Trauma can refer to any experience where a person feared for their safety, the safety of another, experienced extreme stress, or any situation that was overwhelming, scary, or dangerous. This includes car accidents, natural disasters, violence, abuse, neglect, or being deprived of basic needs, to name a few. In these experiences a person’s nervous system is pushed into ‘survival mode’, which has large and sometimes lasting impacts on physical, emotional, spiritual, and mental well-being and is shaped by a person’s sociocultural context and history. Trauma-informed physiotherapy takes all of this into consideration from assessment through treatment.
Trauma-informed physiotherapy also recognizes that a patient’s trauma history can impact their physical body, whether that is the physical manifestations of trauma (including developing chronic pain, experiencing emotional distress or avoidance, having decreased mobility and increased tension, and being more susceptible to future injury), injury from a trauma, or past events that impact the patient’s well-being but are unrelated to their reason for seeking physiotherapy. Trauma-informed physiotherapy can address this by providing a safe, supportive, confidential, individualized, and holistic approach to care, taking into account your physical symptoms and your emotional and psychological well-being.
Trauma-informed physiotherapists approach patients with empathy and a deep understanding of the effects of trauma on the body and mind. They have specialized training and experience working with trauma survivors and prioritize safety, support, trust, transparency, and patient autonomy. They work collaboratively with patients and adapt to their unique physical, mental, and emotional needs. Trauma-informed physiotherapists use a specialized approach that recognizes and responds to the effects of trauma.
The first sessions with a trauma-informed physiotherapist are focused on the patient and creating a safe and supportive environment where trust can be built over time. Beginning this process can include asking about any triggers or difficulties and taking time to understand the patient as a whole person, including their trauma history, support systems, healthcare experiences, and understanding any other factors that might be affecting their physical, mental, spiritual, and emotional health. Usually a brief physical exam is done, but is not always necessary in the first session. From all this information, the trauma-informed physiotherapist will work with the patient to create an initial treatment plan tailored to their individual needs and goals with interventions to manage symptoms and regain function, along with resources for self-care or additional care.
In treatment sessions, the focus is on the patient, creating safety, and fostering an environment where the patient is in control and is empowered to be involved with their health. The physiotherapist will use a variety of evidence-based treatment techniques to treat physical issues such as manual therapy, exercise therapy, and electrochemical modalities, and may incorporate additional techniques such as guided relaxation, mindfulness, body awareness, or using nervous system regulation tools. Throughout the treatment process, the physiotherapist will be transparent about treatment plans and reasoning, provide choice, build the skills of the patient, alter the treatment environment to mitigate triggers, use trauma-sensitive language, provide opportunities for the patient to express needs, and uphold the highest standards of confidentiality and privacy.
Both physical healing and healing from trauma are complex and ongoing processes. As such, the physiotherapist can be expected to be non-judgmental, compassionate, understanding, supportive, and committed to their patients. They will utilize their specialized training and experience and provide ongoing support, guidance, and resources, and collaborate with the patient to adjust treatment strategies and goals as needed to move toward healing in a safe, effective, and empowering way.