Mood

"Mood"  has  to  do  with  the  grammatical  marking  of  illocutionary  force,  the  various  things  that  can  
be  done  with  propositions.  English  has  traditionally  identified  four  moods.  

a.  declarative  (or  indicative)  

b.  interrogative  

c.  imperative  

d.  subjunctive  

a.  The  declarative  mood  

Declarative  sentences  present  statements,  objectively.  

Mike  sees  patients  from  Monday  to  Saturday,  mornings  and  afternoons.  

However,  declarative  sentences  may  have  other  language  functions  which  go  beyond  the  objective  
perspective  they  are  usually  associated  with:  

John  has  called  twice  for  an  appointment.  (implying  “Do  not  forget  to  call  him  back”  or  
“”He  must  be  annoyed”).  

b.  The  interrogative  mood  

Interrogative  sentences  present  questions  regarding  the  nature  of  the  topic  that  is  being  dealt  with  
in  the  utterance:  

What  is  the  nature  of  your  problem?  

Do  you  feel  any  pain  in  your  knee?  

But,  again,  as  was  the  case  for  declarative  sentences,  they  may  often  have  other  functions  too:  

Didn’t  I  tell  you  it  would  hurt?  (implying  “I  warned  you  about  it  being  painful”).  

What  did  I  tell  you?  (implying  “I  told  you  so.”)  

c.  The  imperative  mood  

Imperative  sentences  present  directives,  such  as  orders,  instructions,  requests,  invitations  etc.  They  
typically  have  a  verb  with  no  subject  and  in  the  bare  infinitive  form.  “Don't”  can  be  put  before  the  
verb  to  form  negatives.  But  positive  imperatives  can  also  include  an  auxiliary  “do”  to  add  emphatic  
force,  and  the  subject  can  be  included  with  either  affirmative  or  negative  verbs:  

Do  be  careful  with  your  rehabilitation.  

Don’t  lift  any  weight  in  the  following  three  weeks.  

Reach  for  your  right  foot  with  both  hands.  

Turn  off  any  electrostimulation  devices  until  further  notice.  

 You  just  wait  for  my  signal.  

Stand  on  your  right  leg.  

These  are,  of  course,  instances  of  very  straightforward  imperative  sentences;  however,  there  are  
others  where  the  imperative  is  dealt  with  in  a  different  manner.  For  example,  there  may  be  a  
“please”  or  a  question  tag  appended:  

Lie  on  your  back,  please.  

Hold  my  hand  firmly,  will  you?  

And  there  are  other  instances  where  the  imperative  is  presented  through  the  addition  of  a  modal  
verb.  

You  can  get  dressed  now.  (implying  “Please,  do  get  dressed.”)  

d.  The  subjunctive  mood  

In  English,  as  in  Spanish,  the  subjunctive  is  primarily  used  in  subordinate  clauses.  The  subjunctive  
usually  occurs  after  verbs  such  as  the  following  in  the  main  clause:  

• Propose  
• Suggest  
• Recommend  
• Insist  
• Demand  

While  Spanish  has  specific  subjunctive  verb  forms,  different  from  the  indicative  forms,  English  
doesn't  have  separate  indicative  and  subjunctive  forms.  What  are  traditionally  called  subjunctive  
forms  in  English  consist  of  the  following:  

• the  infinitive  (which,  with  the  exception  of  the  verb  to  be,  coincides  with  the  1st  and  2nd  
person  singular  simple  present)  
• “were”,  in  this  case,  coincidental  with  the  past  tense  plural  form  of  “be”  

There  are  some  fixed  phrases  with  subjunctives,  such  as:    

• If  I  were  you  ...,    

• As  it  were…    
• Long  live  ...,    
• Be  that  as  it  may  
• So  be  it    

that  are  probably  best  learned  as  straightforward  idioms.  (“Long  live”...  can  also  be  regarded  as  a  
third  person  imperative.)  
In  any  case,  the  subjunctive  mood,  therefore  does  not  seem  to  be  a  very  productive  concept  in  
English,  except  maybe  as  a  way  of  referring  to  a  very  broad  type  of  meaning:  uncertainty,  unreality,  
hypotheses,  wishes,  etc.  

She  demanded  that  the  patient  be  ready  for  the  treatment.  

The  PT  suggested  that  she  work  a  little  harder  on  her  rehabilitation.  

He  fell  in  a  state  of  numbness  as  if  he  were  dreaming.  

Long  live  our  chairman!  

My  PT  recommended  (that)  I  take  up  stretching  exercises.  

I  insisted  my  PT  treat  my  back  as  soon  as  possible.  

The  subjunctive  may  be  used  for  the  past,  present  or  future:  

My  family  doctor  suggested  (that)  the  PT  change  the  treatment.  

Susan  recommends  (that)  his  patients  keep  a  healthy,  unstressful  lifestyle.  

“Should”  is  sometimes  used  instead  of  the  subjunctive:  

His  PT  suggested  that  he  should  give  up  training  so  hard.  

There  are  other  fixed  expressions  that  involve  the  use  of  the  subjunctive.  These  differ  from  the  
options  that  have  been  reviewed  so  far  in  that  these  expressions  also  allow  the  use  of  other  verbal  
forms.  These  fixed  expressions  are:    

• Wish  
• lf  Only  

I  wish  I  were  not  sick  tomorrow  (but  I  don’t  know  if  I  will  be  sick  tomorrow).  It  implies  a  
wish.  

If  only  I  were  not  sick  tomorrow.  

I  wish  she  had  believed  the  patient's  complaints  earlier  (but  she  did  not  believe  the  
patient's  complaints  early  enough).  In  this  case,  it  implies  a  regret.  

If  only  she  had  believed  the  patient's  complaints  earlier.  

I  wish  you  would  take  your  patients  more  seriously  (the  speaker  complains  about  the  
present  situation).  

   
Modality  

A  basic  distinction  in  the  use  of  language  is  that  sometimes  facts  are  stated,  like:    

It  hurts    

or    

It  hasn't  hurt  for  weeks    

but  in  other  cases,  personal  perceptions,  opinions  and  attitudes  towards  the  stated  facts  are  
expressed:  

I  think  it's  going  to  hurt  

Remember  it  could  hurt    

It  must  have  hurt  a  lot  

The  term  'modality'  includes  various  types  of  personal  perceptions  and  attitudes.  A  broad  
categorisation  of  the  main  types  of  modality  could  be:  

a) possibility,  including  ability  and  permission  

b) necessity,  including  obligation  

c) volition  

d) prediction  

She  can  handle  pain  better  than  I  do.  (Possibility)    

You  must  be  in  agony!!  Your  jaw  is  broken.  (Prediction)  

They  may  have  finished  their  rehab  by  now.  (Prediction)  

You  can't  lift  any  weight,  Mrs.  Brown,  no  matter  how  heavy  it  is.  (Necessity)  

I  must  be  careful  with  my  back  now.  (Necessity)  

These  bandages  shouldn't  be  left  on  the  desk  once  they  are  open.  (Necessity)  

Modal  verbs  are  the  primary  grammatical  device  used  to  express  modality.  The  main  modal  verbs  
are    

May   Might  

Can   Could  

Must  

Will   Would  

Shall   Should  
Along  with  them,  most  grammarians  also  recognise  'semi-­‐modals',  such  as    

Have  (got)  to   Ought  to  

Need   Dare  

which,  in  terms  of  form,  are  slightly  different  from  modals,  but  which  express  similar  types  of  
meaning.    

As  far  as  form  is  concerned,  a  modal  verb  always  has  the  same  form;  in  other  words,  it  remains  
invariable.  And  after  a  modal  verb  we  use  the  infinitive  without  “to”.    

You  may  need  some  crutches,  Mr.  Alston.  

Could  you  raise  your  left  leg,  please?  

I  will  examine  your  shoulder,  so,  please,  take  off  your  shirt.  

Semi  modals  are  different  in  that  they  may  be  followed  by  the  bare  infinitive,  the  to  infinitive  and  
even  the  present  participle  (“-­‐ing”  form)  of  the  verb.  

I  have  to  see  my  physiotherapist  as  soon  as  possible;  my  shoulder  doesn’t  feel  any  better.  

She  didn’t  dare  tell  anything  to  her  GP  because  she  had  quit  her  PT  treatment  without  her  
consent.  

You  really  ought  to  take  up  exercise;  otherwise,  your  knee  will  never  recover.  

 Different  meanings  are  conveyed  by  different  modal  verbs.  Presented  below  are  different  modal  
meanings  and  the  modal  forms  that  express  these  meanings.  

1.  Expressing  Certainty,  Possibility,  Ability  and  Permission  

1.a.  Expressing  Certainty  

1.a.i.  Will  

If  he  stands  on  his  injured  leg  without  the  aid  of  crutches,  he  will  be  in  pain.  

