SEPNZ | Sports & Exercise Physiotherapy New …...BHSc Physiotherapy - AUT 1998 PGD Sports Medicine Otago University – 2001 Masters Health Practice – Physiotherapy (Manipulative

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BULLETIN

ISSUE 3 l JUNE 2014

www.spnz.org.nz

SPNZ EXECUTIVE COMMITTEE

President Hamish Ashton

Secretary Michael Borich

Treasurer Michael Borich

Website & IT Hamish Ashton

Committee Timofei Dovbysh

Blair Jarratt

Justin Lopes

Dr David Rice

Bharat Sukha

Kara Thomas

EDUCATION SUB-COMMITTEE

Dr David Rice - chair

Dr Angela Cadogan

Dr Grant Mawston

BULLETIN EDITOR

Aveny Moore

SPECIAL PROJECTS

Monique Baigent Karen Carmichael

Deborah Nelson Kate Polson

Amanda O’Reilly Pip Sail

Louise Turner Greg Usherwood

LINKS

Sports Physiotherapy NZ

List of Open Access Journals

Asics Apparel and order form

McGraw-Hill Books and order form

Asics Education Fund information

IFSPT

JOSPT

CONTACT US

Michael Borich (Secretary)

26 Vine St, St Marys Bay

Auckland

[email protected]

FEATURE TOPIC: Swimming

Welcome to the June 2014 Bulletin

In this Edition:

EDITORIAL 2

NEW COMMITTEE MEMBERS 3

LATEST NEWS 4

MEMBERS ’ BENEFITS

Discounts 5

FEATURE

A High Performance Journey: Physiotherapist Jordan Salesa 6

CLINICAL SECTION

Article Review: The Practical Management of Swimmer’s Painful Shoulder:

Etiology, Diagnosis, and Treatment. 10

RESEARCH SECTION

SPNZ Research Reviews: Shoulder Pain in Swimmers 12

RESEARCH PUBLICATIONS

JOSPT: Volume 44, Issue 6, June 2014 14

ASICS

Shoe Report: Gel Divide 15

CONTINUING EDUCATION

SPNZ Course: Promotion & Prescription of Physical Activity & Exercise 16

Continuing Education Calendar and APA CPD Event Finder 17

CLASSIFIEDS 18

Page 2

EDITORIAL

It has been a wild few days here in the Bay of Plenty and many other regions around the country so I hope you are

all keeping safe and well.

Since the last bulletin we have gained another committee member as unfortunately Chelsea Lane has had to step

down. Though she was on the committee for just a short time her experience has been useful in the initial develop-

ment of our sports physiotherapy courses. Blair Jarratt has been seconded after expressing interest to us in becom-

ing involved.

Though two of our committee consider themselves Mainlanders, our committee is now very top of the North Island

heavy and lacking in female input. Currently Kara is the only one representing the female half of our membership and

repressing testosterone levels in the board room.

It would be great to have better representation from around the country and a few more females so we have a more

balanced view point of the membership. If anyone has interest in being more involved please talk to me. At present

we are not looking for further committee members but just an interest in being involved.

You will see we have enclosed in the edition bios of our new committee so you can better get to know who are repre-

senting you.

On talking about ideas, our committee is due to have a get together at the end of the month. This is our main plan-

ning session that we hold once or twice a year. As part of this we go through ideas from previous surveys we have

undertaken. However if anyone has any thoughts about courses or anything else they would like to see happen

please let Michael Borich or myself know so we can discuss it at our meeting.

I recently attended the PNZ AGM at which a SIG/Branch day was held at the same time. During this there was an

update on the SuperConference for which we have had some involvement. How to support this was a well discussed

topic by our exec as our Symposiums all received great feedback, especially with regard to the speakers providing

practical advice in their presentations. Our decision was that we need to support the whole profession in the form of

the SuperConference, but we understand CPD budgets are tight so as part of our planning going forward we need to

decide how it and the Symposium are going to work together. Any thoughts on this are welcome.

Though as a SIG we are relatively large, we are still only one of many groups involved in sport and sports medicine

in New Zealand and throughout the world. You will shortly receive the Sports Medicine Australia Sport Health Maga-

zine which is part of our efforts in developing relationships with other groups in both NZ and overseas. This is some-

thing I see as of great value to our members in the long term as they can provide us with useful contacts and re-

sources.

We also have an arrangement with the Australian Physiotherapy Association and Sports Physiotherapy Australia to

access their courses at member rates and are currently talking to SPRINZ about developing a mutually beneficial

relationship. If anyone has affiliations or contacts to other groups or organisations I would be interested to hear from

them.

That is all from me for now. I don’t know how Ang managed to write multiple pages but I think I will go for the short

and sweet approach.

Hamish Ashton

SPNZ President

By Hamish Ashton

Page 3

Introducing Our New Committee Members

Tim Dovbysh

I have been living in Hamilton now for the last four years since graduating from Otago

University with a BPhty. Our clinic covers the greater North Waikato area from which

we gain a diversity of patients across a range of sporting and recreational, and

socioeconomic levels. I’ve been involved in an array of sports at regional and national

tournament level, but more heavily focussed into secondary schools and age group rep

rugby. My spare time is a fine balance of studying towards postgraduate qualifications

through AUT, landscaping our quarter acre forest that will someday resemble a garden,

and getting in some competitive tennis. I look forward to bringing my perspectives into

the exec.

Blair Jarratt

I moved to back to Tauranga last year after growing up in the Bay prior to studying

Physiotherapy at Otago University. I have recently become a director of Bureta

Physiotherapy. The previous five years were spent working in Christchurch

after returning home from five years in the UK. While in Christchurch I

was physiotherapist for the Canterbury Wizards Cricket and Canterbury B rugby.

Leaving Canterbury meant passing up these positions, however I was lucky enough to

travel with the NZ U19 Cricket team to Dubai in February this year for their world cup

campaign. I have two young children, Ashton and Pippa, who keep me pretty busy, but

if I do get a chance, I like to get out on the mountain bike and have completed a number

of races and endurance events in the south. I will be looking forward to some North

Island challenges, and maybe even getting the snowboard back out again.

Justin Lopes

I am a sports physiotherapist based at the Western Springs Association Football

Club. I have worked with New Zealand Football for over 10 years for a variety of age

group teams, including the NZU23 Mens team at the 2008 Beijing Olympics, the

Football Ferns and the High Performance Elite Referees Group. I have also worked

with the New Zealand Roller Derby Team for the last two world cup campaigns. I am

currently the President of the Auckland Branch of Sports Medicine New Zealand. My

emphasis is on hands-on prevention, treatment and performance.

NEW COMMITTEE MEMBERS

Page 4 LATEST NEWS

CONGRATULATIONS...

AISCS EDUCATION AWARD – WINNING RECIPIENT

The winning recipient of the above award for March 2014 is Angela Cadogan from Christchurch.

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

Awards Terms and References.

Angela is attending a conference in Dublin, Ireland, from 4-6 September entitled “The Sporting Hip, Groin, and Ham-

string: A Complete Picture”. This is a combined conference of the Federation of Sports and Exercise Medicine

(Ireland) and the World Federation of Athletic Training and Therapy. Angela is a past president of SPNZ and we look

forward to her feedback on this conference which will appear in a forthcoming issue of our bulletin .

It should be noted that no other applications were received as at 31 March.

The next round of applications closes on 31 August 2014. All members are encouraged to view the Terms and Con-

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

ASICS EDUCATION FUND

A reminder to graduate members that this $1000 fund is available twice a year with application deadlines being 31

March and 31 August.

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

tion in the fields of sports and orthopaedic physiotherapy.

An application form can be downloaded on the SPNZ website sportsphysiotherapy.org.nz.

Dr Angela

Cadogan

Well done to Dr Angela Cadogan who recently was awarded

Specialist Status in Physiotherapy under the Musculoskeletal

Tag. Despite the Physiotherapy Board not yet recognising

Sports as a specialist area, Angela, by becoming a specialist in

New Zealand, now qualifies to become recognised as a IFSPT

Specialist Sports Physiotherapist.

Congratulations Angela, from the Exec, as well as I am sure the

whole membership of SPNZ

SPNZ is now on Facebook

Check us out at:

www.facebook.com/SportsPhysiotherapyNZ

Page 5

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.

MEMBERS ’ BENEFITS

DISCOUNTS

25% off

Medical

books

http://sportsphysiotherapy.org.nz/members/reviews/book-order-form/ for details on how to order.

Members rates on Asics shoes and apparel

http://sportsphysiotherapy.org.nz/members/asics-information/ for how to order

Member discounts to all SPNZ courses and Symposium

http://sportsphysiotherapy.org.nz/courses/ for what is upcoming

McGraw Hill Education

Asics

SPNZ

Page 6

Physiotherapist: Jordan Salesa

FEATURE

A HIGH PERFORMANCE JOURNEY

Qualifications

Trade Certificate (Glazier) – 1989

Advanced Trade Certificate (Glazier) - 1991

BHSc Physiotherapy - AUT 1998

PGD Sports Medicine Otago University – 2001

Masters Health Practice – Physiotherapy (Manipulative and

Acupuncture) - 2009

Background

I come from an extremely close-knit family: an aiga - an extended family in the Samoan sense. I cannot

adequately introduce myself without at least beginning to introduce some of them. My mother is a 4th

generation Pakeha New Zealander who grew up on a farm in the far north. Mum is a nurse at Mid-

dlemore Hospital where she has been for more the 25 years. My father now retired was sent to NZ

in the early sixties by his Faifeau (Minister) father to enrich his wider aiga (family). We hail from the

villages of Satapuala, Neiafu and Falealupo. My wife, Dora Nedelia, a Hungarian native (and daughter

of 1968 Olympian) and raised largely in New Zealand, is a secondary school physical education teacher.

