For any human being, particularly a Lifetime Athlete, injuries happen. In fact, many would say that what happens is a four-letter word beginning with an “s” and ending with a “t.” Regardless, in the presence of an injury we have to determine what exactly is wrong and then embark upon the most appropriate path toward (full) recovery. This is essentially getting an accurate diagnosis of the problem and setting up the best course of treatment.
Let’s confine our conversation to injuries which are the typical aches, pains, strains, and sprains athletes encounter. These can be acute occurrences such as rolling an ankle as well as any chronic or overuse conditions. We’ll exclude major trauma or life-threatening emergencies, which require immediate and often lengthy medical intervention, in our discussion.
In our current world of AI and “Dr. Google,” ostensibly, you can diagnose yourself and you can treat yourself. I generally do not recommend the former and I usually strongly support the latter. This is the distinction we’re getting into today.
The major problem with self-diagnosis is one of sensitivity. Now, I’m not talking about being aware of your feelings or those of others. I’m focusing on how the practice of self-diagnosis has a significant possibility of lacking adequate sensitivity. In other words, the diagnostician – in this case, the self – runs a high risk of not correctly identifying the pathology. This is committing a Type 2 error, or a false negative in which you inadvertently rule out or miss the key problem. This is true in the case of injury diagnosis because even the best AI-generated algorithm is not able to take into account all the dynamic factors involved in athletic injury.
When a diagnosis is inaccurate or incomplete, time and energy (and usually money) is wasted, with subsequent treatment often going in an unproductive direction. This can be frustrating and it can even exacerbate or compound the existing problem. This is why I’ve always been in favor of getting a very accurate diagnosis of an injury. One that includes the underlying causal factors which are usually biomechanical in nature. What happened? Why did it happen?
This naturally segues into treatment. Once we know what has specifically happened to the tissue(s) and the reasons (movement dysfunctions) why this occurred, it’s relatively easy to put together a treatment plan. This is where self-treatment shines. There are innumerable resources to help you develop and apply the correct protocols for healing and rehabilitation.
As a physical therapist, I’m a big advocate for PT’s (and some related professionals) in this capacity. Someone who not only has the degrees, licenses, and certifications to help you cut to the chase in the diagnosis and treatment process, but who also possesses abundant experience in sports and orthopedic injury management. This isn’t every PT, but it’s a lot of us. And I’m not dissing other practitioners either. But their background and track record has to be strong in this arena.
Now let’s make a couple of summary statements about self-diagnosis and self-treatment. For any condition or injury that goes beyond the most minor, utilize the healthcare system to get an accurate assessment. This might mean going through your primary care physician and possibly an orthopedic surgeon (for imaging and to rule out the necessity of surgery) but in most cases you have direct access to your local sports and orthopedic PT. Get a diagnosis and a treatment plan and then further customize it to your unique body’s needs. Most of your treatment will be exercise-based (in the capacity we’re discussing) and much of this can and should be done independently. Periodic check-in appointments for guidance and upgrades may be indicated.
This is the model that I’ve always endorsed and it is a managed care philosophy that many of us were doing long before the concept became “official.” PT’s are trained (and licensed) to be “self-policing” professionals and, in most cases, we really do know best. We don’t need a third party (usually an insurance company) telling us how many visits the patient requires. Of course, this problem came about because crappy clinicians and often unknowing yet overutilizing patients drove costs up with excessive, unnecessary, and redundant visits. Sorry for getting on my soapbox a bit there, and let’s not even go further down that rabbit hole.
Back to the topic at hand, here’s some advice on the inevitable diagnosis and treatment journey you’re going to experience. Hopefully only a couple times, but…
Make a list of your symptoms and experiences before your diagnostic appointment. This is very helpful for the diagnosing clinician to piece together the data in comprehensive fashion. It can support and corroborate the findings from clinical tests and imaging studies.
Write down your specific questions and concerns and bring them with you. It’s easy to forget things when you’re in the office, so having a list is valuable. Keep it reasonable in length but expect to get some answers. That said, have some understanding of how the system works and that most clinicians don’t have unlimited time for your appointment.
Research your diagnosis fully and gain a greater understanding of the problem. Once you’ve got your problem correctly identified, study up and learn as much as you can about it. Be a little careful in recognizing that every source of information on the internet is not always vetted.
Consider a second opinion. If you’re left with any doubts, and need some reassurances that you’re heading in the right direction, seek another expert’s input. This isn’t always warranted, but when you have uneasy sensations, go with your gut.
Remember that healing and rehabilitation are not the same thing. Most injuries are self-healing. If you manage load appropriately, and support it with good sleep and nutrition, your body is programmed to repair itself. You’ll notice I said manage load as opposed to unload, as tissue loading is required as a stimulus for repair. However, this will be a different progression for a bone stress injury (BSI) than for a tendinopathy. That’s where expert guidance from a pro is really important. You can be healed and symptom-free, yet not fully rehabilitated back to prior functional status (or beyond). Getting into relatively advanced training (when the time is right) is the key to making a full comeback and minimizing the risk of reinjury.
Establish a relationship with a PT or other professional that is more consultative than dependent. When your participation is active and relatively autonomous, it’s empowering for you as well as your practitioner. Use your PT for the things he/she is really good at, which is deductive reasoning, problem solving, and program design. Learn to manage the basic stuff yourself, like therapeutic exercise performance (once you’re properly coached) and modality application (when indicated).
Be patient with the process and expect some ups and downs. This is just one of the journeys of life and it’s decidedly nonlinear. Your progress is impacted by all the things that happen in a day. Since you can’t (and shouldn’t want to) live in a bubble, accept that stress, sleep, nutrition, and other lifestyle elements have an impact on tissue healing as well as overall health.
Consistency is king, but there is no perfect. Get most of your stuff in, most of the time, and you’ll be fine.
In general, be conservative early and aggressive later. The timeline here depends on the injury for sure, but let’s just say keeping things pretty basic and building volume before intensity over the first 6-8 weeks…is money. After that, introduce more challenging aspects into your programming…just do it gradually.
Utilize high-level return to play criteria. This isn’t just for Olympians and professionals. Do an analysis of your sports demands and an honest assessment of your body’s capacities. Make sure you’re fully capable of the physiologic requirements and biomechanical stressors that the thing(s) you love necessitate.
Use the knowledge acquired from the injury to adjust your training program moving forward. An injured area is almost always a weak link in the future. Over and over again, research shows that the single most significant risk factor for an injury is prior history of the same injury. This is because the healing process is repair, not regeneration (with respect to connective tissues), and you might come back at 98% integrity at the injury site, but it won’t be 100%. That stated, training can be designed to support the area better, offset undesirable forces, and improve movement quality.
Keep Kicking Ass…for LIFE! That’s what it’s all about. Be careful with self-diagnosis. Rely on the experts. And once you have some guidance, do most of your treatment yourself. You know you. You can “do you” better than anybody else.