One of the hardest things to do in the clinic is to regularly practice things at which you are uncomfortable or less skilled. Most physical therapists work a busy day with patients and have notes to complete afterwards. The desire to do anything PT-related outside of those obligations can be exhausting. What we must do as clinicians, if we are to regularly improve, is reflect upon our weaknesses. They often can be difficult to identify, because we think we are examining our patients as efficiently and effectively as possible. But what lies unknown remains unknown.
An easy way to start reviewing weakness is selecting techniques or other aspects of care with which you are less successful. Maybe it includes a lumbar manipulation or educating a patient on pain science. A more difficult weakness to identify is that which you are unaware is occurring. There are a couple methods of reflection I like to use for these. One is to review groupings of patients that have had less than optimal outcomes with your care. Maybe there is something else that should be included in managing the patient? Another method is to regularly review other PT blogs or courses that may point out examination or treatment techniques with which you have less experience.
So how do we manage these things? For the technique or education aspects, it is simple - practice. To develop an expertise level at something, it requires lots and lots of practice. This is easier said than done for some things. For example, if you want to practice lumbar segmental mobility assessment, you can perform this on every one of your lower quarter patients. You will know more than almost every one of your patients, so go ahead and practice assessment techniques. You will notice differences between tissues and segments far more easily over time. Now, certain treatment techniques should not be practiced on patients as liberally. For example, cervical manipulations carry some level of inherent risk, so it is essential the clinician already have sufficient skill when performing. These sorts of techniques should be practiced for prolonged periods outside of patient care before performing on patients. For more non-technical aspects, it may benefit from some form of peer discussion or mentoring. As we've said many times before, it helps to have multiple perspectives in clinical development. Someone may have had some other success or experience that could benefit you in the future. Regardless of how you work on your weakness, it is important that we take the time to identify them and then address them.
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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.
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