Time to recognize the importance of physical therapy

We hear the team doctors and the orthopaedic surgeons who treat the injuries of professional and college athletes mentioned all the time. Rarely do the men and women who rehabilitate those athletes get the credit they deserve.

When I treat patients in my clinic, I recommend physical therapy as part of the treatment plan fairly often. Many of my patients play competitive sports or exercise religiously, so they often resist my recommendation to work with a physical therapist. They comment that they don’t need PT because they go to the gym every day. It takes me quite a bit of convincing to explain to them that physical therapy is very different, but it will help them return to activity more quickly and safely than they can achieve on their own.

Plus I have seen over and over how valuable physical therapy is after surgery. A good physical therapist can make all of the difference between a good outcome from surgery and a great one. It can be the difference between a patient only recovering enough to exercise and recovering well enough to return to sports at his or her previous level of play.

Physical therapy for patellofemoral pain

October is National Physical Therapy Month. I would love to help people with musculoskeletal injuries and surgeries recognize how important physical therapy can be. I have invited some of the orthopaedic surgeons and sports medicine physicians active on social media to share their thoughts on physical therapy and its role in the care of athletes’ injuries.

Derek Ochiai, MD, an orthopaedic surgeon specializing in hip arthroscopy and sports medicine at the Nirschl Orthopaedic Center in Arlington, Virginia:

For sports medicine in general and in my specialty of hip arthroscopy, many times compensation patterns arise as a result of the injury. I can restore normal biomechanics, but those secondary compensations can persist. Physical therapy is a vitally important component to returning to full, pain free, normal function after complex hip arthroscopy or most other sports medicine procedures. I try to work closely with all therapists for my patients, as close communication between surgeon and therapist optimizes results.

Read more about Dr. Ochiai on his website and follow him on Twitter (@DrDerekOchiai).

J. Martin Leland, MD, an orthopaedic sports medicine surgeon at the University of Chicago:

In order to achieve the best results in Medicine, all members of the healthcare team need to be working together. The best example of this is the relationship between the Orthopaedic surgeon and the physical therapist. A patient’s results after surgery can often be more dependent on the physical therapist and the post-operative rehab than the surgery itself! The skill and guidance of a trained physical therapist is absolutely essential to an excellent outcome after muscle and joint injuries.

Follow Dr. Leland on Twitter (@DrMartinLeland) and connect with him on Facebook.

Howard Luks, MD, an orthopaedic surgeon in Westchester County, New York:

The keys to success in treating musculoskeletal injuries include having a well-educated and motivated patient…. Being under the care of an experienced surgeon, and perhaps most important- being under the care of a physical therapist who is well voiced in the unique needs of injured athletes. Physical therapists play a very important role in the treatment of musculoskeletal injuries. They are seeing you more often, monitoring your progress, correcting imbalances and actively facilitating your return to the field. With some surgical cases… I would dare to say that the therapist has the most important role after the patients themselves in assuring a fit and ready return to sports.

Check out Dr. Luks on his website, and follow him on Twitter (@hjluks).

Physical therapy after ACL surgery

Aaron Gray, MD, a family physician and sports medicine physician at the University of Missouri:

Physical therapists are able to perform more in depth and comprehensive movement and strength assessments of patients. They are able to focus in on the cause of the problem which is often not in the same location of where someone has pain. Most overuse injuries are caused by differences in strength or range of motion on side to side and unless you fix the root of the problem, the pain will just keep coming back when sports are resumed.

Learn more about Dr. Gray at his website and follow him on Twitter (@MizzouSportsDoc).

Andrew M. Blecher, MD, a sports medicine physician in Los Angeles, California:

Some people believe that physical therapy is simply ice, heat, ultrasound and some strengthening exercises. The truth is most injuries can heal just fine without these things. However, good physical therapy is a constant progression of manually breaking down diseased tissue, remodeling healthy tissue, improving balance, proprioception, joint stability, body mechanics, endurance and performance. The truth is that ALL injuries benefit from these things. Physical therapy can “entertain the patient while the injury heals itself”. But good physical therapy will heal the injury and make the patient better then they have ever been before. As doctors we can help patients get back to where they were before an injury. But physical therapists can make them better than they have ever been. Performance enhancement and future injury prevention should be part of every good physical therapy program.

Read more about Dr. Blecher on his website and follow him on Twitter (@the_jockdoc).

Steve A. Mora, M.D., an orthopaedic surgeon specializing in sports medicine, shoulder, knee and elbow in Orange County, California:

Physical therapy has been a critically important adjunct to the treatment of my patients. I use physical therapy for both nonoperative and postoperative patients. Because of physical therapy patients have had some great success stories. There’s nothing better than hearing that PT completely took care of my patients pain especially when they thought that they were going to require surgery. I believe that the success of physical therapy treatment depends on the quality of the physical therapist, patient motivation and education. The physical therapy which I rely on is usually not modality based but rather based on manual hands-on type of treatment which focuses on flexibility, range of motion and core strengthening principles. The approach to treating patients with physical therapy is very much patient specific. I do not recommend a shotgun approach. I ask the therapist to focus on certain deficiencies which I have noted in my physical exam. For example patients with anterior knee pain get physical therapy focused on quadriceps tendon flexibility, patella mobility posterior capsule stretching, and full extension.

Patient motivation and education is also very important. Patients need to understand that physical therapy is an adjunct and not the only thing that they need to be doing during their rehab. I tell patients that they should rely on their home exercise routine just as equally as they do on the physical therapy. This is especially important for the Worker’s Compensation patient. I take this approach so that the patient is empowered and not completely reliant on a therapist. In summary physical therapy has played an important role in the success of my practice. Without physical therapy I would not be as successful in managing my patients’ orthopaedic problems.

Check out Dr. Mora on his website and follow him on Twitter (@myorthodoc).

Man undergoing physical therapy on his shoulder

Dr. Kevin Marberry, chairman of orthopaedic surgery at A.T. Still University in Kirksville, Missouri:

In my practice, physical therapy bridges the gap in recovery between the surgical intervention and the patient’s return to activity. Physical therapy, in the form of passive joint movement, has been shown in numerous studies to protect the health of the joint. It is especially beneficial for the patient after surgery as it keeps joints moving in a controlled setting without excessively stressing the surgical repairs.

Follow Dr. Marberry on Twitter (@DrKMarberry).

Nicholas DiNubile, MD, Orthopedic surgeon and best-selling author in Havertown, Pennsylvania:

As a orthopedic surgeon, team physician and sports medicine specialist I have learned over the years that what I do in terms of making a diagnosis, or performing surgery, is only Step 1 in getting athletes back in the game. The real work begins then, and physical therapists are critical every step of the way on the path to full optimal recovery. And it’s not just about re-gaining strength and motion. Physical therapists not only rehabilitate, but also motivate and educate. Sports Medicine as a field would not have made the phenomenal strides that it has without physical therapists as a key player on the athlete’s R & R (recovery and rehabilitation) team!

Read more about Dr. DiNubile on his website, and follow him on Twitter (@DrNickUSA).