Injury Prevention in Netball

With Netball taking over as the main focus sport next term within the School I work, I felt it necessary to make a review of the current literature regarding injury prevention in Netball players

Proactive or reactive

Netball involves rapid acceleration, deceleration, and directional changes which place considerable forces through articular and periarticular structures, similar to other field and court sports ¹. A high rate of overuse injuries occur among both elite and amateur players; lower back, ankle, knee and the shoulder are sites of the most consistent injuries, with injuries from the lower limbs coming from repeated impacts with hard surfaces during landing, hopping and, to a lesser degree, when pivoting. Young people especially are at particular risk of sports injury because of high levels of exposure at a time of major physiological change ². Although fewer lower-limb injuries occur in junior players ³, incidence of injuries from falls at 35% suggests that such injuries could be due to poor balance or a lack of other key movement skills ⁴.

It is important therefore to understand the frequency and nature of sports injuries at the youth level to assist in the development of effective injury prevention strategies. Once again the role of any Strength & Conditioning/athletic development coach is to get the athlete fit and ready to take the field of play.

Even national squad multi-disciplined teams have confessed to being reactive rather than proactive with regards to the injury prevention/strength & conditioning programme of its Netball structure ⁵. Previous attempts of being proactive include the use of ankle or knee guards but without a detailed strength and conditioning programme alongside; this shows a lazy approach to injury prevention. The evidence is uncertain regarding the use of knee braces, although there is some evidence from cadaver studies that knee bracing does offer protection to knee ligaments under external load ⁶. This effect may not carry over to the high-velocity, multidirectional forces encountered during sporting activity, such as Netball. What is becoming clear is that there is significant and consistent evidence in the literature to support the use of injury-prevention strategies in adolescents that include preseason conditioning as well as functional training, education, strength and balance programmes that are continued throughout the playing season ⁷.

Screening

The effects of screening players, both before and throughout the season has several advantages; highlighting injury risk of players, physiological imbalances and the progress of fitness development. In addition, the act of screening players can develop self-evaluation/awareness of their own anatomy, body mechanics and the purpose of specific aspects of their training.

Upon working with a handful of Netball players this term; some were unable to control a basic lunge or squat movement under body weight conditions, yet were loading these movements in a gym situation. This caused compensation strategies and accentuated stress on areas of relative flexibility, where injuries appeared. By screening these elements separately, it is possible to demonstrate to players and coaching personal the reasons for these problems, as well as laying foundations for the changes that would be necessary to overcome them. An example of a progressive screening could be: Single leg balance-single leg squat-dynamic hopping with turning in the air. This example looks to screen for possible knee ligament tear/sprains of which are consistent with an inability to counterbalance external torque/rotation when landing or pivoting.

Hypermobility

Hypermobility or generalised joint laxity is defined as a condition in which most of an individual’s synovial joints have a range of motion beyond normal limits. The prevalence of hypermobility in schoolchildren has been estimated to be 13–27%⁸, with a higher prevalence in girls than boys ⁹. In some sports, hypermobile joints may be associated with a performance advantage—for example, spin bowlers in cricket, gymnasts, and ballerinas. However, previous studies have revealed an increased incidence of musculoskeletal complaints such as arthralgias, joint subluxations, joint dislocations, and sprains in sportsmen with hypermobile joints ¹⁰.

Hypermobility in the knee joint-a risk factor for potential knee ligament injuries

The Beighton index gives an overall composite score of 0–9 with regards to joint hypermobility and can also be categorised into three groups: 0–2 (not hypermobile); 3–4 (moderately hypermobile); 5–9 (distinctly hypermobile) ¹¹. Not surprising that the indices of injury rates increase alongside the increase in the Beighton index. But researchers still argue whether this is a cause or effect scenario due to the cross sectional method of most of the research. What seems to be more conclusive is that patients with hypermobility syndrome have been shown to have impaired joint proprioception in both the knee and finger joints ¹². This impaired proprioception may not just account for an increase in acute injuries, but may also explain the increased incidence of secondary degenerative osteoarthritis seen in hypermobile joints ¹³.

