VOLUME 26 – ISSUE 4 • summer 2008

Opinions expressed throughout this journal are the Contents contributors own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be YOU HEARD IT FIRST AT SMA 2 held responsible for the accuracy of statements made ‘May we find the wisdom to stop repeating the mistakes of history’ in advertisements nor the quality of the goods or services advertised. All materials copyright. Gary Moorhead On acceptance of an article for publication, copyright passes to the publisher. THERE’S STATS AND THEN THERE’S EDUCATED GUESSWORK 4 Publisher Medicine is a science and this is what separates it from witch-doctoring Sports Medicine Australia or faith-healing PO Box 78 Mitchell ACT 2911 Tel: (02) 6241 9344 Dr J Fax: (02) 6241 1611 Email: [email protected] CAN SOFT TISSUE MOBILISATION BE A STIMULAUS FOR FACILITATING Web: www.sma.org.au NEUROMUSCULAR CONTROL AND LEARNING? 6 Circulation: 4000 ISSN No. 978-0-9805297-2-2 The example of Triathlon and optimal neuromuscular control Editors Andrew Chapman John Orchard & Janelle Gifford Managing Editor PERSPECTIVES FROM BEIJING 8 Lesley Crompton By a jack of all trades and master of resourcefulness! Chief Executive Officer Gary Moorhead Liz Broad Subscription Manager INTERESTED IN PROMOTING WALKING AT WORK? Ken Warwick FIRST THINGS FIRST, ASSESS YOUR WORKPLACE ENVIRONMENT! 11 Advertising Manager Lesley Crompton Researchers from ten universities aim to promote employee physical Design/Typesetting activity through workplace walking at each of their respective institutions Whalen Image Solutions Nicholas Gilson SMA State Branches SPORTS PERSONAL ACCIDENT INSURANCE: ARE YOU REALLY COVERED? 15 ACT Coaches, referees, other officials and volunteer workers may not be covered ACT Sports House, 100 Maitland St Hackett ACT 2602 Tel: (02) 6247 5115 Nello Marino New South Wales PO Box 3176 Rhodes NSW 2138 FOOTBALLERS AND FORTITUDE – WHY ICONS OF THE GAME CAN ‘LOSE IT’ 17 Tel: (02) 8116 9815 Five different reasons why some footy players ‘lose it’ on and off the field Northern Territory PO Box 2331, Darwin NT 0801 Clive Jones Tel: (08) 8981 5362 CONFERENCE 20 Queensland Sports House, 150 Caxton St, Milton QLD 4064 What’s happening at ‘be active ‘09’ and wrap up of the 2008 conference Tel: (07) 3367 2700 Davina Sanders South Australia PO Box 219, Brooklyn Park SA 5025 THERAPEUTIC JOINT AND SOFT-TISSUE INJECTIONS 26 Tel: (08) 8234 6369 A discussion of different soft-tissue injections and their evidence of efficacy Victoria and Tasmania Sports House, 375 Albert Rd, South Melbourne Justin Paolini VIC 3205 Tel: (03) 9674 8777 POSTOPERATIVE MANAGEMENT OF ATHLETIC ANKLE INJURY 28 Western Australia Challenges for the Physiotherapist when rehabilitating an athlete after ankle surgery PO Box 57, Claremont WA 6010 Stuart Imer Tel: (08) 9285 8033 CRICKET AUSTRALIA INJURY REPORT 2008 32 Subscription Rates 2008 An analysis of injuries sustained in Australian Cricket over an entire decade Australia A$35 Overseas A$50 John Orchard, Trefor James, Alex Kountouris and Marc Portus SMA members receive Sport Health as part of their membership fee TENNIS DRUG BAN PROVES THAT WADA HAS LOST THE PLOT 44 Single copies and back copies A$15 One of the worst ever drugs-in-sport decisions has recently been handed (includes postage) down by the International Tennis Federation PP No. 226480/00028 John Orchard For subscriptions contact Ken Warwick Phone: (02) 6241 9344 Cover photograph: Australian Sports Commission Email: [email protected] From the CEO You Heard it First at SMA

By Gary Moorhead

When people make mistakes – and US Surgeon General’s Report on Physical guidelines’ by doing 30 minutes of particularly where similar mistakes Activity and Health, and led to the moderate physical activity and sitting for have been made in the past - they are development of national physical activity the rest of the day. (8) often criticised by referral to George guidelines in mnay countries, including Brown’s proposition received support in Santayana’s aphorism “those who cannot Australia, which now encourages people an article published in the October 2008 remember the past, are condemned to to “put together at least 30 minutes of edition of the American College of Sports repeat it”. (1) Santayana went on to moderate-intensity physical activity on Medicine’s journal Exercise and Sports say: “May we find the wisdom to stop most, preferably all, days.” (6) Science Reviews. This paper (9) focused repeating the mistakes of history”. In her presentation at the 2008 SMA mainly on the impact of sedentary, as A determination to learn from the past conference, Brown raised the possibility opposed to active behaviour; however, underpins many research projects, that basing today’s guidelines on data it included data which showed that, particularly longitudinal studies. collected in the ‘60s and ‘70s may in a person whose activity never rose Longitudinal studies usually follow be problematic, because, in terms of above “light”, daily energy expenditure one or more very large cohorts of physical activity, the past really is a substantially exceeded that of another subjects over long periods of time with “foreign country.” With significant person who had engaged in an hour of continuous or repeated monitoring of technological change in transport, structured exercise during the day. The the subjects to help understand the communication, work and leisure, the American paper supported Brown’s 2002 matters under investigation. It could amount of “incidental” physical activity paper in also raising the “importance be said that by researching using in normal daily living has decreased of considering the full range of energy longitudinal studies, we are ensuring that markedly since the 60s. Everyone is expenditure rates observed in the activity we are “remembering the past” and not familiar with examples of the loss of range below moderate intensity.” repeating the “mistakes of history”. physical activity in our increasingly car The study of the impact on health of and screen-dependent lives. When did But what if the lessons of the past sedentary behaviour (or sitting time) you or your children last walk to work happen to be irrelevant – or misleading? is becoming a a major concern of or a social event, or to a post-box to post public health researchers, with some L. P. Hartley’s famous 1950’s novel ‘The a letter? If physical activity guidelines of the most cutting edge work being Go-Between’ begins with: “The past is a recommend levels of PA (for health undertaken in Australia. The most recent foreign country; they do things differently benefit)over and above the ‘background’ edition of the British Journal of Sports there.” (2) What if this were literally true? or ‘incidental’ activity of everyday life, Medicine devotes an entire issue to In other words, the past was sufficiently what happens if these background physical activity issues and the impact different from the present that we could levels decrease markedly? Are we really of sedentary behaviour is one of its not apply past evidence to learn how to suggesting that there will be health major themes. The editorial is written by deal with present situations. benefits from 30 minute of moderate Professor Steve Blair, keynote speaker activity each day if the other 23.5 hours This radical assertion was made by at the 2007 SMA national conference. are spent sitting or lying down? Professor Wendy Brown in delivering Blair writes in the latest BJSM “I believe the Refshauge Lecture at the 2008 Sports Further, it is possible that by focusing on Medicine Australia national conference. structured activity to the exclusion of the (3) importance of incidental activity, we are in danger of getting a seriously distorted Longitudinal studies are usually picture of overall activity levels. considered gold-plated in population health research and their outcomes Brown illustrated this point by reference are often the basis for guidelines and to a study published in 2002 (7) which recommendations. In the area of physical showed that daily energy expenditure activity, the guidelines promoted by of an office worker who ‘met the various governments around the world guidelines’ through, for example, playing are largely based on the longitudinal squash, were not very different from studies of London bus drivers and those of a housewife/mother who was conductors (Morris) (4) and US waterside ‘on her feet all day” yet did not meet workers – longshoremen - and Harvard the guidelines, because her day was University alumni (Paffenbarger) (5). filled with constant, but lower intensity These studies, and others, gathered data activity. The conclusion was that we during the 1960s and 1970s, with many need more information on whether continuing into the 1980s and beyond. being active all day at a low level has The data were summarised in the 1996 the same health benefits as ‘meeting

2 Sport Health From the CEO

that evidence supports the conclusion exclusion of other age groups has been that physical inactivity is one of the most the thrust of most government policy important public health problems of the targeting obesity in the last decade. 21st century, and may even be the most Based on the work of SMA members important.” (10) such as Olds, Brown and many others, Sports Medicine Australia has repeatedly Obviously, the major concern for made this point in various submissions governments and policy makers in all to the Australian Government in recent of this is what to do about “the most years. Our most recent submission on important public health problem of the this topic to the Preventative Health 21st century”? Taskforce said: In the autumn 2008 edition of Sport “the strategy must target all Australians Health (11) I wrote about how one of as clearly all are at some risk; however, the first policy responses to the problem extra efforts will be needed where risk – the developing and promoting of is highest. SMA has been critical of physical activity guidelines - had been previous government policy which has running into difficulty. The problem is concentrated on children (obesity rate that, as research in the field advances, of 6%) while making less effort with guidelines require review to clarify issues other population groups where risk relating to the dose (intensity, frequency, is much higher (e.g. men aged 45- duration, type) of activity for health 54 where obesity rates are 25%). It is benefit. Because physical activity is such impossible to obesity-proof a population a complex behaviour, one of the greatest by an exclusive focus on children. squandered public resources and created challenges is framing a simple guideline Commendably, the Report does not fall skepticism in the public mind about that covers activity for health benefit into this trap. Weight gain is incremental recommendations and guidelines. AND activity for weight loss. (Hint: through most people’s lives, with spikes “simple” simply doesn’t fit!). However, at certain times such as child birth and thanks to Professor Brown’s contribution marriage for women.” (13) Nutrition v. “Nutritionism” at the 2008 SMA conference, researchers SMA physical activity researchers have Subsequently, Professor Olds has and policy makers now know to look often complained about the imbalance in completed a major research project for more critically at the evidence from representation afforded physical activity, the Australian Government on obesity in longitudinal studies in a ‘previous age’. on government consultative bodies children. One of the more shocking (for looking at obesity and other health Anyone with an interest in this topic some) conclusions from this and other issues, compared to the numbers of would be well advised to register for research conducted by Professor Olds nutritionists. the 2009 SMA national conference (“Be is that obesity rates in children have in Active ‘09”, Brisbane, 14-17 October) fact plateaued – we are not looking at Radio National recently replayed where the world’s leading researchers an epidemic of obese children in the an interview with Michael Pollan, a in the area will be presenting their latest near future. This may seem a rather Professor of Journalism at Berkeley. research outcomes on some of the issues breath-taking – even bold - assertion Pollan was promoting a book he has raised here. (See www.beactive09.com given the volume of reported “evidence” written on nutrition called “In Defence of for more information.) to the contrary. (Try googling “obesity, Food”. The interview would give some children, Australia” and you will get wry amusement to these physical activity Tim the Mythbuster a flood of articles all promoting the researchers and the book probably imminent obesity epidemic in children.) should be compulsory reading for all In 2006, the Refshauge Lecture was Professor Olds says: SDA members – if only to refute his delivered by Professor Tim Olds at the suggestion that the science of nutrition SMA national conference held in Fiji. “While this may be a temporary lull, and is “where surgery was in about the year The paper, titled “Obesity Wars” worked clearly a problem still exists, the evidence 1650 – interesting, but you wouldn’t through some of the more murky issues suggests that we won’t be faced with want to get on the table!” (15) in the research and publicity about skyrocketing rates of childhood obesity in obesity and took to task many popular the near future.” (14) In the book (and repeated in the (mis)conceptions, particularly in regard interview which can be accessed via Hopefully, the work of Professors Brown to physical activity and obesity in podcast under “Information” at www. and Olds and other SMA members will children. sma.org.au ) Pollan suggests: bring some balance to the debate and to A key point of Old’s paper was that policy-making. While the causes may be • Nutrition has been hijacked away “fatness and physical activity track complex and the possible solutions may from “food” to an obsession with relatively poorly from childhood to be varied and multi-faceted, there is no “ingredients” and that these are adulthood…” (12) Perhaps another way doubt that obesity rates and the health then reproduced as supplements of saying this is that you can’t immunise problems stemming from these rates are which lack the positive benefit the a person against obesity by focusing climbing at an alarming rate. The worst ingredients had when they were part solely on what they do as a child. outcome would be to tempt politicians of a foodstuff. Regrettably, a focus on children to the with a “quick-fix, magic bullet” that >> to Page 5

VOLUME 26 – ISSUE 4 • SUMMER 2008 3 DR J There’s stats and then there’s educated guesswork By Dr J

How much of sports medicine is art and Shane Watson and Andrew McDonald, his hero, the Australian captain Allan how much is science? There are certainly are ambidextrous and write left-handed Border. Michael Clarke was taught to lots of grey areas in sports medicine but bat and bowl right-handed. Our bat right-handed by his Dad who was a where there might be two opinions of recently retired great wicketkeeper- natural right-hander. Fortunately these which neither is unequivocally correct. batsman, Adam Gilchrist, was another two went with these impulses rather But we all need to remember that right-hander who batted left-handed. He than the coaching textbooks. medicine is a science and this is what found he batted so much better with his This observation is probably the separates it from witch-doctoring or faith- top hand (the right) controlling the bat cricketing equivalent of a Moneyball healing. As such, good sports medicine that he famously gripped a squash ball approach, as per the baseball story of clinicians should also be scientists and in his bottom hand (the left) to try to the Oakland Athletics. Moneyball is the have a keen interest in science. reduce its influence on his swing. story of Billy Beane, who is a baseball The most interesting science I’ve read An interesting trend, but as scientists executive who chooses his players based and observed of recently qualifies in we need to ask whether it is statistically much more on statistical observations my mind as a paradigm shift. It regards significant. I don’t have the necessary than traditional coaching ones. The most batsmen in cricket and what should be data on hand to tell you exactly but a famous of these is that statistically it is natural stance for a right-handed or left- ball-park estimate can work out that it more advantageous to get to first base handed batsman. Traditional coaching almost certainly is. I would like to toss on a walk than on a hit, which is the of course dictates that a right-handed up that there are, say, 100,000 batsmen opposite of traditional thinking. The batsman should adopt a stance on the in Australia and that at least 80,000 of traditionalists view a walk as a pitching side as if addressing a golf ball with a them (80%) bat with an orthodox stance. error, rather than a skill of batters. right handed club or hitting a forehand If these figures are accurate, then a Moneyball analysis shows that teams that shot in tennis. An increasing number batsman is 2-3 times more likely to win manage to draw a lot of walks win a lot of international cricketers seem to be an Australian contract if he bats in an of matches, because they strike out less either natural right handers who bat unorthodox fashion. I think the 80% often and because the walks tire out the left handed or vice versa. This list is figure is a conservative estimate and that arm of the opposition starting pitcher. I no longer a short one. Of contracted perhaps up to 95% of batsmen in the am now fascinated to find out whether Australian batsmen, Matt Hayden, community would bat the same way that the Moneyball analysts in baseball have Mike Hussey and Shaun Marsh are they hit a tennis forehand. This would worked out whether unorthodox batting right-handers who bat left-handed mean that those who bat as if they were in baseball is as much of an advantage whereas Michael Clarke and Adam hitting a double-handed tennis backhand as it is in cricket. Voges are left-handers who bat right- are 10 or more times more likely to I first read about the cricket batting handed. Ricky Ponting, the captain, make it to the elite level. paradox in an article written by Peter is a natural right-hander and one of Hopefully you are following why I Roebuck in the Sydney Morning Herald seven contracted Australian batsmen believe that this represents a scientific/ in November 2000. He was reviewing who bat in the traditional fashion. So coaching paradigm shift. If you are 3 a book called The Best of the Best by roughly 40% of contracted Australian times or more likely to be successful Charles Davis, who is apparently a batsmen currently bat in an unorthodox doing something in an unorthodox Melbourne academic. I couldn’t find fashion whereas 60% are ‘orthodox’. fashion, then the only conclusion that a this book on Amazon.com and I tried This actually isn’t a freak statistic but is scientist can draw is that the orthodox to order it from a different bookselling indicative of a modern trend. Australia’s fashion is wrong. Our fathers and website which managed to charge my next two big things with the bat, Phil schoolmasters who are teaching six credit card and not send me the book, so Hughes and Dave Warner, are both right year olds how to bat should be telling I’ve never read it! However the statistical handers who bat left handed. In the their kids to invert what the traditional observations Roebuck discussed in this West Australian squad over 50% of the coaching manual is telling them. Or article bore a great resemblance to the batsmen take stance in an unorthodox at the very least telling the kids to try ones that I would read about a couple of fashion. Visiting South Africans batsmen batting both ways and consider the years later in books like Moneyball, The this summer included Graeme Smith, unorthodox stance if it feels good. Mike Wages of Wins and The Blind Side. Davis, Jean-Paul Duminy and Ashwell Prince Hussey apparently decided to bat left- with statistical analysis, also asserted who are all right-handers batting left- handed because he wanted to look like that night watchmen were a waste of handers. Two Australian all-rounders,

