How To Clinically Reason Each & Every Technique Or Rehab Exercise You Use Whatever Your Patient’s Injury
Posted By: Andy Barker
Then this blog is for you.
You know that once you have made a diagnosis and have identified your patients problems…
The next step is for you to fix these problems.
These problems might be a limitation with range of movement (ROM) at a particular joint, a lack strength or balance or something else.
Regardless of what problem or problems they have…
The sole job of your treatment plan is to fix these problems to help your patient get out of pain and improve their function.
But where do you start?
Which problems do you fix first?
How do you know when one problem is fixed and when to move on to the next one?
Regardless of whether you use hands-on treatments or rehab, or both…
This blog will help you understand how to tackle a patient’s treatment plan and know where to start with any patient, with any injury.
It’s all about your clinical reasoning…
Everything you do…
Whether you are using a treatment technique or prescribing a rehab exercise…
Should be trying to fix a problem.
That problem might differ for each patient.
It might be a loss of shoulder flexion or reduced hamstring strength.
The more specific you are with your treatments and rehab prescription the quicker and more successful your patient results will be.
Just throwing a random treatment technique or rehab exercise at a patient will get you random results.
Some patients will respond well, some patients symptoms won’t change and some might actually get worse.
This is the ‘kitchen sink’ approach.
The reason this happens and why it is so common with New Grad’s is the largely the result of a poor patient assessment…
Where you are not quite sure what to do…
So you do a bit of everything.
The most frustrating thing about this ‘kitchen sink’ approach is that it lacks any sort of clinical reasoning.
So even if your patient does respond well to your treatments or rehab, you don’t actually know what actually worked and improved their symptoms.
Because you did everything!
How to stop this ‘kitchen sink’ approach
To help you know where to start the key is clearly identifying what problem or problems you are trying to fix.
If you are just using treatment techniques or rehab exercises because you have used them before or just because you were taught to use this exercise for this type at problem at Uni…
Then is it any wonder you are not getting consistent positive patient results?
If you lack the understanding about exactly what you are trying to fix in the first place then you will always feel uncertain and maybe a little confused about where to start.
To stop this…
Be clear on what problems a patient has.
List them out in your notes and then make sure you can reason each intervention you are planning to use.
Whether that intervention is a treatment technique or rehab exercise…
Make sure you can clinically reason why it will help fix one of your patients identified problems.
Save time by being more specific
The ‘kitchen sink’ approach also leads to more work for you as a therapist.
Say your patient comes back for their next session and feels better.
Maybe you were able to improve ROM for their shoulder or knee injury.
Whilst your patient has been able to maintain most of the improvements you made in the last session you might want to spend a few minutes reusing some of these techniques given the success they had last time.
But where do you start?
If you used 5 or 6 different techniques and you don’t know which of those 5 or 6 techniques actually helped your patient…
What do you do?
In short, you have one of two choices…
1. Pick them at random and hope one of them works or…
2. Do them all again
You use treatment techniques or make your patient spend time on rehab exercises that are doing nothing to help their symptoms.
This is valuable time that could be spent on rehab and stop you rushing the end of each appointment…
Trying to cram your patients rehab and let them ask any questions, maybe re-book and take payment, all before the end of your session.
Can you justify what you are doing?
If you feel lost and not sure what to do next, your natural reaction is to just go back to what has worked for you in the past.
You will use that treatment technique or rehab exercise that worked with another patient…
Or maybe try to use a technique or exercise you have seen another therapist use on Instagram…
Even if you can’t justify why you are doing it.
Think back to your last 5 patients and the hands-on techniques or rehab exercises you used.
What were you trying to fix?
Were you trying to restore a particular ROM or action, or improve a specific muscle output or strength in a certain direction or target balance or proprioception…
Or were you just using a certain technique or exercise just because they have an ankle, knee or shoulder injury?
If you find yourself sometimes doing this…
Here’s what to do instead.
Firstly, do not be overwhelmed if you pick up more than one issue during your patient assessments.
Most patients will have more than one issue.
They might have a ROM and a strength problem.
They might struggle with a certain movement or position or need some advice to help them sleep better or sit better at work.
If they do have more than one problem…
Pick their biggest problem and treat this first.
Pick the one issue that is going to have the biggest impact on their symptoms and their day.
This will be individual to each patient.
A patient might tell you that their biggest issue is the back pain they get putting their socks and shoes on every morning (lumbar flexion).
But when you assess them you notice they have a limitation and apprehension to movement with not just lumbar flexion, but with lumbar extension and left side flexion.
This is 3 issues.
But whilst they have several movement issues…
You should pick lumbar flexion.
Because restoring lumbar flexion is going to help your patient be able to put their socks and shoes on more comfortably.
This was what they told you was their biggest issue.
This is simple but logical.
This is clinical reasoning.
Not only is this simple…
But it will help you focus on just ONE issue…
And stop you feeling overwhelmed trying to fix several issues at the same time.
Results get your patients on side.
If you are able to improve a patients symptoms, even just a little bit in that first session, then you will get their attention.
You have proved to them that you can change their symptoms or improve their function.
If you can do this then they will ’buy in’ to what you are saying and your treatment plan.
This ‘buy in’ means that they will listen to what you say and go away and do as you asked them.
They will go away and do their exercises.
This means when they come back for their next appointment they are much more likely to have kept the improvements you made in the session…
And are ready to kick on with the next step of their rehab.
Getting those early wins, is important.
If patients can’t see how you are going to help them they will quickly lose confidence in you.
They won’t do their home rehab and will make excuses as to why.
They may even question whether or not you might be able to help them.
This is particularly hard as a New Grad as you most probably look like a young and inexperienced therapist.
Maybe you look like the last therapist that wasn’t able to fix their last problem, like that neck pain, that is better, but is still there.
But if you can help them, if you can take away their pain and get them back to full health…
They won’t care if you are 5 months or 5 years out of Uni…
They just want to get back to the job, sports or hobbies they enjoy the most.
And if you can show them you can help them…
They will be all ears and a great patient to work with.
Save time and effort by avoiding the kitchen sink approach: Stop and think about any treatment or rehab exercise you plan on using, before you use it
Clinical reasoning: Can you reason what treatment technique or rehab exercise you are using?
Pick the biggest issue first: Use the information from your patients subjective assessment (aggravating factors) and your objective assessment to find their biggest issue, then treat this first
Just to finish off…
If you haven’t already head to my website to download my latest FREE CPD resource…
In this special resource you will also discover…
The #1 Reason Why New Grads Can’t Seem To Get The Right Diagnosis No Matter How Hard They Try!
Why You Should Never Trust People Who Tell You That The Shoulder Is ‘Complex’ And What You Should Do Instead
The Honest Truth About Getting Great Results With Shoulder Pain Patients And Why It Can Be So Much Easier Than You Ever Imagined!
And Much, Much More!
PS. Even though this resource focuses on the ‘shoulder,’ all the content included can be applied to ALL other joint assessments, treatments and rehab!
Get Your FREE COPY Right HERE.