Hey Kyle! That article demonstrates the inconsistency between protocols as well as the subjective liberty with designing them that can take place based off of surgeon experience, opinion, and surgical method done. While this may not be a bad thing, as we utilize similar methods with our own practice, this does mean that there isn’t a very specific guideline to follow for post-op procedures. I am limited in my experience with multiple clinics, I have noticed different protocols for same/similar procedures. The biggest factors for progressing patients during rehab for me personally are based off of patient’s symptom irritability/severity, prior level of function, and compliance with PT recommendations and HEP.

Thanks for sharing Sarah. We do see a lot of inconsistency between protocols for a number of factors and individuality plays a significant role in development of a plan of care.

But on the flip side, the consistencies between protocols may be more important. Protocols do provide clinicians with a guideline on what to protect and how to protect. They may not be as important for what to do, but what not to do.

Can you or David find an example of this in the study Kyle listed?

Sarah and Laura both bring up great points about how it is arguably more important that we know what to avoid in the protocols rather than following the suggestions of what to do. I agree with Sarah that ultimately the patient’s pain and irritability will ultimately dictate everything that we do. I think protocols definitely have a place as a framework or a guide with surgeries, especially when it comes to procedures that we’re not familiar with. I think as long as we have a good understanding of the surgical procedure, the anatomy involved, and the current state of the patient, we should be able to navigate the rehab without relying on the protocol. If we truly know what was involved with the surgery, then we will automatically have a good idea as to what to avoid when rehabbing the patient. This coupled with our understanding of tissue healing timelines will help us guide our patients back to their PLOF. I think a very interesting part of the article was how, although the exact exercises and timelines for incorporating these interventions varied between physicians, the phases and progressions for the protocols were more or less the same. I think thanking the timeline into account, coupled with the response to the patient with increased loads, should help navigate these types of surgeries.