1.Theres a lot of debate today in the LBP field specifically & musculoskeletal pain in general about manual therapy vs exercise. Motor control vs strength training. The role of patient education, etc.
2. The issue of client preferences is a no brainer to me as I’m in the trenches & validate my clients #livedexperience. I seek interaction & collaboration. @MyCuppaJo
3. This way I’m able to guide by the side & be an Alfred rather than a “fix it” Batman Superhero for them. @jasonsilvernail @MKargelaDPT

4. I rarely do any passive care, but don’t force PNE or PIP on them. Instead I listen to their story then explore movement w/ them in a reassuring way. @PeteOSullivanPT
5. The aim is to give them a positive experience w/ movement - by finding a safe starting place - which helps them reconceptualize their beliefs about the relationship of activity & harm, hurt & harm, tolerance & adaptation, etc.
@jpcaneiro @bunzli_s
6. After they have a positive experience we can support this w/ simple concepts like “the motion is the lotion”; pain traffic light metaphor, cup/capacity metaphor; health span benefits of “movement snacks” & progressive resistance training; @GregLehman
7. “wear & repair” not “wear & tear”; false + rate of imaging findings in healthy, asymptomatics; @Tash_Stanton @MaryOKeeffe007

8. “Optimal loading is early loading.”@philglasgow podcasts.apple.com/us/podcast/inf…
9. In the end the goal is that our clients have tangible hope by virtue of feeling less fragile & more resilent. Their gradual reactivation experience is positive so they now prefer self-management. @JanHartvigsen @AliceKongsted
10. “Self-management support is integrated into the delivery of the intervention when clinicians help patients making sense of their symptoms, discuss pain behaviours, and avoid supporting negative beliefs.” sciencedirect.com/science/articl…
11. In turn I provide support for this via
- video of their exercises
- specific, written instructions of sets, reps, frequency for each exercise
12. - personalization of the routine so it’s a) relatable & b) not a “cookie cutter” (ie make it meaningful so it’s about their profile not my program)
13. - ongoing debriefs via text jamanetwork.com/journals/jamai…
14. - reminders that flares are normal & they are resilent
- Plan B mindset w/ criteria-based milestones for modifying the self-management program w/ either progressions or regressions based on outcomes. @LKTphysio sci-hub.st/downloads/2020…
15. - introduction to group strength training w/ peers onlinelibrary.wiley.com/doi/10.1002/ms…
16. It all begins by establishing trust and relatedness by hearing a person's story, by finding out what their goals are, what their concerns are. This is how we learn to become better at helping people. @adiemusfree @sconinxphil
17. People have a lot of fear because they've been told that they have something they can't change. They've lost hope. We're in a dire situation today, and we're all in an ideal position to help upskill people to the value of movement, to the safety of movement. @PainRevolution
18. We want to give people a positive experience w/ movement. Our mission is to stem the tide of the inactivity crisis. And we do that by teaching people that if they want their body to feel better, that they should feel their body move better. We’re the guide. We're the coach.
19. “Motivation represents undoubtedly a critical factor for sustained exercise, with intrinsic motivation being especially important for long-term adherence.
20. Available data suggest that individuals with a high exercise adherence report positive exercise experiences including enjoyment in the past.”

21. “When we demonstrate competence, we inspire confidence. When we persistently present as clear communicators...when we show we care; & when we are consistent in our messaging, then we are not just changing thoughts – we are changing biochemistry…
22. “We are promoting positive adaptation.” @simplysportssci @DavidGJoyce @DanLewindon
23. “…it matters how we communicate; how we present; how we develop relationships; how we inspire belief, foster understanding & nurture emotional engagement & shared ownership; how we cultivate relationships & respect; & how we engrain the implicit trust that we truly care.
24. “These considerations are neither incidental add-ons nor superficial nice-to-dos; they are the beating heart of consciously crafted coaching and the foundational bedrock of effective…programmes.”
25. The more I listen to learn my client’s story the more resilent their trust in me is. My goal is to give tangible hope & an achievable plan. It starts from hearing their story or “cry of the soul”
@giovannifrappo @MyCuppaJo @adelaide_psn
26. Then we explore movement collaboratively, interacting to find a “safe starting place” & positive experience w/ movement.  Fragilista who are over-protective reconceptualize the threat value of activity & “see” through this positive experience that movement is friend not foe.
27. As a result they find tangible hope. My role is to create the environment & provide the constraints which challenge them at the edge of their tolerance or capability so they have evidence of resilence.
28. In this way their embodied beliefs modify & their lived experience has greater affordances. It’s an enactive, BPS, client-centered process driven by the health coach’s empathy for their context - especially #socialdeterminantsofhealth @MattLowPT @Peter_Stilwell @jeubanksMD
29. @PeteOSullivanPT’s real secret is passionate curiosity to learn a persons story. Which in turn helps you connect the dots for the person from their story to your plan & thus make it meaningful. Even when it’s complex which it often is. @philglasgow @adriennelufkin
30. @JillAHayden @cochranecollab Summary if evidence of exercise for chronic LBP.
31. Why & how support can be effective for MSP clients
@threader_app “compile” thanks @MeganPomarensky

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More from @CraigLiebenson

21 Nov 20
@DerekGriffin86 LBP is complex & the social of BPS the code breaker between the dichotomization of pain science & biomechanics. I never got it when Waddell introduced Engel’s BPS model only focusing on biomechanics or YFs. Now I see social/environmental context as Job 1 to unmask. @_Tyson_Beach
@DerekGriffin86 @_Tyson_Beach “Kind Care Requires Unhurried Conversations
Health care providers must have time to know their patients in “high definition” to best meet their needs.”

@DerekGriffin86 @_Tyson_Beach “psychological factors are only the tip of the iceberg. Social & contextual factors,which have largely been overlooked in sports medicine, directly impact health outcomes,well-being & sport injury recovery by facilitating or impeding health & health behaviour change” @LKTphysio
Read 18 tweets
29 Mar 20
2) Zoom capped us at 100. Sorry. Anyone know how to let more in? HK, Norway, Belgium, Bolivia, Argentina ....
3) says it all
Read 16 tweets
15 Feb 20
Education is the first approach in evidence-based MS care
But l, education is poorly understood acc to Moseley which is why we do the Teach Back of which I’ve posted dozens online @PainRevolution
Evidence based reasurance & reactivation from Rehab of the Spine
Read 16 tweets

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