Title: The Next Edge of Interaction

Synopsis: I will be presenting on the Biopsychosocial model and what purpose it has served in terms of advancing the care of the patient in pain. I will also present on its limitations as being potentially non-falisifiable when used as a theory and still being somewhat mechanistic in terms of an explanatory model. I will then present on the phenomenological approach advocated by Geniasus, Cohen, Quintner and others and how this approach adds depth and understanding to the BPS approach when treating our patients.

Cory Blickenstaff owns and operates Forward Motion Physical Therapy (http://blog.forwardmotionpt.com), which provides on the job site physical therapy clinics in the Vancouver, WA area utilizing various movement and manual therapy approaches to empower people toward an autonomous state of health as it relates to movement.

Cory also co-hosts, along with Sandy Hilton, of the popular Pain Science and Sensibility Podcast (http://ptpodcast.com/podcasts/pain-science-and-sensibility/) on the PTPodcast Network (http://ptpodcast.com). 

Cory works with individuals who are dealing with movement related problems such as pain or orthopedic injury as well as employers who are struggling with the consequences of pain and injury on their workforce.  Services are also provided to individuals hoping to improve performance at work/play/fitness and who are looking for guidance on maintaining healthy movement through the lifespan.

He has presented nationally on topics including application of graded exposure, graded activity, edge work, novel movements, movement variability, as well as application of care to the workplace. He also authored a mono-graph on prevention strategies in the workplace through American Physical Therapy Association (https://www.orthopt.org/content/c/24_1_the_injured_worker). 

Title: Making Moving Person Centered

Synopsis: Getting people moving is a challenge for both pain and for health in general.  Our modern messages focus around the benefits of exercise and moving, but are they enough to motivate people? How can we do better? Is it about the meaning behind the action? Join Ben Cormack to find out more. 

Ben Cormack has a passion for getting people moving and using and understanding movement as an important tool to help others. Originally from a fitness background, Ben has gone on to study Sports therapy and widely in the fields of rehabilitation, pain science and movement over the last 15 years.

Ben owns and runs Cor-Kinetic, an educational company who use modern research into pain, movement and neuro sciences to provide a reasoning process and rehab skills to those who also place a priority on using movement and exercise as key competencies.  Cor-kinetic have provided educational services for the NHS, Elite level sports clubs and universities as well as individual physio’s, Osteopaths, Chiropractors, sports therapists, rehab, and personal trainers

Title: Psychologically Informed Practice: Beyond The Two Day Workshop

Synopsis: Psychologically informed practice (PIP) is a bit of a buzz word in terms of how clinicians should work with people living with chronic pain, or any long-term condition. It is recommended I n many clinical guidelines (Nice Guidelines for low back pain and sciatica) and stratification measures (STarT Back for eg) Yet there exists continued confusion regarding what exactly is and how to deliver this approach.

Much training at present focuses on delivering knowledge and skills in, typically, brief weekend style workshops, with an assumption that delegates will introduce these concepts into their practice. However behavior change is complex, and the introduction, and maintenance of, new behaviors, including new ways of working with patients requires more than a short training course can deliver. Many clinicians work in isolation and although SOME provides a valuable source of support there currently exists a gap in the support for clinicians working with these populations.

In this talk I plan to introduce the concept of PIP and look at the varied ways this is represented in the literature and practice. I will draw on the cognitive behavioral literature and model to develop a working definition of this concept. I will present our work at UCLH/UCL on observing clinicians to provide a real-life clinical example(s) of this approach being applied in practice. I will contrast this with the bulk of literature in this field which looks at theories and reports of behaviors.

I will then look at training packages that introduce strategies typically included under the umbrella of PIP. I plan to look at the skills introduced (briefly as this will be covered by others at the Summit eg ACT and MI) and where gaps exist.

I will then showcase some work we have been doing with the Physiotherapy Pain Association (PPA, A special interest group of the Chartered Society of Physiotherapy (CSP) in the UK, I’m the current Chair). This pilot, drawing on the work of Prof. F Keefe, will be developed to support clinicians with online supervision and training. I will be able to present preliminary data from it for this talk.

