Physical Therapy for sports injuries
Q: I am 26 years old and am involved in different sports, such as softball and basketball, on local teams. I love both of them and do not want to give up either, although both my family doctor and certain family members keep telling me I should. Over the past two years, I’ve sprained the outside of my right ankle five or six times. I see a local physical therapist in my neighborhood when I re-injure it, but the treatment lasts only two or three weeks at a time. By then, my pain is usually gone, and she says that I test “strong” throughout my foot and ankle. She recently suggested that I wear a foot and ankle support to help me with stability and to prevent future sprains. Is this a good idea?
Mackenzie , Coeur d’Alene, ID
A: For the short-term, yes! I believe that a strong but pliable ankle support will help you from repeat spraining. But, you should not rely on an ankle support. The issue of repetitive spraining, especially in the ankle joint, has nothing to do with strength. As you and your physical therapist can attest to…you test strong. What concerns me at this time is your neuromuscular system, the specialized sensory cells located in and around the joint capsule and at the end of ligament that tell your brain where your joint is relative to the world. Repeat “sprainers” usually have a diminished ability to take in sensory information, process it, and react sufficiently enough to prevent injury. Yours may need to be re-trained. Re-training is easy, but it requires dedication. Many of the exercises include balance activities through the joint, joint ROM, progressing to more advanced exercises, but with your eyes closed! Taking out the vision will make you more aware of the involved joint and, thus, you will re-train it.
Q: My doctor has referred me to physical therapy services several times in the past for my lower back. Every time he writes a prescription, he orders the use of modalities for the pain. The therapist I see follows the doctor’s request and usually treats me using heat, electrical stimulation, and ultrasound. The therapist, usually an assistant or aide, tells me that the treatments really work, but my symptoms never go away completely for more than a few weeks at time. Are these modalities really “cure-alls” or is there something else that I should be doing?
Russ, Washington, D.C.
A: Modalities can be a wonderful adjunct to any physical therapy program, provided they are used in the correct way and at the correct time, relating to actual injury. In my experience, modalities are often used today as “feel-good treatments” and do nothing for the actual cause of the pain. If all you are receiving is modalities based on the physician’s recommendation, the bigger piece of the pie is being either missed or ignored. The licensed physical therapist working with you must also realize this. Fortunately, for you, since March 2007, Washington D.C. has had direct access concerning the practice of physical therapy. This means that you can have access to a licensed physical therapist without a physician’s referral. The next time your symptoms appear I suggest that you seek out a licensed physical therapist who isn’t so modality top-heavy and works with you directly on a treatment-to-treatment basis.
Q: My thirteen-year-old son has been told by his pediatrician that the back pain he sometimes experiences is actually “growing pains” and that it is quite normal at this time in his life. When he does complain of pain, it’s usually felt all along his spine after he’s been sitting for long time. He then tells me that it feels better when he “stretches it out.” What are your thoughts on this condition from a physical therapist’s standpoint?
Heidi, San Diego, CA
A: It sounds like this is a classic case of Postural Syndrome, one of the three classifications of pain developed under The McKenzie Method. Your son falls into the appropriate age group and complains of the usual manifestation of symptoms: pain along the spine after sitting for an extended period, especially in poor posture. The pain of Postural Syndrome is not related to growth plates in the spine, but to a constant stretch placed upon soft tissue. If you were to bend your finger backwards to its end-range from the joint and hold it there, you would feel similar pain after a few minutes. This condition is easily fixable, but it takes a lot of conscious thought and dedication. Your son must practice sitting in good posture for a few minutes at a time, without any kind of support behind him, to build up his tolerance and endurance. He will, and should, feel a new type of temporary muscular pain as he progresses. This pain will eventually go away, and its presence is one way to know if he’s compliant with his practicing.
Q: I’ve been diagnosed with a heel spur and plantar fasciitis. My podiatrist had told me that physical therapy wouldn’t help me right now, but would after the surgery to remove the spur, which looks to be the direction we’re heading. Do you agree, and is there anything that I can do in the meantime before the surgery?
Frank, Lewes, DE
A: If the heel spur is large enough to warrant surgical removal, I would have to agree with your podiatrist. The plantar fasciitis is most likely secondary, meaning it’s being caused by the spur in one way or another. The pain from the spur causes altered mechanics of the foot, or the spur might irritate the plantar fascia directly. What I would recommend in the meantime—because physical therapy cannot directly affect the bone spur—is to work on the flexibility of the plantar fascia prior to the surgery. The plantar fascia begins on the anterior tubercle of the calcaneus and continues to the first metatarsal head, the big toe. For the most effective stretch, use a towel or dog leash looped around the big toe, and gently pull your foot toward you until you feel that specific area being stretched. I’m a firm believer in intermittent stretching versus static. So, pull your big toe back and then release, ten to twenty times per session.
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"Physical Therapy for sports injuries"
authored by:
Scott Kushner, PT, MS, Cert. MDT, is the author of Back to Basics: A No-Duh Guide to Prevent Back Injury – and Maybe Even Surgery. He received his formal education at Thomas Jefferson University, College of Graduate Studies, in Philadelphia. Kushner ...
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