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I Still Believe Physical Therapy is the Worst Kept Secret in Healthcare

May 15, 2017 • Other • Brett Neilson

I still believe physical therapy is the WORST kept secret in healthcare. Last year I wrote a blog titled “Physical Therapy – The WORST Kept Secret in Healthcare” which allowed for some great discussion by the readers on the topic of physical therapy and where we fit into the healthcare system. This blog post followed an open discussion called the “Chelan Chat” at the Washington State Private Practice Special Interest Group (PPSIG) spring conference at Lake Chelan, WA. The ‘Chelan Chat’ is a twist on the Annual Graham Sessions hosted by the Institute of Private Practice Physical Therapy and was moderated by Steve Anderson. This year I was asked to present an “I believe” speech, that I would like to share with everyone here as a means to continue the discussion and a call to action. Here it goes,


I believe we are in the “story” business as physical therapists. We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! A vast majority of people fail to recognize the difference between a story and fact. In fact, most people view stories as facts and as Carnegie Mellon research shows, our stories carry far more weight than facts. In reality, a story is what we tell ourselves about the facts, it is not real. Our point of view is not the truth, it is our perspective. And perspective is based on our knowledge, previous beliefs, environment, the context or space we are in, our mood, our emotions, social pressures, and so on. Essentially our perspective is based on where we are at in life when we make up the story. I believe it is therefore important to remember that our perspective is just one angle on the facts, it is not the only story. Facts do not determine our point of view, our stories do.

So, I would like to invite you into my story on why I believe physical therapy is the WORST kept secret in healthcare.

Most of you are familiar with the common phrase “the best kept secret”. Being the best kept secret is great when you want to keep something a secret, such as your favorite coffee shop, restaurant or favorite place to vacation. However, when it comes to the role of physical therapy in healthcare, I believe that we are still a SECRET to a majority of consumers. This was highlighted in 2007 by Stephanie Carter and John Rizzo when they demonstrated that less than 7% of patients with musculoskeletal conditions utilize outpatient physical therapy services and again in 2012 in the Fritz and Childs study.

So, hopefully you are sitting there asking yourselves, why are we a secret? I believe we are the worst kept secret in healthcare for four main reasons:

  1. We have an identity crisis
  2. We suck at marketing
  3. We don’t know how to sell our product
  4. We are bullies to our brothers and sisters

Despite our shortcomings as a profession, I believe we are the BEST profession in a broken healthcare system and it is our time to move into the limelight.


I believe we have an identity crisis- In 2 words how would you describe a physical therapist?

With a sample of convenience of like-minded individuals at PPSIG, when asked how would you describe physical therapy, I received several answers across the board. There was no cohesion in our professional identity and I believe there would be even more disparity if we were to ask the broader community of over 203,000 physical therapists. Lisa Saladin, PT, PhD, FAPTA, said, as described in the guiding principle “identity” of APTA’s vision for the profession, The human movement system is our professional identity. We need to own this!

Physical therapists like to identify themselves with their training or specialty rather than their profession. I hear this on a regular basis “I am a Maitland therapist” “I am a Feldenkrais therapist” “I am a woman’s health therapist” and the list goes on. Are we ashamed of our profession? Have we tarnished our brand?

I believe that we lack cohesion in what physical therapy really means and that many therapists find that the professional title of “physical therapy” does not well define them. I believe this is why they choose to tout their merits over their profession. Ever since I attended my first house of delegates, I have always said, the beauty and the beast of physical therapy is the heterogeneity of our profession. Jeff Moore said it best, “The heterogeneity of physical therapy is killing our brand”. Unlike Starbucks, we lack consistency and this lack of consistency makes our brand unsellable and often times makes it difficult for our profession to be taken seriously by consumers and the rest of the medical profession. I believe that we owe it to our profession to not bury it’s merits in our alphabet soup, but rather highlight that we are proud to be a physical therapist first and foremost. I believe that our profession should define us and it is time that we band together as the MOVEMENT SPECIALISTS as our professional identity.

I believe we are the best profession.


We suck at marketing and our consumer does not know what we do.

I believe our consumers do not know what we do and if we lack an identity it is very hard to sell our product. Physical Therapy is not sexy, nothing says this more than the 7% who utilize our services. What about the other 93%?!? I agree, it is tough to compete with big firm advertising. Think about it, next time you are watching television, what are consumers being drawn to? Yep, drugs, surgery, and cool gizmos that make false claims and come with an attractive partner and a puppy. Where is PT? We cannot even compete with copper wear who pays Brett Favre ridiculous amounts of money to sell their products on ESPN. And people buy them because they believe it will solve their problems. I believe we can do better.

