injury problems within their professional clubs. Linking in with the Doctors or Physio's of those teams and, to be fair, if someone does sustain an injury, they are in a professional club, so it is not for me to dictate what treatment they have. It is just to make sure they are comfortable with the treatment they are getting, and 99 times out of a hundred the club looks after them professionally. So we just get together as a group of players, the recent tour to Ireland we literally had two training sessions together… It is meeting the players, reintroducing yourself, assessing them, screening them, checking where they are at, providing maintenance or treatment during the week that we are there together. To be honest, it is more maintenance than treatment because if someone is injured, they won't be on tour. And they are then looking at liaising with the clubs after the tour with loading data, GPS data and any relevant bits. Mark Palmer and Mark Fulcher All Whites Medical Team walking to training. Doha, Qatar (2014)
The Medical structure in the All Whites has changed, depending on how the coach wants to work it. So for the last 4-5 years, I have been head of Medical Services and co-ordinated a Doctor, another Physio and a Sports Scientist, but sometimes their people do that so when Dr Mark Fulcher was involved he would do that, and that doesn't worry me. Coaches often want to be liaising with the Physio because they have a better knowledge of the musculoskeletal injuries and returning people to sport. That changes a little bit from coach to coach. JL: Dealing with "club versus country" can be a challenge; having to communicate with clubs… that must take up a lot of time? RJ: It does, and it is niggly. When you are coming into friendly games, 'injuries' occur, and you have to try and work through that with the player and the club. I think for big games, like crucial World Cup Qualifiers, Peru, Olympic Games, players will come, for other games, there is pressure from their clubs so it is a delicate balance to get that right and it is one of the more challenging parts of the job. It can be very frustrating at times as well, particularly when the players move around a lot and you develop a good relationship with the Physio or medical staff at a club. Then you find the player has moved somewhere else and you find you have to build that relationship up again. New Zealand is perceived as a very weak footballing nation, small and insignificant, so that doesn't help that relationship as well. When you are dealing with some big clubs as well, it is a really hard part of the job, and if the team doctor wants to take ownership of that side of the role, I am really happy for him to take it. JL: The job obviously takes up a lot of time… How much time on average would you say you spend on a weekly basis on the role? RJ: Sometimes it can be zero and sometimes it can be hours and hours and hours. I don’t think this job would compare to what the All Blacks do or Hockey or Netball, but before a tour, it can be really hectic. You can be on the phone for hours and hours each day, emails and things like that, but at the moment we have no games until March. I have dealt with an injury to a player, who got injured in the last tour this week but realistically I would only be doing phone calls or emails for the three to four weeks unless someone gets injured. And then it's just a touch base. To be honest, I have a hands-off approach if someone gets injured. For example, Ryan Thomas ruptured his cruciate, he was at PSV Eindhoven, a very professional environment, so we touched base to check he is OK, and to see if he needed anything from me, but I could just leave them to it.
