bio - nsca · doctrine • n9 (physical therapy technician) scope of practice • building the...
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SFC ELKINS IS PASSIONATE ABOUT PROVIDING THE BEST POSSIBLE LEADERSHIP AND HEALTHCARE TO SOLDIERS AND ALL THOSE WHO SUPPORT OUR MISSIONS. IT IS HIS INTENT TO BRING BROAD VISION TO THE PHYSICAL THERAPY TECHNICIANS ACROSS THE ARMY AND BE THE VOICE FOR POSITIVE CHANGE WITHIN THE ENLISTED RANKS.
IT IS SFC ELKINS INTENTIONS TO DEVELOP PT TECHS THAT HAVE THE DESIRE AND CONFIDENCE TO VENTURE ABROAD AND TAKE OWNERSHIP OF OUR SOLDIERS WELL‐BEING BY BEING “OUT FRONT”! LEADING PRT WITH THE INTENT TO ADMINISTER INJURY PREVENTION AND HUMAN PERFORMANCE OPTIMIZATION. “WE WILL BE THE SUBJECT MATTER EXPERTS IN CORRECTING THOSE BAD HABITS AND HEALING OUR SOLDIERS. YOU WILL BE EMPOWERED AND SUPPORTED TO LEARN ALL YOU CAN AND OFFER THE BEST POSSIBLE OPPORTUNITIES TO BE THE TIP OF THE SPEAR WHEN IT COMES TO IP/HPO”.
BIO:
SFC Elkins, Darin E. Senior Enlisted AdvisorRehabilitation and Reintegration Division (DASG‐HSZ‐R2D) Healthcare Delivery and Services, MEDCOM G‐3/5/7 Office of the Army Surgeon General
RESTORATIVE PHYSICAL READINESS TRAINING
SFC DARIN ELKINS
BRIEFING OUTLINE
PURPOSE: Highlight the Injury Prevention and Human Performance Optimization from the Physical Therapy Technicians perspective.
• Intent• Concept• Program Basics • Program Focus Groups• Program Example• Impact
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Doctrine• N9 (Physical Therapy Technician) Scope Of
Practice
• Building the Soldier Athlete (BSA) Reconditioning (Profile) Physical Training Supplement– Core document for ARP– Details unit‐level exercise regimens for specific
musculoskeletal injury types
• BSA Injury Prevention & Human Performance Optimization– Details unit‐level exercise regimens for the
uninjured Soldier
• FM 7‐22 (Formerly Training Circular 3‐22.20– Primary Army doctrine for all APRT
Doctrine• Warrior Transition Command Policy MemWarrior Transition Command CTP Policy & Guidance (Dec 2010)– Describes all processes of the CTP– Describes roles and responsibilities of the WTU PT
• o 09‐005: Physical Training for Soldiers in WTUs (14 Oct 09)– All WII Soldiers conduct ARP 5 hrs/wk according to ability
– In conjunction with other physical activities (e.g adaptive sports, MWR programs, etc.)
INTENT
• Utilize SR 68F (N9) as subject matter expert for Restorative PRT Program; develop plan of progression IAW PRT guidelines
• Conduct PRT for profiled soldiers• Evaluate and assess profiles • Maintain physical readiness in conjunction with profile
• Reduce risk of re‐injury
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Purpose of ARP in the WTU
• Reconditioning of WII Soldiers in the WTUs• Address deficits in any of the six domains of a Soldier’s life.• Prevent new injury or aggravation of existing injury• Speed recovery• Facilitate teamwork amongst all medical providers• Organized system of physical training for commanders• Consistent with Army Physical Readiness Training (APRT)
Doctrine• Not the traditional Restorative APRT for typical MSK injury
– It can be (but not exclusively) a modified version of APRT– Not synonymous with Army Physical Fitness Testing (APFT)
LINES OF COMMUNICATION
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RPRT COMPLETE
Profiled Soldier
Physical Therapy 68F(N9)
Chain of Command MTFReadiness
Status / Updates
• Physical & Mental Fitness / RTD
• Mentored Rx / Eliminate Malaise
RTD / Readiness
Go to War
MMRB / MEB
RTD / MNR
↑Access to Care / Rx Plans / RVU’s
RESTORATIVE PRT PROGRAM CONCEPT
Participants:• Soldiers On Current Physical Limitation Profile• Pre‐operative orthopedic Soldiers• Post‐operative Soldiers IAW prescribed profile• Pregnancy profile Soldiers
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Why is an OrganizedProgram Necessary?
• RPRT is part of Army culture and requirement
• Traditional: “Profile” PT organized by broad categories (e.g. all injured or slow/fast runners) – Problem: non‐specific type or dosage of
physical activity
• “Profile” PT executed/perceived incorrectly?– Command complaints: lacks discipline and
Soldiers return to the barracks – Soldier complaint: ridiculed for injury, “lumped
together” with “malingerers”– Might result in less than optimal recovery,
aggravation, re‐injury or new injury?
