A colleague of mine posted the following questions on social media:
For those working as a PT or DC for more than 5 years, how much has your clinical perspective and approach change compared to when you first started?
Was your original perspective due to/a reaction to PT/DC school, a clinical, or some other experience?
What do your perspectives and approaches look like now?
I thought I would put my thoughts together on what I have earned and where I have progressed to in my close to 15 years of being a Physical Therapist and Strength coach.
These are are my thoughts on how my approach to therapy and coaching has morphed and progressed over my career to where I am at today.
▪️It is much more simplistic in all aspects of evaluation, testing, and treatment. in my opinion, LESS IS MORE
▪️I take much less of a tissue and specific dx based approach to my physical therapy patients.
▪️I am more focused on encouraging movements and activities that the patient or client can do rather than harping on their limitations. I still acknowledge those limitations and formulate a plan with the patient to address and improve them while at the same time getting to work reinforcing the things that can do and tolerate
▪I have become more focused on finding ways to load and challenge my patients/clients day 1 especially in the basic movements of the squat, lunge, hinge/lift, push, pull, and carry. In my opinion, we underload our patients and clients especially as the get up in age, which in my mind just creates more fear and fragility for them.
▪️I use much less manual therapy these days and when I do use it I try to make sure the proper narrative accompanies it and I progress to active treatments as quickly as possible.
▪️I have become more focused on the subjective portion of the evaluation. Utilizing motivational interviewing techniques, active listening, asking open-ended questions, etc. The patient will generally give you most of the answers you are looking for if you ask the right questions and truly listen,
▪️Along those same lines, I have become much less focused on the objective portion of the evaluation. I gather some basic info, rule out red flags, and get to work. I make sure whatever testing I do is geared toward their complaints and/or goals. I think too much time and fluff occurs in this area. Don't forget every session is also a chance to retest something.
▪️I have become more focused on simplifying home programs and keying in on motivation and habit building around all aspects of their health outside of their specific complaints as well.
▪️I try to make sure to keep the goal, the goal (thanks to Dan John) Everything I put into a program should have a clearly defined reason and connection to patient's wants, needs and goals. Anything else is just unnecessary fluff.
▪️Don't take credit for your patient's success, or take their lack of success personally. Give them all of the credit for their wins and when they falter help to pick them back up as best as you can but don't blame yourself if you truly did your best.
▪Lastly building relationships matters. You can be the most skilled PT/coach in the world but if your patients or clients don't buy into that then those skills are worthless.
Anyway, you can take these observations however you want, but these are my thoughts based on experience, learning from others, staying up to date with research, and constant self-reflection.
If you have any questions or just want to chat feel free to reach out to me at johnpaul@guidrypt.com
Dr. JP GUIDRY DPT CSCS TPI