Physiotherapy · Perth WA
Cognitive Functional Therapy
CFT — Evidence - Based Chronic Pain Management
For people living with persistent pain that doesn't follow normal patterns — where standard treatments haven't worked, where rest makes no difference, and where pain has started shaping everything you do.
With Lachlan McDonald — Osborne Park
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Pain beliefs and thought patterns that keep the nervous system in a threat state
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Movement behaviours shaped by pain avoidance — and how to safely retrain them
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Lifestyle drivers — sleep quality, stress, diet, and physical deconditioning
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Nervous system sensitisation and immune-mediated pain amplification
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Gradual functional restoration — rebuilding confidence and capacity, one movement at a time
🏥 AHPRA Registered Physiotherapists
👤 CFT delivered by Lachlan McDonald
📋 No GP referral required
💳 HICAPS on-site — all health funds
📍 Osborne Park · Applecross · Myaree
What Is CFT
A different approach to persistent pain
Cognitive Functional Therapy is an evidence-based physiotherapy approach specifically developed for people with chronic and complex pain — pain that has lasted longer than expected, doesn't respond predictably to treatment, or has become woven into everyday life in ways that are hard to explain.
It was developed by Professor Peter O'Sullivan and his team at Curtin University in Perth — which means the research underpinning what your Beyond Health physiotherapist does was largely conducted right here in Western Australia.
CFT works by identifying and addressing the specific combination of factors keeping your pain going — not just the physical tissue, but the nervous system responses, the movement behaviours, the lifestyle contributors, and the thought patterns that have developed around pain over time. It is not a single technique but a clinical reasoning framework that is tailored to you individually at every session.
The goal is not simply to reduce pain — it is to restore your confidence in your body, your capacity to move freely, and your ability to live the life you want without pain dictating your decisions.
What Is CFT
"An integrated behavioural approach for the targeted management of disabling pain — combining cognitive, functional, and lifestyle elements in an individually tailored programme."
O'Sullivan et al., Physical Therapy, 2018
Developed at Curtin University, Perth WA
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"An integrated behavioural approach for the targeted management of disabling pain — combining cognitive, functional, and lifestyle elements in an individually tailored programme."
3 yrs
Duration of sustained effects shown in the RESTORE trial (The Lancet Rheumatology, 2025)
A $5K+
Cost savings per person over one year compared with usual care (RESTORE trial)
Understanding Your Pain
Not all pain works the same way
What Is CFT
Pain that makes sense
You injure something. It hurts. It heals over days to weeks. The pain signals genuine tissue damage, and as the tissue recovers, the pain reduces in proportion. This is how most people understand pain to work.
- Proportional to injury severity
- Reduces as tissue heals
- Predictable — rest and treatment help
- Managed well by standard physiotherapy
Persistent Pain — The CFT Patient
Pain that no longer follows the rules
Pain that continues well beyond the tissue healing window. That comes and goes with no clear pattern. That seems to worsen with rest. That flares from triggers that shouldn't cause pain — stress, poor sleep, being stationary too long. This is not imagined pain. It reflects real changes in how the nervous system processes and amplifies pain signals.
- Persists beyond expected healing timeframe
- Unpredictable — can feel random or disproportionate
- Influenced by stress, sleep, emotions and posture
- Often accompanied by fear of movement or re-injury
- Gradually narrows what you feel safe doing
The Science Behind It
Why persistent pain is a nervous system story
Central sensitisation — when your alarm system gets stuck
The nervous system has a remarkable ability to adapt. In chronic pain, this adaptation works against you — the central nervous system becomes increasingly sensitive to input, interpreting signals as threatening even when no new tissue damage is occurring. The brain's pain response is not simply a readout of what's happening in your body. It is a prediction, shaped by context, memory, stress, and learned associations.
This is why the same movement that caused pain yesterday might cause agony today after a bad night's sleep, but feel manageable on a good day. The pain is real — but the driver has shifted from tissue damage to nervous system state.
The immune connection — microglia, astrocytes and T cells
Recent neuroscience has identified specific immune cells in the nervous system — microglia, astrocytes, T cells, and natural killer cells — that become activated in response to sustained pain and perceived threat. These cells can amplify pain signalling and maintain a chronic pain state even after the original injury has resolved.
Critically, the research shows that addressing the psychological and emotional context of pain — reducing feelings of threat, fear, and helplessness — directly de-escalates this immune-mediated pain response. This is not a philosophical point. It is a mechanistic basis for why CFT's cognitive components produce measurable physical change.
