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As physical therapists, our work centers on one fundamental question: How do we help our patients accomplish their goals? Over time, I’ve found a simple but powerful framework that brings clarity to treatment planning and patient engagement. It’s rooted in human potential, inspired by mentors like Maggie, and emphasizes celebrating what patients already have while guiding them toward what they need to achieve what they want.
Every treatment journey starts with the patient’s goals. These goals can vary widely:
Climbing a flight of stairs without pain
Running a marathon
Simply getting out of bed more easily in the morning
Taking the time to ask, “What do you want to accomplish?” ensures we align treatment with their personal vision of success.
Once we know what the patient wants, we work backward. What stands in their way? Often it’s a missing piece in their movement system—limited hip extension, poor glute activation, lack of core stability, or inefficient posture. These “needs” represent the functional barriers we must address in order for the patient to move closer to their goals.
Here’s where the magic happens. Instead of focusing only on limitations, ask: What do they already have that we can build upon?
A patient struggling with posterior depression during gait may still have strong anterior elevation on the opposite side. By leveraging that available pattern, we create opportunities to improve the limited one.
Someone with scapular limitations may still be able to generate an isometric contraction in mid-range. From there, we can progress to isotonic work and combination of isotonics to expand motor control.
A patient with full passive motion but poor active control can use isometrics at end range as a bridge toward functional strength.
In each case, we celebrate existing capacity and radiate it into more challenging patterns. This shift—from deficits to resources—empowers patients and accelerates progress.
Greg once posed a simple question that I’ve carried into every treatment: If you could give this person one thing today, what would it be? That “one thing” represents the next step they need to progress toward their goal. From there, trace back to what they already have, and use it as your entry point.
Helping patients succeed isn’t just about fixing deficits. It’s about honoring their goals, addressing their needs, and celebrating their strengths. By consistently moving through this framework—Want → Need → Have—we not only guide patients toward better function, but also foster motivation and resilience.
If you’d like to dive deeper into frameworks like this, or have questions about how to apply them in your own practice, I’d love to connect.