PAGE
SEPNZ BULLETIN
ISSUE 11. OCTOBER 2019
Climbing - Novel Forces p12 p23 SPRINZ: Field-based assessment of physical fitness in children
p27 Incidence, mechanism and risk factors for injury in youth rock climbers
p29 UPCOMING SEPNZ COURSES
www.sepnz.org.nz
PAGE 2
SEPNZ EXECUTIVE COMMITTEE
Members Page
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 Dr Angela Cadogan Emma Clabburn Rebecca Longhurst (Chairperson) Justin Lopes Dr Grant Mawston Dr Chris Whatman
Visit www.sepnz.org.nz
Join us on Facebook
Follow us on Instagram
Follow us on Twitter
ADDITIONAL USEEFUL WEBSITE RESOURCES: List of Open Access Journals Asics Apparel - how to order McGraw-Hill Books and order form Asics Education Fund information
BULLETIN EDITOR Emma Clabburn
International Federation of Sports Physical Therapy (IFSPT) Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
SPECIAL PROJECTS Karen Carmichael Rose Lampen-Smith Amanda O’Reilly Pip Sail
BULLETIN ADVERTISING DEADLINES: February Bulletin: 31st January April Bulletin: 31st March June Bulletin: 31st May August Bulletin: 31st July October Bulletin: 30th September December Bulletin: 30th November
Advertising terms & conditions click here.
CONTACT US Michael Borich (Secretary) 26 Vine St, St Marys Bay, Auckland secretary@sepnz.co.nz
PAGE 3
CONTENTS
SEPNZ MEMBERS PAGE See our page for committee members, links & member information
2
EDITORIAL: By SEPNZ President Blair Jarratt
4
EDUCATION UPDATE: By SEPNZ education chairperson Rebecca Longhurst
5
APP REVIEW: Measure App - Level Function / Bubble Level, Spirit Level
6
MEMBER BENEFITS: Discounts
10
FEATURE ARTICLE: Novel Forces by Nick Taylor
12
EXTRA: COACHES CORNER: Interview with Rob Moore
17
SPRINZ: Field-based assessment of physical fitness in children
23
CLINICAL REVIEW: Incidence, mechanism and risk factors for injury in youth rock climbers
27
UPCOMING SEPNZ COURSES
29
RESEARCH PUBLICATIONS: BJSM Volume 53, Number 11, 12 June 2019
30
CLASSIFIEDS
31
PAGE 4
EDITORIAL
Just a couple of months to go before Christmas. I am sure it's been a tough time for some over the last couple of weeks with the loss in the semi-final of the rugby world cup to our beloved All Blacks. Out of the dark days, we are now getting into the warmer weather, so let's look forward to all those summer sports and the variety that NZ has to offer. I have just come back from the well
run PNZ Business symposium in Auckland which had a variety of exciting speakers. It was great to see so many business owners and managers up there listening to the progressive content of the day, showing that this group is truly a talented bunch of clinicians, leaders, visionaries, and entrepreneurs. Congratulations to Lee-Anne Taylor who won the SEPNZ prize to the Gold Coast sponsored by ASICS. The prize included complementary SMA attendance, accommodation thanks to ASICS and SEPNZ contributing to travel to the event. LeeAnne looks like she had a great time and we are excited to hear about her trip in our next bulletin. If you want to see a snippet of what she got up to, have a look at our SEPNZ Twitter feed. Thanks for the photos Lee-Anne and thank you to all those who entered our competition. We are keeping with the theme of getting away from the core sports of New Zealand, so this month we target yet another growing sport in NZ - Climbing. We have an excellent article from SEPNZ member Nick Taylor on the specific injuries to the hand and the reasons behind this, with some take-home clinical advice on how to identify these injuries. Also, we have added an extra piece in this bulletin from a coach’s perspective. I sat down over a coffee with National Climbing coach Rob Moore and discussed how this sport has developed, where it’s going, and how we as physiotherapists can have an understanding of the new style of climbing. Most importantly we discussed how Physiotherapists could assist the coach’s role, -don't be afraid to pick up the phone and call your local coach (with your client’s consent) when you have their athlete in your clinic. Encompassing the full patient care model, especially in the younger athlete, is hugely important in the full facilitation of rehabilitation in what we say and do with our clients. Thank you to Karen Carmichael for her clinical review of the article on the Incidences, Risk Factors and Mechanisms, which ties in well with the commentary from both Nick and Rob. It was interesting to read that climbing with preventative taping may lead to a higher incidence, coupled with Rob's comment that taping does not seem to be effective with growth plate and pulley injuries.
However, as Nick Taylor pointed out in his article, lumbrical tears are well managed in the injury phase with buddy taping. Therefore, when advising on these injuries it’s imperative not to get these two different situations (injury management vs climbing), and differential diagnoses mixed up. With the education obtained out of this bulletin, you can offer appropriate advice to your clients and insights into an accurate diagnosis. A common theme in the media and many articles is youth development in sport; therefore, we must continue to research young people and their involvement in the future of our diverse and changing sporting landscape. Dr Sayumi Iwamoto, Kelly Sheerin, Marissa Downs and Patricia Hume from SPRINZ, AUT provide us with an article on a field-based assessment of physical fitness in children. There are clinical implications from this data for measuring children that we can use in our clinics tomorrow, so long as we can either invest in some technology or lay out a Y balance test as a minimum.
For those involved in the SEPNZ educational program there is an update as to where our educational pathway is potentially going. With discussions on advanced practitioner status and our Australian colleges having a pathway to this through education, we see this as an important consideration for all those involved in our courses. With climbing a new addition to the 2020 Tokyo Olympics, there is a sport climbing wall under construction in the Bay of Plenty, multiple climbing centres opening around NZ and a good dose of social media - expect to see more of these clients and injuries turning up in your clinic. A number of these articles have mentioned two films; The Dawn wall and Free Solo so go ahead and add these to the rainy day viewing list. Time to get out there and enjoy the sun. Until our Christmas Bulletin …...Haera Ra.
Kind Regards Blair Jarratt SEPNZ President
PAGE 5
EDUCATION UPDATE
Rebecca Longhurst SEPNZ Committee Member Education Chairperson
The SEPNZ Education Committee aims to consistently deliver quality robust Sports Physiotherapy Education. The SEPNZ Sports Certificate was introduced in 2013 with the competencies for the IFSPT membership as a foundation for the planned courses. There have been numerous challenges over the past however many years, meaning that the landscape in which the Sports Certificate sits in has now changed. The dissolving of the College of Physiotherapists and the Board now taking over the Advanced Practitioner Status, coupled with challenges in finding and retaining quality presenters and low participant numbers have meant that delivering the Sports Certificate has taken longer than expected to create and deliver. The Education Committee is currently looking at other options to ensure we can consistently deliver quality robust Sports Physiotherapy Education. There is still one more course to be created for the Certificate and we are hoping to have that course developed and delivered in 2020. Recently we collaborated with SMNZ to run the 2018 Roadshow and student strapping courses. We are investigating partnering with Sport and Exercise Australia (SEPA) and the Australian Physiotherapy Association (APA) to deliver their Sports Physiotherapy courses and pathway, which fits our remit of world class Sports Physiotherapy Education. This, in addition with roadshows, concussion workshops and other ad hoc courses may be the direction we are heading. We are interested in feedback from members about their interest or otherwise on partnering with SEPA/ APA. We would also like to know of anybody that would be willing to assist with the delivery and development of courses, ideas for workshops or ad hoc courses that you would be interested in us bringing to you. Please email becsvw@hotmail.com with any thoughts you may have.
EXPRESSION OF INTEREST The SEPNZ Education Committee is calling for expressions of interest for presenters for our SEPNZ courses. If you would be interested in doing this, please send your CV along with a covering letter to: becsvw@hotmail.com
PAGE 6
APP REVIEW
Back to the App... Your App Review
Measure App - Level Function / Bubble Level, Spirit Level Thank you to Niamh Egan for the recommendation and help with this review. Measurement of joint range of movement (ROM) is one of the most common evaluations performed whilst managing individuals in a sports physiotherapy setting. Using a universal goniometer has traditionally been the measure of choice while assessing ROM, however smartphone applications are transforming how we accomplish many daily functions, and assessment of joint ROM is no exception. There is both an Android and Apple option reviewed for this edition and so I hope you all get a chance to have a play and practice with this cool, free technology.
