Polodoc: In or Out

Dr.med. Andreas Krüger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013

In or Out

Stabilty & mobility of the shoulder

A shoulder brace can support the joint post-injury

Photography courtesy of Polodoc

A free range of motion in the shoulder is key for a strong and correct swing during polo, just a small limitation of range of motion or instability can decrease the performance. Hypermobility in the joint or weakness in the rotator cuff can also open the door to injuries. The flawless interaction between the motor cortex in the brain (where the action is created) and the muscle contraction in the extremity (where action happens) after an injury or surgery is key. Until now, many shoulder rehabilitation protocols missed focused work on this important area. With new training and rehabilitation technologies, neuroplasticity can build up new neural networks. The brain changes through growth and reorganisation of individual neuron pathways, thus making new connections, and systematic adjustments like cortical remapping which leads to faster recovery and higher performance.

Injury Pattern

Dislocation of the shoulder is an injury in which the upper arm bone pops out of the cup-shaped socket that is part of the shoulder blade. This happens when the swing is suddenly stopped or when a player falls on the shoulder or arm. The most common is the anterior (front) dislocation. The shoulder is the body’s most mobile joint, which makes it susceptible to dislocation. A dislocated shoulder needs prompt medical attention. Players with a hypermobile joint may encounter little popping symptoms due to subluxation without full dislocation. Missed hits, hitting in the ground or fouls are the major causes for injuries and can lead to impaired shoulder function with instability.

Morphologic injuries of the musculoskeletal system through these actions are well studied and understood. The complex interaction of neuronal networks and perfect function of sophisticated steering programs remains a large field of research. One of the biggest challenges is achieving swift and full stability and free range of motion, so that precise and powerful hits after injury are possible whilst playing the game without mental restrictions.

Symptoms and Diagnosis

The shoulder joint is the most frequently dislocated joint of the body. Dislocated shoulder signs and symptoms may include a visibly deformed or out-of-place shoulder with swelling or bruising. The shoulder can dislocate forward, backward or downward, completely or partially, though most dislocations occur through the front of the shoulder. Mostly intense acute pain and inability to move the joint is present. Shoulder dislocation may also cause numbness, weakness or tingling near the injury, such as in the neck or down your arm. The muscles in the shoulder may spasm from the disruption, often increasing the intensity of your pain.

With clinical examination on the field, a locked arm and the deformed shoulder are important symptoms of a shoulder dislocation. Further assessment is performed with standard X-ray in the hospital. Examination of the nerve injuries, especially of the axillary nerve, is mandatory.

Secondary MRI/CT of the shoulder is required for precise diagnosis and later management of the injury.

Treatment

Currently, most of the first dislocations are reduced under soft skilful traction and medical sedation in a hospital setting. A conservative treatment is mostly the gold standard for first dislocations. Early physiotherapy is key to regain motion and strength in safe and stable parameters. Most important is to prevent a second dislocation, which is opening the door for chronic instability and early degeneration of the shoulder joint. New techniques and gadgets can improve the eye-hand coordination and reaction time with exercising. Here key movement pattern can be trained in a safe environment with full surveillance of the correct training moves through sensors on all extremities.

Before a return to play on the field regaining a perfect bilateral function should be analysed and aimed for.

For more information on Polodoc contact Andreas Krüger at drmedkrueger@gmail.com or www.polodoc.ch

Expert Opinion

Stephan Niedecken, Anna Martin–Niedecken & Dave Baucamp, Founders of Sphery.ch

The Zurich-based FitTech startup Sphery Ltd specialises in game-based, personalised and multimedia training concepts and technologies, which are combined with innovative and unique hardware and software designs. ExerCube is the core product of our firm – an immersive and adaptive fitness game setting where rewards can be activated and friends around the world can be challenged. Sensor on the arms and legs as well as a heart rate band are needed on the player. With the app the training successes can be tracked.

Stephan Niedecken

Advantages for users:

The functional body & brain training, which can be individually adjusted in real time, offers scientifically proven training and therapy advantages compared to traditional dual-task or single-task training and is suitable for players with all fitness level with or without impairments suitable. The appropriate exercises can be put together individually depending on the target like high intensive workout as well as regeneration and recovery. The burpees can also only be used at a later point in time and serves, among other things, to improve the supporting force of the shoulder. By calibrating the patient at the start of the game, the range of motion, for example, the height of the goals to be achieved and the resistance of the exercises (shadow boxing, light touch or strong blows into the padded walls) is also determined. The continuous processing of visual and auditory stimuli and a corresponding reaction through the appropriate exercise, ensures an unconscious increase in hand-eye coordination and promotes massively the neural networking. Through the functional exercises based on their own body weight, the patient not only improves mobility and strength of the shoulder, but also strengthens the rest of the body and reduces the risk of imbalances or poor posture developments.