Rehabilitation after torture: physiotherapy and clinical support

The organisation Freedom from Torture, (FFT) formerly the Medical Foundation for the Care of Victims of Torture, has provided clinical and other services to survivors of torture who arrive in the UK for 30 years.

 

It also strives to protect and promote their rights. While the main therapeutic work is in psychological therapy, a small number of volunteer physios promote the physical rehabilitation of survivors.

 

Physios are in a unique position to help. Most survivors, as well as being psychologically traumatised, have musculoskeletal (MSK) injuries and chronic pain. Our skills in physical rehab – combined with our understanding of pain, as well as our skills in building therapeutic relationships – give us lots of tools to help them regain function and learn to manage their pain.

 

At FFT we work only with the most traumatised people, so rehab work must be carefully and gently paced. However, FFT physiotherapists see only a tiny percentage of people who come to the UK seeking safety after they have been tortured. Others may be referred to an NHS physio for the many and varied MSK injuries they have.

 

Working with survivors can be challenging but also immensely rewarding. Many survivors need interpreters, but even when language difficulties are overcome, torture can result in such feelings of worthlessness that they appear to lack motivation.

 

Asylum seekers often live in poverty, with a poor diet and constant stress. Focusing on exercises at home may be hard. The capacity for memorising things is impaired by trauma and people may feel too ill or afraid to go out, or lack money to travel. A crowded waiting room or a busy gym may provoke anxiety. And coming from a different culture, they may not share our understanding of pain or mental ill health.

 

Many survivors cope well with their traumatic histories and most are grateful for the help they receive, and will do all they can to work towards their own rehab. NHS physios need to be alert to the possibility that a patient who is seeking asylum may have been tortured. Treating them may take a little longer, but the rewards for helping repair a damaged life are incalculable.

 

As one of our physios recently said: ‘I am still amazed at how powerful simply listening and acknowledging someone’s experience can be. The act of engaging in exercise and activity can be a signal of hope for rehabilitation that has been deeply buried by severe trauma. Working closely with psychological therapists gives a unique and holistic value to physical therapy.’