Current students and recent grads...I was wondering what your respective schools teach about pain? Is the BSP model introduced? Are you being taught that poor posture causes pain / pain comes from damaged tissues or that pain and posture are not correlated?
Pain Science
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We have been taught that pain is very complex haha. It can literally come from/be correlated with many things. Poor posture can cause pain in various ways..."forward shoulders" can contribute to subacromial impingement...poor sitting posture (excess thoracic kyphosis) can cause abnormal forces through the involved discs possibly causing disc pathology. Also taught that pain is referred from damaged tissues. This is so basic though, it really is more in depth than this as you most likely know as I see you are a student. May I ask why you asked?? Pain is a pretty interesting topic IMO and it seems like new research is coming out fairly frequently.
I am a 3rd year (set to graduate in May) and I have been doing some independent research and reading a lot from people such as Jason Silvernail (a DPT and an expert on pain) and it is really challenging my previous long held beliefs.... from what I have read,it seems that there is very very WEAK correlation between pain and posture...pain is NOT purely biomechanical in nature and sometimes impairments we identify during the orthopedic exam (ie forward rounded shoulders, tight hamstrings, anterior pelvic tilt, etc...) may have nothing to do with the person`s pain perception. Presence of pain does not always equal tissue damage.
This is NOT to say that biomechanics is completely irrelevant..there are certainly times when tissue damage is driving the pain (ie acute injury, inflammation) but often times that is not the case as far as I understand.
I am asking because I am just curious as to what other schools taught? My school briefly covered the BSP model and tried to incorporate it into case studies which we would use to practice orthopedic examinations. However, looking back I wish this had been covered in much more detail...at the same time though, I do recognize that being an entry level DPT program, the ULTIMATE goal is to get us ready for the boards so they could not dedicate enough time for this topic. But it really seems to be that pain science is going to be at the forefront of our profession in the years to come.
This is NOT to say that biomechanics is completely irrelevant..there are certainly times when tissue damage is driving the pain (ie acute injury, inflammation) but often times that is not the case as far as I understand.
I am asking because I am just curious as to what other schools taught? My school briefly covered the BSP model and tried to incorporate it into case studies which we would use to practice orthopedic examinations. However, looking back I wish this had been covered in much more detail...at the same time though, I do recognize that being an entry level DPT program, the ULTIMATE goal is to get us ready for the boards so they could not dedicate enough time for this topic. But it really seems to be that pain science is going to be at the forefront of our profession in the years to come.
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I think the curriculum in most programs is lacking in proper pain science education. Resources like somasimple and the works of Lorimer Moseley and David Butler in addition to Adrian Louw have been paramount to gaining more knowledge on the complex nature of pain. I was fortunate enough to attend the San Diego Pain Summit that was just held and it was very informative.
My school's teaching on pain centered around the the biomedical model and I fear they still do. I wasn't exposed to forums like SomaSimple and the writings/research of Moseley, Butler, etc until my 3rd year through my own independent study. As mentioned above, Jason Silvernail has some great threads on SS. I'd recommend his thread on Crossing the Chasm as a great starting point.
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Our pain teachings have definitely not been related to posture (sure, some can be). We have examined it through an abnormal neural response coupled with environmental and psycho social factors. We differentiated acute from chronic pain completely (acute is more tissue whereas chronic is not tissue caused). I forget if the model has a name, but for chronic care you deal with pain awareness and cognizance first VS acute dealing with tissue abnormality first. (They are opposite approaches).
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Pain science was presented to us within our ortho spine sequence, though never really mentioned in later coursework for UE and LE. Beyond patient education and understanding that pain is not the sensation of tissue damage, it's not entirely clear to me how it fits into clinical practice.
You can give people flyers and books and quizzes to assess their understanding. And it seems like it can help you avoid fixating on pathology or pulling your hair out when pain persists. It can orient you to support the person in moving in a low-fear, pain-reduced way to acclimatize to lower pain activity--but maybe that's something people should be doing even without a fancy neuromatrix.
There is still the "B" in the BPS model, which seems to include much of the postural stuff that is the meat and potatoes of PT. Can nociception be altered by movement or position? This is where PTs seem able to bring something to the table.
Maybe I'm misunderstanding pain science. If so, I'd welcome correction from anyone more in the know than me.
I've spent a fair amount of time on Somasimple in the past (and even attended a seminar with Barrett Dorko). Given the extent of handwringing over there regarding how marginalized their point of view is, I was surprised that it was front and center at the start of our ortho sequence. Maybe things are changing?
But even on somasimple, I don't think they do a terribly good job at articulating how this should inform clinical practice (Jason Silvernail seems like an exception to this generalization, however).
You can give people flyers and books and quizzes to assess their understanding. And it seems like it can help you avoid fixating on pathology or pulling your hair out when pain persists. It can orient you to support the person in moving in a low-fear, pain-reduced way to acclimatize to lower pain activity--but maybe that's something people should be doing even without a fancy neuromatrix.
There is still the "B" in the BPS model, which seems to include much of the postural stuff that is the meat and potatoes of PT. Can nociception be altered by movement or position? This is where PTs seem able to bring something to the table.
Maybe I'm misunderstanding pain science. If so, I'd welcome correction from anyone more in the know than me.
I've spent a fair amount of time on Somasimple in the past (and even attended a seminar with Barrett Dorko). Given the extent of handwringing over there regarding how marginalized their point of view is, I was surprised that it was front and center at the start of our ortho sequence. Maybe things are changing?
But even on somasimple, I don't think they do a terribly good job at articulating how this should inform clinical practice (Jason Silvernail seems like an exception to this generalization, however).
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if you haven't, read "Explain Pain" by Moseley and Butler. Attend a course taught by Moseley, Butler, or Louw. be patient with the change in paradigm. It will challenge everything that you "know" to be true. IMO biomechanics still has a large and important role in recovery but the psychosocial aspect is critical. We are seeing more and more chronic pain patients or even relatively acute patients where the amount of pain that they experience does not correlate with their injury. In years past they were labeled malingerers or wimps. The more we (and they) know about pain, the more effective we will be at helping those people.
