Is this normal for a physical therapist?
July 1, 2018 2:50 PM   Subscribe

I had my first physical therapy appt. for my knee last week and have some questions about appropriate/inappropriate PT actions.

So, I imagine that physical therapists are pretty touchy-feely people because it goes with the job and they have to sometimes massage parts of you or whatever, but I'm wondering if all of this is typical/appropriate for a physical therapy/sports rehab eval. This was for my first appt. -- I talked to the guy about my knee problem and he evaluated it and showed me what/where the problem was, and helped me do some exercises I can start doing at home. It was in a separate room with a closed door, not in the gym part.

Later on, I wondered, "Was that all normal for a physical therapy appt.?" While it actually didn't make me feel uncomfortable (mostly because of the friendly, non-creepy vibe I was feeling from him, and also he's younger than me), I'm curious because I've never gone to PT before.

The guy complimented my sneakers and tattoos, which seemed normal, but then when he rolled his chair over to the table I was sitting on to take a look at my knee and explain the problem, he had me rest my leg on his legs/lap rather than have me hang my legs over the side of the table or lay them on the table. (This seemed normal at the time but later seemed odd.) At one point when he went on talking, I could tell he belatedly realized he didn't need my leg up there anymore and took it off. There was also a point later when I was wondering if he really needed to be running his hand up and down my lower leg to show me something rather than just gesturing, but I can see that being normal. He didn't ask me anything weird during the appt. -- just if I was a [mycity] native and where else I've lived, when I said I hadn't always lived here.

When we went to the computer and we were standing there scheduling my next appointments in his calendar, I made some comment about how I was hoping they'd show up in my online patient account too (meaning that I can be disorganized about appts.), and he kind of laughed and said, "I know!" and touched my (bare) arm (in a way that, say, doctors don't do). Then he gave me his business card and wrote his direct number on the back and then pointed out the printed number on the front was for appt. scheduling with the front desk staff. Why doesn't he just have his direct line printed on the front of his cards too? He's not new.

ANYWAY, sorry for the book I just wrote -- am I overanalyzing and being totally silly about this? My gut feeling says no, but again, I've never been to PT before...
posted by trillian to Sports, Hobbies, & Recreation (23 answers total)
Being in a closed room is normal, but the rest of it sounds more on the touchy-feely end of the spectrum than I’m familiar with. Are there other therapists in the practice that you can switch to? Even if 9 out of 10 people were to say this was normal, you have a total right to your own comfort level and boundaries.
posted by matildaben at 2:58 PM on July 1, 2018 [2 favorites]

my experience with PTs is they will put their hands all over you but will/should explain before doing it. both for consent the first time or two and to warn you to say something if it hurts. and good ones cultivate an absolutely creep-free vibe so that you should never have to wonder if you're being appropriately (physically) manipulated versus patted/stroked.

I have had numerous private physical therapy sessions with male PTs that I felt great about. the worst and most invasive one was with a woman PT, and it was violating though not sexual. I've also had a couple of public personal training sessions with male trainers that were inappropriate and unpleasant in spite of happening in a crowded gym. it's not just what they do physically, it's how they do it.

in general it is normal for them to touch you, normal for them to be comfortable and casual about it, including to the point of resting your foot on their leg (IF it makes practical sense for whatever they're doing to it). it's not normal to be touched for no reason or for it to feel social/too friendly. you should not get the strong sense that the PT is enjoying himself or has forgotten what he's doing.

if you need more sessions I'd pick a different PT because just practically, if you're uncomfortable you'll be tenser and the therapy won't work as well. he sounds a little sketchy but even if he's not, there are PTs who won't make you wonder.
posted by queenofbithynia at 3:08 PM on July 1, 2018 [8 favorites]

My physical therapy appointments were about the same. But if you don't like it you can always switch to someone else and/or get your PT to tell you before they're going to touch you and how they are going to touch you. I put a stop to several things during my appointments that made me feel uncomfortable and it wasn't awkward at all. The PT just adjusted his plans to whatever I was comfortable with.
posted by ilovewinter at 3:12 PM on July 1, 2018 [2 favorites]

PTs (and sports meds) are pretty casual about touch, IME - they’re used to flinging body parts around, massaging and manipulating them for evaluation and treatment, etc. Also, most have a friendly, people-pleasing orientation, he might have gotten caught up in the talking.

