The convergent validity of the central sensitization inventory in chronic whiplash associated disorders   March 7th, 2022
Whiplash associated disorders remain the most common injury associated with motor vehicle accidents and a major cause of disability (Ritchie et al, 2013). The consequences for people suffering a whiplash injury can be substantial with an evidential impact on their daily living (Campbell et al, 2018). Still, the exact pathophysiology is not entirely clear.
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A new decennium… But what do we know about whiplash? Twenty whiplash facts to start 2020   January 14th, 2020
The term “whiplash” is given to the acceleration-deceleration mechanism of energy transfer to the neck and head at impact. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during sport (horse riding, diving, snowboarding) and other mishaps.
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Subgrouping patients with chronic whiplash-associated disorders; a way of improving the effect of our therapy?   January 30th, 2019
Whiplash associated disorders (WAD) is among the most common accident-related disorders (about 300 per 10.000 inhabitants in western countries) that have extensive consequences for patients, healthcare services and insurance companies (Tournier et al. 2016).
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INVITED BLOGPOST: NECK PAIN AND CENTRAL SENSITIZATION: WHERE ARE WE HEADING?   October 5th, 2018
Neck pain represents one of the most frequent musculoskeletal disorders, with a huge impact in terms of health-care costs and it is the fourth leading cause of disability.
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INVITED BLOGPOST: The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete   October 4th, 2018
For effective treatment of non-specific neck pain, physiotherapists should be able to rely on the evidence from scientific research. However, scientific research evidence is poorly integrated in physiotherapy. One possible cause for this poor integration is that RCTs do not reflect “the real world” of physiotherapy clinical reasoning.
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The invisible injuries: Post-Concussion Syndrome VS. Whiplash Associated Disorder   March 7th, 2018
On Thursday January 18th, I was looking at the newspaper and the latest news sport header read: “football career ends after concussion: ‘Good guidance’ was missing”.
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Acupuncture Analgesia and Chronic Whiplash   January 18th, 2018
An acupuncture treatment can reduce pain sensitivity in patients with chronic whiplash associated disorders (WAD). But it has been hypothesized that many of the experimental results in acupuncture research could be interpreted as stress-induced analgesia.
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​Sensorimotor incongruence, a true contributor to chronic pain?   March 16th, 2017
Musculoskeletal pain is a highly prevalent disorder. People often seek help from a physiotherapist to relieve their pain and related limitations.
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What you see is what you get?   November 24th, 2016
What you see is what you get, no? Not for whiplash patients!
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Margot De Kooning, PhD candidate   October 4th, 2016
(August 30, 2016) 7:15 pm: The moment Margot De Kooning got rewarded for five years of hard work, by being promoted to ‘Doctor in Rehabilitation Sciences and Physiotherapy’.
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Chronic Whiplash-Associated Disorders: Reorganization of the Brain?   August 31st, 2016
A wide range of human brain imaging techniques has provided the opportunity to explore in vivo the neurophysiological processes of the brain. This neuroimaging research has shown neuronal plasticity, which refers to the possibility of the central nervous system including the brain to adapt but also to maladapt structure, function and organization.
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Chronic stress affects brain morphology and functioning: relevance to cancer survivors and chronic pain?   April 4th, 2016
Many patients with chronic pain suffer from stress intolerance, and some patients have developed chronic pain during or following a stressful period or (life) event (e.g. motor vehicle accident, trauma exposure). When chronic pain is present, stress typically worsens the pain (severity). Taken together, stress and chronic pain are closely connected. In this blog post fascinating research findings regarding the effect of chronic stress on the brain are presented, providing a neuroscientific explanation why chronic stress may lead to the development of chronic pain.
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Neck pain, cervical movement control dysfunction and the influence of scapula on neck pain: results of a PhD   March 19th, 2016
Recently, I finished my PhD on Fisioterapia Manual at the University of Alcalá (Madrid, Spain). This PhD comprises five manuscripts related to neck pain, cervical movement control dysfunction and the influence of scapula on neck pain.
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Potentiating placebo-analgesia in clinical practice   January 1st, 2015
Manchikanti and colleagues (2011) make in their paper entitled ‘placebo and nocebo in interventional pain management: a friend or a foe – or simply foes?’ an argument for a revaluation of placebo effects in clinical practice. They make the claim that clinicians should not try to avoid the placebo effect, but should try to potentiate it, as this effect isn’t just unethical and mythical but must seen as a very real phenomenon, which can be understood from a vast body of both psychological and neurophysiological research.
