Despite the growing amount of scientific evidence supporting exercise as an effective rehabilitation intervention for clients, translating that research into practice has proven challenging for clinicians. The result is that clients aren’t having their impairments appropriately assesses for the best object outcomes. Rather, clients often guide the progress based solely on their subjective biases. In more extreme cases, we see individuals who need intervention to assist with their impairment who are turning solely to exercise and attempting to rehabilitate without the guidance and skill or a licensed therapists.
It is time for a reset.
We must translate evidence-based rehabilitation into daily clinical practice to ensure that all clients receive adequate, intense, and progressive exercise rehabilitation.
Building on concepts taught in “Fundamental of Precision Therapy” course , this 2 day course furthers the step-by-step approach for therapeutic exercise dosing and delivery by adding precision design concepts for the upper quadrant. As hands-on professions, practical lab components using real clinical scenarios are mixed with interactive discussion-based lectures for skills that can be applied right away in the clinic. To help therapists build advanced clinical reasoning skills in exercise prescription, therapeutic exercise design is taught with an emphasis on the “why”, “how”, and “when” rather than on specific exercises. Hands-on skills for the clinical application of hand-held dynamometry in comprehensive assessment, documentation of objective strength measures, and precision exercise dosing are practiced and mastered.
We urge clinicians to move beyond symptom moderation alone, and this course focuses on delivering clinically meaningful improvements to clients in all 4 outcome domains: symptom moderation; impairment correction; subjective functional performance; and objective functional performance. Further, we teach a systematic structure to the order of interventions provided to a client within one session as well as the progression from session to session.
Our framework, the MET MET-odology, is a contemporary development of medical exercise therapy concepts introduced by Oddvar Holten. It does not replace your current treatment practices (the tools in your toolbox), rather it provides structure to them (your very organized toolbox).
Topics: hand-held dynamometry, exercise prescription, exercise design, optimal improvement, 4 outcome domains, upper quadrant
- Apply the 2 guiding principles of the MET MET-odology in therapeutic intervention selection for the UQ.
- List 3 factors to achieve optimal patient improvement.
- Develop 1 UQ treatment session plan.
- Recognize 3 factors from the clinical interview which help create patient buy-in into the treatment plan.
- Identify measurement tools for the UQ to achieve meaningful improvements in 4 outcome domains.
- Apply the 4 training principles to therapeutic exercise prescription for the UQ.
- Apply the biomechanical concepts of torque and length tension in therapeutic exercise design for the UQ.
- Operate a hand-held dynamometer (HHD) in 1 biomechanical examination for the UQ.
- Execute Clinical Fatigue Tests (CFT) in 3 clinical scenarios for the UQ.
- Interpret the results of the CFT to appropriately dose 2 therapeutic exercises for the UQ.
- Design 1 precision therapeutic exercise prescription for the UQ.
All modules are a combination of lecture and lab.
07:45 AM Registration
08:00 AM Introduction; Pre-course reading discussion; Clinical Scenarios
09:00 AM The MET MET-odology: Review and updates
10:00 AM Break
10:15 AM Optimal Patient Improvement for UQ
– Change the story
– Outcome domains (Symptoms / Impairment)
12:45 PM Lunch
01:30 PM Optimal Patient Improvement for UQ
– Outcome domains (Subjective and objective performance)
– Training principles
03:30 PM Break
03:45 PM Design considerations for UQ
– Biomechanical considerations
– Functional Integration
– Tissue response
05:30 PM Adjourn
07:45 AM Check-in
08:00 AM Design considerations for UQ
– Muscle bias tests for UQ
10:00 AM Break
10:15 AM Dosing considerations for UQ
– Dose the weak link in the movement pattern
– Dosing for Symptom moderation and ROM
– Exercise-bias tests for UQ and CFT
12:15 PM Working Lunch – Clinical Scenarios (shoulder, elbow, wrist)
01:00 PM Delivery considerations for UQ
02:00 PM Revisit Clinical Scenarios (practical interaction)
03:00 PM Post- course interaction / Q&A
04:00 PM Adjourn
Course reading materials provided by MET following registration.
- Osteras H, Torstensen TA. The Dose-Response Effect of Medical Exercise Therapy on Impairment in Patients with Unilateral Longstanding Subacromial Pain. The Open Orth. Journal, 2010, 4, 1-6 1.
- Rosa DP, Borstad JD, Pogetti LS, Camargo PR. Effects of a stretching protocol for the pectoralis minor on muscle length, function, and scapular kinematics in individuals with and without shoulder pain. J Hand Ther. 2017 Jan – Mar;30(1):20-29
- Stasinopoulos D, Stasinopoulos I. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. J Hand Ther. 2017 Jan – Mar;30(1):13-19.
- Thomson S, Jukes C, Lewis J. Rehabilitation following surgical repair of the rotator cuff: a systematic review. Physiotherapy. 2016 Mar;102(1):20-8.