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  • What Went Wrong? A Case Study of Patient Injury During Physical Therapy Session

    A patient injures herself during a physical therapy session. What happens next?

    The patient faces a longer recovery time, of course. And depending on the physical therapist's (PT's) approach to risk management, the PT could be facing a potentially costly and career-damaging malpractice claim that might have been avoided.

    The latest case study (.pdf) now available from Healthcare Providers Service Organization (HPSO) recounts the story of a self-employed contract PT working at a rehabilitation facility. His patient, a 49-year-old woman, is recovering from a hit-and-run accident that resulted in a vertebrae fracture, a wrist fracture, and a crushed spine. She's morbidly obese, a heavy smoker, and takes prednisone.

    Five months into treatment, the patient is injured during a physical therapy session. She files a malpractice claim against the PT.

    Could the injury have been avoided? Was the exercise she was performing at the time of the injury set up and monitored correctly? Was the exercise itself evidence-based? And what other elements of the PT's practice are likely to be exposed in mediation or a court hearing? The HPSO case study lays out the facts.

    "Case studies like these are a reminder for PTs that risk management is not just a part of practice, but a professional responsibility," said Nancy White, PT, DPT, OCS, APTA executive vice president of professional affairs. "Things can and do go wrong, but a PT who fully understands risk is better able to protect the patient, which in turn protects the PT."

    The latest case study joins a series of case studies available at the HPSO website. HPSO is the official provider of professional liability insurance for APTA members. For further information visit www.hpso.com/APTA.


    • Nobody can keep up with all the evidence all the time, especially given the wide scope of our practice. Any advice how to obtain evidence based information?

      Posted by Patricia Becker on 4/30/2015 12:02 PM

    • My question is this and has nothing to do with the injury. What is my ability/liability to refuse to treat a morbidly obese smoker that is in this condition, will not progress well, and has secondary gain in several facets of her presentation?

      Posted by jeff on 4/30/2015 2:39 PM

    • This article is very eye opening. I learned that no matter what there is no substitute than having liability insurance because there are so many things that could happen. For example, as was stated in this article, there is the possibility of having a patient who is prone to injury and although it couldn't have been avoided there is still legal mitigation that must take place. Thanks for teaching us of the importance of malpractice insurance.

      Posted by Blakeley Southern on 6/26/2015 6:52 PM

    • I am a high school student and I feel that the physical therapists should have watched the patient more carefully because she was obese. At the same time the therapists could've been watching her and she may have twisted or turned a wrong way. There are always two sides to a story and after reading this I only see one side and that is the patients side.

      Posted by Sha'Nise Gibson on 5/11/2016 4:58 PM

    • I have prostate cancer I enter this study at the VA and now they tell me I have a mass over my heart and now they want to check my lungs for cancer when I went into the study my PSA was going down and I fell pretty good

      Posted by Craig Johnson on 5/18/2016 11:24 PM

    • I suffered an injury at work and due to the paperwork and the other aspects that come with the given circumstance I had to wait almost 7 months until I was able to start therapy. An 8 week program that I really enjoyed and saw progress in my injury to the point I believed I would get an early release date. I was introduced to a more intense program in which some of the excersises were too much but I trusted their expertice because I saw improvement, second day into this I injured myself slightly above the area I originally hurt and then the next 5 weeks have been hell since they keep telling me that is normal and that I can't worry about it too much because it is a flare up. I keep trying to make them acknowledge that something happened and that this should be treated as an injury not just a flare up but they are trying to convince me that I am stronger in other areas. But the feeling and pain are similar to the 3-4 month of my injury.

