SPNZ BULLETIN PAGE
Issue 5 October 2017
Feature SPNZ Sports High Performance Sports Physiotherapy Certificate Courses - Tamsin Chittock FEATURE TOPIC: Care of the High Performance Athlete
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SPNZ Members’ Page Welcome to Sports Physiotherapy New Zealand SPNZ EXECUTIVE COMMITTEE President
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An application form can be downloaded on the SPNZ website sportsphysiotherapy.org.nz.
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Contents FEATURE TOPIC: Care of the High Performance Athlete
SPNZ MEMBERS PAGE See our page for committee members, links & member information
2
EDITORIAL By SPNZ President Hamish Ashton
4
FEATURE High Performance Sports Physiotherapy. A Christchurch Perspective - Tamsin Chittock
5
SPRINZ Monitoring Athlete Training by Angad Marwah
7
In this issue:
SPNZ COURSES Sideline Management - SPNZ Level 1 Course
10
Injury Prevention & Performance Enhancement Part One: Injury Prevention (Myth Busters and Mind Traps) - SPNZ Level 2 Course
11
Promotion and Prescription of Physical Activity and Exercise
12
The Upper Limb in Sport - SPNZ Level 2 Course
13
ASICS ASICS Grant Report by Lee-Anne Taylor
14
CLINICAL SECTION- ARTICLE REVIEW Pain in Elite Athletes Neurophysiological, Biomechanical, and Psychosocial Considerations: a Narrative Review
19
RESEARCH PUBLICATIONS BJSM Volume 51, Number 20, October 2017
21
CLASSIFIEDS Situations Vacant, Courses and Online Survey
22
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Editorial Hamish Ashton, SPNZ President Greetings all th
The 4 SPNZ Sports Physiotherapy Symposium is just finished and I should be sitting back and putting my feet up for a while. I however have looked in my diary and have physiotherapy related activities on every weekend until the end of November. Not exactly the best way to stay in the good books with my wife, especially when the property needs tidying up big time. I wish to say a big shout out to our exhibitors that helped over the weekend. Asics – not only there as an exhibitor but also sponsoring Chris Bishops talk and the cocktails, USL, Footscience, Gensolve, Rocktape, KIKO medical, and Whitely Medical. Support those who support us. It is always hard for me to judge personally how our symposiums go as I have a lot on my mind running the AV and making sure things are going smoothly. With the different venue this time round I was able to hide at the back and even get to see most of the talks. What I do know was that we had a great selection of speakers, and what they demonstrated was some of the breadth of our capability as a sports physiotherapist. A few of the talks I felt opened our eyes as to areas we could focus more on. Ones that other professions or people are currently working in – be it to our detriment. Initial feedback coming through has been very positive, with comments like: “A well-run and inspiring conference”
we will become Sports & Exercise Physiotherapy New Zealand - Hakinakina me Kori Tinana Haumanu Korikori Aotearoa. Ricky Bell has kindly provided us a Maori translation to go with this – which after some practice, I hope I did justice to the pronunciation on Sunday. Changes of name will slowly be integrated into things once the paper work has done. Visually there won’t be huge changes as we have not altered our current logo significantly. Our website and social media will all still be accessible even after the changes become official. One thing that has unfortunately taken a back step over the last month or so is the advertising of our courses. We currently have four that are open to go ahead, proving there is sufficient interest, before the end of the year. Registrations for these are either via our website or directly via the PNZ events pages. Remember to use you SPNZ discount code. If you ever forget it, just go to the “Sports Certificate Courses” main page and there is a link there. In a few weeks will be the PNZ AGM. For the first time in as long as I can remember there are a number of candidates standing for the vacant exec positions. This is great for the profession as it shows people are showing some interest in what is happening. If by the time this gets to you voting is still open and you haven’t – have your say. We will possibly even get a result before the NZ government is decided on! As I haven’t written enough to fill my page I will finish with these:
“It was full of interesting presentations - well done” “As a paediatric physio who works with disabled children I wondered if I had been sensible registering to come, but I loved it and learnt a lot that I can adapt for my client group”. This year due to circumstances the symposium was later in the year and we moved it to Auckland. We are always keen for feedback and it is always easier to get from those who attended than those who didn’t. For future planning it would be valuable to know why people couldn’t attend. I have therefore created a twoquestion survey https://goo.gl/forms/ iffcc034hLrwWdox1 . Please help us by responding. One of the key things that happened over the weekend was our Special General Meeting on Sunday morning. Earlier in the year we surveyed you all about this and the positive response to the proposal was significant. To formalise this we needed to vote on this, and this was done on Sunday at the SGM. It is my pleasure to say that there was a unanimous agreement to the proposal. As soon as the documentation goes through
By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest. Confucius Wisdom is the power to put our time and our knowledge to the proper use. Thomas J. Watson Hamish
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Feature High Performance Sports Physiotherapy
A CHRISTCHURCH PERSPECTIVE - TAMSIN CHITTOCK Originally from England, I am a bi-hemispherely trained physiotherapist completing my BSc in 1995 in Bristol, UK, and then my post grad in Sports Medicine at Otago in 2000. My passion in physiotherapy has always been about maximising function and ability in movement, whether that be with people post-stroke or with an amputation, or in elite sports people. I have had a varied career across sports and private practice and am thankful that I am as passionate about what I do now as I was 20 years ago. Professionally sports-wise, I moved from rugby to rowing whilst in the UK looking at the incident of disc injuries in rowers. This link to rowing continued when I moved to New Zealand, and I was lucky enough to be involved at a national level as the rowing team evolved from a team of eight, to one of 56 and to become a world Gordon, Lisa Carrington and Tamsin, Rio 2016 leader. I made a choice not to tour whilst my kids were young, but I kept working in private practice, remained involved with the Regional Performance Centre for rowing at Christchurch and started working with locally based kayak athletes. This then eventuated in an opportunity to cover the national kayak teams touring in 2015 -2016. This allowed me to be a part of an inspirational world class team, and taught me much about true performance focus. My experience as a sports physiotherapist is that my opportunities have arisen in a somewhat unpredictable and unsystematic way. I have tried to continue to learn and develop skills without an end aim, but to be open to things. I aim to work with sports that I am interested in, that I fit their culture and with situations that are a positive challenge. The HPSNZ expression of the 5 Plus philosophy of physiotherapy provision, I feel is a great step towards describing our true role in sport. Christchurch HPSNZ I wanted this article to be more about Christchurch and how the HPSNZ landscape has been challenged and changed, and its future post quakes. Pre-2011, with international facilities for athletics, swimming and tri based at QE2 and good kayak and rowing facilities next to our hockey centre in Kerrs Reach (east Christchurch), Christchurch was a great base for athletes. With good university and job opportunities, alongside good training and coaching arenas, the future looked bright. Like so many parts of our lives these things disappeared or were irreversibly changed post February 2011. With the emphasis rightly on housing, health and schools, elite sport was not a focus, and
