The Resilient Knee Project

NEWS:

Opportunity - Seeking Partnership

Join Our Team: Seeking Partner, Digital Creator and Project Manager for Exciting Healthcare Collaboration

Are you a talented digital creator and experienced project manager looking for a rewarding opportunity in the healthcare sector?

We invite you to join our team as we embark on an innovative collaboration aimed at revolutionizing patient care.

As the clinical lead of this project, I am seeking a passionate and skilled digital creator and project manager to partner with me in developing a groundbreaking solution. Together, we will create an app that empowers individuals with knee-related concerns to optimize their knee health and overall well-being.

This collaborative venture will require your expertise in digital content creation, app development, and project management. Your ability to translate clinical insights into user-friendly and engaging digital experiences will be invaluable in shaping the future of knee wellness.

If you are enthusiastic about merging healthcare and technology, and are driven by a desire to make a meaningful impact in people's lives, we would love to hear from you. Join our team and help us transform knee care, empowering individuals to take control of their knee health journey.

Ready to make a difference? Apply now and be part of an exciting and dynamic project that will reshape the way we approach knee health and patient care.

We look forward to welcoming you to our team and embarking on this rewarding collaboration.

Please contact Daniel O’Grady if you’re interested in discussing this role further.

0432 898 597

dan@kinfolkwellness.com.au

About The Resilient Knee Project

"Revolutionizing knee pain management through the power of running"

The Resilient Knee Project has a goal of inspiring people around the world to restore the health of their knees through a specialized knee program with a focus on building physical capacity through running.

Our graduates are able to get back to running and feel like themselves again, without relying on medication or surgery.

A groundbreaking new treatment for persistent knee pain and early arthritis, called The Resilient Knee Project has been developed by a leading physiotherapist and running coach Daniel O’Grady.

The treatment focuses on the use of running as a core therapy to improve knee health and reduce pain and inflammation.

The new program is based on the latest research and clinical evidence, which suggests that running can be an effective and safe way to improve knee function and reduce the risk of future knee problems.

The program includes a customized running program, with a gradual and progressive increase in mileage, as well as specific exercises and techniques to improve knee stability and strength.

"We are excited to offer this innovative and effective treatment to our patients," said Daniel O’Grady, lead physical therapist at The Resilient Knee Project. "Running has long been considered a high-impact activity that can be harmful to the knees, but our program has shown that with proper training and technique, it can actually be a beneficial form of therapy for individuals with persistent knee pain and early arthritis."

The Resilient Knee Project has already helped numerous patients improve their knee health and reduce their pain, and the clinic is now accepting new patients through in person assessment or digital online programs from anywhere in the world.

A Different Way To Think About Tendons

Such a simple but profound statement by Prof. Jill Cook 💥

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Every single tendon in your body is alive & dynamically reacting to its environment 🌳

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❌Tendons are not just simple inanimate structures that connect muscle to bone & break down overtime!

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Instead, when tendons are subjected to repeated loading, such as through weight-bearing exercises 🏃‍♀️or resistance training 🏋🏻‍♀️they respond by ⬆️the production of collagen fibers and other structural proteins, which can strengthen the tendon tissue.

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But this is a SLOW process.

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It takes time and patience….often with a 2 steps forward, 1 step back pattern.

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Tendons prefer consistent loading, (& not sudden surprises 😲)

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That is why load management is so important ✅

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And load hides in ‘hard to find places’ 🔎 …so a bit of detective work is often needed to get to bottom of persistent cases.

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There are many nuances in tendon rehab, so having an experienced Physiotherapist who can guide your recovery, acting as your coach can be an invaluable part of your team👬

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❌Rather than relying on medication, ice, cortisone injections and EVEN MORE rest to heal, tendons need lots of blood flow and movement ASAP.

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Most importantly tendons need regular targeted micro-dosing of stress ➕adequate time to recover ✅

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It's also worth mentioning that certain factors such as age, genetics, and underlying medical conditions can affect tendon health and its ability to adapt to changes in loading.

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When we reframe our bodies as complex living ecosystems, rather than complicated mechanical machines that needs fixing and repairing, we can access our inbuilt (but often dormant) human superpower: POSITIVE ADAPTATION ✅

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To learn more & take a listen to Jill Cooks podcast episode

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Any questions or comments about your tendon rehab, feel free to drop in the comments 👇

10 Ways To Get Upstream of Pain

Here are ten examples of behaviors that can help address the underlying causes of pain and potentially prevent or reduce the occurrence of pain:

1. Exercise: Regular physical activity can help strengthen muscles, improve flexibility, and reduce the risk of developing chronic pain.

2. Stress management: Chronic stress can contribute to pain and other health problems. Engaging in stress-reducing activities, such as meditation, yoga, or deep breathing, can help prevent or reduce pain.

3. Regular change of position: Avoiding prolonged static postures and positions can help reduce the risk of developing musculoskeletal pain, such as back pain or neck pain.

4. Proper body mechanics: Using proper body mechanics when lifting, carrying, and performing other physical tasks can help prevent injury and reduce the risk of pain.

