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
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.