Embed Size (px)
Citation preview
PAGE
SPNZ
NEWS
BMJ Learning Modules
FEATURE
Phoenix Physiotherapist
EXERCISE
PROMOTION &
PRESCRIPTION
Level 1 SPNZ Certificate Course
FEATURE TOPIC: Football
SPNZ BULLETIN
Issue 3 June 2015
PAGE 2
In t
his
is
su
e:
SPNZ MEMBERS PAGE
See our page for committee members, links & member information 3
EDITORIAL
By SPNZ President Hamish Ashton 4
LATEST NEWS
BJM Learning Modules 5
MEMBERS’ BENEFITS
Discounts 6
FEATURE
Robert Lee: Head Physiotherapist, Wellington Phoenix FC 7
SPRINZ
Progressing Rehabilitation Training with Exogen Exoskeletons 10
RESEARCH PUBLICATIONS
JOSPT Volume 45, Number 6, June 2015 11
BJSM Volume 49, Number 12, June 2015 12
CLINICAL SECTION - ARTICLE REVIEW
The Football Association medical research programme: an audit of injuries in academy youth football 13
Three distinct mechanisms predominate in noncontact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases 14
CASE STUDY
Grade 1 ACL rupture in an elite football player 16
CONTINUING EDUCATION
AUT Enhancing Muscular Performance online paper 17
Local course and APA CPD Event Finder 18
The Biomechanics Lab: Managing runners in practice 19
CLASSIFIEDS 20
Contents
PAGE 3
SPNZ Members’ Page
SPNZ EXECUTIVE COMMITTEE
President Hamish Ashton
Secretary Michael Borich
Treasurer Michael Borich
Website & IT Hamish Ashton
Committee Monique Baigent
Timofei Dovbysh
Blair Jarratt
Justin Lopes
Emma Mark
Bharat Sukha
Kara Thomas
EDUCATION SUB-COMMITTEE
Hamish Ashton - chair
Dr Angela Cadogan
Justin Lopes
Dr Grant Mawston
Dr Chris Whatman
BULLETIN EDITOR
Aveny Moore
SPECIAL PROJECTS
Karen Carmichael
Kate Polson
Amanda O’Reilly
Pip Sail
Louise Turner
Visit our website www.spnz.org.nz
CHECK OUT THESE LINKS
Sports Physiotherapy NZ
List of Open Access Journals
Asics Apparel and order form
McGraw-Hill Books and order form
Asics Education Fund information
IFSPT and JOSPT
CONTACT US
Michael Borich (Secretary)
26 Vine St,
St Marys Bay
Auckland
A reminder to graduate members that this $1000 fund is available twice a year with application deadlines being
31 August 2015.
Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing
education in the fields of sports and orthopaedic physiotherapy.
An application form can be downloaded on the SPNZ website sportsphysiotherapy.org.nz.
ASICS EDUCATION FUND
Welcome to Sports Physiotherapy New Zealand
Follow us on Twitter
Join us on Linkedin Groups
Join us on Facebook
ADVERTISING
Deadlines for 2015:
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.
PAGE 4
Editorial
The last few weeks have been full of football. The U20
World Cup would have just finished by the time this
goes out and the Women’s World Cup will be reaching
the finishing stages. The U20 boys have performed
their best ever reaching the knockout rounds. Having
worked with a number of them as U17’s it has been
interesting to see them play and it has been a huge
step up from two years ago. Though we have still a
long way to go, we, as a nation, are becoming
competitive. Hopefully the women will win this week
and make it through to the knock out rounds as well.
They have been playing well over the last year, but
not quite been there.
Justin – one of our exec members - is currently in
Canada with the women’s team. I would like to
congratulate him on his efforts and representation of
SPNZ. Congratulations also to any of our members
that were involved with the U20’s.
Talking of stepping up, we had our AGM in Auckland
recently. Attendance numbers were very low, not
helped by being a wet and windy Monday night.
Hopefully the turnout is not a reflection of the interest
and enthusiasm of the membership. Though we are
all busy these days it is good to remember we are all
volunteers and support in any form or shape in what
we do is appreciated. Ideas and a helping hand are
also very welcome. However, following the meeting
we have two new executive members: Monique
Baigent, who was one of our newsletter helpers, has
joined the exec, along with Emma Mark from
Wellington who has joined us also. Thanks to these
two new exec members and others who expressed
interest in helping out.
We are starting to think about planning for next year
and hopefully the exec will have a weekend planning
meeting at the end of the winter season. PNZ has just
released the dates for the next SIG Superconference.
It will be held mid-September in Auckland again, and
PNZ are starting to look for speakers. So if anyone
has any ideas for speakers please send them through
to me ([email protected]). Due to this now looking
like it will be a regular feature we have had thoughts
on where our symposium fits in. From comments I
hear it is something we intend to continue with but at
this stage are looking to shift it to the alternative year
to the Superconference. We are looking at the
possibility of something smaller next year as a fill in.
SPNZ has worked hard over many years to develop
and secure a number of benefits for its members.
Despite advertising them regularly in the bulletin we
feel they are under-utilised, possibly due to members’
lack of awareness of them. I invite you to take this
opportunity to check what we have to offer – click
here.
One of the recent major benefits has been our
agreement with the BJSM. There are two new
updates on this. Firstly, as part of our agreement we
have a NZ edition of their journal. This is coming out
in July. What does this mean to us? We get to
promote SPNZ, its courses and events, as well as
choosing the publications for the issue. This issue has
been a test case for us as we didn’t have a long time
to prepare. We however have managed to find a
number of articles that reflect us as New Zealanders,
as well as our approach of providing practical hands
on information that can be used in day to day practice.
The second part is we now have access to their
learning modules. These are great CPD tools that are
done online, so great for the person that needs that
extra few hours, or just can’t get out of town to the
next course. They are also free!!
