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Current Soft tissue techniques for Physiotherapists in Sport and Exercise: developing skills and justifying treatment choices

19 Oct, 17 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

 

By Vikki Mills  @vikki_mills80 and Faith Fisher-Atack BSc @physiofaith

The ACPSEM recently hosted the 2 part soft tissue techniques course, “Current Soft Tissue techniques for Physiotherapists in Sport and Exercise”. This course is an integral part of the ACPSEM pathway which develops clinicians and enables them to progress to Bronze, Silver and Gold levels. It was aimed at practicing clinicians in sports medicine to equip them with the hands on skills necessary for soft tissue management.

There are many schools of thought emerging in sports and exercise medicine which question the use of “hands on” physiotherapy, specifically massage or soft tissue mobilisation. As physiotherapists working in elite sports settings, the thought of completing a day without utilising “hands on” techniques in some capacity is difficult for us – as Physiotherapists- to imagine. Patients often expect massage as a part of treatment too. In spite of massage being an integral part of our day to day routines, many attendees could not recall having formal massage training. It is also important for clinicians to be able to justify soft tissue work as a valid treatment choice, and feel confident that an evidence base underpins decision making. Thus, the course provided details on current research and how massage fits into a wider treatment plan addressing all components of musculo-skeletal and biomechanical dysfunction.

Here are some examples of how course attendance has influenced our clinical reasoning and changed our clinical practice.

Evidence base

During the course we explored the evidence base behind sports massage, and discussed the justifications articulated to clients. It became quickly apparent that course attendees were not fully aware of several fundamental reasons for using massage, with most attendees noting blood flow improvement as the main justification. We were exposed to many other reasons, including the positive impact of wellbeing, biomechanical, physiological, neurological and psychological effects (Moraska 2007).

Practical skills

The content of this course was highly practical, allowing us to develop our techniques and gain feedback from both tutors and peers. Evidence has suggested that differences in practitioners’ proficiency affect the effectiveness of massage (Donozama et al 2010). Therefore, handling and optimising patient position was fundamental to the effectiveness of not only the treatment but the wellbeing and comfort of the therapist.

Technical skills gained included a detailed breakdown of individual massage technique during the first course session, with further study and practice of more advanced skills involving tool assisted soft tissue release techniques, cupping and myofascial release in the second course session. Development of massage techniques and application over the entire 4 days addressed specific soft tissue dysfunction, which included muscular imbalances, trigger point development and altered motor patterns.

Lecturers

To host a course for 4 days (the course was held over 2 weekends, 6 weeks apart) to teach fundamental skills to clinicians already practicing in the sporting environment is no easy feat, yet Colin Paterson and Ros Cooke managed to pull this off. Their knowledge, skills and experience in addition to their enthusiasm made for an engaging and enjoyable learning experience.

For any clinician embarking on the ACPSEM CPD pathway it is compulsory that they undertake and evidence post graduate training in massage. This course provides an opportunity for any practicing clinician to challenge their current knowledge and practice. The theory and content challenged thoughts, beliefs and existing skills. We now feel better equipped to justify, articulate and carry out soft tissue techniques as a treatment modality.

Further information on this and other courses which underpin the ACPSEM CPD pathway can be found at https://www.physiosinsport.org/index.php/cpd/cpd-pathway

Vikki Mills BSc (HONS) MCSP HCPC ACPSEM AACP

Vikki has been a charted physiotherapist for 15 years working in both the private and elite sport setting. Vikki divides her clinical practice between Leeds United Academy and community MSK services. Her clinical interests include paediatric lower limb biomechanics and growth related pathology.

@vikki_mills80

Faith Fisher-Atack BSc (HONS) MCSP HCPC ACPSEM ACPAT

Faith is a chartered Human and Veterinary Physiotherapist and clinical director of Equine Physio Services, a physiotherapy practice specialising in equine and rider biomechanics and performance. Former Head of Sports Science and Medicine at Leeds United Academy.

@physiofaith

References

Donozama N, Shibasaki M (2010) Differences in practitioners’ proficiency affect the effectiveness of massage therapy on physical and psychological states.
Journal of bodywork and movement therapists. Volume 14 issue 3 July 2010 pages 238-245

Moraska A (2007) Therapist education impacts the massage effect on post-race muscle recovery. Medicine and science in sport and exercise

At the barre Part 1: Ballet dancers – observation, principles of management and unique considerations

17 May, 17 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Luke Abnett @balletphysio

Observing dancers

Ballet is an interesting and challenging field of sports medicine, and to be optimally able to manage injury rehabilitation it is important to know your sport. In this case it is important to know your art, because ballet doesn’t see itself as a sport at all. In fact, the entry level position in the Corps de Ballet of the Royal Ballet company carries the title of ‘Artist’. However, these athletic artists require just as coordinated a sports medicine approach to perform at their peak as any other sport.

In this blog I will share my experience of working for six years in ballet medicine to demystify some of the quirks of this population. I will explore some basic principles of ballet, the habits of its artists, the specialised equipment they use, and a typical balletic body.

Basic Principles

Classical ballet is an aesthetic art form and the most important outcome is how a performer subjectively looks whilst performing, rather than any objectively measurable physical achievement such as speed or strength. By way of example, the dancer who jumps higher may be overlooked in favour of the dancer whose technique and alignment is more visually appealing. Ballet aims to please the eye of the observer by creating the illusion of weightlessness in making seemingly effortless shapes with dancers’ bodies. Additionally groups of dancers coordinate their movements to make patterns and lines on the stage. To achieve this precision of movement, and precision of prescribed balletic positions.

There are two features of classical ballet which distinguish it from other forms of dance. Firstly dancers dance in a ‘turned out’ position, that is the lower limb is externally rotated (with maximal contribution from the hip joint but additionally from joints at the knee and foot). This allows the audience to see the line of the leg as it is either bent, extended or in some cases hyperextended more clearly than if the leg is viewed in the anatomical position. Secondly female dancers frequently dance on pointe, or on the tips of the toes, to add to the impression of weightlessness and to lengthen the leg line.

Habits

Dancers’ technical practice involves a high degree of repetition of set positions in various sequences, with the intention of maximising precision and efficiency of movement and therefore minimising risk of injury. However, the extreme nature of some ballet positions at the end of a joint’s available range of motion increases this risk, and the low variability of very repetitive movements may increase this risk further.

There is also a relatively limited capacity for practising ballet technique whilst resting one body part. Dancers commonly report feeling the technique of ballet as a whole-body position or movement, with part-practice of these positions feeling confusing and counterproductive. For example if a dancer was avoiding end range ankle plantarflexion to rest a posterior ankle impingement injury, it would be difficult to practise a high leg extension (which demands hip abduction/external rotation, knee extension and ankle plantarflexion). Changing the ankle position would change the overall feeling of ‘stretch’ in the leg as a whole and, even though the knee and hip ranges would not be limited by the ankle injury, the whole manoeuvre would tend to be avoided.

