Rest and ice. Rest and ice. Rest and ice. The broken record plays "rest and ice" repeatedly. It is a phrase uttered by injured athletes and clinicians around the world. And it doesn't matter if you are an elite athlete or a weekend warrior. Same record.
If you are active, then chances are good you have sustained some form of injury in your sport history. Chances are just as good that you have been told to "rest and ice" by any number of clinicians.
With the state of sport science, it's time for the collective sports wisdom to change. Rest and ice is not the solution.
We hear the phrases bantered about by physical therapists, lobbyists, and legislators alike: unfettered direct access, restricted direct access, and many other state-dependent variations on a similar theme.
There is oftentimes much rejoicing when physical therapists gain some "degree" of access for consumers. Celebrations take place in the streets. The proclamations of "another state with patient access" can be heard resounding through the valleys.
But there is a significant difference between access - and permission.
Each of us, injured or not, has a daily struggle against gravity. Fortunately for us, we adapt to the demands imposed upon us, assuming we are in an environment (cellular and metabolic) in which we can do so.
Our capacity, our load tolerance, fluctuates as a function of both training and de-training. Daily. Humans are very dynamic in this process.
Unfortunately, one of the biggest problems in the world of injury recovery is the blatant ignorance of some simple principles that govern life on planet earth.
You can now add three more high-profile athletes that have recently found (or will soon find themselves) under the knife of the spine surgeon: tennis pro Andy Murray, former F1 world champion Kimi Raikkonen, and Arian Foster, running back for the Houston Texans.
I am starting to get concerned that spine surgery is becoming trendy in international sport. At first, I thought it was just a reflection of the over-utilization that is witnessed in the general public in the United States. But now, "minor" spine surgery is all over the sports pages.
I have two words for these, and many other, athletes: directional preference.
We spend a lot of time and energy thinking about the stimulus. It comes in the form of a training session, a treatment, or a medical intervention. In the world of sport, coaches focus on the specific training session(s) to perform in order to enhance performance. In the world of health care, we focus on the treatment intervention that will provide a specific treatment effect. The stimulus reigns supreme in our collective consciousness.
But a stimulus is only as good as the response it evokes. Better yet, a stimulus is only as good as the body's ability to recover from and adapt to the applied stimulus.
Recovery is the critical, and oftentimes forgotten, component of optimal health.
You have the freedom of speech. You have the freedom of assembly. You have the freedom of expression.
In the United States, you have a lot of freedoms and rights. But, strangely enough, you don't have the freedom to choose your health care provider. There is, more often than not, some gatekeeper-driven law that is trying to "protect you" while ultimately controlling who you receive care from and how it takes place.
Most would consider this blatantly unacceptable if it happened to their freedom of speech or expression. But in the vast majority of US states (32), this is exactly what happens.
In health care in 2013, it is high time for consumers to have The Right To Choose.
Although we probably already have enough "models of care" to last a lifetime, I think we would do well to focus on one simple abbreviation: ADTO, or Assessment-Diagnosis-Treatment-Outcome. This model could, quite simply, save millions if not billions of dollars for health care consumers. But before it can do so, it needs to become a foundation for researchers, clinicians, and patients alike.
Across the continuum of health care, our goal as clinicians should be reliability, consistency and reproducibility. There should be a scientific method-based foundation for health care. But even if we have this, patients need to also have it as their accepted community standard of care.
So what does ADTO mean to patients? And why is it important?
The phrase comes up regularly in patient care: "There is not one treatment approach that will work for all patients". This then leads to the inevitable perceived need for an "eclectic treatment approach".
Of course, the more "tools in your toolbox", the better a clinician you are believed to be. Ugh.
I hear this regularly in both clinical and educational settings. You know what? I disagree. Completely. There is one approach that applies to all patients. It is highly effective, and it is critical to clinical success.
It's name? Science - and more specifically, clinical reasoning and critical thinking.
Function. It is the holy grail of physical therapy. We focus our efforts on understanding an individual's function - and how to make them function better.
Anatomy and physiology are taught to provide us with the foundations of function. However, both are traditionally taught as a mess of rote memorization of muscle origins and insertions, innervations and actions.
What is lost in the mix is the big picture view - that "Form Follows Function". If we can understand the function of the human body, the dynamic entity that it is, then the anatomical foundations make far more sense. This requires teaching functional anatomy based on, imagine this, function!
The sport activity has to be the problem. That in itself has to be related to the cause of my low back pain, even without a specific mechanism of injury. Oh, it has to be because I [insert here: am not flexible enough, have a weak core, or any number of deficits].
These are the words of countless active patients (and the clinicians that work with them) that suffer from low back pain. Both groups will create magical scenarios for the onset of an episode of low back pain with mechanisms that have little to no chance of actually existing. But they sure sound good, don't they?
Sometimes, it’s the daily stuff that is most important. With that said, let's take a look at the Case Of The Sitting Runner.
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Allan Besselink, PT, Dip.MDT has a unique voice in the world of sport and health care, one that has been defined by his experiences as physiotherapist, mentor, McKenzie practitioner, coach, innovator, author, educator, patient, and athlete. Read more about Allan, contact him, get updates via email, or connect with him on Twitter, Facebook, Google+ and LinkedIn.