Scott Webb (Host): Most athletes will suffer contact or overuse injuries, and that includes kids and adolescents. And today I'm joined by physical therapist Michelle Foss from Shriners Children's Portland. She's here to discuss the most common injuries that they see at Shriners and how she and the rest of the team work together to help young athletes return to the courts and fields, often overcoming mental and physical hurdles along the way. 

Welcome to Healing Heroes PDX, the podcast series from Shriner's Children's, Portland. I'm Scott Webb.

Michelle, it's so nice to have you here today. I was telling you and reminiscing a little bit about my daughter. She's 17. She plays basketball and she and my son have both been to PT numerous times, but you're the expert here. I feel like I'm an expert, but you're the actual expert. So just want to have you get rolling here today and just talk about your role as a physical therapist, as it relates to student athletes. 

Michelle Foss, PT, DPT: The student athletes come to us from the physicians and at least here at Shriners, and we're starting to get people from outside of the Shrine coming in. And our role is to basically assess what the goals are of the student athlete. Are they wanting to get back to their sport?

Typically the answer is yes. And they're very keen to get back out on the court or the field. and then what we're doing is trying to set like a realistic timetable to figure out how we can stepwise achieve that ultimate goal of getting back out onto the field or the court.

We're working with doctors, we're working with athletic trainers, whether that's athletic trainers here in house or we're working with the athletic trainers hopefully at the school, or at least getting the family to know that they need to get in contact with the athletic trainers. And then setting up that expectation, especially at that first appointment, that this is going to be your work, that your homework, if you will. 

 And you're going to do it every day. And we give exact, like, you're going to do these five exercises and you're going to do it this many times a day and this many sets of this many reps. And, it changes as they progress back.

Host: Yeah, that was one of the eye opening things for my daughter, in her most recent visit with physical therapy was how much homework she had. And it makes me think since you mentioned that, like, what can families expect, and I'm assuming that's one of them, that they're going to have to do some of this at home.

We can't fix everything in that 45 minutes to an hour, you know, in those visits. So, what can families expect that first time when it comes to sports related PT? 

Michelle Foss, PT, DPT: The evaluation is going to set the stage. So that first time when you come into PT, it's a few minutes of talking just to get to know each other. I like to get to know the person that I'm working with, as do the rest of my colleagues. I can speak for them because I've worked with them and gotten to know them in that capacity as well. But we try to get to know the person that we're working with and then we create the goals together and we talk about like if they have restrictions or something like that, whether it's surgical or nonsurgical and what they can and can't do and then if there needs to be like a letter for PE, let's say, then we make sure that the letter comes from the doctor.

Sometimes the physical therapist can help just get like an excuse form and then the student can do their physical therapy exercises in PE. And then, we come up with some exercises based on what we saw, whether that be strength or balance or whatever we need to work on. And then my philosophy just personally is that my student athletes are going to get four to six exercises and it's going to try to cover everything that we're trying to work on so they're interrelated.

And I start speaking about them directly as how they relate back to the field, back to practice, back to their sport, so that it speaks to them personally. Because I'm working with a, again, a person, and I'm speaking to the parents and sometimes I'm talking about how we don't want to push or how we need to make sure that we know ourselves, we're maybe not the best at following the homework, because maybe we've had PT somewhere before. But how can we be successful?

And so we set up like a safe environment to talk about and be honest of how we can, do things and how we can move forward. And then I'm seeing them probably weekly, sometimes twice a week, and we're checking in making sure those exercises are getting done.

Host: Yeah, I don't know if everybody will get this reference, but the original Karate Kid, you know, when Mr. Miyagi was wax on, wax off, you know, paint defense, those kinds of things. And I think about that when I think about PT, especially with my daughter, when she had her quote unquote homework is because it wasn't clear to her how those exercises might relate back to her sport and get her back on the court or the field sooner.

So it sounds like that's something that you do that, yes, this is homework, but there's a sort of a method to our madness, right?

Yeah.

Michelle Foss, PT, DPT: And I say those words exactly. There is method to my madness. I am a big believer in the Philadelphia 76ers, "trust the process." And I, quote that and reference it quite often. And then I do say there's method to my madness because I understand in the first typically 15 minutes what we need to do, and I've kind of got a map already formulating as we're talking.

And by the time we're finished with that first 15 minutes, I pretty much have a roadmap mentally built. And I'm very communicative, meaning I'm talking to the family, especially the student athlete. And helping them understand, like, why we're doing what we're doing, how is this going to help, and how does it relate back, like I said.

And I do this constantly, and, sometimes the people will roll their eyes a little bit. Not like in a bad way, but kind of look at me like, okay, Michelle, you've said this a million times. We get it. You know, kind of thing. But it sticks, and that is why I repeat myself multiple times.