I believe APTA’s #ChoosePT is a nice start and a step in the right direction, but does not carry the weight to move the needle. Their campaigns largely focus on statistics and pain and fail to recognize the patients real problem (their internal motivator), the reason they seek our services, their function and participation. A direct quote from the tv ad is “physical therapist treat pain with movement and exercise”. Contrast this with the Advil commercials that shows people of all ages doing the things they love with the slogan of “what pain? Nothing works stronger and longer than Advil liquid gels”. What are you going to choose as the consumer?

I believe the vast majority of physical therapy companies waste their marketing budgets, marketing their services to potential physician referral sources. In doing so, they are trying to tell the physicians why their clinic is better than clinic XYZ down the street, killing our brand. I believe we do this because it is the thing we have always done. But let me remind you, what got us here will not get us to where we are going. I believe that the future of marketing in PT is direct to consumer marketing, cutting out the middle man. I believe in doing so, our profession will be liberated from the shackles that have held us back for so many years. I believe marketing to the consumer a consistent brand will allow our profession to grab a larger share of the healthcare pie. I believe it is time that we band together to showcase our great profession.

I believe we are the best profession.


We don’t know how to sell our product.

I believe that the vast majority of physical therapists undersell what we do. We sell services not products. Imagine just for a moment if “health” was a product like a good bottle of wine, rather than a service. If it was a product, our consumer could read the label, touch the bottle, taste it. I believe that if therapy was like wine we would sell a whole lot of wine, but it is not. Physical therapy is a service and a service that lacks consistency. Using sales and marketing campaigns based on emotional stories will outperform anything else and as a profession we need to learn how to better sell our product like a good bottle of wine.

I believe we expect our patients to buy our product, sight unseen and without even getting to sample it. Furthermore, most of us lack the ability to show our patient this value. I believe we fail as a profession to tell our consumer what is really going on, how long it will take to get better and what can be done about it. We just expect our customer to hand over their credit card and pay the $40 copay until we determine we no longer want to see them. There is no proof in this than the front office person who is TRAINED to schedule patients out for several weeks before they have even met the PT. Do we not value our own product? I believe that our product is superior than anything out their and we need to show our patients this value. We need to use test-retest of meaningful positions and activities. We need to keep our attention and their care focused on their internal drivers for seeking our care in the first place. We need to measure our outcomes. If we can do all this, we bring incredible value to our client that will keep them coming back for more.

Why on earth do we DISCHARGE our patients!?! What do you call a business that cannot wait to get their customer in the door, sells them something, and then says, I hope to never see you again? Physical therapists! Why do we do this? I believe we should focus on our customers who love our service and become their life PT. Get them back into our “store” as their first stop when they have a movement dysfunction.

I believe we are the best profession.


We are bullies to our brothers and sisters

Why can we not play nicely in the sandbox? Physical therapists are so quick to criticize each other, go to battle over internal issues and politics and put each other down. I see this on a daily basis with turf wars surrounding care models, use of assistive personnel, the use of interventions like dry-needling and the list can go on. I believe what matters to our patients has little to do with our care model or our interventions. In fact, John Childs showed us in his 2015 study of 750,000 patients that even the worst physical therapy was still far superior to no PT at all. I believe that we are our own worst enemy. We are not the enemy. I believe imaging, drugs, surgery and injections are the enemy. Often, my patients have been through the medical merry-go-round by the time I see them and for some of them, they are still spinning. They have been wronged by so many people in healthcare and in life, we are not the enemy, our healthcare system is. So, why on earth are we the shy kid in the classroom (called healthcare), yet we are the bully in the physical therapy sandbox, willing to kick, scratch and beat each other up over trivial things such as the interventions we use and care models we view as ideal. I believe we all have our own story which is based off our own point of view and we somehow are lead to believe that everyone should think the same way we do. I know I am victim of my own biases. I believe we are wasting an incredible opportunity to help a great deal more. When will we recognize that our POWER as a profession has little to do with what we do with our patients and has EVERYTHING to do with TIME, TRUST and delivering a consistent experience of HOPE, COMPASSION and EMPATHY that helps them on their road to recovery. We are wasting an incredible opportunity to help a great deal more!

Physical therapy is still the WORST kept secret in healthcare. Physical therapy is the best profession. I believe it is time we share our secret with the world. Thanks for reading my story.



Brett Neilson

Brett D. Neilson is a physical therapist who holds a Doctorate of Physical Therapy (DPT) and is both board certified in orthopaedics (OCS) and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT). He is the Admissions Director and Assistant Professor of Hawai’i Pacific University’s Doctor of Physical Therapy Program. Dr. Neilson...

