ISSUE 3 l JUNE 2014
BULLETIN FEATURE TOPIC: Swimming www.spnz.org.nz SPNZ EXECUTIVE COMMITTEE President
Website & IT
Timofei Dovbysh Blair Jarratt Justin Lopes Dr David Rice Bharat Sukha
Welcome to the June 2014 Bulletin In this Edition: EDITORIAL
NEW COMMITTEE MEMBERS
MEMBERS ’ BENEFITS
Dr David Rice - chair
Dr Angela Cadogan Dr Grant Mawston
BULLETIN EDITOR Aveny Moore
SPECIAL PROJECTS Monique Baigent
LINKS Sports Physiotherapy NZ List of Open Access Journals Asics Apparel and order form
A High Performance Journey: Physiotherapist Jordan Salesa
Article Review: The Practical Management of Swimmer’s Painful Shoulder: Etiology, Diagnosis, and Treatment.
SPNZ Research Reviews: Shoulder Pain in Swimmers
JOSPT: Volume 44, Issue 6, June 2014
Shoe Report: Gel Divide
Michael Borich (Secretary) 26 Vine St, St Marys Bay Auckland email@example.com
Asics Education Fund information
McGraw-Hill Books and order form
CONTINUING EDUCATION SPNZ Course: Promotion & Prescription of Physical Activity & Exercise
Continuing Education Calendar and APA CPD Event Finder
EDITORIAL By Hamish Ashton
It has been a wild few days here in the Bay of Plenty and many other regions around the country so I hope you are all keeping safe and well. Since the last bulletin we have gained another committee member as unfortunately Chelsea Lane has had to step down. Though she was on the committee for just a short time her experience has been useful in the initial development of our sports physiotherapy courses. Blair Jarratt has been seconded after expressing interest to us in becoming involved. Though two of our committee consider themselves Mainlanders, our committee is now very top of the North Island heavy and lacking in female input. Currently Kara is the only one representing the female half of our membership and repressing testosterone levels in the board room. It would be great to have better representation from around the country and a few more females so we have a more balanced view point of the membership. If anyone has interest in being more involved please talk to me. At present we are not looking for further committee members but just an interest in being involved. You will see we have enclosed in the edition bios of our new committee so you can better get to know who are representing you. On talking about ideas, our committee is due to have a get together at the end of the month. This is our main planning session that we hold once or twice a year. As part of this we go through ideas from previous surveys we have undertaken. However if anyone has any thoughts about courses or anything else they would like to see happen please let Michael Borich or myself know so we can discuss it at our meeting. I recently attended the PNZ AGM at which a SIG/Branch day was held at the same time. During this there was an update on the SuperConference for which we have had some involvement. How to support this was a well discussed topic by our exec as our Symposiums all received great feedback, especially with regard to the speakers providing practical advice in their presentations. Our decision was that we need to support the whole profession in the form of the SuperConference, but we understand CPD budgets are tight so as part of our planning going forward we need to decide how it and the Symposium are going to work together. Any thoughts on this are welcome. Though as a SIG we are relatively large, we are still only one of many groups involved in sport and sports medicine in New Zealand and throughout the world. You will shortly receive the Sports Medicine Australia Sport Health Magazine which is part of our efforts in developing relationships with other groups in both NZ and overseas. This is something I see as of great value to our members in the long term as they can provide us with useful contacts and resources. We also have an arrangement with the Australian Physiotherapy Association and Sports Physiotherapy Australia to access their courses at member rates and are currently talking to SPRINZ about developing a mutually beneficial relationship. If anyone has affiliations or contacts to other groups or organisations I would be interested to hear from them. That is all from me for now. I donâ€™t know how Ang managed to write multiple pages but I think I will go for the short and sweet approach.
Hamish Ashton SPNZ President
NEW COMMITTEE MEMBERS
Introducing Our New Committee Members Tim Dovbysh I have been living in Hamilton now for the last four years since graduating from Otago University with a BPhty. Our clinic covers the greater North Waikato area from which we gain a diversity of patients across a range of sporting and recreational, and socioeconomic levels. Iâ€™ve been involved in an array of sports at regional and national tournament level, but more heavily focussed into secondary schools and age group rep rugby. My spare time is a fine balance of studying towards postgraduate qualifications through AUT, landscaping our quarter acre forest that will someday resemble a garden, and getting in some competitive tennis. I look forward to bringing my perspectives into the exec.
