Truth is you might never be sure you made the right diagnosis.

But you can almost always be 99.9% sure with the right assessment.

As long as you have a sound assessment structure, are safe, and can make a logical and reasoned decision, in the best interests of your patient or athlete, then you will always be able make the right call.

This sounds easy…

But it’s not!

It can be tough and you might doubt yourself that you made the right call.

Maybe you cover a sports game and a player goes done clutching his knee, but settles quickly, you assess him on the pitch and clear him to carry on, but is he ok?

His mechanism looked awkward and the coach keeps asking you if he is ok, as he keep rubbing his knee at any break in play.

Or maybe you have a patient in clinic that asks you direct ‘tricky’ question like…

‘’How long until I can get back squatting in the gym?’’ or

‘’When do you think I’ll be able to get back to work?’’ or

‘’Will this problem ever go away?’’

The type of question you hope that your patient never asks, but they always do.

Everything inside you is telling you to give them good news…

‘’You will be fine in a few sessions’’

‘’Course you will, we will get rid of this problem in no time.’’

You want to be the bearer of good news.

This is normal because you want to be positive and you genuinely want to help.

But you need to think about how you respond to these types of questions before you speak.

When you have seen a lot of patients or athletes these kind of questions become easier as you can talk about similar injuries you have managed before.

You can use those previous cases as a ‘yard-stick’ to help you give a more accurate prognosis to the athlete or patient in front of you.

But if you are relatively inexperienced therapists then you will not have that luxury.

But even so, even if you have seen loads of this type of injury before, whether your 1 year or 10 years out if Uni, a better way to respond to these types of difficult questions is always to talk to a patient or athlete about the steps needed to get back to full fitness and not focus on the time-frame.

I know this is hard as you will often get asked directly those tricky questions like…

‘’How long will it be until…’’

If you work in sport, or want to work in sport this is your bread and butter.

An injury happens and the first question is…

‘’What is it?’’

Followed quickly by…

’’When will I be back playing?’’

Sometimes these conversations are happening at half-time, in the changing rooms, sometimes even at the side of the pitch!

It could be the player, his teammate, the head coach, the press guy…

Everyman and his dog wants to know what is going on and it’s on you to tell them.

The biggest tip I could give you is to not make a call if you are not sure and certainly do not make promises you might not be able to keep.

If you tell a patient it will be 4 sessions until they will be back in the gym or tell a player they’ll only miss a couple of games, then you best be 100% sure you are right!

Patients and athletes will remember everything you tell them.

If your player is 3 weeks into a 4 week lay off, then at the 3 week mark you start telling them it’s going to be another 2-3 weeks until their back, you’ve lost them. 

They will say you got it wrong, and rightly so, because you did…

Or they might think your rehab and treatments have not been good enough to get them back.

They might question your skills and expertise, and you know that if an athlete or patient loses faith in you and your rehab plan it can be hard, sometimes impossible, to get them back on board.

This might all happen because you felt pressured to give a diagnosis or time-frame in the heat of the moment, or were trying to please a patient in your clinic.

Trying to be positive or trying to please your patient or athlete, has done the exact opposite and actually made your job to get them back to full fitness much more difficult. 

To stop this happening it is always better to talk in terms of steps rather than time where possible.

I got asked a ‘difficult’ question by a patient in my private clinic just last week.

He’s a professional rugby player that has been struggling with some patella tendon pain that the club physio’s have not been able to get on top of.

We went through his assessment and it presented like a relatively simple patella tendon case.

He’d been doing all the isometrics and eccentrics, even some heavy slow resistance training, all the protocols that the evidence says is best, but the problem was not actually his knee.

Yes, of course he had knee pain and his patella tendon was angry, but it was secondary to a poor recruitment pattern of his glutes and hamstrings.

In short, his quads were overworking, because his glutes and hamstrings were underworking.

As the quads insert into the knee, via the patella tendon, and given the quads were doing more work than we would like them to do, was it any wonder he was struggling with patella tendon pain?

The rehab he was doing was actually making him worse, as was loading the quads even more.

But before we got into his treatment and rehab in the first session, he asked me…

‘’So Andy, when will I be back running?’’

My response…

‘’Based on your assessment and what is going on, injuries like this usually take between 4-6 weeks to fix up…

What we first need to fix up is getting your knee moving pain-free, getting your full range of movement back…

And get your hamstring and glute doing more of the work.

These are the 6 steps we need to progress through to get you back to where you need to be, back running and back on the rugby pitch.

The more time and effort you put into your rehab the faster you will get there…

I said 4-6 weeks as a rough guide but if you hammer your rehab we could knock some time off for sure…

Does that make sense?’’

His reply…

‘Yes, 100%. What do you need me to do?’’

This sort of response gave him what he thought he needed, a time-frame.

But it also gave him what he actually needed, a plan.

A time-scale is not a plan, it is just telling you how long…

And a time-scale misses the important bit as to HOW you are going to get them back to their desired goal.

The HOW is your treatment plan, the steps you will go through to get you from A to B, from injury to full fitness.

Showing your patient or athlete the plan is key as it shows them exactly what they need to do to get back to full fitness.

Just giving a time-frame, some patients and athletes will just assume it is ‘time’ they need to heal and get better…

And if that is the case then you might struggle to keep your patients on board with their rehab as they wrongly assume it is the days, weeks or months of time you gave and not your rehab that will fix them up.

Show them how, and like my patient they will have complete clarity about what they need to do and will go away and do every rep of every set you prescribe…

I’d given him a goal to hit 45 seconds for a simple glute and hamstring isometric exercise, before his next session 7 days later.

3 days after his first session he had already nailed it.

Managing these difficult questions does not need to be hard.

If you have strong assessment structure, and can plan a simple, logical and progressive rehab plan, you will always make be confident you have made the right call.

Whether you work in a hospital, clinic or sports club you will get asked these same ‘tricky’ questions all the time.

To deal with them properly you need to have full confidence in your assessment skills to nail your diagnosis and have conviction in your rehab planning and decision making to be able explain and guide a patient to athlete through a full treatment plan, from start to finish!

I’ll be going into the topic of managing difficult questions from players and coaches in more depth, plus a whole lot more, in my next FREE webinar…

’Pitch-Side Trauma – Avoiding Mistakes To Keep You & Your Athletes Safe’

It’s live on Wednesday 12th May 2021 at 19:00 (UK Time)

On this webinar you will also discover…

• If You Should Even Be Covering Sports Games As A ‘Physio’ & What These Means In Terms Of Your Insurance & A Possible Law-Suit (99% of Therapists Do Not Know This)
• The #1 Thing You MUST Do Before Covering ANY Game To Keep You & Your Athletes As Safe In The Event of A Serious Injury
• What Medical Kit Is Mandatory & Why This Is A Must For Any Pitch-Side Therapist, At Any Level of Sport
• How To Complete A Quick On-Field Assessment, Rule Out Any Serious Injury & Be Confident You Have Made The Right Call
• Plus I’ll Be Holding A LIVE Q & A Session To Answer Any Questions At The End

Register your free place here.

See you there,

Andy

P.S. There are not many seats left for this one-off webinar and with most of my events often filling up to capacity, do not wait around to secure your place.

Do it right now by clicking here.