The more we use something the more prone it is to breaking. If you drive a car around for 150,000 miles, it is bound to need a bit of work along the way. If you use your computer frequently, you are bound to have a hard drive burn out once or twice. Our bodies are no different. “Accumulating injuries are the price we pay for the thrill of not having sat around on our asses,” after all – at least according to strength coach Mark Rippetoe.
When our car needs repairs we head to a qualified mechanic. When our computer suddenly stops working, we turn to our tech geek to help solve our problems. When your body breaks in some way, though, to whom do you turn? It is important to have a good healthcare professional in mind for whatever the problem may arise.
Since most people reading this are interested in athletic performance and nutrition, healthcare professionals associated with injuries and injury prevention will be crucial. Most recreational athletes, however, don’t have a healthcare professional that they turn to in a time of need or injury – hell, most recreational athletes don’t even know how to find them!
First, let’s identify the different classes of healthcare professionals that we may turn to if we start to experience joint or muscle pain that may be related to training.
Sports Medicine/Orthopedist
The Orthopedist (Ortho) is the go-to medical doctor for any sort of joint or muscle pain. An orthopedist (in the US, anyway) acts as a portal for physical therapy treatment. That is, you typically can’t go for PT that is covered under insurance without receiving an exercise prescription (script) from an Ortho first. Orthopedists are highly trained in the reductionistic methodologies associated with joint and muscle pain. Most Orthos have a specialty. Oftentimes they are a knee specialist or a shoulder specialist – make sure to ask their specialty when making an appointment or asking others for a recommendation. Usually, the end result of a meeting with an Ortho is: you need surgery, you should go for physical therapy, you need rest, you need painkillers, or you are untreatable. Painkillers are only appropriate in very extreme circumstances and are over prescribed. You will almost never see an Ortho recommend soft tissue work (like massage therapy), even though it can solve many problems.
Family Doctor/General Practitioner
Your general practitioner may be helpful when you are coming down with a cold or have a strange rash that suddenly broke out. When it comes to muscle or joint pain, they usually don’t provide much help since this is not their area of expertise. If you are experiencing pain that is related to your training then you may want to call your general practitioner and ask if he/she has any recommendations for an orthopedist. When asking for a recommendation, make sure that you explain details of your injury. This will save you money on co-pay or visit fees and you will wind up with at least a starting point to see a doctor that specializes in your problem area.
Physical Therapist
Physical Therapists (PTs) oftentimes are the best resource on any joint/muscle pain issues. Sadly, as stated above, most insurance companies don’t cover your PT appointments unless you have seen an Ortho and received a script from them. In recent years, PTs have been lobbying to become a portal themselves. This would circumvent the need to see an Ortho first – but the movement hasn’t been successful just yet. Many times, a physical therapist will do a short exam on you first before treatment. The treatment usually consists of exercises that follow the guidelines on the script written by the Ortho. Many times, the PT will consult the Ortho throughout the course of your treatment to provide follow up and request changes (or verify details) on the script. Physical therapy can take 2-6 months (or even longer) depending on the injury. Many people feel they can do the job of a PT in their own home by just doing the exercises – but this is often not the case. A high quality PT will be moving their client (i.e. you) along according to a timetable. They should have a good idea of when you are ready to continue activity-as-normal.
Chiropractor
People seem to either love or hate chiropractors (Chiros). That is because the Chiropractic practice, overall, is so unregulated that you have some really talented professionals mixed into the same heading as first class whackos. In my experience, there are more whackos than talented professionals, but that’s just my opinion. The benefit of a Chiro is that you don’t need a portal. Chiros tend to be expensive and, most times, they run you through a flurry of introductory appointments (sometimes as many as six appointments in two weeks) all at full charge. If you choose to change Chiros, your new Chiro will likely want to do his own set of introductory appointments – so be prepared to drop another hefty sum of cash. Chiropractors focus on adjustments rather than therapy. They may recommend exercises to aid the rehabilitation process, but the philosophy is that the mechanical adjustments of subluxations (bones that are slightly out of place) will alleviate stress, inflammation and pain. Additionally, the belief is that if we keep our bones aligned properly, then our bodies will perform better. Personally, I tend to treat Chiros as an “if-all-else-fails” method. In the past, Orthos have told me that some conditions were untreatable – such as my very chronic patellar tendinitis – and a Chiro was able to help with the pain dramatically. Chiros promote their practice as a much more immediate resolution to problems such as pain. If you are not experiencing significant results within two months, you may need to find another professional.
