Clinical assessment of the lumbar spine

Clinical assessment of the lumbar spine

Abstracts / Journal of Science and Medicine in Sport 14S (2011) e1–e119 of central neurotransmission in the heat might contribute to elucidate the me...

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Abstracts / Journal of Science and Medicine in Sport 14S (2011) e1–e119

of central neurotransmission in the heat might contribute to elucidate the mechanisms of fatigue. Studies from our lab showed that DA significantly enhanced performance, coinciding with the attainment of high core temperatures and heart rates, without any change in thermosensation and in the perception of effort.2,3 In contrast, increased brain concentration of Noradrenaline (NA) strongly decreased performance in the heat and no effect of 5-HT could be detected.4,5 Thermal regulation appears to be an important factor that will mainly be influenced by brain DA and NA in the PO/AH, although the exact role of other neurotransmitter systems is not clear so far.6 It is very unlikely that one neurotransmitter system is responsible for the appearance of central fatigue. Most probably central fatigue is caused by a complex interplay between the different neurotransmitters systems, with the most important role for the catecholamines DA and NA. Although work to date has given us clear observations on external behavioural changes after pharmacological interventions, the exact role of the different brain areas linked to exercise capacity and thermoregulation have yet to be elucidated.

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INVITED, Thursday 20 October, 1100–1230, Orion & Pleiades Room 8 The case of the water polo player’s shoulder—Clinical reasoning, assessment and management M. Magarey School of Health Science, University of South Australia, Australia A national level water polo player presented with a long term painful shoulder that was significantly interfering with her ability to both swim and throw, particularly shooting for goal. She has had extensive physiotherapy management over many years, evaluation by a number of expert water polo physiotherapists and management in the context of training and competition tours. This paper will explore the reasoning associated with the player’s presentation and management over a three month period, including medical, imaging and surgical considerations. doi:10.1016/j.jsams.2011.11.010

References

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[1]. Meeusen R, Watson P, Hasegawa H, et al. Central fatigue. The serotonin hypothesis and beyond. Sports Med 2006;36(10):881–909. [2]. Watson P, Hasegawa H, Roelands B, et al. Acute dopamine/noradrenaline reuptake inhibition enhances human exercise performance in warm, but not temperate conditions. J Physiol 2005;565(Pt 3):873–883. [3]. Roelands B, Hasegawa H, Watson P, et al. Acute DA reuptake inhibition enhances performance in warm but not temperate conditions. Med Sci Sports Exerc 2008;40(5):879–958. [4]. Roelands B, Goekint M, Heyman E, et al. Acute norepinephrine reuptake inhibition decreases in normal and high ambient temperature. J Appl Physiol 2008;105(1):206–212. [5]. Roelands B, Goekint M, Buyse L, et al. Time trial performance in normal and high ambient temperature: is there a role for 5-HT? Eur J Appl Physiol 2009;107(1):119–126. [6]. Hasegawa H, Ishiwata T, Saito T, et al. Inhibition of the preoptic area and anterior hypothalamus by tetrodotoxin alters thermoregulatory functions in exercising rats. J Appl Physiol 2005;98(4):1458–1462.

Clinical assessment of the lumbar spine

夽 Qualisys

supported speaker.

doi:10.1016/j.jsams.2011.11.009

J. Saunders Sydney University Medical School, Australia The approach to assessing a patient with a lumbar spine problem often is very dependent on the craft group of the assessor. Manual therapists will be interested in things that do or do not move, EP’s in strength and gait cycle imbalances, surgeons with nerve compression and physicians with excluding disease (bone, inflammatory, metastatic). That is systematic practitioners will tend to follow the model of pain that they know (mechanical, inflammatory, degenerative, psychosocial). General practitioners are therefore often surrounded in confusion. It is important as a member of a team looking after athletes (industrial athletes) or active people that we learn from each other about significant components of physical assessment that maybe relevant to this particular individual. HISTORY: Mechanism (or lack of) injury can be important as it may well suggest which structure was injured. “I slipped downstairs and landed on my back.” Is this statement adequate? Is there more you would like to know? Age gender past incidences of low back pain, activities are all important. THINGS YOU SHOULD NOT MISS! How can you build into your consultation these important clues that this may be a serious disease?? What aspects of history, physical examination and imaging are important here? THINGS YOU SHOULD KNOW! Should an exercise physiologist know how to identify a stress fracture of the

