The Australian Institute of Sport (AIS) develops evidence-based position statements on new and complex topics in sports science and sports medicine, in order to provide guidance and leadership for the Australian high performance sport system.
Current positions on:
Sport-related concussion is a growing health concern in Australia. Research into the management of concussive injuries is progressing rapidly and so too are the guidelines for diagnosis, removal from sport, management, return to learn and return to sport.
In partnership with the Australian Medical Association, Australasian College of Sport and Exercise Physicians and Sports Medicine Australia, the AIS has developed the following resources outlining best practice management for sport-related concussive injuries.
Recent advances in the field of genetics have led to an increase in use and availability of genetic testing. While genetic testing has proven to be of value in clinical medicine, there is no evidence to support the use of genetic testing for athletic performance improvement, sport selection or talent identification. Use of genetic testing as an absolute predictor of athletic prowess or sport selection is unscientific and unethical.
The following resources developed by the AIS address the implications of recent advances in the field of genetics and the consequences for athlete health and wellbeing.
Urinary Tract Infections
Athletes with spinal cord injuries are at increased risk of developing urinary tract infections. However, information around prevention and management is limited, particularly for elite spinal cord injured athletes.
The following resource developed by the AIS and the Australian Paralympic Committee represents a set of clinical recommendations for the prevention and treatment of urinary tract infection in spinal cord injured athletes.
Sport Specialisation in Young Athletes
1. The ASMC re-affirms the well-recognised position that for the vast majority of young individuals, regular exercise is not only safe but should be encouraged.
2. Exercise has a beneficial effect on many health outcomes and may also help improve academic performance.
- Regular moderate to vigorous physical activity (MVPA) in the childhood and adolescent years has both short and long-term benefits. These include improved aerobic fitness and strength, more favourable body composition, improved bone density, reduced symptoms of anxiety and depression, improved school performance and reduced cardiometabolic risk.
3. The ASMC supports the WHO, Australian Government Department of Health, and New Zealand Ministry of Health guidelines for physical activity for children and youth aged 5-17.
- Children and youth should accumulate at least 60 minutes of moderate - to vigorous intensity physical activity
- Amounts of physical activity greater than 60 minutes provide additional health benefits.
- Most of the daily physical activity should be aerobic. Vigorous-intensity activities and those that strengthen muscle and bone should be performed at least 3 times per week.
- Sitting time should be broken up and recreational screen time should be limited to no more than two hours per
4. However, the ASMC notes that there has been a growing trend toward young athletes specialising at an early age in a single sport. It appears that the major societal driver of this is a perception that early specialisation leads to increased sporting success.
5. In this position statement the following definitions are used. These reflect the most commonly accepted definitions in the relevant literature:
- A ‘young athlete’ is defined as an athlete 18 years old or younger.
- Sport specialisation is defined as the intensive, year-round training in a single sport at the exclusion of other sports.
- ‘Early’ specialisation is defined as sport specialisation occurring before the age of 12.
6. A young athlete’s degree of specialisation may be ascertained by the use of three questions:
- Does the athlete play or train for more than eight months per year in a given sport?
- Does the athlete choose a main single sport?
- Has the athlete stopped playing other sports to focus on a single sport?
7. The ASMC notes that, with the exception of rhythmic gymnastics, there is no evidence that early specialisation is beneficial in achieving elite status in sports where peak performance is attained in adulthood.
- In fact, there is evidence to the contrary, suggesting that athletes who maintain a broader sporting base till after the age of 12, then specialize, are more likely to be ‘successful’ in their chosen sport.
- There is one paper that suggests that a combination of organised training and free play based on a single sport may lead to increased sporting success at a junior level. This has not been proven or disproven to lead to success at an adult level.
- Popular concepts that advocate early specialisation (e.g. the 10,000 hours concept), were never intended to be applied to sport and are not relevant in the sporting context.
- The concept of early sports specialisation improving the chances of ‘future success’ largely came from retrospective studies comparing expert and non-expert musicians. Sport Specialisation in Young Athletes — Position Statement
8. There is evidence to suggest that there are physical harms associated with sport specialisation.
- There is evidence that young athletes with overuse injuries are more likely to be highly specialised than uninjured athletes.
- This risk is independent of age, sex, and total hours of organised sport.
- However, athletes with acute injuries may be less likely to be sport specialised.
- Resistance training among these at-risk populations has been shown to reduce injury risk by up to 68% and improve sport performance and health measures, in addition to accelerating the development of physical literacy.
