How many times have you racked your head wondering; why is this not getting better? How come they’re still in pain? How do we have all of this evidence and knowledge at our disposal, yet individuals do not respond as anticipated? The science says, for injury ‘Z’ treat with ‘X’ and rehabilitate with ‘Y’, yet when we apply those tools they don’t work? Why are they not getting better? What are you doing wrong? What are they doing wrong?
Often times we immediately point the finger in the wrong direction. First, we think “There must be something else wrong that I missed during my evaluation.” Another is “Well, [the client] must be doing something that I told him/her to avoid.” Also, “Let’s try doing this instead.” For readers of this blog who are health care providers, how many times have you said one of the above lines when therapy failed?
While it is not wrong to ask the above questions, these shouldn’t be the first questions you ask. You need to make sure you and the client are upholding the 3C+P approach: consistency, commitment, correctness, + patience. Let me explain how all of these are needed for optimal outcomes.
Once you have identified the problem and developed a treatment plan, you must consistently and religiously follow the plan. Lack of consistency is one of the problems with standard outpatient care. How can clients get better with 2-3 visits per week? How can they improve when insurance lapses after 12 visits? There are 168 hours in a week; spending < 2% of that time in therapy will not elicit the desired outcomes. As clinicians we must continually attack the underlying problem. Many of the chronic conditions we face are a result of learned patterns. The only way to break the cycle is to continually teach the body what it needs to do.
Both clinician and client must be committed to the plan. How many times have you provided clients clear directions, only to hear “Yes, I did as you told, but I did go to Zumba” … “Yes, but I did go hiking” … “Yes, but I read online I should do [stretches], so I tried them.” You’re left shaking your head.
Clinicians, don’t let your head grow bigger, you’re worse than the client. Clinicians continually seek the best for their clients. The problem is that clinicians are also impatient. The first sign of adversity, or delay in expectations, you begin seeking alternative treatment.
Correctness comes in to play during execution of exercise. If you’re not performing the exercise to perfection, then you might as well not be doing it all. A friend recently asked me, ”Why the term of corrective exercise? Shouldn’t all exercise be corrective?” I said, “No, exercise is movement. Corrective exercise is perfect movement.”
Our bodies are masters of cheating. I can ask 10 people to squat and each person will have a slight variation to the squat. Limited dorsiflexion, glute weakness, tonicity through the posterior oblique fascial line, overactive iliopsoas, and I could go on; all will have a subtle impact on movement because of the body’s way of cheating and taking the path of least resistance.
Similarly, when a client is asked to perform a rehabilitation exercise, the body can and will compensate. The practitioner must watch for and immediately correct any sign of compensatory movement. Performing the exercise improperly can create more problems than not doing the exercise at all.
This is probably the hardest for both client and clinician. You will have roadblocks. There will be setbacks along the planned route. Pain may return and performance may decline. Don’t over react. Stay the course.
It is most difficult to have patience near the end of training. The client feels great and is tired of the restrictions. The client sees no reason why they must see this through. The clinician wants the client to be happy and releases them. Remember it takes a minimum of 4-6 weeks minimum to obtain desired adaptations. That is for each adaptation! Usually, the road of performance or rehabilitation has many adaptation hurdles. Stay the course, don’t quit the plan! Be Patient!
I explain this approach with every client I train. I will not train any client unless they fully understand this approach. Both client and clinician want successful outcomes. In my opinion, nothing matters more than the 3C + P approach. You can have an alphabet soup of credentials after your name. You can have all the gadgets and gizmos at your disposal. If your plan is missing one of these elements the success rate declines.