4 Sport Health DR J

>> from Page 3 time and that teams were more likely to performance also drops. This is the sort • Nutritionists have complicated matters lose if they enforced the follow-on. In of statistical analysis that needs to be to the extent where people feel they cricket injury surveillance we worked carried out in cricket as well. It would need an “expert” to tell them how to out a couple of years later that bowlers be very interesting to find that, say, if a eat – something people had managed in teams who enforced the follow-on pace bowler sends down 50 overs in a to do successfully without “experts” were much more likely to get injured. Test that his performance would drop a for millennia. Even though this is an important factor certain percentage in the next few weeks • “Low fat” foods are possibly worse to consider, it is probably the memory of after that. If there is statistical back-up for for people than the original version VVS Laxman pulling a Test out of the fire this observation, does it mean that for because of the added ingredients used that has stopped the Australian captain back-to-back Tests a team should rotate to replace the fat. from ever enforcing the follow-on in its fast bowlers a la baseball? If Billy • The acceptability of any processed recent years. Beane was in charge of a cricket team, food is probably in inverse proportion he would order his statistical consultants to the number of added ingredients. This December just gone, Peter Roebuck to answer this question and, if necessary, wrote a follow-up article on batting • A number of foods have been he’d be prepared to throw tradition in with the wrong hand. It was again an wrongly targeted as unhealthy. E.g. the trash can. excellent article with the only criticism eggs. being that it didn’t acknowledge Charles A final challenge for those of us working • The big “no no’s” in eating if you Davis’ book as his first article did. In the in the field is to try to find a way to want to avoid excessive weight gain first article, there was statistical back- objectively demonstrate the true value of include: large (normal today?) portion up from the Davis book. Left-handers good sports medicine to team success. sizes, eating alone and snacking and in Test cricket have averaged 33 over Intuitively there are times when the eating in front of the television. the years compared to the 28 averaged medical team declares a player fit to Gary Moorhead is the Chief Executive by right-handers. Apparently much of play who was in serious doubt, who Officer of Sports Medicine Australia this difference is due to natural right- then goes on to win the match with Correspondence: handers who bat left-handed, who have an outstanding performance, that we [email protected] a much better collective batting average can feel as if we have made a major than orthodox batsmen. Roebuck’s contribution to team success. In general NB Footnotes in Sport Health. latest article further raised my eyebrows we may feel important in our own Footnotes in Sport Health are designed when he mentioned that the two biggest minds, but we are perhaps yet to win to provide sufficient detail to allow a reader to access additional information names in batting of the last decade, over the average sports administrator. through a standard web search engine. Brian Lara and Sachin Tendulkar, both One of the beauties of sport is that the They do not attempt to conform to any write left-handed and bat right-handed. value of the best athletes is so simple standard academic standard. Tendulkar and Lara sound as if they are to appreciate (and it is also one of the both ambidextrous, like Watson and reasons why sportsmen can earn so McDonald, which is probably also more much money). It is particularly the case Footnotes. (1) George Santayana “Reason in Common Sense” (p. common in elite athletes. Dave Warner in a sport like cricket where objective 284) is starting to use a double sided bat for individual statistics are available. The (2) L.P. Hartley “The Go-Between”. Twenty/20 games so that he can swing best batsmen have the best averages and (3) Asics Conference of Science and Medicine in Sport, Hamilton Island, 16-18 October 2008. the bat both ways and perhaps this the best bowlers take the most wickets. (4) Morris JN et al. Coronary heart disease and physical may set a trend for the future. Roebuck Is there such a think as the best sports activity of work. Lancet 1953. (5) Paffenbarger RS, et al. Work activity of longshoremen concedes that the best batsman of physician or the best physiotherapist? I as related to death from coronary heart disease and all-time, Don Bradman, was a natural imagine that many sports administrators stroke. N Engl J Med 1970. (6) Department of Health and Ageing, National Physical right-hander who batted right-handed. would think that either there is no such Activity Guidelines for Australians, website. Perhaps though we will soon need thing, or that if there is such a thing as (7) Brown WJ, et al. “How active are young adult women? Health Promotion Journal of Australia, to see it as a concept of the twentieth the best that it would be determined 2002. century that batsmen should generally by the clinician who had the best (8) Brown WJ. “Stand up, sit down keep moving: how much activity for a merry and bright old age?” bat in the orthodox fashion. personality and who was popular with Refshauge Lecture, Asics Conference of Science and the players. Medicine in Sport, 17 October 2008. The next paradigm shift in cricket might (9) Pate R, et al. “The Evolving Definition of Sedentary”. also have a baseball origin. We’ve I am a believer that there is such a Exercise and Sport Science Reviews, October 2008. (10) Blair S, “Physical inactivity: the biggest public already shown in various cricket papers think as quality in sports medicine and health problem of the 21st century.” British Journal over the last few years that there are physiotherapy and that it probably plays of Sports Medicine, 2009; 43. (11) Moorhead G., “Giving the Right Advice: making correlations between high pace bowling more of a part in team success than guidelines fit the available evidence versus KISS workloads and injury. Because injury risk administrators currently realise. However, (Keep It Simple Stupid)”, Sport Health, Autumn 2008. (12) Olds T. “Obesity Wars”. Abstract. Journal of Science is still only a secondary consideration for it won’t be lobbying that allows us to and Medicine in Sport 9:6. 2006 (Supplement). selectors, we haven’t yet seen bowlers prove this point in the future. It will be (13) SMA submission to Preventative Health Taskforce, get rotated out of the Australian Test statistics. We need to come up with our January 2009. (14) Olds T. “Childhood obesity epidemic a myth, says team. However, in baseball there is own objective performance indicators research” reported in The Australian, 9 January statistical data that shows that if pitchers that can demonstrate our true value (or 2009. (15) Pollan M. LifeMatters, “Old Food”. Radio National send down too many pitches, not only otherwise) to the teams we work with. 22 May 2008 and 19 January 2009. Also available does their injury risk increase, but their Anything else is educated guesswork. from the SMA website.

VOLUME 26 – ISSUE 4 • SUMMER 2008 5 soft tissue mobilisation Can soft tissue mobilisation be a stimulus for facilitating neuromuscular control

and learning? By Dr Andrew R Chapman

The importance of performance. The link between The example of triathlon neuromuscular control and athlete neuromuscular control Success in triathlon depends largely performance is especially important on the triathlete’s ability to run at “Neuromuscular control” refers to the in the context of endurance sports interaction between the neural and maximum efficiency, and thus on such as running and cycling, i.e. sports optimal neuromuscular control (i.e. muscle systems and the resulting control for which athletes repeat the same optimal movement and muscle of movement patterns and muscle movement pattern over and over again, recruitment patterns) when running recruitment patterns. This interaction and who therefore rely very much “off the bike” (i.e. when running is fundamental to all movement; a on the efficiency of their movement. after cycling). Therefore, triathletes coordinated neuromuscular system There is also a very strong relationship rely on their ability to develop a very effectively translates cardiorespiratory between neuromuscular control and high level of neuromuscular control capacity into efficient movement. musculoskeletal injury. for running (i.e. their ability to learn Neuromuscular control is therefore optimal neuromuscular control – or one factor that underpins athlete phrased more generally their ability to Thoracic Rack Warning, this device may enhance performance The thoracic rack is the perfect tool for your clinic. Have your clients mobilise their thoracic spine before, during and after treatment to enhance your clinical outcomes.

For more information on how the Thoracic Rack can help you or your clients call Portacovery on 02 6253 2388 or visit www.portacovery.com

6 Sport Health

Untitled-1 1 14/1/09 5:26:28 PM soft tissue mobilisation

learn a very efficient running stride) “fitter” and more fatigue resistant) will Soft Tissue Therapists, Physiotherapists, and subsequently on their ability to not necessarily improve their ability to Osteopaths, etc, in their clinical decision- utilize this very high level control run off the bike. Indeed, our research making process, and b) coaching and when running off the bike on race day has shown cycling can interfere with performance management staff in the (i.e. their ability to execute optimal neuromuscular control of running planning of athlete management. neuromuscular control – to use what independent of fatigue. While a mere they have learned – and not let cycling 20 min of cycling has no direct effect References “interfere” with neuromuscular control on running neuromuscular control in 1. Chapman, A.R., B. Vicenzino, P. Blanch, et for running). Similarly, triathletes’ most (70%) highly trained triathletes, we al., Patterns of leg muscle recruitment vary preparation for competition involves did show that running muscle activity between trained and novice cyclists. Journal of Electromyography and Kinesiology, 2007. 18: p. large running volumes and practicing is effected by a mere 20 min of cycling 359-371. running after cycling. Evidence of in 30% of highly trained triathletes. We 2. Saunders, P.U., D.B. Pyne, R.D. Telford, et al., Factors affecting running economy in trained the relationship between altered, or also showed that this altered muscle distance runners. Sports Medicine, 2004. 34(7): p. “underdeveloped”, neuromuscular recruitment is associated with reduced 465-85. control and musculoskeletal injury run economy (i.e. greater oxygen 3. Dalleau, G., A. Belli, and M. Bourdin, The spring- mass model and the energy cost of treadmill suggests that the ability of a triathlete consumption and therefore less efficient running. European Journal of Applied Physiology, to complete large running volumes running) and >2 times greater likelihood 1998. 77(3): p. 257-263. 4. Anderson, T., Biomechanics and running economy. in training without injury is also of a history of exercise-related leg pain Sports Medicine, 1996. 22(2): p. 76 - 89. dependent on their ability to learn and (i.e. a history of shin pain, tibial stress 5. Chapman, A.R., B. Vicenzino, P.W. Hodges, et al., Cycling impairs neuromuscular coordination during use movement and muscle recruitment fractures, etc). running in triathletes, which reduces performance patterns that are specific to running and and is likely injury-related. Medicine and Science in Why would soft tissue mobilisation not adversely influenced by cycling. Sports and Exercise, 2008. 40(5): p. s87. be an effective stimulus for facilitating 6. Cowan, S.M., K.L. Bennell, P.W. Hodges, et al., Optimal neuromuscular control is clearly neuromuscular learning and execution? Delayed onset of electromyographic activity of critical to triathletes’ performance and vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome. injury, but our studies of triathletes Soft tissue interventions, although rarely Archives of Physical Medicine and Rehabilitation, demonstrate that both interference with linked to neuromuscular control and 2001. 82(2): p. 183-189. 7. Chapman, A.R., B. Vicenzino, P. Blanch, et al., Does neuromuscular learning and interference learning in their efficacy, are a vital cycling effect motor coordination of the leg during with neuromuscular execution can occur component of our management of running in elite triathletes? Journal of Science and in triathletes and that this interference Medicine in Sport, 2008. 11: p. 371-380. performance and injury in endurance 8. Chapman, A.R., B. Vicenzino, P. Blanch, et al., Leg has implications for both performance athletes, including triathletes. muscle recruitment during cycling is less developed and injury. in triathletes than cyclists despite matched cycling Neuromuscular control is clearly training loads. Experimental Brain Research, 2007. one factor that underpins athlete 181(3): p. 503-511. performance and musculoskeletal 9. Brashers-Krug, T., R. Shadmehr, and E. Bizzi, Interference with Consolidation in human motor memory. Nature, injury. Our research has also shown 1996. 382(6588): p. 252-5. neuromuscular learning that interventions such as taping, 10. Karniel, A. and F.A. Mussa-Ivaldi, Does the motor control system use multiple models and context In order to balance the training demands orthotics and plyometrics appear to switching to cope with a variable environment? Exp of the three disciplines, triathletes provide a stimulus to the neuromuscular Brain Res, 2002. 143(4): p. 520-4. system that may facilitate greater 11. Franettovich, M., A.R. Chapman, P. Blanch, et al., A often practice two or three disciplines physiological basis for anti-pronation taping from in one training session or complete learning (i.e. greater neuromuscular a critical review of the literature. Sports Medicine, separate training sessions for different adaptations) and improved execution 2008. 38: p. 617-631. 12. Franettovich, M., A.R. Chapman, and B. Vicenzino, disciplines with only short recovery (i.e. improved neuromuscular control Tape that increases medial longitudinal arch height periods between these sessions. While during competition – in other words, an also reduces leg muscle activity: a preliminary study. Medicine and Science in Sports and Exercise, this “multidiscipline training structure” improved ability to use the high level 2008. 40(4): p. 593-600. maximizes overall training volumes, of neuromuscular control that has been 13. Chapman, A.R., B. Vicenzino, P.W. Hodges, et al. Cycling impairs neuromuscular coordination during our research has shown it might learned, rather than using a suboptimal running in triathletes: this impairment reduces actually interfere with adaptation of level of neuromuscular control). While performance, is associated with increased risk of injury but can be improved by the use of a taping the neuromuscular system – in other there is little evidence to support the intervention. in European Congress of Sports words, the ability of triathletes to learn efficacy of soft tissue therapy as such a Science. 2008. Estoril, Portugal. more skilled and more efficient muscle stimulus for influencing neuromuscular 14. Walker, M.P., T. Brakefield, A. Hobson, et al., Dissociable stages of human memory conslidation recruitment patters appears to be limited, learning and execution, there is a logical and reconsolidation. Nature, 2003. 425: p. 616-620. or “interfered with”, because of the way argument to suggest it may be effective 15. Weerapong, P., P.A. Hume, and G.S. Kolt, The mechanisms of massage and effects on they structure their training. in this way. The effectiveness of soft performance, muscle recovery and injury tissue interventions for e.g. achieving prevention. Sports Med, 2005. 35(3): p. 235-56. Interference with an immediate change in localised muscle tone and localised muscle Institutional affiliations: neuromuscular execution recruitment, and the link between 1 Division of Physiotherapy, The soft tissue intervention and improved Most triathletes show a decrease University of Queensland, Brisbane, athlete recovery, provide a basis for in run performance and report a Australia perception of impaired coordination such an argument. On this basis, there when running off the bike. While is a strong case for future research 2 Applied Research Centre, Australian fatigue is likely to contribute to this investigating the effectiveness of soft Institute of Sport, Canberra, Australia perceived incoordination and loss of run tissue interventions as a stimulus for 4 School of Kinesiology, Simon Fraser facilitating neuromuscular learning and performance, these effects may also be University, Vancouver, Canada due to interference with neuromuscular execution. We suggest the possible control independent of fatigue. If this effects of soft tissue interventions on 5 Department of Kinesiology and is the case, addressing fatigue alone neuromuscular learning and execution Physical Education, McGill University, (i.e. training our athletes to become should definitely be considered by a) Montreal, Canada

VOLUME 26 – ISSUE 4 • SUMMER 2008 7 FROM THE BEIJING Olympics Perspectives from Beijing

By Dr Liz Broad

In 2008 I was fortunate enough to be in an esky for those sports who did difficulty finding suitable food. included as part of the canoe / kayak not have access to their own slushee The smaller dining areas were useful staff for the Beijing Games – my official machine. to save a bit of time or have a little title being “sports scientist” (the unofficial The main dining hall served food 24hr more peace / ‘intimacy’ when eating. one being “jack of all trades and master / day throughout the entire period of The range of options offered was more of resourcefulness”!!), but naturally the games. On entry to the hall, there restricted than in the main dining hall, this incorporated my sports nutrition were fridges of drinks (water, Powerade but there was enough to enable a full expertise. Canoe / kayak had 16 athletes and various Coca-Cola drink brands). meal to be consumed. Drink vending across two disciplines – slalom who Then there was the cold food section, machines were available throughout competed in the first week, and flatwater which included salad items, breakfast the village, and everyone who stayed who competed in the second week. We cereals, breads, fruit, yoghurts, milk, nuts in the village had a special key which also had a section manager, six coaches, and dried fruits, and ice creams. At the enabled them to use the machines, a physiotherapist and myself – thereby back of the dining hall was all of the according to an allowance (which was exceeding our AOC staff allowance hot food servery. This was divided into not very restrictive). There were signs by three. Hence, three of us were sub-sections, such as Asian style, Western up in all the rooms advising athletes not required to ‘share’ accreditations with style, Pizza / Pasta. Unfortunately there to drink the water from the taps, and other Australian team staff, and were were no signs up to indicate what was there was always a plentiful supply of not able to live in the athlete village. being served in each section each day, bottled water available at venues and The following is a small insight into my so athletes had to line up and see what throughout the village. perspective of the food / hydration side was available when they got to the of my role in Beijing. servery counter itself. If they didn’t like At the venue: it, they would have to turn around and I was based at the canoe / kayak Food: line up at a different servery. Finally, in and rowing venue, so I will limit my Athlete Village one corner was McDonald’s, which from description to what was available at this all accounts became extremely popular particular venue. Food provisions within the athlete as the primary caffeine source until village were similar to other Olympics, the queue became excessively long! I The canoe / kayak and rowing venue with one main dining hall and a couple only ate in the main dining hall twice, was located approximately 1hr drive of smaller sub-sites. According to Prof. so am unable to judge on variety and (at best 45 mins) from the main village. Louise Burke, the food hygiene and quality, however there weren’t too many Generally our athletes trained twice safety procedures were top notch, and complaints from my athletes - generally a day, which meant staying at the certainly the Chinese worked extensively a good indication that they had no venue (or going to a nearby hotel, see in the lead up to the games to source below) rather than travelling back to quality food suppliers. There did not seem to be any restrictions in taking food away from the dining hall – at least not that were policed strictly. Each of the apartments (housing 6-7 athletes or staff each) had a small fridge and a freezer shared between two apartments so there was suitable storage space. The Australian team members also had access to power bars, Powerade Recovery and Powerade Energy Edge, gels, muesli bars and liquid meal supplement powders through the AOC and Louise Burke. Louise also had gastrolyte (for hydration purposes) and slushees (used for pre- cooling) on tap, which could be frozen in a large freezer and taken to a venue

8 Sport Health FROM THE BEIJING Olympics

the village then out again for a second training session. At the venue there was one dining hall which provided lunch only to athletes and staff from all three disciplines from around 11.30 – 2pm. From the information I was able to obtain, this dining hall was not supplied from the athlete village. It generally served four hot options, three mixed salads, some cold meats, bread, fruit and a dessert. Disturbingly, the bain-marie items were not kept hot with a burner underneath – if one was put out initially, it did not appear to be replaced once it had gone out. Furthermore, the lids of the bain marie’s were allowed to remain open – hence, raising concern about the food safety, especially in the latter stages of the serving period. so they could relax in air-conditioned who had also provided some home Another complication we experienced at comfort, have a dip in the pool, and see favourites!! My only complaints were the venue was that no sports drink was the physiotherapist. It was also an area that after four weeks there I knew the supplied at all by BOCOG during the where we could store extra supplies of menu off by heart, high fibre options training period – only water. Considering food and sports drink, make up slushees for breads / cereals were few and far the athletes were there for nearly two for pre-cooling, and freeze ice jackets between, and didn’t want to see fried weeks prior to the start of competition, it / vests for the athletes to use. Where rice again for at least four years! meant we had to rely on them bringing necessary we were also able to provide their own sports drink in from the venue lunch, although this was rarely accessed OR supplying it ourselves, which was General Operations: by those living in the village. difficult as we were not allowed to bring The games were run very well from an bulk fluids into the venue through the Since this hotel was an official BOCOG operational viewpoint. Everything was main gates (the only way of entering!). “off-site” hotel, it was under tight security on time – buses, race times, and so on. After a day or two I found I was able just like the village – I even had to open However, there was also the need at to bring in a small quantity of sports a can of SustagenTM I’d brought for one times to work around the system, rather drink slushees in my bag without the of our athletes so they could see it was than with it. For example, the ice bath risk of them being confiscated at the edible! It also meant their food supplies we had running at the venue during gate, which worked reasonably well were strictly controlled and they did competition had to be hidden (thanks as it provided a backup when athletes a much better job than the venue in very much to good relationships with forgot to bring their own supplies. These terms of food safety. A dining hall was boat manufacturers!), since no electrical had to be frozen after making so I could set up separately for athletes and staff items were allowed to be brought transport them to the venue without the (as opposed to other hotel guests such into the venue by teams; apparently risk of them melting on the way. as family and friends), which provided the Mexican team had a small freezer three meals / day. There were always confiscated! This also meant that Once the competition began, small five-six hot options at both lunch slushees had to be brought in through athlete lounges were set up, which had and dinner, plus salads. These were a the gates rather than made on site, so hot and cold drinks, biscuits or Moon blend of Asian and Western styles – for thankfully we had large eskies supplied Cakes (a Chinese cake) and fresh fruit to example, at one sitting there might be through the AOC which were used to snack on whilst the athletes watched the roast beef, as well as a spicy chicken store them in once I’d managed to get competition on TV. stir fry. There was always pasta and a them into the venue itself. rice served separately at each meal, and At my hotel: In general, my experience in Beijing at least two vegetables. Most options For the four weeks of the games I was was exhausting and at times frustrating could be considered moderate to low located at a hotel close by the venue – the security and other aspects of an fat, although there was generally at (less than 10 mins on a Chinese bike!). Olympic Games can understandably be least one high fat option at each meal. The Australian rowing team reserves very inflexible. So, what did we achieve? Certainly the lightweight rower reserves and extra staff were also located there, Well, apart from outstanding results by didn’t have too many difficulties eating as were some of the international teams, the athletes - 1 Gold, 1 silver, and 3 to maintain their weight restriction. such as the entire Canadian flatwater bronze medals - I walked away with the Breakfast included eggs, bacon or ham, canoe / kayak team. We had a recovery satisfaction of being a master at beating dumplings, fruit, juice, breads and a area set up here for the athletes to the Chinese Olympic system! toaster, although the cereals were limited come to in between training sessions, so we were very grateful to Louise Correspondence: [email protected]

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10 Sport Health walking at work Interested in promoting walking at work?

