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dr medical Markus Klingenberg in an interview about screening in prevention and rehabilitation
dr medical Markus Klingenberg, born in 1978, is a specialist in orthopedics and accident surgery, sports medicine, chirotherapy and emergency medicine. In addition, he is qualified as a diving physician, nutritionist and doctor for prevention and health promotion. As an author, Dr. Klingenberg regularly writes articles on sports medicine topics for various specialist journals and works as a speaker in sports medicine training courses for doctors and trainers.
Markus, you are an orthopaedist, sports physician and author. What is your everyday life like?
I work in Bonn as a partner in a joint practice made up of orthopaedists, neurosurgeons and radiologists, which is part of the Beta Klinik. My focus is on the conservative and surgical treatment of joint problems and sports injuries. In addition, there is the medical management of the sports rehabilitation area.
The combination with our own imaging, surgical options and a sports and rehabilitation area enables comprehensive patient care. In addition to the consultation hours and the operational work, I spend a lot of time with our physiotherapists and sports scientists.
You publish a lot on the topics of screening and movement analysis. What made you decide to deal with the subject of screening?
During my time as an assistant doctor at the Sporthopaedicum in Bavaria, part of the work consisted of postoperative checks on patients who had had their anterior cruciate ligament replaced. On some days, more than 30 patients showed up for check-ups three, six, nine or twelve months after their surgery. The typical orthopedic examination is very focused on the knee joint and the stability of the cruciate ligament. Mobility of the knee joint, Lachmann test, front drawer and a KT-1000 measurement are standard and were mostly within the normal range.
Out of interest, I studied one-legged stand, finger-to-floor spacing, a deep squat, and ankle mobility. I was surprised how often clear deficits were visible in these tests, although the patients were subjectively very satisfied with the result. That was the trigger for me to deal intensively with various functional screening methods.
How do you use these methods in everyday life today?
A screening is an integral part of my everyday life. Inspection, palpation and verification of function are part of every orthopedic examination. In everyday life, however, “function” often only means checking certain areas – mostly where it hurts. I incorporate general movement patterns into my investigation and then work my way to the painful region in a structured way. For the patient, this often means an aha moment – “I hadn’t even noticed that before.” or "Do I have to be able to do that?". In this way, the willingness of the patient to carry out a complete screening in the field of sports and rehabilitation and subsequent training also increases.
Sooner or later, a structural problem in the musculoskeletal system will lead to functional adjustments and a change in neuromuscular control. Therefore, it is of course important to detect and treat structural complaints through physical examination and imaging, but at the same time to recognize and treat functional deficits as well. Exercise is one of the most effective medicines. We should dose them just as carefully.
Is there a difference for you whether you screen an athlete with or without symptoms?
Basically, the principles and the movement patterns that I examine and the test methods are the same - it's also the same musculoskeletal system. The extent varies depending on an injury pattern.
For me, screening is a continuum. From a movement analysis, I derive exercise recommendations that can be carried out with the help of a therapist or on my own. Logically, it is necessary to check the success of these measures over time. Depending on the result, we call the athlete back after three, six or twelve months. We call it our recall system. Dentists have been successfully demonstrating this to us for decades with regular one to two examinations per year.
As part of your recall system, especially in sports, do you see a connection between a successful course of therapy or training and compliance with regeneration times?
The recall system creates a status quo of the basic physical abilities and thus the basis for meaningful training goals. Furthermore, it creates awareness in the athlete for preventive training. In this way, we can address relevant deficits in the musculoskeletal system before noticeable symptoms occur. The topics of breathing and sleep are also addressed.
How important is regeneration in sport for you?
Regeneration is just as important for improving physical performance and well-being as training and nutrition. Missing or insufficient regeneration
often leads to reduced performance, injury or illness. More than once I have contracted an upper respiratory tract infection myself due to a lack of recovery. It is always crucial to keep an eye on the sum of the “stressors”. Training, work and private life must be taken into account during regeneration. Ultimately, it's about finding a balance or balance.
You also teach a course on Return to Sport . What do the participants learn there?
The course teaches effective screening methods that can be easily integrated into prevention and rehabilitation programs. In terms of time, space and finances, the effort involved in screening is very manageable. Course participants are trainers, therapists and doctors. Good and appreciative communication between these groups is a very important success factor for returning to sport after injury.
I particularly like the exchange during the course and the joint work on case studies. Another focus is the connection between a screening and the exercises to be derived from it. It is crucial that what has been learned can be put into practice immediately. This includes meeting the organization, documentation and billing.
What equipment does a trainer or therapist need to screen with your algorithm?
It was important to me to keep the amount of accessories very manageable. You will need a mat, a stick with a length indicator, a hurdle, a tape measure, portable weights, balance pads and an Easy Balance Test . Most trainers already have a smartphone with a stopwatch and camera function. That's basically it.
Do you actually give training yourself and how often do you train yourself?
For me, training is an indispensable compensation for my everyday life. That's why I try to train at least half an hour six days a week. Regardless of that, I still work as a coach myself to a small extent. I have a contract with a well-known German telecommunications group for PT and coaching for their management. This training usually takes place very early in the morning, before the customer and I start our actual day-to-day work. It is important to me that I know what I am talking about when leading my team of therapists and trainers or giving training.
What tools do you use regularly?
It is important to me to familiarize the athletes and patients with training equipment as part of our care, which they can then use independently. This includes above all mini and super bands, fascia rollers and balls, sling trainers, kettlebells, balance trainers and of course a mat. Training equipment offers the athlete excellent help for self-help and, in my experience, also supports the motivation to implement a training session.