Enjoy the arrival of winter and be safe
Hamish
Hamish Ashton, SPNZ President
PAGE 5
Latest News
BMJ LEARNING MODULES
As part of our agreement with BJSM we also get access to the BMJ Learning modules.
Examples of the available modules include:
Managing patients with minor skiing and snowboarding injuries in primary care
Frozen shoulder (adhesive capsulitis)
Tennis elbow: diagnosis and treatment
Jumper's knee - in association with the British Journal of Sports Medicine
Acute lateral ankle ligament injuries - in association with the BJSM
Learning outcomes are given for each module so you have a good understanding of what you are going to cover.
An example of the ankle one is included below.
Acute lateral ankle ligament injuries - in association with the BJSM
Throughout the modules there are small tests to assess your knowledge to make it a more objective learning
experience.
For instructions on how to access these modules go to the BJSM page on our website and follow the instructions in
the document enclosed.
After completing this module you should know:
When to suspect an ankle fracture
What the most frequent acute ankle injuries are
How different ankle sprain severities can be
ascertained
Which diagnostic test to use to ascertain ankle
sprain severity
What treatment options there are for an ankle
sprain
Why secondary prevention after an initial ankle
sprain is important.
After completing this module you should be able to:
Apply the Ottawa ankle rules
Differentiate the most frequent acute ankle
injuries based on presentation
Ascertain the severity of an ankle sprain
Advise a patient on the best secondary
preventive measure.
PAGE 6
25% off
Medical
books
McGraw Hill Education
Asics
Members’ Benefits
http://sportsphysiotherapy.org.nz/members/reviews/book-order-form/ for details on how to order.
Members rates on Asics shoes and apparel
http://sportsphysiotherapy.org.nz/members/asics-information/ for how to order
SPNZ
Member discounts to all SPNZ courses and Symposium
http://sportsphysiotherapy.org.nz/courses/ for what is upcoming
There are many benefits to be obtained from being an SPNZ 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.
DISCOUNTS
PAGE 7
Feature
Please describe your current role and how you ended up there.
Through my previously established NZ based contacts in
football I was offered the Phoenix head physiotherapist
role in 2013. This is an unique role as it is NZ’s only
professional football team, playing in the Hyundai A
CONTINUED ON NEXT PAGE
Robert Lee: Head Physiotherapist, Wellington Phoenix FC
I am a New Zealand born and trained physiotherapist currently
working for the Wellington Phoenix Football Club. Football
became my passion at an early age as I enjoyed many years
representing at a national level. Both fortunately and
unfortunately, this led to spending a considerable amount of
time on the physio table and although this led to less playing
time, it was here that my interest in sports physiotherapy really
began as I came in contact with some very skilled and driven
physiotherapists. As my football career seemed less and less
likely, (as I became slower and less agile), a career in
physiotherapy and football physiotherapy seemed more and more like a suitable vocation and one
I actively pursued.
I graduated from AUT (BHSc Physio) in 2007 and completed my Post Graduate Diploma in
Musculoskeletal Physiotherapy from AUT in 2010. Working in private practice post graduation for
Roland Jeffery I learnt the ropes of football physiotherapy and developed clinical practice skills.
Initially, I worked as a football physio for various club teams, including my own (player/physio can
be an interesting role), and I spent numerous weekends working voluntarily for federation football
tournaments and age group teams. This progressed to National League teams, such as Waitakere
United, which involved travelling nationally and internationally, and from there I became heavily
involved in the NZ under 17 qualifiers for two World Cup campaigns.
I was then very fortunate to progress my football physiotherapy career to a full time role in 2010 as
I was appointed as the head academy physiotherapist at Celtic FC, Glasgow, Scotland. During my
time at the club I progressed to the reserve/under 21 physiotherapist.
This was certainly an eye opening experience. The sheer scale of professional football in the UK
was a huge step up. The most outstanding differences were the facilities available to the players
and medical/conditioning staff. This included customised gymnasiums, on-site isokinetic
dynamometers, pool conditioning and recovery facilities, Alter G treadmills, and indoor and
outdoor heated fields. Not to mention very expensive travel protocols such as a chef on the bus
for longer away trips to optimise nutrition/recovery. Dealing with players that are worth
unimaginable amounts of money was an interesting and daunting task at times, but hugely
rewarding.
While at Celtic I travelled to many European top clubs, visiting facilities and sharing knowledge
with the medical staff, including those of Barcelona and Marseilles, UK clubs such as Sunderland
and Aston Villa, and the English FA national training centre.
League. I am with the team full time on a day to day
basis. I cover all trainings, rehabilitation of injured
players and I also travel with the squad to all away
games. In season I typically work six days a week,
however working seven is not uncommon depending on
the injury load and travel schedule.
PAGE 8
Feature
Robert Lee: Head Physiotherapist, Wellington Phoenix FC continued...
Who else is involved in the “support” team that you
communicate with and how do you integrate with
them to optimise injury prevention and
rehabilitation?
At the Phoenix we are fortunate to have two full time
sports scientists - Lee Spence and Adam Allan and a
second physiotherapist that works alongside me, Brent
O’Conner. We are a very close knit team. The integration
with the sport science staff is crucial in the effective
management of our players which is enabled by a flow of
communication regarding player wellness and
performance. We converse and analyse on a daily basis
regarding the training load of all our players. We track
daily-weekly-monthly GPS and HR data to pick dramatic
increases or decreases in training load that may signal
potential injury risk. This also helps us prepare the
players just right for the weekend, avoiding over- or
under-training. We meet formally in
weekly and daily meetings,
however running conversations
throughout the training day are just
as important.
I am also very fortunate to work
closely with sports physician Dr
Jake Pearson. His knowledge and
advice, especially on more complex
injuries involving multiple structures
or those requi r ing fur ther
investigations and interventions,
are crucial in optimal management
of our players.
Last but not least, my relationship
and communication with the
coaching staff is very important.
Daily meetings ensure we are all on the same page
regarding player training and health status, optimising
team selection for each match. Coaches are inherently
good at picking up on a drop in performance that may
relate to a musculoskeletal or a health related disorder
that can be addressed by the physiotherapist.
What are your specific areas of interest/research?
Due to the nature of my role my interests naturally lie in
efficient injury management and rehabilitation. I get very
excited about rehab and return to play protocols that
both ensure a quick return to play while minimising the
risk of re-injury. In particular, protocols regarding groin/
adductor and hamstring are useful as these muscle
groups rank highest in the frequency of muscular strains.
I’m always on the look out for research that has excellent
transferability to the professional athlete setting,
especially research that is conducted amongst
professional football players. There is a wealth of
literature on both these areas. Recently I have found the
Asklings et al. (2014) study regarding hamstring
rehabilitation and eccentric exercises in elite footballers
useful as it provides some great exercises and a
suggested protocol.
Injury prevention is also an interest of mine as it may
save lost training days and missed matches. This
includes both pre-season screening and ongoing daily
analysis. I am constantly fine-tuning and adapting pre-
screening protocols to elicit the most relevant, readily
accessible information in the most streamlined fashion.
Pre-season I look closely at biomechanics and clues to
potential overload with the Movement
Competency Screen developed by Dr Matt
Kritz. Also strength profiling of the
adductors (dynamometry) and hamstring/
quadriceps (isokinetic dynamometer).
Ongoing daily analysis involves everything
from subjective markers like daily wellness
scores, readiness to train scores, reported
muscle soreness, sleep quality and fatigue
levels, which we gather on a daily basis.
Objective daily assessment of joint range of
motion, muscle length and muscle strength
(dynamometry) will be assessed for players
that are identified as having low subjective
scores or those we are keeping a close eye
on due to recent injury, under performance
or possible over- or under- training, as
indicated by GPS or performance. Values are frequently
compared to baselines gathered in pre-season
screening.
What do you think are the key elements in
successfully preventing injury?
In addition to the screening methods mentioned above, I
believe injury prevention in the professional or semi-
professional environment really comes from early
identification of risk factors, whether this be objective or
subjective. Maximising recovery and nutrition is another
key factor, especially when a lot of travel is involved. It
is also critical to really “know” the players. This means
knowing how much individuals can be pushed or when to
back off.
CONTINUED ON NEXT PAGE
PAGE 9
Feature
Robert Lee: Head Physiotherapist, Wellington Phoenix FC continued...
It is the combination of all the above information that
creates a wider picture of an athlete and helps identify
the level of injury risk.
What are the types of injuries you commonly see?
Typically muscular strains of the adductor group and
hamstrings rank the highest in frequency. Due to the
dynamic nature of football, alongside the heavy kicking
load, inguinal/hip pain is often associated with groin
injuries and therefore all possible contributors to
dysfunction must be examined and addressed. Contact
injuries such as ligament sprains of the ankle and knee
are also common but are unpredictable in frequency and
vary from season to season. Injury mechanisms in
football continually surprise me, due to the high paced
and truly agile nature of the game combined with varying
physical presentations of players.
What are the key attributes you feel are required to
work with elite level athletes?
Working with elite athletes is certainly challenging as it is
a demanding environment which is results driven.
Key attributes to work in this environment are confidence
in your training and practical experience. This goes a
long way in effectively treating elite athletes as they need
to trust and buy in to your methods. You need to be
organised and truly a team player. It is very important to
not only know the sport you are involved in, as you will
gain added insight into what is required of the athlete,
but to also have a passion for the sport as this will drive
your performance as a physiotherapist in this
environment.
What do you see as the major challenges for Sports
Physiotherapy?
In sports physiotherapy it is key to not only rehabilitate
the injury but to keep levels of conditioning and strength
maintained. This involves working around and with the
injury which can be a challenge for mid to long term
injuries. However if approached appropriately it is an
excellent opportunity to work on general conditioning and
strength and return the player to competition in a better
condition than prior to injury. This can reduce chance of
re-injury and translate to an increase in performance. In
the professional environment this is especially important
and involves a diverse range of training modes such as
spin, pool work, off feet gym based conditioning, fitness
work such as boxing, cross training and added core/
stability strength sessions. It is here again that the
relationship with the conditioning staff is very important
as the load will be both shared and integrated.
It can also be a challenge to continually manage ongoing
causes of dysfunction or potential injury. As generally in
sports, if the athlete is performing well and results are
positive, underlying causes can be neglected or
overlooked as they are seen as unimportant (until they
present with pain!). Therefore, the challenge is not only
getting the athlete to buy into ongoing maintenance or
prevention work but to keep it interesting and sport
specific with a clear correlation to their performance.
It is also important to be open minded to management
strategies. There is a wealth of knowledge and expertise
that can be gained and shared across codes, and being
equipped with many options while working in
professional sports, particularly football is very helpful.
Reference:
Askling, Tengvar and Thorstensson. (2014) Acute hamstring
injuries in Swedish elite football: a prospective randomized
controlled trial comparing two rehabilitation protocols. British
Journal of Sports Medicine, 47,953-959.
Development, reliability and effectiveness of the movement
competency screen (MCS) Matt Kritz, MSc, A Thesis submitted
to the AUT University in the fulfilment of the degree of Doctor
of Philosophy. May 2012.
PAGE 10
SPRINZ
Progressing Rehabilitation Training with Exogen Exoskeletons
By Kim Simperingham and John Cronin
Researchers at the Sports Performance Research Insti-
tute New Zealand (SPRINZ) have begun to quantify the
effects that added weight has on a range of sporting
movements. One such study involved quantifying the
kinematic and kinetic changes in sprint-running perfor-
mance that occurred when an added load of 5 % of
body mass was attached to either the upper or lower
body. Upper and lower body loading had differential
effects on sprinting performance and a short video clip
regarding the findings from this study is available at
www.sportsphysiotherapy.org.nz/exogen.
