Whether a patient has been experiencing pain for 1 week or 1 year, some are highly sensitive to any increased mechanical forces on the tissues. Therapeutic exercises can leave our patients with worse pain and more functional limitations, even when the individual is performing the activity or exercise in a biomechanically sound manner. Even when this individual is provided effective pain science education, even gentle movements might leave them worse.

This webinar explores the gaps between pain science education and therapeutic exercise prescription. Participants will learn the science supporting two different processes used to effectively guide sensitized patients to increasing therapeutic exercise and activity without the need to use their strength of will to persevere.

This webinar is produced by PABC.

Presented on Nov 9 2016


Neil Pearson

Neil Pearson, PT, MSc(RHBS), BA-BPHE is a physical therapist, Clinical Assistant Professor and a faculty member for international yoga therapist training programs. He is the recipient of national and provincial awards in pain education, and in physiotherapy pain management. Neil is the founding Chair of the Canadian Physiotherapy Pain Science Division, and developer of an online pain self care curriculum. Neil is also author of ‘Yoga Therapy’ in the 2016 book Integrative Pain Management, and of a recent peer-reviewed article - Reconciling movement and exercise with pain neuroscience education: A case for consistent education.


  1. Webinar recording (1:24)
  2. PowerPoint handout
  3. Cory Blickenstaff, PT, MS, OCS & Neil Pearson, PT, MSc (RHBS), BA-BPHE (2016): Reconciling movement and exercise with pain neuroscience education: A case for consistent education, Physiotherapy Theory and Practice. 
  4. Complete the free steps of Pain Care for Life (formerly Pain Care Pro)

Q&A from the Webinar

Q: So if walking is painful, would you have the pt walk gently & breathe?
A: If walking is painful, we would want to look at which aspect of it is the issue - length of time, posture, stress, altered gait, can all increase the pain. As a PT I would look at thesis and follow the guidelines even if he can only walk 10 feet a t first. Sometimes though imagined walking is a better starting place. Regardless he need to play with the edge, with safety and whether the benefits are outweighing the consequences - if we are specifically talking about changing a sensitized nervous system.

Q: I use gentle touch in the area adjacent to the pain area and then move towards the pain area, can you comment on that
A: Yes - staring in the painful area with touch or any mechanical force can worsen pain when sensitized. It is much easier for the system to adapt when we don't jump right into the fire.
Q: and try to keep their tension low?
A: Yes, try to keep muscle tension low while active

Q: Who was the fellow you talked about who did the vagus nerve research?
A: Stephen Porges and the PolyVagal Theory - he has a book out of his work.

Q: I always struggle with how much hands on is appropriate with this population. Typically what percentage of your treatment would be hands on?
A: Percentage per person is usually 33% or less in time, but some people, even with CRPS do well with much more. And of course the people who think THE treatment is hands on is when I really struggle to find ways to get them to do their part.