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mcgillianaireThe Oman Tribune newspaper carried a feature about the work my dad has done for sports medicine in Oman over the past 20 years. Rather disappointingly they didn't upload the actual article onto the newspaper's website, but my mum scanned and sent it to me this morning. I've typed it up and pasted it below. I'm proud to be his son. :) Enjoy and maybe you'll learn something new/useful!
Doctor brings pain to its knees
Chance brought Ramanathan to Oman, his skill keeps him here for two decades, writes Jeta Pillai
It was a chance meeting in England in 1987, with the then head of orthopaedics in Oman that brought Dr EBS Ramanathan to the Sultanate. Ramanathan went on to become the pioneer of sports medicine in the country. He recalls: "On my way back to India from England, I met the then head of orthopaedics, Wahid Al Kharusi, who asked me to come to Oman and then move on to India. But two years have become 20, because this is a good place and very challenging. We had to start sports medicine from scratch. I work mainly in Khoula Hospital, where we have the National Trauma Centre and the National Sports Clinic. Today it is a very busy department."
Ramanathan is a keen sportsman. That is why, while training as an orthopaedic surgeon in England in the early eighties, he developed an interest in sports medicine and later pioneered it in Oman. Ramanathan, 54, played hockey for Madras University and also the combined universities of India. "All through my career, I have been interested in sports and in England I worked under the famous orthopaedic surgeon, Basil Helal, who used to look after the British Olympic team and from there on I took it up myself." He has also worked under other big names in sports medicine, including John Ireland from England, Charles Brown from Boston and in the famous Hospital for Special Surgery in New York, he trained with Stephen O'Brien and David Altchek. Ramanathan had his basic medical education in Chennai. He then did his FRCS in general surgery and orthopaedics and later his M.Ch in orthopaedics from the University of Liverpool.
95% of the patients who come to his sports clinic are footballers and 90% of them have knee injuries. "Unfortunately the severity of knee injuries in Oman is much greater than in Europe, because the ground is very hard. At the grassroots level, football is played on a hard ground. And the physical education discipline is not so good. This takes a toll on the knees," said Ramanathan.
The most common injury is damage to the anterior cruciate ligament (ACL), which is found across the world. "Paul Gascoigne had it, Ronaldo had it twice, cricketer Yuvraj Singh has got it, but he is carrying on. He has good secondary ligaments, but as time passes they start stretching out and his knee will give way and he will have to undergo surgery. When you lose the ACL, you will be able to run straight, but the moment you pivot, your knee gives way and there is a lot of trouble in the knee joint." He added: "70% of non-contact injuries take place when you are going to kick the ball and the non-kicking leg goes into hyper-extension; it is a sort of double-jointed and the twist on that damages the ACL. With direct injury you do not have much control."
My dad in the middle of an operation. Most of his surgeries are performed with only an arthroscope that relays its images via the monitor.
In the US, there is a lot of effort to avoid such non-contact injuries with neuro-muscular training among women. "In the US, soccer is more popular among women. They have done a very good evidence-based study, where it is found that certain types of pre-season training will reduce injuries. Neuromuscular training tries to get coordination between muscles, your thinking and your nerves. It was found that when soccer players were landing, their hips were flexed and knees straight. All they did was turn it around with the knee bent and the hip a little straighter and then a few steps - with this they could break the fall and reduce the pressure on the knee joints. This is coordination between the muscles and nerves. For Oman, we have to do our own study."
Most muscle cramps and pulls take place due to dehydration and fatigue. "Even in Europe, a lot of the injuries occur during extra time, when the muscles are fatigued and dehydrated. Here it can occur earlier, because the players are already dehydrated."
