Wednesday 21 December 2011
This is a case study of a patient that I have been working with for nearly a year. The patient, Tom has given his permission for me to discuss his case as well as using his full name and photos.
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| Tom being airlifted to hospital following the accident |
Tom first made contact with me when he emailed in early February regarding his rehabilitation for a hip injury. Tom’s background is as follows, he is a 56-year-old man, who is a keen cyclist and is very fit and active and he is retired from the US Military. On the 16th September 2009, whilst cycling in the French Alps Tom came off his bike whilst travelling at speed. The resulting accident left Tom with a dislocated hip and fractured acetabulum.
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| This is Tom stabilised, awaiting surgery. |
Due to his Military background Tom was able to be air lifted to a US military hospital where he underwent a number of operations to stabilize the pelvis. On the 10 March 2010 Tom was discharged from his US Air Force doctor, but was then subsequently admitted to the John Radcliffe Hospital for a MRSA infection that resulted in all his metal work having to be removed. He then under went physiotherapy through the NHS from May 2010 to August 2010.
Tom then began to see an acupuncturist as he was still in a large amount of pain and unable to walk without a limp. This is due to the complications suffered as a result of the surgeries and the healing process called heterotopic ossification around the acetabulum. This is a presence of bone in the soft tissue, where it should not normally exist. This and a huge amount of scar tissue were causing a lot of muscular tension that caused pain. This pain was so debilitating that Tom was still taking a cocktail of pain killers (tramadol and paracetamol) to help control this pain.
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| Adam from Revolution Sports Injuries Clinic treating Tom at his home. |
Adam from Revolution Sports Injuries Clinic, Wantage explains "as a Sports Therapist was to treat this muscular tension to reduce his pain, increase his range of movement and begin to get the damaged muscles firing correctly so he could start strengthening work, and get back on his bike."
Over the next 4 months Tom saw a huge reduction in his pain, which has resulted in Tom lowing his medications dramatically. The major success was to be able to get Tom back on a bike and he achieved his personal ambition of being able to cycle across the Pyrenees Mountains by June 2011!
Tom has now embarked on his next challenge, which is to cycle across America to raise money and awareness for American and British Military Charities. This event is called Sea 2 Sea.
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| Tom during his cycle trip across the Pyrenees Mountains in June 2001 |
Tom explains the event “This event will take place from 21st April to 8th July 2012. Departing the Repatriation Centre at Brize Norton, Oxfordshire, England, cycling to arrive at London Heathrow Airport. Arriving in the USA in Seattle, Washington then cycling east to finish the American leg towards Washington, DC. The total journey will be over 4000 miles.”
Tom goes on to say “To raise national and international awareness for UK and US veterans by having a joint UK/US nationwide cycling event 21 April - 08 July involving thousands of UK and US citizens.
My aim is to raise $10,000,000 for US military charities (i.e., Paralyzed Veterans of America, Wounded Warriors) and £5,000,000 for UK military charities (i.e., Army Benevolent Fund, British Legion, Help for Heroes) through their websites.”
For more information on Tom’s amazing new challenge go to www.sea2sea.org please view the video of when Tom met David Cameron to discuss this amazing charity event.
If you also like more information on Sports Therapy and the Sports Therapist who is helping Tom with his on going rehabilitation go to www.revolutionsportsinjuries.co.uk
Tuesday 22 November 2011
Every month I use the injuries that I am treating in my clinic to gain inspiration for writing this article. This month I have decided to focus on Carpal Tunnel Syndrome (CTS).
CTS is an entrapment of the Median nerve due to compression on the carpal tunnel. This is termed a neuropathy, which is a blanket term for nerve damage.
Causes of Carpal Tunnel Syndrome
There are a number of possible causes. It is important to correctly diagnose this because otherwise treatment will be less affective.
The main factors include:
- Traumatic wrist injury such as a sprain or fracture.
- Repetitive activity
- Pregnancy, this can cause increased fluid retention.
- Congenital, some people has smaller, narrower carpal tunnels
CTS is three times more common in woman compared with men. There is also a higher prevalence in people with diabetes as well as other conditions, which directly affect the nervous system.
Carpal Tunnel Symptoms
CTS usually has a gradual onset, it may affect one or both wrists. It can begin with only night pain. Other symptoms include:
- · Dull ache at wrist and forearm
- · Pain in thumb and fingers, excluding the little finger
- · Weakness in fingers and hand
- · Worse at night
- · Pain radiates into forearm, elbow and wrist.
Diagnosis of Carpal Tunnel
If you suspect that you may have CTS you should visit an injury professional such as sports therapist, physiotherapist or doctor. They will be able to give you a correct diagnosis
Treatment of Carpal Tunnel SyndromeInitially, total rest is required. This may involve immobilizing the wrist using a support. Cryotherapy and anti inflammatory’s, may also be required.
Following this phase, stretching and strengthening exercises should be used to help reduce of its reoccurrence, these should be prescribed by a sports therapist or physiotherapist.
For more information on Carpal Tunnel Syndrome, or to book an appointment at Revolution Sports Injuries Clinic, Grove Technology Park, Wantage, Oxfordshire please contact Adam on 07827324789 or go to www.revolutionsportsinjuries.co.uk
Wednesday 2 November 2011
During November each year, Movember is responsible for the sprouting of moustaches on thousands of men’s faces in the UK and around the world. The aim of which is to raise vital funds and awareness for men’s health, specifically prostate cancer and other cancers that affect men.
On Movember 1st, guys register at Movember.com with a clean-shaven face and then for the rest of the month, these selfless and generous men, known as Mo Bros, groom, trim and wax their way into the annals of fine moustachery. Supported by the women in their lives, Mo Sistas, Movember Mo Bros raise funds by seeking out sponsorship for their Mo-growing efforts.
Mo Bros effectively become walking, talking billboards for the 30 days of November and through their actions and words raise awareness by prompting private and public conversation around the often ignored issue of men’s health.
At the end of the month, Mo Bros and Mo Sistas celebrate their gallantry and valor by either throwing their own Movember party or attending one of the infamous Gala Partés held around the world by Movember, for Movember.
Adam Dobson from Revolution Sports Injuries Clinic is supporting Movember as part of the tfd bro’s with a Mo. If you would like to join our team or make a donation go to:
The Movember Effect: Awareness & Education, Survivorship, Research
The funds raised in the UK support the number one and two male specific cancers - prostate and testicular cancer. The funds raised are directed to programmes run directly by Movember and our men’s health partners, The Prostate Cancer Charity and the Institute of Cancer Research. Together, these channels work together to ensure that Movember funds are supporting a broad range of innovative, world-class programmes in line with our strategic goals in the areas of awareness and education, survivorship and research.
Friday 30 September 2011
This month I am going to talk about myofascial headaches, what this is, how it occurs and how a sports therapist, sports massage therapist or physiotherapist can treat it.
What is a Myofascial Headache?
Myofascial headaches are caused by myofascial pain, which is defined as a regional pain syndrome, characterized by referred pain from a trigger point located in a taut band of muscle (1). This pain can manifest itself in the form of either unilateral or bilateral headache. The pain duration can vary between hours to weeks and is usually of a moderate severity. This pain can radiate into the frontal, temporal and orbital regions (2).
What is a myofascial trigger point?
The simplest way to describe a trigger point is an area of thickening or a nodule in a muscle. This will also be an area of tenderness. Trigger points develop in muscles that are either over active or in areas of weak musculature (1). There are a number of myofascial trigger points that can cause headaches. Most of these are found in the musculature of the neck and shoulders. The muscles that are particularly susceptible are the Trapezius muscle, Levator Scapulae, Temporalis, Frontalis and Occipitalis. These cause tension on the insertion points at the Occiput this in turn radiates pain across the cranium. Treatment for Myofascial Headaches
A sports therapist or physiotherapist is able to affectively treat this sort of injury with the use of vertebral mobilizations, soft tissue massage as well as stretching and possibly some strengthening work. The use of myofascial trigger pointing and dry needling are affective ways to release the triggers. This will release the tension on the insertions of the occiput.
References
1. Skootsky S.A., Jaeger B., Oye R. K: Prevalence of myofascial pain in general interal medicine practice. West J Med, Aug. 1989, 151: 157-160
2. Hooper P. D: Treatment of head pain, Williams & Wilkins, 1994, pp 333-4
Tuesday 30 August 2011
This month the focus is lateral Epicondylitis of the elbow or its more well known name; Tennis elbow. I am seeing quite an increased number of cases of this injury recently. Over the next two months I will also look at Golfers elbow and elbow bursitis. It is important to remember that these injuries tend not to be just sports related but can be traced back to occupational related factors.