My (female) PT did stuff like that all the time - but on reflection, that would have been a year or so into sessions. The first few months were a lot more formal.

From what you’ve written, it sounds like your PT was absent-minded, maybe? That said, being male and young, he might have been less mindful than a woman might have been about how unexplained touch could unnerve female clients. But yeah, if you’re not comfortable, see someone else, there’s certainly someone out there who’ll be a better fit.
posted by cotton dress sock at 3:25 PM on July 1, 2018 [3 favorites]

I would say overanalyzing. I work in rehab. I am a nurse, not a PT but work next to physical therapists all day and I would all of this normal apart from touching your arm when he said, "I know". I would say this is minor, depends on your comfort level. Probably not anything. It is over friendly and familiar. If it makes you uncomfortable, you might try someone else.

Why doesn't he just have his direct line printed on the front of his cards too? He's not new. -- this is especially not important.
posted by loveandhappiness at 3:34 PM on July 1, 2018 [11 favorites]

I just finished six weeks of PT for torn hip tendons, and this seems normal to me. The only slight exception is touching your arm, but that still seems within the normal bounds of friendliness. However, if this person makes you uncomfortable or if you’d prefer to work with a woman, you have every right to change therapists.
posted by FencingGal at 4:04 PM on July 1, 2018 [3 favorites]

Mr. DTMFA is a physio, and I showed him this q. His response was that if you felt uncomfortable about the interaction, either at the time or thinking back on it, then it's time to get a new therapist. That being said, his thought was that none of these behaviors are in themselves unusual or red flags. It would depend on the tone of the overall interaction and the vibes you got from the therapist, and none of us were there with you to judge that.
posted by DTMFA at 4:46 PM on July 1, 2018 [8 favorites]

ACL repair patient reporting here... all that was normal for my PT sessions, - the first one more private and the latter ones in the "wirjout" area. AND I've watched lots of other public rehab stuff happening for othersnnn yeah, it's hands on. DTNFA is right on qith everything said upthread. Be confident in your physio and be well.
posted by mightshould at 5:08 PM on July 1, 2018

All of that sounds completely normal to me for PT. PTs are not doctors. They are, literally, hands-on.
posted by DarlingBri at 5:16 PM on July 1, 2018 [2 favorites]

I’ve had tons of knee PT, 5 different therapists. All that you described has been done to me, except maybe the arm touch when laughing. But everything else, including the phone number, reads “normal pt behavior” to me. The phone number was probably because he doesn’t want complete strangers, who can get his card off the front desk, having his direct number. But he may be fine with actual patients having it. Complimenting your tats and sneakers is rapport-building. The other stuff is what they do for a living. They touch people over and over. It’s normal for them. But what’s important is that you feel comfortable, and this therapist may be too familiar for you. It’s fine to look for another.
posted by greermahoney at 5:51 PM on July 1, 2018 [4 favorites]

Agree with the above, your PT was building rapport because you were going to be working physically closely together for your therapy. It's totally fine to ask for a different practitioner, but since it sounds like you otherwise like him, you could also start your next appointment with a request to ask you verbally before he touches you or you can call it out in the moment if he, say, touches your leg when words would suffice.
posted by momus_window at 6:11 PM on July 1, 2018 [1 favorite]

He probably didn't have a choice about the card and phone number. It was probably created by another staff member to the standards of the business.
posted by SemiSalt at 6:14 PM on July 1, 2018 [2 favorites]

I've had PT where I've basically had my butt (glute) massaged by a male therapist, albeit in the public room (because this particular clinic didn't have private space). I've also had kinesiotape applied (again, in a public room) that involved me laying face down and having my bare back exposed. Both times I wondered, "Is this weird?" but then I realized there was no other way for my problems to be treated. I will say, being the public room made it less weird - maybe you could ask for that in the future?
posted by raspberrE at 7:45 PM on July 1, 2018 [2 favorites]

My PT has touched more or less my entire body aside from the actual gronch area and nothing you posted sounds way out of line. Like others have said they are pretty hands on in general. The number thing is also not that weird, my MT did the same thing when I first saw him and it was because he was a contractor to the facility and it was the best way to reach him.
posted by Sternmeyer at 8:10 PM on July 1, 2018

Reading between the lines it sounds like you got a flirty vibe from him. If you got that vibe, you are 99% likely to be correct that he was flirting with you. It would be totally ok if you disliked that vibe, and ok to find a new physiotherapist.
posted by pseudostrabismus at 8:24 PM on July 1, 2018 [2 favorites]

It's normal, but not entirely professional. I'm a massage therapist, and here are some things we are advised against:

Mentioning someone's tattoos, ever. It's inappropriate unless the client brings it up first.

