Trauma-Focused Physical Therapy With April Gamble PT, DPT

Welcome back to the Healing Pain Podcast with April Gamble PT, DPT

What really is the “healing process” for a trauma survivor? Many programs, exercises, and advice exist on how to deal with trauma, but do they really address its root cause? Or are they mostly surface-level techniques that only treat the symptoms, not the problem? In this episode, April Gamble, PT, DPT shares how to address trauma by its root cause and how she uses trauma-focused techniques to treat her patients suffering from pain, anxiety, or other effects of trauma. Bringing a bigger vision to the profession, she also shares with us her deeper work on justice and injustice and how they impact our beliefs and engagements with care. Filled with honest realizations and helpful trauma advice, tune in and learn how to start your healing process too!

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Trauma-Focused Physical Therapy With April Gamble PT, DPT

We are discussing trauma-focused care. Trauma is an event or a life circumstance that is experienced by an individual. It can be physically or emotionally harmful. It can be life-threatening. It can have lasting adverse effects on an individual’s function, which includes their mental, physical, social, emotional as well as spiritual well-being. If you work in the pain recovery space, you’ll recognize that there are high rates of comorbid chronic pain as well as post-traumatic stress disorder or trauma. In the context of chronic pain, this is often experienced as medical trauma. However, we shouldn’t ignore early life childhood experiences, the distress that we experience as adults on an ongoing daily basis, or even how entire communities or populations can be exposed to a traumatic event.

Here to speak with us about trauma-focused care is Dr. April Gamble. April is a licensed physical therapist who has been living and working full-time in the Kurdistan Region of Iraq. They have several years of experience in community-driven efforts to develop equitable rehabilitation services with an emphasis on persistent pain, mental health, trauma focus, and interdisciplinary rehabilitation. April serves as principal investigator for funding efforts, research activities, and program development on initiatives in the United States, Kurdistan, Federal Iraq, and the Greater Middle East North Africa region. April’s also the Founder and Director of ACR, which aims to develop community-driven efforts to develop equitable rehabilitation services.

April is also the Physiotherapy Director at WChan Organization for Human Rights Violations, where they lead the development of treatment services for survivors of torture and war trauma. This is the last episode for the year 2022. I want to take this time to thank you for tuning in to each episode with us and supporting the work that we do to educate people and raise awareness around safe and effective ways to recover from chronic pain. I wish you and yours a happy and healthy holiday season as well as a prosperous new year. We will return with a new episode on January 4th, 2023. Stay tuned. Without further ado, let’s begin and let’s meet Dr. April Gamble and learn about trauma-focused care.

April, thanks for joining me on this episode. It’s great to be with you.

Thanks, Joe. I’m happy to be here.

People were introduced to you in the introduction I read, so they have a full picture of your bio and what you’re about, the things that you’re interested in professionally and personally, and your credentials. Give us an idea of who you are and your professional identity to the patients that you’re working with who are working through trauma in a trauma-informed way.

I’ll read a personal statement that I’ve crafted. It’s something I always come back to because I feel like in our profession, we often introduce ourselves with credentials, and this is what I do. The way I think about it is what we bring into the work is what matters. We bring our own cultures, backgrounds, and experiences. I’ll read a short little statement that represents who I am so folks can understand that a little more.

I was born and raised in Michigan as a descendant of European immigrants who traveled to the States like so many before and after with the hope of a better life. I respectfully acknowledge that my birthplace is seized territory of Nacion Ave. The wealth, power, and advantages that I experience, including where I live now in Kurdistan, Iraq, are the result of colonization, ableism, and the enslavement of Black people.

The unearned opportunities that I have as a White American come at the expense and suffering of many. I’m taking responsibility for this and for my role in upholding systems of oppression. My work as a physical therapist is embedded in my core belief that we can create a world where justice is the reality for all. I lean into experiences of discomfort so I can come equipped to mobilize effectively under the leadership of those that face oppression every day to revolutionize rather than retreat. I will make mistakes. I will unintentionally oppress in silence. I know that it is the impact of my actions that matter.

