Integrative care is a term embraced by many practitioners and clinics to describe their approach to patient care. I won’t attempt to tell you what this new term means to all practitioners in all fields, but I would like to tell you what it means when I care for patients at my own physical therapy practice.
In my practice, integrative care means first understanding what you, as the patient, are trying to convey during our first meeting. There is of course the physical problem that first brought you in the door, but there are also the implications of your pain or injury on your daily life. I want to hear about them. I want to understand your goals and objectives so that I can work with you in achieving the best possible outcomes. Although I’m the practitioner, it is my philosophy that the patient is in charge of her or his healthcare.
My first responsibility as a clinician is to recognize that all systems in the body are related to one another. My second is to embrace the uniqueness in how each person approaches and prioritizes their healing process. In doing so, I appreciate how patients’ feelings and prior experiences, both emotional and physical, lay the foundation for their success in treatment. The two spheres of integrative care, the emotional and the physical, are rich areas to explore, and I’ll address each in turn.
Considering the emotional components of patient care means looking at two factors: how suffering from physical pain or an injury can cause emotional distress, and how past pain or trauma can, in turn, contribute to physical pain and discomfort in the present. It means looking at the connection between the physical and the emotional as a two-way street, on which either one can have a considerable effect on the other with both positive and negative consequences.
To heal as a complete person (not just a symptom or body part) your feelings need to be validated and your history understood by the practitioner who is caring for you. It is completely normal for physical injury or pain to have an emotional effect on the person living with them, and it is just as normal that emotionally painful events in the past, like past physical injuries, have an effect on your present condition. As a physical therapist, I also believe in recommending that patients seek the help of a psychotherapist specializing in trauma if I observe that an underlying trauma is either blocking progress or may be the true source of pain. Recognizing and respecting the link between physical pain and emotional well-being is a crucial component of integrative care.
It is equally important to look beyond the site of pain or discomfort in order to evaluate imbalances in other parts of the body; this method of tracking symptoms to their source forms the physical sphere of integrative care. In using this approach, my colleagues and I often find that it is other, seemingly unconnected regions of the body that contribute the most to your pain or discomfort. Nowhere is this more evident than when we conduct physical therapy evaluations for pelvic floor patients, as the pelvic floor encompasses several systems of the body all within one area.
To start, however, we first look to posture when assessing any new physical therapy patients, as it affects how you sit, stand and walk. Simply put, moving the wrong way causes pain, and how you “hold” yourself when you perform daily tasks may be aggravating your symptoms. Think about what position you are in when you sleep at night. Are your hips dropping to one side and your neck to another? Being in a strained position for several hours at night can stress ligaments and muscles. This same concept happens when we sit at a desk all day or have to lift small children frequently. Body awareness and movement patterns have to be part of the way to pain-free life, and in our integrative practice, we instruct you in techniques to improve your movement patterns day to day.
Finally, my colleagues and I approach treatment by using the least invasive means possible. We often refer to this process as “unlayering”. This means as time unfolds during our treatment sessions together, we are able to get to know you better, how you approach healing, and how to best support you. We see how you respond to bodywork, exercise, stress, and change in self-care practices throughout the course of your treatment.
The integrative care model considers comprehensive personal history before developing treatment protocol. Because of this, it's a style of patient care that can lead to better outcomes for many patients. It’s about collaborating with you, the patient, to provide you with the best personalized care possible. It also means it may be necessary to refer out to other skilled clinicians such as psychotherapists, medical providers or acupuncturist if you may need more than physical therapy. When focusing on you as a person and not just your symptoms, we can witness how integrative treatment supports patients to heal as whole people.