With the steady rise of interest in personal health and wellness, holistic medicine has become increasingly popular among patients seeking a more whole-body approach to their medical concerns. Some healthcare practitioners have embraced this integrative approach that addresses more than just the physical aspect of health, while others remain skeptical of its claims and associated methodologies. Many clinicians practice holistic medicine, but what is it exactly and where do physical therapists fit in?
Holistic, Alternative, and Complementary Medicine: What’s the Difference?
Before we begin to understand how physical therapy fits into the holistic medical philosophy, we first need to define what holistic medicine actually is. Despite the rising popularity of a holistic approach to medicine, there is some confusion about what it means to practice it. Part of the reason for this is the fact that terms that are used to describe a variety of related, but distinct, medical treatments are used interchangeably.
The simplest definition of holistic medicine is that it is a “treatment that deals with the whole person, not just the disease.” Taking that definition a step further, we can describe holistic medicine as an integrated healthcare approach that aims to address the physical, mental, spiritual, and emotional aspects of illness or injury. Holistic providers believe that these factors are interdependent and, ideally, should all be addressed in order to achieve an optimal outcome. These providers may use many forms of treatment and are not limited to the use of either traditional (Western) or alternative medicine.
“...we can describe holistic medicine as an integrated healthcare approach that aims to address the physical, mental, spiritual, and emotional aspects of illness or injury.”
Alternative medicine, on the other hand, is any treatment that is used in place of traditional medicine; this includes special diets, the use of herbs and vitamins, and energy techniques such as reiki, therapeutic touch, and magnet therapy. When a provider combines traditional and alternative treatments, this is known as complementary medicine; the use of acupuncture to treat some side effects in cancer patients receiving chemotherapy is one such example.
Holistic medicine is best characterized as an approach to healthcare that encompasses many types of treatment, all with the ultimate goal of addressing the whole person–physically, mentally, spiritually, and emotionally. Holistic practitioners attempt to improve the health of their patients by considering the above factors while placing emphasis on preventive care, fostering a strong patient-practitioner relationship, and empowering patients to achieve optimal health and wellness.
Is Physical Therapy Considered Holistic Medicine?
A quick search for the term “holistic medicine” shows that many clinicians with varying backgrounds practice holistically, including medical doctors, chiropractors, massage therapists, and nutritionists. What about physical therapists? Can PTs be considered holistic medical providers? As with everything else in physical therapy, it depends. In this case, it depends on the individual therapist and their practice philosophy.
According to the American Physical Therapy Association (APTA), the goal of physical therapy is to optimize movement and function to improve an individual’s quality of life. Physical therapists are experts in physical health; our primary function is to address the functional aspects of illness or injury. However, a physical therapist can be considered holistic if they address other aspects of an issue that may be interfering with a patient’s functional ability or quality of life.
Integrating Holistic Medicine Into Physical Therapy
A Case Study
Let’s say a patient returns to physical therapy with neck pain and headaches that you, her physical therapist, have previously determined are due to cervical muscle tightness, poor posture, and stress. She has been having trouble improving her range of motion and admits that she has not been compliant with her stretching and strengthening exercises. She works as a software developer and has been stressed lately because there are several project deadlines coming up. You find out she has been having trouble sleeping because she tends to lay in bed at night playing games on her phone to unwind after a long day.
As a physical therapist with a holistic approach to treatment, you understand that adequate sleep helps repair and grow muscle tissue, promotes alertness, and reduces stress. A 2013 review published by the American Pain Society also suggests that pain and sleep are related, citing evidence to support a directional relationship between impaired sleep and pain exacerbation. You educate her on the importance of sleep for recovery and good sleep hygiene practices, such as disconnecting from her phone at least 30 minutes before bed, which helps her fall asleep more quickly.
Getting enough sleep can reduce stress at work, provide more alertness in the evenings, and give her more time to spend time on exercise. Adherence to her home exercise program helps to release the muscle tension that builds up throughout her day, which reduces the intensity of her headaches, and leads to a more relaxing night. This, together with improved sleep habits, promotes a restful night’s sleep—the cycle continues.
Should I practice holistically?
In considering a holistic approach to PT it's important to consider that evidence supports a link between psychological factors and pain. A 2018 systematic review published in the British Medical Journal Open (BMJ Open) found that certain psychological factors such as self-efficacy and resilience are correlated with reduced pain intensity and disability.
Meanwhile, factors such as anxiety, depression, and catastrophizing are correlated with increased disability and pain intensity in patients with chronic shoulder pain. This review coincides with the surge of interest in topics related to psychologically-informed PT (PIPT) as evidenced by the inclusion of lectures on PIPT at the APTA Combined Sections Meeting (CSM) 2019, as well as the rise of psychologically-targeted interventions in PT practice.
One possible argument against practicing holistically is that it would add “one more thing” to the ongoing list of a PT's responsibilities. This is a valid concern and one that must be considered seriously before offering this type of approach for your patients. While no special credentials are needed, staying up-to-date with research is important in understanding how various non-physical factors affect functional recovery and the experience of pain.
In the example above, knowledge of sleep research and its impact on recovery is an integral part of responsibly advising and educating the patient. Another factor to consider is the importance of familiarity with current state practice laws in order to stay within the legal scope of practice guidelines.
Covering holistic practitioners to hard and fast clinicians and everyone in between, we spoke to 795 PTs about their thoughts on the industry! Check out the results of our 2019 Physical Therapy Report!
On the other hand, physical therapists are in an ideal position to assess a variety of contributors to impaired function because of the amount of time we spend with patients per session and the frequency with which we interact with them over multiple sessions. Treating patients in a holistic way can address the multifactorial nature of pain and disability and empower them to be in charge of their own health while also emphasizing the physical therapist’s role in general health and wellness education.
It is always important for physical therapists to recognize when a medical condition is not within their scope of practice and to refer to the appropriate healthcare professional when necessary. Additionally, when considering the use of a holistic approach in physical therapy, the rules of evidence-based practice still apply–the clinician should take into account their own experience and skills, each patient’s values and preferences, and the best available evidence.
Physical therapy is not always considered holistic medicine, but it can be; ultimately, it is up to each therapist to consider the pros and cons and decide if this is the right approach for themselves and their patients.
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