Training Volume & Injury Recurrence Rates in Rowers

Training Volume in rowers injuries has a direct relationship with injury recurrence and the severity of the injury. Research indicates that land training and use of the Ergo is resulting in more injuries than boat training. However, repetitive motion for extended periods of time, combined with poor technique will have an influence on the development and severity of injuries #HandConsultSA

Cubital & Carpal Tunnel in a 14 year old Rower

This is an image of a 14 year old girls hand. She is an avid rower. She has had a Carpal Tunnel Decompression and was referred to hand therapy for the management of left upper limb and hand pain, numbness, altered sensation and poor functional use of the left hand. She now has signs and symptoms of Cubital Tunnel Syndrome. In addition to rowing, she does Archery. The Archery movement pattern has created changes in the flexibility and strength in her left shoulder compared to the right. The first image demonstrates the Carpal Tunnel Decompression scar, the wasting of the Adductor Pollicus muscle and the changes in the first CMC joint as a result of rowing. Young rowers have not completed grow

Double Crush Syndrome

The original definition of Double Crush Syndrome (DCS), although based on sound pathophysiologic processes, may be limited in scope because investigators have shown that compressive pathology is not the only contributor to nerve pathology. Despite the controversy surrounding the diagnosis, DCS is an important concept because it emphasizes the fact that patients' symptoms may not simply be related to one anatomic site of compression but may also be caused by a remote compressive lesion or a systemic process, such as peripheral neuropathy. Multiple studies have illustrated the increased susceptibility of nerves to compressive pathology secondary to systemic illness. Baba et al reported an incr

Junior Rowers

Junior rowers (age under 19 years) compete at the same race distance and train with similar frequency and duration as elite senior rowers, yet data related to injuries are scarce. This may be because the incidence of severe rowing injury is underreported. Training volume is significantly associated with injury. Athletes who average more than seven training sessions per week during a rowing season are at a higher risk of developing an injury #HandConsultSA #RowingInjury

Approach to Injury

Assessment of changes in the training process (intensity, volume, or frequency) along with equipment, technique, and biomechanical issues (muscle imbalances, alignment, and length of extremities), or deficiencies in strength. Research reports that up to 50 % of injuries in elite rowers have been related to land- based training, including ergometer training and weight training. Furthermore, recent evidence suggests that completely removing an injured athlete from training is predictive of injury recurrence, as he or she must play ‘catch-up’ upon return to sport. Maintaining a normal training load whilst avoiding both aggravating factors and complete prolonged rest is therefore important #Hand

The Rowing Discipline

Rowing consists of three main disciplines: flatwater (e.g., traditional Olympic and collegiate style racing), open water (coastal rowing), and indoor. Rowers use two oars each (sculling) or one oar with rotation to port (right) or starboard (left) (sweep rowing). Sculling boats include the single, double, and quadruple sculls. Sweep rowing is done in crews of two (called a pair), four, and eight athletes. A coxswain, who steers and faces forward, is always employed in an eight, sometimes in fours, and rarely in pairs. In boats with no coxswain (called ''coxless'' or ''straight''), steering is controlled by one rower turning his/her foot to move the rudder mechanism #HandConsultSA #RowingInju

Rowers Injuries

The focus for this week will be on Rowing injuries in young adults. The rowing stroke is a repeated continuous cycle, from a position with the legs flexed, elbows straight to a fully extended knee position and elbow flexion with the oar handle drawn into the body. A strong back and core strength is a vital component to increase power through the stroke and avoid injury. Poor technique is common, especially in novice rowers, and unless this is rectified, injuries are almost inevitable. Rehabilitation of an injured upper extremity requires knowledge of the sport, experience in treating related upper extremity injuries in both acute and chronic phases of rehabilitation. A successful treatment o

Mallet Injuries - uncomplicated yet no clear consensus on best practice

Mallet finger, or thumb, is a common traumatic injury to the hand. Mallet injuries result from disruption of the extensor tendon mechanism at the distal interphalangeal joint (interphalangeal joint of the thumb) either due to tendon rupture (a soft tissue mallet) or avulsion (a bony mallet) leading to the inability to extend the distal interphalangeal joint. If untreated, a mallet injury may become chronic leading to a swan neck deformity of the finger. On occasion, a Swan Neck Deformity may present soon after the injury. Immobilisation with a splint is the most common conservative treatment for undisplaced, closed bony andclosed soft tissue mallet injuries, but there is a lack of consensus

Theun's Journey: Results after 1 week of CMMS

The results were impressive as the patient gained 50 degrees of flexion in the MCP joints. The scar tissue also improved and is softer and more mobile. The pattern of motion has improved as it is no longer an intrinsic minus pattern due to extrinsic tightness of the extensor tendons. He is yet to achieve a full fist and has been provided with a second cast that positions the MCPJ's in further flexion to achieve lengthening of the scar tissue over the dorsum of the hand. The second will be worn for 2 weeks. No therapeutic intervention is needed in between cast changes. Theuns has been provided with his cast exercises to improve MCPJ flexion and maintain PIPJ & DIPJ flexion.

Theun's Journey: Initial Presentation

Theuns attended Physiotherapy for 1 year and had 64 sessions of dry needling (Image 1) before he was referred to hand therapy. Prior to deciding on using the CMMS technique, Theuns attended our Hand Surgery & Therapy Meeting where a team collaborated with regards to the best decision for future management. The team agreed that further surgical intervention would be expensive, painful and require intense post surgical rehabilitation. The CMMS technique, however, would be safe, inexpensive and only require intermittent hand therapy. The CMMS technique was therefore applied. Physio Dry needling sessions with Physiotherapist Image 1: Initial Flexion Image 2: Initial Scar Image 3: Initial cast de

Theun's Journey: Degloving Injury

Theun was involved in a car accident (Image I) in August 2017. His right, dominant hand got caught between the car seat and the door. As he pulled his hand up to release it, the dorsum of his hand was degloved. He was taken to hospital where the wound was debrided (Image 2) and a split skin graft was applied to the degloved area (Image 3). Unfortunately, a full thickness graft was not done at the time.The risk of having a split skin graft applied to the dorsum of the hand is that the graft will adhere to the underlying tendons and tissue. This will result in the development of extrinsic tightness and an inability to make a fist. Furthermore, the thin coverage does not allow the secondary pro

Cubital & Carpal Tunnel in a 14 year old Rower

This is an image of a 14 year old girls hand. She is an avid rower. She has had a Carpal Tunnel Decompression and was referred to hand therapy for the management of left upper limb and hand pain, numbness, altered sensation and poor functional use of the left hand. She now has signs and symptoms of Cubital Tunnel Syndrome. In addition to rowing, she does Archery. The Archery movement pattern has created changes in the flexibility and strength in her left shoulder compared to the right. The first image demonstrates the Carpal Tunnel Decompression scar, the wasting of the Adductor Pollicus muscle and the changes in the first CMC joint as a result of rowing. Young rowers have not completed grow

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