PATIENT-CENTRED REHABILITATION AND PHASED RECOVERY: A CLINICIAN’S GUIDE Cliff Eaton MSc, MCSP, International Clinical Support Specialist at Enovis, provides an overview of the potential interventions for dealing with soft-tissue injuries.
In the case of ACL injuries, many surgeons now prefer to wait until pain and inflammation are under control, hence our early interventions can expedite their surgical intervention. Also, pain and inflammation both result in neuromuscular inhibition via the AMI process, resulting in muscle atrophy and weakness. So, to enhance our post op muscle strengthening, addressing pain and inflammation early on is a really important consideration. Patient education is important to manage their expectations and provide self-help measures. These may include modifying activities of daily life. Patient’s expectation must be managed. Accelerated rehab programmes and early return to sport are now largely dismissed due to the high recurrence rates. Therefore, patients must also be realistic about time scales. Discuss Return to train times rather than Return to Play times. This will help with a patient’s optimism on being able to return to their desired activity.
Rehabilitation of injuries such as ACLs and LE can complex. So let us consider our potential interventions for dealing with these challenges using the acronym PEACE and LOVE, which is gaining popularity over the acronym PRICE, which is essentially used for acute presentations. PEACE and LOVE, put forward by Dubois et al (2020), encompasses the whole rehab process and puts the patient at the centre rather than the injury. 20
Acute management’ •
Protection (Brace/Taping)
• •
Elevation
Avoid anti-inflammatories – Cryotherapy, PBMT
• •
Compression
Education - activity modification • Patient expectation • Time scale
Protection from further exacerbation is recommended immediately after injury for 2-3 days - bracing provides stability and enhanced proprioception during the rehab process. Inflammation (only present in acute presentations) is an essential part of the healing process and should not be retarded by anti-inflammatory medication. Cryotherapy could be used instead, and compression could be incorporated using the Aircast Cryocuff. Current literature suggests that ice only provides an analgesic effect and does not influence the inflammatory process. Modalities like High intensity Laser Therapy, and to a lesser extent Ultrasound, which are inflammatory ‘optimisers’, are very effective at this stage but do require the patient to visit the clinic at least 3 times a week but preferably daily for the first two weeks.
Rehabilitation phase •
Load – progressive optimal loading
• Optimism – perceptions, catastrophizing, pessimism • Vascularisation – ESWT and PBMT • Exercise - restoration of pain free ROM and ADL • S.A.I.D. principle (Specific Adaptation to Imposed Demands)
...
20
Made with FlippingBook - PDF hosting