This ‘all or nothing’ approach is culturally embedded within ballet and also tends to affect training as a whole. In fact this makes sense when considering that, during a performance, a dancer must perform every step of their role to the full, otherwise they would not be permitted on stage. The unfortunate side-effect of this approach is that ballet training periodisation historically lags behind that of other athletic pursuits.

Equipment

Ballet generally uses little equipment. Footwear is designed either for flexibility, to enable the dancer full freedom of movement of all foot and ankle joints, or rigidity, to enable the dancer to maintain neutral metatarsophalangeal joints when dancing on pointe.

Dance floors are sometimes sprung to reduce the shock of impact of jumping on the feet, legs and lumbar spines of dancers, though some theatre floors may be concrete. Most studios have floors that are flat, but some older theatres’ stages may be ‘raked’ – meaning sloping up towards the rear of the stage to give the audience a better view of the performance. This angulation adds the additional challenge of trying to avoid ending up in the orchestra pit when dancing pirouettes!

Ballet Physique

Ballet favours aesthetically pleasing lines, so hyperextended knees, excessive hip external rotation, excessive lumbar extension and excessive ankle plantarflexion with a high medial longitudinal arch are all favoured characteristics. A significant proportion of ballet dancers is hypermobile1, though this brings its own challenge of having sufficient strength to control excessive movement at the end of joint range. Ballet dancers (especially females) also tend towards low BMI and other female athlete triad risk factors, which could partially explain risk of bone stress injury2,3.

If a healthcare practitioner working in sports medicine considers that the typical ballet dancer is naturally hypermobile, regularly practises positions of extreme flexibility, uses unsupportive footwear and trains with a high degree of repetition, it is unsurprising that overuse injuries form the majority of those sustained by professional dancers. In part two of this blog I will explore some of the more common ballet injuries and discuss their mechanisms.

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Luke Abnett has specialised in ballet physiotherapy for six years, having managed healthcare provision at the Royal Ballet School and now working in private practice in central London and leading a Dance Medicine Clinic in Surrey.

Email: balletphysiotherapist@gmail.com

Facebook: BalletPhysio

Twitter: @balletphysio

Instagram: balletphysiolondon

References

  1. J Rheumatol. 2004 Jan;31(1):173-8.

Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers.

McCormack M1, Briggs J, Hakim A, Grahame R.

  1. Am J Sports Med. 2014 Apr;42(4):949-58. doi: 10.1177/0363546513520295. Epub 2014 Feb 24.

Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women.

Barrack MT1, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, Nattiv A.

  1. J Sci Med Sport. 2014 May;17(3):271-5. doi: 10.1016/j.jsams.2013.07.013. Epub 2013 Aug 8.

Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences.

Ekegren CL, Quested R, Brodrick A.

Using strength and conditioning in Physiotherapy

10 Apr, 17 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Emily Drakes

My interest in strength and conditioning started after watching an evening lecture from Raphael Brandon. I was intrigued by the theory behind exercise prescription. Also, physiotherapy seems to be moving more and more towards exercise as the mainstay of treatment, as seen in the recent NICE guidelines for low back pain1, so this seemed like the right path to follow.

For those of you lucky enough to work with S&C coaches you will have them on hand to guide exercise prescription. However for most of us working in physiotherapy teams, having more of an S&C background can offer valuable insight into the best way to strengthen and prepare a patient for their activities whether that is a seasoned marathon runner or a stay at home parent with children to carry.

It has been refreshing in learning about S&C to put injuries to one side and focus on the most effective way to plan an exercise programme. Many physiotherapist’s are preoccupied with making an exercise look like the movement or sport they are trying to rehabilitate their patient to i.e. giving a patient who plays football a ball to use in an exercise. However when if you break down the amount of time a footballer spends with a ball over 90mins it amounts to 90s2! The rest of the time is spent running, changing direction and jostling for the ball. Obviously a lot of the time a footballer is training involves a ball but unless you break it down in to the components of a skill you have no overload. This is what S&C essentially comes down to, ensuring specific adaptations to imposed demands. We need to understand the way a force is developed in the sport/activity we are interested in and in the exercise we are choosing to prescribe to get the desired outcome.

There are some general principles that I now use daily that are key to exercise prescription. Firstly a needs analysis, which is something we all do to some extent but it formalises the process of deciding where a person is dysfunctional for the activity they are struggling with. The diagram below outlines this:

Once you’ve specified the activity and what one would need to perform that successfully/pain free then you would look at the gap between the person in front of you vs. the ideal attributes they need. Once you know this, targeting their exercise should be much easier.

The needs analysis and the selection of exercises both incorporate the principle of dynamic correspondence described by Siff and Verkoshansky3. This is a guide on the different aspects of the activity to consider and how the exercise you are choosing will correlate to it.

Unless you are doing the exercise itself i.e. kicking a ball you are not going to be 100% specific, however as discussed above in order to overload the components you need to break it down into parts. We will use the example of squatting and sprint ability in football:

 

 

 

 

 

 

There are 5 key aspects to consider:

  • Amplitude and direction of movement

This is the most familiar principle in that we are looking at the direction of force relative to the performed movement.

The squat does not look like a sprint however the lower limb movement of the hip, knee and ankle triple extension on the ascent on the squat is similar.

The transmission of force from a flexed position to full extension in the squat is similar to the explosive action a footballer will need to perform when starting to sprint.

  • Rate and time of peak force production

The peak rate of force production of a footballer sprinting is within 100 – 200 ms4 and for a squat is 300ms5 therefore it may not be as fast as it needs to be, however you may choose to use a lighter load at performed at maximum speed to improve this. It has been seen that 40-50% of 1RM achieves peak velocity and power in a squat.

  • Dynamics of effort (whether a concentric max effort or eccentric slow effort is desired for each lift)

The training stimulus and effort needs to be greater than the sporting skill or activity we are training for, which in a heavy weighted squat certainly would be for sprinting over 30m. Peak power for the concentric phase of a squat is 4000W5 and for sprinting it’s 1200W4 in the propulsion phase.

  • Accentuated region of force development (Joint angle specificity)

The squat will yield a greater range of movement than the sprinting motion. This means that you are overloading the skill by creating greater strength in a larger range of movement. Based on research football players accelerating the knee angle averages at 89 degrees6, correlates well with a parallel squat (90 degrees).

  • Regime of muscular work (Type of muscle action)

For a squat the initial phase is eccentric action of the quadriceps and glutes then concentric extension on the ascent of the glutes, quadriceps and hamstrings. In a sprint the initial movement to overcome inertia is concentric which corresponds with the ascent phase of the squat. The top speed running of a footballer will involve the glutes, hamstrings and quadriceps moving from concentric to eccentric muscle action, as does the squat7.

The greater power needed through the triple extension phase of the squat achieves greater motor recruitment which is thought to be one of the reasons a squat correlates so well with sprint speed in soccer players as the athlete is able to use more of the motor units to generate max speed8.

