Treating the Cause

Just easing symptoms won’t get athletes back in the game. Find the root cause of injuries, and correct them.

By Dr. Patrick Sexton

Patrick Sexton, EdD, ATC/R, CSCS, is Program Director for Athletic Training Education at Minnesota State University-Mankato. He has also served as Head Athletic Trainer at the University of Wisconsin-La Crosse.

Training & Conditioning, 13.6, September 2003,

Picture this: You are driving home one day, when, suddenly, you hear a loud clanking noise under the hood and your car begins to run poorly. This causes you great concern because you have a long trip planned to your best friend’s wedding, so you decide to bring your car to a mechanic. After a very brief check of the car, the mechanic adds a little oil and says you should be able to make it to the wedding, no problem.

How would you feel about jumping in the car and heading out on the highway? On the one hand, you might feel pretty good, since it didn’t take long or cost much! On the other hand, you may be concerned that the mechanic’s “fix” might not really work.

What should the mechanic have done? He should have performed a systematic assessment of the car in order to determine exactly what was causing the noise, then discussed the entire situation with you, including possible repair options. With that information, you could then decide whether or not to drive the car to the wedding.

What if the “car” was really an athlete’s low back, the “clanking” was really pain, the “wedding” was really a football game, and the “mechanic” was really a certified athletic trainer? Now how would you feel about this situation?

Sometimes, as athletic trainers, we get so caught up in trying to get our athletes ready for the next competition that we end up only treating the symptoms and not the cause of the symptoms. This is especially true with chronic injuries. Treating the symptoms is certainly not wrong—we all want to help our patients feel better—but it is also imperative that we determine the cause, or causes, of the pain, and address those. Otherwise, the injury will not get better and will probably just get worse.

The point is that even though just making the noise go away might make you feel better about going on the trip, it does not fix the problem. It is crucial that you address the underlying problems that contributed to the athlete’s injury, and effectively communicate to the patient his or her treatment plan. The patient must understand why you are choosing specific modalities and exercises and limiting activity if he or she is going to comply with your plan and understand both the short- and long-term goals of the treatment regimen.

There are always a variety of factors that you must consider when making treatment and rehabilitation plans for your patients. Getting at the root of the problem can be truly difficult, but it is one of the most important parts. Chronic injuries occur for a reason. Something—usually more than one factor—has to cause them. As an athletic training student and future healthcare professional, it is up to you to perform a systematic and complete injury evaluation that identifies all possible contributing factors to the presenting injury. This involves communication with the athlete—well-thought-out questions will yield the most information about the athlete’s injury.

Next, develop an appropriate plan that will not only treat the pain, but also address all of the factors that may have contributed to the injury in the first place. A treatment plan that includes four basic components (modality selection, activity level, exercise selection, and pre- and post-activity treatment) should be designed. It should also be communicated to the athlete with time for questions.

The athletic trainer must first select the appropriate therapeutic modality or modalities based on the current stage of tissue healing. The appropriate parameters, also based on the current stage of tissue healing, should be used in the application of all modalities. And because soft-tissue healing is a continually changing process, modalities must also be changed in order to accommodate the changing physiologic environment of the tissue.

All activity, including practice, competition, weight training, leisure, and normal day-to-day functions should be evaluated and altered as necessary. This will allow the athlete to perform at his or her highest level without causing further injury or retardation of the healing process. Activity should be continually reassessed in order to keep the athlete as active, yet as safe, as possible.

Therapeutic exercise of some form should always follow the application of a therapeutic modality. Exercise plans can range from passive stretching to resistive exercise to tissue mobilization. Exercise will influence tissue healing and the development and maturation of scar tissue. In addition, exercise selection should address deficiencies or characteristics that may have contributed to the injury in the first place and should be used to correct those factors.

Finally, your treatment plan should recognize that pre- and post-activity treatment should be separate and distinct. It’s great if the patient is participating in some sort of activity, but your job is to ensure that pre-activity treatment is designed to promote healing and prepare tissue for the allowable level of activity. Post-activity treatment is also designed to promote healing, but it should be used to minimize any damage or irritation that may have occurred due to the change in physiologic environment brought about by the activity.

By developing a well-rounded treatment and rehabilitation plan—one that addresses all of the causes of the injury and includes the athlete in every phase—your athletes will benefit in both the short term (because they will be able to play) and the long term (because they won’t be back with nagging injuries). They will feel better and perform better.

Now how do you feel about your mechanic? Don’t you wish he had learned, as a student mechanic, to always find the cause and fix it, rather than just putting a little oil on it?