Can orthos administer rehab?

[GH253]

Can orthos do anything in the way of administering theraputic exercise, or are they obliged to refer patients to PTs. I don't agree with the way physical therapy is currently practiced and would have a hard time referring patients to most clinics.

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[st0w]

I don't know about an answer to your question, but I'm curious what aspects of physical therapy you specifically don't agree with. Can you elaborate a bit?

 

[GH253]

I don't know about an answer to your question, but I'm curious what aspects of physical therapy you specifically don't agree with. Can you elaborate a bit?

The field of physical therapy is afflicted with massive ideological problems. There is almost no appreciation for the value of, let alone the requirements for, proper strength training exercise. Instead, therapists focus on using as many worthless modalities (ice, heat, EMS, etc.) as they can get away with billing the patients' insurance for, while the "exercise" component typically consists of instructing the patient to move his limbs through space with little or no resistance, using elastic bands or little pink dumbbells, stretching (an archaic and almost totally worthless activity), and low-intensity steady-state activities like cycling (also utterly worthless). The arena of exercise and physical training has a critically imporant philosophical component which is almost totally overlooked in physical therapy. Without a firm ideological base, therapists are suceptible to whims and fads of the fitness indurstry, which is why so-called "proprioception" and "core" training have taken hold recently. The whole field of orthopetic rehabilitation has become a sick joke, to the degree that I could not in good conscience refer a patient to physical therapy.

 

[SOUNDMAN]

so why don't you just outline in a protocol what you actually want them to do, and if they don't do it, send them to a PT that would. Or hire a PT that believes like you do and send your patients to them.

 

[truthseeker]

The field of physical therapy is afflicted with massive ideological problems. There is almost no appreciation for the value of, let alone the requirements for, proper strength training exercise. Instead, therapists focus on using as many worthless modalities (ice, heat, EMS, etc.) as they can get away with billing the patients' insurance for, while the "exercise" component typically consists of instructing the patient to move his limbs through space with little or no resistance, using elastic bands or little pink dumbbells, stretching (an archaic and almost totally worthless activity), and low-intensity steady-state activities like cycling (also utterly worthless). The arena of exercise and physical training has a critically imporant philosophical component which is almost totally overlooked in physical therapy. Without a firm ideological base, therapists are suceptible to whims and fads of the fitness indurstry, which is why so-called "proprioception" and "core" training have taken hold recently. The whole field of orthopetic rehabilitation has become a sick joke, to the degree that I could not in good conscience refer a patient to physical therapy.

Unfortunately, you simply haven't found the right PT clinic. There are many PTs just like what you describe. Good PTs in my view, look at patients just like good orthopedists. They find the mechanical flaw/failure and modify. Sometimes it is pure strengthening, sometimes it is proprioception. Do you not believe that ligament failure is more often due to a late contraction rather than a weak one?

Keep looking. Good orthopedic surgery fails without good PT.

 

[GH253]

Unfortunately, you simply haven't found the right PT clinic. There are many PTs just like what you describe. Good PTs in my view, look at patients just like good orthopedists. They find the mechanical flaw/failure and modify. Sometimes it is pure strengthening, sometimes it is proprioception. Do you not believe that ligament failure is more often due to a late contraction rather than a weak one?

Keep looking. Good orthopedic surgery fails without good PT.

Ligement failure is more often due to a linebacker hitting your knee with 1000 pounds of force than anything having to do with proprioception.

 

[truthseeker]

Ligement failure is more often due to a linebacker hitting your knee with 1000 pounds of force than anything having to do with proprioception.

Sure, that happens but more often it happens without contact during uncontrolled pivot episodes. Read the papers by Elizabeth Arndt MD and Randy Dick of the NCAA during a long term, ongoing study of ACL tears in women. They profer different hypotheses why ACL tears are much more common in women than in men and some of their conclusions include: relative lack of athletic exposure (girls are/were more likely to play non-athletically when young), unhelpful anatomy (narrow intertrochlear notch, bigger Q angle, body fat: lean body mass ratio), and strength.

In this article ( http://bjsm.bmj.com/cgi/content/full/42/6/394 ) it references that the highest percentage of ACL tears when compared to all injuries in that particular sport is in women's gymnastics. Not many linebackers there.

