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The Mind-Body Connection

You don’t have to be a professional or even a casual athlete to benefit from the ways sports medicine is helping people from all walks of life get back to the lives and hobbies they love post-injury.

While its name may conjure images of sidelined sports heroes clawing their way back to mobility, flexibility and recovery, the reality is that anyone can access the specialized, individualized, full-patient care that practitioners deliver to patients with all kinds of backgrounds and lifestyle goals—and often without a referral or other barriers to treatment. 

“A lot of people hear ‘sports medicine’ and think we only treat athletes, but anyone can see us,” says Dr. Luis Gandara, a board-certified primary care sports medicine physician at the Orlando Health Jewett Orthopedic Institute. “We are trained to take care of the whole person. Our goal is to make someone who’s in pain fully functional and get back to their life again.”

A branch of medicine focused on physical fitness as well as both the treatment and prevention of activity-related injuries, sports medicine—also sometimes called sport and exercise medicine—is considered its own distinct field of health care, with training and standards befitting medical treatment of any specialty.

For more than 20 years, Carey Rothschild has been a physical therapist; for more than a decade, she’s been a professor at the University of Central Florida’s (UCF’s) department of physical therapy. 

During her career in sports medicine, Rothschild has seen the trends and philosophies driving the practice definitively shift from a biomedical model—one that focuses almost entirely on the body structure’s injured ligament, joint, muscle or tendon—to a much more comprehensive study of interconnected physical, mental and environmental factors, or what she describes as the “biopsychosocial model.” 

“It’s really incorporating the mind and body together, because sometimes people’s pain levels go up just because they’re stressed,” she explains. “When I first started practicing, I don’t think I ever even considered that how well someone sleeps every night can be related to how much pain they have, or what the effects of their diet, nutrition and social interactions are. Understanding those things is something that’s really changed in the past 10 years or so.”

Rothschild is also an athlete herself, with swimming and marathons factoring significantly into her life. That first-person understanding of how much an active lifestyle means to an individual, however they define staying active for themselves, has helped her both while working with patients one-on-one and emphasizing the intangible side of sports medicine to the students she teaches.

Amanda Williamson, who’s been a physical therapist for six years and a member of the Florida Physical Therapy Association (FPTA) since her student days, currently works in an outpatient environment at Orlando Health. In both the association and her professional home, she has noticed the same rising trends and holistic approaches as Rothschild has, particularly the importance of both getting to know and establishing trust with a patient.

“Really, it’s about being that facilitator helping people meet their individual goals, and establishing a good relationship with a client to figure out what their goals and needs are,” says Williamson. “One of the benefits of the location I work at is each patient is seen one-on-one, so that really helps develop that relationship. I definitely think that’s important because everybody has very different needs.”

Surrounding a patient with a team of supportive experts, rather than expecting a doctor, physical therapist, sports psychologist or coach to wear the hats that perhaps are better suited to professionals from other field is also a relatively newer approach in sports-medicine treatment.

“Having a team around an athlete is very beneficial, partly because we can have open communication with the patient and their other providers, such as trainers, therapists or their coach,” Gandara notes. “We all want the patient to be assessed accurately and given the appropriate diagnosis, and we do that by listening to them and then working together to develop a plan to get that patient to be better than they were before.”

Knowing now that outside factors, emotional hurdles and fear of exacerbating a pre-existing injury can all influence a patient’s recovery beyond a physical ailment’s impact, professional practitioners have developed a bigger-picture approach to administering sports medicine. It’s all part of increasingly understanding how the neurology of pain can impact anyone from an elderly patient recovering from hip surgery to an up-and-coming high school athlete with their future and a scholarship on the line. 

“The previous definition of pain described an uncomfortable experience because you have some injury or damage to your body tissue,” Rothschild says. “But now we know it’s not just related to the body tissue. Sometimes, when you’ve had a previous injury and you start to feel some of those symptoms again … you’ll start having a little sensitivity, and then the nerves send a message to the brain that says, something feels fishy and basically create the pain response.”

Beyond a better understanding of all the influences at play in each patients’ recovery, technological advancements and offerings like telehealth are also changing the ways treatment is delivered. And patients today have more access than ever to information about everything from their injuries’ onset to the realities shaping their recovery timelines—the latter being both a benefit and a hurdle.

“A lot of times, patients have already gone on the internet, they’ve already found their diagnosis, they’ve already decided what treatment they want to have,” Rothschild explains. “And so as a physical therapist, you have to be mindful of the patient’s expectations. If they think you’re going to do XYZ and you’re not doing XYZ, then they’ll probably find another person to go to.”

In terms of the hands-on application of sports medicine, utilizing the patient’s own biology to harness the regenerative power of plasma-rich platelets has been one of the biggest developments in treatment in the past decade.

“Some procedures are being done on major league players, like augmentation of tissue that has been injured in the past, which is done using the patient’s own blood platelets in a growth treatment with their platelet-rich plasma,” says Gandara. 

Given how much more comprehensive treatments under the umbrella of sports medicine have become the process of becoming a physical therapist has accordingly grown more involved and demanding over the years.

“Within the profession of physical therapy in the last 20 years, we’ve advanced from a bachelor’s degree to a doctorate profession,” Williamson says. “With that expansion into the doctor of physical therapy, that’s an opportunity to take on a bigger role in managing patients and then also being able to collaborate with physicians and athletic trainers as a team treating a patient rather than just a single individual.”

She adds that being affiliated with a group like FPTA, especially before she had earned her degree, is advantageous not only for the network of peers it connects members with, but also the educational opportunities that comes with talking shop and sharing ideas—all to patients’ benefit.

“There’s a lot of research to support that those who are engaged in their professional association are more engaged in their professional lives,” adds Williamson. “The biggest benefit for me has been the networking and the opportunity to reach out to individuals, so if I come across a case where I’m not quite sure what direction to take, I have a host of individuals that I can reach out to for help and support.”

Rothschild notes that the UCF physical therapy department curriculum has, like similar programs, grown more demanding over the years. A UCF graduate degree takes nine semesters to complete and includes research, clinical internships and even a course about how a patient’s “life load”—or their standard obligations and stressors—can impact their pain levels. 

“Our physical therapy program has a 12-week course dedicated to teaching the students the science of pain, evaluating that pain and evaluating the person,” she says. “Physical therapists are always going to ask questions about the patient’s history and their primary reasons for coming in, but this dives a little bit deeper and asks mental health questions, screens for anxiety and depression, and looking at the overall patient.”

The field of sports medicine will continue to evolve, utilizing technological advancements and applying breakthroughs in understanding how the mind and body both influence recovery. But one thing will always remain the same: Good medical professionals will always work to earn their patients’ trust, help them come back better and stronger, and be there to manage the emotional expectations of someone eager to put their injury behind them.   

“We make sure patients understand that if you don’t do things the right way today, it can affect you for the rest of your life,” says Gandara. “We tell them that there will always be injuries in life and in sports; we talk to the patient, we talk to their parents, we let them know the timeframe so they don’t get desperate and try to come back too quickly. We let them know that the goal is to get them back in the game, but they have to go through rehabilitation first.”