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Rehabilitation & Pain Science Archives - Breathe Education

How to teach movement skills with Gabriele Wulf and Rebecca Lewthwaite

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Dr. Rebecca Lewthwaite received her PhD in kinesiology (what in Australia we call exercise science or human movement) from UCLA. She is Director of Research and Education in Physical Therapy and Director of Rehabilitation Outcomes Management at Rancho Los Amigos National Rehabilitation Center in Los Angeles, and an adjunct faculty member in biokinesiology and physical therapy at the University of Southern California (USC).

Dr. Lewthwaite’s research focuses on the role of confidence and autonomy support in motor performance and learning, in a variety of individuals, from those undergoing physical rehabilitation to developing and high-performing athletes. Recent work includes the facilitation of confidence building in individuals recovering from stroke. As an investigator in the recent ICARE clinical trial in stroke rehabilitation, Dr. Lewthwaite co-designed with Carolee Winstein the investigational Accelerated Skill Acquisition Program (ASAP) around skill acquisition principles common to OPTIMAL theory. She was an intercollegiate athlete in two sports and a coach on a national championship softball team at UCLA. She and Gaby Wulf co-authored the OPTIMAL theory of motor performance and learning.

Dr. Gabriele Wulf is a sport scientist with PhDs from the German Sports University in Cologne and the University of Munich. She is a UNLV Distinguished Professor in the Department of Kinesiology at the University of Nevada, Las Vegas (UNLV).

Dr. Wulf has conducted research in motor learning for more than 30 years. She studies factors that influence the learning of motor skills, including attentional focus and motivational variables. She has published approximately 200 journal articles and book chapters, as well as two books, both of which I have read, and they are both excellent!

Dr. Wulf has received various awards for her research, including UNLV’s Barrick Distinguished Scholar Award. She was elected Fellow of the National Academy of Kinesiology and given the North American Society for the Psychology of Sport and Physical Activity’s (NASPSPA) Distinguished Scholar Award. She has served as President of NASPSPA and the Founding Editor of two journals in the movement sciences. Dr. Wulf has given keynote addresses to national and international societies in movement science and physical therapy. She and Rebecca Lewthwaite co-authored the OPTIMAL theory of motor performance and learning.

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The Female Athlete with Antony Lo

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Antony Lo is a Sydney based physiotherapist who specialises in female athletes, and in particular female Crossfit athletes.

Having successfully grown 2 private practices, Antony sold these to concentrate on his Specialisation Training Program and developing educational courses for health professionals and the general public. He still consults at 2 locations in Sydney seeing everyone from children to the elderly, as well as his sports-specific patients. He also travels around Australia to deliver seminar information for his course The Female Athlete, and to provide consultations for those interested in his approach.

I have been friends with Antony since 2006 when we worked together. Every time I talk with Antony I learn something valuable, he is one of the practitioners I admire the most, and who I have learned the most from.

In this conversation we talk about pelvic health, urinary incontinence, low back pain, making quick changes and Antony’s approach to evidence-based practice.

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Pelvic Instability – Not A Thing

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Read the Research:

Relaxin levels during pregnancy are not related to pelvic pain

  1. Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review (Aldabe et al., 2012)
  2. Association between the serum levels of relaxin and responses to the active straight leg raise test in pregnancy (Vøllestad et al., 2012)

The sacroiliac joint basically doesn’t move – even in people with diagnosed “pelvic instability”

  1. Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain (Kibsgård et al., 2017)
  2. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test (Sturesson et al., 2000)

Pregnancy is characterised by widespread tissue hypersensitivity

  1. Pregnancy is characterized by widespread deep-tissue hypersensitivity independent of lumbopelvic pain intensity, a facilitated response to manual orthopedic tests, and poorer self-reported health (Palsson et al., 2015)

You can’t palpate movement of the pelvic joints (even if you think you can)

  1. Manual palpation of lumbo-pelvic landmarks: a validity study (Kilby et al., 2012)
  2. Inter-examiner reliability of four static palpation tests used for assessing pelvic dysfunction (Holmgren et al, 2008)
  3. Clinical tests of the sacroiliac joint: a systematic methodological review. Part 1: reliability (van der Wurff et al., 2000)(a)
  4. Clinical tests of the sacroiliac joint: a systematic methodological review. Part 2: validity (van der Wurff et al., 2000)(b)

The biggest predictor of recovery from pelvic pain is – belief that you will recover

  1. Prognostic factors for recovery from postpartum pelvic girdle pain (Vøllestad et al., 2009)

A person-centred approach to pain with Kjartan Vibe Fersum

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Kjartan Vibe Fersum is a postdoctoral researcher at the University of Bergen, Norway, and was the lead author on the original CFT paper in 2012, with co-authors Peter O’Sullivan, Skouen,  Smith, & Kvåle.

