News

  • When to load and by how much? Opload Congress 2017 – 2nd World Congress of Sports Physical Therapy By Rosie Mew

    Load - When to load, How to load and by How Much - is a hot topic in the sports world, and is an ideal focus point for the 2nd World congress of Sports Physical Therapy, held in Belfast 6th - 7th October at the iconic Titanic centre.

    Conference content was extremely good. Yes, finding the coffee was a bit like qualifying for the crystal maze, and at times it was quite Physiology and science heavy -  scatter charts flashed in front of my eyes before I had time to digest their content or meaningfulness. However, the data heavy aspects were balanced out with speakers highlighting how to apply this science into practice. As clinicians, my colleagues and I regularly make decisions about loading and how to adapt and progress loading regimes. The lectures built upon my existing knowledge and helped develop greater understanding of how loading regimes are tailored to bone, muscle, ligament and tendon injuries. There was also discussion on progressed loading for “return to play”. Some clinically relevant gems included:

    Learning the benefits of a 5-6 day rest period for recovery vs a 3 day rest period

    Coping with seasonal congestion and successive demands through busy competitive periods

    Adapting loading in relation to physical and mental fatigue

    Benefits of integrating unforeseen and ever-changing load mechanisms

    Potential advantages of training for my favourite new terminology: the ‘speed vaccine’.

    If you have looked at the Physios in Sport and Exercise CPD pathway, you might wonder what some of the benefits are of progressing through to Gold level. For me, they made a huge difference to my conference experience. Having booked late and missed the early bird discount, it was brilliant to learn that “Gold members” (those with Gold level CPD) were given a conference discount, invited to a drinks reception at the spectacularly domed City Hall and to join the speakers and executive committee members for a meal afterwards. Although often uncomfortable in more formal ‘networking’ environments, I really enjoyed the opportunity to mingle and chat in a relaxed manner with the people that inspire me within our field of Sports Physiotherapy. If you need more affirmation on why to pursue Gold Membership accreditation then the surprise invite to a private gathering and glass of wine with Dame Katherine Grainger may be just that. It definitely made it worthwhile for me and was my congress highlight. Not only is she one of my all-time favourite athletes, with her dogged determination in her pursuit of that elusive gold medal and her ability to pick herself up again and again when everything suggested she should quit, but she is also able to speak eloquently and inspire a room full of people without prompts or notes and remain completely on point. Apparently she is quite good in a rowing boat too. 

    Photo: Dame Katherine Grainger and Rosie Mew

    I left the Conference with some great learning points that I am keen to put into practice. I’m  now better armed to tailoring my loading progressions to specific injuries and return to play, and also how to load optimally.

    For more information on the conference, see @opload_2017 #opload http://www.opload2017.com

    Rosie Mew works part time for EIS, British Gymnastics, England Hockey, England Athletics and in private practice in London City Centre. She was the lead Physio at London 2012 Paralympics.

     

     

  • ACPSEM Soft Tissue Techniques - Blog by @vikki_mills80 and @physiofaith

    The ACPSEM hosted a 2 part soft tissue techniques course aimed at practicing clinicians in sports medicine to equip them with the hands on skills necessary for soft tissue management.  The course was held over 2 weekends, 6 weeks apart with completion of all 4 days which included the submission of a case study.

    There are many schools of thought emerging in sports and exercise medicine which question the use of what is often termed ‘hands on’ physiotherapy, specifically massage or soft tissue mobilisation. As physiotherapists working in elite sports settings, the thought of completing a day with-out utilising ‘hands on’ techniques in some capacity is for us, impossible to imagine, let alone our athletes. However, despite being an integral part of our day to day routines, could either of us recall ever having any formal training on ‘massage’? The answer was no!

    We highlight several examples of how this has changed our practice and thought processes to justify the use of massage as part of our clinical tool kit.

    Evidence base

    During the course we explored the evidence base behind sports massage, and discussed the justifications we articulated to our clients. It became quickly apparent that we were missing several fundamental reasons for using massage, with most attendees noting blood flow improvement as the main justification. We were exposed to many other reasons, including the positive impact of wellbeing, biomechanical, physiological, neurological and psychological effects (Moraska 2007).

