SEPNZ Bulleting December 2018

PAGE

SEPNZ BULLETIN

ISSUE 6. DECEMBER 2018

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best evidence synthesis p9

p8 APP Review: Overall Rating: 5/5

p11 Adductor Strengthening Programme

p18 Use of Cold-Water Immersion as a Recovery strategy in Rugby Union 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 - Bharat Sukha Committee Emma Clabburn Rebecca Longhurst Justin Lopes Visit www.sepnz.org.nz

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

Join us on Facebook

Follow us on Twitter

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

BULLETIN EDITOR Emma Clabburn

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

SPECIAL PROJECTS Karen Carmichael Rose Lampen-Smith 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 mborich@gmail.com

PAGE 3

CONTENTS

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

2

EDITORIAL: By SEPNZ President Blair Jarratt

4

MEMBER BENEFITS: Discounts

6

WINNER: ASICS Education Fund

7

APP REVIEW: Ham Horn

8

CLINICAL REVIEW Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best evidence synthesis. By Pip Sail

9

FEATURE ARTICLES Does an adductor strengthening programme increase adductor strength and prevent adductor-related groin injuries in football? By Rebecca Blyth

11

Use of Cold-Water Immersion as a Recovery strategy in Rugby Union

By Rebecca Peace

18

RESEARCH PUBLICATIONS BJSM Volume 52, Number 23, December 2018

26

CLASSIFIEDS Situations Vacant

28

INVITATIONS Survey of Knowledge Attitudes and Behaviours of physiotherapists to Sports Related Concussion

30

Symposium Registration

31

PAGE 4

EDITORIAL

Hello, And so another year is drawing to a close with this our final bulletin for 2019. It has been a big year for our group with the changing of the guard from Hamish to myself, and there is plenty of work to get through with the change to PNZ unified model in our sights in 2019. As a SIG we are proud to announce that we finished this year with 1015 members, which as far as we know is the first time in history that a PNZ SIG has had over 1000 members. So thank you to our members for being part of SEPNZ. Its been another busy couple of months for our executive with our face to face meeting in early November at the Trinity Hotel in Tauranga to check out the venue and prepare for the biannual symposium in March. Justin and I also attended the PNZ leadership day in late November which was a great chance to meet up with the other SIG's, branches and PNZ executive. We are excited to see the role out of the practitioner side of the PNZ website and the new market campaign if you haven't seen it "Don't say oh, say physio". The last bulletin we ran the photo competition for the cover of BJSM and although there wasn't a huge timeline to get entries in, we did receive 12 entries and we will be announcing the winner of this shortly.

In this issue, we focus on and celebrate our students and their enthusiasm for our profession.

This bulletin brings together a mix of our new graduates, and postgraduate students to show that life long learning is alive and well in our profession.

Rebecca Peace a postgraduate student for Otago University contributes to this bulletin with her literature review of the use of cold-water immersion as a recovery strategy in rugby union and she comments on the most beneficial protocol to use with this population. Rebecca Blyth is currently working towards Masters of Sports Physiotherapy at the University of Otago, and her review explores the research behind adductor strengthening for the prevention of groin injuries in footballers with some clinical exercises which would be of benefit to your football players.

Last week Bharat, Justin and Michael from the SEPNZ executive attended the AUT student prize giving for the 4th Year students to award the SEPNZ prize for the best individual contribution in the fields of sports, exercise and recreation to Matthew Weir. Congratulations Matthew!

We never stop learning and every 6 months we offer up the ASICS Education Fund. In August Tom Adams, as part of his PhD at AUT, received this award to assist in his research in shoulder instability. Well done Tom we look forward to your upcoming thesis. The next round for this grant closes in March 2019.

Pip Sail adds an article review on the risk factors for, and prevention of, shoulder injuries in overhead sports. Also, there is an interesting App review from Justin Lopes. I am unsure of its clinical relevance, however, it's a handy app to have and can be used in many different contexts, so it's worth exploring.

For some, this time of the year is used to reflect and make a plan for the year ahead and for others it is just surviving the Christmas parties and getting on holiday with family and friends. From all on the SEPNZ executive, we wish a safe and Merry Christmas and we hope that your plans include a possible trip to Tauranga for our symposium in March. The majority of our program and speakers are confirmed. Please be aware that the early bird rate closes at the end of January for this, for more information please check out our website for the up to date agenda and booking information. Enjoy your summer, and see you in 2019 in Tauranga.

Noho ora mai

Kind Regards Blair Jarratt SEPNZ President

CONTINUED >>

PAGE 5

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

Blair Jarratt SEPNZ President

What role do you play on the exec?

President – I took over this role from Hamish Ashton this year. I started on the executive 5 years ago helping to work on the sports physiotherapy contract that members can download in our resources section of the website and later looked after the website.

Life outside of SEPNZ? My wife Sheree and I have two children - Ashton aged 9 and Pippa aged 7 and we live in Tauranga. I am the codirector of Bureta Physiotherapy in Tauranga with 18 staff, at this time of the year on the weekends the family will be at the beach. All year and when I have some time (usually ridiculously early in the mornings) you will find me out on the mountain bike as we have a pretty good bunch of riders here in Tauranga that get out 3 times a week.

Previous teams worked with / sporting background....and present?

I cut my teeth on sports physiotherapy pretty early on in the piece starting off when I was a Otago student with University Rugby, then more stints in Rugby in Canterbury working with High School Old boys, Sydenham, Canterbury Metro, and finally into Canterbury Rugby. Also while in Canterbury I worked with Canterbury Cricket, and the Canterbury Wizards for a number of years. I toured with NZ U19 Cricket to Australia and then onto the U19 world cup in Dubai. Currently I work with the Mount Surf Life Saving Club who are currently in full swing for the season and also help out with our staff that work with some of the Bay of Plenty's top rugby club’s - Mount Maunganui Rugby and Te Puna Rugby Favourite tune on a roadtrip?

Most of the road trip tunes are pretty dominated by the kids around this time of year, Pippa is pretty relentless at pumping the Christmas carols, however I try to slip a few Dad tunes in. I am enjoying the new rendition of “Africa" by Weezer.

Favourite sporting physiotherapy moment?

Wow….. tough question I’m not sure I have a favourite moment, being part of a winning team is always exciting but in sport there is always winning and losing and good things to take away from both. Working in the management of a team and helping getting players back into what they love doing after significant set backs and injuries is always rewarding.

Favourite/best or worst destination as touring Physio and why?

.

Working in Forsyth Barr Dunedin stadium for the Canterbury and Otago Rugby final was a pleasure as it was pouring down outside but Dubai was a eye opener for a place to Tour.

MEMBER BENEFITS

PAGE 6

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.

Asics Benefits Asics Education Fund http://sportsphysiotherapy.org.nz/members/education/ SEPNZ has funding for Members who wish to attend courses or conferences that are relevant to the field of Sports Physiotherapy for the furtherance of education in Sports Physiotherapy.

It is available twice yearly.

August 31st.

Applications close March 31st and

Objectives of the SEPNZ Education Fund: •

For grants to members of the SEPNZ, a SIG of the NZSP, who wish to attend courses or conferences that are relevant to the field of Sports Physiotherapy for the furtherance of education in Sports Physiotherapy.

