Re-Sensitization is where it’s at

central sensitization

Unless you’ve been under a rock as a clinician, the term ‘central sensitization’ should be in your vocabulary.  It has gained popularity through the cycle of pain science, especially over the past 5-10 years.  Even though it appears central sensitization is new and sexy, it is not a modern term, and to my knowledge, the seminal paper on it by Dr. Woolfe goes all of the way back to 1983. Much change and marketing has happened in this 33 year span, but even still, the thought process of this term has been around for centuries.

central sensitization

You can find 6 ways to Sunday to explain this phenomenon to your patients, which I do using my “Pain Cartesian Scale (here too).  I encourage you to find the best way to translate this to your patients in the context they need to understand.  My colleague and friend, Dr. Matt Dancigers, explains this better than anyone else I know.  I highly recommend reading his blog.

Nevertheless, I find the explanation of central sensitization to be somewhat limiting to achieving better outcomes for my patients.  Don’t get me wrong, it does help, but not an extraordinary game changer.  What I find works better in clinical practice is the term, “Re-sensitization”.  This is an ad-on to central sensitization and of course has to go alongside it in your education, but seems to be more of a heavy hitter in regards to applicability for the individual—especially after he/she has felt results and gained your trust.

In a nutshell, the way I assimilate Re-sensitization to patients is one they understand—it is an exacerbation of symptoms.  We all know this happens for any condition, but especially chronic pain.  I translate the importance of a healthy diet, stress reduction and general exercise, of ways to reduce re-sensitization—-this is a multi system issue (endocrine, metabolic, cardiovascular, etc) and not just musculoskeletal.  But for the main purpose of my point in this post, I recommend  focusing on a specific HEP based off of what worked for the patient under a course of care.

In some individuals, a general exercise program at a gym may just do it.  But what I find, and I’m sure many of you, is that you need something specific for the area/region that seems to be the one that is picked at the most.  It could be a neural glide, self-mobilization, myofascial ischaemic compression, etc etc—-but your job, and what I get most out of the umbrella term of sensitization, is to find and prescribe what works with the upmost confidence and highest power to desensitize the system to prevent re-sensitization.

It works like this: Peripheral sensitization leads to Central sensitization—-we can ramp down this entire system (and local region) through our interventions—-but then Re-sensitization occurs over a course of Time—this is where intervention is needed again—by either specific HEP and or Therapist Treatment.

resensitization

It is challenging to put more concepts into words and make it applicable to your setting, approach, and patient type.  But, I do hope you are learning more about central sensitization and now the phrase re-sensitization—which has been successful for me in the science of pain.  It also helps me establish a wellness program and principle of coming back to me vs medication/physician/surgeon if exacerbation occur as an overall successful business plan.

As an added bonus for reading my blog,, I am offering a FREE, 30 min, E-mentorship session for anyone who feels they would like more information on re-sensitization, but also mentorship and guidance on complicated cases.  Just email me at harrisonvaughanpt@gmail.com with “re-sensitization” in subject line. You may just find it to be beneficial and would like to go through a mentoring process. Feel free to contact me for more information and read about the Program more on my E-mentorship page.

 

 

 

 

What angle are you addressing your patients?

There is an old saying in the orthopedic manual world that goes to the tune of:”You can teach a monkey how to manipulate, but not why and when to manipulate”

Any clinician who has been around the realm of manipulation in clinical practice can relate to this statement. However, I think it can apply to other aspects of our care too. Let me give you an example.
During one of my recent e-mentorship sessions, my mentee was providing me a story of a patient who is seeking his care after failure to improve following 4 weeks at another facility. This individual is diagnosed with achilles tendinosis.
What comes to mind when treating this diagnosis?
I guarantee a large percentage of you, including myself, jolt with excitement and say, “eccentric training!”

We say it without much thought as it is what the research says works. The highest of the evidence pyramid glows with excitement.  

