And we use the phrase, especially at a high performance
level, is, you know, knowledge is power. So the
more you understand about the simple elements
of your physiology and being healthy, and we
optimise that health and prioritise that health,
well then it helps them to optimise their performance
as well. Hi Sharon, it's my pleasure to have
you on Evidence Strong Show. If you could briefly
introduce yourself. Hi, my name is Sharon Kearney.
I live in New Zealand in Christchurch. I am a
physiotherapist by trade. Currently, I work for
Netball New Zealand in two capacities. I'm the
high performance physio for the leading team,
which is called the Silver Ferns. But I also
work in the Netball Smart program, which is the
injury prevention program for Netball New Zealand.
And the injury prevention program is more based
towards the community. side of netball within
our country. Awesome. So that's the topic of
our conversation. Netball Smart and additional
frameworks you guys develop look amazing and
hopefully they do a lot of good in female sport
from the community to high performance. So I'm
keen to learn, where are you in this journey
of improving female sport? Wow, that's a good
question, Alex. I think when you're on this journey,
you are always at the beginning because there
always is so much more. to do and the more you
do the more you feel like you're still at the
beginning I suppose if we go back to the beginning
Netball Smart was funded by ACC which is our
insurance company in New Zealand and the idea
behind that was they wanted to decrease significant
injuries our significant injuries in netball
are ACLs and ankles but they also gave us three
objectives so it was decrease significant injuries
it was increase awareness of Netball Smart and
then the third one was approved player welfare
is what they called it at the time. So I suppose
what that... Those three key objectives generated
an environment for us to develop a holistic program.
With the key outcome, because it's an insurance
company, we have to decrease the cost of ACL
and ankle injuries, but it also gave us almost
poetic license to look at other elements of supporting
females and female health, really. At the beginning,
ACC said that if we did a neuromuscular warm
-up based on maybe the FIFA warm -up, we would
decrease... ACLs by 50%. Wow. If we're thinking
about that in a community space, we understood
that they were exaggerating that stat because
the evidence tells us that if you have a very
tailored program, which is monitored, which is
delivered by experts, yes, you will potentially
get that outcome. But our community netballers,
community coaches coaching in a community environment,
and they don't have access to physiotherapists
and streets and conditioning coaches. So then
we decided. that for us to try and achieve that
outcome, we needed a far greater program, not
just a neuromuscular program. We needed to educate
our coaches and our athletes and their extended
whānau or family around the key elements of an
injury prevention program. So that would be,
yes, the neuromuscular warm -up, but yes, what
we call smart movement, which is your ability
to jump, land, decelerate well and effectively.
Smart training, it's a strength. aerobic -based
sports. So we need to educate our coaches and
our athletes that you need to be fit and strong
to play our game. Smart injury management. We
will have injuries and we try to mitigate and
decrease. But then also when you get an injury,
how do you mitigate or decrease the impact of
that injury? So that's the smart management.
And then preparation. So smart preparation. How
can you prepare for an event like training? So
that's about hydration, nutrition, shoe selection.
You know, our game is a really challenging...
game and if they choose a poor shoe to do it
and then potentially they're more likely to be
injured so that's the smart preparation focus.
The last piece that was added to the pie was
player welfare or well -being and initially we
looked at that from quite a holistic you know
like load perspective how do we educate our parents
and our coaches that load management is important
that going through adolescence peak height velocity
knowledge is really important and then delved
little bit further because a very close colleague
of me Kylie Cox came to me and wanted to do some
research into understanding females knowledge
of their menstrual cycle in relationship to health
and well -being and performance and initially
she said well I'd like to do it in triathletes
And I said, hang on a minute, we've got a captive
audience here. Netball is the most popular women's
sport in New Zealand. Why don't we do it in netballers?
So I pulled Kylie into the fold and we did some
research at a secondary school level. And it
came across quite glaringly that our young females
had no real sound knowledge of female physiology.
understanding of their own health and well -being
and an understanding of how the menstrual cycle
might be a barometer of their health and well
-being. So once we found that out, then we decided,
well, okay, if that is the case, clearly they're
not being educated well about being a female
and a healthy female. We do know in a school
setting, they get their sex education. So it's
more around you're a female, you're made to reproduce.
reproduce. This is how you reproduce. And this
is how not to get pregnant, but not stepping
back and going, this is what a female is. This
is why you have hormones. This is how to be a
healthy female. So we decided that we would develop
some resources to begin with, as you will see
on our website, and then have taken those resources
to the community. And we use our Netball Smart
developers who are based around New Zealand to
start delivering some simple workshops on being
a healthy female and what does that mean but
we also tie all our other messages in as well
about jumping and landing about neuromuscular
warm -ups about being fit and strong enough to
play our game so we try to continue to have that
strong holistic overall program to support our
young females in their sport so that's sort of
that's how we started and it's been quite a journey
but I suppose if I take put my other hat on I
work in the high performance space. So I'm the
lead physio and medical coordinator for Netball
New Zealand. So I have the luxury of working
in the high performance space and in the community
space. And I used to be the high performance
physio for Netball New Zealand for a long time,
a number of years ago. I moved out to move into
Netball Smart and then I moved back in because
I saw there was a wonderful opportunity for us
to connect the high performance physiotherapy
program and medical program with our Netball
Smart program from the community up. So the ideal
scenario is if our athletes navigate through
their community netball. they're healthy and
well in the present and for the future but if
they have the sheer joy of becoming an elite
athlete the messages they're getting at a community
space are the same messages that they're getting
at a high performance space but at a high performance
space it's just more concentrated so just overall
trying to improve the female athlete health literacy
of our population that play that play netball
so that's sort of I came back into the high performance
space because I just saw that there was this
gap and I have the luxury of working in Netball
Smart and how can I marry those two together
to continue to improve our education and health
literacy. Because one of the big things, Alex,
is we want our athletes to enjoy being a netballer.
We want them to have a quality experience in
netball. We want to use it as a vehicle to help
educate them about looking after their health
and wellbeing. And we want them to leave netball
having had a positive experience. and... from
a health perspective, you know, hopefully be
in as good or a better place as they navigate
out and then want to come back into our sport,
whether it be coaches or umpires or just a parent
who's supporting their young netballer because
they've had a really positive health experience
within our sport. It's a lofty goal. But anyway,
I suppose you've got to be driven by lofty goals
or otherwise you'd just sit at home on your couch
watching Netflix. It sounds amazing because it
sounds like you're building a framework that
gives every... education for years because if
you think about even community sport, the little
girl enters the team when they're in primary
school and they can play as long as they want.
They can leave and they can come back to their
recreational community or competitive netball.
and they have this tricking in education and
hopefully gaining skills for life, whether they
will decide to go pro or not, that what they
learn, all the skills with the sport itself,
we know that this is valuable in itself already.
But if they can gain some additional skills in
terms of health management, fitness management
and so on, understanding of their own physiology,
they are so much ahead. Yes, that's exactly right.
Use the phrase, especially at a high performance
level, is, you know, knowledge is power. So the
more you understand about the simple elements
of your physiology and being healthy, and we
optimize that health and prioritize that health,
well, then it helps them to optimize their performance
as well. So a healthy athlete at a performance
level who is on the court training, who is in
the gym training, who is on the court performing,
is going to get better at their sport versus
sitting. on the sideline, either ill or injured
because they haven't been able to manage things
well. It also gives them a little bit of autonomy
because we do know in a high performance environment,
our athletes are pushed to the edge to be the
best that they can be. But we want them to do
it in a way that they understand what that could
mean. And you'll know as well, we deal a lot
within sport, especially at a performance and
even recreational level with LEA, low energy
availability. But if our athletes actually understand
that the fueling needs for them is not just around
training, I need to fuel to train, but I need
to fuel to run my physiological systems in my
body. I need to fuel to support my ability to
concentrate, to be able to study. I need to fuel
to be able to be a social human being. If they
understand that in a bigger picture and they
understand that earlier, then hopefully we are
going to prevent some of these scenarios where
we have these young athletes that end up... in
LEA and then ultimately in REDS and then with
ongoing health issues as they navigate out of
our sport and decide that they want to have children
but they have challenged their system for so
long that their physiological systems have shut
down and it's hard to reactivate those if it's
been happening for such a long period of time
so we're really trying to increase the awareness
of our athletes particularly in a high performance
space around that so they're making some decisions
about what they do based on knowledge, not just
because they're told they need to run harder,
jump faster, be fitter, be leaner. They understand
how that impacts on their body as well. Right.
