Quick Access to Quality Care

The Zoom connection was spotty.

“So you said you’re from the Twin Cities? I love Minneapolis,” I stated.

“Not Minneapolis,” she said. “Leopolis!”

Wait, what?

“And now I live in Pella.”

After the reconnect, I had Sally Egan of Advanced Physical Therapy & Sports Medicine (APTSM) begin anew.

“As an onsite provider at three companies and a municipality in Northeastern Wisconsin, it’s my job to help create and maintain healthy environments for employees,” said Egan. “And the best way to do that is to provide quick access to quality care.”

Egan is a veteran of APTSM’s industrial rehabilitation team, a group of licensed athletic trainers and physical therapists dedicated to keeping employees healthy, safe, and on the job. Like many of her colleagues from the athletic training world, she began her career in the high school setting, as the athletic trainer at nearby Shawano High School (about 15 minutes away from what she refers to as the “Twin Cities”) for nearly a dozen years.

She stresses the similarities between the two environments.

“What we do as industrial athletic trainers is bring the sports medicine model of immediate, consistent care to the workplace,” said Egan. “And we do this at no cost to the employee.”

Which is so important to her clients, everyday people who are just trying to make a living and put food on the table.

Egan understands that concept well.

“I grew up in this area on a very small dairy farm. I know what it's like for a family to live paycheck to paycheck and not able to get healthcare when you really should, because you just can't afford it,” said Egan. “So being able to provide that service—literally in my hometown—is just an amazing opportunity for me.”

Interesting that she and her chiropractor brother (“two tiny farm kids”) both pursued careers in health care. It makes complete sense, though, as she describes it as a simple transition from fixing tractors or boards on a wall to fixing people.

The similarities don’t end there, as Egan quickly points out.

“You have to be adaptable and inventive because you don't usually have the resources. That's what onsite rehab is. You don't have a lot of equipment, so you have to work with what you have,” she said.

The companies and organizations she works with rely on Egan to deliver services known as “rapid response,” where direct access to care means employees will be seen in 24-48 hours for an evaluation. That kind of quick care creates the opportunity for an improved healing timeframe, as the onsite provider can swiftly address and manage issues that, if left untreated, could become a recordable injury.

“We can prevent that from occurring,” said Egan. “So you’re keeping the employee healthy and keeping them at their job, and you’re saving the employer money by reducing direct and indirect costs that result from such an injury.”

Again, she leans on her sports medicine background.

“One domain of athletic training is about reactive and emergency care, which in industry is rapid response and OSHA first aid. So we're there for that assessment, and occasionally wound care and emergency care,” said Egan. “For injuries, we’re able to assess and make appropriate decisions if this is something that you can rehab or treat, or make that decision for a proper referral and guide them to where they should go for the best quality and line of care.”

Developing a relationship and a rapport with her employees is crucial.

“Well, it’s on me to get out on the floor and make connections,” said Egan. “You need to show them that you're there to know them as a person, not just a patient.

Forming such bonds requires a level of trust, something Egan says comes naturally when employees get treated right away and feel better. Whether it’s Egan making the rounds on a factory floor or working with a patient who scheduled an appointment in a (usually) small treatment room, the brief interactions are the sources of the best kind of marketing there is word of mouth.

“One employee will say, ‘Sally has done great things for my shoulder. Go see if she can help you.’ And that keeps my days full,” said Egan.

Egan highlights additional services she can provide if companies so choose. One company, for instance, wanted to offer their office personnel some strategies to improve general wellness. So, every week at the scheduled time, staff members stop what they are doing, grab a chair, and join Egan at the center of the office, where she leads them in fifteen minutes of stretching and body mechanics.

“It’s just a special need that the company felt strongly about, and we can do those types of things,” said Egan. “We individualize services based on the company. I meet with HR every single week at my companies just to keep the lines of communication open. We’re there to prevent health issues as much as possible, so that kind of collaboration ensures their needs are being met.”

The stability of the Wi-Fi connection notwithstanding, someone needed to get going. Technically her “day off,” Egan was headed to a side gig, teaching chair yoga to retired adults. But she wanted me to know she hadn’t looked at list of questions I had sent her prior to the interview.

“I wasn’t going to prep for this. Because what works in this field is that we're ourselves. We're not scripted. You get the real me,” said Egan.

The small-town country girl paused, and before signing off acknowledged one final similarity between her job as an industrial rehabilitation specialist and her work with high school athletes in a previous life.

“We’re in healthcare for a reason, and that’s to help people. I get to make those personal connections with industry clients just like I did in sports medicine. And the best part is when I get somebody that comes in and says, ‘Thank you so much for helping me. I feel so much better, and I didn't know if I was ever going to feel better.’

“That’s the best part of my job.”

—

Click Here to learn more about our Industrial and Tactical Medicine and Wellness programs.

Does Selecting the Right Running Shoe Help Prevent Injury?

Josh Zilm PT, DPT

Does Selecting the Right Running Shoe Help Prevent Injury?

It’s spring and time to strap on those shoes and get outside.

There has been an entire industry built around providing runners with the best possible shoe.  When answering the question, “Does selecting the right running shoe help prevent injury?” one often has to tread lightly as there are many opinions.  As physical therapists, we like to turn to the scientific literature to answer a question.  Can a running shoe offer a return on energy? Is it better to run barefoot?  Are minimalist shoes better? What about orthotics?  Those are topics for another time.  This post will focus only on the running shoe’s ability to reduce injury and not attempt to answer any of those other questions that can often muddy the waters. 

