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Saturday, December 14, 2019

Philosophy of Treating Athletic Injuries (Part 2)

Philosophy of Treating Athletic Injuries (Part 2)
A patient should have already answered in their mind the following thoughts before coming to the initial visit (these can be sent to them in the initial email or fax of paperwork). 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, financially, and/or emotionally?
4.     Do I need to know exactly what is wrong on the first visit, or can X-rays, 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 with regard to your care.
So, you have an injury and want freedom from it. Some of the basic Golden Rules that everyone must follow are:
1.     No running, dancing, etc., if you cannot walk without pain.
2.     Never exercise with pain; if you have an injury, you cannot do anything that keeps producing the pain cycle.
3.     If there is swelling, you must work on that daily to reduce it as soon as possible with compression, massage, elevation, contrast.
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 two weeks. You are just not ready.
6.     Alternative activities to cross-train are normally encouraged to maintain cardiovascular fitness.
With some injuries, the sequelae of scar tissue accumulation and muscle weakness, joint instability 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 a result of the injury, only partial rehabilitation may occur. It is so important to quickly produce a pain-free environment (0-2 pain levels maintained). How to get there normally dictates some of the early treatment.

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 that most 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 a certain treatment. This is not always a simple task to accomplish. Temporary orthotic devices, like Power step or Sole, which can be modified for greater support if needed, have created a wonderful diagnostic test to see which 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, which 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's or therapist's plan of attack, and 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.
The above is from my book: Secrets to Keep Moving. 

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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.