Very important. Could we go into the details
how the education actually is implementing from
the community to high performance level? So at
a high performance level, for example, I'm presently
traveling the countryside with Kylie Cotts. our
specialist in smart health, and we're delivering
workshops into our top domestic competition athletes.
So, and okay, we have an hour in front of them.
That's all we have because they have timetables
that are bottlenecked. But what we're doing,
and we did it last year as well, so we talk about
smart health performance. So this is understanding
being a female, understanding your health in
a performance setting where you are going to
be challenged consistently. That's one element
of what we do. The athletes also have their PHEs
or their performance health evaluations. So they
have a medical, for example. We're trying to
help them understand that when they're having
blood tests, why are you having blood tests for?
And what does that mean in terms of your health
and well -being versus I just did some blood
tests. I don't know why I did them, but I just
did them. So just trying to help them understand
how their performance health evaluation is about
evaluating their health and how they need to
ask. good questions and we arm them with some
information to help them ask those questions.
We link in very closely with the nutrition program
so the athletes have a nutritionist and so if
we have any concerns when we're delivering workshops
around some of the questions the athletes might
ask around LEA or REDS we link them back into
the nutritionist. workshops in the ideal world
we have the sncs the physios and the coaches
and the athletes all in the and the nutritionists
all in the room together so not only is the athlete
learning about female athletic health but so
is the coach so is the snc can't say hand on
heart we're 100 we're doing that 100 well at
the moment because still in our setting sometimes
the coaches or the snc will go oh that's their
their journey that's their knowledge but we're
trying to encompass everybody so that they all
fully understand it. So that's where we're starting
at that high performance space. We could do a
better job if we had more time. We're developing
some online learning. So if someone asks some
questions, then we can gear them towards some
online learning modules that we've developed.
And we're sort of like growing that library because
we are fully aware that we can't give them everything
in one hour. We're fully aware they'll have some
other questions, but then how How can we help
them understand where to go? But I think the
face to face thing, Alex, is really, really important
because it's that. connection and that relationship
that you develop with your athletes by bringing
female athletic health forward into a conversation
that then encourages them to go and look more
for it. Whereas if you just go, oh, here's a
whole lot of resources, go and navigate your
way through our website and look at these modules,
they don't connect enough with it to understand
that that's a really good idea. So we do believe
that the face -to -face modules are really important
to catalyst, to kickstart their curiosity. wanting
to find out more about their overall health and
well -being and help them then navigate where
they may need to go if they're having some concerns,
you know, the nutritionist, the endocrinologist,
the doctor. So that they do start generating
that understanding, knowledge and power to be
autonomous in their overall health. High performance
space. I think it's having the in -person workshop
with someone outside coming in and providing.
I'm not sure whether it's a safe place, but it
shows that this is an important topic. This is
to be considered and gives almost permission.
Because high level athletes sacrifice to some
degree their health for performance. But I think
it is. is important to bring the health into
the conversation so they are one aware that they
are doing it and two that they can prevent some
of the things be it with low energy availability
or you know the consequences if you prolongly
in this phase when you're not fueling your body
properly you may end up here these are the risks
so they are can balance being an athlete professional
athlete with being a healthy human being knowledgeably
and with a lookout to the future Just what professional
athletes are amazing in is in suffering and compromising
their health and almost ignoring the health issues
sometimes for this better performance. And we
praise them for that and they are rewarded for
that. And that's how they become heroes. That's
the job. But we want them to last long. We want
them to be amazing human beings and healthy and
then moving on from being a professional athlete
to other roles in sport or outside and being
productive and so on. So because they have amazing
skills after, we don't want them to just fade
away. So this conversation, making it important,
is also, I think, part of what is needed in professional
sport. I completely agree. And that's the thing.
