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SEPNZ BULLETIN
ISSUE 13, FEBRUARY 2020
DRUG FREE SPORT: Encouraging physios to ‘Speak out’ about doping in sport P14
p10 Athletic footwear: A synergy of Performance
p16 Imaging with ultrasound in physical therapy: What is the PT’s scope of practice?
p19 UPCOMING SEPNZ COURSES
www.sepnz.org.nz
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SEPNZ EXECUTIVE COMMITTEE
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President - Blair Jarratt Vice-President - Timofei Dovbysh Secretary - Michael Borich Treasurer - Timofei Dovbysh Website - Hamish Ashton Sponsorship - Emma Lattey Committee Emma Clabburn Rebecca Longhurst Justin Lopes Emma Lattey
EDUCATION SUB-COMMITTEE Rebecca Longhurst (Chairperson) Emma Clabburn Justin Lopes Dr Grant Mawston
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SPECIAL PROJECTS Karen Carmichael Rose Lampen-Smith Amanda O’Reilly Pip Sail
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CONTENTS SEPNZ MEMBERS PAGE See our page for committee members, links & member information
2
EDITORIAL: By SEPNZ President Blair Jarratt
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SPECIAL REPORT: Physiotherapist Intraprofessional Collaborative Practice
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APP REVIEW: Hudl Technique App
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MEMBER BENEFITS: Discounts
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ASICS ARTICLE: Athletic footwear: A synergy of Performance
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FEATURE ARTICLE: DFSNZ: Encouraging physios to ‘Speak out’ about doping in sport
14
CLINICAL REVIEW: Imaging with ultrasound in physical therapy: What is the PT’s scope of practice?
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UPCOMING SEPNZ COURSES
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RESEARCH PUBLICATIONS: BJSM February 2020 - Volume 54 - Issue 4
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CLASSIFIEDS
21
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EDITORIAL The year twenty-twenty is well and truly here as we move into the 3rd month. Exercise continues to prove
itself on the international stage, and it was a pleasure to be able to write the recent BJSM editorial on making history for the SEPNZ BJSM edition https:// bjsm.bmj.com/content/54/5/255. The message of exercise as a polypill continues to strengthen as more research continues to be published. Justin Lopes from your executive along with Sports Medicine New Zealand is putting the final touches on our feature CPD event for this year. If you are unaware of our roadshow coming up all the information and registration is on page 17. This roadshow is another example of our ability to bring international and quality CPD to your doorstep. You can learn more on our two keynote speakers - Bill and Michael, by reading their biographies later in the bulletin. In each of the six centres, they will be joined by local experts to make this a must-attend CPD event for 2020. If you are interested in the ankle and foot or looking to home in on your assessment and skills, then the combined workshops and mini conference are a great option. At the time of writing this over 60 tickets have been purchased so this event will no doubt sell out. If you would like to know even more about the heavy keynote hitters, I suggest you check out their active social media accounts (mainly twitter). In this edition, SEPNZ member Vijay Vallabh, along with executive member Emma Lattey discuss Intraprofessional Collaborative Practice, - an excellent point to bring up. Too often we hear patients putting down previous providers when we all know that when we turn up to work, we do so to give the best we can. As a profession, we need to be better at looking out for our peers (be it in our practice or a colleague down the road) and building up the public perspective of physiotherapy, not just building our own practice. This edition’s app review by Emma Lattey, features the "Technique" app, which I have used in practice for some time. If you don't have this, then I would suggest that you download this right now before reading any further. This app gives video analysis feedback which can be slowed down and edited to explain movement patterns. Coaches and trainers can be added to the group to review athletes making this a powerful tool in the education of several parties.
If you read this Bulletin several months ago, Chris Bishop wrote an article on 'dual-density and performance gain'. Chris is back to discuss his concept of the" synergy of performance". I don't think I need to discuss this any further with a concept named as such. It's hard to ignore the constant updates on the impeding coronavirus, and I wonder what part physiotherapy and exercise prescription will play in the recovery of the masses infected. Such as the unfortunate news of COV-19 reaching New Zealand, SEPNZ has had to cancel the experimental APA level 1 course due to lack of interest at this time. Our first impressions were of disappointment, but on the other side, it does survey the market at present, and it would seem that in the current climate this is not something of interest for our membership. Maybe other factors are at play……. our other SEPNZ courses are filling up! Page 19 is where you can find more information. We round out this Bulletin with a feature article on drug-free sport and a physiotherapist's responsibility in reporting doping - do you know where you sit regarding patient privacy on this issue? Pip Sail contributes to our clinical content with a review on rehabilitative ultrasound scanning and this emerging tool. As ever we are always open to feedback on our Bulletin or any other aspect of your SEPNZ membership. We hope to see you at the foot and ankle roadshow!
