Farewell to Idiosyncratic Injury Management!

Hello, and welcome to my first Sports Injury blog.  This blog is intended for physio's (PT's), Sports Medicine Physicians, Athletic Trainers, and any member of the general public with an interest in Sports Medicine.  What I hope to achieve is the stimulation of thought and discussion via the challenging of status quo, of course with a strong emphasis on a scientific and biological basis for injury management.

For far too long sports injury management has been idiosyncratic, passed down from one physical therapist or trainer to the next, with little emphasis placed on the scientific basis for such interventions.  "Shin Splints" is indiscriminantly treated with orthotics.  Ice is the apparent panacea for all ails, from tendinitis to osteitis.  (Personally I think it may be far more effective at times in a glass of scotch!).  And the IT Band has been stretched, scraped, rolled, and generally annihilated in an attempt to cure any pain somewhere below the waist!  More recently we have seen the advent of PRP (platelet rich plasma) injections and shock wave therapy.  One athlete was investigated last summer by a major sporting body after receiving stem cell injections overseas.  And as recently as this week a local professional was sent for experimental electrical stimulation for a long standing injury, according to the Washington Post.

These treatments and more are frequently administered without strong scientific rationales.  Often when treatment fails or the athlete is slower to respond than expected or hoped, all logical thinking and scientific reasoning is abandoned.  Now don't get me wrong, I'm not suggesting that a treatment shouldn't be used unless its efficacy is proven with a double blind randomized controlled trial (although it would be nice to have some sort of evidence basis).  Sometimes clinical application and anecdote precedes science.  However, the application of an intervention should always be treated as the scientific testing of a hypothesis, not  a needle in a haystack search for a cure.

If one understands the pathophysiology of an injury at a cellular level, it is indeed possible to formulate a hypothesis as to the tissue response to intervention based on physiology.  In this instance, when an injury fails to improve one can reason that a change in one or more of the experimental variables (ie. treatment variables) might lead to the desired physiological / cellular response.  This can then be implemented and re-evaluated scientifically.  In this way, even in the case of new and experimental or novel treatment approaches, there remains a scientific basis for each intervention with a rational approach to changes.  The use of interventions because one does not know what to do next, can thus be almost entirely eliminated.  Notwithstanding, there are always those cases where no amount of scientific reasoning leads to a desirable outcome.  But all reasoned approaches should be exhausted and an understanding of physiology is imperative in giving those enough time to have a physiological effect that represents clinical improvement.  (NB: it takes time for effects to represent clinical improvement, and how much time differs from tissue to tissue, cell to cell, injury to injury!).

Thus the tone is set for this blog.  So if you enjoy a little controversy, and love sports medicine, hopefully you will find these discussions challenging and stimulating.

Stay tuned for the next topic - "Are Biomechanics Obsolete?  Ushering in the 'Biomechemical' era".