APPLE App: Measure App – level function Cost: Free Requires: iOS 12 on iPhone SE, iPhone 6s or later, iPad (5th generation or later), iPad Pro, or iPad touch (7th generation). What it is used for: The Measure app uses augmented reality (AR) technology to turn your iOS device into a tape measure and a level. Where to find it: Apple’s recent software upgrade (operating systems iOS 7 and above) a new Measure App which includes a ‘level’ function has been introduced – previously present in the Compass app. This level function has the additional bonus of being included in the Apple App suite (that is, it is standardly installed/upgraded with each software upgrade).
CONTINUED ON NEXT PAGE >>
PAGE 7
APP REVIEW ANDROID App: Bubble Level, Spirit Level Seller: NixGame Category: Tools Updated: 6/06/2018 Version: 3.23 Size: 4.9M Cost: Free Requires: 4.0.3 and up What it is used for: Measuring angles/level Where to find it: Download from Google Play
PRACTICAL APPLICATION Since researching for this app review I have been using my iPhone measure app level function, as the following 2019 study demonstrates, to measure dorsiflexion in a weight bearing lunge position in the clinic with a wide range of patients. To measure the weight-bearing lunge, the short arm of the device was placed flat against the posterior heel, approximately 1cm superior to the posterior calcaneal tuberosity and held perpendicular to the shank of the tibia until the measure (in degrees) remained fixed. The degree was determined by the long axis of the device relative to the horizontal (zero degrees).
CONTINUED ON NEXT PAGE >>
PAGE 8
APP REVIEW
“Using the iPhone level measure, within the Measurement App has demonstrated to be an easy to use and reliable measurement tool for healthy adults. Clinicians should consider how the use of this technology may assist in their clinical practice to assess and measure treatment outcomes.�
CONTINUED ON NEXT PAGE >>
PAGE 9
APP REVIEW Pros: • • • •
Super quick and easy to use as outcome measure in the clinic. You can calibrate the level to use a starting point of your choice. Very basic, but cheaper and less fumbly than a goniometer! Can hold device in portrait or landscape mode.
Cons: • Need to keep using and investigating app with other joint ROM measurements to determine further uses and best positioning of device
OVERALL RATING = 4.5 / 5 References Banwell, H. A., Uden, H., Marshall, N., Altmann, C., & Williams, C. M. (2019). The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study. J Foot Ankle Res, 12, 37. doi:10.1186/s13047-019-0347-9
MEMBER BENEFITS
PAGE 10
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/
PAGE 11
PAGE 12
FEATURE ARTICLE
Novel Forces Nick Taylor, BHSc (Physiotherapy), PGCert HSc (Rehabilitation), NZ Registered Hand Therapist Global interest in rock climbing continues to rise. Its inclusion in the 2020 Tokyo Olympics has further energised the competitive climbing scene, and the mainstream release of the films The Dawn Wall and Free Solo has fuelled public curiosity. In New Zealand new indoor climbing facilities have opened in Auckland and Christchurch in the last 12 months bringing us closer to international standards, and there are an increasing number of domestic competitions for climbers of all ages and levels. At the elite level we have climbers engaging in intensive training regimes and competing on the international stage. Climbing at a high level generates unique stressors for the fingers. The precise loading depends on the particular grip type being employed, with the phalanges and supporting soft-tissue structures subjected to a variety of novel forces (Schweizer & Hudek, 2011; Schweizer, 2009). Given sufficient time and appropriate progression of loading impressive physiological adaptation results, including cortical thickening and hypertrophy of the flexor tendons and pulley ligaments (Bollen & Wright, 1994; Klauser et al., 2000). However, even in a well-trained athlete overload and failure of these structures can occur. This article addresses three of the most common hand injuries that climbers sustain, and provides brief guidelines on diagnosis and management.
Schöffl, 2016). The aetiology rather is that of a fatigue fracture, with repetitive loading leading to an initial stress reaction that can progress to a stress fracture if not adequately rested (Schöffl & Schöffl, 2016). Regular use of the crimp grip is thought to contribute to these injuries (Schöffl & Schöffl, 2016). The crimp is a climbing specific grip type that involves contact with the distal phalanx pulp only, hyperextension of the DIP joints, flexion of the PIP joints to 90 degrees or more, and mild flexion of the MCP joints.
Growth plate fractures Climbing is especially popular among adolescents, in whom favourable strength-to-weight ratio and general flexibility allow rapid progression up the grades. Youth climbers now routinely compete alongside adults at the highest level, attempting demanding routes involving small holds and dynamic movements. The primary concern here is that if the phalangeal growth plates are yet to close there is risk of failure of the physis under the high loads and external social pressure of the competition environment. Growth plate fractures of the fingers are now the most common injuries experienced by youth climbers, with data suggesting that the incidence of these has risen precipitously in the last two decades (Schöffl, Popp, Küpper, Schöffl, 2015; Schöffl & Schöffl, 2016). By far the most common bone affected is the middle phalanx of the middle finger, and the fracture pattern is typically Salter Harris III (Schöffl & Schöffl, 2016). These injuries tend to occur during the growth spurt phase that precedes growth plate closure: 10-14 for girls, 12-16 for boys (Schöffl & Schöffl, 2016). Onset is generally not traumatic, although the patient may associate a particular move during a climb with inception of pain (Schöffl &
Figure 1. The crimp grip. Reprinted from “Pathomechanics of Closed Rupture of the Flexor Tendon Pulleys in Rock Climbers”, by R. Marco, N. Sharkey, T. Smith et al., 1998, The Journal of Bone and Joint Surgery, 80(7), p. 1013.
The rationale behind this position is that increased PIP joint flexion results in an increased moment arm for the flexor tendons, and increased friction between the tendons and the pulley ligaments (Schweizer, 2000). For a youth climber, however, this grip can result in uneven compressive forces at the middle phalanx growth plate that when used too frequently can result in failure (Schöffl & Schöffl, CONTINUED ON NEXT PAGE >>
PAGE 13
FEATURE ARTICLE 2016). It follows that youth climbers should be encouraged to minimise use of the crimp. The hallmark clinical symptom for this injury is maximal tenderness on palpation at the base of the middle phalanx dorsally (Bärtschi, Scheibler, & Schweizer, 2019). Any youth climber with this presentation should be treated with high suspicion of a growth plate fracture. X-rays are first-line imaging and must include an oblique projection as these fractures often run in an oblique plane, and can be missed on a pure lateral view (Bärtschi et al., 2019). Plain films may be unremarkable in the case of a stress reaction, and dependent on the context, referral to a specialist for consideration of CT or MRI may be appropriate. For both confirmed fractures and suspected stress reactions it is necessary to remove the climber from sporting activities. There is evidence to suggest that permitting climbing in the presence of this hallmark tenderness, even with an unremarkable X-ray, places the climber at high risk of developing a growth plate fracture (Bärtschi et al., 2019). Figure 2 is an X-ray series demonstrating this scenario, with tenderness present at the first appointment yet the climber continued to train.
Figure 2. Development and healing of a growth plate fracture. Reprinted from “Symptomatic epiphyseal sprains and stress fractures of the finger phalanges in adolescent sport climbers”, by N. Bärtschi, A. Scheibler, and A. Schweizer, 2019, Hand Surgery and Rehabilitation, 38(4), p. 252. A graduated return to sporting activities is commenced once radiological union and resolution of symptoms have been achieved. Referral to a hand therapist for fabrication of a thermoplastic splint for wear in the interim should be considered. Pulley Ligament Injuries The pulley ligaments are the most commonly implicated structures in adult climbing injuries and range in severity from sprains to multiple ruptures (Schöffl, Popp, Küpper, & Schöffl, 2015). The most frequently injured ligaments are the A2 and A4 pulleys of the middle and ring fingers (Schöffl & Hochholzer, 2003). The typical mechanism is a sudden overload in the crimp position caused by a foot unexpectedly slipping off a hold (Schöffl & Hochholzer, 2003). With a full rupture there may be an audible ‘snap’ that can be heard at some distance. Diagnosis is based on subjective history and maximal tenderness on palpation being present over the affected ligament. Loading in the crimp position will reproduce pain, whereas loading in other positions is often relatively comfortable. Ultrasound is both sensitive and specific when it comes to grading the injury, with 2mm tendon-bone distance the threshold for differentiating partial from full ruptures (Klauser et al., 2002). The ultrasound assessment should be performed with the finger in resisted flexion. Partial tears and single pulley ruptures typically do well when managed conservatively, multi-pulley ruptures need surgical review (Schöffl & Schöffl, 2006). Climbers can generally continue to train and climb with a partial tear albeit with modification. Crimping is completely avoided, as are sharp holds that may press directly on the injured tissue. Further modifications depend on the level and short-term goals of the climber but may involve substituting traversing for time on routes, reducing climbing grade, and limiting dynamic movements. Any position that generates pain should be meticulously avoided. In the case of a single pulley rupture custom thermoplastic splinting forms the mainstay of conservative treatment, with a pulley protection ring preventing direct compression of the healing pulley and excessive tensile loading (Schneeberger & Schweizer, 2016) . Continuous wearing of the splint CONTINUED ON NEXT PAGE >>
PAGE 14
FEATURE ARTICLE and cessation of climbing activities for 6 weeks is recommended. Graduated loading on the finger is then reintroduced with continuing avoidance of the crimp position until pain free, which may take several months.
