PAGE

SPNZ Course The Lower

Limb in Sport

Feature Masters Sport,

the Next Generation of

Athletes

Members’ Benefits

Find a physiotherapist

FEATURE TOPIC:

Masters Games

SPNZ BULLETIN

Issue 2 April 2017

PAGE 2

SPNZ Members’ Page

SPNZ EXECUTIVE COMMITTEE

President Hamish Ashton

Secretary Michael Borich

Treasurer Timofei Dovbysh

Website Blair Jarratt

Sponsorship Bharat Sukha

Committee Monique Baigent

Timofei Dovbysh

Rebecca Longhurst

Justin Lopes

Emma Mark

EDUCATION SUB-COMMITTEE

Hamish Ashton

Monique Baigent

Dr Angela Cadogan

Rebecca Longhurst

Justin Lopes

Emma Mark

Dr Grant Mawston

Dr Chris Whatman

BULLETIN EDITOR

Aveny Moore

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A reminder to graduate members that this $1000 fund is available twice a year with application deadlines being

31 August 2017 and 31 March 20178.

Through this fund, SPNZ remains committed to assisting physiotherapists in their endeavours to fulfil ongoing education

in the fields of sports and orthopaedic physiotherapy.

An application form can be downloaded on the SPNZ website

sportsphysiotherapy.org.nz.

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PAGE 3

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

MEMBERS’ BENEFITS

Find a Physiotherapist 6

FEATURE

Masters Sport, the Next Generation of Athletes - a New Challenge for Sports

Physiotherapists

7

POST-GRAD STUDENT CONTRIBUTION

What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a

Running Population? PHTY542 Sports Physiotherapy written assignment

11

ASICS REPORT

Footwear for the Ageing Athlete: Keeping the Masters Bodies Active with the Right

Footwear

15

HPSNZ CORNER

HPSNZ FAQs 17

CLINICAL SECTION- ARTICLE REVIEW

The Training–Injury Prevention Paradox: Should Athletes be Training Smarter and

Harder?

18

SPNZ CONTINUING EDUCATION

SPNZ Level 2 Course: The Lower Limb in Sport 20

RESEARCH PUBLICATIONS

BJSM Volume 51, Number 8, April 2017 21

CLASSIFIEDS

Situations Vacant 22

Contents

FEATURE TOPIC: Education

PAGE 4

PAGE 5

Editorial

Greetings all

I hope you have all managed to survive the recent

weather bombs. Our thoughts go out to those from

Edgecumbe and other region affected by the rain.

Events like this, Kaikoura and Christchurch continue to

remind us that we are at the mercy of nature at times. It

provides a reminder to reassess our insurance needs as

business owners. How would you manage if something

happened to your practice and you couldn’t work there

for some time?

As you are all aware we recently had our AGM in

Christchurch. This was my first visit back there in several

years and though there are some still sparse regions it is

good to see some positive developments in the city. At

our AGM, it was my great pleasure to acknowledge two

long standing members with Life Membership awards.

Unfortunately, neither could be there on the day, but I

hope to be able to catch up with them personally in the

near future to thank them for their efforts.

The first one was to Graeme Nuttridge. Graeme was the

first president of what is now Sports Physiotherapy New

Zealand. Back in the mid 90’s when several us were

getting together to discuss sports medicine and the

physiotherapists role in what was a growing special

interest area, Graeme pulled us all together into a

national group - the New Zealand Sports and

Orthopaedic Physiotherapy Association (NZSOPA).

Newsletters went out and courses were held, and it was

the start of much more to come.

Some years later Tony Schneiders took over the reins.

Tony was president for 12 years and really grew the SIG

into what we have today. Although he now lives and

works in Australia he has been a strong supporter of

what is now SPNZ, both locally in New Zealand and

around the world. Tony is Vice President of IFSPT, our

world sports physiotherapy body, where he continues to

promote sports physiotherapy worldwide.

While in Christchurch we had the first of a new initiative,

the SPNZ concussion workshop. This was run by Dr Deb

Robinson (ex All Blacks doctor) and was received

enthusiastically by those that were there.

Physiotherapists on the side line are often the first on the

scene of a concussion. The half day programme covered

immediate care and triage of a suspected injury through

to the guidelines involved with return to play. Though

concussion is seen by many as a medically managed

issue there is no doubt that we are often the first contact

on the field of play, as well as being heavily involved with

supervising their return to play.

The concussion workshop is something we wish to bring

to the centres to provide as many physiotherapists as

possible with these skills. We are currently sorting out

dates for a workshop in Wellington and Auckland. We

are also looking for dates in Tauranga and hope to have

one in Northland sometime. Due to the practical nature

of the course we are restricted to 30 per workshop. If

there are any regions who have a group interested, get

hold of me at help@spnz.org.nz and we will try to

arrange something for you depending on tutor

availability. Christchurch sold out in 48 hours, so get in

quick when you see the registrations open. As with all

courses members will be notified first.

Shortly, we will be seeking your opinion on a number of

issues as we move forward and further look to develop

our SIG. Your opinions are always important to us and

though it is not always possible to do everything for

everybody straight away, we will do our best to create

opportunities for all our members, no matter where they

live or play. Look out for these surveys as we have a

very exciting prize which will be announced shortly.

Finally, from me for this issue is a quick note on our

upcoming Sports Physiotherapy Symposium. This year it

will be held in Auckland over the weekend of October 14

-15. Like previous symposiums all speakers will provide

practical knowledge that you can use in your practice.

Two of the exciting speakers already confirmed – Phil

Glasgow (Phil was Team GB’s Chief Physiotherapy

Officer at the Rio 2016 Olympics. He is also a visiting

professor of the Ulster Sports Academy at the University

of Ulster and teaches on a number of postgraduate

sports medicine programmes at various UK and

European universities), and Chris Bishop (Chris is a

Podiatrist and Biomechanist based in Adelaide, and a

consultant to ASICS Oceania). Following on from

the excellent feedback from our recent Roadshow event

we will again be showcasing clinical excellence and

expertise from our leading local physiotherapists and

sports medicine professionals. Put these dates in your

diary now as it will be a great weekend of knowledge,

comradery, and professional networking.

Stay safe over the autumn changes

Hamish

Hamish Ashton, SPNZ President

PAGE 6

Members’ Benefits

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.

Find a Sports Physiotherapist

Are you aware the SPNZ website has a “Find a Sports Physiotherapist” section?

This is an opportunity to list and promote yourself as a sports physiotherapist.

This site is for athletes and the general population to find a physiotherapist with knowledge or interest in a particular sport.

It will be accessed by groups, such as the upcoming Masters Games in Auckland.

Get your name listed now!!!

To be listed fill out the link https://goo.gl/forms/0a0MOlHCHDYyZcAg2 All listings are in a similar format so look at some examples to know what information is appropriate.

If you already have a listing, please check it – any changes email help@spnz.org.nz

Massey University Research Enquiry

My name is Lawrence Chu and I am currently a fourth year industrial design student at Massey

University Wellington researching post-exercise muscle recovery. As part of my primary research I am

looking to meet with some physiotherapists or other experts to have discussions on their experiences

and what they know in their respective fields. This is to increase my insight on the topic further than

what are already published in books and academic sources. If you are interested in talking about

yourself and if you are based in the Wellington region, I would love to meet you face to face and have a

chat.