Host: And those of us parents in the audience, we understand the value of repeating ourselves and the necessity of repeating ourselves to kids and adolescents. We could do a separate podcast on that, on just listening and the value of listening and all of that. Just wondering, what are some of the most common reasons you see kids in adolescence, whether that's the most common injuries or whatever, like most of the kids in adolescence, the athletes that end up there, why are they there?

Michelle Foss, PT, DPT: So I'm seeing a lot of um endurance sport athletes, you know, whether you want to consider basketball, soccer endurance, with basketball in particular, at sprinting, but you're out on the court a long time, especially if your coach trusts you to be out there. It's a lot of ankle sprains, overuse injuries. We do see people who've had knee surgeries that'll need to be surgically repaired by our surgeons here, or even outside of the hospital, like I said.

So we'll see ACL repairs, and meniscal repairs in particular. We have hip injuries that happen from time to time. So sometimes that doesn't really need surgery. We do see people post operative for hip injuries. But it's not quite as common as the knee and the ankle fractures.

And then of course, shoulder dislocations, subluxations. You're talking football players, wrestlers, sometimes even basketball players or volleyball players. And then I work with a lot of people who have had either back pain or spinal surgery.

Host: Yeah, so really the whole gamut, the greatest hits, if you will, of sports injuries, of course. And generally, you know, it is probably adults who listen to these podcasts, but if you could speak to the kids, what would you want them to know about participating in PT, in a PT program?

Michelle Foss, PT, DPT: The sessions are yours. You actually have the control. We are the guides as the physical therapists, but I can only do so much with the information that you give me. So if you want to share more and have, you know, better explanations, you get to ask why, you get to ask how, you get to ask how much, how hard is this going to be? 

It's a trust the process situation like I said, so if you are able to give me what you can and show me what you can do and you ask those questions, I can answer them for you so that you feel like you understand why you're doing it, more than like not necessarily the movement. Usually athletes don't necessarily have issues with movements.

Sometimes they do and then we can break it down. We can break it down to as basic a movement as possible and we can put those pieces back together until we get, that whole movement, to where you feel comfortable with it, not painful, whatever that might be.

Host: Yeah, I know that sports medicine, at least in my experience, and I'm sure the experience of others is very much an experience, right? So I'm sure it's just this like sports medicine experience at Shriners Children's. So I just want to know like, what makes it different? Why are you guys the right place, the right choice for folks?

Michelle Foss, PT, DPT: I think a couple of things. One is that if you're a patient here who's coming from one of the physicians, and I'm able to talk to physicians outside of here, but I can literally walk downstairs and go talk to the doctor over lunch or I can call them at their desk, from my desk and they can see that it's me calling them.

 I also like live and breathe sports, and I have since I was born basically. So, I've been watching you name the sport and the Olympics and anything. So like, I might not be a dancer. I might not be a lacrosse player or whatever, but I have a very good idea as to what movements you need to get back to, what the competition level is, especially for cheer and competitive dance and stuff like that. Basketball, volleyball, all the club sports. I have reference points for that, and we have people here who also have reference points for that as well. It's not just me. I just happen to be the one that's speaking right now.

Host: Yeah.

Michelle Foss, PT, DPT: But we have a team approach, and I talked about the athletic trainer too. I'll go down and talk to the athletic trainers who are here and I'll pick their brains as well to, kind of come up with a game plan sometimes. So, it's a team. You get a whole team when you come here.

Host: Yeah. I love hearing that, you know, you've got these athletes, many of whom are on team sports and then they come there and they can probably really identify with that, that team approach. And maybe in some respects, you and I are both basketball fans, maybe in some respects, you're kind of like the point guard, you know, for that team, leading the athletes through this process, through this experience.

And you mentioned earlier about setting goals with athletes and their families in that first visit. So then how do you measure success? Is it being able to sort of check off and yep, we've reached all these goals. Is it getting back on the fields and the courts? Like what's a successful experience from your perspective?

Michelle Foss, PT, DPT: We have questionnaires and then we have tests that we can do. So depending on what you're doing; let's say it's post op like an ACL tear and you had a surgical repair. Well, we have a motion lab here. I'm part of that team as well. So it's physicians, PT's, APT's, myself, and then the athletic trainers and the motion lab people who are also specialists in their fields. Along with some PTs that work in there and we break down different movements and analyze those. So you can do something as extreme as that or you know we have different hop tests or just checking like motion if we were we had like a stiff shoulder essentially, an overuse injury for a pitcher, how much range of motion are we getting?

Do we have full range of motion? Now are we able to throw that, you know, 45, 90 feet, whatever, however many feet, and get that distance. We don't have the ability to like throw in here, but I can take a look at your throwing motion. And then I can have you take a video of you throwing your distance.

