#Anti-fragile: First quarter “pearls” 2017

The first quarter of 2017 has included an exciting array of courses that have taught me a lot. For someone who graduated in 1986, that is an amazing statement all by itself!


Theme of this quarter: #antifragile. Read on!


There is so much to learn; we are at an exciting point in the history of physiotherapy. Physiotherapists are leading the “charge” in pain biology education, making sense of low back pain, and the integration of pelvic pain into clinical practice, to name a few. Pelvic health integration is coming from both external PT’s (Julie Wiebe, Antony Lo) and lots of great internal physiotherapy thought leaders!


Come see what I took away from this first quarter’s conferences and courses…


January kicked off with our 2nd online version of the Level 3 course on Clinical Skills For Treating Pain. Labs are completed independently on this course with video instruction; otherwise, it is a full-blown version of the Level 3 course from the comfort of your living room. There is a “bonus” two-hour meeting 8 weeks after the online course for participants’ to present their case studies (this doesn’t happen in the “live” version). Therapists participate in clinical problem solving skills as well in this follow-up meeting, in order to address questions that have popped up as they start to change their practice.


The highlight for me has always been the San Diego Pain Summit (SDPS) in early February, a multi-disciplinary conference with the likes of Professor Moseley and Professor O’Sullivan as keynote speakers. Always held in beautiful San Diego, it is a meeting of the minds and social media. Bloggers, podcasters, live tweeting, and those active on Facebook as a medium for disseminating information are all present to listen to the world’s leaders in pain, pain science and everything biopsychosocial. For a biopsychosocial geek- phenomenal!


There were two highlights from the SDPS. Ben Cormack of Cor-Kinetic, Functional Therapeutic Movement fame (www.cor-kinetic.com) did a pre-conference course on functional exercise.


#thepersonmatters, #nottheexercise. Patients need to know WHY they are doing something and HOW it fits into their lives. Movement (not therapeutic exercise) is what they need, making sure it fits easily into their daily life. Movements need to come from the things that they cannot do- squatting, sitting, reaching, lifting. The trick is variability and finding a way to make it symptom-free. Then it becomes rehab!


I loved Ben’s saying, “Do you need to work ‘in’ (evoke the relaxation response) or work ‘out’ today?” We need to view exercise like taking vitamins; we need a balanced diet. How many days do your patients work “in” vs. work “out”? Are they listening to their bodies?


#tellmeyourstory. The biggest thrill for me was to meet and listen to Professor Peter O’Sullivan. During his pre-con course he assessed two pain patients in front of the group. A prolific researcher (215 studies and counting) and all-around nice guy, he simply asked patients to tell him their story, and then he sat back and listened; I mean, really listened and reflected back- great motivational interviewing skills! Like Ben, when it came to testing, he didn’t look at ROM, he looked at function, fear and willingness to move…..and he didn’t lay them down on the table once to “assess” any structures. Do we really need to pathologize persistent pain? That was a mind-blowing question, even for me!!


#makingsenseoflowbackpain. Research is showing that back pain is a contextual problem and the psychosocial components (fear, catastrophization, beliefs and thoughts) are the most important pieces to understand. Enter Peter O’Sullivan’s name into You Tube and watch a master at work (click here to watch).


#changeyourframework. It is time to change your framework for LBP. Low back disability is an iatrogenic problem; we have created it as a medical system. We need to normalize fears and beliefs not contribute to them. This Cognitive Functional Therapy (CFT) approach has shown significant improvement vs. usual care in several RCT’s for low back pain. Fersum et al (2012) (http://onlinelibrary.wiley.com/doi/10.1002/j.1532-2149.2012.00252.x/full)


Hands down, this was the best course that I have ever taken. Challenge your beliefs and biases by spending some time on www.pain-ed.com.


Everything that Peter’s wide-reaching research group publishes is put up on this website with free access. Their group has made it easy for us to stay on top of their research!


