Understanding and Managing Power Imbalances

Posted: October 16, 2025

A patient hesitates to ask questions during an appointment. They’re uncomfortable during treatment but feel like they can’t say anything. Eventually they stop coming to physiotherapy all together, even as their pain gets worse.

This scenario is one example of what can happen when the power imbalance between physiotherapist and patient goes unacknowledged and unmanaged – patients hesitate to speak up and care suffers.

In more extreme cases, unmanaged power imbalances can lead to boundary violations and harm to patients.

Physiotherapists hold a position of power in therapeutic relationships with patients. Recognizing this dynamic is essential to providing safe and collaborative care.

In this blog post we’ll explore why power imbalances exist and share strategies for how physiotherapists can share power with patients.

Why Power Imbalances Exist

There is an inherent power imbalance in the physiotherapist-patient relationship because:

The patient depends on the physiotherapist’s knowledge and expertise to help them with their health issues, including reducing pain, returning to work or getting back to activities they enjoy.

The physiotherapist has intimate knowledge of the patient and their challenges.

The patient may be asked to remove clothing and allow the physiotherapist to touch and examine them, which can make someone feel vulnerable.

The physiotherapist may be responsible for completing forms and reports that determine the patient’s access to other services.

Some factors that can lead to an even greater power imbalance:

The patient is in pain or facing a significant loss of function.

The patient has limited choice in the health-care providers they see.

The physiotherapist holds additional power due to race, gender, language or socioeconomic status.

Strategies to Share Power

Reflect on Your Own Power

Your identity – race, gender, education, and more – can influence how patients perceive and interact with you.

If you have more privilege in society, you have a bigger responsibility to manage power imbalances.

Here’s an example of what that might look like in practice. A man physiotherapist recognizes that his woman patient may be uncomfortable being alone in the treatment room with him with the door closed. He asks the patient if she would prefer to leave the door open or he provides the treatment in an open area.

Be mindful of tone, body language, and assumptions. Consider what steps you can take to make patients feel safe and comfortable.

Use tools like the wheel of privilege to deepen your awareness.

Build Collaborative Relationships

A physiotherapist may be an expert on a patient’s condition. But the patient is the expert on their experience of the condition, their values and priorities.

Take extra care to listen to patients and ensure your treatment plan responds to their wants and needs.

Share your clinical reasoning with patients using straightforward language. Make sure these conversations are ongoing throughout your time together.

Most patients don’t have the extensive knowledge of anatomy or body systems that physiotherapists do. But patients are still experts on how they’re feeling and what their goals are.

Make efforts to bridge the knowledge gap so patients can be active participants in their care and have the information they need to make informed decisions. This is also a key component of getting consent.

Prioritize Conversations About Consent

Take time to ensure a patient understands the treatment or assessment you’re proposing.

Make sure you outline the expected benefits and any risks or potential side effects. Go over alternative treatment options and what could happen if the patient chooses not to have treatment.

Answer the patient’s questions and make sure they know they can stop the treatment or assessment at any time.

Continue to check-in with the patient throughout your time together and look for non-verbal cues they might be uncomfortable.

Going Forward

Power imbalances are inherent in physiotherapy – but they don’t have to be harmful. By recognizing your position and taking steps to share power, you create space for safer and more effective care.

What’s one way you can share power in your next patient interaction?