Trauma Informed Physical Therapy
Have you ever experienced something in your life that went tragically wrong or a series of events that didn’t go the way you thought they would? Have you ever experienced something deeply distressing? Something that marked you or affected a season of your life? This, my friends, is called trauma. And you are not alone. Statistics show that approximately 90% of US adults have suffered trauma at least one time in their lives. 1
What is Trauma?
The word trauma can evoke very different thoughts and feelings for people. According to the Oxford Dictionary, the general definition of trauma is “a deeply distressing or disturbing experience.”2 However, there is a wide range of trauma severity. Licensed professional counselor Aundi Kolber states that there can be big “T” trauma or little “t” trauma.3 Big “T” trauma can occur after a terribly painful event, an episode of assault or abuse, a natural disaster, or a personal or global tragedy. Little “t” trauma can occur from an accumulation of several non-life-threatening insults over time (microaggressions, relational strife, poverty, etc.)4 I am not minimizing big “T” trauma or the devastating effects it can have on our health. However, I think that we as a culture minimize the little “t” traumas and how they can affect our day-to-day functioning. Kolber likens little “t” trauma to a thousand little papercuts over time.3 One papercut by itself may not be painful or debilitating, but a thousand over time cause pain and require attention. 3
Did you know that trauma affects your body?
Why is this important? Because a history of trauma can impact your rehabilitation experience after having a musculoskeletal or neuromuscular injury. And your physical therapist can help!
What is trauma informed therapy?
Trauma informed therapy is a well-known term that is used widely in the realm of counseling services and psychology today. The definition of trauma-informed therapy is taking into consideration a person’s history of trauma and how it affects their nervous system, their perspective of their circumstances, their behavioral reactions, and their social engagement capabilities.5
A trauma informed provider uses this information to assess the client’s ability to tolerate certain treatments to avoid triggering the nervous system into a trauma response. This framework is prevalently used by counselors, therapists, and mental health practitioners, who primarily address the psychosocial aspects and mental health care needs of an individual. But it can be used by physical therapists as well.
We cannot separate the mind-body connection and the role of the nervous system in how our bodies respond to pain and other stimuli. In physical therapy, we must address the whole person. That means we must take into account the psychosocial aspects that are occurring in your life, trauma history included, as we carefully select treatment interventions for you.
How do we recognize the impact of trauma on our body?
Well, the body has a beautiful way of regulating our social engagement system and our body’s ability to function in our world. Our nervous system is constantly assessing our environment to determine if we are safe or if there is a threat. When our nervous system feels safe, our reasoning remains intact, we are able to interact playfully with others, and our senses remain calm and unalarmed. When our nervous system perceives a threat, factors that previously did not bother us are more likely to cause us to quickly escalate out of our window of tolerance where we lose our ability to interact with our world from a place of reason.6
What does this mean in physical therapy?
It means that big “T” trauma and little “t” traumas can have a significant impact on our physical health. The body remembers traumatic events whether big or little and sometimes chooses to remind us of our story in unexpected ways.
This can play out in a variety of ways. I have worked with patients who have exhibited lower pain thresholds and an increased sensitivity of the nervous system when it comes to pain. Some decline massage, stretching, and touch in general because it escalates them out of their window of tolerance. Many patients have cried in physical therapy sessions from the overwhelming experience of feeling limited, debilitated, or powerless in their bodies. Others have been hesitant or avoidant to do specific movement patterns or functional activities that are intended to be helpful but trigger a painful event or experience for them (such as a serious fall or a traumatic injury). The activity in therapy literally brings back the forgotten or emotionally suppressed memory to the attention of the nervous system. (In a hopeful situation, this memory can be addressed and properly integrated to help the body heal.)
These are all classic examples of the effects of little “t” and sometimes big “T” trauma impacting our body’s ability to navigate its environment. It is important to recognize that these things are common and that they can be discussed with your physical therapist.
This is me. How should I respond?
If this is you, remember that you are not alone, and we are here to help! Talk with your physical therapist about the activities that cause you to escalate out of your window of tolerance or trigger a painful response for you. Your physical therapist can help to develop a plan that causes your nervous system to feel safe with exercise, touch, and movement. Give feedback along your rehab journey. As your body experiences safe movement and touch, it can actually help repair the nervous system and the framework your body has built around pain and trauma.6 Be kind to yourself in the healing process. Together, we can create a successful rehabilitation environment and a place for your nervous system to feel safe so that your body can heal.
References
- Khoddam, Rubin. How Trauma Affects the Body. Psychology Today. Posted Mar 3, 2021. Accessed September 6, 2023. https://www.psychologytoday.com/us/blog/the-addiction-connection/202103/how-trauma-affects-the-body
- Definition of Trauma. Oxford Languages Dictionary and Google Search. Accessed September 6, 2023. (https://www.google.com/search?q=definition+of+trauma&rlz=1C1GCEA_enUS1067US1067&oq=definition&gs_lcrp=EgZjaHJvbWUqBggAEEUYOzIGCAAQRRg7MgYIARBFGDsyBggCEEUYOTIGCAMQRRhAMhIIBBAAGBQYgwEYhwIYsQMYgAQyBggFEEUYPDIGCAYQRRg8MgYIBxBFGDzSAQkyMDQzMWoxajSoAgCwAgA&sourceid=chrome&ie=UTF-8
- Kolber, A. Try Softer: A Fresh Approach to Move Us out of Anxiety, Stress, and Survival Mode–and into a Life of Connection and Joy. 1st ed. Tyndale; 2020.
- Barbash, Elyssa. (2017, Mar 13). Different Types of Trauma: Small ‘t’ versus Large ‘T’ – An accumulation of smaller or less pronounced events can still be traumatic. Psychology Today. https://www.psychologytoday.com/us/blog/trauma-and-hope/201703/different-types-trauma-small-t-versus-large-t
- Marschall, Amy. What is Trauma-Informed Therapy? Very Well Mind. Posted Nov 23, 2021. Accessed September 6, 2023. https://www.verywellmind.com/trauma-informed-therapy-definition-and-techniques-5209445
- Kolber, A. Strong Like Water: Finding the Freedom, Safety, and Compassion to Move through Hard Things–and Experience True Flourishing. 1st ed. Tyndale; 2023.
