The Importance of Staying Non-Weight Bearing After Surgery
No acronym strikes as much anxiety into the heart of an orthopedic patient like N.W.B. or Non-Weight Bearing. N.W.B. refers to the restriction an orthopedic surgeon places on a patient following surgery. But why do orthopedic surgeons torture their patients with the temporary commandment: thou shalt not set thy foot on the floor?
It comes down to one very simple reason, tissue healing. A variety of tissues benefit from limiting the stress of weight bearing during the healing period.&Wounds heal better when they are not stressed by walking. Studies show that patients can benefit greatly by avoiding early weight bearing&after &surgery, one of the most difficult areas to heal.
Most commonly, surgeons limit weight bearing following fracture repair or . In these surgeries bone surfaces are squeezed together tightly and held in proper alignment. Once the first cast/splint is placed and the surgeon leaves the OR to talk to the family,&the race is on. Will the bones heal or will the metal used to hold the bones in place break first?&Many factors can be adjusted by the surgeon, including:
Titanium or Stainless Steel Screws
Multiple Plate and Screw Formations
Locking Screws
Minimally Invasive Placement
Bone Graft
Bone Stimulators
The choices are extensive. But, the most powerful thing that helps healing is a cooperative patient.
The action of placing the foot on the ground creates a variety of forces going in different directions: UP, DOWN, RIGHT, LEFT, FORWARD, BACKWARD, AND ROTATIONAL. These forces stress a newly fixed interface. If the interface is excessively stressed, the hardware can fail or the bone can break around the hardware. This causes the bones to lose alignment and the formation of a malunion (bones healing in the wrong place). Sometimes, the bones don't heal at all. If there is too much motion, the body&misinterprets&the forces and instead of healing with bone it heals the interface with joint-like characteristics. This is known as a nonunion. In either condition, malunion or nonunion, the race is over and the patient and the surgeon have lost.
As a surgeon, my goal is to find surgical techniques and instrumentation that not only allow early weight bearing, but benefit from controlled protected weight bearing. Examples include correction of &with stable bone cuts that heal faster with walking, and ankle fracture repair with&minimally&invasive and specialized plating techniques that neutralize the weight bearing forces. Regardless of skill, some surgeries cannot be best performed without limiting weight bearing. , Osteoarticular transplantation surgery (otherwise known as cartilage restoration), and Total&Ankle Replacement are some examples.
When I have to resort to non-weight bearing, I encourage the patient to partner with me in the healing process.&I explain why it is essential to avoid walking on their foot and I am always looking to find ways of making it easier to survive those weeks of N.W.B. Crutches and walkers can only get you so far and wheelchairs are very limiting.
are a great alternative option. They give the patient much more freedom and ease of movement when they are forced to keep weight off a healing foot. &
It is true that some patients are their own&(namely those who don't follow their doctor’s orders). However, a patient armed with knowledge is always more likely to be an ally in the Amazing Healing Race.&
Dr. Lance Silverman is an orthopedic specialist and founder of . Dr. Silverman is an accomplished orthopedic surgeon. He received his medical degree from Baylor College of Medicine in 1996 and is a board-certified member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society.
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New ModuleAdd content here.I think this is one of the most important issues in education today, and one that needs to be talked about.
As the new school year is beginning, it is critical to have good classroom management.
Classroom Dojo is not that.
Before I begin, I admit that I have never used Classroom Dojo.
I understand that that does not make me an expert.
But I never will.
Here is why:
Classroom Dojo offers a system where students’ behavior can be monitored throughout the day. Teachers can use an ipad, Smartphone, or computer and continuously adjust a student’s behavior points.
If someone is off task, the teacher can take points away.
If they begin to focus, they get points and move up.
By the end of the day, in theory, you have a measure of how good (or bad) the student’s behavior was.
The students’ points can be projected on to an interactive whiteboard, so students can actually see how they are being rated – judged – at any given time.
And all the other students can see everyone as well.
First, public displays of student behavior is nothing more than public shaming.
All children in the classroom are aware of what is going on – the kids know when someone is not behaving well.
However, by using a public symbol, whether it be a color card, a stop light, a clip, or a Dojo monster with points, it becomes a public display.
It also becomes a conversation at home around the dinner table.
“Johnny was on red today.
Abby lost points today.”
There is ample evidence that public shaming is not motivating, and does not encourage long term change.
Imagine: Ben is sitting at his desk, working on writing.
His neighbor pokes him and does an arm pit fart, and both kids laugh.
Then the teacher moves both of their points down.
Kayla is frustrated with her reading, and puts her head down on her desk, and her points go down.
A whole group of kids are playing at the sink and making soap castles, so the teacher moves the class points down.
ZAP, ZAP, ZAP. No doubt some kids straighten up with the zaps.
If someone were tasing me, I sure would.
But I wouldn’t like that person very much.
And I wouldn’t want to go back.
