By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults
When I was a new graduate PT, I had endless energy and thought I could help everyone. After nearly 30 years in practice, I’m still passionate and optimistic about what I do, but now at 50++ years old instead of 24, I recognize that I can’t change the world – at least not all by myself.
Your chances of getting better require a lot more than just having a good PT. It’s truly a TEAM effort, and Mother Nature (e.g., what you’ve inherited genetically, how you heal, etc.), your lifestyle choices and many other factors impact your health and capacity for improvement. However, there are some common threads that apply to us all, and they’re very, very important. Simply put, it takes good old-fashioned teamwork to achieve success in PT. Despite what you’ve heard, there’s most definitely an “I” in Team (me as your PT), but there’s also most definitely a “U” in Team (you as the patient getting PT).
That’s right – let’s talk about what we each need to bring to the table in order to make Your PT as successful as possible in terms of the outcomes You achieve!!!
“TEAMWORK Makes the DREAM WORK?”
You’ve got to embrace the Team perspective in PT and understand your part, which is NOT a passive role most of the time. It’s likewise important to understand that we’re all different and experience things quite uniquely, so Patient A is not likely going to experience a total knee joint replacement the same ways that Patient B does, even if they both have the same condition (e.g., arthritis), the same highly skilled Orthopedic Surgeon and the same awesome PT throughout the process of surgery and rehab.
So — what wisdom can I share with you after 30+ years of doing this PT thing?
When it comes to “successful outcomes” in PT, it’s been my experience that it’s pretty clear there are some key concepts in play. Some research tells us that the patient’s attitude about their circumstances is critical, as is having a trusting relationship that’s forged between patients and their PT (NOTE: we’ll need to agree that “TRUST” is a 2-way street here!) This trusting relationship is referred to as the “therapeutic alliance.” Now take a deep breath because equally as important is the patient’s compliance with the overall plan you and your PT decide upon. That’s right — you actually have to be disciplined enough and able to forge through the Process of your PT. Perhaps the single-most important factor to having the best chance for success is this: Showing up for your appointments on time and ready to do whatever you need to do. Remember – PT is an investment in your Quality of Life! How much you’re willing to invest plays a huge part in your chance of having successful outcomes! Being “All In” means actually following the plan that’s been developed by you and your PT, which includes: realistic goals, a realistic time frame for achieving your goals, a rational decision about how often you should attend PT and what you should be doing outside of PT, such as a home exercise program.
If you have a negative outlook on your circumstances and your potential to improve, you’re not likely going to be successful in PT because you don’t believe in it — you’re simply not invested — therefore you’re not likely to comply with the plan and you’re certainly not likely to work very hard throughout the process. If you don’t trust your PT and don’t believe in your heart and soul that your PT is both competent and motivated to facilitate your success, you’re not likely going to give PT much of a chance. But even if you have a great attitude and trust your awesome PT with all your heart, if you don’t actually show up for your PT or don’t remain true to the home exercise plan (i.e., you’re noncompliant with the plan of care), then your chances of having a successful outcome are slim at best.
I would argue that there is one really, really, REALLY important “wild card” to this discussion. Let’s face it – many patients who need PT are dealing with pain on some level. Pain is a real you-know- what, and I don’t know too many people who like or invite pain, to be sure. I’ve seen many instances when pain dictates everything. More than that, I’ve seen many cases when fear of pain (i.e., expecting an activity or exercise to hurt) causes an avoidance of the activity altogether or results in pain-avoidance behaviors like excessive muscle or postural guarding, offloading (i.e., shifting yourself around to make what you really should be doing a lot easier), and excessive substitution (e.g., using muscles other than the targeted muscle to do what the targeted muscle is being asked to do, such as when a person hikes their shoulder up to try and raise their arm overhead instead of activating the primary shoulder muscles.)
Q: Why would someone do that? A: To avoid pain, whether real or anticipated.
Since PT so often involves painful conditions (e.g., having a knee replacement or rotator cuff surgery, tennis elbow, Achilles tendonitis, severe neck or back pain, etc.), the extent to which these pain avoiding behaviors exist plays an extremely important part when it comes to your chances of having successful outcomes.
Your PT experience should NEVER BE MISERY and, therefore, should NEVER BE FEARED! Your best chances for success in PT must always take this into consideration!
If you’re suffering from a painful condition, consider seeing your physical therapist for an evaluation to see how they can help. Here at Summerville PT & Balance we have everything you need to get through your Rehab and we know that it’s not a cookie-cutter approach. We treat each patient individually according to each patient’s tolerance. It might be challenging at times, but you can bet that we’re right there in it with you! Your success is our success, so should you need outpatient PT, be sure to check us out to see if we’re the right match for your needs!
3 Keys to a Positive Outcome in Physical Therapy; (found online Feb. 10th, 2019) at: https://3dpt.com/3-keys-to-a-positive-outcome-in-physical-therapy/
The importance of pain-related fear and pain catastrophizing in physiotherapy; (found online Feb. 10th, 2019) at: https://physiotherapy.ca/importance-painrelated-fear-and-pain catastrophizing-physiotherapy
Fear-avoidance model; (found online Feb. 10th, 2019) at: https://en.wikipedia.org/wiki/Fear-avoidance_model