I’m a physical therapist.

I’ve worked as a physical therapist for 25 years; 23 of them licensed.

Over the years, I’ve seen and heard a lot of things related to physical therapy and rehabilitation, but one question still has me scratching my head…here it is:

I’ve worked in most every PT-related workplace imaginable, private practice and hospital-based outpatient PT, hospital rehab, nursing home rehab, aquatics, acute ICU care, subacute care, cardiac rehab, pre-employment screening, home care and cash-based wellness. I also contracted my services as a PT.

Over the years, I’ve heard many interesting questions from my patients. The one I’m recalling was some 15 years ago (give or take five years it’s harder to say exactly when now). The question was posed by a 30-something healthy woman. During physical therapy, she asked me a question that was way outside my areas of expertise. Okay already, I’m getting there.

She asked if smoking one cigarette every evening was bad for her health, as she saw many benefits of how it relaxed her.

Well, my very first thought was h@## yes it’s bad for you! Cigarettes have tar and a thousand other things that are bad for you and have been proven to be linked to many health problems!

She proceeded to rationalize to me how it relaxed her and got her ready for bed. I thought about it for several days until I saw her again in outpatient physical therapy. I thought of her claims of relaxation reflection and closure to the day based on the habit of one cigarette a day. I couldn’t support my answer with research, as I couldn’t find any. I could find no studies on the effects to the body of habitually smoking one cigarette a day for many years.

Definitely aware of scientifically proven negative consequences of smoking I pondered the tradeoff of this woman’s significant pleasure and relaxation I contemplated longer than I should have.

After three days of thought I saw this woman again for outpatient therapy. I replied—a second time—with my previous answer to her question…but I had my doubts.

Could it be that smoking one cigarette a day for my 30-something healthy patient provides, overall, a health benefit? Is it possible the significant relaxation she claims is more beneficial than the hypothetically (un-researched) small risk of harm it most certainly brings with it?

Now, of course, as any practitioner’s would, my thoughts wandered to more positive ways to bring about relaxation in the evening. Could reading meditating or enjoying some carrot juice eventually bring about the same feeling of relaxation and closure to the day? That would most definitely be a better way.

But the fact remains, if this person is benefits, significantly (psychologically and perhaps physiologically as well) from a small dose of a thing that we all know is bad for us can it be that perhaps it is good for her?

For some odd reason, this conversation about the trade-offs between physical and mental health has stayed with me over the years and I’ve never asked anyone else’s opinion about it. Perhaps I’m amused by the small things?

So now I’m asking!

How would you have responded?

And, nope, I am not making this up at all! I’m still, to this day, struggling with my answer.

Brian Scherff PT, Developer of theMATtable.com