I keep hearing on social media about “overly complicated treatments”. I also keep hearing most of the same people promoting “simple” interventions and “keeping it simple”.

I would like to make a few points.

  • Most of the same neurocognitive skill sets that are required to truly benefit from pain neuroscience education and treatments to reduce fear are the same as those for motor skill learning (e.g., attention, working memory). Why aren’t these called “overly complicated”? This is similar for Cognitive behavioral Therapy.
  • When you subgroup people for neurocognitive and sensorimotor function, suddenly there are no overly complicated treatments. Sure there is a small challenge and this is useful for neuroplasticity.
  • Pain is not simple. A simple intervention will most often provide basic results. This means either small treatment effects, or it will not alter the trajectory of the presentation. Musculoskeletal pain can present with a wide variety of Motor, Sensory, Behavioral, Psychological, Mild Neurological Factors, Neuro-Immune-Sympathetic-Endocrine dysfunction. There is nothing simple when all are present.
  • If you are looking at a Population based intervention, rather than an Individual based intervention and you only have 2-4 treatment sessions, a basic program may be best (pending the screening questionnaire information).

There are many reasons for reduced neurocognitive function, including, but not limited to:

  • neurodevelopmental disorders / learning difficulties
  • neuro-inflammation / low grade systemic inflammation
  • endocrine dysregulation
  • autonomic dysregulation
  • post concussion syndrome
  • atypical birth history
  • major surgery as an infant

Education level is OK for larger epidemiological studies, but it is not very useful for screening neurocognitive function. There are too many false positives and negatives. It is not uncommon to see patients with higher education who have a problems learning or a diagnosed learning difficulty. This can also happen in the physiotherapy profession.

A patient who presents with low back pain could also have a wide variety of other relevant presentations

  • developmental coordination disorder (with habitual use of end range spinal movements and poor sensory motor function)
  • asthma
  • irritable bowel syndrome
  • Restless leg syndrome
  • high blood pressure
  • chronic sinusitis

Will a simple strengthening intervention sort this person out? No, but neither will a motor control based intervention.

Simple doesn’t have to mean strengthening. Neurological based interventions such as primitive reflex inhibition, postural reflex facilitation or specific sensory motor rehab exercises are also simple. These can be combined with targeted exercises interventions to improve Motor Behavior.