Can GPS Tracking Prevent Injuries....?

So the domestic football season has finally come to an end, and if you are a good premiership club you are looking to address the injuries that your players sustained over the course of the last season, and to try and prevent them from happening again next season... But how exactly do you achieve that? Well Arsenal FC will be GPS tracking all of their players in future to find out.

The theory is that Arsenal will be able to ascertain the fatigue levels of their players by monitoring how far and fast they run during each training session, and the length of time the player has his foot on the floor during the stance phase of their running gate (load data). Essentially if the player is in good shape he will be on his toes and will be moving around quickly, and if the player is tired then their movement will be slower and their load data will increase indicating that the player is potentially at risk of being injured.

The system which is similar to one being used in aussie rules will take some time to get up and running as they will need to establish the players normal level of activity and how this changes during training and matches but if it helps predict or reduce the incidence of injury then it is a great idea. Whilst it may be some time before the benefits of this system are realised it is a bold step, it shows the dedication and investment that top flight clubs are prepared to make to reduce their ever lengthening injury lists. Will this system result in players being rested for matches based on their poor performance in training? Probably yes, and herein lies the crux of the issue with this system – are all players’ consummate professionals who always give 100% in training? No. But they will soon learn that with this system that there is nowhere to hide.

On a similar theme AC Milan have invested in perhaps the most advanced multipurpose medical centre on the planet, which they use to maintain the players’ fitness and to detect any potential injuries. As well as the more normal sports therapy/physiotherapy practitioners they have specialist’s from the fields of neurology, biochemistry, psychology, dentistry and chiropractic that contribute to overall well being of the players. The psychological element is very interesting as there is lot of evidence to suggest that there is a psychological factor involved in injury and it is less common for sports psychologists to work in football than other sports.

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Scrubs...

To coin a football phrase it’s squeaky bum time, I have two pieces of coursework due next week, dissertation due on the 14^th May, then it’s exams and then around about the 4^th June its all over. If only I could fast-forward a month…. Despite the pressing deadlines I was fortunate to be able to spend some time with one of the master class presenters at this years Society of Sports Therapists Student Conference Dr Ian McDermott. I spent Friday morning at the London Bridge Hospital where I observed an ACL reconstruction and a high tibial osteotomy. The ACL reconstruction is a relatively straightforward procedure now and estimates suggest that  in the US approximately 100,000 ACL reconstructions are carried out each year. Dr McDermott carries out in the region of 40-50 each year. To see what i'm talking about have a look at this video - not exactly the same technique but it uses an allograft and is a quite similar albeit shortened view of what I saw.

High Tibial Osteotomy

The high tibial osteotomy on the other hand is not a routine procedure. The osteotomy is essentially the breaking and realigning of the tibia in order reduce the effect of osteoarthritis on one side of the knee. During the arthroscopy the surgeon will assess the state of the articular surgery on the affected side of the knee, and possibly carry out drilling or microfracture to the affected cartilage in an attempt to stimulate cartilage regrowth. 

Normal Cartilage (left) Cartilage damage (middle) and cartilage drilling (right) 

When the arthroscopy is finished the remainder of the operation is carried out with a portable x ray machine, so everyone in the operating theater is required to lead lined aprons - lets face it none of us want to have our bits frazzled. The tibia is then drilled and a fragment of bone removed so that the tibial plateau can be realigned, it is then fixed in place with a wedge replacing the removed bone. That makes it sound remarkably simple - it wasn't. The thing that surprised me most about both operations was the heavy duty tools that were used and also the force required for elements of each procedure.

It was a great experience being able to view both operations and it gives me a better understanding of the surgical procedures involved which in the future will help shape they way I rehabilitate patients. Thanks to Ian McDermott and his team for making it a great day. If you get a chance to view some surgery I'd highly recommend it.

None of the photo's or x-rays of the operation are from my visit. 

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Snickers time...

Living just a stones throw from the start of the Virgin London Marathon has its disadvantages but it also gives unique access to one of the worlds biggest sporting events. On Sunday thousands of nervous runners will anxiously line up at the start in Blackheath hoping to make it to the finish line. For most it will be the reward for the hard winter nights running in the rain and snow, but for those who have followed the Jade Goody marathon diet it will be a cigarette and a can of beer at mile five and a trip to the St John’s ambulance at mile 10. Ok so those people are in the minority but they do exist, I’ve seen them. The organisers rightly ask that if you can’t run 15 miles two weeks before the marathon that you should give up your place and they will very generously give you a place the following year, the catch, well if you are a running for a charity they will still want the cash that you guaranteed when you accepted your place.

In 2009 approximately 32,000 runners started the marathon and around 25,000 finished. Injury is an inevitable part of the marathon but it is not as risky as the media would have you believe, obviously the very occasional death makes the headlines but the chance of that happening is very small.

Marathon Injury Stats:

Likelihood of Injury

 

    • Contact with St John’s Ambulance: 1 in 6

    • Visit to A & E: 1 in 800

    • Hospital admission: 1 in 10,000

    • Death: 1 in 67,414

Injury Classification

Social 2%

Constitutional 4%

Topical 15%

Muskoskeletal 79%

Definitions:

    • Social - Self Treatment/Request for Fluids

    • Musculoskeletal - Cramps, painful joint, bones or muscles;

    • Topical - Blisters, abrasions, runner’s nipple, skin chafing etc.

