Was a line crossed?

Male physiotherapist closely treating a female patient

Was a line crossed?

27 Feb, 2026

BMS, the APA’s insurance partner, together with Scott Shelly and Alexander Sheridan of health law firm Barry Nilsson, examine two hypothetical scenarios that could be seen as boundary violations and offer practical safeguards to help mitigate risk.

A casual comment on a patient’s appearance. Forgetting to provide an adequately sized towel for a patient to cover themselves.

Not clearly explaining the manual therapy involved as part of the treatment.

Could the above examples result in allegations of a boundary violation?

Scenario 1

Sam has seen his physiotherapist, John, numerous times over the past six months, following an ACL surgery.

Over this time, Sam and John have developed a friendly rapport.

Sam starts to feel pain in his hamstring and attends John for a consultation.

After an initial assessment, John advises he will provide soft tissue massage to the area to assist with extension and reduce pain.

John asks Sam to remove his shorts and lay on the treatment table facing down.

Sam, hesitates but starts to undress and John subsequently hands Sam a small towel to cover himself.

The towel is small and does not provide much coverage. John also locks the door prior to commencing the treatment.

During the treatment, John says that he often finds himself in this position as he works for the local football club.

After the treatment, Sam calls the clinic and asks to see a different physiotherapist for future consultations as the recent consultation made him feel uneasy.

Key lessons and safeguards

The shared Code of conduct places obligations on physiotherapists to obtain informed consent and to work collaboratively and respectfully with the patient’s they treat.

In this scenario, John:

1. did not appropriately obtain informed consent from Sam as he did not:

provide Sam with a sufficient explanation of the treatment he proposed to provide
explain why it would be clinically appropriate for Sam to remove an item of clothing
provide Sam with an opportunity to ask questions or express concerns
provide Sam with privacy to change
provide sufficient coverage (draping) for Sam to cover himself

2. made a comment in an attempt to build rapport with Sam, however the comment made Sam feel uncomfortable

3. could have offered an appropriate chaperone to ‘sit in’ during the consultation to make Sam feel more comfortable

4. made Sam feel unsafe by locking the door.

John allowed the familiar and friendly nature of the treating relationship to compromise his compliance with his professional obligations, leading to a lapse in providing appropriate care.

If Sam were to make a complaint to a regulator, it is likely that the regulator would consider that John has practiced inappropriately.

When treating future patient’s John should recognise the inherent power imbalance in the patient-practitioner relationship and maintain professional boundaries.

When providing treatment that may leave a patient feeling vulnerable, extra care should be taken to obtain informed consent and to provide opportunities to ensure the patient is comfortable through draping or other means.

Scenario 2

Helen attended a consultation with physiotherapist Shelley for pain in her shoulder and pectoral muscle. Helen has a toddler and believes the pain is due to lifting and carrying her child.

After initial assessment, Shelley explains she will provide soft tissue massage and strapping to Helen’s shoulder.

While administering the massage, Shelley also extends the therapy to Helen’s chest area.

Helen did not say anything, as she had explained she also had pain in that area, but felt uncomfortable as Shelley did not explain that she would also apply massage to that area.

Key lessons and safeguards

Due to the ‘hands-on’ nature that physiotherapy requires, particular care and vigilance should be taken when applying manual treatments.

Often the treatment you provide as a physiotherapist will feel routine to you but not to the patient.

Physiotherapists providing treatment to areas where the patient feels vulnerable is a common complaint to regulators and one which can have serious consequences for practitioners where inappropriate conduct is alleged.

It is therefore important to ensure that you:

consider whether to offer the patient treatment by another physiotherapist which may be important when treating a different gender
use effective communication, clear and straightforward language that clearly explains the nature of the treatment and its intended result
ask the patient to explain, in their own words, what they understand of the treatment
are aware of a patient’s literacy abilities, are sensitive to a patient’s cultural background and needs
provide the patient with an opportunity to raise any questions or concerns regarding the treatment
gain informed consent before starting treatment and continuing through the treatment
take active steps to ensure the patient is comfortable and aware of the treatment being provided once the treatment commences
ensure that the above steps are clearly recorded in your clinical records.

When practitioners provide treatment to patients which the patient might find uncomfortable, practitioners may consider providing an information sheet to the patient which outlines the treatment to be provided, the reason for the treatment and any steps the physiotherapist is able to offer to make the patient feel more comfortable such as additional draping or a chaperone.

Where an information sheet is used, this should be used in conjunction with a conversation with the patient to ensure informed consent.

Not all cases of boundary violations come from ill intent as many arise from miscommunication or simple oversight, so it is important to always be mindful and be vigilant of the treatment provided.