Commonwealth Day #3 – Refelection 3

XX Commonwealth Games
XX Commonwealth Games

Commonwealth Reflection #3;

The Glasgow 2014 commonwealth games are now well and truly underway with Saturday 26th July promising to be a busy schedule of competition across various sports including netball, Judo, and tracking cycling. The athletes are in full swing and the medals are coming thick and fast with this in mind I undertook my third shift at the Games Village Polyclinic.

 

The What?

The poly clinic environment, as I’ve previously mentioned, is a fast paced and exciting environment but requires a cool and collected approach to ensure the athlete gets 1005 the elite care they deserve.  But sometimes the system can be slowed down with bureaucracy  with a classic example of this coming when SEM doctors require ultrasound scans for soft tissue damage. SEM had to refer to radiography for U/S and were unable to perform U/S sans themselves. So SEM referred to radiography but radiography would only do MRI scans due to higher sensitivity rates (1) (2).

 

 

Courtesy of Shoulderdoc.co.uk
Courtesy of Shoulderdoc.co.uk

So What?

The systems clearly works within the polyclinic with this clinic seeing upwards of 400 contacts in a day, but the system can be slowed down. Ideally, the SEM doctor would like to use U/S as part of the assessment process but this may not be time efficient. HCP’s need to carry out a full and thorough assessment of the presenting condition and provide appropriate care, which in this case involved using U/S scans for soft tissue injury. However the radiography preferred MRI scans for diagnostics which cost a lot more money to provide. The resolution came when SEM were finally able to use the diagnostic U/S scans for the athletes. This is by no way a criticism of the current system but goes to show with the best laid systems they need to be flexible to provide a high level of care within a high-octane environment.

 

Now What?

  1. Multi-disciplinary healthcare provision is idealistic and can work with clear and concise communication as well as team work to overcome problems.
  2. Systems and approaches to care provision need to flexible to ensure correct diagnosis and treatment are provided
  3. The athletes are the main priority and excellent care needs to be provided to ensure the best outcome for the athlete

 

Thanks for reading.

 

Tom

 

 

Reference:

1) B Hamilton, R Whiteley, E Almusa, B Roger, C Geertsema1, Johannes L Tol (2013); Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries; Br J Sports Med.

2) K M Khan, B B Forster, J Robinson, Y Cheong, L Louis, L Maclean, J E Taunton (2003); Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study; Br J Sports Med

 

 

'prehab not rehab'
‘prehab not rehab’

 

Commonwealth Day #2 – Refelection 2

20140709-092114-33674932.jpg
XX Commonwealth Games

Commonwealth Reflection #2:

Hello and welcome back. Thank you for reading my first reflection on my experiences in the Glasgow 2014 commonwealth games. After completing my first poly clinic shift, I was excited to get back in clinic and enjoy shift number two on Wednesday 23rd July, OPENING CEREMONY NIGHT

A little wiser from previous shift, I was feeling more confident in my new surroundings and raring to go one day before competition began.

The What?

So Wednesday turned out to be a quieter shift in the polyclinic due to preparation for the opening ceremony. Naturally, most the attendees were either competing the following day or an acute injury needing attention in preparation for the games.  The team scheduled to cover the evening shift was the same team I worked with the previous day, so I was glad to have some familiar faces in the clinic.

 

So What?

A number of athletes came to the polyclinic seeking intervention for strapping and taping, this is something that is usually undertaken by the national team medical staff but as some nations have differing budgets, not all nations have a full medical team at the games and so they optimised the services at the polyclinic.

Over the course my shift I assessed and treated athletes from sports including Judo, weightlifting, hockey and long jump. these four examples demonstrated a good variety of stage of injury and the appropriate treatment undertaken, difference in teams and the medical support available to prevent such injuries, and expectations from treatment.

– A Judo athlete attended clinic requesting strapping and taping for bilateral posterolateral corner of the knees. No pain upon assessment and so I taped the knees. I think there are many properties to tape and differences between tape and strapping but one underlying factor is the psychological impact it has. I believe that it gives competitors confidence to push their bodies to the highest level despite the absence of injury. In the injured athlete it can be high effective to stabilise a joint (i.e subluxed shoulder).