The industry

The running shoe industry dates back to the mid to late 1800s, but most credit the start of the modern-day training shoe to the founder of a little company called Nike when he started selling shoes out of the back of a van in the 1960s.  Since that time running and shoes have grown into a multi-billion dollar industry.  Did you know that the first New York City Marathon was held in 1970 and had 127 competitors?  That is quite a contrast from 52,812 finishers in 2018.  As the sport has grown so has the market for better shoes with an attempt to meet the needs and demands of the runner.  Research, technology, science, expert opinion, and business has delivered a vast shoe market that boast a variety spanning barefoot the ultimate support and cushion.  So with all the shoes available today, is there a shoe for your foot type that can reduce injury associated with rigors of the sport?

The Amazing Foot

The foot is designed to help our bodies absorb energy as we impact the ground in an action called pronation.  The foot and ankle accomplish these amazing feet through a team effort.  We have muscles from our trunk to our feet that actually fine-tune how the body absorbs shock and then in a split second prepares to propel us forward with each step.  Running injuries are most often associated with the loading phase of running and more specifically the rate at which we load.  Don’t be afraid I won’t get too technical, but it is important to understand that the primary focus on injury reduction regarding the shoe is slowing the rate of loading, that is how fast our bodies have to accept the load with each strike of the foot on the ground. 

Foot Type

The hard part about designing the perfect shoe is that there are 7.66 billion people on the planet with a lot of different foot types (I know they are not all runners).  Thankfully, the orthopedic and running world has been able to classify foot type to offer some order to our attempts to best categorize the variety of feet that walk or run into the clinic.  Foot type does offer some predictive value to the injuries that we typically experience.  Nature(genetics) and nurture(lifestyle) lend way to a spectrum of people have rigid high arched feet, flat feet flexible feet, and everything in between.  The shoe industry has tried to match foot type with the appropriate shoe.  For example, the rigid high arch foot type should consider a softer shoe, while the flat flexible foot could use a more supportive shoe. 

The Shoe Spectrum

The soft shoe would be categorized as a “cushioned” shoe while the more supportive shoe is given the name “motion control”.   It would be intuitive to think that a person with a poor ability to control the position of the foot would benefit from added support and the person with a rigid high arch foot may need a little more cushion because they hit the ground harder.  (funny that studies show that joint reaction forces are actually higher in a cushioned shoe versus minimal support.  The working theory is that runners hit the ground harder with a cushioned heel simply because it’s cushioned.)  This could be a multiday conversation, but my attempt is to explain the basic shoe spectrum that starts with no support(barefoot/running sandal) to motion control(high degree of pronation control).  There are many variations within this spectrum that attempt to meet the needs of the runner, but the question we are trying to answer is can we reduce injury by pairing the runner with the right running shoe?   What does the research say?

Theisen et at 2014 Br J Sport Med completed a study looking at over 200 runners.  They found:

1.      Midsole Hardness and Injury rates: no different.  The amount of cushion had no significant difference in injury rates.

2.      Energy absorption and injury risk have no scientific correlation.  A shoe that absorbs energy does not reduce injury rates.

3.      Shoe wear does not appear to have an effect on biomechanics.  You cannot correct your biomechanics by running with a shoe.

4.      1% increase in metabolic cost for every 3.5 ounces of shoes.  Heavy shoes require more energy.

The recommendation:   Promote light shoes.  Refrain from claiming that shoes reduce injury through cushion or biomechanical changes.

Ryan et al. (2011) Br J Sport Med found;

• Shoe assigned by foot posture index(match the shoe with the foot type).  Static foot type should not be the determining factor for shoe selection.  The highest rate of injury was in runners wearing a motion control shoe that were appropriately matched based on foot type. 

The recommendation: Don't use the algorithm alone in an attempt to match foot type and shoe type to dictate the choice of running shoe.

Nielsen et al. (2014) Br J Sports Med.

• Foot pronation was not associated with increased injury risk in novice runners wearing a neutral shoe.  The “Over pronator” did not experience a greater rate of injury when left unsupported versus supported.

The recommendation: Let comfort dictate.  Give the runner a starting point in shoe selection, but do not feel locked into a shoe, especially motion control. 

Conclusion

Shoe type may offer a good starting point for a new runner when selecting shoes.  Based on the current literature I would recommend starting your search with a shoe that matches your foot type, but don’t feel boxed into a certain type of shoe.  Look for something that is comfortable when you run.  In more recent literature motion control shoes have been associated with higher rates of injury which gives rise to concern for recommending a motion control shoe.

Also, a lighter shoe consumes less energy.  The weight of the shoe does matter.   

One of the questions I often ask in the clinic is, “Do you run to get stronger or get stronger to run” (Dr. Chris Powers, USC).  I see a lot of runners try to compensate for bad mechanics through shoes and more running, but the truth is many people lack the strength to support the activity of running.  A physical therapy running evaluation can be a great tool as you begin or return to running.  Injury reduction comes from improved biomechanics something that we are all capable of with the right instruction.  Like many things in running, there are no short cuts.  Consistent effort = results.  The right running shoe may do a lot of things for the athlete, but with the exception of protecting the bottom of the foot and toes, there does not appear to be evidence supporting the claim that they reduce injury rates in runners.