David Butler stated how his first Explain Pain/The Sensitive Nervous system talk went at IFOMPT several years ago... in summary, not well. Luckily, Lamb told Butler not to give up teaching about CN sensitization and pain science education. Butler dedicated this talk to him.
25 years into the paradigm
- The brain is changeable throughout the lifespan
- Functions do not necessarily reside in a pariticular area
- It can change from within
I even learned this in Neuro Rehab courses when I was in school, glad we are now many years later applying this to what we do in all physical therapy fields
Butler's 4 "apples" for the crowd, the Manual therapist as a
2) brain reinhibitor and sculptor
1) a Biopsychosocialist
- PTs have 2 mental frameworks
- research shows that most physio's first use a biomedical approach... until that doesn't work, then they switch to a biopsychosocial approach
"the bio in biopsychosocial is not biomedical"
- use nailboard to represent neuro signatures
- this is a great visual tool to explain to patients virtual representations of their body parts in the brain
- when other neurons become disinhibited - chronic/persistent pain - smudging of the image occurs
- push in other pins around the hand, etc... to represent cortical smudging
- as PTs, we have been reinhibiting all along
- we can do it better
- add evidence based neuroscience education
- have reasoning skills to correctly identify true CS (central sensitization)
- work deeper into brain to resculpt prior to MT or exercise
- possibly the first few sessions of education, 30 minutes at least prior to manual therapy and movement
- "get some good movement templates in there before we get u moving"
- left/right discrimination - use of the recognise apps!
- motor imagery
- mirror therapy
3) an Immunotherapist
- Beggs s et al 2010 mol pain 6:74
- this was a fascinating study, full link above
- with nerve injury, within 6 hours crossed blood/spinal barrier
- blue die travelled much farther than control
- blue areas indicate immune activity
- glial cells, schwann cells produce cytokines, etc.
- Butler's list of immune buffering behaviors
- ability to develop coping skills
- perception of stressor - good or bad?
- social interactions
- belief systems
- homuncular refreshment
- increased thalamic glial signals are noted 20 years post limb denervation
- this is an "experienced immune system" - remembering the pain during times of stress or when ill
- the brain "playing it again"
- many re-injuries not re-injuries - they're just the brain on replay
4) as a linguist
- overlap between limp (antalgic gait) and the language output "bone on bone in there"
- "a disc is going to blow" - David reckons, the patient's life is going to blow
- metaphors contextually enriched by neuroplastic paradigm
- motion is lotion
- you are not your thoughts
- ships are safest in the harbor but that is not what they are designed for - for graded exposure
- use the next one on the right patient, with the right condition, at the right time... wait for it....
- if your back was on your face, you'd take better care of it
Manual therapists are "Total Body Construction Workers" - I should buy that domain!
Change the name to Pain Treatment, not Pain Management