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Through Mike Basten PT, DPT, MTC

Over the past two decades, more and more states have provided patients with pain with direct access to physical therapy without a physician referral. Although the state of Arizona has offered this type of access for several years, insurance companies have only recently begun paying for physical therapy without a doctor’s referral. Direct access is just one of many reasons why you should look into physical therapy first. There are many more.

There is increasing data showing that seeing a physical therapist first can reduce costs and improve the overall outcome of injury rehabilitation. The American Physical Therapy Association (APTA) just published a groundbreaking study: ‘The economic value of physical therapy in the United States,’ confirming that physical therapy (PT) can help Americans live better lives while saving the healthcare system millions of dollars annually.

Historically, the process from injury to recovery has involved seeing a doctor, trying medications, receiving diagnostic imaging, resting, and hoping for a resolution. If the problem was not resolved, the next step was to try physical therapy and perhaps some type of medical intervention such as injections or surgery. However, due to the rising costs of medical care, insurance companies and patients have started looking for methods to reduce the costs of rehabilitation. One of these methods is to first try PT for musculoskeletal problems.

Top three reasons to seek PT for pain first

1. Reduce or eliminate pain without drugs or opioids.

Physiotherapy offers the opportunity to reduce or eliminate pain through specific therapeutic exercises and hands-on manual therapy techniques. Additional treatments such as ultrasound, electrical stimulation, and taping techniques can also reduce pain during recovery.

Physiotherapy has come a long way in the past 20 to 25 years, as have the patients it helps. Due to costs and other factors, the goal now is to solve the problem as quickly as possible with as little use of health care as possible. PT allows the therapist to treat the cause of the pain early and begin rehabilitation by restoring the correct mechanisms that may be causing the pain.

A 2018 study analyzed 200,000 commercial and Medicare Advantage insurance beneficiaries seeking treatment for low back pain. It found that those who were initially referred by a physical therapist, chiropractor, or acupuncturist, compared to those who had an index visit by a primary care provider, reduced the likelihood of early opioid use by 85%-91% and long-term opioid use by 73% reduced. %-78%.

2. Savings on diagnostics

Being able to go straight to physiotherapy is cost-effective. For example, a patient avoids paying to see a doctor for a referral, and the doctor may order expensive diagnostic tests before determining that PT is the appropriate treatment method. A qualified therapist will work to avoid unnecessary diagnostics during your recovery, which can increase out-of-pocket costs and affect your long-term well-being. They will also work with your doctor to explore pre-surgery, post-surgery, and non-surgery options for a full recovery.

If physical therapy can address the reasons contributing to the pain, in many cases you can avoid surgery altogether. If you do need surgery, preoperative physical therapy can improve mobility and strength and help you get into better shape, allowing you to recover from surgery faster and with better results more easily with postoperative physical therapy.

When we look at patients who went to physical therapy first, there was an average savings of over $250 in one study and over $1,000 in another. Overall, there were significant savings across the board with less imaging, less medication, and even less treatment.

3. Improve mobility.

If you have difficulty standing, walking, or with transitions, such as moving from a sitting to a standing position, exercises to improve flexibility and strength can improve your ability to move more easily, making daily activities more enjoyable. Physical therapists can help you identify areas where you’re not moving correctly, predisposing you to future injuries, and correcting those movements to keep you injury-free. A PT can also instruct and fit you for an assistive device such as a cane, crutches, or other aids designed to improve your mobility.

PTs are also trained to recognize when physical therapy is needed not the correct or best first course of action and can point patients in the best direction. The physician-PT team is still the standard in treating musculoskeletal problems and guiding people with pain to a full recovery.

The search for full recovery is a journey without shortcuts and without a finish line. A journey that will lead to astonishing and satisfying results. At Foothills Sports Medicine Physical Therapy, our therapists embrace the journey. We take you, your pain and your full recovery seriously and do not believe that a good enough recovery is good enough. We strive to do everything we can to help you regain your full, healthy life.

If you have questions about immediate access to physical therapy, contact the Foothills Sports Medicine Physical Therapy clinic nearest you and schedule a free pain assessment.

The literature search was led by Dr. Kristian Goulet of the University of Ottawa’s Faculty of Medicine and the Children’s Hospital of Eastern Ontario (CHEO) calls on provincial and territorial governments to mandate schools – including those involved in school sports – and sports organizations to establish policies and protocols set, update and enforce to prevent concussions, with a sharp emphasis on body contact.

Currently, hockey organizations in Canada allow body contact in competitive and recreational leagues from the age of 13. But studies have shown that when body contact is initiated, injuries increase significantly, including concussions.

Nearly half of hockey injuries are caused by body checks, with injury rates four times higher for children and teens in leagues where body checks are allowed. Other studies have shown that concussions are reduced by more than 50% when body contact is eliminated. An estimated 200,000 concussions occur in Canada each year, mainly affecting children and youth. Ice hockey is the leading cause of all sports and recreation-related brain injuries in pediatric age groups, in both boys and girls.

Dr. Goulet is hopeful that this review will prompt Hockey Canada to forge a new path forward to strengthen our understanding of concussion and guidance for clinical management, especially as it relates to acute care, ongoing symptoms and prevention.

“Sports are incredibly important to the mental, physical, emotional and social health of our children. However, it is our duty as caregivers, parents, coaches, administrators and decision makers that we make every reasonable effort to make sports as safe as possible,” says Dr. Goulet, an assistant professor at the Ottawa School of Medicine and the medical director of the CHEO Concussion Clinic, the Eastern Ontario Concussion Clinic and the Pediatric Sports Medicine Clinic of Ottawa.

Effect of the FIFA 11+ injury prevention program in collegiate female soccer players over three consecutive seasons.

Magoshi H, Hoshiba T, Tohyama M, Hirose N, Fukubayashi T. Scand J Med Sci Sports. May 21, 2023. doi: 10.1111/sms.14379. E-publishing prior to printing.

https://pubmed.ncbi.nlm.nih.gov/37211876/

Take home message

Over three seasons, injury prevention programs effectively reduce lower extremity injuries, especially those considered non-contact or moderate-severe.

Background

Injury prevention programs reduce the risk of lower extremity injuries. However, most studies have only examined the effectiveness of these programs over one season. It would be useful to verify whether these benefits persist if a team continues to implement an injury prevention program for multiple seasons.

Study aim

The authors conducted a non-randomized controlled trial to investigate the effectiveness of an injury prevention program (FIFA 11+) to reduce the risk of injury for up to three seasons among football teams in the Kanto University Women Football Association Division 1 (similar to NCAA Division 1).

Methods

Four teams agreed to run the FIFA 11+ program for 20 minutes before practicing 2-3 times a week. Three teams refused to agree to the program and represented the control group. Each team’s athletic trainer or physiotherapist recorded sports-related injuries, participation in training/matches and how often a team completed FIFA 11+. The authors defined a sports injury as an injury that causes a player to miss at least one day of training or competition.

Results

Adherence to the FIFA 11+ program was high (~88%). Compared to the other teams, the teams implementing the FIFA 11+ program have reduced the number of new injuries in a season by 36 to 61% – especially for non-contact, moderate or lower extremity injuries. Teams running FIFA 11+ may achieve better results each subsequent season (e.g. lower rate of new injuries in Season 2 versus Season 1), but this may be mainly due to the athletes who were on each team all three years.

Viewpoints

This study adds to the many previous randomized clinical trials showing that injury prevention programs reduce the risk of lower extremity injuries within a single season. This study provides good evidence that injury prevention programs can be effective over three seasons, especially for athletes who complete the program for all three years. It would be interesting to see the incidence of injuries in male football players and other sports associated with lower extremity injuries. Furthermore, it would be useful to confirm these results with a cluster-randomized clinical trial with a larger sample size to verify that athletes who perform FIFA 11+ continuously over multiple seasons experience greater protective benefits each year. Based on this research, it is unclear whether the benefits are due to the very high compliance rates (~88%), which is likely because teams actively decided to start the FIFA 11+ program rather than being randomly assigned to complete it program to execute. This highlights a major benefit of convincing a team to implement these programs.

Clinical implications

Clinicians should recommend that teams incorporate injury prevention programs into weekly team activities.

Questions for discussion

1. We often hear that a lack of time or coaching support for these programs is a barrier. WWhat are some strategies we can implement to combat this problem?
2. Would incidence remain low with a once-a-week approach if maintained during the off-season?

related posts

Coach the coach, make ACL injury prevention programs stick!
Injury prevention warm-up programs, one size fits some?
Back-to-school injury prevention programs
Forget about 7 minutes of Abs. What about the 10-minute lower extremity injury prevention program?

