How To Develop Your Perfect Step By Step Physiotherapy Treatment Plan

My biggest achievement as a therapist has been building my own structured, step-by-step system. I had been stumbling around in the dark for years and finally I had clarity and then came confidence.

It can seem daunting at first, sitting down and deciding just how such a system would work. 

Today, I’ll hopefully make it all seem a little less scary. I’ll cover how you can take your existing skills, combine it with what you have learnt in CPD courses and build your own, structured step-by-step system..

Patient Problems

When a patient comes to you they don’t just have back pain. They have a problem that has motivated them to come to you. They want to get back to the activities they can’t do, whether it is running or a simple walk to the shops. It is not about the back pain. Someone is coming to you for guidance and a solution to get back to where they need to be.

I see it so often. Therapists are so focused on a diagnosis that they forget the person in front of them. But when you look at it this way and look at the person in front of you, it changes the way you think. You can start to see what you need to be successful in getting that person from where they are now, in pain, to where they need to be.

It is important to keep it simple. Do not get overwhelmed and bogged down in worrying about a diagnosis built on inaccurate tests. These tests are important but as a therapist, you shouldnt be focusing on one thing.

Your patient has a problem, they have some movement behaviours that are unhelpful in getting them to their end goal. Ultimately as therapists we need to undo those, build their confidence and help them get back to where they need to be.

This is all very simple but what skills do we actually need to implement a system and get our patients back to where they need to be?

Subjective Assessment

Your subjective assessment is held together by some key skills. Here you piece together the clues as to what is causing the problem and why it happened in the first place. You need to be able to ask the right questions, you need to set expectations and you need the authority that means your patient will trust what you say.

When was the last time you did a CPD course and spent time improving on your subjective assessment and the skills that go with it? This is module one in the mentorship and one of the most important. Most therapists are shocked by just how important this process is.

Objective Assessment

The skill here is finding out what the real obstacles are and what habits contribute to the problem. 

Think back, what courses have you done, what books or papers are you reading to improve your objective assessment? It is a crucial part of what we do as therapists so it is always worth improving on.

Communication & Explanation

It should come as no surprise that you need excellent communication and explanation skills. You can know all of the pain science in the world but it won’t make a difference if you can’t explain the problem to your patient effectively.

The amount of times I have seen a patient who has been failed by traditional approaches, and they bring along all of this information from previous healthcare specialists or therapists. I ask them, has someone explained what this means in the real world? Every single patient will say no. What they have been given is some diagnosis or long winded explanation. 

We need to pull ourselves down to the patients level not bring them up to us. Effective communication is key.

Rehab Planning

What you are really giving your patient here is clarity. You are designing a treatment plan and giving your patient a road map of where they are now and how they get back to where they need to be. If a patient doesn’t have a road map they won’t adhere to your exercise plan, they’ll lose interest and ultimately end up cancelling and never coming back. If you don’t provide that road map, it will come back to bite you.


Of course, hands-on treatment is a string tool for every therapist. I don’t mind hands-on treatment but I certainly don’t get carried away. Remember, the most dangerous number is one, one exercise, one hands on treatment, if that doesn’t work what do you do then? 

Your hands-on treatment will not give you all of the load tolerance you need. In my experience if hands on treatment will make a difference, it will help in the first 60 seconds. There will be no more value of doing a hands-on technique for a half hour session. It’s simply wasted time.

Ironically, so many therapists spend a lot of time and money improving on this area. I was the same. But hands-on should be the smallest part of the session. In the mentorship we teach a useful process to help break this cycle of endless hands-on treatment….

test – treat – retest

This way of thinking means you aren’t getting bogged down in endless hands-on treatment and short-lived results.

We have all given complex pain neuroscience explanations… It may work well with some patients but not everyone.

Today I’ll lay out clearly what to do if your science explanation fails…

Undo Adaptations and Increase Load Tolerance

If the person is a little rigid and has a pain experience you need the skills to treat that. You might use some exercises.

Personally, I like breathing exercises to assist with this. I like to get the patient from fight or flight, into rest and digest and get the diaphragm and pelvic floor moving. This will help the rib cage and will influence the pelvis which will have a positive effect on all other peripheral tissues. 

Simple skills and exercises like this will improve the pain experience, increase movement and increase load tolerance.

Higher Level Loading Progressions

Here you need the skills to help your patient coordinate their movements. Effective coordination will get them back to thoughtless and fearless movement, outside of conscious control. Ultimately you are changing their movement habits.

Within this increase of load tolerance you need the ability to coordinate and be successful on what the patient needs to do to get everything doing its job. Keep this simple. We don’t want to isolate muscles. All we are trying to do is get everything to do its job.

Strength and Conditioning

Finally, we need skills to ensure the hard work stays put. We need the patient to be resilient. When they go back to the real world, they need to be fit enough to perform those tasks they need to.  

8 Pillars

Now that we have covered these key areas and skills… What courses have you done that fit into this list? Write each core skill down and decide where you are weakest. This way you can focus on how to build and improve your system.

In the mentorship program we focus on these 8 pillars and the skills that keep them working.

There is a lot more to physio than just getting people strong. The reason there is a lot more is because the person has a problem. They have a problem doing X, Y and Z and it isn’t always about getting them stronger. It is about their movement habits and using the right amount of energy to do these tasks that they need to do. To do this, they need step-by-step graded exposure based on these 8 pillars.

Control Over Chaos

Ultimately we need a structure to control the chaos. 

The most dangerous number in business is one and it is the same in physiotherapy. One hands on treatment, or one approach is just dangerous. There will always be a time when a patient comes in and they are not responding as expected. If you are equipped, you know where you are trying to go, know what you’re trying to do and have the right information, you can be adaptable. That’s why it is important to take the best parts from every course you do and use it to create your own structured system.

In the mentorship we take the good things that you are doing and the good things from courses you have done in the past and boost it with information on each of these 8 pillars. In the end, you can build your own system. 

Final Thoughts

A great place to start is to take a step back. Ask yourself, where do you need to go with your next CPD course. Where are your weakest links and how could you improve? Will these help you build your own system?

If it seems a bit overwhelming and you’d like some help, book a strategy call today and start your journey.


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