A Deeper Look at a Physiotherapist’s Role in Trauma Recovery

Originally written 23/04/2023

Physical pain is often experienced by individuals with PTSD, but could physiotherapists play a deeper role in their recovery? Due to changes in the nervous system caused by traumatic events, those affected may experience pain, muscle tension, and physical sensations that act as reminders of their trauma. Here, I outline some of the ways I work with clients who have pain and PTSD, differing slightly from traditional physiotherapy and exercise approaches.

Proprioception and Body Awareness
Proprioception refers to our sense of body position in space—a key component of balance and bodily awareness. Trauma can impact the brain's spatial awareness, leading to sensations of dissociation that disconnect individuals from their bodies. Dissociation, a protective response of the nervous system, allows for emotional numbness but often results in physical numbness as well. Reconnecting with bodily awareness can be challenging and emotional, so a physiotherapist with some training in psychotherapy can provide a supportive approach.

Breathing as Interoception and Nervous System Regulation
Breathing is a primary form of interoception (internal body awareness) and a gateway to nervous system regulation. It also plays a critical role in acid/base balance, which is foundational to overall body function. Physiotherapists bring a unique understanding of the biomechanics and physiology of breathing.

Anxiety and panic, common in those with PTSD, can make physiological breathing feel unfamiliar or uncomfortable. By learning about and practicing physiological breathing, individuals can:

• Better tolerate internal sensations (interoception)
• Build skills for emotional regulation
• Develop a greater sense of control over sensations associated with changes in breathing

Relaxation and Eccentric Muscle Control
Relaxation and muscle lengthening are important for managing baseline muscle tension. Many people are less familiar with techniques for relaxing and reducing activation in specific muscles, even though stress often manifests as tension, such as in the neck and shoulders. PTSD can cause hyperarousal, where the body remains in a heightened state of readiness, leading to persistent muscle tension.

Motor Pattern Education and Movement Diversity
Motor pattern education focuses on how we move. Often, our most practiced movements become habitual, relying on "favorite" muscles or patterns. However, as with financial planning, diversity is important. To change these patterns, mindful movement and sensation training can help by:

• Enhancing focused attention and interoception
• Reducing repetitive movement patterns, which may help prevent overuse injuries
• Supporting core activation and functional movement

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By Tessa Rose Gillespie

References:

1. 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. 2. Bremner, J. D., & Vermetten, E. (2001). Stress and development: Behavioral and biological consequences. Development and Psychopathology, 13(3), 473–489. https://doi.org/10.1017/S0954579401003042
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4. 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
5. Shin, L. M., Rauch, S. L., & Pitman, R. K. (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals of the New York Academy of Sciences, 1071(1), 67–79. https://doi.org/10.1196/annals.1364.007
6. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Viking.