Written by Shelly Fetchen DiCesaro
Reviewed by Jeffrey Driban

The research, published in The BMJ on August 2 analyzed data from 1.6 million babies and found that about 40 percent of babies with early corticosteroid exposure — defined as exposure at 34 weeks’ gestation or earlier — were born at term. The full-term babies had an increased risk of both short- and long-term health problems, including admission to the neonatal intensive care unit, breathing and growth problems and an adverse neurological outcome, the researchers found.

Corticosteroids are used to increase the chances of survival of very premature babies and reduce health problems. However, the effects on long-term child health are not well understood, especially in infants who exceed expectations and are born on term. The research shows that many babies exposed to steroids avoid preterm birth, but new risks arise for other future health complications.

“Preterm birth is very difficult to predict; we need better prediction models to prevent overexposure to interventions such as steroids because there is a potential risk,” said Sarah McDonald, senior author of the study and professor in the Department of Obstetrics and Gynecology at the McMaster University.

To conduct the study, researchers conducted a systematic review and meta-analysis of data from seven randomized controlled trials and ten population-based studies involving 1.6 million babies born since 2000.

More than half of infants exposed early to corticosteroids were born together at term (37 weeks or longer) and late preterm (34-36 weeks), and researchers found similar results in this combined group. For very preterm infants, antenatal steroids can potentially save lives and reduce serious morbidity, but as pregnancy progresses, the benefits shift to risks.

“Antenatal steroids are a double-edged sword: highly beneficial for babies born very preterm, and potentially harmful for babies born at term,” says McDonald, Canada Research Chair in Maternal and Child Disease Prevention and Intervention.

The authors say more research with long-term follow-up in randomized controlled trials is crucial. They also warn against a less liberal approach to steroid use during pregnancy.

The study was supported by the Canada Research Chairs program.

Self-reported mental health measures among incoming collegiate student-athletes who had SARS-COVID-19

Anderson MN, Gallo CA, Passalugo SW, Nimeh JM, Buckley TA. J Athl train. 2023 [published online ahead of print, 2023 May 26]10.4085/1062-6050-0554.22.

Full text freely available

Take home message

Athletes with a history of COVID-19 infection may report slightly worse depression and anxiety scores than peers without a history of COVID-19.

Background

More than 75% of people have cognitive problems after a COVID-19 infection, and about one in three experience persistent neuropsychological effects such as depression and anxiety. It remains unclear whether athletes with a history of COVID-19 infection experience more depression or anxiety than athletes without a history of COVID-19.

Study objectives

The authors compared patient-reported anxiety and depression between incoming collegiate athletes with or without a history of COVID-19.

Methods

Participants were freshmen or transfer student-athletes in a more comprehensive concussion study that answered a question about their history of COVID-19 and any mental health measures. Participants reported on their mental health using the Satisfaction with Life Scale, Hospital Anxiety and Depression Scale, and State-trait Anxiety Inventory.

Results

The authors examined 79 athletes with a history of COVID-19 and 99 without a history of COVID-19. Overall, those with a history of COVID-19 had worse depression and anxiety scores, especially among women. However, these differences were small – often less than a one-point difference. When the authors examined how many student-athletes met clinical cutoffs for depression or anxiety, almost everyone in each group (>94%) did not meet clinical cutoffs for depression or anxiety, regardless of their history of COVID-19.

Viewpoints

Patients with a history of COVID-19 may have worse mental health outcomes than patients without a history of COVID-19. However, because many of the patients scored within normal limits, the clinical applicability of the difference may be questionable. It would have been interesting to know if the time since having COVID-19 or its severity influenced mental health outcomes among student-athletes. This type of analysis would require more student-athletes.

Clinical implications

The authors suggested that clinicians should be aware that student-athletes with a history of COVID-19 could be at greater risk for mental health problems if another event (e.g., concussion, joint injury) occurs.

Questions for discussion

Why do you think there was such a negligible effect on athletes’ mental health after COVID-19 infection? Do you think we should be concerned about the mental health effects in athletes after COVID-19 infection?

Related posts

We must break the stigma of seeking mental health care among student-athletes
Addressing the Mental Health Needs of NCAA Student-Athletes of Color: Fundamental Concepts from the NCAA Summit on the Mental Health and Well-Being of Diverse Student-Athletes
Adolescent mental health, not football, is a reason for mental health problems in adulthood

Written by Mitchell Barnhart
Reviewed by Jeffrey Driban