Pain and Disability on the Rise... What Have We Been Doing Wrong?

History of Neuro-Orthopedic Rehabilitation in 60 seconds...

"While modern healthcare has improved in many ways, statistics associated with musculoskeletal pain and disability continue to stubbornly evidence a system that has not yet grasped the full nature of persistent pain and suffering... patients are not the only casualties of a generally failing system. A call for change is ubiquitous."

The NOR integrative approach was developed by a multi-disciplinary team to offer an alternative, systematic approach to physical rehabilitation, intended to improve the rehabilitation of pain and musculoskeletal complaints of all kinds.

The FNOR program was developed as a project to develop a physical therapy-based solution for Failed Back Surgery Syndrome

"Possibly the most fortuitous outcome of this project has been that as the NOR approach became more integrative, it began to yield better and faster clinical results... and more satisfied practitioners!"

As medicine embraces the integrative approach, physical therapy's response is encapsulated in the Neuro Orthopedicac Rehabilitation approach... Efficient, Less Costly, More Effective, and Person-centered Rehabilitation for people suffering from pain and complex injury.

Why Neuro-Orthopedic Rehabilitation (NOR) makes PT, DC, MD, DO, PA-C, RN, OT, ATC professionals better.

Neuro-Orthopedic Rehabilitation specialists typically report...

Improved Success with PAIN!: NOR emphasizes pain management as a priority. The program includes some novel and highly effective approaches to addressing acute and chronic musculoskeletal pain by rehabilitating the nervous system at every level.

Faster, More Efficient Therapy: The NOR approach is based on the "NOR Rehabilitation Matrix" concept, a robust clinical framework that guides an organized and rational approach to therapy.

The Ability to Harness the Nervous System for Better Clinical Outcomes: NOR is a pioneering program in the merging of neurorehabilitation and orthopedic physical therapy. Our program, 10 years in development, is based on the idea that physical injury occurs in structures of the body but the adverse consequences of injury are expressed as changes across a range of functions and networks in the brain and nervous system.

Greater Practitioner Enjoyment and Satisfaction: One of the frequent consequences for clinical practitioners who deal with those suffering from persistent pain is professional burnout! Owing to its strong integrative foundation, NOR practitioners often report enjoying greater clinical success, practice enjoyment and stronger, therapeutic relationships with their patients.

Clinical Team Coordination and Training: One of the challenges of multi-practitioner teams is variability in clinical approaches and issues with consistency and training. The NOR matrix is a clinical framework that allows practitioners from different clinical backgrounds to better harmonize their individual skills and techniques. The matrix also facilitates team training around an evidence-based clinical system.

Improved Patient Communication & Management: The NOR matrix allows the patient to better understand where they are... where they're going... and what they have to do to achieve better clinical outcomes.

WHO IS THE NOR PROGRAM INTENDED FOR?

The NOR program has been developed for physical therapists (physiotherapists) (DPT, PT), medical physicians (MD, DO), chiropractors (DC), nurses (RN, MSN) and ancillary staff (PA-C, PTA). Our courses have also been attended by athletic training and rehabilitation specialists.

THE 4 KEY AREAS OF VALUE IN THE NOR OFFERING:

1. THE NOR (INTEGRATIVE) THERAPEUTIC MATRIX

The framework that makes the integrative approach, simpler, more practical and more effective! The matrix guides appropriate “triage” of procedures such that the therapist is always guided to the highest leverage interventions first, leading a higher frequency of clinical success, especially in the early stages of rehabilitation. Some practitioners newer to the NOR system typically describe a sense of “knowing what to do next” in more cases, based on their exposure to the matrix.

2. HIGHLY PRACTICAL & EFFECTIVE PAIN TREATMENT PROCEDURES:

Treating pain is one of the highest priorities of this program: Before attending NOR, practitioners often use a variety of therapeutic procedures, typically delivered in a trial-and-error-based approach. The NOR matrix offers a rational, organized approach to delivering novel analgesic procedures as well as a more organized approach to applying existing techniques.

3. NOVEL APPLICATIONS TO DRIVE THE BRAIN & NERVOUS SYSTEM TO BOOST ORTHOPEDIC OUTCOMES!:

The musculoskeletal system cannot function in isolation of the nervous system. The NOR perspective is that musculoskeletal injuries are most often associated with (at least) subtle changes in the nervous system. These changes are opportunities for enhanced rehabilitation (conversely, when they are unaddressed, they may represent hurdles that impeded optimal / complete rehabilitation from injury.)

4. USEFUL CLINICAL TECHNIQUES:

NOR includes a number of highly-practical, intentionally selected clinical techniques, ranging from manual procedures, methods of mobilizing various tissues of the body, diagnostic methods, therapeutic exercises and more. Some of these are novel (developed by the NOR team) while some are proven clinical techniques presented within the context of the NOR approach. All techniques are selected for their utility (in other words: we kept what worked best and disregarded the rest).

COMMON QUESTIONS:

Why and How Does NOR utilize Clinical Neuroscience?

The NOR program is a pioneer in the integration of Neuroscience with Orthopedics. A practical understanding of the brain and nervous system is important in physical rehabilitation is that pain is largely a nervous system experience and as such is modifiable by techniques that modify the brain. Further, the multimodal NOR^TM approach is based in part on the premise that the brain is best stimulated by therapies that are tailored to the individual’s unique nervous system and by directing this therapies at affected areas of the nervous system.

How is this going to make YOU a Better Rehab Specialist... IMMEDIATELY?

Better Results! Better with Pain! Ability to Work Faster & More Efficiently! More consistent success with musculoskeletal complaints! Consistently Improve patient Quality Of Life (not just alleviate pain)!

Above: Some practitioners discuss the changes NOR has made in the practice, even in the earliest stages of the program.

Most attendees report that the NOR program markedly improved their skill and confidence in rehabilitating patients in severe pain... immediately following their first course, this is particularly true of lower back pain. Furthermore, most report that the NOR approach allowed them to deliver quality results more efficiently. No matter what your rehabilitation background or stage in career as a professional, if you are seeking simple, effective, evidence-based, systematic approach to rehabilitation, it is likely that you will benefit from the NOR program.

As rehabilitation practices seek to expand their services, it can become difficult to manage the complexity of increased services, techniques and approaches - the NOR framework simplifies the rehabilitation approach, in a reproducible system that is a solid structural foundation to any rehabilitation practice that can be individualized and modified according to the unique needs of the practice.

How does NOR analyze biomechanics differently?

Simply put "walking is the most fundamental movement pattern".

While biomechanics and gait analysis are very active fields of study, the NOR program pioneered the application of gait analysis as a foundational element in the treatment of bodily pain (most notably lower back pain).

Painful conditions (especially of the pelvis and lumbar spine) are often associated with abnormal gait and movement patterns. Restoration of normal gait and movement frequently facilitates resolution of pain.

What "sort of things" (material) are presented in NOR courses?

NOR courses are highly practical. The NOR program is "hands-on" and intended to develop the practical skills required of a modern, physical rehabilitation specialist.

Here are some examples of the type of material you might expect in an NOR course:

Tissue and Joint Mobilization Techniques (not joint manipulation or 'adjusting'): A rational approach to targeted tissue mobilizations.

Pain, Pain, Pain! A Range of Effective, Pain Treatment Techniques (incl. a number of novel (some patented) methods, ranging from manual therapy methods to analgesic technologies for mitigating and resolving pain. NOR was developed to solve the pain problem in persistent post-surgical pain (failed back surgery syndrome) - it's our strength as a program.

Approach to Nerve-Mediated Pain (not "nerve flossing" or "nerve gliding"): The NOR program is a leader in the application of therapeutic techniques for mitigating neurogenic inflammation (a burgeoning field of discovery in medicine) and ubiquitous, nerve-mediated pain. The NOR team also draws on deep experience (and credentials) in the application of neurodiagnostic technologies.

Brain, brain, brain! CNS Stimulation & Rehabilitation Techniques (techniques developed from translational research and neurorehabilitation are adapted to promote rapid gains in stability and strength and meaningful improvements in level of function.

Efficient Biomechanical Analysis Techniques (incl. Application of Video Kinematics in Gait Analysis) in the assessment of Biomechanics: The NOR program is the pioneering program in the application of these technologies in the context of persistent pain and complex injury (esp. lower back pain). Techniques will be taught by highly experienced experts in the application of these technologies.

Intelligent, Personalized Structure to Rehab Programming, incl. NOR's Approach to Therapy Progression based on "Neuro Cues" (a novel approach developed by the NOR team referred to as "layering", which guides progression of therapeutic programming based on evolving feedback from nervous system.)

Management of Complex, Multi-System Injury (incl. concussion, mTBI) - an approach based on addressing musculoskeletal and central systems simultaneously for improved levels of function in multi-system injury (such as those incurred in high-impact, contact sport).

Integrative Case Development and Implementation (incl. pharmacologic and surgical considerations). Our multi-disciplinary team presents an integrative paradigm, incl consideration of common therapies, such as pharmacotherapy.

Application of Therapeutic Technologies (incl. several, highly effective and novel applications of neural and neuromuscular stimulation (neuromodulation).)

Post-surgical to Return to Play Rehabilitation (NOR's multi-disciplinary team presents an integrative approach to rehab that considers the range of presentations from post-surgical to return-to-field-of-play.

Supportive Devices (a rational approach to ancillary procedures such as taping and supportive devices) NOR emphasizes a shift from "everything and the kitchen sink" approach to modalities to a rational approach, based on an integrative paradigm.

Is this Program Appropriate for a Sports Rehabilitation Practice?

Yes. While NOR is not developed as a "sports specific" training program, the program heavily emphasizes a novel approach to rehabilitation of conditions and injuries commonly associated with sports (e.g. ACL rehabilitation, tendon complaints and concussion).

Above: Physiotherapist (Physical Therapist) for Welsh National Football Team and English Premier League Football team briefly discusses his experience with NOR.

Our program has been apparently well received by a number of sports specialists from around the world, from a number of specialties incl physical medicine and rehabilitation (physiatry), physical therapy and chiropractic.

Above: President of FICS (International Federation of Sports Chiropractic) & published author on topic of running, discusses his experience with NOR.

Our approach to rehabilitation has also been adapted and applied by sports, training and conditioning specialists, including been adapted to large sports programs at college and professional level.

Above: Matt Shaw sports conditioning specialist discusses his program's experience with NOR. Matt reported that NOR markedly reduced injury and improved performance in athletes, across multiple sports, in their program.

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