Q & A

How Using the Biopsychosocial Model Can Help Us Overcome Pain

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Hector Lozada, PT, DPT, OCS, discusses the Biopsychosocial Model in working with pain and physical trauma in the Pilates studio.

What is the meaning of the term “biopsychosocial”?

As late as the mid-twentieth century, medicine as a whole was very much based on biology. When someone sought medical care, medical professionals would go directly to the physiological part of the body and fix that specific part, and they believed the whole organism (the person) would be okay. If the problem was in the pancreas, they would treat only the pancreas, and the same goes for the heart or any organ.

Since the latter part of the twentieth century, though, studies have shown that we should never care for someone by looking solely at the part of the body that is injured or malfunctioning without taking into consideration the psychological components (mood, personality, behavior) and the cultural (religion, family, socioeconomic status) components of their ailment.

It sounds like common sense, and it is common sense for a lot of the Eastern cultures, but in the Western world, we only started treating these other contributing factors relatively recently.

Why should Pilates teachers incorporate the “biopsychosocial” method into their teaching?

When we as professionals work with a client, we want to understand as much as possible about their full experience, for example, what are their stressors, their goals, their weaknesses and strengths. We don't just want to know about their bodies, we also want to know about their minds. When I see a client, I want to determine why her knee hurts, and I want to know how are things at work, how well she sleeps, and if she has a support system of friends and family. A client who believes she has the energy and tools to improve and reach her goals will most likely succeed. So, we are looking at her psychological state. A person's beliefs and goals can drive, or hinder, their ability to heal.

A client who believes she has the energy and tools to improve and reach her goals will most likely succeed.

The social component of The Biopsychosocial Model relates to the interaction with others and the roles they play in your life. You can imagine that a client who recently broke up with a partner will have a very different Pilates session than a client who just met somebody special. When you observe and acknowledge those three realms (biological, psychological, social) with your client, you develop a special bond. Additionally, your client knows you see her as a person and not just as a painful knee, and they know they are supported fully.

Are there social or psychological components that are more important than others in determining rehabilitation after a medical diagnosis?

From the psychological component, we should be aware of stress at work, stress at home, and any kind of recent trauma. If someone experienced whiplash or neck injury in a car accident, we know there is a strong psychological component that is linked to the trauma of being in the accident, which is compounded with the injury in the neck. Not only will they be experiencing physical pain, their stress levels may be elevated as well.

So, we try to assess the levels of stress in the person and find if there is underlying stress or depression. A medical professional might also look at the environment. I live in the middle of New York City, for example, so I think about noise and car pollution and how those types of factors increase stress.

From the social component, we might consider religion. If a male client follows a religion that frowns upon a man interacting physically with a female, he might have discomfort and increased stress in a Pilates studio setting, which could delay his rehabilitation. Those are things to be considered.

How does the stress or trauma of an experience compound pain and vice versa?

We often think about pain as beginning at the exact point of an injury. Once the injury heals, the pain goes away. But the reality is that many factors contribute to the experience of pain. Take for example, just hypothetically, if you were bitten by a squirrel. You immediately will experience pain from the bite. But now you also have hospital bills, you may miss work and lose income which causes you to miss other bills, you may be afraid to go outdoors for fear of being bitten by a squirrel again, so you are now limited not just physically by the injury, but also psychologically. You may miss out on the experiences of life that make you happy, which can limit your healing.

In the future, any input that elicits a nociceptive response (pain arising directly from nerve stimulation) in the area where you were bitten by the squirrel can cause a very different reaction. Imagine you are walking along, and a tree brushes your arm, exactly where the squirrel bit you. You will feel the physical pain, and there is a good chance you will also feel the stress, anxiety and emotional suffering that occurred as part of that original event.

A psychological goal could be to improve someone’s mood so they feel happier by the end of the session and then tailor the rest of the session based on the biological goals.

How can a Pilates teacher use The Biopsychosocial Method in working with clients who experience chronic pain or trauma?

For a teacher, the social part of someone’s life may be much more obvious because that is what people talk about. But the psychological component is important to pay attention to as well.

There are a couple of ways learn information about what a client is going through and what is affecting them that can be found in both what they say and don’t say.

First, we should listen very well to how people express themselves. If someone is going through a difficult time in their lives or have high levels of stress or anxiety it will come up in the conversation. It’s important to listen for language cues.

Second, we should pay attention to body language. Someone who is not in their best state is going to have a certain posture. The person may avoid direct eye contact with you or may appear irritable. Alternately, the person may be moving slowly and have low energy. You can tell if your client is having a fight or flight reaction to their experiences by how they show up at the Studio.

During any given visit, a teacher can define a psychosocial goal in addition to the biological goal of the session. A psychological goal could be to improve someone’s mood so they feel happier by the end of the session and then tailor the rest of the session based on the biological goals. The opposite situation could be a person with high levels of stress. In this case, you may do breathing exercises to bring their energy down and help them feel calmer.

It’s a very human and holistic approach because you are assessing what someone is bringing into the studio, and then working with them based on how they express or comport themselves.

This Q&A is part of our expert Q&A series on "Overcoming Pain." To hear more from Hector Lozado and other experts on this topic, join the PMA Pre-Con. Learn more.
About the Author

Kathy Schader

Kathy currently teaches Pilates in Manhattan Beach, CA, and she loves sharing the transformative power of Pilates. When not in the studio, she enjoys spending time with her family and being active outdoors in Southern California.


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