How effective is that coloured stretchy tape?

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It’s far from unusual given the current plethora of televised sport (World Cup Football, NRL, AFL, Tennis) to see brightly coloured stretchable tape adorning athletes bodies in a variety of intricate patterns. Indeed this type of tape has proved very popular since its appearance at the 2008 Beijing Olympics. As a Sports Physiotherapist, I have always wondered about the effectiveness of such tape. After all, the stretchable tape seems to really only have contact with the athletes skin which isn’t exactly rigidly adhered to the underlying structures it’s meant to influence.

A recent 2013 European Journal of Physical Rehabilitation Medicine. article concluded that “although the tape has been shown to be effective in aiding short-term pain, there is no firm evidence-based conclusion of the effectiveness of this application on the majority of movement disorders within a wide range of pathologic disabilities. More research is clearly needed.” A further March 2014 Systematic Review article in the Journal of Physiotherapy concluded that the most up to date evidence does not support the use of this intervention in the treatment of musculoskeletal conditions.
Clearly food for thought.
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Why ? What sport is teaching my son…… ?

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I have a 7 year old son- he absolutely loves AFL football, owns a selection of 12 team jerseys, watches as many games as he can live or on TV. He knows all the players by name, runs around the house, kicks the ball, spins, weaves and self-commentates in between destroying the furniture! He has a favourite team, and every game wears a jersey of the team he supports on the day and tries as hard as he can to emulate the skills and efforts of his heroes. He wants to be “a Carlton footballer when he grows up” but this week he asked me a question that sent a chill through me-
“Dad, if I want to be a footballer, does that mean I have to get needles every week like the Essendon players did?”
Now before you accuse me of supposition and innuendo- it has been well established that this team did engage in a program of supplementation throughout 2012 that did involve players receiving multiple injections weekly. And yes, my son knows this because not only does he love watching AFL, he loves listening to all the programs that breakdown the game week by week. It would be hard for him not to know what happened in AFL season 2012, given all the media attention. However my son’s question is not so naive- indeed its a very good question and one I that I cant help reflecting hasn’t been asked before. With the current state of play, a team taking our countries national sporting drug testing agency (charged by sport in Australia with the job of ensuring “fair play”) to the federal court to dismiss evidence- Im wondering what this is teaching my son?
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When did we as a society lose sight of the concept of fair play in sport that we have people willing to defend the need to have players injected multiple times in order to “play” sport? Indeed, I’m totally at loss to understand how otherwise extremely fit, healthy young sportsmen can happily receive regular non-medical injections as part of their regular physical preparation and not think something is amiss. Have our ethics and integrity as a society become so blinded by the desire to win that we consider a program of non- medical injections acceptable? If a whole team of players are indeed healthy, what is the rationale behind a regular injecting program of supplementation if it is not to improve performance?

As the parent of a young child who would love nothing more than to grow up to play AFL like his sporting heroes, what do I tell him?
“Yes son, if you want to be the best, leave no stone unturned, and that includes getting regular injections”.
As a lifetime supporter of sport, and someone who has worked within the field of sports medicine for 25 years I can’t help but feel somehow that the current situation indicates we, as a society, have lost our way in respect to integrity and ethical decision making around sport. I hope my son, as he grows, has been empowered to ask “why?”, has the ability to make informed decisions and the strength of character to disagree when presented with situations where requested actions do not meet with his sense of ethics, fair play and sense of self. I hope my son, if he makes a mistake, is man enough to say “sorry, how can I make amends?”, rather than look to blame others, look to loopholes in the methods for which his mistake was discovered, and forces injunctions aimed to deflect and hide from the fact that he has made an error. I hope my son learns from his mistakes, grows from his mistakes and becomes a better person. I hope my son understands that success in sport requires discipline, dedication, hard work and effort; success does not come as result of a pharmaceutical “arms race” dependant on who has the best “secret” supplement regime. I hope my son realises that, in this case, sport isn’t life, and that sport, in the spirit of “fair play” can embody all that is great about human endeavour. For these reasons I’m not going to be discussing “needles for football” with my son, because I’m sure it wont teach him to be the man either he or his father would wish for. And that, unfortunately, is a lesson I wish those trying to defend the happenings in AFL in 2012 would understand. It’s not about the sport- its about your ethics, integrity and sense of fairness.
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Placebo Effect and the Sports Physiotherapist

Sometimes, patients symptoms improve or resolve with unconventional treatments suggested by unqualified “advisors” or “gurus”. Despite all the research to the contrary, the patient or athlete will swear by this course of treatment. I recently assessed one such patient who attributed his absence of shoulder pain symptoms to the removal of milk from his diet. How to handle this? Tell the patient how wrong he is, and the absence of any research or valid theories to support his unconventional treatment? Its time’s like these that I smile to myself, reflect on this great placebo video and kindly pat the patient on the back and let them know I’m here next time if they need any help.

Tendonitis or Tendinosis? Baby out with the Bathwater?

