Treatment Planning and Intervention
What you must know
Treatment planning links assessment findings to measurable goals, dose, and progression criteria. Understand tissue healing phases (hemostasis/inflammation, proliferation, remodeling) and how they set loading parameters. Know exercise prescription principles - specificity, overload, progression, and the difference between isometric, isotonic, and isokinetic work - plus mobilization grades (Maitland I–V), stretching, manual therapy, splinting/orthotic principles, modalities, and activity modification/ergonomics. Be able to write a SMART goal and justify progression or regression.
Traps in questions
- Aggressive loading in the inflammatory phase is a classic wrong answer; early care favors protection and pain control.
- Mobilization grades: grade I–II for pain, grade III–IV for stiffness; grade V is a manipulation. Questions often mislabel these.
- Modalities are adjuncts, not stand-alone cures - a plan built only on ultrasound or heat is usually the distractor.
- Splinting trade-offs: immobilization protects tissue but risks stiffness; a static progressive or dynamic splint addresses contracture differently than a static one.
- Goal wording: "improve function" is not measurable; specify activity, criterion, and timeframe.
Rule of thumb
Match load to phase and irritability: low irritability tolerates progression; high irritability calls for symptom modulation and gentle dosing. If a plan cannot state how you will know it is working, revise it.
Worked example
A patient two weeks post distal radius fracture fixation has mild edema and limited wrist AROM. Plan: edema control, gentle AROM within precautions, isometric wrist and finger work, education on activity limits, and a SMART goal ("active wrist extension to 40° within 3 weeks"). Progression is tied to pain and surgeon precautions.