9. There is an association between early sport specialisation and a number of more general harms. There is evidence that early sport specialisation may lead to:
- Lower overall perception of health,
- Earlier cessation of sporting activity and possible burnout,
- Less fun derived from playing sport,
- ‘Psychological needs’ dissatisfaction – which is a predictor of mental illness.
10. There are a number of simple rules that can guide appropriate training loads in young athletes. These can be used by those who have a duty of care over young athletes. Therefore, the ASMC recommends that;
- At any available opportunity, parents, coaches, athletes and sporting bodies should be made aware of both the
lack of benefits and the increased risks of harms associated with early specialisation.
- Athletes under the age of 12 should be encouraged to partake in a wide range of physical activities, both organised and informal, to maximise their health outcomes.
- Informal physical activity (‘free play’) should be encouraged as a valid form of physical activity especially in those under 12.
- Those who wish to focus on a single sport should be encouraged to delay specialisation until after the age of 12, or even until late adolescence.
- An athlete’s readiness to specialise should not be determined by physical maturity alone. Social, emotional and psychological maturity is also required in order to successfully specialise in one sport.
- Those individuals who have control over the training parameters of young athletes consider the use of simple guidelines in order to minimise the risk of issues relating to early specialisation, sport specialisation and training volume. These include:
- Limiting total sport participation (training and competition) to no more than 16 hours per week, irrespective of the total number of sports played,
- Ensuring that the ratio of hours spent in organised sport (training and competition) to those spent in ‘free play’ does not exceed 2:1,
- Limiting hours spent in organised sport (training and competition) per week such that they do not exceed the athlete’s age. E.g. a 10 year old should not train more than 10 hours per week across all sports (this supersedes point 10.f. (first dot point) above where relevant),
- Adhering to the evidenced-based load guidelines for a specific sport (e.g. Cricket Australia Youth Pace Bowling Guidelines).
- Sport Specialisation in Young Athletes Position Statement(PDF • 265.2 kb)
Best practice guidelines on:
These guidelines are intended to inform the safe practice of dry needling in sport-related physical therapies. They may also be used as a reference for the development of minimum standards by National Sporting Organisations. It is recommended that NSOs and NIN partners consider adopting these guidelines.
It should be noted that these guidelines refer only to trigger point dry needling or dry needling, and do not address other forms of invasive needle therapies such as pharmacological trigger point injection or traditional acupuncture.
Overview on Guidelines
Dry needling is within the scope of Physiotherapy/Physical Therapy practice. There are however risks associated with this type of therapy and while the incidence of risk such as induced pneumothorax are classified as rare, they are still a concern identified within research literature. These guidelines outline the essential requirements in the use of dry needling, to inform the growing number of practitioners using these techniques.
Individual States and Territories may have specific legislation applicable to dry needling, covering topics such as skin penetration and infection control. Practitioners must ensure that they comply with local State and/or Territory legislation.
Practitioners engaging in dry needling treatment are encouraged to read and follow these guidelines for general safety and maintenance of clinical standards.
Safe Treatment Procedures
Evidence in the effectiveness of dry needling is limited in the current literature. The benefit to risk ratio of dry needling treatment therefore needs to be considered. In the high performance sport environment, practitioners aim to use innovative and interactive treatments.
1. Limit the use of needles in anatomical areas of high risk if potential benefits of treatment are outweighed by potential side effects (this includes areas around lung fields, eyes and neurovascular structures).
2. Practitioners must have high-level knowledge of local anatomy and anatomical variations in areas of risk.
Experience in needle use differs from practitioner to practitioner. Not all practitioners are skilled in use of dry needling in high-risk anatomical areas.
3. Where any doubt exists, practitioners should refer to or seek guidance from other practitioners with appropriate experience.
4. Practitioners should stay up to date with current trends and research, while engaging in continued professional development to remain competent in this field of practice.
Consent must be obtained from the client before proceeding with any dry needling practice. A practitioner may be deemed liable for an unavoidable complication when the risks of that complication were not initially explained to the athlete.
Dry needling should not occur unless the risks of the procedure have been explained to, and accepted by the patient.
Several components constitute valid treatment consent:
- Consent must be voluntarily given,
- Consent must be informed; practitioners breach their duty of care if they fail to warn the athlete of the risks associated with treatments or procedures they are going to perform, and
- Consent must be obtained from those with legal capacity to do so; adults (18 years and over); children require parental or legal guardian consent [NSO coaches within the AIS daily training environment are seen as holding legal guardianship]. While common law recognises that the rights of a child to consent increases as their ability to understand and comprehend increases, caution must always be exercised.
