Sport Health Volume 39 Issue 4 - Best of the Best Special Edition by Sports Medicine Australia

Sport

health VOLUME 39 ISSUE 4 2022

Best of the Best Special Edition PLUS

• Returning to Sport After ACL Injury • Sports Related Concussion – Focus on Female Athletes • LGBT+ Inclusion in Australian Sport: What’s the Score? • Challenges and Stresses Leading up to the Paralympic Games

Contents REGULARS

Challenges and stresses leading up to the Paralympic Games

From the Chair In the year ahead, we face an exciting roster of events and opportunities for SMA Members to get involved with.

Dr. Nima Dehghansai discusses the challenges that Paralympians face leading up to the Paralympic Games.

20 LGBT+ Inclusion in Australian Sport: What’s the Score? Co-Founder of Proud2Play Ryan Storr highlights the importance of LGBT+ inclusion in sport and what we can do to achieve it.

From the CEO We return to normal level of sports across the country and look forward to what SMA has planned for the upcoming year.

FEATURES

Sport Related Concussion – Focus on Female Athletes Shreya McLeod discusses the specificity around concussion in female athletes and understanding why women are more susceptible to concussion.

Opinions expressed throughout the magazine are the contributors’ own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made in advertisements nor the quality of goods or services advertised. All materials copyright. On acceptance of an article for publication, copyright passes to the publisher.

VOLUME 39 • ISSUE 4 2022

Is Running the Best Form of Physical Activity Neil Ames, avid runner talks about the impact that ParkRun has had on communities and individuals.

Publisher Sports Medicine Australia Melbourne Sports Centre 10 Brens Drive Parkville VIC 3052 sma.org.au ISSN No. 1032-5662 PP No. 226480/00028

Copy Editors Jack Sullivan and Archie Veera Senior Marketing and Communications Officer Archie Veera Design/Typesetting Perry Watson Design Cover photograph Paul Bradbury/ gettyimages Content photographs Author supplied; www.gettyimages.com.au

Volume 39 • Issue 4 • 2022

INTERVIEWS

No time to waste during the COVID-19 pandemic and beyond

In this feature, Dr Vincent Gouttebarge sheds light on the process of screening for mental health disorders in professional footballers.

5 Minutes with Professor Gary Nicholls

38 Sports Medicine Around the World: China

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People who Shaped SMA: Julie Cooke

Returning to sport after ACL injury Author Tracy Ward shares the importance of both physical and psychological factors of returning to sport after an ACL injury.

43 Sports Trainer Highlight: Hugh Burns

VOLUME 39 • ISSUE 4 2022

FROM THE CHAIR

Return to face-to-face events, SMA Conference and the best Sport Health has to offer. IN THE YEAR AHEAD, WE FACE AN EXCITING ROSTER OF EVENTS AND OPPORTUNITIES FOR SMA MEMBERS TO GET INVOLVED WITH.

elcome to this of Sport Health. We have the opportunity to look back on all that has been achieved in the past 12 months and how we have navigated our way out of the heights of the COVID-19 pandemic. We’ve been thrilled to get back to delivering face-toface events and courses across the country and have been able to move to at least 30% of events delivered in an in-person format. In the past 12 months alone, we have run over 400 courses across the country, from Level 1 Sports Trainer to Emergency Care for Suspected Spinal Injuries. Alongside this, we have continued to run our popular online webinars, and provide access to world class speakers and resources for a larger number of members than ever before. We look forward to our 2022 SMA Conference, returning in a faceto-face format on the Gold Coast. This presents the opportunity to collaborate with our fellow members once again, and share our experiences and knowledge from navigating the last 12 months. The conference also affords us the opportunity to connect with sports medicine professionals and hear from some of the leading individuals in the field.

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At this year’s Conference we welcome a number of world-renowned leaders in the fields of sports health as keynote speakers. The highly renowned Dr Susan White, who has been heavily involved in multiple Olympic and Paralympic Games, will deliver the Sir William Refshauge Lecture. We also welcome Professor Dr Vincent Gouttebarge who is an Extraordinary Professor at the Section Sports Medicine of the University of Pretoria and the Chief Medical Officer at FIFPRO (Football Players Worldwide). Professor Jill Cook, an Emeritus Professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne will also be presenting a keynote address. There will also be many other world-class sports medicine professionals who will be presenting at the conference this year. Looking forward to the second half of 2022, we will continue to provide a large number of face-to-face and online events across the country to our members. We will continue to source leaders in their fields of sport medicine to provide members with the highest quality resources and learning opportunities. We will also

Our return to more inperson sporting events has opened the door for SMA to push forward into providing face-to-face events and courses for our members. continue to run nationally accredited Safer Sports courses Australia-wide. This special edition of Sport Health combines the best articles from several previous editions to provide a comprehensive snapshot of sports medicine as a whole. It will cover topics such as concussion, ACL injuries, mental health, diversity, running, and sports health with para-athletes. We hope you enjoy reading this edition of ‘The Best Of’ Sport Health.

Professor Gregory Kolt

FROM THE CEO

What has been achieved and what is yet to be in 2022. WE RETURN TO NORMAL LEVEL OF SPORTS ACROSS THE COUNTRY AND LOOK FORWARD TO WHAT SMA HAS PLANNED FOR THE UPCOMING YEAR.

elcome to this special print edition of Sport Health.

In this 2022 edition, we provide you with the best of the best. Our most popular articles chosen by you, our members, over the past 12 months. While Sport Health has been delivered online for the past two years, we recognise the importance that only a physical copy of the magazine can provide, especially those who work in and around clinics. With a return to normal levels of sport across the country now upon us, our members have been increasingly engaged across a range of sporting codes and activities to provide the best injury prevention strategies, injury assessment, management and treatment for the public. Sport Health is just one means of providing members with insights, practical tips and tricks to manage the most challenging of situations. Our professional development program and Event Series is continuously growing, providing our members the invaluable opportunity to learn from peers, and contribute to discussions on particular sporting injuries and issues. The pinnacle of our Event Series is our

In this edition we look to provide the best articles and experts that Sport Health has to offer, with a large range of topics to indulge in. annual Conference which will be held at RACV Royal Pines in November. Attracting speakers and delegates from across Australia and the world, there will be four major streams, sports and exercise science, physical activity and health promotion, clinical sports medicine and sports injury prevention. The Conference is designed to cater for all of our members, not just those who are academics, researchers, or clinical practitioners. Our Sports Trainer members and Students are encouraged to attend, as much of the information and research presented at the Conference is highly relevant in a day-to-day setting within many common sporting codes.

Into the year ahead, Sports Medicine Australia is excited to be working on a number of important projects that will continue to build upon SMA’s profile within the community. Our relationships with like-minded organisations and government entities continue to strengthen, and we participate actively in a number of important initiatives and collaborations. Membership of SMA remains your ticket to ensuring that you have access to the best available knowledge and expertise across a substantial network of peers and subject matter experts. No other organisation within Australia matches our unique multidisciplinary approach: giving members a holistic view of sports medicine, not just within their own field of expertise. In this addition of Sport Health, we look forward to showcasing our best articles across the following topics of concussion, ACL injuries, mental health, diversity, running and sports health with para-athletes. We hope you enjoy this addition of Sport Health and we look forward to your continued support as we work with our members towards achieving our Vision: Enhancing health outcomes for all Australians, through knowledge, training and safe participation in sport, exercise and physical activity.

Jamie Crain jamie.crain@sma.org.au VOLUME 39 • ISSUE 4 2022

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Sport Related Concussion

Focus on Female Athletes BY SHREYA MCLEOD

AUSTRALIA’S ELITE SPORTSWOMEN HAVE EXPERIENCED A PERIOD OF UNPRECEDENTED SUCCESS OVER THE PAST DECADE. CURRENTLY, OVER 600,000 AUSTRALIAN WOMEN ARE PLAYING A VERSION OF FOOTBALL IN THE FORM OF SOCCER, AUSTRALIAN RULES, RUGBY LEAGUE OR RUGBY UNION.

he rise in participation in contact and collision sports has led to a concomitant increase in injuries, such as sport related concussions (SRC). A concussion is defined as a transient brain injury, caused by a direct blow or an indirect force transmitted from the body to the head or face. Typically, SRC is considered a functional neurological disturbance rather than a structural injury, making it difficult to detect on routine brain imaging. Recognising when someone has sustained a concussion, removing the athlete from play, and carefully assessing recovery in a stepwise manner, are all critical elements prior

Photo: Pornpak Khunatorn/ iStock

FEATURE: SPORT REL ATED CONCUSSION: FOCUS ON FEMALE ATHLETES

to returning the athlete to play. At the professional level, several contact and collision sports have adopted sideline technology, allowing medical staff and independent spotters to identify potential concussive events. However, at the community level, it is a medical diagnosis that frequently relies on selfreported symptoms such as dizziness, confusion, unsteadiness, nausea, and headaches. Symptoms may present immediately or evolve over a period of time, usually within the first 24 hours. Symptoms Headache is the most commonly reported symptom following a concussion.

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FEATURE: SPORT REL ATED CONCUSSION: FOCUS ON FEMALE ATHLETES

Women rate headache, pressure in the head and emotional lability higher than men. Other symptoms may include dizziness, fatigue, memory loss, concentration difficulties, insomnia, neck pain, irritability, visual disturbances, and feeling in a fog. Within the general population, women are also up to five times more likely to suffer from migraine headaches and, therefore, clinicians should consider the headache presentations of female athletes and offer appropriate management. Depending on the type of headache a multifactorial approach involving sleep hygiene, diet, hydration, exercise and stress reduction may also be indicated. Risk factors Women tend to be more aware of their symptoms and are more likely to report them, however, under-reporting still exists. As with men, women may minimise their symptoms to avoid missing games or not consider their injuries serious enough to warrant further discussions with the medical team. Although the research on the length of recovery is mixed, there is overall support for women taking longer to recover than men, with an average of 6-20 days longer. Recent studies have shown that women are still symptomatic up to 28 days post-concussion compared to men. Both genders report symptoms such as headaches, mental fatigue, concentration difficulties and mood swings. Men, however, are more likely to report amnesia and disorientation as their main symptom while women tend to complain of drowsiness and sensitivity to light. Women may also perform worse on neurocognitive testing. Broshek 6 6

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Photo: PeopleImages/ iStock

Sport Related Concussion Focus on Female Athletes

et al. found that females reported 1.7 times more cognitive concerns such as difficulty concentration, compared to males. They also have a lengthier return to play trajectory.

Female athletes are more likely to sustain a concussion when compared with their age and sport-matched male counterparts.