1.a.ii.  Won’t  

I’m  sorry,  Mr.  Rushmore,  but  I  won’t  be  here  for  your  next  session.  Mrs.  Richards  will  take  
care  of  you.  

Both  “will”  and  “won’t”  are  used  not  only  to  express  certainty  in  the  present  and  in  the  future,  but  
also  to  express  certainty  in  the  past:    

It  will  have  been  Mike  who  cancelled  his  appointment;  I  know  he  is  out  of  town  for  
business.  

She  won’t  have  been  the  patient  with  the  muscle  pull  in  her  back;  Maggie  is  now  living  in  
Sheffield.    
1.a.iii.  Must    

She  has  been  in  bedrest  for  over  a  month  now.  Her  mucles  must  be  really  weak.    

In  this  sentence,  the  speaker  states  that,  according  to  his  knowledge  and  experience  (his  expertise),  
the  muscles  of  the  patient  must  have  weakened  through  bedrest.  It  does  not  necessarily  have  to  be  
so,  but  he  is  expressing  a  very  strong  belief  (certainty  derived  from  logical  inference).    

“Must”  is  only  used  in  the  affirmative  to  express  certainty.  

1.a.iv.  Can’t  

When  the  certainty  derived  from  logical  inference  is  expressed  in  the  negative,  instead  of  “must”,  
“can't”  has  to  be  used:  

According  to  his  clinical  situation,  that  diagnosis  can't  be  true.  

For  past  situations  we  use  “must  have”  and  “can't  have”.  We  can  also  use  “couldn't  have”  instead  of  
“can't  have”:  

Taking  into  consideration  the  situation,  the  family  of  the  patient  couldn't  have  asked  for  
more.  

I  strongly  believe  it  can’t  have  been  your  stretching  exercises  that  caused  your  acute  
lumbalgia.    

1.b  Expressing  Possibility  

The  collection  of  modal  verbs  that  are  used  to  express  possibility  is  as  follows:  

Can   Could   May   Might  

If  certainty  were  scaled  according  to  the  use  of  modal  verbs,  the  resulting  classification  would  read  
as:    

Can   May   Could   Might  

To  express  possibility  in  the  present,  the  four  aforementioned  options  are  available;  the  choice  
among  them  will  only  depend  on  the  level  of  certainty  about  the  statement:  

Moderate  exercise  can  improve  your  health.  (high  level  of  certainty).  

Proper  sitting  posture  may  reduce  the  risk  of  back  injuries.  (moderate  to  high  level  of  
certainty).  

You  could  suffer  an  ankle  sprain  even  lying  in  bed.  (moderate  to  low  level  of  certainty).  

She  might  feel  better  after  just  a  session  of  ultrasound.  (low  level  of  certainty).  

1.b.i.  May  and  Might  

“May”  and  “might”  are  used  for  the  present  and  for  the  future.  They  are  followed  by  an  infinitive  
without  to  (know)  or  an  infinitive  without  to  in  its  continuous  form  (be  stretching).    

They  may  know  what  to  do  now  about  my  muscle  pull,  but  I  feel  utterly  lost.  

She  may  be  stretching  after  such  a  long  training  session.  

“May”  is  not  uncommon  in  conditional  sentences  that  are  related  to  both  present  and  future  times.  

If  you  insist  on  lifting  such  heavy  weights,  you  may  well  suffer  a  serious  cervical  strain.  

The  forms  of  “may”  and  “might”  are  frequently  used  in  the  negative:    

She  might  not  need  a  new  prosthesis.  

However,  “may”  and  “might”  are  seldom  used  in  the  interrogative  form  in  the  sense  of  possibility.  

Alternative  forms  are  often  adopted  to  avoid  the  use  of  “may”  or  “might”:  

Do  you  think  she  is  OK  to  start  working  again?    

or  

Is  she  likely  to  start  working  again?    

rather  than  

Might  she  be  OK  to  start  working  again?  

Similarly:  

Is  she  likely  to  get  injured  again  if  she  doesn’t  complete  the  treatment?  

rather  than  

May  she  get  injured  again  if  she  doesn’t  complete  the  treatment?  

1.b.ii.  Could  

“Could”  sometimes  replaces  might  as  a  near  synonym:  

Do  you  think  their  relatives  are  waiting  for  her  at  the  waiting  room?    

or  

Could  her  parents  be  waiting  for  her  at  the  waiting  room?  

rather  than  

Might  her  relatives  be  waiting  for  her  at  the  waiting  room?  

1.b.iii.  Can  

“Can”  expresses  a  different  kind  of  possibility  than  that  of  “may”.  The  construction  “subject+can”  
expresses  “it  is  possible  according  to  regular  circumstances”:  
 Can  I  recover  in  less  than  a  week?  (expresses  “Is  it  possible  that  I  recover  in  less  than  a  
week?”)  

Yes,  Ms  White,  you  can  stand  on  your  right  foot  again.  (expresses  “It  is  safe  for  you  to  stand  
on  your  right  foot”)  

To  express  possibility  in  the  past,  the  options  that  are  available  are  “may  have”,  “might  have”,  “could  
have”:  

Your  injury  might  have  healed  earlier  if  acupuncture  had  been  performed  as  a  
complementary  treatment.  

Mr.  Burns  was  lucky  to  be  diagnosed  soon;  if  not,  he  could  have  undergone  surgery  for  his  
pubalgia.  

Arnold  may  have  complained  about  his  knee  because  he  actually  suffered  a  patellar  
dislocation.    

To  express  possibility  in  the  future,  “may”  and  “might”  are  the  commonest  options,but  “could”,  
which  expresses  possibility  but  with  a  hint  of  suggestion,  may  also  be  used:  

The  range  of  options  for  your  condition  is  wide.  We  might  start  with  passive  physiotherapy  
and  see.  

Louise  does  not  know  what  to  do  when  she  finishes  her  degree.  She  may  enrol  in  a  Masters  
program.  

We  could  meet  when  you  have  finished  your  rehab  session  today,  couldn't  we?  

I  could  be  attending  a  Conference  in  Naples  this  coming  spring.  

1.c.  Expressing  Ability  

In  order  to  express  ability,  the  options  are  the  following:  

Can  (only  in  the  present   Could  (only  in  the  past   Be  able  to  (for  
tense)   tense)   present,  past  and  
future  situations)  

Mike  Williams  can  treat  very  special  plantar  fasciitis  cases.  

Angela  Johnson  is  able  to  relieve  very  serious  cases  of  torn  rotator  cuffs.  

Can  you  read  lumbar  MRI?  Yes,  I  can.  

Are  you  able  to  read  lumbar  MRI?  Yes,  I  am.  

While  the  primary  options  to  express  ability  in  present  situations  are  “be  able  to”  in  the  present  or  
“can”,  “Could”  may  also  be  used  to  talk  about  ability  in  an  imaginary  situation:  

I  must  admit  I  couldn't  do  what  you  do.  You  are  a  much  better  PT  than  me.  
As  for  the  past,  ability  may  be  expressed  with  the  use  of  “could”  or  “be  able  to”  in  the  past  form  
(was/were).  There  is,  however,  a  slight  difference  between  “could”  and  “be  able  to”  in  the  past  form:  
“Could”  is  used  to  say  that  someone  had  the  general  ability  to  do  something:  

When  I  was  studying  my  degree  I  could  diagnose  almost  any  lower  back  injury.      

while  “be  able  to”  in  the  past  is  used  when  the  meaning  is  that  of  someone  having  managed  to  do  
something  in  one  particular  situation;  in  other  words,  it  expresses  a  specific  ability  to  do  something  
at  a  particular  time  in  the  past.  “Managed  to”  can  replace  “be  able  to”  in  the  past:  

In  2010  I  was  able  to  see  up  to  7  patients  every  morning.  

In  2010  I  managed  to  see  up  to  7  patients  every  morning.  

“Could”  may  also  refer  to  a  past  situation  when  the  ability  to  do  something  was  not  eventually  
fulfilled:  

Anne  could  have  been  a  very  good  physiotherapist  but  she  wasted  her  talent.  

To  talk  about  ability  in  the  future,  “be  able  to”  is  used  with  the  auxiliary  “will”:  

If  you  study  English  for  the  Health  Sciences,  you  will  be  able  to  work  with  a  larger  number  
of  patients.    

1.d.  Expressing  Permission  

To  express  permission  the  options  are  “can”,  “could”,  “may”  (more  formal  than  can),  “might”  (even  
more  formal  than  “may”)  or  “be  allowed  to”.  

In  the  present,  all  of  them  are  possible  when  demanding  permission:    

Could  my  colleague  see  your  MRIs,  Ms  Harrison?  

May  I  talk  to  you  about  your  treatment,  Mr.  Drake?  

