Let me introduce this topic with some food for thought by putting forward two scenarios.
Scenario 1: You’ve diligently stuck with the training as per the marathon training plan you downloaded online. Even the hill work and tedious long runs on Sunday mornings. You’re on track to complete your first marathon but as you approach the 22 mile mark you begin to get chest pains. Only your debut marathon you think this is normal so continue pushing on filling your mind with positive, motivational thoughts like your work colleague told you to do as you might ‘hit the wall’ like that article in the running magazine said. You don’t reach the 22 mile marker. As medics perform CPR and check the emergency contact information for next of kin on the reverse side on your race number they wonder is there a history of cardiac events in the family (the greatest risk factor) or had you undergone cardiac screening prior to starting out on this road to ticking off that first item on your ‘bucket list’. Was there an underlying arrhythmia (abnormal heart rhythm) that, if detected, may have prevented this episode?
Scenario 2: I leave the test centre fuming and cursing. “A money racket! That’s all that is!”. They’ve failed me on a rear fog light, front brake pads and also a warning light on the dash board (something to do with the passenger airbag). I was aware of the warning light. It flashes every time I turn on the ignition and stays on. It has done so since a few weeks after the last NCT but I figured as long as my car started, got me from A to B it can’t be that bad a thing. And on reflection as I pull in for a coffee it’s not, provided I am not involved in a road traffic accident. And as long as I don’t happen to have a passenger in the car with me at that time. The NCT, as annoying as it can be, has just informed me about some of the safety issues I need to get addressed. It has highlighted the areas that put my car at risk of being involved in an accident.
Screening and testing have become more and more common practice in all walks of life. Be it a BER certification for your home, cancer or cardiac screening for health, or NCT for your car they all exist with the one universal goal: prevention. Detect an existing problem and put the measures in place to correct it, hence avoiding future problems. But with health there are guidelines to follow. There should be an understanding of the condition or disease being tested for and should be worthwhile identifying early with treatment available to be put in place if a problem is detected.
Let’s throw a third scenario into the mix, one I’m all too familiar with. A patient presents to the clinic with a recurring problem. It happens over and over. The usual pattern is it will flare up, settle down and they will get back doing their activity before happening again weeks or months later. This could be an ankle sprain or hamstring strain, shoulder impingement, low back pain or knee pain with a runner. They ask why it keeps happening.
A mechanical problem like this is usually happening for a reason and may not be entirely to do with the structure suffering the recurring injury at the time. It may have to do with an insufficient movement system somewhere else along the kinetic chain. The challenge is to detect this discrepancy in stability or limitation in mobility and target the areas with specific rehabilitation and re-education strategies. But does an athletes screening differ to occupational? Not hugely. This is not isolated to sporting populations. The ability to raise the arm above shoulder height is just as important for someone doing some DIY painting at home as it is for a midfielder to catch a ball above his head. The fundamental movements remain the same. The ability to squat, perform some single leg stance work and balance are applicable across a broad spectrum of populations. The information we gain from looking at the performance of these tasks tells us a lot about how someone might bend when lifting at work or if they have the ability to get into positions safely without putting themselves at risk of injury.
I spent last Sunday afternoon with the Kildare senior hurling team screening a group for their upcoming season. Now is the time to detect the movement faults that might put them at risk of injury for the year ahead. It is important that during this time we gain information about injury history and what was done about it at the time. Research will tell us that there is strong evidence that previous injury along with inadequate rehabilitation increases the risk for re-injury (Murphy et al, 2003). There is a significant relationship between increased muscle tightness and the incidence of lower limb injuries in athletes (Krivickas and Feinberg, 1996). With GAA this would be reflected in the high incidence of hamstring and groin related injuries so this is something included in their assessment with an active straight leg raise test. The musculoskeletal screen should address areas specific to the needs of that sport, e.g. throwing sports such as baseball have a high incidence of shoulder injuries, where runners will be more prone to lower limb tendonopathies, so assess accordingly.
When carried out at the start of season this gives the athlete, coach and medical team baseline data that can be compared to throughout the season and the start of the following season. It ‘flags’ areas that need maintenance work and the athlete can then monitor this before, during or after a training session or game. The screening itself is quick yet in-depth. It firstly gives an overall look at how the person moves and then goes into more detail based on the findings.
For serious conditions such as cancer and cardiac health if there is a family history it is worthwhile undergoing screening and regular checks as guided by you GP. Or if you are yet to have that conversation with your GP maybe have it today. If your car is due its NCT get it booked in and drive safely in the knowledge that you or other drivers are at less risk. And if you want to get to the bottom of that recurring injury or just keen to stay injury free book in for an assessment and talk to your Chartered Physiotherapist about Musculoskeletal or Functional Movement Screening.
For more information on any of the issues addressed throughout this article please contact Rob via email at firstname.lastname@example.org, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit http://www.mccabephysiotherapy.com
Rob McCabe MISCP
MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine
Orchard House, Moorefield Rd, Newbridge, Co. Kildare