Physical Therapy & Sexual Misconduct: What You Need to Know

An important component of any physical therapy examination or treatment session is touching. Physical therapists often use their hands to examine, mobilize, and perhaps massage your body. Touching may be used to help you understand how to move properly, and it can be a helpful component in getting your muscles contracting the way that your PT wants them to maximize your functional mobility.

But what sort of touching is acceptable in physical therapy, and what if your PT touches you and it feels bad or violates your personal comfort or space? What if you're a PT and a patient makes unwanted or inappropriate advances or comments to you?

Touching in Physical Therapy

Palpation is the act of using the hands to examine a body part. Physical therapists may use palpation techniques during their evaluation to help determine your problem and to find the best treatment for your condition. Touching usually involves direct skin-to-skin contact; your therapist's hands are used to press into your skin to assess your condition.

Your PT may use palpation in various ways, including:

• To investigate for inflammation
• To feel if a muscle is contracting
• To passively move your body during range of motion (ROM) exercises
• To guide your body while you move in various directions
• To help prevent you from falling or to assist you while walking or rising from a bed or chair
• To help you move around in bed during bed mobility training

Sometimes, your injury may require your physical therapist to examine or touch areas of your body that are private or sensitive. This may require that you expose private parts of your body, like your hip or buttocks, and this exposure may make you feel uncomfortable. Add palpation and touching to the mix, and your discomfort with the situation may increase, and this may have a negative effect on your emotions and your overall rehab outcome.

Part of the training to become a physical therapist involves proper patient positioning and draping. This is meant to ensure patient modesty is maintained during your PT evaluation and treatment sessions. Draping techniques may involve using a sheet or towel to prevent unwanted exposure of your body that may make you feel uncomfortable.

Proper palpation and massage techniques are also taught as part of a physical therapy curriculum. This includes making sure that touch is appropriate, and that it is solely directed at assessing and treating specific impairments you may have. Maintaining patient comfort, trust, and safety is paramount when using palpation techniques.

When palpation is done in a professional and therapeutic manner and maintains patient safety and comfort, it is considered appropriate.

What If Your PT's Touch Feels Wrong?

If you are seeing a physical therapist for treatment and you feel like you have experienced inappropriate touching or behaviors, you should take action immediately. Some things you can do may include:

• Talking to your therapist and explaining how the touch is making you feel
• Talking to your therapist's manager or supervisor
• Finding a different physical therapist for your rehab
• Speaking to a hospital representative (if you receive your PT services in the hospital)
• Contacting your state board of physical therapy to report the action

Most often, speaking with your PT is a good option, as many times your PT doesn't realize how his or her palpation is affecting you. By talking about what is going on with your feelings regarding touching, your PT can make adjustments to his or her approach to your care and minimize or eliminate any touching and palpation.

If you feel that your physical therapist has touched you inappropriately and this has violated you sexually, you should contact law enforcement officials. It is never acceptable for a PT, or any other healthcare worker or person, to touch you sexually or in a way that violates your body in a sexual manner. If you feel this has happened, you should protect yourself and contact law enforcement.

What If You Start To Feel Attracted to Your PT Due to Touching?

What if you are going to PT, and you like the palpation and touching? What if this causes positive emotions, and you become attracted to your physical therapist? Acting on these emotions is never acceptable. Your physical therapist may be a nice person, but the therapist-patient relationship must remain friendly and non-sexual. Although you may develop a personal relationship with your PT, this relationship must remain friendly and never romantic or sexual.

If you are having feelings towards your PT and this is becoming a barrier to you concentrating effectively on your rehab, you should probably ask to work with a different therapist. Your physical therapy sessions should always remain professional, and you should remain focused on improving your pain-free mobility.

Inappropriate Behaviors of Patients Against Therapists

Physical therapy is a two-way street. Both you and your physical therapist should be working together as a therapeutic alliance to help improve your pain-free mobility. That means your PT should treat you with respect and dignity, and you should treat your PT the same way.

Many physical therapists report harassing or inappropriate behaviors from their patients. This may include saying inappropriate things or inappropriate or unwanted touching. Inappropriate patient sexual behavior is defined as any verbal or physical act of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which it is carried out. And healthcare providers—like physical therapists—are likely to experience this form of harassment while working.

A recent study published in the Physical Therapy Journal examined the problem of inappropriate patient behaviors towards physical therapists. The researchers surveyed 892 physical therapist professionals and PT students and found that 84 percent of them experienced some sort of inappropriate interaction or behavior from patients over the course of their career. The 12-month prevalence of inappropriate behaviors was 47 percent.

The study found that you are more likely to experience inappropriate patient sexual behaviors if:

• You are a female PT
• You have fewer years of direct patient care
• The patient is male
• You are a PT who works with patients who have cognitive impairments

The authors of the study concluded that there is an extremely high prevalence of inappropriate sexual behavior of patients towards therapists. Increased education for students and professionals, as well as focused workplace policy and support, may be necessary to help mitigate this problem.

As a physical therapist, you must always strive to maintain a professional work and clinical environment. This can be challenging if a patient is acting inappropriately. Addressing these behaviors directly with the patient can help put an end to them. If a patient continues making you feel uncomfortable with inappropriate comments or advances, you should excuse yourself from further care with that patient. Speaking with a supervisor or colleague can be helpful, and discharging the patient from your care may be necessary. The American Physical Therapy Association (APTA) has taken a strong stance against harassment, and resources are available through the association to help PTs navigate and understand this difficult topic.

If you are a patient receiving therapy, be sure to keep your comments and actions professional. You may learn a lot of personal things about your PT while working with him or her, and your therapist may touch you during your assessment or treatment. But you must always keep your relationship with your PT an appropriate and professional one.

Properly Performing Hands-On Techniques

If you are a physical therapist, you can do certain things to properly perform hands-on techniques, and you can help keep your patient's mind at ease while performing your assessments or treatments that require palpation. These may include:

• Always properly positioning and draping your patient to maintain modesty
• Always asking permission to touch or move your patient. (It is your patient's body after all. You should never assume it is acceptable to simply touch, grab, or move your patient without permission.)
• Properly explaining when, where, and why you are touching your patient
• Asking your patient if he or she would like another therapist or healthcare worker present during the palpation portion of the assessment or treatment
• Asking if your patient would prefer to have a therapist of another gender perform any palpation techniques or be present during your examination or treatment

At all times, the patient's feelings should be considered, and an environment where the patient is protected should be created. This may mean refraining from performing palpation or manual techniques and finding alternatives to those techniques if your patient verbalizes discomfort with your prescribed methods and treatments.

A Word From Verywell

One of the benefits of physical therapy is the close bond that may be formed between the therapist and the patient. This bond can help motivate you, and it may help you have a positive physical therapy experience. Sometimes, a caring touch from your therapist is all that is needed to comfort you and help you succeed in PT. 

Sometimes in therapy, palpation and touching are needed to assess and treat your condition. And sometimes, your condition may require that your PT touch you in private or semi-private areas of your body. This touching should always be professional—no exceptions. The behaviors between the PT and the patient must always be friendly and cordial, and never overtly or directly sexual. Understanding appropriate and inappropriate touching and behaviors in the PT clinic can keep you safe and ensure that you have a positive rehabilitation experience with your physical therapist.