What kind of rehabilitation protection is required for ice and snow sports injuries
Wen | Reporter Ling Xin of Caijing
Editor| Wang Xiao
The Chinese short track speed skating team won the first gold medal of the Chinese delegation at the 2022 Beijing Winter Olympics in the mixed relay race, and outside the track, The retired short track speed skating Olympic "four champions" Wang Meng also rushed to the hot search for "immersive commentary" in a live broadcast on a platform.
She was the head coach of the short track speed skating national team, took almost all the athletes of the gold winning team such as Wu Dajing and Ren Ziwei, and accurately judged the Chinese team to win the first gold before the referee announced the final result, and the golden sentence "You don't have to look at the replay anymore, my eyes are the ruler" is all over the net.
Hundreds of millions of people watched Wang Meng explain that the injuries she occasionally mentioned in the live broadcast made many Chinese "difficult to reconcile". She is the person who won the most medals in the history of the Chinese Winter Olympics, and in 2014, almost everyone expected her to set a new record at the Sochi Winter Olympics in Russia, but only 21 days before the opening of the event, she suffered the most serious injury of her career and never stood on the international stage again.
What is the key to returning to the field after injury for top athletes like Wang Meng? What happened to Wang Meng's injury? Is it just a well-known fracture?
"At the end of the pistes is orthopedics". With the rise of the "ski fever" of the Beijing Winter Olympics, the Sports Medicine Department of Shanghai Sixth People's Hospital has operated on dozens of patients with ski injuries, and the incidence of muscle and ligament injuries without surgery is higher.
Sun Yang, a special rehabilitation expert of the Beijing Winter Olympics of the Chinese Steel Frame Snow Team, told Caijing that the maximum speed of most of the tracks may exceed 120 kilometers per hour in steel frame snowmobile competitions, so it is also known as "ice F1". Athletes may suddenly experience pressure due to centrifugal force in curves during gliding, and serious injuries include concussions, cervical spunlash or fractures, joint injuries, etc.
Ice and snow lovers must not only find the right coach, but also seek medical treatment in time when they have an injury. Behind more and more ski resorts, a medical industry segment is waiting to rise.
Broken bones can be joined, but cartilage damage cannot be regenerated
"The most serious damage was not the bones and ligaments, and nearly a third of the articular cartilage in Wang's ankle was contured. With this injury, most people may cause ankle dysfunction, which is lameness. Ma Xin, secretary general of the foot and ankle surgery group of the Orthopedic Branch of the Chinese Medical Association and vice president of Huashan Hospital affiliated to Fudan University, told Caijing.
Ma Xin was the chief surgeon who treated Wang Meng. On January 16, 2014, Wang Meng collided with a male teammate while training in Shanghai, and was rushed to the hospital with a severe fracture of his right foot, and underwent surgery at Huashan Hospital that night, but was unable to participate in the Sochi Winter Olympics 22 days later. At that time, she was the first athlete in the history of the Winter Olympics to win the women's 500m short track speed skating championships, and she was also the person who won the most gold medals in China at the Winter Olympics, a record that remains to this day.
"Just two days before I was injured, I finished the Olympic Test Match, and South Korea sent some people to visit, and after watching it, they themselves said that we only competed for relay this time, and we couldn't do it alone, and we slid too fast." Wang Meng recalled when attending a public program.
Dr. Ma Xin, who personally received the consultation, knew that at that time, Wang Meng's ankle joint was broken, and the medial ligament, lateral ligament, and middle ligament were also broken. He lamented that she could return to today's normal walking, "really strong."
Although the inner ankle is the most severe crushing fracture, this is only the least affecting Wang. "The bones can be put together very beautifully, and after they are picked up and grown, they can be restored to the same as the original, and the function is not affected." The impact of ligament breakage is relatively large, and its tightness and strength after repair are not the same as before. The most serious is the cartilage damage, which cannot be regenerated. Ma Xin said.
On the night wang was injured, Ma Xin and colleagues at Huashan Hospital performed emergency surgery, removing many pieces of bones from the joints and using steel plates and screws to put the bones and ligaments together. The problem is in the cartilage, "the moment of injury, the cartilage of the tibia and the talus, all of a third of it is frustrated." This position is the weight-bearing surface, and without cartilage, there is bone to bone."
The body's native transparent cartilage grows on the surface of the bone, which can relieve the vibration and friction generated by the joints during activity, allowing people to move smoothly and painlessly. This cartilage, once contused, is not renewable and is also a key to leading sequelae. Ma Xin and his team drilled holes in its bare bone surface, allowing the bone marrow to grow and transform into fibrocartilage. "It's not as lubricating as transparent cartilage, but it works."
Photo: Ma Xin, vice president of Huashan Hospital affiliated to Fudan University, diagnosing patients Photo/ Chen Xi
More than a year after the operation, Wang Meng recovered well from his fractures and returned to Shanghai to undergo surgery to remove the steel plates and screws. Surgical exploration of the joint found that the fibrochondrite had covered the original bare bone surface, the joint was well moved, and there was no secondary degenerative damage.
Ma Xin said, "Her daily life is not affected now, and she can even do strenuous exercise, I think she has a very good physique, very strong, and rehabilitation means have also played a vital role." Although she lost a lot of cartilage, her exercise of peripheral ligaments and muscles helped the injured area to disperse a lot of pressure. ”
China's surgical level is in line with international standards, why do athletes still have to go abroad for rehabilitation?
In the relevant programs of this Winter Olympic Games, Wang Meng not only burst into flames because of the frequent explosions of golden sentences during the commentary, but even re-stood on the ice rink to skate. In this regard, Ma Xin was a little surprised, "When I first saw so much cartilage peeling off, I was worried that her ankle joint would be destroyed and she would become crippled in the future." ”
Ordinary people have been seriously injured like this, even if they recover, the ankle joint should be "spared", at least they can no longer participate in strenuous exercise, "bones grind bones, it is very painful." Ma Xin believes that Wang Meng can recover, first, her willpower is relatively strong, and her physical fitness is also quite good. The credit for rehabilitation is not small.
"Our doctors often say that after the operation, it is only 51% complete, and the remaining 49% really depends on the rehabilitation team." Ma Xin said.
Caijing has interviewed a number of sports medicine professionals and rehabilitationists who believe that although China's sports medicine started and promoted late, the use of new technologies is almost synchronized with developed countries such as Europe and the United States, including cartilage transplantation, autologous or allogeneic ligament repair technology, and minimally invasive surgery through preoperative accurate evaluation. Even, in some well-known large hospitals, the amount of surgery in the exercise system is even larger than that of foreign hospitals, and the technology is more skilled.
"Many athletes, including those with high sports requirements, who have surgery in China, will still choose to go abroad for rehabilitation." This is a pity. Ma Xin said.
Photo/Physician and rehabilitator guide patient training together Source/Respondent Provided
Rehabilitation therapists are scarce in China, with only 36,100 therapists in 2018, according to the China Health Statistical Yearbook. Very few of them focus on orthopedic rehabilitation.
There is a Chinese saying that breaks the bones for a hundred days. In fact, in the eyes of doctors, if you blindly recuperate after surgery without engaging in rehabilitation training, or if the rehabilitation is not scientific, it is very likely to leave sequelae.
Ma Xin has seen many patients who have been cast for several months after joint surgery, but when they are removed, they find that the joints are stiff and their mobility is obviously worse. This is also the reason why many patients with chronic joint injuries are very taboo surgery. In case there is a cartilage contusion like Wang Mao's, the postoperative inactivity, the bare bones will spontaneously fuse, like a brick wall, dead together, then it may really be limp.
The purpose of rehabilitation training is to make the injured area grow in accordance with the normal trajectory of the joint, so that its active function can be restored as soon as possible, not just look good. This training is related to the operation, the patient's fitness, and recovery progress. For example, doctors feel that the bones are fixed very firmly during surgery, and the patient enters rehabilitation earlier, and even weight training is no problem.
"If the bones are broken badly, I will tell the rehabilitation doctor that the amplitude of this patient's movement should be small and slow," said Ma Xin's Huashan Medical Rehabilitation Department, which works closely with the surgeon.
"Rehabilitation is very personal." Ma Xin pointed out that it is difficult to set a unified model for the rehabilitation of a certain injury, it is best to give one-on-one guidance by the rehabilitation teacher, some patients feel that it is not very painful after surgery, desperately moving, may be the original spelled bone and joint loosened again, or even displaced, which will also affect the recovery.
Qualified rehabilitation therapists often gather in the Third Hospital of Beijing Medical College, Huashan Hospital, Shanghai Sixth Hospital and other super "top three" famous for orthopedics. In such a hospital, medical resources are in short supply, and if the rehabilitation division is given to one patient for too long, the basic needs of other patients cannot be met.
Solve the problem of rehabilitation payment
Despite the lack, the rehabilitation department did not catch fire. Rehabilitation programs in public hospitals cost very little, and too many such projects are carried out, and hospitals have to lose money.
