The following is the third part of a transcript of the Dr. Jay Show from 1560 The Game in Houston, TX. Participating in the discussion are Dr. J. Michael Bennett, a Board Certified Orthopedic Surgeon and Sports Medicine Doctor with offices in Richmond and Sugar Land, TX; Danny Arnold, Director of Plex Sports Medicine, Physical Training, and Therapy; and Bob Lewis of 1650 The Game. If you have an orthopedic or sports medicine issue, please call our office at 281-633-8600 to schedule an appointment. Click this link to see the previous part of the Show and this link to move to the first part of the Show, which describes the purpose of physical therapy.
Here’s the transcript of the discussion:
DR BENNETT — Always be aware of the “too good to be true” deal. These are the people that promise you a speedy recovery no matter what your physician says. These are the cavalier therapists out there that have their own agendas, that have their own idea of what you went through, and they want to put you through their own program. The problem with that is they were not in your shoulder, they were not in your knee; every rotator cuff is a little bit different, some repairs are a little bit more tenuous, a little bit weaker than other repairs, some are stronger, it just depends on the tendon quality. You’ve got to take that into consideration with who you’re talking to and dealing with.
BOB LEWIS – Who’s in charge of your care plan when you’ve gone to an orthopedic surgeon and you’ve been released? Who’s in charge of that rehab care plan?
BENNETT – That’s a great question. Typically, the plan is actually a prescription, one written by your physician. Now there are a number of facilities out there that are cash based, which you can go to and just pay cash and do whatever you want to do and you don’t need a prescription. But most facilities require a prescription and that prescription has a protocol that the physician follows. I use the same protocol that I used when I was at the University of Miami and when I was with Tampa Bay. I think this makes a big difference because it gives the therapist a guideline of what my preference is and I can adjust it. As the surgeon, I’ve been in your shoulder; I know what the repair looks like and what it took to reconstruct that shoulder. The therapist, although they are well meaning and want to do what’s best for you to get you through your rehab quickly, they may not know exactly what happened during the surgery or how hard it was or what your tissues looked like and all of that makes a difference in the rehabilitation. I usually give the patients a script for their therapy and a copy of the protocol that I give the therapist and I tell them that this is the protocol that they’re going to go by and that I want them to do their due diligence and check the therapist and make sure the protocol is being followed. The ones that I use are very good about following the protocols but every once in a while due to convenience, the patient will go to their own facility that wants to do its own protocol. I’ll go out there and call that facility and say, “What’s going on here? This patient is supposed to be doing this, and you have them doing that” and that’s where we’ve crossed that communication gap because I’ve reached out to that therapist.
Don’t be led by poor information or misinformation. Ask questions. Make sure you have some time with the therapist. Make sure you’re well taught on all the home exercises and that you’re not being herded through the facility like a bunch of cattle. Like I said before, you don’t want to go to a place where they stick you in a corner, have you work on some bands and let you do your own exercise.
LEWIS – Is most therapy one-on-one or are there situations where there’s group therapy?
BENNETT – There are situations where there is group therapy and that’s fine as long as that therapist is taking your needs into consideration and they understand the rehabilitation. It doesn’t make sense to me that you would group four patients under one therapist and have a different rehabilitation protocol for each patient. For instance, if I have my own protocol, and “Jim” has another physician and another protocol and they group us two patients together and they’re saying, “Okay, this is what you want to do,” I think that can work when it’s at the beginning when it’s mainly the basics and it’s all about passive motion and then active assisted motion and then active motion. Maybe that works in those early, early phases. But a lot of times the therapy changes based on where they’re at in regards to whether they’re two months out, three months out, and for me, I start my strengthening around three months, but some docs may want to start it a little bit later or a little earlier, so there’s different tweaks in the protocol and that needs to be taken into consideration.
I’m not a big fan of group therapy but I think it’s okay with some basic injuries like ankle sprains or things like Patella Femoral Syndrome, where the kneecap becomes irritated and it has a lot to do with the mechanics of the knee and a lot to do with muscle atrophy, where you’ve got weakness in your quadriceps and tightness in your hamstrings and a lot of times that can cause anterior knee pain. A lot of the therapy for that is pretty much the same so you can group people together if you are doing some really basic stuff. But the post-operative stuff makes a big difference and you want to make sure you are following a protocol.
If you have questions about the information discussed here, please call our office at 281-633-8600. We have two offices serving patients in the metro Houston area — one in Richmond, TX, and the other in Sugar Land, TX.