Lawrence

oahgniyux@gmail.com

PAGE 7

Feature

Masters Sport, the Next Generation of Athletes

- A New Challenge for Sports Physiotherapists

Participation in masters sports has steadily been

increasing globally over the past 30 years to the point

where, in latter years, it has commonly been described

as a “recent boom”. Contributing largely to an

exponential rise in participants is a generational aspect –

baby boomers are staying active longer and are

therefore participating and competing in sport as older

adults.

An 80-year-old Japanese national successfully climbs Mt

Everest at the age of 80 for the third time. Roger

Robinson, running for NZ, sets a masters marathon

record of 2:18:44 at the age of 41. He continues to run in

the over-70’s even following a recent uni-compartmental

knee replacement. Maybe this subculture is indeed

rewriting the rules of ageing!

The sheer numbers of masters athletes may surprise a

few of us – the World Masters Games, held every 4

years, and to be held in Auckland this month (April 21-

30) has attracted more than 25,000 registered

competitors from 100 countries participating in 28 sports,

all of which speaks volumes in terms of continued

physical activity for the ageing sector. The goal of these

games is encouraging participation in sport throughout

life.

Locally, the NZ National Masters Hockey tournament

regularly attracts 60-70 age-graded provincial teams, a

total of more than 1000 competitors. Other sporting

codes such as touch, tag, athletics, waka ama and

tennis also encompass masters grades for national

tournaments, rugby and rugby league have “president’s”

grades with altered rule changes for safety, while a

number of other sports such as bowls and golf have

historically had regular participants in the older age

group bracket. The NZ Masters Games also attracts

many sports (e.g. swimming, netball, squash) and a high

number of participants and its popularity is reflected in

this being an annual event. One perceived advantage for

CONTINUED ON NEXT PAGE

PAGE 8

Feature

Masters Sport, the Next Generation of Athletes - A New Challenge for Sports Physiotherapists

continued...

the older athlete is the availability of time and financial

security which act as catalysts for participation.

“Second Wind: The Rise of the Ageless Athlete” (by Lee

Bergquist, an American masters sports athlete) and “The

Masters Athlete” (by Dr Peter Reaburn, sports scientist

and masters competitor) are two of a rising number of

publications that are indeed a further testament to the

boom of interest. However, the infancy of masters sports

in comparison to the general sporting population also

means that the pace of research has just begun to take

hold over recent years. So, masters athletes remain a

challenge to researchers world-wide with an open field of

investigative topics – injury rates and prevention,

hormonal changes, performance limitations, motivational

drive and lifestyle benefits to mention a few. Anecdotally,

one can assume that as future research provides

increased knowledge, the masters athlete will reach as

yet an unknown and untapped performance potential.

So, what drives the masters athlete? Subjective analysis

at various tournaments/events show that motivation is

largely driven by personal challenge, passion and

achievement, and this can be anything from setting

records to experiencing health benefits. Also, a number

of athletes have recognised a sporting ability later in life,

others have not achieved their goals when young,

particularly at provincial and international level, while

some seek the challenge of simply keeping fit and

healthy. There are also people like Peter Snell, New

Zealand’s “Sports Champion of the 20th Century” and

who is famous for his 800m and 1500m heroics at the

Rome and Tokyo Olympics in the 1960’s where he won

three gold medals. He will be competing in the World

Masters table tennis event at the age of 78. Deb

Reardon, a NZ surf life saver started her sport at the age

of 50 and is motivated to keep training and remain fit to

help others by patrolling every summer. Seeking

opportunities to socialise appeared to be a less

important motivator. At the other end of the spectrum

from social masters (often called “Golden Oldies”), the

older competitive participants represent models of high

functional capabilities and they have been shown to

have fewer chronic diseases such as diabetes and

cardiovascular issues when compared to their non-

athletic peers whilst also enjoying higher levels of

physical and mental health (1). Further to this, and in my

experience, many competitive athletes let ability define

their age and not vice-versa.

So, what are some of the issues distinct to the masters

athlete? Competitive masters athletes, like the younger

sporting population, have high expectations of care

including rehabilitation and return to sport. However, as

we know, the ageing body predisposes itself to natural

changes in physiology, structure and function lending

itself to more illness and injury. So, specific

considerations are required for the masters athlete

predominately due to a reduction in bone density and

muscle mass; reduced elasticity of soft tissue; an

increase in body fat; reduction in strength, flexibility and

coordination; reduced maximal aerobic and anaerobic

power; reduced heat and cold tolerance; and

degenerative changes. BL Marks (2) showed health

benefits in veteran(senior) tennis players – enhanced

aerobic capacity (VO2 max), greater bone densities,

lower body fat, greater strength and maintenance of

reaction time performance in comparison with age

matched less active controls. However, Lindsay and

Dunn (3) concluded that training induced cardiac

hypertrophy of the left ventricle may have associated

fibrosis, and Pigozzi et al (4) concluded that the findings

of a false ST segment depression, although still not fully

understood, may be related to physiological cardiac

remodelling induced by regular training. So, these two

latter examples of research also illustrate that topics are

still very open for investigation, debate and discussion.

So, what is the role of the sports physiotherapist? The

significant changes with ageing signals that a distinctly

more vigilant approach is required by the sports

physiotherapist from preparation to sideline and clinical

management to rehabilitation. Injuries range from strains

and sprains (e.g. calf/TA, groin, hamstring, Lx, patella

tendon, rotator cuff) to contusions (e.g. fractures –

clavicle, A/C joint, tibial) to medical emergencies.

Preparation

• Pre-participation screening/evaluation – be more

closely allied to the sports physician to gain more

familiarity with medical issues and associated risk

factors, e.g. medication (eg. beta blockers, insulin,

diuretics, NSAIDs, blood thinners), sudden collapse,

exercise induced asthma, head injury, female

athlete issues

• Understand pre-existing conditions and take into

account that asymptomatic individuals still have

natural ageing processes occurring such as

degenerative changes to bone and soft tissue e.g.

rotator cuff tendons, TA, knee, hip and lumbar OA,

CONTINUED ON NEXT PAGE

PAGE 9

Feature

Masters Sport, the Next Generation of Athletes - A New Challenge for Sports Physiotherapists

continued...

lumbar stenosis

• A more acute awareness of the types of injuries in a

sport

• An awareness of those returning to sport after years

of inactivity

• An awareness of performance abilities in climatic

extremes of heat and cold: hyper- and hypothermia

• A possible need for more protective equipment

• Care with warm up – an extended slow warm up and

not introducing any new activity e.g. high leg lifts

that, if, foreign to an individual, may cause injury.

