- Email: [email protected]
World Cup fever—Germany 2006—the beautiful game?
ARTICLE IN PRESS
Physical Therapy in Sport 7 (2006) 56–57 www.elsevier.com/locate/yptsp
Editorial
World Cup fever—Germany 2006—the beautiful game? The great football circus that is the World Cup is due to kick off on the 9th June in the host nation Germany. This global sporting extravaganza arises passion and spectating figures to a level only witnessed in football every 4 years. People who may not express much of an interest in this sport during regular domestic seasons get carried away with national pride and expectation. The media coverage during the build up to the World Cup and over the one month the matches take place will be intense and will cover many of the issues pertinent to those of us working in sport. Injuries, especially to key players will come under immense scrutiny and the man in the street will know the anatomy, pathology and recovery rates of a metatarsal fracture, for example. Indeed it can raise awkward questions for clinicians from their clients about different modalities of treatment and their benefits. Does hyperbaric oxygen therapy accelerate recovery? Do bone stimulators work? The general perception being that if a certain player is receiving a certain treatment then it must be efficacious and why is not generally available? The usual mantra being that if it is good enough for ‘so and so’ it is good enough for me. The rationale that may be lost in this scenario is that the weekend warrior is not the same as a high profile, highly paid professional athlete. The pressure to perform means that any niggle or injury receives round the clock attention and the medical team are under pressure to get the player back on the pitch. The World Cup is the pinnacle of most footballers’ careers and the world stage gives them an opportunity to raise their profile and individual worth. In these instances ‘the normal rule book’ can be thrown out of the window, and the risk:benefit ratio assessed for each scenario. Players are used to being in the limelight and are put forward as role models with respect to their performance both on and off the pitch, and this is no less so than when players are ill or injured. Another issue that will undoubtedly be raised is that players play too much football, leading to fatigue, injury and burn-out. Much will be made in the Northern hemisphere that the World Cup comes at the end of a season when players are tired and yet there has been no suggestion of ending the regular season much earlier 1466-853X/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.ptsp.2006.03.002
during a World Cup year. Comparisons will be made between different leagues with respect to the numbers of games played. There will be a call for a break in the season, like the winter break that occurs in the Italian League. However, there is no evidence yet to suggest that this reduces injury rates. The World Cup is truly a world event with 32 teams from 6 continents, and teams are vigorously supported by large numbers of travelling supporters. Whilst rivalry between opposing fans is a given in football, the tournament presents an example of how sport can bring the world together and transcend religious and territorial squabbles that otherwise seem to dominate the world stage. Politicians will attempt to hijack events for their own gain, but hopefully the beautiful game will defeat all the side issues. To the minority who will be working there and to the majority who will be watching, let’s hope Germany 2006 is a huge success and presents all the positive aspects of the beautiful game. Continuing with the football theme, the first piece of original research in this issue is presented by Parry and Drust. Availability to train and play can be influenced by a number of factors apart from injury, such as suspension, illness and personal reasons. Data was collected from an English Division One soccer club over two consecutive seasons to ascertain whether injury was the major single factor why players were unavailable. However, illness and suspensions combined accounted for 1 in 4 incidents of players not being available for first team selection. The authors discuss these factors and suggest recommendations to reduce the frequency of these non-injury-related events. The authors also discuss some of the issues related to collecting injury data in soccer. readers may be interested to read a consensus statement that has subsequently been published by Fuller et al. (2006) that tackles (no pun intended) injury definition and methodological issues related to injury statistics in soccer. Landing from a jump is a common mechanism for knee injury, and a number of biomechanical risk factors have been identified in the literature. Louw and colleages present a pilot study on the intervention of a 6-week neuromuscular exercise programme in
ARTICLE IN PRESS Editorial / Physical Therapy in Sport 7 (2006) 56–57
adolescent basketballers. The emphasis of the programme was on good technique and the programme is described in detail. At the end of the programme, the researchers reported improvements in biomechanical outcomes during the execution of landing from a jump shot, compared to a control group who had no intervention. The findings suggest that neuromuscular exercise may have a role to play in injury prevention and this study adds to the evidence reported in adult athletes. Clinicians commonly employ different modes of heating to increase soft tissue extensibility. In this issue Meakins and Watson compare the thermal effects of conductive heating (using a hot water bottle) and Longwave ultrasound (LWUS) on ankle mobility using a non-injured achilles tendon model. Whilst results showed that both methods had a significant improvement in the range of motion of dorsiflexion, as measured by a weight bearing lunge test, the conductive heating method demonstrated a trend to be more effective. The authors discuss the relative merits of using a clinicians valuable time when potentially the same effect can be achieved with a home/self treatment application. However, as the dose/response effects of both types of ultrasound (MHz and LWUS) continue to be debated, this paper shows that a 10 min application of LWUS at 0.94 W/cm2 does have an effect in this instance. More clinicians are becoming involved with exercise prescription schemes for a wide variety of pathologies that vary from cardiovascular disease, obesity to conditions such as depression. The next piece of original research by