List of the most popular hashtags for theme #BIOPSYCHOSOCIAL

This is a continuation of our collaborative #EvidenceInformedHumaningSeries with @labsrehab @sharken_atc @reachrehabchiro @infophysiotherapy @korerehab @physionightout @thelevelupinitiative @pulsephysioptbo Start a genuine/real conversation ️. Real conversation is predicated upon searching , articulating and planning . If you are involved in a real conversation, you’ll note that you’re listening and talking ️. But mainly LISTENING & VALIDATING. Seriously though, if you listen carefully, you will be amazed at what they will tell you. A few things I’ve learned from a mentor with 50+years (YES, that's right, 50+ years ) of physio experience were: 1.) “You’ll be stunned at what people will tell you if you TRULY listen with minimal judgement." . Upon reflecting on her first point, I realized going into a clinical interaction with minimal judgement is so important (but it's also tough as HELL as I continue to make mistakes, but learning to be BETTER)! Because in my estimation, if we go in with our biases and judgements, we may overemphasize importance of some points while de-emphasizing the importance of others. Essentially you skew the story to fit your own paradigm (i.e., confirmation bias). This ain’t ❌ best practice, as you’d deny ✋ VALIDATING their stories . Anyhow, onto my second lesson… . 2.) “If you listen carefully, sometimes your client’s will tell you exactly what’s wrong with them." . 3.) “Sometimes, they will even tell you what needs to be done to address and resolve their concerns.” . Take points: Start a genuine conversation with minimal judgement, validate their stories before showing off! --------------------- Follow @neuroorthobasedapproach From: Twitter @trishgreenhalgh, Trisha Greenhalgh

This is our collaborative #McKenzieTherapySeries with @strengthinevidence_physio! - Centralization and abolishment of symptoms associated with McKenzie’s repeated extensions were thought to be related to ⬇️ disc pressure, helping to reabsorb the fluid (AKA extensions are thought to normalize herniation). - This disc theory have been adopted and popularized by many therapists. But does extension really ⬇️ herniation? - Abdollah et al., (2018) obtained L4-S1 MRI image from participants living with LBP (early 40s) then 3x10reps of end range extensions were performed. This was followed by 'hanging out' in a passive extension posture for 15 mins, then immediately rescanned (pain scores weren't measured). - Overall they found, no ❌ change in fluid distribution within the L5-S1 disc or nucleus region as a result of extension exercises but did indicate more fluid concentration in the anterior part of the L4-5 disc following the extensions. - In contrast, Beattie et al., (2010) found immediate pain relief after 5 minutes of Grade 1-4, PA glide on L1-5 AND 3x10reps of extensions in lying were associated with increased diffusion of water in the L5-S1 intervertebral disc. - Our opinion: The observed differences between these studies may be attributed to the additional application of manual pressure (in McKenzie, PA glide is considered the advanced force progression compared to the extension exercises). But we aren't certain given limited mechanical effects associated with manual therapy but perhaps it's enough to help the disc? -------------------- Follow @neuroorthobasedapproach Refs : Abdollah et al., (2018). MRI Evaluation of the Effects of Extension Exercises on the Disc Fluid Content and Location of the Centroid of the Fluid Distribution. Beattie et al., (2010). The Immediate Reduction in Low Back Pain Intensity Following Lumbar Joint Mobilization and Prone Press-Ups Is Associated with Increased Diffusion of Water in the L5-S1 Intervertebral Disc.

Couldn’t think of a better way to kick off the week than with this amazing post by @dr.caleb.burgess . Great timeline to remember . Posted @withrepost • Healing Times . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ One of the most common issues I encounter when helping people recover from an injury or from surgery is of the healing times of various tissues. Everyone wants to be better NOW, but this isn't realistic. Tissue healing takes TIME. We can't rush it. And it's important to understand that tissues heal at different rates depending on their physical makeup and blood supply, among other things. Additional contributing factors, such as diabetes, age, poor nutrition, inadequate rest, etc can further delay the healing process. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ This chart shows the AVERAGE range of healing times for various tissues in the body, including different grades of tissue injury for muscles, tendons, and ligaments. It can serve not only as a guide but also a reminder that we can't force our bodies to heal faster than physiologically possible. What we can do is OPTIMIZE the healing process by rehabbing appropriately, eating high quality food, getting adequate rest, and staying PATIENT and POSITIVE throughout the journey. . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ❤️ SAVE this chart as a reference and TAG a friend recovering from injury who could use it too! Questions? Comments? I'm happy to help! . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ Axe, M. J., & Shields, C. L. (2005). Potential Applications of Hyaluronans in Orthopaedics. Sports Medicine, 35(10), 853-864.

Back in 1956, a standard treatment approach for low back pain was heat and ultrasound. McKenzie’s patient, Mr. Smith, had been dealing with right-sided low back pain radiating into his leg for three weeks and had been getting the usual treatment without improvement. - One day Robin McKenzie, New Zealand physiotherapist, casually told his client to go into the treatment room and lay face down on the table. McKenzie and the front desk staff had forgotten that the table was inclined. When McKenzie entered the room he was very concerned because Mr. Smith had been laying in this position for 5 minutes. Extension of the spine was once thought to be harmful for the back. - Yet, McKenzie maintained his composure and asked Mr. Smith how he was feeling, to which Mr. Smith replied that he was much better and that his leg pain had gone away! - McKenzie’s discovery that day set in motion his use of client-specific postures and repeated movements for assessment and treatment. We are glad McKenzie made this “mistake” or shall we say “discovery”... ------------------------ Follow @neuroorthobasedapproach Source : McKenzie, R. (2011). Treat Your Own Back, 9th edition.

