physios supporting physios:
psychological series - episode 3

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."

post-op / early rehab aka the ‘let's do this’ phase


SET THE TONE: In this phase, you may just be in a sweet spot because the athlete has calmed down since you have helped set the expectations for pre-and immediate post-op procedures. This time period, as Arden et al. explains, is when the negative emotions of fear, anxiety, anger, depression, and frustration have retreated a bit, and the athlete is likely on that “head down eyes forward” grind in order to get on the fast track to their goals. You want to REAP THE BENEFITS of this mindset, and here are some ways you can...

☝️Set small, attainable, yet challenging goals during sessions. It is important to ensure their success with prescribed tasks, while avoiding those that are so simple that the athlete feels insulted that you think so poorly of his/her abilities. (COMPETENCE)

☝️Encourage visualization of tasks and successful completion of said tasks, to promote carry over of confidence to their actual completion. (CONFIDENCE)

☝️Once they are familiar with certain tasks/exercises, allow them to carry out certain portions of a rehab session on their own and/or allow them to choose between a handful of appropriate exercises from time to time. (AUTONOMY)

☝️Start to challenge them aerobically as they would be in a practice/game without heavy use of the injured limb. Athletes crave that “finisher” style workout. Ex: Airdyne intervals, rope slams or sled pulls (arms only) (ATHLETIC IDENTITY)

☝️Be their forever hype man/woman. We know how important a support system is, so be the best one you can be for your athletes!

These particular tips are focused on fostering autonomy, competence, motivation and self-efficacy, while minimizing fear, anxiety, frustration, and loss of athletic identity. Considering that the literature highlights these factors as significantly impacting rehab outcomes, we believe that we should be spending quality time trying to manage them and promote BEHAVIORS that foster the factors that positively influence outcomes, and discourage the factors that negatively influence outcomes.


• 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