SPNZ Newsletter Feb 2012 by Sports & Exercise Physiotherapy NZ

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BULLETIN

ISSUE 1 l FEBRUARY 2012

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

Dr Tony Schneiders

Secretary

Michael Borich

Treasurer

Dr Gisela Sole

Website

Hamish Ashton

Bulletin

Angela Cadogan

Committee

Mark Cartman Bharat Sukha Jim Webb

EDITORIAL ASSISTANT Aveny Moore

SPECIAL PROJECTS Monique Baigent Nathan Wharerimu Amanda O’Reilly

ADVERTISING Advertising terms & conditions click here. Deadline: 30th day of Jan, Mar, May, Jul, Sept & Nov.

LINKS Sports Physiotherapy NZ List of Open-Access Journals SPNZ Research Reviews Asics Apparel and order form McGraw-Hill Books and order form Asics Education Fund information

Welcome to the February 2012 edition of the SPNZ Bulletin. We hope you all had a great Christmas and New Year break. SPNZ are in full swing preparing for the 2012 Symposium “Prevention, Practice and Performance” in Tauranga. We have some great speakers lined up including Jill Cook, Pete Gallagher (All Blacks Physiotherapist), Mr Matt Brick (orthopaedic surgeon), Dr Dale Speedy (Sports Physician), Richard van Plateringen (Podiatrist) and more. Only 5 weeks to go so get your registration form in now! Our AGM will be held in conjunction with the Symposium, and this year there will be an executive position up for nomination. We encourage as many members as possible to attend this important AGM. Details can be found on page 3. Following an executive meeting held in December 2011 the executive made the unanimous decision to continue with the current range of benefits including JOSPT and the Sports Physiotherapy magazine, and we are also planning on increasing the continuing education courses on offer in the coming year. Make sure you remember to renew your SPNZ membership when you re-join Physiotherapy NZ to continue receiving the wide range of membership benefits. Thanks to Gavin d’Souza, the NZ men’s Hockey Black Sticks physiotherapist who has provided us with the feature article in this Bulletin, talking about the Champions Trophy that was held in Auckland in December 2011. We are pleased to announce the SPNZ 2011 Student Research Prize winners from AUT University and the University of Otago. Their abstracts are included in this Bulletin. We always welcome your feedback or ideas for the SPNZ Bulletin, so please feel free to contact us about this, or any of the SPNZ activities. We hope to see you all at the 2012 Symposium. SPNZ Executive.

Physiotherapy NZ IFSPT

INSIDE:

JOSPT



SPNZ 2012 Symposium “Prevention, Practice & Performance” - REGISTER NOW



SPNZ Positions available



Gavin D’Souza-NZ mens hockey Black Sticks physiotherapist



Article Review: Hip Biomechanics and Pathology in the Athlete

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Latest Research



2011 SPNZ Student Research Prize Winners

and MORE…….

IN THIS EDITION

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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

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SPNZ Symposium: Prevention, Practice, Performance. Renew Your Membership to SPNZ

Sebel Trinity Wharf Hotel, 17th & 18th March 2012.

Remember to renew your membership to SPNZ when you renew your PNZ membership for 2012.

Speakers include:  Dr Jill Cook  Pete Gallagher (All Blacks Physiotherapist)  Mr Matt Brick (Orthopaedic Surgeon)  Dr Dale Speedy (Sports Medicine Physician)  Dr Lynley Anderson (Bioethics)  Bryan Stronach (NZ Cricket Strength & Conditioning Coordinator)  Caryn Zinn (Sports Nutrition)

Please remember that Physiotherapy NZ collect our membership subscriptions for us and membership renewal for SPNZ this takes place at the same time. Ensure that under “Special Interest Groups” that “2012 Subscription to Sports Group” is ticked in order for you to renew and continue your SPNZ membership. See a list of SPNZ membership benefits below.

SPNZ Member Benefits

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

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FREE Editions of the Quarterly APA “Sports Physio” Magazine

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25% Discount on all McGraw-Hill book publications

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

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

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Access to website with clinical and relevant articles.

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Sports Physiotherapy Forum to discuss ideas and ask questions

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Bi-monthly NZSOPA Bulletin featuring Course and information updates.

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FREE classified advertising in the NZSOPA Bulletin

Activity,

SPNZ AGM Notification The SPNZ AGM will be held in conjunction with the SPNZ Prevention, Practice, Performance Symposium. Date:

Sunday 18th March

Time:

8.00am—8.30am

Venue:

Sebel Trinity Wharf Hotel Trinity Rooms 51 Dive Crescent, Tauranga

Richard van Plateringen (Podiatrist)…

AND MORE

Details on page 4 or on the website:

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



Nominations are open for one position on the SPNZ executive committee. Nomination forms are available from the AGM link on the SPNZ website www.spnz.org.nz We encourage all members attending the symposium to attend the AGM to vote, to hear the latest update on SPNZ’s position and activities.

SPNZ Symposium 2012.

SPNZ Student Research Award Winners 2011 SPNZ award $500 each year to AUT University and University of Otago 4th Year Physiotherapy Student Research Prize winners. Congratulations to the 2011 winners of the Student Research Awards for two excellent projects. The winners were: AUT University: Thomas Mason and Joshua Rogers “Outcome Measures Assessing Pain Levels Pre- and PostTotal Knee Arthroplasty: A Literature Review” University of Otago: Ben McLeod, Bridget Henderson, Connor Austin, Mark Crouchley and Michelle Borren. “The Challenges of Finding Sports Concussion Information on the Internet”

Asics Education Fund - March 2012 Applications are now being received for the March funding round. SPNZ allocate $1000 twice per year to members requiring financial assistance with research or conference attendance relevant to sports and orthopaedic physiotherapy. You may be eligible. Next deadline for applications is 31st March 2012. For more information click the link below: Instructions and Application Form

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 2011 is €20. To view contents of the current issue click here or see page 16 of the Bulletin.

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SPNZ SYMPOSIUM 2012

PREVENTION, PRACTICE, PERFORMANCE Sebel Trinity Wharf Hotel Tauranga March 17th and 18th 2012.

