The third annual San Diego Pain Summit was dedicated to helping physical and manual therapists apply pain science into clinical practice. The Summit was an entire week of workshops that included two days of conference presentations. As with the prior two years, the 2017 Summit included multiple opportunities to network and socialize.
For those interested but unable to attend, videos of presentations are available. Video purchases help to ensure that a SDPS 2018 will be held and to secure the venue.
Pre-Summit
Wow!! 7 More Days!!!! Follow along at #sdpain. Begins Feb. 7th. Don't get jealous if folks start tweeting pics of themselves wearing shorts.
RT @MassageFitMag: Rounding shoulder is likely adaptation to pain, not a cause. #sdpain #physiotherapy #physicaltherapy #fitness
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See this view? This is Mission Beach- 1 mile from the 2017 #sdpain Summit conference venue. Register:… https://t.co/Rsr3zJP5Gj
RT @MassageFitMag: #science should be used as guide to answer & produce more questions, esp for those suffering from pain #sdpain ...
@Farmer_MindBody While you're here in SD for the 2017 #sdpain Summit you can walk over to Pacific Beach to watch th… https://t.co/vYnJTA4Qa2
RT @MassageFitMag: Rounded shoulders likely adaptation to minimize/avoid pain, not a causation #physicaltherapy #sdpain #massage
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Hunting for trigger points w/ palpation is unreliable, #research finds. #physicaltherapy #physiotherapy #sdpain
https://t.co/7uVzas4TVG
1994 study w/ 610 older women found no association between kyphosis & back pain, #disability, poorer #health #sdpain
https://t.co/7kxoqgNJgH
LOL #sdpain @SanDiegoSummit @bsaragiotto https://t.co/42Mourv4kj
Pain science and education... 😂 https://t.co/XQ9aFpFAO8
"We want people to understand that the back isn't vulnerable" #sdpain #physio
#physicaltherapy #fitness https://t.co/4qsC466ZYz
"We want people to understand that the back isn't vulnerable" There you are now @MaryOKeeffe007 in @thecsp Frontlin… https://t.co/unA4kVWlfV
Has anyone studied PTSD and persistent pain? I've often thought they sound like similar processes...#pelvicmafia #sdpain #GetPT1st
So close to the 2017 Summit! By the 7th your feed will be filled w/ #sdpain tweets about shorts, sunshine, #painscience, & craft beer!
Oh no! Rain predicted for Monday! Whose the one bringing the rain with them to #sdpain? No cupcakes for you!! ;)
Woo Hoo! 2017 #sdpain Summit is ON next week! Learn the La Jolla clap before you get here: https://t.co/SfIgA8EJx1 https://t.co/IYt863vd6f
2017 #sdpain Summit special guest Dr. Beth Darnall @BethDarnall interview w/Dr. Karen Litzy @karenlitzyNYC Listen:… https://t.co/My6i9nWlpA
Don't forget! Follow #sdpain for the latest and up to date Summit happenings! First workshop starts tomorrow- conference on Feb. 10 & 11.
@dfjpt @CorKinetic @2reyallen & #sdpain MC Jason Erickson getting ready for the Summit week. https://t.co/9vzfuxNf33
Getting ready for @CorKinetic workshop at @SanDiegoSummit tmw! #sdpain https://t.co/OZENkXwgXV
| Tuesday | to Top |
Follow the 2017 San Diego Pain Summit - #sdpain
First day of the week-long Summit, follow along at #sdpain.
Diagnosis + classif of pelvic girdle pain disorders. Illustration of the utility of a classification system… https://t.co/Lf477nAJBW
Please find complimentary access to this months articles https://t.co/PYxvp742ry… #sdpain @SanDiegoSummit https://t.co/9InMkozdal
Enhance placebo, avoid nocebo: How contextual factors affect PT outcomes
https://t.co/U4aQoZMJvl Maybe of interest… https://t.co/KdpukTPcYW
#SDpain summit 2017 Keynote speaker 2B recorded! Get 2 video packages- Live Stream (approved for CE's for... https://t.co/c5XYN2WuSx
Click to register for #SDpain summit! Registration closes tomorrow! https://t.co/NS9Q1XGnC8
SD Pain Summit 2017! #sdpain
Kicking off the #sdpain Summit with Ben Cormack's workshop: Functional Therapeutic Movement. Follow along on... https://t.co/1BksEOvyME
"Restore movement happiness" Great goal for our clients who are paralyzed by pain! #SDPAIN
Missing out on the #sdpain Summit? Today is the last day to register for the 2 days of presentations on Feb. 10 &... https://t.co/AVDYSyCzbb
Altering the constraints for a constraints-based approach to exercise @CorKinetic #sdpain
Discussing many options to modify external constraints to fit the human in pain #sdpain https://t.co/JFX55g8OiA
Our 3 words for @CorKinetic: Worth learning from. What's yours? #sdpain #fitness
#Pilates better than cycling at 6 wks for LBP but not 6 mos. #fitness #sdpain @CorKinetic
https://t.co/wNLznZ0aoO
#Pilates better than stationary cycling at 6 wks for low #backpain but not 6 months. #sdpain https://t.co/PLbAJCjmb6
#Pilates better than cycling at 6 wks for LBP but not 6 mos. #fitness #sdpain @CorKinetic
https://t.co/wNLznZ0aoO
Systematic reviews aren't gold standard of evidence. Shitty data = shitty results. #garbageingarbageout #sdpain @CorKinetic
Systematic reviews aren't gold standard of evidence. Shitty data = shitty results. #physiotherapy #sdpain https://t.co/9mIIO2lwBf
Systematic reviews aren't gold standard of evidence. Shitty data = shitty results. #garbageingarbageout #sdpain @CorKinetic
Keynote speaker for #sdpain just arrived in USA! Please welcome @PeteOSullivanPT! @SanDiegoSummit @CorKinetic… https://t.co/mK8aIvQRuh
Wow 😳 thx Mary - just arrived in USA 🇺🇸 they let me in!! https://t.co/kLnV45Z5Y8
@PeteOSullivanPT Enjoy #sdpain Pete! Would have liked to say hi again. So many welcoming and wonderful people.
Photos taken this morning by 2017 #sdpain Summit attendee Julie Tudor. https://t.co/eYXjwEPcZB
| Wednesday | to Top |
Listening & empathizing patients' problem can be more effective than your favorite treatment. #physiotherapy #sdpain @CorKinetic
Go to the P in pain not to the Y in agony. Excellent quote from @CorKinetic when discussing exercise dosing #sdpain
Next #sdpain summit event: Peter O'Sullivan's workshop starts in a few hours. https://t.co/pI5HC9iXIO
Looking forward to Pete O'Sullivan and CFT #sdpain
@MassageFitMag Looking forward to all the #sdpain posts this week. You always do such a fab job of them Nick👍👍 #WishIWasThere
Getting ready for Peter O'Sullivans cognitive functional therapy course at #sdpain
#sdpain @PeteOSullivanPT Coming up any second now!
#sdpain @PeteOSullivanPT Sees thoroughly medicalized, profoundly disabled patients in pain.
#sdpain @PeteOSullivanPT Had the opportunity to develop this behavioural model we will examine next few days
#sdpain @PeteOSullivanPT One's ideas get tested on a daily basis doing this work
#sdpain @PeteOSullivanPT Lots of collaborators on the team.
#sdpain @PeteOSullivanPT We want to change the story on pain!
#sdpain @PeteOSullivanPT What are the causes of back and pelvic pain? List? Disc, fear, hate their boss, "bad" posture, "core" weak..
#sdpain @PeteOSullivanPT We're obsessed with fashion and posture
#sdpain @PeteOSullivanPT "injury" on the list, inflammation, genetics.. Genetics is strong factor. Behaviours around pain are learned early
#sdpain @PeteOSullivanPT We often think of inflammation and tissue damage together. You can have back pain without injury.
#sdpain @PeteOSullivanPT Not a single study to show relationship between laxity of pelvic ligaments and pain
#sdpain 30% of ED/ER visits for nontraumatic pain @PeteOSullivanPT
#sdpain @PeteOSullivanPT predictors of pelvic pain don't look any different from predictors of back pain. Sleep, stress, depression.
#sdpain @PeteOSullivanPT Children with ligament laxity/ hypermobility have no increase in MSK pain
#sdpain @PeteOSullivanPT When pain emerges in life it's during times of rapid change. Be that physiological or what have you.
#sdpain @PeteOSullivanPT Does obesity cause pain? Some evidence for that but not what you think - has more to do with metabolic process
#sdpain @PeteOSullivanPT Bottom line: It's complex!
#sdpain @PeteOSullivanPT Small influence of obesity on back pain - metabolic/inflammatory rather than physical load from weight
#sdpain @PeteOSullivanPT Risk profiling is more revealing than single factors
#sdpain @PeteOSullivanPT How do you diagnose back and pelvic pain? Diagnostic label can have (-) impact.
#sdpain @PeteOSullivanPT Belief is the strongest predictive factor on pain becoming persistent.
#sdpain @PeteOSullivanPT Greatest predictor of post-pregnancy back pain is the *belief* that it won't get better after the birth
#sdpain @PeteOSullivanPT How do you manage the problem? We are doing a terrible job actually.
#sdpain @PeteOSullivanPT Strongest predictor of developing pain after pregnancy = beliefs
#sdpain @PeteOSullivanPT We have a big industry that feeds on people's misery. Half the spinal surgery in the world is in the US.
#sdpain @PeteOSullivanPT Half of all spinal surgery on earth is performed in the USA and we have the worst outcomes
#sdpain @PeteOSullivanPT We have the view that back pain gets worse with aging. It's not true.
#sdpain @PeteOSullivanPT "Sleeping on the floor isn't an injury! No one gets hurt while sleeping!"
#sdpain @PeteOSullivanPT So he got back arthritis sleeping on the floor at a camp? This is how dumb these diagnoses are!
#sdpain @PeteOSullivanPT No evidence around mattresses and back pain. None.
#sdpain @PeteOSullivanPT "Whats the evidence with mattress types and back pain? Well there's none"
#sdpain @PeteOSullivanPT Common belief: Back pain is caused by 'injury' and 'damage'.. response is to believe the back is vulnerable
#sdpain @PeteOSullivanPT Not a single study shows that ergonomic interventions help
#sdpain @PeteOSullivanPT Studies don't support lifting with a straight back
#sdpain @PeteOSullivanPT Is it dangerous to sit slumped? No.
#sdpain @PeteOSullivanPT "Ergonomics is a billion dollar industry. What's the evidence for ergonomic interventions for back pain? None"
#sdpain @PeteOSullivanPT Put more books in the backpack, because loading backs makes them stronger and more resilient.
#sdpain @PeteOSullivanPT No evidence that core strength prevents pain
#sdpain @PeteOSullivanPT Bone health maxes at 21. We want to load kids backpacks up. I tell my kids put another book in there. And a brick.
#sdpain @PeteOSullivanPT Heaps of research/RCTs that shows that multifidus and TrA don't have anything to do with back pain
#sdpain @PeteOSullivanPT Beliefs and behaviours are REALLY hard to change. It's not simple. Sometimes mindset is flexible, sometimes rigid
#sdpain @PeteOSullivanPT There are no rules around loading in Nepal
#sdpain @PeteOSullivanPT They are not bending their knees and keeping a straight back
#sdpain @PeteOSullivanPT We all have a genetic risk for all kinds of stuff from depression to disc prolapse
#sdpain @PeteOSullivanPT So you see clusters. Times of rapid change - emergence at adolescence, physical, emotional, physiological change
#sdpain Pain typically emerges around times of rapid change (physical or social transition)
#sdpain @PeteOSullivanPT Times of vulnerability. Life stages.
#sdpain @PeteOSullivanPT If you're thinking bad stuff how does that make you feel?
#sdpain @PeteOSullivanPT Cognitive factors, emotional, social, physical lifestyle factors all influence pain. All are modifiable factors
#sdpain @PeteOSullivanPT Back pain: genetics+lifestage+cognitive+emotional+social+physical+lifestyle
#sdpain @PeteOSullivanPT You can't change structure but you can change how you think about it
#sdpain @PeteOSullivanPT Can't change structure (even a surgeon can't turn back clock) but can focus on all those other factors
#sdpain @PeteOSullivanPT Framework to understand pain; you've got to triage. One must consider the factors and how they go together
#sdpain @PeteOSullivanPT Pain emerges at about age 14 for a certain percent of the population. By age 17 20% are reporting persisting pain
#sdpain @PeteOSullivanPT Episodic spine pain starts in adolescence - how we respond sets tone for handling it the rest of their life
#sdpain @PeteOSullivanPT If back pain was something that emerged with arthritis and DJD it wouldn't be starting in adolescence
#sdpain @PeteOSullivanPT Good to catch them early or the horse is gone - prevent chronicity.
Hastag a seguir hoy es .... #sdpain
#sdpain @PeteOSullivanPT Pain across time looks a lot like the profile of asthma, with emergent flareups usually around times of stress
#sdpain @PeteOSullivanPT When you're run down, tired, fatigued
#sdpain @PeteOSullivanPT Time course of LBP resembles episodic asthma rather than discreet time frames. https://t.co/bD7XCQC44q
#sdpain @PeteOSullivanPT We separate out quickly those with a clear biomechanical compont vs ones who dev't b pain after sleeping on floor
#sdpain @PeteOSullivanPT repeated strain, awkward lifting, traumatic injury, ask what else is going on in life
#sdpain @PeteOSullivanPT screen out fractures, pathology, etc.
#sdpain @PeteOSullivanPT Very uncertain relationship between pathology and pain. Many stories of impressive pathology without back pain
#sdpain @PeteOSullivanPT degree of tissue damage does NOT correlate to amount of pain or behavioural response
#sdpain @PeteOSullivanPT Screen for redflags (ca, infection, fracture, etc.). MRI findings are common in asymptomatic people
#sdpain @PeteOSullivanPT Pathoanatomical diagnosis for LBP does not hold up. More important is what people think about their Dx
#sdpain @PeteOSullivanPT Advanced imaging well known to worsen outcomes in back pain
#sdpain @PeteOSullivanPT There is a relationship between structure and pain. But it's not very strong or consistent.
#sdpain @PeteOSullivanPT What predicts sciatic pain is presence of inflammatory mediators around nerve in epidural fat, not size of bulge
#sdpain @PeteOSullivanPT Fissures do not predict back pain
#sdpain @PeteOSullivanPT No correlation between amount of pain and how disabled you are, and the scan of how bad your "degeneration" is
#sdpain @PeteOSullivanPT Berg et al 2013, no connection between scan results and pain/disability ratings in cohort pending disk replacement
#sdpain @PeteOSullivanPT Inflammation around end plate does have a relationship to back pain. Stress factors. Mood. Visceral obesity
Follow @jasonsilvernail for #sdpain workshop w/Peter O'Sullivan updates.
#sdpain @PeteOSullivanPT Modic endplate changes and edema better correlated with pain than other factors (yes incl disk herniation)
#sdpain @PeteOSullivanPT Your perception changes your physiology
#sdpain @PeteOSullivanPT Natural history of disc prolapse is really good. People need to be told that.
#sdpain @PeteOSullivanPT Natural history very favorable for disk herniation and structure change doesn't predict outcome
#sdpain @PeteOSullivanPT All of us have experienced pain in our lives and have responded differently to it
#sdpain @PeteOSullivanPT Peter was told to get on with it (If he had pain as a child).
@PeteOSullivanPT Teaching kids to "dust it off and get on with it" sets them up for a healthy relationship with pain. #sdpain
@PeteOSullivanPT how we see our body, understand our condition etc has a huge influence on outcomes. #sdpain
#sdpain @PeteOSullivanPT Peter got over a bad wrist injury. He simply didn't accept the verdict that the wrist was stuffed. He worked.
#sdpain @PeteOSullivanPT How people see their bodies is a strong indicator of their long term trajectory
#sdpain @PeteOSullivanPT It swelled every day but after a couple years it was perfect again.
#sdpain @PeteOSullivanPT Brain will decide whether it hurts or not
@PeteOSullivanPT Pain is an output of the brain - hugely influenced by environment. #sdpain
#sdpain @PeteOSullivanPT For some reason we have increased the threat around backs. They are treated differently from wrists and ankles etc
#sdpain @PeteOSullivanPT Disconnect pain from tissue damage. They are enormously influenced by context.
#sdpain @PeteOSullivanPT People's beliefs about back pain drive their behavior - people believe the back is vulnerable.
@PeteOSullivanPT Culturally we've created fear of back pain that has a huge influence on how society experience back pain #sdpain
#sdpain @PeteOSullivanPT Nociceptive pain is protective. Next stage is inflammatory.. it's necessary for healing. 2 years later, not so much
@PeteOSullivanPT Acute pain is good because it allows us to recover and heal. Environment influences level of inflammation #stress #sdpain
#sdpain @PeteOSullivanPT Story and video about the iatrogenic consequences of how medicalizing pain disables people. What we say matters!
@PeteOSullivanPT Normal acute injury augmented by poor information "your pelvis is out" can end up with horrendous outcomes. #FFS #sdpain
@jasonsilvernail is live tweeting @PeteOSullivanPT from #sdpain summit - worth your time to follow! https://t.co/F0ohlnvMn6
#sdpain @PeteOSullivanPT Back pain: genetics+lifestage+cognitive+emotional+social+physical+lifestyle
#sdpain @PeteOSullivanPT Headache causes? tired, stress, etc. Risk factors for headache are same as for back pain. Sensitivities fluctuate
#sdpain @PeteOSullivanPT Systems will sensitize through changes in your processing.
CNS fluctuates regularly with mood, energy, sleep, stress - all strong predictors for pain development #sdpain #SanDiegoPainSummit
#sdpain @PeteOSullivanPT System sensitizes more around vital organs and midline
#sdpain @PeteOSullivanPT Emerging research on systemic inflammation and gut health worth following in its relationship to pain
#sdpain @PeteOSullivanPT Sensitized systems perceive non-noxious input as nociceptive
#sdpain @PeteOSullivanPT When a system is really sensitive EVERYTHING hurts
#sdpain @PeteOSullivanPT Sensitization is a widespread phenomenon that's highly context-dependent.
@PeteOSullivanPT When the system is really sensitive - everything hurts and other systems can be dysfunctional eg. irritable bowel #sdpain
#sdpain @PeteOSullivanPT Spectrums of back pain: If it's a clear pain that changes with posture and loading, they aren't usually depressed
#sdpain @PeteOSullivanPT Difficult to localize? there will be central drivers involved
#sdpain @PeteOSullivanPT Persistent back pain will be way less linked to mechanical factors
#sdpain @PeteOSullivanPT Often they're mixed though.
#sdpain @PeteOSullivanPT Body chart portion of your intake form very helpful to give clues to sensitization
#sdpain @PeteOSullivanPT Pressure pain threshold is a good indicator of centralized systemic sensitization
@PeteOSullivanPT widespread pain locations far more likely to have central mechanisms + anxiety/catastrophising… https://t.co/1w8auSkrXw
#sdpain @PeteOSullivanPT If they are sensitive to touch they'll usually be sensitive to movement
#sdpain @PeteOSullivanPT Looking at threatening vs. non threatening images.. just looking at threat or thought of threat can trigger pain
#sdpain @PeteOSullivanPT A thought can prime the system to activate neural networks.
#sdpain @PeteOSullivanPT Changes in brain are more predictive of pain than MRIs of structure
#sdpain @PeteOSullivanPT Signs of nervous system sensitization much more important than MRI findings in predicting pain and disability
#sdpain @PeteOSullivanPT Drawing out image perception of the body part is useful. Can decrease pain by changing the visualization
If there is a disconnect between the real and virtual body (imagined) it is highly predictive of pain - brain views it as a danger #sdpain
#sdpain @PeteOSullivanPT disconnection between body parts, thinking things are "out of place" R linked 2 increased stress&pain
#sdpain @PeteOSullivanPT Discrepancies between real and virtual body may help drive pain experiences
#sdpain @PeteOSullivanPT People look for explanations and meaning for their pain, construct explanations that drive their behavior...
#sdpain @PeteOSullivanPT ...we can help that or hurt that with medical care. We need to help make sense of pain
#sdpain @PeteOSullivanPT Beliefs are influenced by culture, social messages and context, and previous experiences. Helps predict behavior
#sdpain @PeteOSullivanPT Negative beliefs about back pain, fear of movement, and decreased self efficacy are predictive of disability.
#sdpain @PeteOSullivanPT Neg. beliefs, fear of mvmt, and decreased self-efficacy are predictive of long term disability.
@PeteOSullivanPT Catastrophising + fear of movement + low self efficacy = poor predictors of outcomes #sdpain
#sdpain @PeteOSullivanPT A lot of these noceboic inputs come from us. Practitioners.
Negative beliefs, fear of movement, decreased self efficacy - all predictive of disability #sdpain
#sdpain @PeteOSullivanPT One's beliefs are fueled by one's values. If you value health and movement, you won't be as susceptible
@PeteOSullivanPT --> Negative illness information - largely comes from healthcare professionals. Not deliberate - just not helpful #sdpain
#sdpain @PeteOSullivanPT Don't dish rubbish out to people
#sdpain @PeteOSullivanPT "He's a really empathetic doctor but he's dishing out rubbish" Discussing iatrogenic injury in medicine.
#sdpain @PeteOSullivanPT Don't hand out mixed messages. Nothing wrong with being strong, but don't link it to protecting a vulnerable disc
#sdpain @PeteOSullivanPT We have to learn to disconfirm strong beliefs by identifying small discrepancies in their own story
How we work to combat a pt's incorrect beliefs is a delicate affair - can backfire. Need to help them disconfirm beliefs themselves. #sdpain
#sdpain @PeteOSullivanPT Discusses reflection technique and motivational interviewing concepts to help patients change beliefs
Primary care is where we need to make sure the right interventions are delivered. Secondary care is too late. #reassurance #sdpain
#sdpain @PeteOSullivanPT It's all about primary care - once it gets to secondary care the horse is out of the barn.
#sdpain @PeteOSullivanPT Audiotape yourself talking to patients and find out what sort of messages you are actually giving people.
#sdpain @PeteOSullivanPT Best way to change your patient education process is to record yourself talking to patients and hear what you say
Instability = 'liable to pop out - not a lot you can do" --> reduced locus of control --> poor outcomes. #sdpain #watchyourlanguage
#sdpain @PeteOSullivanPT Validation is really important. Validate the pain but disconnect the beliefs.
Validate the pain but disconnect the ideas/images from the pain. Helps them to change behaviour #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Language that's harmful is language that creates fear, too much focus on structure, belief that pain = harm..
#sdpain @PeteOSullivanPT When listening to patients in pain, "Validate the experience but disconnect experience to the belief."
Harms of language - too much focus on structure, negative language and beliefs, body symmetry #sdpain #stopit
#sdpain @PeteOSullivanPT Talk up variability of movement. Do that movement in a different way.
#sdpain @PeteOSullivanPT Language harms - we are so judgmental of the body and these judgments drive unhelpful beliefs in patients
#sdpain @PeteOSullivanPT People in pain often lose variabilty. Which is not healthy.
#sdpain @PeteOSullivanPT "The perfect posture is the one that changes frequently"
#sdpain @PeteOSullivanPT People in pain lose movement variability. They take these same awkward stiff movements into everything they do
#sdpain @PeteOSullivanPT People feel really vulnerable about sleeping because they don't have as much control over positions.
Hey, I think that I co-wrote an article about that once ;) https://t.co/9AwEqUDvxb #sdpain https://t.co/jDAahHXFM6
Sleeping can be a really threatening experience for pain - no conscious control so people can end up really tense and rigid #sdpain
#sdpain @PeteOSullivanPT catastrophizing is fixation on pain, magnification of threat, adopting a helpless outlook
#sdpain @PeteOSullivanPT Pain catastrophizing linked to fixation on pain, magnification of threat value and adoption of a helpless outlook
#sdpain @PeteOSullivanPT catastrophizing is a failure of the health system not of the individual
#sdpain @PeteOSullivanPT Pain catastrophizing usually driven by medical care - it's our (medicine's) fault, not the patient's!
#sdpain @PeteOSullivanPT "I can't stop thinking about my pain" is linked to hyper vigilance, and worry
#sdpain @PeteOSullivanPT Building self-efficacy is handing them back control over their health. Don't encourage dependency
"People with low self efficacy are the people I am reluctant to do any hands on therapy with" @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT People with low self efficacy I'm very reluctant to do manual therapy with - need to build their abilities instead
#sdpain @PeteOSullivanPT Re: emotional responses to pain, talk to the observation. "You look rundown.. how's it going for you?"
Talk to the observation - an easy way to reflectively listen - i notice you.... It looks like you...... #sdpain
#sdpain @PeteOSullivanPT Don't stick it into the psychological basket. Emotion is normal, emotional response is normal.
"what are you thinking when you get that pain" Trying to elicit thoughts and images give a good idea - fear of harm or fear of pain? #sdpain
Avoidance as a strategy to control pain is a slippery slope to a sad life. @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT If you use avoidance as a strategy to control pain, you lose your normal life
#sdpain @PeteOSullivanPT Using avoidance to control pain is OK shortterm but longterm leads to worry and fear and depression.