• An extended recovery period – training and warm

downs

• Care with stretches – number, speed and holding

times

Sideline

• Take an overall more vigilant approach to action

especially for warning signs and symptoms

• Station yourself as close as possible to the field/

event

• Note closest defibrillator( AED) location

• Note any individuals that may predispose

themselves to injury due to, for example, poor

balance or coordination, lack of skill/technique

Treatment/Rehabilitation

Be aware of:

• Contraindications e.g. pacemakers, metal implants,

medications like blood thinners

• Fragility of skin e.g. deep tissue massage,

myofascial release, strapping/taping

• Depth of trigger point release

• Slower healing rates

• Exercise – appropriate exercise, speed and

numbers of repetitions, slower progressions, longer

intervals and recovery

• Stretching -as mentioned

• Mobilisations/manipulations with respect to bone

mass/density especially in the female athlete

• Reduced balance and coordination

• Lifestyle needs

A recommended reading is “Selected Issues for the

Master Athlete and the Team Physician: A Consensus

Statement” (5)

Finally, to illustrate a couple of experiences on the

hockey field:

• A 56-year-old playing for the NZ Men’s Masters 55

age group versus Australia in Hobart in extremely

cold conditions who had a complete avulsion of his

biceps femoris tendon origin from the ischial

tuberosity whilst pivoting and changing direction off

that leg. Managed conservatively after

considerations of: surgical vs conservative recovery

time (approx. equal), work, financial and social

factors. Returned to jogging with a shuffle at 9

months. Retired from the sport having played for 48

years. Retired having played for 48 years but

continues to be active at the gym and remains

heavily involved with the sport.

• A 55-year-old playing for North Harbour Men’s

Masters endured a collapse via a cardiac event in

the second half of the game. CPR administered

immediately by an opposition player (a doctor), and

one of the referees (a fireman). The player was

revived with a defibrillator care of the ambulance

staff. Nil past history. Returned to play. An AED is

now located at this hockey ground.

These examples alert the sports physiotherapist to be

prepared for a severe injury that may be more common

with the masters athlete. Having said that, my

experience in masters hockey over the past 20 years

tells me that many participants are now well prepared

and an awareness of injury prevention combined with

management involving the physiotherapist and allied

health professionals has resulted in fewer, overall

musculoskeletal injuries.

So, there is no question that the older athlete is more

prone to injury. The sports physiotherapist, with a sound,

meticulous and professional approach, along with future

research findings will continue to play a major and

defining role in this field. This will assist masters athletes

to continue to push the boundaries of their endeavours.

Just ask Roger Robinson.

PAGE 10

Feature

Masters Sport, the Next Generation of Athletes - New Challenge for Sports Physiotherapists

continued...

REFERENCES

1. Wright V J and Perricelli BC 2008 “Age related rates of

decline in performance among elite senior athletes”

AJSM 36(3) 443-50

2. Marks BL “Health benefits for veteran tennis players)”

BJSM 40 (5) http://dx.doi.org/10.1136/

bjsm.2005.024877

3. Lindsay M and Dunn F “Biochemical evidence of

myocardial fibrosis in veteran endurance athletes”

BJSM 41(7) http://dx.doi.org/10.1136/

bjsm.2006.031534

4. Pigozzi et al “Role of exercise stress test in master

athletes” BJSM 39(8) http://dx.doi.org/10.1136/

bjsm.2004.014340

Bharat Sukha

A physiotherapist of 26 years, predominantly in

private practice (owner, Physiosport) .

I started my academic life with a BSc in Biosciences

at Auckland University, worked in agriculture for 5

years, had a 4-year OE (backpacking Americas, UK,

Europe, Africa and Asia) and then returned to study

physio in Auckland with a PGD in Sports Medicine

some years later. An SPNZ executive committee

member for several years.

A tennis player in younger days who then became a

hockey player and coach for 34 years (and still

going!!) at the Roskill Eden Hockey club; Auckland

and NZ Masters hockey rep.

Experiences include:

Lecturer: Human physiology and anatomy, Dept of

Sport and Recreation, AUT;

“Cultural Awareness for Physiotherapists”, AUT

Physio: International experience includes: Canadian

Cycling team, Commonwealth Games; NZ Hockey, 7

years (NZ Juniors, Junior and Senior Academies, NZ

Men); Other – Ironman, Oceania Veteran Games.

5. “Selected Issues for the Master Athlete and the

Team Physician: A Consensus Statement”.

Medicine and Science in Sports and Exercise:

April 2010 42 (4) pp820-833. (/acsm-msse/

toc/2010/04000)

6. “Coaching Masters Athletes”, Coaching

Association of Canada

ACKNOWLEDGEMENT

Coaching Association of Canada (and Kona

Hawaii 2011 Ironman) for their kind permission

to reproduce the front cover.

Eden Park Stomp, Feb 2017

PAGE 11

What is the Best Practice Assessment and Management of Gluteal

Tendinopathy in a Running Population?

Post-Grad Student Contribution

PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT

Assessment

Dysfunction of the gluteal tendons is a result of

catabolic degenerative and interstitial cell response to

load. This is combined with accumulative lateral

compression and high tensile stress during eccentric

contractions (Mulligan et al., 2015), with excessive hip

adduction and internal rotation during static and

dynamic postures mostly to blame (Grimaldi et al.,

2015). Video analysis during assessment of sports

specific tasks or the use of a single leg squat proves to

be beneficial in identification of these faulty movement

patterns (Brukner and Kahn, 2012).

A consistent diagnostic hallmark of GT is tenderness on

palpation over the lateral greater trochanter (Woodley

et al., 2008; Brukner and Kahn, 2012). The patient may

also report pain at night or when lying on the affected

side, sitting with their legs crossed, prolonged weight

bearing on the affected limb and a reduced tolerance

for physical activity. There may also be lateral thigh or

buttock pain referral. (Woodley et al., 2008; Brukner

and Kahn, 2012). Special orthopaedic tests of the hip

appear to possess weak diagnostic properties for GT,

therefore a battery of tests may be used to strengthen

examination findings (Grimaldi et al., 2015). Superior

tests in the literature include pain with resisted hip

abduction, resisted de-rotation from external rotation in

90 degrees of flexion and single leg stance for 30

seconds (Lequesne et al., 2008; Woodley et al., 2008).

The Patrick and Ober tests have conflicting evidence

regarding their overall validity in GT (Woodley et al.,

2008) and although they are commonly used this

should not be in isolation. The Trendelenburg sign has

been shown to have relative validity when assessing for

gluteal pathology, particularly in runners where the

practitioner must distinguish between pain inhibition or

true weakness (Brukner and Kahn, 2012; Mulligan et

al., 2015). Radiology, preferably radiography,

ultrasound of magnetic resonance imaging (MRI), in

acute episodes may be necessary to rule out bony or

significant soft tissue injury. It is agreed however, that

findings on imaging do not always correlate with the

clinical picture. (Woodley et al., 2008; Grimaldi et al.,

2015).

The trochanteric bursa may also be implicated,

although radiological and surgical studies have shown it

is rarely the culprit of symptom manifestation and is

often over diagnosed in lateral hip pain (Mulligan et al.,

2015; Mellor et al., 2016). Further differential diagnosis

should include intra-articular hip disorders, muscle

tears, iliotibial band (ITB) disorders, lumbar or sacroiliac

dysfunction, inguinal hernia and snapping hip (Mulligan

et al., 2015).

