The following blog post is inspired by one of my favorite TED talks given by a physical therapist named Erwin Benedict Valencia.


Often, patients show up thinking the only time they have to put into rehab is the thirty-sixty minutes in physical therapy 1-2 times a week. For less severe injuries, or acute injuries this may be the case. However, when patients are dealing with an ongoing injury, severe injury, or chronic pain, just coming to physical therapy 1-2 times a week is only part of the puzzle.

Patients may be confused when we probe more with the questions:

“What is going on in your life?”

“What is your typical day right now?”

“What is your stress level right now?

Physical therapists are not trained in being a psychologist, but we are trained to understand pain science. If you were really sick with the flu, it is common knowledge that it is advisable to get extra rest, fuel your body with healthy food and water, and not over-exert yourself with exercise and work. A similar concept applies when you have chronic pain or injuries. If you have long standing pelvic pain you wouldn’t want to sit an 8 hour work day fueled by 3 cups of coffee, then go and sit another two hours at a work dinner. If you have chronic neck pain you wouldn’t want to be staring at a computer hunched over for 8 hours, then go home and catch up with friends holding your phone to one ear and your toddler in another. Add in the factor of a possible daily increased general stress level such as your boss putting 3 deadlines on you, your child being sick, or your car getting towed because that yellow line on the sidewalk is barely visible, it is no surprise that life can get a little overwhelming at times.

Pain is “not in your head” but your head can trick you. We now know from research by the great neuroscientist and physical therapist Lorimer Mosley that pain can be a tricky non straightforward concept, one of them being that “pain is modulated by many factors from across somatic, psychological, and social domains.” Thus, in the scenarios above I like to coach patients in finding ways to decrease their load and stress level to help form another puzzle piece to complete their journey of healing. In the example of a chronic pelvic pain patient who sits for work, brainstorming ways to manage their stress and sitting loads can be a huge help. These solutions may include considering a sit/stand desk, alternative seating cushions, scheduling a couple 15 minute breaks in the day to lay down, breath ,and do appropriate stretches, and learning how to say no to things that do not need to be prioritized so they have increased time for self care. As Erwin Benedict Valencia says, “leave room for cream in the coffee cup” because you are less likely to “have a spill when unexpected things occur.” The more time you take care of yourself as a priority, the easier it can be to deal with increased stressors and their effects on pain when they come along.  Often, healing involves a couple of factors to achieve success and physical therapy is just one of those factors. When you address the other factors outside of physical therapy, it helps to enhance the effects and success of physical therapy.

Andrea Wood, PT, DPT, PRPC

Knowledge is power, empower yourself for your health


Mosley, L. Reconceptualising Pain According to Modern Pain Science. Physical Therapy Reviews. 2007; 12: 169-178.