Physiotherapy for survivors of torture

Hough, A. (1992). Physiotherapy, 78(5), 323-328.
This article was reviewed by Mark Deschepper, doctoral physical therapy student at the University of Minnesota, 2014.
A link to the full text of the article is below.
Through physical contact and the trust built in the physiotherapy relationship, physiotherapy is a vital link of rebuilding the personality of torture survivors.  Survivors will speak the unspeakable with the therapist and through this they pass through the milestones of recovery in which needs to be acknowledged so the survivor knows their therapist will listen to them, be believed, and will walk the road to recovery with them.  In this article, physical therapy examination and treatment principles for survivors who were subjected to various types of torture are described.
Introduction (pages 1-4): 
Survivors in which physical therapists will come in contact with likely suffer from nightmares, phobias, depression, PTSD, intractable pain, withdrawal, have a sense of meaninglessness and may have guilt for surviving while others did not. All of this will challenge the therapist to get the details they need from their client.  Through trust and a professional relationship physical therapists can help their clients succeed.
The role of physiotherapy is to heal/reduce physical damage, relieve stress and help meld the client’s mind and body. Melding the mind and body is a role of the physiotherapist because tortures have often used physical torture as a way to disconnect the mind from the body and physical contact is necessary to meld them back together. Physical contact may not be part of the initial physical therapy sessions in order to avoid triggering the client’s fear. It may take time to establish a relationship with the client and work into increasing physical contact. Furthermore, when assessing the client it is important to ask the client questions in a way that is not interrogating as to avoid memories of torture.
Survivors of torture often have the following:
  • Abnormal posture and gait
  • Chronic spasms of muscles
  • Hyperventilation
  • stress
  • signs of falanga
  • signs of suspensions
Falanga (page 4-5):
  1. Signs:
  • Standing pain which increases with walking
  • Tight anterior tibialis muscles
  • Fixed tarsal bones
  • Pivoting gait
  • Lumbar pain
  • Damaged soft tissue on bottom of feet
  1. Treatment:
  • Ultrasound
  • Mobilizations
  • Deep massage
  • Gait and posture re-education
  • Balance exercises
  • Orthotics
  • Treatment of lumbar spine
Suspension (page 5):
  1. Signs:
  • Neuromuscular problems
  • Nerve compression
  • Muscles atrophied/spasms
  • Subluxation of AC and/or SC joints
  • Ischaemic contracture or paralysis
  1. Treatment:
  • Reduce abnormal muscle tone
  • Joint mobilizations
  • Strengthening
Hyperventilation (page 5):
Hyperventilation is common and exacerbated in survivors, especially in those who have suffered from suffocation or struggled to avoid screaming and/or speaking their friends’ names for a prolonged period of time.


  • Relaxation techniques
  • Breathing awareness
  • Visualization
  • Abdominal breathing
  • Yoga breathing techniques
  • Verbal counting and breathing into bags
Stress (page 6):
Stress is common in survivors and their symptoms may or may not overlap with their physical injuries.


  • Exercise with relaxation techniques
  • Breathing techniques
Precautions (page 6-7):
  • Don’t approach from behind
  • Avoid bright light
  • Allows client to stay fully clothed if necessary
  • Avoid treatments that may remind them of their torture such as electric stimulation, ice and water
  • Avoid acupuncture
  • Avoid manipulation
  • Avoid standing over clients


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