I came around the corner just as he was sitting this elderly gentleman down.
He looked at me and said: “deal with this I’m going back to the bench”.
Fairly confused, I looked at this elderly gentleman and asked what happened?
He was on the ice taking pictures of the hockey team, as he walked off he slipped and fell on the ice.
Bearing weight on the right side was painful, but there wasn’t a lot of pain while sitting down. I grabbed his leg and passively moved it, no pain.
He called his wife (who was more than a little upset as the game had just started and now she was missing it) because I said he needed to go to the hospital.
We draped his arms over our shoulders and walked him out to their mini-van. She took him to the hospital and I didn’t see them for another year.
For years I have taught first aid courses to other Massage Therapists.
I have viewed the power point slide, I have repeated the information in the slide, I have highlighted the importance of the slide.
The slide I’m talking about says you should all 911 if:
- The injury involves the head, neck, or back.
- The injury makes walking difficult.
- The injury involves the thigh bone or pelvis.
- There is an altered level of consciousness.
However, things didn’t add up.
When it comes to treating injuries and dealing with first aid, one of the things we always harp on is “Mechanism Of Injury” (MOI).
We always use this as a method to quickly determine if there is a spinal, head or neck injury, to see if spinal precautions need to be taken. For those of you who have taken advanced or even basic first aid (and let’s be honest, just as the anatomy pro’s that you are) you understand the importance of stabilizing the neck to reduces possible spinal injuries.
But in this case the mechanism of injury made me second guess myself.
We always worry about further injury when a persons injury is a result of:
- A fall from any height.
- Found unconscious for an unknown reason.
- A diving injury.
- A blow to the head, neck or trunk.
- A car accident.
- Lightning strike or electrocution.
- A persons helmet is damaged.
But this guy didn’t fall from a height, so why would I worry about the injury being that extensive!?
All he did was slip on the ice, there was no fall from a height of any kind.
But like an idiot, I didn’t use the information I had taught so many times.
Walking was difficult and the injury was to the pelvis, it should have been a 911 call.
However since I didn’t think the mechanism was bad enough, I was comfortable to get him to the hospital without using an ambulance.
For years I taught these courses and never understood why there would be a power point slide about Osteoporosis.
NOW I KNOW!
When I saw this fellow a year or so later, he looked completely different (he had developed some other health issues well beyond his fall that night).
I asked him how things turned out, he said he had broken his hip and had to have a full hip replacement (as a disclaimer, the injury caused the hip problem, not the fact that I didn’t call 911 that day, I just should have handled things a bit better).
Osteoporosis is the leading cause of bone and joint injuries in older adults, the bones don’t have enough calcium, which makes them frail.
According to osteoporosis.ca there are some frightening statistics:
- 70-90% 0f 30,000 annual hip fractures are a result of osteoporosis.
- 1 in 3 women and 1 in 5 men will suffer a fracture due to the disease.
- Without BMD (bone mineral density testing) 80% of fracture patients are not getting proper osteoporosis therapy.
- 80% of all fractures in people over the age of 5o are a result of osteoporosis.
- Fractures from Osteoporosis are more common than heart attack, stroke and breast cancer combined.
Think about what this means for your practice.
How many people do you see on a regular basis that are over the age of 50?
This exact situation could happen at any point in your clinic with an older person coming in for treatment. That gentleman didn’t know he had Osteoporosis, but was diagnosed with it after he fell.
If at anytime one of your patients comes in and suffers a fall on-site that seems harmless enough but there is an injury to the pelvis or thigh and makes it difficult to walk, be sure to call 911 and get them to the hospital in an ambulance. If the person suffered a fall at home and is coming in for treatment, there are some things to look out for. Check for any deformities in the area they are complaining about, along with swelling and point tenderness that could indicate possible injury.(1)
Studies are showing how exercise and strength training are effective ways to manage Osteoporosis once a patient receives the diagnosis, which also plays an important role in building confidence to prevent future falls. As Massage Therapists we want to make sure to use the appropriate pressure when giving treatment, to avoid any injury while the patient is on your table. One study researched a L5 unilateral pedicle fracture on a 66 year old man as a result of an aggressive back massage.(2)
Do yourself, and your patients a favour by not making either of these mistakes when trying to help them out.
- Badiyani K, Bottomley J. OSTEOPOROSIS AND ITS MANAGEMENT IN THE ELDERLY. Gerinotes [serial on the Internet]. (2014, Mar), [cited October 24, 2016]; 21(2): 11-18. Available from: CINAHL Complete.
- Guo Z, Chen W, Su Y, Yuan J, Zhang Y. Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review. European Journal Of Orthopaedic Surgery & Traumatology [serial on the Internet]. (2013, Nov 2), [cited October 24, 2016]; 23(2): 149-153. Available from: CINAHL Complete.