A rehabilitationist at a hospital in Shanghai gave an example to Caijing that according to the requirements of the Medical Insurance and Price Bureau, the joint loosening operation may take 15 minutes to do very laboriously, but the fee is only 60 yuan, "not as much as the little girl in the shampoo room to earn more." ”
For patients, although Medicare controls the cost per trip well, it does not include long-term payments. After surgery such as orthopedics, Medicare can pay for rehabilitation for the first three months. For such a serious injury as Wang Meng, which requires long-term follow-up, the current rehabilitation costs cannot be fully included in the medical insurance reimbursement.
Top athletes like Wang Meng have a complete rehabilitation personnel and program. Because they have high requirements for exercise, they basically have to carry out about an hour of one-on-one rehabilitation training every morning and afternoon.
The average patient has a hard time getting one-on-one training three times a week. According to Caijing, after general orthopedic surgery, it is initially a weekly follow-up, if it recovers well, it will be changed to three weeks, and then six weeks, three months or even half a year will be followed up again.
Ordinary people will suffer no fewer or less injuries than athletes. A sample survey of the Tohoku Ski Resort showed that 60% of the injured were beginners.
Xu Caiqi, a doctor at the Sixth Hospital of Shanghai, analyzed Caijing that unlike common land sports such as jogging, ice and snow sports require both cardiopulmonary support, muscle explosiveness and joint stability and flexibility are very important.
Someone had 72 "snow friends" around him during a ski season who had broken bones. "Skiing has a lot of emergency stops, changes of direction, the rotation requirements of the knee joint are very high, and the pressure on the joints is even greater than when playing basketball. People with less specialized power patterns are prone to muscle strains or joint injuries. Xu Caiqi said.
Moving at high speeds on snow and ice may also result in injuries due to collisions. For example, during the taxi process, the steel frame snowmobiler may suffer sudden pressure due to centrifugal force in the curve, poor control during the sliding process and other reasons such as impact injuries and contusions, serious injuries including concussions, cervical spine whiplash injuries or fractures, joint injuries and so on.
Photo/ Sun Yang, a special rehabilitation expert at the Beijing Winter Olympics, guides athletes to recover by hand Source/Provided by the interviewee
In the Nordic region where skiing is prevalent, there was a statistic that 35% of the injuries caused by skiing were concentrated in the knees, 20% were located in and around the ankle joint, and the shoulders and elbows were also high-incidence areas. These are joint areas that are especially in need of rehabilitation to help recover.
For patients with such joint injuries, Xu Caiqi used to ask a therapist engaged in sports rehabilitation to sit together, "Most sports injuries do not require surgery, and can be slowly recovered through rehabilitation treatment." When patients come, I give them an assessment, and the therapist can do rehabilitation and guidance for them directly in the clinic."
Some private medical institutions specializing in sports rehabilitation also operate in this way. The general doctor's visit time is five to six minutes, and the rehabilitator will spend half an hour to evaluate the patient in detail, and then give close guidance. However, such a "combination clinic" generally lasts about an hour, about 1,000 yuan at a time, and it is also hundreds of yuan larger to simply receive rehabilitation physiotherapy. The recovery time is long, and even professional sports clubs can sometimes be a little tangled.
More than half of the client base of the earlier private rehabilitation institutions have related consumer medical insurance. "Our customers are mainly some foreign executives, or people who have stayed abroad who know more about rehabilitation." Ji Jingjing, director of operation of the compound musculoskeletal clinic, introduced to Caijing.
Most commercial medical insurance can cover part of the cost of rehabilitation treatment, which is an important reason why rehabilitation medicine can be popularized in Europe, the United States and Australia. In the United States, some union organizations even force employees to undergo physical therapy to avoid high compensation due to the development of labor injuries and the resulting post-surgery. Before engaging in a certain sport, such as the arrival of the new ski season, find your own rehabilitator to evaluate it, and then exercise after exercising for weak parts, which is also the habit of some foreign "snow friends".
In China, not many people know about sports rehabilitation, and payment is a bigger bottleneck. At present, most of the commercial insurance schemes that can cover the cost of rehabilitation treatment are from multinational insurance companies. Domestic insurance companies are also developing such insurance types, mostly patients pay first, and then reimbursed by insurance companies.
For private medical institutions, such payment methods can bring limited customers, and they prefer to cooperate with insurance companies to enter their direct payment list. "This can become a recommended institution for insurance companies, and customers will also be preferred." Yu Qianfei, product director of The Remobilization And Bone Clinic, hopes that with the help of this channel, the subdivision of rehabilitation treatment will be known to more people.
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