Understanding musculoskeletal disorders requires considering not only the clinical and scientific aspects of these conditions but also how they are perceived by the general public. What do people think a pathology is? What do they believe is the right treatment? These perceptions are constantly at odds with my own perspective as a physiotherapist.
Through my work in Phnom Penh—and in previous professional experiences—I have observed recurring patterns in how people think about musculoskeletal issues and the treatments they seek. Unfortunately, I see a persistent gap between modern scientific understanding and the outdated concepts still widely accepted by both patients and some healthcare professionals. The positioning of physiotherapy in medical literature and clinical practice often fails to keep up with current research.
It takes more than a decade for new scientific evidence to reach not just universities but active clinical practice. As a result, many chronic pain patients come to me with outdated beliefs about their conditions. For example, while physiotherapy has transitioned from passive approaches to active rehabilitation, the public still largely associates it with passive techniques. Similarly, the medical field has moved from joint protection to movement stimulation, yet many people still fear movement as a risk rather than a solution.
The Fear of Movement: A Key Factor in Chronic Pain
One of the most important lessons from the past 10–15 years of research in physiotherapy and rehabilitation medicine is that fear of movement (kinesiophobia) and movement avoidance are primary drivers of chronic pain. While chronic pain is influenced by multiple factors, the widespread misunderstanding that “resting” an injured body part is always beneficial is a major issue.
Modern physiotherapy management in 2025 is about encouraging patients to move beyond their pain threshold in a controlled and progressive way. The peripheral nervous system—especially the nerves around joints—plays a crucial role in pain generation. Avoiding movement can lead to increased sensitivity in these nerves, reinforcing pain and disability.
Most of the time, patients avoid movement because they fear damaging their body further. They see pain as a sign that something is “broken” when, in reality, pain is often a response to nervous system hypersensitivity rather than actual tissue damage. Yes, caution is necessary in the acute phase of an injury—especially after a fall or accident involving structural damage. However, in chronic conditions, prolonged rest and avoidance behaviors are often the problem, not the solution.
The Role of Education in Physiotherapy
If you come to me for physiotherapy, a significant part of our session will be dedicated to patient education. Each patient brings their own set of beliefs and experiences, and my role is to guide them toward evidence-based solutions.
Theoretical knowledge is essential—it can completely reshape how patients perceive their condition. Proper education reduces fear, empowers patients to take action, and helps break the cycle of chronic pain. This is what physiotherapy is truly about: helping people regain control of their bodies and their lives.
Hands-On Treatment and Exercise Therapy
Beyond education, physiotherapy involves hands-on techniques to relieve pain, improve mobility, and restore function. However, manual therapy alone is not enough. The third pillar of treatment is movement and exercise therapy, which is often the hardest part for patients.
Adherence to exercise is one of the biggest challenges in rehabilitation. Athletes generally understand the importance of movement, but for those who are unfamiliar with regular exercise, incorporating it into daily life can be difficult. As physiotherapists, our job is to motivate and support patients in performing exercises that will actively reduce their pain and improve their condition.
This is why I also use rehabilitation software—such as Physitrack—to ensure continuity beyond in-person sessions. A structured and personalized exercise program helps patients stay on track, making their recovery more effective and sustainable.
Conclusion
Physiotherapy in 2025 is about updating outdated beliefs, encouraging movement, and providing the right combination of education, manual therapy, and exercise. If you have questions or need guidance, feel free to contact me.
I am Yannick Sarton, physiotherapist and osteopath at Studio On in Phnom Penh, and I am here to help.
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