MASSAGING LEG AFTER CAST IS REMOVED, IF SWELLING IS THERE, KINDLY CONSULT Dr.

A 23-year-old Delhi man recovering from a fractured ankle died after his mother gave him an oil massage to relieve the pain. 

The man injured himself while playing badminton in September. His ankle was put in a cast to immobilise it while it healed, which led to a blood clot forming in his leg veins. Even after the plaster was removed, the man had pain and swelling in his leg. 

“Deep vein thrombosis is a known complication of plastering the legs. It is not very common, but it happens. Hence, it is important that an orthopaedic doctor be consulted in case the pain and swelling persists even after the plaster is removed,” said Dr Sudhir Gupta, head of the department of forensic medicine at All India Institute of Medical Sciences (AIIMS), where the postmortem was conducted.

Nearly 70 of every 100,000 patients of bone injury may have deep vein thrombosis, a problem also faced by fliers due to cramped leg room in aircraft, after such immobilisation. 

The postmortem confirmed that death was caused by a large clot, 5X1cm in diameter, which dislodged from the leg veins during the massage and travelled to the pulmonary artery that supplies blood to the lungs, causing instant death.

The 23-year-old was rushed to AIIMS emergency at 9.30pm in an unconscious and unresponsive state. 

“The force applied on the leg during the massage dislodged the clot and resulted in the death,” Dr Gupta said. “This should serve as a warning for people to not massage an area that has been recently hurt. It is okay to put herbal oils or anti-inflammatory creams, but pressure must not be applied on the area. If there are clots, then they will dissolve on their own.” 

The case has been reported in the latest issue of Medico-Legal Journal. It says massages are often given for general fitness and for treating minor health problems. The mother had massaged the leg to alleviate pain and was unaware of the complications. 

“There was no advice recorded in the hospital by the doctors about the risks and dangers of a massage to this affected leg. This advice should have been provided,” it says.

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Why some people 'choke' under pressure revealed

A new study has tried to shed light on why some people choke under pressure and fail to achieve something.

Researchers from The Johns Hopkins University suggested that in situations like this, performance depends on two factors: the framing of the incentive in terms of a loss or a gain, and a person's aversion to loss.

The study found that those with high loss aversion choked when told they stood to gain a lot, while those with low loss aversion choked under the pressure of large prospective losses. By monitoring the participants' brain activity as they were presented with incentives and then performed a skilled movement task, the researchers found that performance is influenced by a brain area called the ventral striatum.

Vikram Chib, Ph.D., assistant professor of biomedical engineering at the Johns Hopkins University School of Medicine, said that they can measure someone's loss aversion and then frame the task in a way that might help them avoid choking under pressure.

The researchers found that an incentive - as a potential gain or loss - had a profound effect on person's behavior while performing a skilled task and the effect of pressure was different for those with high versus low aversion to loss, as high loss aversion seemed to help players' performance when they were threatened with increasing losses.

Chib believes that these results confirm that the ventral striatum is the interface between incentive-driven motivation and execution of physical performance, and he hopes these insights could help coaches and others to work with - or overcome - people's loss aversion in order to maximize their performance. More importantly than playing sports, the insights could help people taking important tests, pilots flying under dangerous conditions or surgeons performing difficult procedures.

The study was published online in The Journal of Neuroscience.

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