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CONTENTS JANUARY 2015 ISSUE 63


Publisher/editor TOR DAVIES tor@sportex.net Art editor DEBBIE ASHER debbie@sportex.net Sub-editor ALISON SLEIGH


Journal watch BOB BRAMAH


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COMMISSIONING EDITORS Brad Hiskins - Australia & NZ Whitney Lowe - USA & Canada Humphrey Bacchus - UK & Europe Glenn Withers - Worldwide Dr Marco Cardinale - Worldwide Dr Thien Dang Tan - USA & Canada Dr Joseph Brence, DPT, COMT, FAAOMPT, DAC


TECHNICAL ADVISORS Steve Aspinall Bob Bramah Paula Clayton Stuart Hinds Rob Granter Michael Nichol Joan Watt


BSc (BASRaT), MSc MCSP, MSMA


MSc, FA Dip, Mast STT Dip SST Dip SST


BSc (BASRaT) MCSP, MSMA


Prof Greg Whyte PhD, MSc, BSc


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8 Vitamin D in sport and4 Journal Watch 12 The challenges of youth 18 Tennis elbow


The latest key research from this quarter


exercise medicine Are low levels affecting performance?


Psychosocial response to injury and rehabilitation in youth athletes


Rehab guide for this difficult condition


CONTENTS 22 Patellofemoral pain


Proximal intervention for PFP management


27 Concussion neuroimaging 32 Research reviews 34 Social Watch


Are we protecting our athletes? Rotator cuff pathology Some of this quarter’s best resources TO FIND OUT MORE ABOUT SPORTEX VISIT DISCLAIMER


While every effort has been made to ensure that all information and data in this magazine is correct and compatible with national standards generally accepted at the time of publication, this magazine and any articles published in it are intended as general guidance and information for use by healthcare professionals only, and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case. To the extent permissible by law, the publisher, editors and contributors to this magazine accept no liability to any person for any loss, injury or damage howsoever incurred (including by negligence) as a consequence, whether directly or indirectly, of the use by any person of any of the contents of the magazine.


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The publishers give no endorsement for and accept no liability (howsoever arising) in connection with the supply or use of any goods or services purchased as a result of any advertisement appearing in this magazine. www.sportEX.net


3 Welcome


JAN 2015


2014 has been the year in which the fuse was lit on the time bomb that is concussion management in sport. Most sports medicine practitioners believe we ‘ain’t seen nothing yet’ and that things are going to get worse...much worse. In July this year a federal judge in the US removed a cap on damages paid out to thousands of NFL players experiencing neurological problems related to concussions suffered during their professional playing careers. However it might be worth mentioning here that the NFL has an annual revenue of $10 billion. Also this year the National Collegiate Athletic Association (NCAA), which according to Wikipedia is a non-profit association which regulates athletes of 1,281 institutions, conferences, organizations, and individuals, had a suit filed against them asserting that the organisation was negligent by failing to adopt any formal concussion policy until 2010 – and failing to establish any minimum standards when it finally did. This is serious stuff! American sport is infinitely better funded than most, if not all, of our sports in the UK. National governing bodies of impact sports where concussion is a signficant risk to their athletes, could be crippled by law suits along the lines of those that the NFL and NCAA have had to deal with. There is no doubt that this is one of the biggest sports medicine issues that NGBs are going to have to face, and it could well drag on for some time to come.


Tor Davies, physio-turned publisher and sportEX founder tor@sportex.net


best practice manual


promoting in


HIGHLIGHTS therapy


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