Key Pain Drivers CFT Addresses
😴 Sleep deprivation and fatigue
🥗 Pro-inflammatory diet and lifestyle
📉 Physical deconditioning
💭 Catastrophic pain beliefs
😰 Stress and psychological distress
🧠 Pain-related fear and avoidance
🔁 Unhelpful movement habits
🏥 Passive treatment dependence
The CFT Process
How treatment actually works
CFT is not a formula. It is a clinical reasoning process that adapts to you. Here is what the treatment journey typically looks like — though the pace and emphasis of each phase depends entirely on your individual presentation.
PHASE 01
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Making Sense of Your Pain
A thorough, non-judgemental history of your pain journey — its onset, its patterns, what has influenced it, and how it has shaped your behaviour and beliefs. The aim is to identify your specific pain drivers, not apply a generic protocol. This phase takes longer than a standard physio appointment — that is intentional.
PHASE 01
2
Movement Assessment
How has pain changed the way you move? Which movements do you avoid? What compensations has your body quietly adopted? Your physiotherapist observes how pain has shaped your movement habits — protective postures, guarded movements, and avoided positions — then begins to gently challenge them.
PHASE 01
3
Exploring and Changing Pain
The turning point — seeing whether pain can be altered through subtle movement changes, breathing control, relaxation, and mindfulness. For many patients, experiencing that pain can shift — even slightly — in a safe environment is the beginning of a fundamental change in their relationship with pain and their body.
PHASE 01
4
Gradual Functional Restoration
Building a progressive programme that reintroduces previously avoided movements, activities, and aspects of life — at a pace that accumulates evidence in your nervous system that these things are safe. As confidence builds, the scope of what you can do expands. Pain stops running the diary.
Is CFT Right for You?
Conditions we commonly see with CFT
● Chronic lower back pain (lasting more than 3 months)
● Persistent neck pain
● Fibromyalgia
● Chronic pelvic pain
● Recurrent back or joint pain
● Pain following surgery where expected recovery has stalled
● Persistent pain after accident or injury
● Pain associated with significant fear of movement
● Pain that has not responded to previous treatment
CFT is specifically for persistent pain — not acute injury
If you have a fresh sports injury, post-surgical pain in the early recovery phase, or an acute musculoskeletal complaint, standard physiotherapy is more appropriate. CFT is designed for pain that has become complex, unpredictable, or resistant to the usual approaches.
Not sure whether CFT is right for you? Book an initial assessment and your physiotherapist will conduct a thorough clinical assessment before recommending the most appropriate approach — which may or may not be CFT.
Is CFT Right for You?
The Evidence Base
Developed in Perth.
Proven globally.
CFT was developed at Curtin University in Perth by Professor Peter O'Sullivan — one of the world's leading chronic pain researchers. The approach now has a substantial body of clinical trial evidence behind it, with the most rigorous research published in 2024 and 2025.
The RESTORE trial — the largest clinical trial of CFT conducted in Australia — showed effects sustained at three years: clinically meaningful reductions in disability and pain compared with usual care, at a cost saving of more than A$5,000 per person. These are not typical physiotherapy trial results.
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RCTs included in most comprehensive meta-analysis to date (2024)
3 yrs
Sustained effects shown in the RESTORE trial follow-up (Lancet Rheumatology, 2025)
1,228
Participants across included trials — meaningful sample size for clinical claims
High
Certainty evidence for improvements in pain self-efficacy at medium and long term
Physical Therapy · Dec 2024
CFT for Chronic Low Back Pain: Systematic Review & Meta-Analysis
Low-to-moderate certainty evidence that CFT reduces disability at short, medium and long-term timepoints compared with alternate treatments including usual care. High certainty evidence for improvements in pain self-efficacy.
The Lancet Rheumatology · 2025
RESTORE Trial 3-Year Follow-Up
CFT produced sustained reductions in pain-related disability and pain intensity at three years, outperforming usual care. Treatment was also found to be cost-effective, saving more than A$5,000 per person over one year.
Pain Medicine · 2025
CFT for Chronic Spinal Pain: Meta-Analysis
Across eight RCTs (n=1,228), CFT demonstrated clinically relevant reductions in disability and pain at short-term follow-up compared with other conservative interventions, with effects persisting in longer-term follow-ups.
What to Expect
Your first CFT consultation
1
A longer first appointment
Your initial CFT consultation will typically take 60–75 minutes. This is longer than a standard physiotherapy appointment by design. Understanding your pain properly requires adequate time — for your story, your history with treatment, what your pain means to you, and how it has changed what you do. A rushed assessment misses the most important information.
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A reflective, non-judgemental conversation
Your physiotherapist will ask questions that go beyond standard clinical intake. How has your pain affected your work, your relationships, your sense of self? What have you been told about your condition? What do you believe is causing it? This is not prying — it is essential clinical information for identifying your specific pain drivers.
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Physical assessment and movement exploration
You will be assessed physically — but not in the way you might expect. The interest is in how you move, how you protect, how your body has adapted around pain. We are also looking at whether pain can change — even slightly — when you alter how you move, how you breathe, or how you hold your body. This is often the first moment many patients realise their pain is more modifiable than they believed.
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A clear explanation and collaborative plan
At the end of your first session, your physiotherapist will explain what they found, what it means, and what they believe are the key drivers of your pain. You will leave with a clear understanding of your condition and a plan that makes sense to you. CFT requires your active participation — your physiotherapist guides and coaches, but you are in the driver's seat.
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Ongoing sessions and home practice
Subsequent sessions build progressively on what was established in the first appointment. CFT involves a home practice component — exercises, movement explorations, and lifestyle practices between sessions. The research shows that treatments involving 7–8 sessions over 12 weeks with a booster session at 6 months produce the most sustained outcomes. Your programme will be tailored to your pace and circumstances.
Book a CFT Consultation
With Lachlan McDonald — Osborne Park
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Your Practitioner
Lachlan McDonald, Sports & Exercise Physiotherapist — CFT trained, elite sport background
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Initial Consult
60–75 minutes · Comprehensive history, physical assessment, pain driver analysis and first treatment
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Follow-Up Sessions
45–60 minutes · Progressive functional restoration programme
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What to Bring
Any previous imaging or reports, a list of current medications, comfortable clothing
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Private Health Insurance
HICAPS on-site — all major funds accepted. Medicare EPC referrals also accepted where eligible.
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Referral
No GP referral needed to book directly
What to Expect
CFT versus standard physiotherapy
Standard physiotherapy is excellent for acute injury and structural conditions. CFT is a distinct approach for persistent and complex pain — not a replacement for standard care, but an evolution of it.
Standard Physiotherapy | Cognitive Functional Therapy | |
|---|---|---|
Primary focus | Tissue structure, biomechanics, acute injury | Full biopsychosocial picture — tissue, nervous system, lifestyle, cognition |
Assessment depth | Physical examination, postural/movement analysis | Extended history including pain beliefs, fear, behaviour, sleep, stress and lifestyle drivers |
Treatment duration | 30–45 minutes typical | 60–75 min initial; 45–60 min ongoing — longer appointments are clinically necessary for complexity |
Patient role | Receiving treatment — relatively passive | Active participant — self-management is the goal, not treatment dependency |
Suitable for | Acute pain, sports injuries, post-surgical rehab, structural conditions | Persistent pain (3+ months), complex or recurrent pain, pain with fear/avoidance, treatment-resistant presentations |
Long-term outcomes | Strong for acute conditions; limited for chronic pain | Sustained effects at 3 years demonstrated in the RESTORE trial (Lancet Rheumatology, 2025) |
Your CFT Practitioner
Meet the physiotherapist delivering CFT at Beyond Health
Standard physiotherapy is excellent for acute injury and structural conditions. CFT is a distinct approach for persistent and complex pain — not a replacement for standard care, but an evolution of it.
Lachlan McDonald
Sports & Exercise Physiotherapist
CFT
Chronic Pain
Sports Rehab
Complex Injury
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Available at Beyond Health Osborne Park
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AHPRA Registered Physiotherapist
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Elite sport background — Rugby Union, AFL, Cricket, Combat Sports
A physiotherapist who understands complexity
Lachlan is a Sports and Exercise Physiotherapist with experience across elite sporting environments — working with Rugby Union, AFL, Cricket, and Combat Sports organisations at a high level. That background in elite sports has given him a depth of clinical experience in complex, persistent, and pre- and post-operative injury presentations that is rarely found in private practice.
His work within elite sport means he understands what it is to have pain that doesn't follow a clean timeline — injuries that were "cleared" but still affect performance, presentations that defy simple structural explanations, and athletes whose psychological relationship with their body has become a bigger barrier to recovery than the physical injury itself. This is precisely the patient type that CFT was designed for.
