Professor Benita Olivier

Objective: 

This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports.

Introduction: 

Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This is the first review to include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population.

Inclusion criteria: 

Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies reporting on participants with growth abnormalities will be excluded.

Methods: 

Databases searched will include MEDLINE (Pubmed), CINAHL Complete (EBSCO), CLinicalKey, SPORTDiscus (EBSCO), Physiotherapy Evidence Database (PEDro), Scopus (Elsevier), ScienceDirect (Elsevier) MasterFILE Premier (EBSCO), Academic Search Complete (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL) and ClincalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer.

Background: The Functional Movement Screen (FMS) assesses the quality of movements, including the deep squat (DS), which is used in sports settings. The validity of the individual item scores has yet to be established.

Objectives: To investigate the validity of the FMS DS by comparing the sagittal plane kinematics of participants who achieve different observer scores.

Method: Seventeen injury-free, adolescent male cricket bowlers were assessed. The movement was captured using the Optitrack® motion capture system. Simultaneously, observers scored participants’ execution of the DS according to the standard FMS scoring criteria. Participants were grouped into Group 1 (lowest score), Group 2 (altered movement mechanics) or Group 3 (perfect score) according to observer scores. Specific joint angles of each group were compared using the Kruskal–Wallis and Mann–Whitney U tests.

Results: There were significant differences in the degree to which the femur passed the horizontal between Group 3 and Group 1 (p = 0.04, r = 0.61) and Group 2 and Group 1 (p = 0.03, r = 0.66) and the difference in the degree to which the torso was kept vertical between Group 3 and Group 1 (p = 0.02, r = 0.66) and Group 2 and Group 1 (p = 0.02; r = 0.72).

Conclusion: Kinematic differences exist between participants who achieve different observer scores for the FMS DS.

Clinical implications: While differences in sagittal plane kinematics have been observed in participants scoring high on the FMS DS and participants scoring low, further investigation into the validity of the frontal plane kinematics is warranted, as well as the concurrent validity of the individual scoring criteria.

Introduction.
Injury surveillance is an important part of injury risk reduction in the sporting population. This study describes the type, side (dominant or non-dominant), occurrence, impact, activity of onset, and severity of foot and ankle injuries in elite South African male and female cricketers.

Methods.
Foot and ankle injuries sustained by elite cricket players between 2018 and 2021, obtained from the records of Cricket South Africa, were descriptively analysed.

Results.
A total of 104 foot and ankle injuries in 82 players were recorded. The majority (n = 100; 96%) of injuries were on the non-dominant side. Bowling (n = 31; 30%) and fielding (n = 20; 19%) contributed to most injuries. The majority were first-time (n = 83; 80%) and non-impact injuries (n = 62; 60%). Fifty percent (n = 52) of injuries rendered players unable to participate in at least one match or practice session. Lateral ankle ligament injury was the most common injury sustained (n = 36; 35%).

Conclusion.
The findings from this study can inform future researchers and assist healthcare service needs relating to injury risk reduction and management programmes. Effective rehabilitation programmes may reduce the risk of reinjury. Ideally, these programmes need to be role specific.

Background: Despite differences between left- and right-handed athletes in other sports, minimal evidence exists regarding biomechanical similarities and differences between left- and right-handed cricket fast bowlers performing an equivalent task.

Objectives: This study aimed to compare the kinematics between left and right-handed fast bowlers performing an equivalent task (i.e. bowling ‘over the wicket’ to a batter of the same handedness as the bowler).

Methods: Full body, three-dimensional kinematic data for six left-handed and 20 right-handed adolescent, male, fast bowlers were collected using the Xsens inertial measurement system. Time-normalised joint and segment angle time histories from back foot contact to follow-through ground contacts were compared between groups via statistical parametric mapping. Whole movement and subphase durations were also compared.

Results: Left-handed players displayed significantly more trunk flexion from 49%-56% of the total movement (ball release occurred at 54%; p = 0.037) and had shorter back foot contact durations on average (0.153 vs 0.177 s; p = 0.036) compared to right-handed players.

Conclusion: Left- and right-handed bowlers displayed similar sagittal plane kinematics but appeared to use non-sagittal plane movements differently around the time of ball release. The kinematic differences identified in this study can inform future research investigating the effect of hand dominance on bowling performance and injury risk.

Background.
Although many cricket-playing nations have conducted research on bowling volume (BV) and injury risk, this relationship amongst international South African pace bowlers is yet to be investigated. Environmental, socio-economic and training strategy differences warrant similar research in a South African context. The purpose of this preliminary study was to establish whether South African pace bowlers have similar BV and injury associates compared to other elite fast bowlers.

Methods.
This study was a prospective, observational, cohort study that monitored match and training BV and injuries amongst pace bowlers playing for the South African national team between April 2017 and April 2019. A sample of convenience that included 14 bowlers was selected. Bowling volume was quantified as the number of deliveries bowled during training and competition. Acute-, chronic- and acute:chronic BV ratios were independently modelled as association variables.

Results. 
There were 39 injuries with the most being to the lumbar spine (25.64%). Moderate-to-low and a moderate-to-high acute:chronic bowling load ratios were associated with a lower risk of injury. Chronic bowling load was associated with injury (z = 2.82, p = 0.01). A low acute workload, low chronic workload, moderate-high chronic workload and moderate-low acute:chronic ratio were also associated with an increased risk of injury.

Conclusion. 
These findings confirm that there appears to be a dose–response effect between training BV and the likelihood of an injury occurring with a moderate-to-low and a moderate-to-high BV ratio being optimal. Considering the small sample size, the findings should be interpreted with caution.

Background: Injury prevention is a growing focus for golfers in general and for elite golfers in particular. Movement screening has been proposed as a possible cost-effective means of identifying underlying risk factors and is widely utilised by therapists, trainers and coaches.

Objectives: Our study aimed to establish whether results from movement screening were associated with subsequent lower back injury in elite golfers.

Methods: Our prospective longitudinal cohort study with one baseline time point included 41 injury-free young elite male golfers who underwent movement screening. After this, the golfers were monitored for 6 months for lower back pain.

Results: Seventeen golfers developed lower back pain (41%). Screening tests that were able to differentiate golfers who developed and those who did not develop lower back pain, included: rotational stability test on the non-dominant side (p = 0.01, effect size = 0.27), rotational stability test on the dominant side (p = 0.03; effect size = 0.29) and plank score (p = 0.03; effect size = 0.24). There were no differences observed in any other screening tests.

Conclusion: Out of 30 screening tests, only three tests were able to identify golfers not at risk of developing lower back pain. All three of these tests had weak effect sizes.

Clinical implications: Movement screening was not effective in identifying elite golfers at risk of lower back pain in our study.

Context: Elite golfers have a high incidence of low back pain. Recent reviews have emphasized the need for investigation into how to prevent low back pain in golfers, prompting the current study. Design: Prospective longitudinal cohort study. Methods: Forty-one injury-free golfers were included in this study. At baseline, lower quadrant joint angles and club and ball performance were measured while each golfer performed 10 drives. The golfers were then monitored for 6 months and were allocated into 2 groups depending on whether or not they developed low back pain. The initial, baseline kinematic variables of the low back pain group and the uninjured group were then compared. Results: Over the 6-month monitoring period, 17 (41%) of the golfers developed low back pain. At baseline assessment, the low back pain group had 4° less lead ankle dorsiflexion at setup (P = .01; effect size = 0.82), 6° less lead knee flexion at the top of the backswing (P = .05; effect size = 0.64), 6° less lead ankle dorsiflexion at the top of the backswing (P = .01; effect size = 0.82), 6° more trail hip adduction at the top of the backswing (P = .02; effect size = 0.79), 9° more trail knee flexion at impact (P = .05; effect size = −0.64), and 6° more trail hip adduction at the end of follow through (P

Objective: The aim of this study was to determine the level of disability and risk of chronification among patients presenting with neck pain at tertiary hospital in Kenya.
Design: A cross-sectional descriptive study.
Setting: Physiotherapy and general outpatient clinics at Nakuru Level V Hospital in Nakuru, Kenya.
Subjects: 45 patients who presented with neck pain
Main outcome measures: Neck Disability Index (NDI) and Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) to screen for disability and pain chronicity respectively.
Method: Data was collected using Neck Disability Index (NDI) and Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). It was then analyzed using the statistical package for the social sciences (SPSS) version 25.0 for descriptive and inferential statistics.
Results- Out of the 45 participants, majority were female 73.3% (n=33), 82.2 % (n=37) were aged 36 years and above, 68.9% (n=31) were married, 42% (n=19) were office workers and 60% (n=27) were employed. Most of the participants (55.5%) were at low risk of chronification and 56% had a moderate disability. The mean NDI score was highest among the patients who scored high on the (OMPSQ) (45.5). There were significant mean differences between the domains of pain chronification with Orebro score.
Conclusion: Persistence and high pain duration in neck pain patients seems to be associated with high levels of disability. The study emphasizes on the importance of educating and increasing awareness of neck pain to prevent chronicity and reduce its economic burden.

Background: Rugby union is a physically demanding collision sport that requires optimal neuromuscular function
for maximal power output, with mechanical power an integral component of performance. Peak power (Pp) and
relative Pp are parameters of neuromuscular function commonly assessed through the countermovement jump
(CMJ) as a measure of fatigue. The Wattbike cycle ergometer test (CET) is a non-load bearing method of evaluating lower limb power. The cost-effective CET could therefore offer a viable alternative to the CMJ.

Objectives: This study aimed to determine the concurrent validity of the CMJ and CET.

Methods: Thirty-eight professional rugby union players performed twelve CMJs on a force platform with four loads
(bodyweight: BW-CMJ; 20kg: 20-CMJ; 40kg: 40-CMJ and 60kg: 60-CMJ) and a six second peak power (6PPO) CET assessment on a Wattbike ergometer.

Results: CMJ power outputs were [BW-CMJ: Pp - 3101±648 W; 20-CMJ: Pp - 2724±513 W; 40-CMJ: Pp - 2490±496 W; 60-CMJ: Pp - 2238±366 W] and CET [Pp – 1310±161 W]. None of the CMJ-Pp values showed relationships with any CET power variables. Large (r = 0.51-0.63; p = 0.000 – 0.001) relationships
were found to be between relative CMJ and relative CET power outputs. Bland-Altman plots, which were used to
determine the level of agreement between the two assessments, showed the agreement between the tests was
poor. 

Conclusion: Though positive relationships existed between relative CMJ and relative CET power variables, analyses of the level of agreement in the Bland-Altman plots suggest that the two power assessment methods are not interchangeable measures of power.

Background: The trunk connects the upper and lower limbs and transfers energy during movement. Exploring the role of the trunk muscles in bowling performance affords us the opportunity to uncover potential mechanisms to improve bowling performance.

Objectives: To investigate the association between bowling performance and trunk muscle stability, strength-endurance and thickness in adolescent pace bowlers.

Methods: Adolescent pace bowlers participated in this crosssectional study. Trunk muscle stability was measured using Sahrmann’s Stability Scale, strength-endurance using the Bourbon Trunk Muscle Strength Test and thickness of the abdominal wall and lumbar multifidus muscles using ultrasound imaging.

Results: Forty-six pace bowlers with a mean age of 15.9 ±1.2 years participated. The average ball release speed was 109.2±11.8 km.h-1 . This measurement was higher in level four of stability than in level two (mean difference 22.2 ± SD 6.8 km.h-1; p= .018). No link between ball release speed and strength-endurance could be found. Multiple correlations of moderate strength (r > 0.4) exist between ball release speed and absolute trunk muscle thickness with height and weight as confounding factors. The relationship between accuracy and the trunk muscle variables investigated in this study is weak.

Conclusion: Bowlers with better trunk muscle stability bowled faster than those with a lower level of trunk stability, irrespective of their age, height and weight. Trunk muscle thickness correlated with ball release speed; however, confounding factors such as height and weight play a role and therefore, findings need to be interpreted with caution.

Purpose

Previous studies found that trunk muscle asymmetry may play a role in preventing injury in cricket fast bowlers, while the association with bowling performance has not been investigated. This study aims to describe the side-to-side differences in trunk muscle thickness and determine the association between bowling performance and these side-to-side differences in trunk muscle thickness in adolescent fast bowlers.

Methods

In this observational cross-sectional study, bowling performance, namely ball release speed and bowling accuracy, was recorded in adolescent fast bowlers. Ultrasound imaging measured external oblique, internal oblique, transversus abdominis and lumbar multifidus muscle thickness.

Results

Fast bowlers (n = 46) with a mean age of 15.9 (±1.2) years participated. On the non-dominant side, the external oblique and internal oblique at rest were thicker than on the dominant side (external oblique: p = 0.011, effect size = 0.27; internal oblique: p 

Conclusions

No relationship between bowling performance and side-to-side differences in internal oblique muscle thickness could be established, while more symmetrical external oblique muscles may be linked to faster ball release speeds.

Purpose: People with neck pain are likely to have negative respiratory findings. The purpose of this study was to investigate the relationship between neck  pain and dysfunctional breathing and to examine their relationship to stress. Method: This cross-sectional study included 49 participants with neck pain and 49 age- and sex-matched controls. We measured neck pain using the numeric rating scale (NRS); neck disability using the Neck Disability Index (NDI); dysfunctional breathing using the Nijmegen Questionnaire (NQ), Self-Evaluation of Breathing Questionnaire (SEBQ), breath hold time, and respiratory rate (RR); and stress using the Perceived Stress Scale (PSS). Results: Participants with neck pain scored higher on the NQ (p 0.50; 95% CI: 0.25, 0.68 and 0.33, 0.73, respectively) and PSS scores (r > 0.50; 95% CI: 0.29, 0.78 and 0.31, 0.73, respectively). SEBQ scores showed a fair correlation with NRS scores and RR a fair correlation with NDI scores. Conclusions: Participants with neck pain had more dysfunctional breathing symptoms than participants without neck pain, and dysfunctional breathing was correlated with increased neck disability and increased stress. The NQ and SEBQ can be useful in assessing dysfunctional breathing in patients with neck pain. =

Objectif : les personnes qui éprouvent des douleurs cervicales sont susceptibles d’avoir des problèmes respiratoires. La présente étude visait à examiner le lien entre les douleurs cervicales et une respiration dysfonctionnelle, de même que leur lien avec le stress. Méthodologie : la présente étude transversale incluait 49 participants ayant des douleurs cervicales et 49 sujets témoins appariés. Les chercheurs ont mesuré la douleur cervicale au moyen de l’échelle d’évaluation numérique (ÉÉN); les incapacités cervicales au moyen de l’indice d’incapacité cervicale (IIC); la respiration dysfonctionnelle au moyen du questionnaire de Nijmegen (QN), du questionnaire d’autoévaluation de la respiration (QAÉR), de la durée de retenue de la respiration et de la fréquence respiratoire (FR); et le stress au moyen de l’échelle de perception du stress (ÉPS). Résultats : les participants qui éprouvaient des douleurs cervicales obtenaient des résultats plus élevés que les sujets témoins au QN (p 0,50; IC à 95 %, 0,25, 0,68 et 0,33, 0,73, respectivement) et les scores de l’ÉPS (r > 0,50; IC à 95 %, 0,29, 0,78 et 0,31, 0,73, respectivement). Les scores du QAÉR ont révélé une corrélation claire avec les scores de l’ÉÉN et la FR, ainsi qu’avec les scores de l’IIC. Conclusions : les participants qui éprouvaient des douleurs cervicales avaient plus de symptômes de respiration dysfonctionnelle que les participants sans douleur cervicale, et la respiration dysfonctionnelle était corrélée avec une incapacité cervicale et un stress accrus. Le QN et le QAÉR peuvent être utiles pour évaluer la respiration dysfonctionnelle chez les patients éprouvant des douleurs cervicales.

INTRODUCTION: The high prevalence of injury among rugby players emphasizes the need for research related to injury risk factors. Physical fitness-related risk factors are likely culprits contributing to both contact and non-contact injuries. Establishing associations between preseason measured physical fitness aspects and injury risk, not only provide players’ baseline fitness parameters but could also identify injury prone players, thereby contributing to injury prevention strategies. Therefore, the objective of this review was to assess and summarize scientific literature related to the association between preseason measured physical fitness tests and in-season injury among male rugby players.

EVIDENCE ACQUISITION: A systematic review was performed in compliance with the PRISMA 2020 Guidelines. This review considered observational, prospective cohort study designs. Studies that included male rugby (rugby union, rugby league, Australian football rules and rugby sevens) players aged 18 years or above from all levels of participation, evaluating the association between physical fitness test outcome and injury, were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies in any language. Searched databases included Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), the Cochrane Controlled Trials Register in the Cochrane Library, ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, SPORTDiscus with Full Text, SCOPUS and Science Direct. Key words used were “rugby,” “injury,” “physical fitness,” and “risk factors.” Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal tool for cohort studies from the Joanna Briggs Institute (JBI SUMARI).

EVIDENCE SYNTHESIS: A total of 16 studies were eligible for inclusion in this review. The mean critical appraisal score was 82.63% (SD=17.86). Forty-meter sprint speed was associated with injury in all three (100%) studies that included the test. Inconsistencies in the statistical analysis, however, make comparison difficult. None of the studies that investigated upper (N.=1) and/or lower body power (N.=3) identified power as a risk factor. Conflicting results were found for the association between strength, flexibility, cardiorespiratory fitness, and injury.

CONCLUSIONS: Identifying factors associated with injury risk is an important step in the injury prevention paradigm. Once identified, players can be screened for risk factors prior to participation in sport. Interventions, based on screening results, which not only improve performance but also decrease players’ risk of sustaining injuries (i.e., physical fitness related risk factors), provide additional incentive for compliance. Overall, this review highlights the inconsistency in testing methods used to gauge specific physical fitness constructs among rugby players, limiting the extent to which comparison of results and pooling of data is possible.

Achilles Tendinopathy (AT) can cause disability among athletes involved in running events and often leads to an early exit from a sporting career. AT has been associated with intense, prolonged, and repetitive functional demands exerted on the achilles tendon. It is thought to affect the athlete’s dynamic balance ability and performance. A cross-sectional study was conducted in high altitude training camps among long-distance Kenyan runners (N=410) to examine the prevalence of this musculoskeletal dysfunction and the runners’ dynamic balance ability as measured using the Star Excursion Balance Test (SEBT). The prevalence of AT among the long-distance runners was 13.9% (n=57), comprising 42 men (73.7%) and 15 women (26.3%), with a median age of 27 years. A total of 61.4% (n=35) of the runners covered on average 151- 200 km per week. The mean weekly training mileage was 170.0 km with an average pace of 3.3 minutes per kilometer. The mean composite SEBT scores for the dominant and non-dominant legs were 81.85 and 82.42%, respectively. The average normalised reach distances on SEBT were 72.9%, 84.3%, and 89.2% for anterior, posterolateral, and posteromedial directions, respectively. There were statistically significant mean differences in scores between male and female runners, with these being higher in males compared to females (p

CONTEXT AND OBJECTIVES: The Sport Science Lab(R) (SSL(R)) screening protocol includes novel methods of assessing flexibility, strength, plyometric ability and rugby specific fitness. The objective of this study was to investigate the association between these tests and injury among professional rugby players. DESIGN: Prospective cohort study. SETTING: Fitness facilities of participating teams. PARTICIPANTS: Thirty-nine injury-free, elite, adult (>18 years), male rugby players. MAIN OUTCOME MEASURES: The test battery consisted of eleven flexibility-, nine strength- and six plyometric tests and a rugby specific fitness test (RSFT). Injuries were recorded weekly during the 2019 rugby season. Associations between test results and injuries were analysed utilising suitable tests of association i.e., sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value and odds ratios (OR) (with confidence intervals (CI)). Bivariate correlations and logistic regression were performed to assess the relationship of the predictor variables to the outcome. RESULTS: Players who achieved the set standard for the RSFT (OR = 3.17; 95% CI = 0.79-12.75), triple horizontal broad jump (OR = 2.40; 95% CI = 0.86-19.61) and lateral depth jumps (OR = 2.40-3.44; 95% CI = 0.53-18.84) were two to three times less likely to sustain an injury during the season. CONCLUSION: Players with superior rugby specific fitness and cyclic linear- and lateral plyometric ability, may have a decreased risk of sustaining injuries.

Background: Injuries related to endurance running have attracted attention as the sport has become more competitive, and as athletes seek to improve their performance. Consequently, endurance runners are increasingly becoming more susceptible to lower extremity running injuries. Objectives: The aim of this study was to establish the prevalence of running-related injuries among professional endurance runners in the Rift Valley, Kenya.

Methods: We used a cross-sectional survey design targeting professional endurance runners who had participated in both local and international running competitions. The sample size consisted of 209 respondents selected through stratified and simple random sampling techniques, of which 167 participated in the study. A self-administered questionnaire was used to collect data on the prevalence of injuries among the endurance runners. The data were analysed using descriptive statistics.

