Happy Independence Day to the American Healthy Wealthy and Smart family! On this week’s episode, Greg Lehman and I review the evidence and rethink effective treatment strategies. Greg is both a physiotherapist and chiropractor who treats musculoskeletal disorders within a biopsychosocial model and simplifies pain science for clinicians around the world.
In this episode, we discuss:
-Why explaining pain leads to better treatment outcomes
-The case for and against repeated spinal flexion
-Does glute activation or inhibition affect pain?
-Functional training and the carry-over effect
-And so much more!
Greg stresses that most physical therapists should rethink what is valuable to their patients. He states, “The technical mastery is less important…It probably has more to do with how your patient feels comfortable and how you respond to them rather than you being a good robot who knows lines of drive and the biomechanics. That isn’t what is valuable and isn’t supported in all the research that we have.”
Greg also questions the effectiveness of being so specific with our interventions and takes a broader approach in his treatment philosophy. “I don't think there is any treatment that ever has to occur… It’s actually a neat, big question for therapy I would like to see addressed more. Is there ever a treatment that is absolutely necessary for a specific condition or are there a number of things that can be helpful? I tend to believe there are a number of things—I have my biases—but I think most things aren't that specific.”
Greg builds patient self-awareness with education and believes it is his most effective treatment tool. “I go right into education for low back pain. I am not too worried about getting them super active right away. I want to encourage them to getting back to doing the things that are important. If they tell me they are afraid to do a number of things that they like doing and they are meaningful activities, my go to intervention is to convince them they can start doing those things again.”
Greg suggests shifting our focus as clinicians from a purely biomedical approach to treatment and instead developing our psychosocial expertise. “I really believe it is okay to be simple. We don't really need the complexity that we try to do, especially the biomechanics. The big point of that is if you simplify your biomechanics, your physical interventions, it can allow you to develop your skills in the other areas, the psychosocial stuff and start taking more classes outside our typical training—psychologists, social workers, that type of stuff. That’s where we can build our skill set. There's not a better manipulation, there’s not that special exercise technique that you need to learn. It’s fun but it’s not necessary for patients with pain.”
For more about Greg:
He is a physiotherapist and chiropractor treating musculoskeletal disorders within a biopsychosocial model.
Prior to his clinical career he was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two yearly students to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory subsequently publishing more than 20 peer reviewed papers in the manual therapy and exercise biomechanics field. Greg 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. He 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 clinical musings can be seen on Medbridge Health CE and various web based podcasts. Greg is currently an instructor with therunningclinic.ca and with Reconciling Biomechanics with Pain Science. Both are continuing education platforms that provide clinically relevant research that helps shape and refine clinical practice.
While he has a strong biomechanics background he was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. Greg believes successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. He is active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice. Further in depth bio and history of my education, works and publications.
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