Injuries occur at some time to most people. They can be from accidental events, disease, or from subtle damage due to wear and tear that occurs over long periods of time. Treatment of the different injuries begins with a comprehensive individualized evaluation. After a detailed history is taken, the therapist evaluates the patient's ability to perform specific movements or appropriate tasks. Once the problems are identified, an individualized treatment plan is developed for the correction of these problems. This involves a hands-on approach to correct the things that are causing pain, limiting function or performance at a higher level. Our therapists are skilled at identifying the subtle changes in the body and its environment and at choosing the best exercises and procedures. Our hands-on approach, along with in-depth patient education, has been proven very successful.

The evidence base for Explain Pain
Butler, D. S., & Moseley, G.L. (2003). Explain Pain. Adelaide: Noigroup Publications, www.noigroup.com. Click here for a print version

Introduction

There are a number of dimensions to evidence. Everyone, when injured or in pain wants to know what is wrong and how long the problem will last. It is self evident that patients who get answers will have increased satisfaction and better coping strategies including less anxiety.

The education models based on Explain Pain are novel in that they utilise neuroscience education about the whole body, including the nervous system. There is a particular focus on the brain and it therefore involves education about the role of thoughts, attitudes, perceptions and superstitions as well as tissue damage and healing. These education models are based firmly within the biopsychosocial approach (Waddell, 2004). Pain is seen as not necessarily a sign of damage but more an individual response to threat, real or perceived. Psychological factors are strong predictors of long term disability and chronic pain (Burton, Tillotson, Main, & Hollis, 1995; Fritz, George, & Delitto, 2001). Explain Pain education gives a biological base to the psychological factors.

Modern views of evidence based medicine pay attention to basic sciences and controlled trials (Sackett, Rosenberg, Muir, & al., 1996).

Basic sciences

New paradigms such as the neuromatrix (Melzack, 1999), in association with rapid developments in brain imaging techniques such as functional MRI (e.g. (Flor, 2000; Verne, Robinson, & Price, 2004) and an understanding of stress biology allow the predictions that altering the threat value of an injury, procedure or pain state will have a beneficial influence on biological coping and healing systems such as the immune, endocrine, sympathetic, motor, respiratory and pain systems (Butler, 2000; Butler & Moseley, 2003; Melzack, 1999).

Controlled trials

There are a number of studies on the effects of education on pain and disability. Most are biomechanically i.e. structure based education programmes with reported benefits ranging from excellent (Udermann et al., 2004) to very little (Gross, Aker, Goldsmith, & Peloso, 2000).

Therapeutic neurophysiology education often includes the structural issue, if relevant, but goes into depth on the neuroscience and in particular on the brain. The approach is summarized by Moseley (2003a) and in the patient directed book Explain Pain (Butler & Moseley, 2003)

A randomised controlled trial has shown that one to one education sessions about the neurophysiology of pain will result in significant changes in pain beliefs and attitudes (Moseley, 2002). Another RCT has demonstrated that pain neurophysiology education (and not structure specific education) will alter pain cognitions and physical performance (Moseley, Hodges, & Nicholas, 2004). In addition, changes in pain cognitions after a one to one pain physiology education programme are also associated with changes in physical performance. Pain thresholds can be increased during physical tasks (Moseley, 2004). Pain neurophysiology education will improve the outcome of other therapeutic approaches such as various exercise strategies (Moseley, 2003b).

Many therapists initially believe that patients are unable to take on information about pain neurophysiology. However, Moseley (2003) showed that patients and therapists can understand the neurophysiology of pain, but professionals usually underestimate the ability of patients to understand.

The greater use of imaging strategies is likely to produce more studies similar to a recent case study (Moseley, 2005) which demonstrated that pain physiology education markedly reduces widespread brain activity characteristic of a pain experience.

