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Sunday, July 25, 2010

Philosophy of Treating Athletic Injuries (Part IV)

Problems arise when the doctor treats the patient on a slow course, cutting expenses, when the patient wants to be cured today. Some patients must face reality. If they want the best, more effective treatment of their problem, they must give the time and energy and expense to accomplish it. Medical care costs are getting out of control, and paying for it more of a burden.

The second purpose of this 4 part article is to minimize the patients for going elsewhere when their treatment is slow or recurring. Again, communication is the key. The doctor or therapist must respect the patient as a person and the patient must view the doctor/therapist as someone truly concerned. Sometimes, there are no good answers. I try to limit those to a small percentage. I find that if I can communicate with a patient, treatment goes well. If the patient never trusts me, communication will not go well, and the treatment will be shaky with constant problems.

A patient should already have answered in their mind the following thoughts at the initial visit. These are:
  1. How serious do I think the problem really is?
  2. Do I want only home remedies or can I afford the time and expense of physical therapy done 2 or 3 times a week for 3 or 4 weeks?
  3. Could I totally rest from my sport if advised? Would that devastate me physically and emotionally?
  4. Do I need to know exactly what is wrong on the first visit, or can xrays, bone scans, MRIs, etc wait if initial treatment does not work?
  5. Do I want to take the necessary steps to prevent recurrences if lifts, shoe inserts, daily exercises, prolonged therapy is recommended, or do I think of this as a one-time occurrence?
  6. Is the cost of care a big issue? What does my insurance cover? What is my deductible?
Without knowing the answers to these questions, the doctor or therapist may make some wrong decisions in your care.

So, you have an injury and want freedom from it. Some of the basic rules that everyone must follow are:
  1. No running, dancing, etc, if you can not walk without pain.
  2. Never exercise with pain; if you have an injury, you can not do anything that keeps producing the pain cycle (see the separate post on Good Pain vs Bad Pain)
  3. If there is swelling, you must work on that daily to reduce as soon as possible with compression, massage, elevation, contrast (see post on Secrets of Contrast Bathing).
  4. If there is stiffness, full return to activity is restricted until the stiffness is greatly improved.
  5. If the decision to start your activity has been made, and you are experiencing a return in symptoms, you must rest again for minimum of 2 weeks. You are just not ready.
  6. Alternative activities to cross train are normally encouraged to maintain cardiovascular fitness.
With some injuries, the sequellae of scar tissue accumulation and muscle weakness, joint instabilities and stiffness, chronic swelling and nerve hypersensitivities, all can play a role in a slow return to normal activity. Rest alone may not help some injuries, and treatment may be prolonged in addressing these issues. Of course, no athlete wants to deal with that. If there has been permanent damage as the result of the injury, only partial rehabilitation may occur.

For most injuries, reversal of the cause is often helpful, and even mandatory. Without finding the cause, the injury may chronically recur over and over. But for many injuries, that can be overdone or misused. For example, flat feet can cause knee pain, or prevent knee pain from getting better. So, should all patients with knee pain and flat feet get corrective inserts? If you realize 90 + percent of all patients with knee pain get better without correcting the flat feet, you can perhaps see that treating flat feet in all cases of knee pain would be improper. The clinician needs to select only those patients that really need it. This is not always a simple task to accomplish. Temporary orthotic devices, like Your Sole, which can be modified for greater support if needed, have created a wonderful diagnostic test to see what patients may need permanent corrective devices. The patient's response to the insert will help make the decision on custom orthotic devices easier. But, this is just a small example of cause reversal. With every injury, there are a myriad of common causes, and some not so common causes, that may need to be treated as treatment goes along.

So the doctor and therapist must have free communication with the patient each step of the way in rehabilitating the injury. The patient must understand the doctor or therapist's plan of attack, but help advise on the limitations of time, expense and energy. The patient should be given clear guidelines on the present activity level allowed, the proposed treatment plan, and options for further treatment if needed. With this communication, injuries can become a learning process for the patient, and a guideline for further injury prevention.

I sure hope this 4 part blog on the Philosophy of Treating Athletic Injuries helps if you develop an injury, or if you are presently experiencing an injury and communicating with a doctor or therapist.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.