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Strain-Related Conditions in Competitive Athletes Unequal leg length triggers a chain reaction

Issue 01/2017

Dr. Raùl Carrillo from Mexico has been part of the medical delegation for the Ukrainian national team at no less than nine Olympic Games (Summer and Winter Olympics) and provided medical assistance during multiple world championships in different disciplines. The chiropractor is known for his expertise in injuries affecting the neuromusculoskeletal system.

Bauerfeind life: Which parts of athlete’s body are the most at risk?
Dr. Carrillo: According to statistics from the International Olympic Committee (IOC), the most common symptoms can be found in the back. Powerful biomechanical forces primarily affect the lumbar spine – then comes the cervical spine, then the upper back, followed by the knees, ankles and shoulders.

What kind of injuries and biomechanical alterations can be observed?
Dr. Carrillo: It’s well known that excessive strain can trigger a cascade effect. For example, an athlete with legs of different lengths must realize that the function of all joints belonging to the movement axis will be impaired: ankles, knees, hips and spinal joints. The bordering osteocartilaginous structures are also affected, and obviously the associated muscles and tendons.

What can be the consequences of such a cascade effect?
Dr. Carrillo: I remember an extreme case of a competitive Taekwondo world champion, whose right leg was one centimeter shorter than the other. With this athlete, one could speak of a chain reaction. She had compensatory scoliosis due to the short limb. This sideways curve of the spine, in turn, caused severe, persistent pain in her middle and lower back. In addition, she suffered two meniscal tears in her right knee that were surgically treated due to the overloading and altered gait. And this painful situation was completed by a hip injury with recurrent bursitis and chronic muscle problems in the TFL and ischiotibial muscles. We identified all of these symptoms retrospectively, after we examined the athlete thoroughly.
The first domino to fall was the difference in leg length. Thus we had to start from point one in order to try to achieve a more stable, functioning structure.

Team players in the treatment plan designed by Dr. Carrillo: GenuTrain S …
Team players in the treatment plan designed by Dr. Carrillo: ManuTrain, GenuTrain S, and AchilloTrain …

How important are orthopedic aids such as supports and orthoses in your work?
Dr. Carrillo: Orthopedic aids play a decisive role especially in combination with physical therapy or chiropractic care. For me, they are of great value in helping to reduce mechanical overload placed on highly stressed joints, ligaments, tendons and muscles. They help injured athletes return to their sport faster.
They also contribute to the prevention of further damage. And they can also help protect and stabilize places in the body which are especially vulnerable, such as the knee after cruciate ligament repair, during all postoperative stages.

Can you name some concrete examples?
Dr. Carrillo: After collateral ligament or meniscus injuries, I like to use the GenuTrain S. The GenuTrain P3 works wonderfully with patients who suffer from a patellar disfunction such as “mistracking”, where it can stop or prevent cartilage injuries.
In order to protect the hand from excess strain after carpal tunnel surgery while allowing it to move freely during everyday activities, I use the ManuTrain active support or the ManuLoc Rhizo if there is any involvement of the 1st metacarpal like with De Quervain’s syndrome. When it comes to the ankle, the AchilloTrain helps me during postoperative or non-surgical care for ruptured Achilles’ tendons or with tendinosis.

Team players in the treatment plan designed by Dr. Carrillo: OmoTrain, ManuTrain, GenuTrain S, and AchilloTrain.
… and also OmoTrain.

What experiences have you and your patients had with these products?
Dr. Carrillo: Basically, I must say that Bauerfeind products provide excellent stability due to their neuromuscular effect. When I use supports for knees, elbows and ankles, my patients tell me that they are much more comfortable – and most importantly, involve no friction – when compared to the neoprene supports they had been using.
And medical products made of neoprene can sometimes even cause abrasions. One of Bauerfeind’s achievements is their outstanding materials and the anatomic design of their products, as well as their long durability.

Are there sports disciplines which can especially benefit from a certain support?
Dr. Carrillo: Archers and fencers can really benefit from the OmoTrain shoulder support. These athletes must often train for hours with their arms fully extended. The strain on the rotator cuffs is enormous, and muscle tears are not uncommon.
In addition, there are bursitis and severe tendinosis. Here, the active support can make training a lot easier by reducing the stress on the tendons and muscles in the shoulder area at the rotator cuff.

How often are supports and orthoses prescribed in Mexico?
Dr. Carrillo: No more and no less than in other countries where the population has become aware of the advantages of a healthy lifestyle, meaning that the general population are becoming more active in recreational sports or just getting involved in a self-regulated fitness program.
In Mexico, required medical aids are usually provided by the public healthcare system. Meanwhile many private patients obtain these products themselves, or they are provided by their insurance.

Can stress symptoms in sports be prevented?
Dr. Carrillo: As a member of the Ukrainian Olympic Team for the last nine Games, Summer and Winter Olympics, as well as the Mexican Taekwondo Team since 2006, I’ve gained considerable experience with these issues relating to the neuromusculoskeletal system. My answer is: It makes sense to perform preventive structural and biomechanical evaluations at an early stage, especially with kids starting with serious long hour training programs for different sports or physical activities like ballet , dancing, etc.
This includes for example ergonomic adjustments made to training and competitive equipment or techniques.
It is very important to promote the interaction between patients, coaches, physical therapists, orthopedic specialists, radiologists and chiropractors – in the athletes’ best interest regarding health and performance. The most important thing in my experience is developing a great sense of TEAMWORK.

Dr. Raùl Carrillo

Dr. Raùl Carrillo betreute die ukrainischen Olympioniken in Rio de Janeiro und nutzte dort auch den orthopädietechnischen Service von Bauerfeind.

The Director and founder of Rebioger/Integra Clinics is also a member of the medical staff at the Swiss Hospital and the Angeles Hospital in Monterrey, Mexico. He is a Northwestern College of Chiropractic graduate with postgraduate studies at the Centro Internacional de Restauración Neurológica (CIREN), in Havana, Cuba. The specialist has been holding presentations worldwide on sports-related injuries of the neuromusculoskeletal system.

Images: Bauerfeind