Results: The prevalence of running injuries was 63% (n=106). The prevalence among males (n=64; 69%) was higher in comparison with that of females (n=42; 57%). The posterior thigh was the most common site for injuries among the athletes (n=87; 52%), followed by the lower back (n=78; 47%) and ankle (n=63; 38%).

Conclusion: The prevalence of running-related injuries was high among professional Kenyan endurance runners compared to other populations. These findings therefore form the basis of future research to explore the mechanisms behind the injuries and the feasibility of targeted injury prevention programmes.

Background: The Indian Ocean Island Games is a multi-sport event that occurs every four years and includes athletes from seven islands of the Indian Ocean.

Objective: This study aims to describe the injury and illness epidemiology of the athletes participating during the 2019 Indian Ocean Islands Games.

Material and Methods: This prospective cohort study recorded injury and illness cases from athletes who competed in these Games. All medical physicians received detailed instructions and training on data collection using an injury report form. All athletes (minor and adults) who provided consent, or consent given from the minors’ guardians, were included in this study. Athletes who did not provide consent for this study were excluded.

Results: 1 521 athletes (531 women and 990 men) reported 12 injuries per 100 athletes (n=160) and 6 illnesses per 100 athletes (n=85). The percentage of distribution of injuries were highest in football and basketball. Most injuries occurred during competition compared with training Joint sprains were the most common type of injury (28%), followed by muscle strains (19%). Men suffered the majority of injuries (79% vs. 21%). Similarly, men sustained more illness than women (57% vs. 43%). Most illnesses affected the respiratory system (67%), and infection was the most common cause of illness (84%) in participating athletes.

Discussion: These findings are similar to previous events in other parts of the world. However, unique ailments, not previously reported on, were discovered.

Conclusion: Epidemiological data from this study can be inferred to athletes who compete in similar multi-sport events and/or Olympic Games in the Indian Ocean region.

Background: Numerous factors account for injury prevention or lack thereof in any team setting. With the increasing burden of injuries in women’s football, and limited human resources accessible in sub-Saharan Africa, it is important to investigate the ways in which standardised injury prevention practices can be achieved.

Objectives: The study aimed to evaluate injury prevention knowledge, beliefs, and practices in women’s football teams in the University Sport South Africa (USSA) Football League in Gauteng Province, South Africa.

Methods: A cross-sectional self-administered survey was conducted among women’s football teams registered to participate in the USSA Football League in South Africa’s Gauteng Province.

Results: A total of 107 respondents participated in the study, which included both players (n=98; 92%) and their support staff (n=9; 9%). The median (interquartile range) age of the participants was 22 (20-25) years. In the population sampled, 36% of the participants perceived that they had adequate knowledge of injury prevention practices in football, while others felt they had limited knowledge of the basic injury prevention programmes (IPPs). The results also indicated that the injury prevention practices of coaches (93%) and their beliefs in this regard (70%) are sufficient for achieving the basic injury prevention goals. Most of the respondents (89%) indicated that a medical support system is important in attaining the goals of injury prevention.

Conclusion: Members of women’s teams in the USSA Football League have recognised limited knowledge about the basic IPPs, while they do employ some of the basic injury prevention practices in football. These practices could be influenced by the beliefs of the coaches and the players, and most of them believe that IPPs are important. It is essential as key stakeholders that coaches' and players' education and knowledge of injury prevention strategies should be considered as an integral part of the process to succeed. It should be strongly highlighted and implemented, thus augmenting the credibility, trust and compliance for IPPs in the sport.

Twenty20 cricket and batting in particular have remained vastly understudied to date. To elucidate the effects of batting on the batter, tools which replicate match play in controlled environments are essential. This study describes the development of two Twenty20 batting simulations, for a high and low strike rate innings, generated from retrospective analysis of international and domestic competition. Per delivery analysis of probabilities of run-type and on/off-strike denomination produce ball-by-ball simulations most congruent with retrospective competitive innings. Furthermore, both simulations are matched for duration and dictated through audio files. The `high' strike rate innings requires a batter to score 88 runs from 51 deliveries, whereby 60 runs are from boundaries. Similarly, the `low' strike rate innings requires a batter to score 61 runs from 51 deliveries, where 27 runs are scored from boundaries. Because batting simulations dictate run scoring outcomes, a method of quantifying a batter's performance from bat-ball contact scores is described. Ten elite batters achieved a mean performance score of 72 (SD = 26) and 88 (21) for the low and high strike rate simulations respectively. This study provides sport practitioners with a training technique to improve specific skill acquisition and enables research in understudied Twenty20 batting.

Background: Considering the injury incidence rate (IR) associated with elite-level rugby, measures to reduce players' injury risk are important. Establishing scientifically sound, pre-season musculoskeletal screening protocols forms part of injury prevention strategies. Objective: To determine the interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab((R)) (SSL) screening protocol. Methods: We determine the interrater and intrarater reliability of 11 flexibility and nine strength tests. Twenty-four injury-free, elite, adult (> 18 years), male rugby players were screened by two raters on two occasions. To establish intrarater and interrater reliability, Gwet's AC1, AC2 and intraclass correlation coefficients (ICC) were used for the analysis of binary, ordinal and continuous variables, respectively. Statistical significance was set at 95%. Results: Flexibility tests which require lineal measurement had at least substantial interrater (ICC = 0.70-0.96) and intrarater reliability (ICC = 0.89-0.97). Most of the flexibility tests with binary outcomes attained almost perfect interrater and intrarater reliability (Gwet's AC1 = 0.8-0.97). All strength tests attained at least substantial interrater (Gwet's AC2 = 0.73-0.96) and intrarater (Gwet's AC2 = 0.67-0.97) reliability. Conclusion: The level of interrater and intrarater reliability of most of the flexibility and strength tests investigated supports their use to quantify various aspects of neuromusculoskeletal qualities and possible intrinsic risk factors amongst elite rugby players. Clinical implications: Establishing the reliability of tests, is one step to support the inclusion thereof in official screening protocols. Results of our study, verify the reliability of the simple, clinically friendly strength and flexibility tests included and therefore support their use as preparticipation screening tools for rugby players. Further investigation as to the association thereof to athletes' injury risk and performance is warranted.

Purpose: The aims of our study were to (1) describe the tests that physiotherapists use to assess lumbopelvic movement control and (2) compare physiotherapists’ and physiotherapy students’ ability to evaluate lumbar movement dysfunction in patients with non-specific low back pain (NSLBP). Method: A quantitative, observational, cross-sectional study design was used. A total of 93 qualified physiotherapists and 96 students participated in our study. The physiotherapists reported whether they were familiar with lumbopelvic movement control tests and indicated which tests they used to assess lumbopelvic movement control (Part 1). Both the physiotherapists and the students evaluated and classified lumbopelvic movement control while observing videos of patients with NSLBP (Part 2). The responses from physiotherapists and students were described and compared between the two groups using the Fisher exact test (p ≤ 0.05). Odds ratios were calculated in terms of years of experience and level of education. Results: A total of 80 physiotherapists (86%) were familiar with lumbopelvic movement control tests, but only a few were using those tests as part of the assessment of patients; 12 (13%) used waiter’s bow; 16 (17%) used rocking forward; 17 (18%) used rocking backward; 32 (34%) used sitting knee extension; 34 (37%) used prone knee flexion; and 70 (75%) used posterior pelvic tilt. The physiotherapy students and qualified physiotherapists generally agreed on the ratings of most of the videos (e.g., as correct or incorrect). A difference was found in only 3 of 24 videos for both the qualified physiotherapists and the physiotherapy students (p = 0.001, p = 0.007, and p = 0.033, respectively), which indicates that qualified physiotherapists and students agreed and classified 21 videos the same. No differences were found in the ability of physiotherapists (regardless of experience) or students to classify patients as presenting with either a flexion or an extension pattern. Conclusions: The majority of physiotherapists were familiar with lumbopelvic movement control tests, but only a few used them. Both the physiotherapists and the students were able to classify patients with NSLBP presenting with either a flexion or an extension pattern. =

Objectif : 1) décrire les tests qu’utilisent les physiothérapeutes pour évaluer le contrôle des mouvements lombo-pelviens et 2) comparer la capacité des physiothérapeutes et celle des étudiants en physiothérapie à évaluer la dysfonction des mouvements lombaires chez les patients ayant des douleurs lombaires non spécifiques (DLNS). Méthodologie : étude d’observation transversale quantitative auprès de 93 physiothérapeutes qualifiés et de 96 étudiants. Les physiothérapeutes ont indiqué s’ils connaissaient les tests de contrôle des mouvements lombo-pelviens et quels tests ils utilisaient pour évaluer ces mouvements (partie un). Tant les physiothérapeutes que les étudiants ont évalué et classé le contrôle des mouvements lombo-pelviens à partir de vidéos de patients ayant des DLNS (partie deux). Les chercheurs ont décrit et comparé les réponses des physiothérapeutes et des étudiants au moyen du test exact de Fisher (p ≤ 0,05). Ils ont calculé les rapports de cote d’après les années d’expérience et le niveau d’instruction. Résultats : au total, 80 physiothérapeutes (86 %) connaissaient les tests de contrôle des mouvements lombo-pelviens, mais seuls quelques-uns les utilisaient dans leur évaluation des patients. Ainsi, 12 (13 %) utilisaient la courbette du serveur; 16 (17 %), le balancement vers l’avant; 17 (18 %), le balancement vers l’arrière; 32 (34 %), l’extension du genou en position assise; 34 (37 %), la flexion du genou en position couchée; et 70 (75 %), la bascule postérieure du bassin. Les étudiants en physiothérapie et les physiothérapeutes qualifiés s’entendaient généralement sur la classification de la plupart des vidéos (correct ou incorrect). Ils sont parvenus à des résultats différents à l’égard de seulement trois des 24 vidéos (p = 0,001, p = 0,007 and p = 0,033, respectivement). Ainsi, les physiothérapeutes et les étudiants ont classé 21 vidéos de la même façon. Les physiothérapeutes (quelle que soit leur expérience) et les étudiants n’ont pas démontré de différence quant à leur capacité de classer les patients qui présentaient un profil de flexion ou d’extension. Conclusion : la majorité des physiothérapeutes connaissait les tests de contrôle des mouvements lombo-pelviens, mais seuls quelques-uns les utilisaient. Tant les physiothérapeutes que les étudiants étaient en mesure de classer les patients ayant des DLNS dans un profil de flexion ou d’extension.