This was a brief illustration of how strength and conditioning principles can be used to look deeper into the activity or sport you are looking to achieve with a patient. It has certainly highlighted to me over my degree so far that there is a lot more to train than what a movement looks like which can help you prepare your patient or athlete in a more well rounded way for their sport.

References

  1. https://www.nice.org.uk/guidance/NG59
  1. Bradley, Sheldon, Wooster, Olsen, Boanas & Krustrup (2009) High-intensity running in English FA Premier League soccer matches, Journal of Sports Sciences, 27:2, 159-168
  2. Siff,MC. (2003) Supertraining(6thEd).Denver,CO:Supertraining Institute
  3. Plisk,SS.Speed,agility,andspeed-endurancedevelopment. In: Baechle, TR, and Earle, RW (Eds.), Essentials of Strength Training and Conditioning (3rd Edition). Champaign IL: Human Kinetics; 457-485, 2008.
  4. Nummela, Rusko and Mero (1994). EMG activities and ground reaction forces during fatigued and non fatigued sprinting. Medicine and science in sports and exercise 22(2) 605-609
  5. Zink, Perry, Robertson, Roach and Signorile (2006). Peak power, Ground Reaction Forces and Velocity During the Squat Exercise Performed at Different Loads. Journal of Strength and Conditioning Research, 20(3), 658–664
  6. Spinks, Murphy, Spinks and Lockie (2007) The Effects of Resisted Sprint Training and Acceleration Performance and Kinematics in Soccer, Rugby Union and Australian Football Players Journal of Strength and Conditioning Research 21(1), 77-85
  7. Wisloff,U,Castagna,C,Helgerud,J,Jones,R,andHoff, J. Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players. British Journal of Sports Medicine 38(3): 285-288, 2004.
  8. Markovic, Jukic, Milanovic and Metikos (2007) Effects of Sprint and Plyometric Trianing on Muscle Function and Athletic Performance Journal of Strength and Conditioning Research 21(2), 543-549.

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Emily Drakes, ACPSEM Physio

The International Sports Physical Therapy Specialist: reflections on the UK situation (what we may take for granted)

16 Sep, 16 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Colin Paterson ,MSc PGCert (Ed) MCSP SFHEA RISPT

I recently presented at the Japanese Physical Therapy Congress in Saporro on the development of the International Federation of Sports Physical Therapy (IFSPT) competencies. Specifically, how we use them in the UK in relation to our Continuous Professional Development (CPD) pathway. I met with a variety of sports physical therapists in Japan, national committee members, the Lead Physical Therapist for TOCOG/Tokyo 2020 games to share knowledge and learn more about the professional context in Japan. These experiences spurred me to reflect on the specialty in the UK. Notably, the status and skill level of the profession and opportunities that exist in the UK- that others may take for granted.

Selfie at the top of the ski jump used for the Winter Olympics in Saporro 1972.

At the top of the ski jump used for the Winter Olympics in Saporro 1972.

Broad and enriching scope of practice

In the UK, physiotherapists are autonomous, first contact health care professionals able to work in a number of environments: hospitals, private clinics, the community and the sports field. With extending skills and scope of practice, physiotherapists with appropriate training adopt skills and roles previously only undertaken by doctors. In sport these skills and experiences continually grow and develop. Sports physiotherapists work at all levels from aiding the patient with a chronic long term condition to exercise, to recreational weekend warrior athletes, to high level elite athletes. In the UK they are the ‘go to’ practitioner for sports injury management advice, rehabilitation and advice to optimise sporting performance unlike other countries where athletic trainers have a greater presence.

This scope of practice isn’t the case in other countries where physical therapists are not always licensed to be a first contact practitioner, or work pitch side. They may not be able to use advanced skills or perform the trauma management role. UK sports (and exercise medicine) physiotherapists must not take this for granted. They must maintain the high reputation of the profession. Experienced physiotherapists also need to ensure a legacy by supporting new physiotherapists to work within the specialty to maintain its strong presence and reputation.

Organizational support networks

The UK sports Physiotherapy group, the Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), has always maintained strong UK links with other sporting bodies and also internationally with IFSPT and WFATT (athletic training group). This facilitates UK physios involvement in discussions, debates and information exchange – positioning us well to influence and implement best practice. The ACPSEM/UK was one of the first countries worldwide to have a sports physiotherapy CPD pathway based on the IFSPT competencies (IFSPT 2016. See Figure 1) when they were developed in 2004 (Bulley et al 2004). Only 8 countries now have an approved pathway for members to call themselves a Registered International Sports Physical Therapists, again something we shouldn’t take for granted in the UK.

ifst-graph

Figure 1. IFSPT Competencies.

Part of my trip to Japan was to provide support and advice on their preliminary discussions about developing their own specialty pathway. The build up to the 2020 Olympic Games are motivation and an opportunity to negotiate change. The IFSPT sees mentoring and support, on an individual or wider scale as an important element of developing the specialty worldwide. The IFSPT competencies underscore the skills and knowledge required to be a sports physical therapist. They also promote what the profession can offer (by and for individuals, educators, and employers) and guide development. The journey from being a novice to expert requires more than years of experience. Research highlights the need for the development of critical reflection skills, deliberate action/practice, organised and varied knowledge, and having a patient centred focus (Paterson and Chapman 2013. Higgs et al 2008. Jensen et al 2006. Edwards and Jones 2007). When did you last look at the competency document and reflect on your skills and development?!

Standing on the shoulders of giants

Personally I would like to thank all those sports physiotherapists who have impacted me, mentored me and provided me with opportunities to develop and learn. I am not sure I have thanked them enough. Have you thanked your mentors? UK sports physiotherapists must thank the work of the current ACPSEM committee and also all those members of previous executive and regional committees who have put in the hours to develop and provide the opportunities that currently exist for sports physiotherapists. The status we have as a profession and Physiotherapy specialty is taken for granted by some, but it has been earned.

Still, there is always more to be done and developed.

Reflecting back and aspiring forward

I will finish by asking you to take a moment to reflect on your career to date; how have you got to where you are? What/who are your influencers? Are you providing opportunities for others? Can you call yourself a registered international sports physical therapist?

We all have a role to play in maintaining the strong reputation and skill level of sports physiotherapists in the UK and globally. This involves promoting what we can offer and looking to make developments where appropriate. What capacity do you have to contribute? I will leave you with one last question to reflect on: do you take the sports physiotherapy specialism for granted?

References

Bulley, C., Donaghy, M., Coppoolse, R., et al (2004) Sports Physiotherapy Competencies and Standards. Sports Physiotherapy for All Project.(online) available at http://ifspt.org/wp-content/uploads/2012/04/SPTCompetenciesStandards-final-draft.pdf (accessed 07.07.16)

Edwards, I and Jones MA 2007 Clinical reasoning and expert practice. In: Jensen GM, Gwyer J, Hack LM, Shepard KF 2007 Expertise in PhysicalTherapy Practice,2nd edition.

