PAGE

p18

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best evidence synthesis p9

APP Review:

Overall Rating: 5/5 Use of Cold-Water

Immersion as a Recovery strategy

in Rugby Union

SEPNZ BULLETIN ISSUE 6. DECEMBER 2018

www.sepnz.org.nz

Adductor Strengthening

Programme

p11 p8

PAGE 2

ADDITIONAL USEEFUL WEBSITE RESOURCES:

List of Open Access Journals

Asics Apparel - how to order

McGraw-Hill Books and order form

Asics Education Fund information

International Federation of Sports Physical Therapy (IFSPT)

Journal of Orthopaedic & Sports Physical Therapy (JOSPT)

SEPNZ EXECUTIVE COMMITTEE

President - Blair Jarratt

Vice-President - Timofei Dovbysh

Secretary - Michael Borich

Treasurer - Timofei Dovbysh

Website - Hamish Ashton

Sponsorship - Bharat Sukha

Committee

Emma Clabburn

Rebecca Longhurst

Justin Lopes

EDUCATION SUB-COMMITTEE

Dr Angela Cadogan

Emma Clabburn

Rebecca Longhurst

Justin Lopes

Dr Grant Mawston

Dr Chris Whatman

BULLETIN EDITOR

Emma Clabburn

SPECIAL PROJECTS

Karen Carmichael

Rose Lampen-Smith

Amanda O’Reilly

Pip Sail

Join us on Facebook

Members Page

Follow us on Twitter Visit www.sepnz.org.nz

BULLETIN ADVERTISING DEADLINES:

February Bulletin: 31st January

April Bulletin: 31st March June Bulletin: 31st May

August Bulletin: 31st July October Bulletin: 30th September

December Bulletin: 30th November

Advertising terms & conditions click here.

CONTACT US Michael Borich (Secretary)

26 Vine St, St Marys Bay, Auckland mborich@gmail.com

PAGE 3

SEPNZ MEMBERS PAGE

See our page for committee members, links & member information 2

EDITORIAL: By SEPNZ President Blair Jarratt 4

MEMBER BENEFITS: Discounts 6

WINNER: ASICS Education Fund 7

APP REVIEW: Ham Horn 8

CLINICAL REVIEW

Risk factors for, and prevention of, shoulder injuries in overhead sports: a sys-tematic review with best evidence synthesis. By Pip Sail

9

FEATURE ARTICLES

Does an adductor strengthening programme increase adductor strength and

prevent adductor-related groin injuries in football? By Rebecca Blyth 11

Use of Cold-Water Immersion as a Recovery strategy in Rugby Union By Rebecca Peace

18

RESEARCH PUBLICATIONS

BJSM Volume 52, Number 23, December 2018 26

CLASSIFIEDS

Situations Vacant 28

INVITATIONS

Survey of Knowledge Attitudes and Behaviours of physiotherapists to Sports Related Concussion

30

Symposium Registration 31

CONTENTS

PAGE 4

Hello, And so another year is drawing to a close

with this our final bulletin for 2019. It has been a big

year for our group with the changing of the guard

from Hamish to myself, and there is plenty of work

to get through with the change to PNZ unified model

in our sights in 2019. As a SIG we are proud to

announce that we finished this year with 1015

members, which as far as we know is the first time

in history that a PNZ SIG has had over 1000

members. So thank you to our members for being

part of SEPNZ.

Its been another busy couple of months for our

executive with our face to face meeting in early

November at the Trinity Hotel in Tauranga to check

out the venue and prepare for the biannual

symposium in March. Justin and I also attended the

PNZ leadership day in late November which was a

great chance to meet up with the other SIG's,

branches and PNZ executive. We are excited to see

the role out of the practitioner side of the PNZ

website and the new market campaign if you

haven't seen it "Don't say oh, say physio". The last

bulletin we ran the photo competition for the cover

of BJSM and although there wasn't a huge timeline

to get entries in, we did receive 12 entries and we

will be announcing the winner of this shortly.

In this issue, we focus on and celebrate our

students and their enthusiasm for our profession.

This bulletin brings together a mix of our new

graduates, and postgraduate students to show that

life long learning is alive and well in our profession.

Rebecca Peace a postgraduate student for Otago

University contributes to this bulletin with her

literature review of the use of cold-water immersion

as a recovery strategy in rugby union and she

comments on the most beneficial protocol to use

with this population. Rebecca Blyth is currently

working towards Masters of Sports Physiotherapy at

the University of Otago, and her review explores the

research behind adductor strengthening for the

prevention of groin injuries in footballers with some

clinical exercises which would be of benefit to your

football players.

Last week Bharat, Justin and Michael from the

SEPNZ executive attended the AUT student prize

giving for the 4th Year students to award the

SEPNZ prize for the best individual contribution in

the fields of sports, exercise and recreation to

Matthew Weir. Congratulations Matthew!

We never stop learning and every 6 months we

offer up the ASICS Education Fund. In August Tom

Adams, as part of his PhD at AUT, received this

award to assist in his research in shoulder

instability. Well done Tom we look forward to your

upcoming thesis. The next round for this grant

closes in March 2019.

Pip Sail adds an article review on the risk factors

for, and prevention of, shoulder injuries in overhead

sports. Also, there is an interesting App review from

Justin Lopes. I am unsure of its clinical relevance,

however, it's a handy app to have and can be used

in many different contexts, so it's worth exploring.

For some, this time of the year is used to reflect and

make a plan for the year ahead and for others it is

just surviving the Christmas parties and getting on

holiday with family and friends. From all on the

SEPNZ executive, we wish a safe and Merry

Christmas and we hope that your plans include a

possible trip to Tauranga for our symposium in

March. The majority of our program and speakers

are confirmed. Please be aware that the early bird

rate closes at the end of January for this, for more

information please check out our website for the up

to date agenda and booking information. Enjoy

your summer, and see you in 2019 in Tauranga.

Noho ora mai

Kind Regards

Blair Jarratt

SEPNZ President

EDITORIAL

CONTINUED >>

PAGE 5

GET TO KNOW THE TEAM - 2 MINUTES WITH...

Blair Jarratt

SEPNZ President

What role do you play on the exec? President – I took over this role from Hamish Ashton this year. I started on the executive 5 years ago helping to work on the sports physiotherapy contract that members can download in our resources section of the website and later looked after the website. Life outside of SEPNZ? My wife Sheree and I have two children - Ashton aged 9 and Pippa aged 7 and we live in Tauranga. I am the co-director of Bureta Physiotherapy in Tauranga with 18 staff, at this time of the year on the weekends the family will be at the beach. All year and when I have some time (usually ridiculously early in the mornings) you will find me out on the mountain bike as we have a pretty good bunch of riders here in Tauranga that get out 3 times a week. Previous teams worked with / sporting background....and present? I cut my teeth on sports physiotherapy pretty early on in the piece starting off when I was a Otago student with University Rugby, then more stints in Rugby in Canterbury working with High School Old boys, Sydenham, Canterbury Metro, and finally into Canterbury Rugby. Also while in Canterbury I worked with Canterbury Cricket, and the Canterbury Wizards for a number of years. I toured with NZ U19 Cricket to Australia and then onto the U19 world cup in Dubai. Currently I work with the Mount Surf Life Saving Club who are currently in full swing for the season and also help out with our staff that work with some of the Bay of Plenty's top rugby club’s - Mount Maunganui Rugby and Te Puna Rugby Favourite tune on a roadtrip? Most of the road trip tunes are pretty dominated by the kids around this time of year, Pippa is pretty relentless at pumping the Christmas carols, however I try to slip a few Dad tunes in. I am enjoying the new rendition of “Africa" by Weezer. Favourite sporting physiotherapy moment? Wow….. tough question I’m not sure I have a favourite moment, being part of a winning team is always exciting but in sport there is always winning and losing and good things to take away from both. Working in the management of a team and helping getting players back into what they love doing after significant set backs and injuries is always rewarding. Favourite/best or worst destination as touring Physio and why? . Working in Forsyth Barr Dunedin stadium for the Canterbury and Otago Rugby final was a pleasure as it was pouring down outside but Dubai was a eye opener for a place to Tour.

