Keeping track of future professional directions

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With changes in the medical and health care professions over the past decades I often ponder the shape that our professions will take in the coming years. Whilst 30 years ago the sports medicine professions focused predominantly on treating injuries associated with sport per se, current day practice covers the important area of injury prevention and health gain through a wide variety of physical pursuits. In trying to predict the areas of endeavour that our professions may be involved in, a simple Internet search can be quite enlightening. With a few moments spare I searched the Internet under the term “physiotherapy news”. To my surprise several quite diverse stories surfaced that, although not directly related to physiotherapy, provoked some thoughts on the role that those in the sports medicine professions may have in health care over the coming years.

The first Internet media story reported on plans to make exercise mandatory in early childhood or daycare centres in New South Wales, Australia, to counter the problem of childhood obesity. Whilst an initiative like this should be applauded, it begs the question of how early childhood educators are going to implement such practice. Some recent research I led on physical activity in the early childhood age group found that although early childhood educators were in favour of increasing physical activity in this age group, they felt under-trained and under-skilled to do so (Kolt et al., 2005). It could be that physiotherapists with an understanding of child development, preventative health care, and exercise practices could contribute to such an initiative. This would enhance the safe implementation of such changes. The second story I encountered described a UK initiative to provide children in “deprived areas of England” with pedometers as a way of encouraging them to become more active. Whilst not debating the efficacy of such an approach in improving the physical activity, surely physiotherapists should have involvement to ensure that safe and appropriate physical activities are being taken up, and that such behaviour changes do not increase the risk of injury to participants. I also came across another story outlining Masala Bhangra, one of the latest fitness crazes in the US. Masala Bhangra is a fusion between a Punjabi folk dance (Bhangra) and aerobics and is being conducted in many states across the US. Whilst the benefits of such an activity are no doubt numerous, as sports medicine professionals we should be able to analyse such new activities and identify any potential injuries that may arise from increased participation. By using such stories as examples, I am encouraging you to stay ahead of the game in helping to shape your professional practice over the coming years. If we can see the directions that sport, exercise, and general physical activity are heading, we should be able to have input both into the safe participation in such pursuits as well as the inevitable management of injury that arises from participation.

In this issue we bring a mix of original research, literature review, and a case study. The lead paper by Kofotolis and Kellis examined the cross-training effects of proprioceptive neuromuscular facilitation training on peak torque and endurance of the knee flexor and extensor muscles. Akhbari and colleagues investigated the effects of a stability training program on functionally unstable ankles by focusing on balance measures and muscle activity onset. Their training program demonstrated a decrease in muscle onset time and an improvement in balance. The last of the original research papers in this issue addressed the under-researched area of imagery or visualisation and its role in rehabilitation. In this paper, Christakou and Zerras studied the effectiveness of imagery on pain, oedema, and range of motion in athletes with grade II ankle sprains. Whilst the study did not find any significant effects in these domains, the authors provide some important suggestions for future research in this area. This issue also contains a systematic review of the efficacy of continuous passive motion after anterior cruciate ligament reconstruction. From this review, Smith and Davies suggest that the evidence for this mode of treatment is still unclear and is limited by several methodological weaknesses. The final paper in this issue is the interesting case study of an ice burn following cryotherapy application during a clinical research study. The authors, Hardaker and colleagues, provide some sound advice regarding cryotherapy application in relation to thermal gradients and ambient temperature.

By the time this issue reaches you, many of our readers would have experienced one of the flagship events of our profession, the 15th International World Confederation for Physical Therapy Congress in Vancouver, Canada. Our next issue will include a report from that Congress, and issues throughout 2008 will showcase a number of the presentations in the area of sport and exercise.

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Reference 

1. Kolt, G. S., Schofield, G. M., McLachlan, C., Oliver, M., Lucas, P., Maddison, R., et al. (2005). Active movement scoping exercise and programme evaluation—report to Sport and Recreation New Zealand. Auckland, New Zealand: Auckland University of Technology.
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