Negative Language Has a Negative Impact on Patient Belief

Have you ever heard of “The Nocebo Effect?

The nocebo effect is a pervasive problem that occurs when features of a treatment context elicit adverse health reactions. Reference

We often emphasize the importance of good communication with our patients. On the other hand, negative language can have a detrimental impact on care outcomes.

Numerous research studies have demonstrated that improper use of language can have a negative impact on clinical outcomes…and here’s yet another study about this topic: Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents

Some of the take-home points provided by the authors include:

  • Negative communication has an effect on state anxiety and illness beliefs in the recipient of the message.
  • Nocebo communication (e.g., vague descriptions, negative language) resulted in higher state anxiety.
  • Nocebo communication led to higher rates of concerns, and the belief that complaints would last longer.
  • Nocebo communications led participants to believe that the treatment would be more successful.

Here’s a Summary of the Research from Our Point of View

This is the first study we’ve found that indicates that the use of negative language, when educating patients about their lower back pain, had an effect on the recipients’ levels of anxiety and their views about their condition. The participants who saw the educational video with the nocebo communication exhibited a greater state anxiety compared to those who watched the control video with positive or neutral messages.

The participants’ perceptions of their illnesses also differed, with those in the nocebo condition reporting higher rates of worry and a perception that their ailments would last for a longer period of time.

Previous research on the relationship between negative language usage, negative expectancies, and nocebo effects has found that these findings are consistent with those findings.

An Unusual Result of Nocebo Communication was Discovered

Surprisingly, the authors also discovered that participants who provided with the negative or nocebo video presentation thought that their treatment would be more successful. (“To what extent do you believe that your therapy can assist with your illness?”) It’s possible that individuals in the nocebo group just thought they needed more treatment than they actually did.

Interestingly, these findings demonstrated that even in those who do not currently have back pain, relatively little communication is needed for pain-free individuals to develop negative views regarding LBP. When considered in conjunction with data from other studies indicating that nocebo effects have the potential to increase care seeking, pain, and bad outcomes, this provides significant cause for concern and calls for more inquiry.

In addition, once such expectations have been accepted as certain, it is difficult to reverse them.

It’s Imperative that You Consider Proper Use of Language When Treating Your Patients

The findings of this study need to serve as motivation for physiotherapists (and all other healthcare personnel) to refrain from using language that is negative expectancy-enhancing toward their patients during consultations and treatment.

There is a lack of understanding and awareness among physical therapists regarding the environmental elements that affect musculoskeletal illnesses and their use in therapy.

Musculoskeletal problems are frequently and traditionally defined using negative phrases. Understanding the impact of positive and negative language is likely to result in better patient outcomes – the results that we are looking for when treating all of our patients.

Let this Research by Your Motivation to Improve Your Communication Skills

If it is your desire to learn more about how communication can positively affect your treatment outcomes, we encourage you to contact us to learn more about our educational offerings.

The Best Physical Therapy Continuing Education Courses in 2023

For physical therapists looking to stay ahead of the curve, continuing education is essential. But with so many options available, it can be hard to know which companies offer the best physical therapy continuing education courses. From online classes that teach communication skills and evidence-based practice to courses focused on hands-on techniques, there are plenty of ways for physical therapists to learn more about their field and improve patient care.

In this blog post we’ll explore types of con-ed courses and some of the advantages and disadvandages of each..

Table of Contents:

How to Find the Best Physical Therapy Continuing Education Courses

Keeping abreast of the most recent advancements in physical therapy is a must for PTs, but how is a clinician supposed to do it with so little time (you know, there’s treatment, charting, family, recreation…it’s tough). Whether it be in-person events like CSM, or online courses, you want to find the best physical therapy continuing education courses that meet your needs and also are part of work/life balance.

Licensed Physical Therapists and Physical Therapist Assistants Need Options for Continuing Education Requirements

Online courses provide an easy and cost-effective way to do this (and that’s why we decided to offer two courses which we consider may be the best physical therapy continuing education courses available). With online courses, you can take advantage of the convenience and flexibility to learn at your own pace from any place with internet access.

Another Advantage with Online Physical Therapy Con Ed – You Can Squeeze It In…

If you are caught in a jam or have some down time during lunch or in the evening, your mobile phone or laptop allows you to easily and quickly access physical therapy con-ed & their materials. This means that you don’t need to be tied down by the traditional clinical settings or schedules – which makes it much easier as a busy professional in physical therapy practice.

Online physical therapy continuing education courses also offer flexibility when it comes to learning. Interactive components, such as chat rooms providing direct communication with educators and fellow physical therapist students, are often incorporated into online courses to promote “connection” despite physical separation. This allows everyone to stay connected even when they’re not physically together – making it easier for the group to share ideas and get feedback on the topics without having face-to-face contact.

Key Takeaway: Online courses provide an easy and cost-effective way to do this (and that’s why we decided to offer two courses which we consider may be the best physical therapy continuing education courses available).