Blair Jarratt I moved to back to Tauranga last year after growing up in the Bay prior to studying Physiotherapy at Otago University. I have recently become a director of Bureta Physiotherapy. The previous five years were spent working in Christchurch after returning home from five years in the UK. While in Christchurch I was physiotherapist for the Canterbury Wizards Cricket and Canterbury B rugby. Leaving Canterbury meant passing up these positions, however I was lucky enough to travel with the NZ U19 Cricket team to Dubai in February this year for their world cup campaign. I have two young children, Ashton and Pippa, who keep me pretty busy, but if I do get a chance, I like to get out on the mountain bike and have completed a number of races and endurance events in the south. I will be looking forward to some North Island challenges, and maybe even getting the snowboard back out again.
Justin Lopes I am a sports physiotherapist based at the Western Springs Association Football Club. I have worked with New Zealand Football for over 10 years for a variety of age group teams, including the NZU23 Mens team at the 2008 Beijing Olympics, the Football Ferns and the High Performance Elite Referees Group. I have also worked with the New Zealand Roller Derby Team for the last two world cup campaigns. I am currently the President of the Auckland Branch of Sports Medicine New Zealand. My emphasis is on hands-on prevention, treatment and performance.
Dr Angela Cadogan
Well done to Dr Angela Cadogan who recently was awarded Specialist Status in Physiotherapy under the Musculoskeletal Tag. Despite the Physiotherapy Board not yet recognising Sports as a specialist area, Angela, by becoming a specialist in New Zealand, now qualifies to become recognised as a IFSPT Specialist Sports Physiotherapist. Congratulations Angela, from the Exec, as well as I am sure the whole membership of SPNZ
AISCS EDUCATION AWARD – WINNING RECIPIENT The winning recipient of the above award for March 2014 is Angela Cadogan from Christchurch. This recipient has satisfied the Education Committee of the criteria for application as per the SPNZ Education Awards Terms and References. Angela is attending a conference in Dublin, Ireland, from 4-6 September entitled “The Sporting Hip, Groin, and Hamstring: A Complete Picture”. This is a combined conference of the Federation of Sports and Exercise Medicine (Ireland) and the World Federation of Athletic Training and Therapy. Angela is a past president of SPNZ and we look forward to her feedback on this conference which will appear in a forthcoming issue of our bulletin . It should be noted that no other applications were received as at 31 March. The next round of applications closes on 31 August 2014. All members are encouraged to view the Terms and Conditions of this award available on our website at sportsphysiotherapy.org.nz.
ASICS EDUCATION FUND A reminder to graduate members that this $1000 fund is available twice a year with application deadlines being 31 March and 31 August. Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing education in the fields of sports and orthopaedic physiotherapy. An application form can be downloaded on the SPNZ website sportsphysiotherapy.org.nz.
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FEATURE A HIGH PERFORMANCE JOURNEY Physiotherapist: Jordan Salesa
Qualifications Trade Certificate (Glazier) – 1989 Advanced Trade Certificate (Glazier) - 1991 BHSc Physiotherapy - AUT 1998 PGD Sports Medicine Otago University – 2001 Masters Health Practice – Physiotherapy (Manipulative and Acupuncture) - 2009
Background I come from an extremely close-knit family: an aiga - an extended family in the Samoan sense. I cannot adequately introduce myself without at least beginning to introduce some of them. My mother is a 4th generation Pakeha New Zealander who grew up on a farm in the far north. Mum is a nurse at Middlemore Hospital where she has been for more the 25 years. My father now retired was sent to NZ in the early sixties by his Faifeau (Minister) father to enrich his wider aiga (family). We hail from the villages of Satapuala, Neiafu and Falealupo. My wife, Dora Nedelia, a Hungarian native (and daughter of 1968 Olympian) and raised largely in New Zealand, is a secondary school physical education teacher. We have four children: 12 year old son, Ephraim, 11 year old Tiana, eight year old Ruby, and seven year old Vincent. My sister, Fia, is currently teaching in Auckland. My younger brother, Damon, a Rhodes Scholar, is currently Associate Professor and Head of Pacific Studies at the University of Auckland. My younger sister, Leilani, is a primary school teacher in Auckland. My elder brother, Shane, was killed in a car accident in 1981; he would be 47 now. My family has managed always to both challenge and support me, furnishing me with an intimate understanding of sharing, communication, tolerance and experience. My strengths emerge from my family, to whom they return. I am fearlessly proud of my heritage and all it encompasses I draw great strength from being who I am: a Samoan and a New Zealander. I hold the chiefly title of Toleafoa and like many would like to see the All Blacks play in Samoa but I do not wish to beg the AB’s play in Samoa, they just should, as to me, it is the epitome of arrogance that NZ Rugby chooses not to play the 8 th best rugby nation in the world. I left Selwyn College in Auckland in the 7th form with only school certificate, got an apprenticeship and did my trade qualifications in glazing (windows!). I continued to have fun and play sport (mainly club rugby) for several years before deciding that I may be better suited to trying out physiotherapy. I went to AUT which was, I think at the time, AIT and was either the first or second year of students to do the four year degree.
