First of all, Dr. Brence's post was very well written and explained pain and its various classifications well. I wish I had the time to write and cite a post as long as he did! It should help anyone with questions about the Pain Science approach. I use the biopsychosocial approach when needed, but don't think it fits all patients, like every approach, should be unique to the patient based on their presentation. It should compliment a practitioners toolbox, but not be the only tool.
I disagree with a few of his points. I think generalizing OMPT or any hands on technique as "poking something that hurts" is simplistic at best. That is equivalent to stating pain education is like teaching a chronic pain patient they are nuts.
Using MDT rules for all exercises and hands on techniques makes it nearly impossible to worsen a patient's condition if you actively listen to their subjective report. If any treatment, whether it is IASTM, joint mobs, functional release, neurodynamic tensioners, is causing discomfort, or even pain, I stop and ask the patient if the pain continues after cessation of the treatment. If it immediately stops, or goes away after a few minutes, the condition is not worsening. It is unlikely the CNS is becoming overly sensitized if the pain ceases immediately, gets better as the treatment progresses, and you are able to demonstrate improvement in an objective measure of strength, ROM, or function after the treatment.
I do agree that PT should not be "no pain, no gain." I only use force as a progression, despite using stainless steel tools to release tissues, you can be very light and progress your depth according to tissue release and patient tolerance. There is a difference between treatment and eliciting pain without any gain in function, strength, or ROM. Any manual technique may be uncomfortable, but only because there is a problem in the surrounding joints, tissues, or peripheral neurodynamics. This is outputted by the brain, but does not mean there are not peripheral "issues in the tissues" so to speak. Many of the areas I treat are either adjacent or sometimes farther away than the area the CNS may be perceiving as a threat, so I think the discomfort perceived is not only CNS sensitivity, but mechanical dysfunction. For example, a frozen shoulder may have elbow, forearm, cervical, and thoracic dysfunction, despite the patient only complaining of moderate to severe pain in and around the GH capsule. The other areas "don't hurt" but may be uncomfortable to treat.
Another clinician wanted to ask Joe, "How would you treat a patient that is already in pain, say s/p TKA?" Iit would be difficult to even move some of these patients without at least causing some discomfort. Hopefully this will generate some CIVILIZED discussion. Anything that gets out of hand will be moderated, and then closed.
I also wanted to add this great comment from a reader on Dr. Brence's original post.