VOLUME 25 – ISSUE 2 • WINTER 200 7

Incorporating The Bulletin

Opinions expressed throughout this journal are the Contents contributors own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). A TASTING PLATE OF CONFERENCE SPEAKERS 2 Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made Insights into the backgrounds, achievements and aspirations of the in advertisements nor the quality of the goods or 2007 National Conference speakers services advertised. All materials copyright. On acceptance of an article for publication, copyright Gary Moorhead passes to the publisher. Publisher DEALING WITH THE DOUBLE EDGED SWORD OF THE MEDIA 6 Sports Medicine Australia PO Box 78 Mitchell ACT 2911 Dr J Tel: (02) 6241 9344 Fax: (02) 6241 1611 PATHOMECHANICS OF LOWER BACK INJURIES IN JUNIOR AND Email: [email protected] Web: www.sma.org.au SENIOR FAST BOWLERS: A PROSPECTIVE STUDY 8 Circulation: 5000 Marc R Portus ISSN No. 1032-5662 Editor John Orchard CONVENTIONAL, REVERSE AND CONTRAST SWING BOWLING 9 Managing Editor Rabindra D Mehta Dominic Nagle Chief Executive Officer THE HOW AND WHY OF SPORTING EXPERTISE 10 Gary Moorhead Implications from the study of experts to skill acquisition in cricket Subscription Manager Michael Woods Bruce Abernethy Advertising Manager Nathan Kruger WHY DO FAST BOWLERS BOWL NO-BALLS? 11 Design/Typesetting Whalen Image Solutions “It’s bloody laziness, lad” and other explanations! Ian Renshaw and Keith Davids SMA STATE BRANCHES ACT ADOLESCENT FRACTURE IMPLICATIONS RELATED TO GROWTH 12 ACT Sports House 100 Maitland St Hackett ACT 2602 DA Bailey, CM Engstrom and DG Walker Tel: (02) 6247 5115 New South Wales EVIDENCE FROM BASEBALL THAT UMPIRING DECISIONS ARE PO Box 3176 Rhodes NSW 2138 Tel: (02) 8116 9815 INFLUENCED BY GAME CONTEXT 13 Northern Territory Clare MacMahon PO Box 2331, Darwin NT 0801 Tel: (08) 8981 5362 SMA(ACT) INJURY REPORTING TRIAL 14 Queensland Sports House, 150 Caxton St, Milton QLD 4064 Results and analysis Tel: (07) 3367 2700 John Lockie and Patricia Donaghue South Australia PO Box 219, Brooklyn Park SA 5025 Tel: (08) 8234 6369 RUGBY LEAGUE INJURIES AT STATE OF ORIGIN LEVEL 19 Victoria and Tasmania John Orchard and Wayne Hoskins Sports House, 375 Albert Rd, Albert Park Vic 3206 Tel: (03) 9674 8777 ROTATOR CUFF TEAR 25 Western Australia PO Box 57, Claremont WA 6010 Joseph Myers Tel: (08) 9285 8033 SCIENCE IN AUSTRALIAN SPORT: ITS ORIGINS AND CHALLENGES 26 SUBSCRIPTION RATES 2007 Frank Pyke Australia A$35 Overseas A$50 SMA members receive Sport Health as part of their GROUND CONDITIONS AND INJURY RISK: WHAT DO WE REALLY KNOW? 28 membership fee Dara Twomey Single copies and back copies A$15 (includes postage) BULLETIN 31 PP No. 226480/00028 For subscriptions contact Michael Woods Phone: (02) 6241 9344 Email: [email protected] Cover photograph: Australian Sports Commission FROM THE CEO A tasting plate of conference speakers Gary Moorhead

For the benefit of readers socioeconomic inequalities in physical “The development and evaluation of considering attending the Sports activity and diet among women. This computer-tailored health education - I Medicine Australia national work is important as it’s among very was one of the first to work in this field. conference -- this year badged few studies internationally that have Also, a series of systematic reviews I “be active ‘07” and to be held in attempted to move beyond merely was involved in as a project leader on Adelaide from 13–16 October -- the documenting socioeconomic gradients the association of physical and social major speakers at the Conference in these key health behaviours to environmental factors with physical have contributed to this article, the investigating the underlying pathways activity and nutrition. Many claims aim being to reveal a little more by which socioeconomic disadvantage have been made that the obesogenic’ about them, their backgrounds contribute to increased risk of sedentary environments are the main driving force lifestyles and poor diet. We identified behind the present obesity epidemic, and interests. a range of personal, social and but our reviews show that there is not All speakers were asked to respond to environmental factors that are potentially much scientific evidence yet supporting the following four questions: important and might be key intervention the fact that such environmental factors points for strategies aimed at promoting are strongly associated with obesogenic 1. What do you consider the most physical activity and healthy eating behaviors.” (Johannes Brug) important piece of work or research you among socioeconomically disadvantaged “I participated in a few studies that found have undertaken and why (or of which groups.” (Kylie Ball) you are most proud)? that exercise (alone) was effective in “A kinetic, kinematic and EMG study reducing rates of falls in older adults.” 2. What persons, events or specific of the effect of football boot midsole (David Buchner) research had a significant influence on height on hamstring muscle activity” “Most proud of: research into the your career development? - because it led directly to a fairly radical incidence and determinants of injury change in thinking on football boot 3. What is the most exciting project you affecting female gymnasts. My work design, and ultimately the production of have planned for the future? was the first prospective cohort research a commercially available football boot to document the nature and incidence 4. What single piece of advice would/ that we believe may directly influence of injuries affecting competitive female injury.” (Simon Bartold) could you give to policy-makers seeking gymnasts which used exposure data to turn research into policy and practice “An article published in Arthritis and (ie, hours and athletic exposures) as in your field? Rheumatism in 2004 (Vol 50, pp 3306- a basis for determining injury rates Satisfying for an organisation like SMA 3313) entitled “The “enthesis organ” and for testing risk factors of interest. which promotes multidisciplinary concept: why enthesopathies may not Perhaps most important: co-editor (with information-sharing and problem- present as focal disorders. This article N. Maffulli) of two edited volumes on solving, the responses reflect the has had a very important impact on the ‘Epidemiology of Pediatric Sports different disciplines and backgrounds clinical rheumatologists who have begun Injuries’ in Karger Publishers’ Medicine to recognise that enthesopathies should and Sport Science book series. These from which the speakers are drawn. not necessarily be regarded a focal were the first published volumes on They also give a fascinating “taster” of problems, but as multifocal disorders. the epidemiology of injury in pediatric what is to come in Adelaide in October. It helps them understand why patients sports.” (Dennis Caine) present with the symptoms they do. More details about the speakers can “Probably my single most important (Michael Benjamin) be found at http://www.sma.org.au/ work has centred on creation of a ACSMS/2007/speakers/default.asp “Two immediately come to mind: first, theoretical model that uses an hourglass a 1989 paper on cardiac respiratory and inverted triangle as heuristics in 1. What do you consider the fitness and mortality which revealed attempting to account for both the most important piece of the protection that could be derived ‘products’ and ‘processes’ of motor work or research you have from moderate fitness – this changed a development, respectively. When undertaken and why? (Or of prevailing mindset and has been cited this information is combined on an which you are most proud). more than 1200 times; second, the individual learner level with what we first paper I published showing it was know about the process of movement “In 2003-4 I led a study funded possible to be active, fit and healthy, skill learning, we gain essential by the National Heart Foundation regardless of weight.” (Steve Blair) information for guiding us in the investigating the mechanisms underlying

2 Sport Health FROM THE CEO

selection and use of a wide spectrum of easons other than changing rearfoot his thinking about planned health teaching styles.” (David Gallahue) motion.” (Craig Payne) promotion, Karen Glanz to systematic and stepwise research in behavioural A tasting plate of “The research I’ve conducted on the “Research soon to be published nutrition, Vic Strecher was the key psychological aspects of sport injuries demonstrating that a 12 week behavioural pioneer in computer-tailoring research.” is pleasing because of the feedback intervention conducted by an exercise (Johannes Brug) conference speakers I receive regularly from colleagues physiologist increased physical activity overseas who find the applied levels in sedentary people with chronic “The most significant influence on my implications particularly helpful in the disease beyond the National Guidelines career development was the Robert professional training of physical trainers. at 12 weeks with these levels being Wood Johnson Clinical Scholars Program. I’m also proud of the contributions my maintained independently at 12 months This two-year fellowship influenced me students and I have made in the career with no ongoing professional follow up.” to do research in prevention and geriatric transitions area, which is now a staple (Daryl Sadgrove). medicine.” (David Buchner) topic in most conferences world-wide.” “The studies performed together with “My early work with Steven Roy MD (Sandy Gordon) my colleagues were among the first to (Eugene, OR) on ‘Stress changes of “To develop the RESTQ-Sport in a series show that physical exercise may have the distal radial epiphyses in young studies and to get it published with a a profound effect on ageing skeletal female gymnasts’ (AJSM, 1985). I had high ranked publisher. And of course muscle, connective tissues and bone. initially approached Steven regarding seeing the RESTQ-Sport used in practice The evidence extending from the cell my interest in researching overuse and in research by other researchers. and tissue level structure and function of injuries, particularly growth plate Also to have the first book edited muscles and bones to the “whole body” injuries, affecting young distance focusing on recovery in sport. Kellmann measures of physical performance clearly runners. Interestingly, Steven was seeing M (Ed): Enhancing Recovery: Preventing illustrated the adaptability of the ageing gymnasts in his practice who presented Underperformance in Athletes. musculoskeletal and cardiovascular with stress injuries affecting the distal (Michael Kellmann) system.” (Harri Suominen) radius and invited me to work with him in tracking and describing these injuries. “All of my research has relied on 2. What persons, events This work led next to my doctoral work colleagues and teams so, keeping on the epidemiology of injury affecting in mind the collegial nature of the or specific research had a young gymnasts.” (Dennis Caine) research, I feel that contributions to the significant influence on your field of tendinopathy research, stress career development? “On a personal level: my wife Ellie has fracture management, and exercise “Having a wonderful team of colleagues been immensely helpful throughout prescription in frail populations have in the Centre for Physical Activity and my career. On a professional level: the made a difference to improving patient Nutrition Research at Deakin. I’ve works of theorists such as Jean Piaget, outcomes.” (Karim Khan) now been working with this group for Urie Bronfenbrenner, Erik Erikson, Nicoli Bernstein and others has served “I cannot identify one particular piece eight years and still enjoy every day!” to help me think through issues of of research that is most important, but I (Kylie Ball) motor development and movement skill have especially focused on the energy “My father for suggesting I should learning and most importantly what it and nutritional needs of active women become a podiatrist; Brian Sando means in practical terms for parents, across the lifecycle and their unique for stimulating my interest in and teachers, coaches and therapists.” relationship with food and body image.” encouraging my involvement in sports (David Gallahue) (Melinda Manore) medicine; a chance encounter with Mark “Attending the University of Alberta “Most important: (a) New Paradigm: Doherty from ASICS which defined (Canada) during unpaid leave of absence Impact forces, soft tissue vibration and my interest and eventual passion for from the University of Aberdeen opened muscle tuning. Application to shoes, research into technical athletic footwear. my eyes to both unimaginable research surfaces and apparel; (b) New Paradigm: This ultimately was to determine my and career opportunities. Coming to Instability of shoes and development working future.” (Simon Bartold) Australia 20 years ago was also an of small muscles and stability.” “The encouragement and belief in the unanticipated and unplanned epiphany.” (Benno Nigg) importance of my work that has come (Sandy Gordon) “This is tough - but recently the Fun from Professors Jan Gillquist and Karola “International contacts due to 5 project (see http://www.hawaii. Messner (Linköping, Sweden) and from conference participation (eg, Craig edu/publichealth/faculty/profile/nigg. Professor Dennis McGonagle (Leeds, Wrisberg, Cal Botterill, Mark Andersen).” html), because this is an award-winning UK).” (Michael Benjamin) (Michael Kellmann) dissemination project promoting physical “My main advisor for my PhD, Professor activity and healthy nutrition in 20,000+ Gerjo Kok, was very influential. “I owe a huge debt of gratitude to so children across Hawaii.” (Claudio Nigg) Furthermore, at the start of my career I many SMA members that starting to name them here would take up the “The work that showed there is no won a fellowship from the Dutch Cancer rest of the journal! But they know correlation between changes in the Society that allowed me to travel to the who they are! If I could point to a rearfoot motion with foot orthotics US and Canada where I met professors ‘system’ influence, I would say that the and clinical outcomes which is what is Lawrence Green, Karen Glanz and Vic multidisciplinary nature of Australian believed. Foot orthotics work, but for r Strecher. They influenced my research focus. Larry Green introduced me to sport and exercise medicine provided

VOLUME 25 – ISSUE 2 • winter 2007 3 FROM THE CEO

a tremendously rich training ground. 3. What is the most exciting incentives) on physical activity levels in I benefi ted from the mentorship of project you have planned for older adults.” (David Buchner) physiotherapists, sports physicians, the future? “I am working on a new co-edited remedial massage therapists, exercise volume (with P Harmer and M Schiff) scientists and researchers in various “Based partly on the fi ndings identifi ed for the IOC’s Encyclopaedia of Sports disciplines. This provided unique insights in our Heart Foundation study described Medicine book series. This book is titled that one-dimensional training can never above, my colleagues and I at Deakin ‘Epidemiology of Injury in Olympic match.” (Karim Khan) recently won a major NHMRC Strategic Award to fund a fi ve-year research Sports’ and includes 30 sport-specifi c “Great mentors who believed in me and program examining obesity risk, and chapters. This book should be published helped me as a new faculty member.” strategies to prevent obesity amongst by early 2009.” (Dennis Caine) (Melinda Manore) socioeconomically disadvantaged “Soon I will be retiring from professional “Professor Wartenweiler who women and children.” (Kylie Ball) life and, in addition to revising both attracted me from nuclear physics to “Can’t tell you. For the moment it is a of my textbooks -- Understanding biomechanics.” (Benno Nigg). secret, but it is HUGE!” (Simon Bartold) Motor Development: Infants, Children, Adolescents & Adults (8th Ed) and “I will always point back to my Masters “I never give too many details away Developmental Physical Education for All supervisor Dr. Kerry Courneya, who of what I have not yet done, in case Children (5th Ed) -- I intend to devote my introduced me to this area and instilled an anyone beats me to it!! However, suffi ce time and energies to our six grandchildren unparalleled motivation.” (Claudio Nigg) it to say that it will be a project that as well as to my passions of mountain ”Proving critics wrong.” (Craig Payne) largely centres on the attachment of the climbing, a downhill skiing. My hope is Achilles tendon.” (Michael Benjamin) to climb all 56 peaks over 14,000 ft (13 “I continue to be strongly infl uenced down, 43 to go).” (David Gallahue). by the passionate, enthusiastic and “Two studies: one a study of a cohort of professional AAESS members who 5,500 children aged 15, the other a study “Appreciative coaching applications continue to break new ground and of post-menopausal women looking at to sport science, exercise and health fi nd new and exciting ways of doing dose response.” (Steve Blair) domains excites me. I envision research things. As a professional I have benefi ted “The HOPE project. This is an EU- opportunities in all three areas in the greatly from these relationships.” (Daryl funded project to bring all scientifi c years ahead.” (Sandy Gordon) Sadgrove) projects on obesity prevention across “Extending the Sport and Exercise “Professor Eino Heikkinen who Europe together to build a network Psychology Service at The University of originally introduced me to the fi eld of of networks of researchers to help to Queensland for research and service.” connective tissue and ageing research, gain further insight in the obesogenic (Michael Kellmann) and my doctoral students and colleagues, environments and intervention “Can’t say today, Gary, but hope to have particularly Vuokko Kovanen, Sarianna possibilities. See www.hopeproject.eu. news in a week.” (Karim Khan) Sipilä, Sulin Cheng and Marko Korhonen The project was launched in June this who have kept me involved in active year.” (Johannes Brug) “We are currently working on a diet and research work besides all administrative “The most exciting research project that exercise intervention to determine how duties.” (Harri Suominen) I am currently involved in relates to we might reverse menstrual dysfunction the effect of incentives (eg, economic in active women. We are also very

STC2007 The Victorian Sports Trainers Conference

Victorian Branch Sunday 11th November

STC is an opportunity for Sports Trainers and First Aiders to improve their knowledge and skill base. STC also offers the • The multi-disciplinary sports medicine team chance to network with other Trainers and with presenters from various Sports Medicine and Exercise disciplines • Practical activities • Keynote speaker STC2007 • Victorian Trainer of the Year Award

Melbourne Sports and Aquatic Centre Topics Albert Park VIC 3206

To register your interest and find out more visit www.smavic.org or email [email protected]

4 Sport Health FROM THE CEO

interested in how we can help women It does not hurt to form powerful “Two things: 1, canvas all stakeholders have better relationships with food, so partnerships wherever possible.” thoroughly prior to embarking on they view food as something that fuels (Simon Bartold) any research in the first place, and 2, their sport and something to be enjoyed, follow through -- particularly with those “Pay greater attention to supporting not feared.” (Melinda Manore) stakeholders bracketed as ‘management’ individuals who consistently prove their because without their FULL commitment “Many”. (Benno Nigg) worth, rather than focusing too much even the best research simply won’t on the nature of the project itself.” “Again, there are several but one that will get beyond ‘publications’. Publications (Michael Benjamin). have a profound impact is the analysis DON”T make a difference: execution of one of my projects which is testing “In physical activity, the problem is so of research implications DOES.” some of the criticisms and underlying complex, it needs to be attacked on (Sandy Gordon) assumptions of the Transtheoretical Model all fronts. One area for focus is better “Don’t skimp - have faith in the evidence of Behavior Change.” (Claudio Nigg) counselling in clinical settings and and in those people with a track schools. We need to take inspiration “Determining how foot orthotics work record in making change; have the from things that have worked, such as so they can be better prescribed.” courage to support them fully. Don’t the impact of infant seats and seat belts (Craig Payne) expect unrealistic short-term results. on motor vehicle injury and inoculation Oops, I guess that was three things.” “Submissions to government for on diseases in general.” (Steve Blair) (Karim Khan) the broader recognition of exercise “There are no single shot magic bullets physiologists and new models of care “This is a difficult question but, if I to change health behaviour so do not for chronic disease management.” had to name one thing, it would be to expect quick solutions. But results of (Daryl Sadgrove) make the workplace and schools more our behavioural physical activity (and nutrition and physical activity friendly. “The association between obesity and nutrition) research do provide concrete This would help make being active and osteopororis, particularly the interaction pathways that will help to tackle the eating well the ‘default’ instead of the of genetic and environmental factors obesity epidemic.” (Johannes Brug) exception in peoples’ lives from their (exercise, diet) in bone marrow adiposity youngest years.” (Melinda Manore) “My advice to policy-makers is that and the links between adiposity and the they should not be misled by claims “No politics -- just facts and functional properties of bone.” (Harri Suominen) that physical activity behaviour is understanding.” (Benno Nigg) entirely personal choice. There is strong 4. What single piece of advice “Make physical education mandatory in scientific evidence that both personal grades K-12.” (Claudio Nigg) would/could you give to and environmental factors influence policy makers seeking to physical activity levels in a population. “Not is all as it seems.” (Craig Payne) turn research into policy and The role of policy in influencing lifestyle “Investment into sustainable community- is commonly summarised as “make the practice in your field? based lifestyle interventions for chronic healthy choice the easy choice” and this “It’s important that policy and practice disease is the way to go. In addition to approach is appropriate for physical are evidence-based. Often in the fields of providing greater access to individual activity.” (David Buchner) physical activity promotion and obesity and group secondary prevention services prevention, it’s tempting to develop “I feel that policy-makers need to for individuals, these programs will strategies on the basis that they seem encourage the increased involvement of also provide greater awareness in the intuitive or ‘common sense’, particularly healthcare professionals such as sports community, improve competition in the when empirical evidence is sometimes physical therapists and athletic trainers marketplace, raise industry standards and slow in coming and confusing or in children’s and youth sports. These provide infrastructure and resources to inconsistent. However there are many healthcare professionals should be on- support other public health campaigns.” expert researchers working in these site and available as often as possible (Daryl Sadgrove) areas who are only too happy to share to treat injuries, oversee rehabilitation “The policy makers should trust and turn their expertise and help to translate and timely return to practice, and to into policy and practise the encouraging research evidence into policies/strategies offer sport-specific injury prevention findings of the researchers in that that are empirically-grounded and thus programs.” (Dennis Caine) exercise, even if moderate in nature and potentially more effective and cost- commenced at an advanced age, may effective.” (Kylie Ball) “For those interested in the applied aspects of research and theory, we significantly contribute to healthy and “First, in this country, there needs to be must continually ask the question active life among the ageing population. a lot more money for research. Without first posed by the father of modern And beyond that, even recognise the this, we go nowhere. To turn research psychology, William James: If it doesn’t results obtained in master athletes, which into policy or practice does demand a make a difference-- What difference offer a “barometer of possible”, i.e. what elderly people can still do when they degree of purity of the research and, if it does it make? By doing so, we can maximize their genetic potential by is good enough, if the research changes cut through to the critical elements of exercising regularly.” (Harri Suominen) the boundaries sufficiently, then changes the issue at hand and package new should follow. That said, the process, knowledge in forms that are relevant More information about the even in the presence of groundbreaking and understandable, and as such Conference(s) can be found in the new ideas, can be slow and frustrating, increase the potential for real change.” centre page section of this edition of so a degree of perseverance is necessary. (David Gallahue) Sport Health.

VOLUME 25 – ISSUE 2 • winter 2007 5 D R J Dealing with the double edged sword of the media Dr J

This winter is the first time for seven slightly injured. It goes to show that every up getting bitten. When you think of this years that I won’t be the doctor for time you let a player take an injury into advice and the number of experienced the NSW State of Origin rugby league a game, you take a risk. At your own heads who generally keep their thoughts team. You hopefully get to reflect club, where you are letting players take to themselves, you can mount an after every year of doing a job but at risks on a weekly basis, the management argument that it is a good policy for the end of a lengthy stint with a team is most likely to forgive the occasional sports medicos never to talk to journalists. it is a particularly good time for self- recurrence in return for getting many of On the other side of the coin, there are appraisal. Elsewhere in this edition its players back early from injury. In rugby some sports medicos who have managed of Sport Health there is an analysis league State of Origin games, the players to develop and maintain a high profile. of the medical management of NSW are even more desperate to play than at Even though there is obviously a potential Origin players over seven years. club level, but the clubs themselves are personal benefit in doing this, I would Some readers may find the raw stats never going to be forgiving about injury argue that there is also an upside for the a bit dry, but injury epidemiology recurrences. Hence the high pressure profession as a whole. The list of high is one of my interests. Although of being a regular football club doctor profile medicos ranges from specialist there are not too many comparisons cranks up a notch further when you get media doctors (Peter Larkins and Peter available, I’m satisfied with the low to Origin level. Brukner in Melbourne) to team doctors (enough) rate of players breaking Another issue worth reflecting on from (Nathan Gibbs and Martin Raftery in down when taking injuries into the Origin was commenting on injuries to Sydney and John Mayhew from across matches. From a political viewpoint, the media, as it was a constant challenge the Tasman) and even includes surgeons this is even more important at to not be implicated in any media story (Merv Cross, David Young, Julian Feller) representative level, as clubs are with the potential to upset someone. In and physios (Errol Alcott). Does the fact understandably filthy when a player an Origin camp, there is a continuous that they maintain a high profile hurt exacerbates an existing problem scrum of journalists in the hotel lobby anyone else in the profession? during a non-club game. The (which usually only disperses at about potential for this to annoy clubs can’t 4am each night when the last of them is be understated when you consider Legitimate News refused bar service). Basically they are that it is the major reason why State I suppose like everything else you all expected to come up with one story of Origin was shelved in the AFL. shouldn’t make generalisations but each, per day, and on slow days injuries should look at each piece of potential Over the seven years, the one injury are a good staple to fall back on. It is an media publicity in its context. If, say, exacerbation in the NSW team that interesting question as to whether it is Andrew Johns has just announced his particularly upset the club involved was generally good or bad for team doctors retirement due to a neck injury and you a player who suffered a pneumothorax to make comments to the media. were one of his doctors who advised in an Origin match after taking a rib If you look around the country, there are him to retire, then it would be bordering cartilage injury into the game. While many long-standing team doctors with on petulant to give a ‘no comment’ I can completely understand why the distinguished service to their teams who response to a question about this. It is a club was very disappointed, in terms of hardly ever get quoted in the press, such legitimate news story and an issue that severity of this injury before the game, as Bruce Reid, Peter Friis, Trefor James the Newcastle and other fans deserve it was definitely on the milder end of and Rod Moore. Harry Unglik worked to be informed about. It is the sort of the spectrum. There was never any for North Melbourne for many years issue that, in AFL circles, would call for a suggestion from anyone beforehand and virtually never spoke to journalists. commentary from a Larkins or a Brukner, that he wasn’t fit to play. I’ve overseen At one medical meeting he explained but interestingly the beast of the sports dozens of players with worse rib injuries that this policy was due to being badly media doctor hasn’t yet evolved in get through Origin, finals and regular burned early in his career when he Sydney or rugby league circles. club games (some with the aid of local answered a question strictly off-the-record anaesthetic and some without) who What happens in such a circumstance that became a newspaper headline the haven’t picked up a pneumothorax. is that the journos will tend to call the next day. I’ve also heard of a saying that However, in this unlucky situation, the doctors from the other rugby league talking to journalists is like owning a player copped an accidental swinging teams also and ask them for any pet crocodile -– it looks pretty cool for boot to his chest wall which was already additional comments. If you don’t have a while but in the end you always end

6 Sport Health D R J

any new information to add most of the headline in the Herald-Sun three weeks remind themselves that the number one time, most of us will let the ball pass after the only conversation I had with the reason why they get paid far more than through to the keeper. The danger is journalist. The headline read something someone working in an identical job that it’s hard to comment accurately on like “AFL: Come clean on jabs”, with an in, say, netball, is because of the media a player when you don’t have the full introductory sentence of something like interest in the game. clinical information. However, I’d contend “Leading sports medicos have claimed An unforgettable and quite surreal that this sort of issue (Andrew Johns’ the AFL isn’t doing enough research on experience from my time in State of retirement) is one which you can give local anaesthetic use in football”. Origin was being in camp when the a green flag to, in terms of answering a I’ve seen similar headlines arise after famous ‘Mark Gasnier mobile phone question from a journalist. That is, there is so-called investigative sports journalists message’ story broke a few years ago. a legitimate news story there which itself have managed to trap a handful of team This story blew up like a volcano over dictates the back page headline. Whatever doctors into conceding that players at a number of days with some key juicy comment you make is not going to be their clubs occasionally use caffeine elements: sexual harassment of a girl, highlighted much, because it doesn’t need tablets, for example. Basically the but one who had a nightclub history; to be, as the editors already have their technique is the journo ringing around a superstar player who was too good headline and the journos are just looking for a collection of seemingly innocuous to throw out of the game; his mates for filler quotes. quotes (which they all are individually) covering up for him; the voice message The alternate red flag question is one from a few sports doctors but then mysteriously finding itself at the office of where there is no actual major news using the innocuous quotes to create a (perhaps) the highest bidder. The entire issue, but you are being asked for a story which runs with an inflammatory week seemed like Groundhog Day with comment. Your natural inclination here headline. Local anaesthetic is one of some 70 year-old woman continually is to think that, because you are being the football journalists “go to” topics in calling Ray Hadley on 2GB saying: asked a question that has no major the sports medicine genre, along with “Ray, I was trying to listen before when context, it might be safe to answer it. caffeine use, Sudafed use, players with you played that absolutely disgusting hepatitis and HIV, concussion, long-term message that that awful player left on Badly Bitten effects of football on the knee, illicit drug that poor girl’s message bank, but my use, safety of playing in the heat, etc, etc. hearing isn’t too good. Do you mind I got bitten badly myself last year by playing it again for me so I can just a journalist from the Herald-Sun in check that it was really as disgusting as I Melbourne who called to ask a question Soap Opera thought it was?” on local anaesthetic use in the AFL. His One thing that does surprise me as much hook was along the lines of “…we were as the media overreaction to a minor issue trying to do some research on the use is the counter overreaction of everyone Reality Check of local anaesthetic in football players else in the football industry to the initial Our coach that year, at a press and noticed that there is hardly anything overreaction. We live in a media climate conference, described the mood of the published on the topic, although we’ve where they blow almost everything out of Origin camp as being “about on a par found that you’ve published a couple of proportion, so it shouldn’t be surprising with the Holocaust”. This of course research studies on it. Does it surprise next time it happens, should it? It seems drew more outraged complaints from you that hardly anyone else around to be part of the ongoing soap opera that Jewish members of the public, furious the world has done any study on local one rule of being a sports administrator is that the Holocaust was being trivialised. anaesthetic use?” In retrospect, this may that you can’t laugh off a media beat up, There was one phone message that was have been a safe topic to answer if a but instead you need to put your most revealed privately to the rest of the staff famous player had just had a femoral serious face on and appear to be furiously late in the week that was about the only nerve block accidentally administered getting to the bottom of the problem. reality check we got for the whole camp. the day before and there was an obvious It was from the Channel Nine CEO at Although we think it is tough sometimes story brewing. However, the fact that the time, calling the coach from a meeting working in sports medicine, imagine questions came out of the blue didn’t in the USA, saying words to the effect being the media officer for a football flash enough warning lights for me and of “Well done, it was looking like it was organisation: your mission statement I made the mistake of saying words to going to be a boring Origin series this is that “we want you to maximise the the effect of “Yes, I am surprised that year with low TV ratings, but I knew amount of exposure our organisation more research hasn’t being done on the you and the boys would come up with gets in all forms of the media but, in topic, as local does get used a fair bit in something to spice it up”. doing so, make absolutely sure that professional sport and occasionally leads you avoid all controversial issues”. The to side effects”. only problem being, of course, that I wouldn’t claim to be naïve enough the media are generally completely not to think that this sort of comment uninterested in any issues which aren’t wouldn’t lead to a quote in a newspaper, controversial, reflecting the wishes of the but I was quite astounded that it viewing public. Despite the pressure of was one of the listed quotes which working in a high profile sport, those in contributed to a front and back page the football industries must constantly

VOLUME 25 – ISSUE 2 • winter 2007 7 CRICKET

Pathomechanics of lower back injuries in junior and senior fast bowlers: a prospective study Marc R Portus, Howard Galloway, Bruce C Elliott and David Lloyd

