Celtic Phoenix Ireland

Question: Portray about the Celtic Phoenix for Ireland. Answer: 1. As per the article, the given bailout is 64 billion for example $89 billion USD. This is near two-fifths of the economys GDP. Subsequently the genuine GDP is near: (5/2)*($89 billion) = $222.5 billion. After there is a 11.2% constriction, the GDP will psychologist to: [{(100-11.2)*$222.5}/100] = $197.58 billion USD. The given yearly development pace of the Euro Zone is 1.2%. In light of present conditions, state, the economy would take A years to recoup. The estimation of A can be found by the procedure: 197.58*(1+0.012)A = 222.5 By taking care of this issue for A, the worth turns into A = 10 (roughly). Thus, it would take right around ten years to recoup from the economy (Lancaster 2012). 2. The total national output (GDP) is the money related worth of all the completed products and enterprises which are created inside a nation's outskirts in a given period. Gross domestic product is normally assessed on a yearly premise; it very well may be figured on a quarterly premise also. A nation's GDP may ascend for different reasons. One of the essential reasons is, expanding the populace. The GDP is tallied by including the absolute populace's pay. Consequently, the ascent in populace will prompt expanding absolute income, bringing about an expanded GDP. In view of this explanation, GDP alone can't portray the precise image of a nation's economy. To get the genuine substance of a nation's economy, one needs to discover its per capita GDP. A nation with high populace number may have a higher GDP than a nation with less number of populace, however that doesn't suggest the previous nation is in a superior position financially than the later one. The GDP per individual or per capit a is equivalent to the absolute GDP of the nation, partitioned by the whole populace of the nation, for example Gross domestic product per capita of a nation = (Total GDP of the nation/Total populace of the nation). This is a superior pointer of an economys quality. Presently, if there is an ascent in populace which is more noteworthy than the expansion in GDP, the GDP per capita of the nation will fall, as the denominator gets higher than the numerator (Wuyi and Kaike 2014). By along these lines, the GDP of the nation has outperformed its past pinnacle, and simultaneously, the GDP per capita stays underneath the pinnacle (Barnes et al. 2013). 3. The national salary character speaks to the strategy where the total national output (GDP) is estimated, as the entirety of uses in various exhaustive spending areas (Kaldor 2015). The character, as demonstrated as follows, states that GDP of a nation is the aggregate of individual utilization uses (C), private speculation uses (I), government utilization consumptions (G), and uses on trades (X) short uses on imports (M): Gross domestic product = C + I + G + (X M). Individual utilization consumptions (C) incorporate the products and ventures, purchased by local residents. Private local speculation (I) remembers consumptions by organizations for fixed venture and any adjustments in business inventories. Government uses (G) incorporate acquisition of products, administrations, and structures from household firms and the remainder of the world by bureaucratic, state, and neighborhood government. Fares (X) comprise of the merchandise and ventures that are offered to the outside purchasers. Imports (M) incorporate those items and administrations which are bought from the remainder of the world, by the household residents. The distinction among fares and imports (X M) is known as the net fares (Cooper et al. 2013). From the article, unmistakably the purpose for the quick development of GDP is the development in the net fares (X - M). It has nothing to do with the utilization of the residents of Ireland, household venture, and government consumption. The contrast among fares and imports has expanded which is going about as a parity of the national pay (Mackenbach and Looman 2013). The residential utilization of the nation stays low, alongside the lower level of venture and government consumption, which delineates the shortcoming of the economy of the nation. Be that as it may, here, the expanded net fares are balancing the lessening brought about by the little volume of utilization, and thus, expanding the (GDP) of the nation (Economist.com, 2016). Accordingly, the expansion in net fares not really demonstrates a solid economy (O'Hagan and Newman 2014). 