Written By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

Owner: Healthy Aging Physical Therapy

"PIVOT! PIVOT!"

Lately, my kids have been watching Friends from the beginning, and as a ’90s girl myself, it’s been a total nostalgia trip. The quotes, the scenes, the moments that were so ingrained in my younger years are suddenly playing in the background of my house again. And of course, one of my all-time favorites - and probably yours too - is the Pivot scene.

You know the one. Ross, Chandler, and Rachel are attempting to move a couch up a narrow staircase, and as they get wedged in the corner, Ross repeatedly shouts "PIVOT! PIVOT!" in sheer desperation. The couch, of course, is going nowhere.

And as hilarious as that scene is, it also got me thinking - sometimes in life, we feel just as stuck. Whether it’s our health, our habits, our work, or something deeply personal, we often find ourselves wedged in a corner, unsure how to move forward. But just like Ross (though hopefully with a little more success), the solution is often simple: We have to pivot.

Why Pivoting is Essential

We tend to believe that change is impossible or overwhelming. Maybe it’s because we see others seemingly doing so much better, or because we’ve tried before and failed. Maybe we tell ourselves the odds are stacked against us.

But here’s the thing: we don’t have to see the climb the whole staircase - we just have to take the first step.

A pivot isn’t about a massive overhaul. It’s not about solving everything at once. It’s about shifting direction just enough to create momentum. And once we start moving, it becomes easier to make the next best choice, climb that next step - make our way towards the top.

Getting Patients to Pivot

As physical and occupational therapists, the hardest thing we face isn’t learning the latest new technique or mastering clinical documentation. It’s getting our patients to make changes - getting them to pivot toward better health.

We all know how easy it is to get stuck. We get set in our habits, convinced that things are unchangeable, too difficult, or simply not worth the effort. Our patients often feel the same way. When we encourage them to move more, to push past their comfort zones, or to try a new approach to managing pain, we’re often met with resistance. And honestly? We get it. Change is hard. But change is also necessary.

The key is not expecting someone to change everything all at once - it’s helping them take just one step. They don’t need to see the whole staircase. They just need to find where they can pivot in a way that makes sense for their life and circumstances.

How the Therapy Profession Has Pivoted

The role of the physical and occupational therapist has changed dramatically over the years. When I, and many of my colleagues, went to school, therapy education was focused on fixing. The emphasis was on what we, the clinician, could do to the patient - through our hands, through mobilization, through guiding patients through movement patterns. Most of the continuing education available after graduation were in specific manual therapy techniques or skilled handling techniques - designed to help people recover movement after an injury or a stroke. We were trained to believe that if we just applied the right technique, the body would heal.

But then science evolved. And guess what? It turns out, long-term improvements in movement, strength, or in pain reduction don’t come from what we do to a patient. They come from what the patient does for themselves.

The research is clear: Passive interventions - where the clinician is doing all the work - do not lead to long-term improvements in pain or function. What does work? Movement. Nutrition. Stress Management. Sleep. The things we put into our bodies. The activities we do with them. The rest we need to make sure that they get. And most importantly - the habits we build and maintain.

So, as science has changed, so have we. The field of rehabilitation has had to pivot. And as individual therapists, we’ve had to pivot with it. Because it doesn’t help anyone to keep doing the same thing that doesn’t work (isn’t that the definition of insanity?).

We've had to shift from focusing on what we can do to a patient to what we can empower a patient to do for themselves.

And science supports this shift - research like the OPTIMAL Theory (Wulf & Lewthwaite, 2016) highlights that people improve more when they:

Believe they can improve (Enhanced Expectancies). Patients need to experience small wins to build confidence in their ability to change.
Have control over their choices (Autonomy Support). When patients feel like they have control over their own care (rather than being told what to do), they are more likely to follow through.
Focus on meaningful goals (External Focus of Attention). Instead of instructing a patient to “activate their glutes,” we might tell them to “push the floor away” or “root down and rise up, like a tree.”

It turns out, progress isn’t just about prescribing the perfect exercise - it’s about creating the right conditions for motivation, autonomy, and confidence to grow.

This is why Healthy Aging Physical Therapy does things differently.

How We Help Patients Pivot Toward Better Health

At Healthy Aging Physical Therapy, we don’t set goals for our patients - we set them with our patients.

✔️ Every patient fills out a self-assessment survey to help them identify what truly matters in their daily life.
✔️ We don’t just hand out exercises; we help our patients work through barriers that might get in the way of making lasting change.
✔️ We recognize that every patient is a whole person - not just a broken arm or a leg, or a back in pain. Every patient has a personal history, experiences, and individual challenges that impact their health and their sense of self-efficacy - or lack of it.
✔️ We take the time to understand our patients - their goals, their fears, and what drives them - because we know that real progress only happens when it’s meaningful to the person doing the work.

And let’s be honest - it’s not all unicorns and rainbows. We work with older adults. Many of them have 80+ years of experience, opinion, and habits that are sitting right there with them. That’s a lot of lived experience to navigate! But that’s why we take the time to build trust, to have real conversations, and to help our patients figure out where they can pivot to make the next best choice for themselves.

Final Thoughts: The Power of Small Shifts

At the end of the day, therapy (just like life) isn’t about finding a magic fix - it’s about making small, meaningful shifts in the right direction.

The next time you feel stuck - whether in your health, your career, or your personal life - channel your inner Ross Geller. Take a deep breath, assess the situation, and find your next best move.

Just remember: you don’t have to move the whole couch at once. You just have to pivot.

PIVOT! The Key to Moving Forward in Health, Wellness, and Life