what you need to know when starting pt
I asked over 40 respected physical therapists and coaches what they think every person who’s starting physical therapy should know.
Here are 8 of the biggest takeaways/themes across all responses, along with some of my favorite answers.
Whether you’re a provider or a person who’s currently in PT, these are essential messages you need to hear (or that your clients should hear) as you work back towards doing what you love.
Focus: There are many factors that are outside of your control, especially as you’re getting started. Shift your focus to what you CAN control (it’s usually more than you think) and watch the number of things you can control INCREASE over time.
Consistency: It wins every time. You will not get where you want to be without consistency day after day. This is especially important with what you do OUTSIDE of the time you spend with your PT.
Anti-fragility: You are not fragile or broken. Your body will adapt and heal. Your PT is here to help you, and with their guidance, you will come back stronger.
Time Horizon: This is not an overnight process—if you expect quick changes, you are setting yourself up for frustration and disappointment. Set realistic expectations with the help of your provider, and play the long game.
Progress: Progress is not linear—there will be ups and downs, periods of feeling good and periods of flare-ups. This is NORMAL! What matters is that the bigger trend over time is positive.
Reframe: Progress can be measured in lots of ways. It isn’t as black and white as simply being out of pain—progress can look like doing more with the same amount of pain, or seeing a quicker return to baseline after a flare-up event. Reframe and expand the metrics you use to track improvement.
Ownership: Take ownership of your physical therapy journey and be an active participant. Rehab is not passive—it is something YOU have to commit to and actively invest effort into.
Process: Good rehab is not a quick-fix visit or a generic sheet of theraband exercises. It an individualized, holistic program that meets you where you’re at, outlines a roadmap towards your goals, and guides you along that path from pain to performance.
Here are some of the actual responses I received. All of the PTs I asked are people who I respect tremendously, who practice what they preach, and who are genuinely invested in the health and wellbeing of their clients. Collectively, they have hundreds of years of experience treating people and are some of the most forward-thinking and open-minded providers I know (AND…they all lift😎). Read on for some of the most valuable, no-BS advice you’ll ever hear on how to approach and be successful in PT.
Dr. Andy Fata-Chan, PT, DPT, SFG-1
If you focus on the things you can control, eventually the amount of things you can control will expand.
Dr. Susie Spirlock, PT, DPT
Rehab takes TIME and CONSISTENCY. Rehab is not Amazon Prime 2-day shipping. It can take weeks to months to start to notice improvement and even more months on top of that in order to finally get full resolution of symptoms.
Effective rehab is not sexy. All those ‘cool’ exercises you see on social media are just that — cool. However when it comes to rehab, it’s usually the basics, tailored to you, and performed consistently that are the ones that WORK for pain.
Flare-ups are to be expected. When we rehab, the goal is to push into mild but tolerable, sore but safe pain, so we can encourage tissues and the body to adapt. BUT, you will be able to tolerate more load, volume, frequency with the SAME levels of pain you experienced with LESS of these things as rehab progresses. Progress trends will be positive, but not linear.
Dr. Katie Dabrowski, PT, DPT, CSCS
The absence of pain is not the only thing that determines if you’re “better.” Progress is not only present when/if pain “disappears.” Progress is also tolerating more than you were able to in the gym with the same level of pain, longer time passing between flare-ups, or a flare-up that isn’t as intense as before, for example.
Dr. Roni Glassman, PT, DPT
There are 168 hours in a week. Seeing me for 1 or 2 of those will not cure you! True change comes from the work and dedication you put in outside of PT. I am just here to guide you in the right direction 😊
Dr. Meghan Sak-Ocbina, PT, DPT, ATC, CSCS
It’s more important that your PT is willing to listen and work through things WITH you than have all the answers for you. It’s a 50/50 team effort and two way street!
Dr. Drew Thompson, PT, DPT
Strap in and be ready to play the long game.
I think with clients starting a PT or fitness journey, everyone wants to know how long will it take me to reach “X” goal. As movement experts, we know that answer is different for each client and depends on a lot of incredibly variable factors.
For myself I’ve found that finally committing to playing the long game with my fitness has completely taken the pressure off and allowed me to fall in love with the process of learning to move better and building strength/resilience. Sure I set goals, but the way I look at it, I’ve got all the time in the world to eventually hit my fitness goals. As long as I’m progressing forward towards them, I’m golden!
I think the same thing applies with clients starting a PT journey. When people ditch the timeline/expectations of when they think things “should” be happening, they can start to appreciate the journey and trust the process of moving towards their goals.
I think this mindset shift would drastically eliminate the number of people who “fail” PT because they didn’t reach complete symptom resolution within the 6-8 weeks written on their PT referral. I’d be willing to bet a good number of those people who “failed” were just starting to build momentum to swing the pendulum but then they quit because they didn’t see the results in the timeframe they had expected. Strapping in for the long game puts you in the right mindset to show up and do the work. Obviously healthy to occasionally come up for air to appraise progress and assess if you’re still moving towards your goals, and if you are, put your head back in the water and keep swimming.
