In healthcare, we strive to treat every person holistically, not just the injury in
isolation. A person is more than just an ankle or a back. Patients are people with
frustrated employers expecting them to return to work. They are people with families who
expect them to cook, take their children to school and play with them after. Maybe they are
people with impatient coaches who expect them to return to sport. The people in our lives
are not always as understanding and supportive as we want them to be. Often we hear stories
similar to these where patients are not given the environment or time they need to heal and
family members or employers often tell our patients that they are “over dramatic” and that
the pain is “in their head”. Therefore, your physiotherapist may be using the
biopsychosocial model when attending to injuries and pain.
Biopsychosocial is simply broken down as:
biology (your physical health, actual or potential tissue damage due to injury and genetic
factors)
psychology (coping mechanisms, perceptions, previous pain experiences, expectations for
recovery)
social/environmental (home/work environment, stress)
Even if you do not realise it, pressure from work, fear of movement, poor expectations of
recovery, lack of understanding of one’s injury etc. can be a factor contributing to one’s
pain experience and may affect healing.
The mind has a significant role in both the presentation and progression of injury and the
recovery process. Coping skills, beliefs about one’s injury, work or home stress may delay
recovery while positive environments and ideas can enhance recovery.
Each session is an opportunity for the patient to engage with their physiotherapist and
allow the physiotherapist to understand the influence of the patient’s context – Stress,
anxiety, fear which may limit the patient from performing otherwise normal daily activities
and participate in daily life. While every physiotherapist will perform an evaluation to
assess for physical changes such as; muscle power, joint range of motion, pain, movement
patterns and the impact of inflammation or delayed healing, they will also ascertain which
activities you would otherwise perform in the absence of pain or injury in order to better
formulate treatment goals and guide treatment choices.
Each person has something in which they participate, either big or small which requires a
multitude of activities and movements which, once hampered by pain or injury, participation
may not be so simple. Losing control of our lives and feeling powerless to pain or injury
can change our beliefs about what we can accomplish in our day to day lives. Everyone will
have arrived at the physio’s rooms with some expectations and beliefs about their injury and
it is the role of the physiotherapist to discuss openly with their patient about treatment
goals. The patient should always be allowed to participate in their goal setting and
treatment plan together with advice and input from their physio and arrive at a mutual
understanding of how best to progress in a way that is realistic and achievable.
Sean Croxford
Physiotherapist ( KPSMC )