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A High Performance Journey: Physiotherapist Jordan Salesa continued….. CONTINUED FROM PREVIOUS PAGE. Past Sports/Orthopaedic Physiotherapy commitments/involvement I have, like many people, packed in as much as I could cope with in terms of my professional career. It has taken me to many places around the globe and furnished me with massive opportunities, and unbelievable challenges. I have met great people and had tonnes of great fun along the way and I have loved doing it. I initially started working as a physiotherapist with Auckland age grade rugby teams whilst I was a second year physiotherapy student. I did this for about seven to eight years working with many many great people, players and coaches. I started with under 16’s and did every Auckland and Blues team except the top jobs until 2003. Funnily, I missed out on the Auckland NPC job to my now business partner, Mark Plummer, who has remained in that role since then. Around the same time I began my business relationship with Karen Sutton who had already established a fantastic working relationship with Samoan rugby (including my uncle who had long played for Samoa). It was then I began my great journey with Samoan sport that eventually ended at the Rugby World Cup in France 2007. I initially worked with the Samoa 7’s team on the inaugural World Series at the same time as taking over from my colleague, Nicola Marsh, the Manu Samoa team itself. My uncle (yes we Samoans have lots of them!) was also the head of the Samoan Olympic Committee which no doubt assisted my applications to go with Samoa to the Sydney Olympics and Manchester Commonwealth Games. When I did not secure the Auckland NPC job I changed track a little and at the same time had applied for an advertised role with the NZ Olympic Team to go to Athens. Luckily for me I was selected and that started what I guess was a parallel journey that included “my” two countries. From 2000 – 2007 I was a physiotherapist for Samoa to the Sydney Olympics, Manchester Commonwealth Games, the National Rugby Team (including two RWC’s and every test match played during that time), the 7’s team, the South Pacific Games, and Mini-South Pacific Games. During that time period I also went with the NZ teams to Athens and Melbourne. I have maintained a role within nationalised high performance system since 2007 which has really placed me in a good position to maintain roles within the multi-sport or pinnacle events. From 2007 until now I have been to several swimming pinnacle events, the 2008 and 2012 Olympics, the 2010 Commonwealth Games, and soon the
2014 Commonwealth Games as well. I have been extremely fortunate on the professional front. None of which would have been possible with the support of my aiga, in particular Dora – hope it was worth it girl. Please describe your current role and how you ended up there. I essentially spend three days a week working as a hands-on physiotherapist at the National Training Centre for High Performance Sport NZ. I work with several sports within the centre and have a key role with swimming.
This is a great role that I have thoroughly enjoyed over the last seven years. I initially started this role directly with the NZ Academy of Sport North Island (the precursor to HPSNZ) and the elite swimming squad based at Millennium Institute of Sport and Health in Albany. Jan Cameron, the then national swimming coach, asked me my thoughts on how to create a high performance support team that doesn’t include money! From that time until now NZ has grown a high performance medical system that will begin (or rather has begun) to rival the best around the world. When I initially started, to my knowledge the only physiotherapists working with sports as truly paid professionals were limited to perhaps some
A High Performance Journey: Physiotherapist Jordan Salesa continued….. CONTINUED FROM PREVIOUS PAGE. NPC and Super teams along with the Warriors - probably only 10 or so people? Now I know HPSNZ have more than 15 physiotherapists, albeit some part time, and many more working within rugby set ups and of course now the Breakers. The actual role that I perform currently is relatively what we would all think, lots of “bottom of the cliff” management and rehabilitation. Increasingly though, with more time and resources being allocated, our roles allow time for and focus on “top of the cliff” action. Things like screening, monitoring and tracking various factors play important parts of our daily roles. With the rest of my work time (never stops really) I own, manage or rather chase my tail with my three other coowners of the Physio Rehab Group. We have 14 practices in Auckland and what’s really great for me is that we all have elite level sporting roles: Karen Sutton works for Samoan Rugby, Mark Plummer is the Auckland NPC and Blues Physiotherapist, and Sarah Fanuatanu is one of the two physiotherapists for the Warriors.