OBJECTIVE: This review will evaluate the effectiveness of exercise intervention versus no intervention or alternate intervention to prevent shoulder injuries in athletes. INTRODUCTION: Injury-prevention research has proven the effectiveness of exercise in preventing sports injuries in general and in the lower limb specifically. However, the results have been extrapolated to sport-related shoulder injuries from limited evidence. Similar reviews have been faced with insufficient high-quality evidence and limited studies due to restrictive target populations, resulting in reduced generalizability. INCLUSION CRITERIA: Peer-reviewed randomized controlled trials, with adequate control arms, investigating shoulder-injury events after exercise intervention in athletes, both training or competing in sports, will be included. Studies with substitute end points for injury events and non-self-propelled athletes, or vehicle-assisted athletes, will be excluded. METHODS: A comprehensive search of multiple databases will be used to find relevant studies. The databases will be searched from inception to April 2021, with no language restrictions imposed. Keywords and derivatives of "sport," "exercise intervention," "prevention," "shoulder injury," and "randomized controlled trials" will be used.Sources will include Academic Search Ultimate (EBSCO), CINAHL Plus (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), MasterFILE Premier (EBSCO), MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro), ProQuest Health and Medical Complete and Nursing and Allied Health Source (ProQuest Complete), ScienceDirect (Elsevier), Scopus (Elsevier), SPORTDiscus (EBSCO), and Web of Science (Clarivate Analytics). Data appraisal, extraction, and synthesis will follow JBI guidance for systematic reviews of effectiveness. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020204141.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of surgical management versus non-surgical management on pain, range of motion, intracompartmental pressure values, patient satisfaction, recurrence of symptoms, return to activity, function, strength, and sensation in patients diagnosed with chronic exertional compartment syndrome of the anterior compartment of the leg. INTRODUCTION: Chronic exertional compartment syndrome is the most prevalent cause of exercise-induced leg pain in athletes. Current evidence suggests that the best methods for management include activity modification or cessation, injection of botulinum toxin into the affected compartment, or surgical intervention. Due to the limited number and quality of studies available, the evidence needs to be synthesized to pool findings from current research and to identify gaps in the literature. INCLUSION CRITERIA: This review will consider studies that include people with chronic exertional compartment syndrome of the anterior compartment of the leg diagnosed through a combination of elevated intracompartmental pressure values and patient history. Studies that include patient-reported outcome measures will be included. METHODS: MEDLINE, SPORTDiscus, Physiotherapy Evidence Database, MasterFILE Premier, CINAHL Complete, ProQuest Health and Medical Complete, Scopus, and Science Direct will be searched from 1956 to date. Gray literature databases will also be searched. Two reviewers will independently retrieve and screen full-text studies, critically appraise included studies, and extract data. Meta-analyses will be performed where possible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020189661.

BACKGROUND: Learning styles of health care professionals are unique and tend to be profession- specific. This study aimed to compare the learning styles of undergraduate occupational therapy and physiotherapy students and to determine the relationship between preferred learning styles, demographic factors, and academic performance
METHOD: The study design was a cross-sectional, descriptive study. Undergraduate occupational therapy and physiotherapy students completed a self-developed questionnaire and the Grasha-Reichmann Learning Style Inventory
RESULTS: A total of 313 students with a mean age of 19.6±1.58 years participated in this study. The results showed that students preferred the collaborative (75%) learning style, with the first-year students scoring significantly higher in the collaborative style (3.97±0.48; p
CONCLUSION: The predominant preferred learning styles are the collaborative and participant styles. The application in the teaching space should be carefully considered for the selection of teaching approaches and activities. This study points to the Physiotherapy and Occupational Therapy programmes need to align to the collaborative style and respond with a variety of teaching methods. The associations shown between preferred learning styles and demographic variables point to the need to pay attention to diversity when selecting teaching approaches and activities

OBJECTIVE: The objective of this systematic review is to describe the incidence and prevalence of injuries in female cricket players participating in recreational-, school-, club-, and elite-level cricket. INTRODUCTION: Recent investments in women's cricket, stand-alone tournaments, and increased visibility through new broadcasting milestones has increased participation in many countries. With increased participation of women in cricket comes increased risk of injury. Epidemiological data are needed to underpin evidence-based injury-prevention strategies. No systematic review or meta-analysis of injuries is currently available to provide a comprehensive overview of synthesized findings to make the evidence accessible. INCLUSION CRITERIA: Studies on female cricket players of all ages and participating in all levels of cricket will be included. Studies that contain data on only male cricket players will be excluded. Studies where data from female cricket players can be distinguished from male players will be included. Injuries sustained when playing cricket, that are self-reported or diagnosed by a health care professional will be included. Definitions of injury including, but not limited to, medical-attention injuries, general time-loss injuries, or player-reported injuries will be considered. METHODS: MEDLINE, SPORTDiscus, Physiotherapy Evidence Database (PEDro), EBSCO MasterFILE Premier, EBSCO CINAHL Complete, ProQuest Health and Medical Complete, Scopus, and ScienceDirect will be systematically searched from inception to the present. Cochrane Central Register of Controlled Trials and ClincalTrials.gov will be searched as well as gray literature databases. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. If possible, meta-analyses will be performed. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020166052.

OBJECTIVE: The objective of this review is to determine the concurrent prevalence of temporomandibular disorders and headaches in patients. INTRODUCTION: Temporomandibular disorders affect the temporomandibular joint and associated orofacial structures. It is the second-most common musculoskeletal disorder experienced by adults. Headache is one of the most pervasive neurological disorders and can be an extremely disabling condition. Temporomandibular disorders and headache are known to often occur simultaneously and have a bi-directional relationship due to their close anatomical association. INCLUSION CRITERIA: The systematic review will include all studies with adult participants (>18 years) experiencing headaches (migraine, migraine with/without aura, tension-type, cervicogenic, and chronic headache) with symptoms of temporomandibular disorders occurring concurrently. METHODS: An initial search of PubMed will be followed by CINAHL, the Cochrane Central Register of Controlled Trials in the Cochrane Library, EBSCO MasterFILE Premier, PEDro, ProQuest Health and Medical Complete, Science Direct, and Scopus. Titles and abstracts of studies will be reviewed, and full text articles will be selected if the inclusion criteria are met. Studies that meet the eligibility criteria will then be assessed by two independent reviewers. Full-text articles will be selected if the inclusion criteria are met. A standardized critical appraisal checklist for studies reporting prevalence data will be used to assess methodological quality and a standardized data extraction tool will be used. The results from the included studies will be analyzed using JBI SUMARI software. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42019139689).

Background: Work-related musculoskeletal disorders (WRMSDs) are a public concern to social-care and health systems, as well as individuals. Globally, WRMSDs are classified as one of the prevalent causes of disability.

Objectives: The primary objective of this study was to determine work-related risk associated with musculoskeletal disorders amongst flower farm workers. The secondary objective was to determine the relationship between WRMSD risk over the previous 12 months and socio-demographic characteristics.

Method: A cross-sectional descriptive study was conducted. A sample of 270 participants was drawn from 897 farm workers, of which 184 presented with WRMSD as assessed using the Nordic Musculoskeletal Questionnaire. Quantitative data were collected using the Rapid Entire Body Assessment questionnaire. Inferential statistics were analyzed using the Pearson’s chi-squared test (X2) test and based on an alpha level of p

Results: Respondents who reported medium risk were 49 (26.6%), 80 (43.5%) reported high risk while 55 (29.9%) reported very high risk. There was no relationship between WRMSD risk and socio-demographic characteristics.

Conclusions: Flower farm workers in Kenya were found to be at risk of sustaining WRMSDs although socio-demographic factors did not play a role in the level of risk.

Clinical Implications: The high prevalence of WRMSDs necessitates policy reform in the flower farm industry. Furthermore, the timely identification of potential disorders and the associated risk factors is necessary to ensure early intervention.

OBJECTIVE: The objective of this review is to assess whether pre-season physical fitness parameters are associated with in-season injury risk among adult male rugby players. INTRODUCTION: Pre-season neuromusculoskeletal screening protocols (which include tests related to different physical fitness parameters) are injury prevention strategies employed to manage athletes' in-season injury risk. A systematic review exploring the association between in-season injury and specific physical fitness parameters may justify the inclusion or exclusion of these tests in official screening protocols. INCLUSION CRITERIA: This review will consider prospective, observational cohort studies that investigate injury-free adult (aged 18 years or above) male rugby players, from all levels of participation (recreational, sub-elite and elite). Studies investigating physical fitness parameters and their association to rugby-related neuromusculoskeletal injury will be included. METHODS: The proposed systematic review will be conducted in accordance with the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from several databases and resources. Two independent researchers will screen, appraise and extract data from studies meeting the inclusion criteria using standardized critical appraisal and data extraction tools. Data synthesis will be conducted and a Summary of Findings constructed to summarize data and draw conclusions. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 130240.

Objective: 

The objective of this review was to collate and map gross anatomy curricular and pedagogical approaches for physiotherapy students.

Introduction: 

Knowledge of anatomy is essential for physiotherapy clinical diagnosis, treatment effectiveness and safe practice. The information on this topic is sparse, and what does exist is diverse. This scoping review describes anatomy educational approaches for physiotherapy students and provides needed insight into this topic.

Inclusion criteria: 

No limits were applied on the date of the database search or age of participants. Languages were limited to English, French, German and Spanish. Studies had to include information on gross anatomy curricula or pedagogy for physiotherapy students, or information from qualified physiotherapists or those teaching gross anatomy to physiotherapy students.

Methods: 

Included studies were mainly sourced from EBSCOhost (CINAHL, ERIC and MEDLINE), PubMed and Scopus databases. Perusal of reference lists facilitated further retrievals. Studies published from inception up to 21 July 2019 were included. Studies were identified and screened, and the process was reported in a PRISMA flow diagram. JBI methodology for scoping reviews was followed. Selected studies were charted according to a template created and published in a JBI scoping review protocol.