Higgs, J., Jones, M.A., Loftus, S and Christensen, N 2008. Clinical Reasoning in the Health Professions. 3rd Edition. London. Butterworth Heinemann

IFSPT 2016 www.ifspt.org (accessed 27.7.16)

Jensen, G.M., Gwyer, J., and Hack, J 2006. Expertise in Physical Therapy Practice. 2nd Ed. Elsevier, St Louis

Paterson, C and Chapman, J 2013. Enhancing skills of critical reflection to evidence learning in professional practice. Physical Therapy in Sport. 14(3); 133-138

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By Colin Paterson MSc PGCert(Ed) MCSP SFHEA RISPT, Senior Lecturer (Physiotherapy) Brighton University. UK, Member of the IFSPT Registration Board. Chair of the ACPSEM UK

 

Training error and achilles pain

29 Jul, 16 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Tom Goom @TomGoom, Sports Physiotherapist at the Physio Rooms and the creator of Running Physio; lead on Running Repairs Course  http://www.running-physio.com/running-repairs-course/

Achilles tendinopathy is a common problem among runners and can be a challenge to manage. As clinicians, we want to help the patient find a balance between the load being applied to the tissue and its capacity to manage this load. This blog is the first in a series that will examine key factors in achieving this balance by assessing and modifying tissue load and increasing load capacity, and offer PRACTICAL applications of knowledge. We are, of course, more than just tissues being loaded and we have to keep the person at the very centre of a biopsychosocial approach. In this case that person will be Al…

Meet Al.

He’ll be joining us as the key figure in a multi-part blog series on managing achilles tendinopathy in runners. Al is a runner with a sore achilles. He will be our case-study to address all aspects of tendinopathy within a biopsychosocial approach. This first blog is about what training errors may have lead to Al’s symptoms. We’d like readers to join in and share their thoughts about it by tweeting @BJSM_BMJ and @physiosinsport using the hashtag #AchillesAl.

A bit more about #AchillesAl

Before we delve in, let’s learn a bit more about Al. Al is 49 year old runner with a 2 month history of right mid-portion achilles pain. He runs an IT company, is married with 2 teenage children and is generally fit and well. His main goal is to complete a marathon in 5 months time in under 3 hours and 30 minutes. His current PB is 3:36 and he’s determined to beat this before he turns 50 next summer!

He reports a gradual onset of achilles pain that began as a niggle then progressed over a couple of weeks to become swollen and painful. It has settled somewhat since, but hurts at the start of a run and then flares-up the following morning if he’s ‘overdone it’. He doesn’t usually get pain with activities of daily living, unless his symptoms have already been aggravated by a run.

Subjective history and objective examination leads to a diagnosis of right mid-portion achilles tendinopathy. Which leads us to an important question:

What factors/conditions have caused this to develop?…

Research suggests 60-70% of running injury occurs as a result of training error. It’s important to identify which training errors may have led to an injury so a runner can learn how to adjust their training to prevent a recurrence. The best way to do this is to get a thorough overview of a runner’s training structure and how it’s changed in the lead up to the injury. Particularly important is to identify relevant change. By this we mean changes to the training that would influence the load on the injured tissue or its capacity to manage that load.

Subjective history is vital in identifying training errors. There’s no recipe to this but it typically involves looking at weekly training structure,examining longer term changes (depending on chronicity of symptoms) and hunting, delving and exploring to see what’s changed!

Al’s a very modern runner. At a touch of a button he sends you his typically weekly training schedule;

image1 goom

What are your thoughts? Can you see any training errors that might be relevant?

This snapshot it useful but doesn’t tell you the whole picture so Al shares his training schedule in the weeks just prior to the onset of his pain;

image 2 goom

What do you think? Any relevant change that might have increased achilles load? Let us know on #AchillesAL.

So we have an overview but there’s still more to know! We need to hunt out those extra, key bits of information. A good subjective isn’t a box ticking exercise to ask pre-determined questions, it’s an exploration of a patient’s personal insights to see where it leads you.

We asked Al, “anything else that’s changed during this time? Did your type of training change, did you change your running surface?”

Al replies, “I’ve been pushing a bit harder to improve my pace and I also switched all my training to the treadmill a couple of weeks before it got really sore as the weather was shocking!”

We’re starting to see a couple of reasons how Al’s achilles may have become overloaded and sore but there’s another piece or two left in this puzzle! We know Al’s goal, a sub 3:30 marathon, we can use this to approximate what Al’s running pace should be at each training session. Al may have this information if he’s following a structured plan. However, questioning him further he says his training plan was provided by a friend and doesn’t have those details.

This final step is tricky. For many of us we might need some help approximating training intensity, we might feel it’s outside of our role. In an ideal world we’d work within an integrated, multi-disciplinary team and ask a running coach to help. Sadly for a lot of clinicians we can become quite isolated in clinics and may not have access to this.

**Action point** look to connect with local running coaches in your area to facilitate MDT working

If you feel confident to delve a little further there are some good online resources that can help. The Macmillan Calculator can be a useful tool. If we put Al’s goal time and a recent race time in to the calculator it gives us some approximations of his training paces;

  • Speed session: 400 metre intervals ~ 1:34 – 1:39, 800 metre intervals ~ 3:17 – 3:27 (i.e. Run an 800m interval in between 3 mins 17 secs and 3 mins 27 secs)
  • Tempo run: 7:21 – 7:37 minutes per mile
  • Easy run: 8:10 – 9:11 minutes per mile
  • Long slow run: 8:15 – 9:32 minutes per mile

We can then compare that to Al’s schedule;

image 3 goom

With all the information to hand, what training errors can you see and how might they affect the achilles?Share your thoughts by tweeting@physiosinsport and @BJSM-BMJ on hashtag #AchillesAl.

Once you’ve given it some consideration scroll down, past the humorous ‘error in loading’ image below to see our conclusions…

Al’s case is interesting because if all you knew was his training basics (e.g. how many times a week he runs, how far and on what days) it’s unlikely we’d identify the key training errors. His training volume (how much he does) is at a normal level for him and only increases very slightly from week to week (approximately 5%). His training frequency (5 sessions per week) remains constant. It’s only when we explore training intensity, pace and type that following the ‘training errors’ appear;

  1. Training structure – too much speed work
  2. Long runs are too fast
  3. Rapid change in training type – addition of treadmill
  4. ‘Failure to adapt’

Research by Stephen Seiler suggests that endurance athletes should do roughly 80% of their training at low intensity. Indeed even the world’s best distance runners do a lot of slow running in their training. Typically a marathon training schedule for a recreational athlete involves 1 speed session per week. Al has replaced a recovery run with a second speed session and not adapted his other training to accommodate this so his schedule now includes too much high intensity work.

