By Steve A. Mora MD
Orange County Orthopedic Surgeon
As an Orange County orthopedic doctor I have the privilege of treating patients who work in various fields. One of my favorite patient groups to treat are police officers from the various agencies throughout California. These patients are unique in that they have a high level of commitment and their jobs are physically demanding and dangerous. Because of their commitment, police officers will do everything they can to heal and get back to their job. There is nothing more satisfying than being able to help police officers reach a level of function necessary to get them back to their regular work or as they say in their field “being 10-8”.
The one common denominator that police officers have is that they are all truly committed to their career, i.e., their calling. These committed men and women do not want to be off work unless it is absolutely necessary. Police officers work very hard to get into the police academy and pass the rigorous testing required to become a police officer. They do not want to compromise their positions or worse let their colleagues down. They will not complain unless the problem is so bad that they can no longer do their job. They tend to be very concerned about taking painkillers and prefer alternative options. If possible they prefer non operative treatment just so that they can keep working. If surgery is necessary they want to be off long enough so that they can be fully recover. In general police officers prefer not to do a desk job unless it is truly going to help them with transitioning back to their regular job. Taking care of injured police officers requires an understanding of not only their written job description but a complete understanding of the difficulties both physically and emotionally that they deal with on a day to day basis.
I am a sports medicine specialist. My practice focus has been on on mixed martial arts injuries. As I started to slowly take care of more and more of our local police officers I quickly realized that some of the injuries suffered by police were actually very similar to those suffered by mixed martial artist. Upper extremity injuries involving the shoulder and elbow tend to be associated with trying to control a physically combative or non cooperative suspect. For example about 75% of the shoulder injuries I see in police officers are due to injuries sustained after a single event. They can occur while trying to handcuff a non-cooperative suspect. They can also occur after a fall with the suspect. Or they occur from a forceful twist or pull during a struggle. These injuries include shoulder dislocations/ subluxations, pectoralis or biceps tendon tears, labral tears and fractures.
In addition to the abrupt traumatic injuries, police officers also suffer injuries related to cumulative trauma and progressive degeneration. Due to the fact that there is a unwritten code to not complain and just get on with work, police officers will often times allow nagging injuries to worsen over time. These cumulative trauma type of injuries are due to the repetitive nature of their job as well as the harmful effect of the gear they are required to wear. For example there is empirical evidence that the heavy gun belt can have harmful long term effects on their posture; especially while sitting. It is very difficult to sit properly in a car with a 30 pound cumbersome utility belt and a heavy bullet proof vest. The gun belt does not allow one to sit properly against the seat. The fully loaded belt does not allow a police officer to sit properly nor to apply a seat belt. In our experience this equipment can lead to chronic poor posture and deleterious compensation that leads to chronic injuries of the back and the shoulders.
Back injuries associated with the utility belt are so predictable that The State of California has recognized low back pain in police officers on duty for a minimum of five years to be an automatic Workers Compensatiom injury also known as presumptive injuries. The many other presumptive injuries can be seen at http://porac.org/resources/law-enforcement-presumptive-on-duty-injuries/
Repetitive shoulder injuries can occur from long standing poor scapular posture and reaching forward with the right arm to type on their MDT computers.
Pivoting hundreds of times a day as they exit and enter their patrol cars also leads to knee and back injuries. Some of the common shoulder injuries associated with progressive degeneration include: rotator cuff tears, AC joint arthrosis and biceps tenosynovitis.
My approach to treating these problems is to first provide non operative options including physical therapy, injections, chiropractic active release treatment and if approved platelet rich plasma injections. I will also recommend specific posture shirts which can sometimes be covered by the insurance company. I will also recommend lifestyle modifications such as weight loss and cross training with yoga or Pilates.
The goal is make them well enough to stop further injury, heal, and help them reach a high level of function that is necessary for them to do their job. Sometimes the police officer simply needs to be taken off work for a short period to allow rest and focus on rehabilitation such as aggressive stretching and physical therapy. Let’s not forget that sometimes time and rest heals wounds.