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FEATURE ARTICLE JL: If you were to provide advice or suggestions for people wanted to get involved in building up to working with elite teams, what is the best pathway to do that? RJ: You need to be involved in your sport. Get involved at ground roots level, the best level you can…for football that's club level. Network and develop relationships with coaches. As a coach moves up the grades, they will take you with them as a Physio. I have found that on a number of occasions as well, so building those relationships is really good. Doing Post Graduate study, or further courses through Sport and Exercise Physiotherapy NZ, I think that's really important to help with your knowledge. You need to work as hard as you can and be involved as much as you can. You can see the Physio's who are involved at the elite level are really passionate, so that would be my advice… Love the sport you want to be involved with and do study around it and become really great at doing that particular sport. JL: You have an extensive practice, which you help to run and you treat in the clinic too. You have lots of hats on at one time which can be challenging. As far as the development of new graduates that come into the clinic, you have a good training programme. What are the expectations of new graduates? Do you provide opportunities for them, or do they have to get them themselves? RJ: the clinic has a structured inservice programme for the new graduates, both from a professional and clinical side, so that gets them up to speed. We usually try and get those Physio's into clubs if they are interested in football, either a First Team or Reserve Team. We try and buddy them up now with a mentor. Historically, perhaps when we were young Physio's you had one physio at a club, but now we try and have a young physio with an experienced Physio so that they can learn from that. We also have specific in services around all those things, working with teams, first aid, but I think those new graduates need to get the most of the opportunities that get presented to them so if the door opens they need to walk through and take the opportunity. If you develop relationships with clubs and coaches, I think that's just as important as having the clinical and professional skills as well. JL: You are a member of SEPNZ…What do you see the value of being a member is? RJ: I think it’s great. The things that come to mind is the newsletter, I think it's a comprehensive newsletter, which is clinically relevant, produces good stuff you can read and it has good take-home messages. I know that is really important. I know my staff get a lot of information around that. I think the
opportunity for courses and conferences that are up to date, provide current information, and current practical skills are valuable to you as well. I think it's also just networking with all those people that have a common interest, we all have different sports we are really passionate about. Still, there is a lot of cross over in principals from a lot of those sports, and you can pick ideas about how they manage bits and pieces as well and have little take-home points that you didn't think were relevant as well. I would encourage people to become a member, I think it's valuable, and without it, you are a little behind the eight ball and are relying on other courses and things to go to. JL: Where do you see Sports Physio going now? Not just football stuff but in general. Where do we need to get better? RJ: That's a really interesting question, it's a long one to answer… I think having excellent clinical, practical skills is important to be a good Sports Physio. Having a Post Graduate Diploma, whether it is in Sports Physiotherapy or Musculoskeletal Physiotherapy is really important. I think working in elite sport is becoming more and more specialised for Physiotherapists. There is a big cross over between a Sports Scientist, Trainer and Physio. I am pretty old now, so I am relying on old knowledge and expertise, but having good knowledge in other peoples disciplines is really important. I think sports courses and conferences need to develop individualised traits that we can learn and develop from as well. For instance, getting expertise in GPS and Loading… As a Physiotherapist, we may not be involved in collecting the data but understanding how it relates to an injury is really important. Working with medications and other things that the Doctor does and the cross over in roles. The more information the Physio can have from those courses, the better. I think it is getting more and more specialised as the years go by. If you want to hear more about Roland, I would suggest you listen to the "Between two beers podcast which has some fascinating tales in it too – check out this link Between Two Beers podcast with Roland Jeffery https://www.spreaker.com/user/nzme/roland If you know of successful SEPNZ members we would love to celebrate them; please email Justin@sepnz.org.nz to let us know who we should be interviewing!
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APP REVIEW
Back to the App... Your App Review TeleHab—by Emma Lattey My app review this issue is of a remote exercise platform called TeleHab which provides exercise prescription for practitioners, and guided exercise for patients. Telehealth for remote exercise prescription is more important now than ever before and this free platform is definitely worth a try!
Seller: Version: 1.2.0 Seller: Size: Category: Version: Compatibility: Languages: Age rating: Copyright: Cost:
What it is used for?
Vald Performance Pty Ltd 25.4 MB Health & Fitness 1.2.0 Requires iOS 11.0 or later. Apple and very recently An droid (01.06.2020) English 4+ Vald Performance 2014-2019 Vald Performance Pty Ltd Completely free!
With the current COVID-29 situation forcing us to find ways to connect differently with our patients, this app is a brand-new exercise prescription tool which provides increased exercise information and accountability for those we treat. Built with practitioners in mind, TeleHab focusses on alleviating the frustrations of traditional exercise prescription platforms. By using TeleHab as part of your telehealth solution you can view clients exercises prior to their online consult to give them instant feedback, motivation and next steps.
Who would benefit from this App? Any physiotherapist who prescribes exercises to their patients would benefit from TeleHab. Even patients without access to the app can get a PDF of their program printed/sent to them which includes detailed exercise description. We are all aware that dedication to injury rehabilitation often starts with positive expectations and intentions, but compliance rates are low once your patient steps outside the clinic. With TeleHab, you can have complete visibility of your patients in the clinic and at home for a better rehabilitation experience. PRACTICAL APPLICATION TeleHab allows the clinician to search, build, save, assign and monitor each individual exercise program, which removes some of the biggest stresses of traditional exercise prescription platforms.
