Physical therapy & your mental health

In the U.S., new physical therapists need a Doctor of Physical Therapy (DPT) degree, which usually takes about 3 years after college. All states require PTs to be licensed.

PTs work in outpatient clinics, hospitals, nursing and care facilities, and people’s homes.

For example

• Back and neck pain
• Balance problems and falls
• Long-term pain, such as fibromyalgia
• Recovery after surgery, like a knee or hip replacement
• Recovery after a stroke or brain injury
• Sports and work injuries

Research links pain to fear, anxiety and depression. The American Physical Therapy Association says addressing these factors has been shown to help reduce pain.

That’s why a PT may ask how you’re sleeping, how you feel about moving, and what matters most to you.

Recovery can take away the things that usually lift your mood and give your days shape. Missing them is a real loss.

Keeping even small pieces of routine, like a morning walk to the end of the street or a weekly call with a teammate, can help you feel more like yourself.

A review of 11 studies with 983 injured athletes found that motivation, confidence and low fear were linked with returning to sport sooner and at the same level as before.

Fear was a common feeling when athletes went back to sport, even though their emotions became more positive as rehab went on. The authors said clinicians should pay attention to these feelings during rehab.

Depression affects about one in three stroke survivors at any one time. It is linked with poorer recovery and lower quality of life, which is why it deserves attention.

If you or someone you care for is in stroke rehab, tell the care team about low mood. It’s a normal part of the conversation, not a complaint.

Adjusting to a body that works differently can bring grief, as well as new strengths. Both can be true.

Feeling pain does not necessarily mean a physical injury has happened. Learning how pain works can lead to positive changes in the brain.

Reviews suggest that pain education can help with pain, function and worry about pain, especially when combined with exercise or physical therapy.

Because fear often comes with pain, a PT may bring movement back gradually. This can start with simply imagining a movement, then moving in ways that are pain-free, and slowly building back to everyday activities.

Each small success teaches your brain that the movement is safer than it feared.

For chronic pain, long periods of bed rest won’t improve pain and may make it worse. Keeping up normal activities as much as you can usually helps.

After a new injury or surgery, though, follow the rest and activity advice your care team gives you.

A 2024 review of 218 trials found exercise eased depression. Walking or jogging, yoga and strength training worked best. Exercise seemed to help people with and without other health conditions.

A PT can help you find movement that’s safe for your body, so that pain or injury doesn’t shut you out of these benefits.

Psychologically informed physical therapy blends psychological strategies into a PT’s treatment for long-term muscle and joint pain. Approaches include graded activity, CBT-based PT, and acceptance-based PT.

Honest evidence: CBT-based PT helped more than standard exercise in the short term in a few studies. The authors call it a promising model, but say more convincing evidence is needed.

PTs track your progress. Noticing that you can walk a little further, or climb stairs more easily, can be a real boost.

Ways to notice progress

• Ask your PT to show you how far you’ve come
• Celebrate small milestones
• Keep a short note of what you can do each week

Treatment often includes a home exercise programme. Having a plan and someone checking in can make it easier to keep going on hard days.

Imaging tests like X-rays, CT scans and MRI are often not helpful for finding the cause of chronic pain. If a PT suspects a serious problem, they will refer you to a physician.

This can be reassuring: a scan showing “wear and tear” doesn’t mean you can’t get stronger and feel better.

Things worth telling your PT

• If an exercise makes pain much worse for a long time afterwards
• If you feel scared of a movement
• If life is making it hard to do your home exercises
• If your mood is low
• What you most want to get back to

For chronic pain, look for a PT who has experience treating it. You can ask about this when you book.

It’s okay to switch if you don’t feel heard. Feeling safe and respected with your PT is part of good care.

Even if your state allows direct access, your insurance plan may still ask for a referral or limit the number of visits. Call your plan or ask the clinic to check before you start.

Questions to ask

• Do I need a referral for coverage?
• How many visits are covered each year?
• What will I pay per visit?
• Is this clinic in my network?

• Ask about a sliding-scale fee or a payment plan
• Ask if some visits can be done by video
• Ask for a strong home programme so you need fewer visits
• Check whether community health centres or university PT clinics offer lower-cost care

You can bring a support person, ask what to wear, and ask the PT to explain each step before it happens. If you’ve had hard experiences in medical settings, the “Medical trauma” guide may help.

Things you could say

• “I can see how hard you’re working.”
• “It makes sense that this is frustrating.”
• “What would help most this week?”

• Drive them to appointments, or help them book
• Help with chores while they recover
• Join them for a walk or home exercises
• Notice and celebrate small wins with them

Saying “just push through it” can make fear worse. Saying “you can rest when you need to” can also lead to doing too little. Ask what their PT has advised, and support that.

If they seem withdrawn, hopeless or stop caring about things they love, encourage them to talk to their clinical provider or a therapist. Low mood during recovery is common and treatable.