Knowledge of sports

A working knowledge of the sport you are working in is not essential but gives you invaluable insight which will prevent mistakes being made that may impact on the players, as well as on your ability to do your job. Think about common mechanisms of injury (MOI) and gain an understanding of the forces involved in your sport. This can be invaluable if you do see the injury as it happens. It helps to understand the physical needs and demands on the athletes – this can affect how busy you are likely to be on match day and what kit you always carry with you. In contact sports, such as rugby or American football, fractures, dislocations and lacerations are more common than in swimming, for example. Aim to have a good understanding of the rules and bylaws of the sport – in sports such as Judo you are not allowed to enter the mat or touch a player in competition until the umpire has given you permission or the player is disqualified. In many sports, such as rugby league, you are given unconditional access to the field of play in order to attend injuries. Knowledge of the substitution rules can assist you to work with the players and coaches to best serve everybody’s interests.

CPD

As with any area of clinical practice, practitioners must maintain their CPD. In the sporting setting this may include first aid training, which may extend to advanced trauma management and advanced life support, to advanced management of musculoskeletal injuries and acute injury, to medico-legal training, etc. Professional sporting requirements generally require a minimum of five years post-qualification and Masters level postgraduate training. At the time of writing this chapter, the preparations for the 2012 Olympic Games are in full swing. Physiotherapists wanting to participate in events such as the Olympic Games, the Commonwealth and World University Games, or to work with elite athletes need to be HCPC-registered physiotherapists and preferably members of the CSP, hold a degree or graduate diploma in physiotherapy, have a minimum of five years post-registration experience and usually at least two years experience in training and competitive environments. Previous experience of working at major games and multi-sport experience, and active involvement with British Universities and Colleges Sports Association (BUCS) for student sport, is not usually essential but considered an advantage.

Applicants are usually asked to provide proof of their own CPD in the sports medicine fields, including evidence of regular cardiopulmonary resuscitation (CPR) training. A massage therapy qualification from a recognised Sports Massage Association (SMA) course and a diploma or MSc in Sports Physiotherapy is often considered an advantage. It is recommended that physiotherapists join appropriate special interest groups. For those working in sport the Association of Chartered Physiotherapists in Sports Medicine (ACPSM) provides an excellent support service, a well-structured CPD programme, mentoring, a quarterly journal, conferences and advanced notice of employment and voluntary positions in sport. Evidence of working towards, or having achieved, ACPSM silver level CPD standards are usually regarded favourably when applying to work at this level. It is worth mentioning at this point that many of these positions are voluntary or only provide an honorarium, with applicants expected to fund themselves and find their own accommodation. Applicants are usually required to commit to a minimum period of two weeks service when working for the host city at a major games such as the Olympic Games in London in 2012. However, working as part of Team England or Team GB, or for BUCS at a World University Games, all accommodation, travel and food would be paid for.

Physiotherapists wanting to work in sport should consider CPD in the following fields:

Legal responsibilities

When contracted by a team or athlete as the physiotherapist or first aider you have assumed a duty of care (Dunbar 2006). As long as you work within your scope of practice and practise first aid skills in accordance with accepted first aid practice, it is unlikely that a civil action for alleged negligence would succeed (Dunbar 2006). It is worth noting that if you are ‘employed’ as opposed to working as a volunteer, the club may be liable in any litigation proceedings.

It is important that physiotherapists working with children (those under the age of 18) obtain an enhanced Criminal Records Bureau (CRB) check (free for those in voluntary positions) from the club at which you will work. If you are being remunerated for your work you may have to pay for your own CRB check. The majority of sport national governing bodies (NGB) in the UK have embraced child protection and safeguarding policies and further embedded them at club level through accreditation schemes such as Clubmark (Sport England 2011). It is advised that you check with your club in the first instance, but if you do require further support and information contact the NGB directly. According to Dunbar (2006), provision for sport is subject to Health and Safety Executive (HSE) regulation and, as such, physiotherapists working in sport should comply with the relevant safety and reporting procedures. Serious accidents occurring to athletes and/or first aiders are regarded as ‘notifiable’.

Medical insurance

Membership of the CSP will normally provide sufficient professional and public liability insurance cover to work in amateur sport. However, if diversifying into working with elite athletes the limit of liability may not provide enough cover. If working with racing animals, such as horses and greyhounds, then it is advisable to contact the CSP for further advice as the scope of activities insured excludes animal or veterinary physiotherapy (CSP 2010).

Doping, and WADA and TUEs

The WADA promotes, coordinates and monitors doping in sport. The WADA’s responsibilities in science and medicine include, among others, scientific research, the prohibited list, the accreditation of anti-doping laboratories and therapeutic use exemptions (TUEs). Athletes may have illnesses or conditions that require them to take medications. If the medication an athlete is required to take happens to be on the prohibited list, a TUE may give that athlete the authorisation to take the needed medicine. The purpose of the International Standard for Therapeutic Use Exemptions (ISTUE) is to ensure that the process of granting TUEs is harmonised across sports and countries (WADA 2010).

The rules and regulations surrounding drug use prescribed or otherwise are complicated and may seem draconian. The team doctor would normally deal with TUEs at the elite level. Physiotherapists working in high level sports should be extremely careful ‘prescribing’ any ‘medication’ (Taylor 2008). If in doubt, athletes are advised not to use anything no matter how innocuous it may seem. More information can be found on the UK Sports, WADA and the ‘100% ME’ websites (see Table 16.1).

Concussion management

Concussion or traumatic brain injury (TBI) is common in sports. About 90% are mild in nature and are referred to as mild TBIs (mTBI) but obviously all TBIs have the potential to develop serious complications (Solomon et al. 2006). The following discussion provides an overview only and should be supported by further reading and attendance on trauma management courses.

There appears to be no clear definition of concussion. However, the Concussion in Sport (CIS) Group at the International Conference on Concussion in Sport in Prague (2004) offered the complex definition below (McRory et al. 2005). This CIS definition represents a consensus of opinion from experts in the sports medicine field and is recommended as the most current (Solomon et al. 2006):

Sports concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilised in defining the nature of a concussive head injury include:

1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’  force transmitted to the head.

2. Concussion typically results in the rapid onset of short lived impairment of neurologic function that resolves spontaneously.

3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.

4. Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.

5. Concussion is typically associated with grossly normal structural neuro imaging studies.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

The responsibilities of being a physiotherapist Physiotherapy in women’s health Changing relationships for promoting health Neurodynamics Joint arthroplasty Musculoskeletal assessment

Stay updated, free articles. Join our Telegram channel

Join