Patient Physical Therapist Communication

Some of the Best Physical Therapy Continuing Education Courses Focus on Communication Skills

Good communication is essential for physical therapists, occupational therapists, and physical therapist assistants to provide the best care possible. This means understanding patients’ needs, being able to listen effectively, and developing treatment plans that will be successful. Con ed courses offered by groups like the American Physical Therapy Association, can help physical therapists & PTAs hone their communication skills so they are better equipped to handle any situation with confidence.

Physical Therapy Practice Professionalism Requires Providers to Invest in Development – Don’t Forget Communication Skills

Continuing education requirements often seem cumbersome, even unnecessary.  While manual therapy skills and clinical treatment approaches dominate the continuning education credit space, one of the most important skills needed, i.e. communication skills, is often forgotten.

Licensed physical therapists and physical therapist assistants know that care starts with the subjective interview of the patient, yet we often don’t spend enough time taking continuing education courses about this topic.

Comprehending the patients wants and needs (patient goals) from their therapy is a crucial part of successful communication. In order to gain insight into a patient’s objectives, it is important to:

  • Be Aware of the Current Clinical Research that will Guide Your Care,
  • Have the Right Mindset before Asking Questions (Prioritizing Pateint Needs First),
  • Know What Questions to Ask (Open-Ended Question are Often Best)
  • Be an Active Listener,
  • Be Aware of Both Verbal & Non-Verbal Cues
  • Provide Answers that are in the Patient’s Best Interest,
  • Be Open to Options & Alternatives.

Continuing education credits earned from courses on communication skills can provide guidance on techniques such as paraphrasing key points made by the patient or using open-ended questions that invite further discussion rather than a simple yes/no answer – thus enabling physical therapists to become adept conversationalists who really understand where their patients are coming from before providing advice or solutions.

Interacting with patients and colleagues (think about the importance of getting feedback from your peers) effectively necessitates strong communication skills, which should be developed through continuing education programs. Evidence-based practice involves utilizing research evidence in clinical decision making, allowing physical therapists to provide high quality care based on best practices.

Case Study: It’s a fact that more than half of Americans are overweight or obese. This additional weight often times slows or even prevents healing. Having the right communications skills, like those offered in our Weight Management for Rehab Patients, are a perfect example of how better communicating with patients can lead to the best possible treatment outcome.

evidence based practice levels of evidence

The Best Physical Therapy Continuing Education Courses are Evidence Based

EBP is a major factor in physical therapy, being an indispensable part of the profession. Continuing education is a must for physical therapists to remain abreast of the most recent studies and techniques in treating patients, thereby enabling them to successfully implement evidence-based practice. Through these courses, PTs, OTs, and PTAs can learn how to properly apply EBP in clinical settings.

For example, one course might cover the basics of evidence-based medicine, including its importance and benefits. It could also provide guidance on how to assess patient data when making decisions about treatment plans or developing protocols for specific conditions or injuries. Moreover, it could assist practitioners in comprehending the numerous forms of proof to be taken into account when crafting a care plan for their patients.

Communicating Treatment Options Based on Evidence

Another course might focus more specifically on applying EBP in practice by teaching therapists how to communicate about treatment options for shoulder problems (this is the topic of our shoulder continuing education course). This type of course would also discuss different approaches for evaluating outcomes in the clinical literature from interventions that are available (i.e. physical therapy comparted to drugs, injections, or surgery) and provide strategies for incorporating new treatments into existing programs or creating entirely new ones if needed.

A great example of this is learning the communication skills on how to gain trust from a patient that might be convinced they need shoulder surgery for impingement when the clinical literature suggests otherwise (like this study here concludes).

Don’t Forget About Continuing Education Courses About Technology

Finally, continuing education courses are available to help physical therapists use technology in evidence-based practice. These can involve the utilization of electronic medical records systems or other digital tools, which allow for greater efficiency while optimizing accuracy and consistency in patient care delivery over time.

Remote Therapeutic Monitorning (RTM) is a great example of a skillset that physical therapists need to master which are in the best interest of patients and can also help mitigate the ever declining insurance reimbursement conundrum.

Clearly, having a thorough comprehension of evidence-based practice is essential for delivering superior care, and this would be difficult to accomplish without an extensive familiarity with the subject. Professional Development courses provide an opportunity for therapists to expand their knowledge base in order to stay current with clinical, communication, research trends, and advances in technology.

Key Takeaway: Remaining informed of the most recent evidence and optimal methods is vital for PTs to deliver excellent care, making continuing ed classes a must. These courses cover everything from basics of EBP, interpreting research results, developing clinical pathways and utilizing technology in practice – all crucial elements for providing top notch patient care.

physical therapist evaluating a shoulder patient

Continuing Education Credits are All About Professional Development

Physical therapists understand the importance and licensure requirements of professional development and continuing education. Staying abreast of the newest studies, approaches, and interaction strategies is critical for delivering optimal care to those in need.

Through the internet, physical therapists, occupational therapists, and assistants can now easily access a vast array of online courses to keep up with their field. From evidence-based practice to soft skills like communication and patient engagement, there are plenty of opportunities for physical therapists to learn new skills without having to leave home or take time off work.