I create and engage with a community of accountability. As my own healing, freedom and opportunities are intimately interconnected with those of every human and our planet, I do not come to save or heal or fix. I come to their witness a quiet daily recognition so different from the desire to repair. I strive to create a space where differences are celebrated, collaboration breeds growth and healing, acts of resistance to assimilation and oppression are embraced, and a new way of being can be imagined within ourselves, our clients, our profession, organizations, and communities. Thanks, Joe, for letting me share that.

I’m going to let that sit for a moment for ourselves and everyone else reading. That is something that’s extremely new for the vast majority of physiotherapists or physical therapists to hear coming from a colleague’s mouth in the first person. I want to thank you for it. It’s obviously a brave step forward for our profession.

For people who follow along with me every episode and are always looking for brave voices to not only try to support and uphold the things that I’m doing and my perspectives but also people who have a bigger vision for our profession and who we are as professionals. Obviously, the wrapped up in introduction that you provided us is a lot. This is not something you typed up yesterday because you were going to sit down and talk with me for about 45 minutes or so. Give us an idea of how this all started to develop in you as a person.

For me, it’s a long journey. It doesn’t have this one moment and it’s a clear, concise narrative and story, which is the reality when we do transformation work within ourselves. Even the process of writing a personal statement like that is an ongoing thing where I keep embedding different aspects of my own work and transformation into it. A lot of that is embedded within the topic we’re talking about, trauma-focused physiotherapy, because trauma is related to injustices. It’s connected to how we move in the world.

Trauma is related to injustices and connected to how we move in the world. Click To Tweet

Give us an idea of the capacity in which you work and serve people now and where that all takes place.

I live full-time in Kurdistan, Iraq, which is the Northern region of Iraq in the Middle East, or Iraq as Americans say. I’ve lived outside the US for several years. After my Doctorate and residency, I moved outside of the US. I am freelance which means I have the wonderful opportunity to work alongside different communities and organizations, both in my community in Kurdistan and the US and in a global community as well. A lot of what I do is mental health physical therapy, trauma-focused physical therapy, and then also the development of rehab services. I’m working with communities to strengthen their physical and mental health rehab services in a variety of settings.

Was this something that you discovered while you were in physical therapy school or was this something that was an idea even before you went through your DPT program?

No, I definitely didn’t know it was a thing during physical therapy. Even the concept of trauma wasn’t talked about in physical therapy when I was a student. I don’t know if it’s now.

The two things that you mentioned there, mental health physical therapy or physical therapy and mental health, however you want to look at that, and trauma-focused or trauma-informed care is barely spoken about at this point in DPT education. It does exist in some schools in some way, but not to the degree of life and professional experience that you have now.

For me, I was a lot of professional development along the way, working alongside colleagues that are mental health professionals, counselors, and psychologists. Often, I couldn’t find a mental health physical therapist so I would have clinical supervision by a counselor or some other mental health professional to help support my development.

That can be difficult right there. I’ve been through similar pathways where in one sense, you have the opportunity to be peer-led by a mental health professional. It’s interesting because it opens up your world to how they think and approach things. That’s wonderful. I’m not sure if you felt the same way but I’m interested to hear your experience. At the same token, you still have to take the interaction and the learning that you are exploring and receiving with them and then start to mold it into your own practice. Oftentimes, I also found that they aren’t quite sure what we do and how some of the techniques or interventions they have could parlay into what we’re doing as professionals.

I’ve definitely experienced the benefit of having colleagues and supervision with physios going through similar professional journeys of conceptualizing mental health physical therapy, trauma-focused physio, and also other mental health providers. For me, it’s a lot of taking what exists within our profession, like modern pain science, polyvagal theory, and basic body awareness therapy, developing those skills and then conceptualizing and integrating it into a treatment designed for survivors of trauma.

HPP 297 | Trauma-Focused Physical Therapy
It’s a lot of taking what exists within our profession, conceiving it under developing those skills and then conceptualizing and integrating it into a treatment designed for survivors of trauma.


How do you describe trauma-focused physical therapy? We can be heavy on terms in this show. For me, at least, the way I’m looking at things, there’s integrative pain care, which covers a whole bunch of things. There are trauma-informed pain care, trauma-informed care, and trauma-focused care. Help us unpack how you approach these topics and conceptualize them in your practice.