Can  we  sit  and  wait  here  until  the  ambulance  arrives?  

When  it  is  a  question  of  granting  permission  in  the  present,  only  “can”,  “may”  and  “be  allowed  to”  
are  possible:  

Yes,  you  can  start  walking  without  the  orthesis  now.    

I  am  allowed  to  swim,  but  not  to  jog.  

You  may  come  in  without  an  appointment.  Your  case  is  serious.  

Permission  in  the  past  is  granted  only  with  the  “be  allowed  to”  (was/were)  form:  

Were  you  allowed  to  join  the  session  once  it  had  been  started?  

To  grant  permission  in  the  future,  there  is  only  one  option  available,  and  that  is  “be  allowed  to”  but,  
in  this  case,  the  auxiliary  “will”  adds  the  idea  of  future  permission:  

My  PT  has  told  me  that  I  will  be  allowed  to  work  again  when  my  back  is  fully  recovered.  
 As  for  asking  for  permission,  among  the  number  of  options  that  were  available,  can,  may,  
could  or  might  (from  less  to  more  formal)  are  possible:  John,  can  I  pull  your  shirt  a  little  
further  up?  (if  you  are  asking  a  friend).  

Ms  Lin,  may  I  pull  your  shirt  a  little  further  up?  (if  you  are  talking  an  acquaintance  or  to  a  
patient  you’ve  known  for  a  long  time).  

Could  I  pull  your  shirt  a  little  further  up,  Mr.  Hall?  (if  you  are  talking  to  a  regular  patient).  

Might  I  pull  your  shirt  a  little  further  up,  Dr.  Jones?  (only  in  extremely  polite  situations).  

2.  Expressing  Necessity  

The  notion  of  necessity  in  this  handbook  and  at  this  point  will  imply  two  different  meanings:  on  the  
one  hand,  it  will  express  the  notion  of  pure  necessity;  that  is,  it  means  that  something  cannot  be  
avoided.  On  the  other  hand,  it  will  convey  the  idea  of  obligation;  in  this  second  case,  necessity  is  
established  on  a  more  subjective  or  personal  level,  and  borders  on  the  idea  of  suggestion  or  advice.    

2.a.  Pure  necessity  

To  express  the  meaning  of  pure  necessity  (something  that  cannot  be  avoided  or  something  that  
cannot  be  avoided  being  done),  the  verb  forms  are  limited  to  “must”  or  “have  to”:  

Necessity  in  the  present     Necessity  in  the  past.   Necessity  in  the  future  

must,  have/has  to.   had  to   will  have  to.  

In  terms  of  form,  “must”  is  to  be  used  only  in  those  sentences  that  make  reference  to  a  present  
situation.  For  past  and  future  situations,  “must”  is  no  longer  an  option,  and  “have  to”  is  the  only  
choice  available.  Therefore,  to  express  pure  necessity  in  the  past  and  in  the  future,  “have  to”  will  
take  its  past  or  future  forms  (“had  to”  and  “will  have  to”).    

Even  though  “have  to”  and  “must”  are  both  used  in  sentences  expressing  pure  necessity  in  the  
present,  there  are  some  differences  between  them:  

“Must”  is  the  preferred  option  when  the  speaker  expresses  personal  feelings  or  speaks  with  
authority,  expressing  what  is  necessary:  

Your  hip  is  in  a  really  bad  condition.  You  must  start  using  a  walking  stick.  

Similarly,  when  stating  that  it  is  necessary  to  avoid  doing  something,  “mustn't”  (i.e.,  not  allowed  to)  
is  the  preferred  option:  

You  mustn't  undertake  any  physical  activity  while  being  in  this  condition.  

“Have  to”  is  used  when  the  speaker  does  not  express  personal  feelings  or  does  not  impose  his  own  
authority,  but  just  gives  facts  or  relates  his  statement  to  the  authority  of  others,  often  a  law  or  a  
rule:  

All  PTs  have  to  pay  their  licence  fees  to  practice.  
To  express  that  something  is  not  necessary,  we  can  use  the  negative  forms  of  “need”  or  “have  to”:  

•  No  necessity  in  the  present:  “needn't”  or  “don't/doesn't  have  to”.  

•  No  necessity  in  the  past:  “didn't  need”,  “didn't  have  to”.  

•  No  necessity  in  the  future:  “won't  have  to”.  

In  conclusion,  we  use  “mustn't”  when  we  are  not  allowed  to  do  something  or  when  there  is  a  
necessity  not  to  do  it,  and  we  use  the  negative  form  of  “have  to”  or  “needn't”  when  there  is  no  
necessity  to  do  something  but  we  can  do  it  if  we  want  to:  

The  doctor  says  I  mustn't  get  overtired  but  I  needn't  stay  in  bed.  

The  doctor  says  I  mustn't  get  overtired  but  I  don't  have  to  stay  in  bed.  

2.b.  Obligation  or  advice  

Obligation  means  that  something  is  the  right  thing  to  do.  

When  we  want  to  say  what  we  think  is  a  good  thing  to  do  or  the  right  thing  to  do  we  use  “should”  or  
“ought  to”  (a  little  stronger  than  “should”).  

“Should”  and  “ought  to”  can  be  used  for  giving  advice:  

You  ought  to  sleep.  

You  should  work  out.  

You  ought  to  give  up  smoking.  

Ought  he  to  see  a  doctor?  Yes,  I  think  he  ought  to.  

Should  he  see  a  doctor?  Yes,  I  think  he  should.  

it  should  not  be  forgotten  that  there  are  plenty  of  other  ways  of  expressing  modality  and,  hence,  
possibility,  necessity,  volition  and  prediction:  

Don’t  lift  any  weight,  Mrs.  Brown!!  

Maybe  they  have  already  finished  their  rehab  by  now.  

I'm  quite  incapable  of  enduring  pain  as  she  does.  

They  weren't  allowed  to  leave  any  bandages  on  the  desk  once  they  were  open.  

I'd  better  take  care  of  my  back  now.  

I  bet  you  are  in  agony;  your  jaw  is  shattered.  

How  is  he  supposed  to  use  the  crutches?  

I’m  likely  to  need  some  more  training  before  I  start  a  full  time  career.  

Exercise  1.  Complete  the  text  below  with  the  appropriate  modal  verb,  selected  from  the  
options  provided.  
The  Story  of  Helen  Keller,  The  Girl  Who  Could  Not  See,  Hear  or  Speak  

I’d  like  you  to  know  the  story  of  Helen  Keller,  who  (1)  a.  could  neither  see  nor  hear;  b.  a.  must  
neither  see  nor  hear;  c.  a.  should  neither  see  nor  hear;  d.  a.  can  neither  see  nor  hear  _________  from  
the  time  she  was  a  baby.    

I  (2)  a.  must  say;  b.  can  say;  c.  might  say;  d.  ought  to  say  ________  there  was  nothing  wrong  with  
Helen  Keller  when  she  was  born.  Her  father  and  mother  were  very  proud  of  their  pretty  baby,  who  
tried  to  say  “pa-­‐pa”  and  “ma-­‐ma”.  

For  nineteen  months  Helen  grew  bigger  and  stronger.  She  was  able  to  walk  when  she  was  a  year  
old;  she  (3)  a.  might  say;  b.  should  say;  c.  could  say;  d.  might  have  said  ________  a  few  words.  

But  one  day  the  child  fell  ill.  She  (4)  a.  may  have  been;  b.  must  have  been;  c.  ought  to  be;  d.  should  
have  been  _________  very  ill.  For  days  she  was  laid  up  with  a  high  fever  and  soon  the  parents  learned  
that  their  darling  would  never  be  able  to  see  and  hear.  

She  (5)  a.  should  not  hear;  b.  must  not  hear;  c.  cannot  have  hear,  d.  could  not  hear  _____________  what  
was  said  to  her  and  did  not  know  how  to  talk,  she  (6)  a.  should  not  play;  b.  could  not  play;  c.  cannot  
have  played,  d.  must  not  play  ________  with  other  children.  

When  Helen  was  6  years  old  her  parents  took  her  to  Washington  to  find  out  if  doctors  could  do  
something  to  make  her  hear  and  see  again,  but  the  doctors  said  they  (7)  a.  may  do;  b.  must  do;  c.  
ought  to  do;  d.  could  do  __________  nothing.  The  child  was  hopelessly  deaf.  Dr.  Bell  said  the  Kellers  
(8)  a.  should  address;  b.  must  address;  c.  should  be  addressed;  d.  must  be  addressed  _________  the  
Perkins  Institution  for  the  blind  in  Boston  and  ask  if  they  (9)  a.  must  send;  b.  could  send;  c.  must  be  
sent;  d.  may  have  sent  _________  someone  to  help  the  child.  

