“We must consciously be non-judgemental of individuals with centrally sensitized pain. Our goal is to bring joy into our patients’ lives by having them participate in life again …that is what we do as Physiotherapists” Janet Holly, PT


After introducing myself to the patient and asking them about what type of work they do, I pretty much immediately ask, “Can you name 3 activities that are important to you that you have difficulty doing and you wish to do again?”

I 100% agree with Janet Holly as she says that our goal is to bring joy into our patients’ lives …wow!

“We need to shift the idea of us being pathology detectors and correctors, to us being facilitators of recovery.”  Lorimer Moseley, PT


“Our mindset should always be, how do I facilitate recovery rather than what can I detect that’s wrong and try and correct it.” Lorimer Moseley, PT


My PT education and the majority of my post-graduate courses focused on finding things “wrong” with my patient. I was taught to immediately look for “abnormal” foot structures, “abnormal” patellar tracking, “abnormal” scapular movements, “abnormal” pelvic positions, etc. It seems like it is in the PT DNA to be pathology detectors, however as Lorimer Moseley says our focus must be on facilitating recovery and function and less on specific flaws we see in our patients.

“Do not throw out your ortho when you are doing pain management. Sometimes when we expect central sensitization, we may find specific mechanical issues and tissue pathology.” Greg Lehman, DC, PT


I also agree with Greg Lehman when he says we cannot abandon our orthopaedic skills as there is a time and place for it. I still assess for MCL laxity by performing a valgus stress on the knee, I still perform a thigh thrust test to test for SI joint irritation and I still do the O’Brien’s test to see if they may have a major labral injury… these patients may need more than just pain education. Let’s not throw out the baby with the bath water!


“Rehab is ‘Physical Homeopathy’ where the cause of the injury becomes the treatment but starting with small dosages. So if bending forward and heavy lifting was the cause of the low back pain, then focus on graded exposure to bending forward and lifting.”  Greg Lehman, DC, PT

The mentality that I used to have early on in my career was that if a patient injured themselves during lumbar flexion, they should 100% avoid lumbar flexion. If they injured themselves with left rotation, then they should avoid left rotation and etc. This was unquestionable common sense to me. But was it correct?

Yoga              Flex

Based on pain science, I no longer teach my patients to avoid activities that actually caused their pain, but I teach them to modify, then gradually expose them to the same movement or activity that initially “injured” them. This approach may be the single most effective method of reducing fear and the risk of developing chronic pain.

This approach may contradict the philosophy of always going in the opposite direction that caused the injury.


Yes it is true that lumbar flexion and rotations are often the cause of a back injury and often aggravating factors, but that could simply be explained by the fact that lumbar flexion and rotations are what we most often do with our spine. This does not mean that we must avoid bending and twisting just because it was the cause of the injury.


One would never suggest that since walking is the primarily cause of ankle sprains, we must limit our walking to prevent ankle injuries.

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