What if following the clinical guideline is sometimes the wrong call? Not occasionally. In the kinds of MSK situations that come up regularly. That's the argument physiotherapy researcher Matt Low makes in Part 2 of this conversation, and it's worth sitting with.

About Matt: Matt Low is a physiotherapy clinician and researcher based in the UK whose work sits at the intersection of philosophy, epistemics, and clinical practice. He asks uncomfortable questions about what physical therapy actually is and where it's going.

In this episode:

• Why rigid guideline adherence can be an ethical problem, not a clinical safety net (SIJ fusion as a concrete case)
• How value-based care's four pillars create friction rather than harmony in practice
• What AI is already doing to MSK services right now (Cambridge UK is procuring AI for MSK management today)
• Why ambient documentation tools change more than just note-taking
• The contextual architect: what the PT role looks like when AI handles algorithmic pathways
• What decentering the human in PT curriculum would actually mean in practice

Resources mentioned:

• Chad Cook's paper on value-based care in MSK practice
• Dave Nicholls' work on the future of physiotherapy
• Deleuze and Guattari (rhizome concept applied to clinical thinking)
• Part 1 of this conversation

Want to keep developing this kind of reasoning? Modern Pain Pro is the community where clinicians work through exactly this.

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Evidence-based practice has a blind spot: not in the research itself, but in how we rank one form of knowledge above all others.

In this episode, I sit down with physiotherapist and PhD candidate Matt Low to unpack what he calls epistemic fluency, the ability to move between different forms of clinical knowledge depending on what the situation actually requires. We cover why population-based research gives you a map but not your patient's territory, how Aristotle's three forms of knowledge apply directly to clinical reasoning, and why the biopsychosocial model functions better as an analytical tool than a practice guide.

We also dig into the Back Cafe — a 3-arm RCT on lumbar spinal fusion rehab that compared a progressive training program, a video program, and a social cafe setting run by a senior physiotherapist. At the 2-year follow-up, the back-cafe group outperformed the training group on pain and beat both other groups on daily task performance. The study raises hard questions about what the active ingredient in rehabilitation actually is.

This is Part 1 of 2.

LINKS

• Join Modern Pain Pro
• Matt Low's blog
• Back Cafe study (PubMed)
• CauseHealth (Matt's network)

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Most chronic pain patients aren't failing to improve because they aren't trying. They're failing because no one in their care has helped them see what they're actually up against.

In this solo episode, Mark breaks down why even well-intentioned biopsychosocial care often falls apart in practice -- and why the fix isn't just adding more disciplines to the team.

Key takeaways:

- What the Misdirected Problem Solving Model reveals about chronic pain care
- Why patients still separate the "body problem" from the "mind thing" even when seeing both PT and a psychologist
- How incoherent clinical narratives keep patients locked in biomedical thinking
- What true interdisciplinary care actually looks like vs. parallel care happening in silos
- How PTs can bring the psychosocial in -- and why psychology needs to bring the body back into the conversation
- What a unified clinical story sounds like in practice

A free webinar is coming up focused on building this framework in your own practice. Registration HERE

If this episode hit home, subscribe and check out Modern Pain Pro -- where clinicians go deep on exactly this kind of work together. - https://modernpaincare.com

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if the best thing you could bring to a complex pain case… is curiosity instead of certainty?In this episode, Mark Kargela sits down with physical therapist and pelvic health specialist Faith Stokes to explore what trauma-informed, psychologically informed care actually looks like in practice. When patients present with persistent pain, grief, trauma, or complex comorbidities, rigid clinical labels and quick solutions often fail. Faith shares how clinicians can step back, regulate themselves, and create space for the patient’s story to guide care.

This conversation dives into practical ways to show up more human, grounded, and effective when treating messy cases that don’t fit the textbook.

In this episode, you’ll learn:

• Why you don’t need to be “the expert” in the room
• How clinician nervous system regulation changes patient outcomes
• What trauma-informed care actually looks like during treatment
• How curiosity improves clinical reasoning in complex pain cases
• Why acknowledging a patient’s story can transform rehabilitation
• How to integrate psychological awareness without abandoning physical treatment

If you treat persistent pain, pelvic health conditions, or complex chronic cases, this conversation will change how you approach patient care.

