European therapies V Australia, clarify!!!

[vitt]

dear all

this message is addressed to all of you that work in the medical field mostly. I have been wondering about this for a long time and hope someone can provide a clear answer.

over a year ago I had a hip arthoroscopy for a labral tear, I was in Oz and told that there was not a therapy that could help, after 6 months I developed a adductor tendinopathy, and there too I was told that tenotomy was my only and best option.

At that point I had enough of it and decided not to go throu the op and actually come back to my home coutry, Italy, and see what other options were here. Well this is where I get VERY FRUSTRATED because here I found out there are some very good therapy that can be used, and today I am doing much better and have almost finished the treatment succesfully without the need for surgery.

The theraphies I used are called: Tecar/Indiba, Laser CO2, Lorenz Biotech

I was also told by my italian orthopedic that I didnt even need to have the hip arthoroscopy in the first place because there is something called "magneto therapy" - it's like a tube you get into - that most likely would have helped healing the tear!!!!!!!!!

Now my question is why wasn't I told about these therapies, or anbything similar available in Oz? aren't they available there? and why not?

When in Oz I went to see very important doctors, but I dont want to do names here.... and neither of them meantioned anything about doing therapies. I wonder whether is just the approach to the problem that's different, or is australia behind?

can anyone pls clarify this with me, thanks vittoria

[leah]

Hi Vitt, its been a while since i've read the forum. I'm in bad shape at present with the O.Pubis and fibromyalgia. You were very unwell last year, so am hoping the treatments you mentioned have helped you with the pain. Hope to hear an update from you and others who can recommend any treatments or therapy available in Melb, Australia. thanks leah

[kjwilkin]

Hi Vitt & Leah,

I am a sports trainer and know of 2 or 3 really good sports physician in Melbourne that specialise in hip and groin injuries. They all work for AFL clubs and am sure they would be able to help.

Let me know if you want their details.

[Vixen]

I wonder whether is just the approach to the problem that's different, or is australia behind?

Evidence suggest Aust is leading the way with hip treatments, from reading it seems people are still getting tears repaired without treatment of the root cause, ie FAI resulting in them coming back in a couple years with more tears. Even from a laymans perspective it is easy to understand that FAI is a mechanical problem and must be addressed by shaving down the bone, no "therepy" is going to have any effect on this condition.

I would be very cautious about getting advice on complex condition like this from a "sports physician" as they are very much a "jack of all trades and a master of none" > stick with the specialist in the field.


This from Aust leading hip surgeon makes it clear >

ALMOST 10 years ago, Matthew Knights spent an entire pre-season doing ... not much.

The Richmond captain was one of the early victims of osteitis pubis, the mysterious groin complaint that limited his running, hurt when he kicked and soon became one of football's buzz terms. "OP" was the new scourge of footballers, and it still strikes them down.

Now there is a new threat. Femoroacetabular impingement is a hip condition that affects young and active people and a possible leading cause of many OP cases, not to mention chronic hip injuries, adductor problems and even back pain.

FAI has emerged and become understood only in the past five or six years, and one of Australia's leading hip experts, John O'Donnell, believes it will be the next big thing on the AFL injury scene.

"FAI," he said, "is the new OP."

FAI is caused by a small, bony bump on the "ball" part of the ball-and-socket hip joint - the head of the femur. Experts are still not sure whether the bumps - known as Ganz lesions or femoral neck bumps - exist from birth, but O'Donnell suspects they develop in early teenage years, as people become more active.

A lesion can sit there for years, possibly forever if a person isn't particularly active, and not do anything at all. But if it starts to grind into the cartilage lining either the ball or the socket, it will cause irreversible damage, and inevitable arthritis - be it one month down the track, two years or 10 years.

O'Donnell believes there would be four or five players on each AFL list with the condition; the demands of the sport - to run, twist and, most particularly, kick the ball across the body - promote that sort of movement and friction in the hip. The damage occurs only through that movement - you can't worsen someone's injury by jumping into them, and the condition can be picked up by watching how someone moves, before being confirmed on either an MRI or a CAT scan.

"There's all sorts of weird things people do," O'Donnell says. "Sometimes they walk with their feet turned out, rather than straight ahead, and you might see someone riding a bike and they have their knees a long way out from the cross bar; they can't get their knees in. All those things may be due to this."

Once detected, the lesions can be removed with a simple arthroscopy, which might mean eight to 12 weeks on the sidelines. O'Donnell deals with about 10 FAI cases a week, and has seen some people up and running in six weeks.