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Abstracts / Journal of Science and Medicine in Sport 14S (2011) e1–e119

pars interarticularis? Should a physician be able to recognise lack of intervertebral movement? Should a surgeon be able to recognise lack of TA/multifidus strength? SO HOW CAN ALL THIS BE ACHIEVED IN ONE CONSULTATION: The use of a systematic system or sheet may aid to reminding us to carry out simple screening tests in all the facets that we need to know. I will present a systematic system of history taking and physical examination that encompasses ALL the categories of problems that may occur with the lower back and share this with audience members. doi:10.1016/j.jsams.2011.11.011 SYMPOSIUM, Thursday 20 October, 1100–1230, Carnac Room

doi:10.1016/j.jsams.2011.11.012

10 Developing evidence-informed exercise guidelines to prevent lower limb injuries among community Australian Football players—The NoGAPS project C. Finch 1,∗ , P. Donaldson 1

Paper 1 The design of a study to better understand facilitators and barriers towards safety guideline uptake – the NoGAPS project. Paper 2 Where should community Australian Football invest in injury prevention? A review of over 30 years of injury reports. Paper 3 What is the evidence-base for exercise as a lower limb injury prevention strategy in community Australian Football? Paper 4 Translating the scientific evidence for preventing lower limb injuries into training guidelines: the role of mechanistic versus clinical versus epidemiological studies. Paper 5 Gaining expert consensus on lower limb injury prevention exercise guidelines for community Australian Football – the NoGAPS project.

White 1 , N.

Andrew 2 , D.

Lloyd 3 , A.

1 Australian

Centre for Research into Injury in Sport and its Prevention (ACRISP), Australia 2 Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Australia 3 Musculoskeletal Research Program, Griffith Health Institute, Griffith University, Australia Translating scientific evidence about effective interventions into evidence-based, useful and useable guidelines for community sport is one of the biggest challenges facing the sports injury prevention research community. The aim of this symposium is to shed some light on how to approach this challenge by presenting a series of papers based on Phase 1 of the NHMRC-funded National Guidance for Australian (football) Partnerships and Safety (NoGAPS) partnership project. The symposium will begin with an overview of the project including a description of the study protocol. This will be followed by two papers reporting the results of reviews of the literature—the first of these will describe the epidemiological profile of lower limb injuries in community Australian Football, while the second will outline the evidence-base for exercise as a lower limb injury prevention strategy in community Australian Football. The fourth presentation will focus on the process of translating various forms of scientific evidence into guidelines for use in community sport. The final paper will describe and present the findings of an expert consultation process designed to ensure the developed guidelines are contextually relevant and supported by the opinion leaders in the field. The symposium will conclude with an interactive discussion with the audience.

11 The design of a study to better understand facilitators and barriers towards safety guideline uptake—The NoGAPS project C. Finch 1,∗ , B. Gabbe 2 , D. Lloyd 3 , J. Cook 4 , W. Young 5 , M. Nicholson 6 , H. Seward 7 , A. Donaldson 1 , T. Doyle 8 , P. White 1 1 Australian

Centre for Research into Injury in Sport and its Prevention (ACRISP), Australia 2 Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Australia 3 Musculoskeletal Research Program, Griffith Health Institute, Griffith University, Australia 4 Department of Physiotherapy, School of Primary Health Care, Monash University, Australia 5 School of Human Movement and Sport Sciences, University of Ballarat, Australia 6 Centre for Sport and Social Impact, La Trobe University, Australia 7 Australian Football League Medical Officers Association, Australia 8 Human Protection and Performance Division, Defence Science Technology Organisation, Fishermens Bend, Victoria, Australia Background: Limited information exists about how best to conduct intervention implementation studies in community sport settings. It is clear that considerable research effort needs to be directed towards understanding the context within which evidence-based injury prevention interventions are to be implemented, whilst continuing to build the evidence-base for the effectiveness of sports injury interventions. Methodology: The NoGAPS project is the first large-scale international study to identify factors that influence the translation of evidence-based injury prevention interventions into practice in community sport and to explore their adoption by