This week, the State Netball & Hockey Centre is playing host to the 2016 Wheelchair Aussie Rules National Championships. I'm proud to say that I will be there to volunteer my skills, and I hope to see some of you there, too.
Since London 2012 there has been a global increase in participation in disability sport. Here in Melbourne, participation has exploded with organisations like Disability Sport & Recreation, the Victorian Institute of Sport, and Disability Sports Australia all pushing the cause.
As fantastic as this increased popularity is (and it really is wonderful), it comes with one downside - more injuries are occurring as a result of disability sports; those injuries are different to able-bodied sports injuries and unfortunately, there isn't a lot of understanding of disability sports injuries.
To illustrate this, I have 2 case studies that I want to share with you.
CASE 1: SINGLE-LEG RUNNER, MALE, 30
Prosthetics technology has advanced by light years in the last decade, but we're still waiting for a prosthetic leg that provides sensory input to the central nervous system about position, speed, stride length, etc.
A patient presented to me with constant ankle and foot pain, which seemed to be worse after running. There was no sign of a sprain, but he said he felt unstable. All standing balance tests were negative, but he ran as if he was about to fall.
Before he had needed his leg amputated, he had been a regular runner but was only new to single-leg running. He was unstable because his body hadn't learned how to rely on the sensory input from just one biological leg. To compensate for the lack of positional understanding, the stabilising muscles in his leg were tightening and shortening to provide more stability but were also causing pain and stiffness in the ankle.
This patient needed a team of people to correct wat was going on - an exercise physiologist to help train the central nervous system to trust his one biological leg, a running coach to maximise the sensory input of that one leg, and me to help train the stabilising muscles to lengthen and relax after exertion.
Tight muscles can happen to anyone, but an injury just like this could only really happen in a single-leg runner.
CASE 2: WRIST SURGERY RECOVERY, FEMALE, 48
In 2016, the most detailed map of the human brain to date was released. 96 more sections were identified and described than the previous plan (which was published in 1909), but there is still a long, long way to go. We have a good idea of where certain brain functions occur, but until we can see inside a living brain with a higher degree of specificity, we only guess as to how those functions occur - that means we are always surprised by the response that the brain has to trauma.
A patient with hemiplegia (one-sided paralysis as a result of a stroke during birth) presented after requiring wrist surgery after a fall. Two weeks after the surgery, there was no improvement in the swelling, pain, or range of motion. The surgeon had ruled out any structural abnormality. The physiotherapist, the surgeon, and I all came to the same conclusion - all the muscles of the forearm had shortened, causing pain, swelling, and decrease the range of motion in the wrist.
A global muscle spasm isn't a "normal" reaction to surgery, and we don't know why it happened. We do know that it did happen, and we also soon found out that any strong, direct treatment made things worse, not better - another quirk of this patient's post-stroke nervous system.
It is now three months after surgery, and the rehabilitation is still ongoing. It took some trial and error to find a multi-modality approach that is seeming to work and all of the team, including myself, had to be very adaptable to the changes that happen in patients with neurological disability.
These 2 case studies are quite different, but they have some things in common.
Those three things aren't just true for these 2 cases. They are true for every disability sports injury that I have come across.
To talk about treatment for injuries sustained from disability sports, or for more information on those injuries, email me directly via the contact page. For specific information on an injury you have, or for treatment, contact one of my clinics directly. You can find that information here.
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Dr Mitch Clark