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Trauma-Informed Physical Therapy: Fostering Healing and Empowerment

Trauma-Informed Physical Therapy: Fostering Healing and Empowerment 1920 1080 ResilientRx

Physical therapy is often viewed as a means to recover from injuries, manage chronic conditions, and regain physical function. However, for individuals who have experienced trauma, the journey to physical well-being can be more complex than the physical ailments that they may be facing. Trauma can have far-reaching effects on a person’s physical, emotional, and psychological state, making traditional physical therapy approaches potentially challenging or even re-traumatizing. This is where trauma-informed physical therapy comes into play, offering a compassionate and sensitive approach to healing.

What Is Trauma-Informed Care?

Trauma-informed healthcare recognizes the prevalence of trauma and its potential impact on a patient’s ability to engage in therapy. Nearly 90% of individuals seeking healthcare services have experienced at least one traumatic event in their lifetime, with 20-30% going on to develop PTSD (Al Jowf GI, et al, 2022). These experiences can range from physical or sexual abuse, domestic violence, combat exposure, or natural disasters, which can leave lasting imprints on the mind and body.

The core principles of trauma-informed care focus on creating a safe environment, emphasizing choice and collaboration, adapting treatment approaches, and promoting self-care and coping strategies. By understanding the signs and symptoms of trauma, such as hypervigilance, avoidance behaviors, or emotional dysregulation, physical therapists and other providers, can tailor their interactions and treatment plans to meet the unique needs of each patient. This is no easy task and takes time to develop individually as the provider and the relationship with the patient.

What Does Trauma-Informed Physical Therapy Look Like?

A positive example of trauma-informed physical therapy in action might look like this:

Sarah, a survivor of domestic violence, arrives for her first physical therapy session after sustaining a shoulder injury. The physical therapist greets her warmly and takes the time to explain the treatment process, emphasizing that Sarah has the choice to pause or stop at any time. The PT creates a comfortable space by allowing Sarah to choose where she would like to sit and provides a private treatment room as opposed to out in an open gym in front of other patients and staff.

Throughout the session, the physical therapist maintains open communication, frequently checking in with Sarah and allowing her to guide the pace and intensity of the exercises. If Sarah exhibits signs of distress or discomfort, the PT promptly adjusts the treatment approach or suggests a break. Fostering a sense of control and empowerment helps Sarah build trust and confidence in the therapeutic process.

In contrast, a less-than-ideal interaction might unfold like this:

John, a combat veteran struggling with PTSD, attends a physical therapy session for a back injury. The therapist, unaware of John’s trauma history, proceeds with a rigid treatment plan without considering potential triggers or emotional responses. The PT’s commanding tone and forceful adjustment of John’s body position could inadvertently trigger flashbacks or a heightened stress response, leaving John feeling overwhelmed and unsafe.

Without a trauma-informed approach, the physical therapist may miss critical cues or fail to create an environment that promotes trust and empowerment, potentially hindering John’s progress or even causing further distress.

Why Provide Trauma-Informed care?

Imagine 3 patients, each with a limp. One has a splinter in their foot, the second has sciatica, and the third had a knee replacement 4 weeks ago. They all may appear to have a similar gait, but treatment for each is wildly different because of their underlying root causes. The same is true for patients with trauma. We know that no two individuals are the same, so we must take the time to view them through a holistic lens, every single time.

Research has shown that trauma-informed care can significantly improve patient outcomes and engagement. A study by Reeves in 2015 found that individuals who received trauma-informed care reported a greater sense of safety, trust, and overall satisfaction with their treatment. Although trauma-informed care (specific to physical therapy) has been studied very little, a growing body of research supports the positive impact of trauma-informed approaches on reducing dropout rates and improving treatment adherence among trauma survivors.

Most physical therapists you’ll find are “people persons” and are empaths, so a good PT should naturally incorporate principles of trauma-informed care (Heywood, et al, 2024). However, integrating trauma-informed principles into physical therapy requires ongoing education and training for healthcare professionals. It involves developing a deep understanding of trauma’s impacts, recognizing potential triggers, and implementing strategies to create a safe and empowering environment for patients. 