What are your specific areas of interest? Professionally, I am interested in seeing athletes succeed. Whether that is simply getting them training again or better still, knowing that they have not missed any training and that I have played a role in this. I think my clinical interests lie around capturing very clear objective data and having clarity around planning, interacting with, communicating and goal setting with athletes when rehabilitating. I enjoy numbers even though I’m not particularly good at maths. I think quantifying clinical measures (and effectively capturing it) can guide us in terms of possible prevention but equally with rehabilitating athletes. Simple clinical measures such as repeated functional tests are great at informing us what a specific group of athletes may look like prior to injury, or if they do get an injury what effect did it have on the measure (if any). In my day to day work at HPSNZ this has led me to utilise hand held dynamometry (HHD). We have amassed a great deal of consistent data using the HHD, primarily testing hips and shoulders. I presented a small snap shot of this at the Sports Medicine NZ Conference last year but have some on going work with Dr Chris Whatman from AUT SPRINZ unit. One way we are currently going to utilise the HHD is taking weekly strength measures of elite swimmers’ internal and external shoulder rotation. With this we can establish maximums, minimums, ratios and compare these with the other shoulder. This data can also be analysed along-side training volumes (critical in swimming) and intensities, biomechanics and other strength measures, and in some instances we may be able to establish specific standards around what an elite swimmer’s measures should be. Do you have specific information regarding screening tools/injury prevention strategies that would be useful for our members to consider? What do you think are the key elements in successfully preventing injury? Are you involved in performance aspects for your clients? Sharon Kearney (HPSNZ Lead and Silver Fern Physiotherapist) and I, with guidance from a number of others.
A High Performance Journey: Physiotherapist Jordan Salesa continued….. CONTINUED FROM PREVIOUS PAGE. have established the HPSNZ MCS and MSK Screening tool. There are numerous difficulties when trying to establish screening tools. Whilst we have established this tool, and we at HPSNZ have the resources to capture consistent data, it is vitally important to understand that you must know the magnitude of the problem. What injuries do we get? What is the extent of the injury problem?
Armed Forces around the world stress fractures have very high rates in basic training. In a major project over several years researchers measured and tried many interventions. Boots, orthotics, marching off road etc, etc - all of these failed. The thing that worked the most was ensuring recruits slept more than six hours a night. This dropped stress fractures by 60%!! http://ow.ly/ wLsQP
For me the crucial question is “What is the cost of injury”? The van Mechelen model is a very simple way to view injury and injury prevention.
Step 3: put in place an intervention
Screening seems to be a bit of a fad of late. I don’t necessarily think that this is a bad thing as it means we are thinking “top of the cliff”. I think however that it’s important to remember that the “commercialisation” of screening is a different mind-set. The Functional Movement Screen, the Y Balance Test, and many other like systems whilst very useful tools are just that, tools.
Step 4: the first step.
What are the major challenges in your area of work?
Step 1: establish the magnitude of the problem Step 2: understand the aetiology
Often in our desire to help we put the tools before the tool box! e jump straight to steps 2 and 3 without fully understanding and analysing step 1. If we don’t understand the incidence and severity the best screening tools in the world won’t necessarily help the problem. Think blood pressure. This is easily screened but the interventions are tough! Some very clear recent examples of clever injury prevention come from the Cricket Australia and the Israeli Army. Cricket Australia was recently able to decrease their international fast bowler back injury rates by 25% by simply dropping their elite camps at a certain time of the year. In
What exciting developments do you see for physiotherapy in the near future? Elite sports physiotherapy is an enjoyable and challenging place to work. Every day I see things I want to do better or should have done better or at least in a different way. I see huge potential in elite sport for clever, hard working, practical physiotherapists to advance us much further right here in NZ. I caution us all to not be siloed within our professional or personal paradigms as none of us hold all the truth.
CLINICAL SECTION ARTICLE REVIEW The Practical Management of Swimmer’s Painful Shoulder: Etiology, Diagnosis, and Treatment.
Reference: Bak K, (2010). The Practical Management of Swimmer’s Painful Shoulder: Etiology, Diagnosis, and Treatment, Clinical Journal of Sports Medicine 20(5): 386-390.
ABSTRACT Shoulder pain is the most common musculoskeletal complaint in competitive swimmers. Problems with the shoulders of swimmers resemble that of the disabled thrower’s shoulder, but the clinical findings and associated dysfunctions are not quite the same. Therefore, swimmers with shoulder pain should be evaluated and treated as a separate clinical entity, aimed toward underlying pathology and dysfunction. Balanced strength training of the rotator cuff, improvement of core stability, and correction of scapular dysfunction is central in treatment and prevention. Technical and training mistakes are still a major cause of shoulder pain, and intervention studies that focus on this are desirable. Imaging modalities rarely help clarify the diagnosis their main role being exclusion of other pathology. If nonoperative treatment fails, an arthroscopy with debridement, repair, or reduction of capsular hyperlaxity is indicated. The return rate and performance after surgery is low, except in cases where minor glenohumeral instability is predominant. Overall, the evidence for clinical presentation and management of swimmer’s shoulder pain is sparse. Preliminary results of an intervention study show that scapular dyskinesis can be prevented in some swimmers. This may lead to a reduction of swimmer’s shoulder problems in the future. Article Review This article, as the title suggests looks at the swimmer’s painful shoulder. The author is reviewing his 20 years’ experience in this field, bringing together his previous research in the area of swimmer’s shoulder. This is always a complex area and this is a good article to refresh your approach to those swimmers with a problematic shoulder. The article is broken up into sections on eitology, diagnosis and treatment. There are some great tables that neatly summarise the main points. Etiology Shoulder pain is the most common musculoskeletal problem for swimmers, between 40-91% prevalence. The most common pathology appears to be rotator cuff – related pain. The author believes the main factor in the development of shoulder pain is the high training volumes during adolescence when growth is still occurring. This can affect the muscular balance of the core, the scapulothoracic articulation, the rotator cuff, and the glenohumeral mobility. “An elite swimmer older than 13 years typically performs between 0.5 and 1 million are cycles per arm per year”. Shoulder pain often comes on with a sudden increase in training, such as using hand paddles or increasing time or intensity for example during a training camp. The author believes that high training load in the adolescent/growing years can induce changes in flexibility and stiffness which may predispose the swimmer to shoulder pain. This is commonly seen in a swimmer’s physique with a typical S-shaped spine (enlarged thoracic kyphosis and lumbar lordosis). This posture typically has an effect on scapular thoracic biomechanics and the development of scapular dyskinesis, more likely to lead to an impingement. Studies referenced in the article have shown that impingement on average occurred 24.8% of the stroke time. Table 2 in the article listed the structures at risk during the swimming stroke; subacromial bursa, Supraspinatus tendon, capsule and labrum. Most overhead athletes with painful shoulders show some degree of scapular dyskinesis. The scapula involved is placed in a more abducted, protracted, and laterally displaced position. In this position impingement is more likely to occur. Along with this swimmers are also subject to fatigue due to high training volume, so the scapular dyskinesis gets worse as sessions progress. “Scapular dyskinesis may be a primary etiological factor, with fatigue playing a contributing role”. Diagnosis The author Klaus Bak has identified 5 main categories of swimmer’s shoulder. These included 3 increasing levels of impingement with both extra and intra-articular pathologies such as bursitis, tendon and labral tears. Along with inCONTINUED ON NEXT PAGE.
ARTICLE REVIEW CONTINUED... CONTINUED FROM PREVIOUS PAGE. stability and acromioclavicular pathology. In just about all of the types scapular dyskinesis is present. As always history is important, a gradual onset of pain, especially at the anterior or lateral aspects of the shoulder. Is there any clicking, and where is it felt? This could indicate labral involvement or an acromioclavicular problem. A dead arm feeling with the arm overhead could also point towards a labral tear. The swimmer should be examined in standing and repeated active movements performed assessing possible scapular dyskinesis and painful arc. Also don’t forget to look at core stability and joint laxity tests. Pain provocation tests such as Hawkin’s, O’Brien’s active compression sign and labral shear tests should all be performed along with evaluation of glenohumeral rotation in 90 degrees. Bak states that the Apprehension test is more frequently positive in 135 degrees, than in 90 degrees in swimmers with shoulder pain. Bak believes that the most useful diagnostic imaging is magnetic resonance arthrography although it is invasive and costly. Both ultrasound and MRI although useful in ruling out other pathologies but have low diagnostic accuracy for partial cuff tears. Arthroscopy has improved the understanding of swimmer’s painful shoulder pathology, and can include the finding of labral tears, bursal side tears of supraspinatus, enlarged capsule and