At Beyond Health, Lachlan brings this clinical depth to private practice — working with everyday people whose persistent pain has the same complexity, even if the context is different. Whether you are a recreational athlete, an office worker, or someone whose pain has defied multiple treatment attempts, Lachlan's approach is grounded in understanding your full picture before deciding on a direction.
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AHPRA Registered Physiotherapist
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Specialist in complex injury management and rehabilitation
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Youth athletic population experience
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Elite sport experience — Rugby Union, AFL, Cricket, Combat Sports
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Pre- and post-operative rehabilitation expertise
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Cognitive Functional Therapy (CFT) trained
✓ Is CFT Right for You?
Sport taught me that pain is rarely just a tissue problem.
Working in elite sport, you quickly encounter athletes whose pain has become entangled with fear, identity, pressure, and expectation — and where treating the tissue alone produces at best a temporary fix. CFT gave me a clinical framework for those presentations: a way to understand the full driver profile of someone's pain and address it systematically, rather than treating what the scan says and hoping for the best. That approach works for athletes. And it works equally well for anyone else whose pain has become more complex than a standard treatment model can accommodate.
Questions
Frequently asked questions
Still have questions? Call us on 08 6162 9288 or email admin@beyondhealthchiro.com.au — we're happy to help you work out whether CFT is the right approach.
No. Cognitive Behavioural Therapy (CBT) is a psychological intervention primarily delivered by psychologists. Cognitive Functional Therapy (CFT) is a physiotherapy approach that integrates cognitive and behavioural elements within a physical and functional rehabilitation framework. Your CFT practitioner at Beyond Health is a registered physiotherapist — not a psychologist. The approaches share some theoretical foundations around the role of thought patterns and behaviour in chronic conditions, but CFT is specifically designed for musculoskeletal pain and functional restoration.
No. Physiotherapists are primary healthcare providers in Australia, which means you can book directly with us without a referral. However, if you have a chronic condition and your GP has referred you under a Chronic Disease Management (CDM) plan, you may be eligible for Medicare-subsidised sessions. Contact your GP to discuss whether a CDM plan is appropriate for your situation, or call us and we can explain your options.
The clinical research suggests that CFT produces its best results when delivered as approximately 7–8 sessions over 12 weeks, with a booster session at 6 months. This is a guide, not a fixed prescription — some patients require more, some fewer. Your physiotherapist will give you a realistic indication at your initial consultation based on your presentation. CFT is not an open-ended treatment — the goal is to equip you with the understanding and skills to self-manage your pain, reducing your dependence on regular treatment over time.
Some patients notice a temporary increase in pain awareness during the early phases of CFT, particularly when exploring movement patterns that have been avoided for a long time. This is expected and is part of the process of recalibrating the nervous system's responses. Your physiotherapist will move at a pace that is manageable and will always explain what to expect at each stage. The aim is never to push through pain in a way that reinforces fear — it is to gradually demonstrate that certain movements are safe, even when they initially feel threatening.
CFT sessions are claimed as physiotherapy consultations under your private health extras cover. If your policy includes physiotherapy, it will cover CFT sessions in the same way as any other physiotherapy appointment. We have HICAPS on-site at all three Beyond Health clinics for on-the-spot claiming. The only difference from a billing perspective is that initial consultations are longer — and therefore priced accordingly. Check with your insurer if you have any questions about physiotherapy benefits under your specific policy.
This is one of the most common situations we see. Standard physiotherapy is excellent for acute and structural conditions, but it was not designed for persistent, complex pain. If your pain has been present for months or years, has not responded to hands-on treatment, and seems to be influenced by factors beyond the physical — stress, sleep, fear of movement — then you have likely been receiving the wrong type of care for your presentation, through no fault of any practitioner. CFT specifically addresses the neurological and behavioural components of pain that standard physiotherapy does not target. That is why the research shows it produces different outcomes.
CFT is delivered by Lachlan McDonald at our Osborne Park clinic (454 Scarborough Beach Road, inside Fitness Cartel). Please mention that you are specifically booking for CFT when making your appointment so we can allocate sufficient time for your initial consultation. Call us on 08 6150 7831 or book online and select Lachlan McDonald as your practitioner.
Take the First Step
Ready to understand your pain and take back control?
CFT delivered by Lachlan McDonald at Beyond Health Osborne Park. No referral needed. Medicare CDM plans accepted. All private health funds via HICAPS.
✓ No referral · ✓ HICAPS on-site · ✓ Medicare CDM accepted