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This month's newsletter will be directed toward the high school and college age athlete. We were fortunate enough to treat two athletes who needed more precise direction than they had been offered. One was a high school football player and the other a college track and field athlete. One had a torn meniscus, resulting in arthroscopic knee surgery. The other, cut his upper leg (quadriceps) with a chain saw. Both needed specific professional help. Unfortunately, since they were exceptional athletes, the physicians assumed they knew enough to get their strength back in order to return to their sport without specific direction.
The football athlete tried, using his own knowledge and with the help of a personal trainer, to get his strength back following his surgery. Nothing he and his trainer tried, despite their hard work and effort, seemed to help him regain his strength, power and quickness. He and his family were about to drive to Indianapolis for a possible second surgery because they were convinced the orthopedist missed something. As a last resort, a friend suggested McDonald Physical Therapy, and they came into our clinic.
After hearing this patient's story and hearing what he was doing to regain his strength, we were a bit perplexed. We called the orthopedist, who guaranteed us, this athlete's knee was clean and that all was well with his knee. The surgeon was convinced the problem was with the rehabilitation. Taking the surgeon's word, because he was a very capable and reliable surgeon, we began rehabbing this athlete with a more intense exercise process. As a result of our redirection of his exercise program, we were able to regain his strength, power and quickness, and he was able to get back, stronger and quicker than before. He had a successful season without any problems.
The college athlete's situation was much more challenging and took much more time. He did think he was capable of rehabbing himself, even though nothing he had done had helped him up to that point. He had been trying, using his own knowledge and the college strength conditioning coach with little success for 3 months. He came into our clinic thinking we could educate him quickly and let him work out on his own. Unfortunately, his quadriceps repair was too large and required extensive direction and more time then he had thought or hoped.
His therapy was tedious and time consuming. It required one on one for most of his exercise time with us. There was little he could do on his own for 6 weeks. By the 6th week, he was strong enough to begin strengthening in ways he had done in the past. This made his exercise experience more enjoyable and his attitude more positive. As a result, he started coming into our clinic more energized and hopeful of returning to his sport as strong as ever.
In both cases, we think these athletes should have been directed, even if it was only for an evaluation, to professional physical therapists. We realize there are many physical therapy providers and it can be confusing, especially since insurance seems to control where many of us can go for medical care. However, how important is your health or your children's health? We have been in the Michiana Area for over 30 years. We believe it's important to be your own health care advocate and find the best care possible. Might this require asking people who have had success with their rehabilitation in the past with similar injuries? Absolutely!  Would it be worth it, even if you might have to pay a bit more of a co-pay? That is for you to decide.
I have, more often than not, chosen to look around for the best possible health provider for my family and for the patients that come into our clinic. It is our responsibility to get the best health care possible for all the patients we meet. We are a family owned private practice; we are not one of the many corporate companies in our area. We are here for you and your family and have been for over 30 years. If you are not progressing as you had hoped from an injury or surgery or if you are frustrated because you are not improving and getting back to the sport you love, please give us a call.

Enjoy the journey,

Health Information
9 Things You Should Know About Pain

Shoulder Pain Woman

1. Pain is output from the brain.

While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual "road map" to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.

2. The degree of injury does not always equal the degree of pain.

Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).

3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding(s) may not be the cause of your pain.

A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.

4. Psychological factors, such as depression and anxiety, can make your pain worse.

Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.

5. Your social environment may influence your perception of pain.

Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.

6. Understanding pain through education may reduce your need for care.

A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.

7. Our brains can be tricked into developing pain in prosthetic limbs.

Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb - or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (postamputation).

8. The ability to determine left from right may be altered when you experience pain.

Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn't clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)

9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way.

While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can't be determined what your pain "feels like."

Author: Joseph Brence, PT, DPT

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