It’s a no-brainer that we always want to make decisions to better the patient, and the most important thing we can do is to treat the person, not the injury.

Authored by Nick Cross, Managing Director and Senior Physiotherapist at Melbourne CBD Physio

A patient’s problem will not simply be solved by addressing the body alone. This seems obvious, but it’s a common pitfall to focus solely on treating the musculoskeletal pathology without considering all of the other human elements that make us human. 

We recently had the pleasure of discussing the biopsychosocial components of healthcare with Sports Psychologist David Williams, who works with Geelong Football Club and in private practice at Strongest Psychologist. 

The biopsychosocial model is a model that looks at the interconnection between biology, psychology, and socio-environmental factors.

All three factors play a role in a patient’s journey through health care. A more traditional model of medicine might be to address exclusively biology through just looking at the body, or via manual treatments, medications or surgery. This however ignores the psychological and social factors that affect a patient’s health such as their motivation to get better, financial access to health care and perceptions of physiotherapy as well as their own perceptions of recovery. 

The interconnection of biological, psychological and socio-environmental factors in pain and injury. Source: Unknown

How does the biopsychosocial model apply to physiotherapy? 

Physiotherapists with years of clinical experience and postgraduate qualifications have highly tuned clinical reasoning and pattern recognition when it comes to identifying certain pathology. They have the ability to land on an accurate diagnosis and prescribe a treatment plan optimal to each individual. These physiotherapists can identify complex injury, associated pain types and know what treatment modalities work best for certain presentations. However, when a patient does not respond as you would presume they would, our chat with Dave Williams has reminded us to stop and consider what other factors are contributing to our patient’s progress, other than what is happening at the site of their pain or injury. 

It is a common pitfall to dive straight into treating a person with a clinical intervention. As health providers, we need to make sure that we are asking questions to address the patient’s psychology and socio-environmental factors, as well as their body. Addressing all three will result in an optimal health outcome. 

Sports Psychologist David Williams, who works with Geelong Football Club and in private practice at Strongest Psychologist presenting on taking a human performance perspective on client care. Source: Melbourne CBD Physio

If we think of physiotherapy as a road trip, patients are sitting in the driver’s seat and their physiotherapist is the roadmap. Physios are here to help as much as we can, provide a plan, guidance, support and knowledge but we lean on the patient to give us a guide on how we can best help them. Treatment ultimately depends on what goals the patient wants to achieve, whether that be to alleviate pain, get back to everyday movements, or improve high performance. We need to ask our patients the right questions that encompass their body, mental state and social factors to make sure we’re giving them the best roadmap for them. 

Asking the right questions helps us make sure that our patient is ready for intervention and gives us confidence to prescribe treatments on varying points of the physiotherapy timeline. Here’s three questions your health professional should be asking you to help set you up for success:

  1. What would you like from me today?
  2. How do you perceive this problem will get better?
  3. What is a successful outcome for you? How can we track and measure this?
  1. “What would you like from me today?”

This is a forward question that can be used in the early parts of a session. Instead of assuming, it helps the health provider quickly establish what the patient is looking for in the session. Some common session goals might include pain relief, a second opinion on a diagnosis, a simple explanation of why the problem is occurring, or even why other modalities may or may not have worked in the past. For some patients, their biggest need might actually be support or for their pain/condition to be seen and validated. Instead of immediately running down the diagnosis line and straight into a treatment, asking this question at the beginning of the sessions helps us establish mutual goals for ongoing care.

2. “How do you perceive this problem will get better?”

Asking this question might seem in conflict with the point of seeking specific health care advice, but no one knows the patient better than themselves. Asking how the patient thinks the problem could be resolved gives us great insight to their goals, past history and self management strategies. It also gives both the patient and clinician a chance to discuss treatment modalities and their beliefs and expectations around why one would be more appropriate than another. 

3. What is a successful outcome for you? How can we track and measure this?

We believe this is a great question to help steer away from using “pain vs. no pain” as a sign of intervention success. If someone is in pain, the most common goal is to address it and to see it resolve. But as we learnt from our talk with Dave Williams, pain and the psychology of pain is such a complex system that involves so many intertwined biopsychosocial factors. 

Pain is not always a true indication as to whether someone is progressing in their physiotherapy treatment as painful symptoms in certain presentations can often be very slow to resolve. In leading physiotherapy clinics such as Melbourne CBD Physiotherapy, we firmly believe that our practitioners need to be led by objective measures to show if their intervention has worked and is progressing towards the goal. Showing that progress is being made through objective measures can also steer the conversation away from pain and into performance, no matter how big or small the patient’s goal may be.

About Nick Cross

Nick Cross is the Managing Director and Senior Physiotherapist at Melbourne CBD Physiotherapy. Nick has extensive experience in elite sport and has consults for many high profile athletes. Nick tours nationally and internationally with Athletics Australia working with the country’s top performing track and field athletes.

Nick is also the chair of the Victorian Sports and Exercise Committee and National Board Member of the Sports and Exercise Group. Both of these positions are held as part of the Australian Physiotherapy Association. Nick is also an active researcher through the La Trobe Sports Exercise and Medicine Research Centre who has special interests in foot and ankle, hamstring and pelvic injuries.

BlogThe 3 Questions We Should Ask: Taking a Holistic, Biopsychosocial Approach to Physiotherapy
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