Dr. Stephen Alterado, PT, DPT
The main thing is that you are not fragile. Pain does not necessarily mean tissue damage or that you’re making your injury worse. Most clients need “permission to move” and as therapists, we should collaborate and find ways to help them become more resilient and robust.
Dr. Grace Schwemmer, PT, DPT, ATC, CSCS
Your one goal should be to move the needle at least 1% everyday. Rehab is no different than anything else in life, consistent effort wins every time.
Dr. Dylan Carmody, PT, DPT, CPSS
Rehab ‘difficulty’ is different for everyone. Rehab is hard no matter what, but for some the difficulty lies not in the exercises, but in the consistency and trusting the process, others lies in the frustration of ups and downs. Knowing that ‘your battle’ comes in different shapes and sizes helps to keep expectations settled when a curveball inevitably hits.
Dr. Joey Scambia, DPT, SCS, CSCS
I think every patient or client starting physical therapy needs to understand that rehab does not take place solely within the four walls of a clinic. I often find myself telling a variety of patients that the 23 hours spent outside the clinic are just as, if not more, important than the one hour spent inside it. Physical therapy is not just a one-hour session; it is an entire process where both the individual and provider work together to achieve a common goal, often returning to a meaningful activity. Physical therapy is not something that is done to you—it requires hard work, consistency, and trust in the process.
Dr. Kaylee Kuzma, PT, DPT
I think everyone needs to hear that rehab is a marathon, not a sprint. Seeing progress will take time and will not happen over night, but do not give up on the work and the effort.
Dr. Conner Weeth, PT, DPT
I hear you, you can do this, I’m proud of you.
Dr. Josh Ostrom, PT, DPT, SCS, CSCS
Every client should hear a clear explanation of what they are dealing with, how long it is likely to last, and what are the steps within the plan and to reach their goals.
Dr. Susan Kang, PT, DPT
Be curious, engaged, and ask questions. Understand why you’re doing something—not just going through the motions. Just like learning anything new, the more you understand, the better prepared you’ll be if you (or someone else) encounter a similar injury in the future.
Hailey Barragan, CPT
You’re not broken and you will get better with time. Progress will not be linear so focus on the small wins vs the end result.
Dr. Kim Manlangit, PT, DPT
Think of your rehab journey similarly to the stock market. There will be ups and downs daily/weekly/monthly, but what is most important is looking at it from a bigger timeline and that you’re trending towards a positive direction.
Dr. Raegan Langeliers, PT, DPT
The process of healing is NOT linear, flares ups do NOT equal failure but actually give us more data on where you’re at and directs our next steps! No two athletes paths will look the same, don’t compare!
Dr. Hannah Breal, PT, DPT
You have to take ownership of the process and you have to be a very active participant; it's not a passive thing. PT is not done to you. It's not like when I give my CPA my taxes and he just takes care of them. I think every client in PT that does really well, really wants to learn and they have a lot of questions. They want to understand and they take ownership of the process. They're really bought in, they have a really open mind, and they're really involved. I think that in order to make health changes, you have to take full ownership even though sometimes we're dealt shitty cards. I think the best way to handle anything in life is to figure out how my actions played a role in this, because that's what gives you control. Especially because pain is so disempowering and you feel like you don't have any control. You have to control what you can control and what you can control is usually a lot more than you think. Ask your PT questions, do your homework and give them feedback. The more involved you are in the process, the more you'll get out of it.
Dr. Tilia Fu, PT, DPT
I think something that is always beneficial to remind pts is that pain and rehab will ebb and flow. I like using that stock market analogy where you’ll naturally have dips every once in a while but hopefully your overall trend continues in upwards growth. At the end of the day pain is a normal part of life that will constantly ebb and flow. Don’t base your progress solely based on those dips bc they’re just a snapshot in time.
Dr. Jake Thein, PT, DPT, CSCS
It's probably going to take longer than you think, so look at the process as brick by brick, inch by inch, slowly improving and increasing capacity over time. These things are the key, especially compared to any quick fix, special manual technique, fancy joint circles, or some sort of labeled technique.
Dr. Denise Griffith, PT, DPT
Most clients need to hear that the body wants to heal and will heal. Our job is to create an environment for the body to do what it wants to do, and heal.
They also need to hear that progress back from an injury isn’t linear. There will be ups and downs/good and bad days. Because it’s impossible to be perfect in reintroducing load and volume etc. However, the overall trajectory should be in the right direction if the rehab plan is correct.
Also, the expectation of rehab is return to full function, including high level sport/activity participation. Activities of daily life is not sufficient and will not prevent future injury. From this perspective, every client is an athlete and needs to approach rehab as one.
