Physical therapy may be required when a person has dealt with a reoccurring musculoskeletal issue or suffers acute debilitating injury to bone, ligament, tendon, muscle or nerve tissues. Once they have committed to beginning physical therapy, what a therapist does and says can affect how patients view the effectiveness of their treatment and affect patient outcomes.

Encourage patients with exercises and words. Showing a patient they are indeed capable of using various pieces of equipment and moving their body efficiently will boost confidence. There does not need to be complete mastery of one exercise to implement another. Using an elastic band to exercise the shoulder muscles is great when starting a rehab protocol, but it does not have to stay there. Show the patient the same exercise with a cable machine, use lighter dumbbells to activate the same muscles, change torso position to engage abdominal bracing. Allow them to realize what their body is capable of. Using words can affect a person’s emotions, especially when put in a negative context. A patient should not be described as weak; they need strength. A muscle is not super tight; it needs to be lengthened. For example: “We are going to strengthen your quadriceps and lengthen the hamstrings to start with.”

Knowing what led a patient to physical therapy and what end goals they have for themselves is important for a clinician to know so they can encourage them to reach their goals. With a positive demeanor and active listening, repeat the patient’s most prominent areas of concern, show non-verbal acknowledgments such as a head nod and quickly document to maintain nonverbal contact. Asking open-ended questions without assuming anything that is not said by the patient can help them develop their goals. Here is an example of an open-ended question: “I understand lifting your arm overhead hurts. How does this affect your daily activities?”

Knowing what activities are being affected will help to set reasonable short-term goals. The patient should be included in this process. Expectations may have to be tapered, but this will also ease the acceptance of the condition or injury.

Accomplishing the goals set forth by the therapist and patient will encourage commitment by observing results, no matter how small. This is where affirmations can flow. If the patient puts in the work to reach a positive outcome, let them know. Highlight the accomplished goals and develop more progression collaboratively.

Once a person becomes a patient, they need to be allowed to tell their story. Allow them to get it all out, this history will help to identify causative behaviors and beliefs about their current state. The clinician can also begin to identify their activity level and discuss goals. Using short term goals can help to motivate the patient by having a finish line in site. It is also important to note the person is not stepping into fitness program, they are beginning an exercise regimen with pain. Pain is something that must be dosed correctly, allow them to be open about what is being felt. Educate what the sensations are and how the exercise will help them to reach their goal. Clinicians are providing a controlled environment to rehabilitate the body, mimicking the movements of the patient’s life, provide the same variety life does. Physical therapy’s goal is to return the patient to a functioning state, but there is nothing stopping a clinician from returning them more educated, motivated to move and stronger.

Consider enrolling in Grand Canyon University’s Bachelor of Science in Biology with an Emphasis in Pre Physical Therapy degree program. This program is offered by the College of Nursing and Health Care Professions and walks students through the foundational understanding of physiology and biology required to undertake a promising career in physical therapy. To learn more about the programs offered by the College of Nursing and Health Care Professions, visit our website or click on the Request Info button on this page.

References:

¹ Vong, S. K., Cheing, G. L., Chan, F., So, E. M., & Chan, C. C. (2011). Motivational enhancement therapy, in addition to physical therapy, improves motivational factors and treatment outcomes in people with low back pain: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 92(2), 176-183. doi:10.1016/j.apmr.2010.10.016

Having built a positive relationship through listening and understanding the patient’s needs and creating goals, a clinician can evoke an internal commitment from the patient. There is no immediate need to demand compliance with home exercises, but the patient should be asked if this is a change they can make.

This gives them a chance to establish barriers and encourages self-motivation to improve, with zero demands. An inactive lifestyle could be a contributing factor to them being a physical therapy patient. Showing proper empathy for their fears or barriers will increase trust and positive views of the current plan. Assessing commitment beyond the clinic also gives the therapist a chance to gauge their willingness to make positive changes at that time. Patients with low back pain were able to lift more. They showed a more significant commitment to home exercise programs after performing physical therapy with enhanced motivational treatments (MET) compared to physical therapy alone.¹