Career Advice For Osteopaths

As we approach the end of the 2018 academic year in Australia, a new cohort of student osteopaths are about to graduate and enter the next stage of their journey as an osteopath.

With this in mind I have reached out to a number of osteopaths, from new graduates to experienced practice owners, academics and entrepreneurs, to share with you some career advice in the form of a tweet (280 characters or less, although some couldn’t help themselves, and went a little longer).

The aim of this post is to help start you thinking about what you want from your career, and what you might have to do (or not do) to achieve that. I hope it will also save you some of the frustrations I (and many others) have gone through in the early stages of our careers.

A successful professional life looks different to everyone.

For some, it means making a lot of money. For others, it’s about having time flexibility. Others still want to have a big reputation and sphere of influence. Many want to be anonymous instead.

There is no one way to define success, however there are some common practices between all who have achieved success in their own way:

  • Self awareness
  • Patience
  • Flexibility
  • Discipline
  • Reflection
  • Mentorship

Whether you are a student, a recent graduate or an experienced professional, there is always potential upside in hearing from others what they believe to be important to achieving professional success.

If I have seen further it is by standing on the shoulders of giants. – Isaac Newton

Absorb What Is Useful

When it comes to receiving advice, it’s important to take what is relevant to you on board, and not get too caught up in the rest. I’ve tried to reach out to a variety of practitioners, with different professional skills and experience, to give a broad perspective on osteopathy.

Absorb what is useful. Reject what is useless. Add what is essentially your own. – Bruce Lee

So, without further ado, posted in the order I received them, the advice for new osteopaths:

Giles Gyer

Giles is an osteopath (2012 graduate of College of Osteopaths, London), medical acupuncturist and sports/remedial massage therapist and is the co-found of OMT Training, a teaching organisation for manual and physical therapists. I don’t know Giles personally, but apparently we look similar enough for a colleague to use his image (from Google Images) on a PowerPoint slide when introducing me, so he had to be part of this piece. His advice is:

“YOU are the most important person in the treatment room” the key to longevity within osteopathy is to look after your body and your hands.. Don’t use techniques that compromise your joints especially your thumbs and back.. Be opened minded to other professions, they’ve got some great skills and techniques you can steal!!

Follow Giles on Twitter and OMT Training on Instagram.

Aaron Anderson

Aaron is an Australian trained Osteopath. He completed his studies in Australia – Osteopathy with Distinction (RMIT), Sport Science (University of Ballarat). Aaron treats both adults and children. Aaron operates Movement Squared, both in Melbourne and Hong Kong locations (definitely a long commute), and additionally has been an onsite practitioner in both the corporate and sports performance world. He is currently completing a Masters in High Performance Sport through ACU. His advice is:

I recommended to my Associate try to excel in Anatomy and HVLA. These fields can easily put you in the top 10%. Be out and about in person. That’s when people will enquire directly about making an appointment. Still better than running an awesome social media campaign in my experience.

Find out more about Aaron and his business Movement Squared or follow Aaron on Twitter.

Jena Chang

Jena is an osteopath who graduated from RMIT in 2013. She works in private practice at Box Hill Osteopathy and Complete Health Osteopathy and Pilates. Her advice to new osteopaths is:

RE: job hunting
If they are interviewing you, you have a right to interview them back. Finding the right workplace is essential in your growth and development as your as your emotional well-being! Never settle for less.

Follow Jena on Instagram (side note: I love Jena’s content, it’s so positive) and Facebook.

Bruce Duncan

In over twenty five years as an Osteopath, Bruce has treated people from all walks of life. He has been Osteopath to the Australian Open Tennis Tournament since 2004, and at the Hawthorn Football Club since 2015. A graduate of RMIT, class of 1992, Bruce founded North Carlton Osteopathy in 1998. His advice is:

Interpersonal skills maketh the osteopath. Diagnostic & hands-on skills are a given, but connecting with warmth, understanding & empathy will take you next level. Build trust and take ownership of their management together.

Follow Bruce via North Carlton Osteo on Instagram and Facebook.

Alison Sim

Alison is an osteopath and pain management specialist. She graduated from Victoria University in 2001 and went on to complete her Masters in Pain Management from Sydney University Medical School and Royal North Shore Pain Management Research Institute. Alison works in private practice at Brighton Spinal and Sports Clinic and Pain Matrix in Geelong, treating people with chronic pain, and runs an education company for allied health professionals, Beyond Mechanical Pain.

