Some helpful literature to suggest that low back triggers are often attributed from increased stress and/or depression as well as being more sedentary.

Good news for us in rehab is that PT is often a deterrent to flares!

Movement is medicine. If we create fear of movement, then what message does that send if your patient experiences a flare?

What Triggers Acute Low Back Pain Flares by Leonard H VanGelder
Via @@camfallerdpt on instagram.

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Many individuals with pain can become fearful of movement, or exercise, if it appears to provoke symptoms. 

Having the knowledge that exercise can be beneficial despite pain, here are 6 practical steps clinicians can take to reconceptualize this fear.

6 Steps for Reconceptualizing Pain-Related Fear Through Exercise by Cameron Faller

👉Step 1: Understand What The Patient Understands - Provide questions that elicit information about their beliefs and perceptions as to why they have pain in the first place.

👉Step 2: Challenge Unhelpful Beliefs - Question their beliefs about their safety with exercise. Prescribe exercises or movements that were previously avoided/or painful as new associations may form that inhibit prior fear.

👉Step 3: Enhance Self-Efficacy - Ask them their level of confidence when performing a specific exercise. Discuss what might occur when they perform that exercise. Begin with easier exercises and progress to more difficult ones which may build better self-efficacy.

👉Step 4: Provide Safety Cues - Validate reasons as to why tissues may be sensitive given disuse. Provide information about building tolerance and strength to carry over towards functional deficits.

👉Step 5: Provide Advice on Suitable Levels for Pain - Find an acceptable and tolerable level of pain for your patients and try to keep exercises within its range. Educate on recovery and having symptoms calm down over 24 hours modifying if pain persists longer than that time period.

👉Step 6: Provide Advice on Exercise Modification - Find the sweet spot. Don’t make activities too easy that have no functional carryover. If an exercise is too painful, educate on ways to reduce load, modify range, or change position to decrease symptom provocation.

Exercise has many therapeutic benefits mentally and physically especially for individuals in pain. Don’t let pain be a barrier to receiving successful outcome

via @camfallerdpt and @modernpaincare - reposted with permission

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You learned about them. You studied them. You were tested on them. But the real question is, how important are they to use?

Understanding Clinical Prediction Rules for Lumbar Manipulation by Cameron Faller

Understanding Clinical Prediction Rules for Lumbar Manipulation

Clinical prediction rules (CPRs) were developed using multivariate statistical methods to help clinicians select particular interventions to use depending on a cluster of findings a patient presented with.

Given the black and white matter of how the CPRs were created, this allowed for the opportunity to write a lot of test questions whether it was the NPTE or the OCS exam.

However, as many practicing clinicians know, the clinic is not black and white and we cannot always shoehorn patients into classifications or rules.

So what do we do instead?

Before we release Episode 55 of our Modern Pain Podcast, we wanted to discuss some of the common limitations and pitfalls the research has shown when fully examining CPRs.

Newsflash, some patients may respond well with lumbar manipulation but we might not necessarily need a rule to tell us that.

Similarly, those same patients that satisfy the criteria to have a lumbar manipulation performed may also respond equally well with other interventions.

So how do we go about selecting what types of interventions to perform? What exactly does patient-centered care look like without using these rules?

via Cam Faller and Modern Pain Care on instagram

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Only three months into the year 2021 and pubmed already has over 170,000 articles published pertaining to the topic of medicine.

With many medical providers already suffering from high caseloads along with increased work and documentation standards, it becomes difficult to dive into all the new practical literature that is constantly updating.

In order to at least try to keep your head above water, many providers will read the abstract which is a short summary of the article’s main findings and results. 

The problem with that, is that many abstracts contain spin to “beef” up their findings better promoting it for publication.

In order to detect whether abstracts are prone to spin, Paul Ingraham, who is much smarter than me, has delivered 5+ red flags you can identify to appraise whether the article contains a lot of spin.

5+ Red flags an abstract contains spin by Cameron Faller

👉Omission of effect size and making too much of P-values instead

👉Emphasizing positive results for less important outcome measures 

👉Touting positive “trends” (which is just jargon for a positive result that was almost statistically significant)

👉Filling up the abstract with excessive editorializing and speculation, especially anything that smacks of an “excuse” for inconclusive (padding with special pleading7)

👉Excessive positive “context” for the study (“homeopathy helps millions of people every year”)

👉Encouraging “more study” not because it’s actually justified, but because the researchers didn’t find what they wanted

https://www.painscience.com/articles/research-tips.php

So before you go making claims or stating what the evidence suggests because of the conclusions written in the abstract, it is important you screen the article for any red flags and take a deeper dive to actually appraise it’s validity towards your practice.

Via Cam Faller’s Instagram

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🔥TOP 5 FRIDAYS🔥

Patients often present to the clinic with a variety of preconceived beliefs and perceptions that will shape their experience.

The beliefs that we hold are often critical and essential to the identity we display. But what happens when those beliefs are built from irrational theories and are detrimental towards their health?

As health care practitioners, it is not only important for us to help patients make sense of their pain but it is pertinent that we address any maladaptive belief guiding them towards a more logical way of thinking.

However, if you really think about how you came to believe the things you feel are important, you would know it didn’t happen overnight. 

So don’t expect the same for your patients. Instead, develop a process where you slowly integrate new thoughts and ideas into their mind allowing them to rationalize them into new beliefs.

Here are 5 steps in accomplishing this difficult task as described similar to the art of planting a flower with a patient who believes their back is damaged and will not heal: 

5 Steps to Reframe Poor Beliefs and Misconceptions by Cameron Faller

👉Find a Healthy Environment - Ensure the patient is willing and ready to accept new ideas and may be open to conversation. 

👉Plant Some Seeds - Begin by skillfully planting seeds (ideas) that may contradict or falsify their belief.

👉Add Adequate Water and Nutrients - As the patient starts to become skeptical, utilize contextual factors to slowly add in support for a new belief.

Keep it Cared For - Continue supporting 👉any new beliefs by helping your patient rationalize their initial experience and thought process justifying why it may have been incorrect

👉Watch it Thrive - Motivate your patient to hold onto new beliefs by reminding them of all their accomplishments and improvements from when they first began.

Via Cam Faller's Instagram

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Staying updated with the best evidence can be very challenging. Just searching the keyword “pain” in pubmed, 60,000 articles were published in the year 2020 alone. Plus with every article you read, you find 5 more articles that either confirm or refute the conclusions forcing you to want to read more.

Because of this, I often get asked how do you find your articles, how do you access them, and how do you know which articles are well done vs which ones aren't. These are all great questions to consider so I am delivering my top 5 steps with how I stay updated with the evidence.

1. Sign up for Table of Content (TOC) Alerts with your favorite Journals - TOC alerts will notify you when new articles are published. You can specify your alerts in regards to article type, keywords, or just receive alerts when your favorite journal publishes new articles.
2. Join organizations that publish monthly journals - Being a member for your professional organization allows access to monthly journals that will relate specifically to the field you practice in. I am currently a member of the APTA as well as their Orthopedic Section where I receive two journals (online and mailed) a month.
3. Follow researchers and other esteemed professionals on social media - I have a love/hate relationship with social media. There is a lot of high quality content shared, but you must first maneuver through the BS and “gurus” out there trying to capture your attention to make a profit.
4. Participate in a Journal Club or form your own - Find friends or colleagues willing to embark in a journal club with you or search online for different groups that meet consistently to talk about hot topics.
5. Listen to a variety of podcasts within your respective field - If you would rather listen than read, there are plenty of podcasts out there that have episodes discussing specific articles or the evidence on a particular topic. Caution is warranted given that podcasts may contain a lot of bias and interpretation from the host so it is important you take the information with a grain of salt.

It may seem overwhelming and difficult at first, but with practice and consistency, you soon will find what works!

via Dr. Cameron Faller on instagram

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