SPNZ Newsletter April 2012 by Sports & Exercise Physiotherapy NZ

Page

BULLETIN

ISSUE 2 l APRIL 2012

View the SPNZ Bulletin online in flip-format http://issuu.com/sportsphysiotherapynz

Welcome to the April 2012 edition of the SPNZ Bulletin.

SPNZ EXECUTIVE COMMITTEE President

Angela Cadogan

Secretary

Michael Borich

Treasurer

Dr Gisela Sole

Website

Hamish Ashton

Committee

Dr Tony Schneiders Bharat Sukha Jim Webb David Rice

EDUCATION SUB-COMMITTEE Dr Gisela Sole Chelsea Lane Jim Webb

David Rice Dr Grant Mawston

EDITORIAL ASSISTANT Aveny Moore

SPECIAL PROJECTS Monique Baigent

Kate Polson

Nathan Wharerimu

Karen Carmichael

Amanda O’Reilly

Deborah Nelson

Helene Barron

ADVERTISING Advertising terms & conditions click here.

LINKS Sports Physiotherapy NZ Asics Apparel and order form

It was great to see many of you at the SPNZ Symposium “Prevention, Practice, Performance” held in Tauranga last month. The symposium was well attended with 230 in attendance, and was well supported by our trade sponsors Formthotics, Auckbritt, USL Ltd, Gensolve, Pilates Progress and St Johns. Our keynote speaker, Dr Jill Cook, presented an outstanding blend of clinically relevant information regarding the assessment and management of tendinopathy that was well supported by current research evidence. Jill was accompanied by a range of other invited speakers who delivered high quality presentations on a range of topics. For those who attended the symposium and completed the online survey, copies of all speakers presentations are available to you. Thank you for your valuable feedback, we will take this on board as we continually strive to improve the quality, delivery and value of our biennial symposiums. At the SPNZ AGM (held on Sunday 18th March), Dr Tony Schneiders stepped down as President. Tony has made a significant contribution to SPNZ that has resulted in the group to becoming one of the largest Special Interest Groups of PNZ, with what is now a growing and extremely capable team of executive, subcommittee and volunteer members. At this meeting, I was elected President of SPNZ for the next twoyear term and my background can be found on the following page. Tony will continue to serve on the SPNZ Executive, and in his position as Board member of the International Federation of Sports Physical Therapy (IFSPT), Tony will act as the SPNZ representative to the IFSPT. At the AGM, Mark Cartman also stepped down from the SPNZ Executive after serving as Treasurer and made a valuable contribution to SPNZ. David Rice was elected to replace Mark on the Executive. More about David’s background is also included on the following page.

McGraw-Hill Books and order form

CONTINUED ON NEXT PAGE….

Asics Education Fund information Physiotherapy NZ IFSPT JOSPT

INSIDE:



Article Review: Fostering Adherence to Injury Preventive Exercise Recommendations in Young Athletes

26 Vine St, St Marys Bay



Latest Research

Auckland



Courses and Conferences

mborich@ihug.co.nz



Positions available

Michael Borich (Secretary)

and MORE…

Page 2

We also have a growing group of Special Projects Team volunteers. Thanks to our long-serving members Monique Baigent, Nathan Wharerimu and Amanda O’Reilly, and our most recent additions, Karen Carmichael, Kate Polson, Debs Nelson and Helene Barron, we can continue to provide a wide range of clinical and research information in each edition of the SPNZ Bulletin. We are always looking for willing volunteers, so if you are able to spare some time (a little or a lot!) we would be very pleased to hear from you. We also welcome feedback about the Bulletin, or any other aspects of SPNZ you would like to bring to our attention. We hope you enjoy this edition of the SPNZ Bulletin. SPNZ Executive

