Consultant Q&A with Sports Physician Dr Cath Spencer-Smith

We put questions from 4 of our BOOST PHYSIO patients to Sports Physician Dr Cath Spencer-Smith.  Dr Spencer-Smith specialises in Sports and Exercise medicine and she has treated a range of sports people from Olympias and Paraolympians to the occasional exerciser.  You can view her website here.She sees patients privately at the Wellington Hospital and other locations.

Dr Cath Spencer-Smith. Sports Medicine Physician.

BOOST PHYSIO Patient: I’m an Israeli dancer (women aged 35) and have been dancing for 15 years. I have gotten Achilles tendonitis 3 times over the past 6 years. Should I stop dancing?

Dr Cath Spencer-Smith:  Achilles problems needn’t mean you have to give up the activity you love. Whilst dance can be challenging on tendons, there are often underlying biomechanical factors, which can be corrected. There are many treatments which can be successful in returning people to robust activity. Excessive tightness in the calf complex can increase unnecessary load on the Achilles, as can poor conditioning in the gluteal muscles, and the soleus in the calf. If these tire easily, the shock absorbing capacity in the leg reduces, the knee tends to sag inwards on landing, creating torsion and strain in the Achilles. Good physiotherapy and podiatry can be really helpful here. Eccentric exercises and correction of stiffness in the ankle joint can be effective in helping you to recondition the tendons, and shockwave treatment can help if you are continuing to suffer, so don’t give up, get help.

BOOST PHYSIO Patient:  I’m a 65 year old man and I enjoy doing yoga and tennis but I have developed lateral epicondylitis (tennis elbow). Its been 6 months of rest and physio with no help. What now?

Dr Cath Spencer-Smith: Tennis elbow can be distressing problem. It’s essentially a breakdown of the common tendinous attachment in the forearm which you use to cock the wrist back with. You don’t have to play tennis to get it! The forearm can become overloaded for a number of reasons. We often see that the ability of the shoulder to successfully control and decelerate a swinging arm and racket is poor. This means that the forearm has to take up all the shock. Some players have racquet with too large a handle or two small a grip for their palm. This means they have to maintain a suboptimal, constant tight grip, which pulls on the attachment of the forearm muscles. Sometimes technique is at fault. For instance, a tendency to have a floppy wrist with backhand or failing to step through with the body when returning serve are common errors. It’s also important to consider what you do in the rest of your day-to-day life. Several hours of computer mouse usage a day, or weekend of DIY, be enough to bring the problem on. Most cases of tennis elbow can be improved with eccentric exercises, the use of tennis elbow clasp to reduce the tug at the affected site, and shock wave therapy can be very useful in resolving difficult cases.

BOOST PHYSIO Patient: I’m a fit and healthy 20 year old guy and play football three times a week. I have noticed I get pain in my inner thigh when I start to play or run the past few weeks. What could this be?

Dr Cath Spencer-Smith: The causes of inner thigh pain can vary and its helpful to understand whether the pain is high up and almost into the groin, all lowdown nearer towards the knee. Footballers often have problems with controlling forces across the pelvis, especially if their gluteal muscles are weak. This can lead to overload of the adductor muscles, and  the hamstrings (where they insert at the knee). Where the adductor muscles and other muscles attached on to the bony pelvis, shearing forces can set up a pattern of pain due to a condition called osteitis pubis. This slightly old-fashioned term describes overload, or ‘see-sawing’ which occurs when unbalanced forces act on the pelvis and its muscular restraints. If you place a fist between your bent knees and squeeze, should be painless, but if you have overloaded the adductors, or have osteitis pubis, this will be painful. It’s really important that you don’t make the mistake of trying to play on with this pain. Get a proper assessment of proper treatment.

BOOST PHYSIO Patient: I’m a 32 year old guy and play semi professional water polo. I got hit hard by a ball with my hand outstretched behind my head and now have shoulder pain. I was assessed by my Physio who said I had a hypermobile shoulder joint. Is this a good or bad thing?

Dr Cath Spencer-Smith: Water polo Paces high demands on shoulders, and if the shoulder’s hypermobile, it can make it difficult to control the upper limb and the forces that act across that shoulder joint. In addition to the shoulder being lax, which can place undue stress on the rotator cuff tendons and the restraining soft tissues, I would also be concerned that there is a risk that you might have acquired what is called a ‘SLAP’ tear. A SLAP tear is a tear of the ring of gristle, (aka labrum) which surrounds the shallow shoulder socket. Sometimes the mechanism of your injury can also overly stretch the capsule, which surrounds the shoulder. If either the labrum or the capsule is not functioning properly (because it is torn or stretched) the shoulder can risk further injury or dislocation. These injuries need special imaging to pick them up and sometimes in very persistent cases a key-hole operation is needed to put it right. If you are struggling to make sufficient progress despite the excellent stability work you do with your physio, you may need to be referred to a specialist such as a sports doctor, who can carry out the tests needed to confirm the diagnosis and organise the appropriate treatment.

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