#sdpain @PeteOSullivanPT Find out what their worries are. If they R an anxious person generally, they'll probably have harder time with pain
#sdpain @PeteOSullivanPT Look for indications you need to work with a psychologist on generalized mood disorders apart from just back pain
#sdpain @PeteOSullivanPT Don't stigmatize. "That's common" Let them cry if they need to. Keep tissues around. Be comfortable re: emotion
Anxiety -> nervous system excitement -> increased sensitivity -> pain -> more anxiety = risks for chronic cycles of pain #sdpain
#sdpain @PeteOSullivanPT Re: low mood, get people back to the things they love and that will lift mood.
Get people back to the things they love - helps with identity. #sdpain
Pain increases if identity is lost. Getting ppl back to what they <3 to do is one key. #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT "We spend too much time treating sx & not returning people to things they love."
#sdpain @PeteOSullivanPT Coping styles of avoiding or overdoing are both unhelpful
#sdpain @PeteOSullivanPT "Have you avoided anything because of your pain?" You'll often see patterns of avoidance based on fear
#sdpain @PeteOSullivanPT Fear and pain influence physiology and each other.
#sdpain @PeteOSullivanPT E.g., Sit stand test, you can see fear in the behaviours. Exposure training is so important.
#sdpain @PeteOSullivanPT "Fear has the habit of feeding the very thing we're frightened of."
#sdpain @PeteOSullivanPT Key thing is therapist's confidence. YOU have to really believe movement won't damage the patient
"Chronic pain is not the fault of the person but a failure of the #healthcare system and culture." ~ @PeteOSullivanPT #sdpain Via @2reyallen
#sdpain @PeteOSullivanPT Exposure training to a threatening task.
#sdpain @PeteOSullivanPT The biggest obstacle we have is getting people to start doing things they are afraid of - but it's critical.
#sdpain @PeteOSullivanPT Anticipation of pain and guarding strategies are often part of why some movements remain painful
It's much easier to get pain "treated" than dealing w/ the root of pain, such as emotional & environmental factors. @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Differing psychologically-derived clusters in people with CLBP R associated with diff multidimensional profiles
#sdpain @PeteOSullivanPT Return to work is massively important for wellbeing
#sdpain @PeteOSullivanPT Health system feeds disability through its incentives and complexity. Malingering is actually quite rare
#sdpain @PeteOSullivanPT The only reason you rest is a broken bone with a bone sticking out.. that's pretty much it
Hearing all the awesome things going on at the 2017 #sdpain Summit? You don't even have to miss out on Peter... https://t.co/MmtHARJTDQ
#sdpain @PeteOSullivanPT We should be teaching healthy ways to respond to pain and injury in school health classes
@PeteOSullivanPT #sdpain https://t.co/TFsT5ci7kG
#sdpain @PeteOSullivanPT We should use screening tools all the time. But nothing beats a good interview and clinical examination
#sdpain @PeteOSullivanPT Patients don't necessarily expect that a PT will be interested in how people feel and think
#sdpain @PeteOSullivanPT People think going to a PT is about posture and muscles, not how you feel or what you think. But it needs to be
#sdpain @PeteOSullivanPT If you are not interested in the full spectrum of human being you should get a different job.
#sdpain @PeteOSullivanPT Become comfortable with emotional human expression.
#sdpain @PeteOSullivanPT If you don't want to know or care about how people feel, go ahead and find another job. Rehab is about that too
Higher disability/stress --> higher the intensity of low back pain, like pain sensitivity. #sdpain @PeteOSullivanPT https://t.co/VB1lwpa95b
#sdpain @PeteOSullivanPT You can't separate cognitive beliefs and factors from physical health and performance
Higher disability/stress --> higher the intensity of low back pain, like pain sensitivity. #sdpain @PeteOSullivanPT… https://t.co/e6BStUKyBV
Higher disability/stress --> higher the intensity of low back pain, like pain sensitivity. #sdpain @PeteOSullivanPT https://t.co/VB1lwpa95b
#sdpain @PeteOSullivanPT SOCIAL FACTORS: Relationships with sig oth very important. bullying, workmates.. can be obstacles to resolution
#sdpain @PeteOSullivanPT Social factors are important. Relationships especially with main partner and work colleagues very influential.
Relationship w/ significant other is vital to your degree of chronic low back pain. How u treat each other matters #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Socio ec status, financial, work, seeking comp, poor family function, life stress events
#sdpain @PeteOSullivanPT Ask them if they feel these factors are influencing their stress. If so how. What strategies do they have.
#sdpain @PeteOSullivanPT Explain the connection between stress and pain. Help by exploring options with them
#sdpain @PeteOSullivanPT Off-loading so important. Building structures around stress management
Be w/ those who bring out the best in you, not the stress in you. #sdpain
Yes! Abusive relationships or having an overprotection sig other can contribute to chronic low back pain. #sdpain https://t.co/jKKAG21OPU
Be w/ those who bring out the best in you, not the stress in you. #sdpain
#sdpain @PeteOSullivanPT Have referral criteria for psychology just as you would for the emergency room...
#sdpain @PeteOSullivanPT ...suicidal ideation, panic attacks, major social stressors among others.
Cortisol levels in response to stress predict musculoskeletal pain: low response leads to increased inflammation response & pain #sdpain
Retweeted J Silvernail DPT,DSc (@jasonsilvernail):
#sdpain @PeteOSullivanPT Negative beliefs about back pain,... https://t.co/BFoeS97WTq
Psychosocial factors can affect specific hormones, such as HPD, that can affect severity of MS pain #sdpain
https://t.co/1dvxtPUNWj
Psychosocial factors can affect specific hormones, such as HPD, that can affect severity of MS pain #sdpain… https://t.co/A246wazFa3
Psychosocial factors can affect specific hormones, such as HPD, that can affect severity of MS pain #sdpain
https://t.co/1dvxtPUNWj
Some excellent #PainScience nuggets coming from @SanDiegoSummit at the mo if you follow #sdpain & for the next week. Thnx to all Tweeters👍👍
#sdpain @PeteOSullivanPT Dealing with people on opioid meds...
#sdpain @PeteOSullivanPT Dealing with people on opioid meds... work hard to get them off them.
#sdpain @PeteOSullivanPT The goal is to return to normal homeostasis. Need to deal on multiple fronts.
#sdpain @PeteOSullivanPT Beliefs, cognitions, behaviours, responses.
#sdpain @PeteOSullivanPT Most of it is industry driven
#sdpain @PeteOSullivanPT Significant early life trauma, such as sexual abuse, system is massively primed to be sensitive
Back pain is never a single cause: bone/tendon/muscle health, circulating cytokines, lower pain thresholds, etc. #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Distress, pain, and behavioral responses. Sleep deprivation and sleep cycle disruption are important also
#sdpain @PeteOSullivanPT If you can get sleep regulated, way easier to get the system to calm down
Getting sleep regulated can be a major help to resetting a sensitised system @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT If you can get sleep improved you can do a great deal to reduce pain sensitization
#sdpain @PeteOSullivanPT Strong association between MS and non-MS pain symptoms. Strong beliefs in PTs re: physical factors
#sdpain @PeteOSullivanPT Large numbers of pain areas highly correlated to large numbers of generalized non-MSK symptoms
#sdpain @PeteOSullivanPT There are extrinsic physical factors (e.g., how much you need to lift, how often etc.), and intrinsic ones, which
#sdpain @PeteOSullivanPT ..are how the body responds to pain
#sdpain @PeteOSullivanPT Relationship of physical factors to pain: data are very different than clinician beliefs!
#sdpain @PeteOSullivanPT Movement becoming slower and stiffer, abdomen pressurized - everything is recruited. Usually only need to do that..
Without pain, we see a large variety of movement; with pain, much more limited movement options and speed #sdpain
#sdpain @PeteOSullivanPT with a massive effort. If you're like that all the time, consequences will be biomechanical. Too much load.
#sdpain @PeteOSullivanPT Like having your fists clenched all day.
#sdpain @PeteOSullivanPT Most common feature of those in pain
- inability to relax. Stiffer, slower, less varied movement.
#sdpain @PeteOSullivanPT If patient says they feel weak, loaded, tight, stiff, they probably need to move.
#sdpain @PeteOSullivanPT A lot of the timing of TrA contraction studies have never been replicated.
#sdpain @PeteOSullivanPT Re: multifidous, muscle that is co-contracted all the time can also degenerate
#sdpain @PeteOSullivanPT Discussing how misinterpreted research and cultural ideas about fitness started&sustained the core stability idea
#sdpain @PeteOSullivanPT You can get people to be hyper-vigilant by getting people to contract specific muscles and make them worse
A strong association between non-musculoskeletal symptoms and musculoskeletal pain symptoms #sdpain… https://t.co/nJarpK1o8B
"The brain thinks of movement, load, function...well, fun, actually. Not single muscles." #sdpain @PeteOSullivanPT
A strong association between non-musculoskeletal symptoms and musculoskeletal pain symptoms #sdpain… https://t.co/fIt1nZG3dp
A strong association between non-musculoskeletal symptoms and musculoskeletal pain symptoms #sdpain… https://t.co/nJarpK1o8B
#sdpain @PeteOSullivanPT "We got rid of our real time U/S machine b/c it kept us focused on the muscle and not the person."
#sdpain @PeteOSullivanPT Best to deal with people and their lives, not specific muscles. Not about muscles, it's about complex synergy.
#sdpain @PeteOSullivanPT How long did it take to learn to write with a pencil? No one ever talked about specific muscles.
#sdpain @PeteOSullivanPT Writing and any motor skill is learned through layering of sequences
#sdpain @PeteOSullivanPT complex motor tasks are something we learn naturally - we don't learn them splitting them into muscle contractions
#sdpain @PeteOSullivanPT Important to be in tune with your own body, to model, demonstrate for patient.
#sdpain @PeteOSullivanPT Be in tune with your own body to coach others. "I can't do backflips, but I'm not teaching that!"
People's perception of their body is often really inaccurate. Using a mirror to demonstrate postural tension can help. #sdpain
People's perception of their body is often really inaccurate. Using a mirror to demonstrate postural tension can h… https://t.co/TrTq1lRChD
People's perception of their body is often really inaccurate. Using a mirror to demonstrate postural tension can help. #sdpain
#sdpain @PeteOSullivanPT Nothing wrong with doing planks and being strong. But if you're doing it all the time it's unhealthy
#sdpain @PeteOSullivanPT Push ups, planks and core work is great but not if you are walking around doing it all day
#sdpain @PeteOSullivanPT No difference between types of exercise. Improvement comes when beliefs change.
"Being strong and doing push-ups, squats and core is good, but I don't think that walking around all the time like that is good" #sdpain
#sdpain @PeteOSullivanPT You can deliver an intervention with an empowering message and it can be effective even if intervention is average
#sdpain @PeteOSullivanPT Has changed his assessment of even his own previous research in light of changing evidence and larger context
Reading #sdpain tweets @PeteOSullivanPT talk making me look 4ward as always 2workshop in London in June!
Biggest… https://t.co/wx7kyY5nUP
#sdpain @PeteOSullivanPT great when patients who have failed come back - self reflection for practitioner #movewiththetimes
Follow #sdpain for some fantastic info coming from the Sandiego pain summit over the next few days👍 https://t.co/z8DcGxLctK
#sdpain @PeteOSullivanPT If you can get sleep improved you can do a great deal to reduce pain sensitization
#sdpain @PeteOSullivanPT He hasn't been able to get media outlets to publicize papers that conflict with cultural ideas about pain
#sdpain @PeteOSullivanPT Not all rowers get back pain. Clearly a vulnerable and a non-vulnerable group.
#sdpain @PeteOSullivanPT Physical factors: training load is a factor, especially rapid increases. But not universally.
#sdpain @PeteOSullivanPT Is back pain associated with slump sitting? Whole bunch of things were associated but mostly being male
#sdpain @PeteOSullivanPT Just slump sitting on its own was not a predictor.
#sdpain @PeteOSullivanPT Physical factors:
Slumped posture and back pain: no, but mental health, self-efficacy, and low activity level
#sdpain @PeteOSullivanPT Strongest predictor was mental health.
#sdpain @PeteOSullivanPT Strongest predictor of adolescent back pain: poor mental health
#sdpain @PeteOSullivanPT Being female with back pain at 14 was the strongest predictor of having disabling back pain at 17.
Muscle relaxation when bending forwards is normal response; in pain, the loss of relaxation is the most common MSK finding #sdpain
#sdpain @PeteOSullivanPT Absence of flexion relaxation of back muscles during forward back flexion was a strong predictor of back pain.
@PeteOSullivanPT #sdpain most common aberrant EMG finding in CLBP is loss of relaxation of the LxES during flexion
#sdpain @PeteOSullivanPT Most common EMG difference in those w/ LBP compared to healthy controls is absence of flexion-relaxation response.
People tend to co-contract in the direction they hurt - not great in a sensitised system - adds to physical load #sdpain @PeteOSullivanPT
If the system is sensitive to load, muscle co-contraction during activities (core contraction) may produce pain #sdpain
#sdpain @PeteOSullivanPT Kids and school bags: perceptions of fatigue and heaviness associated with pain. Not the load. The perception.
#sdpain @PeteOSullivanPT Greater associations between perceptions of fatigue and bag heaviness than actual weight of school bag
#sdpain @PeteOSullivanPT Peak bone health is age 21. Load them up as much as possible before 21.
#sdpain @PeteOSullivanPT Physical activity while carrying a school bag was protective against back pain. Load up kids and make 'em walk!
#sdpain @PeteOSullivanPT Teach kids to be strong and resilient - walk or ride to school with backpack - load those bones while young!
@JonFass dumb question but what do you mean by #sdpain ???
#sdpain @PeteOSullivanPT Some practical exercises on how co-contraction of core reduces mobility and increases load https://t.co/Xftm4UtO5k
#sdpain @PeteOSullivanPT Reviewing biomechanics of lifting - no clear benefit to diff lifting methods in terms of load/shear. Kingma 2010
#sdpain @PeteOSullivanPT If back pain was all about lifting and biomechanics it would be figured out by now. But it isn't and hasn't.
#sdpain @PeteOSullivanPT Relaxed core better for lifting for most all life and work tasks. Only extremely heavy loads might change that
Bending at back, knees or hips: none were superior in spine shear, flexion or compressive forces at 15kg loads #sdpain
#sdpain @PeteOSullivanPT Reviewing biomechanical lifting data. @GregLehman "it's always the biomechanics that challenges the biomechanics"
No need to stiffen ur abs to lift in daily activities. But stiff abs are needed for heavy-ass squats or deadlifts. #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Flexed lifting is the easiest, permits the most lifting
#sdpain @PeteOSullivanPT Lifting from a flexed position - back muscles work more efficiently. Lifting in lordosis increases work/load
#sdpain @PeteOSullivanPT Not one study in vivo has shown that discs bulge in flexed lifting
#sdpain @PeteOSullivanPT "Not one single study in vivo to show a lot of these biomechanics rules. It's all sensors in dead tissues"
#sdpain @PeteOSullivanPT Lifting w/ flexed lumbar posture is more efficient for lumbar musculature than lordotic posture. Holder 2013
#sdpain @PeteOSullivanPT So much resistance against publishing studies that refute "common knowledge" and longstanding beliefs.
Backfire effect can impede personal progress & growth. It's ok to let go of old beliefs and examine new ones.… https://t.co/4VQ7n23gXF
#sdpain @PeteOSullivanPT So much resistance against publishing studies that refute "common knowledge" and longstanding beliefs.
#sdpain @PeteOSullivanPT People with CLBP tend to use double the amount of muscle activation to lift - increases load/work/force
#sdpain @PeteOSullivanPT Increased compressive load in people with back pain relative to nonpainful group. Co-contraction a problem
#sdpain @PeteOSullivanPT All that bracing and pre-contracting before lifting does is increase load on structure and make pain worse
#sdpain @PeteOSullivanPT More compression and shear in those with LBP on a lifting task - more upright/lordotic too.
#sdpain @PeteOSullivanPT Clarification: ergonomic training says one posture is better than another. However, you're going to fatigue quicker
Spine flexion more efficient in lifting than lordosis, but it's ok to lift in lordosis, depending on load & person's perception. #sdpain
#sdpain @PeteOSullivanPT ..with your back in lordosis. However lordosis might add to LBP.
#sdpain @PeteOSullivanPT Joletta @MyCuppaJo is telling her story.
You can tell the people in pain because they're the ones sitting up straight. @PeteOSullivanPT #sdpain
Obesity correlating to pain is about inflammatory loading. @PeteOSullivanPT #sdpain
There's no "best" posture for standing/sitting.Too many factors to blame posture/biomechanics as sole cause #sdpain… https://t.co/ZuP1fHKCv9
#sdpain @PeteOSullivanPT Now working with patient case: the resilient @MyCuppaJo ! https://t.co/kj7eE13OVL
22% greater chance of chronic pain if a person believes they won't get better. @PeteOSullivanPT #sdpain
There's no "best" posture for standing/sitting. Too many factors to just blame posture/biomechanics for pain… https://t.co/0P2E687F7j
There's no "best" posture for standing/sitting.Too many factors to blame posture/biomechanics as sole cause #sdpain… https://t.co/ZuP1fHKCv9
The biomedical and biomechanical industry feeds off people's misery. @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT @MyCuppaJo Now reviewing her journey of being medicalized and battle with work comp and her job
#sdpain @PeteOSullivanPT @MyCuppaJo "I felt like I had permission to let go of the postural/structural model"
#sdpain @PeteOSullivanPT @MyCuppaJo Can hear a pin drop in the room as Joletta shares her story and experiences and her challenges.
#sdpain @PeteOSullivanPT @MyCuppaJo Exploring feelings, fears, and ideas about pain and how it affects her life.
#sdpain @PeteOSullivanPT @MyCuppaJo Demo of open ended questions exploring impact of pain on life and working to find the primary concern.
#sdpain @PeteOSullivanPT @MyCuppaJo High fitness firefighters - she saw them get pain with incidental tasks rather than high load demands
| Thursday | to Top |
"Chronic pain is not the fault of the person but a failure of the healthcare system and culture" @PeteOSullivanPT… https://t.co/NEqZSwwxVL
"If you use avoidance to control your pain you will lose your life." @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT @MyCuppaJo "People get sad when they don't do the things they love."
Telling patients their back is vulnerable & need more "visits" may make their pain worse. #sdpain @PeteOSullivanPT… https://t.co/3s2wqJ3mKB
#sdpain @PeteOSullivanPT @MyCuppaJo Professor putting on a motivational interviewing clinic - use of questions, reflection
With anxiety & worry (A&W) you want the help of a psychologist. They fire up the system. Don't stigmatize A&W. @PeteOSullivanPT #sdpain
"The healthcare system only gives people w/ pain options to give up locus of control." @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT @MyCuppaJo Vigilance/Anxiety associated often with compulsively provoking pain to "check it"
#sdpain @PeteOSullivanPT @MyCuppaJo Using questions to try to find implicit beliefs about and challenge them gently
"The opiate crisis is industry driven -legalizing drug addiction." @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT @MyCuppaJo Unhelpful pain beliefs are all about social conditioning. As @BarrettDorko says, "The Culture"!!
"The brain thinks in movement and load, not individual muscles."
@PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT @MyCuppaJo Demo nicely illustrating so much of what the first day was about - unhelpful beliefs and fears important
#sdpain @PeteOSullivanPT @MyCuppaJo Doing visualization to explore virtual body and relation to pain
#sdpain @PeteOSullivanPT @MyCuppaJo Diaphragmatic breathing in her guarded position (sitting) with some tactile feedback
#sdpain @PeteOSullivanPT @MyCuppaJo
J: "I'm really good at tension"
P: "You're really good at being hard on yourself too"
#sdpain @PeteOSullivanPT @MyCuppaJo Doing some demos of her movement strategies and relating them to her painful area
#sdpain @PeteOSullivanPT @MyCuppaJo Finding portions of her movements that are painful and showing her how to correct them
@dfjpt @jasonsilvernail tweeting @PeteOSullivanPT #sdpain workshop. Recommend to follow- great stuff!
#sdpain @PeteOSullivanPT @MyCuppaJo Focuses on movements and positions that are related to things she cares about most from the interview
#sdpain @PeteOSullivanPT @MyCuppaJo "I think it was Silvernail who posted some link that my surgery wasn't backed by evidence"
Missing out on the workshops? Don't miss the #sdpain presentations https://t.co/v0o0bge7UR
#sdpain @PeteOSullivanPT @MyCuppaJo Doing repeated movements painfree that challenge ideas about her pain gently, while showing her strength
#sdpain @PeteOSullivanPT @MyCuppaJo Joletta with tremendous good humor and bravery during whole process.
#sdpain @PeteOSullivanPT @MyCuppaJo "it's not just relaxing [tight muscles] - it's about relaxing while loading something else"
"People think it's about relaxation; it's not. It's relaxing one area while loading the hell out of something else" @PeteOSullivanPT #sdpain
#sdpain PeteOSullivanPT MyCuppaJo "it's not just relaxing [tight muscles] - it's about relaxing while loading something else"
@PeteOSullivanPT @MyCuppaJo @SanDiegoSummit #sdpain Joletta Belton- what a superstar volunteer!
The whole system and culture is about "I'll fix you" not "I'll help you help yourself." @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT @MyCuppaJo "Exercises are redundant. They're there to disconfirm the unhelpful beliefs and restore function"
Super good content flowing from #sdpain live tweeting #followit
Flying to San Diego tomorrow to tweet and collect tweets from the SD Pain Summit's two days of talks. #sdpain https://t.co/fYcMTws9n9
Loving the updates from #sdpain!
Follow the 2017 Summit conference on Twitter - #sdpain.
Catch @CorKinetic speak in London at #LePubScientifique when he's back from #sdpain. Learning with beer in hand 🍺🤓 https://t.co/x6UsAMNCkg
Superb workshop at #sdpain. Today is second day with Peter O'Sullivan. https://t.co/eHhveLaSN5
#sdpain @PeteOSullivanPT A synopsis so far by Rey Allen. https://t.co/5W13vdeLMy Looking forward to day 2!
Day 2 of @PeteOSullivanPT CFT course: yesterday was a slam dunk, today should be a home run #MixedMetaphors #sdpain
#sdpain #PeteOSullivan How do you take the info, create a nice package to help people go on a new journey?
#sdpain #PeteOSullivan Going through the clinical reasoning forms now...
#sdpain #PeteOSullivan You don't need to call an event in the lumbar spine a "trauma"..
"When you hold your back in lordosis, there's very little give in the system" #DropThePlumLine #sdpain
#sdpain @PeteOSullivanPT "if you look at screening tools[pnt report surveys] they are a bit better than a coin toss."
#sdpain @PeteOSullivanPT Reviews show that screening tools only slightly better than coin toss. Nothing beats a good patient interview.
"With persistent pain, an orientation towards structure is self-defeating."
@PeteOSullivanPT #sdpain
Screening movement: think "adaptive" (helpful, assists healing/protective) vs "maladaptive" (provoking the pain). #sdpain
Feel the pain #sdpain
#sdpain @PeteOSullivanPT Many behaviors adaptive in acute pain - encourage rather than try to eliminate (e.g. lateral shift) @BarrettDorko
#sdpain @PeteOSullivanPT Many localized pain conditions do worse w/ cont'd direct treatment - less poking, rolling, needling maybe better
Why do we even call labral tears a pathology? @PeteOSullivanPT #sdpain
"Labral tears in the hip are so poorly correlated to pain why do we call them pathology? They should be morphology" #sdpain @PeteOSullivanPT
"Why do we call them pathologies (labrum tears, disc bulge, etc.)? We should call them morphology."
@PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Review clinical reasoning form that is more about beliefs and behaviors. Radar chart at end for decisions - nice
Reviewing facets of case -emotional, cognitive, movement, social, health, lifestyle, patho-anatomy helpful to direct attention #sdpain
#sdpain @PeteOSullivanPT "When my pain goes up, my anxiety does also, it's like a race to see what can get worst first" - @MyCuppaJo
#sdpain @PeteOSullivanPT "We see a range of people, we just use different metaphors" -When asked about people w/low health literacy...
#sdpain @PeteOSullivanPT ...often easier since they don't have as many unhelpful medicalized beliefs.
#sdpain @PeteOSullivanPT perhaps it is more important for practitioners to know pain neuroscience - less to teach it to patients
#sdpain @PeteOSullivanPT sometimes pain neuroscience education just doesn't hit the mark with patients. Depends on the patient
#sdpain Living is an intervention - particularly doing fun stuff. Exercises are boring! @PeteOSullivanPT
#sdpain @SanDiegoSummit Help the patient to make sense of THEIR pain - the factors that are relevant to their story - not generic info
#sdpain @PeteOSullivanPT CFT Management Plan sample: making sense of pain, exposure with control, lifestyle changes, give control over pain
Controlablity of pain can be a massive way to reduce anxiety, hyper vigilance, catastrophising - creates safety. #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT "We can get massively distracted by structural treatment, and lose the big picture"
#sdpain @PeteOSullivanPT If anxiety or worry becomes a persistent barrier to progress, consider psych referral.
#sdpain #PeteOSullivan Poking chin not associated with neck pain at all. tall straight neck is. Pisses off physios!
Recent study in 13 y/o's found that neck pain was higher correlated with upright posture v slouch "that really pisses off the PTs" #sdpain
#sdpain @PeteOSullivanPT Painful backs persistently moving to extension/upright is a common pattern of movement he sees in patients
@PeteOSullivanPT debunking long held postural myths with research - pissing off physiotherapists #partofthejob… https://t.co/HZKXz6ltyF
#sdpain @PeteOSullivanPT Examination needs to be about finding the patients story not checklists or series of closed questions - MI concept
#sdpain #PeteOSullivan Getting away from ticking boxes, sitting back and listening to the story, is best door in 2 motivational interviewing
#sdpain #PeteOSullivan Best way to learn motivational interviewing, videotape yourself, observe your own conversational style, body language
The most dangerous practitioners are empathetic ones who are telling people nonsense @PeteOSullivanPT #sdpain
#sdpain #PeteOSullivan Most dangerous practitioner: empathetic, kind, talk rubbish, keep people coming back forever.
#sdpain @PeteOSullivanPT "The most dangerous people are the empathetic ones who feed their patients rubbish" Fosters dependency
#sdpain #PeteOSullivan If you're dealing with pain you have 2B reflective of yourself, know your own emotional status, B comfortable with it
#sdpain @PeteOSullivanPT Empathetic providers who pass bad info have busy practices - they keep people coming back but don't really help
#sdpain #PeteOSullivan We use the back as a model but all these things go for pain experienced anywhere.
#sdpain #PeteOSullivan Patient satisfaction is not linked to outcome. Got to be careful! Nice guy, likes to do repetitive surgery...
#sdpain @PeteOSullivanPT Satis vs Outcome disconnect "My surgeon really cares for me - look how often he's going back in there to do more"
Patient Satisfaction doesn't always link up with good outcomes #sdpain
#sdpain #PeteOSullivan This system: enduring results after a year, longterm satisfaction, they are in control, may not need any sessions.
#sdpain #PeteOSullivan What triggers an episode of acute LBP a case crossover study. 2015
#sdpain #PeteOSullivan Irish dancer study 2015. Predictors of pain, main one was anger and hostility.
#sdpain @PeteOSullivanPT Calahan 2015: predictors of pain in dancers - none biomech...
#sdpain #PeteOSullivan Also subjective health complaints, history of pain, insufficient sleep, NOT biomechanics!
#sdpain @PeteOSullivanPT ...sleep, anger, subjective health complaints, hx of pain, more daily pain. Not functional screening biomech stuff
Predictors of injury in dancers - anger/hostility, subjective health, insufficient sleep NOT biomechanics #sdpain https://t.co/Yzz4WbCUT2
#sdpain #PeteOSullivan Motor responses (should be called behavioural responses) reflect NS response to pain, threat, emotion etc.
#sdpain #PeteOSullivan Adaptive behaviour is protective. Defence not defect.
#sdpain #PeteOSullivan Pain in absence of pathology does not serve any useful purpose. Driver will be worry and anxiety around pain itself
#sdpain @PeteOSullivanPT Maladaptive behavior - performing a task in a manner that provokes pain and disability
#sdpain @PeteOSullivanPT Shows example of lateral shift that is protective/adaptive and a limp that maladaptive.
#sdpain #PeteOSullivan Directional pain responses vary. it was hooked up to structures. Unhook and carry on with directional sensitivity.
Mal-adaptive or unhelpful movement patterns can often be in the direction of the very thing that triggers pain #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Reviews MDT research and talks about how it's useful but important to unhook it from the disk structure.
"The unfortunate thing about directional preference (McKenzie) is that it was linked to anatomy and pathology. We need 2 shift that" #sdpain
#sdpain @PeteOSullivanPT Patients have both mechanical and nonmechanical behavior of symptoms often - ok to pursue mechanical treatment
#sdpain #PeteOSullivan Pain provoking vs: pain relieving behaviours
#sdpain @PeteOSullivanPT "20 years ago I'd say oh that's an unstable spine. Now I just say that's a screwed up way to move, lets change it"
#sdpain @PeteOSullivanPT Many maladaptive movements are actually provoking patients into what makes them worse - ID and try to change
#sdpain @PeteOSullivanPT Video examples of maladaptive movements into lumbar flexion - avoidance, sequencing problems, etc
Revisiting the #BPS model of pain, what we should consider when applying to clients or patients. #sdpain… https://t.co/T6NrYiQUuz
Excellent paper on the benefits and considerations in adopting the BPS model in treatment of pain:
Calibrating... https://t.co/GXznuJ7MwS
#sdpain @PeteOSullivanPT Missing link in rehab - thoughts and emotions on movement
#sdpain #PeteOSullivan Missing link: thoughts and emotions that drive behaviour can be addressed at the same time as the behaviour itself
#sdpain #PeteOSullivan Not into subgrouping pain anymore.
Correlation b/w pain, disability, depression anxiety and increased trunk muscle contraction - protective, makes sense but unhelpful #sdpain
#sdpain @PeteOSullivanPT We like to classify people with psychosocial and just say oh those are yellow flags, send them off to psych
#sdpain #PeteOSullivan Understanding combinations of presentations gives you more freedom
#sdpain @PeteOSullivanPT Those without maladaptive behaviors and beliefs don't really need our care - they will be fine with natural hx
#sdpain #PeteOSullivan two factors that drive activity of multif are fear, and body posture
Physical factors - postural extension + cognitive factors - fear - tend to increase muscle contraction of LxES during movement #sdpain
#sdpain @PeteOSullivanPT Lots of evidence on cocontraction and increased EMG responses in those with pain. Maladaptive cocontractions common
#sdpain #PeteOSullivan How do you sit? How do you bend? Those two factors are the main pieces of a back pain story that are meaningful
Lack of ability to relax LxES during flexion very predictive of the presence of back pain @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Watching patients move often more useful than on-table clinical exam for your ddx and finding maladaptive mvmts
#sdpain #PeteOSullivan Look to see what they're doing in each direction.
"Unloading a painful limb will cause co-contraction of that limb, and you get caught in a painful cycle" @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Deconditioning linked to avoidance and sedentary behavior
#sdpain @PeteOSullivanPT Many braces and supports not helpful in long term - sends message that the body is weak and needs protection
#sdpain @PeteOSullivanPT Tape and braces fine for acute stage pain but don't let them feed into maladaptive beliefs on long term
#sdpain @PeteOSullivanPT [Prof says controversial but accurate thing] "Oh you're going to tweet that aren't you?" Me: oh yeah
#sdpain #PeteOSullivanGenetics predicts probably about 40-45% of whether you get disabling back pain
Eradicating back pain is not a concern - our target should be reducing the fallout from back pain - disability etc #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Pain is not always a problem in itself, being disabled by pain and pathologising pain is the main problem
#sdpain @PeteOSullivanPT "Pain is not my concern, being disabled by pain is my concern."
Experiencing pain - genetics are highly predictive; responding to pain - family behaviors (learned behavior) is predictive #sdpain
#genetics can play a significant role in how much pain you may experience, about 40-50%. #sdpain @PeteOSullivanPT https://t.co/GWpcKDvzvr
#genetics can play a significant role in how much pain you may experience, about 40-50%. #sdpain #physicaltherapy https://t.co/8u8YK9oxsj
#genetics can play a significant role in how much pain you may experience, about 40-50%. #sdpain @PeteOSullivanPT https://t.co/GWpcKDvzvr
Adopting neutral spine while moving is likely a protective behaviour to avoid pain rather than "ideal" way to move.… https://t.co/cnfbmqM7yV
Adopting neutral spine while moving is likely a protective behaviour to avoid pain rather than "ideal" way to move. https://t.co/Q3GCVVmDlf
#sdpain #PeteOSullivan Another patient being interviewed.
#sdpain @PeteOSullivanPT New patient case now - great patient too who is smart and self aware "opioids are a dead end road" wanted self mgmt
#sdpain @PeteOSullivanPT patient "I don't think about what happened i think about what I can do to make my life better"
#sdpain @PeteOSullivanPT I keep thinking of Louis Gifford: "goal of PT is to restore fearless thoughtless movement"
Feeling better after a treatment is not proof that it "works" #sdpain #alternativemedicine https://t.co/3yOTUq2pwL
Sorry, alternative health people:
feeling better after a therapy is no proof it works
https://t.co/b4PlhJcD2r
#sdpain @PeteOSullivanPT Great reflective questions and Prof acknowledging patient's strengths to build on
#sdpain @PeteOSullivanPT Knowledgeable patient but whose adaptive behaviors seem not consistent with his verbalized understanding - common!
"The most difficult thing in being in pain is the commitment to activity, not activity itself" patient interview #sdpain
#sdpain @PeteOSullivanPT Patient "I try to focus on having good posture in my shoulders - I have some friends who are stooped over"
#sdpain @PeteOSullivanPT Prof gently using MI to find out what patient believes about his pain and what to focus on
#sdpain @PeteOSullivanPT Prof focusing on areas of maladaptive beliefs, summarizing and checking understanding with patient
#sdpain @PeteOSullivanPT Prof starting with diaphragmatic breathing in painful position (sitting)
#sdpain #PeteOSullivan Step one, relax, let core go so that breathing doesn't pressurize the trunk cylinder
#sdpain @PeteOSullivanPT Immediately moves from breathing to showing patient where his cocontraction is maladaptive thru experience
#sdpain @PeteOSullivanPT No "therapeutic neuroscience education" per se - done in small doses and connected to patients experience
#sdpain #PeteOSullivan If I'm leaning forward to stand up, gravity is pulling me down. I don't need to engage core to stand up.
#sdpain @PeteOSullivanPT Prof using questions to explore why a patient believes something - even when they agree on a new concept together
#sdpain @PeteOSullivanPT ID'ing stiff movements that are maladaptive and retraining them a big part of the approach
"Look at Usain Bolt: is he stiff? No, he's dancing before a race before he takes off. We need core strength for power, not to sit" #sdpain
#sdpain @PeteOSullivanPT Patient: "I had already programmed my body to engage those muscles"
#sdpain @PeteOSullivanPT Lots of reps of retrained movements in between discussing things - a lot of volume of new movements w/new pattern
#sdpain @PeteOSullivanPT Pain at night in bed - Prof watching patient move and roll on plinth
#sdpain @PeteOSullivanPT Prof often coaches 'breathe into the movement' to help cue less co-contraction
Prof @PeteOSullivanPT giving a masterclass on assessment & motivational interviewing, not 1 special test used #sdpain #listen2patients
#sdpain @PeteOSullivanPT "oh well now I'm rotating my back? And I'm not experiencing pain" Prof then asks what's different to check learning
#sdpain @PeteOSullivanPT Now working supine comfort - Prof abducts and ERs patient hips just as @BarrettDorko has been saying for years
"Let the armor go, is that it?" Our patient finds the key to his pain #sdpain #MotionIsLotion
#sdpain @PeteOSullivanPT Retraining painful movements -start with breathing and relaxation, cue movement slowly, watch for cocontraction
#sdpain @PeteOSullivanPT Retraining movements gives patients control over their pain - huge factor in reducing threat and restoring function
#sdpain @PeteOSullivanPT Patient "It doesn't feel normal it just feels unnatural - slouchy to sit like this. But it feels better"
#sdpain @PeteOSullivanPT Often asks "How confident are you in ..." to help find problematic movements
Prof @PeteOSullivanPT uses iPhone photos of the patient 2 show that relaxed posture (no pain) is still "good posture" to the patient #sdpain
#sdpain @PeteOSullivanPT "only two things that are really rested - major trauma or broken bones" Everything else should be worked
20 yrs of experience has little relevance when 19 of those yrs are based on what u learned in 1st yr #sdpain
20 yrs of experience has little relevance when 19 of those yrs are based on what u learned in 1st yr #sdpain https://t.co/oRNlfkYQoi
20 yrs of experience has little relevance when 19 of those yrs are based on what u learned in 1st yr #sdpain
#sdpain @PeteOSullivanPT Uses whiteboard to summarize major themes for the patient. Diagrams successes and what changes need to be made
#sdpain @PeteOSullivanPT "What have you learned today about how to move differently? Why is that important, why does it help?"
#sdpain @PeteOSullivanPT Uses smartphone camera to do some filming of movement before/after to show patient changes
"Ur not going 2 end up like that (disability) because ur not on that path, you don't need 2 work so damned hard 2 avoid it" #sdpain #trust
#sdpain #PeteOSullivan learning to trust your back: relax when you move.
#sdpain @PeteOSullivanPT Summarizes for patient the movement habits to break with the changes made today
"The best exercise is living."
@PeteOSullivanPT #sdpain
"The best kind of exercise is living" @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Habit break list targeted to what patient said was problematic and what was improved with movement retraining.
#sdpain #PeteOSullivan When you roll, lead from the head.
.@PeteOSullivanPT "relax when you love....I mean move, relax when you move!!!" I'm sure both are grand Peter! #sdpain
@PeteOSullivanPT challenges: "Google my name & core strength" #sdpain
#sdpain @PeteOSullivanPT Patient: "There's a lot of core stuff out there." Prof: "Google my name and core stability" [laughs from crowd]
Alright, #sdpain. You hooked me in with all the @PeteOSullivanPT tweets. See ya at the #APTACSM precon.
@jasonsilvernail any chance you're going to put together a blog post summarizing #sdpain? Great info from @PeteOSullivanPT!
Waiting in the plane at OAK for weather to (hopefully) improve at San Diego airport. #sdpain
#sdpain #PeteOSullivan When you ask for the story, they'll tell you something really important in the first minute.
#sdpain @PeteOSullivanPT Now patient demo over and Prof reviews clinical reasoning form and beliefs, cognitions, emotions, other factors
The only massage #magazine based on science, critical thinking, & patient-centred care. Subscribe today! #sdpain
https://t.co/NrTAYYJqdy
"Be strong - but only when you need it" Often the missing piece in the core stability thing. #sdpain @PeteOSullivanPT
#sdpain @PeteOSullivanPT Discussing core strength ideas: good to be strong, but tension during ADL is provocative for most.
#sdpain @PeteOSullivanPT Good news is that the system is plastic and can change. Most patients get control over their pain w/retraining
#sdpain #PeteOSullivan fear of damage fuels so much pain and what looks like disability and movement impairment.
#sdpain @PeteOSullivanPT Fear and the belief you're damaged drives so much of this. We create this monster.
"The fear of pain is the driver of pain."
@PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Patients are being told they have no damage on their scans but also they have to be careful when they ban. Huh?
#sdpain #PeteOSullivan Allodynia is the ultimate barb wire fence. That's the brain saying "Don't come near me."
Cuando me recriminen que en twitter no se aprende les enseñaré este Tweet y este hilo. Gracias @jasonsilvernail… https://t.co/mj2Sz5UQ1y
#sdpain @PeteOSullivanPT If you don't want to know or care about how people feel, go ahead and find another job. Rehab is about that too
#sdpain @PeteOSullivanPT Allodynia is ike the ultimate barbed wire the brain creates - Keep away from me - keep me safe
#sdpain @PeteOSullivanPT Making sense of their pain through experience, validate and respect patients to help them move forward
#sdpain @PeteOSullivanPT "Allodynia is like the ultimate barbed wire fence." Be conscious of provoking sx in these patients.
#sdpain @PeteOSullivanPT "I'm not always a big fan of pacing, I reckon sometimes people pace themselves into disability"
#sdpain @PeteOSullivanPT Adaptive pain behavior resolves on its own - don't retrain a usefully adaptive behavior (like lateral shift)
#sdpain @PeteOSullivanPT The skill is about listening to patients and eliciting information not as much in examination/treatment as we think
#sdpain @PeteOSullivanPT Some people vulnerable to negative messages - must build on success quickly with behavioral change/experience
"We need a health system intervention. We need to change the thoughts about pain" #sdpain
#sdpain @PeteOSullivanPT "You can't confront the thoughts without confronting the behaviors. They're inseparable."
Practitioners - Help bring about cultural change so that we can help influence society's beliefs about back pain #sdpain
Follow @jasonsilvernail @beyondmpain @JonFass @dfjpt for #sdpain day 2 wksp w/O'Sullivan @PeteOSullivanPT
#sdpain @PeteOSullivanPT When you dethreaten the system, it doesn't have to remain on high alert.
#sdpain #PeteOSullivan Total combined treatment effect: non-specific FX of the clinical encounter and the specific FX of tx, e.g. of advice
#sdpain @PeteOSullivanPT You can dish out all the good evidence based care you want but if in a confrontational unhelpful way it won't work
#sdpain #PeteOSullivan Behavioural experiments help to disconfirm beliefs and fears
#sdpain @PeteOSullivanPT Forming relationship is key - therapeutic alliance and motivational interviewing
#sdpain #PeteOSullivan Important that patient walks out feeling empowered not dependent
#sdpain @PeteOSullivanPT Power of reflective questioning and behavioral experiments - patients discover the way forward themselves
"The goal is to disconfirm the patient's deepest fear about their pain and movement" #MakeItSafe #NoPainAllGain #sdpain
"We are usually convinced more easily by reasons we have found ourselves than by those which we've been told." @PeteOSullivanPT #sdpain
A physical examination should chase the functional movements that are important to the patient but pain interferes @PeteOSullivanPT #sdpain
"You can't change beliefs until you change behavior" (Linton 2006) #sdpain
#sdpain @PeteOSullivanPT Self mgmt: "The trick is leading the person to the place where they feel they've made the discovery themselves."
What do you want to do? That is your intervention @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Interested in pain control and functional recovery, not necessarily 100% pain relief
#sdpain @PeteOSullivanPT The journey: make sense of pain, exposure with control, lifestyle change
#sdpain #PeteOSullivan Making sense of pain is really important for patients. Exposure with control. Lifestyle change. It's a journey
#sdpain #PeteOSullivan The journey is different for every individual
Journey to recovery.1 Making sense of pain 2 Exposure with control 3 Lifestyle modifications @PeteOSullivanPT #sdpain
#sdpain #PeteOSullivan Two biggest things: patient education and behavioural experimentation
#sdpain @PeteOSullivanPT Keys in rehabilitating people in pain 1) make sense of pain 2) expose with control 3) change lifestyle
#sdpain #PeteOSullivan Economic evaluation is important - put in lots of time at the start and save buckets of $ later
#sdpain #PeteOSullivan Brushing teeth, rolling over, picking up a pencil, none of these are "injuries"
Es importante que el paciente salga de la consulta sintiéndose con poder y control y NO dependiente (otra bomba de… https://t.co/vnCOecLpGT
#sdpain #PeteOSullivan Important that patient walks out feeling empowered not dependent
#sdpain #PeteOSullivan Reassurance can go really badly if you just say, oh you're OK; listen, hear the story, do behavioural experimentation
#sdpain @PeteOSullivanPT Reassurance is about helping them make sense of their pain not assuring them they're fine - use language that helps
Challenge beliefs by helping patients to identify discrepancies in their narrative. @PeteOSullivanPT @SanDiegoSummit #sdpain
#sdpain #PeteOSullivan Use the B-Exp to disconfirm their beliefs. Ask them if it makes sense. When they say yes, they are feeling reassured.
https://t.co/bMOKct4wGG Great article about factors that influence patient-therapist interactions @MaryOKeeffe007 @PeteOSullivanPT #sdpain
#sdpain #PeteOSullivan De-threatening information, especially ergonomic beliefs, cultural beliefs, etc.
"Questioning is non-threatening, telling can lead to threat" #sdpain
#sdpain #PeteOSullivan Questioning is non-threatening. Telling is threatening.
Roll with resistance - telling is threatening, questioning is non threatening. Let the patient disaffirm their beliefs themselves #sdpain
#sdpain @PeteOSullivanPT Questioning is non threatening, telling is. Use reflective statements and summaries after questions
#sdpain @PeteOSullivanPT Disputing rigidly held beliefs can destroy the alliance you've established with your clients.
#sdpain #PeteOSullivan McCullough et al. 2012. "Lumbar imaging and reporting epidemiology" <- good paper
#sdpain #PeteOSullivan Behavioural learning through pain control
#sdpain #PeteOSullivan Autonomic arousal can be accessed and decreased through slow relaxed belly breathing
#sdpain #PeteOSullivan Vigilant people: They focus on the pain, not on the behaviour driving the pain. Get them to focus on the behaviour.
#sdpain #PeteOSullivan Teach them to correct the behaviour. Then they can become vigilant about that instead.
Patient body disconnect - actual versus reality https://t.co/JcBLvXEuKN @PeteOSullivanPT #sdpain @SanDiegoSummit
#sdpain #PeteOSullivan You have to teach people to break their own "rules" - e.g., no sitting, not sleeping on back, core engaged, etc
#sdpain #PeteOSullivan We're here to help people learn that their pain is not dangerous.
#sdpain #PeteOSullivan Extinguishing pain behaviours by teaching how to respond differently to pain.
#sdpain @PeteOSullivanPT "Often the very behavior that provides pain relief is the one they've been avoiding."
Never attempt to directly correct patients'/clients' beliefs. Changing minds takes time. #sdpain Via @brainpicker
https://t.co/AF7MMDghU6
Never attempt to directly correct patients'/clients' beliefs. Changing minds takes time. #sdpain #psychology https://t.co/QA2p4F7EBP
Never attempt to directly correct patients'/clients' beliefs. Changing minds takes time. #sdpain Via @brainpicker
https://t.co/AF7MMDghU6
Ahora me caigo de sueño, pero mañana a repasar #sdpain. (Siempre se aprende algo en tuitaland 😉)
Exercise has positive effects for hip & knee #osteoarthritis symptoms, despite little evidence #sdpain
https://t.co/GldXl34GfO
Become vigilant to the pain behavior rather than the pain.
@PeteOSullivanPT #sdpain
For really disabling conditions make sure you bring the family in with the treatment - its a team approach @PeteOSullivanPT #sdpain
Mañana toca repaso #SDPAIN 👌🏻 https://t.co/QbgJUsIVGQ
#sdpain #PeteOSullivan Important that patient walks out feeling empowered not dependent
#sdpain @PeteOSullivanPT Identify a maladaptive behavior, mirror it, retrain it to disconfirm, patient practice and habit change
"These are basic things that should be taught in PT schools...how to listen, how to talk to patients" #sdpain
"Don't give me gizmos & machines. Give me tools that help patients empower themselves." @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT "Its not about exercises, it's about the habit and behavior change. What's 10 minutes of exercise gonna do?"
"Don't give me gizmos & machines. Give me tools that help patients empower themselves." @PeteOSullivanPT #sdpain https://t.co/OcX8tCJv7b
"Don't give me gizmos & machines. Give me tools that help patients empower themselves." @PeteOSullivanPT #sdpain
"Write everything down everything that's important, have them explain it 2 their significant other. If important, they need to know" #sdpain
#sdpain #PeteOSullivan Integrate into valued activities ASAP
What is it that you love to do? Has pain been stopping you doing them? These are the things we need to focus on #sdpain
Sleep is like a really good analgesic - why would you not take it seriously as an intervention? #sdpain @PeteOSullivanPT
Exercise doesn't have to suck for it to be effective - set activity goals based on patient preference @NickEfthimiou #sdpain
#sdpain @PeteOSullivanPT Lifesyle changes to work on: sleep hygiene, regular exercise to preference (activity), set goals, min 30m 4x wk
#sdpain #PeteOSullivan Sleep hygiene, activity levels based on preference, set goals, graded activity (social), min of 4 times/wk for 30 min
#sdpain #PeteOSullivan pain-related distress sounds better than depression and anxiety. We can deal with that - it's in our scope
Exercise as the "poly-pill"- fixes just about everything. @BJSM_BMJ @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Pain related distress is not some kind of psychological disorder that needs referral. Can be addressed in rehab
#sdpain #PeteOSullivan Refer out for major depressive disorder, anxiety disorder, major social stressors, work with other HCP, don't abandon
Build a team around the patient - a fortress of support #sdpain
Just got to the west coast to be a part of the San Diego Pain Summit. #sdpain @ Dana Hotel and… https://t.co/8iAJdjzLMh
#sdpain @PeteOSullivanPT Pro tip: For those fearful of flexion have them 1) lean fwd in chair 2) reach towards toes 3) then have them stand
In case you weren't convinced at the end of the second day... https://t.co/Jjzy9pgHxU @kjartanfersum @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Reviewing CB-CFT evidence - now @kjartanfersum trial that got my attention to this model of care in 2012
Still not convinced? https://t.co/L6wcva3b0G @kieranosull #sdpain
#sdpain @PeteOSullivanPT Bunzli 2016 Responders to tx accepted BPS model, achieved independence, controlled pain and returned to normal
#sdpain #PeteOSullivan Time constraints are a real obstacle. You have to be able to set the rules around your work.