It  was  a  wonderful  day  for  Helen  Keller  when  Ann  Sullivan  arrived  in  March  1887  to  take  charge  of  
the  child  who  (10)  a.  should  neither  hear  nor  speak;  b.  must  neither  hear  nor  speak;  c.  could  
neither  hear  nor  speak;  d.  might  neither  hear  nor  speak  ___________.  Helen  was  nearly  seven,  Ann  
Sullivan  was  past  twenty.  

Ann  Sullivan  found  a  way  to  make  herself  understood.  She  gave  the  child  a  doll,  and  taking  Helen  
Keller’s  hand  she  slowly  spelled  out  "d-­‐o-­‐l".  The  child  learnt  for  the  first  time  that  things  (11)  a.  
must  have;  b.  can  have;  c.  ought  to  have;  d.  can  be  had  __________  names.  

When  Miss  Sullivan  later  spelled  into  the  little  girl’s  hand  the  word  “w-­‐a-­‐t-­‐e-­‐r”  and  then  let  the  
water  from  the  pumps  run  over  her  hand,  a  new  light  seemed  to  brighten  the  face  of  the  child.  By  
means  of  the  hand  language,  Helen  and  her  teacher  (12)  a.  should  talk;  b.  might  be  talked;  c.  might  
talk;  d.  could  talk  _________  to  each  other.  

When  Helen  was  10  she  was  determined  that  she  would  learn  to  speak.  At  first  she  learned  only  the  
sounds  of  the  letters  of  the  alphabet,  but  soon  she  (13)  a.  could  say;  b.  might  say,  c.  can  say;  d.  had  
to  say  ___________  words  and  sentences.  
In  the  story  of  her  life  Helen  Keller  writes,  “I  shall  never  forget  the  surprise  and  delight  I  felt  when  I  
uttered  my  first  connected  sentence:  “It  is  warm.”    

At  the  age  of  20  Helen  Keller  passed  the  entrance  examinations  to  Radcliffe  College.  Helen  did  
extremely  well  in  her  classes  and  (14)  a.  could  be  kept  up  with;  b.  could  keep  up  with;  c.  should  
keep  up  with;  d.  must  be  kept  up  with  __________  the  other  students.  Helen  wrote  “The  Story  of  My  
Life”  while  she  was  in  college.  In  her  writings  and  lectures  Helen  did  everything  she  (15)  a.  could;  b.  
can;  c.  must;  d.  should  _________  to  help  and  encourage  others  who  were  blind.  

Passive  Voice  

Voice  is  one  of  the  features  of  the  verb.  There  are  two  voices,  i.e.  two  different  ways  of  saying  more  
or  less  the  same  thing:  the  active  voice  and  the  passive  voice.  

The  PT  told  John  to  exercise  three  times  a  week  (active  sentence).  

John  was  told  by  the  PT  to  exercise  three  times  a  week  (passive  sentence).  

Both  sentences  are  correct  and  contain  the  same  elements,  but  they  do  not  mean  exactly  the  same.  
In  the  first  sentence,  the  PT  gains  prominence  by  being  placed  in  initial  position  and  “takes  control”  
of  the  verbal  action.  In  the  second  sentence,  on  the  other  hand,  it  is  John,  placed  in  initial  position,  
who  “governs”  the  verbal  action.  By  using  the  passive  voice  the  object  of  the  sentence  in  the  active  
voice  gains  prominence  by  being  placed  at  beginning  of  the  sentence.  The  use  of  the  passive  is  
preferred  when  it  is  not  that  important  who  or  what  did  the  action.  In  the  example  above,  if  it  is  not  
so  important  who  told  John  to  exercise,  the  passive  sentence  could  be  used.  

The  passive  voice  is  only  possible  when  the  main  verb  is  a  transitive  verb.  Verbs  such  as  the  
following  will  always  take  the  active  voice.  

John  seems  worried  about  his  patient  

Your  condition  is  serious,  Mr  White  

She  travels  a  lot  because  she  is  a  very  well-­‐known  physiotherapist  and  has  patients  all  
over  

In  terms  of  form,  the  passive  voice  is  formed  by  using  the  verb  “to  be”  as  an  auxiliary  and  putting  it  
into  the  same  tense  as  the  verb  in  the  active  voice  was  and  adding  the  past  participle  of  the  main  
verb  in  the  active  sentence:  

People  often  recommend  ice  treatments  for  this  kind  of  patient  (active  voice)  

Ice  treatments  are  often  recommended  for  this  kind  of  patient  (by  people)  (passive  voice)  

The  object  of  the  active  verb  becomes  the  subject  of  the  passive  verb  (“ice  treatments”),  and  the  
subject  of  the  active  verb  becomes  the  agent  of  the  passive  verb  (“people”).  The  agent  can  be  left  out  
if  it  is  not  important  to  mention  it.  If  it  needs  to  be  mentioned,  it  will  placed  at  the  end  of  the  
sentence  preceded  by  the  particle  “by”  (...  “by  people”;  this  wouldn’t  be  the  case  in  the  present  
sentence).  
Some  sentences  have  two  objects,  indirect  and  direct.  In  these  sentences  the  passive  subject  can  be  
either  the  direct  object  or  the  indirect  object  of  the  active  sentence:  

The  new  physiotherapist  prescribed  Mary  a  different  treatment  (active  voice)  

There  are  two  possibilities:  

Mary  was  prescribed  a  different  treatment  by  the  new  physiotherapist  (passive  voice)  

A  new  treatment  was  prescribed  to  Mary  by  the  new  physiotherapist  (passive  voice).  

Caveat:  object  forms  of  the  pronouns,  when  the  sentence  is  transformed  into  the  passive  voice,  will  
adopt  the  subject  form  if  they  become  subjects  either  of  the  main  clause  or  of  the  subordinate  
clause.  

Active   Passive  

Present  simple    

Physiotherapists  treat  all  sorts  of  injuries   All  sorts  of  injuries  are  treated  by  
physiotherapists  

Present  continuous    

John  is  taking  care  of  a  very  famous  sportsman   A  very  famous  sportsman  is  being  taken  
care  of  by  John  

Present  perfect    

Someone  has  referred  him  to  my  clinic     He  has  been  referred  to  my  clinic    

Present  perfect  continuous    

They  have  been  studying  your  case   Your  case  has  been  being  studied  by  them  
(rarely  used)    

Your  case  is  being  studied  by  them  

(preferred  option)  

Past  simple    

The  physiotherapist  reduced  the  fracture  of  the   The  fracture  of  the  patient  was  reduced  by  
patient   the  physiotherapist  

Past  continuous    

They  were  carrying  the  injured  person  to  the   The  injured  person  was  being  carried  to  the  
hospital   hospital  by  them  

Past  perfect    

They  had  studied  the  MRI  before  reducing  the   The  MRI  had  been  studied  by  them  before  
fracture   reducing  the  fracture  

Past  perfect  continuous    

The  gland  had  been  producing  an  excess  of   An  excess  of  hormones  had  been  being  
hormones   produced  by  the  gland    (rarely  used)  

An  excess  of  hormones  was  being  produced  

by  the  gland    (preferred  option)  

Future  Simple    

This  device  will  stretch  your  arm  for  you   Your  arm  will  be  stretched  for  you  by/with  
this  device  

Future  continuous    

They  will  be  seeing  you  more  often   You  will  be  being  seen  by  them  more  often  

Future  perfect    

At  the  end  of  the  year,  he  will  have  treated  more   At  the  end  of  the  year,  more  than  a  thousand  
than  a  thousand  patients   patients  will  have  been  treated  by  him  

Future  perfect  continuous    

They  will  have  been  treating  back  injuries  for  over   Back  injuries  will  have  been  being  treated  
twenty  years   by  them  for  over  twenty  years  (rarely  used)  

Back  injuries  will  have  been  treated  by  them  

for  twenty  years  Preferred  option)  

Caveat:  it  is  to  be  noted  that  although  in  the  table  above  all  possible  passive  verb  forms  have  been  
stated,  the  passive  of  continuous  forms  is  not  very  commonly  used.  

Modal  verbs  are  transformed  into  the  passive  voive  by  using  a  passive  infinitive,  either  present  or  
perfect:  

Active   Passive  
Must    

You  must  follow  my  advice   My  advice  must  be  followed  

Should    

I  should  stretch  my  muscles  before  I  start  any   My  muscles  should  be  stretched  before  I  
activity   start  any  activity  

May    

You  may  have  damaged  your  lumbar  vertebrae     Your  lumbar  vertebrae  may  have  been  
damaged    

MIght    

She  might  injure  her  back  if  she  keeps  on  doing   Her  back  might  be  injured  if  she  keeps  on  
that   doing  that  

Can    

They  can  now  run  longer  distances  than  ever   Longer  distances  can  now  be  run  (by  them)    

Could    

She  could  hardly  bend  her  waist  when  she  first   Her  waist  could  hardly  be  bent  when  she  
arrived   first  arrived  

Ought  to    

They  ought  to  have  told  you  about  your  condition   You  ought  to  have  been  told  about  your  
condition  

But  the  form  of  the  passive  voice  may  vary  depending  on  the  main  verb,  as  the  following  examples  
show:  

She  likes  her  colleagues  to  take  good  care  of  her  patients  (active  voice)  

She  likes  her  patients  to  be  taken  good  care  of  (by  her  colleagues)  (passive  voice)  

She  wants  someone  to  plaster  my  ankle  (active  voice)  

She  wants  my  ankle  to  be  plastered  (by  someone)  (passive  voice)  

My  PT  advised  me  to  spend  less  time  sitting  at  my  desk  (active  voice)  

I  was  advised  to  spend  less  time  sitting  at  my  desk  (by  my  PT)  (passive  voice)  
 or  

My  PT  advised  that  I  should  spend  less  time  sitting  at  my  desk    

John  urged  his  patients  to  stop  using  medical  equipment  without  supervision  (active  voice)  

John’s  patients  were  urged  to  stop  using  medical  equipment  without  supervision  (passive  
voice)  

or  

John  urged  that  his  patients  should  stop  using  medical  equipment  without  supervision    

The  doctor  commanded  the  PT  in  ward  to  follow  his  instructions  very  strictly  (active  voice)  

The  PT  was  commanded  by  the  doctor  to  follow  his  instructions  very  strictly  (passive  
voice)  

or  

The  doctor  commanded  the  PT  that  he  should  follow  his  instructions  very  strictly    

She  was  determined  to  gain  muscle  strength  (active  voice)  

She  was  determined  that  muscle  strength  should  be  gained  (passive  voice)  

Doctors  and  PTs  agreed  to  release  my  brother  from  hospital  (active  voice)  

Doctors  and  PTs  agreed  that  my  brother  should  be  released  from  hospital  (passive  voice)  

I  decided  to  use  a  different  approach  for  your  tendinosis  (active  voice)  

I  decided  that  a  different  approach  should  be  used  for  your  tendinosis  (passive  voice)  

People  believed  he  had  suffered  a  cervical  whiplash  (active  voice)  

He  was  believed  to  have  suffered  a  cervical  whiplash  (passive  voice)  

People  knew  he  had  been  suffering  this  pain  in  his  back  for  quite  a  long  time  (active  voice)  

He  was  known  to  have  been  suffering  this  pain  in  his  back  for  quite  a  long  time  (passive  
voice)    

People  knew  he  had  been  suffering  this  pain  in  his  back  for  quite  a  long  time  (active  voice)  

It  was  known  he  had  been  suffering  this  pain  in  his  back  for  quite  a  long  time  (passive  
voice)  

Of  the  two  options,  the  use  of  the  non-­‐finite  form  is  the  preferred  one.  

Use  of  the  passive  voice  

The  passive  voice  is  used  when  it  is  not  necessary  to  mention  the  doer  of  the  action  as  this  is  
obvious:  

The  clinic  has  not  been  properly  cleaned  

 When  I  intended  to  go  back  home,  my  car  had  been  towed  away  

It  is  also  used  when  we  don't  know  who  did  the  action,  or,  similarly,  when  the  subject  would  be  
“people”  or  “one”:  

One  sees  this  kind  of  injury  almost  everyday  (active)  

This  kind  of  injury  is  seen  almost  everyday  (passive)  

People  told  me  she  had  forgotten  to  do  her  exercises  (active)  

I  was  told  that  she  had  forgotten  to  do  her  exercises  (passive)  

And  it  is  also  used  when  the  action  prevails  over  the  person  who  does  it:  

My  ankle  has  been  healed!!  

And  the  passive  may  also  be  used  when  the  speaker  wants  to  be  detached  from  the  effect  of  the  
sentence;  therefore,  this  use  of  the  passive  voice  is  relevant  when  presenting  disagreeable  
information:  

I’m  sorry,  but  rates  have  been  raised  for  this  type  of  treatment  

is  preferred  to  

I’m  sorry,  but  we  have  raised  the  rates  for  this  type  of  treatment  

Exercise  1.  Change  the  sentences  below  from  active  to  passive.  Remember  that  it  is  not  
always  necessary  to  mention  the  subject  in  a  passive  sentence.    

1. The  nurse  noticed  a  rise  in  the  patient's  pulse  rate.  

Passive:............................................................................................................................    

2. The  consultant  is  allowing  him  to  watch  the  operation.  

Passive:......................................................................................................................................    

3. People   believe   physiotherapy   students   will   be   studying   a   lot   on   their   own   time   and   doing   a  
large  number  of  clinical  practices.  
Passive:  Physiotherapy  students  ………………………………………………………………………………………………….  
4. They  thought  the  patient  had  already  been  for  a  few  sessions  of  physical  therapy.  
Passive:  The  patient  …………………………………………………………………………………………………………….  
5. They  know  that  strength  deficits  of  8-­‐10%  each  decade  of  life  will  leave  many  of  our  patients  
living  at  a  marginal  functional  level.  
Passive:  Many  of  our  patients  ……………………………………………………………………………………………..  

6. All  chemists  sell  the  tablets.  

Passive:.....................................................................................................................................    

7. The  doctor  diagnosed  appendicitis.  

Passive:............................................................................................................................................    
8. The  paramedics  comforted  the  injured  person  until  the  ambulance  arrived.  
Passive:...........................................................................................................................................    

9. The  midwife  delivered  the  twins.  

Passive:..................................................................................................................    

10. The  gland  was  producing  an  excess  of  hormones.  

Passive:..................................................................................................................    

11. They  looked  after  him  very  well  in  hospital.  

Passive:..................................................................................................................    

12. People   didn’t   know   that   this   regulation   would   exclude   all   smoking   by   people   living   in   places  
like  this.  
Passive:  This  regulation  ……………………………………………………………….………………………………………….    

13. You  cannot  take  the  lotion  orally.  

Passive:..................................................................................................................    

14. Toxic  fumes  poisoned  the  workers.  

Passive:.......................................................................................................................................    

15. Doctors  are  predicting  a  rise  in  cases  of  whooping  cough.  
Passive:........................................................................................................................................    

16. The  drug  suppresses  the  body's  natural  instinct  to  reject  the  transplanted  tissue.  
Passive:.........................................................................................................................................    

17. A   seriously   injured   patient   may   require   months   of   PT   to   regain   the   strength   needed   to   stand  
and  walk.  
Passive:  ……………………………………………………………………………………………………………………………………  

18. We  examined  the  tissue  under  the  microscope.  

Passive:..................................................................................................................    

19. They  already  knew  exercise  creates  measurable  health  benefits.  

Passive:  Measurable  ……………………………………………………………………………………………………………….  
20. 21%  of  regular  patients  thought  that  children  were  treated  better  by  the  law  than  themselves.  
Passive:  Children  …………………………………………………………………………………………………………………….  
21. Some  people  believed  PTs  were  closer  in  training  to  nurses  than  they  actually  are.  
Passive:   PTs  
…………………………………………………………………………………………………………………………….  

22. The  doctor  gave  me  an  unpleasant  mixture  to  drink.  
Passive:..................................................................................................................    

23. A  parasagittal  plane  passes  vertically  through  the  midline  and  cuts  the  body  into  halves,  right  
and  left.  
 Passive:  …………………………………………………………………………………………………………………………………….  
24. People  don’t  know  physiotherapists  work  in  mental  health  care.  
Passive:  Physiotherapists  …………………………………………………………………………………………………………  
25. A  few  people  thought  that  the  fee  would  put  people  off,  especially  older  people  
Passive:  People  ……………………………………………………………………………………………………………………….  
26. Who  patients  thought  was  the  best  PT  in  town  has  little  to  do  with  reality.  
Passive:   Who  
………………………………………………………………………………………………………………………………  

Exercise  2.  Column  A  contains  verbs  that  are  important  in  PT.  In  Column  B  there  are  
sentences  with  blanks  requiring  these  verbs.  ,Fill  in  the  blanks  in  the  sentences  in  Column  B  
with  the  appropriate  verbs  (in  italics)  taken  from  Column  A.  You  will  have  to  adapt  the  verb  
form  in  some  cases.  

A   B  

Specialise   1. After  the  accident  the  passengers  were  _________  in  hospital  for  cuts.    

Treat   2. Nurses  ____________  the  wounds  of  the  accident  victims.    

Diagnose   3. He  ___________  in  children  with  breathing  problems.    

Soothe   4. She  ____________  from  headaches.    

Endanger   5. She  was  ____________  against  smallpox  as  a  child.    

Operate   6. Some  forms  of  cancer  cannot  be  ________.    