•

For grants to members of the SEPNZ who wish to undertake research in fields relevant to Sports Physiotherapy.

•

For such other purposes in the opinion of the majority of the Approval Committee as shall be for the education or benefit of the members of the SEPNZ.

Asics Shoes and Apparel http://sportsphysiotherapy.org.nz/members/asics-information/ Shoes and clothing at members rates.

PAGE 7

ASICS EDUCATION FUND

$1000 Education Fund

WINNER August 2018

Thomas Adams The winning recipient of the above award for August 2018 is Thomas Adams.

The award will assist him on a research project for the successful completion of a PhD through the Auckland University of Technology. Currently Tom is a clinical educator at the AUT Integrated Health Clinic. Tom has satisfied the Education Awards Committee of the criteria for application as per the SEPNZ Education Awards Terms and References.

Tom’s research investigates the relationship between shoulder instability and measures of submaximal force control at the shoulder and aims to add further understanding of recurrent instability following traumatic anterior shoulder dislocation as well as help to contribute to the knowledge base for neuromuscular rehabilitation strategies. This research will be conducted in 3 separate studies concluding in Dec 2020.

Tom will keep SEPNZ aware of his progress and a brief summary of his thesis will be published in the bulletin.

The $1000 fund is available twice a year. The next round of applications closes on 31 March 2019.

Through this fund, SEPNZ remains committed to assisting physiotherapists in their endeavors to fulfil ongoing education in the fields of sports and orthopedic physiotherapy.

All members are encouraged to view the Terms and Conditions and download an application form from the SEPNZ website sportsphysiotherapy.org.nz.

PAGE 8

APP REVIEW

Back to the App...

Your App Review

By Justin Lopes (Back to Your Feet Physiotherapy) It is time for another app review, (there have been complaints there have been too few).

So while you relax over the festive season, perhaps this review will give you reason, to download and use this handy app. (although some of you may think it’s

. But using it

makes me smile...So I push the button once in a while. When words fail me, I have found, to best illustrate how you feel, with a sound, which can be very satisfying, Try it, (I am not lying). Download ‘Ham Horn’ immediately, but please use it judiciously…

HAM HORN Seller: Carrot Creative Size: 7.2 MB Category: Entertainment Compatibility: Requires iOS 10.0 or later. Compatible with iPhone, iPad and iPod touch.

Languages: English Age Rating: Rated 4+ Copyright: © 2013 Carrot Creative, LLC Price: Free

Where to find it: Download from Apple store, or Android Play, Pro’s: • The Sad Trombone makes me happy • The Rap Air Horn makes any tune you are listening to sound cooler and more like a remix.

• You can use the Rap Air Horn while changing stations from The Edge to Classic Hits and tell the kids it’s a new remix • You can record your own ‘Dope Sound” Cons: • I wish I could turn it up louder at times.

• You need to have the app open as sometimes the best opportunities to use the Sad Trombone are missed and doing it 10 seconds later when the timing is not spot on can detract from the effect…

How I use the app:. A little bit sarcastically…We have found it adds a new dimension to our Webex meetings.

Take home message: A fun little app. **Back To The App accepts no responsibility for inappropriate use of Ham Horn. Use wisely!

Overall Rating: 5/5

PAGE 9

CLINICAL REVIEW

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best evidence synthesis Martin Asker,1,2 Hannah L Brooke,3 Markus Walden,4,5,6 Ulrika Tranaeus,1,7 Fredrik Johansson,1,2

Eva Skillgate,1,2 Lena W Holm1,3

British Journal of Sports Medicine 2018;52:1312-1319.doi:10.1136/bjsports-2017-09254

By Pip Sail, PhysioFix

Abstract:

To assess the evidence for risk factors and prevention measures for shoulder injuries and the effect

of primary shoulder injury prevention measures in overhead sports by systemic review.

Shoulder injuries and shoulder pain are substantial problems in overhead athletes. This problem highlights the need for injury prevention strategies. Identifying risk factors and developing injury prevention strategies based on these risk factors are key components for preventing injury in sport.

A common feature of overhead sports is the repetitive use of the shoulder with the hand above the head. There may be sex and age differences as observed in other anatomical sites in other sports8,18,19 and contact sports may be at higher risk.

Biomechanical factors such as shoulder mobility, coordination and poor technique may also be factors.

Overhead sport is defined as a sport in which the athlete, with the forearm/hand , repetitively propels a ball or shuttle against an opponent.

The principle findings from the systematic review were that the studies were of poor quality, the results were inconsistent and most risk factors had only been explored in one study.

Investigating modifiable risk factors, such as biomechanical, physiological,

and

psychological

measures

alongside

modifiable training factors is required to develop successful injury prevention measures. This asks the question whether practitioners should be considering performance and return to play parameters rather than an injury prevention perspective.

CONTINUED >>

PAGE 10

CLINICAL REVIEW

What should the practitioner do?

Practitioners should strive to build their work on evidence-based medicine. This means integrating individual clinical expertise

with

the

best

available

external

clinical

evidence

from

systematic

research. 78

Since there is little evidence to suggest that shoulder screening for injury prevention is effective79 the main purpose should be to evaluate current shoulder status, measure improvements in performance and serve as normative values to attain before return to play after injury.79-81 When the evidence is limited look for position statements and expert panel opinions.77

Conclusions: All investigated risk factors for shoulder injury in overhead ports had limited evidence, and most were non-modifiable (eg,sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.

A full set of references is available on request.

PAGE 11

FEATURE ARTICLE

+

Does an ADDUCTOR STRENGTHENING PROGRAMME INCREASE adductor strength PREVENT adductor-related groin injuries in football?

By Rebecca Blyth (Masters of Sports Physiotherapy Student, Otago University)

Groin injuries are

one of the most prevalent injuries in football accounting for 8-18% of all injuries (Esteve,

Rathleff, Bagur-Calafat, Urrútia, & Thorborg, 2015; Serner et al., 2014). Adductor injuries account for over 60% of groin injuries, resulting in adductor injuries being the second most common injury in football (Ishøi et al., 2016; Jensen et al., 2014). Preventing adductor injuries is crucial in football not only because of the high incidence but also due to the time-loss associated with the injury; 40% of adductor injuries experience more than 28 days absence from football (Ishøi et al., 2016). Several studies have suggested that along with previous adductor injuries and increased age, reduced adductor strength is a risk factor for sustaining an adductor injury while playing football (Engebretsen, Myklebust, Holme, Engebretsen, & Bahr, 2010; Esteve et al., 2015; Ryan, DeBurca, & Mc Creesh, 2014). It has been well documented that specific adductor strengthening programmes show an increase in adductor strength, with increased eccentric strength being of particular importance (Harøy et al., 2017; Ishøi et al., 2016; Jensen et al., 2014).

There is conflicting evidence surrounding whether the increase in adductor strength relates to a reduced injury risk.

The aim of this critical review is to review the risk factors for adductor injuries, to review if adductor strengthening programmes increase adductor strength and explore if increased adductor strength reduces adductor-related groin injuries in football.

