CEU Review: Modern Pain Sciences by NXT Gen Institute of Physical Therapy

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Course Title: Modern Pain Sciences: Manual Therapy’s Keys to Motivation, Input and Plan

Date: December 7th, 2014

Location: Pittsburgh, PA

Faculty: Joseph Brence, PT, DPT, COMT, FAAOMPT, DAC & Francois Prizinski, PT, DPT, OCS, COMT, FAAOMPT, DAC

Throughout my didactic and clinical education as a student at the University of Pittsburgh, I was exposed to very little in terms of modern pain science or therapeutic neuroscience education and I believe this is very common across all graduate programs. Considering most every patient being seen in a outpatient physical therapy clinic is being seen due to pain or functional limitations secondary to a painful condition, it was apparent that I needed to improve this area of practice. In the months since graduation, I have taken online courses by Adriaan Louw at MedBridge and have read the recent literature being put out by Moseley, Butler, Puentedura, and others. When I realized that Joseph Brence and Francois Prizinski of NXT Gen Institute of Physical Therapy were hosting a course at Revolution Physical Therapy just outside of Pittsburgh, I knew I had to attend.

Opposed to most continuing education courses, this course was firmly imbedded in clinical reasoning and decision making, which was made evident very early in their presentation. The emphasis on medical screening and attaining a proper initial prognosis/need for referral was good to hear as it is an area often neglected by clinicians and is VERY important as we transition to the primary point of contact for many patients with neuromusculosketal complaints. As someone is currently going through the Maitland Certified Orthopedic Manual Therapist (COMT) process, I was very pleased to see several of these concepts being included within their proposed framework. This approach is entrenched in patient response and attaining a firm understanding of the complaints of the patient and the exact movement(s) that bring on the patient’s chief complaint (comparable sign). This is in place of more biomechanical measures taught and used by therapists utilizing other orthopedic manual therapy examination/treatment philosophies.

In addition to this framework, there was an obvious emphasis on pain science principles and treatment options. This was the area I was most looking forward to and it did not disappoint. Topics ranged from the epidemiology to the current theoretical approaches for the onset of pain. Learning about the pitfalls of the Gate Control Theory was refreshing and very much coincides with my biases and why many patients do not respond to a purely biomedical approach. The introduction and explanation of the Neuromatrix was thorough and, in my opinion, is more telling with regards to patients presenting with a painful condition. This theory takes into consideration a Biopsychosocial approach, which means each individual’s painful experience is created based on contributions from the involved tissues/nervous system (biological), kinesiophobia/catastrophizing (psychological), and our interactions with our environment and support systems (social).

In addition to the lecture portion of the course, there was also ample lab time to learn to examination and treatment interventions. In all, there was about 3.5 hours of lab instruction, which was very well organized and informative with frequent one-on-one instruction from the presenters. Once again, many Maitland techniques and examination philosophies were evident, however many concepts were taken further and were organized in a efficient progressive manner to more easily determine the patient’s comparable sign. A large portion of the lab included Neurodynamic testing and treatment, which is an area that I have had little exposure. Following the lab, I felt as though I had enough confidence in the examination and treatment of patients presenting with positive neural tension of the upper quarter, which was a huge takeaway for me.

All in all, this was a fantastic course and allowed me to expand my knowledge of therapeutic neuroscience education and its place in clinical practice in addition to broadening my hands-on examination/treatment of Neurodynamics. I would definitely recommend this course to anyone who needs a more efficient examination system, a better understanding of TNE, or exposure to neurodynamics.

Below are several videos taken by the presenters of our course, which was an added bonus as I can frequently refer back to these videos if any of the techniques become fuzzy over time…

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