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Re: tkr
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Re: tkr - June 20, 2007 8:36:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
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My impression of the website is that it has very credible information that someone worked hard to put in a systematical order. I actually wish I had the brains to put something together like that. I always respect people that have original ideas. Hats off to PTupdate. At no time did I conclude that there was not a wealth of information on PTupdate. At no time did I conclude that one should not go to PTupdate. There are a million good PT websites out there. SJ thank you I will look into MYptspace (sp?) as you recommended.
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Re: tkr - June 20, 2007 9:32:00 AM
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savela
Posts: 63
Joined: October 7, 2004
From: toronto
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When I have difficulty finding protocols I search on Goggle. I have found many clinics/hospitals have web sites with rehab protocols, some Universities for their Med students, and also the military sites.
I work in an out pt clinic and am the only PT, so I have called PT's in hospitals for their thoughts/advice/protocols and they were happy to take the time to help. Good luck in your search.
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Re: tkr - June 20, 2007 10:14:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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what's a protocol?
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Re: tkr - June 20, 2007 10:21:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
Status: offline
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Flaortho, thank god.. i thought i was the only one outthere.
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Re: tkr - June 20, 2007 10:48:00 AM
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orthotherapist
Posts: 217
Joined: February 6, 2007
Status: offline
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Protocol is an outdated word -
One should have many tools at their disposal to accurately evaluate and then treat the patient (not the TKA, rotator cuff repair, etc)that sits in front of them.
Use the most recent literature findings to guide your work with the functional deficits that the patient presents with. Use your knowledge of healing times, surgical procedure etc to determine patient progression.
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Re: tkr - June 20, 2007 10:55:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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I must admit I rarely work with any immediate post op patients, but if i did, of course I would want to know what was done surgically to shape some of my aggressiveness and technique, but other than that, we all know how a muscle heals, how bone heals, etc, and what it means to increase motor control, stability, strength, rom, and thereby increasing functional independence, throw in some gait retraining etc, and then it is up to you to find what works best for you and what works best for your patient and merge the two together. I know that I had some very obese older patients who did best just riding a bike doing AAROM pushing their bad leg with their good and slowly bringing the seat closes, some bilateral partial squats on the total gym, and literally nothing else, and did amazingly well. I have had some others who had to do isolated hip and knee and ankle exercises, proprioceptive exercises, endurance type exercises, some neural flossing, etc, but they all essentially had the same procedure. Just take what is being presented, see how they respond, and continue to progress. Ok, done with my 2 cents
Ben Galin, PT, DPT, OCS
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Re: tkr - June 20, 2007 8:51:00 PM
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savela
Posts: 63
Joined: October 7, 2004
From: toronto
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I agree with the above posts, but I feel "protocols" are important for many reasons.
I do not treat many post OP's and do not have easy access to surgical consults.
Yes, I can easily assess the deficits of a pt., but many surgeons in Canada have restrictions, and they refer to PT with "follow the protocol".
I do not work in a hospital, and have to chase the Doc to find their individual restrictions (which I feel is frustrating).
Yes the TKR stuff is straight forward, and maybe I got off topic posting in this section, but I can relate to the posters request for help.
I have 3 ACL repairs on my case load and they all have different restrictions. The last thing I want is to delay their progress or worse, wreck their repair with contraindicated treatment.
I mainly post on this site when ethics and business topics pop up, because I feel I have something helpful to say.
I read this site daily to learn new stuff.I have used many treatment tech. and I have and had great outcomes.
Honestly, I am reluctant to post about treatment plans, since I have read many "slams" about other PT's treatment plans.
My PT education taught me to ask for help, when I was not sure, use EBM, and to be fair and tolerant.
But..... when some PT's ask for help, some "posters" make us feel that we should know the answer and that we are not great PT's.
If you have not noticed Joshua5 has not posted a reply.
I may be wrong, but it may be because he/she was feeling attacked or stupid. Surgical tech. are progressing rapidly, and asking for "protocols" is not a stupid question.
Everyone who reads this site, wants to learn. If a PT or student asks for help, don't make it difficult, do not be rude, be honest and give your best advice.
Thanks to all that have given me great advice.
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Re: tkr - June 21, 2007 4:30:00 AM
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orthotherapist
Posts: 217
Joined: February 6, 2007
Status: offline
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unfortunately most doctors that say follow the protocol probably do not know what the protocol is
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Re: tkr - June 21, 2007 5:21:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
Status: offline
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ortho, well dont forget they did get a 7 minute evaluation that they waited 2.5 hours for.
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Re: tkr - June 21, 2007 6:37:00 AM
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orthotherapist
Posts: 217
Joined: February 6, 2007
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i have used the "follow the protocol" script as education for the doctors that refer to me. Since they usually do not have a particular protocol I will approach them with my ideas on how to rehab their patient based on the surgical procedure (I review op report first) and recent published evidence.
They are typically very pleased that I am aware of the specific surgical procedure and that I have a "protocol" (just my ideas for that specific patient based on my evaluation). they have done their part (surgery) and now the MD is confident that the patient in is going to get the proper rehab.