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Ruth Mary Cemens

Commented • April 20, 2022

These posts are very old so this will probably go out there with all the other old dead messages. But I want to say it anyway. Maybe what PT's need to do is look at themselves long and hard. You enter physical therapy, in most cases recovering from injuries or surgery. In my case a verified failed to succeed 4th back surgery and a TKR that is anything but successful in my opinion. I am mad, I am in pain and I am frustrated. Walking is good for you they say but because of my back I can't make it down the alley and back. What is your pain level?(GOD how I hate that stupid question) Do you mean when I am just sitting here looking at you or when I get up and try to make it back to my car? Well then let's start. Oh yes, the bicycle--the healing apparatus for all of you--not so much for me because you ignored the fact that the OTHER knee is in terrible shape and moving it like this will cause it to hurt terribly all night and in tomorrow. The steps, the leaning against the bar and standing on one leg; the one I always refuse, the ball between me and the wall, because I KNOW what you have ignored, that my knees will not bring me back up. Up and down on your toes on a low board, to help the back of the legs---of course you are killing my plantar fascia, but what the hell. There is not a set of things, we jump around and there is no permanent healing. I am a whole person, not a section, arm, legs, back. They interact. And then you tell me to go home and do these exercises. Do I have this equipment? Do I have an adjustable table? Can I get down on the floor and back up? Am I over weight? YES and part of that is because I am a picky eater and part is because I can't even go for a walk or to the park or any of that so I am bored and in pain and I eat to comfort me. Would I like to lose weight? YES so help me. work with me to form a menu that will work with the foods I eat and not tell me that I will learn to like such and such. No I will not, not any more than I will like coming into your facility to gain nothing that lasts. Give me a set program where I can see maybe week by week that there is improvement. Comfort me with words of encouragement. And be honest with me. Say I am sorry but there is nothing I can do to stop your back pain--nothing. But I can work on you knee and maybe help you there. and maybe before you leave I could massage your shoulders for 2 minutes to help alleviate your frustration.


Commented • March 10, 2021

You have no idea how liberated I feel by reading this article. You point out several things that are ALWAYS in the back of my mind, but I question myself (and I shouldn't)... particularly how we put each other down all the time. I experienced that in my clinicals, with self-centered and non-encouraging CIs, and I've had a couple other bad experiences with co-workers and supervisors since. To be honest those experiences tainted my perspective and I've never really gotten over it, and as we know we are wired to focus on the negative, so the many numerous positive experiences I've had with other PTs in my journey are less at the forefront of my memory. It's made me constantly question myself, how good I am, how worthy I am, and I'm always feeling intimidated by other therapists, when I know that I have a lot of great knowledge and skills. It's like being in a relationship with a narcissist. I want to be someone who changes that. I want to treat other PTs with respect and encouragement and kindness 100% of the time. I want us to help each other thrive, and I don't want to charge people in my OWN PROFESSION to help them in their journey.


Commented • July 27, 2020

So this is what happens when a writer does the homework needed to write quality material. Thank you very much for sharing this wonderful content.


Commented • December 4, 2019

Keep up the great work! Thank you so much for sharing a great posts.

Brett Neilson

Commented • November 18, 2019

Tristan, Thanks for reading and commenting. I know that physical therapy is likely to be beneficial for your partners back pain. I wish her well. Brett

Tristan Stewart

Commented • November 18, 2019

It's pretty interesting that you talked about how physical therapy isn't marketed that well so a lot of patients don't understand the benefits of physical therapy. My partner hurt her back this summer while trying to work in the garden doing manual labor. I think that some physical therapy will help her back heal so that she can get back to normal life.


Commented • October 4, 2019

great article, but here is what is BAD about it…. in my opinion:)….Insurance companies do not sleep. they look for an occasion to cut costs all the time. so if their representatives (aka investigators) read such a truthful article they find what they have been looking for. in other words, such article as yours may give them a reason to put a cap on reim

Brett Neilson

Commented • September 18, 2019

Becky - Great question! Show up at the office (or call) and ask for their cash rate. All clinics/organizations will have a cash rate for their services. If they do not, then shame on them, and make them an offer. Best of luck as you finish out your rehab!

Brett Neilson

Commented • September 18, 2019

Becky - Thanks for taking time to read this blog and provide your perspectives as a patient. We greatly value you and I am so grateful to hear about your mostly positive experiences in PT. We need more people like you to sing the praises of PT to their medical providers. You have the power to be a huge influencer in your community to help others. Thanks again for your passion for what we do.


Commented • September 17, 2019

Be authentic! Be YOU! Sell your education and life experiences. Relate to the patient, listen to what they want from you and create something special just for them. I have had about 10 PTs in my life and only four stand out! THEY were the only reason I got my lazy, depressed body into their office. It's OK to let us know you! Where I am going now, I had the best time doing PT because he treated me like I mattered. Then his narcassitic, robot like manager took me into HIS schedule! He rarely even works with patients and says he's in meetings all day. He gets threatened when he sees a connection happen. No one has any say in this. Totally shattered my PT experience. I am SO greatful for people in your profession! I am really excited about your blog! You all NEED to know how important you are in a person's recovery! Also, Doctors really don't get the many functions a PT covers. You are SO important! Thanks for letting me ramble?