This talk will end with recommendations, and suggested solutions, for delegates regarding supervision and mentoring support.

Diarmuid Denneny is professional lead physiotherapist at the Pain Management Centre (PMC), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust in London, U.K. Clinically he is an advanced practitioner physiotherapist and independent prescriber and he works, in an MDT,  with people living with ongoing pain.

Diarmuid is interested in psychologically informed practice and the role for physiotherapists in supporting people who have pain, and medication related issues. He has published peer reviewed articles relating to physiotherapy practice in pain including a systematic review of trigger point manual therapy, a rapid review of automated outcome measures and an observational study on behaviours of experienced physiotherapists working within a psychologically informed model.

Diarmuid is a member of the guideline development committee for the NICE chronic pain guidelines. He is a module lead (Strategies for the Self-Management of Pain) for the UCL MSC in Pain Management. He also has interests in the non-medical management of CRPS and is a committee member of CRPS UK.

Title: Becoming A Responsible Human Interactor

Synopsis: The science of pain has reached an exciting phase. New discoveries are pushing the limits of and reframing even the most basic ideas regarding underlying mechanisms, pushing the rehabilitation and medical fields to the threshold of advancing novel and efficacious treatments for diverse pain conditions. Given these rapid expansions in knowledge, the potential to have a conscious positive impact on society through those we treat, engage with, and educate is profound.

As evidence mounts, we continue to learn that the context we construct, the environment we create, the expectations we set, and the words we use throughout the often complex and challenging process of musculoskeletal rehabilitation have a significant impact on the clinical outcome. These perceptions we create contain both the ability to heal and harm those we interact with. Gaining an improved understanding of the frequently hidden influence that language and contextual architecture can have on musculoskeletal rehabilitation is of paramount importance to elevating clinical practice and improving outcomes.

The words we use in patient education and regular daily conversation with patients frame the concepts that build the narratives patients adopt concerning their bodies and their capacity for healing. Our language needs to reflect our professional values of first doing no harm and our interactions should focus on each patient’s own goals. Our task is to encourage each patient’s self-efficacy, build internal locus of control, and positively influence outcomes through the environment we create and messages we convey. Our responsibility as contextual architects is to be purposeful in our influence in a responsible manner by using credible methods and plausible explanations consistent with best evidence with the patient’s individual goals and best interest as the guide.

This course will examine theories of human perception, the experience of pain, and the manner in which we can both purposefully and inadvertently influence patient outcomes via human interaction and contextual influences.

Jarod Hall, PT, DPT, OCS, CSCS is a physical therapist in Fort Worth, TX. His clinical focus is orthopedics with an emphasis implementation of the current science of pain to aid in the management of both chronic pain and acute injuries. Jarod has shown clinical excellence in securing designation as a board certified Orthopedic Clinical Specialist (OCS) and Certified Strength and Conditioning Specialist (CSCS). He is lab faculty at the UNTHSC DPT program, instructing in the assessment and treatment of orthopedic injuries, pain sciences, strength and conditioning, and manual therapy. Jarod regularly presents continuing education at the state, national, and international level for practicing physical therapists, occupational therapists, and chiropractors. In addition, Jarod developed and leads both an orthopedic board specialty examination preparatory course through OPTIM Manual Therapy and Fellowship as well a virtual mentorship with Modern Pain Care for practicing physical therapists seeking to further their clinical expertise. He is the author of the clinical resource text “Sticks and Stone: A Collection of Analogies and Stories to Better Understand Pain”.

Title: Know It, Own It, Change It - Transforming the Way We Think and Do Health and Health Care for the Good of All

Synopsis: Change is needed. As care providers and researchers, we have an opportunity to support and promote systematic change in health care and health research by addressing the implicit and explicit barriers that limit our ability to provide appropriate care to those that need it in a way that honors each person.

This dynamic presentation aims to develop awareness and promote a thriving, inclusive environment to explore these challenges and identify steps forward. Considering inter/personal engagement, organizational cultural support, and system structures, we will address fragility, inclusivity, and key points for taking action to enable access and representation in health care for all.

Be ready to engage, discuss, and generate tips for implementing creative solutions!

