Top 5 Fridays! 5 Mistakes Clinicians Often Make | Modern Manual Therapy Blog

Top 5 Fridays! 5 Mistakes Clinicians Often Make

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...


  1. I am guilty of most of these things, but mostly of trying to fit too many things into the first session. I think we all want to help, but too many treatment options is not always the best approach. I have to step back and think about a measured approach.

  2. Right on, and that is difficult to admit. Starting with the least amount of inputs is often better to a sensitized nervous system.

  3. Plus if you throw too many things at them, you don't know what helped and didn't help.

  4. That's true, same for home exercises, or what made them worse.

  5. In certain clinical situations and business models therapists are pressured to bill X number of minutes/units. This definitely leads to over treating and wasted energy. Luckily I am not in that type of situation but I know it occurs often. This is to the detriment of the patient. 1:1 care should be the norm and if a patient only needs 30min of treatment once a week then so be it. That should be our clinical judgement as autonomous practitioners. Our patients are our priority not insurance companies, MDs, management, etc. We need to do what is best for them.

  6. The mistake would be working for companies that prioritize quantity over quality. I know people have mouths to feed, but it's a HUGE problem in our profession. There are more mills than quality practices out there and as a whole, really mars our public perception.