One-to-one or strength in numbers – is there a best way to deliver exercise based physiotherapy?

Musculoskeletal (MSK) conditions are common and costly, resulting in significant personal, social and economic burden (here and here) [1, 2]. While physiotherapists deliver many interventions (e.g. massage, spinal manipulation, dry needling, etc.), exercise is probably the most commonly used and researched component of physiotherapy, with many RCTs … [Read more...]

Expressing pain: which patients do we trust?

Trustworthiness is one of those instant judgements we automatically make about other people, affecting our behaviour towards them [1]. We wanted to know whether clinicians’ judgements of patients’ trustworthiness affected their estimation of patients’ pain [2]. There seem to be so many grounds on which the complaint and expression of pain is met … [Read more...]

Neural underpinnings of fear of movement in chronic low back pain – what do we know now?

Manual therapists such as physical therapists or chiropractors observe that some patients with seemingly identical back pain problems recover within weeks while others develop chronic pain and disability. What does research tell us about this phenomenon? Past research has identified and verified that one of the strongest links to the maintenance … [Read more...]

Pain Management – it’s a sham

If we posit that pain is an output of the brain that is based on the perception of threat, it would follow that decreasing threat, whatever it may be, would positively influence a person’s pain experience. This has led to some exciting therapeutic advances aimed at altering threat, which include encouraging patients to rewrite their pain experience … [Read more...]

We should be worried about gravity?!?!

We all know how common back pain is and how back pain comprises a significant proportion of the 1 in 4 people with persistent pain. There is clearly an established link between the meaning of one’s pain and the fear it evokes, right?  Someone’s perception of what it happening in their back relates to their pain, right?  Castrophisation scales and … [Read more...]

Should proprioceptive training be a priority in the management of chronic pain?

Avid readers of know all too well that chronic pain can be associated with perceived distortions of the painful limb, be it in size, shape or posture [1-4]. In some cases, those with chronic pain report that they have limited awareness of the location of their painful body part [4, 5]. What they report may be a disturbance to the … [Read more...]

Painful Diabetic Neuropathy from a Bio-Psycho-Social Perspective

Painful Diabetic Neuropathy (PDN) is a complex and multi-dimensional condition that affects up to 20% of people with diabetes. PDN is associated with considerable morbidity, mortality and diminished quality of life (QOL). Unfortunately, pain treatment with medication in PDN is frequently unsuccessful or only partially successful [1]. Patients with … [Read more...]

Group Cognitive Behavioural Therapy – can we do better?

Cognitive behavioural therapy (CBT), a  management strategy for chronic pain and its consequences [1], is frequently conducted in groups to minimise cost [2] and maximise efficiency. Although clinicians often report knowing when a group will go well or badly based on who is in the group, evidence that group composition can influence outcomes is … [Read more...]

Why physical therapy treatments for low back pain may not be living up to their potential

Low back pain (LBP) is a leading contributor to people living with disability throughout the world,1 and the problem appears to be getting worse rather than better.2 Scientists and clinicians, therefore, need to improve treatment for LBP to shift this trend and reduce disability. People with LBP change how they control their posture for … [Read more...]

Low Back Pain Treatment in Primary Care

In general, most acute low back pain (LBP) recovers spontaneously within a few days or weeks. No active treatment has shown to actually shorten the time it takes for acute back pain to recover. The purpose of medication, manipulation, acupuncture, physiotherapy etc. is at best to ease the pain while one is waiting for nature to heal. And one should … [Read more...]