Are we teaching our physiotherapists enough about psychology?

By Caroline Heaney


Physiotherapists are healthcare professionals involved in the treatment and rehabilitation of a broad range of patients in a variety of settings (e.g. hospitals, clinics, and sports clubs). This means that physiotherapy training and practice needs to cover a diverse spectrum of areas. Physiotherapy, as suggested by its name, is primarily concerned with the physical condition and has traditionally focused on just the physical aspects of injury and impairment. More recently however, consideration of the psychological condition during treatment has grown in importance. In line with this in recent years there has been a move away from the biomedical model towards the biopsychosocial model in physiotherapy practice.

Although UK bodies such as the Chartered Society of Physiotherapy (CSP) and Health and Care Professions Council (HCPC) acknowledge that an understanding of psychology is important to effective physiotherapy practice, and research has consistently shown the importance of psychological factors in physiotherapy, there appeared to be little known about psychology education within UK physiotherapy programmes and how effective this education is. A literature search failed to find any recent investigations examining the psychology content of UK programmes. In fact the most recent detailed investigation was published in 1989. We therefore decided to undertake our own investigation titled ‘A Qualitative and Quantitative Investigation of the Psychology Content of UK Physiotherapy Education Programs’.

The aim of this investigation was to examine current psychology provision within UK physiotherapy programmes to see if progress has been made since Baddeley and Bithell’s investigation in 1989. Specifically, the investigation aimed to examine the nature and extent of psychology covered in physiotherapy programmes. Representatives from seventeen UK universities that run physiotherapy programmes endorsed by the CSP and HCPC were interviewed regarding the psychology content of their physiotherapy programmes.

What did we find?

All of the universities claimed to include some degree of psychology content within their physiotherapy programmes, with health psychology being the most commonly cited topic area taught. It was largely agreed that psychology is an important component in the education and training of physiotherapists. However, there appeared to be great diversity both within and between universities in the provision of psychology education, and an underlying inconsistency between the reported importance of psychology and the demonstrated importance of psychology through its visibility within physiotherapy programmes. Such diversity and inconsistency was also reported by Baddeley and Bithell (1989), perhaps indicating that limited progress has been made in standardising the psychology curriculum for physiotherapy students over the last twenty-five years.

With regard to the delivery of psychology content, most universities used an integrated approach where psychology content was embedded into other aspects of the curriculum rather than delivered in discrete chunks or modules. The key reason cited for this was that of contextual relevance; it was largely felt that an integrated approach to the delivery of psychology content would lead to a more applied understanding of the topic. It was beyond the scope of the study to accurately determine whether or not the integrated approach to psychology content delivery is effective, however, it is possible that such an approach could sideline or de-emphasise the importance of psychology in physiotherapy practice. It has been suggested that an integrated approach may have a negative impact on confidence in using psychology. Another concern is that this approach can lead to vast inconsistencies in the volume and quality of psychology taught, both between and within universities, and difficulties in quantifying the amount of psychology covered. In line with this, when questioned regarding the amount of psychology in their physiotherapy programme, most were unable to provide an estimate and those who did varied greatly with responses ranging from 5-80%.

Key to a thorough understanding of psychology in an applied context is an understanding of the theoretical underpinning. Therefore, it would be reasonable to expect that the psychology content of physiotherapy programmes would contain a strong theoretical underpinning. However, this was not the case for all universities, with 41% of participants indicating that their psychology provision did not contain any theoretical underpinning. This is suggestive of a degree of superficial coverage of psychology amongst these institutions, which could potentially disadvantage students. One way of improving this situation would be for bodies such as the CSP and HCPC to set more prescriptive guidelines in this area.

The majority of participants rated psychology as highly important in the training of physiotherapists, stating the need for a holistic approach and an understanding of people and behaviour as the key reasons for this. However, this begs the question as to why its coverage is often hidden and why such inconsistency remains between universities in the nature and extent of their coverage. One answer to this may lie in the sheer volume of content required to be covered in physiotherapy programmes. Whilst this study focussed on the psychology content of physiotherapy programmes it is important to note that physiotherapy students have to cover a vast number of other topic areas. When asked what factors dictate the amount of psychology that is covered, time/space in the curriculum was the most commonly cited answer. The second most common answer related to staff; namely the quality, enthusiasm and availability of staff. It seemed that universities were only able to provide good psychology provision when they had access to staff able to facilitate this, which was not always possible.


It is clear that many physiotherapy programmes in the UK provide students with an appropriate grounding in psychology that will positively impact upon their professional practice and that these universities contain strong advocates for psychology amongst their staff. However, this is not always the case and there appears to be great variance in the psychology provision within physiotherapy programmes, which could potentially disadvantage some students. The findings from our study suggest that more needs to be done to standardise the psychology content of physiotherapy programmes in order to ensure that students at all institutions receive a similar level of training in psychology, which will have a positive impact on their professional practice.


The Final Goodbye

I have shared my heartache at the prospect of retiring from athletics on this blog before (see Goodbye…a letter to my sport and When is the right time to retire from sport?), but now the time has finally arrived. Two weeks ago I decided to retire. I started the season with no intention of retiring and was focused on the new challenge of being an 800m runner, but after a highly disappointing first race I know that now is the right time. In that race I ran significantly slower than I wanted to and with that came the realisation that I would not be able to hit the targets I had set myself. As I ran down the final 100m of the 800m race in last place I realised that I want to be remembered for being the athlete that I was and not the athlete that I’ve become.

SEAA 2006 400mH

Two years ago when I retired from the 400m hurdles I wasn’t ready to fully retire, but now I am. There is no doubt that my phased retirement has made this final decision easier to take, but I do still feel great sadness to be saying goodbye to the competitive side of the sport that has been my life for more than 20 years. I will still stay involved in the sport – I can’t let it go completely. I will continue to train and will eventually move into coaching, but I know it will never be same. Nothing will ever replace the feeling of competing on the track and that’s something I will have to come to terms with, but I look forward to the prospect of doing so.


What do physiotherapists need to know about sport psychology?

By Caroline Heaney


There’s lots of research out there to suggest that the use of sport psychology strategies during sport injury rehabilitation can lead to positive outcomes for the injured athlete. It therefore follows that educating physiotherapists and other sport injury rehabilitation professionals about sport psychology is likely to be of significant benefit, but what exactly do physiotherapists need to know about sport psychology and how is it best delivered to them?

These were the questions that I attempted to answer in a recently published journal article (Heaney, Walker, Green & Rostron, 2015), which aimed to review the recommendations of previous literature in this area and identify the appropriate content and mode of delivery for a sport psychology education intervention for already qualified physiotherapists. Three broad areas that sport psychology education for physiotherapists should cover emerged: (1) understanding of the psychological impact of injury, (2) interventions and psychological skills/techniques, and (3) referral and professional boundaries. In order for such education to be effective it is important that it is applied in nature and delivered in a short duration, flexible package.

To view a full text version of the article please click on the link below:,XMZM2EMl

Please note that this full text version of the article is only available free of charge until 18 February 2015.

The abstract from the article is reproduced below:
Sport psychology education has been shown to have a positive impact on the practice of sport injury rehabilitation professionals (SIRPs). The purpose of this paper is to review recommendations relating to such education. The paper presents a review of existing literature relating to the content and mode of delivery for a sport psychology education programme for SIRPs. The review seeks to address four questions: (1) What topic areas do researchers suggest should be integrated into the sport psychology education of SIRPs? (2) What topic areas are currently being recommended by professional bodies? (3) What are the findings of research examining the impact of sport psychology education on SIRPs? and (4) What do researchers recommend to be the most appropriate mode of delivery for sport psychology education for SIRPs? The findings of the review suggest that in order to maximise adherence amongst already qualified SIRPs sport psychology education should be delivered in a flexible short duration package. Additionally three broad areas that sport psychology education should cover emerged: (1) understanding of the psychological impact of injury, (2) interventions and psychological skills/techniques, and (3) referral and professional boundaries. This has important implications for the future training of SIRPs.

Sport psychology in the news – December 2014

In the Christmas and New Year rush I forgot to post my latest collection of recent sport psychology related articles/stories in the media for December, so here it is.

Please note that I do not endorse the content of any articles included in this list.

Phillip Hughes death: world of cricket comes to terms with tragic loss

By Caroline Heaney, The Open University

The cricket world has been rocked by the tragic death of 25-year-old Phillip Hughes who lost his life two days after being struck on the back of the head by a cricket ball during a match in Sydney.

In a heart-warming tribute, several Australian cricketers gathered at the Sydney Cricket ground where the incident took place following the news of this death. This act not only showed respect for Hughes, but it also showed great solidarity amongst the cricketers. Such solidarity will be important as Hughes’ teammates and the wider cricketing community come to terms with his death.

Sean Abbott, a friend of Hughes, who bowled the ball that ultimately caused Hughes’ death will particularly need the support of his fellow cricketers. Abbott did nothing wrong – he bowled a perfectly legal ball, but he will still probably experience feelings that could affect his future in the game. Thankfully, the cricketing world has shown united support for Abbott. For example, former Australian captain Mark Taylor stated: “I hope Sean Abbott can forgive himself because the cricket community doesn’t blame him at all” – a sentiment that is shared throughout the world of cricket.

Grieving for teammates

The death of a teammate can be deeply difficult for sports people to deal with. Teammates share a great bond. They spend a lot of time together, have shared goals and aspirations, share challenging times, and often develop strong friendships. The loss of a teammate, particularly in such tragic circumstances, will be hard for Hughes’ fellow cricketers to come to terms with.

Previous research by Keith Henschen and John Heil that examined the impact of the death of a teammate on sports performers found that players experienced feelings of shock and disbelief in the immediate aftermath following a teammate’s death, and experienced continued deep negative emotions such as depression as time progressed. Due to the close bond between teammates the death of a teammate can be more akin to that of a family member than to that of a colleague.

The emotions experienced by the sports people in this research link to grief response models which suggest that people progress through a series of stages as part of the grief process. In Kubler-Ross’ well-known grief model from 1969. These stages are: denial, anger, bargaining, depression and acceptance. Obviously grief is not a simple process and there are individual differences in the way that people experience grief, but this offers a framework of typical responses. To help people cope with the grief of losing a friend or teammate and progress through these stages it is important that they receive support, and it is pleasing to hear that Abbott is receiving that from a counsellor.

Risk of more injuries

Hughes’ death will have an impact not only on his teammates, but on the cricket world as a whole. An incident like this makes players realise that they are not invincible and can cause a reality check that can lead to more cautious play. For example, bowlers the world over might think about the potential consequences of their ball before bowling as a direct consequence of this incident and be in fear of causing harm to another player.

Batters too may be more fearful of getting hurt. Fear of injury and death are not conducive to good performance and in fact caution can actually cause more injury. In Henschen and Heil’s study, an interesting finding was that injury rates were higher in the two weeks following a teammate’s death than at any other point during the season.

Sport psychologists and other professionals are crucial at this time to help players cope not only with the grief of losing a member of their fold, but also with the impact this can have on their play and performance. The loss of such a young and talented player is truly tragic and will have an impact on cricketers everywhere. Let’s hope that the legacy of camaraderie and team spirit he left behind him will help his fellow players deal with the loss.

The Conversation

Caroline Heaney does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
Read the original article.

Sport Psychology in the News

From today I will be starting a regular digest of recent sport psychology articles and stories in the media.

Here is the first instalment, featuring a few articles from October and November 2014:

Please note that I do not endorse the content of any articles included in this list.

OUSA Conference, 29th June 2014

Today Jess Pinchbeck and myself led a session at the Open University Student Union Conference on effective goal-setting. We thought it might be useful for those who attended to have a copy of the slides, so here they are:

Goal setting

We really enjoyed the session and would have loved to have a little more time to answer questions. If you enjoyed the session, you may also find the resource below useful.

Finally if you want to find out more about our Degree in Sport, Fitness and Coaching visit: