This recent article, "You're Injured. Who Can Help?", published in Runner's World speaks to the important contributions chiropractic makes to injury treatment. In addition, the article discusses the importance of the proper credentialing of specialists and why being a CCSP makes Dr. Kuhn so unique in his field.
You're Inured. Who Can Help?
By Carl Leivers
“The doctor will see you now.” For years, that phrase marked the beginning of your medical treatment. But over the last decade, the medical landscape has changed dramatically for runners. The road back from injury no longer automatically starts with a visit to your primary care physician.
Depending on the state and the insurance plan, runners are increasingly able to use chiropractors, massage therapists, orthopedists, and physical therapists without a referral. That shift is positive for athletes looking to get back quickly to training, says Bryan Heiderscheit, a physical therapist and the director of the University of Wisconsin Sports Medicine Runners Clinic. The new model lets runners get the treatment they need in a more timely fashion.
Josh Glass, a USATF chiropractor for the 2012 Olympics, says the hands-on treatments a runner can receive from a physical therapist, massage therapist, or chiropractor is “by far one of the most beneficial things someone can do to get an injury to heal quicker.” Glass says that easier access to that treatment helps runners reduce the amount of time lost to injury.
But if the changing sports medicine world allows the runner quicker access to a variety of treatments, the choices it presents can also be confusing. With no mandated first step, how do you know which direction to turn?
Choose a Gatekeeper
Even though you may have access to many treatment options without a referral, it’s still beneficial to rely on a consistent point person when you’re injured, says Robert Wilder, medical director of the Runner’s Clinic at the University of Virginia. A practitioner you consistently see at the first sign of injury can better coordinate care with the other specialists you may need to visit.
Lyle Micheli, founder of the Micheli Center for Sports Injury Prevention and past president of the American College of Sports Medicine, says that having a primary contact is also helpful so the practitioner has a better idea of what has changed since previous visits that might be causing your problems.
Trust is important, Glass says. The professional you see first “has the responsibility of not just doing what they can within their scope, but the responsibility of referring to other specialties within the health care world that are appropriate for the patient,” he says.
Because of that responsibility, take time to choose your gatekeeper carefully.
To find a practitioner who can provide the treatment you need—and that person need not be a medical doctor—consider the following factors:
1. Licensing Matters
Make sure the person you’re considering is licensed, says Holley DeShaw, a massage therapist with the 2012 U.S. Olympic track-and-field team. DeShaw says that regardless of reputation, it’s important that any practitioner you may be considering backs up the services they offer with the correct credentials.
Licensing is a way to guarantee a certain level of education as a protection for the public. “The more people delve out of their scope of practice, the more likely bad things are to happen,” Glass says. If the worst-case scenario does happen, the recourse available to the patient may be limited if the individual is not licensed.
2. Look for Advanced Certifications and Education
Although any practitioners who are licensed will have a general level of knowledge in their fields, advanced certifications are important, says Jay Dicharry, a physical therapist and author of Anatomy for Runners. These advanced certifications show that practitioners have the experience and training in a specific field that can allow them to better understand the cause of your injury and the best treatment options.
In addition to specific certifications, continuing education in different techniques within a profession is important—for example, if your chiropractor takes out a Graston tool, he should be certified in the Graston Technique, and it’s appropriate to ask. The more training in different treatment techniques a practitioner has, the more options that person has to help treat your injury, increasing the odds of a successful recovery.
3. Experience as a Runner and Working with Runners
A practitioner with experience working with athletes is better suited to treat them, says Jack Ransone, a certified athletic trainer and the USATF medical coordinator for the 2008 Olympics. Someone with experience working with athletes will not only have a better chance of knowing how to treat problems like overuse injuries effectively, but will also have a better understanding that athletes often heal quicker than the general population, he says.
Seeing a practitioner who has personal experience as a runner can be helpful. Someone who understands what Dicharry calls “the psychological, the emotional, and the almost addictive aspect of running” can allow for a treatment plan that is a better fit for runners. Dicharry cautions, though, not to automatically assume that anyone who likes to run is a running specialist; to be sure, you’ll need more knowledge of his or her education and training.
4. Good Word of Mouth
In addition to training and experience, Heiderscheit says that good word of mouth is a consideration when choosing a practitioner. Runners are a savvy group, and when a practitioner provides effective treatment, word gets around. (Alternatively, bad experiences will make their rounds as well.) It’s important not to base your decision on one person’s experience, but consistently good or bad reports about practitioners can be telling. “If you’re continually hearing about a certain individual or group that is highly recommended by a variety of runners, that is something to pay attention to,” Heiderscheit says.
If the recommendation, however, comes primarily because a practitioner is known for not telling patients they have to stop running, get more information. Dicharry suggests asking what tests the practitioner performed to make sure it was safe for the patient to keep running. Although it may be tempting to hear that you don’t have to stop training, he says, “You want to go get the answer you need to hear, rather than the answer you want to hear.”
It Takes a Team
Because no practitioner can effectively treat every type of injury, your initial gatekeeper should be comfortable working with a larger team that includes chiropractors, massage therapists, physical therapists, and physicians. “The more people you have in your corner that are experienced and you trust, the better,” Glass says.
Your gatekeeper needs to be part of a network of professionals. John Ball, a Phoenix-based chiropractor who specializes in elite and recreational runners, as well as other professional athletes, says an effective practitioner can guide you to the appropriate options, even if that means referring you to a professional with a different specialty or area of expertise—much like the old model of seeing a primary care physician who would then decide on the person best-suited to provide treatment.
Ball emphasizes that it shouldn’t fall to patients to determine what treatment is appropriate or who they need to see for a specific type of injury. Those decisions should be left to the initial practitioner who evaluates you. So, while the same steps you use to decide on your initial contact still apply when looking for other practitioners, the experts recommended by your primary contact should be your best bet.
The ideal situation is having someone “who is really good at diagnosing, really good at treating, and works with a network of others,” Glass says.
Be a Good Patient
To get the best results, it’s about more than just picking great practitioners, though. You also have to be a good patient. It’s important to view the relationship between you and your team as a two-way street, Wilder says. And that starts with actually seeking treatment when you’re hurt.
Micheli agrees, suggesting that it’s time to get an opinion if pain has persisted or increased over three weeks. Glass adds that if you have pain that causes you to alter your stride and it lasts for more than a few days, it’s time to get it checked out.
It’s helpful to get your thoughts in order before the appointment. DeShaw says you need to articulate where you are in your training cycle and what your goals are so the practitioner can decide what treatment options would be best, based on your situation.
Wilder adds that taking those goals into account while creating a treatment plan allows the runner to have input in the process—and usually results in better outcomes.
Having a training log that you can bring with you can also help. “In many cases, an overuse injury is going to occur because you changed something in the last three to six weeks,” Ransone says. Being able to look back over the training log can help evaluate the injury and potential causes at the same time.
While you’re being treated for an injury, Glass says that listening to the practitioner and backing off when you’re told to is key. “I want you to keep running, but if you’re running with a limp, you’re either making the injury you have worse or creating another one,” he says.
Finally, it’s important to take an active role in your care. Not everyone will respond the same way to the same type of treatment. “It’s important for athletes to find what truly works for them,” DeShaw says.
After all, in this new medical model, knowing when to say, “The patient will see you now,” is the first step to getting the best results from your treatment.
Learn Your ABCs
The letters after practitioners’ names can provide insight into the level of training and expertise they have, but only if you know what they mean. Here are some of the most common titles and certifications that runners should look for.
Board Certified in Therapeutic Massage and Bodywork
Requires additional education, experience, and testing beyond licensure
Certified Chiropractic Sports Physician
Requires additional education and testing in sports-specific chiropractic treatment
Doctor of Chiropractic
Doctor of Osteopathic Medicine
Takes the same licensing exams as MDs, but schooling includes additional training in the musculoskeletal system
Doctor of Podiatric Medicine
Requires the same licensing as MDs, with special training in human movement, focused on the foot and ankle
Licensed Massage Therapist
Doctor of Medicine
Orthopedic Clinical Specialist
Physical therapy certification that requires additional experience, training, and testing in treatment of orthopedic injuries
PT (or MPT, DPT)
Physical Therapist (or Masters of Physical Therapy, Doctor of Physical Therapy)