Briony believes in basing her treatments in a modern understanding of anatomy, neuroscience and rehabilitation research. She carefully considers whether each treatment approach makes sense, and looks for supportive evidence whenever possible. She avoids approaches that look good on the outside, but have no good foundation beneath them.
Read on to find out more about the evidence for her three main areas of practice:
Evidence for using pain neuroscience
in clinical practice
Pain neuroscience is a body of knowledge that is scientifically well-established and affects every choice Briony makes in her clinical practice, from how she talks about injuries to how she prescribes exercises. She seeks to reduce the 'threat value' associated with an injury, and re-teach the brain that movement is not dangerous.
There is also evidence that shows that simply learning about pain science can be extremely helpful for people living with pain.
The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. (Louw et al, 2016)
"Current evidence supports the use of [pain education in chronic pain conditions] for reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization."
Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial. (Van Oosterwijck et al, 2013)
Research studies showing the benefits of learning about pain:
Physiotherapists receive rigorous university-level training in human anatomy, physiology, clinical conditions, and interpreting research. Some conditions, such as tennis elbow and achilles tendinopathy, have well-researched protocols that can be followed. Other conditions, such as low back pain, have more general guidelines.
Physiotherapists form hypotheses and treatment plans based on 'what makes sense' given all the information available to us, and using a broad base of knowledge.
Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature (Neelapala et al, 2018)
"Strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA."
"An integrated model that focuses on how psychological and neurobiological factors interact with... existing personal and environmental factors to contribute to the development of chronic WAD."
Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials (Searle et al, 2015)
"A beneficial effect for strength/resistance and coordination/stabilisation exercise programs."
Examples of research Briony bases her treatments on:
Evidence-base for mindfulness
The longevity of mindfulness-type meditation practices over centuries and the experiences of millions of people are one type of evidence that this is an effective method of improving well-being. There is also mounting modern scientific evidence that supports mindfulness as a quite powerful medical adjunct. It is now used in mainstream clinical contexts, including at publicly-funded pain centers all over Canada.
Studies have shown that there are benefits for stress, pain, anxiety, and depression. As a physiotherapist, I am mostly interested in using mindfulness to help people who have musculoskeletal pain.
Statistically significant effects on depression symptoms and quality of life in people with chronic pain. There is some evidence that mindfulness meditation decreases pain, although there are not enough high-quality studies to be sure.