Hypotheses for genderbased differences These gender-based differences are believed to be a result of a combination of factors. Physical factors such as shorter neck dimensions, smaller head mass and narrower neck girth result in reduced neck strength in women. This, in turn, predisposes women to greater head-neck acceleration during impacts. Researchers believe that women may have a lower biomechanical threshold for SRC than men, with peak linear accelerations up to 20g lower, and that the diagnosis of SRC is based on the frequency and magnitude of head impact exposure. Anatomically speaking, male brains have more grey matter than white matter, indicating more active neurons whereas female brains have more white matter, suggesting better communication between areas of the brain. Additionally, males tend to be single hemisphere dependent for most tasks whereas women are bi-hemisphere dependent. If a head injury temporarily disrupted the supply of glucose and oxygen to the brain, it would have a significant impact on recovery. Finally, varying levels of female sex hormones in a cycle could alter concussion risk. A study found that sustaining a concussion in the follicular phase (after menstruation, before ovulation) was less likely to lead to symptoms a month later, compared with the luteal phase (after ovulation, before menstruation) resulting in

Photo: Chinnapong/ iStock

FEATURE: SPORT REL ATED CONCUSSION: FOCUS ON FEMALE ATHLETES

poorer outcomes. However, these effects may be negated when women take contraceptive pills, reducing the severity of concussion symptoms but not necessarily altering days to recovery. Despite these differences, women are an understudied population, with very few studies addressing these concerns, resulting in a lack of gender specific treatment guidelines. Repeated concussions and long-term risk Understanding exactly why women are more susceptible to concussion is necessary to reduce the potential risk associated with participation in contact and collision sports. Future research needs to investigate other longer-term consequences of concussion, with women playing beyond pregnancy and childbirth. There are concerns, for example, that head impacts can increase the risk of neurodegenerative diseases such as Alzheimer’s and chronic traumatic encephalopathy. In the ageing population, women are known to have higher rates of Alzheimer’s disease, relative to men. Although concussion is a potential risk factor in developing dementia, studies have not yet examined the interaction between SRC and neurodegenerative diseases in women.

long-term implications of single head impacts and repetitive concussions.

Therefore, female brains are thought to be hungrier than males, with greater blood ﬂow resulting in faster metabolisms.

Sports-related concussion is a health concern, and women are at higher risk of sustaining a sports-related concussion compared to males. Although there have been studies that investigated outcomes after concussion, females remain an understudied population, despite representing a large proportion of the organised sports community. Making informed, evidence-based decisions about risk and benefit needs to rely on objective data in the form of prospective studies, in order to determine how concussions affect women across the lifespan.

Author Bio Shreya McLeod, is a Titled Sports & Exercise/ Musculoskeletal Physiotherapist, has more than 15 years’ experience treating national and international athletes. Shreya is currently undertaking a PhD at The University of

Prospective clinicopathological studies in women are needed to assess the interaction between repetitive exposure to head impacts and the potential changes in brain and behaviour across the lifespan. These studies need to apply a multifactorial approach by considering cognition, genetic risk factors, mental health, and menstrual cycle function pre- and post-injury, to better inform the

Newcastle, New South Wales, in the identification of concussion in Women’s National Rugby League. She has a research interest in injury risk reduction, particularly in female contact and collision sports. She is also a Lecturer in the undergraduate Physiotherapy program at the Australian Catholic University in North Sydney, New South Wales.

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FEATURE: CHALLENGES AT THE PARALYMPICS

Challenges and stresses leading up to the Paralympic Games WHILE THERE ARE NUMEROUS BENEFITS TO SPORT PARTICIPATION (I.E. DEVELOPMENT OF MOTOR SKILLS, IMPROVED PHYSICAL AND PSYCHOLOGICAL HEALTH), THE STRESSES AND CHALLENGES ASSOCIATED WITH THE HIGH-PERFORMANCE SPORT MAY BUFFER THESE POSITIVE OUTCOMES. WITHIN THIS HIGH-INTENSITY ENVIRONMENT, THERE IS A HIGH EXPECTATION FOR ATHLETES TO PERFORM AT THEIR BEST WITH SEVERE CONSEQUENCES FOR BELOWAVERAGE PERFORMANCES. NOT TO MENTION THE INCREASE IN MEDIA EXPOSURE AND SOCIETAL AWARENESS OF ONE’S PERFORMANCE. THE AMALGAMATION OF THESE FACTORS CAN EXPOSE ATHLETES TO EXHAUSTION AND BURNOUT, INCREASE CHANCES OF PHYSICAL INJURIES, AND IN EXTREME CASES, RESULT IN PSYCHOLOGICAL AND PHYSICAL DISORDERS. 28 8

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hile there are numerous benefits to sport participation (i.e. development of motor skills, improved physical and psychological health), the stresses and challenges associated with the high-performance sport may buffer these positive outcomes. Within this high-intensity environment, there is a high expectation for athletes to perform at their best with severe consequences for below-average performances. Not to mention the increase in media exposure and societal awareness of one’s performance. The amalgamation of these factors can expose athletes to exhaustion and burnout, increase chances of physical

FEATURE: CHALLENGES AT THE PARALYMPICS

Photo: dusanpetkovic/ gettyImages

There were a wide range of challenges expressed by athletes and coaches which were categorised into sport-specific, personal, and uncertainties.

injuries, and in extreme cases, result in psychological and physical disorders. In the high-performance context, athletes are not alone in dealing with high expectations and criticism. Coaches too are prone to dealing with lofty expectations to support athletes’ potential and meet continuous sporting demands including balancing of expectations from a wide range of stakeholders (directors, administration team, support staff, parents, athletes) and increased scrutiny by media and news outlets which can result in exhaustion and burnout. The lead-up to major Games (e.g. World Championships, Olympics/

Paralympics) can exacerbate these challenges, as often, there is an increase in training intensity, number of qualification tournaments, and training camps. Simultaneously, life outside of sport is usually put on hold while sport demands increase (i.e. media engagements, travel, etc.). Not to mention, the Quadrennial contract that coaches receive is often dictated by the team’s performance at the Paralympic Games while athletes’ performances can dictate future opportunities (i.e. being selected for the team the next quad, public speaking, sponsorship, etc.). Therefore, understanding the challenges athletes and coaches face, and how they navigate these circumstances may help develop resources to better support them. In this study, we interviewed fourteen high-performance Australian Paralympic athletes (n=8) and coaches (n=6) to better understand challenges, solutions, and strategies utilised by athletes and coaches in the lead up to the Tokyo 2020 Paralympic Games. Challenges There were a wide range of challenges expressed by athletes and coaches which were categorised into sportspecific, personal, and uncertainties. Sport-specific challenges Sport-specific challenges captured the experience of athletes and coaches directly within the sporting environment. These challenges were either specific to their sport (e.g. budgetary constraints), tied directly to individuals (e.g. moving cities to access coaches), or factors that occurred within the sporting environments (e.g.

training and competition contexts). From a coaches’ perspective, there were budgetary constraints that they had to navigate to meet demands of increased travel costs due to training camps and qualification tournaments. Australia’s geographical location relative to other countries was not contributing to the cause. The constant travel also contributed to increased stress for athletes due to the physical and psychological demands including time zone changes, accommodations away from home, lower quality of sleep, slower recovery, and reduced energy. The geographical makeup of Australia also impacted the experience of athletes and coaches in the decentralised training environments. The lack of frequent in-person training contributed to a slower progression in building trust and developing relationships between athletes and their coaches and teammates. Therefore, coaches utilised training camps as an opportunity to increase comradery and increase team chemistry through team activities (sport and non-sport related). The looming performance expectations at the Games also increased the importance of strategic training to ensure optimal recovery and build-up was implemented so the athletes could be at their peak at the Games. This was especially significant for athletes who had impairments that could impact their physical well-being if the training load was not appropriately managed, increasing the stakes of careful planning. VOLUME 39 38 • ISSUE 4 2022 2021

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FEATURE: CHALLENGES AT THE PARALYMPICS

Challenges and stresses leading up to the Paralympic Games There were numerous sport-specific challenges athletes and coaches dealt with including the need to travel for tournaments and training camps which came at a cost financially, physically, and socially. There was also a clear emphasis on the athlete and coach dynamic to better understand athletes’ impairment, their abilities, and tendencies, and how these factors interact, in order to better structure effective training and maximize athletes’ potential in the lead up into the Games. Personal challenges The decentralised environment and geographical makeup of Australia forced some athletes to relocate cities or countries to work with their coach. The extensive commitment to their sport also prevented athletes from committing to other activities or opportunities (i.e. vocation or education), furthering the importance of performing well at the Games. The limited vocational opportunities also left athletes with limited financial means during the lead-up to the Games, forcing them to be strategic with their spending. Coaches were also compelled to spend extensive time away from their families, attending training camps and qualification tournaments. But coaches highlighted the families had grown accustomed to this type of lifestyle and were understanding the circumstances, which was welcomed by coaches since it reduced stress in one aspect of their already stressful situation. In summary, the increase in training camps and qualification tournaments during the lead-up to the Games increased demands for athletes and coaches’ time, compelling them to sacrifice in other areas of their lives. For coaches, it was mainly time away from family, while for athletes, they perceived this as time away from their social circles and potential education or vocation developments. 30 10

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Uncertainties One of the main uncertainties concerning athletes’ and coaches’ preparation leading up to the Games was the COVID-19 outbreak and its impact on qualification tournaments. It is important to note that the COVID-19 virus was not declared as a pandemic at the time the study was conducted, and participants were more concerned regarding the possibility of qualification tournaments being postponed or cancelled. Athletes showed little concern regarding the possibility of cancellation of the Games, while coaches had some inclination and potential of the outbreak affecting the Games but felt it would be important to proceed as planned until given reason to alter direction. Other uncertainties included the lack of information pertaining to the

number of accreditations each sport can receive at the Games which prevented coaches from developing strategies and implementing these during training. Therefore, limiting the type of Games-specific strategies that athletes can work on with their coaches. For some athletes who have impairments that fluctuate in severity, there were concerns regarding how they would feel on the day of their competition. Athletes highlighted the importance of consistency in their schedule (sleeping pattern, eating cycle, and nutrition macros) to increasing the likelihood of positive outcomes during the Games. The main uncertainty was related to the development of the novel coronavirusCOVID-19, which impacted training camps, qualification tournaments, and delivery of equipment for Tokyo 2020.

Photo: satamedia/ gettyImages

FEATURE: CHALLENGES AT THE PARALYMPICS

Lastly, there were concerns regarding athletes’ physical and mental state on event day, with some athletes concerned regarding how their body would respond and whether there will be any impairment-related complications to deal with on the day of the competition. Strategies Strategies highlighted the range of tools athletes and coaches utilised or plan to implement to combat or prevent some of the challenges. Anticipation and Preparation While there were numerous uncertainties during the lead-up to the Games and how the they may proceed, participants emphasised the importance of anticipating challenges and developing solutions to be prepared for a wide range of outcomes. This involved rehearsing certain aspects of the competition outcome during training and coaches focusing on creating an environment that may facilitate opportunities for athletes to learn and adjust (e.g. introducing unexpected challenges during training to see how athletes cope with the changes).

Similarly, athletes also noted the importance of aiming high but also realising the realistic chance of a ‘less than ideal’ outcome. In addition, there were uncertainties regarding accreditation which created a complex situation for coaches to navigate and prepare for as they attempted to develop a training environment similar to the Games.

