A New Approach To Physiotherapy Management - Directional Bias


A new approach to physiotherapy management

We are currently in an era where essentially all aspects of life are evolving at rapid rates. Look at some of the latest innovations in technology and medicine and you’ll understand what we mean. Just think that not long ago social media didn’t even exist. Now it’s a staple in most people’s lives. There’s even talk of driverless cars taking over our roads in the very near future.

Similarly, physiotherapy is always evolving and changing. Being an evidence-based profession, techniques evolve as new research and studies emerge, shedding light on best practice for various conditions and what treatments are merely a “sham”. Gaining traction in the physiotherapy community is the utilization of the directional-bias approach to rehabilitation and exercise.

What does directional-bias mean?

You know how your one friend had a sore back and got shown a great exercise to fix it? Then you shared that with another friend, and now you’re all doing this stretch to alleviate your back pain? That would be an example of a “generic” exercise prescription, essentially taking a one-size-fits-all approach. Directional-bias, conversely, looks to individualise treatment by prescribing each individual specific exercises, in a particular direction, to overcome their specific problem. If you consider the idea of ‘injury mechanism’ (essentially looking at how you got injured), everyone will have different stories. Some hurt their back bending over in the garden for hours, others copped a knee from an opposing player while marking a ball in football, while another group of individuals feel sore after sitting in a chair all day. So why would we treat them all the same way?

Additionally, exercises are made even more specific by performing them only on one side – if the assessing physiotherapist believes this will be of more benefit. Many people are resistant to such an approach initially, question whether exercising on one side will make them “uneven”. The simple answer is, you were already uneven to begin with, and hence the particular problem has arisen, requiring this single-sided, directionally specific approach.

As an example…

This is essentially a very basic example of how the approach works:

Say we take the aforementioned individual who was bending forward in their garden for hours and has now developed a sore lower back. Additionally, they tell us that bending forward to put their socks on hurts, but going for a walk actually alleviates some of the discomfort.

We can already see the picture developing. This individual seems to have a preference for extending their back (i.e. the opposite of bending forward) since they initially hurt themselves by bending forward for an extended period of time. We therefore would NOT prescribe any exercise which involves bending forward, because it would be counterproductive. This individual would likely benefit from an “extension-based” program (picture your typical yoga “upward dog” pose).

Does this mean the individual in our example should never bend forward?

Not at all! It simply means that, in their sensitive, acutely injured state, it is best to avoid it in the short-term. Once we can overcome this short bout if pain or discomfort, we would look to regain movement in all directions!


While the above example was quite straightforward, there are far more complicated cases. Not all problems have a clear “aggravating factor” – sometimes every movement hurts! This is where our physiotherapists come in; utilizing a specific battery of tests and functional measures in order to identify the best possible treatment and exercises for your specific needs.

If you have any queries about a specific issue, or would like to discuss having an assessment with one of our physiotherapists, please do not hesitate to contact us for a friendly chat.