When we examine the pace of each run in detail we see his speed sessions are at about the right pace, e.g. 800 metre intervals in around 3:25 which is well within his target pace of 3:17 to 3:27. His tempo runs are also on target, at around 7:25 to 7:35 minutes per mile. Al’s running a little fast during his easy runs at 7:50 minutes per mile when he should be 8:10 to 9:11.

The biggest issue though appears to be his long, slow run. Al should be doing these slowly according to his plan. His target is 8:15 to 9:32 minutes per mile and typically these runs are around a minute per mile slower than race pace. Al has been doing these at race pace (~8:00 per mile) in an attempt to improve his time. Some coaches recommend doing long runs close to race pace but you need to ensure your body is coping with it and strike the right balance between pushing performance and increasing injury risk. That makes the ‘failure to adapt‘ training error particularly pertinent; if you’re pushing yourself hard you need to monitor how well your body is coping and adapt your training if you start to struggle or you get pain. Al ignored his pain and barely changed his schedule until it reached a point where he couldn’t run.

Thoughts from the MDT

I asked my go to guy for training advice, Exercise Physiologist John Feeney from Pure Sports Performance for his views on Al’s training;

“From a coaching point of view, I don’t think I would ever advocate doing a ‘long run’ at race pace unless it was part of the athlete’s periodised training plan – i.e. a race pace half marathon as part of a marathon training plan. I always have trouble trying to get athletes to slow down during their long, aerobic runs. Its perhaps more a question of educating the athletes about the benefits of the long, slow runs so they don’t take them for granted and appreciate that these should be exactly what they say on the tin…..long and slow!

The need to look at the intensity of training is crucial as this will impact on the overall training load for that session. I have no problem in incorporating 2 HIT sessions for athletes (even novice athletes) in a periodised training plan. Whilst this will lead to short-term fatigue and overreaching, it often results in high levels of adaptation and super-compensation. However, having said that these twice weekly sessions are well controlled, separated by at least 48 hours and form part of a 4-6 week training block, which itself is part of the periodised programme. The overall training load across a week tends to remain the same as other sessions are adapted accordingly.”

How does this influence the achilles?

When identifying training error it’s important to try to reason through how it might influence the load on the injured tissue. Neilsen et al. (2013)reported that injuries to the achilles, calf and plantar fascia are more likely to occur with an increase in training pace (rather than volume). Hamner et al. (2010) found the calf complex to be the greatest contributor to propulsion and load on the gastrocnemius, soleus and achilles tendon increases as we increase running speed (Schache et al. 2014). Some runners will move towards a more forefoot strike as they accelerate (Forrester and Townend 2015) and this has been found to increase achilles load (Almonroeder et al. 2013).

It follows then that the load on Al’s achilles is likely to increase if he increases training intensity. This isn’t necessarily an issue unless the increase is too rapid and excedes Al’s load capacity. Perhaps it might not have done until he added another variable into the mix…

Recent research by Rich Willy et al. (2016) compared overground and treadmill running and found peak achilles tendon force was 12.5% greater on the treadmill. The rapid introduction of treadmill running in addition to increased training intensity may well have tipped the balance and overloaded the tendon.

It’s important to discuss these findings with Al and explain how we think his training may have caused his achilles pain……Al takes on the key messages but, understandably, has some questions…

“What training should I be doing now then?”

“How could I modify it to help my achilles?”

Over to you guys…what do you think? What else might you want to know from Al?

Tweet your answers to @physiosinsport and @BJSM_BMJ on hashtag #AchillesAl and we’ll feature the best suggestions in part 2!…

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Tom Goom @tomgoom, is a Sports Physiotherapist, Physio @thephysiorooms, creator of Running Physio and lead on Running Repairs Cours http://www.running-physio.com/running-repairs-course/

Beating the odds: How the ACPSEM CPD pathway can help physios who want to work in sport

4 May, 16 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Nikki McLaughlin @Nikkimacphysio

Having just read @sianknott‘s recent blog on behalf of @sport_wales, I am inspired to give a brief synopsis of how to use current and existing infrastructures of governing and professional bodies to progress through your career as a sport physio – being an Olympic year, what better time to share the info.

Rabbit in headlights

Where do I go from here???

Now when you first start out it’s a bit like a rabbit in the head lights – you don’t know where to go or what to do…so my main aim for this blog is to give some advice and personal experience on where you can go as a newly graduated physio who wants to work in sport, or for those looking for more exposure in multi sport events.

I wouldn’t say I am the most experienced sports physiotherapist out there but if I didn’t have the help and support from some key figures in the sports physio world (you know who you are), I would never have worked with some of the teams I have, or travelled to the farthest corners of the world. Therefore, I am merely just trying to return the favour by  “Paying it forward”.

CPD Pathway and Education-Going for gold.

Firstly, I have found and continually use the Association of Chartered Physiotherapists in Sport and Exercise Medicine (ACPSEM) as a great resource for  professional development and networking. The organisation has a clear and structured CPD and educational pathway. The process is straight forward and the “pathway provides a road map to help sports physiotherapists to plan, implement and reflect upon their learning”.

The ACPSEM accreditation levels are internationally recognised by the International Federation of Sports Physiotherapists, theBritish Olympic Association and Sports National Governing Bodies. Evermore, employers are using the CPD levels as essential criteria on their job descriptions to ensure that they can be confident in the physiotherapists sporting experience. With more competition in the marketplace from other sports practitioners, the pathway can add value to your professional credibility.

Secondly, the organisation clearly has some influence within the market place. It’s members regularly liaise with Health Professions Council and Chartered Society of Physiotherapy to inform them of any changes and/or updates of working practices of physiotherapists working in sport medicine.

To volunteer or not????

As you enter into the sporting world it is very easy to get caught up in the volunteering process.  Now I for one feel strongly about this and speak from experience. All too often you hear of physios covering or volunteering for sports to gain experience but quite often end up working alone or exposed, and I’m not against volunteering but what I will say and question is what are you getting from it?

Perhaps an example would help better here? – If you a covering a social sporting side to gain experience and you are the sole practitioner and responsible for trauma cover, question are you really going to benefit from it or are you just exposing yourself to a potentially vulnerable situation?

working alone pitchside

Exposure pitch side the need for team support is essential

If however, you are involved within a team there is no reason why you cannot volunteer and access the previously mentioned ACPSEM pathway documentation and mentoring system. This will support you to clearly define objectives and learning outcomes from within your role making the experience more worthwhile.

If you really seek a structured experience, with exposure within multi sport events then BUCS as an organisation is a  great place to start.  Throughout my career I have been heavily involved and still am. The cohort of physio and medics are so varied in their professional and sporting backgrounds that the information or learning you can gain is invaluable regardless of experience. Is it costly? simple answer no, all you have to do is give your time and be willing to work the hours and in environments your not used to.

