SPNZ Bulletin feb 2013 by Sports & Exercise Physiotherapy NZ

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ISSUE 1 l FEBRUARY 2013

BULLETIN FEATURE TOPIC: ALL BLACKS SEVENS RUGBY - Matt Wenham Current Membership: 805 SPNZ EXECUTIVE COMMITTEE President Secretary Treasurer Website & IT Committee

Dr Angela Cadogan Michael Borich Dr Gisela Sole Hamish Ashton 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 Karen Carmichael Deborah Nelson Amanda O’Reilly Kate Polson Charlotte Raynor Nathan Wharerimu

ADVERTISING Advertising terms & conditions click here.

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

Welcome to the February 2013 Edition In this Edition: EDITORIAL: Career Pathways and Job Opportunities for Sports

Physiotherapists

LATEST NEWS

SPNZ COURSES

IFSPT REPORT

FEATURE: All Blacks Sevens Physiotherapist - Matt Wenham

We profile Matt Wenham, Physiotherapist for the All Blacks Sevens, who has led the medical/physiotherapy team at the IRB HSBC Sevens World Series for more than ten years.

CLINICAL SECTION Article Review: Epidemiology of knee injuries in professional male rugby union players: A literature review

RESEARCH SECTION SPNZ Research Reviews: Incidence and Prediction of Injury in Rugby Sevens, Professional Rugby and Football. Recovery Strategies: do they work?

JOSPT: Volume 43, No. 2, February 2013

Research Reviews

ASICS SHOE REPORT: Cricket the Poor Cousin??... Not Anymore

CONTINUING EDUCATION CALENDAR

AWARDS

2012 Student Research Award– AUT and University of Otago

SPNZ WEBSITE INFORMATION

CLASSIFIEDS

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CAREER PATHWAYS AND JOB OPPORTUNITIES FOR SPORTS PHYSIOTHERAPISTS By Dr Angela Cadogan

The increased amounts of government and private funding, combined with the proliferation of professional and semi-professional sport in New Zealand has resulted in an expanded career pathway for Sports Physiotherapists in this country. Gone are the days when ‘Sports Physiotherapy’ is provided in the clinic. Increased job opportunities at an advanced level have re-located physiotherapists into travelling team roles or with individual athletes, and employment or contract positions within National Sporting Organisations. In this article we take a look at the career pathway that now exists for Sports Physiotherapists, focusing on the job opportunities that now exist for Sports Physiotherapists working at an advanced level outside the clinic setting.

History of Sport in New Zealand New Zealand has a long history of sporting prowess on the world stage. Sport in New Zealand reflects our colonial heritage. From the early days of the British settlers, the popularity of rugby union, cricket and netball, primarily played in Commonwealth countries paid testament to our British roots.

Professionals in an Amateur Game In the 1940’s, annual community sports days adapted from British models hosted contests ranging from professional athletics to wood-chopping and incomprehensible Scottish pursuits. Most professional sport was marginalised, practised only by those with great talent in boxing, wrestling or billiards, or badly in need of extra income. As wartime bonds faded from immediate memory in the 1950s and 1960s, leisure activities became a little more individualistic, and competitive sport was no exception to this trend. It was during this time that the likes of Bruce McLaren (Formula One), a young Sir Bob Charles (golf), Elsie Wilkie (lawn bowls), Yvette Williams (long jump), Murray Halberg, Peter Snell (middle distance running) and a host of other ‘amateur’ athletes excelled on the world stage, helping to put New Zealand on the world sporting map. Although there are reports that Rugby League split from Rugby Union to become professional in 1895, and there were some murmurings of payments driven by some individuals athletes in the 1970’s and 1980’s, the proliferation of professional sport in New Zealand didn’t really begin in earnest until the 1990’s. Rugby Union became professional after the 1995 Rugby World Cup, and professional national and domestic cricket contracts were offered for the first time in 2002. Other sports including netball, hockey and football continue to transition from the amateur to professional status. CONTINUED ON NEXT PAGE….

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Career Pathways and Job Opportunities for Sports Physiotherapists continued….. Rise of Professional Sport “Professional” in the sporting context implies that an athlete receives payment to enable them to dedicate the time required to training and competition, without the financial barriers imposed by having to ‘earn a crust’. Sport in New Zealand has, and will continue to ‘professionalise’ in response to growing international competition, and having to ‘keep up’ with other sporting nations to remain competitive. The financial aspect of sport has resulted in increased commercialisation. Sport has become a “product”, with sporting organisations now operating a fully fledged “businesses”, with athletes as their “employees”. High profile and lucrative sponsorship deals are dependent upon the profile of the sport, which in turn depends, to a large degree, upon the performance of the individual or team. As a sports physiotherapist involved in this environment, this results in enormous amounts of accountability. Your inability to correctly diagnose, refer, or rehabilitate a professional sports person in the arena of professional sport can have not only career implications for the individual athlete but also for the sport, and it’s governing bodies in terms of performance and sponsorship arrangements if key players are not available. In Australia, a physiotherapist is currently involved in court proceedings, being accused of ending the career of a promising golfer by failing to correctly diagnose back pain, and for the application of inappropriate treatment. Sport is now a business, and the stakes are high.

Salaries for Professional Sports People “Stuff.co.nz” (the font of all knowledge) recently revealed New Zealand highest paid sports people with annual incomes as follows: Russell Coutts (yachting) Ryan Nelson (football) Sonny Bill Williams (jack of all trades) Dan Carter (rugby) Richie McCaw (rugby) Scott Dixon (motorsport) Ross Taylor (cricket) Jerome Kaino (rugby) Brendon McCullum (cricket) Benji Marshall (rugby league)

$15.2 million $5.2 million $2.5 million $2.5 million $2 million $1.5 million $1.5 million $1.4 million $1.1 million $1.1 million.

While these may be similar to physiotherapy salaries (tongue firmly in cheek), the total amounts will also include endorsements. However, in many cases the contracting sporting organisation (NZ Rugby Union, NZ Cricket, NZ Rugby League) will be paying a good portion of these amounts as player salary or contract payments. While there are many New Zealand athletes who are paid much more nominal sums the point I am making here is that there is now an awful lot of money at stake, For Sports Physiotherapists, this results in an elevated level of accountability for having appropriate and proven levels of sport-specific knowledge, practical skills and behaviours, combined with considerable experience in that sport at higher levels.

Government Funding Making New Zealand consistently one of the most successful sporting nations in the world is a government priority. (Sport and Recreation Minister Murray McCully). In the 2009/10 year, the Government announced a massive funding injection for high performance sport: an extra $10 million in 2010/11, increasing to $15 million in 2011/12, and $20 million annually after that. This means that in 2012/13, funding for high performance sport will be more than $60 million a year. Part of this funding has helped develop world class training facilities in Auckland, Wellington and Dunedin, as well as the National Cycling Centre of Excellence (Cambridge) and the Rowing High Performance Centre (Lake Karapiro). The government also contributes lump sums for pinnacle events, such as the $1million funding boost for the 2013 Winter Games. However, Sport NZ's investment is only part of the funding landscape for the sport and recreation sector. Philanthropic trusts, gaming trusts and community funders also play a significant role in supporting the sector. (Other sources of funding). CONTINUED ON NEXT PAGE….

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Career Pathways and Job Opportunities for Sports Physiotherapists continued….. Changing Landscape of Sports Physiotherapy The advent of professional sport, and the increasing government emphasis on high performance sport funding and results on the world stage, has changed the sports physiotherapy landscape. Gone are the days when ‘Sports Physiotherapy’ was provided in the clinic all week, with only a couple of hours on the sideline at the weekend. Professional sport and increased government funding has taken advanced Sports Physiotherapy practice out of the clinics, and placed it firmly ‘on tour’, and created both clinical and management positions within national sporting organisations and within centres of excellence. It has also created new opportunities for advanced Sports Physiotherapists to work individually with an increasing number of government funded athletes enabling payment for physiotherapy services, where previously this was not possible. Roles with International and Domestic Teams While international teams existed prior to professional sport (they just weren’t paid), the team physiotherapist is now an affordable institution for the majority of teams, rather than an unaffordable luxury. We are also competing in an increasingly larger number of sports on the world stage, hence and increasing number of international teams requiring physiotherapy services. Most sports support at least six domestic/provincial level teams (in New Zealand such as HRV, ITM Cup, or overseas such as football, basketball and softball), as well as many more local club teams. In addition, sporting franchises also contract physiotherapists to work with their teams e.g Super Rugby has six New Zealand teams, Indian Premier Cricket League etc. We now have many more representative teams (U21, NZ Maori, NZ’A’, etc) in many sporting codes that provide competitive opportunities for developing players. These teams also travel with a physiotherapist in most cases, again increasing the opportunities for sports physiotherapists at this level. In New Zealand at present, it is conservatively estimated that there are over 100 such paid positions for sports physiotherapists. Many club-level teams, particularly in major sports, also have team physiotherapists who may or may not be paid. Roles in Talent Development The professional era has necessitated an increased focus on the development levels of sport. “Talent Development” programmes aim to produce more skilled and conditioned athletes at younger ages with the goal of increasing the concentration of high quality competition at higher levels. The younger age of development level athletes presents its’ own unique physical, psychological and ethical challenges for the more than 20 physiotherapists nationwide charged with managing the medical, physiotherapy and conditioning needs of these young athletes. Roles with Individual Athletes While few individual athletes are fully professional, the increasing amount of government sports funding through organisations such as Sports New Zealand and High Performance Sport New Zealand, also means many individual athletes now receive more financial assistance with the aim of improving their placings in world rankings and at pinnacle events such as Olympic and Commonwealth games. While in some sports such as swimming there may be one physiotherapist allocated to a group of individual athletes increasingly, individual athletes such as Val Adams and Sophie Pascoe, engage the services of one physiotherapist who may travel with these athletes. While it is unclear exactly how many such positions exist within New Zealand, the number is certain to increase in the future as athletes try to maintain the edge on the world stage and see high quality advanced sports physiotherapy services as a critical component of achieving this goal.

CONTINUED ON NEXT PAGE….

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Career Pathways and Job Opportunities for Sports Physiotherapists continued….. Roles within National Sporting Organisations National Sporting Organisations (NSO) typically have high performance systems in place that serve talented development level athletes/squads, representative teams (U19, U21, NZ ‘A’, Emerging Players, and other ad hoc teams), as well as the international ‘flagship’ team e.g. All Blacks. This has created opportunities for contracts/employment based within various sporting organisations in the following roles:    

Injury Surveillance Systems Injury Prevention Programmes (squads or individuals) Medical Case Management and Return to Sport Processes Service Coordination (“Lead” or “High Performance” physiotherapist).

These positions are often based on-site at the NSO base, and vary between one day per week to full-time work. Although injury assessment and management is not part of the job in all cases, when carried out, is not done in the clinic setting. Conservative estimates put the number of such positions in New Zealand at present at over 70. Medical Coordinator/Director To my knowledge this precedent, (Physiotherapist as a Medical Director), has not been set in New Zealand to date, however it is now happening in other countries.[1] Key responsibilities of the medical director are to align the healthcare delivery strategies of all components to provide consistent high-quality care to all teams, administering team medical coverage, over-seeing technical considerations, such as doping control and providing all teams with updated, evidence-based health -care information. On the administrative side, the role involves development and maintenance of budgets, procuring athletic health insurance, and purchasing equipment ranging from athletic tape to automated external defibrillators. The role involves coordinating educational activities, conferences, and injury-prevention projects for the sporting organisation. The large, and sport-specific scope of physiotherapy knowledge, administration and management required at this level is evident. Roles within Centres of Excellence Government funding has provided dedicated sports medicine facilities in several centres of excellence around the country. Opportunities are available in these centres for advanced level sports physiotherapists to work with high performance athletes to oversee their injury prevention and management. These services are provided within the centre of excellence, where physiotherapists have direct access to world class support personnel (biomechanists, strength and conditioning coaches, anthropometry, exercise physiologists, nutritionists etc).

So, with well over 200 high level sports physiotherapy positions either part- or full-time in New Zealand, what is the pathway to a career in elite sport?

Getting There No Substitute for Experience Historically, high level positions in sports physiotherapy have been based upon opportunity, rather than due process. While this is still the case to some extent, there are now more robust application processes in place. To be capable of fulfilling physiotherapy roles at the top level requires experience, experience and more experience. While knowledge and skills are important, without sport-specific experience to provide the ‘filler’ with which to bind together the knowledge and skills, you will not last in the unique, high pressured, highly competitive and extremely fickle environment of elite sport. CONTINUED ON NEXT PAGE….

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Career Pathways and Job Opportunities for Sports Physiotherapists continued….. Getting the experience will require a significant investment of your time that will not necessarily be remunerated in the early stages. While payment for service is the goal to strive for in Sports Physiotherapy, the reality is that not all sporting organisations have the means to pay, particularly at lower levels, meaning turning down unpaid experience may ultimately disadvantage those who require ‘miles on the clock’. Knowledge and Skills Sport-specific knowledge and skills are a prerequisite for providing high quality Sports Physiotherapy services. In New Zealand, post-graduate continuing education in sports physiotherapy is scarce. As I pointed out earlier, with sporting organisations investing large sums of money in their athletes, it would make sense that the higher the level of physiotherapy service required, the higher the level of knowledge and skill (and experience) is required to give that ‘investment’ the best chance of performing to their full ability (ie. staying on the field!). While SPNZ are working to address the deficit in advanced Sports Physiotherapy education in New Zealand, evidence of ongoing education provides a framework for progression through this pathway. The diagram below summarises the roles now available for Sports Physiotherapists, and the associated levels of education and/or achievement.

