Wow, what a first day! Las Vegas is insane and adding 10k+ PTs on top of that makes for a terrific conference. PBRs are chilling in the make-shift cooler in the sink and saving cash on avoiding the house-wins-everytime-games so far. Therefore, after day 1, LV is a winner and tough to say if other venues can compete. If you are not here this week, make plans next year as what else is going on in the states during the first week of February?

Time flew by today and I didn’t get a chance to mingle through the exhibit halls too much so today as it was all about learning. Some cool, modern, new-age products and services should be included later this week. But today, it was the nitty gritty, 6-hours of post-graduate continuing education that tested my gluteal ischaemic compression and twitter thumb-itis tolerance. Seriously, I never tweeted so much. Check out what was written at #CSM2014 or my handle @intouchpt

2/3 of my con ed day was spent with the guys from down-under, Lorimer Moseley and David Butler. Needless to say, these guys did not disappoint! I have been able to read some of their texts/papers/blogs and watch YouTube videos, but nothing compares to a live performance. I applaud the 8+ or so sections of APTA to pass the hat around to get these guys to the states.

As expected, the topic was Explaining Pain. Through the crude humor (which was loved!), heavy accents and blotchy microphone interference initially, the lectures lived up to the expectation and one of the draws that led me 3000 miles this weekend.  Here are some pics:






Lorimer Moseley starts things off and after a thorough introduction to the past perception of pain, anatomy review of C-fibers and A-deltas, how pain is protection and then he goes into something I can relate to: the Protect-O-Meter.

This concept really sits in deep with me. Maybe it is due to an image is powerful and I can understand it, or it is just simply a great tool to assist in educating patients. I am better at numbers and models than psychological intervention, so I know I can draw this on my whiteboard in my clinic room. Most of you PTs are probably the same, hence, the reason you went down this field. I tried this on “5 D’s of Pt Intervention  but just not as good!


Sorry, I did not draw the Protect-O-Meter in the class as I thought I had it in my notes, so this one below is one I depicted from memory. I’ll try to post a screen shot of Moseley’s as soon as I get it.

In addition to information that I know of altered MRI findings on asymptomatics, my prior pain science knowledge and good judgement pep talks; this Protect-O-Meter is something I take back on Monday.  This is really what we want from a conference right?

Quite different presentation from Moseley. The no-filter, balls to the walls (or for you women: vag to the badge) and mannerisms that gets the entire crowd laughing; he was quite entertaining. One of the major topics that he brings to the arena is the use of metaphors in clinical practice. The following is paraphrased from the lecture:
Metaphors are powerful: “my muscle is knotted”, “my knee is a rusty hinge” as patient says, or us: “nerve root injury”, “pins and needles”. Don’t respond to metaphors with metaphors. So, don’t say we will put some oil in that hinge or the knee is rusty,
Ontological metaphors: People are trying to objectify pain. We don’t have a link of pain with an object.
Invasive metaphors: “Like a knife in there”
Prognostic metaphors: “I have completely stuffed my back”.
Disembodiment metaphor: “I have y leg now”, “my back is killing me”
Philosophical metaphor: “Ships are safe in the harbor, but that is not what they are built for”—we want you to be out in the ocean!
“no freaking out over flareups”—everyone has these! don’t
“its a bend in the road, not the end of the road”
“best position is the next position”
I thought I had heard ever metaphor possible working in the rural south, but damn the ones down under got mine beat!

I already agree with his statement that we do not need to repeat a metaphor with a metaphor. I am sure you are doing the same too. But, one of the aspects that I will bring back to me on Monday (at least to clinical education), is the fact that I will get my students to note “e-flags”.
– e-flags: during your subjective assessment, make red e-flag notes besides subjective statements by the patient that distinguish pain science education (such as I have 3 bad discs, I have been diagnosed with degeneration, etc.)
soften your language: Say, can you lift you “recovering” leg instead of “bad” leg. This will remind you to educate about this topic either on day one or subsequent visits. Simple, but effective as we can lose what the patient says with our other examination procedures.

Another point that I thought was highly important is the following statement: So, if a patient says, “So you’re telling me it is all in my brain?!” You can respond in somewhat of the following manner: Brain changes and is beautiful! “The majesty of the brain” Give metaphors such as blind individuals have larger representation of fingers on somatosensory cortex, etc. “You have plenty of space to adapt” with your anatomy.

Just as Butler departed his lecture, I will leave you with this paraphrased statement from the expert:
“Acknowledge the pain and respect / honor the output that the patient is giving you. Pain experience is individual, you do not know how they are feeling.”

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