KEYNOTE SPEAKER Dr Jill Cook - Monash University, Australia 

Is clinical presentation of tendinopathy linked to pathology?



Can we prevent tendon injuries?

INVITED SPEAKERS: Pete Gallagher - All Blacks Physiotherapist Dr Dale Speedy - Sports Physician Mr Matt Brick - Orthopaedic surgeon Bryan Stronach - NZ Cricket Strength & Conditioning Dr Lynley Anderson - University of Otago (Bioethics) David Rice - Physiotherapist Caryn Zinn - Sports Nutritionist Richard van Plateringen - Sports Podiatrist

WORKSHOP DETAILS: http://www.sportsphysiotherapy.org.nz/workshops.html

REGISTRATION OPEN:

Click the links below for:

SPNZ Members

$300

Provisional Programme

Physiotherapy Students

$220

Speaker Profiles

PNZ Members

$300

Registration Form

Non-PNZ Members

$300

Click here to register

Accommodation Workshops

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SPNZ POSITIONS AVAILABLE The SPNZ Bulletin is published every two months (6 editions per year) and is one of the most important means of communication between the SPNZ Executive and members. As this Bulletin goes to press we are still finalising the Editor position, but if you are interested please let us know! We are also looking for willing volunteers to join the Special Projects Group to help review articles and assist with other aspects of executive activities.

BULLETIN EDITOR: Final Notice for Expressions of Interest in this Position The role of the Bulletin Editor is to plan, coordinate and collate content for each Bulletin. This also involves delegating and coordinating a small team of ’assistants’ to provide material for each edition. It is possible this could be a shared position. Requirements: 

An interest in sports and orthopaedic physiotherapy



Access to literature databases would be advantageous

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Good communication skill



Ability to coordinate a small team of assistants (Assistant Editor and Special Projects Group (n=4))

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Organised and reliable with good time management

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No formatting or desktop publishing is required as this role has been outsourced.

Time Required: approximately 4 hours per month. The Bulletin Editor would also attend SPNZ Executive meetings (1x per year) and also be involved in regular Skype meetings with the Executive (approx. every 6 weeks).

SPECIAL PROJECTS GROUP: Volunteers required to join the Special Projects Group. Role:

At present the role primarily involves a brief review of 1-2 articles for the Research Reviews in each edition of the Bulletin. There is potential for involvement in a non-office bearing capacity with other aspects of SPNZ as the need arises.

Time requirement:

As much or as little as you can provide. At present this is approx. 1-2 hours every 2 months.

If you are interested, or would like more information about either of these positions, contact: Angela Cadogan phone 0211503731 email acadogan@vodafone.co.nz

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FEATURE FEDERATION OF INTERNATIONAL HOCKEY CHAMPIONS TROPHY 2011 Gavin D’Souza - Black Sticks Physiotherapist BSc, Dip Phys, Dip MT, PGCert HSc (Sports Medicine)

Gavin D’Souza is a Morrinsville-based sports physiotherapist. Gavin has had extensive experience with athletes and teams at the elite level, and has been the NZ mens hockey Black Sticks physiotherapist for the last 9 years. In December 2011 the Black Sticks competed in the Federation of International Hockey (FIH) Champions Trophy Tournament, held in Auckland, NZ. The team performed well, equaling their previous best tournament results against strong international competition. Gavin talks to us about his role during the tournament, and as the Black Sticks Physiotherapist

Name:

Gavin D’Souza

Training: Undergraduate: BSC(University of Waikato)1984. Dip.Phys (Auckland Technical Institute) 1989. Post-graduate: Dip.MT (NZMPA)1995. PGCertHSc (Sports Medicine) (Auckland University)

Physiotherapy Sports Experience: N.Z. Men’s Blacksticks : 2004 Athens Olympic Games 2008 Beijing Olympic Games. 2006 Melbourne Commonwealth 2010 Delhi Commonwealth Games. N.Z. Health Team: 2002 Manchester Commonwealth Games

All Whites: 2000 Merdeka Tournament, Malaysia 2000 Oceania Nations Cup, Tahiti.

How did you become involved with Hockey? I successfully applied for a position as Physiotherapist for

the N.Z. Under 21 Hockey Team for the 2001 Junior World Cup in Hobart, Australia. After this initial involvement, I got asked to become involved with the Men’s Hockey Team in 2003. I have been involved with the team since then.

2011 Champions Trophy, Auckland, NZ The Champions Trophy is played annually between the top 8 ranked hockey nations in the world. The tournament is ranked only behind the Olympic Games and the Hockey World Cup, in order of importance. Twenty-four matches were played over a 6 day period. The teams involved in order of world ranking were: 

Australia



Germany



Holland



Great Britain



Spain



Korea



New Zealand



Pakistan.

The Black Sticks’ best performance at a previous Champions Trophy Tournament, was 4th in 1978. In the 2011 Champions Trophy we also finished 4th, losing to Holland in the Bronze Medal play-off. The competition was a chance to see some of the world’s best players in action on home turf. These in-

FEATURE cluded Teun de Nooijer from Holland and Jamie Dwyer from Australia.

What was your role as physiotherapist during the tournament? My role during the tournament was injury management on and off the turf. This included acute, sub-acute and chronic injuries. Acute injuries were sustained at trainings and matches. Left: Phil Burrows receives treatment for laceration caused by ball. The cut required 15 stitches. This was good publicity for hockey , as the picture made both Sunday papers.

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nosis when the tournament is only a few days away. The team squad of 16 players has to be named 24 hours before the tournament start. Once the tournament starts the squad canâ&#x20AC;&#x2122;t be changed, so a decision to keep an injured player or bring in a new player is an important one. Management of an injured player We had one such injury to one of our players in a warmup match against Great Britain. The player while competing for the ball with an opponent, twisted and hyperextended his right knee. He was unable to continue the game and was uncomfortable weight-bearing. Clinical findings Initial assessment revealed no significant swelling with pain over the lateral and posterior aspect of the knee. There was limitation with end range flexion and extension. Liagamentous testing and meniscal testing were negative. My provisional diagnosis was posterior capsular sprain with the possibility of a meniscal tear. With the tournament being in Auckland I had ready access to our Medical Director, Dr Tony Edwards. The player was assessed by Tony the day after the injury and an MRI Scan was arranged. MRI Imaging revealed posterior capsular swelling, bone bruising and a mild, proximal gastrocnemius tear.