CONTINUED ON NEXT PAGE

INTRODUCTION

Gluteal tendinopathy (GT) is described as one of the most prevalent lower limb tendinopathies, and refers to

debilitating pain or symptoms over the greater trochanter of the hip. It presents commonly in sedentary populations

and is most prevalent in females over the age of 40 (Grimaldi et al., 2015; Mellor et al., 2016). The syndrome is also

abundant in runners with numbers proposed to further increase, particularly with expanding running and fitness

communities (Grimaldi et al., 2015; Mellor et al., 2016). Unfavourable effects on well-being, quality of life and

degrading general health are characteristic to this condition, thus the desire for timely identification and return to

physical activity is strong (Mellor et al., 2016). The literature around the management of GT is broad and

encompasses a range of moderately supported treatment strategies, with gold standard management for the active

population remaining unclear (Grimaldi et al., 2015; Mellor et al., 2016). Although gluteus medius/minimus

tendinopathy are frequently to blame, the complexity of the multifactorial pathology that may be associated with GT is

often overlooked, resulting in poor management alongside premature return to sport and further risk of injury. This

report will briefly explore the appropriate assessment of GT, followed by a focus on the multivariate supply of risk

factors and the selection of management options reported in the literature, with the aim of highlighting favourable

sports specific treatment strategies and their role in successfully allowing return to pain free running.

PAGE 12

What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a

Running Population? continued...

PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT

Risk Factors for GT in runners

The workload-injury aetiology model from Windt and

Gabbett (2016) summarises the complex interplay of

external and internal risk factors that contribute to

injury, with those that are modifiable being a focus

throughout rehabilitation.

Intrinsic

Modifiable intrinsic risk factors associated with the

development of GT include previous injury, proximal

strength deficits, faulty foot loading patterns and

functional leg length discrepancies (Niemuth et al.,

2005; Mulligan et al., 2015; Barton et al., 2016; Windt

and Gabbett, 2016).

Proximal strength is vital when referring to the closed

kinetic chain theory, where adequate control of distal

segments is necessary to prevent injury. This is

particularly important in runners where balanced

biomechanical forces at the hip are required in order to

reduce detrimental lower limb movement patterns

(Niemuth et al., 2005). Niemuth et al. (2005)

demonstrate significant strength deficits in the affected

hips of injured runners, with the abductors and flexors

both proving to be weaker than the hip adductors. This

may be associated with the work by Rio et al. (2015a)

who recognise the contradicting evidence around the

relationship between pain and altered motor control in

patellar tendinopathy. They suggest that altered

corticospinal control involving an imbalance of

excitability and inhibition, combined with changes in

strength and tendon capacity is as a result of a

protective adaptation to pain. Previous injury along with

non-resolution of the above factors may therefore

increase the likelihood of symptom reoccurrence.

Running technique is also recognised in the literature

as a contributor in the development of GT, although

research quality shows room for improvement. The

repetitive nature of running places the lower limb under

loads up to eight times body weight (Anderson et al.,

2001). Inadequate cadence, stride length and foot strike

patterns have been associated as modifiable risk

factors contributing to a lack of hip control (Heiderscheit

et al., 2011; Chumanov et al., 2012), with Daoud et al.

(2012) describing a two-fold increase in lower limb

injury risk in a runner who adopts a rear foot strike

pattern versus a forefoot pattern. It must be noted that

normal levels of hip adduction will result due to

gravitational and acceleration loads, along with the

ground reaction force falling medial to the hip

(Novacheck, 1998; Niemuth et al., 2005).

Extrinsic

Extrinsic risk factors include training load, level of

competition and changes in terrain such as a cambered

ground or running in the same direction around a track

(Niemuth et al., 2005; Mulligan et al., 2015; Barton et

al., 2016). Spikes in workload are strongly associated

with injury risk as a result of increased exposure and

fatigue, and may serve to alter the effect of modifiable

risk factors (Windt and Gabbett, 2016).

Although the majority of movement in running is in the

sagittal plane, it is reported that 18.9% of total running

energy is devoted to control of frontal plane movements

(Niemuth et al., 2005). It is thus apparent that protocols

focusing on correcting the cause of these reported

movement and training faults play an important role in

the prevention and management of GT in runners.

Management

Gait retraining

There is substantial evidence to support the immediate

biomechanical effects of running technique re-training

in uninjured populations. Strong evidence for those that

are injured is lacking, although it should be recognised

that alterations in a runners’ kinematics can significantly

affect how external and internal forces are generated

through the pelvis (Daoud et al., 2012). An increase in a

runners preferred cadence by 10% has been shown to

reduce peak adduction moments, stride length, impact

loading and energy absorption of the hip (Heiderscheit

et al., 2011; Chumanov et al., 2012). Chumanov et al.

(2012) report an increase in gluteus medius and

maximus contraction during the late swing phase of the

gait cycle with an increased cadence, thus benefiting

motor control during the subsequent foot contact. They

report no significant increase in contraction during

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Post-Grad Student Contribution

PAGE 13

What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a

Running Population? continued...

PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT

stance phase, although this may be beneficial as it

results in improved lateral pelvic control without

increased energy use. Alteration in foot strike patterns

and footwear choice have also been associated with

injury risk and although the literature is conflicting,

results are promising. A runner who develops more of a

forefoot rather than rear foot strike pattern, preferably in

minimalist shoes, demonstrates reduced ground

reaction forces (Daoud et al., 2012; Rice et al., 2016)

as well as increased cadence and subsequent

reduction in stride length, both of which have been

linked with minimising adductor angles (Heiderscheit et

al., 2011; Daoud et al., 2012; Altman and Davis, 2016).

Real-time feedback is supported, with external cues

such as metronomes, music and verbal instructions

being the most valued among experts in the field

(Heiderscheit et al., 2011; Barton et al., 2016). It is

important to note that an individualised adaptation

period for these alterations is required, with McCarthy

et al. (2015) suggesting 12 weeks as an appropriate

timeframe for changes in motor patterns. This should

aid in the reduction of injuries such as stress reactions

in the metatarsals of which have been associated with

prompt transitions to forefoot running (Rice et al.,

2016).

Pain management and adjunct treatments

When comparing the effects of shock wave therapy

(SWT), corticosteroid injection (CSI) and a home

exercise programme (HEP) for lateral hip pain, Rompe

et al. (2009) report that although CSI has very

favourable short term results, after one month this was

significantly reduced. After four months’ SWT was the

superior treatment and after 15 months’ SWT and HEP

were equally successful. It must be noted however that

the HEP included ITB stretching which may have

slowed response due to the known compressive

properties of tensor fascia lata (TFL) and gluteus

maximus at the greater trochanter (Mulligan et al.,

2015; Mellor et al., 2016). Non-steroidal anti-

inflammatory drugs, ice, heat and ultrasound have also

been reported in the literature as early pain

management options, although their long term efficacy

is questioned (Cook et al., 2016; Mellor et al., 2016).

Rio et al. (2015a) also argue that these unimodal

treatments do not address local or central deficits in

tendon capacity, muscle strength or corticospinal

control across the kinetic chain when compared to

exercise. Surgery is reserved for if conservative

management fails, although if the athlete is managed

appropriately this can be avoided (Mellor et al., 2016).

Strength and neuromotor control

It is evident that strength imbalances in the hip that

exist in the frontal plane may play a significant role in

the development of GT in runners. Exercises should

therefore focus on targeted strengthening of the hip

abductors and dynamic control of adduction and

internal rotation during functional tasks. It is vital to

initially restore controlled strength in the deep hip

stabilisers through various degrees of instability

(Brukner and Khan, 2012). Following this, focused

gluteal strengthening can commence, ensuring that

throughout progressions the athletes pain is monitored

and they demonstrate adequate deep hip control as

well as lumbo-pelvic stability (Brukner and Khan, 2012).