Stay flexible in your thinking and humble about your role. Listen and learn from your patients. Keep a strong focus on life outside of work. Keep learning and evolving for your whole career.

Follow Alison’s work via Beyond Mechanical Pain on Twitter and Facebook.

Claire Reed

Claire is in her first year of practice as an osteopath, after graduating from RMIT with the class of 2017. Claire primarily works at Coburg Osteopathy & Health Services, and earlier this year organised the #3058Workout, a massive charity exercise day that raised over $11,000 for cancer council. She has had a great start to her career, no doubt with more to come. Her advice is:

Keep reading and asking questions. Your colleagues are your greatest resource and supporters so use them, ask them questions and observe them as often as you can.

Follow Claire on Instagram.

Nathan Kelly

Nathan, The Surfing Osteopath, a graduate of the class of 2013 from Southern Cross University, owns and operates Universal Health & Performance on the Gold Coast. He practices in an evidence informed manner, utilising traditional osteopathic techniques, dry needling and strength and conditioning principles to help people with injury management and rehab as well as performance enhancement. His advice is:

You’ve spent the last 5 years learning everyone else’s version of osteopathy, it’s now time to spend the next few years exploring how you want yours to look. Osteopathy is a framework which you can build from, and that’s the brilliant part of this job; the exterior is yours to create. The heart of osteopathy is inherently punk, it was born out of rebellion and questioning of the status quo. So keep asking questions, keep studying the human condition and keep osteopathy punk.

You can follow Nathan on his popular Instagram page.

Jacqueline Shergold

Jacquieline (Jacqui) graduated with me from Victoria University in the class of 2011, and since graduating has worked in private practice in Ireland, studied a Diploma in Paediatric Osteopathy at the Osteopathic Centre for Children (OCC) in London and now works as part of a multi-disciplinary team at a specialist baby treatment centre. Her advice is:

Listen. Listen to your instincts. Listen to your peers and mentors. Listen to your patients and listen to what their bodies need and want. Listen to podcasts and go to conferences/workshops/lectures. Take time to listen and you’ll be amazed at what you hear.

For more information, check out her practice website or connect with her on LinkedIn.

Jade Scott

Jade is a graduate of Victoria University, in the class of 2001. She is the owner and director of Western Region Health, one of Australia’s largest osteopathic practices. Jade has been involved in clinical education for a number of years and has an extensive graduate mentorship program in place in her practice and was involved in the development of the 5th year student internship program. Recently Jade has been presenting to osteopathic and allied health business owners on employment models in healthcare. Jade still practices and has a particular interest in maternal and paediatric health. Her advice is:

Don’t confuse confidence with conviction

Never underestimate the need to ‘fake it till you make it’

Social recognition is the key to filling your books

A patient’s financial situation should never cloud your ability to deliver their best treatment plan
Always go above and beyond

‘See how you go’ is not an option

‘Find, it fix it, leave it alone’ should be replaced with ‘find it, fix it, address the predisposing factors and maintain health’

Money is a wonderful byproduct of loving what you do

Core values make us the best at what we do (professionalism, integrity, respect, care and innovation)

If you surround yourself with brilliant people, remarkable things happen…

You can find out more about Jade via Western Region Health and follow them on Facebook for the latest updates.

Shane Buntman

Shane is a graduate of the Victoria University program, class of 2004. He currently operates a large practice across two locations in Melbourne’s CBD – Melbourne Osteopathy Sports Injury Centre. Shane has previously worked in the UK, and before osteopathy studied biology and genetics, as well as worked as  remedial massage therapist. Shane is passionate about developing the profession of osteopathy, and writes for Osteopathy Australia in their quarterly magazine on the topic of business in healthcare/osteopathy. Shane’s advice is:

Every time you step into the consulting room think ‘I’m representing the entire profession Osteopathy’.

It’s not about how interesting you can be, it about how interested you can be in others.

You can find out more about Shane via the MOSIC website and follow them on Facebook and Instagram.

