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Let’s get moving: Physical therapy from a provider’s perspective

A career spent in the infantry coupled with an active lifestyle led to 12 knee surgeries for U.S. Army Gen. Robert B. Brown, Commanding General of U.S. Army Pacific. Shown here (center) greeting soldiers at the National Training Center Fort Irwin, Calif., Brown credits an effective physical therapy regimen for getting him back in the field. (U.S. Army Sgt. Michael Spandau) A career spent in the infantry coupled with an active lifestyle led to 12 knee surgeries for U.S. Army Gen. Robert B. Brown, Commanding General of U.S. Army Pacific. Shown here (center) greeting soldiers at the National Training Center Fort Irwin, California. Brown credits an effective physical therapy regimen for getting him back in the field. (U.S. Army photo by Sgt. Michael Spandau)

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“Hey ma’am, do you remember me?” said a male voice. Army Maj. Sarah Baker, a physical therapist, looked up to see a young infantry soldier standing next to her as she sat in a dining facility in Iraq. “I got back to my unit and look at me now. Thank you for helping me get here,” he said.

Baker, now the director of orthopedics and rehabilitation at Fort Belvoir Community Hospital in northern Virginia, had helped the soldier a few years earlier. He was in his mid-20s at the time and had sustained a shoulder injury while deployed. He returned to the United States for surgery and worked with Baker in the months after to regain motion.

She recalled that he worked relentlessly through rehabilitation to return to his unit when it redeployed. Baker met with him two to three times a week for several months, using a progressive in-clinic treatment program, a disciplined home exercise program, and a variety of modalities in order to break through his range of motion barriers, she said. After about nine months, he was discharged from the program.

“We don’t always get to see folks several years down the road, especially in the Military Health Care system,” said Baker. “To see how far somebody had come and the gratitude he felt to be back with his unit and to be mission-capable, it was awesome.”

Physical therapists work with patients in both clinical and deployed settings to treat a variety of musculoskeletal conditions, including joint stiffness, overuse injuries, weakness, combat-related injuries, and limited function. They help patients restore or maintain functional abilities, reduce pain, and prevent injuries. While PTs are most commonly known in orthopedics and sports rehabilitation, they are also involved in injury prevention, human performance optimization, women’s health, and heart health, Baker said.

Army Maj. Jose Durbin, assistant chief of physical therapy at Tripler Army Medical Center in Honolulu, Hawaii, said physical therapists have a large skill set that prepares them for working in a direct access setting. As first line providers, they can evaluate and diagnose musculoskeletal conditions, refer patients to other specialists, prescribe non-narcotic medications, and order imaging for patients when indicated, he said.

“We are well-trained to recognize what’s appropriate for us to manage and what needs to be seen by someone else,” said Durbin. “When it does fall within our scope, we have a large arsenal of tools to address that particular condition.”

Physical therapy is often the first step in helping patients with conditions involving the joints, bones, or muscles, said Durbin. Physical therapists frequently use a multimodal approach to help patients during their rehabilitation. This can include manual therapy or hands-on techniques, exercise, and various modalities. They also provide patients with the education and tools they need to continue their program at home.

Gen. Robert Brown, commanding general of U.S. Army Pacific, has always enjoyed an active lifestyle, but that lifestyle, coupled with the career of an infantryman, has taken a physical toll. The wear and tear eventually led to torn patella tendons in both of his knees, resulting in 12 surgeries over the years. Physical therapy has helped him recover mobility, flexibility, and overall well-being, he said.

“I don't know how I'd recover without my physical therapy regimen,” said Brown, who received care from Durbin at TAMC for several months after surgery. The regimen he used, which included home exercises, sped his recovery and helped him deal with other physical challenges that came up as he compensated for his knee after surgery. “It’s a lot of work, but the reward of being fully recovered is worth it.”

Patients work with their providers to structure an individual treatment plan. Depending on their needs and injury, treatment options can include therapeutic exercise, aquatic therapy, transitional gym training, or inpatient care.

“Major Durbin provided a tough but achievable path to better flexibility and reduction in pain following my recent surgery,” said Brown. Fitting in physical therapy while on the road can be challenging, but the key to successful recovery is the patient's discipline and adherence to the program, he added. “One may have a tremendous care plan, but if poorly executed or executed inconsistently, the results may not be the same.”

Musculoskeletal conditions don’t get better with time, Durbin warned. The sooner people get evaluated and receive guidance or treatment, the more likely they are to see quicker improvements, receive the tools to maintain progress, and prevent worsening of the condition, he said.

“A lot of people will put things off because they can still get by, but sometimes they wait until they hit that breaking point where it significantly impacts their quality of life or prevents them from doing the things they enjoy,” said Durbin.

Brown admits he used to try to ‘soldier through’ much of his discomfort during his recoveries from knee surgery. As a result, full recovery took more time. Knowing that a key component of readiness is preventive care, Brown encourages all service members to maximize their readiness by seeking medical treatment when they need it and following the advice of the experts.

“The body is an amazing and resilient thing, and sometimes it just needs a little bit of guidance in the right direction,” said Baker. 

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