Currently SPRINZ researchers are working with an elite
rugby sevens athlete that is progressing towards a re-
turn to the rugby field and ultimately towards Rio Olym-
pic goals following a broken leg during the 2014 sea-
son. Recent testing at AUT Millennium’s Running &
Cycling Clinic (http://www.autmillennium.org.nz/health-
and-fitness/clinics/rcc) was completed to quantify the
asymmetries between legs during running. A horizontal
impulse deficit (-27 %) in the affected leg was particu-
larly noticeable, however by wearing an Exogen suit
with an added mass equivalent to just 2 % of body
mass attached to the lower body (i.e. 0.6 kg on each
leg), horizontal impulse from the affected leg was
acutely increased by 34 % (and by 10 % on the non-
injured side).
It is anticipated that the acute improvement in balance
between left and right legs, and the chronic benefit from
the additional specific loading provided by the Exogen
suit will positively contribute to the athletes’ successful
rehabilitation and return to sport. Our researchers will
track the progress of this athlete as well as those from
a range of sports as we continue to quantify and under-
stand the benefits of this new technology.
If you would like to find out more about the Exogen
product, then you can visit the Lila company website
www.movementrevolution.com or contact Kim Simper-
ingham ([email protected]) regarding Ex-
ogen-related SPRINZ research; and for more infor-
mation about SPRINZ research in general you can visit
www.sprinz.aut.ac.nz.
The Lila Exogen exoskeleton is a compression-based suit that enables small amounts of added weight to be attached to almost any part of the arms, legs or torso. This new technology opens a whole range of novel training possibilities such as: loaded speed, agility and skill training; acute enhancement of training and sports performance through contrast loading; and of particular interest to sports physiotherapists, a means of adding progression to rehabilitation exercises through targeted loading in increments of 100 g in an activity specific or sport specific manner.
To see the Exogen suit in action
click on these video links:
on YouTube: http://youtu.be/k_3WOE1V_GA
or down load (20MB)
http://sportsphysiotherapy.org.nz/?p=2200
PAGE 11
JOSPT
www.jospt.org JOSPT ACCESS
All SPNZ members would have been sent advice directly from JOSPT with regards to accessing the new JOSPT
website.
You will have needed to have followed the information within that email in order to create your own password.
If you did not follow this advice, have lost the email, have any further questions or require more information then
please email JOSPT directly at [email protected] in order to resolve any access problems that you may have.
If you have just forgotten your password then first please click on the “Forgotten your password” link found on the
JOSPT sign on page in order to either retrieve or reset your own password.
Only current financial SPNZ members will have JOSPT online access.
Volume 45, Number 6, June 2015
CASE REPORT
Orthopaedic Manual Physical Therapy for Shoulder Pain and Impaired Movement in a Patient With Glenohumeral
Joint Osteoarthritis: A Case Report
MUSCULOSKELETAL IMAGING
Avascular Necrosis in a Patient With Hip Pain
RESEARCH REPORT
Low Back and Lower-Limb Muscle Performance in Male and Female Recreational Runners With Chronic Low Back
Pain
Performance on the Modified Star Excursion Balance Test at the Time of Return to Sport Following Anterior Cruciate
Ligament Reconstruction
The Use of Compression Stockings During a Marathon Competition to Reduce Exercise-Induced Muscle Damage:
Are They Really Useful?
Thrust Joint Manipulation Curricula in First-Professional Physical Therapy Education: 2012 Update
Epidemiology of Ankle Sprains and the Risk of Separation From Service in US Army Soldiers
Cross-cultural Adaptation and Validation of the Exercise-Induced Leg Pain Questionnaire for English- and Greek-
Speaking Individuals
Research Publications
PAGE 12
Research Publications
British Journal of Sports Medicine
www.bjsm.bjm.com
Volume 49, Number 12, June 2015
CONSENSUS STATEMENT
Doha agreement meeting on terminology and definitions in groin pain in athletes
Adam Weir, Peter Brukner, et al.
http://bjsm.bmj.com/content/
ANALYSIS
Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence?
Michael P Reiman, Kristian Thorborg http://bjsm.bmj.com/content/
REVIEWS
Prevention of groin injuries in sports: a systematic review with meta-analysis of randomised controlled trials
E Esteve, M S Rathleff, C Bagur-Calafat, G Urrútia, K Thorborg
http://bjsm.bmj.com/content/
The epidemiology of groin injury in senior football: a systematic review of prospective studies
Markus Waldén, Martin Hägglund, Jan Ekstrand
http://bjsm.bmj.com/content/
Men at higher risk of groin injuries in elite team sports: a systematic review
John William Orchard
http://bjsm.bmj.com/content/
Risk factors for groin injury in sport: an updated systematic review
Jackie L Whittaker, Claire Small, Lorrie Maffey, Carolyn A Emery
http://bjsm.bmj.com/content/
Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis
Andrea B Mosler, Rintje Agricola, Adam Weir, Per Hölmich, Kay M Crossley
http://bjsm.bmj.com/content/
Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic
review with meta-analysis
M P Reiman, A P Goode, C E Cook, P Hölmich, K Thorborg
http://bjsm.bmj.com/content/
Return to sport after hip surgery for femoroacetabular impingement: a systematic review
Nicola C Casartelli, Michael Leunig, Nicola A Maffiuletti, Mario Bizzini
http://bjsm.bmj.com/content/
Pubic apophysitis: a previously undescribed clinical entity of groin pain in athletes
Matthieu Sailly, Rod Whiteley, John W Read, Bruno Giuffre, Amanda Johnson, Per Hölmich http://bjsm.bmj.com/content/
PAGE 13
Clinical Section - Article Review
Abstract
Objectives: To undertake a prospective epidemiological study of the injuries sustained in English youth academy
football over two competitive seasons.
Methods: Player injuries were annotated by medical staff at 38 English football club youth academies. A specific injury audit questionnaire was used together with a weekly return form that documented each club’s current injury
status.
