Beyond the Injury: Modern Physiotherapy Is Treating the Whole Person

This month, I look to shine light on how physiotherapy is evolving. It is moving from a focus on the body as “machine- like”, to considering thoughts, emotions, social context, and how our bodies and experiences are connected to the world around us. I want to explore (without boring everyone) what these approaches look like, and how they’re changing care.

Let’s start with the biomedical model, which has been the dominant way of thinking in healthcare for a long time. Basically, this model treats the body like a machine made up of separate parts, and when something goes wrong, the assumption is that there’s a specific biological problem that needs to be “fixed”. This approach makes a lot of sense for obvious injuries (like an acute ligament injury, a dislocation, or a fracture). But it can fall short when it comes to ongoing or persistent issues, where the structural findings don’t always match what a person is actually feeling. (The gap between symptoms and what we see on imaging is a topic I hope to explore in another article!)

Next, let’s explore the biopsychosocial (BPS) model. This came as a response to the limitations of treating the body as just muscles, bones, and forces. Humans are more than their physical body, they are complex beings. This model proposes that health and illness are influenced by biological, psychological, and social factors. In physiotherapy specifically, this framework recognizes that patient concerns are not solely a product of tissue injury (it also does not ignore this aspect). As a summary, this way of treating recognizes that injury is influenced by biological aspects (inflammation, tissue pathology, sensitization, etc), psychological factors (fear, beliefs about damage, etc), and social contributors (support system, culture, work demand, etc). This broader view helps us treat people (not just tissues), and acknowledges the many pieces that influence how injury and healing are experienced.

The biopsychosocial model is definitely a “step up” from the old biomedical approach, but it is really easy to fall into applying in a “boxed-in” way. For example, treating the biological, psychological, and social pieces as separate “things” to manage. That’s where the enactive approach comes in. Instead of separating everything into categories, it looks at how our experience of pain and injury is shaped by our whole lived experience (like how we move, perceive, and interact with the world around us). From this perspective, injury isn’t just something we “have”; it shows up in the way we’re relating to our world in the moment. Treatment, then, isn’t about fixing one factor at a time, it’s about helping people shift patterns in how they live and move, so they can feel more confident and capable in their everyday lives.

In short: the biomedical approach focuses mainly on structure, the biopsychosocial model looks at the person within their broader context, and the enactive approach encourages new ways of moving and engaging with life.

To wrap things up, working within more contemporary models doesn’t mean we stop looking for structural changes or screening for serious pathology. We still assess thoroughly, identify red flags, and stay up to date with current research for managing conditions. In my opinion, these more contemporary models add perspective. They remind us that people are complex, and that injury and pain are shaped by so much more than structure alone.

We want to understand not just your injury, but how it shapes (and is shaped by) the way you move through life. We’re also excited to share that our team has recently grown. Kelly Bischke, owner and Registered Psychologist at Rivan Psychology, now practices out of Bragg Creek Physiotherapy. She supports people from all walks of life in finding calm, clarity, and confidence. Our whole team is here to help you move, live, and feel your best.

Bre Maughan
Registered Physiotherapist (MScPT, BScKin)
Bragg Creek Physiotherapy
www.braggcreekphysio.com