Working with adolescent teenagers can be a never-ending challenge for parents, teachers and coaches alike.  Physical therapists as well can be faced with various hurdles in working with patients of this age because of the role they may play in the lives of youth. A logical and coherent approach in dealing with teens is a necessity. 

Rebecca Sheaffer, PT, DPT, OCS, has found great success with this patient population and can be an example to others interested in this unique and rewarding patient group. Sheaffer is a facility director for Phoenix Rehabilitation and Health Services in their Royersford, PA, facility, having served in this position for the past five years. 

During her youth, Dr. Sheaffer trained and competed for fourteen years as a gymnast, reaching a competitive Level IX rank. She has twelve years of professional experience in the field of physical therapy, initially spending the first seven years of practice in a hospital setting and the past five in an outpatient clinic.

Her work with gymnasts began early in her career while she was in the hospital environment and expanded in her current position as an OP facility director. She went on to build a PT practice with gymnasts and branched outward from her nucleus of working with gymnasts to further include cheerleaders, dancers, springboard divers and baton twirlers. 

From Personal Experience to Professional Expert
Working in an outpatient setting has provided Dr. Sheaffer with the opportunity to become involved with a number of local gymnastic programs and athletes. She started by personally visiting the teams and facilities to provide injury screenings. Coaches, parents and gymnasts alike quickly recognized how her personal and professional experience could be invaluable to the students, and her practice grew by word of mouth. Although many of the injuries Dr. Sheaffer treats are common to the general population, the unique challenges and demands of the sport requires a modification of the treatment plan. 

Based on her past participation as a gymnast, along with her background as a therapist, she recognizes that gymnastics is a sport that stands alone in comparison to other sports, due to a variety of factors. Dr. Sheaffer pointed out that she considers gymnastics a sport unto its own. It is a sport of repetition, and gymnastics has language, verbiage and terminology which are both distinct and unique, she noted. Due to the nature of the gymnasts' participation and the sport itself, the injuries are unique and the types of injuries she sees are sport specific.

In addition to the physical side, the mental and emotional aspects to the sport and injuries need to be considered as well. Gymnasts in their early teens must physically and emotionally deal with puberty. At the heart of each gymnast is a continual pursuit of perfection. When working with a thirteen- or fourteen-year-old gymnast, many non-physical issues can come in to play. Usually, a vast portion of a teenage gymnast's self-identity is being a gymnast. A participant doesn't simply "do gymnastics" or doesn't partake in gymnastics, they ARE a gymnast! The sport is in their blood, and a large volume of self-esteem is wrapped up in being a gymnast. It's part of their being, a huge part of their soul and who they are as a person. It is critical that the physical therapist take this into account as it will become a huge opportunity for both bonding and influencing the athlete, which can affect the long-term recovery and return to the sport

Dr. Sheaffer described her approach to working with athletes as consisting of two major domains:  looking at what is bothering the athlete "here and now" and examining the athlete for "the long term." She noted that due to her background as a gymnast, she is prepared to reintegrate gymnasts into the sport after an injury and modify routines so the athlete can perform without aggravating an injury. It is the job of the therapist to understand the big picture.    

Treatment in the Clinic and Gym
Dr. Sheaffer's contact with the gymnast starts with a visit to her facility by direct access or a medical referral, or a visit to the athletic facility. No matter how the contact begins, Dr. Sheaffer will ultimately meet the athletes, coaches and parents in the actual training facility to watch the skills and routines. Some treatment will occur at the physical therapy clinic, including stretching, strengthening and manual work.  As soon as it is feasible and appropriate, treatment will also include a trip to the gym to modify the routine and make recommendations to the coach.

Throughout the treatment process, Dr. Sheaffer continues to develop a strong working relationship with the patient and the coach. When dealing with teenagers, as a teacher, coach or therapist, the ability to be "on their level" and be accessible to the athletes is paramount.  Teen athletes need to know that the therapist has the knowledge and ability to do something to help with their individual situation. This leads to an enhanced level of trust from the teen which can be difficult to accomplish. Through it all, gaining and maintaining trust is crucial. 

Dr. Sheaffer pointed out that knowledge of gymnastics is a critical element to the process of patient care. Her many years as a gymnast gives her the ability to speak the language of the sport and understand the skills needed to excel, also allowing her to modify routines so the athletes can compete without aggravation of an injury.

Case Studies
Dr. Sheaffer's unique work is well demonstrated by two recent cases; one a stress fracture of the first rib and the other an antero-lateral ankle impingement. In the case of the stress fracture, the gymnast experienced extreme pain and parasthesias during weight bearing through the upper extremities. Dr. Sheaffer worked with the coaching staff and the athlete's skill set to modify her beam and floor routines. For this athlete, a routine was developed where she did not have to weight bear through her upper extremities for participation in either event without compromising the routine's difficulty. 

The same process was utilized with the athlete who had the ankle impingement. Her balance beam routines required extreme dorsiflexion under load.  Modifications were made to the individual's routine which included substitution of an alternate skill of the same difficulty level that did not require this extreme motion. Dr. Sheaffer's understanding of both the sport and her profession allowed her to help both athletes continue training and competing without risk of pain, re-injury or compromising the most difficult of skills they performed. 

Dr. Sheaffer also works with cheerleaders, divers, dancers and baton twirlers in addition to gymnasts. Conceptually all of these sports have the same foundation as gymnastics; therefore, her expertise translates well when working with these athletes. She currently works with a cheerleader who has a lis franc sprain, a diver with a spondylolisthesis and a baton twirler with an adductor strain.  Each of these athletes has been able to finish their competition seasons this year, each winning awards of various degrees. 

As word of her expertise and successes spreads, one would expect this to be a major growth area for her professionally and for the athletes she helps for years to come.  

Dr. Sheaffer noted that no matter the situation, it is improper to sacrifice the body of the athlete.  A happy medium is required where resumption of training and competing occurs, but not at the expense of the physical well-being and health of the gymnast. Many of the injuries Dr. Sheaffer treats are repetitive stress injuries as gymnastics itself is a sport of repetition. Dr. Sheaffer's concern goes far beyond the present problem. In the forefront of her mind is protecting the long-term interests and the health of her participants for years after the completion of the last dismount.