BUCS volunteer

BUCS events, particularly the larger ones, provide an excellent opportunity for doctors and physiotherapists looking to enhance their sporting experience. BUCS currently operate two multi-sport events where are large number of doctors and physiotherapists come together to work and share knowledge and skills.  Involvement in the domestic programme can additionally lead to a variety of international opportunities. I can say that these have been some of the best working trips I have been on and made some real life-long friends.

For domestic events, BUCS provides expenses and daily rates for ACPSEM qualified physiotherapists and doctors. Students and newly qualified individuals are also able to be involved in a shadowing capacity. Interested in volunteering click here

If after reading this blog your keen to progress further in the Sport and Exercise Medicine world, then volunteer and get involved because who knows, you may be attending the next World University Games, Commonwealth Games or  Olympics Games………………………

See you there?

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 Nikki McLaughlin @Nikkimacphysio works at Baseline Physiotherapy in Cardiff and Caerphilly, http://www.baselinephysiotherapy.co.uk/

 

Team physio for the Commonwealth Youth Games- 40 hours of travel, 2 lost bags, 10 medals, and countless learning experiences

11 Jan, 16 | by BJSM

By Stuart Butler @PhysioButler

Travelling as a Sports Physiotherapist with Team England for the September 2015 Commonwealth Youth Games in Samoa is always an honour but also comes with responsibilities. The games saw up to 1000 young Commonwealth Athletes between 14 and 18 represent their countries and compete for 107 Gold Medals over 9 days. The 2 main venues hosted swimming, archery, athletics, boxing, lawn bowls, rugby sevens, squash, tennis and weightlifting.

image3

To be frank- physios are a logistical nightmare. We have bags, tables, coloured tape, lucky bandages and magic spray, and you’ll often find us lugging it across the airport knocking things/people over as we go. Looking after the athletics team on this (nearly 40 hour) trip to Samoa, apparently meant we needed to pack everything – including the kitchen sink!

And there’s the time difference. On landing, we only had 12 hours to resolve our jet lag and get on with the task of competing; we needed to be clever en route to cope and be at our best for competition. Thanks to the wonderful help of Luke Gupta from the EIS, we had a plan: stay up for nearly 36 hours (using some cleverly timed power naps) and put our body-clocks onto Samoan time as soon as we got on the plane. Needless to say it was difficult, but a shower in Hong Kong airport helped, and with the support of the team staff and athletes we really did hit the ground running with very little / no jet lag issues.

We hit the ground running apart from two rather important bags! In transit on our 3 flights we (temporarily) lost two bags of kit, not bad out of nearly 150 items including bags and physio couches, but, as luck would have it, it was the two medical bags that were held up. One was mine (although I had split both my 2 bags in half: half medical / half personal kit – always a useful tip when travelling as a physio with teams). Another physio had also lost their medical bag. Our bags were returned two days later, in the meantime, since we were so remote, we relied on the generosity of others to help. Fortunately, the sports medicine fraternity is very small, and generally very accommodating. We borrowed a few bits and shared kit. Still, I was quite grateful to be reunited with a few shorts and socks.

image2

A recent outbreak of Dengue Fever meant we applied and encourage the use of large amounts of “Deet”. Overall, there were no major issues apart from a cut foot that required an x-ray to check that there was no glass in it. I’m always nagging athletes to put something on their feet but you can’t watch them all the time!

Samoa was amazing: probably one of the best trips I’ve ever been fortunate to be a part of. There was success on the track (10 medals), opportunities to explore (To Sau Ocean Trench is amazing) and to also give something back. It was fantastic to take some time out to visit a local special needs school, and humbling to interact and take time to enjoy displays of singing and dancing. Our boxers performed shadow boxing and we played running races. It was also great to see so many of our 16/17 year old athletes warmed so much to so many of the children that they gave up their own kit to give as gifts.

image1

Travelling with teams abroad creates a host of logistical and practical challenges but thorough planning, an open mind, and good communication can go a long way.

Fa’afetai (thank you).

*******

Stuart Butler, Sport and Exercise Physiotherapist in London and for England Athletics @PhysioButler

Missed the ACPSEM Biennial Young Athlete conference? Not to worry- here are some highlights with links to key resources

25 Nov, 15 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

CONFERENCE REPORT

By Zachary Spargo (@ZachSpargo)

The Physios in Sport (ACPSEM) Biennial Young Athlete Conference was in no uncertain terms an absolute classic! Great speakers, hot topics, lots of networking and above all – mini burgers for lunch! The focus was on managing the young athlete within all aspects of sport to ensure their development into a robust, resilient and successful adult. This BJSM podcast is a good place to whet your appetite https://soundcloud.com/bmjpodcasts/managing-load-in-young-footballer-practical-tips-to-customize-treatment-training-sam-blanchard

Here’s some of the educational nuggets that the two days entailed:

Physical Development and Risk

(J Bunce, A Renshaw & P Read)

CLIMBING WALL 4The day opened with a discussion on the optimal training programme for the younger athlete. A balance between resistance and power sessions was suggested to be the best route. The need to make sessions fun for youngsters was keenly stressed, giving examples of Manchester City’s playground and Brighton and Hove Albion’s climbing wall.

Andy Renshaw highlighted one of the key messages of the conference: You simply cannot rely on adult data to predict injuries in younger athletes. Using the Fuller et al. (2006) injury definition consensus statement http://bjsm.bmj.com/content/40/3/193, Andy was able to expertly illustrate the differences between the populations. His data showed for example that anterior thigh strains were the most commonly occurring injury in the academy teams (18% n=23) compared with a majority of posterior thigh injuries in the adult game. Paul Read went on next to identify some of the main risk factors for injury in adolescent populations including:

  • Previous injury
  • Fatigue
  • Movement skill/neuromuscular skill
  • Growth and Maturation
  • Seasonal Variation (Greatly increased loads pre-season)

Will Abbott (Brighton and Hove FC) also reiterated the importance of load management and monitoring throughout the season, but spoke of the need not to purely focus on velocity of activity.