Results: 

Fifty-four studies satisfied the inclusion criteria. Various studies gave calculable length of intervention in weeks (n=14, 26%), hours (n = 7, 13%) or both (n = 21, 39%). The majority of studies (n = 50, 93%) were cross-sectional studies; three were randomized controlled trials (6%). Mean sample sizes varied from 55.3 ± 30.4 (professional behaviors, ethical and humanistic aspects) to 323.2 ± 219.7 participants (multi-modal and blended learning). Overall, 29 studies (54%) included physiotherapy students or personnel in physiotherapy anatomy programs exclusively in the sample. Other disciplines with physiotherapy students included medical students (n = 12, 22%), and occupational therapy students (n = 10, 19%). The interprofessional education category (n = 8) determined that interdisciplinary teamwork led to increased anatomical learning and awareness of future clinical roles. Computer-assisted learning (n = 9) was effective as a stand-alone or adjunct pedagogy, useful for self-study and helped anatomical knowledge retention. Team-based learning (n = 2), peer teaching (n = 6) and clinical input incorporating case-based learning and horizontal and vertical integration (n = 4) resulted in anatomical knowledge retention and were associated with mastery of anatomical understanding, an increase in examination confidence and higher examination grades. Contradictory learning outcomes resulted from the use of online videos in blended and multi-model learning studies (n = 7). Increased student participation in asynchronous online discussion forums benefitted academic learning outcomes. The category of curriculum, pedagogy and materials (n = 15) identified and compared different survey results pertaining to the curricular aspect of the objectives of this review. One study investigated the flipped classroom concept. The use of anatomy content to encourage professional, ethical and humanistic aspects (n = 3) of physiotherapy students’ behavior resulted in positive outcomes.

Conclusions: 

This scoping review revealed a multi-faceted topic with many types of interventions and outcomes recorded. It identified variations in pedagogies, curricular content and learning approaches integral to the subject and their impact on gross anatomy education for this population. Beneficial behavioral, anatomical learning, knowledge retention and academic outcomes were identified.

Background: Evidence-based practice (EBP) and evidence-based physiotherapy (EBPT) have been investigated in different physiotherapy clinical settings. However, there has been no research into knowledge and adherence in respect of evidence-based sports physiotherapy standards in Kenya.

Objective: To determine the levels of knowledge and adherence towards EB sports physiotherapy standards among physiotherapists in Kenya.

Method: A cross-sectional study using quantitative methods and in conjunction with a self-administered questionnaire was conducted in a population of 700 physiotherapists.

Results: The response rate was (n=391; 55.9%). Involvement in structured sports physiotherapy practice accounted for (n=129; 32.9%). High levels of EBP knowledge (n=265; 67.8%) were reported. More males (n=185; 73.4%) than females (n=80; 57.5%) presented with high levels of EBP knowledge. Those with specializations (n=65; 83.3%) demonstrated higher levels of EBP knowledge than those without (n=200; 63.9%). Adherence to EBP process steps accounted for (n=143; 36.6%) of the population. More males (n=104; 41.3%) than females (n=39; 28.1%) adhered to the EBP process. Those with specializations (n=48; 61.5%) and those without (n=95; 30.4 %) adhered to the EBP process. Gender, training and specialization were found to have statistically-significant associations with knowledge and adherence (p

Conclusion: Physiotherapists in Kenya present with high levels of knowledge in EB sports physiotherapy but with lower levels of adherence to the EBP process.

Clinical implications: Limited adherence to EBP standards despite high levels of knowledge points to an inferior quality of care for athletes with sports physiotherapy needs. Attention to the limiting factors to adherence may improve the quality of care.

Background: Treatment of chronic pain is challenging and there is often failure of recovery, with the need to look at different approaches in its management. Central mechanisms may contribute to chronicity (i.e. disturbance in body schema). Laterality judgment is dependent on body schema and can determine affected central mechanisms. Objective: This review aimed to determine whether there are laterality judgment differences between chronic pain and pain-free individuals. Methods: A search was done of various databases, using combinations of keywords, and reference lists of full-text articles. Articles were considered from inception until February 2018. Eighteen studies were included. Methodological quality was assessed by two reviewers using the JBI Critical Appraisal Checklist. Studies were analyzed broadly then divided into subgroups. A meta-analysis or narrative review was done. Results: There was high heterogeneity for broad outcome measures, complex regional pain syndrome (CRPS1), and upper limb pain. Analysis for accuracy in lower limb conditions showed a medium significant effect size (0.59) and significant 95%CI (0.11–1.07). Low back and cervical pain results could not be pooled into meta-analysis (due to different methods of reporting). Conclusions: Laterality judgment impairment was shown in CPRS1, upper limb pain, hand and wrist pain, carpal-tunnel syndrome, facial pain, knee osteoarthritis, and leg pain. No conclusions could be drawn in low back pain, due to the low-quality evidence and differing results. There was no impairment in whiplash-associated disorders and nonspecific cervical pain showed conflicting evidence.

Background: Knowledge of neurophysiology of pain influences healthcare providers’ attitudes and beliefs about patients with chronic low back pain which affect management choices.

Objectives: The aim of this study was to determine the level of knowledge of pain and attitudes and beliefs towards patients with chronic low back pain among final year undergraduate students from the School of Therapeutic Sciences at the University of the Witwatersrand.

Methods: This cross-sectional study included two questionnaires – Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) for measuring attitudes and beliefs about pain and the Neurophysiology of Pain Questionnaire (NPQ) for knowledge of pain. These were distributed to 224 students. An analysis of variance and a two-sided t tests compared data with p ≤ 0.05.

Results: The study had a 65% response rate (n = 145), of which the majority were female students (n = 115, 79%). Overall, the mean correct NPQ score was 6.01 (± 1.98), with a significant difference among the programmes (p = 0.005). Mean NPQ scores for each programme were as follows: physiotherapy 6.97 (1.77), biokinetics 6.31 (2.43), exercise science 6.25 (2.5), pharmacy and pharmacology 5.69 (1.39), nursing 5.32 (1.39) and occupation therapy 5.21 (2.09). The mean correct scores for HC-PAIRS were 63.1 (8.9), with significantly higher scores in females than males (p = 0.04). Knowledge scores had a low inverse relationship with scores for attitudes and beliefs towards patients with chronic low back pain (r = -0.304; p = 0.0002).

Conclusion: There is a deficit in knowledge of pain among final year students in the School of Therapeutic Sciences, with a low correlation with attitudes and beliefs towards patients with chronic low back pain. Therefore, improving the knowledge of pain might result in a change in these attitudes and beliefs.

Clinical implications: The results have shown an association between knowledge of pain and attitudes and beliefs towards patients with chronic low back pain. Therefore, knowledge is one of the factors that could contribute in changing the attitudes.

Background: High injury prevalence rates call for effective sports injury prevention strategies, which include the development and application of practical and reliable pre-participatory screening tools.

Objectives: The aim of this study was to investigate the intra-rater and inter-rater reliability of the one-legged hyperextension test (1LHET), the empty can (EC) and full can (FC) tests, the standing stork test (SST), the bridge-hold test (BHT) and the 747 balance test (747BT).

Method: Thirty-five healthy, injury-free male athletes (cricket and soccer players), aged 16–24 years, were evaluated by two physiotherapists. For each of the tests, the participants were evaluated twice (on two consecutive days) by each physiotherapist. Both the intra- and inter-rater reliability were determined. Cohen’s kappa (k) was calculated for the 1LHET, the EC and FC tests and the SST. The intraclass correlation coefficient (ICC) was used for the BHT and the 747BT. A confidence level of 95% (p ≤ 0.05) was applied as the criterion for determining the statistical significance of the results.

Results: The SST presented with the lowest level of intra-rater agreement (ICC = –0.20 to 0.10). On the other hand, the EC test was the only test where one rater achieved an excellent intersessional agreement (k = 0.80; 95% confidence interval [CI] 0.40–1.20). Substantial to excellent results for the inter-rater agreement for both sessions were recorded for the 1LHET (k = 0.70–0.90) and the BHT (ICC = 0.70–0.90).

Conclusion: Reliability values need to be considered when making clinical decisions based on screening tests. A more refined description of the testing procedures and criteria for interpretation might be necessary before including the six screening tests investigated in this study in formal screening protocols.

Clinical implication: Confirmed reliability of screening tests would enable sports professionals to make informed decisions when designing preparticipatory musculoskeletal screening tools and when dealing with the management of injury risks in athletes.

Background. Anatomy is essential to prepare physiotherapy students for future clinical practice. Student learning styles and lecturer teaching styles may influence learning outcomes.

Objective. To determine if the learning style of this student population is consistent and compatible with lecturers’ teaching styles for better learning outcomes.

Methods. A descriptive cross-sectional study was undertaken during 2015 and 2016. The Grasha-Riechmann learning style scale (GRLSS) and Grasha-Riechmann teaching style scale (GRTSS) were used to measure learning styles of two consecutive physiotherapy student cohorts and teaching styles of their anatomy lecturers, respectively.

Results. Student samples were small (group 1: N=59 and group 2: N=54), but response rates high (n=39; 66.1% and n=43; 81.5%) in 2015 and 2016, respectively. Mean Likert scores for GRLSS indicated that the most popular choice for learning style was the dependent style (mean (standard deviation) 3.81 (0.75)) for group 1 and the independent style (3.68 (0.61)) for group 2. Female students preferred the dependent style (group 1: n=12; 30.8% and group 2: n=10; 23.3%) and male students the participant style (group 2: n=6; 14%) of learning. Lecturers scored highest in the expert category of teaching styles. Compatibility between learning and teaching styles was seen in both years based on comparisons made using teaching style clusters, where the identified GRLSS and GRTSS were grouped together and seen to fit into specific cluster categories.

Conclusion. Consistency in learning style choice was observed. A degree of cohesion between student learning styles and their respective lecturers’ teaching styles augured well for good interaction between staff and students.

