Episode 10: Your Physical Therapist Knows Things You Don’t

For an orthopedic surgeon, the operation may be the most technically demanding part of a patient’s treatment.

It is not necessarily the part that determines how the patient experiences recovery.

A surgeon may see a postoperative patient three or four times. The physical therapist may see that same patient 20 or more times. They see the frustration, the fear, the small gains, the setbacks, and the questions a patient may never bring back to the surgeon.

That makes the relationship between surgeon and physical therapist much more than a handoff.

In this episode of Healthcare Unscripted, Dr. Hunter Greene sits down with physical therapist Tony Mikla, who has more than two decades of experience working with athletes and orthopedic patients. Their conversation centers on something particularly important for young surgeons: how to work with an experienced physical therapist as a real clinical partner.

The Patient Is Recovering From More Than a Procedure

Tony starts with a simple observation: patients generally arrive in physical therapy because they have lost something.

Maybe it is the ability to compete. Maybe it is running, playing with their children, or participating in a team. Maybe it is simply moving without pain.

The injury and surgery matter, but the patient’s real goal is getting that part of life back.

That changes the role of rehabilitation.

A good physical therapist is not simply moving a patient through exercises. They are trying to understand who that patient is, what they want to return to, and what needs to happen to get them there.

That also means much of recovery is psychological. Patients have often never been through a major orthopedic surgery before. They do not know what normal soreness feels like. They do not know whether they are ahead, behind, or exactly where they should be. They may interpret one difficult week as evidence that something has gone wrong.

The therapist is there repeatedly through that uncertainty. For the surgeon, that is an enormous clinical resource.

A Protocol Is a Framework, Not a Cookbook

Postoperative protocols matter. But patients do not progress in identical increments simply because the calendar says they should.

Tony points out that a patient who is technically six weeks out from an ACL reconstruction may clinically look more like a four-week patient or an eight-week patient. A therapist who simply follows the protocol without evaluating the person in front of them is missing the point.

Dr. Greene sees that distinction as particularly important for young surgeons learning which therapists they trust.

The protocol establishes boundaries and expected timelines. The therapist provides the ongoing judgment inside those boundaries.

And the surgeon has information the therapist may not have. A rotator cuff repair is not simply “a rotator cuff repair.” Tissue quality, fixation, patient age, the location and nature of the repair, and how confident the surgeon felt intraoperatively may all change how aggressively rehabilitation should progress.

That information needs to make it across the operating room door.

Communication Is Part of the Treatment

A surgeon completes the procedure. A therapist may spend the next six to nine months helping the patient regain function.

Those are not separate episodes of care. They are one recovery.

Dr. Greene and Tony repeatedly return to communication because both sides hold information the other needs. The surgeon knows exactly what happened in the operating room. The therapist sees how that repair behaves over time and how the patient is actually progressing between postoperative visits.

Sometimes the therapist also hears things the surgeon does not. Patients may admit that they did something they were not supposed to do. They may disclose symptoms they are embarrassed to mention at a surgical follow-up. They may simply be more candid with someone they see several times every week.

That creates another reason for the surgeon-therapist relationship to remain open. The therapist may provide an early signal that the patient is struggling, progressing unexpectedly, or worried about something that needs the surgeon’s attention.

Your Therapist Can Teach You Something

Young surgeons understandably enter practice with extensive technical training. That does not mean they have seen every version of recovery.

An experienced physical therapist may have watched hundreds of patients progress through the same procedure. They know what six weeks often looks like. They recognize patterns. They know which patients tend to get anxious at a particular stage and which problems deserve a phone call.

Dr. Greene specifically points to the value of veteran therapists for young surgeons. When he was beginning to perform hip arthroscopy, postoperative protocols themselves were still evolving. Working with experienced therapists was part of figuring out what actually worked as those procedures developed.

That requires a certain kind of confidence from the surgeon: Not less expertise, but enough confidence to recognize expertise somewhere else.

Patients Remember Communication

Tony has another unusual vantage point: physical therapists hear what patients say about their surgeons after they leave the surgeon’s office.

And according to him, most of what separates the positive experiences from the negative ones comes back to communication. Patients want access. They want follow-up. They want someone to look at them, listen to what they are trying to return to, and explain what happens next.

Trust is built through both empathy and authority. Patients need to feel that their clinician understands their life and their goals. They also need confidence that the person guiding them has seen this before and has a credible plan. Tony describes that combination of listening, education, and clinical authority as the basis of trust.

Technical excellence matters. But from the patient’s side of the exam table, technical excellence they cannot understand or access can be difficult to distinguish from indifference.

The Surgeon Does Not Own the Recovery

One of the most useful lessons for an early-career orthopedic surgeon may be recognizing that a successful recovery is inherently collaborative.

• The surgeon knows the operation.
• The physical therapist knows the rehabilitation process and sees the patient repeatedly as it unfolds.
• The patient knows what they are trying to get back to.

When those three perspectives stay connected, the protocol becomes more intelligent, expectations become clearer, and problems are more likely to surface early.

“An experienced physical therapist is not simply the person carrying out postoperative instructions. They are another set of experienced eyes on your patient.”

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