Smith 1

Caroline Smith
Dr. Schilling
FYS Lead Out Loud
December 3, 2015
Physical Therapy and Psychology
After and injury or surgery going into physical therapy can be a scary and nervewracking thing. A person wants a physical therapist that is caring and understanding to the pain
they are going through and will understand the fear of re-injury. They do not want a therapist that
figures out what the injury is, and what needs to do fix it, and just gives the exercises to the
patient and tells them to do them everyday. A big part of recovering from an injury is
psychological. There is a need to have the one on one interaction with the physical therapist, and
for them to tailor the recovery program to the individual to help build confidence in the specific
injured body part back up. Physical therapy is defined as the treatment of disease, injury, or
disability by physical and mechanical means (Merriam-Webster dictionary), while psychology
is defined as the science or study of the mind and behavior or the way a person or group
thinks (Merriam-Webster dictionary). These two fields of study, one that is all physical and one
that is all mental, seem like they would have nothing to do with each other, yet they do.
Psychology is increasingly becoming more and more prominent in physical therapy, and physical
therapist need to understand how the mind works in order to help patients fully recover more
quickly and efficiently.
Psychology is needed in physical therapy and many of the physical therapist today realize
that. The more this need is brought to the attention of other physical therapist, and incoming
physical therapist, more can be done to educate them. A recent study was conducted with athletic

Smith 2
trainers and physical therapist. 1000 physical therapist and 1000 athletic trainers were randomly
asked to complete a survey. Of those people contacted, 309 athletic trainers responded and 356
physical therapist responded. In this study it was found that the majority of the of physical
therapist and athletic trainers in their field respectively, believe having psychology knowledge
and skills is effective in recovering from an injury. The current physical therapist believe
psychology is an important factor in recovery, research indicates that psychological skills are
not only important but essential during the rehabilitation of injured athletes (Hamson-Utley,
Martin, and Walters). This means the young people looking into physical therapy as a possible
career need to take this information seriously, and take more psychology classes and minor in it,
or even major in it along with pre-physical therapy.
Although many physical therapists believe psychology is an important factor in recovery,
very few know how to actually apply it. Psychology can be applied to physical therapy in many
ways, from consequences of pain, setting attainable goals, and giving reassurance to the patients.
All of these aspects of psychology are important in physical therapy but, although 63% of
physical therapists in a primary care setting were aware of the importance of psychological
factors, only 47% reported knowledge of utilizing them clinically (Linton and Shaw). This
proves that there is a need for the up and coming physical therapist to have a good understanding
of psychology in order to help patients. Being able to set attainable goals goes a long was in
helping the patient gain confidence. If the physical therapist gives an exercise or goal that may
not be attainable, it can cause the patient to lose confidence if recovering fully. Going through an
injury or a surgery can have a big affect how a person feels mentally, especially an athlete. When
an athlete gets injured it can take a toll on them after the first few months. They are not used to
sitting out and want to get back to playing as soon as possible, and it can get very frustrating for

Smith 3
them if they feel like they will not be able to return. The physical therapist needs to know how to
handle these psychological situations with the people, and help them to continue getting better,
and not lose confidence.
Depression can have a big impact on how an individual will recover from an injury, and a
physical therapist needs to be prepared to deal with patients with physiological disorders like
depression. There have been many studies on the affects psychological factors have on physical
therapy. One of these studies was on how catastrophizing pain and depressed mood affect the
outcome in physical therapy treatment. In this study 42 physical therapist studied a patient that
had on going pain problems. With these patients the physical therapists gave them a baseline test
and then gave them exercises through out the study and then did a follow-up test. After the base
line the patients were divided into sub groups depending on the level of pain and the level of
depression. The results of this study showed that not only do the treatments need to target the
pain, but also be tailored to the patient specifically and deal with their depression (Bergbom,
Katja, Thomas, and Steven). These patients that have long term catastrophizing pain do
experience depression very often, and depression affects how well the patient will recover, if at
all, and can cause a fear of reinjuring the same body part or muscle. It is the physical therapist
job to come up with a plan that will help the patient not only recover, but also help them gain
confidence back in themselves. The physical therapist also has to be there to encourage the
patient when they hot a rough patch and feel like they will not get better. All of these things seen
simple, but they are psychological, and if the physical therapist has a background in psychology
it will make it that much easier to do the job right.
A persons confidence and faith in themselves will affect how efficiently the individual
recovers during physical therapy. There has been another study that has been done recently was

Smith 4
on the relationship between post injury recovery and self-efficacy. The definition of self-efficacy
is, a belief in ones ability to perform a set of actions (Connolly, Atiken, and Tower). It is
believed that if self-efficacy is higher, then the individual will have more confidence and
motivation to get better, which is all psychological. This study was not a direct experiment with
people but instead was all based on research and other experiments that had already been done.
Through this research it was concluded that when physical and psychological health are
increased self-efficacy also increases, which helps patients recover faster. Psychological health
can mean a lot of different things, ranging from a persons fears, moods, and emotions. The more
a physical therapist understands all of theses psychological factors, the more they will be able to
help improve the psychological health of their patient. The better the psychological health patient
has will help them recover.
Physical therapy has been around for a very long time, and is always evolving, and is
essential in fully recovering from an injury. Physical therapy first started to come about during
world war I around 1914 to 1917 when rehab was needed for injured soldiers. These physical
therapists did not actually have an education or degree in physical therapy, but were just trained.
By world war II medicine was becoming more advance, so in response physical therapy also
became more advanced and important. As more people were able to survive more drastic injuries
from the war, the more the physical therapist needed to know how to treat them (News from the
Foundation for Physical Therapy). As physical therapy became more and more well know and
used, specific education programs were made for this profession. As the profession continued to
grow the need for it to become specialized also grew. Some of theses specialized areas include
aquatic, orthopedic, neurology, and geriatrics. In all areas of physical therapy, the physicians
referral used to tell the physical therapist what to do, and how to treat the patient, but now it is

Smith 5
becoming more and more common for the physical therapist to be the one in charge of the rehab
program for the patient, and decide what needs to be done for full recovery. This will allow the
the patient to have the best chance at recovery because the physical therapist will be able to
monitor and change the rehab plan over time and according to how the patient is responding to
the exercises given. The mental/psychological state of the patient is also not given into account
when the physician would tell the therapist what to do. Therefore, the physical therapist is now
able to put together a program that takes in to account how the patient is dealing with the injury
and rehab psychologically.
A form of physical therapy that Bill Bowen created that heavily involves psychology is
called psycho-physical therapy. This type of physical therapy is, a method of therapy that
integrates approaches of both psychotherapy and body therapy in one simultaneous process. The
therapeutic work is continually integrating the physical with the psychological and vice versa
(Bowen). Psycho-physical therapy is based on eight principles: parts are never separate from the
whole, all aspects of human experience are integrative in nature, the body is the primary vehicle
through which the therapeutic work is done, the therapeutic relationship creates the container of
the therapy, the work serves the clients therapeutic goals, the work is focused on building
resources, awareness is the foundation of the transformation process, the therapeutic approach is
a balance of analytic and process orientation, and the therapeutic work is grounded in the client's
daily life. A psycho-physical therapy session would be different for every person depending on
the patient and therapist. However, some things will be similar in all sessions between people.
All or most of the sessions engage the body as a central and interactive part of the therapeutic
process. This may include physicalizing aspects of the psychological process, deepening somatic
awareness, working with movement patterns, hands-on body work, etc. (Bowen). All of these

Smith 6
activities used in therapy use knowledge of psychology, and help people with more of their
emotional and psychological problems in recovering. This is one of the first programs that
involve knowledge of psychology in a specific physical therapy program, and more are need like
it.
Aside from the psycho-physical therapy there have not been any other programs that
specifically use psychology in the treatment and recovery of injuries. There are multiple reasons
for why psychology has not yet been incorporated in other ways. One reason is that most current
physical therapist now understand that psychology is important in recovery, but they do not
know how to apply it in real life situations. This means current students studying to become
physical therapist need to be educated in psychology, and ways to apply it physically. The more
that physical therapist understand psychology, more programs can be made for people that need
more psychological help when it comes to recovering, or can include it more psychological
exercises in normal physical therapy sessions. Another reason why there are no other programs
that include psychology could be patients dont realize how big an impact psychology has on
recovery, so there is not a high demand for it. Therefore, the public also needs to be educated on
the uses of psychology in physical therapy, and how much it helps.
Psychology is becoming more and more needed in physical therapy, and the physical
therapist need to be educated on how to use psychology when helping a patient recover from an
injury. There currently are not many programs that specifically include psychology in the rehab
program, and more are needed. In order for this to happen current students studying to become
physical therapist need to be educated in psychology and understand how to use it to help
someone get better more efficiently. Many people go to physical therapy year after year, and

Smith 7
some never get better. Including psychological factors in the exercises will help everyone get
better faster, and needs to happen soon.

Smith 8
Works Cited
Bergbom, Sofia, Katja Boersma, Thomas Overmeer, and Steven J. Linton. "Relationship Among
Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy
Treatments." Physical Therapy. American Physical Therapy Association , 30 Mar. 2011.
Web. 6 Nov. 2015.
Bowen, Bill. "Psycho-Physical Therapy." Psycho-Physical Therapy. N.p., n.d. Web. 29 Nov.
2015.
Connolly, Fiona R., Leanne M. Aitken, and Marion Tower. "An Integrative Review of Selfefficacy and Patient Recovery Post Acute Injury." EBSCOhost. N.p., 27 June 2013. Web.
10 Nov. 2015.
Hamson-Utley, J. Jordan, Scott Martin, and Jason Walters. "Athletic Trainers' and Physical
Therapists' Perceptions of the Effectiveness of Psychological Skills Within Sport Injury
Rehabilitation Programs." Journal of Athletic Training. The National Athletic Trainers'
Association, Inc, June 2008. Web. 06 Nov. 2015.
Linton, Steven J., and William S. Shaw. "Impact of Psychological Factors in the Experience of
Pain." Physical Therapy . American Physical Therapy Association , 28 Jan. 2011. Web. 6
Nov. 2015.
"News from the Foundation for Physical Therapy." Physical Therapy 95.3 (2015): 475-76. Jones
and Bartlett Publishers. Web.
Merriam-Webster. Merriam-Webster, n.d. Web. 10 Nov. 2015.