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Physical Therapy for the Injured Athlete: Surgical vs. Non-Surgical Rehabilitation

Just as every athlete is unique, so is every injury. Athletes that suffer sprains, strains, and contusions all heal at different rates. Some sports may allow a particular injury to return faster, such as a soccer player with a wrist sprain but a basketball player with a fractured ankle may take longer. Overall, there is variability when it comes to rehabilitating an injury but certain guidelines offer a general time frame and outcome.

A common question parents and athletes have is about surgical and non-surgical rehabilitation. The following article outlines the significant difference during post surgical and non surgical rehabilitation.

Non-Surgical Therapy: Therapist has Large Influence

If your child’s doctor sends you to physical therapy for a sprained ankle, the physician will offer guidelines but the PT will offer a more detailed timeline and expectations. During the treatment, a therapist will use the subjective and objective measurements, such as range of motion, swelling, strength, stability, etc. to determine treatment options. Therefore, there is great variability on progress and interventions based upon the extent of the injury and how your child is responding. The therapist will assess progress and make recommendations towards returning to sports. Often time there is some "wiggle room" where it is okay to push an athlete with various exercises with only very minimal risk of further injury.

Altogether, the physical therapist assessment is going to have a significant impact of when your child returns to competition.

Post-Surgical Therapy: Doctor is Always in Charge

This type of rehabilitation has no "wiggle room" as the physician dictates what is done. The main reason for your doctor being 100% in charge of progression and return to sports is for several reasons:

1. The doctor has physically looked inside your child’s body, identified the injury, and repaired it.

2. Each physician has particular surgical techniques that over time have predictable outcomes in response to a guided therapy program.

3. The therapist is instructed to follow protocol throughout each phase of healing, as physiologically surgical procedures heal as a predictable rate.

Even if your child had an ACL repair and one month later says, "I am doing fine, nothing hurts" they will not be cleared to return to running. The physician’s protocol may say something like "progress with squats and lunges if range of motion and strength are appropriate." That does not loosely translate into "start wind sprints tomorrow." No matter how much your child pressures or attempts to convince their physical therapist to speed things up, they are probably going to shoot down any requests and say, "you will find out from your doctor at your next visit."

Remember, that orthopedic surgeon went through four years of undergraduate study, four years of medical school, and probably another four to six years of residency to have the ability to hand you a five page packet and say "follow these guidelines for your rehabilitation." Just trust them (as physical therapists do) they are only looking out for your child’s best interests.



Posted February 14, 2012