SPORTS MEDICINE

KEY POINTS FOR CLINICAL REASONING ■ The long period of ineffective treatment is a pattern in itself. ■ The vascular clues are often there throughout, if you look for them. ■ An exercise induced pattern should always prompt you to explore the vascular hypothesis further.

■ Regardless of the sport, an exercise or effort related pain/numbness would indicate examination of the vascular system.

■ Be cautious not to make the symptoms fit a particular hypothesis (ie. lum- bar nerve entrapment, compartment syndrome) in the absence of anything to support it.

■ Explore the vascular hypothesis with in-depth questioning ■ Explore the GH, FH, PMH with targeted questions – ask about specific named vascular disease i.e. heart disease, peripheral vascular disease, stroke, clotting abnormalities etc.

■ Consider whether the athlete may be suffering elevated clotting levels i.e. dehydration, recent travel, use of EPO.

■ Simple pulse palpation testing (providing it is done post exercise/effort) in the clinic, will often reveal enough for you to send the patient on for further more sensitive examination.

■ Pencil Doppler U/S will help you to confirm/deny your pulse palpation findings.

KEY POINTS FOR PRACTICE 1. Ensure you reproduce symptoms in the exercise test. 2. Pulse palpation works well if you are practised. 3. Hand held Doppler U/S is a useful tool if you have access to one. 4. Ensure you have patient consent to exercise to that (maximal) level – they do it daily so will seldom refuse!

5. Ensure your triage letter is clear and contains your objective findings. 6. A positive post exercise ABPI is an indication for further vascular examination.

References 1. Taylor A and Kerry R. Altered haemodynam- ics; vascular issues in sport. sportEX Medicine

2002;12(Apr):9-13 2. Abraham P, Bickert S, Vielle B, Chevalier JM, Saumet JL. Pressure measurements at rest and after heavy exercise to detect moderate arteri- al lesions in athletes. Journal of Vascular Surgery 2001;33(Apr)(4):721-727 3. Abraham P, Bouye P, Quere I, Chevalier JM, Saumet JL. Past, present and future of arterial endofibrosis in athletes: a point of view. Sports Medicine 2004;34(7):419-425 4. Schep G, Bender MH, Kaandorp D, Hammacher E, de Vries WR. Flow limitations in the iliac arteries in endurance athletes. Current knowledge and directions for the future. Int J Sports Medicine 1999;Oct;20(7):421-428 5. Stager A, Clement D. Popliteal artery entrap- ment syndrome. Sports Medicine 1999;28 (1):61-70

THE AUTHORS

■ Alan J Taylor MSc MCSP HPC regis- tered. Alan graduated from the Nottingham School of Physiotherapy in 1982. A keen sportsman, he suc- cessfully combined his early career as a physiotherapist with that of a pro- fessional cyclist - completing the Professional Tour of Britain in 1988. Alan gained his Masters degree in Sports injury and therapy at the Manchester Metropolitan University in 1998. His subject matter led to a spe- cial interest in vascular issues relating to manual therapy. He has worked extensively as a manual therapist in South Africa, New Zealand and the UK. He currently works as a consultant physiotherapist (vascular)/physiother- apy manager at the Nottingham BMI

www.sportex.net

Hospital and is a part time lecturer on the MSc courses at Manchester and Nottingham Universities.

He lectures

world wide on sports medicine subjects and altered haemodynamics. He has also authored a number of papers in peer reviewed journals and a chapter in Grieves Modern Manual Therapy IV.

■ Roger Kerry MSc MCSP. Roger Kerry is associate professor in the division of physiotherapy education at the University of Nottingham.

His areas

of teaching and research include vascular pathology, clinical reasoning and musculoskeletal practice and pro- fessional issues.

He is widely

published, teaches extensively and has presented internationally on these subjects.

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