Five Rules for New Orthopedic Physical Therapists

Recently had the pleasure of being the Clinical Instructor for my first DPT Student. Since his rotation ended, I have been reflecting on my time mentoring….what I did right….what I could have done better. Out of that I came up with five rules that new DPTs should follow in the Ortho PT world.

Rule 1: 85/15 Rule

Recently, I’ve been reading the book “How to Win Friends and Influence People” by Dale Carnegie. It has been a great book to better understand how to effectively communicate with and lead others. This book would be a great read for any new DPT, and this quote sums up why. All the techniques/correctives/etc in the world won’t work if you fail to effectively get your patients to believe in you. Confidence, empathy, caring, listening…..

“Research carried out by the Carnegie Institute of Technology shows that 85 percent of your financial success is due to skills in “human engineering,” your personality and ability to communicate, negotiate, and lead. Shockingly, only 15 percent is due to technical knowledge.”

Rule 2: Watch Patient Perform their Chief Complaint

Rule 3: Test-Treat-Retest

When performing manual therapy always test a movement before and after performing manual. Too often, young DPTs and DPT students want to “throw the kitchen sink” and perform every possible manual skill possible. Instead, slow down and try to pinpoint what manual technique(s) are causing the desired outcome.

Rule 4: Active Health Participation >>>> Passive

Making the patient an active participant in their healthcare is much more effective than them being a passive recipient of care. The problem comes when you get those patients that don’t show any signs of improvement until you perform and manual therapy technique. My solution has always been to follow up manual work with an active treatment. For example, after lumbar mobilizations a patient might perform a set or two of press ups. With this, I hope to emphasize that improvement can occur with more than my hands and reinforce the importance of performance of their home exercise program.

Rule 5: Reinforce Mobility with Stability

After any technique that improves mobility, reinforce the new mobility with corrective exercises. This is best explained by Gray Cook in “Movement”:

“It’s as simple as this: If mobility is measurably improved, use it. If you gain hip extension, use it. If you gain shoulder flexion, use it. The stability work reinforces the new mobility, and the new mobility makes improved stabilization possible because new mobility provides new sensory information. New and improved sensory information is required for new and improved stability.”

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