(Co-presenting with Dr. Miciak, Dr. Milligan, and Dr. Ossai)

Sandy Hilton, DPT, graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and earned a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995.

Sandy teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, and co-teaches Advanced Level Male Pelvic Floor Evaluation/Treatment for Entropy Physiotherapy as well as Neurodynamics and Sensory Integration for Pelvic Pain and a Practical Application of Pain Science course with Pelvic Health Solutions.

Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women.  Sandy is also pursuing opportunities for collaboration in research into the clinical treatment of pelvic pain conditions.  Sandy has co-authored two papers, 2 book chapters and "Why Pelvic Pain Hurts" a patient focused book.

Title: Clouded Hope: Our Role In Addressing Opioid Use Disorder

Synopsis: It is evident that we are amidst a medical crisis. Chronic pain rates continue to rise and prevalence rates are now at a staggering high. One third of every American will experience chronic pain to which the primary treatment is opiate based medications. Opioid use is at an overwhelming high and we are now starting to see the downstream effects of these prescription narcotics, including opioid use disorder (OUD). In 2016, roughly 2.1 million Americans were diagnosed with OUD and 11.5 million self-reported opioid drug misuse. The aim of this course is to explore the role of non-prescribing medical providers in managing opioid use disorder and to provide hope for clinicians and patients who are struggling with OUD.

Marcos Lopez is a Physical Therapist in San Antonio, Texas. He is a board certified orthopedic clinical specialist. He completed the Therapeutic Pain Specialist program through International Spine and Pain Institute in the Fall of 2016 and completed Evidence in Motions Fellowship in Manual Physical Therapy program in the Summer 2019. Dr. Lopez has spoken at State and National conferences regarding physical therapy, integrating pain neuroscience, and evidence-based practice. He is lecturer for Modern Pain Care and facilitates their online mentorship program. He has served on various leadership positions within the Texas Physical Therapy Association at the district and State level. He practices in an outpatient orthopedic private practice and serves as the primary physical therapist in a substance abuse rehabilitation clinic called NuHope. His role with NuHope is to provide weekly group educational sessions on pain science and to provide physical therapy to treat their underlying pain conditions while they actively taper off of opioids.

Title: Chronic Pain Management In Low Income And Homeless Populations: When Uncertainty Is The New Normal

Synopsis: This presentation will provide an overview of the challenges faced with the management of chronic pain in the low-income communities, and in particular those who are classified as homeless.

Due to the higher rates of moderate to severe mental illness and substance abuse, individual clinicians often lack the resources and training to adequately address these issues. This presentation will examine the efficacy of current strategies implemented by primary care community clinics utilizing an integrated approach to pain management and if these strategies can be implemented more broadly in both rural and urban settings which struggle in providing management of chronic pain for their more vulnerable populations.

Jamie Lowy received his Masters of Science in Physical Therapy in 1998 from the University of the Pacific in Stockton, CA. He has worked in the home health setting since 2000 as a field clinician, preceptor, and clinical manager. In 2016 he started training in chronic/persistent pain management with the goal of expanding the role of PTs in home health to address issues of pain incorporating best practice strategies as evidenced in the latest pain science research.

This culminated in co-authoring the “Pain Management in Home Health Practice” resource with fellow SDPS attendee, volunteer, and presenter Keith Waldron for the APTA home health section. Jamie has recently taken on a new role in the Primary Care setting in addressing broader population health needs for the low income and homeless community in the realm of persistent pain management that utilizes an integrated approach between physiotherapy, PCPs, and behavioral health clinicians.

Jamie presents to local health care practitioners on pain management and has presented at the APTA Combined Sections Meetings. In addition to pain science, Jamie has also worked to introduce incontinence management and pelvic PT into his home health and primary care clinic practice, owing much of this to the mentorship of Drs. Sandy Hilton and Sarah Haag.

He is an avid martial artist and has been most recently training in Aikido with his teen son.

Title: Know It, Own It, Change It - Transforming the Way We Think and Do Health and Health Care for the Good of All

Synopsis: Change is needed. As care providers and researchers, we have an opportunity to support and promote systematic change in health care and health research by addressing the implicit and explicit barriers that limit our ability to provide appropriate care to those that need it in a way that honors each person.

