US Olympic Team Doc: Challenges and Advice for Athletes

Carol Peckham; Gloria M. Beim, MD

Disclosures

February 03, 2014

In This Article

New Treatments and Diagnostics

Medscape: Are there other new treatment or diagnostic modalities that you've learned about during your travels?

Dr. Beim: Yes. One good example is instrument-assisted soft tissue mobilization (IASTM), which is used for patients with chronic muscle scar tissue from an injury, tendonitis, or plantar fasciitis. IASTM employs stainless-steel tools to free up all the adhesions, and it takes only about 5 minutes. The patient might need 2 or 3 treatments. Physical therapists and chiropractors can use it as well.

When I first learned about that technique, I came back to my practice and signed up not only myself but also 3 of my physical therapists for a course at the Olympic Training Center in Colorado Springs.

I learned it because sometimes when I travel with teams, I don't have a therapist or a trainer or anybody else with me; I may be it -- the doc, the psychologist, the trainer, the massage therapist, everything. So I like to have as many arrows in my quiver as I can to treat these people, and I love this technique.

During the Summer Olympics, a pole vaulter had an adhesion above the kneecap and was really limited by it. Three days before the competition, the athlete was in a lot of pain. I used this little technique and the athlete won a gold medal. Another recent instance: My husband is a ski racer, and just last week he had a quad injury. I did this technique on him and he won a silver medal in his giant slalom race. It is amazing.

Medscape: This is a totally noninvasive procedure?

Dr. Beim: Completely noninvasive. As a surgeon, here is what's so cool about it: Say I have a patient with a muscle or fascial restriction from a scar that wasn't responsive to therapy. What would I do ordinarily? For instance, I might see some hardware in there (for instance, a plate and screws from prior surgery) and the scar is in that area. I may take my scissors and pickups and free up the scar. With IASTM, I do the same thing -- release the adhesions and the scar -- but I don't make any incisions. It is remarkable. I don't work for this company and didn't even tell you the name of the company, so I can't get in trouble. But it is remarkable.

Medscape: Are there any other new treatments that you've learned about in your travels and think are useful?

Dr. Beim: Yes. Ultrasound-guided microtenotomy is amazing. You look at the tendon on ultrasound and the partial or chronic tearing and scarring. Then you make a tiny incision with a #11-blade scalpel and put this tiny probe, under ultrasound guidance, into this scar. The probe sends ultrasonic waves, which cuts it up, injects fluid, and sucks the tissue out all at the same time under live ultrasound imaging.

It takes about 60-70 seconds, all under local anesthesia. You don't even need a stitch because the incision is so small. The main indications for it now are patellar tendonitis, Achilles tendonitis, plantar fasciitis, tennis elbow, and golfer's elbow.

I have a great example of its use from the last Summer Olympics. A track and field athlete had had chronic patellar tendonitis for a year. Therapy had failed and he still had some muscle imbalances and hip weakness. I told him, "You know what? You need to do some hip strengthening." He came out to my clinic for a few weeks to work with my therapist and was maybe 60% better within about a year of therapy and conservative measures. At that point, he had an area of scarring embedded in his tendon that you could see on ultrasound and MRI. Because conservative measures were failing, this was an indication to surgically open up the tendon and clean out the scar -- open scar debridement of the tendon.

Fortunately I had learned about ultrasound-guided microtenotomy before this and had trained in it, so I performed it on this young man. He is currently, I think, 14 weeks out, and for the first time in 2 years he is absolutely pain-free and is doing great in his training. It is just miraculous.

Medscape: Is ultrasound-guided microtenotomy widely available now?

Dr. Beim: It was FDA-approved about a year and a half ago, and any surgeon can be trained to do it. However, you have to be a good ultrasonographer, which is, I think, the limiting step, because many orthopedists don't do ultrasound themselves. They might have their physician assistant or radiologist do it, but you really need to do it yourself to correctly perform this procedure. Once you are proficient at ultrasound, this procedure is quite simple. You just go in and take out the bad tissue and that's it. It just makes sense to use this approach rather than making a big incision and violating normal tissue to get to the diseased tissue.

This is another technique that I picked up through my travels and have taken into my practice. So, bottom line, being associated with these international Games has changed my practice for the better. It has been amazing.

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