Hot Topics

(S Parris, M Stewart, T Quantrell, M Hendry, A D’Silva, & J Hanson)

  • Safeguarding: The welfare of the child must always be, the absolute paramount consideration of the healthcare professional.
  • Persistent Pain: Treat the symptoms not the scan (35% of athletes have damage on MRI but no symptoms). ‘Pain is the ideal habitat for worry to flourish’ (Eccleston & Crombez, 2007). Understand our mouths are THREAT MACHINES!
  • Golf: Surprisingly little physical preparation for young golfer currently. Identify physical markers, technical markers and evaluate how your treatment/preparation has effected performance.
  • Sudden Cardiac Death: Exercise is good! However can be a trigger in rare cases for sudden cardiac death (SCD). Some of the conditions causing SCD can be screened in the young athlete. http://blogs.bmj.com/bjsm/tag/sudden-cardiac-death/
  • Concussion: If in doubt sit them out! Chronic traumatic encephalopathy has a clinical manifestation of early onset dementia (post mortem findings of repetitive head injury). http://bjsm.bmj.com/content/47/5/250.full

Orthopaedic Physiotherapy Management

(P Bennett, I Tak, S Ahamed, Mo Gimpel, P Glasgow, A Wallace, M Allen & A Harris)

  • Gymnastics Adolescent Spine: In a sample of female Olympic gymnasts (12-20 years) 12/19 had degenerative discs and 3/19 had spondylolysis. Our role is to create a robust young athlete, with regular screening and early detection of issues. Must have full fitness before returning to activity after injury! See this podcast from Dr Pippa Bennet for more information: https://soundcloud.com/bmjpodcasts/legendary-england-football-chief-medical-officer-on-acl-injuries-red-s-and-sport-team-culture
  • Hip/Groin: Reduced hip range of motion (internal rotation) in athlete with groin pain. Increased anterior pelvic tilt results in decreased range of motion which ultimately affects ball striking power in footballers. Southampton FC’s Mo Gimpel demonstrated a tremendous reduction in hip/groin injuries with a movement dissociation programme. He also noted the need for an iliopsoas/glute activation programme before stepping on the pitch at any time!

Monitoring and Prevention

(N Cameron, J Strickland, A Johnson, W Abbott, L Abnett, J Elphinston & R Brandon)

  • Apophysitis Syndromes: Affects children during secondary growth spurts, especially those involved in physical activity (ages 8-16). Using a self-developed treatment algorithm (including absolute rest, stretching and massage), Jenny Strickland was able to reduce recovery time significantly to an average of 19 days.
  • Screening: Amanda Johnson highlighted the main reasons for screening your youth athletes as follows:
  • Cardiac investigation
  • Growth related injuries
  • Flexibility
  • Strength
  • Load monitoring
  • Endurance and sprint ability

But it was stressed that clinicians should not intervene without evidence and to ensure your protocols are to the highest standard!

Physios in Sport Young Athlete Conference 2015: In Summary

This is really just the tip of the iceberg in relation to what was on offer! I’m really sorry I haven’t been able to include something from all the speakers because they were all absolutely incredible throughout the two days. I urge all readers to look out for where they can find them at other conferences around the world.

If you have any questions then don’t hesitate to comment below!

PLUG ALERT: Look out for the next ACPSEM Biennial conference in 2017! Plus have a nosy at all the brilliant CPD opportunities on the Physios in Sport website.

Zachary Spargo MSc Physiotherapy student (pre-registration), BSc (Hons) Sport and Exercise Science (@ZachSpargo). Currently studying at York St John University and is the Yorkshire and Humber CSP Communications Lead for the region. ACPSEM student member.

 

Athlete Monitoring in Sport- Key Principles and Practical Tips By Jason Laird (@PhysioReel)

29 Oct, 15 | by BJSM

By Jason Laird (@PhysioReel)

Photo from: http://www.prozonesports.com/prozone-performance-lab-kinetic/

Photo from: http://www.prozonesports.com/prozone-performance-lab-kinetic/

Within elite sport the use of data and  technology is now commonplace. In particular, the use of athlete monitoring tools is now the norm for many sports looking to prevent injury. These tools are primarily aimed at monitoring training load (exposure) and an individual’s response to this exposure. The link between this monitoring data and injury incidence is now being closely analysed.

Prevention of Injury

In order to fully understand the role of athlete monitoring in the prevention of injuries we first need to delve a little deeper into the types of prevention available in sports medicine.

Within epidemiology research there are examples of different types of prevention; primary, secondary, and tertiary (1, Health Knowledge Link). In the context of elite sport, primary prevention is aimed at removing or controlling the exposure to risk factors. Screening for these risk factors (most commonly in pre-season) often leads to targeted prevention strategies (2, 3). For more information on other types of risk factors in sport see Bahr and Holmes’ paper (4).

Secondary prevention aims to detect changes from a normal baseline (usually via a screening tool) in order to intervene and stop a problem from progressing. A good example of this in the medical world is screening for cervical cancer, that well establishes the link between screening findings and the disease (5, WHO link).

Athlete monitoring is a type of secondary prevention that analyses subjective and objective data in order to detect a change in the athlete. This information gives us a real-time snapshot of how the individual is responding to their current exposure level and shows any occurrence of trends.

Linking monitoring findings to prevention

Identifying a causal link between monitoring findings and injury incidence in order to prevent injuries before they happen is perhaps the ‘holy grail’ in this field. This requires plenty of ongoing research, particularly in the areas of validity and reliability of tests and their possible combinations. See this great blog on ‘Diagnostic Validity’ by Andrew Cuff via Tom Goom (6) for more information on how to understand validity and reliability within physiotherapy research.

There is now a huge selection of tools at our disposal to collect subjective and objective data from athletes. Some of these require relatively expensive equipment and bespoke analytical programs whereas others need just a pen and paper and a chat with the athlete and coach. A great video to use as an introduction is one from Dr Bryan Mann (7) and shows how simple and effective monitoring can be in a busy sports environment.

Some further examples of athlete monitoring in elite sport can be seen here in Rugby Union (8) and the NFL (9). With these types of tools having the potential to keep players fit and available for longer, some sports teams are placing serious investment into staff and technologies aimed directly at collecting monitoring data and researching the output.

There are some recent studies investigating how factors such as hamstring strength (10) and increases in training load (11,12) can link to injury risk in elite level sport and the evidence base surrounding athlete monitoring and injury is sure to grow. In the meantime, different types of monitoring continues to be commonplace in elite sport. There is a whole host of technology companies and equipment manufacturers being used across the world and fully integrated into sports teams.

Practical tips for athlete monitoring

Finally, here are a few practical tips:

  • Pick tests relevant to your sport

The tests you choose should relate well to your sport and look to target your key time loss injuries, as well as being valid and reliable tests for your athlete group. It may also be useful to look into the minimal detectable change and standard error of measurement of the tools you are going to use (13, Rehab Measures link).

  • Start simple and small

Don’t make the tests too extravagant or time consuming from the outset. Start small and simple and add more as required. An easy start point for athletes is the use of subjective wellbeing data, with recent evidence indicating that this type of ‘self-report’ data may be of more use in detecting changes than objective tests (14).

  • Create ‘Buy-In’ with the athlete and coaching team

Bringing the athlete and coaches on the journey with you regarding what you aim to achieve by collecting the data is perhaps the most important part of the whole process. As everyone begins to understand what the tests are showing and what the trends look like it will allow you to have more impactful contextual discussions around the data.

  • Quick feedback of data

The faster you can feedback the data to athletes and coaches the better; this will help massively with buy-in and also provide an opportunity to have discussions on live data, rather than just what happened last week.

Happy monitoring!

