The more we use something the more prone it is to breaking. If you drive a car around for 150,000 miles, it is bound to need a bit of work along the way. If you use your computer frequently, you are bound to have a hard drive burn out once or twice. Our bodies are no different. “Accumulating injuries are the price we pay for the thrill of not having sat around on our asses,” after all – at least according to strength coach Mark Rippetoe.
When our car needs repairs we head to a qualified mechanic. When our computer suddenly stops working, we turn to our tech geek to help solve our problems. When your body breaks in some way, though, to whom do you turn? It is important to have a good healthcare professional in mind for whatever the problem may arise.
Since most people reading this are interested in athletic performance and nutrition, healthcare professionals associated with injuries and injury prevention will be crucial. Most recreational athletes, however, don’t have a healthcare professional that they turn to in a time of need or injury – hell, most recreational athletes don’t even know how to find them!
First, let’s identify the different classes of healthcare professionals that we may turn to if we start to experience joint or muscle pain that may be related to training.
The Orthopedist (Ortho) is the go-to medical doctor for any sort of joint or muscle pain. An orthopedist (in the US, anyway) acts as a portal for physical therapy treatment. That is, you typically can’t go for PT that is covered under insurance without receiving an exercise prescription (script) from an Ortho first. Orthopedists are highly trained in the reductionistic methodologies associated with joint and muscle pain. Most Orthos have a specialty. Oftentimes they are a knee specialist or a shoulder specialist – make sure to ask their specialty when making an appointment or asking others for a recommendation. Usually, the end result of a meeting with an Ortho is: you need surgery, you should go for physical therapy, you need rest, you need painkillers, or you are untreatable. Painkillers are only appropriate in very extreme circumstances and are over prescribed. You will almost never see an Ortho recommend soft tissue work (like massage therapy), even though it can solve many problems.
Family Doctor/General Practitioner
Your general practitioner may be helpful when you are coming down with a cold or have a strange rash that suddenly broke out. When it comes to muscle or joint pain, they usually don’t provide much help since this is not their area of expertise. If you are experiencing pain that is related to your training then you may want to call your general practitioner and ask if he/she has any recommendations for an orthopedist. When asking for a recommendation, make sure that you explain details of your injury. This will save you money on co-pay or visit fees and you will wind up with at least a starting point to see a doctor that specializes in your problem area.
Physical Therapists (PTs) oftentimes are the best resource on any joint/muscle pain issues. Sadly, as stated above, most insurance companies don’t cover your PT appointments unless you have seen an Ortho and received a script from them. In recent years, PTs have been lobbying to become a portal themselves. This would circumvent the need to see an Ortho first – but the movement hasn’t been successful just yet. Many times, a physical therapist will do a short exam on you first before treatment. The treatment usually consists of exercises that follow the guidelines on the script written by the Ortho. Many times, the PT will consult the Ortho throughout the course of your treatment to provide follow up and request changes (or verify details) on the script. Physical therapy can take 2-6 months (or even longer) depending on the injury. Many people feel they can do the job of a PT in their own home by just doing the exercises – but this is often not the case. A high quality PT will be moving their client (i.e. you) along according to a timetable. They should have a good idea of when you are ready to continue activity-as-normal.
People seem to either love or hate chiropractors (Chiros). That is because the Chiropractic practice, overall, is so unregulated that you have some really talented professionals mixed into the same heading as first class whackos. In my experience, there are more whackos than talented professionals, but that’s just my opinion. The benefit of a Chiro is that you don’t need a portal. Chiros tend to be expensive and, most times, they run you through a flurry of introductory appointments (sometimes as many as six appointments in two weeks) all at full charge. If you choose to change Chiros, your new Chiro will likely want to do his own set of introductory appointments – so be prepared to drop another hefty sum of cash. Chiropractors focus on adjustments rather than therapy. They may recommend exercises to aid the rehabilitation process, but the philosophy is that the mechanical adjustments of subluxations (bones that are slightly out of place) will alleviate stress, inflammation and pain. Additionally, the belief is that if we keep our bones aligned properly, then our bodies will perform better. Personally, I tend to treat Chiros as an “if-all-else-fails” method. In the past, Orthos have told me that some conditions were untreatable – such as my very chronic patellar tendinitis – and a Chiro was able to help with the pain dramatically. Chiros promote their practice as a much more immediate resolution to problems such as pain. If you are not experiencing significant results within two months, you may need to find another professional.
While massage therapists are not really medical professionals, they like to think that they are! A good massage therapist will be able to greatly reduce many types of muscle pain. The pain relief from a massage therapy session should be immediate. If you find yourself in massage therapy undergoing the same treatments for six months then you are wasting a ton of money. If you aren’t feeling better a few days after a single session then you likely did not need massage therapy in the first place, or your therapist didn’t know what they were doing. Before going to a massage therapist, you may want to consult an Ortho, PT or Chiro to see if there are any special techniques that you can request. For example, if you have very bad hip pain then an IT release is a common massage therapy procedure that can greatly help with the pain. In another example, in some cases, a lower back deep tissue massage can greatly help for pain caused by a herniated disc. Using a massage therapist as your portal tends to lead to wasted money and time.
So, now we know the options that are available. No matter which type of specialist you decide to see, there are a handful of universal concepts to keep in mind when seeking out a professional to help you with your injuries.
Professionals who work with sports teams
Most good Orthos are associated with a major league, minor league or Olympic team of some sort. If you live out in the middle of the boonies, that may not always be the case. If you are lucky, you may be able to find physical therapists, Chiros or massage therapists that work with teams as well, but they are few and far between. If at all possible, make sure the teams they work with have a significant amount of overlap with the sports for which you train. For example, if you train the Olympic lifts, an Ortho with direct experience O-lifting or with football teams would be very beneficial. In another example, a PT who used to train in gymnastics would be a great professional that you should see if you train in gymnastics or parkour. Sometimes you can’t always be that lucky – but I had the good fortune of working with a Chiro that trains in parkour, a PT who trained in gymnastics and an Ortho who worked with the USA Olympic gymnastics team after he had trained gymnastics in his youth. Not too bad considering my main sports are parkour and gymnastics.
Word of mouth
As I said in the short section on general practitioners, you want to make sure that you ask for recommendations. When asking for recommendations make sure the professional has experience in fixing your problem area. Also, ask for recommendations from credible people. People who train similarly to how you train may have already found a professional that understands their sport. If all else fails, ask other medical professionals for their recommendations based on the problems you are experiencing.
Professionals that want YOU to be proactive
Many professionals fall into the trap where they look at the problem and provide a solution. These “solutions” may fall under surgery, adjustments, six months of physical therapy, multiple massage therapy sessions, whatever. All of these treatments have their place but some professionals look at these treatments as end-alls or shortcuts to your end goal of getting back to performing. The real thing to look for is a professional that wants you to take it to the next level. They want to perform the treatment but they emphasize that it is on you to follow through and lay off of it when it needs rest and to perform the exercises they prescribe. Their hand should be one of guidance through your recovery so that you can learn from the experience and hopefully treat yourself in the future.
Professionals that explain themselves
Keep in mind that the professional mostly assumes that you don’t know your elbow from your knee, literally. Most times, they will keep things in laymen’s terms so that they can communicate with you effectively. Pry in on them and ask questions to get them to explain why they are recommending a certain treatment. Any professional that is worth their salt can explain why they are making a decision regarding your health. When they present an treatment, always ask for an alternative option; find out why that is the alternative and not the primary recommendation. These questions will get you answers that allow you to treat yourself in the future and give you peace of mind that you are getting the proper treatment.
If you respect them they will respect you. This means a higher quality of care and treatment. Yeah, yeah, as per the Hippocratic Oath, they are supposed to take care of you no matter what – but psychology is psychology. When you like someone you treat them better. When it comes to respecting your practitioner, make sure you schedule a time that is early. Late appointment times are annoying and no one wants to stay late at the office – not even your healthcare provider; who woulda thought? But, also make sure that the professional is behaving like a professional and respecting you, as well. If you go to an Ortho, many times there is a physician’s assistant (PA) involved, as well. A PA oftentimes screens the patients for the doctor. If you need a lot of imaging, for example, then you might not see the doctor on your first trip to the office. Some offices don’t let you see the doctor at all. When making your appointment, make sure that the doctor sees all patients that don’t need imaging first. If you don’t need imaging and a diagnosis is going to be made then your doctor should be present. If you ask “will I see a doctor when I am being diagnosed?” and the receptionist gives you any answer aside from, “yes” then I would try to find another doctor.
To sum it all up, the more athletic you are the more medical professionals you will need to have in mind for the various strains, pulls and injuries you accumulate along the way. Know the types of professionals that are out there, know the physiology of your ailment beforehand and ask questions. If you approach your injuries in this way then it is likely that you will learn a ton along the way.