First things first, assess your workplace environment! By Nicholas Gilson

1. Introduction of society in physical activity through buffer, universal accessibility, aesthetics walking. Student initiatives are important and shade”; we changed this last We are a group of researchers from from a health promotion perspective, but item descriptor to “cover”, which we ten different universities across the we are presently targeting employees, considered to be equally applicable to world. Our collaborative aim is to given that these people are probably sites with hot and colder climates. promote employee physical activity more at risk from chronic disease, through workplace walking at each of Prior to using the audit tool, each lead through an older age profile and our respective institutions. This article researcher collected information on key occupation types that involve high describes a pre-intervention audit of campus characteristics (position, size and volumes of prolonged sitting and lower campus environments and comments staff/student numbers) and identified levels of walking. For example, recently on how well they lend support to our key walking routes – researchers used published data, from three of our sites in planned walking initiative. Reflections by their own discretion in selecting these Australia, Spain and the UK, found that lead investigators are used to highlight routes, with the primary criterion for during a typical workday, academics and findings and challenges. Conclusions selection being major staff thoroughfares administrators averaged less than 10,000 discuss implications for colleagues between buildings and facilities. The daily steps and sat for around six hours/ interested in promoting workplace audit tool was then used to assess route day [3]. walking. “walkability”. Local teams walked each Other pilot data from some of our UK route, measuring step counts with a 2. Project Background university employees have shown the pedometer and qualitative indicators of positive impact walking interventions suitability were recorded, such as “good Encouraging people to be physically had on workday step counts, risk factors level of route-maintenance” or “high active through walking is a fun, practical for chronic disease, productivity and job levels of traffic managed by appropriate and cost effective way of improving satisfaction [4, 5]. Following on from this pedestrian crossings”. Immediately and maintaining health throughout the success, we now stand on the threshold following completion of each route, lifecycle. Every step is a step in the right of implementing a large international quantitative ratings of the route’s direction for the inactive, with small study, involving each of our ten suitability were taken, and these were increases in physical activity associated respective sites. One of the strategies we scored on a scale of 1-5 (poor-excellent) with steep reductions in chronic plan on using to try and encourage an for each inventory item. disease risk [1]. These small increases increase in sustained step counts will be also provide a sound platform for the In carrying out this audit process, our the use of route-based walking during inactive to progressively move towards key concern was how we standardized work breaks. We have argued that the achieving recognized healthy guidelines scoring across sites. Ordinarily, this could built environment, or the way in which for walking – current criteria advocate be achieved through site visits by a we design our urban surroundings, will the accumulation of at least 10,000 daily coordinating researcher. However, in our be one of the most important factors steps as a minimal public health goal case this was not possible given that our influencing this type of walking behavior for adults. Importantly, 3,000 to 4,000 of collaboration was occurring across ten [6]. With this in mind, we have recently these steps should be achieved through campuses in five different countries. We audited our campus physical infra- bouts of brisk walking, sustained for ten overcame this problem by posting digital structures, assessing the extent to which minutes or more [2]. recordings of routes on the internet local environmental characteristics are before sites went ahead and began Physical activity researchers and able to support a route-based walking their audits; lead researchers scored practitioners face the on-going challenge initiative. these routes, with the group contrasting of how to effectively encourage people data to establish protocol and audit to walk more, and ideally attain these 3. The Audit Process comparability. This process was repeated daily step targets. Our collaboration Our group selected an audit tool in person at the local level, to ensure is focused on meeting this challenge developed to assess workplace comparable scoring between site teams. within university workplaces. Universities ‘walkability” in nine specific areas typically employ large numbers of [7]. These items are described by the people and host even larger numbers 4. Audit Outcomes inventory as “pedestrian facilities, of students - they therefore have the The local auditing process took between vehicle conflicts, crossings, route- potential to engage a large cross-section one and two weeks to complete, with maintenance, walkway width, roadway

VOLUME 26 – ISSUE 4 • SUMMER 2008 11 walking at work

time demands dependant on the number We identified 17 key routes around We identified 21 key routes around of routes and researchers within each campus. The average length of these campus. The average length of these team. Quantitative data was entered into routes was 574 steps with length ranging routes was 654 steps, with length ranging a standardised Excel template and sent from 310 to 1,057 steps. Inventory from 190 to 3,543 steps. Inventory items to a coordinating researcher for collation items showed that these routes were showed that these routes were generally and site comparisons. Local teams have generally well-maintained, accessible, well-maintained, accessible, with low recently triangulated inventory scores and attractive. However, our audit raised levels of vehicle conflict; where this did with qualitative data to form a précis of specific challenges which we need occur, right of way was provided for their campus physical infra-structures, to consider - the buffer between the pedestrians through traffic-controlled with a view to identifying environmental pedestrian and other traffic was often crossings. Our challenges concern strengths and weaknesses. The following quite small and this may be considered walkways that traverse parkland; these provides an initial insight into audit an aspect of the environment that is were often lacking in natural and outcomes as they relate to each site - not conducive to encouraging walking. artificial cover. Our hot and humid lead researchers highlight key campus Moreover, the routes were rated less summer will make walking on these characteristics and reflect on the local positively in respect to pedestrian routes difficult at lunch times. Also, challenges audit data raise for route- crossing facilities. buffers between pedestrians and cars based walking. Guy Faulkner, Faculty of Physical were sometimes poor and this factor may discourage our employees from Barbara Ainsworth, Department of Education and Health, University of walking particular routes. Exercise and Wellness, Arizona State Toronto, Canada. University, USA. [email protected] Marie Murphy, School of Sports [email protected] Our walking initiative will take place Studies, University of Ulster, Northern Ireland. Our walking initiative will take place at at the main university site which is [email protected] the Polytechnic campus, a 660 acre site approximately 316 acres in size. The that was once entirely a US Air Force urban campus is embedded centrally Our walking initiative will take place at within the city of Toronto. Accordingly, Base (Williams Air Force Base). The the Jordanstown Campus, which is a 116 the ‘grid’ network and high street acquired land is located approximately acre, well-established, suburban green- connectivity of the campus lends 25 miles from the main campus in field campus, situated on the shores of itself to ‘walkability’. The site hosts Tempe, Arizona. The site hosts around Belfast Lough, eight kilometres to the approximately 7,500 employees and over 700 employees and 9,300 students. north-west of the city. The site hosts 50,000 students. around 3,000 employees and 23,000 We identified 13 key routes around We identified 23 key routes around students. campus. The average length of these campus. The average length of these routes was 645 steps, with length routes was 475 steps with length ranging We identified ten key routes around ranging from 112 to 1,449 steps. from 175 to 849 steps. Inventory items campus. The average length of these Inventory items showed that these routes demonstrated that these routes were routes was 398 steps with length were generally difficult to negotiate with well-maintained, accessible, and with ranging from 155 to 777 steps. Inventory lack of suitable walking surfaces and appropriate pedestrian facilities including items showed that these routes were insufficient connectivity. The majority traffic-controlled crossings. Given the generally well-maintained, accessible, of the routes lacked the presence of setting, some routes are alongside very with moderate levels of vehicle conflict; crosswalks and buffers creating potential busy streets with less than ideal buffers where this did occur, right of way conflict with motor vehicle traffic. Routes between the traffic and pedestrians. was provided for pedestrians through that were recently reconstructed have Some routes can be challenging to walk traffic-controlled crossings. Inventory made an effort to utilize landscaping in winter because of snow and ice. data raised concerns that many of our to steer people on the appropriate and Cover is particularly problematic at this walkways were narrow with few buffers safest paths toward the point of entry for time (January-February). Having said between traffic and walkway. Routes buildings. They have also made efforts this, our initial focus at the University also tended to lack cover and light. The to incorporate safety, disability access, of Toronto will be on how to increase elevated position of the campus, wet cover, and the creation of green space walking when the conditions are most prevailing conditions and failing light for recreational purposes. conducive to that behavior (spring, presents a challenge to the sustainability of route-walking through our winter Stuart Biddle, School of Sport & summer and fall). months. Exercise Sciences, Loughborough Nicholas Gilson, The School of University, UK. Human Movement Studies, The Ailsa Niven, School of Life Sciences, [email protected] University of Queensland, Australia. Heriot Watt University, UK. [email protected] [email protected] Our walking initiative will take place at the university campus, which is a Our walking initiative will take place Our walking initiative will take place at 437 acre, well-established, suburban at the main university site, which is a the main university site, which is a 200 green-field campus, situated adjacent 282 acre, well-established, suburban acre campus of mature meadow and to the small university market town of green-field campus, situated in a bend woodland to the west of Edinburgh, Loughborough in the centre of England. of the Brisbane River, seven kilometres approximately ten kilometres from the The site hosts around 3,100 employees to the South of the city’s central business city centre. The site hosts around 1,600 and 15,500 students. district. The site hosts around 4,500 employees and 6,800 students. employees and 34,500 students.

12 Sport Health walking at work

We identified 12 key routes around is a small, 7 acre, urban campus, situated approximately 1,000 acres, located in campus. The average length of these one kilometre away from the city centre. the heart of Tuscaloosa, a west central routes was 521 steps, with length The site hosts just under 700 employees Alabama city of approximately 78,000 ranging from 70 to 1050 steps. Inventory and around 8,000 students. residents situated on the Black Warrior items showed that these routes were River. In 2007, the University of Alabama We identified 10 key routes around generally well-maintained, with adequate was home to approximately 3,021 campus. The average length of these walking space provided, relatively low employees and 25,580 students. routes was 823 steps, with length levels of vehicle conflict and a good ranging from 380 to1,503 steps. Overall, Twenty-six key routes were identified level of buffer area between walking walking routes were perceived as around campus using campus maps areas and roads. The attractiveness of highly walkable on inventory items. For and input from Faculty, staff, and the the routes varied with some functional example, routes were well maintained University Planner and Designer. The routes between buildings and others and self-contained within the campus; average length of these routes was 1,090 incorporating more greenery and space, they rarely came into conflict with traffic. steps, with length ranging from 309 to highlighting the potential for a pleasant However, routes often lacked cover and 2,959 steps. Inventory items revealed walking environment on campus. The shade and this may be a problem for that these routes were generally well- accessibility of the walking routes for less sustainability of route-walking through maintained with accessible, barrier-free able bodied people could be improved. winter and summer. In addition to this, sidewalks, averaging acceptable width; There were limited routes offering shelter our team also faces the challenge of moderate aesthetic appeal, often due or shade, which could be important implementing route-based walking on to current campus construction; and because Edinburgh has occasions of cold a small campus, with a limited number moderate potential for vehicle conflict. and wet weather, and this is a commonly of routes. We will be looking at ways in However, most major intersections cited barrier to physical activity. which we can connect campus and non- on campus provided traffic controlled Andy Pringle, Carnegie Research campus routes, to provide variability and cross-walks for pedestrians. Many Institute, Leeds Metropolitan choice for our employees. walkways traversed green space, yet University, UK. routes generally only provided moderate Afroditi Stathi, School for Health, [email protected] natural or artificial cover and shade – this The University of Bath, UK. may be a challenge given Tuscaloosa’s Our walking initiative will take place [email protected]. subtropical climate, which provides at the Headingley Campus, which is Our walking initiative will take place a mild winter, but a hot and humid located on 100 acres of parkland next at the main university site, which is a summer. Finally, due to relatively recent to Beckett Park. The campus is situated 200 acre, friendly, suburban green-field support for a Master Plan to enhance three miles to the North of the City of campus, situated at the top of a hill the campus aesthetics and provide a Leeds in the UK and hosts around 3,600 at Claverton Down, overlooking the more pedestrian-friendly campus, several employees and 14,000 students. UNESCO World Heritage city of Bath. specific events have created changes in We identified 28 key routes around The site hosts around 2,600 employees walking routes and potential confusion campus. The average length of these and 13,000 students. in campus navigation. These changes routes was 140 steps, with length have included moving parking to the We identified 20 key routes around ranging from 99 to 448 steps. In summer, periphery of campus and introducing a campus. The average length of these inventory items showed that these campus transit system, several bike lanes, routes was 1002 steps, with length routes were generally well-maintained, more sidewalks and trails. ranging from 176 to 2884 steps. accessible, with low levels of vehicle Inventory items showed that these routes conflict; where this did occur, right were well-maintained, with low levels of 5. Conclusions and of way was provided for pedestrians vehicle conflict. Cover for walking was through traffic-controlled crossings. Key Message found to be acceptable and routes were Many walkways traversed parkland, Overall, the findings of this ten site aesthetically pleasing with designated however routes were often found audit show that our university campuses lunchtime walks in woodland areas lacking in natural and artificial shelter are generally well-suited to support a on the periphery of the campus. Our and some in parkland were not paved or route-based walking initiative. Having lowest scoring item was “accessibility” graveled. This is important as Leeds has said this, some offer better support than and while route scores were acceptable a changeable annual climate with cool, on this aspect of physical-infrastructure others and inventory items provide rainy and windy conditions possible our team will be looking at ways in valuable insights into where we might any time of year. Heavy rain leading which employee access from buildings target efforts and resources to maximise to muddy and slippy walking surfaces and facilities can be improved – this will impact prior to intervention. Physical potentially discourages employees from be particularly important for less able infra-structure characteristics which taking longer walks in the aesthetic bodied people. warrant attention include “connectivity parkland within the campus. and variety of walkways, accessibility, M. Renee Umstattd, School of Anna Puig-Ribera, Llicenciatura traffic buffers, crossings and cover”. Human Environmental Sciences, en Ciències de l´Activitat Física i This latter characteristic was considered The University of Alabama, USA. l´Esport, Universitat de Vic, Spain. a particular issue for many lead [email protected]. [email protected] researchers. How we resolve this issue, The University of Alabama is an inner Our walking initiative will take place at and sustain route-based walking in hot city, residential campus that includes the only campus of the university, which and colder climates, will be a major >> to Page 16

VOLUME 26 – ISSUE 4 • SUMMER 2008 13 FrOM THE CEO REPAIR, RECOVER & REFUEL.

The Melbourne Vixens netball team represent their home city in the elite Australia and NZ Championship competition. The Melbourne Vixens includes Australia’s best female athletes and a new generation of netball stars, with seven Australian squad members in the team, including recent World Champions Julie Prendergast, Bianca Chatfield and two-time Commonwealth Games gold medallist Sharelle McMahon.

Sports Dietitian Kerry Leech speaks with Sharelle McMahon, captain of the Melbourne Vixens Netball team.

Q. What is your favourite food? I’m a little partial to chocolate but my favourite meal is chicken and vegetable risotto.

Q. Cereal or toast for breakfast? Definitely a cereal girl, eating muesli, yogurt and milk helps me to keep going through the morning.

Q. Sharelle, you are working with Netball Victoria as well as playing and training with the Vixens - how do you fit it all in? I’m very busy. I manage it with a very up to date diary!

Q. So how do you manage healthy meals on the run? I need to be organised and pack food each morning. It makes drinks like Sustagen important as I can have them in the car on the way to or after training.

Q. What flavour Sustagen is your favourite? That’s easy, Chocolate - I told you I am a chocolate girl!

Q. How do you feel Sustagen helps your recovery? Netball is a hard game, I tend to come out of each game with a few bumps and bruises. Sustagen after each game helps to get the recovery process started and provides a great source of protein and carbohydrate.

Q. So what now for Sharelle McMahon? The Vixens are finished for the season but the Australian team has international matches over the next few months against New Zealand and England. So plenty of training camps, travel and tough matches. No slowing down for me!

