Does managed care get you running again?

When President Clinton tore a quadriceps tendon and needed physical therapy, his physical therapist warned him that some patients take as long as a year to fully return to running. On top of that, she warned that runners who are suddenly injured, and forced to stay off their feet, typically gain 20 to 27 pounds. That's when the President's intensive VIP physical therapy kicked in.

The President went from wheelchair to crutches to cane to full rehabilitation in a very short time. This was accomplished by two physical therapy sessions a day, one in the morning, another in the afternoon. The typical physical therapy session began with an examination of the President's knee, followed by stretches and range-of-motion exercises. Gradually, as the knee healed and strengthened, he progressed to more strenuous workouts, including weightlifting, and shorts stints on the stationary bicycle, treadmill, and mechanical stairs. He then began a run-walk program and ultimately returned to non-stop running. Within four months after his surgery, the president played 18 holes of golf.

Since the President had access to an aggressive physical therapy program, he was not only able to walk again quickly, he was also able to run and golf. What most runners and other non-professional athletes have access to is not quite so "presidential." The physical therapy available to the rest of us is limited by managed care.

Managed care has caused coverage for health care to be rolled back from every corner. Both patients and health care providers have had to make compromises. Physical therapists must help patients extend their own care to at-home rehabilitation programs in which they try to manage their injury throughout their recovery time largely on their own. The therapist can help the patient establish both short and long term goals for rehabilitation using visits to teach exercises to use at home or at their gym.

In addition to dealing with the injury, a runner has other important rehabilitation issues to consider. Exercise is a top priority for a recovering patient in physical therapy. An aerobic conditioning program comprised of exercise to promote muscular endurance and to burn calories is of the utmost importance so that athletic individuals will not lose the fitness level while healing an injury.

Nutrition counseling is the next step to keep you from gaining weight during rehab. Runners are used to consuming large amounts of food to fuel their high-energy demands. An injury can leave you feeling hungry without the usual caloric expenditure.

Runners should evaluate a health plan's physical therapy and rehabilitation benefits before choosing health insurance coverage. Also make sure your physical therapist can provide comprehensive care that maximizes your chance of full rehabilitation and return to your athletic lifestyle, so that if you're injured you can get running again, just like the President. (Bruce Wilk, P.T., O.C.S. is director of Orthopedic Rehabilitation Specialists in Miami, FL)