I hear patients say physical therapy doesn't work

[sprtsmeddoc]

Hello, I'm on my clinical rotations and I hear patients say all the time that physical therapy doesn't work, it's too painful to complete or that they're worse off after doing physical therapy. Any suggestions on how to get/keep patients motivated to do physical therapy? None of the patients seem to be compliant.

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[Fiveoboy11]

Are these patients actively referred to a physical therapist? If so call their actual physical therapist and ask what their thoughts are. Of course relay the patient and your concerns to the physical therapist, keep them in the loop, ask them to address the concerns in the next visit. Ask if there's anything you can do to help. But frankly I don't know if a solution is to pep talk the patient and maybe take a back seat and allow the physical therapist to do their job. Just my opinions.

 

[NITRAS]

No hydrocodone for you!

 

[KeikoTanaka]

I laugh in people's faces when they say physical therapy doesn't work. I say "Oh, so Arnold just got huge sitting on a couch? Athletes just magically get stronger studying in class? I lost 70 pounds in high school staring at the wall? Physical Therapy works because it is nothing more than directed exercise, and you're clearly not putting in enough of an effort to make it work"

 

[Fiveoboy11]

I laugh in people's faces when they say physical therapy doesn't work. I say "Oh, so Arnold just got huge sitting on a couch? Athletes just magically get stronger studying in class? I lost 70 pounds in high school staring at the wall? Physical Therapy works because it is nothing more than directed exercise, and you're clearly not putting in enough of an effort to make it work"

Some of this is true

 

[KeikoTanaka]

Some of this is true

Yeah, obviously I'm not going to get into like specifics of physiology and what not with a regular person. The point of this was simply that, it is a very VERY widely accepted fact exercise improves pretty much every aspect of health (albeit some rare diseases) - and if you don't "believe in physical therapy" that's just... Idk. I can't even comprehend how one would not believe in PT.

 

[gymgal526]

It's very challenging to keep patients motivated to complete physical therapy if they don't 'buy into it'. While you can't control that, it's definitely part of your job to educate your patient on why PT is important. Find out what their goals are, and figure out what you can do to help them attain those goals.
For example, if your 60 year-old patient doesn't believe in PT, but has injured his low back and wants to return to golf, break it down for him. Discuss why core exercises are important and how this will help him return to the golf course. Rather than addressing lower function activities (i.e. marches, leg lowering, BKFO), put him on a physioball for core activation and do some diagonal work for higher functional strengthening.
The fact is, some patients just won't ever buy into PT--they just don't. As a PT or PTA, you do your best to provide the education necessary to help this patient.

 

[Fiveoboy11]

Yeah, obviously I'm not going to get into like specifics of physiology and what not with a regular person. The point of this was simply that, it is a very VERY widely accepted fact exercise improves pretty much every aspect of health (albeit some rare diseases) - and if you don't "believe in physical therapy" that's just... Idk. I can't even comprehend how one would not believe in PT.

Kind of like arguing with a flat earther huh?

 

[truthseeker]

Yeah, obviously I'm not going to get into like specifics of physiology and what not with a regular person. The point of this was simply that, it is a very VERY widely accepted fact exercise improves pretty much every aspect of health (albeit some rare diseases) - and if you don't "believe in physical therapy" that's just... Idk. I can't even comprehend how one would not believe in PT.

I actually think that talking about the anatomy and some physiology with your "normal" patients adds to your credibility and often motivates them to follow your plan. If we just tell someone "what" to do, they are less likely to do it, than when we tell them "why" they should do it. You shouldn't have to believe in something that is proven, but with that said, they have to believe that you know what you are talking about and they need to buy in for them to invest the time and put in the work that is essential for their recovery.

 

[KeikoTanaka]

I actually think that talking about the anatomy and some physiology with your "normal" patients adds to your credibility and often motivates them to follow your plan. If we just tell someone "what" to do, they are less likely to do it, than when we tell them "why" they should do it. You shouldn't have to believe in something that is proven, but with that said, they have to believe that you know what you are talking about and they need to buy in for them to invest the time and put in the work that is essential for their recovery.

I get that. But, believing in the person who's treating you is very different than "believing in PT". Like, if one person has a horrible Orthopedic, they go to another, it's not like they just "Don't believe in Orthopedics". Also, admitting that you personally don't have time to do PT to see results, is also very different than "Believing in PT", or thinking it doesn't work, like what the OP was saying.

Now, I will 100% agree with you in regards to educating patients who think it's too painful to complete or perform - you have to get over that initial pain "hump" for your body to begin healing and if you don't move it at all because of pain, the joint will become so stiff and immobile later on - leading to countless other problems elsewhere. Definitely educating them is important, but that still doesn't sit right with me that just because something doesn't work for you doesn't mean it doesn't work in general. Sounds like more of an excuse by the patient to soften the blow when they quit. "I'm not a QUITTER, it's just painful and doesn't work" - It's easier to blame the external environment than blame internal motivation for something not working.

 

[ya1]

Hello, I'm on my clinical rotations and I hear patients say all the time that physical therapy doesn't work, it's too painful to complete or that they're worse off after doing physical therapy. Any suggestions on how to get/keep patients motivated to do physical therapy? None of the patients seem to be compliant.