As part of this, communication between athletes and coaches was seen as paramount to a successful outcome. Therefore, exploring multiple means of communication including transparency and clarity in information sharing was very important to be effective. For athletes, they supplemented this by utilising visualisation and imagery strategies to cope with the uncertainties and develop alternative contingency plans. This level of preparation was reported to reduce physical and psychological stress both for athletes and coaches. Managing Expectations It was also evident that managing expectations within the team were important to the chemistry and growth of the team. This included

managing athletes’ expectations on the level of support they would receive both in preparation and during the Games. For support staff, it was important for coaches to clearly articulate each person’s role to prevent miscommunication and ensure a smooth transition on competition day. But more importantly, coaches realised through self-reflection that they needed to manage their own expectations and take care of their health, so they can be in the right mind frame to be able to support the athletes when it matters. Managing their own expectations also helped deal with their personal stress levels. Similarly, athletes also noted the importance of aiming high but also realising the realistic chance of a ‘less than ideal’ outcome. Understanding the multiple narratives allowed athletes to better cope with the doubts that crept into their minds during training. Coaches, too, realised the importance of psychological support at the event, in case an athlete had a disappointing race and needed support in coping with the results. Therefore, for both coaches and athletes, the focus was mostly on their preparation and performance at the Games, and less on the outcome (i.e. medaling or podium finish). Post-Tokyo All the participants were focused on their current goal of achieving the best they can at the Tokyo 2020 Games, thus, conversations regarding post-Tokyo were a mere reflection of what the athletes and coaches miss and what things they would be looking to incorporate into their lives with the reduced workload post- Paralympic Games. For athletes and coaches, inevitably, the performance at the Games dictated certain outcomes post-Games. Thus, there was the theme of ‘pressure.’ VOLUME 39 38 • ISSUE 4 2022 2021

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FEATURE: CHALLENGES AT THE PARALYMPICS

Challenges and stresses leading up to the Paralympic Games Pressure Coaches realised that the outcome of the Games may dictate their employment opportunities. However, unanimously, coaches accepted this as part of their job and highlighted the pressure of performing at the Games was not influenced by the lack of uncertainty regarding their employment status post-Games. Athletes were also aware of the potential opportunities (e.g. public speaking, sponsorship) that could be presented after an ideal performance at the Games. Others in the ‘grey area’ in their careers, saw the Games as feedback to whether they would continue to train for Paris 2024 while some athletes saw the 2024 Paralympic Games as an opportunity to ‘redeem’ themselves if they have a bad performance at the 2020 Paralympic Games. In summary, while athletes and coaches understood the repercussions of their performance at the Games, they were solely focused on a good performance, rather than the consequences that may occur because of it.

Takeaway Points The findings from this study highlight the wide range of challenges that athletes and coaches navigate through as they prepare for the Paralympic Games including sportspecific (budgetary constraints, need for meticulous planning and commitment to increased training, increased travel) and personal factors (lack of social, personal, vocational, or educational outlets). Uncertainties including the COVID-19 pandemic, qualification status, and accreditation also contributed to the stress participants dealt with in preparation for the Tokyo 2020 Paralympic Games. However, athletes and coaches demonstrated strategies including anticipation, planning and managing expectations in dealing with some

of these challenges. Contingency plans, effective communication, and understanding of each other’s roles appeared to be paramount in coping with expected and unexpected events both in preparation, leading up to the Games, and performance at the Games. Lastly, while there was little consideration to outcomes postTokyo, participants did look forward to resuming activities in their lives outside of sport and decreasing the level of commitment in their sport for a short time. There was pressure to perform at the Games as it may have consequences post-Games; however, athletes and coaches were laser-focused on their performance at the Games and less worried about the consequences of poor performances.

About the Author Dr. Nima Dehghansai Nima currently works as an Athlete

Personal Participants highlighted that the preparation for the Games has been exhausting, leaving them disconnected from their families and social circles. In addition, extensive training has had a toll on their bodies. Thus, they were looking forward to a mental and physical break while incorporating their social life back into their lives. Some athletes demonstrated excitement to be relocating back to their ideal living conditions while others shared sentiment to revisiting families and friends while others were looking forward to commencing or resuming vocational or educational commitments. For coaches, they were looking forward to some family time to make up for the time lost preparing for the Paralympics. 32 12

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Development & Talent ID specialist at Paralympics Australia. He utilises researchdriven empirical evidence to inform policies and initiatives that optimise the sporting environment to maximise athletes’ development. By using a mixed method designed research program, Nima aims to continue to expand and further understanding of factors that impact athletes’ experiences in the Paralympic system, from initiation and recruitment to development across their athletic careers. Nima’s holistic approach to developing strategies in sport has resulted in numerous international collaborators including universities in Australia, Canada, Germany, The Netherlands as well as Australian and Canadian national sporting organisations. Nima along with colleagues, Dr. Ross Pinder and Dr. Joe Baker are authoring a book that examines talent identification and development in Paralympic sports.

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FEATURE: THE IMPACT OF PARKRUN

Is running physical the best form of

If so, does that make parkrun world leading industry best practice for physical activity programs? NEAL AMES, MEMBER PARKS & LEISURE AUSTRALIA

n the running “fraternity” there is a book that is referred to in whispered reverence, Born to Run (Christopher McDougall). For running tragic’s it is our ‘raison de’ etre’ (our reason for being). It tells a story of a South American tribe who are experts at running, and the desire of a group of Americans to travel to their home and race them. For me personally, it is not that part of the story that is so powerful, it’s the evolutionary evidence that the author uses to explain our species connection to and fascination with running. Thankfully, being a curious person, I had already sought out the reasons that we run, and its impacts on our development as a species, many years back, but the book reaffirmed and reminded me of those reasons. To put it simply, without our ability to run and more importantly our evolution as the best runners on the planet, we wouldn’t be here as a species. In the scheme of evolutions slow-motion pace of natural selection, we did not need to be the quickest, just

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the most efficient to achieve selection edge. Running, and our evolutionary quantum leap in exchanging hair follicles for sweat glands, allowed us to become marathon runners. Whilst every other species remained as mouth breathers, needing to regularly stop and pant to cool themselves, humans can run all day, cooling ourselves through the sweat on our skin. This makes for a great hunting advantage as its easy to catch dinner when it can’t run away from you. Therefore, we are a species that evolved, and dare I say, were born to run! It may no longer be critical to our survival, but it is still in our genes, including the chemical responses that make it easier for us to run. I still have endorphin highs when I run, a combination of chemicals that give runners that warm buzz. Which brings us to the physicality of running. Earlier humans may have assumed that if something hurts, like running, then it is bad for you,

Nepean Parkrun in Penrith.

FEATURE: THE IMPACT OF PARKRUN

activity? and that is often the case. If running hurts they may have assumed, then it is bad. However, more recently science has been able to show that in fact running is good for our bones, our heart and our lungs. research shows that runners have increased bone mass density, greater lung capacity and stronger heart muscles; adaptations which result from the physical demands of this activity.

However, even up until a few years ago it was assumed that running was bad for other parts of our body, including our soft tissue, like cartilage and tendons, and it was benign for our most important organ, our brain. A number of important research articles released in 2019 disproves those assumptions. We now understand that running actually strengthens our soft tissues and has profound neurological

effects, including heightened cognitive capacity and improved mental health Let me tell you a story. I have always struggled, somewhat, with depression. Winston Churchill termed his battle with depression, the “black dog”. I have run for the last 30 years, and I was always aware that it made me feel good, especially afterwards. More recently we have seen organisations

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FEATURE: THE IMPACT OF PARKRUN

Is running physical activity? the best form of

program, it is a successful community engagement program, and it activates or re-activates Australia’s iconic parks and open spaces. I will come back to unpack those answers in a wee little bit, but first... In May 2016 Mark Band, CEO Parks & Leisure Australia (PLA) wrote to Parkrun Australia to congratulate the organisation on its outstanding success. Mark stated; “Parks and Leisure Australia (PLA) is writing to Parkrun Australia to congratulate your organisation on the significant success that you are seeing with your parkrun events.”

Australian parkrun statistics as at 16 March 2018

such as the Black Dog Institution appear. On my running vest I have a little pin of a black dog, to remind me of the benefits of running. One Sunday last year I did a long run in the Dandenong’s in Melbourne. When I got back, I posted about my experience on social media. To paraphrase I said, “went for a run in the Dandenong’s today, the black dog went with me, but about halfway through I left him behind, and at this point he hasn’t come home”. My brother responded by stating that he wasn’t aware that I had a dog. After educating him on the black dog we both had a laugh. Just another benefit of running. If you yourself are not a runner, hopefully I have sold you on the benefits of running. I have set out for the reader a layperson’s understanding

Launch of Dolls Point Parkrun, Botany Bay.

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of the benefits of running. And that brings me to ‘Parkrun’, as I put my recreation planner’s hat on. Parkrun was developed in London in 2003, by two intrepid computer geeks, and with just six original runners, it is now a world-wide phenomenon. It is now facilitated in more than 22 countries worldwide and has more than 350 different courses here in Australia. A couple of years ago I wrote an article, which sought to unpack the success of Parkrun, both as a physical activity program as well as a social experiment. Our natural connection to running as a species sits as the bedrock of Parkrun. I have heard many in the industry ask, “so why is parkrun so popular?”. The response to that question has three separate answers. They are: it is an effective physical activity

At the time of writing that letter Parkrun had been operating in Australia for five years, and many working in the industry, within local government, state government or with the federal government had seen or heard of the growth in the “movement”. Most parkrun’s are conducted in parks managed by LGA’s and parkrun need to seek permission to hold their events in each specific location. Council officers needed to be approached, applications submitted and in most cases councilors briefed by the local event coordinators. As you can see by the latest statistics below parkrun has spread far and wide and so the interaction of local parkrun volunteers and government officers has led to an increase in parkrun’s profile with the industry.

FEATURE: THE IMPACT OF PARKRUN

Parkrun, in its simplest form, is a free five kilometre timed run, or walk, held each and every Saturday morning at local parks in 350 individual locations around Australia Mark, in his letter went on to state; “PLA and its members are very aware of the work being done by Parkrun both in providing a “best practice” physical activity program for individual communities but also in bringing awareness of Australia’s diverse parks to their communities.” In writing to Parkrun PLA had already started to notice the three components that were leading to its outstanding success, its success as a physical activity program and its value in introducing Australians to their parks. Now, let’s unpack the reasons for parkrun’s success. Industry “Best Practice” Physical Activity Program Parkrun, in its simplest form, is a free five kilometre timed run, or walk, held each and every Saturday morning at local parks in 350 individual locations around Australia. Before running their first run a new participant obtains a unique barcode from parkrun’s website, which they present to the “scanner” at the end of the run/walk. Their time is recorded and normally within an hour an email arrives in the participants

Volunteers and runners at Bateman’s Bay Parkrun, pouring rain.

Wayﬁnding volunteer at St Peters Parkrun in Sydney Park. The backbone of Parkrun are the volunteers.

inbox with their time and their position compared to everyone else that participated, how many runs they have completed and an age grading, which compares their performance against their peers from around the world, based on the five kilometre distance. The two guys that created parkrun, in Bushy Park in London, got the IT right, and everything else has flowed from there. Parkrun attracts world class runners, first timers, walkers, parents with prams, people with dogs, people in hairy suits, in Santa costumes and people in fairy outfits. They do it on Christmas Day, on New Year’s Day, in the rain, in the snow, in mud, and most importantly in very large numbers.

in the community through programs such as Yoga in the Park, Mum’s with Pram’s, and “Energise”. Local governments have been so committed to the cause that some of them have employed Physical Activity Officers to deliver programs. But in my 20+ years in the industry I have not come across one program that had the “stickiness” and the sustainability that saw it grow and be embraced by the community as a whole. That was until Parkrun.

Governments, of all stripes, have been trying to develop successful physical activity programs, that the community will engage in, and stay engaged in, for the last ten years at least. In the early 2000’s Peter Beattie, then Premier of Queensland, had called an “Obesity Summit” in Parliament House in Brisbane to try and work it out. I personally was involved in delivering programs such as the Club Development Program and the Active Inclusion Program whose focus was providing physical activity programs

The ongoing and sustained success has been noticed, most notably by universities and researchers. A number of research programs have been undertaken to examine Parkrun and its success. Researchers at Loughborough University in England have Completed a longitudinal study; ‘Study of Parkrun on Lifestyle and Exercise’, better known as SparkLE. The aim of the research was to “study participants in terms of demographics, current physical activity, the perceived impact of involvement and parkrun performance statistics”. The SparkLE research was published in the International Journal of Behavioural Medicine. The researchers observed; “The evidence suggests that parkrun is attractive to non-runners; with 38 • ISSUE 4 1 2020 VOLUME 39 2022

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FEATURE: THE IMPACT OF PARKRUN

Is running physical activity? the best form of

women, older adults and overweight people well represented. Fitness improvements were observed and there were many positive perceived beneﬁts, suggesting parkrun may be an effective community-based intervention for improving public health.” In that short sentence are all the deliverables that millions of dollars of grant funding, being delivered by some of the smartest and most dedicated people, have been striving for, but unable to find. (Authors Note: other more general research has been conducted, using both Parkrun’s massive dataset, and other running events data. Prof AstellBurt and Fung at the University of Wollongong have developed world leading findings based on running participation, to show not just the benefits of running, but also the benefits of being in nature whilst running. Most exciting is the research coming from major running events, such as City to Surf in Sydney, where 20 years of data, from one million runners per year is showing participation trends across different suburbs and demographics, and the connection between where you live, your physical activity and your propensity to have either good or bad health outcomes). Socio-Cultural Community Engagement The second reason for Parkrun’s success is one that has received less attention, but is inherent and obvious, for those that participate, and that is the socio-cultural nature of parkrun. This benefit is harder to put your finger on, so stay with me and I will try to explain it. Parkrun is a celebration of the social connections that we all crave. That connectedness that holds societies together and drives people to want to be involved, that provides the motivation to get out of bed and drive (in some cases) for up to two hours, often in the rain, for a 20-30-minute run. A component of Parkrun that is 38 18

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Parkrun is a celebration of the social connections that we all crave. That connectedness that holds societies together and drives people to want to be involved. celebrated is the volunteers. At each Parkrun there is a need for at least six volunteers, an event director, a scanner, turn-around person, marshals, pacers, tail-end Charlie, and others. A simple but unenforced directive from Parkrun is that each runner is expected to volunteer three times a year. It’s in the volunteers where the real value of community engagement is found. A large percentage of Parkrun volunteers do not actually participate in the run/ walk, they are there purely to volunteer. Volunteer Australia, in its 2012 report “State of Volunteering in Australia” (Volunteering Australia, 2012) found that “Contributing to the community is important to the majority of volunteers. We also know from research that people volunteer for diverse reasons,

including the personal satisfaction it gives them, the sense of belonging to community”. It is this simple observation that reveals the true value of Parkrun, “a sense of belonging to community”. The volunteers at parkrun don’t just perform their respective roles, they also create the community, the atmosphere, the motivation and the sense of belonging to something that is bigger than the individual, that draws not only the volunteers back, but also the participants. Throughout all my Parkruns there has not been one where I was not encouraged and congratulated by another participant or volunteer. You often see people cross the finish line to receive high fives and shouts of exhilaration. At the pre-run briefing conducted by the event coordinator, milestones are celebrated, complete with cheers and claps. When I did my 100th run (in -3 degrees at Campbelltown in Sydney) there was more celebration from total strangers, than what I had ever experienced before. Milestone t-shirts are given out for 50 and 100 runs creating a constant cause for celebration. From a socio-cultural perspective it can sometimes appear religious in nature. Photos are also another key component of creating the Parkrun community that members embrace and utilise to showcase their efforts.

The author at Kamay parkrun on Botany Bay, with the heads, Cape Banks and Botany Bay National Park in the background.

FEATURE: THE IMPACT OF PARKRUN

Activating Australia’s Iconic Parks and Coastal Reserves Mark Band, in his letter to parkrun on behalf of PLA stated “The other value that parkrun brings to the Australian community is in the enhanced awareness of Australia’s fabulous parks. From the St Peters Parkrun at Sydney Park, Albert Park in Melbourne, the Gold Coast coastline at Kirra, the rugged coast at Shellharbour, the beautiful heritage listed Queens park in Toowoomba, Hobart, Kirwana coastal walk, Newfarm in Brisbane, the Hunter river foreshore development in Newcastle to Sandon Point at spectacular Bulli. One of the values of parkrun is the iconic locations in which they are conducted. Parkrun has done much for bringing ordinary Australian’s back into their parks or introducing Australian’s to parks that they had never visited before”. To me, as a recreational & open space planner, this is where I see the real value of Parkrun; “where the rubber hits the road”.Parkrun is bringing people, who normally would not go to a park, back into our parks, our reserves, our coastal reserves and our council parks. A case in point is Panania Parkrun in Sydney. A park, often overlooked, along the George’s river, has been revitalized by Council, purely because Parkrun had started an event there. Parkrun often uncovers “hidden” gems, such as Newport Lakes Park in Melbourne, an old quarry, completely hidden in amongst suburbia, known only to the locals, unless you went there for Parkrun. As an industry we strive to get government, and the community to value their parks, to value their provision and to ensure that they are protected. By having an event that brings people into parks we achieve our aim. Another worthy mention is St Peters parkrun in Sydney, an old disused brickwork and dumping site which has been converted

Shellharbour parkrun, Killalea State Park (an old coastal sheep farm)

into Sydney’s new showcase park by Sydney City Council; St Peters Parkrun introducers Sydneysiders to this breathtaking achievement in open space planning. Research shows that when people become aware of parks, and engage with them, they become advocates for those parks. Parkrun participants who engage with their local parks are now becoming “protectors” of those parks which is important from an environmental sustainability standpoint. Conclusion Parkrun has grown exponentially over the last five years. There are now more than 350 individual parkrun’s being held around Australia every Saturday morning. Volunteers are engaging, runners are running, walkers are walking, land managers are providing support and parks, reserves, beaches, national parks, regional parks, dams and sporting

precincts are being activated. Parkrun has proven that it is world best practice for physical activity programs, it is creating “community” and it is showcasing our open spaces. PLA acknowledged that in 2016 when it wrote to parkrun and stated; “your organisation should be congratulated” Parkrun is not the cause of an increase in running, it is just merely the best example of our innate desire to run, to move through beautiful landscapes, and to see and experience new things. Latest Ausplay data, released by Sport Australia, shows a significant increase in running for Australian’s. People are starting to rediscover what it is like to move, to challenge yourself, and to gain health benefits from that activity. We as a species have not suddenly found running, rather we have rediscovered it and realised that we are born to run.

About the Author Neil Ames is a running enthusiast. Marathons and ultra-marathons are his thing. If you have a wry smile to that statement it probably means you’re one too. Before COVID-19 lockdown he had completed 282 parkruns on 88 different courses in four different states. As a recreation planner, open space planner and with in-depth knowledge of parkrun he considers himself well placed to comment on running and parkrun from an industry perspective. 38 • ISSUE 4 1 2020 VOLUME 39 2022

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FEATURE: LGBT+ INCLUSION IN SPORT

LGBT+ Inclusion in Australian Sport: What’s the score? T

here has been significant progress across Australian society for Lesbian, Gay, Bisexual, Transgender in Australia in recent years. For example, marriage equality was introduced in 2017 allowing same-sex couples in Australia to marry, off the back of a lengthy public campaign. However, research shows that the sport sector in Australia lags behind broader Australian society, and discrimination towards LGBT+ people is still common across sporting landscapes. Substantial evidence exists which identifies that discrimination in the form of homophobia, biphobia, and transphobia has significant detrimental impacts on both physical and mental health and wellbeing on LGBT+ people. Therefore, those working across sport, allied health, and movement settings need to ensure that they are providing environments and experiences that are free discrimination for LGBT+ people. In this article, I will briefly summarise the research I have conducted in Australia on the topic of LGBT+ inclusion and highlight some important lessons from co-founding and helping lead a LGBT+ sports-based charity. You may also see different iterations of the LGBT+ acronym. There is no right or wrong acronym to use,

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but often, when certain letters are used, it is just being used to specifically refer to the identity groups being referred to. For example, I use LGBT+ to refer to sexual orientation (who you are attracted to) and gender identity (who you are), and the plus refers to other identities associated to these two concepts, such as pansexual, asexual, and non-binary people. What do we know? Research undertaken in the past two decades here in Australia and other countries such as the United Kingdom and the United States, identifies that homophobia, biphobia, and transphobia is prevalent within sport and movement settings. Such discrimination can include verbal abuse, physical abuse, and exclusion through both policies and practices. Unfortunately, the inclusion of transgender people within sport, has become extremely politicised, and trans women in particular, have become the target of increased abuse and vilification. Transgender children have even been targeted by trying to exclude them from playing community and grassroots sport. Often, the arguments used against transgender people are based on factually incorrect information, prejudice, and ignorance. For example, there is often unsubstantiated concerns

around bathrooms. However, every household in Australia has a genderneutral toilet, which most individuals use with little fuss or concern. As a sport for development researcher, this is problematic and disappointing, because we know that sport can, and is often used a as tool to increase quality of life, connect people to their local communities, and helps foster social capital and foster new social connections. What we often see is the opposite however with regards to LGBT+ people, and sport is used as a platform to exclude, alienate, and vilify, which leads to poor mental health outcomes. It is important to note also, that LGBT+ people do not have higher rates of mental health concerns because they are gay, bi, or transgender, but because of the impact of discrimination across society. Therefore, practitioners and those working in the field of sport and health, must ensure they are helping to combat discrimination directed towards LGBT+ people. Some of the research I have conducted is confronting, especially around young people. For many young people, playing school sport and participating in Physical Education is a fun and enjoyable experience, but for many young people of diverse

FEATURE: LGBT+ INCLUSION IN SPORT

“PE was a really shitty thing for me, especially at the Catholic school. I was out and doing my bit as part of the community to ensure other people were safe. So, changing into our PE uniforms was the worst. I had to either go in an hour before everyone else or I had to wait for everyone else to be done because I was beat up when I tried to change with the other girls. They were like calling me ‘fag’ or ‘dyke’ and they just beat me up. It was horrible. The school did nothing about it and like it was constantly that fear from Year Eight onwards” (Young Trans Man, 18).

Have an understanding that an LGBT+ person most probably will have witnessed or experienced homophobia, biphobia or transphobia some point or another within sport or movement settings.