As more research emerges there is a belief amongst some specialists that removing the lesions early enough might see off some cases of OP before they start, or before they become chronic. Similarly, removing the lesion might spare players operation after operation to trim cartilage that will only get damaged again because the cause of it still sits there. That, in turn, could reduce the number of them who need hip replacements years after their careers end.

"People talk about chronic hip flexor problems, and groin strains - there's lots of different names for it, but I suspect they're all essentially the same thing," O'Donnell said.

"It's a good one to get early and hopefully prevent all those other things from occurring. I guess we'll find out in time what the impact is, but what we do know is that when we first started to trim off the bits of torn cartilage, a lot of those guys did fine for one or two years and then they started getting their problems back because they still had the bumps there, and they were still rubbing.

"Since we've been taking the bumps off, which is about six years, with very few exceptions they don't come back. At least so far. At the very least it gets them from two years to six years, and hopefully a whole lot longer. That's what we'll find out."

That, then, poses another question. If a player has a lesion, but is not symptomatic, what do you do? Carlton faced that question last November when they drafted Matthew Kreuzer knowing he has a lesion on his right hip but also knowing it had not begun to grind into his cartilage. He wasn't injured, but he had something that could cause injury.

Through the AFL's draft camp medical screening, the teenager consulted a specialist who recommended he continue to train and play but predicted he would need surgery in the first two years of his career. Knowing he has the condition at least means the Blues can monitor it - a better alternative than having their No.1 draft pick break down and lose years off his career.

O'Donnell would have made the same decision and kept Kreuzer out of the operating theatre. But his opinion could change in the next few years, as more becomes known about the long-term benefits of scraping a lesion away as soon as it is discovered.

"Right now, I'd wait until there are symptoms ...

But it's interesting. It will be interesting to see what more we find out about it."

[Vixen]

that most likely would have helped healing the tear!!!!!!!!!

Also cartlidge never repairs/regrows hence why they have to use hamstrings, etc to fix cartlidge damage in knees.

Also having put the therepy description through google plus "hip" I find liitle eveidence of its wide spread use, most hits come up for cosmetic surgery and eyes..............

[kjwilkin]

Vixen,

They never use hamstrings to repair cartilage damage in knees. Hamstrings are used for knee reconstructions.

You are completely ill-informed about sports physicians. I know of 2 sports physicians in particular who have helped people get over their groin and hip problems, both elite and the amateur athletes. Most sports physicians actually have particular areas that they specialise in.

Hip surgeons only know how to operate and are not usually very aware of good conservative treatments.

[Vixen]

Vixen,

They never use hamstrings to repair cartilage damage in knees. Hamstrings are used for knee reconstructions.

You are completely ill-informed about sports physicians. I know of 2 sports physicians in particular who have helped people get over their groin and hip problems, both elite and the amateur athletes. Most sports physicians actually have particular areas that they specialise in.

Hip surgeons only know how to operate and are not usually very aware of good conservative treatments.

Sorry, you are quite right, hamstrings for ligament repair, not with standing damaged cartlidge does not regrow/regenerate, yes ? which is the point I was making.

Hip surgeons only know how to operate and are not usually very aware of good conservative treatments

conservative "therepies" are well and good, but not useful when a mechanical fault is the problem, ie FAI'S in particular.

Case in point >

CARLTON expects Matthew Kreuzer to be back in full training by the start of the club's pre-season after sending the young ruckman for "preventative" hip surgery.

The Blues' football manager, Steven Icke, told The Sunday Age that rather than wait for Kreuzer's hip condition to cause any permanent damage, the club's medical staff had decided to act before any symptoms presented.

Before Kreuzer was drafted, it was discovered he had a condition called femoroacetabular impingement (FAI) , which meant there was a bony bump growing on his hip joint.

The bump could have sat there for years and done nothing, but had it begun to grind into Kreuzer's hip cartilage, it would have caused permanent arthritis and potentially cut a few years from his career. It is considered by some experts to be a leading cause of osteitis pubis.

Icke said Kreuzer, who had the routine arthroscopy at the end of his excellent debut season, would not miss any of the pre-season and would no longer have to worry about the hip troubling him.

"It's a precautionary thing we've done with him, rather than him showing any symptoms," said Icke. "The view was that rather than have it become a significant thing down the track, we could make an important decision now in terms of his longevity.

"You never want to engage in surgical procedures unless there's some sort of necessary reason to do so, and symptomatically he wasn't suffering a great deal of pain from it, but the medical view was that it could become a problem down the track, so why wait until that happens, why not fix it now?

"It was done for preventative reasons and he'll be ready to go for pre-season. The recovery time isn't too bad, so he'll be right to go and on track when we come back."

The Blues will resume training on October 28.