A Systems-Based Approach to Physical Therapy: Understanding Complex Conditions

Introduction

This article is a deeper dive for patients who have tried multiple treatments without lasting results and want to understand why.

Many of the patients I work with have already tried physical therapy, often multiple times, without lasting results. They have seen many other providers trying to find answers. Manual work often helps realign them but their body doesn’t have the ability to maintain that alignment on its own.

Patients often present with:

• Multiple areas of discomfort

• Recurrent injuries

• A range of other symptoms, including:

  • Anxiety

  • Sleep disturbances

  • Digestive issues

  • Sinus congestion or breathing difficulty

  • Tinnitus or balance problems

  • Vision or vestibular symptoms

  • Neurological complaints such as neuropathy or movement disorders

These symptoms may seem unrelated, but they are often connected through how the body functions as a system.

It’s Not Just About Pain, It’s About System Function

Traditional physical therapy is often diagnosis-driven, focusing on the location of pain.

While effective in many cases, chronic conditions are frequently more complex.

The body functions as an integrated system involving:

• Musculoskeletal mechanics (movement patterns)

• Pressure regulation (breathing, ability to create compression and decompression within the body)

• Nervous system control

Disruptions in one area can influence others, a concept supported by the Regional Interdependence model (Wainner et al., 2007).

The Role of Pressure, Airflow, and Movement

Efficient movement depends on the body’s ability to regulate pressure and coordinate muscle activity.

Normal movement depends on the body’s ability to:

• Shift pressure effectively

• Expand and contract where needed

• Coordinate muscles in a balanced and integrated way

When this breaks down:

• Some muscles become overactive

• Others become difficult to access

• Movement becomes compensatory

This can lead to:

• Multiple areas of pain

• Ongoing strain on specific tissues

• Symptoms that seem unrelated but share the same underlying cause

• The nervous system remaining in a more protective, reactive state, impacting autonomic function

Research has shown:

• The diaphragm plays roles in both respiration and postural control (Hodges & Gandevia, 2000)

• Altered breathing mechanics are associated with chronic pain and motor control dysfunction (Hodges et al., 2012)

• Breathing patterns influence the autonomic nervous system, which affects stress, digestion, and cardiovascular function (Zaccaro et al., 2018)

This can contribute not only to pain, but to broader symptoms such as anxiety, poor sleep, and digestive dysfunction.

Why Symptoms May Seem Unrelated

The nervous system integrates multiple body systems.

Research supports connections between:

• Breathing dysfunction and anxiety and panic symptoms (Ley, 1999)

• Posture and balance/vestibular function (Horak, 2006)

• Cervical spine dysfunction and headaches, dizziness, and sensorimotor changes (Treleaven, 2008)

• Autonomic regulation and gut function and inflammation (Mayer, 2011)

Because of this, patients may experience multiple seemingly unrelated symptoms that share a common underlying driver.

Why Traditional Treatments Often Don’t Last

Common interventions can provide temporary relief but may not address the full system:

• Stretching tight muscles- Muscles often remain tight due to protective neurological patterns, the body relies on them for stability

• Strengthening exercises- Strength gains are limited if the body cannot properly access or coordinate the muscle. You can not strengthen what you can not activate.

• Manual therapy- Effective for short-term relief but may not change movement patterns long term

These interventions are often helpful but incomplete.

This aligns with research on Motor Control and the importance of retraining coordinated movement (Hodges & Moseley, 2003).

A Different Approach: Restoring Function

The approach I use with patients focuses on:

• Identifying asymmetries and imbalances

• Improving breathing mechanics

• Restoring the body’s ability to manage pressure

• Retraining coordinated movement patterns

By addressing these foundational elements, it becomes possible to:

• Reduce strain on overloaded structures

• Improve overall function

• Create more lasting changes

The goal is to restore the body’s ability to function as an integrated system.

This systems-based perspective is consistent with the American Physical Therapy Association movement system framework and approaches such as those taught by the Postural Restoration Institute.

This Process Requires Time and Effort

Changing long-standing patterns requires:

• Awareness

• Active participation

It is both physically and neurologically demanding. However, for many patients, this provides a path beyond temporary relief toward meaningful improvement in both pain and overall function.

Conclusion: A Different Option for Complex Cases

Many patients seeking this approach have been told: “You’ve tried everything” or “This is just how it is.” They may benefit from a different framework, one that focuses on restoring how the body functions as a system. If you’re dealing with complex or persistent symptoms and this framework resonates, this approach may be worth exploring.

References

• Hodges PW, Gandevia SC. (2000). Activation of the human diaphragm during postural tasks. J Physiol.

• Hodges PW, et al. (2012). Pain and motor control: from experimental to clinical application. J Electromyogr Kinesiol.

• Hodges PW, Moseley GL. (2003). Pain and motor control of the trunk. Spine.

• Wainner RS, et al. (2007). Regional interdependence. J Orthop Sports Phys Ther.

• Zaccaro A, et al. (2018). How breath-control can change your life. Frontiers in Human Neuroscience.

• Treleaven J. (2008). Sensorimotor disturbances in neck disorders. Manual Therapy.

• Horak FB. (2006). Postural orientation and equilibrium. Phys Ther.

• Mayer EA. (2011). Gut feelings: the emerging biology of gut–brain communication. Nat Rev Neurosci.

• Ley R. (1999). The modification of breathing behavior. Behav Modif.