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.

 

Commonwealth Day #1 – Reflection 1

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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

NFL Injuries 2013/14

Hello everyone, thought id share this infographic from Wall Street Journal. It shows all the injuries sustainted fornm one season during NFL.

 

Not surprisingly the knees have taken a heavy load of the injuries, and those ankles are at high risk of injury. Looks like a slight correlations between reduced injuries and increased protective armour in that area. However, there is still plenty of shoulder and concussion injuries.

 

Enjoy the viewing.

 

Thanks
Tom

Neuromuscular Control – What does it mean???

Neuromuscular Control – What Does it mean?

Neuromuscular control is certainly a complex procedure undertaken by the body but this has been made easier to understand by Vern Gambetta, a top performance coach from the U.S. Great reading and this will certainly improve that understanding of movement.

Movement is quite simple and from that wonderful simplicity comes the complexity of sports skill and performance. Twenty-five years ago in an attempt to better explain movement and how we should effectively train movement I came up with this simple diagram I call the Performance Paradigm.
NMC
It was somewhat like what Albert Szent-Gyorgi, once said, “Discovery consists in seeing what everyone else has seen and thinking what no one else has thought.” Essentially it is the stretch shortening cycle of muscle with a more global interpretation and proprioception brought into consideration. It is the basis for what some people call the Gambetta Method; to me it is common sense. I use this to evaluate movement efficiency or deficiency and then to guide training and if necessary rehab.

Essentially all movement is interplay between force reduction and force production. The quality of the movement is dictated by our proprioceptive system. We begin movement by loading the muscles – this is the force reduction phase. Basically this is the eccentric loading phase as a well as instantaneous isometric action that lends stiffness to the muscle. This is the most important component of the performance paradigm, but probably the most overlooked as well as the most misunderstood. There are several reasons for this; the most notable being that it is less measurable. Because it is more difficult to quantify we have tended to emphasize the more measurable component, force production. It is during the force reduction phase that most injuries occur. Think landing on one leg and tearing an ACL or planting to cut and spraining an ankle. It is during this phase that gravity has its greatest impact; it is literally trying to slam the body into the ground.

Once force has been reduced the subsequent result is force production. Force production is easy to see and easy to measure. Consequently it gets an inordinate amount of attention in the training process. We see it because it is the outcome. It is how high or far we jump. It is how much we lift. But just because it is easy to see and measure does not mean it should receive the inordinate emphasis, in training that it does. It must be stressed that it is the component of the performance paradigm that is highly dependent on the other phases.

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The third component of the Performance Paradigm is proprioception. Ultimately it is the glue that binds a whole functional program together is proprioception. Proprioception is the awareness of joint position and force derived from the sense receptors in the joints, ligaments, muscles, and tendons. It is that component that gives quality to the movement. “The quality of movement, in part, is dependent upon neurologic information fed back from proprioceptors within muscles and joints to the higher brain centers. The information returning to the central nervous system from the periphery includes “data” concerning tension of muscle fibers, joint angles, and position of the body being moved.” Logan and McKinney (Page 62) It is the feedback mechanism that positions the limbs to be able to achieve optimum efficiency. It is a component of movement that has been all but ignored in most traditional training programs until recently. It is highly trainable, especially if it is incorporated as part of a whole program.

It is almost too simple. Perhaps to appreciate proprioception we should look at the extreme case of a stroke victim that is able to return to normal movement patterns. Why can’t an athlete who has all their capacities enhance the quality of their movement by focusing on the same things that the stroke victim has to focus on to get back to function? The key to that is proprioception. We must strive to constantly change proprioceptive demand throughout the training program in order to enhance the quality of movement.

The performance paradigm will serve as a guide to determine how we train all components. It can also serve as a very useful guide to help us to evaluate movement from a slightly different context. It should serve as a guide to be more functional in our approach by emphasizing the timing and sequence of all three components of the paradigm. The synergistic interplay between them will produce the highest quality of movement.

It is very easy to get caught in the trap of measurable strength. How much you can lift or how many foot-pounds of force you can express on a dynamometer are meaningless numbers. Functional training does not depend on measurable strength. Quality of movement, coordination and rhythm are more important. The goal is always to apply the strength that is developed in the actual sport performance. How is the force expressed? Can you produce and reduce the force? Force production is all about acceleration, but often the key to movement efficiency and staying injury free is the ability to decelerate and stabilize in order to position the body to perform efficiently. A good functional training program will work on the interplay between force production, force reduction and stabilization. The end result is functional strength

Thanks for reading, see my next post on ACL and neuromuscular control!!!

