Exposing the roots of chronic pain
Associate Professor Suzanne Snodgrass is a physiotherapist, educator and prolific neuromusculoskeletal researcher currently dedicated to uncovering the hidden causes of chronic neck pain.
Examining both neural and kinematic processes, Associate Professor Suzanne Snodgrass is using a multi-pronged approach to identify the mechanisms that may define and modulate chronic non-traumatic neck pain.
Suzanne believes that recent research trends in her field disregard possible biological causes through an overly narrow focus on psychosocial contributors. She cites a recent study in whiplash that suggests the presence of pain may contribute to psychological distress, rather than stress leading to pain.
"They showed that the participants had some psychological distress issues, but when their pain went away, so did many of the psychosocial factors associated with their pain."
"This makes us question the assumed relationship between them. If you have psychosocial distress, it's not inevitable that you get pain. So there must be something else causing pain, perhaps a biological factor that we're just not measuring yet."
Suzanne is keen to determine the reasons for recurrent neck pain; if it is how the brain is wired or how it controls movement, whether the joints are stiff or stuck, or whether it's related to the way a person moves during daily tasks. She queries whether there could be an issue with the link between the brain and the muscles.
"We are looking closely at all the alternatives to psychosocial determinants causing pain. If we can identify a biological cause of the pain, then we could design better treatments."
Observing and measuring the way people complete functional tasks and correcting abnormal movement is one of the core functions of physiotherapy. However, due to clinical measurements focusing solely on movement within a single plane, and the practice of movement correction based on the observation skills of individual therapists, the relationship between pain and movement deviation has been difficult to quantify.
"Traditional treatments focus on correcting impairments. But what are the mechanisms creating the impairments?" she asks.
"I would associate range of motion with pain, but it doesn't always come out in studies as one of the main factors."
"I think that's because we correct the movement when we are actually measuring it."
"It could be quite different if we could find a way to measure how someone is naturally moving."
To this end, Suzanne has established a specially designed movement lab, using 3D motion analysis to record and measure the movement of participants who suffer neck pain, as well as a healthy control group. The data will then be analysed to identify the differences between the groups.
She is collaborating with Dr Suzi Edwards, based at the Ourimbah campus, who has shown that people with lower back pain were very controlled in their movement.
"One of the things we may find in investigating neck pain, is that it's not a particular movement pattern causing problems, it may be that it's a lack of movement," Suzanne explains.
"If this is the case, we can design interventions to get people moving again."
Another possible cause of pain that Suzanne is exploring is relative to how the brain controls movement. She is using Magnetic Resonance Imaging (MRI) to assess connections between the motor cortex and the thalamus, a part of the brain involved in motor planning.
The next step will be to measure if there are changes in the brain or neck muscles after participants undertake a regime of task specific training.
"There's evidence in relation to lower back pain that if interventions involve a specific exercise, we will see changes not only in the way a person performs a particular movement, but in the way their brain organises to perform that movement."
"We'll be looking to see if that happens in neck pain as well."
"Again, that's linking the motor movement, or the muscle performance, to the brain mechanism telling the muscle to perform."
THE NEXT WAVE
Suzanne is also a talented educator.
In addition to her role supervising research students, she coordinates the first year entry course into Physiotherapy, teaches third year core musculoskeletal physiotherapy, and contributes to the curriculum across the school in the areas of musculoskeletal, spinal and sports physiotherapy.
"I like working with young people. They are just so bright and talented," she enthuses.
Always looking at ways to improve practice, Suzanne turned her innovative thinking toward improving assessment processes for physiotherapists in training.
Funding from the Health Education and Training Institute NSW in 2013 allowed Suzanne and her team to trial a new method of recording feedback and creating dialogue between clinical educators and students on clinical placements.
Adapting software designed for giving students exam feedback, the Electronically-Facilitated Feedback Initiative (EFFI) created a new forum for reflection for both the student and educator.
Suzanne is working with Associate Professor Trevor Russell at the University of Queensland to gain more funding for further development of this mechanism. The first step is to iron out the technological glitches in the process, which she hopes will become a standard tool for educators.
"The good thing about physio is that we've moved to an online national assessment form for clinical placements. The ability to link into this will result in a feedback dialogue linked to the student's assessment."
A SPORTING CHANCE
Choosing a career in physiotherapy was an obvious path for Suzanne.
"I played a lot of sports and I was very interested in how the body works. Physio is a profession where you can learn that," she confirms.
Originally from the United States, she obtained a Bachelor of Science (Physical Therapy), from the University of North Carolina. Extensive travel followed intensive work as a sport physiotherapist in the States, and Suzanne finally settled in Australia.
Working in private practice, but looking for a change, Suzanne heard that the University of Newcastle was setting up a physiotherapy degree.
Approaching Professor Darren Rivett regarding a possible position, Suzanne was urged to pursue her research masters, after which she embarked on her PhD.
Years of practice inform her search for practical, pragmatic solutions for easing chronic pain. Although she enjoys teaching, five years after completing her PhD, it is research that still ignites her passion.
"I became more interested in research as I had more opportunities to answer more advanced and interesting questions," Suzanne explains.
"The more research I do, the more enthralled I am with it."
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