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Myofascial trigger points: fact or myth? Let the battle continue   January 1st, 2015
The concept of myofascial trigger points keeps on inspiring researchers and clinicians. With the recent publication of an interesting review article in Rheumatology, the concept is really challenged.
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The balancing exercise of exercise prescription in chronic pain?   January 1st, 2015
​In a very recent review and clinical guideline of Heather Kroll, a nice overview is given about how exercise affects pain. But besides listing possible mechanisms of exercise induced analgesia, she reviews the therapeutic modalities and benefits for a wide variety of chronic pain diagnoses.
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Wandering about the effects of visual feedback on pain   January 1st, 2015
​Some months ago I came across a novel study by Harvie and colleagues (2015); they used virtual reality to investigate the effect of overstated or understated visual information on cervical rotation in patients with neck pain. This empirical study shows that we might need to reconsider how we interpret diagnostic provocation tests in daily care, e.g. that it is not a solid measurement for primary nociceptive information or tissue provocation.
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Central sensitization pain : Where are we now and which options do we have for treatment?   January 1st, 2015
Conventional rehabilitation for people with chronic pain is often unsuccessful and frustrating for clinicians. What it is becoming clear more and more is that new therapeutic approaches are needed in view of current understanding of neural mechanisms underpinning chronic pain. In this regard, three papers aiming to summarize the role of central sensitization in chronic musculoskeletal pain and looking for guide clinicians in the rehabilitation of patients with chronic pain have been recently published.
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Exercise therapy for rewriting pain memories? Applying graded exposure in vivo principles during exercise therapy for targeting the brain circuitries orchestrated by the amygdala   January 1st, 2014
Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories.
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Treatment Options for Central Sensitization Pain in Clinical Practice   January 1st, 2014
In 2011, Pain in Motion published a paper explaining to clinicians the various options we have for treating the mechanisms involved in central sensitization.
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The Psychological Flexibility Model: A basis for integration and Progress in Psychological Approaches to Chronic Pain Management   January 1st, 2014
A recent article by Lance M. Mc Cracken and Stephen Morley published in the Journal of Pain addresses the place of theory and models in psychological research and treatment development in chronic pain. It argued that such models are not merely an academic issue but are highly practical. Such models ought to integrate current findings, precisely guide research and treatment development, and create progress. The dominant psychological approach to chronic pain is cognitive behavioural therapy (CBT).
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Cognitive performance in patients with chronic central sensitization pain   January 1st, 2014
Persistent pain in the absence of structural pathology remains a challenging issue for clinicians. Besides the suffering from the pain itself, chronic ‘unexplained’ pain is often accompanied by other debilitating symptoms such as fatigue, sleep difficulties, dizziness, psychological symptoms, and cognitive problems among others. A growing body of scientific research underlines the involvement of a common pathophysiological mechanism of central sensitization (CS), commonly known as an hypersensitivity of the central nervous system, in overlapping chronic pain conditions such as chronic fatigue syndrome (CFS), fibromyalgia (FM) and chronic whiplash-associated disorders (WAD).
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Tea with discussions about combining manual therapy with pain neuroscience education   January 1st, 2014
Interpreting scientific results in clinical practice can be, to say at least, challenging. Especially when it is somewhat contradictory to what you have heard during all those years of extensive training in both physiotherapy education and other courses. As one of my friends recently put it this way: ‘The more I learn about pain, the less I know and the more confused I get.’
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WILL COMPUTERS REPLACE THERAPISTS? THERAPEUTIC PAIN NEUROSCIENCE EDUCATION VIA E-MAIL   January 1st, 2014
Therapeutic pain neuroscience education (TPNE) is becoming increasingly popular as (part of) the treatment of (chronic) pain and aims at altering the patient’s thoughts and beliefs about pain. Previous research has demonstrated the efficacy of TPNE in the treatment of chronic pain. TPNE is mostly given in one-on-one sessions, which has limitations, as it is time intensive, cost intensive and limited to patients in remote areas. Pain in Motion previously showed that written TPNE does little to alter pain, pain cognitions or illness perceptions in patients with fibromyalgia.
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