It Takes A Village

Collaboration with mental health professionals and other members of the interdisciplinary team is essential, and can further enhance the effectiveness of trauma-informed physical therapy, while addressing the physical and psychological aspects of healing. As healthcare providers, it is our responsibility to recognize the profound impact of trauma on an individual’s well-being and tailor our approaches accordingly. By embracing trauma-informed physical therapy, we can foster an environment of compassion, trust, and empowerment, enabling individuals to embark on their healing journey with dignity and resilience.

If you are in need of physical therapy, but need more focused care in a safe and welcoming environment, contact us today, or book an initial evaluation.


  1. Al Jowf GI, Ahmed ZT, An N, Reijnders RA, Ambrosino E, Rutten BPF, de Nijs L, Eijssen LMT. A Public Health Perspective of Post-Traumatic Stress Disorder. Int J Environ Res Public Health. 2022 May 26;19(11):6474. doi: 10.3390/ijerph19116474. PMID: 35682057; PMCID: PMC9180718.
  2. Reeves, E. (2015). A synthesis of the literature on trauma-informed care. Issues in mental health nursing, 36(9), 698-709.
  3. Heywood, S., Bunzli, S., Dillon, M., Bicchi, N., Black, S., Hemus, P., … & Setchell, J. (2024). Trauma-informed physiotherapy and the principles of safety, trustworthiness, choice, collaboration, and empowerment: a qualitative study. Physiotherapy Theory and Practice, 1-16.

Empowerment in Recovery: Self-Efficacy Can Make A World of Difference

Empowerment in Recovery: Self-Efficacy Can Make A World of Difference 1920 1080 ResilientRx

Embarking on a journey of physical rehabilitation to overcome pain or injury is not just a matter of mending the body; it also involves cultivating a mindset that fosters resilience and belief in one’s abilities. In this blog, we delve into the realms of self-efficacy in rehabilitation, explore helpful strategies and the powerful connection between the mind – all of which could be a game changer!

What is Self-Efficacy?

Self-efficacy is one’s belief in their ability to succeed in specific situations or accomplish a particular task [1]. It is having confidence in yourself and your skills. Imagine you’re attempting to learn a new sport, such as rock climbing. If you believe in your ability to master the techniques (by practicing and getting coached) despite initial struggles, that reflects higher self-efficacy. However, if you doubt your capability to improve and feel overwhelmed by the challenge, harboring thoughts like “I’ll never be able to do this,” that indicates lower self-efficacy. This belief in your potential directly impacts how you approach the goals of scaling tougher routes, navigating roadblocks  like fear or fatigue, and persevering when plateaus arise in your skill development. Persistent pain or an injury is very similar. They require nurturing self-efficacy – having courage to try, make mistakes, learn and grow despite uncertainties.

Mindset & Its Role in Healing

A positive mindset and fostering self-efficacy can play a pivotal role in the healing process. Numerous research studies have demonstrated the powerful influence our mental state and beliefs can have on physical outcomes. In a study published in The Journal of Pain, researchers found that patients with higher levels of self-efficacy experienced less pain and disability after undergoing surgery compared to those with lower self-efficacy [2]. This suggests that believing in one’s abilities to manage pain and recovery can positively impact healing trajectories.

Another study in the Scandinavian Journal of Pain examined the effect of cognitive behavioral therapy (CBT) aimed at boosting self-efficacy beliefs in individuals with persistent (aka chronic) pain [3]. The results showed patients who received CBT reported significantly less pain, disability and depression compared to control groups. Cultivating a mindset focused on coping capabilities rather than perceived limitations facilitated better quality of life.

The mind-body connection is strong. Mental practices like positive self-talk, imagery, and relaxation techniques can modulate pain pathways in the brain and reduce physical tension [4,5]. By learning to reframe negative thought patterns through mindset work, patients become better equipped to manage pain sensations during rehabilitation.

Ultimately, patients who adopt an optimistic, determined outlook and maintain beliefs in their potential for recovery tend to adhere better to treatment regimens, persist through challenges, and experience better long-term outcomes [6]. One important point is that this does not replace or deemphasize hard work and consistency on the physical level, but rather serves as an enhancement to the entire process.