athletes disappeared to other centres, and the ones left dispersed. Amazingly quickly HPSNZ, along with the Council, IOC and Apollo projects constructed a “temporary� Christchurch centre behind Jellie Park community pool and fitness centre. It opened in May 2013, comprising of gym space, indoor netball court, flume and recovery space, medical room, lounge and office/meeting rooms. The Tactix Netball franchise based themselves there along with their physiotherapist, Sharon Kearney, and the odd collection of athletes remaining started to utilise the space. The physiotherapists working across these sports were encouraged to work out of Apollo rather than their private clinics, to start to create a medical team. This happened when travel around Christchurch CONTINUED ON NEXT PAGE
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Feature High Performance Sports Physiotherapy
A CHRISTCHURCH PERSPECTIVE - TAMSIN CHITTOCK cont’d... performance area, with the hope they will progress on to a full-time role with in HPSNZ network. All the physiotherapists here work both in HPSNZ and private practice, which I think is important in our region. We support many athletes who are just into the carding system, so we need to have strong links with private practice and to work alongside with good understanding of both environments. The Future
Rory and Tom Walsh at the Ngai Puna Wai build start became a bit easier. The centre grew, with mostly supporting development and regional athletes. Yet some amazing performances have come from here. Tom Walsh throwing in a self-laid circle under the hydro slide has climbed the world rankings, and Sophie Pascoe has dominated from a training zone with no 50m pool. Perhaps these circumstances have developed our famous Christchurch resilience and give something to performance? The numbers of carded athletes based here is still low, so it is difficult to provide a truly world class, multi service team on a full-time basis, but in 2016 the first hours based physiotherapy position was made available in Christchurch. I applied and got this part time position. I truly believe in the HPSNZ model where we are not just performing injury treatment, but are an integral part of the strategic and operations team around an athlete’s performance and development. At Apollo, the open plan clinic space sits next door to S&C and the gym, which makes for true interdisciplinary collaboration. I am found on the gym floor working with athletes with coaches and S&C as often as at the treatment bed. This means I can watch, learn from, and discuss with all the amazingly experienced providers that work with the sports. The chance to be a part of developing a true pathway for sports physiotherapists into HPSNZ work as we developed the Christchurch regional model, is also something I’m excited and passionate about. The first pathway role was filled this month with a physiotherapist starting alongside the developmental area of Pathway to Podium and RPC rowers. This is not a siloed position though, with support from me and the other physiotherapists here, to provide experience in the high-
Early 2018 we hope to see the opening of Ngai Puna Wai, Christchurch’s new and only athletics track. For HPSNZ physiotherapy we hope to see the first of the physiotherapy intern positions start here in Christchurch; this will reflect the existing S&C intern programme, and further enhance the physiotherapy pathway into high performance sport. The Apollo Centre has been handed over to the council and HPSNZ is the tenant until our move to the central city “Metro” facility planned for 2020. Here we hope to have a replica facility based within the community run centre, alongside other sports organisations such as Sport Canterbury. The centre will have 50m pool, courts, gym and shared meeting and recreational spaces. It will also have a sustainable team of physiotherapists who contribute fully across the high-performance space. The future is bright.
Tom Walsh and Angie Petty in our physio room in Apollo
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SPRINZ
Monitoring Athlete Training By Angad Marwah In this edition we hear from SPRINZ postgraduate student Angad Marwah, a strength and conditioning coach with North Harbour Rugby and Auckland Pathway to Podium. Angad provides a practical example of real world athlete monitoring that will be of interest to all those working with athletes.
(low training loads prior to high demand competitions). The GPS units can provide a comprehensive view of athlete’s physical workload. The coaches can therefore utilise this information and minimize the cost of injury by managing player’s external workload and also monitoring their readiness.
Use of technology in sports can help to gain greater understanding of the physical demands and technical aspects of the sport. In doing so, strength and conditioning (S&C) coaches are able to better plan their exercise and training prescription to keep the athlete injury free and also help them perform to the best of their ability. Modern performance analysis has been made user friendly with the introduction of devices such as GPS units that are increasingly being used and applied to a range of sporting codes. These units provide detailed information about an athlete’s or a team’s external workloads such as movement patterns, training intensities and physical activity of athletes during a game or a training session.
Generally speaking, the term S&C invokes an image of a gym or a weights room where the athlete is following a set of prescribed exercises to make them fitter, faster and stronger. Therefore, it is easy to assume that this is the start and finish of a S&C coach’s responsibility i.e. make athletes lift big weights and make them run fast. In fact, the term S&C encompasses all aspects of training that are employed to improve performance and prepare the athlete for competition (Gamble, 2015). This includes the use of both physical and psychometric monitoring tools.
Use of technology offers an opportunity to provide more detailed and meaningful insights into the demands of a sport and an athlete’s internal (e.g. heart rate) and external (e.g. GPS) workloads. This information is useful to coaches and other members of the support staff.
So why does information??
an
S&C
coach
need
this
One of the most commonly used methods of monitoring recovery in the field involves the use of a self-reporting tool. This typically comprises questions regarding relevant aspects such as sleep quality, muscle soreness and readiness to train.
Some of the metrics we are currently monitoring at North Harbour Rugby (via GPS) include speed, high intensity meters, distance covered and total number of sprints. The benchmark for these values are selected from published research in Time Motion Analysis studies of rugby and different player positions.
Before the start of the rugby season, I met with John Lythe from High Performance Sport NZ who was able to guide me in the right direction and give me a few pointers regarding some of the key variables that would be useful in building an effective athlete monitoring system. Based on his advice, I was able to create a simple questionnaire with the use of Google Docs (see figure 1 for examples of questions covered) that is user friendly, not time consuming and gives us a good picture of an athletes’ state of readiness.
