Beyond "Biomedical-Plus": Reclaiming the biopsychosocial model in musculoskeletal physiotherapy.

BACKGROUND: The biopsychosocial (BPS) model is widely endorsed as best practice in musculoskeletal (MSK) physiotherapy. However, its implementation often remains constrained by biomedical assumptions, with psychosocial approaches primarily used to improve adherence, reduce symptoms, or restore function. As a result, contemporary BPS practice risks becoming "biomedical-plus" care rather than a genuinely integrated approach.

MAIN MESSAGE: We argue that physiotherapists can move toward a more authentic application of the BPS model through three interconnected foundational conditions - the 3Cs: professional Confidence, role Clarity, and Compassionate communication. Together, these foundational conditions support physiotherapists in engaging with the emotional, relational, and social dimensions of pain. Many physiotherapists report uncertainty when addressing trauma, psychological distress, or social determinants of health, often due to limited training, lack of supervision, and fragmented interdisciplinary systems. Rigid professional boundaries may discourage meaningful engagement with psychosocial and social contributors to pain, while entrenched patient expectations for biomedical explanations and passive treatments can make person-centred BPS conversations challenging. Addressing these barriers requires a shift from viewing psychosocial care as an "add-on" toward understanding pain within broader relational and social contexts.

CLINICAL IMPLICATIONS: Authentic BPS physiotherapy requires educational reform, interdisciplinary collaboration, supportive service structures, and communication approaches that validate lived experience while promoting meaningful participation. By strengthening Confidence, Clarity, and Compassion, physiotherapists are well positioned to support not only physical recovery but also self-management, social connection, autonomy, and engagement in valued life roles.