Jon Marshall

Jon, owner of Back in Health Osteo is an osteopath and acupuncturist with clinic locations in Melbourne and Singapore, where he is currently based. Jon graduated from the program at RMIT in the class of 2008, and in 2011 he completed his Masters of Acupuncture, having previously studied a diploma prior to osteopathy. He is a master of the Japanese martial art Aikido and he founded the Melbourne Budo Academy in 2010, which teaches Aikido, Brazilian Jiu Jitsu, Shinkendo (Japanese swordsmanship),  Japanese Jujutsu, and Judo. He also teaches dry needling and cupping courses through his education company, Manual Medicine Australia. His advice is:The greatest thing that I would like to impress on you is that your learning NEVER stops.

Keep all your textbooks and don’t burn your notes. You will refer to them and keep learning from them over your entire working life; they have been written by some real giants in the Osteopathic world and we are lucky to be able to stand on their shoulders.

Don’t be overwhelmed, everything you have learnt in the course takes years to sink in, just keep learning and studying.

Be a generalist before a specialist. Be a Manual Medicine Master.

Work on yourself professionally and personally.

Don’t put down similar professions as it is unprofessional and it makes you sound like a knob. Everyone has something to teach us and never stop honing your craft.

Get together with colleagues, attend seminars and maximise your potential and be the very best Osteopath you can be.

Don’t get lazy or complacent, go out and chase your dreams.

Leaving Melbourne, while hard may be the best decision you ever make professionally…..

You have one of the best jobs for work life balance.

Keep healthy, take regular breaks and taste those sweet fruits!

The future is bright!

You can follow Jon’s clinics on Instagram and Facebook.

Tina Maio

Tina is a highly experienced osteopath who graduated from the osteopathy program at Victoria University in 1999, having also completed a Physical Education degree there previously. Tina owns and consults at Coburg Osteopathy and Health Services, where she treats people from all walks of life, but has established a reputation for her work with athletes, from the junior level all the way through to elites. Tina is particularly known for her work with golfers, with her current stable of players on the US PGA Tour, Nationwide Tour, European Tour, One Asia Tour, Japanese Tour and PGA and LPGA. Tina has presented locally and internationally in sports osteopathy and sports medicine. She is on the leadership committee for the Clinical Practice Group in Sports Osteopathy through Osteopathy Australia and is a clinical advisor for EMS Swiss Dolorclast. Her advice is:

Allocate time to professional development that excites you, it will create lightbulb 💡 moments that will fuel your passion for wanting to help others. Be committed to you career, but don’t abandon your personal life. Remember that working with people in pain is exhausting so take steps to look after yourself.

You can follow Tina through the Coburg Osteopathy Instagram and Facebook pages.

Nigel Roff

Nigel graduated from RMIT in the class of 1993. He practiced in Sydney for 6 years before establishing Willsmere Health Osteopaths in Kew, Victoria in 2000.  He practises patient-centred care with an emphasis on current evidence-based practice. He has a special interest in distance running and the treatment of injuries associated with running, and can also provide training advice. Nigel describes himself as having “No specialisations, I just treat people and their nervous systems”, but he also describes himself as a “hack runner”, so he is definitely modest (he recently competed the Chicago marathon, which is fairly far from “hack”). Nigel is an example of a practitioner who has built a successful career in osteopathy without having a high profile, except with his patients, where it counts most. His advice is:

Assume nothing, actively listen to your patients, they will tell you what’s wrong. You may not be able to help but that’s ok. And finally you are not responsible for your patients problems.

You can follow Nigel on Twitter or Facebook.

Anne Cooper

Anne is a former nurse and a 1989 graduate of the International College of Osteopaths, making her the most experienced practitioner on this list. She founded what is now Central Sydney Osteopathy in 1990 and has had a huge influence on the profession over the years. She has been president of Osteopathy Australia, and is now a life member, she is currently president of the NSW Osteopathic Council and has previously sat on the Osteopathy Board of Australia. Anne calls herself a dinosaur, but dinosaurs are extinct, while she is still overseeing a busy practice and seeing patients. Her advice is:

A new business is like any newborn; feed it when it asks to be fortified, nurture it, love it and help it grow strong and robust. That means 100% attention. Meet your patients needs, and very soon they will meet yours.

Osteopathy is medicine, not sports science. The human form, and what ails it, is not a predictable equation. Our job is simply to assist homeostasis. Treat what you find in that one unique patient, not what you’ve been told you should find.

If you think your patients should reflect your own image, then you’ll struggle. Appeal to ALL types. Old, young, fat, normal and thin, non/sporty, sick, well, straight, gay, black coffee and white, mums, overworked, unemployed.

When you graduate you don’t chat about technique at conferences and reunions. You talk business. So get it right from the start. This is a physical job, output exactly matches input, and if you get it right from the start you’ll enjoy a comfortable lifestyle and a deeply satisfying career.

You can follow Anne via the Central Sydney Osteopathy Facebook page.

 

Della Buttigieg

Della is a graduate of the Victoria University program, class of 2003. She is the founder of Melbourne Osteohealth, and a lecturer at Victoria University. She is a caring and passionate osteopath with particular interest in pain and rehabilitation for long term health and function. She firmly believes that the key to preventing many health problems from developing and recurring lies in educating our patients; arming them with an understanding of the their pain and teaching them how to reduce or eliminate it. Recently she has been involved in presenting on both the theory and application of pain science to clinical practice for allied health professionals. Her advice is:

What most patients want is someone who can help them feel good again and while better movement, more sleep and a balanced diet are a good start, humans never feel better than when they are having fun… prescribe fun!

You can follow Della via Melbourne Osteohealth on Instagram and Facebook.

Heath Williams

Heath is the founder of Principle Four Osteopathy, Corporate Work Health Australia and Ergawell. He is a graduate of Victoria University, class of 2003, and currently lectures there along with Southern Cross University, primarily in rehabilitation. Heath previously has worked in the UK and Sweden, and is currently a member of the Osteopathy Australian Clinical Practice Group for Occupational Health and Safety. Heath has a big focus on continuing education, and has undertaken numerous courses, workshops and seminars covering topics as diverse as manual therapy and exercise rehabilitation all the way through to communication. His advice is:

Be curious and open to opportunities! Learn from your own experiences, your clients and your colleagues and say yes to opportunities. Life will never be dull and work will always be fun and engaging.

You can follow Heath on his popular Instagram or Facebook pages.

Josh Lamaro

Josh is a graduate of the Victoria University osteopathy program. He owns Paleo Osteo in Bendigo and Torquay in Victoria, which is an “evolutionary medicine and nutrition clinic”. He has a special interest in the treatment of chronic conditions such as fibromyalgia, chronic fatigue syndrome, and auto-immnune diseases using the modern and traditional principles employed by Osteopaths. Certified in anti-ageing medicine through the Australasian Academy of Anti-Ageing Medicine, Josh uses functional medicine principles to help address his patients’ health in a wholistic manner. His advice is:

There is an alarming trend in osteopathic education at the moment that is tending away from what osteopathy really is.

There is a tendency to look for the “tissue causing the symptoms” and eradicate or palliate the symptoms. The ancient wisdom of the body is that it is always seeking balance, and will find it irrespective of the minds influence on what is “normal.”

A metaphor might be something like a boat sinking due to a hole in the bow of the hull. The passengers on the boat necessarily have to run to the rear of the boat to counterbalance it away from the sinking end. This could be seen as an “abnormal” distribution of human weight on a vessel (analogous to abnormal lab tests, abnormal tissue tonus etc,) but without this shift having occurred, the result would be far more disastrous. It is therefore of little use to usher the passengers back down the front (medicate/palliate/undo local “restriction,”) rather, what must be done is to seek the true reason the body is needing to find balance in this way.

Asking “why?” til one can no longer ask it anymore lands you somewhere in the realm of where to begin.

You can follow Josh on Facebook and Twitter.

Stephen King

Stephen is dual qualified as an osteopath and physiotherapist. He graduated from the Victoria University osteopathy program in the class of 2010, and the University of South Australia physiotherapy program in 2013. He is the director of Movement Assessment Technologies (MAT), which teaches allied health professionals about movement assessment and functional rehabilitation, The Injury Rehab Centre, a practice in Cheltenham, Melbourne which integrates the concepts taught through MAT and the host of the 21st Century Physio podcast, where he interviews industry leaders about the future of physiotherapy and allied health. Prior to working as a clinician he was a personal trainer and strength and conditioning coach, which is where his interest in movement started, and nowadays he spends his time helping professionals get better outcomes for their clients and patients. His advice is:

My top 3 things that I wish I knew as a new grad.

