How often do you treat ankles? I know that I treat them every day, and it is likely that you do to. Osteochondral lesions are very underdiagnosed causes of ankle pain and dysfunction. The astute sports physiotherapist should be aware of the hallmarks of this diagnosis. This article aims to present an overview of the evidence based assessment and management of osteochondral lesions of the ankle.
Osteitis Pubis is a condition that many consider rare, however, it is probably more common than you may think. The incidence of groin pain, in some sports, is as high as 13% (Ekstrand and Ringbord, 2001). Thus, it is highly likely that as a sports physiotherapist you will encounter may athletes with a diagnosis of osteitis pubis. Therefore, as is frequently stated on this site, you need to be aware of the current research and evidence based practice, even in a world with limited research.
The sports physiotherapist will commonly treat shoulder presentations. One of the most common presentations, particularly in an athletic population, is subacromial impingement syndrome (or external impingement). Therefore, it is essential that the sports physiotherapist be fully aware of the more common contributing factors and treatments for this condition. This article discusses the effect of posterior capsule tightness and the “Diablo Effect” on subacromial impingement syndrome.
The sports physiotherapist will frequently assess and diagnose acute knee injuries. In doing so, we will regularly rely on the results of special orthopaedic or clinical tests. However, if we are going to use these tests to make diagnoses and therefore guide our treatment decisions, it is vital that we are aware of the diagnostic accuracy of clinical tests. This article evaluates the research regarding the diagnostic accuracy of commonly used clinical tests for medial meniscus tears.
Femoroacetabular impingement (FAI) is, as the name suggests, an impingement or abutment of the chondro-labral structures between the femur and acetabulum. Whilst the diagnosis of femoroacetabular impingement has only recently gained attention, it is known that the presentation is more common in the athletic population. High activity athletes are at increased risk; particularly athletes who participate in sports which require them to frequently move into a position of internal rotation and flexion. This makes it an important diagnosis for the sports physiotherapist to be aware of current research and the best practice.
This post continues down the same theme as the article I wrote regarding return to play assessment for upper limb injuries. If you have not read this yet, I strongly recommend you read it first. Along the same vein, this article loosely outlines my sideline assessment for a lower limb injury. The process guides my decision making about an athlete’s ability to return to play. Of course, it also gives me information as to the likely quality of the performance the athlete will give upon return, which can help the coaching staff decide whether they will risk an “injured player”.
My Favourite Dynamic Postural Control Objective Outcome Measure Firstly, thanks for checking out the video. I hope that it was helpful and if you are not already using the Star Excursion Balance Test you will now. This is the information that I felt was too ‘nitty gritty’ to include in the video. Reliability of the […]
When to allow an injured player to return to play is a dubious subject. Whilst the level of risk will vary, any time an injured player takes the field there is a clear and present danger of further damage. In the case of acute soft tissue injuries logic suggests that the principles of RICE and No HARM must be implemented and thus no further exercise that day. However, try telling the athlete and coaching staff that. There are times when the sports physiotherapist will stretch their boundaries when it comes to return to play, discussed here. Therefore, it is important to have an objective, clear and structured assessment to implement on the acutely injured player to assess their ability to return to play (RTP).
I think the world of developing clinical prediction rules (CPR) are exciting. Whilst this may be related to my scientific, rather than creative, way of thinking, I just feel that they will lead to improved management of the conditions that sports physiotherapists treat. Some clinicians believe that they will lead to recipe-based approaches to physiotherapy, but I just don’t think that will be the case. Clinical prediction rules are not, and would never be, a substitute for a skilled assessment, diagnostic process, and implementation of interventions. They will however lead to a higher level of clinical reasoning and ultimately improved outcomes.
Below I discuss an article regarding the preliminary determination of a CPR for identifying patients diagnosed with patellofemoral pain that are most likely to respond to orthotics. Once validated, this would be a clinically useful rule for deciding when to utilise orthotic therapy. This is particularly important given the expense associated with the purchase of orthotics and the prevalence of this condition.
Neck injuries, and the possibility of a spinal injury, in sport is a very serious issue. As sports physiotherapists we frequently assess neck injuries, and inappropriate diagnosis and subsequent management has the clear potential for catastrophic consequences. At times it can be difficult to differentiate the serious from the benign, and hence make appropriate decisions. However, it is fortunate that there is a sound evidence basis for when patients with traumatic neck injuries should be sent for further investigations.
Do you want to know when you should send an athlete for radiography. Read on.