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Physical Therapy Etiquette Shouldn’t Tie You Into Knots (or “How To Love Your PT”)

As my long time readers know,  I occasionally use the Ehell blog as a platform for public service announcements based upon my own experiences.   May is EHell’s own Melanoma Awareness Month after I had been diagnosed with malignant melanoma and underwent a 4 hour operation and biopsy (all clear!) seven years ago.  February is the month for Ehell’s Gynecology Cancer Awareness instituted after I had a hysterectomy 3 years ago to treat uterine cancer.  (My oncologist said if one has to get cancer, mine was the “best”, i.e. least aggressive, slow growing and I did not need radiation or chemo.  Ask me about the Da Vinci surgery robot! It’s awesome!)   I have been gratified and thrilled when readers have privately messaged me to report that, based on those PSA posts, they saw their doctors and discovered skin cancer early enough to treat successfully or had pelvic exams/PAPs and caught a cancer early.  *That* is what makes publishing a blog so worthwhile.

October is National Physical Therapy Month and we are celebrating it here on Ehell because I’ve been in Physical Therapy since July of this year for first a shoulder problem I had put off for months and then as fate would have it, I injured my already compromised pelvis and started PT for that.  I retired from wedding planning about 7 years ago in large part because my lifelong problems with my hips were worsening and I just couldn’t physically do the standing and walking needed throughout the wedding day any more.    So I started PT on my hips with a great deal of trepidation and fear of those big spasms I knew I could experience.

I bring a blue hand towel (affectionately known as “Old Blue”)  with me to PT sessions which I use to cover my face and head during the TENS/Stim and heat pad segments, the better to hide tears of frustration sometimes.  But my PT Guys have consistently been positive and encouraging because they have a long term perspective and confidence in physical therapy’s evidence based treatment modalities.  I’ve peeked out from under Old Blue, with tears glistening in my eyes from a tough PT session, to see a PT Guy squatting by my table telling me I am not going backwards, that all of this is normal and expected.  RAH!  RAH! Cheer me on, PT Guy!   And sure enough, after over 18 months of near constant pain and spasms in the left hip, that all ended within weeks of starting therapy.   It’s a freaking miracle!   I began to refer to my left hip by its new name, “Maximus, The Gladiator Glute”.    The right hip is my problem child taking a lot longer to decide that spasm tantrums are not the road to happiness before we could progress to improving strength.   It would not be an exaggeration to say that physical therapy changed my life in a way I did not realize could happen.   Thanks, PT Guys!

Lest anyone think that all my PT sessions are characterized by crying, twitching and pain, there has been a lot of joking going on, too.   I try my darnedest to get the office receptionist and the PT Guys to laugh and I usually succeed.  Look forward to a future Feel Good Friday where I reveal my ongoing “behind the scenes” running joke with the PT Guys.

Physical Therapy is unlike most medical professions in that the patient and therapist spend a considerable amount of time interacting with each other.  I’ve spent far more hours in hands-on therapy with the PT Guys than all my oncologists, allergy nurses and PAs combined.   So, it stands to reason that with that much interaction going on, there should be etiquette guidelines to frame expectations and how to relate as patient to medical professional.   And thus I present Ehell’s…

Physical Therapy Etiquette

1. Physical therapists are medical professionals.  Doctors of Physical Therapy attend 3 years of postgraduate studies to acquire that degree, must pass licensing exams, and adhere to strict ethical and board standards.   They are not massage therapists, fitness trainers, or masseuses so don’t call them that.  Ever.   “Masseuse”, in particular, can having an icky connotation so don’t go there.

2. Do your homework.  I think some patients have an unrealistic expectation that going to PT once or twice a week will miraculously cure them of what ails them with no expenditure of their own effort towards their recovery.   PT is a therapeutic alliance between the patient and the therapist where the maximum benefit is achieved when both parties do their best job. When only one part of that equation is working,  results will be mixed at best.   Don’t lie to your therapist claiming you did your home exercises and stretches because while your lips are telling fibs, your pathetic muscles are telling a different tale and therapists have an uncanny ability to hear your muscles’ whispers of woe.

3. Watch those boundaries!   Because there is more time for talking during multiple sessions, there can be a temptation to cross verbal boundaries both intentionally and unintentionally.  There are social and personal boundaries your therapist may not want to cross.   I try to pay attention to what the therapist is NOT saying and use that as a guide as what areas of conversation I should avoid. For example,  your therapist may refer to his/her spouse and children but if he/she never mentions their names, don’t ask for those names.   If your physical therapist brings up a topic of conversation, it can be safely assumed that you can enter the conversation, too.   I try to avoid contentious topics such as politics solely out of self preservation.  Topics like that make me tense which seems to defeat the purpose of being there.  When in doubt, ask.   Unsure as to whether giving a small Christmas gift (a book) to both therapists’ small children was appropriate, I asked the office secretary for guidance.

I am a gregarious extrovert and I have no problem talking with complete strangers. As the proverb says, “In an abundance of words, sin abounds”, and the more one talks, the odds of saying something really stupid increases.   And trust me,  I can definitely say stupid things quite innocently and then realize later that what I said wasn’t the best choice of words.   Fortunately my Dr. PT Guy is exceptionally adept at diverting the conversation to new topics, a conversational skill Ehellions know and refer to as “beandipping”*.   He does it so seamlessly that I often don’t realize he’s masterfully changed the subject.    Dang, he’s good at it.

And it should go without saying that sexual innuendos and references to sex are completely off limits.  Yes, I know we live in a hyper-sexualized culture where even dog food, adult incontinence pads and Chlorox are advertised on TV using sex and you have to cover your children’s ears during the evening news on the latest political drama.   But suggestive comments, deliberate innuendos and any sex talk is a major disservice to your physical therapist who is bound by state and board ethics standards.   Don’t  lead your therapist into temptation by doing or saying anything that could make them feel instantly awkward around you and potentially damage his or her career.

4. Put the cell phone cell/camera away. Some clinics have very explicit directions to put away the cell phone and strict prohibitions against cameras in order to protect the HIPAA privacy of other clients. It makes sense that if you, as the patient, are to devote your attention to following your therapist’s directions, you need to not be distracted with looking at a cell phone or taking phone calls. Your scheduled appointment time will likely be paced to include any number of modality treatments and if you are delaying that by talking on the phone or looking at some text, you will not benefit as fully from PT and you risk running over into someone else’s time.

The camera thingy should be common sense but no, some things are not always obvious. During PT for a shoulder issue, I wanted to take a photo of a pulley system I had been using so that my husband could see it and make one for me. Another patient was using the piece of equipment and while I knew enough of privacy to not take a photo of the patient, neither the physical therapist nor the patient were privy to my understanding or intentions. My physical therapists are great guys but none of them possess the talent to read minds despite their uncanny ability to know when you did not do your home exercises.   All my physical therapist could see was me preparing my iPhone to take a photo so he calmly and quietly asked me to not take that photo. I was baffled because I was intending to only take a photo of the equipment and queried him further, “Why?”  He replied, “It’s a HIPAA issue.” I was still confused…how can it be a HIPAA issue to take a picture of a piece of machinery? Is this a guy joke? I remember scanning his face to see if there was any indication that he was pulling my leg. He does have a very dry sense of humor. What seemed like seconds ticked by while I tried to read his face and mentally sort out my own confusion. Finally the corner of his mouth went up in a small smile which I interpreted to mean “Please” and I nodded “yes” slightly to convey that I understood him and I put my iPhone away.

It was only later that the full ramifications of what I had done hit me. I had placed my PT Guy in an awkward position where he was compelled to protect another patient and had I been obtuse and continued with my goal the situation could have escalated to at least one of us being unhappy. None of us is entitled to make other people’s lives more complicated or difficult.

5.  Clean thyself.   That means come to physical therapy having showered before and wearing clean clothes.   I added this “rule” at the recommendation of several Ehell readers who apparently experienced patients in states of varying degrees of uncleanliness.   I’m sure, as medical professionals, physical therapists have seen, touched and smelled it all but, please, don’t inflict more of that on your hapless therapist.