I conceptualize trauma-focused physical therapy as a mental health physiotherapy service aimed to directly address or treat the physical, psychological, and social effects of psychological trauma and ongoing stress within our unique knowledge, skills, and abilities that we have as physical therapists. It’s staying within our scope of practice. It is a new conceptualization. There are a few research articles out there integrating, including one that I contributed to, but it hasn’t been formally conceptualized. I feel like a lot of it is an ongoing process, which is exciting but can also feel a little intimidating.

They lose a sense of groundedness when they hear things like this because oftentimes, if it wasn’t learned in school, then they have no reference point of where this comes from. You come in with this wonderfully needed and excellent conceptualization of trauma-focused physical therapy, but then people hear words like psychological and spiritual potential. People say, “What is that? That’s not what I’m doing, and this wasn’t what I was trained to do. Where does that fit, and how does that fit?” How have you started to take the skills and tools that we have as professionals and start to build that out into a trauma-focused physical therapy intervention?

One thing is laying the foundation of the biopsychosocial spiritual approach. If you’re a physical therapist that is embodying that, then the trauma-focused skills can come from that. If you’re also integrating the modern pain science or integrated pain approach, a lot of that foundation is the same. If we think about the physiological changes that happen in the nervous system with trauma, what happens from that is persistent pain, central sensitization, experiences of depression, anxiety, post-traumatic stress, and all the problems with functioning. It all has a physiological underpinning. Once you understand that and can hold that, it’s quite easy to see how you can approach it.

Trauma is a DSM-5 diagnosis, so it obviously is in the realm of psychology. What you’re saying is there are cognitive processes or changes that are impacted by trauma. Those need to be addressed and treated. There are also physiological or bodily changes that happen with trauma. Those also need to be attended to and addressed. A lot of the skills and tools we have as physical therapists or physiotherapists can help with the reprocessing and the recovery of trauma.

If we say, “As a physical therapist, I’m comfortable. I can address physiological changes.” Physiological change is what creates social effects. That affects someone’s social functioning. It’s what creates emotional effects from trauma. We are inherently addressing the social, physical, emotional, and spiritual by focusing on physiological changes.

Let’s dig down a little bit deeper so that people understand. Give us an example of a trauma symptom that’s in the body that’s physiological in nature, and then connect for us how that physiologic symptom impacts someone. You didn’t even say cognitive function but social function. The way I am reading into that is someone’s bodily experience, or physiology has the potential to impact how they function in the world or in their environment.

I think of a client I worked with who is a survivor of trauma. There’s a lot of economic hardship and ongoing stress that presents with persistent pain for years, primarily back pain and has been to, like a lot of folks in the US, lots of doctors diagnosing them with a variety of different things in their back. They have a lot of strong beliefs about their back and their diagnoses. How that was playing out in their daily life and how we can think about it from a social perspective is they were no longer playing with their kids, so they couldn’t get on and off the floor to play with their kids anymore.

They weren’t being physically active. They couldn’t do the roles and responsibilities that were theirs within their social ecosystem and their community. You have the persistent pain aspect, but if you think of the bigger trauma, the trauma is sensitizing and creating changes in the nervous system. From that, you have persistent pain, but you also have social effects that are not related to the pain. It’s related to heightened fear and threat response related to sleep problems that are all coming from these physiological changes. Everything is interwebbed into each other, so you’re going to have social and emotional interactions between those.

There are a lot of things that sustain both trauma and pain so they become similar in so many ways.

Especially when you’re living in an ongoing stressful environment, it’s not possible to always take the stress or source of the trauma that’s on going away. We can, as physical therapists, create changes in the person’s body and in their nervous system that allows them to interact in a more functional way within that.

The people you’re working with potentially are embedded within social and cultural contexts where the precipitating trauma is not necessarily removed or may only be removed for certain times.

I work with a lot of people in prisons and with refugee experiences. The prison environment isn’t inherently traumatic. Even in the US, people who are living in communities where there’s poverty, ongoing gun violence, experiences of racism, oppression, marginalization, and lack of access to healthcare for the queer community. Many of us are living in this ongoing state of stress and trauma.

Indeed, both in the US and outside the US. Tell us what skills do you think a physical therapist needs to start to engage in this work.