Purpose: A common factor in all forms of headache is the presence of myofascial trigger points (TrPs). The aim of this study was to compare the presentation of patients with cervicogenic headaches and patients with non-cervicogenic headaches in the sensitivity of TrPs in their upper trapezius, sternocleidomastoid, temporalis, and posterior cervical muscles. Method: This was a descriptive, cross-sectional study. The following variables were compared between patients with cervicogenic (n=20) and patients with non-cervicogenic (n=20) headaches: sensitivity (pain-pressure threshold) of TrPs in the upper trapezius, sternocleidomastoid, posterior cervical, and temporalis muscles (using a handheld, digital algometer); level of disability (using the Henry Ford Hospital Headache Disability Inventory questionnaire); demographics (age, sex); anthropometrics (BMI); and clinical presentation (duration and intensity of symptoms). The independent Student t-test and χ2 test were used to determine the differences between the two groups. Effect sizes (Cohen's d) were calculated when relevant. Results: The two groups were similar in level of disability, demographic and anthropometric data, and clinical presentation. However, TrP sensitivity in the right upper trapezius (p=0.006; Cohen's d=0.96) and the left upper trapezius (p=0.003; Cohen's d=1.06) muscles was higher in the cervicogenic group. Conclusions: Increased sensitivity of TrPs in the upper trapezius muscle may be used as a differentiating factor in the diagnosis of cervicogenic headaches. This finding emphasizes the importance of integrating this muscle into the rehabilitation programs of patients with cervicogenic headache. = 

Objectif : les zones gâchettes myofasciales (ZG) sont un facteur courant de toutes les formes de céphalées. La présente étude visait à comparer la présentation de la sensibilité des ZG chez les patients atteints de céphalées cervicogéniques par rapport à celle des patients atteints de céphalées non cervicogéniques dans le trapèze supérieur, le muscle sternocléidomastoïdien, le muscle temporal et le muscle cervical postérieur. Méthodologie : dans la présente étude transversale descriptive, les chercheurs ont comparé les variables suivantes entre les patients atteints de céphalées cervicogéniques (n = 20) et non cervicogéniques (n = 20) : sensibilité (seuils de douleur aux points de pression) des ZG dans le trapèze supérieur, le muscle sternocléidomastoïdien, le muscle cervical postérieur et le muscle temporal (à l'aide d'un algomètre numérique portatif); taux d'incapacité (à l'aide du questionnaire du répertoire du degré d'incapacité lié aux céphalées du Henry Ford Hospital); données démographiques (âge, sexe); valeurs anthropométriques (IMC) et présentation clinique (durée et intensité des symptômes). Ils ont utilisé le test de Student indépendant et le test du chi carré pour établir les différences entre les deux groupes. Ils ont calculé les tailles d'effet (d de Cohen) lorsque la situation le justifiait. Résultats : le taux d'incapacité, les données démographiques, les données anthropométriques et la présentation clinique des deux groupes étaient semblables. Cependant, la sensibilité des ZG dans le trapèze supérieur droit (p = 0,006; d de Cohen = 0,96) et le trapèze supérieur gauche (p = 0,003; d de Cohen = 1,06) était plus élevée dans le groupe cervicogénique. Conclusions : la plus grande sensibilité des ZG dans le trapèze supérieur peut représenter un facteur de différenciation pour diagnostiquer les céphalées cervicogéniques. Cette observation fait ressortir l'importance d'intégrer ce muscle aux programmes de réadaptation des patients atteints de ce type de céphalées.

An evening state of spinal hyperexcitability has been proposed to be a possible cause of evening increases in restless legs syndrome symptoms. Thus, the objective of the current study was to assess the circadian variation in spinal excitability in patients with restless legs syndrome based on flexor withdrawal reflex and crossed extensor reflex responses. The reflexes were elicited on 12 participants with restless legs syndrome and 12 healthy control participants in the evening (PM) and the morning (AM). Reflex response magnitudes were measured electromyographically and kinematically. Both the reflexes showed a circadian rhythm in participants with restless legs syndrome but not in control participants. Changes in ankle (median flexor withdrawal reflex PM: 16.0 degrees versus AM: 2.8 degrees , P = 0.042; crossed extensor reflex PM: 0.8 degrees versus AM: 0.2 degrees , P = 0.001) angle were significantly larger, and ankle angular velocity (median flexor withdrawal reflex PM: 38.8 degrees s(-1) versus AM: 13.9 degrees s(-1) , P = 0.049; crossed extensor reflex PM: 2.4 degrees s(-1) versus AM: 0.5 degrees s(-1) , P = 0.002) was significantly faster in the evening compared with the morning in participants with restless legs syndrome, for both reflexes. For participants with restless legs syndrome, evening change in hallux angle was significantly larger than morning responses (median PM: 5.0 degrees versus AM: 1.3 degrees , P = 0.012). No significant differences for any of the electromyographic or kinematic variables were observed between participants with restless legs syndrome and controls. The flexor withdrawal reflex and the crossed extensor reflex show a circadian rhythm in participants with restless legs syndrome suggesting an evening increase in spinal excitability. We hypothesize the circadian variation in spinal excitability may be due to a possible nocturnal form of afferent circuitry central sensitization in the dorsal horn of the spinal cord in patients with restless legs syndrome.

Background: A rugby union game consists of 80 minutes of strenuous exertion. Forwards are required to participate in the arduous activity of scrummaging throughout a game.

Objectives: The purpose of this study was to identify whether rugby-match simulated fatigue modified individual scrummaging technique and reduced performance.

Methods: Twelve forwards (body mass 106.2±13.3 kg; stature 179.5±8.4 cm) had individual scrum kinetics and kinematics assessed prior to and following a protocol that simulated a rugby match. The simulated rugby match protocol required participants to run at various velocities and perform rugby specific tasks. Rating of Perceived Exertion (RPE) was assessed using a 6-20 Borg scale and Visual Analogue Scale (VAS). Blood lactate, heart rate and RPE were measured prior to, at mid-point and after the simulated game, while markers of muscle damage (blood creatine kinase activity (CK) and urea) were measured prior to and following the protocol.

Results: RPE (p

Conclusion: Physiological fatigue does not influence individual scrummaging performance and technique.

OBJECTIVE: To investigate if diurnal changes in spinal excitability (plantar reflex) occur in restless legs syndrome (RLS) participants compared to healthy matched controls. METHODS: Thirteen RLS participants and 13 healthy control participants' plantar reflex responses were evaluated in the evening (PM) and the morning (AM). Plantar reflex responses were assessed electromyographically, using motion analysis (kinematically) and by subjective nociception (Visual Analogue Scale). RESULTS: RLS participants showed a circadian variation in plantar reflex responses whilst control participants did not. Evening ankle angle changes were larger and faster in RLS participants compared to morning responses. In addition RLS participants displayed significantly smaller change in ankle angle and significantly slower ankle movements in the evening and the morning as well as significantly lower lateral gastrocnemius maximum amplitude in the compared to control participants. CONCLUSION: The findings of the current study support the theory of RLS circadian fluctuations in spinal excitability. An unexpected finding was decreased plantar reflex responses in RLS participants compared to healthy control participants. However this finding supports the theory of mechanical hypoesthesia in RLS. The results of this study provide further insight into the pathophysiology of RLS, highlighting that not all sensory processing is affected in the same manner.

Objectives.

This study aimed to determine if abdominal muscle thickness, activation and symmetry are associated with prospective in-season injury among adolescent cricket pace bowlers.

Design.

A quantitative, prospective, observational study design was used.

Setting.

Data was collected at an indoor venue at a secondary school.

Participants.

28 injury-free, male, adolescent pace bowlers between the ages of 13 and 18 participated.

Main outcome measures.

Muscle thickness of the transversus abdominis (TA), internal oblique (IO) and external oblique (EO) muscles were measured at rest and during an abdominal drawing-in maneuver (ADIM) i.e. activation, using ultrasound imaging. Incidence of injury was monitored monthly during the cricket season.

Results.

Thickness of the non-dominant IO at rest was greater than the dominant side for pace bowlers who remained injury free during the cricket season (p = 0.01, effect size (ES) = 0.65). This was, however not the case for bowlers who sustained injuries (p = 0.47; ES = 0.24). TA percentage change during ADIM (activation) on the dominant side was less in bowlers who sustained non-contact injuries compared to those who remained injury free (p = 0.03; ES = 1.17).

Conclusions.

Asymmetry in IO thickness may play a protective role against injury, whilst poor TA activation on the dominant side may pose a risk to injury.

Study Design.

Systematic review with meta-analysis.

Objectives.

To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component.

Background.

Neural mobilization, or neurodynamics, is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown.

Methods.

A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta-analysis, with pain, disability, and function as the primary outcomes.

Results.

Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0–50]: mean difference, −9.26; 95% confidence interval [CI]: −14.50, −4.01; P.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia.

Conclusion.

This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time.

Objectives
The aim of this study was to determine the differences in three-dimensional pelvic and hip kinematics during a single-leg drop-landing task in active sports participants with long-standing groin pain compared to healthy matched controls.

Design
This was a descriptive study incorporating a cross-sectional design.

Setting
The study was conducted at the Unit for Human Movement Analysis, Stellenbosch University, South Africa.

Participants
The study sample was comprised of 20 male club level soccer, rugby, running and cycling participants between the ages of 18 and 55 years. Ten cases with long-standing groin pain and ten asymptomatic matched controls participated.

Main outcome measures
Three-dimensional pelvic and hip kinematics were captured with an optical motion capture system during a single-leg drop-landing task.

Results
Participants with groin pain landed with more downward lateral pelvic tilt (0.77°, p = 0.01, r = 0.35), hip abduction (2.05°, p

Conclusions
Sports participants with long-standing groin pain have altered pelvic and hip kinematics during single-leg drop-landing compared to healthy controls. The kinematic differences may contribute towards the persistent nature of groin pain, although these strategies may also be present as a result of the presence or the expectation of pain.

A scrum is a contest to win possession of the rugby ball. The current study investigated potential kinematic parameters related to individual scrummaging force production. Twenty-five “tight-five” players (body mass: 103.0 ± 12.1 kg; height: 1.85 ± .09 m) individually scrummaged against an instrumented ergometer, while body kinematics were captured. Pearson’s correlations between force generation and kinematics of individual scrummaging performances were performed. Body mass was correlated to the engagement (r = .641), peak (r = .531) and sustained (r = .438) forces. Stance width was significantly correlated with the individual scrummaging forces at engagement (r = .422) and sustained phases (r = .540) but not at peak phase (r = .369). Higher scrummaging forces were achieved at lower pelvic and back heights. The only significant relationship during the start-sustained phase was the change in pelvic height (r = −.562). Changes in right hip (r = −.477) and right knee (r = .474) angles were correlated to the change in force during engagement-peak phase. During engagement-sustained phases, change in force magnitude was correlated to changes in pelvic height (r = −.585), left hip (r = .549) and right ankle (r = .657). The change in pelvic height (r = −.518) was the only correlate during the peak-sustained phase. The presented data highlight the role of a lower body height and wider stance in the attainment of greater individual scrummaging force.

Context:
The Functional Movement Screen (FMS) has been found to be a valid preparticipation screening tool in the prediction of injury among various athletes in different sports. The validity thereof in the prediction of injury among adolescent cricketers is yet to be established.

Objective:
To determine if a preseason FMS total score is a valid predictor of in-season injury among adolescent pace bowlers.

Design:
Prospective observational quantitative study.

