Bio-Psycho-Social perspective

As previously mentioned under “vision and purpose”, we’ll implement a bio-psycho-social approach the best we 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*. The right diagnosis it 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.

* Which in this field 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.

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.

What did I just read?

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.