The Importance of Ongoing Consent in Physical Therapy: Your Body, Your Choice

During the training to become a Physiotherapist, one of the first lessons we learn is about ethics, which includes the crucial issue of consent. Let me share a recent experience that really brought home the importance of this topic.

Yesterday, I was working with a client who shared a recent body work appointment she had attended. The client mentioned that her pain had become more intense and spread throughout her body during and after the session. It's not uncommon for pain to shift or temporarily increase after bodywork, typically improving within 48 hours. However, in this case, the pain had significantly worsened during the session, and the provider told her, "I need to do this, just breathe." Have you ever tried to breathe normally while experiencing intense pain? It's incredibly challenging.

My client explained that she had to use deep, labor-like breathing to tolerate the discomfort. She assumed the pain was supposed to happen because the therapist didn't communicate otherwise. This situation left me feeling saddened and prompted me to explain that effective communication and continuous consent are paramount during any treatment. Pain levels should never exceed your level of comfort or tolerance, you should never feel like you are being forced to endure.

What is Consent?

Consent is not a one-time event; it's an active, ongoing process. Signing a form doesn't mean you've surrendered your rights or your ability to choose and question what’s happening to you. If a practitioner can't explain why they're doing something, how can you genuinely give your consent?  Consent needs to be informed.

The Role of Consent Before, During, and After Treatment

• Before/Initial Session:

It’s important to understand why your information is being collected, where it will be stored, and who will have access to it. Your therapist should review any risks involved, the benefits, and what to expect both during and after the session. Even during the intial history taking, if you are uncomfortable with sitting, you should be given options for how you can sit, stand, or lay down based on your comfort level. 

• During the Session:

Consent should always be informed and ongoing.  If you’re uncomfortable at any point, you have the right to ask for adjustments. Whether it’s another pillow, a different position, or adjusting the headrest, your comfort should always be a priority. Communication is key—practitioners should continuously check in with you, especially before touching sensitive areas like your neck, chest, or pelvis.  There should be communication about whether you are comfortable exposing the area to be treated vs. being told.

• After the Session:

After the session, it’s important to communicate how you’re feeling. How are you feeling now that you are sitting up? Do you need some time to sit in the waiting room? Your well-being continues to be important even after the treatment has concluded.

Real-Life Example

Imagine you are receiving body work and the therapist starts working on your neck. If your eyes are closed, they should still inform you of their actions. If your eyes are open, they should check if you're comfortable with what they’re doing. If they notice an issue with your mid-back during a neck assessment, they should discuss this with you, explain why they might want to work on that area, and ask for your consent before proceeding.

Your Rights and Personal Power

This is your body and your choice. You deserve clear explanations, open communication, forewarning of any actions, regular check-ins, and ample opportunity to ask questions. Don’t hesitate to speak up if something doesn’t feel right. Your comfort and consent are not just a formality—they are fundamental rights that should be respected at all times.

In conclusion, ongoing consent is an integral part of ethical and effective physical therapy. It ensures that you, as a client, are always in control and comfortable with your treatment. Remember, it’s your body, and you have the right to make informed choices about your care every step of the way.

Click this link to read about the Informed Consent Standards for Physical Therapists in British Columbia.

If you have any questions or feedback, please email me at hello@vibrantsol.ca.

To book a Holistic Physiotherapy session, please click here.