Key Takeaway: Remaining abreast of the newest research-based approaches and communication strategies is essential for physical therapists to provide quality care. Continuing ed is an essential tool for keeping our abilities sharp in the areas of evidence-based practices and communication, allowing us to remain abreast of recent developments and guarantee top quality care.

We Encourage You to Check Out Our Online PT Continuing Education Courses

From online courses, communication skills development, evidence-based practice implementation, and professional development resources – there is something for every physical therapist out there looking to take their career further. Most understand that by investing in PT/OT CEUs, one can keep abreast of the current best evidence and hands-on techniques.

In addition, we hope this article also shined a spotlight on the importance of communications skills development.

Three Ways to Connect For More Information, About Our Offerings

When seeking out the best physical therapy continuing education courses in 2023, ACE (Accredited Continuing Education) provides a great opportunities to learn and grow professionally.

Call us today for more information (781) 229-8011

Email us at

Visit our Contact Page & Fill Out Our Form

Another Reason Why We Created Our Communications Course About Weight Management for Rehab Patients

It’s very important for physical therapists to know how to address the problem of obesity.  Being overweight or obese, has a negative impact on not only wellbeing, but it also affects the ability of the body to recover from musculoskeletal injuries.

Researchers Interviewed Patients and the Results were Troubling

How do patients with obesity feel about their interactions with physical therapists?  It’s an important question that clinical researchers had to ask.

According to the findings of a research paper published in 2015, some patients perceived negative weight judgements from elements of physiotherapy interactions and environments.

While some obese patients perceive some interactions with their therapists as negative, it was not quite clear how  physical therapists felt about patients that are overweight.

A 2016 Study Confirmed That Physical Therapists Need Help with How They View Obese Patients Needing Care

In a follow up study in 2016, the objectives were to evaluate the ways in which physical therapists think about overweight patients.

The authors gathered data from six different focus groups that were held in Queensland, Australia, and consisted of 6 focus groups of 4 to 6 physical therapists who talked about weight in the context of physical therapy. A wide range of physical therapy specialties were embodied by the total of twenty-seven participants.

The Results of This Study Demonstrate a Real Opportunity for PTs to Improve Their Knowledge About Obesity and Communications Skills

The study uncovered four ways that physical therapists think about the treatment of patients that are overweight:

1. Most of the physical therapists demonstrated some understanding that larger patients might feel discomfort in physical therapy interactions. Around one-third of participants had not considered how patients who are overweight might feel and had little or no idea that they might feel discomfort. 
2. The physical therapy participants felt that patients that are overweight are difficult to treat.
3. They felt that being weight has simple causes (poor diet and a lack of exercise).
4. They did understand that talking about the impact of being overweight is important when discussing treatment with obese patients.

The Conclusions of This Research Paper Suggest More Therapist Education is Needed

The findings suggested that the ways in which certain physical therapists conceptualize weight could potentially result in unfavorable encounters with patients who are overweight.

The results of this research suggests:

  • Physical therapists need to have a more nuanced understanding of how patients who are overweight might feel in a physical therapy setting.
  • The complexity of the causes of being weight, and the possible benefits and disadvantages of introducing weight-management discussions with patients needs to be more deeply explored.
  • Education should develop comprehensive understandings of working with patients of different sizes, including knowledge of weight stigma, in order to combat the issue.

Reinforcement of Our Motivation to Offer Our Con-Ed Course on About Weight Management

Dr. Mike Stare, PT and co-owner of ACE, had personal experience going from the condition of being overweight and out of shape to returning to an ideal weight and achieving peak fitness.  This allowed him to conservatively recover from a serious shoulder injury.  You can read more about his personal journey here.

ACE is on the Cutting-Edge Physical Therapy Continuing Education

Weight management is an issue that physical therapists need more understanding about.  We encourage clinicians that want to know more about how to approach overweight & obese patients to take our course so they can better address the needs of this growing population.  Click to visit our contact pager and connect with us.

Treating Patients as People

Recognizing The Person In Each Patient Will Strengthen
Your Relationship And Improve Long-Term Outcomes

Physical therapists, like all healthcare providers, have an array of duties and responsibilities that are put in place to ensure that they are providing the best possible care for their patients. But for many therapists, the sheer volume of these responsibilities, combined with the often fast-paced environment of a clinic and the high demands for patient visit rates and turnaround, can make it extremely difficult to meet all expectations without some type of a tradeoff.

In this type of environment, when something has to give, some therapists may end up spending less time with patients and fail to give them the attention that they each deserve. But sadly, this can come at the peril of both the therapist and the patient. Not only does it fail to meet the standards of high-quality care that all physical therapists should be providing, but it can also lead to worse outcomes, as research has shown that patients who have a positive interaction with their therapist are more likely to experience improvements than those who do not.

It is therefore important for physical therapists to regularly remind themselves that a positive patient-therapist relationship should always be a top priority of their care, and to continually learn ways to improve upon these skills. At a 2017 Placebo Symposium held in Sydney, Australia, healthcare experts were asked to list which universal lessons they felt were essential for every healthcare provider to be aware of, and among these were the following:

  • Support patients in developing helpful expectations about their treatment
  • Always remember that you’re treating people, not tissues
  • Use words wisely, as they can both heal and harm
  • Listen to your patients, and show them that you’re listening
  • Talk with your patients, not at them
  • Realize that learning communication skills takes time and intensity
  • Emphasize both empathy and competence in your interactions with patients
  • Develop a better understanding of research methodologies for studying treatments and their effects

The author went on to describe some of the key ways the patient-therapist relationship could be improved upon by breaking down every healthcare encounter into four components: a person seeking help, a person hoping to deliver help, a treatment ritual, and a social context. By finding ways to understand and address each of these components, there is significant potential to improve patient outcomes. In particular:

  • Physical therapists should first make efforts to understand details about the person seeking help (ie, the patient) such as how they identify with their condition, how they frame recovery, and what their main concerns are
  • Therapists should also prioritize understanding the person hoping to deliver help (ie, themselves) by studying how they view their contribution, how they view the person seeking help, how they frame their treatment and recovery, and the context in which they’re given the authority to help
  • Regarding the treatment ritual, therapists should be more cognizant of how they describe the interventions in each treatment plan by choosing their words carefully and avoiding language that make be more likely to turn patients away from their care
  • Finally, therapists should examine the social context for therapy, such as how different communities perceive health care in general, physical therapy specifically, and various conditions, what language is used regarding health care and how this language evolves over time
Contact ACE to learn more

Here at Applied Continuing Education (ACE), we believe that a positive therapist-patient interaction should be at the core of everything we do in the field, and these principles are integrated into our two physical therapy continuing education courses (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”). If you’re interested in improving your communication skills with patients and would like to learn more about our courses, review the ACE website to see if the courses align with your needs and values. You can also contact ACE at 781-229-8011 or, as Mike and Justin are both more than happy to discuss our courses and answer any questions you might have.

Evidence Based Continuing Education Courses

Most Physical Therapy Continuing Education Courses Are Missing The Mark

Nearly all physical therapists have to take continuing education courses each year to update their knowledge and skills and stay up to date on the latest developments in the field. The requirements for continuing education vary from state to state, and it’s up to physical therapists to follow the appropriate regulations to maintain their license in each state. But even though physical therapy continuing education is a requirement to retain one’s license, physical therapists shouldn’t view it merely as an obligation, but as an ongoing learning opportunity that helps them keep up with the evolving landscape and ensure they’re providing the best possible care to patients.

In return, however, physical therapists often expect—and rightfully—that the courses they attend are of high quality and therefore worth their time and money. In particular, considering the importance of evidence-based interventions in physical therapy, all therapists prefer to only participate in continuing education courses that are closely aligned with the latest evidence and clinical guidelines in the field. But despite how important this concept is, not all physical therapy continuing education courses are created equal, as many are not truly evidence based.

Taking stock of the current physical therapy continuing education landscape
Physical therapy researchers questioned the quality of the continuing education offerings and decided to conduct study to investigate this. Their primary goal was to determine what percentage of physical therapy continuing education courses were providing instructions on interventions that were evidence based, which they did by systematically assessing all data on orthopedic and sports physical therapy continuing education courses available in the U.S. in 2020. The main inclusion criterion was that each course provided education about a specific intervention intended to treat a musculoskeletal disorder in adults.

Each of the interventions identified in these courses was then isolated and graded within a hierarchy system. To assess if an intervention was evidence based, it was compared with relevant clinical practice guidelines or a systematic review that supported it with at least moderate level evidence, and if it was in alignment, it was deemed “evidence based.” If a conflict was found between the guidelines and systematic reviews, researchers always favored whichever was the more recent of the two.

From their search, researchers identified 319 courses and included them in the final review. Most courses (78.7%) taught only one type of intervention, while 16.9% of courses taught two types of interventions. Overall, 52.7% of the courses reviewed involved interventions that were not supported by either a clinical practice guideline or systematic review. Furthermore, of the 65.8% of interventions that were not recommended by a clinical practice guideline, very few (20.0%) were supported by a systematic review. The continuing education courses that taught interventions classified as soft skills were the most likely to be supported by evidence (82.9%), while the interventions categorized as modalities were the least likely to be supported by evidence (30.5%).

The finding that one of every two physical therapy continuing education courses provides instructions not supported by the latest evidence should alarm both physical therapists and those who create these types of courses. This trend can have numerous downstream effects, as many physical therapists rely more on continuing education than published research to inform their treatment decisions. Therefore, there is a real possibility that patients may not receive interventions supported by the latest evidence in their course of care, which could prevent them from receiving the greatest benefits from treatment.

At Applied Continuing Education (ACE), it is a core principle that our courses are based on the latest evidence to ensure that participating physical therapists can provide the highest standard of care to their patients. We currently offer two courses (“Weight Management for Rehab Patients: Crucial Skills for PTs and OTs to Help Patients with Weight Management” and “Shoulder Pain and Dysfunction: Effective Therapy for the Treatment of Common Shoulder Disorders,” both of which are built on a strong base of research. For more information, explore the ACE website or contact us at 781-229-8011 or

Patient Centered Care – We Have a Physical Therapy CEU Course for That

Do You Know How to Take A Patient-Centered Care Approach, Improve Therapeutic Relationships, and Outcomes?

