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Trauma-Informed Physical Therapy: Fostering Healing and Empowerment

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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.

How Stress and Anxiety Affect Pain

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Anxiety disorders, commonly associated with chronic stress, are the most common mental illnesses in the United States. In fact, anxiety disorders affect nearly 40 million adults each year. People suffering from anxiety are three to five times more likely to visit the doctor than those without anxiety disorders.

The reason?

Stress and anxiety do not just have an impact on the mind. Together, they cause or enhance chronic pain. Many of us forget that anxiety or worry can cause several painful physical symptoms — chronic fatigue, heart palpitations, muscle aches and weaknesses, headaches, and more. 

Here’s a deeper look into the impact chronic stress and anxiety have on the body.

Man really feeling how stress and anxiety affect pain

How can stress and anxiety impact pain response? 

Have you ever noticed that your muscles hurt more when you’re worried about work or family? Do you get headaches more as you think about something too much? These are all small signs of how anxiety and stress can impact our body’s pain levels.

Research has also proven that stress and anxiety can influence pain perception (how we perceive pain). Some people, when their cortisol levels spike, experience stress-induced analgesia — which suppresses our sensation of pain. 

Stress-induced hyperalgesia, on the other hand, occurs when stress, anxiety, or even fear, are already present, elevating pain and increasing intensity and duration. 

The fight or flight response affects pain

We all know the “flight or fight” response our bodies experience when we undergo stress. When our bodies activate this response, it dumps higher levels of cortisol into the bloodstream which spikes our blood sugar. Your body also experiences an increased heart rate and adrenaline output. Over a period of time, this influx of cortisol can harm your body and cause you to be more susceptible to injury and pain. 

In the fallout of this response, people tend to feel exhausted, which can heighten mental and physical ailments and decrease their immune system response. 

The nervous system and stress

Stress is very closely aligned to the nervous system. Your body’s reaction to stress can tip off pain perception in the body and, because the nervous system extends into the brain, can impact the way your body responds to pain. Over time, your body may develop a more sensitive nervous system reaction to stress and anxiety, which could be the cause of chronic pain. 

Woman sits at computer looking very stressed out and anxious because of how stress and anxiety affect pain

Common physical symptoms of stress and anxiety

The longer a person experiences chronic stress and anxiety the more intense the symptoms may be. You could equate it to heart health — the longer you eat fatty, high-sugar, and highly processed foods, the greater your chances are for heart disease. So, the more often you’re stressed, the more vulnerable your body becomes because of the wear and tear that results. 

Symptoms of stress and anxiety often go unnoticed or are mistaken for something minor. However, consistently experiencing the following systems can wear out your body. 


This is the most common symptom associated with stress and anxiety. Because the mind is in a constant state of alertness, it tires out much faster than the mind of someone who may not often experience stress and anxiety. Even after healthy sleep, people can still feel exhausted because of mental fatigue or the physical symptoms that come along with prolonged high-cortisol levels in the body. 

Heart palpitations

Having heart palpitations can be distressing, which may cause a continued increase in cortisol levels and can increase heart rate. Heart palpitations feel as though your heart is pounding too fast and skipping beats. 

Muscle aches and weakness

Tension is usually to blame for muscle and joint pain caused by stress and anxiety. Prolonged periods of these emotions cause muscles to tense up and leave you feeling stiff. A high level of stress consistently can impact immune system functions, making it more difficult for your body to fight off inflammation. 

Muscles also tend to become weak, especially in the legs and arms. During a fight or flight response, blood flow is increased to the limbs to make it easier to take action against a perceived threat. After the adrenaline response has ended, muscles can become sore and painful. 

Woman laying down clutching her head and stomach feeling sore from stress and anxiety


Headaches and migraines are other common results of chronic pain and anxiety. Because other systems, such as teeth grinding, tension in the face, and poor posture often accompany stress and anxiety, prevalent headaches and migraines that are extremely painful are likely. Sharp pain or dull aches accompanied by pressure in the head and eyes are usually the headaches caused by stress and anxiety. 

Find relief for your pain

Stress and anxiety are common ailments in the U.S., but if you’re experiencing pain that you believe is associated with stress, it’s time to get help — for both your brain and your body. The key is to manage daily habits to ensure this type of pain does not get out of hand. 

If you are experiencing pain that is impacting your daily life, our team can help. With extensive training in treating patients with chronic stress and anxiety disorders, we can get you back on track to feeling calm, relaxed, and healthy in no time. 

To find relief from your chronic pain, book a free consultation today!