TA Physio

prehab not rehab for sport injury prevention
prehab not rehab for sport injury prevention

Kiniesiology Taping Course

KINESIOlOGY TAPING COURSE

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This exciting one day clinical Physiotherapy course will enable participants to:

  • Develop their understanding of the role of Kinesiology taping
  • Develop expertise in the application of Kinesiology Tape for common clinical conditions
  • Become proficient at applying Kinesiology  tape effectively to a variety of regions

 

Venue: Birmingham City Hospital, Dudley Road, Birmingham, B18 7QH

Date: Saturday 16th February 2013 (9 am: 4.30pm)

 

Tutor: Melanie Betts , MSc (Manip Ther); MMACP; MCSP; HPC;

London 2012 Olympic Volunteer Physio, Private Practitioner, World Student Games (1995) and World figure skating championship (1995). Great Britain Swimming Team from 1995-1999. She  was the physiotherapist for the Great Britain Target Shooting Team 2001-2010. These roles took her to Manchester 2002 & Melbourne 2006 Commonwealth Games, and the Athens Olympic Games 2004. She is also a sought after MSc Manual Therapy/ MACP Clinical mentor.

Fee: £95 (Includes all taping materials)

Contact: Gerard Greene, MSc (Manip Ther); MMACP; MCSP; HPC; PgCertEd

Ph: 07968 011832

Email: greenegerard@hotmail.com

Facebook: HarbornePhysio

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Runners Need Gleuts of Steel

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So many peolpe are training and runing over the winter, and thats a great away to get fit or die trying. But to help keep those unwanted injuries at bay,  try these exercises. These exercises help prevent leg injury’s in so many sports and activities, not to mention keeping your posterior nice and perky.

So here they are…

1) This video is a demo of the ‘Crab Walk’

Crab Walk

This video is a demo of the ‘Waltz Walk’

The Waltz

Finally this is a demo of the ‘Pee’d your pants Walk’

The Pee’d Pants

So there we go, a great first attempt at video blogging from Adam Meakins

If you have any questions or comments I would love to here them so please leave me a comment….

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Thanks for reading and watching

TA Physio

beach running

Marathon Injury Prevention (SECRET TIPS)

So knowing how competitive runners can be,  I thought I’d give the insiders tips on how to get ahead and stay ahead in your marathon preparation training.

Having done some further research, I had a good chat with Max Dillon who runs for Milton Keynes Running Club in triathlon’s, half marathons, marathons and 35/40/50 mile fell runs. Now, Max has vast experience for his age in running and he knows when and how to train. Having completed half marathons in sub – 1hr 20 minutes, training and staying fit is necessary to get the best results.

This article will look at Max’s advice for training and recovery as well as injury prevention:

Thinking about doing a marathon can be daunting but once you start the training, it becomes addictive. The issue being that many runners DON’T:

1) build the training gradually

2) allow enough COMPLETE rest days

3) or train hard enough when needed.

The advice and experience given by Max could be invaluable to make your training and performance more finely tuned, and help you get ahead of the competition:

  • Training should built from the ground up, gradually increasing the running miles.
  • Speed work needs to be hard and fast, this is advised by elite Ethiopian runners.
  • Long runs should be gentle and more enjoyable, these are about building endurance not speed.
  • Rest days are key for injury prevention. Complete rest is required. Consider that daily activities are NOT rest, and try to completely rest to avoid fatigue or overtraining.
  • Ice baths can help recovery after long runs. Evidence for this post-training is inconclusive BUT some runners believe it helps recovery. 10 minutes in an ice bath is good enough for Jessica Ennis, its good enough for you.
  • Compression Leggings can assist with venous blood flow post training to aid recovery. I.e Wear them to bed, that’s Max’s advice not mine. Keep the lower extremity blood flow and warm to the legs can assist with recovery. Again evidence is limited with these leggings, but give it a whirl!
  • To avoid common running injuries, try Sport Tape. its great for reducing overactive and control muscle fatigue especially something like Shin Splints.

  • When hill running, this requires vast amounts of eccentric quadricep control, especially running down hill. Do some eccentric quads loading exercises in the gym and build it gradually.
  • Day before the race, do a 20 min very light jog or strides to shake everything out. this is make sure your ready for race day and have no lethargy.
  • Active recovery post race is key, NO RUNNING, light swimming or gentle spin bike session will aid with muscular movement and quicker recovery.

A lot of this advice is individual to each runner but if you don’t try them, they you’ll never know if they can help.

A few common running injuries occur when first training, so these can be prevented by early assessment, early intervention, early return to sport. The commonest are Patellofemoral Pain Syndrome, Hip and Proximal Weakness, and Delayed Onset Muscle Soreness. TA Physio can assist with all these problems to enable you to continue running.

Let me know how it goes, if you have any questions for TA Physio or Max Dillon, then add them in the comments box below.

Thanks for reading.

TA Physio

Marathon Training Advice

Marathon Training Advice

So, its the time of year where everyone ramps up their training for the marathon season. Needless to say, the level of experience amongst runners varies widely. So this is a short guide for marathon training so you make it over the 26mile mark…..

….according to The Virgin London Marathon website, the following tips are noted:

10 Marathon Training Tips

1. Training Plan and Rest

Training for a single event such as the marathon can involve several phases of different types of running. Just as each week is comprised of different workouts, each phase is also somewhat different. A common fault to marathon training is not planning adequate rest. Many runners train too hard when they should be recovering from workouts, thereby not allowing for good quality training later in the training phase. Physical training stresses the body, and during recovery it adapts. Without rest and recovery, there can be no adaptation. The definition of rest is different for every runner. For the highly trained, it may be simply 30 minutes of easy running. For others, it may be a day completely off from training. All athletes need a day of complete rest (zero or very little exercise) regularly. This may be every week, ten days, or every two weeks. Nevertheless, it should be programmed into a training plan and adhered to. This allows the athlete to recover completely from workouts, and to train hard when it is time to train hard.

2. Weekly Mileage

Almost every runner gauges his or her training by weekly mileage. It’s useful for getting an idea of the volume of training, but too many runners feel it is the only measuring stick. How much one is training is a combination of volume and intensity. Don’t get hung up on logging a set number of weekly miles. If a day or two of training is missed due to injury or illness or other reason, don’t try to cram two days of training into one. Just pick-up the program and continue. Lost days are simply lost.

3. Marathon Tempo Running

One of the most important factors in marathon training is tempo running, which is defined as + 10 seconds per mile from your projected marathon pace. If you’re planning on running 26.2 miles at 7:00 per mile, then do lots of training at or near this pace. This is one of the major differences between elite runners’ marathon training and others training for the event. Most runners or joggers are simply trying to finish the event in halfway decent condition. Elite runners are essentially “racing” the event. That is, they will attempt to run 26.2 miles at a pace faster than their everyday run pace. Nearly everyone else is running marathons slower than their everyday pace. Marathon race pace for elite runners is at an interesting point, physiologically speaking. Many terms are used to describe this level, such as “threshold” and “capacity.” They all describe the same thing. Marathon pace usually uses most of the capacity of the aerobic energy system and very little of the anaerobic energy systems. Traditional road race and track training tends to ignore this marathon pace. Most training is done well above or below it. But the marathon is a unique event, and one of the limiting factors to performance is fuel economy, and training at projected marathon tempo trains your body to use fuel (specifically carbohydrate) efficiently.

4. Simulate Race Conditions In Training

To a large degree, simulate race conditions as much as possible during training. Don’t go out and race a marathon daily, but every facet of the race needs to be practiced. This training program includes tempo running toward the end of long runs, allowing your body to maintain your marathon race pace beyond 20 miles. Runners should also practice water stops and drinking large volumes of water and/or carbohydrate solutions during training. If you are training for a marathon such as Boston, then some downhill running needs to be incorporated. Try to train at the time of the day the race starts and in the predicted weather conditions as much as possible. Do a “dress rehearsal” several weeks prior to the event in a race or long run. This is the time to try out all racing clothing, shoes, socks, and pre-race meals. You want to do this far enough in advance to allow for changes to take place – and your blisters to heal.

5. Train the Long Runs

The long training runs of over 18 miles are the most important workouts in any training program. Every coach has a different philosophy on the long runs. Every week for 16 weeks is not required. Vary the long runs, mixing in some marathon tempo running. Much of a long training run is generally done at 30-45 seconds per mile slower than projected marathon race pace. Depending upon what training was completed in the previous few days, it may even be as slow as 1:30 per mile slower than projected race pace. Many runners get caught up in trying to run too much of a long run too hard. All too often, someone has a great workout of 18 miles at marathon pace three weeks before the main event, only to have a poor result.

6. Train and Compete with a Group

Running with a group is one of the most effective things an athlete can do to help his or her training. Everyone has a day when they are sluggish and needs the encouragement of a friend during a workout. At some point in time you will likely repay the favor by helping out that friend. Team running is great race strategy, but be careful that the group does not get too competitive and all of a sudden is racing the workout. Sometimes it is essential to select a person who is a good judge of pace and effort to control the tempo of a run, especially a long run. Don’t race the workouts.

7. Planned Racing

“How much” and “which” preparatory races are important questions. Much depends on the particular marathon and race schedule. It is easy to race too much leading to a major marathon. Since races typically fall on weekends, it usually means missing a long run or trying to do a long run the day after a race (generally not a good idea). Some runners like to do a couple of long races as long tempo runs a month or so prior to a targeted marathon. It is a good idea if you can go to a race and run at marathon pace. Be warned, however, most marathoners can’t do this; they are simply too competitive and run too hard. A limited number of races within a marathon training program (perhaps three over a 12 week period) to assess the progress of a program is sufficient.

8. Strides, Drills, and Stretching

This is another component that can make a big difference on race day. Doing a complete set of strides, 6-8 x 100-meter efforts at mile race pace (not sprints), two to three times per week is enough to maintain leg turnover by stimulating certain neural pathways and fast-twitch muscle fibers. And some days it just makes your legs feel better. Drills focus on a small aspect of the running stride and exaggerate it. Drills always pay off in the latter miles of the marathon when the major muscles are failing and the accessory muscles are called upon to help maintain running form. A brief stretching session done regularly will help improve your performance and reduce your risk of injury. (The debate of whether to stretch before or after running is hotly contested, so try both and see what works for you.) The total routine need not last for more than 15 minutes. Muscle groups to stretch include the quads, hamstrings, Achilles tendons, calves, back, and the upper body. Stretch according to need, depending on soreness, tightness or the upcoming workout. Some tips for stretching are: warm-up for at least 5 minutes with light jogging; perform stretches in a controlled and smooth manner; hold each stretch for at least 15-25 seconds; and, don’t strain, bounce or force a stretch.

9. Be Flexible with Your Workouts

Training for a marathon can take its toll on the body, and so set your self realistic training targets. Pushing through without consideration for the body can lead to over training. So be flexible and if you dont hit your target for that session, then dont worry. You’ll get it next time.

10. Listen to Your Body

Pay close attention to what your body tells you. Listen to yourself honestly. If you’ve been fatigued for several days in a row, then you may need to schedule in some rest and recovery time. Persistent foot pain for several weeks usually doesn’t just go away. Usually, it gets worse. It is always better to deal with these types of problems as early as possible, rather than wait until they grow into something serious – check out my blog posting on common running injuries

Enjoy The Run

TA Physio

Hypermobility Awareness & Assessment

Hello again,

Just sat here thinking about work during my time off and what I realised is how many of my clients are hyperlax, hypermobile or have hypermobility syndrome. Shockingly, 90% of these clients are not aware of this underlying condition and have never had it diagnosed by a fellow healthcare professional.

This article is to highlight how to assess and diagnose hypermobility during clinical assessments. There is a significant need for more awareness of these conditions, for the patient to understand their body and for clinicians to factor this into their rehab.

 

What is the Hypermobility Syndrome?

Connective tissue proteins such as collagen give the body its intrinsic   toughness. When they are differently formed, the results are mainly felt   in the “moving parts” – the joints, muscles, tendons, ligaments   – which are laxer and more fragile than is the case for most people. The   result is joint laxity with hypermobility and with it comes vulnerability   to the effects of injury.

The Hypermobility Syndrome is said to exist when symptoms are produced,   a state of affairs that may affect only a minority of hypermobile people.   It is probably more correct to refer to Hypermobility Syndromes (in the   plural) as a family of related genetically-based conditions which differ   not only in the particular protein affected, but also in the degree of   difference of formation. Thus at one end of the spectrum are the diseases   with the potentially serious complications such as Marfan Syndrome or   Ehlers-Danlos Syndrome Vascular Type (formally EDS IV). At the other end   are what is now called on good evidence Benign Joint Hypermobility Syndrome   (BJHS) and Ehlers-Danlos Hypermobile Type (formerly EDS III), which may   be one and the same

 

Hypermobility or Hypermobility Symdrome?

Hypermobility and hypermobility sydrome (HMS) can be diagnosed by a set of tests called the Beighton Score, and then tested against the criteria for HMS which is called the Brighton Score:

Beighton Score:

The Beighton modification of the Carter & Wilkinson scoring system   has been used for many years as an indicator of widesparead hypermobility.   A high Beighton score by itself does not mean that an individual has HMS.   It simply means that the individual has widespread hypermobility. Diagnosis   of Hypermobility Syndrome or HMS should be made using the Brighton Criteria.

The Beighton score is calculated as follows:

Score one point if you can bend and place you hands flat on the floor without bending you knees.
Score one point for each knee that will bend backwards.
Score one point for each elbow that will bend backwards.
Score one point for each thumb that will bend backwards to touch the forearm.
Score one point for each hand when you can bend the little finger back beyond 90°.

If you are able to perform all of above manouevres then you have a maximum   score of 9 points.

Brighton Score:

An important landmark was passed in July 2000 with the publication   in the Journal of Rheumatology (2000; 27: 1777-1779) of the Brighton Diagnostic   criteria for the Benign Joint Hypermobility Syndrome (BJHS).

The actual criteria have been reproduced (as published) below.

Major Criteria

  • A Beighton score of 4/9 or greater (either currently or historically)
  • Arthralgia for longer than 3 months in 4 or more joints

Minor Criteria

  • A Beighton score of 1, 2 or 3/9 (0, 1, 2 or 3 if aged 50+)
  • Arthralgia (> 3 months) in one to three joints or back pain (>     3 months), spondylosis, spondylolysis/spondylolisthesis.
  • Dislocation/subluxation in more than one joint, or in one joint on more than one occasion.
  • Soft tissue rheumatism. > 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
  • Marfanoid habitus (tall, slim, span/height ratio >1.03, upper: lower segment ratio less than 0.89, arachnodactyly   [positive Steinberg/wrist signs].
  • Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring.
  • Eye signs: drooping eyelids or myopia or antimongoloid slant.
  • Varicose veins or hernia or uterine/rectal prolapse.

The BJHS is diagnosed in the presence two major criteria, or one major   and two minor criteria, or four minor criteria. Two minor criteria will   suffice where there is an unequivocally affected first-degree relative.

BJHS is excluded by presence of Marfan or Ehlers-Danlos syndromes (other   than the EDS Hypermobility type (formerly EDS III) as defined by the Ghent   1996 (8) and the Villefranche 1998 (9) criteria respectively). Criteria   Major 1 and Minor 1 are mutually exclusive as are Major 2 and Minor 2.

 

The Subjective Give Away.

During your subjective assessment you should look for comments made by clients about their flexibility.

 

Clients may report that they feel a disconnection to their movements whilst partaking in sport. They may report numerous episodes of tripping for no reason, theymay alos report a long history of ankle problems. Ankle instability is well documented in HM and HMS sufferers as they have the flexibility in the ankle ligaments for them to stretch wihtou causing damage.

 

It is also well documented that dancers have exceptional flexibility, and most commonly ballet dancers, so their past times or activiteis may include dancing.

 

Such comments as, ‘I’ve always been very flexible’, ‘I’ve sprained my ankle loads of times’, ‘I used to do a lot of dancing’ are a sign for you to investigate further.

 

Start with the Beighton Score and then consider the Brighton Score is you suspect more. Always provide as much information to clients about HM or HMS, if you are unsure then direct them to a good source of information. The website below is excellent.

 

Thank you for reading this article.

Information regarding HMS and HM is available at www.hypermobility.org