When patients’ frustration boils over, physiotherapists need more than clinical skill. They need calm, strategy, and support.

While most physiotherapy sessions are collaborative and positive, occasional flare-ups of aggression do happen — and when they do, they can be confronting.

The waiting room was already tense when Maya, a physiotherapist in a busy metropolitan hospital, stepped out to call his next patient. The man, recovering from a workplace injury, had been pacing back and forth for ten minutes. His shoulders were tight, his jaw clenched. By the time she entered the treatment room, his frustration spilled over. He raised his voice, blaming Maya for delays in insurance approvals, accusing her of not caring. His fists were clenched, and the space between them suddenly felt too small.

“In that moment,” Maya recalls, “I knew the session wasn’t about exercises or progress. It was about safety — his and mine.”

Stories like this are not unusual in healthcare. WorkSafe Victoria has found that up to 95 per cent of healthcare workers experience violent or aggressive behaviour during their careers, most often in the form of verbal abuse or intimidation, though only a fraction of incidents are ever formally reported. While much of physiotherapy is collaborative and supportive, the close proximity of treatment, the presence of pain, and the frustrations of long waiting times can turn some encounters into flashpoints.

Maya resisted the instinct to match the man’s energy. Instead, she deliberately lowered her voice, steady and calm, to counterbalance the aggression. She kept an open stance but subtly shifted so there was always a clear path to the door. Rather than dismissing the outburst, she acknowledged it: “I can see how frustrating these delays have been for you.” The man’s voice wavered, still sharp but less explosive.

The aggression hadn’t disappeared, but it had slowed. Maya then set a clear boundary: “I want to help, but I need us to speak respectfully to continue.” It was a quiet line in the sand, one that made it clear the behaviour could not continue unchecked.

Behind the scenes, Maya’s colleagues were alert. The clinic had a discreet signal system for calling in extra support if needed. Just knowing she wasn’t alone made it easier for her to hold her ground. Over the next few minutes, the man’s breathing steadied. He eventually sat down, tension still visible but no longer dominating the room. The session went ahead, adapted to the circumstances, with careful pacing and space for the patient to vent his frustrations.

Looking back, Maya doesn’t attribute the outcome to a single tactic. “It wasn’t one magic phrase,” she says. “It was the training I’d had, the practice in spotting early warning signs, and the confidence that if it escalated, my team would step in. That’s what made the difference.”

Aggression in healthcare rarely happens without cause. Pain, frustration, financial stress, or mental health challenges often sit just below the surface. In physiotherapy, where progress can feel slow and gains are hard-won, patients sometimes lash out at the person closest to the problem: their clinician. Recognising these triggers doesn’t excuse the behaviour, but it helps physios respond with empathy and control rather than defensiveness.

The challenge, however, should not rest on the shoulders of individual clinicians alone. As Safe Work Australia’s Model Code of Practice: Managing psychosocial hazards at work emphasises, exposure to aggression is a workplace risk that must be actively managed by employers. That means more than a one-off training session. Clinics and hospitals need clear protocols, supportive design features like accessible exits and panic buttons, and — most importantly — a culture that encourages staff to speak up when they feel unsafe.

Maya has since reflected on that day many times. What stays with her is not just the relief that the situation de-escalated, but the reminder of how vulnerable frontline clinicians can be. It’s a lesson that continues to shape how she approaches every patient interaction, reminding her that clinical care and personal safety are often intertwined. “You walk into a room thinking about treatment plans and exercises, but sometimes the focus shifts to keeping the interaction calm and safe. If you haven’t prepared for that, it can be confronting.”

Preparation, she says, is both personal and collective. On a personal level, she practices grounding techniques to steady her breathing when tension rises. Collectively, her workplace has built regular refresher sessions into their calendar, ensuring new staff and seasoned clinicians alike stay confident in de-escalation. Most importantly, there is an understanding across the team: if someone presses the alarm, no one hesitates to respond.

Not every story ends as smoothly as Maya’s. Some situations can escalate further, but his experience shows that aggression can be managed, not just endured. With training, awareness, and team support, physiotherapists can navigate tense encounters without losing sight of their role as healers.

Aggression may never be eliminated from healthcare, but it can be met with calm, clear strategies that protect both patients and staff. Episodes like this are the exception, not the rule — and being prepared ensures clinicians can handle them safely when they arise.