Massage Therapist
While massage therapists are not really medical professionals, they like to think that they are! A good massage therapist will be able to greatly reduce many types of muscle pain. The pain relief from a massage therapy session should be immediate. If you find yourself in massage therapy undergoing the same treatments for six months then you are wasting a ton of money. If you aren’t feeling better a few days after a single session then you likely did not need massage therapy in the first place, or your therapist didn’t know what they were doing. Before going to a massage therapist, you may want to consult an Ortho, PT or Chiro to see if there are any special techniques that you can request. For example, if you have very bad hip pain then an IT release is a common massage therapy procedure that can greatly help with the pain. In another example, in some cases, a lower back deep tissue massage can greatly help for pain caused by a herniated disc. Using a massage therapist as your portal tends to lead to wasted money and time.
So, now we know the options that are available. No matter which type of specialist you decide to see, there are a handful of universal concepts to keep in mind when seeking out a professional to help you with your injuries.
Professionals who work with sports teams
Most good Orthos are associated with a major league, minor league or Olympic team of some sort. If you live out in the middle of the boonies, that may not always be the case. If you are lucky, you may be able to find physical therapists, Chiros or massage therapists that work with teams as well, but they are few and far between. If at all possible, make sure the teams they work with have a significant amount of overlap with the sports for which you train. For example, if you train the Olympic lifts, an Ortho with direct experience O-lifting or with football teams would be very beneficial. In another example, a PT who used to train in gymnastics would be a great professional that you should see if you train in gymnastics or parkour. Sometimes you can’t always be that lucky – but I had the good fortune of working with a Chiro that trains in parkour, a PT who trained in gymnastics and an Ortho who worked with the USA Olympic gymnastics team after he had trained gymnastics in his youth. Not too bad considering my main sports are parkour and gymnastics.
Word of mouth
As I said in the short section on general practitioners, you want to make sure that you ask for recommendations. When asking for recommendations make sure the professional has experience in fixing your problem area. Also, ask for recommendations from credible people. People who train similarly to how you train may have already found a professional that understands their sport. If all else fails, ask other medical professionals for their recommendations based on the problems you are experiencing.
Professionals that want YOU to be proactive
Many professionals fall into the trap where they look at the problem and provide a solution. These “solutions” may fall under surgery, adjustments, six months of physical therapy, multiple massage therapy sessions, whatever. All of these treatments have their place but some professionals look at these treatments as end-alls or shortcuts to your end goal of getting back to performing. The real thing to look for is a professional that wants you to take it to the next level. They want to perform the treatment but they emphasize that it is on you to follow through and lay off of it when it needs rest and to perform the exercises they prescribe. Their hand should be one of guidance through your recovery so that you can learn from the experience and hopefully treat yourself in the future.
Professionals that explain themselves
Keep in mind that the professional mostly assumes that you don’t know your elbow from your knee, literally. Most times, they will keep things in laymen’s terms so that they can communicate with you effectively. Pry in on them and ask questions to get them to explain why they are recommending a certain treatment. Any professional that is worth their salt can explain why they are making a decision regarding your health. When they present an treatment, always ask for an alternative option; find out why that is the alternative and not the primary recommendation. These questions will get you answers that allow you to treat yourself in the future and give you peace of mind that you are getting the proper treatment.
Mutual Respect
If you respect them they will respect you. This means a higher quality of care and treatment. Yeah, yeah, as per the Hippocratic Oath, they are supposed to take care of you no matter what – but psychology is psychology. When you like someone you treat them better. When it comes to respecting your practitioner, make sure you schedule a time that is early. Late appointment times are annoying and no one wants to stay late at the office – not even your healthcare provider; who woulda thought? But, also make sure that the professional is behaving like a professional and respecting you, as well. If you go to an Ortho, many times there is a physician’s assistant (PA) involved, as well. A PA oftentimes screens the patients for the doctor. If you need a lot of imaging, for example, then you might not see the doctor on your first trip to the office. Some offices don’t let you see the doctor at all. When making your appointment, make sure that the doctor sees all patients that don’t need imaging first. If you don’t need imaging and a diagnosis is going to be made then your doctor should be present. If you ask “will I see a doctor when I am being diagnosed?” and the receptionist gives you any answer aside from, “yes” then I would try to find another doctor.
