Undergraduate feedback BSO LONDON for Osteopath Robin Lansman's tutoring of sports clinic

Hi Robin please see feedback below.

Many thanks,

Owen Ziv & Kamilla

 • Really good to be pushed to be concise and efficient with case history process.

 • Good to be lead by someone who really understands and uses exercise prescription and now feel more confident considering this as a dominant feature of a consultation rather than feeling I always have to do hands on treatment.

 • Different insight into global bio-mechanical analysis and the value of scanning

 • 4 week block is a bit too short 6 week blocks would give students a better chance to get the most from the experience.

 • Its was good to work as a small team on cases together and be more able to bounce ideas about as a team.

 • It was good that Mr Lansman leads on the treatments and evaluation at time quite a lot and give us an opportunity to observe the thought processes and learn from his experience.

Increase in Sports Injuries cases seeking NHS accident and emergency assistance

Rise in sport injury cases treated in A&E

13 Jun, 2012 10:30 CET

Accident and emergency departments in England have seen a 15 per cent rise in sports injury cases in a year, Health and Social Care Information Centre provisional figures show.

**Regional data available on request from this publication

Just over 388,500 cases were treated in the 12 months to February 2012; up from nearly 338,200 in the previous 12 month period.

Sports injury attendances rose by a greater percentage than A and E admissions overall, which rose by seven per cent during the same period, although both figures may be affected by increased recording of A and E data over time.

Just over half of all A and E attendances for sports injuries involved young men aged 10 to 29 (205,500) according to today’s report, which also shows attendances peak on Saturday afternoons between 3pm and 5pm; and Sundays between 11am and 4pm.

In the 24 months to February 2012, attendances were high in March and early autumn (September and October) and lower in summer (June to August) and December.

The report also shows that in the 12 months to February 2012:

• Hospitals in the South West Strategic Health Authority (SHA) recorded the highest rate of A and E attendances for sports injuries in the under-40s (20.4 per 1,000 of this age group; or 50,100), while London SHA recorded the lowest rate (6.8 per 1,000; or 31,400).

• Just under six per cent of sport injury cases seen in A and E resulted in an admission to hospital (22,200), while just over half (53 per cent, or 207,000) saw the patient discharged with no further treatment.

• Sports injuries account for about two per cent of A and E cases recorded in HES, but 12 per cent of crutches recorded as issued by A and E departments (7,500) and nine per cent of splint treatments (18,600); along with seven per cent of plaster of Paris treatments (13,600).

HSCIC chief executive Tim Straughan said: “Sport seems to be catching the public imagination at the moment with the Olympics just around the corner. While our hospital figures do not of course represent levels of sports participation over time, they do give an insight into the amount of injuries ending up in A and E through sport.

“Today’s report shows that there has been a considerable rise in such injuries being treated by A and E staff, with cases up by about 15 per cent in a year. About half of all of these cases – so just over 200,000 – were for males aged 10 to 29.”

http://www.cisionwire.com/the-nhs-information-centre/r/rise-in-sport-injury-cases-treated-in-a-e,c9272102

Changes in ankle mechanical stability in those with knee osteoarthritis

Article Review by Robin J Lansman D.O., 

Sports Injury Tutor, British School of Osteopathy, London

This case control study aims to examine the correlation between Osteoarthritis in the knee and how that has an effect on the ankle sub-talar joint, by assessing it’s stability using an arthrometer. 

The ankle function was measured in A/P displacement as well as in inversion and eversion.  The study reports that among 27 million people in the United States suffering from osteoarthritis, the knee joint is the most commonly afflicted joint and it presents a large disruption to normal activities of daily living and exercise.  Disruption to the muscle function and particularly gait cycle is commonly observed to cause a compensation both above and below the knee joint.  This is perhaps something that Osteopaths observe as part of their normal patient assessment and something which is taken into account frequently.  There is a point when severe O/A of the knee reaches a point when O/A of the knee produces not just bio-mechanical changes in function of the ankle but actual arthritis at the ankle joint.

Consideration in patient management may therefore be that ankle rehabilitation should be a focus with any patient who is suffering from knee O/A.

This study was careful to exclude from its’ subjects any cases where there had been other traumas sustained in the hip area, surgical procedure or any other direct injury to the ankle, such as fracture.

A simple grading system was used to assess the osteoarthritic knee joints with zero representing no O/A, and then a scoring system used between 1, 2 and 3 to assess severity, independently assessed by two different orthopaedic surgeons.  Each patient was also assessed for pain levels,  level of stiffness and level of functional activity for the knee joint, so that each participant in the survey (15 subjects with O/A knee were compared with 15 healthy controls).

The sum assessment of the knee disability was scored out of a total of 96 points in total, to give an overall feeling of “disability” and how badly affected the particular individual   was by the O/A.  The ankle sub-talar joint was assessed using an arthrometer which basically allowed the foot to be fixed to an adjustable plate, which then in turn could be placed under different loadings to access the ankle function in different ranges of motion.

The data was recorded using a digital spatial kinematic linkage using customised software to assess the data that was collected.  The statistical analysis used on the case control design was a 2 x 2 case control design.

The study’s results were also made interesting because each of the arthritic knee patients also had the opposite knee and ankle tested, i.e. the side without the O/A. 

University patients with O/A knees exhibited considerable reduction in A/P joint displacement as well as in inversion and eversion when compared to the healthy group. 

It should also be pointed out that all subjects used for this study, even when they had O/A knee changes reported no actual symptoms at the ankle joint even though on testing there was considerable restriction in the ranges mentioned in the results.

Although the ankle joints may not have been symptomatic and may have exhibited dysfunction there was no X-ray taken of any of the reduced function ankle joints to actually confirm the presence of any early stage O/A in these ankle joints.  It does seem however that other results from another study by Tallroth et al, found significant correlation of the severity of the O/A and deviation of the ankle joint mechanics and alignment but in fact reported no clear relationship between ankle joint, mal-alignment and ankle O/A, although specific studies investigating ankle O/A exhibit similar restriction in range of movement in inversion, eversion and A/T displacement.  Moreover it seems that in this study where there was no frank O/A of the ankle were at a lesser stage of restriction than a population who actually suffer from ankle O/A.          .

It seems the most notable observation perhaps that Osteopathic practitioners can bear in mind is that observing gait can indicate a considerable amount of useful information to the clinical assessment of patients and that the varus or valgus of the knee has a direct relationship for the normal weight bearing function of the ankle and indeed, alterations at the hip with increased hip flexion and abduction, as well as at the ankle, for example when climbing stairs, are very easy to notice with a patient suffering from knee, mild to moderate knee O/A.

At a point in time the ankle sub-talar joint motion may not be able to compensate for the knee pathology.  A major limitation of the study is unlike an osteopaths ‘hands-on’ approach to examination and palpation, this study is measuring non-physiological movements using mechanical means to produce data, when in fact there is no measurement of natural physiologic motion, strength or function of the ankle sub-talar     joint.  A key finding however, and a suggestion to clinicians is the need to examine the ankle sub-talar joint mechanics and overall physiological motion to help maintain patient function in cases of the O/A knee.  Indeed patients may not be aware of ankle discomfort and therefore it is possible that this is not a reported area of symptoms that may or may not be assessed.

A suggestion of this study would be rehabilitation and treatment for patients with knee O/A should focus on the entire lower extremity to ensure function is maintained at all joints, in particular the ankle joint.  Additionally for them to do exercises for the whole lower extremities should be advised for mobility, joint functionality and possibly to prevent any changes for the ankle and the hip causing additional problems for these patients.

On an Osteopathic perspective it is uncertain whether Osteopathic practitioners utilise examination procedures that will incorporate the lower limb biomechanics in relation to spinal mechanics?

So taking this study a step further, might be using something such as a ‘Squatting’ test, which would then actually allow the observer to assess function between the ankle, knee, hip and through into the spinal function giving a more global impression of function.  Perhaps something for further discussion.

The measurement of ankle dysfunction on the opposite, supporting leg ie. the ankle on the side which is not affected by O/A in the knee is actually also doing more weight-bearing as a result of avoiding weight-bearing on the painful knee side.  As a result it would be expected that although the dysfunction is measurable in the ankle on the affected side,  was in fact weight-bearing compression loading through the supporting non-arthritic side may become more dysfunctional perhaps not when loaded using a mechanical arthrometer but indeed because of muscle loading changes which could produce stiffness and also a change in function in the ankle joint, something perhaps also that Osteopaths look at with a shift of weight-bearing which is a concern.   