14 Sport Health

Important Information: We do not proceed with work unless our clients are completely satisfied, so 12/08/08 NI please check this printout carefully, particularly for the issues listed below. Technical: colours (choice and number), eyemarks, best before/use by panels and print free areas. Legal: The client should check that the printout and all NES00179 SUSTAGEN text complies with applicable laws, including trademarks and food standards. Printing: This printout is not an accurate representation of final printed YELLOW MAGENTA colours, so we recommend that you send us the cromalin proof to check for NESTLE FRESH AD FINAL colour accuracy. Once satisfied, please sign. By signing or email of approval, you confirm that 2 you have checked artwork thoroughly and accept responsibility for the artwork. BLACK CYAN 100% INSURANCE Sports Personal accident insurance:

Are you really covered? By Nello Marino

In a recent edition of Sport Health Liability) and personal accident covers. from an accident, being a sudden, (Winter 2008) Gary Moorhead alerted us Whilst millions of dollars in claims unexpected, specific event occurring at to ‘Doing the Right Thing’ in which he are made each year, most claims are a definable place or time and occurring highlighted the importance of ensuring associated with Personal accident solely and directly from the accident and the right balance of injury prevention insurance. independently from any other cause. information and strategy included in Policies will usually further clarify this Sports Personal accident insurance programs which promote sport and definition by specifically excluding is likely to vary from one insurer to physical activity. sickness and pre-existing injuries or another. This applies to the benefits congenital conditions. Such definitions The article cited a number of anecdotes provided, the sums insured and the and conditions then generally exclude describing ‘senior’ SMA office holders, terms and conditions applicable to the heart attack from being covered under a manager and an associate who policy. Two policies may have the same these sorts of policies. had recently become injured in their sums insured, however what is covered endeavour to embrace a more active and how claims are settled may be Whilst sports personal accident policies lifestyle which was most likely more entirely different. may contain additional benefits there reflective of their activity in years are three areas that form the ‘core’ But who is covered under the sports past. The article suggested that the of the cover and therefore attract personal accident insurance? In most injuries suffered by these individuals the most attention. These areas are instances this refers specifically to the may have been prevented had a more Capital Benefits (Death and Permanent players participating, but does not conservative, considered and informed Disability), Loss of Income and Medical always necessarily include coaches, approach been taken in their return to Benefits. It is these areas that we will referees and other officials and volunteer activity. focus on in this article. workers of the organisation. This being Having a very close association with at the case insurers may provide flexibility The Capital Benefits cover relates to least one of the injured parties referred as to who is to be insured under the more serious injuries – those involving to in these anecdotes prompted some policy, but sporting organisations and Death or Permanent Disability. The discussion about sports insurance, most ‘participants’ need to be aware of what is policy will provide a scale of Capital notably personal accident insurance, and stated in the policy and/or schedule. Benefits, which will list various provided an opportunity to outline just Permanent Disabilities and state what The intent of sports personal accident what exactly what is and isn’t covered percentage of the Sum Insured applies to insurance is to protect participants whilst by these types of insurance in situations that particular Permanent Disability. they are involved in the activities of the where someone is injured whilst sport. Policies will often provide cover Loss of Income cover, as the name participating in a sporting activity. when insured people are participating suggests, addresses the situation where An article published in 2006 by Rod in games and training, attending official an insured person is injured whilst Hughes of OAMPS Insurance Brokers social functions of the sport, involved participating in the sport and cannot provides a wonderful summary of these in administration and other volunteer attend his/her normal occupation, types of insurance and the following activities of the sport, travelling to and therefore losing income. Important includes article extracts and a summary from those activities already mentioned matters are the amount of weekly of the key points raised regarding sports and also staying away from home for the benefits applicable to the policy, the personal accident insurance. purpose of taking part in a competition, number of days excess (e.g. a 7 day match or training session. excess means that the player will not Many would be well aware that receive benefits for the first week of sporting organisations including clubs In order to make a claim under disability) and the maximum period and associations carry a variety of the policy an injury (or death) to a for which weekly benefits will be paid insurances. The sport specific range of participant needs to occur. But what (e.g. a common maximum period is 52 sports insurance available to sporting is the definition of an injury in these weeks, meaning the injured player is organisations are typically public liability, circumstances? This will vary from policy entitled to receive weekly benefits for up professional indemnity, directors and to policy, but definitions usually refer to one year). officers (also known as Association to bodily injury (or death) resulting

VOLUME 26 – ISSUE 4 • SUMMER 2008 15 INSURANCE

The amount the policy will pay is usually are made, but also because government contribute to evaluating the value of the a set percentage of the actual income legislation restricts what the insurer cover provided, as does the matter of lost (e.g. 85%) up to a maximum of can pay. The Health Insurance Act whether expense reimbursements are the specified weekly sum insured. This 1973 Section 126 prevents a general paid periodically or at the end of the nominated percentage goes towards insurer from paying any benefits on treatment period when the player has determining the value of the policy, but medical expenses which are entitled to recovered. perhaps even more important is the a Medicare rebate – this includes not Sports personal accident insurance is matter of how the loss of income benefit being able to pay the Medicare ‘gap’. a commonly provided policy of most is paid. Receiving benefits periodically Therefore it is only on non-Medicare sporting organisations and competitions. (e.g. monthly) is obviously much more medical expenses that a sports insurance However all participants, including practical than a situation where the policy is able to provide a benefit, coaches and officials, should familiarise benefit is paid lump sum when the being medical expenses such as Private themselves as to whether this is the case injured party has recovered and returned Hospital (accommodation and theatre in their sporting circumstance. to his/her occupation, as may be the fees), Dental, Ambulance, Physiotherapy, case under some policy wordings. In the Osteopath and other remedial therapies. From personal experience as a recently event of long periods of time off work injured participant it gave me some The insurance benefit will be the injured player will generally need comfort to know that the thousands of reimbursement of a nominated regular payment to meet everyday living dollars of non-medicare expenses spent percentage of these non-Medicare necessities. predominantly on physiotherapy would medical expenses up to a maximum be reimbursed, at least in part. Medical Expenses – or to be more amount per player per injury. An precise non-Medicare Medical Expenses. excess will apply, which means that Many thanks to Rod Hughes from This is the area of sports insurance cover the excess amount will be deducted OAMPS Insurance Brokers for his where the highest number of queries from the benefit paid. Again the permission to reproduce parts of is received – contributed to by the fact percentage reimbursed, the maximum his article ‘Sports Personal Accident that this is the area where most claims benefit and the excess amount all Insurance’.

>> from Page 13 challenge – in light of the resource we report from the Chief Medical Officer. Dannenburg AL, Cramer TW and have and a tight intervention start-time, London: Department of Health 2004. Gibson CJ. Assessing the walkability of providing additional campus cover to the workplace: A new audit tool. Am J Tudor-Locke C, Hatano Y, Pangrazi RP, existing routes could be unrealistically. Health Promot 2005, 20; 39-44. et al. Re-visiting how many steps are An alternative may be to provide indoor enough. Med Sci Sports and Exerc 2008; route-options for staff during inclement 40: S537-543. Acknowledgements weather. Lead researchers would like to recognize Gilson ND, McKenna J, Puig-Ribera A, et Beyond the immediate needs of our own the important contribution of the al. The International Universities Walking project, this article highlights a valuable following in helping to complete and Project. Employee step counts, sitting audit tool and process. We faced a guide the audit process. times and health status. Int Journal of number of challenges in standardizing Workplace Health Management. In press. Tracy Washington (Arizona auditors, both between and within State University), Mark Dawson sites, yet overcame these challenges Gilson N, McKenna J, Cooke C, et al. (Loughborough University), Filippe successfully through the creative use Walking towards health in a university Scerbo and Venus Shyu (University of of internet technology and the sharing community: A feasibility study. Prev Med Toronto), Elizabeth Coward and Wendy of best practice and expertise. These 2007: 44; 167-169. Brown (The University of Queensland), learned experiences provide a simple Gilson ND, McKenna J, Puig-Ribera A, et Jose M Saavedra and Yolanda Escalante message for other researchers and al. The International Universities Walking (University of Ulster), Mhairi MacDonald practitioners interested in promoting Project. Employee step counts, sitting and Samantha Fawkner (Heriot Watt workplace walking – namely, assess and times and health status. Int Journal of University) and Stephen Willis and audit your physical environment before Workplace Health Management. In press. Jim McKenna (Leeds Metropolitan intervention, with a view to using audit University). data to adapt strategies where possible. Gilson ND, Brown WJ, Faulkner G, As our campus audits demonstrate, this McKenna J, Murphy M, Pringle A, For further details on this article and process is particularly important for multi- Proper K, Puig-Ribera A and Stathis A. information on the “International site, international initiatives, with varied The International Universities Walking Universities Walking Project” contact physical and geographical landscapes. Project: Development of a Framework for the coordinating researcher Dr Nicholas Workplace Intervention using the Delphi Gilson, School of Human Movement Useful Sources Technique. Journal of Physical Activity Studies, The University of Queensland, and Health. In Press. Brisbane, Australia. Tel: +61 (0)7 336 Department of Health. At least five a 56114 or email [email protected] week. Evidence on the impact of physical activity and its relationship to health. A

16 Sport Health FootballerS Footballers and Fortitude – Why Icons of the game can ‘lose it’

By Dr Clive Jones

It’s understandable why a lot of footy line between instrumental aggression; the field either directly or indirectly. fans from all codes are scratching their that is within the rules of the game Things like pats on the back, cheers heads over the number of professional with a goal beyond the aggressive act from the fans, affectionate nicknames players caught for illicit drug use, violent itself, and hostile aggression; that is void derived from incidents of hostility and a behaviour and general unruliness off the of any other purpose apart from the range of other factors can reinforce and field. Before I offer some explanation as primary goal of inflicting injury or harm encourage a player to see their hostile to why this might be occurring in some on someone else. The player who can acts as a significant and highly valued instances, it’s important to point out that hold a strong moral code of keeping the part of themselves. For the young, there are no solid statistics to suggest aggression within the rules of the game in growing personality looking for a sense that such behaviour is any more prolific order to achieve a higher goal beyond the of self and clarity of identity it can be in footy players than in the general aggressive act itself is in a better place for a significant trap where they foreclose population. So in this sense – people are keeping their behaviour in check than their identity by shutting out the broader people. the player who keeps their aggressive qualities of who they are and instead behaviour focused on simply inflicting take hold of a hostile stereotype instead. So when looking at this issue we first When hostile aggression stems from have to accept that such behaviour is harm on the opposition. the players sense of self it becomes a going to stand out much more in the difficult thing to address. This is because public eye with a high profile personality 2. Not knowing where to draw for the player in this mindset, there is than with a Mr or Ms anonymous the line more at stake than simply changing behaving in the same way. For some players it’s the simple behaviour. Changing hostile behaviour Even so, it is still fair to say that the mistake of not being able to keep their in this instance would mean giving up general community, fans, the families aggressive play on the field. Being what they have come to believe is a of those affected, coaches and the all keyed up to be aggressive on the highly valued and esteemed part of them respective CEO’s are genuinely field can be a difficult thing to wind selves. To give up the hostile aggression concerned over such behaviour’s down from after the game has ended. for this player means to give up a very and see it as a significant issue to Switching aggressive mindsets on and off significant part of who they believe they be addressed. As an initial step to between games and training sessions is a are. understand how such issues may arise, I tough call. But what makes it tougher is have provided five different reasons why when the player is switching on hostile some footy players of all codes can be aggression rather than instrumental prone to ‘lose it’ on and off the field. aggression. Instrumental aggression is kept within the boundaries of the game and therefore it’s easier to switch Five factors that can off from it once the game is over. contribute to players ‘losing it’ Hostile aggression on the other hand is on and off the field behaviour less associated with the game because it lies outside the rules and it 1. Being hostile rather than is not connected to any specific goal instrumental in their within the game either, other than to hurt someone else in opposition to them. aggression This type of aggression finds it easier to One factor for some players is the permeate into the rest of the player’s life difficulty in differentiating between outside of sport making them at greater instrumental aggression and hostile risk of aggressively hostile outbursts aggression. It’s obvious that all codes of throughout their daily life, normal football are aggressive sports. Particularly routines and relationships whenever in league and union where good play someone is in opposition to them. involves hitting hard in tackles and making the opposition hurt. In balance, 3. Having a limited self image and with the proper boundaries in place, For some players a large portion of this is all a part of the excitement and their self image is built around their challenge for both the fans and players tough and aggressive play. One reason alike. Unfortunately though, some for this is because players will often players do find it difficult to draw the be rewarded for aggressive acts on

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4. Misunderstanding what it 5. Being too narrow in focus in a neglect of the athlete’s broader life means to be a tough bloke goals, responsibilities and commitments Something that is prolifi c in high to the detriment of the player and those The tough bloke mindset is prolifi c in performance sport is for athlete’s to get closest to them. all codes of footy. This manifests in caught up in a narrowed competitive the perspective of ‘tough blokes don’t focus beyond the scope of their The bottom line is there is more to life cry they just punch walls’. In the footy competition and training sessions. than sport. It is when the player has culture of toughness, aggression is Athletes need to narrow their focus to their professional career in perspective often the only intense emotion that allow for all other distractions to be with the rest of their life, and holds due is readily accepted and understood. put on hold and out of the way while consideration for others around them, Other emotions like grief, sadness, focusing intently on the game or training that they are more likely to maintain a depression, fear and anxiety can be session at the time. It’s important to do healthy and more balanced approach prone to suppression in the ‘tough guy’ this. A distracted player performs poorly to life on and off the fi eld. Aiding in the environments leaving a lot of emotional and is also at greater risk of injury. achievement of this can be done through baggage hanging around. One way to Unfortunately though, some athletes the coach, support staff and the athlete keep those other emotions at bay is by and support staff think this narrowed intentionally addressing the areas of self medicating through alcohol or other focus should be maintained beyond the concern mentioned above. forms of illicit drug use. It takes a lot sporting fi eld into everyday life. This of courage to face the full spectrum of can result in an imbalanced perspective By Dr Clive Jones Dipt, emotions that conjure up from within that can promote quite a selfi sh and self DipLifeCoach, DipCouns, indulgent point of view. To be locked us at different times. Being stuck in the BEd, MEd, GradDipPsych, culture of the tough bloke mindset can into a mindset 24/7 whereby the only have a man deny the essence of what it thing that matters is the game and PhD(psych), MAPS., CoCouns, means to be human. This will only ever every other issue in life is ignored or CoSp lead to personal trouble and distress. considered insignifi cant in comparison Dr Clive Jones is an Assistant Professor to the competitive goal of the athlete is of Sport Psychology at Bond University. a very ineffective mindset to hold for life outside the weekend game plan and Correspondence: [email protected] weekly training sessions. It only results

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Brisbane is set to host the paramount workshops, free papers, posters and Mr Mark Fenton (Asics Sponsored sports medicine, sports science, sports a trade exhibition. It will also provide Speaker) injury prevention and physical activity extensive networking opportunities. National Center for Bicycling and promotion conference in Australia - “be Walking & the University of North The goal of be active ‘09 is to provide active ‘09”, from 14 - 17 October 2009. Carolina’s Pedestrian and Bicycle a scientifi c forum in which delegates Information Center be active ‘09 combines the 2009 from Australia and around the world Australia Conference of Science and can come together to discuss and Refshauge Lecturer Medicine in Sport “Active Sports Medicine debate the latest scientifi c research Professor Caroline Finch (Australian for all”, the Seventh National Physical and evidence on all forms of physical Sports Medicine Federation Fellows Activity Conference “ReActivating activity - from elite sport to walking Sponsored Speaker) Australia” and the Sixth National Sports in local communities. An emphasis NHMRC Principal Research Fellow, Injury Prevention Conference “Staying will be placed on identifying areas of School of Human Movement and Sport Safe to Be Active”. be active ‘09 brings scientifi c knowledge that will be of Sciences, University of Ballarat together some of the fi nest speakers greatest interest to practitioners and Dr Marc Hamilton from Australia and around the world to policymakers. The anticipated outcome Associate Professor of Biomedical present a comprehensive scientifi c forum of be active ‘09 is to assimilate, interpret Sciences, Dalton Cardiovascular on all facets of these fi elds - from elite and share scientifi c evidence with key Investigator, University of Missouri performance to community participation stakeholders who are in a position to in sport, physical activity and their develop recommendations concerning Professor Stephen Harridge impact on individual and public health. effective policies and programs within Professor of Human and Applied their own jurisdictions. Physiology, Division of Applied be active ‘09 is a multi-disciplinary Biomedical Research, School of event. It will bring together the Biomedical and Health Sciences, King’s most infl uential researchers and Speakers include: College London practitioners in these fi elds. The Dr Caroline Broderick conference showcases the latest Senior Lecturer, Sports Medicine Dr Karl Landorf developments through keynote and Program, School of Medical Sciences, Senior Lecturer and Research invited presentations, symposia, practical The University of New South Wales Coordinator, Podiatry Department,

INVITATION The organisers invite the submission of abstracts that address the overall conference Call for Papers be active ’09 theme “be active ‘09” in sports science, sports medicine, physical activity promotion and sports injury prevention. 3 concurrent events We encourage all researchers, practitioners, policy makers and students who wish to present their work to submit abstracts for presentation at the ACSMS, the NPAC, or the NSIPC. 2009 Australian Conference of Science and Medicine in Sport All abstracts must be submitted online at www.beactive09.com and must be received “Active Sports Medicine for all” by 31 March 2009. Seventh National Physical Activity Conference SUBMISSION “ReActivating Australia” Each conference has its own submission form and you must complete one form for Priority will be given to papers relating to the following conference themes: Settings each abstract you are submitting for review. approaches - integration across policy and interventions ~ Sedentary behaviours / You must tick the boxes on the submission form to indicate the main focus of your sitting time and workplaces as a setting for intervention ~ Supportive environments abstract, and to identify your submission as a ‘free paper’ or as one of a group of papers and supportive environments planning ~ Priority population groups ~ Secondary and which are being submitted as a symposium. tertiary prevention ~ Children and adolescents ~ Advocacy, communication and social marketing CONFERENCE HIGHLIGHTS ~ Speakers including: Sixth National Sports Injury Prevention Conference • Refshauge Lecturer Professor Caroline Finch • Professor Willem van Mechelen “Staying Safe to Be Active” • Mr Mark Fenton • Dr Lorimer Moseley • Associate Professor Marc Hamilton • Dr Chris Rissel ~ Innovative research presented at free paper and poster sessions plus hands-on workshops