Commented • September 17, 2019

I am SO happy I came across this site! I am not a PT but I have spent a huge part of the last 6 years in PT. I have had 16 procedures that all started with a simple "total knee". Failed surgeries, setbacks in PT each time they failed, lack of proper rehab time, Failure again, another surgery, PT. Then YOU'RE DONE! I am currently sweating out the last day this PT will be finished. I have told them I would do self pay when the Insurance stops, but they don't have a reply for me. The guy who runs it has no idea how to promote and retain patients. How do I get him to engage with me and give me an answer? I am SO WORRIED about this and am in no way ready to be finished! On this one surgery, there have been 4 redos and every time I have to start over at square one. Help me!

Brian H.

Commented • August 31, 2019

Great blog, I actually had to get some physical therapy done due to a knee injury. I decided to get the PT done by a licensed physician at the Houston Physicians Hospital and they really gave me their time in helping me recover from the injury.


Commented • July 21, 2019

great article, but here is what is BAD about it.... in my opinion:)....Insurance companies do not sleep. they look for an occasion to cut costs all the time. so if their representatives (aka investigators) read such a truthful article they find what they have been looking for. in other words, such article as yours may give them a reason to put a cap on reimbursements or deny coverage. I fully agree with you on the "lies" part, but I am not sure if it is such a great idea to share it publicly, as it may gradually lead to disqualifying us as HC professionals.

Brett Neilson

Commented • June 13, 2019

Hi Dana - Thank you for taking the timed to read this blog post and comment. On behalf of the medical system, I want to apologize to you for your less than optimal experiences. I will connect with you via email to see if I cannot help facilitate getting you to someone who can help. Hang in there, this will get better for you. - Brett

Dana S

Commented • June 12, 2019

Im responding as a patient, not a professional. You mention SI slippage but can you elaborate? My diagnosis is SI joint dysfunction but I still don't really understand the disease. I've had steroid shots (never again) physical therapy, oral steroids, opiates, visits to the chiropractor... The chiropractor put me on a flat table and then the table made a noise and he said he had just adjusted my SI joint. It felt very smoke and mirrors to me. He said I had a partial sublocation or something similar. MRI does not show this. Unfortunately the steroid injections caused fat atrophy so now I have more degradation of tissue in that area. PT consisted of a one size fits all program where I was left to do the exercises on my own...and everyone just loves to use the tens machine and heat pad in PT. One lady did use tape in that area to "help stabilize" my joint. Anyway, still in pain, fairly unwilling to try more PT or chiropractic. Im interested in your knowledge of SI issues and if sublocation or slippage is actually a thing. Also , if movement or lack of movement is causing this. Believe it or not, this started when I began high intensity yoga and fairly basic hiking. You seem like you want to share knowledge so thanks in advance for your thoughtful response. BTW, I'm 5'6, and 105#. Im underweight but it's hard to eat when you have chronic pain.

Brett Neilson

Commented • May 24, 2019

Roshi - Thanks for reading and for your comments. I will agree with you in that there is an underutilization of technology in physical therapy. This contributes to the lack of "sex appeal" in physical therapy and may be one reason why we see an underutilization of our services. Thanks for reading!

Roshi Fu

Commented • May 20, 2019

I could be biased, but I'm going to bring up two topics to fuel the fire. You know what's missing in physical therapy that every other healthcare profession has an abundance of? A need for actual products (not just services) and reoccurring services. Dentists develop and sell teeth cleaning products and provide yearly teeth cleanings, physicians require you to go in for yearly check ups and sell you medications, pharmacists sell medication and you have to go to one to receive your meds, and chiropractors have developed all kinds of back pain devices and contraptions over the last decade and also encourage you to come back to their clinic for yearly checkups. But what about PTs? I haven't heard of any popular products developed by a PT outside of the McKenzie lumbar roll. Some PT clinics sell exercise equipment and foam rolls, but most of these items are not PT-specific and can be found for cheaper online. Also, I can usually go to a PT to learn some exercises to take home and never have to go back again, so these is no need for reoccurring services. I believe these are two issues that PTs have to solve if they wish to gain more market share and impact in healthcare. Most importantly, we have to start offering patients value BEYOND what we can provide them during a few sessions in the clinic. This could come in the form of offering physical or digital products, free on-site education sessions, group therapy/training programs, a gym/spa membership with unlimited access to PTs, etc. I believe it's this type of outside-of-the-box thinking that's going to get our profession more in the mainstream.

Brett Neilson

Commented • April 29, 2019

Alex - Thank you for the comment and for checking out this blog post. I completely agree with you and this is why our Professional Association (APTA) has focused our professional specialization on the "movement system". Physical therapists are "movement system" specialists. Thanks again for your input!