Kind Regards Blair Jarratt SEPNZ President
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SPECIAL REPORT
Physiotherapist Intraprofessional Collaborative Practice Why respect and communication between sports physios benefits our patients and promotes our profession. Emma Lattey and Vijay Vallabh A therapeutic alliance is defined
as a sense of collaboration, warmth, and support between medical professionals and their patients, and our ultimate goal as sports physiotherapists is to help provide the best possible outcome for our patients. Effective teamwork and collaboration between health care professionals and amongst physiotherapists contributes to the following: (1) (2) (3)
optimizes health-services strengthens health systems improves health outcomes.
So, are we doing enough as sports physiotherapists in New Zealand to communicate with, promote, and respect others in our own profession?
grad or a seasoned professional it is worth another read – you’ll find a copy of it here :https://sportsphysiotherapy.org.nz/ sportsphysiotherapy.org.nz/documents/SportsPhysiotherapy-Code-of-Conduct_v-Dec-2013.pdf Most relevant to this article is section nine which is titled “Effective relationships” and it has three very valid points. A sports physiotherapist will:
i. Maintain effective, collaborative and professional relationships with other medical/ healthcare professionals (including physiotherapists, sports physicians, sports doctors, GP’s) involved in the patient’s care. ii. Maintain respectful relationships and behave in a professional manner with non- medical/health care personnel (including coaches, managers, support and administration staff, match officials etc.). iii. Not undermine relationships between another sports health care provider and their patient.
Let’s start by referring back to our Sports Physio Code of Conduct 2013, and whether you are a new
In the real world, communication between physiotherapists is not always easy as we are time poor. One thing we are notoriously unreliable at doing is providing appropriate patient information, or a handover, especially when athletes return to their home environment or club/team for follow-on attention from their regular treatment providers. Because we don’t get paid for our time when doing a CONTINUED ON NEXT PAGE >>
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SPECIAL REPORT handover - and for some that may be thought of as a perceived barrier to not do one. We can also ask ourselves – What else is in it for me? The answer may include but not be limited to professional courtesy, patient rapport and respect, developing a relationship with a new physio that may help your professional development, promotion of the profession, one team philosophy regardless of where and who they work for, soft marketing, and the feel good factor.
treatment. Remember that everyone has a bad day, and overall we all want the best outcomes for our patients, so find a pragmatic, inclusive way to report back to the other physio (if it is relevant), but most importantly structure your response back to the patient in a sympathetic way which is not damaging to the other clinician. All too often, patients are left feeling stuck in the middle between opposing opinions, differing diagnoses and conflicting clinical outlooks, resulting in poor outcomes.
As is already mentioned, we must never lose sight of doing what is best for the patient – appropriate handover information optimises patient outcomes and should always occur. To not provide appropriate handover information is requiring the athlete to convey to their subsequent treatment provider what “their” opinion is of what has occurred – this opens us up to all sorts of potential issues, from not knowing whether or not the athlete actually understood what our treatment regime/options were, or what the planned goals re outcome may have been – and now we are leaving this information to be relayed by the athlete to the next therapist – obviously not a best practice situation.
To the new graduate physiotherapists reading this,
Another example of where we have a tendency to let ourselves down as a profession, is when we see a patient or athlete who has seen or had a bad experience with another physiotherapist for
welcome to the best job in the world. In your first years out, we recommend you put yourselves in different scenarios, get your hands dirty on the sidelines, keep an open mind, maintain professionalism, and most importantly ask for help. Don’t hesitate to refer on to another physiotherapist for a second opinion – a great learning opportunity for your own clinical practice – or refer on to another colleague who focuses in an area you are not as experienced in, eg. hand therapists, vestibular, womens’ health. Finally, it doesn’t matter what level you’re working at or how experienced you are, respect in our profession is incredibly important and there is no place for egos when working towards positive patient outcomes.
Vijay Vallabh has over 20 years of sports physio experience working with cricket, netball, and rugby teams in Wellington. He has been the physiotherapist for the Black Caps NZ Cricket Team since 2015 and is a senior physio at ProActive Physio. Vijay has a super support team in his wife and two beautiful children.
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APP REVIEW
Back to the App... Your App Review Hudl Technique App Happy 2020 to everyone and to start your sports physiotherapy year is another app review, this month it is the Hudl Technique App. Seller: UberSense Inc Size: 85 MB Version: 6.1.3 Category: Sports Compatibility: Requires iOS 10.0 or later. Apple and Android Languages: English, French, German, Japanese, Korean, Simplified Chinese, Spanish, Traditional Chinese Age rating: 4+ Copyright: Agile Sports Technologies, Inc Cost: Free or Go Elite for $89.99 per year
What it is used for?
To record, analyse and improve technique through slow motion video analysis and play back. It provides instant feedback to a patient or athlete during a physio session, gym session, sports practice, race or game.
Who would benefit from this App?
Any physiotherapist working with athletes or patients where immediate video feedback is useful to their sporting performance or injury understanding.
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APP REVIEW PRACTICAL APPLICATION
I have used this app recently with athletes when following the Melbourne ACL Rehabilitation Guide, especially with the single leg squat/rise alignment testing. Used in combination with the metronome app it is a great way to specify an outcome measure and feedback to the athlete about any technical issues regarding their squat alignment and body position. I have not used it for this sporting population but there are very positive reviews online for golf swing analysis using the separate golf app called Hudl Technique Golf.
