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.
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?
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 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.
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
1) Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005; 436:100-110.
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 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).
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.
Multi-disciplinary healthcare provision is idealistic and can work with clear and concise communication as well as team work to overcome problems.
Systems and approaches to care provision need to flexible to ensure correct diagnosis and treatment are provided
The athletes are the main priority and excellent care needs to be provided to ensure the best outcome for the athlete
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.
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.
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).
– 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.
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
Don’t just do what the athlete thinks will help. Clinically reason the problem and take suitable action in the form of treatment
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
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.
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.
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.
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.
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.
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
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.
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.
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.
Thanks for reading and watch this space for updates
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.