Rehabilitation is a procedure that allows the patient to recover from any injury, illness and/or disease to as normal as possible (Hawk, Schneider, Evans & Redwood, 2012). The purpose of this is to allow the patients to be at optimal potential by restoring their physical state to “normal” as soon as possible. This is a final procedure of healing mechanism for the patients helping through the damage that has caused the patient to have a normal life as possible again ("The Role of Rehabilitation", 2017).
Chiropractic is about the relationship between the spine and the nervous system, which is connected from the brain to the rest of the bodies via spinal cords and nerves (Murphy, 2000). With injury, illness and/or disease, there is somewhat disturbances between the nervous system and the part of the body that have been affected by the symptoms. Due to this fact, the signals received by the brain may not be as specific thus restoring the normal functions much slower. Without the optimal functions of the body, the ability of the body to heal itself may not be quick causing delay of injury, illness or disease (Haavik & Murphy, 2012).
With the nervous system being free from interference by chiropractic care, it will have better transmission of information of the stimulus applied to and around the body (Haavik & Murphy, 2012). In return, the healing mechanism is more specific and quicker allowing the body system to notify and heal itself. If there is no accurate information given to the brain and vice versa, the effect of healing mechanism may not be as effective. Despite receiving treatments or rehabilitation by another profession that may benefit the patient, it may not be as effective compared to patients with the interference-free nervous system. Therefore, every treatment can benefit with the chiropractic care.
For example, if a patient injures the ankle by rolling and had a surgery due to fracture, this patient requires rehabilitation when it fully heals due to muscle atrophy. With rehabilitation, the patient is able to recover and able to start walking. However, there is a possibility to roll the ankle again and sprain or even fracture may occur. With chiropractic care, not only the patient is recovering from the injury quicker but also prevents the patient to roll the ankle in the future (Haavik & Murphy, 2012). This is due to signals coming from the brain is reactive enough to prevent rolling of the ankle.
This shows that the rehabilitation with chiropractic care can benefit further by allowing the patients to achieve beyond its “normal” status (Mootz & McCarthy, 1999). Without chiropractic care, they can only recover up to their initial stage and fixes the problem that has occurred. Although this may be enough for the patient to have a normal lifestyle, there is a higher chance of the patient to have the same injury, illness or disease again. Therefore, allowing the patients to remove the main cause of the problem, which may be occurring with the nervous system should be looked after first (Sadlon, 2017).
1. Discuss at least three rehabilitation techniques that are at
your disposal to help aid this patient; such as active stretching, strengthening exercises, trigger point therapy, ergonomics etc.
Osgood Schlatter’s disease is a common repetitive injury that occurs often in adolescents who are involved using the legs often (Gholve et al., 2007). With this disease, the person may not be able to use the knee efficiently due to pain. The pain occurs on the tibial tuberosity as the tendon from the quadriceps muscle pulls the tendon on the patella that eventually pulls the tibial tuberosity. This is due to overuse of these tendons during growth spurts hence causing stress on the tibial tuberosity. The result of Osgood Schlatter’s disease forms a bump at the tibial tuberosity as the gap fills with either cartilage or bone. However, the symptoms may last until the growth spurt has finished, which may take one to two years. As the patient is a professional swimmer, missing out in an intense training is crucial for his career and his future. Therefore, rehabilitation is recommended for the patient to have strong legs again for training.
Osgood Schlatter’s disease causes pain due to inflammation around tibial tuberosity area. It can limit to what the patient can perform to help ease the pain. Therefore, it is best for the chiropractor to instruct the patient based on their stages of the pain ("Q & A: My Top 5 Tips on How to Self-Treat Osgood-Schlatter Disease", 2017).
The initial management that chiropractor can teach the patient is how to reduce the inflammation and pain. The best way to reduce the inflammation and pain after training is icing or cryotherapy (Hansen, 2017). By applying ice on the tibial tuberosity after training reduces the swelling of the knee as it causes vasoconstriction. This will also control pain as nerve activity around that area slows down. As this disease causes inflammation significantly, this is the best temporary pain release for the patient to perform. This is a very good management of the pain release and inflammation reducing process as it can be easily performed by the patient themselves and readily available for them at home.
Another basic thing that the chiropractor can perform and teach the patient is stretching ("Physical Therapy in Baton Rouge for Knee – Osgood-Schlatter Disease", 2017). Stretching of leg muscles such as quadriceps and hamstring is a very important procedure as Osgood Schlatter's disease is caused by the tendons pulling on the tibial tuberosity. Stretching can be performed by the chiropractor and it is something that patient can do anytime, anywhere. This should be done every day in the morning, prior/after the training and night. This will stretch the muscles allowing the tissues that are pulling on the tibial tuberosity to release constant stress by increasing its flexibility of muscles. This is a crucial stage as it prevents the patients from overstressing the area thus will not cause further harm thus more pain. However, this should be performed with care as it may harm the patient if not stretched properly.
To provide further management of the pain, there are strengthening exercises for the leg and hip muscles (CCRA, 2017). It is another rehabilitation technique that can be done by the patients. By having stronger muscles with good endurance, it allows the muscles to tolerate stress applied onto the tibial tuberosity much better. This requires the patient to engage the muscles therefore, it may cause the patient discomfort. Therefore, the chiropractor should educate the patient when and how to do strength exercise. Overdoing certain exercise can cause more harm resulting further inflammation to the tibial tuberosity.
What chiropractor may be able to provide to the patient is trigger point therapy ("Trigger Point Release For Beginners | The Art of Manliness", 2017). Trigger point therapy is a release of muscle tension by massaging or stretching the constricted area of muscles. By releasing constricted areas of muscles such as quadriceps and hamstrings, it reduces the pain that is caused by the disease. This therapy will also allow stretching more effectively and decrease the symptoms of pain much quicker. In regards to Osgood Schlatter’s disease, trigger point therapy can help the patient significantly as it is related to muscles pulling on the tendons resulting inflammation of tibial tuberosity. By releasing the tension in the muscles, it will allow the patient to relax more and naturally manage the pain and stress that occur on the tibial tuberosity. Therefore, it will decrease the inflammation and pain allowing the patient to use their legs more during swimming training.
2. Name at least three concomitant health care practitioners you will be referring to during your care. Making sure to discuss the rehabilitation methods they will be using to help the patient.
One of the healthcare to refer to is the acupuncturist. Acupuncture is Traditional Chinese Medicine based care, which deals with the complete healthcare system ("What is Acupuncture? – PAANZ", 2017). This profession utilises meridian points by putting fine needles into the specific point in our body to manage optimal homeostasis. By triggering meridian points, it helps the patient reduce the symptoms of inflammation, relaxes the trigger point and ease the pain. These allow the body to heal itself naturally. In regards to the patient with Osgood Schlatter’s Disease, the acupuncturist will put needles where it is required to reduce the inflammation and increase local microcirculation (Camp, 2017). Having more blood vessels flowing to the tibial tuberosity area will help the healing process of the disease. As acupuncture is a holistic healing medical profession, it goes very well with the chiropractic, which views the human body as a whole. With chiropractic care, the nervous system of the patient is free from interference, therefore, the signals going around the body and to the brain is very accurate. With acupuncture, this is introducing an external stimulus into the body (Morris, 2016). This stimulates the body to reduce the symptoms as it signals the brain to induce healing mechanism.
Another care practitioner to refer to is the massage therapist. Massage therapists involved in not only releasing muscle tension promoting relaxation but also increases circulation of blood and lymph (Mayman, 2017). It also speeds and aids the recovery of the muscles after an activity such as swimming. This is very crucial treatment as exercise causes the muscles to tense, which results in pulling the patella tendons thus further harming the patient. By relaxing the muscles back to normal resting length, it will reduce the inflammation and help to heal the damage much quicker. Since the patient is a competitive swimmer, he will be using the legs often, therefore, having a massage done after training is crucial to relax the muscles to prevent further damage. This allows the patient to manage muscles accordingly for efficient care and management of the disease.
Laser therapist such as low-level laser therapy (LLLT) is also a good recommendation for the patient with Osgood Schlatter’s disease. LLLT use a LED light therapy, which reduces the pain and inflammation of the area by improving tissue repair (Hashmi et al., 2010). It is applied to the area where pain occurs and induces the tissue around the area to be active. This is possible as laser reduces the inflammation and restores the ATP production allowing the healing to occur more quickly ("ATP Therapy – Low Level Laser Treatment", 2017). By inducing the healing effect of the tissue, it allows the patient to use their legs much quicker and heals the tendons. With tendons being healed quickly, it will not be pulling the tibial tuberosity of the patient which will result in less or no pain ("Laser Therapy", 2017). Therefore, low-level laser therapy will help the patient to be back on swimming competitively again.
Physiotherapists are one of the practitioners that can help with easing the pain and allow the increased level of activity such as swimming. Physiotherapy may include various methods such as taping with kinesiology tapes ("Kinesiology Tape for Knee Pain, Swelling, Recovery after Surgery, Injuries", 2017). Kinesiology tapes can relieve pain, reduce inflammation and provide support for the knee injuries preventing further damage. As the tape stabilises the joint, it allows acceleration of recovery from injuries involving muscles, ligaments, and tendons. Also, this is very good for patients who are active in swimming because the kinesiology tapes are waterproof thus allows the patient to continue to wear it while training. Despite limiting some of the movement, this will not only allow the patient to train but prevents further damage being done to tibial tuberosity by stabilising the knee joint.
3. Outline the benefits and difficulties of co-managing this patient with other health care professionals.
Osgood Schlatter's disease is mainly muscles and tendons related issue. This indicates that despite chiropractic is beneficial for the patient alone, the patient is a professional swimmer. This addresses that he requires the use of knees much quicker than average people thus requiring further care such as rehabilitation. With other professional managing the problem together, there is a better chance of the patient to get back to swimming training with high intensity much faster for better performance.
The benefits of co-managing this patient with other profession is that it will enhance the care of the patient allowing faster recovery. Since the patient has a knee injury, management of this injury will be specific to the patient such as knee rehabilitation programme or very focused on treating the knee. By having specific treatments from various health professionals, healing process would occur much quicker. This would allow the patient to have a higher chance of getting back into intense swimming training for better performance in competition.
Another benefit is that listening to a various healthcare professional would make the patient aware of the problem he has regarding this disease. Since the patient is only 13 years old, the patient may not follow the protocols that profession asks to do so to heal better. For example, if the patient only listens to one of the health profession, the patient may disregard what condition he is in and ignore what they have to say. However, listening to various profession teaching the patient about this problem would make him more aware of the problem and follow the protocols that profession asks such as stretching, muscle training and more. By going to different health professions, they will also teach their parents how to manage the problems together. Since there is a possibility that parents do not know about this disease, it will be best for the parents to manage the disease together physically and psychologically to help their child to be able to train soon.
However, there are few difficulties co-managing the problem with another profession. One example is that there will be many different varieties of advice and treatments given by different healthcare professionals. For example, the massage given and taught by the massage therapists and physiotherapy may be different. This may confuse the patient as to what needs to be done to take care of his knees. By hearing many options available for the care of the knees, worst scenario that could occur is that they may not go to any of the profession for care. This is due to confusion to which the patient may think is the best treatment available. Therefore, too many options may not be beneficial.
Another difficulty is that profession not recognising others profession for treatment. For example, some profession has pride in their work and that they may think that other profession does not work and not recommending the others. By doing so, it causes the patient to get confused as to whether which profession benefits the most and does not go to another profession. This is not good for the patient as they can benefit from all other cares and not by just one care.
With co-managing, there are many benefits but at the same time difficulties. Osgood Schlatter’s disease is something that can be very manageable with other healthcare professions and allow the patient to be back to normal training by having a faster recovery. However, if the profession does not accept other healthcare, the second opinion may not matter. But also they may not seek for other professional advice in the future when different problems occur. Therefore, educating the patients is the first and foremost for any issues with the body for providing the best care possible for the patient.