Exercises may include but are not limited to hip

rotation, bridging, squats, side stepping, balance

training and resistance work. Sports specific training

including gait retraining for runners should be

incorporated. Large hip adduction angles as well as

active hip abduction through range should be avoided

in the very acute phases if painful (Brukner and Khan,

2012; Mellor et al., 2016). Snyder et al. (2009) have

researched the effect of closed chain hip abduction and

external rotation exercises on hip motions during

running and have demonstrated reduced internal

rotation moments following a six-week progressive

strength programme. Leung et al. (2015) discuss the

benefit of externally paced strength exercises with a

metronome and their superior effect on increasing

excitability and reducing inhibition when compared to

commonly prescribed self-paced exercises. This ability

to address altered corticospinal control is important in

the adequate correction of faulty movement patterns

and although further research is required for its use in

GT, it should be considered where possible during

strength programmes. It should be noted that there is

no strong evidence available for the use of eccentric

exercises in GT specifically.

Load Management

Although complete rest is catabolic for tendons, it is

important to initially identify and correct deficits in

CONTINUED ON NEXT PAGE

Post-Grad Student Contribution

PAGE 14

What is the Best Practice Assessment and Management of Gluteal Tendinopathy in a

Running Population? continued...

PHTY542 SPORTS PHYSIOTHERAPY WRITTEN ASSIGNMENT

training load (Barton et al., 2016; Cook et al., 2016).

Load management may aid in acute tendon

regeneration and is fundamental in the prevention and

treatment of injury (Grimaldi et al., 2015; Cook et al.,

2016; Drew et al., 2016). Initially, reducing activities that

involve high eccentric efforts of the gluteals is

necessary, including hopping and bounding and may

include overall running distance (Grimaldi et al., 2015).

Spikes in workload are strongly associated with injury

and with reference to the work by Windt and Gabbett

(2016), high chronic workloads must not increase by

more than 10% week to week and the acute: chronic

work load ratio should be kept moderate. Educating the

athlete on these risk factors is important during the

rehabilitation phase of an injury.

Athlete education

Further education on reducing compression forces and

pain include applying a donut shaped relief pad to the

affected side when sleeping and avoiding unilateral

stance or sitting with crossed legs. The treating

physiotherapist may choose to include lateral

distractions and posterior glides of the hip (Mulligan et

al., 2015), as well as friction massage of the tendon

(Cook and Purdam, 2009).

Questionnaires

Gabbett (2016) also acknowledges the importance of

athlete well-being monitoring through the use of

questionnaires to allow coaches and physiotherapists to

alter an athletes training if need be. The stress

response model adapted from (Williams and Scherzer,

2010) supports this and is a useful way to familiarise

practitioners on the multiple stresses that athletes may

encounter. The VISA-G questionnaire has been shown

to have good reliability and validity as a way of

measuring the severity of disability associated with GT.

It is also useful in determining the effectiveness of

treatment, although it must be acknowledged that the

questions are not aimed at athletes and are only mildly

sports specific as sedentary populations are currently

the most prevalent group affected (Fearon et al., 2015).

Conclusion

This report has discussed the identification and variable

management options of GT in the active running

population. Risk factors including altered running

technique, poor motor control and training load were

explored and serve to appropriately direct the focus of

treatment strategies. Although addressing pain is

critical in the early stages of tendinopathy management,

efforts at rehabilitation are more likely to be successful

when the focus is on restoring balanced function of the

hip and the kinetic chain. For a runner with GT, running

technique interventions, targeted neuromotor control

exercise and load management should be included in

the treatment process. If work rates exceed an athletes’

limits or compressive and tensile loads at the lateral hip

are poorly addressed, treatment outcomes and risk of

future injury are compromised. Although further

research is required for its role in GT, adopting this

active approach may not only aid in the treatment and

prevention of injury but also enhance wellbeing and

performance of the runner.

References

Click here for a full list of references.

By Grace Fursdon

Bachelor of Physiotherapy (Otago) and Post Grad

Diploma on Sports and Exercise Medicine (Otago).

This review was completed as part of the Sports

Physiotherapy paper, University of Otago. Grace

was undertaking this paper towards a Post-

graduate Diploma in Sports Medicine.

Post-Grad Student Contribution

PAGE 15

Footwear for the Ageing Athlete:

ASICS Report

Keeping the Masters Bodies Active with the Right Footwear

They say a good red wine gets better with age…BUT

ONLY if you look after it and cellar it in the right

conditions. It is the extra TLC that makes the difference.

This is no different to managing our older patients.

Ageing is associated with numerous structural and

functional changes to the body. These changes in turn

influence the adaptive capacity of our soft tissues,

meaning that our body cannot handle the load that it

once use to without experiencing pain and symptoms.

So, what is different about these statesmen/women of

our generation and how they walk:

• They walk slower than young adults with a

decline of approximately 0.1-1.2% per year from

20 years of age (Arnold 2016). This is likely due

to changes in muscle strength, fear of falls and

altered sensation/proprioception. This reduction

in walking speed directly shortens stride and

step length.

• A less propulsive gait pattern (Boyer at al. 2012).

This can be explained by the above variables, as

well as the resultant changes in reduced

pressure noted under the heels and balls of the

foot, as well as reduced ankle power generation

and strength.

• In terms of joint movement, there is less range of

motion (Arnold et al. 2015). Mobility of the joints

is desirable to allow efficient function of the foot,

yet it is likely that older feet are in fact stiffer.

So in those older individuals who want to stay active,

what can we do to help them stay fit and injury free?

Well finding them the right shoe is a good start. But that

matriarch of the family, the active retiree or the masters

athlete, how do we help them select their perfect shoe?

I think as health professionals we can follow five key

criteria to assist in this process

1. Understand any age-related changes that are

occurring in their body.

This can be a sensitive question, but the information

generated in any investigation is pivotal to selecting

the right shoe. Therapists need to take the time to

conduct a thorough movement analysis profile of

their patient. Combined with a detailed subjective

history about past injury and any age-related

pathological processes at play, the information about

joint structure and function greatly assists in

identifying the type of shoe the individual may need.

2. Provide the required information to assist

retail to find the right shoe…but DON’T

suggest just one shoe!

Are you the therapist that does not send in a letter

with your patient to the shoe store to assist in the

selection of shoes, but then complain they have been

provided the wrong shoe when they present back in

your clinic?

Yes absolutely…too often in clinic I see the wrong

shoe prescribed to the wrong individual. But whose

fault is that? It’s not always the retail attendant.

Shoe prescription is an art, but it is also a treatment.

Retail attendants may be experts in footwear, but they

are not trained health practitioners, and we cannot

simply expect them to understand age-related

pathological processes (although some do try…).

Perhaps with a bit of effort, we could actually assist

them in choosing the right shoe…

Ask any retail attendant about what their number one

reason for returns is (outside of material failure) and it

would certainly relate to their medical team

disapproving of the shoe choice made. Let’s remove

this possibility and send our patients in-store with

information to help the retail attendant do their job, just

as if we were referring our patient to another therapist

or surgeon. But don’t just suggest one shoe…give the

retail attendant the details of what you want from a

shoe and allow them to match the best shoe to your

patient’s foot type and needs.

3. Educate your patient

Never has their been more choice in the market. More

choice though generally means more confusion. In my

experience, those individuals that know what is wrong

with them, what they need and what their practitioners

is asking for are those that generally get the best

results. Purchasing footwear is no different. Given we

often wont be in the shoe shop with them, it is

important that we provide our patients with criteria to

evaluate whether the shoe is correct for them. Clearly

CONTINUED ON NEXT PAGE

PAGE 16

Footwear for the Ageing Athlete:

ASICS Report

Keeping the Masters Bodies Active with the Right Footwear

explaining what makes a shoe comfortable, what type

of support they need from a shoe (and where it should

be positioned) and why it is important to get properly

fitted will all go a long way to your patients choosing

the best shoe.

4. Know your product

As we age gracefully, our body loses some of the

natural dampening process that help our body

attenuate impact forces. The fat pads underneath the

foot thin out, the foot gets stiffer and our joints just

don’t seem to be moving as much as they used to…

We are talking about fitting footwear to an age

demographic that are likely experiencing some form of

degenerative arthritis or change in the mechanical/

structural properties of the soft tissues in the body.

Their bodies just don’t function he way they used to.

So how could this all be assisted with footwear

technology? Think cushioning system, trustic designs,

last designs, upper materials, toe springs and shoe

geometry…shoes are powerful manipulators of human

movement, yet there is a wide range of products our

there between the big manufacturers. The only way to

stay atop of this is to organise visits with each of the

major companies you use every six months to spend

the time understand their product and what is new/

changed since the last model. Ensure that you then

make the effort to understand what products are going

to be stocked by your local store so that you can refer

appropriately.

5. Have a great relationship with your local store

Just as we invest time in developing medical

relationships with potential referrers, so should we be

with our local shoe store. After all, it is in the best

interests of your patients. Go in and meet them.

Provide your contact detail. Tell them to call you if they

have any concerns about the shoes for a particular

patient. I for one would much rather get the 5-10

phone calls a day from my local store clarifying a small

question to ensure my patient can be provided with

the right shoe there and then, rather than having to

come back to me for approval or recommendation of

another shoe. They are the shoe experts…respect

their knowledge…but be n hand when they need

yours.

You never know, the referrals may in fact even be

reciprocated and come back to you!

So in summary…is the ageing foot different to the

young foot? Yes it is. Do shoe companies make shoes

for the older athlete to account for the changes in foot

function? Not really. Should we expect the retail

attendant to select the perfect shoe for our patients

without any background history? No we shouldn’t. But

as health practitioners, if we take on some more

responsibility, educate our patients and provide a

detailed referral for shoes, I think we will go a long way

to improving the prescription of shoes to our maters-

aged patients.

By Dr Chris Bishop PhD

Director of Biomechanics - The Biomechanics Lab

Post-doctoral research fellow - UniSA

Chris Bishop content provided through the

support from our SPNZ sponsor

– ASICS

PAGE 17

HPSNZ Corner

Welcome to the High Performance Sport New Zealand (HPSNZ) corner.

Each bulletin we are looking to supply content from physiotherapists working in high performance sport.

This bulletin we posed questions that we are regularly asked by members to

Jennifer Sayer, Megan Munro and Fiona Mather from HPSNZ.

1) What qualities and attributes do you think make

a good sports physiotherapist?

Fiona Mather: Flexibility in approach; the ability to

adapt to a variety of coaching styles, training

environments and personalities whilst maintaining a

high quality and professional manner

Jennifer Sayer: Level headed and calm under

pressure. Assertive enough to present difficult

information to coaches and management in “under-

pressure” environments, even when it is not what they

want to hear. Need to be able to laugh at yourself – take

what you do seriously but not yourself. Need to be able

to prioritise and manage your time and work effectively

and efficiently as part of the team. Understand the

boundaries between yourself and the athletes – which

sometimes seem to be more “blurred” within the

sporting environment but which are equally, if not more

important than they are in private practice – to protect

both yourself and the athletes.

Megan Munro: I think the ability to communicate, work

as a team, appreciate and compliment other disciplines

within your team and to understand performance and

what it takes to make an impact on performance. You

need to have the ability to see the bigger picture, and

to understand your place in that picture.

2) How do I get into a High Performance

Physiotherapy role, or how did you get into your

High Performance Physiotherapy role?

Fiona Mather: Experience and understanding of

the broader aspects of the role, be prepared to

demonstrate where you have been effective in the

following areas within a performance environment;

injury management (understanding the coach and

athlete perspective and pressure of competition

calendar and the impact upon return to play decisions)

Injury prevention (apply a critical approach, injury

surveillance/interventions whilst demonstrating efficacy

of any intervention programme – a post graduate

qualification helps show a critical approach can be

applied to the practical situation), experience at

national and international competition and understand

the vagaries of the role of in the domestic and touring

environment.

Jennifer Sayer: Pay your due diligence – put in the

hours in grassroots sports first, building up your

foundation of experience – be this initially unpaid or low

paid eg club rugby/ netball/ football. Align yourself with

well-respected clinics who have a good development

programmes. Attend regular SMNZ and sports SIG

learning opportunities to start networking. Post

graduate courses eg Masters in health practice/ SPNZ

courses/ sports first aid courses. Remember – that the

physio world is small - everybody you meet within the

discipline has the potential to “make or break” your

career – so treat people with the respect that you want

them to extend to you. Work hard – anything worth

having requires you to put the effort in.

Megan Munro: I volunteered as a physio at the London

2012 Olympics and Paralympics. Best summer of my

life! The rest is history, it opened huge doors for me and

I've never looked back.

3) What other skills, aside from manual therapy

and on-field physio intervention do I need to work

as a physiotherapist in a High Performance

environment?

Fiona Mather: Critical thinking; elite sport often

presents quite unique challenges to the sports

physiotherapist. A successful outcome demands an

enquiring mind and a robust rationale for interventions

which must focus on performance without

compromising the long term health and wellbeing of the

athlete. The practitioner who displays a balance of

confidence within his/her scope and an honesty when

the picture is less certain will build trust with athlete,

coach and wider Multi-disciplinary team.

Jennifer Sayer: Sense of humour. Sense of the “bigger

picture” rather than the day to day “fixing” of injuries –

need to look at preventative strategies and

management strategies rather than just standing at the

bottom of the cliff when things go wrong. Good

communication skills – in person and through other

means. Respect – for the athletes, for the coaches and

for the processes of HP sport.

Megan Munro: I work in Para sport and I think it's

important to be able to think outside the box/laterally

and have a good imagination. I think working in Para

sport really improves your clinical reasoning as very

little is 'normal' and you are constantly challenging

yourself to come up with unique, unconventional ways

of achieving a performance outcome or injury

prevention strategy.

If you have any questions that you would like answered

in the HPSNZ corner, please email them to Rebecca

Longhurst: Rebecca.Longhurst@hpsnz.org.nz

PAGE 18

Clinical Section - Article Review

INTRODUCTION

The relationship between training load, injury, fitness and performance is critical to practitioners who work with

athletes and teams (physiotherapists, sports scientists, strength and conditioning coaches). Dr. John Orchard

reported in a British Journal of Sports Medicine blog that both inadequate and excessive loads would result in

increased injuries, reduced fitness and poor team performance.

