How to Determine the Best Treatment Approach
What is the best treatment for [insert here]? Is the answer simple? Potentially, but here’s the thing, the answer to that question is often more complex than most realize. As Physical Therapists, we know the answer tends to be complicated because we’re asked this type of question all the time. As the person with the injury or issue, however, we understand you are eager to resolve the problem. So, let’s discuss this more. To get a bit more specific, it may also sound like –
I tore my meniscus while I was dancing, what do I do?
My rotator cuff is torn. How do I fix it?
Yesterday I threw my back out, how do I make it feel better?
Essentially, insert any injury and then ask, “How do I fix it?”
There’s a large problem with this question. It implies that a specific injury is fixed with a specific treatment plan. Unfortunately, that couldn’t be further from the truth.
Treatment Goes Beyond a Diagnosis
For insurance purposes, it’s necessary to have a diagnosis. To eliminate discomfort, it’s not. It may sound crazy (and completely against how the medical world operates), but it’s true. What we do need to do is figure out the following two things:
- What caused the discomfort in the first place (previous injuries, faulty mechanics, muscle imbalances, weakness, decreased mobility, etc.)
- What is continuing to contribute to the discomfort (again – faulty mechanics, muscle imbalances, weakness, decreased mobility, compensations due to pain, etc.)
Once we figure out why the discomfort is currently present, we initiate strategies to decrease that discomfort. As the reason for the current discomfort starts to resolve, we move to addressing the underlying causes. The overall treatment strategy is simple, but the nuts and bolts of it are not.
The Nuts and Bolts of Treatment
For the rotator cuff example, looking at the nuts and bolts includes –
- Strength assessment of all 4 muscles of the rotator cuff
- General shoulder strength
- General range of motion
- Muscle length
- Joint mobility
- Thoracic spine mobility
- Shoulder blade coordination
Even then the above list isn’t all-inclusive. In some individuals, baseball players for example, we’re going to look at the elbow as well because the shoulder and elbow are so interrelated for their sport demands. For CrossFitters, we may look at the wrist, hip, or ankles, depending on which motion is giving them discomfort.
After we get that information, we compile it. Does it form a clear picture? Out of all the positive findings, what is driving the pain the most at the moment? Is the root cause apparent at this point in time? Do we need to wait for pain to improve before we get a better picture?
Finding a Treatment Plan Forward When Injured
Once we’ve compiled, sorted, and processed the information, we move forward with a treatment plan. We trial a treatment technique that targets the current cause of the discomfort and is aimed at bringing down the individual’s pain in the moment. After we try the treatment, we re-test to see if we were correct. Ideally the answer is yes, but if not, we move forward to consider our options.
If we didn’t get the change we were hoping for, we look at the quantity of the treatment we did. Did we do enough? If not, we do more and then re-test. Are the symptoms worse? Then we did too much. We educate the client that we found the symptoms, but we overdosed and we then give them strategies to mitigate the increased symptoms we accidentally created.
Sometimes, the first guess is truly wrong. When that’s the case, we go back to our plan and re-evaluate. What is the next logical solution? Is there something we missed? From there, we develop a strategy based on the next most likely option.
It’s Science, But It’s Not Black and White
To go back to the question of My rotator cuff is torn. How do I fix it?, does it now make sense why it’s difficult to answer that question well with very little information? To take it even further, we could almost argue it’s unethical to answer those questions because we truly don’t know if we are helping or not!
So, next time you are injured, we advise against googling “exercises to decrease knee pain.” Instead, we recommend you find someone who is an expert at helping people get rid of pain. You’ll get the solution you want much faster with fewer hiccups along the way. There’s a reason physical therapy is an entire profession. It takes clinical decision making to develop a good treatment plan, not just having a set of exercises.
Click here to schedule a 30 minute Discovery consultation (in person or over the phone) and let’s get you back to your desired active lifestyle.