Philosophy of Treating Athletic Injuries (Part III)

     Here are some basic principles in the treatment of athletic injuries. The first priority is to decide on the severity of the problem. The two important categories are major and minor. A major injury needs no guesswork in treatment philosophy. The patient may develop permanent injury if not treated quickly, accurately, and intensely. This is the first type of injury we discussed with the inability to walk, severe and intense pain, etc. Diagnosis is important. Xrays are taken, and MRIs, or other tests are considered quickly. Physical Therapy is initiated. Expense, time, risk of radiation become minor concerns or no concern of all. These, in a way, are easier to initially treat. Cookbook teaching is present for most. Follow the book and success in treatment is usually obtained. It may take months or years to rehabilitate, the patient may never run or ski or dance again, but the doctor is the hero. He/She prevented it from getting worse, taking longer, etc. Hopefully, you are completely cured and can resume all activities.

Fortunately, 90 percent do completely recover!!!

And, fortunately, less than 5 percent of all injuries are considered in this major category.

The patient's outlook on their injury varies according to:

1. outlook on severity: major or minor problem to them
2. expense of possible treatment
3. time and energy of possible treatment
4. speed of recovery desired

     Therefore, with 95 percent of all injuries considered minor in consequences,  the doctor/therapist must come to grips with the patient's perspective. The doctor or therapist then maps out a plan of attack after the initial evaluation. Always important to have, this plan of attack  has different variables. These are:

1. Further diagnostic testing ---now or only if not getting better
2. Initial treatment plan---with physical therapists, with home exercises, with medications, with casts, with lifts or other shoe inserts, with training adjustments (ie. rest, alternative exercise), and with taping and other treatment modalities
3. Back-Up treatment plan---if patient does not get better, if patient is better but wants faster relief, and if patient wants insurance to prevent reflares
4. Patient Education Advice---how to prevent recurrence of injuries by knowing the cause of a particular injury (and the causes of most injuries)

As the doctor or therapist maps out the proposed treatment plan, it is based on what the majority of patients with the same or similiar problem became better with. Dr Blake tries to point out all the possibilities of diagnosis, cause, and treatment, and then allow the patient to decide how much expense, time and energy he or she wants to build into the rehabilitation plan. Most patients are started on a home exercise program and other self-help ideas (KISS principle). X rays are not routinely performed, with 90 percent of the time the injury limited to soft tissue. Casting is done when walking is difficult, but removable casts are revolutionizing the process. Much less muscle atrophy is seen with removable casts than the traditional permanent casts. Cortisone shots should be limited to only mandatory situations due to their possible weakening effects. Never have tendons injected with long-acting cortisone since possible ruptures can occur.

     The patients are advised what the next step would be if they are not responding. Sometimes there are so many possibilities of treatment that they all can not be covered in the initial visit. Surgery rarely is needed for a particular problem, so it is not mentioned at the initial visit normally. The doctor or therapist tries to discuss with the patient:

1. his/her immediate concerns at the full diagnostic examination (if the diagnosis is still questionable, does the patient want xrays, MRIs, etc)
2. the patient's ability to begin therapy now, speeding up the process of healing (I can think of very few injuries which would not be helped by therapy)
3. their concerns for a rapid (as fast as possible) recovery

For some, it will seem strange that some patients do not want the "best", fastest care. The problem is that with this "fast" care comes with expense, time, and energy. These are commodities some patients, most patients, are short on. Most of the time we settle on a slower, but still effective, course of action.