By DiAnne Adams, DO
When it comes to the healing of an injury or condition, having a doctor and physical therapist who work closely together can be extremely beneficial to the patient. At Tulsa Bone & Joint Sand Springs, I work hand-in-hand with our physical therapy team on a daily basis.
In many cases, orthopedic or sports medicine doctors have to refer outside their company to a physical therapy group. Sometimes they are referring to a PT they have never met or perhaps never even spoken on the phone with. However, at Tulsa Bone & Joint, we have a qualified group of PTs on our staff – and at Sand Springs, we are literally under the same roof.
3 benefits to using a sports medicine doctors and PT who work together:
- Improved communication.
Madison is an example of a patient that Dr. Adams and Dan Skierski have been able to treat together. While cheering, Madison’s knee twisted and popped. She came to Tulsa Bone & Joint Sand Springs, and Dr. Adams and Dan treated her knee for full recovery.
I’ve been working closely with Dan Skierski, DPT, manager of physical therapy here at our Sand Springs clinic, for the last year and a half. During that time, there have been countless times when we’ve been able to consult about a patient face-to-face. Since PT visits are usually quite frequent, the PT can help if there has been an acute change between appointments, or they can identify other contributing factors to the patient’s original diagnosis that the patient may have forgotten to mention during the doctor visit.
This leaves out the middle man of a front desk person, nursing staff, etc. This direct communication can often lead to quicker outcomes on treating the patient.
Also, this direct communication increases accountability for the patient. If I ordered PT for a patient, and he only showed up once out of the six weeks that were directed, Dan lets me know. This helps me know how committed (or uncommitted) the patient may be to the healing process.
- Quicker outcomes.
For better or for worse, much of healthcare is driven by what insurance companies require. When it comes to treating injuries, insurance companies try to steer physicians to take the most conservative approach in treating patients.
Dan Skierski treating Madison for her knee injury.
As a nonsurgical sports medicine physician, I am committed to exploring various options that will help my patients, and one of the most beneficial options is often physical therapy. Insurance companies frequently mandate that before they will cover higher-level imaging (like an MRI), the patient needs to first try six weeks of physical therapy.
There have been times when this approach has actually worked to speed up the process toward needed imaging. Since the PT has a one-hour session with the patient two or three times a week, and I only see the patient for 10 or 15 minutes, the PT has more interaction with and observes the patient’s movements more than the physician. There have been times that I’ve been able to request approval for higher-level imaging just a week or two into therapy thanks to something the PT has noticed and mentioned to me.
This speeds up treatment and allows us to jump through some of that insurance red tape a little quicker.
- Convenience to the patient
It’s very convenient for a patient to be able to see both the doctor and PT in one afternoon. This means less time in the car, less time waiting for appointments, and overall – happier patients!
The next time you’re looking into sports medicine or orthopedic care, consider a group that employs its own PT team. It will no doubt benefit you as a patient in the long run!
As a former collegiate athlete myself, I try to keep the athlete’s best interest at heart. With the recent recommendations from the AMSSM and AOSSM, my job as a sports medicine physician is to help educate athletes, parents and coaches about the dangers of sports specialization at a young age.
According to a study by the American Academy of Pediatrics in 2018, athletes who specialize in a single sport are 81% more likely to experience an overuse injury. However, multi-sport athletes have less potential for injuries, burnout and have a higher likelihood of scholarship opportunities at the college level.
Studies suggest that early sports specialization engages frequent repetitive movement, which leads to higher stress in muscles, ligaments and tendons. In a growing child, this is a perfect storm for injury patterns to develop. This in turn leads to burnout and decreased athletic performance.
How to prevent burnout and overuse injuries:
- Limiting repetitive movement in sport and training, for example, high pitch counts during practice and games.
- Preseason conditioning programs and 2+ hours a week in injury prevention training can reduce the risk of injury.
- Plan on periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors.
- Ideally, give yourself two consecutive months/year away from the specialized sport to allow the body to recover.
- To reduce the likelihood of burnout, emphasis should be placed on skill development rather the competition or winning.
Multi-sport athletes tend to be better athletes and have the potential for collegiate scholarships and professional contracts. Encourage your athlete to have fun, and remember: If they are not, they may be suffering from burnout or an overuse injury.
The January Therapist of the Month is Megan Burkdoll, OT. Megan completed a Master of Occupational Therapy from the University of Oklahoma. She is also certified to perform Functional Capacity Evaluations. She is currently studying for the Certified Hand Therapist (CHT) board examination (good luck, Megan!). Additionally, she is a board member for the Oklahoma Occupational Therapy Association (OKOTA).
Megan is a Tulsa-area native. She was born and raised in Broken Arrow and attended Bishop Kelley High School.