PAGE 6

There are many benefits to be obtained from being an SEPNZ member. For a full list of Members’ Benefits visit http://sportsphysiotherapy.org.nz/benefits/

In each bulletin we will be highlighting individual member benefits in order to help members best utilise all benefits available.

MEMBER BENEFITS

Asics Benefits

Asics Education Fund http://sportsphysiotherapy.org.nz/members/education/

SEPNZ has funding for Members who wish to attend courses or conferences that are relevant to the field of Sports Physiotherapy for the furtherance of education in Sports Physiotherapy. It is available twice yearly. Applications close March 31st and August 31st. Objectives of the SEPNZ Education Fund: • For grants to members of the SEPNZ, a SIG of the NZSP,

who wish to attend courses or conferences that are relevant to the field of Sports Physiotherapy for the furtherance of education in Sports Physiotherapy.

• For grants to members of the SEPNZ who wish to undertake research in fields relevant to Sports Physiotherapy.

• For such other purposes in the opinion of the majority of the Approval Committee as shall be for the education or benefit of the members of the SEPNZ.

Asics Shoes and Apparel http://sportsphysiotherapy.org.nz/members/asics-information/

Shoes and clothing at members rates.

PAGE 7

ASICS EDUCATION FUND

$1000 Education Fund

W I N N E R August 2018

Thomas Adams

The winning recipient of the above award for August 2018 is Thomas Adams. The award will assist him on a research project for the successful completion of a PhD through the Auckland University of Technology. Currently Tom is a clinical educator at the AUT Integrated Health Clinic. Tom has satisfied the Education Awards Committee of the criteria for application as per the SEPNZ Education Awards Terms and References. Tom’s research investigates the relationship between shoulder instability and measures of submaximal force control at the shoulder and aims to add further understanding of recurrent instability following traumatic anterior shoulder dislocation as well as help to contribute to the knowledge base for neuromuscular rehabilitation strategies. This research will be conducted in 3 separate studies concluding in Dec 2020. Tom will keep SEPNZ aware of his progress and a brief summary of his thesis will be published in the bulletin.

The $1000 fund is available twice a year. The next round of applications closes on 31 March 2019.

Through this fund, SEPNZ remains committed to assisting physiotherapists in their endeavors to fulfil ongoing education in the fields of sports and orthopedic physiotherapy.

All members are encouraged to view the Terms and Conditions and download an application form from

the SEPNZ website sportsphysiotherapy.org.nz.

PAGE 8

APP REVIEW

It is time for another app review, (there have been complaints there have been too few).

So while you relax over the festive season, perhaps this review will give you reason, to

download and use this handy app. (although some of you may think it’s . But using it

makes me smile...So I push the button once in a while. When words fail me, I have

found, to best illustrate how you feel, with a sound, which can be very satisfying, Try it,

(I am not lying). Download ‘Ham Horn’ immediately, but please use it judiciously…

HAM HORN

Seller: Carrot Creative Size: 7.2 MB Category: Entertainment Compatibility: Requires iOS 10.0 or later. Compatible with iPhone, iPad and iPod touch. Languages: English Age Rating: Rated 4+ Copyright: © 2013 Carrot Creative, LLC Price: Free

Where to find it: Download from Apple store, or Android Play, Pro’s:

• The Sad Trombone makes me happy • The Rap Air Horn makes any tune you are listening to sound cooler and more like a

remix.

• You can use the Rap Air Horn while changing stations from The Edge to Classic Hits and tell the kids it’s a new remix

• You can record your own ‘Dope Sound” Cons:

• I wish I could turn it up louder at times. • You need to have the app open as sometimes the best opportunities to use the Sad

Trombone are missed and doing it 10 seconds later when the timing is not spot on can detract from the effect…

How I use the app:. A little bit sarcastically…We have found it adds a new dimension to our Webex meetings. Take home message: A fun little app. **Back To The App accepts no responsibility for inappropriate use of Ham Horn. Use wisely! Overall Rating: 5/5

By Justin Lopes (Back to Your Feet Physiotherapy)

Back to the App Your App Review

...

PAGE 9

CONTINUED >>

CLINICAL REVIEW

By Pip Sail, PhysioFix

Shoulder injuries and shoulder pain are substantial problems in

overhead athletes. This problem highlights the need for injury

prevention strategies. Identifying risk factors and developing

injury prevention strategies based on these risk factors are key

components for preventing injury in sport.

A common feature of overhead sports is the repetitive use of

the shoulder with the hand above the head. There may be sex

and age differences as observed in other anatomical sites in

other sports8,18,19 and contact sports may be at higher risk.

Biomechanical factors such as shoulder mobility, coordination

and poor technique may also be factors.

Overhead sport is defined as a sport in which the athlete, with

the forearm/hand , repetitively propels a ball or shuttle against

an opponent.

The principle findings from the systematic review were that the

studies were of poor quality, the results were inconsistent and

most risk factors had only been explored in one study.

Investigating modifiable risk factors, such as biomechanical,

physiological, and psychological measures alongside

modifiable training factors is required to develop successful

injury prevention measures. This asks the question whether

practitioners should be considering performance and return to

play parameters rather than an injury prevention perspective.

Risk factors for, and prevention of, shoulder injuries in

overhead sports: a systematic review with best evidence synthesis Martin Asker,1,2 Hannah L Brooke,3 Markus Walden,4,5,6 Ulrika Tranaeus,1,7 Fredrik Johansson,1,2 Eva Skillgate,1,2 Lena W Holm1,3

British Journal of Sports Medicine 2018;52:1312-1319.doi:10.1136/bjsports-2017-09254

Abstract: To assess the evidence for risk factors and prevention measures for shoulder injuries and the effect

of primary shoulder injury prevention measures in overhead sports by systemic review.

PAGE 10

What should the practitioner do?

Practitioners should strive to build their work on evidence-based medicine. This means integrating individual clinical

expertise with the best available external clinical evidence from systematic research.78

Since there is little evidence to suggest that shoulder screening for injury prevention is effective79 the main purpose should

be to evaluate current shoulder status, measure improvements in performance and serve as normative values to attain before

return to play after injury.79-81 When the evidence is limited look for position statements and expert panel opinions.77

Conclusions:

All investigated risk factors for shoulder injury in overhead ports had limited evidence, and most were non-modifiable

(eg,sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.

A full set of references is available on request.

CLINICAL REVIEW

PAGE 11

FEATURE ARTICLE

+

Does an

ADDUCTOR STRENGTHENING PROGRAMME

INCREASE adductor strength

PREVENT adductor-related groin injuries in football?

Groin injuries are one of the most prevalent injuries in football accounting for 8-18% of all injuries (Esteve,

Rathleff, Bagur-Calafat, Urrútia, & Thorborg, 2015; Serner et al., 2014). Adductor injuries account for over 60% of

groin injuries, resulting in adductor injuries being the second most common injury in football (Ishøi et al., 2016;

Jensen et al., 2014). Preventing adductor injuries is crucial in football not only because of the high incidence but also

due to the time-loss associated with the injury; 40% of adductor injuries experience more than 28 days absence from

football (Ishøi et al., 2016). Several studies have suggested that along with previous adductor injuries and increased

age, reduced adductor strength is a risk factor for sustaining an adductor injury while playing football (Engebretsen,

Myklebust, Holme, Engebretsen, & Bahr, 2010; Esteve et al., 2015; Ryan, DeBurca, & Mc Creesh, 2014). It has been

well documented that specific adductor strengthening programmes show an increase in adductor strength, with

increased eccentric strength being of particular importance (Harøy et al., 2017; Ishøi et al., 2016; Jensen et al., 2014).

There is conflicting evidence surrounding whether the increase in adductor strength relates to a reduced injury risk.

The aim of this critical review is to review the risk factors for adductor injuries, to review if adductor strengthening

programmes increase adductor strength and explore if increased adductor strength reduces adductor-related groin

injuries in football.

Risk Factors

Risk factors for adductor injury can be either non-

modifiable or modifiable. The two most significant non-

modifiable risk factors in predicting adductor injury are a

previous adductor injury and increased age (Arnason et al.,

2004; Engebretsen et al., 2010; Ryan et al., 2014).

*CONTINUED >>

By Rebecca Blyth (Masters of Sports Physiotherapy Student, Otago University)

PAGE 12

FEATURE ARTICLE

Although previous adductor injuries are a non-modifiable

risk factor, as football players having had previous

groin injuries are up to seven times

more likely to sustain a subsequent

injury (Arnason et al., 2004) it is

reasonable

to consider primary prevention

of utmost importance

(Engebretsen et al., 2010).

Weakness of the hip

adductor muscles is

considered the

most significant modifiable intrinsic risk factor for

adductor injury (Engebretsen et al., 2010).

Engebretsen et al. (2010) carried out a prospective cohort

study that concluded weak hip adductors increased the risk

of groin injury by four times. However, this disagrees with

a study suggesting that having higher maximal power was

more likely to be associated with a groin injury (Arnason

et al., 2004). The disparity between the two studies results

is likely due to the difference in measurement methods.

Engebretsen et al. (2010) used a specific measurement of

isolated adductor strength using hand-held dynamometry

while Arnason et al. (2004) measured power using a squat

and jump test. Likely due to the increased specificity of

the measurement in Engebretsen et al. (2010), it has been

widely accepted in the literature that reduced adductor

strength is a risk factor for groin injury (Ryan et al., 2014).

Further supporting the notion that reduced adductor

strength is a risk factor for adductor-related groin injuries

is a study that measured pre-season adductor strength in

those with and without past-season groin pain (Esteve et

al., 2018). This cross-sectional study concluded that

athletes who had more than six weeks of groin pain in the

previous football season had significantly reduced

adductor strength (Esteve et al., 2018). This highlights a

link between previous injury and reduced adductor

strength. Although a previous groin injury is the most

significant risk factor, part of this may be due to

inadequate rehabilitation and therefore reduced adductor

strength when returning to play. Esteve et al. (2018) also

found that athletes with current groin pain had a 10%

reduction in adductor strength in the adductor squeeze test.

This is in line with a study from the Australian football

league who showed that adductor strength was reduced

both before and during the onset of groin pain (Crow et al.,

2010). Considering the weakness could be identified in the

weeks preceding groin pain or injury it is reasonable to

suggest that reduced adductor strength is a measurable

and modifiable risk factor (Crow et al., 2010). In

agreement with these two studies is a meta-analysis that

suggested that pain and reduced strength on the

adductor squeeze test was more likely in athletes

with hip and groin pain (Mosler, Agricola, Weir,

Hölmich, &

Crossley, 2015).

An assessor blinded

study strengthens

this finding showing that football players with

adductor related groin pain had significant eccentric

adductor weakness when compared to matched

asymptomatic controls (Thorborg et al., 2014). The

blinding of this study is a strength as when using a hand-

held dynamometer, clinicians may subconsciously adjust

the pressure they are applying if they know which

participants are in the pain group versus the control group.

The agreement surrounding groin pain reducing adductor

strength and adductor weakness increasing injury risk is

convincing, the studies discussed above are well-designed

cross-sectional and cohort studies which provides

clinicians confidence in interpreting the results. It is

important to understand the risk factors for adductor-

related groin injuries when trying to provide preventative

strategies to reduce injury rates.

*CONTINUED >>

PAGE 13

FEATURE ARTICLE

Adductor Strengthening Programmes

Adductor strengthening programmes have been suggested as a solution to reducing groin injuries as they aim to

strengthen the hip adductor muscle group. As football involves eccentric adductor strength during kicking, there has

been suggestion that eccentric adduction weakness should be targeted in football injury prevention programmes

(Ishøi et al., 2016; Jensen et al., 2014; Thorborg et al., 2014). A study comparing elite football players to matched

recreational athletes showed that football players had increased eccentric hip abduction strength, however there was

no significant difference in eccentric hip adduction strength (Thorborg, Couppé, Petersen, Magnusson, & Hölmich,

2011). This was a surprising result, but suggests that playing football does not induce eccentric hip adductor

strength increases and therefore this is an area that needs to be targeted in off-field training (Thorborg et al., 2011).

There has been good success in using eccentric exercises to reduce hamstring injuries in football (Al Attar, Soomro,

Sinclair, Pappas, & Sanders, 2017) but the success of similar eccentric programmes in adductor injuries have not

been so extensively researched.

Adductor Strengthening and

Increased Adductor Strength

Table 1 above summarises three studies that investigated

the effect of an adductor strengthening programme on

adductor strength. The three studies reach consensus that

performing an 8-week adductor strengthening programme

does increase adductor strength, although there was

variation in the strength increases and the adductor

exercises prescribed. All three studies were randomised

control trials providing high level evidence. Ishoi et al.

(2016) found the largest increase in adductor strength using

the Copenhagen adductor (CA) exercise, it was a well-

designed randomised control trial with excellent

compliance rates. Haroy et al. (2017) used the same CA

exercise, however was different to the previous study as

the exercise was incorporated into the Federation

Internationale de Football Association (FIFA) 11+ in place

of the Nordic hamstring exercise. The strength increase

was much smaller although was still significant and this

study is particularly relevant as the FIFA 11+ is widely

recognised and used by football teams of all levels. The

CA exercise targets eccentric strength at the same time as

also having isometric and concentric components, Figure 1

shows the CA exercise being performed. A possible

*CONTINUED >>

PAGE 14

FEATURE ARTICLE

reason for the large difference in the strength increase

despite using the same exercise is the dosage of the

exercise programme. Ishoi et al. (2016) used greater sets

and repetitions than Haroy et al. (2017) resulting in a

difference in the total number of repetitions completed.

This suggests that there is a dose-response correlation with

increased volume of exercise inducing a greater strength

improvement. Jensen et al. (2014) showed a 30% increase

in adductor strength, similar to that of Ishoi et al. (2016)

using 8-weeks of elastic band exercises. This study also

asked the athletes to work through a slow and controlled

eccentric phase with the bands to target eccentric strength.

The three studies all show that with the use of minimal

equipment and simple exercises, it is possible to get a

meaningful increase in hip adductor strength.

Adductor Strengthening and

Reducing Adductor-related

Groin Injuries Table 2 summaries two studies that directly investigated

the effect of adductor strengthening on the incidence of

groin injuries in football players. Both studies showed a

reduction in the number of groin injuries, however only

one of the studies reached statistical significance. Both

studies were of good methodological design with a large

sample size and randomisation protocols. The two studies

differed significantly in their intervention programme.

Haroy et al. (2018) used the CA exercise or suitable

regressions exclusively in comparison to Holmich, Larsen,

Krogsgaard, & Gluud (2010) which asked the athletes to

complete six different exercises targeting the adductors,

core strength and coordination. The 31% reduction in

injuries in the Holmich et al. (2010) study seems a large

reduction but didn’t reach significance. This is due to

basing the sample size on a 50% injury reduction rate and

having difficulty getting clubs to remain in the trial for its

entirety. Coaches were asked to supervise the players,

however there was no direct measure of compliance, this is

a potential reason significance was not met as the players

may not have been completing the prescribed exercises. In

comparison, compliance in the Haroy et al. (2018) study

was good and they performed two separate analyses on

varying levels of compliance. They found that increased

compliance led to a greater reduction in injury risk, in

agreement with the dose-response relationship discussed

above; those with excellent compliance almost halved their

injury risk, however both groups reached significance.

The compliance rates are likely due to having only one

exercise which is easy for the athlete to perform. It may be

seen as isolating to adductor related groin injury only, but

as this accounts for the majority of all groin injuries, it is

the most important area to address (Harøy et al., 2018).

Along with the excellent compliance rates, Haroy et al.

(2018) implemented the strengthening programme in the

*CONTINUED >>

PAGE 15

FEATURE ARTICLE

preseason to gain a strength effect before injury counting

in the competition started. This early implementation

would appear to have had significant benefit in reducing

the rate of injuries.

Although the studies discussed in Table 1 did not directly

measure the injury rates and therefore cannot explicitly

state that adductor strengthening prevents injury, they all

hypothesised with the increased adductor strength there

would be a reduction in adductor-related groin injuries.

This was a reasonable hypothesis to make considering the

evidence discussed in the risk factor section where

adductor weakness was shown in players with adductor-

related groin pain, and those with adductor weakness were

more likely to sustain an adductor injury.

Discussion

Eccentric adductor weakness is a modifiable risk factor for

adductor-related groin injuries. There is also convincing

evidence that current adductor pain is a risk factor for

adductor injuries in several kicking dominant sports. The

studies tabled above show the benefits of using an adductor

strengthening programme to increase adductor strength and

prevent adductor-related groin injuries in football. This

evidence is echoed in other sports with a high prevalence

of groin injuries, such as ice hockey. A study of

professional ice hockey players identified reduced

adductor strength as a risk factor for injury and found that

an adductor strengthening programme had a preventative

effect on the rate of groin injuries (Tyler, Nicholas,

Campbell, Donellan, & McHugh, 2002).

A common discussion among the articles used in this

review was the reduced eccentric adductor strength in

footballers and the use of eccentric exercises in

strengthening and prevention programmes. The adductor

longus tendon complex is put under high levels of

eccentric stress during football, particularly while kicking

(Jensen et al., 2014). Decreased eccentric adductor longus

strength may compromise the energy absorption of the

tendon and leave it more vulnerable to injury with

increased stress at the adductor longus insertion (Thorborg

et al., 2014). As previously mentioned, eccentric training

has proven effective in increasing eccentric hamstring

strength and reducing hamstring injuries in football (Al

Attar et al., 2017). There has also been research to show

that a rehabilitation programme including eccentric

*CONTINUED >>

PAGE 16

*REFER TO REFERENCES ON NEXT PAGE >>

FEATURE ARTICLE

adductor exercises has proven effective in the management

of adductor-related groin pain (Hölmich et al., 1999).

Until the Haroy et al. (2018) study there was no significant

evidence that adductor strengthening prevented adductor

injuries in football players. There has been great success

in the implementation of the FIFA 11+ programme

worldwide and through all levels of football. This

programme is effective in preventing injuries in football

(Gomes Neto et al., 2017) however there is no exercise

included which targets eccentric adduction strength in the

FIFA 11+ model. This has been identified as a gap in the

warm up and training programme, with the suggestion of

the CA exercise to be added to the FIFA 11+ to target the

prevention of adductor-related groin injuries (Harøy et al.,

2017).

An obvious theme throughout the studies included in this

review was the use of the CA exercise. The CA exercise

has excellent clinical applicability being a partner exercise

that requires no equipment and can be completed on the

training pitch. Several of the studies also reported that

there was no associated harm or risk when performing the

CA exercise during their studies (Harøy et al., 2018; Harøy

et al., 2017; Ishøi et al., 2016). An electromyography

(EMG) study found that the CA exercise, band adduction

and the adduction machine were all considered high

intensity adductor exercises with high EMG activity of

adductor longus and an eccentric component (Serner et al.,

2014). Considering the eccentric adduction weakness

highlighted in football players, these exercises are

potentially the best exercises to use for injury prevention

(Serner et al., 2014). This hypothesis has been proven by

studies showing the use of the CA exercise and band

exercises have increased eccentric adductor strength and

had an effect on the reduction of adductor related groin

injuries (Harøy et al., 2018; Harøy et al., 2017; Ishøi et al.,

2016; Jensen et al., 2014).

The findings of this review do have some limitations, with

the main one being the populations studied. Although

there has been a variety of levels of football players

included all have been youth and adult male players,

therefore generalisability to female and children playing

football remains unknown. However, male football

players do have the highest prevalence of groin injuries,

hence the use of this population in the studies reviewed.

Conclusion

There is consensus in the literature that adductor-related

groin injuries are highly prevalent in football and first line

prevention is crucial due to the time-loss associated with

the injury and the high rate of re-injury. There is evidence

to suggest that eccentric hip adductor weakness is

prevalent in football players. A strengthening programme

consisting of eccentric adductor exercises has proven to

increase eccentric adductor strength and reduce the rate of

adductor-related groin injuries in football players. The CA

exercise has shown success and is a promising exercise for

the prevention of groin injuries as it can easily be

performed pitch side or as part of the FIFA 11+

programme.

PAGE 17

References

Al Attar, W. S. A., Soomro, N., Sinclair, P. J., Pappas, E., & Sanders, R. H. (2017). Effect of injury prevention programs that include the Nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports Medicine, 47(5), 907-916. doi:10.1007/s40279-016-0638-2

Arnason, A., Sigurdsson, S. B., Gudmundsson, A., Holme, I., Engebretsen, L., & Bahr, R. (2004). Risk factors for injuries in football. The American Journal of Sports

Medicine, 32(1), 5-16. doi:10.1177/0363546503258912 Crow, J. F., Pearce, A. J., Veale, J. P., Vanderwesthuizen, D., Coburn, P. T., & Pizzari, T. (2010). Hip adductor muscle strength is reduced preceding and during the

onset of groin pain in elite junior Australian football players. Journal of Science and Medicine in Sport, 13(2), 202-204. doi:10.1016/j.jsams.2009.03.007 Engebretsen, A. H., Myklebust, G., Holme, I., Engebretsen, L., & Bahr, R. (2010). Intrinsic risk factors for groin injuries among male soccer players: a prospective

cohort study. The American Journal of Sports Medicine, 38(10), 2051-2057. doi:10.1177/0363546510375544 Esteve, E., Rathleff, M. S., Bagur-Calafat, C., Urrútia, G., & Thorborg, K. (2015). Prevention of groin injuries in sports: a systematic review with meta-analysis of

randomised controlled trials. British Journal of Sports Medicine, 49(12), 785-791. doi:10.1136/bjsports-2014-094162 Esteve, E., Rathleff, M. S., Vicens-Bordas, J., Clausen, M. B., Hölmich, P., Sala, L., & Thorborg, K. (2018). Preseason adductor squeeze strength in 303 Spanish male

soccer athletes: a cross-sectional study. Orthopaedic Journal of Sports Medicine, 6(1), 1-8. doi:10.1177/2325967117747275 Gomes Neto, M., Conceição, C. S., de Lima Brasileiro, A. J. A., de Sousa, C. S., Carvalho, V. O., & de Jesus, F. L. A. (2017). Effects of the FIFA 11 training program

on injury prevention and performance in football players: a systematic review and meta-analysis. Clinical Rehabilitation, 31(5), 651-659. doi:10.1177/0269215516675906