A musculoskeletal pain condition is an injury or disorder that involves the musculoskeletal system, which includes the bones, muscles, joints, ligaments, and tendons. These disorders are one of the leading contributors to disability throughout the world, and about 30% of Americans are currently affected. Musculoskeletal pain conditions can develop anywhere in the body, but the spine is by far the most common location, as low back pain and neck pain are among the top reasons for visiting a doctor. Other common musculoskeletal pain conditions include osteoarthritis, tendinitis, strains, sprains, fractures, and tears of ligaments and tendons.

Humans are Complex – Our Physical Therapy Con-Ed is Something that Will Help You Better Address Your Patients’ Needs

A multitude of factors are involved in the development musculoskeletal pain conditions, include genetics and various psychological, social, and biophysical factors. Therefore, physical therapists and other healthcare providers that administer musculoskeletal rehabilitation should strive to develop a broader understanding of how these biopsychosocial factors influence musculoskeletal conditions.

Doing so will improve healthcare providers’ ability to deliver higher quality care for patients with persistent musculoskeletal pain, primarily by using a patient-centered or personalized approach to care.

What Exactly is a Patient-Centered Approach?

In a patient-centered care approach, the healthcare provider prioritizes seeing the patient as a person, having a biopsychosocial perspective, and sharing power and responsibility with the patient in a therapeutic alliance. This type of approach helps to establish:

  • Meaningful connections,
  • Shared decision-making, and
  • patient-centered communication;

However, many clinicians experience difficulties when integrating patient-centered care principles into their practice.

This Research Supports the New Approach, but It Requires Additional Physical Therapy Continuing Education

In response, a symposium about patient-centered care for patients with musculoskeletal conditions with the goal of enhancing physical therapists’ patient-centered approach to practice and better equip them to support patients with these conditions. A paper was also published to share the key elements of this symposium with physical therapists and other clinicians, which is summarized below.

Members of the symposium defined three key facets of patient-centered care to help support the transfer of this knowledge into clinical practice:

1) establish meaningful connections,

2) employ shared decision-making, and

3) support self-management.

Establish meaningful connections – That’s Exactly What Our Shoulder & Weight Management PT CEU Courses Provide

According to the symposium members, the therapeutic relationship between patients and practitioners is at the core of a patient-centered care approach, since a positive relationship between these parties is associated with better clinical outcomes, patient satisfaction, and adherence to the management plan.

Therefore, healthcare providers should aim to establish meaningful connections with their patients to strengthen this relationship and form a therapeutic alliance. When done properly, this can help maximize the effectiveness for and with the patient seeking care.

The following three suggestions were made to help healthcare providers achieve meaningful connections with their patients:

  • Acknowledge the patient through words, body language, validation, and actively individualizing management
  • Use therapeutic touch to clarify physical problems and to connect the individual back to their body
  • Take a deliberate and responsive approach to meet the needs of the patient within or outside the clinical consultation

Employ Shared Decision-Making

Shared decision-making is the next step in the therapeutic alliance in which the person seeking care is treated as an equal partner of the healthcare provider. It aims to move away from the traditional model of healthcare in which the “doctor knows best” and makes all decisions for the patient. Instead, the patient is included in their treatment planning, which allows for their experience to combine with the clinician’s skills to collectively determine the most appropriate next steps for achieving their goals. Shared decision-making involves outlining valid options of treatment and discussing each of these to understand possible risks and benefits. This process can be supported using decision-making aids or tools to facilitate a collaborative approach between the therapist and the patient.

Support Self-Management

The final facet of patient-centered care involves teaching patients with musculoskeletal pain to actively take ownership of their management and the resulting outcomes. Since many musculoskeletal conditions are persistent, optimal long-term outcomes are far more likely if the therapist teaches them the following self-management skills:

  • Problem solving
  • Goal setting
  • Action plans
  • Progress
  • Regress
  • Reflecting
  • Managing their pain

It can be challenging to teach these skills, but since the characteristics of many long-term musculoskeletal conditions are similar, helping patients establish certain core principles (eg, engaging in exercise, a healthy lifestyle, a positive therapeutic relationship, and education on biopsychosocial modifiers) can lead to self-efficacy and resilience for any other musculoskeletal conditions that may arise.

Contact ACE to Learn More – We Have a Unique Approach to Physical Therapy Continuing Education & You’ll Earn PT CEUs as Well!

Applied Continuing Education (ACE) is heavily invested in promoting a patient-centered approach to care, and these principles are consistently interwoven into our two physical therapy continuing education courses (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”).

If you’re interested in improving your communication skills with patients and would like to learn more about our courses, review the ACE website to see if the courses align with your needs and values.

You can also contact ACE at 781-229-8011 or, as Mike and I are both more than happy to discuss our courses and answer any questions you might have.

