Self-management for low back pain

I have had an interest in low back pain since the early stages of my career as a physiotherapist. My relatives, friends and patients complained about this condition and its recurrence even after receiving treatment. At that time, I was intent on finding a “cure” for this condition. I often browsed the literature to find the causes and possible … [Read more...]

Good news for chronic nerve pain sufferers…but it could have been better

This post is a republishing of a recent article in The Conversation by Michael Vagg: The announcement on Friday last week that pregabalin (Lyrica) made it onto the Pharmacutical Benefits Scheme (PBS) is a huge relief for sufferers of chronic nerve pain. It also means that the true cost of providing appropriate care to chronic pain sufferers … [Read more...]

Want to turbo-charge your rehab? Go to the movies!

Jack Nicklaus is on the short list of the greatest golfers of all time, and I love his evocative quote, “before every shot, I go to the movies.” He never hits the ball (not even in practice) without first having a very sharp, focused picture of it in his head. He constructs a detailed image of the green, every dimple on the ball, the trajectory and … [Read more...]

Exercise is often ineffective as a short-term pain killer for patients with chronic pain

When healthy people start to exercise, the brain activates powerful descending analgesic systems (pain inhibitory actions). This leads to increased pain thresholds during exercise, making it less likely that we will feel pain during, or immediately following, exercise.  However, brain-orchestrated analgesia or pain inhibition is often impaired in … [Read more...]

It worked before but now it doesn’t? Graded Motor Imagery in Clinical Practice

While pain may be a universal experience, one experience that can often plague and frustrate everyone is that time when something works one moment but then all of a sudden doesn’t work the next. If you’ve ever had the pleasure of experiencing this you’ll find that it applies to many things in life whether it be the temperamental office photocopying … [Read more...]

The Opioid Bank. It seems we are facing another global crisis!

Opioids. We all know what they are and that there are a lot of them going around, but it wasn’t until I was asked to write this blog on the information overloading review by Manchikanti and friends (2010) that I realised quite the extent. And to tell you the truth, it’s painfully scary! In a nutshell, well over half of the review pumped out … [Read more...]

Pain assessment flowchart. Patient, practitioner and environment

In my general physiotherapy practice about one in five patients come with complex pain, disability and loss. I love sorting out the pieces of the puzzle that creates these situations. A challenge is not to get lost amongst all the pieces. So I take the patient on a journey of discovery as I find all the pieces, so I can then help them see their … [Read more...]

Does graded motor imagery satisfy the Burns test?

In the last post, I put Explaining Pain (EP) through its paces on the Burns test of 5 criteria that need to be met if we are to accept a theory of how a treatment works.  Well, today I am going to put graded motor imagery (GMI) through the same test, just to give you all an idea on how far we have to go.  As we point out in the Graded Motor Imagery … [Read more...]

More fragility in core stability

The evidence for the role of exercise in chronic low back pain has been a bit of a theme on the blog here at BiM. We’ve discussed different perspectives regarding the evidence of its efficacy (see here, here and here), where it sits against other treatments in that regard and considered a recent review of its effects, or lack of, on parameters of … [Read more...]

Graded motor imagery, one shark and two men on a mission

We recently got an email from the guys at Neuro Orthopaedic Institute, or NOI as they are more commonly known.  Now, none of us at BiM are part of NOI but we like the stuff they do and thought that this latest venture was worth giving a shout out for. The feedback we got from people who attended has been great.  This is what they did.... Tom Giles … [Read more...]