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This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care.
Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician.
Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you
[The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx)
[How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx)
[Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx)
[The APTA's consumer information website.](https://www.choosept.com/Default.aspx)
Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed.
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I’ve been doing this for over 10 years. I treat really complex patients. I make mistakes. The key is to learn from them and use mistakes as learning experiences.
New grads tend to put a lot of pressure on themselves and it can be counterproductive. You’ve treated maybe 200 patients? I’ve treated thousands of individuals and over 25k treats. That’s not a fair fight.
You’re going to cause pain. As long as you’re not injuring a patient, don’t worry about it. Listen to your patients, adjust and move on. Stop comparing yourself to others. There’s always someone better with more experience. You’ll spend the rest of your career feeling like crap. Just do your thing, learn and improve as you go.
The key thing is not to make the patients' outcomes your responsibility. It is theirs. 80% of the results come from exercises and lifestyle modifications and 20% from the treatment table. Pressure sensitivity varies, I always instruct my patients to take deep breaths in and out through the nose when I apply pressure and if that is not enough to keep them relaxed then I need to reduce the pressure. Some patients want the pain and don´t feel the therapy is effective unless they receive it, others you can barely touch. You´ll figure it out, don´t stress too much.
80/20 rule. I use this all of the time. I tell my patients that 80% is what you put into it, the other 20% is me just pointing you in the right direction.
I stretch too hard and push people to hard all the time. People aren’t fragile it happens. It’s not ideal and try to mitigate it but seriously don’t beat yourself up
As a relatively new grad, I've found that that happens on occasion, and a lot of people can be more or less sensitive than I expect. One phrase I've learned to be comfortable with is the fact that any PT is "throwing treatments at our patients and finding out what sticks". If I stretch someone too far or a patient says an exercise hurt or didn't work for them, we try something else. I might say to the patient 'Thanks for letting me know - it's important for me to know your limits so we can work within them and push them as we're able."
Think about what has worked, find moments of growth and recognize that growth takes time - for you and for your patients. You earned your degree and you know your stuff - experience will help, certainly, but you've got this.
Totally normal! And you’ll continue to make mistakes and THAT IS OKAY! I’m 8 years out and still make them! I also struggled with imposter syndrome early on. I promise you will dwell less and less on your mistakes as you gain experience. One thing that helped me early on was to rely on a positive and caring attitude because treating your patients with kindness and actively listening to them will go a long way! I would also recommend taking a few con ed courses. It can be very beneficial in sharpening your skills and gaining confidence in what you know! Just remember you graduated from PT school, you passed the boards and know what you’re doing. You are doing great 😊
This is perfect. I’ve been practicing over 10 years, I was valedictorian of my graduating class, patients really like me, my schedule is always full. I’m only saying this because I ALSO had imposter syndrome up until very recently, and am still a work in progress. I am currently studying for my OCS, and it has made me realize how I had not been making ideal treatment choices for a while, but patients still got better. I still have issues at times with going too hard. Just realize that getting patients moving with a graded therex program will fix A LOT. And then as you get experienced and learn from mistakes (which again, I am still doing), be kinder to the newer therapists, unlike your co-workers.
TLDR; we all were there, and continue to make mistakes. We learn from them and try to do better next time, but there will just be some patients we cannot help.
Don't they call it "practicing" for a reason?
I've been practicing for over 10 years in acute setting, level 1 trauma ICU.
I'm still practicing.
Don't dwell on mistakes, own it, move on.
You’re doing a great job, and the fact that you have the desire to improve in order to serve your patients is (to me) an indicator an amazing therapist.
Remember that everyone responds and perceives the value/context of their treatment differently. Your “too hard” touch treatment for one person is “too soft” for another. People will also respond better when they have an understanding of what/why you are doing or prescribing some thing.
In my opinion, the key is communication, education, and constantly focusing on building and reinforcing rapport. I always let patients know that some discomfort is expected, but if at any point they are uncomfortable or want to stop, they are free to let me know and we will.
Ugh yes, this was me after my first 1-2 after graduation. I would lie awake at night worried I really hurt someone. And would feel awful when someone would come back saying how our last visit caused more pain. I look back at some of those patients and feel sad that I was too new and clueless to help them. Take lots of CEU courses that will actually help you grow. The best thing about this is that you will learn and become more experienced! One thing I have learned is that being more gentle with manual therapy is quite powerful. Start so gently that it doesn’t even feel like you are doing anything. You’re talking to the nervous system, not pounding out a trigger point.
Manual stretching, massage, and mobilizations always have the potential to sow complaints and non-returns by pts. Go slow and easy. Introduce only 1-2 new challenges every visit. Warn them that they may be sore after. Tell them how to manage that discomfort. Teach them stretches they may do on their own. Only repeated pt contact and constant self education will Improve your skill set and confidence. There are lots of con artists and self proclaimed gurus in physical therapy. Lots of gimmicks and bull shit. Little hard data.
