The  Australian Commission on Safety and Quality in Health Care’s, 2017, "Osteoarthritis of the Knee Clinical Care Standard" provides an evidence-based approach for patients with knee osteoarthritis, to enhance symptom control, joint function, psychological wellbeing, quality of life, participation in usual activities, and to lessen the disability of knee osteoarthritis.

The Standard relates to care that patients aged 45 years and over should receive when they present with knee pain and are suspected of having knee osteoarthritis.

The Standard was revised and updated in August 2024. The Clinical Care Standard has been endorsed by 22 organisations, including The Australian Physiotherapy Association.

The Clinical Care Standard considers new evidence and expanded priorities so that people with knee osteoarthritis receive consistent care.

The Clinical Care Standard comprises of eight quality statements focussed on comprehensive assessment and diagnosis, appropriate use of imaging, education and self-management, physical activity and exercise, weight management and nutrition, medicines used to manage pain and mobility, patient review, and surgery, in line with contemporary evidence and international guidelines.

1) COMPREHENSIVE ASSESSMENT AND DIAGNOSIS
A patient with suspected knee osteoarthritis receives a comprehensive assessment, including a detailed history, a physical examination, and evaluation of factors affecting quality of life and participation in activities. A diagnosis of knee osteoarthritis can be confidently made based on this assessment

2) APPROPRIATE USE OF IMAGING
Imaging is not routinely used to diagnose knee osteoarthritis and is not offered to a patient with suspected knee osteoarthritis as there is a poor correlation between radiological evidence of osteoarthritis and symptom severity.

3) EDUCATION AND SELF-MANAGEMENT
Information about knee osteoarthritis and treatment options is discussed with the patient, including:

• Strategies to support increased physical activity
• Strategies to improve comfort and mobility
• Weight management guidance
• Strategies to optimise overall health
• Discussion of non-pharmacological pain management
• Referral to other clinicians
• Adjusting the management plan as needed
• Involvement of the patient’s family / support team as appropriate

4) PHYSICAL ACTIVITY AND EXERCISE
A patient with knee osteoarthritis is advised that being active can help manage knee pain and improve function. Exercise will not cause damage and is not a risky activity.

5) WEIGHT MANAGEMENT AND NUTRITION
A patient with knee osteoarthritis is advised of the impact of body weight on symptoms. Loss of excess weight can reduce knee pain and improve function, reducing the need for medicines and surgery. A 5-10% weight loss over 20 weeks is associated with reduced pain and improved quality of life.

6) MEDICINES USED TO MANAGE PAIN AND MOBILITY
Patients should speak with their GP and pharmacist regarding the management of their medicines, any possible side effects, and any potential interactions. Patients are not offered opioid analgesics for knee osteoarthritis because the risk of harm outweighs the benefits.

7) PATIENT REVIEW
A patient with knee osteoarthritis receives planned clinical review at agreed intervals, and management is adjusted for any changing needs.

8) SURGERY
A patient with knee osteoarthritis who has severe functional impairment despite optimal non-surgical management is considered for timely joint replacement surgery or joint-conserving surgery. Arthroscopic procedures are not offered to treat uncomplicated knee osteoarthritis.

​For more information and resources, see:
​www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard

​Success in sport is dependent on a number of factors like skill, fitness, squad size, tactics, and psychological factors. Athlete durability is also an important component of success.

In team sports, research shows a strong link between player availability and the success of the team, and that injuries and illness are the most common reasons for athlete unavailability in training and matches (REF). Research in team sports demonstrates an inverse relationship between injury burden and success of the team. Lower player availability is associated with failure to achieve key performance indicators. Injuries detrimentally affect the final ranking position in team sports (REF). And, research from professional European football shows lower season injury rates results in more successful seasons (REF).

Injuries and illnesses also affect success in individual sports. In elite track and field athletics, injuries and illness and their influence on training availability during preparation are major determinants of an athlete's chance of performance goal success or failure. Research shows the likelihood of achieving a performance goal increases by 7-times in athletes who complete >80% of planned training weeks. And, training availability accounts for 86% of successful seasons (REF).

