Námskeið FS: Reconciling biomechanics with pain science

Greg Lehman BKin, MSc, DC, MScPT

  • Dagsetning: 24. janúar - 25. janúar 2020
  • Staðsetning: Húsnæði Ísí, Engjavegi 6
  • Tími: 08:30 - 17:00
  • Bókunartímabil: 6. september - 13. desember 2019

Leiðbeinandi: Greg Lehman BKin, MSc, DC, MScPT

Significant research in the pain neurosciences and biomechanics field often appears to
undermine the reasoning and justifications for many of the traditional therapeutic approaches
and techniques of the many rehabilitation professions. By addressing both the weaknesses and
strengths of the biomechanical approach we can see that treatment can be much simpler,
congruent with the cognitive, neuroscience approach and best evidenced based practice.
This course provides a framework to utilize an alternative biomechanical approach that blends
neuroscience pain education. This course teaches the therapist how to teach patients about
pain science in a treatment framework that still utilizes specific/corrective exercise and manual
therapy. Therapists are taught a model of treatment that simplifies the assessment process
and the treatment.

LEARNING STYLE
This course is a mix of a discussion based lecture, case studies and practical components. The
practical components are used with the case studies to “feel” the interventions. However, there
no “specific” techniques. Rather, the point is to show that the framework helps the therapist use
their own techniques but in a different way. Further, we can then share “techniques” from all
participants in the class. Exercises are demonstrated and time is given to practice these
exercises. When exploring how Key Messages relate to pain and changing behaviour the
practical component helps the therapist use their own experiences and “stories” to fit with the
Key Messages of pain and behaviour change.

OBJECTIVES

 

  • Provide assessment techniques to aid in diagnosis and management common musculoskeletal complaints

  • Demonstrate how biomechanical treatments and explanations can address the multidimensional nature of pain

  • Demonstrate how cognitive restructuring and goal setting of meaningful activities can be used alongside mechanical treatments to address the multidimensional nature of pain

  • Provide and teach exercise prescription that is informed by biomechanics and therapeutic neuroscience

  • Explain the “pain science” behind common clinical problems and learn methods of applying therapeutic neuroscience education

  • Identify and use their current movement based skills within a graded exposure and graded activity paradigm

 

 

LECTURES
Treatment Fundamentals Lecture (60 minute practical) 9am to 11 am

 

  • An alternative to the kinesiopathological model of treatment is produced

  • A case for simplicity is made

  • Clinical reasoning for safety, potential red flags and contraindications to a biopsychosocial approach

  • A simplified framework to incorporate both biomechanical treatments with psychosocial treatments is outlined

  • a four 15 minute practical exercise break to introduce the concept of comprehensive capacity and graded exposure to:

  • Achilles tendinopathy

  • Comprehensive shoulder exercise prescription

  • Painful hip adduction

  • Painful lumbar spine flexion

 

When Biomechanics Matters (11am - 1pm)

 

  • an exploration of the utility and limitations of the biomechanical model in pain and injury management

  • introduction to how the current biomedical model can be simplified and modified to be consistent with the best evidence of both pain science and biomechanical science

  • Exploration of spine stability theory, scapular dyskinesis and common kinesiopathology models of pain and dysfunction

  • A framework for when movement quality is important for pain and injury

  • The importance of habit interruption as a rationale for changing movement quality

 

Expose or Protect: the role of spinal flexion in low back pain and injury (2pm - 3pm)

Symptom Modification Model of Injury/Pain Management (3:00 to 5pm - Practical 45
minutes)

  • the comprehensive capacity and graded exposure approach to injury and pain treatment will be detailed

  • Techniques from various schools of thought (Mulligan, ART, myofascial release,

  • Sahrmann, CFT, tendinopathy research) are demonstrated and reconceptualized to fit into a simpler clinical decision making framework

  • We've distilled common biomechanical treatments to justify those treatments within an alternative model

  • students will learn a framework and simplified clinical reasoning tool to help guide therapy

  • Symptom modification as clinical reasoning to guide interventions as demonstrated through case studies

  • simplifying both manual therapy, movement based interventions and exercise therapy via understanding the commonalities amongst our most popular interventions

  • traditional manual therapy techniques will be reframed to be maximize a biopysychosocial intervention approach

  • active and passive approaches to the symptom modification interventions and how these manual therapy approaches are supported by exercise interventions will be taught.

 

Day 2

The comprehensive capacity model of exercise prescription. (9:00-12 am - practical 30
minutes)

  • A simplified approach to exercise prescription is shown

  • The importance of comprehensive capacity and movement options is highlighted and illustrated when it is necessary

  • an evidence based approach to understanding pain and rehabilitating common conditions

  • an approach to understand the assessment of sensitivity in exercise prescription demonstrations of the exercise interventions

  • case study autopsies are performed illustration common themes behind various treatment approaches and how a simplified intervention can be effective

  • A review of common themes in tendinopathy and how that research can guide much clinical practice

 

The Point of Pain Science and Key Messages Workshop (1-3 pm)

  • Pain science primer

  • Identifying potential false beliefs that might influence pain and disability

  • How to deliver Key Messages that are chosen by false beliefs

  • Interviewing techniques are illustrated to help change opinions and ultimately change behaviour

  • case studies are presented by the class and solved with facilitation from the instructor and the group

  • a reconceptualization of common clinical tests is demonstrated to show that much of our current testing can be modified to still be useful

  • Specific examples demonstrating how to begin meaningful treatment “when everything hurts” and all manual therapy and exercise therapy has failed


Recommended Reading
Moseley GL, Butler DS. Fifteen Years of Explaining Pain: The Past, Present,and Future. J Pain. 2015
Sep;16(9):807-13. doi: 10.1016/j.jpain.2015.05.005. Epub 2015 Jun 5. Review. PubMed PMID:
26051220.
Nijs J, Lluch Girbés E, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal
pain: Innovation by altering pain memories. Man Ther.2015 Feb;20(1):216-20. doi:
10.1016/j.math.2014.07.004. Epub 2014 Jul 18.
Ng L, Campbell A, Burnett A, Smith A, O'Sullivan P. Spinal Kinematics of
Adolescent Male Rowers With Back Pain in Comparison to Matched Controls During
Ergometer Rowing. J Appl Biomech. 2015 Aug 6. [Epub ahead of print] PubMed PMID:
26252195.
O'Keeffe M, Purtill H, Kennedy N, O'Sullivan P, Dankaerts W, Tighe A,
Allworthy L, Dolan L, Bargary N, O'Sullivan K. Individualised cognitive
functional therapy compared with a combined exercise and pain education class for patients with
non-specific chronic low back pain: study protocol for a
multicentre randomised controlled trial. BMJ Open. 2015 Jun 1;5(6):e007156. doi:
10.1136/bmjopen-2014-007156. PubMed PMID: 26033941; PubMed Central PMCID:PMC4458611.
Sanchis M, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central
sensitization in shoulder pain: A systematic literature review. Semin Arthritis
Rheum. 2015 Jun;44(6):710-6. doi: 10.1016/j.semarthrit.2014.11.002. Epub 2014 Nov 13. Review.
PubMed PMID: 25523242.
Struyf F, Lluch E, Falla D, Meeus M, Noten S, Nijs J. Influence of shoulder
pain on muscle function: implications for the assessment and therapy of shoulder
disorders. Eur J Appl Physiol. 2015 Feb;115(2):225-34. doi:
10.1007/s00421-014-3059-7. Epub 2014 Nov 28. PubMed PMID: 25431129.