PT CEUs – Learn How to Manage Rotator Cuff Disease Much Better

Using Certain Terms Can Make Patients More Likely To Think Surgery Is Needed For Shoulder Pain

Here’s what a common PT CEUs course will go over: the rotator cuff connects the upper arm bone (humerus) to the shoulder blade (scapula) with four muscles, each of which has a tendon that attaches to different parts of the scapula. These tendons form a “cuff” around the head of the humerus, and all the muscles work together to control and stabilize the shoulder. As a ball-and-socket joint, the rotator cuff helps secure the “ball” portion of the joint—the humerus—as the arm moves and rotates within the “socket” (the scapula). It plays an extremely important role in keeping the shoulder stable when performing many overhead movements (eg, reaching, throwing, and picking up items), but because the rotator cuff is used so frequently, it’s also extremely vulnerable to injury.

There’s nothing wrong with this – we all need a review and foundational information.  But read on to learn more about something we often miss at PTs…and our PT CEUs course can teach you.

You’ll Be Surprised What You May NOT Know When It Comes to Treating the Shoulder…and What We Can Teach You

“Rotator cuff disease” is an umbrella term used to describe all disorders that involve the rotator cuff, including rotator cuff tears, bursitis, subacromial impingement syndrome, and rotator-cuff related shoulder pain. But research has shown that using certain diagnostic terms and labels can influence patients’ treatment preferences.

For example, two surgical procedures—subacromial decompression surgery and rotator cuff repair—are frequently performed to treat rotator cuff disease despite current evidence indicating that these procedures are no better than placebo or nonsurgical treatment.

It’s possible that patients who are diagnosed with subacromial impingement syndrome and told that their pain is caused by a bone spur that is reducing the subacromial space may believe surgery is needed to fix the issue, when other language might lead to a different opinion.

You Were Taught Some of This Stuff in School, but Arguably, Some of the Most Important Care Comes from the Language You Use

Researchers therefore conducted a study to determine if different diagnostic labels for rotator cuff disease influence patients’ perceived need for surgery. Patients were recruited from five countries and asked to participate, which led to more than 1,600 participants being included in the study. All participants were first instructed to read a standardized vignette about hypothetical shoulder pain that was written in an optimistic style, free of language that could potentially induce fear, and designed to imply that their symptoms would eventually improve. After reading the vignette, participants were randomized to 1 of 6 diagnostic labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator cuff-related shoulder pain, shoulder sprain, episode of shoulder pain. They were then asked to rate their perceived need for surgery, imaging, an injection, a second opinion, and to see a specialist after being given one of these diagnostic labels.

UPDATE – December 27th, 2022 – we wrote a detailed, additional post about the importance of communication – click here to read that and learn how you can get some PT CEUs if you attend our shoulder course.

Changing Your Approach to Communication Can Save Patients Money, Time, & Reduce Risk

Overall, participants in all groups assessed their perceived need for surgery as low, but there was some variation between groups. Participants who were given a rotator cuff tear diagnosis had the highest perceived need for surgery when compared to those who were given a bursitis diagnosis. The perceived need for imaging was moderate across all groups, but highest in participants who in the rotator cuff tear and subacromial impingement groups compared to the bursitis group, and there were no differences between groups for all other outcomes.

These findings suggest that using certain diagnostic terms for rotator cuff disease can indeed impact individuals’ perceived need for surgery and imaging tests.

The terms “rotator cuff tear” and “subacromial impingement syndrome” appear to make individuals more likely to believe surgery and/or imaging is required, while “bursitis” and “shoulder sprain” appear to be associated with a lower perceived need for these interventions.

Since these terms can be used interchangeably, healthcare providers should be more careful when determining how to deliver a diagnosis to patients, as doing so may help to lower the rates of unnecessary surgical procedures and imaging tests.

We Have a Shoulder Physical Therapy Con Ed Course That will Teach You This and So Much More!

At Applied Continuing Education (ACE), we focus heavily on the importance of clear communication with patients and carefully choosing the best diagnostic terms in our two physical therapy continuing education courses (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”).

If you want to improve your communication skills and are interested in learning more about our courses, review the ACE website to see if the courses align with your needs and values.

You can also contact ACE at 781-229-8011 or, as Mike and I are both more than happy to discuss our courses and answer any questions you might have.

6 Physical Therapist Communication Tips for Better Patient Care

Physical Therapists Have More Time With Patients Than Most Providers;
They Should Use It Wisely By Sharpening Their Communication Skills

Every interaction between a healthcare provider and a patient should be seen as an opportunity for the provider to learn as much about the patient’s condition and for the patient to express these details in the limited amount of time allotted. But as nearly any person can attest to, this clear exchange of information does not always occur, and some patients leave the visit confused and with more questions than answers.

Why is this so common in health care? The answer, of course, is complicated and multifaceted, but at the root of the problem is one very notable cause: poor communication.

Patients are Often Afraid

From a patient’s perspective, visiting a healthcare provider can be seen as a daunting or intimidating experience, especially if it’s their first time seeing the clinician or if they are dealing with a new condition. This fear may prevent the patient from speaking clearly, asking questions that arise during the visit, or letting the clinician know when they don’t understand something that’s been said.

