physios supporting physios:
psychological series - episode 6

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."

the late stage post-op phase


The primary concepts of this phase are to reinforce CONFIDENCE in knee function in higher level activities, foster improved SELF- EFFICACY for returning to training as well as returning to sport. @stephallen.dptoutlined earlier this week concepts from the Walker paper that there is a dynamic interaction of factors that cause physical and emotional appraisals of the tasks at hand. 

Many of the strategies that were discussed in earlier stages lay the foundation for addressing them now and making sure our athletes are successful. 

In many ways our literature has addressed the physical components for making clearance decision for sports and meeting those standards earlier doesn’t always lead to long term success. Part of the conversation with your athlete is letting them know rehab should primarily get them to “training” shape and does not mean the road ends here. But it’s a good thing! They should be equipped with confidence with things like… 

Load Management strategies: It’s not just sets and reps, but also ways to assess internal training load as well. Internal training load takes into account their cognitive stressors and beliefs as well and progressively “loads” the person at a better rate.(AUTONOMY) This allows your client to modify the rehab/training/practice session based on what their brain AND body are ready to do rather than just what you or their coach says. (Eckard, 2018) 

Mindfulness strategies: This could take several different forms. During your sessions, check in with your patients mentally to see where they are. Ask thoughtful questions to get them to reflect. This may mean referring them out to get professional counseling in some cases, but ultimately it makes sure the path is leading towards things that matter to the patient and their voice is valued. 

Positive Vibes: This is a great time to remind the athlete on how far they have come up to this point, especially on days where the motivation is lacking. Reframe some of their concerns from a cognitive impasse to a scalable challenge. Your confidence as the guide is crucial to mitigating fear and avoidance tendencies down the line. 


• 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