2010 Paulatim Magazine - RAAMC Association

inversion and knee strains. A quick recovery is needed to enable the
member to resume his role in the best possible physical condition.
Adapted treatment regimes are often applied, extending the normal
treatment into the field for the situation they are going into.
An example of this is a Costovertebral joint strain, where the member
continues the correction OTW by using a rolled up towel, cat stretches or
a tennis ball under the joint. Lumbar facet joint dysfunction is another
example that was often seen because of the weight carried OTW. This
dysfunction was usually successfully treated quickly with a localised
Lumbar manipulation, with a follow up program.
The mind set of SOTG members is also of consideration in their
rehabilitation. They are highly motivated and focused individuals which
can be used to a physiotherapistís advantage in their rehabilitation by
facilitating and accelerating their recovery. Due to their high fitness
level, recovery can be fast tracked but this can be off set by the
physical demands placed on the body when performing their assigned
tasks OTW. Having such a close invested hands on application to their
injury; the physiotherapist is in the best position to offer careful
guidance to the patient (and to their superior) in what they can and
canít do OTW in terms of their injury, as not to aggravate or to put at
risk their recovery rate.
The weight from body armour, ammunition, weapon, helmet and back
pack whilst on extended patrols or riding inside a Bush Master (BM)
vehicle, was found to contribute to spinal joint dysfunctions.
Manipulation to these joints, muscular dry needling, specific mobilising
stretches and strengthening programs facilitate a quick and effective
recovery. Occasionally taping was also used to maintain correction and
to de-load the injury site. One example of a potentially serious
condition experienced by a SOTG member was constant bilateral pins
and needles extending down the arms from C7 and 8 nerve roots. This
problem had the potential to return the member to Australia for long
term treatment, thereby depleting the unit of a valuable operator and
effectively reducing the effectiveness of his section as their was no
replacement and also adding a monetary cost for the ADF. This member
was able to remain in country with his section whilst undergoing
mobilisation treatment (grade III unilateral PAís) to his lower neck
region, together with neural glides, and was able operate normally OTW
with some careful guidance in regards to specific exercises and postural
advice. He made a full recovery prior to the end of his rotation.
Lower leg muscular-skeletal injuries pose a serious challenge for the
physiotherapist because of the need for the member to be able to jump,
run, squat and land from various heights (e.g. inserting from a
helicopter, jumping down from a B M vehicle or running over rough
ground whilst under fire). The physiotherapist carefully balances the
restoration of movement, with strength and stability and the reduction
of pain. One particular example was an ankle inversion sprain in which
the SOTG member was rehabilitated from an inability to weight bear
due to pain, weakness and swelling through, not only to full function
Grade III unilateral mobilisation to C7/T1 to restore segmental mobility
for the nerve root to exit.
but to a function that demanded the ankle to perform beyond normal
expected requirements. Again, he was able to stay with his unit and be
a valuable participant in their operations while undergoing his
rehabilitation.
Another aspect of this deployment was the concept of Hearts and Minds.
I provided a physiotherapy service once a week to US FST Camp Ripley,
treating local Afghan civilians who had been injured either through
accident or conflict. This contributed to their overall perception that we
were the preferred help rather than the Taliban. There were many
orthopaedic conditions, the majority being fractures as a result of gun
shot wounds. One example was an elderly Afghan man who had been
shot in the thigh, fracturing his Femur. Not only was there a need to
keep his upper and lower limbs functional but also a requirement for a
walking frame, which I fashioned out of two unserviceable metal chairs
for him to mobilise with. This allowed him to return home using the
walking frame and freed up a valuable bed space which was much
needed in the FST. Treating many of these hypo-mobile ankles and
knees following removal of the external fixation and rehabilitating
them back to functional walking again, harked back to those earlier
days of physiotherapists in WW1.
The experience of front line physiotherapy taught me the need to draw
upon all my years as a physiotherapist to deal with complex clinical
issues that were posed in a unique but demanding environment, and to
often think laterally to overcome clinical problems or deficiencies.
PAULATIM
PA U L AT I M – M A GAZINE O F T HE R OYA L A U S T R A L I A N A R M Y M E DICAL C O R P S – 2 0 1 0 9 1