A roadmap for choosing interventions

I have worked with a lot of students- from a lot of schools- and one of the most consistent shortcomings of classroom education is how to choose interventions.  Interventions are not random.  They should not (necessarily) be based on your favorite exercises or what an awesome blog from a big name PT showed you, or someone’s IG.  If you want to know what someone needs to do, look at their impairments and their goals- the answer is right there.  If you place a list of impairments side-by-side with a list of their goals, it becomes very simple.  Choose the intervention that links the impairment to the goal.  For example, if the impairment is “tight R hamstring” and the goal is “patient will be able to bend forward to retrieve objects from floor to waist height without increased pain or compensation” it’s pretty easy to figure out what to do, right?  Stretch their hamstrings, and then strengthen them in the new range, Athletic Training and Physical Therapy 101.

The nuance comes in the answers to  “how do you want to stretch their hamstrings?” and “how do you want to strengthen in the new range?”  There might be a few wrong answers to these questions but there are a ton more right ones.  

Want to stretch in supine with a rope? Great.  

Want to stretch in standing with the foot elevated using a hip hinge? Perfect.  

Want to have them seated in a chair with their legs outstretched and their trunk leaning forward? Go for it! 

Once you know what the goal of the intervention is (to stretch the hamstrings) the choice is a combination of best available evidence (what does the research say is the most effective way to create length in the hamstrings?), your clinical experience (what stretch have most people be able to perform easily, correctly, and effectively?), and patient preference (ie. if the patient tells you they need something that they can do when they feel tightness mid-run). Hopefully you noticed those bolded words are the components of evidence-based practice. In this example, we can probably get rid of supine stretching, right?  My clinical experience tells me that most runners aren’t going to lie down on the side of the road to stretch so cross that one off the list and move on to the next option. 

Same goes for strengthening.  We can strengthen hamstrings with:

prone knee flexion with a cuff weight

seated knee flexion in a machine 

Nordic hamstring curls 

good mornings 

lunges 

deadlifts

single-leg deadlifts 

squats 

kettlebell swings 

and about a 1000 more exercises! 

All of these are correct and will benefit the patient.  Choose the ones that 1) the patient can and will do safely and correctly and 2) that gets the patient closer to the goal of bending forward to pick something up from the ground.  

The key to choosing the right interventions will always lie in your ability to link your impairments to your goals.  Think of the plan of care as your patient’s map to health and wellness where impairments (A) are the starting point and the goals (B)  are the finish line. The interventions you choose are the stops along the way that take the patient from A to B.

Published by Penny Goldberg, PT DPT ATC

Penny Goldberg, PT, DPT, ATC is the assistant director and sports physical therapist at ReQuest Physical Therapy in Gainesville, Florida. Penny earned her doctorate in Physical Therapy from the University of Saint Augustine in 2012 and completed an American Physical Therapy Association (APTA) credentialed sports residency at the University of Florida in 2014. At UF she provided physical therapy services for varsity athletes from all sports. She became a Board Certified Clinical Specialist in Sports Physical Therapy in 2017. She completed a Bachelor of Science degree in Kinesiology with an emphasis in Athletic Training and a Master of Arts degree in Physical Education with an emphasis in Biomechanics from San Diego State University in 2001 and 2004, respectively. Her Master’s Thesis was on preventing concussion and dental injuries in Division I Women’s Soccer players and prevention of athletic injuries has continued to be a major focus of her career. Prior to physical therapy school, Penny worked as a Certified Athletic Trainer at the University of San Diego, California State University at Northridge, and Butler University where she worked extensively with athletes from the volleyball, baseball, soccer and softball teams. She also has substantial experience working with swimmers as she was a competitive swimmer and later spent several years coaching in the club she grew up in. Penny is an active member of the APTA, a credentialed clinical instructor, and a Clinical Athlete Provider. She has presented at national meetings on Kinesiophobia in Outpatient Physical Therapy, Differential Diagnosis of Ankylosing Spondylitis, Transient Osteonecrosis of the Femur in an Active Female, and Tibial Plafond Fracture in a High-level Distance Runner. She has also published on topics including returning to sports after anterior cruciate ligament reconstruction and fear of movement/re-injury across the spectrum of outpatient physical therapy diagnoses. She is currently serving on the committee that is developing the assessment tool to be used in physical therapy residency training as well. Penny has focused her continuing education on running gait analysis, biomechanics of the shoulder in overhead athletes, strength training for runners and youth athletes, post-surgical rehabilitation and return to sport testing protocols, and training the female athlete. She has recently become more active in building relationships between physical therapists and athletic trainers to improve the overall experience for athletes with injuries after noticing the divide between the professions was growing rather than coming together. She has started a Facebook group called “PT/AT Connection- Physical Therapist and Athletic Trainer Mentoring” that is open to students and professionals that are PTs, ATs, and dual credentialed PT/ATs where she hopes to foster inter-professional collaboration and provide mentoring for physical therapy and athletic training students and young professionals. Additionally, she recently launched her website- oPTimal-educATion.com (but it’s still very much under construction!) where she will house educational materials and resources. The blog is up and running at www.oPTimal-educATion.com/blog with posts directed at addressing some of the most common struggles that students encounter during their clinical experiences. Additional topics to be covered in the blog include building inter-professional relationships, leadership skill development, and mentoring of students and young professionals from both disciplines.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: