Cognitive Behavioral Lumbar Physical Therapy with Peter O’Sullivan

Peter O’Sullivan is from physiotherapist originally from New Zealand. He completed later his post graduate manipulative training in Australia. He is a musculoskeletal professor at University of Curtin in Perth, Australia. He is well known internationally as a clinician, researcher and professor of musculoskeletal pain disorders. 

During the most recent physio-pedia interview, Peter discusses the multidimensional components of pain. He discusses pain beliefs and behaviors and how it affects clinical practice and research. His research focuses on the cognitive functional approach in the lumbar spine largely due to the number of cases that present clinically. Peter discusses how movement related to pain is largely behavioral. Over protecting painful structures because of fear often times causes compensatory issues. Physiotherapists should consider address retraining movement into a means of moving without compensatory pain patterns. Ultimately retraining the concept that movement is safe is key.

There are three components of pain that should be addressed:

  1. Cognitive behavioral beliefs-pain beliefs
  2. Functional behavioral aspect-movement patterns
  3. Lifestyle adaptations due to pain and avoidance of activities

Peter discusses how picking up a shoe demonstrates motor control patterns that may be pain related. He recommends using a questioning for helping patients to problem solve a more effective pattern of movement without driving compensatory pain such as tensing up when doing particular movements. 

Peter additionally discusses the difficulty of imaging with MRI. People who pursue imaging typically will have some pathoanatomical finding. This can further complicate pain processing and behaviors within movement patterns. People tend to grasp onto imaging findings and act in a protective manner towards what they perceive to be a significant finding on imaging despite our beliefs that it may at times be incidental. 

Peter discusses how when patients discuss the lack of benefits with therapy and how it is more helpful in the learning process. In these cases, stress may negatively impact pain and cause flares. Educating patients to focus on extra care towards their body in more stressful times is important. Focusing on good sleep patterns, eating a health diet, avoiding alcohol, maintaining an exercise program, utilizing relaxation techniques are strategies helpful in decreasing sensitivity within the body. It is important for us as physiotherapists to educate our patients on these principles.

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