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Paralympic Inspiration

The Vancouver 2010 Olympic and Paralympic Games were on Canadian soil and I was thankful to be part of the medical team in the sister location of Whistler, B.C. The Olympics had all the glitz and glory that one would expect. Then, the Paralympic athletes arrived and these inspirational, elite athletes enriched my life therapeutically and personally beyond words.


October 21, 2010
By Renee Sheldon RMT

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The Vancouver 2010 Olympic and Paralympic Games were on Canadian soil and I was thankful to be part of the medical team in the sister location of Whistler, B.C. The Olympics had all the glitz and glory that one would expect. Then, the Paralympic athletes arrived and these inspirational, elite athletes enriched my life therapeutically and personally beyond words.

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A BRIEF HISTORY
In 1948 Dr. Ludwig Guttmann organized a sporting competition for spinal cord injured veterans of the First World War, to be held after the summer Olympics. This organized event was, arguably, the first games event dedicated to disabled athletes. This sporting competition has grown to attain international status and ,in 1988, after the Seoul Olympics, the Greek prefix “Para,” which means “beside” or “alongside,” was officially added to the word Olympics, and the Paralympics have since been partnered with the Olympic Games.

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Elite athletes’ body awareness is extremely astute and their bodies are like finely tuned machines.


 

THE TRUE MEANING OF ELITE
Before the Paralympics began, RMTs were instructed to review lifts and transfers for potential use in injuries and to become familiar with the hoists that were installed over the hot and cold therapy tubs. Of course, this is the responsible approach to providing optimal care. However, to my knowledge, during the games in Whistler,  little, if any, assistance was required at all to lift the injured athletes! This serves as a reminder of the calibre of athletes we were dealing with!

The first athlete I treated was missing a leg and using crutches. He had his interpreter with him. I asked the interpreter, “What brings him in today?” The interpreter replied, “He wants a leg.” I say, “Pardon?” Again, “He wants a leg.” And so my journey began . . .

One by one, the athletes from all over the world came in, telling stories of land mines, hand grenades, and being shot. The reality of war was before our eyes. There were so many stories, so many atrocities. Some athletes had overwhelming scars and injuries. Sporting accidents, car accidents and other, most unusual, stories rounded out what we heard within the clinic.

As I would try to grasp the magnitude of each athletes’ situation, they would talk about how thankful they were to be alive, how proud they were to represent their country and how strongly they felt support and faith had pulled them through. They would then talk about their competition with that fierce drive that separates those at the top from recreational, social athletes.

Their athleticism was astounding and mesmerizing, and they had an inexplicable spirit that was like no other.

Life lessons were taught to us every day by these athletes, who unknowingly, were changing the lives of everyone they met.

THERAPEUTIC APPROACH TO CARE
Right now, how much do you know about disability? If an amputee or a spinal cord patient walked into your clinic… would you know what to do? It was apparent to me that, even after 15 years, I had much to learn about this branch of care.

This article will present some areas of awareness for amputee and spinal cord injury patients, which comprised the majority of patients I saw in the Whistler Polyclinic.

DEFINITION OF AMPUTEE
Amputation in Latin is “amputare,” which means “to cut away.”  Some conditions or situations that lead to amputation include: cancer, war, diabetes, trauma, infection and/or sporting accidents.

A person  may experience various sequellae as a result of an amputation, including: psychological/emotional; loss of physical ability; grief and bereavement; shooting pain; excruciating pain; intense burning; paralysis; social implications; and phantom limb phenomenon.

AMPUTEE THERAPY CARE AT ELITE ATHLETIC EVENTS
At the Polyclinic, each massage therapy appointment was 30 minutes long. To “treat”  athletes at these Games is contraindicated, as it could have detrimental effects on their performance – unless they have had an acute injury or issue that needs immediate attention. The therapist also has to be aware that some of these athletes have never received therapy (in some cases, due to lack of funding) ,and that awareness and education might be necessary for the athlete to become aware of the benefits of such care.

There was also the issue of a language barrier, as we saw athletes from all over the world. This created a challenge when trying to obtain information in regards to the extent of their disabilities.

The following are some areas of awareness regarding amputees that require consideration on the part of a therapist who is treating one in an elite sporting event:

Postural impairments – Many of the amputee athletes that I saw had partial or total loss of leg(s). Obviously, this would have an effect on posture and stability. The main complaint of these athletes was lumbar/sacral pain. I would try to assess and do muscle energy techniques, along with general Swedish and sports massage, to gently encourage alignment and decompress the area. 