muscles are bipennate, with dual origins in adjacent FDP tendons, and this shear force may result in an intramuscular tear. The climber will experience a sudden sharp pain in the palm, and will be unable to engage in the same type of pocket again without discomfort (Schweizer, 2003). Clinically there may be tenderness on palpation at the injury location in the palm, with ultrasound confirming hematoma or tenosynovitis of the adjacent flexor tendons in more severe instances (Lutter, Schweizer, Schöffl, Römer & Bayer, 2018). Pain is easily reproduced by having the patient actively flex the adjacent fingers and passively extending the affected one (Lutter et al., 2018).
Figure 3. Thermoplastic pulley ring splint. Reprinted from “Pulley Ruptures in Rock Climbers: Outcome of Conservative Treatment with the Pulley-Protection Splint - A Series of 47 Cases”, by M. Schneeberger and A. Schweizer, 2016, Wilderness and Environmental Medicine, 27(2), p. 212.
Risk of pulley ligament injury can be reduced by limiting crimping in positions which involve insecure feet, and being mentally prepared to release the hold if the feet start to slip. A thorough warm-up consisting of at least 100 moves has been shown to increase the compliance of the pulley ligaments, and may also help to prevent injury (Schweizer, 2012). Lumbrical Tears Pocket holds have small openings that restrict the number of fingers that can be used, and pose a unique risk to the intrinsic muscles of the hand. It is common for climbers to actively flex the fingers adjacent to the loaded ones in order to gain the increased force application offered by the interconnection of flexor digitorum profundis (FDP) muscle fibres and tendons (Schweizer, 2001). The risk here is that if a sudden foot slip occurs resulting in the engaged fingers slipping into extension, a shear force may be created through either the third or fourth lumbricals (Schweizer, 2003). These
Figure 4. Provocative test for lumbrical tear. Reprinted from “Lumbrical muscle tear: clinical presentation, imaging findings and outcome” by C. Lutter, A. Schweizer, V. Schöffl, F. Römer and T. Bayer, 2018, Journal of Hand Surgery: European Volume, 43(7), p. 769. For more severe cases two weeks of immobilisation may be necessary, otherwise as long as the injury position is avoided climbing may continue and is generally pain-free (Lutter et al., 2018). Practically this is achieved by buddy taping the small and ring fingers together in the case of 4th lumbrical tears, and the middle and ring fingers for 3rd lumbrical tears. Stretching prevents restrictive scar tissue CONTINUED ON NEXT PAGE >>
PAGE 15
FEATURE ARTICLE forming and consists initially of the intrinsic minus position, progressing to gentle stretching in the provocation position pictured in Figure 4 (Lutter et al., 2018). Lumbrical tears can be avoided by maintaining the fingers adjacent to the loaded ones in extension when using pockets. The holding force will be reduced in this position and thus this represents a performance/risk trade-off that may not always be practical for high-level climbers.
Clinical Tips Any youth climber presenting with pain at or near the PIP joint should be held at high degree of suspicion for growth plate fracture Youth climbers should be encouraged to minimize use of the crimp grip Tendon-bone distance as measured by ultrasound is useful for grading pulley ligament injuries Multi-pulley ruptures require surgical review Buddy taping is normally sufficient to allow for return to climbing following a lumbrical tear
Nick Taylor (BHSc (Physiotherapy), PGCert HSc (Rehabilitation), NZ Registered Hand Therapist) Nick is a registered hand therapist, physiotherapist, and avid rock climber, having climbed throughout New Zealand and overseas. He regularly treats climbers for their injuries including members of the New Zealand Senior and Junior National Climbing Teams, and works with coaching staff on implementing safe training practices and injury avoidance strategies. He enjoys keeping up to date with the latest research on climbing injuries and performance.
PAGE 16
FEATURE ARTICLE References Bärtschi, N., Scheibler, A., & Schweizer, A. (2019). Symptomatic epiphyseal sprains and stress fractures of the finger phalanges in adolescent sport climbers. Hand Surgery and Rehabilitation, 38(4), 251–256. https:// doi.org/10.1016/j.hansur.2019.05.003 Bollen, S. R., & Wright, V. (1994). Radiographic changes in the hands of rock climbers. British Journal of Sports Medicine, 28(3), 185–186. https://doi.org/10.1136/bjsm.28.3.185 Klauser, A., Frauscher, F., Bodner, G., Cihak, C., Gabl, M., Schocke, M., … Zur Nedden, D. (2000). [Value of high-resolution ultrasound in the evaluation of finger injuries in extreme sport climbers]. Ultraschall In Der Medizin, 21(2), 73–78. https://doi.org /10.1055/s-2000-316 Klauser, A., Frauscher, F., Bodner, G., Halpern, E. J., Schocke, M. F., Springer, P., . . . zur Nedden, D. (2002). Finger pulley injuries in extreme rock climbers: Depiction with dynamic US. Radiology, 222(3), 755–761. https:// doi.org/10.1148/radiol.2223010752 Lutter, C., Schweizer, A., Schöffl, V., Römer, F., & Bayer, T. (2018). Lumbrical muscle tear: Clinical presentation, imaging findings and outcome. Journal of Hand Surgery: European Volume, 43(7), 767–775. https://doi.org/10.1177/1753193418765716 Marco, R. A. W., Sharkey, N. A., Smith, T. S., & Zissimos, A. G. (1998). Pathomechanics of closed rupture of the flexor tendon pulleys in rock climbers. The Journal of Bone and Joint Surgery, 80(7), 1012–1019. https:// doi.org/10.2106/00004623-199807000-00010
Schneeberger, M., & Schweizer, A. (2016). Pulley ruptures in rock climbers: Outcome of conservative treatment with the pulley-protection splint - A series of 47 cases. Wilderness and Environmental Medicine, 27(2), 211–218. https://doi.org/10.1016/j.wem.2015.12.017 Schöffl, V., & Hochholzer, T. (2003). Pulley injuries in rock climbers. Wilderness and Environmental Medicine, 14(1), 94-100. https://doi.org/10.1580/1080-6032(2003)014 Schöffl, V., Popp, D., Küpper, T., & Schöffl, I. (2015). Injury trends in rock climbers: Evaluation of a case series of 911 injuries between 2009 and 2012. Wilderness and Environmental Medicine, 26(1), 62–67. https:// doi.org/10.1016/j.wem.2014.08.013 Schöffl, V. R., & Schöffl, I. (2006). Injuries to the finger flexor pulley system in rock climbers: Current concepts. The Journal of Hand Surgery, 31(4), 647–654. https://doi.org/10.1016/j.jhsa.2006.02.011
Schöffl, I., & Schöffl, V. (2016). Epiphyseal stress fractures in the fingers of adolescents: Biomechanics, pathomechanism, and risk factors. European Journal of Sports Medicine, 3(1), 27–38. Retrieved from http:// www.eujsm.eu/index.php/EUJSM/article/view/95/49 Schweizer, A. (2000). Biomechanical effectiveness of taping the A2 pulley in rock climbers. Journal of Hand Surgery, 25(1), 102–107. https://doi.org/10.1054/jhsb.1999.0335 Schweizer, A. (2001). Biomechanical properties of the crimp grip position in rock climbers. Journal of Biomechanics, 34(2), 217–223. https://doi.org/10.1016/S0021-9290(00)00184-6 Schweizer, A. (2003). Lumbrical tears in rock climbers. Journal of Hand Surgery, 28(2), 187–189. https:// doi.org/10.1016/s0266-7681(02)00250-4 Schweizer, A. (2009). Biomechanics of the interaction of finger flexor tendons and pulleys in rock climbing. Sports Technology, 1(6), 249–256. https://doi.org/10.1002/jst.68 Schweizer, A. (2012). Sport climbing from a medical point of view. Swiss Medical Weekly, 142, w13688. https:// doi.org/10.4414/smw.2012.13688 Schweizer, A., & Hudek, R. (2011). Kinetics of crimp and slope grip in rock climbing. Journal of Applied Biomechanics, 27(2), 116–21. https://doi.org/10.1123/jab.27.2.116
PAGE 17
FEATURE
Coaches Corner SEPNZ President Blair Jarratt went to Rocktopia recently and had a chat with one of the coaches about the injuries climbers want to avoid and how the sport is evolving.