The relationship between lower System (120 Hz) and a Kistler force back and front foot impact (p = 0.13), back injuries and fast bowling plate (1060 Hz) to record impact forces as well as a more laterally flexed lumbar technique has been researched during the front foot contact phase. A segment at the instant of front foot for approximately 20 years. The hierarchical trial selection model was impact and peak vertical ground reaction evolution of equipment available to used to analyse three to six deliveries force (p = 0.26). The technique factor sports biomechanics researchers per bowler. The premise of this was that significantly differentiated senior now means the full three- to analyse the deliveries that were lumbar bony stress injured bowlers dimensional kinematics of the trunk characterised by higher relative ball was the range and velocity of pelvic can be measured. Previously fast speeds and accuracy scores to improve obliquity in the phase from front foot bowling research has used 2D or the ecological validity of laboratory impact to ball release (p = 0.02). Peak planar methods when prospectively testing. Pelvis, lumbar (lumbar rig), vertical ground reaction forces were also assessing the link between the fast thorax and shoulder kinematics were experienced at the commencement of bowling action and injury. This measured in the flexion-extension, this phase. research has provided the basis lateral flexion and rotation axes using a for the link between the ‘mixed’ Bodybuilder for Biomechanics (Oxford Conclusion technique - the predominant feature Metrics, UK) custom written kinematic These results indicate that age, growth being a large shoulder counter- model. Bowlers were tracked through and physical maturation are likely to rotation of the upper trunk in the the season and were grouped by the be important factors to consider when transverse plane – and lower back type of lower back injury that caused assessing potential pathomechanics in injuries. The present study used a them to miss at least one match after a fast bowlers technique. Adolescent three-dimensional inter-segment clinical and radiological diagnoses. fast bowlers in this research were trunk model and prospectively These groups were: Group 1 = Bony more susceptible to “breaking down” tracked a junior and senior cohort Stress Injury; Group 2 = Soft Tissue when using higher ranges and rates of through a cricket season to assess Injury; Group 3 = No Lower Back Injury. trunk counter-rotation (ie, the ‘mixed’ further the pathomechanics of lower Statistical differences between injury technique). In contrast the senior back injuries. status groups within each cohort were bowlers seemed to be more resilient assessed by analysis of variance. to the increased spinal torsion of the Methods mixed technique (similar magnitudes Sixty-eight fast bowlers attended the Results were recorded to juniors). Seniors were, Australian Institute of Sport in Canberra The junior lumbar bony stress injured however, more likely to suffer lower over a one month period early in the bowlers exhibited higher levels of back injuries when higher ranges and 2002-03 cricket season. Forty-four of axial counter-rotation throughout all rates of lumbo-pelvic motion in the these were junior bowlers and played trunk segments (pelvis, lumbar, thorax, lateral flexion axis were recorded. Age- competitive age-level cricket in Sydney shoulder) than junior non-injured specific technique coaching, workload and Canberra (mean age 15.1 ± 1.3 bowlers. The range and velocity of management and physical conditioning years). Twenty-four bowlers formed counter-rotation of the pelvis and lumbar programs for fast bowling would appear a senior cohort (mean age 23.6 ± 3.4 segments in particular were significantly to be important implications from years) who were professional cricketers higher in the junior bony stress injured these findings. from the state cricket associations bowlers (p = 0.01). Statistically, juniors of Victoria, New South Wales using excessive levels of trunk counter- Acknowledgements and Queensland. rotation had a 5.6 times greater relative Cricket Australia funded this study risk of lumbar bony stress injury. Each bowler delivered 18 deliveries at and many in-kind contributions were Conversely, for the senior bowlers, there match pace in the AIS Biomechanics received from colleagues and staff at were no axial trunk rotation (counter or Laboratory, which permitted full length Cricket Australia, Cricket NSW, ACT forward) variables that were higher for run-ups and had a synthetic grass cricket Cricket Association, the Sutherland back-injured bowlers. Rather, the senior pitch. Bowling technique was analysed Shire Junior Cricket Association and the back-injured group displayed patterns of using an 8-camera Vicon Motion Analysis increased trunk lateral flexion between >> to Page 9

8 Sport Health CRICKET Conventional, reverse and contrast swing bowling

Rabindra D. Mehta*

So how many swing types are there eagerly spread by the media, rather than a reversed direction while maintaining in cricket and, as some cricketers the basic principles of science. the same grip, bowling action and argue, does it really matter what you bowling speed is what makes reverse The actual construction of a cricket call a particular type of swing? Well, it swing so attractive and effective. Of ball and the principle by which fast matters because the science dictates course, another reason why reverse bowlers swing the ball is unique to what type of swing it is. Of course, swing has gained such notoriety is cricket. A cricket ball has six rows of cricket bowlers do not have to know its constant link to accusations of prominent stitching along its equator, or understand the science, but it sure ball tampering. which makes up the ‘primary’ seam. would be nice to know when a certain The better quality cricket balls used in On a visit to the ECB National Cricket type of swing will be effective and competitive cricket are, in fact, made Academy in England in December in which direction the ball is likely out of four pieces of leather, so that 2005, I realised that there was still some to swing. I sure wish I knew half of each hemisphere has a line of internal confusion regarding the true definition what I know now when I hurled that stitching forming the ‘quarter’ seam. of reverse swing. They had a practice cricket ball down the pitch at more The two quarter seams are traditionally session devoted to reverse swing than ‘fair’ speed in the 70s. set at right angles to each other. These using balls with one side deliberately Aficionados know cricket as a game primary and quarter seams play a critical roughened. Some of the bowlers swung of infinite subtlety, not only in strategy role in the aerodynamics of a swinging the ball quite well, and they thought and tactics but also in its most basic cricket ball. It is believed that this type of in the reverse sense. However, the mechanics. On each delivery, the ball swing originated around the turn of the ball generally had the seam straight can have a different trajectory, varied century, but there is evidence that it was up (not angled) and it swung towards by changing the pace, length, line or, in existence well before that time. the smooth side. This was obviously most subtly of all, by swinging the ball not conventional or reverse swing The basic aerodynamic principles through the air so that it drifts sideways. and so I developed the new term: responsible for conventional swing of a Such movement has always fascinated ‘contrast swing’. So how is contrast cricket ball were identified decades ago cricket fans, but seldom do they swing different from conventional and and many papers have been published understand the underlying mechanisms reverse swing? For one thing, the swing on the subject. For conventional swing, that cause the cricket ball to swing. In direction is determined by the bowling the ball is delivered with the seam fact, more often than not, they have to speed, as opposed to seam and smooth/ angled towards second slip or leg slip rely on myth and folklore readily and rough surface orientations. The most and the ball swings in the same direction exciting feature about contrast swing is as the seam is pointing. A shiny, smooth that just about any bowler (regardless surface facing the batsman helps in >> from Page 8 of bowling speed) can implement it in achieving conventional swing. Over practice and the ball will swing even if Australian Institute of Sport. The athletes, the last 25 years or so, several empirical the seam is completely ‘bashed-in’. As Patrick Farhart, Rebecca Dennis, John investigations have also been conducted most cricketers are aware, it is much Orchard, Tom Cross, Kevin Osborne, on cricket ball swing, which revealed easier to release the ball with the seam Leanne Monte, Steve Mullaly and Steve the amount of attainable swing and straight up, rather than angled towards Dowlan deserve special mention. identified the parameters that affect it. the slips or fine leg. Thus, even mere Marc Portus is at the Cricket I first heard about the ball swinging mortals should be able to swing such Australia Centre of Excellence the wrong way in the summer of 1980. a ball, and in either direction, since the in Brisbane; Howard Galloway in This phenomenon soon became known bowling action is the same for both the Biomechanics Department at as ‘reverse swing’ and took the cricket swing directions. The Canberra Hospital, and Bruce world by storm. For reverse swing, the *Sports aerodynamics consultant, Elliott and David Lloyd at the ball is released in the same way as for Mountain View, California, USA School of Human Movement and conventional swing, but it swings in a Exercise Science at The University direction that is opposed or reversed Correspondence: [email protected] of Western Australia to that of the seam. For reverse swing, it helps to have a rough side facing the Correspondence: [email protected]. batsman. The ability to swing the ball in com.au

VOLUME 25 – ISSUE 2 • winter 200 7 9 CRICKET The how and why of sporting expertise Implications from the study of experts to skill acquisition in cricket

Bruce Abernethy

Expertise in cricket is not easily performance, than to the enhancement of skills without the impediments known to acquired. Consequently, finding basic attributes, such as visual acuity, that be associated with conscious control. means to accelerate the acquisition of do not need to be at supra-normal levels Understanding more about who become expertise through improved training to support expert performance. methods or enhanced identification experts and what conditions are and support of talented performers One of the main reasons experts necessary to support and promote their is fundamental to a successful outperform non-experts on skills like skill learning is fundamental to improving sports system. The systematic study anticipation is that they attend to different the developmental pathways for of sports expertise can assist with cues and pick-up information from promoting the emergence of exceptional identifying the essential attributes different features of their opponent’ performers. It is now well established of exceptional performers, in actions. Studies selectively occluding that an individual’s early experiences determining the unique ways in potential cues for anticipation indicate that can have a powerful and enduring which experts differ from non- experts have a unique ability to pick-up influence on the likelihood of eventually experts and in providing guidance information from the isolated motion of becoming an expert. Being relatively as to what factors should be given the bowling hand and arm that assists in older in entering junior sport teams, emphasis in talent identification the early identification of the type of ball growing up in rural and small towns and development. Recent research that has been bowled (Müller et al, 2006) rather than large cities, having a broad is informative as to the limiting plus experts show a greater ability to use range of experience in different sports factors to batting expertise, the use early ball flight cues to aid successful before specialising, experiencing early of different information (‘cues’) by bat-ball interception (Müller & Abernethy, exposure to playing against adults and batsmen of different skill levels and 2006). Different eye movement strategies having access to environments that permit the developmental factors known to may also distinguish better players from large amounts of unstructured practice be associated with the emergence of novices (Land & McLeod, 2000), although and play, all appear to be conditions cricketing skill. additional experimental confirmation that are favourable to the development of the visual search patterns of cricket of expert ball-sport players (Abernethy Comparisons between experts and batsmen of different skill is required. & Farrow, 2005). For sports, like cricket, non-experts on tests of different sub- Knowing the differences in information with an historically diverse talent base, components of batting skill provide usage between players of different skill reflecting on these critical developmental a means of determining what factors level can help determine what must be experiences of current expert players likely do, and do not, limit performance. learned in order to become an expert may provide important leads as to the Experts consistently outperform non- but this does not, in itself, help ensure essential characteristics that need to be experts in such sub-skills as pattern an accelerated rate of skill learning retained within the junior sports systems recognition, anticipation and the for non-experts. Simply drawing non- and developmental pathways for the next concurrent performance of multiple experts’ attention to the sources of generations of potential experts. tasks. Experts, for instance, are adept at information used by experts is unlikely Abernethy B, Farrow D. (2005). Contextual factors anticipating the intention of a bowler to be effective as a form of training influencing the development of expertise in Australian from advance vision of their pre-release athletes. Proceedings of the ISSP 11th World Congress of unless there is some parallel means of Sport Psychology. Sydney: ISSP. movement patterns (Abernethy & Russell, providing the experiential base to ensure Abernethy B, Russell DG. (1984). Advanced cue 1984) and this may explain the expert’s the ‘meaning’ of the information available utilisation by skilled cricket batsmen. The Australian ability to provide the impression of having Journal of Science and Medicine in Sport;16(2):2-10. from particular cues is understood. Land MF, McLeod P. (2000). From eye movements to ‘all the time in the world’ to execute Further, explicitly drawing the attention actions. Nature Neuroscience;3:1340-1345. their strokes. Experts show little or no Mann DL et al. (in press). Is optimal vision required for of non-experts to particular cues used the successful execution of an interceptive task? Human differences from non-experts on general by experts may be counter-productive Movement Science. functional tests of vision, cognition or given that the experts’ use of such Müller S, Abernethy B. (2006). Batting with occluded motor ability with even visual acuity being vision. Journal of Science and Medicine in Sport;9:446-458. information is frequently below the level Müller S et al. (2006). How do world-class cricket able to be degraded dramatically without batsmen anticipate a bowler’s intention? Quarterly of consciousness and largely immune Journal of Experimental Psychology;59:2162-2186. any major impact on batting performance to interference from stress and other (Mann et al, in press). It is more sensible consciously-mediated effects. A major Acknowledgments: for coaches to devote practice time with focus of current research is therefore to non-elite players to the enhancement Supported in part by funding from find more implicit practice methods that of skill components, like anticipation, Cricket Australia and the AIS. can facilitate the learning of expert-like that are clearly essential for expert >> to Page 11

10 Sport Health CRICKET Why do fast bowlers bowl no-balls? “It’s bloody laziness, lad” and other explanations!

Ian Renshaw and Keith Davids

Despite the fundamental importance achieved low levels of inter-trial variability as run-up speed and bowling style of the run-up to successful at the bound footfall (0.08 m to 0.16 impact on movement production. The performance in fast bowling, few m). Analysis of step length adjustments data imply that bowlers need to visually studies have examined how bowlers during the run-up revealed that bowlers regulate the run-up instantaneously (in a regulate footfall placements during appear to regulate their steps as needed subconscious way) early and late in the approach runs. The traditional throughout the whole of the run-up. run-up rather than focus on ‘standardisng understanding of strategies in the More specifically, although there were the non-standardisable’. cricket run-up is that repetitious some individual differences, typically, Second, it seems that the inconsistent practice over time can lead to the bowlers regulated steps very early and start points do not lead to high levels standardisation of a movement very late in their run-ups. In a follow-up of variability at the end of the run-up. pattern, leading to the view that no- study, the same bowlers bowled when Clearly, no-balls are not due to laziness balls are caused by lazy inattention no umpire was present. Although bound in adhering to consistent starting of bowlers to legal foot placements footfall variability was generally similar to locations. However, before advising when practising. In this article conditions when the umpire was present, bowlers to throw away their markers, we discuss findings from a series absence of umpires led bowlers to adopt we suggest that it is likely that the of studies aiming to enhance our very different run-up patterns to those marker is important in developing some understanding of how the run-up is observed when umpires were present. consistency in the number of steps used regulated during bowling. In a third (case) study, we required in the run-up. one bowler to bowl with (i) umpire In three studies completed so far, present, (ii) no umpire present and (iii) Third, bowlers should always practise in the run-ups of medium-fast bowlers no stumps and umpire present. Results conditions that closely replicate match were filmed using a panned video showed that the absence of umpire and conditions. The early visual regulation camera (operating at 50 Hz) elevated stumps led to the bowler being much strategy displayed by the professional perpendicular to run-up direction. Heel more precise in placing his foot near his bowlers in our study implies that it makes to popping crease distances for each check mark than when the umpire was sense for bowlers to practise with umpires foot placement were determined and present. Interestingly, although inter-trial and stumps present, since this strategy subsequently data were analysed in variability within each condition was will ‘educate the attention’ of experienced Excel 2000. Traditional group analyses similar at the front foot landing position and inexperienced bowlers in identifying (eg, means and deviations) individual (0.08 m, 0.08 m and 0.04 m), the mean key information sources with which to analysis of each run-up using methods distance of the final footfall placement couple footfall placements. pioneered by Montagne et al (2000) was progressively closer to the popping were conducted. crease as more information was removed Further research is needed to build on these preliminary findings by studying Data from the initial group analysis from the environment (umpire present bowlers’ intentions, differences due to of run-ups of UK professional cricket = 0.35 m; absent = 0.21 m no umpire or expertise and intra-individual differences bowlers when umpires were present stumps = 0.04 m). This finding illustrated in run-ups when no-ball and legal revealed some surprising findings. First how bowlers adjust movement patterns deliveries are bowled. In this way we we noted that, despite the high level of according to information available in intend to provide a comprehensive inconsistency displayed by the bowlers the environment. understanding of run-ups that can enable in the starting position of the run-up Our findings have enabled us to begin coaches to effectively improve bowlers’ (range 0.20 m to 0.97 m), all bowlers to understand how bowlers control their run-ups and where necessary solve run-ups and to provide coaches and persistent no-ball problems. bowlers with some basic information >> from Page 10 Montagne G, Cornus S, Glize D, Quaine F, Laurent M. to underpin the practising of run-ups. (2000). A perception-action coupling type of control in long jumping. Journal of Motor Behavior; 32:37-43. Professor Abernethy is at the First, coaches need to understand that Institute of Human Performance, repetitious practice does not lead to Ian Renshaw and Keith Davids are memorisation of standardised motor University of Hong Kong, and the at the School of Human Movement patterns in cricket run-ups. Rather, Studies, Queensland University of School of Human Movement Studies, the individual patterns of step length Technology. The University of Queensland adjustment observed in our studies suggest that individual constraints such Correspondence: [email protected] Correspondence: [email protected]

VOLUME 25 – ISSUE 2 • winter 200 7 11 FROMCRICKET THE CEO Adolescent fracture implications related to growth DA Bailey, CM Engstrom and DG Walker

