1. Mechanical Sensitization of Peripheral Neurons

All physical medicine specialists (e.g. orthopedists, physiatrists, chiropractic physicians, physical therapists) are trained to evaluate patients for 3-4 cardinal signs indicative of neural distress. Those signs are numbness, tingling and weakness and sometimes balance. These classic evaluations and the standard tools used to assess them are in every doctor's treatment room. Missing from that tool kit in many places is the awareness of how to evaluate an under-explored domain of neural distress...mechanical sensitization. 

Over the past 40-50 years, the research in this domain has grown, culminating in a Nobel Prize in Physiology being awarded to Ardem Patapoutian in 2021 for his discovery of the actual receptors (PIEZO1 and PIEZO2) on neurons that change when the neuron becomes more sensitive to mechanical stimulus. 

Other notable researchers and clinicians like Alf Brieg, MD; Robert Elvey, PT; David Butler, PT; and Michael Shacklock, PT,PhD have added invaluable items to the clinical assessment of mechanical sensitivity of peripheral nerves. 

In the process, classic icons of physical medicine like Travell and Simons' Myofascial Trigger Point Theory have seen their already weak theoretical base suffer erosion. Researchers such as Geoffrey Bove, DC; John Quintner, MD and Milton Cohen, MD have shown that all of the cardinal signs of trigger points are attributable to mechanically sensitized peripheral nerves. This, in turn, yields new approaches in manual therapy, some of which we have developed and teach in our coursework, to address these common tender points of mechanical interface disruption much more quickly and effectively than standard pin and stretch techniques.

2. Pain Neuroscience Education

Many doctors have been fascinated by the findings in pain neuroscience research over the past several decades and justly so. Suddenly, it seemed, many of the hallmarks of pain management were being called into question as we learned more about the high prevalence of pathological findings on imaging of asymptomatic patients. We toyed with social media widgets that showed us how important perception and beliefs are to pain and performance. 

As much as these findings called many of us in physical medicine to question our structurally based tests, we all dashed our optimism on the rocks as our patients asked us, "Are you saying it's all in my head?"

In more recent years, researchers like Adriaan Louw, PT, PhD and others have provided us with more pragmatic tools to explain these complicated, systems-based problems to our patients.

3. Metabolomics

Research in the field of aging and geriatrics has morphed over the past decade into "longevity" and metabolomics. Steadily we have learned through complicated research that perhaps good health needn't be so complicated. Much of our health depends on whether we do the things Mom told us to do:

1. Go outside and play
2. Get to bed on time
3. Eat your vegetables
4. Don't hit your brother

Blessedly, several savvy bloggers and podcasters (e.g. Peter Attia, MD and Andrew Huberman, PhD) with solid credentials have helped us to access this obtuse literature and have even brought it to popular appreciation. However, among the under-appreciated systems that this research affects are both the central and peripheral nervous systems. Now doctors can begin to appreciate that beyond questioning about signs and symptoms of polyneuropathy and mood, our conversations should include sleep, stress management, diet and exercise to reduce sensitivity of neurology in our pained patients. Oxidative stress from "hard living" and "willful self-poisoning" are valid targets in the clinical treatment plan.