Treatment was carried out predominantly in my hotel room or, acutely, at the ground. I also supervised a daily walk and stretch each morning before breakfast. Cold Water Immersions were carried out at the Millenium Institute of Sport & Health, on the North Shore. Other Support Staff that were involved in different capacities during the tournament were a Psychologist, Sports Physician, Strength & Conditioner and a Nutritionist. These support staff were more involved as the tournament was based in Auckland and access to these personnel was easy. Ocassionally one of these personnel may travel overseas with the team, but usually only the Physiotherapist goes.

Biggest challenge as a sports physiotherapist working at the elite level? Like most Sports Physiotherapists, the biggest challenge for me is keeping players on the field for important matches, despite inevitable injuries. They seem to occur in pretournament practice matches with amazing regularity.

Return to sport The player settled steadily on a daily basis. He was uncomfortable in full knee extension. 2 days out from the tournament he was able to train (with his knee taped to limit end range extension), at 60%-70%, then eventually at 75%-85%. He was reassessed during and after training and coped well with the gradual increase in workload. He eventually took a full part in the tournament. The challenge, from my point of view, was relying on my clinical skills initially to make an accurate diagnosis and prognosis. This was backed up by imaging. Implementing a graduated loading programme during training ensured a safe and timely return without further injury.

SPNZ is now on Facebook

Check us out at:

www.facebook.com/SportsPhysiotherapyNZ Website Gems

Diagnosis and Prognosis The challenge is to make an accurate diagnosis and prog-

Links to Video clips

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CLINICAL SECTION ARTICLE REVIEW Neuromuscular Hip Biomechanics and Pathology in the Athlete MR Torry, ML Schenker, HD Martin, D Hogoboom, MJ. Philippon. ABSTRACT

Dynamic movement occurs at the hip joint and is characterized and constrained by the anatomy of the region, including osseous, ligamentous, and musculotendonous structures. In many sports, athletes suffer a minor hip injury or perform repetitive motions that exacerbate a chronic pathologic or congenital hip condition that leads to increased capsular laxity and labral tears over time. Although joint mechanics for total hip joint replacements (THR) are well described, little is known with regard to hip joint mechanics in injuries such as hip labral tears that are observed in younger athletes. In addition, although hip arthroscopic techniques have been developed and evolved over the last 5 years, particularly with respect to femoro-acetabular impingement (FAI) and hip labral repairs, the mechanisms of these injuries across various sports are not well understood. Moreover, rehabilitation protocols associated with hip injury and post-arthroscopy remain rooted in traditional theories and paradigms. Although advances in imaging and surgical techniques have provided new knowledge in the diagnosis of hip pathology, the functional anatomy, biomechanics and neuromuscular strategies of the hip joint with respect to the aetiology and management of these conditions requires updating to inform rehabilitation practices and to prevent recurrent injury. The purpose of this article was to review the literature related to the osseous, ligamentous support as well as the neuromuscular control strategies associated with hip joint mechanics. The neuromuscular contributions to hip stability and mobility with respect to gait are provided because the data related to gait represents the largest body of knowledge regarding hip function. Further, this article describes the probable mechanisms of injury in sporting activities most often associated with hip injury in the young athlete. Reference: Clinics in Sports Medicine (2006); 25:179-197

Introduction This general review of the literature was reportedly written to inform post-arthroscopic rehabilitation practice, however many of its findings are relevant to the aetiology and conservative management of hip pathology. The review covers functional anatomy, biomechanics and EMG findings as well as identifying potential aetiological factors for hip pain in various sporting groups. While the authors discuss femoro-acetabular impingement and hip labral tears at length, the functional anatomy, neuromuscular mechanisms and EMG findings are applicable to rehabilitation of a wide range of hip conditions in groups of athletes, as well as the general population. FUNCTIONAL ANATOMY Factors contributing to stability of the hip joint Osseous factors Three biomechanical and anatomic geometries of the femur and acetabulum are significant to joint stability and preservation of the labrum and articular cartilage: 1. appropriate femoral head–neck offset 2. acetabular anteversion 3. acetabular coverage of the femoral head.

Femoro-acetabular Impingement Proper function of the hip joint necessitates that the amount of offset from the femoral head to the femoral neck be enough to allow a full range of motion without impinging upon the acetabular labrum. A lack of offset from the femoral head to the femoral neck has been described as a cause for femoroacetabular impingement (FAI) [1]. Flexion at the hip may cause the osseous femoral head–neck junction to come into contact with the acetabular labrum, resulting in impingement [1–3]. A large femoral head can compensate for a flat head–neck junction by simulating offset and adding stability to the joint [4]. Anteversion Normal anteversion of the acetabulum is essential to maintaining a normal relationship with the femoral head and is critical in avoidance of impingement [8]. Normal range of acetabular anteversion as defined by Tonnis and Heinecke [9] is 15° to 20°, decreased anteversion is 10° to 14°, and increased anteversion is 21° to 25°. An increase in external rotation is commonly found with decreased acetabular anteversion. Anteversion of the femur is also important in maintaining proper static and dynamic mechanics in the hip. Antever-

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CLINICAL SECTION ARTICLE REVIEW CONTINUED... sion of the femur diminishes with age. A healthy 1 year old has an average anteversion of 31°. This anteversion decreases to 24° at 8 years and to 15° by 15 years [14]. The McKibbin instability index is based on the sum of the angles of the femoral and acetabular anteversion. This ratio will affect range of motion. The sum of the angles of femoral and acetabular anteversion predicts instability for summed angles of 60° or more and predicts low instability for angles of less than 20°. The authors found that, of 290 hips tested, 38% had a low and 6% had a high index.

