SPNZ June 2012 Bulletin

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BULLETIN

ISSUE 3 l JUNE 2012

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

Welcome to the June 2012 SPNZ Bulletin.

SPNZ EXECUTIVE COMMITTEE President

Angela Cadogan

Secretary

Michael Borich

Treasurer

Dr Gisela Sole

Website Committee

Hamish Ashton Dr Tony Schneiders Bharat Sukha Jim Webb David Rice

EDUCATION SUB-COMMITTEE Dr Gisela Sole

David Rice

Chelsea Lane

Dr Grant Mawston

Jim Webb

EDITORIAL ASSISTANT Aveny Moore

SPECIAL PROJECTS Monique Baigent

Kate Polson

Nathan Wharerimu

Karen Carmichael

Amanda O’Reilly

Deborah Nelson

Helene Barron

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LINKS

In this issue we feature the London 2012 Summer Olympic Games being held from 27th July to 12th August. This will be followed by the 2012 Summer Paralympic Games from 29th August to 9th September. Athletes and officials from 185 countries representing 26 sports will participate in the summer Olympic Games. New Zealand is sending a strong Olympic squad including athletes participating in athletics, boxing, canoeing, cycling, equestrian, hockey, football (soccer), judo, rowing, sailing, shooting, swimming, taekwondo and triathlon. The Olympics is the pinnacle sporting event for amateur sport, and we wish all athletes and teams all the best for a lucrative medal haul. Our best also goes to the physiotherapists providing support to these athletes and teams in what will no doubt be an extremely busy and demanding time. We look forward to reporting some good results in the SPNZ August bulletin.

Sports Physiotherapy NZ List of Open-Access Journals

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SPNZ Research Reviews Asics Apparel and order form McGraw-Hill Books and order form Asics Education Fund information

CONTACT US Michael Borich (Secretary) 26 Vine St, St Marys Bay, Auckland. mborich@ihug.co.nz

INSIDE THIS EDITION:    

Olympic Feature: Louise Johnson - Physiotherapist for Valerie Adams NZ Physiotherapist in the News: Geoff Scott assists Fabrice Muamba after cardiac collapse.

SPNZ Research Reviews: Tendinopathy Asics Education Fund - 31st August deadline approaching and MORE…….

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Many SPNZ members are among those travelling to London to provide physiotherapy support to athletes and teams competing at the games. Among these is Louise Johnson (Pakuranga Physiotherapy, Auckland), who is the physiotherapist for Valerie Adams, well known to most New Zealanders for her shot putting prowess, and arguably one of New Zealands’ highest performing athletes. Louise has provided SPNZ with an entertaining article in which she discusses her role in working with Val. The SPNZ Special Projects Group have also supplemented this with reviews of articles relevant to ‘high intensity’ sport, and cover some of the information presented by Dr Jill Cook at the recent SPNZ Symposium held in Tauranga in March 2012.

The SPNZ Executive continue to work hard behind the scenes. We welcome Chelsea Lane and Dr Grant Mawston to the SPNZ Education sub-committee, joining Dr Gisela Sole (chair), David Rice and Jim Webb (SPNZ Executive). The Education sub-committee are currently planning a series of continuing education courses focusing on advancing sports physiotherapy competencies for physiotherapists working with “athletes” of all ages and abilities, at all levels of sport.

The committee are getting together on June 29 th, and we will provide updates on course development as more details become available. As is our policy, SPNZ members will be given priority notification of these courses and discounted registration fees for what are expected to be very popular courses.

Until the next edition, we hope you all weather the winter well and enjoy the coverage of the 2012 Olympic Games.

Angela Cadogan SPNZ President

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Deadlines: August bulletin: October bulletin : December bulletin:

30th July 30th September 30th October

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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Asics Education Fund—August Funding Round Open SPNZ Website Upgrade and Public Resources International Journal of Sports Physical Therapy—Individual memberships available SPNZ Membership Benefits

IFSPT REPORT

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FEATURE

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Louise Johnson - Physiotherapist for Valerie Adams provides us with a valuable and entertaining insight into her role working with one of New Zealand’s greatest athletes

FEATURE

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New Zealand Physiotherapists in the News - Geoff Scott, Head Physiotherapist at Tottenham Football Club, shares his experience of being at the game where Fabrice Mumba suffered a cardiac arrest earlier this year.

CLINICAL SECTION

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Asics Shoe Report: Gel Nimbus 14

RESEARCH SECTION

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Sports Physiotherapy NZ Research Reviews: Tendinopathy 

A “polypill” for acute tendon pain in athletes with tendinopathy?

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Landing strategies of athletes with an asymptomatic patellar tendon abnormality.

