Jason Silvernail: Paradigm-shifter

Jason Silvernail is a prominent voice in the world of physiotherapy and pain science, and argues that while biomechanics has some value in terms of understanding pain, that value has been largely overrated.  It has now come to our attention that pelvic tilt, core strength, and “postural abnormalities” are perhaps trivialities when understanding a patient’s pain.

Jason Silvernail

“Every time pain science gets discussed there are always people who push back and it’s nearly always, acknowledged or not, the straw man of “biomechanics doesn’t matter.” No one has said that biomechanics doesn’t matter. Mechanical origin pain by its nature is biomechanical and the concepts of neurodynamics are also.

The problem is that people have been trained to think things like pelvic tilt and core weakness and short muscles are significant biomechanical problems that must be creating a large nociceptive drive that therefore pain science discussions ignore nociceptive pain. But we need to put biomechanics “in its place” not “out of our mind” when thinking about pain.

We need to start to question closely our clinical reasoning processes and realize that not every impairment to movement or function is equally contributing to a pain experience, and many may be irrelevant. We discover which ones are relevant and worth correcting through a systematic assessment and reasoning process – two of the most common and most supported by randomized trials are the McKenzie MDT system and the Maitland manual therapy system.

What we don’t do is assume every kind of positional, movement, muscle length or strength, nerve mobility, or joint accessory movement impairment is contributing nociceptive drive.

And that they all need to be addressed and that acknowledging the published research evidence that many of these impairments are normal findings unrelated to the pain experience is somehow ‘ignoring biomechanics’. It’s a testament to how indoctrinated people are into the biomedical model that their concept of pain begins and ends with their ability to find things to blame and fix in the patients body.

I for one won’t apologize for trying to move people in the fitness and rehabilitation world away from such a simplistic, practitioner-centered, outdated view to a more complex, patient-centered, and modern view of the pain experience.

If people want to say that means ignoring biomechanics we will just have to keep pointing out this strawman argument when we see it – but I am really sick to death of this particular canned response. ” Dr. Jason Silvernail, DPT