Risk Factors Risk factors for adductor injury can be either nonmodifiable or modifiable. The two most significant nonmodifiable risk factors in predicting adductor injury are a previous adductor injury and increased age (Arnason et al., 2004; Engebretsen et al., 2010; Ryan et al., 2014).

*CONTINUED >>

PAGE 12

FEATURE ARTICLE Although previous adductor injuries are a non-modifiable

adductor strength (Esteve et al., 2018). This highlights a

risk factor, as football players having had

link between previous injury and reduced adductor

previous

groin injuries are up to seven times

strength. Although a previous groin injury is the most

more likely to sustain a subsequent

significant risk factor, part of this may be due to

injury (Arnason et al., 2004) it is

inadequate rehabilitation

reasonable

strength when returning to play. Esteve et al. (2018) also

and therefore reduced adductor

found that athletes with current groin pain had a 10% reduction in adductor strength in the adductor squeeze test. to consider primary prevention

This is in line with a study from the Australian football

of

league who showed that adductor strength was reduced

utmost

importance

(Engebretsen et al., 2010).

both before and during the onset of groin pain (Crow et al.,

Weakness

of

the

hip

2010). Considering the weakness could be identified in the

adductor

muscles

is

weeks preceding groin pain or injury it is reasonable to suggest that reduced adductor strength is a measurable and modifiable risk factor (Crow et al., 2010).

In

agreement with these two studies is a meta-analysis that suggested that pain and reduced strength on the considered the

adductor squeeze test was more likely in athletes

most significant modifiable intrinsic risk factor for adductor

injury

(Engebretsen

et

al.,

with hip and groin pain (Mosler, Agricola, Weir,

2010).

Hรถlmich,

&

Engebretsen et al. (2010) carried out a prospective cohort

Crossley,

2015).

study that concluded weak hip adductors increased the risk

An assessor blinded

of groin injury by four times. However, this disagrees with

study

strengthens

a study suggesting that having higher maximal power was

this finding showing that football

more likely to be associated with a groin injury (Arnason

adductor related groin pain had significant eccentric

et al., 2004). The disparity between the two studies results

adductor

is likely due to the difference in measurement methods.

asymptomatic controls (Thorborg et al., 2014).

Engebretsen et al. (2010) used a specific measurement of

blinding of this study is a strength as when using a hand-

isolated adductor strength using hand-held dynamometry

held dynamometer, clinicians may subconsciously adjust

while Arnason et al. (2004) measured power using a squat

the pressure they are applying if they know which

and jump test. Likely due to the increased specificity of

participants are in the pain group versus the control group.

weakness

when

players

compared

to

with matched The

the measurement in Engebretsen et al. (2010), it has been widely accepted in the literature that reduced adductor strength is a risk factor for groin injury (Ryan et al., 2014).

Further supporting the notion that reduced adductor strength is a risk factor for adductor-related groin injuries is a study that measured pre-season adductor strength in those with and without past-season groin pain (Esteve et al., 2018).

This cross-sectional study concluded that

athletes who had more than six weeks of groin pain in the previous football season

had significantly

reduced

The agreement surrounding groin pain reducing adductor strength and adductor weakness increasing injury risk is convincing, the studies discussed above are well-designed cross-sectional

and

cohort

studies

which

provides

clinicians confidence in interpreting the results.

It is

important to understand the risk factors for adductorrelated groin injuries when trying to provide preventative strategies to reduce injury rates. *CONTINUED >>

PAGE 13

FEATURE ARTICLE

Adductor Strengthening Programmes Adductor strengthening programmes have been suggested as a solution to reducing groin injuries as they aim to strengthen the hip adductor muscle group. As football involves eccentric adductor strength during kicking, there has been suggestion that eccentric adduction weakness should be targeted in football injury prevention programmes (Ishøi et al., 2016; Jensen et al., 2014; Thorborg et al., 2014). A study comparing elite football players to matched recreational athletes showed that football players had increased eccentric hip abduction strength, however there was no significant difference in eccentric hip adduction strength (Thorborg, Couppé, Petersen, Magnusson, & Hölmich, 2011). This was a surprising result, but suggests that playing football does not induce eccentric hip adductor strength increases and therefore this is an area that needs to be targeted in off-field training (Thorborg et al., 2011).

There has been good success in using eccentric exercises to reduce hamstring injuries in football (Al Attar, Soomro, Sinclair, Pappas, & Sanders, 2017) but the success of similar eccentric programmes in adductor injuries have not been so extensively researched.

Adductor Strengthening and Increased Adductor Strength

designed

Table 1 above summarises three studies that investigated

the exercise was incorporated into the Federation

the effect of an adductor strengthening programme on

Internationale de Football Association (FIFA) 11+ in place

adductor strength. The three studies reach consensus that

of the Nordic hamstring exercise. The strength increase

performing an 8-week adductor strengthening programme

was much smaller although was still significant and this

does increase adductor strength, although there was

study is particularly relevant as the FIFA 11+ is widely

variation in the strength increases and the adductor

recognised and used by football teams of all levels. The

exercises prescribed. All three studies were randomised

CA exercise targets eccentric strength at the same time as

control trials providing high level evidence. Ishoi et al.

also having isometric and concentric components, Figure 1

(2016) found the largest increase in adductor strength using

shows the CA exercise being performed.

the Copenhagen adductor (CA) exercise, it was a well-

randomised

control

trial

with

excellent

compliance rates. Haroy et al. (2017) used the same CA exercise, however was different to the previous study as

A possible

*CONTINUED >>

PAGE 14

FEATURE ARTICLE reason for the large difference in the strength increase

in adductor strength, similar to that of Ishoi et al. (2016)

despite using the same exercise is the dosage of the

using 8-weeks of elastic band exercises. This study also

exercise programme. Ishoi et al. (2016) used greater sets

asked the athletes to work through a slow and controlled

and repetitions than Haroy et al. (2017) resulting in a

eccentric phase with the bands to target eccentric strength.

difference in the total number of repetitions completed.

The three studies all show that with the use of minimal

This suggests that there is a dose-response correlation with

equipment and simple exercises, it is possible to get a

increased volume of exercise inducing a greater strength

meaningful increase in hip adductor strength.

improvement. Jensen et al. (2014) showed a 30% increase

Adductor Strengthening and Reducing Adductor-related Groin Injuries

having difficulty getting clubs to remain in the trial for its

Table 2 summaries two studies that directly investigated

may not have been completing the prescribed exercises. In

the effect of adductor strengthening on the incidence of

comparison, compliance in the Haroy et al. (2018) study

groin injuries in football players. Both studies showed a

was good and they performed two separate analyses on

reduction in the number of groin injuries, however only

varying levels of compliance. They found that increased

one of the studies reached statistical significance. Both

compliance led to a greater reduction in injury risk, in

studies were of good methodological design with a large

agreement with the dose-response relationship discussed

sample size and randomisation protocols. The two studies

above; those with excellent compliance almost halved their

differed significantly in their intervention programme.

injury risk, however both groups reached significance.

Haroy et al. (2018) used the CA exercise or suitable

The compliance rates are likely due to having only one

regressions exclusively in comparison to Holmich, Larsen,

exercise which is easy for the athlete to perform. It may be

Krogsgaard, & Gluud (2010) which asked the athletes to

seen as isolating to adductor related groin injury only, but

complete six different exercises targeting the adductors,

as this accounts for the majority of all groin injuries, it is

core strength and coordination.

The 31% reduction in

the most important area to address (Harøy et al., 2018).

injuries in the Holmich et al. (2010) study seems a large

Along with the excellent compliance rates, Haroy et al.

reduction but didn’t reach significance. This is due to

(2018) implemented the strengthening programme in the

basing the sample size on a 50% injury reduction rate and

entirety. Coaches were asked to supervise the players, however there was no direct measure of compliance, this is a potential reason significance was not met as the players

*CONTINUED >>

PAGE 15

FEATURE ARTICLE preseason to gain a strength effect before injury counting

state that adductor strengthening prevents injury, they all

in the competition started.

This early implementation

hypothesised with the increased adductor strength there

would appear to have had significant benefit in reducing

would be a reduction in adductor-related groin injuries.

the rate of injuries.

This was a reasonable hypothesis to make considering the evidence discussed in the risk factor section where

Although the studies discussed in Table 1 did not directly measure the injury rates and therefore cannot explicitly

Discussion adductor-related groin injuries. There is also convincing evidence that current adductor pain is a risk factor for adductor injuries in several kicking dominant sports. The studies tabled above show the benefits of using an adductor strengthening programme to increase adductor strength and prevent adductor-related groin injuries in football. This evidence is echoed in other sports with a high prevalence of groin injuries, such as ice hockey. ice hockey

related groin pain, and those with adductor weakness were more likely to sustain an adductor injury.

A common discussion among the articles used in this

Eccentric adductor weakness is a modifiable risk factor for

professional

adductor weakness was shown in players with adductor-

A study of

players identified

reduced

adductor strength as a risk factor for injury and found that an adductor strengthening programme had a preventative effect on the rate of groin injuries (Tyler, Nicholas, Campbell, Donellan, & McHugh, 2002).

review was the reduced eccentric adductor strength in footballers and the use of eccentric exercises in strengthening and prevention programmes. The adductor longus tendon complex is put under high levels of eccentric stress during football, particularly while kicking (Jensen et al., 2014). Decreased eccentric adductor longus strength may compromise the energy absorption of the tendon and leave it more vulnerable to injury with increased stress at the adductor longus insertion (Thorborg et al., 2014). As previously mentioned, eccentric training has proven effective in increasing eccentric hamstring strength and reducing hamstring injuries in football (Al Attar et al., 2017). There has also been research to show that a rehabilitation programme including eccentric *CONTINUED >>

PAGE 16

FEATURE ARTICLE adductor exercises has proven effective in the management

included all have been youth and adult male players,

of adductor-related groin pain (Hölmich et al., 1999).

therefore generalisability to female and children playing

Until the Haroy et al. (2018) study there was no significant

football remains unknown.

evidence that adductor strengthening prevented adductor

players do have the highest prevalence of groin injuries,

injuries in football players. There has been great success

hence the use of this population in the studies reviewed.

However, male football

in the implementation of the FIFA 11+ programme worldwide and through all levels of football.

This

programme is effective in preventing injuries in football (Gomes Neto et al., 2017) however there is no exercise

Conclusion

included which targets eccentric adduction strength in the

There is consensus in the literature that adductor-related

FIFA 11+ model. This has been identified as a gap in the

groin injuries are highly prevalent in football and first line

warm up and training programme, with the suggestion of

prevention is crucial due to the time-loss associated with

the CA exercise to be added to the FIFA 11+ to target the

the injury and the high rate of re-injury. There is evidence

prevention of adductor-related groin injuries (Harøy et al.,

to suggest that eccentric hip adductor weakness is

2017).

prevalent in football players. A strengthening programme consisting of eccentric adductor exercises has proven to

An obvious theme throughout the studies included in this

increase eccentric adductor strength and reduce the rate of

review was the use of the CA exercise. The CA exercise

adductor-related groin injuries in football players. The CA

has excellent clinical applicability being a partner exercise

exercise has shown success and is a promising exercise for

that requires no equipment and can be completed on the

the prevention of groin injuries as it can easily be

training pitch. Several of the studies also reported that

performed pitch side or as part of the FIFA 11+

there was no associated harm or risk when performing the

programme.

CA exercise during their studies (Harøy et al., 2018; Harøy et al., 2017; Ishøi et al., 2016).

An electromyography

(EMG) study found that the CA exercise, band adduction and the adduction machine were all considered high intensity adductor exercises with high EMG activity of adductor longus and an eccentric component (Serner et al., 2014).

Considering the eccentric adduction weakness

highlighted in football players, these exercises are potentially the best exercises to use for injury prevention (Serner et al., 2014). This hypothesis has been proven by studies showing the use of the CA exercise and band exercises have increased eccentric adductor strength and had an effect on the reduction of adductor related groin injuries (Harøy et al., 2018; Harøy et al., 2017; Ishøi et al., 2016; Jensen et al., 2014).

The findings of this review do have some limitations, with the main one being the populations studied.

Although

there has been a variety of levels of football players *REFER TO REFERENCES ON NEXT PAGE >>

PAGE 17

FEATURE ARTICLE

References Al Attar, W. S. A., Soomro, N., Sinclair, P. J., Pappas, E., & Sanders, R. H. (2017). Effect of injury prevention programs that include the Nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports Medicine, 47(5), 907-916. doi:10.1007/s40279-016-0638-2 Arnason, A., Sigurdsson, S. B., Gudmundsson, A., Holme, I., Engebretsen, L., & Bahr, R. (2004). Risk factors for injuries in football. The American Journal of Sports Medicine, 32(1), 5-16. doi:10.1177/0363546503258912 Crow, J. F., Pearce, A. J., Veale, J. P., Vanderwesthuizen, D., Coburn, P. T., & Pizzari, T. (2010). Hip adductor muscle strength is reduced preceding and during the onset of groin pain in elite junior Australian football players. Journal of Science and Medicine in Sport, 13(2), 202-204. doi:10.1016/j.jsams.2009.03.007 Engebretsen, A. H., Myklebust, G., Holme, I., Engebretsen, L., & Bahr, R. (2010). Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. The American Journal of Sports Medicine, 38(10), 2051-2057. doi:10.1177/0363546510375544 Esteve, E., Rathleff, M. S., Bagur-Calafat, C., Urrútia, G., & Thorborg, K. (2015). Prevention of groin injuries in sports: a systematic review with meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 49(12), 785-791. doi:10.1136/bjsports-2014-094162 Esteve, E., Rathleff, M. S., Vicens-Bordas, J., Clausen, M. B., Hölmich, P., Sala, L., & Thorborg, K. (2018). Preseason adductor squeeze strength in 303 Spanish male soccer athletes: a cross-sectional study. Orthopaedic Journal of Sports Medicine, 6(1), 1-8. doi:10.1177/2325967117747275 Gomes Neto, M., Conceição, C. S., de Lima Brasileiro, A. J. A., de Sousa, C. S., Carvalho, V. O., & de Jesus, F. L. A. (2017). Effects of the FIFA 11 training program on injury prevention and performance in football players: a systematic review and meta-analysis. Clinical Rehabilitation, 31(5), 651-659. doi:10.1177/0269215516675906 Harøy, J., Clarsen, B., Wiger, E. G., Øyen, M. G., Serner, A., Thorborg, K., . . . Bahr, R. (2018). The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine, Published Online First: 10 June 2018. doi:10.1136/bjsports-2017098937 Harøy, J., Thorborg, K., Serner, A., Bjørkheim, A., Rolstad, L. E., Hölmich, P., . . . Andersen, T. E. (2017). Including the Copenhagen adduction exercise in the FIFA 11+ provides missing eccentric hip adduction strength effect in male soccer players: a randomized controlled trial. The American Journal of Sports Medicine, 45 (13), 3052-3059. doi:10.1177/0363546517720194 Holmich, P., Larsen, K., Krogsgaard, K., & Gluud, C. (2010). Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scandanavian Journal of Medicine and Science in Sports, 20(6), 814-821. doi:10.1111/j.1600-0838.2009.00998.x Hölmich, P., Uhrskou, P., Ulnits, L., Kanstrup, I.-L., Nielsen, M. B., Bjerg, A. M., & Krogsgaard, K. (1999). Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. The Lancet, 353(9151), 439-443. doi:10.1016/S0140-6736(98)03340-6 Ishøi, L., Sørensen, C. N., Kaae, N. M., Jørgensen, L. B., Hölmich, P., & Serner, A. (2016). Large eccentric strength increase using the Copenhagen adduction exercise in football: a randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 26(11), 1334-1342. doi:10.1111/sms.12585 Jensen, J., Hölmich, P., Bandholm, T., Zebis, M. K., Andersen, L. L., & Thorborg, K. (2014). Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial. British Journal of Sports Medicine, 48(4), 332-338. doi:10.1136/bjsports-2012-091095 Mosler, A. B., Agricola, R., Weir, A., Hölmich, P., & Crossley, K. M. (2015). Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 810-822. doi:10.1136/bjsports-2015-094602 Ryan, J., DeBurca, N., & Mc Creesh, K. (2014). Risk factors for groin/hip injuries in field-based sports: a systematic review. British Journal of Sports Medicine, 48, 1089-1096. doi:10.1136/bjsports-2013-092263 Serner, A., Jakobsen, M. D., Andersen, L. L., Hölmich, P., Sundstrup, E., & Thorborg, K. (2014). EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. British Journal of Sports Medicine, 48(14), 1108-1114. doi:10.1136/bjsports-2012091746 Thorborg, K., Branci, S., Nielsen, M. P., Tang, L., Nielsen, M. B., & Hölmich, P. (2014). Eccentric and isometric hip adduction strength in male soccer players with and without adductor-related groin pain: an assessor-blinded comparison. Orthopaedic Journal of Sports Medicine, 2(2), 1-7. doi:10.1177/2325967114521778 Thorborg, K., Couppé, C., Petersen, J., Magnusson, S. P., & Hölmich, P. (2011). Eccentric hip adduction and abduction strength in elite soccer players and matched controls: a cross-sectional study. British Journal of Sports Medicine, 45(1), 10-13. doi:10.1136/bjsm.2009.061762 Tyler, T. F., Nicholas, S. J., Campbell, R. J., Donellan, S., & McHugh, M. P. (2002). The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. The American Journal of Sports Medicine, 30(5), 680-683. doi:10.1177/03635465020300050801

.

Rebecca Blyth, currently working through postgraduate studies at Otago University, having just completed PGCert (Sports Physio) and moving into the PGDip (Sports Phyio) next year. Working in private practice in Drury, South Auckland with a range of sports injuries, workplace injuries and a varied musculoskeletal caseload. Particular interest in sports physiotherapy and sports medicine with experience in football and rugby teams .

PAGE 18

FEATURE ARTICLE

By Rebecca Peace (Bachelor of Physiotherapy Graduate 2015, Otago University)

Introduction With the ever increasing demands of competition scheduling and training loads in team sports such as rugby union, research into optimal recovery strategies is continuing to evolve (Tavares, Smith, & Driller, 2017). One such recovery method is the use of cold-water immersion or ice baths. Cold-water immersion therapy (a form of cryotherapy) by definition is the application of ice or extreme cold to the body to treat injury and/or aid a rugby athlete’s return to sporting performance (Higgins, Cameron, & Climstein, 2013; Stephens et al., 2018).

The aim of this literature review is to investigate the current evidence regarding cold-water immersion as a method of performance recovery by means of its physiological effects and best application technique in rugby union.

*CONTINUED >>

PAGE 19

FEATURE ARTICLE Demands and effects of rugby union

postulated that muscle damage as a result of exercise, in particular damage to fast twitch muscle fibres, may lead to

Rugby union is a high paced game involving full contact

changes in temporal and local muscle recruitment patterns,

collisions, as well as high intensity aerobic and anaerobic

as well as an increase in time required to reach peak

activity with short periods of rest (Garcia, da Mota, &

muscle velocity (Takeda et al., 2014).

Marocolo, 2016; Adamczyk, Krasowska, Boguszewski, & Reaburn, 2016; Barber, John, Brown, & Hill, 2017). Over

The resultant detrimental impact on a rugby athlete’s

the course of a standard rugby season, athletes cycle

performance

through periods of training, game time and recovery

interventions, such as cold-water immersion, to fast track

sessions (Higgins, Climstein, & Cameron, 2013; Higgins,

the athlete’s post-performance recovery (Chow et al.,

Heazlewood, & Climstein, 2011; Higgins, Cameron, &

2017; Barber et al., 2017).

emphasises

the

need

for

in

season

Climstein, 2013). Tight turn around time between each session may not provide the athletes with sufficient time to recovery to pre-session performance levels (Higgins,

Physiological effects of cold application

Cameron, & Climstein, 2012; Barber et al., 2017). As result, accumulative performance stresses on the body may

Cold-water immersion post-exercise produces a variety of

lead to increasing fatigue levels, muscle micro-damage and

local and systemic effects. Firstly, the introduction of cold

muscle soreness, as well as declines in power and

triggers an initial vasoconstriction response in local blood

neuromuscular function (Garia et al., 2016; Adamczyk et

vessels that is shortly followed by vasodilation 2-6 minutes

al., 2016; Higgins et al., 2011; Chow, Yam, Chung, &

later (Adamczyk et al., 2016). Increased filling of blood

Fong, 2017).

vessels via vasodilation and, therefore, the ventricles of the heart,

significantly

changes

systemic

cardiovascular

The most commonly discussed consequence to repeat

parameters (such as stroke volume), promoting blood flow

performance stress in the literature is Delayed Onset

and oxygen delivery to recovering muscles (Adamczyk et

Muscle Soreness which develops in response to muscle

al., 2016; Garia et al., 2016).

tissue micro-damage, inflammation and elevated lactate levels produced by the exercising muscles (Higgins,

Second, application of cold assists in the modulation of

Cameron, & Climstein, 2013; Adamczyk et al., 2016).

local muscle micro-damage. During exercise, core and

Symptoms of delayed onset muscle soreness peak at 24-48

muscle temperatures increase as a result of exertional heat

hours post-exercise and include: pain, muscle soreness and

(Chow et al., 2017). Increase in temperatures promotes

tenderness, loss of muscle power, decreased flexibility and

enzymatic breakdown of muscle fibre structure, shown by

in some cases muscle swelling or oedema (Higgins,

increased blood concentrations of serum creatine kinase

Cameron, & Climstein, 2013; Adamczyk et al., 2016;

(Higgins, Cameron, & Climstein, 2013; Banfi, Melegati, &

Garia et al., 2016).