McWhorter and colleagues evaluates the effect of loaded and unloaded, and static and dynamic activities on foot volume in healthy subjects. They found that loaded and static activities had greater increases in foot volume than their counterparts. Furthermore in the majority of cases, static cycling (unloaded and dynamic) actually had a decrease in foot volume in healthy subjects. These findings provide evidence of the type of activities/exercise that should be employed for patients who have compromised venous return. This would include those with lower limb musculoskeletal injury associated with oedema. Preferential activation of vastus medialis oblique (VMO) would be desirable in an exercise regimen for subjects presenting with patellofemoral pain. Herrington and colleagues investigate the effect of gender, hip position, mode of exercise and type of contraction on the overall muscle activity of VMO and vastus lateralis in healthy subjects. They found significantly greater activity in both muscles with concentric rather than eccentric exercise, but the other variables had no
57
effect in this instance. The authors discuss several key points with regard to this field of research, namely the different ways of quantifying muscle activity/activity ratio, whether this should be assessed at joint specific angles and, as with all studies on healthy subjects whether subjects with pathology demonstrate different behaviour. The penultimate paper in this issue is presented by Johanson and colleagues who investigated the effects of gastrocnemius stretching on ankle ROM and a functional parameter of the gait cycle in a sample of subjects demonstrating lower limb overuse syndrome(s). The sample was randomised into an intervention and nonintervention group, the intervention being a passive stretch in a NWB position held for 30 s, with 5 repetitions on each leg and a 5 s rest period between each repetition, twice a day for 3 weeks. The results showed an increase in passive range of dorsiflexion in the intervention group. However, there was no comparable change in ankle dorsiflexion or time to heel-off during the stance phase of gait. Hamstring injury, or rather recurrent injury, continues to provide a clinical challenge. Evidence is emerging for effective preventative programs, and Verrall, Slavotinek, and Barnes (2005) demonstrated this with an Australian Rules football team. The causes for injury are often cited as multi-factorial, but the relative importance of these various risk factors is less clear. Foreman and colleagues present a systematic review of the evidence for predisposing factors related to hamstring injury in sport. This will make interesting reading for anyone involved with screening, prevention and rehabilitation in this area. That’s all for this issue, enjoy the football. References Fuller, C. W., Ekstrand, J., Junge, A., Andersen, T. E., Bhar, R., Dvorak, J., Hagglund, M., McCrory, P., & Meeuwisse, W. H. (2006). Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. British Journal of Sports Medicine, 40, 193–201. Verrall, G. M., Slavotinek, J. P., & Barnes, P. G. (2005). The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players. British Journal of Sports Medicine, 39, 363–368.
Editor Zoe Hudson E-mail address: [email protected].
Physical Therapy in Sport 7 (2006) 56–57 www.elsevier.com/locate/yptsp
Editorial
World Cup fever—Germany 2006—the beautiful game? The great football circus that is the World Cup is due to kick off on the 9th June in the host nation Germany. This global sporting extravaganza arises passion and spectating figures to a level only witnessed in football every 4 years. People who may not express much of an interest in this sport during regular domestic seasons get carried away with national pride and expectation. The media coverage during the build up to the World Cup and over the one month the matches take place will be intense and will cover many of the issues pertinent to those of us working in sport. Injuries, especially to key players will come under immense scrutiny and the man in the street will know the anatomy, pathology and recovery rates of a metatarsal fracture, for example. Indeed it can raise awkward questions for clinicians from their clients about different modalities of treatment and their benefits. Does hyperbaric oxygen therapy accelerate recovery? Do bone stimulators work? The general perception being that if a certain player is receiving a certain treatment then it must be efficacious and why is not generally available? The usual mantra being that if it is good enough for ‘so and so’ it is good enough for me. The rationale that may be lost in this scenario is that the weekend warrior is not the same as a high profile, highly paid professional athlete. The pressure to perform means that any niggle or injury receives round the clock attention and the medical team are under pressure to get the player back on the pitch. The World Cup is the pinnacle of most footballers’ careers and the world stage gives them an opportunity to raise their profile and individual worth. In these instances ‘the normal rule book’ can be thrown out of the window, and the risk:benefit ratio assessed for each scenario. Players are used to being in the limelight and are put forward as role models with respect to their performance both on and off the pitch, and this is no less so than when players are ill or injured. Another issue that will undoubtedly be raised is that players play too much football, leading to fatigue, injury and burn-out. Much will be made in the Northern hemisphere that the World Cup comes at the end of a season when players are tired and yet there has been no suggestion of ending the regular season much earlier 1466-853X/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.ptsp.2006.03.002
