Paincast

Ep20: Nuancing the Controversies of Spine Flexion: Discussing the Evidence with Dr. Tyson Beach (Part 2)

Dr. Tyson Beach is currently a teaching professor at the University of Waterloo, teaching courses on the biomechanics and assessment of human movement, exercise prescription, and low-back disorders. His previous research focused on quantitative motion analyses, prevention of work-related musculoskeletal disorders, and advancing fundamental knowledge of spinal mechanics, control, and injury causation. He also collaborates with other knowledge producers (researchers) and users (practitioners) to design, implement, and evaluate physical activity and exercise programs for workers and athletes.
This episode is a continuation of the discussion from the last episode. We continued to discuss important factors to consider when reading the literature relating to lifting and spine flexion. In this episode, we went more in-depth in spine biomechanics during lifting in different contexts.
Relevant articles (Part 2)
Frost, D. M., et al. (2015). Exercise-based performance enhancement and injury prevention for firefighters: contrasting the fitness-and movement-related adaptations to two training methodologies. J. Strength Cond. Res., 29(9), 2441-2459.
https://uwaterloo.ca/centre-of-research-expertise-for-the-prevention-of-musculoskeletal-disorders/resources/position-papers/improving-workplace-manual-handling-training-programs
Mawston, G.,et al. (2021). Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals. Gait & Posture, 86, 245-250.
Marras, W. S., et al. (1995). Biomechanical risk factors for occupationally related low back disorders. Ergonomics, 38(2), 377-410.
Marras, W. S.,et al. (1993). The role of dynamic three-dimensional trunk motion in occupationally-related low back disorders. Spine, 18(5), 617-628.
Dolan, P., et al. (1994). Passive tissues help the back muscles to generate extensor moments during lifting. J Biomech, 27(8), 1077-1085.
Dolan, P., & Adams, M. A. (1993). The relationship between EMG activity and extensor moment generation in the erector spinae muscles during bending and lifting activities. Journal of biomechanics, 26(4-5), 513-522.
Kalkhoven, J. T., et al. (2021). Training load and injury: causal pathways and future directions. Sports Med, 51, 1137-1150.
Adams MA. Biomechanics of back pain. Acupunct Med. 2004 Dec;22(4):178-88. doi: 10.1136/aim.22.4.178. PMID: 15628775.
Discussion flow(00:01:37) How movement-focused training facilitates the transfer of movement behaviour from training to work (00:05:51) Why typical occupational training does not work to change injury reporting (00:11:18) There is no universal safe way to lift for all people (00:15:05) Arguments for the irrelevance of flexion: "Most heavy lifting is associated with back pain", "everyone flexes when they lift", and anecdotes of people lifting flexed with no pain(00:19:09) How movement plays a role in load management in principle and in practice (00:26:19) Unpacking how flexed lifting postures produces greater lifting strength and efficiency(00:31:40) Meaning of "efficiency"(00:36:37) Ability to adapt to loading in active vs passive tissues (00:38:00) Details of multi-level spine modelling, flexion increases shear loading and decreases passive tissue tolerance(00:42:16) Different perspectives amongst biomechanists and meaning to the practitioners (00:43:32) Posture plays a role in load management (00:44:59) Neutral/lordotic posture creates muscle shear to counter external anterior shear (00:48:04) Relationship between flexion and compression forces along the column(00:51:14) Meaning of "neutral" on a tissue level, functional level, and practical level (00:55:53) Involvement of the flexion-relaxation phenomenon (00:59:27) Amount of flexion perceived in the eyes vs in the joints  (01:01:53) What conclusion can we make? (01:04:35) What about powerlifting? 
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep19: Nuancing the Controversies of Spine Flexion: Discussing the Evidence with Dr. Tyson Beach (Part 1)

Dr. Tyson Beach is currently a teaching professor at the University of Waterloo, teaching courses on the biomechanics and assessment of human movement, exercise prescription, and low-back disorders. His previous research focused on quantitative motion analyses, prevention of work-related musculoskeletal disorders, and advancing fundamental knowledge of spinal mechanics, control, and injury causation. He also collaborates with other knowledge producers (researchers) and users (practitioners) to design, implement, and evaluate physical activity and exercise programs for workers and athletes.
In this episode, we discussed the epidemiological and biomechanical literature around lifting with spinal flexion. Acknowledging that biomechanics is only one of the many factors in low back disorders, the goal of the discussion is to highlight the nuances in understanding biomechanics literature rather than to provide a definitive answer to this topic.
Relevant articles (Part 1)
Saraceni, N., et al. (2020). To flex or not to flex? Is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta-analysis. JOSPT, 50(3), 121-130.
Nelson, N. A., et al.. (2009). Quantifying relationships between selected work-related risk factors and back pain: a systematic review of objective biomechanical measures and cost-related health outcomes. Int. J. Ind. Ergon., 39(1), 202-210.
Wells, R., Van Eerd, D., & Hägg, G. (2004). Mechanical exposure concepts using force as the agent. Scand J Work Environ Health, 179-190.
Impellizzeri, F. M.,et al. (2023). Understanding training load as exposure and dose. Sports Med, 1-13.
Kalkhoven, J. T., et al. (2020). A conceptual model and detailed framework for stress-related, strain-related, and overuse athletic injury. J Sci Med Sport, 23(8), 726-734.
Callaghan, J. P., et al. (2001). Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin Biomech, 16(1), 28-37.
Gunning, J.L., et al. (2001). Spinal posture and prior loading history modulate the compressive strength and type of failure in the spine: a biomechanical study using a porcine cervical spine model. Clin Biomech, 16(6): 471 480.
Gooyers, C. E., et al. (2015). Exploring interactions between force, repetition and posture on intervertebral disc height loss and bulging in isolated porcine cervical functional spinal units from sub-acute-failure magnitudes of cyclic compressive loading. J Biomech, 48(13), 3701-3708.
Discussion flow
(00:01:35) Introduction(00:04:53) High-level summary of the flexion discussion(00:06:40) Discussion on the epidemiological evidence: Issues with measuring exposure(00:10:05) Discussion on the epidemiological evidence: Measurement of spine motion(00:12:55) Discussion on the epidemiological evidence: Reporting absolute vs normalized spine motion(00:16:03) The kinematic of flexion needs to be nuanced by the corresponding kinetic information and load distributions(00:17:50) The challenging nature of epidemiological work(00:20:12) Summarizing the epidemiological discussion(00:23:23) The necessity to contextualize "flexion"(00:24:56) Evidence from the ergonomic literature(00:26:58) Evidence from tissue biomechanics(00:29:43) Criticisms of evidence from tissue biomechanics(00:30:51) Caveat with using tissue disruption studies to understand low back pain(00:33:41) Nuancing tissue loading and adaptation(00:34:58) Short summary of discussion on the tissue biomechanics literature(00:36:06) Addressing the argument of facilitating tissue adaptation by progressively overloading spinal flexion
 
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep18: Should We Stop Inflammation? Implications for Acute Musculoskeletal Management with Dr. Lucas Lima

Dr. Lucas Lima is a research associate at the Alan Edwards Centre for Research on Pain at McGill University. He is a physiotherapist with a PhD and postdoctoral training in pain neuroscience. His latest research, published in the Science Translational Medicine journal, has garnered significant media attention for challenging current practices in acute musculoskeletal pain management, specifically the suggestion that NSAID’s might increase the risk of developing chronic pain.
In this episode, we talked about what inflammation is, recent evidence on the relationship between inflammation and chronification of acute pain, the benefits of exercise to prevent chronic pain, improve recovery of present and future injury, and evidence-based recommendations on NSAIDs and cryotherapy (icing) post-injury.
Resources
Main paper: https://www.science.org/doi/full/10.1126/scitranslmed.abj9954
Pain center Youtube page: https://youtu.be/751NtSbCh6Q?si=U7rFeRfYXzPgkUFZ
Dr. Lima's email: lucas.vasconceloslima@mcgill.ca
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep17: Patellofemoral Pain Etiology and Management Misbeliefs with Dr. Judi Laprade

