Five Characteristics of an Outstanding Physical Therapist
If you’ve had physical therapy multiple times before, chances are you know that it’s possible to have an outstanding, good, average, poor, or dismal physical therapist (PT). But, if you haven’t had physical therapy before, how do you pick where to go or who to see? And, if you have had physical therapy, how should you evaluate what type of care you’ve experienced?
We suggest you use the following five characteristics that we’ll discuss to assess the quality of the physical therapist you saw. In the interest of full transparency, we can’t take the credit for this info. This comes straight from the Institute of Clinical Excellence. What we have learned from the instructors in this company, has been – without a doubt – one of the reasons we get the clinical outcomes that we do at Resilience RX.
It may seem counterintuitive to the previous statement, but we’d like to say one more thing before we get started. We don’t perfectly exhibit all of these characteristics all the time. Truly, no one can accomplish that. However, these characteristics are traits we are constantly striving to improve. Physical therapy is a profession – there’s art and science to it – and our goal is to continually learn and hone our skills.
Ready to dig in? Let’s go!
1. A Conversational Physical Therapist is a Good Physical Therapist
This is HUGE. If your physical therapist can’t hold a conversation, make jokes (or make attempts at jokes), and not take life too seriously, you’re not going to have good results. Why? There is an insurmountable pile of research that shows that those who like the person they work with get better results than those who don’t. Bedside manners are important.
However, there’s a flip side to this. Most people typically stop here when they evaluate their physical therapist. Is she nice? Do I like him? If yes, they tend to assume that the individual is competent and worthy of trust. We’d like to put forth the idea that the next four items we’re going to share are just as important as this first one and that individuals should be evaluated by more than their likeability.
2. Lead From the Front
Optimal recovery involves prioritizing sleep, eating well, having good coping mechanisms for stress (that are actually used), and exercising regularly. If your physical therapist isn’t doing these behaviors themself, how well do you think they can assist you in modifying your behavior?
We’re not saying the PT has to be perfect, but we are saying they need to be an example. He or she needs to be a leader. We feel it’s a bit hypocritical to ask others to do something that we don’t do ourselves. Yes, that may sound blunt, but we believe inspiration and examples better elicit behavior change than lecturing and facts. After all, if facts changed behavior, would we really see all the preventable health issues that we face as a country?
Furthermore, we’d like to argue that you best understand something by going through it yourself or physically doing it. Knowing what a 1RM feels like is crucial if you’re treating weightlifters. Understanding what your body goes through when training for a half marathon is important if you want to help someone else do the same. If a PT doesn’t regularly engage in strength training, we believe they can’t optimally strength train others as well as someone who does.
3. Test, Re-Test
The best way to know if you are being effective is to re-evaluate immediately after treatment. At Resilience RX, we test before treating to develop a hypothesis. Then, after we treat, we re-test. This re-test gives us the information needed to confirm or refute our hypothesis.
Physical therapy is much more complex than applying a list of “knee exercises” to a knee injury. It involves understanding how things are intertwined with the pain at hand. Deficits (lacking flexibility, strength, or mobility) can be present that don’t contribute to the pain. We’re fans of figuring out exactly what is causing your pain and honing in on that.
Rotator Cuff Example
One of Dr. Sarah’s favorite diagnoses to treat are rotator cuff injuries. With rotator cuff injuries, strength test(s) at the shoulder is(are) painful. She’ll test to determine which directions are painful, treat one muscle, and then retest all the painful tests.
This allows her to know what muscle is influencing which aspects of the pain. If one muscle influences all of the painful directions, she’ll focus her time there instead of treating everything that could be causing pain. This typically makes for happier clients because it looks like less needling, less home exercises, and quicker results. It also helps her learn how to better serve individuals across the board because it’s easier to identify patterns when you have good, clean data.
4.Competency Across the Body is Crucial for Physical Therapists
If you’re really good at treating shoulders but can’t get someone out of hip pain to save your life, we’d argue you may be a good shoulder physical therapist, but you’re not an outstanding physical therapist. Whether someone with chronic pain, tennis elbow, shoulder impingement, sciatica, hip tightness, knee pain, incontinence, Achilles issues, plantar fasciitis (or more) walks in the door, an excellent PT should be able to get them pointed in the right direction. Sure, your PT may not be “the best” at everything and there may be some areas that your PT is better at, but that’s normal.
5. Ruthlessly Methodical
It’s impossible to make good decisions with bad data. A good PT will be methodical about data collection to the point where it may annoy you (and that’s a good thing!). When tests are done in even slightly different ways, it’s possible to get different results. Nerve tension testing is a great example of this.
Nerves exist in a matrix throughout the body. That means if you pull on a nerve in the foot, it’s going to affect how far the nerve in the arm can be stretched before pain or tingling starts. This means that when testing nerve tension in the arm, you’ll get different results if someone’s legs are crossed or if they have their opposite hand on their belly vs. by their side.
If you test nerve tension in the arm with the legs uncrossed, treat, and then retest with the legs crossed, you may find no change. However, crossing the legs increases nerve tension. Therefore, you really just got a false negative. If the legs were uncrossed again while nerve tension was tested, you’d find you could stretch the nerve in the arm further before pain started, which is an indication that what you’re doing is working. Paying attention to the small things is what gives the best data.
Physical Therapist 2.0
We put being ruthlessly methodical last because most PTs don’t get to this step. Why is that? It’s because most don’t re-test after doing a treatment. The large majority of physical therapy looks like applying a list of exercises and hands-on treatment that typically work without assessing to see what specifically is and isn’t working. Sure, you get results for about 80% of individuals this way. But, you’re missing about 20% of folks that don’t fit into the typical patterns of pain that are seen.Additionally, the more re-assessing that is done, the more specific treatment is. When treatment is specific, you do less better. This is what Physical Therapy 2.0 is all about. To sum it up in this quote by Antoine de Saint-Exupéry – “Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.” It’s not about throwing darts at the wall and hoping something sticks. It’s about zeroing in and being as effective as possible.
An Outstanding Physical Therapist
So, there you have it. Five different characteristics we’d argue are necessary if you want to work with an outstanding physical therapist. We’ll re-list them here so you can see them all in one place.
- Conversational
- Lead From the Front
- Test, Re-test
- Competency Across the Body
- Ruthlessly Methodical