Case studies Physio
Case study - Tickhill Runner's Max Polson persevered with physiotherapy to reap rewards
This could be a swimmer who comes to see Jono for a swim analysis session, or an athlete whose racing times have plateaued and visits Dave for a lactate threshold test.
Both of these individuals will know that it is not good enough to simply attend the session, watch their personal coaching video or read through their extensive test results, before going home and forgetting all about it, as they know they will never improve unless they put Jono and Dave’s wise words of wisdom into action!
However, as is clear from the name of our business, physiotherapy forms an important and vital cog in the wheels of our sports performance clinic, and it is also the most essential service for our clients to listen to, understand and implement the advice and treatment offered by our specialists.
Now we know that it is not possible to exceed 100%, because Sir Alan Sugar has told us so in The Apprentice, but, if it was, our latest physiotherapy case study went above and beyond that percentage level of dedication and enthusiasm for his treatment.
Tickhill AC’s Max Polson first came to the clinic for a lactate threshold test with Dave, after being inspired by a talk Jenny organised for his running club focussing on the importance of wearing the right footwear, as well as injury prevention.
Max only started running a few years ago after falling out of love with fitness and falling foul of the fast food and boozing wagon. Inspired to lose weight and return to his former fitness levels by the London Olympics and realising that watching sport on TV did not equate to actually participating, he lost four stone and then had his first experience of the lactate threshold test after a number of enthusiastic recommendations.
He could not be more positive about his session with Dave: “I can genuinely say it’s the best thing I’ve ever done. When I had my test I was at a point where running was becoming more than just running for fun. The competitive nature took over and I wanted to see how fast I could go at my new racing weight!”
He joined Tickhill AC soon after, quickly becoming a dedicated member, and, together with their friendly support and his test results, he chopped his 10k best down from a pre-test PB of 53 minutes to a an incredible post-Coach Tune time of 42:11!
Max said he could not recommend the lactate test service highly enough: “After seeing Dave, I have such a better understanding of why we run at the zones given, how important rest days are, nutrition, and so much more.
The amount of information I got was amazing. Checking out my haemoglobin levels and hematocrit was an eye opener, and with Dave’s guidance I’ve improved dramatically!”
However, last June the cruelty of fate stepped in after the Field Account Manager ‘landed funny’ while playing football, shattering his tibia plateau.
He joked that “the surgeon said I’d done a good job, and the level of break was given a 5 out of 6!”
His injury was no joking matter though, forcing him to wear a brace for four months, before having to relearn how to bend his leg, weight bear and pivot. He was given a number of NHS physiotherapy appointments, but when he realised time was passing quickly and he wasn’t seeing great improvements, he came to see our team at Blizard Physiotherapy.
Max explained how serious the situation was when he first came to the clinic: “The physiotherapists said there are some points on the knee they look for when analysing an injury, but mine was just a big swollen lump!”
This is where our physiotherapy team can take over the story, and explain the full extent of the Tickhill runner’s problems when he arrived at our doors.
THE INJURY EXPLAINED
“A fracture of the tibial plateau is a serious injury and more so for the sporting population. It is serious because the tibial plateau is important for the smooth functioning of the knee joint.
THE PHYSIOTHERAPIST’S INITIAL ANALYSIS
“When Max came to see us quite a while after the fracture had happened, his right knee was unusually still very swollen, and it was difficult to find bony landmarks, which, as physiotherapists, we use to identify specifically what we are looking at.
THE PATIENT’S DESCRIPTION OF THEIR SYMPTOMS
“When we asked him about the symptoms he was feeling it was clear that the pain was probably not due to the fracture itself. He explained that he was woken at night with pain, and a sense that his knee didn't feel like it belonged to him, both when touched, and when sensing how it should feel without touch. He also explained that it felt ‘floppy’, and a sense that it was much bigger than it actually was.”
THE PHYSIOTHERAPIST’S EXPLANATION OF THE PATIENT’S SYMPTOMS
“These are all signs that the nervous system is malfunctioning and altering perception of what is normal sensation and awareness. The nervous system can also produce its own swelling, as opposed to the injured area producing the swelling.”
PHYSIOTHERAPIST’S PHYSICAL ASSESSMENT RESULTS
“When we assessed Max, it was obvious that despite all the rehabilitation he had undertaken, he was still not weight bearing through his right side. This was no fault of Max, his brain imagery had become modified to his new post-fracture abnormal body position and image, which happens very often, so we had to just get him using his old model again. In addition to not weight bearing through his right side walking, he was pivoting round on his left leg, getting out of a chair using just his left leg.”
PHYSIOTHERAPIST’S INITIAL SUGGESTIONS FOR TREATMENT
“Sometimes it is the easiest changes that get the quickest results. We highlighted the weight bearing and pivoting issues, Max laughed, and went about changing his body movements to incorporate use of his right leg again. It is amusing, but it also has the potential to cause the most longer term problems.”