#sdpain @PeteOSullivanPT Limits of CFT: takes time, requires some training, readiness for change needed (patient), clinician mindset
A willingness to be self reflective and question yourself as a practitioner - makes for a much better therapist @PeteOSullivanPT #sdpain
https://t.co/v1AATfGWXx #sdpain @PeteOSullivanPT
#sdpain #PeteOSullivan Pain behaviours R really hooked 2 the fear. Unhooking them from cognitions can B done by behavioural experimentation
@MyCuppaJo @PeteOSullivanPT https://t.co/s8z5KY6S6v Check out Jo's blog. Great tool for patients to read #sdpain https://t.co/Cy2TGIIZQa
#sdpain #PeteOSullivan "Back pain - separating fact from fiction" <- youtube video with Peter https://t.co/RjfqkDvRAX
#sdpain @PeteOSullivanPT https://t.co/TBNpWB1VnN Back Pain: Separating Fact from Fiction
#sdpain @PeteOSullivanPT Be courageous and playful in your interactions with your patients.
Immense value in @PeteOSullivanPT #sdpain course this week, so much value in live evals. Well worth the trip, will… https://t.co/dP9qzxwEQD
Follow the 2017 Summit conference at #sdpain!
https://t.co/gaiLqdGBoZ #sdpain cc @dfjpt https://t.co/vrt5ieafqA
#sdpain #PeteOSullivan McCullough et al. 2012. "Lumbar imaging and reporting epidemiology" <- good paper
Has the 2017 #sdpain been blowing up your social feed lately? Get in on the education with the Basic Video... https://t.co/TdbilnwrL6
Images from #sdpain Media Nick Ng https://t.co/akNScgg24w
#sdpain @PeteOSullivanPT As therapists, we often allow our fear of seeing others in pain prevent us from convincing them to confront theirs.
10% weight loss = 50% reduction in knee pain from OA. No drug can do that. #sdpain https://t.co/3CjCDst51u
10% weight loss = 50% reduction in knee pain from OA. No drug can do that. #PrioritiseRightTreatment @ProfTimNoakes https://t.co/feynkHm1cF
| Friday | to Top |
Na het lezen van de posts van @dfjpt en @jasonsilvernail op van #sdpain heb ik de cursus ook gedaan 😋 Ben jaloers! https://t.co/OyHzUZ5KXk
Glad that I got my spot secured already! Looking forward to low back pain star @PeteOSullivanPT 's course! https://t.co/0jFA8et299
Wil je wat leren over lage rugpijn? Kijk even de feed van #sdpain terug..@THIM_hogeschool
@jasonsilvernail @PeteOSullivanPT wave the pink flag, or perhaps the green one 👍🏼#sdpain https://t.co/KU5NSgpFqW
Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories
#sdpain @SanDiegoSummit… https://t.co/K2QoIH9AwE
Gracias por la retransmisión. Luego haré una lectura completa de este Ht y del de #sdpain.... casi na!!! https://t.co/APALl8cFg9
Lo que van a disfrutar @elefanteG85 @NachoFabiani @luistorija @haroflay123 @Fisio_alcala
Va por vosotros!!!
#RCzerapi
#sdpain es el hashtag que hay que seguir hoy.
RCT effects of graded activity versus physio in patients with chronic low back pain #sdpain @SanDiegoSummit… https://t.co/2NSF8gRqYN
Physio assessment of pts' psychosocial status: Are we standing on thin ice? A qualitative descriptive study #sdpain… https://t.co/1FDUrQbX1W
I will be live-tweeting #sdpain pain today, for those who may be interested. https://t.co/wxk2GaQI5t #nowork #allplay #alwayslearning
Up early listening to birds and a foggy walk. The calm before the conference (having slept through the pool party l… https://t.co/MUm6LgF9jw
#sdpain #PeteOSullivanPT A list of Peter O's papers on pubmed https://t.co/frk6RkBdiY
Won't be doing pics this yr, and I prob won't photoshop tats on prominent PTs, but you can follow the new me or… https://t.co/9McfZYa3Fl
I will be live-tweeting #sdpain pain today, for those who may be interested. https://t.co/wxk2GaQI5t #nowork #allplay #alwayslearning
#sdpain Schedule today: @PeteOSullivanPT 900-1000, RuthWerner 1035-1120, @HeadStrongPT 1330-1415, @Farmer_MindBody 1445-1530 then panel talk
Diagnosis &classification of pelvic girdle pain. A mechanism approach within a biopsychosocial framework #sdpain… https://t.co/aeI4a2IVYB
@GregLehman @sack_joanie @UM_MedSport May not be at #sdpain but still learning!! https://t.co/hGXqqg4rmT
#sdpain about to begin. San Diego Pain Summit. Keynote speaker: Peter O'Sullivan
San Diego Pain Summit 2017. Very excited. First speaker Dr. Peter O'Sullivan #sdpain
#IOMNS https://t.co/PxoWZ1rsjZ
#sdpain 2017 is about to begin with keynote speaker @PeteOSullivanPT 👍
#sdpain A plug for https://t.co/2wHQvGQN8a - click to learn more
Great start to #sdpain by @lissanthea and the 'Lycra clad uprising' of @bodyinmind Pain Revolution… https://t.co/OXb47QRNOb
"Is there anyone here for the first time?" MC Jason Erickson asks - ~80% of the audience raised hands #sdpain #TheWordIsGettingOut
What a pleasure to be able to kick off #sdpain with a poem for the #painrevolution https://t.co/moDU7wJycO https://t.co/fAjtYsfKqD
Great start to #sdpain by @lissanthea and the 'Lycra clad uprising' of @bodyinmind Pain Revolution… https://t.co/OXb47QRNOb
Why isn't "exercise science" just "science"? We could go all day... @HeadStrongPT #sdpain
Why isn't Chinese food just "food?" We could go all day.... #sdpain
#sdpain Now coming to the stage: @PeteOSullivanPT
Warning,I'll be tweeting summaries from the #sdpain workshop the next to days. Filter as you wish. Back to normal flow on Sunday.
Repping the #walkinggallery at #sdpain today. Proud to tell the stories of hugging patients @ReginaHolliday https://t.co/lJ6s1DfuhP
#sdpain @PeteOSullivanPT- talk titled - "A Paradigm Shft in Understanding and Managing LBP"
Research begins w/ a hypothesis, & often data doesn't fit w/ researchers' beliefs. So beliefs have to change. #sdpain @PeteOSullivanPT
#sdpain keynote: Peter O'Sullivan on "A paradigm shift in understanding and managing low bac, pain.
#sdpain @PeteOSullivanPT So often pain is iatrogenic, medicinne is creating a monster. Leads to guarding. Patients become trapped.
O'Sullivan - Health system too often pushes belief that there's nothing an individual can do about their own pain. Ignores belief. #sdpain
#sdpain @PeteOSullivanPT Patients with LBP often cannot explain their symptoms with injury, yet we treat patients as if they have damage
'we treat pain like it's tissue damage' - this is part of the problem in helping people in pain. @PeteOSullivanPT #sdpain
O'Sullivan - Pain often initiates without industry. Belief that pain is linked to structure results in downward protective spiral #sdpain
#sdpain @PeteOSullivanPT Folks in US probably treat people with pain worse than any other place in the world (e.g scans, narrative, drugs)
Data around treating low back pain is pretty disturbing.MRIs, opioid use,injections&fusions all increased dramatically over 10 years #sdpain
O'Sullivan - What you see on a scan is not predictive to pain. Long term use of opiods is useless. Creates addiction. #sdpain
#sdpain @PeteOSullivanPT Disability burden of LBP rising in face of spending increasing amounts of $ on diagnostic imaging and procedures.
O'Sullivan - We have a cultural belief that what you see in a scan will make sense of the experience of pain. Doesn't. #sdpain
Back pain is the largest disability of all disorders
- Peter O'Sullivan #sdpain
There is an exponential increase in LBP in adolescence - these are not growing pains. @PeteOSullivanPT #sdpain
Most back pain is managed by avoiding things - that pattern can start young, and persist (also doesn't fix the pain!) #sdpain
We're spending billions on pain yet it's getting worse. Thx for leading a paradigm shift @PeteOSullivanPT #sdpain https://t.co/UYmNZzRZY8
O'Sullivan - We start trying to control pain by reducting activity - physical, work, school, ... #sdpain
28% of 17 yr old have LBP - learned behavior to avoid can begin early, let's change this w #selfmanagemt #sdpain
#sdpain @PeteOSullivanPT "There's an escalation in healthcare seeking present as people transition to adulthood."
O'Sullivan - We learn our behavior around pain from our family and peers. #sdpain
#sdpain @PeteOSullivanPT Stealing locus of control = creating misery.
#sdpain @PeteOSullivanPT Those that miss school as kids due to pain more likely to take time off work as adults.
Even young people believe LBP will eventually stop them from doing physical activities #tragic #sdpain
Healthcare providers do need to take a look at what they're doing, and not create misery. #sdpain https://t.co/0WXqD9dbdl
#sdpain @PeteOSullivanPT Stealing locus of control = creating misery.
Glorious talk 'no wonder we are creating misery' @PeteOSullivanPT on the negative beliefs on back pain #sdpain… https://t.co/mePDe4eWwp
Most back pain is managed by avoiding things - that pattern can start young, and persist (also doesn't fix the pain!) #sdpain
#sdpain @PeteOSullivanPT The majority of adolescents believe that a back in pain needs to be rested to allow for resolution.
"Patients will say 'I've had lots of stuff done 2 me, but I have nothing 2 do for myself when I get pain'" @PeteOSullivanPT #sdpain #empower
#sdpain If adolescents have bad beliefs about how to deal with pain or what pain is, what can we do in schools to help shift thoughts early?
O'Sullivan - Adults with back pain believe you have to "protect" your back because "it's a damaged vulnerable structure". #sdpain
#sdpain @PeteOSullivanPT Health care providers convey unhelpful beliefs about pain both implicitly and explicitly.
Glorious is the right word @SandyHiltonPT excited to get back to the clinic because what we do every day really mat… https://t.co/Op3srOEsFG
Glorious talk 'no wonder we are creating misery' @PeteOSullivanPT on the negative beliefs on back pain #sdpain… https://t.co/mePDe4eWwp
Genetic predispositions to pain are correlated to the nervous system, not structure #sdpain
O'Sullivan - we know: Genetic predisposition via nervous system, influenced by times of change & emotions, life stages. #sdpain
O'Sullivan - A number of items related to pain are modifiable. #sdpain
Life stress events (especially early in life) can have an increased in likelihood of having more back pain. #sdpain
O'Sullivan - Life stress factors pain related. The more one is upset by pain, the higher the pain burden. #sdpain
@jptlowy @SarahHaagPT precisely - & even if they did, reln btw findings on imaging & pain is poor #sdpain
We rip out the confidence of vulnerable people by telling them they're fragile and broken (paraphrased @PeteOSullivanPT ) #sdpain
O'Sullivan - "Why would you tell a vulnerable person they're vulnerable?" We rip out their confidence install negative beliefs. #sdpain
#sdpain @PeteOSullivanPT The more distressed someone is about their painful experience, the more pain they feel, more disabled they become..
#sdpain @PeteOSullivanPT ... more sensitive to touch, bothersomeness, and distortion of body perception.
"Why would you tell a vulnerable person they're vulnerable? No wonder they end up disabled from pain" @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Even if the person in front of you is a train wreck, don't verbalize it (to them at least).
#sdpain @PeteOSullivanPT Stop saying "Wear and Tear" - implies that things will get worse with increased activity. Increases fear & anxiety
Is the burden of #chronicpain caused in the clinic? We have all made mistakes with our language, we know better so… https://t.co/eZIaGb0m2R
'We've created a culture of fear around pain. But pain is part of life' @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Fears in LBP: Doing more harm, scared of pain. Created by severity, unpredictability of pain
#sdpain @PeteOSullivanPT We've created a culture that fears pain, something which should be embraced as a normal part of life.
Language of back pain - freaks people out! Deranged discs? More likely deranged clinicians! #sdpain
O'Sullivan - We learn to be afraid of pain -- pulls people int flight-fright response and "guarding". #sdpain
"Patients say 'I'm frightened of pain' We created a culture of avoiding & being fearful. That has a profound physiological impact" #sdpain
O'Sullivan - The basic activities of human living go from unconscious to being guarded and feared. Abnormal movement and tempo. #sdpain
#sdpain @PeteOSullivanPT People in pain do activities that were once unconscious but become planned, fearful and threatening.
#sdpain @PeteOSullivanPT BPS factors can not be separated. They are all part of the same human being. https://t.co/BWkBfuhEJo
Yup. Pain is a human experience, an emergent life phenomena. We add fear, threat and shame. No wonder it costs us b… https://t.co/uLnoYKGWfZ
'We've created a culture of fear around pain. But pain is part of life' @PeteOSullivanPT #sdpain
Mundane activities have gone from being unconscious 2 being planned, fearful & threatening - Bunzli et al 2012 #sdpain
O'Sullivan - Strong correlation between bracing (protective contraction) and levels of pain. #sdpain
Can you give us a review on Facebook? What do you like about us and what we can do to improve? Thanks! #sdpain
https://t.co/i9QgTvB3yZ
"Fear begins to drive behavior even over what your own body is telling you" @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT We default to cultural beliefs to guide our behavior when in pain: tighten core, sit up straight, etc.
O'Sullivan - People stop moving. They gain weight. Feedback into nervous system and inflammation. Get stuck in positive feedback. #sdpain
Too many people come to me & have been told that the one thing that made them feel better is 'bad' for them&will 'm… https://t.co/cLQlwMkinC
"Fear begins to drive behavior even over what your own body is telling you" @PeteOSullivanPT #sdpain
Fun to sit at #sdpain talking about #chronicpain, and keeping an eye on #himss17 too. Love how we're all singing the same songs about change
@jptlowy right? The cool thing is that we get to learn, stop, move out of old beliefs as the evidence says to STOP. cc @MaxiMiciak #sdPain
None of your pieces are out. But if people think that&come back to get 'put back in'- good for biz, bad for health #sdpain
"Good for business, bad for health" @PeteOSullivanPT on reinforcement of people's concern by the "You are out of alignment" cycle #sdpain
Caution: correlation does not equal causation, widespread pain + psychosocial factors are associated but which comes first? #sdpain
O'Sullivan - Sensitization in structures in the low back -- associate with reorganization of nervous system, not phys injury. #sdpain
#sdpain @PeteOSullivanPT Telling a vulnerable person they're broken is good for our business (dependency) but bad for their health.
#sdpain @PeteOSullivanPT Thoraxes, pelvis', leg length, spinal alignment ... https://t.co/ZvcHVPcLQs
"Good for business, bad for health" @PeteOSullivanPT on reinforcement of people's concern by the "You are out of alignment" cycle #sdpain
Scans of the brain and nervous system are more predictive of pain than scans of bones, joints, muscles. #sdpain @PeteOSullivanPT
PT's feel underprepared to treat the whole person - psychosocial factors are crucial - assessment & management #sdpain
O'Sullivan PT's are often not prepared to deal with psycho-social factors predictive of LBP #sdpain
"I hear all the time 'you want 2 treat the patient like a psychologist' No, I want 2 treat them like a human being" @PeteOSullivanPT #sdpain
We need to stop with all of the ridiculous tests that don't really tell us how to help people - @PeteOSullivanPT #sdpain
Must listen to what is important to the person - help them do what they love #occupationaltherapy #sdpain
#sdpain @PeteOSullivanPT 2015 study: PT stigmatize patients with pain as demanding and attention seeking https://t.co/JFOTmuSVn5
Therapeutic alliance crucial - communication! #sdpain
#sdpain @PeteOSullivanPT FORMING A RELATIONSHIP IS MOST IMPORTANT. Stop checking off boxes on forms and learn patient's values.
Making sense of #pain is part of first step to live well #sdpain
O'Sullivan - Cognitive approach - focusing on unhelpful beliefs and behaviors. Take people back to the things they love. #sdpain
Those who are pushing back "pain science" and calling it a "clique" is adopting a "pointless, pseudopedantic argument." #sdpain
Personalized explanation for their pain in biopsychosocial model #sdpain
Diagnostic label is not good reassurance #sdpain
#sdpain @PeteOSullivanPT The Journey: make sense of pain, graded exposure, return to lifestyle.
.@JonFass @SarahHaagPT @PeteOSullivanPT
Moving that mindset to Non Pain too. Cheers #sdpain
If it is hurts you have options! I'm sensitized but not damaged #sdpain
#sdpain @PeteOSullivanPT Reassurance: more than talk, give patients tools to succeed. #selfefficacy
"You can relax & put your foot up and do what ever you want because that is normal" @PeteOSullivanPT Normalize and expose w control #sdpain
Asking people about their life, their loves and their dreams as well as their pain opens up the possibilities for l… https://t.co/62Tv7IKGgb
#sdpain @PeteOSullivanPT FORMING A RELATIONSHIP IS MOST IMPORTANT. Stop checking off boxes on forms and learn patient's values.
@Jerry_DurhamPT @JonFass @PeteOSullivanPT Instead of 'non pain', I'd say 'back to life' or 'not scared' or 'confident'. #sdpain
Normalize body movements - gently & then build confidence #sdpain
Opioids aren't helpful for low back pain- 'why in the hell do we keep doing that?'. @PeteOSullivanPT #sdpain
We "do" #opioids because people need "something" in the face of human suffering. Change to how we deliver care and… https://t.co/sRJKrQn803
Opioids aren't helpful for low back pain- 'why in the hell do we keep doing that?'. @PeteOSullivanPT #sdpain
Experiencing movements while relaxed increases confidence #sdpain
#sdpain @PeteOSullivanPT: GOAL - change the patient's common sense model of pain.
@lissanthea Irony is that the more we 'do', the less helpful we're being.... #sdpain
#sdpain @PeteOSullivanPT Now can be calm and relax, stay engaged, stop protection. https://t.co/T9ZftfS0YK
#sdpain @PeteOSullivanPT: GOAL - change the patient's common sense model of pain.
O'Sullivan - Website. https://t.co/7Fm5GmDMZg #sdpain
#sdpain If you haven't, bookmark https://t.co/eHJ2MvqkdQ.
@PeteOSullivanPT - great keynote speaker at San Diego Pain Summit. Thank you #sdpain
#sdpain @PeteOSullivanPT Speaking about aversiveness and ambivalence with painful patients - motivational interviewing.
#sdpain @PeteOSullivanPT Give patients an opportunity to make choices. #empowering #locusofcontrol https://t.co/F3sRzHHMzy
#sdpain @PeteOSullivanPT Speaking about aversiveness and ambivalence with painful patients - motivational interviewing.
Exercise/movement is an important part of life - necessary to maintain health - not optional. #sdpain
Change label system around back pain "the cool thing is, it doesn't look like your scan is your problem" vs "Non-specific back pain" #Sdpain
Never tell patients their back pain is "non-specific." Instead, give patients a multi-dimensional explanation to change. #sdpain
"We have evolved over time, we used to think in terms of sub groups, we don't do that anymore" @PeteOSullivanPT evolving w evidence #sdpain
"Once it's fused, it's fused. Treat it like a normal spine'. @PeteOSullivanPT LOVE THIS TALK! Can't wait to hear more @APTAcsm #sdpain
Ppl w/ LBP are likely to experience pain when watching how others bend, flex, etc than those who have no LBP #sdpain
https://t.co/dxUwgx9UJa
It's our job as health professionals to be educators - so shouldn't we learn how to do it well? #sdpain
#sdpain @PeteOSullivanPT Validation is one of the most important things that you can give a patient.
@neiljlangridge change what we can change, accept what we cannot #serenity I think listening is first step #sdpain
@SarahHaagPT @JonFass @PeteOSullivanPT
I'm talking in context of those without Pain in healthcare....
#sdpain
"Validation is 1 of the most important things 2 give 2 patients, their pain is real. Relay their story back 2 them" @PeteOSullivanPT #sdpain
#sdpain @PeteOSullivanPT Wonderful metaphor:puzzle. Pts give us pieces; We assemble pieces in meaningful narrative to validate their exp.
#sdpain @PeteOSullivanPT Pts come to us with a box of puzzle pieces. Our goal: Put together in a way that is non threatening & validating.
#sdpain Ruth Werner: Title - Intro to Research Literacy/Make Research Reelvant
Ruth Werner up next on "Research Literacy" at #sdpain
What you see in a scan does not predict pain, disability, or future pain. #sdpain @PeteOSullivanPT
Werner - Not an academic and an advocate for research literacy in massage therapist field. Often an uphill slog. #sdpain
Negative beliefs are associated with disability & care seeking behavior. #sdpain
Negative beliefs, fear of movement, and low self efficacy = ^ pain and disability. #sdpain
#sdpain Ruth Werner: external validity is integral for application of research in clinical practice
Werner - First introduction to research at 2007 Fascia Conference, but had no context for presentations. #sdpain
Fascia research: Very little relevance to massage therapy. Mostly to find ways to study fascia, not applied science. #sdpain
Werner - Access: Pubmed and Google scholar. #sdpain
'Research creep' - what happens when you're looking for literature on a topic&you get distracted by the other things to learn! #sdpain
"You can spend hours on pubmed the same way you can spend hours on YouTube, but you might end up a bit more enriched" Ruth Werner #sdpain
Werner - Not everything that makes it into print is good quality research. #sdpain
Werner - Replicable / Reliable Research is described and be reproduced. #sdpain
Werner - Internal validity - Does the research make sense and show what is claimed. #sdpain
Werner - Finally, can the research be applied to practice. i.e. Evidence-Informed practice. #sdpain
Ruth Werner dislikes misinterpretations of research. It ticks her off like having a lukewarm bowl of pho. #sdpain
Werner - Balance between patient goals and preferences, clinical experience, & research evidence #sdpain
"It's not that research dictates what U do, it's the balance of patient values, clinical judgment & best evidence" Ruth Werner #sdpain #EBP
Never take expert opinions as "fact." They can change often (or not) like underwear & are prone to bias, misinterpretation, deepity #sdpain
Massage therapy to stretching connective tissue length? Current research TL;DR consensus: Doesn't really work. #sdpain
Werner - Looks at two papers. Go & Lee (pmc 5080143) and Ferreira et al #sdpain (free full-text pubs).
Be willing to be wrong. Research should and can inform clinical decisions. Patient is more important than finding. #sdpain #RuthWerner
Research is critical for clinical practice. Some people think scientist say "Eureka!" but they also say "bollocks"… https://t.co/SrYAooML2W
"Are you brave enough to question your own assumptions?" #sdpain #RuthWerner
Werner : When we hit "intellectual" firewalls, theres not much we can do.. #sdpain
What do you do when someone reference dumps a load of research that is written in Russian and/or Chinese to support their claims? #sdpain
"Using language with precision is critical. If we came to common understandings, we're probably not as divided as it looks" R Werner #sdpain
Werner - question on difference of clinical & statistical significance . #sdpain Former: does the difference make a life difference. #sdpain
#sdpain @jasonsilvernail's view at lunch today, sitting across from 2016 NSCAPersonal Trainer of the Year & HOF ind… https://t.co/Qlnaf3yJfL
Next speaker at #sdpain, Roderick Henderson on "Making Sense out of Exercise and Pain."
#sdpain - Next up is @HeadStrongPT, "Making Sense out of Exercise and Pain."
Hear Julie of @IofManualNeuroS share her 1st half thoughts from @SanDiegoSummit #sdpain
https://t.co/1GL0Kb3kJs
Here's Jeff of @IofManualNeuroS sharing his 1st half thoughts from @SanDiegoSummit #sdpain
https://t.co/k10Cgbw3j4
#sdpain @HeadStrongPT "has biceps to match his brains"
Now onstage: @HeadStrongPT with a discussion on exercise and pain #sdpain
#sdpain @HeadStrongPT h/t to @somasimple
Henderson - We are in the midst of two halthcare crises #sdpain
#sdpain @HeadStrongPT We're dealing with chronic diseases wrong (pain is just one example)
#sdpain @HeadStrongPT Persistent pain leads to low QoL scores, high levels of distress, and early entry into long-term disability
#sdpain @HeadStrongPT Irony - we evolved to move, but have engineered our lives to not move. (Don't confuse with him with paleo-anything)
Persistent pain gets people into long term disability earlier
Roderick Henderson #sdpain
Henderson -- Persistent Pain and physical inactivity
;#sdpain
#sdpain @HeadStrongPT We have devolved to engineering movement out of our daily lives for the sake of convenience.
Move more frequently, but don't go "full Paleo." @HeadStrongPT #sdpain
#sdpain @HeadStrongPT Pain and physical inactivity should both be considered simultaneous but related health care crises.
Physios get nervous when personal trainers to screen or "treat" pain, like S&C cringe when physios prescribe exercise. #sdpain @HeadStrongPT
"The problems of pain: poor management and poor understanding" @HeadStrongPT #sdpain
#sdpain @HeadStrongPT HS Stool Pulls - evidence that PTs may need to improve understanding of movement. https://t.co/pOjzExh0dE
Henderson -- Addressed by a wide rang of Health professions.
