I am just as guilty of these mistakes as anyone else, as long as you learn from your mistakes, you are gaining valuable experience.
1) Using a high threshold strategy when a low threshold strategy would work better
- as a review, check out this excellent post via Dr. Aaron Swanson on high vs low threshold strategies
- I understand why people choose certain exercises like bird dogs, side planks, Y's and T's, but when the patient is holding their breath, recruiting unnecessary muscle groups, and overall using an inefficient movement strategy, it's probably not the right exercise at that moment
- this is why it's imperative to have 1:1 sessions not only for manual therapy, but for exercise as well
- bottom line: if you are prescribing a certain exercise for stability, and it does not improve rapidly, try regressing it
2) Not changing it up enough
- regardless of your intervention strategy (OMPT, repeated loading, corrective exercise), you should see rapid improvements within 2 visits
- if not, first make sure the patient is being compliant with their HEP
- if they are, change up your strategy
3) Changing it up too quickly
- if your patient walks out feeling and moving better, the intervention you chose is useful as a neurophysiologic reset
- it's what they are doing in between visits that is causing preventing the improvements from sticking
- if they are compliant with HEP frequency, intensity, duration then it may be one or many factors they are doing to negate their own reset
- prolonged sitting, not enough movement in general
- movements that are opposite the directional preference
- poor sleep, diet, smoking, etc
4) Assuming a majority of your caseload can get to 100%
- is 100% pain free movement and function needed for ADLs? - no, but everyone wants it
- there are many reasons why patients may not get to 100% pain free
- beliefs, lifestyle, overall health, overbreathing
- some patients who come in with debilitating 10/10 are often happy with 1-2/10 pain that occurs only on occasion, if you have given it your best and it's been 4-6 weeks of treatment, it becomes increasingly unlikely you are going to make another milestone after that timeframe
- sometimes they need a referral out to a different practitioner within the same discipline or a completely different one
- sometimes they just need more time
5) Throwing too many interventions into 1 treatment session
- a question I will often get looks like this
- I have a patient with calf pain when running, and I have tried
- dry needling, IASTM, phonophoresis, estim, calf stretching, kinesiotaping for x visits with no change
- first of all, you most likely have to look a above and below, at the patients movement strategies or training (training exceeding capacity)
- but more importantly, if it was indeed a true local problem only, I would just choose maybe a little light IASTM, followed by some WB functional mobilization which would be the same repeated loading strategy I would instruct for HEP
- sometimes they are not improving because they are being over-treated, I find rarely is someone under treated if they are getting 1:1 sessions with a decent amount of time (even 15-20 minutes can make rapid changes in pain and function)
Any other common mistakes you have made or see in other clinicians? Chime in below, or on the facebook page!
Keeping it Eclectic...
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