Marketing at its best.
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Re: tkr - June 21, 2007 6:46:00 AM
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physioo
Posts: 184
Joined: June 26, 2006
From: Canada
Status: offline
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PTUPDATE.Com
John Duffy, PT OCS, is currently Director of NovaCare South Hills Sports Medicine Clinic, located in Pittsburgh, PA. Since becoming director in 1993, John has grown this clinic to become one of the busiest and most successful offices in Western Pennsylvania. A 1991 graduate of the University of Pittsburgh's Physical Therapy program, John went to work at Allegheny General Hospital in Pittsburgh until he became director of SHSMC in 1993. Since that time, John was also District Director for all 15 Health Trax Rehabilitation Services clinics, Manager of Clinical Operations for 12 Nova Care offices, and Clinical Coordinator for more than 10 physical therapy programs. John has performed multiple start-ups, including a complete hospital department. He has started many clinical programs, including: Occupational Medicine, orthotics, work hardening/conditioning, home care, occupational/hand therapy, and his own comprehensive outcomes program. He has also served as a commentator for ESPN radio, and is a Health and Fitness guest on the Ellis and Tom Radio Golf show on ESPN
NOW THATS WHAT A PHYSIO SHOULD BE...
will be a member soon
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Re: tkr - June 21, 2007 7:07:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
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well there it is folks....the concluding statment to why PTs should not use protocals. thanks physioo
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Re: tkr - June 21, 2007 8:21:00 AM
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physioo
Posts: 184
Joined: June 26, 2006
From: Canada
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I never use protocols and never intend to use them...I am not saying they are bad....
but I believe every client is different and the assessment is what gives you the exact treatment...
Question for you Rage.....
i realize u r a cert MDT
what do u think of McKenzie therapy? Do you find success in using McK?
Some of ur input would b g appreciated...
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Re: tkr - June 21, 2007 8:24:00 AM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
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sorry, i dont want that last post to be misinterpreted. i just was wondering what i may have said that possibly turned this post into PTupdate is not credible. I just dont like protocals cause in may turn PT's into robots instead of movement specialists. I really dont think PTupdate is concluding they are good or bad (protocals). its a website that you can get data from. If you guys want to make another post regarding how good PTupdate is then go for it.
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Re: tkr - June 21, 2007 4:33:00 PM
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ragempt
Posts: 111
Joined: August 14, 2006
From: linden, michigan
Status: offline
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Hi physioo, yes i got the Cert back in 2002. actually a DIP MDT is a higher rank in the mckenzie method. I have seen a few of them on here. Mckenzie is a great great method maybe the best method for back pain out there (well thats my opinion). The Mckenzie method does not fix everybody but its well researched. I wantedd to be well rounded (not there yet but trying) in more than one form of treatment. I have seen Mckenzie therapist go over board in repetitive movments. sometimes general strnghtening is as good as the Mckenzie method. When i talk to Dip ranked mckenzie therapist my mouth drops. they really know their research.
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Re: tkr - June 21, 2007 4:57:00 PM
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SJBird55
Posts: 2432
Joined: May 10, 2004
From: Michigan
Status: offline
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Hey, Duffy... how good are you? ;) I just have to know!
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Re: tkr - June 21, 2007 5:49:00 PM
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PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
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I'm **** good
Actually, I could not figure out why a bunch of people just joined, and did not realize this forum was up and running again. Now I know why
Protocols are just guidelines, often necessary for those clinicians who are not completely up on the literature, or those who really don't know what was done surgically
As most PT's never take the time to read anything, I prefer that physicians DO send patients to PT with some type of protocol. How many "average" (read..most) PT's really understand the mechanics of a meniscal repair, and the reasons why flexion is limited in the early stage? How many understand why the protocol changes for a type II SLAP repair done arthroscopically? Send these people to an average PT with a script that says "evaluate and treat" and I guarantee a fu_ked up outcome
But, using protocols can create their own issues. The Wilk protocols for the SLAP repairs have a few issues, in my humble opinion, so I have changed them to make more clinical sense to me. I had the (mis)fortune of boozing it up last Friday night with a PT who was called in as an expert witness in a lawsuit against a PT....who used a protocol on a person and caused a cuff retear that could NOT be fixed again. Ooops, he used the wrong protocol!
So, I thank many of you for the kind words regarding the site, and I am glad that it helps you with your patient care......the main reason I have not stopped updating the site (even with threats of divorce.) Fortunately for me, if the wifey dumps me because I am always at the clinic or updating the website, I know SJ will come down to Pittsburgh and shack up with me
John Duffy PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: tkr - June 22, 2007 1:50:00 AM
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SJBird55
Posts: 2432
Joined: May 10, 2004
From: Michigan
Status: offline
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Presumptive of you, Duff.
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Re: tkr - June 22, 2007 4:49:00 AM
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physioo
Posts: 184
Joined: June 26, 2006
From: Canada
Status: offline
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haa hilarious
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