Valentini, 2007; Adamczyk et al., 2016). In the study by Banfi et al. (2007) it was reported that application of cold-

At a physiological level, a decline in neuromuscular

water immersion in conjunction with active recovery

function occurs as a result of delayed onset muscle

(cycling) significantly reduced serum creatine kinase levels

soreness (Takeda et al., 2014). In a study by Takeda et al.,

post intervention compared to passive recovery (resting at

2014, it was documented that knee extensor force output

room temperature). Similar findings were reported by

activity decreased following eccentric exercise. It was

Barber et al. (2017) where serum creatine kinase *CONTINUED >>

PAGE 20

FEATURE ARTICLE

concentration was significantly blunted 24-48 hours post

perspective that cold therapy, such as cold-water

application of cold-water immersion.

immersion, could be beneficial for the management and/or prevention of delayed onset muscle soreness following a

Heating and its associated metabolic processes may also

rugby session.

impair joint proprioception via changes in somatic sensory input (Chow et al., 2017). In the study by Chow et al.

(2017) it was concluded that the application of cooling,

Cold-Water Immersion Protocols

both at room temperature and with ice, improved postexercise proprioception; as long as cooling was not to

Protocols for cold-water immersion post rugby game or

extreme temperatures.

training vary across the literature. Rugby union is highly demanding of the lower limbs for explosive take offs,

Thirdly, use of cold aids in the reduction of skeletal muscle

running, direction changes and pushing in scrums. As

inflammation post exercise. Locally, cold causes a

shown in Table 1, the majority of research immerses the

decrease in capillary permeability, thus reducing fluid

athlete’s lower limbs to the level of the iliac crest or

diffusion into the interstitial space of the muscle that

superior iliac spine.

causes swelling/oedema (Barber et al., 2017). A decrease in capillary permeability reduces inflammatory cell

The most common protocol used an immersion depth to

infiltration, thereby lessening the muscle cell breakdown

the superior iliac spine, a temperature range of 10-12°C

that causes muscle micro-trauma (Higgins, Climstein, &

and a time of two sets of 5 minutes with a 2.5 minute rest

Cameron, 2013; Adamczyk et al., 2016; Barber et al.,

between. All included studies that used the temperature

2017; Tavares et al., 2018).

range of 10-12°C, demonstrated beneficial findings in support of cold-water immersion.

Fourthly, cooling assists in modulation of neural pathways and the sensation of pain. As previously discussed, cold

Immersion temperatures range from 5°C to 15.9°C, with

reduces muscle oedema, therefore decreasing compression

the average temperature being 10.8°C. Stephens et al.

and irritation of skeletal muscle free nerve endings (Barber

(2018) used the highest temperature of 15.9°C and had the

et al., 2017). Likewise, the reduction in local muscle

longest immersion time of 15 minutes. In contrast Chow

temperature reduces receptor sensitivity, nerve conduction

et al. (2017) used the lowest temperature of 5°C but had

velocity, muscle spindle afferent signalling and stretch

the shortest immersion time of 1 minute. This study‘s

reflex responses required for pain production (Adamczyk

findings demonstrated a greater detrimental effect on knee

et al., 2016; Barber et al., 2017; Garia et al., 2016; Chow et

proprioception when compared with room temperature

al., 2017; Tavares et al., 2018). Cold application promotes

water immersion; whether this detrimental effect was as a

improved parasympathetic activity, aiding the return of the

result of the cooler temperature or the short duration of

exercised body to functional and neural homeostasis (Garia

immersion is unknown.

et al., 2016; Stephens et al., 2018).

Three studies used whole body immersion, excluding the Finally, as the symptoms experienced with post-exercise

head. Lindsay, Lewis, Gill, Gieseg, & Draper (2015) and

delayed onset muscle soreness incorporate all of the above-

Takeda et al. (2014) reported inconclusive findings. In

mentioned components, it is plausible from a physiological

comparison, Stephens et al. (2018) demonstrated positive *CONTINUED >>

PAGE 21

FEATURE ARTICLE

effects on recovery only in athletes with a high body fat percentage.

Variability in research findings could be attributed to several factors, including sample size and make up (for example, professional level rugby players verses under 20 year olds), different immersion levels and temperatures, duration and repetition of immersions, as well as the pre and post immersion measurements used (for example, perceived level of soreness verses counter-movement jump or blood creatine levels).

*CONTINUED >>

PAGE 22

FEATURE ARTICLE

Effects of CWI on performance and Muscle Soreness

Physiological measures The effect of cold-water immersion on physiological

Subjective Measures

markers, such as serum creatine kinase, skin and/or core temperature and thigh circumference, gives an objective

The primary outcome measure used across the literature to

measure of effect on the rugby athlete’s physiological

measure the effectiveness of cold-water immersion is an

performance recovery. Minimal to no effect was

athelete’s level of perceived muscle soreness (Higgins,

documented on salvia cortisol levels (Tavares et al., 2018).

Climstein, & Cameron, 2013; Banfi et al., 2007; Barber et

Blood serum creatine kinase recovery varied across the

al., 2017).

All three studies that used the immersion

literature, with several studies reporting faster stabilisation

protocol of 2x5 minutes with a 2.5 minute break, reported

post cold-water immersion (Banfi et al., 2007; Barber et

positive changes in both the athlete’s perceived level of

al., 2017; Tavares et al., 2018) and another reporting no

muscle soreness and delayed onset muscle soreness

effect compared to a control group (Takeda et al., 2014).

symptoms (Higgins, Cameron, & Climstein, 2012; Higgins, Cameron, & Climstein, 2013; Higgins, Climstein,

All studies reported significant reductions in skin

& Cameron, 2013).

temperature compared with contrast therapy and control groups. In the study by Stephens et al. (2018) body

As previously discussed, application of cold has a positive

composition (high fat versus low fat participants) was

physiological effect on the sensation of pain. Given that

applied to the protocol of 15 minutes immersed in 15.9°C.

symptoms of delayed onset muscle soreness peak at 24-48

Given that body fat acts as a heat insulator, decline in core

hours post exercise (Adamczyk et al., 2016), outcome

temperature was significantly higher in low fat individuals

measures for delayed onset muscle soreness need to be

(Stephens et al., 2018).

assessed over this timeframe. Higgins, Cameron, & Climstein (2013) followed rugby athletes over a 48-hour

