A couple of weekends ago a good friend and I made the journey to Seattle for a course that he adamantly suggested we attend. He and I were initially were supposed to attend the San Diego Pain Summit with Lorimer Mosely but that ended up not being the case. Instead, Seattle was a better fit for us due to our patient schedules and it payed off in ways I did not expect. Its not every day that a course makes you rethink everything you are doing and then backs it with robust research. More than a paradigm shift in treatment, this was more a shift in thought process and communication.
Greg Lehman is a Chiropractor, Physio, researcher, comedian and Canadian. He spent many years working and researching with Pr. Stuart McGill at the Univ. of Waterloo working in spine biomechanics lab and is now educating practitioners on chronic pain and modern pain science. He is very deft at making the difficult seem easy and simple and weaving it with humor and humility.
The course was packed with research on when, how and why biomechanics is and is not important in regards to chronic pain. He is no way stated that pain was just an output of the brain, but stated that we need to first and obviously rule out red flags and pathophysiological issues. After the acute and sub-acute phase of healing, pain should resolve and if it doesn’t then we need to look a little deeper.
I will dive into some of the key points that I took away from this weekends course and suggest that you research Greg Lehman on Youtube, Facebook and on his site, www.physiofundamentals.ca
Chronic pain is about Sensitivity.
How much pain we feel is due to the sensitivity of the system and not necessarily the amount of damage. This is a very important thing for our patients to understand. When pain persists, the spinal cord receptor becomes sensitized to its constant excitation and amplifies the signal to the brain. If the brain decides that the information being sent is not important then the signal will be turned down or what is called descending inhibition, and this is one of the great benefits of exercise for decreasing pain.
This means that you hurt, but you are not harming yourself.
Remember, you are STRONG, RESILIENT and ROBUST
Communication may be the most helpful or detrimental aspect of our contact with our clientele. In the medical community today we are very familiar with speaking in absolutes and thought viruses (thanks Erson Religioso,PT) like the “A” word (arthritis) or “D” word (degeneration) and other inflammatory words. This choice of vocabulary is a form of nocebo and has led our patients to believe that they are fragile and frail which leads to anxiety and restriction in their movement capacity and desire out of fear of further injury. The greatest thing that we can do for our patients is educate them that they are not their imaging as their physician will lead them to believe. A good education source is the VOMIT (Victims of Medical Imaging Technology) posters seen here It is beneficial to tell and show the patient that they are strong, resilient and robust through exercises that get them up and moving in a pain free way. The way we do this is through……
Symptom Modification and neurological variability
One of the ways that we as practitioners will effect change in our patients is from our manual therapy techniques. This works on the nervous system through at term known as sensory gaiting. This is the introduction of interesting mechanoreception which reduces the processing of nociception. This allows us to down regulate the nervous system and get our patients up and moving which is something that the body desperately needs for complete healing and pain resolution.
This can also be done through exercise modification or graded exposure which is how we overcome all of our fears. Because the brain will learn to associate pain with a particular movement, graded exposure allows the brain to experience a novel form of movement that was associated with a prior painful movement that can break the association. This process offers the brain variability or movement options and when we begin to move in different ways ( motor control changes, increased stability or mobility, etc) we allow what was once a sensitive and painful pattern the ability to recover and desensitize.
I would suggest reading up on pain science, but if you are smart you will begin first register for this course as it is a fresh and desperately needed view which will help practitioners immediately with their patient interaction.
I am truly glad that I attended and will also find any reason I can to return to Seattle. That place is awesome!