Kevin Pietersen Injury

[physiomitch]

Hi

Please note the following is not aimed at any specific person or Physiotherapist, more at the system of teaching and education. As a teaching/practicing Physiotherapist I am well aware of the restrictions in our field, and in the medical field when it comes to sports injuries.

As most fans of cricket will agree it was a shock to hear of KP's withdrawel from the team for the rest of the ashes due to his tendon achilles injury. However, as a Physiotherapist, I was even more shocked that he has undergone surgery for an injury that should have been teated successfully with Physiotherapy. This surgery in my opinion, should have been avoidable. Listening to the commentators saying that his Physiotherapy consisted of injections, ice and exercise made my hair stand on end!

Is this what Physiotherapy in sports has come to? Treating an obvious exercise induced injury with pain killers and MORE exercise, as if strengthening is going to magically fix the problem. The last thing he should have had done was surgery, as this is an easily treatable condition. It seems there is a serious lack of knowledge of functional anatomy and biomechanical sequences that lead to this type of injury. Was there any assessment done of the sympathetic nervous system and its blood flow control to the lower limbs? Was there any assessment done of the muscle strength of the hips, thighs, calves to ascertain any biomechanical weakness? Was there any assessment done of the fascial tightness patterns common in these types of injuries? Was he training too much, resulting in all of the aove?

It seems from what I read in the press, that the focus of treatment has always been the TA, nothing else has been assessed for a possible CAUSE of the condition, as if the TA on its own just became inflamed. Granted we don't get every detail in the press, so I admit I am assuming somewhat. Ta's very seldom are the cause of their own condition, unless traumatised directly by a kick etc. Ta's become victims of the biomechanical imbalances from the hip down, tight TFL, tight ITB, tight posterior tibial fascia, weak dorsiflexors, etc, etc. But it is this lack of understanding that seems to be leading to so many top sportsmen and women undergoing unnecessary surgery...not to mentions career ending injuries.

What can surgery actually gain? Releasing the TA is actually a diagnosis, not always a treatment. It diagnoses that the TA was tight, under excessive abnormal strain, probably thickened, which is what it will do when stressed, to prevent tearing, and this should lead one to think 'why was the TA like this?' Treating the cause not the symptom is surely the best way to go about things, yet this does not seem to come into the realms of sports medicine. Mark my words, KP will probably end up like Flintoff, retiring early because the causee of his problem was never treated!!!

I would be intersted in any comments on this subject, maybe I am just ignorant, but 17 years experience in successfully treating TA pain and dysfunction without any surgery, makes me feel I am not.

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[physiobob]

Thanks for your interesting post.Unfortunately you can't believe what you read in the press. I would suspect the injury may be something he has had for a long time and that he has had a lot of physio etc. on without lasting success.

Now that is not to say that the physio would not have worked in theory but in practice we are dealing with 'professional' sportsmen. That should really be renamed as 'Paid Sportsman' as the concept of looking after their assets, injury prevention, appropriate compliance with advice etc.is often non-existent. Of course I am not directing this at Mr Petersen but one can't know if in reality surgery was the only practical option at this time.

So my comment is that even when we feel we know what works, what we would like our clients to do we all to often find that what they are actually interested in doing is a totally different thing. God love professional sport!

[ginger]

Mitch, I support and salute you, you have taken the words , almost , out of my mouth. Too much so called "sports medicine " I fear , is undertaken by medical practitioners whose approach is to assume pathology first, neurology last.
It is possible ,that the impetus for this surgery was taken out of the actual physio's hands ( who may well have had a non local solution )by a louder voice with the appearance of verissimilitude and a medical credential. This cricketer is not and will not be the only one to have his/her better interests denied by well meaning , but ultimately sciolistic heavyweights in the sports med fraternity.