Complex Client: What’s Your Plan?

A lot of the clients I see have seen a number of other doctors or therapists and they haven’t improved.  We have all had that client or patient who comes in and is a train wreck.  Could be physically, emotionally or even both but they are a mess.  Sometimes they can’t even explain to you what hurts, when it hurts or really much at all about the problem other than “it just isn’t right.”

How do you handle this situation?  Do you have a system?  Do you have a plan for this?

I hope you do, otherwise your business isn’t going to be around for very long, particularly in the cash based world where people are paying for results.  They are making a conscious choice to forgo using their insurance and, rightfully so, expect to see results that match what they are paying for.

For me, the SFMA, FMS and other similar systems have been beacons of light to developing my system of assessment.  I have and will probably always be a firm believer that being a one trick pony is the fastest way to hurt yourself and your client.  I really like the SFMA as a framework for assessment and understanding where the underlying problem may be rather than just focusing on symptoms.

The FMS is a system that can be used in non-painful situations to assess how an athlete or individual moves.  There has been a lot of static via online and social media about its use, but a lot of it has been because people are looking for this system to predict outcomes which it is DEFINITELY NOT designed to do.

Both systems give you a flavor of how well a person is moving and for a skilled clinician, act sort of like an MRI of movement.  They let us see each movement in its own isolated world but don’t necessarily tell you the entire story.  These formalized assessments are just a piece of the puzzle.

I constantly tell my staff that your assessment starts from the moment the client steps out of their car, before they even know you are watching them.  In our athletes, even though they have all been screened prior to training at our facility, we are constantly assessing their movements during their activation work, dynamic warm up and of course when they are under load during power and strength training.

We also are assessing when a person is fatigued during metabolic conditioning…how does their movement change?  Do they maintain competence or does it deteriorate?

By being able to assess a client’s movement in all of these different conditions you have, in my opinion, taken the first step to assessing a complex client.   Now what about the deeper question…why are they moving that way?

The common answers would be, well, it is either a mobility or motor control (stability) problem.  Did you assess joint integrity?  Did you assess tissue quality?  Is the person in pain?  If the person is in pain, it is well documented that their motor patterns will be altered and weakened…did you take that into consideration?

I am not sure if there is one system that “does it all”, but I am sure that if you don’t have some sort of standardized system of assessment that you are behind the curve from the great clinicians and strength coaches out there.

When I started getting into the golf fitness, performance and rehab world, I went, like most of us did, to the Titleist Performance Institute certification courses.  I think what Greg and Dave have done with that program is amazing from both a clinical and business standpoint and view them as leaders.  That being said, I can’t say I use every element of their golf screening system to a “t”.  We have made modifications to tests as we feel we have found more representative tests or some tests that weren’t really affecting how we were programming or training based on our data.

What those tests are doesn’t matter.  What does matter is that I have a system in place to catch every element of dysfunction that a client may present with.

So what is your system of checks and balances?  How are you objectively assessing the elements of movement, tissue, mobility and motor control?  If you don’t have any answers to these, here are some great resources to start you down the path of discovering your better practice.  Even if you don’t use them, understand what they are and what the goals of the people who designed them were to create your own.



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