Monday, 15 June 2015

Don't Lay Down Sally!

Running. It’s not just about your legs. Sure, strong hamstrings, powerful glutes, and quads can hurl you down a track, but they’re not the be all and end all of speed. In order to harness that energy, you must have control, and control is far more difficult to achieve if it’s not innate. 

Bob running at school (digitally altered image that's nothing like Bob)
When I watch runners, I watch their hands. When I run, I’m conscious of my hands especially when I’m tired. There was a good runner at my high school. Bob Moore was his name. He ran with a loping, stretched out and lazy gait that mimicked the sort of student he was. Kind of like the Dalai Lama in sneakers. I might have been smarter than Bob, but I was never going to be as fast as him. Once I’d accepted that, I decided to at least try and run like him. I worked out quickly that the easiest way to start was with my hands. 

Bob ran with his thumb lightly touching his index and middle fingers. There was no tension, just the slimmest of contacts. Somehow, this connection worked to release any tightness in his arms and shoulders, directing all energies to where they were required.  I saw Bob recently at a school reunion and we talked briefly about that. He laughed as I explained my theory, and said he just ran without wasting time about thinking how his hands were held.

I'm sure that scaphoid's gone too...
I’m sure Sally Pearson has always been a Bob Moore sort of a runner as opposed to a Hamish Anderson type. At least, I’m sure she was until she got good, really good. Because at her level, everyone is powerful, and everyone is quick. Differences are minute, and control is crucial. With her fracture of her ulnar, her radius, quite possibly the scaphoid, and the dislocation, the potential for a loss in motion is significant. 

Wrist extension, finger extension and significant loading to push off
A loss in motion means that as she runs, there is a reduction in the co-ordination of her wrist movement which in turn affects her balance as she hurdles. There is also the certainty that her starts would be affected because of an inability to weight bear through the affected hand. But would that be enough of a reason for Sally to pull out of World Championships that are 10 weeks away? 

Left wrist extended and fully pronated. Could be tricky now.
At two weeks post fracture, Sally would not yet have any idea of what her wrist would be feeling like in another two weeks, let alone ten. Her fracture on x-ray, whilst significant, isn’t going to keep her from running, but it will stop her from running well at least in the short term. It will rob her of that sense of fluidity she has always had, and the control she has developed. That affects her training, and that affects her ability to compete at an elite level. I think Sally is aware of this and I think that is why she has pulled the pin early. 

I can only hope that the surgeon who operated has been able to do so in such a way that Sally is already moving her wrist. I can only hope that the rehab staff she has have the good sense to ask for help before it is obvious that things aren’t progressing because whilst I’m sure they’re world class with hamstrings, I bet they don’t see “exploded” wrists every day like I do. Will she be able to run like Bob Moore again? Time will tell. I just hope she never runs like Hamish Anderson!

Look after those fingers,


Wednesday, 3 June 2015

Playing with Plastic.

No bunny hurt in the taking of this photo
At the risk of doing myself out of a job, and incurring the wrath of hand therapists everywhere, I want to share front-line management of thumb MP joint injuries. Greg Hoy, the hand surgeon I work with, refers to tears of the radial collateral joint of the thumb as "AFL (Australian Rules Football) thumb". Tears to the ulnar collateral ligament are more commonly recognised as "skiers or gamekeepers thumb. 

No matter what the moniker nor whether the ulnar collateral, radial collateral, volar plate, or a combination of all three ligamentous structures of the thumb MP joint are injured, taping is usually not sufficient to allow the player back to sport safely. Splinting is required. 

I find smug, self serving amusement in the fact that so many skilled therapists and doctors shrivel at the thought of using thermoplastic to support a joint. Whilst their trepidation works to my advantage, ultimately it helps no one. So here is a basic recipe.

It should look similar to this too thick, poorly fitted pre-fab thing 
  1. Get a piece of thermoplastic, 1.6mm thick.
  2. Cut out a pear shaped piece, long enough to extend from just proximal to the IP joint of the thumb, to just distal to the CMC joint. 
  3. Put the plastic in hot water just as if you were softening a mouth guard.
  4. When it has softened enough, place it over the dorsum of the thumb, working it into shape so that it contours well
  5. Trim to fit, making sure it doesn't impinge over the CMC with wrist extension and radial deviation.
  6. Tape on
  7. Refer to a hand therapist for treatment (happy with that BC?)

Before something
Different players in different positions like different things about these splints. Some can't have any coverage over the thenar eminence. Some like it to wrap around the proximal phalanx. As long as it protects the MP joint, and restricts movement but permits play, it's good. 

After something

Rehabilitation after that is more involved, and here's where you need to refer to an experienced hand therapist because the splint cannot be expected to do anything more than limit more damage. If you can get that at least half right, it's a start. I can always fix up your smashed up, finger dinted thermoplastic disasters afterwards and no one needs to know but us!

Look after those fingers,