DISABILITY SPORT

ASSESSING THE INJURY A thorough subjective examination should be conducted as usual, however a brief history of any pre-existing or underlying conditions should be included as this often is an important influence. It may impact as a predisposing factor in the presenting problem, and/or may need to be considered in the management plan for recovery.

Details of recent training and competition and proposed training and competition plans should be discussed, alongside a summary of any rest and recovery strategies, daily routines and 'activities of daily living' (ADL) which may affect the injury site. Greater detail regarding lifestyle and the impact of cumulative loads are crucial as often the athlete is not able to exclude an exacerbating activity completely, but still may be able to effectively reduce loads if he/she understands the impacts. A good example of this is where a wheelchair user sustains a shoulder impingement problem. He/she may feel unable to reduce load due to dependence on the shoulders to perform transfers to and from the wheelchair and for propulsion. Careful discussion can highlight ways that cumulative load can be realistically reduced and improve co-operation when developing the management plan.

Figure 1: A sports wheelchair for ten- nis has a 20o camber applied to the wheels to assist stability and turning

Posture Posture must be assessed from the sports performance point of view, but also should include evaluation of everyday posture. The setting-up of ambulation

aids such as crutches, stick, frame or wheelchair can impact greatly.

Athletes may use a variety of ambulation aids for different tasks. One athlete may compete in an everyday wheelchair (eg. shooting,

A CASE EXAMPLE

Shoulder impingement in a wheelchair tennis player Player A is a 38 year old recreational wheelchair tennis player. He presents in the clinic complaining of intermittent antero-lateral shoulder pain. He uses a lightweight wheelchair for daily ambulation and a dedicated sports wheelchair for his tennis.

Include in your assessment:- ■ Postural analysis of his sitting position in his everyday wheelchair – could posture be improved by education, adjustment to the upholstery, changes to lifestyle habits?

■ Detail of exposure to load at training and during match play (eg. duration, intensity, frequency) ■ Detail of tennis equipment (eg. racket weight and length, grip size, string tension, balls, court surface) ■ Postural analysis of use of the sports wheelchair (the athlete may not bring this wheelchair to the initial assessment, but it is worth getting him/her to do so at a later date to facilitate assessment and impact on the injury site)

■ Discuss ADL activities (eg. transfer methods from bed to chair, chair to bath/shower, in and out of the car etc). Enquire how many of each is done each day? Could frequency or load be reduced for a short period to facilitate healing? Would long-term changes be possible and beneficial? Could technique be adjusted to minimise forces?

■ Analysis of technique - Is the player developing new shots? Is technique correct? Does the athlete have sufficient strength and flexibility to conduct the manoeuvre?

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archery, table tennis, wheelchair curling), but another could be ambulant for daily activities and yet participate in sport in a wheelchair (eg. some wheelchair basketball players, or wheelchair tennis players) (figure 1). Some athletes use a wheelchair everyday, but use a frame or a specialist chair for sport (eg. some throwing classes in field sports, a sled in sledge hockey, a sit-ski for skiing), or they may be dependent on a wheelchair for everyday ambulation but compete without it in sport (eg. equestrian, swimming, sailing). Assumptions cannot be made according to disability and wide variation exists even in sports where it is likely that a partic- ular device may be used.

In general, the sports chair or frame is adapted to take into consideration some of the needs of the athlete; however it can usually benefit from review in the light of the presenting problem, as often it has not been optimised for best performance, and may well be a source of contributory factors to injury.

REHABILITATION AND GOAL SETTING When planning rehabilitation and setting goals for management it is necessary to be aware of physical limitations so that the athlete is not set tasks he cannot achieve. However, it's equally important that an athlete is challenged by his rehabilitation (3) and that the plan is thorough, dealing with all aspects and factors which may be impacting on injury. Performance issues must be fully addressed, and the management plan should cover a wide variety of aspects ranging from everyday and general fitness advice, to specific high performance details.

Movement patterns in an athlete with a disability are often unusu- al and 'normal' patterns do not apply. For example, a non-disabled person would turn from a supine lying position to side lying by using the hip to initiate the roll, whereas a person with a spinal cord lesion who has no abdominal muscle function (eg. a complete upper thoracic lesion) would use his shoulder and his head as the instigators of movement. When teaching rehabilitation exercises then, it is crucial to understand how movement might be being produced and to remember this when re-educating movement. Motor re-education is a challenge as initial motor learning of the