impingement. Treatment “Swimmers at a high level with more than 5 swim training sessions a week should perform dry land exercises to prevent effects of swim training on their body posture, stability and strength”. The goal of prevention exercises and coaching is to (1) decrease the amount of internal rotation of the arm during the pull phase, (2) improve early initiation of external rotation of the arm during the recovery phase, and (3) improve the tilt angle of the scapula. Coaches play a large role in the prevention of shoulder problems in swimmer’s with good technique and appropriate training load important. Coaches should look at ensuring body roll and scapula retraction as well as ensuring a dry land programme working on flexibility of the anterior capsule, pectoralis minor and the cuff along with endurance of the cuff and scapular stabilizers. There have not been many studies done on prevention programmes, but the author has shown in previous unpublished studies that a scapular stabilizing programme prolonged the time before scapular dyskinesis was seen compared with a control group. Core stability should also be considered. When prevention has not worked and a shoulder becomes painful, getting treatment quickly is important, the longer things go on the more likely it is to progress to surgery and the return rates to swimming following surgery are not high 20 -56%. When pain starts, active rest and reduced training is imperative. Along with technical stroke analysis and correction, the coach plays a major role here. If problems persist exercises should be applied and aimed at the specific dysfunction. If pain persists NSAID’s and then maybe a corticosteroid injection can be considered (although controversial). The last “resort” is surgery, but as mentioned the success in terms of return to swimming are not high. Conclusion Shoulder pain is common in elite swimmers. Prevention should be the first option, and therefore technical and training mistakes need to be identified. High amounts of training in adolescents is still a huge cause of shoulder pain and more studies on this are needed. Improvement of scapular kinesis and endurance seem to be important, and therefore a dry land programme addressing these areas and core stability are vital in any training regime. Early recognition of pain and problems should be encouraged as the outcomes are more likely to be favourable, than if the problem is left to become more severe. This is a good article to read if you are treating swimmer’s shoulders. It was an excellent follow up to Mary Margery’s talk on swimmer’s shoulder at the symposium. An underlying theme seems to be that good scapular kinesis/kinematics is vital for swimmers and that over training and poor technique are often major contributors to shoulder pain. We therefore need to get coaches on board and educated if there is to be a reduction in the amount of shoulder pain swimmers experience. Reviewed by Karen Carmichael BSc, BPhty, M(SportsPhysio)
Shoulder Pain in Swimmers www.sportsphysiotherapy.org.nz/resources
Shoulder Pain In Swimmers: A 12 month prospective cohort study of incidence and risk factors Walker H, Gabbe B, Wajswelner H, Blanch P, Bennell K (2012). Shoulder pain in swimmers: A 12 month prospective cohort study of incidence and risk factors. Physical Therapy In Sport 13, 243-249. Article Summary Shoulder pain is a common musculoskeletal problem experienced by competitive swimmers for which several risk factors have been proposed. These include glenohumeral range of motion and laxity, scapula dyskinesia, rotator cuff strength imbalance, gender, competition levels, stroke, distance and paddle distance. Biomechanical analysis of freestyle has indicated that shoulder impingement may occur and most frequently in the recovery phase of the stroke where the shoulder is abducted and externally rotated. Decreased external rotation may lead to sub-acromial impingement syndrome. Overuse loading during swimming may lead to rotator cuff thickening and tendinopathy. Those with decreased external rotation perform the task at the limit of shoulder and as a result have increased tendon thickening and therefore at greater risk of impingement. High external rotation ranges may indicate changes to the shoulderâ€™s passive restraints and neuromuscular control. Changes in neuromuscular control leads to increased translation and secondary impingement of the biceps and rotator cuff. The purpose of this article was to investigate shoulder injury incident rates and identify predictive risk factor. There was a particular focus on glenohumeral internal and external rotation range and joint laxity. The study followed 74 competitive swimmers over 12 months in Melbourne, Australia. Competitive swimmers were defined as those training over 5 sessions per week and competing at state level of higher. The swimmers completed questionnaires regarding demographics training, swimming and injury history. Active range of motion (internal and external rotation at 90 abuction) and passive joint laxity was measured. Shoulder injury was defined as significant shoulder pain that interfered with training or competition. Significant shoulder injury (SIP) was defined as lasting greater than 2 weeks. 