Like, you know, when you're at practice or you go to practice and you're throwing with like your dad or the trainer or the coach or something like that so that we can then break that down. So, we have high tech things and we have lower tech things that we can use.

Host: Yeah. It sounds fairly objective, right? Like it's not just, yeah, it looks good. Yeah. That yeah. That's how you throw a ball. real objective criteria to make sure that we, okay. These were our goals. This is where we want it to be. And here's where we are objectively. Right.

Michelle Foss, PT, DPT: Yes. And that is how I write my goals. That's the PT side of it. That's the side that the student athletes are not, you know, necessarily I'm taking their words and making it like PT speak for the charting system. And then we do have to come up with those objective measures essentially.

 So that isn't arbitrary like, oh, you seem fine. If somebody seems fine, they're probably not ready to go out for a number of reasons. But if you're feeling good about stuff and now we're starting to hit those tests and do them and they look good and we can actually like measure that, then we're saying, okay, yeah, you've met your goal. Now you're ready to go back.

Host: I'm sure, Michelle, that families, kiddos, adolescents might be nervous about things before they start PT, you know, related to a sports injury. What are some of the things, maybe the most frequently asked questions or nerves and what hope do you provide or what answers do you give them when they're like, we're a little nervous about this, right?

Michelle Foss, PT, DPT: Yeah. And I think that's totally normal to be nervous. Especially if you've never had PT before. But the biggest question that has popped to my mind is like, how long is this going to take? And what they mean is how long is the session and then how many weeks am I going to have to do this?

Am I going to have to do this multiple times a week? And it really depends on what you're talking about. But if you come in with like an ankle sprain, we're probably looking at, you know, weekly, six to eight weeks. That's just a very blanket, I haven't taken a look at anything, but, again, doing your homework and setting that expectation, and then really truly listening to what the question is.

Because sometimes I get questions that I've never heard before and they're very good. So just encouraging people to not be afraid to just throw something out there, because it might not be a common question, but I'm happy to answer it if I can.

Host: Yeah. My daughter had the same concerns before we, the first time she went was, okay, where is this place? What's it like? What do we do? How long will we be here? How many sessions? You know, just typical things. And it's okay for patients and the kids and adolescents to be advocates for themselves and just speak up. Right?

Michelle Foss, PT, DPT: Oh, absolutely. If you feel brave enough to even say like, I'm nervous about this, which that's a hard one, especially when you're an adolescent. I don't get many high school students that walk in here and say, I'm really nervous. But you kind of get that sense.

And so, that's why I try to get to know, the person, like, immediately. Like, what grade are you in? What do you like to do? What are you interested in? Oh, you're wearing a, this team sweatshirt or you're wearing a, this high school sweatshirt. Tell me about it. You know, so

Host: Break the ice a little bit.

Michelle Foss, PT, DPT: Yeah, exactly.

Host: That's awesome. So we talked about setting goals and objective criteria and PT speak and all of that. So it makes me wonder how and when do you decide that a patient no longer needs therapy? Like, I'm sure you might say, well, this is six to eight weeks, or maybe it won't be that long. Maybe it will be longer. So how do you know when someone's really ready, when they're done?

Michelle Foss, PT, DPT: Based on how the goals are written, I kind of review them. What the general thing is, is like, are you able to run and we'll do running tests. We'll practice like direction changes. There are tests for that. So just like the PT choosing the correct objective tests basically to say like, okay, this person looks really good.

Their knee isn't like going in. They look like they're stable. And, usually you do more than just one run through to make sure that everything really is truly looking good. Typically we try to cross over into like the kids getting back on the court or the field or whatever, whether that be like, they've been cleared by the physician to get back into actual contact, like physical impact sports and stuff like that. And sometimes they're like non contact where they can do some drills, but sometimes they're cleared for everything. So just making sure that like they've been cleared by the physician, they're passing the tests and you know, are they mentally ready to go?

Cause if they're not, like we're definitely checking in at every single session to make sure that the kids are like,feeling good.

Host: Yeah.

Michelle Foss, PT, DPT: And if they're not, we have resources here that we can kind of help try to find to talk about it at least. And usually, the athletes only need like one or two conversations with whoever, just to kind of figure out like what's really going on. And then it's like, I'm just scared because I don't want to get hurt again. And once they're to kind of talk that out and they'll start talking to me about it more and more.

And we can sort of try to recreate that situation as much as possible so that hopefully we can face that fear and see that it's going to be okay.