CONTINUED ON NEXT PAGE >>
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APP REVIEW
Pros: • • • • • • •
Compliance and feedback from my patients was good especially over lockdown when exercise prescription was very challenging. Over 4,000 exercises on the system. Simple, easy to use interface. Patients have the option to record and upload videos of their exercises for extra accuracy and accountability. Can send or print PDF version of exercise program which includes diary to complete daily exercises. Videos are easy to follow, and instructions are comprehensive – you are able to add extra notes also. Did I mention it’s free!!
Cons: •
• •
It’s a new app so there are many exercises missing, quite a bit of doubling up, and limited gym equipment use. However, you are able to email the Telehab team with your selected exercises to upload and they are very forthcoming. (Looks like Pilates reformer and gym exercises won’t be far away if their social media profile is anything to go by). One of my issues is the limited set/rep/timing options with certain exercises. I’ve been using “The Rehab Lab” for so many years takes me much longer to design a program and insert individual patient details!
OVERALL RATING = 4.2 / 5
MEMBER BENEFITS
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There are many benefits to be obtained from being an SEPNZ member. For a full list of Members’ Benefits visit http://sportsphysiotherapy.org.nz/benefits/
In each bulletin we will be highlighting individual member benefits in order to help members best utilise all benefits available.
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
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RADIOLOGY
Imaging Utility of Knee Auckland Radiology Group Thanks to Auckland Radiology Group for the content which in this edition is provided by Dr David Dow.
Ultrasound offers high-spatial resolution imaging of superficial knee anatomy.
The extensor mechanism of the knee is a superficial structure which can be reliably interrogated with ultrasound.
Correlation with radiographs is routinely recommended at the time of ultrasound. Radiographic review of quadriceps and patella tendon outlines, ossification/ mineralisation within tendons and osseous pathology at tendon attachments improves ultrasound interpretation.
Pathological entities which can be identified at ultrasound include: •
Quadriceps and patella tendon tears and tendinosis
•
Prepatellar and infrapatellar bursitis
•
Paediatric/adolescent entities of Sinding Larsen Johansson and Osgood Schlatter syndromes
•
Popliteal cyst (Baker's cyst)
Intra articular structures such as the cruciate ligaments, menisci and cartilage cannot be accurately assessed with ultrasound and the modality offers limited evaluation of the medial collateral ligament and lateral collateral structures. Assessment of these structures are best achieved with MRI.
Fig. 1: Normal extensor mechanism anatomy https://radiologykey.com/imaging-of-the-knee CONTINUED ON NEXT PAGE >>
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RADIOLOGY
Fig. 2a. Proximal patella tendinosis and tendon tear: Tendon thickening with loss of the normal fibrillar architecture and a fluid filled tear defect Fig. 3. Full thickness quadriceps tendon tear defect with the distal stump remaining attached to the superior pole of the patella
Fig. 2b. Intratendinous neovascularity of tendinosis
Fig. 2c. MRI confirms a fluid filled tear deficit of the proximal patella tendon
Fig. 4a. Osgood Schlatter’s: Tibial tubercle irregularity with fragmented mineralization within the distal patella tendon
Fig. 4b. Osgood Schlatter’s: Distal patella tendon thickening, echogenic tibial tubercle irregularity and echogenic mineralization within the distal patella tendon CONTINUED ON NEXT PAGE >>
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RADIOLOGY
Fig. 4c. Osgood Schlatter’s: Intratendinous hyperaemia and echogenic mineralization within the distal patella tendon Fig. 6a. Prepatella bursitis: Increased prepatellar soft tissue density
Fig. 5a. Sinding Larsen Johansson: Corticated ossification within the substance of the patella tendon and separate from the inferior pole of the patella, consistent with remote traction injury of the osteotendinous junction
Fig. 5b. Sinding Larsen Johansson: Echogenic ossification within the substance of the patella tendon and separate from the inferior pole of the patella, consistent with remote traction injury of the osteotendinous junction
Fig. 6b. Prepatella bursitis: Adventitial prepatellar bursal fluid
Fig. 7a. Baker’s cyst interposed between the semimembranosus and medial head of gastrocnemius tendons CONTINUED ON NEXT PAGE >>
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RADIOLOGY
