Many of the articles I write are geared towards an audience of other fitness professionals. This one, however, I hope will serve as a helpful “user guide” for lifters, athletes, martial artists, and fitness enthusiasts.
If you compete in a sport it is nearly inevitable that you will suffer an injury at some point. Obviously injuries will vary widely in severity, but regardless they need to be addressed and/or treated in some way. It has been my experience that many of my friends (in particular my fellow Jiu Jitsu athletes) are reluctant to seek out treatment to help with their injuries. They cite many reasons for this, but I think it really boils down to that they either have had bad experiences in the past (did not get the desired result from treatment), and/or they simply do not want to be told that they need to take time off from training. Expanding on that a bit, I have noticed a trend that many people do not like the feeling of being reliant on their clinician for treatment, and would rather go at it alone than feel like they are dependent on a clinician (or really be dependent on anyone else, regardless of who that person is). On the flip side, if they had an option to work with a clinician who could empower them to take their treatment into their own hands, they would be significantly more willing to seek their expertise and partner with them for the rehab process.
What I think many people do not realize is that there absolutely are clinicians out there who absolutely will empower you to take your rehab into your own hands. They can help you identify what motions or activities will aggravate your injury (so that you can avoid them), what exercises or stretches are likely to give you relief from your symptoms (so that you can do them on your own), and they can give you guidelines to work within so that you can still train, but just do it in a smart way that will not prolong or further irritate your existing injury. The purpose of this article is to help you – the reader – find those clinicians more easily; essentially to help you pick them out from the crowd.
Speaking from first hand experience, just in the last few years I’ve had a fair number of my own injuries (mostly Jiu Jitsu related) and have trusted my rehab process to these clinicians. I have worked through lumbar disc herniations, tedonosis in my elbow, a pinched facet joint in my back, a pulled groin, and am currently rehabbing a grade 3 separation of my AC joint (and they call BJJ “the gentle art” apparently). Based on my own personal experiences as well as discussions I have had with some of the top clinicians in the area, here are some things I have noticed that are consistent amongst the best providers:
- They never assume the site of pain is the source of pain. For example, the first time I had a bulging disc in my back, my back itself was not in any pain. However, my leg was in so much pain I couldn’t even walk – I thought I had somehow pulled my groin and/or hamstring. They were able to quickly identify that the pain in my legs was actually being caused by my disc pushing on the nerves.
- They always use a “test, treat, re-test” protocol. They will almost always do some sort of test to see what exactly provokes the symptoms, because this gives them information they can use to decide on a treatment protocol. Then, obviously they do the treatment, after which they test again to see how symptoms compare to before the treatment. If the symptoms see a bit of immediate improvement, they know they’re on the right track. If their initial treatment does not yield any improvement, they will try other treatments until they find one that does the trick. This process is imperative for giving the patient (i.e. YOU) confidence that this process will work, because you get to experience it in real time.
- The majority of the time, the treatments they do are at least in part “active” – meaning they are exercises or stretches they have you do, rather than treatment being restricted to only adjustments or manual therapy that they do on you. These “active” modalities will leave you feeling empowered that you are in charge of your own pain and your own rehab process, and that you will not be reliant on the clinician for an extended period of time.
- Based on how the process above went, they are almost always able to send you home with one or two exercises/stretches to do as homework. Again, this leaves you feeling empowered to be in charge of your own pain and rehab process. It also gives you tools to manage your pain if you end up getting a flare up.
- They understand the importance of loading your tissues and building capacity/tolerance to loading. When you experienced your initial injury, it is essentially because the amount of load (or force) that was imposed on that tissue exceeded the capacity of that tissue to tolerate that load. During the injury the tissue is damaged, so your tolerance is often reduced even more. The clinician can help you with the strengthening process to get back not just your range of motion, but also the strength and load tolerance that you had before the injury (or better yet, improve it more than you’ve ever had).
- During the processes above, they can outline for you how to adapt your training to maximize your healing while also continuing to train as much as is reasonable. Rarely is necessary to stop training completely, but it is important that you work within certain parameters to make sure you do get a chance to heal. Often these guidelines will change as you get closer and closer to complete recovery. For example, at some points in the process you may receive instructions like “It is OK to work through a little pain, maybe 3/10, but don’t exceed that. Also, make sure the pain goes away when you stop your activity. If the pain stops when you stop, it is probably OK. But, if the pain continues even after you stop the activity, you probably overdid it.” Keep in mind, the above is not the right guideline ALL THE TIME, it is just an example of what you could hear at certain points in the process. Make sure you listen to your clinician about what guidelines they give you at different points in your rehab process.
To help guide you towards finding the right clinician for your rehab needs, I asked a few trusted local clinicians to describe what they suggest you look for as far as philosophy and credentials, what questions to ask others who have been seen by a particular clinician, as well as how to contact them for an appointment if you are in the Portland, Oregon area.
First up, we have Josh Kidd, DPT. Dr. Kidd actually trains patients out of our gym in NW Portland, as well as in Wilsonville, OR. He has been a resource for me in all of my injuries outlined above, and is one of the best clinicians you’ll find as an athletically minded person. In addition to being a great clinician, he takes his own lifting seriously and is one of the fittest/strongest lifters we have at Industrial Strength. I have full trust in him to help me through all of my rehab needs, and I don’t know what stronger recommendation I can give. Here is what Dr. Kidd of Advance Sports and Spine Therapy has to say,
“Trying to find the right clinician when you are injured can result in a lot of confusion. You might hear “if it hurts, don’t do it” or “no pain, no gain”. So which is it? Or you might hear “you need to stop all activities” or “you need to come in 2-3x a week for 6 weeks to fix this problem”. Well, to be honest a majority of patients can rapidly improve their problem independently with a little guidance from the right clinician.
