When Professor Michele Sterling FACP graduated as a physiotherapist in 1982, pain was viewed very differently from the way it is today.

The profession, and healthcare more broadly, was firmly grounded in a biomedical understanding of musculoskeletal disorders. 

If a patient had neck pain or back pain, clinicians looked for a structural cause, addressed the presumed tissue dysfunction and expected recovery to follow.

Michele, a Specialist Research Physiotherapist (as awarded by the Australian College of Physiotherapists in 2009) and an APA Titled Musculoskeletal Physiotherapist, found that her clinical experience began to reveal gaps in that thinking.

‘I’d seen patients that I didn’t really feel like I helped very much. I did what I was apparently supposed to do and they still had pain.’

This reflection would ultimately shape the direction of Michele’s career and help to position her among Australia’s leading pain researchers.

Michele describes becoming a physiotherapist as stemming from what she laughingly calls the ‘17-year-old altruistic ideal of helping people’. 

Undertaking work experience at a Brisbane hospital and seeing physiotherapists working with a patient following stroke, she decided it looked like meaningful work.

After graduating from the University of Queensland, Michele worked clinically for around 20 years across the public and private sectors in Tasmania and Queensland, developing a broad musculoskeletal background. 

It was during her postgraduate musculoskeletal training at Curtin University in 1992, known colloquially as the ‘manips’ course, that her thinking began to shift.

At the time, the emerging field of pain science was beginning to deepen its understanding of the central nervous system’s role in pain generation and persistence. 

Concepts now familiar to physiotherapists – including central sensitisation, altered nociceptive processing and the interplay between physiological and psychological factors – were only beginning to gain traction. 

‘We were still very much in a biomedical model. 

'That’s how I’d been trained, that if someone had spinal pain it was a joint in their neck or their back that was causing the problem and if you treated that it should go away.’

Yet many patients did not fit into that neat trajectory. 

‘Thinking back to patients I’d seen, I thought maybe this explains why people didn’t progress as well as I thought they should.’

It proved to be a turning point for Michele. She began looking at patients in a different way and it added a deeper dimension to her practice, including a more expansive understanding of the processes going on psychologically and physiologically. 

Like many experienced musculoskeletal physiotherapists reflecting on practice from previous decades, Michele is candid about how clinical attitudes have evolved.

‘In those days we tended to blame the patient a bit – that they weren’t doing their exercises or they weren’t trying, which was terrible – but that seemed to be the culture of the day.’

Instead, Michele became increasingly interested in why some people recover from musculoskeletal injury while others transition into chronic pain, disability and distress. 

That curiosity led her into research, completing a PhD and moving into a full-time research career in 2003 after securing an NHMRC fellowship. 

Importantly, Michele never viewed research as disconnected from clinical care. 

‘I’ve always tried to make my research clinically relevant so that it can be applied elsewhere.’

That translational focus has become a defining feature of her work. 

At the University of Queensland’s RECOVER Injury Research Centre, Michele leads the Improving health outcomes after musculoskeletal injury program and is the director of the NHMRC Centre of Research Excellence in Better Health Outcomes for Compensable Injury. 

Her work has focused on understanding prognostic indicators following whiplash-associated disorders, identifying risk factors for poor recovery and developing interventions that can alter recovery trajectories.

Her research has helped physiotherapists better understand why some people develop persistent pain following an apparently non-catastrophic injury, including the role of stress responses, psychological distress, pain modulation and altered nervous system processing. 

Whiplash-associated disorders in particular have become a major focus. 

Michele Sterling.

Although they are commonly dismissed as minor injuries, the burden is substantial and many people develop ongoing pain, disability and reduced participation.

Michele has spent years trying to better understand the transition from acute to chronic pain and, crucially, what physiotherapists can do early on to interrupt that process. 

‘I think we can do an awful lot up the front end. 

'That’s what I try to look at – preventing the development of chronic pain and trying to do research into what early physio interventions can do to avert that course to chronicity.’

This work has increasingly drawn on the biopsychosocial framework, particularly for people experiencing high levels of distress after injury. 

Rather than positioning psychological care as separate from physiotherapy, Michele has explored how physiotherapists can incorporate simple, evidence-informed strategies into treatment while still addressing physical impairments, movement dysfunction and exercise progression.

One intervention Michele is particularly proud of involves training physiotherapists to deliver early psychological training – specifically stress inoculation – for people with acute whiplash who are at high risk of poor recovery. 

‘The ones who aren’t so distressed get better pretty well with ordinary physio, but this is trying to teach physios some strategies to help patients manage their distress in conjunction with physiotherapy, not as a replacement for it.’

The intervention reflects Michele’s broader belief that physiotherapists are uniquely positioned within pain care but are often under-recognised for their contribution. 

‘The goal I always see with people with pain is to get moving again and get back to doing what they’re doing. I don’t know if any drug will ever be able to do that.’

For Michele, physiotherapy’s role in pain management extends well beyond specialist pain clinics. 

‘People sometimes think it’s only relevant to physios working in pain clinics, the very chronic end of pain, but that’s not true.’

Instead, she sees physiotherapists as essential to early intervention, prevention of chronicity and helping patients re-engage with meaningful activity and function.

Michele’s work has also focused on better understanding nociplastic pain and the clinical descriptors used to differentiate nociceptive, neuropathic and nociplastic presentations. 

This area is increasingly relevant to musculoskeletal physiotherapists navigating complex pain states. 

While the science continues to evolve, Michele believes physiotherapists should not underestimate their role in addressing broader influences on recovery.

Michele’s contributions have been recognised internationally. 

She serves as secretary on the council of the International Association for the Study of Pain and in 2024 she became the first physiotherapist to chair the World Congress on Pain in Amsterdam. 

Locally, she was chair of the scientific committee for the Australian Pain Society for many years and she has received many accolades for her research including Research Australia’s 2023 Health Services Research Award.

Michele has also worked tirelessly to strengthen physiotherapy’s visibility within musculoskeletal pain care, including helping establish a rehabilitation section within Pain, the field’s leading pain journal. 

‘I’ve tried to fly the flag. I think I’ve had some small successes.’

Those successes now include being named Australia’s leading pain researcher in The Australian’s top 250 researchers list, a recognition Michele says came as a complete surprise to her. 

‘I didn’t even know until I read it in The Australian. I thought “I wonder if I know anybody in this list.” There you go, I was in it!’

Despite the accolade, Michele remains firmly focused on what comes next. 

Her current work includes broader implementation of online physiotherapist training for whiplash management and new studies examining interventions for chronic whiplash, an area she says has received comparatively little physiotherapy research attention in recent years. 

‘I would love to still have another 20 years to work.’

The questions driving Michele now are the same ones that first unsettled her decades ago in clinical practice: why do some patients recover while others do not and how can physiotherapists better help those who are struggling?

For Michele, the answer has never sat solely in pathology, imaging or impairment. 

Instead, it lies in understanding the person in front of us – their physiology, psychology, lived circumstances and capacity to recover – and equipping physiotherapists with the tools to intervene earlier and more effectively.

It is a philosophy that has shaped Michele’s distinguished research career and quietly informed the way many physiotherapists think about pain. 

Looking back, Michele doubts her younger self could have predicted the direction her career would take. 

‘That was never planned. It just sort of happened as I went along and thought that’s what I want to do.’