increasing their knowledge and understanding,
then we want them to have some autonomy in terms
of that decision -making about pushing themselves
to the edge and sacrificing. So if I sacrifice...
my health at this moment to be the best that
I can be I'm doing it and I understand and I
know that I can pull myself back so it might
be for example you know like triathletes who
may feel that they perform really well at a certain
weight but they live on that edge understanding
that it is challenging their body but then also
they know once they've competed they can pull
themselves back into possibly a healthier state
but if they don't understand that and they haven't
got that sort of underlying knowledge then they
all almost like unwittingly go down trajectory
of less than optimal health for their performance.
And as you know, Alex, until they get to that
tipping point where that less than optimal health
actually has a significantly negative impact
on their performance. Yeah. So yeah, that's our
sort of like underwriting philosophy is how do
we just help them understand this? Because we
want them also, you know, there's quite a lot,
there's been quite a lot of media in New Zealand
around female athletes finishing their performance.
professional careers, their high -level careers,
and then deciding that they want to move into
the next part of their life, which is having
a family, and being really challenged by it because
they have compromised probably their reproductive
system for a while by living on that edge. And
it doesn't happen as readily and as easily as
they thought it might. And that can be really
psychologically challenging for any female or
any high -performing athlete who then wants to
make a decision about the next part of their
life. I wanted to ask you whether it would be
all right for you to go roughly what you are
able to squeeze within this one hour workshop
so what we have figured out having done these
workshops over a while through the community
space and at a high performance space is how
we deliver it so what we squeeze in is giving
them an idea about hormonal balance like what
are hormones what are female hormones what are
the other hormones that we have within our body
system what they're for and then how those hormones
influenced by lifestyle so lifestyle be whether
that your training intensity your recovery your
nutrition and other lifestyle stresses so helping
them understand that how their body works is
influenced by all of those things and then delve
a little bit more into the female hormones we
discuss the menstrual cycle and what happens
and and how it happens but how from a at a brain
perspective if we're thinking about FSH and LH.
Hormones come from the hypothalamus in the brain
and then how the ovaries generate hormones as
well. So just trying to get them to understand
a little bit of that. And then what then can
impact on that? So we talk a lot about energy
in versus energy out. So if you're training at
a really high intensity, obviously your energy
out is greater. So therefore your energy in has
to be greater to maintain that body homeostasis.
And so for a lot of them, you know, when they
go and talk to their nutritionist, they listen
to it as a very mechanical approach sometimes.
This is what you just need to do to fuel. But
when we delve into it and understand help them
understand it from a health perspective and a
hormonal perspective then they figure out Some
of them that, yes, that mechanical eating is
really important. I've just got to get that fuel
in because I'm expending so much here. And if
I don't, then some system in my body will have
to compromise. And what would that system, you
know, what could that system possibly be? It
might be an immune system. It might be your reproductive
system. So we try to educate them in a way that
your menstrual cycle is a barometer of, can be,
not always, can be a barometer. of what you're
actually doing to your body by challenging it
with high energy output and then And then we
sort of evolve into how your PHE is really important,
how your nutrition consultations are really important
to support your overall health and wellbeing
at that performance level. What often happens
is they'll, then they'll start asking questions,
especially those ones who are at the end of starting
to evolve into the end of their career about
how can they ensure that they are maintaining
optimal hormonal health. And then we help them
sort of like navigate through that around. okay,
well, here's where you can go, here's where you
can go and get some consultations to understand
where you're at in terms of your overall hormonal
health. That's sort of general. It's quite general,
but it's just sort of like continuing to open
up their ideas. But ideally moving forward, because
we're working in the community space, so in the
community space we deal in a secondary school
level, but any athlete that's on a pathway, so
it might be the top secondary school kids. that
are in a netball program, the New Zealand secondary
school team, the under 21 teams, the NNL team,
which is the team that sits underneath our top
domestic competition, they are all getting smart
health. workshops. So the ideal scenario moving
forward is that as they navigate into this performance
space, they've had some education, they've already
started thinking about their health, they've
already started understanding it. So when we
get to the top end, it's fine tuning it because
they've got some background and understanding.
