Sunday, September 9, 2012

APPLIED SCIENCE OF MANUAL THERAPY IN ORTHOPEDIC REHABILITATION

 
Orthopedic setting has set my soul in a blaze to discover more about the human body. The dynamics of healing and reinjury fascinates me to understand every phase of it. My biggest yearning is to find a concrete therapeutic tool that will totally maintain the individual to it's healing phase. I noticed every after surgical procedure, a patient is undergoing a cycle of repeated progression and regression of their condition. There is pain, stiffness and tightness either on the same day or one at a time until clinicians would determine it is fully healed.
 
I work in an Orthopedic Clinic where we are packed with 50-60% of post-operative knee injuries and 30% post-operative hip injuries. I was one of the privileged practitioners to apply strain-counter strain together with some of the mainstreams in Manual Therapy and Physical Therapy protocol. Whenever I see a knee post-op patient, I look closely on how they walk. I carefully analyze every phase of gait pattern to fully determine in which phase the patient sways a lot or almost losing his balance along the course of the gait cycle. Each of the five components of gait has its corresponding muscles responsible for the execution of smooth ambulation (Initial Contact, Loading Response, Midstance, Terminal Stance, and Preswing). If for example you observed that the patient lacked sufficient force to initiate foot contact, the first thing that comes in your mind could be decrease strength in knee extensors or pain during pressure loading on either the knee or foot. You should also pay attention to the joint articulation. The alignment of the fibula has something to do with the congruency of the whole knee unit. Most clinicians purports a fixed approach in physical rehabilitaion. Although the mechanism of injury have been synthesized by the past literatures together with their distinctive therapeutic approach. The extent of injury, functional capacity and the degree of recovery still depends on each patient.
 
Combining the concepts of lymphatics, fascial train, zero balancing, and reflexive deafferentation technique can be the most powerful tool in optimizing the post-op patient's healing capacity which I already mentioned in my past entries. In my workplace, I get to use more of patellar surfs to increase mobility and stability for most of my patients with p/o knee and hip injuries. The area of BL 37 in acupuncture which I often drag by my finger tips (without using any needles) towards the medial side while stabilizing the patella has amazed me in treating post-op knee and hip injuries. I am still connecting the science in somatic pain distribution in relation to the Yin-Yang flows and myotatic reflex, which I know there is an existing, common ground for all of them in order to simplfiy the therapeutic mechanism in a more parellel concept for orthopedic conditions.
 
 
 Im still looking for other concrete, scientific approach which would make sense in both worlds.  Most of the Physical Therapy Facility would strive for quantity over quality, but my ideations on delivering health care services is relentless to a common goal: making our patients be functional as soon as possible. I am encouraging fellow clinicians to dig deeper on this matter and find a better way to make your patients pain-free and living a life as close as they had before the injury.

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