5. Consent to have dry needle techniques administered must be voluntary from the athlete.
6. Information of the treatment to be given must be explained in full to the athlete.
7. Informing athletes of the potential risks associated with dry needle techniques is an important and essential part of any treatment regime.
8. Consent can be provided in either a verbal or written form. Where provision of consent is verbal, the obtaining of consent must be noted in the AMS medical record at the time of treatment.
An information sheet (example provided in Appendix A) must be provided to the patient receiving treatments over and around the trunk area. This sheet should detail warning signs relating to pain or treatment complications as well as the emergency procedure to follow if significant symptoms occur after treatment.
9. Explain adequate warning signs and management protocols if utilising skin penetration in areas over or adjacent to lung fields.
10. Provide the client with an information sheet with warning signs and emergency protocols to ensure they are adequately informed of the appropriate post-treatment care.
Practice specific requirements
- Any practitioner conducting dry needling in clinical practice will have undertaken an appropriate formal course of training. This includes massage therapists who must hold a nationally recognised diploma or advanced diploma (AQTF standard). If dry needling has been learnt at a post-graduate workshop, practitioners must complete a minimum of 60 hours face to face training and 15 hours supervised clinical practice (AMT – massage therapy code of practice).
- Practitioners must ensure they have appropriate indemnity insurance that covers dry needling practice.
- Within certain controlled environments outside of the AIS, such as at Olympic or Commonwealth Games, practitioners will not perform dry needling unless they have received prospective approval to do so by the Medical Director and/or the Head of Physical Therapies.
- It is recommended that in an NSO environment, no practitioner performs dry needling unless they have received prospective approval to do so by the Medical Director, Head of Physical Therapies and/or High Performance Director
- A greater degree of caution must be exercised in environments where there is reduced opportunity for backup support in the event of any adverse outcome from dry needling. Such environments include overseas travel and remote locations. NSOs and practitioners should consider whether dry needling is appropriate in situations where teams are remotely located and/or there is no doctor located with the team.
- All dry needling treatments must be recorded in the AMS medical record
Dry Needling on AIS Campus site
- All Dry Needling conducted within the AIS campus must follow the AIS Dry Needling Protocols, this includes treatment administered at training venues or in the athlete Residential Village.
- The practice of dry needling at the AIS must at all times be conducted in accordance with government regulations pertaining to safety and hygiene. The AIS is subject to annual inspections in relation to the infection control activity license from the ACT government, specifically for the purpose of dry needling.
Sharps and body penetration procedures
These requirements are in line with the APA position statement on skin penetration (November 2007), ACT Health, Infection Control Guidelines for office practices and other community based services (2006) and Australian Guidelines for the Prevention and Control of Infection in Healthcare NHMRC.
- Wash hands appropriately before treatment and handling of needles, prior to insertion and removal of needles (hand washing is the first step in infection control programs).
- Treatment area must be appropriately conducted within a treatment cubicle or an area of low traffic to prevent accidental movement of needles or an athlete (particularly in the case of treatment of high-risk areas such as the thoracic spine).
- The work area must be clean and tidy.
- Cover work surfaces with disposable coverings (sheet/ towel/disposable covers).
- Disinfect skin in treatment region with swab (70% isopropyl alcohol or povidone-iodine).
- Sharps should be handled with care in order to prevent accidental needle stick injury.
- All sharps must be immediately and appropriately disposed of in a recommended Australian Standards container after use. This applies in both clinic and team travel environments.
- All practitioners performing dry needling should be immunised against hepatitis B infection
- A new swab is required be used for each separate area of the body. For example, if needles are to be inserted into the back and the legs, a separate swab is required for the back and each leg.
- All appliances used in the penetration of skin in acupuncture procedures are required to be sterile and single use only. This includes: acupuncture needles, ear press needles, dermal hammers and guide tubes.
- When necessary to grasp a needle shaft to facilitate insertion, the following methods must be used:
- use a fresh pre-packaged sterile alcohol swab or fresh sterile dry swab
- use a sterile glove.
- Suction cups and other non-sharp devices applied to a skin area directly after the use of a dermal hammer, lancet or prismatic needle, are required to be cleaned and disinfected or sterilised prior to being reused.
- Bamboo suction cups are single use appliances and must not be reused, as bamboo is porous and difficult to clean after use.