SPNZ EXECUTIVE CHANGES SPNZ PRESIDENT As the SPNZ Bulletin Editor, I also find myself in the unusual position of also having to introduce myself as the new President of SPNZ! I am a sports and manipulative physiotherapist currently based in Christchurch. After graduating from AIT in 1990, I worked with a number of club rugby and provincial rugby teams, as well as the Auckland Rugby League Team. In 1998 I completed the Diploma in Manipulative Therapy (Dip MT) and in completed a Masters Degree in Sports Physiotherapy at Curtin University in Perth, Western Australia in 2000. After returning to NZ I worked as the NZ Cricket White Ferns Physiotherapist for 8 years, as well as travelling with the NZ ‘A’ mens cricket team for 4 years, and was the stand-in physiotherapist for the NZ Black Caps for several of their domestic tours. During this time I was also the Sports Medicine and Science Coordinator for NZ Women’s Cricket, was the physiotherapist for the World XI cricket team that toured NZ in 2007 and also worked as a team physiotherapist for the Ahmedabad Rockets in the Indian Cricket League. In February 2012 I completed my PhD investigating clinical and diagnostic imaging predictors of painful shoulder conditions, and was part of the review panel for the recently published ACC Guidelines for Imaging of Shoulder Disorders in Primary Care. I currently work part-time in private practice in Christchurch and am working on some short-term research contracts for AUT University. I also assist on the NZMPA course weekends and am an independent reviewer for the Health and Disability Commission. I am honoured to have been elected to the position of SPNZ and look forward to the next two years in what is shaping up to be an exciting time for both SPNZ and for the physiotherapy profession.

SPNZ EXECUTIVE MEMBER We welcome David Rice who was elected onto the SPNZ executive at the 2012 AGM. David is a lecturer and senior research officer at AUT University, and is also a pain neurophysiologist working in the Pain Management unit at North Shore Hospital in Auckland. David has almost completed his PhD investigating “Neural mechanisms and treatment of quadriceps arthrogenic muscle inhibition following knee joint injury, surgery and pathology”. David has a particular interest in the neuromuscular consequences and rehabilitation of knee injury and pathology, pain mechanisms and pain management. David presented some of his work at the SPNZ Symposium held last month in what was an excellent presentation. We wish him well for the final stages of his PhD submission and examination process. As well as being elected to the SPNZ Executive, David is also on the SPNZ education sub-committee and there is no doubt he will be a great addition to the team.

IN THIS EDITION

Page 3

To locate a page quickly, click on the ’pages’ symbol at the top of the pdf reading panel at left of screen and select the required page.

LATEST NEWS

Page 4

SPNZ Symposium: Prevention, Practice, Performance. Sebel Trinity Wharf Hotel, 17th & 18th March 2012. The 2nd SPNZ Symposium went well and we were pleased to see so many of you there. Thanks especially to the presenters, who provided high quality and very clinically based information on a range of topics. Thanks to all of you who filled out the symposium survey. The Executive are currently going through the feedback which will be used to continually improve the quality and value for money for our next symposium in 2014. We will advise details of this closer to the time.

Changes to the SPNZ Executive New President and executive committee member elected. At the SPNZ AGM (19th March 2012), Angela Cadogan was elected President of SPNZ, taking over from Dr Tony Schneiders. David Rice was also elected to the SPNZ Executive to replace Mark Cartman who also stepped down after serving extensively in his role on the Executive. More about Angela and David can be found on Page 2.

Differential Diagnosis of Adolescent Conditions—Clinical Resource An attachment is included with this edition of the SPNZ Bulletin covering many adolescent conditions seen in practice. You can download or print this resource by clicking on the file attachment. A copy can also be downloaded from site.

at the bottom left of your screen and double click on the “Resources” in the members section on the SPNZ web-

SPNZ Member Benefits Remember to take advantage of the full range of SPNZ member benefits: 

FREE online access to JOSPT (value approx USD$275)



FREE Editions of the Quarterly APA “Sports Physio” Magazine



25% Discount on all McGraw-Hill book publications



Funding Support for continuing education and research (Asics Education Fund).



Substantial discount, Advanced Notice and preferential placing on SPNZ Educational Courses.



Access to website with clinical and relevant articles.



Sports Physiotherapy Forum to discuss ideas and ask questions



Bi-monthly NZSOPA Bulletin featuring Activity, Course and information updates.



FREE classified advertising in the NZSOPA Bulletin

International Journal of Sports Physical Therapy - Individual Subscriptions Available The IJSPT journal is available to purchase for individual members. SPNZ members interested in subscribing to this journal can purchase an individual subscription through the journal directly. To purchase a subscription go to the IJSPT website, and click on “subscriptions”. Subscription rate for 2012 is €20. To view contents of the current issue click here.