Megan says her favorite part about being an OT is getting to help patients return to the activities that bring meaning to their lives. “Being an occupational therapist has provided me with the opportunity to learn about a wide variety of hobbies, careers, and roles that I may not otherwise get to experience.”
Megan is a newlywed – she and her husband were married in June 2019. Their 1-year-old puppy, Tripp, keeps them busy.
Congratulations, Megan! Thanks for taking such great care of Tulsa Bone & Joint occupational therapy patients!
By Tony Jabbour, MD
All of us want our children to succeed. Many of us have children who have been playing a sport most of their lives and show potential for a college athletic scholarship. Sometimes it seems parents and coaches will go to great lengths to try to ensure their child can continue playing that sport, even when a physician has advised against it. They’re even willing to enter a risky game of Russian Roulette to ensure the child continues playing the sport.
More than 30 million children and teens participate in a variety of sports in the U.S. each year. Not surprisingly, about 10 percent will sustain an injury, sidelining them. Most injuries are simply mild strains or sprains. Some injuries, however, are devastating injuries, such as fractures, concussions, or major ligament injuries.
The highest rate of injuries in athletes occur in contact and collision sports. American Football, a collision sport, probably accounts for the majority of emergency room visits. Football injuries can include spine injuries, concussions, major knee ligament injuries, and shoulder dislocations.
Certified athletic trainers and sports medicine physicians’ goals are to provide a safe place to play and to assure safe return to sports after an injury. However, it seems the goal of some parents is to keep your athletic teenager in the game at all cost.
Our sports medicine team at Tulsa Bone & Joint works diligently with the athlete and the coaches to help return the athlete to play when it is safe to do so. The sports medicine physician makes the un-biased recommendation of whether or not an athlete can return to play, and coaches and parents usually agree.
Sometimes, though, parents seek other professional opinions to get clearance for their athlete to play. It seems like these parents are playing Russian Roulette with their child’s injury. Russian Roulette, by definition, is an activity that is potentially very dangerous. These parents’ primary goal is to keep the athlete playing yet another football game, instead of thinking of the dire, long-term consequences of their decision.
Here are the two injuries I see parents play Russian Roulette with their child’s injuries:
- ACL Injuries.
In regards to a torn knee ACL, usually we recommend that the athlete stop playing pivoting sports for a season until surgical reconstruction. When the ACL tears, it will not heal on its own. As a matter of fact, when the knee becomes unstable after an ACL tear, there is a very high likelihood that the athlete will cause more extensive knee cartilage damage upon return to playing. The more cartilage is damaged, the more arthritic changes will occur at a young age.
After the athlete is sidelined, many parents begin “shopping” for another physician that will clear their child to play again. Usually the second opinion doctor will put the athlete in a functional ACL brace that offers the athlete a false sense of security. However, the brace will not stop the athlete from damaging the knee further. It seems that the second opinion physician is just trying to appease the parent.
Unfortunately, many of these athletes that return to play with an unstable knee will damage more cartilage in their knee. This decision by the parents to return to play will cause lifelong problems for that athlete and will ultimately limit their sports’ career.
- Traumatic Shoulder Dislocation.
When a collision athlete develops a traumatic shoulder dislocation, the decision to stop playing for a season is best. A collision athlete with a dislocated shoulder has a 90 percent chance of re-dislocating his shoulder upon return to play football. If that shoulder is stabilized surgically, there is a 90 percent chance of not having a re-dislocation.
Unfortunately, some parents want their teen to keep playing, and they obtain a brace from another doctor. Sadly, just like with ACL injuries, I have seen many collision athletes sustain a second shoulder dislocation upon return to play. With subsequent shoulder dislocations, the athlete damages more cartilage and is destined to develop shoulder arthritis at a young age.
I recommend that parents ask the sports doctor many questions when their child is injured. Most importantly, ask yourself if the sports doctor is taking into account the potential lifelong consequences of your child’s ill-advised early return to play.
Congratulations to our December PT of the Month, Anton Urgello. Anton is a physical therapist at Tulsa Bone & Joint Owasso. He graduated with his DPT from Saint Louis University on May 2017. He is also certified in Kinesiology Taping Certification.
His family moved to Chicago from the Philippines when Anton was 13. His younger sister is currently studying physical therapy at Saint Louis University as well. Anton is engaged to be married Summer 2020. He enjoys going to the gym, basketball, tennis, video games, and watching movies/shows on Hulu and Netflix.
Anton’s favorite part about being a physical therapist is meeting and interacting with different people with different stories and helping them get to them get back to normal to do their work and hobbies.
Congratulations, Anton! We’re glad you’re a part of our team!
