Got a call from an athlete that suffered a back injury. I love athletes! (It is so inspiring to see someone who loves to exercise, even if it means postponing other things in life) The irony is that in the doctor world, (when I worked with University of Central Florida), I had to hold athletes back from exercise with threatening scholarship status until they were fully healed. At the opposite end of the spectrum, the typical workmans comp patient is looked at as a potential malingerer. It is ashame but I think some large industries treat the worker as expendible, if one is injured; either get them back to work ASAP, or get them so they can be "let go". (In the last 15 years, I've learned much about doctor patient rapport, I have found when the bond of compassion and trust is not entertained in the exam room, there is no way that doc will make the best choices/decisions for the one that is suffering). Case in point-in my old private practice, I saw alot of patients, I had to since I worked for the hospital and I had to produce patient hourly turn over that matched the rest of the country. If I saw less than average, I was "wasting time" or "talking too much". Imagine that, a doctor trying to get the most information out of the encounter by talking too much and being penalized for it. If- as I walked in the room, I already had the idea in my head "I gotta get out of here as fast as possible" I am not going to pay attention to your symptoms or suffering, I will get a few bits of info the nurse got from you and write the best drug that works the fastest! How about this: if I meet and greet you as your doctor but the lawyers say you can potentially bring me to court with a malpractice suit, how am I supposed to feel compassion for anything you are telling me about your sickness? Without compassion, I'm not going to care about details or how your family is being effected or how you are sleeping. This is why I left private practice (.....but more about working in an ER.....watch for future posts)
Any way, nice guy calls to inquire about acupuncture and he is willing to go outside workmans comp and pay out of pocket just to get better fast. Very admirable! Seems he hurt his low back with a heavy lift and was seen by a PA, then a Doc, then sent to PT and discharged after about a month. Now back to work, light duty but still in pain and not fully aware of any follow-up. When I dismiss or as I call it "graduate" my patients from my care, they should have the recuperation plan memorized back and forth, the diagnosis, the maintenance exercises, the use of medicines and what to do with flare ups. Looks like none of this was given to the patient, poor guy!
(big inhale....) well..the studies say the average back pain at work is caused by a muscle pull. "Mechanical low back pain" as it is called in ICD9 coding. Since it is muscle, it should heal up fast. If a broken bone heals in 4-6 weeks, a back muscle should heal up 1/2 the time. To make it heal even faster than normal human speed, we use medicines like steroids, muscle relaxers, narcotics and even injections into the muscle or spinal column. This with physical therapy should get an injury back to normal. If the physical therapist feels there is no progress, the doc instructs him to do a FCE (functional capacity evaluation) and if given a "good effort" and if the patient can't perform the activity required for the postition, he will be let go or terminated-unless there is a lighter position available. It seems very harsh but there are some who really milk the system and refuse to return to work and claim disability costing the country millions of dollars to feed them the rest of their lives. It is because of the few that the majority get scrutinized.
Anyway, if the therapist did his job and did all that could be done to help this patient, and the occ med doctor has released him......muuhahaa....now it's my turn. I evaluate the foot stance, knee position, back flexibility, spine curvature, gait with normal walk and then if possible with the sport of choice. We look at muscle development, baseline flexibility, nutrition status- and with we I mean a physical therapist with a dedication like what I have to helping. I like the therapy centers with employees that also teach or partake in pilates, yoga, taichi. The old physical therapy centers that were (big chains) of centers from the 90's, I felt didn't have the quality of the privately owned ones. Those are the centers that put you on a bike for 30 minutes or warm compress for 20 minutes and there goes half of your visit. Then obviously, when poor progress is made in therapy, patient gets sent back to me as a failure and a surgical opinion has to be made, or stronger medicine prescribed or steriod injected or all the visits allowed by insurance have been maxed for the year!
What I would do is all the above and then comes the integrative medicine, acupuncture works well to "cool down" spasm. Note: it only provides an opportunity for the patient or the therapist to rehab more aggressively. Herbal medicines work in conjunction with prescribed meds to heal the muscle. We all know antiinflammatories like advil, motrin, aleve, naprosyn....how about oregano, turmeric, frankinsense, devils claw, glucosamine sulfate, helicrysium....or even high dose vitamin D? Fact is that the average american diet stinks so much and better than average nutrition is needed to heal better. The average athletic diet is lacking in calories. Average vitamin supplement (GNC) doesn't get absorbed or doesnt contain what is written on the label. Even the mind body part of healing is very rarely utilized. I used to know a sports psychologist in Wheaton but only the elite athletes would go because every one always said "I don't need a psychologist, I'm not depressed".....oh boy, the education I would have to give.
Bottom line is when the body mind an spirit are functioning optimally, the injury and pain will go away with light speed! Yes, back pain is just muscle that is spasmed, but due to the pain, walking, running, biking, swimming, or just sleeping and breathing are altered. Then attitude is altered, then peace is altered, then relationships are altered, then time at the gym is altered....then there is anger and distrust....then everything is painful or someone elses fault.
Always report (sometimes on a weekly basis) how the injury is even after discharge. Live life "post injury" different than before. I always say, if you never worked on flexibility before, from this point until you die, you must now incorporate that into the daily routine. Optimize on nutrition for the time of rehab and for at least 3 months after discharge. Never return to competitive training until all pain is gone. (athletes develop engrams that make the body learn poor or compensated technique, -just a set up for another injury). Always go outside work comp and seek out complementary and alternative doctors. You may have to pay but just do it. Try not to listen to "the mind" when it says....you did this weight, distance or speed before, so just try it while you are still injured. Adrenaline and epinephrine are fight or flight hormones and will make you do stupid things. This is why I meditate, I can control fight or flight and substitute it with oxytocin, serotonin and all the peaceful hormones, this leads to better decisions, judgement and outcomes. (Ghandi, Jesus, Buddha...). Cross train in a sport you never liked before during the down time of the injury. Likelyhood is, if you do a sport you never liked, you will develop different muscles, still keep the heart in "shape", and it may make you a more well rounded athlete in the future. Finally.....Visualize and MEDITATE!
