Short vs Long

When we see a client in our practice, we go through a series of important decisions. But one remains the most difficult, when do you focus on a short term ‘fix’ and then, when do you think about the long term?

Once we have a comprehensive history of the problem we will examine the area and develop a reasoned diagnoses. Straight away we then have to make a decision, do we concentrate on the injured area and continue to formulate a plan based on this, or do we continue to assess and find the reasons behind the injury and focus on the long term? Here lies the dilemma.

The main factors that will influence this decision are actually found out during our history taking and further signalled by our diagnoses. The most straight forward example to describe this is an acute muscle injury vs a gradual onset of knee pain.

For an acute muscle injury, it is most likely that initially we will focus on the injured tissue and be singularly focussed on managing that area, looking for quick, short improvements. These injuries are normally traumatic and come on suddenly and the explanation of the injury will reflect this. It would not make sense (and quite often you are unable) to start looking around the body for reasons why that muscular tissue has been injured. You wouldn’t put a footballer on a treadmill to look at running style the day after they have sustained a tear of their hamstring! Instead we identify the hamstring injury, get an accurate idea of the degree of injury, remove the factors that may worsen the injury (this may be running, or in extreme cases even walking) and immediately start to get that athlete moving in different ways. Quickly you would see improvements and then it logically makes sense to progress to looking at the long term and for reasons as to why they may have injured the hamstring area.

Conversely in the second example, a runner with a gradual onset of knee pain, it is logical not to get internally focussed on the injured area only. Instantly when talking to the runner we would see there was no clear reason why the injury occurred. We will most likely ask much more in depth questions as to the runners training history, their load management (see previous blogs) and look at the whole body to see why the knee is getting over loaded. This case would be appropriate to look at running style as there is likely to be a certain volume of running that the runner could do without pain. We then formulate a diagnoses and as before remove the problematic variables. Then we formulate the plan, involving rehabilitation for any of the issues we may have found with a focus on the long term improvement from the offset.

Obviously there are exceptions to these basic rules, but those exceptions still follow the same trends as above. You get an accurate diagnoses, remove the influences that could make the injury worse and then start the rehab process involving as much of the long term factors that you have identified as you can. It is more a question of when you look at the long term, not if!

So next time you are unfortunate enough to sustain an injury, think about the above to help you understand where your rehab focus needs to be!

If you have any questions please get in touch over on our facebook page!

 

 

 

Same injury….different athlete….

Hi all.

This week has been a busy week for us with the final stages of the British Junior Squash Open at the weekend and with many of the University’s Scholarship athletes returning from their Christmas break. There have also been lots of discussions within the department about several high profile athletes injury stories in the press over the holiday period.

I think one of the most contentious and high profile stories is Zlatan Ibrahimovic’s return from anterior cruciate injury (ACL). Whilst he has received huge praise for his dedication and determination to return at 7 months, many medical professionals have registered their concern about his early return.  Adding fuel to this debate is the player’s injury ‘recurrence’ which has seen him side-lined for at least another month at the end of December.  So why has he had a recurrence? Well this could be down to many factors. Being absent from training and playing for such a significant period will always make you more susceptible to another injury. Moreover he may have had additional injuries alongside the ACL which have been aggravated on his return.

So the big question did he return too soon? There are many factors that are used to determine an athlete’s readiness to return; these include strength, cardiovascular fitness, movement analysis and psychological readiness. Undoubtedly Zlatan Ibrahimovic would have met all of these targets before returning to training and match play. Many ACL rehab specialists will advocate a minimum of 6-9 months before returning to competitive sport. I think taking into account the research related to re-injury and the significance of the surgery I think it is reasonable to aim for a 9 month return to sport in the professional environment.

Does this differ for your amateur athlete? Ultimately yes. Professional athletes have the luxury of being able to focus on their rehabilitation full-time and the ability to work with physiotherapists and strength and conditioning coaches on a daily basis. So what does this actually mean? Well… there’s no juggling of work and rehab; when there’s those days that you just don’t feel like hitting the gym there’s people there to motivate and encourage you and essentially force you to the work that you need to do! This will have the ability to help professional athletes meet their goals sooner than amateur athletes.

So when thinking about amateur athletes sustaining significant injuries requiring complex surgery I would always look to allow 12 months before returning back to the previous level of sport. Juggling work, family and life commitments all take their toll and do have a negative impact on rehabilitation. Setting a target of 12 months is realistic and allows for not only the recovery from the injury but also gives the time to develop skill acquisition, confidence and reduce the fear of re-injury.

Here at Physiokinetic we deal with a wide range of athlete’s from amateur to fully professional. We are able to tailor rehabilitation to meet the lifestyle and goals of the patient. So if you need advice on management of an injury come and see us!

Have a great weekend from all at Physiokinetic!

Thanks Becki