To accomplish this, muscles that cross the hip must regulate their stiffness. Muscular stiffness is determined by a complex neural feedback control system. A highly regulated hierarchy of neuromuscular control strategies begins with the activation of the single fibre and progresses to the mechanical properties of the whole muscle. Specific neuromuscular components that regulate muscle stiffness include: 1. muscle activation frequency (i.e., temporal summation) [23]. 2. muscle fibre recruitment (i.e., spatial summation) [24].

Ligamentous factors

3. sarcomere length–tension relationship [25].

The hip capsule is comprised of a series of ligaments, which can be subdivided into functional and anatomic components. The five primary ligaments discussed in the hip are the iliofemoral (lateral and medial arms), pubofemoral, ischiofemoral, the ligamentum teres femoris, and the ligamentum orbicularis. The collagen structure of the hip as demonstrated by electron microscopy is similar to that of the shoulder and the elbow [15].

4. sarcomere force-velocity relationship [26].

The iliofemoral ligament (also referred to as the Yligament of Bigelow) is the largest of the ligaments and reinforces the capsule anteriorly. The ischiofemoral ligament supports the capsule posteriorly and the pubofemoral ligament reinforces the capsule inferiorly. These ligaments are connected to each other by the circular ligamentum orbicularis, which circumvents the femoral neck. Most authors agree that the iliofemoral ligament limits extension [16], the pubofemoral ligament limits abduction, and the ischiofemoral ligament limits internal rotation. It is thought that with an elongated or surgically resected iliofemoral ligament, the ligamentum teres has a limiting effect on external rotation. There is debate regarding the ligament limitation in other motions. The ligamentum orbicularis appears to play a vital role in stability. Although studies have described independent motions limited by the ligaments, it is believed that they do not function independently. The ligament complex surrounding the hip acts to stabilize the hip in all ranges of motion. Neuromuscular factors Maintaining an appropriate femoral head position within the joint capsule and labral complex is paramount to normal hip function and failure in this mechanism can lead to debilitating labral and cartilage compression in active individuals. Thus, hip congruency, although affected by, is not solely dependent upon the femoral head acetabular bony and labral constituents for complete hip stabilization. The ligaments described above and the muscles that cross the hip joint contribute and provide for articular congruency and maintain articular stabilization (i.e., limit translations of the femoral head within the acetabular– labral complex).

5. passive sarcomere length tension relationships [27]. 6. Intrafusal and extrafusal (muscle spindle) fibres feedback mechanisms [28]. 7. Muscle force and moment regulation by skeletal muscle architecture [29,30]. Regarding Point 7 (above), muscle stiffness regulation by skeletal muscle architecture. Functionally, the force generated by a muscle is proportional to its physiologic crosssectional area (PCSA). The total excursion of a muscle is determined by its fibre length. Within this article, a comprehensive table (Table 1) is provided that summarises the mechanical properties of the larger muscles surrounding the hip joint. Mathematical models based on this information highlight the diverse behaviours among individual muscle fibres within a specific hip muscle as well as illustrating the changing roles specific fibres of a particular hip muscle may have while undergoing flexion and extension [31,33,34]. The considerable change in fibre moment arms within each muscle indicates that the force generating capacity of a muscle may in fact change with different femoral, pelvic, or lumbar motions. FUNCTIONAL HIP JOINT BIOMECHANICS The review goes into an in-depth discussion regarding invivo estimates of joint and limb segment kinematics, internal joint reaction forces and muscle moments. The authors discuss the limitations of earlier inverse dynamic solution models in estimating contributions and moments of individual muscles and point out that recent developments in model sophistication, and more accurate estimates of muscle fibre length have improved the understanding of contributions of individual muscles to hip muscle function. From recent studies they report the following function of individual hip muscles during the gait cycle: Early stance (first 0% to 30% of stance): gluteus medius, maximus, and minimus provided the majority of the support.

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CLINICAL SECTION ARTICLE REVIEW CONTINUED... Foot flat to just after contralateral toe off (e.g., 10–50% of stance): gluteus maximus and posterior medius/ minimus contributed significantly to the vertical ground reaction force. Midstance: With assistance from joints and bones to gravity, the anterior and posterior gluteus medius/ minimus generated nearly all the support evident in midstance. Posterior gluteus medius/minimus provided support throughout midstance, while the anterior gluteus medius/minimus contributed only toward the end of midstance (Fig. 1B). Late stance: the iliopsoas developed substantial forces during late stance, but this muscle did not make substantial contributions to support [38]. Opposing actions of anterior gluteus medius: The study of Anderson and Pandy [38] has shown that the muscular actions of the gluteus medius and minimus depend strongly on body positions. Anterior gluteus medius/minimus possesses a moment arm at the hip that acts to flex the hip as well as abduct it. These two actions oppose one another and prevent the anterior gluteus medius from generating support in early stance no matter how large its force. As the hip extends during mid and late stance phase, the anterior gluteus medius moment arm falls close to zero. The muscle becomes more of a pure abductor and its action more closely resembles the actions of the posterior gluteus medius. EMG of HIP MUSCULATURE The authors point out the considerable amount of available literature regarding EMG of the hip musculature for walking, climbing stairs, and various sporting motions. Due to space limitations and the completeness of data content, only the EMG of hip muscles during gait are presented in this article. Pectineus, Piriformis, Superior and Inferior Gemullus, and Obturator Internus and Externus Muscles Studies on the muscles of the hip joint have typically neglected the roles of the deep musculature. These muscles are often thought to be the “rotator cuff ” muscles for the hip. The pectineus has been shown to be moderately active at mid-heel strike to mid toe-off, functioning to limit femoral abduction and contributing to femoral medial rotation. Assessing the functional EMG of the pirifirmis, superior and inferior gemullus, and obturator internus and externus) has proven difficult given their anatomic locations and relative inaccessibility and their proximity to femoral vessels. Iliopsoas The iliopsoas, it is the only muscle that has the anatomic prerequisites to simultaneously and directly con-

tribute to stability and movement of the trunk, pelvis, and leg. This muscle has two major portions (the iliacus and the psoas) with separate innervations, which makes selective activation of each portion feasible for any given movement. The only point that is agreed upon is that this muscle is a flexor of the hip and probably has some influence on the lumbar vertebrae and pelvis in maintaining appropriate postures. Andersson et al [57] concluded that the iliacus primarily stabilizes the motions between the hip and pelvis, whereas the psoas assists in stabilizing the lumbar spine in the frontal when a heavy load is applied to the contralateral side. Iliacus 

notable activity throughout flexion of the hip during the “sit -up in the supine position” [56] and during a sit-up from the “hook-lying” position.

Psoas Major 

slight activity during relaxed standing and strong activity during flexion in many postures [57].



Likely to have a significant role in maintaining upright postures [59].

Gluteus Maximus 

active during extension of the thigh at the hip joint, lateral rotation, abduction against heavy resistance when the thigh is flexed to 90°, and adduction against resistance that holds the thigh abducted [60].



moderate activity when bending forward and when straightening up from the toe-touching position [61].



during standing, rotation of the trunk activates the muscle that is contralateral to the direction of rotation (i.e., corresponding to lateral rotation of the thigh) [61].

Gluteus Medius and Minimus 

gluteus medius and minimus are quiescent during relaxed standing serve to confirmed that these abductors prevent the Trendelenburg sign, during abduction of the thigh and in medial rotation [61].



activity in all the glutei was minimal in bicycle pedalling [63]



anterior part of the gluteus medius active in the initial stage of elevation (flexion) of the thigh in erect posture.

Tensor Fasciae Latae 

moderate activity in this muscle during flexion, medial rotation, and abduction of the hip joint [64-67].



the rotary influence of tensor fasciae latae at the knee has been argued but no activity was seen [66]



TFL was active during bicycling, showing their greatest

CLINICAL SECTION

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ARTICLE REVIEW CONTINUED... activity during the hip flexion phases [63]. Adductors of the Hip Joint 

adductors were activated during flexion or extension of the knee, and became more active with resistance in children [69, 70].



similarly, adults exhibited activity during flexion of the knee, but only a minority was active during extension compared with children. This difference may be related to postural control, and these muscles may be facilitated through reflexes of the gait pattern rather than being called upon as prime movers.



during adduction, the longus was always active while the magnus was almost always silent unless acting against resistance [71].



adductor longus and magnus were both shown to be active during medial thigh rotation but not during lateral rotation of the hip with the upper fibres of the adductor magnus showing the greatest activity [71].

there is marked difference between the two parts of the adductors magnus: the upper, possessing a pure adductor role and was active throughout the whole gait cycle, while adductor brevis and longus showed triphasic periods with the main peaks occurring at toe-off [62]. SPORT SPECIFIC MECHANISMS OF INJURY The review outlines theories for possible mechanisms of injury in several sports including golf, figure skating, ballet, hockey and running. Only hockey and running are included in this article overview, however the interested reader is referred to the original article for information on the other sports. Hockey Hockey players may suffer from traumatic hip injuries after direct blows to the greater trochanter. Isolated labral tears and chondral injuries from simple mechanical shearing are commonly found in these patients [78]. In addition to trauma, hockey players can suffer from overuse-type hip injuries. Significant flexion, abduction, and slight external rotation forces are present at the hip. As a goalie, the hip sustains significant flexion and internal rotation forces. In flexion and abduction or flexion and internal rotation, any morphologic abnormality at the femoral head–neck junction would hit the anterosuperior labrum and the acetabular rim. This abnormality is found in patients with cam-type femoroacetabular impingement [1,2,79] and is a very common finding in elite hockey players undergoing hip arthroscopy. Whether this is a subtle developmental deformity exacerbated by sport or

whether there is a unique mechanism for the development of cam-type impingement in athletes is still not known. Running Although most cases of hip instability are present in athletes whose sports demand excessive rotational movements, runners may also present with subtle anterior hip instability [80]. In the stride phase of high-level extensive running, repeated hip hyperextension may stretch the anterior capsule and iliofemoral ligament. The resulting microinstability may subtly increase femoral head translation, and with repeated insults, cause labral tear and chondral injury. During running, when the foot contacts the ground the femur is in an abducted position in relation to the pelvis. Thus, the gluteus medius and tensor fascia latae are eccentrically loaded. As the running support phase progresses, these muscles must then contract as abduction occurs at the hip. Thus, it is believed that gluteus medius weakness may lead to decreased thigh control manifesting in increased thigh adduction and internal femoral rotation. These changes may predispose the runner to several pathologic conditions including iliotibial band syndrome at the knee [81]. References available on request.

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CLINICAL SECTION ASICS SHOE REPORT

KAYANO 18 The new generation Gel Kayano 18 moves up a level as the stand out shoe in support, comfort and performance of the Asics stable. There are significant improvements in comfort and weight reduction while maintaining the supportive qualities with the new Dynamic Duomax. Improved Comfort: Research has shown that poor comfort causes a higher rate of injury (Mundermann et al, 2003). The Kayano 18 has removed the traditional hard thermoplastic from the heel and replaced it with the flexible heel clutch system. This innovative system allows the shoe to adapt to individual differences in the anatomy of the heel and ankle. Being flexible, allows it to move with the heel preventing heel irritation at propulsion when the calves are pulling upwards to move the body forward. Combined with PHF (personal heel fit – ASICS’s moulded foam in the heel) there is a significant improvement in all round comfort from heel contact to toe off. Biomorphic fit has been added to the medial side of the shoe to improve comfort at propulsion when the 1st ray plantarflexes and 1st MPJ dorsiflexes. A layer of soft foam called Soft Top Solyte over the Dynamic Duomax further improves comfort and prevents irritation on the medial arch during midstance when the foot is flattening. A good option where blistering in the arch is a concern. Gender specific Soft Top Solyte allows for altered loading patterns between men and women. Improved Performance through Weight Reduction: A key change to this years model is the significant weight reduction. A lighter shoe during swing phase of gait uses less muscle expenditure and enables a faster transition when resupinating from midstance to propulsion. The lighter, more dynamic heel clutch system, and outsole/ midsole tooling changes with a Full Guidance Line makes

