By Lt. David Groves, Naval Hospital Guam
Keeping a machine running at optimal performance requires ongoing maintenance. The human body is no different. Often times the body has been severely injured or to the point that it requires rehabilitation to work properly. This is where physical therapy (PT) steps in. PT focuses on restoring and optimizing human functional mobility.
As a physical therapist (PT) at Naval Hospital Guam, I help restore function or movement, where the ability has been lost, regardless of the joint or region. As a military PT, I understand that my patient, loss of mobility not only hinders their readiness or ability to perform their job, but, affects their overall military mission as well. But how serious is it?
Injuries are currently the leading health problem for the U.S. military, resulting in more than 1.8 million medical encounters among more than 800,000 service members annually (USAMSA 2006). According to one source, nonbattle injuries have become a major cause of morbidity and mortality during combat operations. Whereas infectious disease was the leading cause of nonbattle hospitalizations in World Wars I and II and the Korean War (Hauret et al / Am J Prev Med 2010;38(1S):S94 –S107 S95).
I work with tactical warfare athletes. These people are functioning at a high level and it’s my job to help return them to their high level of competency, which is often one of the most challenging things to do. Here in Guam, in our outpatient setting, we typically see injuries from sports, work related trauma, or specific injuries such as a stabilized fractures, torn muscle, tendons, ligaments, and over training injuries.
To maintain this high level of functionality and readiness, service members must care for themselves. Maintaining optimal health which is a result of physical exercise and balanced nutrition meals is the ideal way to do this. Although most military members meet the standards injuries do occur. If this happens it’s important to recognize that there might be an injury early and to immediately seek medical attention.
If basic remedies, such as rest, ice, compression, elevation, do not work for an injury, members should see their primary care manager (PCM) or consult a physical therapist. We’ll evaluate your injury to see if there is something structurally wrong that is hindering your healing. After evaluating the total extent of the injury we’ll develop a rehabilitation plan.
Naval Hospital Guam is an excellent medical facility to help our patients recover. When a plan is developed my team and I communicate directly with the patient’s PCM, by sharing with them the patient’s diagnosis and care plan. If the evaluation demonstrates that rehabilitation is not the best route for a patient’s recovery we’ll help establish additional diagnostic appointments with their PCM or other appropriate physicians such as an orthopedist. If our patient’s requires continued medication use, I’d refer them back to their PCM for medicinal prescription and management.
The best way to support my patients isn’t to just focus on the big picture goal, military readiness, but to focus on the patient centered goal. Two people may perform the same job, but one person’s goal may be different from someone else’s. For example one person may want to simply get back to riding their bike and another may want to go hike a mountain. Our job really entails finding out the patient’s functional goals and trying to get them back to those so they can participate and function fully in society.
Naval Hospital Guam’s PT Department also provides inpatient therapy services for people that may have suffered a stroke, or traumatic brain injury. We see people who have lost function on their upper or lower extremities, they can’t do simple things like roll over, and they can’t do any activities of daily living. But as their medical management helps them improve, rehab is there to guide them into their functional recovery whatever that may be.
However, not every injury or disorder can expect full recovery. If so, the rehabilitation team helps guide our patient towards adaptation. You work around whatever that person’s limitations are to provide them the opportunity to live independently as much as possible. We help them adapt to their situation, their environment, and their home needs. Some patients with extensive injuries might require in home services, something that is offered separately from the hospital.
Sometimes we are the coach. Sometimes a person doesn’t acknowledge they can push past their present limitations. But knowing the medical history behind their limitation helps us to get them past it safely, and that is a key portion of what rehab is.
Those who receive regular treatment services within the hospital are usually seen by a PT technician. These technician’s help patients carry out the physical therapist directed plan of care.
Plans are prescribed by the PT and can be as simple as independent exercises done at home to more skilled and guided hands on care within the clinic. I also provide onsite evaluations for the special warfare units as well as tenant commands at their request.
Although I’m passionate about what I do, I always stress the importance of injury prevention, from good conditioning related to sound nutrition and exercise. For those who maintain high levels of fitness I understand the demands of military life, from physical activity, to on the job requirements that can still cause injury,
When I get someone who has been injured injury, it can be difficult to return them back to a very high level of performance. Although, PT supports the warfighter and the military mission, we also support injured family members and aim to meet the specific needs of each individual. The rewarding part of being in the medical field, and specifically the rehab profession, is the fact you are helping people and getting them back to doing the things they love.