That's ultimately where we're moving forward
and why the workshops in the community space
is really important for Joe Brogg's average net.
but also any of those kids that are hoping to
aspire to be a Silver Fern and be in that performance
space moving forward. And I think the thing is
we're pretty early on in the piece. It's, you
know, like we're three years down the track.
We've learnt a lot. We are revisiting our resources
that we've developed and changing them because
what we started with what we thought was the
right track is not quite the right track and
we're subtly changing that. So how have you changed?
Just the way we approach it. So more around that
when sometimes it can be really confronting if
you stand in front of a group of young females
and go menstrual cycle because of, you know,
you start with the menstrual cycle. So what we
don't is we start with exactly. There are some
people in NZ that are developing, that are working
in the space as well. And they, you know, they
talk about the power of the period and having
your period is amazing. Well, our young athletes
are no way in anywhere near that thought process
to them. it's actually an inconvenience so what
we've figured out is that when we talk about
hormonal balance we talk about being healthy
we talk about energy and energy out and how the
system works and that your menstrual cycle is
a barometer of that it's a far more pleasant
way to navigate through it and a far less confronting
way to navigate it than confront them initially
with a discussion about the menstrual cycle because
rightly or wrongly as a female population we
still don't we there's there is still stigma
about talking about the menstrual cycle. So that's
what we've learned. So our workshops are quite
different to what they used to be. So therefore
our resources will reflect that as we just evolve
and change them. I think the messaging as such
is the same, but it's just how we package that
messaging to help our athletes navigate through
the resources in a way that's not so confronting.
But communicating and discussing the menstrual
cycle from a Polynesian and Maori perspective
is very different from a Western European. So
we're working very closely with a colleague of
mine to help us understand how we can co -design
and co -deliver female athletic health, but in
a culturally sensitive way. So that's our next
sort of like, as we revamp and review what we're
doing already, how can we then link in to the
indigenous population and support their needs
as much as, I suppose, the Western side of medicine.
So that's pretty, that's going to be a pretty
interesting space. And it's just very new. It's
ideal timing because we are revamping what we're
doing and what our approach is. So, but it's
a big job. Will you have like separate version
or will you blend both together? How do you go
about it? Really good point. So we will look
at all spectrums because we have within New Zealand,
we have kura who are full Maori immersion teaching
environments. So how we would present in that
environment would be very different to how we
present made. be in a combined Māori and Western
view versus a very Western view. So we're just
navigating that at the moment. We haven't come
with a conclusion, but I think what we will find
is that we will have quite a number of different
ways to deliver it. So we're very mindful of
meeting the needs of the community that we are
working with. So co -design and co -delivery
has to be forefront. We're very much in the translation
phase. So buttoning down on what we've... not
go exploring too far. I'm really good at exploring
to the detriment of myself. But understanding
that now it's more about the exploiting. It's
more about the connection. It's more about delivering
what we've got in variable different ways because
there's still a big part of the community that
we haven't connected with yet. So that's where
Netball Smart's going now is less about developing
you, but more about developing the connections.
And less about exploring. More about connection.
Yeah, exactly. More about taking what we have
developed and ensuring that we are delivering
to the community, helping the community understand
the importance of Netball Smart. And yeah, working
with the coaches, the players, anybody and everybody.
Thank you for your work. Thank you for your service.
Other sports are watching. So I wish you all
the best and hope to learn from you in the future.
One more question before we finish. Where people
can find you if they want to connect? see your
org see where what you're up to and maybe ask
a question so the website so it's www .netballsmart
.co .nz all our resources go onto our website
the joy of ACC is they fund us to do this and
we deliver workshops we develop resources for
free so we don't charge for anything that's because
netball because ACC want us to decrease injuries
and so therefore so anything on our website is
free available so there's the videos there there's
the resources and somewhere in amongst those
resources there'd be my email address sharonk
at netballnewzealand .co .nz so that's where
the brains trust of netball smart sits on our
website so i suppose go and go and have a look
and download and use whatever you like thank
you so much it was a pleasure okay hey thanks
alex nice to see you bye