Physiotherapist Matthew Ash APAM has spent much of his career working with people whose pain persisted long after an injury should have healed. 

Rather than focusing solely on the painful body part, Matthew’s approach centres on understanding the person in front of him and drawing on an integrated team of health professionals to help them reconnect with activities and improve their quality of life.

Persistent pain is rarely straightforward, Matthew says. 

While he acknowledges that physiotherapists are often highly skilled at assessing movement, identifying impairments and prescribing rehabilitation, Matthew, who is an associate physiotherapist at private practice myPhysioSA, says people living with persistent pain frequently present with challenges that extend well beyond physical function. 

Years of pain can influence beliefs, behaviours, confidence, relationships, work participation and mental health, creating a clinical picture that demands a broader approach.

For Matthew, one of the most valuable lessons from more than two decades in physiotherapy has been recognising that successful pain management depends on treating the whole person, not just their symptoms. 

After graduating from the University of South Australia (now Adelaide University) in 2003, Matthew initially worked in private rehabilitation hospitals in Sydney, where he was exposed to multidisciplinary pain programs. 

He began developing a deeper understanding of contemporary pain science.

‘I was fortunate enough through UniSA to have Dave Butler as a lecturer of mine. 

'I was one of the first cohorts to actually start the pain neurosciences course at uni.’

This early exposure to pain education was cemented through his work alongside pain specialists and rehabilitation teams.

It was after returning to Adelaide and joining myPhysioSA, which has nine locations across South Australia, that Matthew joined the practice’s Hills Integrated Pain Team and saw firsthand what coordinated pain management could look like in the private setting.

Today, that multidisciplinary approach remains a defining feature of the way the practice manages clients with persistent pain.

While many physiotherapists understand the value of collaborative care, Matthew believes genuinely integrated models remain difficult to access in private practice. 

Matthew Ash.

‘I think the model we have is unique in private practice in that we actually have a clinical psychologist with pain experience who works within the pain team.’

The arrangement allows physiotherapists to work with a psychologist, sharing information, aligning treatment goals and, in some cases, conducting joint consultations. 

For patients who experience pain influenced by fear, anxiety, stress, trauma or longstanding behavioural patterns, that collaboration can significantly improve engagement and outcomes, Matthew says. 

‘We know that when we try to treat someone with pain, it’s complex; it’s body and mind. It’s all interconnected. 

'So we need to be addressing the whole person.’

The patients Matthew sees are often well into their pain journey by the time they arrive at the clinic. 

Persistent low back pain and complex regional pain syndrome feature prominently in his case load and many patients have already consulted multiple practitioners before seeking physiotherapy. 

‘The unfortunate thing is we sometimes see patients too late in their post-injury journey. 'We’re then trying to undo unhelpful beliefs and behaviours.’

Beliefs can become deeply ingrained over time. Patients may have received conflicting explanations of their pain, developed fear about movement or gradually withdrawn from activities they once enjoyed. 

Others have become convinced that pain automatically signals damage, despite evidence that persistent pain is often far more complex than tissue pathology alone.

One of the most common patterns Matthew encounters is fear avoidance. 

‘People have learnt not to move because they’re worried it’s going to cause pain.’

For physiotherapists, addressing that fear requires more than simply prescribing exercises. 

It involves helping patients rebuild trust in their bodies, gradually increasing confidence in movement and creating experiences that challenge long-held assumptions about pain and activity. 

‘What I find, a lot of the time, is that patients have not learnt to trust how their body moves and not learnt to be relaxed and comfortable in their movement.’ 

The process often begins with listening.

In an era of busy clinics and growing demand, it can be tempting to focus immediately on assessment findings, treatment plans and outcome measures. 

Matthew believes that persistent pain management frequently requires clinicians to slow down and understand the patient’s story before anything else. 

This, he says, builds your rapport and trust with patients, many of whom have spent years feeling misunderstood or unheard.

Some arrive at the clinic feeling frustrated after cycling through multiple treatments with limited success. 

Others have lost confidence, not only in their bodies but also in healthcare providers. 

‘Some patients have gone through so much and you’re just another clinician they need to see. 

'At any point, you might spend the whole session just talking to them. And that’s okay.’

Matthew has seen pain education evolve significantly. 

While modern pain science has transformed clinicians’ understanding of persistent pain, translating complex neuroscience into meaningful conversations remains a skill in itself. 

‘I think earlier on, we probably talked to patients in a way that was too scientific. It was too neuroscience.’ 

Rather than overwhelming patients with technical explanations about nociception, sensitisation and neuroplasticity, Matthew now focuses on helping people understand how pain relates to their own goals and experiences.

For private practice physiotherapists, effective pain management for their clients is not about choosing between manual therapy and exercise or between biomedical and biopsychosocial approaches.

Matthew says it is about understanding the individual and tailoring treatment accordingly. It’s a philosophy he extends to the treatment room. 

Throughout his career, Matthew has invested heavily in building relationships with GPs, surgeons, psychologists and pain specialists. 

Those professional connections improve communication and help establish trust before patients arrive for their first appointment.

Strong referral relationships have become an important part of the myPhysioSA model and they reflect a broader lesson for clinicians interested in developing care in pain management, Matthew says. 

‘As physios, we need a team around us to manage chronic pain. We can’t do it on our own.’

And for younger physiotherapists considering a career in pain management, Matthew highlights the importance of mentorship, support and patience. 

Progress in clients’ recovery can be slow and outcomes are rarely achieved within a handful of consultations, he says. 

Yet despite the challenges, Matthew says the long-term impact on clients’ lives continues to make the work worthwhile. 

‘If you can get someone on board and engaged, the longer-term benefits are so rewarding.’