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From Chronicity…… to Performance
Mark SextonChartered Physiotherapist
The Plan
Learning Plan
Early IdentificationEarly Management
PreventionTreatmentRehabilitation
OutcomesCase Studies
Movement
Nociception
Tissue Pathology
Central Sensitisation
Neurogenic Pain
PeripheralNeuropathic Pain
PsychoEmotionalSocial
Plasticity
Lorimer Moseley
Central Sensitisation
• Trauma
• Emotional Response, Fear
• Initial Injury severity
• Flaring of old scars
• Maladaptive
– Psychological
– Emotional
– Movement
Central Sensitisation
• Pain
– Severity, Hypersensitivity
– Latency
– Allodynia
– Pattern – Unpredictable Agg/Easing factors
– Palpation non-differential
– Neural involvement
CRPS
• Pain Severity, Hypersensitivity
• Swelling
• Skin Shine, Sweat
All Movement has Effect…
…and Vice-Versa
Langevin HM and Sherman KJ,
Pathophysiological Model for cLBPIntegrating
Connective Tissueand
Nervous System Mechanisms
Med. Hyp. 2006
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Neural Tissue
Plasticity
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Neural Tissue Plasticity
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Connective Tissue
Plasticity
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
Pathogenic Mechanism
Langevin 2006
MovementPostureExercise
Treatment
Tissue Pathology
Dysfunction
Direct Tissue Mechanical Stimulus
Cognitive/BehaviouralMovementTreatment
Placebo
PsychosocialGenetic
Pathogenic Mechanism – Therapeutic interventions
Langevin 2006
Movement
Nociception
Tissue Pathology
Central Sensitisation
Neurogenic Pain
PeripheralNeuropathic Pain
PsychoEmotionalSocial
Learning Plan
Early IdentificationEarly Management
PreventionTreatmentRehabilitation
OutcomesCase Studies
Chronicity…… to Performance
Mark SextonChartered Physiotherapist
Thank You!
References
• Smart KM, Blake C, Staines A, et al. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with nociceptive, peripheral neuropathic and central sensitisation pain. The discriminant validity of mechanism-based classification of low back (+-leg) pain. Manual Therapy 2012: 17; 119-125.
• Nijs J, Van Boudewijn H, Oostendrop RAB. Recognition of central sensitization in patients with musculoskeltal pain: application of pain neurophysiology in manual therapy practice. Manual Therapy 2010: 15; 135-141.
• Nijs J, Van Houdenhove B. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice. Manual Therapy 2009:14; 3-12.
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