Tools in the Toolbox and K.I.S.S.

This past week, I was reminded of a couple of simple but important concepts when it comes to giving and receiving rehabilitative health care.

A common phrase in the rehabilitation world regarding skill sets is "tools in the toolbox".  This analogy refers to both manual and diagnostic skills that therapists acquire in school and through continuing education courses.  I am all for expanding my skills and knowledge in order to better serve my patients.  But once I realized that there is no one "magic bullet" treatment that will help everybody, I gained a lot more confidence as a physical therapist.  While the possibilities for acquiring knowledge are limitless, I no longer feel that I am missing the one thing.   

Several years ago, I asked the instructor of a class I was taking about a specific manual technique. She detoured from her agenda to give us her perspective as a 35-year veteran therapist.  

"Look," she said, "I have been doing this for a long time now.  Many of these latest and greatest techniques and interventions are things that have been around for decades.  Don't forget that there is a lot of savvy marketing behind a lot of this.  Don't think that you have to spend a lot of money to become certified in this or that special technique.  I'm not saying that they can't be helpful.  I'm just saying that there's not one technique that necessarily better than another."

Those remarks have resonated with me ever since as I consider which courses I am going to pursue in an effort to make myself a better clinician.  And her advice doesn't just pertain to therapeutic techniques.  It also applies to rehabilitative devices that therapists often prescribe to their patients for home use, such as the following example.

The other day, while instructing a patient on how to perform a soft tissue technique for her homework, she asked me if a particular brand of ball (which I will not mention) is "better" than the lacrosse ball I had her using.  Her question relates to the concept that simple is very often effective. It's a ball.  It doesn't need a fancy name attached to it.  My personal feeling is that I want patients to be able to use tools and techniques that are inexpensive yet effective.  If someone is trying to convince you that their magic ball with a thousand dimples on it, or their special foam roller with spikes protruding from it will get you better faster, be leery.  I'm not saying they won't work for you.  I'm simply advising you to save you money and keep it simple.

Fancy bells and whistles often grab people's attention.  The more equipment in a gym or rehabilitation center the better, right?  The more letters credentialing a practitioner's academic achievement the better, right?  Perhaps, but don't be blinded those alone.  All the tools in the world are meaningless unless they are properly and effectively applied to yourspecific needs.  

Yesterday, I was at my local car dealership to have my car inspected.  I saw a woman ambulating past me with a cane in her right hand.  Her shoulder was jacked up by her ear, indicating that her cane might not be fitted quite right for her.  So I stopped her, and after identifying myself as a physical therapist, asked if anyone had ever properly sized her cane.

"No," she replied.

After explaining the rationale for how to fit a cane, and asking her permission, she allowed me to resize it.  After shortening it about 3 inches and handing it back to her, she said the following:

"That feels much better.  My shoulder doesn't hurt anymore.  I have been going to physical therapy three times a week for several months now, and nobody said anything.  God is good!"

My entire interaction with her lasted less than 2 minutes.  I did not lay a hand on her to perform any special technique.  Just a simple adjustment of her cane had her feeling better immediately.  This is not rocket science.  It was just Keeping It Simple by observing, explaining and offering to help.

I'll continue to pursue continuing education because it constantly keeps me focused and helps my patients.  But I have come to understand that the most important tools therapists have in their toolboxes are their observation and listening skills, their ability to effectively educate folks, and their kindness in wanting to help people feel and function better.