Are you struggling to get more shoulder patients onto your schedule as an occupational therapist?
Are the physical therapists hogging all the shoulder patients in your clinic?
Do you want to get patients that come to you as the Occupational Therapist in your clinic with general complaints of shoulder pain without accident or injury?
I want to share my framework on treating patients with shoulder pain and the “soft skills” that are often forgotten in the hands-on techniques.
(If you are looking for shoulder CEU courses or want to develop your skills with shoulder patients, get the details of our hand therapy mentorship program)
Patients may present to your clinic with complaints of shoulder pain, limited range of motion, and even feeling like they have no strength. Not only are they in pain, but they are confused about what to do to get rid of their pain and limited function.
Patients may present to your clinic without a script, accessing your services as a direct access patient if that is allowed in your state. Or they are coming to seek your services as a direct order from a physician.
Regardless of how they come to you, as the expert Occupational Therapist, you need to be able to provide an evaluation that lets them know you can help, a treatment that gets rid of their pain and explain all of this in a way that they understand.
When patients are clear about what is wrong and how you will help them, that’s when they buy into your plan. They will want to return to you, giving you a chance to work your magic skills to help them return to complex occupations such as working out or as simple as putting on a bra.
Here’s my framework of how I train my occupational therapists and students to evaluate and treat patients that come to our clinic – no matter how much or little experience they have with treating shoulders.
Evaluating in a way that gets buy-in from the patient.
After the age of 40, people start having more wear and tear of shoulder tendons and feel the years of imbalances beginning to catch up with them. People who are “too tight” and don’t have enough motion can show up with shoulder pain. Hypermobile people will have shoulder pain for a whole other reason.
You can go into your general questions of history and injury. But don’t think you have to “ask questions in a certain order”!
Let’s think about the type of patient that might be coming to you with general shoulder pain. They might be a younger person with good motion. They might be an active person who is fit and loves playing golf, but now their shoulder pain is not allowing them to play. They might be an older adult who is less active. You will need to change your questions and the order of your questions based on the type of patient you have in front of you.
Our evaluation and questions that get buy-in come only when we ask great questions that let the patient know that we know what they are going through and that we have seen this before!
One of the easiest things I do is watch them from the minute they come in and observe how they move, which hand they write with, or how they reach. From there, I can start to ask.
Example:
“Tell me, what’s going wrong with your shoulder?”
“Based on what I can see already – you look like you have great motion – but let’s take a look at how your arm moves in all directions, and I want you to tell me which direction hurts you the most. I will also be doing certain tests to see what bothers you most and find your imbalances.”
Another significant way to get buy-in from the start of the evaluation is to PREDICT where they will hurt and tell them.
Example: “Based on what I see already and what you have told me, normally bringing your arm out to the side with rotation may produce a sharpness in pain, so go slowly up and stop before you have pain.”
When they say, “wow, how did you know that was going to happen?” that is you showing your expertise.
By speaking to them like you know their problem and have treated this before so much that you can predict what’s going to happen – you will get buy-in from your patients even before starting any treatment.
Start with broad questions and then narrow them down based on their answers. Make the questions relevant to them. And I also recommend you explain why you ask specific questions so that they understand why they have to share so much information with you.
People who know, like, and trust you from that first initial visit, will come back to you time and time again. They will allow you to share your skills and expertise.
Treatment that will get them asking to be with you.
Many of you may have just started your career in hand therapy, or you may be more experienced – but no matter what, we KNOW a lot more than our patients, and we forget that they don’t know as much as we know.
Too often, we use insider language and take for granted the amount of knowledge that we have. I promise that even if they are medical professionals or a therapist themselves, they are at your clinic and you still need to treat them as someone who is seeking your expertise.
After the evaluation and you have determined…
YES! – you have signs and symptoms of shoulder impingement.
YES! – you have signs and symptoms of shoulder tendinitis.
Whatever you determine, you must explain what they have in a way that they understand.
People are confused! But the doctors said I have “THIS,” and I looked it up on Google, and I think I have “THIS.”
This is a sign of confusion. They are asking you, as the expert, for answers without always asking you directly. Again, when you can predict where they might be confused and tackle it before their flood of questions, it will allow them to see you as someone who knows more about them and their injury.
Example: “When I see clients that come in with shoulder pain just like you, most people are confused or unsure about what happened and why…let me explain what I have found and our plan to solve your problem.”
In school, we are taught to include our patients in the treatment plan. In practice, we may have forgotten and often tell them what to do. This just leads to our frustrations that patients are not doing their home program. When they don’t do them, and they don’t get better, they think that therapy doesn’t work.
I coach my therapists to ask this one key question. I want to know what kind of help my patients are looking for. “What is the one thing you want out of your therapy experience…do you want me to help you just get rid of pain, or do you want me to help you get rid of pain AND also give you the best chance of this problem not coming back?”
Most will pick the latter and want not to have this problem come back. Great! “Since that is what you want, I’m committed to helping you achieve that goal, and I’m going to need your commitment as well.”
At each session, this is your opportunity to remind them in different ways of their commitment to themselves that they want lasting changes. I’m NOT a fan of 50/50. You give 50%, and I give 50%, so what? Are we half-assing it?
No! I’m as committed as you are, and that’s at 100% me and 100% you.
This commitment that they make will increase the likelihood that they will show up for their appointments and ask for you every time. This will allow them to get the outcomes that they want.
Getting the outcomes.
Let’s face it. We can ask great questions, we can get buy-in, but what we need are outcomes.
People who come to experts want to know “Will this get better?” and “How long will it take?”
The better we can get at answering these questions, the better our outcomes.
For example, “Based on what I saw at the evaluation, and you said you are committed to doing the movements that I need you to do, YES (give them a solid answer), shoulder impingement is something that can be solved with therapy.”
“How long this takes can depend on what you can do on your own in conjunction with coming to your therapy appointments.”
Often, we can find that shoulder impingement or shoulder tendonitis are due to imbalances due to tightness of certain anterior shoulder muscles, weakness of the rotator cuffs, and imbalances of how the posterior muscles activate.
There are too many techniques that can be used to help someone with shoulder pain, like manual treatments or exercise-based treatments—even various modalities like tools and tapes.
Whichever technique you pick as your specialty skill, do it with confidence. Explain to your patients why this works for them. And always remember who your patients are and what they want, not what you want.
In conclusion, this framework on treating shoulder pain allows you to know how to approach your patients at evaluation, treatment and get the outcomes that your patients ultimately want from you as the expert occupational/physical therapist.
In an age of information overload, quick fixes, and confusion, we need to remember that the people who need our help are human beings seeking connections to someone who cares about them. These are often skills you possess already and might have forgotten due to the fast-paced world we live in.
Apply this approach and increase your chances of having more patients come to you for help.
You, as the hand therapist, need to know which is which intimately… so that you can effectively manage your treatments, manage your expectations, their expectations, and ultimately get the best possible outcome.
If you are working alone or even if you are working with others but want that extra guidance…attention to help you critically think through and case, and make decisions about what to do next, grab the details of the Hand Therapy Mentorship program. Sign up today to get all the details!