  1. Do not take everything from Uni as fact – a lot of what you learnt is out of date (it’s not 1898).
  2. Osteopathy is more than a 3x3m room. Think outside the box, set goals and work hard.
  3. Be the change you want to see.

You can follow Stephen via MAT on Facebook, Instagram and YouTube and through The Injury Rehab Centre on Facebook and Instagram.

Dr Nic Lucas, PhD

Nic is an osteopath, medical researcher, lecturer turned entrepreneur. Having completed his osteopathic studies at Victoria University in 1999, he went on to further studies at the University of Newcastle in epidemiology and pain medicine, before completing his PhD in diagnostic medicine at The University of Sydney. While at uni, Nic founded the International Journal of Osteopathic Medicine (IJOM) and served as an executive editor for 19 years and sold to Elsevier, the world’s largest medical publisher. He also started the Student Osteopathic Medicine Association (SOMA), helped develop the osteopathic course at The University of Western Sydney, where he went on to lecture for almost 9 years, and sat on numerous osteopathic committees and registration boards. After selling his two osteopathic practices, he has moved into coaching online entrepeneurs with his company X10 Entrepreneur.

Are you an Osteopath, or are you qualified as an Osteopath? Big difference. Don’t lose sight of yourself in a Title. Your identity is greater than your qualification. You can go anywhere, do anything. There’s never been more opportunity. Don’t ask for permission to go be awesome AF.

You can follow Nic on Facebook, Instagram or check out his website.

Summary

You probably started to sense a trend with the advice given.

While a few of the quotes mentioned technique, the majority talked about attitude, and the big picture.

Common themes were personal growth, education, self-care and listening/communication. This might not make sense now, but when you see such diversity in methods, all with similar results, then you have to look deeper at what is being done.

At the end of the day, this is just a milestone in your life journey. Graduating may feel like “everything” right now, but over time, you will grow and it will become “something”.

You have the opportunity to make an impact on people’s lives, which is an amazing privilege.  I wish you every success in your future, both personally and professionally, and hope that this blog helps you in some way.

Finally, start building your network. The internet makes this easier than ever before, and will strengthen your professional life immensely.

Good luck!

Class of 2011 at Victoria University (phone cameras have come a LONG way since then).

 

Nick Efthimiou Osteopath

This blog post was written by Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

You can follow Nick on Facebook, Instagram, Twitter and connect with him on LinkedIn and Snapchat.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 


 

 

Rehabilitation Is More Than Just Exercise

Exercise is NOT a magical pill – it is great for many things though.

There is a current trend to treat painful problems with exercise, conflating it as rehabilitation.

Before I elaborate, let me make a few things clear:

  • Done correctly, exercise is a good thing, for most people
  • Exercise can be part of the recovery process from pain and injury
  • Exercise has many health benefits
  • I promote exercise actively – if you follow my social media accounts you’d see that

However, exercise is not therapy, nor is exercise rehabilitation.

Yes, exercise can be part of rehabilitation, but it isn’t the same as rehabilitation.

We must keep in mind, however, that motor skill learning and exercise are not synonymous. – Stevans and Hall, 1998

I teach a workshop that talks about using kettlebells for rehab.

In it, I present this argument that performance training and rehab are on the same continuum, with health somewhere to the right of middle.

A slide from my Kettlebells for Rehab Workshop

My point is this:

Performance training is aiming to maximise performance of a particular task.

Rehab is aiming to improve physical performance in one or more aspects.

The principles of stimulus and adaptation still hold.

What doesn’t hold is that you can use performance training to achieve a rehab goal, if the deficit is not performance related.

There is a saying that you can’t put fitness on top of dysfunction.

That’s not completely true, but nor is it true that simply adding load makes things better.

Solely focusing on resolving dysfunction (whatever that means) and solely focusing on building capacity (performance) are both inadequate.

So what happens when rehabilitation is inadequate?

  1. Presenting issue (often pain or injury) is not adequately resolved
  2. Increased risk of future injury
  3. Impaired performance (be it at sport, work or activities of daily living)

Strength Training Is Not Rehabilitation

I have a weak back.

I need to train my core.

