Maitland concept Treatment Progression

Transcription

1 Maitland concept Treatment Progression Darren Earnshaw PT, MMT, FAAOMPT, CMDT,

2 Session 2 Better /same /or worse? Specifics use subjective asterisks. Often specifics reveal different story. If worst why.fish for it often not your treatment but something they did.

3 If worse Was it Your treatment? Your assessment? Something they did? As you cannot logically differentiate between assessment vs. treatment effect Repeat same treatment Unless significant flare that you feel definitely associated with treatment adjust Change treatment totally?? Lower dosage, change direction Do not throw out a technique until sure was the technique/dose that made worse

4 If better Similar logic to if worse Was it treatment or assessment HOWEVER If you are on a good thing stick to it.

5 If the same Similar logic to worse or better Did assessment cancel out treatment effect Repeat same treatment.

6 So just do same treatment?? Essentially yes unless Significantly worst can alter Very confident benefitted from your actual treatment Then can add something else.

7 When to add other treatment Consider specifics of patient Are there other deficits to consider Strength Stability Motor control proprioception

8 Session 3 same or worse If next session the same The most frustrating response Am I lost, on the wrong track? Time to revisit/refocus assessment on most Comp Sign Am I Rx the comp sign appropriately? Was I too timid (same)/aggressive (worse) in my intervention?

9 Session 3 - better Why change anything?? May want to add adjunctive exercise that adds to manual technique May want to add strength/motor control etc.

10 Augmented exercises As soon as possible addition of home exercises to augment clinical techniques advocated Usually can add 1 st level stability type exercise for lumbar spine second session as doesn t involve movement of spine and inner core exercises always part of rehab whether stiff dominant problem or not.

11 Prognosis Patient s perspectives and expectations Patient s social, occupational and economic status Mechanism of the symptoms The balance between pain (inflammatory components) and stiffness (mechanical components) The level of irritability Degree of tissue damage Duration, history and progression of the disorder General health and presence of pre-existing disorders

12 Prognosis Important to consider when planning most effective way of managing treating a problem 3 times a week for 4 weeks prescription is often prescribed by doctors to allow therapists ability to treat appropriately in initial phases Is often utilized too literally by therapists due to Convention Business model Lack of thought

13 Treatment Progression If progress slows or does not go according to plan, think: Am I treating the correct structures, in the correct direction? Am I treating too gently or vigorously? Retrospective assessment may be of help here. Example: If symptoms are worse: Why grade? Direction? Too long? If symptoms are the same (ISQ): Why not strong enough? Direction? Structures? If symptoms are better: Progress the grade, duration, position, direction or do the same?

14 Treatment Progression The decision to stop treatment should be based on the pathology, the state of the structures and the norm for the patient. The aim of treatment is to clear as many joint and comparable signs as possible and to make what is abnormal, normal.

15 Treatment Progression Don t be greedy if you get a good result with a particular treatment technique. More is sometimes less. Use a technique twice unless it was a disaster you may have not performed it correctly. Always have a reason for selecting or changing a technique. Use the least amount of force possible to accomplish your treatment goal. Be aggressive only when necessary and make it a conscious decision, not an unintended happening.

16 Technique Selection and Progression Considerations Adding treatment; consider adding a physiological or accessory technique, mobilize an adjacent segment or initiate treatment on an additional component. Warn the patient about possible soreness after the initial evaluation or treatment. Differentiate between treatment soreness and condition related soreness.

17 Summary Think and be logical If you add to much in a session Any change what was cause???

18 Our patient retrospective assessment Did I get all the info I need? Did I get enough info re specifics of previous treatment? What specifically? Any manual therapy? If manual therapy similar to what I did? What dosage?? Has he had a lay off while getting rehab?? If doing extension look at how? Look at how often? Get more into what workouts consist off Is the fact he feels better misrepresentative of them being helpful??? When he runs often feels ok but later worse?? Is this case with weight training??

19 Our patient retrospective assessment If not progressing Consider other theories SI dysfunction?? Broader adaptive responses following injury that need addressing? Consider may need stability vs movement. Consider may have to adjust training regime as may be counteracting your treatments. Look more at strength/muscle length relationships. May need to refer to different type of specialist.

20 Maitland personal commitment to patient Remember your obligation is to do all can for your patient. Realize your limitations. Ego is irrelevant.