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SPNZ BULLETIN

FEATURE TOPIC: Netball

Issue 4 August 2015

PAGE 2

SPNZ Members’ Page

SPNZ EXECUTIVE COMMITTEE

President Hamish Ashton

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Timofei Dovbysh

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Justin Lopes

Emma Mark

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Kara Thomas

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Dr Angela Cadogan

Justin Lopes

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Dr Chris Whatman

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31 August 2015 and 31 March 2016.

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in the fields of sports and orthopaedic physiotherapy.

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In t

his

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SPNZ MEMBERS PAGE 2

See our page for committee members, links & member information

EDITORIAL 4

By SPNZ President Hamish Ashton

MEMBERS’ BENEFITS 5

IT Benefits

FEATURE 6

Roger Athy-Knibbs—Physiotherapist for Kia Magic

PLANET OF THE APPS 9

App: Ankle

SPRINZ 11

In Sickness and in Health - Making Exercise a Lifetime Partner

ASICS GRANTS 12

Winners of the Asics Education Award and the SMA Conference Grant

CLINICAL SECTION- ARTICLE REVIEW 13

Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains

CONTINUING EDUCATION

SPNZ Level 1 Sideline Management 16

Local course and APA CPD Event Finder 17

RESEARCH PUBLICATIONS

JOSPT Volume 45, Number 8, August 2015 18

BJSM Volume 49, Number 16, August 2015 19

CLASSIFIEDS 20

Vacancies

Contents

FEATURE TOPIC: Netball

PAGE 4

Editorial

Hi to all.

I was procrastinating on writing this as I couldn’t think on

what to say when social media came to my rescue. Yet

again the medical personnel for sports teams are in the

news. This time it’s a coach taking his frustrations out on

them.

For those who have no idea what I am talking about, Jose

Mourinho, the Chelsea Football team manager, has

accused the team doctor and physio of not understanding

the game and thereby putting the result of the game at

risk. Earlier in the game the Chelsea keeper was sent off

meaning they played most the game with 10 men. Late in

the game with the teams locked in a draw a Chelsea

player went down. For those not familiar with football, for

a medical person to attend a player we need to be called

on to the field by the referee. However, after we attend to

them the player has to leave the field until the referee

calls them back on. This left Chelsea with only nine men

on the field for a short period of time.

Did this affect the result – no. The keeper being sent off

probably had a much greater effect on the game. Should

they have gone on? More recent footage shows the

referee calling them twice before they went on. They

obviously weren’t entering the field of play without

forethought. Did they do the right thing – yes. A player

was down injured asking for assistance and the referee

called them on to assess the player.

Mourinho has stated that the doctor’s and

physiotherapist’s positions are now at risk and they are

likely to be stood down from sideline duties. Is this a

permanent or temporary situation? We will no doubt find

out in time.

This brings up a couple of points for us to consider if

working on the sideline. The first is know your sport.

Know when are you allowed to enter the field of play and

what happens afterwards with respect to assessing the

player and their return (if fit) to the game.

Get to know the personality of your players. I have a

player who tends to fall over readily when an opposition

player makes contact with him. Over the two years

working with him he has gained us a number of penalties.

Though I am always aware of what is going on I am

overall slower to prepare myself to go out onto the field

when he goes down.

Finally build a relationship with your coaching staff. I find

it best when working with a new coach to explain your

thought processes to them – “based on my experience if

this player misses training this week they are 95% likely

to be able to play this weekend, but if they train they may

be out of action for the next week”. Distinguish between if

it is dangerous to play them e.g. they are concussed, or

they will just be sore. If you are working in a tournament

situation with multiple games per day over consecutive

days then this is a challenge. It can become a case of if

we rest them today they will be OK for the final, but if

don’t do well today we won’t make the final. However

the health of the athlete is always your primary concern

and not the season result. This is where our view point

differs from the coaching staff.

Player welfare is also the area I sometimes have

discussions with the referees and their assistants. As

mentioned in football, with which I am involved, we

have to be called on by the referee. They then want the

player moved off the pitch as soon as possible to allow

play to continue. However letting us on the field

sometimes takes longer than it could. I have talked with

a senior doctor about this to see if there is anything in

the rules that can help us, but my understanding is that

there is nothing. Remembering that player welfare is

paramount, my view and recommendation is that if you

are concerned about the welfare of the player just go.

This especially is the case for suspected head injuries.

In saying this choose wisely if you do. Removing a

player from the field is all about good communication.

Letting the referee know you just need to assess them

first and stabilise the situation generally results in a

positive response.

