Showing category "Persistent Pain" (Show all posts)

Yoga Therapy

Posted by Scott White on Thursday, June 22, 2017, In : Persistent Pain 

Case study and evidence

Clinical yoga can be practiced at any age, and also applied as a pain management treatment at any age. Here is Penny practicing at age 79. Several years ago, as a result of persistent shoulder pain, Penny was advised by one surgeon (rather stridently) that she needed bilateral shoulder replacements, and another "more conservative" physician recommended bilateral arthroscopy. 

However, through multifactorial treatment, including education, and a graded yoga program, she i...

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Yoga in Clinical Practice

Posted by Scott White on Sunday, February 5, 2017, In : Persistent Pain 
The Science of Nocebo, Placebo, Iatrogenesis and Evidence Based Yoga

Clinical Yoga

Clinical yoga is essentially physiotherapist instructed yoga, designed with an evidence based framework, taught individually, with a biopsychosocial focus and neuroscientific understanding.

This approach to treatment is founded on an understanding of the neuroscience behind the patient-therapist relationship:

There are certain behaviours and brain mechanisms that are initiated by an individual who experiences pain ...

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Consensus: Exercise First For Fibromyalgia

Posted by Scott White on Monday, July 25, 2016, In : Persistent Pain 

Nonpharmacological therapies take centre stage


1.    Note that this consensus statement from the European League Against Rheumatism (EULAR) notes that exercise should be a mainstay of therapy for the treatment of fibromyalgia.

  1. Broadly, the group did not endorse most pharmaceutical interventions, especially drugs with a high potential for abuse.

Updated recommendations on the management of fibromyalgia by the European League Against Rheumatism (EULAR) emphasize exercis...

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Yoga for Pain: Personal experience and Evidence

Posted by Scott White on Wednesday, June 22, 2016, In : Persistent Pain 

·         P   

This picture above is me practicing at my teacher’s (Kales) house today. In the context of writing about pain experience, evidence and yoga, I should point out that when I first met Kale, in 2009, I could barely move. 2 years of chronic pain, and what I now recognise as sensitisation, fear avoidance and textbook chronicity markers, I could barely even sit on the ground (hip and knee pain), my squatting ability was non existent (too stiff, too sore). Additionally, I was too ...

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Yoga and Overcoming Pain. An Evidence Based Approach.

Posted by Scott White on Monday, May 18, 2015, In : Persistent Pain 

ovement, and exercise generally, are crucial aspects of effective pain management in the case of long standing pain conditions.


Pain is a vital aspect of the body’s defence mechanism. However, when pain responses occur beyond normal physiological healing times, this type of pain is counterproductive [1].

A rapidly expanding body of research is demonstrating that mind-body exercise, specifically yoga, can be immensely beneficial for managing persistent pain [2-8].


Improving function (e....

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Fibromyalgia Bends To Yoga

Posted by Scott White on Monday, March 2, 2015, In : Persistent Pain 

Key Points from the article below:

1. Clinicians should explain to interested patients that yoga may take away some of the debilitating symptoms of fibromyalgia.

2.Women who practiced yoga had greater improvements in symptoms and functioning, including: pain, fatigue, mood, pain catastrophizing, acceptance, and other coping strategies.


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**Treatment and Prevention of Headaches**

Posted by Scott White on Monday, March 2, 2015, In : Persistent Pain 

Nonpharmologic Management:

Educating patients about headache and its management, identifying and managing triggers (via diaries), modifying lifestyles, and understanding the importance of adopting and adhering to interventions are relevant to all persons with headache.

Strong candidates for nonpharmacologic treatment include individuals with significant headache-related disability, comorbid mood or anxiety disorders, difficulty managing stress or other triggers, medication overuse, and patients...

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Plantar Fasciitis Management

Posted by Scott White on Monday, March 2, 2015, In : Persistent Pain 

**Two things physiotherapists and patients should know**

>>Plantar Fasciitis Management<<

1. Don’t recommend surgery to patients for plantar fasciitis before trying six months of non-operative care.

With six months of consistent, non-operative, exercise based treatment, plantar fasciitis will resolve up to 97% of the time. Surgery has a much lower rate of success and has the added possibility of post-operative complications.

2. Don’t routinely recommend X-ray for diagnosis of plantar fasciiti...

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Choosing Physiotherapy Treatment Wisely

Posted by Scott White on Monday, March 2, 2015, In : Persistent Pain 

**Two things physiotherapists and patients should know**

1. Do not employ passive physical agents for chronic pain conditions. Instead, encourage participation in an active treatment program:

There is limited evidence for use of passive physical agents to obtain clinically important outcomes for musculoskeletal conditions.

A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life.

While there is some evidence of short-term pain relief for cert...

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Yoga and physiotherapy research:

Posted by Scott White on Sunday, September 21, 2014, In : Persistent Pain 

1. Pain Relief

Among people with chronic low back pain, doing yoga for just 12 weeks led to greater improvements in back function than usual care, [1] and yoga for 6 months has been linked to significantly less disability, pain, and associated depression. It’s not only back pain that stands to benefit, either.

Yoga has been found to benefit many types of pain, including that from fibromyalgia [2], arthritis [3], joint pain [4], and neck pain [5].