4. The Neoclassical financial aspects is a lot of clarifications to different issues of financial matters which centers around the assurance of products, yields, and dispersion of pay in the business sectors present in an economy through the idea of flexibly and request. The Neoclassical financial matters mostly deals with the microeconomics idea of the nation, and along with Keynesian financial aspects frames the neoclassical structure. It works on the standard financial aspects today (Lawson 2013). On account of Ireland, there are adequate requests just as gracefully in the business sectors at present. In this way, at present, Ireland can spend more. The expansion in spending by the general population is very much anticipated. This will bring about developing interest and utilization. An expansion in speculation will tail it. The national pay character is: Gross domestic product = C + I + G + (X M); C = utilization uses, I = private speculation uses, G = government utilization uses, X = trades and M = imports. The expansion in C and I are not the only one going to build the national salary situation of Ireland. Arranged consumption by the legislature is additionally expected to roll out a reasonable improvement. Most of the salary Ireland is getting now is from different worldwide organizations (MNC) (Lunn 2013). In spite of the fact that the flexibly of income is consistent now, it isn't ensured later on. To roll out this improvement in pay changeless, the specialists need to accept activities as quickly as time permits. The current assets must be utilized to build the interests in the gainful regions of the nation's economy. The expansion in C, I and G will bring about a solid, economical salary of Ireland. This will build the flexibly and request situation of the economy reinforcing the economy (Sexton 2014). References: Barnes, S., Bouis, R., Briard, P., Dougherty, S. what's more, Eris, M., 2013.The GDP effect of change: a basic recreation framework(No. 834). OECD Publishing. Cooper, R., Edey, H.C. what's more, Peacock, A.T., 2013.National pay and social bookkeeping. Routledge. Economist.com. (2016). Celtic phoenix | The Economist. [online] Available at: https://www.economist.com/news/money and-financial aspects/21678830-ireland-appears there-monetary eternal life celtic-phoenix [Accessed 21 Aug. 2016]. Kaldor, N., 2015. Keynesian financial matters following fifty years. InEssays on Keynesian and Kaldorian Economics(pp. 27-74). Palgrave Macmillan UK. Kubiszewski, I., Costanza, R., Franco, C., Lawn, P., Talberth, J., Jackson, T. what's more, Aylmer, C., 2013. Past GDP: Measuring and accomplishing worldwide certifiable advancement. Biological Economics, 93, pp.57-68. Lancaster, K., 2012. Numerical financial aspects. Messenger Corporation. Lawson, T., 2013. What is this school called neoclassical economics?.Cambridge Journal of Economics,37(5), pp.947-983. Lunn, P.D., 2013. The job of dynamic inclinations in Ireland's banking crisis.Irish Political Studies,28(4), pp.563-590. Mackenbach, J.P. what's more, Looman, C.W., 2013. Future and national pay in Europe, 1900-2008: an update of Prestons analysis.International diary of epidemiology,42(4), pp.1100-1110. O'Hagan, J.W. furthermore, Newman, C. eds., 2014.The Economy of Ireland: national and sectoral strategy Issues. Gill Macmillan Ltd. Sexton, L.A., 2014. Ireland's information economy strategy: convictions, drivers and possibilities. Wuyi, Z. what's more, Kaike, W., 2014. The Main Contents, Effects and Revelations of the Latest Adjustment on GDP Accounting in USA.Statistical Research,3, p.002.

Human Resource Management at Delphi Essay -- HR HRM

Human Resource Management at Delphi Human Resource Management is the usage of HR to accomplish authoritative goals. Different examinations have reasoned that an organization?s HR is its kin. It tends to be a huge wellspring of upper hand. Making serious progress through individuals requires a basic change in how directors consider an association workforce and how they see the work relationship. It's another methodology inside the structure of authoritative, conduct that goes past the job of just work force organization. I have figured out How work investigation is a fundamental procedure of deciding the aptitudes, obligations and information required for performing employments in an association, How remuneration incorporates all prize that people recuperation because of their business, and The Occupational Safety and Health is an affirmed state word related wellbeing and wellbeing program. With today?s work power getting progressively assorted, an association must accomplish more to amplify the advantages of the various representatives. Human Resource Managers are advancing from the ?Old School? sideline player to the cutting edge contenders. Individuals have consistently been integral to associations, however their vital significance is developing in today?s society. Though the human asset stock is worried about mentioning to the board what singular representatives can do, Job Analysis is increasingly key. It characterizes the employments inside the association and the practices that are important to play out the activity. It is fundamental and inescapable human asset procedure. The motivation behind employment examination is to acquire answers to six significant inquiries: 1) What physical a psychological assignments does the laborer achieve? 2) ... ...a perilous tag on it, if it?s risky. The association needs a framework that can control the compartments. At the point when an individual looks at the holder, that equivalent individual should check it in toward the finish of the move. This will guarantee appropriate naming of the compartments. Taking everything into account, every one of these things can be benefical to an association if use in appropriate setting. I have figured out How work examination is a foundational procedure of deciding the abilities, obligations and information required for performing employments in an association, How remuneration incorporates all prize that people recuperation because of their business, and The Occupational Safety and Health is an affirmed state word related security and wellbeing program. Regardless of whether an association decide to actualize elite work rehearses or the association has qualified individuals to play out the work that should be finished.

Ethical System Table

Bearings: 1. Fill in a word meanings of every essential moral hypothesis. 2. Recognize interchange names or varieties of each moral framework dependent on your perusing of the content and supplemental materials. Match this present reality models recorded beneath with the comparing frameworks. The first has been finished for you in the table. a. I accept individuals ought to have the option to eat sand on the off chance that they like its flavor. b. I accept that if sand will be eaten, it ought to be accessible for everybody to eat. c. I accept individuals ought to have the option to eat sand since it is the correct activity. . I accept individuals ought to have the option to eat sand since it is useful for one’s wellbeing. e. I accept individuals ought to have the option to eat sand on the off chance that they choose they need to, whether or not it is somebody else’s sand. f. I accept individuals ought to have the option to eat sand on the off chance that they need to o n the grounds that they are allowed to settle on the choice themselves. g. I trust I will eat sand since it is the standard supper for my locale. 3. Build up your own work environment model that fits with every framework. Present every working environment situation in a considerable passage of around 40 words. Despite the fact that the table field will extend to suit your working environment models, you may show them toward the finish of the table; make a note in the table to see the joined models, nonetheless, so your facilitator knows to search for situations beneath the table. 4. Arrangement references as indicated by APA measures and incorporate them after the table. |Ethical Theory or |Brief Definition |Other Names for Theory |Real-world Example|Workplace Example | |System | Duty-based Ethics |Regardless of outcomes, |Deontology, pluralism, |C |It is my obligation to finish | |certain moral standards are |moral rights, rights-based|I accept individuals |instructions my manager gives me, regardless of whether I | |binding, concentrating on the job rather | |should have the option to |do not concur with the idea. It is my | |than results or good commitment |Categorical basic |eat sand in light of the fact that |moral commitment to regard authority | |over what the individual would | |it is the privilege |figures. | |prefer to do (Trevino and Nelson, |Golden rule |thing to do. | |2007, Ch. 4). | |In morals, deontological morals, | |or deontology (Greek: deon meaning| | |obligation or obligation), is a hypothesis | |holding that choices ought to be | |made exclusively or essentially by | |considering one's obligations and the | |rights of others. A few frameworks are| | |based on scriptural or principles from | |sacred. | |Consequence-based |â€Å"†¦an moral choice should |Consequentialist Theories |B | |Ethics |maximize advantages to society and | |I accept that if |I realize that we marked an agreement for a big| | |minimize hurts. What is important is |Utilitarianism |sand is going to |new customer however we can’t declare it until | |the net parity of good | |be eaten, it |next month. The advantages to resolve of the | |consequences over bad† (Trevino and | |should be |company and representatives exceed the | |Nelson, 2007, Ch. 4). | |available for |consequences of making an early | |everyone to eat. |announcement. I should make the | |announcement. |Rights-based Ethics |Rights are viewed as |Contractarianism |A | |ethically right and substantial since |Social Contract |I accept individuals |Employees reserve the option to expect a safe | |a huge or administering populace | |should have the option to |working condition since that is a piece of | |endorses them (Ridley, 1998). | |eat sand in the event that they |the implicit agreement in present day America. | |like the flavor of | |it. | |Human Nature Ethics |Ethical values that are hard coded| |D | |into individuals as being a piece of the |â₠¬Å"Common Courtesy† |I accept individuals |A collaborator wants to switch shifts | |human race. Characteristic propensities | |should have the option to |to care for a debilitated relative. In the event that the | |instead of man-made law for making| |eat sand on the grounds that |other individual doesn’t have a squeezing | |decisions. | |it is useful for |engagement it is ideal to switch the | |one’s wellbeing. |shift and help them out. | |Relativistic Ethics |Moral differences are brought about by |Moral Relativism |F | |the certainty that everybody in principle | |I accept individuals |Based on the position somebody has in a | |is directly in their own particular manner. |â€Å"When in Rome, do as the |should have the option to |company it may not be fitting for them| | |Individuals just must be genuine |Romans do. |eat sand in the event that they |to have obvious piercings or tattoos when | |to themselves and nobody else. | |want to in light of the fact that |a increasingly proficient mien should be | |they are allowed to |maintained. Others might have the option to since it| | |make the choice |doesn’t influence their presentation or the | |themselves. |company picture in their position. | |Entitlement-based | |E | |Ethics | |I accept individuals | |should have the option to | |eat sand on the off chance that they | |decide they need | |to, paying little mind to | |whether it is | |someone else’s | |sand. | |Virtue-based morals | |The uprightness morals approach focuses|Community morals, |G |The quality control group in our organization | |more on the trustworthiness of the moral|professional |I trust I will |has to convey food handlers and wellbeing | |actor than on the ethical demonstration |responsibility |eat sand in light of the fact that |cards. I ought to have the option to believe that food| | |itself. In temperance morals, |The Disclosure Rule |it is the standard|provided as test fulfills the guidelines of | |character is a lot of characterized by | |meal for my |the rules that they acknowledged when | |one’s network (Trevino and Nelson,| |community. |getting that confirmation. | |2007, Ch. 4). | Reference Trevino, L. K. , and Nelson, K. A. (2007). Overseeing business morals: Straight discussion about how to do it right (fourth ed. ). Hoboken, NJ: Wiley. Ridley, Aaron. (1998). Starting Bioethics. New York: St. Martin's Press.

Prepare for takeoff...and a quick landing free essay sample

I plunk down in seat 17A, directly over the wing of the plane and glance around. There are several individuals that I don't have a clue, nor will ever get an opportunity to know. The plane murmurs to life as the motor pushes the 2000 pound mass down the runway. The plane quickens speed as it is lifted into the sky, leaving the natural ground and going into the new, open sky. During the flight I communicate calmly with the steward or attendant, yet never actually. At times, I sit close to an individual that I can identify with and interface with, conversing with them essentially the whole time we are noticeable all around, astounded and somewhat dismal when hearing the pilot’s voice originate from the radio, advising everybody to â€Å"Put your plate tables up and your seat in the upstanding situation for landing,† demonstrating a close to end to the discussion so altogether delighted in. We will compose a custom article test on Get ready for takeoffand a fast arrival or then again any comparable subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page At the point when the flight is finished, you’re compelled to go separate ways, yet will recollect that individual creation an effect on your life, regardless of whether it b a little or huge one, making your excursion critical. For the duration of our lives, we experience an assortment of progress. Here and there we are compelled to change from the natural to the obscure, yet there will consistently be individuals who sway our lives any place we go. At the point when I chose to go to ASU, I realized that I would not know anybody once I left Tennessee for Arizona, and that I’d need to begin my life without any preparation again. The main thing I knew about was the way that I was progressing from the natural, to the new. I’ve meet several individuals throughout my life; I stay in contact with a few, yet many become a haze of faces, mixing in with the remainder of the individuals that I meet. Making dear companions is troublesome when you continually and out of the blue need to move, something I was acclimated with growing up as a military imp. In any case, there are a couple of individuals that have been carved into my memory, having a perpetual effect. A considerable lot of my companionships wo uld take off, however would reach a conclusion with guarantees of â€Å"keeping in touch,† gradually slipping after one of us moved away and the status of being â€Å"best friends† would end, vanishing as we vanished from each other’s lives. My closest companion lives in Tennessee, and before I left for school, I needed to bid farewell to her. It was a hard idea realizing that subsequent to going through for all intents and purposes each day with her for as far back as 18 months, we would need to abandon seeing each other for quite a long time at once. I was concerned that such an extraordinary kinship would end, much the same as the numerous others I had been a piece of. Seven and a half months after the fact, we despite everything talk each day. We are as yet ready to identify with one another and each other’s lives regardless of not having seen each other for so long. Not at all like the numerous different kinships that smallly affected me, this kinship has and has had an enormous one. Our kinship presently can't seem to slip, the captain’s voice still unheard from the speakers advising the travelers to, â€Å"Put your plate tables up and your seat in the upstanding situation for landing,† flaggin g the finish of a long excursion, yet I question that will ever occur.

Does anonymity on the web give people too much freedom to torment Essay

Does obscurity on the web give individuals an excessive amount of opportunity to torment others - Essay Example Potential casualties are additionally secured along these lines. Patients and guardians, for example, can discuss delicate issues in open gatherings (Milner). Survivors of separation and violations can likewise stand up namelessly. These days, there are uncountable visit rooms where individuals get the chance to talk straightforwardly of how they feel about their employments, companions and even ways of life. The discussion on sexual orientation fairness, for instance, saw numerous ladies and men communicate. Both uncivil and neighborly reactions were acknowledged in the discussion. This settled on it simple to arrive at speedy choices by has. As Milner claims, Anonymity can enable the individuals who look for comfort and equity to stand up .Victims of assault, for instance, can discuss their trial without the dread of dismissal or disgrace. Then again, mysterious individuals can scare other web clients or even go similar to following them. Predisposition inspired following and sexua l intrusion of security are a significant hazard that accompany secrecy. The two meddle with different people groups work and general way of life. Individuals persuade an opportunity to be heard on the web through Anonymity. Prior to the innovation of the web, just persuasive individuals were sufficiently blessed to be tuned in to. Namelessness likewise guarantees the insurance of Democracy and non military personnel rights. Talking about political issues without secrecy would not be conceivable. This is on the grounds that legislators are extremely compelling individuals and consequently regular people would not chance encounter by communicating their perspectives. Individuals become acquainted with what others think concerning specific issues. Then again, individuals can exploit and abuse their opportunity of articulation to hurt and compromise others on the web, a demonstration called trolling. Trolling can be hostile, upsetting and now and again stunning. Obscurity on the web just gives web clients enough opportunity to communicate. Namelessness doesn't give individuals opportunity to torment others. It is a benefit that needs not be meddled with. As

Kinesthesis and Physically Active Learning

Kinesthesis and Physically Active Learning Theories Cognitive Psychology Print Kinesthesis and Physically Active Learning By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Updated on June 23, 2019 MoMo Productions / The Image Bank / Getty Images More in Theories Cognitive Psychology Behavioral Psychology Developmental Psychology Personality Psychology Social Psychology Biological Psychology Psychosocial Psychology Kinesthesis also referred to as kinesthesia, is the perception of body movements. It involves being able to detect changes in body position and movements without relying on information from the five senses. You are using your kinesthetic sense whenever you are involved in a physical activity such as walking, running, driving, dancing, swimming, and anything that requires body movement. What Does Kinesthesis Do? Through your sense of kinesthesis, you can tell where different parts of your body are located even if your eyes are closed or you are standing in a dark room. For example, when you are riding a bicycle, receptors in your arms and legs send information to the brain about the position and movement of your limbs. When you think of the five major senses (vision, smell, touch, taste, and hearing), you might note that these all tend to focus on perceiving stimuli outside of the self. Kinesthesis is one type of sense that is focused on the bodys internal events. Rather than using this sense to detect stimuli outside of the self, your sense of kinesthesis allows you to know where your body is positioned and to detect changes in body position. When you need to perform a complex physical action, your sense of kinesthesis allows you to know where your body is and how much further it needs to go. Kinesthesis and  Learning Styles Kinesthesis relates to one of the three major learning styles in Fleming VAK model. According to the theories of learning styles, people learn best if the instruction is offered according to their learning preferences. An individual with a kinesthetic learning style would learn best by doing, or actually performing an action. Imagine, for example, that you are trying to learn  how to hit a baseball with a bat. If you have a kinesthetic learning style, you might learn best by actually performing the action. Instead of just reading about how to hit a ball or watching other people perform this action, you need to actually get a bat in your hands and practice swinging the bat at a ball. Kinesthetic learners are thought to enjoy being physically active, tend to excel at sports and often have fast reaction times. The VAK/VARK model of learning suggests that people with this learning style may prefer lessons that involve movement such as performing an experiment, working with a group or performing a skit. While the concept of learning styles is enormously popular, particularly in the field of education, most research has found that there is little evidence supporting the idea that instructing students according to their preferred learning style has any difference on educational outcomes. However, if you are a person who prefers learning by doing, as kinesthetic learners often do, you can perhaps take advantage of this knowledge when you are trying to learn something new. Rather than bore yourself with reading instruction manuals or listening to lectures, look for ways that you can gain hands-on experience.