To sum it all up, the more athletic you are the more medical professionals you will need to have in mind for the various strains, pulls and injuries you accumulate along the way. Know the types of professionals that are out there, know the physiology of your ailment beforehand and ask questions. If you approach your injuries in this way then it is likely that you will learn a ton along the way.
Chris first became interested in human performance enhancement during a short time as a martial artist. This led him to focus his computer engineering degree more intently on human anatomy and physiology. For the past 3 years, Chris has continued to dedicate all of his free time to studying human physiology as well as practical approaches to enhancing human performance through exercise, diet and lifestyle. Through his contributions on the American Parkour website, he has helped hundreds of novice and intermediate athletes identify goals and better training practices to excel in their discipline. Since September 3, 2007, parkour has been the sport/discipline of choice for Chris. He currently follows his own, custom program of strength and skill training which is heavily based in gymnastics. Originally from Brooklyn, NY, Chris currently resides in Colorado Springs, CO working as a Biomedical Research Consultant. 
Hey,
would be interesting what your opinion on Kinesiology or Osteophathy practitioners is.
Thanks!
Ernie,
I don’t really have any experience with osteopaths aside from an old friend who is going for her DO. They would probably be along the same lines as your Ortho or general practitioner. Granted, a DO looks at things from a more wholistic point of view, so it may prove to be more beneficial than someone who is reductionistic like an Ortho/GT. In short, I don’t really have enough experience to comment.
Kinesiologists, in my experience, are not really medical professionals that one would see for help on an athletic complication. Kinesiology, strictly speaking, is the study of how muscles move bones (study of human movement). They don’t really provide assistance for rehabbing complications though they may be useful in identifying some pathologies, particularly in things like gait analysis where I hear most of them coming into play as a health professional. If you need gait analysis then that is usually falls under the PT blanket. From what I understand, most practicing kinesiologists really have another field that is their own (such as PT) but just have a concentration or focus on kinesiology.
Would be glad to hear some other opinions/counter thoughts on this.
Chris
Hey Chris!!
As a practicing chiropractor for over 3 years now, I was initially appalled by your comment about chiropractors. More so b/c we are actually highly regulated, with lots of schooling required, often times with more classroom hours about the human frame than most general practitioners (and sadly, some Ortho’s). But you are also right that there are as many good docs as bad docs, which honestly is the case with any profession (I should know as I practiced engineering for 7 years in the automotive industry). Sadly, I think the media makes that look worse, as well as what is taught in some of the schools. Real chiropractic care focuses on the balancing of the nervous system by correcting the spinal bones which protect the central nervous system.
The CNS is key, as this is the home of our autonomic nervous system, and it has a direct effect of our overall health. In fact, most of our brain power is set to help us stand upright in gravity, by processing all of the inputs from the muscles along the spine. The greatest concentration of these inputs (muscle spindles) are located in the upper cervical spine around the base of the skull down to the first 2 or 3 cervical bones, and commonly a misalignment in this area will not only cause postural distortions (making the body work harder to stay upright), but also starts to affect the relationship of sympathetic (fight/flight response) and parasympathetic (rest/digest) nervous systems, pushing the body into more sympathetic response, which prevents healing, and promotes more breakdown of our bodies. In our society, we tend to live in what is called a sympathetic dominant state because of our high stress lives. All of this science really comes down to the fact that much of the problems with our form, structure, etc. stems from a misalignment in the upper cervical spine, or what we call an upper cervical subluxation.