There’s quite a lot. Maybe what I could do is I can list some, and then if there’s some that you want to dive into, we can talk more about it. The assessment and treatment are rooted in a biopsychosocial spiritual approach and all the skills that come with that, as well as goal and value settings based on the act theory way of doing things, modern pain science, interdisciplinary work, an inherent understanding and application of post-traumatic growth and strength-based approach.

Culturally responsive care is also important, and some skills and treatments are around arousal regulation and body awareness. Another important one for me personally, but also generally, is that the provider works through their own experiences of trauma so that they can show up and create a safe space for the clients and develop that therapeutic relationship. Your own personal trauma doesn’t influence that in an unhelpful way.

That’s an interesting concept. That’s one that we have not started to approach yet in our profession. If you go into many mental health training programs, sometimes, they will require that you receive 7 or 8 sessions of therapy first to start to examine your own life experiences and how that could potentially inform the work that you’re doing as a licensed professional. It’s interesting to me because I used to hire for a long time. I hired physical therapists. In those interview processes, always somewhere it comes out, “I wanted to become a physical therapist because I sustained an injury or car accident. I tore my ACL playing a sport. My grandfather had a stroke and I was the primary provider.”

Within that, as humans and as potential and future professionals, we know our own trauma experiences in some way and what it was like to test our resiliency and then learn how to grow within that entire context. As a profession, before we go into practice, we don’t necessarily start to reflect upon how our previous life experiences could impact the person in front of us, including our biases.

I’ve learned a lot from the mental health community from that. Even the concept of clinical supervision that’s ongoing as a professional is common practice in mental health, but in physical therapy, that’s not common practice. Even after your first year, you might not even have clinical supervision, an approach that’s not just embedded in treatment planning or clinical decision-making but also your biases, how you are responding to this person, what you are bringing into that treatment space, and how you are creating justice and equitable treatment interaction for each client.

Justice is a term that is coming up more and more in the literature both in the worker’s comp pain management world. Also, in many other aspects of healthcare, how people have feelings of justice or injustice potentially and how that impacts their belief systems and engagement with care. Talk to us about justice because a lot of your work intersects with justice almost at every moment of the day.

I also identify myself as a justice-centered physical therapist. The way I move in the world as a physical therapist, but also as a human, is justice-centered. How I describe that is it’s working towards a world where the systematic causes of health disparities or injustices are removed and all people have equitable and opportunities for health, wellness, and function. If I think of myself working in a trauma-focused space, it is inherently irresponsible for me to only be providing treatment for survivors of trauma without taking responsibility for the systems and the experiences that are causing the trauma.

HPP 297 | Trauma-Focused Physical Therapy
If one thinks of working in a trauma-focused space, it is inherently irresponsible to only provide treatment for survivors without also taking responsibility for the systems and experiences that are causing the trauma.


For me, not only do I want to work downstream, which is the idea of working to provide treatment and rehab services, but I also want to work upstream to stop the traumatic experiences from happening to contribute to changes in our political and academic health systems. Those traumatic experiences no longer happen and we don’t have oppression anymore.

The idea of injustice within the system came up when I was interacting with another professional who has been on a similar path that you’ve been on. They are looking more into working with women suffering from trauma in pelvic health practice and starting to explore all the different types of trauma-informed and psychology-informed courses that are out there. The question she had for me was, how do I start to change the practice I work in? She was working in more of an ortho sports practice that also had a little bit of this, bringing in the women’s health component.

That was her place. She was having a hard time fitting into the systems of the practice. As she started to learn more about things like the ACT and trauma-informed care, she noticed that she started to change. We talked about this a lot. At the end of this conversation we had, she said, “I don’t think I can fit into this system because this system is persisting and causing trauma in some people and patients.”

It’s something that a lot of physical therapists, especially in the United States, are starting to become aware of because they’re aware of the neuroscience of pain and how that starts to intersect with the neuroscience of trauma. They start to look at what they’re doing and the systems that they work in. They’re saying, “I don’t know if I can change this. I might have to leave it or completely scrap it and start something all over again.” Those are difficult places for professionals to define themselves in.

