With the "wide world of sports" growing ever wider, so is the need to treat the injuries that will inevitably befall professional and amateur athlete alike. With problems as varied and sometimes complex as the human body itself, it's no wonder that sports PTs are so busy diagnosing and treating a multiplicity of ailments. A look at just a small sampling of these dedicated practitioners reveals the very active and challenging world shared by athlete and therapist.

A MYRIAD OF TREATMENTS

Dave Damon, PT, OCS, ATC, and Scott Richards, PT, MSPT, ATC, are partners at Kitsap Physical Therapy (KPT), Port Orchard, Wash, and they treat a full spectrum of injuries in patients of all ages, with a primary focus on typical musculoskeletal injuries. Damon and Richards share their physical therapy space with Silverdale Fitness, which is owned by three of their company's therapists, giving them a spacious 10,000-square-foot facility equipped with a host of cardio and strength training equipment to serve their patients.

Damon's principal areas of interest are orthopedic postoperative rehab of the spine and extremities, along with manual and sports therapy applications. He's a certified Sportsmetrics trainer (Sportsmetrics is a program developed by Frank Noyes and his staff from the Cincinnati Sports Medicine Center that focuses on the biomechanics of jumping and landing to help reduce knee injuries and pain), and oversees KPT's postoperative protocol literature and course reviews.

Richards' original background is in athletic training (ATC since 2001), and he continues to work with high-level athletes in sport-specific rehab programs for return to sport. He also works with a variety of orthopedic conditions and with clients varying in age from children to the elderly. Currently, he runs KPT's golf rehab program, structured upon the FITforeGOLF education that he has received.

Damon and Richards also have specialists on staff for a variety of conditions, including those related to women's health, vestibular/balance issues, lymphedema, complex hand injuries, and, of course, sports-related injuries.

Sports injuries vary substantially, "but those we see more often," Damon says, "are shoulder instabilities, ankle sprains, knee collateral and cruciate ligament insufficiencies, as well as postoperative repairs and arthroscopic debridements, to name a few of the more common conditions."

In addition to hands-on manual therapy mobilization, manipulation, and myofacial techniques, KPT utilizes various technologies in conjunction with these skills, a fact that "we are not ashamed to admit, as some seem to be," Damon adds.

Principal among the modalities and products that are used to help manage pain and effusion are pulsed and continuous ultrasound, and interferential, premodulated, biphasic, and Russian electrical stimulation, provided by such manufacturers as Dynatronics, Salt Lake City; Chattanooga Group, Hixson, Tenn; and Rich-Mar, Chattanooga, Tenn. Other modalities include cold vasopneumatic compression by Game Ready, Alameda, Calif; infrared therapy by Anodyne, Tampa, Fla; and TENS units. Cold laser is also sometimes utilized.

Of particular interest to Damon are the various therapeutic tapes that have become available. "There can be a great deal of benefit from the appropriate application of these tapes," Damon says. He uses standard athletic tapes such as White tape, Elasticon, and light flex tapes, as well as Kenisio tape and "McConnel" tape (Leukotape P and Cover-Roll stretch).

Most of his more interesting cases, Damon believes, involve the use of tapes. Typically, he'll use Kinesio tape when there is significant bruising or swelling involved, because the tape's elastic properties are designed to increase the efficiency of the lymphatic system to allow for drainage of blood or inflammation. "The changes in bruising can be pretty amazing, where the area underneath the tape is significantly less discolored than the areas surrounding it."

Damon uses McConnell tape to improve the biomechanics of a certain joint and assist in proper patellar tracking or to achieve better seating of the humeral head in the glenoid fossa. Not only will this technique create better movement, but it will reduce pain as well. "We utilized this taping with a college-level pitcher rehabilitating from surgery to repair a combination SLAP labral tear and Bankhart lesion. He presented with instability of his pitching shoulder, and the taping allowed for faster return of full range of motion to better prepare him for sport-specific activities as the rehab program progressed," he says.

In sum, Damon believes that tapes are a key contributor in reducing pain, offering support, facilitating more proper movement patterns, and assisting with effusion and ecymosis reduction.

A modality that Damon believes can be effective as well as challenging is infrared. "Infrared is a modality that has been shown to be effective with diabetic neuropathy and wound healing, and, anecdotally, has proven useful with a variety of other painful musculoskeletal conditions," he says. Its effectiveness, however, in Damon's view, is variable, and a challenging aspect of its use is that "it is often not a covered modality despite research supporting its validity." Electrical stimulation, on the other hand, is a proven pain modulator, "as well as having a favorable effect on swelling."

Damon believes that as technology continues to improve, so too will the use of modalities. "The goal with any athlete is to return him/her to competition as quickly as possible," he says. Here, Damon points out a limiting factor of his profession: "Unfortunately, physical therapy differs from athletic training in that therapy usually occurs between two and five times per week, whereas treatment by athletic training departments at schools and universities can be performed multiple times per day. If that were possible in physical therapy, it would significantly increase the efficiency of such technologies as interferential and Russian stim."

Damon adds that, to some degree, the athletic community has not kept up with advances in treatment of the general public. "Modality changes in the athletic arena have not occurred as consistently over the past few years as with the general population, particularly considering the introduction and increasingly frequent use of modalities such as infrared and cold laser therapy."

A case that Damon fondly recalls involved the competitive swimmer Anne Olsen. "Sometimes we're privileged to work with very delightful and courageous people. One lovely and very tough woman we were fortunate to work with following her rotator cuff repair was Anne Olson. What's special about her story is that she also had congenital hip dysplasia and other health challenges, yet went on to win a silver medal at the National Senior Games swim competition."

A FOCUSED PHILOSOPHY

Andre van Commenee, PT, has a simple treatment philosophy: "Get the patient from point A to point B as quickly and safely as possible." The urgency Commenee is referring to is applied to high-level competitive athletes "There's a big difference between running in the final of the Olympic Games and running in a local 5K," Commenee says.

Commenee has been a PT for 24 years and is the director of Active Rehabilitation, Pasadena, Calif, the official medical/rehab center for the ChivasUSA Youth Soccer Teams, Extreme Boot Camp, and preferred establishment for Team in Training.

Himself a former decathlete, Commenee competed for the Dutch National Track & Field Team, then moved to the United States in 1989 after having worked on the movie, Indiana Jones and the Last Crusade, providing his PT services to actors Harrison Ford and Sean Connery. More recently, he worked on the 2008 sequel, Indiana Jones and the Crystal Skull.

Commenee provides an example of his quick-and-effective-fix approach: "A British decathlete who was dependent on his sponsorship for his income and had to medal to continue that sponsorship, injured himself with a medial hamstring partial tear. We administered ice for 15 minutes every hour for 48 hours day and night, plus TENS treatments. The result was that despite his injury he came in third, and received another contract for 8 more years." Commenee emphasizes that the criticalness of the situation called for a radical solution. "We would never do that in ordinary circumstances … you don't take that kind of risk with the average person."

Having worked at the Olympic Games, the World Cup of Soccer, and the World Championship of Track & Field, Commenee has often been in situations where he had to get good results in a hurry. "The advantage of working with world-class athletes is that you're expected to get results quickly. In general, I want to see clear results within six treatments, two to three sessions per week," he says.

His approach is scientific and based on verifiable outcomes. He has given lectures for 15 years, presenting topics about training principles and biomechanics. In 2006, he published an article in Physical Therapy Products magazine titled, "Evidence Matters—How to Start an Evidence-Based Practice."

Commenee's modality of choice for pain reduction is the Empi Select, a compact handheld device that works by producing mild transcutaneous electrical nerve stimulation that reduces the transmission of pain messages to the brain. Specifically, the stimulation reaches the peripheral nervous system and provides pain relief by masking pain signals or by preventing them from reaching the brain. Additionally, the stimulation triggers the release of endorphins, the body's natural pain relievers.

The Empi Select is lightweight and portable with a built-in belt clip for hands-free therapy. It has one-touch intensity controls, a large screen showing the intensity levels, and preprogrammed site-specific buttons for the back, hand, low back/hip, shoulder, and knee. Dan Marino is one of the well-known athletes who has benefitted from the Empi Select.

Commenee was introduced to the device by one of his therapists, who had used it when she was interning at another clinic. His wife, Kathy, tried it for a stiff back after "doing too much, too soon," according to Commenee, "and got very good results." His patients also like it, and "if they're happy, I'm happy," Commenee says.

"In sports therapy, there's always something going on, trying to find a better way," Commenee says. "These days, the buzzword is 'core' training, strengthening the stomach, back, and pelvic muscles to support the rest of the body." This can certainly have value, Commenee believes, but it isn't the solution to everything. "For example, if a person has a chronic knee problem, yes, it could be a weakness in the pelvic muscles, but it could also be a problem with mobility in the big toe. You have to be open to consider all the possibilities."

Alan Ruskin is the staff writer for Physical Therapy Products. For more information, contact .