The Orthopaedic Model of Care
Why are we so in love with the orthopaedic model of clinical management?
Are orthopaedic surgeons necessary? Absolutely.
Are orthopaedic physical therapists necessary? Most definitely.
Are most patient presentations in outpatient physical therapy, chiropractic, and massage clinics orthopaedic related? Perhaps.
But I would argue that this is based on the clinician's mindset and way of thinking.
Upon patient presentation, many clinicians perform their history and physical assessment and render an orthopaedic diagnosis. It is indeed important to reveal which structure is injured, if there is tissue damage, but I'd argue that this has the potential to become iatrogenic as well. We frequently "diagnose" tendinopathies, ligament sprains, and neuropathies and perhaps utilize a local approach successfully. But far too often, we become so enamoured with the tissues that we fail to see the true problem in front of us. The forest, if you will.
On some occasions, the bigger issue is a functional one as opposed to a structural one. Especially in acute, non-traumatic athletic injuries.
In other cases, the chronic ones for example, the problem often lies in a faulty representation of the body by the mind...even in athletic situations.
Now do I think local approaches are unnecessary? Of course not, sometimes we must facilitate anti-inflammation and symptom modulation. But I do think we should spend more time and attention into a central nervous system-centered and tissue sparing approach.
And finally, I believe an interactive and educational approach becomes paramount as well. I am not suggesting to disregard the orthopaedic model entirely, I just don't think this model of care is always appropriate.
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