Pros:
• Simple, user-friendly way to video and analyze movements in an athletic population. • Options of slow motion in 1/2, 1/4, or 1/8 time. • Easy to use drawing tools to measure or highlight form. • Able to compare two videos stacked or side by side. • Easy to send videos through to athletes, trainers, and coaches, for multi-disciplinary input and explanation. Cons:
• Pressing the back button once you have viewed a video is unreliable. I thought it was just my phone but looking through reviews it happens to others as well. • I’m on the free version of the app and now get inundated with reminders to upgrade. • Many poor reviews from Android users after a recent update.
OVERALL RATING = 4.2 / 5
MEMBER BENEFITS
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There are many benefits to be obtained from being an SEPNZ member. For a full list of Members’ Benefits visit http://sportsphysiotherapy.org.nz/benefits/
In each bulletin we will be highlighting individual member benefits in order to help members best utilise all benefits available.
issuu Our newsletters are available as a flip book online on ISSUU http://issuu.com/sportsphysiotherapynz There are also heaps of other resources on the site and a number of them have been grouped for your benefit. Click the “Stacks” button to find copies of sports related magazines for free. These include: Football Medic, Journal of Physiotherapy and Sports Medicine, Sports Performance and Technology and more.
Podcasts
Podcasts are recorded interviews or talks that are made available for access anytime. A number of sports medicine related podcasts are available which have been linked to our website. http://sportsphysiotherapy.org.nz/members/resources/freepodcasts
Journals
Not studying at present and miss the library at physio school? There are a number of journals that are available online for free. This list is increasing as more companies are developing free access journals, but please let Hamish know if you are aware of ones not on the list. We currently have a list of sports medicine, orthopaedic related and sports science. http://sportsphysiotherapy.org.nz/members/resources/journal/
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ASICS ARTICLE
Athletic Footware: A synergy of Performance
Dr. Chris Bishop PhD Director of Biomechanics, The Biomechanics Lab A lot of people don't give footwear enough credit.
and knowledge 30 years ago compared to now.
Not only is footwear a powerful manipulator of human movement, but it can also have a drastic effect on human performance. So what goes into the design of a shoe that can have such an effect? A lot of hard work, innovative thinking, creative design and calculated execution. As a result of this hard work and innovative thinking, World Athletics has now established rules in footwear design limiting the number of carbon fibre plates as well as the stack height of the midsole. On one hand we can thank NIKE and the controversy around AlphaFLY, yet every company was doing something similar. They were exploring the ability of footwear to influence performance. But this was right at the top end of runners. The elite of the elite. What about our recreational runners? Is there a way we can help them improve performance too? We know from the science that there are three ways in which footwear can influence human performance (through a surrogate measure of running economy): 1.
Shoe mass
2.
Longitudinal bending stiffness
3.
Cushioning
Maximizing all three creates what is known as a 'Synergy of Performance." So let's explore these factors. Firstly - is light mass all the rage? We know light shoes influence performance. This was originally proposed by Ned Frederick back in the 1980s, with the finding of increasing shoe mass by 100g had a negative effect on running economy in the order of magnitude of 1%. Roger Kram and his lab have validated this finding (see Franz et al. 2012), which makes Ned's experimental findings even more impressive given the lack of equipment
Figure extracted from Franz et al. (2012) But is there a point (of explicit mass) by which just putting a shoe on will result in improvements in running economy? A colleague of mine (Dr Joel Fuller who is now at Macquarie Uni) wrote a great review that identified a US size 9 shoe that weighed < 220g would instantaneously result in an improvement in running economy. Yet there was one comment from Kram’s keynote at the Recent FBG symposium in Canada that really resonated with me… “The design of competition shoes for road racing on paved surfaces should not overemphasize weight minimization at the expense of cushioning… (Tung et al. 2014)
So is light weight really better…In pursuit of light weight, what do we compromise? Durability? Energy return? I'm not sure I'm willing to sacrifice both… So moving on…is a stiff forefoot a good idea? We know from the early work out of Calgary by Roy
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ASICS ARTICLE and Stefanyshyn that longitudinal bending stiffness has a benefit to the physiological cost of running, as long as it is tuned to the individual. Too stiff (or not stiff enough) and the runner will receive a negative benefit. This was recently put into context by Oh and Park whom identified increasing longitudinal bending stiffness was ok as long as it does not interfere with natural 1st MTP joint motion.
that the Vaporfly 4% has changed the landscape of running. I can't, in my time in footwear, remember a shoe that has had a bigger impact on the footwear industry as this shoe. And haven't they copped a fair bit of negative press about the shoe. But when you look at it closely, and understand the mechanics, it isn't a spring. It is simply a lever to optimise the mechanical advantage of the foot. The vaporfly works in two ways:
1. The proprietary cushioning (see section on cushioning) 2. The carbon fibre plate. With respect to the latter, NIKE have clearly explained the design and development of the plate. It started with four prototypes: 1. A baseline shoe
Figure extracted from ROY & STEFANYSHYN, D. J. (2006). Enter the team at NIKE. And their innovative and game changing concept to a plate through the shoe. Is this any different in function to applying a propulsion trusstic through the midsole or manipulating material density to create a similar effect (think racing flats for the last 30 years)? Or is just a sign of the current market where engineering and production advances have now made this possible and feasible? Emma Farina leads the running team at NIKE. And an impressive team it is. And with the budget NIKE has, I would expect nothing less! There is no doubt
2. Prototype 1 which have a stiff plate with no curvature (same cushioning as baseline shoe) 3. Prototype 2 which have a stiff plate with mild curvature through the forefoot (same cushioning as baseline shoe) 4. Prototype 3 which have a stiff plate with extreme curvature through the forefoot (same cushioning as baseline shoe) m
So what did they find? The curvature of the plate had a large effect, with the more severe curvature prototype having the greatest effect on reducing the negative effect of increasing bending stiffness (see Figure 1 below from Abstract). What one would normally expect is that a result of
Extracted from Farina et al. (2019). Footwear Science. https://doi-org.access.library.unisa.edu.au/10.1080/19424280.2019.1606119
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ASICS ARTICLE increasing forefoot longitudinal bending stiffness you would get net energy loss at the MTP and a net external increase in the ankle plantarflexor moment but this wasn’t the case. It’s like the runner receives the best of both worlds; maximise power around the MTP whilst not making the calf work harder. And how is this done? Through the shoe of course! Roger Kram, who oversaw the external validation work of the shoe at University of Colorado Boulder, has presented data to support the fact that the shoe itself was doing some of the work. This is likely the holy grail, reducing the work at the MTP without increasing it at the ankle, knee or hip. Is a plate the only way to do this? Well arguably not. Think about toe springs and midsole geometry. It is feasible to create a propulsion mechanism through the forefoot that may assist runners in a similar way. That’s the concept of the EvoRIDE from ASICS. It may not improve performance 4%, but the impact that it can have on optimising propulsive mechanics may well be similar for the recreational runner. So what about cushioning? In short, cushioning has a big impact on both the perception of comfort, as well as the vibrations applied to the body. However, what a lot of people fail to understand about cushioning is what influences it? There are two distinct factors 1. Compliance 2. Resilience The compliance of a shoe has formed the traditional view of cushioning. Soft bouncy midsoles like BOOST, Everrun etc have entered the market with large applause. The immediate perception of a comfortable ride has sold many millions of pairs of shoes (irrespective of durability). Interestingly, research has suggested that regardless of whether you run on hard or soft materials, the magnitude of load applied to the body is the same. However the perception of the load can be different, and likely explains why some people prefer different materials to others. So if it isn’t compliance that makes cushioning so good, then what is it? The magic in these new smart materials we are seeing (i.e. Zoom X in the Vaporfly 4%) seems to be the
resilience of the material. Resilience of foam is defined as the energy restored from the material after a load has been applied. This is commonly referred to as energy return. In presenting loading data of the 4%, Kram eloquently demonstrated that just because you have a compliant midsole, does not mean that has a negative effect on energy return. Infact, high compliance, coupled with high resilience, results in a material that loses minimal energy through the loading cycle. Where the Zoom Streak returned 65.5 % energy and the Adidas adios boost 2 (the shoe Denis Kimetto broke the world record in) returned 75.9%, Zoom X was recorded a staggering 87.0% of energy. According to Martyn Shorten who tests shoes for Runner's World, this is the highest recording of energy return ever recorded by a shoe. What ultimately results is less energy lost in the midsole, and therefore more returned to the runner to assist with propelling forward momentum. Impressive huh…YEP Despite these three factors combining together to create a synergy of performance, I am going to take the opportunity to discuss some of the findings we presented recently on midsole density. Yes I will at this point declare a conflict of interest given my consultancy role with ASICS, but I do feel our results suggest the dual density midsole design can also contribute to this synergy of performance. DuoMAX - ASICS dual density midsole system. What does it do? There has been a staple in the ASICS footwear range since Kayano 1 (yes that it 26 years!). And that is duomax. ASICS' patented dual density midsole system. Now I want to address the elephant in the room of the role of dual density midsoles. I honestly feel they have been harshly dealt with on the online stratosphere. There are many individuals calling for the extinction of this technology. I routinely read 'they are heavy', 'they don't control pronation' so why include them in the shoe. Yet I am yet to ready a really good study showing these shoes don't work (and yes there are multiple ways to define 'work'). In fact, there is a range of really good studies that show benefits of medial posted shoes. This makes it all the more surprising that companies are deviating away from this technology (despite anecdotal feedback from consumers that some find these types of shoes more comfortable) given the lack of conclusive evidence to support their lack of effect. I also want to highlight that not all dual density systems are the same So what did we do… CONTINUED ON NEXT PAGE >>
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ASICS ARTICLE We built two versions of the Kayano 23, with the only difference between the shoes being the presence (or lack of) DUOMAX design. We then got people to run both fresh and in the presence of fatigue (with fatigue created through running back-to-back 3km time trials as quick as they could). What we found was instantaneously, there was a physiological benefit (2%) running in the DuoMAX shoe regardless of foot posture, with the benefit increasing to 3% when running in the presence of fatigue. This also translated into a performance benefit, with the dual density shoe assisting in maintaining performance (i.e. faster time trial performance in the dual density shoe) in the presence of fatigue. This was measured as a 6.8s improvement in 3km time trial performance, equating to an improvement of some 24 m. This is a clear and substantial benefit of this design feature. And something that should be considered in a lot of recreational runners…fatigue influences performance! TM
References Bishop, Chris (2019) Dual density midsole design improves running economy and performance when fatigued, Footwear Science, 11:sup1, S136-S137, Farina, Emily M, Haigh, Derek & Luo, Geng 2019, ‘Creating footwear for performance running’, Footwear Science., vol. 11, no. sup1, pp. S134 –S135. FRANZ, J. R. , WIERZBINSKI, C. M. & KRAM, R. (2012). Metabolic Cost of Running Barefoot versus Shod. Medicine & Science in Sports & Exercise, 44 (8), 1519–1525. doi: 10.1249/ MSS.0b013e3182514a88.
So to summarise, of course there is a desire for every runner to find the perfect shoe. And at the moment, we don't know what that is. But we do know that when we get footwear right, different components combine to create a synergy of performance.
Roy J and Stefanyshyn DJ. (2006) Shoe midsole longitudinal bending stiffness and running economy, joint energy, and EMG. Med Sci Sports Exerc. 38 (3):562-9.
So what contributes to this synergy?
TUNG, K. D. , FRANZ, J. R. & KRAM, R. (2014). A Test of the Metabolic Cost of Cushioning Hypothesis during Unshod and Shod Running. Medicine & Science in Sports & Exercise, 46(2), 324–329. doi: 10.1249/MSS.0b013e3182a63b81.
1. A shoe that is durable. If it can be light, that is even better! 2. A forefoot stiffness that is tuned to the individual needs, one that doesn't restrict MTP ROM and one that doesn’t increase the moments acting around the ankle 3. A shoe that is resilient and returns energy stride after stride after repeated loading And if running in the presence of fatigue, perhaps considering a shoe with DuoMax might help too!
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FEATURE ARTICLE
Encouraging physios to “Speak Out” about doping in sport. Hayden Tapper, Investigations & Intelligence Manager, DFSNZ Introduction
Drug Free Sport New Zealand (DFSNZ) is the organisation responsible for keeping sport clean in New Zealand, and free from doping. We work across New Zealand’s sporting community to protect clean athletes and promote clean sport. The February 2019 edition of the SEPNZ Bulletin featured an article about the physio’s role regarding athlete use of supplements and medications – to help avoid inadvertent doping. This article touches on the more sensitive area of athletes who might divulge information about doping to their physiotherapist.
There is no doubt that sport at all levels benefits from the dedication of time and expertise provided by physios and other medical professionals throughout the country. Enhanced treatment techniques and technology have improved the outcomes for many injured athletes and resulted in many victories on the sports field.
The Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct (CEPC) has guidelines about patient confidentiality and the circumstances when confidentiality can be foregone. But there is an equally important part of the Code which deals with the health and wellbeing of a patient being a physio’s first priority.
Physios can and will spend many hours with their athletes on the treatment table preventing or rehabilitating injuries. So much so that their role will often extend beyond the treatment table.
The Sports Physiotherapy Code of Conduct also interprets and explains the principles contained with the CEPC as they relate to the sporting environment and includes a specific section on prohibited performance enhancing substances.
The many hours of contact time will often result in the physio becoming a confidant of sorts, where athletes talk about and divulge many details of their life. At the high-performance level, where physios travel overseas for periods for sport, they become an integral member of the team and are often the most informed about what’s really going on in the team. The information divulged from an athlete to a physio can range from simple chit-chat about an injury treatment or what they got up to in the weekend, through to more serious and sensitive information about their personal lives or those of their teammates.
What can you do if one of your patients discloses information relating to doping or you suspect an athlete is doping?
Prohibited substances or performance enhancing drugs (PEDs) are banned in sport because they give athletes an unfair advantage, but just as importantly, they are banned because they are harmful to the athlete’s health. In fact the revised 2021 World AntiDoping Code lists ‘health’ one of the primary reasons for having the Code. If you suspect an athlete is doping or may be considering doping, your first option as a medical professional may be to discuss with the athlete the reasons that might be behind their behaviour and the health risks. We would also encourage you to report the matter to DFSNZ – in the interests of both the athlete’s health and clean sport.
You can report suspicions of doping without identifying the athlete (ensuring no breaches of the CEPC) and anonymously if you wish.
You would not be the first medical professional to find yourself in this difficult situation – which may involve a patient you are treating or an associate of theirs. CONTINUED ON NEXT PAGE >>
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FEATURE ARTICLE What information can be reported?
information is important to us.
Any information, no matter how insignificant you think it may be, is valuable to DFSNZ.
Where action is justified and if appropriate, DFSNZ may work with the person reporting the information, to glean further intelligence and formulate a plan of action that might include a targeted education plan, targeted testing, or further investigation.
Examples of the type of information reported include athletes being offered steroids or “gear” over social media or being offered unspecified “vitamins” by management or coaching staff. Others have reported conversations they have overheard about using drugs in sport.
Sports officials and competitors have reported suspicions about sudden dramatic increases in performance by some athletes and rumours they may have heard about drug use. We have also received information from people with concerns about the health of athletes they know. Any suspicious doping activity can be subject of a report. It doesn’t matter when, where or who it involves. There is no such thing as bad information. If you have the smallest of suspicions, we would like to hear about it.
Any information provided is treated in the strictest confidence and stored in a secure location.
So how can you report suspicious activity? DFSNZ have recently launched our “Speak Out” programme. “Speak Out” encourages anyone to make a confidential report to DFSNZ if they see or hear something related to doping in sport. You can contact DFSNZ on 0800 DRUGFREE and speak to our Investigations and Intelligence Manager, email
intel@drugfreesport.org.nz What does DFSNZ do with the information?
or
DFSNZ is not just about testing athletes. A major part of our work is educating athletes about the harm doping can cause and providing them with important information to help ensure they make the right choices and compete clean. Our preference is to educate athletes first and test second. But that is not always possible or practical.
make contact through the
A more recent evolution in the world of anti-doping is the increasing role intelligence and investigations plays in detecting (and deterring) doping in sport. This is evident at the macro level in recent doping scandals such as the Russian doping scandal and Alberto Salazar (athletics), which were uncovered as a result of information provided by individuals. But intelligence is also useful at the micro level in helping us determine the focus of our education programmes, which athletes or teams we might select for testing and where an anti-doping rule violation is strongly suspected, investigating that further. Anti-doping organisations around the world are being increasingly proactive in gathering and using intelligence to inform their anti-doping programmes. At DFSNZ we assess every piece of information we receive and consider carefully what, if any, action to take. Even if we take no action, all information is stored in our database for future reference, subject to further information we might receive. It might be that we need one last small piece of the puzzle – so all
Speak Out web page (drugfreesport.org.nz/reportdoping-in-sport). While we would prefer to speak with you regarding to report to ensure we get the most accurate information, reports can be made anonymously if you prefer. Information we receive is kept in the strictest confidence.
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CLINICAL REVIEW
Imaging with ultrasound in Physical therapy: what is the PT’s scope of practice? A competency-based educational model and training recommendations. Jackie L Whittaker,1 Richard Ellis,2 Paul William Hodeges,3 Cliona O’Sullivan,4 Julie Hides,5 Samuel Fernandez-Carnero,6 Jose Luis Arias-Buria,7 Deydre S Teyhen,8 Maria J Stokes9 Br J Sports Med 2019;53:1447-1453.doi:10.1136/bjsports-2018-100193
By Pip Sail Abstract There remains considerable confusion and inconsistencies in terminology associated with physical therapist use of ultrasound (US), due in part to the manner in which US is used across the profession and in part that previously identified gaps related to scope of practice and specialised training is growing. There are limited continuing education opportunities for physical therapists to become proficient in using US within their professional scope of practice. There are 4 broad categories of physical therapy US application.
interventions. Interventional US has been utilised by physical therapists as a safety adjunct for acupuncture, trigger point release, and percutaneous electrolysis. 43
44
45,46
• Research US imaging: a procedure used in basic, applied, and clinical research that aims to inform physical therapy practice. It is important to note that within each of the four categories of physical therapy US applications, a variety of US-based imaging techniques can be used depending on the clinical or research goal In addition to a lack of regulatory oversight, surveys conducted in the UK, Australia, and New Zealand demonstrate that there is no internationally accepted criteria for physical therapists training in US, with continuing education or mentoring opportunities varying widely across countries and no minimal competency required for US for patient care. With the rapid growth of US use by physical therapists, the profession needs clear and consistent guidelines from regulatory and professional associations to mitigate confusion about the scope of practice for physical therapists. 67
• Rehabilitative US imaging: defined as a procedure used by physical therapists to evaluate muscle and related soft tissue morphology and function during exercises and physical tasks and to assist in the application of therapeutic interventions aimed at improving neuromuscular function. 9
• Diagnostic US imaging: a procedure examining the effects of injury, lesion or disease on joint surfaces, muscle, tendon, ligament, bursa, vessels, nerves and solid visceral organs. This application may be the most controversial given that traditionally these applications have been under the scope of a consulting imaging specialist. 35
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Each category of physical therapy US is associated with unique knowledge, skill sets and potential for perceived infringement with the scope of other healthcare practitioners. Although there are some overlapping concepts, the issues and barriers associated with specialised training, competent use and reporting differ. In the fields of diagnostic and interventional US there are established criteria for training, competent use and regulation however in some countries this may not be available and it is important to consider that physical therapists gaining their US training through courses established for 69
• Interventional US imaging: a procedure to accurately, safely and efficiently guide ‘dry’ and ‘wet’ needles for a variety of invasive
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CLINICAL REVIEW other healthcare professionals may lead to physicals therapists operating outside their scope of practice. In contrast to diagnostic and interventional US, the field of Rehabilitative Ultrasound Imaging (RUSI) lacks professional oversight, standard curriculum and regulation for training. This has resulted in a paucity of high-quality, evidence-based training opportunities; a lack of standardisation in the performance and reporting of RUSI applications; and a potential for insufficiently trained operators. Entry to practice education programme, access to postgraduate education to support safe competent practice is needed. 41 67 68
A competency-based education model of training is suggested, driven by â&#x20AC;&#x2DC;productâ&#x20AC;&#x2122; rather than process, where learning outcomes are identified and the curriculum is built in blocks to ensure that students achieve the competencies described in the learning outcomes.
