Whilst physical pain is common among people suffering with PTSD could physiotherapists play a deeper role in recovery? Due to the significant changes to a person’s nervous system, emotionally traumatic events can result in pain, muscle tension and other physical sensations acting as reminders to their previous trauma. Below I’ve outlined some ways in which I work with clients who have pain and PTSD in a slightly different way to traditional physiotherapy/exercise approaches.
Proprioception is a concept referring to our body’s position in space. Physiotherapists are trained to facilitate proprioception for better balance and bodily awareness.
In the case of trauma, the part of the brain responsible for spatial awareness can be affected. When a patient experiences sensations of dissociation. They are creating a disconnect from their body. This is effective for emotional numbness with collateral physical numbness. It can make it harder for someone to be aware of where their body physically is. This can impact balance as well as movement generally.
Starting to learn about their body awareness, could be very emotional or triggering. Dissociation is a protective mechanism of the nervous system responding to a perceived threat/s. This is why a physiotherapist with some psychotherapy education can be helpful to ease into the experience gently.
Breathing is a form of interoception (sensory experience inside the body) and therefore a gateway to nervous system state regulation. Furthermore, it plays a significant role in acid/base balance which underpins regulation of all the body’s functions. Physiotherapists are unique due to learning about the physiology and biomechanics of how the body breathes.
Anxiety and panic can be common body symptoms that persist in people with PTSD. Learning about normal physiological breathing can assist with:
Better tolerating internal sensations (interoception),
Building skills for emotion regulation
Locus of control over sensations associated with breathing changes
Relaxation and eccentric muscle control can play an important role in reducing baseline muscle tension. Most people are much less aware of how to relax, lengthen and reduce activation in specific muscles.
Think about the tension held in your neck and shoulders. Emotional and psychological stressors can activate low level muscle activity in preparation to fight or flight as needed. Hyperarousal, experienced in PTSD sufferers, can mean their systems are always primed and experience this more often.
Motor pattern education is about the way we move. Simple movements we practise often can be done on autopilot using our ‘favourite’ muscles/patterns. Diversity in movement is important and changing our patterns, requires improved interoception. This promotes:
Focused attention, develops interoception and position of self
A combination of breathing and motor pattern education may facilitate benefits to core activation, movement and function. This is important for balance.
Reduces repetition of movements which may have an effect on preventing overuse injuries
If this piqued your interest or you want to learn more, sign up to our June Workshop: Physical therapies’ role in mental wellbeing.
1. Blaauwendraat, C. & Gyllensten A. L. (2017) One-year follow-up of basic body awareness therapy in patients with posttraumatic stress disorder. A small intervention study of effects on movement quality, PTSD symptoms, and movement experiences, Physiotherapy Theory and Practice, 33:7, 515-526, DOI: 10.1080/09593985.2017.1325957
2. Kearney BE and Lanius RA (2022) The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Front. Neurosci. 16:1015749. doi: 10.3389/fnins.2022.1015749
3. Meuret, A. E., Ritz,T., Wilhelm, F.H., Roth, W.T. & Rosenfield, D. (2018). Hypoventilation Therapy Alleviates Panic by Repeated Induction of Dyspnea. Biol Psychiatry: Cogn Neurosci Neuroimaging 3:539–545. Doi: https://doi.org/10.1016/j.bpsc.2018.01.010
4. Van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. Penguin Random House, UK.