~ Earn 20professionalSport Health development points 14 - 17 October 2009, Brisbane Convention & Exhibition Centre

call_for_papers2.indd 1 8/12/2008 12:25:07 PM BE ACTIVE ‘09

Faculty of Health Sciences, La Trobe Occupational Health, Co-director EMGO Workshops University Institute, VU University Medical Center, (Pre-booking essential) Amsterdam Dr Michael Lloyd A wide range of hands-on clinical Assistant Sport Psychology Network Detailed biographies and areas of workshops as well as the following new Coordinator, Queensland Academy of interest can be found at http://www. areas: Sport; Sport Psychology Consultant / beactive09.com/speakers/default.asp Service Provider, Australian Institute of • Sports Medicine Emergency Care for Sport Sessions include: Health Professionals • Business and practice development Professor Thomas Marwick • Sports medicine for health professionals Professor of Medicine, University • Clinical physiotherapy • Talking to and using the media of Queensland, Princess Alexandra • Nutrition and Physiology • Health impact assessments Hospital, Brisbane • Sports injury treatment and prevention • Designing, implementing, and Dr Lyle Micheli • Biomechanics • Shoulder evaluating physical activity Director, Division of Sports Medicine, interventions Children’s Hospital Boston • Motor control • Settings approaches - integration • Assessing physical activity Clinical Professor, Orthopaedic Surgery, • CPR accreditation Harvard Medical School, Boston, across policy and interventions Massachusetts • Sedentary behaviours / sitting time and workplaces as a setting for Posters Dr Lorimer Moseley intervention A stand-alone Poster session presenting Senior Research Fellow, Prince of Wales • Supportive environments and the latest research in sports medicine Medical Research Institute, Sydney supportive environments planning and science, physical activity and sports Dr Chris Rissel • Priority population groups injury prevention research (with wine). Director, Health Promotion Service, • Secondary and tertiary prevention Sydney South West Area Health Service • Children and adolescents research Prizes • Advocacy, communication and Associate Professor, School of Public Sixteen research awards valued at Health, University of Sydney social marketing • Sports psychology $28000 in total for the best research Dr Mark Tarnopolsky • Pain presented. Professor of Pediatrics and Medicine, • Knee / ACL be active ‘09 Conference Research Hamilton Hospitals Assessment Center • Foot & Ankle Awards (The Australian Sports Medicine Endowed Chair in Neuromuscular • Paediatric exercise science Federation Fellows Awards): Disorders, Director of Neuromuscular • Schools and Injury Prevention and Neurometabolic Clinic, McMaster • Research practice translation The Australian Sports Medicine University Medical Center, Hamilton, • “Best of the Best”. Best Paper winners Federation Fellows’ Awards 2009 are: Ontario will present again in a fi nal plenary ASICS Medal - Best Paper Overall session to determine the winner of the Professor Willem van Mechelen $3000 prize (plus cash component from Asics Medal and $5000 prize for Best Head, Department of Public and qualifying prize) Paper overall. >> to Page 29

INFORMATION DEADLINES • All abstracts must be unpublished original work and not previously presented in Abstract submission 31 March 2009 Australia • Researchers are also invited to join with colleagues to submit a group of three or four Early bird registration 31 July 2009 abstracts which focus on any aspect of the conference theme to be presented in a single symposium session. Please refer to the online submission forms for further details Author registration 31 July 2009 • All accepted abstracts will be published in a December 2009 supplement to the Journal of Science and Medicine in Sport, providing registration fees have been paid by the 31 Website www.beactive09.com August 2009 • For online submission of abstracts • Accepted abstracts may be eligible for one of the prestigious Australian Sports • To register interest in the conference Medicine Federation Fellows Awards*. A complete list of awards and conditions will be posted on the website • For more information on trade and sponsorship opportunities * To qualify for a conference award the presenting author must register for the full conference and be a member of Sports Medicine Australia. Membership is open to both Australian and international delegates. Further conditions apply For further information please contact: for abstracts short listed for awards. See website for details. Sports Medicine Australia, PO Box 78, Mitchell ACT 2911 Abstracts are to be submitted online at www.beactive09.com. If this method is not possible please contact the Conference Secretariat. p: +61 2 6241 9344 | f: +61 2 6241 1611 | e: [email protected]

VOLUME 26 – ISSUE 4 • SUMMEr 2008 21

call_for_papers2.indd 2 8/12/2008 12:25:11 PM 2008 CONFERENCE WRAP UP What happened at the 2008 Conference?

The 2008 SMA national conference, Details of the Conference research award Asics Best Paper - Performance the Asics Conference of Science and winners are listed below. Enhancement and Basic Science Medicine in Sport at Hamilton Island ($2000) Congratulations to the following in mid October was again a highlight Dr Stephan Riek, The University of 2008 Australian Sports Medicine of the year. A total of 389 attended Queensland Federation Award winners: the conference, including 50 overseas Superimposed vibration confers no delegates, featuring more than Asics Medal - Best Paper Overall additional benefit compared to resistance 200 presentations. ($5000 prize including Presentation training alone Package at ACSM) Co Authors - A. Popple, S. Verscheuren SMA owes a debt of thanks to the Mr James Gaida, Deakin University & R. Carson organising committee Associate Professor Patients with chronic painful mid- Jill Cook, Professor Wendy Brown and Asics Best Paper - Health Promotion portion Achilles tendinopathy have a Dr Anita Green. We would also like to ($2000) dyslipidaemia that is characteristic of say a big thank you to Mark Doherty Dr Nicola Burton, The University of insulin resistance and Asics Tiger Oceania for sponsoring Queensland Co Authors - L. Alfredson, Z. Kiss, J. a 2nd boutique conference in another HABITAT: Is living in a disadvantaged Cook & H. Alfredson fantastic location. Some candid (and not area associated with mid aged residents’ so candid) photos are available at http:// physical activity and use of recreational www.sma.org.au/ACSMS/2008/photos. facilities? asp and abstracts will again be published Co Authors - G. Turrell, L. Wilson & K. as an electronic supplement to the Giskes Journal of Science and Medicine in Sport Asics Best Paper - Injury Prevention (JSAMS). ($2000) Mr Andrew van Essen, a Podiatrist Dr Rebecca Dennis, The University of from Adelaide, was welcomed into the New South Wales Australian Sports Medicine Federation Throwing workload and injury risk in Order of Fellows at the Fellows AGM elite Cricketers and Dinner at the Conference. Co Authors - R. Saw, D. Bentley & P. Farhart Asics Best Paper - Lower Limb ($2000) Dr Natalie Collins, The University of Queensland Contoured prefabricated foot orthoses are superior to flat inserts in the short Asics Medal winner Mr James Gaida term management of anterior knee pain and Mr Mark Doherty from Asics Co Authors -K. Crossley, T. McPoil & B. Vicenzino Ken Maguire Award for Best New Asics Best Paper - Clinically Relevant Investigator - Clinically Relevant Conditions ($2000) Conditions (Presentation package at Dr Dennis Taaffe, The University of ACSM) Queensland Mr James Gaida, Deakin University Alterations in muscle attenuation Patients with chronic painful mid- following detraining and retraining in portion Achilles tendinopathy have a resistance trained older adults dyslipidaemia that is characteristic of Co Authors - T. Henwood, M. Nalls, D. insulin resistance Fellows President Dr Shane Conway and new ASMF Fellow Mr Andrew van Walker, T. Lang & T. Harris Co Authors - L. Alfredson, Z. Kiss, J. Essen Cook & H. Alfredson

22 Sport Health 2008 CONFERENCE WRAP UP

Asics Award for Best New Wendy Ey, Women in Sport Award Letter to the Conference from Investigator - Lower Limb ($500) a delegate that has attended (Presentation package at ACSM) Ms Maria Romiti, University of Ballarat Mr Kent Sweeting, Griffith University Barriers and facilitators towards a netball 35 of the past 40 conferences. Achiliies tendinosis: How does landing intervention program (“Down to Dear Gary, prolotherapy compare to eccentric Earth”) among coaches of junior teams I would like to congratulate you loading exercises Co Authors - P. White, N. Saunders, L. and your staff, all the various levels Co Author - M. Yelland Otago, A. Donaldson & C. Finch of organisation and particularly the John Sutton Award for Best Queensland Academy of Sport Scientific Committee, Wendy Brown, New Investigator - Performance Best Poster - Clinically Relevant Anita Green, and Jill Cook for hosting a Enhancement and Basic Science Conditions ($500) marvellous conference – the ACSMS 08 (Presentation package at ACSM) Ms Verona du Toit, University of at Hamilton Island last weekend. Mr Simon Dannapfel, Waikato Institute Western Sydney You asked what I thought may have of Technology How effective are orthoses in the contributed to the overall enjoyment The acute effect of prolonged intense treatment of exertional medial shin pain? and success of the conference. My cycling and blackcurrent extract on Co Authors - M. Smith & B. Vicenzino observations can only ever be a protein carbonyls in well-trained male Journal of Science and Medicine in personal perspective from a long-term cyclists Sport Best Poster - Health Promotion physiotherapy clinician committed to Co Authors - T. Lowe & R. Cummins ($500) maintaining interest and staying at the NSW Sporting Injuries Committee Miss Victoria Archbold, Leeds cutting edge of this field. Basically, Award for Best New Investigator - Metropolitan University the bottom line to me, the worth of Injury Prevention ($2000) “I wish I was normal”: the psycho-social any conference relates to the clinical Dr Dara Twomey, University of Ballarat effect of adolescents living with type 1 and practical gems I can take from the Do hard playing fields increase the risk diabetes speakers and add to my special box of of injury in community level Australian Co Author - E. Webster jewels. Every speaker gave me a jewel – football some many. Best Poster - Injury Prevention ($500) Co Authors - L. Otago, C. Finch, I. Ms Lauren Petrass, University of I believe the sessions I attended were Chivers & J. Orchard Ballarat all of a very high quality and relevant Asics Award for Best New The role of child supervision as a risk or to hands-on application. I think the Investigator - Health Promotion protective factor for childhood injury in groupings were useful for each session. I ($2000) active play didn’t miss one session. Dr Mitch Duncan, Central Queensland Co Authors - J. Blitvich & C. Finch The social content and net-working University Best Poster - Performance opportunities were as effective as any Association between degree of Enhancement and Basic Science conference I’d ever been to. Perhaps the urbanisation, physical activity and ($500) venue and dinner/meeting locations had perceptions of the environment in Mr Amin Ahmadi, Griffith University & something to do with this – everybody Queensland adults Queensland Academy of Sport was within a hands-throw from Co Authors - K. Mummery, R. Steele, C. Deriving upper arm rotation from Vicon everybody else. Caperchione & G. Schofield to enhance the first serve in tennis Certainly the destination, hotel and Co Authors - D. Rowlands & D. James facilities were all marvelous, and conductive to relaxation which allowed delegates to focus on the proceedings. Overall, I would have to rate the conference one of the most enjoyable I’ve been to – the Gala Dinner was particularly fun. So, once again, many thanks for your management. Look forward to seeing you again – certainly in Brisbane for the ’09 conference, if not before. Best Wishes, Peter Dornan

Some winners of the Australian Sports Medicine Federation Fellows’ Awards 2008 from left to right Maria Romiti, Natalie Collins, James Gaida, Dara Twomey, Simon Dannapfel, Rebecca Dennis, Dennis Taaffe, Nicola Burton & Stephan Riek

VOLUME 26 – ISSUE 4 • SUMMER 2008 23 From the CEO We put our heart & ‘sole’ into providing your patients with the perfect t.

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Australia: theathletesfoot.com.au T: 1800 677 621 / New Zealand: theathletesfoot.co.nz T: 0800 2378 348 24 Sport Health CLEANEDGE Getting a CleanEdge: A partnership approach to prevent doping in youth

Young athletes and those responsible for their wellbeing can now wise up to the dangers of performance and image enhancing drugs by logging onto Sports Medicine Australia’s new anti-doping website, CleanEdge, www.cleanedge. com.au. An initiative of Sports Medicine Australia Victorian Branch supported by the Victorian Government, CleanEdge provides relevant and credible anti- doping education for those involved in and who administer community sport. The website acts as an educational resource and information hub bringing together some of the best national and international resources. The website also contains new information that explores healthy ways to enhance performance, the facts about, and the consequences of, doping in sport in a variety of mediums. It includes nutrition • With coaches or sporting clubs Activities can be run as a one-off or as and training tips, as well as suggestions • With teammates part of a series – dependant on what for key sport stakeholders to help young works with your setting. • With parents or children athletes maintain a positive involvement Through providing doping information in sport and recreation. • In a classroom to all those involved in sport, it is hoped • In conjunction with other anti doping “By learning how to improve that the message of approaching sport resources and activities performance naturally through nutrition, ‘cleanly’ is adopted by all athletes in training and preparation, both physically Some highlights of the website are: the aim that safer, cleaner, fairer and and mentally, sports participants healthier sporting environments can be • Video interviews of elite athletes will avoid the dangers associated created. providing anti-doping messages with doping and achieve a healthy to aspiring athletes. These include To visit CleanEdge go to outlook on how to approach sport and such athletes as Joanne Fox – water www.cleanedge.com.au. For more physical activity,” said Sports Medicine polo, Kathryn Mitchell – javelin, Kate information phone 03 9674 8777 or Australia Victorian Branch President, Dr Quigley – softball and Janne Errington email [email protected] Bolzonello. Smith – wheelchair basketball. Sports Medicine Australia Victorian The CleanEdge website can be used: • Video information and advice from Branch would love to hear SMA • By all involved with young athletes to sporting professionals including members’ thoughts on this new initiative. give advice sports dietitians, physiotherapists, Visit www.cleanedge.com.au to submit doctors, exercise physiologists and • By athletes themselves comments. psychologists. • To encourage healthy practices • An ‘Education Kit’ with a range of • To learn about drugs in sport different activities about performance • To learn about how to get an edge in and image enhancing drugs, and sport improving sporting performance.

VOLUME 26 – ISSUE 4 • SUMMER 2008 25 AustralASIAn COLLEGE OF SPORTS PHYSICIANS Therapeutic Joint and Soft-tissue Injections By Dr Justin Paoloni

The Medicare Benefits Schedule injection treatments [1]. As this definition There is level 2 evidence of decreased (MBS) is compiled and organised currently stands, there is no patient pain with corticosteroid injection in by the Australian government. This rebate available for soft-tissue injections patella tendinopathy [9] and Achilles document outlines the indications and to treat tendon injury, muscle injury, tendinopathy [9-10], and for decreased use of medical procedures for which injury to ligament or fascia, or nerve pain with polidocinol injection the patient can claim reimbursement entrapments. sclerotherapy in patella tendinopathy [11] from the government. The indications and Achilles tendinopathy [12]. Here we will briefly discuss different are generally clearly defined, and one soft-tissue injections and their evidence such item number is specifically for of efficacy (see Box 1 for levels of Injury to Ligament and Fascia “injection into joint or other synovial evidence)[2]. Medial collateral ligament (MCL) cavity” (Item number 50124). This injury in the knee is common and definition covers some therapeutic may be recalcitrant to treatment, injections given by medical practitioners Tendon Injury especially where proximal attachment such as: joint injections, subacromial Tendon injury includes a spectrum of calcification is noted (Pelligrini-Stieda injection, Trochanteric bursal injection, injury such as degenerative tendon injury lesion). Corticosteroid injection is prepatellar bursal injection, olecranon and partial tendon tears. Therapeutic the recommended treatment for this bursal injection, and retrocalcaneal or injections are commonly used to treat condition despite only level 4 evidence retroAchilles bursal injection. It could tendon injuries and can be an integral for treatment effect of decreasing pain also easily be justified that this item part of the management of these chronic and increasing function [13]. number also covers injections for conditions, especially where moderate to Morton’s neuroma and the associated severe pain or disability is a feature. Plantar fasciitis is another common intermetatarsal bursa, and injections recalcitrant musculoskeletal condition, There is level 1 evidence that for de Quervain’s tenosynovitis, tibialis and corticosteroid injection is often corticosteroid injections decrease posterior tenosynovitis, or trigger finger required as part of treatment. There is elbow pain and increase function, as the tendon sheaths have a synovial level 1 evidence for decreased pain with including grip strength, when used as lining. However, there are many this treatment [14-15]. a treatment for injury to the extensor commonly used therapeutic soft-tissue carpi radialis brevis (ECRB) tendon Lumbar back pain, including injury to injections, with appropriate evidence in lateral epicondylosis [3-4]. Other the iliolumbar ligament, is prevalent in of efficacy, which are not covered by therapeutic injections used to treat lateral the general community and there is level this definition. These injections give no epicondylosis, and having evidence 2 evidence of efficacy of prolotherapy patient rebate under the MBS. of efficacy in reducing pain, include: or normal saline injections reducing pain It is my strong belief that the scope of autologous blood injections (level 2) and disability [16-17]. therapeutic injections covered under [5], polidocinol sclerotherapy injections this MBS item needs to be broadened, (level 2) [6], and botulinum toxin Nerve Entrapments injections (level 2) [7]. There is level 3-2 or a new item number introduced, to One of the mainstays of therapy in evidence that corticosteroid injections more effectively reimburse patients for the treatment of nerve entrapments is decrease elbow pain as a treatment clinically indicated and evidence based the use of corticosteroid injections to for flexor/ pronator decrease soft-tissue swelling. There have tendon injury (medial level 1 evidence of treatment effect in epicondylosis) [8]. carpal tunnel syndrome [18-19], and Achilles tendon level 3/ level 4 evidence of effect in injury and patellar suprascapular nerve entrapment in the tendinopathy are shoulder[20], radial tunnel syndrome extremely common (posterior interosseus nerve entrapment musculoskeletal in the forearm)[21], and meralgia conditions that often paresthetica (entrapment of the lateral require therapeutic femoral cutaneous nerve of the thigh as injections as part of it passes through the inguinal fascia in their management. the groin)[22].