But in this case…it didn’t work. The patient wasn’t satisfied…the outcomes were not positive. The patient decided to seek out a cash based service.  

Fast forward a few treatments — patient recovered and returned to soccer.

So what was the difference?

I can’t take the credit as my mentee did a full examination and came up with a plan of care. He did it all and came from a different thinking process.  I can say that the treatment was based on concepts and principles. These concepts and principles that have been around for decades and do not fail.  

So what’s the moral of the story?
“You can teach a monkey to read the research, but not why and when to use the research”
Literary articles are intended to be another layer to your treatment to justify it even further based on your assessment using concepts and principles. In this case, the research was the first layer versus secondary or tertiary layer.  In this age of evidence , I continue to urge the importance but at a different layer.  
If you find yourself doing the following:

Give my e-mentorship program a shot. I personally believe you are attacking the problem from the wrong angle. 

Let’s work together to get your patients better— quicker — give them that experience we all look forward and spread the good news.  
Next time you want to spend $100 on a local continuing education course for a day, give me time once/week for a month.  I guarantee it’ll change your thinking process and up your game.  Contact me so we can work together personally to make you a better clinician and get the outcomes your patients deserve. 

Don’t Chicken Out! Prescribe “Clucking” to Your TMD Patients

I recently nerded it up from home and on the go while learning about TMJ disorders and treatment approaches from the Manual Therapist himself, Dr. Erson Religioso.  The following is my analysis from Dr. Religioso’s Eclectic Approach to TMJ Disorders. 

If you would like access to 600 accredited courses and growing from the comfort of your home, as well as patient education models, and HEP software—and you like my stuff….be sure to use my affiliate link, inTOUCH, in order to save $100 off A YEAR for the low price of $200 for access to continuing education through MedBridge.  Not a bad deal at all!

The following blog post originally appeared on MedBridge Education’s blog on July 6, 2016.  Click the previous link for access to a 2 minute clip on tongue resting position.

From my experience teaching interns in the clinic, they are normally nervous about treating temporomandibular joint disorder (TMD) as it is typically not covered at physical therapy school. In the video segment below, Dr. Erson Religioso III takes a simple, yet productive approach to explaining the problematic TMD condition.

Dr. Religioso’s course is a great introduction for new graduates and a detailed refresher for experienced clinicians. His knowledge of the TMJ and its relationship with the upper cervical spine is simplified in a digestible manner that allows the learner to step away from the screen and perform effective treatments immediately.

A Diversified Approach

The course focuses on treating the patient by decreasing threat and tone through an eclectic orthopedic manual therapy methodology. You will learn the relationship of posture to TMJ, education through “clucking”, and several other effective approaches to patient care. Moreover, because Dr. Religioso’s work incorporates interdisciplinary techniques, he is able to answer numerous clinical questions:

  • Why should the movement screening come before the repeated movement exam?
  • Why does he try to relieve pain rather than produce pain?
  • Why does he place his hand over the maxilla vs mandibular (not just due to pain over the TMJ)? Hint: The biomechanical component!
  • Why can loading the joint with repeated movements assist in re-setting the central nervous system better than unloading the joint? Hint: It’s opposite of what most clinicians do!
  • Why using a tool can inhibit tone better than hands/fingers?
  • Why certain soft tissue patterns are effective in individuals with high tone vs low tone?
  • Why does he use soft tissue work first in the treatment sequence?
  • Why is working on soft tissue on ipsilateral side vs contralateral side (where we normally would stretch as “tight” tissues) a better approach?
  • Why does regional interdependence play a huge role in treating TMD and in soft tissue mobilization techniques to multiple patterns of the upper quarter?

Besides the answers to all of these questions, Dr. Religioso also focuses on patient education of posture, neck position, and the cause/effect for patients to keep improvements.

If you have read his blog, you will hear echoes of Dr. Religioso’s writings in his voice as he describes what worked for him in treating TMD over many years. His advanced training by Dr. Racabado, one of the pioneers of TMD in the states, is evident in his course.

