As I have started a study in a rather unknown field of physiotherapy it would be good to write an article on this specialty. While writing the article I soon found out there’s a lot to write about. Excuse my elaborateness.
When you google on psychosomatic physiotherapy/physical therapy you’ll find some stuff on chakra healing, core energy balancing and other pretty alternative therapies. You’ll also find that there are three universities around the world that offer psychosomatic physical therapy as a specialty in their curriculum; Bergen in Norway, Perth in Australia and Utrecht in the Netherlands. If you are so bold as to search for medical evidence it will be hard to find anything under psychosomatic physiotherapy. Most of the evidence is found under the domain of psychology.
My colleagues (when being funny) seem to typify psychosomatic physiotherapy as physiotherapy that revolves around one question: “how do you feel?”. There is truth in this. But psychosomatic physiotherapy goes further than that.
Let’s look at a definition. I could not find one readily available, so I thought one up. Psychosomatic physiotherapy treats physical complaints, but takes into account that psychosocial aspects can hinder or stop recovery. Worst case scenario is even that physical problems occur due to psychological complaints.
Psychosomatic physiotherapists work a lot with unknown and/or unexplained complaints. Now how does this psychosomatic thing work?
When confronted with physical complaints a person will show behavior to improve the situation. You can differentiate between cognitive, behavioral, physical and interpersonal consequences.
Cognitive consequences:
- Extra attention to physical functioning creates heightened awareness to complaints. Whereas distraction takes away this awareness.
- With selective attention a person only experiences something when it fits a certain expectation. For example when you experience a stomach ache you will be alert to anything that happens in your belly. This confirms something is wrong with your stomach.
- Anticipation or self fulfilling prophecy. When someone suffered a heart attach in the past they might think that a pain in the chest is a prelude to another heart attack. This causes anxiety, which in turn can cause pain in the chest. Voila, a vicious circle.
Behavioral consequences:
A person might show either of two behaviors when faced with physical ailments.
- Rest. The thought is that doing too much increases complaints. Doing nothing leads to boredom and despondency. The body weakens even further and a negative vicious cycle occurs.
- Over activity. At the first signs of recuperation a person will become just as active as before the complaints started and therefore causing a relapse. This will create a saw tooth pattern of resting and overloading.
Physical consequences:
A person with complaints will try to avoid certain postures to alleviate pain. Over time these postures can exacerbate instead of alleviate pain.
Interpersonal consequences:
Complaints have influence in the way we interact with our surrounding. We work, have partners, we play and we study. What if this is made impossible due to these complaints? Coping resources in life become less and less. A person becomes agitated. This induces the vicious cycle again.
You might imagine that vicious cycles can also occur when somebody overloads or rests too much due to psychological problems. This can induce physical complaints as mentioned above. In the domain of psychosomatic physiotherapy this has a very high prevalence.
So with all these vicious cycles and psychosocial problems; what do we psychosomatic physiotherapists do? Basically we show people these mechanism and teach them ways of doing things differently. People have to alter their way of living in order to have a sustainable result. You can imagine this to be one of the most complex things to do. The thing to keep yourself interested in the profession.
What are the interventions we use? Relaxation therapy, mindfulness training, biofeedback training, breath exercise therapy, rational emotive behavior therapy and exercise therapy. These therapies are well researched and have a high evidence.
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