When are you ready to progress?
As a physical therapist, I work with a lot of different people. Quite often they come to me with the same written diagnosis, but their symptoms, their movement and their function are all different. The evaluation process is the most detailed in assessment, from the patient’s history (including all prior injuries, surgeries etc.), to watching them move, and determining what is needed to help them move differently. My follow ups are very similar and I always do some movement assessment. Not only does this help me to see if we’re making progress, but it also helps to focus our treatment for the day. We always have our goals set from the eval and our daily treatments may vary a bit to keep us on the right path toward achieving those goals. For this reason, I can’t answer the blanket question “what is your plan of care for each session?” My response will always be “it depends”…on where they are at on that day. This can be frustrating to some and it can be freeing and help make big changes if we follow what the body is telling us.
Of course, I do have a sequence for how I progress a client’s exercise program. The key to finding the right one will be determined first by what you need and second by how well you are able to perform a beginner skill. For instance, someone who has back pain or neck pain frequently starts PT in a super stressed out state (because they’re in pain and can’t do the things they love) and frequently hold their breath. Our findings in movement may be limitation with forward bending toward their toes, shallow breathing and decreased abdominal and low back stability. Their first home exercise would be 90/90 breathing. If they return the next session and still have trouble touching their toes, but can take an efficient breath with good postural control, they may progress to a heel raise and even a plank in one session. If they cannot perform the exercise correctly, we’ll continue to work on building that base first before progressing. For each person this will differ.
This is 90/90 breathing the baseline. https://youtu.be/LcIAoG7sZzw
As coaches, or as athletes we want to progress, and to do so quickly at times. Sometimes we push the skills faster than an athlete is ready which sets everyone up for a possible injury or mishap. This is why it’s important to have a plan for progression. Can you do a baseline skill correctly, with good control and alignment, without holding your breath? If yes, move on. If no, what do you need to do to get there. As a coach, you may need to course correct, but if you stick to solid basics, you will see your athletes excel beyond expectations.
The client I was working for whom my plan of care was not written out initially had 3sessions in which we worked on different exercises to improve his breathing. On the 4th session, he nailed it and was able to progress 2 levels up and then we worked on his obliques. He struggled with breathing and rolling the first time, but now he maintains his core and his breath, rolls like a champ and was able to progress into some standing exercises. His mobility is near normal and he notes he is able to do more through his day without pain. Had we pushed thru that core stability and breathing, he would still be struggling to move. Sometimes more is not better. Better is better. Building on that better is the best :)
If you have questions about if you’re ready to progress email me at Laura@MoveBetterLLC.com and let’s start the conversation.