Sports med center gets holistic makeover
Alternative medicine is part of treatment
More than 60% of the referrals to a Chicago sports medicine center come from former patients, which shows that attending to patient satisfaction can pay off for rehabilitation facilities. "We started the program in 1988, and from the beginning, we’d see anybody and everybody, and we still do, but we always felt that our patients were our best referral sources," says Joel Press, MD, medical director of the Center for Spine, Sports and Occupational Rehabilitation, which is part of the Rehabilitation Institute of Chicago (RIC).
The center, which occupies 10,000 square feet in a freestanding building that also features a separately owned health center, sees about 300 new patients per month, Press says.
The center’s staff includes four physicians and seven full-time therapists and athletic trainers, as well as physical therapy and occupational therapy aides. Within the past year, the center has added complementary medical treatments to its service menu. The center now has a chiropractor, an acupuncturist, and an orthotist, who can work with the team on inserts for shoes. Also, a podiatrist rents space at the center and is available to see patients when necessary.
Having the entire staff within the same center cuts down on the length of time between the physician’s initial evaluation and the time when the prescribed treatment begins. Also, there is a collaboration between physicians and therapists, so that if a therapist believes a patient might benefit from some other type of treatment, the therapist can easily consult with the physician to make appropriate referrals and changes to the treatment plan.
Everyone is on the same page’
"That’s the beauty of it: the working relationship between physicians and therapists, whether it’s the occupational therapist, physical therapist, orthotics person, pain psychology people, chiropractor, or acupuncturist," Press says. "Everyone is on the same page philosophically, and we’re all in the same physical plant."
For example, a back patient will be seen by a physiatrist for a physical exam. The physiatrist will make a diagnosis and devise a treatment plan according to the patient’s specific problem. The plan could include shoe inserts or an injection in the spine or joint in addition to an exercise program, Press explains.
The center’s main services include the following:
• Evaluation and treatment to prevent re-injury. Comprehensive evaluations assess the patient’s injured area and entire muscular system to determine whether there are imbalances that might have contributed to the injury. Patients are taught about posture, body mechanics, and injury prevention. The staff may use the Gold Coast Multiplex health club, located within the same building, for its weight training equipment, pool, and other amenities that might assist in treatment.
"We offer rehabilitation beyond the resolution of symptoms," Press explains. "Patients who just get better with the right medications typically will see their problems return unless their whole muscular system is evaluated and treated."
The center focuses on treating the patient holistically and devising exercise programs that are functional. "A straight leg raise is not a functional activity," Press adds. "So the more we make the exercises feel and look like sports and activities and movements, the more exercises patients will do."
• Sports rehabilitation. After a consultation and thorough examination, the physician creates an individualized rehabilitation program that is devised to keep the patient in good physical condition while allowing him or her to heal. Therapists use Cybex equipment, video analysis, radiology services, and electrodiagnostics to customize the patient’s treatment plan.
"The important thing is to get the patient active and back into sporting and daily activities and to make the patient smarter so he can do it on his own," Press adds. "We’re not here to fix people, but we make them able to do what they want to do, and we make them independent sooner than they would have been."
Often patients will be prescribed one or two treatment modalities and will return for a total of five to 10 sessions. "Very rarely do we see people three times a week for six weeks," Press says. "Most of the problems are acute or subacute, and we get patients going on exercise treatment right away." Patients are given their exercise homework and told they will be re-evaluated when they return.
Spine rehab focuses on education
• Spine rehabilitation. This nonsurgical approach to back and neck problems focuses on alleviating pain and improving overall fitness. Therapists and physicians stress education, with the philosophy that patients who have a better understanding of their condition will benefit from conditioning and exercise treatments and will reduce their risk for re-injury. Patients who have low back pain, sciatica pain, and sacroiliac joint pain also might receive epidural steroid injections as part of the management of lumbar spine pain. Situations in which patients might be referred to a complementary modality include the following scenarios:
• Chiropractic care. A patient with a spine problem related to a degenerative change causing significant limitations in motion or who has pelvic hip muscles and joints that are stiff in movement could benefit from the more aggressive manual therapy that a chiropractor could provide, Press says. "Some of these problems can be treated by a physical therapist because most of them have significant training in advance manual skills," Press says. "So I might send the patient to the physical therapist, and the therapist will say, I can’t get it here,’ so let’s have the chiropractor have a look at him."
• Acupuncture. Patients who have acute pain problems that need to be brought under control quickly could be referred to the acupuncturist. Also, patients with more localized pain could benefit from this treatment. "We will not attempt acupuncture treatment for long periods of time, because our philosophy here is that we’re not here to fix you, but we want to get you over the hump," Press explains. "Some treatments, like acupuncture, can become too passive, and patients believe they can come here to be fixed."
• Pain psychologist. Patients who have ongoing pain problems may need biofeedback or stress management counseling, and the pain psychologist can assist with these issues. If the patient’s pain is chronic, the physician might refer the patient to the chronic pain program that is part of RIC. "We use pain psychology people as an adjunct to parts of our program; if a patient has had multiple back surgeries, we’ll refer the patient to them," Press says.
• Work hardening. An interdisciplinary evaluation measures patients’ physical strength, flexibility, and ability to perform job-related tasks. The evaluation, which identifies deficits and assets, is used in creating a program that will help the patient improve his or her essential work-related skills. This treatment might involve four to eight hours each day of real and simulated job activities, as well as exercise programs and education. Therapists also will evaluate the patient’s work site for safety and comfort.
Likewise, the rehab facility’s staff can provide injury prevention evaluations to local businesses that want to reduce back injury and repetitive motion disorders. Occupational and physical therapists will visit the work site and analyze injury risk factors.
Need more information?
• Joel Press, MD, Medical Director, Center for Spine, Sports and Occupational Rehabilitation, Rehabilitation Institute of Chicago, 1030 North Clark, Suite 500, Chicago, IL 60610. Telephone: (312) 238-7767.