February 8 & 9 - 2 Day
Instructor: Greg Lehman, DC, MScPT
1.2 CEU's (approved by the California Physical Therapy Association)
About the Workshop
This course is a mix of a discussion based lecture, case studies and practical components. The practical components are used with the case studies to “feel” the interventions. However, there no “specific” techniques.
Rather, the point is to show that the framework helps the therapist use their own techniques but in a different way. Further, we can then share “techniques” from all participants in the class. Exercises are demonstrated and time is given to practice these exercises.
When exploring how Key Messages relate to pain and changing behavior the practical component helps the therapist use their own experiences and “stories” to fit with the Key Messages of pain and behavior change.
Significant research in the pain neurosciences and biomechanics field often appears to undermine the reasoning and justifications for many of the traditional therapeutic approaches and techniques of the many rehabilitation professions. By addressing both the weaknesses and strengths of the biomechanical approach we can see that treatment can be much simpler, congruent with the cognitive, neuroscience approach and best evidenced based practice.
This course provides a framework to utilize an alternative biomechanical approach that blends neuroscience pain education. This course teaches the therapist how to teach patients about pain science in a treatment framework that still utilizes specific/corrective exercise and manual therapy. Therapists are taught a model of treatment that simplifies the assessment process and the treatment.
Upon completion of this course, the participant will be able to:
- Provide assessment techniques for partitioning the role of biomechanics and therapeutic neuroscience in the treatment of pain and injury.
- Demonstrate how biomechanical treatments and explanations can address the multidimensional nature of pain.
- Provide exercise prescription that is informed by biomechanics and therapeutic neuroscience.
- Learn different methods of applying therapeutic neuroscience to a traditional biomedically based practice.
- Learn the practical applications of the best research on tendon pathology, symptom modification, and graded motor exposure.
9am - 1pm: Treatment Fundamentals Lecture & 60 min practical
- An alternative to the kinesiopathological model of treatment is produced.
- A case for simplicity is made.
- A simplified framework to incorporate both biomechanical treatments with psychosocial treatments is outlined.
- Four- 15 minute practical exercise breaks to introduce the concept of comprehensive capacity and graded exposure to:
- Achilles tendinopathy
- Comprehensive shoulder exercise prescription
- Painful hip adduction
- Painful lumbar spine flextion
1pm - 2pm: Lunch
2pm - 3pm: Graded exposure and three faces of flexion pain: incorporating biomechanics into the biopsychosocial approach. Includes a 20 min. practical
- Biomechanics, load, and stress are still important variables in injury management.
- Determining when biomechanics are important is evaluated during this section with a special emphasis on flexion related pain.
- How to use graded exposure principles to decrease pain and change movement behavior.
- A guide to the concept of facilitating and not fixing.
3pm - 5pm: Symptom modification model of injury/pain management with a 45 min practical
- The comprehensive capacity and graded exposure approach to injury and pain treatment will be detailed.
- Techniques from various schools of thought (Mulligan, ART, myofascial release, McGill, Sahrmann, CFT, tendinopathy research) are demonstrated and reconceptualized to fit into a simpler clinical decision making framework.
- Distill common biomechanical treatments to justify those treatments within an alternative model.
- Students will learn a framework and simplified clinical reasoning tool to help guide therapy.
- Symptom modification as clinical reasoning to guide interventions as demonstrated through case studies.
- Simplifying both manual therapy, movement based interventions, and exercise therapy via understanding the commonalities among our most popular interventions.
- Traditional manual therapy techniques will be re-framed to maximize a biopsychosocial intervention approach.
- Active and passive approaches to the symptom modification interventions and how these manual therapy approaches are supported by exercise interventions will be taught.
9am - 9:30am: Demystifying manual therapy. Simple research on manual therapy on physiology that should profoundly shape all manual therapy interventions.
9:30am - 11am: Just load it
- A simplified approach to exercise prescription is shown.
- The importance of comprehensive capacity and movement options is highlighted and illustrated when it is necessary.
- An evidence based approach to understanding pain and rehabilitating common conditions.
- An approach to understand the assessment of sensitivity in exercise prescription
- Demonstration of the exercise interventions:
- Case study autopsies are performed to illustrate common themes behind various treatment approaches and how a simplified intervention can be effective.
- A review of common themes in tendinopathy and how that research can guide much clinical practice.
11am - 12pm: The point of pain science and key messages workshop
- Pain science primer.
- Identifying potential false beliefs that might influence pain and disability.
- How to deliver key messages that are chosen by false beliefs.
- Interviewing techniques are illustrated to help change opinions and ultimately change behavior.
- Case studies are presented by the class and solved with facilitation from the instructor and the group.
- A reconceptualization of common clinical tests is demonstrated to show that much of our current testing can be modified to still be useful.
- Specific examples demonstrating how to begin meaningful treatment "when everything hurts" and all manual therapy and exercise therapy has failed.
12pm - 1pm: Lunch
1pm - 3 pm: The point of pain science and key messages workshop, continued.
About the Instructor, Greg Lehman
I have an interesting educational combination of physiotherapy, chiropractic and strength and conditioning training. I have spent 2 1/2 years completing a MSc in spine biomechanics, 4 full time years in chiropractic college (spending more than 15 hours per week for four years practicing manual therapy) and seven years working as a researcher in exercise and clinical biomechanics. After working for several years I spent an additional 2 years obtaining a MSc in Physiotherapy (Queen's)
Awards and Academic Pursuits
I have been in the rehabilitation field for more than 20 years. Following my undergraduate degree in Kinesiology (4 full time University years) I was awarded the Canadian Society for Exercise Physiology Gold Medal for highest academic performance in Kinesiology. This degree allowed me to obtain certification as a Strength and Conditioning Specialist and Certified Fitness Appraiser and I have worked as a Strength and Conditioning coach for Sir Wilfrid University's Men's Basketball team and for Queen's University Women's Varsity Hockey Team.
My success in university resulted in being awarded a graduate scholarship (NSERC) to Waterloo University to be 1 of only 2 Masters students studying with Dr Stu McGill, a world leader in Spine Biomechanics, exercise prescription and athletic performance.
As a faculty member at the Canadian Memorial Chiropractic College I developed a research program that produced more than 20 publications on exercise biomechanics, golf fitness andthe science of manual therapy. I taught more than 25 graduate students in Spine Biomechanics and Research Instrumentation and supervised more than 50 students and 20 undegraduate research theses.
I was subsequently awarded a Researcher of the Year award by the Ontario Chiropractic Association.