Physiotherapy and Mental Health with Chris Smith

April 28, 2020 at 12:44 PM

Compiled by our Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE


Over recent years mental health has received a lot more attention both in the mainstream media and through public health promotion. The most recent data available from the Ministry of Health demonstrated 176,310 people were engaging with mental health and addiction services in 2017. At the time, that figure represented 3.6% of the population. This number has been rising each year since 2011, therefore, it could be suggested that today this number is even higher.

But what does mental health mean? In its simplest form, it describes our emotional, psychological, and social well-being. Of course, this can be changeable dependent on lifestyle factors and events. Realistically, we are all likely to struggle with our mental health at certain points in our lives. In fact, with all of us out of routine and lacking social interaction at present in this lockdown, now is an important time to consider our mental health and that of our loved ones and how we might manage it.

Within physiotherapy we deal with patients with a range of physical and mental health issues. From my own personal experience in a previous role, I was amazed when taking patient histories how many were on medication to manage depression and anxiety. In fact, poor mental health has been linked with both the development of musculoskeletal pain and can be an outcome as a result of pain. For example, depression has been linked with increased likelihood of developing low back pain, and vice versa developing low back pain can also lead to depression. This biopsychosocial model of healthcare has been become increasingly recognised over the last decade and integrated into new guideline production for a range of health conditions as it recognises the link between mental, physical, and social factors - and the impact these have on people’s health.


Mental health has always been taught as part of undergraduate physiotherapy courses. What has changed however, is the bias and amount of time given to these topics. When I qualified in 2007 we had one module on mental health, namely discussing conditions such as depression, anxiety and schizophrenia. However, we did not use a framework such as the biopsychosocial model to discuss in detail how a patient who presented with a knee injury for example, may go on to develop deepening depression due to the impact of this condition on their normal levels of exercise, unemployment, and lack of social activities. All these factors are shown to impact upon a client’s mental health. 
More health research over the past decade, along with greater investment into mental health services, has helped to bring this topic to the forefront. More open discussion in the news, and openness of celebrities and high-profile figures discussing their own personal struggles, has assisted with the prevalence of mental health and encourages people to relate and be forthcoming with their struggles. Also, with the promotion of World Mental Health Day on global social media platforms such as Facebook and Instagram the message appears to be one of acceptance and has less stigma in the present day.  

What can we do to manage it?

The first step is identifying what it is affecting your mental health. We are all complex human beings with many aspects to our lives which can impact our mental health. Perhaps ask someone external if they can help you identify, as they may have a more objective view of your situation. Identifying what it is that’s upsetting you will aid in helping you start to manage the situation. 
Talk with people you trust about your feelings. This could be a friend, family or your partner. Just being listened to by someone you trust can help you feel supported and lessen the load. Talking about your feelings is not a sign of weakness. If further professional input is required discuss with your health professional/G.P about referral to psychology services for talking therapies. 

Regular exercise can improve your mood and regulate your sleep pattern. This is believed to be due to chemicals called endorphins that get released into your bloodstream. Exercise also increases confidence and self-esteem, and can give you social interaction which in turn can aid mental health.

Eat a healthy diet and try to limit intake of alcohol if your mental health is affected. Excessive alcohol intake is not a healthy way to manage your mental health and there are services aimed at helping reduce symptoms of dependency.

Try and regulate your sleep pattern. Getting into a good sleep routine has been shown to be essential to good physical and mental health. Sleep hygiene is a topic which has received more attention over recent years and guides you through various factors which may be impacting the quality of your sleep. Take a look into this for further information:

Mindfulness and meditation have had a growing role in the management of stress and mental health over the last decade and have both shown positive psychological outcomes in some patients. Therefore, contacting a professional skilled in these techniques or self-directed learning and practice could be considered.

Put yourself first. Ask for help from people if you need it. Learn to say no and take regular breaks during tasks to reduce the physical and mental stress from building up. 

Do something you're good at and enjoy. This tends to boost self-esteem and it also release endorphins, which again help with mood. Also, do something to help others:  friends, family or volunteering. This can help improve feelings of self-worth. 

There can be a role in managing certain mental health conditions with prescription medication. If this is a route someone wishes to explore this is a decision between you and your G.P to decide on the most appropriate option. 

As physiotherapists, we tend to have more time available than would be in briefer G.P encounters, so we have the luxury of being able to talk more to our clients and listen in order to understand their situation. From here we aim to understand the "whole problem" and the way an injury may be affecting someone’s life. This then enables us to make a plan with our clients to manage their whole health and not just the pathology of the injury in front of us. If our skills are not enough to manage the problem alone, we can refer on to GP's for onward referral to appropriate services as required. 


George, E., & Engel, L. (1980). The clinical application of the biopsychosocial model. American journal of Psychiatry, 137(5), 535-544.

Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical psychology review, 31(6), 1041-1056.

Ministry of Health. 2019. Office of the Director of Mental Health and Addiction Services: Annual Report 2017. Wellington: Ministry of Health.

Pinheiro MB, Ferreira ML, Refshauge K, Maher CG, Ordonana JR, Andrade TB, Ferreira PH. Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J. 2016;16:105–116.

Rosenbaum, S., Tiedemann, A., & Ward, P. B. (2014). Meta-analysis physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry, 75(0), 1-11.

Sani, S. H. Z., Fathirezaie, Z., Brand, S., Pühse, U., Holsboer-Trachsler, E., Gerber, M., & Talepasand, S. (2016). Physical activity and self-esteem: Testing direct and indirect relationships associated with psychological and physical mechanisms. Neuropsychiatric disease and treatment, 12, 2617. - Date accessed 15/04/2020

Tags: physiotherapy, mental health, biopsychosocial, wellbeing
Category: Physiotherapy