Imagine this.

You go to see your doctor and before you even tell the doctor what has been going on…

The doctor just gives you some pills and shows you the door.

Hopefully this would never happen.

Clearly the doctor needs to ask you about what symptoms you have, how long you have felt unwell and other possible important information like any possible allergies…

Possibly even examine you…

Then prescribe you with the right medication or advice for your illness.

We would consider this as poor practice.

But as poor as this may be, many therapists do this very same thing day in and day out, with their patients!

You go through your assessment and even if you are unsure what the diagnosis is, you carry on regardless…

Prescribing rehab exercises or using treatment techniques you are comfortable with…

Techniques or rehab exercises that have worked well in the past with similar patients…

Or using some random exercises that seem to be popular this week on Instagram!

This is no different to that bad doctor.

You should never start treating your patient until you are clear about what you are actually trying to fix.

Here are 3 simple steps you can follow to ensure you don’t make this big mistake and ensure you can clinically reason any treatment technique or rehab exercise you use. 

#1 Set Expectations 

There seems to be confusion in the therapy world about the aim of the initial assessment. 

The main aim of your initial assessment is to…

1. Identify what problem or problems you patient has…

2. Identify their end of goal of treatment and…

3. Outline a treatment plan to your patient, showing them how you are going to get them from injury, and back to full health.

That’s it.

Only when you have done these 3 things would you then start to consider your treatments and rehab.

Often if you do a thorough job of the above or with more complex cases, you may not even get time for treatment and rehab in that first session. 

And that’s cool.

If you have time for treatment and rehab in the initial assessment…great…

But this should never be at the expense of a rushed patient assessment.

If you miss important information in the assessment, you might not pick up something sinister that you might need to refer on, or diagnose the wrong thing, causing you to start treating the wrong problem.

Failure to miss something sinister is clearly important as these patients may need referring on. 

Failure to treat the right problem may mean your patient does get better. 

Patients want to get fixed…usually quickly and without flare ups and re-injury.

This might seem pretty obvious.

But first they need to understand what problems they have got and what is causing their symptoms.

Whilst you might think you are delivering a better service by including treatment and rehab in your first session you are not if you are sacrificing precious assessment time to do this.

The long and short of it is…

If you do a poor assessment…

There is a much higher chance you identify the wrong patient problems.

This results in a waste of time, effort and energy for you, and your patient, on the wrong issues.

With any initial assessment you need to make it clear to your patient at the start of the session what the aim of the session is.

This might sound something like this…

‘The aim of this session is to find out about about you and your injury, identify your problem and for us to devise a treatment plan that is going to help you get back to the activities that your current injury is stopping you from doing.’ 

#2 Don’t Rush

If you have set expectations about the main focus of your initial assessment that should put less you pressure on not to rush your assessments.

The subjective assessment comes at the start for a very good reason.

It informs what you do next and in particular what you will test in your objective assessment, particularly your special testing.

Get this wrong and then it could send you down the wrong path, trying to look for issues in the objective that do not need addressing.

If at any point during the subjective you are unsure about what your patient is trying to describe, stop.

Don’t make the mistake of just carrying on and never be worried about repeating questions or asking patients to clarify certain things.

If something does not add up and what your patient reports does not make clinical sense in your head…

If your patients answers seem a little different to what you might expect given the rest of their assessment…

Then there is probably good reason why.

You need to make sure your patient’s injury story makes sense and doesn’t have any gaps.

Ensure you take a full subjective history, including a proper past medical history and be clear about the exact end goal you are trying to achieve with your patient.

Only when you have this information and only then…

Should you progress to your objective assessment. 

#3 Find Problems Not A Diagnosis

Even with the best assessment in the world, there will be times where finding a specific injury or structure is almost impossible to diagnosis.

9 times out of 10 this does not matter.

Providing you have not rushed, you should come to the end of your patient assessment, having ruled out any possible sinister problems…

And have a list of problems you intend to fix.

These problems are not the diagnosis.

These problems are the issues your patient has that are giving them pain or impacting their function, or both.

It is really important to remember that whilst you should always try to identify a diagnosis, this may not always possible.

As a therapists you do not treat a patients diagnosis…

You treat their symptoms, like a loss of ROM, strength, instability, balance, proprioception, poor movement or pain.

A great assessment, with or without a diagnosis, will give you the information you need.

It will give you a list of problems.

Prioritise these problems…

Then get to work with your treatment plan to fix them.

Hope this helps

Andy

PS. If you get your assessments wrong, not only could you miss something sinister but you could end up wasting your time, effort and energy (and your patients) on the wrong thing!

If this sounds like you…

Then let’s jump on a call.

I’ll walk you through how to structure a super simple but structured assessment so you feel well prepared and confident for any patient that walks through the door.

I’ll tell you the exact same questions and tests I use with every assessment I do, whether I am working with a professional athlete or a member of the general public.

Want to learn more?

Book a call right here.