8 COMMUNICATION TIPS TO IMPROVE ATHLETE BUY-IN

Mentorship

Jun 9

Entering the Communication Matrix

Through all of our schooling, and continued education courses thereafter, we tend to focus more on: the new modality course, a trendy movement philosophy, or the latest fancy sport science technology. However, one aspect that is grossly underdeveloped are the skills to communicate and gain buy-in from the patient. Having the most effective evidence-based program won’t make a difference if the patient doesn’t trust you or feel you are the investment he/she needs. Merely engaging in daily communication with our patients doesn’t guarantee our proficiency in effective communication skills. Here are some tips I have accumulated over the years that have helped create buy-in and changed the way I communicate with my patients.

Understanding patient expectations

I always start with asking my patients about their experience in physical therapy. Your athlete sustained an injury that can keep them out a few weeks, or an entire season. They have worries and fears and are instilling trust in YOU to help them get healthy once again. So, I like to delve deeper into their thoughts and expectations from the first visit. They will typically fall into one of three buckets:

1 ) They have had physical therapy before and loved it: don’t screw up!

2 ) They had PT and hated it or it didn't work: win over the skeptic!

3 ) They are a first time PT patient: guide the rookie!

Understanding a patient’s expectations and previous experiences with rehab can change the way you approach their care. Gaining trust and buy-in from your athlete will likely happen in the first couple minutes of your session and will set the stage for the rest of the care. Remember the power of the placebo effect: if a patient believes that therapy will work, their outcomes and prognosis will be elevated.

2. Power Dynamics

Every day we put on a different “social hat” depending on the person and the adaptation of social demeanor. As therapists, we are the experts in the room and we have to be assertive to make sure that our patients get the best outcomes. However, we might have to interact with surgeons, which brings another expert to the table. They have the ultimate power over that patient's care and how we choose to discuss the plan of care will be different. What about when we have to interact with the parents of the athlete? We are still the experts in the room; however, no hierarchy will supersede the parent of the patient! Always keeping the communication transparent and letting them know you have the best interest in their child’s health is paramount. Finally, when speaking to my athlete, I emphasize to them that this is a “team” approach. In a more technical sense, the healthcare framework would be called the “shared decision model”. We cannot get to the end goal if we do not work together. I tell them to always speak their mind and be honest about their difficulties during the rehab process. No matter who we are speaking to, we have to understand roles in power dynamics. Self-reflect and plan on how to change the tone, delivery and questions, in order to create great relationships.

3. personality traits

Once we have understood the power dynamics, and who we are speaking to, it is important to know basic personality traits, and how to communicate with them. Are they analytical and prefer communicating with facts and logic? Are they more emotional-driven and need positive reinforcement during the process? Is it the high-level athlete that will push themselves to their limits and you have to reel them back with strict instructions and timelines? For a much deeper dive on this topic, I encourage you to check out Brett Bartholomew’s work with his Art of Coaching and his book Conscious Coaching. He goes over different archetypes. Not everyone fits into one particular bucket, but it helps to understand how to communicate with a certain individual, what would motivate them, what might make them upset, and how to tap into getting the most out of this person.

4. learn about their life

In school we are taught the subjective exam and there is a heavy focus placed on pain: its irritability, severity, location, aggravating, and easing factors. While this is vital information to help the patient and form a diagnosis, this is symptom-based questioning and does not focus on the person themselves. What is their current state of emotion? People that have fear avoidance, particularly with athletes, are at a higher risk of re-injuring themselves. and stress plays a strong role in the body’s ability to recover. Is this a single parent with three kids and working two jobs? Is this a CEO of a company working 18-hour days? Is this a 12-year-old child with a short-attention span? The more we get to know our patients, the better we can get an idea of how to help them. They only see us a couple of hours a week so it is important to know how we can best help navigate their lives, and how we can meet them where they are in their busy lives and emotional state.

Additionally, getting to know the patient beyond their pain will give you a rapport that may impact both your patient’s confidence in you and their motivation for therapy. If your patient feels like you are investing in them as a person, not just a patient, they are more willing to invest in their rehab process.