Set Realistic Goals With SMART Criteria

Goal-setting is crucial for rehabilitation. Physical therapy is a very goal-oriented process. One strategy to enhance self-efficacy and stay motivated is to establish realistic, achievable goals using SMART goals:

  • Specific: Define the goal clearly, e.g. “Run an 8 minute mile pace around Lady Bird Lake without knee pain.”
  • Measurable: Establish tracking criteria to measure progress e.g. “distance, pace, and pain levels are all objective, measurable and easily tracked.”   
  • Achievable: Ensure goals are realistic based on your capabilities, e.g. “you’ve done this before and have a passion & experience with running.”
  • Relevant: Align goals with overall priorities and well-being, e.g. “running is your outlet and you understand all the positive physical & mental health benefits of it.” 
  • Time-bound: Set a timeframe for added focus and accountability, e.g. “by the end of this year.”

Celebrate Small Wins To Build Big Confidence

Achieving incremental success cultivates a sense of accomplishment, reinforcing the process [7]. Celebrating the mini victories boosts confidence and self-efficacy and each small step forward provides evidence that improvement is possible. Acknowledging this is a highly motivating tool [8]. When we acknowledge even the small milestones along the way, it triggers feelings of pride and intrinsic motivation, which helps sustain effort. Savoring the small wins also helps combat unhelpful thought patterns that can hinder self-efficacy. Simply noticing or internalizing successes, no matter how small, makes it harder for self-doubt to take root [9]. Positive reinforcement deepens the belief of “I can do this,” and even takes it further to “I will do this.”

Overcome Challenges With Support

Healing and recovery are unfortunately rarely linear. Ups & downs and even setbacks are very common, but they don’t have to define your journey. Building resilience and maintaining perspective allows overcoming challenges without losing sight of goals. In addition to the strategies listed above, having a supportive network through friends, family, and your physical therapist (or other healthcare provider) is immensely powerful. The therapeutic alliance forged between patient & therapist significantly impacts treatment outcomes [10]. And no matter what your circumstances are, chances are you are not alone. There are people out there dealing with very similar issues that may be worth connecting with through avenues like the internet, social media, or local support groups.

The Big Picture

Cultivating self-efficacy acts as an empowering force throughout the rehab process. By setting realistic goals, celebrating small wins, maintaining a positive mindset, and leaning on a supportive network, individuals can nurture an unwavering belief in their ability to heal and overcome adversity. This sense of self-efficacy becomes an invaluable tool for persisting through challenges, adherence to treatment, and ultimately achieving meaningful recovery. With patience, resilience, and an empowered perspective, the path to optimal healing is wide open!

Whether you’re on your healing journey with new or old aches, pains, or injuries, we’re here to help! Book with us today to help you reach your goals and improve your quality of life!


  1. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman.
  2. Oyefeso, O.O., et al. (2017). Effects of preoperative self-efficacy among patients undergoing total knee replacement. The Journal of Pain, 18(7), 844-853.
  3. Helminen, E.E., et al. (2015). Cognitive impairment, maladaptive coping styles and recovery over one year in first-ever stroke patients. Scandinavian Journal of Pain, 9(1), 144-152.
  4. Elkins, G., et al. (2007). Mind-body therapies in integrative oncology. Society of Integrative Oncology, 71(2), 167-173.
  5. Hassett, A.L., & Finan, P.H. (2016). The role of resilience in the clinical management of chronic pain. Current Pain and Headache Reports, 20(6), 1-9.
  6. Nicholas, M.K., et al. (2012). Self‐efficacy and chronic pain. Pain management: A practical guide for clinicians, 141-159.
  7. Amiot, C. E., et al. (2004). Integrating the self and identity: Processes of self-validation and the cognitive structural model of the self. Self and Identity, 3(1), 57-75.
  8. Amabile, T., & Kramer, S. (2011). The power of small wins. Harvard Business Review, 89(5), 70-80.
  9. Peen, C., & Wong, P. T. P. (2021). Self-Efficacy as a Positive Youth Development Construct: A Conceptual Review. The Journal of Positive Psychology and Wellbeing, 5(2), 194-221.
  10. Ferreira, P. H., et al. (2013). The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Physical Therapy, 93(4), 470-478.