Fractures are common in childhood the following findings would appear Figure 1. A unilateral L4 pars and adolescence; approximately one- to have some relevance in terms of stress fracture (axial MRI) in a third of boys and girls sustain at least adolescent fracture incidence. right arm bowler. one fracture before the age of 17. During the adolescent years there is a While the fracture rate is higher in dissociation between linear growth and boys than in girls, the peak incidence bone mineral accrual. Peak linear growth occurs about two years earlier in precedes peak total body bone mineral girls and in both sexes is associated accrual by over eight months in boys with the timing of the adolescent and 11 months in girls. This lag time growth spurt (Bailey et al, 1989). In between linear growth and bone mineral terms of adolescent athletes, stress acquisition has clinical significance. fractures are common overuse Adolescent fracture incidence is at a peak injuries associated with repetitive during this period (Bailey et al, 2003). loading of both the appendicular Consistent with the above observation, and axial skeleton. Symptomatic when corrected for size, apparent bone stress lesions of the lumbar spine mineral density actually shows a drop are clinically significant injuries during the adolescent growth spurt lumbar vertebrae was characterised by in adolescent athletes engaged in period (Faulkner et al, 2006). an insidious onset of low back pain activities involving repeated, forceful directly related to fast bowling. All the hyperextension and axial rotation The adolescent growth spurt is a critical symptomatic L4 pars lesions in the fast of the thoracolumbar spine such as time fo r bone mineral accretion. bowlers developed between 15 to 17 gymnasts and cricket fast bowlers. Weight-bearing physical activity is a years of age and were all unilateral stress modifiable determinant of bone mineral fractures lateralised to the non-bowling To investigate bone strength and bone accrual during the growing years. We arm-side (Figure 1). In addition, pre- mineral accretion in growing children, have demonstrated that the growing existing asymptomatic L5 pars lesions the Saskatchewan Pediatric Bone Mineral skeleton responds to increased everyday were observed in 20% of the adolescent Accrual Study was initiated in 1991. physical activity by increasing the fast bowlers with the majority (73%) of The longitudinal study involved the accumulation of bone mineral (Bailey et these cases being bilateral non-united collection of anthropometric growth and al, 1999). However, at very high levels (chronic) defects. In the swimmers, maturity measurements taken every six of intensity,veruse injuries have the there were no lesions at the L4 vertebral months and DXA scans of the total body, potential to produce stress fractures in level although 20% of these “control” lumbar spine and proximal femur taken adolescent athletes, particularly in sports athletes had pre-existing asymptomatic annually. Subjects were followed from involving repetitive, forceful loading of L5 pars defects. 1991 to 1997 and again as adults from the immature skeleton. 2002 to 2006. Of the original sample of It is tempting to speculate that there is 228 subjects (113 boys and 115 girls), A 4-year prospective MRI study was a differential timing with regard to the 145 have been retested during the young conducted to investigate isthmic-type development of the ‘cricket-specific’ L4 adult years. lesions of the pars interarticularis in the unilateral stress fractures and the more lumbar spine of fast bowlers (N=51) and ‘generic’ L5 pars defects with the majority To control for maturational differences swimmers (N=20) aged between 13 and of the L5 lesions occurring at a younger between boys and girls of the same 17 years (Engstrom & Walker, 2007). age (potentially pre-PHV) while the L4 chronological age, we determined Annual MRI examinations in the bowlers fractures in the current cohort of bowlers the age of peak linear growth (PHV) (4 yrs) and swimmers (2 yrs) consisted likely occurred post-PHV. Furthermore, it for each individual subject. This gave of thin sagittal and axial (parallel to the seems likely that the injury mechanism/s us a common maturational landmark L4/5 disc space) images to optimise underlying the L4 and L5 pars lesions (equivalent to 92% of adult height) visualisation of the individual pars. may be different with a ‘cricket specific’ which was used as the baseline for Overall, symptomatic L4 and L5 pars unilateral loading of the lumbar spine comparisons between boys and girls. during repetitive axial rotation and/ Bone mineral and structural bone interarticularis lesions developed in 22% and 1% of the adolescent fast bowlers or lateral flexion associated with the strength values were determined at development of the L4 pars lesions on points representing ages 3, 2, 1 years on respectively. Clinically, the development of these neural arch lesions in the caudal the non-bowling arm side (Engstrom either side of PHV. Using this approach >> to Page 17

12 Sport Health CRICKET Evidence from baseball that umpiring decisions are influenced by game context Clare MacMahon

Traditional approaches in sport collection, balls were designated -1 and pitch changes based on the context. decision-making research test strikes +1. When the two components of Moreover, previous pitches (ie, definite problems with a ‘correct’ and the decision were combined, responses strikes, definite balls) and the pitch count agreed upon answer. In many cases, ranged from ‘definite ball’ at -5 to appear to be strong contextual factors, however, the most critical decisions ‘definite strike’ at +5. given that their influence is shown not are often the least clear-cut. This is only in umpires and players but also in In a basic judgment task, participants particularly the case for officiating participants with little experience with viewed 32 video clips of definite balls and decisions. The approach used in this the sport. The results of this study also definite strikes. In a ‘direct information study was to examine borderline or provide evidence that umpires use a task’, participants made a ball-strike ambiguous decisions for the ball- normative rule of ‘hastening the game’, decision for the same 16 borderline strike judgment in baseball. or moving it along by calling strikes pitches presented in four different (Larsen & Rainey, 1991). When an individual batter faces a conditions: 1, following one definite pitcher and does not hit the ball, the strike; 2, following two definite strikes; This work not only shows that context plate umpire must judge the flight 3, following one definite ball; and 4, influences decisions but also provides path of the ball relative to the strike following two definite balls. All borderline a useful approach to understanding the zone. If a pitcher throws four balls, the clips were seen in each condition. complexity of critical decisions in a variety batter is ‘walked’ to first base, with the of sports. Specifically, these results allude In the ‘summary information’ or ‘pitch opportunity eventually to score. If a to further work in cricket umpiring to count task’, participants were shown 12 pitcher throws three strikes, the batter study decisions and potentially design borderline pitches in four different pitch is retired for an ‘out’. Three outs end an interventions to improve decision making. count conditions: 1, a neutral count of inning, diminishing the batting team’s For example, this method can be used 0 balls and 0 strikes; 2, a ‘batter-ahead’ opportunity for points. The pitch count, to examine critical difficult decisions count of 3 balls and 0 strikes; 3, a neutral which tallies the number of balls and such as wides, no balls, outs and LBWs. but critical count of 3 balls and 2 strikes strikes during an individual batter’s Contextual factors such as the score, stage (where a ball decision leads to a walk to ‘at bat’, is thus an important piece of in the match and status or ranking of a first base and a strike decision leads to contextual information, showing whether player and strength of an appeal may all an out); and 4, a ‘pitcher-ahead’ count or not the pitcher or batter is ahead, and influence decisions. Studying these factors with 0 balls and 2 strikes. how critical the situation is. is the next step in this area of research. Umpires and players were significantly Baseball pitches were filmed from the better at calling pitches than controls in Acknowledgments umpire’s perspective using a helmet- the basic judgment task, and thus it is mounted camera. Pitch clips were viewed The author would like to acknowledge a task that taps into experience-based by three expert baseball umpires who the invaluable input of Janet Starkes expertise. In the ‘direct information task’, classified them as ‘balls’ or ‘strikes’. This from McMaster University in Ontario, all participants called target clips closer resulted in a pool of definite ‘ball’ clips, Canada, and Neil Charness from Florida to the strike end of the scale when and a pool of definite ‘strike’ clips where State University, as well as post-doctoral viewed after definite balls than when the three experts agreed. Disagreements funding from the Social Sciences and they followed definite strikes. Similarly, in between the experts were used to identify Humanities Research Council of Canada. the ‘pitch count task’, participants called ambiguous or borderline pitches. Larsen JD, Rainey DW. (1991). Judgment bias in baseball pitches more towards the strike end of umpires’ first base calls: A computer simulation. Journal We recruited 31 baseball umpires, the scale when there were three balls in of Sport and Exercise Psychology;13:75-79. 16 baseball players and 27 control the count (3-0, 3-2), then in the other two Clare MacMahon is at Victoria participants with little to no baseball pitch counts (0-0, 0-2). A final interesting University, Melbourne, Victoria experience to complete three tasks. finding is that, compared to the players Correspondence: The basic task was to watch a clip and and control participants, umpires showed [email protected] classify it as a ball or a strike. Participants a greater overall tendency to call strikes as were then asked to rate their certainty opposed to balls. on a scale from 1 to 5, where a 1 was These findings provide evidence that definite and 5 was borderline. Post data the standard for evaluation of a baseball

VOLUME 25 – ISSUE 2 • winter 200 7 13 INJURY REPORTING SMA(ACT) Injury reporting trial Results and analysis

John Lockie and Patricia Donoghue

Largely because of the impracticality other applications can be derived from one patient at a time, don’t see the next of available reporting forms, injury this, or got in other ways as a separate until you are finished with this one, record-keeping by trainers in the exercise, albeit at some extra cost. Data etc). They are far more likely to be in Australian Capital Territory is sparse. collection for other applications certainly medias res – in the middle of it all; in a So we developed an injury recording contributes to the overall goals of athlete crowded dressing room or on a muddy methodology better suited to the care and injury prevention, and is a playing field, surrounded by a confusion environment in which trainers legitimate component of a trainer’s role, of athletes who are focused on getting work and, with the support of the but it is not the core business. on with their sport. So record-keeping ACT branch of SMA, tested. As a needs to be quick and intuitive, or it For first aid coverage supplied to by-product of the methodology, a won’t happen. external clients, SMA(ACT) has used source of statistical data emerged a number of different injury reporting Where trainers are simply ordered to that could be useful in estimating the forms, most of which were designed for supply data in an impractical way, full extent of sporting injuries across something else. They may have been with the best will in the world, there a region. suitable for their original purpose, but is significant risk of a low correlation all have critically serious failings when between the data supplied and reality. Why we needed to applied to recording coverage. For the What was needed was an injury do something purpose of recording what the trainer recording methodology that was The need for injury reporting is well has done for each athlete, the forms practical in a trainer’s environment and accepted, but often more from habit seek irrelevant data, are large, unwieldy, would capture data essential to the than from a considered need to collect unnecessarily complex and difficult to trainer and the trainer’s employer. information for specific purposes. The complete outdoors. lack of obvious purpose, combined The key point is that trainers can’t with the impracticality of the available be assumed to work in a clinical recording forms, has meant that environment (air-conditioned room, record-keeping by trainers, from our observation, is usually at best sketchy, at worst non-existent. Figure 1 - Sports Medicine Australia Treatment Log There are three major applications for DATE: 1 Apr 2004 TRAINER: John Page: 1 of 1 EVENT: School AFL injury and treatment data, each requiring VENUE: Stirling Oval EVENT DIRECTOR: Bill Smith ph: 0416 123 456 significantly different detail: TIME PLAYER ID ASSESSED TREATMENT CONDITION including advice to seek professional help if • epidemiological studies to yield condition has not improved within 24 hrs trends, which may in turn suggest or 1030 Heather - Fraser Minor sprain RICE, advise teacher no RTP today support injury prevention strategies; Primary R ankle • personal injury records of athletes, 1120 Fred Smith – Yass HS Head clash, Advised manager: rest and no RTP, to help them and their medical possible mild gave Fred head injury sheet to give professionals provide on-going concussion to parents treatment; and 1125 Bill – Kaleen PS Graze L knee Dressed • records of treatment for the treating practitioner in case the treatment 1140 Yass HS #27 Blister R thumb Dressed is questioned at some stage in 1210 1030 Played again, R RICE, lecture NO RTP, strongly advise the future. ankle worse see physio ASP In the core business of a trainer (injury 1230 Sue – Dickson College Pain L shin Ice, plantar fascia taping, RTP within prevention and immediate management), limits of pain the major reason is the last of these: 1315 Fred – Casey HS #12 Fall on R hand, Ice and support, to Calcary A&E by car what was done, and to whom. Data for ? frac R radius with Mum

14 Sport Health INJURY REPORTING

What we did Figure 2 - Sports Medicine Australia Event Coverage Injury Summary 1. Design a more practical DATE: 1 Apr 04 TIMES: 1200 - 1600 VENUE: Griffith Oval EVENT: High School rugby EVENT DIRECTOR: Bill Smith TRAINER(S: John L methodology NOTE – These are the injuries that presented to the First Aid Centre or were treated on field by the Trainer; they are Despite the inadequacies of the ‘official’ NOT necessarily the total for the event. injury report forms, many experienced Immediate referral to medical professional Immediate return to play possible after treatment trainers do keep some form of record, but in their own way. So these informal Minor Less Severe techniques were brought together with Severe the specific needs of coverage recording, Laceration/cut/abrasion III I in an attempt to produce a succinct, Bruise/cork III II useable, standard recording instrument. Strain/sprain/overuse/tracking IIIII III III Some of the issues considered included: Fracture/dislocation/subluxation (including suspected) II I What data to collect Concussion/superficial head/spinal (including suspected) II Much of the information sought in all the existing forms is irrelevant to coverage Environmental causes (eg heat stress) II reporting; the sex of the athlete, their Medical condition I date of birth, whether they were a Other (eg winded, cramp, blisters, splinters etc) III player or official, just to mention a few examples. As well as being unnecessary, Misc – athlete not assessed (eg. general advice, IIIII IIIII II some of these are of a sensitive or give out ice, bandaids etc) invasive nature. All the information that TOTALS was considered necessary in regard to a treatment was: • date/time and place Privacy Statistics • a way of identifying the athlete Collecting data about people, particularly When trainers do coverage for a client, • assessment of injury/injuries medical-related data, must very much a component of recording what they • treatment given comply with privacy laws. A general have done for athletes is to generate • advice given, and to whom. theme of most such laws is that for the client a profile of the trainers’ information should only be collected activity during the event. This requires Reporting form: menu or free-form where there is an agreed legitimate the collection of some statistics. But, It was assumed that trainers are need. There were also considerations consistent with our goals, this also needs competent and so will follow protocols of duration and security of storage, to be done quickly and in a format that (such as TOTAPS), can name body confidentiality and so on. is practical in a trainer’s environment. parts and describe injuries. Hence the bulky ‘menu’ style of the existing forms What constitutes a significant injury, The result was a methodology involving (which causes each to occupy at least an worth reporting three levels of reporting: Most injuries treated during coverage are A4 page) was considered unnecessary, A Treatment Log (Fig 1) to record all minor, the treatment routine, and seldom because it would be quicker to write a assessments and treatments other than seem worth reporting; the more so if it few words than scan long menus and the most trivial. This is completed as takes longer to do the reporting than do tick boxes. It was accepted that this soon as possible after treating someone the treating. However, even the most would mean additional work if the data (ideally immediately) and remains the apparently trivial injury might turn out were to be later encoded for analysis. property of the trainer. It is the trainer’s not to be so. So the expectation is that responsibility to keep the log for a Re-presentations some record will be made of any injury reasonable period of time (12 months Another drawback of existing forms where the trainer does an assessment, is currently suggested) in case details of is that they assume that the athlete even if no treatment is given. will not return once initially treated; if treatments are required in the future. Duty of care they do, another form is required. In A Statistical Summary (Fig. 2) covering While it remains a matter for legal practice, athletes often re-present, for re- various types of injury and grades of clarification, there may be a difference assessment once swelling has subsided severity. (With a ‘minor’ injury, the between the duty of care owed by a for example. The reporting form needs athlete can return to play immediately trainer doing what is essentially first to be able to follow an athlete at least following treatment; a ‘severe’ injury aid and that owed by a fee-for-service until the end of a day. requires immediate presentation to clinician to a patient. This difference a hospital accident and emergency could affect the level of recording department (A&E); ‘less severe’ is necessary to constitute a ‘reasonable’ somewhere in between.) This is record of events. completed as a rough copy by putting

VOLUME 25 – ISSUE 2 • winter 2007 15 FROMINJURY THE REPORTING CEO

ticks in the appropriate boxes during the Some 49 different events (over 800 • Event organisers appeared interested event. After the event, the trainer makes coverage hours), representing 12 in the statistics gathered. Even if this a fair copy, by turning the ticks into different sports, were covered by interest is not translated obviously numbers, and submits it to SMA(ACT) 17 trainers (some of whom covered to injury prevention action, at the with the invoice for the event. more than one event). The trial was very least it promotes the profile of evaluated, using questionnaires to injury prevention. An Incident Report (Fig. 3) for any trainers and clients, interviews with significant incident which, in the • The Executive Officer, SMA(ACT), SMA(ACT) staff and feedback from the judgment of the trainer, may give rise to estimated that the workload SMA(ACT) committee. claims against either the client or SMA. associated with the trial, apart from All ambulance calls are in this category. In summary, results from the trial were: a few hours of set-up, was an Reports are completed after an event with insignificant addition to the other • From the trainers’ responses, the details from the treatment log and are booking and billing tasks associated methodology allowed the majority of submitted to SMA with the invoice for the with event coverage. injuries to be recorded immediately event. If the trainer is unsure if an incident So the methodology appears reasonably after treatment. This gives some is worth reporting, at the very least the practical in a Safer Sport environment sense of confidence in terms of treatment log must have sufficient detail and trainers are prepared to use it. It relative completeness and accuracy to generate one later if asked. offers a standard way to record treatment of recording, with little reliance and provides statistics where currently on memory. 2. Trial it there are none; and it does this at a The Board of SMA(ACT) and • There was strong preference for the minimal cost of both time and money. National Office agreed to a trial using trial methodology over current forms Hence it appears a major improvement the methodology for all coverage which, if anecdotal evidence is to be over the forms suggested in the Sports undertaken over the five-month believed, are seldom, if ever, used. First Aid Manual, Level 1 Trainer Manual period between November 2004 and • Even though no direct benefit comes and other ad hoc survey forms being March 2005. The aim of the trial was back to the trainer from recording used for a purpose other than that for to measure the practicality and cost of statistics, there appeared to be a which they were designed. using the methodology and to see to strong belief among trainers that The SMA(ACT) committee was presented what extent the data collected met the reporting injury trends is worthwhile, with an interim report on the trial which needs of trainers, SMA, coverage clients provided it does not detract unduly included a summary of the statistics and any others with a general interest in from their ‘core business’. gathered. The committee concluded sports injury data. that the statistics were useful to the extent that they should continue to be collected.

Figure 3 - Sports Medicine Australia Incident Report What could be done next ATHLETE NAME: Sony Tavis Sporting injuries can be counted in TEAM: Hawker College many ways and there have been PLAYER: #2 innumerable studies focusing on sub- DATE: 8/3/04 sets of the problem: injuries within a TIME OF FIRST PRESENTATION: 1130 VENUE: Manuka particular sport, or age-group, or event, TREATED BY: JL or whatever.

DETAILS OF INJURY Of the various estimates of overall Inversion R ankle, pain 8/10 sporting injuries in Australia, most seem to focus on severe injuries (ie, those that TREATMENT present to hospital A&E, sports medicine 1130 Splint and stretcher off clinics or other medical professionals) 1145 Unable to tolerate ice, pain still 8/10. and for good reason, because these are Called ambulance and parents the most costly to treat and the sources 1155 Parents arrived and took charge keep formal records which can be 1200 Ambulance to Canberra Hospital A&E accessed for counting purposes. ADVICE GIVEN (Indicate to whom) But these are only the injuries that are COMMENTS serious enough to warrant professional 1500 From Teacher: x-ray confirmed fracture attention, and probably represent only a small proportion of all injuries across all levels of sport and recreation. Non-referred injuries may cost less to treat but, multiplied by their probable

16 Sport Health INJURY REPORTING

frequency, they would be a major of the ACT over the same period. So, if >> from Page 12 national cost and disincentive to the number of severe sporting injuries et al, 2007), whereas the bilateral L5 participation. Where participation in in the ACT over the period were known defects may involve a more ‘symmetric’ activities is being promoted as a health (roughly equal to A&E presentations due hyperextension of the lumbar spine. In benefit, they could be an important to sporting causes), then a reasonable the adolescent fast bowlers, the pars at factor in identifying the net benefit of estimate of total sporting injuries in the the L5 and L4 vertebral levels may be exercise. (Is it cheaper to treat sprained ACT could be calculated. particularly vulnerable to stress injuries ankles now than deal with obesity- Unfortunately, in 2005 the ACT as the maximal strength of the neural related conditions in 10 years time?) Department of Health did not keep arch in these caudal vertebrae may not occur until 30 years of age, although in Reliably recording injuries treated by records of whether or not presentations to hospital A&E departments were practice differences in the timing and/or SMA First Aid captures a much greater sporting injuries, but to do so would the injury mechanism/s for lesions proportion of injuries than those presumably be just a case of managing at these levels would appear to have currently accounted for as presentations the process and finding resources. implications for clinical decision making to hospitals or medical centres, or and potential interventions for injury counted via health insurance surveys. SMA, as a national organisation, offers management/prevention strategies. coverage in most areas of Australia. If The fact that severe injuries are identified Bailey et al, 1989. J Bone Joint Surg;71:1225-1231 and counted separately may offer a this injury recording methodology were Bailey et al, 1999. J Bone Mineral Research;14:1672-1679 means of estimating the total injury count used on a regional, state or national Bailey et al, 2003. J Musculoskel Neuron Interact;3:335-337 across a population. basis, it could provide a valuable source Engstrom & Walker, 2007. Med Sci Sport Exer;39:28-33 Engstrom et al, 2007. Med Sci Sport Exerc;39:910-917 of injury data where currently there is Following the trial, the SMA(ACT) Faulkner et al, 2006. J Bone Mineral Research;21:1864-1870 none; and this could be a fertile field for Committee required that statistics epidemiologists to play in. Acknowledgements collection continue for coverage The work reported in this paper was during 2005 and beyond. The resulting Acknowledgments supported in part by grants from the 2005 data covered a wide range of Canadian National Health and Research different sports (more than 12), with Sincere thanks go to: Development Program (DB) and the lots of participants (93,000) and lots of The Committee of SMA(ACT) for Australian Sports Commission (CE, DW). opportunity to get injured (4,200 hours). supporting the trial, and individual The breakdown by injury type held members for their constructive DA Bailey is at the School of no great surprises, nor was it possible suggestions, the Executive Officer Human Movement Studies, The to make much of the absolute figures SMA(ACT) for providing resources given the variety of sports and variable University of Queensland, and the duration of risk. However, it did indicate to support the trial and the many College of Kinesiology, University that 67 out of roughly 2000 injuries (a bit experienced trainers in the ACT who of Saskatchewan; CM Engstrom is under 3.5%) were severe. provided invaluable input and assistance at The University of Queensland; during this project. and DG Walker is at the School of Given the ACT population (330,000), the Human Movement Studies at The numbers are such that, in broad terms, John Lockie and Patricia Donoghue University of Queensland. the trial population might be considered are Level 2 Sports Trainers. as approximating the ACT as a whole. So This article is based on a paper the proportion of all injuries counted by they presented at the 2006 SMA SMA that are considered severe should Southeast Regional Conference. be reasonably close to the proportion of severe injuries that occurred in the whole

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Phone: (02) 9594 6580 • Email: [email protected] Internet: www.bbclasses.com.au b•a•c•k RUGBY LEAGUE Rugby league injuries at state

of origin level John Orchard and Wayne Hoskins

Injury incidence for the NSW Origin team over the period 2000-2006 was calculated as 327 injuries per 1000 player hours (based on medical presentation) or 98.9 injuries per 1000 player hours (based on missing a following game). These rates are signifi cantly higher than the comparative rates at an NRL club (the Sydney Roosters, with rates of 247 and 34.1 respectively) over the same time period. However, there are biases which could account for the higher calculated injury rates, including greater availability of medical staff at Origin level and fewer days until the following game after an Origin match.

Rugby league is a collision-type sport played in Australia, New Zealand, England and France at the professional level. There are 13 players on the fi eld at any given time with an interchange bench of 4 players. A maximum of 12 player movements per match are permitted, including interchanging for the blood bin and injuries1. Matches typically last for 80 minutes. Rugby League has a high rate of injury, particularly contact mechanism injury2, 3, as tackles occur in the game approximately every 10-15 seconds. An increased risk of injury with higher injury rate between the NRL team and Players are involved in 20-40 intensity play has been hypothesised9. the State of Origin team. physical confrontations per match4 Thus, it was the objective of this study with the percentage of injuries to present the incidence of injuries over Methods caused by tackling ranging between a seven-year period from 2000-2006 The medical offi cer for both the State 38.2% and 77.2% 5. In the hierarchy inclusive (21 matches) for one State of of Origin and Sydney Roosters team of matches played, international Origin team (New South Wales) and to prospectively recorded all injuries matches are offi cially the ‘top’ level compare the incidence to that seen at an presenting for treatment into injury of the game. However, the traditional NRL club (the Sydney Roosters) over the databases. Included in the databases three-match State of Origin series, same seven-year period. The fi rst author were all occasions of players leaving played between New South Wales of the study was the team doctor for the the fi eld (and being replaced) due to and Queensland during the middle two teams over this period. of the season, is considered to have injury or illness and whether the player perhaps the highest intensity of In addition to being a descriptive study, was subsequently able to return to the all matches. a particular hypothesis to be tested was fi eld or not and whether or not injuries that the intensity of State of Origin would caused players to miss subsequent Rugby league injury incidence has been games. The scope of the study was all previously reported. Although a number lead to an increased incidence of injury, of injury defi nitions have been used, a with the null hypothesis being that there games for the NRL (National Rugby large number of studies have defi ned would be no detectable difference in the League) matches (regular season and an injury as that requiring a ‘missed Table 1 - Format of State of Origin series 2000-2006 match’5, 6. Studies using this defi nition have documented incidence rates that Year Interchange rule Timing of matches Time between games Result have varied between 34.4 and 52.3 2000 Unlimited interchange Wednesday nights Two weeks NSW 3-0 injuries per 1000 hours5. While muscular injuries (haematomas and strains) are 2001 12 interchanges per team Sunday nights Four weeks Qld 2-1 the most frequently occurring injuries 2002 12 interchanges per team Wednesday nights Two then three weeks Drawn 1-1 in professional rugby league7, 8, when an injury defi nition requires a ‘missed 2003 12 interchanges per team Wednesday nights Two then three weeks NSW 2-1 match’, joint and ligament injuries and 2004 12 interchanges per team Wednesday nights Three weeks NSW 2-1 bone fractures become more frequent, 2005 12 interchanges per team Wednesday nights Three weeks NSW 2-1 particularly affecting the knee, ankle and shoulder5. 2006 12 interchanges per team Wednesday nights Three weeks Qld 2-1

VOLUME 25 – ISSUE 2 • winter 2007 19 RUGBY LEAGUE

Table 2 – Match injuries during Origin games for NSW team

Year Game Match Players Lacerations Missed Missed Missed 2-3 Missed 4 Missed Total injuries leaving no one games of more entire missed any field games game games season games injured 2000 1 6 1 2 1 1 2 3 2 3 3 1 0 1 1 2 3 5 4 1 3 1 1 2001 1 6 0 3 3 0 2 5 0 2 0 3 3 3 3 0 0 3 0 2002 1 6 2 2 2 2 2 2 7 1 3 0 3 1 4 3 5 0 0 3 2 2 2003 1 6 2 1 4 1 1 2 5 2 1 2 1 1 2 3 7 2 1 4 1 1 2 2004 1 7 0 0 6 1 1 2 5 0 0 4 1 1 3 5 0 2 2 1 1 2005 1 6 0 1 5 0 2 6 1 0 1 3 2 5 3 11 1 1 7 3 3 2006 1 5 1 0 4 1 1 2 4 0 0 4 0 3 6 1 1 3 1 1 2 Total 21 119 21 22 61 21 6 6 3 36

finals) and New South Wales State of in Tables 3 and 4. The injury rates both as an Origin match onset injury Origin matches. for the two levels of play are similar (although it had a gradual prodrome) although Origin injury rates are slightly and as an injury recurrence. Another The format of the State of Origin series higher, taking into account the various injury was an acute onset shoulder each year is listed in Table 1. definitions of injury. The exception was instability episode which involved a A match injury recurrence (for the State injuries causing players to leave the field, moderately-severe axillary nerve palsy. of Origin team) was defined as an injury which was higher at NRL level than Although this same player had been to the same body part which had been at Origin level (although not reaching carrying a chronic A/C joint injury on medically assessed prior to the start of statistical significance). the same side, this shoulder injury was the match and which caused the player not considered a recurrence. Subsequent to miss subsequent games for his club Serious injuries to these two major injuries, the players after the Origin match. involved missed game time in the season As seen in Table 2, there were only three after the onset of injury. The third match injuries which occurred during the 21 Comparisons between the injury injury which caused the player to miss Origin team matches that caused the incidences were done using a Taylor the remainder of the season was a grade player to miss the entire remainder of Series expansion and 95% confidence III knee MCL injury. intervals. Compared to other methods the season (approximately 3 months). for calculating confidence intervals, this One was a degenerative knee condition The six match injuries that caused the generally leads to slightly wider ranges. that appeared to have an acute onset players involved to miss at least four when the player was scoring a try during weeks (but not the remainder of the Results an Origin match. However, the player season) were a fractured clavicle, a had suffered some knee soreness for the fractured thumb, a grade II hamstring Match injury incidence for Origin games previous month (although neither the strain, another knee MCL injury, an ankle is detailed in Table 2, with comparative club nor Origin medical staff had noticed syndesmosis sprain and chronic ankle rates for the Sydney Roosters (at NRL an effusion). This has been recorded posterior impingement. level) over the same time period detailed

20 Sport Health RUGBY LEAGUE

Table 3 – Match injuries during Roosters NRL (first grade) games

Year Games Player Injuries Players Lacerations Missed Missed Missed 4 Missed Total hours leaving one 2-3 or more entire missed any field game games games season games injured 2000 30 520 184 56 21 8 6 3 2 19 2001 27 468 103 27 14 2 6 4 1 13 2002 28 485 127 37 24 8 8 3 4 23 2003 27 468 101 32 17 8 3 4 1 16 2004 27 468 87 36 10 5 2 5 0 12 2005 24 416 101 25 15 7 2 3 0 12 2006 24 416 99 29 7 3 7 2 3 15 Total 187 3241 802 242 108 41 34 24 11 110

Table 4 - Comparison of match injury incidence (NSW Origin vs. Roosters NRL)

Series Any medical Incidence any Incidence 2 + Incidence 4 + Incidence Incidence presentation missed games missed games missed games lacerations injuries leaving field Origin 2000-2006 326.9 98.9 41.2 24.7 60.4 57.7

Roosters 2000 353.8 37.8 21.9 9.9 40.4 107.7 2001 220.1 28.8 24.4 11.1 29.9 57.7 2002 261.7 49.1 32.0 15.0 49.5 76.2 2003 215.8 35.5 17.8 11.1 36.3 68.4 2004 185.9 26.6 15.5 11.1 21.4 76.9 2005 242.8 30.1 12.5 7.5 36.1 60.1 2006 238.0 37.6 30.1 12.5 16.8 69.7 Roosters 2000-2006 247.4 34.1 21.4 10.9 33.3 74.7 Odds ratio (Origin: 1.32 (1.06-1.65) 2.90 (1.96-4.29) 1.93 (1.09-3.40) 2.28 (1.09-4.78) 1.81 (1.13-2.91) 0.77 (0.47-1.27) Roosters) incl. 95% CI

One potentially serious match injury Injury risk of State of reason for the difference is probably suffered was a pneumothorax although, Origin matches mainly because the next game for Origin in terms of missed football time, this players is scheduled in 2-4 days time The raw risk of being injured during a only caused the player to miss two club (for Origin matches other than in 2001), State of Origin match (causing the player matches and he played his next match compared to an average of seven days to miss a club match) is 10% (36/357). in another Origin game three weeks for Roosters NRL games. The risk of This compares to a 4% risk of being after the initial injury. He successfully missing more than one game was 4% for injured during a Roosters NRL match completed this game although Origin players (15/357) compared to 2% (and then missing the following match) apparently had a recurrent rib injury for Roosters players (69/3077). later that season when playing for his over the same time period (110/3077). club (although no recurrence of the The player game exposure of 3077 for Management of lacerations the Roosters is calculated as being 17 pneumothorax). Over the 21 Origin games studied, there (number of players in a team) multiplied were 22 lacerations that required closure. No NSW players suffered knee ACL by the number of Roosters games per Eleven of these were initially closed with injuries in Origin matches over this season except for the final match of the staples, five were closed with sutures seven-year period, although one player year. The final match of the year is not and six with skin glue. In the time who was selected in the squad was ruled included in this exposure calculation as period from 2001-2006, when limited out in camp with a knee ACL injury that there was no match available to miss the interchange was used, only one player had occurred playing for his club the following week. weekend prior. It is noted incidentally was forced to interchange off the field that one Queensland player was known This difference in injury risk is statistically to have his laceration managed (and this to have suffered an ACL injury in the significant, meaning that it is unlikely was a forward who the coach elected Origin series over the same time period. to be due to chance. However, the true to have leave the field anyway). Other

VOLUME 25 – ISSUE 2 • winter 200 7 21 FROMRUGBY THE LEAGUE CEO

Table 5 - Training camp assessments NSW Origin team

Year Game Injuries Illnesses Injuries which: Players ruled out during camp: assessed treated Were Caused Were Occurred With pre- Due to Due to new from player ongoing during existing injury in illness in player’s to miss but had not training injury camp camp last match previous led to miss camp match 2000 1 7 0 3 0 4 0 2 0 0 2 6 2 2 2 2 0 1 0 0 3 7 3 5 1 1 0 1 0 0 2001 1 10 1 6 1 3 0 0 0 0 2 9 0 5 2 2 0 1 0 0 3 10 2 6 2 2 0 3 0 0 2002 1 7 4 4 1 2 1 1 0 1 2 11 2 6 2 3 2 1 1 0 3 10 1 4 2 4 1 2 0 0 2003 1 11 4 7 0 4 0 0 0 0 2 9 1 6 1 2 4 0 0 0 3 7 4 2 1 4 2 1 0 0 2004 1 15 4 6 1 8 0 4 0 0 2 10 3 6 2 2 1 4 1 0 3 9 0 6 2 1 2 1 0 0 2005 1 11 6 4 0 7 2 0 0 0 2 14 1 6 0 8 1 0 1 0 3 15 1 4 3 8 1 5 0 0 2006 1 9 4 4 0 5 3 1 1 0 2 8 9 2 0 6 1 0 0 0 3 15 4 3 1 11 1 0 0 0 Total 21 210 56 97 24 89 22 28 4 1

players were initially managed by team similar rate of injection (and for a similar the camp, so that some chronic injuries training staff with gel, gauze and tape profile of body parts) to that used by the (eg, bursitis) could be managed this and then had their wound closed by the same first author for regular season NRL way in camp. It is problematic avoiding doctor at the first available opportunity. matches11. Of these, approximately half contact training in the days after a Although the process of stapling players (17) were for injuries previously being cortisone injection in the regular season, on or near the sideline is controversial10, injected by their club doctors in NRL given the average of seven days only it has definitely allowed interchanges to games. Six of the 39 injuries were not between matches. be ‘saved’ by the NSW Origin team over injected pre-game by prior arrangement this time period. but were performed during the match Injury recurrence for an injury that occurred in the match As can be seen from Table 4, the match There were few recurrences from the itself. In addition, six extra players (on incidence of lacerations in Origin of 210 injuries assessed during Origin top of the 39) used an EMLA patch camps that worsened during Origin 60.4 injuries per 1000 player hours is (topical local anaesthetic) to play. matches. Incidents which were or may significantly higher than the rate at the have been considered recurrences Roosters over the same time period of Over the same time period, 12 cortisone included: 33.3 lacerations per 1000 player hours. injections were used on Origin players (in 21 training camps). Exact 1. A player who took a chronic ankle Use of cortisone and comparative figures for the Roosters for posterior impingement condition into local anaesthetic cortisone injections are not available, but an Origin game, which worsened during the game. He elected to Origin players were injected 39 times the Origin rate is likely to be higher. The 9-10 day period of an Origin camp gives have mid-season surgery after this with local anaesthetic to play over the game (mentioned above under time of the study, representing 10.9% of a more desirable ‘rest period’ after a cortisone injection, if completed early in serious injuries) and returned later in players taking the field. This is a very the season.

22 Sport Health RUGBY LEAGUE

2. A player who took a rib cartilage Discussion injury into an Origin game and, in Previous literature has demonstrated a new incident, was accidentally that severe injuries are more common at kicked in the chest and suffered higher levels of play at the professional a pneumothorax (also mentioned level12, 13. This has been suggested to be above). While technically the rib the result of factors such as an increased cartilage and lung are separate body intensity of play, increased player fatigue parts, the overlap between a rib and pressure on players to participate injury and a traumatic pneumothorax with minor injuries which are susceptible is such that this injury was to exacerbation and more severe injury14. considered to be a recurrence. At the professional level an increasing 3. A player who took a quadriceps number of players will miss a match strain into the game and suffered a each week with injury as the season minor re-strain in the final minutes progresses15. However, during the finals of the match. Although he actually series this number decreases. This has frequent in the State of Origin series. played very well, vindicating the been hypothesised to be a result of more Despite this high incidence, most of selection, because he was unable to aggressive medical management and these injuries are dealt with on the field back up for his club this technically players being more willing to take risks of play rather than utilising one of the was a recurrence. He only missed and carry injuries into important games15. 12 limited interchanges available. In the one match for his club. A similar situation may exist with State rugby league there is ‘limited’ rather 4. The player also mentioned of Origin rugby league, with it being a than ‘zero’ tolerance for player bleeding. previously under serious injuries who highly sought-after selection, so players If a player is seen to be bleeding, the had been suffering what appeared may be more likely to want to carry an referee allows him to remain on the to be minor knee soreness coming injury into the game. On the other hand, field and have the wound attended to into an Origin match and then had at Origin level there is often pressure before re-joining the play. If he is seen an acute episode during the match to from a player’s NRL club on the Origin to be bleeding a second time, the referee the same knee. medical staff to rule out players who are can then force him to leave the field. Although episode number 3 was carrying injuries that have any significant This ruling is now preferred to the use ‘unlucky’ to be considered an injury risk of recurrence, as the cost of any of a ‘blood bin’ with a free interchange, recurrence (as the selection to play was recurrence would be carried by the club as competitions which have trialled probably correct), there was one player more so than the Origin team. this have considered that too much who re-sprained an ankle during an A similar dilemma occurs in other sports, advantage was given to teams which Origin match and also didn’t play for his most notoriously in soccer, where received free interchanges from ‘blood club the following weekend. However, a player’s club side (eg, an English bins’. A number of procedures are used he was suspended for one match from Premier League team) may argue that a to close wounds such as bandaging, 10 an incident in the same Origin match, player should rest an injury whereas his suturing and stapling and generally so technically he did not miss a match national team may argue that he should lacerations do not cause the player to after the Origin with a recurrence from play in an international game. This arises miss any subsequent matches. the injury. because soccer internationals (like rugby A lack of literature documenting injury This list of injury recurrences makes league State of Origin) are often held recurrence exists in the sport of rugby the percentage of injuries which were mid-season. In sports or competitions league (as it does for many other sports). assessed that recurred 2% (4/210). where the international or representative At the professional level, recurrence rates Expressed as a percentage of team games are held at the end of the club have been measured at approximately matches, there were 0.19 injury season, there is relatively less pressure 10% of all injuries occurring12, with the recurrences per team match. from the club to have players rest minor most common injury types to be prone injuries. It is also worth noting that the to recurrence being back injuries, rib By comparison, the Roosters had concept of a State of Origin match was injuries, hamstring and quadriceps 26 injury recurrences over the time originally used in Australia in the sport of strains15. However, defining an injury period 2000-2006 (187 NRL matches), Australian Football for interstate matches recurrence and an ‘at risk’ injury remains from a total of 494 injuries that were between Victoria, South Australia and difficult. considered prior to the match to be ‘at Western Australia. However, the AFL risk’ of recurrence. This reflects an injury has ceased holding mid-season State of Further injury surveillance is required recurrence rate of 5% (26/494) and a Origin matches in recent years, partially at the NRL level to assess the impact rate of 0.14 recurrences per team match. because too many selected players were that participation in State of Origin It is difficult to draw any conclusions prevented from playing in them by their matches has on players for the duration between the recurrence rate at NRL clubs when carrying minor injuries. of the season. This has received level and Origin level because these anecdotal attention in recent seasons rates vary in an inconsistent fashion. The Lacerations are a very frequent injury as it has been suggested that teams 7 recurrence rates at both levels are fairly in rugby league , with the findings of with more representative players often low but obviously not zero. this study suggesting they are more suffer a slump in performance for 1-2

VOLUME 25 – ISSUE 2 • winter 200 7 23 RUGBY LEAGUE

doctor from 2000-2006 and has a PhD and MD in sports injury epidemiology. Wayne Hoskins is a medical student at the University of Melbourne who has previously published papers on rugby league injury epidemiology. Acknowledgment is extended to Elizabeth Steet, who is physiotherapist to the NSW State of Origin team and was physiotherapist to both Sydney Roosters and NSW Origin teams over the time of the study period. References 1. Orchard J, Steet E, Walker C. Effect of the limited interchange rule on players leaving the field at an NRL club. Sportslink. 2003;Sept:12-14. 2. Gibbs N. Common Rugby League Injuries: recommendations for treatment and preventative measures. Sports Medicine. 1994;18(438-450). 3. Gissane C, Jennings D, White J, Cumine A. Injury in summer rugby league football: the experiences of one club. British Journal of Sports Medicine. 1998;32:149-152. 4. Gissane C, White J, Kerr K, Jennings D. Physical collisions and injury rates in professional super months after the Origin series due recovery period they would receive after league rugby. Cleveland Clinic Journal of Medicine. to a combination of player fatigue a standard NRL match. Certain minor 2001;4:137-146. and injury. It would be interesting to injuries that would recover within seven 5. Hoskins W, Pollard H, Hough K, Tully C. Injury in rugby league: a review. Journal of Science and compare injury rates in NRL games for days may not have recovered within Medicine in Sport. 2006;9(1-2):46-56. the remainder of the season between the 2-4 day period. Notwithstanding this 6. Gissane C, Jennings D, Kerr K, White J. A pooled data analysis of injury incidence in rugby league Origin representatives and non-Origin bias, if a player does miss an extra match football. Sports Medicine. 2002;32(3):211-216. players to see whether there was a for his club, it has the same impact on 7. Seward H, Orchard J, Hazard H, Collinson D. Football Injuries in Australia at the elite level. major difference. team performance as if he had missed a Medical Journal of Australia. 1993;159:298-301. match from an injury playing in an NRL 8. Stephenson S, Gissane C, Jennings D. Injury in Recognised limitations exist in the study game, so it is not misleading to conclude rugby league: a four year prospective survey. British conducted. The number of players Journal of Sports Medicine. 1996;30:331-334. from this study that State of Origin participating in State of Origin and the 9. Gabbett T. Influence of training and match intensity games are more likely to lead to players on injuries in rugby league. Journal of Sports number of total matches is far less than Sciences. 2004;22(5):409-417. missing further matches through injury that of even a single NRL club, lowering 10. Orchard J. Video illustration of staple gun use than regular NRL games. to rapidly repair on-field head laceration. British the power of the study. The definition Journal of Sports Medicine. 2004;38(4):E7. of an injury, which is subject to debate 11. Orchard JW. Benefits and risks of using local anaesthetic for pain relief to allow early return 16 in the rugby league literature , is hard to Conclusion to play in professional football. British Journal of apply consistently between Origin and As the rates of injury are higher for Sports Medicine. 2002;36(3):209-213. 12. Gibbs N. Injuries in professional rugby league. A NRL levels. Although the team doctor State of Origin matches than NRL three-year prospective study of the South Sydney was the same for both teams in this games under most categories examined Professional Rugby League Football Club. American journal of sports medicine. 1993;21(5):696-700. study, at Origin level all training sessions (including lacerations) it suggests that 13. Gissane C, Jennings D, Kerr K, White J. Injury and even team functions were attended there is a consistently slightly higher rates in rugby league football: impact of change in playing season. American Journal of Sports by the doctor whereas for the Sydney injury incidence which may be due to Medicine. 2003;31(6):954-958. Roosters only matches, injury clinics the increased pace and intensity of the 14. Estell J, Shenstone B, Barnsley L. Frequency of Injuries in Different Age-groups in an Elite Rugby and occasional training sessions were game. However, because of the biases League Club. Australian Journal of Science and attended by the doctor. This gives a bias present in the study, further research is Medicine in Sport. 1995;27(4):95-97. required to confirm the hypothesis that 15. Orchard J. Missed time through injury and injury towards medical presentation at Origin management at an NRL club. Sport Health. level, compared to NRL level. the higher intensity of State of Origin 2004;22(1):11-19. leads to a higher injury rate. 16. Orchard J, Hoskins W. For Debate: Consensus injury If a ‘missed game’ definition of injury definitions in team sports should focus on missed playing time. Clinical Journal of Sport Medicine. is used, there is again a bias towards Authorship and 2007;17(3):in press. Origin games appearing to have a higher acknowledgement injury rate. This is because players must generally ‘back up’ within 2-4 days John Orchard is the Sydney Roosters after their Origin game for their club medical officer, a position he has held side, as opposed to the usual 5-9 day from 1998-present. He was NSW Origin