Risk factors for Netball related injuries

Not warming up before a game. A simple precaution but still not adhered to by some coaches. One study found that only 60% of netballers reported warming up before training and the game! Previous studies have shown that the range of movement of a joint can be different before and after a warm up ¹⁴. This is very important when you consider the amount of joint related injuries in Netball. Participants who reported training for at least 4 h/week had significantly fewer injures than those who trained for <4 h/week ¹⁵. However, it should be noted that the quality of training should always outweigh the quantity of it.

Although disagreement still surrounds the most effective warm up for Netball, and indeed most sports, I have included some necessary key points when designing any warm up:

-           Make it fun

-           Include multi directional changes of direction

-           Provide an environment for players to develop decision making-don’t just go through the routine

-           Mimic the sport to a degree in the warm up; if you’re preparing for a rugby game-contact has to be essential. Cricket = catching and throwing the ball from a variety of different body positions

Conclusion

Injury prevention strategies should seek to reduce the incidence of common injuries in netball by gaining and understanding the mechanisms associated with each of these injuries. Training programs should be specific to netball and focus on demands of the games. Skills and movement patterns of individual positions during game play should form the basis of these programs. All injury prevention programs, resources and strategies should be produced in formats that encourage coaches and players from all levels of competition to take them up. It may also be appropriate to investigate if injury prevention models that have proven effective in other sports could be extrapolated to netball. Lastly, education, both from a coach and player perspective, is vital if injury prevention programmes are going to be successful in the long term.

References

1.      Smith, R., Damodaran, A. K., Swaminathan, S., Campbell, R., Barnsley, L. (2005). Hypermobility and sports injuries in junior netball players. British Journal of Sports Medicine, 39(9), 628–631.

2.      Lidqvist, K. S., Timpka, T., Bjurulf, P. (1996) Injuries during leisure physical activity in a Swedish municipality. Scandinavian Journal of Social Medicine, 24, 282–92.

3.      Finch, C., Valuri, G., Ozanne-Smith, J. (1998). Sport and active recreation injuries in Australia: evidence from emergency department presentations. British Journal of Sports Medicine, 32(3), 220–225.

4.       Routley, V. (1991).Sports injuries in children-the five most commonly presented sports. Hazard, 9,1–8.

5.      Elphinstona, J & Hardman, S. L. (2006). Effect of an integrated functional stability program on injury rates in an international netball squad. Journal of Science and Medicine in Sport, 9(1), 169—176.

6.      Paulos, L. E., Cawley, P. W., France, E. P. (1991). Impact biomechanics of lateral knee bracing. The anterior cruciate ligament. American Journal of Sports Medicine, 19(4), 337–342.

7.      Abernethy, L., & Bleakley, C. (2007). Strategies to prevent injury in adolescent sport: a systematic review.  British Journal of Sports Medicine, 41(10), 627–638.

8.      Van der Giessen, L. J., Liekins, D., Rutgers, K. J. (2001). Validation of Beighton score and prevalence of connective tissue signs in 773 Dutch children. The Journal of Rheumatology, 28, 2726–2730.

9.      Larsson, L. G., Baum, J., Mudholkar, G. S. (1987). Hypermobility: features and differential incidence between the sexes. Arthritis & Rheumatism, 30(12), 1426–1430.

10.  Finsterbush, A., Pogrund, H. (1982). The hypermobility syndrome: musculoskeletal complaints in 100 consecutive cases of generalized joint hypermobility. Clinical Orthopaedics and Related Research, 168, 124–127.

11.   Boyle, K. L., Witt, P., Riegger-Krugh, C. (2003). Intra-rater and inter-rater reliability of the Beighton and Horan joint mobility index. Journal of Athletic Training, 38(4), 281–285.

12.  Hall, M. G., Ferrell, W. R., Sturrock, R. D., et al. (1995). The effect of the hypermobility syndrome on knee joint proprioception. British Journal of Rheumatology, 34(2), 121–125.

13.  Jonsson, H., Valtysdottir, S. T., Kjartansson, O., et al. (1996). Hypermobility associated with osteoarthritis of the thumb base: a clinical and radiological subset of a hand osteoarthritis. Annals of the Rheumatic Diseases, 55, 540–543.

