A New Type of Physiotherapy

Physiotherapy Extends Beyond Movement

As physiotherapists we are constantly bombarded with information, education and courses that focus on movement. Many physiotherapists centre their practice around how to best observe, correct and reinforce appropriate movement patterns. Physical therapists are considered movement experts and are able to diagnose conditions and prescribe exercise to improve pain and/or dysfunction. Through movement physical therapists are able to help individuals vastly improve their quality of life. However, the assessment of movement or specifically, biomechanics, is only a piece of the proverbial pie that encompasses human systems. To truly provide care to individuals we must peel back the layers and understand the neuropsychological factors that influence behaviour and subsequently, movement.

Why Understanding Behaviour is Important

Behaviour is the way in which we act or conduct ourselves and is influenced by our previous lived experiences. From a physical therapy perspective we can look at behaviour through the lens of function or inversely, dysfunction. An individual’s ability or inability to perform a certain task can significantly impact their emotional and physical behaviour especially if the task brings intrinsic joy or positive self-value. For example, Kirby is an avid runner and participates socially in a run club twice a week. However, recent ankle pain prevents her from participating on runs with the club. If approached purely from a movement or mechanical perspective we can provide a diagnosis and beneficial treatment plan that will help mechanically. However, a behavioural approach may elicit information on self-efficacy, self-esteem and most notably, answer the why questions. Why is run club important to Kirby? Why did she choose to seek out physiotherapy services? Physical therapists need to consider the whole person, understand individual behaviour and practice through a multi-systems approach.

The Biopsychosocial Approach

Thankfully, a multi-systems model known as the biopsychosocial model of pain assists practitioners in identifying various influencers of pain. This biopsychosocial approach describes pain and disability as a multidimensional, dynamic interaction among physiological, psychological, and social factors that reciprocally influence one another and may result in complex and/or chronic pain syndromes. Moreover, recent evidence suggests that there is a strong bidirectional correlation between mood disorders (i.e. anxiety, depression), trauma and pain. As chronic pain becomes more prevalent and a larger component of practitioner caseload, physical therapists will need to be equipped academically and emotionally to appropriately treat individuals. Scholastically, physical therapists receive exemplary training in neuromuscular, cardiopulmonary and orthopaedic pathophysiology in regards to pain. However, we require further education that encompasses cognition and emotional distress, psychological vulnerability, and conditioned responses that influence pain experiences and subsequent behaviour. As an evidence-based health profession it is imperative that we follow the literature and provide further education to physical therapists in pain science.