Introduction: Bio-Psycho-Social perspective

I implement a bio-psycho-social approach the best I can – to tend to the entire individual. It might sound academically fancy or pretentious but mostly just means that humans are more complex than the meat alone. Since you’re here, it’s quite likely the first part, the biological, you think of. But we might have to tend to other parts as well to ease as much suffering as possible. With purely physical problems it’s easy enough to allow you to tend just to the physical parts, that’s when more typical physical rehab is used. To be more precise, but still vague enough – the BPS approach seems to do the trick a lot better than if you were to look at the physical part alone – especially with more complex rehab, if the pain at hand actually origins in something but the physical, longer term pain over months and years with or without pathology or perhaps in management of what might not heal, where the disability level can increase incredible amounts if you don’t tend to all aspects.


Biological – tends to your physical being.

This is where the poking, prodding and mechanical stuff happens and we think about the pain itself; where, when, how, for how long, how did you get it, what if…, can you relieve or make it worse, does any meds help and so on to boil it down best we can. Orthopedic tests could be used to make the pain more or less and/or to look at some other quality of a structure. Once pleased with the knowledge it’s possible to deduce what seems to be the problem and hence there’s a diagnosis* [which in the field of physiotherapy or manual therapy is more of a good enough guess, however silly that might sound. In other fields there’s blood samples or x-rays showing very objective things that without hesitation equals a diagnosis. In this area the x-rays tells us less, unless it’s really obvious (fracture or ruptured something etc). Arthritis, degenerative things, partial or even complete tears might be completely irrelevant to the pain bothering the patient.]. The right diagnosis is crucial to a good treatment. You’ll need to know why you’re in pain to be able to give it what it needs. How people usually refer to pain is a bit too diffuse; we need to know what structure signals for the pain and ideally why it signals as it does and/or gets interpreted it way it does by the brain. The hard part, why people generally have to study this, is because “knee” isn’t one structure, it’s a bunch of small ones. There’s a lot of reasons why a knee could hurt, since it consists of a bunch of stuff and there’s plenty more acting on the area.

Next step, solution. Most things benefit from some sort of “physical therapy”, which is a broad term, but the biological part of it can be condensed to something quite simple when we’re treating it conservatively – start where you are and progress to where you want to be. Do that at a speed where your body can adapt to the increasing demand. Unload initially if something actually needs that – and then load the tissue in as full of a range of motion you can, bonus points for actively using that range of motion in daily life as well. A change of bio mechanics by learning motor control and how something should be used might be useful, unless it’s enough to just give it a higher tolerance to stress so it’ll be fine with what you put it through in daily life anyway.

I quite often treat issues with manual therapy as well. That is, in some sort of way, muscle and joint mobilization to relieve pain and/or increase function. Obviously just useful if it’s relevant to the case at hand, which is why we need the right diagnosis. This part can usually be mimicked decently enough by self-massage, self-mobilizations and stretch, which should be implemented in treatment programs where they fit.

Medications fit perfectly fine under this category as well as food related ones. Trying to cut weight or malnutrition can definitely bother both pain and healing.


Psychological – tends to your psychological aspects.

Today, there’s a lot pointing to the fact that stress can cause or amplify existing pain. Psychological distress itself can manifest as pure physical pain when it gets bad enough, less than that amount could amplify already existing pain. Unfortunately stress is A LOT of different stuff, which we on one hand are made to handle – it’s a naturally occurring thing – but on the other hand we’d preferably be stressed for a while and then get to rest. Unlike today.

With that said, if you can sort up your life in other “unrelated” ways, taking stuff of your mind and/or physiology(sleep deprivation is an extraordinary example) that could stress you, that might definitely help. Pain, ought to be why you’re here, is a stressor itself. Relieve pain – get less stress and you’ve got something affecting pain positively by breaking a negative spiral.

