Are We Creating New Myths as we Dismantle Old Ones? – Southeast Sports Seminars

Are We Creating New Myths as we Dismantle Old Ones?

start-with-why
What is FTCA? First, Let’s Start with Why…
March 14, 2018
fasting-benefits
New Study Supports the Dramatic Positive Effects of Fasting
March 16, 2018

Guest Blog from Ryan Kendrick (Dynamic Tape) — We were taught in our first year of university (nearly 30 years ago) that you say ‘a person with a disability’ and not a ‘disabled person’. The terms are even better now but the point is that you put the person front and centre.

We need to assess and consider the entire person, their beliefs, values, goals, preferences, fears, family, social support, home situation (both physically and socially) as well as their pain, function, abilities, tissue damage or pathology etc. Engel proposed the Biopsychosocial Model in 1977 to do just this, to be anti-reductionist and to not compartmentalise. Sackett in 1996 when coining the term ‘Evidence Based Medicine’ reinforced this idea suggesting that the evidence from the literature needed to be factored in with patient values and preferences, expertise of the clinician (no good having evidence if you can’t perform the test procedures or don’t know when to do what) and situation specific factors.

It seems ironic to me that the more recent ‘movement’ to explode myths seems to be doing exactly what the BPS model was developed to avoid – compartmentalising. Instead of an holistic approach it is now seen by many as BIO or PSYCHO and SOCIAL. In my career I believe that the good clinicians have always been effective because they were good at evaluating the patient and communicating with them to enhance the therapeutic interaction or patient/therapist relationship. Providing a pathway forward that the patient was involved in developing, could understand and that reflected their goals and needs while explaining honestly and factually to the best of the current understanding whether this was someone with acute pain and mainly peripherally and nociceptive driven or someone with episodic, fluctuating or persistent pain +/- central sensitisation or a stronger influence from psychosocial factors. Focus was always on early movement and resumption of activity.

In this link (below) we see a systematic review showing low to moderate evidence of a small effect of pain neuroscience education. It is not the panacea that some make it out to be. We see similar levels of evidence with lots of interventions that are currently dismissed as belonging to the dinosaurs.

We certainly have a better understanding of some of the pain mechanisms now and our terminology continues to improve to reflect this but the good clinicians have essentially and possibly unwittingly always implemented these strategies as part of their overall management.

Some other pet hates –

Biopsychosocial does not equal pain neuroscience.

Plain and simple.  The two are not one and the same.

Persistent pain may or may not involve central sensitisation.
Secondary hyperalgesia is not necessarily pathological.

It is normal and usually fully reversible. When it does not resolve as it should is an issue.

Correlation or predictive value of psychosocial yellow flags are no more evidence of causation than correlation/association/predictive value of other things

…e.g. hip adduction with ACL injuries. Many people have these yellow flags and don’t go on to chronicity and others have persistent pain without the psychosocial predictors just as some people have ACL injuries without high frontal plane knee angles.

The onset of the initial pain is generally precipitated by nociception +/- tissue damage

…(with possibly associated inflammatory mediated or neurogenic pain) and peripheral input continues to be relevant in persistent pain (psychosocial factors may influence magnitude and likelihood of chronicity, and accounts for the variation between individuals with similar injuries at the outset but does not generally create the pain without precipitating peripheral input initially for the general musculoskeletal things that we see).

Patients don’t necessarily need to become pain neuroscientists to become better.

It could in fact be detrimental if you tell someone that fear can wind up their pain but you have not provided a strategy to reduce fear or worse still, your education is incongruent with their situation e.g. they do have ongoing tissue damage and nociception that you have failed to detect and you tell them that they are capable of doing these movements and it won’t cause any further damage (I know this from personal experience as a child when a piano fell on my leg). Great way to increase anxiety and fear and wind up the pain system further.

Pain education is the only way to manage the psychosocial aspects…

This depends on the situation and relative influence (e.g. Smith et al, 2015) showed that removing the nociception via radio frequency neurotomy attenuates both physical and psychological factors associated with chronic whiplash. As effect of RFN wear off and nociception returns so to do the psychological issues.

In dismantling some ‘old’ myths (which is a good thing), the myth busters seem to be creating plenty of new myths which are possibly just as unhelpful. Possibly having a character limit or twitter doesn’t help as people try to post something that will get attention but I have seen some long posts also which rather obnoxiously pull apart old beliefs but make many of the same mistakes or biases and perpetuate a new myth. But everyone wants to be part of a ‘movement’.

The study related to this research commentary can be found in the link below – https://www.ncbi.nlm.nih.gov/pubmed/29443723

Ryan Kendrick is an Australian Musculoskeletal Physiotherapist and the developer of Dynamic Tape.  He earned his Bachelor of Physiotherapy degree from the University of Queensland, Australia in 1994 and a Masters in Musculoskeletal Physiotherapy under the same world renowned guidance, which included Gwen Jull, Carolyn Richardson, Paul Hodges and Bill Vicenzino. Ryan has worked extensively in the area of Musculoskeletal & Sports Physiotherapy with roles including Personal Physiotherapist to former world number four, Greg Rusedski on the ATP Tennis Tour and British Davis Cup team, and Team Physiotherapist for Essex County Cricket Club in the United Kingdom. As a Private Practitioner he has been involved in the management of European Tour Golfers and Olympic and Commonwealth Games athletes in the disciplines of swimming, rowing, fencing, archery and triathlon to name a few.

Due to the strong biomechanical nature of the injuries in these sports and the limitations encountered with the available taping products, Ryan set about developing a product that would permit full range of movement but allow genuine mechanical assistance to alter movement patterns or to assist the role of injured tissues. The result is Dynamic Tape. Accompanying this is the Dynamic Taping Method, a novel approach to taping based on biomechanical principles and physiology of muscles, ligaments and connective tissue.

Ryan has also been a Clinical Tutor for the Musculoskeletal Component of the Griffith University Physiotherapy programme. He has had a number of television appearances in Australia including on the ABC Television programme ‘The New Inventors’ where his PosturePals product won the episode.

X