Commonwealth Day #9 – Reflection 4

XX Commonwealth Games
XX Commonwealth Games

 

The 2014 commonwealth games is coming to a close within the next few days. The Glasgow platform has provided some amazing sporting outcomes and a great experience for athletes, team officials, and Clydesiders alike. As part of the medical services, working in the polyclinic has given me a taste of the multi-sport elite level competition, and whilst it is hard work, it’s certainly something I have thoroughly enjoyed.

 

The What?

I have learnt a lot from being in the polyclinic environment and working alongside some fantastic physiotherapists over the past two weeks. When an athlete is injured, they usually transferred to the polyclinic, from the field of play, to receive world-class treatment. However, what happens when the athletes doesn’t listen?

 

So What?

A netball player presented to the polyclinic with an acute ankle sprain, 2 days previously, she sprained her ankle competing. Treatment was provided to aid recovery but as part of my assessment, I enquired as to when she was competing next, the reply I received was ‘5pm today’.

As physiotherapists, we naturally want to promote activity and sports participation, but sometimes the body needs time to heal. The athlete always wants to play and the coach always wants their best players fit for action. The difficulty comes when the coach is present to hear your opinion about an injury or doesn’t choose to hear it.

I advised the netball player that should not play on her ankle in its current state, despite the fact that she had a game that afternoon, and this is why.

The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis
The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis

The tissues within the body are maintained in homeostasis through training and competing. The tissues and structures in the body are pushed into ‘supraphysiological overload zone’ when competing, which means that are optimised within the ‘Envelope of Function’. When these tissues are overloaded beyond the ‘Envelope of Function’, i.e an injury occurs, then tissues fail and break or rupture. due to injury, the envelope of function is reduced and tissue homeostasis is disrupted.

 

What this means in the context of the athlete competing, is that they have a reduced physiological ability to perform to their highest level, which would be needed at an international event like the Commonwealth Games. If the athletes does compete with a reduced ‘Envelope of Function’, then they risk further injury as the tissues get overloaded beyond the envelope sooner. The cycle of boom and bust can re-occur until the tissue is given sufficient time to heal and repair to restore tissue homeostasis.

 

Now What?

1) Communicating the importance of tissue healing to athletes is difficult but needs to be emphasised to avoid boom and bust cycle of injury.

2) Communicating the outcomes of clinical assessments to the athletes medical team should be done immediately to discuss return to competition but athletes want to play and coaches want their best players available for selection, so getting this message through can be difficult.

3) Treatment of injuries should be looked at in the short-term and long-term outcomes with the athlete at the centre of the treatment goals

 

Reference

1) Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005; 436:100-110.

 

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TA Physio

am driven and passionate about healthcare focused on delivering successful patient outcomes through personalised rehabilitation. So far, I have established a successful career in physiotherapy rehabilitation and gained valuable experience in contributing to marketing strategies within multi-national companies. In 2005 I graduated from UWIC with a degree in science, health, exercise and sport, and then specialised in Physiotherapy and graduated Coventry University in 2008. Since commencing my physiotherapy career I have gained valuable experience in musculoskeletal, sports rehabilitation, and community based neurological and falls prevention rehabilitation within the NHS. In 2010 I set up TA Physio to provide a personal and flexible service for clientele requiring sports rehabilitation, falls prevention & rehabilitation, musculoskeletal physiotherapy as well as bio mechanical assessment in North London. In 2011 I joined AposTherapy as a junior therapist and developed over 2 years to become a Senior AposTherapist in 2013. Recently I have been promoted to lead the London Clinic development and growth reporting directly to the UK Clinical Lead and overseeing ten members of clinical staff. The responsibilities included developing vital HCP links to build referral pathways, accountable for staff development and clinical needs of the AposTherapy London Clinic. In 2014 I provided physiotherapy to elite athletes at The Glasgow 2014 Commonwealth Games. I was based within the busy and dynamic polyclinic within the Athletes' Villages. The aim is to help Glasgow 2014 deliver a direct access physiotherapy service to the people at the heart of the Games. Specialties: Gait Analysis, Deviations and Gait Rehabilitation; Sports Specific Rehabilitation; Orthopaedic Post Operative Rehabilitation; Musculoskeletal Physiotherapy; Clinical Blog Writing; Development and Growth of Clinical Services; Presenting to Healthcare Professionals & Advisory Boards.