Injury management - Sports Injury

Getting a second opinion: 3 ways to make sure…

by Pete Colagiuri - Sports Physiotherapist

If you’re thinking about a second opinion, you probably feel like your injury has been misdiagnosed or mismanaged.

A second opinion can serve an important and vital role in injury management.

Knowing when and how to get a second opinion to make it most effective is the key, as well as knowing how to respond to the outcome.

Why are some conditions misdiagnosed?

Misdiagnosis typically occurs when a clinician places too much emphasis on a particular aspect of a case, eg. If the patient has pain at night or has lost weight recently.

This happens when the follow up questioning isn’t detailed enough or the answers are not explored and confirmed.

We see this most often when there is time pressure and our time with the patient is limited due to workload or scheduling.

The average time that a medical specialist gives a patient to respond to a question before asking the next question is only 7-8 seconds!

Misplaced emphasis can also occur when the patient overemphasises a particular aspect of their history, such as the pain starting the day after they tripped in the park.

This emphasis often happens due to concerns of the patient about the event, their own reasoning of the association between the two or external input from well-meaning friends/social media about the link between their symptoms and a potential cause.

How you can help to get the right diagnosis

To aid in objectivity, I recommend the following to my patients:

1. Keep an activity log

This includes what you were doing and how your symptoms behaved over the course of at least 3-4 days. This can help to isolate aggravating activities and look at trends over a longer time frame.

2. Get several photos of the injury over the first 3-5 days

This helps to show how the injury responded and the pattern of swelling or bruising over the time.

3. Ask observers for their input

Much like the police interviewing witnesses to a car accident, the most unbiased observations often come from those around us. Ask family and friends if they’ve noticed anything about the way you move, your posture, habits or any other changes that coincide with your symptoms.

How do I know when to get a second opinion?

Seeking a second opinion should occur based on the expected timeframe and response to management of the original diagnosis.

Patients should always clarify their diagnosis and how long it should take before they should notice an improvement and/or be symptom-free.

As that timeframe approaches, discuss your progress with the treating practitioner and the reason for any delay in your recovery.

If you’re not seeing the expected recovery and you’ve exceeded the predicted timeframe by 50%, it’s time to confirm your diagnosis and management approach with a second opinion.

We need to view a second opinion as a way of confirming the diagnosis and plan, rather than being seen as doubting the initial findings.

Many patients are hesitant to seek a second opinion, thinking of it like cheating on a partner.

But a confident clinician is never threatened by external input – it’ll either confirm they’re on the right track or discover something that was missed.

Either way, the patient gets a better outcome and isn’t that our overall goal?

12 things your physio wish you knew!

by Pete Colagiuri - Sports Physiotherapist

Working as a Physio for over two decades seems to reinforce many common themes.

Here are the 12 things your Physio wish you knew about your injury and management.

It’s 12 things that they’re probably too polite to say or didn’t want to sound critical of another practitioner.

But these 12 things will help you understand the process and your injury for a better outcome.

If you can add to our 12 things, head to our Facebook page and let us know your tips.

Managing expectation

#1 Motivation can’t change tissue healing rates

Wanting to return to sport sooner doesn’t change the way tissue heals.

Motivation is great to help build strength faster, or get fit quicker, but it doesn’t make cell regeneration speed up.

#2 Short cuts very rarely lead to the right destination

If there was a faster/easier way, the medical world would just adopt that method and ditch the old slow approach.

If it hasn’t become the new normal, then the shortcut is most likely a distraction. PRP is probably one of the best current examples of this.

#3 There are (almost) no fixed limits

The body’s ability to adapt will always surprise you. Statements like “my doctor said I can never run again” completely miss this point.

You might have to work harder than others and be more patient, but if you provide the body with the right stimulus and time to respond, the sky’s the limit for almost everyone.

The Online World

#4 Social media is a bad place to get medical advice

Social media went from chatting with friends to a trusted source of information on politics, celebrities and medical advice.

Unfortunately that level of trust is misplaced with so much misinformation from reliable-sounding sources.

#5 Dr Google isn’t a great place for a diagnosis, but it’s a decent library of info after a proper diagnosis

We’ve all heard funny stories of Dr Google’s suggested diagnoses but your Physio rates it as a great source of info (if you know where to look).

Many trusted sites, with qualified authors and peer review processes, can actually provide very helpful info and improve your understanding of the injury.

Getting active

#6 Rest cures nothing

As point #3 above says, the body is wonderfully adaptive to the stimulus applied to it. But if that stimulus is next to nothing, the body heads that way pretty quickly.

Rest leads to loss of strength, fitness, flexibility and more. It’s one of the biggest causes of delayed recovery and re-injury.

#7 “Dose dependent relationship” is a polite way of saying “not doing your exercises won’t achieve the outcome”

If your Physio explains that exercise is “dose dependent”, that basically means that your improvements are proportional to your completed exercise sessions.

So if you don’t do your exercises, well…doing nothing gets nothing basically. And when exercise is the best approach to fix most injuries, it’s worth finding 10 minutes a day for it.

#8 Stretching doesn’t actually lengthen muscle

One of the most resilient myths in the exercise world is that stretching lengthens muscle. It doesn’t. Research has confirmed that countless times.

What it can do is compromise (read: re-injure) healing tissue, aggravate tight nerves and overload inflamed joints.

Although the urge to stretch can feel overwhelming, listen to your Physio on that one.

#9 ITB rolling is a waste of time

Another resilient myth is good ol’ ITB foam rolling. “I do it because my friend/coach told me to” and “it hurts like hell but I have to do it” are common explanations.

The ITB (on the side of the thigh) is a dense band of connective tissue. It doesn’t shorten or tighten and it never needs compressing – it actually hates compression, just like every other connective tissue.

