Treat the Primary Impairment!

In school, physical therapy students learn to find many impairments. Some are important and others may be irrelevant. They often find six or seven impairments and start treating them all during a single session. For example, a patient with glenohumeral joint dysfunction will likely have shoulder range of motion deficits, scapular strength deficits, 1st and/or 2nd rib dysfunction, thoracic and CTJ dysfunction and more. Ranking the importance of these impairments is difficult. Where should the clinician start their treatment? 

Knowing what region to address first is a difficult task. There is not one answer because each case is different. Generally, I work from the spine outward and proximal to distal. In the shoulder example above, I would treat the thoracic spine and CT junction prior to treating the glenohumeral range of motion deficits. I would strengthen the scapular muscles prior to addressing shoulder muscle strength. Regardless, I want to focus on one or two impairments per treatment session. Novice clinicians attempt to treat every impairment during each treatment session. This treatment method gives a small dose of treatment to several regions of the body. This is largely ineffective.

My recommendation: Choose a SINGLE impairment goal for each patient and fix that one goal. In the shoulder example above, my primary goal would be to fix thoracic spine mobility. I would focus my entire treatment session on thoracic spine mobility and range of motion exercises. Of course I would want to sustain the mobility changes with scapular neuromuscular reeducation exercises, but only after the mobility has been achieved. This method simplifies the entire session. Instead of focusing on which impairment one should treat next, think about what exercise or treatment one can use to treat the primary impairment. Addressing impairment #1, often corrects problems two, three, and four. 

Jim

---

---

Like this post? Check out our Insider Access Page.

Want to make a Guest Post? Check out our current guest postings including this one on the Asterisk Sign.

This post is an introduction to the topic, and if it generates enough interest, I can expound more on the current topics and further discuss the art of this subject as well. Definition: Test, treat, re-test is executed by the PT performing a simple, reproducible, reliable test with a patient. The PT will then perform one or more treatments. The PT will then perform the same test. READ MORE