Pain, movement and play: common sense for complex problems

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.

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.

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.

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.