A holistic approach to Chronic pain

August 9, 2024

A Holistic Approach to Chronic Pain

Physiotherapy has always been devoted to understanding patients’ pain and how to alleviate, manage and prevent it. So, what’s changed?


As the landscape of pain management advances, it is increasingly clear that a multidimensional approach to pain is not just beneficial but necessary.


One of the best ways to manage pain is through a biopsychosocial (BPS) approach. This broader approach means looking at the whole person and using a combination of different strategies to manage pain effectively. We might need to use a mix of medications, exercise, lifestyle modification, diet, relaxation and stress management techniques.


This approach also means you may need help from different health professionals. It’s important to find professionals who take the time to understand you and your unique needs, as not all healthcare providers are familiar with managing chronic pain.


Physiotherapy plays a central role in treating chronic pain as part of a holistic approach to pain management. Your Physio will assist you with coping strategies, both physical and psychological. Your treatment will consist of education and understanding partnered with exercises for strength, range, coordination and balance. Your Physio may liaise with your ‘team’ and direct you to other health practitioners who can help you better understand your condition and improve your everyday activities. Your team may include your local GP, a pain specialist, psychologist and an exercise physiologist.


What exactly is Chronic Pain?


Chronic pain is defined as pain that has persisted for more than three months. It can be anywhere in the body and can start from a serious injury or something quite insignificant. There does not need to be any evidence to prove it exists. It won’t necessarily show up on any imaging or blood tests.


Pain originates in the brain as a protective mechanism, but persistent pain does not always indicate ongoing harm or damage. The brain interprets signals from the body and environment to determine whether we feel pain. The nervous system, or “pain system,” includes many nerves and brain cells.


Chronic pain often results from a hypersensitive pain system rather than tissue damage. This hypersensitivity can be influenced by thoughts and feelings, such as fear or anger. Chronic pain can lead to reduced activity, deconditioning, and increased fear of movement. The goal in managing chronic pain is to shift focus from the initial injury to modifying the brain’s interpretation of danger and calming the pain system.


There are numerous chronic pain conditions including Rheumatoid Arthritis, SLE, Fibromyalgia and Polymyalgia Rheumatica and Chronic Lower Back Pain amongst many others.


Our understanding of the causes and treatment of pain has advanced. Modern approaches to treating low back pain focus on physical activity and encouraging people with low back pain to self-manage their pain and activity. One of the challenges of helping patients is in overcoming a traditionalist approach that relied on dispensing pain medication. 


“The brain is responsible for what we feel but doesn’t get it right all the time” – Kal Fried


What does Self-management look-like?

  • Setting personalized and achievable goals
  • Creating a pain management plan that incorporates team-based care
  • Developing your skills and ability to self-manage chronic pain
  • Reviewing and adjusting your pain management plan regularly.


If you would like to learn more about Chronic pain here are some good resources to get you started:


  • Learn more and become a painchanger at https://chronicpainaustralia.org.au/painchanger/
  • Understanding Pain with Mr Brainman- a simple video that helps you understand what current research says about chronic pain – that it’s not a joint or muscle problem, rather a ‘re-wiring’ of the brain perception of itself.
  • Rethinking persistent pain – Professor Lorimer Moseley explains how pain works and explains new approaches to reduce your pain.
  • Book: Why does it still hurt? – Science journalist Paul Biegler discusses how the power of knowledge can overcome chronic pain.
  • The following article and podcast will give you a taste of his book where Biegler talks about his own chronic pain journey and very clearly explains the concept of central sensitisation, where the body creates its own understanding of what is painful.