Clinicians, on the other hand, are almost always crunched for time. According to one study, most doctors spend less than 16 minutes with patients, while only about one-third spend 17–24 minutes and only 11% spend more than 25 minutes. Other research has found that physicians tend to overreport the length of patient visits and that the average amount of time they spend with their patients is only about 10 minutes. This extremely limited window of time is perhaps the greatest barrier in effective patient-provider communication, as it often doesn’t allow enough space for patients to adequately describe their condition, concerns, and goals. Similarly, it prevents physicians to give detailed responses and for patients to have the time to process these responses before asking appropriate follow-up questions.

Why Physical Therapist Directed Care is Different

Physical therapists are in a unique position when it comes to patient-provider interactions. Unlike most physician visits, physical therapists typically spend far more than the average 10–15 minutes with each patient. This is most notable in the initial evaluation performed during the patient’s first visit, in which the therapist spends the better part of the 45- to 60-minute visit with the patient. Therapists also see patients more frequently than most other providers—usually 2–3 times per week—and each visit allows the therapist to check in with the patient’s progress and discuss any new issues.

For these reasons, physical therapists should take advantage of the rare opportunity they have for lengthy and ongoing relationships with their patients by prioritizing effective communication. Communication skills are rarely a focal point in physical therapy school, and while some physical therapists do learn these skills in the field, all physical therapists can benefit by improving their practice by learning how to communicate better in order to spend more quality time with their patients.

With that in mind, here are six tips to help you improve our communication skills with patients:

  • Know your audience: every patient is different from the next, and it’s your job to get to know each one through your interactions
  • Talk in their language: recognize how your patient communicates and adapt your treatment and speaking style accordingly; it also helps to determine what type of learner the patient is, which will make it easier to craft your message in a style they can understand
  • Listen to your patients; don’t just hear them: give your patient adequate time to speak and make it clear that you’re listening to them rather than merely hearing what they are saying; here are some ways to ensure you’re listening:
    • Maintain eye contact
    • Smile and/or nod to show that you understand what they’re saying
    • Use body language that suggests the patient is your focus
  • Be honest: clear and honest expectations from the first visit through the end of care is a great way to manage expectations, and when you keep a clear dialogue on what is expected by both parties, the opportunity for miscommunication is reduced
  • Keep it short and sweet: aim for clarity and brevity whenever you can, as overly verbose and complicated responses can easily confuse patients
  • Leave room for nonverbal communication: it’s perfectly fine for periods of silence to occur during a patient’s visit; allowing room for silence also opens the door for nonverbal communications like body language

Contact ACE to Learn More

At Applied Continuing Education (ACE), we consider clear communication with patients to be among the most important goals for physical therapists, and both of our physical therapy continuing education courses (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”) are heavily focused on teaching ways to improve your communication skills with patients.

Learn More or Email Us

If you’re interested in learning more about our courses, review the ACE website to see if the courses align with your needs and values. You can also contact ACE at 781-229-8011 or, as Mike and Justin are both more than happy to discuss our courses and answer any questions you might have.

Why Words Matter to PTs

When Treating Patients, Always Aim To Choose The Right Words

As a physical therapist, whether you realize it or not, your words matter a great deal. Every time you interact with a patient, from the initial evaluation to the discharge visit, you have an opportunity to communicate clearly and help the patient understand as much as possible about their condition and their progress. Doing so will make the patient feel like they’re playing an active role in their own rehabilitation and increase their chances for a successful outcome.

Sometimes It’s Not Easy…

But always choosing the right words can be difficult, especially when it comes to telling the patient their diagnosis. Many—if not most—conditions treated by physical therapists can be classified by more than one term. Some, like a herniated disc, have what seems like a plethora of associated or synonymous terms (eg, bulged disc, ruptured disc, slipped disc), and which one you decide to use may be influenced by various factors.

You Can Learn, Practice, and Communicate with Greater Skill

Research suggests, however, that the terms you select when you deliver a diagnosis and prescribe a treatment plan really do make a difference. For example, one study evaluated how various terms affected the perceptions of about 2,000 patients with rotator cuff disease. Patients were randomly assigned to one of four groups in which combinations of four terms were used to describe their diagnosis and treatment. The diagnostic terms were “bursitis” and “rotator cuff tear, and appropriate definitions were given for each, and the treatment terms were “guideline-based advice” and “treatment recommendation.” Guideline-based advice provided positive prognostic information and encouraged for patients to stay active and not to worry about their diagnosis, while treatment recommendation stressed that treatment was necessary for recovery. All patients were then asked to assess their need for surgery (the primary outcome) and several secondary outcomes.

Study Finds – Just One Medical Term Can Change a Patient’s Perceptions

Results showed that labeling rotator cuff disease as “bursitis” decreased patients’ perceived seriousness of their condition and need for surgery, imaging, or to see a specialist compared to “rotator cuff tear.” “Guideline-based advice” also decreased the perceived need for surgery, imaging, injections, a second opinion, the seriousness of the condition, and recovery expectations compared to “treatment recommendation.” These findings show that simply telling a patient that they have bursitis rather than a rotator cuff tear and offering them guideline-based advice rather than treatment recommendations can significantly alter how they feel about their condition and whether additional interventions are necessary.