You can still get all of these lectures in video format (click here). Well worth the investment!


#socialpillariscrucial. It warmed my heart to see the inaugural run of our “social” based pelvic health course take flight at the end of February (I believe that it is also the first “social” pillar pelvic health course in North America). Dr. Jeffrey Mogil (Canada’s Research Chair on Pain from McGill University) at the SDPS had an excellent lecture (purchase lectures here from the conference) on the most neglected “pillar” of the biopsychosocial model, social modulation of pain. He urged us to take this pillar very seriously.


Who knew? We read his mind and did just that by organizing the “Sex, Shame and Culture” course scheduled for the end of February.


Consensus from the first class was that the Sex, Shame and Culture course should be mandatory for all clinicians. We ask our patients to be vulnerable physically and emotionally with us in the treatment room, but what have we done to “earn” this right? How well do we understand the social science behind vulnerability, shame and sex? What strategies do we use when shame shows up in the treatment room? Shame is a construct that creates more threat for our patients; in other words, our best intentions to help may create more threat and pain for our patients. Yikes!


This course will be available online shortly, and it is highly recommended that everyone participate.


We were also privileged to be given a beautiful rendering of five important sub-cultures within Canadian practices from our very own pelvic health community of therapists; it was incredibly helpful to understand the cultural and religious beliefs/expectations of Hindus, Muslims, Christians, Jewish people, and aboriginal people. Thank you to Mohana Priya Thayalan, Safa Rahman, Chana Ross, Sheela Zelmer and Charity Fleming for their vulnerable and accurate reflections of their culture and belief system with regards to sex. For those of us who took this course, our ability to understand the specific challenges and beliefs of these individual groups will change our practice significantly.


Wow….we are just getting out of February and the learning has been non-stop! I hope that you joined us for at least one of these courses.


After experiencing the thrilling but tiring escapade through the first two months of the year, this next course was timed perfectly!


#burnoutandselfcare. March came in “like a lamb” with Shelly Prosko’s Self-care retreat to address burn-out and self-care; someone should inform the weather man that this “lion” stuff is passé. This intimate group of 8 clinicians kicked off the retreat at the Scandinave Spa, followed by an understanding of the science behind burnout, self-compassion and self-care. Shelly’s meditation, yoga practices and self-care practices created a wonderfully relaxing and rejuvenating weekend for us, and gave us a host of techniques to use with our patients. Namaste.


#antifragile; #fitnessistherapy; #movementisexercise; and I could go on and on. Last weekend rounded out the end of our first quarter courses. Antony Lo came all the way from Australia to challenge our beliefs about pelvic floor function, low back pain, rectus diastasis, and pelvic organ prolapse. Antony “bulletproofed” our cores by using principles from Crossfit. Yup, you heard that right- #crossfitisnotadirtyword.


Antony examined the research behind loading our cores and pelvic floors, especially with rectus diastasis and prolapse. Our patients are not fragile, and we should not create iatrogenic problems. This course was sold out; several of us had personal-best dead lifts, and many of us did sit-ups for the first time in decades. This is the first course that I took in 31 years that gave me specific skills in teaching squats, lunges, running and step-ups. Now, that is functional!


Second quarter is almost upon us- what do we have in store?


#sexisanADL- Karen Brandon’s course will teach us how to talk to our patients about sex and sexual function. It is more than just asking our patients if they have pain. Do you know how to follow-up with appropriate questions and give therapist-specific answers and guidelines for one of the most important ADL’s of life? Come on, you’ll all agree that we would give up running and lunges before sex.


Antony’s course was sold out, and we expect the same of Karen’s! However, there are still a few spots, so don’t delay!


The 4th annual symposium (think networking, exciting research and prizes galore), and a visceral course just for pelvic health therapists (Ramona Horton) will round out the second quarter, along with many of our regular courses.




Written by:

Carolyn Vandyken