Well that’s my ramble for another issue. Remember to

look out for our sideline management and acute trauma

courses to improve your skills in this area.

Hamish

Hamish Ashton, SPNZ President

PAGE 5

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.

Facebook - facebook.com/SportsPhysiotherapyNZ

Sports Physiotherapy New Zealand has a Facebook page to help keep our members up to date with the latest news and articles out there on the web.

“Like us” and receive regular news and information.

Twitter - twitter.com @SportsPhysioNZ

We have recently added a Twitter account to our list of ways of keeping contacted with the world.

Follow us and join in the conversations.

Follow links through to interesting articles and hear titbits from conferences as they happen.

Podcasts - SPNZ Members Section

In the Members Resources Section of the website there are links to

some free podcasts.

These are a great way to listen to world renowned experts from your

home in your own time and credit some CPD at the same time.

IT Benefits

PAGE 6

Feature

Roger Athy-Knibbs Physiotherapist for Kia Magic

BSc ( Hons ) Physiotherapy

Roger graduated from the University of Southampton in 1998. He has 16 years experience working

in sports physiotherapy with three years in his current position with the Kia Magic.

Roger took the position of team physiotherapist for London Wasps U21 in

1999 and in 2002 was elevated to head physiotherapist/medical

coordinator for the senior team. Over the next five years he established

one of the primary rugby medical teams at one of English rugby’s premier

clubs. He also worked closely with the England rugby and British and Irish

Lions medical teams.

Leaving the UK in 2007 Roger moved to New Zealand with his Kiwi wife

and their two children (the youngest being just 10 days old) and settled in

Tauranga. He took a position as principal physiotherapist in a private

practice, which gave him the opportunity to work with the BOP Steamers, BOP Cricket and BOP

Netball.

Roger also currently works with New Zealand Cricket, Waikato ITM rugby team, Northern Districts

Cricket and Bay of Plenty Cricket.

ANZ Netball and Kia Magic

The ANZ Championship launched in 2008 with 10 teams

(five from Australia and five from New Zealand). It

succeeded two national leagues: Australia's

Commonwealth Bank Trophy (1997-2007), and New

Zealand's National Bank Cup (1998-2007).

Netball has the highest participation rate of any women's

sport in both countries. Australia and New Zealand have

dominated the international history of netball, between

them winning every World Championship title since

1963. The ANZ Championship is the first professional

netball competition in Australasia and the world's best

netball league. The Waikato/Bay of Plenty Kia Magic are

the most successful New Zealand team to play in the

competition. They are the only team in the league to

have made the finals every year since the competition’s

inception, and are the only New Zealand team to have

won the Championship - in 2012. Under a revised finals

format this season the Kia Magic won the inaugural NZ

Conference trophy.

How did you become involved in your current role?

During the inaugural ANZ championship campaign one

of the Tauranga based players picked up a significant

ankle injury. She came to me for treatment and

rehabilitation, and despite being initially told that the

injury would end her season, she returned to play in the

finals series. This introduced me to the Magic

environment and netball. Later during the year I then got

the opportunity to work with the Bay of Plenty Gold team

during the Lion Foundation championship, which

consisted of members of the Magic team. Over the next

few years I continued my involvement with BOP Netball

and Magic, covering the incumbent physiotherapist for

training sessions and some games during the season.

In 2013 I was invited by Noeline Taurua to take the full

time physiotherapy position for the forthcoming ANZ

campaign. The role involved attending two to three

training sessions per week with the team as well as all

games both around NZ and in Australia. Over the three

years that I have been with the team my role has

developed considerably.

What are your roles with the team?

When I first became involved with the team my role was

to manage player injuries and court-side cover at training

and game day. My role has grown since then to:

Game day physiotherapy including court-side

cover, pre- and post-game treatment

Post-game and training recovery sessions

Liaise with the strength & conditioning trainer on

player management through the week

Management of medical provisions

Injury management and rehabilitation of all

franchise players from time of injury to return to

playing

CONTINUED ON NEXT PAGE

PAGE 7

Feature

Roger Athy-Knibbs Physiotherapist for Kia Magic continued...

Liaise with coaching and fitness staff to ensure

players are in peak condition for championship

games

Weekly management meeting

Perform pre-signing medicals

Carrying out pre-season screening

Develop and maintain close relationships with

consultants and other medical experts

Make referrals to consultants and other medical

professionals

Preparation of end of season medical report

Communicate with the Silver Ferns medical team

for international squad members

What are your specific areas of interest/research?

I am currently in the process of completing my Masters

of Health Rehabilitation and writing my thesis on tibialis

posterior assessment. The function of this muscle has

been widely recognised to provide mid-foot stability and

maintain the medial longitudinal arch of the foot.