Clear & Confident Treatment Strategies

As physical therapists, we know that manual therapy, exercise, and education are key components to overall patient care. The treatment of TMD is no exception. Home exercise programs fuel the patient’s retention from short-term manual relief. This course reinforces that essential message for therapists. “Clucking” is a fundamental aspect of the HEP that I took away. What will be yours?

Thanks everyone for reading! Continue to aim high and finish strong.

In Touch Therapy – full time PT position available 

The team at In Touch Therapy in South Hill, VA is continuing to seek out the right Physical Therapist candidate for our growing practice.  I want to send out an offer to my readers (who can then pass the word of someone you know) once more before advertising through typical means.  We would like to have someone who has interest in topics that I have written about in the past on the blog and looking to advance their clinical skills through in-house mentorship by myself and owner, Dr. David Love.  

This is a fantastic opportunity for a new grad or even a seasoned clinician who just feels like they are doing “same ol thing” and not getting challenged at their current position.  I rarely see your post-op patient for just exercises. You will see a very unique case load with high percentage of direct access and even chronic pain that gives you that self-satisfaction of making a difference everyday.  
Feel free to contact me at harrisonvaughanpt@gmail.com for questions or more information. 

The following is our formal advertisement. 

Our private practice has been making a difference since 2002 – join the ITT team! Help us continue to grow our orthopedic/manual therapy based outpatient center. New grads and seasoned professionals welcome. 1:1 treatment times are coupled with mentorship and collaboration with experienced clinicians for a rewarding work environment. We are looking for positive, driven team members who want to help people and are eager to learn from one another. Flexible schedules, monthly production bonuses, health/dental/vision package, matching retirement, and PTO. Current VA license required. 

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Introducing Integrative Clinical Concept’s Summer Tour

I am pleased to announce the inaugural start and end of summer 2016 tour of a new continuing education company, Integrative Clinical Concepts (ICC)!

For those of you in the states of Virginia/North Carolina,Dr. Alex Siyufy and Dr. Jake McCrowell will be teaching in both capitals, Raleigh and Richmond, in August & September.

This is a fantastic opportunity to learn both soft tissue mobilization techniques and how to integrate manual therapy into higher level motor control exercises for the athletic population.

Early bird rate of $225 (regular rate $245) ends July 17, so get on it if you want to attend!

Feel free to contact me at harrison@iccseminars.com if you have any questions.

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marketing

APTA Launches #ChoosePT Opioids Campaign

All,

Just received email from APTA promoting a new campaign to position PT as a safe and effective intervention for chronic pain instead of opioids.

In case you do not get emails from APTA or follow through social media, I am forwarding the email below.

I deal with chronic pain on a daily basis and it is an uphill battle of course but we have the best measures conservatively to help our patients with minimum to no use of prescription medication.  Continue to aim high!

———————————————————————-

 

Hi, all:

 

Today, APTA launched a campaign called #ChoosePT to position physical therapists as a safe and effective alternative to prescription opioids for long-term pain management. For the past six months, we’ve been planning the campaign, which includes elements of paid, earned, social and owned media. Here is a link to the press release, http://prn.to/1X72HPe.

 

While APTA will initially focus outreach in states where the CDC has identified high abuse and opioid prescribing trends, this is a nationwide effort to position PT as part of the solution. Coincidentally, opioids have taken a tremendous toll on families and communities in Tennessee, so we strategically chose to launch the campaign in Nashville, while we’re in town for NEXT Conference and Expo. We’ve placed four outdoor billboards in high traffic areas on I-40 going into and out of Nashville and they will be up through July 6. The Country Music Festival and Bonnaroo attracts hundreds of thousands to this area during this time.

 

Other elements of the campaign include a print PSA distributed nationally to small community newspapers,  a national digital ad buy targeting websites where consumers are searching for health information, a professionally produced and nationally distributed television and radio PSA, social media promotion and engagement, and targeted media relations outreach to reporters covering the opioid epidemic. We will be working with chapters and sections to generate local support for the campaign, specifically during Pain Awareness Month in September and National Physical Therapy Month in October.