It is hoped that with the evolution of Sports Physiotherapy within professional, and higher levels of sport (regardless of payment status) will progress according to this type of model. This requires that the physiotherapy profession recognises the high level, diverse and unique industry requirements of advanced sports physiotherapy practice, and the sport-specific physiotherapy and management skills required to work in this environment. It also requires sporting organisations to recognise levels of qualification and skill within sports physiotherapists applying for positions within their organisation. Dr Angela Cadogan President SPNZ REFERENCE 1. Lifshitz L: A sports physiotherapist as medical director: taking a leadership role. Journal of Orthopaedic and Sports Physical Therapy 2012, 42(9):748-749. For young physiotherapists with an interest in Sports Physiotherapy, there is a pathway to the elite level of Sports Physiotherapy practice. SPNZ are currently developing and beginning to roll out education courses that will help you achieve the knowledge and skills required and these courses will be taught by physiotherapists with proven experience at international level. We are also willing to provide advice and guidance for any physiotherapist interested in working at higher levels of sport. Please contact our secretary mborich@ihug.co.nz

LATEST NEWS

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More Website Resources on the Way Visit the SPNZ Website to see our latest additions to member resources. http://www.spnz.org.nz/ STOP Sports Injuries SPNZ has recently become a partner of Stop Sports Injuries, an American based organisation with a specific interest in stopping sports injuries to children. They have some great resources, some of which are linked from our website. Public Information - Health Advice Tab This section is slowly coming together. As well as a link to the Find-a-Physio section we are adding general advice for coaches, athletes and parents. If you have any resources you feel would be a good addition forward them to me help@spnz.org.nz. As we get more public information on board we will get the opportunity to promote the website to the public and sporting bodies. This will add value to your Find-a-Physio listing. Members Only Resources We are also loading more member only resources. These can be found under Members - SPNZ Resources.

SPECIAL PROJECTS GROUP - Call for Volunteers Do you have 1-2 hours available every 2 months? Want to be involved in SPNZ ( as little or as much as you like ) without the commitment of a committee position? Need CPD points for Professional Activity or Self-Directed Learning? Have ideas for SPNZ that you would like to share? Join our Team of SPNZ Volunteers At present the activities primarily involve short article reviews for the SPNZ Bulletin, but as the groups activities grow, there is scope for involvement in other activities, and we are always looking for new ideas and input from members and Special Projects Group volunteers.

Interested? Contact Michael Borich (secretary) mborich@ihug.co.nz

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31st January 31st March 31st May 31st July 30th September 30th November

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SPNZ COURSES

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SPNZ COURSE TIMETABLE 2013 SIDELINE SAFETY A course for physiotherapy students who work on the sideline with sports teams. Learn about the role of the sideline ‘medic’, relationships with other professionals, pre-participation preparation, injury prevention, first aid, injury assessment and management including concussion assessment and management, and sports taping. Open to:

3rd and 4th Year Physiotherapy Students

Date:

16th March 2013

Location:

AUT University, Auckland.

More Information:

help@spnz.org.nz

IMMEDIATE CARE AND SPORTS TRAUMA MANAGEMENT A course for qualified physiotherapists working at any level and type of sport. This course is presented by Emergency Medicine Specialists with sporting experience (NZRU, Rugby World Cup 2011), and consists of a mixture of lectures, video, interactive and hands on practical sessions covering: 

Emergency life support



Airway assessment and management



Assessment and stabilisation of head and spinal injuries, fractures and dislocations



Management of anaphylaxis



Management of environmental emergencies (heat illness and hypothermia)



Emergency transport and communication with other health professionals

Open to:

All SPNZ members

Presenters:

Dr Rob Everitt and Dr Duncan Reid (Emergency Medicine Specialists) and Stephanie Vos (NZ Resuscitation Council Trainer)

Date:

Sunday 7th April 2013

Location:

Waitakere Hospital, Auckland

Cost:

$402.50

More Information:

http://sportsphysiotherapy.org.nz/courses/

To Register:

Download registration form and send to: nzsp@physiotherapy.org.nz

IFSPT REPORT

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INTERNATIONAL FEDERATION OF SPORTS PHYSICAL THERAPY ( I FSPT ) REPORT

Dr Tony Schneiders IFSPT website London 2012 Olympic Games The London Olympic Games were the pinnacle of sporting highlights for 2012 with many IFSPT member organisations competing and many of their physiotherapists involved. This was a great opportunity for IFSPT to network with relevant sporting organisations and this was facilitated by Nicola Phillips, the IFSPT president, who played a lead role with Team GB that performed so well on home soil. Nicola has recently created strong links with Marie-Elaine Grant, the new Physiotherapy representative on the International Olympic Committee (IOC) Medical Committee. She is very positive about working with IFSPT regarding the development of a global Sports Physical Therapy network linked with the IOC movement. This will hopefully be endorsed by the IOC once the new IOC Chief Medical Officer starts this year. Nicola has also been involved in ongoing work related to selection criteria and evaluation for recruiting allied health volunteers to subsequent Olympic and Commonwealth Games. The authors of this project plan to publish the results in a peer review journal over the next year and it will include links to IFSPT competencies as part of the documentation. It should be of strong relevance to New Zealand and could be adopted by the New Zealand Olympic Committee (NZOC). On the subject of the IOC movement, Nicola has also been busy editing chapters for the new IOC Handbook related to Sports Therapies and titled “Handbook of Sports Medicine and Science, Sports Therapy” which has now been published. Check it out for yourself at this website. http://au.wiley.com/WileyCDA/WileyTitle/productCd-1118275772,descCdtableOfContents.html New Members of IFSPT Membership of IFSPT continues to grow and now stands at 25 countries and late last year IFSPT welcomed Cyprus and Finland to the organization with the latter completing the trifecta of Scandinavian countries with full membership status. IFSPT now represents over 18,000 members worldwide. The IFSPT executive recently met and discussed new strategies for further increasing the membership with a particular focus on WCPT member organisations in South America, the Pacific and Africa who are currently under represented on IFSPT. The possibility of associate member status for developing countries was also discussed and will be explored further. 2012 Team Concept Conference On 28 November 2012 the Executive Board (EB) of IFSPT held its 2012 meeting in Las Vegas, hosted by the American Sports Physical Therapy Section. Over 100 delegates, including a number of attendees of IFSPT Member Organisations also attended the IFSPT pre-conference symposium “Global Concepts” on 29 November, with approximately 400 attending the Team Concept Conference from 29 Nov - 1 December 2012 (Report on this conference to follow in next Bulletin). The ability to run a symposium/workshop hosted within a major conference is a strategy that allows IFSPT to utilise its executive and co-opted members to present relevant topics with the income generated going mostly back to IFSPT. This is important as IFSPT has just last year returned it finances to the “black” after many years servicing debt incurred by a

IFSPT REPORT

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IFSPT Report continuedâ&#x20AC;Ś.. failed conference in Europe. At Global Concepts, I presented a paper on the use of manual therapy in sports physical therapy practice which, while being a little away from my area of sports medicine research, was hopefully well received. Being a global organisation, in order to spread the meetings that IFSPT member organisations must attend fairly across continents, this year it is likely that the South African Sports Physiotherapy Group will inaugurally host both the IFSPT General Meeting and a pre/post IFSPT symposium. Feedback on IFSPT Welcome Look out for the next e-news from the IFSPT for further details on activities and happenings within the organisation. As SPNZ representative to IFSPT and a member of the executive board, I would love to receive your feedback regarding the work IFSPT are doing so please donâ&#x20AC;&#x2122;t hesitate to contact me at any time to discuss.