24 Sport Health PHYSIOTHERAPY Rotator Cuff Tear

Joseph Myers

Rotator cuff tears are among the rotator cuff disease) seen in younger the subscapularis. This ‘cascading effect’ most common causes of shoulder individuals to irreversible rotator cuff increases the load on neighbouring, pain and dysfunction in adults. It tears (Stage 3 rotator cuff disease) seen unaffected fibres. The supraspinatus is estimated that approximately in older populations. Both extrinsic and and infraspinatus are the two most 65% of the shoulder cases seen by intrinsic factors have been discussed common tendons involved with rotator orthopaedic surgeons and nearly as causative mechanisms of rotator cuff disease. Previous observations 33% of all orthopaedic injuries are cuff disease. Extrinsic factors include have shown that as tears migrate into related to rotator cuff pathology. primary and secondary subacromial neighboring tendon(s), post-operative Research studies have shown that a impingement and acromion morphology. strength, active range of motion and majority of individuals over the age Extrinsic factors like impingement result patient satisfaction suffer while the need of 60 have significant rotator cuff in tendon fraying from the pinching of for surgical intervention increases. It is disease including tears with 100% the supraspinatus tendon between the commonly recognised that functional of individuals over the age of 70 anterior portion of the glenoid and the outcome negatively correlates with exhibiting some form of rotator cuff coracoacromial arch during the functional the number of tendons involved (ie, disease. The prevalence of rotator task of arm elevation. This impingement more tendon involvement results in cuff tears (partial or full) greatly can lead to secondary, intrinsic factors diminished function). For example, increases after the age of 50, with accelerating the rotator cuff pathology. patients with isolated supraspinatus more than 50% over the age of 70 Intrinsic factors include vascularity tears have a higher functional capacity having a tear. In addition, more than abnormalities and primary degenerative to perform overhead tasks than patients 80% of those over the age of 80 had changes within the substance of the with a rotator cuff tear involving both a rotator cuff tear. In a community tendon. Vascularity abnormalities are the supraspinatus and infraspinatus. survey of 644 individuals older often attributed to the “critical zone”. Patients with small full thickness rotator than 70 years of age, approximately This zone is present when the head of cuff tears (ie, isolated supraspinatus 21% had some type of shoulder the humerus occludes vascularity of the tears) have a significantly higher rate of pain related to the rotator cuff. supraspinatus tendon during shoulder good to excellent outcomes compared to Magnetic resonance imaging (MRI) abduction. Chronic micro-trauma occurs patients with larger tears that involve the has demonstrated the incidence of from repetitive shoulder motion, which supraspinatus and infraspinatus. rotator cuff tear and reported that can develop into partial and complete 54% of the 46 individuals over the tears. Many of the changes produced by Functional impairment with age of 60 had some type of rotator decreased vascularity and chronic micro- rotator cuff tears cuff tear. Of the individuals who trauma have been attributed to ageing. were under 40, only 4% exhibited a These degenerative changes have been Individuals diagnosed with a rotator cuff tear. From these results, it appears observed in patients as early as their third tear commonly describe an impaired that rotator cuff lesions are a natural decade. It is believed that, as individuals ability to perform common activities correlate of ageing. get older, degenerative changes, of daily living that require shoulder such as loss of muscle fibre integrity, elevation overhead. Impairment included Pathology of rotator decreased cellularity and deformity in inability to lift a milk container, comb one’s hair and reach a high shelf cuff tendon the articular surface of the glenohumeral joint, occur more frequently, thereby prior to surgery. Preoperative patients The rotator cuff is one of the largest increasing the likelihood of chronic soft demonstrate an inability to actively tendonous structures in the body, playing tissue degeneration. flex, abduct and rotate the involved a key role in guiding movement and shoulder. Resisted elevation was also stability at the shoulder. High functional Rotator cuff degeneration is often the diminished in these patients. In a study demands placed on the rotator cuff may combination of two or more intrinsic of 237 shoulders with rotator cuff tears, subject the tendon to tissue overload and extrinsic factors. This degeneration 50% of the patients were unable to lift and failure, with pain manifesting initially develops in the supraspinatus a 1 lb object to a shelf, toss underhand, secondary to rotator cuff tear12. Rotator tendon near its anterior insertion. wash the back of the opposite shoulder cuff disease was classically described Supraspinatus tears tend to cascade and do their usual work. Those with a by Neer as progressing from reversible posteriorly into the infraspinatus then rotator cuff tear had difficulty lifting 8 lb anteriorly across the bicepital groove into subacromial impingement (Stage 1 >> to Page 30

VOLUME 25 – ISSUE 2 • winter 2007 25 SCIENCE Science in Australian sport: Its origins and challenges Frank Pyke *

One of the significant factors The Harvard Fatigue Laboratory had independently with a specific focus associated with Australia’s improved a major impact on our understanding on assisting participants with mental performance in international sport of exercise and sport physiology strategies and techniques. during the past two decades has not only within North America, but Unfortunately, none of these been the use made of science and internationally. Like Cotton, several advancements occurred soon enough to technology in preparing athletes for European scientists from Scandinavian prevent Australia’s dismal performance competition. Its sport scientists have countries as well as others from Italy, at the 1976 Montreal Olympics where become widely regarded throughout Belgium and Germany worked there it won only five medals, none of the world for their work with high during this era and then returned home them gold. There was a public outcry performance athletes and for the to apply their learnings. regarding these poor results which innovative technologies that they Cotton’s background in physiology, acted as a catalyst for Federal, State and have developed. combined with his experience as Territory Governments to direct more Science was first introduced to Australian a champion swimmer, led to him funding into elite sport. Subsequently sport back in the 1940’s and 50’s developing talent identification tests the Australian Institute of Sport was when Professor Frank Cotton from on bicycle and rowing ergometers opened in Canberra in 1981 and, during the Department of Physiology at the and conducting research projects on the following fifteen years, similar University of Sydney teamed up with swimming, running and rowing training. organizations were established in each fellow scientist and swimming coach, His influence was significant and State and Territory. Within this national Forbes Carlile. Together they developed provided an early cutting edge in the network of Institutes and Academies of scientifically based training programs training of athletes. He is regarded as Sport, sport science was regarded as an which were implemented by the coaches “the father of sport science in Australia”. essential ingredient of high performance of several swimmers who went on to programs and scientists from each of the Following Professor Cotton’s become Olympic champions at the 1956 sub-disciplines were employed to assist contribution, there was a lengthy period Games in Melbourne. These included coaches develop their athletes. when sport science progressed only Dawn Fraser, Murray Rose and Jon slowly as it tried to gain a toehold in While international success did not Henricks. It was at Cotton’s suggestion the Australian University system. This come immediately, there were clear that Henricks made the successful was finally achieved in the 1960’s and signs of a performance revival at the transition from distance swimmer to 70’s, mainly as a result of the efforts of a 1992 Olympics in Barcelona where sprinter and, in Melbourne, won the number of physical educators who had the Australian team won seven events 100 metre freestyle and was a member completed post-graduate qualifications and a total of 27 medals. And then, at of the winning 4 x 200 metre freestyle in exercise and sport science in North both the Sydney 2000 and Athens 2004 relay team. America and then returned home to play Olympics, Australia amassed its highest Cotton spent time during the 1930’s leadership roles in University programs. ever number of total and gold medals working as a foreign research fellow Their contribution was supplemented respectively,and on both occasions at the famous Fatigue Laboratory at by others who had a strong interest finished fourth on the medal tally among Harvard University in Boston. This in sport and were located in University competing nations. Excellent results have multi-disciplinary laboratory was active departments of anatomy, physiology, also been achieved by Australian teams between 1927 and 1947 and involved psychology, engineering or the in recent Winter Olympic, Paralympic physiologists, biochemists, physicians, physical sciences. and Commonwealth Games as well as psychologists and sociologists principally in non-Olympic sports such as cricket, Initially the dominant sub-discipline was dedicated to conducting both field and netball and golf. exercise physiology but others, such as laboratory research associated with the biomechanics, skill acquisition and sport During this period, sport science has World War II war effort. However, it also psychology, developed rapidly. Interest made rapid progress in Universities had a close connection with sport. Some in information processing and motor throughout the country and course of the subjects studied were champion control occurred a little later and the sub- graduates have played key roles in runners such as Clarence De Mar who discipline associated with developing the preparation of high performance competed in 32 Boston Marathons, and refining skill was subsequently athletes; some with national teams or winning seven, and Glenn Cunningham labelled motor behaviour. Sport professional football clubs and others and Don Lash, world record holders in psychology, which was firstly aligned with Institutes and Academies of Sport. the mile and two mile, respectively. with skill acquisition, also developed Sport science is also an important

26 Sport Health SCIENCE component of courses offered within the Research and Development competancy gaps, give them extra national coaching accreditation scheme responsibilities and encourage their If Australia is to continue to lead the way which provides coaches who work in development. in applied sport science it must bolster the high performance area with a solid its research efforts and encourage the The sport science trainee programs grounding in each of the sub disciplines. development of innovative methods and which exist in several Institutes and Some scientists have developed close technologies. Academies of Sport have provided some relationships with head coaches in opportunities for this process to occur. Scientists working within the Institute particular sports and between them Young scientists in their final year of and Academy network are heavily they have had a significant influence University studies have been placed with involved in the preparation of athletes on the performances of individual scientists and coaches in the network for competition which leaves them athletes and teams. Others have either who act as their mentors. Several with limited time for research and become successful elite coaches or high trainees have subsequently progressed to development projects. Scientists within performance program managers and, full-time positions within the placement University departments of exercise in these roles, have had an even more organization or, alternatively, have and sport science find that the funding direct effect on the quality of athlete found similar opportunities elsewhere available for research into high development programs. in the national network or with national performance sport is very limited so they sporting organizations. While sport scientists can take some seek grants in other areas, particularly of the credit for Australia’s turnaround from agencies in the health field. in international sport, there are still Individual Athlete Despite this, a number of innovative significant challenges ahead if they are Programming technologies have been developed in going to continue to provide athlete the areas of performance evaluation, Increased attention needs to be given to preparation programs with a competitive equipment design, movement and prescribing training programs based on edge. It will require greater emphasis game analysis, decision making and individual need. The scientific support being placed on collaboration, research anticipation training which are world team is in the best position to play a and development, succession planning leading and have helped create a lead role in this process. Where should and individual athlete programming. winning edge. training time be best spent - on fitness, technique, tactics or psychological Collaboration However, it is vital that more substantial attributes such as the capacity to funding is dedicated to research in elite Some scientists need to adopt a more concentrate and manage anxiety? How sport. Grants need to be available to collaborative mind-set, where they not much recovery time should be allowed? both the Sports Institute/Academy and only work closely with athletes and University sectors in order to validate In order to maximize the overall coaches but with all other members the content of existing high performance effectiveness of the training program, of the athlete support team. Too often programs as well as discover new ways it is important that the coach not only we find scientists from a particular forward. Close collaboration between understands the demands of the sport sub-discipline preferring to work staff working in each of these sectors but also the attributes of each athlete. independently. This raises the question- should be strongly encouraged in grant Athlete evaluation procedures which Is sport science fragmenting? Is there applications and throughout the conduct identify individual strengths and too much specialization and not enough of research projects. limitations are part of the arsenal of integration. A multi-disciplinary approach sport scientists and should be utilised is required to maximize the benefits of Succession Planning extensively in planning programs and science to the athlete. This is the case monitoring progress. whether planning individual training The objective of succession planning is programs, competition strategies or to facilitate a seamless transition from Conclusion rehabilitation following injury. one generation to the next. Valuable information and skills have often been If Australia is to maintain its present high While there are occasions when lost when a senior person such as a standing in world sport it is essential scientists from the same sub-discipline head coach or sport science coordinator that it continues to build on the early need to focus on a specific issue, they leaves an organization.This is felt even scientific work of Professor Frank Cotton also need to understand that biological more if that person moves to a rival club and scientist / swimming coach Forbes systems and organs are interrelated. This or overseas country. Carlile in seeking to gain a competitive requires pooling the collective expertise advantage over its rivals.This will require of the multi-disciplinary support team In order to retain some of this athletes to have state of the art training which not only includes other sport knowledge, it is important to have methods and cutting edge technologies scientists but also physicians, physio a mentoring system in place which at their disposal. A team approach, and massage therapists, nutritionists, prepares others to either fill the breach managed by the coach, in consultation physical preparation staff and career and or remain within the organization in with the athlete, and including scientists education advisors. Good teamwork some expanded capacity. It is good from each of the sub-disciplines as is based on open communication, a management practice to identify well as other support personnel, will willingness to collaborate and a shared someone within the organization go a long way to ensuring that the commitment to provide athletes with who has the potential to replace an potential of the country’s athletic talent support of the highest quality. incumbent if it becomes necessary. is maximized. This allows time to fill any of their >> to Page 30

VOLUME 25 – ISSUE 2 • winter 200 7 27 INJURY RISK Ground conditions and injury risk What do we really know? By Dara Twomey

The social, economic and methodology to enable this link to be Although the hardness of grounds in the environmental effects of the drought made.7 The majority of the research Australian Football League (AFL) was on the farming community are undertaken in this area in Australia has measured using a penetrometer as an widely publicised and acknowledged, been in elite Australian Rules football objective measure15, most other studies however, the implications of and more recently in rugby league. Also, used subjective measures or player recall these dry conditions on the risk it is important to note that the emphasis to determine hardness.17 Game speed of injury while playing sport on has been on injuries to the lower limb has also been correlated with hardness harder ground is also of critical in many studies and has even been of playing conditions at elite level importance to the well being of restricted to specific lower limb injuries, football and rugby league, with harder sporting communities. At present, such as anterior cruciate ligament injuries grounds having a faster game speed.18,19 natural turf surfaces throughout (ACL), in some studies. Factors including Norton et al. (2001)18, also reported that Victoria and elsewhere in Australia hardness, traction, grass type, and there would be an increased collision are being declared unsuitable for weather have all been cited as possible impact force on harder ground due players and consequently closed for contributing factors in the link between to faster game speed. According to use. Therefore, it would seem both injuries and ground conditions. Milburn & Barry (1998)1, harder ground pertinent and opportune to examine The two main surface characteristics that results in increased strain on ligaments the existing evidence of injury have been related to injury, particularly and tendons and is therefore thought risk on harder, drier natural turf of the lower limb, are ground hardness to contribute to higher injury rates. surfaces and the links that have been (the effect that the surface has on Interestingly in another study20, although reported between ground conditions absorbing impact energy) and traction higher levels of injuries were associated and increased injury risk. (the type of footing or grip a surface with harder ground conditions this Intuitively, there exists a relationship provides).8 Traction is most highly relationship disappeared when adjusted between extremes in surface conditions correlated with grass cover and hardness for time of the season, suggesting that and injury. For example, a harder/drier with soil moisture content.9,10 An early- the association initially found may have surface would prevent the sliding that season bias reported in injury rates11-14 been spurious.20 Also, in the UK when reduces torsional loading on the leg was one of the main instigators for the rugby league season was changed during sudden movement or contact linking ground hardness with increased from winter to summer they attributed with another player, but could increase injury risk. In the seasons 1997 – 2000, some of their increase in injury incidence 15 the risk of injuries, such as fractures, Orchard found that the rates of injury to ground conditions, but lacked solid when players are falling on the hard in the Australian Football League (AFL) evidence due to observational measures surface. Equally, a softer surface will in Victoria were lower than those of the of the ground conditions.21,22 Friction reduce friction and cause slipping more northern states of Australia. The and torsional resistance from boots during sudden movement but will be greatest discrepancy of incidence due 1 15 has been shown to be higher in drier a softer landing for players. However, to location was in ACL injuries. This conditions on natural grass compared to there has been a paucity of published was attributed to weather conditions wet conditions23 which may increase the studies in international sports science and hence ground conditions but it is risk of injuries. Moreover, Lambson et al. and sports medicine literature that have also important to note that the type of (1996)24 found that the wearing of a boot conclusively and validly related sports grass on the football fields varied with with longer and more peripheral cleats injuries to ground conditions. From climate. Orchard (2001)14 found there was associated with an increased risk of an international perspective, various was no significant relationship between characteristics of ground conditions have ground hardness and risk of ACL injuries anterior cruciate ligament (ACL) injury been linked to injuries in such sports as at elite level football but there was a due to increased shoe-surface traction on American football, soccer, rugby union, trend towards an increased risk when natural grass. A factor often implicated and Gaelic football.2,3,4,5,6 Many of these the ground was harder. While ACL in the non-contact ACL injuries is the have been sports injury epidemiology injuries, due to their severity, frequency interaction between the player’s shoe 25 studies which have not been able to and burden on the health care system, and the playing surface , however there determine causality between ground have been the focus of much research is a lack of reliable findings to support or conditions and injury risk because, on ground conditions, other non-contact refute this. either they did not collect the necessary injuries to the lower limb have also been The main equipment used in previous 16 ground conditions/weather data during reported in warmer, drier climates. studies for measuring ground hardness the study or they did not use appropriate are the Clegg hammer and the

28 Sport Health INJURY RISK

penetrometer. The Clegg hammer Naturally, the weather has a direct effect In conclusion, there would appear to be measures maximum deceleration for on the condition of the ground and very little solid evidence to substantiate a light object but doesn’t penetrate hence has been a factor linked to injury the notion that drought stricken grounds the thatch layer, and the penetrometer risk and ground conditions. Increased are much too dangerous to play on and measures depth of soil penetration.15 rainfall results in increased soil moisture. require immediate closure. This is not Penetrometers have revealed a slight Orchard (2001)14 stated that in the longer to say that some players will not sustain softening of the ground over the term, traffic on grounds with greater injuries on hard playing fields and progression of the winter season but moisture will have an adverse effect undoubtedly there would be an increase can vary significantly with the amount on the thatch layer of the grass. He in abrasions, repetitive microtrauma of recent rainfall.15 There appears to found that ACL injuries in the AFL were injuries and possibly fractures. However, be no universally accepted tool to associated with reduced rainfall over there is a paucity of evidence to suggest measure shoe-surface interaction, the previous year, and not over shorter that there is a significant increase in however, it is presently an emerging periods, suggesting that long-term effects injury rates and hence an increased area of development. The studded of rain on the thatch layer (reducing injury risk. To date there has not been boot apparatus which measures grass root density) were more important any research to link ground conditions rotational traction or grip has increased than the soil moisture content.14 Orchard in community grounds to injury risk in popularity but its use has not yet also found that weather conditions in players using them. The fact that been well published. Importantly, the associated with dry field conditions players may naturally adjust their playing reliability relationships between these were also significantly associated with behaviour as a protective mechanism measuring tools, and their link with injury risk.14 The specific weather against injury on harder surfaces must injury risk has not been well established. patterns were high water evaporation also be considered. The literature to date in the month before the injurious match suggests that many gaps in this area of Grass type has been a factor associated and low rainfall in the year before the research need to be addressed to make with injury, particularly anterior cruciate match.14 In a recent study examining the significant advances and provide a solid ligament injuries.26 The main types influence of environmental and ground evidence base for the development of of grasses used on football fields in conditions on injury risk in rugby league, injury prevention strategies in the future. Australia are, bermudagrass, kikuyu they also found that less rainfall was Currently, work is being undertaken grass, rye grass and rye/annual blue also associated with a higher number of by the University of Ballarat to address grass mix. Most of the AFL grounds, match injuries.19 some of the gaps and provide evidence where elite level matches are played, of injuries related to ground conditions at are covered in either rye grass or One major limitation of the research community level football and to examine annual blue grass or a mixture of both to date is that most of the ground the validity and reliability of ground of these.27 Orchard (2002)16 found in conditions when related to injury have measuring equipment. The findings of a study of AFL matches and grounds been based on subjective observations this research, expected to be published over a five year period that there was rather than direct measurements.4,31 in 2008, will undoubtedly have a positive a 26% increased risk (1.26 relative risk) In most cases, the reliability of these impact on the health and wellbeing of of lower limb injury on bermudagrass observational checklists have not been sporting communities both nationally predominant grounds over rye grass established and their validity has been and internationally. predominant grounds. Rye grass is assumed. Another significant limitation considered to lead to lower shoe- with all of the work carried out on REFERENCES surface traction than bermudagrass ground conditions linked with injuries in 1. Milburn, P. & E. Barry (1998). “Shoe-surface because it creates less thatch and does Australian Rules football to date is that it interaction and the reduction of injury in rugby not contain stolons which may create has all been based at elite level venues. union.” Sports Medicine 25(5): 319 - 327. 2. Andresen, B., et al. (1989). “High school football excess friction between shoes cleats and The extrapolation of the results from injuries: field conditions and other factors.” grass layer.26,28-30 Chivers et al. (2005)26 these studies to sub-elite, community Winconsin Medical Journal 88 (10): 28-31. have recently analysed the percentage or junior level is questionable and has 3. Cromwell, F. & J.G. Walsh (2000). “A pilot study examining injuries in elite Gaelic footballers.” British of bermudagrass and annual blue not been substantiated. Interventions Journal of Sports Medicine 34: 104-108. grass over the course of the season on such as ground watering, clearly 4. Alsop, J.C., et al. (2000).”Temporal patterns of injury during a rugby season. “Journal of Science and various AFL grounds and found a high inappropriate in drought conditions, Medicine in Sport 3(2):97. 14,15,32 correlation between grass type and have been suggested , but any 5. Durie, R. & A. Munroe (2000). “A prospective ACL injury incidence. Their findings intervention cannot be put into place survey of injuries in a New Zealand schoolboy rugby population.” New Zealand Journal of Sports suggest that annual blue grass mixed until the exact nature and contribution Medicine 28(4): 84-90. with either rye or bermudagrass may of ground conditions and shoe- 6. Wong, P. & Y.Hong (2005). “Soccer injury in the lower extremities.” British Journal of Sports have higher ACL injury risk than rye surface interactions to injury risk has Medicine 39: 473-482. grass alone. Since rye grass has been been established. Furthermore, the 7. Sport & Recreation Victoria (2007). “Sports Ground traditionally associated with cooler drier interactions of grass type, player’s choice Conditions and Injury Risk – Implications for sports grounds assessment practices in Victoria.” Retrieved climates it has been the predominant of boot and shoe-surface interaction May 28, 2007, from http://www.sport.vic.gov.au grass type on Victorian football fields. are not yet well understood. It would 8. Orchard, J., et al. (1999). “Rainfall, evaporation and the risk of non-contact anterior cruciate ligament As a consequence of the current therefore seem premature to be making injury in the Australian Football league.” Medical climatic changes and escalating drought recommendations about what are Journal Australia 170: 304 - 306. experienced, it may no longer be the acceptable ground conditions with 9. Baker, S. (1991). “Temporal variation of selected 33 mechanical properties of natural turf football most suitable grass type for football respect to preventing injury. pitches.” Journal of Sports Turf Research Institute fields in Victoria. 67: 53 - 65.

VOLUME 25 – ISSUE 2 • winter 200 7 29 INJURY RISK

10. Bell, M. & G. Holmes (1988). “The playing quality 20. Lee, A. & W. Garraway (2000). “The influence of 28. Chivers, I. & D. Aldous (2004). “Performance of association football pitches.” Journal of the Sports environmental factors on rugby football injuries.” monitoring of grassed playing surfaces for Turf Research Institute 61: 19 - 47. Journal of Sports Science 18: 91 - 95. Australian Rules football.” Journal of Turfgrass and 11. Ekstrand, J. & B.Nigg (1989). “Surface-related 21. Gissane, C., et al. (2003). “Injury rates in rugby Sports Surface Science 70: 73 - 80. injuries in soccer.” Sports Medicine 8(1): 56-62. league football: impact of change in playing 29. Mueller, F. & C. Blyth (1974). “North Carolina high 12. Seward, H., et al. (1993). “Football injuries in season.” American Journal of Sports Medicine 31: school football injury study.” Journal of Sports Australia at the elite level.” The Medical Journal of 954 - 958. Medicine 2(1): 1 - 10. Australia 159: 298-301. 22. Hodgson, L., et al. (2006). “An analysis of injury 30. Orchard, J. (2000). “The ‘northern bias’ for injuries 13. Hawkins, R.D. & C.W.Fuller (1999). “A prospective rates after season change in rugby league.” Clinical in the Australian Football League.” Australian epidemiological study of injuries in four English Journal of Sports Medicine 16(4): 305 - 310. Turfgrass Management 23(June): 36 - 42. professional football clubs.” British Journal of Sports 23. Heidt, R. J., et al. (1996). “Differences in friction 31. McMahon, K., et al. (1993). “Australian Rules Medicine 33(3): 196-203. and torsional resistance in athletic shoe-turf surface football injuries in children and adolescents.” The 14. Orchard, J., et al. (2001). “Intrinsic and extrinsic interfaces.” American Journal of Sports Medicine Medical Journal of Australia 159: 301 - 306. risk factors for anterior cruciate ligament injury in 24(6): 834 - 842. 32. Griffin, L., et al. (2006). “Understanding and Australian Footballers.” The American Journal of 24. Lambson, R., et al. (1996). “Football cleat design preventing non-contact anterior cruciate ligament Sports Medicine 29(2): 196-200. and its effect on anterior cruciate ligament injuries: injuries.” American Journal of Sports Medicine 15. Orchard, J. (2001). “The AFL penetrometer study: a three year prospective study.” American Journal of 34(9): 1512 - 1532. work in progress.” Journal of Science and Medicine Sports Medicine 24(2): 155 - 159. 33. Orchard, J. & H. Seward (2006). “AFL Injury in Sport 4(2): 220 - 232. 25. Livesay, G., et al. (2006). “Peak torque and Report.” Sport Health 24(3): 15 - 20. 16. Orchard, J. (2002). “Is there a relationship between rotational stiffness developed at the shoe-surface ground conditions and climatic conditions in interface: the effect of shoe type and playing Dara Twomey is at the football?” Sports Medicine 32(7): 419 - 432. surface.” American Journal of Sports Medicine University of Ballarat School 17. Alsop, J., et al. (2005). “Playing conditions, player 34(3): 415 - 422. preparation and rugby injury: a case-control study.” 26. Chivers, I., et al. (2005). “The relationship of of Human Movement & Sports Journal of Science and Medicine in Sport 8(2): 171 Australian football grass surfaces to anterior cruciate - 180. ligament injury.” International Turfgrass Society Science. Correspondence: 18. Norton, K., et al. (2001). “Evidence for the aetiology Research Journal 10(1): 327 - 332. [email protected] of injuries in Australian football.” British Journal of 27. Orchard, J., et al. (2005). “Rye grass is associated Sports Medicine 35: 418 - 423. with fewer non-contact anterior cruciate ligament 19. Gabbett, T., et al. (2006). “Influence of injuries than bermuda grass.” British Journal of environmental and ground conditions on injury risk Sports Medicine 39: 704 - 709. in rugby league.” Journal of Science and Medicine in Sport, In Press.

>> from Page 25 >> from Page 27 above their head without bending the are more likely the result of the actual The competitive standards in international elbow and could not throw a softball tear, and not the pain associated with sport are forever on the rise and overhead. It has also been demonstrated it. From the results of our research, being good enough today provides that patients with isolated supraspinatus physicians and therapists may now no guarantee that this will be the case tears had less difficulty with overhead implement rehabilitative interventions tomorrow. Everyone involved in the tasks such as placing objects on to either as a means of conservative prepararation of athletes must strive for a shelf overhead than patients with treatment or prior to and following their continual improvement so that good supraspinatus and infraspinatus surgical intervention that specifically performances become even better, until involvement, but were still dysfunctional. address the deficits identified. As a result, the better ones become the best. The use functional outcomes should exhibit of modern science and technology is an Over the last three years, we have improvement. essential part of this process. strived to identify the biomechanical, neuromuscular and pain factors that Dr Joseph Myers is Assistant Further Reading impair the overhead function in patients Professor in Sports Medicine Horvath, S.M. and E.C. Horvath (1973). with symptomatic, full thickness tears (School of Health and The Harvard Fatigue Laboratory: Its of the supraspinatus and supraspinatus- Rehabilitation Sciences) and History and Contributions. Englewood infraspinatus. While data collection is Assistant Professor in Orthopaedic Cliffs, New Jersey: Prentice Hall continuing, an analysis of the current Surgery (School of Medicine) at data suggests that individuals with full Massengale, J.D. and R.A. Swanson the University of Pittsburgh and thickness rotator cuff tears demonstrate eds.(1997). The History of Exercise one of the keynote speakers at the decreased humeral rotation strength and Sport Science. Champaign, Illinois: 2007 SPA Conference. For a full (predominantly internal rotation); Human Kinetics. decreased humeral elevation strength; author biography and details of Vamplew, W., Moore, K., O’Hara, J., decreased external rotation, abduction, Joseph’s conference presentation, Cashman,R.A. and I.F. Jobling (1992). flexion and extension range of motion; visit the APA website: http://www. The Oxford Companion to Australian decreased scapular upward rotation and apaconferenceweek07.asn.au/nsg/ Sport. Melbourne, Australia: Oxford elevation; and more variability in muscle spa_program.htm University Press. activation patterns of the shoulder girdle, with suppression of the dynamic *Dr Frank Pyke was the Executive stabilisers being a common theme. Director of the Victorian Institute Additionally, these results are consistent of Sport between 1990 and 2006 after the injection of lidocaine to and is now an Adjunct Professor decrease pain (average drop in pain at Deakin University and the was three points on a 10 point VAS), Universities of Queensland suggesting that the deficits experienced and Ballarat.

30 Sport Health BULLETIN Notice of Annual General Meeting and Call for Nominations

Notice is hereby given that the Annual General Meeting of Sports Medicine Australia will be held at the Adelaide Convention Centre, North Terrace, Adelaide, South Australia at 4.45PM Tuesday 16 October 2007.

Agenda 1. Opening 6. Consideration of financial statements & audit report 2. Roll Call, Apologies and Proxies 7. Board Election (if required) 3. President’s Welcome 8. Appointment & remuneration of auditors 4. Minutes of the Previous AGM 9. Special Business 5. Reports 10. Close

Call for Nominations – Board of Directors Members are asked to provide nominations for positions on the Board of Directors of Sports Medicine Australia. Executive Members: • President • Vice President • Financial Director

National Directors • NSW • South Australia

Discipline Director

I of hereby nominate for the position of on the National Board of Directors of Sports Medicine Australia

Proposer’s Signature Date

Seconder (full name)

Seconder’s signature Date

Nominations should reach: Sports Medicine Australia, PO Box 78, Mitchell, ACT 2911 or fax to (02) 6241 1611 BY NO LATER THAN 5.OO PM (EST) ON MONDAY 24 September 2007

VOLUME 25 – ISSUE 2 • winter 2007 31 FROM THE CEO

Notes to the validity of nominations to the Board of Directors of SMA Appointment and Election of Appointment and Election of Appointment and Election of the Executive National Directors the Discipline Director Any nominee for the Executive shall not Each State Branch shall elect a National Discipline Groups will be asked to vote be eligible unless they have served on Director from and by the Federation for nominations to the position of the the Board for 2 of the last 5 years. A membership in their state through Discipline Director at their Discipline nominee for the position of President elections coordinated by the CEO. Group AGM. must also have served on the Board for Any nominee for National Director shall The Discipline Director will be elected at the 12 month immediately prior to his not be eligible unless they have served the AGM by the Council of Disciplines. nomination. at least two of the last five years on their Any nominee for Discipline Director A retiring President shall not be eligible State Council or Board. must be a member of a Discipline for any Executive position for a period of Group. 2 years following his retirement from the office of President.

Thomas Franklyn Penrose (1933-2007) It is with great sadness that I announce Western Australia in 1974 to undertake held positions as an Exercise Science that Tom Penrose passed away early PhD studies (all but handing that thesis and Injury Prevention consultant for Tuesday morning, 12 June 2007, after in). Tom then returned to Wollongong numerous community organizations, a short but acute fight with cancer. He in 1978 to take up a Senior Lecturer including his beloved Illawarra Hawks only began feeling ill in late April this position at the University of Wollongong, NBL team. year and was diagnosed with cancer where he remained until retiring in 31 I was privileged to have worked with just 3 weeks ago. His son, Jason, December 1996. Tom here at Wollongong for over a let us know that it was a very rapid At Wollongong Tom was the driving decade, sharing with him the experience deterioration but, fortunately, he did not force behind establishing, in 1984, of establishing those first courses in suffer badly or for long. the Human Movement and Sports Human Movement and Sports Science. Tom was a passionate pioneer of Science program, which provided the In fact, it was via Tom’s support that Exercise Science and Rehabilitation here foundation of the Exercise Science I was given a chance to start my own at Wollongong and throughout Australia, and Rehabilitation programs we have academic career at Wollongong. Tom’s and for this reason I would like to today. Twenty one years ago he also unselfish passion and determined share a few highlights of Tom’s career. pioneered establishment of the Illawarra drive to develop the profession of After completing a Diploma of Physical Academy of Sport, which has become Exercise Science, together with his Education at the University of Sydney a model for regional academies of love of basketball, will stay with me (College of Education) in 1954, followed sport across Australia. Tom was also a as inspiration to ensure we continue by teaching positions within the NSW highly active member of the Australian to provide innovative and professional Department of Education, Tom ventured Sports Medicine Federation (South Coast programs in Exercise Science here at to the University of Oregon to complete Branch), the Illawarra Sports Medicine Wollongong and throughout Australia. his Master of Science (1965). In Centre and, during its formative years, Our hearts are with his wife, Patricia, February 1966 he joined the Wollongong the Australian Association of Exercise and his children, Jason and Lisa, at this Institute of Education as a Lecturer & Sport Science, acting as National sad time. before traveling to the University of Secretary from 1991-1993. He also Julie R Steele

Goings This is the last edition to be prepared by Managing Editor, Dominic Nagle, who has sold out and gone to work for the AMA. The new Managing Editor will be Lesley Crompton ([email protected])

32 Sport Health