Scientific Program

Day 1 :

Keynote Forum

Areerat Suputtitada

Chulalongkorn University,Thailand

Keynote: Sensitization in myofascial pain syndrome

Time : 9:0:00

Physiotherapy 2017 International Conference Keynote Speaker Areerat Suputtitada photo

Areerat Suputtitada, MD, is Professor of Physical and Rehabilitation Medicine. She is the Chairperson of Neurorehabilitation Research Unit at Chulalongkorn University and Chairperson of Excellent Center for Gait and Motion at King Chulalongkorn Memorial Hospital in Thailand. She was invited as international speaker for more than 60 times around the world. She received 18 international and national awards, and published more than 60 international and national articles in the areas of her expertise including neurological rehabilitation, spasticity and dystonia, gait and motion, and pain. She is an expert clinician in ESWT for various indications in the field of physical and rehabilitation medicine. She has been elected and appointed to important positions at ISPRM such as the Chair of Women and Health Task Force and the International Exchange [email protected]@gmail.comrn


Sensitization in corresponding spinal segments plays a major role in the formation of continuous pain in a given part of the body. The term called by Professor Andrew A. Fischer for this phenomenon is “spinal segmental sensitization” (SSS). Chronic pain is contributed by sensitization of spinal nociceptive neurons, regardless of the original provoking events. SSS is a hyperactive state of the spinal cord caused by irritative foci sending nociceptive impulses from a sensitized damaged tissue to dorsal horn neurons. The clinical manifestation of dorsal horn sensitization includes hyperalgesia of the dermatome, pressure pain sensitivity of the sclerotome and myofascial trigger points within the myotomes, which are supplied by the sensitized spinal segment. In Myofascial pain syndrome (MPS) first described by Professor Janet G Travell and Professor David G Simons, active myofascial trigger points present lower pressure pain threshold when compared to people with no pain or the presence of only latent trigger points. There are significant elevated levels of substance P, calcitonin gene-related peptide (CGRP), bradykinin, tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), serotonin, and norepinephrine in the vicinity of the active myofascial trigger point. Overall, pH was significantly lower in the active trigger point. Treatment rationale and techniques may evolve from this information, and should be taken into account when dealing with chronic patients with amplified pain responses. The mechanism consists of the nociceptive stimuli generated in the sensitized areas bombarding the dorsal horn of the spinal cord. This causes central nervous system sensitization with resultant hyperalgesia of the dermatome and sclerotome and spreads from the sensory component of the spinal segment to the anterior horn cells, which control the myotome within the territory of the SSS. The importance of SSS is emphasized by the fact that it is consistently associated with musculoskeletal pain. The development or amplified activity of MTrPs is one of the clinical manifestations of SSS. The segmental desensitization treatment consists of injection of local anesthetic agents in the involved dermatome to block the posterior branch of the dorsal spinal nerve along the involved paraspinal muscles. In addition, local anesthetic injection is applied peripherally near the foci of irritation in local soft tissue, directly into taut bands and trigger points, using a needling and infiltration technique. Stretching exercises, local heat application and additional transcutaneous electrical nerve stimulation (TENS) treatment complete the muscular relaxation after the injections. Extracorporeal shockwave therapy (ESWT) can also play a role in desensitization.

  • Physical Therapy Science Physiotherapy in sport related injuries Advancement in Physiotherapy Manual & Manipulative Therapy Artificial Physiotherapy Methods Womens Health & Palliative Care

 Fellow of the American Academy of Orthopedic Manual Therapists, sports Injuries, orthopedics, dry needling


Purpose:Currently at Johns Hopkins Hospital, there is an ongoing quality improvement initiative investigating the benefits associated with the implementation of the Low Back Pain Clinical Practice Guidelines on a large clinical scale. The purpose of this educational session is to provide attendees with the framework required for performing similar projects within other healthcare systems. Additionally, we will discuss potential research implications for these types of initiatives.