The Global Goals speakers are shown from left to right: Stephen Mutch, Scotland; Tony Schneiders, New Zealand; Henning Langberg and Bente Andersen, Denmark; Maria Constantinou, Australia; Mario Bizzini, Switzerland; Dr. Tim Brown, USA; Michael Dalgleish, Australia; and Nicki Phillips, Wales.

Ka kite ano Dr Tony Schneiders

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FEATURE ALL BLACKS SEVENS PHYSIOTHERAPIST PHYSIOTHERAPIST - MATT WENHAM

In this bulletin we profile Matt Wenham. Matt is a Partner in Northcross Physiotherapy in Auckland, and Physiotherapist for the current All Blacks Sevens. He has had extensive involvement with National Sports teams including NZ Rugby Sevens, NZ Tall Blacks, NZ Rugby U20’s and NZ Black Ferns. He has led the medical/physiotherapy team at the IRB HSBC Sevens World Series for more than ten years. As a Sports Physiotherapist he has been involved in five World Championship campaigns (Black Ferns 2006, NZRU U20s 2008/09, IRB 7s WS 2010/11 and 2011/12 ) and toured with the NZRU Sevens team for the 2010 IRB Series and successful Commonwealth Games in Delhi. How did you become the All Blacks Sevens Physiotherapist? A wise person once said that to achieve a “dream” job required: 

30% Aspiration



40% Perspiration



20% Dedication



10% Inspiration

That’s the truth. When I finished my nine years of university in 1996 (four in Otago studying PE) and five in Auckland (undergrad/postgrad) I rolled my sleeves up and put my hand up for any sports job there was (Club Rugby Physio in Wellington, Netball age group physio in Wellington, Capital Shakers Physio, Wellington Sevens Physio, International Sevens Medical Manager, Black Ferns Physio, NZRU U20’s Physio, Tall Blacks Physio, NZ Sevens Physio......and now All Blacks Sevens Physio. This has taken 16 years of my life....and I figure about four more years until I get told to move aside (hopefully). What are the physical requirements of a modern day Sevens player? A recent research paper by IRB which I have been participating in says that the modern day Sevens athlete is: 

Younger than a 15’s national team member



Lighter than a 15’s national team member



Shorter than a 15’s national team member



Fitter than a 15’s national team member



Slightly more likely to suffer an injury to the lower limb



Injuries are more severe than those suffered by international 15’s players

In short Sevens athletes are physical freaks. They have to have the speed of a sprinter, the endurance of a 1500m runner, the power of a field athlete, the strength of a weight lifter and the mental/intestinal fortitude of a rower. Gordon Tietjens demands that our team is the fittest team on the World Series circuit. Mark Harvey (our S&C trainer) delivers that, and my job is to stop them getting broken.....it’s a constant balance between being thrashed and recovery to do it all day after day after day. What is my role in the team? My JD reads like a cure for insomnia but basically it reads that I am responsible for the physical and mental preparation and wellbeing (wellness) of our group of athletes (who will number 20 players in 2013). I screen them, conduct injury prevention programmes with Harvs, panelbeat them post-training and help drive our 15+ point recovery programme. Sometimes I massage them, sometimes I listen to them, sometimes we have movie nights/ comedy nights around the physio table while I am treating. Mostly I treat, but perhaps even more so I listen and try to act as a conduit between the players and the coaching staff (fishheads!). CONTINUED ON NEXT PAGE….

FEATURE

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All Blacks Sevens Physiotherapist continued….. Sometimes I clean up after them, sometimes I drive the team bus, sometimes I nurse them when they are broken, sometimes I crack a few big heads and growl at them, sometimes I defend them if they’ve stuffed up. In one team session I said I felt like the big brother operating in the space between the younger child (player)getting told off for not doing anything right and the Dad (Coach) always growling that they could always do better...that’s a good summary of my role I reckon. What Injury Prevention strategies do I use? My mantra is this. The thing that predicts an injury is a history of previous injury. Know your athlete’s history when they first roll into your camp and you will quickly reduce their risk of further injury. Secondly, know the sport. As you can see my athletes are predisposed to serious lower limb injuries so both myself and our S&C coach spend a lot of time running injury prevention sessions (ie. trigger point and myofascial release sessions each morning, gym/training primers and prehab drills, flexibility assessment and training sessions, recovery strategies and performance/recovery nutrition with Richard Swinbourn, our nutritionist). Nothing we do is revolutionary....we use a lot of strategies and vary it up depending on the environment we are in. More importantly we try to educate the players as to “why” we do the things we are doing. What are the most common injuries I see? The IRB research paper confirms what I know. Mostly lower limb injuries to the ankle and knee, plus muscle tears to the hamstring and calf. Being a contact sport we have a fair few broken bones/dislocations but by and large I would categorise the injuries into two sub-groups:  

Overtraining: Tendinosis/tendinitis of Achilles, plantar fascia, patella tendon, and proximal hamstring, bony stress injuries- os pubis, shin and foot Undertraining: Acute muscle strains....mostly of the lower limb

In short we have a group of five athletes who have been in the team for four to six years and have the training miles and the battle hardening that comes of surviving that number of Titch’s training sessions and that number of tournaments.....these athletes are more prone to the over-training injuries but by and large through Darwin’s theory of evolution they demonstrate the survival of the fittest principle. The second group of athletes we have are the up and coming stars who burst out of school/U20’s onto Titch’s radar. These are talented athletes with all the right physical building blocks but quite often they have never, ever trained like a world class athlete. When they come into one of our camps they get a rude shock. Usually if they take all the messages on board they go away from their first camp and either train the house down or give up. Those that come back are trying to impress, but sometimes due to the shortness of training windows are prone to overtraining strains. Trying to manage this dilemma is my biggest challenge. What are the challenges with a “tournament” sport like Sevens? We play 10 tournaments a year in Australia, Argentina, Dubai, South Africa, New Zealand, USA (Las Vegas), Hong Kong, Japan, Scotland and England plus one pinnacle event like Sevens RWC in Moscow, Russia in 2013 (CG in Scotland 2014, Olympics in Rio 2016). We are currently on the road for 150 days a year, we spend 180 hours in the air travelling and our players and management team are dispersed across the length and breadth of New Zealand on return and we do not have a “base” as such. The biggest challenges for me are in keeping 20 players fit for selection for every camp/tournament and then case managing our “broken” players remotely around the country or globe. One of the major challenges is in making decisions on a players fitness when we are across the world and the coach needs to know if that player is going to be fit for selection for that tournament, the next day or the next week......that’s what really gives me grey hairs!

CONTINUED ON NEXT PAGE….

FEATURE All Blacks Sevens Physiotherapist continued….. What recovery strategies do we use? 

Active recovery



Hydration



Nutrition (performance and recovery)



Contrast baths



Pool recovery



Compression clothing



Massage



Normatec



Sleep



Travel plans



Humidiflyer masks



Fireflys



Blue Lights



Competition



Relaxation

Pictured with the All Blacks Sevens gold medal winning team at the New Dehli Commonwealth Games 2010, Matt is fourth from the left in the back row.

