What to Look for in a Physical Therapist: Evidenced Based Practice
By Erin Ward, PT, DPT
Board-Certified Orthopaedic Clinical Specialist
The New York Times published an article on July 6th offering some tips on what to look for from a physical therapist. A physical therapist should guide your rehab journey; therefore, you have the right to make sure you feel comfortable, confident, and supported by your clinician.
During your primary consultation with your therapist, take time to tell your story and dialogue with your clinician. Someone who uses open ended questions and practices active listening will allow more time and space for you to explain your history thoroughly in your words. You may have experienced persistent pain issues for months or years, and by the time you enter the clinic, you might be feeling exasperated to repeat the same story. Perhaps you experienced a traumatic injury you’d rather not re-live. Nevertheless, it is important that you explain. This enables a good physical therapist to understand and delve deeper with follow up questions about your workout routine or job demands so that they can identify potentially contributing factors to your problem. Someone who takes stress levels, sleep hygiene, or nutrition into account will better see the ‘big picture’ and recognize other lifestyle adjustments to help you feel better.
Today, Physical Therapists obtain a Doctor of Physical Therapy Degree. Programs in physical therapy focus on three prongs of evidence-based practice:
- Best available evidence / research
- Practitioner’s clinical expertise;
- Patient values / preferences
Best Available Evidence/Research
The field of medicine changes as researchers perform more studies and meta-analyses. That means your therapist should stay up to date with published literature and continuing education opportunities and adapt their treatment techniques to best practice. Current trends in healthcare suggest a more active approach to rehab using exercise, movement training, and functional training as primary interventions as opposed to relying on more passive modalities such as ultrasound, electric stimulation, heat/cold packs. An active approach to your health leads to better outcomes. This should come as good news to everyone: it is all about building self-efficacy, the confidence to move in a safe and healthy manner. We control whether we stretch, strengthen, and move; the power for change is in our hands.
Physical therapists educate clients about potential helpful and harmful activities and behaviors and advise how to modify accordingly. If your body seems cranky you may need to temporarily pause or reduce certain painful activities to allow your body to calm down and recover. But research shows that graded exposure to load is vital to help the body build up resiliency and better load capacity. A skilled clinician can explain this process to you in a way that makes sense, using simple language. They will also help you titrate your dosing of activities so that you can make progress over time, see the fruits of your labor, and eventually return to the sports, hobbies, or positions you have been missing. The concept of behavior modification and lifestyle change remains crucial to developing self-efficacy and empowerment. In general, a physical therapist has done his or her job when they’ve taught you how to manage your symptoms independently, so you can reduce your frequency of visits over time as you become more self-reliant. By creating good habits, you will likely maintain and even continue to improve your strength and activity capacity because you have been set up for success. At Movement Systems Physical Therapy, your physical therapist will guide you to better health with diagnostic and treatment expertise in movement and pain science. You are never “discharged” from your physical therapist’s care – rather you are “discontinued” from an episode of care once you obtain independent management or have fully recovered from your injury or surgery – much like your PCP after an ear infection. We are here for you for all your movement related health care needs
Practitioner’s Clinical Expertise
A physical therapist will initially serve as a coach for the client, but the partnership should also function as a team collaboration. The knowledge of the therapist will enhance your treatment because of their familiarity with the anatomy, kinesiology, and physiology of your problem. They will also likely rely on anecdotal evidence based on previous clients with similar complaints as yours. Your therapist’s past experiences and strategies can help guide your future plans, especially when navigating complex cases or presentations that may not respond to more traditional or predictable interventions. A therapist’s critical thinking skills and willingness to re-assess and change course of action speaks volume about their awareness, humility, and adaptability
Patient’s values & preference
What you think and care about matters. A good physical therapist will help create a plan that incorporates the types of activities that you find important. Maybe you hate running but recognize you are missing cardio in your weekly routine — how about considering biking, swimming, hiking, a short HIIT routine, or even walking into your day as an alternative? If you are a yogi maybe your physical therapist can give you a 5-10 dynamic flow to start your morning. If you play a certain sport maybe drills can simulate an athletic environment. If you avoid the gym and have never lifted a dumbbell in your life, your therapist should meet you where you are at and can use basic daily tasks like picking up grocery bags or getting on/off the toilet as opportunities to practice certain skills. The best types of exercise are the ones that you will complete, so work with your therapist to find a mode that excites you.
The rapport you develop with your physical therapist will likely impact your treatment experience and outcome, so make sure you feel heard, validated, and understood by your clinician. The environment should foster respect and honesty, so you feel comfortable voicing concerns or frustrations. At Movement Systems Physical Therapy, sessions last 60 minutes with your physical therapist which gives them time to listen, educate, teach, coach, motivate, and inspire. At the end of the day, the time you spend with your physical therapist should be enjoyable and well worth the investment of time and healthcare dollars. You should be “forever better” for having spent the time together. Time flies when you’re having fun!
Infographic. Benefits of Physical Therapy. The Centers for Advanced Orhopaedics website. Published September 27, 2019. Accessed July 16, 2021.
Smith D. What to Look for in a Physical Therapist. The New York Times. Published July 6, 2021. Accessed July 7, 2021.
Components of Evidence Based Practice. American Physical Therapy Association website. Published March 23, 2020. Accessed July 8, 2021.