The One Thing We Need to Do With Everyone

I am often asked by students or people attending one of my seminars, “what is the one thing you do that you find works the best.”  What a loaded question!  I wish it were that simple that I could teach everyone just one magic technique.  I have been reflecting on this question for several months, planning on writing a post to provide an answer.  I took me sometime to figure out how I wanted to answer the question, but I think I might have an answer

 

The One Things I Do That Works the Best

The one thing that I would say that I do that works “the best” is probably something we should all be doing with everyone.  It’s not a stretch, it’s not an exercise, it’s not the latest fad in equipment, and it’s not the lastest manual technique.  It’s actually so simple, that it took me awhile to figure it out.  It is assessing and Reassessing.

A proper assessment and reassessement is by far the best thing we can do for every patient and client we encounter.  This is really the key to understanding each individual, what they need, and what works for them.   Everything should start with a proper assessment and then after treament or training, reassess!  Do it every time you work with that person and even multiple times a session.

Ask them, “what is your primary complaint?”  Assess it.  Quantify it.  Treat it.  Reassess it.

This simple concept can have many meanings.  At the simplest level, imagine if you were working with a weight loss client and didn’t assess their body weight.  How would you know what was or wasn’t working?  How would you know how much improvement that client has made?

For the clinician, we have many evaluation and assessment tools – range of motion, joint mobility, strength, flexibility, and many many more.  But these measurements are irrelevant to the patient.  They don’t really care if they gained 10 degrees of motion.  They simply want to feel better and move better.

OK, your shoulder hurts.  When does it hurt?  What can you do to recreate that pain?  Great – you just established a baseline that you can reassess.  Don’t get me wrong, you still want to take objective measure, but you now have a real life baseline assessment that the patient can feel.

This is why tools like the FMS and SFMA are valuable – systematic methods of assessing movement.  This is especially true in the fitness fields, where assessments are even more limited.  Quantify the quality and feel of movement to assess changes.

FMS

Ultimately, this is going to always lead to better outcomes – instead of just applying treatment or exercise and hoping it works, assess what really works and adjust as needed.

 

Assess and Reassess

How do you apply this?  The wrong way would be to just start working on someone that complains “my back hurts.”  “Well, hop up and let’s start throwing some massage techniques and exercises at it.”  In this example, there was no assessment, just treatment, so what do you reassess?  Pain?  That is not always the best assessment.

Maybe a better way would be to assess when and how the back hurts.  What movements bother you?  What can’t you do?  Now, provide care to that person and reassess what you just observed.  Simple, yet a powerful message when a person stands up and says, “wow, I can now touch my toes, that really worked!”

Here is an example of a recent patient I evaluated with complaints of left sided diffuse mid thoracic and rib pain.  I provided a comprehensive evaluation, but I will just cut to the chase and outline the important details.  His primary complaint was pain.  I could of just started trying to treat the area to reduce sympotms and essentially “chase the pain.”  However,  my primary focus was on his limited multisegmental rotation to the left.

Multisegmental rotation doesn’t tell us enough, so I dug deeper.  He had a moderate loss of thoracic rotation to the left.  I could of stopped here as the location of his symptoms were in this area, but I again dug deeper.  I was fine with his hip mobility.  However, I found that his pelvis was shifted with a left anterior tilt, causing his entire pelvis and SI joint to rotate to the right.  Subsequently, his lumbar spine was orientated slightly to the right, meaning his “neutral” was actually rotated to the right slightly, causing what looked like limited rotation to the left.

Thoracic Spine Mobility ExercisesWith my assessment in hand, I went to work.  First, I wanted to start at the thoracic spine to see what the precentage of invovlement may have been.  I worked on soft tissue, joint mobility, and few thoracic mobilization corrective exercises.  Reassessment at this point showed a fairly large improvement of thoracic rotation to the left.  I could of again stopped here, but I also wanted to check multisegmental rotation to the left, which only showed approzimately a 50% improvement in rotation to the left.

If I just stopped here, I would have restored half of his dysfunction, and I bet he would have slipped right back to where he started.

I next went to the pelvis and with a few exercises and manual techniques improved his pelvic alignment.  Reassessment of thoracic rotation and multisegmental rotation showed normal symmetrical movement, and naturally a reduction in his complaints of pain.

That is the power of assessing and reassessing.  Not just once, but multiple times in one session so that I can narrow down the effectiveness of each technique as best as possible.

 

The Power of Reassessment

That was a pretty good example of how I really narrowed down and enhanced by treatments by assessing and reassessing.  To summarize some of the key points:

  • Helps you individualize and find what works.  This is the no-brainer concept, to see if there was an immediate improvement that can be directly correlated to what you just did to the person.
  • Helps you find out what doesn’t work!  Don’t underestimate this one.  By properly assessing and reassessing you also find out what doesn’t work, which is just as valuable so you can shift gears and try another approach.
  • This is also diagnostic.  By assessing what does and doesn’t work you may also narrow down the exact dysfunction.  Perhaps their limited thoracic rotation is related to soft tissue changes rather than joint mobility.
  • Helps buy in.  Lastly, but probably most importantly, assessing and reassessing helps build buy in, confidence, and compliance from the person.  They will see immediate benefit in what you do.