Sometimes PT indeed does not work. If there are no changes within 1 month, refer pt back to MD or to PTs/professionals who may have skills that you do not have and may be able to help the pt.
Do not hurt pt. Do treatments within pain-free range only. Maybe when you get more experience it may be ok to give treatments that hurt but then you ARE confident pt will feel better, but as a new grad, it is safer for you and for pt to do treatments within pain-free range only. (Just my personal opinion.)
To motivate pt, you may try to explain them (in a simple language) what you are doing with them, why, and how each treatment is supposed to help them.

 

[truthseeker]

ya1, if you treat your total knee patients or your rotator cuff patients to only move where it doesn't hurt, they. will. fail. I tell my patients to sue the doctor that told them that a total knee wouldn't hurt. Its obviously tongue in cheek, but also true. the trick is explaining the difference between hurt and harm. I know this is off topic, but that is a hot button issue for me.

 

[fozzy40]

ya1, if you treat your total knee patients or your rotator cuff patients to only move where it doesn't hurt, they. will. fail. I tell my patients to sue the doctor that told them that a total knee wouldn't hurt. Its obviously tongue in cheek, but also true. the trick is explaining the difference between hurt and harm. I know this is off topic, but that is a hot button issue for me.

"Sue the doctor." Nice.

 

[truthseeker]

"Sue the doctor." Nice.

you get that its a joke right?

 

[CurlyHairedGirl]

Hello, I'm on my clinical rotations and I hear patients say all the time that physical therapy doesn't work, it's too painful to complete or that they're worse off after doing physical therapy. Any suggestions on how to get/keep patients motivated to do physical therapy? None of the patients seem to be compliant.

I'm answering this question both as someone who has been through physical therapy multiple times and as someone who is considering going to PT assistant school. I'm thinking that PTAs have more people contact and less paperwork/management responsibilities than PTs?

I had a therapist (PTA) assign me a particular exercise that used gravity against body weight (and chunky tennis shoes) as resistance, on a very small muscle that would not naturally be used against body weight in isolated fashion. My original overuse injury stemmed from repeatedly using that muscle group in a weekend of heavy activity, when I had been working a lot (and not exercising much) in the few months prior to this. I later found out this was a muscle that had trigger points,

I could do the exercise initially, but as time went on, I got weaker and weaker as I repeated the exercise. So for several weeks was begging for a different way to do the exercise. Meaning I was definitely a "non-compliant patient". Eventually the therapist let me do the same exercise with resistance bands, which made a huge difference in my ability to do the exercise. However, the PTA wanted me to switch back after only a week of the "modified" exercise. Eventually I saw a doctor who diagnosed trigger points and gave me trigger point injections, which in the space of 5 minutes helped more in terms of restoring range of motion than the 2 months of PT had helped. I ended seeing that physical therapy office and about 6 months later found a PT practice that worked better with avoiding the particular exercise.

 

[truthseeker]

I'm answering this question both as someone who has been through physical therapy multiple times and as someone who is considering going to PT assistant school. I'm thinking that PTAs have more people contact and less paperwork/management responsibilities than PTs?

I had a therapist (PTA) assign me a particular exercise that used gravity against body weight (and chunky tennis shoes) as resistance, on a very small muscle that would not naturally be used against body weight in isolated fashion. My original overuse injury stemmed from repeatedly using that muscle group in a weekend of heavy activity, when I had been working a lot (and not exercising much) in the few months prior to this. I later found out this was a muscle that had trigger points,

I could do the exercise initially, but as time went on, I got weaker and weaker as I repeated the exercise. So for several weeks was begging for a different way to do the exercise. Meaning I was definitely a "non-compliant patient". Eventually the therapist let me do the same exercise with resistance bands, which made a huge difference in my ability to do the exercise. However, the PTA wanted me to switch back after only a week of the "modified" exercise. Eventually I saw a doctor who diagnosed trigger points and gave me trigger point injections, which in the space of 5 minutes helped more in terms of restoring range of motion than the 2 months of PT had helped. I ended seeing that physical therapy office and about 6 months later found a PT practice that worked better with avoiding the particular exercise.

No doubt there are good PTs and bad PTs. trigger points are a response to overload, not a primary cause of things. Generally the best way to treat them is to figure out why they start, and prevent it by either changing posture, or technique. Obviously, sometimes you have to treat them (injections, massage, stretching or whatever) but that will ALWAYS be a management strategy, and not a path to resolution.

IMO the treatment should look like the test should look like the task. i.e. some PTs will have their ACL patients get on all fours and do a fire hydrant exercise like their patient is a male dog doing its business. I have never seen anyone tear their ACL doing something like that. It doesn't look anything like walking, or balancing, or cutting etc . . . so its like trying to get better at throwing darts by riding a bike. It just doesn't translate.

 

[Fiveoboy11]

No doubt there are good PTs and bad PTs. trigger points are a response to overload, not a primary cause of things. Generally the best way to treat them is to figure out why they start, and prevent it by either changing posture, or technique. Obviously, sometimes you have to treat them (injections, massage, stretching or whatever) but that will ALWAYS be a management strategy, and not a path to resolution.