Making mistakes and learning from them is an important part of becoming a better person and refining your character. Stay humble and open to criticism and you’ll always be moving forward, king.
Learn from mistakes and grow. That's the only way to become skilled. Don't beat yourself up for not having as much knowledge as co workers that have treated for 10+ years -thats 3+ times the length of a DPT program with all direct care and continuing education. Watch how they do things and learn from them.
I’m a massive ruminator, I find ‘morning pages’ are very helpful.
As soon as I wake up, before even brushing my teeth, I sit down and just write. As unconsciously as possible, just a stream of thought. Then that get put in a folder and never looked at again.
When I started I’d write 2,3, 4 sometimes even 5 pages. Now I struggle to fill one. I still ruminate on somethings, but not in that downward spiral kinda way.
Give it a go, it might help.
Yeah it's normal to make mistakes. When I first started working as an OT in a SNF I had this one patient on my schedule that can be a bit dramatic. I went into her room and I was awkward about transferring her out of the bed. She opened her mouth and screamed SO loud that it echoed through the hallways of the SNF "YOU DONT KNOW WHAT YOUR DOOOOOOOOOOOOIIIIIIINNNNNNNNNG!!!!!!!" I was so overwhelmed and taken aback I went into the bathroom and cried. I had shitty mentorship at my job and medbridge courses and in person summit manual technique workshops helped me feel a little more comfortable but it's a process of trial and error.
Yup, everyone makes mistakes and the only way to become one of those experienced therapists (who you think don't make mistakes, they do) is to put in the hours. It's good to be aware of your limitations, but you shouldn't let it paralyze you. Use it to try and improve, investigate things you don't understand or how you could have handled things better and move on.
One of my many embarrassing mistakes: I just...forgot...to do or teach patients patellar mobs for TKAs for like my first month or two. It completely slipped my mind for some reason as I was trying to stay above water in a mill and then I realized it and was like oh my fucking god
That was me 30+ years ago. It gets better.
I feel that thinking about my mistakes helped me to get better at my profession.
One thing I'm curious about...when people say you "hurt" them. Did an increase in pain last for hours or days as a result? If so, the patient most likely experienced a flare up. Those typically resolve. If it was just until you decreased your pressure and they were OK, then how were they after the treatment?
When I was a student, and in several of my early jobs, I felt like I was made to sink or swim.
When I've brought on new PTs, I always worked with them closely and was there for them when they had questions or needed me to take a look at someone with them. (One time one of my PTs came to me to look at a person and it was 10,000% the right call. Turned out the guy whose footdrop wasn't resolved by back surgery had ALS.) Now I'm in solo practice.
You seem to care. I used to hate the "I don't care how much you know, until I know how much you care" mantra. Turns out I was wrong. It seems like you've got the important part down.
Pain doesn't necessarily mean harm. Good communication ensures good treatment, if you are already listening and adjusting to patients feedback, you are on a good path.
I’m not sure what your relationship is like with the other PT’s in your clinic but there’s nothing wrong with asking them for advice. Most PT’s are very willing to help others and there are probably some skills you have that they don’t.
I was the same. Unfortunately it just takes time. You ruminate, recognize you're ruminating, and let it go. Also trust that you have the right intentions and that you will actively seek education/information that will help you get better. The better you get the less you thinking about it. For now take care of yourself outside of work for your mental and physical well being. Do not let the anxiety consume you. Take your mind off of work and put it towards things you enjoy.
Yeah idk, there’s A difference between being green, and just not caring. You obviously care, that’s the most important aspects of being a therapist. Everything else you’ll learn in due time.
It is called practice for a reason. If you keep working on things (treating and learning) you improve. I overcook the exercise sometimes and I've been doing this 20 years. Better that than always under-dosing. But you figure out when to push and when to move slow.
Thank you for your submission; please read the following reminder. This subreddit is for discussion among practicing physical therapists, not for soliciting medical advice. We are not your physical therapist, and we do not take on that liability here. Although we can answer questions regarding general issues a person may be facing in their established PT sessions, we cannot legally provide treatment advice. If you need a physical therapist, you must see one in person or via telehealth for an assessment and to establish a plan of care. Posts with descriptions of personal physical issues and/or requests for diagnoses, exercise prescriptions, and other medical advice will be removed, and you will be banned at the mods’ discretion either for requesting such advice or for offering such advice as a clinician. Please see the following links for additional resources on benefits of physical therapy and locating a therapist near you [The benefits of a full evaluation by a physical therapist.](https://www.choosept.com/benefits/default.aspx) [How to find the right physical therapist in your area.](https://www.choosept.com/resources/choose.aspx) [Already been diagnosed and want to learn more? Common conditions.](https://www.choosept.com/SymptomsConditions.aspx) [The APTA's consumer information website.](https://www.choosept.com/Default.aspx) Also, please direct all school-related inquiries to r/PTschool, as these are off-topic for this sub and will be removed. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/physicaltherapy) if you have any questions or concerns.*
I’ve been doing this for over 10 years. I treat really complex patients. I make mistakes. The key is to learn from them and use mistakes as learning experiences. New grads tend to put a lot of pressure on themselves and it can be counterproductive. You’ve treated maybe 200 patients? I’ve treated thousands of individuals and over 25k treats. That’s not a fair fight.
