Here are 5 things to help you organize each follow up session.
I know that not everyone has the luxury of seeing a patient 1:1. If not, those jobs exist, but you still need 1:1 time with patients, even if it's fifteen minutes. A lot can be done in that time with a plan.
1) Ask them how they are doing (other than the reason why they're in your office in the first place)
- set the tone
- be overwhelmingly positive
- comment on something physical about them
- "You're moving much better" "You look like you're feeling much better.." etc
- ask them how something in their personal life is going
- when you finally get to their symptoms, give them 3 options if they're having trouble
- are you "better, worse, or no change?"
- these are the only possible outcomes since last session
- if not better, try to find something objective that improved, some patients concentrate on their pain, without realizing their movement has improved
- could be movement quantity or quality
2) Look for asymmetries or dysfunctional patterns
- Find the most asymmetrical movement in an upper or lower quarter depending on what their main complaint is
- if their are multiple DNs, and you have limited time, pick one (the most limited) to focus on for a few visits
- use clinical judgement if a DN farther away from their complaint area is more limited than one that is closer
- i.e. my current COTW tennis player
- I am focusing on improving her shoulder mobility and thoracic mobility first, and her left hip extension mobility last
- in 20 minutes, I work on the lateral upper arm, upper trap, levator scapula, subscapularis, 1st rib, mobilization with movements to the thoracic spine, then ITB, and MWM to the L hip
- stick to the same asymmetries for 1-2 visits until they improve and move on
3) Progress your treatment - avoid visit stagnation!
- have a plan in mind - what's your endgame?
- every 1-2 treatments or at least once/week, you should change up treatments and the patient's exercises
- if performing the same treatments, do them in a different order
- for MDT, progress them to a patient generated overpressure
- think of the movement or pattern you want the patient to be able to do
- work on all the dysfunctions that are limiting that movement/pattern
4) Review the exercise program
- keep it simple, if possible, most patients only need between 2-4 exercises
- ask them the mode you instructed at last visit
- have them demonstrate them, make corrections as necessary
- don't assume if they demonstrated it correctly once, they are doing it correctly now
- I've seen patients deviate so much a few visits later, the exercise resembled something I'VE NEVER TAUGHT ANYONE IN THE ENTIRE HISTORY OF MY CAREER
5) Reassess the pattern, asymmetry, or functional limitation
- forget special tests, outcome measures, etc.
- show the efficacy of your Tx
- pre and post test after their ther ex, show that the exercise program helps correct their movement just as much as your Tx
Have a great weekend everyone!
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