Ep 279: Treat the athlete, not her scan, with Pirette Claes & Dr Pim van Klij

I s- I suppose there's also a bit of a movement, and we've seen this particularly in the osteoarthritis field, where there's a push for radiologists when they're reporting on imaging to move, shift the language they're using.

And, and I've certainly seen studies where they will test different types of language and messaging and, and how that's interpreted by patients.

And Pierrot, it sounds a bit like that's what you're alluding to here, is sometimes it's the language can seem really scary when, when you read your X-ray report and it says you've got sclerosis of the pubic symphysis, you think, "Oh my gosh, that's, that seems really bad." So how do you, how do you s- explain what's going on to athletes and, and how do you break that cycle between seeing the image, seeing the report, and freaking out?

Yeah.

I think it's very important to really emphasize that it's something you see a lot in healthy athletes as well, and maybe also focus on the fact that it's not just wear and tear, but that it's also just a sign of female athleticism.

It's almost like celebrating the, the athleticism as opposed to saying, "You've got something wrong with your pelvis."

Yeah, exactly.

But I do think it's very important to point out that we need to follow these athletes over time, so to do to a longit- like the longitudinal study, so as to see what comes of these radiographic findings.

Pim, in your clinical experience, what has worked with these conversations with athletes around imaging?

Especially in professional sports, when there is somewhat of an injury, one of the first questions is, "Hey, doc," or, "Hey, physio, how much time is it gonna take me?" And then, yeah, we try to give them somewhat of a scientific-based answer, which is kind of tricky.

And then the second question is, "Okay, can I get an X-ray or an MRI or an ultrasound to just prove it what I have?" And then the tricky part starts again because then we end up maybe with an X-ray where we see a lot of things around, for example, the pubic symphysis while having pubic-related groin pain, for example.

And then we still just don't know what is causing the pain.

For athletes, sometimes one and one is two, but it's not that easy, I would say, to just combine the clinical perspective with this additional imaging.

Even MRI studies have a bit of the same issue around these, these morphological things.

So that's the reason why we call it nowadays morphological changes and not deformities or lesions anymore because that will get the message a bit away from disease and illness.

There's some difference around that, that area.

So I would say we have to describe it.

We screen it sometimes, especially if you think around red flags, okay, of course you need additional imaging.

But if you just look into an overuse injury, we first go on the clinic and just work with clinical parameters first.

And if it stagnates or gets worse, okay, then you can later on in the, in the rehab, you can make a side path towards additional imaging.

Always start first with your clinical examination and your clinical progression.

And we have more and more studies that are bearing that out.

I'm thinking particularly of a lot of the Aspetal work in hamstring injury, where really the imaging findings are not adding much, if anything, to the clinical examination, and it s- really speaks to having strong examination skills and working hard on developing those as a clinician as opposed to relying on the imaging.

I suppose it's hard when a lot of professional teams now are investing in imaging within the team setup, so it becomes, it becomes expected.

Yeah.