Today I attended the annual meeting of the Swiss Sports Physiotherapy association (@SportfisioSwiss), Sportfisio.ch.
The organization is led by fantastic open-minded physiotherapists, amongst others: President Stephan Meyer, head of sports physio at Swiss Federal Institute for Sports in Magglingen (and my colleague there) and long-time physio for the Swiss National Football team. Mario Bizzini of FIFA 11+ fame, from the Schulthess Klinik in Zürich. Nicolas Mathieu, professor of sports physio at the Higher Education School of Canton Valais. Suzanne Gard, @SuzanneGard, physiotherapist at Swiss Olympic medical center at Geneva university hospital and National delegate at EUSSER.
This one day meeting brings together great speakers from the world of sports physio, conditioning, science and medicine, and this year was no exception. Here is the program.
Aside from the usual excellent networking opportunities and discussions with passionate sports health professionals, here are a few key points I took away from the various presentations:
- Shirley Sahrmann of Washington University, St.Louis (USA)
Shirley first reminded the audience that physiotherapy needs to be understood as expertise I human movement systems, beyond simple pathology treatment and anatomical labels.
She presented the concomitant joint movements in the lumbo-pelvic area linked to mobilization of the lower limbs (knee flexion, hip flexion), and how these are caused by muscle chain flexibility issues not related to simple muscle length. This she describes as intra- and inter-joint relative flexibility issues. As the knee is flexed in a prone position, pelvic rotation occurs earlier in LBP patients and it happens before the quadriceps muscle has been completely elongated, indicating the coupling of muscle chains. In this case of imbalanced relative passive stiffness of muscles, stretching of the quadriceps will not be effective, whereas restoration of movement control at the lumbo-pelvic area through anterior wall activation will. These faulty movement patterns are replicated in everyday life and it may well be that a better conscience of these altered movement patterns might suffice to reduce chronic low back pain, as many practitioners experience on a regular basis.
- Dianne Andreotti (SMARTERehab)
Dianne presented 2 key messages:
– The coupling of tactile discrimination ability and muscle strength generation. Muscle fiber recruitment can be at fault in weakness of inadequate muscle activation patterns, which ca be corrected by simple two-point discrimination training, or TENS application, showing the links between sensory and motor pathways.
– The identification of primitive reflexes in adults and how these can be indicative of faulty movement and responsible of chronic pain or recurring injuries, mostly addressing hamstrings. These primitive reflexes are normally occurring in the newborn and tend to disappear. The Landau reflex is a good example: lying prone and arms extended to the front, the patient is asked to lift arms, shoulders and head. This should happen without concomitant hamstrings activation and hamstrings-driven hip extension, which would be indicative of faulty recruitment and elevated tone linked to chronic or recurring conditions. It becomes then important to actively and consciously repeat the muscle activation (hold contraction for 5-10 sec) in order to decrease muscle tone in the hamstrings.
The relevance of these motor control and recruitment patterns are not precisely known and I am particularly interested in the role this might play in hamstrings injury prevention. As we conduct reinforcement programs (like the Nordic hamstring drill), we face conflicting results in various studies about its efficacy. Might it be that these motor patterns should be addressed first before a strengthening program can have a chance to be effective in injury prevention? In other words, should we move away from strength-only programs?
- Michael Romann (Swiss Federal Institute for Sports, Magglingen)
Michael is a sports scientist with interest in talent identification and athlete development. His research focuses on biological maturation in young athletes, mostly in soccer. He presented the relative age effect (RAE), the prevalence of athletes born in the first quarter of the year in elite soccer teams starting at U15 level: more than 50% of the athletes are born form January 1st to March 21st. The other aspect is early- vs late-maturers and how important it is to screen for maturation using either gold standard hand X-ray, or none irradiating Mirwald formula (combining standing and sitting height).
- Prof. Peter McNair (Auckland, New Zealand)
In 2 talks, Prof. McNair addressed joint pathology, starting with arthrogenic muscle inhibition (AMI) as an early consequence of joint aggression, be it surgical or traumatic. AMI consists of a reduced capacity for muscle activation (20 to 40% reduction) resulting in strength deficit and atrophy. It occurs early on but persists for month and even years.
In the PT management, he recommends working at low knee angles, where joint pressure is minimal (20 to 40 degrees max) and he reminds us of the benefits of joint (not muscle) icing before and during exercises, TENS to enhance muscle activation and muscle strength build-up, and mentions studies showing efficacy of ibuprofen treatment in the effusion/AMI phase. Intra-joint (knee) corticosteroid injection seems to provide benefits as well, although I would be reluctant to use it early on. After all, this joint reaction early after 
surgery may be there for a reason, and it may not be optimal to absolutely get rid of it (that was Shirley Sahrmann’s question). Also, never forget that activation deficit are bilateral and comparing with the uninjured side may falsely reassure about progresses made.
In his second talk, he looked at young to middle-aged active patients with early-onset knee OA, insisting on the necessity to work on strength, high loads being more beneficial, alongside with cardiovascular training.
- Nicola Maffiuletti (Schulthess Klinik, Zürich)
Brilliant talk on quadriceps inhibition post surgery, building on the previous talk by Prof. McNair, Nicola brought concepts, evidence and practical applications for the management of muscle activation deficits. He looked at 5 areas:
– Contralateral training, using the brain’s ability to integrate unilateral signals and stimulate excitation of both spinal anterior horns. Start 7 days post-op, 20 min per day, 80% 1RM, 5×6 reps (2 min recovery), conc-eccentric (Papandreou M et al, 2013).
– 
Mental training: using sports psychology long known techniques of mental imagery and direct observation, both known to activate brain cortical motor areas (fMRI) and enhance muscle activation. Start in the 2nd week, 15 min/day, 3 sets of 10 imagined maximal knee isometric extensions (Lebon F. et al, 2012).
– Neuromuscular electrical stimulation: optimization with device improvement through wide-pulse and multipath stimulation (Hortobagyi and Maffiuletti 2011).
– Eccentric training: with different new devices available, it makes it easier to implement and a 6 to 12 week program can safely bring to excellent strength improvements (LaStayo P. et al, 2014).
– Ballistic training: rapid low load movements are the best in his opinion (no references provided there) to elicit optimal muscle recruitment and activation.
6. Carla Stecco (University of Padova, Italy)
Carla has conducted facsinating research on anatomical question around muscle fascias and their role in modulating muscle mobility and strength. Beautiful anatomy lesson and food for thought about tissues that may play more than a passive role.
Really enjoyed the whole day, and the organizers had the pleasure to announce next year’s 1st international #sportphysio conference in Bern, Switzerland, around ReturnToPlay (RTP) issues with an impressive line-up, November 20-21 2015. Book the date, it is going to be an exceptional conference.
Thanks to @SportfisioSwiss and see you all there in a year!
DrSportSante