My knees aren’t as strong as they were.

Almost every day I hear stories from patients correlating their pain with weakness.

There is a meme floating around about the relationship between strength and pain that is growing in power and becoming really hard to undo.

If there was a direct link between strength and pain, we would not see strong high level athletes suffering from chronic pain.

But we do.

The main reason I suspect we see this link is two fold:

  1. Visually, strong people fill our idea of health and fitness.
  2. Simplicity: it is easier to blame on weakness, teach somebody how to strengthen the so called weaknesses and then use strength as an outcome measure.

Strength training can definitely be part of a rehabilitation program.

But getting strong alone is not the reason we see improvements in pain.

Strength training, done properly, improves movement quality, load tolerance and builds confidence. All these contribute to improving pain in certain conditions.

Stretching Is Not Rehabilitation

The second common issue is “tightness”.

People often feel tight and cite this as a reason they need to stretch.

Therapists then perform an assessment.

They say this feels tight, this is weak. Stretch this. Strengthen that.

If only it were that simple!

Stretching is a valuable technique. I use it as part of my own personal exercise programs, and often prescribe stretching to patients.

Stretching has value beyond lengthening muscles (which it actually doesn’t do*), like improving body awareness (interoception) and relaxing both body and mind. All of this can help people in pain improve.

But alone, stretching is not rehabilitation. In fact, changes to flexibility are not associated with improvements in pain.

Oh and by the way, feeling tight doesn’t actually correlate with being “stiffer”. This has been shown in research. One is a perception of the body, the other is a physical property.

“Cardio” Is Not Rehabilitation

Whether it is going for a run, stationary cycling or walking – all these forms of exercise can have positive effects on health, pain and function.

However, again, is it rehabilitation?

Time again we see improvements with these (and other) cardio activities, which do not correlate to improvements in fitness or endurance.

Again, this isn’t to say cardio exercise has no value in a rehabilitation program, it is simply saying, that cardio in and of itself is not rehabilitation.

What Is Rehabilitation?

Comprehensive rehabilitation should involve restoring optimal function to both the sensory and motor systems, in a manner that builds resilience and enhances adaptability.

Huh? Does that sound complicated? It kind of is. We are talking about the body, which still remains a mystery to us.

We don’t know it all.

But what we do know, is that rehabilitation should be tailored to the individual, and process based.

It should include education and a graded exposure that takes context into account.

It should have objective outcomes that measure improvements in function, but should also focus on resolving the presenting pain or injury as best as possible as well.

Exercise can definitely (and usually should) be part of this process, but I have seen many fit and “dysfunctional” people over the years, along with many people who have “rehabbed” themselves to become stronger and fitter but still suffering from their initial complaints.

There of course, is a balancing act – it’s not always about the pain – and often improving function in spite of pain is the best outcome, but that doesn’t make exercise alone magically turn into rehab.

How Do You Do It?

Educate, Educate, Educate

Without properly educating someone about what they are doing and why they are doing it, rehabilitation lacks meaning. When things lack meaning we don’t give them appropriate focus, which leads to lack of results.

This is why the who treatment encounter should be centred around education from the beginning.

Create the appropriate context, and then each intervention fits into that context.

Sensory Rehabilitation Should Precede Motor Rehabilitation

When somebody has referred pain down their arm or leg, I will test their reflexes.

A reflex tests both the sensory and motor function of the related nerves.

The body has to sense the stimulus (the tap of the reflex hammer on the tendon) and then respond to it.

If you have impaired sensory function, but your motor function is fine, then you won’t demonstrate normal reflexes.

Rehabilitation is similar.

If you have impaired sensory function, your motor function (movement, strength etc) will not be at the level it should be.

Initially, rehabilitation should aim to restore sensory function – this can be achieved in many ways with manual therapy/taping (sensory nerve stimulation), body awareness exercises (enhancing interoception), mobility/flexibility exercises (enhances sensory input), motor control exercises (enhances proprioception).

If someone displays poor sensory awareness, improving this will often develop their motor qualities concurrently, as outputs are a product of inputs and processing.

This is why simply exercising doesn’t always improve things. It’s not just what you do, but how you do it.

Rehabilitation Should Be Contextual

Soldiers in the army face numerous challenges when deployed. An uncertain and continually changing environment, unpredictable tactics from enemies, and the threat of death create extremely high stress situations.

