Identifying a
Pattern
There are several patterns within rehabilitation. To name a
few, there is a pattern to the way an injury evaluation is performed, the order
certain exercises are performed in and even patterns within how the exercises
themselves are performed. Rehabilitation protocols also follow basic patterns. For
this assignment, I’ll evaluate the post-surgical and post-injury rehabilitative
protocols.
Below, I have selected one non-surgical knee injury and one
surgical knee injury. I did so to point out that the rehabilitative process is
essentially the same despite the injuries being completely different. The same
would hold true for a shoulder surgery compared to an ankle sprain.
Non-Surgical Medial Collateral Ligament Sprain (complete
rupture) Rehab Protocol:
Post-Surgical Anterior Cruciate Ligament Repair Protocol:
Both these protocols are broken down into phases (weeks) and
begin with pain control with gentle range of motion exercises. They then
progress light strengthening exercises and proprioceptive activities. Strength
and endurance are then improved upon until the patient is considered “functional”.
Once functional, the patient may begin more aggressive sport or work-related activities
such as running and agility drills.
This particular pattern is the essence of musculoskeletal rehabilitation.
This pattern is largely based on scientific data collected through numerous
studies to determine healing rates, tissue composition and appropriate exercise
selection (just look at the reference pages!). Without this pattern patients
may not have favorable outcomes post-injury.
Re-Patterning
Because this pattern of rehabilitation is scientifically
sound, there is not an applicable way to “re-pattern” it. Though, there is a
way to teach this pattern in a different way: backwards. Thinking about the
ultimate goal of functionality, whether it is work or sports related, requires
reaching smaller goals first. Functionality requires basic strength, basic
strength requires a certain range of motion to achieve full strength. This range
of motion cannot be reached until pain and swelling are controlled. If the
student can re-think the rehab process from the end stage back to the
beginning, they will have a better understanding why the overlaying pattern is
the same for almost any injury. If they happen to be working with a patient or
athlete who is “stuck” from reaching a particular goal they will be able to
look at the rehab and see if there were any gaps in therapy. Was
balance/proprioception not addressed? Was range of motion not restored? In
addition, they will be able to come up with better rehabilitation plans
themselves (where there is no documented protocol) when dealing with injuries
because they will have a better understanding of the importance of each goal.
Discussion
Patterning is a cognitive tool used to identify a repetition
and be able to predict the next “move” or an outcome. My original pattern is the
overlaying pattern of the rehabilitative process for a musculoskeletal injury. This
pattern is typically broken down into smaller phases or stages in which certain
goals are to be achieved i.e. controlled/decreased pain and swelling, weight
bearing vs. non-weight bearing, range of motion at a certain degree, strength
at a certain percentage of the unaffected limb, improved proprioception and
muscular endurance, etc. before moving on to the next phase. These goals are
largely based on scientific data collected concerning healing rates, tissue
type, tissue remodeling (healing), appropriate and effective exercises and
preventative measures.
Because rehabilitation is based on science, it is difficult
to re-pattern the process and have it still be sound and applicable. Though,
teaching the pattern does not necessarily have to follow the “from beginning to
end” principle. Instead, why not identify the desired outcomes and describe,
starting from the point of the final outcome, each goal that must be achieved prior
to?
It makes sense that you cannot achieve one larger goal (full
function) without achieving smaller goals prior to it (full range of motion)
and there is nothing wrong with teaching from “start to finish”. Though, I feel
if the student has to “discover” each goal by working backwards, their grasp
will be more firm than it may have been otherwise. This will especially help
them when they have to develop their own rehabilitation plans for patients. Not
every injury comes with a documented protocol to follow! Understanding what it
takes to reach the final outcome will undoubtedly help them plan a solid
rehabilitation program for their patient or athlete.
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