Clinical Management: What Impairments Should You Prioritize First

Happy Monday everyone, and welcome to the next episode of the podcast.

I’m your host, Dr. Scott Gray. And so today I think I’ve got a pretty great podcast of information that I’m going to share.

Over the weekend, I was talking to some different clinicians and it came up, you’ve got all these lists of impairments and things that you need to get done, but what do you prioritize and attack first?

And I know I struggled with this going on as a young clinician, but as I gained more experience, there’s really a way you need to prioritize them. And so I guess we’ll just attack them one by one.

So the big things, obviously, if their tissue reactivity is so high and they’re in pain, obviously you have to prioritize that because the patient wants to be out of it.

So you do have to address it, even though I don’t like talking about that and doing that a lot of times.

When it’s just they’re not sleeping at night and they’re just miserable, you have to go after that and just calm that stuff down.

So I’m not going to really discuss that part because there are many different tactics and ways to do that, but let’s say you get someone who’s more subacute and tissue irritability isn’t really an issue, but you’ve got all these different impairments.

They’ve got knee, back pain, shoulder pain. Where do you go, right?

And so the big thing I would say is you need to attack one of the joints or multiple joints of the thoracic spine, the hips, or the feet.

And so the reason why is because if you look at the human body, in most cases, at least, the foot or the hip are going to affect the knee, which is a common complaint, right?

If someone has hip pain, chances are there’s something going wrong with the hip. If someone has foot pain, it’s usually a foot issue, whether it be the ankle, the subtalar joint, the midtarsal joint, the first ray, or it’s a hip issue.

Now, if I have someone with lower back pain, it’s usually a hip or thoracic spine issue. And if I’ve got someone with a shoulder or neck pain, it’s usually a thoracic spine or scapula issue, or something along those lines.

So that’s the first thing that goes through my mind is, “Okay, what are the big key areas I can address that are driving and influencing this joint or area?”

And so it’s usually the hips, the feet, or the thoracic spine in some form or fashion.

And from here, you need to address the joint, and so I say joint over muscle and tissue, because if you don’t have adequate joint mobility or there’s this function in that joint if it’s hyper-mobile and the joint’s irritated, then… Because the joint rules at the end of the day, right?

It gives off a ton of proprioceptive feedback, and a muscle can’t function if a joint isn’t functioning and having normal motion.

So those are the things that go through my brain when I’m prioritizing clinically what do I need to address here right now? And at the end of the day, it’s usually the hips, the feet, or the thoracic spine.

They have some sort of dysfunction that’s influencing it for a subacute patient. And then from there, I’m going to attack that joint, whether it be manipulation…. It might be exercise and stability stuff if that joint is hyper-mobile.

So I hope that helps. That’s part one, of what goes through my mind clinically when I’m addressing these things and prioritizing, where do you go with treatment?

What do you want to address first?

And then from there, you can address other impairments and things, but you’ve got to get the hips, the feet, and the thoracic spine moving optimally and well to take the pressure off the most common things that we see at the clinic.