Fishing for a Happy Ending

You had to feel for Boyd Rankin, the towering English fast bowler, as he trudged off the SCG yesterday clutching his left hamstring. He had broken down not once but twice on his debut. The look of anguish on his face was so palpable it even evinced sympathy from this one-eyed Aussie fan. You don’t like to see a young man’s dreams dashed before your eyes. And at 204cm tall there was no place to hide for Rankin.

The shame of it was that it could have been preventable, according to those who know. The instant diagnosis was a torn or strained hamstring, a sensible conclusion based on conventional wisdom. But that appears not to be the case. Here’s how Cricinfo’s George Dobell summed up the “mystery” of Rankin’s condition.

“After a scan showed no injury, the England camp claimed Rankin had simply been suffering from cramp and should be fit to resume bowling duties in the second innings.

Such a scenario would raise questions about Rankin’s physical condition going into the game. While the weather in Sydney was warm – it reached 27 degrees at one stage in the afternoon – it was some way below the extremes experienced in Perth or in Alice Springs.

It is possible that nerves could have played a part. The 29-year-old Rankin has endured a long journey to the Test environment and knows, coming into a struggling team at the end of a series, that he may not enjoy many opportunities to prove his worth at this level.

It is also possible that tension played a part, or that the pain has some psychosomatic origin. He has been known to experience similar problems with his left foot after suffering from a stress fracture in it several years ago.

The schedule may also be relevant. While Rankin has bowled almost every day in the nets, he has not played a match since the end of November, when he delivered 14.5 overs during the game in Alice Springs. It may be that he came into this game simply lacking match fitness.

While Rankin was monitored by the England medical team ahead of play after reporting general stiffness, there was no specific concern about his hamstring and he was subsequently cleared to play.

In other words, the England medical staff have no effin’ clue! My mate Geoff Fisher of Southport Physiotherapy in Melbourne reckons the “general stiffness” is the best clue.

He diagnoses and cures people every day who pitch up with mystery conditions. I went to him 10 years ago with what a chiropractor had called “a degenerative knee condition.” Every time I ran for more than five minutes, I would get a searing pain behind my left knee. The chiro had said this was wear and tear, a symptom of ageing. If I wanted to run I would need to sign up for a long term plan of therapy. This fortnightly regime consisted of the chiro rubbing the back of knee for an hour hard enough to start a campfire before cracking my back in a dramatic finale. I always walked out feeling two inches taller and pain-free but always the knee would flare up again.

I was referred to Geoff by triathlete coach Oscar Carlson who swore that he would fix what ailed me. I was prepared for another long term regime, but one that might get me back on the track. It was sad to think that after an active 40 years I would have to make a compromise with the ravages of time.

He asked me straight up: “Was there a moment when you recall actually hurting your knee? Some kind of trauma?”

“No,” I replied. “It just kind of crept up on me.”

With that, he began to work gently, but insistently, on my lower back. I kept waiting for him to get to my knee but he never got close. I came back for two more treatments and the same routine was repeated. To this day the pain in my knee has never returned. Geoff explained that I had been suffering referred pain in my knee from a protective response in my lower back. I have had various aches and pains since in toes, ankles and hips, all of which have been relieved by Geoff’s continuous mobilisation method. I have referred countless people to Geoff who have all reported good results.

Geoff and I had a talk about Michael Clarke’s well-publicised back and the words ran in The Australian last March. It summarises the issue of referred pain.

“AT the end of a disastrous tour of India, Australia’s skipper Michael Clarke literally carries the burden of the nation’s expectations on his dodgy back.

While this weekend’s fourth Test in Delhi is the first match Clarke has missed through injury, the timing is ominous with back-to-back Ashes series looming.

Clarke’s “degenerative” back condition, a “bulging disc” first diagnosed when he was 17, has become an ever-present concern for the 31-year-old.

Leading Melbourne physiotherapist Geoff Fisher believes Cricket Australia must re-examine its protocols about managing injuries if Australia’s most valuable asset is to pay his way.

Fisher questions whether the team doctor should be in charge of diagnosing and overseeing treatment regimes for conditions like Clarke’s. “In sporting teams, doctors have become the front line of diagnosis for such pain but they are hopelessly out of their depth in dealing with musculoskeletal problems,” says Fisher.

“If the Australian team’s frontline response is medical then it will almost certainly fail.”

Fisher claims there is an over-reliance by sports doctors on CT scans and X-rays to diagnose pain. Scans often reveal abnormalities in the structure of a joint or limb, like Clarke’s bulging disc, he says.

“The doctor will say, ‘we see there is change in the structure of the joint. There’s evidence of wear and tear or abnormality. We can’t explain why it’s happening but we know it is happening because of the pain’.”

Studies have shown that up to 40 per cent of people have abnormalities in their spines that don’t automatically cause pain. Clarke’s pain, often described as his back “locking up”, may have nothing to do with discs or vertebrae. It may in fact be a protective response from the muscles of his back, not an injury at all.

It’s a problem that blights the lives of millions of people who spend too much time chair-bound or sitting in motor vehicles with knees elevated higher than hips. This places excessive strain on the postural muscles that keep the spine stable. Spinal muscles will attempt to control movement by an increase in tightness and tone.

“By reducing the range of movement, threats to the spine, are reduced. These responses are hard-wired and self-increasing, built into the neurology of the brain and spinal anatomy.”

The giveaway clue is that Clarke often suffers tightness in his hamstrings, Fisher says.

If Clarke’s problem is related to his spinal muscles, it is a treatable condition, using safe non-invasive manual therapies, says Fisher.

Working with triathletes, Fisher uses a variation of an Australian-devised therapy known as “continuous mobilisation” which might provide an alternative for Clarke.

Fisher’s method of manual therapy is designed to “turn off” the protective behaviour in the spine and the referred pain is often immediately relieved.

Fisher says that 95 per cent of his patients with chronic pain in their head, legs, knees, arms, feet or hands, are in fact suffering from “referred pain”. If, like Clarke, they haven’t suffered a trauma or arthritis, the source of the problem is invariably found in the lower back or neck where muscles have engaged in a protective response to guard the spine.”

The response from other chiros and physios was outrage. Some went on Twitter to call for Geoff’s deregistration and worse. He was “dangerous”, one said. Of course, Geoff is dangerous, he threatens the livelihood of these quacks who want to sign us up to long term treatment plans costing thousands of dollars. He wants to cure people not turn them into patients by convincing them their problems are due to advancing age.

I emailed Geoff last night about Rankin’s predicament and his response was succinct.

“No mystery there, just another sportsman with a slightly dodgy back that had given rise to various bouts of referred symptoms. Simple to resolve, if you knew how.”

As much as I want Australia to whitewash the Poms 5-0, I’d like to see Rankin back on the field. I suspect that Geoff could get him back out there.

Moreover, Geoff’s message is don’t accept that your aches and pains are a consequence of being a little older, that you’re wearing out. It’s mostly bullshit.

No I’m not on a commission for referring people to Geoff. It’s such a pleasure to see people’s faces when they become pain-free.

Drop him an email on fishergn@hotmail.com.   

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