When police officers return to work they are expected to be able to climb walls, quickly reach behind their backs, wear the heavy gun belt, wrestle, squat, and run after folks. Therefore I do everything I can to make their surgery as solid as possible. Because of their unique job that has high strenuous and heavy physical demands I need to make sure that the surgery I do is going to be effective and durable.
The post operative rehabilitation is just as important as the surgery. Police officers need to go to physical therapists who understand their job and physical requirements. I choose physical therapists who are in tune with their needs and who also understand Workers Compensation rules. Therapy also needs to be efficient and effective. I implement a specific home exercise program which augments the therapy. I look at all the factors that may affect the outcome including including nutrition, endocrine, and psychological support.
Most of the injured police officers I treat is through the Worker’s Compensation system. Unfortunately the system is extremely difficult to navigate and work with. The Worker’s Compensation system has rigid rules and protocols that often leads to delay in care. Even though I’ve been treating Worker’s Compensation injuries for many years it is still very difficult to get police officers the treatment which they require in a efficient manner. Not only should the doctor understand Worker’s Compensation well but it’s also very important that the patients also understand their rights. For example in some cases after 30 days of the initial injury a patient has the right to choose their own specialist as long as the specialist is on the Medical Provider Network. An excellent reference that I can help patients navigate through the complexities of Worker’s Compensation is the textbook California Workers Comp How to Take Charge When You’re Injured on the Job by Christopher A. Ball.
Another example of the importance of understanding Worker’s Compensation applies to physical therapy. Physical therapy after a surgery is usually limited to 24 visits. However an additional 6-8 visits might be obtainable if the right language such as “Work Hardening” is used on the Request For Authorization form and the prescription. Additionally workers compensation rules also allows for 24 visits of chiropractic benefits. So after my patients finish their postoperative physical therapy it is not uncommon for me to send them for chiropractic therapy. The key once again being that the chiropractor also on board with the rehabilitation goals and appropriate treatment to help with the officer recover.
Although I enjoy taking care of police officers I prefer not to see them injured and I hope that in the future there are more resources spent on injury prevention. I would hope that someday the utility gun belt problem be solved. There is work being done on trying to find ways to unload the gun belt including alternatives such as utility vests, gun outriggers, pressure offset mechanisms and unique posture apparel designed to offset the weight of the bullet proof vest.
Most of this work is being done by the industry and not yet backed up with scientific proof. We recently looked at an offloading snap-on utility belt device in City of Anaheim. The final results of this questionnaire based study are pending.
There has also been limited research on comparing the gun belt to an offloading vest. Research which I am aware of has not clearly proven that an offloading vest will definitely reduce injuries. There is evidence that the vest is more comfortable and may allow for easier mobility. However there is a concern that switching the weight from the waist to the shoulders will invariably lead to a different array of physical injuries.
In the future, I am looking forward to seeing less police officers with cumulative injuries of their shoulders, back and knees. I am in a privileged position being at the front line of treatment; I have seen many success stories which I do not credit myself but rather credit my police officer patients who are truly committed to their health and their jobs. In the meantime I will continue to do all I can to keep them healthy. There’s nothing better for me than to help those that help and protect us.
Please let me know if I could ever be of service. I can be reached at SMora@restoreorthopedics.com
Steve A. Mora MD
Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He completed his training at the UC Irvine where he finished in the top of his class with AOA Medical Society honors. He completed his Orthopedic Surgery training USC. He completed an extra year of training with a Sports Medicine, Cartilage, Shoulder, and Knee Fellowship at Santa Monica Orthopaedic and Sports Medical Group. He is currently practicing Orthopedic Surgery in Orange County. Dr. Mora’s practice focus on sports related trauma, knee ligament and cartilage repair, shoulder rotator cuff and instability, hip arthroscopy and partial knee replacement. He sees athletes of all levels including professional soccer and UFC/MMA. He is team doctor for the Anaheim Bolts pro indoor soccer team and Foothill High School. Dr. Mora performs Cartilage transplantation, partial custom knee replacement, OATS, tibial osteotomies, meniscus transplant, ACL reconstruction, shoulder reconstruction, elbow arthroscopy, hip arthroscopy, platelet rich plasma and adult stem cell injections. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.
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