during a World Cup year. Comparisons will be made between different leagues with respect to the numbers of games played. There will be a call for a break in the season, like the winter break that occurs in the Italian League. However, there is no evidence yet to suggest that this reduces injury rates. The World Cup is truly a world event with 32 teams from 6 continents, and teams are vigorously supported by large numbers of travelling supporters. Whilst rivalry between opposing fans is a given in football, the tournament presents an example of how sport can bring the world together and transcend religious and territorial squabbles that otherwise seem to dominate the world stage. Politicians will attempt to hijack events for their own gain, but hopefully the beautiful game will defeat all the side issues. To the minority who will be working there and to the majority who will be watching, let’s hope Germany 2006 is a huge success and presents all the positive aspects of the beautiful game. Continuing with the football theme, the first piece of original research in this issue is presented by Parry and Drust. Availability to train and play can be influenced by a number of factors apart from injury, such as suspension, illness and personal reasons. Data was collected from an English Division One soccer club over two consecutive seasons to ascertain whether injury was the major single factor why players were unavailable. However, illness and suspensions combined accounted for 1 in 4 incidents of players not being available for first team selection. The authors discuss these factors and suggest recommendations to reduce the frequency of these non-injury-related events. The authors also discuss some of the issues related to collecting injury data in soccer. readers may be interested to read a consensus statement that has subsequently been published by Fuller et al. (2006) that tackles (no pun intended) injury definition and methodological issues related to injury statistics in soccer. Landing from a jump is a common mechanism for knee injury, and a number of biomechanical risk factors have been identified in the literature. Louw and colleages present a pilot study on the intervention of a 6-week neuromuscular exercise programme in
ARTICLE IN PRESS Editorial / Physical Therapy in Sport 7 (2006) 56–57
adolescent basketballers. The emphasis of the programme was on good technique and the programme is described in detail. At the end of the programme, the researchers reported improvements in biomechanical outcomes during the execution of landing from a jump shot, compared to a control group who had no intervention. The findings suggest that neuromuscular exercise may have a role to play in injury prevention and this study adds to the evidence reported in adult athletes. Clinicians commonly employ different modes of heating to increase soft tissue extensibility. In this issue Meakins and Watson compare the thermal effects of conductive heating (using a hot water bottle) and Longwave ultrasound (LWUS) on ankle mobility using a non-injured achilles tendon model. Whilst results showed that both methods had a significant improvement in the range of motion of dorsiflexion, as measured by a weight bearing lunge test, the conductive heating method demonstrated a trend to be more effective. The authors discuss the relative merits of using a clinicians valuable time when potentially the same effect can be achieved with a home/self treatment application. However, as the dose/response effects of both types of ultrasound (MHz and LWUS) continue to be debated, this paper shows that a 10 min application of LWUS at 0.94 W/cm2 does have an effect in this instance. More clinicians are becoming involved with exercise prescription schemes for a wide variety of pathologies that vary from cardiovascular disease, obesity to conditions such as depression. The next piece of original research by McWhorter and colleagues evaluates the effect of loaded and unloaded, and static and dynamic activities on foot volume in healthy subjects. They found that loaded and static activities had greater increases in foot volume than their counterparts. Furthermore in the majority of cases, static cycling (unloaded and dynamic) actually had a decrease in foot volume in healthy subjects. These findings provide evidence of the type of activities/exercise that should be employed for patients who have compromised venous return. This would include those with lower limb musculoskeletal injury associated with oedema. Preferential activation of vastus medialis oblique (VMO) would be desirable in an exercise regimen for subjects presenting with patellofemoral pain. Herrington and colleagues investigate the effect of gender, hip position, mode of exercise and type of contraction on the overall muscle activity of VMO and vastus lateralis in healthy subjects. They found significantly greater activity in both muscles with concentric rather than eccentric exercise, but the other variables had no
57
effect in this instance. The authors discuss several key points with regard to this field of research, namely the different ways of quantifying muscle activity/activity ratio, whether this should be assessed at joint specific angles and, as with all studies on healthy subjects whether subjects with pathology demonstrate different behaviour. The penultimate paper in this issue is presented by Johanson and colleagues who investigated the effects of gastrocnemius stretching on ankle ROM and a functional parameter of the gait cycle in a sample of subjects demonstrating lower limb overuse syndrome(s). The sample was randomised into an intervention and nonintervention group, the intervention being a passive stretch in a NWB position held for 30 s, with 5 repetitions on each leg and a 5 s rest period between each repetition, twice a day for 3 weeks. The results showed an increase in passive range of dorsiflexion in the intervention group. However, there was no comparable change in ankle dorsiflexion or time to heel-off during the stance phase of gait. Hamstring injury, or rather recurrent injury, continues to provide a clinical challenge. Evidence is emerging for effective preventative programs, and Verrall, Slavotinek, and Barnes (2005) demonstrated this with an Australian Rules football team. The causes for injury are often cited as multi-factorial, but the relative importance of these various risk factors is less clear. Foreman and colleagues present a systematic review of the evidence for predisposing factors related to hamstring injury in sport. This will make interesting reading for anyone involved with screening, prevention and rehabilitation in this area. That’s all for this issue, enjoy the football. References Fuller, C. W., Ekstrand, J., Junge, A., Andersen, T. E., Bhar, R., Dvorak, J., Hagglund, M., McCrory, P., & Meeuwisse, W. H. (2006). Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. British Journal of Sports Medicine, 40, 193–201. Verrall, G. M., Slavotinek, J. P., & Barnes, P. G. (2005). The effect of sports specific training on reducing the incidence of hamstring injuries in professional Australian Rules football players. British Journal of Sports Medicine, 39, 363–368.
Editor Zoe Hudson E-mail address: [email protected].