The Fitch-O'Reilly Protocol
Our philosophy and treatment protocol for spinal instability be it neck or back is, we believe, to be superior in every way to the philosophy and treatment of our competitors, whether physical therapists, chiropractors or whomever. Rather than just treating the symptoms, we strive to treat the origin of the problem. The supporting muscles of the spine require endurance or slow twitch strength. Hence, that is the way we treat them. If postural creep is a problem then we address it. If ergonomics are a problem, then we address that as well. Unlike most of our competitors, we don't just guess at important objective measurements such as range of motion and strength. We actually measure them.Our treatment protocol follows the 10 principles outlined below:
1) Stability before mobility: Chiropractors manipulate, physical therapists stretch, and medical doctors prescribe muscle relaxors. It is our view at PPT that all 3 may be wrong with respect to spinal instability. Manipulation may further the instability, indiscriminate stretching may do the same. Muscle relaxors impede the only support the patient has left. At PPT, we endeavor to strengthen the surrounding musculature to help support the spine and stop aberrant motion as our first priority.
2) Stop Creep: Poor postural habits are identified and addressed early on. Realizing that creep did not occur over a short time, it is not expected to resolve over a short time. The initial goal is to stop its progression and then subsequently reverse what we can over time. We first establish a baseline of individual postures by taking a lateral view picture. From the picture, we measure approximate spinal curves. Published normative values vary, but here at PPT we use 30 degrees as normal for all curves. Our method of measurement is not an exact science such as from radiographs, so we utilize pre and post rehabilitation pictures to verify our findings.
For more information on posture, click here.
3) Discriminate Stretching Only: It is the view of PPT that indiscriminate stretching of the cervical spine or anywhere in the spine for that matter is contraindicated and may exacerbate an instability. We do, however recognize that stretching is a valuable and essential tool in spinal rehabilitation. It is absolutely necessary that only shortened tissues that interfere with normal movement be stretched. Careful here. Therapists frequently mistake muscle guarding for muscle tightness. They are not the same. In the case of whiplash, the guarding is an effort of the musculature to stabilize the spine. In effect, the neck is 'too loose', yet many, even most PT's elect to stretch this. We at PPT believe this to be ABSOLUTELY WRONG and we trust that none of our therapists will practice this.
4) Manual Therapy (myofacial release and discriminate joint mobilization): These manual therapy techniques can be very helpful in improving posture and spinal function, but just as in stretching below, care must be taken to ensure that mobilization is used only in areas of tightness.
5) SlowTwitch over Fast twitch: It is our belief that many of the exercises used by our colleagues in physical therapy are appropriate, but often are not applied optimally and are of limited use as such. Where we differ is that we utilize these exercises in a sustained contraction format in an effort to strengthen the more functional slow twitch properties of associated musculature.
6) Technology: Unlike most of our competitors, we at Progressive Physical Therapy don't just guess at important objective measurements such as Range of Motion (ROM), strength and posture. We actually measure them. In order to accurately measure these variables, we utilize the most advanced technology available. Currently, we use the MCU or Multi-Cervical Unit for the neck and the Monitored Rehab Systems Back Extension machine and the BTE Vector for the low back. This technology is valuable for assessing range of motion and strength. It is also useful for isometrically and isotonically exercising spinal musculature. Additionally, the technology does an excellent job identifying the specific areas of tightness which need stretch.
7) Modalities as needed: We at PPT do utilize and recommend the use of various modalities for both palliative and restorative purposes during rehabilitation. These modalities include, but are not limited to various kinds of electrical stimulation, ultrasound, dry stick injection, heat , ice, phonophoresis, and inotophoresis. Many modern physical therapists especially those with manual therapy certifications such as mine, (IOC) vilify their use. We at PPT could not disagree more. We continue to believe that modalities are a valuable tool in the rehabilitation of the spine.
8) Ergonomics: Patients are taught basic ergonomic principles and how to implement these concepts to save their backs from unnecessary wear and tear. The 'Back Saver' chair was invented and patented by myself, Barry E. Fitch, DPT and is an extremely useful tool is preventing and even reversing postural creep.
9) Follow-up: After successful rehabilitation, patients with progressive spinal deterioration are encouraged to schedule with their physical therapist for a recheck every 6 months for 3 years. This is much like routine preventative care at the dentist and is felt to be necessary to monitor the condition of the spine and to proactively adjust a patient's home program as indicated.
10) Research: We at Progressive Physical Therapy realize that research is often a Catch 22 situation. That is to say that most researchers are poor clinicians and conversely, most clinicians are poor researchers. Therefore, much of the available published research has limited practical use. At PPT we are continually involved in in-house clinical research which is implemented by seasoned clinicians with consultation of qualified researchers. Much of this research is in the form of tracking outcomes of treatment interventions to verify the efficacy of our treatment protocols and methods. Results of this research are used as a feedback mechanism to improve our treatment methods and outcomes.
Our spinal stabilization program generally runs from 6 to 12 weeks (18-36 treatments).