Cookie Cutter Protocols

Hello Everybody!

I’d like to discuss one basic treatment philosophy today; cookie cutter protocols. What role, if any, do they play in our treatments? I’ll start by saying in an ideal setting I would prefer to assess every athlete’s health and quality of movement then address not only the injured tissue but any imbalances they may have as means of injury prevention. Unfortunately this is rarely feasible due to time constraints as I’m sure many of you can relate. It’s my impression that cookie cutter protocols often get a bad reputation as being unspecific and impersonal, but is there some sense to using them?

First let’s get on the same page and define what a “cookie cutter” protocol looks like. I consider a cookie cutter protocol to be a “one size fits all” type of rehab. It doesn’t matter what sport/position you play, if you suffer a lateral ankle sprain you will complete exercises XYZ over the next 2-4 weeks. Second, we should make a distinction between macro-protocols and micro-protocols. I would consider a macro-protocol to be something like a post-surgical procedure that spans weeks to months. A micro-protocol would be the exact exercises you prescribe a patient for today or tomorrow.

Given those descriptions I think I have opened up my first observation, most post-op protocols would fall into the category of cookie cutter. Post-op protocols are always based on the science available relating to the injury/surgery performed, meaning if the research somehow showed that ACL repairs required 10 months of non-weight bearing in order to heal, then our protocols would demand 10 months of non-weight bearing (thank goodness this isn’t the case). However post-op protocols can change, this is generally dependent on the progress made by the patient and the opinion of the surgeon. I think in this application, cookie cutter protocols are necessary because 1) they are based on relevant science and 2) even if the patient progresses safely and quickly, we need an “average protocol” to refer and compare.

Now let’s consider micro-protocols. If we think of exercise and rehab as a science experiment, it is vital to limit as many variables as possible to ensure that our interventions have a direct correlation to our results. If we consistently change rehab exercises it would be difficult to observe cause and effect, thus making it harder to identify the specific treatments or exercises that have the greatest impact. Plus it is easy and satisfying to just simply hand out a single protocol to a patient both in clinic and as a home exercise program without having to make alterations.

I wanted to focus more on how cookie cutter protocols can fit into modern practice because I think this is the less popular view. However, they tend to be less specific and less sensitive from one patient to another. Also, they often focus on one body part/injury and often leave out the opposite limb or other limitations the patient might have.

What are your thoughts? Do we use cookie cutter protocols too much? Not enough? Do they still have a place in current treatment models?

More next time,

Mark D.

@MarkDomATC