Laurie's Blogs.

A blog recently came across my desk.  It started out like this:

“I am a physical therapist.  I am a physical therapist who uses manual therapy.  One who uses exercise in many forms.  I use pain neuroscience and specific treatments to address persistent pain (PNE, graded motor imagery, graded activity and exposure).  I dry needle.  I use heat, ice and, hell, sometimes I might use ultrasound.  However, the most important clinical “technique” of all:  the reasoning on how, when and why I use them.”

(From:  http://www.evidenceinmotion.com/blog/2017/08/11/not-defined-technique/)

And it hit home!  I harp about this.  Many of you have heard me make reference to, “It’s not a magic dishwasher & it’s not a magic wand!” (or some iteration of the same sentiment), in regards to the over prescription of the underwater treadmill (UWT) and laser therapy without a sound underlying rationale for WHY each is being used.

The blog went on to describe how our ‘reasoning approach’ is what we should value above and beyond any of the techniques themselves.  Now, each of us may have our favourite, our ‘go to’ techniques that we love and employ more than anything else.  For me, it’s spinal manual therapy, followed by laser (yes, I do love that magic wand…).  But it’s the justification that is more important.

I can justify the manual therapy, as I understand the rationale behind it’s use:  It is wonderful for pain management of spinal conditions, and some peripheral conditions as well.  I use my laser because it may also help with pain management as well as healing of tissues.  I am very confident in my assessment skills, so that my assessment of WHERE to utilize these tools is precise.  What teaching others over the last nearly 2 decades has taught ME, is that when a student asks me WHY I chose a certain treatment plan, I had better have an answer.  It has been a true gift to strengthening my clinical reasoning to have had so many students cross my path over the years!

So, I want to challenge all of you, especially if you feel like you are stuck in a rut, or if you review your charts and see that you are pretty much doing a cut and paste for all of your treatments.  Critically analyze the rationale for what you do.  And, in saying that, don’t just do a cut and paste of what was taught to you in your training, but really think!  Yes, the UWT may help with strengthening of muscles.  But, is it appropriate for the stage of healing of your patient? (i.e. is your patient now too advanced for it now?)  Is it a specific enough exercise to strengthen one particular muscle or group?  Is it the best use of time or money (i.e. the biggest bang for the buck), or would something different be more appropriate?  Are you using it as a stand-alone treatment or should you be combining it with something (or something different)?  Are you using the UWT in a traditional manner and/or could you use if differently to make a bigger impact (i.e. interval training)?  Are you progressing each session (why or why not)?

I want you to think about having someone question your every decision.  Trust me, it will make you a better practitioner, and open you up to new or different ways of thinking.  All in all, making you a better care giver for your patients, and a more engaged and dynamic practitioner!