How to choose a good physiotherapist?

Why might my progress in physical therapy slow down?

Progress in physical therapy may slow down when the treatment plan no longer meets your needs or when obstacles to resuming your activities remain. Your physical therapist can reassess your challenges, your goals, and your response to treatment to adjust your care.

If several weeks of follow-up show no progress, it’s time to discuss your progress. Pain is important, but your ability to walk, sleep, or return to work also deserves attention. Persistent difficulty does not mean you are to blame for your problem.

Patients and physical therapists interviewed in a review of 13 studies described active listening, explanations, tailored care, and the time devoted to them as important aspects of their relationship. These accounts help us understand the care experience; however, they do not, on their own, predict treatment outcomes.¹

The eight guidelines below will help you discuss the quality of your care. They are not a test that guarantees a specific outcome or judges a healthcare professional based on a single detail.

Effective care is based on practice guidelines: recommendations that expert groups derive from available studies on a health issue. In a study of 145 people with low back pain, care that was more consistent with the guidelines was associated with fewer difficulties in daily activities and fewer treatment sessions. This study examined the care received; it does not prove that adherence to the guidelines alone accounted for these differences.^{2, 3}

What are the 8 signs of high-quality physical therapy?

High-quality physical therapy includes attentive listening, tailored exercises, clear explanations, pain management strategies, a focus on active care, a personalized plan, consideration of your personal experience, and your involvement in decision-making. The following guidelines primarily address common pain in the back, neck, shoulders, and joints. After an accident, surgery, or in the case of a specific medical condition, the plan must also take into account the precautions specific to your situation.

1. You have the physiotherapist's full attention

Your physical therapist should give you the time you need to listen to you, examine you, and answer your questions. Explaining and checking your exercises requires genuine attention. You should be able to talk about your difficulties during your appointment without feeling rushed to finish.

2. You have personalized exercises to do at home

Therapeutic exercises can reduce pain and improve function in people with common back, neck, shoulder, or knee pain.⁴ Your at-home exercise program should be tailored to your specific condition and any precautions you need to follow. Your physical therapist should demonstrate the exercises, check your form, and explain their purpose, frequency, and any adjustments you may need based on your symptoms.

3. You understand your problem and the findings of the assessment

Your physical therapist should provide you with a clear and understandable diagnosis and explain the limitations of their evaluation. A specific cause cannot always be identified. You should understand what the results mean for your activities, what possibilities still need to be explored, and when another evaluation would be helpful.

A good physical therapist will explain your condition to you and help you resume your activities. Guides on common muscle and joint pain recommend explaining the problem and adapting your physical activity and exercises accordingly.³

A thorough evaluation does not require an X-ray or an MRI for every instance of pain. These tests become useful when their results can change the course of treatment, especially if the evaluation suggests a serious problem. Guidelines recommend a physical exam, targeted use of imaging, and monitoring of your progress.³

4. You know what to do when you're in pain

Your physical therapist should give you advice on how to better manage pain at home. The plan may, for example, include a gradual return to activities and ways to temporarily modify difficult tasks. The advice should help you manage your daily life, beyond just medication, heat, or ice. For lower back pain, the recommendations place particular emphasis on explanations and a gradual return to activities.⁵

5. No electrotherapy as the main treatment

At Physioactif, we prioritize explanations, tailored exercises, and a return to normal activities rather than electrotherapy devices as the foundation of treatment. These devices include, in particular, TENS, which applies electrical stimulation through the skin, and ultrasound. Regarding the use of TENS for neck pain that has lasted more than three months, a Cochrane review concludes that the results are too uncertain to establish its effect on pain compared to a sham device.⁶ Your follow-up care should, above all, provide you with the tools to make progress in your daily activities.

6. You have a personalized treatment plan

Your physical therapist should explain the treatment plan, the goals, and how your progress will be measured. The plan should take into account your expectations, activities, preferences, and limitations. If you have difficulty resuming an activity or are not making progress, the plan should be reevaluated.

7. Your personal experiences and circumstances are taken into account

It can be difficult to talk about stress, anxiety, and fears. Your physical therapist should address these topics with respect and explain how they relate to the challenges you’re facing. Fear of moving, concerns about an injury, and difficulties at work can make it harder to resume your activities. Talking about these issues helps tailor your care to your specific situation, without making you feel responsible for your pain.

High-quality care takes the patient into account. The physical therapist must also look for signs of a serious problem that requires medical evaluation, and then consider psychological and social factors, such as your fears, your support system, and your work situation.³

8. Your treatment is not exclusively passive

Your care shouldn't be limited to receiving hands-on treatments, such as joint mobilizations or manipulations. Explanations, advice, and tailored exercises also give you an active role in your care. You participate in decisions and agreed-upon activities; your physical therapist guides you and adjusts the plan together with you.

Manual therapy can be included in the treatment plan as a complementary measure. For common muscle and joint pain in adults, guidelines recommend using it to support other treatments, such as exercises and advice.³

Should we give physical therapy a second chance?

A new physical therapy evaluation can help identify your challenges and adjust your treatment plan after a disappointing experience. Talking with your current physical therapist can also help you review your goals and treatment plan.

You may have gone through a course of treatment without seeing any progress, or you may have felt that your concerns weren’t heard. This experience is worth discussing. It doesn’t predict the outcome of any future treatment you may receive.

Ask for an explanation and a plan that meets your needs. You can discuss expected progress, ways to measure it, and next steps if the situation does not change. A second opinion may be helpful if the explanation or plan does not address your concerns.

What studies does this article draw on?

This article is based on six publications focusing on the relationship with a physical therapist, treatment recommendations, exercises, lower back pain, and TENS for persistent neck pain. The findings primarily concern common muscle and joint pain; they are not a substitute for an evaluation tailored to your specific condition.

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1. O'Keeffe M, Cullinane P, Hurley J, Leahy I, Bunzli S, O'Sullivan PB, et al. What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2016;96(5):609-22. (Back to section: 1)
2. Rutten GM, Degen S, Hendriks EJ, Braspenning JC, Harting J, Oostendorp RA. Adherence to clinical practice guidelines for low back pain in physical therapy: do patients benefit? Phys Ther. 2010;90(8):1111-22. (Back to section: 1)
3. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86. (Back to sections: 1, 2, 3, 4, 5)
4. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017;12(6):e0178621. (Back to section: 1)
5. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383. (Back to section: 1)
6. Martimbianco ALC, Porfírio GJ, Pacheco RL, Torloni MR, Riera R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database Syst Rev. 2019;12(12):CD011927. (Back to section: 1)