Suffer   7. The  calamine  lotion  will  __________  the  rash.    

Prescribe   8. The  doctor  ___________  appendicitis.    

Dress   9. The  doctor  ____________  a  course  of  antibiotics.    

Cure   10. The  drug  __________  the  body's  natural  instinct  to  reject  the  transplanted  tissue.    

Suppress   11. The  operation  may  _____________  the  life  of  the  patient.    

Vaccinate   12. The  surgeons  decided  to  _______________  as  the  only  way  of  saving  the  baby's  life.    

   
Infinitive  and  present  participle  constructions  

Verb+-­‐ing  

There  are  certain  verbs  that  are  usually  followed  by  another  verb  using  the  structure  verb+-­‐ing  
(present  participle  construction):  

Admit:  She  admitted  having  stopped  the  treatment  for  no  reason  

Avoid:  I  always  avoid  spending  much  time  sitting  in  the  same  position  

Deny:  My  patient  denied  having  refused  to  follow  my  advice,  but  I  know  she  had  

Dislike:  We  all  disliked  wasting  our  time  with  patients  who  did  not  follow  our  advice  

Enjoy:  She  enjoyed  working  in  that  ward,  even  when  patients  were  not  always  easy  to  deal  with  

Finish:  Have  you  finished  using  the  stretcher?  

Imagine:  She  wouldn’t  have  imagined  suffering  such  excruciating  pains  

Involve:  The  follow-­‐up  involves  keeping  a  healthy  lifestyle  

Mind:  She  didn’t  mind  admitting  new  patients  as  long  as  she  could  offer  the  best  to  all  of  them  

Miss:  She  missed  seeing  her  patients  when  she  accepted  her  new  position  in  the  administration  
services  

Postpone:  Had  you  postponed  coming  in,  Mr  Johnson?  I  was  not  aware  of  it  

Practice:  Please,  Mr.  Jones,  you  should  practice  walking  with  the  crutches  rather  than  refusing  to  
use  them  

Regret:  I  never  regretted  having  studied  physiotherapy  

Risk:  Nobody  should  risk  recovering  just  for  the  sake  of  taking  up  a  hobby  

Stop:  You  should  stop  practicing  any  physical  exercise  until  further  notice  

Suggest:  My  GP  suggested  going  for  rehab  five  days  a  week  

Give  up:  Did  you  give  up  skiing?  

Keep  on:  She  keeps  on  paying  no  attention  to  what  I  say  

Caveat:  with  admit,  deny,  regret  and  suggest  a  "that..."  structure  may  also  be  used:  

She  admitted  that  she  had  stopped  the  treatment  for  no  reason  

My  patient  denied  that  she  had  refused  to  follow  my  advice,  but  I  know  she  had  

I  never  regretted  that  I  had  studied  physiotherapy  

My  GP  suggested  that  I  went  for  rehab  five  days  a  week  

Verb+Infinitive  
The  following  verbs  are  commonly  followed  by  a  to-­‐infinitive  (verb  +  infinitive  structure):  

Afford:  I  cannot  afford  to  go  on  with  the  ice  treatment;  it  is  really  expensive  

Agree:  The  patient  agreed  to  be  referred  to  a  physiotherapist  

Appear:  This  appeared  to  be  one  of  the  worst  cases  we  had  ever  admitted  to  our  clinic  

Arrange:  She  arranged  everything  to  finish  her  follow-­‐up  and  I  was  so  proud  she  did.      

Attempt:  They  have  attempted  to  reschedule,  but  the  number  of  patients  is  overwhelming.  

Dare:  My  oldest  patient  didn’t  dare  to  set  her  foot  on  the  step,  as  it  hurt  her  a  lot.  

Fail:  We  failed  to  diagnose  him  properly,  so  we  decided  to  send  him  back  to  the  traumatologist.  

Forget:  Do  not  forget  to  bring  your  clinical  history  with  you!!  It  is  really  important.    

Intend:  They  intended  to  move  the  patients  in  the  ward  to  the  PT  department  before  Monday.  

Learn:  I  have  learned  to  walk  with  crutches  very  easily.  It  is  better  than  the  wheelchair.  

Manage:  Susan  managed  to  have  Ms  Green  walking  again  in  less  than  a  month.  

Need:  I  don’t  need  to  see  the  scan  results.  I  already  know  what  the  problem  is.    

Offer:  My  wife  offered  to  drive  me  to  rehabilitation.  

Plan:  My  PT  did  not  plan  to  continue  with  my  treatment,  but  I  still  feel  pain.  

Pretend:  She  pretended  to  feel  better  so  as  not  to  worry  her  family,  but  she  was  in  constant  pain.  

Promise:  Dr.  Ho  promised  to  continue  the  follow-­‐up  after  she  was  released  from  hospital  

Refuse:  She  refused  to  carry  on  with  electrostimulation  

Seem:  Mr.  Morgan  seems  to  be  making  progress  with  his  plastic  walker  

Tend:  I  know  patients  tend  to  be  really  nervous  when  they  arrive  at  my  clinic.  

Threaten:  The  patient  threatened  to  take  us  to  court  for  malpractice  

There  are  a  number  of  verbs,  however,  that  are  followed  by  the  infinitive  construction  but  are  
subject  to  some  modifications;  thus,  want,  ask,  expect,  help,  would  like  and  would  prefer  usually  take  
either  the  verb+infinitive  construction  or  the  verb+object+infinitive  construction:  

My  PT  asked  my  wife  to  come  with  me  for  the  first  session,  as  I  might  feel  sick  afterwards.  

She  asked  to  be  seen  by  a  traumatologist  as  soon  as  possible.  

Mr.  Greenaway,  I  want  you  to  raise  your  arm  over  your  head  until  you  feel  pain.  

We  all  wanted  to  use  the  new  techniques  on  Mrs.  McMillan,  but  she  was  very  reluctant.  

Do  not  worry,  Mrs.  Anderson,  I  will  help  you  to  get  dressed  afterwards.    

Being  impatient  does  not  help  to  recover,  John.  You  should  know  it.  
The  verbs  make  and  let  also  take  the  infinitive  construction  with  an  object;  however,  they  are  not  
followed  by  the  full  infinitive  (with  “to”)  but  with  the  base  infinitive  construction  –in  other  words,  
the  infinitive  without  “to”.  

Some  of  the  exercises  make  me  feel  in  pain.  I  am  not  sure  if  I  am  on  the  right  path.  

They  didn’t  let  him  leave  the  ward  until  she  was  fully  recovered.  

Finally,  there  are  some  verbs  which  do  not  take  the  verb+infinitive  construction,  but  can  only  be  
used  in  the  verb+object+infinitive  construction.  These  verbs  are  the  following:  tell,  order,  remind,  
warn,  force,  invite,  enable,  teach,  persuade,  get:  

I  told  Mr.  Rowan  not  to  use  his  wheelchair  again,  but  crutches,  instead.  

Please,  Mike,  remind  me  to  send  these  reports  to  Dr.  Samuelson  by  Tuesday.  

Verb+infinitive  and  verb+present  participle  constructions  

Some  verbs  can  be  followed  either  by  an  infinitive  or  by  a  present  participle.  These  verbs  are  the  
following:  advise,  allow,  permit,  like,  hate,  love,  can't  stand  and  can't  bear.  

PTs  advise  stretching  before  any  activity  is  undertaken.  

His  PT  advised  him  to  stretch  after  his  training.    

They  don’t  allow  smoking  in  any  of  the  wards.  

She  doesn’t  allow  her  patients  to  discontinue  the  follow-­‐up.  

They  permitted  bringing  food  into  the  Paediactric  ward,  as  this  made  children  feel  at  home.  

He  did  not  permit  patients  to  enter  the  room  until  he  had  finished  cleaning  it.  

I  liked  playing  football  until  I  injured  my  knee.  

He  likes  his  patients  to  feel  confident  during  the  treatment.  That’s  why  he  sees  only  a  few  a  
day.  

I  can’t  stand  to  see  some  PTs  discussing  patients  in  public.  

She  can’t  stand  being  in  pain  for  any  longer.    

Some  verbs,  among  others  remember  and  try,  may  be  followed  either  by  a  verb  in  the  –ing  form  or  
by  a  verb  in  the  infinitive,  but  the  two  patterns  present  different  meanings:  

Remember  to  close  the  door!!  (do  not  forget  to  close  the  door)  

I  remember  closing  the  door.  (I  remember  I  did  close  the  door)  

She  tried  to  raise  her  arm,  but  it  was  really  painful.  (She  couldn’t  raise  her  arm  because  of  
the  pain).  

She  tried  raising  her  arm,  but  it  was  really  painful.  (She  raised  her  arm,  but  it  was  painful).  

Verb+ing  constructions  
There  are  some  verbs  that  are  only  followed  by  the  –ing  form.  These  verbs  are:  dislike,  enjoy  and  
mind.  

