Physical therapy continues to apply rehabilitation techniques on a regular basis.
I just conducted a little survey of my readers, and they largely concur.
Most people continue to adhere to protocol:
However, there has been a recent rise in criticism of these rules and individuals who adhere to them on social media.
Even after graduating from college, students are refusing to follow standards.
Over the years, I’ve heard a lot of grievances, including:
Instead of following a piece of paper, we must utilise our minds.
Physiatrists shouldn’t use a recipe book.
Physical therapy is not a binary process.
We must personalise our therapy strategy.
I can at least somewhat comprehend and concur.
We have devoted a lot of time and effort to our education on the workings of the human body as physical therapists (or other rehabilitation specialists).
We’ve put many hours (and money…) into becoming physical therapists and become the best at what we do.
Based on our experiences and the results of our patients, we have spent years honing our talents.
We ought to be using our minds and customising programmes for every individual.
But if we apply rehabilitative methods appropriately, we can do this more effectively.
To best understand how we should be employing rehabilitation protocols in our practises, it helps to break down exactly what they are and are not in physical therapy.
Rehab Protocols Are Not Recipe Books
book about physical therapy
Rehab protocols are not intended to be exhaustive recipe books, so let’s get that out of the way immediately.
When a physical therapist thinks they can’t perform anything that isn’t clearly stated in the protocol, they might frequently feel immobilised by it.
In reality, an effective rehabilitation strategy should explicitly outline the dangers, deadlines, and goals for gradually applying stress to repairing tissue.
These were created using what we know about the fundamental science of how the body heals.
Between what you unquestionably SHOULD be doing and what you unquestionably SHOULD NOT be doing, there is still a lot of grey space.
Consider this an opportunity to create your own sandwich using your preferred recipe.
Bread must be spread on both sides, but the patient, your education, and your experience will all influence what foods you sandwich between the pieces of bread.
Like me, you could have your own tastes.
With my patients, I frequently take actions that are not expressly stated in a protocol but which I am certain are consistent with the objectives and safety measures of the protocol.
ACL rehabilitation’s early stages can benefit from core exercise, as can treating the soft tissue of the traps after rotator cuff surgery.
You can still conduct them even if they aren’t listed in the protocol expressly.
The cornerstone of your programme is rehabilitation procedures, which should be modified in light of:
The distinct objectives of each person
the precise wound or operation
Any simultaneous injuries, which are frequent
Following an injury, rehabilitation protocols serve as guidelines.
It’s a prevalent misperception that procedures are suggestions rather than rigid laws.
All of the nonoperative rehabilitation regimens that we have developed over the years are meant to serve as a roadmap for you as you take patients back from injuries.
Many of them really have stages rather than hard deadlines with criteria for advancement.
For instance, the following would be some of each phase’s objectives while treating a baseball player who has had a Tommy John injury:
Phase 1: Promote healing, increase range of motion, establish a foundation of strength, and improve proprioception
Phase 2: Maintain flexibility, increase strength, and improve dynamic stability
Phase 3: progressively add strain to tissue and advance to vigorous sports activities
Phase 4: Progress toward a return to sport
You may use these rules to decide what is and isn’t acceptable for each of the aforementioned phases by taking a look at the phases listed above.
Your own tastes may be relevant in this situation.
You like yellow mustard, I enjoy spicy mustard with my ham and cheese.
I’m not going to pass judgement.
They are both suitable.
For nonoperative cases, you should apply a procedure in this manner. Postoperative cases are different, and we’ll cover it in more detail below.
Nonoperative rehabilitation protocols are utilised to break the rehab sequence into manageable pieces for nonoperative injuries, yet there are situations when you may wish to restrict an exercise or activity for a certain period of time.
After Surgery, Rehabilitation Protocols Are Required
procedure for knee rehabilitation
The unquestionable requirement for post-operative rehabilitation programmes is one area in which I have strong opinions.
Physical therapy after surgery includes several crucial components called rehabilitation regimens.
To ensure that patients recover from surgery and go on effectively, a set of standards of care must be established and disseminated.
Many of them can be surgeon-specific, i.e., individual surgeons may want you to move more quickly or more slowly according on their expertise.
We as physical therapists must adhere to the operating surgeon’s instructions.
They are more familiar with the interior of your patient and their procedure than you are.
Following surgery, measures are utilised to ensure that the wounded tissues are protected, healed, and loaded progressively.
The least probable scenario is that you will return the individual as swiftly and securely as possible if you just wing it and don’t follow a routine.
For instance, having too much or too little shoulder range of motion after an anterior labral surgery can both be harmful.
The patient will have the highest chance of success with a postoperative rehabilitation regimen that is properly thought out.
It might be challenging for a novice practitioner to prioritise the precautions and limitations of challenging patients.
For instance, our rehabilitation programmes offer 16 different ACL reconstruction protocols and 13 different rotator cuff repair treatments.
Based on a number of variables and concurrent injuries, we modify the rules.
This is essential.
Is it Finally Time to Stop Employing Rehabilitation Protocols?
I sincerely doubt it; in fact, I firmly believe that, when used properly, rehab regimens are effective.
To reject protocols as unimportant to our profession or as something we are above adopting is, in my opinion, really naive.
A protocol, on the other hand, only outlines what you CAN and CANNOT do.
Your “options” are not limited to what is allowed by the protocol.
Consider these as precautions to ensure that you are not moving too quickly or slowly.
A protocol often does not cover all of the treatments and exercises that must be done.
Your knowledge and expertise will be useful in this situation.
While determining whether the chosen intervention can be safely carried out within the protocol’s constraints, you must also consider what additional interventions you can safely carry out to assist the patient.
A rehabilitation plan that is not “skilled” physical therapy should not be blindly followed.
But we must recognise that treatments and healing tissues frequently have timetables.
A truly professional doctor is aware of this and integrates their considerable knowledge and personal therapeutic preferences with the recommendations of a rehabilitation regimen.
Do You Wish to Use My Protocols?
procedures for physical therapy rehabilitation
We just changed and enlarged all of our protocols and put them entirely online and downloadable if you’re interested in adopting the protocols that I co-developed with Kevin Wilk and Dr. James Andrews.
Our procedures, which are based on decades of study, empirical data, and experience, have been published in a number of journals throughout the years.
They are now the most popular and well-regarded rehabilitation methods.