I wanted to share this article with you about collaboration between trainers and physical therapists.  It was recently put up by Mike Reinold and Jonathan Goodman.  This topic is very important to think about as we continue to evolve as a profession.  Unfortunately, there is still a disconnect between health care professionals.  Why is this? 

Reinold put it best:  "Medical departments in the sports world now consist of a team of multidisciplined physicians, athletic trainers, physical therapists, strength coaches, massage therapists, and other health care professionals."  It works well for the sports world and it should work outside the professional sports.  While trainers and physical therapists may disagree with certain points of this article, specifically the assessment component for example, what Mike and Jonathan are trying to say is that we can all work together to help each other and the clients/patients.  Yes, certain health care professionals scope of practice may overlap at times, but instead of fighting about it we can play to our strengths. 

This is not just about the patients/clients care.  It is a multidimensional communication issue.  Physical therapists need to think about the business side as well.  With reimbursements continuing to get smaller while we continue to push for direct access, wouldn't more referrals from trainers, massage therapists, etc be great?  In the same thought, wouldn't it be great to be able to refer our patients to another health care professional to ensure they continue to stay healthy and pain-free? 

Physical therapists and trainers have great opportunities to collaborate with each other to not only learn from one another but refer to each other for the best possible care for the client.  After all, isn't that what being a health care professional is all about? 

Mike and Jonathan have already begun to recieve comments, both good and bad, regarding the article.  We don't live in an ideal world and there will be arguements both ways.  So I ask:
 
Is collaboration between trainers and PT's possible?
What barrier's do you see preventing healthy collaboration between trainers and physical therapists? 
What needs to be done between professions to encourage more collaboration between trainers and therapists?

The female athlete triad is an important topic in sports medicine.  So what is the female athlete triad and why is it so important to know?  

A study providing a questionnaire to about 91 collegiate coaches in 2006 (Pantano, 2006) discovered that only 43% (39 coaches) could accurately list the components of the female athlete triad.  Therefore, as physical therapists it is extremely important for us to be able to recognize this triad when we are often spending a great deal of time with these female athletes during rehabilitation.  

The female athlete triad consists of three interrelated spectrums: low energy availability (with/without eating disorders, amenorrhea, and osteoporosis.

The American College of Sports Medicine (ACSM) has a long history of position statements that have continued to be revised as more evidence and research on the female athlete triad has come out.  Most recently in their 2007 position statement they stated:  
"Low energy availability (with or without eating disorders), amenorrhea, and osteoporosis, alone or in combination, pose significant health risks to physically active girls and women (Nattiv et al., 2007)."  

Low energy availability is one of the more recognizable components to this triad.  Research tells us that dietary energy intake - exercise energy expenditure = energy availability (amount of dietary energy remaining for other body functions post exercise) and when this energy availability is too low, physiological mechanisms reduce the amount of energy used for cellular maintenance, thermoregulation, growth, and reproduction.  Interestingly enough, in a study from 2003, the most common causes for the negative energy balance for these female athletes was unintentional because of the training schedule and lifestyle (Papanek, 2003).  
As far as the amenorrhea component, knowing basic definitions will help you begin to understand.  Primary amenorrhea- delay in the age of menarche (15 years), Secondary amenorrhea- absence of menstrual cycles for more than 90 days, Oligomenorrhea- cycles at intervals longer than 35 days (4-9 cycles per year).  
Lastly, bone mineral density is an important component to be aware of.  Athletes in WB sports usually have 5-15% higher BMD than non-athletes. Therefore, looking into low BMD more closely in these female athletes, even in the absence of a prior fracture, is essential.  

So why is it critical to recognize these 3 key signs for female athlete triad?  Simply put, having this sustained negative energy balance is capable of starting a complicated surge of physiologic adaptations.  These adaptations may be necessary for survival of organs but may cause additional problems such as decreased healing rates or elimination of reproductive processes (menses).  

Hopefully this begins to give you a general overview of the main components of the female athlete triad and why it is important to look out for.  Part 2 will explain ideas on what to do when you recognize these signs and treatment for female athlete triad.  

This video is presented by Robert Butler who has done quite a bit of studying on the FMS.  In this video he discusses some of the most current evidence behind what numbers are considered "normal" in the FMS.  The most recent studies he refers to indicate how a 14 is pretty typical of a score for FMS instead of this "lofty goal" as he puts it.  Furthermore Robert explains how important it is to consider the reasons to why those that don't score a 14.  In other words, why is that person(s) not scoring a the typical score?  How do we modify our corrective exercises to make those movement patterns more efficient?  

Check out the other articles Robert Butler has on FMS and the up to date current literature behind the reliability and validity of it (All on the FMS website).  

This blog post by Allan Besselink discusses briefly the runner and how clinicians often attribute leg length discrepancy to injuries.  Allan makes a very valid point in his post: running injuries are typically related to training.  That could mean overtraining, improper training, lack of supplemental training (weights, flexibility, etc) and so on.  He points out that the inter-rater reliability for palpation of anatomic landmarks are poor at best, meaning we do not know if there is a leg length discrepancy.  He explains his thought process on this topic throughout the post.