Kablooey! You have a bout of back pain. It's unpleasant and so off to the.... (insert health professional) you go. You tell your story, they ask a bunch of questions, do an assessment, a bit of jiggery pokery and then give you a couple of exercises to do (be it stickmen, printed or videos downloaded [...]
Diagnosis is an important part of healthcare provision. Quite simply, people want to know what’s wrong with them in order to know what can be done about it. Clinicians diagnose so to provide the person living with a disease, the appropriate treatment (Gifford, 2014). Historically, in musculoskeletal medicine diagnosis has taken the form of identifying [...]
Warning: This blog is lengthy, contains jargon, waffling and rabbit holes. In one of the scenes in the movie The Matrix, Morpheus introduces Neo to the Matrix for the first time. Morpheus explains the construct, a loading program, where anything can be loaded from clothing to equipment, training simulations, anything they need. Cue abstract from [...]
This month I decided to put me feet up and support the voice of my fellow colleagues. I get contacted by many clinicians, of all levels of experience, wanting to chat about where they should take their career. Many are sat at a crossroads unsure of which way to turn, with some even considering leaving [...]
Groundhog Day is a 1993 movie starring Bill Murray. Murray portrays Phil Connors, a cynical television weatherman covering the annual Groundhog Day event in Punxsutawney, Pennyslyvania, who becomes trapped in a time loop forcing him to relive the same day repeatedly. This short blog is a deep dive into Groundhog Day as an analogy for [...]
In my last post I shared my thoughts on the comparisons between dispositional reasoning and process based therapy, with the focus being on workable processes of change rather than trying to find the "magic bullet" of pain elimination. To try and explain this, I would like to reference parts of a chapter from Rethinking Causality, [...]
Physiotherapy has been going through some significant changes in the last 20-30 years. Probably one of the most significant is the paradigm shift from the biomedical to the biopsychosocial (BPS) model. The BPS model shifting the emphasis from tissue pathology to a systems based approach capturing biological, psychological and sociological components. Despite the argument that [...]
I do wonder what the response might be to the title of this blog? Physiotherapy within pain management is still very much in the midst of an explaining pain / CBT evolution, but I do wonder if we have disregarded what our peers in other professions have been questioning with respect to their own methods? [...]
Physiotherapists tend to have a bit of a reputation for jumping onto bandwagons. In writing this blog I am committing hypocrisy by admitting I am a strong proponent of Acceptance and Commitment Therapy (ACT). Yes, it’s true I can be accused of jumping onto a bandwagon. If I look up the meaning of bandwagon here’s [...]
There’s a moment in the Lord of the Rings, where Frodo and Sam are walking in the rocky terrain of the Misty Mountains trying to head towards Mordor. Sam speaks about the familiarity of the terrain and Frodo, jaded, responds with, “That’s because we’ve been here before, we’re going in circles” Eventually, it is Golum, [...]
There’s a deeper philosophical perspective within Acceptance and Commitment Therapy (ACT). Clinicians can familiarize themselves with the strategies and techniques within ACT and use them as everyday clinical tools. Defusion, Acceptance, Values and Commitment sit on either side of the ACT Hexaflex within a clear delineation (see figure 1)and so these techniques could be seen [...]
"Your doctor has asked me to write a report on why there's been so little progress" Those words must be dreaded by every person that lives with pain. It must be hugely invalidating for someone who has been through so much in an attempt to try and understand, resolve or "get on top of" their [...]
“It’s important that you pace your activity, this is to minimize the risk of your pain increasing. Once you identify how long you can spend at a task before your pain increases, you will eventually be able to increase your time doing the task.” Pacing Activity pacing (AP) is a term widely used to describe [...]
Anyone who reads my blogs will know that I like to venture off the beaten track and explore how transferable knowledge between areas of interest or other specialties relate can be implemented into our understanding of persistent pain. I’ve blogged a few times about exercise dosage here, here and here and I thought I would [...]
A common experience for people living with pain is the enigmatic behavior of pain. People feel a lack of control due to the unpredictability, intensity or severity of pain. This can significantly affect a person’s ability to achieve a desired outcome, such as playing with their kids, being able to vacuum, being able to work, [...]
The situation is real, a worldwide pandemic, and as we currently stand the chance of a vaccine for Covid-19 may be 12 to 18 months away. Currently, the recommendations from the World Health Organization to help reduce the spread and ‘flatten the curve’ include: Wash your hands frequently Maintain Social distancing Avoid touching, eyes, [...]
I’ve been sifting through the concussion and whiplash evidence for a good 4-5 months now and quite frankly it is complex. I understand the challenges the evidence demonstrates in determining the diagnostic nuances between each. For example, there are many symptoms that overlap between concussion and whiplash (Elkin, Elliott, & Siegmund, 2016; Rebbeck, Evans, & [...]
People in pain often describe how much their pain hurts, often displaying its level of intensity through facial expression and tone of voice. The word 'intensity' is defined as 'the quality of being intense' Another definition refers to intensity as: 'extreme depth of feeling' Quality refers to the words to describe the characteristics and feeling [...]
I’ve just spent the last two days in Auckland CBD at the bi-annual Brainstorm conference. A conference specifically focused on all things concussion. So, I thought I would give a quick rundown of my highlights. I think the biggest thing that confirmed my thinking was the huge parallels between pain management and persistent post concussion syndrome [...]
Usual care physiotherapy for chronic musculoskeletal pain, does anyone still do that? I recently read a single – blinded randomized controlled trial article (Domingues et al., 2019) discussing the effectiveness of combined Manual Therapy with Exercise compared to “usual care” physiotherapy for the treatment of chronic non-specific neck pain (CNSNP). The first cynical thought that [...]
The lord of the rings has to be one of my all time favourite movies. One of the most interesting characters in the movie is Gollum. People familiar with the movie will know the story of how Gollum came to be. Before the ring of Sauron poisoned his mind he was known as the hobbit [...]
We can use ACT? A psychological therapy?? But that’s stepping outside my professional boundary, I couldn’t possibly… Ok, back up! I can’t speak for Occupational Therapists (OTs) but Physiotherapists (PTs), really?? Are you honestly saying you’re crossing a line? Let’s take a wee trip down my memory lane shall we. On my journey with [...]
'Oh, I've been shaking I love it when you go crazy You take all my inhibitions Creativity, there's nothing holding me back You take me places that tear up my reputation Manipulate my decisions Creativity, there's nothing holding me back There's nothing holding me back There's nothing holding me back' Adapted from Shawn Mendes, [...]
“Heroes are made by the path they choose, not the powers they are graced with.” –Brodi Ashton / Iron Man(Attribution) Superheroes have fueled the imagination and inspired us. We are currently in the cinematic age and renaissance of superheroes. Since 2008, when the first Iron Man movie was released, Marvel have released no less than [...]
I have been a bit of a runner for most of my life. Where I grew up in the Highlands of Scotland there was plenty of cross country running tracks to be explored. Of course that was mixed in with mountain biking, fly fishing, kayaking, sailing, football, hiking, rock-climbing… you get the picture. I have [...]
I’ve pondered for quite some time if we can efficiently tailor exercise programs for people living with pain. Recent evidence (Hodges, 2019)and a consensus amongst peers, suggest that a hybrid approach to pain management programs is necessary. As proposed by Hodges, (2019) this would include stratification, identification of pain mechanism and subgrouping based on movement and/or psychology. The multidimensional [...]
I saw this video and just had to share it to metaphorically emphasise the power of touch. There are some in the physiotherapy profession that bang on about how pointless manual therapy is, and whilst the evidence base confirms that we are unlikely doing anything mechanically (i.e. resetting joints, correcting leg length discrepancies, increasing tissue [...]
I'm a bit of a runner, always have been. Nothing overly competitive but participated because of the health benefits. So, whilst exercise has physiological effects on the body there is also another side to running that interests me, the philosophy. More specifcally the sense of freedom, the adventure and the opportunity to reflect and consolidate my [...]
Persistent pain is certainly a complex beast and if we are to discuss particular body regions, low back pain would have to be the kraken* of all musculoskeletal disorders. In 2018 it was still the number one cause of disability globally and has dominated the number one spot spanning nearly 3 decades (James et al., [...]
I've decided to share a story about someone that had a wonderful outcome from engaging in a pain program. The story takes you on a rollercoaster ride of physical and emotional experiences. I agreed to share it because the story identifies areas in our current practice that have created misconceptions about pain and what to do [...]
Complex Regional Pain Syndrome is a tricky condition. It’s a challenging pain condition for clinicians and can be a crippling pain condition for people living with it. The condition presents as a diverse set of signs and symptoms including inflammatory, sensory/motor, autonomic abnormalities and pain. Most commonly, CRPS tends to present following an injury directly [...]
I'm always on the hunt for new information on why physiotherapists should broaden their perspectives through 1) how we connect with people and 2) in what ways we connect with them. Connectivity is an emerging concept in physiotherapy. Several papers have been published discussing and arguing the broader view of the connections people make between ‘one’s [...]
I recently carried the torch for the PhysioCPDRevolution by presenting some of my own musings and readings about what might be a direction for physiotherapy. Below is a slightly adapted version of the transcript I presented. The presentation was recorded on Facebook Live (here). The PhysioCPDRevolution was also a year old and so I [...]