Fig. 7b. MRI equivalent demonstrating the Baker’s cyst
Key points: 1. Pathological entities of the extensor mechanism of the knee can be reliably interrogated with ultrasound due to the high spatial resolution of superficial structures
2. Radiographic correlation improves ultrasound interpretation
3. Intra articular and collateral structures are best characterized with MRI
Author Dr David Dow
Musculoskeletal Radiologist
Auckland Radiology Group
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CLINICAL REVIEW
Eighty-two percent of male professional football (soccer) players return to play at the previous level two seasons after Achilles tendon rupture treated with surgical repair. By Pip Sail Achilles tendon rupture (ATR) is an injury that commonly occurs during sports participation and for the professional athlete, it can be career ending. In the general population the clinical outcomes following ATR have been extensively investigated in surgical and non-surgical cases. It was found that 80% of the cases in the general population cohort were able to perform sport activity after ATR.
1,2
8% of the players who played in at least two full seasons after returning to play had a re-rupture. There were no predictors of re-rupture.
3
4-7
However, there was very limited data on which to advise professional football (soccer) players. This study aimed to analyse the time to return to training and match participation following ATR in professional footballers and the occurrence of complications including re-rupture rate. 9-11
The Players were identified through internet-based injury reports, player profiles/biographies and press releases as reported by Jack et al, using the keywords 'Achilles Tendon Rupture’ and ‘Transfermarkt’ and were considered eligible if they were found to have an ATR and repair between 2008 and 2018 and were enrolled as a professional footballer at the time of injury. 12
96% of male professional football players after suffering an index ATR and having surgical repair returned to unrestricted football practice after a mean of 199 +/- 53 days from injury. Players who were classified ’international’ returned to play a mean 32+/11 days earlier. There was no difference between player positions and time to return. All players who returned to training participated in official competitions after ATR. The mean time for return to competition was 274 +/- 114 days. The number of matches played 2 seasons and 1 season before the ATR was similar for those that returned to the same level of play and those who did not and the number of matches played the first season and the second season after return to play were significantly higher in those that resumed their level of play.
DISCUSSION Participation in a national team was a predictor of faster recovery, the assumption being that elite athletes have access to top level care and stronger motivation to recover. A 6-7 month lay-off should be considered a reasonable expectation for professional players. Return to competition occurred on average around 9 months after the injury and more than 2 months after re-joining the team which shows that the physical and mental fitness required to compete is slow to return after ATR. Only 82% of athletes that returned to a second season were able to perform at their pre-injury status. Footballers aged 30+ and those who sustained rerupture were more likely not to return to their preinjury level and therefore extreme care should be used to prevent Achilles re-injures and realistic expectations of not returning to their desired performance should be considered in athletes experiencing ATR in their 30’s. A higher re-rupture risk was reported in lower divisions. It is possible that lower divisions are not able to demand expensive and high standards of rehabilitation. Of more importance is that several reruptures occurred during early rehabilitation or early return to sport highlighting the risk of re-injury in the case of incomplete recovery, inadequate rehabilitation and over estimation of readiness. CONCLUSION Almost every professional football player was able to return to unrestricted practice and competition after a mean of 7-9 months; complete recovery to full and continuous match participation could be delayed for up to 2 seasons. Only 82% of players were still CONTINUED ON NEXT PAGE >>
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CLINICAL REVIEW
CLASSIFIEDS
competing at a similar pre-injury level during the following 2 seasons. Players of 30+ who ruptured their Achilles tendon were more likely to retire than younger players who sustained a similar injury. The data from this study provide clinicians, coaches and athletes with a realistic prognosis associated with Achilles tendon rupture in professional footballers.
