Non-Verbal Communication Behaviors of Physical Therapists During Patient Pain Discussions: Frequency, Patterns, and Associations with Patient Engagement

Background: Non-verbal communication (NVC) constitutes the majority of relational meaning in clinical interactions, yet its specific role in physical therapy encounters — particularly when patients discuss pain — remains understudied. Objective: This study investigated which NVC behaviors physical therapists exhibit most frequently during patient pain discussions, and how these behaviors relate to patient engagement. Methods: A structured observational study was conducted across six physical therapy sessions at a FYZICAL Therapy & Balance Center. Ten non-verbal behaviors were coded on a three-level rubric (weak, moderate, strong): eye contact, nodding, sitting at eye level, posture, physical proximity, personal warmth, leaning forward, concerned facial expression, informative communication, and quiet listening/silence. Results: Quiet listening and informative communication appeared consistently across all six sessions. Eye contact, nodding, and leaning forward were present at moderate-to-strong levels in four or more sessions. Sitting at eye level — though variable — was associated with notably higher patient disclosure during sensitive discussions when it occurred. Conclusions: Several NVC behaviors consistently support patient engagement in physical therapy pain contexts. Clinicians who demonstrate appropriate physical proximity, sustained eye contact, and expressive warmth create an environment in which patients feel heard, understood, and more willing to articulate pain experiences. These findings have direct implications for physical therapist training curricula and clinical communication frameworks.