Reading Your Audience: Determining your Treatment Approach for Each Individual
by Ryan Darling (RMT, R.Kin, CSEP-CEP, B.Sc, M.Sc. Kinesiology)
A health history is a vital component of your initial assessments with new clients coming to you for help. It is a critical time to gain insights into their physical health history, acquire information on the injury cause, duration of discomfort and other activities they may have attempted to resolve it. But, more importantly, the initial health history is an opportunity for you as a therapist to learn other, potentially more subjective details about your client.
We have likely all had the all-or-nothing, "no pain, no gain" individuals walk into our office. They have told us about how they have attempted to mash, stretch and strengthen their injured area into oblivion to make it better. Conversely, we have also likely seen the overly cautious, fear-avoidance type individuals who tell us (if they're honest with themselves and you) that they are slowly becoming agoraphobic toward anything they even think might remotely negatively impact their symptoms and potential maintenance and/or progression of their issue.
Neither of these individuals’ approaches will lead to improvements in their ability to recover from the issue. The former will likely be adding further stress inputs to a tissue that could very likely be in need of proper rest or low threshold approaches. The latter is too afraid to input any form of stress and therefore will only allow the area to likely continue to de-condition further and potentially become more pain-sensitive.
In both cases, carefully selected questions for each individual can help you determine into which camp they fall and as a result, direct your approach to their treatment plan. This will also inform the client education that you may provide to them. The former will likely need to be taught about tissue capacity/recovery principals and concepts and ideas pertaining to the need for rest to allow for proper recovery and adaptations to occur to remedy the issue. The latter, may need to be taught more about what pain really means (hurt vs. harm principles) and the need for stressful inputs to be provided in a controlled manner. By doing so, it can both reduce tissue sensitivity and also allow for exercises to have a training effect and improve the tissue’s capacity - which could be the reason for the discomfort in the first place.
The key tool in this process is to listen intently to your client as they describe their situation. Allow the client to tell you what they want to tell you; what they deem is important information to you. Your questions should not direct, but rather seek more detail or clarification on the information that they are providing to you during this initial meeting. Opportunities for teaching or challenging beliefs will come later, but in this initial session it is vitally important to show the client that you are genuinely interested in hearing what they believe to be the issue and important details. This will allow you to develop the rapport that will be necessary to challenge their (potentially long-standing) beliefs surrounding how they need to go about recovering and improving the situation that brought them to you. This may occur later in the session and in on-going future follow-up visits.
This is not to say that rapport will be developed in one appointment. But, it is to suggest that first impressions have a lasting effect. Take advantage of this first appointment to make sure your client knows that you value their role in the treatment process and it will undoubtedly lead to more successful outcomes for your clients and greater job satisfaction for you.