Any injuries that are considered “training-load-related” are also considered “preventable”. Strength and conditioning

coaches aim to develop resilience by exposing players to intense physical training in lines with the competition

demands. Medical practitioners on the other hand usually advocate for reducing training loads to reduce the risk of

“load-related” injuries.

In terms of performance; several studies have shown an improved performance after a greater training volume and

intensity. One study looked at fifty-six runners, cyclists and speed skaters of whom undertook twelve weeks of

training. A ten percent performance improvement was associated with a ten-fold training load volume increase.

How to measure training loads:

Training loads are measured via external training loads

(i.e. physical work) accompanied by an internal training

load (i.e. physiological or perceptual). Individual

characteristics of an athlete (i.e. training age, injury

history) combined with the external and internal training

loads determine the training outcome.

External training loads are commonly measured using a

global positioning system (GPS). These can measure

speed and distance as well as non-locomotor sports-

specific activities (e.g. collisions in rugby).

Internal training loads are commonly measured using a

session-rating perceived exertion (RPE) multiplied by

the session duration. These are normally referred to as

arbitrary units or exertional minutes.

Well-being is also a common monitored measure in high

performance sport. These subjective questionnaires are

normally rated on a simple five, seven or ten-point Likert

scale and question athletes on items such as their

mood, stress levels, energy, sleep and muscle

soreness.

The Training–Injury Prevention Paradox:

Should Athletes be Training Smarter and Harder?

CONTINUED ON NEXT PAGE

Reference:

Gabbett, T.J. (2016). The training – injury paradox: should athletes be training smarter and harder?

Br J Sports Med, 50: 273-280

The relationship between training loads and injury:

Numerous studies have looked at the external training

load of an athlete in their given sport and correlated it to

an injury risk. For example, fast bowlers in cricket who

bowled more than 50 overs in a match were at

increased risk of injury.

Internal training loads research has shown correlation

with external load. For example, in professional rugby

union players, higher one-week arbitrary units and four-

week cumulative loads were associated with higher risk

of injury.

In rugby league, there has been shown to be no

significant relationship between field training loads and

incidence of strength and power injuries. However,

strength and power training loads have significant

association with the incidence of contact and non-

contact field training injuries. To minimize training-

related injuries, scheduling of field and gymnasium

sessions should be carefully considered to reduce

residual fatigue between sessions.

PAGE 19

Clinical Section - Article Review

Training adaptations between younger and older

athletes:

The chronological and training age of an athlete

influences adaptations and injury risk to training. Both

older and younger rugby league athletes improve in

muscular power and maximal aerobic power; however

the improvements are greater in the younger athletes.

A study on Australian Football League players showed

that at a given training load older and more experienced

players were at greater risk than younger and less

experienced players. This may be confounded by the

older players having previous injury history which is a

major risk factor for a new injury.

Given the above research, it is suggested that training

programmes should be modified to accommodate

differences in training age.

Training load – injury relationship and predicting

injury:

Over a two year period, Gabbett used the session-RPE

load monitoring to determine the relationship between

load and likelihood of injury in elite rugby league

players. Players were fifty to eighty percent more likely

to sustain a preseason injury within the weekly training

load range of 3000 to 5000 arbitrary units. This arbitrary

unit was considerably lower in competition phase.

Injury data was recorded prospectively for a further two

years and an injury prediction model was developed

based on planned and actual training loads. If a player

exceeded the weekly training load threshold, they were

seventy times more likely to test positive for non-

contact, soft tissue injury compared to players that did

not succeed the threshold, of whom were 1/10 as likely

to test positive.

Week to week changes in training loads:

A study on Australian Football players has shown that a

rapid change of greater than ten percent training load

was associated with a forty percent increase likelihood

of injuries. Large week to week changes of 1069

arbitrary units has also been shown to increase risk of

injury in professional rugby union players. To minimize

the risk of injury, practitioners should limit weekly

training loads increases to less than ten percent.

The Training–Injury Prevention Paradox: Should Athletes be Training Smarter and Harder?

continued...

Acute and chronic training load:

Using acute and chronic training load ratio provides an

index of athlete preparedness. Chronic determines the

state of ‘fitness’ and acute determines the state of

‘fatigue’ for an athlete. The ratio considers the training

load that the athlete has performed relative to the load

the athlete has been prepared for.

Data from cricket, Australian Football and rugby league

has established a guide to interpreting and applying

acute: chronic workload ratio. A ratio range of 0.8-1.3

could be considered the training ‘sweet spot’, while a

ratio of equal or greater than 1.5 represents the ‘danger

zone’.

As this data relates to the above sports, caution is

recommended when applying these ratios to other

sports.

CONCLUSION

There is a strong relationship between high training

loads and injury. The problem with high training load

appears to be more related to the inappropriate training

prescribed such as excessive and rapid changes in

load. This paper highlights the importance of monitoring

training load preferably via an acute: chronic training

workload ratio to assist with long-term reduction in

training-related injuries.

Implications for practice:

• Scheduling of field and gymnasium sessions

should be carefully considered to reduce residual

fatigue between sessions.

• Training programmes should be modified to

accommodate differences in training age.

• To minimize the risk of injury, practitioners should

limit weekly training load increases to less than

ten percent.

• An acute: chronic training load ratio range of 0.8-

1.3 could be considered the training ‘sweet spot’,

while a ratio of equal or greater than 1.5

represents the ‘danger zone’.

By Amanda O’Reilly

BPhty (Otago)

PAGE 20

SPNZ Continuing Education

This course is for registered physiotherapists who work with individual athletes or teams in which lower limb injury is

common. The focus of the course is on pathomechanics and kinetic chain deficits as they relate to injury prevention and

performance, diagnosis and advanced rehabilitation of lower limb conditions.

By the end of the course you will understand the pathoaetiology of common lower limb injuries, be able to perform key clinical and

functional tests, rehabilitate lower limb injury in a number of sporting contexts including football, running 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 all attendees have previously

completed training in exercise prescription (The SPNZ Level 1 Promotion & Prescription of Physical Exercise or equivalent).

We however understand that the timing of the courses sometimes does not suit, and people have undertaken previous courses

that may cover the same information. We therefore have developed a quiz based on the level one course that if passed will

enable you to undertake the level two courses. You only have one opportunity at doing the quiz for each course. To access the

quiz follow the link. To make the registration process smoother please don’t register until you have been confirmed as passing

this course. To attain the Certificate in Sports Physiotherapy ALL level one and two courses must be undertaken.

Location:

AUT North Campus (AA119 building)

90 Akoranga Drive, Northcote,

Auckland

Click for Google map

Click for AUT North Campus map

Date:

Saturday 20th May 2017

8.30am – 4pm

Sunday 21st May 2017

9am – 4pm

Course Fee:

SPNZ Member $450.00

PNZ Member $520.00

Non-PNZ Member $650.00

The course will cover:

• Pathomechanics of lower limb injury in running sports, football and other lower limb sports

• Performance-related functional tests for the lower limb

• Diagnostic tests and imaging investigations for common sporting pathologies of the lower limb

• Design and implementation of rehabilitation programmes including post-surgical rehabilitation

• Integration with coaching and biomechanics for technique modifications

• Return-to-sport decision planning and processes

• Assessment and management of challenging lower limb conditions

The Lower Limb in Sport (SPNZ LEVEL 2 COURSE)

Presenters:

Dr Peter McNair Professor of Physiotherapy

Geoff Potts Sports Physiotherapist, Clinical Educator & DHSc Student

Justin Lopes Sports Physiotherapist

To register:

Registration will be limited to the first 26 paid registrants

Complete online registration via Physiotherapy New Zealand

PAGE 21

Research Publications

British Journal of Sports Medicine

www.bjsm.bjm.com

Volume 51, Number 8, April 2017

REVIEWS

Personalising exercise recommendations for brain health: considerations and future directions

Cindy K Barha, Liisa A Galea, Lindsay S Nagamatsu, Kirk I Erickson, Teresa Liu-Ambrose

http://bjsm.bmj.com/content/

β-alanine supplementation to improve exercise capacity and performance: a systematic review and meta-analysis

Bryan Saunders, Kirsty Elliott-Sale, Guilherme G Artioli, Paul A Swinton, Eimear Dolan, Hamilton Roschel, Craig

Sale, Bruno Gualano

http://bjsm.bmj.com/content/

Resistance training interventions across the cancer control continuum: a systematic review of the implementation of

resistance training principles

C M Fairman, P N Hyde, B C Focht

http://bjsm.bmj.com/content/

ORIGINAL ARTICLES

Training load--injury paradox: is greater preseason participation associated with lower in-season injury risk in elite

rugby league players?

Johann Windt, Tim J Gabbett, Daniel Ferris, Karim M Khan

http://bjsm.bmj.com/content/

EDITORIAL

Paradoxes and personalised medicine: from preseason to post-diagnosis

Jane S Thornton

http://bjsm.bmj.com/content/

EDUCATION

A higher sport-related reinjury risk does not mean inadequate rehabilitation: the methodological challenge of

choosing the correct comparison group

Ian Shrier, Meng Zhao, Alexandre Piché, Pavel Slavchev, Russell J Steele

http://bjsm.bmj.com/content/

PAGE 22

TAURANGA

Foundation Clinic

Sports Physiotherapy Position

All of us at Foundation really love our job. We pride ourselves on being a strong, dynamic, and effective team

working together to ensure the best benefits for our patients.

Due to an ever expanding patient load Foundation is in need of another high quality sports physiotherapist.

Foundation is one of Tauranga’s leading sports physiotherapy and rehab clinics. Work along-side a clinical team

that consists of highly qualified physiotherapists, massage therapists, sports physician, dietician, mental skills

coach, strength and conditioning coaches and full time reception.

The position will involve working in the Bay of Plenty’s leading health club “Aspire Health and Sports” as well as

Mt Manganui’s newest athlete training facility “THE ATHLETE FACTORY NZ.”

Generous appointment times allow for an emphasis on manual/manipulative physiotherapy and exercise

prescription encompassing full rehabilitation in the onsite rehabilitation gym.

The position is permanent full time, however part time options will be considered for the right person. Start date

negotiable. Remuneration package to be discussed, with various options available, including allowance for CPD.

We are looking for a fun, competent, hard-working individual with high work ethic, excellent communication and

enthusiasm who is keen to learn and enhance their clinical skills. At least 3-5 years experience working in sports

or private practice preferred, however applicants with any sports physio experience will be considered.

All applications will be treated with utmost confidentiality.

For more information check out our website www.foundationclinic.co.nz

For expressions of interest forward your CV and covering letter to: Craig Newland:

craig@foundationclinic.co.nz

Classifieds

CAMBRIDGE

Body Performance Clinic

Full or Part Time Physiotherapist We are offering a unique opportunity to work in a brand-new physiotherapy and rehabilitation clinic with exposure to emerging talent and the high performance environment. We are located in the heart of Cambridge, the “town of champions” and hub for high performance sport in New Zealand, and have close links to Rowing NZ, Cycling NZ, as well as local sports medicine doctors and specialists. We are looking for physiotherapists, both full time and part time, starting in early 2017. This is an exciting opportunity to work alongside a highly experienced, motivated and high energy team. Our principal physiotherapist is Masters qualified and a two times Olympic Games physio. You can expect on-going support as part of our strong mentoring program along with an allowance for CPD to assist with post-graduate study, courses and conferences. We provide generous appointment times. Our well-equipped exercise therapy area allows for exercise prescription and rehabilitation of clients onsite. Team fit is incredibly important to us – we are team led, family centered and strongly connected to our community. We are firm advocates of the enormous health benefits of movement and activity, and are looking for like-minded people to join our team. If you have an active interest in wellness and gym based rehab, a strong desire to learn and enhance your clinical skills, and a drive to work as part of a high performing team then we want to hear from you.

If this sounds like you please send your CV and cover letter to:

jobs@bodyperformance.co.nz

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TARANAKI

Taranaki Physiotherapy

Physiotherapist

Are you a physiotherapist looking for an amazing place to work that offers flexibility, friendly staff and patients who

genuinely value your service? Want to live in a beautiful part of the country that offers incredible outdoor

opportunities, great beaches and a stress free way of life? Taranaki is that place and Taranaki Physiotherapy is

offering that job.

Due to our continued growth we are looking for an enthusiastic, motivated physiotherapist to join our fantastic

team, ideally in a full-time capacity, however we are open to negotiation around work hours. The right candidate

will be adaptable, have excellent communication skills and have high standards of professional clinical service.

Competitive remuneration is offered.

We are a general practice with a supportive work environment. We offer opportunities in sports physiotherapy

and our staff are members of both PNZ and SPNZ. We are committed to further education and offer ongoing

clinical supervision, along with opportunities and support for training in your areas of interest.

Applications from all levels of experience will be considered.

If you wish to apply for this position please provide your CV and covering letter to:

tim@taranakiphysiotherapy.co.nz

Any enquiries can be directed to Tim Connole on 0274637307.

Classifieds

HAMILTON

Sports Med Physiotherapy

Musculoskeletal Physiotherapist

Sports Med Physiotherapy has an exciting opportunity for an enthusiastic musculoskeletal physiotherapist to work

as part of our friendly team. Due to the increasing demand for treatment in our busy private practice in Hamilton,

we have a physiotherapy position coming available in June.

Sports Med Physiotherapy is a long established clinic and is well equipped having private consultation rooms and

a fully equipped gymnasium. Our clinical treatment philosophy is one of providing clinically pertinent manual

therapy coupled with quality gym based rehabilitation exercises.

Our current physiotherapist’s are post-graduate trained and our principal has just finished a 6 year stint with the

Chiefs Super Rugby Team. We have also previously had a long association with the Paralympic Cycling Team,

Magic Netball Team and the New Zealand Triathlon Team.

We aim to maintain a very supportive work environment for our staff and provide monthly onsite CPD and funding

for external courses. The length of our patient appointment times are flexible, giving you the ability to individually

tailor treatment to benefit your patient.

Private practice work experience would be ideal, but we are also very open to working with, and mentoring, new

graduates in our clinic. This fulltime position will begin as a 9 month contract, but has the potential to become

permanent. The clinic uses Gensolve and an understanding of this would be advantageous but not necessary.

Candidates must be eligible to work in New Zealand, have an annual practicing certificate and registered with the

Physiotherapy board of New Zealand. Remuneration will be based on experience.

Please send a CV with covering letter to malovell@me.com.