Dysfunction has been demonstrated to lead to acquired

adult flat foot or Pes Planus, however in recent years its

role in medial ankle stability and function though the gait

cycle has also been acknowledged. With ankle and foot

injuries being commonly seen in netball, the role of this

muscle is important to understand in both prevention and

rehabilitation.

What are the types of injuries you commonly see?

ANZ netball has brought new challenges for all the

players, from young up and coming players to seasoned

internationals. The demands placed on each player have

increased significantly, and the pace and physicality of

the game has meant that all the girls involved with each

franchise now undertake regular weights and speed and

agility sessions. Players are therefore fitter, faster and

stronger, and consequently injuries are now often more

traumatic in their nature.

Jumping related injuries are most commonly seen.

Ankles are often the most affected, but we have also

seen a significant increase in the number of ACL injuries.

The physical nature of the modern game has increased

the close contact of the players throughout the court, so

it is not uncommon for a player to step on an opponent’s

foot, and it is under these situations that inversion

injuries occur. Include the extra pace that the game is

played at and these injuries become significantly

traumatic. Whilst lateral ligament injuries are the most

common we are certainly seeing more episodes of high

ankle sprains (anterior inferior tibiofibular ligament), and

posterior impingement problems. We have also seen a

rise in the number of achillies tendon injuries ranging

from tendonopathy to rupture.

The change of loading through the knee joint has seen

an increase in injuries such as ACL ruptures, patella

tendonopathy and MCL injuries. A major factor in these

injuries is the increase of speed and agility of the

players. The most important skill any netball player has

to master is the ability to stop within one step once the

ball is received. With the modern evolution of the game

and the players’ ability to move faster over a smaller

area, the physical demands that are being placed on

knee and ankle joints are significant, especially when

having to decelerate from such high speeds so quickly.

Upper limb injuries are not commonly seen in netball, but

we are seeing players going into games with strapping

applied to their shoulders and wearing supportive

garments for elbows and wrists, again demonstrating

that the physical demands of the game are resulting in

injuries that have not been a part of the game previously.

What do you think are the key elements in

successfully preventing and managing injury?

Pre-season screening is a tool that is useful for gaining

an appreciation of the current status of each player. It

allows me time with the player to evaluate any

dysfunctions or weaknesses present. From this

information the trainer and I will put together prehab

programmes to address these issues.

CONTINUED ON NEXT PAGE

PAGE 8

Feature

Roger Athy-Knibbs Physiotherapist for Kia Magic continued...

Understanding the demands that are required for each

player is equally important and in some ways contributes

more greatly to how we prevent and manage any injury.

With the demands that are placed on the players both on

and off the court, understanding and having a handle on

their ongoing physical and mental status is a major factor

in preventing injury. Players often pick up injuries when

both physically and mentally tired, so if we can limit this

by managing their training loads and court time, it means

we get the best out of them as well as limiting risks of

picking up injuries.

Injury education,

management and

intervention are

other important

tools that we use.

My approach to

injury manage-

ment is to be

proactive and not

reactive where at

all possible. We

can never account

for those one off

events that cause

injury such as an

achillies or ACL

rupture, but if a

player pulls up

with a lower back

spasm or a tight calf due to compensatory actions of joint

restrictions, then their problem has not been managed

well. All players who play for the Kia Magic are educated

to identify and discuss any stiffness, soreness or pain

and not to assume that it will heal itself. From this,

treatment intervention and management can be planned,

to keep them playing and preventing deterioration into a

more serious issue.

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?

One of the areas that we pride ourselves on as a

management team, is our communication and how we

manage to get the best out of all the players. Regular

contact with our trainer allows us to modify programmes

to suit injury status, and withdraw players from

programmes and training if required. We discuss week

prehab programmes ensuring that we are progressing

their development and limiting the risk of injury. I

regularly talk to our head coach reporting on player

injury/health status. We discuss their wellbeing, training

schedule, work load for the next week, and demands of

travel, especially when going to Australia. This not only

ensures the players are peaking each week for games

but also minimising the risk of injury.

What are the key attributes you feel are required to

work with elite level athletes?

Understanding, knowledge and hard work.

It is obviously important to understand the sport you are

working in but as a physiotherapist it is equally important

to understand the

players you are

working with. How do

they manage

themselves, their

injuries, their time?

How do they prepare

for a game, do they

have any special

requirements such as

stretching, strapping

in a certain way, is

there any medication

that they are reliant

on such as asthma

inhalers? These are

important aspects

that help them to

perform at their best.