Thigh circumference, as a measure of skeletal muscle

period post cold-water immersion and reported a

inflammation and oedema, was found to have no

statistically significant finding in regards to pain at 48

statistically

hours. Post cold-water immersion muscle pain scores had

immersion compared to control groups (Higgins, Cameron,

reduced to 13% compared to 20% of baseline in the control

& Climstein, 2013; Tavares et al., 2018).

significant

difference

post

cold-water

group. Webb, Harris, Cronin, & Walker (2013) and Tavares et al. (2018) similarly reported the most beneficial

Due to inconclusive findings of physiological markers for

effects on muscle soreness occurred 18-42 hours post cold-

measurement of beneficial effect, it is not possible to draw

water immersion.

conclusions as to how much skin or core temperature and serum creatine kinase levels need to decrease in order to

Over the course of a heavy training week, a reduction in

aid a rugby athlete’s performance recovery.

perceived muscle soreness resulted in positive effects on a rugby athlete’s perception of fatigue and overall training

Functional Measures

effort (Higgins, Cameron, & Climstein, 2013; Higgins, Climstein, & Cameron, 2013; Takeda et al., 2014; Barber

Finally, sports-specific or functional measures could be

et al., 2017).

used to relate level of recovery to the specific demands of

PAGE 23

FEATURE ARTICLE

rugby. Such measures used across the literature, include

lower limb balance. As mentioned previously, cold alters

vertical jump height, counter-movement jump tests and

mechanorecpetor sensivity and nerve conduction velocity

timed sprints or 50m hop tests. Tavares et al. (2018)

(Chow et al., 2017; Tavares et al., 2018). Therefore, cold

reported a small benefit in recovery of neuromuscular

could potentially effect lower limb joint position sense

function, with a faster recovery of counter-movement jump

(proprioception) and balance required for hopping and

score when compared to passive recovery. Higgins,

jumping functional measures. Chow et al. (2017)

Cameron, & Climstein (2013) made a similar conclusion,

conducted a study investigating this exact theory and

reporting an accelerated return of muscle power when

concluded the cold-water immersion did decrease knee

compared with passive or contrast bath therapy.

joint proprioception to a much greater extent than passive recovery;

In contrast, Garcia et al. (2016) reported no change in

however,

cold

did

not

alter

overall

somatosensory inputs for balance control.

counter-movement jump testing; however, they did note a decline in muscle tests of longer duration (such as a 30

Given

the

accelerated

recovery

of

sport-specific

second vertical jump or continuous hop). Likewise,

neuromuscular function with the use of cold-water

Higgins et al. (2011) and Takeda et al. (2014) described a

immersion on a rugby athlete ’s recovery, it could be

significant detrimental effect on sprint speed during a

concluded that within congested periods of rugby (i.e. less

timed 50m dash.

that 48 hours between sessions), cold-water immersion may aid recovery and performance (Tavares et al., 2018;

Another performance factor that could be influenced by

Higgins, Cameron, & Climstein, 2013).

cold-water immersion is the neuromuscular control of

Clinical application To apply the evidence to practice in the rugby environment, as shown above, several factors need to be taken into account. Firstly, what is the reason for trying to hasten the athlete’s recovery of performance?

What beneficial effect needs to be gained from recovery? Is there concern over muscle power loss or development of delayed onset muscle soreness? What are the individual athlete’s rugby sporting demands and how might their body composition contribute? Taking all of these questions and the current best evidence into account, cold-water immersion should, in theory, have positive physiological and psychological effects. Out of the studies included in this review, the most beneficial protocol for application of cold-water immersion seems to be 2x5 minute intervals with a 2.5 minute break of immersion to the level of the superior iliac spine in 10-12°C water.

If a rugby athlete reports perceived performance enhancements with the use of cold-water immersion, we should not rule it out as a beneficial technique for aiding recovery. To date, the research has not been able to define the most effective balance of temperature, time and technique to ensure cold-water immersion is beneficial for every rugby athlete’s recovery.

PAGE 24

FEATURE ARTICLE

References Adamczyk, J. G., Krasowska, I., Boguszewski, D., & Reaburn, P. (2016). The use of thermal imaging to assess the effectiveness of ice massage and cold-water immersion as methods of supporting post-exercise recovery. Journal of Thermal Body, 60, 20-25. doi: 10.1016/j.jtherbio.2016.05.006 Banfi, G., Melegati, G., & Valentini, P. (2007). Effects of cold-water immersion of legs after training session on serum creatine kinase concentrations in rugby players.

British Journal of Sports Medicine, 41(5), 339.

Barber, S., John, P., Brown, F., & Hill, J. (2017) The efficacy of repeated cold water immersion on recovery of following a simulated rugby union protocol. Journal of Strength and Conditioning Research. Advanced online publication. doi: 10.1519/JSC.0000000000002239 Chow, G. C. C., Yam, T. T. T., Chung, J, W. Y., & Fong, S. S. M. (2017). Effects of postexercise ice-water and room-temperature water immersion on the sensory organisation of balance control and lower limb proprioception in amateur rugby players: a randomised controlled trial. Medicine, 96(7). doi: 10.1097/ MD.0000000000006146 Garcia, C. A., da Mota, G. R., & Marocolo, M. (2016). Cold water immersion is acutely detrimental but increases performance post-12h in rugby players. International Journal of Sports Medicine, 37(8), 619-624. doi: 10.1055/s-0035-1565200 Higgins, T., Cameron, M., & Climstein, M. (2012) Evaluation of passive recovery, cold water immersion, and contrast baths for recovery, as measured by game performance markers, between two simulated games of rugby union. Journal of Strength and Conditioning Research. Advanced online publication. doi: 10.1519/ JSC.0b013e31825c32b9 Higgins, T. R., Cameron, M. L., & Climstein, M. (2013). Acute response to hydrotherapy after a simulated game of rugby. Journal of Strength and Conditioning Research, 27(10), 2851-2860. doi: 10.1519/JSC.0b013e31828151b6 Higgins, T. R., Climstein, M., & Cameron, M. (2013). Evaluation of hydrotherapy, using passive tests and power tests, for recovery across a cyclic week of competitive rugby union. Journal of Strength and Conditioning Research, 27(4), 954-965. doi: 10.1519/JSC.0b013e318260ed9b Higgins, T. R., Heazlewood, I. T., & Climstein, M. (2011). A random control trial of contrast baths and ice baths for recovery during competition in u/20 rugby union.

Journal of Strength and Conditioning Research, 25(4), 1046-1051. doi: 10.1519/JSC.0b013e3181cc269f Lindsay, A., Lewis, J., Gill, N., Gieseg, S. P., & Draper, N. (2015). Effect of varied recovery interventions on markers of psychophysiological stress in professional rugby union. European Journal of Sport Science, 15(6), 543-549. doi: 10.1080/17461391.2015.1029982 Stephens, J. M., Halson, S. L., Miller, J., Slater, G. J., Chapman, D. W., & Askew, C. D. (2018). Effect of body composition on physiological responses to cold-water immersion and the recovery of exercise performance. International Journal of Sports Physiology and Performance, 13(3), 382-389. doi: 10.1123/ijspp.2017-0083 Takeda, M., Sato, T., Hasegawa, T., Shintaku, H., Kato, H., Yamaguchi, Y., & Radak, Z. (2015). The effects of cold water immersion after rugby training on muscle power and biochemical markers. Journal of Sports Science and Medicine, 13(3), 616-623.

