Thank you to ASICS for this awesome opportunity to attend the Sports Medicine Australia (SMA) conference and to SEPNZ for supporting this! To Chris Horrocks from ASICS and his podiatry comrades’, I’m glad you are all fit and healthy and able to run long distances as your navigation skills need a bit of professional development! I really appreciated your sponsorship, insights and unplanned tourist opportunities!
“Exercise is Medicine” is the focus of this review and an overarching theme of the conference. As physiotherapists working with exercise as a treatment modality we are well placed to be engaged in multiple facets of exercise – Prehab (Injury and disease prevention); Rehabilitation and Performance.
Start with the end goal in mind, what is the outcome that needs to be achieved? Understand what components are required to be evaluated, monitored and achieved. What the requirements are for the end outcome e.g. motor control, stability, mobility, strength and conditioning, psychological profiling and performance measures (Professor Phil Glasgow Head of Physiotherapy and Rehabilitation, Irish Rugby Football Union). While presented with a performance perspective, good advice to heed with any client. Please note this presentation was given a few days after the All Blacks destroyed Ireland in the quarter finals, so well done Phil on a great presentation!
Carrying on from above know your individual – for some of us we have a good fortune to be able to work with and monitor athletes in a performance environment, so have very clear baselines and norms for that person to work with. There was emphasis on the whole – collect information on well-being – sleep, stress, mind-sets, nutrition and hydration. In a clinical setting I would say the challenge for us all is to collect more informative data on our clients than just their presenting condition to have a holistic approach. Within the sport performance environment map a clear framework to link to your outcomes goals, provide feedback in real time and have honest conversations.
Image: Professor Phil Glasgow slide from keynote address
Individualise except for kids’ device time – let’s understand the relationship between devices and flourishing and get some guidelines on their use! The increase in mental health issues within children ages 10-14 in Canada is a concern and potentially a global trend. The Compass study is a prospective cohort project monitoring 90,000 secondary school children, with some interesting insights https://uwaterloo.ca/compass-system/compass-system-projects/compass-study (Professor Guy Faulkner, University of British Columbia).
Loading monitoring and management
Tissue healing and appropriate loading was a key focus in performance sport (Professor Phil Glasgow), understand the individuals’ previous tissue injuries, understand the tissue response both theoretically and individually, load appropriately, create tissue adaptation, monitor and progress (avoid sudden changes) accordingly.
Monitoring systems are designed to provide information that can be used to inform coaches’ decision making and improve the training process, Professor Aaron Coutts, University of Technology Sydney explored the current literature to provide the following insights. “Fitness-fatigue model” and the “Training process framework” provide a conceptual bases for athlete monitoring with the goals of improving performance readiness and reducing injury risk through controlled training. There is little high level evidence to show relationships between training load and performance and/or injury in team sports and the currently training load models do not fit the proposed mechanistic models for injury (See image below from Kalkhoven, Watsfor & Impellizzeri, 2019 retrieved from https://osf.io/preprints/sportrxiv/vzxga/)
Performance models are unstable and cannot be used practically for predictive purposes. Despite the fact that there is stronger evidence for using internal load, most practitioners in team sports prefer external load measures of training. Athletes self-reported measures have stronger support and better feasibility than most objective athlete response measure, however these are often not validated and we should be wary of them. In summary, training is complex and practitioners need to embrace the uncertainty and use their clinical making skills for the individual. In other words there is no magic bullet!
Physical activity is positive psychology in motion – physical activity has the capacity to prevent mental illness, foster positive emotions and teach individuals to buffer against the stresses of life and thrive in adversity (Professor Guy Faulkner). Using the PERMA elements – positive emotion, engagement, positive relationships, meaning and accomplishment have been shown to increase happiness and well-being. “Butts in a boat” is a dragon boat rowing club for mean in the Vancouver area who have had a prostate cancer diagnosis http://www.vancouverprostate.com/butts-in-a-boat/. The ability to monitor a particular group during an activity is beneficial within allied health alongside the obvious exercise profits. There’s the challenge NZ, create meaningful programmes to target specific groups for the delivery of exercise with the emphasis on the individual benefits.
Indeed Canada is well underway with it’s “Betters campaign” based on following the trends in physical activity of the nation have created a whole health campaign and resources for the nation https://www.participaction.com/en-ca. While I know we are into sport and exercise I couldn’t help but admire the breadth of their health campaign and emphasis on person monitoring.
Image: Retrieved from https://www.participaction.com/en-ca/everything-better/poop-better
Early loading of tissue can lead to early return to play in elite sport (Professor Phil Glasgow), it was suggested for every day delayed for starting rehabilitation there was an increased 3.3 days to return to sport. Within their environment shoulder reconstructions surgeries begin loading 1 week post op, with the surgeon’s consent!
Research has also indicated that exposing children to different sports with multidirectional activities such as basketball, hockey and football creates a bone tissue response that reduces stress fractures by 50%, with better outcomes if the frequency has been prior to 10 years of age. Earlier development of cardiovascular fitness and muscular adaptation allows for muscle memory and becomes easier for trained individuals to retrain. I have to say while my son has been involved in 10 different sports this year and getting him to and from everything has been a hassle, it’s great to have some evidence to support the rationalisation of the petrol costs!
Several speakers referred to work within the Australian schools – “Burn to Learn” https://app.education.nsw.gov.au/sport/File/3496 and “Iplay” Iplay.org.au are examples of programs to support schools with the delivery of physical activity; Burn to Learn using high intensity interval training (HIIT) and Iplay skill development resources. Continued engagement in physical activity has not only physical benefits but also mental health.
Prescribing Exercise like the Medicine it is was Professor Maria Fiatarone Singh, University of Sydney reviewing medication verses exercise effects across the age ranges. Consider chronic diseases in young adults such as Cognitive dysfunction/brain atrophy, Depression, Hypertension, Hyperlipidaemia, Insomnia, Systematic inflammation and Insulin resistance/Glucose intolerance, with the exception of the last one there are no drugs available but research indicates exercise is an effective intervention. As we continue to age exercise therapy is still effective in comparison with drug therapy. With resistance training and cardiovascular training commonly prescribed but current research is showing moderate intensity exercise delivered for 150 minutes per week can reduce mortality. Certainly frailty can be combated through resistance activities using our normal training parameters of 70-80% of 1RM. So as we age we must consider the therapeutic benefits of resistance training for falls prevention etc.
Exercise can be used as an intervention instead of surgery. Controversial work from Professor Ewa Roos, Professor and Head of Research Unit, University of Southern Denmark reviewing randomised controlled trials where exercises provided pain relief, 68% clinical relevant improvements in function, postponement of TKJR surgery for 2 out of 3 subjects for 2 years with no serious adverse reactions.
Of course prevention is the best medicine, given that 65% of OA joints (in Australia) are related to obesity and joint injury. Injury prevention protocols for football and netball have good evidence of reducing injury risks. The movement of the strengthening component of the 11+ to the end of training has improved compliance alongside the addition of the Copenhagen adduction to the strengthening regime. Great to see Sharon Kearney from Netball NZ had a poster presentation at the event about the reduction in injury rates post NetballSmart re-launching.
Image: Sharon Kearney, Netball NZ
While we are a group that is predominantly focused within Sport and Exercise, I would challenge us to all start thinking outside of our clinical environments and apply our knowledge into the community. Create, implement and research sport and exercise programmes and continue to push for a more active (and healthy) society.
Again thank you for the amazing opportunity to attend this conference, I feel incredibly inspired by what I heard and will be working towards change.
“The first step towards getting somewhere is to decide that you are not going to stay where you are”
expression of interest
The SEPNZ Education Committee is calling for expressions of interest for new members to join the SEPNZ Education Committee.
If you have a passion for Sports Physiotherapy and an interest in helping our members receive quality robust Sports Physiotherapy education, please send your CV along with a covering letter to: