Trauma-Informed Physiotherapy Care: A Pathway to Healing and Recovery

“Trauma is not what happens to you; it is what happens inside you as a result of what happens to you”

~ Gabor Mate, MD

When we think of physiotherapy, we often imagine the physical healing process—rebuilding strength, mobility, and function after an injury or surgery. But for many people, especially those who have experienced trauma whether ‘major’ trauma or trauma with a small ‘t’ to paraphrase Dr. Gabor Mate, physical recovery can be deeply intertwined with emotional and psychological factors. Trauma-informed physiotherapy care recognizes this connection, offering a more compassionate, holistic approach to treatment that addresses not just the body, but also the mind and emotional well-being.

Understanding Trauma and Its Impact on the Body

Trauma can take many forms. It might stem from a single significant event, such as an accident, assault, or natural disaster, or from more chronic sources like childhood abuse, domestic violence, or prolonged medical issues. Even seemingly minor experiences, such as a lonely childhood or a negative healthcare encounter, can leave lasting imprints on the nervous system. Trauma can affect how a person experiences pain, responds to treatment, and navigates the rehabilitation process. The body and brain are often in a heightened state of alert after trauma whether it is trauma with a capital T or small ‘t’. This can manifest in various ways during physiotherapy sessions, including:

• Hypervigilance: The client may be overly sensitive to touch or movement, fearing that even a gentle intervention could cause harm.
• Muscle Guarding: The body may unconsciously tense up, protecting itself from perceived threats, which can hinder mobility and make it harder to progress in rehabilitation.
• Fear of Re-injury: Trauma survivors often carry a heightened fear of re-injury, which can prevent them from fully engaging in exercises or following through with their rehab plan.
• Emotional Responses: Trauma can trigger unexpected emotional reactions during physical therapy, such as anxiety, dissociation, or even flashbacks, especially if the therapy involves the body parts related to the trauma.

When Trauma Becomes a Barrier to Rehabilitation

When a person with a history of trauma seeks physiotherapy, their experience can be influenced by emotional and psychological barriers that make the rehabilitation process more challenging. Some of the common barriers trauma survivors may face include:

• Trust Issues: Trauma survivors may find it difficult to trust healthcare professionals, especially in situations where they feel vulnerable, such as during manual therapy or exercises requiring close physical contact.
• Avoidance: Fear of pain, re-injury, or triggering memories of past trauma can lead clients to avoid certain movements or exercises. This can slow down progress and limit the effectiveness of treatment.
• Difficulty Communicating Pain: Clients with trauma histories may struggle to express their pain levels accurately. They may either downplay their symptoms or have difficulty distinguishing between physical pain and emotional discomfort.
• Limited Coping Strategies: Without proper emotional support, clients may feel overwhelmed by the rehab process and find it difficult to stay motivated, particularly when treatment is long-term or progress is slow.

The Importance of Trauma-Informed Care in Physiotherapy

Trauma-informed physiotherapy care recognizes these barriers and seeks to create a safe, supportive environment that prioritizes the client’s emotional and psychological needs alongside their physical recovery. A trauma-informed physiotherapist is sensitive to the fact that each client brings a unique history and set of experiences that can influence their rehabilitation journey. Here are some key aspects of trauma-informed care in physiotherapy:

• Creating a Safe Space: A trauma-informed physiotherapist works to establish an environment where the client feels safe, both physically and emotionally. This may involve explaining each step of the treatment process in detail, offering choices about treatment options, and asking for consent before physical contact or adjustments.
• Building Trust: Trust is critical in any therapeutic relationship, but it’s especially important for trauma survivors. A physiotherapist can build trust by listening actively, respecting the client’s boundaries, and maintaining transparency about treatment plans and goals.
• Pacing and Patience: Trauma survivors may need more time to adjust to treatment, especially if they experience heightened sensitivity to pain or fear of movement. A trauma-informed physiotherapist will pace sessions according to the client’s comfort level and ensure that the exercises are manageable and non-threatening.
• Collaboration and Empowerment: Instead of a top-down approach, trauma-informed care emphasizes collaboration between the client and the physiotherapist. By involving the client in decision-making and respecting their autonomy, the therapist empowers the client to take an active role in their own recovery.
• Addressing Emotional Reactions: If a client has an emotional response during treatment, a trauma-informed physiotherapist responds with empathy and understanding, offering support and allowing the client to process their feelings. Recognizing when a client needs to pause or switch focus can prevent re-traumatization and support overall recovery.
• Holistic Consideration of Pain: A trauma-informed approach also recognizes that pain is not just a physical sensation but can be influenced by emotional, mental, and psychological factors. By adopting a biopsychosocial model, physiotherapists can address the full spectrum of pain and help clients find coping mechanisms that support both their mental and physical well-being.

Why Trauma-Informed Care Matters When Selecting a Physiotherapist

When choosing a physiotherapist, it’s essential to find someone who is knowledgeable about trauma and its potential impact on rehabilitation to ensure that both the body and the mind are cared for during the recovery process. A trauma-informed physiotherapist can make the difference between a client feeling supported and empowered versus feeling overwhelmed or retraumatized. They understand the complexities of pain, anxiety, and emotional responses that can arise during physical treatment, and they have the skills to guide clients through those challenges.

If you or someone you’re arranging care for has a history of trauma, it’s important to communicate this to your physiotherapist. This allows them to tailor the treatment to your specific needs and ensure that your care plan respects both your physical and emotional boundaries.

How Mindset Rehabilitation Integrates this Approach

At our practice, all of our physiotherapists and coaches are dedicated to providing trauma-informed care. We understand that past trauma—whether minor or major—can impede the rehabilitation process. Our team is trained to create a safe, supportive, and empowering environment for every client, ensuring that emotional and psychological needs are addressed alongside physical recovery. By incorporating trauma-informed principles into every session, we help clients overcome barriers to rehabilitation and achieve their goals with compassion and understanding.

The home is an ideal safe space where we strive to interact with our clients in a non-intrusive, respectful way. Our clients choose the space they prefer to receive treatment in whether it is their home, a community centre, gym, or outside in nature. Remember, trauma-informed physiotherapy care is not just about healing the body. It’s about recognizing the profound connection between physical, emotional, and psychological health. By holding a safe, supportive, and client-centered environment, our physiotherapists foster opportunities for our clients to experience true holistic healing.