The data collected from the above metrics helps coaches in the decision making and planning process and they can use this to drive on-going athlete performance optimisation. Information collected can be used to minimize injury risk by reducing occurrences of overtraining i.e. increased stress on the body usually caused by lack of recovery time between sessions with an increase in training intensity levels as well as undertraining, which is generally lack of preparation
The players are required to complete this form the day following each training and record their perceived training intensities, muscle soreness and sleep quality. Once all athletes have recorded their responses to the training sessions (these could be multiple i.e. gym session and field session on the same day), the responses are then filtered on a separate spreadsheet which is pre populated with values that will automatically “red flag” a response that is of concern
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SPRINZ Monitoring Athlete Training continued... (See figure 4). (I enlisted the help of Josh Trewin, who is completing his PhD at AUT to help set up the spreadsheet). Similarly, if the athlete is injured or does not complete a session due to an injury, that is also recorded and flagged. This information is then given to the Lead S&C coach and also the team physio who can then alter the training programmes for those identified players. This is a simple and yet effective way of reporting athlete wellness and monitoring their workload throughout the week. It has become common practice in professional and elite sports particularly to track and monitor measures of workload on a daily and weekly basis. The primary objective of this is to monitor the cumulative stress placed upon the athlete from competition and training, in order to detect whether they might be at increased risk of injury, for example due to excessive fatigue (Gamble, 2015). However, it is also important to note that while tracking athlete training load is an easy and effective way to measure wellness, it is also important to not generalise the responses across all individuals as the degree of individual variation will be substantial. Therefore it is important to get the players into a habit of completing the questionnaire so that the strength and conditioning coaches can get a better picture of a player’s wellbeing over a period of time. I have found this to be an effective way of monitoring players’ physical and wellness data which we can use to calculate chronic vs acute workload over time. The two summaries (data from GPS and athlete responses from the questionnaire) also provide a good insight about trainings and how athletes train. By having access to this information, we are able to better plan our training sessions and intensities, we are able to record and create historical performance data and can assign workload targets at athlete and team level (can be adjusted over time based on performance in training). Most importantly, these procedures are a simple yet effective way to look after the number one asset (the players) and build a culture of accountability in a professional team sport environment.
Figure 1: North Questionnaire
Harbour
Rugby
Athlete
Monitoring
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SPRINZ Monitoring Athlete Training continued... Figure 2: Excel Spreadsheet that updates the responses and highlights as necessary:
Angad is currently completing a Masters in Sport and Exercise at AUT with the focus on how caffeine affects immunity in team sport athletes when exercising in heat. Angad is also working as a Research Assistant in the Performance Analysis area for AUT and as a Strength and Conditioning Coach with Auckland Pathway to Podium. Angad is also the Assistant Strength and Conditioning coach at North Harbour Rugby, doing GPS analysis and also running the athlete monitoring system.
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SPNZ Courses
SIDELINE MANAGEMENT (SPNZ LEVEL 1 COURSE) This course is for registered physiotherapists who work with individual athletes, or on the sideline at sports games or events who want to upskill in the areas of pre-game preparation, first aid, acute injury assessment and management, and post-event recovery strategies. By the end of the course you will have all the tools you need to manage pre-event preparation, post-event recovery and to confidently assess, manage and refer common sporting injuries and wounds.
Location: Physiotherapy Department Burwood Hospital 255 Mairehau Road Christchurch
Date: Saturday 2nd December 2017 9am – 5pm Sunday 3rd December 2017 8am – 4.30pm
Course Fee: SPNZ Member $405.00 PNZ Member Non-PNZ Member
$486.00 $607.50
The course will cover: •
Ethics and professional issues in sports physiotherapy
•
Splinting of hand and finger injuries
•
Pre-event preparation and warm-up
•
Indications for medical and radiology referral
•
Strapping
•
Return-to-play decision making
•
Sports First Aid
•
Post-event recovery
•
On-field injury assessment
•
Anti-doping regulations and banned substances
•
Concussion assessment and management
Presenters:
Dr Deb Robinson (Sports Medicine Physician – former All Blacks doctor & current Crusaders doctor) Angela Cadogan (Physiotherapy Specialist – Musculoskeletal) John Wilson (Strength & Conditioning) Emma Mark (Physiotherapist Marist St Pats and Habit physiotherapy, previously Nigerian national rugby federation and championship level UK) Craig Hawkyard (Hand Therapist) Drug Free Sport NZ
To Register:
Registration will be limited to the first 27 paid registrants Online registration via Physiotherapy New Zealand
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SPNZ Courses
Injury Prevention & Performance Enhancement
Part One: Injury Prevention (Myth Busters and Mind Traps) SPNZ LEVEL 2 COURSE
This course is for registered physiotherapists who work with individual athletes or teams. Delivering athletes to the start line in optimal health is a key element of Sports Physiotherapy. Our ability to identify individual risk factors and deliver effective prevention strategies is paramount in supporting robust athletes.
Location:
Date:
AUT Millennium (SA213) 17 Antares Place, Rosedale, Auckland
Saturday 11th November 2017 8am – 4pm
Course Fee: SPNZ Member PNZ Member Non-PNZ Member
$225.00 $260.00 $325.00
The first in a 2-part course which will cover the following areas: •
Present the latest evidence and best practice in injury prevention
•
Explore successful data collection models to support team and individual sports
•
Workshop methods to identify the major health issues in your sport/athletic population
•
Explore the relevance of screening for injury prevention in sport
•
Practical workshop to explore selection, relevance and efficacy of key screening tests.
Presenters: Fiona Mathy
Head of Performance Therapies at HPSNZ (physiotherapist)
Sharon Kearney
Previous Silver Ferns physiotherapist and current Tactix physiotherapist
To Register: Registration will be limited to the first 26 paid registrants Online registration via Physiotherapy New Zealand
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SPNZ Courses
PROMOTION AND PRESCRIPTION OF PHYSICAL ACTIVITY AND EXERCISE Physical inactivity is responsible for the growing epidemic of obesity and health-related conditions. Physiotherapists play a critical role in promoting and prescribing physical activity in all age groups and are ideally placed to prescribe exercise for those with chronic health conditions, and to those wanting to return to recreational activity or competitive sport following injury.
A course covering the promotion and assessment of physical activity levels, exercise testing and ways to effectively prescribe physical activity and exercise for individuals ranging from inactive to those involved in competitive sports. Presented by:
Dr Grant Mawston and Dr Peter McNair
Date & Time: Location:
Cost:
Saturday 11th November 2017 (9am – 4pm) Sunday 12th November 2017 (9am – 4pm) AUT North Campus (AA building) Click for AUT North Campus map 90 Akoranga Drive, Northcote Auckland Click for Google map SPNZ members $425 *PNZ members $510 *Non-PNZ members $640 *PNZ price structure requirements for CPD events Cost includes morning and afternoon teas, lunch on both days and course manual.
This course is suitable for: Physiotherapists wanting to improve their knowledge and skills in assessment and prescription of physical activity and exercise to use with patients on a daily basis. This course provides a bridge to Level 2 SPNZ courses and important background information for those considering university postgraduate study.