The US healthcare system is doing what it was designed to do. It’s oppressing and creating health inequities. The system is designed for that. I completely feel with the people who feel like I can’t work within the system anymore. I see a lot of physical therapists and colleagues in the US working outside of it now, trying to reimagine, “How can we provide community-centered and justice-centered healthcare?”

They’re not doing it within the healthcare insurance system. They’re creating their own organic services. Also, we have a lot of privileges in Kurdistan because we inherently have a lot more freedom. We can develop healthcare services. Not that it is relevant for whatever is needed by the community, but it’s relevant for the physical therapist. For example, we can create documentation that is clinically relevant for the physical therapist and for the community because we don’t have to report to an insurance company. What I hope is that, as physical therapists in the US and globally, we can work to reimagine what healthcare services and physical therapy services can be and take steps to make them happen.

A mental health approach to physical therapy is a big part of that.

When I come to the US and I’m hanging out in physical therapy circles, people at CSM Conference are like, “What do you do?” I say, “Mental health physical therapy.” They zone out because they don’t even know how to conceptualize and what questions to ask. It’s because it’s been isolated from the physical therapy profession, especially in the US context. It seems like there’s some movement to bring that in, but it’s going to take some time.

With the flexibility that you encounter because you’re working overseas and you’re not at the mercy of an insurance company, you’ve also started to create some unique interventions of your own pain science but starting to bring in a lot of other things. Can you tell us a little bit about that program you’ve created?

There are two I’ll highlight. One is I work with WChan Organization for victims of human rights violations. They’re a local Kurdish NGO in Sulaymaniyah, Kurdistan. There, we’ve created together a physical therapy group treatment service that goes along with counseling group treatment for survivors of trauma and torture within the prison. That does embed a lot of pain education, therapeutic neuroscience education, body awareness practices, arousal regulations, and sleep. It all is embedded in the trauma recovery model, which is a way of framing clinical treatment services for survivors of trauma. We’ve done a pilot study to show the outcomes. That’s one example.

If I heard you right, there’s a component delivered by a mental health provider and by you.

Not myself but the Kurdish physical therapists. They do it.

You train someone to deliver this. The physical therapists that are delivering this, what does it look like? You’re obviously going beyond traditional physical therapy and body-oriented technique. It sounds like there’s more of a psychoeducational component to this.

If you were a client in the session, there would be about 8 to 12 clients with you, and there are two physical therapists facilitating the group together. In each session, progression inherently happens over about 10 to 12 group treatment sessions. Each session has regulation techniques, maybe breathing, progressive muscle relaxation, mindfulness, and body scan. There is education, but an interactive education, especially within that group setting. That’s a lot focused on pain neuroscience education, then there’s movement.

There are often movements that are aerobic exercises because we know the research shows how supportive that is for experiences of pain and other effects of trauma. Also, basic body awareness therapy inspired movements. We integrate a lot of play and social interaction within all the movements and exercises that we do, and then we progress along. Another important aspect is the whole session ten is reflecting on the changes they’ve experienced physically, emotionally, and socially, and looking towards the future about how they want to maintain those and celebrating what they’ve done.

Aerobic exercise is supportive of experiences of pain and other effects of trauma. Click To Tweet

This occurs over ten sessions.

Correct with an assessment, a post-assessment and an individual session in the middle as well.

How long is each session approximately?

About 90 minutes.

You have a nice chunk of time with people.

In parallel, the clients would also have group counseling. They’d have two sessions a week, a group counseling and a group physical therapy.

In the pain neuroscience aspect or the therapeutic pain science, you mentioned basic body awareness therapy, which is a term most US-based physical therapists probably have not heard of. Can you give us an idea of what that is?

I’m probably not going to use the right words that a basic body awareness therapist would use because they can be quite specific. How I conceptualize it is a framework for approaching movements. It can be quite different than how we approach movement in the US context, which recognizes body awareness that integrates a lot of guided imagery and cognitive processes into your movement. Basic body awareness therapy is a well-studied exercise intervention. You can probably speak to it more too, Joe. There are a series of structured specific movements that you can do in that. Also, our physical therapist in Kurdistan has created BBAT-inspired movements that are specific to the culture. They use a lot of cultural specific movements as well.

