By Lillian Lau, APA Titled Musculoskeletal Physiotherapist and Practice Principal, Annandale Physiotherapy & Sports Injury Clinic. M.Man.Thpy, BAppSc(Phty).
Short answer: the patients who get the best results are the ones who ask why, say honestly which exercises they actually did, and push back when something does not feel right. Your physio cannot feel what you feel. Without you telling us, we are guessing.
Your Physiotherapist Isn’t Always Right — And That’s OK
Do not treat your physio’s word as absolute
I say this to patients, and it surprises some of them.
We give you exercises based on what we assess on the day. That is a snapshot.
Then you go home, and things change. You get busy. Something else flares up. You do the exercise slightly differently from how you understood it. You skip the one you hate.
None of that is a failure on your part. It is just what happens. But we cannot account for any of it unless you tell us.
“This one doesn’t feel right”
There are many different ways to train one muscle group. Many.
So if I have given you an exercise and it does not work for your body, or you cannot get the technique right at home, or it feels like it is doing more harm than good, that is useful information, and I want it.
It is not rude to say so. It does not mean the plan was wrong. It means we swap it for one of the several other options that achieves the same thing, and you end up with a program you will actually do.
The alternative is that you quietly stop doing it, I never find out, and six weeks later we are both wondering why you have not progressed.
Be honest about what exercises you actually did
The most useful sentence a patient can say to me is some version of: “I did this one most days, but I didn’t really do that one.”
I am not there to be disappointed in you. That information lets me do two things. I can rebuild the program around what fits your life, and I can remind you why the one you skipped matters, in case it turns out to be the one holding everything up.
Adherence is not a moral test. It is a design problem, and it is my job to solve it.
Ask your Physiotherapist why
Education is the most powerful tool a physiotherapist has. I am fairly convinced of that.
If I do not explain why you are doing something, you will not do it. And even if you do it, you will not know what you are supposed to be feeling, where you should feel it, or whether you are doing it correctly. Understanding the purpose is what makes an exercise work at home when I am not standing next to you.
So ask. Ask why this exercise, why this many, why now, and what it should feel like.
A physio who cannot answer that clearly is a problem. A physio who is annoyed by the question is a bigger problem.
What pain is acceptable, and what is not
Here is the thing patients get stuck on: some discomfort during rehab is normal and expected. Pain that is severe, escalating or clearly changing the way you move may be a reason to modify the exercise, and your physio can help you work out the difference.
I can watch you do an exercise and tell if your technique is off, or if you are guarding, or if you are compensating. Sometimes I can see it on your face. What I cannot do is feel how much pain you are in.
So when you tell me, one of two things happens. Either I reassure you that what you are feeling is normal for your condition at this stage, which is often the case and takes a real weight off. Or we adapt it, because what you are describing is the kind of pain that will cause a new problem.
Both of those outcomes are good. Silence is the only bad option.
Every physio gets it wrong sometimes
I include myself in that.
If you have done the program properly, the way we agreed, and you have gone backwards rather than forwards, that is real information. It usually means the original diagnosis needs revisiting. Something deeper is going on that the first assessment did not catch.
That is not a scandal. Assessment is a hypothesis, and hypotheses get updated. What separates a good physio from a poor one is not being right the first time; it is noticing when they were not and correcting course.
This is why we reassess, and why I will sometimes ask a patient to book a slightly longer session. A proper reassessment is every bit as important as the initial assessment, because it is the only way to confirm we are still treating the right thing.
Why I start from scratch, even if you have already been diagnosed
When someone comes to me with an existing condition and a history of seeing other practitioners, I do something that occasionally puzzles them. I do not ask what they were diagnosed with, and I do not ask what was done.
Sometimes people start telling me anyway, and I will gently stop them.
It is not that I do not respect the other clinician. It is that knowing their conclusion clouds my judgement. If I walk in already holding someone else’s diagnosis, I will unconsciously look for evidence that confirms it, and I will find it, because that is how brains work. I would rather take your history and assess you properly first, and form my own view.
I may well ask later what exercises you were given, if it becomes relevant. But I do not need it up front.
There is a deeper reason too. Even if a diagnosis is completely correct, it does not tell me what to treat. You do not treat the condition, you treat the impairments that come with it. Where are you lacking strength. Where are you lacking mobility. What is your movement pattern actually doing.
Two people with the same diagnosis can need almost entirely different programs, and the assessment is the only way to find out which one you are.
What good care looks like
If you take one thing from this, take this: the quality of your physiotherapy depends heavily on the quality of the conversation.
Find someone you can be honest with. Ask them why. Tell them what you actually did and what actually hurts. Challenge the exercise that does not feel right. Expect them to explain themselves, and expect them to change their mind when the evidence says they should.
That is not a difficult patient. That is the best kind of patient there is.
Common questions
Is it rude to tell my physio an exercise isn’t working?
No, it is genuinely useful. There are many ways to train the same muscle group, so a different option can usually be substituted.
What if I haven’t been doing my exercises?
Say so. It lets your physio redesign the program around your actual life rather than continuing with one that is not happening.
How much pain is normal during rehab?
Some discomfort is expected, but the amount that is acceptable depends on your condition and stage of recovery. Describe what you are feeling to your physio rather than deciding alone.
Should I tell a new physio what I was previously diagnosed with?
You can, but do not be surprised if they prefer to assess you from scratch first. Starting fresh reduces the risk of inheriting an incorrect assumption.
How often should I be reassessed?
Whenever progress stalls or changes direction. If you have followed the program and gone backwards, that is the clearest possible signal for a reassessment.
Lillian Lau is an APA Titled Musculoskeletal Physiotherapist, a credential awarded by the Australian Physiotherapy Association on the basis of postgraduate qualification, clinical experience and peer assessment. She holds a Master of Manual Therapy from the University of Western Australia and has practised since 2006.
Annandale Physiotherapy & Sports Injury Clinic, Shop 51, 62 Booth Street, Annandale NSW 2038. Serving Annandale, Forest Lodge, Glebe, Camperdown, Lilyfield, Leichhardt and Rozelle. [Book an appointment].