Very Acute Therapy
This week I found myself at an outpatient orthopedic clinic treating work-related injuries. The clinic was one of several in the area. They have agreements with many local industries to provide medical and therapy services to injured employees. The injured worker sees the doctor at the clinic, is given a script for therapy and starts as soon as possible.
The majority of patients I evaluated were between one and two days post-injury, with six visits ordered. There is still ample chemical pain around the injury that pain response is unreliable. The presence of acute chemical pain means nothing is going to significantly decrease the pain and everything is going to hurt. Most of the diagnoses included the word strain. That wasn't very helpful.
Most of these people were still working. After therapy they would often go right back to doing something that would make them hurt. Light duty for them didn't mean sitting at a desk or filing. It meant doing the same job with lifting or positional restrictions.
I was taught to rest acute injuries and use modalities for pain control. When I was learning the McKenzie method, we were told to wait at least a week before evaluating back injuries. The only exceptions were postural training and flexion avoidance when appropriate. The six visits were spread over two to three weeks. They would be halfway through therapy before a real assessment could be completed.
I don't know why there was such an emphasis on starting things so early. Obviously the employer doesn't want to lose valuable worker time to injury. Starting sooner would seem to imply being finished sooner. Movement heals but you don't want to move someone too early and cause an injury. I can see the point of gentle movements initially but continuing to work sort of defeats the purpose.
I've read some literature talking about having PTs in the emergency room. The purpose was for gait training, education and screening some patients for safe discharge home. That makes sense to me. Maybe I'm completely missing the boat on this one.