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3.  Low back pain in junior Australian Rules football: a cross-sectional survey of elite juniors, non-elite juniors and non-football playing controls 
Low back pain in junior Australian Rules footballers has not been investigated despite findings that back pain is more prevalent, severe and frequent in senior footballers than non-athletic controls and findings that adolescent back pain is a strong predictor for adult back pain. The aim of this study was to determine the prevalence, intensity, quality and frequency of low back pain in junior Australian Rules footballers and a control group and to compare this data between groups.
A cross-sectional survey of male non-elite junior (n = 60) and elite junior players (n = 102) was conducted along with a convenience sample of non-footballers (school children) (n = 100). Subjects completed a self-reported questionnaire on low back pain incorporating the Quadruple Visual Analogue Scale and McGill Pain Questionnaire (short form), along with additional questions adapted from an Australian epidemiological study. Linear Mixed Model (Residual Maximum Likelihood) methods were used to compare differences between groups. Log-linear models were used in the analysis of contingency tables.
For current, average and best low back pain levels, elite junior players had higher pain levels (p < 0.001), with no difference noted between non-elite juniors and controls for average and best low back pain. For low back pain at worst, there were significant differences in the mean pain scores. The difference between elite juniors and non-elite juniors (p = 0.040) and between elite juniors and controls (p < 0.001) was significant, but not between non-elite juniors and controls. The chance of suffering low back pain increases from 45% for controls, through 55% for non-elite juniors to 66.7% for elite juniors. The chance that a pain sufferer experiences chronic pain is 16% for controls and 41% for non-elite junior and elite junior players. Elite junior players experienced low back pain more frequently (p = 0.002), with no difference in frequency noted between non-elite juniors and controls. Over 25% of elite junior and non-elite junior players reported that back pain impacted their performance some of the time or greater.
This study demonstrated that when compared with non-elite junior players and non-footballers of a similar age, elite junior players experience back pain more severely and frequently and have higher prevalence and chronicity rates.
PMCID: PMC2967511  PMID: 20958973
4.  Low back pain status in elite and semi-elite Australian football codes: a cross-sectional survey of football (soccer), Australian rules, rugby league, rugby union and non-athletic controls 
Our understanding of the effects of football code participation on low back pain (LBP) is limited. It is unclear whether LBP is more prevalent in athletic populations or differs between levels of competition. Thus it was the aim of this study to document and compare the prevalence, intensity, quality and frequency of LBP between elite and semi-elite male Australian football code participants and a non-athletic group.
A cross-sectional survey of elite and semi-elite male Australian football code participants and a non-athletic group was performed. Participants completed a self-reported questionnaire incorporating the Quadruple Visual Analogue Scale (QVAS) and McGill Pain Questionnaire (short form) (MPQ-SF), along with additional questions adapted from an Australian epidemiological study. Respondents were 271 elite players (mean age 23.3, range 17–39), 360 semi-elite players (mean age 23.8, range 16–46) and 148 non-athletic controls (mean age 23.9, range 18–39).
Groups were matched for age (p = 0.42) and experienced the same age of first onset LBP (p = 0.40). A significant linear increase in LBP from the non-athletic group, to the semi-elite and elite groups for the QVAS and the MPQ-SF was evident (p < 0.001). Elite subjects were more likely to experience more frequent (daily or weekly OR 1.77, 95% CI 1.29–2.42) and severe LBP (discomforting and greater OR 1.75, 95% CI 1.29–2.38).
Foolers in Australia have significantly more severe and frequent LBP than a non-athletic group and this escalates with level of competition.
PMCID: PMC2674424  PMID: 19371446
5.  Golf-related lower back injuries: an epidemiological survey 
This study describes the playing characteristics of golfers who had an injury to their lower back in the course of play or practice in the previous year (12 months).
A retrospective survey was mailed to members of randomly selected golf clubs across Australia. Statistical methods used included 2-sample t test to compare means of 2 independent populations and the χ2 test to examine the association between categorical variables/factors in the study.
Of 1634 Australian amateur golfers surveyed, 17.6% of golfers sustained at least 1 injury in the previous year. The lower back accounted for 25% of all golf-related injuries in the previous year, making the lower back the most common site of injury. The golfer with a golf-related lower back injury was likely to have a previous history of lower back injury, while the injury had a progressive onset compared with an acute single onset. The follow-through phase of the golf swing was reported to be associated with the greatest likelihood of injury compared with other phases of the swing. Most of the injured golfers received treatment of their injury with a general practitioner (69%), a physiotherapist (49%), or a chiropractor (40%).
Practitioners treating golfers with a history of lower back injury should evaluate the golf swing follow-through to identify potential causes of aggravation to the lower back. Targeted measures such as spinal manipulative therapy, soft tissue and back exercise, and conditioning programs to assist the strength and mobility of the golfer could then be implemented.
