SOFT TISSUE TRAUMA

Cycling is one of the most popular sports in the world. Whilst it has many benefits including offering low impact exercise or a competitive challenge, there can be major dangers facing road cyclists especially when the injured athlete fails to seek appropriate management of extensive soft tissue trauma during the acute phase of healing.

BY NICK

DINSDALE, MSST

INTRODUCTION The objective of this case study was to devise a suitable, sports-specific, functional rehabilitation plan for a 43 year old male competitive cyclist with extensive soft tissue trauma to the right lower limb. The plan would adopt best available research, evaluation- based progression criteria, motivational strategies, and clinical reasoning to traverse grey areas. Furthermore, these considerations would embrace the scientific principles underlying tissue healing throughout treatment and the successive stages of rehabilitation. Cycling is considered to be one of the most popular sports in the world (1) offering an excellent alternative for athletes seeking low impact exercise (2). For those who want a challenge, competitive cycling is extremely demanding both physiologically and psychologically (3). In the last decade, British cycling as an elite sport has seen unprecedented success with a host of world and Olympic champions (4) most recently, winning 9 gold medals in the 2008 world track championships in Manchester. However, to achieve this level of success requires an enormous amount of dedication accompanied by some of the most demanding training schedules seen in sport. Elite endurance cyclists typically ride 350-450 miles per week (mpw), equating to 20-25 hours in the saddle

SEEN UNPRECEDENTED RECENT SUCCESS

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BRITISH CYCLING AS AN ELITE SPORT HAS

CASE STUDY:

A COMPETITIVE CYCLIST WITH

EXTENSIVE SOFT

TISSUE TRAUMA OF THE LOWER LIMB

(5). Unfortunately this presents major dangers for those cyclists undertaking their training on the UK’s busy roads.

HISTORY A 43 year old male club and regional competition cyclist, averaging 250 miles per week (mpw), was hit from behind by a motor vehicle and knocked off his cycle while out training. He was immediately taken to hospital and subsequently discharged following x-rays later the same day.

The cyclist first consulted me 10

days after the accident complaining of severe pain in his right leg and was experiencing great difficulty walking. The cyclist informed me that the x-rays were clear, although the posterior aspect of the right leg had suffered major trauma, due to the impact of the motor vehicle. According to the cyclist, the hospital had not advised him on how to manage the soft tissue damage using PRICE, failed to explain the associated consequences, nor provided crutches to enable immobilisation. To compound the situation the cyclist was self-employed, had continued to work, and not sought any interim treatment. Consequently, the damaged tissue had been exacerbated resulting in increased swelling, extensive bruising (figure 1), and excessive pitting oedema (figure 2).

Unfortunately these deleterious

tissue effects had been assisted by natural gravitation while standing and walking.

The resulting rehabilitation process

would prove to be both interesting and challenging.

CONCEPT OF INJURY AND REHABILITATION All connective tissue injuries, regardless of their severity, must undergo the same healing process (6, 7). A consensus exists, consisting of four overlapping, interlinked phases (figure 3); bleeding, acute inflammation, proliferation, and remodelling (8, 9). It is generally accepted that treatment and rehabilitation should be based on sound scientific principles underlying tissue healing (7). Rehabilitation is the successful restoration of the injured athlete to the pre-injury level of physical fitness and competition (10), ideally in the shortest, safest, possible time (11).

Rehabilitation should be systematic, consisting of controlled progressive phases (12), each with clearly defined aims, which must be strictly adhered to (13). Rehabilitation can be enhanced by encouraging adherence (14) achieved through patient education (15) and introducing motivational strategies (16). Conversely, poor adherence is a documented factor limiting effective recovery (14). SWOT analysis is a simple management tool which can be used to educate, motivate, and encourage patient adherence. SWOT analysis would therefore be used to highlight potential strengths, weaknesses, opportunities, and threats at each successive stage of the rehabilitation process to enhance recovery (figure 4).

CLINICAL EXAMINATION AND OUTCOME MEASUREMENT

Upon receiving patient consent, the 11