What the course will cover: The course will provide a combination of lectures, practical demonstrations, practical assessments and
case studies and will cover the following topics: • • • • • • • •
Principles of exercise prescription Promotion and assessment of physical activity Assessment of neuromuscular performance Aerobic and functional capacity testing Strategies to enhance exercise adherence Screening for return to sport Exercise risk screening and goal setting Physiological effects of disuse and ageing
To Register:
NOTE: Registration will be limited to the first 27 paid registrants Online registration via Physiotherapy New Zealand
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SPNZ Courses
The Upper Limb in Sport (SPNZ LEVEL 2 COURSE) This course is for registered physiotherapists who work with individual athletes or teams in which upper limb injury is common. The focus of the course is on pathomechanics, diagnosis and advanced rehabilitation of upper limb conditions and kinetic chain deficits as they relate to injury prevention and performance. By the end of the course you will understand the pathoaetiology of common upper limb injuries, be able to perform key clinical and functional tests, rehabilitate upper limb injury in a number of sporting contexts including swimming, throwing, racket and contact sports, and develop individualised return-to-sport programmes.
Course Pre-requisite: This is an advanced rehabilitation course. As such, it is a pre-requisite for this course that the attendees have completed the Level 1 Promotion and Prescription of Physical Activity and Exercise course. Alternatively if you feel have a good knowledge of exercise and its safety guidelines you may do the enclosed quiz (click HERE).
Location: AUT North Campus (AA building) 90 Akoranga Drive, Northcote, Auckland
Date: Saturday 18th November 2017 8.30am – 5pm
Course Fee: SPNZ Member $405.00 PNZ Member $486.00 Non-PNZ Member $607.50
Sunday 19th November 2017 9am – 4.00pm
The course will cover: •
Pathomechanics of upper limb injury in collision sports, swimming, throwing & racquet sports
•
Performance-related functional tests for the upper limb
•
Diagnostic tests and imaging investigations for common sporting pathologies of the upper limb
•
Design and implementation of rehabilitation programmes and processes
•
Integration with coaching and biomechanics for technique modifications
•
Return-to-sport decision planning and processes
•
Injury prevention including conditioning, pacing and workload management
Presenters: Dr Angela Cadogan Physiotherapy Specialist (Musculoskeletal) Mandy Gumbly Registered Hand Therapist Sports Physiotherapist TBC
To Register: Registration will be limited to the first 26 paid registrants Online registration via Physiotherapy New Zealand
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ASICS ASICS Grant Report By Lee-Anne Taylor
Thank you for your support and financial assistance in attending the International Sport Science and Sport Medicine conference (ISSSMC) held in Newcastle on Tyne, UK in September. It was a fantastic experience and I was privileged to be one of four to give an original communication on a pilot study conducted in the lower north island, piloting a preseason netball specific programme. Key Summary points: •
Pre-season programme indicates an improvement in athlete measures such as strength and agility
•
Functional movements improve following a pre-season programme
•
Optimal timing for delivery is pre-season, the period in time before any netball trials or trainings begin
•
Some form of neuromuscular programme is required during the netball season e.g. Neuromuscular warm up protocol (Netball Smart) to enhance the injury prevention effect
•
Further research is required into the number of netball hours adolescent players are engaged in and the prevalence of injuries
Netball is a dynamic sport involving high impact pivoting movements, jump and landing which are associated with higher prevalence of injuries (Simpson, Reid, Ellis, & White, 2015). Due to the nature of the netball game, players are susceptible to both knee and ankle injuries. One of the most devastating of these is an Anterior Cruciate Ligament (ACL) injury which generally requires surgical intervention and a six to nine month rehabilitation programme before returning to the court (Davis, Ireland, & Hanaki, 2006). From the period of 2008/9 to 2012/13 there was an increase of 34% of surgically repaired ACL attributed to netball injuries (Simpson et al., 2015). The likelihood of returning to the same level of sport following an ACL injury is between 45-80%, with an increased risk of re-injury of 20% (Lohmander, Ostenberg, Englund, & Roos, 2004; Myklebust, Holm, Maehlum, Engebretsen, & Bahr, 2003). Alongside this, research indicates a strong link between ACL injury and development of osteoarthritis in the knee joint within ten years of the injury (Oiestad, Engebretsen, Storheim, & Risberg, 2009). With adolescent females two to eight times more likely to rupture their ACL than male counterparts (Michaelidis & Koumantakis, 2014), there is a need to provide preventative programmes for female teams. Ankle injuries also have a higher incidence in females, almost double compared with males with indoor/court sports having the highest occurrence, 13.6 per 1000 exposure hours (Doherty et al., 2013). There is substantial evidence that supports the use of pre-season conditioning programmes (Abernethy & Bleakley, 2007), neuromuscular programmes (Hübscher et al., 2010), specific injury prevention training programmes (Sadoghi, von Keudell, & Vavken, 2012) and neuromuscular warm up protocols (Herman, Barton, Malliaras, & Morrissey, 2012) to reduce the rate of knee injuries. Proprioceptive training, a component of all these programmes has also been found to reduce ankle injuries by 36% (Schiftan, Ross, & Hahne, 2015). Programmes that are conducted over six weeks which include education, strength, jumping and landing, agility drills and sport specific skills have been found to improve landing biomechanics, vertical jump height, agility testing and strength which translates into athletic performance (Myer, Ford, & Hewett, 2004; Noyes & Barber-Westin, 2015). These programmes appear to be most effective if they commence pre-season and are continued in some format throughout the playing season (Myer et al., 2004; Noyes & Barber-Westin, 2015). This research was conducted between February and April of 2016 with three netball centres and three secondary
school teams involved in the pre- (initial) and post- (at the end of six weeks) testing. Two of the netball centres and of the one secondary school teams took part in the six week intervention programme; the remaining centre and CONTINUED ON NEXT PAGE
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ASICS ASICS Grant Report continued... teams forming the control group. The intervention was delivered in consecutive weeks with players in the U15 age bracket completing the programme twice a week and those in the U17 age bracket completing the programme three times per week with an educational session held once per week. Table 1 provides an overview of the participants and baseline results. Table 1. Participant profiles and mean (SE)š baseline testing results
Mean (SE) Age *** Netball hours per season (hrs) BMI Menarche (%)² Previous injury (%) Ankle Elbow Knee Shoulder Previous surgery (%) Ankle Knee - ACL Shoulder
Intervention Group n=82
Control Group n=30
n=112
15.0 (0.13) 203.4 (12.31)
16.7 (0.16) 186.1 (19.75)
15.4 (0.13) 198.8 (10.43)
21.8 (0.37)
22.3 (0.54)
21.9 (0.31)
95.1
96.67
95.5 (0.02)
12.2a 1.2 a 11.0 1.2 a
47.0b 0.0 a 23.3 0.0 a
Total
21.4 0.89 29.5 0.89
2.4 a 4.9 a 1.2 a
3.3 a 0.0 a 0.0 a
2.6 3.6 2.6
8.5 a
36.7 b
16.1
a
a
10.7
6.8 (0.65) 41.7 (3.82)
8.1 (0.94) 59.1 (5.68)
7.2 (0.54) 46.4 (3.26)
Left side hold (s)***
21.9 (1.68)
44.0 (3.67)
27.8 (1.82)
Right side hold (s)***
25.1 (1.97)
41.4 (3.70)
29.5 (1.87)
Right jump (cm)
29.0 (0.51)
27.3 (0.76)
28.6 (0.43)
640.9 (28.68)
635.6 (44.11)
639.4 (23.97)
28.8 (0.47)
26.3 (0.76)
28.1 (0.41)
Current injury (%) Ankle Knee Pre-testing Press up Prone hold (s)*
Right jump power (Watts) Left jump (cm) Left jump power (Watts)
9.8
13.3
635.0 (28.39)
614.3 (41.68)
629.3 (23.49)
Broad jump (cm)**
181.3 (2.15)
169.0 (3.15)
178.0 (1.85)
Illinois agility (s)***
18.5 (0.09)
19.4 (0.16)
18.8 (0.08)
Functional Movement Screen*
10.9 (0.25)
9.8 (0.23)
10.6 (0.20)
Single left leg balance (s)
16.5 (1.92)
10.3 (1.83)
14.85 (1.51)
Single right leg balance (s)
18.8 (2.35)
19.4 (4.46)
19.0 (2.09)
* P<0.05, **P<0.01, *** P<0.001 derived from an ANOVA and indicating a significant difference between control and intervention groups means 1 SE: Standard Error of the Mean 2 Differing superscripts indicate that the control and intervention group proportions are significantly different at the 0.05 level as determined by a z-Test
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ASICS ASICS Grant Report continued... There were 12 players that indicated playing hours over and above 400 hours a season which strongly correlated with previous knee and/or ankle injuries (83%). Alongside this 67% of these players were complaining of current ankle injuries. Some anecdotal investigation into player workloads had been completed by Netball New Zealand (NNZ) staff and as a result of this, the NZ U21 coach for the 2013 Youth World Cup reducing her player workload for the 2012/2013 season to only two netball campaigns only (i.e. playing for only two teams) due to evidence in research literature to suggest any more than that per season had a higher risk of injury (Southby, 2014). The initial testing indicated that on average players were poor in their strength measures such as; press up, prone and side holds which were well below the suggested national standards by NNZ (Netball New Zealand, 2014). Players averaged 28cm and 29cm jump height (left and right respectively) and scored lowly on the Functional Movement Screen (FMS) with an average of 10.9. A score of lower than 14 on the FMS is thought to be an indicator for risk of injury in adolescents (Chorba, Chorba, Bouillon, Overmyer, & Landis, 2010). Statistically significant improvements (paired t-Tests; P<0.05) in those who undertook the programme are identified in Table 2. Table 2. Pre- and post-test differences in measures1,2 and intervention versus control3,4 group comparisons Measure
Between group analysis
Control group
Intervention group
n
Mean difference ± standard error
p-value2
n
Mean difference ± standard error
p-value2
p-value3
Controlled for age p-value4
Effect size
Press up
82
7.1 ± 0.66
<0.001
17
2.5 ± 1.19
0.500
0.004
0.012
0.8
Prone hold (s)
82
31.1 ± 4.12
0.002
17
13.6 ± 1.19
0.183
0.085
0.229
0.5
Left side hold (s)
82
23.8 ± 2.45
0.030
17
3.0 ± 5.54
0.602
0.001
0.003
0.9
Right side hold (s)
82
24.4 ± 2.68
0.001
17
0.8 ± 6.77
0.911
0.001
0.002
0.9
Right jump (cm)
79
-0.6 ± 0.27
<0.001
17
1.2 ± 0.66
0.089
0.008
0.026
0.3
Right jump power (Watts) Left jump (cm)
79
-12.1 ± 5.71
<0.001
17
25.5 ± 13.95
0.086
0.111
0.027
0.3
79
-0.5 ± 0.28
<0.001
17
0.6 ± 0.75
0.415
0.008
0.241
0.1
Left jump power (Watts) Broad jump (cm)
79
-10.3 ± 5.84
<0.001
17
13.0 ± 15.75
0.420
0.111
0.243
0.1
80
-0.4 ± 1.80
<0.001
17
-2.8 ± 2.90
0.924
0.974
0.132
0.1
Illinois agility (s)
79
-0.6 ± 0.07
<0.001
17
-0.9 ± -0.65
0.001
0.073
0.200
0.4
Functional Movement Screen Single left leg balance (s) Single right leg balance (s)
82
5.7 ± 0.27
0.020
17
1.9 ± 0.52
0.002
<0.001
<0.001
1.6
81
5.9 ± 3.32
0.031
17
15.3 ± 11.22
0.192
0.293
0.383
0.2
81
2.2 ± 2.95
0.064
17
8.0 ± 7.79
0.320
0.430
0.597
0.2
¹ p-values in bold indicate a significant difference 2 p-value derived from paired t-tests between pre- and post-testing measures 3 p-value derived from one way ANOVA (dependent variable=change [post-pre], independent variable=intervention or control) 4 p-value derived from one way ANOVA (dependent variable = change [post-pre], independent factor=intervention or control; independent covariate=age)
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PAGE 17
ASICS ASICS Grant Report continued... When comparing the results from the control group to the intervention participants; press ups, side holds both left and right and the FMS show greater improvement in those completing the pre-season programme. Similar results were found when analysing the effect of age on the results, i.e. the older the player the greater the change. There were also indications that compliance (the percentage of the programme completed) affects right side hold strength. When comparing the U15 and U17 results there is a weak correlation between the number of sessions per week, with the number of press ups a player completed and the FMS score, suggesting there is an improved outcome by doing the programme three times per week rather than twice. However this result may be influenced by the age and development of adolescent females and would need further evaluation to determine the effect. Interestingly, the right and left handed jump reach height and broad jump reduced at post testing for the participants (0.5cm, 0.6cm and 0.4cm respectively). The pre-season programme used a regime by Hewett, Lindenfeld, Riccobene, and Noyes (1999) previously found to decrease the risk of knee injury using a plyometric programme reducing potentially dangerous landing forces and increasing hamstring muscle power. When analysing the effects of plyometric training there is conflicting evidence supporting an improvement and showing a slight reduction in jump height (Markovic & Mikulic, 2010). Factors such as muscle damage and residual fatigue are thought to affect vertical jump height (Markovic & Mikulic, 2010). Investigation into the compliance data revealed that players were involved in school and club trials and trainings towards the end of the pre-season programme indicating that the delivery period was not within the true pre-season window. Optimal timing for this programme would be to complete the six week programme and then start school and club netball trials and trainings. This overlap of the pre-season programme and the start of the netball season may have negatively impacted the results for these measures if players were involved in plyometric training and/or netball games which involve repetitive jumping and landing. Further investigations into jumping programmes for adolescents, is also required to ensure both optimal neuromuscular control and improvements in jump height occurs. These findings indicate an athletic improvement in strength, agility and the FMS indicates that there is a reduction in the risk of injury for these players after undertaking the pre-season netball programme as the FMS score is over 14. The control group, however, only improved in agility testing and the FMS but their mean score was still below 14 suggesting that they are at higher risk of injury leading into the netball season. Over the course of the season there were 13 lower limb injuries sustained, 9 ankle injuries, one anterior shin pain and 3 serious knee injuries. The incidence rate for ankle injuries was similar in the case and control group and were predominantly contact injuries. Two ACL injuries were sustained in the control group and one patella dislocation in the case group. Pre-season