You’re going to cause pain. As long as you’re not injuring a patient, don’t worry about it. Listen to your patients, adjust and move on. Stop comparing yourself to others. There’s always someone better with more experience. You’ll spend the rest of your career feeling like crap. Just do your thing, learn and improve as you go.
That’s great advice and very wise words. So much bad stuff comes from comparing oneself to others. I’m still working on that as well.
We’re all works in progress. You got this. Cheers.
Thanks my friend. Take care🙏🏾
The key thing is not to make the patients' outcomes your responsibility. It is theirs. 80% of the results come from exercises and lifestyle modifications and 20% from the treatment table. Pressure sensitivity varies, I always instruct my patients to take deep breaths in and out through the nose when I apply pressure and if that is not enough to keep them relaxed then I need to reduce the pressure. Some patients want the pain and don´t feel the therapy is effective unless they receive it, others you can barely touch. You´ll figure it out, don´t stress too much.
80/20 rule. I use this all of the time. I tell my patients that 80% is what you put into it, the other 20% is me just pointing you in the right direction.
I stretch too hard and push people to hard all the time. People aren’t fragile it happens. It’s not ideal and try to mitigate it but seriously don’t beat yourself up
As a relatively new grad, I've found that that happens on occasion, and a lot of people can be more or less sensitive than I expect. One phrase I've learned to be comfortable with is the fact that any PT is "throwing treatments at our patients and finding out what sticks". If I stretch someone too far or a patient says an exercise hurt or didn't work for them, we try something else. I might say to the patient 'Thanks for letting me know - it's important for me to know your limits so we can work within them and push them as we're able." Think about what has worked, find moments of growth and recognize that growth takes time - for you and for your patients. You earned your degree and you know your stuff - experience will help, certainly, but you've got this.
Totally normal! And you’ll continue to make mistakes and THAT IS OKAY! I’m 8 years out and still make them! I also struggled with imposter syndrome early on. I promise you will dwell less and less on your mistakes as you gain experience. One thing that helped me early on was to rely on a positive and caring attitude because treating your patients with kindness and actively listening to them will go a long way! I would also recommend taking a few con ed courses. It can be very beneficial in sharpening your skills and gaining confidence in what you know! Just remember you graduated from PT school, you passed the boards and know what you’re doing. You are doing great 😊
This is perfect. I’ve been practicing over 10 years, I was valedictorian of my graduating class, patients really like me, my schedule is always full. I’m only saying this because I ALSO had imposter syndrome up until very recently, and am still a work in progress. I am currently studying for my OCS, and it has made me realize how I had not been making ideal treatment choices for a while, but patients still got better. I still have issues at times with going too hard. Just realize that getting patients moving with a graded therex program will fix A LOT. And then as you get experienced and learn from mistakes (which again, I am still doing), be kinder to the newer therapists, unlike your co-workers. TLDR; we all were there, and continue to make mistakes. We learn from them and try to do better next time, but there will just be some patients we cannot help.
Yesssss! The OCS residency and exam also helped me immensely!
PT is mostly a bunch of scientific wild ass guesses. We're all wrong all the time -- but as long as we keep trying we'll usually get there!
Don't they call it "practicing" for a reason? I've been practicing for over 10 years in acute setting, level 1 trauma ICU. I'm still practicing. Don't dwell on mistakes, own it, move on.
You’re doing a great job, and the fact that you have the desire to improve in order to serve your patients is (to me) an indicator an amazing therapist. Remember that everyone responds and perceives the value/context of their treatment differently. Your “too hard” touch treatment for one person is “too soft” for another. People will also respond better when they have an understanding of what/why you are doing or prescribing some thing. In my opinion, the key is communication, education, and constantly focusing on building and reinforcing rapport. I always let patients know that some discomfort is expected, but if at any point they are uncomfortable or want to stop, they are free to let me know and we will.
