In my 10 years working as a physical therapist and barbell coach in multiple settings, one thing follows me everywhere: confidence.
I have worn confidence in many ways. It was worn as low self-esteem and self-doubt in my abilities as a diagnostician in my early years. Coming off as stupid or disorganized in initial physical therapy evaluations to the client, my boss, and peers was a prevalent fear.
For a long time, I felt silly, disorganized, unprepared, and even unqualified to be evaluating physical therapy clients in the outpatient practice I was working at. Even though New York State literally gave me a license to practice physical therapy, I felt like I was constantly going to mess up, forget to do something, miss something, or seem disheveled when I was, in fact, supposed to be the doctor of physical therapy someone was coming to for help. I felt like my clients wouldn't succeed in the expected time frames, and they and their doctors would be displeased with my rehabilitation abilities leading to lost referrals.
With each physical therapy evaluation and treatment, though, my confidence began to increase. Clients were happy, feeling better, gaining function, and I started to see clients from the same doctors repeatedly.
When I started working with barbell strength lifters and powerlifters, my confidence, again, took a turn for the worse.
Even though I had confidence in myself as a physical therapist to diagnose and treat orthopedic injuries and surgeries, I often questioned my abilities with those challenging chronic pain injuries that barbell athletes often deal with. I felt overwhelmed by the complexities of rehabilitating sport-specific injuries and often wondered if I had enough time, knowledge, and expertise to help them have pain-free training sessions and PRs on the powerlifting platform again.
But again, with that new addition to my career, the confidence was built with time and experience.
"Information is not knowledge. The only source of knowledge is experience. You need experience to gain wisdom."
-Albert Einstein
I had all the tools. I had graduated with my Doctorate of Physical Therapy and New York State Physical Therapy License. I was full-body certified in Active Release Techniques, I received the Starting Strength Coach Certification, and I was a USA Powerlifting nationally ranked competitive powerlifter. But still, every time I grabbed my clipboard, quickly skimmed through intake forms the client had filled out only moments before as I stood outside the room to evaluate them, my heart rose up to my throat, and my brow became slightly moist.
Would this be the one where I'd miss red flags? Would this be the one where I had no clue? Would this be the one where my mind went blank?
You'd think I'd give up with all that anxiety and self-doubt. That I'd look for a simpler, easier job where clients' health and satisfaction didn't depend on me. But I didn't. I knew from my mentors, clinical instructors, friends, and professors that with time and experience, I'd fall into my zone of genius, becoming less anxious, more confident, and ultimately happier with myself and my job.
While the pressure and apprehension surrounding those first clinical encounters with new clients remain, I look at it a bit differently now. If we find ourselves without these feelings at any point, we need to check our beliefs in ourselves because it means we have stopped questioning, learning, and growing. But what I have taught myself is how to feel confident and sure of myself even in the face of new challenges and unknowns when working with new physical therapy, rehab coaching, and barbell coaching clients.
"Life can only be understood backwards; but must be lived forwards."
-Soren Kierkegaard
Over the last 10 years of clinical growth as a physical therapist and powerlifting coach in multiple settings, ultimately owning my own hybrid physical therapy practice, I've identified a few key things that lead to confidence and flow with initial evaluations.
Below is a list of six things you should implement right now to start helping you feel more ease and confidence going into both physical therapy and powerlifting coaching initial consultations.
Create An Organized & Informative Intake Process: This sets the stage for appearing professional, trustworthy, and confident to your potential new clients. It also allows you to collect as much important information as you want. This allows you to prepare and make some clinical decisions (such as referring out if it's a diagnosis you're not comfortable with or seeing a physician first to get cleared for physical therapy or exercise) before meeting with the client for the first time. By gathering a magnitude of specific information in advance, you can organize your thoughts and plan a bit of the examination in advance. This also allows you to spend more meaningful time engaging in dialogue with your client. As they say, "responses during the history-taking process provide important diagnostic information, providing 80% of the information needed to determine the [client's] source of symptoms" (Primary Care For The Physical Therapist: Examination And Triage)
Develop Your Own Systematic Approach To The Physical Therapy Examination: While they teach us how to conduct an evaluation in physical therapy school, our brains all work and organize information in their own ways. Create a roadmap of the order that makes the best sense for you to examine your clients in how your brain processes information. Write it down, repeat it to yourself five times before you go to bed at night, and look at your cheat sheet before you walk into each evaluation.
Have Red Flags On Speed Dial In Your Brain: Simply memorizing key things that require an immediate referral to the emergency room or a doctor for further investigation can save your brain the hassle of recalling and sifting through the information under pressure
Don't Be a Hero & Refer Out As Needed: Admit to yourself you don't know everything. Certain things are either a) out of your scope of practice as a coach or clinician or b) an orthopedic injury or medical diagnosis that you simply don't like or have success with. Refer out. The client and your business will thank you.
Provide Tangible Takeaways In The First Visit: Sometimes, it's hard to come up with an entire home exercise program or a complete barbell training program on the spot during the initial consultation. However, sending a client away with something tangible increases their satisfaction with the initial assessment leaving them with a feeling of accomplishment and having something to help them start working towards their goals. Something as little as writing down the key points you talked about or one or two things they can change in their daily activities helps them feel like they received immense value from meeting with you.
Design A Friendly Follow-Up Process: It's a well-known fact that people like to feel valued, appreciated, and important. Having a simple email, text, or phone template you can use to thank the client for the opportunity to work with them can often "seal the deal." See how they're doing after the initial consultation and provide them an avenue to reach out to you to answer any questions that have arisen since you were together. This creates a positive and impactful follow-up to the initial visit leading to long-term retention and positive outcomes.
You may be thinking, "this is great, but how do I even get started with all of this?" Don't worry, I have you covered. I've created a PDF workbook for you to download and walk through this process yourself. After spending 30-60 minutes with this free workbook, you'll have all six steps set up for you and be heading into those physical therapy evaluations or powerlifting consultations with four times more confidence than you had before.
When you're done, head into my free Facebook group for Clinical Coaches and share your Workbook for a PRS Clinical Coach to review!