It is quite commonly known that when mild arthritis occurs in one knee or one lower extremity joint it is common that the joint that wears out first is that of the supporting leg .because the patient has been adopting an antalgic posture tend to weight-bear even more heavily on the good side so in fact that side is the side that becomes arthritic at an accelerating rate and often is the knee joint surgery which needs replacement first even though it was the matter to suffer from many symptoms.

 In the meantime, the authors suggest the results of this study indicate a need to rehab both knees after a total knee replacement is done. The operated knee is important but the effect of the non-operated limb can't be ignored.

Reference:

Clare E. Milner, PhD, and Mary E. O'Bryan, BSEd. Bilateral Frontal Plane Mechanics After Unilateral Total Knee Arthroplasty. In Archives of Physical Medicine and Rehabilitation

Knee pain and Nerve root innervation cycle

 Many patients present in my practice with symptoms that  appear to be similar to the problem mentioned! The L3 Nerve root innervates the knee and thigh muscle and simply pulls on the knee-cap and produces motion - ideal for walking the golf course. 

The somewhat normal stooped Golf posture also relieves any nerve root compression associated with even mild age related normal degenerative change of the spine.

Once in bed ( especially if a soft mattress) the spinal position relative to the Nerve roots is shifted and this irritates the nerves and may produce a referred pain into the thigh muscle and spasm that pulls on the knee cap and compresses it painfully into contact with the femur underneath --- especially if the cycle continues for many weeks! 

Since there is no structural damage the pain is relieved on gentle exercise.

The Spine needs a structural and functional examination to conform these suspicions for a treatment plan to be planned and acted upon. 

Sports Bio-mechanics and muscle chains workshop by Robin Lansman feedback from Osteopath and Runner

"I attended a day-course at the BSO on sports biomechanics and muscle chains. It was the first time I had returned to the institution since I graduated over 7 years ago. It felt a bit strange initially, but not much had changed about the place. The course was taken by Robin Lansman, who had run a few tutorials when I had been an osteopathic student. The idea of the course was place the osteopath within the scheme of sports-related therapy, and to use a bench mark of assessment to identify lesions within the whole myo-fascial system of the body. The particular test that was focused on was the Squat Test. This was done with the feet slightly pigeon-toed to tighten the hip girdle and amplify spinal restriction. Each squat was accompanied with the raising of both arms in front, preferably using a small weight. Squats are repeated until fatigue starts to set and problem areas can be identified or reported."

I've tried to implement this approach on a number of patients already, and it appears to bring issues to the surface. I've also started reading 'Anatomy trains', by Thomas Myers, many years after I first bought it. It's a bit idiosyncratic but has plenty of useful information about myofascia."

Heel pain? Which type is all important in the treatment and resolution

Parameters and Clinical Presentation

Heel pain is more aptly termed Calcaneodynial is an extremely common complaint.  The problem can be as simple as a nail or foreign object in the shoe or as complicated as a bone tumour.

All age groups can be affected, although heel pain is rarely seen below age 8.

Onset can be insidious or rapid and the course may be acute or chronic.

Symptoms can include pain located at the inferior aspect of the heel either medial, central, or lateral, retro-calcaneally, surrounding the plantar periphery, or radiating up the medial or lateral aspects of the calcaneous.

Pain can be intense following rest or improved with rest and becoming progressively worse with activity.

The range of pathological entities that can produce heel pain is vast, and includes inflammatory and degenerative arthropathies, metabolic disturbances, nerve entrapments, trauma, and overuse syndromes.

These underlying entities can be divided into two basic etiologies, metabolic and mechanical.

Although heel complaints usually fall distinctly into one of these two categories according to the clinical appearance and history, it is certainly possible to find cases where both etiologies are present simultaneously and the symptoms superimposed.

Plantar muscles can also contact and cause pain in the heel - the advice can involve contrast bathing and myofascial release treatment when appropriate

Treatment we use at BodyBackUp

Insoles from BODYBACKUP

HOT or  Cold packs

Tennis elbow? Golfers Elbow? Diagnosis and tips?

Robin Lansman D.O.  Osteopath established “Body Back-Up Osteopathy & Sports Injury Clinics” in 1988.  He runs workshops for healthcare professionals at under-graduate and post-graduate in London, across the UK and Europe.

