Welcome to OrthopaedicProtocols.com

 There are two objectives in the successful management of musculoskeletal (MSK) injuries;

  1. The restoration of anatomy (often referred to as ‘healing’; achieved through a period of ‘protection’)
  2. The restoration of physiology (often referred to as ‘rehabilitation; achieved through progressive ‘exercise’)

Protocols exist in healthcare to help patients achieve the best possible outcome.

  1. Protocols help healthcare professionals in making informed decisions and recommendations to patients based on their clinical presentation at any given point in time.
  2. In the event that surgery is required to restore anatomy, these patients will typically receive a post-surgical rehabilitation protocol provided by their surgeon.
  3. In the event surgery is not required, these patients will typically require a non-surgical treatment plan and rehabilitation protocol provided by an orthopaedic physiotherapist (often in collaboration with a family physician, sportsmedicine physician or orthopaedic surgeon).
  4. Protocols are not a ‘universal recipe’ for every patient with the same condition, but rather a framework that outlines a safe, appropriate and progressive pathway that is individualized by a physiotherapist and / or surgeon based on the patient’s clinical presentation.

Inherit to the process of writing a protocol is;

  1. Knowledge of the injury, condition or procedure and biological healing timelines.
  2. The awareness of risk factors that could have a negative impact on the final outcome (i.e. inadequate rest, premature activity, delayed activity)
  3. The inclusion of language to minimize the occurrence and impact of these risk factors. (i.e. short term goals, timelines, etc).

In my professional opinion, it’s the responsibility of every healthcare professional to;

  1. Conduct a thorough MSK assessment consisting of a history, a detailed description of the patient’s subjective complaints and thorough physical examination.
  2. Use a differential diagnosis approach to arrive at a valid and reliable “clinical” diagnosis.(i.e.anatomical tissue(s), severity of injury).
  3. Educate the patient on their diagnosis, prognosis, biological healing timelines and an evidence-based treatment plan for their condition (i.e. set realistic expectations, responsibilities, timelines)
  4. Develop and educate the patient on a safe, appropriate and progressive non-surgical treatment plan and rehabilitative protocol (protection to facilitate tissue healing and rehabilitation pathway)
  5. Monitor the trajectory of the patient’s subjective complaints and rehabilitation  and – in the event the patient is not progressing on schedule – be open to getting a second opinion or revising the clinical diagnosis, current treatment or rehabilitation plan.
  6. In the event of surgery, adherence to the post-surgical protocol provided by the surgeon.
  7. Educate the patient on their role and responsibilities in executing their treatment plan and rehabilitation program as prescribed as well as the consequences of non-compliance and/or delayed action.

Bottom line – protocols help co-ordinate collaborative care to prevent clinical problems and consequently help compliant and engaged patients to achieve the best possible outcome.

The views expressed here are my own alone and not those of any provincial, national or international orthopaedic or physiotherapy body/ organization. If you’re a healthcare professional and interested in more information on post-surgical or non-surgical protocols, I invite you to email me at terrykane@orthopaedicscanada.com .