A pioneering model of care is placing physiotherapists at the centre of a new approach to managing chronic pain through better sleep. 

The program, announced recently at the Florey Institute of Neuroscience and Mental Health in Melbourne, integrates sleep assessment directly into physiotherapy practice— offering a transformative shift in how clinicians approach long-term pain.

Physiotherapist Peter Allen APAM has seen firsthand how patients can continue to struggle despite high-quality rehabilitation.

‘There were people I’d seen for years who made little progress,’ Peter says. 

‘Once we introduced a sleep-focused lens, we started getting remarkable outcomes. 

'Some no longer need ongoing physio— something I never thought I’d see.’

Peter was a key figure in a recent feasibility study involving chronic pain patients, many of whom had undiagnosed sleep disorders.

The study demonstrated that integrating sleep interventions, sleep posture adjustment and sleep disorder screening into physiotherapy practice could lead to significant pain relief and improved quality of life.

‘Sleep is almost completely overlooked in standard pain assessments,’ Peter says. 

‘And physios haven’t traditionally had any practical tools or training to intervene. That’s changing now.’

The new model equips physiotherapists with the ability to screen patients for signs of conditions such as insomnia or obstructive sleep apnoea, refer to medical specialists as needed and prescribe an adjustable bed system developed by SD Labs, the medical division of mattress firm Sleeping Duck. 

Using video-guided fittings, physiotherapists tailor the bed to each patient’s individual needs, supporting optimal posture and comfort during sleep.

‘The bed works like a therapeutic device,’ Peter says. 

‘It allows us to match support to the patient’s pain presentation—whether that’s disc issues, nerve pain or general discomfort—and support them in that position all night.’

The idea for the model grew from observations made by neurosurgeon Professor Tony Goldschlager, who has worked alongside physiotherapists for decades. 

‘All of us in spine surgery operate on approximately 10 per cent of the patients we see. 

'The other 90 per cent need non-surgical care—and physios are the ones managing that,’ Tony says. 

‘They’re already doing so much for patients with chronic pain; this just adds another essential layer.’

Tony began to explore sleep as a factor in persistent pain after seeing countless patients report exhaustion and poor recovery. 

‘It’s not revolutionary to say that poor sleep leads to more pain—but no-one was addressing it,’ he says. 

‘If a patient isn’t sleeping, their pain won’t improve. We had to find a practical way to intervene.’

That led to collaboration with engineers at Sleeping Duck, resulting in the formation of SD Labs and the design of a fully adjustable bed system. 

The initiative expanded further to involve sleep physicians, neuroscientists and academic physiotherapists to ensure it was an interdisciplinary model.

‘We knew physios needed more than just a hunch—they needed tools, evidence and training,’ Tony says. 

‘So we developed a way to screen for sleep issues and adjust sleep posture in a clinically meaningful, scalable way.’

A national professional development program has now been created to support physiotherapists to integrate the model into clinical practice. 

Sixty physiotherapists across 30 physiotherapy clinics have adopted the model so far, with plans to expand to around 100 clinics by the end of this year.

While the initial focus has been on private practice, there is the potential to expand into community and hospital settings. 

‘Rural and regional clinics are a big part of our vision,’ Peter says. 

‘The model is simple to implement and offers meaningful outcomes.’

Although the initial study was small, both Peter and Tony say the results have been compelling. 

‘We’re now preparing for a randomised controlled trial to measure pain levels, quality of life and inflammatory markers,’ Tony says.

‘But even now, the patient-reported results speak volumes.’

Importantly, the program fills a critical gap in physiotherapy care. 

‘Sleep hasn’t historically been part of physio education and most clinics don’t screen for it,’ Peter says. 

‘Now we’ve created a system that’s easy to learn, easy to implement and deeply impactful.’

The approach also reflects a broader shift in how physiotherapy is evolving.

Historically, chronic pain management leaned heavily on medications and surgery. 

While physiotherapists have long been central to musculoskeletal rehabilitation, this model gives them tools to treat another critical piece of the pain puzzle.

Tony is optimistic about what this means for patients and the profession more broadly. 

‘There’s huge potential to improve outcomes and reduce the burden on the health system. 

'But more than that— it’s about empowering clinicians to address pain in a smarter, more holistic way,’ he says.

‘There’s never been anything like this in our field,’ Peter explains. 

‘It’s quick, evidence-based and patient-centred. It’s what physios have been looking for—and what many patients desperately need.’

With more than 3.6 million Australians experiencing chronic pain and the cost of care expected to reach $215.6 billion by 2050, there has never been a more urgent time to think differently about treatment.

‘Before reaching for painkillers or surgical options, I’d recommend looking at your sleep. It’s where recovery truly begins,’ Tony says.

COURSE OF INTEREST: 2024 eTalk #2—Sleep health and physiotherapy: what you need to know