Dr. Laprade received her degree in Physical Education at the University of Western Ontario and then went on to complete her Physical Therapy degree, MSc and PhD in the Department of Anatomy at Queen’s University. She has previously taught Anatomy and Physical Therapy courses at Queen’s University and The Hong Kong Polytechnic University. Currently, she is the Anatomy Course Director for the Kinesiology & Physical Education, Dentistry and Physical Therapy programs at the University of Toronto. Dr. Laprade also teaches an exciting anatomy elective, ANA411Y: Anatomy in Application: Exercise & Biomechanics. Her research in the past has primarily focused on clinical assessment and evaluation of patellofemoral pain syndrome (PFPS) as well as acupuncture management of musculoskeletal disorders. More recently, she has embarked on developing and assessing educational tools for anatomy learning which are designed to enhance 3D learning.
In this episode, we talked about misbeliefs about patellofemoral pain etiology and management strategies, relationship between anatomy, biomechanics, empirical evidence, and clinical reasoning, and the importance for clinicians to keep up with anatomy and the literature.
Resources
Lan, T. Y., et al. (2010). Immediate effect and predictors of effectiveness of taping for patellofemoral pain syndrome: a prospective cohort study. AJSM, 38(8), 1626–1630. https://doi-org.myaccess.library.utoronto.ca/10.1177/0363546510364840
Barton, C., et al. (2014). Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. BJSM, 48(6), 417–424. https://doi.org/10.1136/bjsports-2013-092437
Wilson, T., et al. (2003). A multicenter, single-masked study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome. JOSPT, 33(8), 437–448. https://doi.org/10.2519/jospt.2003.33.8.437
Tiu, T. Using Kinesiology Tape in Physiotherapy Practice for Pain Management. Physiotherapy Practice. Canadian Physiotherapy Association. Spring 2023. Available from https://physiotherapy.ca/app/uploads/2023/05/English.April28.pdf
 
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep16: Pain Education Made Simple for Persistent Pain Patients with Cory Choma

Cory Choma has been in clinical practice since 1996 and is a founding member of CSA. He is one of only 4 Clinical Specialists in Pain Science in Canada and one of a handful of people awarded an Honorary Fellowship at the Institute for the Study and Treatment of Pain. Cory has been teaching GunnIMS domestically and internationally since 2003 and is a senior instructor for the Continuing Professional Development branch of the Faculty of Medicine at the University of British Columbia. Cory is one of the contributing authors for the chapter on GunnIMS in the text ‘Trigger Point Dry Needling: An Evidenced and Clinical-Based Approach’.
In this episode, our discussion surrounds how we engage in therapy with those living with persistent symptoms—all about talk therapy. We talked about how pain education can be simplified, how the body and the mind affect one another, how the biopsychosocial model can be harmonized and manifested, and more.
Recommended resources for you:Singh, B. et al. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. BJSM. http://dx.doi.org/10.1136/bjsports-2022-106195
The Upside of Stress by Kelly Mcgonigal
Brain Rules for Aging Well by John Medina 
Why We Get Sick by Benjamin Bikman 
Mindset by Carol S. Dweck. 
Spark by John J. Ratey 
 
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep15: ”Hands-off” Physiotherapy—Hypnosis for Pain with Alex Chisholm

Alex Chisholm, PT, BScPT, PgCPain, FACHS is a Physiotherapist with over 30 years of clinical experience. Alex received her postgraduate certificate in Multidisciplinary Pain Management from the University of Alberta. She is one of the executives of the Pain Science division of the Canadian Physiotherapy Association and was part of the working group that helped create the Chronic Pain Toolkit with Physiotherapy Alberta. She is a Fellow of the Alberta Clinical Hypnosis Society, previously the Canadian Federation of Clinical Hypnosis, and is a member of the Alberta Pain Society’s Planning committee for their annual Pain conference. In addition, she is a certified ‘Comfort Talk’ trainer. Alex currently works on the Burns and Plastics team at the Foothills Medical Center where she pursues her passion for burn survivor rehabilitation, and has taught nationally and internationally on Pain, Hypnosis and Pain management techniques. In this episode, we talked about what hypnosis is, how it can help patients, practical considerations when using hypnosis, and the power of therapeutic alliance and word choice.
 
Bicego A. et al. Neurophysiology of hypnosis in chronic pain: A review of recent literature. Am J Clin Hypn. 2022 Aug;64(1):62-80.
Hansen E, Zech N. Nocebo Effects and Negative Suggestions in Daily Clinical Practice - Forms, Impact and Approaches to Avoid Them. Front Pharmacol. 2019 Feb 13;10:77.
Fusco N. et al. Hypnosis and communication reduce pain and anxiety in peripheral intravenous cannulation: Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE), a multicentre randomised trial. Br J Anaesth. 2020 Mar;124(3):292-298.
Lang EV, Rosen MP. Cost analysis of adjunct hypnosis with sedation during outpatient interventional radiologic procedures. Radiology. 2002 Feb;222(2):375-82.
Lang EV. et al. Can words hurt? Patient-provider interactions during invasive procedures. Pain. 2005 Mar;114(1-2):303-9.
Kinney M. et al. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2020 Aug;36(8):886-898.
Ferreira PH. et al. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013 Apr;93(4):470-8. doi: 10.2522/ptj.20120137. Epub 2012 Nov 8.
Provençal SC. et al. Hypnosis for burn wound care pain and anxiety: A systematic review and meta-analysis. Burns. 2018 Dec;44(8):1870-1881.
Romanowski KS. et al. American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps. J Burn Care Res. 2020 Nov 30;41(6):1129-1151.
Jensen MP, Patterson DR. Hypnotic approaches for chronic pain management: clinical implications of recent research findings. Am Psychol. 2014 Feb-Mar;69(2):167-77.
Milling LS. et al. Hypnosis and the Alleviation of Clinical Pain: A Comprehensive Meta-Analysis. Int J Clin Exp Hypn. 2021 Jul-Sep;69(3):297-322.
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep14: Yoga for Pain with Lisa Greenbaum