The current standard of practice for the treatment of mechanical low back pain is “broken”.  There is significant cost associated with this treatment and its subsequent protocol.  As a result, the incidence of disabling LBP continues to grow and serves as a major burden on healthcare utilization.  In 2012, the Orthopaedic Section of the APTA published the Low Back Pain Clinical Practice Guidelines. Although these guidelines are based on best evidence, they themselves have not been studied on a large scale. Currently, at Johns Hopkins Hospital, there is an ongoing quality improvement initiative that seeks to explore the benefits of guideline-adherent therapy. The objectives for this initiative include the following:

  • Improve quality of care through guideline adherent therapy education and training
  • Monitor changes in quality of care through improved outcomes collection processes
  • Track changes in utilization and outcomes and communicate these to payers
  • Utilize gathered data for future research studies
    • Validation of Clinical Practice Guidelines
    • Benefits of residency and fellowship training


The session will be broken down into multiple sections in order to give attendees a “how to” type of learning experience. The main sections of the talk are as below

  • How to identify areas in the need of improvement across the clinical staff
  • How to best address make these changes through education and training
  • How to establish baseline levels of performance and track changes in performance following educational interventions
  • Discuss potential research opportunities that these data may support

By the end of this session, our goal is that attendees will have a blueprint for performing similar quality improvement initiatives and research within their own healthcare systems.



Monika Naresh has her expertise in evaluation and passion in improving health and wellbeing. Completed her bachlors of physiotherapy from Amarjyoti Institute Of Physiotherapy. Since 2013 working as independent physical therapist. Achieved  certificates in kineso Taping, Pilates , Dryneedling, bobath technique and many more. Served as assistant head of department at Roshan Hospital and currently proudly an owner at NewWorld Physiotherapy And Rehab Centre


Wellbeing is state of being comfortable , healthy and happy. Apparently, it is imperative for Physical therapist to be fit and healthy in order to influence the wellbeing of the people around and the patients. Undoubtedly, the posture and fitness of Physical therapist is at the cost of providing best treatment to the patients. So, the topic directly relates to how physio take care of themselves as well as their patients wellbeing. Some interesting facts and practical advices would be solely described that would be of great value to all physio. The talk emphasis mainly on all dimensional wellbeing of the physio to connect with the importance of delivering the best by being best.


Gopakumar Sukumaran
Physio Partner Youth Champions League
Official Physio Partner – TAL (The Amateur League) Certified Dynamic Taping Instructor, DT (Australia) Certified Core Conditioning Specialist
Certified IASTM, Prime Physio Blade, Germany
Certified Sports Trainer
Certified in dry needling
Official Physio- Siemens Football Team
Ex Sports Physio for Kuwait Football Club
1.Award in Indian Business Award 2016 for Best Physiotherapy in Bangalore
2. Significant Contribution Award in Physiotherapy (BPN)
3. Best Physiotherapist, Ministry of health, Kuwait
4. Article Presented & Published in Novel Physiotherapy Journal on Core
Stability Training in Spinal Cord Injuries
5. Physio Excellency Award by Physio Foundation India, 2017


India Dynamic tape is an innovative, high-quality, latex-free, 4-way stretching tape designed to absorb load and re-inject that energy back into movement, all without limiting range of motion. Dynamic Taping is about managing  load, managing movement patterns, and managing function by introducing force  into the system and based on sound clinical reasoning.  Biomechanics is defined as “the study of the mechanical laws relating to the  movement or structure of living organisms.”

The management of load, movement and function permeate many physiotherapeutic interventions and for good reason. Load has been shown to induce tendinopathy and drive it through its various stages but is also essential in recovery. A combination of tensile load (overuse) and compressive load is most detrimental and tendons respond differently to different types of loading at different stages of the pathology. Specificity of loading is critical.

Biomechanical evaluation and intervention is regularly incorporated into the management of musculoskeletal conditions. Alterations in kinetic and kinematic factors can be identified and addressing such factors can improve pain and function.

For example, greater magnitude and velocity of navicular drop has been associated with Medial Tibial Stress Syndrome. Hip adduction and internal rotation is predictive of pain severity in Patellofemoral Pain Syndrome.  Similarly, those with poor outcomes post injury or surgery may demonstrate altered mechanics when compared with those with good outcomes or with the uninvolved limb. Those with patella tendinopathy reduce motion at the knee but exhibit increases at the hip  during hopping activities. Following ACL repair, those with poorer outcomes similarly demonstrate meaningful assymmetries at the hip.A patient following total knee replacement may walk with a stiff leg due to a lack of inner range quadriceps control, despite having adequate range of motion.

Orthotics, splinting, taping and bracing attempt to combat some of these changes, primarily by providing a passive restriction to motion or perhaps via neurophysiologic mechanisms. However, when it comes to obtaining a mechanical effect to dissipate load and manage function they have some limitations. Recommendations are made for treatment centers to become trauma- informed that would help this recognition.