"Pain should not be wasted."

 

I heard this phrase back in med school when Gerda Klein, a holocaust survivor, addressed our class. It's always stuck with me but this year, it is taking on new meaning because (chuckle, chuckle, sniffle), I'm in pain a lot. I have had to see a LOT of clinicians this year, each with different styles and strengths. As a result, I am learning exactly how to treat athletes -- specifically, how I want to treat the athletes I will see as patients. Being on the "other" side of the examination table is teaching me more than any rotation ever could -- it's an unexpected gift of this journey. 

 

On the heels of an appointment with my favorite physician (mentor, role model, and friend), I've refined "what I know for sure" about the right way to treat athletes (elite, collegiate, weekend, and pee-wee). Here are my Top 10 Tips:

 

1.     Know their sport. Endurance athletes are different animals than power athletes, both in their psychological make-up and in their training programs. Once you understand the kind of athlete sitting in front of you, communication becomes infinitely more personal, resonant and fruitful. 

2.     Do NOT start by telling them to retire, whatever you do (and please don’t forget that your body language, facial expressions, long sighs, raised eyebrows and crossed arms can communicate that exact sentiment). If you start there, you automatically lose their trust. Their respect, too, but most importantly, their trust. They are coming to you with their athletic identity in crisis, at a vulnerable moment in their lives, asking you to help them stay engaged in something they love and that in some way feeds their souls. If you start by telling them to retire/stop the sport, you're basically telling them to starve themselves. From that point on, you may as well start speaking in a foreign language or just repeat "whaa-whaa-whaa-whaa" like a Snoopy character; they are not listening. If they are, they are doing so with an eyebrow and every defense you can imagine, raised. 

3.     Listen, listen, listen, listen, listen. To their tone, sense of hope, determination, athletic identity; as well as to the mechanism of injury, the predisposing factors, the kind of career they envisage, their short and long term goals and their level of commitment to those goals. And incorporate those details into every part of your conversation. 

4.     Contextualize everything, from their injury (how many per year? per practice? per sport? per gender?), to your experience with similar injuries/patients. Re-tell them the story of how it happened, including details they told you, and some others that you were savvy enough to infer, like the difference between overuse and intermittent-use injury, the role of de-conditioning, and life stressors that may have contributed. Remind them that this has been seen before, treated before and beaten before (if it has) and describe what you have seen and what they can expect. Context is comforting. 

5.     Describe their anatomy to them in detail. They get it. Help them understand how they are built and what to emphasize versus avoid. As an example, I have retroverted hips which protects me against impingement. Who knew! Thus, the fact that I am having impingement signs and symptoms indicates that my chiropractic work may be inappropriate for my anatomy and that some component of my training may need tweaking. Amen! So happy to have learned this. 

6.     Be realistic about pain. If it’s just going to be a “live with it” pain, so be it. If they should be pain- free in short order, tell them. But be direct and do not sugar coat that detail. Safety permitting, having to suck it up is okay as long as the athlete knows that that is what they are in for.

7.     Gather every detail about ancillary treatments and clinicians. From the chiropractor to the masseuse to the physical therapist to the yoga teacher to the psychologist. Each has his/her own opinion and bias and each will fill the athlete’s mind with different diagnoses and “ideal” treatments options, many of which they only talk about because they specialize in them. This can be confusing. So as the physician, it’s critical to corral that information into a single, streamlined narrative that the athlete can understand and follow. Very helpful. 

8.     Safety permitting, come up with a plan of care that is integrated into the training program – not in conflict with it. It’s actually quite stressful to hear, in one ear (from the doc), “after this treatment, you will need to take take 6 weeks off...” and in the other ear hear (from the coach), “so I’ll see you at practice tomorrow? No? Why not? We don't have 6 weeks...” Equally as importantly, the plan of care should be tailored, creative and absolutely specific to the athlete’s functional needs in the short and long term.

9.     Emphasize home care and daily maintenance exercises/activities the athlete can pursue on their own to make sure their outcome is optimal.  

10. Encourage. Elevate. Inspire. Never, ever, ever stop trying to get them better. If they say something along the lines of “I was doing so well and then this happened…” or “Now that I have this injury, I just don’t know…” go ahead and interrupt with a gentle smile, encouraging them to keep the momentum going, to keep doing well, to keep improving, keep striving. Momentum is everything during a training cycle or a competitive season. It absolutely must be maintained in order to buttress morale and I suspect, positively influence outcomes.  

 

Just a short list so far, but I whole-heartedly believe in these 10 tips. Weirdly grateful for the pain that inspired these lessons (chuckle, chuckle, sniffle). :)

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