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Is compressive load a factor in the development of tendinopathy?

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Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load induced tendinopathy

Journal of Orthopaedic & Sports Physical Therapy: Volume 42, No. 6, June 2012

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CONTINUING EDUCATION

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National and international courses and conferences in 2012

SPNZ WEBSITE INFORMATION

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CLASSIFIEDS

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LATEST NEWS

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Asics Education Fund August funding round applications close 31st August 2012.

SPNZ offers $1000 twice per year to SPNZ members to assist with conference attendance or research. Application criteria, forms, instructions and conditions can be downloaded from the Members Section of the SPNZ website click here. You will need to enter your email address (login) and password.

SPNZ Website Upgrade and Public Resources Coming soon – new SPNZ website design and features including resources for public use.

Towards the end of June, the SPNZ website will change. Hamish Ashton has been working hard with the design team to create a new look and improved website functionality. The site will include more information for the public including “What is sports physiotherapy” and “Find a sports physiotherapist”, and over time we will be adding resources to the site for the public use covering basic acute injury management and links to other injury prevention and management resources. If you have any suggestions for material that may be of use to the public, and to your patients, athletes, teams or sporting organization, please let us know. Email acadogan@vodafone.co.nz with your ideas.

International Journal of Sports Physical Therapy - Individual Subscriptions Available The IJSPT journal is available to purchase for individual members.

SPNZ members interested in subscribing to this journal can purchase an individual subscription through the journal directly. To purchase a subscription go to the IJSPT website, and click on “subscriptions”. Subscription rate for 2012 is €20.

To view contents of the current issue click here.

SPNZ Member Benefits Remember to take advantage of the full range of 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 Activity, Course and information updates.

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FREE classified advertising in the NZSOPA Bulletin

IFSPT REPORT

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International Federation of Sports Physical Therapy (IFSPT) Report Dr Tony Schneiders IFSPT website IFSPT Executive The International Federation of Sports Physical Therapy (IFSPT) currently represents 22 member countries and is served by an executive of 7.

These members are Nicola Phillips, United Kingdom (President); Maria Constantinou, Australia (Secretary); Gordon Eiland, USA (Treasurer); Bente Andersen, Denmark; Mario Bizzini, Switzerland; Craig Smith, South Africa; and myself Tony Schneiders, New Zealand.

IFSPT Activities I am currently representative on a number of IFSPT working groups that include the Professional Development Committee, Research Committee, Scientific Congress Committee and the IFSPT Registration Board. The executive committee communicates regularly through email, skype, drop box applications and an annual face to face meeting. This column is aimed to give you a brief snapshot of a few of the activities that myself and other IFSPT executive are involved in at present.

Research Committee However, it’s not just the executive that is working hard for the IFSPT membership. There are also co-opted members who work in various roles on specific committees. One of these being a name you will be familiar with; Professor Peter McNair who is the chair of the Research Committee. One of the priority items that the new research team are looking at is to identify the research needs of IFSPT members. This will take place soon in the form of a survey sent through the member organisations. Look out for it and tell us what you think in terms of sport research and support.

Awards The committee are also looking at establishing a series of awards that members can be nominated or apply for.

Potential categories include; grants/awards for specific projects, postgraduate thesis projects, research travel, and mentorships. In order for these to be available with the limited resources IFSPT have, suitable corporates and institutions will be approached to sponsor awards. Let me know if you know of any that you could recommend IFSPT approach.

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IFSPT REPORT

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Education and Conferences The other area that we are currently working on through the Scientific Congress Committee is to increase IFSPT exposure and to try and raise some funding for resources through educational initiatives such as courses and conferences. We have been looking for partners from our membership to help support this and earlier this year had discussions with the Australian Physiotherapy Association and Sports Medicine Australia before receiving an offer from the Sports Physical Therapy Section (SPTS), of the American Physical Therapy Association to work in with them during their annual conference.

After negotiations IFSPT have now announced its first pre-conference program at the SPTS Team Concept Conference. This program will be held in the Bally's Las Vegas Resort and Casino in Las Vegas, Nevada, USA on November 29. The IFSPT program will highlight sports physical therapy involvement at the Olympic Games, F-MARC projects in soccer, and focus on the latest clinical guidelines on selected topics in various international sports. It is being promoted as an opportunity to hear from international speakers from Europe, Australia, New Zealand and the USA, and to get the latest update on IFSPT activities worldwide. (More details at http:// www.spts.org/education/team-concept-conference). If you will be in Europe later in the year, the Swiss Sports Physiotherapy conference (http://sportfisio-symposium.ch/) is being held in Bern on Nov 16th and is linked to IFSPT and uses speakers from the organisation. IFSPT would like to invite any SPNZ members to attend both events. (Editors note: consider applying for funding assistance for travel, accommodation or registration costs for these conferences through the SPNZ Education Fund – deadline August 31st 2012).