Lisa Greenbaum is a Certified Yoga Therapist and E-RYT 500 Yoga Teacher and Educator. She is the founder of Lisa Greenbaum Yoga + Wellness, a Yoga Education School with a trauma-informed lens. Recognizing that the chronic physical pain we experience is intensified through the chronic stress, poor sleep and mental health challenges that go along with the pain, Lisa’s approach is centred on creating balance for the nervous system that includes meditation, breath work and movement to quiet the fight/flight response and build ease within the body and mind. In this episode, we talked about what yoga is, how yoga can be adapted for people experiencing pain, and how physiotherapists can work with yoga therapists. There is also a breathing meditation demonstration at the end for you to experience.
 
Resources:
Training for Yin+Restore practice, pain management including Chair Yoga https://lisagreenbaum.com/yoga-for-wellness/
Virtual classes that I teach https://lisagreenbaum.com/weekly-online-yoga-classes/
Study on Yoga and Pain: A Mind/Body complex system https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9996306/
Study - Needle electromyographic evaluation of trigger point response to a psychological stressor https://pubmed.ncbi.nlm.nih.gov/8008795/
Yoga Therapist Search https://www.iayt.org/search/search.asp?csy=209092
IAYT also lists a number of studies on Yoga Therapy and Chronic Pain: https://www.iayt.org/page/YTT_IJYT_Pain
 
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep13: Strength Training for Pain with Dr. Michael Mash

Dr. Michael Mash is a Physical Therapist in the United States. He is also the founder of Barbell Rehab, an education company helping fitness and rehab professionals improve the management of their clients dealing with pain. He has a special interest in resistance training for improving strength, power, and longevity. In this episode, we talked about conceptualizing strength training from the biopsychosocial perspective, the role of strength training in pain management, and how physiotherapists can work with fitness professionals. 
Website: https://barbellrehab.com/
Instagram: @barbellrehab
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep12: Supporting Children with Complex Pain with Amanda de Chastelain

Amanda de Chastelain has been working at the Alberta Children's Hospital since 2014 at their outpatient orthopaedics, complex pain clinic, and burn clinic. She is also a current board member and the past president of the Canadian Physiotherapy Association.
In this episode, we talked about pain in the pediatrics context, concrete ways to support children experiencing complex pain and their families, and effective ways of communicating concepts of pain with children.
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Ep11: Mobilization with Movement: Integrating Manual Therapy with Pain Neuroscience with Jack Miller and Jim Millard

The Mulligan concept, or Mobilization with Movement (MWM) is an approach to manual therapy that combines active movement, pain neuroscience, patient autonomy, and hands-on mobilization. We have two very qualified guests to discuss this topic. 
Jack is the senior editor of the Canadian Physiotherapy Association’s Orthopaedic Journal, executive member of the Orthopaedic Division of CPA, the President of the Canadian Academy of Manipulative Physical Therapy, a member of the CPA Specialization accreditation committee, and was a founding member of the Mulligan Concept Teacher’s Association. Jack has presented at conferences internationally, published research articles and multiple textbook chapters, and taught high-level, evidence-based manual therapy courses internationally since 1990. Jack works clinically as an advanced practice consultant triaging patients for imaging, laboratory investigations, medical interventions and surgery.
Jim is the National Director of Clinical Training and Development at CBI Health. Jim has been a clinician for over 30 years and has been teaching the Mulligan Concept in Canada since 2007. He is passionate about communication and storytelling in health care and also teaches clinical relationship building. The writing and study of stories and poetry build empathy and narrative competence to not only get to know ourselves but to meet others where they truly are. Jim utilizes poetry to reflect upon the uncertainty and mystery of being a clinician. He released his first book of poetry, Cuoreosity: The heArt of Being in 2022.
In this episode, we discussed MWM's philosophies, therapeutic effects in the literature, and practical considerations when applying MWM. 
Links:
https://bmulligan.com/
https://www.mulligancanada.com/ 
Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8