Injured players will always want to be back playing the

next day. They will test your knowledge of the anatomy

of the injury, they will demand a progressive

rehabilitation programme and as they draw closer to full

fitness, they will push to return to playing. Without

knowledge of the injury and the rehabilitation process

you risk returning a player to play too early and re-injury.

Knowledge and understanding of the sport allows the

physiotherapist to deliver injury management more

proficiently.

Be prepared to work hard and long hours, being the

physiotherapist for an elite netball team requires many

hours of travel, to training and games. There is also

planning and implementing treatment and rehabilitation

programmes, attending team and management meetings

and all of the administration requirements, such as

writing notes and letters to doctors. For most

physiotherapists this is done as well as working in their

normal day jobs. But the buzz from coming together as a

team and winning in a tough professional sporting

environment makes it well worth it.

PAGE 9

Planet of the Apps

Seller: VU Medisch Centrum Divisie VI Beheer BV

Category: Health & Fitness

Updated: 16/03/2014

Version: 2.0

Size: 30.2 MB

Language: English, German, Northern Sami or Spanish

Website: http://slhamsterdam.com/ankleapp-2/Rated 4+

Cost: $1.29

Requires: IOS 5.0 or later. Compatible with iP{hone, iPad, and iPod touch.

This app is optimized for iPhone 5

What it is used for: Preventing ankle sprains

Where to find it: Download from Apple store

Android or Apple or both: Apple

Pros:

Researched based programme: you can tell your clients there is evidence that if they do the exercises their

ankle will get stronger…

You set the reminder time around your schedule, and the researchers believe compliance is increased as you

need to click through each exercise to demonstrate you have completed it.

Cons:

The animated figures are a bit basic, but do demonstrate the exercises well enough. You would be able to go

over technique with your clients as necessary.

How I use the app: I have given the details for the app to be downloaded along with basic instructions as a home

exercise programme. We review the exercises at next session and correct any technique faults, and modify if they

are getting pain. I recommend it to clients as a prevention programme, but also as a rehab programme post injury.

Overall Rating: 4/5

Your monthly App review

by Justin Lopes - Back To Your Feet Physiotherapy,

SPNZ executive member.

Hi,

This month’s newsletter has a focus on netball injuries and I was tasked to find an app which would help injured net-

ballers… Challenge accepted! Fortunately, whilst scrolling through my twitter feed, a tweet from BJSM popped up

describing just such an app: ANKLE; an app designed by a research group within the Department of Public and

Occupational Health at the VU University Medical Center in Amsterdam. The Ankle app is a research based proprio-

ception retraining programme which patients can download that will prescribe them an eight week set of exercises.

The exercises do include a wobbledisc but the app says you can find another suitable unstable surface (such as a

pillow). You set up a reminder for your three sessions per week, and the app gives you the progressions, along with

animated figures demonstrating how to do the exercises.

App: Ankle

For further discussion on this App check the SPNZ LinkedIn forum page

Click here

PAGE 10

Planet of the Apps

App: Ankle continued...

PAGE 11

SPRINZ

In Sickness and in Health

– Making Exercise a Lifetime Partner

Visitors to a special corner of AUT Millennium are using

a powerful combination of medical and fitness expertise

to help maximise their health in the face of serious

medical conditions.

The team at AUT’s Human Potential Clinic works with

clients to prevent, treat and manage serious illnesses

such as cancer, cardiovascular disease, diabetes and

stroke. Exercise is a key focus of the holistic service,

which facilitates long-term lifestyle changes and

supports people in adopting health promoting habits.

Research shows physical activity is clearly linked to

better outcomes for those with ill health, or classic

precursors such as elevated blood pressure. Physically

active cancer survivors, for example, have been found

to experience 50% lower mortality than survivors who

don’t regularly exercise.

Research also points to the value of individually tailored

exercise programmes. Evidence shows that following a

bespoke exercise plan, based on advanced fitness

assessments, offers vastly better health benefits than

the generic, low to moderate intensity programmes

typically prescribed to patients with health concerns.

Clients visiting the Human Potential Clinic undergo lab-

based exercise assessments, before having a safe

exercise level identified, discussing their exercise

preferences and obstacles, and receiving a bespoke

fitness plan. They then work with expert staff on an on-

going basis, to help stay on track towards achieving

and maintaining their health goals.

By using a sophisticated suite of testing and

equipment, and working closely with referring medical

practitioners, the team gains a clear picture of each

client’s health risks and is able to develop fitness

programmes offering maximum health benefits. This

assessment approach leapfrogs the rough gauges

people often revert to without specialist help, such as

Body Mass Index (BMI) and waist circumference as

indicators of health risk and progress.