This dynamic presentation aims to develop awareness and promote a thriving, inclusive environment to explore these challenges and identify steps forward. Considering inter/personal engagement, organizational cultural support, and system structures, we will address fragility, inclusivity, and key points for taking action to enable access and representation in health care for all.

Be ready to engage, discuss, and generate tips for implementing creative solutions!

(Co-presenting with Dr. Hilton, Dr. Milligan, and Dr. Ossai)

Maxi Miciak's work centers on informing clinical practice and healthcare system decisions to strengthen patient-centered care. Her research focuses on developing, implementing, and evaluating care models and practices that impact the patient-practitioner therapeutic relationship, including how health services and policies support this relationship. Most notably, she developed a pragmatic framework of the therapeutic relationship in physiotherapy to support physiotherapists in taking meaningful action when developing positive relationships with patients.

Her appreciation for the therapeutic relationship developed over 13 years as a physiotherapist working in private practice and on interdisciplinary rehabilitation teams supporting people with a diverse range of musculoskeletal conditions, chronic pain conditions, mild traumatic brain injury, and psychological dysregulation (e.g. depression, post-traumatic stress).

Currently, Maxi is also working with multiple stakeholders across Canada to bridge the research-to-practice/ policy gap by co-developing and co-implementing a framework that assesses research impact on decision-making in policy and practice, dovetailing with her interest in assessing the scale and spread of research and innovation in the healthcare system.

Maxi received a Bachelor of Physical Education specializing in Athletic Therapy (honors) in 1992 and a Bachelor of Science in Physical Therapy (honors) in 1996, both degrees from the University of Alberta, Edmonton, Canada.  In 2015, she completed her doctoral studies in Rehabilitation Science at the University of Alberta.

She is currently a postdoctoral fellow at Alberta Innovates and the University of Alberta, serving as the inaugural Cy Frank Fellow in Impact Assessment.

Title: Know It, Own It, Change It - Transforming the Way We Think and Do Health and Health Care for the Good of All

Synopsis: Change is needed. As care providers and researchers, we have an opportunity to support and promote systematic change in health care and health research by addressing the implicit and explicit barriers that limit our ability to provide appropriate care to those that need it in a way that honors each person.

This dynamic presentation aims to develop awareness and promote a thriving, inclusive environment to explore these challenges and identify steps forward. Considering inter/personal engagement, organizational cultural support, and system structures, we will address fragility, inclusivity, and key points for taking action to enable access and representation in health care for all.

Be ready to engage, discuss, and generate tips for implementing creative solutions!

(Co-presenting with Dr. Hilton, Dr. Miciak, and Dr. Ossai)

Mark Milligan, DPT, Cert TPS, OCS, FAAOMPT is an orthopedic manual therapist that specializes in the evaluation and treatment of musculoskeletal spinal conditions and is Board Certified in Orthopaedics and a Fellow of the American Academy of Orthopaedic Manual Therapy. He is also certified in dry needling and in Therapeutic Pain Science. 

He earned his Doctorate of Physical Therapy at the University of the Colorado, School of Medicine in Denver, Colorado.  He went on to complete an Orthopedic Physical Therapy Residency and Orthopaedic Manual Physical Therapy Fellowship with Evidence in Motion (EIM). He is a full-time clinician and owner of Revolution Human Physical Therapy and Education, a private, cash-based, concierge physical therapy and wellness practice in Austin, Texas. 

Mark is also the founder of Anywhere Healthcare, a telehealth solution for all providers. Dr. Milligan serves as adjunct faculty for the Doctor of Physical Therapy Programs at South College and The University of St. Augustine.  Dr. Milligan is also primary faculty for musculoskeletal and clinical reasoning courses across the country.

Mark has presented at numerous state and national conferences and has been published in peer reviewed journals. He is an active member of the TPTA, APTA, and AAOMPT and is the immediate past Capital Area District Chair for the Texas Physical Therapy Association and has great interest in governmental affairs.