By Miriam Wynne December 13, 2025
Building confidence before and after injury or surgery When you’re facing surgery or recovering from an injury, it often feels like your body has let you down. You might worry about whether you’ll get back to normal, whether movement will hurt, or whether you’re doing the “right” things. It’s completely normal to feel unsure, frustrated, or even a bit scared, especially when everyday activities suddenly feel harder than they used to. Before and after surgery, confidence can take a real hit. Pain, stiffness, and uncertainty can make you second-guess every step. You are absolutely not alone in feeling this way. Confidence isn’t just a mindset, it’s a key part of recovery, and it can be rebuilt with the right guidance and support. Why confidence matters Understanding the psychology of confidence Confidence isn’t about pretending everything is fine or pushing through pain. It’s about knowing what your body is capable of, understanding what’s normal, and recognising your progress - even when it feels slow. Recovery isn’t just physical, confidence, education and reassurance are are all key parts of progress. When you understand the “why” behind each exercise and what sensations to expect, fear is replaced with clarity. And clarity builds confidence. Consistency leads to results People who feel safe and informed tend to stay consistent with their rehab. That consistency is what builds long-term strength, mobility, and trust in how your body moves. Preparing before surgery How prehab builds confidence Feeling nervous before surgery is perfectly understandable. Prehabilitation (prehab) helps you feel prepared rather than overwhelmed. You build strength, improve mobility, and learn the exercises you’ll use afterwards so nothing feels foreign once you’re home. VicGov’s Better Health Channel explains the benefits of preparing physically and mentally before surgery: https://www.betterhealth.vic.gov.au/health/servicesandsupport/seeing-an-allied-health-professional What a typical prehab plan looks like A personalised prehab program often includes: • Gentle strength work (e.g. quads, glutes, core for lower-limb surgeries; shoulder and scapular stabilisers before rotator cuff repair) • Mobility exercises to improve joint movement • Low-impact conditioning for overall fitness • Education about what to expect in hospital and immediately afterwards. • Learning early post-op exercises ahead of time • Strategies for reducing swelling, pain and inflammation Walking into surgery feeling prepared boosts both physical and mental confidence. Rebuilding trust after surgery The early stages of recovery Once surgery is over, recovery really begins. Pain, swelling, or stiffness can make you doubt your body, even when everything is progressing exactly as expected. Gentle, guided movement is what helps tissues heal, restore function, and rebuild trust. The Australian Physiotherapy Association recommends early, guided movement after many procedures to support safe healing: https://australian.physio/ What a typical rehab plan looks like Rehab is structured in stages and matched to your surgeon’s protocol. Early phase (Week 1–3) • Swelling and pain management • Gentle range-of-motion exercises • Supported walking or gait retraining for lower limb or simple arm exercises for shoulders • Safe activation of key muscle groups • Clear guidance on what and how to avoid Middle phase (Week 4–8) • Progressive strengthening • Balance and stability work • Gradual increases in load • Functional tasks such as stairs, sit-to-stand and controlled bending Later phase (Week 8+) • Higher-level strengthening • Functional or sport-specific activities • Hydrotherapy or Clinical Pilates for controlled, confidence-building movement • Planning for long-term independence Each phase is explained clearly so you always know what’s safe, what’s normal, and what comes next. From recovery to resilience Why rehab doesn’t stop when pain settles Pain relief doesn’t mean your recovery is complete. Long-term confidence comes from restoring strength, balance and control. Many people continue with guided exercise, Clinical Pilates or maintenance physio as part of their ongoing wellbeing. The bigger picture • Prehab prepares joints, muscles and the nervous system • Rehab guides how well and how safely you heal • Lifestyle choices; sleep, nutrition, daily movement all support long-term recovery Confidence develops when your recovery has structure, clarity and consistent support. Explore our ongoing exercise and Pilates options . Where EBR fits in Continuing your care after specialist treatment Once your surgeon or specialist completes their part of your treatment, physiotherapy becomes the next essential step. Our physiotherapists work closely with specialists across Melbourne to ensure your rehab aligns with your medical plan. Feeling supported makes it easier to rebuild confidence. Our goal is to guide you from uncertainty to strength, from hesitation to trust, and from recovery to long-term independence. Key takeaways • Confidence is a major factor in surgical and injury recovery. • Prehab helps you feel physically and mentally prepared for surgery. • Early, guided rehab restores trust in your movement. • Progress is gradual but powerful when you have structure and support. • Long-term resilience comes from ongoing strength, stability and good movement habits. • You don’t have to navigate any of this alone. FAQs Do I need to feel confident before surgery? Not at all. Prehab helps build confidence by preparing your body and teaching you what to expect. Is it normal to feel scared to move after surgery? Yes. Pain and stiffness can make you hesitate, even when everything is healing well. How soon will I trust my body again? Many people feel more confident within a few weeks as movement becomes easier and strength starts to return. Can I do the exercises on my own? You can, but physio guidance ensures you’re progressing safely and avoiding compensation or delays. 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