Subscribe for more conversations on modern pain care, clinical reasoning, and treating complexity.

Explore the resources and programs mentioned in the links below.

Link:

Sondermind
Complex PTSD Book
Holistically Treating Complex PTSD Book
IG Post on Veterans Stress and Suicide

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if biomechanics isn’t the reason your patients improve?

And what if your best “tool” isn’t a tool at all?

In this episode, I sit down with exercise physiologist Samuel Bulten to unpack the identity shift many clinicians face when persistent pain doesn’t respond to traditional care.

We discuss:

• Why biomechanics has a weaker link to pain than we were taught
• The ego trap of being the “fixer” in the room
• How ACT and psychologically informed care change clinical conversations
• The tension between objective measures and meaningful life change
• Why therapeutic alliance may matter more than your technique
• How rural practice highlights the limits of biomedical narratives

If you’ve ever felt unsettled leaving school confident—only to feel lost with persistent pain cases—this conversation will help you recalibrate.

If you’re ready to build confidence with complex pain, subscribe for weekly episodes.

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if the guideline isn’t wrong—but incomplete?

And what if your patient isn’t “non-compliant”—just complex?

In this episode, I’m joined by Joost Van Wijchen to explore the tension between clinical guidelines and the messy reality of practice. We unpack the concept of mindlines—the experience-shaped frameworks that actually guide what we do—and why uncertainty isn’t a flaw in care, but part of it.

You’ll learn:

• Why guidelines are population-informed—but patients are personal
• How “mindlines” shape clinical reasoning more than we realize
• Why outcome measures like the Oswestry don’t tell the whole story
• How the capability approach shifts focus from impairments to meaningful freedom
• Practical ways to navigate uncertainty without losing clinical integrity
• How to co-construct care instead of imposing solutions

If you’ve ever felt the tension between measurable outcomes and meaningful outcomes, this conversation will resonate.

If this episode challenges or sharpens your thinking, subscribe and share it with a colleague.

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Mindfulness for pain isn’t candles and breathing apps.

It’s measurable, mechanism-based analgesia.

In this episode, we break down what the neuroscience actually shows about mindfulness and pain modulation—and why it works through pathways completely independent of opioids.

You’ll learn:

• How mindfulness decouples sensation from suffering (insula vs. prefrontal activity)
• Why “trying to relax” can backfire—and what to cue instead
• How thalamic gating may reduce nociceptive input before conscious processing
• The role of predictive processing and reduced anticipatory threat (amygdala + salience network)
• How shifting from narrative mode to experiential mode changes pain
• Why mindfulness still works even when endogenous opioids are blocked
• How improved interoception supports emotional regulation in chronic pain

This is not about turning your clinic into an eight-week meditation program. It’s about understanding the mechanisms so you can apply brief, practical strategies in real sessions.

If you work with complex or persistent pain, this reframes mindfulness as a clinical skill—not a wellness add-on.

Subscribe so you don’t miss Part Two, where we cover the dose-response data and the minimum effective dose.

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What do you do when a patient says, “I don’t care about goals—I just want less pain”?
This moment shows up every day in pain care—and how you respond can either reinforce stuckness or help someone get their life back.

In this episode, Mark Kargela breaks down why pain reduction isn’t wrong—but often incomplete—and how clinicians can navigate this conversation without invalidating the patient or taking away hope.

You’ll learn:
• Why pain reduction alone can narrow a patient’s life
• Red flags that someone is stuck in the pain reduction loop
• How pain scores function as communication—not thermometers
• How to use “creative hopelessness” without confrontation
• Ways to pair short-term relief with long-term valued living
• How to reframe goals when patients fear movement and activity

This episode is for clinicians who want practical, psychologically informed tools to manage complex pain conversations—without abandoning pain relief or overstepping their role.

If you work with persistent pain, this discussion will sharpen how you listen, how you frame goals, and how you help patients move forward—even when pain doesn’t fully disappear.

👉 Subscribe for weekly evidence-informed conversations on modern pain care. - @ModernPainPodcast

👉 Explore the links below for related resources and deeper learning:

• Kenneth Craig Paper on Social Communication Model of Pain
• A biopsychosocial formulation of pain communication
• Creative Hopelessness Guide

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📸 - Follow us on Instagram - https://www.instagram.com/modernpaincare/

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness