What's the plan?.....

(image: Brett Jordan (via Unsplash)

How much treatment?

Assume the following people are new patients. Have a think about how many treatment sessions they will need in the short term (ie to get them as well as you can as quickly as is reasonably possible)

Case 1

A lady in her 60s with degenerative changes in the knees, hips and spine. She gets multiple joint pains. She is somewhat overweight.

No of Treatments ______Frequency:______Resolution of complaint? Yes/No

Case 2

A young woman in her 20s who has had some neck and back pain, possibly related to her work posture. She has had an RTA in the past, and has a stressful domestic relationship

No of Treatments ______Frequency:______Resolution of complaint? Yes/No

Case 3

A fit man in his 30s who has strained his low back lifting something in the garden because he was in a bit of a hurry and was careless with his posture. His symptoms are already resolving significantly by the time he comes to see you.

No of Treatments ______Frequency:______Resolution of complaint? Yes/No

Case 4

A child who with torticollis, who may be a school refuser.

No of Treatments ______Frequency:______Resolution of complaint? Yes/No

What factors influence the number of treatment sessions needed, and the frequency of those treatments?

1. Timescale. Problems that have been present for significant periods of time tend to take longer to improve with functional care. Functional treatment tends to have a cumulative effect. It generally takes more treatments to have an effect on tissue that has altered both functionally and structurally.

2. Structural change. Structural changes that will have occurred with the passage of time, either to joint integrity or muscle flexibility will limit the amount of change that an individual functional treatment will have.

3. Severity. In the short-term, patients with severe symptoms may want more frequent treatment than patients with less severe symptoms.

4. Psychosocial overlay. The more of this there is, the less likely the patient is to respond to treatment.

5. The number of issues that we need to address. The more issues we need to address, the more treatment sessions we may require.

The point is that every patient is different. We should not attempt to apply a single treatment plan to all patients. Treatment plans should be tailored……

Write down a theoretical Management Plan for case 1 from the previous page (the overweight lady with multiple joint pains): (do write it down, it will facilitate the learning process....)

Theoretical Management Plan;

Treatment 1:

Treatment 2:

etc…..

How many treatments will you plan?

Sample Short-term Treatment Plan for case 1:

Treatment 1. Massage (STW), Spinal manipulation (SMT) Homework: spinal flexibility exercises

Treatment 2.   STW, SMT, hip mobilisation Homework: hip flexibility exercises

Treatment 3.  STW, SMT, hip and knee mobilisation Homework: leg stretching exercises

Treatment 4.  STW, SMT hip and knee mobs knee, foot adjustments Homework: use orthotics

Treatment 5.   STW, SMT, knee hip and foot mobs. Discuss weight

Homework: diet diary

Treatment 6.  STW, SMT knee dry needling

Homework: Mckenna food control exercise

Treatment 7.   STW, SMT, hip and knee and foot mobs

Homework: core stability exercises level I

Treatment 8.  STW SMT hip and knee and foot adjustments

Homework: core stability ex level II

This is a hypothetical example, of course, and every practitioner will differ in their opinion about the validity and relevance of the individual aspects of the above plan.

Homework for you:

Much of what we do has common themes. It is helpful however, to clarify in your mind what you will do with patients with common conditions and patterns of presentations.

Write down hypothetical treatment plans for the following:

• Disc prolapse
• Supraspinatus tendonitis
• Cervicogenic headache
• Recurrent mechanical LBP
• Or indeed any/all other conditions that you see regularly

This will help you to clarify in your mind the amount of treatment that may be required for theses conditions, bearing in mind the factors discussed a couple of pages ago.

Pearls:

• Many practitioners underestimate the amount of treatments needed, because they have not clarified in their own mind what it is that both they and the patient need to do.
• If this patient was your grandmother, or your child, what would your plan be? That’s probably a good, caring plan!