Both problems fundamentally misunderstood and Mismanaged. #sdpain
#sdpain @HeadStrongPT h/t to @BarrettDorko re: culture's influence on pain beliefs
"Poor management: spinal fusion, injections, opioids, poor education, orthodox man therapy, dr. Google" @HeadStrongPT #sdpain
Physios & MTs should read @BarrettDorko's work. They can learn a lot. #sdpain @HeadStrongPT
"Poor understanding: beliefs, attitudes, professional education, locus of control" @HeadStrongPT #sdpain
#sdpain @HeadStrongPT Error: clinical decisions focused on anatomical structure without all the info needed to be better informed
"Failed back surgery syndrome - we actually have a diagnosis code for when we screw up" @HeadStrongPT #sdpain
#sdpain @HeadStrongPT "Failed back surgery syndrome more accurately termed failed back surgeon syndrome."
#sdpain @HeadStrongPT Pain is NOT weakness leaving the body
Selling clients & patients idea that "poor posture" = pain tends to "work" b/c it's simple & feeds on their misery. @HeadStrongPT #sdpain
"I have knee pain for 7 years. You got an exercise for that?" @HeadStrongPT #sdpain #facepalm
#sdpain @HeadStrongPT h/t to @IASPPAIN
#sdpain @HeadStrongPT Reminder: effect sizes of ther ex on chronic LBP are small to moderate & noi single form of ther ex is superior
#sdpain @HeadStrongPT Type and dosage of appropriate exercise for pain unclear; effect sizes for LBP are small to moderate.
#sdpain @HeadStrongPT REMINDER: exercise seems to be beneficial but not tremendously so and not for the reasons we initially thought
"Exercise seems to be beneficial, not tremendously so, probably not for reasons we thought" @HeadStrongPT #sdpain
Henderson - IASP - Independent Association for the study of pain #sdpain
#sdpain @HeadStrongPT Exercise should follow the path of manual therapy - not as specific, but viewed more through BPS lens
#sdpain @HeadStrongPT Important to remember that diff modes of exercise have a wide range of unintended non-specific effects
Come to Boston in 2018 for @IASPCongress through @IASPPAIN #sdpain https://t.co/Stk51K7vQ3
Henderson - IASP - Independent Association for the study of pain #sdpain
#sdpain @HeadStrongPT Exercise: means of imparting progresive physical and psychological stresses; dose depends on bio, psych, & soc factors
#sdpain @headstrongPT Reconceptualise exercise as a means of imparting progressive physical and psychological stress.
"Consider looking @ exercise as a means of imparting progressive physical & psychological stress, not strengthening" @HeadStrongPT #sdpain
Henderson Reframing exercise. Imparts progress physical & psych Stress. Dosing is dependent upon a variety of factors. #sdpain
You don't need to squat with ur toes & knees pointing forward, regardless of what your weekend cert or screen says. #sdpain #fitness
#sdpain @HeadStrongPT On exercise: "Keep them on their path-don't drag them up your hill."
Henderson Operator vs Interactor
"Clients need a coach, not a boss"
#sdpain
'Your clients need a coach, not a boss. Nobody likes being told what to do. It's also not sustainable'-Roderick Henderson #sdpain
#sdpain @HeadStrongPT Hey PTs, if you are going to prescribe exercises, understand basic exercise guidelines, ACSM at minimum.
"Nobody gets excited about 'prone on elbows.' They talk about interactions, new things they can do, how they can move" @HeadStrongPT #sdpain
If physios want exercise guidelines, ACSM is a good starting point #sdpain @HeadStrongPT
#sdpain @HeadStrongPT PTs need to implement client-centered guideline-driven activity programming...
"Stop doing dumb stuff." - works of wisdom from @HeadStrongPT #sdpain
#sdpain @HeadStrongPT Interact with your patients, find out what's meaningful to them, and incorporate it. Stool scoots...not so much.
#sdpain @HeadStrongPT Not always clear how to do it. What's clear: stop doing dumb stuff (eg stool pulls). #meaningfulguidance #humanistic
"Stop doing dumb stuff: when I stopped doing dumb stuff, I started filling time with things important to the patient" @HeadStrongPT #sdpain
#sdpain @HeadStrongPT Movement should be used as a teaching tool. Hurt v Harm, Pacing, Neurophys, Coping, Curiosity
If a physio, trainer, chiro wants to "fix" your posture, RUN! #sdpain
#sdpain @HeadStrongPT Use movement as teaching. Encourage curiosity & exploration about how the body moves in response to different inputs.
#sdpain @HeadStrongPT Don't B afraid to take Ur patient into deeper water; encourage safe exploration of stressors w/variety of modes of ex
Henderson - Promote metabolic and movement variability. #sdpain.
#sdpain @HeadStrongPT Give the pt permission and space to move authentically and foster autonomy
I'm more than a little excited... @Farmer_MindBody is up next at #sdpain !
@HeadStrongPT talks about the FMS/SFMA. Not very useful in movement quality assessment and injury prevention or prediction. #sdpain
Never trust a physio or chiro who wants to adjust your coccyx while holding a shot of tequila #sdpain
Is your feed blowing up about #sdpain? Order the videos and watch next week for only $219 https://t.co/v0o0bge7UR
#sdpain - now coming to the plate, @Farmer_MindBody: Birth and Death of the Pain Engram
If you've been a client of mine over the last few years you may recognize this approach #sdpain https://t.co/aijw1X76zt
Never trust a chiro or physio who wants to adjust your coccyx while holding a shot of tequila. #sdpain
Onstage: @Farmer_MindBody #sdpain
#sdpain @Farmer_MindBody Engram: the physical changes in the brain that represent a specific memory (memory trace)
@Farmer_MindBody asking is to recall our first kisses... now I can't stop smiling. I love learning😘 #sdpain https://t.co/7DEkCtURuf
#sdpain @Farmer_MindBody Memories: short-term, sensory, long-term, explicit, implicit, declarative, procedural, episodic...
Farmer A single memory, like first kiss, an engram. Distributed through different parts of the brain in a network of connections. #sdpain
#sdpain @Farmer_MindBody each specific memory is a matrix of a variety of different types of memory. https://t.co/F24kRgvgIv
#sdpain @Farmer_MindBody Memories: short-term, sensory, long-term, explicit, implicit, declarative, procedural, episodic...
Learning changes the structure of neurons, within a few hours @Farmer_MindBody #sdpain
Farmer - Physical changes in the brain - growth and pruning of dendritic spines. #sdpain
Increase in dendrite spine dictates where info goes. Learning changes neuron structure, spine growth/pruning #sdpain @Farmer_MindBody
Farmer Both strength and timing are important in what will be remembered. #sdpain
Farmer - About 4 hours of critical time in determining what will be remembered. Encoding window. #sdpain
#sdpain @Farmer_MindBody Other people in the room have different engrams of their 1st kiss though which "lights up"… https://t.co/jOPMFfPNhW
#sdpain Remember my first kiss. #unremarkable #notmyfault https://t.co/UIjCx2DZn2
#sdpain @Farmer_MindBody Stimulants (caffeine, amphetamine) consumed at 4 hours after new learning exposure augments memory retention.
Farmer - Can prim later learning and enhance encoding after (caffein, amphetamine, scent of opposite sex). #sdpain
Evidence based coffee ❤@Farmer_MindBody #sdpain
#sdpain @Farmer_MindBody Learning of a memory never stops as long as it is continually accessed.
#sdpain @Farmer_MindBody "Pain is the only sense that does not habituate."
#sdpain @Farmer_MindBody Pain is unique perception, sensation does not habituate.
"Pain is the only sense that doesn't habituate" @Farmer_MindBody #sdpain
Pain is the only sense that does not habituate
- Melissa Farmer #sdpain
Farmer - Pain doesn't habituate. #sdpain
#sdpain @Farmer_MindBody Pain=very potent learning signal. Fundamental Chronic pain works with different rules than acute, it's emotional
Farmer: Acute pain and chronic pain are different. Chronic becomes inherently emotional. #sdpain
#sdpain @Farmer_MindBody ...reorganization of the NS with chronic, but not acute pain.
#sdpain @Farmer_MindBody Emotional regions of the brain are responsible active with pain after 1+ yr, not areas of nociceptive processing
#sdpain @Farmer_MindBody Emotional brain regions become involved in sensory processing in individuals with chronic pain and depression.
Farmer : Brain scans of those with chronic pain are similar to those with depression or PTSD. #sdpain
Chronic pain activates emotion areas of the brain, less in acute pain. >1 year, emotional regions produce the pain @Farmer_MindBody #sdpain
#sdpain @Farmer_MindBody Brain Morphological Signatures for Chronic Pain link: https://t.co/RTGuZrh86O
Follow @SandyHiltonPT @waldronphysio @ramblemuse @dfjpt @JonFass @jasonsilvernail for #sdpain tweets.
#sdpain my link: https://t.co/doH2BbQyzc (related to @Farmer_MindBody )
#sdpain @Farmer_MindBody Another link - pertaining to phobias and encoding of memories https://t.co/5dO1gC7N82
Old fear memory and new recognition must be together 2 learn that both can't be right. Violate fearful expectations @Farmer_MindBody #sdpain
Therapeutic memory therapy for #chronicpain changing disorganized brain activation relative to traumatic event… https://t.co/C8EUAeweXF
#sdpain @Farmer_MindBody When addressing fear of movement it is critical to determine the specific core belief underlying the fear.
#sdpain Farmer_MindBody When addressing fear of movement it is critical to determine the specific core belief underlying the fear.
#sdpain @Farmer_MindBody Different memory traces may underlie different symptoms
#sdpain @Farmer_MindBody Older, intense memories rewuire stronger activation methods to destabilize
#sdpain @Farmer_MindBody Psychological defenses may buffer accessibility of memories (suppressed memories).
Farmer - Defenses are there for a reason. Never unpack what you can't pack up by the end of the session. #sdpain
"Chronic pain is maintained like an emotional memory: whatever can be learned can be unlearned" @Farmer_MindBody #sdpain
#sdpain TONS to absorb from @Farmer_MindBody's talk. Gonna need to hit up some of the links to relevant papers and delve in deeper.
Chronic pain is maintained as an emotional memory.
#Melissa Farmer #sdpain
"Emotional memories are strongly encoded yet changeable" @Farmer_MindBody #sdpain
Strong evidence indicate that chronic pain is maintained as an emotional memory, which is encoded yet changeable #sdpain @Farmer_MindBody
"Peripheral and spinal/central mechanisms may require additional approaches" @Farmer_MindBody #sdpain
ALL #chronicpain is emotional #pain relative to brain functional changes @Farmer_MindBody #sdpain https://t.co/JfT4pO9uxn
Every PHYSIO
Please tattoo THIScon your body where you can see it daily..... cheers. #sdpain https://t.co/KyGNB4TOMj
"It's not that research dictates what U do, it's the balance of patient values, clinical judgment & best evidence" Ruth Werner #sdpain #EBP
Next at #sdpain, a panel on psycho-social influences on pain. First panelist, Leonie Koban.
#sdpain Leonie Koban:social factors that modulate pain/relief: presence, social stress, cultural beliefs, therapeutic alliance, social norms
Koban - What other people tell us about pain influences our perception. #sdpain
Put LIFE in the center box.....
Put ANYTHING OUR pts SEE US FOR in the center box....
#sdpain https://t.co/fn7GR2QRYI
Koban: influences #sdpain https://t.co/JIA5NgHPWj
Koban Cites study in 1950's on conformity - giving wrong answer to simple problems when others do. #sdpain
Koban - Social influence on various domains. Affects value-based processing in the brain. #sdpain
#sdpain Leonie Koban: pain behavior is learned by observing parent's reactions https://t.co/8nvkAgZsnD
Koban - Observation of others with high pain tolerance can reduce pain response. #sdpain
#sdpain Leonie Koban: Research: priming subjects w/reported social grp responses to same stimulus changes subjects report of pain (conforms)
#sdpain Leonie Koban: Social info alters pain behavior and physiology by changing expectations related to pain.
Koban - Others' opinions can influence both one's own pain as well as empathy for pain. #sdpain
#sdpain Leonie Koban: Same changes are found in research re: observed pain, not just first-person pain experience. https://t.co/8lGgRou8nQ
#sdpain Leonie Koban: Social info alters pain behavior and physiology by changing expectations related to pain.
Next panelist, Chris Moyers, clinical research, "Examining Psychosocial Factors in Massage Therapy Outcomes". #sdpain
Moyer: Found strong effects compared to controls for depression and anxiety. #sdpain
Moyer: 2004 meta-analysis refutes claim that massage reduces stress hormones. #sdpain
Moyer - It was possible that benefits may have come from informal psychotherapy. #sdpain
#sdpain Chris Moyer: Less chit-chat in MT sessions correlates with improved anxiety/depression symptoms of patients in single study.
Last panelist, Beth Darnalll, Pain Psychology. #sdpain
Not a helpful message to patients! It didn't work for Tiger 🏌🏾#bettermovement #betterPT #sdpain @naiomt https://t.co/7VZGF69PnF
#sdpain @BethDarnall reference to start: https://t.co/vzC45VIOzA Pain is a national health crisis
Darnall - One in three in the U.S. has some form of ongoing pain. #sdpain
#sdpain @BethDarnall People who have mental health conditions are more likely to develop chronic pain
#sdpain @BethDarnall This relationship is bi-directional https://t.co/YC9fWcsz3p
#sdpain @BethDarnall People who have mental health conditions are more likely to develop chronic pain
"If you have to believe that a treatment will work for it to actually work... then it's not a fucking treatment!" @AdamMeakins #sdpain
Darnall - Those who have a mental health condition are much more likely to have chronic pain. #sdpain.
#sdpain @BethDarnall Mechanisms of pain and negative psychological experiences have shared mechanisms (e.g. immune changes)
#sdpain @BethDarnall Psychological distress - is met with increase in pro-inflammatory cytokines
Darnall The key likely is the immune system; proinflammatory cytokine response. #sdpain
Pain is not "psychology" specifically: there are shared mechanisms between both in neural mechanisms @BethDarnall #sdpain #ItsNotInYourHead
#sdpain @BethDarnall Also - brain function (amygdala) and rumination. https://t.co/qC9mfcAmuN
#sdpain @BethDarnall Mechanisms of pain and negative psychological experiences have shared mechanisms (e.g. immune changes)
Darnall - We don't have to have mental health disorders to have expectations negatively or positively affect our pain. #sdpain
#sdpain @BethDarnall Catastrophizing = nocebo effect
#sdpain @BethDarnall We're born knowing how to escape pain, but we can't escape something that is happening inside of us.
Darnall - Pain is a product of the nervous system. Paying too much local attention counterproductive. #sdpain
We're born knowing how to escape pain, not chronic pain which is something inside us. We don't know how 2 modulate that @BethDarnall #sdpain
#sdpain @BethDarnall Pain Catastophizing: increased distress, more mm and jt tenderness, mm tension at rest, pain-related disability
Darnall - Pain catastrophasizing - rumination, helplessness #sdpain
#sdpain @BethDarnall Pain Catastophizing primes the NS 4 pain and sets stage for prolonged symptoms, chronic pain, & poor surgical outcomes
Darnal- Pain catastrophizing - shapes neural functioning; shapes the brain at rest; primes nervous system for pain -> chronic #sdpain
#sdpain @BethDarnall Pain Catastophizing can reduce (not eliminate) chronic pain and increase patient control
Darnall - Cognitive Behavioral Therapy has been effective. #sdpain
#sdpain @BethDarnall Pain Catastophizing can be treated and subj changes in catastrophizing obj'ly changes the brain https://t.co/2f1g1yTF6M
Cognitive Behavioral Therapy may increase prefrontal gray matter in chronic pain - Seminowicz 2013 #BrainPainChange #sdpain @BethDarnall
This is your brain on #catastrophising and giving people tools to soothe their thoughts changes lives @BethDarnall… https://t.co/gieZNGdlkl
#sdpain @BethDarnall A piece of her own research: https://t.co/rgsX39B4wy
Pain isn't a passive experience, we can do something about it and that's exciting - @BethDarnall #sdpain
Darnall - Large effect sizes from two-hour class. (Cohen's D). #sdpain
#sdpain @BethDarnall 1/3 of people after surgery have prolonged pain. Catastrophization is the largest predictor...BAR NONE.
Great presentation by @BethDarnall with the plan and research to back it up https://t.co/zAASUhxfQU #sdpain
Water should be offered if client is thirsty, not to flush out "toxins." #sdpain @PainSci https://t.co/Nql2zYkLTs
"If you google me, I have hate mail" for using the term catastrophizing. @BethDarnall #sdpain
Have you received hate mail b/c you're learning about pain science? @BethDarnall did, & so did we. #sdpain
The 'something' that has happened is the medical model of care. It switches us off to self-manage our pain #sdpain https://t.co/zbMKnQSRs6
#sdpain @BethDarnall We're born knowing how to escape pain, but we can't escape something that is happening inside of us.
Question to those attending #sdpain When will it be mandatory to learn educational pain selfmgt in medical schools?
#sdpain When we have persistent pain, the pain ceases to be the main problem. Sleep, etc becomes the main problems. https://t.co/MiZ3OYrmwx
#sdpain @PeteOSullivanPT Pain is not always a problem in itself, being disabled by pain and pathologising pain is the main problem
For me stretching and exercise plays a major part of the Pain Mgt programme #sdpain https://t.co/GymurF0LoR
#sdpain @PeteOSullivanPT @MyCuppaJo "Exercises are redundant. They're there to disconfirm the unhelpful beliefs and restore function"
Test your pain selfmgt knowledge and skills by playing the Pain Toolkit on-line game https://t.co/hSCH5XrLaa
#sdpain
The Larry Steinbeck Daily is out! https://t.co/0JMUmMZMps Stories via @PranaPT @Brewbound @sempercuriosa #beerevent #sdpain
seeing these #sdpain tweets make me miss @EntropyPhysio. Can't wait for #CSM2017 to reminisce w/ @SandyHiltonPT @SarahHaagPT @RyanSmith_DPT
I just want to thank all the participants who are tweeting at the #sdpain There are some great messages being posted 👍
@healthy_lawyer @ZosiaRMamet @DrJenGunter Like "improving your posture." Hmmmm.....🤔#sdpain
| Saturday | to Top |
Wow. #sdpain Lissanthea Taylor's poem. Well done! https://t.co/zA3eY16U1U
Diagnosis and classification of pelvic girdle pain disorders via case studies #sdpain
https://t.co/JWhgUJ09wo https://t.co/0zly6ZH52l
@JonFass is there any cliff notes or similar from #sdpain ?
@SandyHiltonPT @lissanthea @bodyinmind I was late to the venue and missed it! So I was very glad to see this video! #sdpain
Thank you all for the live tweets! Great stuff coming out of #sdpain 👍 https://t.co/YeUX0ikxNJ
Follow @SandyHiltonPT @waldronphysio @ramblemuse @dfjpt @JonFass @jasonsilvernail for #sdpain tweets.
#sdpain clarification https://t.co/PyIaVV6X3K
Apologies. WE (therapies) can serve to help reduce catastrophizing, but that alone will not abolish the pt's pain;… https://t.co/XDRviKsx7E
Day 2 #sdpain getting going
#sdpain @lissanthea Reading her poem live. Here is a link: https://t.co/WuhfpFn6fa #powerful
Day 2 of @SanDiegoSummit starts now (day one for me) #sdpain
Day 2 of #sdpain with Dr. Jeffrey Mogil
#sdpain resumes with Jeffrey Mogil, "Pain in mice and man: Ironic adventures in translation." (from one animal to another)
#sdpain @JeffreyMogil Topic - translation of research from experimentation to individualized care
#sdpain @JeffreyMogil The challenge of translation. We can't do experiments on you. So we have to use animals to get causal information
@JeffreyMogil start the day @SanDiegoSummit #sdpain
#sdpain @JeffreyMogil Rodents are of great value to science research: small and cheap
Mogil - Can only do correlation in humans. For causal experiments have to go to animals (rodents). #sdpain
#sdpain @JeffreyMogil (BPS) He is going to argue that bio is LEAST likely to translate vs P&S
#sdpain @JeffreyMogil We assume at the bio level things should translate pretty well and not at psychosocial level, but this is backward
"As you go up 2 psychosocial issues, you would think animal studies wouldn't translate. It's actually the opposite" @JeffreyMogil #sdpain
#sdpain @JeffreyMogil Even with all this knowledge we still have a huge translation problem. A drug looks OK in animal model but in humans?
Despite all of info about the brain and spinal cord over the past decade there is still a translation failure from animal 2 human #sdpain
Mogil - Despite micro-neurological knowledge we still face failure of translation. Worked in animals, but not in clinical trial. #sdpain
#sdpain @JeffreyMogil #1 cause of drug not translating from mice to men is (drum roll)...doesn't work in humans.
#sdpain @JeffreyMogil Clinical trial fails, and everyone wonders why.
#sdpain @JeffreyMogil There are problems with the animal models, reproducibility, etc.
Y poor translation from animal 2 human in Research: clinical trials?? Can't reproduce the science?? #sdpain @JeffreyMogil
#sdpain @JeffreyMogil Why? Generalizabiliy? Species diff? Dependent measures? Clinical Trials don't illuminate the data?
#sdpain @JeffreyMogil The talk is about how we might correct the problem
Mogil - Why the poor translation? Wrong animal models? Problem in clinical trials? #sdpain
The issue of genetics: rats and mice are used in Pain research. And only on 1 kind of mouse or rat. Not a lot of diversity #sdpain
#sdpain @JeffreyMogil Lots more rats than mice used in animal research. Genetics: most research is used on 1 kind of mouse and 1 kind of rat
#sdpain @JeffreyMogil 2 species most often used in research: rat & mouse. Most pain research is done on 1 kind of each
Research is done primarily on rats & mice (mostly rats). Limits genetic diversity & is 1* two types. @JeffreyMogil #sdpain
Of all the species in the world research uses only 1 type of mouse and 1 type of rat in pain research. Is this a limitation? #sdpain
#sdpain @JeffreyMogil Strains are different from each other. Some strains are vulnerable, some are resistant, some are average.
"Of all the genetic diversity in the world, we've settled on rats. We've reduced it down, and that can be a problem" @JeffreyMogil #sdpain
Mogil - We've settled on two species (mice and rats) and limited strains of those. Lacks genetic diversity. #sdpain
"I know you can't see what's going on here, but it doesn't matter" (Best description of a slide of data I've heard). @JeffreyMogil #sdpain
#sdpain @JeffreyMogil So, using one strain of rat for pain research, but each strain of rat has great variability in their pain presentation
#sdpain @JeffreyMogil CGRP (calcitonin gene related peptide) associated with heat pain. Is it involved in heat pain or no? Depends on strain
*Treatment* for catastrophizing can reduce chronic pain: Learned skills that dampen distress & pain processing in t… https://t.co/DT1ryFw3BO
#sdpain @BethDarnall Pain Catastophizing can reduce (not eliminate) chronic pain and increase patient control
#sdpain How could we reasonable extrapolate to humans the results of a study on one strain of rat? #inconvenientquestion
Genetics of animal in the research can make the trial of the drug produce vastly different results. Problem if only using 1 animal #sdpain
#sdpain @JeffreyMogil For reasons on cost we only experiment on one strain of rodent at a time. The results are extrapolated to all strains
Mogil - Significant variation between strains - qualitative genetic differences. Lack of generalization. #sdpain
#sdpain @JeffreyMogil High variability in pain response with varying strains of rat models which make generalizability to humans difficult.
"If U do the same test on 12 different strains of rats, there's change in only 1/2. Did the drug work? I don't know" @JeffreyMogil #sdpain
A major problem in the research is the limitation to 1 strain at a time and poor ability to generalize... @JeffreyMogil #sdpain
#sdpain @JeffreyMogil And to humans. Male mice are standing in for human women. And women are the "real clinical problem"
Mogil - Problem using one strain of male rats as a stand-in for middle-age woment. #sdpain
#sdpain @JeffreyMogil 70% of the chronic pain patients are female. Percent of studies that use male mice -> 79%. Can we trust the results?
#sdpain @JeffreyMogil 70% of chronic pain is reported by females - Irony: 79% of rats in studies are male only. #mismatch
70% of patient tend to be women while the studies mainly use male mice. Doesn't match up! #sdpain https://t.co/ayeHrQgTPj
#sdpain @JeffreyMogil Mismatch. Why does this matter? Should we make the assumption that the biology is equivalent?
#sdpain @JeffreyMogil Morphidex failed. It's a cautionary tale..
"70% of pain patients are female, but 79% of research uses male mice only. That matters" @JeffreyMogil #sdpain
"You are making an assumption at your peril" Morphidex studied only on male mice. Clinical trial failed. @JeffreyMogil #sdpain
Mogil - Cautionary story of Morphidex. Idea was to enhance morphine effects. Works in male mice but not in females. #sdpain
#sdpain @JeffreyMogil The data were sealed and the lawyers said, we've moved on. Maybe Morphidex worked in men, not women, but we won't know
The cautionary tale of morphidex: tested only male rats; made a difference; on women made no difference. only tested on male rats #sdpain
Mogil - Drug company refused to look at gender data. Data sealed. "We've moved on". #sdpain
#sdpain @JeffreyMogil In sp.cd. we used to think only the neurons were important but now we know the microglia are JUST as important
#sdpain @JeffreyMogil You start off with mechanosensitive animals, make them allodynic, and male animals will respond differently to females
@jptlowy #sdpain @JeffreyMogil Good question - not the focus of his talk. Context: how male/female rats respond diff to meds.