Events Of course with the IOC’s London Games and FIFA’s Euro 2012 starting over the next two months many IFSPT members and even some of the executive will be preparing for these events. Nicola Phillips will be working as a physiotherapist at the Games while Mario Bizzini is responsible for many F-MARC projects, (FIFA’s medical arm) and will be involved with Euro 2012.

As your IFSPT representative and a member of the current executive I can reinforce that IFSPT is very member focused and aims to add value to the great work that SPNZ is doing. I would love to receive your input and feedback regarding the work we are doing so please don’t hesitate to contact me at any time.

Ka kite ano Tony Schneiders

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FEATURE LOUISE JOHNSON

————————————————————————————————— Physiotherapist for Valerie Adams Louise graduated from Auckland Technical Institute in 1985 and has 20 years experience as a sports physiotherapist.

She is currently the Director of Pakuranga Physiotherapy in Auckland, and a Key Physiotherapist for High Performance Sport NZ (HPSNZ), at the Millennium Institute of Sport and Health (MISH) in Auckland.

Louise has been the physiotherapist for Valerie Adams for the last 10 years. Her other sporting involvements have also included 10 years as the NZ Women’s Hockey physiotherapist, and Louise is a veteran of 3 Olympic Games, 2 Commonwealth Games, 1 University Games and 2 World Athletic Championships. As this goes to press she is also preparing to go the 2012 London Olympic Games.

Louise has provided us with a valuable and entertaining insight into her role working with Valerie Adams, undoubtedly one of New Zealand’s greatest athletes.

Background on Valerie Adams Val has won everything. World Youth, Junior, x3 Senior, x2 Indoor Championships, x1 World Cup, Multiple Diamond League and IAAF Titles, x1 Olympic Gold, x2 Commonwealth Games Gold medals.

If you don’t know this then don’t call yourself a sports physio.

How did you become involved in your current role with Val? She lived down the road – serendipity! I had just finished the NZ hockey team work and was in the process of growing up – marriage, house, and kids. Val and Kirsten walked in one day for a minor problem which fortunately I did not muck up. I had worked previously with Kirsten when she was NZL Javelin Champion and threw at the Commonwealth Games so it wasn’t a total surprise but I can distinctly remember being really really nervous the day she walked in.

Val gave me a pet project – x1 Athlete – Luxury!! But of course this grew and grew as Val continued to smash every age group record and hurtle up the rankings.

sessions. Never forget the basics – a stretch here, a wiggle there, a needle, a knuckle, a manip, a MWM. Top to bottom, test – treat – retest. Physio 101. Simple hands on work – nothing tricky here but less talk and more action please. Then you can start having a bit of fun analysing movements etc. only after you have done the simple stuff.

If there is something that is not a simple fix then I increase my input, involve and co-ordinate appointments to all the right people. I try to go to all appointments as well just so we are all working to the same plan. Coordinate all the paperwork, reports etc. to ensure no stone is unturned. Keep the clinical notes clear, concise and up to date. I am a big believer in no one person being indispensable and so have everything up to date just in case you karck it on the way to work.

What is your role in working with Val? Physiotherapy services first and foremost.

Val trains at MISH in Auckland when in New Zealand. I see her a minimum of x3 per week for injury screening and treatments. These are simple Physiotherapy

When Val is domicile in Switzerland then we regularly communicate to ensure all is good. Val has a medical team at her disposal in Macolin and I communicate with them too. But essentially Val looks after herself with a bag of tricks.

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FEATURE LOUISE JOHNSON

What are your specific tasks/responsibilities?

Between competitions/events To pick up the pieces and help get the Aussies out of the pool.

In preparation for competitions/events That changes from event to event. Sometimes there is not enough time in the day to do all your hands on, organise your gear, attend trainings, write your notes, and report to the right people – even for just one athlete.

Other times you are just on standby and have nothing specific to do but still hang around just out of sight and the highlight is producing one safety pin at the right time.

Val is incredibly self-contained and completely self manages for the majority of her events. However in the pinnacle events it makes sense to have her team handy as you want to have a high performance setup with a no surprises, no regrets environment.

During competitions/events Get to the stadium on time from the warm up track, have your plinth in the correct bus or at the correct pick up point. Otherwise it is to look calm and collected. It is Val’s show – try to enjoy it but don’t forget to scream your t*&% off when she goes nuts post competition.

Enjoy it no matter what the result as you always know she will give 100% effort.

What are the types of injuries you commonly see in this type of sport?

