Physical therapists come in many flavors, and it can be challenging to figure out if your therapist is a good fit. It was interesting and informative to read this article by the NY Times that describes qualities to look for (and some qualities to stay away from!) in a PT. One common misconception in the public is that one size fits all, that PT either works for someone or does not. This is certainly not the case. Sometimes, there is a personality clash in which the therapist and client simply are not a good fit for each other. Other times, the therapist might not be utilizing the best treatment options, or might have difficulty with empathy, critical thinking skills, or other factors that can determine therapeutic outcomes. And of course, sometimes clients do not “buy in”, do not participate in the prescribed exercises, and perhaps may not be ready to make substantial lifestyle changes. All of these factors will determine whether the therapy is successful or not. A strong therapeutic alliance between practitioner and client is required, and the best way for this alliance to be created is for the client to have faith in their therapist.
Here are some qualities to consider when embarking on your therapeutic journey. Keep in mind that these qualities are also important for other therapeutic treatment options, including mental health therapy, chiropractic, as well as speech and occupational therapy.
Prioritizing active over passive interventions:
Historically, physical therapy has relied heavily on passive treatment modalities, such as ice, heat, ultrasound, electrical stimulation, and laser therapy. Manual therapies could also be considered passive, in which cases the practitioner would “perform” techniques such as joint mobilizations, manipulations, and massage on the client without the client having any kind of active role. This type of therapy has a different intention and effect than a hands-on Feldenkrais-inspired lesson. In a passive manual therapy procedure, the practitioner has the mentality of “fixing” something. They may use language such as describing joints as “out of alignment” or something of that nature. This type of treatment can be harmful for several reasons, one of which is that it teaches clients that they do not have agency over their own healing, and require an external source. This differs from a Feldenkrais-inspired technique in which the client may not be participating with volitional movement, but is instead actively participating by visualizing, sensing and feeling effortless movement, and may be asked to join in as the therapist initiates various movements. In the latter case, learning will occur, as clients will begin to feel how they can improve their movement without strain.
While passive manual therapy techniques may have their place, they should certainly not be the primary intervention. Fortunately, over the past several years the field has begun to move away from these options in favor of more active interventions. The passive treatment options are generally not evidence-based, and are often no more effective than sham or placebo interventions. Additionally, relying on these passive modalities could potentially have negative impacts on client’s self-efficacy, or the belief in their intrinsic capacity to heal and improve. By feeling like you need to see a practitioner every week so you can be the recipient of passive interventions can really take away from your motivation to improve independently and trust in your body’s natural healing abilities. Active treatment options are more effective, sustainable, and help to improve your self-efficacy as well as your body’s resilience and healing response. Active interventions are typically exercise and movement based- make sure your therapist is helping to guide you towards these options rather than relying solely on passive modalities.
Using evidence-based treatments:
Research in a field often takes up to 17 years to become implemented in clinical practice. That is why it is important for clinicians to stay as up to date on new research as possible, and not rely on outdated or inefficacious treatment options. The best evidence shows that movement is medicine. Movement and exercise should be the primary lines of treatment in physical therapy to help people move better, feel better, and participate more in life. At the Wellness Station, the primary interventions are almost exclusively movement-based, because this type of intervention has been shown to be the most effective and long-lasting. The services we provide are influenced by the Feldenkrais Method®, which is a gentle and highly effective complement to traditional physical therapy. To learn more about the Feldenkrais Method®, its application into physical therapy, and clinical research that supports its use, please read our white paper written by Paul McAndrew.
Walking the walk:
It is extremely important for a client and clinician to develop a strong therapeutic alliance that is rooted in honesty, genuinity, and integrity. Clinicians must set a positive example, and clients must be able to trust and believe in their clinicians. Perhaps the most important way to find a therapist that you can believe in is considering the question of whether they “walk the walk”. Does your therapist seem like they take their own fitness, health, well-being very seriously? In order for a therapist to be an effective teacher and role model, it is crucial that they are able to feel in their own body the recommendations and lessons that they suggest. They should be able to relate to what you are doing that could be contributing to strain, and help you devise a way to improve the efficiency of various tasks. For example, imagine a client that is having trouble looking up or reaching overhead due to neck pain or mobility restrictions. The therapist should be able to demonstrate how functional movements involve relationships between various body areas (e.g. how movement of the tailbone relates to movements of the neck), rather than isolated movements of specific body parts. If someone is having trouble with this task, the therapist should be able to feel in their own body and help teach the client that by lifting the tailbone while sitting, ease of looking overhead or reaching overhead can be greatly improved. Over the course of therapy, the practitioner should also help develop a plan to improve overall fitness using biomechanical and physiological principles in the context of the client’s individual characteristics.
Interpersonal skills:
Interpersonal skills are exceedingly important for a provider to have. Without good bedside manner, it will be very challenging for clients to feel comfortable, safe, and able to discuss sensitive topics. A therapist must demonstrate empathy, which is the ability to understand and share the feelings of others. Without empathy, the client will not feel listened to, understood, and cared for. Empathy requires the therapist putting themselves into their clients metaphorical shoes, understanding the pain they feel, and meeting them where they are at in life with sensitivity and grace. An empathetic therapist will listen, make eye contact, not interrupt, and not try to force changes. They will ask questions that demonstrate understanding of your life circumstances, express genuine interest and care, and refrain from unsolicited “fix it” advice (e.g. telling you what you “should” do).
Another factor to consider is, how do you feel during your sessions? Is your therapist encouraging? Do they help to calm you down and feel optimistic about your healing journey? Or perhaps, do they make you feel rushed? Does the therapist seem to be rushed? Unfortunately, many providers are rushed, with unrealistic productivity requirements that limit the time they can spend with each client.
At the Wellness Station, we are able to take the time needed with every client in a supportive environment to facilitate healing and enhanced lifelong fitness.
Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team