Fear and uncertainty about your pain are other, in my opinion, usually less thought of stressors. Which is why knowledge could be a useful part of the cure. Diagnosis and what to expect from it is really useful. To some more than others of course. Learning about your limits makes sure you don’t overextend, or perhaps the opposite, might extend your options beyond what you previously thought possible. Both might instill confidence and certainty, and with those comes calm.


Social – tends to your surroundings.

The social mainly connects the psychological aspects in the form of relationships, or lack there of. Social stress from family, friends, colleagues, kids to worry about and take care of, thoughts and worry of love and loved ones passing. The issue could of course be less dramatic or life changing than death itself, maybe you miss the social aspect and your place in the team since you got hurt and get depressed because it’s such a big part of your identity.

But the biological can without a doubt be a part here as well. Living in isolation puts a greater demand for you to do everything. Doing the dishes with horrible back pain or grocery shopping with a newly dislocated shoulder could ruin days ahead.

“So… What?” You might think.

That’s kinda how we’ll look at it. It’s not the solution – but the point of view. And it seems to work quite well when the compliance is high enough and people actually do their homework, which is why we can assume that it’ll work just fine when you do the same. If it didn’t work, I wouldn’t bother with all the text. Promise. You’re a quite complex biological being. So we’ve got to take a few more things into consideration than you might have thought.

It’s a complex matter.

All of the three big troubles that are the main focus here feed on each other, which is why it’s often quite necessary to tend to it in a wide way, rather than just throwing pills at it.
Stress and exhaustion increase sensitivity to pain and might cause depression.
Depression increase sensitivity to pain and is a major stressor.
Pain is a major stressor and might lead to burnout and depression.
The symptoms and what turns into the biggest problem varies from person to person and with how bad the case is, but generally makes people quite useless by the time they try to get help. A bit of pain, a morning of hopelessness or a stressful afternoon won’t bother you enough.

When exhaustion is the major problem being and feeling useless might turn into a huge problem since those are often completely performance based when valuing themselves. It motivates to work harder. All their lives they’ve solved their problems through sheer hard work, and that’s what they’ll keep trying. Never making progress but struggling on. Fighting harder and suffering more. However, it’s solved with just the opposite; but as long as no one tells them that’s the case they’ll keep fighting in quick sand and elevate their pulse with their blood stream filled with venom… or well, cortisol.

That’s a positive feedback loop and the hole they dug gets deeper and deeper.

– Messing things up at work when trying to work gets infuriating. Anxiety!
– Wants to perform but need to sleep three hours in the middle of the day, get anxiety because it took so long – gets stressed and tries to achieve more to calm down/make it better which increase the stress levels.
– Pain hinders activities and taking care of and being with family and might kill sex drive entirely. Bad conscience, anxiety and depression which lead to more pain.
– Long-term stress turns into anxiety which turns into panic attacks, where they might make every day things like shopping, going to the movies, traveling or driving a car dreadful. Social isolation since human interaction takes energy that simply isn’t there might become an issue. Another negative spiral, since we’re quite social creatures. Anxiety can cost tremendous amounts of energy and quality of life, turn into depression and lead to quite large amounts of physical pain.
– A big enough stress response easily gives sleep disturbances, and physical pain sure doesn’t help sleeping. Anxiety about the future, how, when and if it’ll ever get better could be parts of it. If you’ve been robbed of all your capacity, which is everything you once held dear earlier – and you have no idea how to get it back again, your value as a human probably feels kind of low lying there alone in the dark, exhausted, but with eyes wide open.

The point?

The approach is… quite broad, going from physiotherapy, manual therapy and pain science to food, behaviors, social life on all planes, physiology, psychology, neuroscience, pharmaceuticals and… probably a bunch of other stuff if that’s necessary with the common theme of getting you better – and that’s necessary. If you want to get well you can’t neglect some parts of life entirely. Solve problems and do what’s necessary. What do humans need to thrive? Think about it. What’s your biggest problem? Would your life improve plenty if you started doing something about it? Perhaps your problem isn’t where you think it is. Perhaps it’s elsewhere – and if so, you’ll have to start digging THERE. Go for it!

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