Brett Neilson

Commented • April 29, 2019

Astilbe - Thank you for your comments and feedback. I can assure you that as a profession we are working hard to improve access of physical therapy for the greater public. We are in agreement that high co-pays can be prohibitive to accessing care. Thank you for taking the time to share your struggles.

Alex Pagotelis

Commented • April 27, 2019

I agree with everything you're saying. I would say one more thing though. We should as profession specialized in some system of therapy in order to provide a better product twelve patients. I hear it far too often from patients I see that they were seen for months and did not feel any relief. This can no longer happen if you want to be the first choice in treating patients pain and movement dysfunction. Thanks again for keeping this topic going.


Commented • April 26, 2019

I have just one problem and this is coming from a middle income patient with herniated discs and other severe skeletal problems. I can’t keep up with the co-pays. If there wasn’t a specialist co-pay with every visit you would see many more patients. My friends and family talk about going to PT, figuring out what exercises we need and just stay home to do them. Make it affordable and you will help so many more. Make all the post-visits follow ups and you’ll still get paid and your patient will come back if that is possible. Otherwise, the majority of working class patients will continue to copy the first visit doing more harm than good. PS Water therapy is truly the best form of therapy I’ve ever had and your patients have to come back for that.

Augustine Joseph

Commented • April 13, 2019

Awesome Brett. The problem is we sometimes underestimate ourselves. Every physios are brand ambassadors of our profession.

John Ryan, PT, DPT

Commented • April 10, 2019

This is so true. Thanks a lot for sharing this! Dr. John Ryan, PT DPT.


Commented • March 28, 2019

Excellent explanation, it’s simple & focus. Thank you so much for sharing a great article.


Commented • February 19, 2019

Well written article and spot on! PT seems to be full of individualists that are trying to distinguish themselves. In the meantime the profession is losing its role in healthcare, that is reflected by the reimbursements. The lack of a clear product with its marketing is one of the reasons. PT involves so much more than pain management. Reoccurrence, the lack of solutions, shows that there is a lot to improve in the field of patient education and motivation to correct all the behaviors that will cause pain. Be the professional, a functional movement specialist. Understand your customer and his body issues, sell your expertise: a program and the tools to improve movement abilities.

Ridley Fitzgerald

Commented • January 23, 2019

It's interesting to learn more about physical therapy. It makes sense that it's hard to market something that isn't "sexy", as you put it. Still, I hope people learn more about it, especially because it's so helpful.

Brett Neilson

Commented • January 16, 2019

Hi Shannon, thank you for your comments. Yes, we are the best profession in my eyes!

Shannon Grimes

Commented • January 16, 2019

Hi there Brett! This is a very detailed post! It's like an eye-opener to those who doesn't have any idea what PT's really do and how we can help people. Some of the information have an "oh yeah, that's right" reaction while reading it. I hope I can read more of this to help spread awareness to people about PT's and also help other PT claim their profession. Just what like you said "I believe we are the best profession."

Al Chung

Commented • January 2, 2019

I totally agree with you Alexander. We work in a medical system that has been high jacked by big corporations or if a therapist is private they bought into the idea its all about business and profit. Far and few between are the practitioners whose first and foremost concern is to cure the patient. This should be our first and foremost calling. If we are not getting results patients look somewhere else. And it's on us to improve our skills and get them better. Not regurgitate clinical studies or seek certifications that sound impressive but do nothing to get patients better.


Commented • December 20, 2018

Great article! I'm hoping more national campaigns like #chosept will help people become more aware of the benefits of PT, instead of choosing opioids to mask their pain.

Brett Neilson

Commented • October 15, 2018

Thanks for your comments Jon! We have several ongoing efforts in my local area including presentations and face time with the Department of Health. I have decided that rather than sit back and wait for others to act, I decided to influence what I am able to influence locally. Best of luck to you in your community as well!

Jon W

Commented • October 14, 2018

Brett, I agree with your perspective on our profession. If a majority of us understand or at least have some awareness of these problems, where is the leadership in our profession to try to effect some change? I have watched for 25 years while our reimbursement has steadily declined, I have watched other associations create well crafted national marketing campaigns to promote their product to the public directly with great success, for example; Got Milk, or Beef, it's whats for dinner. I think the bigger issue is the void in leadership in our profession. While there are efforts to change reimbursement they only seem to slow the steady decline, versus recover lost ground. I challenge you to find a legislative victory that reversed that trend. What is being done to market our profession, a website that someone might stumble upon? Our profession needs to be more aggressive in it's marketing and as you suggested cut out the middle man and take our message directly to consumers. Unfortunately I think the APTA has diluted their focus and has way too many irons in the fire to focus on the most important things that we need today, recruiting patients and making sure we get paid for our expertise. My concern is if this has been happening for years, or decades, why aren't we trying a different approach?

