In this instructional video Aaron LeBauer, a physical therapist, outlines the communication protocol he uses with new patients during their first (or second) visit. He begins with a focused history, using specific, open‑ended questions and active‑listening techniques to uncover the patient’s primary functional limitation and pain triggers. He then transitions to explaining the movement evaluation, emphasizing the need to assess the entire kinetic chain—not just the symptomatic region—and obtaining explicit permission before observing or palpating. LeBauer details practical logistics: attire recommendations (shorts, tank tops), privacy measures (stepping out while the patient changes, coat hooks, sheet covers), and how to signal readiness (open the door). He describes the hands‑on evaluation, stressing the importance of reproducing symptoms, distinguishing therapeutic pain from harmful pain, and communicating the goal of reducing discomfort over time. Throughout treatment, he instructs patients to provide real‑time feedback, using clear cues like “halt” for stop, and to report any unexpected sensations or spontaneous movements. He also encourages patients to stay aware of their bodies, focus on the therapist’s hands, and adjust position for comfort. The overall message is to set clear expectations, obtain consent, use empathetic language, and empower patients to actively participate in their care.
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Hey, what's up? This is Dr. Labouer with labour physical therapy and what I want to do today in this video is just explain to you some of the things that I tell my patients when we first start or in the first visit. Sometimes if we don't get to it in the first visit, I try my best to get to it in the second visit. But there's a couple things that we, we talk about. One is what they should experience or expect to experience. We're going to talk about pain. So I introduced them to the idea of pain science or that pain isn't always just in your head or because of an injury and what to expect at home. So one of the first things I do is when I'm asking questions for your patience, I try to follow up with some good questions where I get a specific answer. If I don't always get the answer I'm looking for, I try to be more specific and follow up. So sometimes I ask people what you know, I want to find out why are they here? What is it that is the number one thing that brings you here? Or what's the number one thing you can't do that you're unable to do anymore? People say, oh, I can do everything. Or they say, oh, nothing. And I'm like, well, there is a good reason you're here. So that's one thing that we want to find out. So I follow up with what is the number one thing that you aren't doing as well as you would like right now? And people are like, oh, I can do everything. But later on they might say, well, it hurts when I type and say, okay, well, is typing the number one thing that you're not doing as well as you would like or is it the thing that you're not doing in the way that you would like? And so we try to get to that answer. There's a lot of active listening. So people say something. Active listening means you repeat the answer back to them. And what that means is that they understand that, you know what they just said. They feel heard, they feel acknowledged, and that goes a long way. The next would be transitioning from kind of patient history to the movement evaluation. What I want you to do is let people know what to expect during the session. So let them know, okay, next what we're going to do is, is I want to watch you move, I'm going to watch you, I'm going to stand you up and I'm going to have you move. If you're here for neck pain, just because you're here for neck pain doesn't mean we're only going to watch your neck move. I want to see your shoulders, your back, your hips, ankles, look at everything. Is that okay with you? So you ask permission. Is that okay with you? Everyone's going to say yes. Some people might say no. Well, I really want you to work on my neck or shoulder. Okay, well then what you have to do is explain. Sometimes need to, you know, it's not just enough to look at the neck and shoulder because that might be why you've been somewhere else and it hasn't worked. It's because they only focus on the neck and shoulder. We need to look at your back, your hips, and you can leave that in with a story. One of my favorite stories is I had a patient who came in. The only thing that was a problem was when she deadlifted over 300 pounds. Her back hurt or her hips hurt. I can't remember what it was. It wasn't a hip movement problem. It was a thoracic spine problem. So you can relate a story to people and they go, oh, I get it now. And that makes sense. That's why we need to look at these other areas or treat these other areas. Because if the other area doesn't move, you create a compensation somewhere else. And that can be the thing that's so tight that's causing the pain signal, but it's the movement problem elsewhere. So I let people know what to expect. And then most people we treat in shorts and women in a tank top or sports bra or like camisole type top with most of the skin exposed. So what I do is to tell people that I'm going to leave, I'm going to step out of the room while you change. There's coat hook for you on the wall. If you want to hang anything up there. You can put your clothes on the bench, change into your shorts, no socks, no shoes and no shirt for men and for women, make sure they have a tank top on or a strap top so that you can see their shoulders. The reason that's important is one, we need to watch people move and see where the muscles and bones are moving. And two, when we treat, treating directly on the skin is the most effective and the best way that we're going to feel what's going on and treat what's going on. Treating through the clothes is it can certainly be effective and helpful for people, but it's not the ideal. So occasionally if you have people that come in and don't have Shorts or pants. You sometimes you get by it the first time and say, hey, look, you know, we're going to do this today, but next time bring in some shorts. And here's why. If they don't or you need to work directly on the skin, we do have sheets that you can use for top covers. So the point is to let people know what to expect rather than just expect that they already know. Because most people don't know our brand of physical therapy and how it's different. So you ask permission. You also let them know what you're going to do before you're going to do it. And then so you step out of the room. One of the things I tell people all the time is make, you know, open the door when you're ready. Because if they say I'm ready, you might not hear them. So if they open the door when they're ready, you'll hear the door open and you can come in. Occasionally