Physical Therapy: First Point of Contact for Athletes

The first point of treatment for non-professional athletes with sports injuries is usually a visit to the family doctor. The potential problem with this protocol is that not every general practitioner knows how to deal with sports injuries. Doctors typically prescribe drugs such as ibuprofuen to reduce pain and swelling and then recommend immobilizing and icing the affected area. This treatment is known as RICE, which stands for Rest. Ice. Compress. Elevate, and it generally works to help recover the injured area from initial trauma. But RICE does nothing to identify the cause of a sports injury or prevent the same injury from happening in the future. RICE is essentially a passive response to what is usually the result of an active injury.

For any athlete (at any level) hoping to participate in their sport following an injury, RICE treatment is not sufficient for total recovery. Someone needs to analyze the overall trauma to the affected area and whether it can return to full strength and function on its own. There should be an analysis and a strategy established to help the body regain muscular strength and range of motion. Ideally, that process includes an assessment of how the injury occurred in the first place. That assessment might include biomechanics, tests of muscle strength and imbalances, medical history and many other factors that contribute to athletic fitness. The answers are not always simple, but asking them is vital to establishing the best way to proceed in treatment.

Orthopedic care is often the first line of treatment for traumatic injuries to bone, muscle and tendon injuries. Orthopedics looks at the function of bone, muscle and tendon together, how they interact. This is crucial knowledge to determining the net injury trauma to a human body. That's why family doctors typically send profound sports injuries to a qualified orthopedic specialist. Orthopedists assess injury damage through a variety of diagnostic tools including x-ray, MRI, and CAT scans along with tactile and range of motion tests to help figure the extent of an injury. Orthopedic surgeons are qualified to perform surgery to repair damage caused by sports injuries.

Following orthopedic treatment, patients often get referred to see a physical therapist. PTs are a branch of medicine dedicated in part to rehabilitation of the human body from needs due to aging, injury, disease or environment. But here is the problem: At best, the greater medical community and insurance companies (in particular ) seems equivocal about the merits of PT. The following findings were derived from a study titled: Physicians' Referral to Physical Therapy: A Comparison of Primary Care and Orthopedic Physicians' Management of Musculoskeletal Conditions. The survey was posted online at http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102273769.html and was produced for the Academy of Health Services Research and Healthy Policy meeting.

"Musculoskeletal conditions are common reasons for ambulatory care visits to primary care or orthopedic physicians and to physical therapists. The goal of physical therapy (PT) is to maximize a patient's physical functioning and minimize recovery time. Physicians play an important role in access to PT because most insurance plans only cover PT prescribed by a physician. Little is known about factors associated with physicians' referral to PT and whether patients have appropriate access."

The paper goes on to explain the pattern of patient referral to PT from various practices of medicine:

"Diagnosis, illness severity, and PT supply were strong predictors of PT referral in all three models. Insurance status was also a strong predictor and varied by specialty. Primary care visits covered by Medicaid were 27 percent less likely to be referred to PT, relative to visits covered by private insurance. Primary care visits covered by managed care were also 27 percent less likely to be referred to PT. Orthopedic visits covered by workers compensation and managed care were 35 percent and 25 percent more likely to be referred to PT. Some physician characteristics were strong predictors of PT referral and varied by specialty. Of particular note, osteopathic primary care visits were 80 percent more likely than allopathic primary care visits to be referred to PT."

So you see, there is no guarantee the typical patient will be referred to or even hear about the opportunity for physical therapy. Physician opinion on the merits of physical therapy drive some aspects of the referral, while insurance issues sometimes limit the likelihood of referral. This is a shame because in many cases physical therapists may be the most practical and relevant form of medicine to the recovery and health of the patient.

Here are the basics. Physical therapy is the active rehabilitation of the human body through methods such as muscle or joint-specific exercise, range of motion and balance exercises. Physical therapy may also include medical treatments such as electrostimulation to promote blood flow to an injured area, massage and other techniques designed to help a patient recover. Physical therapy is effectively the first stepping-stone on the "road back to health" once a person is involved in recovery from injury or surgery.

Physical therapists can be the most vital resource for healing and recovery for athletes. When an athlete is in recovery mode after a tendon or joint injury, specificity training exercises can restore vital support muscles and tendons to proper working order. The effects of physical therapy can be surprisingly quick and effective. In 2003, US soccer player Shannon MacMillian tore her ACL but came back to make the U.S. Women's National team in a mere three months. She could not have accomplished such a quick recovery without hard work--and the strategic benefit of intensive physical therapy.

If physical therapy can perform miracles for athletes in recovery, what can it do for athletes who are not already injured or need preventative recuperation from mild injuries so they do not turn serious?

That is a question I ask myself all the time. My own experience with physical therapy not only rehabbed a knee after a torn ACL, it cured a chronic case of chondromalacia (runner's knee) that had slowed me down for several years.

That trend toward using physical therapy as preventative or transformative medicine is beginning to take hold in athletic culture. Already there are specific clinics to help women athletes prevent ACL tears. Major rehabilitation clinics and physical therapy institutes are now associated with sports teams at every level from pro right down to recreational leagues. With the intensity of effort being put into youth sports, it may be important to have knowledgeable trainers ready to advise in the event of injury in young athletes.

In fact the time may be right to bring physical therapists to the front line in diagnosing and treating many sports injuries. Making the physical therapy clinic the "first point of contact" when faced with a sports injury not only puts athletes in the hands of people accustomed to dealing with sports injuries, it may save money by preventing more expensive injuries down the line.

The challenge in today's medical community is that almost everyone in the medical community wants to own the right to be the patient's first point of referral. Why? Own that visit and you control the money and referral process. That means if you are an HMO patient, it will be up to you to convince your primary physician that physical therapy can be a cure for your ills. Good luck. One HMO doctor I visited dismissed physical therapy as "a bunch of fluff" when I asked for a referral to deal with pain from a torn tendon under my pelvis. It wasn't until this same doctor picked up a running injury and went through physical therapy that he became a believer in it.

Physical therapy may seem like fluff to some medical practitioners because it utilizes something of a "back to the future" approach, combining the best of the old school with classic exercises like lunges and balance exercises. Modern PT also uses diagnostic kinesiology, training machinery, weights and other equipment designed to give you a controlled environment for strength training and rehabilitation. Physical therapy requires a carefully concocted combination of gut knowledge and intelligent response when it comes to treating sports injuries.

There may be good economic reasons for using a physical therapy assessment as a first point of contact. The cost of preventative physical therapy for a troublesome knee might be $500-$1000. That seems like a good investment compared to a $7,000-$10,000 expense for surgery on a torn ACL. That fee doesn't included time lost to the patient in work and rehabilitation. I've lived that reality and don't wish it on anybody, even my insurance company.

I didn't write this article because I work for a physical therapy company or have an investment in one. This is not even a "white paper" on the topic of physical therapy from a supposed expert in the industry. This is the voice of common sense and practical experience speaking, written by someone who wished he could have gone to physical therapy before major injuries took away the ability to enjoy sports to the fullest.

http://en.wikipedia.org/wiki/Physical_therapy

gateway.nlm.nih.gov/MeetingAbstracts/102273769.html