Page 5

SPNZ SYMPOSIUM 2012

PREVENTION, PRACTICE, PERFORMANCE Held at the Sebel Trinity Wharf Hotel, Tauranga March 17th and 18th 2012

Keynote Speakers

Dr Jill Cook

Mr Mat Brick

Dr Ben Speedy

Workshops

Richard van Plateringen—Podiatry

Pete Gallagher—Functional Movement Screen

Page 6

CLINICAL SECTION ARTICLE REVIEW Are We Having Fun Yet? Fostering Adherence to Injury Preventive Exercise Recommendations in Young Athletes Melanie R Keats, Carolyn A Emery, Caroline F Finch ABSTRACT

Sport and recreational activities are the leading cause of injury in youth, yet there is increasing evidence that many sport -related injuries are preventable. For injury prevention strategies to be effective, individuals must understand, adopt and adhere to the recommended prevention strategy or programme. Despite the recognized importance of a behavioural approach, the inclusion of behavioural change strategies in sport injury prevention has been historically neglected. The purpose of this commentary is to outline the rationale for the inclusion and application of behavioural science in reducing the burden of injury by increasing adherence to proven prevention strategies. In an effort to provide an illustrative example of a behavioural change approach, the authors suggest a specific plan for the implementation of a neuromuscular training strategy to reduce the risk of lower limb injury in youth sport. Given the paucity of evidence in the sport injury prevention setting, and the lack of application of theoretical frameworks to predicting adoption and adherence to injury preventive exercise recommendations in youth sport, data from the related physical activity promotion domain is utilized to describe how sound, theory-based injury prevention exercise interventions in youth may be developed. While the question of how to facilitate behavioural change and optimize adherence to preventive exercise recommendations remains an ongoing challenge, the authors detail several strategies based on two prominent behavioural theories to aid the reader in conceptualizing, designing and implementing effective interventions. Despite the minimal application of behavioural theory within the field of sport injury prevention in youth, behavioural science has the potential to make a significant impact on the understanding and prevention of youth sport injury. Appropriate evaluation of adherence and maintenance components based on models of behavioural change should be a critical component of future injury prevention research and practice. Reference: Sports Medicine (2012); 42 (3): 175-184

Introduction

programme with regards to injury prevention.

We promote physical activity and sporting activities to our developing youth to enhance health and well being. The associated sporting injuries although non life threatening, have negative consequences which can be significant and can result in pain, disability, activity restriction, social and sporting isolation.

Theory of Planned Behaviour (TPB) highlights socialcognitive influences on youth behaviour. Motivation comes from attitude to activity, reinforcement from those important to the child and perceived behavioural control (e.g. confidence and skill to perform the required activity). Here if a child believes the activity is fun, believes that peers, family, coaches endorse the activity and believes that the skills and resources are available for them to partake motivation will be influenced.

Educational programmes, rule changes and modifications, adherence to rules and conditioning programmes have all been shown to have some effectiveness in reducing/ preventing youth injuries. Recently the benefit of improved proprioception and sensorimotor abilities through exercise based neuromuscular training programmes has shown some promise and growing support for prevention of injuries in adolescent. The challenge presented is optimizing this effect by adherence to such ideas and programmes. Studies have shown 12-38% reduction and yet adherence to such programmes has been reported as poor. This paper looks at the role of behavioural theory in neuromuscular training programmes, what behavioural strategies can be adopted to ensure motivation to adherence with the programme.

Behavioural Theory Two theories were explored and integrated to enable the reader to develop tailored interventions for their situation and fully maximize the benefit of a neuromuscular training

Self Determination Theory (SDT), 3 basic psychological needs regulate behaviours, autonomy, competence and relatedness. SDT focuses around a motivational continuum with relative degrees of autonomy from intrinsic/ autonomy â&#x20AC;&#x201C; extrinsic/controlling. Complementing the TPB, SDT focuses on behaviours which are freely chosen and intrinsically motivated, reflecting motivation to perform an activity for its own sake. Adherence is therefore obviously a multifaceted model which ideally requires a team approach involving physiotherapists, trainers/coaches, parents and potentially a role model who has previously sustained such an injury. Physiotherapists play a vital role in education, to ensure a thorough understanding of the rationale behind the activity, assistance with skill enhancement to increase their confidence and performance. The physiotherapists have expe-

CLINICAL SECTION

Page 7

ARTICLE REVIEW CONTINUED ... rience with sporting injuries and can pass on knowledge of the long term affect they may have. Clinically objective measures testing can be a valid tool in promoting adherence and maintenance with players seeing progress in assessment results adding to the credibility of the neuromuscular programme. With implementing such strategies physiotherapists can influence attitude, perceived behavioural control, competence and relatedness.

