Doctors have a lot of power when they talk to patients. Some know this and use it well. Others don’t — and that silence still shapes how patients feel and act.
Sometimes I’ll say to a patient, “It’s okay if we push a little here.” Immediately they’ll answer, “But my doctor said I shouldn’t bend my knee past 90°.” Yeah, I know, Simon. A few degrees more or less aren’t going to rip your ACL out. Your body has a pretty clever security system called pain — and it rarely lets you do anything catastrophic without shouting first.
Once, after watching an ACL surgery, I went out of the operating room thinking: no wonder people are sore after surgery. Surgeons twist, turn, pull, and test the joint under anesthesia in ways most of us would never try awake. That doesn’t make pain meaningless — it just makes context important.
It’s surprisingly hard to separate events from the meanings we give them.
Imagine a young man in a hoodie approaches you, hood up, eyes darting, dressed all in black. He asks to borrow your phone to call a friend. Would you hand it over? Probably not.
Now imagine a well-dressed elderly woman asks politely for the same thing. You’d probably be more willing — until you walk away and find your wallet missing.
Same action. Two different interpretations. We let some statements into our heads without question because they come from someone we think is trustworthy. Other statements we distrust instinctively.
Some people will believe everything a doctor says — useful or not. Others will distrust anything that doesn’t come with a white coat, even if it’s coming from a physio, a friend, or someone who’s actually been through the same thing.
Trust is useful, not infallible.
I get it — feelings matter. Certain professions earn trust: doctors, scientists, teachers. But trusting someone doesn’t make them objectively right. Even the best-intentioned, most qualified person can be wrong or over-generalize.
Sometimes clinical rules are born from research on a specific group: “Don’t bend your knee past 90° for six weeks.” That rule might be based on studies with mostly healthy, middle-aged men, or a particular surgical technique. It might make sense for many people. For others, it may be unnecessary or even counterproductive.
In practice I see this all the time.
I once treated a very athletic, middle-aged man with a fractured femoral head. The standard aftercare plan said he should use crutches for an extended period — a plan designed for the usual patient with that diagnosis: older, less active, often female, at higher risk from osteoporosis. For him, it felt excessive. He was strong and recovering fast.
Was the doctor wrong? Not necessarily. He used the standard information he had — safer to be conservative than sorry. Would this patient possibly have recovered faster with earlier loading? Maybe. In his case, the difference was probably only time, not outcome.
What I want to point out with this story: Rules are for the majority, not the individual.
Rules are useful: they give guidance, reduce risk, and protect both patient and practitioner. But rules can and should be adapted when you understand the why behind them — and when doing so won’t cause harm.
I don’t ignore a doctor’s post-op rules. If something goes wrong after I’ve changed those rules, it’s my responsibility. But understanding the purpose of a rule lets you ask smart questions:
Why this timeframe? Who was studied? Which surgical technique? What are the risks and the intended benefits?
Also remember: measuring exactly 90° of knee flexion with your phone or a goniometer is imprecise. Soft tissue, swelling, and simple measuring error mean a degree or two is irrelevant (or ten, lol). Your knee won’t “fall apart” because you bent it slightly more while getting out of bed.
When a professional gives you information, you can’t change the facts they share — but you can change the meaning you attach to them.
A trustworthy person can still be wrong — and sometimes a standard rule was written for someone else entirely. That doesn’t make the professional dishonest; it just means medicine is messy and people are different.
🧪 Let’s Experiment
As physios, we can’t control what doctors say — but we can help patients reinterpret it in a way that’s accurate, safe, and empowering.
Here’s a simple framework you can use in your sessions to guide patients through medical advice without dismissing the doctor — and without letting rigid rules create unnecessary fear.
🎯 Try This:
Use the Reinterpretation Framework:
- Start with the original medical statement.
Ask your patient:“What exactly did your doctor tell you?” or “How did you understand that?” - Clarify their interpretation.
Patients often add meaning that wasn’t said. For example:
Doctor: “Don’t bend past 90° for six weeks.”
Patient’s interpretation: “My knee will tear if I go to 95°.” - Explain the intention behind the rule.
Briefly outline possible reasons: safety margin – surgical technique – tissue healing timelines – generic protocol for a broad population – outdated habits or tradition. This helps patients understand it’s a guideline, not a sacred command. - Contextualize the rule for this specific patient.
Consider: age, strength, previous activity, swelling, pain, surgical notes.
Then say something like: “For your knee and your healing stage, this rule means X in practice.” - Guide them toward the actual actionable behavior.
Instead of “never bend past 90°,” translate it into something usable: “Stay in a comfortable range; if you accidentally go a bit over, you’re not damaging anything.” or “The goal is gradual loading — not avoiding movement out of fear.” - Reassure without contradicting.
Use phrasing like: “Your doctor’s rule is a good safety guideline. Here’s how we can apply it sensibly to your body right now.”
🧠 Final Thought:
As physios, we’re often the bridge between strict medical protocols and real-life movement. Our job isn’t to fight the rules — it’s to interpret them, translate them, and apply them with nuance. A patient who understands why a rule exists instantly becomes less fearful, more confident, and far more engaged in their own recovery. And in most cases, that understanding makes more difference than the rule itself.
Keep it simple, stay curious, and keep learning—you’ve got this.
Take care,
Carina 🦊