We have four children: 12 year old son, Ephraim, 11 year old Tiana, eight year old Ruby, and seven year

old Vincent. My sister, Fia, is currently teaching in Auckland. My younger brother, Damon, a Rhodes

Scholar, is currently Associate Professor and Head of Pacific Studies at the University of Auckland. My

younger sister, Leilani, is a primary school teacher in Auckland. My elder brother, Shane, was killed in a

car accident in 1981; he would be 47 now. My family has managed always to both challenge and support

me, furnishing me with an intimate understanding of sharing, communication, tolerance and experience.

My strengths emerge from my family, to whom they return.

I am fearlessly proud of my heritage and all it encompasses I draw great strength from being who I

am: a Samoan and a New Zealander. I hold the chiefly title of Toleafoa and like many would like to

see the All Blacks play in Samoa but I do not wish to beg the AB’s play in Samoa, they just should,

as to me, it is the epitome of arrogance that NZ Rugby chooses not to play the 8th best rugby na-

tion in the world.

I left Selwyn College in Auckland in the 7th form with only school certificate, got an apprenticeship

and did my trade qualifications in glazing (windows!). I continued to have fun and play sport

(mainly club rugby) for several years before deciding that I may be better suited to trying out phys-

iotherapy. I went to AUT which was, I think at the time, AIT and was either the first or second year

of students to do the four year degree.

CONTINUED ON NEXT PAGE.

Page 7

A High Performance Journey: Physiotherapist Jordan Salesa continued…..

Past Sports/Orthopaedic Physiotherapy commit-

ments/involvement

I have, like many people, packed in as much as I could

cope with in terms of my professional career. It has tak-

en me to many places around the globe and furnished

me with massive opportunities, and unbelievable chal-

lenges. I have met great people and had tonnes of great

fun along the way and I have loved doing it.

I initially started working as a physiotherapist with Auck-

land age grade rugby teams whilst I was a second year

physiotherapy student. I did this for about seven to eight

years working with many many great people, players

and coaches. I started with under 16’s and did every

Auckland and Blues team except the top jobs until 2003.

Funnily, I missed out on the Auckland NPC job to my

now business partner, Mark Plummer, who has re-

mained in that role since then. Around the same time I

began my business relationship with Karen Sutton who

had already established a fantastic working relationship

with Samoan rugby (including my uncle who had long

played for Samoa). It was then I began my great journey

with Samoan sport that eventually ended at the Rugby

World Cup in France 2007. I initially worked with the

Samoa 7’s team on the inaugural World Series at the

same time as taking over from my colleague, Nicola

Marsh, the Manu Samoa team itself. My uncle (yes we

Samoans have lots of them!) was also the head of the

Samoan Olympic Committee which no doubt assisted

my applications to go with Samoa to the Sydney Olym-

pics and Manchester Commonwealth Games.

When I did not secure the Auckland NPC job I changed

track a little and at the same time had applied for an

advertised role with the NZ Olympic Team to go to Ath-

ens. Luckily for me I was selected and that started what

I guess was a parallel journey that included “my” two

countries. From 2000 – 2007 I was a physiotherapist for

Samoa to the Sydney Olympics, Manchester Common-

wealth Games, the National Rugby Team (including two

RWC’s and every test match played during that time),

the 7’s team, the South Pacific Games, and Mini-South

Pacific Games. During that time period I also went with

the NZ teams to Athens and Melbourne. I have main-

tained a role within nationalised high performance sys-

tem since 2007 which has really placed me in a good

position to maintain roles within the multi-sport or pinna-

cle events. From 2007 until now I have been to several

swimming pinnacle events, the 2008 and 2012 Olym-

pics, the 2010 Commonwealth Games, and soon the

FEATURE

CONTINUED FROM PREVIOUS PAGE.

2014 Commonwealth Games as well.

I have been extremely fortunate on the professional

front. None of which would have been possible with the

support of my aiga, in particular Dora – hope it was

worth it girl.

Please describe your current role and how you end-

ed up there.

I essentially spend three days a week working as a

hands-on physiotherapist at the National Training Cen-

tre for High Performance Sport NZ. I work with several

sports within the centre and have a key role with swim-

ming.

This is a great role that I have thoroughly enjoyed over

the last seven years. I initially started this role directly

with the NZ Academy of Sport North Island (the pre-

cursor to HPSNZ) and the elite swimming squad based

at Millennium Institute of Sport and Health in Albany.

Jan Cameron, the then national swimming coach, asked

me my thoughts on how to create a high performance

support team that doesn’t include money! From that

time until now NZ has grown a high performance medi-

cal system that will begin (or rather has begun) to rival

the best around the world. When I initially started, to my

knowledge the only physiotherapists working with sports

as truly paid professionals were limited to perhaps some

Page 8

A High Performance Journey: Physiotherapist Jordan Salesa continued…..

NPC and Super teams along with the Warriors - proba-

bly only 10 or so people? Now I know HPSNZ have

more than 15 physiotherapists, albeit some part time,

and many more working within rugby set ups and of

course now the Breakers.