Those types of therapies came out in Northern European countries. It took root there, but it has never taken root here in the US. It’s because mental health physical therapy is more accepted there versus in the US. To be honest, there’s a stigma around it that all of us, including you and I here, are working on starting to undo that stigma and the idea that physical therapists can play a role in mental health. In many ways, we have therapies that have already been created that are studied that help people with mental and behavioral health treatments.

Where would you like to see this go? It’s interesting for me to speak with you and to think about the scary thought that I had. A colleague of mine has to leave the United States of America, one of the wealthiest, most educated countries potentially in the world as far as healthcare goes, especially us with our “DPTs.” They have to leave the country and go to another where people would identify as a third-world, war-torn, poverty-stricken culture to develop an evidence-based biopsychosocial approach that’s trauma-focused and can be delivered by physical therapists. It blows my mind.

I want to highlight, too, that I’m not the only one developing it. I’m working with the community in Kurdistan and the Greater Middle East North African region to create these treatment approaches inspired by evidence. As a physical therapy professionals, we don’t have what I feel and witnessed communities are asking for and needing right now. What I hope is that maybe you all in America can learn from what we’re doing and the Northern European and start to take those and apply them in the US context.

I spoke at the Educational Leadership Conference in Milwaukee, the educational conference for DPT educators. The first day, I happened to wander into a room where the president of the APTA, a great guy, was speaking on a panel with a couple of other physical therapists. They were talking about exactly what you mentioned. Communities are out there and they’re looking for us to engage with them.

Obviously, when you have to go out into a community and engage with a community instead of an individual, it’s a different experience. It also, in my opinion, requires different skills and knowledge. They were talking about the opportunities as well as the challenges. Part of my brain always goes to the challenges first, like, “Why can’t we do this? Why has it been difficult for us to do this as a profession?”

One of the things that I proposed to the president of the American Physical Therapy Association was that we might consider or reconsider how we position ourselves as movement experts because, in some way, we may be stigmatizing ourselves as the only thing we can do is movement. People see movement as exercise and fitness. It starts to go down that road. I said maybe we should be behavioral health experts or movement and behavioral health experts.

The panel was 50/50. There were four people on the panel. Two people thought it was great, and two people were confused by what I was saying, and they weren’t quite getting it. A lot of what your work points to is that for us to engage with the community and the challenges that they’re having, we need a broader skillset embedded within a movement system approach.

I feel what you’re saying. A couple of things come to my mind. One, we need a lot of skills to engage with communities in a non-harmful way. That shouldn’t be taken lightly, and like, “Go engage with the community,” because we will inherently cause harm if we do it without skills.

Talk to me what you mean by that. For the most part, professionals are well-intentioned and well-meaning, but when you start to enter into communities that need help and support, how do we have decreased awareness that we could potentially cause more harm than good or cause some harm while at the same time, promoting some good?

It is important to understand the historical lens through where and where we are that healthcare has always been founded on a power differential. The healthcare provider, the physical therapist, is given more power than the community and the client. There is a power difference. Usually, the person in power does not notice. They don’t feel that. They also will bring these unhealthy narratives like, “I’m here to help. I can save and fix.” If the person who is less power in that relationship, then is not able to share what they need. Communities maybe don’t need physical therapy. We don’t need to come to the assumption that they need physical therapy, especially the way we’re doing it right now.

When there is a power difference, usually, the person in power does not notice. Click To Tweet

Communities have strengths, resources, ways of doing things work, and ways of working with persistent pain outside of a medical system. The skill is allowing the community to direct us. That takes a lot of personal skill development around your positions of privilege and your interaction style. That’s probably too long to go into here. It’s more to emphasize, pause and ask people, and get support and mentorship if you want to move in that direction.

The communities that need our help, especially in the world of pain management, are Black indigenous people of color, the elderly, children, LGBTQ+ communities, and women. However, most of us are all trained in a system that’s led by White, male, cisgender, and homonormative men.

As a White person living in a country like Kurdistan, I constantly am thinking about my position of power and privilege in my Whiteness and how that affects how I show up in spaces.

It’s tough from the pain world. It’s a topic in the pain world that we haven’t started to unpack as deeply as we need to.