14.  Bird, H. A. (2004). Rheumatological aspects of dance. The Journal of Rheumatology, 31, 12–13.

15.  McManus, A., Stevenson, M. R., & Finch, C.F. (2006). Incidence and risk factors for injury in non-elite netball. Journal of Science and Medicine in Sport, 9(1-2), 119—124.

Is It Bad For Females To Do Press Ups?

This blog is in response to a question I was asked recently by a girl at Bloxham School; ‘‘I have heard press ups can affect a women’s ability to have baby’s’’.

This is a hardly surprising question due to the way gyms market fitness for females; the majority are encouraged to stay away from the dumbbells and instead are pushed into pilates, spin classes or ‘’core stability’’ workshops! However, this will not prepare the young female athlete for an enjoyable and perhaps successful journey in sport. Strength & Conditioning/athletic development coaches should be encouraging basic bodyweight strength exercises from a young age, especially for female athletes. 

Why should female athletes invest more time in Resistance Training?

There are certain characteristics within the female physiological make up which make them more prone to injury while playing competitive sport:

Hormones: During puberty the production of estrogen in girls increases fat deposition and breast development, whereas testosterone production in boys increases bone formation and protein synthesis. Though estrogen also stimulates bone growth, boys have a longer growth period, and therefore adult men tend to achieve greater stature than adult women. Resistance training can stimulate the synthesis of growth hormone in female athletes, which aids protein synthesis.

Joint laxity: Some females have too much movement in their joints. Resistance training looks to develop key stabilising muscles around the joints.

Lower limb alignment: 

This image shows the Q angle; this is the angle formed by a line drawn from the ASIS to central patella and a second line drawn from central patella to tibial tubercle. An increased Q angle is a risk factor for patellar subluxation, while the average Q angle is 14 deg for males and 17 deg for females. Strengthening the lower limb muscles, especially the vastus medialis obliquus, can help increase the stability of the knee joint in women.

Muscle strength: When expressing strength relative to body weight, the lower body strength of women is similar to that of men, while the upper body strength of women is still somewhat less.

Ligament size: A growing amount of research has shown that females on average have smaller ligament widths when compared to male athletes. It has been speculated that smaller Anterior Cruciate Ligaments (ACL) may predispose females to ACL ruptures. Resistance training has been shown to increase the size and strength of tendons and ligaments, especially in the lower limbs. This takes on even more importance when you consider female athletes are known to be 6 times more likely of injuring their ACL while participating in competitive sports.

But how does this impact on sport?

Apart from the above physiological improvements, the number one factor that strength training achieves is the ability to get the athlete onto the field of play. Staying fit and injury free has to be the main aim for any Strength & Conditioning/Athletic development coach. Strength training, if done correctly can enhance an athlete’s durability. As well as this, many sports which involve contact with the floor and falling over require sufficient levels of strength just in order to prevent upper body limb injuries from occurring.

‘‘I have heard press ups can affect a women’s ability to have baby’s’’

In conclusion, and in response to the above question, even during pregnancy resistance training is recommend to help keep mum and baby fit; as long as the load is light to moderate and the emphasis is on muscular endurance (12-15 reps). Luckily, these types of questions are few and far between at Bloxham and slowly we are starting to change the culture surrounding resistance training and its role with female athletes.

What is Dynamic Correspondence?

Here is a guest blog I wrote for Excelsior Sports performance investigating the term ''Dynamic Correspondence''.

http://www.excelsiorgroup.co.uk/blog/what-dynamic-correspondence

Look at skill development in a ladder format

Look at skill development in a ladder format

Instructive: block training/directive/instructive: one on one lineout training

Randomisation: questions/awareness: small sided games 

This is something I have put together after a coaching clinic I attended yesterday titled ''A day with Wayne Smith: Creating a World Class Attack''

Although a rugby coaching clinic this has many overlaps for coaching in general. As always please comment if you agree or would like to add more to the theory

Reflections on the first half of term

After 6 weeks of Strength & Conditioning + rugby coaching here are my initial reflections:

1) Given the opportunity, most children will attempt to eat junk food. Upon questioning their desire for crisps and snacks they reply ''but sir it is good for me, it will give me energy''. Education is needed in this area and I propose it is one of the most damaging areas for athletic development, especially with the children I work with.

