Rehabilitation for olympians

For athletes, an injury can make or break a career. But help is at hand. The Olympic Medical Institute in London aims to get injured athletes back on track, as Siddartha Dutta explains

One extra day in a year may not mean much to most of us, but to Olympic athletes a single day can mean the difference between competing for a gold medal and nursing an injury on the sidelines. It may be serendipitous that leap years coincide with the Olympic Games to give athletes more time to train, but the Olympic Medical Institute (OMI) does not like to leave things to luck. The OMI is the focal point of medical care for Britain's Olympians and is hoping that its unique set up and attention to detail will mean that luck will not be needed to bring home the medals.

Based out of Northwick Park Hospital in London, the institute is a "one stop shop" for athletes to repair as well as prepare themselves for the upcoming Olympics and other sporting tournaments. The seven bedded facility not only offers many medical services, including diagnostic testing, injury management, and fitness training, but also such things as nutritional guidance and psychological counselling. It is this holistic meticulous attitude which makes the institute the only one of its kind in the United Kingdom.

Caryl Becker, rehabilitation manager and physiotherapist at the centres however, does not believe that the OMI is a world apart from most places. "It's not unique, it's not something that nobody else knows about. It's the fact that it is done as a team. We don't do anything different here than anywhere else. The physio is the same and everything is the same as you would get anywhere else. The difference is the environment in which it takes place. A place where the athletes are being looked after rather than going out and looking after themselves."

Residential rehab

A residential facility was added to the OMI last year, 18 years after the original centre for athletes at the same site was established. "The residential rehab side is new to us. So now we can concentrate on bringing athletes in and really giving them quite intensive rehab support to try and fast track their recovery," says Nick Fellows, general manager of the OMI.

Though residential rehabilitation is a useful facility to have to work athletes through a period of intense exercising in the latter stages of rehabilitation it may not be so earlier on according to Michael Cullen, consultant in sports medicine at Musgrave Park Hospital. He says that early in rehabilitation, the intensity of a residential programme may be too much of an exertion and may end up overloading damaged tissue.

No cutting corners

Cullen says, "Successful rehabilitation depends on accurate assessment or diagnosis of the injury and the formulation of a structured management plan which takes account of the underlying physiological processes involved. The aim is to return the athlete to function or competition in the shortest, safest time--cutting corners will inevitably end in a recurrence of the injury on return to sport."

At the OMI, assessment is done when patients first come in. Initial fitness tests are done using exercise bikes to monitor heart rates. The initial fitness results are then used to monitor fitness progression through out the athlete's stay. These tests involve doctors, physiotherapists, and physiologists. The latter are also given the responsibility of performance monitoring, which involves measuring heart rate and lactate levels.

To help athletes through the rehabilitation process without recurrences, the OMI uses state of the art technology. The Biodex isokinetic dynamometer is used to measure imbalances between muscle groups and relative strengths. "It helps to identify weaknesses that need attention. For example, you could find out if the differences between the quads and the hamstrings are optimal or different between left and right," says Caryl Becker.

Don't forget the psychological

But rehabilitation is more than just a physical recovery from injury. Philip Bell, a doctor from the British Association of Sports and Exercise Medicine, says that rehabilitation is the restoration of normal function and by definition is multidisciplinary: "Rehab must address the physical and psychological aspects of injury.".

The obvious psychological needs of sports people facing setbacks through injury are not ignored by the OMI. The in-house sports psychologist assesses all patients coming in for residential rehabilitation with an initial counselling session. But it is perhaps the support and understanding that they get from the staff that is most helpful.

A good role model

Richard Budgett, director of medical services at the OMI is an eminent sports and exercise medicine specialist in the country as well as being an Olympic gold medallist rower. Having faced the agony of injury just three months before his trip to the 1984 Los Angeles games, Richard Budgett recalls the kind of thing that worries athletes in the run up to a tournament. "A large part of my problem was the terror at having all these sacrifices blown away by one minor back injury and the doctor I saw was absolutely confident. He said get out there, do these exercises for a week and you'll be better, and I was. There's a big psychological element to doctors giving people confidence to get through their injury."

Having a successful Olympic athlete, who has gone through the same setbacks on the medical staff means that patients only need to look down the corridor for motivation. Of course, motivation is seldom a problem with athletes. It is in this respect that rehabilitating an athlete is markedly different to rehabilitating a stroke or trauma patient. "With so much depending on them the athletes are often too motivated," says Richard Budgett. "It's a real challenge because you have to give them quite a detailed programme or they'll cheat and do more, try things out, think, 'Can I do more?'"

Six little things

This eagerness to do things can often lead to athletes feeling that they are underachieving. The formula used at the OMI is one of small goals to be achieved regularly. "We need to know that somebody can go out and compete in a 100 metre sprint or whatever, but for us the goals we set them are tiny little goals on a day to day basis. Little goals give a much more positive outlook than seeing somebody three times a week and feeling maybe like you're not achieving anything," says Caryl Becker.

The extent to which rehabilitation should restore function is different in athletes compared to trauma or stroke patients. "The differences are where do you want them to get back to. With athletes, time is of the essence, and you're continually pushing your boundaries where you don't want to make them worse but you're trying to get them better in the shortest time possible so you're trying to see how much you can get away with without going backwards. Whereas you take a more conservative approach with your average patient," she says.

Free to Olympians

The centre, funded by the British Olympic Association and the English Institute of Sport, does not charge Olympic "passport holders" but other elite athletes have to pay for the services. These services are not restricted to residential rehabilitation but the staff also serve on an outpatient basis allowing patients to access a variety of services by attending at just one location. The rehabilitation gym and facilities mean that outpatients are often encouraged to spend time working on fitness in between consultations and while waiting for results. It seems that there is no time to spare when medals are at stake.

Indeed there is no time to spare even when athletes take advantage of the residential rehabilitation facilities. Coming in for about a week at a time, the residents are thrown right in at the deep end. Assessments, physiotherapy sessions, and fitness training, and that is just an average first day. This is no health spa for élite athletes despite the image that the massage therapy rooms and the hydrotherapy pool might conjure.

In fact the hydrotherapy pool is one of the more recent additions to the facilities and it plays an important role in getting athletes back on track. "The hydrotherapy pool is used in two ways--one is as a fitness tool. If they [athletes] are unable to run for weight bearing reasons they can do aqua jogging in the pool and still maintain a certain level of fitness. Alternatively it can be used for rehab. For instance if someone's got an ankle injury and isn't able to fully hop we can get them hopping in the water before getting them hopping in the gym," Caryl Becker says.

Looking to the future

Hopping aquarian athletes and rehabilitation may be the focus of the centre's attention but the OMI is also looking to the future with its research interests. The research is backed up with a team of physiologists and extensive facilities including a physiology lab where atmospheric conditions can be simulated to give athletes an idea of what they will be facing. High altitude hypoxic simulations stimulate haemoglobin production and the centre has cut down the time needed for athletes to adjust to such conditions from five days to just two.

Current research projects include hot weather acclimatisation, fatigue and unexplained performance (the athletic equivalent of chronic fatigue syndrome), and asthma. In fact, asthma has more than just the athletes in a huff in light of the International Olympic Committee's ever increasing regulations about using drugs. Steroid inhalers are allowed for asthmatics with a medical note yet ß 2 agonists can only be prescribed if athletes have proved their asthmatic status with spirometry. "It's not really helping to catch the cheats so most of the team doctors find it really irritating," says Richard Budgett.

The ultimate aim of the centre is to help the country's athletes to win more medals, something that Nick Fellows believes the OMI is certainly capable of doing. Though the OMI does not profess to be better than anyone else, its unique set up will at least give British Olympic hopefuls the best possible chance to come out on top.