THINK... . You see posts about “text neck” and how it can be harmful. Then you look at many real world examples of people who carry much more weight through their necks yet do not seem to have much issues . “Text neck” is modern day “newspaper neck” that some have chosen to demonize and simplify neck pain down to a single cause in some cases . Pain is far more complex than that. Also the body is resilient. It can get use to and become robust from a variety of things . Whether the body is physically, mentally and emotionally prepared to do something is far more important than the thing they are doing . Awesome info graphic from @paincloud1 . . . #physiotherapy #physio #neckpain #pain #textneck #newspaperneck #headaches #rehab #prehab #exercise #strength #posture #biopsychosocial #complexity

BIOMEDICAL VS. BIOPSYCHOSOCIAL --- Imagine two people at an art gallery looking at the same painting. The first person is trying to get an appreciation by looking at it from 2 inches away. The second person is 5 feet back. Who's going to appreciate the whole work of art more? - The biopsychosocial model appreciates the whole human in front of you. Humans are more than just their tissues. - See the whole picture. Thanks for the analogy Carolyn Vandyken! - Don’t sit still. Make moves! - Nick Hannah, PT Registered Physiotherapist #hannahmoves

WHY DOES THIS EXERCISE HELP MY PAIN? . I could tell you this exercise will help because your back is weak, tight, and rotated and you need more rotational stability to get out of pain. But that's just not likely to be true. It's actually probably a downright lie. Instead, I'll give you some reasons it might work for you. . It might work by exposing you to a stressor that kind of hurts but you tolerate it and move on. Maybe it changes your perception of working the area. . Maybe it changes your perception of your back and makes you more confident in it. . Maybe it shows you that you can experience a sensation in that area and it not be bad or harmful. . Maybe it improves some muscular endurance or strength. . Maybe it helps you fear your pain less. . Maybe it shows you that you're stronger than you thought you were. . Maybe it allowed you to do something you've wanted to do for a long time and gave you a sense of stepping in the right direction. . Maybe it challenged you and you liked that. . Maybe it overrided a sensation you were feeling there with one of muscular effort or just a good pump or burn. . Maybe you thought it was exactly what you needed and it fulfilled that need. . Maybe it did a lot of things, some of which we don't recognize or understand. . Notice how only a couple of those were physical? Exercise is one of the greatest psychological interventions we have. . Want to find the exercise that'll work best for you? Find ones that do some of those things listed above. . Why does an exercise work for one person and not another? Because we're people, and there's a lot more to this than sets and reps. . #Prehab101

Recent neuroscience studies show potent neurophysiological effects of neurodynamic treatments. These treatments can induce immediate, short-lasting pain relief via activating natural opioids , facilitate nerve regrowth and ⬇️ intraneural swelling in humans. . Lengthening the nerve bed, in tensioners, causes an ⬆️ in intraneural pressure and when this is used dynamically it may help to reduce intraneural edema - this can improve symptoms. However, tensioners may be contraindicated in acute conditions, and if they are used too ‘enthusiastically’ they can increase symptoms. . The efficacy of nerve mobilizations in ⬇️ intraneural edema has been demonstrated in unembalmed cadavers, where fluid dispersion has been observed with tensioner neurodynamic mobilization for simulated neural edema. This is great, because having control over intraneural edema through neural mobilization gives us a way to prevent issues due to intraneural edema (such as ⬇️ blood flow to the nerve, possibly leading to sensitization ). . Sliders might be more useful than tensioners for conditions where nerves may be entrapped & sensitized. They are less likely than tensioners to irritate a sensitive nerve because they put less strain on the nerve. . However, similar to tensioners, sliders also may lead to pumping of intraneural fluid and therefore ⬇️ edema though possibly to a lesser extent because they would not ⬆️ intraneural pressure as much as tensioners. . Sliding techniques are also a way to introduce non-painful movements and therefore ⬇️ someone’s perceived threat with movement ------------------------------------------------------------- Follow @neuroorthobasedapproach Refs : Brown, C.L. et al. (2011). The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaver study. Coppieters, M.W., Butler, D. (2008). Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Schmid et al. (2018). Entrapment Neuropathies: Challenging common beliefs with novel evidence.

“If you can’t communicate, it doesn’t matter what you know” – Peter O’Sullivan . Did you know, ~80% of client complaints stem from communication problem⁉️ . Providing education in a clinical setting can sometimes be a BIG challenge! In the case of persistent pain education... . ⚖️ Under-dose pain education = we’re part of the problem. On the other hand, cramming endless info about pain is a surefire way to lose trust & destroy the alliance . Instead, let’s strive to become pain science sandwich artists . The pain science sandwich : . Actively & validate the person’s beliefs about pain / injury. . Education about pain. . Have the explain back to you what they have learned, in a way that a family member would understand. . So what goes in the ⁉️ . Let’s take a page out of Lorimer Moseley’s . 1. Pain provide accurate info about the state of the tissues ‍♂️ 2. Pain is modulated by many different biopsychosocial factors: pain is complex 3. As pain persists, the relationship between pain and the state of the tissues becomes even less clear 4. Pain is more likely related to the person’s perceived threat to the body’s tissues . What’s the best way to educate⁉️ As always, it depends... . We need to learn to meet people where they are at in the recovery process . Some will respond favourably to efforts to reframe their pain, others will shut down . Many will forget or misinterpret much of what we say to them. Provide take- reading materials & follow-up to gauge their understanding . ‍♂️ people also have different learning styles... so ASK! Visual learners will want pictures to accompany words whereas auditory learners will be comfortable learning through conversation . Although researching the effectiveness of pain education is a relatively new idea, there is a growing body of work that is showing promise... Did you know that people with cancer who received effective education reported ⬇️ pain scores & were less likely to use ⁉️ . Today’s take-: ✌️Don’t debate, E D U C A T E . Ask them to rephrase what was discussed to see if they truly understand.