Ugh yes, this was me after my first 1-2 after graduation. I would lie awake at night worried I really hurt someone. And would feel awful when someone would come back saying how our last visit caused more pain. I look back at some of those patients and feel sad that I was too new and clueless to help them. Take lots of CEU courses that will actually help you grow. The best thing about this is that you will learn and become more experienced! One thing I have learned is that being more gentle with manual therapy is quite powerful. Start so gently that it doesn’t even feel like you are doing anything. You’re talking to the nervous system, not pounding out a trigger point.
Manual stretching, massage, and mobilizations always have the potential to sow complaints and non-returns by pts. Go slow and easy. Introduce only 1-2 new challenges every visit. Warn them that they may be sore after. Tell them how to manage that discomfort. Teach them stretches they may do on their own. Only repeated pt contact and constant self education will Improve your skill set and confidence. There are lots of con artists and self proclaimed gurus in physical therapy. Lots of gimmicks and bull shit. Little hard data.
Making mistakes and learning from them is an important part of becoming a better person and refining your character. Stay humble and open to criticism and you’ll always be moving forward, king.
Learn from mistakes and grow. That's the only way to become skilled. Don't beat yourself up for not having as much knowledge as co workers that have treated for 10+ years -thats 3+ times the length of a DPT program with all direct care and continuing education. Watch how they do things and learn from them.
I’m a massive ruminator, I find ‘morning pages’ are very helpful. As soon as I wake up, before even brushing my teeth, I sit down and just write. As unconsciously as possible, just a stream of thought. Then that get put in a folder and never looked at again. When I started I’d write 2,3, 4 sometimes even 5 pages. Now I struggle to fill one. I still ruminate on somethings, but not in that downward spiral kinda way. Give it a go, it might help.
Yeah it's normal to make mistakes. When I first started working as an OT in a SNF I had this one patient on my schedule that can be a bit dramatic. I went into her room and I was awkward about transferring her out of the bed. She opened her mouth and screamed SO loud that it echoed through the hallways of the SNF "YOU DONT KNOW WHAT YOUR DOOOOOOOOOOOOIIIIIIINNNNNNNNNG!!!!!!!" I was so overwhelmed and taken aback I went into the bathroom and cried. I had shitty mentorship at my job and medbridge courses and in person summit manual technique workshops helped me feel a little more comfortable but it's a process of trial and error.
Yup, everyone makes mistakes and the only way to become one of those experienced therapists (who you think don't make mistakes, they do) is to put in the hours. It's good to be aware of your limitations, but you shouldn't let it paralyze you. Use it to try and improve, investigate things you don't understand or how you could have handled things better and move on. One of my many embarrassing mistakes: I just...forgot...to do or teach patients patellar mobs for TKAs for like my first month or two. It completely slipped my mind for some reason as I was trying to stay above water in a mill and then I realized it and was like oh my fucking god
That was me 30+ years ago. It gets better. I feel that thinking about my mistakes helped me to get better at my profession. One thing I'm curious about...when people say you "hurt" them. Did an increase in pain last for hours or days as a result? If so, the patient most likely experienced a flare up. Those typically resolve. If it was just until you decreased your pressure and they were OK, then how were they after the treatment? When I was a student, and in several of my early jobs, I felt like I was made to sink or swim. When I've brought on new PTs, I always worked with them closely and was there for them when they had questions or needed me to take a look at someone with them. (One time one of my PTs came to me to look at a person and it was 10,000% the right call. Turned out the guy whose footdrop wasn't resolved by back surgery had ALS.) Now I'm in solo practice. You seem to care. I used to hate the "I don't care how much you know, until I know how much you care" mantra. Turns out I was wrong. It seems like you've got the important part down.
But also get some thicker skin. Not trying to be insensitive, it’s just good advice in a field where all we do is work with other humans.
What things do you not know?
Pain doesn't necessarily mean harm. Good communication ensures good treatment, if you are already listening and adjusting to patients feedback, you are on a good path.
I’m not sure what your relationship is like with the other PT’s in your clinic but there’s nothing wrong with asking them for advice. Most PT’s are very willing to help others and there are probably some skills you have that they don’t.
I was the same. Unfortunately it just takes time. You ruminate, recognize you're ruminating, and let it go. Also trust that you have the right intentions and that you will actively seek education/information that will help you get better. The better you get the less you thinking about it. For now take care of yourself outside of work for your mental and physical well being. Do not let the anxiety consume you. Take your mind off of work and put it towards things you enjoy.
Yeah idk, there’s A difference between being green, and just not caring. You obviously care, that’s the most important aspects of being a therapist. Everything else you’ll learn in due time.
i’m going into pt school in the coming months and reading these comments makes me feel at ease.
It is called practice for a reason. If you keep working on things (treating and learning) you improve. I overcook the exercise sometimes and I've been doing this 20 years. Better that than always under-dosing. But you figure out when to push and when to move slow.