this model the lightest ever. A Full Guidance Groove running from heel to toes means there is less surface tension making it easier to plantarflex the foot and reach propulsion faster, reducing energy and improving performance . Better efficiency and support through dynamic sensory feedback: Sensory feedback from the foot has shown to affect muscles in EMG studies (Murley et al, 2005). The Dynamic Duomax with a rippled design gives several sensory feedback points through the midstance phase of gait improving efficiency and the wearer’s response. This technology is the beginning of what could be the first signs of receptive tooling to improve runner awareness during midstance. Support is maintained by linking into the Gender Specific Space Trussic and allows for the differences in arch height and pressure under foot between men and women. In summary Kayano 18 is a lighter, more comfortable shoe that has become more dynamic for different running patterns through the Heel Clutch System, Full Guidance Line and Dynamic Duomax. All these features are designed to move the foot into propulsion faster for improved performance and greater comfort. Kayano 17 runners will notice the weight reduction and a more efficient ride from contact to propulsion. Well done to the research and design team. Justin Chong- Bigfoot Podiatry October 2011

RESEARCH SECTION

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS

HOCKEY AND SPORTS INJURIES Reviews by Monique Baigent, Nathan Wharerimu and Amanda O’Reilly www.sportsphysiotherapy.org.nz/resources.html With the NZ men’s Black Sticks performing well in the Federation of International Hockey Champions Trophy in Auckland in 2011, and with the women’s Black Sticks currently competing in the Champions Trophy, the SPNZ Special Projects Group have reviewed a series of papers that are relevant to elite sport, and injuries frequently seen in hockey.

The Western Australian Sports Injury Study. Elliott, B., Finch, C., Hamer, P., & Stevenson, M. (2003). British Journal of Sports Medicine; 37:380-381 Article Summary This was the first longitudinal population based study of sport injuries in Australia. The study aimed to determine the magnitude of sport injuries in the non-elite and determine the costs of these injuries. This cohort study involved 1512 participants of whom were competing at a non-elite level and had not sustained a sports injury in the three months prior to the study starting. Questions about previous injuries, pre-season training, warm-up and cool-down patterns, equipment used, general health, lifestyle and physical activity were asked at baseline. The incidence of injury at this non-elite level was lower than that at an elite level with 16 injuries per 1000 hours of sports participation. The highest injury rates were recorded in contact sports, among male participants and in the 26-30 year old age group. Injury likelihood was reduced if a training programme made by a sport’s professional was undertaken. Participants with back problems or who sustained a sport injury in the 12 months preceding the study had a significant likelihood of sustaining another injury. The average cost of sports injury each season for participants in this study was AUD$126 per injured player. Clinical Significance This study, although Australian highlights at risk population groups in the non-elite sports participants. The study highlights that training programmes are a potential way to prevent sports injuries and should be evaluated as a potential strategy to reducing costs from injuries in non-elite sports participants.

Comparison of injuries sustained on artificial turf and grass by male and female elite football players. Ekstrand J, Hagglund M, Fuller CW. Scand J Med Sci Sports 2011: 21: 824–832 doi: 10.1111/j.1600-0838.2010.01118.x Article Summary The objective of this study was to compare incidences and patterns of injury for female and male elite teams when playing football on artificial turf and grass. Twenty teams (15 male, 5 female) playing home matches on third-generation artificial turf were followed prospectively; their injury risk when playing on artificial turf pitches was compared with the risk when playing on grass. In total, 2105 injuries were recorded. Seventy-one percent of the injuries were traumatic and 29% overuse injuries. There were no significant differences in the nature of overuse injuries recorded on artificial turf and grass for either men or women or match play v training. The incidence (injuries/1000 player-hours) of acute (traumatic) injuries did not differ significantly between artificial turf and grass, for men or women. During matches, men were less likely to sustain a quadriceps strain (P=0.031) and more likely to sustain an ankle sprain (P=0.040) on artificial turf. Clinical Significance This study showed that training and match play on artificial turf did not result in an increased number of injuries compared with play on natural grass. The rate of overuse injuries was similar for both surfaces, however these injuries are difficult to capture in injury surveillance “time loss” data as many players may be suffering an injury but may continue to

RESEARCH SECTION

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS CONTINUED….. play in a limited capacity. Further studies may be required to further investigate the risk of overuse injury on artificial turf using more specific definitions involving loss of sport-specific functional capacity or performance, rather than simply time -lost from sport. The study did identify a small reduction in risk for muscle strains, particularly quadriceps strains, and a slightly higher risk of ankle sprains in male competitors on artificial turf. In general it appears that artificial turf did not result in increased risk of traumatic injury including knee or ankle injuries.

Diagnosis and management of quadriceps strains and contusions Kary, J. M. (2010). Current Reviews in Musculoskeletal Medicine, 2010 (3), 26-31. doi: 10.1007/s12178-010-9064-5 Article Summary This is a narrative review covering the diagnosis and management of quadriceps injuries with a specific focus on sports. Injuries to the quadriceps muscle group occur frequently in sports and athletic activities. The most common mechanism of injury is a sudden forceful eccentric contraction; other predisposing factors are a high percentage of type II, fast twitch fibres and muscle fatigue. Treatment is broken up into stages of healing. In the acute phase RICE is used for the first 24-72 hours; grades 2-3 may need crutches. Post injury, 3-7days of anti-inflammatories are recommended and at 3-5 days post injury a gradual rehabilitation programme can be commenced, depending on severity. Return to sport requires full painfree range of motion, near to normal strength and successful performance of sport specific tasks. The difference between treatment of strains and contusions is a contusion should be placed in flexion for the first 24 hours post injury, to limit haematoma formation i.e. a hinged knee brace at 120 degrees or an elastic compression wrap. A complication of severe quadriceps contusion (9-17%) is proliferation of bone and cartilage called myositis ossificans. This is suspected if symptoms worsen after 2-3 weeks and if there is persistent swelling and a loss of knee flexion. Athletes can still continue to play with this but the ultimate outcome is usually surgery. Clinical Significance This study outlines the diagnosis and treatment of quadriceps injuries; including the different grades of contusions and sprains. Return to sport guidelines and suggested treatment in relation to healing times are all helpful to guide clinical practice.