Brett Neilson

Commented • September 17, 2018

Evander, Thank you for taking the time to read this blog post. This post from a couple years ago was meant to be provocative in a sense to "air the dirty laundry" so to speak in physical therapy and healthcare from my view point. Your view from a patient perspective is welcomed and I certainly appreciate you taking the time to express your thoughts and frustrations with the physical therapy profession. You highlight many of the things that we need to do better, most importantly, measure our outcomes (and publish these) and standardize our practice. It is well researched and documented that there is large variations in care in all healthcare professions, physical therapy included. Additionally, more and more practices are measuring their outcomes, and payment is now being tied to these outcomes in many cases. Our Professional Association is also heavily investing in measuring outcomes. Unfortunately, you have had some less than optimal experiences with physical therapists, for which I sincerely apologize. However, I hope that you will consider giving physical therapy a shot again in the future when musculoskeletal issues arise. It certainly beats the alternative of drugs, injections and surgery in many cases. If I can use an analogy here, I often draw relationships between seeking medical treatment and getting your hair cut. If I received a really bad hair cut, I do not think I would stop getting my hair cut. However, I certainly would look for a new barber. I would encourage you to explore other therapists in your area. I would also be more than happy to tap my network should you need help finding a quality therapist. Again, I thank you for your time, passion and wisdom. Best of luck to you!


Commented • September 15, 2018

Ye gads, this reads like one who’s hellbent on self validation! If you really want to revolutionize physical therapy, why not change the way physical therapists treat prople as if they’re just cows that need extra milking? While I can grant you that they are often an untapped resource, it’s not the marketing that needs tweaking, it’s measuring a realistic end game. I’ve been strung along by enough physical therapists (both good and bad) who’ve treated me for a genetic condition, to know that they’re never going to whip my genes back into shape. I learned the exercises that would most benefit me, so why do I need to traverse the city and do the same ones for you in person? All this blog accomplished was to confirm my suspicions, that physical therapists just want to sell their cookie cutter approach ad nauseum. Previous therapists have claimed they could’ve prevented my need for surgery, which is really just more self-aggrandizement, but has anyone successfully finished physical therapy..... ever?(Rhetorical)


Commented • August 18, 2018

Informative post Thanks for sharing

Brett Neilson

Commented • August 17, 2018

Rachel, thanks for reading and for your comments. Yes, if we can crack the marketing code and figure out how to better market PT over other medical options, we should see the needle move with more than 7-10% of patients with MSK injuries going to PT over drugs, injections and surgery. Thanks again!

Rachel Frampton

Commented • August 16, 2018

I really enjoyed your post on how physical therapy is the worst kept secret in healthcare. I think you made a great point about the fact that the general public doesn't really know the role of physical therapists and that physical therapist companies don't use their marketing budgets wisely. This was very intriguing and could certainly be an area where PTs could improve their image.

Brett Neilson

Commented • July 23, 2018

Thanks for reading and providing feedback!


Commented • July 23, 2018

Thank you for sharing your wonderful opinion on this topic. I like the way your describe all the problems, especially the "We are bullies to our brothers and sisters" where you explained how we all are trying to putting down each other, Therefore, I have bookmarked your website and Please keep sharing your blogs.


Commented • December 24, 2017

This is all well and good until insurance and state practice acts and rules get involved. I honestly belief our hands are tied and things are the way they are because the system is set up to be that way. Yes, time to change the system.


Commented • November 8, 2017

This is one of the best kept secrets actually---and I'm one of the ones who won't play nice in the sandbox. Physical therapy has become a dishonorable mess. I amazed I have kept in it for almost two decades. Where do I even start? Ok how about that most of you really do very little actual physical therapy care. It doesn't really matter if you are Maitland or McKenzie when most of you treat overlapping patients all of the time and you basically have them run through the same exercises while you type notes. And that's what most of you do. Not all but most. Don't even try to argue that fact, especially with someone who has been across the country for 17 years. You keep seeing the same chronic pain patient who is in chronic pain because he is 100 pounds overweight. When I get that same patient back I just discharged a month ago with the same referral I rotate him right back out. Because when your pain is because of your lifestyle I can't help you--and neither can any of you. And all of you "chronic pain specialists?" Name one patient you have solved long term. Name bloody one. Your doctorate is a misrepresentation. You're not a specialized advanced graduate. You are entry level. The doctorate was designed to gain direct access--nothing more. We didn't get it (for reimbursement mostly anyway) and you got stuck 150K in debt. You are NOT a specialty doctor. You did not go to medical school and then specialize in dermatology. Or radiology. You did not go to six years of chiro school or the podiatry version of medical school. You went to PT school after an unrelated degree, got extended internships for no good reason and now are in insurmountable debt. So the PT? Largely a charlatan now. With his patients and to the public at large. That's the best kept secret of our profession.