Herein lies another problem, as not all chiropractors practice only in this area. That’s OK. As you pointed out above, there are some really talented DC’s out there doing good work. I’d like to emphasize two things. Not all DC’s are trained in the upper cervical techniques to properly unlock an upper cervical subluxation. I practice the upper cervical work, specifically a technique called Blair upper cervical, but there are 4 other upper cervical techniques out there, such as Atlas Orthogonal, NUCCA, Orthogonality, and the technique that made Palmer famous, Toggle/Recoil. So right there, just within the upper cervical world of chiropractic there are 5 main techniques. This is where much of the confusion lies, as this does not represent the groups that do other full spine techniques, such as Gonstead, SOT, Applied Kinesiology, Activator…really the list goes on and on. And this is why changing from one chiropractor to another can require a lot of upfront changes, as the goals of the techniques are different. This isn’t unregulated, but rather a matter of finding the right doctor for the right patient. I’ve been under care of all of the above techniques, and I find for myself, the Blair works best, so it’s what I’m attracted to, and I see some amazing results as a consequence of it. My wife’s under the NUCCA care b/c she responds better to that form of care.
Bottom line, I think your order is skewed. Every good chiropractor (and yes you might have to search for one) will be better able to serve the active individual, as they will first be focused on returning your body to its own natural health w/o the use of drugs or surgery. I’m preferential to the Upper Cervical work, as we regularly see great results in a very short period of time, with fewer adjustments. And every sports team these days has a chiropractor on their team to help with injuries, often times getting people back into the game faster than traditional approaches. And if my word isn’t good enough, check out the videos on the next page from Jerry Rice, who attributes much of his career’s success to being under chiropractic care.
http://www.f4cp.com/
Thanks for everything here Chris! I think you’re doing a fantastic job!!
Frederick Schurger, Upper Cervical Chiropractor
Hey Dr. Schurger,
I appreciate your reply and your input is definitely welcomed here!
I can understand how you may find my comments appalling. Lots of schooling is definitely required to be a DC. To follow the same vain as your post (and my post), though, lots of training is required for ALL of these positions and there are good and bad in every field.
While the CNS is key, I feel that sometimes many chiros put TOO much stress on the CNS. It certainly is important but if you keep treating the CNS/subluxations over and over again without results, then its probably not the CNS. Most Chiros are stubborn, though, in my experience and persist. “Well, it wasn’t that adjustment, so lets try another one..and another one..and another one.” Before you know it, you have been in and out for 10 sessions with no results. Good bye to $450, at least, in most cases.
Also, I have seen some really shady chiros who have prescribed supplements based off of biofields and temperature gradients across the spine. This can add up to some brutally costly sums at The Vitamin Shoppe and, oftentimes, there is no real rhyme or reasons for supplements or treatments based on these sorts of diagnosis techniques – especially when biofields and temperature gradients are not supported in any literature that uses the scientific method with good practices.
Truth is, you have a high probability of being financially screwed by a bad Chiropractor than by a bad Ortho or PT. I have been to bad Orthos, PTs and Chiropractors, for sure. When an Ortho or PT screws up, you get hurt – and they are very liable for a lawsuit. This helps to weed out the real whackos from the profession. When a bad chiro screws up or gives worthless supplement prescriptions, it just adds up to a ton of wasted time and money – so a lot of the bad practitioners can roam free and continue to practice.
As a trainee/athlete, to protect your assets if you don’t know of a good Chiro for sure, then it usually pays to go to a PT first. Since that isn’t possible, go to an Ortho first, get the script, and head over to your PT. If, after a month or two of PT, you notice little to no results for a chronic pain problem, then I would say it is your best best to start experimenting with Chiros and massage therapists. This is NOT a shot at Chiros, but allows an athlete to use only 30-60 days trying conventional methods as opposed to months or years with less conventional methods.
If we reverse this order and you go to a chiro first, it has the potential to waste much more time and money. I would say that if you want to go to a Chiro first, set a limit of a few visits since any sort of adjustment should alleviate pain rather quickly.
Do you have any thoughts on that?
Thanks again – I really appreciate the comment!
Cheers
Chris
My list would certainly be very different!
I’ve worked in with all the practitioners mentioned (includgin upper cervical chiros from the comments).
Until all of us understand the scope of practice and how that relates to specific injuries, there’s no ‘better’ practitioner. I’ve seen so many idiotic things in each of those professions that I do my best to stay learning so I don’t have to roll the dice and refer out.
