How To Crush Physical Therapy

I have a lot of empathy for my patients. Not only for the understanding how much it sucks to have an injury, but also the strange new world you find yourself in. Communicating to your therapist clearly while you are simultaneously an emotional mess is hard. Forming new habits is hard. Changing your routine is hard. Not knowing the exact timeline or how things are supposed to go is hard.

But so is training for a marathon, running a PR, trying a new sport, going the distance, lifting more than before, and adapting to hardship. As athletes, we are primed for this. We are so, so good at doing hard things. With this I’m hoping to tap into that athlete skillset and drive to help you get the most out of your Physical Therapy experience so you can get back to crushing it.

The first step is to find a therapist that is best for you and your needs. Endurance athletes are a special breed of human (no matter how much we want to deny it), and it is important for your therapist to understand your sport and mindset. If your therapist asks how far a marathon is…you should respectfully find another one. Rapport between the therapist and patient is crucial for success, so fully trusting them is important. There is not enough time or money to invest in finding the perfect therapist, so this is where word of mouth comes in. Ask your friends and other athletes in the community who they see and what their experience has been like. Don’t rely on flashy instagram posts or buzz word advertising.

Your first session is very important, for both you and your therapist. This is when you get to know each other and lay the groundwork for the rest of your journey. Sometimes I find that patients are unsure of how much to share or what information is relevant. It is crucial to share your entire medical history - not just what you think is relevant to your current injury. Yes, that ankle sprain from high school where you were in a boot for 4 weeks is an important detail. So is the fact that you have frequent headaches. So are conditions like IBS, thyroid disease, sleep disruption, etc. This information should be paired with a comprehensive list of the medications and supplements that you take, as certain medications can have side effects or mechanisms that may be contributing to your pain and function. Think about your goals and expectations for therapy, so that when your therapist asks about them you can have a conversation about it together. Hopefully you feel comfortable in the room so that you can be vulnerable about the emotional and psychosocial components of your injury. As therapists we expect and welcome the vulnerability - so please don’t feel like you’re oversharing or burdening us. Lastly - if your therapist does not spend a significant chunk of time listening to, and connecting with, you as a human - again, respectfully find another one!

Your therapist will give you exercises to complete and potentially some habit changes to try. It is vital to be compliant with these as prescribed, exactly how they were prescribed. Think of these like “medication”. If the instructions say to take 2 pills once a day, taking 4 three times a day is not better and could potentially be dangerous. Conversely, if you don’t complete the exercises as prescribed, it is very difficult for us to assess if our interventions are effective or not.

Following your first session, it is important to pay attention to your symptoms and how they change. Be aware of what makes them worse and what makes them better. We don’t want to encourage hypervigilance or over-thinking, but it is helpful to have that data as we make clinical decisions moving forward. With each successive session you should communicate any changes in stress levels or sleep, as well as other activities that you have done. Things like marathon yard work sessions, standing at an event for a long period of time, wearing high heels, sleeping on a couch because your significant other was snoring, etc. all can have an impact on your body that we need to know about.

Your therapist should help you set expectations about your recovery in terms of timeline, effort, and typical outcomes, but know that recovery from most injuries is not linear. There will be ups and downs, progress and setbacks. Having this be the clear expectation going into the process will be helpful for you to rationalize and remain motivated throughout.

Remember that you and your therapist are a team, and it takes equal effort from both sides to maximize success. Response to certain interventions is variable from person to person, and there is a real possibility of occasional flare-ups or increase in discomfort temporarily. It is imperative to report this to your therapist so that they can adjust treatment as needed. Flare-ups are not typically a setback that will delay recovery - sometimes this increase in discomfort is necessary for progress, and other times it is good information to aid in the ultimate resolution of the problem. However, the old adage of “no pain, no gain”, is NOT true, and you should always listen to your therapist’s instructions of how an exercise or manual therapy intervention is expected to feel.

Last, but not least, DO YOUR EXERCISES.

Wait, did I already mention that?

Keep going, you got this!

Kacy Seynders, PT, DPT