26 Sport Health AustralASIAn COLLEGE OF SPORTS PHYSICIANS

muscle electrostimulation. This may 15. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. be preferable for small joint injections, Amer Fam Phys 2005: 72:2237-42. soft-tissue injections into deeper tissues, 16. Yelland MJ, Del Mar C, Pirozzo S, et al. Prolotherapy injections for chronic low back pain: a systematic or when using therapeutic agents where review. Spine 2004; 29:2126-33. accurate delivery is essential to limit side- 17. Yelland MJ, Glasziou PP, Bogduk N. Prolotherapy injections, saline injections, and exercises for effects (polidocinol sclerosant injections chronic low-back pain: a randomized trial. Spine in tendon, or Botulinum toxin injections 2004; 29:9-16. in tendon injury). Besides these 18. Ly-Pen D, Andreu JL, de Blas G, et al. Surgical decompression versus local steroid injection in examples, the majority of injections can carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis be safely and effectively delivered using Rheum 2005; 52:612-9. palpation guidance alone. 19. Graham RG, Hudson DA, Solomons M, et al. A prospective study to assess the outcome of steroid Pseudoarthroses A separate item number, and greater injections and wrist splinting for the treatment of carpal tunnel syndrome. Plastic Reconstruct Surg A pseudoarthrosis generally refers rebate, may be appropriate for these 2004; 113:550-6. to the fibrous or cartilaginous union procedures which would compensate 20. Taskaynatan MA, Yilmaz B, Ozgul A, et al. Suprascapular nerve block versus steroid injection between accessory bones and the for the increased complexity and risk of for non-specific shoulder pain.Tohoku J Exper Med adjacent larger bone (that often gives the the therapeutic injection, and equipment 2005; 205:19-25. requirements. It may be appropriate 21. Huisstede BM, Miedema HS, van Opstal T, accessory bone its name). These tend et al. Interventions for treating the posterior to cause symptoms in adolescents, and to limit these guided injections and interosseus nerve syndrome: a systematic review of observational studies. J Periph Nerv System 2006; corticosteroid injections may be required item numbers to appropriately training 11:101-10. to treat pain. There is level 2 evidence of medical specialists. 22. Haim A, Pritsch T, Ben-Galim P, et al. Meralgia paresthetica: A retrospective analysis of 79 patients efficacy in treating pain and decreasing evaluated and treated according to a standard posterior ankle impingement with References algorithm. Acta Orthopaedica 2006; 77:482-6. 23. Maquirriain J. Posterior ankle impingement symptomatic os trigonum [23], and level 1. Paoloni, JA, Orchard, J. The use of therapeutic syndrome. J Amer Acad Ortho Surg 2005; 13:365-71. medications in soft tissue injuries. Med J Aust 3/ level 4 evidence of efficacy in treating 2005:183(7),384-388. 24. Schuler MK, Dammann F, Schewe B, et al. Distinctive features of the os naviculare os naviculare (also called os tibiale 2. National Health and Medical Research Council. A pseudarthrosis vs the os naviculare accessorius. guide to the development, implementation and externum)[24], and in os acromiale[25]. Unfallchirurg 2003;106:73-6. evaluation of clinical practice guidelines. Canberra: NHMRC, 1998. 25. Kurtz CA, Humble BJ, Rodosky MW, et al. These examples of commonly used, Symptomatic os acromiale. J Amer Acad Ortho Surg 3. Smidt N, Assendelft WJ, van der Windt DA, et al. 2006; 14:12-9. clinically appropriate, and evidence Corticosteroid injections for lateral epicondylitis: a based soft-tissue injections in sports systematic review. Pain 2002;96:23-40. 4. Newcomer KL, Laskowski ER, Idank DM, et al. Box 1 medicine are not covered by the MBS Corticosteroid injection in early treatment of lateral under the existing item numbers. I epicondylitis. Clin J Sport Med 2001;11:214-22. 5. Edwards SG, Calandruccio JH. Autologous blood Evidence Levels by Study would suggest a few possible options injections for refractory lateral epicondylitis. J Hand Design2 (with option 3 being by preferred one): Surg [Am] 2003; 28:272-8. 6. Zeisig E, Fahlstrom M, Ohberg L, et al. Pain relief Level 1: Systematic review of Item number 50124 be retained for after intratendinous injections in patients with tennis elbow: results of a randomised study. Br J Sports randomised control trials injections into joint and synovial cavities, Med 2008; 42:267-71. (RCTs) and a new item number is added to 7. Wong SM, Hui AC, Tong PY, et al. Treatment of lateral epicondylitis with botulinum toxin: a Level 2: At least one properly the MBS encompassing therapeutic randomized, double-blind, placebo-controlled trial. designed RCT injections to treat tendon injury, muscle Annal Int Med 2005; 143:793-7. 8. Stahl S, Kaufman T. The efficacy of an injection injury, ligament injury, fascial injury, and of steroids for medial epicondylitis. A prospective Level 3-1: Well designed psudoarthroses. study of sixty elbows. J Bone Joint Surg [Am] 1997; pseudorandomised controlled 79:1648-52. trials Item number 50124 is expanded to 9. Fredberg U, Bolvig L Pfeiffer-Jensen M, et al. Ultrasonography as a tool for diagnosis, guidance adequately cover these therapeutic of local steroid injection and, together with pressure Level 3-2: Comparative studies (or injections (by listing each injection and algometry, monitoring of the treatment of athletes reviews of such studies) with chronic jumper’s knee and Achilles tendinitis: its treatment specifically) a randomized, double-blind, placebo-controlled without concurrent controls study. Scand J Rheumatol 2004; 33:94-101. Item number 50124 has an expanded 10. McLauchlan GJ, Handoll HH. Interventions for Cohort studies descriptor to include not just “injection treating acute and chronic Achilles tendinitis. Cochrane Database of Systematic Reviews 2001; Case control studies into joint or other synovial cavity” (2):CD000232. but also “therapeutic injections to 11. Alfredson H, Ohberg L. Neovascularisation in chronic painful patellar tendinosis--promising results Level 3-3: Comparative studies with treat tendon injury, muscle injury, after sclerosing neovessels outside the tendon historical control ligament injury, fascial injury, and challenge the need for surgery. Knee Surg Sport Traumatol Arth 2005; 13:74-80. Level 4 : Case series psudoarthroses.” 12. Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised Dr Paoloni is a Sports Physician Guided Injections controlled trial. Knee Surg Sport Traumatol Arth 2005; 13:338-44. current working at Aspetar, Additionally, the use of accurate 13. Quarles JD, Hosey RG. Medial and lateral collateral Qatar Orthopaedic and Sports guidance for therapeutic injections injuries: prognosis and treatment. Primary Care; Clin Office Practice 2004; 31:957-75. Medicine Hospital is gaining in popularity and this 14. Crawford F. Plantar heel pain and fasciitis. Clinical would include modalities such as Evidence 2005; 13:1533-45. ultrasound, Doppler ultrasound, and

VOLUME 26 – ISSUE 4 • SUMMER 2008 27 Australian Physiotherapy Association Postoperative management of athletic ankle injury By Stuart Imer

Rehabilitation of an athlete after ankle will be managed with backslab casting by posterior ankle arthroscopy, but the surgery provides many challenges for the for two weeks (there are even some vast majority of cases will be anterior. physiotherapist. This patient population surgeons applying aircast braces in the Intramuscular injection of corticosteroid is a very rewarding one to work with, as operating suite, without a backslab at at the time of surgery may afford only the most severe cases will progress all) then progress on to sports ankle some protection to overt inflammation on to surgical management. Therefore bracing at two weeks. I like the ASO progressing on to arthrofibrosis. Also the patient population is skewed to the ankle brace. This allows early range and postoperative intra-articular steroid can most challenging cases, by their very strength work. I progress the patient on be helpful as well as hydradilitation in failure at conservative measures. to partial weight bearing at two weeks recalcitrant cases. Recently collected then full weight bearing at four weeks. data in our clinic suggest that ankles will There are those cases for which surgery Patients can generally start running at remain swollen for three to four months is obviously unavoidable, if restoration six weeks with a full return to twisting post-arthroscopy, much longer than the of even non-athletic activities of daily sports at three months, or even earlier if accepted six weeks. living is to occur. Then there are the physio resources are abundant, as with failed conservatively managed injuries It is critical that physio is part of the professional athletes. that end up at surgery. Particularly with solution and not the problem in the cases where larger surgery is involved Proprioceptive drills should be targeted rehab of these scar-prone patients. for significant traumas, the role of to the sporting and daily needs of the Endless compression through abuse and the therapist in helping restore the athlete. The therapist should keep in mistiming of lunge-type stretching will athlete’s function often shifts to ways mind the platform that the athlete will guarantee extra synovitis in the anterior of compensating for less than ideal be working on. A table tennis player ankle and create fibrosis and stiffness. physiological parameters. These cases will need different drills to a surfer or Too often patients report they have are ultimately most rewarding as they are mountain biker, for example. Tailor your been ‘banging on regardless’ with their also the most difficult to treat. drills accordingly, and be inventive. lunge stretches in a forlorn attempt to Use of moving platforms (e.g. scooter, push into range, even sometimes at the Salient differences with respect to ankle skateboard or even rollerblades) can request of their physio! The net effect injuries include the high prevalence of have your adventurous patients enjoying after a stretching session should have ankle injury, as well as anatomical and their late-stage rehab. Walking balance the patient feeling more flexible and not functional differences. Compared to the beam or fence posts or even slack chain more painful. Try more traction-type knee for example the weight-bearing can challenge others at late stage. Sure, stretches, sustained linear glides in non surfaces are smaller, and the weight- don’t forget theraband kicks, the balance or minimal weight-bearing situations, bearing forces larger. The static restraints disc or rockerboard; just don’t finish your cycling and pool work to help these to instability are multi-arthrodial, their patients’ rehab with only these devices if cases. Full weight-bearing lunge is best role applied across ankle and subtalar they are athletic. left until after six weeks in a lot of these joints, and largely influenced by the cases. other hindfoot joints. The ankle is also influenced greatly by the complex Ankle impingement I have a zero tolerance policy for demands of the foot in adapting to Surgical treatment is usually best done patients wearing thongs, bare feet or surface variations, and the opposing goal through the arthroscope. Remember the currently fashionable flat or negative of being a stable, rigid lever for effective these patients are usually post-instability heel street shoes until six weeks as propulsion. or compression injury, and that they well. Runners (with a small heel lift if probably have an aggressive healing required) are the footwear of choice Ankle instability tendency, which promotes scar tissue or any shoe with a positive heel pitch formation, which creates impingement. so long as the heel is broad and stable. The surgical procedure of choice in Hence they may not be unstable as they Watch out for your young female restoring lateral ligament complex have scarred up nicely and usually too patients who claim to only wear a small stability to the ankle is an anatomical well. These patients will also tend to lay heel. You may need to make sure you repair, like the Brostrom procedure. down scar after surgery, so a minimally are both on the same page with what There is no donor site morbidity that invasive procedure is the best bet. Some constitutes ‘small’. was such a problem in the complicated posterior impingement including os old-style reconstructions. These cases trigonum excision can be dealt with

28 Sport Health Australian Physiotherapy Association

>> from Page 21 With posterior ankle arthroscopy, it is to have input from a skilled podiatrist Best Paper Awards vital to keep FHL gliding gently initially, in difficult mechanical dysfunction of and then progress on to combined the foot and with manufacturing of Asics Best Paper - Lower Limb, $2000 prize dorsiflexion of toes and lunge stretches. custom-made orthotics. There are a Asics Best Paper - Clinically Relevant Posterior ankle scopes take about double lot of simple mechanical interventions Conditions, $2000 prize the recovery time in contrast to anterior that physios should consider. I am Asics Best Paper - Performance arthroscopy, mostly because of the not talking just about issuing ready Enhancement and Basic Science, difficult access to the posterior joint and made, off-the-shelf orthotics. Footwear $2000 prize proximity of neurovasculature and long prescription is the starting point, and it Asics Best Paper - Injury Prevention, flexor tendons. 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Park Clinic, a Melbourne registered (with the exception of some orthopeadic surgery clinic workshops with limits on numbers Footwear and orthotics and Physiotherapist to the requiring pre-booking) It is not unusual for physios to ‘handball’ Australian Cross Country Ski be active ‘09 will be held at the any foot mechanical dysfunction to Team. Brisbane Convention & Exhibition the podiatrist. It certainly is invaluable Centre, 14 - 17 October 2009.

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VOLUME 26 – ISSUE 4 • SUMMEr 2008 31 CRICKET INJURY REPORT 2008 Cricket Australia Injury Report 2008

By John Orchard, Trefor James, Alex Kountouris, Marc Portus

Summary This report analyses injuries occurring prospectively in Australian cricket at the state and national levels over an entire decade (concluding in season 2007-08). An additional emphasis of this report is to document any changes to the injury profile as a result of the growth of Twenty/20 cricket and to predict future changes to the injury profile based on the likely increase in Twenty/20 cricket. The most notable findings of this year’s report are: 1 There was an increase in both injury incidence and prevalence in 2007/08. This relates mainly to an increased number of days of play in domestic cricket with the expansion of the Twenty/20 competition. 2 Because of the short match duration, injury, has gradually increased over the Introduction ten year period in line with increases Twenty/20 cricket has led to an Cricket is one of the world’s major team in scheduling. The average injury increase in match injury incidence sports and is played at the elite level prevalence in 2007-08 was 11.3% of expressed as injuries per 10000 hours according to a dynamic international players missing through injury, although of play. calendar. Injuries in cricket at the 3 Expressed however as injuries per this was not quite as high as the peak figure of 11.4% recorded in 2003-04. elite level are quite common with fast days of play, there is a trend that bowlers the players most susceptible to Twenty/20 cricket is leading to Whether Twenty/20 cricket will have missing time through injury1-8. Much of reduced numbers of bowling injuries, a positive or negative effect on injury the risk of injury for fast bowlers relates but increased number of injuries rates in cricket depends on the changes to overuse, with some evidence that batting and fielding, compared to that are made to the schedule as more at amateur level, where workloads are other forms of cricket. Twenty/20 cricket is introduced. If there far smaller, cricket is a relatively safe 4 The one injury category in particular is no reduction in first class cricket and sport9. It is accepted by most researchers which appeared to increase in 2007- hence the schedule simply becomes that ongoing injury surveillance is the 08 was hamstring and thigh strains, more cluttered, there will no doubt be fundamental pillar of successful injury which reached an all-decade high of an increase in injury rates. A reduction prevention10. Cricket researchers tend to 4.4 injuries per team per season. in first class cricket may however result agree that we should aim to follow the Injury incidence, the number of injuries in a ‘narrowing of the gap’ between the Van Mechelen paradigm using injury occurring per match or per season, risk of injury for pace bowlers and other surveillance as the basis for risk factor stayed at a fairly constant level over positions. That is, fast bowlers are less and interventional studies which can the ten year survey period, but with likely to be injured in Twenty/20 cricket ultimately lead to injury prevention7 11. incidence rates that have peaked in due to reduced bowling workloads, In 2005, cricket researchers published the 2007-08 (20.3 injuries per squad per whereas batsmen and fieldsmen may first ever consensus international injury season and 49.2 injuries per 10000 be more likely to be injured due to the definitions for a sport12-15, an innovation player hours). Injury prevalence, the increased intensity of general play. was soon followed by football (soccer)16 percentage of players missing through and rugby union17. Even though this

32 Sport Health CRICKET INJURY REPORT 2008

consensus was developed quite recently previously20. The methods used for ‘squad’ is defined as 25 players and in 2004-2005, Twenty-20 cricket was Cricket Australia injury surveillance a ‘season’ is defined as 60 days of only in its embryonic stages. Australia are non-interventional, conform to the scheduled match play. only played its first International Twenty- Code of Ethics of the World Medical Injury prevalence considers the 20 match in season 2004-2005 and it was Association (Declaration of Helsinki) average number of squad members not not until the following season that the and have been approved by the Cricket available for selection through injury for first domestic competition started. Australia Sports Science Sports Medicine each match divided by the total number Advisory Group. Bowling workload as a risk factor for of squad members. Injury prevalence is overuse injury in cricket has been The recommended methods of injury expressed as a percentage, representing previously analysed18,19. These studies surveillance internationally were the percentage of players missing have generally looked at overall bowling published in detail in 200512-15. The through injury on average for that team loads (expressed in terms of deliveries definitions are available free in full text for the season in question. It is calculated per week or sessions bowled per week) format on the web at: using the numerator of ‘missed player and subsequent risk of bowling injury, games’, with a denominator of number http://www.injuryupdate.com.au/ rather than acute workloads from a of games multiplied by squad members. images/research/JSMScricketdefinitions. single match. There is a relationship Player movement monitoring essentially pdf between the overall bowler workload requires that all players are defined in (matches and training) and risk of The definition of a cricket injury (or each match as either: (1) playing cricket bowling injury in both adult19 and ‘significant’ injury for surveillance (2) not playing cricket due to injury or junior18 cricket. It appears from this work purposes) is: illness (3) not playing cricket for another (although it is not clearly established) reason (e.g. non-selection with no lower Any injury or other medical condition that number of bowling sessions per grade game available). that either: week (whether they are training or This report covers injuries from the match) correlates best with injury risk. (1) prevents a player from being fully following cricket seasons: available for selection in a major match; The recent expansion of Twenty/20 or In order to promote consistency, the cricket has already changed the nature starting date for the Australian cricket of the cricket calendar and its predicted (2) during a major match, causes a year has been designated as the start of further expansion is likely to change it player to be unable to bat, bowl or keep whichever series commenced after April further still. There are already more days wicket when required by either the rules 1st for every season under consideration of scheduled match play in domestic or the team’s captain. (Table 1). The finishing date has been cricket with the expansion of the The major injury rates presented are at the end of the latest finishing series Twenty/20 competition. The workloads injury incidence and injury prevalence: which started in March each year. of the future for bowlers may be a greater number of days of competition • Injury incidence analyses the The primary recorder of injuries has but, if some of the traditional calendar number of injuries occurring over a been the main team doctor at two is replaced by Twenty/20 matches, a given time period. states (Queensland, Victoria) and for workload profile of higher number of • Injury match incidence considers only the Australian team and the main team short bursts but a decreased number of those injuries occurring during major physiotherapist for four states (New overall overs bowled. matches. South Wales, South Australia, Western Australia, Tasmania). Recorders have • Injury seasonal incidence considers been encouraged to enter most injuries Methods the number of defined injuries that have presented to medical staff Cricket Australia conducts an annual occurring per squad per season. This into the database but to notify which ongoing injury survey recording injuries can take into account gradual onset ones qualified according to the survey in contracted first class players. Methods injuries, training injuries and match definition (and by which criteria). The for this survey have been described injuries in the one measurement. A injury survey coordinator has kept Table 1 - Dates of seasons covered by this survey records of all matches played by squad members (in a spreadsheet) and ensured Year Season Dates (according to April-March cricket ‘year’) that each state provided an explanation 10 2007-08 September 2007-March 2008 to the survey whenever one of their 9 2006-07 September 2006-April 2007 players was not selected, in order to 8 2005-06 June 2005-April 2006 keep the spreadsheet data accurate. 7 2004-05 May 2004-March 2005 Insurance forms completed by medical 6 2003-04 April 2003-March 2004 officers have also been cross-checked 5 2002-03 June 2002-March 2003 to ensure all insurance information was 4 2001-02 June 2001-April 2002 also entered as part of the survey. Media 3 2000-01 April 2000-April 2001 and website reports have been regularly checked by the injury survey coordinator 2 1999-00 May 1999-March 2000 as a way of prompting injury recorders 1 1998-99 October 1998-April 1999 to provide a diagnosis.