You can’t lift serious Olympic style weights for 15 years without stressing your lumbar spine and so we keep a very good eye on this. Also it is public knowledge that in 2005 Val had the end of her right clavicle resected due to distal calvicular osteolysis. Apart from that I am not telling you a thing about Val. Shot-putters are obviously power athletes. A throw takes just over 1.5 seconds and you get x3 to start with. If you are in the top 8 – then you will get another 3. So in all the actual physical component (presuming qualification to the final rounds) is around 9-10 seconds of pure explosive power and technique. So obviously the training is all tailored for this. Huge amounts of weight lifting,

jumping, technique etc. Every imaginable training to get a “kaboom” effect.

The “smack the crap out of it” sensation!

Getting close to major events I live in some fear that this kaboom may come out of some joint exploding it to smithereens. However it is testament to the quality of her training, conditioning and concentration that this has never happened. Only in my imagination!

What have you found to be the key elements of success in dealing with these injuries?

“Keep calm and carry on” Having a systematic approach to pre training, post training priming and recovery.

Empowering Val with as much self-driven prehab and rehab knowledge and tricks. Trusting Val to make good calls when to continue training, modify training and canning training and have a sleep instead.

Always work to a plan and share the responsibility in some way – mainly with a Sports Physician (Dr Graham Paterson), or with another physio. The stakes are too high to think you can fix everything. Never forget your basic Physiotherapy skills and relate them to healing times.

Who else is involved in the ‘support team’ that you communicate with?

Val’s core team is Jean Pierre Egger (JP) – coach, Dr Mike McGugian (Power scientist at AUT-University and HPSNZ) and I. JP and Mike do all the day to day training with Val in NZ and I run the body guard checks. In Switzerland it is JP and Werner Guthor (world famous Swiss shot-putter).

Of course there are other people involved too. Dr Graham Paterson – Sports Physician, Ed Timmins – Chiropractor, Clint Knox – Massage Therapist.

How do you integrate/work with the trainer/coach with respect to injury prevention or rehabilitation?

I attend as many trainings as I possibly can unless Val tells me to buggar off. There is no substitute to being in

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FEATURE LOUISE JOHNSON the field and seeing the hurt. We chat and chat collectively as a group. Sometimes it is all business, other times quiet and calm, other times outrageously loud and aggressive. Anyone who has seen her train at MISH will nod their heads in agreement with the last description. One thing for sure - It is never dull.

Once Val has walked into the call room – your job is done, pack up the plinth and get to the stadium and watch the show. What you see on TV is just a portion of the actual competition – the game has started way before that!

We do have set meetings but also do simple things like lunches. Our mutual respect is huge and paramount for effective team work. We quietly quiz constantly which is very healthy but also trust each other to make calls if necessary.

Post comp is also an interesting time – relief sums it up in a word but your job hasn’t finished.

Are you involved in performance aspects for Val?

Be systematic but adaptable in your approach. Listen very carefully to what your athlete is saying and what it means. Be available. Never talk out of turn – trust is essential. Formulate timelines and outcomes with your athlete immediately and mutually agree on this before they leave your room on day 1 – even if you do not have a clear picture, at least have a plan. Involve key personnel as soon as possible. Don’t ever think you have all the answers

I am particularly good at getting shot puts out of the ground. A grass arena in the tropics is the hardest as the ball disappears into the turf. It is like having a small boiled egg in a big egg cup. You have to lever it out, repair the turf, wipe and dry the ball. Not straight forward – you have to do it with dignity and not falling on your face or looking like Pigpen after. Of course a hard pit with no back stop is also difficult as you have to stop it from rolling onto the track and taking out some unsuspecting 800 metre runner. The art there is not fracturing your own tibia. Mike has to do the counting as for some reason I lose count after x6.

I say this in jest but actually when she is throw training our role is also to keep the public away as man – they can be dumb.

However – I don’t believe I have anything to do with Val’s performance. I am under no illusion about this. I may help to keep her healthy but performance wise – it is all Val. You have also been to several Major events with Val. Can you describe life in the ‘Athlete Village’ and the atmosphere of a competition day for the athlete and you as a physio?

It is an unbelievably humbling experience and very hard to explain. Your job is just to keep calm and on top of everything. Val is an experienced pro now and has her pre competition routine down pat. Sometimes I think my job is just to keep the dickheads out of her way.

We have all seen her game face and so you have to play that game of being available without being in her way. I never want that game face directed at me but I still have to be around. Val has the incredible ability to be very systematic and organised but at the same time adaptable.

What are the key attributes you feel are required to work with elite level athletes?

Seek advice from the experts. I regularly use Jordan Salesa for cultural sensitivity issues, Duncan Reid and Kate Polson for all things Physiotherapy. Be prepared to put your neck on the line and ask for a peer review. It is healthy and professionally stimulating. Sometimes you feel like a real idiot because you have missed the obvious, other times you know you have nailed it in one.

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FEATURE NZ PHYSIOTHERAPIST INVOLVED IN IMMEDIATE CARE AUT graduate and current head physiotherapist at Tottenham Football Club, Geoff Scott describes his involvement in managing the sudden cardiac collapse of Fabrice Muamba.

One of the courses being developed as part of SPNZ’s Educational Programme will focus on Immediate Care Management, and will include screening and management of sudden cardiac collapse, and important aspect for sports physiotherapists. More information will follow soon.

————————–———————————————————————————————————-The incident that happened involving Fabrice Muamba in the 41st minute of the match against Bolton Wanderers was rare and not what you usually expect when working as a pitch-side physiotherapist at any level. As the Tottenham Head Physiotherapist I was one of the team of people who first attended to Muamba after his cardiac arrest. Along with Andy Mitchell, the Bolton Physiotherapist and both teams club doctors we realised the situation was serious immediately.

Upon reaching Fabrice, it was obvious to us very quickly that he was having a cardiac arrest. We had all been trained in Advanced Life Support for incidences such as this, however this was the first time I had been involved directly in such an acute situation, and it was in front of a crowd of 36000 spectators. CPR and then defibrillation was immediately started on the pitch while at the same time we were preparing to mobilise Muamba to a waiting ambulance. The whole incident from collapse to his departure in the ambulance lasted just six minutes, so our involvement was brief. In total Muamba was without a regular heart beat for 78 minutes.

Since the incident we have received a letter from the consultant cardiologist caring for Muamba, stating that he had never seen a patient live and make such a remarkable recovery after such a long period without a spontaneous cardiac output; this he suggested was down to the immediate pitch side care that he received. A lot of things went right that day, the majority of which were down to detailed planning and preparation for such a incident. From training of match day medical staff, well trained ambulance crew and the careful planning of hospital transfer procedures.

Fabrice, along will all players at both Bolton and Tottenham football clubs, have had regular cardiac screening throughout their career. This cannot eliminate all risks of a player suffering a cardiac event. It is however recognised as a useful tool in picking up cardiac defects early and thereby reducing the possibility of future incidences. As a pitch side physiotherapist at any level it is also important that you have the necessary training and equipment to deal with such a situation.

While the level of resources will differ at different levels it is something that physiotherapists need to think about so they are adequately prepared.

Geoff Scott Head Physiotherapist Tottenham Hotspur Football Club

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CLINICAL SECTION ASICS SHOE REPORT Gel Nimbus 14

The Gel Nimbus 14 is ASICS premium cushioning shoe providing a consistent fit and the ultimate in a smooth ride from heel to toe.

The 14th edition is no different with key improvements in performance through weight reduction enhancing responsiveness and ride.

A key technical change to this years model is the lower profile (23mm in the heel - 13mm in the forefoot) and when combined with the new Guidance Trussic that moulds into the Full Guidance Line and a ¾ length Solyte 45 there is significant weight reduction and less midsole resistance in the midfoot and forefoot, allowing the foot to plantarflex easier and reach propulsion quicker. Moving the foot faster through midstance and into toe off is critical for reducing strain on muscles and ligaments often seen in overuse injuries. These key changes link together enhancing ASICS IGS system whilst shaving weight from the shoe and improving comfort.

PHF memory foam (Personal heel fit) found on the medial and a lateral side further improves comfort and fit customization. Biomorphic Fit and discrete eyelet lacing provides the very best in upper fit the Nimbus is renowned for.

Nimbus has always been a stand out shoe for its fit and ride (feel from heel to toe). Nimbus 14 has made major changes in weight reduction that will be noticed immediately. A lighter shoe is more responsive, which improves proprioception and enhances performance as the foot can move from heel to toe off with less resistance.

Furthermore, the lower profiling has removed the need for more cushioning because the foot can move through gait faster and therefore spends less time in midstance. Nimbus 13 wearers will enjoy the new weight reduction without sacrificing comfort and ride. This shoe will suit both rearfoot/midfoot/forefoot strikers and those who pronate and have a high cadence in gait.

The midsole uses ASICS Lightweight Solyte foam with a new rearfoot and forefoot gel configuration aimed at reducing weight and enhancing responsiveness. The new forefoot Gel set up, ¾ length Solyte 45 lasting and podulated flex grooves makes forefoot flex the best its been, allowing the foot to move out of pronation and into toe off faster. ASICS continues there Gender Specific Technical features as a commitment to improving injury prevention in woman. New gender specific cushioning uses different foam densities for men and woman and Plus 3 technology in woman’s shoes adds an additional 3mm of foam in the heel to relieve tension in the female Achilles tendon.