Conclusion This multifaceted model can empower the individual allowing them to take an active role in their own injury prevention. Through attitude, perceived behavioural control, competence and relatedness the motivation of a child can be influenced. Reinforcement from coaches and family will only strengthen the adherence. The most appropriate framework will ultimately depend on its specific application. Physiotherapists need to consider behavioural factors in the design and delivery of injury prevention programmes and ongoing evaluation of adherence to maximise outcomes.

SPNZ is now on Facebook

Check us out at:

www.facebook.com/SportsPhysiotherapyNZ

Website Gems Links to Video clips Online interviews of interest

Page 8

RESEARCH SECTION JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY

April 2012; Volume 42, Issue 4

www.jospt.org

Click on the article title for a direct link to the abstract

Lumber Computerized Adaptive Test and Modified Owestry Low Back Pain Disability Questionnaire: Relative Validity and Important Change Dennis L. Hart, Paul W. Stratford, Mark W. Werneke, Daniel Deutscher, Ying-Chih Wang

Comparative Analysis of the Structural Properties of the Collateral Ligaments of the Human Knee William T. Wilson, Angela H. Deakin, Anthony P. Payne, Frederic Picard, Scott C. Wearing

Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain Pavel Kolar, Jan Sulc, Martin Kyncl, Jan Sanda, Ondrej Cakrt, Ross Andel, Kathryn Kumagai, Alena Kobesova

Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Soccer Mario Bizzini, Dave Hancock, Franco Impellizzeri

Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: Basketball Eric Waters

Suggestions From the Field for Return-to-Sport Rehabilitation Following Anterior Cruciate Ligament Reconstruction: Alpine Skiing Dirk Kokmeyer, Michael Wahoff, Matt Mymern

Suggestions From the Field for Return to Sports Participation Following Anterior Cruciate Ligament Reconstruction: American Football Mark Verstegen, Susan Falsone, Russell Orr, Steve Smith

Low Back Pain: How Does Your Physical Therapist Treat Low Back Pain? Low Back Pain: Do the Right Thing and Do It Now John D. Childs, Timothy W. Flynn, Robert S. Wainner

The Challenge of Return to Sports for Patients Postâ&#x20AC;&#x201C;ACL Reconstruction Guy G. Simoneau, Kevin E. Wilk

Low Back Pain Anthony Delitto, Steven Z. George, Linda R. Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Jo-

RESEARCH SECTION

Page 9

RESEARCH REVIEWS Register (FREE) and download the latest “NZ Research Reviews”

http://researchreview.co.nz

· Why reorganise?

· Clinicians ’ attitudes influence their recommendations

· Becoming en-wheeled

for low back pain

· Humans and wheelchairs: a mutual shaping

· Pain is taken less seriously when you dislike a patient

· Goal setting after acquired brain injury

· Nonclinical factors influence decision-making for low

· Assessment and outcome measurement in PRM · Running injuries: trends and demographics

back pain · Capsaicin 8% patch for peripheral neuropathic pain · Pain education helps oncology patients · TMS reduces fibromyalgia pain · Higher prevalence of musculoskeletal disorders among spine surgeons

· Rising medical practice costs · Intracompartmental pressure testing · Community/family-based interventions · Primary care referrals to orthopaedics · Static stretching and muscle performance · Keeping cool: mechanisms in the heat

Resveratrol shows potential for nucleus pulposusmediated pain

· No evidence to support ultrasound or shock wave treatment of low back pain · Ketamine provides preventive analgesia in renal surgery

· Adherence to injury prevention recommendations · Medial tibial stress syndrome · Kinesiotape: a review · Cementless THA: good results with ceramic bearings · Posterior cruciate-retaining vs posterior cruciatestabilising TKAs · Obese children: decreased dorsiflexion and

· TKA safe and effective in patients >80 years

more flexible feet

· Orthopaedics: not just brute force and ignorance!