Reference List

1: Health Knowledge ‘Epidemiological basis for preventive strategies ‘: http://www.healthknowledge.org.uk/public-health-textbook/research-methods/1c-health-care-evaluation-health-care-assessment/epidemiological-basis-pstrategies

2: Pappas, E., Nightingale, E.J., Simic, M., Ford, K.R., Hewett, T.E., Myer, G.D. Do exercises used in injury prevention programmes modify cutting task biomechanics? A systematic review with meta-analysis. British Journal of Sports Medicine. 2015, 49 (10), 673:680.

3: Clarsen, B., Bahr, R., Andersson, S.H., Munk, R., Myklebust, G. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study. British Journal of Sports Medicine. 2014, 48 (17), 1327-1333.

4: Bahr, R., and Holme, I. Risk factors for sports injuries–a methodological approach. British Journal of Sports Medicine. 2003, 37 (5), 384-392.

5: WHO- Human papillomavirus (HPV) and cervical cancer: http://www.who.int/mediacentre/factsheets/fs380/en/

6: Diagnostic validity: http://www.running-physio.com/diagnostic/

7: Monitoring Fatigue from A-Z, Dr Bryan Mann: http://www.nsca.com/videos/monitoring_fatigue_in_athletes/

8: ‘Kitman Labs Provides ‘Invaluable Tool’ For IRFU- Irish Rugby’: http://www.irishrugby.ie/news/31666.php#.Vd8Bnmfotdh

9: ‘Dolphins aim to prevent injuries with futuristic performance program’: http://espn.go.com/nfl/story/_/id/13665228/miami-dolphins-aim-prevent-injuries-futuristic-sports-performance-program-nfl

10: Freckleton, G., Cook, J., Pizzari, T. The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players. British Journal of Sports Medicine. 2014, 48 (8), 713-717.

11: Hulin, B.T., Gabbett, T.J., Blanch, P., Chapman, P., Bailey, D., Orchard, J.W. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. . British Journal of Sports Medicine. 2014, 48 (8), 708-712.

12: Cross, M.J., Williams, S., Trewartha, G., Kemp, S.P.T., Stokes, K. The Influence of In-Season Training Loads on Injury Risk in Professional Rugby Union. International Journal of Sports Physiology and Performance. 2015, in press.

13: Rehab Measures Database: http://www.rehabmeasures.org/rehabweb/rhstats.aspx

14: Saw, A.E., Main, L.C., Gastin, P.B. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine. In press.

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Jason Laird (@PhysioReel) works for the English Institute of Sport as Lead Physiotherapist for British Judo.

Knowledge, confidence, and fun: First time conference goers (and physiotherapy students) reflect on the ACPSEM “Physios in Sport Young Athlete Conference”

20 Oct, 15 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Jazz Shiret and Aoife Bannon
young phyiosOur recent experience volunteering at the ACPSEM “Physios in Sport Young Athlete Conference,” held in early October at the wonderful Amex Stadium in Brighton, dispelled a stereotype (commonly held by conference newbies) that a “conference” is just full of unapproachable people in suits, giving ‘expert’ presentations, packed-with complex terminology.

We were really excited to volunteer, but as the time got closer  we realised that we would have to make conversation with these ‘well-dressed experts.’ We got slightly nervous.

How do I approach them? Would they want to talk to me, a student? What questions can I ask? Will I sound stupid? Will I understand what they are talking about?

Dispelling the fears with on the ground experience…

Five impressions stood out over the first two days:

  1. Despite unique areas of focus related to the prevention and treatment of young athletes, many of the speakers’ ‘key findings’ had a high degree of relate-ability to a range of sporting environments. From football, to golf, ballet, and gymnastics, we learned that a physio’s primary focus should always be on the development and well-being of the child and their enjoyment of their sport.
  2. The passion and wealth of knowledge that the speakers showed for their interest areas was really inspiring. As one example, a presentation on safeguarding children within a club or organised sport environment highlighted the importance of ethics. We learned: (i) our responsibility is collective, with the child’s interests and health being of paramount importance (ii) the language we use when dealing with young athletes can be a powerful and determining factor in successful management (iii) we must be aware of the reaction that our choice of words could bring about and how this can impact their understanding and form their attitudes permanently.
  3. The conference provided insight into the physiotherapist’s role in a sports club setting (and also showed the similarities to a more traditional MDT seen on our placements). The presenters suggested that the most effective practice requires excellent communication skills, a level of understanding of each discipline and how the roles interlink. A number of speakers mentioned great insights: (i) the importance of gaining the coaches trust and confidence (ii) Good communication between players/children or adolescent, their families and coaches is essential (ii) Correct diagnosis and understanding how training volumes affect injury risk is important, and explaining this to young patients, parents and coaches in language that is meaningful and respectful of them is vital. (iii) The process of returning our athletes back to training and competition following injury or an off season break can be helped by using technology like GPS to monitor the load placed on athletes during these times.
  4. It was also interesting to hear about hot topics such as concussion and head injury (Dr Jonathan Hanson @sportsdocskye), screening young athletes for cardiac problems as early as possible (Dr Andrew D’Silva) and Apophysitis Syndromes (Jenny Strickland).
  5. A final message we took away from the two days was to be mindful of the huge individual variation between young athletes even within those of the same chronological age.

Prior to the conference we were concerned that we wouldn’t be able to understand the content of speakers to an advanced depth. Some concepts were definitely new to us, but rather than inflate insecurities, these moments underscored the importance of continuous learning, reflection, and asking thoughtful questions in order to improve our practice.

Also, the multiple opportunities to ask speakers questions one-on-one lessened our nerves about asking a ‘silly question’ in front of the whole audience. It was really lovely to see how most of the speakers happily took time to engage with students by clearly responding to their questions.

Overall this weekend was thoroughly enjoyable and a rich learning experience. It was an inspirational weekend we will not forget!

We now realise that all those ‘well-dressed experts’ are not scary. They are just normal people who share our passion and do in fact most of the time enjoy talking to us students! The relaxed atmosphere contributed to a successful and enjoyable conference by all.

We significantly expanded our knowledge base, but also confirmed there much more to learn.

Bonus conference highlight

rugby w youthWe both wholeheartedly agreed that the conference highlight was listening to the Richard Parks (@RichardParks), former international rugby player turned extreme adventurer, speak about the critical role physiotherapists (and physiotherapy) played in his career. We fortunately got to meet and chat with and his physiotherapist, Nicky Philips (@NicolaPhillPT), as well as getting a cheeky photo with him. We can now safely say that we won’t think twice about going to another conference soon.

Finally we would like to say a very special thank you to Sam Blanchard (@SJBPhysio_sport) and all the committee members for giving us this opportunity and to all the other volunteers who helped make the two days run smoothly.

Hope you enjoyed the blog,

Yours in sport,

Jazz & Aoife

Jazz Shiret (@JazzShiret) and Aoife Bannon (@AoifeBannon) are both 3rd year physiotherapy students at the University of Brighton as well as being student members for the ACPSEM (@Physiosinsport).

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