Pain Fundamentals: Reconciling Biomechanics with Pain Science
Date: May 20-21
Speaker: Greg Lehman, PT, DC
Contact Hours: Approximately 13.0
Open to: PT, PTA, OT, COTA, AT, CSCS
Description: Significant research in the pain neurosciences and biomechanics field often appears to undermine the reasoning and justifications for many of the therapeutic approaches and techniques of the physical therapy profession. By addressing the 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 teaches the therapist how to teach patients about pain science in a treatment framework that utilizes specific/corrective exercise and manual therapy. Therapists are taught a model of treatment that simplifies the assessment process and the treatment itself. Special topics include therapeutic neuroscience education; cognition target therapeutic explanations; determining when biomechanics matters; assessment and exercise prescription; up-to-date tendinopathy rehabilitation protocols; and a reconceptualization of manual and exercise therapy that is symptom modification-based rather than biomechanically driven.
Course content includes:
- Information on up-to-date assessment techniques for partitioning the role of biomechanics and therapeutic neuroscience in the treatment of pain and injury.
- Demonstration of how biomechanical treatments and explanations can address the multidimensional nature of pain.
- Exercise prescription informed by biomechanics and therapeutic neuroscience.
- Simplified manual therapy techniques that are consistent with therapeutic neuroscience and the biomechanics of manual therapy.
- Immediate means of applying therapeutic neuroscience to a traditional biomedically based practice.\
- Confidence in leaving behind the traditional and outdated biomechanical model of care while learning how to integrate previously learned skills.
9-10:30 a.m. — Treatment Fundamentals Lecture
- 15-minute practical exercise break to introduce the concept of comprehensive capacity to training the ankle complex
10:30 a.m.-noon — When Biomechanics Matters (30 minute practical)
- 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
- Introduction to other explanations for the relevance of biomechanics to painful states
- Practical: modifying single-leg squat test to test for movement habits.
- Practical: progressions and regressions of the single-leg squat test and its derivatives to bias different structures and “train the brain”
Noon-1 p.m. — Lunch
1-3 p.m. — The Point of Pain Science Workshop
- Participants work through the concepts of the Pain Science Workbook to develop personal treatment approaches to teach therapeutic neuroscience education
- Case studies are presented by the class and solved with facilitation from the instructor and the group
- Covers key messages of pain science and interviewing techniques to start addressing the psychosocial aspects of pain and injury
- The Three Faces of Flexion Pain model is used to help partition when biomechanics or psychosocial drivers may be more important in the persistence of pain
3-3:30 p.m. — Demystifying Manual Therapy
- Simple research on manual therapy and physiology that should profoundly shape all manual therapy interventions
3:30-4:30 p.m. — The Tendon Loading Model of Rehabilitation and the Importance of Loading to Common Clinical Disorders (30 minutes lecture, 60 minutes practical)
- An evidence-based approach to understanding pain and rehabilitating common conditions
- An approach to understand the assessment of sensitivity in exercise prescription
- Demonstrations of exercise interventions
- Case study autopsies are performed, illustrating common themes behind various treatment approaches and how a simplified intervention can be effective
4:30-5 p.m. — Challenging Biases: Research Interpretation via Stretching
- Review the literature behind static stretching and performance, injury and mechanism
- Describe the scientific process of continually challenging one’s own biases
- Demonstrate the ability to create patient-specific mobility screens
9-10 a.m. — Three Faces of Flexion Pain: Incorporating Biomechanics into the Biopsychosocial Approach
- • Biomechanics, load and stress are still important variables in injury management
- • Determining when biomechanics are important (includes an emphasis on flexion-related pain)
10-11 a.m. — Assessment Simplified
- A reconceptualization of common clinical tests is demonstrated to show that much of our current testing can be modified to still be useful
11 a.m.-noon — Just load it! The importance of simple exercise progressions in rehabilitation
- Practical alternatives to the traditional model are demonstrated and explored by each student during this interactive and participant-driven lecture and demonstration
- Alternatives to traditional biomechanical screening tools and assessment techniques are taught
- Practical: common exercise modifications
Noon-1 p.m. — Lunch
1-4 pm. — Comprehensive Capacity and the Symptom Modification Model of Injury/Pain Management
- The comprehensive capacity approach to injury and pain treatment will be detailed
- 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 manual therapy, movement-based interventions and exercise therapy via understanding the commonalities among our most popular interventions
- Comprehensive capacity in movement training and screening case studies
- Traditional manual therapy techniques will be reframed to be maximize a biopsychosocial intervention approach
- Active and passive approaches to symptom modification interventions and how these manual therapy approaches are supported by exercise interventions will be taught
Speaker Biography: I am a physiotherapist and chiropractor treating musculoskeletal disorders within a biopsychosocial model. Prior to my clinical career I was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two students annually to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory, subsequently publishing more than 20 peer-reviewed papers in the manual therapy and exercise biomechanics field. I was an assistant professor at the Canadian Memorial Chiropractic College, teaching a graduate-level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students. I have lectured on a number of topics including reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience. My clinical musings can be seen on Medbridge Health CE and heard on various web-based podcasts. I am currently an instructor with therunningclinic.ca and with physiofundamentals.com. Both are continuing education platforms that provide clinically relevant research that helps shape and refine clinical practice. While I have a strong biomechanics background, I was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. I believe successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. I currently maintain three websites geared to health professionals (physiofundamentals.com and thebodymechanic.ca) and patients (painphysiotherapy.ca). I am active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice.