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Issue 2012 | 2 magazine international Air Born Stuntwoman’s Promising Career Saved by MalleoTrain S Innovative treatment of hip pain Hip orthosis SofTec Coxa as part of post-operative treatment plan Page 24 “Appreciation for an underestimated specialist field” Stabilization, movement and healing Ratschow Memorial Medal for Prof. Waldemar L. Olszewski An interview about winter sport injuries Page 31 Page 32 INSOLES ErgoPad® Ê ONE FITS ALL. Foot orthoses with the X factor. Flexible synthetic foot orthoses with variable support. The Oweightflex-XP in the core of the synthetic foot orthosis offers variable support according to individual foot conditions, therapeutic goals and body weight. Motion is Life: www.bauerfeind.com EDITORIAL Dear readers, Our “Made in Germany” products are highly rated all over the world, as demonstrated by the success of our 22 or more subsidiaries and numerous distributors across the globe. There is one subsidiary I would particularly like to mention to highlight the outstanding work of our international team: Bauerfeind Benelux, which celebrated its 25th anniversary this year (p. 21). With warm regards, Prof. Hans B. Bauerfeind Pictures: Bauerfeind When it comes to sport , the summer of 2012 Although the vast majority of osteoarthritis had everything! First there was the European patients are elderly, it is also astonishing to Football Championship, then the Olympic find just how many young people are affected Games and finally the Paralympic Games. by it. In our focus feature (from page 12), two Bauerfeind was on hand at these two major physicians – one from Germany and one from events in London to provide support as an Brazil – discuss various aspects of the broad exclusive supplier of medical care, in the topic of osteoarthritis. “Supports and orthoses” category, to all the athletes involved. Our products were used on For this issue of Bauerfeind life, we have also more than 1,100 occasions at the Olympic and once again talked to health professionals Paralympic Games – which I think is an imand therapists from all over the world about pressive statistic! We medical and theratake a brief look back peutic problems and “With our supports, orthoses, at the involvement of the use of Bauerfeind our orthopedic service medical compression stockings products: from the team at the Games on and orthopedic orthoses, we aim use of the multifuncpage 18f. to boost patients’ well-being and tional orthosis SofTec Coxa for stabilizing enhance their quality of life!” Having the right hip joints in the USA medical aid is right through to important for enabling lymphedema treatathletes to keep up their sporting activities, ment in Australia. as the young lady in our cover picture Our products may be used in a wide variety certainly discovered. From page 28 you can of areas of application and in all sorts of read about how stuntwoman Tally Rodin has a places, but we always have one objective in Bauerfeind support to thank for being able to mind: to maintain and restore health. With continue her career. our supports, orthoses, medical compression stockings and orthopedic orthoses, we aim to The medical focus of this Bauerfeind life boost patients’ well-being and enhance their magazine is on the indication of osteoarthri- quality of life! tis – a widespread condition, but one that is by no means associated only with old age. life magazine 2012/2 3 CONTENTS Focus IMPRINT: Bauerfeind life Magazine International Edition Osteoarthritis: a widespread condition Biomechanical , biochemical and genetic factors all play a role in primary (age-related) osteoarthritis. Until now, less attention has been paid to microtraumas in the development of secondary osteoarthritis, especially in the knee and ankle. Printed on chlorine-free paper Editor: Bauerfeind AG Triebeser Strasse 16 07937 Zeulenroda-Triebes, Germany Tel. +49(0)36628-66-1000 [email protected] www.bauerfeind.com Responsible: Simone Gebler, Christian Grimm Publisher and editorial office: mk publishing GmbH Döllgaststrasse 7–9 86199 Augsburg, Germany Tel. +49(0)821-34457-0 [email protected] www.mkpublishing.de 4 life magazine 2012/2 page 12 Title image Tally Rodin – model , acrobatic ic n. dancer, gymnast , stuntwoman. She had a micro tear in the tibialis posterior tendon of d her right ankle. A Bauerfeind brace helped to save her career. Pictures: Lee Cherry (Title), Werbefotografie Weiss, Stefan Durstewitz, Nick Greenway, headshot-soho.co.uk, fotolia.com/Mary Durden Osteoarthritis: Deadly mictrotrauma – page 12 CONTENTS “We have a face” – page 26 Innovative treatment of hip pain – page 24 The foot as an interface – page 22 Diving: Another world– page 36 Moments page 6 A successful “Tour of Europe” Focus 26 AVE Orthopedische Klinieken, Huizen “We have a face” page 12 12 Osteoarthritis Deadly microtrauma 16 Higienópolis Health Center, São Paulo Looking good on the beach – and staying healthier too Medical page 18 18 London 2012 Making a strong impression 3 Editorial 4 Imprint 8 News 24 SofTec Coxa Innovative treatment of hip pain 20 PD Dr. med. Bernd Wolfarth Health comes first 21 25 years of Bauerfeind Benelux On the way to gold 28 Stuntwoman Tally Rodin Air Born 31 Recognition for Prof. Waldemar L. Olszewski “Appreciation for an underestimated specialist field” 32 Winter sport injuries Stabilization, movement and healing 34 Lymphedema treatment in Australia “Treatment from an early stage is essential” In Motion page 36 36 The outdoor life – diving Another world 22 Science and practice The foot as an interface 39 Service life magazine 2012/2 5 MOMENTS A successful “Tour of Europe” Picture: Jens Blatter Spendentour Mission accomplished! On August 1, the participants of the 2012 Jens Blatter fundraising marathon reached their final destination on the Allalinhorn mountain, 4,027 meters above sea level. The 60 cyclists and their support teams had traveled almost 5,000 kilometers across the continent to get there, passing through Switzerland, Germany, the Netherlands, Belgium, France and Italy in just 17 days on their “Tour of Europe”. During the tour, the participants also stopped by the Bio-Seehotel Zeulenroda – a company in the Bauerfeind Group. Together with Bauerfeind AG, the hotel donated EUR 1,000 to the charity campaign. By the end of August , the total donations raised amounted to 150,000 Swiss francs. The money raised by the fundraising tour will go toward the Eduplex children’s aid project in Pretoria, which works to integrate children with hearing impairments into everyday school life. † For further information please visit: www.jensblatter.ch. 6 life magazine 2012/2 MOMENTS life magazine 2012/2 7 NEWS “Motion Laboratory” in Moscow First Bauerfeind store opened in Russia Ulf Harzmann, International Sales Manager Bauerfeind AG, together with Sergey Shaitov, CEO of Nikamed, and Member of the Executive Board Thomas Bauerfeind (left to right) cut the ribbon to mark the opening of the store. “Dobry vecher” was the Russian greeting used by Thomas Bauerfeind, Member of the Bauerfeind Executive Board, as he welcomed the 40 or more guests invited to the grand opening of the new Bauerfeind store in Moscow. The company’s first retail outlet in Russia was officially opened on April 12, 2012, under the name “Motion Laboratory”, and with a distinctive store format that is regarded as an innovative feature in the Russian retail industry. With the opening of the Moscow store, Bauerfeind is extending its sales network in Eastern Europe. The “Motion Laboratory” is located right on the popular “Prospekt Mira” shopping street and offers customers in Russia’s capital city a new kind of retail concept. Athletes and patients can come to the store, which covers 120 square meters, to receive advice on how medical aids from Bauerfeind can be used in the prevention, treatment and rehabilitation of injuries.There is huge demand in Russia for high-quality medical products, which is why Bauerfeind, as a leading manufacturer of medical aids, started working with Nikamed back in January 2011. Nikamed, which acts as an exclusive sales partner, is the leading company in the Russian orthopedics market and, just like Bauerfeind, it sets great store by the outstanding quality of the products it offers. Russian customers demand exceptional quality too – especially since, with no reimbursement system in Russia, they have to pay for the full costs of their medical aids themselves. Bauerfeind AG is already planning to set up more stores in Russia: additional outlets with exclusive sales partners are due to open in † Moscow and St. Petersburg in 2013. London 2012 London 2012 proved to be a successful premiere: for the first time in history, the Olympic and Paralympic Games were planned and supervised by a single organizing committee. Both events met with a positive response all over the world. Bauerfeind AG from Zeulenroda, Germany, was in London for the Games as an exclusive supplier in the “Braces” category (supports and orthoses). Products provided by the Thuringian medical aid manufacturer were used on more than 700 occasions throughout the Olympics (see page 18). Bauerfeind’s supplier contract with the London 2012 organizing committee (LOCOG) also applied to the Paralympic Games, where Bauerfeind provided on-site medical support for the 4,400 or so Paralympic athletes from 164 countries taking part. From August 29 to September 9, a team of six Bauerfeind employees from Fascinating the world: the London Olympic Summer Games 2012. the United Kingdom and Germany worked in shifts at the polyclinic in the Bauerfeind provided supports at the Olympics and, for the first main Olympic Village in Stratford. Bauerfeind supports for elbows and wrists, time, at the Paralympic Games with its own team of orthotists. as well as supports for the back and knees, were in particularly high demand. The Bauerfeind team was called upon to provide aid almost 350 times during † the Paralympics. For more information, see www.bauerfeind.com. 8 life magazine 2012/2 Pictures: Bauerfeind, Carlos Senkyr A resounding international success NEWS VIII Meeting of the FVL Intensive scientific exchange From September 5 to 7, 2012, more than 300 participants from Latin America, the USA and Europe gathered at the VIII Meeting of the Latin American Venous Forum (FVL) in Viña del Mar, Chile. “Our aim for this congress is to provide a training opportunity for specialists and to encourage the exchange of knowledge regarding the treatment of venous and lymphatic diseases. This will provide specialists with effective ‘working tools’ that they can use for the benefit of their patients,” explained vascular surgeon Dr. Alvaro Orrego, President of the VIII FVL Meeting. Bauerfeind, one of the three diamond sponsors of the event , had its own exhibition stand, where it not only presented its range of compression stockings, but also carried out live measurements using Bodytronic 300 (Image 3D) with the help of its local partner Artevascular. For further † information please visit www.fvl.cl. Bauerfeind was present at the VIII FVL Meeting with its own exhibition stand. GenuTrain P3 with individually adjustable corrective strap GenuTrain P3 The GenuTrain P3 knee support has been revised and is now available with an individually adjustable corrective strap. Together with the two integral pads, the corrective strap holds the kneecap in a central position and protects it against lateral drifting to the outside. The new strap enables you to better adjust the support to your kneecap’s individual size. Its corrective tensile force can thus be matched to the indication in question and the loading situation. This provides optimal relief for the kneecap and guides it securely during movement. † 25th Austrian Women’s Run A win for the Bauerfeind team A new record was set in Vienna on June 3, 2012: exactly 30,052 participants from 66 countries lined up at the start of the 25th Austrian Women’s Run, preparing to run laps around the Prater park in Vienna. The Women’s Run therefore continues to attract more participants than any other race of its kind in Europe. Bauerfeind Austria was represented by various teams at the event , with physicians, physiotherapists and employees of Members of the Bauerfeind team. our various sales partners among those involved. A total of 35 runners and walkers entered the race – all equipped with VenoTrain sports compression stockings. And the Bauerfeind sportswomen proved pretty fast , finishing first in the 5 km run and third over the 10 km distance, ensuring that two of the company’s teams claimed a place on the podium. For more information on the international race, visit www. oesterreichischer-frauenlauf.at. † life magazine 2012/2 9 NEWS VenoTrain micro New standard color “honey” The standard color range for the VenoTrain micro is being brightened up in response to customer demand. The gray-brown “walnut” is being replaced by the golden “honey” tone, which falls between the two beige shades “cream” and “caramel” in the color spectrum. The popular compression stocking range therefore offers an equal selection of light and dark shades. All versions of the VenoTrain micro have been available in † “honey” since July. Bauerfeind’s most popular compression stocking is the VenoTrain micro. cream honey caramel Now available as an individual stocking VenoTrain soft If a medical prescription allows for one compression stocking only, for example in the case of thrombosis prophylaxis following surgery on one leg, medical retailers can now offer patients individual VenoTrain soft compression stockings. The VenoTrain soft individual stocking is available in the color “natural” and in compression classes 1 and 2, and it can be supplied in all standard sizes as a knee- or thigh-high stocking with closed or open toes. This comfortable compression stocking impresses with its reliable medical effectiveness and the beneficial micromassage effect it produces while it is worn. With its “natural”-colored, dye-free finish, it is also ideal for patients with sensitive skin types and is particu† larly recommended for post-operative use. The VenoTrain soft individual stocking is available in Ccl 1 and 2. Medica 2012 MEDICA will once again be welcoming visitors to Düsseldorf from November 14 to 17, 2012. The event is expected to attract some 4,500 exhibitors from at least 60 countries. Bauerfeind will naturally be among those making an appearance at the world’s largest and leading medical trade fair, once again with its own exhibition stand. At Stand 4K50 in Hall 4, the company will focus on presenting its latest new developments and advancements, such as the high-grade ErgoPad weightflex synthetic orthosis, the new generation of the GenuTrain P3, an active knee support for improving patellar tracking, the CaligaLoc ankle support , or the design edition of the VenoTrain micro. Further † information about the trade fair is available at www.medica.de. The MEDICA: a magnet for visitors. 10 life magazine 2012/2 Pictures: Bauerfeind, Messe Düsseldorf/Constanze Tillmann Bauerfeind at the world’s largest medical trade fair NEWS Triathlon de Paris Expo-Village near the Eiffel Tower The Bauerfeind exhibition stand was near the Eiffel Tower. The stand team advised participants and visitors with great dedication. The “Garmin Triathlon de Paris” took place in the French capital on July 7 and 8, 2012. Over 4,500 athletes competed against one another in the swimming, cycling and running disciplines. First of all , the triathletes took part in a qualifying competition for the French “D1” club championships on July 7. As the “Garmin Triathlon de Paris” is designed as a public event rather than as a contest exclusively for elite athletes, even amateur triathletes had the chance to join in the 1,500-meter swim, 40-kilometer cycle ride and 10-kilometer run on July 8. Bauerfeind was also present at this great event , setting up its own exhibition stand by the Eiffel Tower. The Bauerfeind team was supported by its partner “A.C.O.M.M santé”, which supplies Bauerfeind products in the Paris region. Many interested competitors and spectators took advantage of the opportunity to seek advice from the team at the stand about products such as the GenuTrain knee support , the LordoLoc stabilizing orthosis for the † lumbar spine or the VenoTrain sport compression stockings. ErgoPad weightflex The X factor Bauerfeind has developed a new injection molding system for manufacturing synthetic foot orthoses by combining two types of plastic in a single orthotic core. With three different degrees of firmness, the asymmetric “weightflex-X” in the core supports the wearer with a variable supporting force depending on the individual condition of the foot , therapeutic goals and body weight. Thanks to their flexibility in the forefoot and heel areas, the foot orthoses can easily be worn in shoes with higher heels. ErgoPad weightflex, the new orthopedic foot orthosis from Bauerfeind, is based on the spiral-dynamic principle of natural movement. The “weightflex-X” integrated into the orthotic core directs forces from the outside inward via two pivot points, thus supporting the torsional ability of the feet and optimizing the wearer’s gait pattern. Side pieces facing each other act as countersupports. Moderate longitudinal and transversal arch supports raise and stabilize the feet and † reduce non-physiological loads. The foot orthosis can easily be adapted to fit any heel gradient. life magazine 2012/2 11 FOCUS Osteoarthritis Deadly microtrauma The role played in the development of secondary osteoarthritis by very small trauma-related defects of the articular cartilage is often underestimated. This is the view of Professor Dieter Kohn, Director of the orthopedic clinic and polyclinic at the Saarland University Hospital. Basically, a constant series of microinjuries can develop into full-blown osteoarthritis. Fast action is required with regard to treatment. >>> 12 life magazine 2012/2 Picture: Werbefotografie Weiss FOCUS life magazine 2012/2 13 FOCUS >>> Out of 1,000 patients undergoing a knee arthroscopy, some 600 were found to have hyaline cartilage damage. Almost half of these defects were caused by osteoarthritis (Hjelle, K. et al.; see references). Joints bearing the weight of the body are at particular risk. This is especially true of the knee. Between six and eight million people in Germany have osteoarthritis of the knee. Almost half of those aged over 45 and almost all of those aged over 75 have knee symptoms associated with osteoarthritis. A typical example of a common condition. The pressing question still remains unanswered, however. Why is osteoarthritis such a huge problem? Why do 14 life magazine 2012/2 cartilage defects (in adults) not just regenerate? Could it have something to do with the fact that cartilage has no blood supply? Does the synovial fluid, the liquid in the joints, prevent regeneration? Does another, completely unrelated factor play a decisive role? Despite a plethora of studies, including attempts to multiply cartilage cells under laboratory conditions, there is no currently no prospect of a cause-based therapy to combat loss of joint cartilage. Five million steps leave their mark As if all this were not enough. “Why do we keep seeing osteoarthritis of the collarbone and sternum,” wonders Professor Kohn, an orthopedic specialist , “even though there aren’t any weight-bearing joints in these areas at all?” The physician, whose list of publications on osteoarthritis runs to several pages, is reluctant to waste his breath on this: “We simply don’t know.” But do our genes have anything to do with it? There are some families where even elderly members develop no signs of osteoarthritis. With other families, by contrast , many members find themselves affected by joint disease. Even the diagnostics in this area are beset with uncertainty. “Osteoarthritis can be identified objectively on the basis of X-ray Pictures: Werbefotografie Weiss, Bauerfeind Prof. Dieter Kohn, Director of the orthopedic clinic and polyclinic at the Saarland University Hospital , Germany, talking to life magazine. FOCUS but those who play and train for five hours a week and always tend to pick up knocks.” The typical scenarios involve strains and sprains. “It’s frightening how many cases I see of men between 40 and 55 with severe osteoarthritis of the knee, despite being in good physical condition through sports-related training. They all tend to have played a lot of sport during that physically active period between the ages of 15 and 30.” or MRI findings,” explains the physician, “but the findings are not always associated with symptoms. And vice versa!” Although the extremely varied clinical picture associated with osteoarthritis raises many questions, there are a few hard facts as well: we each walk around five million steps every year, reckons the orthopedic specialist. There can be no doubt that this involves some wear and tear. The picture is far less obvious for another causative factor, although Professor Kohn believes its effects can be serious: “We tend to underestimate the many small instances of trauma. Think about footballers, not the top players, orthosis as a case in point. He particularly tends to use this for medial ligament tears. “My experiences of this have only been positive,” he points out. “As movement is guided by the orthosis splints at the side, it becomes possible to stabilize the joint.” The problem: osteoarthritis reveals few early symptoms It is absolutely critical to take early measures to counter osteoarthritis of the knee. ProfesPrevention – the earlier the better sor Kohn is quite clear about this, from both “If only I’d known...” is the reaction of many the physician’s and the patient’s perspecan (amateur) athlete when diagnosed with tive. Instability or excessive strain, lack of osteoarthritis. “I would advise any young exercise or poor diet – all these factors need athlete with what they believe to be a sprain, to be remedied. The trouble is that osteoarbruising, or strain injury to see a specialist. thritis does not tend to hurt during the early And I would advise my colleagues to take stages. This makes education all the more these seriously.” Professor Kohn has been important. Osteoarthritis is synonymous with “in the knee business”, as he calls it , since extensive, poorly defined cartilage defects. 1982. He knows what he is talking about: “If Once the articular cartilage has been compatients are experiencing chronic symptoms pletely lost , the only remaining treatment and an MRI following a ‘nothing injury’ option in many cases is resurfacing with shows visible signs of damage, there will an endoprosthesis. “We need to remember, definitely be consequences. But the consehowever, that we still have a range of options quences, which may not necessarily involve before we get to this stage,” emphasizes surgery, cannot be left to chance. They must Professor Kohn. For example, reconstructive allow the injury to heal and adjust their surgical procedures like repositioning operaactivity levels accordingly. There’s no point tions can improve joint function and thereby getting people fit again, by only dealing with delay the need to implant an endoprosthesis the warning pain while ignoring the lesion for resurfacing purposes. “Foot orthoses and the stress involved. This would inevitaalso provide an effective means of relieving bly mean progression from the preliminary the stress on parts of joints,” says Professor stages, through a period of wear, to eventual Kohn. “Before I decide that a joint prosthesis osteoarthritis.” is called for, I always check whether all opWith the knee, matters are complicated by tions for keeping the natural joint have been † the high risk of injury to ligaments. “You exhausted.” often hear the term ‘isolated rupture of the anterior cruciate ligament’ in this context , but this is misleading,” explains the expert with some frustration. “The forces which cause a ligament to tear are invariably sufficient to cause bony avulsions or cartilage damage as well , no matter how small they are. It’s nonsense to talk about an ‘isolated’ rupture,” he affirms. By implication, talk of “isolated” treatment seems out of place too, since the predominant type of dysfunction is now instability. The orthopedic specialist uses biomechanics to highlight the hidden risk of osteoarthritis associated with instability: “If the knee loses a key ligament , the kinematics are completely out of kilter. The stress on the cartilage increases with SofTec Genu: Multifunctional orthosis for every movement. Shearing forces cause tiny stabilization of the knee. new traumas to the cartilage with every step that is taken. We need to eliminate these by References: restoring stability. The quicker the better.” Hjelle, K., Solheim, E., Strand, T., Muri, R., Brittberg, Orthoses can do a lot of good in such cases. M.: Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18: 730-734. Professor Kohn cites the SofTec Genu knee life magazine 2012/2 15 FOCUS Higienópolis Health Center, São Paulo Looking good on the beach – and staying healthier too Giant rainforests, heavenly coasts – Brazil is nature’s paradise, and it is increasingly becoming a haven for sports enthusiasts too. The country is currently experiencing a real fitness boom, and health centers, which offer orthopedic care as well as medical aids, fit well into this exercise scheme. The treatments provided by Prof. Wagner Castropil also follow an integrative concept. with varying degrees of osteoarthritis often come to him. One thing is of absolute importance to the physician when dealing with his knee patients: breaking through the pain barrier or, as he calls it , the “continuous inhibition reflex”! “It is important to understand,” he explains, “that pain hinders everything. Happiness, motivation, quality of life. And, above all else, movement. The body cries out with every step: Stop, it hurts!” To silence the great inhibitor, Prof. Castropil prescribes many of his osteoarthritic patients the GenuTrain A3 knee support. The 3 As in the name stand for “Anti”, “Arthros” and “Algos” (“against joint pain”). As a rule, the physician prescribes the active support to patients in the early to advanced stages Pain – the great inhibitor of osteoarthritis. “We encourage them to Prof. Castropil treats patients of all ages, put the support on immediately after they including many people suffering from osteo- get up, and to wear it for two to four weeks,” arthritis and even former Olympic judokas. he recommends. He sees pain reduction and He describes how 50- to 55-year-old patients strengthening of the muscles – particularly the quadriceps – as the decisive factors. This, he believes, prevents the “specter of atrophy” from arising. “The result is that patients often do not want to take off the support at all any more after four weeks.” This is understandable, if you consider that the corresponding knee scores (IKDC) have significantly improved, as demonstrated by Prof. Castropil’s tests. just the latest fitness boom that is responsible for the steep increase in patient numbers, but also the clinic’s favorable location in terms of transport links – a decisive factor in a city known for its constant traffic jams. In the land of the Sugarloaf mountain and the Copacabana, the sea has a great deal of attractive appeal. The same is true of health centers in favorable locations. São Paulo is notorious for its constant traffic jams. “It is important for our patients to be able to get to us quickly and easily,” says the physician. The Higienópolis Health Center, which houses the VITA clinic, is on the outskirts of the huge metropolis of São Paulo, the third largest city in the world. Prof. Wagner Castropil checks whether the GenuTrain P3 fits correctly on his patient. 16 life magazine 2012/2 “Envelope of functions” For minor osteoarthritis at stage 1, as well as for knee complaints resulting from overstraining or instability, Prof. Castropil prefers to recommend the GenuTrain P3 (“Permanent Patella Protection”) active support to his patients – to improve the guidance of the patella. He stresses that it fits excellently into the “envelope of functions” concept. This approach to treatment originally comes from the USA. The “envelope of functions” Pictures: Bauerfeind Store Sao Paulo More and more Brazilians want to take up sports. With some of the world’s greatest sporting events, such as the 2014 Football World Cup and the 2016 Olympic Games, due to be held on home soil , Brazil’s distinctive enthusiasm for sport may give rise to more work for people in medical professions, such as the São Paulo-based orthopedic specialist Prof. Wagner Castropil , for example. The specialist in sports medicine and his twenty colleagues at the VITA clinic, the largest private orthopedic clinic in the city, treat around 5,000 patients per month. Prof. Castropil himself performs around 150 shoulder operations and 200 knee operations each year, albeit in cooperating hospitals rather than at the VITA clinic. “People often just used to run once around the block, but now they want to run a marathon,” he says, describing the problem of overambition, which can lead to injuries. “Or they want to look good running along the beach.” The physician believes that it is not FOCUS Prof. Wagner Castropil , specialist in sports medicine, performs around 150 shoulder and 200 knee operations each year. is based on taking a holistic view of the joints, which form seamlessly functioning units in their “protective envelopes”. Under physiological stress, the accompanying ligaments, tendons, muscles, cartilage and bones perform their tasks without any problems. External disruptions can, to a certain extent , be self-regulated within the “envelope”. However, serious injuries, such as a torn cruciate ligament , stop the “envelope of functions” working properly. In the healing phase, all efforts must be made to restore this functionality to its former state. Two floors down: Bauerfeind “There are several options available to me for trying to restore the status quo,” says Prof. Castropil. “Depending on the specific case, I can treat the cartilage with glucosamine, inject hyaluronic acid into the joint , and I can also prescribe the GenuTrain P3 to help re-establish the ‘envelope of functions’.” He prescribes the GenuTrain P3 for use during physical activities only. Luckily for Prof. Castropil’s patients in traffic-riddled São Paulo, to get their GenuTrain A3 or GenuTrain P3, they simply have to take the escalator two floors down. This is because the only Bauerfeind store currently set up in the whole of South America is located directly beneath the VITA clinic. The store was opened at the end of March 2012. Housed in a shopping arcade, the store covers over 50 square meters and sells supports and orthoses, medical compression stockings and orthopedic insoles. The Higienópolis Health Center also houses other medical facilities, such as a cardiology outpatient clinic, a nutritional advice center, and dentistry and physiotherapy practices. However, patients still have some way to go to reach a certain † famous beach from here. For further information please visit: www.vita-org.br life magazine 2012/2 17 MEDICAL Pictures: picture alliance/Kerim Okten, Bauerfeind Colombian triple jumper Caterine Ibarguen attracted some curious glances as she jumped her way to a silver medal wearing a MyoTrain thigh support. 