Dr. Karim Khan MD, PhD, FACSP
Professor Karim Khan, MD, PhD, FACSP, is probably best-known to physiotherapists for his contribution to the management of tendon problems. He has partnered with physiotherapists in multidisciplinary clinical practices, in serving elite sportspeople as well as in research collaborations. As well as his > 250 peer-reviewed publications, Karim is a coauthor of a ‘gold-standard’ textbook for physiotherapists – Clinical Sports Medicine currently in its 4 edition. The book’s 14 physiotherapist coauthors celebrate the many evidence-based therapies that the profession has contributed. Karim is the Director of Research & Education at the Aspetar Orthopaedic & Sports Medicine Hospital in Doha, Qatar and the editor of the British Journal of Sports Medicine. You can get updates from him via Twitter @BJSM_BMJ
More Considerations with Tendinopathy
Michael Kjaer, a tendon expert in Denmark has shown that concentric load may be as effective as eccentric. When considering treatment of tendons qualities of the load should be considered including; relative rest, types of load, progression of load, frequency, pain production, and education of behavior of pain to the patient throughout the time it’s loaded. Dr. Khan refers to the Alfredson study you can find below.
“Turn movement into repair”
Education to the patient is key. Health literacy is needed. Historically we’ve thought we were strengthening but it’s now understood differently.
To Dr. Khan it comes back to health literacy. Love of technology and love of what’s not understood which is promoted deliberately by those that have financial interest in them which is a battle. Improve literacy through various means should be our immediate action.
To professional audiences he has taught often on mechanotherapy and showing through artistic illustration the impact of load on cells and tissue and how the tissue repairs through mechanical loading. You can find the BJSM episode on mechanotherapy here.
Dr. Khan gives the popular story Hogan Alfredson, an orthopedic surgeon in northern Sweden who was dealing with his own Achilles tendon pain. He wanted surgery due to his inability to run and when asking a colleague to repair it and that colleague refusing unless he ruptured it, he attempted to rupture his own tendon through exercise. The outcome was not what he expected.
Listening to the patients. It’s about sitting down and allowing the patient to explain, keeping it broad to allow the patient to reveal potentially critical information. Also be okay with patients choosing poor choices. If they leave your advice seeking the quick fix, they’ll often return once that fails. He received good advice from a mentor long ago in, “Were giving proper care here. Were not giving the quick fixes.”
Doing and Understanding Differently Now
More confidence in conservative methods to treat musculoskeletal conditions where prior he would have thought otherwise. He believes we’re not as close to finding that magic bullet. It’s not a technology solution.
Chad Cook’s text on orthopedic examination and special tests. Clinical Sports Medicine by Peter Brukner and Dr. Khan which features 118 contributing authors including well known physios like Jill Cook, Kay Crosby and Jenny McConnell. BJSM podcast is also a good resource with over 150 episodes.
Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Am J Sports Med. 1998 May-Jun;26(3):360-6.
You can read more here.
Eccentric exercise: acute and chronic effects on healthy and diseased tendons. Kjaer M, Heinemeier KM.
You can read more here.
A good resource regarding secrets of success is in a book titled Outliers. Success comes from an environment that facilitates growth and that encourages success. The idea of having a mentor is also key according to Dr. Khan which he’s made a habit of seeking out along the way. Read widely to invest in the distilled wisdom of others who may have spent a lifetime learning about a particular topic. Ideas like Gladwell or the Heath Brothers on behavior change
You can hear more from Karim Khan on twitter at @BJSM_BMJ