38% of participants sustained a SIP in the 12 months. There was a significant association with SIP and previous injury. They also found that swimmers with high external rotation range (>100) or low ER range (<93) where more likely to have a shoulder injury. Training distances were not a big factor, however this may be due to a considerable portion of data being derived from training averages not direct observation. There was no association with joint laxity and subsequent injury. Clinical Implications The results must be interpreted with some caution as this study was undertaken amongst competitive swimmers, not recreational swimmers, had a relatively high drop out rate and injury rates were self reported so the exact cause and structure causing pain are unknown. While previous history of shoulder injury is a non modifiable risk factor it can used as an indicator to identify swimmers at risk of further injury. As physiotherapists it highlights the need to take a detailed history from clients and work with clients and coaches to direct preventative measures to these swimmers. Measurement of external rotation range may be implemented as a screening tool to further idenfity those at risk of injury and direct specific exercises and preventative measures to these athletes rather than a one size fits all approach with regards to exercises and stretching. As physiotherapistsâ€™ education of the coaches as well as swimmers is vital as they will be the ones implementing the programmes/exercises as well potentially identifying those at risk and directing them to our care. Reviewed by Louise Turner B App Science (Physiotherapy), Masters of Health Practice (Musculoskeletal Physiotherapy)
Shoulder Pain in Swimmers continued…….. www.sportsphysiotherapy.org.nz/resources
Cervical Muscle Activation in Elite Swimmers with Shoulder Pain Hidalgo-Lozano, A., Calderón-Soto, C., Domingo-Camara, A., Fernández-De-Las-Peñas, C., Madeleine, P., & Arroyo -Morales, M. (2012). Elite swimmers with unilateral shoulder pain demonstrate altered pattern of cervical muscle activation during a functional upper-limb task. Journal of Orthopaedic & Sports Physical Therapy, 42(6), 552-8. Article Summary The prevalence of shoulder pain amongst elite swimmers ranges between 42% and 73%. Current research links shoulder pain in elite swimmers to motor control impairments. This study hypothesises that it is not only the activity of the shoulder muscles that is altered by ongoing pain but that the surrounding neck muscles are also affected. A Cross-sectional cohort design was chosen to assess the differences in activity levels of neck muscles between elite swimmers with and without shoulder pain. Surface electromyography from the sternocleidomastoid, upper trapezius, and anterior scalene (ASC) muscles was recorded bilaterally in 17 elite swimmers (18-30 years) with unilateral shoulder pain, and 17 matched elite swimmers without pain. The testing included measuring the level of muscular activation 5 seconds before, 120 seconds into, 150 seconds into, and 10 seconds after a functional upper-limb task. These tasks were cervical flexion in supine and 90 degrees bilateral arm abduction in standing, both held for 10. For the functional task, participants sat at a desk and drew pencil marks in 3 circles in a counter-clockwise direction. Each test was repeated 3 times with a 30-second rest between each. The affected upper extremity was used in the shoulder pain group and the dominant arm in the control group. The results showed significant differ-ences between the groups of ASC muscle activation bilaterally. This was not seen with the sternocleidomastoid and upper trapezius muscles. Swimmers with shoulder pain had higher normalized values in both ASC muscles at 120 seconds (78% on average) and 150 seconds (86% on average) into the task and at 10 seconds after the task (40% on average), as compared with swimmers without shoulder pain (P<.05). Clinical Significance / Applications A great deal more research needs to be done to establish a cause-and-effect relationship between increased activation of the ASC muscles and shoulder pain. However possible implications of this study include:
A potential role for deep neck flexor training in this population. The results seen here indicate higher EMG amplitude from superficial neck flexor muscles, this may be due to compensation for decreased deep cervical flexor muscle ac-tivation.
Motor control techniques targeted towards cervical muscle activation may influence the incidence and recurrence of shoulder pain in elite swimmers.
Greater bilateral activa-tion of the ASC muscles may result in excessive compressive loads on the cer-vical facet joints, a more superficial up-per thoracic respiratory pattern, and altered shoulder kinematics, promoting overload of these structures and the spreading of pain to the contralateral side.
Reviewed by Monique Baigent MHsc (Physiotherapy)
JOSPT www.jospt.org JOSPT ACCESS All SPNZ members would have been sent advice directly from JOSPT with regards to accessing the new JOSPT website. You will have needed to have followed the information within that email in order to create your own password. If you did not follow this advice, have lost the email, have any further questions or require more information then please email JOSPT directly at firstname.lastname@example.org in order to resolve any access problems that you may have. If you have just forgotten your password then first please click on the “Forgotten your password” link found on the JOSPT sign on page in order to either retrieve or reset your own password. Only current financial SPNZ members will have JOSPT online access.