programmes have been found to be effective in reducing injuries in other sporting codes such as football, but appear to be most effective if they commence pre-season and are continued in some format throughout the playing season. Netball Smart has been delivered by NNZ advocating neuromuscular warm up injury prevention programme (modelled on the FIFA 11+ protocol) which would then allow the benefits of any pre-season programme to be further enhanced should this protocol be adopted by netball teams. The findings from this research indicate that there are athletic performance improvements and the potential for a reduction of injury risk by completing a pre-season programme, however, further analysis is required to determine an effect. It is the intention to review the programme and modify for delivery for the upcoming season with particular emphasis on the timing of the delivery of the programme. The ISSSMC conference had several themes - the initial concussion in sport, particularly rugby where their data is suggesting that the incidence of injury and concussion could be reduce by removing the â&#x20AC;&#x153;tackleâ&#x20AC;? in school rugby. In Canada there was a 50% relative reduction in injury rate and a 64% reduction in concussion rate in 11-year-old and 12-year-old when they removed body checking in youth ice hockey (Black et al., 2017). Food for thought? Common sport psychometric testing in the UK are ImPACT and CogState Sport used for baseline and postconcussion tests. Interestingly UK rugby players from levels 1 to 4 (international down) must complete training and testing prior to starting the season using CogState Sport. A history of migraine, educational problems of LD ADHD can increase recovery time for concussion.
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ASICS ASICS Grant Report continued... Linked to concussion there is research emerging that there are gene indicators across several genomes that may make some more vulnerable and therefore prolong recovery. Research questions are emerging - can genetics predict elite sport performance and predict injury risk? Further research in these areas could assist certainly training loads, recovery strategies and rehabilitation programmes. Bone health is a strong issue and the consensus on the type of exercise must include multidirectional forces, high impact movement and involve eccentric forces however the questions still remain relating to the type of exercise, exercise parameters and the timing of the interventions e.g. age of participants. Alongside this the increase in Masters sports participation where athletes tend to be engaged in habitual loading influences throughout their life. Using data from research there is the potential to develop physical activity guidelines and development of strategies to prevent or diminish age-related bone loss. Interestingly masterâ&#x20AC;&#x2122;s athletes are much better off in musculoskeletal and cardiovascular function than age matched non-athletes suggesting a rejuvenation of 20 years. Letâ&#x20AC;&#x2122;s all get and remain active! Trunk strength and stability in relation to sporting performance suggests that full kinetic chain exercises that reflect the challenge of the sporting activity they are required to perform or deficit in is the best approach using overload which in turn can impact power and velocity. Commonly used activities include squatting with minimal differences between overhead, back and front squat EMGs with alterations in foot position not altering the activation of prime movers. Regular exercise in athletes with type 1 diabetes is not always associated with an improvement in overall glycaemic control. Enhanced insulin sensitivity after exercise means that people with type 1 diabetes face challenges managing their insulin therapy, in fact they can go into hypoglycaemic unawareness which in extreme cases can be fatal. A medic needs to understand the differing insulin regimes and associated limitations as well as the pathophysiology of exercise to support an athlete with type 1 diabetes. Hamstring and ACL injuries research return to sport were also discussed with findings suggesting that the less days to start physiotherapy treatment decreased the time to return to play (also days to walking pain free, palpation, flexibility and strength). No evidence (from research) that supports the use of NSAIDs or platelet-rich plasma. Rehabilitation protocols in Norway follow Brukner and Khan (v.5; 2017) rehabilitation model using ROM, motor control and muscle strength as measures alongside psychological factors and clinical judgement. These programmes are individualised and progress from activation of muscle, single leg loading (+/- instability) to involving severe planes of movement, frequently using lengthening exercises and sport specific movements. Similarly ACL return to sport measures should include individualised testing based on functional demands of the sport, including testing throughout the rehabilitation period (time specific) and involve strength, movement control, psychological and functional strength tasks and reactive decision when fatigued. In high performance sport access to sophisticated testing equipment informs the decision making alongside previous data collected on player physical testing. Thank you once again for supporting this!
References available upon request.
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Clinical Section - Article Review Pain in Elite Athletes Neurophysiological, Biomechanical, and Psychosocial Considerations: a Narrative Review Brian Hainline, Judith A Turner, J P Caneiro, Mike Stewart, G Lorimer Moseley British Journal of Sports Medicine 2017;51:1259-1264.doi:10.1136/bjsports-2017-097890
Injury and pain interfere with peak performance. Pain management should be based on physiological, anatomical, and psychosocial influences on the individual’s pain and is not equivalent to injury management, which focuses on musculoskeletal recovery and return to play. Pain commonly accompanies sport injury.1-3 Pain can occur independently of injury, or persist after an injury has healed.8-11 Pain is defined as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’12 Pain is a personal experience influenced by a variety of factors, including neurophysiological, immunological, cognitive, affective and social/environmental influences. 13-18 The longer pain persists, the more opportunity there is for psychological, social and environmental or contextual factors to influence the pain and associated problems such as functional disability. 19 The guidelines regarding management of pain associated with sport injuries in athletes in general and elite athletes in particular, are lacking. For optimal care it is important to understand the aetiology of and influences on pain and to intervene using strategies with the optimal expected outcome and the least expected harm. Pain is not synonymous with sport injury, that is, injury can occur without pain, and pain may develop or persist independent of the status of injury recovery.24-25 ‘Abnormal’ anatomical findings are commonly observed in imaging studies of asymptomatic individuals,26-28 and patients commonly report pain in the absence of relevant imaging finding. 29 Communication between experts in pain medicine and sports medicine has substantial potential to improve the understanding and management of pain in elite athletes. Most pain medicine specialists are not trained in sports medicine, and most sports medicine clinicians do not have specialty training in pain. This leads to a gap in managing and understanding the unique aspects of pain in the elite athlete.
