Cognitive Functional Therapy

Cognitive Functional Therapy is an evidenced based approach to the management of persistent low back pain. The approach has been pioneered by Professor Pete O’Sullivan from Curtin University in Australia, and is unlike any other therapy currently being used for persistent low back pain in that it is a scientifically based programme yet a truly holistic form of management.

Cognitive Functional therapy is a patient centred approach that considers ALL the factors that can cause pain to persist. Physiotherapists trained in this technique have the skills to enable patients to identify factors in their life that are contributing to vicious cycles of pain and disability.

Where models of healthcare have previously failed in the management of persistent low back pain is the primary focus is often on the STRUCTURE of the spine, what the x-ray or MRI findings show. But lots of research has shown that scan findings are not highly predictive of pain, yet multidimensional factors such as health attitudes and beliefs, stress levels, sleep habits, lifestyle issues and levels of physical activity can work together negatively to create a downward spiral of persistent pain and declining functional ability.

Unlike Cognitive behavioural therapy, Cognitive functional therapy considers attitudes and beliefs as well as physical factors such as functional movement quality. The two affect each other. For example, if someone is particularly afraid to bend forwards because they think it is harmful or it’s going to hurt, that fear is likely to change the movement strategy. We see people moving with excessively braced postures, which puts a lot of pressure on the back, and causes it to hurt. A self-fulfilling prophecy develops. By working with someone to improve how they move, to enable movements to become easier and less painful, naturally the fear around moving starts to dissolve.

Stress can have a huge impact on a person’s back pain. Not just by increasing background muscle tension, but by causing the body’s pain alarm system to become more sensitive. Back pain is stressful, and stress aggravates back pain. Another cycle. Cognitive Functional Therapy can help people become more aware of the tension they hold in their body, and can be used to teach people how to reduce the tension through relaxation and mindfulness techniques.

Back pain and sleep are often interlinked, one affecting the other one negatively. Cognitive Functional therapy considers factors such as poor sleep hygiene, and a goal commonly is to restore or improve a person’s sleep but looking at sleep habits, sleep positions, relaxation etc.

Whilst this approach has been pioneered for the use in the management of persistent low back pain, we use elements of the technique in the management of all persistent musculo-skeletal pain disorders… neck, shoulder, knee pain and even recurrent sporting injuries.