6.  Give your therapist the benefit of the doubt.  Not every protocol or modality works with every patient and since your body is different than everyone else’s,  your therapist may have to try different approaches to find the right treatment that fits your needs.  Early on in my therapy on the hip, PT Guy tried a common massage technique of pressure and release which, under usual circumstances, disrupts muscle spasms. It had the opposite effect on me and within seconds things went from ouchy to epic miserableness.   I couldn’t see his face but I imagine his reaction was, “Holy CRAP!  What just happened?!  Gotta fix this!”   I could have hobbled out of that clinic that day believing more harm than good had been done and itching to write a scathing online review but I trusted the long term vision, trusted in the PT Guys’ belief of a positive eventual outcome and stuck with it. Best decision ever.

6. Say “Thank you.”   My PT Guys have a strong desire to see people get better and I appreciate that level of career dedication.  Sometimes a PT session isn’t as fun as everyone would like but say “Thank you” anyway.   If someone is changing your life to be better, expressions of gratitude confirm to them that at least one patient acknowledges the work they do. Having an attitude of gratitude makes you a happier person, too!

*”Beandipping” refers to the conversational tactic of changing the topic of discussion by redirecting people’s attention to talking about something entirely different.  The classic Ehell example of beandipping is being at a party and someone asking an impertinent, invasive question or strays into a topic you would rather not engage in and you respond saying, “Have you tried the bean dip?  It’s especially delicious.  Emma made it and her dips are always so tasty.”

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{ 23 comments }

Comments on this entry are closed.

  • o_gal October 19, 2016, 6:17 am

    I’ve had extensive PT for knee problems, shoulder/neck problems, and ankle/foot issues. PT is wonderful! Yes, I did my homework. Faithfully! 🙂 The Admin is spot on with her etiquette issues. Another one I would add is that the PT area is not your own private gym. I’ve been to 3 different PT offices and at all of them, there are anywhere from 1 or 2 people working on the equipment up to 8 to 10 people. Just because you prefer a particular treadmill or stationary bike does not mean that you get it reserved for you for your sessions. Someone new may be in and their PT has instructed them to use that particular piece of equipment. And please be mindful of the fact that there are other people in the office. Keep your voice at a pleasant low indoor level, and don’t complain that there are so many other people there.

  • CW October 19, 2016, 6:31 am

    This is wonderful. My DH is a PT and the most frustrating patients for him are the non-compliant ones who can’t seem to realize that therapists don’t perform miracles, they provide a treatment plan. Just like going to the doctor for an illness, if you don’t take the medication and follow instructions, it’s not going to get better.

    • admin October 19, 2016, 1:53 pm

      I sent you an email via your log-in email address.

  • Atalaya October 19, 2016, 8:08 am

    The PT office I went to was amazing with a lot of awesome people working there. I honestly cried at the end of my last appointment because I was going to miss not only the employees but the other patients I had gotten to know.

    Here’s my advice, if another patient seems friendly, be friendly with them and help encourage them if they’re open to it! There were some patients who made it known by their demeanor that they didn’t want the interaction but there were many other patients who enjoyed friendly conversation in between exercises or while having some of their treatments performed.

    • admin October 19, 2016, 10:37 am

      I have already made friends with two fellow patients and we are continuing the friendship outside of the clinic. Great advice.

  • Melissa October 19, 2016, 10:22 am

    I know this post was about Physical Therapy (and I agree with everything you said!) but I had to comment because I am a Stage III Melanoma survivor celebrating 4 years cancer free! I knew you were a cancer survivor Mrs Jeanne, but I don’t think I realized it was also Melanoma.

    To anyone who reads this, I highly encourage you to have your skin checked on a yearly basis. If I had listened to that advice, my journey with Mel probably would have ended at a wide excision and nothing else. Because I didn’t have my suspicious mole checked soon enough (out of my own stubbornness), the cancer spread to my lymph nodes and I had those removed, and had to go through radiation and immunotherapy. I still have range of motion issues 4 years after completing radiation (probably need a PT for that! Ha!) And I was so fortunate and blessed through the entire process, but I still do not want anyone else to needlessly go through what I did! My old, not updated in a very long time, blog is linked above if anyone is super bored and wants to read my story.

