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Orthopedics in Olympic sports “Elite athletes are highly compliant patients”

Issue 02/2020

Orthopedist with a sporting past: Dr. med. Maren Pachutani works at Bonn Community Hospital , Germany, – cooperation partner of Rhineland Olympic Training Center – and she helps with the annual basic examination of the team athletes. The former modern pentathlete examines and advises competitive athletes if they have any problems or to ensure injury prevention so they stay healthy during training and competitions.

Dr. med. Maren Pachutani during the squad examination, with pole vaulter Torben Blech.

life: What are your responsibilities when you take care of the squad in terms of sports orthopedics?

Dr. Pachutani: We ask the athletes about their medical history, current and older injuries, problems caused by excessive strain and surgery they may have had. Which medical products do they use and what does their return-to-sports strategy look like? We get a lot of information from the joints’ range of motion, muscle balance and by checking the function of the myofascial system. Based on our knowledge of specific movements during the particular sport , we can detect silent excessive strain to provide advice on prevention. It’s beneficial that we have come to know these elite athletes really well over the years, thanks to our continuous support , and that they’re highly compliant patients. They really want to avoid missing out on training because of injury. In addition to the annual examination, there are weekly office hours for acute problems. My specialism is myofascial syndromes, so I can treat some of the athletes myself and encourage them to do their own exercises.

How do you use supports and orthoses for treatment?

Dr. Pachutani: From the comprehensive range that Bauerfeind provides us with as a service partner of Stiftung Deutsche Sporthilfe, I recommend the Loc orthoses for short-term immobilization for acute injuries or following surgery. This mainly applies to the ankle, knee and hand. Following ankle sprains, I use Train supports for treatment , depending on the diagnosis, either straight away after mild sprains or following immobilization. With feelings of instability or for sports with a high recurrence rate, I like to use the stabilizing support of the MalleoTrain Plus. I also regularly use the AchilloTrain for achillodynia as a supporting measure to go with active movement exercises. And for younger athletes with problems in the area at the front of the knee, the GenuPoint patellar tendon support provides effective relief.

Do these measures also apply to your favorite sport , modern pentathlon?

Dr. Pachutani: Those who have been doing pentathlon for many years are less prone to injury and excessive strain than many other athletes. They have well-balanced muscles and excellent stamina from the running and swimming. Fencing helps pentathletes with quick reactions, and shooting with concentration. During training and competitions, they deliver their performance in all disciplines all in the same day, in any weather. That’s how resistance and immune defense are constantly strengthened. As a physician for the German Association of Modern Pentathlon, I’ve been helping at national and international competitions for more than 12 years. Luckily, no athlete has got into a serious medical situation during that time.

Modern pentathlon

In one competition, this multi-faceted sport includes swimming, fencing, show jumping, and a laser run, which is a cross-country run that has been combined with shooting since 2009. Modern Pentathlon first took place in the 1912 Olympics in Stockholm, initially only for men. Since the 2000 Olympics in Sydney, women have also participated.

But injuries do happen, don’t they?

Dr. Pachutani: The highest risk, especially in a competition, is show jumping on an unknown horse that is randomly picked. The entire range of injuries associated with high-speed sports is possible there. Fortunately, serious injuries are rare. But broken bones in the extremities or the shoulder girdle do happen. During cross-country running and fencing, there’s always a risk of sprains. After it happened to me several times as a youngster, I was told I wouldn’t be able to continue competitive sports. One of my predecessors, the physician for the association then, treated me with an ankle orthosis, similar to today’s Loc system, and gave me stabilization exercises to do. I wore the orthosis consistently, so the injuries healed and my stability returned. Nowadays, part of regular training for the ankle always includes preventive stabilization and proprioception exercises. Athletes prone to supination injuries wear, temporarily or for the long term, activating and gently bracing supports, such as the MalleoTrain or MalleoTrain Plus.

How do athletes respond to these products?

Dr. Pachutani: Very positively. Athletes prefer practical and quick solutions. Free, comprehensive treatment is ensured, thanks to the long-standing cooperation between Rhineland Olympic Training Center and Bauerfeind. When we as the cooperating orthopedists determine a medical need, athletes can be quickly treated with supports, orthoses, compression stockings and foot orthoses, all without red tape. This is coordinated by the Olympic Training Center’s HEIMSPIELE agency and Bauerfeind’s head office, supported by a local medical supply retail partner. Some athletes can’t even imagine training without medical products once they’ve received them. Elite athletes have an outstanding body awareness. The proprioceptive stimulation signals them – this is probably different for each individual and depends on the sport as well – that they can feel stable and that they’re fully ready to perform.

And what is that like with modern pentathlon?

Dr. Pachutani: Modern pentathlon has changed over time and is always being updated a little – but it’s not becoming less challenging. We have all sorts of people among our athletes. This means that a highly personal approach is needed from us, the physicians. We do have modern imaging techniques now, as opposed to years ago, but they’re not very helpful when a functional problem can’t be visualized. Or if the problem isn’t where it hurts. In such cases, the most effective sports medicine requires what has always been available to us physicians: our trained senses. It’s also important to be brave enough to ask a colleague for a second opinion.

A sports orthopedic network

In July and August 2021, athletes from all over the world will compete against each other in various disciplines at the Summer Olympic Games in Tokyo. Until then, every day is all about training and qualification for the competitive athletes. That includes sports orthopedics support at Olympic Training Centers (OTC). Squad athletes are treated quickly and with expert advice, and supported to ensure injury prevention.  Bauerfeind has been the official service partner of Deutsche Sporthilfe since 2013 and helps around 4,000 athletes who are supported by the foundation. The manufacturer of medical aids organizes the supply of products, which also includes adapting products to individuals. For this, Bauerfeind involves over 1,200 quality partners from the medical retail industry. Bauerfeind also supplies a team of its own orthotists to take care of the athletes. They look after individual athletes as well as entire teams, before and during big sporting events: Olympics here we come!

How has the sporting side of pentathlon developed?

Dr. Pachutani: In my day, a competition took place over four days. Shooting was a discipline for the individual , the running competition took place over 2,000 meters with everyone starting together. All of that was very unattractive for spectators. The change to a one-day event , the laser run and splitting the fencing into a preliminary round and final , helped to establish a transparent , very high-profile version of the sport. In my opinion, modern pentathlon is still one of the most remarkable sports that produces great athletes in the Olympic spirit.


Images: OSP NRW/Rheinland/Peter Eilers, picture alliance/dpa/Rainer Jensen/Nic Bothma/Eibner-Pressefoto (2)/Sven Simon, UIPM


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