A lot of people find it strange that a physiotherapist is so focussed on psychology and mental health. Whenever the topic comes up in conversation, there is usually a brief pause while the person I’m talking to tries to connect the dots.
“Wait… what does psychology have to do with a sore knee or a bad back?”
So, we get into it.
At its core, a huge part of psychology is simply understanding human behaviour—and recovering from an injury has everything to do with behaviour. Think about what happens the moment you notice a new pain. Do you book an appointment right away, or do you wait a few weeks to see if it settles on its own? Those are behaviours. Once you do seek help, how closely do you stick to the rehab plan? Showing up, doing the work, or avoiding it altogether—those are all behaviours, too.
Those behaviours don't happen in a vacuum. They are shaped by our past experiences and beliefs. If a certain type of treatment fixed your back pain five years ago, you are going to seek that same treatment out again. On the flip side, if you tried something in the past and it didn't work, you aren't going to waste your time or energy on it a second time. Our beliefs drive our actions.
Past experiences also shape our emotions, which play a big role in how we move. Imagine a specific treatment caused you a lot of pain in the past, and now a new physio suggests trying it again. You’re naturally going to feel a spike of fear or hesitation. The same thing happens with rehab exercises. If a specific stretch or lift hurts every time you try it, your brain starts associating that movement with danger. You start feeling anxious or hesitant before you even begin. And if you feel that way every time you try to do your home exercises, you’re eventually going to stop doing them—no matter how many times your physio tells you they are important.
So, yeah, psychology is a massive part of physical rehab.
Usually, by this point in the conversation, my friend’s wheels are turning. “Okay, that makes sense. So how do you actually use psychology in a session?”
To be clear, I’m not asking about your childhood, and I’m not trying to manage your mental health. I’m a physiotherapist, not a psychologist.
Instead, understanding what drives your behaviour completely changes the recommendations I make. If you aren't engaging with a treatment—whether that's a home exercise or taking a temporary break from a sport—understanding why helps me tailor the plan. Are you skipping it because it causes pain? Are you worried you're going to make the injury worse? Does the treatment get in the way of your job or keep you from doing something meaningful in your life?
These thoughts, beliefs, and feelings directly impact whether a rehab plan actually works. So, I ask about them. We get into the weeds a bit more.
“And what about the mental health piece?” is usually the next question.
It’s a two-way street: an injury can impact your mental health, and your mental health can impact your injury.
Take anxiety, for example. Most of us feel anxious when we get hurt, because anxiety is really just a reaction to uncertainty. How is this going to affect my job? How long will I be in pain? Will I be able to get back to my hobbies or sports? Am I going to need surgery? Injuries are inherently stressful, and that initial wave of anxiety is often what motivates us to seek help—whether that’s seeing a doctor, getting a massage, or booking in with a physio.
However, if that anxiety sticks around or ramps up during recovery, it starts to take a physical toll. It can disrupt your sleep, leave you exhausted, and even amplify the pain you feel (though that’s a topic for another day).
On the flip side, if you are someone who already deals with a lot of anxiety in day-to-day life, navigating rehab can feel even harder. You might hesitate to try new movements out of a fear of pain, a fear of causing harm, or a fear of losing your independence. This is completely normal. At its core, anxiety is just your nervous system trying to protect you.
Because of this, a good rehab plan has to account for your anxiety levels. If a treatment makes you feel overwhelmed or unsafe, you naturally aren't going to do it. But when you feel supported, heard, and safe throughout the process, that protective alarm system quiets down—and actually engaging in your recovery becomes a realistic possibility.
Usually, by this point in the conversation, the confusion has cleared up. My friend nods, taking it all in.
"Huh. I never really thought about it like that. It makes total sense, though."
Of course, this is usually just the tip of the iceberg. People often want to know more—like how stress actually turns up the volume on physical pain, or what a physio can do when someone feels completely stuck in their recovery. Those are great questions, and ones I love diving into.
At the end of the day, though, my answer always comes back to the same simple idea: injuries don’t happen to isolated body parts. They happen to whole people—people with busy lives, past experiences, worries, and goals.
When we pay attention to the psychology behind the injury, rehab stops being a generic list of exercises you feel guilty about skipping. Instead, it becomes a conversation, and a plan built around you. And that’s usually where real recovery starts.
Transparency regarding AI use: I wrote the original draft of this article and used AI to help refine its structure, clarity, and wording. I reviewed and edited the final version before publication.