Commonwealth Day #10 – Refection #5

Well the end is in sight for Glasgow 2014 Commonwealth Games and I’ve had a blast so much so I might go to Rio.

Working in the poly clinic as a physio to the athletes has been a once in a lifetime experience and taught me so much about the world of elite multi-sport events.

I have had the opportunity to work under a great physiotherapy in Lynne Booth and a fantastic team of physio’s from across the UK.

The next goal for me is to get My Physio in sport bronze award and then continue multi-sport event physiotherapy through UK Athletics and BUCS pathways.

Thanks for reading my previous blogs.

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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

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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

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

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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!