VOLUME 39 • ISSUE 4 2022

Photo: Spitzt-Foto/ gettyImages

genders and sexualities, it can be a key site for abuse and bullying. These experiences can cause trauma and stops LGBT+ people from being physically active and playing sport as adults or in later life. Most participants we work with at Proud 2 Play, nearly all recount negative and traumatising experiences as young people, where they were singled out and bullied for being perceived to be different. One recent quote summarises the experiences of young people in school sport settings, from a project on young LGBT+ people’s experiences of sport and physical activity:

FEATURE: LGBT+ INCLUSION IN SPORT

Photo: Natee127/ gettyImages

LGBT+ Inclusion in Australian Sport: What’s the score?

As a sector, we need to ensure we are providing safe and inclusive opportunities and experiences for LGBT+ people, of all ages. However, we know from research that if young people have negative experiences, this prevents them from participating in sport and movement settings at later life. One thing to note however, evident in my research, is that young people do want to play sport and engage in physical activity, to be able to meet new friends, make new connections, and for fun and enjoyment. Often, many sports clubs say ‘we do not have any LGBT+ people in our club’ but one thing I would urge you to consider, especially working with young people, is that there may be some, you are just not aware of them, or they may not have affirmed their identity, or come out yet. Sexuality in particular as a marker of difference can often be invisible, like some disabilities, rather than a visible marker such as race or ethnicity. Additionally, a common phrase I hear from sports organisations and clubs, is ‘we treat everyone the same’. This highlights the differences between equality (treating everyone the same) versus equity (making adjustments based on inequalities), but ultimately, treating everybody the same does not 32 22

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often work for LGBT+ people, because it works on the assumption that everyone is straight and cisgender (when you’re gender identity corresponds to the sex you were assigned at birth). A key challenge for society and the sport and health sector moving forwards, is to ensure we tackle discrimination, and work to ensure that LGBT+ people have positive and enriching experiences, whether that is whilst playing sport, attending a gym, swimming at a local leisure centre, or receiving treatment from a physiotherapist or health professional. Many organisations and people working in the sector do want to be inclusive, but often do not know how or lack education. My research with several Australian Sports Organisations, identifies that many organisations do not engage or enact LGBT+ inclusion because of underlying prejudice towards LGBT+ people, but more commonly, because they do not understand how to engage with LGBT+ inclusion, and are unsure what it means for their organisational practices. There has been a rise in LGBT+ related diversity work in recent years to actively challenge structures and

practices which seek to marginalise and exclude LGBT+ people. There are organisations such as Proud 2 Play and Pride Cup Australia, a rise in pride themed games and celebrations, newly stablished LGBT+ supporter groups in AFL and Cricket, and more visible and out LGBT+ players and role models. There are many ways individuals can help foster a more inclusive society for LGBT+ people. What can you do? We all have a part to play in ensuring people of diverse backgrounds can lead active and healthy lifestyles, where movement and physical activity is a part of people’s every day lives. You can champion LGBT+ inclusion in your organisation or workplace, through active allyship, or you can even just take some small steps to ensuring that all LGBT+ people can access safe and inclusive opportunities. Here are some key things to consider: Have an awareness that people who you work with, engage with, or treat as clients, may be LGBT+. We know that roughly around 10% of the Australian population are LGBT+, so the chances are that you may know

FEATURE: LGBT+ INCLUSION IN SPORT

or work with someone who is of a diverse sexuality or gender. However, they may not disclose this to you, so it is important to not make assumptions. People may not feel comfortable disclosing this to you, it may not be safe for them to do so, or they may need to seek trust from you first. Have an understanding that an LGBT+ person most probably will have witnessed or experienced homophobia, biphobia or transphobia some point or another within sport or movement settings. Research over the past several decades tells us that around 75% of LGBT+ people have experienced or witnessed discrimination in sport, and heterosexual people also experience this too, when their sexuality or gender identity is questioned in a derogative way. Therefore, having this knowledge will mean you engage with LGBT+ people with a little understanding, empathy, and compassion.

Call out discrimination and exclusion when you see or hear it. For many LGBT+ people, it can be exhausting to call out homophobia, biphobia or transphobia, and can be stressful. As a LGBT+ advocate, I know firsthand how challenging it can be, therefore any help and support in tackling discrimination and fostering more inclusive practices, takes the burden of LGBT+ people. In conclusion, please take away from this article that homophobia, biphobia, and transphobia are still present within sport and movement settings, and this leads to poorer

health and wellbeing outcomes amongst LGBT+ people. As attitudes towards LGBT+ people across Australian society progress, policies and practices within the sport and health sectors must progress too. We must ensure every LGBT+ person in Australia can access safe, inclusive, and affirming opportunities and experiences when attempting to lead active and healthy lifestyles. For more information, and to access and view any of the research I have drawn upon to write this article, please get in touch or check out my google scholar page (https://scholar.google.com.au/ citations?user=797iRZkAAAAJ&hl=en).

Biography Dr Ryan Storr is a interdisciplinary social scientist and researcher, specialising in LGBT+ inclusion in sport. He is the co-founder of Proud2Play, a LGBT+ sport charity, which seeks to promote LGBT+ inclusion in sport and active recreation. He has published his research and work in a range of international journals. He has also written in a range of media outlets such as The Conversation, Guardian Australia, and has appeared on television programs on the ABC and Channel 10 news, speaking about homophobia, biphobia and transphobia in sport.

Photo: jacoblund/ gettyImages

Make efforts to educate yourself. This can be done through participating in training and education (www. proud2play.org.au), reading articles, listening to podcasts, speaking and listening to LGBT+ people and friends. This is an ongoing process, and not something that can be achieved overnight.

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FEATURE: SCREENING FOR MENTAL HEALTH

No time to waste during the COVID-19 pandemic

Screening for mental health disorders in football

Author: Vincent Gouttebarge Affiliations: 1. FIFPRO (Football Players Worldwide), Hoofddorp, the Netherlands 2. Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands

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ithin the context of professional football, the mental health of players has been legitimately subject of increasing scrutiny in the past years. The available body of scientific evidence suggests that the prevalence of mental health symptoms among professional footballers is substantial, at least similar to the prevalence from the general population. Because of the ongoing COVID-19 pandemic and its related adverse consequences, professional footballers have reported recently higher rates of mental health symptoms. Regardless how long the professional football industry will remain affected by COVID-19, there is no time to waste anymore and a

systematic screening programme for mental health symptoms among players should be introduced in any professional football clubs. Definition of mental health symptoms Mental health symptoms refer to self-reported adverse or abnormal thoughts, feelings and/or behaviour that do not meet specific diagnostic criteria and do not necessarily cause significant distress or functional impairment.1 By contrast, mental health disorders are typically defined as conditions causing clinically significant distress or functional impairment that meet certain diagnostic criteria such as in the Diagnostic and Statistical Manual of Mental Disorders 5 or the

FEATURE: SCREENING FOR MENTAL HEALTH

Photo: gorodenkoff/ gettyImages

Because of the ongoing COVID-19 pandemic and its related adverse consequences, professional footballers have reported recently higher rates of mental health symptoms.

International Classification of Diseases.1 In professional football, nearly all available body of scientific evidence is directed towards mental health symptoms such as psychological distress, anxiety, depression, sleep disturbance or alcohol misuse.

� Thoughts: excessive self-criticism, low self-esteem, pessimism, hopelessness, problems with focus, concentration and memory;

� Physical changes: low energy, poor sleep, changes in appetite, changes in weight and appearance, evidence of alcohol or other substance misuse.

� Feelings: irritability, anger, mood swings, sadness, extreme disappointment that you just cannot shake, depression, loneliness, emptiness, lack of passion and sense of purpose, lack of motivation;

Mental health symptoms in professional football before and during the COVID-19 pandemic Professional footballers report several mental health symptoms at rates at least similar to those of the general population. In 2013, a preliminary study was conducted in a sample of 149 male professional footballers (mean age of 27 years; mean career duration of nine years; 60% playing in the highest professional league) from Australia, Ireland, The Netherlands, New Zealand, Scotland and United States. 3 In this

� Behaviours: aggression, withdrawal from others/not going outside as much, being much more quiet than usual, unexpected drop of performance (e.g., in sport, school, work);

Photo: Pixfly/ gettyImages

Any professional footballers (as any individuals) can occasionally experience sadness, anger, stress, irritability and anxiety. However, if persistent over a long period of time and/or if impacting the player’s performance or daily life, then it may be that this player is experiencing mental health symptoms. Common experiences of mental health symptoms can include the following adverse thoughts, feelings, behaviours and/or physical changes:2

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FEATURE: SCREENING FOR MENTAL HEALTH

No time to waste during the COVID-19 pandemic Screening for mental health symptoms in football cross-sectional study, the four-week prevalence of mental health symptoms was 10% for distress, 26% for anxiety/ depression and 19% for adverse alcohol use. 3 Subsequently to this preliminary study, a twelve-month prospective cohort study was conducted among 607 male professional players (mean age of 27 years; mean career duration of eight years; 55% playing in the highest professional league) recruited in 11 countries.4 In that study, the same scales for measuring mental health symptoms were used as in the preliminary study. The fourweek prevalence of mental health symptoms found at baseline was 15% for distress, 38% for anxiety/ depression, 23% for sleep disturbance and 9% for adverse alcohol use.4 A sub-analysis of these baseline data showed that the prevalence rates of mental health symptoms were quite similar across five European countries, ranging from 6% in Sweden for adverse alcohol use to 43% in Norway for anxiety/depression. 5 A study among 471 top-level football players from Switzerland found a prevalence of 8% for mild to moderate depression, 3% for major depression, and around 1% for an at least moderate anxiety disorder. In that study (using different scales for measuring depression and anxiety than those used in the studies aforementioned), male players had a lower prevalence of depression and anxiety than female players.6 From March 2020, several public health measures were implemented in order to reduce human-tohuman transmission of COVID-19, for instance travel restrictions, mass home-confinement directives, social distancing, and postponement or cancellation of most ongoing football competitions. Such an unprecedent COVID-19 pandemic created new strains on players, increasing potentially their vulnerability to mental health 10 26

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symptoms. Therefore, an observational comparative cross-sectional survey study was conducted.7 The validated Generalised Anxiety Disorder 7 (GAD-7) was used to assess anxiety symptoms and the validated Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms. Data was collected from March to April 2020 in the COVID-19 study group (468 female and 1,134 male professional footballers), and from December 2019 to January 2020 in the non-COVID-19 comparison group (132 female and 175 male professional footballers). The prevalence rates were significantly higher during the COVID-19 pandemic than before (p<·01): Anxiety symptoms: 18% versus 8% before in female players and 16% versus 4% in male players; Depressive symptoms: 22% versus 11% before in female players and 13% versus 6% in male players.

