SPORTS MEDICINE TIBIAL FRACTURE

CASE REPORT A NOVEL TREATMENT INTERVENTION

FOR THE MANAGEMENT OF A COMPLEX TIBIAL FRACTURE IN AN ELITE RUGBY PLAYER

BY GREG RETTER, PHYSIOTHERAPIST

INTRODUCTION There is a growing body of evidence surrounding the use of mirrors to “train the brain” in conditions that have traditionally been recalcitrant to treatment intervention (1). A common theme across these diverse conditions is incongruence between motor commands and sensory feedback that causes an alteration of proprioceptive representation, or pain perception, in the cerebral cortex (2). This altered somatosensory map may be a significant cause of the ongoing pain often associated with these conditions (2). Recent studies have looked at treatment intervention strategies to normalise this cortical map, using novel techniques to “re-tune” the sensory motor input to the brain (3). The use of mirror visual feedback (MVF) has been shown to help provide visual input of normal movement in an affected limb, which can then serve to compensate for any decreased or aberrant sensory input (4). Features of these central changes may exist in athletes

Alteration in somatosensory map and central pain perception

The use of a graded motor imagery programme including the use of mirror visual feedback (MVF) should be considered in injured athletes who present with sensory disturbances. This intervention has been found to be most effective in the earlier stages of rehabilitation, and may form an integral component of a multifaceted treatment approach. This report considers the evidence from related fields and considers applying this novel treatment in a musculoskeletal context.

who present with musculoskeletal injuries. This report looks at integrating a novel treatment alongside a conventional physiotherapy treatment regimen.

Incongruence between motor commands and sensory feedback

CASE STUDY A 25-year-old semi-professional female rugby player presented to the Intensive Rehabilitation Unit (IRU) at the British Olympic Medical Institute having suffered a severe

Mirror visual feedback (MVF) from normal

movement of affected limb re-tunes sensorimonitor input to brain

Normal limb reflected in the mirror

Normalisation of corticol map and compensation of decreased or aberrant sensory feedback

Figure 1: Brain training using MVF Figure 2: Comminuted fracture of the left distal tibia and fibula

www.sportEX.net

13