 

Patellar Femoral Compartment Stress
Patellar Femoral Compartment Stress

– I saw another weightlifter with acute patella tendon tendinopathy and high irritability, why is this a common occurrence? I could only assume it was due to an increased volume of training in preparation for the games. In an ideal world I would love to sit down with the athlete and analyse the training volumes to cross-correlate it to the onset of injury but in a fast paced environment like a polyclinic as well as communication limitations, this is unrealistic. If I were set within a national medical team I would use those skills to monitor injuries within training regimes and highlight these impacts on injury rates thus enabling a team to improve training and performance. These guys would benefit from some eccentric tendinopathy rehabilitation.

– I saw an acute adductor strain (Grade I – MRI confirmed) from one of the larger commonwealth teams and experienced first interaction with national teams doctor requesting treatment. As part of the immediate management, the athlete was put on cryotherapy in the shape of ‘game ready’. This device works by pumping ice cold water into a cuff that is attached to the athlete. The machine setting mean temperature, length of time and compression can be regulated by the clinician. Its a marvellous piece of kit to have especially as it addresses two of the five P.R.I.C.E principles for the immediate management of soft tissue injuries.

Now What?

  1. Its important as a clinician that all patient are thoroughly assessed especially if we have not assessed or don’t know anything about the athlete
  2. Don’t just do what the athlete thinks will help. Clinically reason the problem and take suitable action in the form of treatment
  3. Taking treatment requests from medical teams is acceptable but again question the reasons behind the intervention.

 

Thanks for reading, hope you enjoy the blog, watch this blog for more Commonwealth games posts

 

Tom

Enjoying Games Life
Enjoying Games Life

Commonwealth Day #1 – Reflection 1

20140709-092114-33674932.jpg
XX Commonwealth Games

Commonwealth Reflection #1:

So yesterday saw my first shift in the Commonwealth Games Polyclinic as a physiotherapist. Working alongside multiple professions under one roof is the idealist approach to rehabilitation and it works rather well.

 

Its my first experience at a multi-sport event, such as the Commonwealth Games, and yesterday was interesting. The polyclinic runs as an MSK service for athletes, volunteers and games family members.

 

The What?

Yesterday, I saw approximately 10 athletes from a variety of sports including discuss,  shot put, weightlifting, swimming, and table tennis. The variety of conditions presented included patella tendonitis, ulnar nerve irritation, patella femoral medial facet osteochondral defect, and congenital hip dysplasia.

 

So What?

All athletes receive a full and thorough assessment from one of the qualified therapists in the poly clinic MSK service. As part of the assessment  we have to take a subjective history. One of the learning points that I reflected on from yesterday was communication. The commonwealth games consisting of multiple nations from the commonwealth meant some athletes had limited understanding of the English language which meant they often came with a team member or staff member to aid communication. Naturally, this is time-consuming but can be effective as long ass questioning is succinct and appropriate. A further point around communicating through an interpreter is consent. It’s important that the athlete give consent for the other person to translate.

Lightening Bolt Strikes Again
Lightening Bolt Strikes Again

The polyclinic environment is vibrant and buzzing with athletes seeking professional advice to optimise their performance in readiness for their upcoming competition. The closeness of other professions within this setting means athletes, volunteers and family members can get medical services quickly. As a physiotherapist that has worked in the NHS and private sector, it’s often the case that these referrals can take some time to come to light. However, yesterday saw how effective a polyclinic environment can prove to be, and this was my first experience of the immediateness of a polyclinic environment. I was able to refer a patient to see a SEM doctor for a hip review within  a few hours – usually it would be quicker, but due to it being end of the day, an appointment was booked for the next morning.

 

A further example of the polyclinic environment functioning effectively was demonstrated when an athlete arrived at 3pm to see the SEM doctor with a suspected meniscus tear, saw myself for some immediate conservative management at 3:30pm, booked a MRI 6pm and results returned by 7pm. The speed of action from the polyclinic team meant that athlete was able to have diagnosis and intervention within a few hours and discharged back to the team medial staff for ongoing rehabilitation.

Now What?

  1. The immediate impact of the polyclinic environment has driven me to understand the further need for improved seed of onward referral in acute conditions. this not only eases the athletes and medical team state of mind but also provides the athlete with the best opportunity for recovery effectively.
  2. Communication in a clear and concise manner is important when treating international athletes. even a small mount of foreign language knowledge from the therapist can aid an assessment and information gathering. Use of posters and body charts or visual aids can aid non-verbal communication. Consent should always be gained from the athlete if translators are present, whether it’s a team member or medial team member.

Thanks for reading, hope you enjoy the blog, watch this blog for more Commonwealth games posts

 

Tom

http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2013/6/27/1372360575939/Billie-Jean-King-Bobby-Ri-008.jpg

Who’s Best at Tennis – Men or Women?

Courtesy of http://www.pinterest.com/pin/382735668304395653/
Smash Shot

Equality and Difference in Men’s and Women’s Tennis 

Every year a debate rumbles on in tennis about gender equality and this year is no exception with Wimbledon currently taking place. Perhaps it might surprise you to know that champions at Wimbledon have only received equal prize money since 2007. Women playing the best of three sets and men playing the best of five has led some to criticise the equal pay received by male and female players because it’s perceived that they don’t do equal work. However, we want to show below that whilst there are differences in the men’s and women’s games, the strengths don’t all lie with the men. Besides, there is a growing number of female tennis players who would prefer to play the best of five sets given the chance.

 

At the 2012 United States Open, IBM carried out research on the difference between male and female tennis players. John Isner hit the fastest serve at 144 miles per hour, whilst Serena Williams was the fastest woman with a serve of 125 miles per hour. The speed of the serve seems to be the main reason for differences in how the men’s and women’s games are played.  Of the 82 players analysed, five women hit a serve of at least 120 miles per hour, whereas only 5 men failed to reach that speed in their fastest delivery. It’s fair to say that women have less power in their serve because of differences in size and strength.

 

However, despite the lower speed of a first serve, women’s return games were far more successful. 47 made at least 75% of their returns whereas only 8 of the men did this.  35 women won at least 40% of their return points against the first serve whereas only 2 men managed this and against second serves 52 women won at least 55% of their return points whereas only 16 men managed this. Williams won from the baseline with 218 from 15 sets (an average of 14.5 winners per set), whereas Murray, leading the men, had an average of 10.2 winners per set.

 

So, whilst tennis may not yet be a perfect specimen of gender equality, it is certainly leading the way in the sports world as one of the few sports where the women’s game is as commercially and professionally successful as the men’s. In some ways the men’s and women’s games are different animals, as shown in this infographic provided by AposTherapy, making it hard to compare the work done. Instead it makes sense to think that equal reward is due to those few men and women who earn the number one world rankings in tennis! If increasing the number of sets in the women’s game is introduced in the future, then so be it.

 

Thanks for reading.

 

TA Physio

 

 

Commonwealth Games 2014

So Amongst all the sporting events taking place this summer…..Glasgow is hosting the Commonwealth Games at the end of this month.

The commonwealth games will see all the top athletes from the commonwealth nations compete for medals.

SPORTS
From the precision of Lawn Bowls to the combat of Wrestling and Judo, the high adrenaline of track events, and the grace and beauty of Gymnastics – find out more about the 17 sports and the medals that will be fiercely competed for at the Glasgow 2014 Commonwealth Games.

I’m excited and immensely proud to be providing physiotherapy at the commonwealth poly clinic within the athletes village.

Watch this space for a Commonwealth Games Diary including top results, shock results, rehab updates and training advice.

20140709-092018-33618176.jpg

Thanks for reading and watch this space for updates

Has a Hamstring Injury Shown Jozy the Alti-door To The World Cup?

Image

Jozy Altidore – World Cup Injury

By Gemma Tomkinson  posted Jun 18, 2014

Jozy Altidore, a 24-year-old USA striker, who plays for Sunderland in the Premier League, suffered a hamstring injury after 22 minutes of the first half of the 2-1 victory over Ghana. He had been running down a ball with Ghana’s John Boye when he grabbed the back of his left leg.

So what is a hamstring injury? The hamstrings are a group of 3 muscles located at the back of the thigh. These muscles are responsible for bending the knee and straightening the hip during activity and are particularly active during running, jumping and kicking.

During contraction of the hamstrings, tension is placed through the hamstring muscles. When this tension is excessive due to too much repetition or high force, one or more of the hamstring muscles can tear. This is known as a hamstring strain. This sometimes occurs with rapid acceleration whilst running or when a footballer performs a long kick. In Altidore’s case it was during sprinting.

Jozy Altidore told reporters after the game “I was sprinting and I felt something … I was crushed. I knew right away I couldn’t continue. It was the worst feeling.”

It appears that Jozy Altidore’s symptoms were more severe than a minor strain as he was unable to continue play and obviously in severe discomfort.

Hamstring injuries can range from a small partial strain to a complete rupture which may require surgical reconstruction. Hamstring strains are graded from grade 1 to a grade 3 tear and are classified as follows:

Grade 1: A small number of fibres are torn resulting in some pain, but allowing full function.
Grade 2: A significant number of fibres are torn with moderate loss of function.
Grade 3: All muscle fibres are ruptured resulting in major loss of function

As with all injuries, a thorough examination is undertaken by the medical team. Further investigations such as an MRI scan or Ultrasound may be required to confirm diagnosis. In Altidore’s case, he’s awaiting MRI results to determine his chances of playing again this tournament.

In terms of rehabilitation from an injury as Altidore’s it is vitally important that treatment starts immediately following injury with the principles of PRICE (protection, rest, ice, compression and elevation).

The initial acute stage of all hamstring injuries will last 24 to 48 hours. After this a full rehabilitation programme should be followed which looks to reduce pain and inflammation, improve flexibility and muscle control and gradually increase the load through the hamstring to a level where you are able to return to full training and match play. The rehabilitation will be designed by a highly trained physiotherapist to include stretching, strengthening, aerobic fitness and sports specific drills. It will be progressed appropriately related to the stages of healing.

Is Altidore out of the World Cup? Many would assume yes but Manager Jurgen Klinsmann remains optimistic and the medical team are working hard with Altidore to give him the best possible opportunity.

Follow us on Twitter @AposTherapy for more World Cup injury updates!

World Cup Injuries – Luis Suarez’s Rehab

Courtesy of The Guardian
Courtesy of The Guardian

After the recent hype around Luis Suarez’s injury and the likelihood of him returning to crunch match tomorrow evening. I’ve re-blogged this post by Amy Buckley from AposTherapy about Luis rehab undertaken to get him back in the game. Enjoy:

 

Millions of football fans worldwide are following closely after Luis Suarez recovery from his recent knee injury. His absence from the game with Costa Rica had a great impact on Uruguay team performance, and now the speculations are if he’s going to play the game vs. England.

Our specialists at AposTherapy decided to provide some professional insights on Suarez injury, treatment and a recovery process.

Suarez suffered from meniscus tear, a knee joint injury, common among football players, when the knee is twisted whilst in a partially flexed position and the foot is firmly planted on the ground.

The medial and lateral menisci of the knee are two crescent-moon-shaped disks of tissue (fibrocartilage) that lie between the ends of the upper leg bone (femur) and the lower leg bone (tibia) that form the knee joint. The menisci act as shock absorbers, evenly distributing the load across the knee and helping to keep the joint stable.

Symptoms of a meniscus tear depend on the size and location of the tear and whether other injuries to the knee occurred with it. A significant problem with meniscus tears manifests itself through ‘locking’ of the knee.  Luis reportedly suffered a lateral meniscus tear, a condition that may be pointed by a significant pain at the outer side of the affected knee.

Treatment options include: Nonsurgical treatment with rest, ice, compression, elevation, and exercises. Surgical repair to sew the tear together. Surgical removal of the torn section (partial meniscectomy). Neuremuscular control treatment. Total meniscectomy, which removes the entire meniscus, is typically avoided because of the increased risk for osteoarthritis (wear and tear).

Luis Suarez, for instance, underwent an arthroscopic. After his surgery, Luis was seen leaving the hospital immobilised with a brace.

Recovery from a meniscus tear depends on many things. The goals of rehabilitation are to restore range of motion, strength, and return the player back to a sporting condition.

Initial stages of rehabilitation will focus on restoring normal range of motion, normalising gait, eliminating swelling, and pain control to enable rehabilitation.

At the second stage of rehabilitation, the player works on good control of the knee through non-impact proprioceptive drills, hip and core strengthening, and quadriceps strengthening.

The final stage of rehabilitation concentrates on returning the player back to the sporting arena through completing sports specific movements and gradually re-introducing impact based activities.

At present, Luis is 3 weeks after his surgery, and through the help of his medical team, he will be working on impact control exercises, increasing the load and demand through a range of plyometric exercises. In addition, he will be working on sports specific balance and proprioceptive drills, hip and core strengthening, and return to light training in preparation for his appearance against England on Thursday.

 

By Amy Buckley posted Jun 17, 2014, AposTherapy Blog