The actual role that I perform currently is relatively what

we would all think, lots of “bottom of the cliff” manage-

ment and rehabilitation. Increasingly though, with more

time and resources being allocated, our roles allow time

for and focus on “top of the cliff” action. Things like

screening, monitoring and tracking various factors play

important parts of our daily roles.

With the rest of my work time (never stops really) I own,

manage or rather chase my tail with my three other co-

owners of the Physio Rehab Group. We have 14 prac-

tices in Auckland and what’s really great for me is that

we all have elite level sporting roles: Karen Sutton

works for Samoan Rugby, Mark Plummer is the Auck-

land NPC and Blues Physiotherapist, and Sarah Fa-

nuatanu is one of the two physiotherapists for the Warri-

ors.

FEATURE

CONTINUED FROM PREVIOUS PAGE.

What are your specific areas of interest?

Professionally, I am interested in seeing athletes suc-

ceed. Whether that is simply getting them training again

or better still, knowing that they have not missed any

training and that I have played a role in this.

I think my clinical interests lie around capturing very

clear objective data and having clarity around planning,

interacting with, communicating and goal setting with

athletes when rehabilitating.

I enjoy numbers even though I’m not particularly good

at maths. I think quantifying clinical measures (and ef-

fectively capturing it) can guide us in terms of possible

prevention but equally with rehabilitating athletes.

Simple clinical measures such as repeated functional

tests are great at informing us what a specific group of

athletes may look like prior to injury, or if they do get an

injury what effect did it have on the measure (if any).

In my day to day work at HPSNZ this has led me to uti-

lise hand held dynamometry (HHD). We have amassed

a great deal of consistent data using the HHD, primarily

testing hips and shoulders. I presented a small snap

shot of this at the Sports Medicine NZ Conference last

year but have some on going work with Dr Chris What-

man from AUT SPRINZ unit. One way we are currently

going to utilise the HHD is taking weekly strength

measures of elite swimmers’ internal and external

shoulder rotation. With this we can establish maximums,

minimums, ratios and compare these with the other

shoulder. This data can also be analysed along-side

training volumes (critical in swimming) and intensities,

biomechanics and other strength measures, and in

some instances we may be able to establish specific

standards around what an elite swimmer’s measures

should be.

Do you have specific information regarding screen-

ing tools/injury prevention strategies that would be

useful for our members to consider?

What do you think are the key elements in success-

fully preventing injury?

Are you involved in performance aspects for your

clients?

Sharon Kearney (HPSNZ Lead and Silver Fern Physio-

therapist) and I, with guidance from a number of others.

Page 9

A High Performance Journey: Physiotherapist Jordan Salesa continued…..

have established the HPSNZ MCS and MSK Screening

tool. There are numerous difficulties when trying to es-

tablish screening tools. Whilst we have established this

tool, and we at HPSNZ have the resources to capture

consistent data, it is vitally important to understand that

you must know the magnitude of the problem. What in-

juries do we get? What is the extent of the injury prob-

lem?

For me the crucial question is “What is the cost of inju-

ry”? The van Mechelen model is a very simple way to

view injury and injury prevention.

Step 1: establish the magnitude of the problem

Step 2: understand the aetiology

Step 3: put in place an intervention

Step 4: the first step.

Often in our desire to help we put the tools before the

tool box! e jump straight to steps 2 and 3 without fully

understanding and analysing step 1.

If we don’t understand the incidence and severity the

best screening tools in the world won’t necessarily help

the problem. Think blood pressure. This is easily

screened but the interventions are tough! Some very

clear recent examples of clever injury prevention come

from the Cricket Australia and the Israeli Army. Cricket

Australia was recently able to decrease their internation-

al fast bowler back injury rates by 25% by simply drop-

ping their elite camps at a certain time of the year. In

FEATURE

CONTINUED FROM PREVIOUS PAGE.

Armed Forces around the world stress fractures have

very high rates in basic training. In a major project over

several years researchers measured and tried many

interventions. Boots, orthotics, marching off road etc,

etc - all of these failed. The thing that worked the most

was ensuring recruits slept more than six hours a night.

This dropped stress fractures by 60%!! http://ow.ly/

wLsQP

Screening seems to be a bit of a fad of late. I don’t nec-

essarily think that this is a bad thing as it means we are

thinking “top of the cliff”. I think however that it’s im-

portant to remember that the “commercialisation” of

screening is a different mind-set. The Functional Move-

ment Screen, the Y Balance Test, and many other like

systems whilst very useful tools are just that, tools.

What are the major challenges in your area of work?

What exciting developments do you see for physio-

therapy in the near future?

Elite sports physiotherapy is an enjoyable and challeng-

ing place to work. Every day I see things I want to do

better or should have done better or at least in a differ-

ent way. I see huge potential in elite sport for clever,

hard working, practical physiotherapists to advance us

much further right here in NZ.

I caution us all to not be siloed within our professional or

personal paradigms as none of us hold all the truth.