Similar findings were found among 191 players in the top Swedish football league surveyed in May 2020.8 Stressors for mental health symptoms in professional football In professional footballers or elite athletes, the occurrence of mental health symptoms is usually multifactorial rather than caused by a single stressor. The complex and dynamic interaction between biological (genetic, biochemical, etc.), psychological (mood, personality, behavior, etc.) and social (cultural, familial, socioeconomic, medical, etc.) stressors play a role in the occurrence of mental health symptoms (as well as physical health problems).9 This interaction can create a potential predisposition and/or vulnerability, which can be strengthened by adverse life events or sport-specific stressors. Recently, the scientific literature has shown that professional footballers

FEATURE: SCREENING FOR MENTAL HEALTH

as well as competitive athletes might be confronted with up to 640 distinct sport-specific stressors that could induce mental health symptoms.10 Especially injuries that lead to a long layoff period can be considered as a major stressor for most players. The total number of severe time-loss (28 days or more) injuries during a football career was shown to be positively correlated with distress, anxiety and sleeping disturbance, revealing that professional footballers who had sustained one or more severe time-loss injuries during their career were two-four times more likely to report mental health symptoms than those who had not suffered from severe time-loss injuries.11,12

Photo: Joseph Calomeni/ gettyImages

The IOC Consensus Statement on Mental Health in Elite Athletes, Mental health symptoms are common in professional football but also in other elite sports.13 Therefore, the

Figure 1: The IOC Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1)

International Olympic Committee (IOC) selected an international expert panel in order to thoroughly review the available scientific literature, which led to the IOC Concensus Statement of Mental Health in Elite Athletes published in 2019.1 This consensus statement emphasises that mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. It addresses all relevant facets related to mental health symptoms and disorders in elite athletes, from diagnostic to treatment.1 In the IOC consensus statement, one principal caveat formulated was the lack of specific tools to assess mental health symptoms and disorders in elite athletes.1 This is peculiar because the prevalence of mental health symptoms among elite athletes, among which professional footballers, either prior or since the COVID-19

pandemic, warrants systematic screening just as other conditions (e.g., musculoskeletal, cardiovascular) are screened. To overcome this lack of specific tools, the IOC established its Mental Health Working Group aiming in part to develop an assessment tool for the context of elite sports. The IOC Sport Mental Health Assessment Tool 1 (SMHAT-1) In the IOC Consensus Statement on Mental Health in Elite Athletes, one principal caveat formulated was the lack of specific tools to assess mental health symptoms and disorders in elite athletes.1 Consequently, the IOC established its Mental Health Working Group aiming in part to develop an assessment tool for the context of elite sports. Therefore, from April 2019 to March 2020, the IOC Mental Health Working Group (i) conducted narrative and systematic reviews of the scientific literature, (ii) explored through an electronic questionnaire the views of elite athletes, (iii) selected the approach VOLUME VOLUME 3938 • ISSUE • ISSUE 4 2022 2 2021 27 11

FEATURE: SCREENING FOR MENTAL HEALTH

Photo: Getty Images/ gettyImages

No time to waste during the COVID-19 pandemic Screening for mental health symptoms in football

and content for a provisional version of the assessment tool, (iv) evaluated and finalised the assessment tool via a modified Delphi consensus process among licensed mental health professionals, and (v) assessed the appropriateness and preliminary reliability and validity of the assessment tool.2 This exercise led to the IOC Sport Mental Health Assessment Tool 1 (SMHAT-1) published in September 2020 in the British Journal of Sports Medicine (https://bjsm.bmj.com/ content/early/2020/09/18/ bjsports-2020-102411.long).2 The SMHAT-1 (Figure 1) is developed for sports medicine physicians and other licensed/registered health professionals to assess elite athletes that are potentially at risk for or already experiencing mental health symptoms and disorders in order to facilitate timely management or referral to adequate support or treatment. The SMHAT-1 relies on a three-step approach: triage step (step one) based on an existing validated screening instrument; screening step (step two) based on six existing validated screening instruments related to the most prevalent mental 12 28

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health symptoms in elite sports; intervention and (re)assessment step (step three) including in some cases a clinical assessment. It is important to mention that physical therapists, athletic trainers and non-clinicallytrained sport psychologists working with a sports medicine physician can use the SMHAT-1, but any clinical assessment, guidance or intervention should remain the responsibility of their sports medicine physician. Because the athletes themselves and all members of their entourage (e.g., friends, fellow athletes, family, coaches) are essential to support athletes’ mental health, the IOC Mental Health Working Group developed the IOC Sport Mental Health Recognition Tool 1 (SMHRT-1). The SMHRT-1 (Figure 1) aims to facilitate early detection of mental health symptoms in elite athletes in order to promote help-seeking for those athletes in need of assistance from a sports medicine physician or other licensed/ registered health professional and to facilitate further assessment and subsequent treatment as applicable. Both the SMHAT-1 and SMHRT-1 are

the first versions of the IOC tools. Analogous to sport concussion and its assessment (SCAT) and recognition (CRT) tools, the IOC Mental Health Working Group intends to revise the SMHAT-1 and SMHRT-1 in the future as needed. No time to waste within professional football The SMHAT-1 should be part of regular screening programmes within professional football: there is no justification why players would be screened systematically for musculoskeletal or cardiovascular conditions but not for mental health symptoms and disorders. Therefore, the SMHAT-1 should be used at least within the pre-competition period (i.e., ideally a few weeks after the start of training), as well as when a player experiences any significant life event (e.g., major injury/illness, surgery, unexplained performance concern). The triage and screening steps of the SMHAT-1 are designed to ideally be embedded in any existing privacy-secured online platforms that most professional football clubs already use. As part of its commitment to supporting the health and performance of

FEATURE: SCREENING FOR MENTAL HEALTH

elite athletes and to the continuing professional development of those who care for them, the IOC Medical and Scientific Commission offers a postgraduate-level Diploma program in Mental Health in Elite Sport for sports medicine physicians and other qualified health professionals, as well as a Certificate in Mental Health in Elite Sport for other members of the athlete entourage (https://www.sportsoracle. com/Mental+Health/Home/). Thanks to the IOC and its SMHAT-1, there is no time to waste within elite sports and in particular within professional football: mental health symptoms and disorders should be screened among players. References 1. Reardon CL, Hainline B, Miller Aron C, et al. International Olympic Committee consensus statement on mental health in elite athletes. Br J Sports Med 2019;53:667-99. 2. Gouttebarge V, Bindra A, Blauwet C, et al. International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes’ mental health. Br J Sports Med 2020 Sep 18;bjsports-2020-102411. 3. Gouttebarge V, Frings-Dresen MHW, Sluiter JK. Mental and psychosocial health among current and former professional football players. Occup Med 2015;65:190-6.

football players. BMJ Open Sport Exerc Med 2016;2:e000087.

encountered by sport performers. J Sport Exerc Psychol 2012;34:397-429.

7. Gouttebarge V, Ahmad I, Mountjoy M, et al. Anxiety and Depressive Symptoms During the COVID-19 Emergency Period: A Comparative Cross-Sectional Study in Professional Football. Clin J Sport Med 2020 Sep 15. doi: 10.1097/JSM.0000000000000886.

11. Gouttebarge V, Aoki H, Ekstrand J et al. Are severe joint and muscle injuries related to symptoms of common mental disorders among male European professional footballers? Knee Surg Sports Traumatol Arthrosc 2016;24:3934-42.

8. Håkansson A, Jönsson C, Kenttä G. Psychological Distress and Problem Gambling in Elite Athletes during COVID-19 Restrictions-A Web Survey in Top Leagues of Three Sports during the Pandemic. Int J Environ Res Public Health 2020;17:6693.

12. Kiliç Ö, Aoki H, Goedhart E, et al. Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data. Knee Surg Sports Traumatol Arthrosc 2018;26:946-54.

9. Engel GL. The need for a new medical model: A challenge for biomedicine. Science 1977;196:129-36.

13. Gouttebarge V, Castaldelli-Maia JM, Gorczynski P et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med 2019;53:700-6.

10. Arnold R, Fletcher D. A research synthesis and taxonomic classification of the organisational stressors

About the Author Dr. Vincent Gouttebarge is a former professional footballer who played 14 seasons in France and The

4. Gouttebarge V, Aoki H, Kerkhoffs G. Symptoms of Common Mental Disorders and Adverse Health Behaviours in Male Professional Soccer Players. J Hum Kinet 2015;49:277-86.

Netherlands. He is currently working as A/Professor at the Orthopaedic Surgery department of the Amsterdam University Medical Centers and as Chief Medical Officer at FIFPRO (Football Players Worldwide). Dr. Gouttebarge’s work focuses on a wide range of sports medicine domains

5. Gouttebarge V, Backx F, Aoki H et al. Symptoms of common mental disorders in professional football (soccer) across five European countries. J Sports Sci Med 2015;14:811-8.

being relevant in elite sports, striving to protect and promote the physical, mental and social health of active and former professional athletes. He is Chair of the International Olympic Committee (IOC) Mental Health Working Group and co-director of the IOC Programs on Mental Health in Elite Sport. Dr. Gouttebarge is

6. Junge A, Eddermann-Demont N. Prevalence of depression and anxiety in top-level male and female

also member of the Concussion Expert Group of the International Football Association Board (The IFAB).

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FEATURE: RETURNING TO SPORT AF TER ACL INJURY

Returning to sport after ACL injury ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES REMAIN ONE OF THE MOST COMMON SPORTING INJURIES THAT ALSO HAVE A COMPLEX REHABILITATION PROCESS AND A HIGH RISK OF RE-INJURY FOLLOWING RETURN TO SPORT. THE CONSEQUENCES OF ACL INJURY ARE DETRIMENTAL TO THE ATHLETE AND HAVE A SIGNIFICANT IMPACT ON THEIR ABILITY TO SUSTAIN INVOLVEMENT IN SPORT AT THEIR CURRENT LEVEL. MANY ATHLETES FOLLOWING ACL INJURY SUFFER A SUSTAINED ABSENCE FROM SPORT, RETURN AT A LOWER LEVEL THAN PRE-INJURY, OR FAIL TO RETURN AT ALL.

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FEATURE: RETURNING TO SPORT AF TER ACL INJURY

f the 50% who do return at their level prior to injury, approximately 30% will sustain a re-rupture within two years. There appears to be a lack of consensus on criteria to determine return to sport following ACL injury, and return to sport should be the primary determinant of success of ACL rehabilitation.