    Please forgive the off subject comment 🙂 🙂

  • Rose Lloyd October 19, 2016, 10:30 am

    I had a rotator cuff rebuilt. The rehab was a bear. I used to cry every session. My physical therapist told me he had a client that called him her “physical terrorist.” I knew where she was coming from. He did a great job on my shoulder and I will be forever in his debt. He also introduced me to tai chi classes as part of rehab and that was a life-long gift.

    My therapist used the video function on my phone to tape the home exercises he gave me each week. So there is a time and place for everything….

    • Honeybee October 19, 2016, 11:48 am

      And I had to have physical therapy to avoid the rotator cuff surgery. You betcha I did those home exercises! If PT had failed, I was going to have to do surgery.

      When they discharged me, they even gave me another band (green) so that I could continue on. I slacked off for a year, but when I started feeling the tightness come back, it was back to those exercises. Really, really don’t want to have surgery, so PT is wonderful.

  • Stampysmom October 19, 2016, 1:09 pm

    Great PSA! I love my PT. He was the one who found the bone cancer in my arm and got me moving to see a dr. In fact he was so frustrated with the lack of support from my dr that he offered to come to my next appt to speak to my dr personally to get the attention I needed. Luckily things started to move and I’m now 3 years clear. He’s amazing.

  • Kirsten October 19, 2016, 1:29 pm

    I’m an occupational therapist (we are also awesome) and I would add: don’t be surprised if your physio asks you to strip to your underwear for whichever half of your body they are treating. If it’s a shoulder injury, you might want to take a vest so you’re not standing there in your bra. If it’s a lower half injury, you might want to take shorts or at the very least wear big knickers rather than a thong. Try not to be embarrassed about it – although it’s new and strange for you, honestly, therapists have seen more naked and semi-naked bodies than we’ve had hot dinners, and for us it’s nothing unusual. And be prepared for them to get their hands onto you, poke, prod, squeeze and generally hurt you!

  • Kat October 19, 2016, 1:36 pm

    I heart my Physical Therapist. I had a persistent foot injury for over a year, that was continually misdiagnosed by three different doctors, but the PT was the one who fixed it. The podiatrist put me in a soft cast and sent me for an X-ray, twice, even though the cast was interfering with her ability to read the film — she diagnosed a hairline metatarsal fracture and prescribed treatments that made the injury worse (I went from “hurts to run” to “can barely walk” and it caused a cascade of new issues in my other leg). The D.O. looked at the exact same films and saw no evidence of fracture, but diagnosed a bipartite sesamoid bone as the root of the problem, declaring that since this was an anatomical variance I’d be stuck with foot pain the rest of my life. He was wrong too, and it only took about three months of PT to heal to the point of being able to both walk and run again, essentially pain-free, after a year of being shuffled from one doctor to another.

    So, thank you so much for that, PT Gal. Wish I could have just seen you first.

  • Jacqueline Miller October 19, 2016, 1:58 pm

    Well said, Miss Jeanne!!! I was in physical therapy on and off for about three years because my adhesive capsulitis decided that migrating from my right shoulder to my left shoulder would be a good idea. My PT and I used to joke that he saw me so often we’d be invited to each others’ children’s weddings.

    Another tip I’d like to add: please be sure you are clean/showered before going to your appointment. PT’s work very intimately with you and showing up unshowered with BO is just plain wrong.

  • NostalgicGal October 19, 2016, 11:02 pm

    I had some injuries and accidents in the days before they thought PT was a good thing, and I paid the price for it. Later they started offering it and I went. I suffered, I cried, and I did every rep, I have a finger to prove that you need to do the PT (it didn’t get any, and though I worked on it later it still has issues, that could have probably been fixed with PT). Only plus when I reinjured the right ankle, was this time I got PT and managed to undo most of the crapola left over from the first time when I didn’t.

