This is my second week of placement at Sports Therapy, Nelson. I spent much of the weekend wrapped up in the Rio 2016 Olympic ceremony and sports performances. Given that I'm placed in a sports physiotherapy clinic I thought I would look briefly to see what physiotherapy-olympic related articles there were in the UoO library database and I came across one of particular relevance - looking at the role of the physio at the 2012 London Olympics. I imagine the physios at the Rio Olympics will see similar trends.
Grant, M., Steffen, K., Glasgow, P., Phillips, N., Booth, L. & Galligan, M. (2014). The role of sports physiotherapy at the London 2012 Olympic Games. British Journal of Sports Medicine, 4(8), 63-70.
- Fun fact: 2012 Olympics were the first summer games which had accredited osteopaths and chiropractors practice within the medical team.
- The medical team in the polyclinic treats both IOC accredited athletes (69%) and non-athletes (31%: coaches, officials, press etc).
- Physiotherapy services were available over 31 days, from the pre-competition period, the opening ceremony and finishing two days after the last competitive event. During that time, ~1860 first appointments were made to physiotherapy services with about half receiving follow up physiotherapy services... (~60 visits first appointments per day on average... except visits were better represented in a normal distribution curve with the peak number of appointments nearing 200 during the middle of the Olympic competition period)
- What did physios see? Overuse injuries were most common (43.6%: most were pre-existing injuries), followed by non-contact acute injuries (23.8%: of which approx one third of these occurred during a warm-up, and approx 15% of these occurred during competition).
- What did Physios do? Manual therapy (mobs & manips), Soft tissue techniques (massage, stretching), strapping, cryotherapy, exercise, therapeutic ultrasound, education, acupuncture.... and to a lesser extent they used laser, interferential current and TENs
There are a few avenues for physiotherapists in New Zealand to be involved in specialist groups, like sports physiotherapy or sport medicine interest groups:
Back in the world of private practice, Sports Therapy. I had a range of new client experiences. I've now used ultrasound on a shoulder and Achilles tendon and must say that making sure the contact medium (gel) doesn't liquefy and go everywhere is a must. Otherwise, I have done a lot of exercise therapy, manual therapy - mainly Maitland style mobilisations... but I also done a Mulligan shoulder mobilisation which was effective too. Otherwise, taping and soft tissue mobilisation is pretty useful. Heel raises, lumbar rolls and back braces have also been seen/used during the placement.
Continuing the Olympic theme, I decided to do my community research project on cupping therapy... yes, you probably did see those circular welts on many athletes, including 23x gold medal swimmer Michael Phelps. I am aware that the evidence for cupping is not strong.... at all. But with all the hype, I became interested and had to have a go at it myself (both on myself, and my patients) - luckily for me, there was a cupping set at the clinic and my supervisor was more than happy to teach me how to use it. My project will look at the different types of cupping techniques (as it pertains to musculoskeletal conditions and sport performance). I'll give an in-service in a few weeks about what I've found, then a presentation in the next PSW week in CHCH. Did you notice that cupping therapy was not listed as a common treatment modality in the 2012 London Olympics... watch this space (but don't get your hopes up). I'll tell you a bit more about cupping therapy next week.
Here are some articles on cupping at the Olympics... a social media frenzy! ...nb. Probably not the most reliable source for accurate & well represented information on cupping therapy...
We had an in-service training from one of the physios at Sports Therapy. I missed the background story about the weekend training course that he attended, but from what I understood it was about primitive reflexes in adults; these primitive reflexes seemed to affect posture and pain (thus relevant to physiotherapists). I felt that there might be more evidence for cupping therapy than this primitive reflex therapy thing. Anyway, the knowledge of what to test, how to test it and how to reduce the problem was passed on to us. For example, one primitive reflex to test was the ATNR (asymmetrical tonic neck reflex) or the 'fencing baby pose' (lying on your back, legs straight, elbow straightened and shoulder abducted to shoulder level... then turn your head to look at your out-reached hand). This test was positive if you lifted or bend your opposite leg/knee. If I remember correctly, to fix this we must pull our knee against into flexion of the hip against a resistance. Re-test, and the problem should be fixed (something like that). I'm not convinced.
There seems to be a trend by some companies (particularly job recruitment agencies) to do an pre-employment physical screening whereby a company has a screening sheet that the client brings in for the physiotherapist to complete with them. The tests aim to identify any physical problems prior to employment. I've seen two screenings done so far - here are some examples of things they had to complete: the first client was seeking a trades job... the client had to lift 35kg from the floor to a waist high bench; hold their hands above their head for three minutes; and be able to kneel on the floor for two minutes on each knee... the other client was applying for an office job and was required to complete a hand strength test (hand held dynamometry); walk in a crouched posture for a certain number of meters; and have full symptom-free neck range of motion. I'm not convinced that they would actually be useful for describing or predicting anything... but that's for the job recruiting agencies to evaluate - we're just filling in the form so they can tick boxes.
My Tuesday sessions with Michael Monaghan continue to be beneficial and enjoyable. We had two clients, the first had multiple yellow flags - I won't go there. The second was a client I had seen, but only had slight improvements in his neck pain (spondylosis / cervical arthrosis). Michael modified my distraction technique and reminded me of the applied anatomy for the cervical spine. We then evaluated my treatment and assessments of each treatment with this client - we found that I had done a pretty good job. So I was feeling good after that! We'll catch up with this client next Tuesday to see how they got on.
We had an educator from CHCH come to Nelson for a quick visit to see how everybody was going - more to look at how students, the University and placements can improve the student-placement-University experience. There was a shared lunch at the hospital, but I was not able to attend due to having placement at that time.
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| An orchard in Nelson... on the cycle/walk track to Rabbit Island |