Photo: olegbreslavtsev/ gettyImages

Return to sport success consists of aligning both physical and psychological parameters and rehabilitation should follow a criteria-based format that measures key physical, physiological, and psychological demands of the athlete’s specific sport and environment, rather than follow a “one size fits all” protocol. As approximately 60-80% of ACL injuries occur in non-contact situations, where the knee is forced in to flexion and then rotated, this makes any sport involving pivoting, twisting, landing from a jump or sudden deceleration high risk. Rehabilitation progress should account for the biology, considering the healing of the graft and recovery of neuromuscular function, as well as the demands of the sport, and the athlete’s internal and external capacity. Time Time is still the most frequently reported criteria for when athletes are cleared for return to sport, and in 90% of these cases this timeframe is nine months post-injury or post-surgery. Those who return to play at nine months or less however, have a seven-fold increased rate of a second ACL injury. This is because time since injury is not indicative of healing, and the graft healing, as well as strength, stability and proprioception of the surrounding muscles must be considered as approximately 70% of ruptures occur within six months of reconstruction surgery. Additionally, there is an increased risk of osteoarthritis (OA) in those who sustain a meniscal injury at the time of ACL injury. 50% of these patients will require meniscal VOLUME 39 • ISSUE 4 1 2021 2022

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FEATURE: RETURNING TO SPORT AF TER ACL INJURY

Returning to sport after ACL injury surgery within the first five years, and trauma following ACL rehabilitation could accelerate poor knee health in future with an increased OA prognosis of 0-13% up to 21-48%. Discharge criteria Athletes who do not meet six key clinical criteria measures prior to discharge back to sport have a four times greater risk of graft rupture compared to those who do meet all six criteria. The six identified measures are: 1. Isokinetic strength testing; This is the strength through range of movement and is measured at various stages to ensure strength throughout. An 85% or more symmetry between legs is recommended. 2. Four hop tests consisting of a running T-test, single hop, triple hop, triple crossover; Hop tests assess dynamic movement for strength

and power, as well as balance and control upon landing. A 90% symmetry is recommended. This is higher than the isokinetic strength testing due to the unpredictability and numerous skills involved that represent sporting activities. 3. Hamstring to quadriceps muscle strength ratio; The hamstring muscles function to resist the forward motion of the tibia produced by the quadriceps and therefore they work with the ACL to prevent further damage occurring. For this reason a higher hamstring to quadriceps ratio is suggested, and for every 10% reduction in this ratio, there is almost an 11% increased risk of graft failure. Physical tests Physical tests should progress through a continuum established by the World Congress of Physical Therapy. This consists of:

Return to sport success consists of aligning both physical and psychological parameters.

� Return to participation; commencing rehabilitation and low level training � Return to sport; sport-specific tasks but at a level with demands below pre-injury � Return to performance; return to their sport and their current or higher level than pre-injury

Strength tests

Criteria to match

Agility & run tests

Single leg bridges

>20

Single leg hop test

>95% compared to the un-injured side

Calf raises

>20

Trip hop test

>95% compared to the un-injured side

Side bridge endurance test

>30 sec

Triple cross over test

>95% compared to the un-injured side

Single leg squat

> 22

Side hop test

>95% compared to the un-injured side

Single leg press

1.5-1.8x body weight

Squat

1.5-1.8x body weight

Star excursion balance test

There is a points system specific for this test

Cooper& Hughes sports vestibular balance test

There is a points system specific for this test

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FEATURE: RETURNING TO SPORT AF TER ACL INJURY

Return to sport should introduce sports-specific drills with optimal loading that progresses to that of the sport requirements. The athlete should be monitored for the ability to withstand the load during the task and maintain this over a consistent training plan. Open skills should be included to challenge the unpredictability and spontaneous elements of game play that require fast reactions and decision-making. The athlete’s capacity to maintain this collectively alongside the onset of fatigue should also be assessed to identify their physical readiness and mental capacity to be “game ready”. The table below details key strength, agility and run measures used to evaluate the athlete’s progress and provide an indication of their position in returning to sport.

outcome measure for evaluating this. These fears must be addressed to optimise patient outcomes and methods include modelling, imagery, relaxation techniques and education in conjunction with a robust physical protocol and a minimum return time of nine months. Summary � Time since surgery is NOT the key determinant for return to sport. Those who return prior to nine months post-injury, have a significantly

higher risk of re-injury or not returning to their pre-injury levels. � All six of the key discharge criteria must be met prior to returning to ensure full physical outcomes are met and provide the greatest chance of success. � Psychological readiness is the largest component for NOT returning and significant emphasis should be placed on addressing fear, confidence, and the mental status of the athlete.

Author Bio Tracy Ward is a Senior Chartered

Psychological readiness Rehabilitation is often strongly focused on the physical outcomes and treatment protocols, that the psychological readiness of the athlete is not considered, or not made a priority. However, if the athlete is not psychologically prepared, no amount of strength and physical rehabilitation skill will overcome this. Fear of re-injury is the single most important cause of failure to return to play, with 30% of athletes reporting this as their primary reason for not returning, and 20% reporting a lack of confidence in their performance as the barrier. Those with self-reported fear have also been identified to be less active overall, have a reduced single leg hop performance, and reduced isometric quadriceps strength, giving an increased risk of re-injury within the first two years. The Tampa Scale of Kinesiophobia (TSK-11) is the recommended

Physiotherapist (MSc, BSc), Pilates Teacher, APPI Course Presenter, and sports medicine writer. Tracy completed her Masters degree in Physiotherapy after she obtained a first-class Bachelor’s (BSc) degree in Biomedical Science. Tracy continuously advances her qualifications, having completed several postgraduate qualifications. She has worked with International level athletes and uses this unique combination of science-based knowledge and clinical expertise to provide rehabilitation and exercise advice. Tracy is the founder of Freshly Centered, a Pilates company leading local classes and Retreats, as well as an online platform of Live classes, Fitness blog, Youtube channel, Workout plans, custom programmes, and an exclusive membership platform for both On-Demand Pilates classes and specialised 6-week rehabilitation programmes. Tracy is also qualified in Kids Pilates, Ante and Postnatal Pilates, and Therapeutic yoga. Tracy is also the author of The Postnatal Pilates Guide ebook, educating new mums on the safe return to exercise postpartum complete with a 6-week Pilates plan.

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5 MINUTES WITH

5 minutes with

Gary Nicholls

How did you first get involved in sports medicine? I first started studying physio straight from school, off the back of deciding whether I was going to do physical education at that stage or physio. I decided to go down the physio pathway, always with the interest of sport in mind, having been heavily involved in sport as a kid myself. But then, physio studies were fairly generic. It certainly wasn’t all sportsbased and my initial workplaces were quite generic rather than sportsbased. Then the interest in sports and particularly in footy, probably drew me back that way after my initial work. What are some of your experiences and takeaways from your time with a professional AFL club? The opportunity arose to be involved initially with Collingwood, with their reserves, and that was both through my work at Olympic Park Sports Medicine Center and association with the medical team who were at Collinwood at the time. It then evolved from there into a joint senior physio role with the Pies. My association there 34

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was 13 years, which was an exciting time. It went from a growth period for the club of sitting on the bottom when I first arrived, to managing to be involved in five grand finals, which was a terrific experience. One of those was the 2010 drawn grand final, followed by a win for the Pies the week after. At the end of 2011, an opportunity arose for me to head across to Melbourne Footy Club. And having come off a degree of success at the Pies, it was a good time to change and transition and take on another challenge. So, I headed across to Melbourne. You were involved with the inaugural AFLW National Academy. What was your experience going into that environment? I stepped back as our kids started to get involved in their own weekend sports. So, I never stepped out of AFL because I didn’t stop enjoying it, but because I just needed to clear a bit of time and space on the weekends. At the same time, I was still working clinically and started treating a few of the women that were up for the initial draft for the AFL system and

they were also involved with the AFL National Academy, which was just being formed at that stage. They asked if I’d be involved to help them get the physio and medical services up and going for the National Academy. That was basically prior to the initial draft. It was an area that I hadn’t really have any involvement with previously, but it was an area that I really came to enjoy. The joy that the girls get in playing their football is terrific to watch. What is your experience going from working in the AFL space to starting your own practice? The biggest difference is having to look at the whole practice as a business, as opposed to just being a clinician or practitioner. Your main concerns are the clients in front of you and their immediate management, and putting in place plans and processes for them to get better. When you take over a business, you have to make sure that the business itself covers its costs. You’re also starting to have staff involved. So, it’s being able to not just mentor, but also be able to develop

5 MINUTES WITH

your staff as well in the manner that you’d like to see them working to a certain degree. It also involves you working more with your office staff and your reception staff. It branches out the need to be able to have a few more strings to your bow. So not just the practitioner, but also the business management, the human resources, and the marketing head, to build and develop your practice. You are part of the SMA board and have been involved with a couple of other organisations as well. How did you come into that space? What drew you to SMA and to getting involved in that capacity? I’ve always enjoyed being involved with committees, from Physio, AFL Physios, and then more recently with SMA. A little bit of the giving back, a little bit of the fact – If you’re going to get the most out of your profession, your workplaces, your environments, the ability to have a bit of voice and to give back is really important. It’s always been that you can be critical sitting from the outside. But if you really want to have a look at how it runs, you need to get yourself involved from that perspective. So that has taken me to a few different committees, and then the opportunity arose to put the hand up for the SMA board and I ran with that opportunity. Fortunately,

I got elected, and it’s been an eyeopening process for myself and also hopefully able to add some value in terms of any of the board discussions. Do you have any advice or direction for anyone wanting to get into sports medicine? I think the biggest key is to be interested and involved wherever you can be. There’s a lot of people that you can learn from out there, and it’s the ability to be prepared to give them a call, drop them an email, or follow up. Because they’re often busy, they might not necessarily get a response the first time, but just to express your interest in the area is key. I’ve seen many young physios I can give you

examples of who are now head physios of AFL clubs purely because they got on the front foot. They were prepared to be involved at a younger age, learn, get experience in that way, and really develop their careers by being able to learn from those around them. Most Physio SMA members are pretty open to assisting and helping the next generation coming through. I think it’s really a matter of being prepared to put yourself out there doing some of the hard yards. I certainly know that the people from my era have done the hard yards in terms of really putting in a lot of work in the first place to get the experiences that has allowed them to develop their clinical practice from there onwards.

Author Bio Gary Nicholls is a Sport and Exercise Physiotherapist with 30 years’ experience in sports medicine, ranging from running his own sports medicine clinic to working with professional high performance teams, state and national representative sides and community sport. Gary is the Chair of the AFL Physiotherapist Association and a member of the Advisory Committee for Australian Physiotherapy Association (APA) National Conferences.

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PEOPLE WHO SHAPED SMA

People Who Shaped SMA

Associate Professor Julie Cooke How did you end up in the educational space working with future clinicians? After finishing my PhD, I moved to Denmark where I taught Biology at the Copenhagen international school. Upon my return to Australia, I moved into the University sector and worked my way up to Associate Professor of Anatomy and Physiology. In addition to my academic role, I am a Lecturer for SMA Safer Sport courses. I deliver First Aid & CPR, Spinal Management and Sports Trainer Level 1.

Can you tell us a bit about yourself and your work within the sports medicine community? I’m an academic rather than a clinician. I am Discipline lead of Sport and Exercise science at the University of Canberra and have most recently been appointed Head of School – Rehabilitation and Exercise Science. I teach anatomy, physiology and sports medicine at UC and my passion is teaching these basic skills for the clinicians to be. My love for Sports Medicine Australia is its multidisciplinary approach and the feeling of connected ness between many professions. 36

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How did you first get involved with SMA? I moved to Canberra in 2009 from Orange (Charles Sturt University) and commenced working at the University of Canberra in the Discipline of Sport and Exercise Science. I met a few people from SMA who dragged me along to a meeting, which happened to be an AGM. From that meeting, I ended up being on the State Council and thoroughly enjoyed the environment and interacting with people on the committee, and then worked my way up to the state chair. Along the way, I made connections with other likeminded professionals, who I am fortunate enough to call my friends and it has been an amazing experience. How has being part of SMA helped your career? Being a part of the community as a member of the SMA ACT State Council and then taking on the role of State Chair and progressing toa

Director on the SMA National Board has given me the opportunity to meet some wonderful people along the way. Connections and networks have allowed for professionals to come in to the University for guest lectures and presentations, such as Dr Rob Reed who has been around SMA for many years. He’s always more than willing to donate his time, as are people such as Dr Warren McDonald and Dr Karen Bisley.