Title: The Lived Experience: A Conversation About Pain

Synopsis: This interactive, conversational format advances our understanding of pain through meaningful conversation and thoughtful exploration of the complexities of pain. Presenters Keith and Joletta will begin the session with an engaging conversational format. They will share their stories of living with chronic pain, their interactions with healthcare, and what it means to recover and live well with pain. These unique insights from the patient’s perspective serve to broaden our understanding of pain and pain treatment, complementing scientific research and clinical expertise. Those in attendance are also invited to join the conversation and interact with the presenters. Attendees can ask questions via the conference app, online via the streaming service, or live from the audience. Clinically relevant and personally meaningful questions will be explored and discussed, having immediate real world value. 

(Co-Presenting w/ Joletta Belton)

Keith Meldrum is a persistent pain advocate with a focus on the integration of the lived experience narrative into the understanding and management of pain. Highlighting the importance of pain science (the biological, psychological, and sociological elements) and self-management and how these affect people’s pain experience. My personal experiences of over 30 years of living with persistent pain as well as my past work experience as a basic life support paramedic in British Columbian afford me unique insight into the complexities of persistent pain. 

Title: Low Back Pain -  What Have Clinical Guidelines Ever Done For Us?

Synopsis: Given the scale and cost of the problem of low back pain, it is imperative that healthcare professionals involved in the care of people with low back pain have access to up-to-date, evidenced based information to assist them in treatment decision making. 

Clinical guidelines exist to promote consistent best practice, to reduce unwarranted variation and the use of low value interventions in patient care. In this talk we will compare the recommendations of international interdisciplinary guidelines for the management of low back pain, highlighting consistent messages, inconsistencies and controversies.

Then we will consider the most difficult question. Why is it so hard to change practice?

 Neil O'Connell is a Senior Lecturer in Physiotherapy in Brunel University London, UK. He divides his time between research and teaching and previously worked extensively as a musculoskeletal physiotherapist. Neil's main research interests are chronic low back pain with a focus of evidence based practice and he has published extensively in this area. Neil is a member of the editorial board of Cochrane's Pain, Palliative, and Supportive Care (PaPaS) group, the Journal of Pain and is the senior commissioning editor for the pain science blog Body in Mind (www.bodyinmind.org  ). He was a member of the Guideline Development Group for the UK's National Institute of Health and Care Excellence (NICE) 2016 clinical practice guideline for the management of low back pain and sciatica and contributed to the NICE Quality Standard on that topic.

Title: Know It, Own It, Change It - Transforming the Way We Think and Do Health and Health Care for the Good of All

Synopsis: Change is needed. As care providers and researchers, we have an opportunity to support and promote systematic change in health care and health research by addressing the implicit and explicit barriers that limit our ability to provide appropriate care to those that need it in a way that honors each person.

This dynamic presentation aims to develop awareness and promote a thriving, inclusive environment to explore these challenges and identify steps forward. Considering inter/personal engagement, organizational cultural support, and system structures, we will address fragility, inclusivity, and key points for taking action to enable access and representation in health care for all.

Be ready to engage, discuss, and generate tips for implementing creative solutions!

(Co-presenting with Dr. Hilton, Dr. Miciak,  and Dr. Milligani)

Dr. Uchenna Ossai PT, DPT, WCS, CLT is assistant professor at University of Texas Dell Medical School for Department of Women's Health and manager of the pelvic health physical therapy program at UT Health Austin.  Uchenna completed her clinical doctorate in physical therapy at University of Illinois at Chicago and completed her residency in Women's Health and Movement Impairment Science at Washington University in St. Louis.  

Uchenna is an American Association of Sexuality Educators, Counselors, and Therapists (AASECT) certified Sexuality Counselor, and is one of only 5 physical therapists in the world with this designation.  

She also serves in the role as adjunct faculty at the University of Michigan, School of Social Work for Sexual Health Certification Program. Her clinical and research interests include sexual dysfunction in marginalized populations, particularly women of color and the LGBTQ+ community.

Uchenna is creator/founder of YouSeeLogic, a judgement-free social media and education platform dedicated to the sex education and empowerment of adults.