Pain Definitions Nociceptive pain: pain generated by a noxious insult that activates the nociceptors in peripheral tissues. Nociceptive pain is associated with tissue damage or inflammation that activates the nociceptors in peripheral tissues. Inflammatory pain (pain associated with active inflammation) is a type of nociceptive pain. Neuropathic pain: pain generated by a lesion-demonstrable by diagnostic investigations or by clear frank trauma-or disease (ie, a known disorder such as stroke or diabetes mellitus) of the somatosensory nervous system. Nociplastic/algopathic/nocipathic pain: pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing activation of peripheral nociceptors or evidence of disease or lesion of the somatosensory system causing pain Pain of unknown origin: pain that cannot be classified as nociceptive, neuropathic or nociplastic/algopathic/ nocipathic. Athletes can present with one or any combination of these types of pain: nociceptive, neuropathic, nociplastic/ algopathic/nocipathic and pain of unknown origin. Regardless of the type of pain, when it persists long term and especially when it is moderate to severe, it is often accompanied by psychological distress (most commonly depression, anxiety or both); sleep disturbance; poor physical conditioning; and physical, social and functional role limitiations.13-15 For all patients who present with pain, including elite athletes, assessment should include usual and variable pain intensity; usual and variable pain location; the impact of pain on performance, mood and physical and social function; duration of pain; nature of any triggering event; and aggravating and alleviating factors. Thorough and precise CONTINUED ON NEXT PAGE
PAGE 20
Clinical Section - Article Review Pain in Elite Athletes Neurophysiological, Biomechanical, and Psychosocial Considerations: a Narrative Review continued... questioning regarding the location of pain is critical for understanding the likely contribution of nociceptive, neuropathic, and nociplastic/algopathic/nocipathic components. Asking patients to rate the extent to which pain interferes with activities is important for understanding how much pain impacts the patientâ&#x20AC;&#x2122;s ability to participate in customary activities46 particularly when pain persists beyond the acute time period. The potential influence of factors within the wider biological domain, the psychological domain and the social/environmental domain needs to be assessed and considered in planning treatment. The sports medicine clinician should consider the possibility of psychosocial factors modulating pain and behavioural responses. Physical examination of the elite athlete requires a full-body approach. The sequence of events that must occur for forces to be transmitted from one body part to another in order to generate speed and power leading to mechanical efficiency is known as the kinetic chain. A breakdown in the kinetic chain can lead to excessive application of compensatory forces in an attempt to maintain a certain level of performance. 47 Consideration of training loads49-53 and periodisation49,51,54-56 should be part of the assessment as breakdown of these components can make an athlete vulnerable to injury or poor recovery. Careful sensory examination will allow the sports clinician to identify neuropathic and nociplastic/algopathic/ nocipathic contributions to pain. When pain persists beyond expected time frames, management needs to extend further. The sports clinician needs a broad appreciation of modern pain biology to optimally manage elite athletes in pain. Contextualising pain experience to the athleteâ&#x20AC;&#x2122;s individual situation is paramount for targeted and optimal management and requires consideration of relevant factors that modulate pain experience including biological, psychological, social and sport-specific and training domains. This article reminds us that as clinicians dealing with elite athletes there are many factors we must take in to account in order to provide an individualised, complete, optimal rehabilitation program.
A full set of references are available on request.
By Pip Sail Physiotherapist
PAGE 21
Research Publications British Journal of Sports Medicine www.bjsm.bjm.com Volume 51, Number 20, October 2017 EDITORIALS ‘Don't let kids play football’: a killer idea James MacDonald, Gregory D Myer Response to: ‘Don’t let kids play football’: a killer idea Rachael Bullingham, Adam White, John Batten The athlete monitoring cycle: a practical guide to interpreting and applying training monitoring data Tim J Gabbett, George P Nassis, Eric Oetter, Johan Pretorius, Nick Johnston, Daniel Medina, Gil Rodas, Tom Myslinski, Dan Howells, Adam Beard, Allan Ryan When is a study result important for athletes, clinicians and team coaches/staff? Rasmus Oestergaard Nielsen, Michael Lejbach Bertelsen, Evert Verhagen, Mohammad Ali Mansournia, Adam Hulme, Merete Møller, Martí Casals REVIEWS Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials Tero Pasanen, Samppa Tolvanen, Ari Heinonen, Urho M Kujala Factors associated with participation in resistance training: a systematic review Ryan E Rhodes, David R Lubans, Nandini Karunamuni, Sarah Kennedy, Ronald Plotnikoff Current state of concussion prevention strategies: a systematic review and meta-analysis of prospective, controlled studies Daniel K Schneider, Ravi K Grandhi, Purnima Bansal, George E Kuntz IV, Kate E Webster, Kelsey Logan, Kim D Barber Foss, Gregory D Myer ORIGINAL ARTICLES ‘FIFA 11 for Health’ for Europe. 1: effect on health knowledge and well-being of 10- to 12-year-old Danish school children Colin W Fuller, Christina Ørntoft, Malte Nejst Larsen, Anne-Marie Elbe, Laila Ottesen, Astrid Junge, Jiri Dvorak, Peter Krustrup Psychological impact of electrocardiogram screening in National Collegiate Athletic Association athletes Irfan M Asif, Scott Annett, Joseph A Ewing, Ramy Abdelfattah, Brittan Sutphin, Kyle Conley, Justin Rothmier, Kimberly G Harmon, Jonathan A Drezner
http://bjsm.bmj.com/content/
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Classifieds PALMERSTON NORTH Rehab Physio Centre Rehab Physio Centre in Palmerston North is looking for an enthusiastic, energetic physiotherapist who will enjoy working with a variety of sports, spinal and work related injuries. We have a fully equipped rehab facility including an on-site gym.
Skills and Experience: We are looking for physiotherapists at any level. What we are interested in is someone with a positive approach who wants to grow their skills and experience and enjoys a social and busy environment. You will receive support from our senior physiotherapists along with on-going professional development. This is what our staff say: I have found Rehab Physio Centre to be an excellent environment to learn and progress my skills in sports and musculoskeletal physiotherapy. The high quality, post graduate senior physiotherapists are capable and willing to teach not only skills but also critical thinking. Rehab Physio Centre’s evidence based approach to the assessment and treatment of patients promotes a range of techniques such as manipulative therapy, acupuncture and rehabilitative exercises. The gym allows for optimal rehabilitation of patients while building your exercise based rehabilitation knowledge and skills. The professional and friendly environment has seen my skills surpass other graduates of my year while still being able to enjoy my role and have a laugh. I highly recommend Rehab Physio Centre as a clinic to work in if you are interested in sports and musculoskeletal physiotherapy. Keegan Harnett, Physiotherapist at RPC December 2015 – current
Interested? Have a look at our website www.rehabphysiocentre.co.nz and, if we sound like your kind of practice, contact Mike Harnett at mike@rehabphyiocentre.co.nz to find out more.