Injury Risk - Health Dissertations - Free Essay Example

Injury risk in elite basketball players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and interven tion that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his g ymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst tra ining, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it enc ompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see sub stantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This wi ll be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather th an a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes w ho participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompan ied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improvin g the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up thei r sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in spo rtsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict oursel ves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review th e desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the fiel d and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their con clusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports gener ally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functio ns of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that t hey work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two cons iderations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be more severely dealt with and that these rules should be supported with more diligent refereeing. In view of the number of dental injuries recorded in the game ofbasketball, Kuala et al. also recommend the mandatory wearing ofdental shields or mouthguards It should be noted that taping and bracing are commonly employed techniques for protection in many sports, but their efficacy has onlybeen demonstrated in sportsmen with a history of previous injury (5,6).These techniques are most frequently applied to the ankle and kneejoints as these joints are both the most commonly affected and alsothey move in a primarily sagittal plane, therefore they are technicallythe easiest to mechanically brace. Other joints can be braced. The elbow can be successfully supported. It’s a common sight in players of racket sports to see a brace in place. Clearly this is of use if there is joint instability, but it is often mistakenly used in cased of â€Å"tennis elbow† where its value is often little more than a placebo. There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. The introduction of â€Å"high-top† basketball boots has not produced any definitive evidence that sprains and st rains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing seems to be more acceptable in terms of comfort for long-term use. Taping is clearly cheaper but will probably have tube re-applied at every sporting occasion. We do not propose to discuss taping in detail as there are a great many different techniques invented by a great many different clinicians, all of whom will, no doubt, claim that there particular method is the best. We do not presume to make a judgement on this issue and when referring to â€Å"taping† this should be taken as a generic process rather than a specific one. In most cases the object of the exercise is to reduce the range of abnormal movement at a joint and also (on occasions) to reduce the possible movement in a normal direction, in an attempt to help to reduce the inflammatory processes that may be present. In most cases, the taping can be applied by the patient themselves after basic in struction by the doctor or physiotherapist. There is the commonly held belief that strapping or braces should not be worn because they impair performance. In a study by Thacker teal., (1999) (27) a careful study of the literature was made and they were able to conclude that â€Å"appropriately applied braces, tape, or orthoses do not adversely affect performance.† They were also able to recommend that, after an ankle injury, athletes should complete supervised rehabilitation before returning to practice or competition and those athletes who suffered moderate or severe sprain should wear an appropriate orthotic for at least six months. In a theme that we shall return to in this piece, Thacker concludes by observing that it is not only doctors and physiotherapists that must assume the burden of responsibility for prevention of injuries in sports, but it is also the coaches, trainers and, indeed, the athletes themselves, who must also share in that responsibility. Pr e-match training is a major area where athletes and their professional advisors can influence both the incidence and severity of injuries. Appropriate strength, agility and flexibility training will all help to reduce the likelihood of problems arising during and after play. Stretching is an area of considerable controversy at present. Most authorities would agree that a pre-match warm-up and stretch is a good sensible prophylactic measure. Hard evidence for this (in terms of randomised, placebo controlled trials) is hard to find. The second edition of Mate and Char land’s book (28) Facilitated stretching, is useful compendium of opinion on the subject. It has been well reviewed by a physiotherapist, Ian Horsley, (29) who makes some very pertinent observations on the text. Controversially, the book expounds the virtues of post-match stretching rather than pre-match stretching. Its particularly useful for an erudite explanation of the current thinking on the anatomy and physiology of the stretch reflex and the impact of this on the various modalities of stretching techniques. In terms of research specifically into the role of stretching in the prophylaxis of injury, an interesting review of the available literature is provided by Young (30) who examined the available literature and came to the conclusion that â€Å"Stretching is perhaps the most common routine advocated by sports coaches and sports medicine professionals. In this study, no evidence for its effectiveness in the prevention of sport related injury was found. â€Å" It is fair to observe, however, that the implication that stretching does not reduce subsequent injury is not justified. Young qualifies his statement by asserting that the reason that â€Å"no evidence could be found† was due tithe fact that the trials studied were not sufficiently scientifically rigorous to provide unequivocal evidence of the benefits of stretching. He cites studies (31,32,33) as examples o f this. Ian Shirer (2000) produces a very thought provoking article (34) in which he specifically looks for the evidence to support the perceived role of stretching in reducing injuries. He points to the fact that many of the trials that came out in support of stretching used stretching as a co-intervention and therefore the effects of stretching could not be isolated. In one, often quoted study, Strand et al.(1983) (35) reported a 75% reduction in injury rates after using stretching as a warm-up routine. Careful reading shows that while thesis true, Strand’s study also used leg guards, special shoes, taping ankles, controlled rehabilitation, education, and close supervision during play, so it was hardly surprising that there was a significant reduction in injury rates. In his pursuit of an answer, Shirer produces some carefully constructed arguments regarding stretching. Most injuries occur during eccentric muscle contractions (36) which has the ability to cause dam age inside of the normal envelope of motion because of the differing length of the muscle sarcomeres (37). Why then, if injuries occur within the normal range of movement, would an increased range of movement prevent injuries? It is a physiological fact that even mild stretching can cause a degree of damage at the cellular level (38). It also appears that stretching has an ability to produce a tolerance to pain or an analgesic effect (39,40,41). Why, he argues, should it be considered prudent to increase the tolerance to pain, produce some damage at the cellular level and then exercise this damaged, partially anaesthetised muscle? Against this he cites the counter argument that there is scientific data to support the warm up as a prophylactic for injuries during a match (42) Other risk factors can be identified that can predispose to injury. Overzealous or misguided training schedules can also lead to overuse syndromes in their own right. In addition to strength training, elit e basketball players will often run considerable distances on a weekly basis in order to improve or maintain their levels of cardiovascular fitness. This can have associated problems and the supervising physiotherapist should be aware of the potential hazards. liotibial band syndrome, tibia stress syndrome, patella-femoral pain syndrome, Achilles tendinitis, and plantar fasciitis have all been associated with overtraining (30). Prophylaxis can be achieved by modifying the training schedule, adequate warm-up and stretching and possibly modifying the footwear. There is evidence to suggest that athletes who train one to three days per week are less likely to be injured than those who train five days per week (30). Similarly, with intense training, athletes who train for15-30 mines. per day have significantly lower injury incidence than those who train for 45 mines a day ( The reference here is to running training not any other form). Interestingly, the results of this study show ed that there was no significance in the prevention of injuries (from the running section of training) when a graduated programme was used. A specific and large study on the subject of ankle injuries in basketball (20) also makes