“These measures are a country mile off the insights we

gain through specialised testing methods,” says Matt

Wood – Exercise Physiologist and Manager of the

Human Potential Clinic. “Cardiovascular fitness has

profound predictive ability. We’re able to test this at

safe levels – without pushing clients to their maximum

limit – using respiratory gas analysis equipment,” he

says.

With cardiovascular fitness the single greatest

modifiable risk factor in achieving longevity, the Human

Potential Clinic hopes to make a significant difference

to the lives of clients and their families.

The Clinic team currently works with clients on an

individual basis, but is in the process of developing a

new group service. Clients will benefit from individual

assessment and consultation, with the addition of group

exercise classes – a move that will allow Clinic staff to

reach more people, without sacrificing the level of

service they receive.

The new group classes are expected to launch later

this year.

Matt Wood measures a client’s oxygen consumption during a consultation at the Human Potential Clinic

http://www.autmillennium.org.nz/health-and-fitness/clinics/hpc

PAGE 12

ASICS Grants

Asics Education Award - Winning Recipient

The winning recipient of the above award for March 2015 is Dr Gisela Sole, Senior Physiotherapy Lecturer from the

University of Otago.

This recipient has satisfied the Education Committee of the criteria for application as per the SPNZ Education

Awards Terms and References.

Gisela is attending the Australian Physiotherapy Association (APA) conference on the Gold Coast, Australia, in

October 2015. An abstract has been accepted for presentation by Gisela on behalf of an Honours student, Arlene

von Aesch, entitled “Management of Anterior Cruciate Ligament (ACL) injuries: physiotherapist’s perspectives”.

The project was awarded the 2014 SPNZ award for the best undergraduate research study at the University of

Otago and the paper is currently under review at “Physical Therapy in Sport”.

The conference will also allow networking opportunities in related fields and updating current clinical and research

trends.

We will look forward to the report on this conference which will be published in the SPNZ bulletin.

The next round of applications closes on 31 August 2015. All members are encouraged to view the Terms and

Conditions of this award available on our website at sportsphysiotherapy.org.nz.

SMA Conference Grant - Winner

Congratulations to Adam Letts Winner SMA Conference Grant

PAGE 13

Clinical Section - Article Review

Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health from the

Orthopaedic Section of The American Physical Therapy Association

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evi-

dence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal im-

pairments.

The purpose of these clinical guidelines is to:

1. Describe evidence-based physical therapy practice

2. Classify and define common musculoskeletal conditions using World Health Organisations terminology

3. Identify interventions supported by current best evidence

Content experts were given the task to identify impairments of body function and structure, activity limitations, and

participation restrictions described using International classification of Functioning, Disability and Health (ICF) that

could; (a) categorise patients into mutually exclusive impairment patterns on which to base intervention and (b)

serve as measures of changes in function over a course of treatment.

The second task was to describe the supporting evidence for the classification.

Individual clinical research articles were graded according to criteria described by The Centre for Evidence-based

Medicine, Oxford, UK198

(Table of Levels of Evidence Page A5)

The strength of the evidence supporting recommendations made in the guidelines were graded (Table of Grades of

Evidence Page A5)

The Orthopaedic Section, APTP, selected consultants to review these clinical practice guidelines which were then

edited utilising the reviewers comments.

This guideline has chosen to classify lateral ankle sprain into two categories:

1. acute lateral ankle sprains (within 72 hours post injury or pain/swelling/limited weight bearing/overt gait

disturbance)

2. ankle instability (post- acute or instability/weakness/limited balance responses/swelling)

Uniformly applied criteria to diagnose chronic ankle instability has not yet been developed.

IMPAIRMENT/FUNCTION-BASED DIAGNOSIS

Incidence

Physically active individuals, particularly those who participate in court and team sports86

, are at higher risk than the

general population.

The overall incidence of lateral ankle sprain may be underestimated as approximately 50% do not seek medical

attention after injury12,177,224

Pathoanatomical Features

The lateral ligaments of the ankle complex are potentially injured with an inversion or supination mechanism.

Structures other than the ligaments can be injured and may contribute to chronic instability. These include subtalar

ligaments, peroneal tendon, nerve injury, retinaculum, inferior tib/fib ligament, osteochondral lesions and

neuromuscular elements.

