"The Masterclasses have been of immense value for my clinical reasoning. They have challenged me to think more deeply about different topics along with practical applications which have improved my patient outcomes."
Play means moving in a way that is exploratory, variable, and personally meaningful. Unfortunately, physical therapy tends to be all work no play, focused on movements that are planned, repetitive, and intrinsically meaningless.
This is especially problematic when pain is complex, because it cannot be “fixed” by applying simple algorithms or formulas. Instead, there needs to be experimentation, exposure to unpredictable challenge, and the motivation and optimism to move forward.
In this class, we will examine the physiological complexity of pain, the difference between solving problems that are complex as opposed to mechanical, and why play is an ideal strategy to promote positive learning and adaptation in the face of uncertainty.
This module provides a review of basic pain physiology, with a focus on describing why pain is often complex, multi-factorial, individual, and hard to predict. The review describes three different hierarchical levels of the nervous system involved in processing sensory information related to tissue damage, and also how the nervous system works with the endocrine system and immune system in creating pain.
Overrated and Underrated Factors in Pain
The module reviews various factors that may contribute to pain, including tissue damage, posture, core strength, dysfunctional movement patterns, anxiety, depression, kinesophobia, and catastrophizing. It reviews evidence suggesting that we tend to overrate postural structural factors and underrate psychosocial factors.
Clinical Implications of Complexity
This module discusses the nature of complex problems and distinguishes them from problems that are merely complicated or mechanical. It explains the difference between reductionist and holistic thinking in medicine, and when one perspective may be more appropriate than the another. It argues that many kinds of pain are complex in nature, and that treating this kind of pain requires a very different kind of approach than pains that are simple and mechanical.
Play as a Way to Solve complex movement Problems
This module discusses the science of play and its relevance in the clinic. Play is a natural behavior that tends to promote learning and adaptation. It is an ideal mindset to solve complex problems, which necessarily require intrinsic motivation to engage in a variety of exploratory behaviors. Most physical therapy tends to more “corrective” than playful, and that this can be counterproductive, discouraging the variability, risk-taking and motivation necessary to adapt to physical challenges.