Principles of treatment 1

  • Morten Hoegh

    Aalborg University, SMI, Owner, FysioDanmark Aarhus, Denmark
  • Peter O'Sullivan

    Professor, School of Physiotherapy and Exercise Science, Curtin University and Specialist Musculoskeletal Physiotherapist, Australia
  • Rob Smeets

    Professor in Rehabilitation Medicine at Maastricht University & Physiatrist at CIR Rehabilitation location Eindhoven, The Netherlands

Chair: Morten Høgh, Denmark
Morten Høgh, Denmark
Physiotherapists have a long tradition of explaining pain with their extensive knowledge about anatomy and biomechanics. However, today neuroscience is the most used approach across disciplines to study the relationship between the tissues of our body (including the brain) and our perception of pain.

This module will dedicate three sessions to provide a principle overview of the nociceptive system
and its most commonly studied modulations (sensitization and descending inhibition/facilitation). The overall aim of the three sessions is to provide physiotherapists with little or no background or training in basic science and/or neuroscience with a narrative approach to understanding the science behind nociception, sensitization and descending modulation.
Myths about back pain
Peter O'Sullivan, Australia
Making sense of back pain
Peter O'Sullivan, Australia
Physical activity and exercise for chronic pain in adults
Rob Smeets, Netherlands
Chronic pain remains a challenging issue for clinicians. Over the past decades, scientific understanding of chronic pain has increased substantially. It has now become clear that chronic pain represents a biopsychosocial problem, with maladaptive changes in the central nervous system, musculoskeletal system and at the cognitive level. Exercise interventions are commonly recommended and used for the management of individuals with chronic pain conditions. Exercise is an effective treatment for various chronic pain disorders. Although the clinical benefits of exercise therapy in these populations are well established (i.e. evidence based), clinicians struggle applying science in daily physical therapy practice and patients with central sensitization often experience a malfunctioning of the exercise induced hypoalgesia, causing increase of pain during exercise.

At the cognitive level, pain catastrophizing and fear-avoidance beliefs are often present in chronic pain patients, and can be addressed by applying cognitive exercise therapy (e.g. graded activity and exposure in vivo). Fear-avoidance beliefs, both in patients and treating physical therapists, have a negative impact on chronic pain outcomes as they delay recovery and increase disability. Such maladaptive cognitive factors are typically addressed in comprehensive exercise therapy programs that include not only exercise but also pain neuroscience education, motivational interviewing, graded activity, exposure in vivo, acceptance and commitment therapy. In this lecture a brief overview of important aspects of assessment, introducing exercise, selection of these treatments and how to increase load of exercise will be provided.

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