Does Anyone Love Doing Physical Therapy? (2024)

“Physical therapy.” Just the mention of these words elicits a variety of feelings and thoughts surrounding this form of treatment—many of which are not positive. For example, “it hurts too much,” “I don’t see any benefit or improvement,” “it’s inconvenient and takes away time from things I need to do,” “it costs too much,” “I look silly doing those exercises,” and “I’m afraid I may hurt myself.”

Many people, after having surgery or experiencing an injury, are prescribed physical therapy (PT). The purpose of the therapy is to hasten and reinforce rehabilitation as well as instruct patients on how to adjust to their conditions and prevent further injury or decline. Despite this, many patients avoid or engage sporadically in treatment.

Generally, athletic individuals are more likely to adhere to the treatment than those who are not used to or dislike physical exercise and discomfort. Clearly, pain tolerance is an important issue; but physical therapists are aware of this and should address it in the exercise regime. The challenge is in discovering and focusing on the specific issues each patient presents, which may affect PT compliance.

All the reasons mentioned above legitimize patients discontinuing or engaging inadequately in PT. However, these are not the only issues that affect patients’ adherence. Lequerica, Donnell, and Tate (2009) discuss the following features related to PT engagement:

• The patient’s medical condition and treatment
• The patient’s personality and cognitive functioning
• The patient’s family or support system
• The physical therapist

The side effects from a patient’s medication may impair effective PT performance (e.g., alertness, endurance). In addition, the medical condition may produce symptoms that are aggravated by PT (e.g., too rapid heartbeat, too strenuous motions affecting incision site).

Aspects about the patient can also serve as a hindrance to PT engagement. Psychological issues, such as anxiety or fear about the pain as well as the possibility of doing further harm can be an impediment to adherence. The nature of the patient’s medical condition in addition to experiencing pain can lead to a depressed mood affecting motivation. Personality characteristics can influence the engagement required for successful outcomes from PT. These include:

• Poor self-discipline
• Low frustration tolerance
• Impatience
• Rigidity—not willing to adapt or take direction

Other psychological factors, such as anger about one’s medical condition, can not only hamper motivation to perform the PT exercises, but to even attend treatment sessions. Denial of one’s injury or medical condition also leads to poor compliance.

Cognitive processes are another set of factors that can impede the effectiveness of PT. These may be the product of the patient’s medical condition, medication, age, or other agents that impact cognitive functioning. For example:

• Memory impairment—remembering when and how to perform the PT exercises
• Comprehension—understanding the need for PT
• Difficulty adjusting to the medical condition and the changes required
• Alertness
• Confusion about the PT instructions

Family members or other people who provide support to the patient can also adversely affect PT (Lequerica, et al., 2009). That is, they may be overprotective and not encourage or even permit the patient to perform the tasks approved by the treating physician or physical therapist. Moreover, family members may minimize the importance of physical rehabilitation and not facilitate the patient receiving PT.

Physical therapists, themselves, can play a role in relation to a patient’s adherence. The therapist may not have an adequate understanding of the patient and how she or he will adapt to their condition and comply with PT. In many instances, patients of all ages feel scared and worried about their medical ailment and whether it will improve. Performing exercises with the therapist can be anxiety arousing, but having to do so alone and unsupervised at home can be frightening.

Patients may believe that their physical therapist does not understand them or has expectations beyond the patients’ capabilities. As a result, patients may be reluctant to admit that:

• They are having problems remembering how to do the exercises correctly
• They have not exercised as often as prescribed
• They are having pain or discomfort performing the exercises

Miller, Litva, and Gabbay (2009) discuss how important it is for the physical therapist to provide “a patient-centered service to put the patient and their needs at the center of the consultation” (p. 33). The importance of the patient-therapist relationship and its impact on compliance cannot be underestimated. Feeling comfortable with one’s physical therapist can enhance patients’ willingness to disclose concerns, ask questions, and follow the treatment exercises (Kirby, Donovan-Hall, & Yardley, 2014). Having their support and receiving positive, sensitive, and constructive feedback increases patients’ confidence and motivation.

Physical therapists can also educate patients about the therapy and its realistic effect on their medical condition and rehabilitation. Stressing the importance of how adherence to PT can improve one’s physical condition and lead to patients regaining more control and independence than they have now can have a profound psychological effect.

As with any form of treatment, “one size does not fit all.” PT is not a guarantee of returning to one’s former self prior to the medical condition prompting intervention. Moreover, the relationship between patients and therapists are not always sympatico, and thus, it may be necessary for the patient to seek another therapist. As with any health-related relationship, patients should be aware of and inform their physical therapist or treating physician if they believe PT is not helping them get better. The importance of playing a role in one’s rehabilitation is a right that should be exercised and respected.

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