Harøy, J., Clarsen, B., Wiger, E. G., Øyen, M. G., Serner, A., Thorborg, K., . . . Bahr, R. (2018). The adductor strengthening programme prevents groin problems among

male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine, Published Online First: 10 June 2018. doi:10.1136/bjsports-2017-098937

Harøy, J., Thorborg, K., Serner, A., Bjørkheim, A., Rolstad, L. E., Hölmich, P., . . . Andersen, T. E. (2017). Including the Copenhagen adduction exercise in the FIFA

11+ provides missing eccentric hip adduction strength effect in male soccer players: a randomized controlled trial. The American Journal of Sports Medicine, 45(13), 3052-3059. doi:10.1177/0363546517720194

Holmich, P., Larsen, K., Krogsgaard, K., & Gluud, C. (2010). Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scandanavian

Journal of Medicine and Science in Sports, 20(6), 814-821. doi:10.1111/j.1600-0838.2009.00998.x Hölmich, P., Uhrskou, P., Ulnits, L., Kanstrup, I.-L., Nielsen, M. B., Bjerg, A. M., & Krogsgaard, K. (1999). Effectiveness of active physical training as treatment for

long-standing adductor-related groin pain in athletes: randomised trial. The Lancet, 353(9151), 439-443. doi:10.1016/S0140-6736(98)03340-6 Ishøi, L., Sørensen, C. N., Kaae, N. M., Jørgensen, L. B., Hölmich, P., & Serner, A. (2016). Large eccentric strength increase using the Copenhagen adduction exercise in

football: a randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 26(11), 1334-1342. doi:10.1111/sms.12585 Jensen, J., Hölmich, P., Bandholm, T., Zebis, M. K., Andersen, L. L., & Thorborg, K. (2014). Eccentric strengthening effect of hip-adductor training with elastic bands in

soccer players: a randomised controlled trial. British Journal of Sports Medicine, 48(4), 332-338. doi:10.1136/bjsports-2012-091095 Mosler, A. B., Agricola, R., Weir, A., Hölmich, P., & Crossley, K. M. (2015). Which factors differentiate athletes with hip/groin pain from those without? A systematic

review with meta-analysis. British Journal of Sports Medicine, 49(12), 810-822. doi:10.1136/bjsports-2015-094602 Ryan, J., DeBurca, N., & Mc Creesh, K. (2014). Risk factors for groin/hip injuries in field-based sports: a systematic review. British Journal of Sports Medicine, 48,

1089-1096. doi:10.1136/bjsports-2013-092263 Serner, A., Jakobsen, M. D., Andersen, L. L., Hölmich, P., Sundstrup, E., & Thorborg, K. (2014). EMG evaluation of hip adduction exercises for soccer players:

implications for exercise selection in prevention and treatment of groin injuries. British Journal of Sports Medicine, 48(14), 1108-1114. doi:10.1136/bjsports-2012-091746

Thorborg, K., Branci, S., Nielsen, M. P., Tang, L., Nielsen, M. B., & Hölmich, P. (2014). Eccentric and isometric hip adduction strength in male soccer players with and

without adductor-related groin pain: an assessor-blinded comparison. Orthopaedic Journal of Sports Medicine, 2(2), 1-7. doi:10.1177/2325967114521778 Thorborg, K., Couppé, C., Petersen, J., Magnusson, S. P., & Hölmich, P. (2011). Eccentric hip adduction and abduction strength in elite soccer players and matched

controls: a cross-sectional study. British Journal of Sports Medicine, 45(1), 10-13. doi:10.1136/bjsm.2009.061762 Tyler, T. F., Nicholas, S. J., Campbell, R. J., Donellan, S., & McHugh, M. P. (2002). The effectiveness of a preseason exercise program to prevent adductor muscle

strains in professional ice hockey players. The American Journal of Sports Medicine, 30(5), 680-683. doi:10.1177/03635465020300050801

.

FEATURE ARTICLE

Rebecca Blyth, currently working through postgraduate studies at Otago University,

having just completed PGCert (Sports Physio) and moving into the PGDip (Sports

Phyio) next year. Working in private practice in Drury, South Auckland with a range of

sports injuries, workplace injuries and a varied musculoskeletal caseload. Particular

interest in sports physiotherapy and sports medicine with experience in football and

rugby teams .

PAGE 18

FEATURE ARTICLE

Introduction

With the ever increasing demands of competition scheduling and training loads in team sports such as rugby union,

research into optimal recovery strategies is continuing to evolve (Tavares, Smith, & Driller, 2017). One such recovery

method is the use of cold-water immersion or ice baths. Cold-water immersion therapy (a form of cryotherapy) by

definition is the application of ice or extreme cold to the body to treat injury and/or aid a rugby athlete’s return to sporting

performance (Higgins, Cameron, & Climstein, 2013; Stephens et al., 2018).

The aim of this literature review is to investigate the current evidence regarding cold-water immersion as a method of

performance recovery by means of its physiological effects and best application technique in rugby union.

*CONTINUED >>

By Rebecca Peace (Bachelor of Physiotherapy Graduate 2015, Otago University)

PAGE 19

FEATURE ARTICLE

Demands and effects of rugby union

Rugby union is a high paced game involving full contact

collisions, as well as high intensity aerobic and anaerobic

activity with short periods of rest (Garcia, da Mota, &

Marocolo, 2016; Adamczyk, Krasowska, Boguszewski, &

Reaburn, 2016; Barber, John, Brown, & Hill, 2017). Over

the course of a standard rugby season, athletes cycle

through periods of training, game time and recovery

sessions (Higgins, Climstein, & Cameron, 2013; Higgins,

Heazlewood, & Climstein, 2011; Higgins, Cameron, &

Climstein, 2013). Tight turn around time between each

session may not provide the athletes with sufficient time to

recovery to pre-session performance levels (Higgins,

Cameron, & Climstein, 2012; Barber et al., 2017). As

result, accumulative performance stresses on the body may

lead to increasing fatigue levels, muscle micro-damage and

muscle soreness, as well as declines in power and

neuromuscular function (Garia et al., 2016; Adamczyk et

al., 2016; Higgins et al., 2011; Chow, Yam, Chung, &

Fong, 2017).

The most commonly discussed consequence to repeat

performance stress in the literature is Delayed Onset

Muscle Soreness which develops in response to muscle

tissue micro-damage, inflammation and elevated lactate

levels produced by the exercising muscles (Higgins,

Cameron, & Climstein, 2013; Adamczyk et al., 2016).

Symptoms of delayed onset muscle soreness peak at 24-48

hours post-exercise and include: pain, muscle soreness and

tenderness, loss of muscle power, decreased flexibility and

in some cases muscle swelling or oedema (Higgins,

Cameron, & Climstein, 2013; Adamczyk et al., 2016;

Garia et al., 2016).

At a physiological level, a decline in neuromuscular

function occurs as a result of delayed onset muscle

soreness (Takeda et al., 2014). In a study by Takeda et al.,

2014, it was documented that knee extensor force output

activity decreased following eccentric exercise. It was

postulated that muscle damage as a result of exercise, in

particular damage to fast twitch muscle fibres, may lead to

changes in temporal and local muscle recruitment patterns,

as well as an increase in time required to reach peak

muscle velocity (Takeda et al., 2014).

The resultant detrimental impact on a rugby athlete’s

performance emphasises the need for in season

interventions, such as cold-water immersion, to fast track

the athlete’s post-performance recovery (Chow et al.,

2017; Barber et al., 2017).

Physiological effects of cold application

Cold-water immersion post-exercise produces a variety of

local and systemic effects. Firstly, the introduction of cold

triggers an initial vasoconstriction response in local blood

vessels that is shortly followed by vasodilation 2-6 minutes

later (Adamczyk et al., 2016). Increased filling of blood

vessels via vasodilation and, therefore, the ventricles of the

heart, significantly changes systemic cardiovascular

parameters (such as stroke volume), promoting blood flow

and oxygen delivery to recovering muscles (Adamczyk et

al., 2016; Garia et al., 2016).

Second, application of cold assists in the modulation of

local muscle micro-damage. During exercise, core and

muscle temperatures increase as a result of exertional heat

(Chow et al., 2017). Increase in temperatures promotes

enzymatic breakdown of muscle fibre structure, shown by

increased blood concentrations of serum creatine kinase

(Higgins, Cameron, & Climstein, 2013; Banfi, Melegati, &

Valentini, 2007; Adamczyk et al., 2016). In the study by

Banfi et al. (2007) it was reported that application of cold-

water immersion in conjunction with active recovery

(cycling) significantly reduced serum creatine kinase levels

post intervention compared to passive recovery (resting at

room temperature). Similar findings were reported by

Barber et al. (2017) where serum creatine kinase

*CONTINUED >>

PAGE 20

FEATURE ARTICLE

concentration was significantly blunted 24-48 hours post

application of cold-water immersion.

Heating and its associated metabolic processes may also

impair joint proprioception via changes in somatic sensory

input (Chow et al., 2017). In the study by Chow et al.

(2017) it was concluded that the application of cooling,

both at room temperature and with ice, improved post-

exercise proprioception; as long as cooling was not to

extreme temperatures.

Thirdly, use of cold aids in the reduction of skeletal muscle

inflammation post exercise. Locally, cold causes a

decrease in capillary permeability, thus reducing fluid

diffusion into the interstitial space of the muscle that

causes swelling/oedema (Barber et al., 2017). A decrease

in capillary permeability reduces inflammatory cell

infiltration, thereby lessening the muscle cell breakdown

that causes muscle micro-trauma (Higgins, Climstein, &

Cameron, 2013; Adamczyk et al., 2016; Barber et al.,

2017; Tavares et al., 2018).

Fourthly, cooling assists in modulation of neural pathways

and the sensation of pain. As previously discussed, cold

reduces muscle oedema, therefore decreasing compression

and irritation of skeletal muscle free nerve endings (Barber

et al., 2017). Likewise, the reduction in local muscle

temperature reduces receptor sensitivity, nerve conduction

velocity, muscle spindle afferent signalling and stretch

reflex responses required for pain production (Adamczyk

et al., 2016; Barber et al., 2017; Garia et al., 2016; Chow et

al., 2017; Tavares et al., 2018). Cold application promotes

improved parasympathetic activity, aiding the return of the

exercised body to functional and neural homeostasis (Garia

et al., 2016; Stephens et al., 2018).

Finally, as the symptoms experienced with post-exercise

delayed onset muscle soreness incorporate all of the above-

mentioned components, it is plausible from a physiological

perspective that cold therapy, such as cold-water

immersion, could be beneficial for the management and/or

prevention of delayed onset muscle soreness following a

rugby session.

Cold-Water Immersion Protocols

Protocols for cold-water immersion post rugby game or

training vary across the literature. Rugby union is highly

demanding of the lower limbs for explosive take offs,

running, direction changes and pushing in scrums. As

shown in Table 1, the majority of research immerses the

athlete’s lower limbs to the level of the iliac crest or

superior iliac spine.

The most common protocol used an immersion depth to

the superior iliac spine, a temperature range of 10-12°C

and a time of two sets of 5 minutes with a 2.5 minute rest

between. All included studies that used the temperature

range of 10-12°C, demonstrated beneficial findings in

support of cold-water immersion.

Immersion temperatures range from 5°C to 15.9°C, with

the average temperature being 10.8°C. Stephens et al.

(2018) used the highest temperature of 15.9°C and had the

longest immersion time of 15 minutes. In contrast Chow

et al. (2017) used the lowest temperature of 5°C but had

the shortest immersion time of 1 minute. This study‘s

findings demonstrated a greater detrimental effect on knee

proprioception when compared with room temperature

water immersion; whether this detrimental effect was as a

result of the cooler temperature or the short duration of

immersion is unknown.

Three studies used whole body immersion, excluding the

head. Lindsay, Lewis, Gill, Gieseg, & Draper (2015) and

Takeda et al. (2014) reported inconclusive findings. In

comparison, Stephens et al. (2018) demonstrated positive

*CONTINUED >>

PAGE 21

FEATURE ARTICLE

effects on recovery only in athletes with a high body fat percentage.

Variability in research findings could be attributed to several factors, including sample size and make up (for example,

professional level rugby players verses under 20 year olds), different immersion levels and temperatures, duration and

repetition of immersions, as well as the pre and post immersion measurements used (for example, perceived level of

soreness verses counter-movement jump or blood creatine levels).

*CONTINUED >>

PAGE 22

FEATURE ARTICLE

Effects of CWI on performance

and Muscle Soreness

Subjective Measures

The primary outcome measure used across the literature to

measure the effectiveness of cold-water immersion is an

athelete’s level of perceived muscle soreness (Higgins,

Climstein, & Cameron, 2013; Banfi et al., 2007; Barber et

al., 2017). All three studies that used the immersion

protocol of 2x5 minutes with a 2.5 minute break, reported

positive changes in both the athlete’s perceived level of

muscle soreness and delayed onset muscle soreness

symptoms (Higgins, Cameron, & Climstein, 2012;

Higgins, Cameron, & Climstein, 2013; Higgins, Climstein,

& Cameron, 2013).

As previously discussed, application of cold has a positive

physiological effect on the sensation of pain. Given that

symptoms of delayed onset muscle soreness peak at 24-48

hours post exercise (Adamczyk et al., 2016), outcome

measures for delayed onset muscle soreness need to be

assessed over this timeframe. Higgins, Cameron, &

Climstein (2013) followed rugby athletes over a 48-hour

period post cold-water immersion and reported a

statistically significant finding in regards to pain at 48

hours. Post cold-water immersion muscle pain scores had

reduced to 13% compared to 20% of baseline in the control

group. Webb, Harris, Cronin, & Walker (2013) and

Tavares et al. (2018) similarly reported the most beneficial

effects on muscle soreness occurred 18-42 hours post cold-

water immersion.

Over the course of a heavy training week, a reduction in

perceived muscle soreness resulted in positive effects on a

rugby athlete’s perception of fatigue and overall training

effort (Higgins, Cameron, & Climstein, 2013; Higgins,

Climstein, & Cameron, 2013; Takeda et al., 2014; Barber

et al., 2017).

Physiological measures

The effect of cold-water immersion on physiological

markers, such as serum creatine kinase, skin and/or core

temperature and thigh circumference, gives an objective

measure of effect on the rugby athlete’s physiological

performance recovery. Minimal to no effect was

documented on salvia cortisol levels (Tavares et al., 2018).

