Top 5 Fridays! 5 Things You Should Do On Each Follow-Up | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Things You Should Do On Each Follow-Up

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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