As sports physiotherapists we assess, diagnose and rehabilitate a broad range of musculoskeletal conditions. Obviously we all see a myriad of conditions which are quite easy to diagnose and are quick to rehabilitate. This is the ideal situation for both the athlete and physiotherapist as the return to play timeframes are short. However, as we are all acutely aware, all sports injuries do not fit this category. Below I discuss my three most hated sports injury diagnoses, in ascending order of hatred.
3. ACL Rupture
I think we all suspected that this would be on the list. Yep, it is the one we all love to hate. After listening to the athlete describe an injury mechanism indicative of ACL rupture, it is truly terrible to perform a Lachman’s examination and get no endpoint, no clunk … season over.
Whilst some of you may argue that it should be higher on the list, I don’t think it deserves the top spot. The ACL surgery recovery, when using an accelerated rehabilitation program, whilst limiting to the athlete’s sporting pursuits has minimal impact on their ADL’s. Most athletes are walking with an essentially normal gait pattern within a few weeks and have lower levels of post-operative pain. But in saying that, I never ever wake up and think ‘I hope I diagnose a ruptured ACL today’ (I don’t enjoy watching blokes cry).
Don’t think it deserves to be on the list at all? Well ask Brent Tate, the elite Australian rugby league player who ruptured his ACL on the weekend (see the video below).
2. Achilles Tendon Rupture
This is a complete shocker too. This is a diagnosis that I rarely see make it in to the clinic, as the athlete normally doesn’t get that far. However, it is one that I have had the misfortune of making on the sideline. Similar to that of ACL I hate that moment when you feel the step deformity in the tendon and realise that she’s gone.
It is season ending. It requires surgery. It is slow to regain normal ADL function (often braced for over a month) and RTP (often 6 – 12 months). It is frustrating; for the athlete and the treating physiotherapist. Just ask David Beckham (see video below).
1. Arthroscopic Rotator Cuff Repair
Bang – rotator cuff repairs – this is my most hated diagnosis. The injury tends to be, but is not always, a season ending one. Average return to play in elite rugby players is 4.8 months when using an accelerated rehabilitation programme (Tambe et al. 2009).
However, the unfortunate thing is that not all orthopaedic surgeons will utilise an accelerated programme. This means an even longer return to play time-frame. In which case, you have a long and slow rehabilitation pathway ahead. Unfortunate too is the fact that in an athletic population, given the mechanism of injury, rotator cuff tears often have concomitant labral lesions.
This makes the arthroscopic rotator cuff repair my most hated diagnosis. You may think it is strange, I know, but it just is.
Check out this cool animation for rotator cuff repair surgery.
For an evidence based approach to dealing with a season ending diagnosis click here.
Tambe A, Badge R, Funk L. Arthroscopic rotator cuff repair in elite rugby players. Int J Shoulder Surg. 2009 Jan–Mar; 3(1): 8–12.