#sdpain @JeffreyMogil Something that blocks microglial activation in males does nothing in females
A bit of geek heaven #sdpain @JeffreyMogil Microglia studies done on male mice are +, on female mice they are - (fe… https://t.co/5H86ufIuC2
#sdpain @JeffreyMogil evidence: huge sex difference in how male and female mice process pain
"No sex difference in amounts of pain, huge sex difference in how it's processed" @JeffreyMogil #sdpain
No sex difference in amount of pain but different in how the pain reacts to treatment @JeffreyMogil #sdpain
Mogil : No sex difference in the amount of pain. But females use T-cells to process pain; males use micro-glia. #sdpain
#sdpain @JeffreyMogil How we measure pain in animals in the first place:
#sdpain @JeffreyMogil Pain researchers may be measuring the wrong thing.
Seems last night's @Jackson_LLP_Law blog was perfectly synced w/ today's #sdpain agenda!
https://t.co/bfVYlqqwfn https://t.co/C91TXzVNOx
#sdpain @JeffreyMogil 70% of chronic pain is reported by females - Irony: 79% of rats in studies are male only. #mismatch
In respect to Pain: females process w/ T cells no microglia; males all microglia. how will this affect treatment? #sdpain @JeffreyMogil
#sdpain @JeffreyMogil What do pain researchers measure in animals? Mechanical allodynia, thermal analgesia, & spontaneous pain.
#sdpain @JeffreyMogil Mostly they measure mechanical allodynia. They don't have a way to measure deep pain
#sdpain @JeffreyMogil Scientists are researching outcomes that don't have clinical application. https://t.co/sKHM7zmIdy
#sdpain @JeffreyMogil What do pain researchers measure in animals? Mechanical allodynia, thermal analgesia, & spontaneous pain.
Mogil - Ongoing, deep-seated pain is something we haven't know how to measure. Measuring wrong symptoms. #sdpain
#sdpain @JeffreyMogil They don't measure spontaneous pain much or well, although they have started to try. Neither mice nor babies speak.
#sdpain @JeffreyMogil Facial grimacing scales are used, cheek bulge etc.
#sdpain @JeffreyMogil There is a moue grimace scale, modeled after human baby grimace scale https://t.co/J56xoXQPwA
#sdpain @JeffreyMogil Grimace scales are being used by veterinarians now
Thinking of my fav @adiemusfree quote "If you measure the wrong thing well, you still don't know anything" @JeffreyMogil #sdpain great talk
#sdpain @JeffreyMogil Hypothesized causes of irreproducibility are thought to be mainly statistical issues
#sdpain @JeffreyMogil Link: https://t.co/k9xsWZVtyn https://t.co/ruQnyBEyJF
#sdpain @JeffreyMogil There is a moue grimace scale, modeled after human baby grimace scale https://t.co/J56xoXQPwA
#sdpain @JeffreyMogil However there are other possible causes. Labs differ greatly. Human presence means less facial grimacing.
#sdpain @JeffreyMogil It matters whether human presence is female or male! If human is male, mice grimace less.
The smell of male humans stress out the mice in research labs @JeffreyMogil #sdpain
#sdpain @JeffreyMogil Mice and rats are afraid of men. More stress-induced analgesia.
#sdpain @JeffreyMogil Rat grimace scale findings R skewed in presence of scent of male humans - simple things making reprod of research dif
#sdpain @JeffreyMogil Less facial grimacing noted in mice in experimental conditions when male researchers were present in room.
#sdpain @JeffreyMogil Treatment advantage. Placebo FX is only increasing in trials in the US. Why?
Mogil - Placebo response have gotten larger over time, but only for trials conducted in the U.S. #sdpain
#sdpain @JeffreyMogil FYI - placebo effect has growing strength in studies in US and NZ, but no where else. Draw your own conclusions.
Placebo effects in research r ⬆️ in the past years from 10% to 30% but only in USA. The Q is why? @JeffreyMogil #sdpain
#sdpain @JeffreyMogil Social manipulation of pain in mice and rats..
"Placebo effect is growing, but only in the USA. In the rest of the world's experiments, this isn't happening" @JeffreyMogil #sdpain
#sdpain @JeffreyMogil Moving on to social modulation of pain in rodents/research animals...
Hmmm.... does direct to consumer advertising from pharmaceutical companies increase the placebo effect in the US? Maybe. #sdpain
#sdpain @JeffreyMogil Lab mice have a social life! They do things even in a cage that can be measured/manipulated. Real paucity of research
#sdpain @JeffreyMogil social behav of mice: grooming, play fighting, competitions (...slide disappeared ;) )
The things we study in clinical trials for #pain are not the things people worry about. Can we make science human c… https://t.co/PGdu6crxVw
Mogil - Lab mice have a social life. Open door for psycho-social experiments. #sdpain
#sdpain @JeffreyMogil socially mediated contagious pain hypersensitivty
Rats in labs do have a social life. #sdpain @JeffreyMogil #ineedtogetoutmore
For all you #painkillers go #onlineshopping at https://t.co/UVTg6ZJoSF and save 70% on your #painmeds +… https://t.co/tfaHwrg6hZ
"If 2 mice are in pain AND they know each other, there's more pain. This is empathy in mice" @JeffreyMogil #sdpain
#sdpain @JeffreyMogil It's only true if they know each other! If the mice are strangers no FX. Evidence of empathy!
#sdpain @JeffreyMogil Measure writhing of mice with nociceptive stim: + writhing if in presence of other mouse, but only if acquainted
Rats have empathy, an emotional contagion. Rats can have targets helping @JeffreyMogil #sdpain
Mogil : Socially mediated "contagious" hyper-sensitivity. Active in cage-mates. Considered to be empathy effect. #sdpain
#sdpain @JeffreyMogil Why do strangers not feel empathy? Stranger danger/stress.
@SandyHiltonPT @NeilOConnell @Pain_NeuRa @dibbygibby I'm thinking writhing scales, and zebra fish lips. Animal studies are hard. #sdpain
Mogil - With strange mice, stress goes up, blocking empathy. Blocking stress, empathy appears. #sdpain
#sdpain @JeffreyMogil Stress maybe prevents empathy. If you block cortisol, they react just like cagemates. Can be replicated in humans
#sdpain @JeffreyMogil Cold pressor test in humans.
R strangers stressful? It is indeed true. Stress may prevent empathy? If u can ⬇️stress u might b able to ⬆️ empathy @JeffreyMogil #sdpain
#sdpain @JeffreyMogil Two people per ice-water dunk. If you're tested across from a friend it hurts more. Your friend didn't make it better
#sdpain @JeffreyMogil Pain - is worse in the presence of friend (emotional contagion) - study with college students with hand in ice bath.
#sdpain @JeffreyMogil Your friend made it worse. If it was with a stranger, no FX.
"If humans are pain-tested with from friends, it's worse than with strangers. That's social contagion, just like mice" @JeffreyMogil #sdpain
Mogil - Humans showed same effect. Watching friends in pain made own pain worse, but not with strangers. #sdpain
#sdpain @JeffreyMogil What is FX of pain on social behaviour? You need proximity.
#sdpain @JeffreyMogil Approach/avoidance manipulation
@SanDiegoSummit trending on twitter right now! Get in the action follow #sdpain @SandyHiltonPT @SarahHaagPT… https://t.co/hVLI82Ifgr
#sdpain @JeffreyMogil Response to pain in the presence of a friend works paradoxically by increasing pain levels-present in rats and humans.
#sdpain @JeffreyMogil If mice are all girls, the free range mouse will spend more time with the mouse in pain.
#sdpain @JeffreyMogil If the mice are cagemates the social contact reduces the pain.
#sdpain Laying down the foundation - mice & us R more alike socially than biologically. How the hell is pain research expected to translate?
Mogil - With female mice that know each other, mouse in middle will spend time with mice in pain, lowering pain. #sdpain
#sdpain @JeffreyMogil Clever experiment in humans. Subject is put in room with another person instructed to do one of three behaviours
#sdpain @JeffreyMogil Either be neutral, pretending to be sick, or pretending to be in pain. Men don't care. Females will sit closer to
Science says it: Men just really don't care. @JeffereyMogil @SandyHiltonPT #sdpain
Do ppl approach or avoid pain? women sit away from ppl pretending 2 b sick close 2 ppl in pain. Men could care less either way #sdpain
#sdpain @JeffreyMogil Subject will sit closer to one in pain, if female. Sociology is easier to translate than bio!
"You would expect that in translation, biology would be easy and sociology would be hard, it's the reverse" @JeffreyMogil #sdpain
Mogil - We can do translation. Works well for sociology but harder with biology (ironic - backwards from per-conceptions) #sdpain
@laurenkDPT @SandyHiltonPT We will do our best. Follow #sdpain @ @waldronphysio @karenlitzyNYC & more are tweeting too!!
Great pres on translational research. thanks @JeffreyMogil Looking forward to next @IASPPAIN poster hall even more! @SarahHaagPT #sdpain
#sdpain @JeffreyMogil We've been lumping when we should have been splitting
How quickly @Twitter trends move! @SanDiegoSummit #17 to #15 in about 10 min! Follow #sdpain 4 amazing content on P… https://t.co/HSxg01SI5r
#sdpain @JeffreyMogil Researchers have been afraid of the estrous cycle. However that is swamped by dominance FX from males
#sdpain 70% of chr pain suffers are documented/reported 2B female. To @jptlowy's ?, do men suffer less, or more quietly? Impact on research?
#sdpain @JeffreyMogil Empathy: many definitions. Russian doll model with social contagion at its core
You need emotional contagion first then empathy can develop. Maybe @JeffreyMogil #sdpain
#sdpain @JeffreyMogil Only true way to study anything in people is to fool them.
#sdpain Now on deck: @CorKinetic
Great talk clearly stating the limitations and the need for careful study "you have to walk before you can run"… https://t.co/TGaR4pDJOv
You need emotional contagion first then empathy can develop. Maybe @JeffreyMogil #sdpain
We can identify the intensity of pain mice feel with visual cues. #sdpain @JeffreyMogil https://t.co/tBXAwlVJ4W
#sdpain @CorKinetic - "Moving away from exercise & towards movement"
#sdpain @CorKinetic Moving away from ex and toward movement.
@CorKinetic Ben Cormack up next. Moving away from exercise and towards movement #sdpain https://t.co/SCQ56ao9Od
@CorKinetic takes the stage, without a sunburn #sdpain #britsunburn
Pretty excited for @CorKinetic 's talk... #sdpain
Moving away from exercise towards movement w/ @CorKinetic #sdpain
#sdpain @CorKinetic Exercise and movement through a pain science lens
Exercise and movement through a pain science lens @CorKinetic #sdpain
#sdpain @CorKinetic what are the psychosocial factors of mvmt and ex?
"Exercise is not what ligaments or joints or muscles do, it's what human beings do" @CorKinetic #sdpain
We have to start looking at movement as something humans do, not what ligaments, muscles and tendons do.
Ben Cormack #sdpain
#sdpain @CorKinetic Ben celebrating the San Diego weather and the fact he has managed not to get burnt to a crisp #sad #notwhatweweresold
We need to look at the psychology &a social context w/ exercise & mvmt vs just the physical factors @CorKinetic #sdpain
Next speaker at #sdpain is Ben Cormack speaking on exercise, movement and pain.
#sdpain @CorKinetic measures still look at physical things. But in patients, we have to go past that.
#sdpain @CorKinetic Movement is something that Humans do, not joints, muscles, ligaments, etc #reconceptualize https://t.co/dltAAIbdCV
Looking forward to @CorKinetic talk. "Movement and exercise and the psychology of the human, blended w pain science" #sdpain
#sdpain @CorKinetic Favourite measure: one Shit-Ton.
#sdpain @CorKinetic a shit ton of new information about pain - standard universal measure
Having fun with movement. Would that change a perception of movement and pain associated w/ mvmt @CorKinetic #sdpain
changing people's perception of what it is to move - can we stop focusing on tissues and focus on fun #sdpain @CorKinetic
We have a shit ton of new information on pain! @CorKinetic #sdpain
#sdpain @CorKinetic Change peoples' perception of what it means to move. Take advantage of predictive capacity.
#sdpain @CorKinetic is advocating for movement being fun. Restore their enjoyment of movement.
Aim of exercise and mvmt should b to bring joy back into someone's life @CorKinetic #sdpain
Cormack - Concepts of how movement affects pain hove remained static. Measurement of published papers by the "shit tonne". #sdpain
Loads of people with chronic pain hate exercise - makes sense. How does this inform our approach? #sdpain @CorKinetic
"2 get people moving & exercising again, would fun be an outcome measure? Would that get people moving again, U think?" @CorKinetic #sdpain
#sdpain @CorKinetic Consider: context, perception, emotion, self efficacy, locus of control, education. (Not found in exercise guidelines)
Context of being in a gym can be really threatening for a person with pain #sdpain @CorKinetic
Find the right context for exercise (match it to the person, not the therapists preferences!) #sdpain @CorKinetic https://t.co/Jd9vHsEehu
Aim of exercise and mvmt should b to bring joy back into someone's life @CorKinetic #sdpain
R we taking in the context surrounding exercise to make it fun for those w/ chronic pain. What is the pt perception? @CorKinetic #sdpain
"How many people in chronic pain might not like the gym, be comfortable there? Would the gym help them?" @CorKinetic #sdpain
#sdpain @CorKinetic Issues: Context, perception, emotion, self-efficacy, L of C, ed., reconceptualization... Cpain issues apply to ex&mvmt
The standard measure for the amount of new research about #pain yet the burden of pain isn't changing? More researc… https://t.co/B3O2ifJ35z
We need to create a positive context and environment associated w/ exercise and empower ppl to do for themselves @CorKinetic #sdpain
#sdpain @CorKinetic We need to create the right environment for people to adopt ex&mvmt
#sdpain @CorKinetic To @Jerry_DurhamPT's point yesterday, these factors always discussed re: pain science, but not… https://t.co/i9PxOz5aS6
#sdpain @CorKinetic Consider: context, perception, emotion, self efficacy, locus of control, education. (Not found in exercise guidelines)
Some of the factors that can influence efficacy of exercise approaches #sdpain @CorKinetic https://t.co/O0FfNPdrDJ
Cormac - Things related to paint not regularly discussed in the literature. #sdpain https://t.co/ElZBNC2bvE
Cormack - What are our aims with exercise? #sdpain
#sdpain @CorKinetic Need to think about what our aims are of getting people to move
#sdpain @CorKinetic Trad aims of ther ex: + load tolerace, mm activity, aero capacity, strength.
Cormack - Promoting self-efficacy - what someone can do for themselves. Maybe creating new positive memories. #sdpain
New aims of mvmt: create new positive memories (turn the DIMS to SIMS) @noigroup @CorKinetic @SarahHaagPT @SandyHiltonPT #sdpain
#sdpain @CorKinetic Creating new positive memories could be an aim of movement intervention -perhaps less important than physical measures
'How moving makes you feel is much more important to me than the usual 'objective' measures' @CorKinetic #sdpain
Having thoughtless and fearless movement could be a fabulous subjective aim #sdpain @CorKinetic
"What about creating freedom in exercise? Exercise is about rules, do people in pain have too many rules?" @CorKinetic #sdpain
#sdpain @CorKinetic Some new motivations for Ex&mvmt: Freedom! creating new positive memories, thoughtless mvmt, basic flow, enjoymnt
#sdpain @CorKinetic Exercise traditionally about rules RE proper execution but can be reframed as thoughtless movement or enjoyment.
Cormack - What about just having basic "thoughtless" movement? Throwing away rules (opening possibilities). #sdpain
#sdpain @CorKinetic What happens if you don't change any physical function measure but you increase enjoyment - still a win?
Many people with pain attend the gym I go. #sdpain https://t.co/cqf75rFQtZ
"How many people in chronic pain might not like the gym, be comfortable there? Would the gym help them?" @CorKinetic #sdpain
Even if no changes r made "physically" how great would it b 2 make these changes for ur pt w/ pain. @CorKinetic… https://t.co/HBLCsJHTuB
#sdpain @CorKinetic New aims: + memories, freedom of mvmt, thoughtless mvmt, fluidity, enjoyment, meaningful, relev… https://t.co/kkYKtyoko0
#sdpain @CorKinetic Trad aims of ther ex: + load tolerace, mm activity, aero capacity, strength.
Exercise has to have meaning to the patient so they will have a reason to engage with it. #sdpain @CorKinetic
@CorKinetic let's add in meaningful and fun! #sdpain
#sdpain @CorKinetic Make it meaningful and relevant. Has to resonate. Mindful. Desensitize. I'm very biased toward mvmt.
"If we can change one thing, it might change everything" Thinking about the Why behind the What. @CorKinetic #sdpain
#sdpain @CorKinetic Clients understanding the 'why' behind the 'what' is critical when considering exercise prescription.
Exercise as an intervention is not "the answer". #sdpain @CorKinetic #itscomplex #pain
Cormack - I'm biased about movement, which is a good thing. But exercise is not the answer. #sdpain
Important to make stretching/exercises fun, set goals and action plans #sdpain https://t.co/HvDQ5cba7Q
R we taking in the context surrounding exercise to make it fun for those w/ chronic pain. What is the pt perception? @CorKinetic #sdpain
#sdpain @CorKinetic It's complex. All models are wrong but some are useful
👍 #sdpain https://t.co/J3yXYAguhg
Find the right context for exercise (match it to the person, not the therapists preferences!) #sdpain @CorKinetic https://t.co/Jd9vHsEehu
No single intervention is going to provide the answer for complex problems. Human beings are complex #sdpain @CorKinetic
@paintoolkit2 Yep - some do. Some don't. @CorKinetic didn't say different, just many don't. #sdpain
Yes!! 👏👏 #sdpain https://t.co/zaUw34SCcl
Exercise as an intervention is not "the answer". #sdpain @CorKinetic #itscomplex #pain
'All models are wrong, but some are useful' - @CorKinetic (quoting someone else whose name I missed). #sdpain
No singular intervention is going to provide the answer for complex things - @CorKinetic #sdpain
Cormack - Exercise is not a magic bullet. It's more complex than that. "Just get them exercising" isn't enough. #sdpain
Exercise is not THE answer. Why do we expect to see large effect sizes from a singular intervention? It's complex. @CorKinetic #sdpain
Why do we expect to see large effect sizes from singular interventions? - @CorKinetic #sdpain
Why do we expect to see large effect sizes from a singular intervention?? @CorKinetic #sdpain https://t.co/J4XE4RThUq
#sdpain @CorKinetic We see small sample sizes, and small FX sizes, but why do we expect large FX sizes out of a singular treatment approach?
#sdpain @CorKinetic Exercise is NOT THE answer - small/mod effect, inconsistent findings. Many other modalities can have + effect.
Why would we expect to see large effect sizes from a single intervention - lots of interventions have small effect size #sdpain @CorKinetic
If we put a few of these single interventions with small effect size together we start to see good changes #sdpain @CorKinetic
Cormack - Why do we expect to see large effect sizes from a single intervention? Look to combinations. [treatment "cocktails"] #sdpain
#sdpain @CorKinetic FX of exercise on pain has small-moderate effect sizes. Should come as no surprise when studying any intervention in iso
Exercise really is pretty good. For general health it is a good thing. We need to educate pt about this @CorKinetic #sdpain
#sdpain @CorKinetic Ex is pretty good, 4 general health, is assoc with decreased pain, decreased inflam, improves cross talk between tissues
#sdpain @CorKinetic Exercise is however associated with decr. pain, anti-inflammatory state, and protects vs some CAs and metabolic disease
#sdpain @CorKineticNo concrete idea how ex works for pain.
At the moment we have no concrete idea on how exercise works for pain @CorKinetic #sdpain
#sdpain @CorKinetic We don't have concrete ideas about how exercise works for pain - tricky thing to measure.
#sdpain @CorKinetic We know exercise 'works' but the exact mechanisms are not clearly delineated in the literature.
#sdpain @CorKinetic Various deficits don't change but pain does. How? No correl between ex and strength, flexibility, stab., endur..
Physical measures don't have to change for people to get better from exercise - @CorKinetic #sdpain
The physical measures we target don't have to get better for people to have less pain. (measuring the wrong thing?) @CorKinetic #sdpain
Cormack - We have NO real concrete idea on HOW exercise works for pain! Physical measures don't have to change for improvement. #sdpain
Strength, flexibility, stability & endurance for back pain change - no correlation. Steiger 2012 @CorKinetic #sdpain
#sdpain @CorKinetic Ex makes people feel better. Maybe that's all.
#sdpain @CorKinetic How does ex help folks in pain? Strength, ROM, & kinematics don't correlate. https://t.co/qOIBCRnHxn
This is because we are all or nothing people/thinkers. We do too much, too soon. Pacing up stretching/exercises are… https://t.co/zLV5GKNgHF
Loads of people with chronic pain hate exercise - makes sense. How does this inform our approach? #sdpain @CorKinetic
So far a big take away from @CorKinetic talk is make exercise program for the individual incorporating what they like & make it fun #sdpain
#sdpain @CorKinetic Nothing has to change (physically, in measures) to feel better.
Why not throw the baby out with the bathwater? Because the baby doesn't like it. I'm really digging this talk by @CorKinetic #sdpain
The research often says we don't need to change objective physical measures-ROM etc to reduce pain or improve function #sdpain @CorKinetic
Main message here is...to keep it bloody simple...oh and fun 😃#sdpain https://t.co/HQrrEOmnoa
Looking forward to @CorKinetic talk. "Movement and exercise and the psychology of the human, blended w pain science" #sdpain
#sdpain @CorKinetic Let's look beyond physical measures.
Helping ppl have fun with exercise is fun for the clinician as well ⬇burnout @CorKinetic #sdpain
Cormack - Continuum between physical and psychological & simple and complex. #sdpain
#sdpain @CorKinetic FX of ex are psychological - if you believe it helps it probably will. Reconceptualizing "work" as "exercise"-> benefit
Expectations play a massive role in recovery https://t.co/0HJbRAnVWr @CorKinetic #sdpain
If u believe exercise will work it probably will. The pt is more likely to do the exercise if they believe it will help @CorKinetic #sdpain
#sdpain @CorKinetic Positive beliefs regarding regular activity or exercise can augment physical characteristics.
Cormack - The most accurate predictor of getting better is their expectation of getting better. #sdpain
What's the #1 thing for prediction of recovery? Expectation of getting better. @CorKinetic https://t.co/ETTY4eAI2n #sdpain
The best evidenced base thing is redundant if it never gets done @CorKinetic #sdpain
Doesn't matter how evidence based an intervention is - if patient doesn't think its going to work it's redundant @CorKinetic #sdpain
@BJSM_BMJ w/ a shoutout from @SanDiegoSummit #sdpain https://t.co/58qpH8U0Xf
What's the #1 thing for prediction of recovery? Expectation of getting better. @CorKinetic https://t.co/ETTY4eAI2n #sdpain
Just b/c we THINK a certain type of training COULD create positive effects does NOT mean it will! #sdpain @CorKinetic
For me....doing daily exercise means I've no need to take ANY pain meds since 1997. #sdpain https://t.co/aCeqCw90bc
Cormack - We have NO real concrete idea on HOW exercise works for pain! Physical measures don't have to change for improvement. #sdpain
#sdpain @CorKinetic We have to be careful about bias in exercise.
Practitioners probably need to check their own bias when prescribing exercise - my preference is not the same as my patient #sdpain
#sdpain @CorKinetic engagement is the crucial thing. Doesn't matter "what"
#sdpain @CorKinetic Biggest challenge - getting people to engage. Empower folks to appreciate how and why to get it done
Biggest challenge for active patients is less about WHAT to do but WHY they do it and HOW to do it. #sdpain @CorKinetic
Watch ur bias as the clinician. Reminds me of talk "if as the PT U can do the exercise U should not teach it" fault… https://t.co/i5BiTzlSpw
Make sure when you are setting goals that they fit with what the patient is wanting to get out of therapy @CorKinetic #sdpain
#sdpain @CorKinetic We could change our ideas about goal-setting - find out what people care about. Interact, listen.
#sdpain @CorKinetic How do we engage: improve goal setting, patient specific outcomes, pt preferences, know previous experiences.
Ur goal setting should be things that the pt really cares about! U get this from listening to the pt @CorKinetic #sdpain
"We need to change our ideas on goal-setting. Create that therapeutic alliance" @CorKinetic #sdpain
Do: Goal setting (get your interview skills up!), outcome measures (patient specific functional scale!), preferences, expectations. #sdpain
#sdpain @CorKinetic How do we do all this? Get to know the patient. Be an interactor. #Ask #listen https://t.co/I9yBtBzi1x
#sdpain @CorKinetic How do we engage: improve goal setting, patient specific outcomes, pt preferences, know previous experiences.
Build on the positive experiences of the pt and address the negative when setting goals @CorKinetic #sdpain
#sdpain @CorKinetic Can we build on the positive? Address the negative? Find the obstacles and barriers? Address them? Main barrier: pain
Patient previous experiences - both positive and negative need to be visited so you can understand them @CorKinetic #sdpain
It's not that we don't think it'll work, it's we've been switched by the medical model to think for ourselves… https://t.co/aZsTiP4UYf
Doesn't matter how evidence based an intervention is - if patient doesn't think its going to work it's redundant @CorKinetic #sdpain
#sdpain @CorKinetic Pain is the #1 barrier preventing individuals from exercising.
Cormack - What can we do?
Goal setting
Client preferences
Exercise experiences (current and past) #sdpain
'Goal setting - Things that people really care about' @CorKinetic #sdpain In the US, can be tricky when pt goals arent covered by insurance
#sdpain @CorKinetic How do we address the pain barrier? Not make pain worse. Dosage. What to create minimum effective dose.
@CorKinetic we must create the minimally effective dose for these pt. This includes ed on what happens if it does go wrong #sdpain
#sdpain #humanistic https://t.co/gITKUTWb0j
"We need to change our ideas on goal-setting. Create that therapeutic alliance" @CorKinetic #sdpain
But... that does NOT mean you take the focus off of what the patient needs help for. (our system is broken :-( ) #sdpain
Cormack - Dosage. Consider what's already happening in people's lives. #sdpain
#sdpain @CorKinetic Education about what to do if sensation goes wrong.
How do we address barriers to exercise adherence? appropriate dose, education, self efficacy https://t.co/FxajtGH2fl @CorKinetic #sdpain
#sdpain @CorKinetic An analogy is sunburn. If I have sunburn, stay out of the sun for awhile. Dosage is key.
👍 #sdpain https://t.co/K8aDCHTRX8
Do: Goal setting (get your interview skills up!), outcome measures (patient specific functional scale!), preferences, expectations. #sdpain
If u get sunburn u change the dose. I stay out of the sun the next day or don't stay out as long next time @CorKinetic #sdpain #dosage
"If I get sunburnt, I just stay out of the sun the next day. The problem isn't sun, it's a dosing error." @CorKinetic #sdpain
👍 #sdpain https://t.co/KHAH7Z2aEN
Build on the positive experiences of the pt and address the negative when setting goals @CorKinetic #sdpain
#1 barrier to exercise is Pain - makes it worse. Ben Cormack at #sdpain. Can that be changed - yes
👍 #sdpain https://t.co/h9XPqaF0E3
Patient previous experiences - both positive and negative need to be visited so you can understand them @CorKinetic #sdpain
Fear of pain 👍 #sdpain https://t.co/SftcoxAkx8
#sdpain @CorKinetic Pain is the #1 barrier preventing individuals from exercising.
#sdpain @CorKinetic Barriers to exercise: Pain and anxiety re worsening, low self-efficacy, envisaging barriers (time, pessimism, dislike)
#sdpain @CorKinetic Give them info on how to manage their dosage. Planning. Help them work out how they are going to self-help
Barriers to exercise adherence: low self efficacy, envisaging lots of barriers to exercise @CorKinetic #sdpain
We've come a long way from #Descartes to Melzack & Wall. #sdpain
Spending time helping a person work out how they will plan for exercise is a worthwhile pursuit. Address barriers @CorKinetic #sdpain
👍 #sdpain https://t.co/VUhTnZb5EJ
@CorKinetic we must create the minimally effective dose for these pt. This includes ed on what happens if it does go wrong #sdpain
#sdpain @CorKinetic Time/ family/ work commitment. It's about the how and why, not the what.
Barriers to exercise: time, work, family, "it just won't help", etc @CorKinetic #sdpain
Pain science has evolved much since #Descartes. 400+ yrs of #research & #philosophy brought modern pain science… https://t.co/bpWt23Nisx
We've come a long way from #Descartes to Melzack & Wall. #sdpain
Cormack - Understand barriers to adherence. Beliefs, time, other activities, anxiety and depression. Need to set realistic levels. #sdpain
#sdpain @CorKinetic Find out current activity levels, why they have previously failed, set realistic level for tx
If exercise 'didn't work' before, it's important to suss out why, and do something different. @CorKinetic #sdpain
set small realistic goals to set up our pt for success. Small achievable goals to activate rewards systems in the brain #sdpain @CorKinetic
Cormack - Aim for small, achievable, goals. #sdpain
#sdpain @CorKinetic Teach family how to provide support
Set realistic expectations for exercise - small goals easy wins - activate rewards system @CorKinetic #sdpain
#sdpain @CorKinetic Ex can help anxiety and depression, at least according to some..
#sdpain @CorKinetic (cont) low levels of support, hx of failed exercise, anxiety, depression. https://t.co/NUZyddL8dR
#sdpain @CorKinetic Barriers to exercise: Pain and anxiety re worsening, low self-efficacy, envisaging barriers (time, pessimism, dislike)
#sdpain @CorKinetic predictive factors: Does ex fit their daily routine? If someone has a doubt, it won't happen.
Ask the pt where and when the exercise will fit into their life! ⬇️the barrier to adherence @CorKinetic #sdpain
#sdpain @CorKinetic #1 thing preventing individuals from complying with regular exercise was inability to include as part of daily routine.
#sdpain @CorKinetic If largest obstacle to exercise is fitting it into daily routine, need to work with pt to develop plan that works 4 THEM
#sdpain @CorKinetic Positive emotional support. Enough time, self-efficacy, previous success
Cormack - Any prescribed exercise and movement has to fit into people's daily routine. If not; won't do it. #sdpain
#sdpain @CorKinetic Brain predicts the future based on the past
Prescribing too many exercises (6 or more) can be an automatic failure of adherence @CorKinetic #sdpain
Cormack - The brain works as a Bayesian predictive machine - merging new info with past. #sdpain
Knowing what can predict adherence to exercise can help address those factors https://t.co/08RkUyqz7A @CorKinetic #sdpain
#sdpain @CorKinetic Therapist behaviours: clarify doubts and questions
#sdpain @CorKinetic Our job - clarify doubt/questions, supervision, inquiry re adherence, justify/explain utility of exercises
👍 #sdpain https://t.co/leyOKSraB4
set small realistic goals to set up our pt for success. Small achievable goals to activate rewards systems in the brain #sdpain @CorKinetic
#sdpain @CorKinetic The PERSON exercising matters, not the exercise
👍 #sdpain https://t.co/Vv5xhFULoN
If exercise 'didn't work' before, it's important to suss out why, and do something different. @CorKinetic #sdpain
#sdpain @CorKinetic The PERSON exercising matters more than the exercises themselves
#sdpain @CorKinetic They need to know why they're doing it
"The person exercising really, really matters, not the exercise." @CorKinetic #sdpain
#sdpain @CorKinetic They need to know how and why. Need support and be able to ask questions
The PERSON exercising matters. - sometimes the obvious needs to be stated. Thanks @CorKinetic #sdpain
The big take homes from a pain science perspective for exercise to be more effective @CorKinetic #sdpain https://t.co/pKs5gGu3aE
👍 #sdpain Problem is here..time is the enemy of the healthcare professionals 🤔 https://t.co/aUDGa7Mdc0
Spending time helping a person work out how they will plan for exercise is a worthwhile pursuit. Address barriers @CorKinetic #sdpain
#sdpain @CorKinetic Find out about potential barriers. Don't just hand out sheets of ex. Educate and plan to address efficacy
Amen 🙏 #sdpain https://t.co/UMh0KOidkK
"The person exercising really, really matters, not the exercise." @CorKinetic #sdpain
#sdpain @CorKinetic Playing on his London accent - has a bit more of an effect in America than in his home town! #usewhatyoucan
#sdpain @CorKinetic Remember FX of ex are more than just physical
Its not rocket surgery #sdpain @CorKinetic
#sdpain @CorKinetic Helpful to consider the social aspect of exercise for high level athletes who are unable to participate in their sport.
#sdpain @CorKinetic Can assess exercise dosage based on 1) immediate and 2) delayed responses. Important to find minimal effective dose.
#sdpain On deck: @JonFass
It is important to workout as well as work in..recovery days are important and necessary and most important OK! @CorKinetic #sdpain
How is ⬇ pain a reward? The pain is still there. Most ppl in chronic pain would accept ⬇ pain. What does recovery mean? @CorKinetic #sdpain
#sdpain @CorKinetic Determining what recovery means to a client is critical for assessing success. Goals may be based on pain or function.
👍 #sdpain https://t.co/qqpnG6I3V7
#sdpain @CorKinetic Determining what recovery means to a client is critical for assessing success. Goals may be based on pain or function.
@PeteOSullivanPT write a book please!!! My conclusions from #sdpain . I wanna learn more and more from you
Conferences to follow today in the #MedEd #FOAMed #hcsm and #PhysicalTherapy communities:
1. #SDPain
2. Concussions2017
Up next...well, me, actually 😬#sdpain #MayGodHaveMercyOnUsAll
Maybe FUN should be an outcome measure of exercise! Ben Cormack #sdpain
What you believe about the exercise you're doing (specifically whether it will work) actually matters 🤔 #sdpain
#sdpain @JonFass "Whilst our Hearts are violently set upon any thing, there is no convincing us that we shall ever be of another Mind."
#sdpain Jonathon Fass: (not on twitter by the look of things)
👍 #sdpain https://t.co/wWqNZ6OT9V
What you believe about the exercise you're doing (specifically whether it will work) actually matters 🤔 #sdpain
Jonathan Fass @JonFass Up next at @SanDiegoSummit #sdpain
#sdpain @jonfass thinks @CorKinetic could power a small country with his energy https://t.co/gtvrDYQj9a
#sdpain Jonathan Fass (<<- correct spelling)
👍 #sdpain https://t.co/dTMu0HgQVQ
@Samhja @paintoolkit2 @beyondmpain I've found a trainer who understands she has to stop me before I want to stop - low reps, small steps
@dfjpt #sdpain @JonFass
#sdpain All about communication. What good are we if we can't convey meaning?
"Whilst our Hearts are violently set upon any thing, there is no convincing us that we shall ever be of another Mind." Mary Astell
#sdpain
"I'm not good at many things, but I'm great at procrastination' - @JonFass #sdpain
@SandyHiltonPT - we are not alone! 😂
@JonFass takes the stage at @SanDiegoSummit #sdpain
Next #sdpain talk by Jonathan Fass - "A Tree Falls in a Forest: Improving Pain Science Communication to Patients and Peers" #sdpain
Never troll if you want to educate and share your knowledge. #sdpain @JonFass
How do we get people to listen to what we need to say? @JonFass #sdpain
We need to use communication to create better alliances with other healthcare providers.
Jonathan Fass #sdpain
#sdpain @JonFass We need to communicate well with everyone in the healthcare system
Fass - Communication is important to improving overall healthcare among multiple providers. #sdpain
#sdpain Communication & trust R needed 2 reduce cog dissonance & unlock potential of therapeutic relationship and… https://t.co/DVVgIz2VPl
Fass : Problem in conflicting messages from different providers. "Congeniality Bias". #sdpain
@waldronphysio @CorKinetic
Love what the "pain science" has brought,,,, to valuable to keep in pain group!!! Cheers. #sdpain
https://t.co/a7siUjboLG @ForwardMotionPT @JonFass #sdpain
#sdpain @JonFass Confirmation bias = human condition. Yes, we are talking to you.
If we can overcome our own confirmation bias we can then overcome someone else's bias @JonFass #sdpain
Nice demo of comfirmation bias - it's what we do! @JonFass (also razzing Rod which is fair, since he's not here) #sdpain
#sdpain @JonFass Dissonance is automatic. It is normal. Again, we all do this. Happens naturally. https://t.co/pcLUq8hExb
#sdpain @JonFass We construct narratives that confirm our worldviews without a second thought.
We don't decide to be against info it is just happening @JonFass #sdpain
'Every presentation should have cats' - @JonFass
I totally agree. But I'm also terribly biased. I love cats.… https://t.co/6QlS5TkMR8
Dissonance theory https://t.co/HNqH0NKj4V #sdpain @JonFass
#sdpain @JonFass Internal conflict between defending current beliefs/views and accepting those that are more accurate.
We can be defensive, but we can also seek accuracy. Overcomes the bias. @JonFass 👍🏼 #sdpain
#sdpain @JonFass Defense motivation competes with accuracy motivation. These motivations can compete with one another
#sdpain To overcome dissonance it helps to be motivated to seek greater accuracy.
Fass - Cognitive Dissonance - choice to protect current beliefs or to seek accurate information. #sdpain
"The accuracy of the information doesn't matter, but can I use that information? That's useful" @JonFass on the battle (automatic) #sdpain
#sdpain @JonFass Unlikely to integrate new information that is contrary to current beliefs if we can't derive it's utility or applicability.
We should recognize that people will automatically push back when we are presenting information.Can we lower our resistance to that?#sdpain
Starting with knowing that there will be pushback can decrease the threat/lower resistance to the information. @JonFass #sdpain
#sdpain @JonFass Start by acknowledging there may be pushback; lower your resistance 2 their resistance. Be less threatening, more congenial
Can we engage our peers 2 show there is less threat 2 the pain science info. What is it helpful and useful..not threatening @JonFass #sdpain
Can we think of cognitive bias as sensitized beliefs? Treat communication like we treat movement. Graded communication? @JonFass #sdpain
#sdpain @JonFass Treat education like movement - graded exposure, be non-threatening
Goal is not to be right but to create frequent high quality communication and strong relationships @JonFass #sdpain 👏👏👏👍👍👍
#sdpain @JonFass Create a safe environment for freq high-quality communication and strong relationships to avoid chaos and poor pt outcomes
We must be willing to demonstrate being accurate and hopefully others will as well @JonFass #sdpain
The goal, to create frequent high quality communication & strong relationships. Open avenues of opportunity to be accurate @jonfass #sdpain
#sdpain @JonFass Educate. Don't alienate.
We must educate and not alienate when it comes to ed colleagues about pain science @JonFass #sdpain
'We can be that unicorn-riding, rainbow shooting, awesome person'. @JonFass #sdpain
Fass - Goal is to have frequent high quality communication, not to be right. #sdpain
#sdpain @JonFass Recurring theme: determine the person's needs and values and tailor interventions and mgmt strategies accordingly.
Show what we do not why we do it. We can do that later with our colleagues. Get them on board by showing efficacy. @JonFass #sdpain
Lower expectations? #sdpain https://t.co/Y5mYx36juc
We should recognize that people will automatically push back when we are presenting information.Can we lower our resistance to that?#sdpain
Match the learner stage to style. Match your approach to the person u r talking to @JonFass #sdpain
#sdpain @JonFass Match your approach to the person you're talking to.
#sdpain @JonFass Interesting article: https://t.co/WmIpYGrBDs
Behavior change happens over time and goes through many stages @JonFass #sdpain
Most HCPs have been trained in the medical model, which doesn't always make them good educators #sdpain https://t.co/RQpSzaZapH
#sdpain @JonFass Educate. Don't alienate.
#sdpain @JonFass scientific curiosity, not scientific knowledge
"Curiosity killed the cognitive dissonance" @JonFass #sdpain
#sdpain @JonFass Curiosity kills dissonance. https://t.co/Mbpu4pafnw
#sdpain @JonFass We're not trying to change everything all at once.
#sdpain @JonFass Gap theory: Being motivated to find answers causes us to actively inquire into subject to resolve our curiosity.
Don't try to change everything all at once. Start with a small curiously and try to fill that small gap. Less defensive behavior #sdpain
#sdpain @JonFass Create small gaps that they can fill.
Fass - Curiosity kiledl the Cognitive Dissonance. #sdpain
#sdpain @JonFass Perhaps consider that we need to know where people are. Are they curious, are they contemplating y… https://t.co/uG4kIV3POm
Learning: walking towards information, not away from it. @JonFass #sdpain
The more you know about a subject, the less likely you are to accept new ideas about that subject - curiosity counts @JonFass #sdpain
#sdpain @JonFass Play the long game.
@JonFass in summary: play the long game: don't have to get all of the info out at one time #sdpain
Scientific curiosity vs. Scientific knowledge.
#sdpain https://t.co/Ld8FKmnTEY
The more you know about a subject, the less likely you are to accept new ideas about that subject - curiosity counts @JonFass #sdpain
@JonFass summary: be consistent with your values. If someone comes at you w/ anger don't come back with it #sdpain
Focus on finding gaps in knowledge not ignorance of knowledge. Don't challenge @JonFass #sdpain
Identify all opportunities to build confidence & trust work to create new ones @JonFass #sdpain
Be consistent with your values - Just be the same person on social media as you are in real life. @JonFass #sdpain
Find gaps in knowledge vs ignorance of knowledge ... @JonFass making the case for civility and consistency in communication #sdpain
#sdpain @JonFass Focus on finding gaps in others knowledge, not ignorance of knowledge. Identify opps to build confidence & trust.
#sdpain @JonFass Disarming dissonance: Gently lead, don't push ideas. Play the long game. Be patient.
Don't dismiss their ignorance. Always give an opportunity for others to change their mind. #sdpain @JonFass
#sdpain @JonFass Play the "long game": Establish therapeutic alliance, find gaps in knowledge, ID chances to build trust, lead gently.
#sdpain @JonFass Recommended reading: https://t.co/3gIsx5UZo9
#sdpain @JonFass Recommended reading: https://t.co/a8Qx6cSHz8
Lesson in changing minds: #DarylDavis #sdpain @JonFass #KKK
https://t.co/deWVmU81WL
#sdpain If you argued with the provocateur version of @JonFass a few years ago, he might regret how he handled that interaction. #Wisdom
@JonFass #sdpain Why I am a big chicken on social media https://t.co/2XXYGPoMPS
#sdpain Approach clinical encounters with curiosity and flexibility rather than certainty and rigidity.
Great news for those following #sdpain you can order the video (do it now!) https://t.co/XQvncWoLNb
#Imneverlonelywhen I'm at the #sdpain Summit surrounded by colleagues!
#Icouldkissyourfor attending the 2017 #sdpain Summit
#CelebrateSD at the @SanDiegoSummit #sdpain @SandyHiltonPT @SarahHaagPT @ForwardMotionPT @MyCuppaJo @CorKinetic @jasonsilvernail
Love this crew at #sdpain so many learnings and great conversations - level up when I'm back in the clinic https://t.co/I2ZOBqdWFp
#imneverlonelywhen I'm at the @SanDiegoSummit #sdpain
❤❤❤ https://t.co/QmdqSJjTtw
#sdpain For the 1st time in 3 yrs they are NOT giving away @ToddHargrove's book for the raffle. https://t.co/XpDhRYTWdc
Do you have a pain rehab metaphor u use with ur patient? Share it here: https://t.co/qKWWISZV8E #sdpain @nakedphysio
Getting ready for afternoon treats #sdpain @SanDiegoSummit @SarahHaagPT @Farmer_MindBody & Carolyn https://t.co/ymJJKXkdlG
"Pain is their harm alarm" Beth Darnell at the Pain Summit #sdpain. Follow Beth she is amazing. @BethDarnall
#sdpain @adiemusfree presenting on behalf of @nakedphysio
@adiemusfree takes the stage at @SanDiegoSummit for Clinicians Get Creative @nakedphysio #sdpain
@nakedphysio sending his love and kisses from Auckland @adiemusfree @SanDiegoSummit #sdpain #wishyouwerehere https://t.co/R7u5LBPlyb
Bronnie Thompson rolls with the first after lunch talk at #sdpain
Bronnie Lennox asks "how many uses can you think of for a brick?" #sdpain
The beautiful Bronnie kicks off "Clinicians get creative" @adiemusfree @nakedphysio #sdpain https://t.co/Ul0lAq4os0
#sdpain @adiemusfree @nakedphysio Metaphors matter & they are everywhere; designed to better understand concepts.
The purpose of metaphors is to better understand concepts @adiemusfree #sdpain
"Metaphors matter - we use them everyday to better understand a kind of concept" Bronnie Lennox #sdpain
Thompson metaphors matter. We use them to understand the world. #sdpain
#sdpain @adiemusfree @nakedphysio Metaphors if used improperly, can increase confusion. #BeCareful
Oops: just found @adiemusfree for her talk quotes #PleaseBeAdvised #sdpain
If we use a metaphor that someone doesn't understand we can end up with crossed wires #Metaphorsareeverywhere @adiemusfree #sdpain
#sdpain @adiemusfree @nakedphysio Metaphors - https://t.co/z36J2zoHPU
#sdpain @adiemusfree @nakedphysio Metaphors can give someone an opportunity to share their feelings and emotions without jargon.
"Poetic language is a meditative exercise...this invokes a profound experience within the reader" @adiemusfree #sdpain
Sometimes a 0-10 scale is not enough for a patient to be able to describe what their pain means to them #sdpain @adiemusfree @nakedphysio
#sdpain @adiemusfree @nakedphysio Metaphors aid the listener/reader's profound experience from the speaker/writer's words
Thompson - life as a train metaphor. For those with chronic pain, Life on the platform unable to board the train. #sdpain
#sdpain @adiemusfree "Hell"(images of) is about body torment.
#sdpain @adiemusfree @nakedphysio What kind of imagery is in your clinic/workspace? Imagery is metaphoric.
"What images are in your clinic? What do they say to your patients?" @adiemusfree #sdpain
Thompson - can use imagery as visua #sdpain
Use of virtual reality as a tool for graded exposure @adiemusfree @nakedphysio #sdpain
Metaphors can bridge unfamiliar or complex ideas, such as pain, to our clients or patients. #sdpain @adiemusfree https://t.co/YSWcTgWdCX
#sdpain @adiemusfree @nakedphysio Viewing video of VR and CRPS by @lee_eugenie. #whoa
#sdpain @adiemusfree @nakedphysio https://t.co/d04Gov6HSv
Thompson - Divides room into groups. Gives each a large sheet w an object picture. Use to create pain metaphores. #sdpain
#sdpain Dr Bronnie @adiemusfree is a great educator. She can pull off group exercises in a lecture setting and make them great!
#sdpain @HeadStrongPT Presenting https://t.co/OqF1jpziuR
#sdpain @PeteOSullivanPT CFT Workshop https://t.co/UFG6C3yXlA
It's not another PP presentation. Audience participation is essential for learning. @adiemusfree rocks #sdpain https://t.co/K28bBmbDF7
#sdpain Dr Bronnie @adiemusfree is a great educator. She can pull off group exercises in a lecture setting and make them great!
We can show our chronic pain patients how they can be useful despite their pain. #sdpain
We can show our chronic pain patients how they can be useful despite their pain. #sdpain @adiemusfree
#sdpain Never start by licking the center frosting. Take your time, savor the experience and save that middle bead… https://t.co/CpVFyZaOcN
#sdpain C.Vandyken representing the #pelvicmafia
Carolyn Vandyken - "LBP: Rethinking the Bio in Biopsychosocial." #sdpain https://t.co/ye1MocYNMO
#sdpain C.Vandyken "LBP: Rehtinking the Bio in BSP"
#sdpain Carolyn Vandyken: Sex and voiding should be Yes-ciceptive not No-ciceptive. (E.g., a good bowel movement should feel good.)
Peeing, pooping and sex are really important to maintain homeostasis. It's supposed to feel good&is more distressing when it doesn't #sdpain
#sdpain Pelvic floor highly affected by stress and tension
#sdpain Hard wired to protect our pelvic floor.
#sdpain C.Vandyken Sex and voiding should not be nociceptive
#sdpain 1st muscle to contract in a threatening situation are muscles of the pelvic floor - makes sense for survival https://t.co/xB6n1Ohv9M
#sdpain Patients who don't breath into their abdomen will often end up with short and tight pelvic floors - stress ass w apical breathing
Vandyken - Pelvic floor muscles are the first to contract with fight or flight stimulus. #sdpain
You don't wanna have an orgasm while you pee, & you don't wanna pee while having an orgasm. Pelvic floor pain often undermined #sdpain
#sdpain C.Vandyken Data indicates that a large % of women with LBP had pelvic floor dysfunction (63% of n=1636, 78% of n=200)
#sdpain 78% of women with low back pain had pelvic floor dysfunction https://t.co/PEl64UaLnf
#sdpain C.Vandyken Pelvic floor dysfunction is not just a lady-problem (one study had 36% of men with involvement)
#sdpain C.Vandyken, herself, has now completed a study that has taken 2+ yrs, to determine prevalence of PelvFloorDys among women with LBP
Vandyken -Study of women with orthopedic referral with LBP. Included internal exam.Excluded those with greater complications. #sdpain
#sdpain C.Vandyken's study: 182 invited to participate, n=100 post-exclusion criteria
#sdpain C.Vandyken's study: Methods: MDT LB assess, PelvGirdlePain determination, PelvFloor Assess, Self-report.