    Practical skills

    The content of this course was highly practical, allowing us to develop our techniques and gain feedback from both tutors and peers. Evidence has suggested that differences in practitioners’ proficiency affect the effectiveness of massage (Donozama et al 2010). Therefore, handling and optimising patient position was fundamental to the effectiveness of not only the treatment but the wellbeing and comfort of the therapist.

    Technical skills gained included a detailed breakdown of individual massage technique in part 1, with further study and practice of more advanced skills involving tool assisted soft tissue release techniques, cupping and myofascial release in part 2. Development of massage techniques and application over the entire 4 days addressed specific soft tissue dysfunction, which included muscular imbalances, trigger point development and altered motor patterns.

    Lecturers

    To host a course for 4 days to teach fundamental skills to clinicians already practicing in the sporting environment is no easy feat, yet Colin Paterson and Ros Cooke managed to pull this off. Their knowledge, skills and experience in addition to their enthusiasm made for an engaging and enjoyable learning experience.

    For any clinician embarking on the ACPSEM CPD pathway it is compulsory that they undertake and evidence post graduate training in massage. This course provides an opportunity for any practicing clinician to challenge their current knowledge and practice. The theory and content challenged thoughts, beliefs and existing skills. We now feel better equipped to justify, articulate and carry out soft tissue techniques as a treatment modality.

    Vikki Mills BSc (HONS) MCSP HCPC ACPSEM AACP

    Vikki has been a charted physiotherapist for 15 years working in both the private and elite sport setting. Vikki divides her clinical practice between Leeds United Academy and community MSK services. Her clinical interests include paediatric lower limb biomechanics and growth related pathology.

    @vikki_mills80

    Faith Fisher-Atack BSc (HONS) MCSP HCPC ACPSEM ACPAT

    Faith is a chartered Human and Veterinary Physiotherapist and clinical director of Equine Physio Services, a physiotherapy practice specialising in equine and rider biomechanics and performance. Former Head of Sports Science and Medicine at Leeds United Academy.

    @physiofaith

    References:

    Donozama N, Shibasaki M (2010) Differences in practitioners' proficiency affect the effectiveness of massage therapy on physical and psychological states.
    Journal of bodywork and movement therapists. Volume 14 issue 3 July 2010 pages 238-245

    Moraska A (2007) Therapist education impacts the massage effect on post-race muscle recovery. Medicine and science in sport and exercise

  • LAST TWO WEEKS! CLOSING DATE for Optimal Loading Conference delegates is 18th SEPT !

    LAST TWO WEEKS! CLOSING DATE for Optimal Loading in Sport Congress bookings is 18th SEPT !

    We only have two more weeks till our Closing Date for anyone wanting to sign up to the next great conference of 2017!

    Click HERE now www.opload2017.com to check the programme, speakers & events

    DO NOT MISS OUT - no more delegate requests can be taken after this date so please so SIGN UP NOW to avoid disappointment!

  • Our next AGM - Friday 6th October 2017

    Next AGM

    Please note our next AGM will be held at The Optimal Loading in Sport Congress on Friday 6th October at 15:40hrs during the coffee break. We hope you will join us there. Please click here to see the full congress programme.

    Find out more about the congress here: http://www.opload2017.com/

  • Blog: Using strength and conditioning in Physiotherapy by Emily Drakes

    My interest in strength and conditioning started after watching an evening lecture from Raphael Brandon. I was intrigued by the theory behind exercise prescription. Also, physiotherapy seems to be moving more and more towards exercise as the mainstay of treatment, as seen in the recent NICE guidelines for low back pain1, so this seemed like the right path to follow.

    For those of you lucky enough to work with S&C coaches you will have them on hand to guide exercise prescription. However for most of us working in physiotherapy teams, having more of an S&C background can offer valuable insight into the best way to strengthen and prepare a patient for their activities whether that is a seasoned marathon runner or a stay at home parent with children to carry.