VOLUME 26 – ISSUE 4 • SUMMER 2008 33 CRICKET INJURY REPORT 2008

Table 2 - Squad numbers per season Squad 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Australia 31 30 32 30 28 31 28 30 31 28 New South Wales 30 32 30 35 31 28 27 37 40 35 Queensland 20 23 26 28 27 30 30 31 32 32 South Australia 31 23 23 27 32 22 30 26 27 30 Tasmania 21 20 27 28 26 24 22 27 32 29 Victoria 26 23 27 31 30 29 26 36 31 25 Western Australia 23 26 30 30 29 30 30 37 34 32

Some of the injury rates reported here is characterised as ‘low risk’ (statement in injury surveillance). The domestic for seasons prior to 2007-08 may vary available at: http://www.nhmrc.gov.au/ Twenty/20 competition (currently KFC slightly from those published in previous publications/synopses/_files/e72.pdf , Big Bash) commenced in season 2005-06 reports. If input errors were found or accessed June 4, 2007). as a limited round of matches but has definitions of injury categories have been expanded in each subsequent been changed then the updated values Results season. for previous seasons are included in this As seen from Table 4, in limited report. Therefore this report reflects the Injury exposure calculations overs (Ford Ranger Cup, One Day most accurate data from past seasons Table 2 lists the number of players in International (ODI) and Twenty/20) and the values presented here supersede each squad per season, whilst Table 3 matches, the number of team days all previous publications. lists the number of matches per team is generally the same as the number per season. Since 1998-99 the Australian In accordance with the recommended of team matches scheduled, with the team has contracted 25 players annually international formula12-15, hours of player exception of washed out games which prior to the start of any winter tours exposure in matches is calculated by count as zero days of exposure. (i.e. during late May or early June). The multiplying the number of team days Australian squad for each subsequent As per the international definitions12-15, of exposure by 6.5 for the average season has been greater than 25 players, hours of player exposure in matches is number of players on the field and then as it includes (from the date of their first calculated by multiplying the number of multiplied by the number of designated match until the new round of contracts) team days of exposure (Table 4) by 6.5 hours in a day’s play. For first class any other player who tours with or for the average number of players on the matches this is 6 hours per day and for plays in the Australian team. State teams field and then multiplied by the number one day matches this is 6.667 hours per can contract up to 20 other players on of designated hours in a day’s play. For day. This gives a designated exposure regular contracts (outside their Australian first class matches this is 6 hours per day in terms of player hours which is used contracted players) and up to 5 players and for one day matches this is 6.667 as the denominator for match incidence on ‘rookie’ contracts. As with the hours per day. This gives a designated calculations. Player days per team per Australian team, any other player who exposure in terms of player hours (Table season are calculated by multiplying the plays with the team in a major match 5) which is used as the denominator for size of the squads (for each match) by during the season is designated as a match incidence calculations. Overall the number of days for matches. A very squad member from that time on. exposure (in terms of match hours minor variation from the international and overs bowled) has generally risen definition recommendations was that an The format of the Sheffield Shield over the period of the survey, although uncontracted player was considered in has consistently been that each of six the highest level of workloads were season 2005-06 to have become part of teams plays ten matches each, one recorded in seasons 2003-04 and 2005- the squad if he was selected as 12th man home and one away against each of 06. Exposure for the Australian team in the team. This change was made in the other teams (60 team matches), has been slightly reduced in the last response to the rule in one day cricket followed by a final (2 team matches) two years due to a reduced number for that season which allowed the 12th at the end of the season. The matches of Test matches. It is likely that for the man to actively play as a substitute, a are all scheduled for 4 days, with the two years commencing 2008-09, if the rule which was only used for this one final being scheduled for 5 days. Since full Test schedule is undertaken, total particular season. 2000-01, the domestic limited overs exposure will again increase. However, (one day) competition has followed The methods used for Cricket Australia the international calendar is possibly the same home & away format as the injury surveillance conform to the about to undergo changes due to the Sheffield Shield. The domestic limited Code of Ethics of the World Medical ever-increasing number of Twenty/20 over series (currently Ford Ranger and Association (Declaration of Helsinki) and tournaments. As has been previously formerly both ING and Mercantile the latest National Health and Medical discussed, increased match exposure Mutual Cup) format during 1998-99 and Research Council (NHMRC) guidelines tends to increase injury prevalence, as 1999-2000 seasons was a single round of for research. As injury surveillance is when matches are scheduled closer matches, with a team from the ACT in non-interventional and the methods together there is less recovery time the competition (although not included preserve confidentiality of the players, it between games.

34 Sport Health CRICKET INJURY REPORT 2008

Table 3 - Team matches under survey from 1998-99 to 2007-08 Team matches played 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Domestic Twenty/20 14 26 32 Domestic One Day 42 42 62 62 62 62 62 62 62 62 Domestic First Class 62 62 62 62 62 62 62 62 62 62 International Twenty/20 1 3 1 9 One Day International 23 34 22 22 32 32 26 35 36 20 Test match 12 13 8 14 8 15 14 17 5 6 All matches 139 151 154 160 164 171 165 193 192 191

Table 4 – Team days played under survey 1998-99 to 2007-08 Competition 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Domestic Twenty/20 14 24 30 Domestic one day 42 40 62 62 62 62 60 60 62 60 First class domestic 222 232 228 228 220 242 234 228 232 236 International Twenty/20 1 3 1 11 One day international 23 34 22 21 32 32 24 35 36 20 Test cricket 53 53 33 61 32 69 58 78 22 28 Total 340 359 345 372 346 405 377 418 377 385

Table 5 – Designated player hours of exposure in matches each season Competition 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Domestic Twenty/20 242 415 519 Domestic one day 1819 1732 2685 2685 2685 2685 2598 2598 2685 2598 First class domestic 8658 9048 8892 8892 8580 9438 9126 8892 9048 9204 International Twenty/20 17 52 17 156 One day international 996 1472 953 909 1386 1386 1039 1515 1559 866 Test cricket 2067 2067 1287 2379 1248 2691 2262 3042 858 1092 TOTAL 13539 14319 13816 14865 13898 16199 15042 16342 14582 14435

Table 6 – Overs bowled in matches each season Match type 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Domestic Twenty/20 241 470 570 Domestic one day 1874 1858 2690 2835 2697 2883 2729 2814 2877 2606 First class domestic 9945 9729 9837 9833 9224 10311 9871 9645 9967 9713 International Twenty/20 20 58 20 171 One day international 1061 1486 1052 980 1377 1417 1057 1577 1488 805 Test cricket 1910 1882 1347 2243 1271 2802 2159 2756 890 1136 Total 14791 14955 14926 15891 14569 17413 15835 17090 15711 15001

Table 7 – Player days of exposure available (for prevalence calculations)1 Team 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Domestic Twenty/20 441 739 947 Domestic one day 990 916 1495 1739 1675 1651 1564 1842 1911 1818 First class domestic 5160 5343 5586 6435 5936 6477 6157 7193 7265 7340 International Twenty/20 27 82 27 227 One day international 678 964 631 608 865 881 640 960 1056 536 Test cricket 1517 1444 947 1707 820 1906 1562 2095 572 790 Total 8345 8667 8659 10489 9296 10915 9950 12613 11570 11658

1 Seasonal incidence calculations use almost identical exposure data except that for prevalence calculations, a player who joins the squad mid-season is not considered to be exposed to missing his first game through injury. This is because an uncontracted player can only be considered to have joined a squad mid-season by playing a game, hence he cannot miss this first game through injury.

VOLUME 26 – ISSUE 4 • SUMMER 2008 35 MORE FUEL MEANS MORE ENERGY.

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36 Sport Health CRICKET INJURY REPORT 2008

Table 6 shows that workload in terms which allowed the 12th man to play as a Table 10 reveals that the higher rate of of number of overs bowled has stayed substitute. match injury overall and bowling injury fairly steady in first class domestic specifically relate tohome , rather than cricket over the past ten years, but has Injury incidence away, ODI matches. Away ODIs have increased in domestic one day cricket Injury incidence results are detailed in not led to nearly as high injury rates as since 2000-01. Twenty/20 cricket will Tables 8-13. Injury match incidence home ODIs for reasons that are explored probably not contribute substantially to is calculated in Table 8 using the total later in this report. overall bowling workload despite the number of injuries (both new and Table 11 analyses match injury incidence new fixtures being introduced, although recurrent) as the numerator and the by a new unit, injuries per 1000 days of the number of days of cricket played will number of player hours of exposure play. This unit was not recommended probably be increased. (Table 5) as the denominator. by the international definitions but Player days per team per season are Injury match incidence in the units enables a more direct comparison calculated by multiplying the size of the of injuries per 10000 player hours is between Twenty/20 cricket and the squads (for each match) by the number higher in one day matches than first other forms. From this, it can be seen of days for matches (Table 7). A very class matches and then higher still in that Domestic Twenty/20 matches have minor variation from the international Twenty/20 cricket. Because first class a lower bowling injury incidence than definition recommendations is that an matches are played over a much longer other forms of domestic cricket in terms uncontracted player was considered to duration than limited overs matches (at of injuries per day of play, even though have become part of the squad if he was both domestic and international level), the incidence is comparable in terms selected as 12th man in the team during they produce a higher number of injuries of injuries per 1000 overs bowled. The season 2005-06 only. This change was per match, even though the hourly rate international Twenty/20 figures follow made because of the rule present in one is lower. a similar trend although are not yet as day cricket during season 2005-06 only accurate due to the small number of

Table 8 - Injury match incidence (injuries/10000 player hours)

Match type 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- Aver. 99 00 01 02 03 04 05 06 07 08 Domestic Twenty/20 41.3 120.4 115.6 102.0 Domestic one day 55.0 34.6 48.4 22.3 37.2 67.0 42.3 65.4 48.4 57.7 48.0 First class domestic 32.3 24.3 22.5 45.0 24.5 23.3 24.1 14.6 28.7 40.2 28.0 International Twenty/20 0.0 192.7 0.0 321.1 247.7 One day international 80.3 61.1 52.5 33.0 72.2 57.7 67.4 19.8 51.3 46.2 53.8 Test cricket 24.2 62.9 23.3 29.4 24.0 44.6 8.8 23.0 23.3 36.6 30.5 All matches 37.7 34.9 29.7 37.7 31.7 37.0 27.9 25.7 37.0 49.2 34.8

Table 9 - Bowling match incidence (injuries/1000 overs bowled)

Match type 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- Aver. 99 00 01 02 03 04 05 06 07 08 Domestic Twenty/20 0.0 2.1 1.8 1.6 Domestic one day 3.2 2.2 3.7 1.1 1.9 2.1 1.5 1.1 1.4 2.7 2.0 First class domestic 1.9 0.9 0.9 1.5 1.5 0.9 1.0 0.2 1.1 2.2 1.2 International Twenty/20 0.0 0.0 0.0 5.8 3.7 One day international 2.8 2.0 1.0 0.0 1.5 0.7 1.9 0.6 2.0 0.0 1.3 Test cricket 1.0 3.2 2.2 1.8 2.4 2.5 0.0 0.7 1.1 0.0 1.5 All matches 2.0 1.5 1.5 1.4 1.6 1.3 1.0 0.5 1.3 2.0 1.4

10 – Home versus away bowling match incidence comparison for the Australian team (injuries/1000 overs bowled)

Match type 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- Total 99 00 01 02 03 04 05 06 07 08 Home one day 3.6 4.4 1.6 0.0 3.2 0.0 4.3 0.0 4.3 0.0 2.1 internationals Away one day 2.0 1.0 0.0 0.0 0.0 1.1 0.0 1.1 1.0 0.0 0.7 internationals Home test cricket 0.0 6.3 2.7 1.9 2.2 4.8 0.0 0.8 0.0 0.0 2.1 Away test cricket 1.8 0.0 1.6 1.7 2.8 0.0 0.0 0.6 0.9 All matches 1.7 2.7 1.7 1.2 1.9 1.9 0.6 0.7 1.3 0.0 1.4

VOLUME 26 – ISSUE 4 • SUMMER 2008 37 CRICKET INJURY REPORT 2008

Table 11 - Match incidence analysis by player days Match type Injury incidence (n Injury incidence (n/1000 Bowling injury incidence Bowling injury incidence /10000 player hours) days of play) (n/1000 overs bowled) (n/1000 days of play) Domestic 20/20 102.0 176.5 1.6 29.4 Domestic one day 48.0 208.0 2.0 90.9 First class domestic 28.0 109.0 1.2 52.1 International 20/20 247.7 428.6 3.7 71.4 One day international 53.8 233.0 1.3 57.3 Test cricket 30.5 119.1 1.5 57.5 All matches 34.8 137.3 1.4 58.8

Table 12 - Injury seasonal incidence by team (injuries/team/season) Team 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Australia 17.7 15.5 18.0 15.5 22.2 18.3 14.8 16.2 26.2 25.0 New South Wales 14.2 11.7 16.3 18.5 9.2 19.9 5.8 8.9 15.0 9.2 Queensland 11.5 17.0 17.2 25.3 15.7 20.4 17.9 15.0 20.6 36.3 South Australia 24.3 13.5 23.1 17.6 17.9 20.3 9.7 17.3 12.7 17.5 Tasmania 17.7 13.9 18.4 16.9 20.5 13.2 19.7 21.7 14.8 12.5 Victoria 18.6 23.3 16.9 20.5 20.0 18.6 13.4 15.9 20.4 29.0 Western Australia 21.1 19.7 14.1 16.6 19.8 15.2 23.6 11.9 12.4 16.3 All teams 18.0 16.2 17.5 18.3 17.8 18.1 15.0 15.1 17.4 20.3

Table 13 - Injury seasonal incidence by body area & injury type Injury type 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 99 00 01 02 03 04 05 06 07 08 Fractured facial bones 0.0 0.3 0.2 0.3 0.0 0.1 0.2 0.2 0.1 0.1 Other head and facial injuries 0.2 0.0 0.0 1.0 0.2 0.1 0.2 0.1 0.3 0.3 Neck injuries 0.0 0.2 0.3 0.0 0.0 0.0 0.0 0.2 0.4 0.0 Shoulder tendon injuries 1.2 1.4 0.5 0.9 1.1 0.0 0.2 0.9 0.6 0.5 Other shoulder injuries 0.0 0.0 0.5 0.7 0.3 0.4 0.9 0.8 0.5 1.5 Arm/forearm fractures 0.4 0.3 0.0 0.0 0.0 0.0 0.2 0.1 0.0 0.0 Other elbow/arm injuries 0.2 0.2 0.5 0.0 1.1 0.1 0.2 0.6 0.3 0.9 Wrist and hand fractures 1.1 0.7 1.7 1.7 1.1 1.0 1.2 0.8 0.5 1.3 Other wrist/hand injuries 0.5 0.7 0.5 0.1 0.6 0.7 1.2 0.4 0.5 0.4 Side and abdominal strains 1.6 1.0 2.1 1.8 0.5 1.1 1.4 0.6 1.7 1.7 Other trunk injuries 0.5 0.0 0.2 0.4 0.0 0.5 0.0 0.6 0.6 0.1 Lumbar stress fractures 0.2 0.5 0.5 0.7 1.4 0.8 0.2 0.5 1.0 0.3 Other lumbar injuries 1.8 1.0 1.4 0.9 1.9 1.9 1.1 1.7 1.0 1.6 Groin and hip injuries 2.0 0.7 1.0 0.9 2.2 2.2 0.8 1.2 1.6 1.1 Thigh and hamstring strains 3.2 1.6 2.6 2.6 1.9 2.9 2.6 1.3 2.1 4.4 Buttock and other thigh injuries 0.0 0.2 0.9 0.1 0.0 0.8 0.0 0.0 0.8 0.5 Knee cartilage injuries 0.7 0.9 1.5 1.4 0.6 0.4 0.9 1.8 0.9 0.5 Other knee injuries 1.6 1.4 0.9 0.6 0.3 0.4 0.0 0.6 0.4 0.3 Shin and foot stress fractures 0.2 0.2 0.3 0.3 0.8 0.3 0.6 0.1 0.5 0.5 Ankle and foot sprains 1.1 1.2 1.0 1.1 1.0 1.6 0.8 0.5 1.0 1.3 Other shin, foot and ankle injuries 0.9 1.2 0.5 2.0 1.6 1.8 1.8 0.6 1.4 1.3 Heat-related illness 0.0 0.2 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 Medical illness 0.7 2.4 0.3 0.9 1.0 0.7 1.1 1.5 1.2 1.3 Total 18.0 16.2 17.5 18.3 17.8 18.1 15.0 15.2 17.4 20.3

International Twenty/20 matches that players over 60 days), divided by the consistent over the past eight seasons. have been played to date. number of player days of exposure Some injury categories have fallen (Table 7). slightly in incidence in recent seasons Seasonal incidence (Table 12 and Table including shoulder tendon injuries and 13) is calculated by number of injuries Table 13 reveals that seasonal incidence wrist and hand fractures although most multiplied by 1500 (for a squad of 25 by body part has generally been categories have stayed fairly constant.

38 Sport Health CRICKET INJURY REPORT 2008

Injury prevalence Injury prevalence by injury category (Table 16) revealed no outstanding Injury prevalence rates follow a similar trends for season 2007-08 other than pattern to injury incidence, although an increase in time missed due to thigh whereas incidence stayed constant and hamstring strains. This may possibly over the past few seasons, prevalence be related to an increased speed of has gradually increased. The disparity movement in Twenty/20 cricket. between the two can be attributed to the generally increased number of matches, Chance plays a role in any injury and with the ‘average’ injury artificially whenever there is a ‘run’ of a certain becoming more severe over recent years injury type in a short time period, because there are more matches to miss it is worth investigating how much (injury prevalence = injury incidence x ‘out of the ordinary’ was the short- any injury which is linked to batting average injury severity). term increase. This can be done by and fielding intensity may potentially be comparing the expected number of increased, as the number of runs scored Injury prevalence rates (Tables 14-16) injuries and the observed number of per ball faced is substantially higher than in season 2007-08 were slightly higher injuries, with statistical tests employed to in other forms of the game. It is known than the long-term average, which is an determine the likelihood that chance was that risk of past injury increases the risk expected outcome given the steadily responsible for the observed increase. of future injury to the hamstrings21. It has increasing amount of match exposure at A calculation was made regarding the also been well documented in the sport domestic level. Although the Australian rate of significant muscle strains for the of Australian football, in particular, that team had a prevalence rate that was Australian team in the Twenty/20 World increasing player age is a risk factor for higher in 2007-08 than some previous Cup and the rate was 6.7 times higher hamstring injury21. seasons, despite low exposure, this may than expected (95% confidence intervals somewhat reflect ageing of the squad. Past history of lumbar spine injury, 1.7-26.5). Basically this is a much higher particularly disc injury or stress Pace bowlers remain the position most rate than normal which is unlikely to be fracture, is postulated as a risk factor susceptible to missing time through fully explained by chance. Specific injury for hamstring strain22. Aeroplane travel injury (Table 15). In season 2007-08, rates for Twenty/20 cricket are not well represents a possible but unproven 18% of fast bowlers were missing (on documented, due to the novelty of this risk for hamstring injury. It is suspected average) through injury at any given form of the game. However the early that reduced ratios of hamstring to time. It is pleasing to report that the data suggests that bowling injury risk is quadriceps strength represents a risk early trend from Twenty/20 cricket that lower in Twenty/20 cricket but batting for hamstring strain injury (H:Q ratio) bowling injury risk may be lower (Table and fielding injury risk is higher. It is and that H:Q ratio may be a product 11) will tend to redress this imbalance logical on the one hand that any injury of specific training23. For example, somewhat. It continues to be a priority related to bowling workload (such as an overemphasis on quadriceps to further research possible risk factors perhaps stress fractures of the lumbar strengthening (leg press exercises) may for pace bowlers in order to control their spine) may be substantially reduced by lead to relative hamstring weakness and injury rates. Twenty/20 cricket, as bowlers are limited perhaps greater susceptibility. For this to 4 overs each per match. However,

Table 14 - Comparison of injury prevalence between teams 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Australia 8.6% 8.8% 11.1% 6.7% 6.8% 11.7% 5.7% 7.7% 10.0% 10.9% New South Wales 5.0% 5.6% 5.9% 5.4% 6.7% 15.1% 3.1% 5.7% 5.8% 6.2% Queensland 3.6% 5.2% 8.8% 16.6% 8.8% 14.5% 15.1% 7.3% 12.3% 18.5% South Australia 9.0% 9.8% 12.1% 14.5% 9.4% 10.1% 2.1% 9.0% 7.9% 4.9% Tasmania 7.1% 6.1% 6.5% 8.8% 8.7% 3.3% 12.1% 21.9% 9.4% 9.6% Victoria 8.0% 5.6% 14.3% 12.6% 9.9% 13.7% 7.5% 11.7% 18.1% 19.7% Western Australia 6.9% 9.3% 7.2% 6.9% 10.5% 9.1% 11.9% 9.2% 9.6% 11.0% Average 7.2% 7.5% 9.5% 9.7% 8.6% 11.4% 8.1% 9.7% 10.3% 11.3%

Table 15 – Injury prevalence by player position Player type 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Batsman 3.9% 3.4% 5.2% 4.7% 3.0% 7.2% 9.8% 6.3% 5.5% 8.5% Keeper 2.8% 1.5% 0.9% 0.6% 0.9% 3.7% 3.2% 2.9% 0.5% 2.0% Pace Bowler 11.5% 14.0% 15.0% 19.4% 16.6% 18.0% 9.3% 14.4% 18.6% 18.0% Spinner 4.9% 1.4% 10.0% 1.1% 3.7% 6.9% 4.2% 8.8% 4.1% 10.6% Total 7.2% 7.5% 9.5% 9.7% 8.6% 11.4% 8.1% 9.7% 10.3% 11.3%

VOLUME 26 – ISSUE 4 • SUMMER 2008 39 CRICKET INJURY REPORT 2008

Table 16 – Comparison of injury prevalence by body area Body region 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 99 00 01 02 03 04 05 06 07 08 Fractured facial bones 0.0% 0.1% 0.2% 0.2% 0.0% 0.0% 0.1% 0.0% 0.0% 0.1% Other head and facial injuries 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% Neck injuries 0.0% 0.0% 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% Shoulder tendon injuries 0.6% 0.4% 0.8% 1.4% 0.7% 0.1% 0.1% 0.8% 0.7% 0.4% Other shoulder injuries 0.4% 0.0% 0.3% 0.6% 0.2% 0.4% 0.8% 1.0% 0.5% 1.1% Arm/forearm fractures 0.3% 0.1% 0.0% 0.0% 0.0% 0.0% 0.1% 0.2% 0.0% 0.0% Other elbow/arm injuries 0.0% 0.0% 0.7% 0.0% 0.6% 0.0% 0.1% 0.2% 0.0% 0.4% Wrist and hand fractures 0.1% 0.1% 0.9% 0.9% 0.3% 1.0% 0.7% 0.6% 0.2% 0.5% Other wrist/hand injuries 0.2% 0.3% 0.1% 0.0% 0.2% 0.1% 0.7% 0.1% 0.1% 0.6% Side and abdominal strains 0.4% 0.4% 0.4% 0.7% 0.2% 0.7% 0.8% 0.3% 0.6% 0.8% Other trunk injuries 0.4% 0.0% 0.1% 0.1% 0.0% 0.1% 0.0% 0.3% 0.1% 0.0% Lumbar stress fractures 0.1% 0.8% 0.6% 1.1% 1.7% 2.4% 0.2% 0.9% 1.6% 0.8% Other lumbar injuries 0.7% 1.3% 0.9% 0.3% 0.6% 0.7% 1.0% 1.1% 0.6% 0.5% Groin and hip injuries 1.1% 0.1% 0.3% 0.8% 0.6% 0.9% 0.3% 0.6% 1.0% 0.7% Thigh and hamstring strains 0.9% 0.7% 0.6% 0.7% 0.8% 0.7% 0.7% 0.3% 1.1% 1.6% Buttock and other thigh injuries 0.0% 0.0% 0.2% 0.0% 0.0% 0.3% 0.0% 0.0% 0.8% 0.1% Knee cartilage injuries 0.4% 0.6% 1.1% 1.2% 1.2% 0.4% 0.5% 1.7% 1.0% 0.6% Other knee injuries 0.9% 0.4% 1.4% 0.1% 0.1% 0.2% 0.0% 0.6% 0.3% 0.4% Shin and foot stress fractures 0.0% 0.1% 0.2% 0.2% 0.5% 0.0% 0.5% 0.2% 0.4% 0.4% Ankle and foot sprains 0.4% 0.4% 0.5% 0.5% 0.3% 1.4% 0.2% 0.5% 0.6% 1.6% Other shin, foot and ankle injuries 0.1% 1.1% 0.1% 0.8% 0.5% 1.3% 0.6% 0.2% 0.4% 0.5% Heat-related illness 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Medical illness 0.2% 0.6% 0.1% 0.2% 0.2% 0.5% 0.6% 0.3% 0.2% 0.3% Total 7.2% 7.5% 9.5% 9.7% 8.6% 11.4% 8.1% 9.7% 10.3% 11.3%

Table 17 - Key indicators for preventable non-bowling injuries over nine seasons Mechanism 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 Sliding into fence 2 2 1 0 0 0 0 0 0 0 Playing football 1 1 0 3 0 0 0 2 1 0

reason, early season hamstring injury of boundaries. However, most cricket be less severe, with the dreaded ACL rates are often higher because training commentators feel that these changes being included in the latter category. has been more ‘general’ (e.g. building have been for the better. up aerobic and strength base in muscles) In 2006-07 one player suffered a serious Discussion & and not specific for cricket match knee injury (ACL) from playing touch Recommendations preparation24,25. football at training, continuing the Injury definition ‘Preventable’ non-bowling tradition of occasional injuries from These injury definitions have been injuries these activities. Fortunately no survey injuries occurred from football activities criticised on the basis that they are It is again worth reporting that injuries in 2007-08. Whilst football cross-training not a comprehensive survey of all from fielders sliding into the fence may always have some part in relieving incidences of ‘tissue damage’ sustained appear to have subsided, with none the boredom from routine other drills, by players26 27. However, the major of these injuries having qualified as a it is constantly worth mentioning that aim when creating definitions was to survey injury since 2000-01. There are in cricketers this appears to be a high set a standard that would be followed some occasional minor injuries suffered risk activity. One piece of advice worth equally in all countries surveying cricket from collision with the rope itself and considering is the use of lower traction injuries28 29. The fact that there has been with the fence if it is an inadequate boots during these activities (e.g. running very slow recent progress in getting an distance from the rope. For the most shoes rather than spikes when playing international register of cricket injuries part, it is apparent that the new rules on grass). Running shoes will increase suggests that the choosing the path of are working well. The moving in of the the risk of slippage-type injuries but lower difficulty was a sensible decision. boundary has changed the nature of the decrease the risk of traction-type injuries. There is still plenty of scope for the game, in that games are higher and faster The slipping injuries tend to fortunately ICC to attempt to coordinate a ‘world’ scoring because of the increased number program of injury surveillance in elite

40 Sport Health CRICKET INJURY REPORT 2008

cricket. This may become a priority once the international calendar stabilises.

Acknowledgements The authors of the injury survey would like to acknowledge the contribution of the following people over the 2007-08 season: Team physiotherapists: Alex Kountouris (Australia), Patrick Farhart (New South Wales), John Porter (South Australia), Michael Jamison (Tasmania), Rob Colling (Western Australia) Team medical officers: Trefor James (Australia and Victoria), Neville Blomeley (Queensland), Terry Farquharson (South Australia), David Humphries and Peter Sexton (Tasmania), Damien McCann (Western Australia) CA administrative staff: Geoff Allardice, Steve Bernard Special recognition is deserved by Dr Simon Carter, who has recently retired after over a decade of service with the Queensland Cricket Association and who has been vigilant at keeping accurate injury records over that entire time period.

References Medicine in Sport 2006;9:3-9. 22. Orchard J, Farhart P, Leopold C. Lumbar spine region pathology and hamstring and calf injuries 1. Orchard J, James T, Alcott E, Carter S, Farhart P. 12. Orchard J, Newman D, Stretch R, Frost W, Mansingh in athletes: is there a connection? British Journal of Injuries in Australian cricket at first class level A, Leipus A. Methods for injury surveillance in Sports Medicine 2004;38:502-4. 1995/96 to 2000/01. British Journal of Sports international cricket. South African Journal of Sports Medicine 2002;36:270-275. Medicine 2005;17(2):18-28. 23. Orchard J, Marsden J, Lord S, Garlick D. Preseason Hamstring Muscle Weakness associated with 2. Stretch R. Cricket injuries: a longitudinal study of 13. Orchard J, Newman D, Stretch R, Frost W, Mansingh Hamstring Muscle Injury in Australian Footballers. the nature of injuries to South African cricketers. A, Leipus A. Methods for injury surveillance in American Journal of Sports Medicine 1997;25:81-85. British Journal of Sports Medicine 2003;37:250-253. international cricket. New Zealand Journal of Sports Medicine 2004;32(4):90-99. 24. Orchard J. Understanding some of the risks for soft 3. Stretch R. Epidemiology of cricket injuries. Int tissue inury--a Malcolm Blight legacy? Journal of SportMed J 2001;2(2). 14. Orchard J, Newman D, Stretch R, Frost W, Mansingh A, Leipus A. Methods for injury surveillance in Science and Medicine in Sport 2002;5(2):v-vii. 4. Stretch R. The incidence and nature of international cricket. British Journal of Sports 25. Verrall G, Slavotinek J, Barnes P. The effect of epidemiological injuries to elite South African Medicine 2005;39(4):E22. sports specific training on reducing the incidence of cricket players. South African Medical Journal hamstring injuries in professional Australian Rules 2001;91(4):336-339. 15. Orchard J, Newman D, Stretch R, Frost W, Mansingh A, Leipus A. Methods for injury surveillance in football players. British Journal of Sports Medicine 5. Leary T, White J. Acute injury incidence in international cricket. Journal of Science and 2005;39(6):363-8. professional county club cricket players Medicine in Sport 2005;8(1):1-14. 26. Mitchell R, Hayen A. Defining a cricket injury [Letter (1985-1995). British Journal of Sports Medicine to the Editor]. Journal of Science and Medicine in 2000;34:145-147. 16. Fuller C, Ekstrand J, Junge A, et al. Consensus statement on injury definitions and data collection Sport 2005;8(3):357-358. 6. Gregory P, Batt M, Wallace W. Comparing Injuries procedures in studies of football (soccer) injuries. 27. Hodgson L, Gissane C, Gabbett T, King D. For of Spin Bowling with Fast Bowling in Young British Journal of Sports Medicine 2006;40:193-201. debate: consensus injury definitions in team sports Cricketers. Clinical Journal of Sport Medicine should focus on encompassing all injuries. Clinical 2002;12:107-112. 17. Fuller C, Molloy M, Bagate C, et al. Consensus statement on injury definitions and data collection Journal of Sport Medicine 2007;17(3):188-91. 7. Elliott B, Khangure M. Disk degeneration and procedures for studies of injuries in rugby union. 28. Orchard J, Newman D, Stretch R, Frost W, Mansingh fast bowling in cricket: an intervention study. British Journal of Sports Medicine 2007;41:328-31. A, Leipus A. Defining a cricket injury [Letter to the Medicine and Science in Sports and Exercise Editor, rejoinder by authors]. Journal of Science and 2002;34(11):1714-1718. 18. Dennis R, Finch C, Farhart P. Is bowling workload a risk factor for injury to Australian junior cricket Medicine in Sport 2005;8(3):358-359. 8. Newman D. A prospective study of injuries at first fast bowlers? British Journal of Sports Medicine 29. Orchard J, Hoskins W. For debate: consensus injury class counties in England and Wales 2001 and 2002 2005;39:843-846. definitions in team sports should focus on missed seasons. Second World Congress of Science and playing time. Clinical Journal of Sport Medicine Medicine in Cricket 2003, Cape Town: 83-84. 19. Dennis R, Farhart P, Goumas C, Orchard J. Bowling workload and the risk of injury in elite cricket fast 2007;17(3):192-6. 9. ACC. ACC Injury Statistics 2006 (First Edition) bowlers. Journal of Science and Medicine in Sport Section 20. Sport Claims. Wellington, NZ, 2006: 2003;6(3):359-367. Correspondence: http://www.acc.co.nz/about-acc/acc-injury-statistics- 2006/SS_WIM2_062694. 20. Orchard J, James T, Portus M. Injuries to elite male [email protected] cricketers in Australia over a 10-year period. Journal 10. van Mechelen W, Hlobil H, Kemper H. Incidence, [email protected] of Science and Medicine in Sport 2006;9(6):459-67. Severity, Aetiology and Prevention of Sports Injuries: A Review of Concepts. Sports Medicine 21. Orchard J. Intrinsic and Extrinsic Risk Factors for [email protected] 1992;14(2):82-99. Muscle Strain Injury in Australian Footballers. [email protected] American Journal of Sports Medicine 2001;29(3):in 11. Finch C. A new framework for research leading to press. sports injury prevention. Journal of Science and

VOLUME 26 – ISSUE 4 • SUMMER 2008 41 FrOM THE CEO Sports Medicine Australia Publications & Resources

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VOLUME 26 – ISSUE 4 • SUMMEr 2008 43 WADA HAS LOST THE PLOT Tennis drug ban proves that WADA has lost the plot By John Orchard

One of the worst ever drugs-in-sport in his hotel room and couldn’t breathe Or perhaps take option B, which in decisions -- and there have been some properly so continued to take his puffer the absence of such a doctor was to shockers, such as Andrea Raducan losing until the attack subsided. risk becoming one of the 5000 annual a gymnastics Gold medal at the Sydney asthma deaths in the USA. At least in This is more than just completely Olympics for taking a Sudafed tablet -- this instance he would have died as a reasonable -- Volandri would have was handed down by the International cleanskin, rather than as a drug cheat. possibly even died if he had not taken Tennis Federation late last week. a high dose of Ventolin during such a Tennis has a chequered history of having Italy’s Filippo Volandri was banned for severe attack. He was in a foreign city let off 16 players in 2004 for positive three months for “abuse” of salbutamol, without recourse to an Italian speaking drug tests for the anabolic steroid the drug better known as Ventolin, doctor and sensibly self-medicated to nandrolone. Nandrolone is a strongly for treating an asthma attack. Ventolin avoid being unable to breathe. performance-enhancing anabolic steroid puffers are on the WADA (World Anti- and the rationale for not suspending the The tribunal apparently accepted all of Doping Agency) banned list, which in players who tested positive seems to this, but still decided to suspend Volandri itself is bizarre given that they have not have been that “the doping must have for three months (and fine him for most ever been shown to enhance sporting been inadvertent as it involved so many of his 2008 prizemoney and ranking performance. players”. So after having turned a blind points), because the dose he admitted eye to so many proven anabolic steroid However, there is sensibly an exemption taking was higher than the dose that he positives, they are now coming down process for asthmatic athletes to was registered to take on his WADA/ heavy on asthmatics taking their puffers apply for which permits them to take ITF paperwork. Click to read the ITF’s during asthma attacks. salbutamol puffers if a doctor diagnoses outrageous press release and entire asthma. Volandri at the time of this so- verdict. Other than WADA and the ITF, called doping incident had registered the international sports journalism The rationale behind this draconian an exemption for salbutamol use which community should also be ashamed verdict can be seen, but the question is had been accepted by the International that it has reported this case as a what the ITF/WADA could reasonably Tennis Federation (ITF) as valid. routine doping decision rather than have expected Volandri to do in the one of the greatest scandals in tennis The complaint of the ITF was that the circumstances (of a severe asthma history. A young man’s life was saved recommended dose for Volandri on attack)? Obviously their expectation is by his sensible use of his own asthma his exemption form was two puffs that he should not have self-medicated medication but his career has been and the concentration found in his but instead, in Indian Wells USA at destroyed by a totalitarian doping urine suggested a much higher dose. 3am have somehow found an Italian- agency. In August 2008, I wrote an Volandri admitted that he had taken a speaking sports physician who was article entitled “WADA is on the verge much higher dose on the night before prepared to not only prescribe a higher of losing the plot”. It has now officially his drug test and had a completely salbutamol dose but who was also been lost. reasonably explanation for having done prepared to fax off a revised form to the so: he suffered a severe asthma attack ITF medical commission.

Sports Physiotherapy Presenter: Melinda Purnell • Heat stress in sport Australia (SPA) Time: TBA • Concussion in children and adults For more visit • Exercise and the metabolic syndrome Upcoming events www.physiotherapy.asn.au • Diving medicine • Hyperbaric chambers NSW Australian College of Sports • Advances in soft tissue injury Club Warehouse Evening Lecture Series management March 12, 2009 Physicians (ACSP) • Workshops on a range of lumbar 7.30pm - 9.00pm Upcoming events spine, pelvis, SIJ, hip and groin VIC pathology for recreational and elite ACSP Clinical Sports Medicine 2009 Lecture Evening sports people. March 25, 2009 Conference 7.30pm - 9.00pm Manly Pacific Hotel, Manly, Sydney Registration open to Medical Practitioners February 28 – March 1, 2009 and Allied Health Professionals. NSW Comprehensive seminar presented by Injuries in Dancers: The Do’s and Don’ts sports physicians. Topics to be covered Registration closes February 28, 2009. of Treatment include: March 26, 2009 To view the program visit • The female athlete www.acsp.org.au

44 Sport Health