Course Review: Greg Lehman’s Reconciling Biomechanics with Pain SciencePete Kissel
Ever have a learning experience and have mutually exclusive reactions of feeling stupider (think I made that word up) because you recognize how little you actually know, yet on the other hand feeling infinitely more comfortable with something and leave feeling empowered? This was my experience with Greg Lehman’s Reconciling Biomechanics with Pain Science course this past weekend.
I had been waiting for this course to return to Toronto for some time. Working in a sports based practice, one area of treatment that I have always felt less comfortable with has been pain science. More specifically, I had one individual patient interaction that had me recognize my void in knowledge in the pain arena. Little did I know this would foreshadow a crazy coincidence and subsequent great learning experience for me during the actual course (more later).
Greg has a diverse background and is known as a bit of contrarian as it relates to conservative care. He began his career as a spine biomechanist working with Stu McGill at the University of Waterloo, then went on to obtaining his Doctor of Chiropractic (at the same time running the biomechanics lab at CMCC), and then to gain a Masters in Physical Therapy. One explanation for my feeling of stupidity during his course is that he is a human pubmed. Now research savants like this can take on one of two persona’s – being humble, or being complete pricks. Greg is able to play the former role in an extremely non-condescending manner. He has a great ability to dissect literature and use it to punctuate his thoughts, as well as pose questions that challenge researchers assertions and his readers/listeners inherent biases as well as his own.
Overall whenever I take a course I look for 3 outcomes. These are my criteria for a useful learning experience:
- Did I learn at least 3 new things that I can immediately implement in my practice?
- Was it both conceptual and practical – preferably practical?
- Would I recommend the course to colleagues?
This course hit all 3.
When I mentioned to colleagues that I was going to Greg’s course, many balked saying there wouldn’t be enough practical knowledge to make it worthwhile. The course was surprisingly practical. That said the contextual definition of ‘practicality’ as it relates to conservative therapy needs to be challenged to understand my statement. Greg’s course at its core is about challenging the pervasive “I need to fix somebody” framework that is persistent in manual medicine. The major themes of the course are to reconceptualize our framework whereby we facilitate adaptability and tolerance and build patient self-efficacy. This is accomplished in a number of ways (which will be explored in 2 follow up blogs), however the main practical component (for me) was how we actually speak to patients and convey messages. To me this is the single most practical thing that can be taught. As an aside, there were a TON of clinical pearls that Greg espoused throughout the course as far ranging as an update on tendinopathy literature, a great presentation on the science behind stretching, exercise examples that may seem obvious but I certainly hadn’t thought of, and lots of group breakout sessions on specific case examples, all of which were great learning experiences. There was not really a “hands on” practical component so if this is what you are specifically looking for, this course is likely not for you.
A second largely false critique of Greg is that he is ‘anti manual therapy’. Greg repeatedly made a point through the course of stating that manual therapy is a huge desensitizer of sensitive tissue. Manual therapy was also encouraged as a symptom modifier, a pain analgesic and can even be anti-inflammatory. My interpretation of Greg’s issue with manual therapy (and I could be wrong here) is not in manual therapy itself, but rather in the intention of that therapy. He is not a fan of “my therapy will ‘fix’ this faulty tissue or dysfunction” and also does not believe it should be a standalone treatment all the time. He is a big fan of using manual therapy as a component of comprehensive care.
Speaking of “I will fix your issue”…..Greg’s course is an alternative to the kinesiopathological model as he views this as too pessimistic. So what the hell does that mean? We have become too reliant upon a fear-based model where we tell people for instance one particular movement pattern is bad and will cause significant damage. We have diminished the human bodies ability to adapt and get stronger. Greg’s premise is simple: Most movements are unavoidable. Therefore we need to expose tissues to a range of movements in order to promote adaptation. An example?
Lumbar flexion and disc pain. Greg went through a great literature review on ‘neutral spine’ as it pertains to the lumbar spine and how many people are taught to be flexion avoidant with disc injuries. I won’t bore you with the specifics, but it was very convincing that:
- it’s impossible to avoid flexion, even when we think that we are, and
- by avoiding this movement in recovery we are inherently avoiding strengthening the very movement that caused the injury to begin with.
Instead, we need to reconceptulaize the movement. The body learns to view flexion as painful, so Greg’s course teaches you strategies to change this fragile viewpoint, relearn flexion typically out of context, and he presents a number of strategies to accomplish this.
Greg appears to also be a big fan of simplicity. To break down his course in 2 sentences it would be these:
- Overall with rehab all we do is stress a structure and ask it to adapt (any structure). **Note that at times adaptability is finite but this will be covered in another blog**
- For injuries – calm shit down, then build shit back up
I am going to post 2 follow up blogs on my main learnings from the actual course itself that will better explain the above statements. One will be on course themes, via my 10 favorite quotes from the course, and the second will be my 10 favorite analogies that can be used as speaking points to have patients better understand complex topics (this was by far the most useful, practical component of the course to me personally and something I have incorporated immediately into practice).
One last note in this initial mind dump. Greg’s mandate is to change the pain science message and to do so he encourages his message to get out there. By taking his course he actually provides you with access to a google drive that appears to be his entire computer. You get literally thousands of research papers (most are prominent and applicable), all of his course notes, his FREE pain workbooks, and even his lecture slides. He is so passionate about this that he even suggests you use his own slides in presentations to others. Common in our industry are escalating course prices, individuals who set themselves up as ‘gurus’ to gain market share, and ‘member driven’ subscription style pricing models to ‘maintain your certification’. There was none of that in Greg’s course and in fact it was the most reasonably priced course I have taken in the past 5 years. He even capped it at 30 people to ensure a positive learning environment (I even know people that tried to sign up and couldn’t get in). The only ‘subscription’ aspect would be my own personal desire to take the same course again – a feeling that I have never had in all the continuing education seminars I have done to this point. In short, he is a very generous educator.
Last point to wrap up a long initial course review. My impetus for seeking Greg’s course was one particular patient that I saw roughly one year prior. She was suffering from chronic pain and I had trouble reconciling my conceptual framework with her symptom pattern and overall fragile presentation. I felt somewhat helpless in trying to aid her recovery back to work and back to a normal life. It’s one of those patients that ‘stuck with me’ ever since as any intervention I attempted, whether exercises or manual care, did not seem impactful. I actually ended up using Greg’s free recovery workbooks with her and tried to learn alongside her through the process. I lost contact with her after about 5 visits. Fast forward to the end of Greg’s course where he used a case example. About 2 paragraphs into the case it said that a Burlington Chiropractor recommended his workbook and it became apparent that the case was my patient! I shot up my hand and told the group I was the chiropractor. She ended up seeking Greg out based upon the info provided in his workbook. Seeing his approach to care for this person was one of the greatest learning experiences I have ever had. I emailed the individual the following day to say how happy I was that she ended up with such a great outcome, returning to her work, and more importantly her life. We are even getting together next week to further discuss some of the concepts Greg touched upon that helped her.
Overall would I recommend this course? Here are my 3 summary points:
- This course changed the nature of my patient interactions. Something that I was able to incorporate the very next day. Based upon this, despite it not being physical it was a very ‘practical’ course.
- This course challenged my conceptual framework. Something that I needed and was happy to have confronted.
- This was the only continuing education course where I would take the exact same course again and happily pay full pop for it. Again, not for a second ‘phase 2 course’ but literally the exact same course.