    It has been refreshing in learning about S&C to put injuries to one side and focus on the most effective way to plan an exercise programme. Many physiotherapist’s are preoccupied with making an exercise look like the movement or sport they are trying to rehabilitate their patient to i.e. giving a patient who plays football a ball to use in an exercise. However when if you break down the amount of time a footballer spends with a ball over 90mins it amounts to 90s2! The rest of the time is spent running, changing direction and jostling for the ball. Obviously a lot of the time a footballer is training involves a ball but unless you break it down in to the components of a skill you have no overload. This is what S&C essentially comes down to, ensuring specific adaptations to imposed demands. We need to understand the way a force is developed in the sport/activity we are interested in and in the exercise we are choosing to prescribe to get the desired outcome.

    There are some general principles that I now use daily that are key to exercise prescription. Firstly a needs analysis, which is something we all do to some extent but it formalises the process of deciding where a person is dysfunctional for the activity they are struggling with. The diagram below outlines this:

    Once you’ve specified the activity and what one would need to perform that successfully/pain free then you would look at the gap between the person in front of you vs. the ideal attributes they need. Once you know this, targeting their exercise should be much easier.

    The needs analysis and the selection of exercises both incorporate the principle of dynamic correspondence described by Siff and Verkoshansky3. This is a guide on the different aspects of the activity to consider and how the exercise you are choosing will correlate to it.

    Unless you are doing the exercise itself i.e. kicking a ball you are not going to be 100% specific, however as discussed above in order to overload the components you need to break it down into parts. We will use the example of squatting and sprint ability in football:

     

     

     

     

    There are 5 key aspects to consider:

    Amplitude and direction of movement

    This is the most familiar principle in that we are looking at the direction of force relative to the performed movement.

    The squat does not look like a sprint however the lower limb movement of the hip, knee and ankle triple extension on the ascent on the squat is similar.

    The transmission of force from a flexed position to full extension in the squat is similar to the explosive action a footballer will need to perform when starting to sprint.

    Rate and time of peak force production

    The peak rate of force production of a footballer sprinting is within 100 – 200 ms4 and for a squat is 300ms5 therefore it may not be as fast as it needs to be, however you may choose to use a lighter load at performed at maximum speed to improve this. It has been seen that 40-50% of 1RM achieves peak velocity and power in a squat.

    Dynamics of effort (whether a concentric max effort or eccentric slow effort is desired for each lift)

    The training stimulus and effort needs to be greater than the sporting skill or activity we are training for, which in a heavy weighted squat certainly would be for sprinting over 30m. Peak power for the concentric phase of a squat is 4000W5 and for sprinting it’s 1200W4 in the propulsion phase.

    Accentuated region of force development (Joint angle specificity)

    The squat will yield a greater range of movement than the sprinting motion. This means that you are overloading the skill by creating greater strength in a larger range of movement. Based on research football players accelerating the knee angle averages at 89 degrees6, correlates well with a parallel squat (90 degrees).

    Regime of muscular work (Type of muscle action)

    For a squat the initial phase is eccentric action of the quadriceps and glutes then concentric extension on the ascent of the glutes, quadriceps and hamstrings. In a sprint the initial movement to overcome inertia is concentric which corresponds with the ascent phase of the squat. The top speed running of a footballer will involve the glutes, hamstrings and quadriceps moving from concentric to eccentric muscle action, as does the squat7.

    The greater power needed through the triple extension phase of the squat achieves greater motor recruitment which is thought to be one of the reasons a squat correlates so well with sprint speed in soccer players as the athlete is able to use more of the motor units to generate max speed8.

    This was a brief illustration of how strength and conditioning principles can be used to look deeper into the activity or sport you are looking to achieve with a patient. It has certainly highlighted to me over my degree so far that there is a lot more to train than what a movement looks like which can help you prepare your patient or athlete in a more well rounded way for their sport.