2) Rugby playing teenagers believe Back and Arms day constitutes a ''hard'' session. Movements not muscles boys........

3) Teenage girls believe S&C consists of getting ''massive''. Again the media has not helped in defining this stereotype and therefore it has provided an initial struggle to get numbers to sessions, but things are going in the right direction.

4) 5th formers (15-16 years old) are at a crucial stage when it comes to their athletic development; they are becoming more aware of the gym, more aware of the ionic protein shake, more aware of body-building magazines and more aware of their ability to play a high level of sport. I coach this year group rugby at the school I work at and it has been fascinating helping them start on a right road towards their hopefully successful athletic future. However, the pressures of playing school/club/county have meant a few boys have been playing twice a week, there was even a case of 4 games within 8 days for one child!!!! Functional Overreaching or Over training!

5) Certain sports develop certain muscular characteristics in young athletes: Rugby + overload of bench press = anterior deltoid dominance and poor posture. Hockey + incorrect running style = muscular imbalance due to unilateral playing style.

If you have any observations on trends in youth sport please feel free to comment below 

Glossary of Terms

Below is a list of terms, some are beneficial to athletic development and some are not! I hope that after my first year at Bloxham the words in the left column have been replaced by the ones in the right. This proves to be a daily challenge due to the ''quick fix'' culture which surrounds young athletes in many gyms.

Detrimental terms for the young athlete	Positive terms for the young athlete
Getting big	Athleticism
Protein	Healthy eating
Training hard	Rest and Recovery
Pecs and arms day	Functional movement
Win at all costs	Long term development
Sports Specific	Fundamental movements
Bench Press	Pull ups

''How can I get big sir''?

If I was asked what had been the most popular question directed at me during my first 3 weeks at Bloxham, the above title would be a safe bet. However, with the help of the P.E/Sport department at the school, we have been able to slowly change children's mindset on what Strength and Conditioning at this level comprises of.

The Split Routine Culture

Amongst the challenges we have faced here is the idea that every session should be based on a hypertrophy driven, split routine programme. Although beneficial for increasing the cross sectional area of the muscle fibre, this programme lacks fundamental athleticism. Talking to the pupils that use this (majority of which are 16-18 yrs old rugby players), this routine has been reinforced by the help of various magazines, tv programmes and the internet-I keep find myself telling the pupils that not everything on the internet is true. In many ways they are products of the system; several of them go to gyms in the half terms and summer holidays-gyms which don't allow children to use free weights-the argument for this being that more staff would have to be on the gym floor and more staff would need additional training, especially with regards to training young athletes. This forces children to be placed in the non-supervised fixed machine corner of the gym, where non specific movements that only focus on one muscle group at a time are encouraged  Luckily, here at Bloxham they have recently taken away all machine type gym equipment and consequently reinforce the idea of a functional athlete.

The all round athlete 

During the Bloxham year various sports are focused on depending on which term you find yourself in. Rugby, Hockey and Cricket take centre stage in the Michaelmas, Lent and Summer term for the boys, while for the girls the split is Hockey, Netball and Tennis. Although we are only 3 weeks into the term, most of the male pupils at the school seem to think that they need to focus on a hypertrophy type programme all year round. Girls, I can happily say, are a lot more professional when it comes to their training needs. However, with the boys in particular, especially 3rd, 4th, and 5th form-they should not be specialising in just getting big. You will naturally get bigger as you get older and getting big for the sake of getting big, especially for rugby, will have long term damage for their athletic development. The all round athlete should be encouraged by all, even up to 18 years old-this is seen by many National Governing Bodies as the time-point where individuals should look to specialise in their chosen sport.

I hope to keep you updated on the challenges + developments that take place over the next year. Please feel free to comment below 

Reflection

Do you take time to reflect on your coaching practise? Without a reflective framework the coach cannot ensure continual re-evaluation of his/her work. Reflective practice demands the coach to examine their own behaviour honestly, reminding them to act responsibly in their actions. Reflective evaluation highlights areas where the population, for example, children, have a great social need besides their particular sport. When designing training sessions it is important to consider the childhood of that child. Extreme training sessions may ruin their childhood.