Results: A total of 3805 injuries were reported over two complete seasons (June to May) with an average injury rate of 0.40 per player per season. The mean (SD) number of days absent for each injury was 21.9(33.63), with an average of 2.31 (3.66) games missed per injury. The total amount of time absent through injury equated to about 6% of the player’s development time. Players in the higher age groups (17-19 years) were more likely to receive an injury than those in the younger age groups (9-16 years). Injury incidence varied throughout the season, with train-ing injuries peaking in January (p<0.05) and competition injuries peaking in October (p<0.05). Competition injuries accounted for 50.4% of the total, with 36% of these occurring in the last third of each half. Strains (31%) and sprains (20%) were the main injury types, predominantly affecting the lower limb, with a similar proportion of injuries affecting the thigh (19%), ankle (19%), and knee (18%). Growth related conditions, including Sever’s disease and Osgood-Schlatter’s disease, accounted for 5% of total injuries, peaking in the under 13 age group for Osgood-Schlatter’s disease and the under 11 age group for Sever’s disease. The rate of re-injury of exactly the same
anatomical structure was 3%.
Conclusions: Footballers are at high risk of injury and there is a need to investigate ways of reducing this risk. Injury incidence at academy level is approximately half that of the professional game. Academy players probably have much less exposure to injury than their full time counterparts. Areas that warrant further attention include the link between musculoskeletal development and the onset of youth related conditions such as Sever’s disease and Os-good-Schlatter’s disease, the significant number of non-contact injuries that occur in academy football, and the in-creased rates of injury during preseason training and after the mid season break. This study has highlighted the nature and severity of injuries that occur at the academy level, and the third part of the audit process now needs to
be undertaken: the implementation of strategies to reduce the number of injuries encountered at this level.
Review:
This is an older article, but the statistics are probably still relevant today. The authors state that football is associated with relatively high incidences of injury. “In the professional game in England, a player suffers, on
average, 1.3 injuries a season and misses an average of 24 days of training and competition per injury.”
This study wanted to clarify if the type and rate of injury in younger players was similar, they hypothesised that young footballers would be more at risk of overuse injuries because of the immaturity of their musculoskeletal
system.
To do this they studied the type and number of injuries at 38 English football academies. These academies were set up in 1998 to help develop the next generation of elite footballers. Each academy was required to have a
physiotherapist on staff.
Player injuries were prospectively reported from July 1999 to the end of May 2001. The study looked at all registered players in the academies from age 9 to 19 years. All injuries were recorded on standard forms. A recordable injury was defined as one that prevented the participant from training or playing for more than 48 hours,
not including the day of the injury. Injuries unrelated to football were not included, nor was absence due to illness.
A total of 4773 players were included in the audit, and during the trial period, 3805 injuries were reported, giving an average injury rate of 0.40 per player per season. It would have been interesting to note if that was an even spread
across players or whether some players had higher injury rates than average.
It was found that defenders and midfielders were injured most often. The incidence of injury occurred linearly with age i.e. the older the player the more injuries (except at 18 years, the authors thought this might be due to a reporting error, due to age group categories in competition being U17 and U19). Interestingly goalkeeper injuries
did not increase with age.
Soft tissue strains, sprains and contusions were the most commonly reported (66%), 54% were on the dominant side and 90% of all injuries were to the lower limb.
The Football Association medical research programme: an audit of injuries in academy youth football
CONTINUED ON NEXT PAGE
Price RJ, Hawkins RD, Hulse MA and Hodson A
British Journal of Sports Medicine 2004; 38:466-471.
PAGE 14
Clinical Section - Article Review
85% of knee injuries were to the MCL, and 83% of ankle injuries were to the AFTL. Osgood-Schlatters and Sever’s disease accounted for 5% of overall injuries, however between the ages of 11 and 13, these two conditions account for nearly 14% of all injuries, this corresponds to the beginning and end of the pubertal growth spurt in males. The peak incidence for Osgood-Schlatter’s was in the under 13 and 14 age groups, and for Sever’s in the under 11 age
group.
This was a significant group of injuries and maybe training and management strategies need to be implemented to manage or even prevent these injuries, as although they are naturally self-limiting with little long term implications
they can be quite distressing and be problematic often affecting players over quite a long duration.
Interestingly only 3% of reported injuries were re-injuries, mostly to the AFTL and MCL. Most of the recurrent strains
were to the quadriceps, hamstrings and hip adductors in that order.
Injury rates were higher at the beginning of the season and after the mid-season break, which is in line with professional football statistics. They hypothesised the reasons for this could be: result of resuming activity after rest, increased activity, a change in activity, or chance. During the game most injuries occurred in the last 15 minutes of each half, with more in the second half than the first half. The authors state they believe the reasons are probably multi-factorial, including neuromuscular fatigue, but also the immaturity of the musculoskeletal and physiological
systems of the players must be considered.
In conclusion, it would seem that in Academy Football Players there is a high level of injury, although mostly soft-tissue, this affects training and availability to play. How these rates compare to adolescents playing football in NZ is unknown, but the types of injuries and location of injury is likely to be similar. In looking at adolescent footballers (and pre-pubescent), special consideration should be given to the lower limb, fitness (especially in the early part of the season) and how to watch out for and manage growth related conditions such as Sever’s and Osgood-Schlatter’s. Physiotherapists should be actively working with coaches in their communities to ensure they are aware
of these factors so a collaborative approach to managing them can be achieved.
The Football Association medical research programme: an audit of injuries in academy youth football continued...
CONTINUED ON NEXT PAGE
Price RJ, Hawkins RD, Hulse MA and Hodson A
British Journal of Sports Medicine 2004; 38:466-471.
By Karen Carmichael BSc, BPhty, M(SportsPhysio)
Three distinct mechanisms predominate in noncontact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases
Waldén, M., Krosshaug, T., Bjørneboe, J., Andersen, T. E., Faul, O., & Hägglund, M. (2015).
British Journal of Sports Medicine, 2015 (0), 1-10. doi: 10.1136/bjsports-2014-094573
ARTICLE REVIEW
On average, one player every second season will sustain an ACL injury in professional football squads. This
incidence has not changed for over a decade, making prevention of ACL injury a priority area within sports medicine
research. This prospective cohort study looked at ACL injury mechanisms in professional male footballers. Three
different professional clubs in Europe were followed from 2000 to 2011 in order to obtain video footage of ACL injury.
Only injuries which occurred during first team match play at club level competition (national and international cup
matches) were included. All videos were viewed independently by five different assessors. A structured format was
used to describe joint biomechanics, injury circumstances, initial foot contact with the ground and the time of ACL
tear. Thirty nine complete tears, confirmed by surgery or MRI, were available for video analysis.
Results showed that 25 out of 39 (64%) injuries were noncontact, eight were indirect contact and six injuries were
direct contact injuries. Most of the ACL incidences (n=30) observed, occurred when the player was involved in a
defensive action. No injury occurred during pre-determined set play. Twenty of the ACL injuries happened while the
player had no ball possession. The majority of the injuries (n=34) occurred in a one leg stance, and in the remaining
five subjects the main load was on the injured leg. Ninety four percent of the injuries occurred during dry playing
conditions. Six of the injuries were judged as foul play by the referee.
PAGE 15
Clinical Section - Article Review
This study identified three main categories in the non-contact and indirect contact injuries: (1) pressing (n=11), (2)
re-gaining balance after kicking (n=5) and (3) landing after heading (n=5). Direct contact to the injured leg or knee
(n=6) was the final main category. The remaining twelve injuries followed no distinct pattern and did not conform to
the categories above.
Pressing is a defensive move where the player makes a sidestep cut to reach the ball or to tackle an opponent. 10 of
11 of pressing related injuries were from non-contact mechanisms. In six of these cases the injured player went in
for a tackle but did not achieve any contact with the opponent. These injuries occurred at high speed with less than
40° hip flexion and 20° or less knee flexion. Median flexion values were low at 25° for the hip and 5° for the knee.
Hip abduction was seen in eight cases, knee valgus in six cases and no clear pattern was seen with ankle eversion.
Losing their balance following kicking (n=5) was another commonly seen category. All of these players were in a non
-contact or indirect contact situations. In most of these injuries the player was clearing the ball at high speed with
unstable balance. Significant hip abduction was identified in three cases as well as knee valgus in three. All hip
flexion was less than 30 °and knee flexion was 20°. The median of both of these flexion values was 10°.
Injuries sustained while landing after heading the ball (n=5) were all non-contact injuries. The players were injured
mainly while landing on one leg only. In all of these situations the injured player landed on his forefoot. The median
flexion angles were 10° for the hip and 5° for the knee at initial contact. Estimates of ankle eversion showed no clear
trend.
The six direct contact injuries were a consequence of tackling or collision situations. The direct tackling injuries (n=3)
were sustained from behind with lateral impact to the knee causing a valgus collapse. In the three collision injuries
there was no specific pattern.
Regardless of the playing situation, knee valgus was commonly seen however dynamic valgus collapse was not.
Except in the case of the three direct-contact injuries resulting from tackling where they all had a dynamic valgus
collapse. 77% of the ACL injuries recorded occurred during defending, which corresponds with other articles’
findings.
The findings showed all injuries sustained while kicking were due to loss of balance and most of the post heading
injuries due to overbalancing on one leg. This suggests that prevention strategies may need to focus on
neuromuscular and postural strategies in jumping, landing and changes of direction. ACL injuries also occurred with
direct contact to the injured leg (15%) all three had concomitant injury to the medial collateral ligament and two had
lateral meniscus injury suggesting a valgus mechanism.
This study found in most circumstance the injured knee had less than 20° of knee flexion at initial contact. This
coincides with video analysis seen in Australian Rules football, all indirect and all but one non-contact ACL injury had
minimal knee flexion (less than 30°) at the time of injury. The theory is that vertical compression at a straight knee
loads the ACL through anterior tibial drawer and internal rotation. Knee valgus also appears to be a common factor
in ACL injury with 15 of 19 measurable video cases being in valgus at initial contact.
Clinical relevance
These findings suggest that prevention programmes should include:
Postural and neuromuscular control of the core and lower limb during drills;
Footwork and changes of direction in defensive playing actions, mimicking the pressing situation;
Practicing landing with a greater angle of hip and knee flexion
Maintaining balance during shooting, passing and ball clearing;
Practicing jumping and landing technique during heading
Promotion of good sportsmanship to avoid aggressive tackling from behind.
Three distinct mechanisms predominate in noncontact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases continued...
Reviewed by Monique Baigent MHsc (Physiotherapy)
PAGE 16
Background
Rehabilitation of a partial rupture of the medial collateral ligament and anterior cruciate ligament of the knee in an
elite football player during final build up to age group world cup football qualifying tournament.
Grade 1 ACL rupture in an elite football player
Case Study
Case Description
17 year old male football goal keeper taken out by another player from lateral side on single leg contact with the
ground during landing.
Immediate medial knee pain VAS 8 severity with inability to continue training. Slight medial swelling of the knee,
progressive during the evening. Ongoing deep, intense medial knee pain.
Ice applied directly at time of injury and at hourly intervals for 10minutes over the following four hours and rest.
Compression applied in the form of elastic sports bandage.
No anti-inflammatory medication taken. Panadol as required for pain relief.
MRI done the following morning revealing Grade 2 tear of MCL and Grade 1 tear of ACL. On immediate consultation
with orthopaedic surgeon was put in a Range of Movement brace for 4 weeks.
Physiotherapy assessment: patient partial weight bearing in a range of movement brace set at zero degrees knee
flexion. Slight effusion over the medial aspect of the knee. Tenderness on palpation of the femoral attachment of the
medial collateral ligament. Medial collateral and anterior cruciate ligament testing positive for laxity and pain
response.
