ARTICLE IN PRESS

1466-853X/$ - s

doi:10.1016/j.pt

Physical Therapy in Sport 7 (2006) 56–57

www.elsevier.com/locate/yptsp

Editorial

World Cup fever—Germany 2006—the beautiful game?

The great football circus that is the World Cup is dueto kick off on the 9th June in the host nation Germany.This global sporting extravaganza arises passion andspectating figures to a level only witnessed in footballevery 4 years. People who may not express much of aninterest in this sport during regular domestic seasons getcarried away with national pride and expectation.

The media coverage during the build up to the WorldCup and over the one month the matches take place willbe intense and will cover many of the issues pertinent tothose of us working in sport. Injuries, especially to keyplayers will come under immense scrutiny and the manin the street will know the anatomy, pathology andrecovery rates of a metatarsal fracture, for example.Indeed it can raise awkward questions for cliniciansfrom their clients about different modalities of treatmentand their benefits. Does hyperbaric oxygen therapyaccelerate recovery? Do bone stimulators work? Thegeneral perception being that if a certain player isreceiving a certain treatment then it must be efficaciousand why is not generally available? The usual mantrabeing that if it is good enough for ‘so and so’ it is goodenough for me. The rationale that may be lost in thisscenario is that the weekend warrior is not the same as ahigh profile, highly paid professional athlete. Thepressure to perform means that any niggle or injuryreceives round the clock attention and the medical teamare under pressure to get the player back on the pitch.The World Cup is the pinnacle of most footballers’careers and the world stage gives them an opportunity toraise their profile and individual worth. In theseinstances ‘the normal rule book’ can be thrown out ofthe window, and the risk:benefit ratio assessed for eachscenario. Players are used to being in the limelight andare put forward as role models with respect to theirperformance both on and off the pitch, and this is noless so than when players are ill or injured.

Another issue that will undoubtedly be raised is thatplayers play too much football, leading to fatigue, injuryand burn-out. Much will be made in the Northernhemisphere that the World Cup comes at the end of aseason when players are tired and yet there has been nosuggestion of ending the regular season much earlier

ee front matter r 2006 Elsevier Ltd. All rights reserved.

sp.2006.03.002

during a World Cup year. Comparisons will be madebetween different leagues with respect to the numbers ofgames played. There will be a call for a break in theseason, like the winter break that occurs in the ItalianLeague. However, there is no evidence yet to suggestthat this reduces injury rates.

The World Cup is truly a world event with 32 teamsfrom 6 continents, and teams are vigorously supportedby large numbers of travelling supporters. Whilst rivalrybetween opposing fans is a given in football, thetournament presents an example of how sport can bringthe world together and transcend religious and territor-ial squabbles that otherwise seem to dominate the worldstage. Politicians will attempt to hijack events for theirown gain, but hopefully the beautiful game will defeatall the side issues. To the minority who will be workingthere and to the majority who will be watching, let’shope Germany 2006 is a huge success and presents allthe positive aspects of the beautiful game.

Continuing with the football theme, the first piece oforiginal research in this issue is presented by Parry andDrust. Availability to train and play can be influencedby a number of factors apart from injury, such assuspension, illness and personal reasons. Data wascollected from an English Division One soccer clubover two consecutive seasons to ascertain whether injurywas the major single factor why players were unavail-able. However, illness and suspensions combinedaccounted for 1 in 4 incidents of players not beingavailable for first team selection. The authors discussthese factors and suggest recommendations to reducethe frequency of these non-injury-related events. Theauthors also discuss some of the issues related tocollecting injury data in soccer. readers may beinterested to read a consensus statement that hassubsequently been published by Fuller et al. (2006) thattackles (no pun intended) injury definition and metho-dological issues related to injury statistics in soccer.

Landing from a jump is a common mechanism forknee injury, and a number of biomechanical risk factorshave been identified in the literature. Louw andcolleages present a pilot study on the interventionof a 6-week neuromuscular exercise programme in

ARTICLE IN PRESSEditorial / Physical Therapy in Sport 7 (2006) 56–57 57

adolescent basketballers. The emphasis of the pro-gramme was on good technique and the programme isdescribed in detail. At the end of the programme, theresearchers reported improvements in biomechanicaloutcomes during the execution of landing from a jumpshot, compared to a control group who had nointervention. The findings suggest that neuromuscularexercise may have a role to play in injury prevention andthis study adds to the evidence reported in adult athletes.