    My DH ripped up his right index finger. He came home with PT homework. I would sit there and go over the sheet and count off EVERY rep, and make him do it. He had a very long round to get that one fixed and his next to the last session I went with to meet ‘Heather’ who was this bright bubbly sweet young ginger haired thing, who was doing the torture to him. She thanked me for making him do his homework, I showed her my messed up finger and said I learned the hard way. She actually kindly gave me some stuff to do, gratis, that seriously did help! (still love you dear, thank you)

    Poor Jeanne! I can still talk lucidly at 7 or 8 pain, but it depends on the pain and how long. At 10 (blacking out or actually passing out) there is very little coherency, I agree. And several hours of unrelenting 7 or so and I’m no longer functional.

    Be clean, wear clothes you can easily be ‘accessed’ in or easy to take off. (I have a few sweats I added zipseams to, Velcro, and you can separate them completely, from from back, tops and bottoms… just for that reason) Save swearing for elsewhere unless you get really massively surprised (yes I can have one slip out, and I do seriously apologize).

    Right now it is quasi-PT, I am wearing a fitbit and have a prescribed distance and number of flights of stairs to climb daily. The device is Bluetooth and finks to a website dashboard through my PC, and my doctor can see everything I do activity wise, in 15 min increments every day. No lying about am I exercising. And he has checked. He will let me go with a few slack bits as long as my weekly is on form and I hit all the goals for that week. So. DO the exercises. Do your PT homework. The only one that will hurt if you don’t is YOU.

    I have a friend that hit a windshield (passenger) in her early 20’s. The insurance gave her money for treatment and PT. She got the medical and instead of PT bought a computer. Mid 30’s, she was barely able to walk, step up a curb, and by mid forties ended up in assisted living as a ward of the state (on dole, disability, and SSDI) She couldn’t lift more than five pounds and needed a walker and someone to come in daily. They tried PT on her and slowed the issues, but. Had she gotten the PT at the time, she would still be a functioning person. The need for that computer messed her up… Do Your PT!!!!!

  • Nancy October 20, 2016, 7:53 am

    Thank you so much for this post. I am currently in agony with no end in sight with my hips – can barely walk and the cortisone shot hasn’t helped.

    There has been no definitive diagnosis as yet, but as recently as Tuesday, my consulting surgeon has suggested that I start physio to see if that mitigates the pain. My husband has been pushing me towards it, but I’ve been hesitant, especially since we don’t know exactly what the problem is yet (surgeon leaning towards Fibromyalgia) and I didn’t want to cause more damage to my already deteriorating bones.

    I’ll be seeing my Rheumotologist (hopefully) soon and will definitely speak to him about starting physio.

    Thanks again for the PSA!

  • Library Cat October 20, 2016, 8:25 am

    Thank you so much for writing this! My sister is a PT, and I’m excited to share this with her. She will be thrilled about your advice to “do your homework.” It’s like the dentist– there’s no point in lying if you don’t floss. Your teeth (or in this case, your muscles) will turn you in.

  • Kay_L October 20, 2016, 12:52 pm

    I had a bad experience with PT and with the orthopedic doc that I was seeing for a lower back and groin problem.

    First of all the doc was just itching to do steroid shots right into my back, something that does carry some risk. And the PT was utterly useless except for one tip that helped–which was to press my hips up against the cabinets when I was doing dishes to ease the pressure on my back.

    The reason the PT was useless was because I couldn’t figure out what it was they were wanting me to do. I had tried asking but the explanation was not clear. While right in front of the therapist, I would do the exercise she was asking me to do in several different ways trying to get her to correct to which one was the right one–she never seemed to even notice.

    They gave me lots of papers with exercises on it that was copied from a book somewhere and the copies were unreadable. The text in the book was set against a color background of some kind but the copies were in black and white.

    The straw that broke the camel’s back was when they brought in some teenager to my session and said she was there to “observe” as some kind of school project. She proceeded to chew gum with her mouth open, clicking and popping it. And I was never asked if it was ok for there to be someone who was not a medical person, not even close to being a medical person–just some teen who thought that being a PT someday might be something she wanted to do.

    It was most awkward when the actual PT left and left this teen alone in the room with me as I was trying to the “exercises” that I still couldn’t figure out…

    Left a really bad taste in my mouth for the whole enterprise.