2. Anxiety and Depression

- Yoga may be an alter...

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What is the evidence for exercise therapy?

Posted by Scott White on Sunday, September 21, 2014, In : Persistent Pain 

A recent study examined 104 systematic reviews. The study concluded that exercise therapy is effective for a wide range of chronic disorders, including:

- Knee osteoarthritis
- Low back pain
- Cystic fibrosis
- Chronic obstructive pulmonary disease
- Intermittent claudication
- Ankylosing spondylitis
- Hip osteoarthritis
- Parkinson's disease
- Patients who have suffered a stroke

Visit for further information about beginning a yoga or pilates program, supervised by registere...

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Chronic Back Pain: An evidence based treatment approach

Posted by Scott White on Friday, August 8, 2014, In : Persistent Pain 

Evidence based treatment approach for back pain

Initial consultation:

¨  In the vast majority of people (<90%)  LBP is benign and represents a simple muscle spasm associated with a mechanical loading incident or a muscle spasm with “central mediation” associated with psychosocial or lifestyle stresses.

¨  Only 1 to 2% of people presenting with LBP will have a serious or systemic disorder, such as systemic inflammatory disorders, infections, spinal malignancy or spinal fracture.


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The integration of yoga and physiotherapy

Posted by Scott White on Saturday, June 7, 2014, In : Persistent Pain 

The physiotherapy profession has undergone a paradigmatic shift in recent years.  In response to mounting research evidence that psychosocial issues cannot be disentangled from biomechanical factors, a conceptual ‘biopsychosocial’ model has been developed [1].  

The current research suggests that better patient outcomes are achieved when a broader view of a patients symptoms is used to contextualise the patient therapist interaction [1].

Subsequently, the emerging research has encourage...

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Evidence based yoga for lower back pain

Posted by Scott White on Saturday, May 31, 2014, In : Persistent Pain 

There is an excellent research article by Eyal Lederman called the Myth Of Core Stability, which examines the dangers of reductionist “core stability programs” in treating lower back pain, and advocates holistic and balanced exercise such as yoga for prevention and treatment. 

Psychological factors such as catastrophising and somatisation are often observed in patients suffering from chronic lower back pain. The research suggests that reductionist core stability/physiotherapy exercises can...

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Research update: Yoga increases quality of life and spinal flexibility better than standard physiotherapy exercises for patients with Chronic Lower Back Pain. [1]

Posted by Scott White on Sunday, May 25, 2014, In : Persistent Pain 

Psychological factors such as depression, anxiety, fear and anger seem to have a greater impact than biomedical or biomechanical factors on Chronic Lower Back Pain disability.

In Chronic Lower Back Pain, the reduction in quality of life could be attributed to pain related sleep disturbances, fatigue, medication abuse[2] functional disability[3] and stress. 

In patients with fibromyalgia[4] and Chronic Lower Back Pain,[5] the degree of pain, perceived disability and Quality of Life were influenc...
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What the Science Says About Yoga

Posted by Scott White on Saturday, May 17, 2014, In : Persistent Pain 

Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve function. Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility.


1. Kiecolt-Glaser JK, Christian L, Preston H, et al. Stress, inflammation, and yog...

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Yoga and Chronic Pain

Posted by Scott White on Friday, May 16, 2014, In : Persistent Pain 
Chronic pain is a common and important problem, but many healthcare practitioners, even those in pain management settings, do not have a clear understanding of modern pain science. Misconceptions about pain can be a major roadblock to effective interventions, including Yoga therapy. 

It is important for practitioners to understand the latest conceptual understanding of how the nervous system experiences pain, including the concepts of sensitisation, neuroplasticity and mindfulness.
It’s equal...

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Imaging tests for lower back pain: When you need them—and when you don’t

Posted by Scott White on Sunday, February 23, 2014, In : Persistent Pain 

ack pain can be excruciating. So it seems that getting an X-ray, CT scan, or MRI to find the cause would be a good idea. But that’s usually not the case, at least at first. Here’s why.

They don’t help you get better faster.

Most people with lower-back pain feel better in about a month whether they get an imaging test or not. In fact, those tests can lead to additional procedures that complicate recovery. For exam­ple, a study that looked at 1,800 people with back pain found that t...

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What to do for chronic back pain?

Posted by Scott White on Tuesday, February 11, 2014, In : Persistent Pain 

A review of the evidence

Spinal Fusion Surgery

Epidural Cortisone Injection

Yoga, Exercise and Mindfulness


Spinal Fusion:

There is very little evidence that spine fusion surgery for back pain is effective. It is very expensive, often leads to complications, often requires further surgery, and is associated with increased mortality (see references below).

Four trials have examined complic...

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Research Update: Meniscus surgery

Posted by Scott White on Thursday, January 23, 2014, In : Persistent Pain 

Torn Meniscus and Menisectomy

Considering surgery for your torn meniscus? A recent study compared "sham" surgery to a real menisectomy. 

The study was reported in the New England Journal of Medicine and included 146 patients with persistent knee symptoms consistent with a meniscus tear, a proven meniscus tear on MRI and no significant arthritis, who were randomised to either "sham surgery" or surgery to remove the torn parts of the meniscus (usual practice). 

Summary Below:

Partial meniscectomy N...

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