He practices in London (Maida Vale) and in Berkshire (Maidenhead).

BODYBACKUP Osteopathy and Sports Injury Clinics

 A pain in the elbow??

Pain in the wrist or elbow is a common problem in any profession where the hands are used for precise and awkwardly angled procedures.  The control needed to use tools, together with the fact that much of the day's work involves using the hands and forearms in this demanding way, also affects the amount of pain experienced.

Using one part of the body to excess over a long period eventually causes the tendons and joints to become inflamed and sore, which then causes the muscles to tighten.  This is known as Repetitive Strain Injury (RSI).

In the condition commonly referred to as Tennis or Golfers' Elbow, pain is normally felt within the forearm muscles and in the area around the tip of the elbow.  However, this is only one way in which RSI can affect the arm.

If gentle pressure is applied to the bony parts around the elbow there may be areas of soreness or pain.  The forearm muscles may feel tight and tender.

The tightest bundles of muscles may even be detectable as bumps under the skin surface.  This is a strong indication that muscles have not been given a chance to relax. 

But what can you do to prevent RSI?

Some of the larger forearm muscles that produce grip are also involved in the twisting action of the forearm, for example, when suturing.  The difficulty arises when the hand is closed, holding the needle, because contraction of the opposing muscle groups within the forearm is required to produce the motion.

After a time, dependent on the workload and the tightness of the grip needed, the muscles will stiffen, so that the turning action gradually becomes harder to perform.

The strength of the grip will further deteriorate, partly due to the fatigue of the gripping muscles but also because of an increase in the pull of the opposing group of muscles.

How to treat yourself

1.    Application of heat

If overused muscles have no chance to meet their normal physical needs, then any damage to the tissue will be slow to heal.  Surrounding the forearm in heat produces the most efficient means of relaxing muscle.

Ideally a hot bath will do that job.  However, applying a wrapped hot-water bottle to the forearm to allow the heat to permeate it fully may provide a more convenient alternative.

2.    Application of ice

Ice can be applied to reduce both pain and swelling, but it is important to use ice carefully.  Since cold causes blood flow to be reduced, people with poor circulation must be cautious of over-cooling.

To avoid skin burn, ice should not make direct contact with the skin.  Instead, a liable bag of frozen peas with a paper towel between the bag and the problem area should be used.

The pack should be left on until the pain has been numbed by cold.  This should be done for no more than five minutes at a time.

3.   

Self-massage

By using self-massage to the forearm, you can stimulate blood flow as well as loosening and relaxing the forearm muscles.

This is cone by using the thumb of the other hand to apply pressure in long even strokes along the length of the forearm, from the mid forearm towards the elbow.  Some areas will appear more tender than others, and will require more attention.

Massaging should continue, even withstanding a moderate level of discomfort.  After several minutes the level of soreness should subside.

If this procedure is followed while bathing the arm in warm soapy water, the process is even more effective and comforting.

                                                                                                                                                                                                                                

4.    Stretching exercises

Gently stretching forearm muscles while they are not in use can help overcome some of the stiffness within the forearm.

First, close the hand tightly and straighten the elbow, putting the forearm muscles in tension.  Slowly bend the wrist backwards until stretch can be felt along the forearm.








Hold that position, and slowly bend the wrist forwards until tension is again felt along the muscle.

Since no gripping work is involved, the tension developed will merely stretch the muscles gently.  If there is a focal point of tenderness around the elbow, the range and intensity of wrist movement must not cause stretch that might aggravate the muscle origins and so worsen the problem.

5.    Use of elbow braces

Reducing the repetitive pull on tendons on their elbow attachments is another way of minimising the risk of RSI.

Where the elbow area has become particularly tender, firmly wrap a forearm or elbow brace just beyond the elbow joint itself around the forearm belly of muscle.

This will effectively transfer the muscle origins.  The pull, therefore, becomes focused on the brace instead of the elbow.

This measure is, however, of only short term value, since moving the muscle origin attachment just causes the tension and muscular fatigue to be confined to lower in the forearm.

A brace can be purchased from chemists and sports shops – ask for advice if you are not sure of your size or how to position the brace properly or ask us at BODYBACKUP!

If the symptoms worsen or show no response to self-help measures, you should seek professional advice.