physios supporting physios:
psychological series - episode 1

Dr. Stephanie Allen from Boston PT & Wellness is back! …with another incredible physiotherapist, Dr. Josh Walters from The Human Movement Rehab. In each episode, they will focus on a specific phase of ACL rehab, highlighting the psychological factors that tend to require greater attention during that given phase. They will share some of the ways that physical therapists can positively affect these factors, based both of their experiences and on the best available evidence.

"We truly believe that physical therapists are in a phenomenal position to address some of the psychological issues that arise during the rehab process, and we hope to help all of you out there gain some confidence in doing so with your athletes and patients."


pre-op phase aka the freak out phase 😩

Immediately after injury, and for those initial few weeks of madness...the athlete or patient is likely in freak out mode. Understandably so!

There are a number of things to be addressed early on, but what I am going to focus on today is the tall task of addressing the athlete's previously held expectations and assumptions about their recovery and return to sport (RTS) (Burland et al. 2018). Depending on the individual, these assumptions can be pessimistic and false, and can absolutely contribute to negative emotions such as fear, anxiety, anger, depression, and frustration (📚Arden et al. 2016). So, how do we address this?

We set realistic and positive expectations through education, of course!

1️⃣Go over all of the things that they CAN work on to be in the best possible position going into surgery (knee range of motion, quad activation, normal walking pattern, minimal pain and swelling, etc).

2️⃣Go over what they can expect immediately post-op; Reassure them that they will be challenged as appropriate. I find that my higher level athletes like to hear that we will be working on upper body and building back up an aerobic base right after surgery as tolerated (more on this to come Friday 😇)

3️⃣Talk about the relative normalcy of pain and swelling and how these may fluctuate throughout the rehab process.

4️⃣HARD Rule: No comparison of self to others with the same injury or to where one "thinks they should be." Ain't nobody got time for that 🙅

5️⃣Make it clear that this process, though not easy, is ABSOLUTELY something they can handle. No, even better...something they can CRUSH. "So start that imagery of yourself playing your sport now" I tell them!

🔑Establish an understanding that hard work, consistency, commitment and flexibility (figurative) will help ensure positive outcomes.
🔑Make sure your athlete/patient never doubts for a second that you are not their biggest fan and that he/she has a solid support system in you, family, teammates, coaches, etc.
🔑Be GENUINELY excited to travel through this journey with them, and express it.


• The "return to sport" we are referring to is more so as it relates to higher level/elite athletes in this case, but many concepts can be extrapolated to all patients.
• The information presented is not intended to replace any necessary medical treatment or to endorse or recommend any particular type of medical treatment.
• This is more of a discussion about principles regarding some of the “soft skills” and less about exercise selection or practice guidelines

Dr. Joshua Walters is a Physical Therapist and avid exercise enthusiast from Oregon via his home state of Texas. He has a Bachelor’s of Science in Kinesiology, and completed his Doctorate of Physical Therapy at the University of St. Augustine for Health Sciences in Austin, Texas. Josh has been a personal trainer for 7 years. He is a CrossFit Level 1 Certified Coach and Certified Clinical Weightlifting Coach with a background in weightlifting and powerlifting. He is currently competing as a 105+ kg lifter in USAW.

Dr. Steph Allen earned her doctorate of physical therapy from Ithaca College in 2013. She stuck around Ithaca and completed an orthopaedic residency the following year, then decided to give travel PT a try. After almost 2 years of travel PT, she settled in Boston, MA at Boston PT & Wellness. She is now focusing on ACL risk reduction (and educating on the subject wherever possible), as well as strength and conditioning and movement pattern training in youth athletes.

CONNECT WITH DR. WALTERS on social media / book an appointment

Instagram: @thehumanmovementrehab
Mind to Movement Rehab

CONNECT WITH DR. ALLEN on social media / book an appointment

Instagram: @stephallen.dpt and @bostonptwellness
Facebook: Steph Allen
Boston PT and Wellness