In addition to his teaching and research at the University of Bergen, he works in clinical practice as a Specialist Musculoskeletal Physiotherapist in Bergen, and a contributor to the Pain-Ed project, where his mission is to inform both the public and health care practitioners about the latest pain research, and to dispel common myths about pain and provide hope for change.

Kjartan is incredibly well-read, but his true genius seems to lie in combining his rich and nuanced understanding of the research with a flexible, person-centred worldview.

This interview has too many gems and insights to list – you must listen to it if you work with people in pain.

Resources

  • Synnott et al., (2015) Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review
  • Kamper et al., (2017) What Do Patients with Chronic Spinal Pain Expect from Their Physiotherapist?

Become a movement optimist with Greg Lehman

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Greg Lehman http://www.greglehman.ca/ is a Canadian physiotherapist, chiropractor and strength and conditioning specialist treating musculoskeletal disorders within a biopsychosocial model. He is incredibly well-read, a highly skilled educator. And he’s funny.

Before his clinical career, Greg received a Natural Sciences and Engineering Research Council MSc graduate scholarship and became one of only two students each year to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory, subsequently published more than 20 peer-reviewed papers in the manual therapy and exercise biomechanics field. He was an assistant professor at the Canadian Memorial Chiropractic College teaching a graduate-level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students.

Greg has lectured on a number of topics on reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience. His courses Reconciling Biomechanics with Pain Science and Running Resiliency have been taught more than 60 times in more than 40 locations worldwide.

In this conversation, Greg and I talk about how the biomechanics research invalidates the idea of ‘dysfunction’ as a cause of pain or disability, why scapular dyskinesis (aka poor scapular positioning and movement) is not a thing, knee valgus during a squat is nothing to worry about and several other interesting topics.

Greg shares his approach of movement optimism, and his basic framework for working within a biopsychosocial model.

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Is it time to let go of our obsession with anatomy?

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I was inspired to write this by Jenna Zaffino’s story in episode 52 of Pilates Unfiltered – I don’t want to put words in Jenna’s mouth so you should listen to the episode after reading this if you’re interested to understand her point of view.

As movement teachers – Pilates professionals, exercise physiologists, physiotherapists – for years we have operated on the assumption that understanding anatomy, physiology and biomechanics are foundational to being an effective practitioner and teacher.

I think this assumption is wrong. You don’t need to know anything about anatomy, physiology OR biomechanics to effectively teach Pilates or help people rehabilitate.

Yep. Anatomy is not important when teaching Pilates. In fact, I think it gets in the way of good teaching.

I will even go so far as to say, you don’t need to know ANY anatomy, physiology or biomechanics in order to be a great teacher and practitioner. The less the better.

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Learning to think critically with Lars Avemarie

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Lars Avemarie is one of the most well-read, clear-thinking people I have come across in the fields of pain science and rehabilitation. Born in Denmark, he currently works in Sweden. He is a physiotherapist and personal trainer, and a prolific blogger, educator and public figure on social media.

In this conversation, Lars shares his experiences going back to university at the age of 39 to study physiotherapy, his advice on learning to think critically and challenge your own beliefs, and how to develop your confidence to effectively apply the biopsychosocial approach to pain rehabilitation.

You can follow Lars on Facebook.

 

 

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Should we give patients the treatment they ask for? With Brendan Mouatt

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During my masters, I did my clinical placement with Brendan Mouatt and his business partner Luke Postlethwaite at their clinic The Biomechanics in Footscray, Melbourne Australia.

Like me, Brendan is a clinical exercise physiologist, and we enjoy talking about evidence-based practice and pain science in particular.

This is a free-ranging conversation where we think about whether we should provide clients with the treatment they expect, and how to navigate professional relationships with people who are not up to date with current best practice.

Brendan also has a thoughtful blog on all things rehabilitation.

How to apply the biopsychosocial model with Nick Hannah

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Nick Hannah is a Canadian physiotherapist who has been taking social media by storm with his funny, poignant and scientifically sound memes advocating a biopsychosocial or whole-person approach to rehabilitation.

Nick’s Facebook page Hannah Moves has over 6,500 likes a the time of recording this interview, and his posts are shared by leading researchers and clinicians around the globe.

Nick’s Instagram page is also a source of much wisdom.

Nick talks frankly about his education, his approach to clinical assessment and treatment and his goals with the meme thing.

How to apply the biopsychosocial framework with Ben Cormack

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Ben Cormack’s business Cor-Kinetic delivers evidence-based rehabilitation courses based on cutting-edge neuroscience, pain science and exercise science. Ben regularly travels the world, delivering courses to health professionals in Europe, North America and Asia each year.

He has presented at the San Diego Pain Summit, guested on many PT podcasts and is a prolific blogger on all things exercise, rehabilitation and pain science.

Ben shares his thoughts on the current best practice in rehabilitation, how to interpret evidence, and how to navigate the tricky relationships with colleagues or bosses who are still working within a biomedical framework.

https://www.facebook.com/ben.cormack.1

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