2018 Commonwealth Games

It was a privilege to be selected as a volunteer sports physiotherapist for Rugby 7's during  the 2018 Commonwealth Games and it was a great experience to have the opportunity to work at the High Performance Centre and the village polyclinic .

As a sports physiotherapist I had the opportunity to provide support for athletes from many countries for pre event preparation, acute care injury diagnosis, management and prevention with many co workers.

Such a large scale event required a lot of time, effort and resources to organise and a huge achievement for the Gold Coast community. Safely, hygiene and communication among various stakeholders was paramount to provide the best clinical care for athletes.


2018 Courses

 Our interventions need to reflect current thinking and the most up to date research available. During 2018 the knee was a strong focus for research presented at the Melbourne Knee Symposium in February. Other courses attended were the Australian Specialist Physiotherapist Educators Complex Spinal courses for an evidence based approach to managing neck pain focusing on exercise and manual therapy.


2019 APA Conference

The Australian Specialist Physiotherapist Educators courses held for both neck and low back pain disorders are designed to advance clinical reasoning and competency. APA Conference will be held in 2019 and will cover a large scope of physiotherapy research and practice. 

Reporting on Injuries

A summary of Dr John Orchard’s 20-year data from his long term injury surveillance system for the AFL. The 2011 AFL Injury Report is a landmark study marking 20 years of the recording of injury data by the AFL.  

Injury incidence
Statistics from 2011 have shown that overall incidence has decreased and there were statistically significant falls in the 2011 incidence of hamstring muscle strains and all lower limb muscle strains. However the primary injury in the game, in terms of injury numbers and missed games remains the hamstring strain. There was a slight increase in injury prevalence in 2011, which can be attributed to higher than usual ACL injuries and fractures. For the first time since the second center rule was introduced in 2005 , there were 4 center bounce PCL injuries in 2011 after only four occurring in total for the period 2005-2010. These lower rates since 2005 have demonstrated the success of the rule. At 9 percent recurrence injuries were at a 20 year low in 2011. 

Impact of substitute rule change 
After one season of the new substitute rule (changing the bench from four interchange players to three interchange players plus one substitute), it is to early to be certain about the impact this will have upon the prevention of injuries within the sport. However evidence does suggest that there is some association between the change of this rule and the reduction in hamstring strains and other lower limb muscle strains in 2011. Shoulder injuries increased in 2011 following a long-term upward trend.

Concussion guidelines 
In 2011, the AFL medical officers association introduced revised concussion management guidelines that strengthened a more conservative approach. Rates of concussion have increased in 2011 however numbers remain low. Importantly longer term trends are relatively constant and it is likely this also represents a change in culture among AFL teams. Many sports have adopted a more conservative approach to concussion management, which may have led to a more cautious decision about return to play the week after injury.

Fast Bowling Injuries in Cricket - Part 2

The copious amount of negative press surrounding the excessive injury rates of fast bowlers has lead to widespread debate within the Australian cricketing community.  The criticism that bowlers of today ‘don’t bowl enough and this is the reason for injury,’ is an unsupported argument due to the lack of comprehensive statistical evidence available, such as injury rates and training loads, necessary to compare past bowlers to present. One way in which cricketers of both the past and present can be compared is through the analysis of competition bowling rates.

Through the analysis of competition bowling statistics it can be concluded that historically both past and present players have bowled with similar frequency. The average number of balls bowled in competition which is examined over a player’s career, was indicated to be approximately 2000-3000 balls per year.  Previously the number of balls bowled by first class cricketers usually built over the first 6-7 years before maintaining some consistency and tailing off.  It can be seen that on average it is around the sixth year of a bowler’s career that they are able to exceed the 3000 balls per season mark.

New information from the Cricket Australia Injury report however states that the age of NSW fast paced bowlers has dropped dramatically over the last few years as they are being fast tracked into senior cricket without the above mentioned six year ‘apprenticeship’; consequently injury rates have risen. 

Over use injuries are believed to be made up of several factors such as intrinsic body make up bowling technique and bowling loads. It has been identified that loads placed on an athlete are the most important factor in the generation of over use injuries. There is currently a mismatch between the high end of bowling loads and the requirements of the longer game. Increasing expectations for younger bowlers has resulted in them being thrust into first class cricket before they are prepared, leading to an injury rehabilitation roundabout and ultimately slow down their progression towards the resilience required to be a successful bowler. 

Fast Bowling Injuries in Cricket - Part 1

Cricket is a sport that is considered to have a moderate injury risk. The high incidence of lumbar spine stress reactions and fractures (bone stress injuries) in fast bowlers that result in long recovery periods in part explains the high prevalence rates. There is not single factor that predisposes fast bowlers to pars injury, but a combination of factors related to localized bones stress, bone geometry and the magnitude and frequency of loading.

Localized bone stress
Fast bowling involves repetitive trunk extension, side flexion and rotation resulting in localized stress through the posterior elements of the vertebra, capable of creating a pars defect or bone stress injury.

High magnitude of bone stress
Ground reaction forces as high as eight times body weight have been reported at front-foot impact during delivery stride and are transmitted vertically through the lumbar spine to provide the high magnitude of load required to develop bone stress. Evidence has been brought out to support the theory that there are certain spin positions during the delivery stride that are responsible for the pars stress required for bone failure. Fast bowlers who deliver the ball from a greater height, have also been associated with an increased risk of lumbar bone stress injury. Ball release height is related to the degree of knee extension at front-foot impact, thus the higher the release height the straighter the knee. This results in stiffer knee segment and greater impact forces being transmitted to the lumbar spine.

Bone geometry (strength)
A bones ability to resist bending forces is dependant on its geometry and there fore its strength. The exact relationship between age and lumbar spine bone stress injury is unknown but it is commonly reported in younger athletes. It is likely that bone is more susceptible to failure before it has full matured making players younger than 25 more vulnerable to pars injury. In cricket it is an injury that is also commonly reported in younger fast bowlers. Studies have shown the relationship between the immature vertebral bone and bone stress injury.

Frequency loading
Bone stress and ultimately fracture is thought to occur when insufficient time is given between loading sessions for the bone to adapt and repair. It has been identified that more than 300 deliveries in a single match or 180 deliveries in the second innings of a games increased the risk of injury in the following weeks after the match. It was found that it was the 21-28 day period after the match when the injury was most likely to occur.

November 2011 Newsletter

Congratulations to all sporting teams on their achievements this year.Particularly to CYMS I would like to  extend my thanks to  Kevin, and coaching  and support staff, especially Blake and Luke,for the opportunity to  work in a great team environment and for the many learning opportunities.

Continuing education and sports coverage have continued to be a high priority of the practice. Attendance to courses in Sydney for real time ultrasound training  and performance arts have been great educational opportunities which we have been able to integrate in our assessment and treatment of injuries.

Our APA National Conference was held in October 2011 in Brisbane with the high quality programme content  contributing to making it one of the best presentations.

Many national and international speakers presented current evidence based research and clinical findings in the sports and musculoskeletal area of physiotherapy to be utilised to  assist patients in our practice.

New assessment and technologies are now used to manage overload for many professional players .Extrapolating some of  the more simple and cost effective measures using i-phone apps will be helpful during the preseason for 2012.This information is available  to  patients through our practice.

Overuse injuries resulting from an increase workload is still an area of concern for researchers and clubs. Current evidence suggests that reducing overload by 10% can reduce injury levels of up to 40%,having a significant effect on players and team performance. Loading for more than four weeks during the season and for no more than four to six weeks off season will result in overload and injury to players.

Adequate sleep has also recently been shown to have a significant effect on the incidence and risk of injury. Were players have less than six hours of sleep at night the incidence of overuse injuries significantly increases. Reported poor sleep quality can also increase the incidence of injury by 61% in some professional sports.

Managing lower limb injuries with barefoot running or minimal rather than regular shoes has been receiving  popular interest, but there is still no clear evidence available on outcomes for players or how to adequately make the transition other than ensuring it it slow and may take up to 12 months. Its suggested that running technique will still  be the main focus in assessing lower limb injury. Avoiding landing with excessive heel impact or thumping, and  overstriding are important factors to address. Interestingly bare foot runners from Kenya  still hold all current international  distance running records.

With the preseason  already here for some players, minimising training downtime post season and over the christmas break is important. Not monitoring the gradual return to training peaks and any significant weight gain during training downtime has been shown to have a significantly increase the risk of lower limb injury.

The knee has continued to be a strong area of recent interest for researchers particularly in the high level of  adolecent females patellofemoral pain and anterior cruciate injury. Screening  patients in this age group for static and dynamic highly predictive  risk factors is important, and commonly the problem is a lack of neuromuscular control.  Overcoming  hip and knee  and more specifically hamstring muscle weakness issues is imperative to decrease the risk of injury and  can be done through specific sports specific training.

Some interesting current research and treatment  programmes have been developed in regard to groin  and osteitis pubis .These have been a great addition to address what are often chronic presentations.

We will be continuing our education programme  with two further sports workshops in Sydney in February 2012, and will be available for sports coverage during the year . Wishing everyone a very happy Christmas and great 2112.