Bloodgate physio free to practise again

Posted by Nell Mead at 15:18 on 14 Jun 2011

The debate continues over the striking off of "Bloodgate" physiotherapist Steph Brennan.  As I blogged before, Steph was struck off the physiotherapy register by the Health Professions Council (HPC) in September 2010 when he pleaded guilty to helping the rugby team for whom he was head physiotherapist, Harlequins, cheat by providing a fake blood capsule to one of the players on the pitch.  By this time, he had already been banned from working in rugby for two years.  In contrast, the pitchside doctor (who cut the player's mouth to "prove" that he had been injured) was deemed fit to continue practising by the General Medical Council. 

Steph - by all accounts a superb clinical physiotherapist - appealed to the High Court against his striking off.  The High Court agreed that he had grounds to appeal to the HPC; and last month the HPC (after initially claiming that the High Court had no jurisdiction) revoked its decision, imposing instead a five-year "caution period".

Since the HPC initially struck Steph off, there has been hot debate among physiotherapists as to whether striking off was the correct action for the HPC to take or whether it was excessive.  Some have taken the view that Steph failed to maintain the "high standards of personal conduct" which form a part of the HPC's regulations and that he therefore deserves all he gets.  My own view is that it was excessive: that Steph clearly made a stupid mistake to put Harlequins before his profession and his morals; but that the public (whom the HPC exists to protect) is not better served by banning this man from practising.  He has also shown very public remorse and has clearly been reflecting on his actions, having undertaken a series of lectures to physiotherapy students on the importance of medical ethics.  I am therefore very glad that the HPC has overturned its own decision.

However, I'll leave the last word to Steph, who feels that his case has highlighted not just the pressure that is faced by physiotherapists working in elite/professional sport but also the importance of withtanding that pressure and keeping a cool head under fire: "I want the profession, and most importantly sports physiotherapists, to learn from my mistakes.  Sports physiotherapy is a very different role for the physiotherapist than any other job in public or private health, but that should not mean we forget our standards of ethics and practice."

Dem bones, dem bones... Knees and pelvises

Posted by Nell Mead at 14:00 on 20 Jun 2011

Dem bones, dem bones, dem dry bones

Dem bones, dem bones, dem dry bones

Dem bones, dem bones, dem dry bones

Hear the word of the Lord

Toe bone connected to your foot bone

Foot bone connected to your ankle bone

Ankle bone connected to your leg bone

Leg bone connected to your knee bone...

OK... you've probably heard a verson of James Weldon Johnson's spiritual somewhere before, and while it's not technically accurate in its anatomy, the concept (that everything in the body is linked and works together, rather than a body being a collection of separate joints) is one I reference a lot.

Today I'm going to talk about the link between knee pain and your pelvis - or, as JWJ might have put it, your knee bone's connected to your back bone.

The large muscles of the thigh - quadriceps at the front, and hamstrings at the back - are biarthroidal muscles.  This means they cover two joints, the hip and the knee.  The quadriceps work to flex (bend forward) the hip and extend (straighten) the knee.  The agonist (opposing) hamstrings work to extend the hip and flex the knee.  Both groups of muscles attach to the pelvis at the top, and to the shin (tibia and fibula) at the bottom.

When you walk, and more violently when you run, your quadriceps pull to swing your leg forward, as your hamstrings pay out at a controlled rate to prevent you from hyperextending and jarring your knee, facilitated by a slight backward rotation of the sacroiliac joint in your pelvis.  As your foot lands, both the quadriceps and the hamstrings contract to control your landing, and then the hamstrings begin to pull to provide the power to propel you forward over your landing foot.

So far, so good.  Everything is working normally; and normal functioning of joints with no structural deficits will cause no pain.  But what happens when there is a glitch somewhere in the system?

The sacroiliac joint of the pelvis (between the sacrum at the base of the spine and the iliac "wings" of the pelvis) is a pretty common source of problems.  There are many reasons why the sacroiliac joint can stop functioning properly - ranging from an impact injury such as a car crash or a fall, to a general poor posture which involves staying too still and not using the joint enough - but the effect generally is that it stops rotating effectively.  When this happens, it impacts on the hamstring's ability to pay out in the swinging leg, and the joint's ability to absorb shock when the foot lands.

When the hamstring doesn't pay out effectively, your body will respond by altering your gait so that it doesn't have to.  You'll take ever-shorter strides and your running gait will alter from a smooth glide forward to a jerky bob-up-and-down movement, which requires more shock absorption from the sacroiliac joints... and thus the cycle is perpetuated.  And if the sacroiliac joints can't absorb shock properly - well, the shock of impact has to be absorbed somewhere, and the knee (particularly the patellofemoral or kneecap joint) is often the victim.  In my experience, this is a very common cause of knee pain, especially in runners.

What can you do to break the cycle?  You need to reverse it: get your pelvis moving, and your hamstrings flexible.  I'll explain how in my next post, so watch this space!

If you are struggling with knee pain when you run, it may well be linked to a dysfunction at your pelvis.  Please contact me for assessment and treatment.