Dear Physio, I Can Take it From Here…

So, when does physical therapy end?

This is just a short piece, a reflective piece, about a value that makes up the very core of what I believe in and what I strive to achieve as a Physiotherapist – empowering my patients with the knowledge and the skills they need to make themselves independent.

These past few weeks have reminded me of a very special part of treating patients – discharging them. For months now I have worked intensely to help the small patient population with whom I have contact. After investing so much time in their development and progress, it is a magical moment when they come to me and say “I am not 100% better but I know what the problem is and I know how to make it better. What I need now is time to follow through on my goals and I can take it from here.”

What a pleasure it is to hear that. I know no one will ever be 100% when it comes to discharge and I am fine with that. First, I don’t set “being 100% pain free” as a goal and secondly, I think we all suffer from pain at some point in time. What I feel is more important is for patients to function normally and in the most ideal way for their lives.

Something patients frequently ask is “How long do I need to keep coming to Physical Therapy?”  Or, “Will I always need to do these exercises?”

The answer to the first – how long does it take you to no longer need Physical Therapy?

The answer to the second – No, you will need them when you need them.

What do I mean by this? Let’s take a look at the ideal stages of recovery involved between initial assessment and discharge.


It all starts at the beginning, when life is altered by pain or injury and when patients seek care because they don’t function in their normal way anymore. Sometimes it can be tough to get the ball rolling, to retrain movement patterns and daily habits, to get pain levels under control, and to motivate patients to begin to drive their own recovery. The first step as Physical Therapist is to understand the problem, the contributing factors, to identify milestones that help patients identify with their own recovery process, and then begin guiding them through rehab until they reach step 2.


Once pain is no longer driving a willingness to come to therapy, what is?

As I often say to my patients – I will sit beside you on this journey to recovery, but I will not drive you there. So, Step 2 is all about helping patients recognise what other barriers need to be overcome or goals need to be achieved before they can function unrestricted.


Once you are functioning well, do you know how to stay that way?

At this point in time I hope that my patients are developing a sound knowledge about how their bodies present/move/behave when they are both feeling good and feeling not so good. Developing this self awareness is a key step towards understanding their bodies better and identifying how their rehab should progress for them to be 100%.


If you’re staying symptom free and doing what you love – do you still need my help?

It is definitely sad to say goodbye but we have to set our patients free. This past week has been sprinkled with discharge assessments–patients who come in smiling because they only have good news to report. They are playing the sports they love, can use exercises to manage any niggles that may come up, are no longer thinking about their injury or their body part, and can see the end goal in sight. And this is when I ask – do you still need my help to get to the end? And with a smile, they reply, “I can take it from here”.

If you are reading this as a patient I want to to ask yourself:

Are you self-discharging too soon? There is a lot of work that lies between reducing pain and discharge.

Are you holding on too long?

Are you taking the steps along the entire journey to make sure your knowledge is developing and growing to accommodate for the changes in your body at that given time?

At TherapydiaSF we strive to form strong relationships with our patients. Communication is the key to break down what problems exist and create individualised treatments for those problems. We all have our niche areas or injuries we love treating, but at the end of the day, you are the person that will direct the treatment path and we are here to help and facilitate you to reach those goals.

Sian Smale, PT, MPhysio has been part of the TherapydiaSF team since 2016. Originally from Australia, Sian is trained in Musculoskeletal Physiotherapy and Clinical Pilates. When not working as a physiotherapist, you can find Sian cycling the hills of Marin, swimming in the elusive outdoor pools of the Bay Area, and chasing down the best avocado toast.

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