Return to sport within 6 months of Achilles tendon repair surgery should be considered with caution as the chance of re-rupture is relatively high. A full set of references are available on request Tēnā koe, We would like to invite you to take part in a research survey exploring the diagnosis and management of common shoulder musculoskeletal injuries. The survey is designed to be completed in about 15 minutes. Please find an Information Sheet which tells you about the project and a Consent Form here: https://www.otago.ac.nz/physio/research/researchstudies/otago739086.html If you are currently practising as a physiotherapist in New Zealand, and would like to participate, please follow the link below. >>> SHOULDER SURVEY We would very much appreciate it if you could complete the survey within the next week. The survey is being conducted by a team of researchers from the School of Physiotherapy, University of Otago. This project has been reviewed and approved by the University of Otago Ethics Committee. If you have any questions do not hesitate to contact us. Thank you for considering participation in our study. Ka nui ngā mihi, Brooke Craig, 4th year Honours student Dan Ribeiro, Senior Lecturer School of Physiotherapy University of Otago
Central Districts Cricket Physiotherapist (7.5 Months Fixed Term) From the BLACKCAPS and WHITE FERNS on the international stage, to backyard cricket with friends in the holidays. New Zealand Cricket are behind it all, promoting and supporting our number one summer sport. We’re a passionate and enthusiastic team, focused on ensuring that cricket is a game without barriers, and committed to living and breathing our vision of cricket being a game for all New Zealanders; a game for life. We’re looking for a Physiotherapist to work with Central Districts Cricket, based in Napier, but with the ability to travel for the entire upcoming season. This role is a key part of the Association and will be responsible for the diagnosis and management of injury and illness for the men’s team, including clinical reasoning and complete and comprehensive player rehabilitation plans related to short and longterm injuries on an individual basis. Ideally, you’ll have a host of relevant experience, covering the following: •
A NZ registered physiotherapist with experience in musculoskeletal physiotherapy • Prior experience with high-performance athletes or sporting organisations • Sound knowledge and experience of strength and conditioning programmes You’ll also have some amazing personal skills and attributes such as: • Effective communication to help you work with athletes, Central Districts Cricket and NZC • Excellent coordination and management to support all player treatment and monitoring • Collaboration to help you work with the wider management group for overall player wellbeing We are a high-performance organization who are proud of our values of inclusivity, optimism, tenacity, fun and respect. To be successful you’ll share our focus on achieving the very best and bring the same value-based approach in what you do. There’s a lot to enjoy about working for New Zealand Cricket and being part of the team behind the teams that represent the best of New Zealand. If this sounds like you, apply here today. Applications close Friday 17 July 2020
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UPCOMING SEPNZ COURSES
Please note these are the proposed courses for 2020. With the current COVID-19 situation this could also change. Once we are confirmed to go ahead registrations will be open via PNZ. Lower Limb in Sport Venue and dates TBC This course is for registered physiotherapists who work with individual athletes or teams in which lower limb injury is common. The focus of the course is on pathomechanics and kinetic chain deficits as they relate to injury prevention and performance, diagnosis and advanced rehabilitation of lower limb conditions. By the end of the course you will understand the pathoaetiology of common lower limb injuries, be able to perform key clinical and functional tests, rehabilitate lower limb injury in a number of sporting contexts including football, running and contact sports, and develop individualised return-to-sport programmes. Promotion and Prescription of Physical Activity and Exercise 22nd & 23rd of August at AUT North This course is suitable for physiotherapists wanting to improve their knowledge and skills in assessment and prescription of physical activity and exercise to use with patients on a daily basis. This course provides a bridge to Level 2 SPNZ courses and important background information for those considering university postgraduate study. The course will provide a combination of lectures, practical demonstrations, practical assessments and case studies and will cover the following topics: Principles of exercise prescription, Promotion and assessment of physical activity, Assessment of neuromuscular performance, Aerobic and functional capacity testing ,Strategies to enhance exercise adherence, Screening for return to sport, Exercise risk screening and goal setting, Physiological effects of disuse and ageing Injury Prevention & Performance Enhancement. 21st and 22nd of November at AUT Millennium
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.
