3/12/2013
BIO:
SFC Elkins, Darin E. Senior Enlisted Advisor
Rehabilitation and Reintegration Division (DASG‐HSZ‐R2D) Healthcare Delivery and Services, MEDCOM G‐3/5/7 Office of the Army Surgeon General
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”.
RESTORATIVE PHYSICAL READINESS TRAINING
SFC DARIN ELKINS
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BRIEFING OUTLINE
PURPOSE: Highlight the Injury Prevention and Human Performance Optimization from the Physical Therapy Technicians perspective.
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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.)
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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)
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LINES OF COMMUNICATION
Chain of
Command
Readiness
Status / Updates
Physical
Therapy
68F(N9)
↑Access to Care /
Rx Plans / RVU’s
MTF
• Physical &
Mental
Fitness /
RTD
• Mentored Rx
/ Eliminate
Malaise
Profiled
Soldier
RPRT COMPLETE
Go to
War
RTD /
Readiness
RTD /
MNR
MMRB /
MEB
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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 Organized
Program 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 MFT-I Hands-on
Interval Training
High Intensity Interval Training
HIT
Maximizing Limitations
Recovery
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PROGRAM BASICS
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Swelling management Restore range of motion
Strength training
Reconditioning
Protect from further injury
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FOCUS GROUPS
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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 plan
Phase 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
• Cardio
Phase 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–UP
5‐8 minutes •
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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
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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
40 sec – 20 sec x 3 intervals
(36 ‐ 38 MINUTES)
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FLEXIBILITY ENHANCEMENT
(13 ‐ 15 MINUTES)
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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
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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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THE FUTURE
Medically Ready
Medically Not Ready
GAPS
Is 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
WHO
HOW
68F(N9)
Available resource with skills to be IP/HPO SME
MFTI/TSAC certification: Functional scope like that of BDE EOA
BENEFIT
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
LINES OF COMMUNICATION
Chain of
Command
Readiness
Status / Updates
Physical
Therapy
68F (N9)
↑Access to Care /
Rx Plans / RVU’s
MTF
• Mentored Rx /
Eliminate
Malaise
• Physical &
Mental
Fitness / RTD
Profiled
Soldier
RPRT COMPLETE
Go to
War
RTD /
Readiness
RTD /
MNR
MMRB /
MEB
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CONCLUSION
• 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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