PHYSIOTHERAPIST’S INDEPTH ASSESSMENT
“We then started to assess what was causing the pain, swelling and altered sensation in his right knee. It certainly wasn’t the joint mechanics, as the knee movements were remarkably good. On palpation of his knee we noticed that the inside lower aspect of his knee was acutely tender to touch, and, in addition, despite his knee flexion being 110 degrees, when we placed the femoral nerve and the quadriceps on tension, his knee flexion was reduced to 60 degrees.
PHYSIOTHERAPIST’S HYPOTHESIS
“We then hypothesised then that the neural system was at fault, and potentially causing the knee pain, swelling, sensory changes and lack of mobility. The saphenous nerve, a branch of the femoral nerve supplies the sensation to the inner and lower aspect of the knee.
MAX’S TREATMENT
“His treatment consisted of mobilising the lumbar joints - where the femoral nerve originates from - and desensitising trigger points in the quadriceps muscles in the thigh (supplied by the femoral nerve). We also mobilised the scar following the surgery as it had become slightly ‘stuck’ to the surrounding tissues. This helped with promoting normal sensory perception again too.”
THE RESULTS AFTER TREATMENT
“The swelling and pain quickly resolved, normal sensation resumed, and Max continued to progress his running. The abnormal movement patterns undoubtedly contributed to irritating the nervous system in his back, and caused the swelling and pain in his knee.
“Without detailed analysis and a focus away from the knee, Max may never have resumed running again.”
Max waxed lyrical about the treatment he has received so far from the Blizard Physiotherapy team:
“I feel I have my own team who look after me! Dave sorts my tests and training plans out, and the physiotherapists sort out whatever injuries I may have. I’ve had niggles in so many different places, but the physio’s are quick to localise the source of the injury, and help solve what’s going on!
“What is also great is that the coaches or physio’s could be dealing with an elite before me, but I get given the same care and attention, which I really like! I always promote Blizard where I can, because when people are doing a great job, the world needs to know!”
“I’m glad to say I’ve stuck with all the exercises given to me, I’ve lost a stone and a half since, and I’ve had a lactate retest with Dave (on my birthday!), and I’m well on the way to recovery.
I have a plan in place until I retest again before marathon training starts for a race on my 30th birthday, on May 15th next year. I’m regularly racing, and I’m currently top of the Tickhill club championship!”
The race director for the recent Tickhill Birthday Bash running event - the club’s third of four annual races they organise - has improved so much that he was able to return to Dave’s infamously tough ‘Tune’s Tempo Tuesday’ sessions in the woods close to the clinic.
It was during a recent session that he was able to take advantage of the all round service provided by the Blizard Physiotherapy team, despite not even being at the clinic for physiotherapy.
Jenny explained what happened: “When I watched him run in the woods a couple of weeks ago, he was lifting his right shoulder and again, weight bearing more through the left side than the right, so it was very fortunate that he had his physio close by to keep him in check!”
Max agreed, although he said he his finding the sessions as “brutal as before”!
“They are tough, but I enjoy pushing myself to get faster, and you couldn’t ask for a better group of people to do it with! The beauty of these sessions is they are top secret, and you don’t find out what is involved beforehand. I’ve recently found out that’s because no one would turn up as they are so tough! But I’m a stats man, so I’ll look at my first tempo session and look again in a months’ time, and I know there will be a vast improvement, and the tempo sessions will have helped massively towards that!”
“I feel I was lucky to see the team at Blizard right from the beginning, and I can see how they are evolving and adapting. In addition, my current trainers have about 140 miles left in them, and so I cannot wait to go over and try some of the On Cloud running trainers! Dave says they have a pink colour for men, so that’ll do me!”
Rather poignantly, he referred to the Blizard tradition of gifting Dave a bottle of wine or beer when the lactate test and heart rate training results in an almost inevitable PB when he explained: “Just before I broke my leg, I was about to buy shares in a vineyard over in Italy, because I was hitting PB after PB, and I thought it was best to go direct to source for his PB wine!”
What a fantastic example Max is of how, if you follow the instructions given by the Blizard team’s experts, no matter what service you have used, in his case both the lactate test and physiotherapy, you too can turn your life around and get back on the road to fitness and PB heaven!
The Blizard Physiotherapy are over the moon with the Tickhill AC runner, summarising:
“Max is an inspiration to many ‘non’ elite athletes out there. He got himself fit, reduced his 10k times dramatically, then had a major setback, but got right back on track as soon as he could.
He sought advice early, as he knew he needed help with the transition back to running, and we have been able to provide ‘hand's on treatment’, but, most importantly in this case, that advice on re-educating movement patterns.”
Well done Max, you are definitely a source of inspiration to many in our neck of the woods, and, perhaps after reading this, you will also inspire those former athletes, injured or not, to start their own journey back to running, by coming to see the team at Blizard Physiotherapy!