5. Ergonomic modifications: Making changes to the environment, such as using ergonomic equipment or adjusting the height of a desk, can help prevent or reduce musculoskeletal pain.

6. Maintaining a healthy weight: Excess weight can put additional strain on the musculoskeletal system and increase the risk of pain. Maintaining a healthy weight can help prevent or reduce pain.

7. Getting enough sleep: Lack of sleep can contribute to pain and other health problems. Aiming for 7-9 hours of sleep per night can help prevent or reduce pain.

8. Quitting smoking: Smoking can increase the risk of developing chronic pain, such as lower back pain and neck pain. Quitting smoking can help prevent or reduce pain.

9. Proper nutrition: A well-balanced diet that includes a variety of nutrients can help support overall health and potentially prevent or reduce pain.

10. Stretching and using a foam roller: Stretching can help improve flexibility and reduce the risk of developing muscle pain.

How to train for a half marathon post-baby

Training for a half marathon after having a baby can be a challenging but rewarding experience.

Here are some tips to help you prepare:

Consult with a healthcare professional

Before starting any new exercise program, it is important to consult with a healthcare professional to ensure that it is safe for you to do so. This is especially important if you had a complicated delivery or if you have any underlying health conditions.

Gradually increase your training

Start with shorter runs and gradually build up your distance and intensity over time.

It is important to listen to your body and not to push yourself too hard too quickly, as this can increase your risk of injury.

Also make sure you have a well supported and cushioned pair of shoes - if you’re just starting back it can be a good time for a fresh pair - that really helps your motivation too.

Incorporate strength training

In addition to running, it is important to incorporate strength training into your program to help improve your overall fitness and reduce your risk of injury. Specifically working on glutes, calves and core can be a great help.

Just make sure you ease into it (be aware of muscle soreness 24-48 hours after a session) and ensure you are getting enough protein for muscle re-build.

Make time for rest and recovery

It is important to allow sufficient time for rest and recovery between workouts to help your body repair and rebuild.

This can include taking rest days or doing low-impact activities such as yoga or swimming.

Stay hydrated and nourished

Proper hydration and nutrition are important for maintaining energy levels and supporting your body during training. Be sure to drink plenty of water and eat a well-balanced diet that includes a mix of carbohydrates, proteins, and healthy fats.

Seek support

Training for a half marathon can be a challenging and time-consuming process. Seeking the support of family, friends, and a running community can help you stay motivated and on track.

Summary

It is important to remember that training for a half marathon after having a baby is a major undertaking and it is important to listen to your body and not to push yourself too hard.

It is also important to consult with a healthcare professional before starting any new exercise program.

Have fun and let me know if you have any questions in the comments section.

Has the pain neuroscience education (PNE) pendulum swung too far?

Pain neuroscience education (PNE) is a form of education that focuses on teaching people about the neuroscience of pain, including how the nervous system processes and perceives pain.

PNE aims to help people better understand their pain and how it is affected by various factors such as emotions, thoughts, and behaviors.

It is difficult to determine whether the pendulum has swung too far in terms of PNE, as it can be a useful tool in helping people better understand and manage their pain.

Having witnessed the rise of PNE in the world of Physiotherapy in the past 20 years, I can’t help but feel it has almost taken over and created a set a dogmatic clinicians who believe that counseling someone in pain to re-wire their thinking and perception is the holy grail in treatment.

In reality, what PNE focused session looks like is a patient presents to a clinic and is given very little in the way of hands on assessment and treatment. The patient does not feel properly listened to or validated. The patient receives a monologue of ‘pain-splaining’ directed at the patients presumed misdirection beliefs and perceptions. The patient leaves in disbelief and concerned about what exactly is Physiotherapy profession stands for and confused at to what it actually does in terms of adding value to their lives.

This is an obviously extreme example, but hearing from some patients first hand, as well as reading about first person narratives, this theme of patient disillusionment is unfortunately on the rise.

Potential harms of PNE focused approach

In the genuine attempt to help, some clinicians may inadvertently dismiss or minimize a person's pain experiences or symptoms, often by citing research or scientific evidence. This can be harmful to the person experiencing pain, as it can invalidate their feelings and experiences and may cause them to doubt their own perceptions.

Another danger is that it can create a rift between the person in pain and their healthcare provider, leading to a breakdown in the patient-doctor relationship. This can lead to a lack of trust and may make the person in pain less likely to seek medical attention in the future.

Another danger of the PNE focused approach is that it may lead to a lack of appropriate treatment or inadequate care. If a healthcare provider dismisses a person's pain experiences or symptoms, they may not provide the necessary treatment or support, which can lead to a worsening of the person's condition and an increase in their suffering.

Unfortunately we may only see the downstream effects of this approach in the years to come.

If there is enough patient disillusionment I see the Physiotherapy brand at risk, with an increase in mistrust of health care professionals.

So then… what is the current research showing about PNE?

Some of the great hopes about the new pain revolution unfortunately haven’t quite lived up to the initial optimism.

Take the RESOLVE study for example, that stated:

“Central nervous system-directed interventions constitute a completely new treatment paradigm for chronic low back pain management. The results have the potential to be far reaching and change current physiotherapy management of chronic low back pain in Australia and internationally”.

These are some big statements and certainly suggest that there are some big changes coming.

The results of the RESOLVE study weren’t exactly ground-breaking, with only small trend toward a positive impact from PNE.

Another study comparing intensive pain education with placebo in people with acute lower back pain showed no clinical benefit, with authors concluding:

“Adding 2 hours of patient education to recommended first-line care for patients with acute low back pain did not improve pain outcomes. Clinical guideline recommendations to provide complex and intensive support to high-risk patients with acute low back pain may have been premature.”

A new recent paper came out showing no changes in outcome comparing Cognitive Functional Therapy with Manual Therapy and core exercise.

Before you accuse me of being anti-PNE, I am well aware of many promising research around PNE and their is definitely good work being done by good people.

But I feel like the negative studies that don’t support the new paradigm get conveniently swept under the carpet and the sacred PNE narrative largely goes unchallenged, especially by clinicians in Australia, where PNE has dominated through large amounts of government research spending.

I can absolutely see the value in good education around pain mechanisms, but I’m just not sure the public is responding in the positive way we would have hoped.

One of the biggest research papers to ever be conducted on patient perception of PNE was published in recently (Weisman et all 2022) showing,

“People with persistent pain tend to express negative attitudes to PNE statements”.

Another research paper that came out in 2021, co-authored by Lorimer Mosely is quoted as saying,

“It is important to combine PNE with other treatment modalities such as exercise and even manual therapy”.

As this paper importantly suggests, it is important to recognize that PNE is just one aspect of managing pain and that it should be used in conjunction with other approaches, such as physiotherapy and medication, as appropriate.

It’s important to recognize that PNE is not a one-size-fits-all approach and that it may not be suitable for everyone.

Some people may find it helpful in managing their pain, while others may not respond as well.

My belief is that all health care professionals should be highly informed about pain neuroscience and how their own thoughts, beliefs and actions can effect the patient, but we may need to re-evaluate how much specific education we try to impart, based on the needs of the individual in front of us.

For patients, it important to work with a healthcare professional that you trust to determine the most appropriate treatment plan for managing pain.

If something doesn’t feel right, you don’t see any significant improvement or you aren’t getting a combination of effective manual therapy, exercise and education based on your goals, please seek further help elsewhere.

What does the future hold?

I must say a big thanks to Luke Bongiorno and the NOI Team for their recent Masterclass presentation which went into great detail into the relationship between Protection and Performance.

The premise of the Masterclass suggested that Protection and Performance are competing priorities in the body and you need to work on both to get your body to an elite level.

For elite level performance, it is the special coach / athlete relationship that underpins an exploration of pushing the boundary of performance whilst acknowledging the background and sometimes subtle (but occasionally bold) protective strategies is what will ultimately limit the expansion of physical capacity.

It takes work to be able to understand and listen to the language of the Protective system and it is the elite athletes, through time and experience really learn to listen to their bodies. They are experts in their bodies and being able to listen to the relevant signal and ignore the noise.

A great example that springs to mind is the recent Australian marathon record, set by Sinead Diver.

At age 45 and competing in her 14th marathon, Sinead made a few changes to her race build-up, explaining that she tempered her training, for the first time.

Rather than pushing herself to the extreme, this time Sinead was weary of over-training.

Sinead:

“If I felt tired, like on a couple of Sunday’s I had a planned to do a pick up and I just thought…

‘I’m not feeling it today, I need to be careful and know that I don’t have to do it just because it’s on my plan’.

So I think I was a bit smarter during this training block”.

Having full confidence to train hard AND smart is skill that takes years to master, especially for marathon runners.

Importantly, rising to the top isn’t simply about using a ‘no pain, no gain’ approach, but actually respecting the body and allowing periods of plateau or even de-training, accepting that this is a normal part of the process.

To finish, I will leave you with an excellent quote in a review by Adrian Louw:

“In this Viewpoint, we argue against PNE as a stand-alone treatment intervention for individuals with persistent pain.

PNE has little to no meaningful effect on pain as a stand-alone treatment.

Physical therapists must focus on movement and use PNE, along with other adjunct interventions, to facilitate a movement-based approach”.

My vision

I think it is really challenging to try and ‘explain pain’ to people who are already in pain. It can be done, but it does run a real risk of backfiring and damaging the patient-therapist relationship.

A more utopian vision would be to make up to date, evidence informed information knowledge about our bodies function a part of our school curriculum, and we learnt how to take care of them - just like a dentist encourages her clients in oral health.

This would include education about how our bodies work with a focus on ‘use it or lose it’ philosophy and trying to make incidental movement fun and socially engaging. Gamifying movement through innovative use of technology is also a promising development.

In terms of pain education, having read, Pain and Perception book published by NOI, I would love to see this book promoted by local book stores and libraries - specifically for people who aren’t in pain.

Some useful ideas packaged in a fun and innovative way would be a good way to well upstream of our current pain epidemic.

Your thoughts?

I’d love to know your thoughts in the comments below - what has been your experience?