Living with pain – can we face it head on and find a way through it? The answer is yes.

One of the therapy approaches we can try as part of our physiotherapy program is called Acceptance and Commitment Therapy (ACT). This is a compassionate and mindful approach to the existence of long lasting pain.

So from the name we understand some critical messages:

Let’s start with:


This is where we recognise and accept our life as it is right now. We would have to face the reality of our discomfort and its limitations on our life. We may also identify things which are unachievable goals right now. However this acceptance or “reality check” might actually allow us to move forward and adapt or create a plan to achieve those goals in the future.

How can we as physiotherapist and client team use this in our pain rehabilitation process?

Our priority would be to ENGAGE with you. Here we could understand where you are at right now. We could also spend some time identifying your personal values or the things that bring meaning and vitality to your life. In this way we could begin to walk a road together as we work out how pain may not be allowing you to do these things that are so important to you.

We want to work on building skills throughout this process. One of these skills is called MINDFULNESS. Imagine being able to learn a purposeful and non judgemental approach to your present experiences. Imagine learning the difference between BEING/REACTING to the thoughts you are having or instead just simply HAVING the thought and not reacting. In this way we could learn to not allow the difficult thoughts, feelings or fears to always have the same impact on us. Another great description for this is “flexible awareness” and mastering this could be the start in planning how we can return to some of our important value based activities.

So how do we do this practically in a physiotherapy and client team?

The physiotherapist is not there to “fix” you or offer you generalised solutions and advice. We want it to be a collaborative planning situation where you will feel empowered to find the way yourself and have a meaningful set of skills for the way ahead. When we choose ACTIVITIES the focus will again be directed by your needs as we plan for tasks and goals that will lead to your VALUE based end result.

This will also be the COMMITMENT part of the ACT process as we use a team effort to draw up the plan and discuss the commitment from physiotherapist and client in working at this plan.

Here is a simple example which we can use to start with:

Write down a VALUE that is important to you:

  • Spending quality time with my husband (but I have a painful knee and often don’t do anything with him).
  • What TASK could you commit to do to try and fulfil this VALUE?
  • Join him for his daily swim in the ocean as we both love the ocean.
  • What GOALS could we set to get there?
  • Need to be able to walk for 5 minutes.
  • Need to climb 10 stairs.
  • Need to negotiate soft sand and waves.
  • Now we can check your BASELINE: And work on some “FLEXIBLE AWARENESS”.
  • What can you do at present? (Walking distance, stairs, balance and strength).
  • What thoughts or fears do you have with regard to your knee pain and your beliefs about what you can do and what will make it worse?

So what is the PLAN?

A discussion and information gathering session on what is safe for knee rehabilitation and what will NOT be harmful to the knee.

We could add to this and give you more detailed information on the successful and effective rehabilitation strategies that do not cause harm for example using hydrotherapy.

And then move onto practical aspects of the plan with the reassurance that it is a safe and graded plan that everyone is happy with.

  • A graded walking plan with gradual increase in distance or time
  • Thigh and buttock strengthening to better support the knee and improve stair climbing
  • Balance exercises in the water and eventually on land to improve confidence for sand and sea.

Hopefully in this way problems that seemed insurmountable are broken into manageable steps with your very important VALUE based activity as the end goal.

We would keep using the mindfulness or flexible awareness as an ongoing process as we gain reassurance from the small and safe activities that don’t cause pain or damage. And in turn possibly think differently or more FLEXIBLY about other activities we previously feared.

This is why we like this therapy approach. Together we have now faced your pain, and your thoughts and fears and still come out on the other side with a plan of action that isn’t terrifying. And most importantly we found you in there, the person you may have thought you lost and now you have a plan and the skills to take your life back.