All ITB rolling tends to do is irritate the bursa (little pads behind the ITB at the hip and knee) and compress the hip. And if something only produces negative results, why are we still doing it?

Medical management

#10 Your X-ray looked like that years before your pain started

The typical story is that a 40-50 year old has knee pain for 3 weeks, doctor orders a scan and, shock horror, there’s arthritis! “Best if you stop running because your knees are wearing away“, says the doctor.

But the truth is that your knee looked like that well before your 3 weeks of pain. It probably looked like that for the last 10 years. You ran successfully for 9 years and 11 months with that knee but suddenly you need to stop?!?

X-rays of arthritic change provide a context to a normal aging process. We all move perfectly well and pain-free for decades with arthritis so ugly scans aren’t the beginning of the end.

#11 Getting a second opinion is not “cheating on your physio”

Any Physio confident in their management doesn’t mind another Physio reviewing the situation. If they’re right, it’ll reinforce that you’re on the right path.

Getting a second opinion doesn’t offend your Physio, particularly if you’re not getting results. Discuss the second opinion with them as it’ll help refine their management.

#12 Be honest and open and let your Physio decide if it’s relevant

Withholding information because you’re embarrassed or don’t think it’s relevant makes it very difficult for your Physio to effectively manage your injury.

Be honest and forthcoming with all the info and let your Physio consider if it’s relevant. And never be afraid that we’ll judge you harshly because of your choices – we’re there to help you, not to judge you.

Advanced rehab for leg injuries

by Pete Colagiuri - Sports Physiotherapist

This post on Advanced rehab follows on from Phases 1 and 2 of leg injury rehab, found here.

Phase 3

Load the injured tissue during complex movements

Select movement patterns that mimic sporting demands.

Control the loading via speed, range and complexity of the movement.

There should be no discomfort or soreness at the injury site, however mild tightness may be experienced.

Eg. Walking lunge for calf tears

Add a combination of heavy loading, complex and high speed movements

Select sport-specific movement patterns

Deliberately involve the injured area but only with correct technique (no compensations).

Add load or speed based on the requirements of the sport.

Eg. Box jumps for return to basketball

Sport-specific cardio

Focus on correct technique separately, ie. not during high intensity sessions.

Be wary of fatigue as it will adversely affect technique.

Short sessions of high intensity with variable workload are best for regaining fitness.

Eg. Running intervals of 100m with longer rest breaks

KT tape for lower back pain

by Pete Colagiuri - Sports Physiotherapist

KT Tape for lower back pain is becoming more common.

It seems that the use of KT Tape for lower back pain is being driven by a move away from medication as a way of managing lower back pain.

Is it actually effective or is it just a big band-aid solution – pun intended?

What is the effect of KT Tape generally?

KT Tape, also known as dynamic tape, is a very elastic adhesive tape applied to the skin.

It doesn’t provide any restriction to movement in the way that classic rigid tape does (that is, as a physical barrier to movement.)

Its job is to provide additional feedback to the brain to assist in controlling movement.

As the trunk/limb moves through range of motion, the tape pulls on the skin and provides increased awareness of that movement.

This can be particularly useful in situations where the normal feedback mechanisms have been disrupted, such as ligament damage, or when improved control of the limb can reduce the risk of reinjury.

When using KT Tape for lower back pain, the intended purpose is to improve the awareness of posture and position.

What are the causes of lower back pain?

In modern medicine, this is literally the trillion-dollar question.

Lower back pain is the most common musculoskeletal injury in the world and accounts for huge amounts of time off work and lost productivity.

You can imagine the research dollars that have been poured in to discovering the cause of lower back pain.

So far, after around 50 years of research, we’ve got (almost) nothing.

We know what doesn’t cause lower back pain and we know who’s most at risk of lower back pain but we haven’t cracked the formula on exactly who will get it.

Posture as a cause of lower back pain has been found to be unreliable as a predictive cause.

So if you fix your posture, it doesn’t save you from lower back pain.

Once you’ve got lower back pain, it’s a slightly different story.

The change in posture that we see in those suffering lower back pain is the body’s way of trying to move away from the pain.

But it can also lead to early muscle fatigue and increased soreness later in the day.

How effective is KT Tape for lower back pain?

As mentioned above, KT Tape is not effective in preventing lower back pain episodes.

KT Tape may have a small role in reducing soreness after the onset of lower back pain.

But it’ll only be effective in those who have poor adaptive strategies – in people who subconsciously adjust their posture for the lower back pain but inadvertently cause more pain.

As a Physiotherapist, our advice would be that it’s not the first thing to try after the start of a lower back pain episode.

But if you’re running out of options or if you feel like improved posture might assist your lower back pain in resolving faster, then it’s worth a try.

How to fit KT Tape for lower back pain

The trick to KT Tape for lower back pain to improve posture is to ensure that the tension is just right.

If you’re using it for standing posture, it should be fitted while you’re standing.

Vice versa if you’re using it for your sitting posture, you should apply it while sitting.

Step 1: Move yourself to the position you’d like to be in – that is the posture that gives you the most relief from your symptoms.

Step 2: Apply the KT Tape with only a tiny amount of tension as it comes off its sticky backing.

Once in place, you should only be aware of the tape sticking to your skin without a great deal of tension.

If it already feels like it’s pulling firmly, you need to reduce the amount of tension by removing half the tape and reapplying it over a slightly shorter area.

Step 3: If you then slump down or move into the undesirable posture, you should feel the tape increase noticeably in tension.

If you don’t feel the tape increase in tension, you need to adjusted to be firmer.

Just lift half of the tape off and reapply it over a slightly longer area to increase its base level of tension.

All done: So the end result is a tape that is barely noticeable when you’re in the correct position and distinctly pulling on the skin when you move into the undesirable position.