RPRT CONCEPT IN ACTION
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MFT-I Hands-on
Recovery
Interval Training
Maximizing Limitations High Intensity Interval TrainingHIT
PROGRAM BASICS
• Swelling management • Restore range of motion• Strength training• Reconditioning• Protect from further injury
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FOCUS GROUPS
• Ankle sprains• Knee injuries• Back pain/injuries• Upper extremity injuries• General de‐conditioned• Overweight• Orthopedic pre/post operative• Pre/post partum pregnancy
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PHASE OF HEALING COMBINED WITH OPTIMUM PERFORMANCE
• Inflammatory Phase ( 1 to 10 days after injury)Core Stabilization
• Proliferation Phase (72 hours to 3 weeks after injury)Core Strength
• Remodeling Phase (3 weeks to 2 years after injury)Core Power
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FOCUS GROUPS (EXAMPLE) INJURY PROGRAM
Phase One (PRT supplement)• Mechanism of injury• What ligaments are injured• Initial treatment planPhase Two (PRT supplement)• Range of motion• Stretching• Weight bearing to tolerance
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FOCUS GROUPS (EXAMPLE) INJURY PROGRAM
Phase Three (RPRT)• Stability • Flexibility • Core stabilization• CardioPhase Four (RPRT)• More advanced exercises (Strengthening and Power)• Preventative rehab• RTD
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PROFILE CONSIDERATIONS AND OUTCOMES
• Screen SM profile for specifics IAW Baylor model timelines
• Follow protocols as prescribed• Develop plan of progression IAW PRT guidelines• Increase morale and esprit de corps
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THE PROGRAM
Interval Training (HIT)
• Warm–Up (Preparation Phase)
• Body weight resistance (Movement Phase)
• Flexibility enhancement (Recovery Phase)
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THE WARM–UP5‐8 minutes
• Jog in place 2‐3 min• Half Jacks• Side‐to‐side knee lifts• Front Kicks• Shuffle Kicks• Power Knees
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BODY WEIGHT RESISTANCE INTERVAL TRAINING
40 sec – 20 sec x 3 intervals(36 ‐ 38 MINUTES)• Body Weight Sumo Squat
• Mountain Climber• Bend and Reach• T‐Push Up• Split Jump/Rear Lunge• Upright Row• Lateral Lunge• Plank Reach• Forward Lunge and Rotation• Squat/Push Press
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FLEXIBILITY ENHANCEMENT(13 ‐ 15 MINUTES)
• Lower Body Stretching – 20 sec each• Single Knee to Chest• Double Knee to Chest• Lumbar Roll• Hamstring Extension• Back Extension• Back Flexion• Cat/Camel Stretch
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IMPACT
• Return to duty• Bridge continuity of care /communication between provider, command and soldier
• Maintain level of combat readiness throughout the entire profiled timeline
• Optimal utilization of profile and recovery time• Increased productivity (generate RVU)• Decreased workload on medical facilities (Group therapeutic procedure code)
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SUCCESSES
• Fort Gordon – IOP• 65th MED BDE‐ Yongsan, Korea• Fort Belvoir – MTF/PT Clinic NCOIC• Fort Myer – MTF/PT Clinic NCOIC• Pentagon – PT Clinic NCOIC
• TRADOC has approved but has not implemented 68Fs (N9) to be assigned to multiple BNs to function as IP/HPO SME
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68F(N9)Available
resource with skills to be IP/HPO SME
MFTI/TSAC certification:
Functional scope like that of BDE
EOA
BCT/TRADOC asset, PRT/RPRT SME,
deployable, decrease cost to Army, decrease
appt times, open potential appt for Family and Retirees, generate
RVU for MTF
WHO HOW BENEFIT
GAPSIs PRT working?
Who is training our Soldiers?How long before SM is seen for acute MSE?
Is Medical Readiness accurately communicated?Pre/Post deployment continuity issues with wellness
Medically Ready Medically Not Ready
THE FUTURE
LINES OF COMMUNICATION
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RPRT COMPLETE
Profiled Soldier
Physical Therapy 68F (N9)
Chain of Command MTFReadiness
Status / Updates
• Mentored Rx / Eliminate Malaise
• Physical & Mental Fitness / RTD
RTD / Readiness
Go to War
MMRB / MEB
RTD / MNR
↑Access to Care / Rx Plans / RVU’s
CONCLUSION
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• Soldiers sustain athletic type injuries since they are required to be athletic.
• Physical Therapy Technicians 68F(N9) are Soldier/Athletes trained to recognize injury prevention techniques and human performance optimization to enhance general wellness of Soldiers.
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