So who is the right clinician? The right clinician is someone who understands the requirements and stress that you as the athlete undergo every day. They use a check/recheck system based your primary issue to effectively and accurately determine how quickly you can return to your activities. They will also focus on self-treatment strategies first so you can get back to what you enjoy and provide you with “a tool” to self-treat. This is often a movement based activity, self-mobilizations, or loading regimen that will result in long term resolution vs. short term fix.
When looking for the right clinician you have options and I would recommend finding a clinician with certifications in MDT or SFMA. Clinicians using these two methods will understand your requirements and give you specific guidelines and strategies to immediately return to your sport. Should symptoms arise during activities they will give you strategies. You will know if the pain is something you can work through (i.e.. No pain, no gain) or something that needs rest (i.e.. If it hurts, don’t do it).
Should you have specific questions regarding how either of these methods can help get you have to want to you enjoy, please contact me at email@example.com or to learn more about these methods please check out www.advancesportsandspine.com”
Next up we have Neville Chu, DPT. Dr. Chu is well known in the Portland area for not only being a DPT, but also a USAW weightlifting coach, and he both coaches a weightlifting team and competes in weightlifting himself. If you participate in weightlifting (often called “Olympic lifting”) then Dr. Chu would be an excellent resource for you since he walks that walk himself. Here is what he has to say,
“There is always a way to train and a reason to train despite the injury. Barring any life-threatening conditions that require absolute rest and inpatient medical care, there is always something to be gained by training and something to be lost by not training. My role with all of my patients and clients is to guide them in their training both to maximize their gains while injured as well as bring them to a place of being able to train unhindered. Here are a few ways you can find me: Neville.firstname.lastname@example.org email@example.com
Next up we have Brad Farra, D.C. Dr. Farra is the owner of Evolution Healthcare & Fitness located in SE Portland, which is Industrial Strength’s partner for our satellite location inside of their facility. Dr. Farra is a strong believer in collaboration between clinician and coach / trainer to ensure the best results for his patients. In addition to being a well respected chiropractor, Dr. Farra spent six years in the US Navy (including being a rescue swimmer) and enjoys many outdoor activities including ice climbing. Here is what he has to say,
“It should not be as difficult as it is to find a healthcare practitioner to properly diagnose and treat your musculoskeletal/sports injury. You want a long term solution and you want to keep participating in your chosen sport or activity, or get back to it as quickly as possible. Your first priority should be to go to the right type of practitioner. An experienced Sports Chiropractor or Physical Therapist is going to be your best bet with a sports injury. The average MD/PCP is not well trained to diagnose and certainly not to treat these types of injuries. The modern day Chiropractic Sports Physician or Doctor of Physical Therapy are the best equipped to diagnose and treat your sports injury, but you have to find the right one. There are bad Physical Therapists and Chiropractors just like there are bad Plumbers and Interior Designers.
I wish I could tell you to look for this qualification, that certification, or a particular designation; it just is not that simple. When it comes down to it, what you need is a referral from a trusted individual that has had personal experience with a healthcare practitioner that treats sports injuries. You then need to drill this person with questions about their experience. Ask them about how long the practitioner spent with them, and not an assistant of any kind. What was the visit like, were there a lot of questions and a thorough exam that lead to a conversation about the diagnosis? Did the practitioner clearly explain the diagnosis and the treatment plan? Were the expectations for the resolution of the problem discussed, and a goal for return to ‘play’ made? What was the treatment plan, did it involve multiple modalities that include rehabilitation exercises, activity modification, soft tissue therapies, therapeutic modalities like laser or ultrasound? Not every injury needs all of these categories, but a practitioner using only one modality is not going to get you the best results. Did they answer all of your questions, did they seem to be in a hurry? Did the condition get better within the expected timeframe? Were there aspects of the experience that they were displeased? There is nothing more powerful than a referral from a trusted individual that has had a direct experience with a good sports injury practitioner.”
Hopefully now you can see that there absolutely are healthcare practitioners out there who are good resources for you as an athlete – people who will work with you to get you back into your sport at full capacity, and who will give you guidelines to work within as you continue your training through your rehab process. What I think will be comforting for many athletes to hear is that clinicians like these want to empower you to keep training and to take charge of your own rehab – they want to send you home with “homework” to do on your own to let you know that you are in control of your own recovery.
I would like to wrap up by thanking Dr. Kidd, Dr. Chu, and Dr. Farra for their contributions. If you are in need of a sports/athletically minded healthcare provider in the Portland, Oregon area, these three would make an excellent starting point. Lastly, if you are a martial art and/or fitness professional I would strongly encourage you to network with the top clinicians in your area. Having people like these three who you can confidently refer to helps everybody come out ahead, especially your trainees.
Thank you for reading, and as always please feel free to share this article with anyone you think would be interested or find it helpful.
– Tony Gracia / Head Coach and Co-Founder Industrial Strength