And Other Remarks Overheard in a Physical Therapy Department
The inner workings of a PT department are mysterious to those outside the biz. Much like when you visit a doctor’s office or go to a restaurant, inquiring minds want to know what goes on behind closed doors.
Within a PT clinic, it’s usually more open than in the above examples. Patients and therapists are out in the gym area, chatting while working and exercising. Conversations occur, comments are made, and questions are asked.
The summary below showcases some of the best and most common questions and remarks I’ve heard over almost 30 years as a clinician.
Do you have to go to school for this?
This might be the most confounding question I’ve been asked. My immediate response, in my head, is always, of course! I wonder, would anyone ask a nurse or doctor if they must go to school to do their job?
Physical therapy remains an enigmatic job to many. I suppose we need to educate the public better about our education requirements and what we do to help people.
Let’s state for the record here, a resounding YES! We go to school to become PTs, PTAs. The programs have changed since the dark ages when I went to school. PT was a bachelor’s degree initially. Then a master’s degree, and currently a Doctor of Physical Therapy is the standard.
Physical Therapist Assistants are required to complete an Associate of Applied Science in Physical Therapy Assisting. Both PT and PTA are required to meet criteria before being accepted into these programs. Once school is completed, then you are allowed to sit for your licensing exam. Passing the exam allows the therapist to practice legally in the state they applied to test in.
Why does my shoulder (knee, ankle) pop?
I hear this question a LOT. For most occurrences, popping joints are not a cause for major concern. If there’s no pain associated with the popping, then there is likely no reason to worry.
Without becoming too technical, here are a few reasons joint popping happens:
- One known cause is gas being released from the joint space.
- Tight muscles create tension in the tendons that causes a “pop” with certain movements. This can happen more so when there is inflammation present, e.g., tendinitis or bursitis.
- Muscle imbalances cause poor movement patterns or arthrokinematics, and that can result in a pop heard when moving your arm or knee.
Then again, some people are just naturally more “poppy” than others. People like gymnasts or dancers, who tend towards being hypermobile, their joints move into an extra range of motion (ROM) as compared to the average person’s ROM.
Hypermobility can cause joint instability or even injury. For example, if the humerus, the top bone in the arm, does not sit well in the joint capsule there can be popping noticed with movement. Or if the patella (kneecap) has too much mobility you will likely hear and feel popping in the knee.
Note: if there is an injury followed by “popping” in any joint, or a gradual increase in the incidence of popping, you should seek medical attention.
I walk every day, isn’t that enough?
The short answer is, NO. If walking was enough to keep your body working properly, we could decrease the need for physical therapy for most. Walking is a great way to move but it doesn’t check all the boxes.
Walking daily has physical and mental benefits, like cardiopulmonary fitness and decreased stress levels. However, walking alone cannot be your only means of activity to ensure balance throughout the body.
To promote a healthy balance, you need to also incorporate strengthening with resistance training, and mobility or flexibility activities like stretching and foam rolling. As a therapist, I always recommend adding balance training to increase your proprioception and decrease fall risk.
Physical Therapists get injuries too?
This question seems to fall in line with the odd perception that doctors don’t get sick. Of course, they do. They are not superhuman or naturally immune just because they’re doctors.
So naturally, PTs do get injured and go through rehabilitation when needed just like patients do. In my experience, it seems therapists choose PT as a career because of previous occurrences of injuries or needing PT earlier in their life. It’s not uncommon for therapists to get injured while working since the job can be very physical. If you spend any time in a therapy department you will notice at least one limping around. That’s a true story!
No pain no gain, right?
Oy, if I had a dollar for every time a patient said that phrase, I could retire.
Let’s clear this up once and for all. The “no pain no gain” thing was not meant for a physical therapy clinic. Despite what many think happens in a PT clinic. We are not trying to cause you more pain. We are trying to help you heal, recover, and return to the life you want to live.
Following surgery, this can feel like the theme of your visits…pain. However, we spend much of our time trying not to hurt you while knowing we must get you moving ASAP to enable the best possible outcomes.
So, will you have some pain at therapy? Yes, but that is not our goal. We do not want patients to work through pain. After all, why would we intentionally reproduce your pain to help you recover? That’s just silly.
On the other hand, I have witnessed that people who have not exercised or been physically active before PT do not understand the feeling of muscle fatigue and they associate it with pain. The basics of strengthening require that the muscle must become tired, AKA fatigued, to build strength. A person who is not accustomed to the “burning” feeling of muscle fatigue will report they have pain.
Therapists are well-versed in educating patients and this is a concept we teach often.
I have a high pain tolerance.
Finally, I feel I must mention that another statement we hear frequently is so subjective that it’s difficult to address with some patients.
Pain is a complicated subject. Everyone feels pain differently. Your experiences shape your concept of pain. Yes, some people have a high pain tolerance, however, EVERYONE does not.
I have explained pain the same way for decades. We use a pain scale in PT, 0-10. I explain it like this: “0 is equal to no pain and 10 is I feel like I’m dying, and I need to go to the hospital right now.” Then I will ask the patient where they think they are on that scale.
When a patient walks in without a problem, sits on the table, looks me in the eyes, and tells me they have a 10/10 pain level, with no facial grimace or evidence of pain, I must question them further.
Childbirth is what many would say is 10/10 pain. Significant industrial accidents, limbs crushed, a fall from a ladder or building, and a rollover car accident are all scenarios from real patients I have treated. Those injuries are life-altering, yet those are not usually the patients that complain of 10/10 pain.
I understand every person is different. I know that stress causes increased inflammation and subsequently higher pain levels. This commentary is not meant to diminish anyone’s struggle, its purpose is to shed some light on the vast differences in perception when pain is the question.
Closing Thoughts
So, I’ve discussed some of the most common remarks heard inside a PT department. I felt compelled to entertain the notion that people want to know what we do. They wonder why their bodies do certain things, and if they have something rare or serious. This is normal. I have witnessed it in every setting where I have treated patients.
Therapists genuinely take all questions and comments with the appropriate concern or levity they deserve. Humor is essential when you work in healthcare. It helps lighten the seriousness of the setting. It is, in and of itself, therapeutic.
After all, we could all use a little more laughter in our lives.
