Paincast

Dr. Tyson Beach is currently a teaching professor at the University of Waterloo, teaching courses on the biomechanics and assessment of human movement, exercise prescription, and low-back disorders. His previous research focused on quantitative motion analyses, prevention of work-related musculoskeletal disorders, and advancing fundamental knowledge of spinal mechanics, control, and injury causation. He also collaborates with other knowledge producers (researchers) and users (practitioners) to design, implement, and evaluate physical activity and exercise programs for workers and athletes.

In this episode, we discussed the literature on exercise interventions for low back disorders. Continuing the discussion from previous episodes (Ep19-20), we talked about factors affecting how people lift, movement-related strategies to manage low back disorders, and how we can encourage people to participate in physical activity.

Note that this episode presents perspectives in movement-based strategies for low back disorders through the lens of biomechanics and exercise. It is not an attempt to address the topic exhaustively, nor does it attempt to address all of low back disorders. 

Relevant articles

1. Carnegie, D. R., et al. (2023). Can we enable individuals to reach further down without rounding their backs before beginning a lift? Examining the influence of starting foot and trunk position on reach depth. Ergonomics, 1-30.

Discussion flow

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episodes posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topics are researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Dr. Tyson Beach is currently a teaching professor at the University of Waterloo, teaching courses on the biomechanics and assessment of human movement, exercise prescription, and low-back disorders. His previous research focused on quantitative motion analyses, prevention of work-related musculoskeletal disorders, and advancing fundamental knowledge of spinal mechanics, control, and injury causation. He also collaborates with other knowledge producers (researchers) and users (practitioners) to design, implement, and evaluate physical activity and exercise programs for workers and athletes.

This episode is a continuation of the discussion from the last episode. We continued to discuss important factors to consider when reading the literature relating to lifting and spine flexion. In this episode, we went more in-depth in spine biomechanics during lifting in different contexts.

Relevant articles (Part 2)

1. Frost, D. M., et al. (2015). Exercise-based performance enhancement and injury prevention for firefighters: contrasting the fitness-and movement-related adaptations to two training methodologies. J. Strength Cond. Res., 29(9), 2441-2459.

Discussion flow

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Dr. Tyson Beach is currently a teaching professor at the University of Waterloo, teaching courses on the biomechanics and assessment of human movement, exercise prescription, and low-back disorders. His previous research focused on quantitative motion analyses, prevention of work-related musculoskeletal disorders, and advancing fundamental knowledge of spinal mechanics, control, and injury causation. He also collaborates with other knowledge producers (researchers) and users (practitioners) to design, implement, and evaluate physical activity and exercise programs for workers and athletes.

In this episode, we discussed the epidemiological and biomechanical literature around lifting with spinal flexion. Acknowledging that biomechanics is only one of the many factors in low back disorders, the goal of the discussion is to highlight the nuances in understanding biomechanics literature rather than to provide a definitive answer to this topic.

Relevant articles (Part 1)

1. Saraceni, N., et al. (2020). To flex or not to flex? Is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta-analysis. JOSPT, 50(3), 121-130.

Discussion flow

(00:01:35) Introduction

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Dr. Lucas Lima is a research associate at the Alan Edwards Centre for Research on Pain at McGill University. He is a physiotherapist with a PhD and postdoctoral training in pain neuroscience. His latest research, published in the Science Translational Medicine journal, has garnered significant media attention for challenging current practices in acute musculoskeletal pain management, specifically the suggestion that NSAID’s might increase the risk of developing chronic pain.

In this episode, we talked about what inflammation is, recent evidence on the relationship between inflammation and chronification of acute pain, the benefits of exercise to prevent chronic pain, improve recovery of present and future injury, and evidence-based recommendations on NSAIDs and cryotherapy (icing) post-injury.

Resources

Main paper: https://www.science.org/doi/full/10.1126/scitranslmed.abj9954

Pain center Youtube page: https://youtu.be/751NtSbCh6Q?si=U7rFeRfYXzPgkUFZ

Dr. Lima's email: [email protected]

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Dr. Laprade received her degree in Physical Education at the University of Western Ontario and then went on to complete her Physical Therapy degree, MSc and PhD in the Department of Anatomy at Queen’s University. She has previously taught Anatomy and Physical Therapy courses at Queen’s University and The Hong Kong Polytechnic University. Currently, she is the Anatomy Course Director for the Kinesiology & Physical Education, Dentistry and Physical Therapy programs at the University of Toronto. Dr. Laprade also teaches an exciting anatomy elective, ANA411Y: Anatomy in Application: Exercise & Biomechanics. Her research in the past has primarily focused on clinical assessment and evaluation of patellofemoral pain syndrome (PFPS) as well as acupuncture management of musculoskeletal disorders. More recently, she has embarked on developing and assessing educational tools for anatomy learning which are designed to enhance 3D learning.

In this episode, we talked about misbeliefs about patellofemoral pain etiology and management strategies, relationship between anatomy, biomechanics, empirical evidence, and clinical reasoning, and the importance for clinicians to keep up with anatomy and the literature.