What is Tennis Elbow?Tennis elbow or lateral epicondylitis is the onset of pain on the lateral (outside) of the elbow. The pain has a gradual onset with tenderness appearing around or below the bony prominence. The injury tends to affect the suffers ability to grip, lift or carry items with the affected arm.
How does the injury occur?
The injury is caused by tiny micro tears in the tendon and fascia, which after the initial healing will tear again leading to hemorrhaging leading to the formation of granulation tissue, as well as calcium deposits around the tissue. Collagen and proteins leak from the site of injury causing inflammation. This leads to increased pressure around the joint that can cut blood supply and also impinge on the radial nerve.
What are the symptoms?
The pain is recurring around the outside of the upper forearm. This is just below the joint line of the elbow.
The pain can be aggravated by lifting, bending or grasping even lightweights, such as a coffee mug. There can also be pain when extending the forearm; this is due to the inflammation of the muscles and tendons.
How to treat this injury
The first thing to do is stop any activity that aggravates the arm. This is ok for sports related factors, but not so easy for people who are getting aggravation from working. The use of an elbow support can help to reduce the aggravating factors.
Seeking the correct treatment is the second, but equally important part of the healing process. Your Sports Therapist or physiotherapist will use a range of treatment techniques such as ice massage, standard soft tissue massage, ultrasound, kinesio taping, advise on anti inflammatory use as well as stretching and strengthening of the muscle groups. After the initial inflammation and pain subside it is key to full recovery that strengthening work is facilitated as this will help to reduce the risk of future onset of the injury.
Tuesday 5 July 2011
With the summer now upon us, and running becoming increasingly more popular, I thought it would be a good time to discuss a common running injury. This month I am focusing on Iliotibial Band Friction Syndrome (ITBFS) also known as Runner’s Knee. This is a condition that causes an ache or pain over the lateral (outside) aspect of the knee and is aggravated by running activities. The Iliotibial Band (ITB) is a tendinous extension of the fascia (connective tissue that surrounds many structures in the body) which covers the Gluteus Maximus and Tensor Fasciae Latae muscles; and attaches to the tibia (shin bone). This injury occurs due to friction between the ITB and the lateral epicondyle of the femur (end of the outside aspect of the thigh bone) and is commonly the result of overuse. Signs and Symptoms:
Athlete’s who are experiencing ITBFS tend to have a dull ache over the lateral (outside) aspect of the knee, which becomes aggravated and turns to pain when running. During examination the athlete may have pain or tenderness approximately 2cm above the lateral joint line of the knee. There may also be swelling present over the lateral epicondyle. If you are running a consistent route, the pain tends to come on approximately around the same distance/time. Repeated flexion/extension (straightening and bending) of the knee can also reproduce the symptoms.
Causes:
There are many different factors that can predispose an individual to ITBFS. These can include excessive foot pronation (flat feet), which can lead to an increase in internal tibial rotation. This in turn places added stress on the ITB and tightens the following muscles: Gluteus maximus, Tensor Fascia Latae, hamstrings, quadriceps. Differences in leg length can also predispose an individual to ITBFS. All of these factors, in combination with running downhill, on cambered roads or for a long duration can all lead to ITBFS.
Treatment:
Treatment of ITBFS is varied and there are many different modalities, which can be used. Some of which may include activity modification to avoid all pain provoking exercise. Symptomatic relief such as ice or ultrasound therapy and soft tissue therapy, which would be aimed at correcting any excessive tightness within the ITB, combined with frequent stretches of the ITB and other tight surrounding structures. Myofascial release has been shown to be one of the most effective treatment methods to relieve ITBFS symptoms, either via a therapist or self release using a foam roller (picture below).Strengthening of the hamstrings, quadriceps, gluteus medius and gastrocnemius are also key during the rehabilitation process to prevent the injury recurring. Kinesio tape is also a beneficial treatment for ITBFS. As demonstrated during our recent Forces March (5 marathons in 5 days), where this treatment method was repeatedly used with excellent beneficial effects.