#sdpain C.Vandyken's study: Results - 96% had PFD, 84% had tenderness to palpation, 67% had PelvFloor weakness, just <30% demo'd prolapse
Vandyken - 100 women accepted for study. Mean age of 41.6 years +/- 13.51. #sdpain
#sdpain C.Vandyken's study: seems that there is a pattern of over-recruitment of pelvic floor
#sdpain The understanding that pelvic floor dysfunction is caused by weakness is probably not true - probably more over recruitment of mm
Vandyken - Standard assumption is weakness of pelvic floor muscles. Study was seeing over-recruitment instead.#sdpain
#sdpain Carolyn's research (unpublished) found high correlation with pelvic floor tenderness and pain full intercourse
#sdpain C.Vandyken's study: High correlation btwn tenderness and intercourse, and btwn tenderness and perineal/geniital pain
"The assumption is that pelvic floor muscles are weak. We are finding that they are tense/over-active, like back pain" C Vandyken #sdpain
#sdpain @PeteOSullivanPT Cognitive Functional Therapy Workshop. Pic by Carolyn Silvernail https://t.co/MdRySKPoPG
Vandyken - Women who had pelvic floor tenderness more likely had disability compared to those with weakness #sdpain
Tenderness of the pelvic floor caused more disability than weakness of the pelvic floor #sdpain
#sdpain C.Vandyken's study: Weaknesses: subj measure of tenderness, no blinding of PT, heterogeneity of sample (7 clinical sites)
Vandyken - Weakness - Subjective measure to define objective tension measure. #sdpain
We need to measure catastrophization with all low back pain patients #sdpain
"We need to be measuring catastrophization with all of our back pain patients, it's highly correlated" C Vandyken #sdpain
Vandyken - 41% of women excluded from study had severe catastrophization. #sdpain
#sdpain C.Vandyken Comorbidities with LBP: ChronicFatigue, IBS, TMJ, RestlessLegs... [slow typing before next slide, not inclusive list]
Using the PCS and the Oswestry (the original, with the sex question) are likely good choices. #Sdpain https://t.co/2BKRjNhVak
We need to measure catastrophization with all low back pain patients #sdpain
#sdpain @CorKinetic Stepping Away from Exercise and Toward Movement. Pic by Carolyn Silvernail https://t.co/lbOfTnxinu
Vandyken - Second highest rate of exclusion was from refusal of internal exam (34%). #sdpain
When we r comfortable with our patients they are more likely to be comfortable with us. #sdpain
#sdpain C.Vandyken's study: 2nd highest reason for exclusion was refusal of internal exam. ???
Pelvic floor muscles r not just weak. There can be a lot of tension there #sdpain
#sdpain C.Vandyken's study: need to be more comprehensive when working with patients with LBP - get comfortable with good/needed questions
#sdpain Pelvic floor health is not just a women's issue
Pelvic floor rehab is orthopedics in a cave. It is not only a female problem. Everyone has a pelvic floor #sdpain
#sdpain C.Vandyken's study: what we need to do - "Orthopedics in a Cave"
The pelvic floor is a part of a tension system. #sdpain
"Pelvic floor dysfunction treatment belongs in the Orthopedic Division, not Women's Health. This is orthopedics." C Vandyken #sdpain
Vandyken - Pelvic floor dysfunction belongs in orthopedics; not just a women's problem. #sdpain
Yes. This. Pretty much all of us have a pelvis. It's not just a woman's issue. Every one of us has a pelvic flo… https://t.co/euu1zFq4O7
#sdpain Pelvic floor health is not just a women's issue
Leaving the rx of the pelvic floor only to specialists is not enough. Need more trained and comfortable treating. C Vandyken #sdpain
#sdpain Some of the best treatment outcomes in the physical therapy world https://t.co/JYXwSbMkBv
Vandyken - Large disconnect between number with PFD and training of healthcare providers. #sdpain
Listen up ladies: it is NOT normal to pee when you are working out! Ever! #sdpain
Peeing while exercising is NOT normal. We need to address these misconceptions #sdpain
#sdpain @JonFass Improving Pain Science Communication. Pic by Carolyn Silvernail https://t.co/kW8YsOaopG
Dear #CrossFit: Peeing while doing the "double under" is NOT NORMAL. Quick telling women that. #sdpain
#sdpain Video Packages still available for purchase! https://t.co/NTTDOIcZ94
#sdpain - Need to practice the right, non-threatening way to approach patients with PFD. #OrthoCave https://t.co/f9w69Hvl5I
Vandyken - The pelvic floor is the only body area "treated" without assessment. #sdpain
#sdpain C.Vandyken's 5 questions: urinary incontinence, fecal incontinence, chronic constipation, painful intercourse, prolapse?
Are you comfortable asking patients about sex/ continence/ constipation? Do you know what it means if patient says pain with orgasm #sdpain
#sdpain C.Vandyken's Don't need to provide internal therapies to make an impact with PFD
#sdpain You can still address and treat pelvic floor dysfunction without being able to do internal examination
#sdpain C.Vandyken's Referral pain may mimic other more common ailments (e.g. piriformis, LBP)
| Sunday | to Top |
Vandyken - Underscores need for PFD screening in women with pelvic girdle and low back pain. #sdpain
Well said Carolyn Vandyken! It is important that we are all at least well aware of pelvic floor dysfunction and appropriate referral!#sdpain
Vaginal prolapse is not a cause of low back pain, based on this study among 152 women. #sdpain #pelvicpainhealth
https://t.co/TAq4ZT5WKW
Question from the crowd:how do I find a pelvic PT I can trust.I live 300 miles from @SandyHiltonPT '. Happy to be in biz w a legend #sdpain
#sdpain - screens apply to male and female patients https://t.co/9PqI3pJG3e
Vandyken - Screening for PSD #sdpain https://t.co/zrGmeXkBIF
@MassageFitMag Pelvic organ prolapse often doesn't cause any pain, but can be distressing... #sdpain
Q: MT says seeing more post-menopausal women w incontinence. A: Needs a referral to pelvic physio. Level 1 evidence of 85% cure #sdpain
The impact of pelvic pain on women https://t.co/5nh7eHUnDw @KJaneChalmers @bodyinmind Pertinent to C Vandyken talk #sdpain
An open invitation (plea) to help us understand pelvic pain & treatment patterns. https://t.co/i6pUxze0GX All who treat pelvic pain #sdpain
#sdpain - panel discussion featuring: @karenlitzyNYC, @jasonsilvernail, @CoachNickT, @JonFass, @CorKinetic
Next up at #sdpain, a panel discussion moderated with Karen Litzy with Ben Cormack, Jon Fass, Jason Silvernail, and Nick Tumminello. #sdpain
#sdpain Panel topic: Facilitating Professional Communication (focus on pain science integration)
Litzy - Topic of interfacing of working with other providers on inclusion of bio-psycho-social model #sdpain
#sdpain @jasonsilvernail @JonFass @CorKinetic @karenlitzyNYC helpful to learn things that aren't good - helps you compare to better things
#sdpain @jasonsilvernail Can be helpful to learn "not so good things" as student to appreciate those things that ARE good.
#sdpain @CoachNickT: You can't punch someone in the face with facts. If you go around punching every a-hole, you become the biggest a-hole.
Some professionals value anecdote and practical info over science #sdpain @CoachNickT
#sdpain https://t.co/Gce9YZzgHf
Paging @TimRethornSPT - even your 'dud' clinical rotations can have value! #dptstudent https://t.co/jF1ghpZ8zH
#sdpain @jasonsilvernail @JonFass @CorKinetic @karenlitzyNYC Ben - some of our best learning occurs in bad situations
#sdpain @CorKinetic Some of our best learning occurs in the worst situations. [Hang in there SPTs]
#sdpain https://t.co/iYMdBhqexQ
.@waldronphysio FYI, this is one of my favorite papers, ever. It is dense, but the analyses are just gorgeous!
Encouraging words for #dptstudent and #freshPT from the panel at #sdpain https://t.co/yDY62u0zPS
#sdpain @CorKinetic Some of our best learning occurs in the worst situations. [Hang in there SPTs]
That will be great and sincerely appreciated. A lot of heavy, exciting material. #sdpain https://t.co/aOc79Nq8di
.@waldronphysio I'll be posting the full presentation on my site, https://t.co/m9OMaMHki5, including links to the film clips!
#sdpain @jasonsilvernail @karenlitzyNYC Jason- folks who are curious are going to be fine worry about the ones who are certain about things
#sdpain @CoachNickT "What kind of evidence would you need to consider rethink your position?"
#sdpain @CorKinetic Ben - Minds change slowly. Rarely do patients have an epiphany. Sometimes you are never going to change people's mind
#sdpain @CorKinetic Keep it amicable. Keep it slow. Respond to other professionals as you would a patient.
#sdpain @karenlitzyNYC @jasonsilvernail Jason - I just stopped telling people stuff - gets people off on wrong foot. Go for alliance first
#sdpain @jasonsilvernail has stopped telling people stuff ... get 'em feeling better & build credibility before having the tough discussions
Cormack - with colleague,What kind of evidence would change you mind? #sdpain
#sdpain @jasonsilvernail @karenlitzyNYC Need to allow patient to let us know what they want to know...... don't talk at them
With an amazing group of Summiters! #sdpain has been intellectually thrilling!! https://t.co/DtzEe8UmeU
#imneverlonelywhen I'm at the @SanDiegoSummit #sdpain
❤❤❤ https://t.co/QmdqSJjTtw
Making vulva cupcakes!!! #sdpain https://t.co/LZIXn9s7PI
Getting ready for afternoon treats #sdpain @SanDiegoSummit @SarahHaagPT @Farmer_MindBody & Carolyn https://t.co/ymJJKXkdlG
Silvernail - once you've gained credibility with someone, only then can you start to have these discussions. #sdpain
#sdpain @CoachNickT If you keep explaining things the same way and need to keep repeating yourself, you are doing it wrong [communicating]
#sdpain @CorKinetic I think biomechanics is a field science. It is probably a big deal.
#sdpain @CorKinetic Biomechanics certainly matters, we just don't always know when.
#sdpain @jasonsilvernail @karenlitzyNYC @CorKinetic As loads increase need to be more aware about mvt also if tissue health is in question
#sdpain @karenlitzyNYC @jasonsilvernail Karen - what happens when client pathologises biomechanics as causative of pain?
"You can't go around punching people in the face with facts!" #sdpain
#sdpain @karenlitzyNYC @jasonsilvernail Ben - you need to unpick these ideas gently
#sdpain @CoachNickT If you want to be less wrong, explain less.
#sdpain @jasonsilvernail @karenlitzyNYC Jason - only focus on helping to change beliefs that lead to maladaptive behaviour
#sdpain @jasonsilvernail is not concerned with beliefs that do not drive behavior. https://t.co/O1t2Uk9P1T
#sdpain @jasonsilvernail It is most imperative to identify faulty beliefs that are driving maladaptive behavior.
Beliefs that drive maladaptive behaviours are the ones we should worry about. #sdpain
#sdpain What other explanations could there be for that? @CoachNickT
Sow seeds of doubt by presenting another alternative rather than telling people they are wrong @CorKinetic @karenlitzyNYC #sdpain
#sdpain @CoachNickT If people understand the fallibility of human reason, people are more likely to consider they may be mistaken. [paraphr]
I love using #WhatIf questions - gets the person to inhabit the question. #sdpain #dptstudent https://t.co/CrWxG96UP5
Sow seeds of doubt by presenting another alternative rather than telling people they are wrong @CorKinetic @karenlitzyNYC #sdpain
Need to wait till people are coming towards you before you start bombarding them with info @jasonsilvernail @karenlitzyNYC #sdpain
#sdpain @CorKinetic Consider presenting your views as an "alternative perspective" or describe your particular process to avoid conflict.
#sdpain @jasonsilvernail @JonFass @CorKinetic @karenlitzyNYC Karen- Help the patient to come up with the answer themselves
#sdpain @jonfass You can't just push people to see things your way and to value things as you do. https://t.co/8ZDTheqyHs
#sdpain @jasonsilvernail Establish alliance with your patient. Allow them to approach you with their questions & educate them accordingly.
#sdpain @CoachNickT "Be a lighthouse, not a courthouse."
@CoachNickT - Be a lighthouse not a courthouse. Don't give people an easy out by being undiplomatic - they attack you not argument #sdpain
#sdpain @CoachNickT The moment you act disrespectfully, it gives others an easy out of a difficult conversation. https://t.co/Sa6AOtJneM
@CoachNickT - When science attacks - you don't have to respect a person's beliefs but you do have to respect them as a human #sdpain
#sdpain https://t.co/qSmrSOlIPk
#sdpain @jasonsilvernail @karenlitzyNYC Best way to bring about change to healthcare systems? 1 Teach the students 2 Mentor new grads
#sdpain Reward: figure out how to change professional education to feature humanistic care that revolves around the… https://t.co/nQpIxKA5NS
Woooooooo! Sounds like something to devote a career to! #sdpain https://t.co/bhyxiMB4yO
#sdpain Reward: figure out how to change professional education to feature humanistic care that revolves around the… https://t.co/nQpIxKA5NS
#sdpain @JonFass continues to emphasize the importance of playing the long game when changing patient beliefs. https://t.co/Qezvo1WYzx
Also teach basic pain selfmgt in schools. Kids learn life skills and they go home and teach parents/family #sdpain https://t.co/2SRJWdqqvM
#sdpain @jasonsilvernail @karenlitzyNYC Best way to bring about change to healthcare systems? 1 Teach the students 2 Mentor new grads
👍 #sdpain Problem solving switches back on the patients ability to selfmge their pain. https://t.co/M8F7MqvFvf
#sdpain @jasonsilvernail @JonFass @CorKinetic @karenlitzyNYC Karen- Help the patient to come up with the answer themselves
To help this process, we need a buy in. See three page 3 https://t.co/LuKX5oKgEm Pain Cycle & 3 questions #sdpain https://t.co/oHqQ9pK6j4
Need to wait till people are coming towards you before you start bombarding them with info @jasonsilvernail @karenlitzyNYC #sdpain
The Larry Steinbeck Daily is out! https://t.co/48jxT2y6bV Stories via @rjbutler_dptphd #sdpain #beerevent
@jasonsilvernail @adiemusfree @PeteOSullivanPT
Woooot!!!! #sdpain
@SanDiegoSummit was phenomenal. Incredibly humbling to be in the same room and meet with great minds and leaders in pain and rehab. #sdpain
Test your pain selfmgt skills by playing the FREE Pain Toolkit game https://t.co/hSCH5XrLaa
#sdpain
I've loved all the tweets coming out of #sdpain and #concussions2017 ! Thanks for keeping us up to date!
The latest Healthcare Today! https://t.co/aVJMlZ7N4w Thanks to @Maureenrcgp @fischmd @Scottphysio #health #sdpain
@JonFass I'm interested in all the tweets I've been seeing from #sdpain Thanks for sharing
#Goodbye #sdpain ✈️
What I learned from #sdpain reveals Twitter's limitations in communicating complex ideas, and therefore its role in knowledge translation.
@SanDiegoSummit @beyondmpain see what everyone else is missing! #sdpain
@PeteOSullivanPT Enjoyed your presentation at #sdpain! Noticed CFT correlates w/ inhibitory learning theory. Simila… https://t.co/u6e8tTI1I5
@JonFass @SanDiegoSummit Likewise! I have to compliment you again on the cog bias move during your presentation. Excellent execution #sdpain
Day 1 of our communication, CBT, ACT and motivational interviewing workshop #sdpain @adiemusfree @SanDiegoSummit https://t.co/ZzRlnycH5c
#sdpain Taking Bronnie @adiemusfree and Alison Sim's communications class this morning. Awesome so far. Beautiful day too!
Physiotherapy | The History of Physiotherapy #physiotherapy #retweet #sdpain https://t.co/V5PJ9RE2i8 https://t.co/OeakyjqPfc
#nofilter San Diego coastline. #vacationmode #sdpain #vacationtimes #california #sandiego https://t.co/fljQ1tqUaw
Teaching psychosocial aspects of pain treatment - the wonderful Alison Sim @beyondmpain #sdpain https://t.co/dl7IxxScuf
Honored to listen to these esteemed clinicians & research scientists speak at the 2017 #sdpain Summit. https://t.co/7RmW2emz8j
| Post-Summit | to Top |
How much pain this man is feeling? Tissue vs pain issue? Any experts from #sdpain care to guess? @MLealPT… https://t.co/2t3DTCKV90
LOL #sdpain @CorKinetic https://t.co/cdZGEPNSXe
Look what happens when Ben @CorKinetic decides to leave! :P https://t.co/XUOWVliP6G
@BethDarnall @SanDiegoSummit #sdpain
Harmful messages can increase patients' perception of pain. Do not catastrophize. #sdpain https://t.co/oNRp7WAAor
Messages that can harm https://t.co/6YNnfuGXQj https://t.co/lw4RACWa30
A Disc Bulge Does Not Always Correlate to Pain. Cause of pain is rarely one factor. #sdpain #physiotherapy
https://t.co/pt9T9vTSNr
Information changes behavior like spaghetti changes a brick -Fordyce #sdpain
Rajam will have 2017 #sdpain videos uploaded/ ready for viewing by tomorrow. Order your copy here:... https://t.co/A3vyFYj0gB
What Happens When You Ignore Plausibility in #physicaltherapy. Same can be said about #massage. #sdpain https://t.co/Udxh2kkWTg
When you ignore plausibility in a treatment or explanation, you open up a can of pseudoscience #sdpain https://t.co/a9WoriS9DY
What Happens When You Ignore Plausibility in #physicaltherapy. Same can be said about #massage. #sdpain https://t.co/Udxh2kkWTg
A Disc Bulge Does Not Always Correlate to Pain. Systematic Reviews #sdpain #physicaltherapy https://t.co/csMAjHWMhb
A Disc Bulge Does Not Always Correlate to Pain. Cause of pain is rarely one factor. #sdpain #physiotherapy
https://t.co/pt9T9vTSNr
Harmful messages can increase patients' perception of pain. Do not catastrophize. Thank you, @PeteOSullivanPT… https://t.co/CJPlPpAaV2
Harmful messages can increase patients' perception of pain. Do not catastrophize. #sdpain https://t.co/oNRp7WAAor
In Bayesian statistics, a RCT simply scales the probability before the trial. The implausible remains so. #sdpain… https://t.co/mechMCYDb0
What Happens When You Ignore Plausibility in #physicaltherapy. Same can be said about #massage. #sdpain https://t.co/Udxh2kkWTg
Repasando #sdpain, no hay ningún tuit que no merezca la pena.
My fave @PeteOSullivanPT quote from #sdpain just came up again- care supported by evidence are good for health, bad for business 1/2 #sowh
@PeteOSullivanPT thank you for putting this in such clear terms so I can better express this concept to my clients!#sdpain
I'd like to wish both @CorKinetic and @lissanthea a very Happy Valentine's Day! #sdpain #sharingiscaring https://t.co/IRkZYpmaAp
An interesting observation of what attendee Ravensara Travillian learned at the 2017 #sdpain Summit. If you want... https://t.co/e4w3LPshTM
Pushing the San Diego Pain summit to the limit with Diane Jacobs right before boarding. #sdpain… https://t.co/U9com8dbUu
@SarahHaagPT @karenlitzyNYC @PeteOSullivanPT I see what you did. #sdpain
There is no such thing as perfect or ideal posture. Timing & variability of your posture matters more. #sdpain https://t.co/NWt6lk0Kw7
There is no such thing as perfect posture. @MassageFitMag #notextneck #APTACSM #sowh @karenlitzyNYC @PeteOSullivanPT https://t.co/mqWXdseuTx
Here is 2017 #sdpain Summit attendee Lissanthea Taylor giving us a peek into an upcoming project being... https://t.co/L6LgNevqvw
Cochrane Review: Muscle Energy Technique not effective for low back pain, BUT.... #sdpain
https://t.co/jO8SdvFnrR
“Why would you tell a vulnerable person that they're vulnerable?” - @PeteOSullivanPT @SanDiegoSummit #sdpain #languagematters
"Wear and tear? Gives patient idea of a car tire, either replace/save it! [surgery/decr activity]” @PeteOSullivanPT @SanDiegoSummit #sdpain
"In making sense of pain to the patient, 'You'll be fine' is NOT reassuring." - @PeteOSullivanPT @SanDiegoSummit #sdpain
"Client needs a coach not a boss. Cannot tell people what to do for long term progress." - @HeadStrongPT @SanDiegoSummit #sdpain
"Seek greater accuracy to combat cognitive dissonance." - @JonFass @SanDiegoSummit #sdpain
"Facts don't matter if the other doesn't perceive them useful." - @JonFass on conversations with the "other side" @SanDiegoSummit #sdpain
"Help people understand the emotional language instead of focusing on the technical." - @adiemusfree on metaphors @SanDiegoSummit #sdpain
@Farmer_MindBody @SandyHiltonPT @pundispice I should've tried at #Sdpain !
"Be the lighthouse, not the court house." - @CoachNickT on approach others who may be misinformed. @SanDiegoSummit #sdpain
“Empowering people to do things themselves is one of the best things we can do." - @CorKinetic @SanDiegoSummit #sdpain
"Exercise is not the magic bullet... Find out what they like. They ARE the magic bullet." - @CorKinetic @SanDiegoSummit #sdpain
"Wait until people come to you before you tell them what you know." - @jasonsilvernail @SanDiegoSummit #sdpain
"Encourage clinicians to step away from practitioner-centered and toward patient-centered care." - @jasonsilvernail @SanDiegoSummit #sdpain
Lissanthea Taylor's poem about chronic pain, at 2017 #sdpain summit. https://t.co/BEYtEaGOGm
Missed the panel? That's ok. Videos for you, play by play. #sdpain https://t.co/U4TIMeETNk https://t.co/76WHNRSXpf
Missed the panel? That's ok. Videos for you, play by play. #sdpain https://t.co/NH0h6VbSon
Missed the panel? That's ok. Videos for you, play by play. #sdpain https://t.co/U4TIMeETNk https://t.co/76WHNRSXpf
2 great resources of massage education, but which is better? If only it were that simple...@Jamie_MTDC… https://t.co/3QDL2NQIBh
Truth! Always critically evaluate claims and evidence, even if they agree with your beliefs. #sdpain @PainSci https://t.co/K8YMmUwnAk
Easy to find "support" for or "promising" evidence of basically ANYTHING these days. Just because there are footnotes doesn’t make it true.
Too much confirmation bias? How well were these studies conducted? Were the citations cherry-picked? #sdpain
https://t.co/mudVpfVGpL
@NickNgfreelance @karenlitzyNYC @SandyHiltonPT That reminds me of the hot tub at #sdpain .... ❤❤❤
@HeadStrongPT Formulating an exhaustive list of presenters at #sdpain with celebrity dopplegangers. You=Stone Cold @JonFass=Ben Affleck..
Finally starting to listen to the #sdpain Summit presentations WOW! @Farmer_MindBody @BethDarnall @CorKinetic @JeffreyMogil @HeadStrongPT
2017 #sdpain Keynote Peter O'Sullivan: https://t.co/JZeG6SlBDM via @YouTube
Ugh, uploaded trailers from 2017 #sdpain, only static! OK trying again tomorrow.
I have an archive of 1761 original tweets from #sdpain up at https://t.co/YJ0mlEpAnW
An associated vocabulary at https://t.co/64EreAnv0y
A very organized tweet summary from #sdpain summit attendee, Keith Eric Grant. Thank you Keith!... https://t.co/HaMYdHyui3
Recent paper co-authored by one of the #sdpain speakers, Beth Darnell, about amygdalar connectivity in chronic... https://t.co/BwH5UDCKIA
@BethDarnall - was wonderful to see your panel presentation at #sdpain - I wanted more! Excited to see where your research takes us all :)
#sdpain If this young woman had only had some access to pain ed she might still be with us. https://t.co/sfMVbYMLWS
Diagnostic & classification de la douleur de la ceinture pelvienne. Une approche du mécanisme dans un cadre biopsyc… https://t.co/plfNSmJasv
Clinically relevant article, encompassing form+ force closure+ biopsychological framework https://t.co/N4SvGAXSYV
If we can't stretch fascia, then WTF are we doing? @massagestl #sdpain
https://t.co/d2sryaQfEL
So good! Here's a clip from Keynote Peter O'Sullivan's #sdpain Summit presentation. Want more? Order the entire... https://t.co/a5ntbJduRy
The Larry Steinbeck Daily is out! https://t.co/GyCmHoD0eg Stories via @SandyHiltonPT @OrthoToday @The_OMPT #exercise #sdpain
Trailers for #sdpain summit 2017 videos https://t.co/rF01JdkSeL Purchase includes downloadable... https://t.co/udKlyHNbGZ
When a patient or client tells you that he or she has pelvic floor pain, what does that mean? #sdpain @SandyHiltonPT https://t.co/ftxZBXDhrp
Dr. Mogil gave an incredible presentation at the 2017 #sdpain Summit. Here's a peek at his presentation. You can... https://t.co/2qkjm8gs0P
A snippet of Jeffery Mogil's presentation at the 2017 #sdpain Summit. Order entire 2017 pack 4 $219 or entire... https://t.co/BwCvt9QCro
@BethDarnall New follower here since #SDpain Summit. You were brilliant! Gonna get your book(s).
2017 #sdpain Summit videos are HERE! Grab yours: https://t.co/2Mz4dy0kqM
Here is a great video from @kieranosull reinforcing @PeteOSullivanPT message from last week #sdpain. https://t.co/AQJTUk3PXk