    References

    1. https://www.nice.org.uk/guidance/NG59
    1. Bradley, Sheldon, Wooster, Olsen, Boanas & Krustrup (2009) High-intensity running in English FA Premier League soccer matches, Journal of Sports Sciences, 27:2, 159-168
    2. Siff,MC. (2003) Supertraining(6thEd).Denver,CO:Supertraining Institute
    3. Plisk,SS.Speed,agility,andspeed-endurancedevelopment. In: Baechle, TR, and Earle, RW (Eds.), Essentials of Strength Training and Conditioning (3rd Edition). Champaign IL: Human Kinetics; 457-485, 2008.
    4. Nummela, Rusko and Mero (1994). EMG activities and ground reaction forces during fatigued and non fatigued sprinting. Medicine and science in sports and exercise 22(2) 605-609
    5. Zink, Perry, Robertson, Roach and Signorile (2006). Peak power, Ground Reaction Forces and Velocity During the Squat Exercise Performed at Different Loads. Journal of Strength and Conditioning Research, 20(3), 658–664
    6. Spinks, Murphy, Spinks and Lockie (2007) The Effects of Resisted Sprint Training and Acceleration Performance and Kinematics in Soccer, Rugby Union and Australian Football Players Journal of Strength and Conditioning Research 21(1), 77-85
    7. Wisloff,U,Castagna,C,Helgerud,J,Jones,R,andHoff, J. Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players. British Journal of Sports Medicine 38(3): 285-288, 2004.
    8. Markovic, Jukic, Milanovic and Metikos (2007) Effects of Sprint and Plyometric Trianing on Muscle Function and Athletic Performance Journal of Strength and Conditioning Research 21(2), 543-549.

    **************

    Emily Drakes, ACPSEM Physio

  • Blog - Using Strength and Conditioning in Physiotherapy by Emily Drakes

    Using strength and conditioning in Physiotherapy

    My interest in strength and conditioning started after watching an evening lecture from Raphael Brandon. I was intrigued by the theory behind exercise prescription and as physiotherapy seemed to be moving more and more towards exercise as the mainstay of treatment, as seen in the recent NICE guidelines for low back pain1, this seemed like the right path to follow.

    For those of you lucky enough to work with S&C coaches you will have them on hand to guide exercise prescription. However for most of us working in physiotherapy teams, having more of an S&C background can offer valuable insight into the best way to strengthen and prepare a patient for their activities whether that is a seasoned marathon runner or a stay at home parent with children to carry.

    It has been refreshing in learning about S&C to put injuries to one side and focus on the most effective way to plan an exercise programme. Many physiotherapist’s are preoccupied with making an exercise look like the movement or sport they are trying to rehabilitate their patient to i.e. giving a patient who plays football a ball to use in an exercise. However when if you break down the amount of time a footballer spends with a ball over 90mins it amounts to 90s2! The rest of the time is spent running, changing direction and jostling for the ball. Obviously a lot of the time a footballer is training involves a ball but unless you break it down in to the components of a skill you have no overload. This is what S&C essentially comes down to, ensuring specific adaptations to imposed demands. We need to understand the way a force is developed in the sport/activity we are interested in and in the exercise we are choosing to prescribe to get the desired outcome.

    There are some general principles that I now use daily that are key to exercise prescription. Firstly a needs analysis, which is something we all do to some extent but it formalises the process of deciding where a person is dysfunctional for the activity they are struggling with. This is outlined in the diagram below:

    Once you’ve specified the activity and what one would need to perform that successfully/pain free then you would look at the gap between the person in front of you vs. the ideal attributes they need. Once you know this targeting their exercise should be much easier.

    The needs analysis and the selection of exercises both incorporate the principle of dynamic correspondence described by Siff and Verkoshansky3. This is a guide on the different aspects of the activity to consider and how the exercise you are choosing will correlate to it.

    Unless you are doing the exercise itself i.e. kicking a ball you are not going to be 100% specific, however as discussed above in order to overload the components you need to break it down into parts. We will use the example of squatting and sprint ability in football:

    There are 5 key aspects to consider:

    Amplitude and direction of movement

    This is the most familiar principle in that we are looking at the direction of force relative to the performed movement.

    The squat does not look like a sprint however the lower limb movement of the hip, knee and ankle triple extension on the ascent on the squat is similar.

    The transmission of force from a flexed position to full extension in the squat is similar to the explosive action a footballer will need to perform when starting to sprint.