    • Constitutional - Chest or abdominal pain, diarrhea, fits, vomiting, collapse

Statistics are, as always open to interpretation but these represent the runners who have made contact with any of the medical staff along the route but it doesn’t take into account those who self refer to their own doctor/hospital or Sports Therapist etc. As expected the vast majority of injuries are musculoskeletal but unfortunately I wasn’t able to find a breakdown of the type of injuries sustained. If you are interested in reading more about the injuries and physiology of marathon runners then you should read Marathon Medicine (beware it is 350 pages) as it covers everything from the shoes you should wear, to the role of genetics and why the African nations have dominated distance running.

As an interesting aside to the marathon there are a unique band of 21 runners known as the Ever Presents who have completed every London Marathon to date, no mean feat when you realise that most of these runners are now aged between 50-70 years old. I wouldn’t want to run a marathon now let alone when I was 70. Full details on this year’s marathon can be found here and if you are thinking of watching there is a great interactive map that tells you when the elite runners will be passing by the various stages along the route.

If you are running on Sunday good luck and make sure you hydrate well in the days before the marathon and good luck also to the London Met students who are working at the marathon this weekend.

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Student Conference

Check out the fantastic line up at this years Society of Sports Therapists Student Conference that is once again being hosted by London Metropolitan University. I think one of the key highlights has to be not one, but two talks by sports medicine guru Karim Khan co author of the best sports medicine book around. Should be a great couple of days nicely rounded off with dinner at the Emirates Stadium with Greg Whyte providing the after dinner speech. I look forward to asking him about his claim that he could have have got David Beckham ready to play at the world cup. 

Full details can be found here - go and buy your ticket. 

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Back in the saddle...

Having realised somewhat belatedly that my sports first aid had run out I am now re-accredited and ready to work again. Having endured a lot of games in terrible weather since the turn of the year it was great to have a glorious day of sunshine yesterday for Glebe FC's 2-1 victory over Welling FC who have one of the best youth set ups in semi pro football. During the time that I wasn't working unfortunately Glebe's title ambitions have come unstuck but it was a good result yesterday and one that will hopefully help us finish second in the league.


Inevitably I am now starting to think about my next steps as a Sports Therapist as I only have another 45 days left as student. Scary thought. Including the foundation year I will have been a student for 5 years and I am more than ready to rejoin the world of work. At least until I find the masters course that I want to do...


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I could just fancy some cheese Gromit. What do you say?

I’m partial to some, now let’s be honest most cheeses yet I’ve never thought about using gorgonzola or perhaps a nice ripe brie to heal an injury. You haven’t either I hear you say? Well it seems some people have. Lindsey Vonn is the most successful American Alpine woman skier in history and was due to excel at the recent Winter Olympics in Canada following her successes at three consecutive overall World Cup Championships (2008, 2009, and 2010).

However just prior to the Winter Olympics, Vonn revealed that she was suffering from periosteal bruising (bruised bone) to her tibia. The solution was not horse’s placenta which is a favourite amongst Premiership football players of late, but Topfen, a soft, tangy Austrian cheese that has a similar consistency to cottage cheese. I was never partial to cottage cheese. So in addition to more conventional treatments like Laser, painkillers, and stretching   apparently Vonn had her shin regularly covered in Topfen to help reduce the inflammation.

Whilst many in the sports medicine community have been quick to distance themselves from cheesegate (although they were strangely quiet over the horse placenta issue), and dairy scientists have held forth over the healing properties of cheese, it is easy to see why Vonn opted for the fromage. Athletes will try anything to get fit again – especially in the build up to a major tournament. Vonn was in training in Austria when she sustained the injury and it is not uncommon to treat injuries with a poultice in Austria.

Did it work? Almost certainly not but you can’t underestimate the power of placebo. Vonn was helped by the unseasonable warm weather that delayed the alpine events in Canada, but out of the five medals that she was chasing she managed a gold, a bronze and a fractured finger. For Vonn it was a disappointment and inevitably it was the cheese that made the headlines.

So is David Beckham sitting at home with his Achilles tendon covered in dairylea triangles? No, but don’t bet that he’s not trying something. 

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A Millimetre from Death?

The six nations provided the usual mix of dazzling highs and disappointing lows and, unsurprisingly, a pretty high injury rate. I didn’t manage to catch all of the games between having to gain clinic experience and exams/coursework, but I did watch the awesome Wales vs Scotland game at the Millennium Stadium that unfortunately saw Scotland’s Thom Evans suffer a spondylolisthesis to his cervical spine. 