Dr. Ian Nay, PT, DPT, OCS
Trust the process. Your pain didn't start last night (usually) and it will take some time to resolve fully. There may even be some ups and downs along the way, but stay the path and communicate with your PT about what is working well vs not working well. Chances are that you will be stronger/fitter than when you started PT.
Dr. Devery Huddleston, PT, DPT
Consistency is key. Which lends to the rehab process is that, a process filled with ebbs and flows. I think it’s important to empower people to look for those little wins and to not be so hard on themselves if there is a plateau or “set back”. The set backs can indicate body taking time to adjust to new stressors, healing, etc. I usually tell people if it’s their first time in PT that I am “the expert of the human body”, but they are the expert of their own body. PTs are there to guide clients to reach their goals so communication is huge on both ends to continue, progress, or change course.
Dr. Brandon Yee, PT, DPT, OCS
Don’t be afraid of load.
Dr. David Skolnik, PT, DPT
Your rehab will be as successful as your mindset wills it to be. If you don’t think you’ll get better, you won’t. If you believe you can fully recover, you will.
Dr. Bailey Pepper, PT, DPT
Some adjustments are a “for now” thing, not a “forever” thing. Scaling back overall volume, finding a modified entry point to movements that used to be easy to perform, tracking daily habits, or getting back into movement after dealing with pain can look different than it used to / you want it to look long term. It’s all part of a bigger picture & working with the right PT will show you the light at the end of the tunnel by keeping YOUR specific goals in mind along the way.
Dr. Lindsey Doan, PT, DPT
Pain is undoubtedly scary, however that doesn’t mean it’s always needs to be looked at as inherently bad or damaging. Look at it as a datapoint, everything that doesn’t bring you pain tells you something and everything that does bring you pain also tells you something. The goal is not to avoid everything that brings you pain, but use this data to find a starting point and work from there.
Dr. Ravi Patel, PT, DPT
Expect for this process to be non-linear. There will be ups and downs. You might have a flare up or two. And, know this is ok. It’s normal and a part of the process because you’re pushing yourself beyond your current capacities. If you control your controllables and stay consistent, you’ll be back to doing the thing.
Dr. Peter Lee, PT, DPT
PT is collaborative, and works best if you are an active participant. It’s effective, but it’s rarely easy.
Dr. Teasie Cleveland, PT, DPT
I think anyone who starts PT needs to understand how the stress load/capacity ratio of their body works (ESPECIALLY all the non-physical factors) & that because of this they have so much more control over how they are feeling then they realize!
Dr. Brandon Ong, PT, DPT
The reason why this is going to work is because the body adapts whether you like it or not. If you trust that it will and that you’re giving your body the right input, you’ll get the results you’re looking for.
Dr. Toni Oluwa-Tofehinti, PT, DPT
Rehab or performance training is going to have peaks and valleys. Progress is never linear!
Dr. Annie Fleming, PT, DPT
Your body is resilient. This is a process that will take time, but if you are intentional about that process we can work together to reach your goals.
Dr. Chris Munoz, PT, DPT
Injuries take time to fully resolve, symptoms and progress may ebb and flow but that’s normal, manage stress and modify/stay active.
Dr. Shane Williams, PT, DPT
Pain is a sign that our body doesn't appreciate what is happening at the moment and it's trying to protect us. It doesn't always mean danger. When you stub your toe, it really hurts but rarely is it ever anything worse than a stubbed toe and maybe a bruised ego. Stubbing your toe isn't going to ruin our body, but it sure feels like it from the pain! Pain is our body communicating with us, we just have to figure out why it's talking so much.
Dr. Jimmy Vaccare, PT, DPT
I think 1 thing that a lot of patients need to hear is “no amount of rehab exercises are going to fix your poor programming.” I say this because so many people want “some exercises for their insert pain” but don’t realize that just a bunch of “rehab exercises” found on the internet is not going to fix the problem. We need to address the root cause and figure out why you are dealing with that pain in the first place. This can usually be found within your program or weeks leading up to the onset of pain. Once you figure out why you are having that pain or injury then you can modify your program and THEN develop a plan which may include exercises for that pain. That is why it is important to find a physical therapist who understands proper programming.
Dr. Harris Choe, PT, DPT, OCS
There are multiple ways to track progress than just pain or no pain. Improvements in your daily mood, sleep quality, range of motion, functional strength, and overall quality of life are important tracking tools as well.
Dr. Vince Van Haute, PT, DPT
For clinicians: Treat the human in front of you, not the diagnosis.
Dr. Pat Bell, PT, DPT
The biggest predictors of success in rehab are your ability to communicate well with your PT, to stay consistent with your program, and the ability to zoom out and look at the bigger picture/trend since you started (especially when you’re in the midst of a flare-up or feeling frustrated). If you can do these 3 things, you’re going to emerge from PT stronger than ever.
Of note: there will of course be nuance and context to consider when applying these principles to your own individual situation. But in some capacity, these messages are broadly applicable to just about anyone experiencing pain, and what they mean for YOU is a great conversation to have with your PT!
