Post Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event like an accident, natural disaster, or personal assault. Physical therapists (PTs) might work with patients with PTSD, particularly those recovering from injury or trauma like a car accident. Understanding the fundamentals of PTSD can help PTs provide empathetic, holistic care and recognize when a patient might need additional support.
This article provides an overview of the fundamentals of PTSD, symptoms relevant to physical therapy, and strategies for PTs to help manage PTSD symptoms during rehabilitation.
Related: An Introduction to Post Traumatic Stress Disorder (PTSD) for Therapy Professionals
What is PTSD?
PTSD is a psychiatric disorder characterized by intense, prolonged emotional distress following a traumatic experience. For patients recovering from trauma-related injuries, PTSD can complicate rehabilitation by affecting motivation, engagement, and tolerance for certain physical therapy interventions.
Key characteristics of PTSD
- Re-experiencing the trauma: Patients with PTSD may relive their trauma through flashbacks, nightmares, or distressing thoughts, which can interfere with focus during therapy sessions.
- Avoidance: Some patients avoid places, activities, or individuals that remind them of their trauma, which can limit their engagement in physical therapy.
- Negative thoughts and mood changes: Feelings of hopelessness, disinterest in activities, or persistent negative emotions may impact a patient’s outlook on recovery.
- Hyperarousal: Symptoms like heightened anxiety, irritability, and hypervigilance can make it difficult for patients to relax during treatment or trust new exercises/manual techniques.
How PTSD affects the body and mind in a physical therapy setting
PTSD is more than a mental health condition as it can have big physical effects that influence a patient’s response to physical therapy. These physiological responses can create challenges for PTs aiming to build trust and provide effective treatment.
The brain and PTSD
- Amygdala activation: The brain’s “fear center” becomes overactive, leading to exaggerated responses to perceived threats, which can make patients feel anxious or guarded during sessions.
- Hippocampus impact: Changes in the hippocampus affect memory recall and emotional regulation, which can lead to poor patient engagement or difficulty remembering exercises.
- Prefrontal cortex disruption: Lowered activity in the prefrontal cortex can impair rational decision-making, possibly leading to a lack of motivation or adherence to rehab plans.
Physical symptoms of patients with PTSD
- Increased muscle tension and pain: Many patients with PTSD experience chronic muscle tension and pain due to heightened stress, which can block mobility and range of motion.
- Fatigue and sleep disturbances: Poor sleep and fatigue are common, affecting energy levels and endurance during physical therapy.
- Increased heart and respiratory rate: The fight-or-flight response might lead to higher heart rates and rapid breathing, affecting a patient’s response to certain exercises or techniques.
Recognizing PTSD symptoms
Recognizing the signs of PTSD can help PTs adapt their treatment approach to better support patients. Symptoms are grouped into four categories:
1. Re-experiencing
- Flashbacks: Reliving the trauma as if it’s happening in the present can lead to sudden distress or loss of focus during therapy.
- Distressing thoughts: Persistent thoughts or emotions related to the trauma might make it difficult for patients to engage fully with rehab.
2. Avoidance
- Avoiding exercises or movements: Patients may resist specific exercises if they remind them of the traumatic event, especially if the injury was related to the trauma.
- Reluctance to discuss progress: Patients may avoid conversations about their recovery, feeling overwhelmed or discouraged.
3. Negative thoughts and mood
- Feelings of hopelessness: Patients with PTSD may feel pessimistic about their recovery, leading to poor adherence to therapy.
- Low motivation: Emotional numbness and lack of interest in previously meaningful activities can make it difficult to build motivation.
4. Hyperarousal
- Increased irritability or agitation: Patients may become easily agitated during therapy, especially if they feel uncomfortable or pressured.
- Hypervigilance: A constant sense of being on edge can hinder relaxation and trust, making hands-on treatments or new exercises challenging.
Diagnosing PTSD in a physical therapy context
While PTs don’t diagnose PTSD, being familiar with diagnostic criteria can help identify patients who could benefit from extra support. PTSD is typically diagnosed by a mental health professional based on DSM-5 criteria.
Key diagnostic indicators for PTs to recognize
- Exposure to trauma: Direct or indirect experience of a traumatic event.
- Presence of intrusive symptoms: Frequent flashbacks or distressing thoughts.
- Persistent avoidance: Actively avoiding reminders of the trauma.
- Negative changes in cognition and mood: Hopelessness, emotional numbness, or loss of interest in activities.
- Hyperarousal: Signs like irritability, hypervigilance, and sleep disturbances.
How physical therapy can support patients with PTSD
PTs play a valuable role in supporting PTSD patients through empathy, communication, and a tailored approach to treatment. The right therapeutic environment can help patients manage their symptoms, improve physical function, and build confidence.
A few strategies include:
1. Trauma-informed care. Trauma-informed care is an approach that recognizes the presence of trauma and its effects, emphasizing safety and empowerment for the patient:
- Safety first: Create a calm, predictable environment to reduce patient anxiety.
- Empathy and validation: Show empathy and acknowledge the patient’s emotional experience, which helps build trust.
- Patient empowerment: Give patients control over their therapy, letting them set the pace for exercises and decide on physical touch.
2. Gradual exposure to physical activity. For patients with PTSD, sudden, intense exercises can trigger anxiety or flashbacks. Gradual, controlled exposure to activity, especially new ones, can help build confidence.
- Start with familiar movements: Begin with exercises that feel safe to the patient.
- Progress slowly: Allow the patient to build comfort with each movement before advancing.
- Use grounding techniques: Encourage mindfulness practices or grounding exercises to keep the patient present and reduce anxiety.
3. Communication and patient education. Educating patients on the purpose of each exercise and how it will help their recovery can help reduce anxiety.
- Clear explanations: Explain the purpose of exercises, emphasizing how they help the patient achieve their personal goals.
- Provide reassurance: Remind patients that physical therapy is a collaborative process, and their comfort level is the priority.
- Teach coping skills: Introduce breathing exercises or relaxation techniques that patients can use when feeling overwhelmed.
Collaborating with mental health professionals
Collaboration between PTs and mental health professionals is key in treating patients with PTSD, providing comprehensive care that addresses both physical and psychological needs.
Effective collaboration strategies
- Communicating often: Regular check-ins with mental health providers can help PTs adjust their treatment approach based on the patient’s mental health progress.
- Share observations: Report any concerning behaviors or symptoms to the mental health team, making sure that they are aware of any changes in the patient’s physical therapy experience.
- Joint goal setting: Coordinate with mental health professionals to align goals for both physical and mental recovery.
Challenges physical therapists may face when working with PTSD patients
While supporting PTSD patients can be rewarding, there are unique challenges that PTs should be prepared for:
- Compassion fatigue. Physical therapists working with trauma survivors may experience compassion fatigue. Self-care, setting emotional boundaries, and seeking support from colleagues can help prevent burnout.
- Patient resistance. Patients with PTSD may resist treatment due to fear of re-traumatization. Physical therapists can address this by creating a welcoming, safe environment and working gradually to build patient trust.
- Complex trauma histories. PTSD is often accompanied by other mental health issues like depression or substance use. PTs may need to adjust their treatment approach and remain flexible.
Conclusion
PTSD is a complex condition that affects both mental and physical health, making it important for physical therapists to understand its impact on rehabilitation. By recognizing PTSD symptoms, adapting treatment to each patient’s comfort level, and practicing trauma-informed care, PTs can provide compassionate and effective support for patients with PTSD.
Collaboration with mental health professionals further improves the care provided, promoting a holistic approach to recovery that helps patients regain control, confidence, and resilience.
