My Physical Therapy Philosophy (Part 2)

Danny Dinh

Physiotherapist

July 18, 2022

The 2 principles that guide my practice

My practice as a physical therapist is guided by 2 core principles:

1. I aim to optimize my patient's time frame of recovery as much as possible.

2. I aim to make my patients as independent as possible in their own rehab and recovery.

I’ve spoken in-depth about the first principle in my previous philosophy article. This article will thus explore the second principle. I will explain how I use proper education and exercise prescription to achieve this principle.

Making my patients as independent as possible in their rehab

This means helping my patients complete their rehab and achieve their personal goals while requiring as little help from me as possible. This is why passive modalities such as ultrasound and transcutaneous electrical nerve stimulation (TENS) machines are never used in my practice. The use of manual therapy techniques, which are maneuvers involving kneading and mobilizing the muscles and joints using the therapist’s hands, is always in supplement to proper education and exercise prescription, not as a replacement. 

An analysis of the pros and cons of manual therapy could span an entire article, and has been discussed at length in the physical therapy literature. To summarize my stance on manual therapy: I value it and use it frequently, but it is never my first option of treatment. It is useful in reducing pain and anxiety and fostering therapeutic alliance. Whenever I use it, I aim to give a patient exercises to “self-massage” themselves so that they can reproduce the effects of manual therapy at home without having to depend on me.

To achieve this principle, we must understand that rehab is a two-way street: I learn as much from my patients as they learn from me. Let’s think about it logically: if you are or were ever in pain, who is the world’s foremost expert on your condition? Who is the only one who knows about your pain’s history, patterns, likes, and dislikes? It would make no sense for me or any other healthcare professional to pretend that we know more about your pain than you do.

If I don’t use ultrasound and TENS machines at all and minimize the use of manual therapy, then what do I do? What does “proper education and exercise prescription” mean? Let’s dig into that.

Knowledge is power

Here’s how the vast majority of my patient evaluations go: I ask them about their physical goals, then list what is preventing them from achieving those goals. One of the most common limitations found on that list is not a physical problem such as pain or stiffness, but a psychological one: fear.

Here are some words my patients told me recently that show this issue:

Pain is a scary thing. It is isolating, limiting, and sometimes unpredictable. When it occurs, our first reflex is to seek a better understanding of it. Show me a person who has never sought the wisdom of Dr. Google and I will show you a liar.

The problem with Googling our symptoms, however, is that instead of narrowing down the possibilities, Google instead shows us all the possibilities, some of which catastrophic and scary. Instead of providing knowledge and decreasing anxiety, it increases it.

This is why when I evaluate my patients, my most important objective is to better understand their condition in order to better help them understand it. 

Once we better understand your condition, we can start testing different treatment strategies together. In my first philosophy article, I discuss the three foremost management strategies I use with my patients. Through a thorough interview, biomechanical examination, and response-based treatment, I help all my patients walk out of their evaluation with a better understanding of their condition, how to treat it, and, hopefully, with less fear and apprehension.

The fear-avoidance model

The fear-avoidance model visualizes why removing fear is necessary for recovery. When we fear pain and stop doing the things we love because of that fear, we become more disabled and that fear holds more power over us. This in terms can lead to an enhanced sensation of pain and even more fear, and ultimately leads to a never-ending cycle: hence the fear-avoidance model.

The only way to break the cycle is to replace the fear of pain with knowledge. This is where I, as a physical therapist and musculoskeletal pain expert, come in.

Exercise prescription

The goal of exercise prescription is to create a program that takes my patients from where they are right now to where they want to be. Thanks to the two-way street of patient education and, of course, me educating myself on my patients, this is possible. A proper exercise program takes into account what provokes the patient’s symptoms, the activities they would like to return to, what exercises they love doing the most, their work schedule and physical demands, and what equipment they have available. 

The programs I make are not pre-made with a body part in mind. There is no bank of programs for a frozen shoulder, a back strain, or a Tennis elbow. Any program given to patients is made from scratch and with them in mind: I am in the business of helping people, not stiff necks or pulled groins.

An open line of communication

Situations change constantly. Your pain may change, you may progress much faster than we thought, your work or sports demands may change, and thus, the program we create together during our first meeting may not always be the best one. In order to ensure that we stay on the right path, it is important to modify the program whenever necessary.

This is most often done during follow-up appointments or, if the change is small enough, by phone call. I have an open line of communication policy with my patients: I am always easy to contact by phone call or email and aim to answer within 1 business day.

The power of independence

The ultimate goal of the 2nd principle guiding my practice is to put the power back into my patients’ hands. To close this off, I’d like to tell you about a story from one of my patients, Ms. E. She had consulted with me over a year ago for neck pain and reached out to me last week: her neck pain had come back and she was deeply anguished. Her pain had previously greatly limited her ability to play her sports, and she was afraid that it was going to ruin her Summer.

Things were different this time around, however. Over the phone call, I asked Ms. E. to explain to me how her pain was, and how it was behaving: it was indeed the same problem as last year. I reasoned that, since the pain was behaving the same way as before, the same program should work. I asked Ms. E. to pull out the old program that we had written and to try it for a few days. If things didn’t improve, we would schedule a session to look at things in-depth.

A week later, Ms. E. texted me to tell me that the pain had completely left. Ladies and gentlemen, this is the power of patient independence: being in complete control of your pain and being able to manage it without having to step foot into a clinic.

Moving forward

If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.

If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at dannydinh.physio@gmail.com or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.

Further reading

Here are some suggestions of articles I have written recently, organized by topics.

An in-depth explanation of my physiotherapy philosophy: Part 1, Part 2

Neck pain: a case study, answering common questions from patients

Low back pain & sciatica: case study 1, case study 2

Knee pain: case study 1

Shoulder pain: case study 1

An explanation of referred pain

Why choose telerehabilitation

7 reasons why I love my profession

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