In the clinical rehab world, many characteristics have to be considered in the course of care for every patient:

  • injury
  • structure
  • nutritional status
  • sleep status
  • motivation
  • physician restrictions
  • motivation
  • attitude
  • ROM
  • strength
  • effusion
  • pain
  • tissue health
  • CNS status
  • access to patient
  • and many, many more

But, the #1 consideration in all cases must always be the same

…unrelenting time!

Out of all the characteristics that are considered, only one has no way of being mitigated through skill, technology, sheer willpower, perseverance, or violence of action.  Everything else can be accommodated for or worked around. Everything but Time.  

To clear up the misconceptions that come to mind, this is NOT an endorsement of time-based protocols or treatment approaches.  In fact, is the exact opposite of that.  In this instance, time must be considered not as the determining factor of what exercises must be done (Week 2- begin strengthening, light jogging, plyometrics) but as a general guide to what is unfolding physiologically in regard to tissue healing.  

One cannot be surprised by the cascade of events that unfold at the cellular level following tissue trauma (injury/surgery).  That process has been well established.  It is expected that as a professional, one should be acutely aware of how the skilled care they provide should leverage what is occurring physiologically in order to maximize efficiency and effectiveness.  

The cascades that all types of tissues in the body follow as they heal are well established.  With this knowledge comes the understanding that there are finite windows of opportunity/time in which certain physiological functions are prioritized.  Once these windows of opportunity close, one’s ability to influence what occurred during that window is at best inefficient and ineffective.  At worst, it is a complete waste of time and energy.  Even an entry level clinician understands that it is significantly easier to limit how much effusion develops in the first 72 hours after an injury/trauma/surgery (an ounce of prevention…) than it is to try and treat a grossly effused joint 7-10 days after injury/trauma/surgery (…is worth a pound of cure.)  

Additionally, it is much more tolerable and empathetic for the patient.  

When everything is a priority, nothing is a priority.  

In this case, that cannot be the case.  Those clinicians that do not keep time at the forefront of their thought-process when treating patients will ALWAYS be behind schedule, but will likely not be able to see it. What they will see (but not recognize but not understand) is:

  • Pain will extend beyond what is typical.
  • ROM will be lagging expectations.
  • Strength levels will be behind. 
  • Effusion will be prolonged.
  • Return to activity will be delayed.
  • Visits will run out.

In short, clinical goals will be missed and patient goals will be missed.  Patients will have notations of “progressing slower than anticipated” in their chart. 

When that happens who is to blame?  

Why does there need to be blame? If you immediately became defensive or want to bring up the fact that patients are responsible for their outcomes (which there is some truth to) those are indicators.  The question I will leave you with to ponder is this – .

Who is the professional they came to to guide their care?  

While we should expect our patients to be actively engaged with their care and explain the importance of them taking ownership of their body, we are the ones that have the knowledge and education in EVERYTHING it will take to help them. If we expect them to take ownership we have to model that as well and take ownership of their outcomes.

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