 

That is probably what I would consider the one thing that we all need to do with every patient or client we see – assess and reassess, what do you think?

 

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17 Responses to “The One Thing We Need to Do With Everyone”

  1. Nice post Mike! I would completely agree with this and add that the one thing I ALWAYS do with my patients is educate them. I feel that this is one thing that can often be overlooked, but is so crucial to not only correcting whatever dysfunction we find, but also preventing it from re-occuring. I think it is safe to say that we need to not only dig deep in finding physical pathology/dysfunction, but also lifestyle and postural habits which may have led to the dysfunction in the first place.

  2. Christie Dowing, PT,DPT, OCS, Dip. MDT Reply September 4, 2012 at 10:29 pm

    Great points Mike and BJ. To follow up on BJ’s comment, not just educate, but follow up on that education. All too often I find that patients perform exercises inappropriately or miss simple pieces of advice…even the simplest exercises or educational points can be misunderstood. It might seem simple to us, but it’s not always that way to our patients. Sometimes we are left scratching our heads as to why a patient isn’t getting better, only to find out they were doing something that had no resemblance to what we taught them. Education is not a one step process…

    Thanks guys!

  3. This is the best thing to do with every patient along with education! I always blog about assess and re-assess. The only thing I would add is, EVERY visit is an eval, not just a treatment. Otherwise, how do you know what to do that day?

  4. Good read Mike, This is a great thing to use in the fitness population as well, to see if all of those mobility drills are actually improving movement in the first place!

  5. I can still remember my ortho professor in school hammering into all of us over and over again assess…treat…reassess!!!
    Thanks for the good advice….

  6. I would definitely agree that a lot of professionals (physios and trainers) don’t re-assess enough. I would also say that one thing to do is always get multiple views with multiple professionals giving input. I have a lot of clients that I coordinate training with their physio, chiro, and even their massage therapists. Many eyes provide a clearer picture.

  7. Great post Mike! I have something similar coming out tomorrow (not to copy you,as I just read this post!). Just shows that this model of treatment is very beneficial for not only the patiients, but us to get the best results.

    Best,
    Harrison
    Intouchpt.wordpress.com

  8. Thanks, Mike. This is one of those crucial things we need to be reminded of and incorporate into our process with every client and patient. Whether you are coaching, training, or rehabbing, the person needs to buy in to be part of the process. Also, as a movement professional, we all need to audit our own work!

  9. Mike, Love the blog but have to disagree with the true effectiveness of the FMS, at least when it comes to sports training. I am a trainer/strength coach/chiropractic student who has become a little weary of the whole functional movement, the fms included. I have read Mel Siff’s thoughts on the FMS and here are some of the points he made that I found most valuable and interesting.

    1.) avoidance does not equal prevention
    2.) sports training must include the capability of coping with unexpected sub-obtimal conditions.
    3.) simply because posture is poor does not mean it’s pathological nor does it mean visually poor posture will lead to more musculoskeletal problems.
    4.)simple isolationist mm testing of muscles cannot determine if one’s muscles will be operating inefficiently or in some state of imbalance in actual multi-articular sporting activity.
    5.)Anything that creates greater awareness of optimal patterns of stability or mobility can help to improve motor skills, posture, and movement efficiency.
    6.)In martial arts and other sports where unexpected situations occur – they are taught how to cope with events what have serious consequence – this should be applied to all sports because athlete’s will react more rapidly and avoid more injury.

    For example, if a novice lifter cannot do the squat or overhead squat with feet shoulder width apart without the butt raising a little, then I allow him/her to take a wider foot stance and to use that butt raise less and less as time goes along. Before long, without any special exercises, stretches or postural alignment toys, that lifter becomes able to move the feet closer and lift with a more erect spine and less butt raising.

    I remember that the Indianapolis colts were one of the first nfl teams to claim the FMS as the end all be all. They claimed it would help with injury prevention. Since, they have been one of the most injury plagued teams in the NFL. There response to criticism about the efficacy of the FMS is “well it helps us rehab faster” … but clearly it isn’t working in injury prevention as they initially believed.

    Again, love the blog and the information you provide. Just my two cents.

    • 1) Avoidance of what?

      2) What does that have to do with the FMS?

      3) It’s a movement screen, not a postural assessment

      4) It’s a movement screen not isolation MM testing

      5) Great point! What does that have to do with the FMS?

      6) Great point! What does that have to do with the FMS?

      Colt eventually got cleaned up, and the Falcons and Ravens that were both in the NFC and AFC Championships are heavy FMS teams and are extremely durable, along with many other facilities that are CORRECTLY using the FMS systems.

      A lot of good point, but unfortunately, none of them are correct or have anything to do with the FMS.

  10. Great article, thanks Mike. The approach sounds like Maitlan, assess, treat, re-assess! Find the comparable sign and make sure what you are doing is working!

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