The Biopsychosocial Model | Assessment and Treatment | Manual Therapy Tutorial, Paul Townley
For many years back pain, for example, was considered via a biomedical model whereby pain is a result of a problem at a specific site or structure. Therefore, by addressing a specific painful area with a specific technique, the problem should decrease—the idea being that “If I push here, and it hurts, then this structure must be responsible, so if I push it in this direction, it will eventually hurt less”.
This theory has recently become less supported empirically. While aspects of the biomedical model may be relevant in some situations, a newer biopsychosocial model (BPS) of assessment and treatment has been suggested and come into vogue. This model, conceptualized by George Engel in 1977, suggests we need to look at a person’s medical condition by considering biological, psychological, and social factors.
The various components of this model may be defined as follows:
Bio = Physiological and/or pathological elements
Psycho = Thoughts, beliefs, emotional, behavior, distress, fear, and coping methods
Social = Socio-economic, socio-environmental, cultural, work issues, family influences, benefits, and economics
Sadly, as is often the case when a new idea or concept enters the arena (although this model is far from new), the tendency is to adopt the bits that are new and comfortable at the expense of the old—often dismissing the old as irrelevant. This may be more noticeable when people are trying to make a name for themselves, which is rarely helpful—along with the guruism that follows it. In my humble opinion, it is always worthwhile combining the good from both. Fortunately, to some extent, this return of the pendulum has started to happen.
By considering all of the factors, both new and old, we should be able to utilize all the tools at our disposal to devise effective assessment and treatment programs with successful outcomes. Back pain can result from or involve several factors, including physical, pathological, psychological, and social. It may manifest itself as pain, movement dysfunction, or both. Psychosocial elements maybe prevalent and have a strong influence; thus, a broad outlook is necessary.
Manual therapists could be considered as being experts in movement dysfunction, whether it be at a cellular or more gross anatomical level. Put very basically—we get things moving when restricted or stabilize them when not, utilizing the skills and techniques we have at hand. The outcome is that we relieve pain and dysfunction in the myriad of ways that we do. This is part of the therapeutic alliance in which several elements, including physical and psychological, play their part.
However, there are factors other than the physical that may prevent a patient from fulfilling their potential with regards to pain-free, fluid function. These include various circumstances at home or work, or a patient’s beliefs about their problem.
Subsequently, a flag system has been developed to help highlight these factors, and this is where an understanding of pain and how it is processed is useful. Indeed, the biopsychosocial model addresses this by considering the interactions between biological and social elements with regards to pain. It acknowledges that pain is an experience that is controlled by output from the brain that may be subject to any contextual effects such as those mentioned—beliefs, home situation, and so forth.
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