      Posted by nick arias on 11/2/2016 8:19 AM

    • My situation is that a psycial therapist had me strath my foot off of a wooden block at least 3 times a week She had me put top of my foot on the block and hang off the block with my full body weight several times a week When I was finished with the 90 day program I went to a foot doctor who sent me for an MRI of my foot witch showed a tear in the ligament of my foot right down the middle of my foot from top to heal I am in terrible pain not able to walk without horrible pain I need to address this

      Posted by Deanna Royce on 5/15/2017 5:01 PM

    • I had a upper back muscle spasm as explained by a doctor and suggested a physical therapist. I went to the physical therapist and he did a physical maneuver and heard a squish sound from my neck. I sat up after the maneuver only to have a sever pain in my right arm, tingling and senselessness in my right palm. The therapist then laid me on a neck tracktion bench with a pillow over my right arm. I went to my family doctor as the pain is now effecting different regions (arm) and along with upper back pain I have neck pain and even more limited neck rotation! The family doctor suggested Mri and with the results conveyed my right arm pain is due to neck herniated disc pinching nerves.

      Posted by Sumanth Maganti on 5/19/2017 10:38 AM

    • A PT Punched me in my arm twice during therapy...I am a female and had just been in an head on collision two weeks prior, Before the accident I was very fit...the pt saw my arms and punched me twice in my arm when i didn't expect it. I now have tingling shooting down my arm, I grabbed my arm and asked him "what are you doing ...that hurts stop it..he acted surprised as if he didnt know that that would hurt me,,I don't know how to deal with this,,,HELP

      Posted by Renee Thomas on 5/27/2018 1:12 AM

    • Was going to a great physical therapist for shoulder and tricep tears. While lifting a weight during rotation i tore my bicep. I trusted them when they said the pain was normal. But it got worse. I quit going after mri showed a new tear. I dont blame them. But now workers comp is pressuring me to go back into physical therapy when i am in severe pain and i am hesitant to do so.

      Posted by Cindy Webster on 5/27/2018 7:23 PM

    • I lost my legs as a baby im 45 now. I had major elbow surgery on tendons n a nerve. Was goin thru therapy and was feeling great. Got to last week of therapy. My palm wont go all the way palm up so he grabbed my hand and put fingers of his other hand around my radual bone at elbow and forced my hand palm up. My elbow and wrist popped and i cant weight bear. Hurts worse than the b4 the surgery i just had. Mri shows ulnar collateral and lateral collateral ligaments torn in elbow and tfcc tear in wrist. I have to have more surgery now. Its hard moving when you dont have legs. Now im back to 1 arm n no legs. Im lookin for a lawyer in illinois now

      Posted by Carl Vollbracht on 8/28/2018 1:14 PM

    • I was left on a lumbar traction machine for an extended period of time causing a re-injury to my lower back and new injury and symptoms to date. Can traction machines cause these damages?

      Posted by Brenda on 10/16/2018 11:16 PM

    • I was put in a mechanical traction table for lumbar. He put me in at 70# alternating for 15 min. I was only instructed to relax and push a red button if I felt any pain. my body kept slipping and the weight would pull more each time. When the PT asked how I was doing I told him I was feeling strange pulling and twisting sensations in my upper back. I even asked if this was normal. he said "no". He asked again if there was any pain. I didn't have any pain, I told him, only the pulling and twisting in certain areas and that these sensations made me feel nervous. He said as long as there was no pain that he thought it was fine. Because I didn't know better and I thought it must be normal, I didn't tell him about how the machine would pull me then stop, then my body would slip down and the machine would pull until it stopped again and then my body would slip again and this repeated multiple times. I had another PT stop the traction 5 min. early because I needed to use the restroom. Immediately after getting up I was in excruciating pain in my upper body. Ice was next I was told and I sat at a couch and picked up a magazine. The first thing I noticed was that I couldn't hold the magazine up due to the pain. I left without ice. I couldn't hold my arms up to drive either. That was on 4/19/18. I could not use my arms at all and could only tolerate being carefully propped up in bed or in a recliner for the next month. The following 4 months I could only tolerate walking or sitting in a normal chair for only 10 minutes tops. It is now 6 1/2 months later and I am still very hurt, unable to walk my dogs, do housework, travel, sit in a normal chair for more than a short time (I still require a recliner with upper body and neck support 90 percent of the day ) or anything of importance to me. The worst part is that when my doctor office called to ask why I had not followed up with the referral to PT, I explained I had done home excersise and I was not in pain anymore. They told me to go anyways because if the pain returned my insurance wouldn't approve imaging unless I did PT first. Why was I put in traction when I reported to everyone that I was no longer in pain is confusing to me. Who is monitoring this dangerous practice. My daily life is nothing but pain now and the quality of my life is severely diminished. An MRI only showed two slipped disc. one at the base of my neck was not there a year ago??? Could traction have caused this? I also cannot tighten my core muscles. I still do not know the extent of the damage done or if I will ever be normal again. I feel like this type of traction is barbaric and should be outlawed.