Matt Wenham BPh.Ed(Otago), BHSc(Physio), PGD(Musculoskeletal)

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CLINICAL SECTION ARTICLE REVIEW Epidemiology of knee injuries in professional male rugby union players: A literature review

Raynor C (unpublished). Epidemiology of Knee Injuries in Professional Male Rugby Union Players: A Literature Review. ABSTRACT Rugby union is one of the world’s most popular team sports but also has the highest reported injury incidence rates. Epidemiology is the study of the distribution, effect and causes of a specific health event. Epidemiologic studies of rugby union players have looked at the severity, type and frequency of injuries. Injuries to the lower limb are most common with a high proportion happening to the knee. Although a higher incidence of knee injuries occur during matches, training acquired knee injuries were most severe and contribute to more days absence. More research is needed to review the relationship between player position and types of injuries. Evaluation tools can be used to assess movement patterns of individuals and as screening tools to identify problem areas. Rehabilitation and prevention strategies can then be established.

INTRODUCTION Rugby union is one of the world’s most popular team sports with an estimated three million people playing annually in 100 different countries. It still has one of the highest reported injury incidence rates compared to rugby league, soccer, ice hockey and cricket. Research literature on rugby union from 1995 onwards has mainly focussed on epidemiology; the study of the distribution, effects and causes of a specific health event. Epidemiologic studies of rugby players have looked at the type, frequency and severity of injuries in the players during a season, specific teams, Rugby World Cups (RWC) and other international rugby tournaments: such as Sevens and Under-20 junior word rugby events. It is important for the sports medical team to be aware of the incidence of the typical injuries in a sport as it may allow them to identify subgroups of players that may be affected. Spinal injuries in rugby union players are more familiar to the general public due to media coverage but it is often the lower limb that makes up the greatest proportion of injuries with a high proportion involving the knee. Only one study to date has looked specifically at knee injuries in rugby union players and there has been no literature review that amalgamates the literature on this subject. The literature review was limited to male rugby union players as the literature on female and amateur level is still limited. Injury Definition The difficulties in comparing epidemiologic data from rugby studies can be down to the variations in injury definition. The International Rugby Board (IRB) has developed a consensus statement on injury definition and data collection for rugby union studies. They defined an injury as a physical complaint where the body was not able to maintain structural and/or functional integrity. They use a classification of severity; slight (0-1 days), minimal (2-3 days), mild (4-7 days), moderate (8-28 days), severe (>28 days), ‘career-ending’ and ‘non-fatal catastrophic’. However the consensus statement does not guide the actual reporting of data – number of players per 1000 player hours. Consequently to compare and contrast some of the data from studies included in the literature review, published prior to the 2007 consensus statement, is problematic. Main Epidemiologic Knee Study A comprehensive study from the English Rugby Union premiership looked at 12 clubs over 2 seasons. This is the only study published to date that has looked specifically at the epidemiology of knee injuries. They recorded them as 11 per 1000 match-played hours compared to training-acquired injuries at 0.16/1000 player hours. Players with knee injuries sustained during training had more days absence than those with match-acquired injuries. This was the equal to 1 player being unavailable every second week due to a training acquired knee injury. On average each premiership team would have 10 knee injuries per season with a combined total of 353 days absence. The most common knee injury was the MCL with 28.9% of all knee injuries, which required an average 35 days absence from playing. Although ACL injuries were the lowest reported 0.01/1000 player hours they were most severe and caused the highest proportion of days CONTINUED ON NEXT PAGE….

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ARTICLE REVIEW CONTINUED... absence with 2292 days for the whole study. Knee injuries sustained during matches were highest in the inside and midfield backs and lowest in front-row forwards and outside backs, however not statistically significant. Rugby World Cups (RWC) Injury surveillance data from the RWC 1995, 2003 and 2007 were included in the literature review. Data from 1999 was never published and the 2011 data had not been published at the time. The author acknowledges the inclusion of a preprofessionalism article of the 1995 RWC but it acts as a good comparison. Knee injuries in 1995; 3.2/1000 player hours, 2003; 12.3/1000 player hours,and 2007; 9.9/1000 player hours. Unfortunately these studies did not elaborate on the types of knee injuries, and only the 2007 research used the aforementioned consensus statement for injury recording, but only mentioned ‘knee ligament’ injuries and did not specify which. Similar to the English study knee injuries sustained in training occurred less frequently, but equated to more days absence. In the 2007 RWC, backs had on average 47.7 days absence for each training-induced knee injury which equated to the whole tournament. Compare this to match -induced knee injuries at 28 days; equivalent to a player being injured in the opening pool games, but being fit to play in the quarter finals and beyond. The relationship between knee injuries and player position was explored but no conclusive position was more at risk. CONCLUSION The wide variety of the injury definition and surveillance data made the articles in this review difficult to compare. Most of the studies in this review reported that the lower limb particularly the knee had the highest amount of injuries, what is interesting is that only one study to date has looked at this specifically. The question now is what to do with this knowledge of injuries and in particular the high incidence rates of knee injuries. Some studies looked at the relationship between injuries and player position. This area was touched on in this literature review, rather than explored and there were conflicting answers for the most injured back or forward and further research is needed in this area. Identifying subgroups of players (such as player position) and their typical injury patterns can lead to prevention and management of these types of injuries. The biggest risk factor for getting an injury is history of a previous injury. Evaluation tools can be used to assess the movement patterns of the participants and used as screening tools to identify problem areas. Tests such as the Functional Movement Screen FMS™ or the star excursion balance test can be used to assess the performance of the participants. Rehabilitation of these problem areas can then be established, including prevention strategies such as prophylaxis strapping for example. A combined approach of assessing player functional movement patterns, injury screening and injury surveillance needs to be high on the agenda within the sports physiotherapy world. In a changing and financially rewarding game since professionalism, why do more rugby union players get injured, when theoretically they should be fitter? Does being fitter offer prevention from injuries? What needs to be done to prevent rugby knee injuries? Why are so many of the injuries occurring during training severe? These questions need to be addressed in future epidemiological studies of rugby union, if the players are to benefit. References can be provided on request.