    Rate and time of peak force production

    The peak rate of force production of a footballer sprinting is within 100 – 200 ms4 and for a squat is 300ms5 therefore it may not be as fast as it needs to be, however you may choose to use a lighter load at performed at maximum speed to improve this. It has been seen that 40-50% of 1RM achieves peak velocity and power in a squat.

    Dynamics of effort (whether a concentric max effort or eccentric slow effort is desired for each lift)

    The training stimulus and effort needs to be greater than the sporting skill or activity we are training for, which in a heavy weighted squat certainly would be for sprinting over 30m. Peak power for the concentric phase of a squat is 4000W5 and for sprinting it’s 1200W4 in the propulsion phase.

    Accentuated region of force development (Joint angle specificity)

    The squat will yield a greater range of movement than the sprinting motion meaning that you are overloading the skill by creating greater strength in a larger range of movement. It has been seen that in football players accelerating the knee angle averages at 89 degrees6, which correlates well with a parallel squat (90 degrees).

    Regime of muscular work (Type of muscle action)

    For a squat the initial phase is eccentric action of the quadriceps and glutes then concentric extension on the ascent of the glutes, quadriceps and hamstrings. In a sprint the initial movement to overcome inertia is concentric which corresponds with the ascent phase of the squat. The top speed running of a footballer will involve the glutes, hamstrings and quadriceps moving from concentric to eccentric muscle action, as does the squat7.

    The greater power needed through the triple extension phase of the squat achieves greater motor recruitment which is thought to be one of the reasons a squat correlates so well with sprint speed in soccer players as the athlete is able to use more of the motor units to generate max speed8.

    This was a brief illustration of how strength and conditioning principles can be used to look deeper into the activity or sport you are looking to achieve with a patient. It has certainly highlighted to me over my degree so far that there is a lot more to train than what a movement looks like which can help you prepare your patient or athlete in a more well rounded way for their sport.

    References

    1. https://www.nice.org.uk/guidance/NG59
    1. Bradley, Sheldon, Wooster, Olsen, Boanas & Krustrup (2009) High-intensity running in English FA Premier League soccer matches, Journal of Sports Sciences, 27:2, 159-168
    2. Siff,MC. (2003) Supertraining(6thEd).Denver,CO:Supertraining Institute
    3. Plisk,SS.Speed,agility,andspeed-endurancedevelopment. In: Baechle, TR, and Earle, RW (Eds.), Essentials of Strength Training and Conditioning (3rd Edition). Champaign IL: Human Kinetics; 457-485, 2008.
    4. Nummela, Rusko and Mero (1994). EMG activities and ground reaction forces during fatigued and non fatigued sprinting. Medicine and science in sports and exercise 22(2) 605-609
    5. Zink, Perry, Robertson, Roach and Signorile (2006). Peak power, Ground Reaction Forces and Velocity During the Squat Exercise Performed at Different Loads. Journal of Strength and Conditioning Research, 20(3), 658–664
    6. Spinks, Murphy, Spinks and Lockie (2007) The Effects of Resisted Sprint Training and Acceleration Performance and Kinematics in Soccer, Rugby Union and Australian Football Players Journal of Strength and Conditioning Research 21(1), 77-85
    7. Wisloff,U,Castagna,C,Helgerud,J,Jones,R,andHoff, J. Strong correlation of maximal squat strength with sprint performance and vertical jump height in elite soccer players. British Journal of Sports Medicine 38(3): 285-288, 2004.
    8. Markovic, Jukic, Milanovic and Metikos (2007) Effects of Sprint and Plyometric Trianing on Muscle Function and Athletic Performance Journal of Strength and Conditioning Research 21(2), 543-549.
  • Alliance Medical Confirmed as Gold Exhibitor for The 2nd World Conference on Sports Physical Therapy - Optimal Loading in Sport.

    "Alliance Medical Diagnostic Imaging are delighted to be a gold exhibitor for The 2nd World Conference on Sports Physical Therapy- Optimal Loading in Sport, taking place at the iconic Titanic venue in Belfast 6th – 7th October 2017. We specialize in MRI, CT, PET CT, DXA, X-ray & Ultrasound scans. At Alliance Medical we are committed to delivering fast access to medical scans with high quality diagnostic care at affordable prices."

    Alliance Medical is Europe’s leading provider of outsourced Diagnostic Imaging across Europe. In Ireland, we are headquartered in Limerick and have 20 clinical locations throughout the country, including Dublin, Cork, Galway and Belfast.

    We invest heavily in our technology and our people to ensure we recruit, train and retain a highly qualified and competent team. Our radiographers are among the best specialists in Europe. Our radiologists are accredited by the Royal College of Surgeons in Ireland.

    Alliance Medical is committed to providing patients with high quality, efficient, affordable diagnostic imaging which is reported by local Consultant Radiologists. We partner with all of the leading Private Health insurance companies to deliver our services to your patients seamlessly.

    For more information on Alliance Medical visit http://www.alliancemedical.ie/

    For further information on ‘The 2nd World Conference on Sports Physical Therapy’ please click here

  • CSP Membership Review. URGENT Response needed

    Dear Members

    Please read the following documents Membership Review QA for Council FINAL - March 17,  MAR17 Paper 03 Membership Review with the highest priority and we strongly recommend you reply to Phil Hulse  hulsep@csp.org.uk  and Rob Yeldham via the CSP enquiries team with your comments regarding the proposed changes to CSP membership.

    In particular please note page 17 (Affliliated member regulations – 1.2 c ) and  Section 8.4 Affliiates and appendix E

    A few points to note:

    Confusion for the public e.g. Sports therapists documenting they are a member of the CSP

    Why only name massage therapists and sports therapist and not any other healthcare professional?

    Physiotherapy managers who are not physios being able to join

    Page 7 diluting of profession, confusing the public, allowing an affiliate category

    Confusion within the members for voting rights

    Cost implication and money generation

    Thank you

    ACPSEM Committee

  • ACPSEM Victims of Fraud

    Dear Colleagues,

    We are writing to you to bring your attention to fraudulent activity with regard to the Association of Chartered Physiotherapist in Sport and Exercise Medicine (ACPSEM) / Physios in Sport association. It has been brought to our attention that someone calling himself Michael Darlington has been contacting sports persons and football club through social media in order to conduct research. The request is to provide pictures of the athlete’s legs and feet and completing a short online survey. A letter endorsed by the Physios in sport or ACPSEM and allegedly sent from our Events and Partnerships Officer Liz Olsen accompanies the request. There are also promises financial remuneration if the survey is completed.
    This individual is not in any way associated and their activity is in no way endorsed or supported by the ACPSEM. In addition, this action goes against the morals and ethics that the research community uphold potentially damaging the relationship between Sport persons and Researchers.

    We are unsure of the motives behind this activity but request that you report any contact from this individual or similar request for research information to ourselves by emailing Liz Olsen at info@physiosinsport.org This fraudulent activity has also been reported to the National Fraud Intelligence Bureau via Action Fraud.

    We would be very grateful if you could circulate this information to any contacts you have with any sports teams or athletes that may be contacted so that we limit this activity.

    Thank for your co-operation
    Tim Sharp
    Education and Research Chair for ACPSEM

  • ACPSEM Research Grants

    The ACPSEM will shortly be releasing funds for small research grants to support research in the area of Sport and Rehabilitation.

    Main aim of the grant

    The main purpose of the grant is to provide specific CPD opportunities, such as post-graduation courses or to contribute to an MSc or to provide support for specific activities such as providing conference and travel expenses to present research. The grant is to support the CPD development plan of the individual. The grant is not to provide any form of required training such as First Aid / Sports Trauma courses.

    Who is the grant aimed at?

    Applications are open to qualified Chartered Physiotherapist and a member of the ACPSEM. It is not necessary that the individual works in sport however the grant application should demonstrate how this would develop their career in sport.

    Level of funding.

    The level of funding is up to a maximum of £1000. Applications are required to justify the level of funding by detailing the expected expenditure.

    Expectations of the ACPSEM.

    The ACPSEM would request acknowledgement of support for any research undertaken or presented that comes as a result of this grant. Individuals may also be asked to provide feedback to Committee in order to either promote the ACPSEM activity or to advertise further grants.

    More details for this grant will be made through the website shortly

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