Interesting article: “Evidence-based treatment of hip and pelvic injuries in runners”

Here is an insightful article I just found, which makes few points I want to be sure I remember.  Although it’s written in reference to runners, I feel it applies to way more than just running injuries.

What is so significant about the article?  Well, for one thing, As someone who spent years looking for help for her SI joint, one of my biggest questions is WHY?  Why did it take so long for me to find answers?  Why did so many people not know what I was talking about?

Well, this 2005 article from the journal Physical Medicine and Rehabilitation Clinics of North America actually sheds a little bit of light on the situation.  I’ll explain.

First, a quote:

The nonoperative sports medicine specialist, in particular the physiatrist and physical therapist, are in an excellent position to integrate treatment of the entire functional kinetic chain through a thorough biomechanical evaluation and comprehensive rehabilitation of the injured runner.

Additional training in the areas of biomechanical evaluation and functional biomechanical deficits should be sought, because residency and even many fellowship-trained programs often overlook these important areas.

Finally, the injured runner is best taken care of in a setting in which different sports medicine specialists are available and work well as a team. No one sports medicine specialist can provide all of the needs to the injured runner

So… what does this all mean?

First of all, let me explain that a physiatrist is a type of doctor who treats musculoskeletal pain, but does not perform surgeries.  Instead, they provide other types of interventions, such as various types of injections to reduce inflammation and speed healing.

So a non-operative spots medicine specialist, in terms of this article, is basically a physiatrist or a physical therapist.

Anyhow.  The authors are addressing people who deal with sports injuries, such as physiatrists and physical therapists, and saying that when it comes to hip and pelvis injuries, it’s really important to look at the body’s movement patterns overall as a whole.

The term kinetic chain refers to this concept: that different parts of the body will work in a chain to produce an overall movement, and it’s important that each piece of that chain is working properly.

The authors call for medical practitioners to seek out additional training in the biomechanics of these areas, because residency and fellow-ship programs (basically, the educational opportunities that every doctor receives as part of their training) do not tend to focus on biomechanics very much.  

This explains why there is such a wide difference in what medical professionals such as physiatrists and physical therapists seem to know:

What sets the really great people, the ones who are able to help, apart from those who aren’t is generally that the former group has sought out appropriate educational opportunities beyond the minimum of what they learned in school.  (At least, in my experience trying to get help with the SI joint).

I have heard this before from my exercise physiology professor, who is also a practicing PT.  He explained that basically, the purpose of any graduate program in physical therapy is to enable to students to pass the exam necessary for licensure.  It does not prepare you for everything you will know to treat every patient you see, which is why pretty much all PT’s pursue additional training in areas that interest them.

So basically– the authors of this article are calling for sports medicine professionals to look at the big picture when it comes to hip and pelvis injuries, and to realize they may not have had enough training to properly identify all of the factors that could be contributing to these types of injuries.  And so, as a means of fixing this knowledge gap, the authors suggest pursuing additional training in biomechanics.

I thought this article was fairly interesting so I wanted to make sure to make a note of it here.   Hopefully it was at least somewhat useful to you as well!

Citation:

Geraci MC Jr, Brown W. (2005).  Evidence-based treatment of hip and pelvic injuries in runners.  Phys Med Rehabil Clin N Am.16(3): 711-47.