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Future efforts should focus on developing international standards for self-governance of US use by physical therapists and ensuring that the training and practice standards are identified, reached and maintained. Greater interprofessional exposure to the use of US is needed to avoid inaccurate assumptions about professional infringement and the appropriate scope of practice for physical therapists. It is imperative that physical therapists continue to provide evidence that US enhances the quality, effectiveness and efficacy of physical therapy management.
A full set of references is available on request
Key note speakers Bill Vicenzino and Michael Nitschke will be presenting in miniconference format followed by a Panel Discussion with a local guest speaker in each location. Guest speakers will be announced next week. Workshops from Bill and Michael will be held before the miniconference. Spaces are limited, get in quick!
https://event.sportsmedicine.co.nz/shop/
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FOOT AND ANKLE ROADSHOW
Bill Vicenzino BPhty, GDSportsPhty, MSc, PhD (@Bill_Vicenzino)
(@Nittaz) Sports & Arthritis Clinic, Adelaide
Chair in Sports Physiotherapy University of Queensland Bill enthusiastically pursues an understanding of the best approach to managing musculoskeletal conditions, and to its dissemination. He focuses his scholarship in the areas of injuries related to physical activity and sports participation. He achieves this as the Chair in Sports Physiotherapy, Director of the Master of Physiotherapy (Musculoskeletal, Sport) and Sports Injuries Rehabilitation and Prevention for Health (SIRPH) research unit at the University of Queensland (Australia). His clinical research has focused on such conditions as tennis elbow, gluteal tendinopathy, chronic ankle instability and patellofemoral pain, with a number of randomized clinical trials attracting NHMRC funding and being published in high impact medical journals (BMJ, Lancet, JAMA). Bill has over 200 peer reviewed publications, 2 books, 26 book chapters and over 300 invited presentations. Michael Nitschke BPod (2006), MAPodA, AAPSM
Michael is a Certified Sports Podiatrist (APodA) and partner in Adelaideâ&#x20AC;&#x2122;s Sports & Arthritis Clinic (SPARC). Hel is also a nationally competitive long distance runner and Level II advanced middle/long distance running coach (AA), and an assistance coach at Adelaide Harriers AC. With a decade of clinical experience in private practice and exceptional anatomy and biomechanics knowledge, Michael now specialises in the diagnosis and treatment of running injuries. He is currently in the process of his post graduate research studies looking at the training characteristics of recreational runners and the relationship between performance and injury risk. As an accomplished track athlete Michael is well versed in working with amateur, junior and elite athletes. However Michaelâ&#x20AC;&#x2122;s passion for the sport has grown beyond that of just the competitive side. Michael is committed to growing the entire running community in South Australia by providing an innovative running service accessible to all runners, recreational and elite.
Bill Vicenzino Keynote: Persistent ankle problems: evidence based solutions.
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UPCOMING SEPNZ COURSES
Sideline Management AUT North 28th & 29th of March 2020 This course is for registered physiotherapists who work with individual athletes, or on the sideline at sports games or events who want to upskill in the areas of pregame preparation, first aid, acute injury assessment and management, and postevent recovery strategies. By the end of the course you will have all the tools you By the end of the course you will have all the tools you need to manage pre-event preparation, postevent recovery and to confidently assess, manage and refer common sporting injuries and wounds. Register here: https://pnz.org.nz/Event?Action=View&Event_id=2874 Proposed courses for 2020 (Not limited to) Lower Limb in Sport Venue and dates TBC This course is for registered physiotherapists who work with individual athletes or teams in which lower limb injury is common. The focus of the course is on pathomechanics and kinetic chain deficits as they relate to injury prevention and performance, diagnosis and advanced rehabilitation of lower limb conditions. By the end of the course you will understand the pathoaetiology of common lower limb injuries, be able to perform key clinical and functional tests, rehabilitate lower limb injury in a number of sporting contexts including football, running and contact sports, and develop individualised return-to-sport programmes. Injury Prevention & Performance Enhancement. Venue and Dates TBC This course will provide you with the key skills used in the enhancement of sporting performance and prevention of injury. It covers the analysis of physical, biomechanical and technical needs of sport, identifying key factors affecting performance and injury prevention. You will learn how to assess athletes and implement an individualised programme designed to optimise movement efficiency, performance and minimise injury risk. You will learn how to develop a sportâ&#x20AC;&#x201C;specific screening assessment, how to monitor injury rates and target injury prevention strategies within different sporting contexts.