So, injuries can determine success of failure in team and individual sports. Therefore, injury prevention strategies should be a focus for success-driven athletes and teams. 

​A number of sporting bodies have developed standardised injury prevention programs that are very effective at reducing injury rates. Sports that include these programs into their training have been shown to have between 50-80 per cent fewer injuries. These injury prevention programs are a series of exercises that are reasonably quick and easy to perform as part of a warm up. They include plyometric (jumping and landing), neuromuscular control (challenging balance, agility, addressing poor movement patterns), and strength exercises.

​For every 1,000 hours of game play, elite football players suffer between 12 – 35 injuries (REF). The most common types of injury sustained during a football game are muscle strains, ligament sprains, and contusions. Ankle, knee, and groin have the highest incidence of injury, and the greatest risk for sustaining an injury is during a football game as opposed to during a training session (REF).

The warm-up program “FIFA11+” is an injury prevention program designed by the Federation Internationale Football Association (FIFA) Medical and Research Centre (F-MARC) in 2006. It was designed to reduce the occurrence of injuries associated with playing football. 

The FIFA11+ consists of three parts and 15 exercises in total:

• The first part of the program involves running exercises and active stretching.
• The second part of the FIFA11+ program introduces six sets of exercises designed to work on the athlete’s core strength, leg strength, balance as well as their agility and plyometric ability.
• The third and final part of the FIFA11+ includes moderate to high speed running with planting/cutting movements.

The FIFA11+ program has been studied extensively over the last ten years to determine its effectiveness on injury prevention and physical performance measures, across a variety of populations. The FIFA11+ program has been shown to significantly reduce the risk of injuries in football (REF). This includes a 77% decrease in ACL injuries  (REF), a 48% reduction in lower limb injuries (REF), and an overall injury reduction of 35% per 1000 hours (REF).

In 2020, Football Australia developed "Perform+" as the primary injury prevention program for football in Australia. The Football Australia Perform+ is an updated version of the FIFA11+ program with more flexibility for coaches and new content targeting hip and groin injury prevention.

PERFORM+ INJURY PREVENTION PROGRAM and more resources for injury prevention in football are available here: footballnsw.com.au/protection-and-safety/injury-prevention/

​Netball Australia has developed the "KNEE Program” to help prevent knee and other lower limb injuries in netball.

Knee and ankle injuries are common in netball, making up three quarters of all injuries. Devastating ACL injuries are unfortunately common in netball, making up 25% of the serious injuries.

The KNEE program offers a range of warm-up exercises that help prevent injury. There are a range of age and experience appropriate exercises for junior, through to elite netballers. They are easily understood by players and coaches, with a number of options offering variability and progression.

It would be great for the KNEE program to be widely adopted by Australia's largest participation sport for females.

​KNEE Program resources are available at: https://knee.netball.com.au

​FootyFirst is a five level progressive exercise training program that has been developed specifically to reduce the risk of common leg injuries in community Australian rules football. 

FootyFirst begins with a warm-up, followed by leg strengthening and conditioning exercises, and training to improve balance, landing and side-stepping skills. It requires only standard training equipment and can replace the traditional warm-up. Once players and coaches are familiar with the exercises, the warm-up should take about 5 minutes, and the strength and conditioning exercises and jumping, landing and changing direction activities about 15 minutes. 

Performed correctly and frequently, FootyFirst will improve performance and reduce injury risk. FootyFirst has been shown to decrease knee injuries by 50% and all leg injuries by 22% (REF). It will improve players’ leg strength and control – from their hip to hamstring, groin to thigh, lower leg, knee, ankle and foot.

Resources include the FootyFirst Coaches’ Manual, a series of posters illustrating the exercises at each level, and the FootyFirst Coaches DVD is available at: aflcommunityclub.com.au/index.php?id=906