Ankle Stability and Movement Coordination Impairment:

Ankle Ligament Sprains

CONTINUED ON NEXT PAGE

Robray L Martin,PT,PhD; Todd E Davenport,DP; Stephen Paulseth,DPT,MS; Dane K Wukich,MD; Joseph J Godges, DPT,MA

Journal of Orthopaedic and Sports Physical Therapy September 2013/Vol 43 (9) A1-A40

PAGE 14

Clinical Section - Article Review

Clinical Course

Acute lateral ankle sprains can vary greatly in their presentation with respect to the amount of oedema, pain, range

of movement (ROM), and loss of function, +/- sensorimotor deficiency (proprioception, reflex reactions, postural

control, alpha-motor neuron excitability, strength).

Sub-acute phases often present with stiffness, swelling, decreased function and instability.

Post-acute is characterised as mechanical instability (increased joint motion of the talar or sub-talar joint) or

functional instabiblity (normal joint motion with perceived instability due to sensorimotor or neuromuscular deficits).

The factors that determine prognosis following acute lateral ligament sprain have largely been unidentified. However,

having high levels of activity (3 times or more per week) and not receiving appropriate treatment after injury may be

related to increased likelihood of residual symptoms11,63,128,175,184,261,268

.

Surgical intervention may be indicated if conservative treatment is ineffective.

There was insufficient evidence to recommend surgical or conservative treatment, however, surgery appeared to

decrease the prevalence of re-injury potentially at the expense of increased risk to developing osteoarthritis.

Risk Factors

Risk factors for acute lateral ankle sprain are categorised as being intrinsic or extrinsic and may be different from

ankle instability.

Clinicians should recognise the increased risk of acute lateral ankle sprain in patients who:

1. Have a history of previous ankle sprain

2. Do not use an external support

3. Do not warm up properly with static stretching and dynamic movement

4. Have reduced ankle dorsiflexion range

5. Do not participate in a balance/proprioceptive prevention

Clinicians should recognise the increased risk for developing ankle instability in patients who:

1. Have increased talar curvature

2. Are not using external support

3. Did not perform balance or proprioception exercises following acute lateral ligament sprain

Risk factors predicting ankle instability are not well documented.

Classification

Traditionally, ankle sprains are graded I,II, and III to represent the extent and severity of ligament damage.163

Clinicians should use the clinical findings of level of function, ligamentous laxity, haemorrhaging, point tenderness,

total ankle motion, swelling, and pain to classify a patient with acute lateral ankle sprain into the ICD category of

sprain and the associated ICF impairment-based category of ankle instability and movement impairments.

Clinicians may incorporate a discriminative instrument, such as the Cumberland Ankle Instability Tool116

to assist in

identifying the presence and severity associated with the ICD category of instability.

Differential Diagnosis

There are many structures that may be traumatised with an inversion force depending on the magnitude of force,

direction of the force and lower limb position.

Chronic ankle instability diagnosis is generally different from that of acute lateral ligament sprain.

Clinicians should use diagnostic classifications other than acute lateral ligament sprain when the patient reported

acitivity limitations or impairments of body function and structure are not consistent with those in the diagnosis/

classification section of the guidelines. The Ottawa231

and Bernese74

ankle rules should be used to determine

whether a radiograph is required.

Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains cont...

CONTINUED ON NEXT PAGE

PAGE 15

Clinical Section - Article Review

Clinicians should use diagnostic classifications other than ankle instability when the patient reported activity,

limitations of impairment of function and structure are not consistent with those presented in the Diagnosis/

Classification section of this guideline.

History and clinical examination are usually sufficient to diagnose acute lateral ankle sprain. For those with

persistent problems, imaging is recommended.

Examination

Clinicians should incorporate validated functional outcome measures such as The Foot and Ankle Ability Measure

(FAAM)168

and the Lower extremity Functional Scale (LEFS)21

as part of a standard clinical examination. These

should be utilised before and after interventions intended to alleviate the impairments of function and structure, activ-

ity limitations and participation restriction associated with ankle sprain and instability.

When evaluating a patient in the post-acute period following recent or recurring lateral ankle sprain, assessment of

activity limitation, participation restriction and symptom reproduction should include objective reproducible measures.

Assessment of impairment should include objective and reproducible measures of ankle swelling, ankle ROM, talar

translation and inversion and single-leg balance.

Intervention

Clinical Guidelines for intervention are divided in to two parts:

1. Protected motion phase (generally associated with the acute tissue healing)

2. Progressive loading and sensorimotor training phase (post-acute)

Protected motion/acute phase use external support to progressively weight-bear based on severity of injury, phase

of tissue healing, required level of protection, extent of pain and, patient preference.

Clinicians should use manual therapy procedures within pain free movement to reduce swelling, increase pain free

mobility and normalise gait patterns75,97

in treatment of acute lateral ankle sprains.