And I would spend a whole lot of time thinking about how not to get zapped, rather than my reading, writing, science, and math work.
Just don’t zap me again.
This is an excerpt from one of the testimonials on the Class Dojo website: “If the class is getting a little noisy, or if a group of students are getting off task, I just start handing out some positive and negative points, and sure enough students refocus and get right back to work.”
Basically, I just start zapping the kids, and they get back to work.
I want you to think about what a system like Classroom Dojo is really doing to students’ focus and engagement.
If you are a kid that is generally a hard working, motivated learner, you now become a hard working, motivated “behavor.”
Your attention is continuously being drawn away from your work to notice how you are doing on your points, or how someone else is doing.
Even if the points are not being changed regularly, your attention is now divided.
I would have been one of those kids.
I would have been very concerned about ensuring that my points stayed where I wanted them, and I would have been checking often to see how I was doing – pulling my thinking and attention away from learning.
If you are a child who is usually on task and doing well, but sometimes slips up, your mistakes are now made BIGGER.
Your occasional goof ups become public errors, and they suddenly become a much bigger deal.
If you are a child that is often getting into trouble, your troubles are there for everyone to see.
You get a continuous reminder of your failures.
Everyone has bad days sometimes.
Let’s imagine that it is not your best day, or worse, it is a terrible day. Everything seems to be going wrong.
We all have those experiences.
If you are in a classroom where that is understood, and your teacher and peers accept you with an attitude of forgiveness and a fresh start, your next day can be good.
You know you can go back to school and try again.
However, if you are in a classroom where your failures are publicly displayed, you are likely to return to school anxious.
You are embarrassed and fearful of having the same bad day again.
I know that if my mistakes were shown for all to see, I would try to fake sick before going back to school.
The bigger issue here is the issue of reward and punishment systems.
ClassDojo is just a smart business idea that picked up on a trend in teaching.
It is certainly not the only example of this type of system.
It is true that reward and punishment systems work quickly.
You will often see fast results, and kids will get on track.
The problem is, the good behavior is short term, or is completely dependent upon a continued reward. Students begin to concentrate more on the reward than anything else, and if the reward is removed, the behavior goes back to what it was before – or worse.
Rewards and punishments actually trigger activity in the addiction center of the brain. Think about that for a minute – we are encouraging our kids to become addicted to reward – praise, stickers, candy, class parties, etc.
This does not build self motivated learners.
It builds addicts.
One thing that I often hear when discussing the topic is the issue of pay.
“You get paid for your job, don’t you?
You wouldn’t do it for free?
What is the difference with rewarding children?”
Yes, I do get paid for my job.
I would get paid exactly the same amount for my job if I did not stay up late working on lesson plans, or if I did not research and read articles on how to improve my practice.
I would get paid the same amount even if I did not go to the store to pick up materials for my class, spending my own money on the supplies.
I would get paid the same amount if I used worksheets instead of interactive lessons, or if I simply didn’t go the extra mile.
But I do those things.
Not because of any sort of monetary compensation.
I do those things because I believe they are the right thing to do.
I do those things because I am self motivated to be the best teacher I know how to be, and to continuously work to improve.
Reward and money aren’t motivating me to go the extra mile.
An internal drive is.
I want to build that internal drive in our students.
Another thing I hear is, “My students love Class Dojo (insert other system here.)”
However, when they get down to what about it the kids love, the argument breaks down.
They love the avatars.
Great – use
and give them avatars there to encourage reading.
Don’t use Dojo just because of the cute monsters.
They love the rewards.
Well who wouldn’t?
We all love candy.
But again, rewards don’t build learners.
They love what their parents say.
Aka, they love praise.
Of course they do.
But we need to be careful about using praise as a reward.
And of course, not all the kids love what their parents say…
I don’t want to criticize a method without offering anything as a solution, so here we go.
I think the most important thing a teacher can do is build relationships with their students, and build a classroom community where respect and contributions are valued and expected.
I think we need to use careful language with students that encourages positive behavior and builds identities for students as contributing members of the class.
I think we need to teach students that feelings, good and bad, are normal and ok. They can handle these feelings appropriately and safely, and they can set goals to improve.
Here are a few suggestions for things to read that offer ideas and alternatives to reward and punishment systems.
First, here are some other bloggers talking about this same thing:
Next, here are some excellent books that get very in depth in discussing the research and application of teaching with “systems”:
Conscious Discipline by Dr. Becky Bailey
Choice Words by Peter Johnston
Finally, here are some of my previous posts that offer other angles on this topic, including ideas for alternatives:
Teaching without tricks, or virtual tasers, or marbles in a jar, or color cards, is harder.
It takes longer.
It is not easy.
But teachers are up to the job.
Building children that are self motivated, that do the right thing simply because it is the right thing, and that treat others with patience and respect is a long, complicated job.
So let’s start doing it properly, because they are worth it.
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