    I never went back. I just took it easy with my back–it was pretty bad for about 4 months and then started to calm down. Now, I am very careful with it. I don’t lift anything for than 20-25 lbs. When Im at the grocery store, I ask the person putting bags in the cart to please not put anything on the bottom because I can’t reach down there to lift up a 20lbs bag of dog food or package of sodas, etc.

    Im glad that others have had really positive results but for me it was just a very bad experience.

    • NostalgicGal October 20, 2016, 11:46 pm

      I would have complained until I either got correct instruction, another PT therapist….whatever it took. You do not have to have messes like that. Go back in, see another doctor if you need to, explain it ALL and get some sorting out.

    • CW October 21, 2016, 7:08 am

      You do have the option of asking to see a different doctor or therapist. Or going to another office all together.

  • Cheapie October 20, 2016, 4:17 pm

    I am currently in the transitional care unit of a nursing home doing PT and OT twice daily. I got here about two weeks ago from a hospital rehab unit where I spent three weeks relearning how to walk due to the removal of a huge spinal cord tumor (benign). I had been recovering from a spinal fusion done on June 1. I did pretty good with a walker up until August when I started regressing. Without going into details, I had a couple of cousins step in and say something more was wrong than just spinal fusion recovery. Yep, the hospital neurosurgeon found the tumor and operated the next morning. I started PT and OT and have done everything they have asked of me plus a bit extra when able. I can now walk again, with a walker. It’s not pretty, but it’s better than the alternative … the possibility of being a paraplegic. I will stay here til they (kick me out) say it’s time for me to go home. I then intend to do aggressive outpatient PT … as many days a week as is recommended for my situation. I will be going to a clinic where they have appropriate equipment to help me even more.

    I would love to be back a 100%, but there are no guarantees. All this could take up to a year or more of intense PT … or more. I have decided to intergrate it into my life as just another part of normal/regular. There are days that are horrible and I rarely get a good night’s sleep, but I have faith that this will all change as long as I do what the OTs and PTs tell me what to do … plus a little extra! After all, a month ago I couldn’t walk. Now I can, with a walker and a PT spotting me and I keep getting better everyday! I love my PTs and OTs!!!!!

    • NostalgicGal October 20, 2016, 11:47 pm

      You Go Girl! You’ll do it.

  • Kira October 21, 2016, 5:47 am

    Sorry have to pull you up on the pain thing. It almost felt like you were judging the person’s perception of their pain because they didn’t align with your perception of your bodies pain. Pain is relative and the worst thing you can do is judge someone and imply what they are telling you is not what is going on in their body. I am sure you would hate someone to tell you your pain is nothing compared to what they have been through. Sure it might not seem appropriate, but who are we to judge and it is a very slippery slope of judgement.

  • MPW1971 October 30, 2016, 1:23 pm

    The last time I was in the ER, the intent of the pain scale is that 0 out of 10 means no pain and 10 out of 10 means debilitating pain. Debilitating pain means that you are unable to stand/sit/move and that you are in tears or throwing up. Those are the two endpoints. In between it’s difficult – the scale isn’t necessarily linear. I broke two ribs and if I wasn’t trying to bend my torso, I could speak normally, but every breath and motion caused some amount of pain. I described my pain as 5 or 6 on that scale. I wasn’t screaming or crying, and I wasn’t throwing up – and I wasn’t trying to be brave. I may be a large middle-aged man, but I don’t claim to have a high pain tolerance and laser hair removal – like an elastic band snapping against your skin – made me flinch uncontrollably.
    The thing is that 10 out of 10 on that pain scale isn’t meant to be the limit of pain you can endure while performing the activity. That 10 out of 10 means “I’m dying”. This isn’t a gym workout where one is encouraged to “push through the pain” or “feel the burn” – physiotherapy is not supposed to help heal damage from an injury, not increase it.
    Lesson to be learned here – there is no point in overstating pain tolerance, and even if 10 means “I’m dying”, proceeding normally isn’t a 9.9 on that scale. Or even a 7. Making that mistake will lead you to overdo your physiotherapy and cause further injuries, all for the sake of vanity.

    • MPW1971 November 2, 2016, 12:11 pm

      The 2nd paragraph should read “physiotherapy *is* supposed to help heal damage from an injury, not increase it”.