  • Compensation – The postural changes and adaption to their sport created some interesting compensation patterns in these athletes. Being educated in the biomechanics of their sport, and their unique partial or total limb(s) loss, helped them to understand the mechanism of pain, stiffness, muscle imbalances,and compensatory changes and, thus, to treat them appropriately.
  • Mobility in daily life and sport event – Many athletes had crutches, wheelchairs, prosthetics and other aids for daily mobility.  Crutches cause increased pressure and tension on the upper body. Forearms and hands take a lot of force and carpal tunnel or thoracic outlet syndromes could be a long-term result of such use.

Prosthetics are used for daily mobility as well as during some of the events such as standing alpine or downhill skiing.

Swelling, stiffness and pain was sometimes noted in the residual limb. Appropriate flushing techniques to the residual limb and hydrotherapy helped to ease symptoms.Overuse

  • Repetitive strain
  • Maintaining optimal performance state
  • Phantom limb pain – The therapist should be aware of phantom limb phenomena. This occurs in 75 to 85 per cent of amputees. The person “feels” the part of the limb that is no longer there. They feel pain, itchiness, aching, burning, increased tension, dry or wet sensations. What is also remarkable is that immediately after amputation the person feels their phantom limb is the normal size and length, but with time the distal end becomes shorter and shorter until it eventually disappears.

SPINAL CORD INJURIES (SCI)
The therapist must be aware that the areas of impairment in a spinal cord injury relate to the segment involved and all segments below. Sensory and/or motor dysfunction mayboth occur. Further reading is recommended due to the complexity of dealing with SCI patients and athletes. An informative web site for this topic is: www.apparelyzed.com.

The following areas that I had to consider, and do an educational review on, are:

  • Temperature sensitivity – There was risk of frostbite to these athletes due to the cold exposure at the Winter Games.  This was due to varying levels of sensory impairment.
  • Bladder management – Some athletes used intermittent catheters for bladder management. The sensation or urge to urinate is lost in some SCI athletes and, therefore, the “pressure” of the bladder in spasm cues the athlete to use an intermittent catheter. This occurred on the treatment table and the athlete was given privacy and support.
  • Spinal instrumentation – Many of the athletes had rods of varying types and lengths implanted into their spines for postural support. Knowing the location and being aware of soft tissue compensatory mechanisms was indicated.
  • Motor and/or sensory patterns – It was important to find where the person could “feel” and be mindful of the areas where sensation was limited or gone.
  • Pressure wounds – Awareness of the type of sports and mobility equipment the athletes used, and locations where pressure or ulcer wounds could occur due to rubbing or limited circulation, was necessary.
  • Lung capacity – The respiratory system can be compromised with a SCI. The spinal segment(s) involved in the SCI will determine the severity of the respiratory impairment. The risk of respiratory infection is increased in these people. The therapist should make sure that the athlete is capable of lying prone without incurring respiratory distress prior to asking him/her to do so.
  • Overuse/repetitive strain
  • Chronic pain
  • Autonomic dysreflexia – This may result from an injury at the level of T6 and up. A massive surge, by the sympathetic nervous system, takes place and can cause dangerously high blood pressure and put the athlete at risk of a cardiovascular concern. Research has been done with athletes who voluntarily induce autonomic dysreflexia. The sympathetic surge is thought to enhance performance and this is called “boosting.” The International Paralympic Committee offers a great article on its website called, “Boosting in Athletes with High Level Spinal Cord Injury: Incidence, Knowledge and Attitudes of Athletes in Paralympic Sport.”

MY PERSONAL PARALYMPIC JOURNEY
During the Paralympics, some of us had the opportunity to stay in the athletes village since there were vacancies because of the lower number of Paralympic athletes versus Olympic athletes. This was a nice alternative to the weeks of taking buses and going through tedious security that I had experienced previously (i.e., during the Olympic Games).

After each shift, I would reflect on my life and all that I had just learned. I would think about those days when I didn’t want to get out of bed. I would think about those days when everything just seemed to go wrong. I would think about those times that I turned over on my ankle, bumped my head or suffered from a cold. Did I complain or get frustrated, feel angry or sad!

Then I would imagine myself without a leg, without my arms or with a spinal cord injury that has suddenly left me wheelchair bound. How would I cope? How would my life change? How would I change? Then I would wonder if I had the inner strength and courage to rise above challenges and adversity. Would I be able to compete on the world stage as an elite athlete and have the frame of mind and spirit of these people who have touched my life?

This article is really to thank all those people who showed me that in life, “anything is possible.”

I urge any therapist who reads this and is looking into becoming involved in this sort of venture, to please look to websites such as the Canadian Paralympic Committee (www.paralympic.ca) for education and links to associations in your area.


Renee Sheldon is an RMT who has worked with athletes at various competitive levels. She has written for a number of publications, and is a recent graduate of the Connecticut School of Integrative Manual Therapy. Renee practises in Pickering, Ont.


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