In these high stress situations, our brains go into survival mode – thinking decreases and insinctive behaviour increases – unfortunately, what is instinctive is often dangerous, so these behaviours must be stopped.

As a result, training for soldiers involves as real as possible simulations, to cause an adaptation to the brain.

As the soldiers are exposed to realistic threatening scenarios, they become less and less sensitive – their brains do not enter survival mode as easily – allowing them to think and act intelligently, even under extreme stress.

With pain, our brains are protecting us from a threat, real or perceived. If you experience pain while you are working, and you work in a fast paced financial office, rehabilitation in a calm clinic room only goes so far.

Rehab should progess in context, from safe and secure to challenging and confronting, to allow the brain to adapt its response.

This is one of the most overlooked aspects of rehabilitation, in my opinion. It is why education is so important, and also one of the hardest things to do.

Rehabilitation Shouldn’t Be Based Solely On Sets and Reps

Fixed set/rep schemes work great in theory.

However, given the dynamic nature of the human body, some days we can do more, some days it’s less.

Creating an environment or set of parameters that allows you to “fail forward” is usually more optimal than grinding out movement to achieve a number.

One of the ways this can be achieved is with self-limiting exercises.

Another is with auto-regulation using a “rating of perceived exertion” (RPE) scale. This requires good sensory awareness. See earlier point.

While exercise is often focused on achieving a number, to ensure progression, rehab is slightly different. Numbers can play a role, but shouldn’t be the main focus. Quality and feelings should, at least in the beginning.

Conclusions

Exercise is definitely an important part of the rehabilitation process, but what we have learnt in recent years is that it doesn’t matter as much what you do, but rather that you do something and how you do that something.

When we frame exercise in terms of capacity (load, volume, range of motion etc) without paying attention to the contextual factors involved in someone’s presentation, we are missing a large part of the problem at hand.

And while it is easy to measure strength and endurance gains, it is much harder to measure gains in body awareness, confidence and resilience.

I myself have been guilty of defaulting to the former many times, purely because patients often demand something tangible, and this is what I am familiar with.

The challenge for everyone involved in rehabilitation from pain and injury is to bring the bigger picture into focus, and to really shift the emphasis towards rehabilitating people, not problems.

 

Nick Efthimiou Osteopath

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 

Pain Science Made Simple

Scary Unkown

When the primary complaint is pain, treatment of pain should be primary. – Barrett Dorko, P.T.

At Integrative Osteopathy, one of my core practices is to empower people through education, so they feel better both in the short term, and the long term as a result of resilience and independence.

A hugely important part of this process is pain and neuroscience education.

Whilst this may sound daunting and perhaps even irrelevant to you, research shows that neuroscience (including pain science) education has a positive effect on pain, disability, physical performance as well as anxiety and stress.

In addition, not learning about pain early on can lead to the rise of chronic pain conditions later, by not alleviating the fear that is often associated with pain (consciously or unconsciously)

Considering how effective this intervention is, and the fact that pain is the number one reason people consult an osteopath in Australia, it’s a no brainer to ensure a thorough teaching about pain precedes any other treatment.

What is pain?

Any teaching about pain must start with exactly what pain is, and currently, the definition put forward by the International Association for the Study of Pain (IASP) is:

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Now that seems straight forward enough, but let’s look at it a little deeper.

What exactly does this mean though?

Pain is more than just a physical phenomenon

Most people associate pain with injury and damage, and whilst this is often a component of pain, pain is much more than damage.

This is why the word potential is used, it implies something else is at play – we don’t need tissue damage to occur in order to feel pain.

Pain is an alarm, not a damage meter. This can be one of the hardest things to grasp when first learning about pain, and will be explored in more depth later in this post.

Pain is an emotional experience

If you have ever experienced pain, you will likely recall not being yourself, you may have been “short” with people, or become more introverted, or demonstrated any number of changes to your normal demeanour.

That’s the emotional part.

Every person’s pain is unique

We commonly use words like sharp, dull, throbbing, aching, burning, stabbing and shooting to describe pain.

This helps communicate each pain experience in a more “universal” manner, allowing clinicians and patients alike to identify certain attributes of pain, potentially helping with diagnosis or coping.

However, what this doesn’t allow for is the uniqueness of pain.

The use of the word experience in the above definition, suggests the individual nature of pain.

We all feel differently and what we feel depends on many factors – our genetics, our current situation in life and our cultural upbringing are just a few of the contributing factors to how we experience pain.

Pain is an output of the brain

Understanding the broadness of pain and the fact that pain is not reflective of tissue damage, the next step is to grasp the concept that pain is an output of the brain, rather than an input to the brain.

To understand what this means, let’s use a simple analogy.

On a computer, we can use a mouse or keyboard to provide an input. This input is then processed, and then, depending on the program in operation, and output is displayed.

Currently, I’m typing in a word processor, which means when I hit the “w” key, w appears on the screen. However, if I were playing a game, that “w” key might move my character in a certain direction.

Same input, different output.

When it comes to pain, we experience it when our brain decides, unconsciously, that the sum of information it is processing is “dangerous” and we realise this danger consciously – the feeling of pain.

Regarding the inputs to the brain, there are 3 main sources (in no particular order):

  1. Cognitive (thoughts)
  2. Affective (emotions)
  3. Physical (messages from the nerves)

What’s interesting, is that only one of the three inputs is regarding the status of the body.

If the sum of all this information is perceived as “dangerous”, then we experience pain, changes to movement and posture, a heightened stress response etc.

So really, pain is a broader part of the nervous’s systems operations to keep us safe. Though sometimes it goes wrong, for the most part, it’s a pretty good system. If it wasn’t, we wouldn’t be here today.

Nociception and pain

We are really diving deep into this pain stuff now, but this is quite an important part of the pain experience.

Nociception is simply the reporting from the peripheral nerves to the central nervous system (brain and spinal cord) on the status of the tissues.

There are 3 main kinds of nociceptors:

  1. Thermal (reporting on heat/cold)
  2. Chemical (reporting on chemical irritation, like inflammation)
  3. Mechanical (reporting on tension and compression)

There is always some nociception occuring, that is so our brain knows what’s happening with our body. However, this doesn’t necessarily turn into pain.

When nociception reaches a certain threshold, then the nerves fire faster, which can alert the brain to something happening. It doesn’t mean there is damage – but only that there is more stimulation of those nociceptors.

This only becomes pain, if, when combined with the other inputs mentioned above, your brain decides the information means “danger”.

Acute versus chronic pain

Acute pain is a completely normal response to dangerous stimuli. It usually follows some form of tissue irritation, which may or may not include damage to the tissues.

This is the pain we experience when we bump into something, strain a muscle or cut ourselves. It serves a protective purpose – alerting us to the incident and getting us to change our behaviour accordingly, so we do no further harm. It usually subsides when healing has taken place – often before (think of a cut, it doesn’t hurt all the time, only in the beginning).

For some people, pain does not resolve after the acute phase, and it becomes chronic pain, which is a problem in and of itself.

Chronic pain occurs due to changes in the nervous system, which make it more sensitive.

Whilst too deep a topic to cover in a short section, the most important thing to grasp about chronic pain is that the longer it has been present, the less correlation there is with tissue damage, and the more sensitive the nervous system has become.

Chronic pain is manageable, but it needs a very different approach to acute pain.

Conclusions

Pain can be thought of as an alarm bell. A highly sensitive alarm bell that often rings for no reason and sometimes keeps ringing despite people cutting of its power supply.

Understanding the complexity underpinning the pain experience is an important step to resolving or managing pain, and one that pays long term dividends.

This post can only touch on the basics of pain, but it is enough to give you an overview of the main components.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



References

Burke, S.R., et al, A profile of osteopathic practice in Australia 2010-11: a cross sectional survey, BMC Musculoskeletal Disorders 2013, 14:227 [http://www.biomedcentral.com/1471-2474/14/227]

Louw, A., et al,  The effect of neuroscience education on pain, disability, anxiety and stress in chronic musculoskeletal pain, Arch Physical Med Rehabilil, 2011 Dec;92(12):2041-56 [http://www.ncbi.nlm.nih.gov/pubmed/22133255]

Melzack, R. and Katz, J. (2013), Pain. WIREs Cogn Sci, 4: 1–15. doi: 10.1002/wcs.1201