Host: Yeah, we probably could do again a separate podcast just on some of those, the really bad sports injuries and the mental side and how long it can take some athletes to stop worrying about re-injury to that, let's say if it was an ACL, that knee or the other knee, a separate podcast, yeah, but it's good to know that you really do talk to the athletes and try to help them and help them regain their confidence, you know, physically, mentally, all of that before back out onto the field, right? Team needs you.

You really, you spend that time, not only getting to know them, but helping them through that process, the confidence process, right?

Michelle Foss, PT, DPT: Definitely. And usually just kind of figuring out that like you can do something that you weren't able to do actually as well before you got injured. And now you're seeing somebody who's a movement expert and be like, oh, I couldn't do that before. This is great. Or like, oh, this is how I got injured.

And then, we kind of build up to that and then we'll work on that movement ah pattern or that specific movement, jumping or something like that. And usually in the kind of the safety bubble of PT, that usually goes pretty well. And then again, that's where it's important that they graduate to working with those athletic trainers who are now in the gym with them or on the field working on those things. So. Yeah.

Host: Yeah, you and I, before we got rolling here today, and this has been good stuff, anytime I get to talk about things that are a little closer to home and my other life, uh, away from the microphone is, is a good day for me. But we share a passion for sports, women's basketball, those types of things.

Just want to get a sense from you about your experiences, what drew you to pediatric physical therapy, you know, how'd you get there?

Michelle Foss, PT, DPT: That's a journey in and of itself. I grew up watching sports. If it was Sunday, I grew up in Denver. So if the Broncos were playing, that's what was on TV. If there was a football game at all, if there was a basketball game, that was what was on the TV at our house before I was even able to play sports.

And then as soon as I could get into sports, you know, I started playing soccer and then basketball, and then volleyball. And I did like a couple of summers of very recreational softball, which is really fun. But definitely like shifted gears. I was a three sport athlete in high school. And I, didn't play division one, division two.

I got on a team for division three for basketball. And, I was just too far away from home. You talk about the psychology of everything. That was hard to realize that, like, I actually needed to switch and focus on the academic stuff, but I got into, essentially being like a student assistant for the women's basketball team at my school, basically about as quick as I could.

And, that opened up the door for me to start working in the training room. And when I was in high school, I was in the training room essentially learning how to tape ankles and, and working which was just volunteer at that point, you know. I was in that training room meeting and talking with athletes from other sports. Kids that I didn't necesarrily know but then I knew them from the training room. Same thing when I was a senior in, in college. Really I was working as as a student medical assistant because we weren't student trainers. You'd have to be certified for that.

Host: Sure.

Michelle Foss, PT, DPT: But so I was just always interested in working in the, background, if you will. And I knew about physical therapy, and I was interested in it. And I finally decided to pursue it and, how did I end up in pediatrics? That's a good question. It literally like two days before PT school started. I thought I was going to do like neuro rehabilitation, people who'd had spinal cord injuries and traumatic brain injuries because that's where I'd volunteered at a hospital back home. And, man, I loved that and the people there, I loved the people there, but I was like, man, I kind of think I want to work with kids and then I took all the pediatric things that I could in PT school and I did a rotation here at Shriners and fell in love with it.

And my husband's from here and he wanted to move back here and found out there was an opening and that's how I ended up at Shriners. But the sports, I didn't get hired to replace anybody. So I just sort of took everybody on. And what I was finding I was working with more of the athletes.

And I had an athletic background, so it was like, just reinforcing all this really cool, fun stuff. And now I've built basically a practice of working with pediatric athletes, and not pediatric where you feel like you're a kid, but these the middle school and high school students that, I'm working with the student athletes that we're talking about. So yeah.

Host: That's awesome. It's been great to get to know you today and learn more about what do and how you do it at Shriners Children's. And I know from my daughter's experience that the first physical therapist she worked with kind of looked like her. You know, she was the same height. She was very athletic. She had played high school and college basketball. And I think there's just something about that for young athletes that they, you know, that they can identify. They want to be able to identify with their physical therapist when they're doing rehab as someone who looks like they could probably still play sports, right?

Michelle Foss, PT, DPT: Yeah. And I mean, I, to talk about point guard, I've always kind of thought of myself as like a coach, but yeah, I played point and I played the two guard. So yeah. And I look the size of it. So And I, yeah, I think, people think I look like I still play. I still wear my basketball shoes just to, you know. Let that show.

Host: That's great. Well, I appreciate your time today. Expertise, compassion, all of that. Thank you so much.

Michelle Foss, PT, DPT: Yeah. Thank you, Scott. I appreciate all your time. Thank you.

Host: And for more information, check out our website at shrinersportland.org. And that concludes this episode of Healing Heroes PDX, the podcast series from the Specialists at Shriners Children's, Portland. Head over to our website at shrinersportland.org for more podcast episodes. I'm Scott Webb. Stay well.