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Silent contributors to injury - illness - performance, 18-19 March 2016 : Session 2 - Pathology : When the neuroimmune system screams: Practical Applications of DIMs and SIMs / David Butler
Available for Clearinghouse for Sport member groups B, C, D & E only. Presenter : Understanding and explaining pain are David’s passions, and he has a reputation for being able to talk about pain sciences in a way that everyone can understand. David is a physiotherapist, an educationalist, researcher and clinician. He is a director of the Neuro Orthopaedic Institute - an international organisation teaching biopsychosocial based pain treatment (, and an adjunct associate professor at the University of South Australia. Among many publications, his tests include “The Sensitive Nervous System” (2000), “Explain Pain” (2003, 2013), The Graded Motor Imagery Handbook (2012) and The Explain Pain Handbook: Protectometer (2015). This Symposium was jointly presented by Sports Medicine Australia ACT and the Australian Institute of Sport. Sub themes for the conference include: Planning Periodisation – Training errors, planning for performance, monitoring injury/illness/performance, planning for the gaps and travel ; Pathology Specific – Muscle, tendon, pain, mental health, gender ; Medical – Iron, Viral, respiratory, infectious diseases, vitamins, probiotic, immunology, genetic development ; Physical – sleep, body composition, energy availability, making weight, gender. Abstract : The brain is a neuroimmune organ and the major organ contributor to pain, performance, illness and injury resolution. Pain is conceptualised here as a brain output, similar to performance in that both are ultimately brain constructions in response to desire, threat and the perceived need to protect. Over the past two decades there has been a revolution in our knowledge of how pain is made by the brain. A vast amount of this research can be clinically integrated within the formula – “we will have pain when our brain’s credible evidence of danger to our body is greater than our brain’s credible evidence of safety to our body.” Perceptions of credible evidence of danger (DIM = danger in me) and credible evidence of safety to our body (SIM = safety in me) emerge from many domains including visual, auditory, cognitive and social as well as input from injured body parts. Logical therapies, in particular education, should aim to remove or reduce the dangers (DIMs) and enhance the safety (SIMS). In this presentation, I will explore one currently silent contributor to the danger/safety balance and that is how what you hear and say contribute to pain, performance and ill health. The language of pain in particular, will be explored from a novel clinical reasoning and neuroimmune science based classification. Most, if not all language is metaphorical, often so embedded that we are unaware of it; for example “pins and needles” and “ stabbing pain” are metaphors. Some metaphors are simple, allow description and attempt equalisation (“it’s like a rusty hinge in there”), others are more complex ontological metaphors as people seek to objectify what is often not able to be objectified and give it voice (“I am fragile today”, “I’m falling apart at the seams”). Other metaphors could be considered prognostic (“it’s totally stuffed mate ”, “I am riddled with it” ) or invasive (“it’s like a knife in there”, “burning inside me). Metaphors suggesting disembodiment are common in pain sufferers (“the arm doesn’t feel like mine”, “the back”, or “my body has failed me” ). The likely neuroimmunogical consequences of holding certain metaphors and “letting the metaphor become you” are discussed in this presentation. Conference program session 2 - Pathology : Changes in muscle morphology, neuromuscular capacity and tendon function with training: implications for athletic performance, patient rehabilitation and aging individuals / Professor Per Aagaard, University of Southern Denmark -- When the neuroimmune system screams: Practical Applications of DIMs and SIMs / Associate Professor David Butler, Neuro Orthopaedic Institute and University of South Australia -- Molecular mechanisms causing common exercise-associated musculoskeletal soft tissue injuries / Professor Malcolm Collins, University of Cape Town -- Role of collagen to keep tendon structures strong and healthy / Dr Stephan Praet, Australian Institute of Sport -- •Questions and answers session / Pathology panel.