There is moderate evidence both for and against the use of electrotherapy for management of acute ankle sprains.

Clinicians should implement rehabilitation programs inclusive of therapeutic exercises for patients with acute lateral

ligament sprain24,258,123,16

Clinicians should include manual therapy procedures such as graded joint mobilisation, manipulation, and

mobilisation with movement, to improve ankle dorsiflexion, proprioception and weight-bearing tolerance in acute

lateral ankle sprain252,271,41,196

In individuals with functional instability, hip muscle recruitment patterns are altered 18,29,30

Clinicians may include

therapeutic exercises and activities for getting hip and trunk muscle coordination, strength and endurance in the

post-acute period in comprehensive rehabilitation programs.

Clinicians can implement balance and sports-related activity training to reduce the risk for recurring sprains but there

is no significant difference in ankle sprain incidence between groups receiving balance training11,243

and sports

related activity training and subsequent sprains.

Ankle Stability and Movement Coordination Impairment: Ankle Ligament Sprains cont...

Summary

Creating evidence-based practice guidelines for orthopaedic physical therapy management of patients with acute

lateral ligament sprain and ankle instability set a standard of medical care.

The ultimate clinical procedure or treatment plan is dependent on the clinical data presented by the patient, the

diagnostic and treatment options available and the patient’s expectations, values and preferences.

A full summary of the recommendations of these clinical practice guidelines can be found on Pages A29-30.

Reviewed by Pip Sail, Physiotherapist

PAGE 16

Continuing Education

The course will cover:

Presenters:

Dr Deb Robinson (Sports Medicine Physician – former All Blacks doctor & current Crusaders doctor)

Angela Cadogan (Physiotherapy Specialist – Musculoskeletal)

Kim Simperingham (Strength & Conditioning)

John Roche (Physiotherapist Canterbury Crusaders & ITM cup)

Craig Hawkyard (Hand Therapist)

Drug Free Sport NZ

To Register:

Registration will be limited to the first 25 paid registrants

Complete the attached Registration Form and return to Physiotherapy New Zealand

Fax 04-801 5571 or Email: pnz@physiotherapy.org.nz

SIDELINE MANAGEMENT (SPNZ LEVEL 1 COURSE)

This course is for registered physiotherapists who work with individual athletes, or on the sideline at sports games or events who want to upskill in the areas of pre-game preparation, first aid, acute injury assessment

and management, and post-event recovery strategies.

By the end of the course you will have all the tools you need to manage pre-event preparation, post-event

recovery and to confidently assess, manage and refer common sporting injuries and wounds.

Location:

Physiotherapy Department

Burwood Hospital

Click for Google map

255 Mairehau Road

Christchurch

Date:

Saturday 3rd October 2015 9am – 5pm

Sunday 4th October 2015

8am – 4.30pm

Course Fee:

SPNZ Member $405.00

PNZ Member $486.00

Non-PNZ Member $607.50

Ethics and professional issues in sports Physiotherapy

Pre-event preparation and warm-up

Strapping

Sports First Aid

On-field injury assessment

Concussion assessment and management

Splinting of hand and finger injuries

Indications for medical and radiology referral

Return-to-play decision making

Post-event recovery

Anti-doping regulations and banned substances

PAGE 17

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?

27 September 2015 Stability Plus Pilates - Foam Roller Auckland

28 September 2015 PhysioScholar - Examination of the Hip and Groin Nationwide

17-18 October 2015 NZMPA - Mulligan Concept Part B Auckland

13-15 November 2015 Otago Branch - Southern Physiotherapy Symposium 7 Queenstown

14-15 November 2015 Clinical Gait Assessment - A step in the right direction Auckland

21-22 November 2015 NZMPA - Mulligan Concept Part B Wellington

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?

28 August 2015 Rehabilitation in Elite Sport Richmond, VIC

3-6 October 2015 Australian Physiotherapy Association - Connect Conference 2015 Gold Coast

21-24 October 2015 Sports Medicine Australia Conference Sanctuary Cove

21 October 2015 Load Management in Lower Limb Bony Stress Reaction/Fractures Eight Mile Plains, QLD

PAGE 18

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 jospt@jospt.org 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 8, August 2015

MUSCULOSKELETAL IMAGING

Fracture of the Scaphoid During a Bench-Press

PERSPECTIVES FOR PATIENTS

Running: Improving Form to Reduce Injuries

RESEARCH REPORT

Gait Retraining for Injured and Healthy Runners Using Augmented Feedback: A Systematic Literature Review