PEOPLE WHO SHAPED SMA

What is a part of your work that stands out to you, or that you’re particularly proud of? For me it’s the education space. I have organised many symposia but the one I am most proud of is the 2019 ACT SMA Symposium, Play Like a Girl: keeping female athletes fit to play and ready for the podium. I was Chair of the Scientific Committee and was able to attract an awesome line up of speakers. Keynotes were delivered by Margot Mountjoy from McMaster University (Canada), who is on the IOC medical team and Grethe Myklebust from the Norwegian School of Sports Science. It was held here in the ACT and in addition to local registrations there were delegates from interstate. The symposium was only a day and a half, but it was well attended and SMA got a lot of media attention and awesome feedback. So that’s one of the stand outs for me. What advice do you have for anyone going into Sports Medicine? Get involved. Come along to some of the events that are offered. SMA offers an array of membership types including student membership, which is free. It is the people you meet along the way that make being a part of SMA rewarding. I am always pushing students to get out there and become involved because what they’re seeing on the weekends as a Sports trainer in injuries is what will be presenting to them when they’re a clinician. So get involved.

Author Bio Dr Julie Cooke is an Associate Professor of Anatomy & Physiology at the University of Canberra. Dr Cooke has held a number of academic positions lecturing Anatomy & Physiology and has 20 years teaching experience at all levels in the tertiary education system and is also experienced in teaching the International Baccalaureate (Biology). She is a member of Lung Foundation Australia, Exercise Sport Science Australia (ESSA), a Director on Softball ACT board, SMA ACT State Council and a Director on Sports Medicine Australia National Board.

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SPORTS MEDICINE AROUND THE WORLD: CHINA

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Photo: hxdyl/ gettyImages

Sports Medicine in China

SPORTS MEDICINE AROUND THE WORLD: CHINA

(CSSM), which includes the following professional subcommittees: sports trauma, medical supervision, sports rehabilitation, sports nutrition, traditional Chinese medicine and sports science, etc. CASM was founded in 1978, then became the national association membership of the International Federation of Sports Medicine (FIMS) representing the interests of Sports Medicine in China. CASM was recognized by Chinese Olympic Committee (COC) and played an important role in ensuring the progress of competitive sports. CSSM was founded in 2007 which was one of the specialty society of Chinese Medical Association (CMA). The member of CSSM includes orthopedic doctors and sports medicine physicians, who devote themselves preserving and improving the health of mankind through exercise and sports participation. Both CASM and CSSM were structured and well-organized national association or society, strongly committed to the promotion and development of Sports Medicine throughout China. Most sports medicine staff in China such as surgeons and physicians graduate from medical colleges or universities. There are 146 public medical colleges and universities in China, which supply five years’ clinical medicine education for medical undergraduates. Medical students graduating from clinical medicine department could be awarded bachelor degree, which is an essential prerequisite for being a sports

Photo: onlyyouqj/ gettyImages

hina sports medicine at present has two national academic organizations, Chinese Association of Sports Medicine (CASM) and Chinese Society of Sports Medicine

There are 146 public medical colleges and universities in China, which supply five years’ clinical medicine education for medical undergraduates.

medicine doctor. Specifically, medical students need study pre-clinical and clinical medicine theories in first four years, then would be designated to different hospitals as interns in the fifth year. Currently, more and more medical students would like pursue the chance of further education, such as studying for master and doctoral degrees of sports medicine after graduation. After graduation, medical students could apply medical license after passing the exam organized by National Ministry of Health. They also need the clinical residency practice training at least 2-3 years in certified university hospitals. After a series of professional clinical training and practice, the residents become professional sports medicine specialists once they are

qualified in the National Assessment of Attending Doctors. The number of sports medicine doctors has been increasing rapidly in past 15 years, and the number of doctors engaged in sports medicine in China has increased from approximately 200 in 2007 to over 10,000 in 2021. Currently, excellent sports medicine doctors who did lots of research and had great skill in surgery proliferated over the country. Indeed, the number of articles published by Chinese sports medicine doctors ranked second in the world so far. Most Physical Therapists (PTs) and Athletic Trainers (ATs) graduate from 54 public sports colleges or universities in China. Once being qualified by the National Qualification VOLUME 39 • ISSUE 4 2022

Photo: aphotostory/ gettyImages

SPORTS MEDICINE AROUND THE WORLD: CHINA

Examination of PTs or ATs, they could supply medical service in prevention, treatment and rehabilitation of sports injuries for professional athletes in sports team. Some PTs or ATs work for professional sports teams, the others work in public hospitals, private hospitals and rehabilitation clinics, to provide rehabilitation services for the public fitness and health. Additionally, there are 15 public traditional Chinese medicine (TCM) colleges or universities in China. The students in the department of

acupuncture and manipulation are awarded bachelor degree after a five- year study. Many TCM doctors achieve good therapeutic efficacy in sports injuries by conservative treatment, such as acupuncture and manipulation. Indeed, the treatment by TCM doctors for sports injury has played a role in sports team especially for athletes’ medical care during sports competitions. All the sports medicine staff including physicians, PTs and ATs are required compulsory continuing education

every year. Their medical practice certificates would be renewed only after completing required credits of continuing education. The Chinese Journal of Sports Medicine (CJSM) is the only special journal for sports medicine in China. CJSM was founded in 1982, which is the official publication of the CASM. It contains original articles addressed to sports medicine doctors, researchers, team physicians, athletic trainers, and physical therapists focusing on clinical and basic studies in sports medicine.

Author Bio Prof. Guoping Li, MD China National Institute of Sports Medicine, Beijing 100061, China Prof. Li is the Former Director of the China National Institute of Sports Medicine and the Former President of Beijing Sports Medicine Hospital. He is the Founding President for Chinese Society of Sports medicine (CSSM), the President for Chinese Association of Sports Medicine (CASM), the Past President, Asian Federation of Sports Medicine (AFSM), the Vice President for the International Federation of Sports Medicine (FIMS), the Member of IOC Medical and Scientific Commission Games Group (IOC-MSC-GG), and the Honorary Chief Editor, Chinese Journal of Sports Medicine (CJSM). Prof. Li graduated from the Beijing Medical University in 1978. He studied and worked at the Mayo Clinic and other key medical institutions in USA for 7 years. He has been engaged in clinical, scientific research, teaching, management and service of sports medicine for 44 years. He has presided over a number of national science and technology support programs and other major research projects. He has published more than 150 Chinese and English papers in core journals and academic conferences and won many awards at home and abroad. In terms of Olympic medical services, professor Li participated in 10 Olympic Games from the Sydney 2000 Summer Olympic Games to the Beijing 2022 Winter Olympic Games, in charge of the medical services for all participating athletes and coaches. He served as Chief Medical Officer (CMO) of the Chinese Olympic Committee from 2000 to 2012. From 2013 to 2022, he served as the member of IOC Medical and Scientific Commission Games Group. Prof. Li has vigorously carried out discipline construction, education and training, academic exchanges, Olympic Games and other major events for a long time. He has made outstanding contributions to leading the rapid development and overall progress of sports medicine in China, which has a wide range of social impact.

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2022 SMA CONFERENCE RACV ROYAL PINES RESORT, GOLD COAST NOVEMBER 16-19, 2022

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SPORTS TRAINER HIGHLIGHT

Sports Trainer Highlight with

Hugh Burns so, I’ve been involved at the different levels of sport, that being grassroots rugby league, local district rugby league clubs, divisional representative league squads and at the elite level as part of Medical Teams. I have particularly enjoyed working with some fantastic physiotherapists and doctors for NSW and Australian Touch Football, as part of Medical Teams at State Cups and was a member of the Medical Team involved with the 2015 Australian Touch World Cup squads. How did you first get involved in sports medicine? I became a Level 1 Sports Trainer around 1996 and became heavily involved with Wyong Junior Rugby League Club on the NSW Central Coast and became their first aid officer attending game days.

I have enjoyed networking with doctors, physiotherapists, podiatrists and other allied health professionals over the years and around 2000 I was the Secretary

for the Central Coast Sub-Branch of SMA. The Sub-Branch was responsible for organizing training courses and holding regular monthly meetings which enabled sports trainers, doctors and physios to be informed of latest information which went towards Professional Development points. What drew you to working with SMA in that capacity? At the time SMA was the peak advisory body for sport and sports related injuries in Australia and I was really keen to learn and become more involved in sport not only as a first responder but someone who could be actively involved in the prevention and management of sporting injuries

It didn’t take long, and I developed a quest for knowledge and had developed a thirst for Advanced anatomy and sports physiology whilst at the same time had undertaken my Level 2 Coaching Course. I thought that by completing a Level 2 Sports Trainer Course, I would attain some more knowledge, that could ultimately make me a better coach. I was part of a group of attendees who were part of one of the inaugural Sports Trainers Camps held in Coffs Harbour. Is there a particular aspect of sports training that you enjoy or an element of your work that particularly stands out to you? I think it’s the dealing with various injuries and the injury rehabilitation side of things. For the last 20 years or VOLUME 39 • ISSUE 4 2022

SPORTS TRAINER HIGHLIGHT

How has being part of SMA helped your career? The courses and the content offer a lot, especially to the sports trainers. I think there is a lot of knowledge that can be gained. The various football codes have their own adaptations of the sports trainer’s role whereas SMA offers more broadly based training, and the courses cover everything that, as a trainer, can be adapted across multiple sports. Being involved with AFL, Rugby League, touch football, surf lifesaving and triathlons over the years I can honestly say that the training that I was given back in the day has held me in good stead and the quest for knowledge is still there. Do you have any advice for anyone wanting to get into sports training? I tell my students the reason why I got into it – It was great for me because it gave me that quest for knowledge to go out and to learn a little bit more about the advanced of anatomy and sports physiology, which helped me as a coach as well. So, I put it across to my students that look, it is a great avenue to take, and you go down that track if you’re interested in sport. If you want

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I have started an education and networking group on Facebook for the sports trainers up here.

I’ve been involved at different levels of sport from grassroots rugby league, local district rugby league clubs, divisional representative league squads to the elite level as part of the medical team.

to take it further, there’s a nice career there that you can jump into. My goal was to jump into that elite field and try and deal with elite athletes. What work do you do in sports trainer education? I am a qualified trainer and assessor and currently run first aid and sports trainer courses around the Far North Coast of NSW and the Gold Coast.

Back in the early days, sporting organizations thought we were just first responders and then the Level 2 Courses started, trainers were well informed and well trained. What I see now is the Sport Trainer is now being pushed back to water boy status due to the increased demand for Allied Health within sporting organizations, so it is my goal to try and raise not only the awareness of Sports Trainers but the training, skills and knowledge that is required in the Sports Trainer’s Role given that some of these people are employed as first responders within their own workplaces Through the Facebook community I hope to set up networking channels with trainers, physios, doctors etc, to enable Trainers to advance their skills and knowledge whilst opening up lines of communication with other trainers, athletes, sports and medical professionals.

Publisher Sports Medicine Australia PO Box 78 Mitchell ACT 2911 sma.org.au ISSN No. 1032-5662 PP No. 226480/00028