Title: Deconstructing Palpation: The Illusion of Touch

Synopsis: Of all the senses, the one most exploited in our culture, is vision. Our world is one that is dominated by visual cues. It’s a precious evolutionary feature to quickly grasp patterns that convey specific information. Probably very essential to our survival.

As manual therapists, touch is our main tool to gather proper information. We make clinical decisions and dispense care according the evidence we have gathered by our sense of touch and through palpatory skills. Much time and effort is devoted to perfecting this skill, even though little of the cortical processes, behind the perception of this information and its processes are understood. By far, it’s a foundational element in manual therapy, of which much is taken for granted.

We have recently understood that the visual-cortex is very much involved in the processing of haptics. Gathering and evaluation of what we touch, share neural substrates with our visual cortex. We make mental maps of what we feel, to better guide our perception of the surrounding world.

In this short presentation, Erik Ouellet will guide you through the sensory processing and cognitive tasks involved in our visual senses, our haptic senses and their cortical relationship. He will demonstrate how humans have developed such an incredible advantage with their sensory/motor skills and how it applies in many modalities of manual therapy.

Above all, Erik will expose the weakness and short-comings of our visual senses and how we can be fooled by simple visual illusions. Thus applying this critical thinking to haptics and what some have come to call, palpatory pareidolia. What we’ve been thought to feel with our hands, through guided visualization and imagery, are mental constructs that trick the mind. This leaves the therapist vulnerable to erroneous assertions and beliefs that these haptic illusions are of therapeutic significance, while what we perceive has little or no relation to what we visualize. Even though our minds are rigged to function this way, we must reassess what it is we feel under our hands, further removing any beliefs that we are physically exerting our will to change tissues.

Erik Ouellet is an Osteopath, Massage Therapist and Personal Trainer residing in Montreal,
Canada. Erik has hosted many conferences on Pain Science and the Biopsychosocial model,
encouaging their clinical applications in manual therapy. He pursues his passion to
communicate evidence informed reasoning by teaching Dermoneuromodulation and
participating in events held in Quebec, France and the USA.

Title: Blood, Spit, Hair, and Poop: How Novel Biomarkers Are Shedding New Light On The Transition To Chronic Pain

Synopsis: Following trauma some people will recovery uneventfully while others will develop persistent pain or functional limitations. The search for the ‘why?’ has consumed tremendous time and resources over the decades, and recently has resulted in an increasing number of ‘risk screening tools’ for identifying the person at highest risk of chronicity.

To date the vast majority of those risk variables and tools have been in the domain of cognition and emotion, yet interventions targeted specifically at early negative cognitions have shown small to no effects in preventing chronic problems. At the Pain and Quality of Life Integrative Research Lab we have been exploring the biological, psychological, and social drivers of chronicity for the past 10 years, and have recently completed the first phase of the ambitious SYMBIOME longitudinal acute-to-chronic/acute-to-recovery databanking project.

This presentation will reveal new markers that have been identified that include genetic, serologic, salivary, endocrine, and microbiotic data. Critical discussion around the ethics of assigning risk and future directions will be included.

David Walton, BScPT, MSc, PhD is an Associate Professor with the School of Physical Therapy at Western University (London, Canada), an Honorary Associate Professor in the discipline of Physical Therapy at the University of Sydney (Australia), an Associate Scientist with the Lawson Health Research Institute, Associate Editor for the scientific journal Musculoskeletal Science and Practice, and Director of the Pain and Quality of Life Integrative Research Lab at Western. A past winner of Early Career Researcher Awards from both the Canadian Pain Society and the Ontario Ministry of Research and Innovation an a National Mentorship Award from the Canadian Physiotherapy Association, he currently holds the titles of Western Faculty Scholar, Western Teaching Fellow, and Mayday Pain and Society Fellow. Following a 10-year career as a clinical physiotherapist, he returned to academia where his >80 publications span the areas of pain assessment, mechanisms of acute-to-chronic pain transition, critical reflections of PT practice, professional education and knowledge mobilization. He has been the lead or co-lead of national and international pain-related initiatives and advocacy efforts, and has earned a rank amongst the world's top researchers in neck pain specifically. Outside of academia he is a martial artist, a father of two daughters, and a fan of the Toronto Blue Jays and barbecue cuisine.