Setting:
Bowlers performed the FMS before the start of the season. Injury incidence was monitored monthly throughout the season. The student t test and Fisher’s exact test were used to compare the FMS scores of the injured and noninjured bowlers as well as the injured and noninjured bowlers who scored ≤ 14.

Participants:
27 injury-free, male, adolescent pace bowlers.

Main Outcome Measures:
The FMS (scoring criteria and score sheet) and standardized self-administered injury questionnaire.

Results:
There was no difference between the noninjured group (16.55 ± 2.57) and the injured (16.1 ± 2.07) group in terms of FMS scores. There was no significant difference between injured and noninjured bowlers who scored ≤ 14. A total FMS score of 14 does not provide the sensitivity needed to assess injury risk among adolescent pace bowlers and no other accurate cut-off score could be calculated.

Conclusion:
Preseason observed total FMS score is a poor predictor of in-season injury among adolescent pace bowlers. Further research should be conducted to determine if a specific FMS test will be a more valid predictor of injury.

Introduction: Despite having been largely understudied, one of the crucial components of a team’s success in rugby is accurate passing. This study identified biomechanical correlates of the rugby ground pass and accuracy performance.
Methods: Sixteen club players (height 1.77±0.04 m; mass 86.8±16.8 kg) undertook a combined total of 96 passes and their respective body kinematics were analysed concurrent with measurements of pass accuracy at 10 m. Two distinct types of body orientations were found to be utilised by the players: a side-on orientation (pelvic rotation >80 °) and a front-on orientation (pelvic rotation Results: Side-on body orientation passes were more accurate than front-on body orientation passes (pConclusion: Therefore different strategies exist within players to perform the ground pass with varying grades of accuracy.

This scoping review seeks to collate and describe the body of existing literature pertaining to curricula and pedagogies used in the gross anatomy education of undergraduate physiotherapy students.Specifically, the review questions are as follows.

• What approaches to gross anatomy curricula and pedagogies used to teach undergraduate physiotherapy students have been documented in available literature?
• What are the outcomes associated with the various approaches to anatomy curricula and pedagogies used to teach undergraduate physiotherapy students?

Objectives

This study aimed to compare the effect of myofascial trigger point therapy (MTPT) and stretching, MTPT and medicine ball exercises, and no intervention, on hip flexor length (HFL), golf swing biomechanics and performance in elite, male golfers.

Design

Single blind, randomised controlled trial with two experimental groups (stretch group: MTPT and stretching; and the ball group: MTPT, a single stretch and medicine ball exercises) and one control group (no intervention).

Setting

Professional golf academy.

Participants

One hundred, elite, male golfers aged 16–25 years.

Main outcome measures

HFL, 3D biomechanical analysis of the golf swing, club head speed (CHS), smash ratio, accuracy and distance at baseline and after the interventions.

Results

Backswing hip turn (BSHT) improved in the ball group relative to the control group (p = 0.0248). Accuracy in the ball group and the stretch group improved relative to the control group (Fisher's exact = 0.016).

Conclusions

Other performance parameters such as: smash ratio, distance and CHS were not compromised by either intervention. This study advocates the use of MTPT combined with medicine ball exercises over MTPT combined with stretching in the treatment of golfers with shortened hip flexors – even immediately preceding a tournament.

Ballet is an art that requires great skill and balance to achieve aesthetic performance. The aim of this study was to determine whether there were differences in the size of the base of support (BoS) and skill (using two previously identified indicators of aesthetic performance: back arch angle and leg separation angle) between two groups of ballerinas with different skill levels. Twenty one professional female ballerinas classed as Corps de Ballet dancers (≤ 2 years academy dancing experience; n=14) and Soloists (>2 years academy dancing experience; n=7) participated in this cross-sectional, descriptive study. All ballerinas performed three unassisted, standard ballet positions en pointe (retiré, arabesque and penché), each held for at least three seconds. Retro-reflective markers were attached to specific anatomical landmarks and tracked by a 12 camera system. The size of the BoS was calculated using a pressure platform. The BoS was significantly smaller for the Soloists than the Corps de Ballet dancers during arabesque (p=0.0239) and penché (p=0.0337) but not retiré (p=0.1131). A statistically significant, inverse correlation was found between BoS and age for all three positions: arabesque (r=-0.4948, p=0.0368) and penché (r=-0.6232, p=0.0099) and retiré (r=-0.5623, p=0.0151). There was no kinematic difference (back arch angle and leg separation angle) between the groups. Our study provides insight into the biomechanics of balance in retiré, arabesque and penché. A link exists between age, skill required for the task and size of the BoS. More experienced dancers may utilise strategies other than a large BoS to maintain balance.

Little attention has been given to the rotational kinematics of the rugby union place kicking performance, especially in a field setting. The place kick is a means to score points. By maximizing the distance and accuracy a kicker is able to achieve increases the number of point scoring opportunities available to a team. The hypothesis of this study was that there is a relationship between distance and accuracy and the rotational kinematics of place kicking performance of rugby players in the field setting. Twelve first-team university rugby players had their full body kinematics measured for five place kicks. Kick distance and accuracy were directly measured. The current study showed a positive correlation between torso (r=.76) and pelvis (r=.66) rotation with kick distance. Place kick distance (r=.24) or accuracy (r=.54) were not correlated to playing experience. Negative correlations between stance elbow flexion (r=-.78), torso rotation (r=-.74) and X-factor (r=-.79) with kick accuracy were noted. Place kick distance could potentially be maximized by improving torso and pelvic rotations. Place kick accuracy could be improved by full extension of the stance arm. The data suggests that larger torso rotations may promote kicking distance; however, they impede kicking accuracy.

Background. The cricket pace bowler utilises various strategies, including a more extended front knee angle, to achieve optimal performance benefits. At times this is done to the detriment of injury prevention. Objective. To investigate the relationship between three-dimensional (3D) knee kinematics during pace bowling action, injury incidence and bowling performance at the start and end of a cricket season. Methods. Knee angle and ball release (BR) speed of injury-free premier league (club level) cricket pace bowlers over the age of 18 years were measured at the start and end of the cricket season. Kinematic, injury- and bowling performance-related (BR speed and accuracy) data were analysed using paired and independent Student’s t-tests, Pearson’s correlation coefficient, χ2 test and a two-way analysis of covariance with repeated measures. Results. Thirty-one bowlers participated in this study, and kinematic data of a subset of 17 were analysed. Nine bowlers (53%) sustained injuries during the cricket season. No statistically significant relationship was found between knee angle and injury. Bowlers who did not sustain an injury bowled with more knee flexion at the start of the season (mean (standard deviation) 157.07˚ (12.02˚)) than at the end of it (163.95˚ (6.97˚)) (p=0.01). There was no interaction between accuracy and knee angle. There was a good to excellent inverse correlation between BR speed and knee angle among bowlers who remained injury free (r=–0.79; p=0.18). Conclusion. Bowlers who remain injury free during the course of the season may use strategies other than the front knee angle to facilitate high BR speeds. Technique-related variables which are more ‘protective’ against injuries while allowing for higher BR speeds should be further investigated among bowlers.

Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of assessment.

Objective. To describe and compare student performance and satisfaction and examiner satisfaction with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment.

Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets.

Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ±16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet.

Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify the effectiveness of neural mobilization techniques in various neuro-musculoskeletal conditions. Outcomes will be analyzed in terms of subgroups such as low back pain, cervico-brachial pain and carpal tunnel syndrome. BACKGROUND: Musculoskeletal disorders were ranked as the second largest contributor to disability worldwide in a study on the global burden of disease. Low back pain and neck pain contributed to 70% of disability in this comprehensive population-based study. Low back pain and neck pain are multifactorial, with heterogeneous populations. It has been proposed that targeting subgroups of patients may result in better treatment outcomes. Neck pain associated with upper limb pain is prevalent. These patients are more disabled than patients with neck pain alone. Similarly, low back pain with leg pain is a common phenomenon and is acknowledged as a predictor for chronicity.Neuropathic pain is often associated with musculoskeletal complaints including low back pain, whiplash associated disorders (WAD) and acute or chronic radiculopathy, and can be a feature of syndromes such as cervico-brachial pain syndrome. According to the International Association for the Study of Pain, neuropathic pain can be described as "pain caused by a lesion or disease of the somatosensory nervous system." Leg pain associated with back pain can be caused by central sensitization, denervation, nerve sensitization or somatically referred pain. In patients with WAD, neck pain is the most common symptom, but upper limb pain, weakness, paraesthesia and anesthesia are often present. Other conditions in which neural tissue is thought to contribute to the clinical picture are, for instance, lateral epicondalalgia and carpal tunnel syndrome.Management strategies for back pain and neck pain are often multimodal. However, the evidence for effective treatment of nerve related pain is lacking. Neural mobilizations are often used to affect the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. Neural mobilizations are defined as interventions aimed at affecting the neural structures or surrounding tissue (interface) directly or indirectly through manual techniques or exercise. Neural mobilizations have been studied in various populations such as low back pain, carpal tunnel syndrome, lateral epicondalalgia and cervico-brachial pain. Neural mobilization techniques studied include cervical lateral glides for cervico-brachial pain, nerve gliding exercises for the treatment of carpal tunnel syndrome, cervical lateral glides for lateral epicondalalgia and the slump as a neural mobilization technique in the treatment of low back pain. No specialized equipment is needed in the performance of neural mobilization techniques, which contributes to its popularity.Neural mobilization is said to affect the axoplasmic flow, movement of the nerve and its connective tissue and the circulation of the nerve by alteration of the pressure in the nervous system and dispersion of intraneural oedema. Neural mobilization decreases the excitability of dorsal horn cells. Neural mobilizations can be performed in various ways using passive movement, manual mobilization of the nerve or interface, and exercise. The aim of neural mobilization is to restore the mechanical and neurophysiological function of the nerve.Only one systematic review on the effectiveness of neural mobilizations could be identified in the literature. Since this review, several more studies have been published on this subject. The authors hypothesize that a review of the more recent literature (2008-2014) may confirm positive support for the use of neural mobilizations for neuro-musculoskeletal complaints as previously seen by Ellis and Hing. This review aims to include a meta-analysis and subgrouping of conditions which will be an extension of the previous review by Ellis and Hing. The outcomes of this systematic review may be used to inform clinical practice and the development of best practice guidelines.

BACKGROUND. The kinesio-taping method, which is becoming increasingly popular, may provide support and stability to joints and muscles without inhibiting range of motion. OBJECTIVE. The aim of the study was to determine the effect of kinesio-taping of the gluteus medius muscle on x-factor (torso-pelvic separation), ball flight distance and accuracy (smash factor ratio). A specific aim was to determine whether a correlation exists between hip abduction strength and x-factor, ball distance and accuracy. METHODS. This study is a one group pretest-posttest quasi-experimental design which took place at a golf facility. Twenty-nine amateur golfers with handicap of scratch ±2, who were between the ages of 18- and 25-years, participated in this study. Biomechanical outcomes were recorded with and without kinesio-tape applied on the gluteus medius muscle of the trail leg. Biomechanical golf swing analysis with the iClub™ Body Motion System determined the x-factor at the top of the backswing. Ball flight distance and accuracy were measured with FlightScope® and dominant hip abduction strength was measured with the MicroFET Hand-held Dynamometer. RESULTS. Kinesio-tape is effective in improving the relative hip abduction strength (p

Decreased trunk muscle endurance has been identified as a risk factor for adolescent LBP, and poor lumbo-pelvic stability has been found to be associated with LBP in the adult population. The aim of the study was to investigate the association between adolescent LBP, trunk muscle endurance and poor lumbo-pelvic stability. Design: A cross sectional study. Participants: 80 adolescents in grade 8 to grade 11, aged 12 to 17 years, at three high schools in Gauteng, who agreed to participate in the study. Method: Data was collected by means of a validated questionnaire and physical tests. The active straight leg raise test was used to record the lumbo-pelvic stabilising muscles. The Sorensen, Shirado and side-bridge tests were used to record trunk extensor, flexor and side flexor muscle endurance, respectively. Results: The results revealed a lifetime prevalence of LBP of 82.50%, one year prevalence of 78.80% and point prevalence of 23.80%. Adolescents with LBP demonstrated decreased trunk extensor muscle endurance but increased trunk flexor muscle endurance (p=0.044), compared to non-LBP adolescents. Poor lumbo-pelvic stability was not associated with adolescent LBP, but was associated with decreased extensor trunk muscle endurance (p=0.031). Conclusion: There was an association between trunk flexor muscle endurance and adolescent LBP, and between decreased trunk extensor muscle endurance and poor lumbo-pelvic stability. No association was found between LBP and poor lumbo-pelvic stability.

Background. The abdominal musculature plays a protective role against lower-back injury. Knowledge of the asymmetry in abdominal wall thickness in healthy, injury-free cricket pace bowlers may provide a useful platform against which pathology could be assessed and the effects of training could be evaluated.
Objective. To compare side-to-side differences in absolute muscle thickness and activity of the abdominal musculature and to compare these measurements at the start, with those at the end of a cricket season among a group of amateur pace bowlers.
Methods. This was a controlled longitudinal prospective study. Rehabilitative ultrasound imaging was used to assess abdominal muscle thickness in 26 right-handed, injury-free cricket pace bowlers at the start and at the end of a cricket season. Thickness measurements were done at rest, during an abdominal drawing-in manoeuvre (ADIM) and the active straight-leg raise (ASLR) on the left (-L) and right (-R).
Results. The absolute thickness of the non-dominant obliquus abdominis internus (OI) was higher than that of the dominant OI at the start (p=0.001; ES=0.87) as well as at the end of the cricket season (p=0.001; ES 1.09). At the start of the season, the percentage change during the ADIM, thus muscle activity, was higher for the non-dominant OI than for the dominant OI (p=0.02; ES=0.51). Absolute thickness of the dominant obliquus abdominis externus (OE) at rest was significantly higher at the end of the season compared with the start of the season (p=0.0001; ES=0.85). During ASLR-R, the activity of the left transversus abdominis (TA) was significantly higher than that of the right TA during ASLR-L (p=0.03) when measured at the end of the season.
Conclusion. This study highlights the possible muscle adaptations in absolute muscle thickness and activity as a consequence of the asymmetrical bowling action.

The Objective Structured Practical Examination (OSPE) format is used during practical examinations as part of the physiotherapy undergraduate curriculum at the University of the Witwatersrand. Various factors influence inter-examiner reliability and investigating the inter-examiner reliability when using the OSPE can lead to improvement of the examination process. The aim of this study was to establish inter-examiner reliability when using the OSPE mark sheet. Methods: Twelve examiners participated in this study. Thirty-three second year PT students were examined at six stations and by two examiners at each station. The Spearman’s correlation test was used to establish inter-examiner reliability. Results: The general inter-examiner reliability of the OSPE mark sheet was high. There was a high correlation between examiners who had the same level of experience (r=0.79 to r=0.93; p

Background: Physiotherapy students are prone to low back pain (LBP) due to studying and their active involvement in clinical treatment of patients. As a result of pathology, muscle activity is influenced, affecting optimal function of the spine. Method: Physiotherapy students enrolled for 2010 at the University of the Witwatersrand participated in a cross-sectional study. A questionnaire and physical assessment were completed. Results: The study revealed that the lifetime LBP prevalence was 36% among physiotherapy students. Associations with LBP were hours of practical exposure, posterior-anterior mobilisations on L4 (p=0.003) and L5 (p≤0.001) centrally and unilaterally, left lumbar multifidus (LM) cross-sectional area (p=0.02), right obliquus internusabdominis (OI) (p=0.02) and right transversus abdominis (TrA) thickness at rest (p=0.02), as well as the pull of the TrA during contraction on the left (p=0.03). Discussion: Hours of practical exposure may play a role in lumbar pathology. Due to pathology, muscle imbalances of LM, TrA and OI affect the stability of the spine which may lead to recurrences. Conclusion: Practical exposure as well as LM, TrA and OI muscle imbalances were associated with LBP in physiotherapy students. Awareness of the factors associated with LBP while studying at an undergraduate level may lead to better prevention of LBP.

Aim: The aim of this study was to establish if knee joint position sense in functional and pre-defined angles is related to ball release speed.
Methods: Twenty one healthy male cricket fast bowlers participated in this study. The ability of each bowler to reproduce pre-defined knee angles of 140° and 160° of knee extension was assessed. In addition, in a subsample of 11 bowlers, elecrogoniometery was used to determine the angles of the knee at ball release and at front foot placement. Electrogoniometery was also used to assess the ability of this subsample of subjects to reproduce these bowling specific knee angles. Pearson’s correlation coefficient was used to determine the relationship joint reposition error in these four positions and ball release speed (significance pResults: There was no statistically significant relationship between knee joint reposition error in the pre-defined (n=21) or bowling specific (n=11) knee angles and ball release speed. The ability of bowlers to reposition their knee angles were also not related to the measured knee angles at ball release or front foot placement.
Conclusion: It is likely that static knee joint position sense is not a major predictor of the dynamic knee angle during the bowling action, or of ball release speed in a homogenous group of competitive bowlers. Although other mechanisms, which are known to operate dynamically, may contribute to knee angles and bowling speeds, it is possible that leg specific proprioception does not play a major role in determining knee angles and bowling speeds.

Management  of  patients  with  rotator  cuff  myofascial  pain syndrome varies  and  successful  intervention  is  dependent  on accurate assessment. The aim of this case report is to show the importance of accurate assessment  and  clinical  reasoning  in  the  physiotherapeutic management  of a  patient  suffering  from  ante-cubital  and  anterior shoulder  pain.  The  patient was  referred  for  physiotherapy  after proving refractory  to  treatment  with  non-steroidal anti-inflammatory medication. The physiotherapist diagnosed a rotator cuff myofascial pain syndrome and treatment proceeded on that basis. Treatment consisted of twitch-obtaining dry needling, myofascial release and exercise therapy.  The result was a change in the harryman rotator cuff functional Assessment Scale score from 22/52 to 43/52 over eight treatments. Strength was regained and subjective pain report on the visual rating scale was improved to 1/10. The case study highlights the importance of accurate assessment and consideration of alternative myofascial sources for pain even in circumstances which initially seem trauma related. Precise diagnosis of the cause - in this case rotator cuff myofascial pain syndrome – will result in effective treatment being administered.

The presence of low back pain (LBP) can be influenced by psychosocial  stress experienced  at  work.  The  aim  of  this  study  was  to  determine the point prevalence for LBP and the psychological stress expe-rienced at work as a factor associated with the presence of LBP amongst staff  employed  at  district  hospital  in  Pretoria,  Gauteng,  South  Africa.  A  self-administered questionnaire was  completed  by  all  participants. Results indicated that the point prevalence for LBP was 47.46%. Sixty five point five seven percent of employees who experienced stress at work all the time, suffered from LBP (p=0.001). Stress experienced at work all the time increased the risk of LBP (OR 3.47 CI 1.46 ; 8.23).  A clinical recommendation resulting from this study is that healthcare providers need to include the provision of education, support and appropriate  referral for patients who perceive themselves to have high levels of stress.

The aim of this case report is to describe the use of physio-therapy interventions in a patient diagnosed with cervicogenic headache(CGH) and temporomandibular dysfunction (TMD). This case study involveda 26 year old male. The subject’s cervical and temporomandibular joint(TMJ) active range of movement; passive accessory movements; headacheintensity, periodicity and response to analgesics; TMJ clicking and discomfort;Numerical Pain Rating Scale (NPRS) scores, were assessed on initial assessment and on discharge 14 weeks later. The physiotherapy interventionincluded cervical and TMJ mobilisation (Maitland approach); trigger pointtherapy and massage; strengthening of the deep cervical neck flexors and scapulothoracic muscles; and posture correction. The subject improved on all outcome measures and was discharged after nine physiotherapy sessions, withfull cervical and TMJ range of movement, improved muscle strength and decreased headache intensity and frequency.This case describes a positive outcome for a patient diagnosed with cervical headaches and temporomandibular dysfunction in which physiotherapy interventions aimed at correcting joint dysfunction, myofascial pain and decreased muscle strength were used effectively.

Low back pain can be infl uenced by demographic, lifestyle and co-morbid factors, but there are few studies on the relationship between these in South African hospital employees. This crosssectional study aimed to determine the point prevalence for low back pain and the factors associated with its presence amongst staff employed at a district hospital in Gauteng, South Africa. A self-administered questionnaire was used. Results indicated a point prevalence of 47.46%. Only female gender was associated with increased risk of low back pain (OR 1.67 CI 1.04 ; 2.69) while for the lifestyle factors, participation in physical activity especially in the form of group exercises was a protective factor (OR 1.66 CI 1.02 ; 2.70). Stress experienced at work all the time increased the risk (OR 3.47 CI 1.46 ; 8.23). Clinical recommendations include special occupational adaptation for females and the incorporation of physical activity, especially group exercise, and stress management strategies into low back pain management programmes.