Those patients who are treated sooner rather than later heal quicker. This is FACT. To rehabilitate and educate the patient in such a way that prevents re-injury, reduces exacerbations and speeds up recovery time is a true service to the patient. T he headlines read, "Olympic Athlete Wins Gold Three Weeks after Knee Surgery"; and, "Superbowl MVP in Spite of Recent Ankle Sprain". When reading headlines like these, as a healthcare provider, you can't help asking yourself, "How did they rehab that injury so fast?" Healthcare professionals that have had the privilege of working with athletes of every caliber know why a "quicker than normal" rehabilitation occurs. Taking this knowledge to the next level and applying it to rehabilitation procedures for the non-athlete is not only the trend of healthcare today, but also a necessary action in quality rehabilitation. In this article, we will examine the differences between athletes and non-athletes and propose why the athlete, typically, heals more quickly; the etiology behind this phenomenon; how these ideas should be instilled in patient rehabilitation; and, of course, lend consideration to insurance reimbursement for this model of care. In examining the differences between the athlete and the non-athlete, we must first call to mind things like conditioning, flexibility and motivation. These aspects are very important and actually, critical in the recovery time of many injuries. When a patient arrives in the office for care, you can pretty much bet on the fact that the patient who is in good condition prior to being injured will rehabilitate more quickly than the unconditioned patient. You must keep this fact in mind when formulating your treatment protocols for your patients. The patient's motivation to recover is an important aspect of care and rehabilitation that you cannot always control. However, it is an integral part of the rehabilitation process. Most athletes are enormously motivated to heal and return to play, as opposed to. for example, a manual laborer who must return to working on an assembly line. This is why you must continually tailor your rehabilitation protocol to keep the patient motivated in the healing process. This is the key to success! A word about the phenomenon of what is called "being centered". Being centered has been found to be the great leveler on the playing field. Centered individuals are those who are clear and concise in their goals, their missions, and who arc ready to plant their feet in the ground and tackle challenges head on. It has been found that having patients explore this aspect of care places more control in their hands and greatly improves the outcome of your care. This is where patient education comes into play. Think about it.. .the better you educate your patients, the more compliant, motivated and focused they are on their own healing. An education in the etiology of the condition the patient is suffering from, the rehabilitation protocols, estimated duration of healing time, and signs of progress will keep your patients on track and will also help prevent future exacerbations or recurrences. The differences between the athlete and the non-athlete are significant when considering the time it takes to progress through a treatment program based on the facts described above. However, this concept goes even further. Let's take a look at the etiology of an injury—for example, a sprain or strain of the lumbar region. The initial inflammatory process for the athlete is the same as for any other patient; the inflammatory process sometimes results in a compensation reaction in the supporting soft tissues. The athlete feels pain and immobility the same as any patient. So, now you ask yourself, "What's the difference here." Does an athlete's interstitial tissue have a superior ability to communicate with his or her brain in the cellular response to injury? This is really very simple; athletes typically seek care a lot sooner than the average person with a new injury. Is this an uncontrollable factor? The athlete has the unfair advantage of having a qualified healthcare provider standing on the sidelines with the ice and compression ready to attack this initial inflammatory process before the compensation reaction begins. One thing you can do about this is to educate your patients—not only about putting ice on a new injury, but about getting into your office ASAP after an injury. Those patients who are treated sooner rather than later heal quicker. This is FACT. Additionally, the athlete typically possesses strength, flexibility and conditioning beyond the non-athlete. These physical qualities give the athlete additional advantages in healing*. Developing strength, flexibility, and conditioning is a neces- sary and integral part of any quality treatment protocol. These factors must be developed in athletes as well as non-athletes, if true correction is to be attained. Considering all the factors we have discussed so far, let's incorporate this knowledge into our practices to better serve our patients. The key is to consider the big picture. Yes, we all want the patient to feel better as soon as possible and have the ability to continue on with their lives: but, there is more. To rehabilitate and educate the patient in such a way that prevents re-injury, reduces exacerbations and speeds up recovery time is a true service to the patient. To attain the physiological correction and etiological prevention that is desirable, treatment protocols should be addressed in phases of care. Completion of all phases is necessary for success. Let's begin with the acute/passive phase of care. In this phase of care, patient education is the key. Explain to your patients, in simple terms, the basic etiology of their conditions and how it might affect other regions of the body, or how inflexibility, reconditioning or poor ergonomics might have been a predisposing factor in the condition. Instruct your patients in what they should and shouldn't be doing at home, as well as what they can expect in treatment, and what to look for as signs of progress. Treatment in the office in this stage of care is very much a passive care protocol. This is the phase in which hot/cold packs, electrical muscle stimulation, ultrasound, etc., are used. The patient is lying on the treatment table passively in this phase of care and, hence, the label, the "passive care protocol." Unfortunately, too many doctors get caught up in this phase of care and it continues and continues and continues. Tell me, how long is it feasible to continue to treat a patient in this fashion? What are the lasting effects in the physiology of the patient by prolonging the passive phase of treatment? How are you changing the predisposing factors of this injury for the patient to prevent re-injury? The fact is that passive care is an easy treatment modality to apply. Let's face it, you can put the patient on a table, set them up and walk away. Humans are, by nature, creatures of habit: one must wonder if this treatment simply becomes habitual and comfortable for the treating doctor. This type of treatment, although effective and necessary in the acute phase, needs to end once the inflammatory process ends. The next phase of care is the subacute phase of care. In this phase, the patient should be graduated into a combination of novice active care activities with some supportive passive care modalities. The active care expert, Vladimir Yanda, was way ahead of his time in considering the patient's static and active insufficiencies in the rehabilitation process. In this phase, insufficiencies, such as tight hamstrings, weak glutcals or an over-facilitated quadratus lumborm muscle, should be addressed. Beginning active care without this consideration can actually "exercise in" a condition rather than correct it. Activities, such as Swiss ball, mild stretching to facilitated muscle groups, and range of motion exercises, are all excellent modalities to start your patients on the road to true correction of their conditions. The active phase of care is the most critical phase of care. In this phase, the patient will realize a true correction of the condition and its predisposing factors. This is the phase of care where your pa- tients spend very limited, if any, time lying on the table. They are utilizing a myriad of ncuromuscular reeducation exercises to sub-cortically stimulate the affected muscle groups and movement patterns, to gain balance and correction. Additionally, high-tech rehabilitation, such as strengthening of inhibited or weak muscle groups with isotonic resistance exercise equipment, will support a long-term correction. This phase must also include lessons in proper body ergonomics and healthy activities of daily living before the patient is discharged from care. At this point, the burning question for any practitioner should be, "What is the third party reimbursement for this type of care?" Active care and the ability of your care to improve your patient's ability to function is the most significant trend in reimbursement today. Third party payors want to know what your patient couldn't do before, and what he or she can do now. In the eyes of a third party payor, pain and the relief of pain is not a functional goal of treatment. Create functional goals for your patients. For example, document a range of motion loss in lumbar flexion, rehabilitate the pa- tient, and then document the patient's improvement. This is information that supports insurance reimbursement. The bottom line is this: Functionally based active care means providing the best treatment for your patients. It is the driving force in third party reimbursement today, and will reduce the rehabilitation time for the patient, and the incidence of future occurrences. In conclusion, incorporating active care protocols in your patient care will facilitate the healing process in a more comprehensive way. It will also result in physiological changes that will address the predispositions that both the athlete and non-athlete patient have to injury. It will keep your patients focused and motivated in the healing process. It will provide your patients with a hands-on education in activities that they must continue to maintain the healthy "state" after their care is complete. In reality, your goal should be to develop the athlete in each patient. EZH Or. Christine Foss is a Senior Coach for Breakthrough Coaching. She can be contacted at l-ti()0-7-ADVICE. or online at www.mvhreakthroueh.com.