PMCID: PMC2647075  PMID: 19674690
6.  Australian chiropractic sports medicine: half way there or living on a prayer? 
Sports chiropractic within Australia has a chequered historical background of unorthodox individualistic displays of egocentric treatment approaches that emphasise specific technique preference and individual prowess rather than standardised evidence based management. This situation has changed in recent years with the acceptance of many within sports chiropractic to operate under an evidence informed banner and to embrace a research culture. Despite recent developments within the sports chiropractic movement, the profession is still plagued by a minority of practitioners continuing to espouse certain marginal and outlandish technique systems that beleaguer the mainstream core of sports chiropractic as a cohesive and homogeneous group. Modern chiropractic management is frequently multimodal in nature and incorporates components of passive and active care. Such management typically incorporates spinal and peripheral manipulation, mobilisation, soft tissue techniques, rehabilitation and therapeutic exercises. Externally, sports chiropractic has faced hurdles too, with a lack of recognition and acceptance by organized and orthodox sports medical groups. Whilst some arguments against the inclusion of chiropractic may be legitimate due to its historical baggage, much of the argument appears to be anti-competitive, insecure and driven by a closed-shop mentality.sequently, chiropractic as a profession still remains a pariah to the organised sports medicine world. Add to this an uncertain continuing education system, a lack of protection for the title 'sports chiropractor', a lack of a recognized specialist status and a lack of support from traditional chiropractic, the challenges for the growth and acceptance of the sports chiropractor are considerable. This article outlines the historical and current challenges, both internal and external, faced by sports chiropractic within Australia and proposes positive changes that will assist in recognition and inclusion of sports chiropractic in both chiropractic and multi-disciplinary sports medicine alike.
PMCID: PMC2042981  PMID: 17880724
7.  Practitioner Perceptions of Emotions Associated with Pain: A Survey 
To discover whether chiropractors consider that emotional factors are associated with pain presentations in their patients and if so, what methods they use to investigate these factors and what strategies they use to manage them.
A telephone survey of chiropractors in Australasia (Australia and New Zealand) and North America (America and Canada). A database of practitioners was obtained for each region. A phoning protocol was established in each region to standardize the survey approach.
Private practice of chiropractic.
Chiropractic centers were telephoned and the attending chiropractor(s) were asked to complete a phone survey. The survey consisted of a series of short questions designed to establish the main techniques used in the practice. Questions focused on whether emotional factors of the patient were recognized and addressed and what role emotional factors play in the management of the patient.
Subjects were registered/licensed chiropractors listed in a publication of the largest association of practitioners in their region.
In Australasia and North America just under half of practitioners surveyed (45.8% and 50.5% respectively) used a technique to evaluate any impacting emotions on the presenting condition. Additionally, 36.3% of Australasia and 33.3% of North America practitioners had a technique to treat emotional factors in the patient. The study also suggests that over 90% of Australasian chiropractors and 80% of North America chiropractors consider emotional factors important in pain presentations.
This study found that a substantial number (80–90%) of the chiropractors surveyed believe that emotional factors influence pain syndromes. However, less than half of these practitioners report that they are able to evaluate emotional factors and approximately only a third report that they are able to treat them. This study shows there is a need for further research of chiropractors to be able to evaluate emotional factors and techniques that can be used to rectify emotional components of their patients' pain syndromes.
PMCID: PMC2647028  PMID: 19674641
Chiropractic; Psychology; Emotion; Biopsychosocial Model
8.  Lower back pain in golfers: a review of the literature 
Journal of Chiropractic Medicine  2005;4(3):135-143.
To review the epidemiological literature on low back pain in golfers and to review the golf swing and relate the literature on the mechanics of the swing to the lower back.
A computer search was conducted of Index Medicus (1966 to 2004), MANTIS (1880 to present) and CINAHL (1982 to 2004) for literature on the following key words: low back, golf, injury. A manual search for relevant references in review papers on the subject was also conducted. The results were collated and literature fitting the criteria were collected and evaluated for suitability.
The lower back is a common site of golf-related injury and has resulted in much research being conducted on the forces produced by the ‘modern’ swing in the low back. An analysis of the ‘modern’ swing when compared to the ‘classic’ golf swing, demonstrates lower rotational forces on the low back in the ‘classic’ swing. However, no studies exist to compare the different types of swing.
The back is an area of the body that undergoes significant movement and muscular activity during the golf swing. It is likely that the significant activity and repetitive nature of the swing are associated with the high rate of injury in golfers. Modification of the golf swing has been hypothesized to reduce the incidence of low back injury in golf. Further research needs to be conducted on the various golf swings to evaluate if different swings change low back injury rates in golfers.
PMCID: PMC2647041  PMID: 19674655
Low Back Pain; Golf; Athletic Injuries
9.  Golf and upper limb injuries: a summary and review of the literature 
Golf is a popular past time that provides exercise with social interaction. However, as with all sports and activities, injury may occur. Many golf-related injuries occur in the upper limb, yet little research on the potential mechanisms of these injuries has been conducted.
To review the current literature on golf-related upper limb injuries and report on potential causes of injury as it relates to the golf swing.
An overview of the golf swing is described in terms of its potential to cause the frequently noted injuries. Most injuries occur at impact when the golf club hits the ball. This paper concludes that more research into golf-related upper limb injuries is required to develop a thorough understanding of how injuries occur. Types of research include epidemiology studies, kinematic swing analysis and electromyographic studies of the upper limb during golf. By conducting such research, preventative measures maybe developed to reduce golf related injury.
PMCID: PMC1175860  PMID: 15967021
Golf; injury; shoulder; elbow; wrist; review
Background: Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football.
Objective: To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with a review of relevant anatomy, assessment and treatment. Also included is a discussion of the efficacy of manual therapy in the treatment of ankle sprain.
Discussion: A detailed knowledge of the anatomy of the ankle as well as the early recognition of factors that may delay the rate of healing are important considerations when developing a management plan for inversion sprains of the ankle. This area appears to be under-researched however it was found that movement therapy and its various forms appear to be the most efficient and most effective method of treating uncomplicated ankle injury. Future investigations should involve a study to determine the effect chiropractic treatment (manipulation) may have on the injured ankle.
PMCID: PMC2051062  PMID: 17987171
Ankle; sport; injury; treatment; chiropractic

Results 1-10 (10)