5. Question sequencing

Confirmation bias is something we continuously have to work to avoid. If you treat a lot of patellar tendinopathies and it walks and talks like a patellar tendionopathy, you’re primed to assume it’s a patellar tendinopathy but every athlete and their pain experience is different. We have to cleanse your mental palette with each new encounter and allow the athlete to lead the conversation. It is our job to lead the conversation away from unrelated tangents, yet still allow the athlete to disclose pertinent information. Between our verbal and nonverbal communication, we can act as a compass with leading questions rather than being the roadmap to the destination. The subjective exam is the most important part of the interaction and if we sit back and listen, the athlete will lead us to the problem, only to have the objective exam fill in our hypotheses. Here are just a few examples of how you can get more out of our subjective:

Instead of asking leading questions such as “so would you say your pain is more of a burning or tingling?” ask broader questions such as “in your own words, how would you describe your pain?” or provide a wide list of words your patient to choose from
Even if you see your patient’s objective measures improving, consider asking your patient “what has changed for you since we have started therapy?” to get a better idea of how they are improving outside of the clinic or gym
While you’ll need to set SMART goals for your notes, when talking to the patient consider phrasing your question as “what would need to be accomplished for physical therapy to be a success?” to get a better read on what the patient is hoping to gain from therapy

6. seek out feedback

It is never easy to be told what you did wrong but having a mindset shift and looking introspectively can allow for growth. As a sports resident, I received weekly mentorship and got pretty used to being told things that I had done incorrectly. Maybe I didn’t enjoy it at the time but it has helped me become a better therapist for my patients. Having the growth mindset to ask your athletes to provide feedback can help further your outcomes as well as improve your relationship and trust with them. When you ask for feedback it is very important to specify what kind of feedback you want. The more specific you can be, the better the patient can give specific feedback and feel comfortable doing so. This can be with a patient with goal setting or exercise programming, or it can be with someone within the medical team, or the parent so you can open up that feedback loop in ways that communication can be better processed.

7. self disclosure

When we look at the Jahari Window (a topic for another day), we can choose to disclose what we want our athlete to know about us. One experience I choose to express to my patient is that I played baseball at a decently high level (very competitive junior college baseball program). And to add I was injured, had surgery, and missed out on an entire season. I choose to tell this story to my athletes because I want them to know that they are not in this journey alone. First, I played sports beyond high school and can relate to the demand and pressure that comes along with it. Second, I went through the grueling rehab of sitting on the sidelines. I understand a part of the isolation, the mental grind, and the journey. The athlete tends to have a sense of relief that I did what it took to return to sport as an athlete, and now I am an advocate for their care on the medical side. Not everyone has to have a similar story but disclosing something of your choice to your athlete can help build rapport.

8. understand their sport

Our job as therapists is to return our athletes to their sport, not just to basic function. I have grown up playing different sports and learned about many others that I knew nothing about. What separates us from general therapists is the ability to do a needs analysis on the patient for what is required of their sport. From biomechanics to energy systems to specific skills required, it is our job to rehab that athlete back to their sport. If my athlete plays a sport that I have not been exposed to, it is my job to do research to better understand how to help them during their rehab. If you can speak the terminology, discuss the strategy, and breakdown the movement patterns needed for their sport, the athlete continues to get buy-in with your program. Sometimes I have to ask my patient to teach me specific aspects of their sport. I once worked with a ballet dancer and she was working on a specific type of dance and within that dance she had to not only work on a difficult maneuver, but she had to complete this for multiple hours a week. I asked her to bring in her ballet shoes and showed me video of her doing the moves. Asking for that level of detail shows that you care, and then as movement specialists, you can use your creativity to reenact what is needed for their sport. Do not be afraid to ask, and be very detailed!

Remember to be human first, practitioner second

Your athlete sustained an injury and they are instilling trust in you to help them get back to sport. Investing in the patient first and learning how to communicate will not only help you gain immediate buy-in but will keep engagement through the entire plan of care. The point of this blog was not meant to overshadow the importance of achieving results with your patients! This was meant to shed light on the skills that are not exactly tangible but extremely important. Do what you do best as a therapist and have them reach their goals with all your expertise. Remember, we are in the people serving business, we are not in just the shoulder/knee/low back business!

MEET THE AUTHOR: BRIAN FISCHER

Brian has worked as a sports massage therapist, strength coach, and sports physical therapist so he’s finessed his ability to communicate with athletes across the rehab and performance spectrum. He’s also been playing guitar for 19 years and enjoys spending his time as lead guitarist Angus Young in his AC/DC tribute band.

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Email: bfischerhealth@gmail.com

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