Tavares, F., Beaven, M., Teles, J., Baker, D., Healey, P., Smith, T. B., & Driller, M. (2018). The effects of chronic cold water immersion in elite rugby players.

International Journal of Sports Physiology and Performance. Advanced online publication. doi: 10.1123/ijspp.2018-0313 Tavares, F., Smith, T. B., & Driller, M. (2017). Fatigue and recovery in rugby: a review. Sports Medicine, 47(8), 1515-1530. doi: 10.1007/s40279-017-0679-1 Webb, N. P., Harris, N. K., Cronin, J. B., & Walker, C. (2013). The relative efficacy of three recovery modalities after professional rugby league matches. Journal of Strength and Conditioning Research, 27(9), 2449-2455. doi: 10.1519/JSC.0b013e31827f5253

Rebecca Peace graduated from The University of Otago with a Bachelor of Physiotherapy in 2015. This review was completed as partial requirements for the PHTY542 Sports Physiotherapy paper, University of Otago.

Rebecca is currently employed in a musculoskeletal private practice in Invercargill, NZ.

PAGE 25

PAGE 26

RESEARCH PUBLICATIONS

British Journal of Sports Medicine December 2018; Vol. 52, No. 23 Treatment after traumatic shoulder dislocation: a systematic review with a network metaanalysis Lauri Kavaja, Tuomas Lähdeoja, Antti Malmivaara, Mika Paavola Consensus statement Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement Martina Zügel, Constantinos N Maganaris, Jan Wilke, Karin Jurkat-Rott, Werner Klingler, Scott C Wearing, Thomas Findley, Mary F Barbe, Jürgen Michael Steinacker, Andry Vleeming, Wilhelm Bloch, Robert Schleip, Paul William Hodges Original research Internal workload and non-contact injury: a oneseason study of five teams from the UEFA Elite Club Injury Study Alan McCall, Gregory Dupont, Jan Ekstrand

Commentary Hamstring injuries are increasing in men’s professional football: every cloud has a silver lining?

Cristiano Eirale Infographics Infographic. Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention Matthew N Bourne, David Pope, Steven J Duhig, Ryan G Timmins, Morgan D Williams, Aiman Al Najjar, Graham K Kerr, Anthony J Shield Infographic: Helping athletes make decisions on dietary supplement use Ronald John Maughan

Modelling the process of falling behind and its psychophysiological consequences Andreas Venhorst, Dominic Micklewright, Timothy D Noakes Bright Spots Editorials So you think you can return to sport?

Trevor A Lentz, Mark V Paterno, Jonathan C Riboh Nutrition and oral health in sport: time for action Ian Needleman, Paul Ashley, Tom Fairbrother, Peter Fine, Julie Gallagher, Daniel Kings, Ronald John Maughan, Anna Katarina Melin, Michael Naylor

Bright spots, physical activity investments that work: Vitality Active Rewards—a smartphone app that incentivises programme members to be physically active Deepak N Patel, Craig Nossel, Jon Patricios, Joel Maboreke

Leadership in physical activity: is this the currency of change in the student healthcare curriculum?

Ann Bernadette Gates, Ian K Ritchie, Fiona Moffatt, João Breda Tackling doping in sport: a call to take action on the dopogenic environment Susan H Backhouse, Claire Griffiths, Jim McKenna

http://bjsm.bmj.com/content/52/15 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/

PAGE 27

COURSE

PAGE 28

SITUATIONS VACANT

Wellington-New Graduate/ Experienced Physiotherapist A full time Physiotherapist position is available starting end of January 2019 in Wellington.

This is a busy local private practice where we treat a wide range of musculoskeletal conditions.

You would work alongside two experienced Physiotherapists, part-time physiotherapists and some new graduates.

We offer extensive in service training and new graduate mentoring.

New graduates have extended appointment times as we encourage learning and quality treatment at all times.

Excellent remuneration including allowance for professional development.

Forward CV to thejvillephysio@xtra.co.nz attn. Liz Bergin or Sharon Gold

Are you a Sports Physiotherapist looking to move to Tauranga or make a change?

This is an excellent opportunity to work with one of the Bay of Plenty’s top rugby teams in a Physiotherapy clinic renowned for creating opportunities to move into higher sports physiotherapy roles with strong links to High Performance Sport New Zealand.

For over fifteen years Bureta Physiotherapy has been providing the highest quality physiotherapy to a wide variety of “every day” patients to elite athletes with a focus on overall health and wellness. Bureta Physiotherapy works with two of the strongest Rugby clubs in the bay, the most successful surf club in New Zealand and other National and International athletes all just minutes from Tauranga CBD and beautiful beaches.

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 postgraduate and Masters qualified physiotherapists, a team of therapeutic massage therapists, an excellent reception team along with close links to local Sports Medicine Doctors and Specialists. The successful applicant will receive on-going support as part of our strong mentoring program along with an allowance for CPD to assist with postgraduate study/courses and conferences.

Start date is negotiable but ideally Jan 2018. We are looking for an enthusiastic, hard-working sports physiotherapist with excellent communication skills, an interest in gym based rehab and a strong desire to learn and enhance their clinical skills as well as build their reputation as a high-quality physiotherapist.

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

PAGE 29

SITUATIONS VACANT

SEPNZ EDUCATION COMMITTEE Expressions of Interest Expressions of Interest to join the SEPNZ Education Committee are now open.

SEPNZ is committed to providing sustainable, quality, robust Sports Physiotherapy Education Pathway that aligns with, and stands up to assessment against, the International Federation Sports Physiotherapy (IFSPT) competencies.

If education in Sports Physiotherapy is a passion of yours and you believe that you have something to offer the SEPNZ Education Committee that could help us to overcome barriers in the delivery of quality Sports Physiotherapy Education with our courses, please send your CV and letter outlining; why you wish to apply, what you offer and how you would look to implement your ideas to help the ongoing review and improvements that we are committed to making within the SEPNZ Education Committee to:

SEPNZ BULLETIN EDITOR The SEPNZ Bulletin is a show piece for publications for physiotherapy 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 • Choose an article to be reviewed for publication • Skills needed are basic time management and a

computer

becsvw@hotmail.com.

Further details on request Contact Michael Borich mborich@gmail.com

PAGE 30

SURVEY INVITATION

Dear Physiotherapist, Sport related concussion is a very topical area right now with significant media coverage. Physiotherapist are often at the forefront of the side line an ongoing management of this condition yet there is not lot of research into physiotherapists knowledge attitudes and behaviours of sports related concussion.

It would be great to see what the profession doing in this area.

Thank-you for considering the invitation to complete the above-named survey. We realise this survey is coming out at a busy time of year, but we hope you can find 10 minutes in your day to complete this.

If you are keen to participate, please click on the link below or copy the link into your internet browser.

The survey is anonymous and voluntary.

https://www.surveymonkey.com/r/G2ZXMGQ Prof Duncan Reid

On behalf of the ACC Concussion research team

PAGE 31

INVITATION