Reviewed by Charlotte Raynor MPhty, PGDipPhty, BSc (Hons), NZRP, MNZSP

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS Incidence and Prediction of Injury in Rugby Sevens, Professional Rugby and Football. Recovery Strategies: do they work? www.sportsphysiotherapy.org.nz/resources

Can serious injury in professional football be predicted by a preseason functional movement screen? Kiesel K, Plisky P.J., Voight M.L. 2007. North American Journal of Sports Physical Therapy. 2;3. Article Summary Athletes with poor dynamic balance or poor fundamental movement patterns are more likely to be injured. This study aimed to assess the accuracy of the Functional Movement Screen (FMS) identifying athletes at risk for injury. The FMS is a comprehensive exam that assesses seven fundamental movement patterns such as squat, lunge and active straight leg raise. Limitations and asymmetries are detected using a scoring system from zero to three, where three is considered normal. Forty six professional football athletes were assessed with the mean score for all subjects being 16.9. The mean score for those who suffered an injury was 14.3 and 17.4 for those who were not injured. Sensitivity for the FMS was 0.54 and specificity 0.91 hence the FMS can be used to rule in the condition studied but has limited capability to rule out the condition. Clinical Applications A FMS score of 14 or less was used to determine the chance of injury compared to an athlete that scored more than 14. This study does have its limitations with low participant numbers, selection bias as only one team in the competition was used and the cut-off score was determined in the same study as the sensitivity and specificity. This should be determined from a separate study. However this study shows that the FMS is easily tested clinically and can be used to address limitations and asymmetries with functional movement patterns that are important in all sporting codes. Assessing and treating these asymmetries may lead to a reduction in injury rate for someone at risk. Reviewed by Amanda Oâ&#x20AC;&#x2122;Reilly BPhty (Otago)

Epidemiological Study of Injuries in International Rugby Sevens. Fuller C, Taylor A, Molloy M (2010). Clinical Journal of Sport Medicine 20:179-184. Article Summary This prospective cohort study examined the incidence, nature and possible causes of injuries obtained during international Rugby Sevens competition. Medical staff involved in the 2008/2009 International Rugby Board (IRB) Rugby Sevens World Series and the IRB Rugby World Cup Sevens 2009 supplied the authors with baseline information and injury reports for players who sustained injury during match play. The authors discussed the injury, player and game characteristics from the current study. They then compared the results to those described in previous similar studies of both Rugby Sevens as well as Rugby Union. There were 104 injuries reported. The most common injury location and type of injury was lower limb joint injury. The most frequent pathologies were ankle and knee ligament injury and hamstring muscle strain. As expected, there were significantly more acute, contact and second half injuries than non acute, non contact, first half injuries. There was no significant difference identified for type, location, nature and cause of injury between backs and forwards. The overall incidence of injury as well as the severity of injury in Rugby Sevens was greater than that reported previously for Rugby Union. The possible reasons for this are discussed further.

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS Incidence and Prediction of Injury in Rugby Sevens, Professional Rugby and Football. Recovery Strategies; do they work? continuedâ&#x20AC;Śâ&#x20AC;Ś.. www.sportsphysiotherapy.org.nz/resources Clinical Applications This study seems sturdy enough. The results were mostly as one would expect and a little bland as a result. Despite this the authors manage to extrapolate their findings and discuss some interesting comparisons between the current study and a previous study of injuries sustained during the 2007 Rugby World Cup. Of note is the higher severity and incidence of injury identified in Rugby Sevens. The authors suggest the nature of the game of Rugby Sevens is a reason for this. Rugby Sevens involves more running, cutting and turning manoeuvres. It is also played at a higher speed than Rugby Union. These factors increase the probability of players sustaining injury. This information can help physiotherapists involved in Rugby Sevens design or modify both prehabilitation and rehabilitation programs. It may be especially helpful if the physiotherapist is accustomed to working with Rugby Union players rather than Rugby Sevens. Reviewed by Nathan Wharerimu MNZSP

Incidence, Risk and Prevention of Hamstring Muscle Injuries in Professional Rugby Union. Brooks JHM, Fuller CW, Kemp SPT, and Reddin DB (2006). The American Journal of Sports Medicine 34(8): 12971306. Article Summary This cohort study looked at 546 professional rugby union players in the United Kingdom over a total of 420 matches and accompanying training, to define the incidence, severity and risk factors associated with hamstring injuries in professional rugby union. They also looked at whether the use of hamstring strengthening and stretching injuries reduced the incidence and severity of these injuries. They graded the hamstring injuries based on the number of days to return to full training and competition. Players were categorized into 3 training groups: strengthening group; strengthening and stretching group; strengthening, stretching and Nordic strengthening group. Results found similar proportions of mild, moderate and major injuries, none had surgery but 3% had steroid injections. With an average of 17 days lost time. 22% of players sustained at least 1 hamstring injury. Recurrent strains were more severe than new injuries. 59% of recurrences occurred within 1 month of previous injury. Forwards and Backs were injured equally during training, but Backs had a much higher rate during games. Rates of injury were higher in the last quarter of a game. The severity of injuries was highest in the 3 rd quarter. Injury risk increased with an increased intensity in training. The incidence of training injuries and overall incidence of all injuries was significantly lower in the Nordic strengthening group. Clinical Applications Overall this study shows there are a number of factors that can be looked at in an effort to reduce the significant number of hamstring injuries that affect rugby players during the season. This study shows that hamstring strains are at a high risk of recurrence during the first month after returning to play suggesting that players returning after injury should perhaps have a lower intensity programme and continue with their rehabilitation even once judged to be fully fit to play. Better return to play and rehabilitation programmes may need to be looked at to reduce the incidence of recurrence. Training volumes and intensity may also need to be reviewed, in view of the higher incidence of injury with higher training levels. With more injuries occurring in the latter parts of the game it would appear that fatigue and possibly cool down at half-time are important considerations in hamstring injuries and may necessitate a look at staying warm during half time and the fatigue levels of players especially the Backs. The study also indicated that it may be possible to reduce the incidence and severity of hamstring injuries through Nordic hamstring exercises. This should be considered when working with teams, particularly for Backs which had a higher incidence of injury during games. Reviewed by Karen Carmichael BSc, BPhty, M(SportsPhysio)

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS Incidence and Prediction of Injury in Rugby Sevens, Professional Rugby and Football. Recovery Strategies; do they work? continued…….. www.sportsphysiotherapy.org.nz/resources

The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball Montgomery, P. G., Pyne, D. B., Hopkins, W. G., Dorman, J. C., Cook, K., & Minahan, C. L. (2008). Journal of Sports Sciences, 26(11), 1135–1145. doi: 10.1080/02640410802104912 Article Summary This randomized controlled trial looks at different recovery interventions and their effectiveness in preventing fatiguerelated changes in performance. Many sports tournaments require athletes to play several consecutive games. This means recovery time is limited and performance levels may suffer. It is standard practice for athletes to consume fluid and carbohydrates and perform static stretches soon after finishing their sport. Compression garments have variable results reported but allegedly provide relief from muscle soreness, inflammation and recovery of force production. Gill et al. (2006) showed full leg compression garments for 12 hours following a rugby match are effective but no more than cold water immersion or active recovery. Cold water immersion is said to limit the oedema within muscles due to exercise and restrict the initial damaging effects of inflammation. Twenty nine male players, mean age 19.1, were followed over a 3-day basketball tournament involving a 48-min game per day. They were placed in one of three treatment groups: carbohydrate and stretching (control), cold water immersion or full leg compression garments. Prior to the tournament baseline measurements were taken in 20-m acceleration, basketball line-drill, YoYo Level 1 intermittent recovery test, vertical jump, a basketball-specific agility test, and the sitand-reach flexibility test. The pre-tournament tests were repeated (excluding the YoYo intermittent recovery test) on the morning of the fourth day to assess any performance deficit from the competition period. In the carbohydrate and stretching control group players went through a programme of 10 stretches completed twice each side for 15 seconds to the lower limb and back, and consumed a post-game carbohydrate bar and 600 ml of fluid in a sports drink. The cold water immersion group followed the same recovery as the control then immersed their bodies up to the mesosternale level, in a plunge pool (11°C) for 5x 1-min intervals. Between immersions they rested 2 minutes. The compression group also followed the control recovery then showered and then put on commercially produced, full-length lower-limb compression garments for 18 hours. Changes and differences seen in testing were standardized for accumulated game time. All players experienced accumulated fatigue over the tournament with small to moderate declines in performance testing. Sprint and agility performance decreased overall by 0.7% and 2.0% respectively as did the vertical jump. Cold water immersion was substantially better in maintaining 20-m acceleration with only a 0.5% reduction in 20-m time after 3 days compared with a 3.2% reduction for compression. Cold water immersion (1.4%) and compression (1.5%) showed similar substantial benefits in maintaining line-drill performance over the tournament, whereas carbohydrate and stretching elicited a 0.4% reduction. Sit-and-reach flexibility decreased for all groups, although cold water immersion resulted in the smallest reduction in flexibility. Clinical Relevance High eccentric loads and accumulative fatigue may result in muscle micro-trauma causing soreness, swelling, stiffness, and reduced range of movement lasting several days. Repeated cold water immersion provides small to moderate performance gains, especially in maintaining line-drill performance and acceleration, compared with compression garments and traditional carbohydrate and stretching routines. A starting player required to play a greater amount of game time during the course of a tournament will benefit from cold water immersion recovery. Full leg compression garments appear to have minimal benefit in the majority of the performance tests used here, and provide no performance benefits with increasing game participation time. Reference: Gill, N. D., Beaven, C. M., & Cook, C. (2006). Effectiveness of post-match recovery strategies in rugby players. British Journal of Sports Medicine, 40, 260–263. Reviewed by Monique Baigent BHsc (Physiotherapy)

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RESEARCH SECTION JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY

2013SPNZ

February 2013; Volume 43, Issue 2

www.jospt.org

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

Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes David M. Selkowitz, George J. Beneck, Christopher M. Powers

The Interrater Reliability of Physical Examination Tests That May Predict the Outcome or Suggest the Need for Lumbar Stabilization Exercises Alon Rabin, Anat Shashua, Koby Pizem, Gali Dar

Risk Factors for Persistent Problems Following Acute Whiplash Injury: Update of a Systematic Review and Metaanalysis David M. Walton, Joy C. MacDermid, Anthony A. Giorgianni, Joanna C. Mascarenhas, Stephen C. West, Caroline A. Zammit

Falls Among Patients Who Had Elective Orthopaedic Surgery: A Decade of Experience From a Musculoskeletal Specialty Hospital Lisa A. Mandl, Stephen Lyman, Patricia Quinlan, Tina Bailey, Jacklyn Katz, Steven K. Magid

Single-Step Test for Unilateral Limb Ability Following Total Knee Arthroplasty Adam Rubin Marmon, Jodie A. McClelland, Jennifer E. Stevens-Lapsley, Lynn Snyder-Mackler

Changes in Regional Activity of the Psoas Major and Quadratus Lumborum With Voluntary Trunk and Hip Tasks and Different Spinal Curvatures in Sitting Rachel J. Park, Henry Tsao, Andrew Claus, Andrew G. Cresswell, Paul W. Hodges

Achilles Tendon Rupture Mario F. Cruz, Susan S. Jordan, Lori A. Bolgla

Hip Pain in a Young Athlete Christopher J. Kovacs, Mark V. Paterno, Sheila Chandran

Strengthening Your Hip Muscles: Some Exercises May Be Better Than Others

Abdominal Pain in Physical Therapy Practice: 3 Patient Cases Jason R. Rodeghero, Thomas R. Denninger, Michael D. Ross

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ASICS SHOE REPORT CRICKET FOOTWEAR

While international cricketers are now reaping the benefits of the foresight of a few during the 80s with the help of Kerry Packer... just on that did you enjoy the mini series? For me it was time to feel young again... the years when I had hair! Sorry I digress, so while the modern day cricketer is paid well for his exploits, well at least those that make the big time... the playing footwear has been an afterthought for many of those years. About 10 years ago we felt that cricket was a poor cousin in footwear development because what was out there as 'real' cricket shoes, used golf plates for the spikes or they were poorly adapted cross trainers where the spike inserts were rammed into the outsole and subsequently studs fell out easily.

The objective for us at ASICS was to develop a plate that would move in unison with the foot. The result was the first ever true cricket plate system made of PU. Being PU, it was flexible enough to run and bowl in. Over the years we have continued to fine tune the process and have new stud configurations and manufacturing processes... but I am proud to say all our cricket shoes were developed first and foremost as a cricket shoe. All our cricket models on the market presently are lighter than previous models and some extremely different. This going forward is our driving ambition to keep getting weight off the cricket shoes, yet not lose the protection that is so important in this game.

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ASICS SHOE REPORT CRICKET FOOTWEAR Having screw in studs in cricket shoes adds weight so how can we improve this? One of the solutions has been the GEL STRIKE RATE where we have taken track and field type thinking in stud development. The result is a lighter shoe but also a super flexible shoe that is super comfortable. I must say having some of the Australian players at our disposal for feedback has been a huge help in the continual development of the shoes, and in particular I would like to single out Shane Watson for being of great help in the development of the shoes. I would also like to thank a lot

of 'club' players from around Australia and New Zealand for their outstanding feedback on the shoes so that we can achieve the results we have with our cricket shoes. It is a proud aspect of our company also that we have had control of the development of these cricket shoes here in the Southern lands because what is normally a Northern Hemisphere dominated sports market. By Mark Doherty SM Product - ASICS Oceania

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CONTINUING EDUCATION Upcoming courses and conferences in New Zealand and overseas in 2013. http://www.sportsphysiotherapy.org.nz/calendar.html

INTERNATIONAL COURSES & CONFERENCES When?

What?

Where?

More information

April 10-12

12th International Congress of Shoulder and Elbow Surgery 4th International Congress of Shoulder and Elbow Therapists

Nagoya, Japan

www.congre.co.jp/icses2013/ index.html

April 17-20

European Congress on Osteoporosis and Osteoarthritis

Rome, Italy

http://ecceo13-iof.org/

April 20-22

International Conference on Sports Rehabilitation and Traumatology: Football Medicine Strategies for muscle and tendon injuries

London, UK

July 11-13

Bone & Joint Decade World Conference

Rio de Janeiro, Brazil

www.boneandjointdecade.org

Oct 27-31

8th Interdisciplinary World Congress on Low Back & Pelvic Pain Advances in multidisciplinary research for better spinal/pelvic care

Dubai, United Arab Emirates

www.worldcongresslbp.com

30 Oct -2 Nov

EBHC International Joint Conference 2013

Taormina, Italy

www.ebhc.org

2013

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AWARDS

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2012 STUDENT RESEARCH AWARD â&#x20AC;&#x201C; AUT SPNZ is committed to assisting undergraduate students in their endeavour to fulfil their roles in the fields of sports and orthopaedic physiotherapy. As such, SPNZ annually presents a Student Research Prize of $500.00 to the Schools of Auckland and Otago respectively. In this manner, SPNZ is able to recognise 4th year students for the outstanding work of their research project. Below is a summary of the research project by the 2012 AUT Student Research winners, Anna Wardlaw and Tim Michels.

