Physical Therapy is naturally an activity-focused therapeutic specialty, but what happens when a patient is afraid of moving? Positive motivation during movement supports the delivery of effective therapeutic treatments towards returning the patient to their optimal state of movement and happiness.
Following an injury or history of prolonged pain, patients can often develop a natural sense of apprehension towards certain activities or movements. When the patient sees a Physical Therapist, their pain and function are objectively evaluated and addressed in their plan of care. However, sometimes the subjective attitudes and individual experiences that are connected to their pain and limitations are not consistently addressed in their plan of care. Early in my career, I noticed that patients increasingly often spent most of our visit discussing how they felt during movement, versus how they performed. I also noticed that how they felt was being left unaddressed from their treatments and future appointments. To use the best level of evidence-based practice, an expert clinician accounts for the best available evidence, their clinical experiences, and the patient’s individual experiences.1 Time and time again, I see the tertiary pillar of evidence-based practice left out. I took it upon myself to remedy this deficit head-on in my own patient interactions.
“To use the best level of evidence-based practice, an expert clinician accounts for the best available evidence, their clinical experiences, and the patient’s individual experiences.”
As I meet with patients across many ages and movement backgrounds, I emphasize the importance of how they feel during their movements and list any reservations they describe. I develop my treatment plans around these experiences and provide a continual, positive, motivation during each patient interaction to constitute a sense of confidence and support. As the patient regains their confidence during movement, any apprehension slowly resolves and a newfound motivation to move blossoms. A patient can receive the best evidence-based physical treatments, and still not reach their goal. Treatments that encompass both physical and emotional components offer a superior experience for the patient to achieve the best overall outcome. This concept is not new, many clinicians already incorporate the biopsychosocial paradigm into their practice, however, there seems to be an overabundance of focus on the bio aspect versus the psychosocial. We can confidently agree that surgery alone will not solve movement limitations and pain. Counseling alone will not solve movement limitations and pain. However, a healthy relationship of both sides of this coin delivered in a positive, supportive, atmosphere is one of the most effective treatments a patient can experience.
Any treatment that is provided unidirectionally, unfortunately has limited effectiveness. Treatments that welcome the patient to participate and support the patient to direct their own path have unlimited effectiveness. Athletes and children, administrative and manual laborers alike, all move and groove in their own unique way prior to injury or pain. Returning them to their unique mobility and enjoyment should be paramount. I am confident anyone reading this knows a patient or two who has experienced this phenomenon. The patient who was afraid to run following an ACL repair, became a long-distance runner and completed their first Boston Marathon. The patient who was afraid to walk in the grocery store in public using a walker, later joined a shag group and won a local dance competition. The patient’s success stories are endless when their physical therapy treatments are met with the happiness of movement and motivation to find movement they love. Pain already takes away happiness with movement, let us not keep that away from our patients. Let us get back to the happy feeling of movement. Let us all get movin’ and get groovin’!
Patients move better when they feel better. Being fearful to move following injury or in pain is common, however incorporating positive motivation and empowering treatments are unfortunately uncommon. Everyone moves and grooves better when they feel better, it is important not to lose sight of that!
Key Words: motivation, activity, positivity
1. Fetters L, Tilson J. Evidence Based Physical Therapy. 2nd ed. F A Davis; 2018.
The authors declare no competing interests.
William C. Stokes, PT, DPT
Board-Certified Orthopedic Clinical Specialist
Tactical Strength and Conditioning Specialist with Distinction
Staff Physical Therapist
Lieutenant, Medical Service Corps, United States Navy
The views expressed are those of my own and do not reflect the official policy or position of the US Navy, the Department of Defense, or the US Government.
Dr. Stokes graduated with his DPT in 2016 from Wingate University in Charlotte, NC. He became a Board-Certified Orthopaedic Specialist in 2022. William is currently an active-duty Physical Therapist in the US Navy. William is an active member of the APTA and APTA NC. William has served in many leadership roles within his state chapter, and throughout many committee and national-level roles within APTA Orthopaedics, Sports, Federal, and Leadership and Innovation.