The ‘Go-To’ Physio Method

Therefore, asking the right higher quality questions that get higher quality information from your patient is critical.

This allows you to make sense of your patient's symptoms and identify the peripheral tissues that are contributing to the pain experience during aggravating and easing movements.

An understanding of modern pain science can be extremely helpful in this pillar to help make sense of those vague ‘aches and pains’.

In the ‘Go-To’ Physio method, the treatment plan is designed by the patient in the subjective assessment (unbeknown to them).

This ensures a patient-centred approach and helps the patient feel empowered and motivated to adhere to the plan in the coming sessions.

There are some other critical tasks covered in the subjective assessment that helps the therapist overcome hidden objections from the patient that could derail the success in further sessions.

The key point here with the subjective assessment pillar is:

Next we move to the objective assessment.

The ‘Go-To’ Physio Method moves away from a ‘diagnosis’ based assessment and towards a ‘shopping basket’ approach.

First termed by Louis Gifford, a shopping basket approach empowers the therapist to easily identify ‘maladaptive’ movement strategies that may still be lingering that are stopping the patient in everyday life.

This empowers you to focus on things you can influence in the objective assessment rather than missing the ‘wood from the trees’ with a strictly ‘diagnosis’ based approach.

A key critical thinking question used in the ‘Go-To’ Physio Method objective assessment is;

This allows you to focus on finding the root problem and ensure the treatment plan solves it once and for all. This simplifies the objective assessment and empowers you to act more effectively with your tactical techniques.

Other key physiological and neurological principles are at play in the ‘Go-To’ Physio Method objective assessment frameworks which includes how human movement occurs in the real world.

This includes the behaviour of muscles and passive tissues to manage perturbations, force steadiness and motor adaptations to pain and/or stress.

Effective communication skills are non-negotiable as a ‘Go-To’ Physio.

Why?

Because this is the start of the treatment process! Louis Gifford said it best;

There is a big therapeutic effect during this process that has the opportunity to update the patient’s belief systems. Therefore this pillar is not only about setting expectations and getting patient ‘buy-in’.

The ‘Go-To’ Physio Method gives you a framework to consistently explain the problem, solution, and plan to a patient.

Unlike most pain science explanations, instead of trying to pull the patient up to our level with fancy words and scientific terms, we need to go down to the patient's level and explain the problem, solution and plan in simple terms that the patient can understand.

The ‘Go-To’ Physio method has simple frameworks in this pillar for executing this skill.

With your effective explanation skills sharp from pillar three, you can now take the high quality information from the subjective assessment and organise it in a way that designs a meaningful treatment plan for the patient.

Another key therapeutic benefit to mapping out the treatment plan and giving a realistic estimate of how many sessions it will take is;

The treatment plan includes key milestones along the journey that allows the patient to see they are on the right track. These milestones are critical for patient adherence in later sessions.

Another key framework for the ‘Go-To’ Physio in this pillar is to design the treatment plan based on the outcomes the patient wants and needs first and foremost.

From here you can then break down the key skills and exercises required for the patient to achieve these outcomes. This ensures you are always designing a bespoke ‘value based’ treatment plan for every patient.

It ensures you avoid trying to fit every patient into a set of exercises but rather look at the person first, pain second. This allows you as a ‘Go-To’ Physio to truly deliver a patient-centred treatment plan.

The 'Go-To' Physio Soft Tissue Release approach (GSTR) is a targeted set of manual therapy techniques designed to identify and address maladaptive movement strategies that may be contributing to your patient’s pain experience. Developed as a piece of the full 'Go-To' Physio Methodology, GSTR aims to work with your patient’s nervous system to restore the ability to tolerate load and redevelop the skills required to achieve the functional outcomes desired.

At the heart of the ‘Go-To’ Soft Tissue Release technique is sound clinical reasoning and clear key performance indicators. This ensures that therapists ‘understand the why’ behind everything they are doing and can easily course correct if they are not on the right track.

This will save your hands but also ensure you do not unnecessarily ‘flare patients up’ or allow them to become ‘reliant’ on hands on treatment.