· Optimal AFOs for Achilles tendon rupture

· MOMHR: effects on bone

· Pronated runners: wedged foot orthoses beneficial

· THA outcome and transfusion threshold

· Treating onychomycosis in diabetics

· Knee osteochondritis dissecans: interventions com-

· Foot health education in RA

pared

· Metatarsalgia: effects of metatarsal pads

· Return-to-sport outcomes after ACL repair

· Foot pain in acute gout

· Osteochondral defects: MACI® effective

· Hallux limitus: internal rotation of lower limb

· Paediatric ACL tear: effects of delayed repair

· Custom foot orthoses for RA · Long-term results of 1st MPJ silicone prosthesis

CONTINUING EDUCATION

Page 10

Upcoming courses and conferences in New Zealand and overseas in 2012. http://www.sportsphysiotherapy.org.nz/calendar.html LOCAL COURSES & CONFERENCES When?

What?

Where?

More information

STOTT PILATES Intensive Mat Plus Course

Auckland

info@corepilates.co.nz

2012 03 May

www.corepilates.co.nz 04–07 May

PNZ Conference

Wellington

www.physiotherapy.org.nz

16 May

STOTT PILATES Intensive Reformer course

Auckland

info@corepilates.co.nz www.corepilates.co.nz

19 May

NZMPA Elbow and Neurodynamics

Wellington

www.nzmpa.org.nz

24 May

McKenzie – Part A

Auckland

Contact: minz@mckenziemdt.org.nz

26 May

Nelson/Marlborough Branch - Hip Symposium

Nelson

click here for info

16 June

NZMPA – Lumbar Instability, MSB and Hip

Christchurch

www.nzmpa.org.nz

16 June

Back in Motion Pilates – Mat Level 2

Auckland

Click here for info

21 June

McKenzie – Part B

Wellington

Contact: minz@mckenziemdt.org.nz

INTERNATIONAL COURSES & CONFERENCES When?

What?

Where?

More information

23 & 24 June

2012 Pre-Wimbledon Sports Medicine and Sports Science Conference

London

www.lta.org.uk/ conference2012

2–6 July

International Society of Biomechanics in Sport

Melbourne

isbs2012

19–21 July

World Congress for the International Society of Electrophysiology and Kinesiology

Brisbane

ISEK2012.com

31 October– 2 November

Be Active 2012 (Sports Medicine Australia)

Sydney

beactive2012

2012

Page 11

SPNZ WEBSITE SPNZ Member Login Your email address is that which you supplied to Physiotherapy NZ.

Your password will be sent to you by SPNZ and can be reset to a password of your choice by clicking on “Reset Password”.

MEMBERS SECTION Copies of all clinical article reviews and SPNZ Research Reviews that appear in the SPNZ Bulletin editions will be placed in the new “Resources” section, as well as an updated list of Open Access Journals. These will be available for

SPNZ’s Research Reviews

Clinical Article Reviews



Osteoarthritis



Barefoot running and the minimalist shoe debate



Injuries in Cricket



Bench pressers’ shoulder—overuse tendinosis of pectoralis minor



Medical Exercise



Blood clots and plane flights



Sport and the Disabled Athlete.



Heat acclimatization guidelines for high school athletes



Management of hamstring injuries—issues in diagnosis



Sideline evaluation of bone and joint injury



Occular injuries in basketball and baseball



Clinical and MRI features of a cricket bowlers side strain

List of Open Access Journals (full text available to all members) 

Sports physiotherapy



Sports medicine



Sports science

AND MORE...

Quick Links to Members Section Resources Copies of SPNZ’s Research Reviews, a list of openaccess journals (full-text available), clinical article summaries and other sports physiotherapy related articles. Vacancies Sports Team Positions and Clinic Positions available Clinical Forum Got a clinical question and want advice from members? Post your question on the clinical forum. Asics Education Grant Information Application form, guidelines and instructions

Book Reviews Book reviews on sports physiotherapy topics Snippets Quick sports physiotherapy tips Calendar Calendar of upcoming courses and conferences Reports Minutes of SPNZ meetings and submissions on professional matters.