Resources

Lan, T. Y., et al. (2010). Immediate effect and predictors of effectiveness of taping for patellofemoral pain syndrome: a prospective cohort study. AJSM, 38(8), 1626–1630. https://doi-org.myaccess.library.utoronto.ca/10.1177/0363546510364840

Barton, C., et al. (2014). Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. BJSM, 48(6), 417–424. https://doi.org/10.1136/bjsports-2013-092437

Wilson, T., et al. (2003). A multicenter, single-masked study of medial, neutral, and lateral patellar taping in individuals with patellofemoral pain syndrome. JOSPT, 33(8), 437–448. https://doi.org/10.2519/jospt.2003.33.8.437

Tiu, T. Using Kinesiology Tape in Physiotherapy Practice for Pain Management. Physiotherapy Practice. Canadian Physiotherapy Association. Spring 2023. Available from https://physiotherapy.ca/app/uploads/2023/05/English.April28.pdf

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Cory Choma has been in clinical practice since 1996 and is a founding member of CSA. He is one of only 4 Clinical Specialists in Pain Science in Canada and one of a handful of people awarded an Honorary Fellowship at the Institute for the Study and Treatment of Pain. Cory has been teaching GunnIMS domestically and internationally since 2003 and is a senior instructor for the Continuing Professional Development branch of the Faculty of Medicine at the University of British Columbia. Cory is one of the contributing authors for the chapter on GunnIMS in the text ‘Trigger Point Dry Needling: An Evidenced and Clinical-Based Approach’.

In this episode, our discussion surrounds how we engage in therapy with those living with persistent symptoms—all about talk therapy. We talked about how pain education can be simplified, how the body and the mind affect one another, how the biopsychosocial model can be harmonized and manifested, and more.

Recommended resources for you:

The Upside of Stress by Kelly Mcgonigal

Brain Rules for Aging Well by John Medina 

Why We Get Sick by Benjamin Bikman 

Mindset by Carol S. Dweck. 

Spark by John J. Ratey 

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Alex Chisholm, PT, BScPT, PgCPain, FACHS is a Physiotherapist with over 30 years of clinical experience. Alex received her postgraduate certificate in Multidisciplinary Pain Management from the University of Alberta. She is one of the executives of the Pain Science division of the Canadian Physiotherapy Association and was part of the working group that helped create the Chronic Pain Toolkit with Physiotherapy Alberta. She is a Fellow of the Alberta Clinical Hypnosis Society, previously the Canadian Federation of Clinical Hypnosis, and is a member of the Alberta Pain Society’s Planning committee for their annual Pain conference. In addition, she is a certified ‘Comfort Talk’ trainer. Alex currently works on the Burns and Plastics team at the Foothills Medical Center where she pursues her passion for burn survivor rehabilitation, and has taught nationally and internationally on Pain, Hypnosis and Pain management techniques. In this episode, we talked about what hypnosis is, how it can help patients, practical considerations when using hypnosis, and the power of therapeutic alliance and word choice.

1. Bicego A. et al. Neurophysiology of hypnosis in chronic pain: A review of recent literature. Am J Clin Hypn. 2022 Aug;64(1):62-80.

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Lisa Greenbaum is a Certified Yoga Therapist and E-RYT 500 Yoga Teacher and Educator. She is the founder of Lisa Greenbaum Yoga + Wellness, a Yoga Education School with a trauma-informed lens. Recognizing that the chronic physical pain we experience is intensified through the chronic stress, poor sleep and mental health challenges that go along with the pain, Lisa’s approach is centred on creating balance for the nervous system that includes meditation, breath work and movement to quiet the fight/flight response and build ease within the body and mind. In this episode, we talked about what yoga is, how yoga can be adapted for people experiencing pain, and how physiotherapists can work with yoga therapists. There is also a breathing meditation demonstration at the end for you to experience.

Resources:

Training for Yin+Restore practice, pain management including Chair Yoga https://lisagreenbaum.com/yoga-for-wellness/

Virtual classes that I teach https://lisagreenbaum.com/weekly-online-yoga-classes/

Study on Yoga and Pain: A Mind/Body complex system https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9996306/

Study - Needle electromyographic evaluation of trigger point response to a psychological stressor https://pubmed.ncbi.nlm.nih.gov/8008795/

Yoga Therapist Search https://www.iayt.org/search/search.asp?csy=209092

IAYT also lists a number of studies on Yoga Therapy and Chronic Pain: https://www.iayt.org/page/YTT_IJYT_Pain

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Dr. Michael Mash is a Physical Therapist in the United States. He is also the founder of Barbell Rehab, an education company helping fitness and rehab professionals improve the management of their clients dealing with pain. He has a special interest in resistance training for improving strength, power, and longevity. In this episode, we talked about conceptualizing strength training from the biopsychosocial perspective, the role of strength training in pain management, and how physiotherapists can work with fitness professionals. 

Website: https://barbellrehab.com/

Instagram: @barbellrehab

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8

Amanda de Chastelain has been working at the Alberta Children's Hospital since 2014 at their outpatient orthopaedics, complex pain clinic, and burn clinic. She is also a current board member and the past president of the Canadian Physiotherapy Association.

In this episode, we talked about pain in the pediatrics context, concrete ways to support children experiencing complex pain and their families, and effective ways of communicating concepts of pain with children.

Paincast is dedicated to bringing together researchers, clinicians, and students to discuss topics related to pain and physiotherapy. The primary purpose is to facilitate knowledge translation and critical thinking. Some episode posit themselves as more educational than others, and some more opinionated than others. The listener is encouraged to critically reflect on the content. While there is an effort to incorporate research evidence, and the topic is researched by the host (Tiffany), we recognize there is room for improvement and there is expertise in the community. As such, we invite constructive critique and that you inform us of any inadvertent errors, so that we may correct them. You may submit your feedback through this form: https://forms.gle/UFfbUHBh8uKwSKgS8