An Investigation in to the effectiveness of neuromuscular control and strength training rehabilitation in anterior cruciate ligament reconstruction Overview A two-part review of literature analysing the efficacy of neuromuscular control training (NMT) versus strength training (ST), and closed kinetic chain (CKC) versus open kinetic chain (OKC) exercises during physiotherapy guided anterior cruciate ligament (ACL) rehabilitation, post-reconstruction. The methodological quality of each article was calculated using the assessment tool developed by Downs and Black (1998). Nine articles met the inclusion criteria for the review. All articles were randomised control trials and moderate in methodological quality overall. Results identified NMT, as a modality, to be as effective as ST in the ACL reconstructed patient on functional and subjective outcomes. Additionally, by exploring specific types of ST, no statistically significant difference was found in OKC versus CKC exercises in clinical outcomes over ranging intervention periods. Clinical significance Presently it cannot be concluded whether OKC or CKC prescription is more advantageous. NMT is as effective as ST in improving functional and subjective patient outcomes in the rehabilitation of ACL reconstruction. However, there is no current consensus regarding parameters surrounding the prescription of NMT. This review highlights a need for highquality trials comparing strength rehabilitation protocols versus a combination of NMT and ST post-ACLR.

Tim Michels and Anna Wardlaw (AUT University)

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2012 STUDENT RESEARCH AWARD – UNIVERSITY OF OTAGO Each year SPNZ award $500 to a student research project from both AUT University and the University of Otago. In this edition we provide a summary of the winning project from the University of Otago.

Does performance on the King-Devick screening test change following physical activity in young rugby league players? Under the support of Dr Doug King (Hutt Valley DHB), Professor John Sullivan (University of Otago) and Dr Anthony Schneiders (University of Otago) we completed a research study aiming to answer the following question; “Does performance on the King-Devick screening test change following physical activity in young rugby league players?” Often a concussion on a sports field goes unrecognised or undiagnosed, especially in community teams where medical personnel are not always readily available. [1, 2] In addition to educating those persons involved in the sport of the critical signs and symptoms associated with a concussion, the availability of a valid screening tool to assist in the identification of a concussion is vital. The King-Devick (K-D) test was originally developed as a measure of oculomotor function in relation to reading and learning disabilities. [3] As decreased oculomotor function is a strong indicator of mild traumatic brain injury, the K-D test is a useful tool to assess for suspected concussions. [4, 5, 6]. The K-D test is a visual tracking test measuring rapid number-reading speed [3]. The test is comprised of one demonstration card for participant familiarisation and three test cards [4]. Each card is populated with rows of single digit numbers, varying in layout, for assessment purposes [3]. Subjects were asked to read the number sequences aloud as quickly as possible without making any errors. The time taken per test card, measured from when the subject begins the first digit and completes the last digit, and the number of uncorrected errors made were recorded and combined to give a score. Before accepting the use of the K-D test in sporting environment situations, it was necessary to establish whether and how the K-D responds to exercise intensity levels associated with sports. This was important as changes in the K-D score may have been related with the effects of fatigue, the effects of neurological changes associated with a concussion, or a combination of both fatigue and neurological changes. As most sports related concussions occur during periods of physical activity there is the potential for these effects to confound the KD results and therefore the need to understand the impact this has on application of the test. To assess the effect of aerobic exercise on the K-D test, we designed a prospective repeated measures study on young (15-17 years) males of the Wellington Under 17’s amateur Rugby League team. All players were baseline tested on the King-Devick test before performing the modified Repeated High Intensity Endurance Test (mRHIET). Re-testing was performed one minute after completion of the test and again after a further seven minutes. Rate of Perceived Exertion (Borg 15 point scale) was also recorded. Participants of the mRHIET were required to complete a series of six 30 m sprints in a 10 m grid with cones marking zero, five and 10 metres, departing on a 30 second cycle. Our intentions for the study were to have the test subjects work in a manner which most closely correlated with a game of competition rugby league. The Repeated High Intensity Endurance Test (RHEIT) closely depicts the nature of exercise associated with Rugby League. [7] For each participant the fastest performance of the two pre-test scores was selected to create a new variable, the best baseline performance (BBP). Individual change scores were determined by calculating the difference between the player’s BBP and post-test 1 and 2 respectively. Statistical significance was set at p<0.05. Fifteen players (mean (±SD) age; 16.5±0.6 yr.; stature: 181.35±5.32 cm; mass: 85.66±11.52 kg) completed the study. Our results showed there was only a minimal change between the median BBP K-D score (43.7 s) and that obtained at post-test 1 (42.1 s; z=-0.1, p=0.932) or post-test 2 (38.9 s z=-1.4, p=0.156) for the 15 players who completed the test protocol. These changes were not significant. The difference observed in the medians (lower and upper quartiles) between the first and second baseline tests (44.5 s [38.2-51.0 s] and 44.7 s [37.1-50.3 s]; z=-1.1, p=0.258) were not significant. Post exercise, there were small differences observed between the BBP and post-test 1 (42.1 s [36.7-46.5]; z=-0.1, p=0.932) and post-test 2 (38.9 s [34.9-47.0]; z=1.4, p=0.156) but again these were not significant.

AWARDS

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2012 STUDENT RESEARCH AWARD â&#x20AC;&#x201C; University of Otago continued... The study found that the exercise intervention utilised did not have any negative effects on the results of the K-D test. Unlike previous studies, the current study specifically incorporated a standardised exercise protocol to test for the effects of exercise. By selecting the mRHIET, a controlled and regimented intervention, it was envisaged that the exercise portion was uniform for all participants. This minimised the variability in results among the cohort being attributed to the exercise component. However, it is unclear whether the absence of differences observed in this study were due to the absence of a true effect or the lack of statistical power to detect a difference due to the small sample size. Additional research is warranted to investigate this further. It has been reported that an increase in a K-D score of greater than 5s from baseline was a characteristic amongst participants suffering head related trauma [4]. Using this proposed value, three participants (20.0%) had changes in their KD times expected to be associated with a concussion, which would require them to undergo further concussion assessments. Contrasting this, five participants (33.3%) scores decreased by 5 s in relation to the baseline. This facilitative effect could potentially mask the cognitive effects in players with a concussion, resulting in a false-negative screen. Our results highlight the wide variability in K-D scores post exercise, and suggest caution needs to be taken when using specific cut-off values and interpreting post-test scores. Further research is warranted on a wider spectrum of sporting activities to explore this. Although studies have found the King-Devick test to be a reliable sideline assessment tool for sports concussion, the neurological effects of exercise, if any, on the test remain poorly researched. The article is being edited at present with the intention of being published. If you are interested in reading the full manuscript, please contact Samantha Leggat at sam.leggat@live.com.

References [1]

Eckner JT, Kutcher JS. Concussion symptom scales and sideline assessment tools: a critical literature update. Curr Sports Med Rep 2010;9(1):8-15.

[2]

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By Samantha Leggat, Nicola McCarthy, Claire Maxwell, Nicholas Naylor & Elizabeth Vollebregt

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