I often ask my patients what their goals are for physical therapy. Most of the time the goals mentioned fall along the lines of “I want my pain to go away” to occasionally “I want to be able to perform “X” again” with “X” referring to some specific activity (running, lifting, sitting in a chair, etc).

Occasionally, our discussion moves to what my goals are for my patients.  What I hope to achieve with our physical therapy sessions is for something much bigger than just reduction in pain. I’m hoping that all of my patients will not only have less pain, but will be able to address what is causing their pain/injury in the first place.  Oftentimes, this may be related to a mobility limitation. Sometimes it’s strength. And sometimes it’s how they move.

Basic strength is one of the easier limitations to work on because it’s something nice and measurable.  But what strength is important?  Dan John is one of favorite strength coaches with many good books and a wealth of knowledge. In one of his books (Intervention: Course Corrections For the Athlete and Trainer) he lists some basic strength requirements and movements (pushing, pulling, squat, hinge, loaded carries, and the Turkish Getup).
If you’re curious, straight from Dan John’s book Intervention, here are some good bench marks to shoot for:
Goals are listed for men (goals for women in parenthesis)

Push: 15 body weight bench presses (body weight bench press)
Pull: 15 pullups (3 pullups)
Squat: 15 body weight squats (135lb x 5 reps squat)
Hinge: Double body weight deadlift (275 lb deadlift)
Loaded Carry: body weight PER hand (85 lbs per hand)
Get up: done on each side with a half-filled cup of water balanced on your fist (same for women)

For my patients, I simplify and modify things slightly so that people have simple strength goals to work on as they recover and graduate from rehab.
I want ALL of my patients, no matter what condition or ailments they may have, to be able to do these basic movements without pain.

1. Pushing: Example: pushups with elbows in (don’t let them flare out to the sides)
2. Pulling: Example: 10 Inverted rows
3. Posture: maintain good posture under loads.  Example: farmers carries, overhand carries, etc
4. Squats: Full squat, back in neutral position, feet flat on the floor and knees in proper alignment.
5. Hinge: both double and single leg hip hinges with good form

If my patients can do a basic strength exercise that emphasizes each of the above movements without pain, I’m pretty happy with their physical ability.  If they want to continue to get better with help, I’m usually kicking them out the door and telling them that at that point they don’t need physical therapy as much as they need personal training (and of course, only with a good personal trainer who knows the importance of doing exercises correctly)

By the time my patients are done with me, I’m hoping that at the minimum they can do an exercise in each of my 5 basic categories.  These will help them work on the basic strength needs. Of course this doesn’t address everything as there may be mobility deficits and movement coordination impairments, but it’s a great start.
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