Avoid These Words…

This is crucial for physical therapists, as it is always a primary goal of ours to help patients recover as quickly and safely as possible without getting caught undergoing tests and procedures that may be costly, risky, or unnecessary. If you struggle to find the right words when speaking with your patients, here are some terms to avoid in your interactions and a few alternatives:

  • Try to avoid words with catastrophic connotations like chronic, degenerative, and unstable, since these terms suggest that the pain is unavoidable and will persist
  • Use “herniated disc” instead of a “slipped disc,” which suggests that the disc has slipped away and won’t return to its original position
  • Avoid using the term “damage” whenever possible; for example, if nerve damage is the patient’s chief complaint, find the cause and use alternative terms like inflammation, irritation, or narrowing of space
  • “Never” is another term to avoid in most cases, as in telling a patient they will never do again; instead, design a treatment program that will help a patient achieve their goal activity, or help the patient modify their goal activity so that it can be performed safely
  • Use “sprain” or “strain” instead of “tear,” which may cause patients to avoid moving the injured body part for fear of tearing it more

Contact ACE to Learn More

Words matter at Applied Continuing Education (ACE), too, as we focus on the importance of speaking to patients clearly and carefully in our two physical therapy continuing education courses (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”).

If you want to improve your communication skills and are interested in learning more about our courses, review the ACE website to see if the courses align with your needs and values. You can also contact ACE at 781-229-8011 or, as Mike and Justin are both more than happy to discuss our courses and answer any questions you might have.

What Sets ACE Courses Apart

ACE Continuing Education Courses Stand Apart From The Rest Of the Pack

At Applied Continuing Education (ACE), we understand that some physical therapists may be flummoxed when it comes to deciding which continuing education courses to take. With a plethora of options available, it can be a tall task to sift through them to gauge which ones are worth the time and will provide an added value to one’s profession. Many courses also look the same and make similar claims, which may further complicate matters.

Justin Pezick, PT, DPT and Mike Stare, PT, DPT know these troubles all too well, and frustration with the continuing education offerings is what motivated them to initially found ACE. Justin and Mike both felt that the physical therapy continuing education landscape wasn’t quite cutting it, with too many courses failing to adequately achieve what they believed continuing education should be providing to therapists. They grew tired of participating in non-personalized, uninspiring, and often irrelevant courses, and decided to start their own instead.

Courses are current and predicated on communication
According to Justin, at ACE, this starts with an unwavering commitment to always keep the courses current and evidence based.

“One of the reasons our courses are different is that they are consistently updated, as Mike and I are continually adding new research and changing the education based on the best and most current research available,”  he said.

The structure of the two physical therapy continuing education courses currently offered by ACE (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”) is somewhat unconventional as well. While most other courses tend to focus primarily on which interventions are most effective and how to implement the latest and best techniques, they often fail to provide guidance on how to communicate with patients about their condition and their treatment plan. But Justin and Mike believe that effective patient communication should be a top priority for physical therapists, and as a result, their courses are imbued with instructions on this front.

Weight management and shoulder pain/dysfunction are both challenging—and sometimes sensitive—issues for patients to deal with. That’s why the ACE courses give therapists the tools to remove any barriers or discomfort that might interfere with a successful treatment experience. In doing so, physical therapists become better able to improve patients’ critical thinking skills and communication skills, which will allow them to connect the treatment methods used to their individual goals and restrictions.

“It’s easy to learn how to perform certain interventions or techniques, but what’s not easy is connecting the treatment methodologies that you’ve chosen for that patient to their goals or barriers and explain why,” Justin says. But this is exactly what the ACE courses teach participants to do. “As a physical therapist, your level of understanding is much different than a patient’s understanding, and you should aim to remove that gap.”

The ACE courses were carefully constructed by Justin, Mike, and a team with more than 250 years of combined experience in the field, and every element has been based on numerous hours of feedback, as well as their personal experiences within the clinic. Instead of just presenting PDFs and FAQs, the courses involve real-world examples of patients and conversations that occurred with these patients, including the original diagnosis and the treatment path that was taken. The goal in each of these examples is to demonstrate what the best course of care is for each patient, even if that means referring the patient out to another type of healthcare provider.

When these pieces all come together, Justin and Mike are confident that it will lead to a better treatment experience with more successful long-term outcomes. Going above and beyond for each patient to teach them how to improve their critical thinking and communication skills will certainly take more time up front, but from a business perspective, Justin sees this as a long-term strategy that will pay off over time.

“You’re helping more people long term because you teach the patient to think criticially and understand how their bodies work, which may allow them to be back-pain free for eight years, and they may refer several other people to that practice for care,”  he says.

Contact ACE to learn more
If you’re interested in learning more about our courses, review the ACE website to see if the courses align with your needs and values. You can also contact ACE at 781-229-8011 or, as Mike and Justin are both more than happy to discuss their courses and answer any questions you might have.