it seems like it's taken a long time. So I'll knock on the door and ask you for, are you ready? They'll be like, oh, okay, hold on. It's just they're taking a really long time to change. Then you come in, evaluate them. I let them know we're also going to get you on the table and do a hands on evaluation and some treatment. I don't promise a lot of treatment the first visit. It's usually mostly still evaluative type of hands on because we still don't know exactly what's going on we're looking for. Can we reproduce the symptoms? Can we ease the symptoms? Can we find the place that the patient is reporting is the problem. I was going to say complaining because people say complaining. Complaining is when you look at that word, the way we use some words, it's not a very nice word to use for people. It's like, oh, they were complaining. I'm not complaining about it. I was telling you it hurt. So where they're hurting are the affected side, the affected area. We won't be able to find that and touch that. Whether we can reproduce it during movement or pressing on it, we take it away or make it worse. That's one of the ways that we know we can help people. And so I let them know that like this is what my goal is. Can I make you hurt more? Can I reproduce the symptoms? Can I make you hurt less? If I can make them hurt more, my goal isn't to make them hurt more all the time, but it's like if you move and it reproduces the symptoms. And it actually hurts a little bit more than when you're sitting here. And then we know the pain is malleable, and it's something that we can change. And we just have to then, with our treatment approach, find a way to get it less and less rather than make it more and more over time. It's not a no pain, no gain type of treatment that we do here. And so that leads me to the next one is as I'm starting to touch patients and treat them, I always let them know that. So what do I say? I say, you know, as we're getting into the treatment, because I'll start with some poking and prodding. I mean, really, I'm just like, pressing gently. And I ask, is this where it hurts? Is this it? Or can you point to the area? And they'll point and fish around for it. And I'll say, okay, let me see if I can find it. And let me know when it. When I find the right spot. And as I press and palpate, it will. If we can reproduce the symptoms or press or touch it, they'll say, yes, okay. And I'll say, great. So as I'm starting, I'll come back to that area. So if that's the most important area, like my back hurts, I'm going to say, look, I'm going to come back to that. Let me go look at some other areas. We'll look at the other areas, too and see, oh, does that reproduce the symptoms or not? Does it actually hurt or not? Is it short or not? And we'll learn that in our evaluation. And as I move into treatment, what I tell people is that what I'm doing doesn't have to hurt to work. A lot of times you won't feel what I'm doing because it's a very gentle, light type of treatment. But you should feel some therapeutic pain. Or I'll start like this. I'll say, okay, we found where it hurts. And I'll start with my treatment doing something a little bit gentle. And I'll say, as I'm treating you, you may feel some therapeutic pain. Therapeutic pain should feel like a burn, a pull, tight, tender. It's reproducing the symptoms, it's relieving the symptoms, maybe even making them a little stronger. But it should feel good. It should feel like, oh, yeah, that's what I need. That's the spot. It should feel like, you know, we're in the place that, you know, is the right spot. If it. And I'll tell people, say, if it doesn't feel right, I need you to let me know. And if for any reason, something you have any sharp shooting pain or pinching, I want you to let me know. And then I say, if this doesn't feel right and you want me to stop, say halt. Because if you say halt, I'll stop what I'm doing. But if you say, ouch, that hurts, or that's it, or oh my gosh, that feels so good, or that's a good spot that hurts, I'm going to keep working because what I want is feedback from you as to what hurts, what makes it feel better. If you're feeling it somewhere else in your body, sometimes when you feel it somewhere else in your body, that's a place that we also need to treat, and that's your body telling us where else we need to look and see if there's a problem there, dysfunction or tissue or restriction or a place that needs some treatment. I also tell people to let me know if they feel it other places in their body because I want them to be paying attention to me, what I'm doing, what I'm treating. If someone says, what are you doing? Especially if I'm using a light technique, I say, well, some of the techniques are really light and gentle, and it might not feel like I'm doing anything at all. A lot of times I'll put that statement in earlier. It doesn't have to hurt to work. And I want you to, you know, if someone says, what are you doing? I'll say, what does it feel like I'm doing? And they might say nothing, because they're all up in their head and not in their body. So what I'll say to them then is, okay, close your eyes. Or if they're face down, you know, I'll say, just focus where you feel my hands. Focus on the sensations that you feel there. And then if you feel something that feels tight, tender, hard, I want you to breathe into it. And so as I'm treating patients, I'm trying to get them to bring their focus to where we're working as well and set them up for an expectation that it doesn't have to hurt. Like, I don't have to barrel my elbow in to you to get it to feel better. It doesn't have to hurt for days for it to feel better. It's not a no pain, no gain type of treatment. And then I also tell people, as they're getting relaxed, sometimes you might feel this in other places. Sometimes you might feel muscles twitch or like you need to move or there's some spontaneous movement in your body or that you need to change positions to get more comfortable. Just feel free to do that. You know, it's. You don't need to apologize to me. Just move if you feel uncomfortable or move if you feel like you need to move or change positions. Because comfort is our. The main thing that we want people and the ability to move and do whatever they need to do. Sometimes as you're treating, you will see some spontaneous movement, some shaking, some twitching. You'll get a. The trigger point response. The, you know, other parts of body will move or let go as people are like, quieting down and softening and relaxing. And that's really important for people. So that's how I introduce my treatments. And if you have any questions, fill in the blanks. Try not to be overly. You don't want to be threatening to them with the language we use. So just be mindful of that. And we want to be impact. We want to empower our patients to do what they need to do to let go.
