Thursday, 3 April 2014

How Specific is Specific?

Specific is very specific is the answer. I recently saw an elite level rower for management of a thumb extensor tendon that she had inadvertently severed on the fin of the hull of her boat. Ivy (not her real name but a nice one) had key competition trials coming up, and her rehab had to be squeezed in somehow.

All power to the thumb
I must have seen over a hundred thumb extensor injuries. It's usually not an especially tricky rehabilitation protocol, you just need to understand how to grade things. The extensor pollicis longus (EPL) is the tendon responsible for hyper-extending the tip of your thumb, and is also responsible for allowing thumb retroposition which is lifting the thumb up, up and away from a flat hand. Ivy had cut hers over the top knuckle of her thumb which meant we could get away with  a hand based splint, and an early motion protocol post surgery.

The only issue was that Ivy was very specific about what she needed the thumb to do. As an elite level rower, she had to be able to actively flex the top joint of her thumb to 70 degrees, and maintain an eccentric load through the EPL in order to control her oar accurately. But what was even more important to her, was that her life after rowing was in no way compromised by a thumb that wouldn't straighten. 

Every session for me became a study of the bio-mechanics of rowing. I have had no experience as a rower, with the few seasons I spent racing outrigger canoes counting for naught. We discussed stroke length, grip strength, grip positions, singles vs doubles, and the myriad of other factors that could affect performance at Ivy's level, right down to the specifics of thumb position.

Go "Ivy" GO!!
Ivy did well in rehab,meeting all the treatment goals we set. However she recently sent me an email after performing exceptionally in the trials. The comment that got me was this, "My thumb felt really good with normal race rowing but the confidence and coordination (ie for the final sprint) is still on the improve." Movement, tendon integrity, and strength were no longer a concern, for they were almost 100%. The specifics Ivy now needed were better proprioception and fine motor co-ordination. And not just for training or for the race, but for the final sprint.

Ivy now has additional exercises designed to help her thumb with that final sprint. No doubt they will help her with life once she steps out of the boat. They will definitely help the next person that cuts a tendon who walks up the stairs and into my clinic because even if they aren't an elite athlete, I know that their specifics will be very specific too. Thanks Ivy, and good luck.

Look after those fingers,


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