physios supporting physios:
psychological series - episode 2

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: setting the table with expectations and mapping out the path 

Getting to work with patients and clients before a major surgery like an ACL reconstruction gives the rehab team an excellent opportunity to set the stage for the road ahead not only physically, but mentally as well. 


One of the best ways to encourage high motivation and self efficacy by gauging where the patients’ beliefs are and appropriately reframing their perspective to foster success towards their goal. Easy enough right? We all know that our education and the way we speak has the potential for good (Nickel et. al, 2017) and not so good purposes (Barsky, 2017) as well as our expectations towards our interventions impacts their effectiveness (Ongario et. al. 2017). So how do we use it well? 

1. Talk them off the cliff- Reassure them that this process has been done before, but it will require patience and persistence on their part to be successful. Find out what their specific goals are and outline that with the surgical protocol. 

2. Open the floor for questions- It’s their body and their journey right? See where their head space is at. Let the person’s support group also be part of the equation as well. Your patient can help also link you as the clinician to the coach and team to keep everyone on the same page. This may be a chance to bring in questionnaires and other outcome measures if they need more metrics to see their success. 

3. Give the lay of the land- foster self efficacy by helping them see the big picture by giving them a road map. Give the patient some goals for week to week that allows them to see the small victories as well as you to assess how they are coping mentally. 

4. Let the patient feel- Set their pain management up early. Outline their tolerable thresholds for their activity. There will be moments when patients have to “embrace the suck” to a certain degree which is normal. 

As you can see, personality goes a long way. Let your patients know who you are and like Steph said always have their back.

If possession is 9/10 of the law, perspective is 9/10 of rehab. 


• 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