Blood serum creatine kinase recovery varied across the

literature, with several studies reporting faster stabilisation

post cold-water immersion (Banfi et al., 2007; Barber et

al., 2017; Tavares et al., 2018) and another reporting no

effect compared to a control group (Takeda et al., 2014).

All studies reported significant reductions in skin

temperature compared with contrast therapy and control

groups. In the study by Stephens et al. (2018) body

composition (high fat versus low fat participants) was

applied to the protocol of 15 minutes immersed in 15.9°C.

Given that body fat acts as a heat insulator, decline in core

temperature was significantly higher in low fat individuals

(Stephens et al., 2018).

Thigh circumference, as a measure of skeletal muscle

inflammation and oedema, was found to have no

statistically significant difference post cold-water

immersion compared to control groups (Higgins, Cameron,

& Climstein, 2013; Tavares et al., 2018).

Due to inconclusive findings of physiological markers for

measurement of beneficial effect, it is not possible to draw

conclusions as to how much skin or core temperature and

serum creatine kinase levels need to decrease in order to

aid a rugby athlete’s performance recovery.

Functional Measures

Finally, sports-specific or functional measures could be

used to relate level of recovery to the specific demands of

PAGE 23

FEATURE ARTICLE

rugby. Such measures used across the literature, include

vertical jump height, counter-movement jump tests and

timed sprints or 50m hop tests. Tavares et al. (2018)

reported a small benefit in recovery of neuromuscular

function, with a faster recovery of counter-movement jump

score when compared to passive recovery. Higgins,

Cameron, & Climstein (2013) made a similar conclusion,

reporting an accelerated return of muscle power when

compared with passive or contrast bath therapy.

In contrast, Garcia et al. (2016) reported no change in

counter-movement jump testing; however, they did note a

decline in muscle tests of longer duration (such as a 30

second vertical jump or continuous hop). Likewise,

Higgins et al. (2011) and Takeda et al. (2014) described a

significant detrimental effect on sprint speed during a

timed 50m dash.

Another performance factor that could be influenced by

cold-water immersion is the neuromuscular control of

lower limb balance. As mentioned previously, cold alters

mechanorecpetor sensivity and nerve conduction velocity

(Chow et al., 2017; Tavares et al., 2018). Therefore, cold

could potentially effect lower limb joint position sense

(proprioception) and balance required for hopping and

jumping functional measures. Chow et al. (2017)

conducted a study investigating this exact theory and

concluded the cold-water immersion did decrease knee

joint proprioception to a much greater extent than passive

recovery; however, cold did not alter overall

somatosensory inputs for balance control.

Given the accelerated recovery of sport-specific

neuromuscular function with the use of cold-water

immersion on a rugby athlete ’s recovery, it could be

concluded that within congested periods of rugby (i.e. less

that 48 hours between sessions), cold-water immersion

may aid recovery and performance (Tavares et al., 2018;

Higgins, Cameron, & Climstein, 2013).

Clinical application

To apply the evidence to practice in the rugby environment, as shown above, several factors need to be

taken into account. Firstly, what is the reason for trying to hasten the athlete’s recovery of performance?

What beneficial effect needs to be gained from recovery? Is there concern over muscle power loss or

development of delayed onset muscle soreness? What are the individual athlete’s rugby sporting demands

and how might their body composition contribute? Taking all of these questions and the current best

evidence into account, cold-water immersion should, in theory, have positive physiological and

psychological effects. Out of the studies included in this review, the most beneficial protocol for

application of cold-water immersion seems to be 2x5 minute intervals with a 2.5 minute break of

immersion to the level of the superior iliac spine in 10-12°C water.

If a rugby athlete reports perceived performance enhancements with the use of cold-water immersion, we

should not rule it out as a beneficial technique for aiding recovery. To date, the research has not been able

to define the most effective balance of temperature, time and technique to ensure cold-water immersion is

beneficial for every rugby athlete’s recovery.

PAGE 24

FEATURE ARTICLE

References

Adamczyk, J. G., Krasowska, I., Boguszewski, D., & Reaburn, P. (2016). The use of thermal imaging to assess the effectiveness of ice massage and cold-water

immersion as methods of supporting post-exercise recovery. Journal of Thermal Body, 60, 20-25. doi: 10.1016/j.jtherbio.2016.05.006

Banfi, G., Melegati, G., & Valentini, P. (2007). Effects of cold-water immersion of legs after training session on serum creatine kinase concentrations in rugby players.

British Journal of Sports Medicine, 41(5), 339.

Barber, S., John, P., Brown, F., & Hill, J. (2017) The efficacy of repeated cold water immersion on recovery of following a simulated rugby union protocol. Journal of

Strength and Conditioning Research. Advanced online publication. doi: 10.1519/JSC.0000000000002239

Chow, G. C. C., Yam, T. T. T., Chung, J, W. Y., & Fong, S. S. M. (2017). Effects of postexercise ice-water and room-temperature water immersion on the sensory

organisation of balance control and lower limb proprioception in amateur rugby players: a randomised controlled trial. Medicine, 96(7). doi: 10.1097/

MD.0000000000006146

Garcia, C. A., da Mota, G. R., & Marocolo, M. (2016). Cold water immersion is acutely detrimental but increases performance post-12h in rugby players. International

Journal of Sports Medicine, 37(8), 619-624. doi: 10.1055/s-0035-1565200

Higgins, T., Cameron, M., & Climstein, M. (2012) Evaluation of passive recovery, cold water immersion, and contrast baths for recovery, as measured by game

performance markers, between two simulated games of rugby union. Journal of Strength and Conditioning Research. Advanced online publication. doi: 10.1519/

JSC.0b013e31825c32b9

Higgins, T. R., Cameron, M. L., & Climstein, M. (2013). Acute response to hydrotherapy after a simulated game of rugby. Journal of Strength and Conditioning

Research, 27(10), 2851-2860. doi: 10.1519/JSC.0b013e31828151b6

Higgins, T. R., Climstein, M., & Cameron, M. (2013). Evaluation of hydrotherapy, using passive tests and power tests, for recovery across a cyclic week of competitive

rugby union. Journal of Strength and Conditioning Research, 27(4), 954-965. doi: 10.1519/JSC.0b013e318260ed9b

Higgins, T. R., Heazlewood, I. T., & Climstein, M. (2011). A random control trial of contrast baths and ice baths for recovery during competition in u/20 rugby union.

Journal of Strength and Conditioning Research, 25(4), 1046-1051. doi: 10.1519/JSC.0b013e3181cc269f

Lindsay, A., Lewis, J., Gill, N., Gieseg, S. P., & Draper, N. (2015). Effect of varied recovery interventions on markers of psychophysiological stress in professional

rugby union. European Journal of Sport Science, 15(6), 543-549. doi: 10.1080/17461391.2015.1029982

Stephens, J. M., Halson, S. L., Miller, J., Slater, G. J., Chapman, D. W., & Askew, C. D. (2018). Effect of body composition on physiological responses to cold-water

immersion and the recovery of exercise performance. International Journal of Sports Physiology and Performance, 13(3), 382-389. doi: 10.1123/ijspp.2017-0083

Takeda, M., Sato, T., Hasegawa, T., Shintaku, H., Kato, H., Yamaguchi, Y., & Radak, Z. (2015). The effects of cold water immersion after rugby training on muscle

power and biochemical markers. Journal of Sports Science and Medicine, 13(3), 616-623.

