Physical Therapy: A Team Sport

I’ve learned a lot during my first year in school and I even wrote a blog about it. I learned even more during my first clinical rotation and I wrote a blog about that too! However, for the sake of being concise, I had to exclude one topic from my previous blogs and in my opinion, this topic deserves its own post.

Physical Therapy Is A Team Sport

I get it, physical therapy isn’t a “sport,” but it requires a team effort nonetheless. Just like any team sport (football, basketball, soccer, etc.), physical therapy requires a joint effort between all the players (the patient, the physical therapist, physicians, friends, family, etc.), in order to achieve a common end goal. Let me get right to the point.

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Contrary to what I believed prior to graduate school, physical therapy is NOT a passive interaction in which the patient simply receives treatment. Instead, from the decision-making process to the treatment itself, the patient must be an active participant in the rehabilitation process.

The patient is an active member of the rehabilitation team.

If we take a step back and look at evidence based practice (EBP), we can better understand how the patient fits into the rehabilitation team and process. EBP is the current standard of practice that is being pushed by the APTA for practicing physical therapists. Here’s what the APTA has to say about EBP:

“The physical therapy profession recognizes the use of evidence-based practice (EBP) as central to providing high-quality care and decreasing unwarranted variation in practice. EBP includes the integration of best available research, clinical expertise, and patient values and circumstances” 

According to the APTA, there are three components to EBP.

1. best available research/evidence
2. clinical expertise
3. patient values and circumstances

From this definition it becomes easy to understand that the patient’s values, preferences and individual circumstances play an important role in the shared decision making process between patient and physical therapist.

In addition to playing an active role in the decision-making process, patients need to be able and willing to learn from their physical therapist. When it comes to rehabilitation, a major role of the physical therapist is patient education.

Physical Therapists are educators.

I understand that earning a doctorate degree in PT is an arduous process that takes a lot of time, money and effort – trust me; I’m going through the process myself. So I hope I don’t offend any of my peers when I say that physical therapists are just as much, if not more, teachers as they are ‘doctors’. Before anyone gets too upset, let me explain my thought process using an analogy.

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The Tricycle Analogy 

In my mind, physical therapy is similar to riding a bike for the first time.

When patients (children) first come to physical therapy they’re riding a tricycle. They’re unsure of how to deal with an issue and they look to expertise and skill of physical therapists (parents) for help, guidance and support. As patients progress through the rehabilitation process, physical therapists, much like parents, need to slowly remove the training wheels and teach patients how to manage their bodies (ride their bicycles) on their own. By doing so, physical therapists, like parents, give patients freedom, confidence and power to be in control of their bodies and live a happier and healthier life.

‘physical therapists, like parents, give patients freedom, confidence and power to be in control of their bodies and live a happier and healthier life.’

In the scenario of learning to ride a bike, it would be extremely selfish of parents not to teach their children how to ride a bicycle on their own just so they could keep them dependent. It would be just as selfish of a physical therapist to keep their patients dependent on their services. Instead of keeping patients relying on their services, it is the job of a physical therapist is to transition the patient from a dependent state into an informed, confident, and capable manager of their own body/condition.

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Hopefully that “tricycle analogy” made sense and gives you more insight as to why patient education is such an important aspect of the rehabilitation process. Much like transitioning from riding a tricycle to riding a bicycle, physical therapy is an active process which requires effort and active participation from the physical therapist as well as the patient.

The quality of physical therapy depends not only on the knowledge and skill of the physical therapist but also on the participation, motivation and understanding of the patient.

In my personal opinion (it’s cool if you disagree), physical therapists are teachers first and ‘doctors’ second. In addition to educating and empowering patients, physical therapists need to recognize and honor the fact that patient preferences should be one of the driving forces in the rehabilitation process. If patients don’t feel comfortable, confident or valued then compliance drops and when compliance drops we lose a team member. When the patient and physical therapist are not on the same team, treatment and progress suffer.

Before I close, I was recently reminded by a fellow SPT of nice concept that has been circulated throughout the rehab community, particularly by people like Zak Gabor. Physical therapists are in many ways a “rehab coach.” In other words, physical therapists are the head coach guiding the rehabilitation process. Like any team, it really comes down to the effort of the players (patients) under the guidance of the coach (PT) to achieve the desired and shared end goal.

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Per usual, I’d like to end this blog post with a quote that, in my opinion, sums up physical therapy pretty well.

“Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” 

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I’m not big into fishing, but you better believe that my patients will never go hungry, even long after they leave the clinic.

Thank you so much for reading,

Joe Rinaldi, PT, DPT

IG: @joearinaldi

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