Rehabilitating our perception of PT profiles
February 22, 2012
"Building the Soldier Athlete: Profile Physical Training Supplement
- An example page from the "Building the Soldier Athlete: Profile Physical Training Supplement," which suggests different exercises to benefits Soldiers with specific injuries.
FORT BLISS, Texas -- Soldiers suffering through an injury often deal with more than just physical pain; there are the frustrations of being unable to perform at their normal level and the stigmas surrounding the physical training profile. For some Soldiers, the stigma of being "broken" or "weak" is enough to prevent them from seeking treatment and hampers their recovery. In response, the Army has begun taking steps to rehabilitate the perception of the PT profile and create an easy-to-follow plan for reconditioning at the unit level.
"Positive profiling is trying to get away from the stigma of having the profile, our medical communication tool with the chain of command, saying things like 'dead man's profile,' which has a negative connotation," said Maj. Cyndi McLean, Officer in Charge of Fort Bliss Soldier Family Care Center Physical Therapy. McLean has more than 15 years of treating Soldiers for the Army and briefs during the Physical Readiness Training Leaders Course and the Commanders and First Sergeants Course here. "We want it to say things like 'patient can do this' and 'they shouldn't be doing A, but they can be doing B, instead.' If they have something wrong with their lower extremities, then we list a whole bunch of exercises they can do for their upper extremities. It lists a whole lot of things that they can do, rather than just what they can't do."
The first step in achieving this aim was to make the Department of the Army Form 3349, the physical profile form, accessible through Army Knowledge Online. The DA 3349 is an electronic form that allows medical providers more room to detail the types of exercises the Soldier is able to do, is easily modifiable, and encourages better communication with the parent unit's chain of command.
"The Soldier needs to be in the mindset of 'I can do these things,' and not 'I'm just completely broken and woe is me.' But instead maybe 'oh, I can't do this right now but there are other things I can do instead,'" said McLean.
A positive profile is the first part of successfully rehabilitating a Soldier, but it is relatively ineffective without a proper and structured system to address physical training while recovering from a medical injury. Until fairly recently, the Army offered little guidance to units on how to incorporate Soldiers with injuries into physical training; however, there is a supplement created by the Office of the Surgeon General entitled "Building the Soldier Athlete: Profile Physical Training Supplement," available to units online.
The supplement outlines a program which groups Soldiers together by the location of their injuries, lower extremities, upper extremities and lower back and by the state of their recovery, red, amber or green. For example, a Soldier who injured their knee and requires crutches would fall under the red lower extremity category. The supplement provides specific exercises this Soldier would be allowed to safely perform along with a proposed PT calendar the Soldier can follow.
Here at Fort Bliss, the 1st Brigade Combat Team, 1st Armored Division, has incorporated the supplement guidance and a number of best practices to create a battalion-level profile PT system. A noncommissioned officer is assigned to a specific group of Soldiers in the same injury and recovery category. The NCO leading profile PT follows a structured calendar to ensure the Soldiers are acting within the guidance of the medical professionals and remaining fit during recovery.
"The system puts these Soldiers in a profile PT program with Soldiers they know, NCOs they trust, keeps them involved at the unit level and keeps their morale up. So they see, 'hey, look, there's Smith and he has an ankle injury too and we are all rehabbing together. My ankle is getting better and I'll be back down at my company level soon,'" said Maj. Jason Silvernail, 1st BCT, 1st AD, physical therapist.
Silvernail said the program empowers the NCO, who might have felt uncertain about which exercises were appropriate for profile Soldiers in the past, to fulfill their role of developing Soldiers and returning them to the fight. When used in conjunction with PRT, Silvernail hopes it will reduce musculoskeletal injuries caused by training errors. The most common PT training errors result in overuse injuries, or as Silvernail describes it, "too much, too fast, too hard."
Another widespread hindrance to treatment is the delayed reporting of injuries. It is much easier to treat an acute injury than a chronic injury, but Soldiers are reluctant to seek treatment due to fear of peer judgment and their own desire to push through the pain to finish the mission. Silvernail suggests the answer is instilling in Soldiers the idea of being a professional athlete.
"Hey, athletes sometimes get hurt. When a professional athlete is hurt, they don't ignore it. If something hurts and isn't working well, that's going to affect their performance on their team, and they owe it to their teammates to get that checked out," said Silvernail, a 20-year Army veteran. "If we put them out in the field, operating equipment, driving vehicles, carrying weapons with live rounds, and they have something, physically, they cannot functionally do and they are trying to hide that -- it might create a problem."
Leadership involvement is pivotal in getting Soldiers to seek treatment quicker, and faster treatment equals faster return to duty. Systems are in place to ensure Soldiers can get treatment for acute injuries. On East Fort Bliss, a Soldier with an acute injury can be scheduled to see a physical therapist the very same day once they are checked out by their primary care provider. On Fort Bliss main post, physical therapists are making themselves available to battalion level sick calls to instantly identify injuries which require additional treatment.
"A lot of Soldiers are just shuffled through Basic Combat Training and Advanced Individual Training, and they are trying to hide their injuries and wait until they get to their duty station, but by the time I see them, they have a hip fracture," said Cpt. Alexandra Hickman, Officer in Charge of Soldier Family Medical Clinic Physical Therapy. Hickman has treated Soldiers for more than nine years.
She recommends any Soldier who is having unexplainable pain, a reduced ability to perform their job or their daily life functions, seek treatment. It is never better to wait it out or "suck it up."
Like everything else in the military, treating an injury requires teamwork and dedication. Soldiers should take an active interest in their recovery and make sure their chain of command is kept up to date on their profile information.
"Let's be proactive. If there is an issue or a question, I encourage the unit to contact me, and I am happy to answer their questions because that is a signal to me their chain of command really cares about the Soldier," said McLean.
To access the "Building the Soldier Athlete: Profile Physical Training Supplement" go to http://www.amedd.army.mil/prr/brigade.html.