References

Burton, K. A., Tillotson, K. M., Main, C. J., & Hollis, S. (1995). Psychological predictors of outcome in acute and subchronic low back trouble. Spine, 20, 722-728.
Butler, D. S. (2000). The sensitive nervous system. Adelaide: Noigroup Publications.
Butler, D. S., & Moseley, G.L. (2003). Explain pain. Adelaide: Noigroup Publications.
Flor, H. (2000). The functional organization of the brain in chronic pain. In J. Sandkühler, B. Bromm & G. F. Gebhart (Eds.), Progress in brain research, vol 129.Amsterdam: Elsevier.
Fritz, J. M., George, S. J., & Delitto, A. (2001). The role of fear-avoidance beliefs in acute low back pain: Relationships with curernt and future disability and work status. Pain, 94, 7-15.
Gross, A. R., Aker, P. D., Goldsmith, C. H., & Peloso, P. (2000). Patient education for mechanical neck disorders. Cochrane Database Systematic Review, CD000962.
Melzack, R. (1999). From the gate to the neuromatrix. Pain, Suppl 6, S121-S126.
Melzack, R. (1999). Pain and stress: A new perspective. In R. J. Gatchel & D. C. Turk (Eds.), Psychosocial factors in pain.New York: Guildford Press.
Moseley, G. L. (2002). Combined physiotherapy and education is effective for chronic low back pain. A randomised controlled trial. Australian Journal of Physiotherapy, 48, 297-302.
Moseley, G. L. (2003b). Joining forces - combining cognition-targeted motor control training with group or individual pain physiology education: A successful treatment for chronic low back pain. Journal of Manual and Manipulative Therapeutics, 11, 88-94.
Moseley, G. L. (2003a). A pain neuromatrix approach to rehabilitation of chronic pain patients. Man Ther, 8, 130-140.
Moseley, G. L. (2003). Unravelling the barriers to reconceptualisation of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain, 4(4), 184-189.
Moseley, G. L. (2004). Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. European Journal of Pain, 39-45.
Moseley, G. L. (2005). Widespread brain activity during an abdominal task markedly reduced after pain physiology education: Fmri evaluation of a single patient with chronic low back pain. Australian Journal of Physiotherapy, 51, 49-52.
Moseley, G. L., Hodges, P. W., & Nicholas, M. K. (2004). A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain, 20, 324-330.
Sackett, D. L., Rosenberg, W. M. C., Muir, J. A., & al., e. (1996). Evidence based medicine: What it is and what it isn't. British Medical Journal, 312, 71-72.
Udermann, B. E., Spratt, K. F., Donelson, R. G., Mayer, J., Graves, J. E., & Tillotson, J. (2004). Can a patient educational book change behavior and reduce pain in chronic low back pain patients? Spine Journal, 4, 425-435.
Verne, G. N., Robinson, M. E., & Price, D. D. (2004). Representations of pain in the brain. Current Rheumatology Reports, 6, 261-265.
Waddell, G. (2004). The back pain revolution (2nd ed.). Edinburgh: Churchill Livingstone.

For more information on chronic pain visit our Chronic Pain Resource

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Our Pilates program is unique in that it combines the benefits of the Pilates philosophy of optimal control and precision of movement with traditional physical therapy manual and exercise techniques to reduce pain and enhance function. Pilates is an exercise approach that focuses on six key principles; centering, concentration, control, precision, breath and flow. These principles are used to teach the mind to control our body movement by optimizing muscular strength and stability. Our Pilates program includes an extensive evaluation by a Physical therapist and development of an individualized plan of Pilates work and manual techniques. Sessions are tailored to the client using Pilates equipment and progress toward self-reliance.

During pregnancy, many postural changes occur slowly as the fetus grows in size often times leading to varying levels of aches and pains for many women. This can be a frightening time, especially for those who are experiencing their first pregnancy. Through appropriate physical therapy intervention we are often able to relieve or eliminate pain and dysfunction associated with orthopedic issues during and post pregnancy. Issues may involve spine and rib joint inflammation, muscle spasms, sacroiilitis (pelvic joint inflammation) due to ligamentous laxity of the pelvic girdle, and sciatica. Treatment may involve massage, neuromuscular exercise re-education to stabilize the pelvic girdle, low-grade joint mobilizations in conjunction with supervised Pilates reformer exercises and home exercises Goals of treatment also include functional improvement as well an education for self care. It is such a magical time that should not be overshadowed by unnecessary pain.

Our community is very sports oriented. There are "weekend warriors", endless youth programs, along with high school and college athletic programs. The therapists at NPPT have an extensive background in sports, and a vast knowledge of the injuries that occur. This experience aids the therapists in not only rehabilitating the injured athlete, but enhancing the athlete's performance using the latest in techniques and philosophy. Many athletes have benefited from specific sports rehabilitation programs at NPPT. The athletes we work with range from young to old, amateur to professional.

The TMJ (jaw joint) disorders are treated by physical therapists via manual interventions, modalities and neuromuscular re-education. We are able to assess the muscular involvement typically related to stress, clenching or grinding of the teeth, poor joint mechanics of the jaw and upper cervical spine, as well as, postural imbalances often associated with this diagnosis. Through the combined techniques of: (1) manual treatments, including joint mobilization & massage, (2) exercises for postural strengthening and stretching, and (3) re-education of the jaw joint mechanics (opening and closing) and tongue positioning we have had great success with treating this disorder.

The body's ability to balance is dependent on vision, muscle and joint and inner ear (or vestibular) function. When there is a problem with any of these functions, a person can develop vertigo or balance problems. The vestibular rehabilitation program at NPPT involves comprehensive assessment of posture, balance, movement and visual systems. A plan is developed that includes exercises and/or treatment designed to improve vertigo, balance and inner ear function. As balance improves, so will muscle tension, nausea, headaches and fatigue often associated with vestibular disorders. For more information on vestibular and balance disorders you can go to www.vestibular.org.

We now offer therapeutic massage. Our prices are as follows:

• $65 for a 50 minute massage
• $40 for a 30 minute massage

For more information, visit our therapeutic massage page. Please call for an appointment.