Ramanathan's experience in trauma has helped him provide exact treatment to sportsmen patients in cases like fracture. Similarly, his experience in sports medicine has helped him treat trauma patients better. "In sports medicine, we pay a lot of attention to soft tissue and try to get them back to sports as soon as possible, for which the most important thing is physiotherapy and exercises." So also in trauma patients, "if you pay a lot of attention to the soft tissue during surgery, there is less chance of infection and post-operative complication." Today, any surgery, including that of the knee replacement, can be done in Oman. "I do about three types of reconstruction and it is on par with anything in the world. The results are very good, because we have adapted according to our patients. The patient profile, the personality of the injury depends not just on the injury, but the patient, doctor's skills and the environment."
According to Ramanathan, sports has many benefits. It provides recreation, teaches sportsmanship and team spirit, nurtures leadership qualities, instils competitive spirit, teaches disciplaine, respect for the opponent, patriotism, and keeps the young away from bad habits. But his advice to youngsters is to avoid over-enthusiasm. "Go level by level; when you jump levels, you are prone to injuries known as over-use injuries. So long as your training is scientific and you get coached before you start the game, you can avoid a lot of injuries."
It is not necessary that treating a top player would give him the most satisfaction. A majority of his patients in Khoula Hospital are grassroots level players. 18-19 year-olds come with ACL injuries and say they can't play. After surgery and treatment, "when they come back to you and say they are back to full time football, it gives you great satisfaction. We have done more than 5,000 arthroscopies and 1,500 ACLs. We cater to the whole country," Ramanathan added. He considers clinical examination the key to diagnosis. 99% of the time, especially for ACL and meniscal injuries, clinical examination gets it right. Clinically, the knee joint is very amenable for examination and each test, if done properly, will give you the correct diagnosis, said Ramanathan. "Even today, most of my patients do not need MRI scan. We do it in case there is something outside the joint and to convince the patient."
Ramanathan is a Senior Clinical Lecturer at the College of Medicine, Sultan Qaboos University; Vice-President of the Indian Association of Sports Medicine; Chairman, Scientific Commission, Asian Federation of Sports Medicine; and a member of the Scientific Commission of the International Federation of Sports Medicine. His heroes are Indian cricketer Sachin Tendulkar and Stephen O'Brien. It was on the latter's advice that he began doing "intra-articular reconstruction, using the patient's tissue. We could have used artifical ligament or ligament from cadaver. But using the patient's own ligament turned out to be a winner."
Doctor brings pain to its knees
Chance brought Ramanathan to Oman, his skill keeps him here for two decades, writes Jeta Pillai
It was a chance meeting in England in 1987, with the then head of orthopaedics in Oman that brought Dr EBS Ramanathan to the Sultanate. Ramanathan went on to become the pioneer of sports medicine in the country. He recalls: "On my way back to India from England, I met the then head of orthopaedics, Wahid Al Kharusi, who asked me to come to Oman and then move on to India. But two years have become 20, because this is a good place and very challenging. We had to start sports medicine from scratch. I work mainly in Khoula Hospital, where we have the National Trauma Centre and the National Sports Clinic. Today it is a very busy department."
Ramanathan is a keen sportsman. That is why, while training as an orthopaedic surgeon in England in the early eighties, he developed an interest in sports medicine and later pioneered it in Oman. Ramanathan, 54, played hockey for Madras University and also the combined universities of India. "All through my career, I have been interested in sports and in England I worked under the famous orthopaedic surgeon, Basil Helal, who used to look after the British Olympic team and from there on I took it up myself." He has also worked under other big names in sports medicine, including John Ireland from England, Charles Brown from Boston and in the famous Hospital for Special Surgery in New York, he trained with Stephen O'Brien and David Altchek. Ramanathan had his basic medical education in Chennai. He then did his FRCS in general surgery and orthopaedics and later his M.Ch in orthopaedics from the University of Liverpool.
95% of the patients who come to his sports clinic are footballers and 90% of them have knee injuries. "Unfortunately the severity of knee injuries in Oman is much greater than in Europe, because the ground is very hard. At the grassroots level, football is played on a hard ground. And the physical education discipline is not so good. This takes a toll on the knees," said Ramanathan.
The most common injury is damage to the anterior cruciate ligament (ACL), which is found across the world. "Paul Gascoigne had it, Ronaldo had it twice, cricketer Yuvraj Singh has got it, but he is carrying on. He has good secondary ligaments, but as time passes they start stretching out and his knee will give way and he will have to undergo surgery. When you lose the ACL, you will be able to run straight, but the moment you pivot, your knee gives way and there is a lot of trouble in the knee joint." He added: "70% of non-contact injuries take place when you are going to kick the ball and the non-kicking leg goes into hyper-extension; it is a sort of double-jointed and the twist on that damages the ACL. With direct injury you do not have much control."
My dad in the middle of an operation. Most of his surgeries are performed with only an arthroscope that relays its images via the monitor.
In the US, there is a lot of effort to avoid such non-contact injuries with neuro-muscular training among women. "In the US, soccer is more popular among women. They have done a very good evidence-based study, where it is found that certain types of pre-season training will reduce injuries. Neuromuscular training tries to get coordination between muscles, your thinking and your nerves. It was found that when soccer players were landing, their hips were flexed and knees straight. All they did was turn it around with the knee bent and the hip a little straighter and then a few steps - with this they could break the fall and reduce the pressure on the knee joints. This is coordination between the muscles and nerves. For Oman, we have to do our own study."
Most muscle cramps and pulls take place due to dehydration and fatigue. "Even in Europe, a lot of the injuries occur during extra time, when the muscles are fatigued and dehydrated. Here it can occur earlier, because the players are already dehydrated."
Ramanathan's experience in trauma has helped him provide exact treatment to sportsmen patients in cases like fracture. Similarly, his experience in sports medicine has helped him treat trauma patients better. "In sports medicine, we pay a lot of attention to soft tissue and try to get them back to sports as soon as possible, for which the most important thing is physiotherapy and exercises." So also in trauma patients, "if you pay a lot of attention to the soft tissue during surgery, there is less chance of infection and post-operative complication." Today, any surgery, including that of the knee replacement, can be done in Oman. "I do about three types of reconstruction and it is on par with anything in the world. The results are very good, because we have adapted according to our patients. The patient profile, the personality of the injury depends not just on the injury, but the patient, doctor's skills and the environment."
According to Ramanathan, sports has many benefits. It provides recreation, teaches sportsmanship and team spirit, nurtures leadership qualities, instils competitive spirit, teaches disciplaine, respect for the opponent, patriotism, and keeps the young away from bad habits. But his advice to youngsters is to avoid over-enthusiasm. "Go level by level; when you jump levels, you are prone to injuries known as over-use injuries. So long as your training is scientific and you get coached before you start the game, you can avoid a lot of injuries."
It is not necessary that treating a top player would give him the most satisfaction. A majority of his patients in Khoula Hospital are grassroots level players. 18-19 year-olds come with ACL injuries and say they can't play. After surgery and treatment, "when they come back to you and say they are back to full time football, it gives you great satisfaction. We have done more than 5,000 arthroscopies and 1,500 ACLs. We cater to the whole country," Ramanathan added. He considers clinical examination the key to diagnosis. 99% of the time, especially for ACL and meniscal injuries, clinical examination gets it right. Clinically, the knee joint is very amenable for examination and each test, if done properly, will give you the correct diagnosis, said Ramanathan. "Even today, most of my patients do not need MRI scan. We do it in case there is something outside the joint and to convince the patient."
Ramanathan is a Senior Clinical Lecturer at the College of Medicine, Sultan Qaboos University; Vice-President of the Indian Association of Sports Medicine; Chairman, Scientific Commission, Asian Federation of Sports Medicine; and a member of the Scientific Commission of the International Federation of Sports Medicine. His heroes are Indian cricketer Sachin Tendulkar and Stephen O'Brien. It was on the latter's advice that he began doing "intra-articular reconstruction, using the patient's tissue. We could have used artifical ligament or ligament from cadaver. But using the patient's own ligament turned out to be a winner."