Clinicians commonly employ different modes ofheating to increase soft tissue extensibility. In this issueMeakins and Watson compare the thermal effects ofconductive heating (using a hot water bottle) andLongwave ultrasound (LWUS) on ankle mobility usinga non-injured achilles tendon model. Whilst resultsshowed that both methods had a significant improve-ment in the range of motion of dorsiflexion, as measuredby a weight bearing lunge test, the conductive heatingmethod demonstrated a trend to be more effective. Theauthors discuss the relative merits of using a cliniciansvaluable time when potentially the same effect can beachieved with a home/self treatment application. How-ever, as the dose/response effects of both types ofultrasound (MHz and LWUS) continue to be debated,this paper shows that a 10min application of LWUS at0.94W/cm2 does have an effect in this instance.

More clinicians are becoming involved with exerciseprescription schemes for a wide variety of pathologies thatvary from cardiovascular disease, obesity to conditionssuch as depression. The next piece of original research byMcWhorter and colleagues evaluates the effect of loadedand unloaded, and static and dynamic activities on footvolume in healthy subjects. They found that loaded andstatic activities had greater increases in foot volume thantheir counterparts. Furthermore in the majority of cases,static cycling (unloaded and dynamic) actually had adecrease in foot volume in healthy subjects. These findingsprovide evidence of the type of activities/exercise thatshould be employed for patients who have compromisedvenous return. This would include those with lower limbmusculoskeletal injury associated with oedema.

Preferential activation of vastus medialis oblique(VMO) would be desirable in an exercise regimen forsubjects presenting with patellofemoral pain. Herring-ton and colleagues investigate the effect of gender, hipposition, mode of exercise and type of contractionon the overall muscle activity of VMO and vastuslateralis in healthy subjects. They found significantlygreater activity in both muscles with concentric ratherthan eccentric exercise, but the other variables had no

effect in this instance. The authors discuss several keypoints with regard to this field of research, namely thedifferent ways of quantifying muscle activity/activityratio, whether this should be assessed at joint specificangles and, as with all studies on healthy subjectswhether subjects with pathology demonstrate differentbehaviour.

The penultimate paper in this issue is presented byJohanson and colleagues who investigated the effects ofgastrocnemius stretching on ankle ROM and a func-tional parameter of the gait cycle in a sample of subjectsdemonstrating lower limb overuse syndrome(s). Thesample was randomised into an intervention and non-intervention group, the intervention being a passivestretch in a NWB position held for 30 s, with 5repetitions on each leg and a 5 s rest period betweeneach repetition, twice a day for 3 weeks. The resultsshowed an increase in passive range of dorsiflexion inthe intervention group. However, there was no compar-able change in ankle dorsiflexion or time to heel-offduring the stance phase of gait.

Hamstring injury, or rather recurrent injury, con-tinues to provide a clinical challenge. Evidence isemerging for effective preventative programs, andVerrall, Slavotinek, and Barnes (2005) demonstratedthis with an Australian Rules football team. The causesfor injury are often cited as multi-factorial, but therelative importance of these various risk factors is lessclear. Foreman and colleagues present a systematicreview of the evidence for predisposing factors related tohamstring injury in sport. This will make interestingreading for anyone involved with screening, preventionand rehabilitation in this area.

That’s all for this issue, enjoy the football.

References

Fuller, C. W., Ekstrand, J., Junge, A., Andersen, T. E., Bhar, R.,

Dvorak, J., Hagglund, M., McCrory, P., & Meeuwisse, W. H.

(2006). Consensus statement on injury definitions and data

collection procedures in studies of football (soccer) injuries. British

Journal of Sports Medicine, 40, 193–201.

Verrall, G. M., Slavotinek, J. P., & Barnes, P. G. (2005). The effect of

sports specific training on reducing the incidence of hamstring

injuries in professional Australian Rules football players. British

Journal of Sports Medicine, 39, 363–368.

Editor

Zoe HudsonE-mail address: z.hudson@qmul.ac.uk.