Psychologically Informed Practice (PiP) is best understood as enhanced physiotherapy in which identification and management of psychological factors is central to reactivation. The PiP approach has been investigated in trials of stratified care linking psychological screening with targeted treatment, but there have been challenges in its implementation in routine musculoskeletal care. The possible reasons for this have been carefully explored and raise questions about both the adequacy of training and the feasibility of implementation of PiP in clinical practice. Recommendations are made for the further development of PiP, the management of psychological obstacles to recovery, and the role of psychologists in this process.