With all due respect, there is a large body of knowledge that supports proprioception as a fundamental/essential part of ACL rehab and most musculoskeletal rehab for that matter. So before you throw the PT profession under the bus, look at the body of research that supports some of their interventions. Your outcomes will surely suffer if you don't.

from the article above:
"If the number of reported injuries is considered, American football produced the greatest number of ACL injuries. However, if ACL injuries are ranked as a percentage of ACL injuries on a team compared with all injuries on that team, female sports dominate the list (female football/soccer, female lacrosse, female gymnastics and female basketball; fig 2A). If the ACL injury rate per 1000 exposures is considered, female gymnastics rate first with men's spring American football second, closely followed by female football/soccer, female basketball and men's in-season American football (fig 2B). "

Sorry, couldn't paste fig. 2B

Here is another nice link. http://www.ehealthmd.com/library/acltears/ACL_causes.html

 

[lirpa]

Ligement failure is more often due to a linebacker hitting your knee with 1000 pounds of force than anything having to do with proprioception.

GH523
I would almost be willing to bet, you have not suffered any sever ligament injuries yourself, or had a bad experience with a pt?
I have had 2 total ACL ruptures, torn mcl and and meniscus
ALL from soccer and im a female, no line backers..and not once was I taken out. they all occured from pivoting and lack of strength training weak hip flexors quads and hamstrings. Physical therapy returned me to play soccer at a university level.
Im pretty sure it was not from having me get on a bike for 15 minutes and play with pink rubber bands.
I feel sad for you that you either have had a bad experience with a certain pt clinic or are just under educated about the profession, but we are being highly trained in all arenas of strength training and prevention!
Trust me no pt enjoys sitting and doing an ultrasound on a patient for 10 minutes, the best part of our job is making people stronger, but you cant just start a total hip replacement patient off on a vigorus static and dynamic circut training program, those theraband exercises and increasing strength exercises are there for a purpose and as far as ive seen our profession has only grown and become more in demand over time!

 

[MinnDasota]

The field of physical therapy is afflicted with massive ideological problems. There is almost no appreciation for the value of, let alone the requirements for, proper strength training exercise. Instead, therapists focus on using as many worthless modalities (ice, heat, EMS, etc.) as they can get away with billing the patients' insurance for, while the "exercise" component typically consists of instructing the patient to move his limbs through space with little or no resistance, using elastic bands or little pink dumbbells, stretching (an archaic and almost totally worthless activity), and low-intensity steady-state activities like cycling (also utterly worthless). The arena of exercise and physical training has a critically imporant philosophical component which is almost totally overlooked in physical therapy. Without a firm ideological base, therapists are suceptible to whims and fads of the fitness indurstry, which is why so-called "proprioception" and "core" training have taken hold recently. The whole field of orthopetic rehabilitation has become a sick joke, to the degree that I could not in good conscience refer a patient to physical therapy.

I'm sorry that you have not experienced what a good physical therapist does. I think that if you take time to see what we really do, you will see that many of us in sports/orthopedic PT are trained in strength and conditioning. Either way, it's definitely more involved and less cookie-cutter than your post suggests.

I am not sure where you practice and hope that what you speak of is not from experience. I practice in NYC and can tell you that we work closely with NYU, Columbia, and Hospital for Special Surgery MDs. NYU and HSS have created rehab networks for their patients because they have found (through research) how important PT is for positive outcomes of their patients. I trained at the Kerlan-Jobe Clinic in Los Angeles and the Steadman-Hawkins Clinic in Vail, Colorado, and they also believed this. This may be something you should look into doing. Get to truly know the PTs in your area and send them some patients. If you like what they do and your patients get better, then you know that practice is credible and place them in your little rehab network. If they don't get better or you don't like their techniques, then send them elsewhere. As these are your patients, I understand that you want them to have the best care possible. So your concern makes sense. I just hope your perception changes about PT.

Most of the "proprioception" and "core" that you speak of is rooted in research such as the ones that truthseeker referenced. It is true that most ACL injuries are non-contact injuries vs. the "linebacker tackle." I did 3 years of research with a well known orthopedic/sports medicine MD at Columbia Presbyterian which confirmed this. If you need references, please direct your attention to the research coming from the Santa Monica Orthopedic Group or Cincinatti Children's Hospital.

By the way, cycling is not worthless. It's perfect for active assistive range of motion following knee or hip surgery. I do use ice a lot as it's the best modality for swelling, but never bill for it. As for stretching, I receive a lot of scripts from MDs specifically asking for stretching, especially in adolecent athletes suffering from spondy's. It is archaic in some cases, but is indicated in many conditions.