Physical problems: pain, reduced range of movement, reduced strength, reduced proprioception, knee instability
Potential problems: knee instability ongoing, fear avoidance of return to sport, physical deconditioning, psychological
loss of top position in team
Goals: relieve pain, increase mobility, increase strength, increase proprioception, return to elite level football training
and compete in World Cup qualifying tournament.
Physiotherapy commenced on day 2 consisting of acupuncture and inner range quadriceps contractions done in the
brace with an allowance of zero degrees knee flexion.
Continuing physiotherapy of friction therapy applied to the ligament, acupuncture, deep tissue massage of the
quadriceps, and active straight leg raises, were maintained with the brace at 30 degrees flexion from week 2.
Weight bearing activities including wall squats, mini squats, bridging, rowing, cycling and proprioceptive exercises
were introduced at week 3 in the brace.
The brace was removed in after 4 weeks and single leg strengthening activities such as lunges, squats, Swiss ball
curls, single-leg deadlifts and step ups were commenced. The athlete was also able to start running in straight lines.
Ball skills and bounding and cutting drills were introduced as the player returned to full strength and was pain-free on
normal daily activities.
At week 6 the athlete was pain-free with good strength and a stable knee and was able to return to football training.
Outcome
Patient had good quadriceps strength with symmetrical bulk and good endurance.
There was minimum tenderness on palpation of the ligament and testing of instability of the medial ligament and the
ACL was negative.
The patient show good proprioception and balance and was able to perform all training drills without any residual
effect from the injury.
Patient made a full physical recovery to allow him to continue to compete at international level
Athlete was struggling with mental component of having been dropped from the squad to travel to qualifying
tournament following a significant knee injury
CONTINUED ON NEXT PAGE
PAGE 17
Discussion
Immediate imaging and correct bracing with appropriate
progressive physiotherapy treatment enhances full recovery of
Grade 2 MCL and Grade 1 ACL ligament injury in elite football
players.
Significant knee injury when managed correctly need not be
career ending.
When MRI is not available immediately, it is important that
clinicians make a correct specific clinical diagnosis to enable to
athlete to receive appropriate early intervention, or refer for
orthopaedic opinion as soon as possible.
Psychological impact of injury on elite athletes should be
addressed during rehabilitation.
Grade 1 ACL rupture in an elite football player continued...
Case Study
By Pip Sail, physiotherapist
Continuing Education
PAGE 18
Continuing Education
For a full list of local courses visit the PNZ Events Calendar
For a list of international courses visit http://ifspt.org/education/conferences/
Upcoming courses and conferences in New Zealand and overseas in 2015.
LOCAL COURSES & CONFERENCES
When? What? Where?
4-5 July 2015 Promotion and Prescription of Physical Activity and Exercise Hamilton
5 July 2015 Hydrotherapy- Introductory course (4-hours) Wellington
6-10 July 2015 New Zealand Shoulder and Elbow Society Conference Rarotonga
6 July 2015 PhysioScholar - Influence of lumbar posture on biomechanics and functional anatomy
Nationwide
9-16 July 2015 PNZ Wellington Branch and Clinical Edge Webinar Series Nationwide
10-11 July 2015 Myofascial Release Therapy Training Courses - The Fundamentals Christchurch
8-9 August 2015 Kinesio Taping Course - KT 1 & 2 Wellington
13 August 2015 Otimising Cycling Biomechanics & Bike Setup Auckland
21-23 August 2015 MNZ 2015 Conference Delegates Information and Registration pack Tauranga
SPNZ members can now attend APA SPA (Sports Physiotherapy Australia) courses and conferences at APA member rates. This includes all webinars and podcasts (no travel required!).
To see a full list visit the APA and SPA Events Calendar
APA CPD EVENT FINDER
APA SPA COURSES & CONFERENCES
When? What? Where?
24-25 July 2015 Running Workshop - Level 1 Riverside, TAS
15 August 2015 Optimising Running Mechanics - Clinical Considerations Fitzroy, VIC
16 August 2015 Level 1 ASCA Strength and Conditioning Coaching Course Sydney Olympic Park, NSW
19 August 2015 Imaging of the Hip Through Our Lifespan Eight Mile Plains, QLD
23 August 2015 Level 1 ASCA Strength and Conditioning Coaching Course Spring Hill, QLD
PAGE 19
Continuing Education
Managing runners in practice:
Considerations in the assessment & prevention of running injuries
Auckland – August 29th 2015
Christchurch – September 6th 2015
Venue: TBC
Time: 9:00 – 5:30
Presenter: Chris Bishop
Director: Biomechanics & Gait Analysis at The Biomechanics Lab
Cost: $300 NZD Program schedule:
9:00 - 10:30: Morning Session 1 – Principles of athlete screening & determinants of performance This session will assume background knowledge of the biomechanics of running, and will provide a clinical template to assess the runner. A method of screening the athlete for injury risk will be demonstrated, as well as a discussion of considerations that affect the performance of runners such as alterations in human physiology, biomechanics, speed, footwear, strength etc. Participants will have the opportunity screen each other in small groups to gain practical experience with the template. 10:45 - 12:15: Morning Session 2 – Principles of exercise prescription and rehabilitation. This session will focus on load management, and provide attendees with the background knowledge and template to accurately prescribe exercise and strength & condition programs in practice. Practical demonstrations of a staged program will occur, focussing on core stability and dynamic control of the lower limb as it relates to the runner. 12:15 – 1:00: LUNCH 1:00 – 3:00: Afternoon session 1 – Consideration in injuries to the leg during running This session will focus on three main injuries to the leg experienced by the runner; hamstring strains, ITB Syndrome and MTSS. Consideration in injury mechanisms of each will be discussed, as well as diagnostic strategies, assessment techniques, gait patterns, treatment direction tests, off-loading techniques and return to running strategies. 3:30 – 5:30: Afternoon session 2 – Consideration in injuries to the foot during running This session will focus on three main injuries to the foot experienced by the runner; Achilles tendinopathy, plantar heel pain and metatarsal stress fractures. Consideration in injury mechanisms of each will be discussed, as well as diagnostic strategies, assessment techniques, gait patterns, treatment direction tests, off-loading techniques and return to running strategies.