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RESEARCH PUBLICATIONS
British Journal of Sports Medicine February 2020; Vol. 54, Issue 4 ORIGINAL RESEARCH The Italian preparticipation evaluation programme: diagnostic yield, rate of disqualification and cost analysis (17 July, 2019) Teresina Vessella, Alessandro Zorzi, Laura Merlo, Cinzia Pegoraro, Flaviano Giorgiano, Michele Trevisanato, Mirella Viel, Pietro Formentini, Domenico Corrado, Patrizio Sarto Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults (15 December, 2018) David Martinez-Gomez, Irene Cornejo, Esther Lopez-Garcia, Esther Esquinas, Kabir P Sadarangani, L Veiga, Fernando Rodriguez-Artalejo
EstebanGarcíaOscar
Team illness prevention strategy (TIPS) is associated with a 59% reduction in acute illness during the Super Rugby tournament: a control–intervention study over 7 seasons involving 126 850 player days (1 August, 2019)
Christopher McGrew, DaisyScarlett MacCallum, Dustymarie Narducci, Rathna Nuti, Le onard Calabrese, Robert J Dimeff, Stephen Paul, Sourav Poddar, Ashwin Rao, Dou glas McKeag Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations (19 September, 2019) FREE John T Parsons, Scott J Casa, Brian Hainline
A
Anderson,
Douglas
Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement—Executive Summary (6 December, 2019) FREE Cindy Chang, Margot Putukian, Giselle Aerni, Alex Diamon d, Gene Hong, Yvette Ingram, Claudia L Reardon, Andrew Wolanin REVIEWS
Martin Schwellnus, Charl Janse van Rensburg, Helen Bayne, Wayne Derman, Clint Readhead, Rob Collins, Alan Kourie, Jason Suter, Org Strauss, Nicola Sewry, Esme Jordaan EDITORIALS Youth sport specialisation: the need for an evidence-based definition (19 December, 2019) Neeru Jayanthi, Stephanie A Kliethermes, Jean Côté 18 highlights from the International Criteria for ECG interpretation in athletes (8 November, 2019) Jonathan A Drezner
Impact of youth sports specialisation on career and taskspecific athletic performance: a systematic review following the American Medical Society for Sports Medicine (AMSSM) Collaborative Research Network’s 2019 Youth Early Sport Specialisation Summit (18 November, 2019)
Stephanie A Kliethermes, Kyle Nagle, Jean Côté, Robert M Malina, Avery Faigenbaum, Andrew Watson, Brian Feel ey, Stephen William Marshall, Cynthia R LaBella, Daniel C Herman, Adam Tenforde, Anthony I Beutler, Neeru Jayanthi Ben Macdonald, Stephen McAleer, Shane Kelly, Robin Ch akraverty, Michael Johnston, Noel Pollock
DISCUSSION To strive is human, to abuse malign: discrimination and non-accidental violence of professional athletes without employee-style statutory protection (25 April, 2019) Victoria Louise Roberts, Victor Eduardo Sojo CONSENSUS STATEMENT AMSSM position statement update: blood-borne pathogens in the context of sports participation (19 March, 2019) FREE
http://bjsm.bmj.com/content/53/23 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/
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CLASSIFIEDS
We're Looking for GREAT Physiotherapists to join Our Team! See the full job description, Video and Mentoring Package via the website link below.
Te Aro Physiotherapy and Pilates, Wellington We'd like to hear from you if you: - Want Great Mentoring and support to grow yourself (at any stage of your career) - Great remuneration and Bonus - Want to work in a close knit team - Want to be able to block out time for CPD and choose to work 4 OR 5 days per week - Are keen to rehab patients back to their best in a BIG rehab gym Live and work in the middle of the South Island, a short drive from Skii Fields, Lakes, Trails, Hot pools and Christchurch All our staff have structured mentoring programs (for all levels), provided by experienced physios. We are part of the international Private Practice Graduate Program, offering options to travel, live and work abroad also with one of our partner clinics NOTE, applicants must be: - Open and Coach-able - Enthusiastic - A team player and People person Apply here: https://work-at-physiosteps.lpages.co/ physiosteps/
Experienced Physiotherapist: Full Time/Parttime, Salary/ Contractor Start time: March/Negotiable Flexible working hours with competitive remuneration We’d like to hear from motivated, enthusiastic physiotherapists who hold New Zealand registration/APC. Join our skilled team supported by our highly efficient administration.
If you have experience as a MSK physiotherapist; competent in strength & conditioning and injury management; confident with clinical assessments – send in your application! We’ll support you with professional development and contribute towards CPD, APC, or NZMPA membership. Please contact Jason by e-mailing your CV to jason.c@tearophysio.co.nz.
www.tearophysio.co.nz https://www.facebook.com/tearophysio/ https://www.instagram.com/tearophysiotherapy/
