Progressing Your Patients Step By Step

Today I’ll be sharing the idea of constraint based physio and some key points to help you effectively progress your patient from session one. Read on to find out more…

The Power Of Constraints…

What happens when you put constraints on yourself, whether you’re a sports physio, physical therapist, manual therapist or any healthcare professional your attention becomes more specific. Everything you do is to help your patient progress to the next step.

If a therapist isn’t focused on building and progressing their patient to the next step it can easily get overwhelming. They begin to worry about the thousands of things they don’t really need to think about yet…

Here Is An Example For You…

Take a rugby league player. They come to you with knee pain and their main goal is to get back to playing rugby league.

The first thing you ask yourself is, what are they going to need to do in their world and back to their goal?

  • Change directions
  • Accelerate – At 110%
  • Deccelerate

I see it a lot in the mentorship. A therapist only sees those and they lose their attention. But in this constrained approach that we teach in the Go-To Mentorship we focus on just going step-by-step. You’re not going to get your patient to accelerate at 110% from session 1, but you don’t need to. Your focus should be on a step-by-step progression.

To make sure we are sticking to the process and don’t skip a step we can use some Key Performance Indicators (KPI) to help us along the way.

Session 1

Back to your knee pain patient… What do we want to find out first? Well the first thing is to split our attention using the 80/20 rule.

We know that the knee is overloading and so we can spend 20% of our time applying hands-on treatment. But 80% of our time we want to be finding out why. Why is the knee overloading in the first place?

We know that the knee is overloading and we will address that with hands on and other methods but the 80% is the WHY? Why is the knee overloading in the first place?

So your first big KPI is restoring full range of motion. This is your 20%. Then for your 80% you want your patient to be able to tolerate some baseline level of loading in the direction that isn’t doing its job properly.

The key with this first session if you don’t overwhelm yourself and you don’t overwhelm the patient. Give effective explanations as to why we are working on certain things and how that will relate to the next session. From there you can see a clear line of progression, in a logical step-by-step manner

Session 2

In session 2 we want to go back and check our KPIs. If your patient has kept the progressions gained last session then great…. but if they have lost that range of motion again then this can be an alarm bell. You then have to ask yourself if you have found the true stressor or has the body gone back to the same habit that led to pain in the first place.

In the first session you may have had your patient loading in a very slow and controlled manner. The next we might get a bit more dynamic. Then when we go to our hopping progressions, we’re gonna really want to bias that direction.

30 Minutes

You should find that 30 minutes is more than enough for a session. You should give your patient one or two exercises to solve a problem. The exercise should be a solution to a problem that you’re finding clinically. That way you’re not just hoping something sticks.You are giving them a solution to something you have found in your assessment and they should understand why they’re doing these things.
By the fourth or fifth session and in every session you should see that your patient is progressing. This is a great position to be in. You know what you’re doing and where your patient needs to be, giving you confidence and clarity.

The great thing about these progressions in private practice and pro sport is it is quick. This step-by-step approach lends itself to quick progression. So, your intention with that first session is to restore the full range of motion, desensitise and find the true stressor.


Take a back pain patient…. When you go through the slump test and you get a positive response, rather than thinking about the nerve we should think about what is influencing that neural tension.

But what has to happen in a slump test? We need ribcage depression. We need the diaphragm to lengthen. We need the intercostal tissues at the back of the rib cage to lengthen. We need the iliocostalis which attaches from the rib cage to the triassic lumbar fascia to lengthen. So if you desensitise those issues that slump will change and we take away that tension.

Rather than focusing on the lower back, all I’m focusing on is our KPI. We can take away the tension, get your patient relaxed then move onto the next thing.

Next session you’ll come and check the slump test again. If we have kept the gains then we may just have a little more to do. My rehab program is teaching my patient how to maintain the gains.

Final Thoughts

Every session it is important to be using your KPIs. Having this step-by-step progression is very powerful. It allows you to focus and have one clear objective per session. Once you get that the next session you have a new goal.

Click here to learn more about the Go-To Therapist pillar method

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