The other thing that came out when you were talking about your experience with the APTA discussion is you asked, “Why are we not able to do that right now?” Some of it is the emphasis and the US culture and the physical therapy culture of productivity. What do our actions show that we value? Right now, we value making money and billing. It’s hard for a physical therapist to ask their employer, “Can I have ten hours a week to work on justice and community-centered services?” Employers don’t get that. That’s a huge culture shift we have to change. Otherwise, we won’t have space to create, reimagine, and reinvent.

There’s no flexibility built into the system in many places. Finding that flexibility takes a lot of work and trying to figure out, “How can I muscle this into a certain part of care?” As you said before, sometimes people get frustrated and say, “I’m going to go build my own system or plan of care,” which is not a bad thing. In the United States, what happens is therapists then take those skills and go to wealthy communities that have the money to pay for the service, but it doesn’t wind up being embedded into the communities that need it and is deserving of it.

We also need to reinvent a sustainable financial approach. Something I’m considering in Kurdistan is how we create a physical therapy and rehab system that doesn’t rely on external humanitarian money. We’re trying to reinvent that now because it’s not sustainable for us.

HPP 297 | Trauma-Focused Physical Therapy
We need to reinvent a sustainable financial approach.


April, it’s been great speaking with you. I admire a lot of the work that you’re doing. It’s needed both, of course, around the world, but even within some people’s hometowns here in the US. People are going to be interested to learn more about you and your work. How can they reach out to you? How can they follow you?

I don’t do social media. You can email me at If you’re interested, you can also check out the resource myself and a group of physical therapists developed from the Middle East North African region called Beyond Pain. It’s freely accessible and downloaded. It’s in English, Arabic, and Kurdish. It is a training and treatment manual that embeds trauma-focused physical therapy concepts included in a lot of modern pain as it’s designed for people with pain.

If you have any questions, you can always reach out to me and I’ll connect you with April. At the end of every episode, I ask you to share this with your friends and colleagues. This is important to share with your physical therapy and physiotherapy colleagues who are interested in pain-informed, trauma-focused, trauma-informed, and mental health physical therapy, which will be on the rise and on increase as we move into 2023 and beyond. Make sure to share this with them on Facebook, LinkedIn, and Twitter. You can tag me on Instagram and I’ll tag you back and share this information. It’s been great being here with you. We’ll see you next episode.


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About April Gamble

HPP 297 | Trauma-Focused Physical TherapyApril Gamble is a licensed physical therapist that earned her Doctor of Physical Therapy in Michigan, USA. April has been living and working full time in the Kurdistan Region of Iraq since 2017, and previously in Jordan and China. They have almost ten years of experience in community-driven efforts to develop equitable rehabilitation services, with an emphasis on persistent pain, mental health, cancer, trauma-focused, and interdisciplinary rehabilitation. April serves as principal investigator and/or primary organizer for funding efforts, research activities, program and service development projects, and professional education initiatives in the USA, Kurdistan, Federal Iraq, and the greater Middle East North Africa Region.

April is the founder and director of ACR, which aims to support community-driven efforts to develop equitable rehabilitation services, in a manner that meets the needs of diverse communities. April is also the physiotherapy director at Wchan (pronounced Wu-chun) Organization for Human Rights Violations where they lead the development of interdisciplinary treatment services for survivors of torture and war trauma. Additionally, April was the 2019 recipient of the International Association for the Study of Pain’s Developing Countries grant which resulted in over 250 Kurdish physiotherapists being equipped with the skills and knowledge to treat pain from a biopsychosocial approach. In additional to numerous conference presentations, April’s publication credits include textbooks chapters in international texts and clinical research trials in peer reviewed international journals. She is the current secretary for the Global Health Special Interest Group of the American Physical Therapy Association (APTA) and the founding chair of the Health Justice Committee of the MPTA’s Oncology Rehab Special Interest Group.


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Effective Date: May, 2018

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The following Privacy Policy governs the online information collection practices of Joe Tatta, LLC d/b/a and ( collectively the “Sites”). Specifically, it outlines the types of information that we gather about you while you are using theSites, and the ways in which we use this information. This Privacy Policy, including our children’s privacy statement, does not apply to any information you may provide to us or that we may collect offline and/or through other means (for example, at a live event, via telephone, or through the mail).

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