Volume 44, Issue 6, June 2014 RESEARCH REPORT Effects of Physical Therapist—Guided Quadriceps-Strengthening Exercises for the Treatment of Patellofemoral Pain Syndrome: A Systematic Review Identifying Barriers to Remaining Physically Active After Rehabilitation: Differences in Perception Between Physical Therapists and Older Adult Patients Ultrasound Imaging: Intraexaminer and Interexaminer Reliability for Multifidus Muscle Thickness Assessment in Adults Aged 60 to 85 Years Versus Younger Adults Ulnar Nerve Neurodynamic Test: Study of the Normal Sensory Response in Asymptomatic Individuals CASE REPORT Management of a Patient With Chronic Low Back Pain and Multiple Health Conditions Using a Pain Mechanisms— Based Classification Approach Use of Thoracic Spine Thrust Manipulation for Neck Pain and Headache in a Patient Following Multiple-Level Anterior Cervical Discectomy and Fusion: A Case Report CLINICAL COMMENTARY The Relevance of Scapular Dysfunction in Neck Pain: A Brief Commentary MUSCULOSKELETAL IMAGING Osteochondroma Fracture at the Distal Medial Femur CLINICAL PRACTICE GUIDELINES Nonarthritic Hip Joint Pain
ASICS SHOE REPORT
The new GEL Divide is designed for the runner who requires stability and likes the feel of a supportive shoe underfoot yet prefers those benefits to come in a lighter weight package (320 grams men’s size 9). The Divide suits runners who heavily over pronate from heel strike and continue to over pronate through midstance and toe off. These runners often have a low cadence with minimal propulsion and conserve energy by letting the joints take the load rather than the muscles. As the muscles fatigue, overuse injuries to the lower limb develop from poor muscle firing patterns. The Divide is built on a 22mm-12mm platform with a 3 density midsole designed to provide maximum support whilst allowing for normal foot function and comfort. A stable Guidance Trusstic in the midfoot with an outsole configuration that reduces movement further strengthens the stable platform. Comfort is important in this category because these runners
impact the ground longer and are usually performing with fatigued muscles. Fluid Ride, a dual stacked midsole boasting ASICS’ two premium foams to give the ultimate in durability and cushioning, has been introduced to manage the cushioning. A top layer of SpEVA provides fantastic cushioning whilst a bottom layer of Solyte maintains the durability. Combining the two foams provides an improved ride from heel to toe with a “bounce back” feel when running. Gender Specific Cushioning used in conjunction with GEL units in both the rearfoot and forefoot delivers the best of ASICS cushioning technology. Furthermore, because a heavily over pronated foot will often be wider (as it splays during midstance and toe off) the Divide’s upper has discrete eyelet lacing and a bunion window with a Clutch Counter in the rearfoot to maximize the fit. The Divide is a very supportive shoe and it will suit the runner who has overuse injuries, runs with a lower cadence and overpronates from heel strike to toe off. Comes in men’s 2E and 4E, women’s D.
ASICS FORERUNNER May 2014
CONTINUING EDUCATION CALENDAR
Upcoming courses and conferences in New Zealand and overseas in 2013 & 2014. For a full list of local courses visit the PNZ Events Calendar For a list of international courses visit http://ifspt.org/education/conferences/
LOCAL COURSES & CONFERENCES When?
2014 21-22 June 2014
Myofascial Release Therapy Training Courses - The Missing Link to Your Tauranga Treatment Practice?
28 June 2014
RockTape (Kinesiology) Taping 1 day Seminar
7 July 2014
PhysioScholar - ACL Reconstruction
12-13 July 2014
Mulligan Concept - Two Day Update with Brian Mulligan
19-20 July 2014
Kinesio Taping - KT 3
26-27 July 2014
SPNZ Promotion and Prescription of Physical Activity and Exercise
26-27 July 2014
PAANZ Musculoskeletal Dry Needling
APA CPD EVENT FINDER SPNZ members can now attend APA SPA (Sports Physiotherapy Australia) courses and conferences at APA member rates. This includes all webinars and podcasts (no travel required!). To see a full list visit the APA and SPA Events Calendar
The Thoracic Spine in Sport
27 July 2014
Level 1 ASCA Strength and Conditioning Coaching Course
2 August 2014
Hamstring Assessment, Prevention and Rehabilitation
2 August 2014
The Sporting Hip
6-7 September 2014
The Thoracic Spine in Sport
6 September 2014
The Sporting Shoulder
11-12 October 2014
CLASSIFIEDS POSITION VACANT HAMILTON Lead Physiotherapist with Clinic Management Role
Performance Plus Physio is seeking applications for the position of Lead Physiotherapy and Clinic Management role. This is a new permanent position, created by the expansion of the business, and will be based at our main clinic site and at the university clinic. A passion for physiotherapy and a solid understanding of exercise rehabilitation, manual therapy is essential.
This person will work as the lead physiotherapist at our main private practice and oversee the daily running of the clinic, in-service programme and mentoring role to the junior staff.
This person will lead a dedicated team of four physiotherapist who work alongside the University of Waikato Hillary Scholar High Performance Sports programme and general university student and staff clientele.
A Top Rate Remuneration Package which also includes an annual bonus payment.
This is a fast paced and energetic environment, in a dedicated team supporting community based clientele, club sport athletes to elite athletes. We treat a variety of clientele, from acute, sports, post-operative and general musculoskeletal conditions to more chronic and complex cases.
If you are an outstanding leader with a passion for delivering excellent service, then this is definitely the next role for you. This position can lead to a future partnership opportunity.
For this Lead Physiotherapist role: e-mail your CV to: email@example.com or mail to: Melissa Gilbertson, Practice Director, PERFORMANCE PLUS PHYSIO LTD 280 Peachgrove Road, Hamilton. Phone: 64 7 8551788 or +64 21 1334106 www.performanceplusphysio.com
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