Although he identified three levels of reflection, Van Manen (1977) did not position one level as necessarily being better than another, recognizing that they can occur in conjunction with one another.

Technical Level

How can I make sure all athletes hear me?
What resources could I utilize to improve the teaching of this task?
Did I achieve the goals I set for this session?
How can I fix this problem?
What part of the training could I change so that it finished on time?

Practical Level

What other ways can I get my message across?
How does my behaviour reinforce stereotypes?
What effect does each type of feedback have on what athletes learn?
What am I doing as a coach to include all learning media?

Critical level

What do I do about those practices that are inequitable or unjust but are part of the team or club traditions?

Why is there a difference between the type of feedback I give to the more skilled and less skilled members of the team?

Conclusion 

The importance of reflective coaching is not just about finding and defining the problem, most people can do that. Organising, planning and acting upon it are essential also. There must also be re-evaluation to see if it has solved the problem and continual evaluation resumed.

Adapted from Department of Education for Northern Ireland (1999) cited by Pollard (2002) this mission statement sums up the truth of the reflective coach: ‘‘At the heart of becoming a good teacher is, above all else, being a learner-a lifelong learner. To learn one has to ask questions of oneself…’’

References 

Pollard, A. (2002). Reflective Teaching: Effective and Evidence-informed Professional Practice. Continuum

Van Manen, M. (1977). Linking ways of knowing with ways of being practical. Curriculum Inquiry, 6, 205-228.

Developing a Coaching Philosophy

This is an area of the coaching process that became apparent to me during my Level 2 S&C qualification, of which I completed in 2010. Despite the official recognition that a philosophy has a direct impact on behaviour (Cassidy, Jones & Potrac, 2009), many young coaches consistently fail to engage adequately with the philosophic concept.

What is a coaching philosophy?

A coaching philosophy is a set of values and behaviours that serve to guide the actions of a coach (Wilcox & Trudel, 1998).

How should one go about developing such a functional philosophy?

Kretchmar (1994) suggests that we should use inductive, intuitive and deductive reasoning in developing philosophy. Therefore, the following questions could be addressed:

What is coaching, and why do I think that?
Why am I a coach?
What is my role as a coach and why do I think that?

Once a philosophical framework has been established, more practical questions should be addressed:

Is my approach appropriate for the athletes?
Is there a better way of doing what I'm doing?
Can I explain and justify my coaching actions and decisions?
How do I ensure that I follow and develop my coaching philosophy?

Conclusion

Developing a coaching philosophy enables coaches the opportunity to identify and clarify what is important to them at the personal level. What needs to be avoided, however, when developing a philosophy, is the superficial adoption of public statements of intent that have little bearing on day to day practice. Lastly, the importance of consistently reviewing and reflecting on your philosophy will help improve your coaching practise.

References

Cassidy, T., Jones, R., & Potrac, P. (Eds.). (2009). Understanding Sports Coaching (2nd ed.). New York: Routledge.

Kretchmar, R. S. (1994). Practical Philosophy of Sport. Champaign, IL: Human Kinetics.

Wilcox, S., & Trudel, P. (1998). Constructing the coaching principles and beliefs of a youth ice hockey coach. Avante, 4, 39-66.

The price of Sports Science

Today I attended the University of East Anglia (UEA) open day with my parents and Suzie, my sister who is looking to pursue a degree in Nursing with mental health. The journey back on the M25 gave me time to reflect on my own degree and whether or not I would choose to undertake the same degree with the new £9,000 price-tag alongside it. 

A survey conducted by Prospects in 2010 found that roughly 8,000 individuals were graduating with a degree in Sports Science! This is an astonishing amount when you consider how many PAID jobs are available within the Sports Science community. However, many graduates do end up changing direction and working within an industry that requires no knowledge of sports science whatsoever. With the new £9,000 tuition fees coming into action this September, it has been estimated that some 200,000 young people will graduate each year with average debts of £45,000. Can this really be justified when colleagues of mine both at Exeter and other ''top end'' institution's manage to only have as low as 4 hours of contact time per week in some semesters? Consequently, even with the rise in tution fees, Sports Science is currently the eleventh most popular option in the UCAS course choice league table.

An example of jobs which a degree in Sports Science can lead to are listed below, this list is not exhaustive by far:

• Physiotherapist
• Personal Trainer
• Police Constable
• Gym Instructor
• Multi-Sports Coach
• Sports Instructor/Life Guard
• PE Teacher
• Lecturer in Sport and Exercise Science
• Sports Psychologist
• Physical Therapist
• Nutritionist
• Performance Analyst 
• Sports Development Officer 
• Strength and Conditioning 
• Sports Medicine 

Is there a realistic opportunity for graduates to attain a full time paid job with such a small market of jobs available?

My overall experience studying at Exeter is one of overwhelming enjoyment and satisfaction. On a academic level I feel I have learnt a great deal of knowledge that I can practically bring into the academic arena. With regards to work experience, both the school and its staff were instrumental in helping me gain internships within my 2nd and 3rd year, of which I strongly believe is a huge asset to any graduate. Although I am sure many other graduates are pleased with the way their degree was conducted, future students will demand more - this is common sense due to the added money spent on their studying. The following list is a description of what I would personally like to see change in order for the Top 10 Sports Science institutions to justify their increase in fees:

- Smaller seminar sizes; maximum of 10 people

- An increase in the average amount of contact hours per week, I personally would like to see a 9-5 schedule adopted 4 days of the week

- Compulsory attendance in masters and PhD experiments, this is an area that not many undergraduates take part in and would greatly effect their leaning experience 

- Smaller year group sizes so lectures can be as interactive as possible 

- Greater links with professional clubs/organisations to help gain work experience for the undergraduates

If you have any more suggestions please feel free to comment below

Conclusion 

Yes, I would take the opportunity to undertake the course again; however, this is probably greatly influenced by my previous experience of studying at Exeter, which I can only describe as fantastic. If, on the other hand I, like my sister, was looking to undertake a degree in the £9,000 category, then I would hope the above points would be addressed and put in place. Sadly, the new era of Sports Science at University is going to see many potential students not undertake this path due to the fear of increased debt.

Clinical Exercise Prescription

Although not an area I wish to pursue as a career, clinical exercise prescription enables me to draw on a lot of the knowledge that I have gained during the last 3 years of my studying. During my last term at University I undertook a clinical module, of which assessment was based on a comprehensive coursework, theory and practical examination. This was by far one of the most enjoyable modules I took whist studying for my degree and consequently when arriving back home I was faced with a great opportunity to use the knowledge in a meaningful way. My granddad, who is in his late 70's now, sadly suffers from several medical conditions; crumbling vertebrae, nerve end damage and arthritis of the spine. He approached me, asking for my advice on this matter, and after discussing his illness and daily lifestyle routine, I have given him a simple programme to complete for the next 2-4 weeks. After this I will assess how he is doing and review his progress. Below I have put together some information regarding exercise, arthritis and what I have recommended to my Grampy!

Exercise as a treatment for Arthritis

- An emerging body of research highlights that light to moderate intensity exercise can play a restorative role in combating the declines in health and functional capacity caused by Arthritis (Strasser et al., 2010).

- Although pain and functional limitations present challenges to physical activity amongst individuals with Arthritis, regular exercise can help manage and minimise typical symptoms (Klippel, 2001).


- In Stenstrom & Minor’s (2003) systematic review of 15 Arthritis health studies, it was found that general health and functional ability improved (by an average of 30% and 18%, respectively) when patients were engaged in dynamic physical activity patterns (Stenstrom & Minor, 2003). 

Process of Arthritis: Bone starts to be worn down. Bone moves against bone increasing erosion and pain. Spurs develop to compensate = deformation = joint moves incorrectly = pain 

Improved Cartilage Health

- As cartilage is avascular, nutrition occurs through diffusion of synovial fluid (O’Hara, Urban, & Maroudas, 1990).

- Diffusion aided by “pumping” effect that mechanical loading produces (Van Den Hoogen et al., 1998).

- Regular exercise in animals may increase proteoglycan content through increased synthesis and retention, particularly in dynamic loading (Van Den Hoogen et al., 1998).

- Dynamic exercise can increase circulating insulin-like growth factor (IGF) by 25% (Melikoglu, Karatay, Senel, & Akcay, 2006).

- Suggestion that IGF’s can stimulate synthesis and reduce degradation of proteoglycans, thus enhancing cartilage health (Melikoglu et al., 2006).

- Larger solutes, like IGF’s, rely on intermittent loading to reach cells, due to importance for production of synovial fluid and distribution across joint surface (O’Hara et al., 1990).

- Implications are paramount to cartilage health as proteoglycans are one of the main contributors to durability (Van Den Hoogen et al., 1998).

Recommendations for future exercise

- Exercise during the day when pain has subsided.

- Some discomfort may be present during or shortly after activity, although this does not mean further joint destruction.

- If pain persists longer than 2-hours post-activity and exceeds pre-activity levels, duration and intensity of activities need to be decreased.

- During “flare ups”, performing range of motion exercises so as not to exacerbate condition is encouraged.

- Every session should incorporate a warm-up and cool-down in order to minimise pain. These may both include slow actions of moving joints through a full range of motion.




An example of some of the exercises I have prescribed - all exercises involve the use of simple resistance bands. Note - all exercises were conducted sitting down due to the patient also having arthritis in the hip. Please feel free to leave any comments regarding the above, I feel this is an interesting topic and hope that this can have a big impact on friends and family who have similar conditions.

References

Klippel, J. H. (Eds.). (2001). Primer on the rheumatic diseases (12th ed.). Atlanta, GA: Arthritis Foundation.
Melikoglu, M. A., Karatay, S., Senel, K., & Akcay, F. (2006). Association between dynamic exercise therapy and IGF-1 and IGFBP-3 concentrations in patients with rheumatoid arthritis. Rheumatology International, 26(4) 309-313.

O’Hara, B. P., Urban, J. P. G., & Maroudas, A. (1990). Influence of cyclic loading on the nutrition of articular cartilage. Annals of the Rheumatic Diseases, 49(7), 536-539.

Stenstrom, C. H., & Minor, M. A. (2003). Evidence for the benefit of aerobic and strengthening exercise in rheumatoid arthritis. Arthritis & Rheumatism, 49(3), 428–434.

Strasser, B., Leed, G., Strehblow, C., Schobersberger, W., Haber, P., & Cauza, E. (2011). The effects of strength and endurance training in patients with rheumatoid arthritis. Clinical Rheumatology, 30(5), 623-632.

Van Den Hoogen, B. M., Van De Lest, C. H. A., Van Weeren, P. R., Lafeber, F. P. J. G., Lopes-Cardozo, M., Van Golde, L. M. G., & Barneveld, A. (1998). Loading-induced changes in synovial fluid affect cartilage metabolism. British Journal of Rheumatology, 37(6), 671-676.

The story so far.......

Hello and thank you for visiting the blog. I find myself graduating this Summer from the University of Exeter with a Sports Science degree, after 3 extremely enjoyable and rewarding years at St Luke's campus. Starting in September I will be taking up the role of Strength and Conditioning Coach at Bloxham School; an exciting opportunity to learn and develop as a coach and already the staff there have made me feel very welcome. However, between now and then I will be working at a English Summer School based up at the historic Rugby School, this will comprise coaching a variety of sports to mainly European children aged between 11-18. I worked for the same company last year and although challenging at times I thoroughly enjoyed it; your communication skills are well and truly tested when coaching sport to children who have a very basic level of English!

My home for the last 3 years, St Luke's Campus-University of Exeter 

The main aim of this blog is to reflect and hopefully debate many of the challenges that I face in the next year. Although coaching during the day at Bloxham, I will be assisting the welfare and pastoral work of a boarding house during the evening, which again will bring new challenges and perspectives. It is also my aim to keep my Sports Science knowledge up to date, this will involve occasionally posting reviews of scientific papers/articles. I hope you enjoy the blog and please feel free to leave a comment whenever you see fit.