Rob Moore has been climbing competitively for 25 years and is co-owner of Rocktopia in Mt Maunganui. He has been coaching climbers for around 20 years at National level. Rob was ranked second in Oceania for speed climbing and has represented New Zealand in climbing as well as 2 other sports. He is also a qualified acupuncturist and focuses on nutrition, periodisation and a broader approach with his athletes.
Blair: As climbing is now an Olympic sport how many national climbers have you got that will be competing for New Zealand?
Rob: There has been an Olympic qualifying event in New Zealand recently from which the top 8 males and females go through to an Oceania Olympic qualifying event in Sydney in March, and then the top 1 from that event goes through to the Olympics in Tokyo. Now, we’ve got a long list of athletes; only 1 of them is currently in Mt Maunganui. We’ve got 1 from Christchurch, 1 in Wellington, 1 in Taranaki, they’re
from all over the place and out of those, it’s going to be hard work to get that one spot. Blair: The broader approach with your athletes - has that come through working with people at a HighPerformance Centre locally, or are you involved in that as well? Rob: Yeah, absolutely. I’ve been probably the only coach running a periodized plan for the last 20 years. I come from a speed skating background and I represented speed skating back in the ’80s, we had periodized plans right from there and it carried on through until my climbing and as technology and knowledge gets better I suppose and working in with the guys down at the High-Performance Centre it’s really good to fine-tune things. It’s constantly learning and evolving and the thing that’s cool about climbing is that the biomechanics that is associated with climbing is sport-specific to climbing. We’re seeing these guys on the wall doing these crazy parkourstyle moves and so we’re getting together with the S&C’s down at the High-Performance Centre and we’re getting the buzz on the wall; how they’re holding themselves on the wall and then we’re trying to work out which muscles are firing, which stabilizers and proprioceptors and things are working at the same time while they’re in this crazy position. It’s quite a cool little aspect. Blair: From that it sounds like there’s a new style of climbing coming out? With what you were saying with parkour-type movies compared to what there was with the traditional type. Is that bringing new injuries to climbing? Rob: Absolutely - the new style of climbing has much bigger holds. It used to be that the terrain would be quite steep, and there would be tiny, little holds that are really crimpy on the fingers. The new style of hold is these massive big holds and a basket-ball sized hold would be a small hold nowadays for a lot of CONTINUED ON NEXT PAGE >>
PAGE 18
FEATURE ARTICLE climbing. And these guys are throwing themselves towards these holds, and so what they’re having to do because the holds are more sloped and not so crimpy, they’re having to learn to stabilize their shoulder girdle differently. From there they need to work out a sort of trajectory of their legs and the bottom part of their torso, so as to not move their shoulder girdle, which allows them to spit off the holds and then try and time the movement of the trajectory of their legs to then come back onto the holds and it’s really fascinating, the way that people are studying this and the modern style of climbing. So, we’re not seeing so much of the same sort of little, tiny holds, which people have been cranking off really hard, and there’s still that aspect to it but nowadays it’s more about the whole full-body movement on the wall. Blair: With that do you think you are getting different injuries? Maybe in the past, it was all fingers but now are you getting more bigger joint injuries like shoulders or even lower limb injuries because the climbers are using force and velocity to get around on the wall? Rob: Shoulder stability has become so important nowadays. Before everything was static and the moves were static so the injuries we were seeing were just located in the same area, wrist extensors etc. A lot of pulley injuries. Whereas nowadays it’s that whole arm, shoulder, back stuff going on. Because they’re throwing themselves at the wall more, we’re seeing some more lower limb injuries as well because of falling off the wall quickly in a way that they would have, in a static move before, fallen quite controlled. So, falling injuries are different but it’s come about from a more exciting climbing style as well. You see these guys flying through the air and limbs are flailing everywhere and then they catch a hold somewhere, and you’re just seeing them swinging off one arm, it’s quite exciting to watch them catch themselves as well. But that comes with its own risk at the same time. Blair: When I thought of climbing before today, it was traditional static climbing sense and now as you say, I can see the sport is evolving like we are seeing in other sports. I guess that’s really important with doing what we’re doing here today, because some Physio’s may think of the traditional way of climbing what’s going on but now we can see the forces
involved in this new emerging style of climbing. It’s got to be a really complete rehabilitation plan involving pelvic stability, trunk stability, shoulder girdle but even into the lower limbs as well because they can generate power off the wall through the lower limbs? Rob: Absolutely, we are seeing the evolving of the sport because of the Olympic format. It was quite boring for spectators to watch before, so the evolving in the sport is more for the TV and more for spectators. So, it becomes a sport that the crowd is really getting behind and getting excited about. So even things we call a “kip dyno”, whereas before we might have been generating power off our legs to explode up to another hold and catch a hold which we call a “dyno”, nowadays that same dyno movement might be done without feet, so what they’re having to do is generate power from their legs to create movement and then time that with the arms pulling at the same time so their generation is like a kip movement, like when you’re doing a pull up with your feet lifting - trying to generate this force and movement off nothing, basically momentum. You’re getting a climber who’s utilizing their body in a totally different way than we’ve seen in the past because we’re moving further and further away from “conventional Rock Climbing” to what is now “Olympic Sport Climbing”, which are two different aspects of the sport. Blair: It sounds like there’s a lot more plyometrics happening whereas in the past it was probably more static and obviously with plyometrics a lot more force? Rob: Absolutely and the speed wall we’re building at the moment (17m speed climbing wall), speed climbing as an event generates its own problems as well because you’ve got repetition, the same movement at high intensity and maximum power, is getting repetition injuries as well. So that’s another one that we’ll have to look at especially. I was talking to one of the American coaches at the World Champs in Italy a while ago, and they were saying that since speed climbing became so popular they’re seeing much more growth plate fractures in juvenile climbers, so that’s another thing that we’ve never really thought about but that repetition of high -intensity movement at full power is pretty hard on those growth plates. We’ve got to be aware with CONTINUED ON NEXT PAGE >>
PAGE 19
FEATURE ARTICLE building our first level of speed climbers we’re going to start seeing some of those injuries come through, so we’ll have to try and avoid those sorts of injuries. Blair: So, they think that those growth plate injuries are not necessarily coming from the impact/ acute injury but probably from generating power? Rob: Absolutely, originally we were seeing growth plate injuries from things like weighted finger boarding.
