“Just Relax?” Meeting with Trauma in the Physical Therapy Setting

Written by Talli Rosenbaum, MSc

In his seminal book “The Body Keeps the Score,” trauma expert Dr. Bessel van der Kolk states “the ability to feel relaxed in one’s body requires the emotional experience of safety.”

Physical therapists (PTs) who provide body-based treatment, particularly interventions that require the patient to be passive and relaxed, need to offer a physically and emotionally safe environment. Yet, individuals who experience ongoing symptoms of arousal and hypervigilance resulting from trauma will not feel safe if asked to “just relax and let go”. Being on guard and ready to react when necessary are mechanisms that have allowed trauma survivors to endure, and asking them to give up those defenses and relinquish control will further decrease their sense of safety.

Physical therapists are not mental health care providers and do not directly treat the emotional distress that patients bring with them to treatment. However, PTs treat the whole person, and not just the body. PTs should, therefore, be informed about trauma, be sensitive to the needs of patients who have experienced trauma, have tools to provide patients with a collaborative approach that best identifies and addresses symptoms such as anxiety and emotional reactivity, and know how to refer and work with mental health care providers.

Trauma is an unusual, life-altering event, which is extremely distressing and potentially life threatening. The lifetime prevalence of traumatic life events is estimated to revolve around 50–90% around the world.

What makes an event traumatic is that it usually elicits a response of overwhelming fear, helplessness and horror, and sometimes, shock and dissociation. Initial reactions to trauma can include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, physical arousal, and blunted affect. These are normal reactions to trauma and most people recover.

There are some, however, who go on to experience ongoing symptoms, and about 5-10% of individuals will develop PTSD (Post Traumatic Stress Disorder) whereby the symptoms of stress that are normative in the immediate aftermath of a traumatic event, persist long after the threat has been removed. There are a variety of factors – biological, psychological and social – that inform why some individuals develop PTSD and others do not. According to Dr. Rachel Yehuda, a pioneering researcher in the field of PTSD,  “Long-lasting responses to trauma result not simply from the from the experience of fear and helplessness but from how our bodies interpret those experiences.”

Trauma symptoms affect people’s experience of themselves and those around them. The alterations in their nervous system lead to dysregulated behaviors, which affect social and professional relationships. People report difficulty concentrating, sleep disturbances and physical symptoms such as chronic pain, including pelvic pain and headaches. Self-destructive behaviors such as substance abuse are common and PTSD is likely to lead to, or exacerbate chronic medical conditions.

As physical therapists treat many conditions related to trauma, it is therefore likely that physical therapy professionals will interact with individuals who present with post-traumatic stress symptoms, or with PTSD. The high prevalence of past trauma or abuse in the general population makes it likely that a percentage of your patients may suffer from trauma symptoms.

Being aware of patient’s history, as well as knowing how to recognize and address these symptoms will improve your patient’s feelings of safety, and ultimately, treatment outcomes. In this webinar designed for physical therapists, participants will learn the basics of trauma, how various types of trauma can affect people, and how trauma can affect how your patient interacts with you in therapy. General physical therapists as well as specialists in women and men’s health, where more invasive and intimate procedures are routinely provided, are invited to view this webinar, and to learn skills for ensuring patients’ emotional and physical health in the physical therapy setting.