She  disliked  being  treated  by  her  former  PT  bacuse  he  was  very  rude  to  patients.  

I  don’t  mind  spending  time  in  my  sessions  as  long  as  I  see  improvement.  

I  enjoy  visiting  patients;  they  feel  far  more  comfortable  at  their  places.    

Ver  +preposition+-­‐ing  

Verbs  after  a  preposition  end  in  –ing.  The  number  of  such  occurrences  is  enormous,  but  some  
examples  will  help  illustrate  this  grammatical  rule.  

She  was  more  interested  in  finishing  her  treatment  than  in  doing  things  properly.  

I  am  sorry,  but  I  was  never  good  at  dealing  with  oncological  patients.  

We  are  all  thinking  about  using  a  different  approach  for  your  injury,  Mr.  Sanders.  

I  apologize  for  having  kept  you  waiting,  Peter.  

We  are  looking  forward  to  hearing  from  you  again,  Ms  Denton.  

He  succeded  in  determining  the  etiology  of  the  problem.  

Mrs.  Harrison  accused  her  PT  of  treating  her  poorly.  

I  thank  you  for  taking  so  much  time  with  me,  Helen.  

Nancy  stopped  him  from  leaving  hospital.  

Please,  forgive  me  for  being  so  nervous.  It’s  my  first  time  here.  

Similarly,  there  are  some  expressions  that  are  followed  by  an  –ing  construction:  

It’s  not  worth  waiting  for  the  X-­‐ray  results;  we’d  better  start  immediately.  

She  is  having  trouble  using  her  prosthesis.  

There  is  no  point  advising  you  not  to  lift  weight  when  you  pay  no  attention.  

Exercise  1.  Fill  in  the  blanks  with  the  infinitive  or  the  –ing  form  of  the  verb  in  brackets  

Mr.  Hart  didn't  want  (leave)  ________________  the  office  until  the  ambulance  was  ready  

Anne  had  decided  __________________  (study)  medicine  when  she  discovered  physiotherapy  

My  family  avoided  __________________  (tell)  me  about  the  consequences  of  the  surgery  

My  assistant  would  like  _________________  (come)  to  the  conference;  could  he  be  attending?  

Jennifer  has  already  planned  ________________  (start)  a  Masters  programme  in  paediatric    

Excuse  Karen,  but  do  you  mind    _______________  (give)  me  a  hand  with  these  patients?  

Mark  kept  _______________  (exercise)  even  when  he  had  been  advised  not  to  
I  am  learning  _______________  (perform)  new  procedures  with  oncological  physiotherapy  patients  

Anthony  helped  me  ______________  (see)  all  my  patients  yesterday  evening  

I've  finished  _______________  (work),  so  please,  come  and  fetch  me  

I’m  so  tired  this  evening  that  I  don't  fancy  ____________  (attend)  the  lecture  

One  of  my  best  patients  dislikes  _______________  (stretch)  before  exercising.  He  is  so  impatient!  

He  recommended  my  father  ______________  (use)  a  cane.  It  will  make  him  feel  safe  when  walking  

Ms  Francis  asked  ______________  (see)  you,  Michael,  not  me  

Remember  you  promised  _______________  (stay)  a  little  longer  today    

My  GP  delayed  ______________  (start)  physiotherapy  until  my  wounds  were  healed  

We  discussed  _______________  (open)  a  new  clinic,  but  in  the  end  we  decided  to  stay  where  we  are  

I  hope  ________________  (see)  you  soon  and  fully  recovered,  Ms  Daniels  

Daniel  never  offers  ________________  (help).  I  really  don’t  like  his  attitude  

I  suggested  you  ______________  (come)  back  in  a  month  and  it’s  been  almost  a  year  

I  demanded  _______________  (see)  the  Head  of  the  Department.  Nobody  had  explained  anything  to  me  

Most  patients  enjoy  _______________  (relax)  for  a  while  after  a  physiotherapy  session  

Your  recovery  involves  __________________  (take)  the  whole  process  very  seriously  

I  miss  ______________  reading  more  about  back  pain,  but  I  don`t  have  the  time  for  that  

My  colleague  postponed  _______________  (register)  for  the  Conference  and  now  there  are  no  flights  

Louise  admitted  ________________  (commit)  plagiarism  in  her  paper  

Did  you  choose  __________________  (start)  your  treatment  today  or  were  you  prescribed  so?  

Maggie  practised  _________________  (manipulate)  shoulder  pain  on  her  own  mother  

Sometimes,  I  can't  help  _________________  (be)  late  with  my  appointments    

It  seems  _________________  (be)  a  very  complicated  matter,  but  I’ll  discuss  it  with  my  colleagues  

I  considered    (move)  to  Spain.  

She  hates  _________________  (see)  patients  late  in  the  evening  

Mr.  Framptom  and  I  agreed  ________________  (try)  electrotherapy  once  a  week  

Did  you  manage  _________________  (complete)  your  routines  with  your  new  cast,  Mr.  Langson?  

I  couldn't  stand  _______________  (delay)  things  forever    

We  arranged  everything  to  get  a  wheelchair  for  a  patient  who  couldn’t  afford  _______________  (buy)  it  

You  have  risked  ________________  (injure)  your  elbow  again,  so  don’t  try  lifting  any  weight  again  
Mr.  Bronston  would  love  _____________  (thank)  thank  you  for  everything  whenever  you  are  not  busy  

Dr.  Crimson  claimed  _______________  (be)  one  of  those  who  introduced  phototherapy  in  Bristol  

I  never  intended  _______________  (hide)  the  risks  of  this  treatment,  but  I  didn’t  stress  them  either  

A  patient  pretended  __________________  (suffer)  a  whiplash  to  get  money  from  the  insurance  company    

I  waited  for  hours  _______________  (register)  online  in  the  Conference  

I  can’t  imagine  __________________  (live)  without  pain  

He  appreciates  patients  __________________  (arrive)  on  time  

They  tolerate  ___________________  (smoke)  but  they  prefer  people  not  to.  

Helen  has  anticipated  _________________  (arrive)  earlier  than  expected  on  Tuesday  

Did  you  prepare  yourself  ________________  (start)  your  routine  today,  Ms  Spenser?  

I’ll  call  a  taxi  for  you,  Ben,  as  it  appears  _______________  (be)  raining  

I  don’t  understand  why  he  denies  ______________  (skip)  the  routines  he  has  been  prescribed  

I  would  prefer  ________________  (schedule)  my  appointments  as  early  in  the  morning  as  possible  

She  expected  me  _________________  (see)  her  as  soon  as  she  came  in  without  an  appointment  

Mr.  Thomas  reported  to  the  doctor  _________________  (suffer)  throbbing  pains  in  his  right  knee  

I  tend  ______________  (be)  overprotective  with  my  infant  patients  

Do  you  recall  __________________  (stub)  big  toe  recently  ?  

Dr.  Fields  mentioned  _______________  (undertake)  new  procedures,  but  I  have  not  talked  to  him  yet  

Unfortunately,  Bob  refused  _________________  (continue)  his  treatment  

Susan,  I  do  understand  _______________  (arrive)  late  once,  but  you  should  call  in  when  you  are  delayed  

Nobody  deserves  ________________  (feel)  such  an  acute  pain  

Kelly  has  just  completed  _________________  (move)  to  her  clinic  and  has  invited  us  for  the  opening  

Dr.  Gerson  had  arranged  ________________  (meet)  us  before  the  surgery  to  tell  us  all  about  it    

.    
Conditional  sentences  

Conditional  sentences  are  characterized  by  a  subordinate  clause  that  imposes  a  certain  condition  –a  
prerequisite-­‐  that  sets  the  basis  for  the  fulfillment  of  the  main  clause.  Conditional  sentences  may,  
therefore,  be  regarded  as  containing  two  different  parts:  the  subordinate,  conditional  or  if-­‐  clause,  
and  the  main  clause,  that  determines  the  effect  of  compliance  with  the  subordination,  the  condition.  
Each  of  these  parts  requires  a  different  verb  form.  

There  are  two  main  characteristic  forms  for  the  conditional  tense:  the  present  conditional  and  the  
perfect  conditional.  

The  present  conditional  tense  is  formed  as  follows:  

AFFIRMATIVE   NEGATIVE   INTERROGATIVE  

Subject+would/should+infinitive   Subject+would/should  not+   Would/should+subject+  

without  to  of  the  main  verb   infinitive  without  to  of  the   infinitive  without  to  of  the  
main  verb   main  verb  

The  perfect  conditional  tense  is  formed  as  follows:  

AFFIRMATIVE   NEGATIVE   INTERROGATIVE  

Subject+would/should+perfect   Subject+would/should   Would/should+subject+  

infinitive  without  to  of  the   not+perfect  infinitive  without   perfect  infinitive  without  to  of  
main  verb   to  of  the  main  verb   the  main  verb  

If  I  were  you,  I  would  take  up  stretching  exercises  as  soon  as  possible  

“If  I  were  you”  is  the  conditional  clause,  and  “I  would  take  up  stretching  exercises  as  soon  as  possible”  
is  the  main  clause.    

