Keep it Simple Stupid: KISS Therapy

Before you guys get all excited sorry I didn’t come up with a new fad therapy that involves kissing….but there is this……

What the F*** did I just watch???....people make money doing this and I’m over here scraping by to pay off my student loans?

And no I’m not going to recommend playing KISS music in the background of the clinic to subliminally message your patients into getting better. 

We've all heard of the K.I.S.S. (Keep it simple stupid) method before. It implies a certain degree of applying the use of common sense to solve problems instead of the much more heavily utilized approach of over thinking issues. It can come off a little rude and sound harsh, but there is merit to having your ego checked and a little bit of grounding occasionally.

The longer I'm a clinician and the more I learn I have come to the realization just how true this may be in both the fitness and rehab realms. There are certain basic and foundational principles that are paramount in training and treatment. These principles regress down to the basic sciences and relationships. For some reason we tend to have the desire to pad our ego by demonstrating how "smart" we are with minutiae of variables that don't bring near the value of basic core principles. There isn't anywhere this is more prevalent than in the newly minted clinician or personal trainer. I regularly work with students and for the most part they all have a burning desire to be great. I love the passion and it's what lead me to clinical instruction. However, the burning desire to be great fuels a mentality that every in single session exercises need to be dramatically different than the past, that we have to have these laser precision eyes that find the smallest of faults and restrictions, and that we have to get that patient well RIGHT NOW. However, this simply isn't true.

Following the theme of this post I'm going to keep it simple as well. How can we re-frame our outlook through the KISS lens? It has been said that experts are masters in the basics. So keeping the theme up I'm going to give a few examples of the simple principles that should guide the bulk of your patient/client interactions.

Build relationships with people. A large portion of how a patient responds to treatment is dependent upon therapeutic alliance and the relationship you have with your patients. Hell, if people don't like you what are the odds they will show up for their treatment or training session? Furthermore, there is actually research that proves the same exact intervention applied by someone with a better relationship with the patient has significantly improved outcomes. Adam Meakins has written a killer post on this here.

When thinking about therapeutic exercise and treatment selection remember basic laws of science such as Wolff's and Davis' laws that simply state that tissues accommodate to loads applied. If you overload tissues under the tissue failure line you will have positive adaptation. Conversely, if you under load tissues below the maintenance line you will have a negative adaptation and atrophy. The tissue homeostasis model should lay the ground work for your thought process in choosing interventions. Scot Morrison has written a great post on this here.

  

Keeping in line with the previous thought, realize that most people just don't move enough and simply getting them moving is adequate. No bells, whistles, fancy functional movements, or movement screen necessary. Help their tissues and nervous system remember what they were made to do. Move. We know that motor control, stabilization exercises, and manipulations are no better than general exercise in non specific low back pain (the majority of what we actually encounter). Your exercises don't have to be fancy balloon blowing, TA contracting, Turkish get up complicated choices that no patient could ever remember how to do at home. Stick to basic movements first and see what happens. Have people move in non-painful ways, improve their body and spatial awareness, and maybe just not be stagnant.

On the other hand, some people move too much. Simply decreasing their load is often enough. The runner who ramped their volume too fast and ended up with an overuse injury just needs to heal and progress load at a slower rate to allow for tissue adaptation. Help them cross train to off load tissues, help them strengthen their system so it can tolerate more stress, or make small changes in mechanics not because they move "poorly" but instead just to help them move differently.

Some people know what to do, they just need accountability. Be their coach, not their healer. You don't have fix anyone, but instead coach, empower, and help individuals take ownership in their own process of healing or improvement.

Special tests aren't that special. Take the time listen to your patient and hear what their complaints are. 80+% of your diagnose will come from a good history. This will often lead to improved therapeutic alliance as well due to the fact you may be the first who has actually listened to your patient's story.

Last but not least gain a basic understanding of pain. Remember that pain is an output from the brain not and input from the body. Remember that pain is based or real or PERCEIVED threat, and that pain can be practiced. The more you have pain the better you may become at generating it. Just like a motor program that becomes very efficient with repeated practice and painful neuro tag can function in the same manner.

If you can do these basics well your effectiveness as a clinician will far surpass the effectiveness you will gain with any specific fad treatment, modality, tool, or injury prediction screen. Try not to put the cart before the horse and buy into all the marketing buzz of the ever changing fads. Focus on the basics until you inherently apply them naturally. Join the simple minded team with me and just K.I.S.S.

Thanks,

Jarod Hall, PT, DPT, CSCS

 

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