Physiotherapy for Functional Recovery in Sexual Trauma Survivors: Breaking the Cycle of Tonic Immobility

Abstract

Introduction: Tonic immobility (TI) is an involuntary defensive “freeze” response reported in some individuals following extreme threat, including sexual trauma. Persistent movement avoidance and altered breathing patterns may coexist with musculoskeletal pain and gait deviations, potentially affecting function. Case Description: A 35-year-old woman with a history of sexual trauma presented with right-sided sacroiliac (SI) joint pain, gait deviation (right out-toeing), and fear of movement. Clinical examination identified SI joint tenderness, lower-limb muscle tightness, and shallow upper-chest breathing during movement tasks and trauma-related discussion. A physiotherapy clinical impression of TI-associated movement dysfunction with SI joint pain and gait deviation was made, with trauma history considered a relevant contextual factor. Intervention: A structured physiotherapy program integrating somatic awareness exercises, breathing retraining, and manual therapy (including muscle energy technique), alongside strengthening and ergonomic advice, was provided over a 6-week period (intervention plus follow-up). Outcomes: Over the program, pain decreased (NPRS 6 to 0), post-traumatic stress symptom severity as measured by PCL-5 decreased (33 to 20), and the right foot progression angle improved (19° to 13°). Functional disability (ODI category) improved from moderate to minimal disability. No adverse events were reported. Conclusion: In this single case, a trauma-informed physiotherapy approach was associated with improvements in pain, gait parameters, and self-reported symptoms. While causality cannot be inferred from a case report, these findings suggest that physiotherapy may be a feasible component of multidisciplinary rehabilitation for individuals presenting with musculoskeletal dysfunction in the context of TI following sexual trauma.