Similar to having an efficient examination, it is important to follow a consistent treatment paradigm and flow within every session. For example, do you prioritize therapeutic exercise or manual therapy first in your treatment session? The answer is manual therapy. If you are currently squeezing your manual therapy into the end of a treatment session, STOP! The manual therapy needs to be performed early in the treatment so that changes in mobility or tissue extensibility can sustained with motor corrective exercises afterward.
As seen in the treatment paradigm below, certain interventions are more appropriate during specific portions of a treatment session. First, a mini-reassessment is always warranted so that an asterisk sign (concordant sign) can be established. After identifying the asterisk sign, it is important to perform any manual therapy and corrective exercises to fix the primary impairments. Assuming the impairments have been corrected, a quick functional warm-up should prepare the patient for power and agility training next (if the patient is appropriate). It is important to perform power training before strength training and metabolic conditioning because power training is a more demanding intervention on the neurological system. Continuing with the paradigm, it is important to perform a light cool down and reassessment of the asterisk sign at the end of treatment.
While certain patients may not be appropriate for all interventions during the first few sessions, the paradigm should be regarded as the ideal structure of a successful treatment session. Using this intervention structure may appear difficult at first. Be consistent and follow this process on a regular basis to instill the practice!
-Jim Heafner PT, DPT, OCS
The treatment paradigm was created by Dr. Dana Tew PT, DPT, OCS, FAAOMPT from the OPTIM Fellowship
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