Commented • May 27, 2017

A fantastic write up about the tug of war in our profession is well explained. The area of marketing on our service is well said comparing to a "wine bottle " product sale. The interesting part of your say brand promotion and quality care was superb. Would like to add up that our care towards an individual as branded under physiotherapy/physicaltherapy takes a public it's as same as any other provide it. On watching a movie or listening to a music it gives joy/relaxation and not to take away anything beyond it. Internal defaming of our own colleagues comes of jealous in the standard and quality of care. Looking forward more from your dear


Commented • May 20, 2017

Thought provoking writing. Yes we are movement specialist. We should brand ourselves.

Dr.Akanksha Kaushal (P.T)

Commented • May 19, 2017

Totally agree with u sir.if the patient is having no result with one physiotherapist , instead of going to another therapist he will think that physiotherapy is of no use.

Liza Tan

Commented • May 18, 2017

You hit it up front and center.


Commented • May 18, 2017

The problem is that most Physical therapist don't care about patients,they care about money,most of physical therapist use old methods of therapy and not willing to try new one,they are scared to get out of box. As a result are bad outcomes. And another things that we deal with patients not with customers. I think this is big difference. I'm from Russia, Worked as a clinical exercise therapist for 15 years,we used new method for people who experienced spinal cord injury,tried to apply my knowledge in Canada,but nobody was interested,they didn't care about it.And I think that first of all physical therapist should change their attitude,they should be focused on a result,on helping people,but not just think about money.The more positive results you gonna get the more attractive you will be for people.

Dr. Akshay Mehta

Commented • May 18, 2017

Very important article and the ensuing discussion. As a cardiologist husband of an eminent physiotherapist wife, I realize the value of all points discussed. My suggestion is to publish: in lay press, in medical journals, thru social media, writing books, etc. People do not know the magic you all are doing.


Commented • May 17, 2017

Brett, Thanks for the relevant posting. First; I am curious what it means to be a "movement specialist." As a physical therapist with many letters after their name, I'm still unsure what this means. How can a profession try to "TM" movement? Movement screens have been shown to provide little to no benefit. The postural and movement "dysfunctions" promoted have little if any validity and anyone in exercise or rehab professions can adapt/modify movements for comfort. https://www.nsca.com/education/articles/ptq/corrective-exercise-trap/ http://bjsm.bmj.com/content/early/2017/05/16/bjsports-2016-097307 https://www.somasimple.com/forums/showthread.php?t=26964 https://www.ncbi.nlm.nih.gov/pubmed/28360142 Second, How do we market what many cannot define is our product? I think Erik Meira hits it on the head when he writes: “A physical therapist is a licensed healthcare professional trained in rehabilitation and the optimization of function after injury or disease whom you can see directly without the need for a physician’s referral." http://thesciencept.com/ethics-of-healthcare-advertising/ One could add in the value as force multipliers (if we decided to pursue it) with direct access, differential diagnosis and members of a healthcare team that refers to appropriate providers when warranted. Physical rehabilitation is who we are and what we do. This exists from the NICU to hospice. From homemakers to elite athlete. For those with orthopedic, cardiovascular, neurological or oncological conditions throughout the lifespan. At some point in our life, its likely we'll all need physical rehabilitation. So I say out with titles that carry little in the way of validity (movement specialists identifying "dysfunctions") and in with what we do. Get people back to who they were/want to be without gimmicks/gadgets but with sound physical rehabilitation.


Commented • May 17, 2017

This is one of the best article which deals our present situation. we as a whole professionals have to change our work etiquette. identity is the major problem . most of us tries to show our patients that we are doing something new on our application and really get strucked on our ground level. for me for sure we have to work on improving our marketing skills.as the years progress physiotherapy is going to be the key for many conditions. its going to be a much helpful one for the whole world. thanks for your article once again brett

Brett Neilson

Commented • May 17, 2017

Lakshmikanth VP, You highlight an excellent point. As Paul Gough would say, we need to learn how to help our patients make better decisions about their health and healthcare. I believe this is the single most impactful thing we can do NOW. This is an uphill battle to compete with pharma. We need to become consumers of the literature in marketing and communication to better get our message across. I would recommend the book "Predictably Irrational" by Dan Ariely as a great starting point for anyone.

Brett Neilson

Commented • May 17, 2017

Thanks for reading. It is unfortunate to learn that things are the same in India, but comforting to know this is a world wide problem. We can all band together as a profession to better help the people we serve. Thanks again for your comment!

