physios supporting physios:
psychological series - episode 5

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."

late stage rehab aka the ‘I'm not to sure about this’ phase


Picture this: the athlete has been crushing it and has conquered all of the major physical hurdles. On paper, this individual is ready to take on the last phase of rehab and dominate in their sport.

BUT ☝️In recent conversations you've been having, your athlete starts voicing concern about readiness to go back to his/her sport and you also notice a concomitant drop in motivation and performance during sessions. What the hell do you do now?!

DO NOT FRET! As Ardern et al. informed us, some of the same negative emotions that occur right after injury tend to "resurface" towards the end of rehab as the athlete is preparing for return to sport. You can turn this around and influence a positive outcome. Here is what the research shows us about this...

💡[The Integrated Model of Psychological Response to the Sport Injury and Rehab Process] ➡️There is an influence of personal and situational factors on the DYNAMIC INTERACTION among cognitive appraisal, and behavioral and emotional responses (See Slides 3 & 4)

💡Cognitive appraisals affect emotions, which subsequently affect behaviors. Behaviors, in turn, can directly affect physical and psychosocial outcomes. The outcome of a behavior can influence an emotional response as well as a re-appraisal of said outcomes with a subsequent behavioral response. this is an ongoing, cyclic process, unique to each person (See slides 5 for example)

💡"Interactions with the sports medicine team" is one of the factors that play a MEDIATING ROLE in this process

WHAT THIS MEANS: There is way more than strength and neuromuscular control that goes into readiness to play. Knowing a bit about this dynamic process allows for detrimental behaviors or factors to be addressed continuously so as not to hinder progress. ⠀
🔑There is nothing fancy about navigating all of this. However, we DO have a few recommendations (See slide 6)


• 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