C. Remodeling Phase
- Optimizing tissue function by continuing and progressing the activities performed during the
repair phase - *Exercise Strategies -Transition from general exercises to sport-specific or gym/workout
specific exercise
VI. Management Options
A. Quit Doing It - Change Technique
- Do something else and work around it
B. Drugs/Medications - NSAIDs
- Narcotics
- Other- Muscle relaxants, TRUE Muscle relaxants
- Injected
- Topical
C. Therapeutic Modalities - Complementary and Alternative Medical Interventions
- Chiropractic and Accupuncture, Cryotherapy, Electrical Stimulation, Laser, Ultrasound, Magnets
D. Surgery - Correct the anatomy, remove displaced mencisus, Stabilize joint, Fix bone/ligament - “Wash-out” a joint
- Replace a joint
VII. "Quit Doing It" - Allow tissue recovery (i.e. Hamstring)
- Prevent worsening injury (i.e. Stress Fractures, Achilles Tendonitis, etc.)
- Unknown or uncertain diagnosis
- You must establish time frames for recovery and testing
- Provide alternate activities
- Be cautious, but not overly conservative,The athlete/patient ultimately decides
VIII. Alter Activities
A. Practical suggestions
- Must know the activity/sport
- Don’t be the coach
- Think outside the “medical” box
B. Running centers- Bike fit
2.Pads, gloves, braces, wraps, etc
- Bike fit
IX. Painkiller sales soar around US, fuel addiction
A. Nationwide (2010), Oxycodone 62 TONS, Hydrocodone 42 TONS, 40-5 mg Percocet®
24 - 5mg Vicodin® for every person in the US
B. Pain out of the Expected
- Wrong diagnosis, Additional diagnosis, Poor compliance, RSD, Neuropathic pain, Malingering
or psychiatric issues - As the MD, What could I have missed?
- Bone contusion or fracture w/ ligament injury
- Compartment syndrome w/ fracture or soft tissue injury
- Cast/splint/brace too tight, Infection/abscess under wound, Nerve injury
C. Non-compliance with treatment
- Doing too much
- Not wearing splint or using crutches
- Not taking medicines
- Fear of addiction, Spreading out doses, Fear of running out, Cost, Diversion
XI. Additional Diagnoses
A. Complex Regional Pain Syndrome (CRPS)
- Signs and Common Symptoms