CAMBRIDGE MSK Physiotherapist An opportunity has become available for a MSK Physiotherapist to join our friendly and supportive team at Vigour Physiotherapy in Cambridge. We are looking for a passionate and motivated physiotherapist, someone who is a hardworking, team player with the ability to work independently when required. We offer a varied and interesting environment, with support and encouragement to use and grow all your skill sets. Applicants will ideally have a passion for manual therapy, sports & exercise rehab. The position will have a focus on musculo-skeletal and sports management and vocational rehabilitation. Vigour Physiotherapy has recently relocated to new, purpose built premises, with fully equipped onsite gym and rehab equipment. We have an outstanding reputation within our local community, providing services to local sports clubs, both local high schools and involvement with WRU and Magic Netball teams. The successful applicant will receive • Competitive remuneration, • Support towards professional development and mentoring • Professional memberships • New Premises with bright and spacious treatment rooms Friendly team environment, supported by a full time administrative team
New grads welcome to apply. Applicants must have NZ residency or valid NZ work permit and a current NZ annual practising certificate. Apply in writing, along with a current CV to clarke@vigourphysio.co.nz or ring Clarke on 0211782187
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Classifieds PALMERSTON NORTH Churchyard Physiotherapy We are busy and need someone great to fill a new fulltime permanent position starting November 2017. If you are: • Passionate about developing your skills in musculoskeletal and sports therapy • A great communicator • An organised and professional therapist • Registered with the NZ Physiotherapy Board Then read on … We have two clinics – one in central Palmerston North that was completely rebuilt and expanded in 2014 and is now a superb facility with spacious rooms, exercise area and with hand therapists on site. The other is the Massey University Student Health Physiotherapy clinic, situated on campus. Both clinics are fully computerised using Gensolve. We have the contract for Manawatu Rugby and the clinic principal has extensive experience working with sporting teams at provincial, national and international levels. If working with sports teams is your thing then there are plenty of opportunities in this area. But it isn’t just about sports injuries – we treat a diverse range of clients so you will get lots of experience treating all musculoskeletal conditions including ACC Pain Service Clients. You will work in a supportive environment, with five other therapists and a great admin team. Senior staff have post grad qualifications in Manipulative Therapy and are willing to share their knowledge and experience. You will be part of our regular inservice education programme and receive assistance with CPD. Our appointments are structured such that you have 40 minutes for new patient assessments and 20-40 minutes for followups. Admin time is scheduled into the day. New graduates and new overseas arrivals are offered additional support and mentoring with senior staff on a one-on-one basis. Bonus sign on payment of $1000.00! If you are interested or just want to know more about the role: Check us out at: www.churchyardphysio.co.nz Call Fiona on 06 3548008 or 027 2203179 Email Fiona fiona@churchyardphysio.co.nz
AUCKLAND The Urban Physio Musculoskeletal Physiotherapist If you’re an experienced physiotherapist with outstanding customer service and treatment skills, our thriving Herne Bay practice would love to hear from you. At The Urban Physio we treat our clients as individuals, returning them to their urban lifestyles through bespoke and personalised treatment. In addition to flawless technical skills, we’re searching for someone who embodies The Urban Physio brand, with a sense of fun, motivation and love of innovation. In return, you’ll have the opportunity to work alongside our Senior Physio who has built a renowned international career supporting New Zealand sports teams and elite athletes. The Role This exceptional role will see you provide a diverse range of musculoskeletal physiotherapy treatments including:
• • • • • • •
Sports Injury Rehabilitation Spinal Manipulation and Mobilisation Pre and Post Op rehab Muscle balance General Musculoskeletal conditions Trigger Point Massage Dry Needling and Acupuncture (if qualified) You will have a minimum of three years’ experience and hold a Bachelor of Health Science (Musculoskeletal Physiotherapy) and preferably have a Post Graduate qualification in acupuncture or dry needling. What to Expect At The Urban Physio, we offer a welcoming environment, with the chance to grow your existing Physio skills and learn innovative treatment techniques. If work/life balance is important to you, we are open to exploring hours to suit, including full and part time work, plus we’re flexible on a start date. We also offer competitive remuneration and support for further professional development. Email your C.V. to info@theurbanphysio.co.nz or to discuss please call Catherine on 0274729963.
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Classifieds OTOROHANGA / TE AWAMUTU Focused Physiotherapy Physiotherapist Position A position has become available in our expanding physiotherapy clinics in Otorohanga and Te Awamutu, both friendly communities in the Waikato. Experienced physiotherapists and new graduates are welcome to apply. Join an experienced team of eight physiotherapists with a variety of specialities including manual therapy, sports physiotherapy, HPSNZ providers, Pilates, acupuncture, cancer rehab, breathing and dizziness experience to name a few. We have on-site clinics and the opportunity to work in a variety of off-site locations such as schools, sports teams and rest homes in our area and in our gym running small group classes. Principal physiotherapist is a provider for HPSNZ and was physiotherapist for the New Zealand Olympic Team Rio 2016 and the upcoming 2018 New Zealand Commonwealth Games Team in the Gold Coast. We are looking for a friendly and enthusiastic therapist with good organisations skills and ability to work well within a team environment. The clinic is fully accredited, with a focus on mentoring, clinical and professional supervision, weekly in-service and CPD support. Our new graduates all have extended appointment times and are paid a salary to ensure you are supported during your graduate year with no pressure while you are learning the ropes of private practice. Full or part time hours of employment are negotiable with competitive remuneration. If you would like to discuss this position contact Kara Thomas on 027 2263 702 or email your CV to kara.thomas@focusedphysio.co.nz. All applications will be kept strictly confidential.
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Classifieds ASSESSMENT OF CENTRAL PAIN MECHANISMS: ONLINE SURVEY Dear Physiotherapist We invite you to spare 10-15 minutes of your time to complete our online survey, which aims to identify the current clinical practice of physiotherapists in relation to the assessment of central pain mechanisms in patients with musculoskeletal (MSK) pain. The results of this survey will help to identify the needs for training in the assessment of central pain mechanisms for better targeted management strategies. You are eligible to participate if you: â&#x20AC;˘ Currently holding an annual practising certificate â&#x20AC;˘ Routinely assess and treat patients with MSK pain To participate, please click on the link: https://otago.au1.qualtrics.com/jfe/form/SV_3HI3276tRr2R0Il By completing this survey, participants will be given the opportunity to enter a prize draw for an eBook on MSK pain mechanisms. Thank you for your time in supporting this study. Sincerely, Abdullah Alqarni PhD Candidate School of Physiotherapy University of Otago Email: abdullah.alqarni@postgrad.otago.ac.nz Webpage: http://www.otago.ac.nz/physio/research/otago444401.html