IMO the treatment should look like the test should look like the task. i.e. some PTs will have their ACL patients get on all fours and do a fire hydrant exercise like their patient is a male dog doing its business. I have never seen anyone tear their ACL doing something like that. It doesn't look anything like walking, or balancing, or cutting etc . . . so its like trying to get better at throwing darts by riding a bike. It just doesn't translate.

I've never seen that exercise being done by a patient in a PT clinic. I kind of want to though just for the comedy

 

[TheTruckGuy]

When I ask patients if they're still going to PT or why they stopped, I get a lot of "the physical therapist just told to stretch, I can do that on my own." "Or they just told me to do squats, and keep doing squats, and it didn't do anything." Then when you ask them to show you the stretches, or the exercise program, and get into how often and for how long they did it, it usually becomes apparent that they either can't remember the exercise routine, because they never did it consistently, or they just admit to stopping after a week or two because they weren't getting better.

The "problem" with physical therapy is that it isn't a quick fix, and I tell my patients that it takes time, effort, and consistency to see results. And most of the time it'll feel like they're not getting anywhere, not improving, or sometimes even getting worse, and then all of a sudden, out of no where they'll be able to do the activity that used to cause them pain and it won't hurt anymore.

I think people read articles and see stories about all these medical breakthroughs and give medicine way too much credit for what we can really do. We can't make pain just disappear. We can technically operate on some conditions, but many times we won't because chances are things will get worse in the long run. And life sucks, as you get older, your body will show wear an tear, that stem cell therapy you read about online will not give you the shoulders/knees of a 20 year old.

Of course, I'm also a military doc, so when I try explaining this to patients they think I'm just not as good as the civilian world doctors that went to "real medical school."

 

[rcpointdujour]

Hello, I'm on my clinical rotations and I hear patients say all the time that physical therapy doesn't work, it's too painful to complete or that they're worse off after doing physical therapy. Any suggestions on how to get/keep patients motivated to do physical therapy? None of the patients seem to be compliant.

It's hard to say whether physical therapy works or not for a specific person because physical therapy is generally too-loose a term for exercise. What we do depends on our training, our continuing education, our understanding about physiology, and how much we care. We must also realize that, despite how good you are, exercise is not the answer for everyone, especially if you don't really know why the patient should perform that particular exercise. I wouldn't worry about those who don't think it works. It may not work for them. I would focus on trying to be the best physical therapist you can be. Understand what you're doing and why.

 

[PikminOC]

When I ask patients if they're still going to PT or why they stopped, I get a lot of "the physical therapist just told to stretch, I can do that on my own." "Or they just told me to do squats, and keep doing squats, and it didn't do anything." Then when you ask them to show you the stretches, or the exercise program, and get into how often and for how long they did it, it usually becomes apparent that they either can't remember the exercise routine, because they never did it consistently, or they just admit to stopping after a week or two because they weren't getting better.

The "problem" with physical therapy is that it isn't a quick fix, and I tell my patients that it takes time, effort, and consistency to see results. And most of the time it'll feel like they're not getting anywhere, not improving, or sometimes even getting worse, and then all of a sudden, out of no where they'll be able to do the activity that used to cause them pain and it won't hurt anymore.

I think people read articles and see stories about all these medical breakthroughs and give medicine way too much credit for what we can really do. We can't make pain just disappear. We can technically operate on some conditions, but many times we won't because chances are things will get worse in the long run. And life sucks, as you get older, your body will show wear an tear, that stem cell therapy you read about online will not give you the shoulders/knees of a 20 year old.

Of course, I'm also a military doc, so when I try explaining this to patients they think I'm just not as good as the civilian world doctors that went to "real medical school."

This is a great thread as I deal with this alot as a psychiatrist also

 

[PikminOC]

When I ask patients if they're still going to PT or why they stopped, I get a lot of "the physical therapist just told to stretch, I can do that on my own." "Or they just told me to do squats, and keep doing squats, and it didn't do anything." Then when you ask them to show you the stretches, or the exercise program, and get into how often and for how long they did it, it usually becomes apparent that they either can't remember the exercise routine, because they never did it consistently, or they just admit to stopping after a week or two because they weren't getting better.

The "problem" with physical therapy is that it isn't a quick fix, and I tell my patients that it takes time, effort, and consistency to see results. And most of the time it'll feel like they're not getting anywhere, not improving, or sometimes even getting worse, and then all of a sudden, out of no where they'll be able to do the activity that used to cause them pain and it won't hurt anymore.

I think people read articles and see stories about all these medical breakthroughs and give medicine way too much credit for what we can really do. We can't make pain just disappear. We can technically operate on some conditions, but many times we won't because chances are things will get worse in the long run. And life sucks, as you get older, your body will show wear an tear, that stem cell therapy you read about online will not give you the shoulders/knees of a 20 year old.

Of course, I'm also a military doc, so when I try explaining this to patients they think I'm just not as good as the civilian world doctors that went to "real medical school."

Lots of nonsense out there too like stem cell injections and vitamin iv