2. Check Patient Compliance: This is a big one and a common culprit. It is our job to educate our patients on why it is essential that they are regularly performing their HEP. If you think how much time our patients spend working with us compared to being outside the clinic, any significant gains must be made (or maintained) independently. With regular performance of an HEP, we should expect to see a weak muscle get stronger, an adaptively shortened muscle lengthen, etc. If we are not seeing the expected improvements, it's time for another chat with the patient. Patients will often complain of not having time to do their HEP. It is here we must tell the patient that we cannot accomplish what we want to do in the clinic without the expected results from a regularly performed HEP. If they are too busy, maybe they need to reschedule their appointment once they have found time.
3. Refer Out: Physical therapy is sometimes used as a diagnostic tool for physicians. We are movement experts and often have a different perspective to offer when examining patients compared to medical doctors. This option actually has a couple different considerations. As you might have guessed, we all likely have impairments that would benefit from physical therapy. Whether or not these impairments are linked to the pathology is a separate issue. That explains why failure to respond to physical therapy after a month is a red flag. Another concern in this area is musculoskeletal pathology that sometimes benefits from skilled physical therapy. An example is meniscal tears. A study came out last year showing that conservative management of meniscal tears was just as successful as surgical outcomes. However, this does not mean that everyone will always respond to physical therapy. If after a few weeks the patient has not seen any significant improvements and is experiencing acute locking/catching in the joint, this patient may not be appropriate for conservative care. This applies to other pathologies as well.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
|The Student Physical Therapist||
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