Monday 6 June 2011
This month I am talking about cryotherapy on acute injuries. Cryotherapy is perhaps the simplest and oldest therapeutic modality in the treatment of acute injuries. It is the therapeutic application of any substance to the body that causes a decrease in body heat, resulting tissue temperature reduction.
An acute injury is an injury of rapid onset and is usually the result of a specific movement/impact or traumatic event. Acute injuries are either the result of extrinsic (outside your control) or intrinsic (within your own body/control) risk factors. These injuries can occur to muscles, tendons, ligaments, joints, bones, plus many more structures with the human body. Examples of acute injuries are fractures, dislocations, muscle/ligament/tendon strains etc.
The Effects of Cryotherapy:
Whenever an injury occurs, there will always be some form of both inflammation and pain. It has long been believed that the use of cryotherapy as a treatment modality can aid in the reduction of both swelling and pain, both immediately and during the rehabilitation process. Edema (swelling) occurs due to an increase in local blood flow, meaning that more blood is sent to the injured site. This is the body’s own self defense mechanism to prevent further damage to the area. However, too much swelling can result in an increase time to recovery, as this needs to be removed before sufficient treatment and rehabilitation can occur. This is where cryotherapy comes into play.
The application of cryotherapy causes a reduction in tissue temperature around the injured site resulting in constriction of the local blood vessels, therefore reducing blood flow and edema in the injured area. Also by minimising the amount of edema early on, this can help to reduce athlete pain as the nerve endings (which send signals to the brain indicating pain) at the injury site will not be as compressed and as a result the athlete will experience a smaller amount of pain. Therefore, following an injury, the sooner cryotherapy is started; the greater the benefit for the athlete during their recovery.
What can be used for cryotherapy?
There are many different items that can be used for cryotherapy. These can be extremely simple and cheap or complex and expensive. Below are just a few examples of each:· Reusable frozen gel packs (Cheap)
· Instant ice packs (Cheap)
· Ice cubes in a plastic bag (Cheap)
· Game Ready Machine (Expensive)
· Cryo Cuff Machine (Expensive)
When applying cryotherapy, for best results in edema and pain reduction, apply with compression and elevation.
Thursday 5 May 2011
Kinesio taping is a technique I use in my clinic that has been given a lot of attention in the press throughout 2010.
Kinesiology taping was first made popular at the Beijing Olympics in 2008. The technique has been developed by Dr Kenzo Kase over the past 25 year, and can now be seen in most sports including football and rugby to name but a few.
Kinesio tape is applied over muscles to reduce pain and inflammation, relax over used muscles, and to support muscles in movement on a 24hr/day basis. It is a non-restrictive type of taping that allows for full range of motion. It is not a fixation tape like most traditional tapes, nor does it obstruct the flow of fluid.
Monday 21 March 2011
This month I am concentrating on over-pronation of the foot, also known as ‘flat feet’. Normal gait cycle of the foot would see pronation of the foot. This is when the foot rolls inwards and the arch flattens. As well as the opposite of pronation, which is supination.
Problems with pronation of the foot occur when it is excessive.
This is quite a common problem and can lead to a number of
injuries such as plantar fasciitis, Achilles tendonitis and shin
splints. The picture below shows someone who overpronates.
The right foot rolls inwards, which causes the lower leg to turn inwards. This puts the knee and hip out of alignment. The left foot has been corrected with an orthotic device.
Does this cause injury?
Excessive pronation usually causes over-use type injuries, most frequently seen in runners.
How can I tell if I overpronate?
1. Look at your feet in standing; have you got a clear arch on the inside of
1. Look at your feet in standing; have you got a clear arch on the inside of
the foot? If not, you maybe an overpronator.
2. Look at your foot wear. If they are excessively worn on the inside of the sole, pronation maybe a problem for you.
3. The wet foot test, with wet feet (be careful you don’t slip over) walk along a section of paving or carpet and look at your footprints. If you overpronate your footprint will be wider. See images below.
2. Look at your foot wear. If they are excessively worn on the inside of the sole, pronation maybe a problem for you.
3. The wet foot test, with wet feet (be careful you don’t slip over) walk along a section of paving or carpet and look at your footprints. If you overpronate your footprint will be wider. See images below.
What can I do?
Speak to a professional, who can analysis your gait pattern and tell you about your gait.
For more information go to www.revolution-ukhealth.co.uk
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