High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players Silvis ML, Mosher TJ, Smetana BS, Chinchilli V, Flemming DJ, Walker EA, Black KP. American Journal of Sports Medicine (2011), Vol. 39, No.4 p715 - 721 Article Summary This study was conducted to determine the prevalence of pelvic and hip MRI findings and association with clinical symptoms in hockey players. Magnetic resonance images (MRI) were obtained of the hip and pelvis region of 21 professional and 18 collegiate hockey players. The subjects were all asymptomatic. The MRI scans were interpreted by 3 radiologists in two separate sessions. They assessed for features associated with common adductor-abdominal rectus dysfunction and hip pathology. Findings of common adductor-abdominal rectus dysfunction were observed in 36 percent of participants. Hip pathologic changes were observed in 64 percent of participants. A total of 77 percent of the hockey players demonstrated MRI findings of hip or groin pathologic abnormalities. Clinical Significance This is a great study that echoes the findings of previous studies that have found significant pathology in asymptomatic subjects. It is fascinating that such a high percentage of players had abnormalities and challenges what is deemed to be a “normal” hip or groin. It highlights the importance of clinical findings rather than simply diagnosing by imaging. One important implication from this study is the pathology identified by MRI in a symptomatic patient may have been pre -existing for a long time so is its presence really the main cause of the pain? Perhaps we as physiotherapists should be further exploring the option of conservative treatment rather than surgery even in the presence of positive findings on MRI.

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RESEARCH SECTION JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY

February 2012; Volume 42, Issue 2

www.jospt.org

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

The Convex-Concave Rules of Arthrokinematics: Flawed or Perhaps Just Misinterpreted? Donald A. Neumann

Manual Physical Therapy for Injection-Confirmed Nonacute Acromioclavicular Joint Pain Kevin D. Harris, Gail D. Deyle, Norman W. Gill, Robert R. Howes

Dynamic In Vivo Glenohumeral Kinematics During Scapular Plane Abduction in Healthy Shoulders Keisuke Matsuki, Kei O. Matsuki, Satoshi Yamaguchi, Nobuyasu Ochiai, Takahisa Sasho, Hiroyuki Sugaya, Tomoaki Toyone, Yuichi Wada, Kazuhisa Takahashi, Scott A. Banks

Clinical Examination Procedures to Determine the Effect of Axial Decompression on Low Back Pain Symptoms in People With Chronic Low Back Pain Gregory Holtzman, Marcie Harris-Hayes, Shannon L. Hoffman, Dequan Zou, Rebecca A. Edgeworth, Linda R. Van Dillen

The Patient-Specific Functional Scale: Validity, Reliability, and Responsiveness in Patients With Upper Extremity Musculoskeletal Problems Cheryl Hefford, J. Haxby Abbott, Richard Arnold, G. David Baxter

Risk Factors for Patellofemoral Pain Syndrome: A Systematic Review Nienke E. Lankhorst, Sita M. A. Bierma-Zeinstra, Marienke van Middelkoop

Learning Lumbar Spine Mobilization: The Effects of Frequency and Self-Control of Feedback Emma G. Sheaves, Suzanne J. Snodgrass, Darren A. Rivett

Effects of a Proximal or Distal Tibiofibular Joint Manipulation on Ankle Range of Motion and Functional Outcomes in Individuals With Chronic Ankle Instability James R. Beazell, Terry L. Grindstaff, Lindsay D. Sauer, Eric M. Magrum, Christopher D. Ingersoll, Jay Hertel

Functional and Biomechanical Outcomes After Using Biofeedback for Retraining Symmetrical Movement Patterns After Total Knee Arthroplasty: A Case Report Jodie McClelland, Joseph Zeni, Ross M. Haley, Lynn Snyder-Mackler

Lateral Ankle Ligament Injury Following Inversion Ankle Sprain Matthew T. Stehr

Anterior Knee Pain: As an Athlete, Am I at Risk?

www.jospt.org

RESEARCH SECTION

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www.spts.org/ijspt Volume Six, Number Four TABLE OF CONTENTS Knee kinematics following ACL reconstruction in females: the effect of vision on performance during a cutting task. Authors: Bjornaraa J, DiFabio R Comparison of hip and knee strength and neuromuscular activity in subjects with and without patellofemoral pain syndrome. Authors: Bolga LA, Malone TR, Umberger BR, Uhl TL Comparison of ankle arthrometry to stress ultrasound imaging in the assessment of ankle laxity in healthy adults. Authors: Sisson L, Croy T, Saliba S, Hertel J Reliability of the sitting hand press-up test for identifying and quantifying the level of scapular medial border posterior displacement in overhead athletes. Authors: Hong J, Barnes MJ, Leddon CE, Alamar B, Van Ryssegem G Effects of forefoot running on chronic exertional compartment syndrome: a case series. Authors: Diebal AR, Gregory R, Aliz C, Gerber JP Electromyographic activity of scapular muscles during diagonal patterns using elastic resistance and free weights. Authors: Witt D, Talbott N, Kotowski S SYSTEMATIC REVIEW The clinical utility of physical performance tests within one-year post-ACL reconstruction: a systematic review. Authors: Narducci E, Waltz A, Gorski K, Leppla L, Donaldson M CASE REPORT Comprehensive strength training program for a recreational senior golfer 11-months after rotator cuff repair. Authors: Brumitt J, Meira EP, Gilpin HE, Brunette M CLINICAL SUGGESTION Chest injuries: what the sports physical therapist should know. Author: Smith D

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

http://researchreview.co.nz

Studies in this issue:

 Kaiser Permanente Healthy Bones program

 Predictors of standing balance in MS patients

 IV zoledronate after 3 years – continue or stop?