      Posted by Deanne Tucker on 11/8/2018 5:51 PM

    • I had a massive slap tear and everything was painful but since I have an appointment with the surgeon soon they added more weights 2-3 #'s per day just to make themselves look good. I'm in much worse pain than before. I almost cried the overhead and shoulder height weights. Nobody watches me while I'm doing these exercises. I'm not sure what to do. Please help!

      Posted by Rick Gomez on 11/13/2018 3:09 AM

    • I had shoulder surgery for a tear and other damage to the shoulder. Went to PT and was doing well until who I thought was a therapist pull my arm back until it made a loud popping sound. After that I went down hill and after I complained I found out the person that did this was not a therapist but a assistant. I ended up having to have the shoulder manipulated. Okay went back and another therapist bent my arm back until I couldn't stand the pain and she wouldn't stop so I was screaming at her that hurts she than took my arm and pulled it over my head anyway. She kept saying you have to go passed your pain level and told the assistant sometimes you have to go passed their pain level. The next day I couldn't move because of the pain and the second day couldn't move the shoulder at all. Had to return to my doctor because the pain was so bad. I was sent to another therapist but was told the other PT had use all my therapy time up so now I can't get help to fix my shoulder and remain in constant pain.

      Posted by THELMA Allen on 5/22/2019 9:27 PM

    • Tell you what. Dont worry about malpractice. Worry about us patients showing you what you did to us, on you....

      Posted by You Bet on 6/25/2019 12:33 AM

    • I was in a car accident in which I tore both my shoulder rotator cuffs and tore bicep in rt shoulder. Also, had a labral tear in rt hip and some low back pain . Had surgery to my rt shoulder and was in therapy. Everything was going very well with the healing process. Had mobility back pretty much and was now starting strengthening. One of the new exercises they wanted me to sit on a yoga ball while pulling on the weight machine. I asked if I could do this on a chair? I said I really wasn't comfortable with getting on the ball bc of the hip tear. He said give it a try it is good for the core. I was hesitant, but thought he knew my issues and thought it was all good to do. Idk why I just didn't demand and say NO?? I guess I just wanted to do anything to get me healed?? Well, as I thought the yoga ball was too low for my hip and as I was walking to my car I could feel my hip getting more sore. Just thought it was bc of a muscle being used now that wasn't . Went home and iced. The pain got worse . To the point I can not lift my leg now or walk really. Steps are very difficult now. I am in quite an amount of pain.I was given Prednisone at ER to help but no real relief. I know I've done more damage and need surgery now to correct it . Going for a new MRI on Wed. to see the extent of damage since last MRI done. Do I have a case against the PT facility or does it go against the physical therapist?

      Posted by Jennifer on 7/7/2019 11:21 AM

    • On my 14th physical therapy treatment - I re-injured -partailly tore my quad off the kneecap after doing a sit my butt down and get back up exercise. Duration was 10 minutes! Then walking to next exercise - 5 steps moving! The knee just gave! They checked it out and said it was okay! I iced it and kept a brace on it. Over the next couple days - it got worse! I pushed thru the swelling and made it to the next pt app’t! The therapist had me do light exercises bending my knee and did some electrical muscle therapy. It was decided, I needed to go back to the surgeon! After going for an Iltra Sound- I have 100% tear off the knee cap again! Surgery is scheduled! 14 weeks down the drain! Possibly losing my job! I have freinds telling me to check into a lawyer! What’s your thoughts!

      Posted by Kevin Williams on 7/9/2019 8:59 PM

    • I had been in an air cast for 4 weeks before starting PT to strengthen my ankle after a sprain. I was pain free and able to do all of the exercises and was feeling totally like I was recovering. I finished our session and was ready to leave and she put a sponge down and asked me do do some lunges and walked away. Well I put my bad foot on the sponge and did a few and felt pain... I told her and then she asked what I did and I showed her and she said that I did it wrong. Well now what? I’m back in a boot off of my feet and the pain is worse than before I ever went! Any suggestions?

      Posted by Ann on 9/4/2019 9:57 PM

    • Last year I had a minor muscle strain in the right glut. I came to be treated at physical therapy. My doctor very young assign me exercise program but didn't explain correct. For 2,5 months I had no abdominal exercises at all, and other exercises start compensating with low back - such as clamshels without ab engagement used muscles in the front leg, leg raises balanced with low back and strengthen quad, instead of glut exercises my low back was working. I got serious muscle disbalance between hamstrings and quads, also serious weakness in the abdominal. After about 1 month my upper back start acting up a lot but doctor told me all is good and things with get better. after 2 months of treatment my knees start coming close to each other, and my feet start pronating, my knees hurting. The doctor gave me squads but I could not do it because the knees hurted. He ignored and kept insisting I do squats. I refused. I explained to him I don't feel my gluts working, and I struggle to keep good form anymore, he just ignored and spoke he is a doctor and knows better. I switched a doctor but to the same company who just put me through strengthening, not reversing. She spoke that everything was done correctly I just need small strengthening. However, she was incorrect and guess was just covering for the company. Extremely strengthening just taught my body to be stable using incorrect muscles. I strained my pelvic floor and could not move much. Few months later just was getting worse, constantly falling tripping over my feet, tons of pain. Xrays within months start showing deterioration in the vertebrates. Any attempts to fix it without knowing what went wrong didn't give any results. In fact without appropriate deep abdominal, spinal, and pelvic stability - I developed hurnias in my abdominal wall, and signs of pelvic floor prolapse, flat feet, pain in the knees. And yet a year ago I was dancing and moving a lot. And the reason why I came there was because I lifted a heavy item and pulled a muscle. Now I can barely walk for an hour a day. I can't even leave a review on google for this review to stay, somehow it dissapear after a day. When I spoke with company they didn't even pay attention to what I told them. Just said they think everything was done correct. It's scary to think that for companies we, as patients are nothing. In my case, the doctors choose to hide and harm my body ,instead of admit that exercise was done wrong and fix it. I researched a lot about what our options as patients, but turned out not many.

      Posted by Natalia on 9/7/2019 3:30 PM

    • I'm 66 and I had a massive tear rotator cuff surgery in March 2019. I was into my 3rd month of PT when my therapist told me my tendon was completely healed at 16 weeks so he was going to be more aggressive with PT. He pulled my arm way past what it could take and my shoulder popped. I was in pain 3 weeks after and went for a new MRI which should a complete tear of the same tendon. The recovery was tough and at my age I cannot go through it again. The PT basically crippled my arm.

      Posted by Laurence Wheeler on 10/2/2019 6:47 PM

    • I was injured on 7/3/2018 and I am still unable to work, Shattered my elbow and damaged my shoulder. From the beginning I complained my shoulder hurt the most. I was brushed off by drs and workers comp because I needed radial head (elbow)replacement. In January I demanded to see someone about my shoulder. I saw two drs, the first wanted to do several small repairs and a rotator cuff repair. Workers comp was not convinced and found a dr willing to forgo the rotator cuff repair. Three months after surgery I was doing great, I thought, OK no rotator involvement. The therapist added additional weight and a new routine to strengthen the arm. I'm not sure what happened but each visit my back and arm got worse. I was left to do my routine on my own for the most part. When I convinced them that something was wrong, they immediately transferred me to another facility. I can no long raise my arm out to the side, lift anything, it hurts to breathe and move due to my back. They did something, PT started saying something and the dr cut her off. I see new therapist today and a spine specialist later this week. I'm in more pain than before. Nearly 16 months from date of injury and I'm back at square one. Does no one rally behind the patient? Where has do no harm gone?

      Posted by Theresa Lugo on 10/22/2019 9:46 AM

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