A spondylolisthesis refers to the slippage of part or all of one vertebra on another which can lead to compression of the spinal cord or spinal nerves. It is rare for this to occur as a traumatic injury and it normally occurs to the lumbar spine, however it is possible for it affect any area of the spine. Initially Thom was unable to move his legs but he hasn't suffered any lasting paralysis and is now back in light training. Former Lions team doctor, and current team doctor for Scotland, James Robson suggested that any further movement of his spine could have resulted in paralysis or even death. He went on to say it was the worst injury he had ever seen – which says a lot for someone in his position. Thom himself believes that he owes his life to the treatment he received from the medical staff - to read an account of the injury from Thom's perspective check out this article very interesting reading... Also have a look at this excellent article from the Scotsman which gives information about the two operations Thom has had and also the rehabilitation necessary from this injury.

Whilst injuries to the likes of David Beckham and Ashley Cole make the headlines because of the profile of the players, this injury highlights the inherent risks involved with rugby but also the excellent quality of care provided by the medical staff. Because of the lack of first aid courses that address the specific nature of the injuries experienced in rugby the RFU developed the Rugby Pitch Side Immediate Trauma Care Course that meets the needs of both doctors and Sport Therapists/Physiotherapists working within rugby. The bottom line is you cannot work at the top level in Rugby without this qualification and the game is better for it. 

On the plus side at least Thom had company in hospital after the game as Chris Patterson (hospitalised with bruising to his kidney) and Rory Lamont (MCL Tear) joined him in Cardiff University Hospital that evening... Plus he gets to listen to the support from his more famous cousin on his radio show over the course of his rehabilitation. We wish Thom all the best in his recovery and look forward to seeing him on the pitch again next season. 

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Another Blue Day...

 Another difficult day for Portsmouth FC fans - not only does the loss to Spurs leave them one game away from relegation they have a lost a further three players to injury. It is too early to tell at this stage but it looks like the injury to Hermann Hreidarsson is quite serious. After the game Harry Redknapp told the BBC "that the players heard his Achilles snap like a gunshot". Several structures can cause loud sounds when they are injured so it is difficult to gauge what is injured at this stage - we'll update you in due course. 

Avram Grant praised the  excellent work being done by the medical staff (are they being paid?) in the light of the fact that they have lost seven players to injury this week alone and they currently have 11 first team players out injured. They only managed to name 13 first team players today so unless David James and Danny Webber only have minor knocks that leaves them with only 10 recognised players for the next game. Not a good week to be a Pompey fan.


We wish Herman Hreidarsson a speedy recovery and a better week for Portsmouth fans. 

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Time Flies....

It has only been a couple of months but what a difference it makes. Gone are the days of three matches a week instead it is 0 games (well it should be 1 but as my Sports First Aid Certificate has run out….) statistical analysis and dissertation time. Oh for the happy days of January. A lot has happened in the intervening period; David Beckham has torn his Achilles tendon, the Six Nations has been and gone, Glebe FC are top of the league and I’ve seen some really interesting injuries. Most recently I’ve observed a stress fracture of the pars interarticularis in a young cricket player who presented with classic symptoms: unilateral low back pain, pain aggravated by lumbar extension, pain on extension whilst standing on the affected leg and pain/tenderness on palpation. Doesn't get much more textbook than that. 


What is more interesting with this case and some of the others I have seen recently (hamstring avulsion, grade 3 ACL tear and a meniscus tear) is the issue of referral for diagnostic imaging to confirm the diagnosis. Almost without fail each case has been knocked back by their GP and their local A&E department despite the referral from their physiotherapist. This shows the dichotomy in the treatment of elite performers who are rushed off to see the clubs preferred specialist within days of injury and the weekend warriors who have to wait weeks or months for referrals to be acknowledged and acted upon…By next week we are hoping for some better news.

Good to see some high profile publicity for Sports Therapy of late with London Metropolitan Alumna Jo Denby on show on BBC Three looking after Eddie Izzard on his epic Sport Relief journey around the British Isles and sports therapist Ellie Steele discussing David Beckham's tendon reconstruction on the BBC.  We're taking over!

Oh and good luck to everyone at uni in their last semester - almost there!

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Zamora Dislocates Clavicle

 

Zamora being helped from the pitch.

Fulham FC striker Bobby Zamora has reportedly dislocated his right clavicle (AC Dislocation) in Fulham's midweek game against Stoke.

 

Zamora following the challenge by Stoke's Abdoulaye Faye

Having personally had the misfortune of having this injury I can vouch for the pain he is feeling. Although I can say I enjoyed the laughing gas they gave me! The AC joint is a common site of injury amongst athletes however I have not seen it reported so often in football. Having said that Zamora is the second Fulham FC striker to dislocate his clavicle in 6 months.

 I was disappointed to see that Zamora walked off the pitch with his arm unsupported, compare that to Nani's shoulder dislocation last year and you see a different approach. They have not mentioned the severity of the injury and from the photo's you cannot see if he has the marked step deformity that typifies this injury. 

If Zamora is lucky enough to have a grade I or II injury he should be fit to return in 6-8 weeks, however if he has a grade III-VI he will need  surgery to reduce the joint and enable the ligaments to heal. 

 A typical AC surgical fixation.

I had a grade IV dislocation and surgery was required however I don't imagine Zamora will need to wait 18 months for both his operations like I did. We wish Zamora all the best for his rehabilitation.


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