 

Please consider supporting this campaign by tweeting and blogging about how PTs treat pain through movement and the importance of patients and health care providers discussing and choosing safer alternatives, including physical therapy.

 

#ChoosePT is both a theme and call-to-action and will be a central part of our consumer campaigns going forward. Here is a link to the landing page, featuring patient tools and resources, www.MoveForwardPT.com/ChoosePT.

 

Let me know if you have any questions.

 

Thank you,

 

 

Erin Wendel-Ritter, APR

Senior Media Relations Specialist

American Physical Therapy Association (APTA)

erinwendel@apta.org

Phone: 703/706-3397

Fax: 703/684-7343

Web: www.MoveForwardPT.com

In Touch Therapy is hiring

 

Not my usual type of post, but want to send out to my readers and pass on to others about a physical therapy job position opening at In Touch Therapy in Virginia.

This is a unique position in a small town seeing a mix of neuro, pediatrics, sports, chronic pain and other outpatient cases in a 1:1 environment under a remarkable team and fantastic mentorship in manual therapy (manipulation, dry needling, cupping, soft tissue mobilization, “Girdle” approach), therapeutic exercise, and how to gain therapeutic alliance and business mindset that has helped the clinic grow to 8 clinicians from just word of mouth—no ads.  It is NOT a run of the mill “get your patient in and out” type of clinic that you will see a bunch of theraband lying around and physio balls for all back pain.

I have been fortunate to be part of this team for 8 yrs and find it a fantastic opportunity for either new graduates or a clinician wishing to make a change from the hustle/bustle.  If you have enjoyed my posts over the years and thought-processes — this is exactly what you will get at the clinic.

If you or you know someone interested, feel free to pass on my email address – harrisonvaughanpt@gmail.com

Thanks everyone!

Harrison

 

Introducing my E-Mentorship Program

I have been fortunate over the years to have fantastic mentorship from clinicians, both in the clinic and through formal education.  It is even one of my “5 L’s—Lean” that I have written about in the past.  I find that mentorship, or apprenticeship, is a key component of clinical care that is lacking in our current clinical education system and even more when entry level DPT students graduate.  Granted, the residency and fellowship programs have blossomed over the years, but not everyone is at the financial or family state to go that route.

I continue to strive for more knowledge and gain insight from others, younger and older than I am.  I really enjoy continuing to mentor DPT students and current DPTs in my clinic.  It is a passion of mine and we both, as well as the patient, gain from this experience!

I know others outside my clinic seek out mentorship, either in their clinic or social medium. I  see cases written on the DPT student Facebook Page and other social mediums asking other professionals opinions on diagnostics and treatment options for difficult cases.  Therefore, I know it is a continued need in our profession.

I am now introducing an E-Mentorship Program that I am providing digitally.  It is something I have wanted to provide for awhile, but never got around to do it.  Here are the basics:

  • I plan to run it just like I would with a DPT student, entry-level clinician or fellow in training—-no gimmicks, not selling “an approach”, or formal lectures through powerpoint—but straight up clinical mentorship with cases that you are seeing right now.
  • My entire career so far has been in a rural environment treating chronic pain and spinal conditions.  No offense if you see mostly post-op (as I don’t…), so not interested in mentoring TKAs—but I specialize in the assessment and treatment of headaches, dizziness and all spinal conditions—-the ones that YOU will be the primary clinician for as not appropriate for surgery and want to get off of medications.
  • If you want lecture format and an 8 hour day course—go to a weekend con ed course.  This will be simple hustle and old school apprenticeship — just in a modern environment that is now available digitally compared to having to be in the clinic with you.

If you would like more information, visit my E-Mentorship Program page and/or contact me at harrisonvaughanpt@gmail.com or call at 919-728-0035