New advances in integrated management of lumbopelvic pain: Addressing the complexity
Speakers: Prof. Paul Hodges PhD MedDr DSc, David Klyne PhD MSc, Marie-Pierre Cyr PhD MSc
|Paul Hodges PhD DSc MedDr BPhty(Hons) FAA FAHMS FACP is a Professor and NHMRC Leadership Fellow within the Centre for Clinical Research Excellence in Spinal Pain, Injury and Health at the University of Queensland. His research has unlocked new understanding of pain, how it relates to how we move, and its rehabilitation. He uses diverse approaches from studies of single cells to applied human research, clinical trials and translation into practice. Paul has won the premier international prize for back pain (the ISSLS Prize) 5 times. About Paul Hodges…|
|David Klyne PhD MSc (MolBiol) DPhty BAppSc is a Fulbright Scholar and Senior Research Fellow within the Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, the University of Queensland. His research probes the neuro-immune pathways involved in pain and how they can be targeted with interventions. His research uses a blend of basic and clinical sciences to study interactions between the immune system, sleep, physical activity and psychological factors.|
|Marie-Pierre Cyr PhD MSc MPT is a Postdoctoral Research Fellow and Banting Fellow (Canadian Institutes of Health Research) at the Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, the University of Queensland. Marie-Pierre’s research is focused on chronic pelvic pain, men’s health, and innovative assessment tools to further understand the neurophysiological and biomechanical mechanisms involved in musculoskeletal conditions. She is a physiotherapist with certification in pelvic health practice from the Université de Montréal (Québec, Canada).|
There is no doubt that lumbopelvic pain is a multifactorial complex problem. There will not be a one-size-fits-all treatment. Outcomes are likely to be improved if treatment can be tailored to meet the needs of the individual. Although training that addresses lumbopelvic motor control continues to be shown to be effective, four key issues have emerged that are likely to impact how this could be tailored.
First, increased recognition of the mechanisms that explain the maintenance of pain suggest that motor control training should be more effective for individuals with features consistent with predominant nociceptive than nociplastic pain. Methods are emerging to identify these mechanisms in clinical practice.
Second, pain in the pelvic region can have multiple mechanisms and chronic pelvic pain related to the pelvic floor and pelvic organs is increasingly recognised. It is critical to consider how to recognise these mechanisms and conditions to tailor interventions accordingly.
Third, poor sleep has emerged as a cause of flaring of symptoms. Evidence has revealed that this relationship is underpinned by interactions between sleep and the immune system – with effects at both the systemic and local level. This has implications for nervous system sensitisation and tissue health. Assessment and management of sleep conditions requires consideration. Fourth, diverse mechanisms are being uncovered that explain the changes in neuromotor control in lumbopelvic pain. These vary over the time course of the condition and explain different findings (e.g., motor cortex adaptation, inhibition, fat infiltration and muscle fibrosis). Different mechanisms require different exercise interventions.
This workshop will address new advances in each of these areas to arm the clinician with techniques to assess and design treatments to address the complexity of lumbopelvic pain.
|9.00 – 9.30||New|
|TOPIC 1: Understanding pain mechanisms and how this can guide treatment selection|
|9.30 – 10.00||Nociceptive, nociplastic and neuropathic pain descriptors – what do they mean and why are they relevant for lumbopelvic pain||Paul Hodges|
|10.00 – 10.30||Using clinical features to discriminate between the predominant pain mechanism descriptors that explain an individual pain||Paul Hodges|
|10.30 – 10.45||Morning break|
|TOPIC 2: Understanding the role of pelvic floor and pelvic health in the lumbopelvic pain|
|10.45 – 11.15||New advances in understanding the role of pelvic floor in the lumbopelvic pain||Paul Hodges|
|11.15 – 11.45||What is chronic pelvic pain and how does it relate to lumbopelvic pain – differential “diagnosis” of when pelvic pain is related to chronic pelvic pain vs. pelvic girdle||Marie-Pierre Cyr|
|11.45 – 12.15||The latest in assessment and training of the pelvic floor||Marie-Pierre Cyr & Paul Hodges|
|12.15 – 13.15||Lunch|
|TOPIC 3: Integrating sleep interventions with lumbopelvic control|
|13.15 – 13.45||How is sleep related to pain and lumbopelvic control – sleep, the immune system, sensitisation and tissue health||David Klyne|
|13.45 – 14.15||Different sleep disorders and how to identify them||Paul Hodges|
|14.15 – 14.45||Tailored interventions for sleep||David Klyne & Paul Hodges|
|14.45 – 15.00||Afternoon break|
|TOPIC 4: Different exercise to address different mechanisms|
|15.00 – 15.30||Tailoring exercise for lumbopelvic pain to match mechanisms – how can exercise be targeted to address neural inhibition, motor control adaptation and immune system impacts on pain and motor control||Paul Hodges|
|15.30 – 16.00||Practical guidelines for targeted intervention – how to select the types of exercise, the intensity, and the structure of training to address the different mechanisms and impacts of pain and injury on the neuromusculoskeletal system||David Klyne & Paul Hodges|
|16.10 – 16.30||Discussion and conclusion||All|