CLASSIFIEDS

Page 12

POSITIONS VACANT PALMERSTON NORTH Locum required — Full-time We are looking for a full-time locum Physiotherapist to work from 16th May to 8th June 2012 and again from 9th July to 17th August 2012. There is also the potential for a part-time position in the period between these locum periods, and ongoing beyond the end of the second locum period. Churchyard Physiotherapy is a busy musculo-skeletal practice located centrally in Palmerston North. There is full reception/admin cover and you will be working with other permanent staff for this time, so there is lots of support and help getting to know the practice. Contact Fiona O’Connor by email at fiona@churchyardphysio.co.nz or by telephone on (06) 354 8008 (work) or (06) 353 2374 (home)

SPORTS PHYSIOTHERAPY POSITION

White Ferns Physiotherapist Fixed term contract position New Zealand Cricket is seeking to appoint a team physiotherapist to work with the White Ferns while on tour during 2012 and 2013. This is an exciting opportunity for an experienced and qualified Physiotherapist. The role will be required to travel with the White Ferns team on all tours managing all physiotherapy requirements. The role also includes close liaison with the White Ferns Coach, Manager, Strength and Conditioning coach and other medical personnel to maintain optimal team fitness. The successful applicant will have:



Registration to work as a physiotherapist in New Zealand



Previous experience working with sporting organisations or teams



New Zealand physiotherapy private practice experience (musculoskeletal)



Previous experience working with strength and conditioning coaches



Strong administrative and organizational skills



Willingness to travel



The ability to work in a team with players, team management, support staff and other officials

A valid passport, a current driver’s licence, a first aid certificate and consent to a police clearance. If you have an interest in international cricket, excellent organisational and interpersonal skills as well as the ability to work as part of a high performing team, email your curriculum vitae and covering letter to fbarnham@nzcricket.org.nz. Initial enquiries to Frances Barnham on +6421528003. Applications close on 17 May 2012.

Page 13

CLASSIFIEDS POSITION AVAILABLE AUCKLAND Bodyreform Physiotherapy and Pilates Limited. Musculoskeletal Physiotherapist position available from April 1st 2012, Grey Lynn, Auckland.

Bodyreform is a modern, warm inviting clinic in the heart of Grey Lynn. One of our physioâ&#x20AC;&#x2122;s is leaving to travel...hence an opening has been created for another motivated physiotherapist to work in a newly renovated, Clinical Pilates and Physiotherapy Rehabilitation Clinic in central Auckland. Vacancy available from April 1 st 2012. You will be required to work with two others, with flexible hours. You could start part time, or 30 hours plus a week. Alternating start and finish times, with a varied caseload which will include manual therapy, massage therapy, rehabilitation and clinical pilates. Very flexible work schedule leaves you more personal time. Our clinic has a rehabilitative focus, treating acute and chronic spine clients, running, cycling injuries, ante and post natal care, general physiotherapy and post orthopaedic care. The successful therapist must also have a genuine interest in practising Clinical Pilates. Intensive In-house training can be provided; with view of physiotherapist progressing to more formal course training would be ideal. An interest and passion to extend your skills and participate in ongoing education courses is important. Therapist must also be able to work independently at times, be a great people person, and achieve self directed learning.

Excellent financial reward. We work on a per hour basis, 30/60 minute treatment times. You will be working within a supportive team. We have a loyal following of clients and referral networks which keeps growing each year. Please email CV to sarah@bodyreform.co.nz or call on 021 751 472 to discuss this position further.

Page 14

CLASSIFIEDS

CLINIC FOR SALE TAURANGA TAURANGA – THE SPINAL CLINIC. A terrific chance to live the lifestyle in NZ’s fastest growing affluent city.

This will be an investment in a centrally located established successful clinic.     

Central to all routes into Tauranga. Business plus rental income. We treat spinal and peripheral pathologies. Audited and Certified since 1996. This clinic is an ACC EPN provider.

This clinic was established by the present owner in 1976 and has a huge clientele of repeat self-referring clients. The building is owned by the current owner – thus a stable leasing arrangement is guaranteed. Lease includes:  clinic  off-street parking  attached double garaging for staff  attached flat overlooking a lovely sunny private garden area. The flat is currently available for tenanting or may be accommodation for an on-site physiotherapist. Interior designed décor with three large treatment rooms and large gym. Tons of natural light. All gear including 4 electric HiLo couches. Air conditioning throughout. Excellent business administration systems. If required: two part-time dedicated and very experienced loyal receptionists. You do the treatments, they do absolutely everything else. Current reception cover: 9 hours daily. Houston Medical VIP system. Principal happy to stay on and impart knowledge and skills for an efficient transition if new owner wishes. For an information pack including extensive photos: Jon Foxon at: j.foxon@xtra.co.nz