I will say that I’ve never heard of a ortho correctly finding the underlying causes of disc problems and the like…..They are good at diagnosing on the level of muscles and joints, but have little means and training to go beyond that into dynamic dysfunction and neuro-visceral issues. They are good at saying whats wrong, and practically useless for getting you back to health!
PT’s tend to write cookie cutter programs, often overlooking the same problesm as the ortho, and typically have a high-schoolers education in terms of strength training protocols.
Chiropractors only have a means to free up a joint, but are often poorly trained as to how to get it to hold.
NUCCA practitioners are in a class of their own, but they think it solves everything, and shun other, often necessary techniques.
Chek practitioners (me) and personal trainers tend to lack a good anatomical basework for their strength protocols.
I just gave the above examples to show that every profession has its weaknesses, and its a crapshoot to find a decent practitioner in each.
We end up bickering too much and no one gets healed because all the different fields can’t combine strengths.
My personal opinion is that is is a TOTAL roll of the dice, as good practitioners are few and far between (and the best guys usually aren’t the ones behind the bought-and-paid for sport team spots)
I do think that if all the practitioners keep their head above the water, keep learning, keep growing, and keep SHARING information with each other instead of competing, we can actually direct people through functional programs of healing.
orthos for diagnosis
chiros for upper cervical work, joint restrictions
pt’s for acute rehab
and beyond-
mike
Mike,
I fail to see how your opinion is different from what I said in my article. We are saying the exact same thing.
Chris
hmmmm…..maybe in my ramblings I never made a strong point.
I rarely refer to ortho’s. An ortho’s only place is serious injury, IMO……otherwise there’s maybe a 20% chance of them actually getting at the problem. I rarely refer to PT’s for the same reason.
Good assessment is rare in any field, that’s why people argue over who treats better…..If they don’t know what’s actually going on, there will be discrepancies in treatment, right?
I don’t like to see chiro’s unecessariy discredited. It simply shows a lack of understanding of what they actually do. Chiro’s do the same thing to other professions. If an ortho knew how to test for subluxations and compensation patterns, then there wouldn’t be much argument……..yet they still archaically believe it doesn’t exist.
My view is to see the cheapest people first….massage therapist, chiro’s, nutritionist, then if you actually need ACUTE care, you move on to a PT or ortho or finally, surgeon.
M
Mike,
I disagree with your ordering because I feel that the cheapest option can also be the most long and drawn out (and potentially ineffective) process.
Let’s be clear, I am NOT disrespecting chiropractors. Chiros, however, think that the cures to all diseases lie in adjustments of the upper cervical spine and sometimes of more distal joints. I am not saying they are all total whack jobs (though some of them are) but I am saying that, in my opinion, they are not the place to start.
Orthos are recommended first ONLY because they act as a portal to PTs (in most states). Orthos, in my opinion, are very ineffective unless acute care is necessary. PT is actually my recommendation of choice because if you don’t get results in 30-60 days you know that you need to explore other outlets. However, if you go to a massage therapist or chiropractor first then you run a high risk of the CMTs/Chiro’s claims of “just one more adjustment/massage” that seems to never stop. The results from a CMT/Chiro, if any, should be immediate. If there are not immediate results then I would cease the treatment. If, as a patient, you have that amount of self control, then going to a CMT/Chiro first is not a bad idea – but it is very easy to fall into the trap and be following a ridiculous set of adjustments for several years.
Off the record, I have had many injuries where I have gone to CMTs/Chiros first and fell into that exact trap. Perpetual visits totally thousands of dollars that did absolutely nothing while the CMTs and Chiros (several of them, not just one or two bad apples) consistently pushed me for more visits.
The main problem is that professionals of ALL fields don’t realize their limitations. Orthos don’t say “maybe you should try chiropractic” and Chiros are extremely reluctant to say “maybe you should see an ortho”. Granted, I am generalizing, but in the general sense that is the case.
Athletes should explore all of these options. I am sorry if you think I am attacking your profession but I assure you that I am not. I even state that I see a chiropractor when necessary who happens to train in my sport. I feel that you are reading what you want to read, not what is written.
Chris