These days it is understood that for most chronic pain, ongoing nociceptive triggers are rare. Instead, therapists have to treat a much more complex mix of central sensitisation, anxiety and fear of pain. This involves having a thorough knowledge of pain neuroscience as well as biopsychosocially-driven pain management strategies. This article will allow you to start by understanding your patient before educating them to understand their pain and then to deliver a graded cognition-targeted exercise therapy plan to free your patient from their fear and limitations of chronic pain. Login or register a free account below to access the contents, key points and discussion questions that accompany the article.
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This content consists of a 18 minute video presentation professionally produced and presented at the Fisic Conference 2015.
This content consists of a 11 minute video presentation professionally produced and presented at the Fisic Conference 2015.
Miss Sarah Cecil is a Chartered Sports Psychologist and works for the English Institute of Sport and as the Technical Psychology Lead focusing on rehabilitation. She has a BSc from St Andrews University, an MSc from Exeter University. Sarah has worked extensively with a range of sports for over 10 years including canoeing, fencing, shooting and women's rugby.
She worked with UKA across both the Olympic and Paralympic Programmes in the lead up to 2012 as well as liaising with Team GB in for the First Games/Homes Games Programme. During the Games Miss Sarah Cecil was based in the Village for the Paralympics and was a key member of the multiple medal winning (29) athletics team.
Currently Miss Cecil works at the Team GB Intensive Rehabilitation Unit, on the UK Sport ECAP and the Help for Heroes FL2SL transition programmes as well as line managing four psychologist within the EIS.
We are all experts in how our own body feels but how does this come about and what happens to this when we're in pain? As a clinician you use specific assessment techniques to understand and validate your patient's pain experience. Are these always appropriate or subtle enough?
This article introduces three bedside tests that explore bodily perception: left/right judgement tasks, two-point discrimination, and localisation of touch. These tests help to identify those patients at risk of their pain persisting and where rehabilitation may be failing. Having a better understanding of what helps construct our body perception and how this can change in pain, helps guide the rehabilitation process. This article includes a certificated elearning assessment, videos and a powerpoint presentation.
If between 5.8-50% of people fail to attend clinic appointments, it's not difficult to imagine how few actually adhere to rehabilitation programmes and this has become one of the key challenges faced by health care practitioners. The pressures associated with returning patients to pain-free function as efficiently as possible requires competence and understanding of the practitioner in developing realistic home exercise programmes. The developing age of technology to assist rehabilitation prescription means that too often, too little time in a clinical setting is dedicated towards effectively prescribing, instructing and teaching the home exercise programme and reviewing its effectiveness in subsequent sessions. This article explores the challenges associated with home exercise programmes and puts forward a series of suggestions about how to maximise adherence to these programmes. The article also includes a certificated elearning assessment, a printable daily self report template for you to use with your own clients and the author's original patient exercise handouts for weeks 1-4 and weeks 5-8 for chronic ankle instability.
Communication about a patient’s pain experience is a fundamental component of rehabilitation, but often requires the use of metaphoric expressions. However, whilst the meaning of some metaphors is clear, for others it can be obscure. This article will allow the reader to understand the influence that metaphors have on rehabilitation and how they can be used for pain reconceptualisation and behavioural change. It will also allow the development of strategies that enable better communication. There is also an audio recording of this article.
Understanding the psychosocial challenges faced by youth athletes can be key to a successful return to competition following sports injury. This article extends other recent articles that have examined the salient role of psychology within sports injury risk, rehabilitation and return to competition (1) by providing an overview of some of the challenges of working with youth athletes as well as presenting some strategies that can be used to enhance the quality of rehabilitation outcomes. It is hoped that this will stimulate reflective practice and increase practitioner confidence in working with some of the psychosocial challenges presented by youth athletes.
It is widely accepted that psychosocial factors can have an influencing role in sports injury risk and the rehabilitation process. The ability of an athlete to effectively cope with elevated stress can determine injury rate and affect rehabilitation outcomes. Sports injury rehabilitation represents a period of time in an athlete’s life where heightened stress levels are the ‘norm’, and one where the athlete is increasingly reliant on others to help them manage these stressors. Sports injury practitioners are ideally placed to provide quality social support to injured athletes. This article will review the role of social support within sports injury rehabilitation to raise awareness and stimulate reflection on our current practice with injured athletes.
As practitioners we all have a range of modalities and tools to treat sport injuries, but how many of us use psychosocial skills to facilitate holistic recovery? There is a growing perspective that sports injury practitioners should be able to use basic psychosocial interventions with athletes as they are usually present immediately after the injury has taken place, and at the time when the levels of pain and confusion experienced by the athlete are at their worst. This article aims to increase knowledge of psychosocial interventions that can be used with injured athletes and provide some basic strategies to be considered in the day-to-day management of sports injury rehabilitation to improve practice.
The idea of a holistic approach to sports injury prevention and recovery is nothing new. This article provides a review of the psychology of sports injury risk, response and recovery. It is hoped this will provoke thought and raise awareness about the psychology of sports injury leading to more effective preventative strategies being adopted and more successful rehabilitation outcomes from sports injury.
Our brains are constantly being remodelled in response to our movement and pain experiences. This article seeks to highlight the neural mechanisms involved in this neuroplastic remodelling, as these processes are vital for therapists to understand. We will look at how we can start to target the cortical representations of the physical parts of the body within our cerebral cortex and the research, science and techniques behind the process.
Movement is a highly variable and contextual activity. The specific movement reaction will be according to the brain interpretation of a given situation and the perceived risk or threat to the body’s tissues. By appreciating this context based reaction we can create assessment, treatment and rehab processes that enable us to understand and then change specific movement reactions that maybe causing pain or limitations thus leading to more applicable treatment methods. This may be the missing link between finding a cause and merely treating a symptom.
The goal of this article is to challenge you to think about how you communicate with your patients on a daily basis. There is increasing emphasis for therapists to provide evidence-based treatments, but applying these techniques will make little impact unless you communicate effectively. Advanced communication is a skill that can be learnt and we discuss here the key components for achieving a spontaneous and useful exchange of information. Improving your communication will not only allow you to understand your patients better but will build trust and respect, resulting in a successful medical encounter.
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