What to Do When You Don’t Know What’s Causing Your Patient’s Symptoms

Every physical therapist encounters situations where the source of a patient’s symptoms is unclear. These moments can feel intimidating, especially early in your career. However, with the right strategies, you can navigate these challenges effectively while maintaining your patient’s trust and progressing toward their goals.

Here’s how to handle three common scenarios:

1. Communicating When You Don’t Know

First and foremost, it’s okay to admit when you don’t know the exact cause of your patient’s symptoms. What matters is how you communicate this uncertainty.

Instead of saying, “I don’t know,” in isolation, frame your response in a way that builds confidence and trust. For example:

1. Educate the Patient: Explain common clinical findings for similar conditions and why their symptoms don’t perfectly align with these patterns.

2. Outline Your Plan: Clearly describe your approach to addressing their symptoms and emphasize your commitment to their care.

Here’s an example:

“Your symptoms don’t exactly match the patterns we typically see with [Condition A] or [Condition B]. However, we have a good starting point, and I’m going to work with you to explore what’s most effective. Here’s our plan for today, and we’ll adjust as we learn more from your body’s responses.”

This approach reassures the patient that they’re in capable hands and fosters collaboration.

2. When Symptoms Can’t Be Recreated

Sometimes, despite a thorough evaluation, you won’t be able to reproduce a patient’s symptoms. This is common and doesn’t mean you can’t help them. Here’s what to do:

• Make an Educated Guess: Based on the patient’s subjective description and history and your objective findings, choose the diagnosis that most closely matches their symptoms.

• Treat Accordingly: Begin with a treatment plan tailored to that diagnosis and monitor their response closely.

For example:

A patient presents with low back pain after bending and lifting, but shows no positive signs on tests like slump or straight leg raise. In this case, you might treat for disc pathology based on the history and mechanism of injury, even without confirming objective findings upon examination. Adjust as needed based on their response to this initial approach.

3. When Multiple Areas Trigger Symptoms

Patients often present with symptoms that seem to involve multiple areas, making it difficult to pinpoint the primary source. For instance, shoulder pain might be exacerbated by both neck and shoulder movements.

In such cases:

• Treat Both Areas: Address each region contributing to the symptoms. For example, you might combine cervical spine mobilizations with shoulder-focused treatment.

• Reassess: After the initial treatment, recheck the patient’s symptoms to determine what’s helping. This iterative process helps you refine your approach and focus on the most effective interventions.

When All Else Fails

If symptoms persist despite targeted treatments:

• Focus on Impairments: Shift your attention to general impairments like range of motion, strength, and flexibility.

• Strengthen Symptomatically: Use strengthening or conditioning of the affected joint as a last effort before considering referral.

This comprehensive approach ensures you’ve exhausted all reasonable avenues before recommending further medical evaluation or interventions.

The Big Picture

Not knowing the exact cause of a patient’s symptoms is entirely normal. Even the most experienced clinicians and specialists encounter uncertainty. What sets effective therapists apart is their ability to:

• Communicate honestly and confidently.

• Develop and adjust treatment plans based on patient responses.

• Stay committed to the patient’s goals and relief.

With practice, these strategies will become second nature, enabling you to approach even the most perplexing cases with clarity and confidence.