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Treatment programming and booking according to your programming should follow best judgement.
Assuming progression/improvement before knowing can lead to both yourself and clients guessing, which ultimately leads to poor booking and the client feeling a sense of "perceived indifference (3min video)"
We all know (or should know!) these simple facts about adaptation and change
1. Neural and muscular adaptations to strength training
- Neural adaptations to strength training can happen as early as 2-4 weeks (Great review here)
- However, hypertrophic adaptations that solidify these neurological adaptations occur only after 6 weeks
Take away: The first 4-6 weeks is the most important for clients who we have identified STRENGTH as a factor for recovery!
2. Habit formation principles
- "We are in the game of "behaviour change" Our intervention is only as effective as the self-efficacy of our clients
- From the research... Habits or "autonomy" of a behaviour are achieved as early as 8.5 weeks but 10 weeks seems to be appreciated as a reasonable timeframe (and this timeframe is from creating daily behaviours!!)
- Accountability is one of the main requests from our clients. This does not mean we must baby them every step, but these clients have identified that sticking to a habit is challenging for them... Use your excellent coaching ability to give them the skills to maintain their own change!
3. How long does it take to learn a new skill?
- In the clinic we TEACH clients how to move, how to exercise, how to manage their pain.
- I'm sure you have heard the "10,000 hours" rule... This study was examining MASTERS. Do our clients need to be masters? NO!
- Josh Kaufman disproved this theory and discovered that 20 HOURS is all that is needed to competently learn a skill (20min Ted talk) (2min read)
- To put this in perspective... 20 hours = 45min a day for 4 weeks, 20mins a day for 8.5 weeks, 10mins a day for 17 weeks
- When we introduce/teach these skills to clients we don't give them everything at once. Remember a good recipe requires someone to follow steps in order.
4. Recovery from injury
- We know there are certain timeframes for recovery with tissue based injuries
- During these times clients will need solutions to move, pain management, gradual loading on a more frequent basis
- Majority of studies of NSLBP and exercise occur on a weekly basis for 6-12weeks
- Cognitive Functional Therapy (CFT) studies, which focuses on making sense of pain (education), exposure with control (graded exposure to movements) and lifestyle change (exercise program) has a more client independence approach and has 8 appointments in 12 weeks or 3weeks of weekly followed by fortnightly appointments for the trial periods.
My 2 cents...
I definitely take in the above with programming for clients. However, when it comes to rebooking I have found that EPs are so conservative with rebooking.
eg. Physio's book in 2 x week for 4 weeks, Chiro's book in 3 x a week for 6 weeks and the monthly for the rest of your life (this is something I have actually heard)
I run through my filter during an initial consult
DO THEY UNDERSTAND THEIR PROBLEM?
DO THEY UNDERSTAND WHATS STOPPING THEM FROM RECOVERY?
DO THEY ONLY HAVE 1 MAJOR CONSIDERATION? (eg. co-morbidities, Hx of pain, BPS factors)
If I can answer YES to all of these questions, I can generally have confidence in the client and myself to book them in weekly for 6-8 weeks and then reduce the frequency of treatment. 6 weeks allows for...
- Initial improvements and developing intrinsic motivation to behaviour change
- Adjustments to programming if pain/condition flares initially
- Enough time in a short period to build self efficacy skills for the client
If a client is a NO to 1 or more of these (Or they are complex and I have not quite figured out what is going on) I may follow a more frequent booking strategy in their treatment plan as they require more support (or we need to communicate that we need to do more repeat testing and treatment to understand their complex problem). This could look like the following...
- 2 times in the first week, then weekly for 10-12 weeks
- Weekly for the first 6-12 weeks
- Weekly hourly appointments for the first 2-4 weeks, then 30min follow ups weekly for 6-8 weeks
We make sure to re-assess the clients situation/progress every 4 weeks at least to ensure we are on the right treatment path and they are making progress towards their goals before progressing to either
- Fortnightly
- Monthly
- Bi-monthly
- Every 12-24 weeks (health check up style appointments)
ALWAYS make sure to ask the client if they feel they are ready to progress to the above frequencies. Remember communication is key for therapeutic alliance with your clients.
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