The Upper has a new lightweight clutch counter system, an innovative rearfoot set up that removes the internal heel counter and replaces it with an external heel counter. This maintains heel stability, minimizes weight and helps the heel counter adapt to all shapes reducing heel irritation and improving comfort.

Product Review by Justin Chong - Bigfoot Podiatry

RESEARCH SECTION

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS

TENDINOPATHY Reviews by Monique Baigent, Nathan Wharerimu and Amanda O’Reilly www.sportsphysiotherapy.org.nz/resources.html

A “polypill” for acute tendon pain in athletes with tendinopathy?

Fallon K, Purdam C, Cook J, Lovell G (2008). Journal of Science and Medicine in Sport 11; 235-238 Article Summary This article discusses some of the physiological factors associated with the pain and pathology of tendon pain as well as the pharmacological management of tendinopathy. The most commonly used pharmacological agents are non-steroidal anti-inflammatory drugs(NSAIDs) which have limited effect on their own. The authors suggest a variant treatment approach they term a “polypill” that consists of ibuprofen and doxycycline. An optional addition to this treatment is a non -pharmacological agent that contains tumour necrosis factor alpha (TNFα) inhibitors such as green tea and fish oil preparations. The authors present evidence for the basis of this treatment approach and suggest a therapeutic dosage.

The authors report that their intention is for this article to stimulate discussion and research into a new area of tendinopathy treatment.

Clinical Applications An interesting article that explores the potential effects of combining a standard anti-inflammatory with an anti-microbial agent. It is thought the therapeutic effect of ibuprofen in tendinopathy is not so much in its ability to alter the inflammatory cascade but more to do with inhibiting aggrecan expression which has a beneficial effect on the matrix. It is also thought to enhance the effect of doxycycline. Doxycyline, normally used as an anti-microbial agent for conditions like acne, is also supposed to inhibit connective tissue breakdown. TNFα inhibitors reduce some of the negative effects that TNFα has on structural breakdown and pain in tendinopathy. These three agents may have a complimentary effect on each other. It would be helpful to know there is a more effective medication available than standard NSAIDs for the treatment of tendon pain, especially one that is accessible, cheap and easy to administer.

Landing strategies of athletes with an asymptomatic patellar tendon abnormality.

Edwards, S., Steele, J. R., McGhee, D. E., Beattie, S., Purdam, C., & Cook, J. L. (2010). Medicine & Science in Sports & Exercise. doi: 10.1249/MSS.0b013e3181e0550b Article Summary Two important risk factors for developing patellar tendinopathy are abnormality of the tendon seen on ultrasound (PTA) and excessive loading. This article examines the loading patterns of asymptomatic subjects with PTA and compares them to a control with normal tendons. The subjects were asked to perform a stop-jump task. Ground reaction forces and lower-limb electromyographic readings were documented along with the three-dimensional kinematics and the peak patellar tendon force.

Results showed no differences in the mean loading forces on the tendons. The sequence of loading and biomechanics of the task however differed. They found that subjects with PTA landed with significantly more knee flexion and extended their hips compared to the controls who flexed their hips. The PTA group also showed more knee internal rotation and ankle inversion at landing and slower flexion velocity. A further difference seen was the PTA recruited the quadriceps muscles last of the lower limb muscles.

RESEARCH SECTION

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS CONTINUED…..

Clinical Applications Development of patellar tendinopathy may not be due to the magnitude of the patellar tendon load but the loading patterns. The conclusion reached was that increased knee flexion in landing is a predictor of tendinopathy. In the clinic those who present with patellar tendinopathy may require landing retraining, especially focusing on reducing knee flexion and emphasising quadriceps activation.

Is compressive load a factor in the development of tendinopathy?

Cook, J. L and Purdam, C. (2012). British Journal of Sports Medicine. 46:163-168. doi: 10.1136/bjsports-2011-090414 Article Summary It is well documented that the tendon pathology is mostly located on the deep surface of most tendons at, or close to, the bone–tendon junction (enthesopathy). This has appeared incongruous with the tensile overload theory because there is less elongation in this region than in the superficial portion of the tendon. The potential role of compression of the deeper transitional layers (and deep proximal/distal fibres of the tendon against the bone) that results in pathology may provide an explanation for this finding, and areas of fibrocartilaginous metaplasia have indeed been found in tendinopathy. Mechanotransduction models suggest that this response could be due to compressive load. Between the compressive (fibrocartilage adjacent to the bone) and tensile (fibrous tissue in the region removed from the bone) zones of the tendon that abut a bone is a transition zone with graduated features of both tensile and compressive pathology.

Tendons that include compressive anatomy making them susceptible to compressive enthesopathy include the Achilles tendon, tibialis posterior, long head of biceps, adductor longus, and gluteus medius. Patients with compressive tendinopathy (enthesopathy) tend to report pain aggravated in positions where compression is accentuated, rather than with activities involving muscle-tendon contraction (i.e dorsi-flexion is more painful than hopping in compressive Achilles tendinopathy).

Clinical Applications As load management is a cornerstone of treating overuse tendinopathy, defining the effect of tensile and compressive loads is important in optimising the clinical management of tendinopathy. Reducing compressive loads in insertional tendinopathies provides an important further unloading strategy for the sensitised tendon. Reduction of compressive loads is often simple, such as changing training strategies, reducing stretching or adding a heel raise, and an athlete with minimal pain may continue some training loads with these interventions. Compressive overload may also explain the resistant nature of these tendinopathies and may explain why not all patients with tendinopathy improve with the “Alfredson” eccentric training protocol for Achilles tendinopathy where dropping the heel below the step may in fact exacerbate symptoms of compressive tendinopathy.

RESEARCH SECTION

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SPNZ PHYSIOTHERAPY RESEARCH REVIEWS CONTINUED…..

Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load induced tendinopathy Cook, J. L and Purdam, C. R (2009). British Journal of Sports Medicine. 43:409-416. doi: 10.1136/bjsm.2008.051193

Article Summary Overuse tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. This article proposes a new model of tendon pathology involving 1. Reactive tendinopathy: occurs due to acute tendon overload that results in short-term tendon thickening and increase in stiffness. These changes are reversible if the tendon is sufficiently unloaded. Patients tend to be younger with recent increase in activity. On ultrasound imaging the tendon exhibits fusiform swelling and increased diameter 2. Tendon disrepair: attempted healing with matrix breakdown within the tendon, increased vascularity and neural ingrowth. Occurs across a spectrum of age groups with chronically overloaded tendons. On ultrasound imaging there is tendon swelling, matrix disorganisation, some collage discontinuity and focal hypoechogenicity. Some reversibility of the pathology is still possible with load management and exercise to stimulate matrix structure. 3.

Degenerative tendinopathy: Advanced matrix and cellular changes, reduction in collagen, and these are less likely to be reversible. On ultrasound imaging the tendon appears hypoechoic. Primarily seen in middle aged/older patients, or young elite athletes with chronically overloaded tendons. May report recurrent episodes of tendon pain, and tendon appears swollen. These tendons may be at higher risk of rupture.

Clinical Applications It can be difficult to ‘stage’ tendon pathology, and it would seem that ultrasound imaging features may assist with this.

Correct ‘staging’ of tendon pathology may then enable more appropriate management in terms of rest and exercise load progression. Although pain appears more related to neurovascular ingrowth, tendons can be painful at any stage and, when combined with response to load, pain levels serve as a useful guide for treatment progression. Treatment should focus on reducing pain to enable loading programmes aimed at effecting change in tendon structure. In the reactive tendinopathy stage, unloading and ibuprofen (NSAID) may be of use and additional exercise may actually be harmful. In tendon disrepair and early degeneration, treatments that stimulate cell activity, increase protein production (collagen or ground substance) and restructure the matrix would be appropriate. Blood injections may be of value and eccentric exercise may help in stimulating collagen production and for general function in this stage of tendinopathy. Other factors such as genes, age, circulating and local cytokine production, sex, biomechanics and body composition may alter the progression forward or back in the continuum and most are also likely to have an important role in the response to treatment in tendinopathy.

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RESEARCH SECTION JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY

June 2012; Volume 42, Issue 6

www.jospt.org

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

In Tribute: Dennis L. Hart, PT, PhD, A Functional Outcome Measurement Visionary Mark W. Werneke, Daniel Deutscher, Steven Z. George

Trunk, Pelvis, Hip, and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome Theresa H. Nakagawa, Érika T. U. Moriya, Carlos D. Maciel, Fábio V. Serrão

The Functional Movement Screen: A Reliability Study Deydre S. Teyhen, Scott W. Shaffer, Chelsea L. Lorenson, Joshua P. Halfpap, Dustin F. Donofry, Michael J. Walker, Jessica L. Dugan, John D. Childs

Quadriceps Activation Failure After Anterior Cruciate Ligament Rupture Is Not Mediated by Knee Joint Effusion Andrew D. Lynch, David S. Logerstedt, Michael J. Axe, Lynn Snyder-Mackler

