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Picture

How to Structure a Treatment Session

10/19/2016

2 Comments

 
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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


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The treatment paradigm was created by Dr. Dana Tew PT, DPT, OCS, FAAOMPT from the OPTIM Fellowship

Efficiency is Key!

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A  consistent treatment approach is equally as important as an efficient examination process. If you are currently struggling to find time to treat, the problem may lie in your examination flow.
Efficient Examination Ebook (use promo code TSPT50 until 11/8 to save >$20)
OPTIM COMT and Manual Therapy Fellowship is now enrolling classes in Dallas, Houston, and Scottsdale! 

2 Comments
Marcus link
2/22/2019 04:32:23 pm

Thanks a lot for mentioning how manual therapy should come first in your treatment sessions. It is important to understand that doing this can help you get more mobility to get back in shape. We are planning on getting our son to a physical rehabilitation facility, so I'm glad I found your page.

Reply
Walter P link
12/20/2020 05:04:50 pm

This iis a great blog

Reply



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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test