Walking into your first physiotherapy appointment can be daunting. You might be in pain, feeling uncertain, and unsure of what to expect. However, the initial physiotherapy evaluation is a foundational step on your journey to recovery. It’s a collaborative process designed to understand your unique situation, diagnose the root cause of your problem, and create a personalized treatment plan.
We at Toronto Wellness physiotherapy clinic help you to have a comprehensive guide to demystify the entire process. We’ll break down exactly what gets assessed in a physiotherapy assessment and provide you with a list of essential questions to ask your physiotherapist. Being prepared will help you feel more confident and ensure you get the most out of this critical first session.
What is the Purpose of a Physiotherapy Evaluation?
The initial evaluation, also known as an initial assessment or consultation, is not just a formality. It serves several crucial purposes:
To Establish a Diagnosis: While your doctor may have given you a referral, the physiotherapist performs their own in-depth assessment to pinpoint the specific physical dysfunctions causing your pain or limitation.
To Understand Your Story: Your goals, lifestyle, and medical history are central to creating a relevant and effective treatment strategy.
To Create a Baseline: The findings from this first session establish a starting point, allowing both you and your therapist to measure progress down the line.
To Build a Therapeutic Alliance: This is your chance to build rapport and trust with your physiotherapist, a key factor in a successful recovery journey.
The Subjective Assessment - Your Story and Medical History
The evaluation typically begins with a conversation, known as the subjective assessment. This is your opportunity to tell your story. Your physiotherapist will listen intently and ask a series of detailed questions.
Key Questions You Will Be Asked:
What is Your Main Complaint? (The “Chief Complaint”)
What brought you in today? Where exactly is the pain or problem?
How Did the Injury Occur? (The “Mechanism of Injury”)
Was it a specific incident (a fall, a twist) or did it come on gradually?
What are Your Symptoms?
Pain, stiffness, numbness, tingling, weakness, or swelling? You may be asked to rate your pain on a scale of 0 to 10.
What Makes it Better or Worse? (Aggravating and Easing Factors)
Does sitting, standing, or walking affect it? Does rest help or make it stiffer?
What is Your Functional Limitation?
What specific activities can’t you do because of this problem? (e.g., climb stairs, sleep through the night, lift your child, play your sport).
What is Your Medical and Surgical History?
Past injuries, surgeries, or relevant medical conditions (e.g., arthritis, diabetes, osteoporosis).
What is Your Goal for Physiotherapy?
This is critical. Be specific! “I want to run a 5k,” or “I want to garden without pain.”
The Objective Assessment - The Physical Examination
After the conversation, your physiotherapist will conduct a hands-on physical exam. You will likely be asked to change into clothing that allows them to see and assess the affected area (e.g., shorts for a knee problem, a tank top for a shoulder issue).
What Gets Assessed Physically:
Observation and Postural Assessment:
The therapist will look at your posture, muscle symmetry, gait (how you walk), and any visible swelling or bruising.
Range of Motion (ROM) Testing:
They will assess how well and how far you can move your joints, both on your own (active ROM) and with their assistance (passive ROM).
Muscle Testing:
This involves testing the strength of specific muscles around the injured area to identify weakness or imbalances.
Palpation:
This is the hands-on component where the therapist feels (palpates) your muscles, joints, and ligaments to identify areas of tenderness, tightness, spasms, or swelling.
Special Tests:
These are specific clinical tests designed to stress particular tissues (like ligaments, tendons, or nerves) to help confirm a diagnosis. For example, a therapist might perform a specific test to check for a meniscus tear in the knee.
Neurological Screening:
This may include testing your reflexes, skin sensation (feeling light touch or pinpricks), and muscle power to rule out nerve-related issues.
Functional Movement Screening:
You may be asked to perform functional movements like squatting, lunging, or reaching overhead to see how your body moves as a whole.
The Diagnosis and Treatment Plan Discussion
After gathering all the information from the subjective and objective assessments, your physiotherapist will synthesize their findings.
What to Expect in This Phase:
The Clinical Diagnosis: They will explain what they believe is the primary cause of your symptoms in clear, understandable language.
Education: You will learn about your condition—what it is, why it happened, and the physiology behind your pain or dysfunction.
The Proposed Plan of Care: This is your roadmap to recovery. It will include:
Short-term and Long-term Goals: Based on the goals you discussed.
Treatment Frequency: How often you should attend sessions (e.g., twice a week for 4 weeks).
Treatment Techniques: An overview of the methods they plan to use.
Home Exercise Program (HEP): You will almost always be given a few simple exercises or stretches to start doing at home.
10 Essential Questions to Ask Your Physiotherapist
Being an active participant in your care is vital. Don’t leave the appointment with unanswered questions. Here is a list of key questions to ask:
“What is my primary diagnosis?” Ensure you understand the underlying issue, not just the symptoms.
“What is the expected recovery timeline?” While every person heals differently, your therapist can give you a realistic general timeframe.
“What are the primary treatment techniques you recommend and why?” This helps you understand the “how” and “why” behind your care (e.g., manual therapy, dry needling, specific exercises).
“What should I avoid doing?” Knowing your limitations (lifting, certain exercises, etc.) is crucial to prevent re-injury.
“What activities are safe for me to continue?” It’s important to stay as active as possible within safe boundaries.
“What will my home exercise program look like?” Understand the frequency, duration, and purpose of your prescribed exercises.
“How will we measure my progress?” This could be through re-testing strength, re-assessing pain levels, or achieving functional milestones.
“How can I prevent this from happening again?” A good physio focuses not just on recovery but also on long-term injury prevention strategies.
“What should I do if my pain flares up?” Have a plan for managing setbacks, which are a normal part of the healing process.
“What are the next immediate steps?” Be clear on what you need to do before your next appointment.
