This is a question I’ve heard countless times from students and new grads. It’s a tough one to answer broadly because, as you know, every patient is different. Factors such as the nature and severity of the injury, secondary complications, age, activity level, and consistency with their PT program all play a role.
That said, I’ve developed a general guideline I share with new clinicians: you should see some progress between every appointment.
Setting Realistic Yet Productive Expectations
I know this might sound overly ambitious or even unrealistic, especially when you’re just starting out. I thought the same when I was a new grad. But here’s why this mindset is critical: it keeps you focused on tailoring treatments to your patient’s unique needs and responding to their progress (or lack thereof).
Progress doesn’t have to mean a total turnaround. It could be reduced pain, improved range of motion, better functional performance, or even subtle changes in their symptoms. These small wins indicate you’re on the right track. Conversely, if there’s no improvement or symptoms worsen, it’s time to reassess and adjust your approach.
The "Insanity" Rule of PT
There’s an old adage you’ve probably heard: “The definition of insanity is doing the same thing over and over while expecting different results.” This applies perfectly to physical therapy. If you continue with the same treatment plan—exercises, manual techniques, or modalities—for several visits without seeing progress, you’re doing your patient a disservice.
The key is to identify what’s working and lean into those techniques. At the same time, be ready to pivot when something isn’t yielding results. This adaptability is what sets effective clinicians apart.
A Real-World Example
Let me share a recent case. I had a patient with posterior leg pain that didn’t align with a typical orthopedic diagnosis. After an initial evaluation and some trial treatments focused on muscular issues, her symptoms worsened by the second visit. Instead of sticking to my original plan, I conducted a full re-evaluation. This time, she exhibited low back pain and positive slump and straight leg raise tests, indicating lumbar spine involvement. By shifting my focus to her lumbar spine, we achieved significant symptom relief.
Had I continued treating the original diagnosis without reassessment, I would have wasted weeks without helping her. Worse, I would have contributed to her frustration and diminished her quality of life. Instead, pivoting early allowed us to achieve meaningful progress.
The Takeaway
Here’s my advice to all clinicians, especially new grads:
Track Progress Every Visit: Whether it’s pain reduction, increased mobility, or functional gains, note improvements. Small progress is still progress.
Reassess When Necessary: If there’s no improvement or symptoms worsen, don’t hesitate to step back and reevaluate. A fresh perspective can reveal new insights.
Adapt and Adjust: Be flexible with your treatment plan. Patients are dynamic, and their response to therapy will guide your approach.
Be Patient-Centered: Your goal is to improve their quality of life. Stay attuned to their feedback and responses to refine your care.
By making clinical decisions based on patient response, you’ll deliver more effective treatments, foster trust, and ultimately achieve better outcomes. Remember, progress isn’t always linear, but your adaptability and attentiveness can make all the difference.
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