This pillar also leans on key mental models (such as second order consequences), critical thinking skills, manual muscle testing and other key frameworks from the ‘Go-To’ Physio Method to apply the right technique at the right time.

The 'Go-To' Soft Tissue Release Technique is more than just a set of manual therapy techniques; it is a comprehensive approach to looking at the person first, pain second and addressing the underlying causes of musculoskeletal dysfunction.

By focusing on the patient’s story, undoing maladaptive movement strategies (using second order thinking principles), improving range of motion, and enhancing load tolerance, GSTR plays a pivotal role in helping the patient ‘feel’ the difference in the first and subsequent sessions.

As part of the ‘Go-To’ Physio Method hands on treatment protocol, the hands on techniques are immediately followed by low level rehab to further reassure the nervous system it is safe to tolerate load.

One of the key ‘Go-To’ Physio principles of the early stage rehabilitation exercises is to put the tissues that are not doing enough work in a position where they've got no choice but to tolerate load.

The early stage rehab exercises ensure that all levels of the nervous system’s ‘threat detectors’ are engaged in the process in order to truly ‘reassure’ all levels that it is safe to tolerate load again.

This pillar is here where you will also use the information gained from the objective assessment to take away the ‘maladaptive’ strategies that the patient’s nervous system will usually try to use as per the motor adaptation literature.

Another key principle at this level is to ensure the ‘attention system’ and subconscious mind is fully engaged in the exercise. The ‘Go-To’ Physio can achieve this using a number of physiological and neurological principles in your rehab approach.

This in turn can decrease the perceived threat, increase range of motion quickly and bring about more long lasting ‘processing changes’ which is advantageous for the high pressure environment of private practice.

The patient will feel the difference immediately and will not become reliant on hands on treatment as these exercises will give the patient the exact same ‘feeling’ that hands on treatment gives them.

As the pain/discomfort begins to ease the ‘Go-To’ Physio changes strategy on the quest to help your patient move with ‘thoughtless, fearless, movement’. A key strategic shift at this level of the graded exposure ladder is putting the tissues that were not doing enough work now into situations where they have to work well with tissues that were doing ‘too much’ work.

This gives the nervous system an opportunity to self organise and allow the synergists and antagonists to cooperate and work interdependently as per real life situations without higher centre involvement.

Another key strategic shift is moving towards more dynamic and faster movements that are more concerned with lengthening changes in the peripheral tissues and rate of change of length. This ensures that if the patient needs to move in a certain direction quickly, the nervous system does not ‘overreact’ with a protective strategy. The exercises at this level will allow the patient exposure to do their everyday tasks with optimal energy efficiency.

Remember…

The work must come before the belief. Your patient must be exposed to situations that are stressful for their nervous system to give them an opportunity to earn back the confidence and self belief in their bodies.

This is where the magic happens and the value is delivered to the patient where the work has to happen before the confidence emerges.

It is at this level where the patient further updates their belief system and they do things again where they never thought was possible.

Raving fans are created at this leve when true value is delivered that far exceeds the price paid for your services.

The final pillar of the ‘Go-To’ Physio Method is Robustness and Resilience. This phase may look different for different patients.

For example an ‘weekend warrior’ or sporting patient may need to build robustness and resilience by managing external loads in the gym.

A field based athlete may need further exposure to acceleration, deceleration and running progressions at this level. This is where the ‘Go-To’ Physio has the skills to train the deceleration, acceleration and top end speed capabilities of the patient in three dimensions.

The ‘Go-To’ Physio must create situations in a graded exposure manner in which we show the patient’s nervous system it is safe to tolerate loading at the highest speeds of movement if applicable.

Remember…

For a non-sporting persistent patient, this phase may look very different to the active sporting patient. This patient may require graded exposure to certain stressful environments and situations whereby they can go into ‘fight or flight’ but then return back to ‘rest and digest’ at the appropriate times. The patient must have the tools to feel empowered to not only survive but thrive in everyday life situations.