Lumbar Traction for Managing Low Back Pain: A Survey of Physical Therapists in the United States

Diagnostic Accuracy of the Slump Test for Identifying Neuropathic Pain in the Lower Limb

Baseline Examination Factors Associated With Clinical Improvement After Dry Needling in Individuals With Low Back

Pain

Atrophy of the Quadriceps Is Not Isolated to the Vastus Medialis Oblique in Individuals With Patellofemoral Pain

Dynamic Balance Deficits 6 Months Following First-Time Acute Lateral Ankle Sprain: A Laboratory Analysis

Impact of Varying the Parameters of Stimulation of 2 Commonly Used Waveforms on Muscle Force Production and

Fatigue

BRIEF REPORT

Responsiveness and Minimal Clinically Important Change: A Comparison Between 2 Shoulder Outcome Measures

Research Publications

PAGE 19

Research Publications

British Journal of Sports Medicine

www.bjsm.bjm.com

Volume 49, Number 16, August 2015

WARM UP

Comprehending concussion: evolving and expanding our clinical insight

Michael Makdissi, Jon Patricios

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

Is tendinopathy research at a crossroads?

Lorenzo Masci

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

REVIEWS

Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis

S R Filbay, A G Culvenor, I N Ackerman, T G Russell, K M Crossley

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

Cerebrovascular reactivity assessed by transcranial Doppler ultrasound in sport-related concussion: a systematic

review

Andrew J Gardner, Can Ozan Tan, Philip N Ainslie, Paul van Donkelaar, Peter Stanwell, Christopher R Levi, Grant L

Iverson

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

Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis

Anne Martin, Claire Fitzsimons, Ruth Jepson, David H Saunders, Hidde P van der Ploeg, Pedro J Teixeira, Cindy M

Gray, Nanette Mutrie

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

ORIGINAL ARTICLES

Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries

John W Orchard, Peter Blanch, Justin Paoloni, Alex Kountouris, Kevin Sims, Jessica J Orchard, Peter Brukner

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

Current hydration guidelines are erroneous: dehydration does not impair exercise performance in the heat

Bradley A Wall, Greig Watson, Jeremiah J Peiffer, Chris R Abbiss, Rodney Siegel, Paul B Laursen

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

Declining incidence of surgery for Achilles tendon rupture follows publication of major RCTs: evidence-influenced

change evident using the Finnish registry study

Ville M Mattila, Tuomas T Huttunen, Heidi Haapasalo, Petri Sillanpää, Antti Malmivaara, Harri Pihlajamäki

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

The effect of eccentric exercise in improving function or reducing pain in lateral epicondylitis is unclear

Irene L C Heijnders, Chung-Wei Christine Lin

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

PAGE 20

TAURANGA / BAY OF PLENTY

Back In Action Physio

Full Time Physiotherapist

Immediate start

EXCITING OPPORTUNITY

Are you passionate about physiotherapy and helping people? Email or call us NOW at Back In Action Physio.

Come to sunny Tauranga and work in practices where we have longer treatment sessions, associations with gym

and doctors, regular in-services and a manageable patient load. We need a full time physio to work with our team.

Hours of employment are negotiable. We have an extensive mentoring programme and are continually sharing our

knowledge.

Check out our website www.biaphysio.com for more information and email Leanna at leanna@biaphysio.com .

Come and join us for some fun and adventures in the Bay of Plenty.

Contact Details: leanna@biaphysio.com

Deadline: none

Classifieds

LINCOLN

SportsMed Lincoln

Physiotherapist – Full Time

As part of the MOTUS Health Network, SportsMed Lincoln is a clinic doing things a bit differently and we ’re looking

for a physiotherapist with a strong commitment to customer focused care to join our team.

We believe great outcomes for our customers start with great teams of well supported professionals, and that ’s why

we put a lot of work into making sure you have the resources, mentoring, development opportunities, and clinical

exposure to make every day just that little bit easier.

We’re confident that our guaranteed base salary, generous ongoing professional development allowance, access to

our incentive scheme, comprehensive in service program, along with access to colleagues with post-graduate

qualifications and experience as mentors offers a unique experience for physiotherapists looking for that something

extra.

As well as the usual busy and varied workload, the multidisciplinary capabilities within the MOTUS Health Network

enhance customer care, as well as offering a fantastic learning environment for our clinicians.

We are looking for a person with a positive, ‘can do’ attitude, a great sense of humour and the ability to work with a

wide ranging customer base, offered by a semi-rural environment.

If this sounds like you, then we would love to have you on our team!

Please enquire in complete confidence to Amy Bourne

abourne@pmg.management