interesting reading. Significant findings included the fact that the ankle injury rate was 3.85 per 1000participations in a match, with almost half missing at least one week of competition as a result of the injury. In terms of prophylaxis, the study finds that factors that increased the risk were: a) A history of previous ankle injury made it five times more likely to sustain a further injury. b) b) Air cells in the heels of shoes made it 4.3 times more likely and c) c) players who did not stretch before the game were 2.6 times more likely to injure an ankle than those who did. The authors noted that taping a previously injured ankle reduced the likelihood of further injury, although they could not quantify the rate of reduction due to other con current factors Male vs. Female considerations Basketball is a sport that is enjoyed by both male and female participants. It does not follow, however, that the injury patterns are the same for both sexes. One can argue that men may tend to be physically heavier, more aggressive and move faster, all of which are indisputable anatomical and physiological facts. These reasons can be cited as reasons why male and female injury patterns are different. Unfortunately that is nowhere near sufficient to explain some of the observed facts. Some of the most studied differences come in relation to injuries to the knee. Women damage their ACL over three times more frequently than men. (20a)If the explanations of body weight, speed or aggression were employed, then one would confidently predict that men were more likely to suffer than women. Arendt (14) studied the problem and postulated that there were possibly a great many factors that could influence the aetiology of the injury. His team thought that it was likely that non-conta ct mechanisms were the main factor in the genesis of these injuries. They cited several different mechanisms of injury including such extrinsic factors such as relative muscular strength, shoe-surface interface and specific body geometry (women have a wider stance than men due to the anatomical shape of the pelvis. They also cited certain intrinsic factors such as cyclical joint laxity (under the influence of the menstrual hormones), the actual dimensions of theatre-condylar notch in the knee (where the ACL runs) and also the actual size of the ACL itself. As a matter of completeness we would also cite the paper by Gael teal. (2005) (43) which also looks specifically at the issue of ACL injury, in the broader context over a prolonged period (1990-2002).This paper provides a very detailed analysis of the injuries sustained while playing basketball. It enhances the arguments for an extrinsic causation of the excess of female injuries by quoting the fact that there was found to b e no significant difference between the injury rates of men and women after direct contact incidents. Women, however, sustained a higher rate of non-contact injuries than men did. Further evidence for non-contact, intrinsic causes for the ACL sex difference is found by comparing the rates of ACL injury in basketball with those rates in football. A similar preponderance in female injury is found (43) implying that the difference is not likely to be sport specific. One completely unexplained finding was the fact that, over the 13 years that the study ran, the ACL injury rate for men progressively fell whereas the rate for women remained constant. The authors did not offer any explanation for this fact other than they postulated that the message to increase proprioception enhancing training may be being absorbed by the male population more effectively that the female population. Gael concludes the article with a comment that bears repeating. Despite focusing in this section on the injury of the ACL, it should be remembered that such injuries are still comparatively rare events when taken in the context of the totality of the sport. The possibility oracle injury should not be allowed to put off participation in the sport. Discussion The whole issue of injury in the area of basketball is the consideration of those issues that are relevant to sport in general and those that are specific to basketball. In this piece we have considered both areas. The incidence and types of injury have been discussed in detail together with the appropriate measures that a physiotherapist can take to minimise the incidence and severity of a specific injury occurring. The knee and ankle are areas at particular risk of injury and we have discussed these as separate cases both in terms of the mechanism of injury and the prophylaxis of the injury. It is clear from reviewing the literature on the subject, that the whole area of stretching before and after exercise is confused, with reputable authorities presenting arguments both for and against the issue. It would appear that, on balance, there is a general ground-swell of feeling that pre-exercise stretching is useful and evaluable prophylactic against injury however, there appea rs to belittle peer-reviewed literature which can be cited as unequivocal support for this view. 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