*Please bring shorts & shaved legs*
76a Kensington Road, Rose Park SA 83646800 [email protected] www.thebiomechanicslab.
PAGE 20
AUCKLAND
Ponsonby Rugby Club
Sports Physiotherapists
Sports physiotherapists wanted for teams at Ponsonby Rugby Club.
We are looking for keen enthusiastic physios who would like to do some team work at our very busy rugby club.
This involves two training nights and Saturday work.
Lovely facilities, great people, plenty of business.
I am keen to hear from Independent qualified and experienced physios looking for paid team work.
I am also keen to provide training and supervision to any interested students or less experienced physios (your
expenses will be covered by the club).
Please contact Tanya Browne
at Sports Physio (NZ) Ltd ASAP
on 0274990539
Or email [email protected]
Classifieds
DUNEDIN
Sportsmed Mosgiel
Physiotherapist – Full Time
Sportsmed Mosgiel Physiotherapy requires a full time physiotherapist to start in May/June 2015.
Sportsmed Mosgiel is a musculoskeletal physiotherapy clinic situated beside the Olympic Gym in Mosgiel. There
is an emphasis on manual/manipulative and rehabilitative physiotherapy with appointment times of 30-45 minutes
duration to ensure quality treatment.
The ideal applicant should have sound musculoskeletal skills, a great work ethic and hold a current annual
practicing certificate. Remuneration is excellent, ongoing education is encouraged and regular in-services are held
in a relaxed and friendly setting.
The applicant should have an interest in sport and dealing with athletes although a wide variety of patients are
seen. New graduates are welcome to apply.
Please forward CV and cover letter in strict confidence to:
Adam Letts
Sportsmed Mosgiel Physiotherapy
Olympic Gym, 9b Gladstone Road
Mosgiel 9024
Email: [email protected]
PAGE 21
CHRISTCHURCH
Ilam Physiotherapy Clinic
Permanent Part-Time Physiotherapy Position
The Ilam Physiotherapy Clinic is a well established, accredited practice in the Ilam/Fendalton area of Christchurch
and is part of an integrated health provider facility.
The Clinic offers a supportive work environment with regular in-services. This is a well remunerated part-time
position which includes a fixed Wednesday afternoon.
Please email your details and CV to Gerald Cummins on [email protected]
Classifieds
AUCKLAND - NORTH SHORE
Forrest Hill Physiotherapy
Full or Part-Time positions
A full or part time role with immediate start is available with Forrest Hill Physiotherapy. This position would ideally
suit an experienced physiotherapist with strong manual therapy skills or an experienced physiotherapist
undergoing post-graduate studies.
Our musculoskeletal practice is a certified and community based clinic with NZ representative team providers
amongst the six other post-grad or Masters qualified physiotherapists. Established over 25 years ago, the clinic
has a loyal patient and GP base and an excellent reputation within the community.
Our clinic has a strong manual therapy and exercise rehab focus, facilitated by a fully equipped Clinical Pilates
studio, rehab gym and a Real Time Ultrasound Imaging service. In addition to fortnightly in-service education, the
successful applicant will work alongside Clinical Pilates Instructors, a continence physiotherapist and massage
therapists. All staff are supported by a skilled and experienced administration team and practice manager. A
comprehensive financial package is offered including support of ongoing education, conferences, courses and
work in special interest areas, e.g. sports teams.
A strong history of clinical acumen and post-graduate qualifications are desirable but PG students with private
practice experience will be considered.
If you fit these criteria and are motivated to work in a dynamic clinical environment,
then please email your CV to Chris McCullough at [email protected]
CHRISTCHURCH
Ilam Physiotherapy Clinic
Locum Required
A locum physiotherapist is needed for the Ilam Physiotherapy Clinic, located in the Ilam/Fendalton area of
Christchurch for the first week of July 2015 and the first week of September 2015.
Please contact Gerald Cummins on [email protected]
PAGE 22
AUCKLAND
Full time physiotherapist
Location: WSAFC, Seddon Fields, 108 Meola Rd, Western Springs, Auckland
Start date: July 2015
Back To Your Feet Physiotherapy are a central Auckland ACC accredited physiotherapy and sports clinic based
onsite at the best footballing facility in the country. We focus on prevention, treatment and performance and pro-
vide services to New Zealand Football, New Zealand Roller Derby, New Zealand Ice Hockey, Auckland City FC
and a whole lot more national and regional teams. We are looking for an enthusiastic and reliable full time physio-
therapist. The successful applicant will be part of a sports focused team and will benefit from a significant mentor-
ing and a comprehensive CPD programme, and a competitive remuneration package, You must hold NZ Board
registration and an APC to apply.
Please direct any questions or email your CV to Justin at [email protected]
The deadline for applications is July 1st 2015.
Classifieds
AUCKLAND
Part-Time Physiotherapist
Location: WSAFC, Seddon Fields, 108 Meola Rd, Western Springs, Auckland Start date: July 2015
Back To Your Feet Physiotherapy is a central Auckland ACC accredited physiotherapy and sports clinic based
onsite at the best footballing facility in the country. We focus on prevention, treatment and performance and
provide services to New Zealand Football, New Zealand Roller Derby, New Zealand Ice Hockey, Auckland City
FC and a whole lot more national and regional teams. We are looking for an enthusiastic and reliable part time
physiotherapist. The successful applicant will be part of a sports focused team and will benefit from a significant
mentoring and a comprehensive CPD programme. You must hold NZ Board registration and an APC to apply.
Please direct any questions or email your CV to Justin at [email protected]
Deadline for applications is July 1st 2015.
