The Modern Pain Podcast Modern Pain Care

Diego Hidalgo a Spanish physiotherapist and osteopath discusses their recent paper - ‘It’s all connected, so it all matters’ - the fallacy of osteopathic anatomical possibilism.

In the podcast they discuss:
• Anatomical Possibleism in Osteopathy and PT
• Anatomy, Pathologization, and Pain Discussion
• Pain Treatment and Cultural Differences
• Concerns Over Over-Diagnosing and Anatomical Possibleism
• Addressing Chronic Pain Challenges
•  Holistic Approach to Pain Management
•  Evidence-Based Approach and Transition to Modern Practice Challenges

‘It’s all connected, so it all matters’ - the fallacy of osteopathic anatomical possibilism
Jarvik study

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this conversation, Mark Kargela interviews Michael Shacklock about his journey and influences in the field of neurodynamics. They discuss the transition from the traditional view of neural tension testing to neurodynamics, the influence of pain science on clinical practice, and the importance of integrating the biological examination with psychosocial factors. Michael also shares his focus on lumbar radiculopathy in his PhD research, specifically looking at unloading the nerve root for pain relief. In this conversation, Michael Shacklock discusses the use of neurodynamic techniques in the treatment of radiculopathy. He explains that movement-related pain should respond quickly to movement, and shares his favorite patient profile for this type of treatment. Shacklock emphasizes the importance of ruling out contralateral tests if they provoke pain, as this indicates reduced cord movement. He also discusses the role of radiology in diagnosing radiculopathy and the challenges of interpreting radiology reports. Shacklock addresses the misconceptions around neurodynamic tests and highlights the need for a comprehensive approach that integrates neurodynamics with musculoskeletal function. He concludes by discussing the application of neurodynamic techniques in acute radiculopathy and the importance of adapting treatment to the individual patient's needs.

If you are looking to go deeper on topics, get training, and become a better pain care clinician, then check out our community at https://modernpaincare.com


**TIMESTAMPS**
00:00:00 Start
00:02:04 Interview Begin
00:07:15 The movement to neurodynamics versus neural tension
00:10:37 How has pain science influenced MIchael's approach
00:14:40 There is a time to specifically treat the tissues
00:18:51 Michael's PhD focus
00:23:32 Crossed straight leg raising as treatment
00:26:50 Differneces between mechanical compresison and inflammtory nerve root issues
00:32:05 Difficulties with radiolgy
00:34:16 Where physios are missing the mark in application
00:38:51 Use of neurodynamics in irritable patients
00:42:04 Michael's view on other movement approaches
00:45:09 Michael's courses and where to find him next

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____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

To go deeper and get support in your practice make sure you check out our community

In this conversation, Mark Kargela interviews Jason Silvernail about the definition and description of Orthopedic Manual Physical Therapy (OMPT). They discuss the misconceptions and misunderstandings surrounding manual therapy and how OMPT differs from other forms of manual therapy. They also highlight the distinguishing characteristics of OMPT, including advanced subspecialty training, focus on clinical judgment, expertise in examination and treatment, and a patient-centered long-term mindset. The conversation emphasizes the importance of evidence-based practice and the need for a nuanced understanding of OMPT. In this conversation, Jason Silvernail and Mark Kargela discuss the value and benefits of OMPT (Orthopaedic Manual Physical Therapy) fellowship training. They highlight the importance of clinical judgment and critical thinking in the practice of manual therapy. They address the misconception of elitism associated with advanced training and emphasize the need for accurate information and informed decision-making. The conversation provides insights into the distinguishing characteristics of OMPT and its role in providing high-quality, evidence-based care for patients.

Helpful Links:
Link to paper 
Clinical reasoning paper in OMPT
Jason's website
Jason's X profile 

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🎙️ - Listen to our Podcast - https://www.modernpaincare.com

____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this conversation, Mark Kargela interviews Ian Harris, an orthopedic surgeon and researcher, about the challenges and problems in healthcare. Ian discusses his journey from being a practicing surgeon to becoming interested in the scientific method and evidence-based medicine. He talks about the resistance he has faced in challenging the status quo and the difficulties in changing the way surgeons think. They also discuss the placebo response in surgery, the blurring of normal and disease states in healthcare, and the overuse of procedures like spinal fusion and regenerative medicine. Ian shares his projects on placebo studies for rotator cuff repair and spine fusion, which aim to provide high-quality evidence to change practice.
Takeaways
The scientific method and evidence-based medicine are crucial in improving healthcare practices.Surgeons often face resistance when challenging the status quo and trying to change the way they think.The placebo response in surgery is complex, and contextual factors play a significant role.The blurring of normal and disease states in healthcare leads to unnecessary interventions and medicalization of normal conditions.Procedures like spinal fusion and regenerative medicine are often overused despite limited evidence of their effectiveness.Placebo studies for rotator cuff repair and spine fusion aim to provide high-quality evidence to guide practice.Books (Affiliate Links)
Surgery: The Ultimate Placebo
Hippocrasy: How Doctors are Betraying Their Oath

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____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this episode, physiotherapist Adam Dobson discusses lumbar radiculopathy and its management. He highlights the challenges in assessing and diagnosing lumbar radiculopathy, emphasizing the importance of precise terminology and understanding mixed presentations.  Adam also explains the role of the neurological examination and the stepped-care approach in managing lumbar radiculopathy. He emphasizes the need for an economical approach to treatment, focusing on patient preferences and activities that are meaningful to them. Adam also discusses the role of physiotherapy in supporting patients' recovery and the importance of balancing tissue-based and biopsychosocial approaches.

Schmid AB, Tampin B, Baron R, et al. Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group. *Pain*. 2023;164(8):1693-1704. doi:[10.1097/j.pain.0000000000002919](https://doi.org/10.1097/j.pain.0000000000002919)

Konstantinou K, Lewis M, Dunn KM, et al. Stratified care versus usual care for management of patients presenting with sciatica in primary care (SCOPiC): a randomised controlled trial. *Lancet Rheumatol*. 2020;2(7):e401-e411. doi:[10.1016/S2665-9913(20)30099-0](https://doi.org/10.1016/S2665-9913(20)30099-0)

Stynes S, Konstantinou K, Ogollah R, Hay EM, Dunn KM. Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain. *PLoS One*. 2018;13(4):e0191852. doi:[10.1371/journal.pone.0191852](https://doi.org/10.1371/journal.pone.0191852)

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____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Simon Kelly discusses his journey as a healthcare professional and his exploration of the role of physiotherapy in pain management. He questions the necessity of physiotherapy for every individual and the challenges of building a virtual practice. Simon also delves into the limitations of the biomedical model of medicine and the need for a more holistic approach.

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🎙️ - Listen to our Podcast - https://www.modernpaincare.com

____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness