JOURNAL WATCH

POSTGRADUATE SPECIALISATION IN SPORTS PHYSIOTHERAPY – ACADEMIC OR CLINICAL EXPERTISE? Phillips N. Editorial. Physical Therapy in Sport 2009;10:83.

In the editorial for this edition of Physical Therapy in Sport, physiotherapist Nicki Phillips looks at the increasing postgraduate specialisation of sports physiotherapy. She notes that The International Federation of Sports Physiotherapy (IFSP), as a sub-group of the World Congress of Physical Therapy (WCPT), has been at the forefront of promoting recognition of expertise in sport and exercise physiotherapy. Postgraduate education at M level has become an expected part of the move towards specialisation, and as a consequence, more and more M-level programmes are becoming available globally. However, the downside to this evolution is that the drive to complete M-level education sometimes supersedes the important role of experiential learning and the value of reflection in expert practice. A further problem is that different countries use varying means of demonstrating specialist practice; they either do it through formal examination or through presentation of an appropriate professional portfolio. Some use a combination of both which is a particular challenge.

sportEX comment

This article uses the upcoming 2012 Olympics as a catalyst for developing an international standard of recognition for specialist sports physiotherapy – one that balances “academic knowledge and clinical experience to support clinical reasoning in an evidence- based profession”. This is a worthy aim that will benefit the services available to athletes at the games and it will also be a legacy after the Games.

HYPERMOBILITY, INJURY RATE AND REHABILITATION IN A PROFESSIONAL FOOTBALL SQUAD – A PRELIMINARY STUDY. Collinge R, Simmonds R. Physical Therapy in Sport 2009;10:91–96.

The starting point of this article was the

hypothesis that increasing levels of joint hypermobility result in an increased risk of injury in contact sports such as professional football. It looked at the prevalence of hypermobility among a group of professional players and an audit of injuries sustained over a season. Thirty-three male football players aged 18–35 years in a second- tier English professional football club were examined during the 2007/08 season using the Beighton joint hypermobility screen. The prevalence of joint hypermobility was found to be between 21 and 42% depending on the cut-off score used for the Beighton scale. Similar injury rates were found in both the hypermobile and non-hypermobile participants (6.2 as compared to 6.3 injuries per 1000 hours exposure respectively). Once injured, the hypermobile group

sportEX comment The results here are similar to those in previous athletic populations and they depend

on which Beighton cut-off score is selected. It may be inferred from this preliminary study that the return-to-play timescales in hypermobile individuals may be extended so as to minimise the potential risk of re-injury and limit their time out of competition. But the results depend on the guidelines used to determine the score at which the joints are said to be hypermobile. This study used the cut-off scores utilised by Stewart and Burden (2004) in their study of rugby players, where a score of 4 or greater represents hypermobility and 7 or greater represents excessive hypermobility.

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showed a tendency towards missing more competitive first team games (12 missed games as compared to 5 per season in non-hypermobile players) and training days (71 days as compared to 31 per season in non-hypermobile players). Note that these findings were not statistically significant. The test used was a 9-point Beighton hypermobility scale. One point is scored for each of the following that the subject is a able to achieve. n Bend and place the hands flat on the floor without bending the knees n Can the knee hyperextend (one point for each knee) n As above for the elbow n Score one point for each thumb that will bend backwards to touch the forearm n Score one point for each hand when you can bend the little finger back beyond 90°.

DETECTING OVER-AGE PLAYERS USING WRIST MRI: SCIENCE PARTNERING WITH SPORT TO ENSURE FAIR PLAY. Dvorak J. British Journal of Sports Medicine 2009;43;884–885.

Detecting the presence of over-age players in age-related tournaments has been a difficult challenge for many sports organisations. “Age-doping” is a form of cheating in which information about the age of a player is falsified to gain advantage in the sport. The paper gives examples of such abuses of the system, such as the sports team in which all the members had birthdays in the same month of the year; and the team had consecutive serial numbers on their birth certificates, where some players were reported to have two sets of travel documents. In perhaps the most amusing example, officials were bemused when players in an “under 16s” tournament were shopping for teddy- bears for their children. As a result of such cheating, FIFA commissioned a study to investigate the use of MRI scans to determine age. A 6-point grading system for the fusion of the growth plate was developed. Based on the normal population, complete fusion was very unlikely to occur before age 17; the probability of fusion under the age of 17 was below 1%. In other words, if an MRI shows complete fusion of a player’s wrist, the player is 99% certain to be older than 17 years. Scans of the wrist were performed in more than 500 football players who had confirmed birth certificates. They were selected randomly at the FIFA U-17 World Cups 2003, 2005 and 2007 and were of different ethnic origins (from Switzerland, Malaysia, Algeria, Argentina, Senegal) and aged between 14 and 19. The MRI scans showed far higher rates of fusion (up to 35%) among these players than among the reference populations, suggesting that some players were older than stated.

sportEX comment Age-grouping techniques are not

perfect at matching physical attributes but they do help to level the playing field. When FIFA announced that they would do MRI testing again at the U-17 World Cup some teams who had qualified for the competition decided to replace up to 15 (presumably over-aged) players from their squads!

sportEX medicine 2010;43(Jan):4-6