I’m always happy to share links and articles written by “thinking” clinicians who are happy to constantly evaluate “the whats and whys” of sports medicine. Very happy to run across this excellent blog article by Adam Rufa evaluating where we are at in our understanding of tendon pain. Nice reading, thoroughly recommended with a link to the relevant journal article. Thanks for sharing Adam.

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Why Does My Shoulder Hurt ?

Continuing on the same theme of “pain” from my last post, I felt it timely to highlight an excellent review on pain and the shoulder published in the British Journal of Sports Medicine from December 2013 (Dean, B; Gwilym, S and Carr,A: Br J Sports Med 2013;47:1095-1104)

As a Sports Physiotherapist treating shoulder injuries, one of the most common questions I am asked is “why does my shoulder hurt?”. The patient, in most cases, is hoping for a simple answer with a simple model of tissue damage = pain ; with the belief that correction of “what is broken will fix the pain”. Unfortunately research increasingly shows us that such a simplistic approach is… well-honestly- considerably too simplistic. I strongly urge the clinician with an interest in the sporting shoulder to read this excellent review which considers the role of 1) peripheral receptors, 2) nociception or peripheral pain processing , 3) the spinal cord , 4) the brain , 5) the location of receptors in the shoulder and 6) the neural anatomy of the shoulder. It is only when considering the complex nature of shoulder pain can one truly consider appropriately the variability in the clinical presentation, treatment and diagnosis of shoulder pain. For those of you interested in reading a guest post on this subject from one of the articles authors, this link from British based Sports Physiotherapist Adam Meakins makes excellent reading.

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Understanding Pain- Essential Education

painpain site 2There is no doubt that one of the greatest challenges for the clinician working in the field of musculoskeletal medicine is explaining to a patient the concept of chronic or persistent pain. I daily review investigations and findings which do not adequately explain many patients pain symptoms, only to be asked “if nothing’s broken, why do I have pain?” Even more difficult is the patient that is fixated on surgery as the answer for a painful condition where there is no evidence (beyond the presence of pain)for surgical intervention.
It is now well established that treatment approaches utilising a bio-psycho-social approach are far more successful, and do require an active education component on the nature of pain.

The Hunter Integrated Pain Service has produced a wonderful video resource explaining the nature of pain – well worth the time for the clinician and patient reviewing and planning management going forward. Equally useful is the ACI Pain Management Network education video.
For those who love written resources to assist patients and younger professionals, “Explain Pain” by NOI is in its 10th anniversary remains one of my all time favourites.

Australian Baseball- Major League History

752676-b6bfe078-b0ef-11e3-9d7e-f018f46e0213Its taken me a little while to sit back, reflect and bring words to life regarding my experience during the historical events surrounding the Australian Baseball Team in Sydney, March 2014. Without doubt, an absolute highlight of my professional career was my involvement as part of the Australian team playing warm up games against the Los Angeles Dodgers and Arizona Diamondbacks prior to the 2014 MLB Season Launch in Sydney this March. The feelings and emotions evoked as we competed (close 4-2 loss to The Dodgers and the amazing 5-0 win against the Diamondbacks) at the Sydney Cricket Ground in our own country, in front of our home fans, our change rooms the historical Australian Cricket Team dressing room, was simply, at times, overwhelming. The closest I can come to compare is our run at The Athens 2004 Olympics (another event I was privileged to be part of), winning the silver medal. Standing on the SCG, reflecting on the enormity of an Australian Team competing with, and defeating some of the most resource rich teams in our sport, I couldn’t help think how far my journey in the sport as a physiotherapist has taken me. Commencing in 1991 with the Gold Coast Dolphins (Part of the “old” ABL), I have been very privileged, through work with national league teams, representative, MLBAAP Australian Academy and Australian National teams to work with not only the “best of the best”, but also many amazing people who have made my journey richer for their contribution. An amazing compilation video of Australian’s who have achieved success at the Major League Level never fails to bring a tightness to my chest, and the proud feeling that I have been involved with almost all (in some capacity) except 2 of the athletes. Watch it- I dare you not to be just a little bit proud of what Australians have achieved in baseball!

Unconventional Thinking

With credit to one of my favoured sites Lifehack.org

“I never made one of my discoveries through the process of rational thinking.” – Albert Einstein

Indeed, every great advance has involved the process of looking “outside the box” and doing something unconventional. If you continue to do the norm, then you are just going to produce normal, conventional results. Think differently, challenge, aspire to make a difference.

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Professional Advice to Live By

I have been very fortunate to maintain a career as a Physiotherapist for 25 years. I really only know a lot about a very small subject, but in the big scheme of things I know very little. The words of legendary British Coach Sir Frank Dick (via Twitter) sum up my thoughts on how to do your work well.

There are only 3 things you need to know. Know what you know. Know what you don’t know. And know someone who does (then work with them! Frank Dick (@frankdickcoach)

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Image Source: Ajith Sankarathil on Education Revolution