Me and Prof. Rabindarjeet Singh at the 1M-WSCEM
The World Congress in Sports & Exercise Medicine ended recently on the 30 August 2014. Held at The Royal Chulan Hotel Kuala Lumpur, this congress was organized by the Society of Sports & Exercise Medicine Malaysia (SSEM) and saw a host of international speakers which compromised of medical surgeons, team doctors, sports and exercise physiologists, researchers and psychologists who presented their findings, thoughts and literature review on the subject of Sports Medicine. I personally attended this conference to improve my level of knowledge regarding different forms of treatment options and the latest scientific and medical practices in the treatment and prevention of injuries. As a fitness trainer, my goal besides providing results is to ensure that my client remains injury free, which places a lot of emphasis on injury prevention. I also work with some of current and clients who have had surgeries or medical complications that may need alternative exercising protocols. Here are just some of the important observations I have picked up during the three day congress which I would like to share with you all. In 2006, during an away match against Reading, I watched not one but both of the Chelsea goalkeepers leave on a stretcher due to some rather horrific and sudden collisions during the match. The team’s medical personals rushed on to the pitch to immediate medical attention and support (which according to manager Jose Mourinho, both players could have potentially lost their lives!). The doctor in charge was Dr Bryan English, who currently is the team doctor for the Middlesbrough football club in the UK. It was a pleasure to see that he would be the first to present in the congress with his topic entitled “Rehabilitation and prevention from injury in football. The use of multiple surfaces to re-establish maximal movement as early as possible”. In the English Premier League and other similar top level football competitions, the ability for the player to be rehabilitated as quickly as possible is vital to save a team’s premiership season. Games are vitally won or lost during the absence of key players and it’s the responsibility of the team staff to ensure the injured player is not only fully rehabilitated and running again, but to also being able to perform at the same level he was before the injury. All this should be done in the shortest time possible. Dr Bryan tries to get his injured athletes (in particular the ones with lower limb injuries) to begin rehab as soon as possible in the pool where there is minimal impact and minimal loading on the joints. In this case the amount of assistance can be varied by first starting them running completely afloat on the pool to then progressing to having them walk on the pool floor with the water at chest level and progressed then to the naval level, which should provide 50% of their bodyweight as resistance. I personally suggest the idea of water aerobics to anyone who is currently recovering from injury or for the older or less mobile clients as a supplement to their physical therapy. Not only the resistance in water for exercises is less and low impact, it also reduces the likelihood of them falling and seriously hurting themselves which may happen when they lose their balance during exercise on regular surfaces. The second stage for the players according to Dr.English was to progress them to doing the same running and agility exercises on soft sand. This is definitely something I was not aware of but after watching the video I could that the athletes pull of the same plyometric and agility conditioning drills done professionally but in a low impact situation. Their goals are
primarily get the player to adapt his muscles to the movements to improve strength and most importantly proprioception (in regards to reactivity and agility) while putting minimal tension on the suspension system of the foot which also include the tendons and ligaments. Also it was noted that training in the sand increases stimulation to the Rectus Femoris, one of the four muscles that make
up the quadriceps. Only then the players are progressed to land based movements. It was interesting to note that all these treatments could actually cut the recovery time into half which could be good to the rest of us regular folk who might benefit from such treatments ourselves so that we resume our daily activity or fitness routine as soon as
possible. Another subject that was of interest to me was the use of prolotheraphy or platlet-rich plasma (PRP) injections in the treatment of muscle tissue tears and even osteoarthritis. According to the American Academy of Orthopedic Surgeons website, PRP is plasma with many more platelets than what is typically found in blood, usually 5 or even 10 times more. It is prepared from blood drawn from the patients, which then will undergo centrifugation to separate the plasma from the other blood cells. This will then be carefully injected into the injured site. Apparently, professional athletes such have Tiger Woods and Rafael Nadal have benefited from PRP in the past. One of the presentations was done by our very own Malaysian doctor, Dr.Mohamad Shariff A. Hamid who spoke about the use of Platlet-Rich Plasma (PRP) injections for Hamstring injury. This was done on Malaysian athletes who had grade 2 hamstring injuries and the findings showed faster RTP (Return to Play) rates were faster then another conventional treatment, Progressive Agility and Trunk Stabilization (PATS) exercises (PRP 21 days vs PATS 34 days). His findings were published in the American Journal of Sports Medicine. It was also noted that the cost of a PRP kit is around RM2000 and would require a more than one injection over a couple of weeks which might not be affordable to many. Another option was presented in another presentation on day two of the congress by Dr Ali Alqathani from Saudi Arabia who was very much focused on the use of Regenerative Sports Medicine such as PRP. He suggested the use of the Hackett-Hemwall Prolotherapy, which
he claimed was significantly cheaper to produce and administer. The injections consists a solution of dextrose water (25%) which will be injected around the injured area for around 2 to 6 weeks. He also recommends it to patients with either Grade 1, 2 or 3 Osteoarthritis. Another form of treatment used would be Neural Plorotherapy, which according to Dr Alqathani, can be used in the treatment for lower back pain, tennis elbow (Epicondylitis), Achilles tendonitis and regular shin-splints (Plantar Fasciitis), all common concerns for most of us who have exercised or played sports over the years. Again, Dr Alqathani was quick to point out that research findings are conflicting on the efficiency of these treatments and it is rather a new form of treatment. I also manage to have a word with him afterwards regarding the use of prolotherapy for the treatment of shoulder injuries (in particular involving the rotator cuffs) for which he told me has had treated and had success with. There were also talks from the medical surgeons, which would be rather difficult for me to review here since I am not really a doctor, let alone a surgeon!
But one presentation that caught my eye was by Dr Nagib Altallah Yurdi from Spain. He starts out with a video on the huge projection screen, showing one of his patients, a bodybuilder performing a set of hack squats on the machine. Now I have used the Hack Squat machine countless times in the past but it did not prepared me for what I was about to witness. Right during the set at almost the 3rd or 4th rep I heard a loud ‘pop’ echoing thought the conference room which actually was the sound of the bodybuilders right knee popping out! And to make things even more uncomfortable, he played the video for the second time! The bodybuilder had in fact snapped off his Medial Cruciate Ligament (MCL) entirely, and had to require immediate emergency surgery. The coaching staff only asked the surgeon three questions, which apparently were the same three questions all surgeons get asked when dealing with athletes. First, how bad is the injury? Second, how long will he take to recover from the injury? And third and most importantly, will he ever be a champion bodybuilder again? The surgeon however had bigger problems, since he could not harvest the hamstring tendon (which is common for ACL and similar injuries) because it would potentially disfigure the other muscles of the bodybuilder which you may or may not know is a huge disadvantage in bodybuilding. The only option was the use of the artificial ligament which the surgeon did manage to pull it off and the treatment was complimented with PRP. It was also important to note, the patient was already walking on crutches and doing physiotherapy two days after the surgery! And to top it all off, he is back to bodybuilding and will be competing in less then 3 months. This really shows the advances in medical sciences to treat some of the most horrific injuries. It also showed the sheer determination of athletes to get back to competition level as soon as possible where else regular individuals who have injured themselves in the past may give up exercise completely. To sum it all up, exercise is helpful and provides many health benefits which were also presented during the conference in regards to improving symptoms of patients with arthritis, improving glucose metabolism and aerobic efficiency and most importantly improving mobility, gait and functionality which improves the quality of life. However competitive sports does come with its risks, and most often a great team of medical staff and rehabilitation specialists can help an athlete get back into the game.