Image 1: Fingerboarding Obviously, our climbers need to have strong fingers so we’re trying to develop strong finger muscles through techniques where we are hanging off small holds. Then generally speaking our 17-18-year-olds are then starting to add weight to those small holds and we’re just doing static hanging off those holds. But, one of the problems I’m facing at the moment is through Social Media, we’re seeing all these people doing this weighted finger boarding and then these younger climbers, no matter how much we try to educate them, they’re going “well this is the way to move forward”, and even at the Youth World Champs, one of my climbers developed symptoms of a growth plate fracture and I had to get them to go and have an x-ray in Italy, and they had a fracture of one of their growth plates, and we found out afterwards that they had been getting one of their friends to coach them. Their friend had told them to do weighted finger boarding after I’d specifically had an expert to come in and had educated and advised the team not to. Blair: That’s almost the world we live in as clinicians and even as coaches, you’re always against what’s happening out there on Social Media and trying to
give your best clinical advice but sometimes you’re against the tide So, in saying that then, I think that’s a good way to go into the next bit, how could physiotherapists make a coach’s job a bit easier? Rob: I suppose education is a big thing. A coach can be saying one thing but if a coach is like your parent and they’re saying the same thing over and over to an athlete, but the athlete thinks they know better… Sometimes I think coming from different avenues, you can try and get people to understand things a bit better and that’s one of the reasons why at our training camps we always have a group of specialists to come and talk at the training camps and show pictures of growth plate fractures and show pictures of some of the injuries that can happen when you’re not listening to what the coach is saying. I suppose if the physios can tell the climbers the same thing then that ends up being more in their psyche. Blair: So out of that, what are probably the most important things that we see with any kind of physio/ coach relationship is communication and making sure that you’re giving your athlete similar ideas as opposed to conflicting ideas. Really making sure we as physios are talking to the coach and making sure that the coach understands what the physio is saying so that you’re not confusing your athlete with conflicting messages. In the end that comes through all sports but it’s good to be touching on that, that’s really important. Communication is key, and then sometimes with young athletes, getting the parents involved as well, so you can always have the coach, the physio and the parents versus Social Media. Hopefully with that group of supportive people, that the athlete find trust in, you may get some clarity. Rob: Yes, I suppose it’s quite sport-specific and a little unique in the fact that with the way that it’s evolving and changing there’s not a lot of education around the things that are happening, so when people see stuff on Social Media that some of the pros are doing they immediately think they’re strong enough or this is or it going to make them strong enough to do it, education through all those 3 mediums is going to be an important part of it. Blair: From a coaching perspective if someone comes into a physiotherapist clinic, who’s a climber, CONTINUED ON NEXT PAGE >>
PAGE 20
FEATURE ARTICLE apart from the plyometrics, is there anything else you think that they should be aware of in your sport. Are there some pressures around weight-loss, to be light enough to generate power? Is that something that comes into it? Are there other things that are external to just how we move on the wall that comes into it? Rob: Yeah, I think I don’t delve into weight-loss stuff a lot with my athletes, there are some of my upperend athletes that we do talk about it and do it with, but on Social Media and training platforms and things like that, it’s quite prevalent that there are 2 ways to get better at climbing. Get stronger or get lighter. So, people are seeing that and at an international level, we don’t have a BMI that’s utilized as a way of limiting climbers, whereas other sports have some work that they do with BMI. So, we’re seeing some of the younger climbers, there was a couple of 16-yearolds this year that got on the podium in a few World Cups and they were very, very thin climbers and there’s been some discussion about it. I was at an International Federation of Sport Climbing symposium in Italy and there was some discussion around BMI there, and of course, climbers know that if they’re lighter they’re going to get up the wall further, so it’s something I think that needs addressing. But now we just focus, in New Zealand on solid training techniques and things that we know are safe, especially in the facility we’re training in here. I know that under 16-year-olds can’t do campus training for example, which is thin wooden rungs that are about 20mm’s thick and they’re on a 15-degree angle overhanging wall, and they have to jump with both hands between the rungs. It’s very high-impact climbing. It’s great for what we call “contact strength”. In climbing have 2 types of strength, we have “finger strength” and “contact strength”. Finger strength is how strong you can crimp something. Contact strength is how quickly you can engage your finger muscles to latch onto a hold. So “campusing” is incredibly good for creating contact strength because you’re latching on instantly as soon as you jump onto those holds, but it does have its downside, which is that it is very easy to cause injuries on the fingers, unless you’re strong enough and developed enough. Getting injured is definitely one of the ways to get weaker in climbing. as soon as you’re injured, and you can’t climb for 6 weeks then that’s not beneficial. Campusing and
weighted finger boarding are the 2 things that we should really stay away from with our younger climbers, as we know they’re very injury prone and very good at creating contact strength and finger strength, but they run a high risk as well, so we wait until they’re out of that juvenile stage. The only time I would let any younger climbers do it is if they have an x-ray of their fingers and I can see that their growth plates are closed, otherwise if there’s any risk that they’re still growing then they stay off that stuff altogether. Blair: Obviously, you’ve got a great relationship here in town with the high performance centre, but throughout New Zealand, if we’re getting climbers coming into our clinic, have you got any top tips for the physios working with them, from a coaching perspective? Rob: Shoulder mobility is huge and trying to teach climbers about it. As climbing is a relatively new sport in New Zealand I think there are not very many coaches that are really qualified. There’s a lot of people that know a little bit about climbing and might have climbed some high grades and they are trying to pass on knowledge without having a fully rounded knowledge. I think I know maybe 3 or 4 really good coaches in New Zealand, so there’s a lot of climbers climbing around New Zealand that have no knowledge of how things work. So, for instance when they’re doing hanging on a fingerboard, what I see a lot is people not engaging their shoulders. So, we’re getting injuries happening to the shoulders, just from lack of knowledge rather than a lack of anything else. So, if the physio can teach a climber about how to engage the shoulders, how to engage the scapula, and all of those little stabilizers that happen around the shoulder girdle this is really important, because a lot of people when hanging from a hang board, just hang with relaxed shoulders, thinking that they’re just working their fingers. But there’s so much more that can go on from that. Body tension for us as climbers, I say it starts from the top of the knees to the top of the shoulders. So, when we’re talking about engaging our core, we’re not just specifically looking at our abdominals but looking at our whole range of stuff. There are 3 things we say that go on for engaging the core, we have the first thing which is we pretend that we’re holding a 10 cent piece between our buttcheeks, so if you’re holding a 10 cent piece between your buttcheeks then you’re CONTINUED ON NEXT PAGE >>
PAGE 21
FEATURE ARTICLE engaging your buttocks, you’re engaging your quads and your slightly turning out your whole pelvic girdle there and so it’s really engaging from the top of the knees up to the top of the pelvis. Then we say that you have to imagine someone’s holding their hand; like a knife blade, in between your scapula and if your hands are up, and you are trying to hold their hand between your scapula then you’re engaging the top of your chest as well. And then the last thing is, we say that when they’re on the wall they should just have a slight hiss, like a snake, so they’re going “hiss” (breathing out air through closed teeth) like this, so you can feel what the engagement of the abdominals is like, and then hold that tight so that then if you’re engaging those 3 things, you’re engaging from your knees right up to your shoulders; and for the climbers on the wall, to be able to hold that body tension through that whole range of stuff, is far more important than just having your abs engaged. And when that comes in, there’s a whole lot of protection that happens around that when you’re there as well. Because your shoulder girdle is solid and stable and then you’re actually engaging the scapula and by doing that you’re protecting the shoulders and there’s a lot that happens that’s not just hanging straight from your arms. New climbers when they’re starting out, think that climbing is all about, just pulling themselves up the wall with their fingers, but there’s so much more, you can rotate and have a good open pelvis, you can get your weight on your feet a lot better, you can stay closer to the wall and so maybe as a physio by looking at how to protect a climber, it’s about educating them on how to use their pelvis well, how to use their shoulders well, more mobility in the shoulders is also really important. Blair: I think you’ve touched on a really important point that we should look at with all shoulder injuries, is that the power of the shoulder is not just driven from the shoulder, the trunk encompasses the pelvic stability and one of the things that possibly sometimes gets missed by physiotherapists if someone comes in with a hand injury is they just look at the hand, possibly the elbow, maybe the shoulder. If you’ve got those people that can’t do any loading of the hand or the elbow, then it’s still good rehab to be working on the proximal muscles because they’re going to need that to stabilize. It’s still good rehab to be working on something not associated directly with the injury if the local area it’s too painful to load it.
Rob: Many injuries are caused by stabilizers or proprioceptors not firing anyway, it’s not always just the place that’s injured, that’s the problem. Blair: IIs there anything that you dread as an injury in one of your climbers coming back to you from the physio? Rob: Growth plate fractures and pulley injuries. Obviously, that’s a long rehab and buddy taping is proven not to be effective. They must rest with pulley injuries. Lumbrical tears - Those aren’t good either and they take a long time to heal. We’ve started to hold a two finger crimp in a different way if using the middle and ring finger. Before we would tuck the outer 2 fingers back down towards your palm, now we are trying to educate our younger climbers to try to hold on with the outer 2 fingers pointing up, rather than down. So, just little things that coaches could be aware of and I suppose physios as well, as physios are probably going to deal with climbers a little bit more than coaches in New Zealand. Blair: Is that a specific hold, the one you were talking about? Rob: Yeah, well if you’ve got a 2-finger crimp with middle and ring finger, we’d now call this the Spiderman hold.
