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
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 4
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 7
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 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 Go to War RPRT COMPLETE RTD / Readiness RTD / MNR MMRB / MEB 9
RESTORATIVE PRT PROGRAM CONCEPT Participants: Soldiers On Current Physical Limitation Profile Pre operative orthopedic Soldiers Post operative Soldiers IAW prescribed profile Pregnancy profile Soldiers 10
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 12
PROGRAM BASICS Swelling management Restore range of motion Strength training Reconditioning Protect from further injury 13
FOCUS GROUPS Ankle sprains Knee injuries Back pain/injuries Upper extremity injuries General de conditioned Overweight Orthopedic pre/post operative Pre/post partum pregnancy 14
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 15
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 16
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 17
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 18
THE PROGRAM Interval Training (HIT) Warm Up (Preparation Phase) Body weight resistance (Movement Phase) Flexibility enhancement (Recovery Phase) 19
THE WARM UP 5 8 minutes Jog in place 2 3 min Half Jacks Side to side knee lifts Front Kicks Shuffle Kicks Power Knees 20
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 BODY WEIGHT RESISTANCE INTERVAL TRAINING 40 sec 20 sec x 3 intervals (36 38 MINUTES) 21
FLEXIBILITY ENHANCEMENT 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 (13 15 MINUTES) 22
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) 23
SUCCESSES Fort Gordon IOP 65 th 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 24
THE FUTURE Medically Ready GAPS Is PRT working? Who is training our Soldiers? Medically Not Ready How long before SM is seen for acute MSE? Is Medical Readiness accurately communicated? Pre/Post deployment continuity issues with wellness WHO HOW BENEFIT 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
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 Go to War RTD / Readiness RPRT COMPLETE RTD / MNR MMRB / MEB 26
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. 27
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