Beyond the Treatment Table: Navigating the Unique Challenges of Being a Therapist and Battling Burnout

Jul 4

Dear Colleagues,

We began this journey, out of personal interest in injury rehab from our own injury experience, or an intense drive to help others alleviate pain, and empower individuals to reclaim their physical lives. Whatever the reason we entered this profession and the privilege of guiding patients through rehabilitation, witnessing their progress, and celebrating their return to functional life is truly one of the most rewarding aspects of our profession. Yet, beneath the surface of our vital work, lies a distinct set of challenges that, if unaddressed, can lead to the unrelenting exhaustion we know as burnout.

As a clinical Athletic Therapist, when I first began seeing patients, three appointments in a row was my max. If I treated hip pain, back pain, and elbow pain, I went home with hip pain, back pain, and elbow pain. As a young therapist, I felt like I gave part of myself to each patient because that was the level of care they deserved. The empathy we put out is real and sometimes it feels almost palpable - Ha! Palpable!

For physical rehab professionals, our work extends far beyond the hands-on session. It's physically, mentally, and emotionally demanding and requires physical and emotional stamina and resilience.

Today, I want to frankly acknowledge some of the primary stressors that make us particularly susceptible to burnout:

The Physical Demands:

Although movement is good, I believe we often overlook how significant this contributes to fatigue:

Providing consistent manual therapy, mobilizations, and soft tissue work is physically taxing, often leading to wrist, hand, back, and shoulder strain over time.
We are constantly bending, lifting, demonstrating exercises, and sometimes in awkward positions to treat effectively (acupuncturing upside-down comes to mind!).
Performing similar movements repeatedly throughout the day can lead to cumulative stress on our own bodies. I personally have dealt with bad tendinopathies in my wrist extensors from performing fascial work year after year.

The Mental Load and Cognitive Strain

It may not appear this way on the outside, but our work is very intellectual and requires continuous critical thinking:

Each patient presents a unique biomechanical puzzle, demanding meticulous assessment, differential diagnosis, and tailored treatment planning.
Designing and continually adapting progressive exercise programs that are both effective and safe for diverse conditions requires constant creativity and problem-solving.
Navigating intricate ethical considerations, managing patient expectations, and ensuring best practice are continuous responsibilities.
Beyond direct patient contact, a significant portion of our day is spent on comprehensive charting, communicating with other healthcare providers, professional development, and administrative tasks, often extending beyond clinic hours.

Emotion and Compassion Fatigue

While I can’t speak for every therapist, I feel our empathetic connection with patients, while essential, comes at a cost:

Constantly supporting individuals through chronic pain, disability, and sometimes slow recovery processes can be emotionally draining.
Patients often look to us for quick fixes, creating pressure to deliver rapid results, even for complex or long-standing issues. Setting patient expectations is vital to their commitment but that also takes a bit of a dance to navigate.
Repeated exposure to people suffering, frustration, and limitations can lead to our erosion of empathy and emotional exhaustion.

The Pressure of Productivity and Caseloads

Many clinical settings place significant emphasis on productivity targets, adding another layer of stress. In addition, some of us feel the overall stress of making commercial rent with other operational bills month over month:

The pressure to see high volumes of patients with limited time for each can compromise thoroughness and increase therapist stress.
The constant challenge of delivering high-quality, patient-centered care while meeting productivity metrics is an ever present dichotomy.

Recognizing the Signs of Burnout in Ourselves

Burnout for us isn't just physical tiredness; it's a profound state of emotional, physical, and mental exhaustion stemming from chronic occupational stress. It can manifest in ways we might recognize in our patients, but it's happening to us:

Physical Exhaustion: Persistent fatigue, aches, and pains that don't resolve with rest, frequent illness.
Emotional Draining: Feeling depleted, apathetic, and emotionally detached from patient stories.
Cynicism & Depersonalization: Developing a detached, less compassionate, or even cynical attitude towards patients or the profession itself.
Reduced Sense of Professional Accomplishment: Feeling ineffective, questioning your skills, or feeling that your efforts are futile.
Irritability & Resentment: Short temper with colleagues or patients, feeling easily annoyed.
Diminished Engagement: Losing enthusiasm for learning new techniques or participating in clinic activities.

I feel alright sharing that I have personally struggled with all of these and on more than one occasion.

Building Resilience: Strategies for a Sustainable Practice

Preventing and actively addressing burnout is not a luxury; it's an ethical and professional imperative to maintain our capacity to provide effective, compassionate, and safe care. Many people in our clinic have heard me say, “What kind of a healthcare provider am I if I do not take care of myself? If I am out of commission, who am I helping then?!”

Here are a few strategies that I hope you find helpful:

Prioritize Your Own Physical Health: Just as we prescribe exercise, movement, and posture we must practice what we preach. Regular exercise, proper body mechanics during treatment, stretching, and adequate rest are non-negotiable.
I often see therapists on a roller in our clinic or doing stretches - that makes me so happy!!
Seek Regular Supervision and Peer Consultation: This is crucial. Debriefing challenging cases, discussing complex patient presentations, and gaining objective feedback from trusted colleagues or a supervisor provides an invaluable outlet and prevents isolation.
14 years into practice and I still do this. Ask Athletic Therapist, Ashley Burr!
Set and Maintain Firm Boundaries: Protect your personal time. Manage your caseload strategically, learn to say "no" when necessary, and ensure a clear distinction between your work and personal life. Your time off is sacred for recharging.
I personally struggle with this one.
Invest in Your Professional Development (Wisely): Choose courses that genuinely excite you and align with your interests, rather than just chasing new techniques or trying to feel confident in your practice.
I have learned that taking continuing education will never alleviate the imposter syndrome. Only experience does that. You can be an effective therapist when you become proficient at those base tools and I always recommend getting good at your base skills first and then expand, otherwise you are just so-so with all your skills.
Cultivate a Supportive Network: Connect with other therapists. Sharing experiences, challenges, and successes with peers who truly understand the demands of our job is incredibly validating and supportive.
Embrace Realistic Expectations (for yourself and patients): Acknowledge that you cannot "fix" every patient, and progress is often slow and non-linear. Celebrate small victories for both yourself and your patients, and focus on empowering rather than curing.
Practice Self-Compassion: Treat yourself with the same empathy and understanding you offer your patients. Recognize your efforts and accept that you are human, not a superhuman healer.

The life of a physical rehab professional is uniquely challenging, yet profoundly impactful. Recognizing the inherent demands of our career is the first step and then proactively investing in physical self-care, regular support from colleagues, and healthy boundaries, can create long-term overall health. Prioritizing your own well-being isn't selfish; it's the cornerstone of effective and enduring practice. In other words, if your ship sinks, it takes everyone down with it, so prioritize your personal health and keep that ship sailing!

Learn more about Nikki

Nikki Smith