Elite Swimmers With Unilateral Shoulder Pain Demonstrate Altered Pattern of Cervical Muscle Activation During a Functional Upper-Limb Task Amparo Hidalgo-Lozano, Carmen Calderón-Soto, Antonio Domingo-Camara, César Fernández-de-las-Peñas, Pascal Madeleine, Manuel Arroyo-Morales

Scaphoid Fracture in a Patient After a Fall Christopher J. Buscema

Ultrasound Assessment of an Acute Biceps Brachii Injury David A. Krause, Jay Smith

Patellofemoral Pain: Proximal, Distal, and Local Factors, 2nd International Research Retreat Christopher M. Powers, Lori A. Bolgla, Michael Callaghan, Natalie Collins, Francis Sheehan

Patient Perspectives Anterior Knee Pain: A Holistic Approach to Treatment Case Report Preinjury and Postinjury Running Analysis Along With Measurements of Strength and Tendon Length in a Patient With a Surgically Repaired Achilles Tendon Rupture Karin Grävare Silbernagel, Richard W. Willy, Irene S. Davis

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

What?

Where?

More information

16 June

NZMPA –Lumbar Instability, MSB and Hip

Christchurch

www.nzmpa.org.nz

16 June

Back in Motion Pilates – Mat Level 2

Auckland

Click here for info

21 June

McKenzie –Part B

Wellington

minz@mckenziemdt.or g.nz

23 June

Motor Control and Sensorimotor Training for Pain and Injury Rehab in the Lumbar Spine

Tauranga

cath.mcfadyen@activep hysio.co.nz

06 July

STOTT PILATES Intensive Cadillac, Chair & Barrels Course

Auckland

info@corepilates.co.nz

14 July

Stability Plus Pilates - Reformer 1

Auckland

Click here

14 July

NZMPA - Lumbar Spine Revisited

Dunedin

admin@nzmpa.org.nz

19 July

McKenzie Institute of NZ - Part B: The Cervical & Thoracic Spine

Christchurch

minz@mckenziemdt.or g.nz

21 July

NZMPA - Shoulder

Auckland

http:// www.nzmpa.org.nz/

27 July

The Milicich Method: Module 1

Christchurch

wayne@ops.co.nz

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

31 Oct - 2 Nov

Be Active 2012 (Sports Medicine Australia)

Sydney

beactive2012

16 November

10th Sport Symposium

Bern

http://www.sportfisio.ch/ index.php/main/getNews

29 Nov- 1 Dec

Team Concept Conference

Las Vegas

http://www.spts.org/ education/team-conceptconference

2012

INTERNATIONAL COURSES & CONFERENCES When?

2012

Page 17

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

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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 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

the

Disabled

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

Sports physiotherapy

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Sports medicine

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Sports science

AND MORE...

Quick Links to Members Section Resources Copies of SPNZ’s Research Reviews, a list of open-access journals (full-text available), clinical article summaries and other sports physiotherapy related articles.

Book Reviews Book reviews on sports physiotherapy topics

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Calendar of upcoming courses and conferences

Page 18

CLASSIFIEDS POSITIONS VACANT MT RUAPEHU Physio Rehab Group Physiotherapist (Part/ Full-time / Locum) Physio Rehab Group provide physiotherapy services both on and off the mountain at Mt. Ruapehu.

We are looking for additional physios to join the Mt Ruapehu Physio Clinic for the ski season and through the summer when Mt. Ruapehu/Ohakune comes alive with a whole raft of other exciting sports. We also service the local and surrounding communities.

We are seeking an enthusiastic Physio with the ability to work, on occasion, as a sole practitioner, and as part of a medical team. The position is well supported by Physio Rehab Group Ltd. Ohakune is the gateway to the Tongariro National Park, with a variety of outdoor activities and two ski fields on Mt Ruapehu. Ski pass and gym membership included.

Please contact Karen Sutton for further information: info@physiorehabgroup.co.nz or phone +64 9 575 4648

CLINIC FOR SALE / POSITION VACANT CHRISTCHURCH Christchurch - Body Wise Health Physiotherapy Clinic For Sale/Permanent Locum

 Keen to be your own boss, work your own hours? OR Are you looking to expand your current business?  A great opportunity to invest in a busy accredited sole practitioner clinic within the Gayhurst Medical Centre.

The owner of this clinic is looking to sell due to change in personal circumstances. Permanent locum position will also be considered for the right applicant.

This friendly established clinic provides the new owner with:  A fully accredited clinic  ACC EPN Interim Contract  Up to date Gensolve Practice Management Systems set up for both referrer and client database.  Excellent Branding and Administrative Systems  Modern clinical equipment including Akron Hi-lo Couch and additional plant/stock.  Reception cover provided by Gayhurst Medical.

Contact the Principal Tina McCormack on 021 419 744 or email bodywisehealth@xtra.co.nz

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