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RESEARCH PUBLICATIONS
British Journal of Sports Medicine June 2020; Vol. 54, Issue 12 ORIGINAL RESEARCH
Peter B O'Sullivan, JP Caneiro, Kieran O'Sullivan, Ivan Lin, Sam antha Bunzli, Kevin Wernli, Mary O'Keeffe
Efficacy of early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture: an assessorblinded, randomised controlled trial (9 October, 2019)
Why should I test my athletes in the heat several months before Tokyo 2020? (29 February, 2020)
Kristoffer Weisskirchner Swennergren Hansen, Per Tange Kristensen, Anders Troelsen
CONSENSUS STATEMENT
Barfod, Hölmich,
Maria Morten
Risk of knee osteoarthritis after different types of knee injuries in young adults: a population-based cohort study (11 December, 2019) FREE Barbara Snoeker, Aleksandra Turkiewicz, Karin Magnusso n, Richard Frobell, Dahai Yu, George Peat, Martin Englund Spikes in acute:chronic workload ratio (ACWR) associated with a 5–7 times greater injury rate in English Premier League football players: a comprehensive 3-year study (21 February, 2019) Laura Bowen, Aleksander Stephan Gross, Mo Gimpel, Stewart Bruce-Low, FrancoisXavier Li Accuracy of the 2017 international recommendations for clinicians who interpret adolescent athletes’ ECGs: a cohort study of 11 168 British white and black soccer players (5 July, 2019) Aneil Malhotra, Harshil Dhutia, TeeJoo Yeo, Gherardo Finocchiaro, Sabiha Gati, Paulo Buller os, Zephyr Fanton, Efstathios Papatheodorou, Chris Miles, Tracey Keteepe-Arachi, Joyee Basu, Gemma ParryWilliams, Keerthi Prakash, Belinda Gray, Andrew D'Silva, Bode Ensam, Elijah Behr, Maite Tome, Michael Papadakis , Sanjay Sharma EDITORIALS Economic evaluations in ‘non-inferiority’ trials: can costs guide decisions between surgical and non-surgical interventions? (19 December, 2019) Steven M McPhail We are failing to improve the evidence base for ‘exercise referral’: how a physical activity referral scheme taxonomy can help (17 December, 2019) Coral L Hanson, Emily J Oliver, Caroline J DoddReynolds, Paul Kelly Back to basics: 10 facts every person should know about back pain (31 December, 2019)
Sebastien Racinais, Mohammed Ihsan
Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018 (19 December, 2019) FREE Andrea Britt Mosler, Joanne Kemp, Matthew King, Peter R Lawrenson, Adam Semciw, Matthew Freke, Denise M Jones, Nicola C Casartelli, Tobias Wörner, Lasse Ishøi, Eva Ageberg, La ura E Diamond, Michael A Hunt, Stephanie Di Stasi, Michael P Reiman, Michael Drew, Daniel Friedman, Kristian Thorb org, Michael Leunig, Mario Bizzini, Karim M Khan, Kay M Crossley, Rintje Agricola, Nancy Bloom, Hendrik Paul Dijkstra, Damian Griffin, Boris Gojanovic, Marcie Harri s-Hayes, Joshua J Heerey, Per Hölmich, Franco M Impellizzeri, Ara Kassarjian, Kristian Marstrand Warholm, Sue Mayes, Håvard Moksnes, May Arna Risberg, Mark J Scholes, Andreas Serner, Pim van Klij, Cara L Lewis REVIEW Epidemiology of injuries in professional football: a systematic review and meta-analysis (6 June, 2019) Alejandro López-Valenciano, Iñaki Pérez, Alberto Garcia-Gómez, Francisco Garcia, Mark De Ste Croix, D Myer, Francisco Ayala
J
RuizVeraGregory
WARM UP BASEM: leadership in sport and exercise medicine despite our uncertain times (1 June, 2020) FREE Robin Chatterjee, Polly Baker
http://bjsm.bmj.com/content/54/7 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/
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INFOGRAPHIC
