A Broader Understanding of pain: Embracing the Biopsychosocial Approach in Physiotherapy

Given the vast scope and many factors that the biopsychosocial approach addresses, some therapists might feel overwhelmed and decide to stick to the more “simpler” approach of “standard” school medicine.

We might think:

– “Yeah, everything is somehow connected anyway.”
– “So, in the end for real, you can’t really say where the pain is actually coming from. That’s not really helpful at all.”

This hard-earned knowledge about the body’s detailed functions, acquired over many years during physiotherapy studies, suddenly seems overshadowed by psychosocial factors. These factors appear to have a much greater influence on our perception of pain than we had previously thought.

It is so convenient to simply treat the body like a machine, as conventional medicine has done for the last 100 years. Fascinated by the successes and inventions of the last century, it made sense for medicine to concentrate on the precise examination of individual parts of the body and thus accumulate a great deal of knowledge. It is only recently that we have begun to zoom out of the details and try to understand the whole again, as it can no longer be denied that the body functions differently to a machine, where individual parts can be replaced at will and on a regular basis. While the human body, like all living things, is in constant exchange with itself and the environment and social and psychological influences can have just as great a real impact on the body as physical factors. It has been found, for example, that social exclusion is processed by the same area of the brain as the physical pain center, so that this “social” pain is, so to speak, not differentiated by the brain in comparison to “real”, physical pain.

So, should we ignore the insights of the past two decades and continue as we have always done?

No, the expanded understanding of pain factors can be a tremendous help, especially for physiotherapists and other body-focused therapists. It allows them to educate patients about their situation more effectively and understand their overall condition much better.

Of course, we primarily address physical tension in the body. However, knowing that the body is controlled by a neurological system that modulates tension and perception is not new. Evaluating these psychosocial factors certainly requires experience. Often, patients are already aware of the stressors affecting their lives and know what they have long wanted to change. Increasing physical activity is often very helpful, but it can also involve other aspects of life that need to be approached with more calmness and mindfulness.

A physiotherapist treats about 600-1000 patients per year. Over ten years, that amounts to 6,000-10,000 different life experiences and stories that contribute to a wealth of experience. The larger this pool of experience becomes, the easier it is to weigh various biopsychosocial factors and understand the personality structures of different individuals.

Initially, it’s crucial to at least start paying attention to these “soft” factors to broaden your perspective and learn. This not only enriches the treatment but also gives the patient a sense of being seen and understood as a whole person.


(Translated from German to English from my old Blog from 2018)