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.
