The Clinical Coach: Building a Successful Treatment Plan

You didn’t think I’d forgotten about our newsletter did you, ?

Last week I was out of town on vacation in Destin, Florida. Beautiful area. I was able to spend some time in the beach and I was able to catch up with my good friend Dr. Cutchins, and meet his wife, and his brand new (1-month old) little baby girl!

She is precious! Dr. Cutchins is a blessed man!

Our conversation brought up a few good points that will most likely make it into one of our upcoming Performance Doctor segments.

But for now, I want to have a serious conversation about treatment plans.

Since I launched the Certified Dry Needling Practitioner course, one of the most asked questions is:

“How do you build a treatment plan?”

My response:

“Every treatment plan is different, based on the techniques you are familiar with, your approach to care, and your patient’s presentation.”

To this day, I still believe that is true.

You can’t recreate the analgesic response of dry needling if you don’t know how to needle.

You can’t recreate the petechiae response from IASTM with ART.

You can’t recreate the neurological signal from an HVLA with a simple joint mob.

You can’t develop a rehab plan, if you are not familiar with applied biomechanics, movement patterns, tissue adaptation principles and most important strength and conditioning principles

If your sole practice is adjusting I am not going to judge you, but there’s something missing in your patient’s care.

If your sole practice is soft tissue… the same.

If your sole practice is movement rehab… you guessed it, you are also missing something.

But it’s okay to specialize in one area. Just don’t fall for the false idea that your specialty alone will be enough. It rarely is.

How to develop perfect treatment plans?

In short… There’s no such thing as a perfect treatment plan.

There will always be hiccups in your care, there will always be something that doesn’t fit.

However, that doesn’t mean you can’t build highly successful treatment plans time and time again.

How do we do that?

Simple, by following the three main treatment principles:

1. Perception

2. Function

3. Performance

Let me tell you a little secret.

Your patient doesn’t care about pain science.

They don’t currently care about ‘hurt doesn’t equal harm’ nor do they care about the analgesic response of the needle via opioid receptors in the brain. Leave this for a 30 second goodbye at the end of the office visit.

The only thing they care about is whether or not you can currently help them.

Sure, they may ask about how is the needling/adjustment/rehab going to help them. But until they do, refrain from over explaining pain science to your patient.

Perception → Function → Performance

Perception is the foundation of a highly successful treatment plan.

No, you are not selling, convincing, or manipulating your patient into an overly expensive or unnecessarily long treatment plan.

No.

You are changing their pain perception.

Here’s where majority of your passive modalities are going to shine, and it’s where I believe Dry Needling is outmatched (at least it has been in my office).

By changing patients pain perception we begin to open the window of the analgesic response. Typically seen almost immediately with dry needling, but also achieved with IASTM, analgesic creams, and some movement therapies.

The reason movement isn’t a priority at this time, is because 90% of the time patients aren’t able to get into the positions you cue them because of fear, uncertainty or flat out too much pain.

In their head, they want the pain gone before they get into a specific position. Don’t blame them, they are the ones experiencing it.

Therefore, the first thing we need to do is decrease the painful stimulus.

Here’s where you start building rapport with your patients, they begin to trust you.

As the pain subsides, you now have the opportunity to improve the function of the region.

Perception → Function → Performance

Here’s where HVLA, mobilizations and even some movement therapies like McKenzie shine.

HVLA and mobs are also considered passive modalities by most practitioners. They are not wrong, but they have a lot more joint/muscle movement than dry needling, IASTM, ART, cupping, Laser, etc.

Now, whether you elect to use MPI, Diversified, Gonstead, Graded Mobilization, Mulligan Mobilization etc…. that’s going to be based on what you know.

Now that you have changed the perception of pain, improved the patient’s function, it’s time to manage their performance.

Perception → Function → Performance

Yes. It’s time to apply some biomechanics, rehabilitative and strength and conditioning principles into your treatment plan.

This is the MOST important principle in your treatment plan.

You can manage pain all day long if you wanted to.

You can improve the function of a joint/muscle as much as you want to.

If you aren’t improving the performance of the system… your patient’s improvements are limited.

I guess if you want a patient that comes back to you for the same issue time and time again, it’s not a bad business model…

But I know that’s not what you want.

I’d wager that 100% of our readers, like yourself, really want to create a difference in your patients lives.

Managing pain and improving joint function are the easy principles in building a treatment plan.

It’s no wonder why so many of our peers have stopped here.

Managing performance is not as black and white as text books would like you to believe. If you are not familiar with the difference between a body weight squat, a front squat, a low bar squat, and a competition squat, maybe you should refer out to another practitioner that does.

If you aren’t familiar with conditioning tissue to create a specific adaptation, maybe you should refer out to another practitioner that does.

That’s okay! You are doing your part so your patient has the best chance to excel.

This is the where 90% of clinicians fail their patients.

The amount of patients that I have seen, that have told me:

“My chiro told me not to run because my muscles don’t fire.”

“My chiro told me to not move my scapula this way/that way.”

“My chiro told me deadlifts are going to give me disc bulges.”

“My chiro told me to avoid lifting weights because of the shape of my back.”

“My chiro told me to just keep doing what I am doing, but my pain is still there 6 months later.”

These are doctors that don’t understand tissue adaptations, rehab or performance principles, and in my opinion are doctors who are not providing their patients with a full solution… or as many like to claim in their websites and instagram posts: a holistic approach.

If you aren’t familiar with improving your patient’s performance, that’s okay.

You can develop a network with like-minded clinicians where you can refer patients back and forth and help them be more successful.

If you are an adjusting only clinic, find a soft tissue specialist and a rehab specialist.

If you are a soft tissue specialist, find an adjusting specialist and a rehab specialist.

Find a way to work together.

I am aware that there are many business owners/clinicians who are afraid of other clinicians stealing their patients.

This is why it’s important to develop a relationship with other clinicians!

But that’s a post for the future.

Now you know exactly how to develop a successful treatment plan.

The timeline of events is where I’ll be expanding more in our upcoming posts as this tends to be different between patients, pathologies and dysfunctions!

Until our next issue!

In health and strength,

If you are ready to level up your skills here’s how I can help:

1. Join over 260 Certified Dry Needling Practitioners and enroll in our upcoming Certified Dry Needling Practitioner cohorts.

2. Elevate your diagnosis, treatment and rehab skill for upper and lower extremity conditions. Enroll in one of our Extremity Rehabilitation Masterclass.

3. Become a SmartCARE member and stay ahead of the curve with our on-demand lectures.