Page 23 - Bauerfeind life international_02_2012

Basic HTML Version

magazine 2012/2
For further information
about Dr. Nat Padhiar and the BMI London Independent Hospital:
and effective treatment. As an expert in the
field based at his private clinic which he has
named after his mentor and friend, The John
King Centre for Leg Pain at BMI London Inde-
pendent Hospital, he estimates that the use
of the term shin splints is resulting in half of
EILP cases being misdiagnosed.
Science and practice
Evidence-based practice: audit and research
are an important and integral part of his
practice. As a Reader in CSEM, Dr. Padhiar
has supervised well over 200 research
projects, published numerous papers, co-
authored a chapter in a book and has a foot
condition named after him, Crisp-Padhiar
Syndrome. One of his current research
projects is a prospective study looking at
the effectiveness of Prolotherapy in Medial
Tibial Stress Syndrome in combination with
Bauerfeind VenoTrain compression stockings,
where he explains ‘Prof Hargen’s study has
shown that compression improves micro-
circulation and thus aids healing’.
Breaking the vicious cycle
Changing the subject to foot and ankle
injuries in sport and the sort of conditions
he is likely to encounter at the forthcoming
London 2012 Olympic & Paralympic Games,
he explains firstly the biomechanics of
the foot and how it affects the lower limb
kinetic chain. “The foot is the interface
between the ground and the body. ‘Normal’
relationships between body segments are
a pre-requisite for ‘normal’ function. Any
significant deviation in position, structure
or function may lead to abnormal compensa-
tion. This is change in position, structure of
a part as a consequence of abnormality. This
usually leads to mistiming of joint motion
in the gait cycle, misalignment of joint, al-
tered angle of muscle function and reduced
capacity to withstand forces acting on that
part. He gives an example, “An overpronated
foot, for example, could be one of the causes
of patella-femoral knee pain.”
His approach to management appears to
be quite simple, “Make a diagnosis (good
history), define the severity of the problem
(imaging and investigations), reduce the
pathology and pain (oral medication, injec-
tions & surgery), strengthen and stabilize
(foot orthoses, braces & physiotherapy),
reduce the pre-disposing factors for long
term benefit & prevention (core stability
etc.) and rehabilitation back to sport”.
Dynamic, just like life itself
The fact that, for Dr. Padhiar, the foot or the
lower extremity also forms the interface be-
tween science and practice is demonstrated
by him as he examines Kerrie-Ann Craddock,
the rugby player from London Saracens RFC
who suffers from chronic exertional com-
partment syndrome of the lower leg. Using a
16g cannula, Dr. Padhiar inserts a Rorabeck
catheter linked to a pressure transducer
into the affected compartments to measure
the intra-compartment pressure both at
rest and during exercise. He stresses the
importance of collecting dynamic data with
pressure tracing which allows for objective
and meaningful evaluation of the results. He
is very critical of the static systems widely
used in Sports Medicine. Dr. Padhiar is again
very proud of his Dynamic Intra-compart-
ment Pressure testing system in The John
King Centre which he partly developed him-
self with the help of a bright physicist, Tahir
Mahmood. “It works just like life itself – and
like Bauerfeind with its active orthoses,” he
says with a smile: “dynamically.”
Kerrie-Ann Craddock (right) suffers from chronic compartment syndrome in her lower leg.
Using a cannula, Dr. Padhiar inserts a sensor into the tissue to measure the local pressure.