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Shared Rehabilitation Cases |
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Shared Rehabilitation Cases
What’s Gone Right?
What’s Gone Wrong?
What Can Go Better?
Michael Shaffer, PT, ATC
August 12, 2004
Sports Medicine Conference
Shared care: Benefits
• Areas of Expertise
– Similar but different
– Benefit athlete
• Professional collaboration/ education
– Self Improvement
– Second opinion
– Mutual respect (legislation, etc)
• Sharing the burden
– Time of year/ travel
– More 1 on 1 time
– Focus on something else
Shared care: Benefits
• Different equipment
– Pool
• Some athletes respond to being away from their team
– Different environment
– 1 on 1 time
– “OK to complain”
– “They treat you better”
• Deflates the athletes/ Perspective
• Marketing
Shared care: Negatives
• Time demands on the athletes
– Two places at once
• Wasted time vs. Unique service
– Expensive
– Wasted “slot”
• ATC’s in unique position
– Know personality of athlete
Shared care: Negatives
• Communication is hard
• Communication is absolutely the key
– One consistent message
– Eliminates redundancy
– Unique service
– “Did you see that too?”
Shared care: Negatives
• Egos/ degrees/ titles/ longevity/ salary
– Can NOT get in the way
– “We are here for the health and well being of the athletes”
• Some athletes do not respond to being away from the team
– Foreign environment
– Loss of social support
• Some coaches don’t either
– Loss of control
– Loss of oversight
What shared care is NOT!
• Direct money maker
– Max= 20-30 athletes
– Downstream revenue generation!!!!
• “It’s the place the Broncos use”.
• HUGE
• “We don’t make money off the backs of our student athletes!”
• “We will make a lot of money off the backs of people who want to be
our student athletes”.
What shared care is not!
• Relegating ATC’s to First Aiders
• Taking away all long term rehab.
Cases
Disclaimer (s) !!
Case #1- Wrestler ACL (Pick one)
• 2.5 wks s/p ACLR with MMR
• “Just started rehab”
• Referring provider: Matt Doyle, ATC
• 0-2-90º
• Quad atrophy
• NWB
Case #1- Wrestler ACL (pick one)
• “The Plan”
– M/ W/ F= Matt
• Everything
• Pool
• Wrestling activities
– T/ TH= Mike
• Flexion contracture
• Quads started
• Gait
Case #1- Wrestler ACL (Pick one)
• What went right?
– Matt referral
– Set plan
– Communicated
• What went wrong?
– 2.5 weeks just started rehab
Case #2- Swimmer
Shoulder Instability/ RC Tear
• 7 wks s/p arthroscopy
• FF= 0-115º; ER 0= 0º ; ER 90= 0-35º,
IR= L1
• Pain for 1 hour after rehab sessions
• Referred by MD, ATC team
Case #2- Swimmer
Shoulder Instability/ RC Tear
• Contract-relax stretching
• Less aggressive passive stretching
• More repetitive use
• Decreased emphasis on strengthening
Case #2- Swimmer
Shoulder Instability/ RC Tear
• 2nd visit (3 days after I/E)
– FF #’d 10º
– ER #’d 5º
• 3rd visit (8 days after I/E)
– FF #’d 15º
– ER #’d 10º
Case #2- Swimmer
Shoulder Instability/ RC Tear
• Final Status
– 5 months (25 visits)
– AROM Inv (Uninv)
• FF= 0-145 (0-150)
• ER 0= 0-45 (0-65)
• ER 90= 0-80 (0-95)
• IR= T7 bilaterally
Case #2- Swimmer
Shoulder Instability/ RC Tear
• What went right?
– Unique service
– 1 on 1 time
– Athlete benefited from different environment
• What went wrong?
– 7 weeks s/p
– Communication
• My fault
• Don’t communicate through the athlete no matter who they are!
– Wasn’t shared rehab
– Team captain
Case #2- Swimmer
Shoulder Instability/ RC Tear
• What could’ve gone better?
– Referred earlier
– PT Communicated
– Shared rehab
Case #3- Male Distance Runner
• 2-3 mos of continued hamstring pain
• Boyd Murray, ATC referred
• Lack of progress/ 2nd opinion
• “Really tight hamstrings. And I’ve stretched him about every way I
know how.”
• “You’ll like him. He has a personality like you.”
Case #3- Male Distance Runner
• Hamstring length= 45º bilaterally
• Pain later in runs or with increased intensity
• Muscle strength/ endurance vs. flexibility
Case #3- Male Distance Runner
• Single visit before trip to Spain (early summer)
• Returned 6 wks later
– Started aggressive ham work.
• 1 month later D/C’d
– “Reports that he is getting stronger and now only feels symptoms when
trying to sprint or at mile 16/18”.
Case #3- Male Distance Runner
• What went right?
– 2nd opinion
– Unique service/ different opinion
– Not shared rehab (by design)
– Communication OK
– Shared burden
• aka what Boyd really meant
• What went wrong?
– He’s back!
Case #3- Male Distance Runner
• What could’ve gone better?
– I would’ve lied on my personality inventory
– I would’ve been out of the office the day he returned
HS Athletes
• Jennie McHenry, ATC
• Communication!
– Jenandpaula@netzero.com
• “So many athletes” / 2 schools
• Heat, Ice , US , Wts.
– E- Stim, SM, Treadmill
HS Athletes
• The Political History
• The Political Climate
• The Political Future
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