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

  1. The restoration of anatomy (often referred to as ‘healing’)
  2. The restoration of function (often referred to as ‘rehabilitation’).

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

Protocols help healthcare professionals in making informed decisions and recommendations to patients based on their clinical presentation at any given point in time.

In the event that surgery is required to restore anatomy, these patients will typically receive a post-surgical rehabilitation protocol provided by their surgeon.

In the event surgery is not required, these patients will typically require a non-surgical treatment plan and rehabilitation protocol provided by orthopaedic surgeons, orthopaedic physiotherapists and / or sportsmedicine physicians.

MSK protocols are not a ‘universal recipe’ for every patient, but rather a framework that outlines a safe, appropriate and progressive ¬†pathway to help patients achieve the best possible outcome, under the guidance of a physiotherapist and / or surgeon.

Inherit to the process of writing a protocol is (1) the awareness of risk factors that could have a negative impact on the final outcome (i.e. inadequate rest, premature activity, delayed activity) and (2) 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 remains the responsibility of every healthcare professional to;

  1. Conduct a thorough MSK assessment consisting of a history, a 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 (a tissue healing and rehabilitation pathway)
  5. In the event of surgery, adherence to the post-surgical protocol provided by the surgeon.
  6. Educate the patient on their role and responsibilities in executing their treatment plan and rehabilitation program as prescribed.

While I appreciate and respect that some clinicians may not share my opinion, it’s been my clinical experience over the past thirty years that problems can arise for one or more of the following reasons. ¬† Regrettably, I believe the following can also contribute to premature or inappropriate surgical referrals as well as chronic neuromuscular pain.

  1. A healthcare professional with limited clinical MSK experience, renders an inaccurate diagnosis and / or an inaccurate treatment plan rather than referring the patient to a more experienced MSK diagnostician / clinician.
  2. An acceptance among some healthcare professionals on ‘radiological’ diagnoses, enabling dependency on passive treatments and pain medications versus pursuing a ‘clinical’ diagnosis at first contact, engaging patients in self-management strategies and progressive physical activity.
  3. An inadequate, incomplete or rushed assessment and physical examination.
  4. Not executing a differential diagnosis approach and eliminating possible diagnoses before proceeding to treatment.
  5. Inadequate or incomplete patient education on their condition, prognosis and biological healing timelines.
  6. An Inadequate or inappropriate treatment plan, including those methods promoting unsubstantiated promises of accelerated biological healing.
  7. Premature, delayed, inappropriate or inadequate rehabilitation program.
  8. Non-compliance with their treatment plan and / or rehabilitation program.

In my opinion, protocols help co-ordinate collaborative care to prevent clinical problems and consequently help patients achieve the best possible outcome.

The views expressed here are my own and not those of any provincial, national or international physiotherapy governing body or 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.

Terry Kane, Registered Physiotherapist

Founder / Owner, OrthopaedicsCanada.com Network

Website: terrykane.ca