If  I  had  known  my  rehabilitation  lasted  so  long,  I  would  have  set  my  appointments  earlier  
in  the  day  

“If  I  had  known  my  rehabilitation  lasted  so  long”  is  the  conditional  clause,  and  “I  would  have  set  my  
appointments  earlier  in  the  day”  is  the  main  clause.  

Note  that  the  conditional  verb  form  is  used  in  the  main  clause.  

The  conditional  clause  can  come  before  or  after  the  main  clause,  but  we  often  separate  them  with  a  
comma  when  the  conditional  clause  comes  first.  The  “if”  can  be  omitted  in  the  subordinate  clause;  
but  then  the  subject  and  verb  are  inverted.  

Were  you  in  my  shoes,  wouldn’t  you  be  complaining  about  your  luck?  

Had  they  been  in  a  rehab  programme,  their  healing  processes  would  have  been  
dramatically  reduced  
Types  and  use  of  conditional  sentences  

Type  0  conditional  sentences  

This  type  is  used  to  talk  about  things  that  always  are  true  (including  general  truths).  The  basic  verb  
tense  combination  for  this  Type  0  conditional  sentence  is:  

If  +  simple  present  +  simple  present  

If  you  apply  electrostimulation  to  a  person,  muscles  extend  and  flex  involuntarily.  

If  you  gain  too  much  weight,  the  joints  in  your  lower  limbs  are  under  much  more  stress  

If  you  don’t  stretch  your  muscles  after  exercising  them,  they  get  sore  

However,  there  can  be  variations  of  this  basic  form.  In  the  conditional  clause  and  in  the  main  clause  
any  of  the  present  tense  forms  (present  continuous,  present  perfect  simple  or  present  perfect  
continuous)  may  be  used  (instead  of  the  present  simple):    

If  you  are  lifting  heavy  weights  for  a  long  time,  your  muscles  get  overstressed  

If  you  have  forgotten  to  take  your  pills  one  day,  do  not  try  to  compensate  it  with  a  double  
dose  the  day  after  

In  the  main  clause  we  can  also  use  the  imperative  instead  of  the  present  simple:  

If  you  feel  you  can  stand  on  your  right  foot,  do  it  

Type  1  conditional  sentences  

This  second  type  of  conditional  sentences  is  used  to  talk  about  future  situations  that  the  speaker  
thinks  are  likely  to  happen.  As  they  involve  an  actual  future  situation,  the  basic  verb  tense  
combination  for  this  Type  1  conditional  sentences  is:  

If  +  simple  present  +  simple  future  (will):  

If  a  new  procedure  comes  out  soon,  I  will  use  it  on  you,  Mrs.  Smith.  Don’t  worry  

If  scientific  evidence  proves  ice  treatments  damage  skin  tissues,  I  will  prevent  my  
students  from  using  them  

However,  there  can  be  variations  of  the  basic  form.  As  was  the  case  for  Type  0  conditional  
sentences,  in  the  conditional  clause  any  form  of  present  tense  may  be  used  (present  continuous,  
present  perfect  or  present  perfect  continuous)  instead  of  the  present  simple.    

If  she  has  agreed  to  fulfill  her  routines,  she  will  not  disappoint  you  

If  she  is  feeling  better,  she  will  be  able  to  start  using  her  crutches  soon  

Modals  can,  may  or  might  in  their  present  forms  are  also  possible.  

If  you  pull  your  muscles  for  too  long,  you  may  suffer  a  serious  injury  
But  variations  may  also  occur  in  the  main  clause;  instead  of  the  simple  future,  any  other  future  verb  
forms  (future  continuous,  future  perfect  simple  or  future  perfect  continuous)  may  be  used.    

If  we  finish  this  course,  we  will  have  completed  a  full  training  programme  on  special  
patients  

If  they  discontinue  their  routine  now,  they  will  be  regretting  it  for  a  long,  long  time  

Type  2  conditional  sentences  

This  type  is  used  to  talk  about  future  situations  that  the  speaker  thinks  are  possible  but  not  
probable  or  to  talk  about  unreal  situations  in  the  present.  The  typical  Type  2  conditional  sentence  
will  be:  

If+past  simple+present  conditional  tense  

If  you  all  studied  harder,  you  would  pass  the  anatomy  exam  

If  I  were  you,  I  would  not  hesitate  about  using  a  walking  stick  

If  I  were  a  student  again,  I  would  certainly  focus  my  practices  on  special  populations  

This  is  the  basic  form  of  Type  2  conditional  sentences,  but,  again,  there  are  possible  variations.  In  
the  conditional  clause  the  past  continuous  may  be  used  instead  of  the  past  simple.    

If  I  were  suffering  headaches  for  so  long,  I  would  definitely  go  and  see  my  GP  

Variations  are  also  possible  in  the  main  clause,  where  “could”  or  “might”  may  be  used  instead  of  
“would”.  

If  I  knew  your  profile,  I  could  also  see  your  hip,  Mr.  Hartmann  

“Could”  instead  of  “would”  expresses  ability  

If  she  hurt  her  right  ankle  last  week  and  still  cannot  walk,  she  may  suffer  a  sprain  

“May”,  in  this  case,  expresses  possibility  rather  than  certainty  

The  continuous  conditional  form  may  also  be  used  in  the  main  clause.  

If  my  knee  were  fully  recovered,  I  would  be  playing  tennis  again  this  weekend  

Type  3  conditional  sentences  

This  type  is  used  to  talk  about  past  situations  that  didn't  happen;  thus,  they  become  impossible  
actions  in  the  past  since  they  cannot  be  reversed.  The  typical  Type  3  conditional  sentence  structure  
will  be:  

If  +  past  perfect  +  perfect  conditional  (would  have)  

If  she  had  known  that  in  advance,  she  would  not  have  wasted  a  minute  before  going  for  
rehabilitation  
This  is  the  basic  form  of  the  third  type  of  conditional  sentence,  but  there  is  a  range  of  possible  
variations.  In  the  conditional  clause  the  past  perfect  continuous  may  be  used  instead  of  the  past  
perfect  simple.  

If  I  hadn’t  been  wearing  the  seatbelt,  my  cercival  injuries  would  have  been  even  more  
serious  

If  you  hadn’t  been  seeing  your  PT  at  that  time,  she  wouldn’t  have  found  out  about  your  
kyphosis  

In  the  main  clause  the  continuous  form  of  the  perfect  conditional  can  be  used  instead  of  the  simple  
perfect  conditional.    

If  you  had  had  a  fracture,  you  would  have  been  screaming  in  pain,  so  it  must  have  been  
something  else  

When  we  are  not  sure  about  something  having  been  possible  or  about  a  certain  ability,  “could”  or  
“might”  instead  of  “would”  are  also  possible  in  the  main  clause.  

If  he  had  been  diagnosed  before,  he  might  have  recovered  much  earlier  

If  the  MRI  had  been  properly  prescribed,  I  could  have  treated  your  ATM  joint  instead  of  
your  neck  

   
Exercise  1.  Use  a  word  from  column  A  to  fill  the  first  blank  in  each  sentence  and  a  word  from  
column  B  to  fill  the  second  blank.  Change  the  verbs  to  the  correct  forms.    

A   B  

Be   Be  

Injure   Injure  

Come  down   Win  

Stretch   Finish  

Lift   Happen    

Go   Have    

Pull   Make    

See   Twist      

Study   Skip  

Follow     Change    

1. If  the  rehabilitation  had  __________  well,  he  __________  back  at  home  by  now.    

2. If  he  hadn’t  __________  his  leg,  he  __________  this  year’s  championship.    

3. If  Jane  hadn’t  __________  his  quadriceps,  she  __________  the  marathon.    

4. If  I  had  __________  the  MRI  results,  I  __________  your  treatment.    

5. If  I  ____________  for  the  Anatomy  exam  properly,  I  would  not  have  __________  such  a  stupid  mistake.    

6. If  he  __________  younger,  he  would  have  probably  __________  such  a  long  treatment.  

7. If  she  __________  with  the  depression,  she  would  have  __________  an  uneventful  recovery.    

8. If  he  __________  the  PT  treatment  as  prescribed,  none  of  this  __________.    

9. If  he  _____________  before  the  race,  his  hamstring  __________  after  just  two  miles  running.    

10. If  she  __________  that  weight  months  ago,  her  elbow  ___________  and  she  would  be  in  good  shape.