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Patients’ physical incompetence is a feature of many clinical interactions; the challenges it presents are not only technical but also interactional. This paper examines how interpretations and interactional consequences of physical incompetence are dealt with during stroke physiotherapy. A conversation analytic approach was used to examine video‐recorded treatment sessions. Analysis demonstrated that managing physical incompetence forms an important element of the organisation of these interactions. Through their conduct, patients and therapists limit and counter its various negative implications, including those which attribute it to failure of a patient's efforts, co‐operation and personal competence, and failure of therapy. Understanding orientations to incompetence and their influence upon interactions provides some explanations, or ‘good reasons’, for certain features of clinical interactions that have …