Mary Riley, PT

Commented • May 17, 2017

Thank you for this powerful message. As a PT with a great deal of respect for the profession and my colleagues, this conversation is long overdue. Follow best practices, refer when a patient requires different expertise than currently in your toolbox and mentor as well as receive mentorship when needed. On the topic of how we treat one another professionally, this conversation needs to begin in school. Identify mentors or be a mentor are the options. Criticizing is the easy option when we identify something we feel needs change. Action is much more difficult. Treat all with respect and keep the lines of communication open. Thanks for framing up this conversation and urging us to action.

Lakshmikanth VP.

Commented • May 17, 2017

We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! Yeah we hear lot of stories about the fact where to rely on. Customer keeps on relying who reduce the pain and improve the function. Where it come PT or a drug which is better for their recovery.... Some of them lacking in this to promote the best is physical therapy.... It's a good article to look into and eye opening.......

Edwin Meelhuysen

Commented • May 16, 2017

Excellent article overall, and I totally agree with most of it. You did lose me with your statement, "I believe imaging, drugs, surgery and injections are the enemy. Often, my patients have been through the medical merry-go-round by the time I see them and for some of them, they are still spinning. They have been wronged by so many people in healthcare and in life, we are not the enemy, our healthcare system is." I think if we are going to achieve the status we desire in the healthcare community, we need to do all the things you mentioned previously in the article, all the while truly being experts. The rest of the providers will grow in their appreciation and respect of us as we communicate intelligently with them and succeed in caring for patients.. We need to not only talk about our value, but demonstrate it with the patients. I have had a number of mentors during my career and those that added the most to the growth of our profession have the respect of their medical provider community. I do not think any of them have gained that by treating them or what they do, as "the enemy," I certainly have not. Let evidence based care weed out what does not work. I believe that when we truly have the patient as our focus, not ourselves, we will be willing to help that patient to achieve success, even if it is outside of ourselves. That combined with excellence and skill and the tactics you outlined will help us grow as a profession. Thanks for the thoughts.


Commented • May 16, 2017

Great insight into the profession of physical therapy. I thought it was like this only in India but its the same everywhere. Very aplty put by my friend Brett. Thank u

Brett Neilson

Commented • May 16, 2017

Teresa, thanks for taking the time to leave a comment. I could not agree more with your affirmations. I also completely agree that PT's need to be better about referring patients to other PTs or healthcare professionals. When we do not, we do this typically for self-interest and it makes our profession look desperate, as if we cannot each get enough patients. This is why we need to learn how to engage with the 93% we have yet to connect with. In order to do this, we need to learn how to educate (not market) the public about what we do and how we can help them with their problem. By problem, I am not talking about back pain or knee pain, etc, but their movement dysfunction that is holding them back from playing with their grandkids or spending a day on the golf course, etc. We need to learn how to better connect with people on their internal motivators and use this to help them make better decisions about their healthcare and health in general. Thanks again for your thoughts.

Craig Johnson

Commented • May 15, 2017

John; So right on!!! Brand, passion, accountability. I think of those three things need to change for PT to become a known as a provider. Jeff is right our diffuse and confusing brand is no help. Reduced variation and increased standardization will help to define the brand. We must be able to answer for the patient/customer the one thing they can count on from a physical therapist for treatment of xyz condition. We must have a brand promise. Passion is about treating the customer with confidence and being able to engage them. Some patients and conditions can be a trial course of treatment, but the level of knowledge, skill, and training should give us confidence in providing a solution to many, many patients. Being accountable to an outcome, a result of treatment will help us break out of the volume based model we now accept. If we cannot be accountable to a result, we have nothing that differentiates us from other providers, and therefore nothing to sell. If we aren't accountable to an outcome, we can only blame ourselves for settling for low payment. • Here's a great TED talk by Casey Brown’s . . . Know Your Worth, and Then Ask for It. https://www.ted.com/talks/casey_brown_know_your_worth_and_then_ask_for_it#t-1338 No one will pay us what we want unless we know what we are worth, and tell the customer what we are worth. It does not mean stating the dollar value of your service right off the bat. It means stating the value of your service in their terms; "you will be able to do . . . you can get back to what makes you happy . . . . You will do again what gives you excitement . . . ." Stating our value is necessary for patient engagement. We can't expect the customer to fill in the gaps for us, We must show them and demonstrate why and how we are different from other providers; and why we are the best choice for them.

Teresa Schuemann

Commented • May 15, 2017

Fantastic article Brett! Thank you for writing and sharing your profound thoughts. I think it is high time to focus on what our message is as PTs and then SPREAD THE WORD, holding no secrets back. I like "Best Profession" slogan. Most other professions do not sell their brand for their specialty. We need to unite to get consumers to utilize physical therapy and INTERNALLY recommend our colleagues and peers based on specialty practice that is effective. Clients should find a Physical therapist and the PT should get that client to the person BEST suited to be effective when a referral is necessary to attain client goal's and excellent functional outcomes!

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