Breaking Down the Initial Evaluation, Part 1: The Subjective

I’ve decided to address the initial evaluation in my first topic series because I think it will serve as a good foundation for future posts to come. In this series, I will highlight how I perform an evaluation – I am not saying that everyone has to do it this way, nor am I saying this is a complete guide to an evaluation; it is simply parts of what I ask my athletes.

Much of what we do as therapists relies on what the client tells us. Many clients don’t know what is pertinent and don’t have the knowledge background to know what pieces of information are useful to us. In an effort to not be too long-winded and not too brief, many times, the client ends up leaving out pieces of information unintentionally. It’s our job as therapists to obtain the information we need through well-phrased questions. For a sports physical therapist, this means understanding each sport and the demands of the sport. I watch a lot of sports and was an athlete my entire life (I continue to coach volleyball following a collegiate career), and I tend to analyze every little movement made by the athletes. I also read articles on biomechanics of various sports. In this topic series, I won’t be breaking down the specifics of each sport – I will follow up with more specific questions to ask in those future upcoming topic series. For those who have a more limited knowledge base or are just unfamiliar with most sports (the list will be a select list of sports because this post would be very long if I tried to address all sports), I will touch on a few highlight questions that I will always ask in my evaluations.

For baseball players the first thing to ask is, are they a positional player or a pitcher or a catcher. For pitchers, it’s important to know their pitch count in practice and in games – this is extremely important for youth baseball pitchers, as they should not be exceeding a certain pitch count each day to prevent injury. Catchers, most commonly, present with knee pain, however it is important to know what their pitcher’s pitch count is as well because the catcher will be throwing a ball that many times in a game and practice as well – not at the same intensity, but it still stresses the shoulder/upper extremity. This goes for volleyball, tennis, and any other overhead athlete – how many repetitions are they performing in practice, in competition? While there isn’t a limit in these other overhead sports on repetitions like there is in baseball, high repetitions will continue to stress the glenohumeral joint and it is important to know how many swings/throws, ball park average, the athlete is undergoing – this is also important depending on the age of the athlete (i.e. pediatric athlete vs. collegiate vs. professional).

Track and field athletes commonly present with non-contact/traumatic injuries. Due to the variety of events, there are a variety of injuries that can surface. Therefore, the first question to ask is what event they participate in – most athletes will participate in up to 3 events in high school and 2-3 specialized events in college. Depending on state regulations at the high school level, the type of event is regulated – in Massachusetts an athlete can participate up to 3 events, but 1 has to be a field event, if only entering in 2 events they can both be track, both field events, or one of each.

For golfers, tennis players, and long distance (5K and higher) runners (should be asked for all athletes, actually), I tend to ask about nutrition and hydration prior to competition due to the duration of competition and being primarily outdoors. Nutrition a few days prior and the hours leading up to competition are important. In most competitive athletes, you want your last “meal” to be about 3-4 hours before competition. Right before and during competition, the athlete should be taking fast carbohydrates to provide energy throughout the duration of the match/game, nothing that will “sit in the gut” and make the athlete feel sluggish (the myth that eating a banana prior to competing has been debunked – it will only make you feel slow and behind).

For the initial evaluation, while it’s important to ask questions specific to their sport, you, as the therapist, may not be familiar with all sports, maybe only a select few. Therefore, it is paramount to do your homework and read-up and learn more about a specific sport that you may not be familiar with. In the meantime, it’ll be essential to understand the athlete’s training schedule/periodization of training. These are just some of the basic questions I would ask on an evaluation – I will get to more sport specific ones in future posts. In the mean time, stay tuned for Part 2: Static Postural Assessment – UE.

 

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