Tavares, F., Beaven, M., Teles, J., Baker, D., Healey, P., Smith, T. B., & Driller, M. (2018). The effects of chronic cold water immersion in elite rugby players.

International Journal of Sports Physiology and Performance. Advanced online publication. doi: 10.1123/ijspp.2018-0313

Tavares, F., Smith, T. B., & Driller, M. (2017). Fatigue and recovery in rugby: a review. Sports Medicine, 47(8), 1515-1530. doi: 10.1007/s40279-017-0679-1

Webb, N. P., Harris, N. K., Cronin, J. B., & Walker, C. (2013). The relative efficacy of three recovery modalities after professional rugby league matches. Journal of

Strength and Conditioning Research, 27(9), 2449-2455.

doi: 10.1519/JSC.0b013e31827f5253

Rebecca Peace graduated from The University of Otago with a Bachelor of Physiotherapy in 2015. This review

was completed as partial requirements for the PHTY542 Sports Physiotherapy paper, University of Otago.

Rebecca is currently employed in a musculoskeletal private practice in Invercargill, NZ.

PAGE 25

PAGE 26

Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis Lauri Kavaja, Tuomas Lähdeoja, Antti Malmivaara, Mika Paavola Consensus statement Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement Martina Zügel, Constantinos N Maganaris, Jan Wilke, Karin Jurkat-Rott, Werner Klingler, Scott C Wearing, Thomas Findley, Mary F Barbe, Jürgen Michael Steinacker, Andry Vleeming, Wilhelm Bloch, Robert Schleip, Paul William Hodges Original research Internal workload and non-contact injury: a one-season study of five teams from the UEFA Elite Club Injury Study Alan McCall, Gregory Dupont, Jan Ekstrand Modelling the process of falling behind and its psychophysiological consequences Andreas Venhorst, Dominic Micklewright, Timothy D Noakes Editorials So you think you can return to sport? Trevor A Lentz, Mark V Paterno, Jonathan C Riboh Nutrition and oral health in sport: time for action Ian Needleman, Paul Ashley, Tom Fairbrother, Peter Fine, Julie Gallagher, Daniel Kings, Ronald John Maughan, Anna Katarina Melin, Michael Naylor Leadership in physical activity: is this the currency of change in the student healthcare curriculum? Ann Bernadette Gates, Ian K Ritchie, Fiona Moffatt, João Breda Tackling doping in sport: a call to take action on the dopogenic environment Susan H Backhouse, Claire Griffiths, Jim McKenna

Commentary Hamstring injuries are increasing in men’s professional football: every cloud has a silver lining? Cristiano Eirale Infographics Infographic. Impact of the Nordic hamstring and hip extension exercises on hamstring architecture and morphology: implications for injury prevention Matthew N Bourne, David Pope, Steven J Duhig, Ryan G Timmins, Morgan D Williams, Aiman Al Najjar, Graham K Kerr, Anthony J Shield Infographic: Helping athletes make decisions on dietary supplement use Ronald John Maughan Bright Spots Bright spots, physical activity investments that work: Vitality Active Rewards—a smartphone app that incentivises programme members to be physically active Deepak N Patel, Craig Nossel, Jon Patricios, Joel Maboreke

RESEARCH PUBLICATIONS

British Journal of Sports Medicine December 2018; Vol. 52, No. 23

http://bjsm.bmj.com/content/52/15

All articles are accessible via our website https://sportsphysiotherapy.org.nz/members/bjsm/

PAGE 27

COURSE

PAGE 28

Wellington-New Graduate/ Experienced

Physiotherapist A full time Physiotherapist position is available starting end of January 2019 in Wellington. This is a busy local private practice where we treat a wide range of musculoskeletal conditions. You would work alongside two experienced Physiotherapists, part-time physiotherapists and some new graduates. We offer extensive in service training and new graduate mentoring. New graduates have extended appointment times as we encourage learning and quality treatment at all times. Excellent remuneration including allowance for professional development. Forward CV to thejvillephysio@xtra.co.nz attn. Liz Bergin or Sharon Gold

SITUATIONS VACANT

Are you a Sports Physiotherapist looking to

move to Tauranga or make a change? This is an excellent opportunity to work with one of the Bay of Plenty’s top rugby teams in a Physiotherapy clinic renowned for creating opportunities to move into higher sports physiotherapy roles with strong links to High Performance Sport New Zealand. For over fifteen years Bureta Physiotherapy has been providing the highest quality physiotherapy to a wide variety of “every day” patients to elite athletes with a focus on overall health and wellness. Bureta Physiotherapy works with two of the strongest Rugby clubs in the bay, the most successful surf club in New Zealand and other National and International athletes all just minutes from Tauranga CBD and beautiful beaches. Generous appointment times allow for an emphasis on manual/manipulative physiotherapy and exercise prescription encompassing full rehabilitation in the onsite rehabilitation gym or one of our partnered gyms in Tauranga. Work alongside experienced postgraduate and Masters qualified physiotherapists, a team of therapeutic massage therapists, an excellent reception team along with close links to local Sports Medicine Doctors and Specialists. The successful applicant will receive on-going support as part of our strong mentoring program along with an allowance for CPD to assist with postgraduate study/courses and conferences. Start date is negotiable but ideally Jan 2018. We are looking for an enthusiastic, hard-working sports physiotherapist with excellent communication skills, an interest in gym based rehab and a strong desire to learn and enhance their clinical skills as well as build their reputation as a high-quality physiotherapist.

For further information, please contact Jacinta Horan on jacinta@buretaphysio.co.nz or

021623627

PAGE 29

SITUATIONS VACANT

SEPNZ EDUCATION COMMITTEE Expressions of Interest

Expressions of Interest to join the SEPNZ Education Committee are now open. SEPNZ is committed to providing sustainable, quality, robust Sports Physiotherapy Education Pathway that aligns with, and stands up to assessment against, the International Federation Sports Physiotherapy (IFSPT) competencies. If education in Sports Physiotherapy is a passion of yours and you believe that you have something to offer the SEPNZ Education Committee that could help us to overcome barriers in the delivery of quality Sports Physiotherapy Education with our courses, please send your CV and letter outlining; why you wish to apply, what you offer and how you would look to implement your ideas to help the ongoing review and improvements that we are committed to making within the SEPNZ Education Committee to:

becsvw@hotmail.com.

SEPNZ BULLETIN EDITOR The SEPNZ Bulletin is a show piece for publications for physiotherapy in New Zealand Can you help us??? We are looking for a bulletin editor to help us put together the SEPNZ Bulletin 6 times a year. • Help will be given to get you started in the role • Publishing knowledge is not needed Duties include: • Contacting people to supply articles • Proof reading articles to make sure they make

sense • Reminding people to send things in on time • Choose an article to be reviewed for publication • Skills needed are basic time management and a

computer

Further details on request Contact Michael Borich

mborich@gmail.com

PAGE 30

SURVEY INVITATION

Dear Physiotherapist,

Sport related concussion is a very topical area right now with significant media coverage. Physiotherapist are

often at the forefront of the side line an ongoing management of this condition yet there is not lot of research into

physiotherapists knowledge attitudes and behaviours of sports related concussion.

It would be great to see what the profession doing in this area.

Thank-you for considering the invitation to complete the above-named survey. We realise this survey is coming out at a

busy time of year, but we hope you can find 10 minutes in your day to complete this.

If you are keen to participate, please click on the link below or copy the link into your internet browser.

The survey is anonymous and voluntary.

https://www.surveymonkey.com/r/G2ZXMGQ

Prof Duncan Reid On behalf of the ACC Concussion research team

PAGE 31

INVITATION