18 life magazine 2012/2 MEDICAL Summer Olympic Games London 2012 Making a strong impression It was the event of the summer: the Olympic Games in London. With its very own team of orthotists, Bauerfeind AG was on hand to provide medical care for all 10,500 athletes from 204 nations competing at the Games. Its supports, orthoses, medical compression stockings and orthopedic orthoses came to the aid of athletes on more than 700 occasions. These are moments we will never forget: the Stratford. With two orthotists on duty per day, stunning success of Usain Bolt , the jubilation the Bauerfeind team was on hand from 7.00 in the Olympic stadium as heptathlete Jessica am to 11.00 pm. The polyclinic was open to all 16,000 or so people staying in the Olympic Village in Stratford, with athletes from all over the world coming along every day in search of medical advice. Some of them also needed Bauerfeind products, either because they had injured themselves, an old problem had flared up again or they were showing various signs of overstraining. A variety of supports Linda Stahl , and orthoses from the Bauerfeind product javelin thrower, range for the feet , knees, hips, spinal column, bronze medal at London 2012. shoulders, hands, and elbows were supplied for this purpose, as well as medical compression stockings and orthopedic orthoses. “To be able to win a medal at the Olympic Games, everything has to be just right – including the medical care. Bauerfeind provided me with very reliable support.” Ennis completed her lap of honor, or the thrilling final of the men’s beach volleyball competition. The athletes in London were provided with the best conditions to deliver top sporting performance – including a sophisticated medical care system. Bauerfeind was involved in the Games once again in 2012 as a partner of the Olympic organizing committee: the company supplied products to the three polyclinics in Stratford (main Olympic Village), Eton Dorney (Olympic Village for the rowing and canoeing events) and Weymouth Portland (Olympic Village for the sailing competitions), as well as to all 35 event venues. From July 16 to August 12, a total of eight Bauerfeind employees from the UK, Germany and the Netherlands worked in shifts at the polyclinic in the main Olympic Village in Hemke van der Zwaag, orthotist (CPO), Bauerfeind Benelux. “I was impressed by the team spirit and the positive atmosphere in the polyclinic. The athletes and staff at the polyclinic were very enthusiastic about our services and our fantastic products. It was an honor to be part of it all!” Bauerfeind: an “exclusive supplier” For this year’s summer games, the London Organising Committee of the Olympic Games and Paralympic Games (LOCOG) invited tenders in a number of different Dirk Schwager, orthotist (CPO), Bauerfeind Germany. “There were so many incredibly gratifying moments. When athletes came back, for example, to tell us that a product had worked and helped them to get back up and running. It’s a great feeling to get such positive feedback from the athletes. We didn’t have a single complaint!” categories. Bauerfeind participated in the tendering process for the “braces” category, along with 15 other companies from around the world. “We were delighted to be awarded the contract ,” said Chief Executive Officer Prof. Hans B. Bauerfeind, “The decisive factor that set Bauerfeind’s >>> life magazine 2012/2 19 MEDICAL >>> bid apart from the rest was the outstanding quality of our supports and orthoses. This is further proof that our “Made in Germany” products are highly rated at an international level.” Working hand in hand In order to provide athletes with the help they needed, the Bauerfeind team worked hand in hand with colleagues from other departments, such as orthopedists. Once a diagnosis had been made, the Bauerfeind orthotists used this as a basis for selecting the right product , assessed what size of product was required, and explained to the athletes how the product works and how they should put it on. The products, such as orthoses, were also individually adjusted to fit if required. Supports, orthoses, medical compression stockings and orthopedic orthoses were supplied to athletes on more than 700 occasions in total. Elizabeth Crane, Managing Director Bauerfeind UK. “Customers in the UK now know that Bauerfeind is not a small family company but an international brand with a vast amount of experience and expertise in medical products.” Bauerfeind products in the spotlight While the orthopedic support provided to athletes was generally not visible to spectators, the Colombian triple jumper Caterine Ibarguen attracted some curious glances as she jumped her way to a silver medal wearing a MyoTrain thigh support. The LumboTrain sported by javelin thrower Linda Stahl , another medalist , could also be seen by observant spectators as it showed through her top. “Supports for the ankle, knee and back were in particularly high demand,” said Lars Birnbaum, Head of Sport Marketing at Bauerfeind. To make sure there would be enough to go round, some 200 extra products in various sizes were shipped in from the company’s headquarters in Zeulenroda. “We had more than 10,000 products here in total , but in the last few days we naturally did not want to have to turn any injured athletes away because the size they needed was not in stock. We managed to handle this perfectly,” † Lars Birnbaum added. Interview Health is the top priority Interview with Dr. Bernd Wolfarth, Chief Physician for the German Olympic team. You have already been involved in five Olympic Games. What was it like for you in London? PD Dr. Wolfarth: There is always something particularly special about the Olympic Games. It was certainly rather easier for us to work in London than in Beijing, purely because there was no language barrier. In Beijing, we Europeans also had to cope with the time difference, a different food culture 20 life magazine 2012/2 What were the most common medical problems? PD Dr. Wolfarth: Infections, as expected. It is important to differentiate between injuries, because there are a lot of simple problems that can be treated directly by physiotherapists and be brought under control. Minor muscular injuries are the most common. Fortunately, we rarely see any serious injuries. What goes through your mind when you have to decide, from a medical perspective, how fit an athlete is to compete? PD Dr. Wolfarth: That is always a difficult decision, especially in the case of athletes involved in sports that only receive any public attention perhaps once every four years, at the Olympics. If an athlete is working toward that one particular moment , and then an infection or a muscular injury puts him out of action, it’s a personal tragedy that affects you, too – there’s no question about it. However, when it comes to making decisions about an athlete’s fitness for sport or competition, the athlete’s health is always † our top priority! Pictures: headshot-soho.co.uk, Bauerfeind, Bauerfeind Benelux/Ridderhof Priv.-Doz. Dr. med. Bernd Wolfarth. and a different climate. The equipment at the polyclinic in the Olympic Village once again left virtually nothing to be desired, and our cooperation with the Bauerfeind team on orthopedic care was excellent. Bauerfeind has also been involved in the polyclinics since the Winter Olympics in Vancouver – which is an ideal situation for us. Whenever we needed anything, we could get hold of just the right product via the short official channels. MEDICAL 25 years of Bauerfeind Benelux On the way to gold On September 7, 2012, Bauerfeind Benelux welcomed guests to a symposium and gala evening to celebrate a very special occasion: the company’s 25th – or “silver” – anniversary. Guests came from all over the world to attend the event in Haarlem. Sparkling atmosphere at the gala evening. Prof. Hans B. Bauerfeind (left) came to celebrate the 25th anniversary with Bram Dieleman. Welcoming the guests of the jubilee. After the Austrian, US, Swiss and French companies, Benelux was the fifth subsidiary established abroad by Bauerfeind AG in the 1980s. When Bram Dieleman took over the management of the company on August 1, 1987, there were just five Bauerfeind orthopedic products and one variety of compression stockings available in the Benelux region. Now the entire product range is on offer and the company is leading the orthopedics and phlebology market in Benelux. Reliable partner An enthusiastic skater, cyclist , skier and golfer, Bram Dieleman likes to draw comparisons between the company and elite athletes: they are always trying to raise the bar a little higher. But they can’t do this alone. Success always depends on having support , a good team and reliable partners. To thank its partners, in particular, for their good cooperation, Bauerfeind Benelux invited them to a symposium entitled “On the way to gold” on September 7. The theme of the event was the future of healthcare and medical supply. The guest speakers included Prof. C. Niek van Dijk (AMC Amsterdam), Prof. H. A. Martino Neumann (Erasmus Medical Center, Rotterdam), Johan de Wit (CVZ), Prof. Dr. Jan Willem Velthuijsen (PriceWaterhouseCoopers), Jan Schutrups (Schutrups, Exloo) and Prof. Hans B. Bauerfeind. The audience came from all over the world to gather in Haarlem, where they enjoyed the sincere Dutch hospitality and the glamorous atmosphere of the event , which was held in a large marquee. The anniversary celebrations finished on a successful note, with music, acrobatic performances and plenty of interesting † conversation. Manager, motivator and initiator Bram Dieleman leads the 35-strong team of employees at Bauerfeind Benelux with plenty of dedication and commitment. “He is a manager, motivator and initiator all rolled into one,” said Prof. Hans B. Bauerfeind, full of praise in his speech at the event. He also reflected on the rapid growth enjoyed by Bauerfeind Benelux, which has led to a few relocations over the past 25 years! The subsidiary was initially based in Tegelen, near Venlo, before setting up office in Haarlem. By 1993, these premises once again proved too cramped, so Bauerfeind constructed its very own, larger building in Holland for the first time. “It was very daunting, as in 1994 – soon after we moved in – the reimbursement for the GenuTrain knee support was abolished,” recalls Prof. Bauerfeind, “Yet in spite of the difficult market conditions, the company was still able to pay the mortgage and Bauerfeind Benelux continued to grow.” The company had grown out of its premises again by 2003, so it moved into its current offices located just 400 meters away. The Bauerfeind office in Haarlem. A chance to mingle after the symposium. life magazine 2012/2 21 MEDICAL Science and practice The foot as an interface ‘I would like the term shin splints to be banned – there should be a law against it!’ Daily Mail , 1.6.2012. Marathon man, Dr. Nat Padhiar has a dislike of the term shin splints and passion for exercise induced leg pain (EILP) in sport. Shin splints – a dinosaur term Where do you start? “With the leg, of course!” Dr. Nat Padhiar has devoted the last 20 years of his career to researching different causes of EILP in sport and has completed a PhD investigating various aspects of Chronic Exertional Compartment Syndrome (CECS). Dr. Padhiar clarifies in his interview with Bauerfeind life that shin splints is an umbrella term describing a number of conditions that cause EILP that can be associated with more than 35 different conditions. Each of these conditions requires a detailed history and objective investigations to make a specific diagnosis in order to provide appropriate Dr. Nat Padhiar, Consultant Podiatric Surgeon at the Royal Hospital London. 22 life magazine 2012/2 Pictures: www.headshot-soho.co.uk He is extremely proud, though not of himself even though he has very good reason to be: Consultant Podiatric Surgeon at the Royal Hospital London, Fellow of the Faculty of Podiatric Surgery at the College of Podiatrists, Honorary Reader in the Centre for Sports and Exercise Medicine (CSEM), William Harvey Research Institute, Queen Mary, University of London and Clinical Lead for Podiatry at The London 2012 Olympic & Paralympic Games, the list is endless. But it is his children, rather than himself, who is the source of his pride – his son Ciaran aged 15 years recently won his school’s annual Golf tournament. His proud father smiles and says, “Sport is very important in our family, it is important not only for health and fitness, but also for things like team spirit , leadership and discipline” and Dr. Nat Padhiar should know. He has completed 34 marathons and over 150 half marathons with two of the marathons on Mount Everest – from Gorak Shep (5164m) which is very near to Base Camp (5364m) to Namche Bazaar (3750m). “I have been running my whole life.” Tennis and cricket are among his other passions. And as a member of a medical team, he has also provided support at the World Student Games, Commonwealth Games, Island Games (Guernsey), Everest Marathon, Mongolia Sunrise to Sunset Marathon, London Marathon and London Triathlon. MEDICAL 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 Independent Hospital , he estimates that the use of the term shin splints is resulting in half of EILP cases being misdiagnosed. 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- 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 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, coauthored 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 microcirculation 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 compensation. 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 , altered 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, injections & surgery), strengthen and stabilize (foot orthoses, braces & physiotherapy), reduce the pre-disposing factors for long 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. 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 compartment 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 used in Sports Medicine. Dr. Padhiar is again very proud of his Dynamic Intra-compartment Pressure testing system in The John King Centre which he partly developed himself 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.” For further information about Dr. Nat Padhiar and the BMI London Independent Hospital: www.londonsportscare.co.uk www.bmihealthcare.co.uk/lih life magazine 2012/2 23 MEDICAL SofTec Coxa Innovative treatment of hip pain With the number of hip arthroscopies projected to double by 2013*, it is important that orthopedic surgeons employ post-operative treatment plans that increase patient compliance. Orthopedic surgeon Dr. Allston Stubbs evaluates approximately 1,500 patients per year and performs arthroscopic hip surgery on an average of 24 patients per month. Using Bauerfeind’s active hip orthosis SofTec Coxa as part of his post-operative treatment plan, he finds higher patient compliance and satisfaction. How do you utilize Bauerfeind active orthoses as part of your protocols? Dr. Stubbs: We use the SofTec Coxa hip brace as a primarily post-operative orthosis. This Bauerfeind brace assists our patients by providing controlled range of motion, lumbopelvic support and lateral impact protection in the event of a collision or fall. How common is sports-related hip pain? Dr. Stubbs: Sports-related hip pain is a common problem affecting a variety of ages and ability levels. The true prevalence is not known, but in my clinic our average age is about 30 years old, with women being slightly more affected than men. What common indications related to hip pain do you see on a regular basis at your clinic? Dr. Stubbs: My clinic primarily evaluates and treats patients with sports medicine-related hip conditions. It may be as self-limiting as a muscle strain or more involved, such as a cartilage tear. We do see hip arthritis as well , but along a spectrum of the earliest stages to more progressed arthritis. Athletes with common cases of cartilage tears, such as femoroacetabular impingement , are evaluated and counseled on treatment options and their return to sport. Who is your typical patient? Dr. Stubbs: Our typical patient is active and passionate about life. Most patients are athletic in some capacity for fitness, as the weekend warrior, and collegiate and professional athletes. Men and women are both affected. Our age range is typically 12 to 70 years of age. 24 life magazine 2012/2 You have tried other products. What makes the Bauerfeind product different , and why did you select its use over the others? Dr. Stubbs: We were having problems with patient compliance with the other hip supports we were using. We found that patient satisfaction and compliance was higher using the SofTec Coxa. Its ease of use, appropriate fitting, comfort , and being a four-season brace gave the patient confidence. Dr. Stubbs – Clinical study Dr. Allston Stubbs is Medical Director of Hip Arthroscopy for Wake Forest Baptist Health and Wake Forest University School of Medicine, and assistant professor in the Sports Medicine Program of the Department of Orthopaedic Surgery at Wake Forest University in Winston-Salem, North Carolina. An expert in hip arthroscopy, he has published orthopedic research, created instructional videos and lectured at conferences within the United States and abroad. As an active researcher, Dr. Stubbs is currently working with Bauerfeind on a clinical study involving the biomechanics of hip bracing. Results of the two-year-study are expected the summer of 2013. Understanding the biomechanical function of sports hip orthoses and its implicit effect on therapeutic post-operative recovery can help in improving the overall outcomes following hip arthroscopy procedures. What features and benefits are most important in use of the SofTec Coxa? Dr. Stubbs: We value patient satisfaction the most in our use of the SofTec Coxa hip brace. We feel the basis of high patient satisfaction relies on a brace that is well made of high quality materials, provides a “customized” feel and effectively transitions the patient “The design of the SofTec Coxa allows each patient to feel as if they have a personalized orthosis.” (Dr. Allston Stubbs) from the immediate post-operative period to the return to full activity. How does the design of the SofTec Coxa allow you to enhance patient treatment? Dr. Stubbs: The design of the SofTec Coxa allows each patient to feel as if they have a personalized orthosis. Most importantly, the fit of the brace can be adjusted throughout Pictures: Nick Greenway How has the treatment of hip pain changed in the last 15 years? Dr. Stubbs: Over the last 15 years, the treatment of hip pain has changed relative to a better understanding of the causes of hip pain and diagnostic tools. Also, a better awareness by medical providers and athletic trainers improved diagnostic capabilities. Highly-informed patients, utilizing tools now commonly found on the internet , are better able to direct their health care professionals to proper hip pain diagnosis and treatment. MEDICAL Orthopedic surgeon Dr. Allston Stubbs explains to his patient how to use the SofTec Coxa. the post-operative period. Further, the range of motion of the brace can be adapted to the patient’s needs and requirements. These qualities ensure a high patient compliance rate over the course of treatment. Where do you see the future of arthroscopic procedures. The SofTec Coxa is a valuable hip treatment , and where do you see the role addition to our patient treatment program, of active orthoses such as the SofTec Coxa in and we’re excited to use it. Our patients are † the future? very pleased as well. Dr. Stubbs: Arthroscopic hip treatment continues to evolve as one treatment option Most hip braces on the market are used for an for patients with hip pain. Orthoses such average of 10 days. How long do your patients as the SofTec Coxa will continue to evolve * The Journal of the American Academy of Orthopaedic Surgeons, June 2012, Volume 6, Number 6. wear the SofTec Coxa for? with the advent of new techniques and Dr. Stubbs: The majority of our patients use the brace for six weeks. We encourage patients to use it whenever they find it appropriate as For further information please contact: they return to their favorite activities. Bauerfeind USA (address, page 39) life magazine 2012/2 25 MEDICAL AVE Orthopedische Klinieken, Huizen, the Netherlands “We have a face” Independent treatment centers are a specialty of the Netherlands. Their focus is on providing immediate and efficient care for patients. With orthopedic problems in particular, the centers are able to make use of the advantages they have over public hospitals and private clinics. The knee orthosis SecuTec Genu. 26 life magazine 2012/2 cated hip operations in ASA III patients are well taken care of by the hospitals, but we can complete a knee arthroscopy in healthy patients within fifteen minutes. That saves both time and money.” But money is not everything, and the physician knows that too. “We are approachable, people can come to us,” he says. “They can Patients don’t want to feel ill call us, send us an e-mail or come in and see The AVE Orthopedische Klinieken, with their us. We have a face!” headquarters in Huizen, have several sites Anonymity in hospitals, the resulting unpopin the Netherlands. The one in Almere is ularity, immense cost increases – all of these an important branch. Situated around 20 factors were reasons for founding the ZBCs. kilometers east of the gates of Amsterdam is Efficiency, high quality and flexibility is the a city with symbolic significance: Almere is motto here. Direct partnerships and costthe fastest-growing city in the Netherlands. saving collaborations are designed to help “Where you are now sitting was under water both the system and the patients equally. For 30 years ago,” Arno van Lieshout explains. In example, AVE Orthopedische Klinieken work a huge land reclamation project , the ground closely with regional hospitals and also with on which Almere stands today was reclaimed local medical supply retailers and physiofrom the Zuiderzeethe neighboring Lake therapists. Ijseel. According to the physician, the city’s Coherence of resources 200,000, predominantly young inhabitants Working collaboratively, it is important to appreciate new structures – even in the Arno van Lieshout and his colleages that healthcare system. “We often see young support is provided in the places where it sportsmen and women who have injured themselves,” he says, describing his main cli- is needed most. That may be on site at a entele. “They don’t feel ill and don’t want to rented hospital bed or on AVE premises. The same applies where medical products be treated as people who are ill. They come to us because it is our job to solve problems are concerned: “With active supports and knee orthoses, I can rely on the team at – and to solve them as quickly as possible.” Bauerfeind,” says the physician. Admittedly People often come to AVE for a second he needs the medical aid itself – such as the opinion. And in many cases, the patient SecuTec Genu knee orthosis, used to provide then stays with the AVE. “Just this morning security following the fitting of artificial a patient came to me after a tibia correccruciate ligaments – more than its bearer. tion to ask when would be the best time to But there is personal contact involved, for remove the plate,” says Arno van Lieshout , example with Edwin Mosterd, Sales Manager describing a particular case. “He had lost confidence in the other physicians after they of Bauerfeind Netherlands, who symbolizes all AVE activities: immediate, quick, and had damaged a nerve during the operation. effective. And there is another medical aid in Now we will continue his treatment.” the Bauerfeind range that is ideal here. The An “approachable” physician GenuTrain, for example, the active support Continuing treatment that others are unwill- for the knee, fulfills the requirements that ing or unable to carry out is one thing, but the orthopedic clinic demands of itself: working with colleagues from the hospitals is “The support provides security in cases of another – and it is much more common. “It knee instability,” says Arno van Lieshout. is never the case that we can do everything “Security – that is exactly what we aim to † better,” the physician concedes. “Compliprovide at AVE.” a ZBC. They are not private clinics, however. Just like other medical service providers, they are recognized by hospitals. Typically for an independent treatment center, facilities such as operating theaters are rented, or x-ray examinations are bought in and used for providing their own services. Pictures: Stefan Durstewitz, Bauerfeind If you are visiting Arno van Lieshout at his place of work, you will be met with a surprising sight: no automatic doors, no long corridors, no stethoscope in his jacket pocket. The physician greets visitors in the very place where he welcomes his patients: at a large wooden desk in a well-lit office. An examination couch, medical posters and a knee prosthesis are the only things that remind visitors they are in a hospital. This is deliberate. “We don’t have a hospital atmosphere,” says the orthopedic surgeon. “The patients like it that way. And so do we.” Arno van Lieshout works together with three other orthopedic specialists at the AVE Orthopedische Klinieken (AVE Orthopedic Clinics) – a so-called ‘ZBC’. The acronym stands for ‘Zelfstandig Behandel Centrum’ – an independent treatment center, which are common in the Netherlands. These centers started to appear in the 1980s. Alongside the public hospitals and private clinics, they form an important pillar of the Dutch healthcare system. There are now around 200 of these small , independent clinics spread all over the country. Thanks to their flexible structures, in most cases the ZBCs are able to treat patients more quickly and more effectively than larger hospitals. Even just the partnership of two specialists can constitute MEDICAL Orthopedic specialist Arno van Lieshout works at the AVE Orthopedische Klinieken, Huizen. For further information please visit: www.ave-orthopedischeklinieken.nl See page 39 for contact information for Bauerfeind Benelux. life magazine 2012/2 27 MEDICAL Stuntwoman’s Promising Career Saved by MalleoTrain S Air Born Picture: private Tally Rodin – model , acrobatic dancer, gymnast , stuntwoman – is not your typical teen. At 18 she has already planned her professional career, one that includes moving from Stouffville, Ontario, to Hollywood, California, to become a top notch stuntwoman. It is an unusual profession to be sure, but one that seems to suit the ambitious and multi-talented athlete. “Doing stunts is exhilarating,” said Tally. “It all feels very natural to me.” A Bauerfeind brace helped to save her career. >>> 28 life magazine 2012/2 MEDICAL Tally Rodin doing a handstand during a contemporary solo. life magazine 2012/2 29 MEDICAL tendon of her right ankle. It was her first injury. As fate would have it , just a week later she had a trip booked to Los Angeles to participate in an intensive dance workshop. Once she could walk, though still in pain, she went straight to the studio and took out al- “It fits perfectly and worked unlike any other product I previously tried.” (Tally Rodin) most everything that involved her right foot. At the competition, she froze her ankle with a gel and competed on it. She admitted it was the worst decision she ever made. “I then bought the cheap braces you get at a pharmacy, wore those in LA and just sat out when my ankle was in too much pain to handle. Other than that , I was using the R.I.C.E. technique (Rest , Ice, Compression, Elevation) as much as possible,” she said. “The MalleoTrain S was my life saver” But her ankle wasn’t healing. Tally’s father, >>> Already an accomplished professional Harley, went online to find a brace that could pop. I collapsed to the ground. Right away with gigs in her portfolio like dancing, support his daughter’s ankle and help it I couldn’t walk. I thought , ‘Oh, my God, modeling and performing as a stuntwoman heal. He discovered the Bauerfeind website my foot’s broken.’ I was only 16 and had in a Sunny D TV and internet commercial , already started my career by teaching dance, and the MalleoTrain S compression brace. A Tally’s love of the art of movement began local podiatrist confirmed that the support it gymnastics, and being a stunt person. I was at a very early age. “I didn’t want to be provided was just what Tally needed. devastated,” she recalled. left behind when my seven-year-old sister Tally had a micro tear in the tibialis posterior “After using the product , I was very happy. It Samantha took dance lessons, so when I was gave me a lot of relief, and every time it was two, I asked my parents to sign me up. But on I stopped worrying about re-injuring my it wasn’t until I turned two and a half that ankle,” said Tally. I was finally old enough to begin lessons,” It has been two long years since her injury, said Tally. She was unstoppable from that but Tally is recovering. Along with wearmoment on. ing the MalleoTrain S, undergoing physioDance and gymnastics soon became a therapy and one PRP injection (Platelet Rich routine part of her after-school day, and as Plasma), her professional days are looking a teen, she spent from 3 to 10 pm every day brighter. She was back into her full training in the gym and studio. Her accomplishments schedule at the end of July. out of the studio, including amateur and pro“I thought my acrobatic dancing and profesfessional dance, acting, martial arts, stunts sional stunt work career was over,” said Tally. and modeling for film, television and stage “The MalleoTrain S* was my life saver beproductions, led to her becoming something cause it provided the ankle support I needed of a celebrity in her community. to continue my extensive training program, and it allowed my ankle to heal. It fits perAnkle injury fectly and worked unlike any other product But Tally’s hard work all came crashing down I previously tried. I’m looking forward to two years ago. “I was practicing around returning to my peak performance level , and my home on the grass when I landed a full I have incredible respect for the MalleoTrain † Tally Rodin, dancer and stunt woman from back layout with 360 spin. I landed too S for saving my career.” Canada. far forward and felt and heard a snap or For further information please visit: www.tallyrodin.com 30 life magazine 2012/2 *Bauerfeind worked with Tally Rodin to produce a neutralcolored MalleoTrain S especially for her that she could wear in competition. The company is now further developing this version for use by athletes who participate in martial arts, dance and gymnastics. Picture: Lee Cherry, Bauerfeind, Wolfgang Maxwitat MalleoTrain S: Active support for greater ankle stability and security during physical activity. MEDICAL Recognition for Prof. Waldemar L. Olszewski “Appreciation for an underestimated specialist field” Prof. Waldemar L. Olszewski is to be awarded the Ratschow Memorial Medal for his life’s work, at the annual conference of the Deutsche Gesellschaft für Phlebologie (German Society of Phlebology) on September 21, 2012. With his work over the decades, Prof. Olszewski has made a significant contribution to the field of lymphology. The Ratschow Memorial Medal The Curatorium Internationalis Angiologiae has awarded the Ratschow Commemorative Medal every year since 1969. The medal recognizes particularly deserving scientists from the field of vascular medicine and associated disciplines for their life’s work. For many years Bauerfeind AG has been a patron of the foundation awarding the medal. Dr. Hans-Jürgen Thomä, Bauerfeind, Prof. Dr. Dr. h.c. Kurt-Udo Tiedjen, award winner Prof. Dr. Waldemar L. Olszewski and Prof. Dr. Eberhard Rabe (f. l. t. r.). The particular interest Prof. Waldemar L. Olszewski has shown in the human lymph system and everything connected with it dates back to the start of his medical studies. “The textbooks contained plenty of information about the circulation of the blood, but nothing about what goes on in the interstitial space,” recalls Prof. Olszewski, who is currently a professor at the Medical Research Center of the Polish Academy of Sciences in Warsaw. “What happens there? How does the intercellular fluid from tissue find its way back into the circulatory system, and what are the forces driving this fluid? These questions bothered me. Not to mention the unresolved questions about the chemistry of lymph. This is how I later became concerned with disorders of the lymphatic system, particularly lymphedemas.” Basic research Over the following decades, the physiology and surgery of the lymphatic system became one of Prof. Olszewski’s main areas of scientific and clinical interest. Numerous groundbreaking discoveries in lymphology can be traced back to him. For example, he made the discovery that the human lymph system is subject to spontaneous, rhythmic contractions. Prof. Olszewski also developed the procedure for lymphovenous anastomosis and conducted research into the chemistry of human lymph, as well as into the hydraulic contractility of subcutaneous tissue. Even the policy of administering low-dose penicillin over long periods, now practiced with great success in a number of Asian countries, to help prevent chronic derma- titis and lymphangitis was inspired by him and his work on the bacteriology of human lymph. “Lymphological research is actually more of a hobby of mine, albeit one I am really enthusiastic about ,” explains Prof. Olszewski, in spite of these various successes. “Vascular surgery is my bread and butter.” And on this point he voices his fundamental criticism: “The world of academic science has totally underestimated the field of lymphology. This is gradually starting to change. As such, I feel that being recognized with the Ratschow Medal is not just a great personal honor, but also shows significant appreciation of a specialist field that has often failed to get the recognition † it deserves.” life magazine 2012/2 31 MEDICAL Winter sport injuries Stabilization, movement and healing Fast , faster, fastest. In skiing, continuously enhanced materials, well-prepared slopes and artificial snow all help fulfill this need for speed. These factors may not bring injury statistics down to zero, but medical treatment options have also been developed further. Bauerfeind life discussed this topic with Dr. Gerhard Oberthaler, a trauma surgeon and team physician for the Austrian Ski Association. You provide support for the players in the Red Bull Salzburg ice hockey team, along with Ludwig Paischer, a successful international judoka, and the athletes of the Austrian Ski Association. What are the particular challenges facing a team physician when it comes to winter sports? thus increasing the chance of accidents at higher speeds. So what are the most common winter sport injuries? Dr. Gerhard Oberthaler: Trivial injuries like sprains, bruises, torn muscle fibers or sprains are the most notable ones. Naturally, we also see serious injuries to joints and ligaments or even broken bones. The higher the speed at which the accident or collision takes place, the more likely it is that serious injuries will occur, such as fractures in the thighs, spine and hips. Are there different types of injuries in Alpine skiing and snowboarding? Dr. Gerhard Oberthaler: Yes, completely different. Alpine skiers are more likely to injure their knees or shins, while snowboarders’ vulnerable points are their wrists and arms. This also explains why, in terms of statistics, knee injuries are the most common injuries in winter sports, but injuries to hands and arms combined occur almost as frequently. Is it possible to identify a trend in this regard over the years? Dr. Gerhard Oberthaler: With the changes Dr. Gerhard Oberthaler: Naturally, I have to be able to ski safely myself, so I can get to equipment and technical possibilities, medical supplies to injured skiers on difficult there has also been a shift in terms of injuand icy slopes quickly and safely. ries. Take ski boots, for example: previously, the leverage forces acting on the edge of the Are there fundamental differences between ski boots often led to fractures in the tibia, the injuries suffered by novice skiers and particularly what are known as boot-top professionals? fractures. Over the years, ski boots have been Dr. Gerhard Oberthaler: You might assume cut higher and higher to transfer the force that professional athletes ski faster and are more effectively to the ski. This has shifted more willing to take risks, meaning that they injuries upward, from the lower leg toward are more likely to suffer more serious injuries the knee. Too much pressure on the skier than amateur skiers. However, amateurs during skiing can therefore cause tears in often misjudge their own abilities, which can the cruciate ligaments, even without a fall. result in accidents both on- and off-piste. Has your work as a trauma surgeon also Better slope preparation and the use of changed? artificial snow also encourage faster skiing, Dr. Gerhard Oberthaler. 32 life magazine 2012/2 Dr. Gerhard Oberthaler: Medicine has naturally developed enormously over the past 20 years. We now have more refined surgical technology and better, that is to say more conservative, medical aids and therapies at our disposal. Today, many operations are performed as non-invasively as possible by MEDICAL in this case. Previously, the patient would have been given a plaster cast , which would have been very restrictive in terms of daily life. It would be five weeks at the earliest before rehabilitation could begin, after the plaster cast was removed. Today, by contrast , patients’ symptoms can be completely eradicated after just five weeks. This is partly due to the use of stabilizing orthoses. What does this mean in concrete terms? Dr. Gerhard Oberthaler: Let’s take the “classic” hand injury, skier’s thumb, as an example. This is a tear in the first metacarpophalangeal joint , and surgery is unavoidable Could you explain how they are used in more detail? Dr. Gerhard Oberthaler: Metal or bioresorbable implants now ensure that joints are stabilized directly after an operation, with orthoses providing additional support. Although using a thumb orthosis such as RhizoLoc reduces mobility in the first metacarpophalangeal joint , it speeds up the healing process. The reason for this is that the movement of the joint can be controlled, which has a positive effect on the metabolism, improving the blood supply to the joint so that it can regain its functionality more easily. Orthoses are also extremely useful for treating strains and supporting muscles. Patients enjoy a better quality of everyday life right from the start as, in contrast to a plaster cast , orthoses can be temporarily † removed for washing. Snowboarders’ vulnerable points are their wrists and arms. Pictures: private, f1online/Imagebroker RM means of keyhole surgery. In terms of the knee, for example, arthroscopic surgery can be performed on a meniscus or cruciate ligament injury. Previously, far more injuries were treated using plaster casts, a method which brought with it a number of disadvantages. With the use of metal implants, i.e. screws, plates, etc., we can achieve faster rehabilitation. life magazine 2012/2 33 MEDICAL Lymphedema treatment in Australia “Treatment from an early stage is essential” The ALA (Australasian Lymphology Association) is the peak professional body promoting best practice in the management , research and education of lymphoedema and works towards increasing public awareness of the condition throughout Australia and New Zealand. “Australia is a very large country geographically, with only 22 million people, and the healthcare system is governed individually by each of the seven states and territories. There are differences for people accessing lymphedema treatment and financial support in each state,” explains Penelope Sanderson, who has served as President of the association over the past two years. The ALA was established in 2000, after a thorough preparation phase, to ensure that 34 life magazine 2012/2 lymphology gains the important status it deserves and the recognition it requires across Australia. Bauerfeind supports the work of the ALA as a Corporate Member.. Extensive campaigning As the leading association of all professionals involved in the field of lymphology throughout Australia and New Zealand, the ALA is working toward a number of initiatives designed to boost training, manage- ment and research in this area. Two years ago, for example, the ALA introduced the National Lymphoedema Practitioners Register (NLPR), a publicly accessible website register of lymphedema practitioners who have been accredited in accordance with the requirements of the ALA. “This is an important step toward building a network of therapists,” Penelope Sanderson is keen to stress, “which enables both patients and healthcare professionals to get in touch with Pictures: Bauerfeind Penelope Sanderson, Manager of the Mercy Health Lymphoedema Clinic in Melbourne, Victoria, with one of her young patients. MEDICAL the experts who are qualified to deal with their requirements.” The ALA also has a key role to play in raising public awareness of the crucial importance of diagnosing and treating lymphedema at an early stage. “This was part of our highly successful inaugural Lymphoedema Awareness Campaign in 2012, which received extensive coverage in the media – both on television and in the local and national press – as well as on our own Facebook page,” says Penelope Sanderson. “The essential points were to provide the public with information about the first warning signs of lymphedema and about how important it is to start treatment early, to prevent the condition from progressing.” Financial support program For those affected by lymphedema, however, early treatment by lymphedema practitioners is only the first step. In the next stage, as part of their therapy, they may also need to wear compression products that they can rely on. Due to the nature of their design, these compression products only have a limited serviceable life, which means that they must be replaced every six months on average. Penelope Sanderson, who is Manager of the Mercy Health Lymphoedema Clinic in Melbourne, Victoria, heads up a multidisciplinary team specializing in treating lymphedema patients. “Here at the Mercy Health Lymphoedema Clinic, we often found that , while patients were certainly willing to undergo treatment , they could not afford the costs of compression products on a long-term basis,” says Penelope. “ Together with our patients and the Lymphoedema Association of Victoria (consumer group) we lobbied the government to set up a fund to finance the costs of compression products for lymphedema treatment. We had to apply a bit of pressure before the government eventually decided, after the completion of a pilot scheme, to provide long-term financing for such a fund. The result is the Lymphoedema Compression Garment Program (LCGP) set up to address the issues for patients on low incomes to receive financial assistance for compression stockings.” It is important that the funding is used to promote effective and targeted therapy. Products endorsed by the LCGP therefore have Lymphatic compression treatment in Australia Bauerfeind has been established in the Australian market for almost five years and in this time has worked closely with the LCGP. The VenoTrain curaflow product range has been widely used and been approved to provide patients with high-quality custom-made lymphatic treatment. The strong, finely meshed knit of these garments combines excellent elasticity with optimally controlled surface pressure. Thanks to its high microfiber content , latex-free materials and special comfort zones, VenoTrain curaflow sets new standards in patient-friendly lymphatic therapy. to fulfill certain criteria. They must be shown to exert controlled pressure in accordance with the RAL quality assurance standards, for example. Their quality also has to be verified in accordance with the Oeko-Tex Standard 100 or an equivalent standard. Lymphedema patients who reside permanently in the state of Victoria and receive a pension or only a low income are eligible for financial support from the program. Depending on a number of factors, the LCGP covers part of the costs of the compression products. Children as lymphatic patients In her work, Penelope Sanderson focuses particular attention on lymphological treatment for children. “In recent years, more and more children and young people have come to us with lymphatic problems. In numerical terms, they still don’t make up a large proportion of our patients, but these VenoTrain curaflow young people have to undergo treatment for the rest of their lives,” she says, outlining the situation. “That’s why it is important for treatment to begin at an early stage, and for the children and their families to be provided with training and support in “ It is important that the funding is used to promote effective and targeted therapy.” (Penelope Sanderson) handling compression products. Those affected are often completely overwhelmed at first when they find out that this is a chronic condition. Here at the clinic, we provide psychological support , as well as advising families on how to deal with a healthcare system that is sometimes far † from straightforward.” For further information please visit: www.lymphology.asn.au (ALA website) www.nlpr.asn.au (NLPR website) MAS Medical , the exclusive Bauerfeind distributor: www.bauerfeind.com.au life magazine 2012/2 35 36 Pictures: Bauerfeind Picture: Corbis/Darryl Leniuk IN MOTION life magazine 2012/2 IN MOTION The outdoor life – diving Another world It is like anything else: you need to look under the surface to see how things really are. This is particularly true of diving. Anyone penetrating the surface of the sea finds they are diving into another world. The ritual is always the same: the final check, turning on the oxygen valve, donning the diving goggles, putting the mouthpiece in place. The leap from the boat into the sea is liking traveling through time to enter a whole new world, a world which cannot even be described properly when standing on the boat. The world beneath the sea is a self-enclosed habitat. We, the >>> divers, are merely guests in this world full of color, fish, and life. life magazine 2012/2 37 IN MOTION Are the oxygen reserves and pressure readings in the green? The diver uses special hand signals to give the OK. are, the more varied their list of favorite diving spots will be. Selected diving hot spots A very interesting diving area, which is also close to Europe, is the Red Sea. Egypt is an ideal base from which to access the many reefs and wrecks, as well as being an affordable holiday destination with a very good tourism infrastructure in the holiday regions. There is a resort to suit practically all pockets and more diving bases than you could wish for. Even little Bonaire has almost 100 diving sites, many of which can be accessed from land. Bonaire is something of a dream island for diving fanatics. Located in the southern part of the Caribbean just 80 kilometers north of Venezuela, the island forms part of the Dutch Caribbean (formerly the Dutch Antilles), along with Aruba and Curaçao. Seen from above, Bonaire looks like a giant boomerang drifting on the sea. During September and October, the “coral spawning” is the kind of event to attract divers who like the sport for its contact with the living, natural world. Set in the Indian Ocean to the south west of India, the Maldives offer some tremendous For further information: Various diving associations offer open-water diving courses. Most diving sport associations have the relevant authorization. The openwater diving training and certification provided by PADI (Professional Association of Diving Instructors, www.padi.com) is recognized by scuba drivers around the world. PADI is also the world’s biggest member organization for sports diving. Professional PADI members make up the majority of sports divers around the world and issue more than 900,000 certificates every year. 38 life magazine 2012/2 sites of natural beauty with their living reefs. The annual average temperature for the Maldives is around 28 degrees. The temperature never drops below 25 degrees and water temperatures remain constant at 28 degrees. In other words, a little piece of paradise. Far more lively than the Maldives is the Divers’ paradise: the Maldives. world’s largest and best-known diving hot spot , the Great Barrier Reef off the east coast of Australia, which at over 2,000 kilometers long offers countless areas for diving. More than two million diving and snorkeling fans slide into the clear water of the Great Barrier Reef every year to enjoy the colorful coral and the limitless variety of fish. Getting started is easy Those new to diving are best advised to complete their diving training at a local diving school. Anyone wishing to start a diving course during a foreign holiday, however, would do well if possible to try and find a diving course which teaches the basics in their own language, since some knowledge of the theory could literally save their lives. Providing you stick to the rules you have learned, diving should be more fascinating than dangerous. Arrogance and overconfidence are † what make it dangerous. Pictures: Fotolia/JonMilnes/traveller >>> The seas around the Earth offer countless sites for diving, and every diver can find something to enjoy under the water. Some like the brightly colored coral and its bizarre shapes or the comical clownfish in the poisonous anemones. Others like the different kinds of sharks, the mantas, and barracudas. There are also those who like the hollows, grottos, and underwater labyrinths, while others get their kicks by exploring old shipwrecks. Wreck diving is one of the greatest fascinations for sports divers. It gives divers the chance to really indulge their appetite for adventure and discovery. It is impossible to describe the feeling of diving down to a wreck, when that initial hazy image becomes ever more detailed and clearer the closer you approach. Wrecks at sea always have their own special story to tell: the story of their life, their destruction, and their watery burial. Rather more controversial , although genuinely thrilling, is cage diving with white sharks, which mainly takes place off South Africa and South Australia. These gigantic sharks with their cold eyes and huge teeth send a shiver down the spine, even in the warmest of water. The more varied a diver’s ambitions SERVICE Bauerfeind worldwide Bauerfeind AG Triebeser Strasse 16 07937 Zeulenroda-Triebes Germany Phone +49 (0) 36628-66-10 00 Fax +49 (0) 36628-66-19 99 Adresses: E-mail [email protected] Croatia Bauerfeind d.o.o. 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Box 505116, UAE-Dubai Phone +971 4 4335 685 Fax +971 4 4370 344 E-mail [email protected] United Kingdom Bauerfeind UK Phyllis House 229 Bristol Road GB-Birmingham B5 7UB Phone +44 (0) 121 446 53 53 Fax +44 (0) 121 446 54 54 E-mail [email protected] USA Bauerfeind USA, Inc. 3005 Chastain Meadows Parkway Suite 700 Marietta, GA 30066 Phone 1 800 423 34 05 Phone (770) 429 83 30 Fax (770) 429 84 77 E-mail [email protected] life magazine 2012/2 39 MEDICAL COMPRESSION STOCKINGS Vena Ve naa femoralis ffem emor oral alis is ——G Vena saphena magna ——G G—— Vena saphena magna Vena poplitea ——G G—— Vena poplitea G—— Vena tibialis anterior G—— Vena tibialis posterior Vena tibialis posterior ——G Vena saphena parva ——G Vena saphena magna ——G medical compression stockings: systematic indication-based treatment. soft | soft S iimpuls + ulcertec For mild to moderate eraate vein problems F advanced vein For ein problems pr F active venous For us uulcers Robust, long-stretch ch stockings with a gentle entle massage effect during ing movement – special al soft S version for people who spe spend end a lot of time sittingg down Short-stretch Sh stockings kings that th generate a constant onstant deep de action even during slight sli muscle movements ements – microfibers makee these stockings sto soft and breathable breathaable A practical combination nation of of oouter stocking andd liner, with a unique pressure w ssure profile that accelerates p erates the th he healing process while h hile ensuring enssuring eexceptional patient nt comfo comfort ort Motion is Life: www.bauerfeind.com