Who has had a bigger impact on your life? A teacher and/or coach you had that taught you how to do something for yourself and helped you learn how to do something you still use and draw on to this day, or a mechanic that fixed your vehicle when it broke down? (nothing against mechanics, just using the situations for example) One situation has likely made a very positive impact on you that carried you through life and maybe helped you navigate difficult times and situations. The other helped you in a time of need but was out of your control (you didn’t do the work), was a one-time thing with no lasting lessons learned or changes that could help you remedy the situation in the future, and will be the same situation when it happens again.
A PT who primarily teaches, instructs, and gives you a plan to help yourself and guides you along the way but doesn’t treat you isn’t being lazy and it certainly isn’t that they don’t care. It may look that way from the outside, however, they are actually helping you get better and giving you the tools and permission to help yourself which can be the most valuable thing they could provide you. Listening to you, collaborating with you, and coming up with a plan that works for you that you can do isn’t being lazy or not caring; it’s being helpful, effective and giving a damn about you.
A PT who treats you and does things to and for you is not helping your sense of autonomy and is creating a sense that you need them to get you better. Where does that leave you when it’s time to be done? Kids with overbearing and overprotective parents that control and do everything for them usually freeze up and don’t know what to do when it comes time to do things on their own. Same situation in rehab when you are treated, then are discharged on your own. Even if you are given a home exercise program, the exercises are likely underdosed and not very progressable which really limits their value. AND, what do you do the next time you run into pain? You believe you have to have somebody treat you again without knowing or realizing that you are perfectly capable of helping yourself and maybe you only need some guidance, not treatment.
It’s one thing to need some help, instruction, and guidance at times or periodically. It’s another have to rely on someone, to feel like you need to be treated and have someone else fix you…
Sometimes a PT can be most helpful to you by not seeing you more than 1 or a couple times. For instance, we know a lot of acute musculoskeletal pain situations will naturally get better on their own in roughly 2-6 weeks. If the PT is aware of the evidence, listens to your situation and able to see the big picture and realize this is likely the case, the best thing they can do for you is reassure you and help you with any exercise and lifting advice and plan you are interested in and then get out of the way. Or, they could assess you, find a bunch of “dysfunctions” that are likely normal human physiological and anatomical variances that have no bearing on your pain situation, nocebo you and make you fearful of your body and doubt your ability to do things and created a situation where you need and rely on them 2-3x/week for the next 6 weeks… even though you were going to get better anyway during that time naturally.
Physical Therapy has this misconstrued view that it’s all about soft tissue work, manual treatments, and “cutting edge” modalities. There are times these things can benefit a person but they really are not necessary to your healing. They operate more on the person’s perception of what they think it is doing to them and their belief that it will help them rather than any actual physiological effect. I would argue they are more necessary for the PT and the clinic as they keep you coming back. The PT needs you to come back and they need to be the one to fix you so their ego can be satisfied… and the clinic needs your copay and insurance reimbursement.
Sorry, that’s just not helpful to you as the person needing help getting out of pain and healing from an injury. You need autonomy, you need support, you need a plan from someone you trust that tells you it’s ok to lift and use a barbell. You also need permission to do something for yourself-it’s incredibly sad that this is the state we’re in, where you “need” permission to lift, because typically in the rehab world it’s not addressed or it’s advised against which is bad advice.
A training plan that meets you where you are at in terms of accommodating and gradually addressing your pain or injury issue can be the best thing for you actually getting better and rehabbing. AND the rehab plan when progressed over time is now regular training that you can continue to do indefinitely and reap benefits from. If pain or injury occurs again, you can still use that training with needed modifications to address the issue and progress back, rinse and repeat as needed.
It may look lazy from an outsider perspective – a PT who operates by having conversations, educating, collaborating, giving you a plan and helping you progress and adjust that plan rather than doing any treatments – but what if they are actually helping you more than any treatments they could give you?