Spiderman
Incorrect Technique
Blair: How do you see climbing evolving? Considering that we’re building a 17m speed climbing wall here in Tauranga, how do you see it evolving in the future? Rob: We’ve now got the AIMS games, and having climbing in it now, we’re seeing a much younger age group of climbers coming through and the AIMS CONTINUED ON NEXT PAGE >>
PAGE 22
FEATURE ARTICLE games format, I invented this format for the AIMS games that was exactly the same as the Olympics format, so that instead of just having climbing on ropes, they do top-rope climbing, and then they do bouldering climbing, and then they do speed climbing as well. So, we’ve tried to get AIMS games to do all 3 of these events that we see in the Olympics so that they’re training our younger guys to then be training for the Olympic event that they might hopefully be doing later. I think our evolvement in that 10-11-year-old level is really growing in New Zealand. But of course, if we’re adding speed climbing to something at that really younger age, then we’re seeing this risk of injury getting a little greater, so it’s just something we have to sort of negotiate and I don’t think we’re going to see how that’s going to pan out until maybe 1 or 2 years, when we’ll see this stuff coming through. Hopefully, we can keep on top of that and make sure it’s safe.
Blair: Something to keep an eye on obviously, and it’s happening in a lot of sports we’re seeing, overload injuries in children maybe just due to the hours that they do, but with the evolvement of sport and the plyometric aspect that we talked about. Also we have young athletes looking on Social Media, keeping in mind that some of the people they’re looking at on Social Media are adults, with good strength and have finished growing and have been doing it for years, how is that changing the sport? Rob: Yeah, going campusing, finger-boarding and doing speed runs without the required time and strength aspect that’s associated with doing that over the years. I supposed this is Social Media’s problem with every sport. I would imagine, you see these topend guys doing these amazing things and you want to replicate it. Blair: Absolutely. Thank you very much for your time.
CONTINUED ON NEXT PAGE >>
PAGE 23
SPRINZ
Field-based assessment of physical fitness in children Sayumi Iwamoto, Toyo University, Japan and SPRINZ Kelly Sheerin, Marissa Downes, and Patria Hume Sports Performance Research Institute NZ, Auckland University of Technology. ABSTRACT Physiotherapists are often asked to assess children to monitor their development and to assess their risk of injury. However, valid and reliable field tests are needed with normative data for children. The aim of this study was to assess intra-day reliability and variability of a lower limb field-based test battery for physical fitness in children. Forty-one healthy children aged 7–11 years participated in this study. Intra-day reliability and variability were assessed for two isometric leg strength measures (knee flexion and extension) using a handheld dynamometer, dynamic balance (Y-balance test), explosive leg strength (jump-mat assessed counter movement jump), and 5m, 10-m and 20-m sprint speed. Intra-day reliability was assessed between two trials measured on the same day via percentage difference in mean scores and effect sizes. Variability was assessed via intraclass correlation coefficients and typical errors of measurement. Percentage difference in the mean scores were less than 5% for all measures. There was good reliability on intra-day testing, however variability was inconsistent. Based on the results of this study, isometric strength tests using the isometric handheld dynamometer, dynamic balance using the Y-balance test and a 20-m timed sprint, including the 5-m split time, can all be used with confidence in future assessment of healthy children aged 7-11 years. The counter movement jump and the 10-m sprint split time were not considered appropriate for use in this cohort given their large variability in test results. This is the first study to report handheld dynamometry testing of strength in healthy children. KEYWORDS: isometric leg strength, dynamic explosive leg strength, sprint speed.
balance,
INTRODUCTION: It is important to assess physical fitness in children given positive health outcomes in adulthood have been linked to good physical fitness in children and adolescents [1]. Several studies have shown that children with good motor skill development tend to be more active than those with poor motor skill development [2]. Field-based testing for children that
enables many children to be measured at the same time without expensive equipment is desirable. The aim of this study was to assess intra-day reliability and variability of a lower limb field-based test battery for physical fitness in healthy children aged 7–11 years. METHODS: The research design was approved by the Auckland University of Technology Ethics Committee (#11/159), and parental consent and child assent were obtained before the study commenced. Forty-one children, free of injury at the time of recruitment, produced two successful trials for each test. Maximal isometric strength was measured isometrically for the knee flexors (KF) and knee extensors (KE) using a handheld dynamometer (Industrial Research Limited, Wellington, New Zealand) with an additional strap. Children were instructed to push as hard as possible against the dynamometer for 5 s.
Figure 1: Hand-held dynamometer used for testing.
Dynamic balance was assessed using the Y-balance test (a modified version of the star excursion balance test), using a protocol previously outlined [3]. Children were instructed to use the big toe of their non-stance foot to move a slider as far as they could in the anterior (AT), posteromedial (PM) and posterolateral (PL) directions.
CONTINUED ON NEXT PAGE >>
PAGE 24
SPRINZ Explosive leg strength was assessed using a vertical counter movement jump (CMJ) via a jump mat (Fitness Technology, South Australia), with feet hipwidth apart and hands on hips [4]. Children were instructed to jump vertically as high as they could. Vertical jump height was calculated based on the jump flight time (i.e. the time from take-off to landing in a jump) and reported in cm.
variability was ‘large’, the measurement considered inappropriate for use.
was
RESULTS: The results for the double measurements of the nine physical fitness tests for the 41 children (21 boys and 20 girls; 8.1 ±1.5 years, 1.35 ±0.86 m, 30.9 ± 6.3 kg) between the ages of 7–11 years, are shown in Table 1. All physical fitness tests demonstrated good reliability, however, CMJ and 10m split showed large variability (Table 1). DISCUSSION: Our study reported average data from 41 children between the ages of 7–11 years for nine lower limb physical fitness tests.
Figure 2: Explosive leg strength was assessed using a CMJ via a jump mat.
Sprint time was assessed over 20-m by using timing gates (Swift Performance Equipment, Queensland, Australia), which also allowed the measurement of 5m and 10-m split times. Children began from a standing start and were instructed to run as fast as they could through the 20-m gate.
Figure 3: Sprint time was assessed over 20-m by using timing gates
Descriptive statistics are presented as means and standard deviations. Reliability measures include the difference in the mean percentage (MDiff %) between trial 1 and trial 2 and Cohen’s effect sizes (ES). Measurement variability outcomes included intraclass correlation coefficients (ICC) and the typical error of measurement expressed as a coefficient of variation percentage (CV%). An ICC and CV% methodology as used in a previous study of young gymnasts [5] enabled an overall interpretation of average measurement reliability and variability for the tests [5]. In cases where the average reliability outcome was ‘poor’ or the average measurement
Physiotherapists can use handheld dynamometry in clinics and at the sports facilities. However, there is still the need for specific methods of use of these devices ensuring correct limb positions, to avoid measurement error. To our knowledge, this is the first study to report handheld dynamometry testing of strength in healthy children. Handheld measurement of leg strength has been used for children with cerebral palsy [6]. Our testing in children showed large variability in jump height results using the jump mat technology for the CMJ with hands on the hips. However, the heights jumped were similar to those reported for English school children aged 10 to 15 years, where jump height was measured using a NewTest timing mat (NewTest Ltd) with a CMJ with arm swing [7]. Their results showed no significant difference in jump heights between boys and girls aged 10 or 11, (boys 10 yrs 21.9 ±5.2 cm, 11 yrs 26.9 ±5.4 cm; girls 10 years 21.7 ±4.7 cm, 11 yrs 25.3 ±5.0 cm) which was the upper age of the children in our study. The counter movement jump with no arm swing as used in our study may be too difficult to replicate by children aged less than 10 years. Sprinting has three different phases being the acceleration phase (up to 10-m), the intermediate phase (from 10-m to the maximum speed), and then maximum speed [8]. Our children had similar sprint speed for the first 10-m to this previous study. As sprinting ability gradually improves with age, our result of large variability in sprint performance is likely due to the age range of the children we tested. While some positive findings were demonstrated in the study, they must be interpreted with some limitations in mind. Although seven of the nine tests employed in this study could be used to measure the physical fitness of children reliably, ultimately, the test CONTINUED ON NEXT PAGE >>
PAGE 25
SPRINZ Table 1. Reliability and variability of trials within the same session for 41 children.