Page 10

ARTICLE REVIEW

The Practical Management of Swimmer’s Painful Shoulder: Etiology, Diagnosis, and Treatment.

Reference: Bak K, (2010). The Practical Management of Swimmer’s Painful Shoulder: Etiology, Diagnosis,

and Treatment, Clinical Journal of Sports Medicine 20(5): 386-390.

Article Review

This article, as the title suggests looks at the swimmer’s painful shoulder. The author is reviewing his 20 years’ ex-

perience in this field, bringing together his previous research in the area of swimmer’s shoulder. This is always a

complex area and this is a good article to refresh your approach to those swimmers with a problematic shoulder. The

article is broken up into sections on eitology, diagnosis and treatment. There are some great tables that neatly sum-

marise the main points.

Etiology

Shoulder pain is the most common musculoskeletal problem for swimmers, between 40-91% prevalence. The most

common pathology appears to be rotator cuff – related pain. The author believes the main factor in the development

of shoulder pain is the high training volumes during adolescence when growth is still occurring. This can affect the

muscular balance of the core, the scapulothoracic articulation, the rotator cuff, and the glenohumeral mobility. “An

elite swimmer older than 13 years typically performs between 0.5 and 1 million are cycles per arm per year”.

Shoulder pain often comes on with a sudden increase in training, such as using hand paddles or increasing time or

intensity for example during a training camp. The author believes that high training load in the adolescent/growing

years can induce changes in flexibility and stiffness which may predispose the swimmer to shoulder pain. This is

commonly seen in a swimmer’s physique with a typical S-shaped spine (enlarged thoracic kyphosis and lumbar lor-

dosis). This posture typically has an effect on scapular thoracic biomechanics and the development of scapular dys-

kinesis, more likely to lead to an impingement.

Studies referenced in the article have shown that impingement on average occurred 24.8% of the stroke time. Table

2 in the article listed the structures at risk during the swimming stroke; subacromial bursa, Supraspinatus tendon,

capsule and labrum.

Most overhead athletes with painful shoulders show some degree of scapular dyskinesis. The scapula involved is

placed in a more abducted, protracted, and laterally displaced position. In this position impingement is more likely to

occur. Along with this swimmers are also subject to fatigue due to high training volume, so the scapular dyskinesis

gets worse as sessions progress. “Scapular dyskinesis may be a primary etiological factor, with fatigue playing a

contributing role”.

Diagnosis

The author Klaus Bak has identified 5 main categories of swimmer’s shoulder. These included 3 increasing levels of

impingement with both extra and intra-articular pathologies such as bursitis, tendon and labral tears. Along with in-

CLINICAL SECTION

ABSTRACT

Shoulder pain is the most common musculoskeletal complaint in competitive swimmers. Problems with the shoulders

of swimmers resemble that of the disabled thrower’s shoulder, but the clinical findings and associated dysfunctions

are not quite the same. Therefore, swimmers with shoulder pain should be evaluated and treated as a separate clini-

cal entity, aimed toward underlying pathology and dysfunction. Balanced strength training of the rotator cuff, im-

provement of core stability, and correction of scapular dysfunction is central in treatment and prevention. Technical

and training mistakes are still a major cause of shoulder pain, and intervention studies that focus on this are desira-

ble. Imaging modalities rarely help clarify the diagnosis their main role being exclusion of other pathology. If nonop-

erative treatment fails, an arthroscopy with debridement, repair, or reduction of capsular hyperlaxity is indicated. The

return rate and performance after surgery is low, except in cases where minor glenohumeral instability is predomi-

nant. Overall, the evidence for clinical presentation and management of swimmer’s shoulder pain is sparse. Prelimi-

nary results of an intervention study show that scapular dyskinesis can be prevented in some swimmers. This may

lead to a reduction of swimmer’s shoulder problems in the future.

CONTINUED ON NEXT PAGE.

Page 11

ARTICLE REVIEW CONTINUED...

stability and acromioclavicular pathology. In just about all of the types scapular dyskinesis is present.

As always history is important, a gradual onset of pain, especially at the anterior or lateral aspects of the shoulder. Is

there any clicking, and where is it felt? This could indicate labral involvement or an acromioclavicular problem. A

dead arm feeling with the arm overhead could also point towards a labral tear.

The swimmer should be examined in standing and repeated active movements performed assessing possible scapu-

lar dyskinesis and painful arc. Also don’t forget to look at core stability and joint laxity tests. Pain provocation tests

such as Hawkin’s, O’Brien’s active compression sign and labral shear tests should all be performed along with evalu-

ation of glenohumeral rotation in 90 degrees. Bak states that the Apprehension test is more frequently positive in 135

degrees, than in 90 degrees in swimmers with shoulder pain.

Bak believes that the most useful diagnostic imaging is magnetic resonance arthrography although it is invasive and

costly. Both ultrasound and MRI although useful in ruling out other pathologies but have low diagnostic accuracy for

partial cuff tears. Arthroscopy has improved the understanding of swimmer’s painful shoulder pathology, and can

include the finding of labral tears, bursal side tears of supraspinatus, enlarged capsule and impingement.

Treatment

“Swimmers at a high level with more than 5 swim training sessions a week should perform dry land exercises to pre-

vent effects of swim training on their body posture, stability and strength”.

The goal of prevention exercises and coaching is to (1) decrease the amount of internal rotation of the arm during the

pull phase, (2) improve early initiation of external rotation of the arm during the recovery phase, and (3) improve the

tilt angle of the scapula.

Coaches play a large role in the prevention of shoulder problems in swimmer’s with good technique and appropriate

training load important. Coaches should look at ensuring body roll and scapula retraction as well as ensuring a dry

land programme working on flexibility of the anterior capsule, pectoralis minor and the cuff along with endurance of

the cuff and scapular stabilizers.

There have not been many studies done on prevention programmes, but the author has shown in previous un-

published studies that a scapular stabilizing programme prolonged the time before scapular dyskinesis was seen

compared with a control group. Core stability should also be considered.

When prevention has not worked and a shoulder becomes painful, getting treatment quickly is important, the longer

things go on the more likely it is to progress to surgery and the return rates to swimming following surgery are not

high 20 -56%.

When pain starts, active rest and reduced training is imperative. Along with technical stroke analysis and correction,

the coach plays a major role here. If problems persist exercises should be applied and aimed at the specific dysfunc-

tion. If pain persists NSAID’s and then maybe a corticosteroid injection can be considered (although controversial).

The last “resort” is surgery, but as mentioned the success in terms of return to swimming are not high.

Conclusion

Shoulder pain is common in elite swimmers. Prevention should be the first option, and therefore technical and train-

ing mistakes need to be identified. High amounts of training in adolescents is still a huge cause of shoulder pain and

more studies on this are needed. Improvement of scapular kinesis and endurance seem to be important, and there-

fore a dry land programme addressing these areas and core stability are vital in any training regime. Early recogni-

tion of pain and problems should be encouraged as the outcomes are more likely to be favourable, than if the prob-

lem is left to become more severe. This is a good article to read if you are treating swimmer’s shoulders. It was an

excellent follow up to Mary Margery’s talk on swimmer’s shoulder at the symposium. An underlying theme seems to

be that good scapular kinesis/kinematics is vital for swimmers and that over training and poor technique are often

major contributors to shoulder pain. We therefore need to get coaches on board and educated if there is to be a re-

duction in the amount of shoulder pain swimmers experience.

Reviewed by Karen Carmichael BSc, BPhty, M(SportsPhysio)

CLINICAL SECTION

CONTINUED FROM PREVIOUS PAGE.

Page 12

www.sportsphysiotherapy.org.nz/resources

Shoulder Pain in Swimmers

Article Summary

Shoulder pain is a common musculoskeletal problem experienced by competitive swimmers for which several risk

factors have been proposed. These include glenohumeral range of motion and laxity, scapula dyskinesia, rotator cuff

strength imbalance, gender, competition levels, stroke, distance and paddle distance.

Biomechanical analysis of freestyle has indicated that shoulder impingement may occur and most frequently in the

recovery phase of the stroke where the shoulder is abducted and externally rotated. Decreased external rotation may

lead to sub-acromial impingement syndrome. Overuse loading during swimming may lead to rotator cuff thickening

and tendinopathy. Those with decreased external rotation perform the task at the limit of shoulder and as a result

have increased tendon thickening and therefore at greater risk of impingement.

High external rotation ranges may indicate changes to the shoulder’s passive restraints and neuromuscular control.

Changes in neuromuscular control leads to increased translation and secondary impingement of the biceps and rota-

tor cuff.

The purpose of this article was to investigate shoulder injury incident rates and identify predictive risk factor. There

was a particular focus on glenohumeral internal and external rotation range and joint laxity.

The study followed 74 competitive swimmers over 12 months in Melbourne, Australia. Competitive swimmers were

defined as those training over 5 sessions per week and competing at state level of higher. The swimmers completed

questionnaires regarding demographics training, swimming and injury history. Active range of motion (internal and

external rotation at 90 abuction) and passive joint laxity was measured. Shoulder injury was defined as significant

shoulder pain that interfered with training or competition. Significant shoulder injury (SIP) was defined as lasting

greater than 2 weeks.

38% of participants sustained a SIP in the 12 months. There was a significant association with SIP and previous inju-

ry. They also found that swimmers with high external rotation range (>100) or low ER range (<93) where more likely

to have a shoulder injury. Training distances were not a big factor, however this may be due to a considerable por-

tion of data being derived from training averages not direct observation. There was no association with joint laxity

and subsequent injury.

Clinical Implications

The results must be interpreted with some caution as this study was undertaken amongst competitive swimmers, not

recreational swimmers, had a relatively high drop out rate and injury rates were self reported so the exact cause and

structure causing pain are unknown.

While previous history of shoulder injury is a non modifiable risk factor it can used as an indicator to identify swim-

mers at risk of further injury. As physiotherapists it highlights the need to take a detailed history from clients and work

with clients and coaches to direct preventative measures to these swimmers.

Measurement of external rotation range may be implemented as a screening tool to further idenfity those at risk of

injury and direct specific exercises and preventative measures to these athletes rather than a one size fits all ap-

proach with regards to exercises and stretching. As physiotherapists’ education of the coaches as well as swimmers

is vital as they will be the ones implementing the programmes/exercises as well potentially identifying those at risk

and directing them to our care.

Reviewed by Louise Turner B App Science (Physiotherapy), Masters of Health Practice (Musculoskeletal Physiotherapy)

Shoulder Pain In Swimmers: A 12 month prospective cohort study of incidence and risk

factors

Walker H, Gabbe B, Wajswelner H, Blanch P, Bennell K (2012). Shoulder pain in swimmers: A 12 month prospective

cohort study of incidence and risk factors. Physical Therapy In Sport 13, 243-249.

RESEARCH SECTION

Page 13

www.sportsphysiotherapy.org.nz/resources

Shoulder Pain in Swimmers continued……..

Cervical Muscle Activation in Elite Swimmers with Shoulder Pain

Hidalgo-Lozano, A., Calderón-Soto, C., Domingo-Camara, A., Fernández-De-Las-Peñas, C., Madeleine, P., & Arroyo

-Morales, M. (2012). Elite swimmers with unilateral shoulder pain demonstrate altered pattern of cervical muscle acti-

vation during a functional upper-limb task. Journal of Orthopaedic & Sports Physical Therapy, 42(6), 552-8.

Article Summary

The prevalence of shoulder pain amongst elite swimmers ranges between 42% and 73%. Current research links

shoulder pain in elite swimmers to motor control impairments. This study hypothesises that it is not only the activity of

the shoulder muscles that is altered by ongoing pain but that the surrounding neck muscles are also affected. A

Cross-sectional cohort design was chosen to assess the differences in activity levels of neck muscles between elite

swimmers with and without shoulder pain. Surface electromyography from the sternocleidomastoid, upper trapezius,

and anterior scalene (ASC) muscles was recorded bilaterally in 17 elite swimmers (18-30 years) with unilateral shoul-

der pain, and 17 matched elite swimmers without pain.

The testing included measuring the level of muscular activation 5 seconds before, 120 seconds into, 150 seconds

into, and 10 seconds after a functional upper-limb task. These tasks were cervical flexion in supine and 90 degrees

bilateral arm abduction in standing, both held for 10. For the functional task, participants sat at a desk and drew pen-

cil marks in 3 circles in a counter-clockwise direction. Each test was repeated 3 times with a 30-second rest between

each. The affected upper extremity was used in the shoulder pain group and the dominant arm in the control group.

The results showed significant differ­ences between the groups of ASC muscle activation bilaterally. This was not

seen with the sternocleidomastoid and upper trapezius muscles. Swimmers with shoulder pain had higher normal-

ized values in both ASC muscles at 120 seconds (78% on average) and 150 seconds (86% on average) into the

task and at 10 seconds after the task (40% on average), as compared with swimmers without shoulder pain (P<.05).

Clinical Significance / Applications

A great deal more research needs to be done to establish a cause-and-effect relationship between increased activa-

tion of the ASC muscles and shoulder pain. However possible implications of this study include:

A potential role for deep neck flexor training in this population. The results seen here indicate higher EMG

amplitude from superficial neck flexor muscles, this may be due to compensation for decreased deep cervi-

cal flexor muscle ac­tivation.

Motor control techniques targeted towards cervical muscle activation may influence the incidence and recur-

rence of shoulder pain in elite swimmers.

Greater bilateral activa­tion of the ASC muscles may result in excessive compressive loads on the cer­vical

facet joints, a more superficial up­per thoracic respiratory pattern, and altered shoulder kinematics, promot­

ing overload of these structures and the spreading of pain to the contralateral side.

Reviewed by Monique Baigent MHsc (Physiotherapy)

RESEARCH SECTION

Page 14

JOSPT

RESEARCH PUBLICATIONS

Volume 44, Issue 6, June 2014

RESEARCH REPORT

Effects of Physical Therapist—Guided Quadriceps-Strengthening Exercises for the Treatment of Patellofemoral Pain

Syndrome: A Systematic Review

Identifying Barriers to Remaining Physically Active After Rehabilitation: Differences in Perception Between Physical

Therapists and Older Adult Patients

Ultrasound Imaging: Intraexaminer and Interexaminer Reliability for Multifidus Muscle Thickness Assessment in

Adults Aged 60 to 85 Years Versus Younger Adults

Ulnar Nerve Neurodynamic Test: Study of the Normal Sensory Response in Asymptomatic Individuals

CASE REPORT

Management of a Patient With Chronic Low Back Pain and Multiple Health Conditions Using a Pain Mechanisms—

Based Classification Approach

Use of Thoracic Spine Thrust Manipulation for Neck Pain and Headache in a Patient Following Multiple-Level Anteri-

or Cervical Discectomy and Fusion: A Case Report

CLINICAL COMMENTARY

The Relevance of Scapular Dysfunction in Neck Pain: A Brief Commentary

MUSCULOSKELETAL IMAGING

Osteochondroma Fracture at the Distal Medial Femur

CLINICAL PRACTICE GUIDELINES

Nonarthritic Hip Joint Pain

www.jospt.org

JOSPT ACCESS

All SPNZ members would have been sent advice directly from JOSPT with regards to accessing the new JOSPT

website.

You will have needed to have followed the information within that email in order to create your own password.

If you did not follow this advice, have lost the email, have any further questions or require more information then

please email JOSPT directly at [email protected] in order to resolve any access problems that you may have.

If you have just forgotten your password then first please click on the “Forgotten your password” link found on the

JOSPT sign on page in order to either retrieve or reset your own password.

Only current financial SPNZ members will have JOSPT online access.

Page 15

The new GEL Divide is designed for the runner who requires

stability and likes the feel of a supportive shoe underfoot yet

prefers those benefits to come in a lighter weight package

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The Divide suits runners who heavily over pronate from heel

strike and continue to over pronate through midstance and

toe off. These runners often have a low cadence with mini-

mal propulsion and conserve energy by letting the joints take

the load rather than the muscles. As the muscles fatigue,

overuse injuries to the lower limb develop from poor muscle

firing patterns.

The Divide is built on a 22mm-12mm platform with a 3 densi-

ty midsole designed to provide maximum support whilst

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ance Trusstic in the midfoot with an outsole configuration

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Comfort is important in this category because these runners

impact the ground longer and are usually performing with

fatigued muscles. Fluid Ride, a dual stacked midsole boasting

ASICS’ two premium foams to give the ultimate in durability

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ing. A top layer of SpEVA provides fantastic cushioning whilst

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GEL DIVIDE

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Page 16

Page 17

CONTINUING EDUCATION CALENDAR

Upcoming courses and conferences in New Zealand and overseas in 2013 & 2014.

For a full list of local courses visit the PNZ Events Calendar

LOCAL COURSES & CONFERENCES

When? What? Where?

2014

21-22 June 2014 Myofascial Release Therapy Training Courses - The Missing Link to Your

Treatment Practice?

Tauranga

28 June 2014 RockTape (Kinesiology) Taping 1 day Seminar Christchurch

7 July 2014 PhysioScholar - ACL Reconstruction Nationwide

12-13 July 2014 Mulligan Concept - Two Day Update with Brian Mulligan Wellington

19-20 July 2014 Kinesio Taping - KT 3 Hamilton

26-27 July 2014 SPNZ Promotion and Prescription of Physical Activity and Exercise Christchurch

26-27 July 2014 PAANZ Musculoskeletal Dry Needling Auckland

APA CPD EVENT FINDER

Course Town Dates

The Thoracic Spine in Sport Rozelle, NSW 27 July 2014

Level 1 ASCA Strength and Conditioning Coaching Course NSW 2 August 2014

Hamstring Assessment, Prevention and Rehabilitation Camberwell, VIC 2 August 2014

The Sporting Hip Douglas, QLD 6-7 September 2014

The Thoracic Spine in Sport Bruce, ACT 6 September 2014

The Sporting Shoulder Banyo, QLD 11-12 October 2014

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

For a list of international courses visit http://ifspt.org/education/conferences/

Page 18

CLASSIFIEDS

POSITION VACANT

HAMILTON

Lead Physiotherapist with Clinic Management Role

Performance Plus Physio is seeking applications for the position of Lead Physiotherapy and Clinic Manage-

ment role. This is a new permanent position, created by the expansion of the business, and will be based at our main clinic site and at the university clinic. A passion for physiotherapy and a solid understanding of ex-ercise rehabilitation, manual therapy is essential.

This person will work as the lead physiotherapist at our main private practice and oversee the daily running of the clinic, in-service programme and mentoring role to the junior staff.

This person will lead a dedicated team of four physiotherapist who work alongside the University of Waikato

Hillary Scholar High Performance Sports programme and general university student and staff clientele.

A Top Rate Remuneration Package which also includes an annual bonus payment.

This is a fast paced and energetic environment, in a dedicated team supporting community based clientele, club sport athletes to elite athletes. We treat a variety of clientele, from acute, sports, post-operative and general musculoskeletal conditions to more chronic and complex cases.

If you are an outstanding leader with a passion for delivering excellent service, then this is definitely the next role for you. This position can lead to a future partnership opportunity.

For this Lead Physiotherapist role: e-mail your CV to: [email protected]

or mail to:

Melissa Gilbertson,

Practice Director,

PERFORMANCE PLUS PHYSIO LTD

280 Peachgrove Road, Hamilton.

Phone: 64 7 8551788 or +64 21 1334106

www.performanceplusphysio.com

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