Skip to main content

You are here

Not Seeing Progress? Here are 6 Questions to Ask. 

BRAIN FUEL 1/10/2021

We’ve all been in this situation. You look at your schedule and it's the client you just can’t seem to move the needle with. You’ve both tip toed the conversation hoping they would turn the corner.  Today, they come to you and say, “I just feel like I am not making any progress”. In this moment, where does your mind go?

“I’m failing this person”  

“I am not smart enough”

This is a pain point. This discomfort can lead to you throwing away your plan and changing course, referring out when not necessarily appropriate, or blaming lack of progress on the client to protect your ego. All of these stunt growth and limit our ability to solve the problem. Rather than letting emotion take the wheel,  we need a prefabricated plan. A template to use this pain as a stimulus for better problem solving and accelerate clinical growth. 

We need an internal audit protocol. ⁠⠀

Here are the hierarchical questions I ask to audit my process. ⁠⠀⁠⠀

1. What factors may be interfering? ⁠⠀

  • What is the probability that we are limited by a physiological process that we cannot influence? ⁠⠀
  • Is the “rate limiting step” time dependent? (i.e healing process) ⁠⠀
  • Is there a precedent for typical recovery time? Are we still within that window? ⁠⠀
  • Are there certain behaviors/occurrences outside of our plan that need to be modified if able?⠀

2. Is the plan we set out being executed appropriately?⁠⠀

  • Is the client adherent to the plan?⁠⠀
  • Is the way they are performing the plan doing what it is intended to do? ⁠⠀

3. Is the dosage correct? ⁠⠀

  •  Is there a chance we are over or under dosing?⁠⠀

4. Is the stimulus we are applying doing what we intended it to do?

  • What key performance indicators have changed? Which have not? ⁠⠀
  • Is there another way to apply this stimulus that may be more effective? ⁠⠀

5. Is the stimulus we are applying the appropriate stimulus⁠⠀

  • Based on new information is the initial plan still appropriate? ⁠⠀

6. Is the management of this issue within my scope of practice or circle of competence? ⁠⠀

  •  Do I know of someone with more experience managing these types of issues⁠⠀

Creating a protocol to lead us through discomfort can help to set the path to growth. We must be consciously aware of the shortcomings of our emotional and reactive initial response and pre-emptively create strategies to manage this. Get comfortable sitting in uncertainty and pain, it is fertilizer. ⁠⠀

⁠What is your process? What questions do you ask yourself? 

- Dr. Anthony Iannarino, Rehab 2 Perform

physical therapy, CEU, Sports Rehab


Fuel Up

Podcast: PT Pintcast: Behind the Scenes on Project 11 The Alex Smith Story

  • PT talk with a pint! Former radio host turned PT Jimmy McKay sits down with Johnny Owens and Larry Callahan to discuss BFR research for Cardiopulmonary disease and the remarkable rehab process of NFL Quarterback Alex Smith. 

Article:  Returning to Exercise After COVID-19- Alex Hubelbank via mikereinold.com

  • Not a peer reviewed article this edition, but this blog post is too pertinent and too high of quality not to share. Through her personal recovery process,  Alex does a phenomenal job of outlining the current recommendations for scaling exercises following a COVID-19 diagnosis. 

Book: Thinking in Bets: Making Smarter Decisions When You Don't Have All the Facts. By Annie Duke   

  • The quality of our outcomes are predicated on two things: Luck and the quality of our decisions. Professional poker champion turned business consultant breaks down the art of making decisions when we have incomplete information. This book carries huge practical applications to decision making in the clinic, gym, or life in general.

Social Media Follow: Dr. Andy Chen  (@Dr.AndyChen)

  • Andy is a hungry young clinician who gets it. His page is an excellent blend of clinical pearls, big picture thinking, life as a young PT in NYC, food, and dogs. In his mission to make adults more athletic he is providing great insights into our own innate resiliency and the power of pushing your clients to the edge of what they believe they can do.