 Dynamic splinting effective for post-op hallux limitus

 Debate for and against calcium supplementation

 Assessing efficacy of treatment for plantar fasciitis

 Monitoring osteoporosis therapy – to scan or not to

 RA patients: low rates of access to podiatry services

scan?

 Bisphosphonate treatment holidays  Association between vitamin D level and bisphosphonate response

 IV zoledronic acid plus sc teriparatide for osteoporosis  U-shaped association of mortality with serum vitamin D levels

 Shoe insoles: reduced impact loads during walking  Foot orthoses: soft-flat most comfortable  Gentamicin penetration decreased in peripheral arterial disease

 Footwear stability: pain and injury in female runners  Multifaceted podiatry of benefit to elderly with disabling foot pain

Studies in this issue:

Studies in the latest issue include:



Home programme intervention



How well are you recovering?



Pain relief: a universal human right



Symptoms of post-concussion syndrome



Measuring the value of long-term (social) care



Continuity of care and its influences

 Compression garments and performance



What patients want from health care

 Characteristics of recurrent ankle sprains



Improving work disability outcomes

 Exercise as the fifth vital sign in healthcare



Helping people with disabilities get hired

 Knee osteoarthritis after ACL reconstruction

 ACL reconstruction: three different grafts with same bone drilling method  Cervical muscle strength and head impact biomechanics in young ice hockey players  Exercise after corticosteroid injection for shoulder pain

http://www.researchreview.co.nz

AWARDS

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2011 STUDENT RESEARCH AWARDS Congratulations to the winners of the SPNZ Student Research Prizes for 2011. The abstracts from the winning entries from AUT University and the University of Otago are included in this Bulletin. We hope to be able to bring expanded versions of the projects in future editions.

AUT UNIVERSITY: Outcome Measures Assessing Pain Levels Pre- and Post-Total Knee Arthroplasty: A Literature Review. Thomas Mason and Joshua Rogers Abstract The number of total knee arthroplasties (TKA) in New Zealand is increasing. Objective measurement of pain pre- and post-TKA is important to determine the efficacy of surgery and rehabilitation. The purpose of this review is to critique all available articles that measure pain outcomes with TKA. Electronic databases (Medline via Ebsco, Cochrane Library, Cinahl, Scopus) were searched up to May 2011 to find relevant articles. Keywords used were “knee arthroplasty” AND “pain” AND “outcome” with either “preoperative” AND “postoperative” OR “before” AND “after”. Two researchers critiqued all articles to assess methodological quality. Fourteen studies were included in the review and the overall methodological quality was found to be moderate. Results showed positive changes in pain in all studies with 10 outcome measures used. The responsiveness of some of the outcome measures is problematic. A research proposal is presented to assess true change in pain by using interval data.

UNIVERSITY OF OTAGO: The Challenges of Finding Sports Concussion Information on the Internet Ben McLeod, Bridget Henderson, Connor Austin, Mark Crouchley and Michelle Borren Abstract Objective: The objective of this study was to observe and document the strategies used by young people when they search the Internet for the information required to answer a sports-related concussion scenario. Design: The study design incorporated the Think Aloud methodology, where the participants searched for the answer to a scenario on the Internet, while describing their decision making processes. Setting: University laboratory environment. Participants: Twenty physically active participants aged 20-26 were recruited from a university population and from the general public. Interventions (or Assessment of Risk Factors): None Main Outcome Measurements: Key outcome measures included: websites accessed, time spent searching, search terms used and the answers to the scenario. The qualitative measures included descriptions of the participants‟ search decisions. Results: The most common score of participants‟ answers to the scenario was 2/7 and most participants reported they had confidence in the information retrieved. Fifty five search terms were used and the most frequently used term was “concussion recovery” (7/55, 12%). Fifty four websites were accessed with Accident Compensation Corporation and KidsHealth each being accessed by seven participants. Participants‟ dialogue was primarily about the site content (265/925, 29%) and site quality (116/925, 12%). Conclusions: Although there is good sports concussion information online, people are not accessing the quality sites. Website designers of quality concussion information need to adapt their sites to be more accessible via search engines and user friendly to the general population. Key Words: Brain concussion, sports, Internet, medicine 2.0, concussion awareness, Think Aloud

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CONTINUING EDUCATION Upcoming courses and conferences in New Zealand and overseas in 2012. www.nzsopa.org.nz/calendar.html LOCAL COURSES & CONFERENCES When?

What?

Where?

More information

18-19 February

Flawless Motion - Sporting Shoulder

Auckland

steph_winstone@hotm ail.com

24 February - 2 March

STOTT PILATES: Intensive Mat Plus Course

Auckland

info@corepilates.co.nz

25-26 February

NZMPA - Cervical Spine

Auckland

www.nzmpa.org.nz

3 - 4 March

Back In Motion Pilates - Mat Level 1

17-18 March

Sports Physiotherapy NZ

Sebel Trinity Wharf,

”Prevention, Practice & Performance”

Tauranga

17 March

NZMPA—Lumbar Spine and SIJ

Christchurch

www.nzmpa.org.nz

24-25 March

PAANZ - Women’s Health Endocrinology Immune Systems

Auckland

www.paanz.org.nz

31 March

Physio’s Guide to Floor and Core Training

New Plymouth

click here for info

12 April

NZ Pain Society 37th Annual Scientific Meeting “A Head of Pain”

Wellington

www.nzps.org.nz

26 May

Nelson/Marlborough Branch - Hip Symposium

Nelson

click here for info

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 Oct - 2 Nov

Be Active 2012 (Sports Medicine Australia)

Sydney

beactive2012

2012

click here

www.nzsopa.org.nz

INTERNATIONAL COURSES & CONFERENCES When?

2012

Page 20

SPNZ WEBSITE SPNZ MEMBER SECTION

www.sportsphysiotherapy.org.nz/members1.html 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.

Book Reviews Book reviews on sports physiotherapy topics

Snippets Vacancies

Quick sports physiotherapy tips

Sports Team Positions and Clinic Positions available Calendar Clinical Forum Got a clinical question and want advice from members?

Calendar of upcoming courses and conferences