Resting client limbs in our laps. It's sometimes neccessary, but in those cases we are advised to put a pillow in our lap if possible to create a boundary.

Any non-therapeutic touch. We are not even supposed to initiate handshakes, only respond to them.

That said, these are guidelines developed to enhance professionalism for massage therapists. They're not neccesarily actionable offences, and people disregard them constantly or don't even remember learning them. 95% of people don't seem to pay attention at all in ethics classes. The rest of us are around human parts all day and become pretty desensitised. I can totally picture myself making some of these faux pas, like forgetting that I still have my hand on someone, if I were a less anxious/vigilant person. I probably have, actually, in spite of being extremely boundary concious.

Physiotherapists likely have different guidelines; they seem to be particularly lax about this kind of boundary stuff compared to RMTs, probably because their public perception is different than ours.

However, those boundary guidelines were developed based on input from clients about things that made them uncomfortable or seemed unprofessional or overly intimate. So your feelings are totally valid and shared by other people.

The things I would be really concerned about here are, first, that your PT didn't adequately describe to you what he would be doing before/while acting. For example, he should have said eg "I'm just going to perform some stretches for your leg" or whatever. You have the right to be informed and have the opportunity to withold consent. Of course there are limits- you can't expect a constant running description of the PTs every move- but it sounds like your PT didn't do a good job with keeping you informed. That would concern me somewhat, especially since you were new.

The second thing I'd be really concerned about is that this encounter made you uncomfortable enough to write this question. That alone is adequate reason to try another PT if you want. Remember that it's not a lifetime commitment... You can try many practitioners and see who you like.
posted by windykites at 4:48 AM on July 2, 2018 [5 favorites]

Ortho surgeon here--I send a lot of patients to PT & work pretty closely with several. This doesn't read as unusual to me, and I definitely put patients' legs/feet on my lap on occasion for some kinds of exams. [If it makes a difference, I'm female and work with kids/teenagers, and have someone else in the room with me (parents, PA, nurse).]

All that being said, if you're not comfortable with your PT, it will likely affect your response to therapy, and it's totally fine to switch. Therapeutic alliance is important!
posted by n. moon at 5:48 AM on July 2, 2018

The card thing is totally standard for the medical field. It is largely to protect the provider, as there are patients you do not want to have your direct line.
posted by Lutoslawski at 7:40 AM on July 2, 2018 [3 favorites]

Sounds normal to me as a PT veteran but having a therapist you trust is super important! I would look for another one if you really get a bad vibe from this guy.
posted by ferret branca at 7:52 AM on July 2, 2018

I've had PT on a few parts of my body and this sounds like my appointments. My PT wrote her direct number on the back of her card too.
posted by PeaPod at 8:58 AM on July 2, 2018

Also sounds normal to me. The only thing that sounds extra is touching your arm, but that can be an innocent friendly gesture. PT is a kind of intimate experience in that you have a stranger up your personal space and you're in theirs sometimes. Regardless, follow your gut!!
posted by purple_bird at 8:59 AM on July 2, 2018 [1 favorite]

Just as a data point - I (male) had a PT (female) earlier this year for a leg injury. It was very hands-on (astym treatment) but each time she verbalized things before she did them (I'm going to apply the gel to your calf now, it might be cold, flip over and next I'll massage your lower thigh, etc). I found this super helpful since I'd never been to PT before.

What you posted sounded pretty normal but if you do switch therapists (which you're totally within your right to do), you might ask the new PT to say what they'll be doing before they actually do it to give you a chance to clarify or ask for things in a way that make you more comfortable.
posted by Twicketface at 12:32 PM on July 2, 2018 [1 favorite]

Thank you, all. Somewhat mixed opinions but overall it seems to be pointing to "yes, typical/normal." I really appreciate the input.
posted by trillian at 7:57 PM on July 2, 2018 [1 favorite]

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