Strength (N)
KF
KE
Balance (cm)
AT
46.8±6.7 48.3±7. 3.1 0.2 small 0 (0.3 to 1 5.9)
good
0.75 7.4 (0.61 to (6.2 to 0.85) 9.2)
small
yes
PL
70.8±10.2 72.7±1 2.6 0.1 trivial 1.1 (0.5 to 8 4.7)
good
0.87 5.6 (0.79 to (4.7 to 0.92) 6.9)
small
yes
PM
68.0±10.1 69.4±1 2.0 0.1 trivial 0.7 (-1.1 3 to 5.2)
good
0.75 8.6 (0.60 to (7.2 to 0.85) 10.6)
small
yes
-3.4 0.0 trivial (-15.4 5 to 10.3)
good
0.59 38.9 (0.37 to (31.6 to 0.75) 50.9)
large
no
5m 1.42±0.12 1.4±0.1 -1.3 0.1 trivial (split) (-3.6 3 to 1.0)
good
0.58 6.1 moderate (0.36 to (5.1 to 0.74) 7.7)
yes
10m 2.47±0.29 (split)
2.4 ±0.3
-3.4 0.1 trivial (-7.2 5 to 0.5)
good
0.68 11.2 (0.50 to (9.4 to 0.80) 14.0)
large
no
20 m
4.3 ±0.5
-0.7 0.0 trivial (-2.8 3 to 1.3)
good
0.83 5.6 (0.72 to (4.8 to 0.99) 7.0)
small
yes
Vertical Jump (cm) Sprint (s)
Trial 1 Trial 2 MDiff ES Reliability ICC CV (%) Variability Appropriate M ±SD M ±SD % for use 10.5±2.5 10.7±2. 2.2 0.0 trivial good 0.86 9.0 small yes 5 (-1.6 9 (0.75 to (7.4 to to 6.0) 0.92) 11.6) 15.5±6.3 15.7±6. 1.2 0.0 trivial good 0.91 11.6 moderate yes 4 (-3.5 4 (0.84 to (9.5 to to 6.1) 0.95) 15.0)
21±6
4.36±0.40
20±10
results were affected by the participants’ level of maturity and motivation [9]. The sample was limited to a small group of active school children therefore it is difficult to generalise these findings to a wider population.
including the 5-m split time. However, due to large variability, the counter movement jump using a jump mat, and the 10-m split time test were not considered suitable for use with children aged 7–11.
CONCLUSION There was good reliability across the different tests for intra-day testing, but variability was inconsistent. Based on the assessments of reliability and variability of childrens’ lower limb field-based testing, future research could assess isometric strength using handheld isometric dynamometry, dynamic balance using the Y-balance test and a 20-m timed sprint,
CONTINUED ON NEXT PAGE >>
PAGE 26
SPRINZ
Dr Sayumi Iwamoto Dr Sayumi Iwamoto is a Professor in the Faculty of Human Life Design at Toyo University, Japan. Her research interests include sports injury prevention and athletic conditioning and she is currently a Research Associate with SPRINZ. As well as teaching Sayumi has worked as an athletic trainer with professional athletes in several sports including baseball, tennis golf and keirin racer.
References 1.
Kvaavik, E., et al., Physical fitness and physical activity at age 13 years as predictors of cardiovascular disease risk factors at ages 15, 25, 33, and 40 years: extended follow-up of the Oslo Youth Study. Pediatrics, 2009. 123(1): p. e80-e86.
2.
Barnett, L., et al., Does childhood motor skill proficiency predict adolescent fitness? Medicine and Science in Sports and Exercise, 2008. 40(12): p. 2137.
3.
Mero, A., Force-time characteristics and running velocity of male sprinters during the acceleration phase of sprinting. Research Quarterly for Exercise and Sport, 1988. 59(2): p. 94-98.
4.
Harman, E.A., et al., Estimation of Human Power Output from Vertical Jump. The Journal of Strength & Conditioning Research, 1991. 5(3): p. 116-120.
5.
Bradshaw, E., et al., Reliability and variability of day-to-day vault training measures in artistic gymnastics. Sports Biomechanics, 2010. 9(2): p. 79-97.
6.
Taylor, N.F., K.J. Dodd, and H.K. Graham, Test-retest reliability of hand-held dynamometric strength testing in young people with cerebral palsy 1. Archives of Physical Medicine and Rehabilitation, 2004. 85(1): p. 77-80.
7.
Taylor, M., et al., Vertical jumping and leg power normative data for English school children aged 10 to 15 years. Journal of Sports Sciences, 2010. 28(8): p. 867-872.
8.
Delecluse, C., et al., Influence of high-resistance and high-velocity training on sprint performance. Medicine and Science in Sports and Exercise, 1995. 27(8): p. 1203-1209.
9.
Harris, J. and L. Cale, A review of children’s fitness testing. European Physical Education Review, 2006. 12(2): p. 201-225.
PAGE 27
CLINICAL REVIEW
Incidence, Mechanism and Risk Factors for Injuries in Youth Rock Climbers: Kaikanani Y Woollings, Carly D McKay, Jian Kang, Willem H Meeuwisse, Carolyn A Emery. British Journal of Sports Medicine 2015; 49-50. doi: 10.1136/bjsports-2014-094067
By Karen Carmichael ABSTRACT Background Rock-climbing participation has grown globally in recent years, and the sport was officially recognised by the International Olympic Committee in 2010. The epidemiology of climbing injuries in adults has been examined, but few studies have investigated injury in youth climbers. Objective To examine the incidence, mechanisms and risk factors for injury in recreational and elite sport climbers and boulderers aged 11–19 years. Study design Cross-sectional. Methods Youth (n=116) were recruited from climbing facilities across Alberta, Canada. Participants completed an anonymous questionnaire from October 2012 to March 2013. Climbing injury incidence proportions and incidence rates (IR) were calculated. ORs with corresponding 95% CIs were estimated for possible risk factors. Results The injury IR was 4.44 injuries/1000 climbing hours (95% CI 3.74 to 5.23). Sprains (27%) and strains (26%) were the predominant injury types, and repetitive overuse was the primary mechanism of injury (42%). Hands and fingers were the most commonly injured locations (21%). Exploratory analyses showed three risk factors for injury: older age (15–19 vs 11–14 years; OR=11.30, 95% CI 2.33 to 54.85), injury in a sport other than climbing (OR=6.46, 95% CI 1.62 to 25.68) and preventive taping (OR=5.09, 95% CI 1.44 to 18.02). Conclusions Injury risk is high in youth climbers. Findings are consistent with the reported rates, types and mechanisms in adults. Modifiable risk factors warrant further investigation to inform the development of injury prevention strategies, targeting high-risk climbers including adolescents and those with previous injury. With the inclusion of rock climbing in the Tokyo
Olympics and the recent documentaries such as Free Solo and the Dawn Wall, there has been renewed interest in the sport of climbing. Many youth are taking up climbing as a sport. There are three main disciplines within climbing. Sport climbing, where the participant is attached to a safety rope, either via a top rope or via lead climbing, where the rope is fed through permanently attached bolts on the route. Bouldering where there are no ropes used as the problems are not as high and crash mats are used to land on. And speed climbing where the object is to get to the top of a wall as fast as possible. An auto belay device is usually used for this. In this study they focused on sport climbing and bouldering, looking at elite and recreational climbers. The study was a cross-sectional study design, using an anonymous questionnaire to look at the risk factors for injury in youth climbers. The author aimed to study male and female youth climbers aged between 11-19 years old. They recruited climbers from competitive junior teams, recreational programmes, lessons and workshops at 10 indoor climbing facilities in Canada. Recreational climbers were those who climbed at least once a month in the preceding year, and Elite were defined as those that participated in competitions in the preceding year and for a minimum of 2 years prior, or participation in international competition during the previous 12 months. Only around half of those approached to complete the questionnaire did so, and then some failed to complete it. So of the original 285 asked to participate only 116 actually returned the questionnaire. The questionnaire asked demographic information including climbing experience, discipline, and venue (outdoor or indoor). It also asked about exposure (hours climbed), injury type and location and mechanism of injury in the last 12 months. The outcome measure was “climbing injury” described as any “physical complaint that resulted CONTINUED ON NEXT PAGE >>
PAGE 28
CLINICAL REVIEW from sport climbing or bouldering, indoors or outdoors, irrespective of the need for medical attention or time loss from climbing activities.� From the methodology it is clear that there are a number of areas where errors and bias may occur. It could be that climbers with injuries self-selected to fill out the questionnaire, thus increasing the incident rate and self-reporting injuries with a low threshold for injury in the definition will also potentially increase the incident rate or clinically significant injuries. Injuries were categorised depending on time-loss from climbing, from minimal (1-3 days), through mild, moderate, severe (>28days) and career ending.
The study had a number of limitations; low number of respondents to questionnaire, recall bias issues and self-reporting issues. So it is hard to draw firm conclusions from it. However it is useful as a starting point for looking at youth injuries in climbers, which, with its inclusion in next year’s Olympic Games should continue to grow as a sport. Key findings were a climbing injury incidence rate of 4.44/1000 climbing hours, comparable to soccer. Upper injuries were more common and likely to be over use type injuries, whilst lower limb injuries were more likely from falls. Older teenagers, injury in another sport and preventative taping were significant risk factors for injury.
Intrinsic and extrinsic potential risk factors were examined and exposure hours were then used to estimate the injury incidence rates (IR). The study was powered to detect a clinically important difference in injury incidence proportion of 20% between the elite and recreational groups.
A full set of references is available on request
The average amount of time spent indoor climbing was seven hours per week over 9 months, less time was spent outdoor climbing (6 hours week/3 months) and unsurprisingly elite climbers spent more time climbing than recreational climbers. Injury rates were high, with 63% of participants sustaining at least one new injury in the 12 months prior to the study. 31% reported multiple injuries. The overall incident rate 4.44/1000 participation hours. 77% of the injuries resulted in at least one day off climbing, the median amount of time lost was 14 days. 54% of participants received medical attention, with physiotherapy the most common treatment reported. The most common injury type (self-reported) was ligament sprain, followed by muscle or tendon strain. The most commonly injured areas were the hands and fingers (21%), shoulders (15%), knees (9%) and ankles (9%). The most commonly reported mechanism of injury was repetitive overuse, followed by falls, and those incurred during strenuous moves. Most repetitive overuse injuries involved the upper body, while most fall-related injuries involved the lower extremity. Climbers aged between 15 and 19 years old were more at risk of injury than those between 11 and 14 years old. Injury from another sport and those who used preventive taping were also risk factors for climbing injuries. There were various theories as to why this might be but was outside of the scope of the study to look at why. Possibly due to previous injury or riskier behaviour. CONTINUED ON NEXT PAGE >>
PAGE 29
UPCOMING SEPNZ COURSES
We have successfully completed The Lower Limb in Sport course & Promotion and Prescription of Physical Activity and Exercise course this month. We have 1 more course available for the year. Get in quick before it sells out.
Injury Prevention & Performance Enhancement. Auckland 30th November and 1st December 2019 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 sport–�specific screening assessment, how to monitor injury rates and target injury prevention strategies within different sporting contexts. Registrations are open now via https://pnz.org.nz/Event?Action=View&Event_id=2750
SOLD OUT! WAITING LIST AVAILABLE!
PAGE 30
RESEARCH PUBLICATIONS
British Journal of Sports Medicine November 2019; Vol. 53, No. 22 ORIGINAL ARTICLES Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults Min Zhao, Sreenivas P Veeranki, Shengxu Li, Lyn M Steffen, Bo Xi Effects of the ‘11+ Kids’ injury prevention programme on severe injuries in children’s football: a secondary analysis of data from a multicentre cluster-randomised controlled trial Florian Beaudouin, Roland Rössler, Karen aus der Fünten, Mario Bizzini, Jiri Chomiak, Evert Verhagen, Astrid Junge, Jiri Dvorak, Eric Lichtenstein, Tim Meyer, Oliver Fa ude
Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial Tania Gardner, Kathryn Refshauge, James McAuley, Mark us Hübscher, Stephen Goodall, Lorraine Smith
requires pragmatic and accelerated action: the case of para alpine skiing in Pyeong Chang 2018
Cheri Blauwet, Nick Webborn, James Kissick, Jan Lexell, J aap Stomphorst, Peter van de Vliet, Dimitrije Lazarovski, Wayne Derman They call us fellows: the challenge of gender bias in the Australasian College of Sport and Exercise Physicians Louise Tulloh INFOGRAPHICS Infographic. Nutrition and oral health in sport: time for action Ian Needleman, Alan Rankin, Paul Ashley, Tom Fairbrothe r, Peter Fine, Julie Gallagher, Dan Kings, Ronald John Maughan, Anna Katarina Melin, Michael Naylor
nfographic. Sports injury-related hospitalisations in Australian children: incidence, costs and trends Reidar P Lystad, Joanne Tran, Kate Curtis, Gary J Browne, Rebecca J Mitchell
Lifetime history of sexual and physical abuse among competitive athletics (track and field) athletes: cross sectional study of associations with sports and non-sports injury Toomas Timpka, Staffan Janson, Jenny Jacobsson, Örjan Dahlström, Armin Spreco, Jan Kowalski, Victor Bargoria, M argo Mountjoy, Carl Göran Svedin REVIEWS
US dietary guidelines: is saturated fat a nutrient of concern? Zoe Harcombe Effects of chronic exercise interventions on executive function among children and adolescents: a systematic review with meta-analysis Yue Xue, Yanxiang Yang, Tao Huang EDITORIALS Education can ‘change the world’: Can clinical education change the trajectory of individuals with back pain? Mary O’Keeffe, Peter B O’Sullivan, Kieran O’Sullivan Supportive interpersonal relationships: a key component to high-performance sport Lauren Burns, Juanita Ruth Weissensteiner, Marc Cohen When van Mechelen's sequence of injury prevention model
http://bjsm.bmj.com/content/52/15 All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/
PAGE 31
CLASSIFIEDS CONCUSSION SURVEY Greetings New Zealand Physiotherapists! We are conducting research to improve our understanding of how NZ Physiotherapists are involved in the recognition, assessment and management of concussion. If you are a NZ Registered Physiotherapist involved in concussion care (also known as mild traumatic brain injury) we invite you to participate in an online survey that will take approx. 10min. Please click here to go to the survey or for more information. https://otago.au1.qualtrics.com/jfe/form/ SV_2lzkGFQVTBLZOOV This project has been reviewed and approved by the School of Physiotherapy Ethics Committee, University of Otago.
If you have any questions please don’t hesitate to contact us: Dr Ewan Kennedy e. ewan.kennedy@otago.ac.nz p: +64 3 479 7473 Sophie Maxtone(Honours student) e: maxso890@student.otago.ac.nz
PHYSIOTHERAPY CLINIC FOR SALE
Large & Profitable Coromandel Clinic For Sale. Rare Opportunity! Not often do opportunities like this present themselves! Come live at the beach and enjoy a true work life balance. Here we have a high-performing Physiotherapy Clinic in the heart of the Coromandel. Are you looking for a lifestyle change or an acquisition to expand your companies reach? • Purpose-built clinic, with three rooms • An EPN accredited practice • Onsite gym and Pilates reformer • Five contract physios and a Practice manager This business has gone from strength to strength with years of consistent growth in revenue and profitability. The cash surplus to a working owner last year was over $240,000! To find out more, please go to linkbusiness.co.nz/WK00036 and press the “Enquire Now” button to complete an online confidentiality agreement. Or contact: Alanah Eagle, LINK Business alanah.eagle@linkbusinesss.co.nz 021 606 345
Broker
***Some details of the business for sale are confidential and can only be disclosed upon contacting the broker and a completion of a Confidentiality Agreement. Due to the confidentiality of this business a stock photo image may be used to represent the business.
PAGE 32
CLASSIFIEDS
Presenter: Brett Harrop, APA Titled Sports & Exercise Physiotherapist Details: This one day introductory course to cricket physiotherapy is aimed at health professionals looking to gain further insight into the assessment, treatment and management of cricketers. The course explores common and unique cricket injuries, providing up-to-date research and clinical perspective. You will take away realistic and useful techniques for immediate application. Content: Epidemiology of cricket injuries Cricket unique injuries (lumbar stress fractures, side strains, posterior ankle impingement) Cricket common injuries (the disabled throwing shoulder, hamstring strains, traumatic hand/finger injuries) Fast bowling biomechanics & workloads Throwing biomechanics & workloads Functional anatomy and common clinical presentations in cricketers Exercise prescription for cricketers (rehabilitation, injury prevention, performance enhancement) Manual therapy & taping techniques Practical tips for working/touring as a cricket team physiotherapist Cost: $200 Registration: www.cricketphysio.com Contact: info@cricketphysio.com