A World of Hurt: Peripheral Neurogenic Pain Neural Entrapment to Neural Dysfunction Exercise Prescriptions
A World of Hurt: Peripheral Neurogenic Pain Neural Entrapment to Neural Dysfunction Exercise Prescriptions
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This two-day course introduces information important to the assessment and treatment of patients dominated by nociceptive pain mechanism involving the peripheral nerve. The Peripheral Neurogenic Pain Mechanism (PNPM) requires specific neurodynamic mechanical exercise prescriptions and pain neuroscience education about peripheral nerves and the pain alarm system. Outlining Chapter Five and Six of “A World of HURT: A Guide to Classifying Pain” book, pain clinicians will learn how to assess and classify neurogenic nociceptive pain mechanism as either “trapped,” “tight,” or “sensitive”. This course highlights neurodynamic repeated movement testing, subjective and objective characteristic patterns consistent with neural entrapments, dysfunctions and/or the beginning signs of central sensitivity in the upper, lower body and spine. This pain neuroscience course features interventions of patient education for neurogenic conditions and specific prescriptive neurodynamic exercises for each neurogenic mechanical problem. The course includes treatment workshops targeting manual therapy for common upper and lower body neural entrapment soft tissue sites, spine directional preference, passive and active neurodynamic mobilization and exercise progression. Video, paper cases and live patient demonstrations (when available) will aid application to clinical practice relating the importance of the specific “words” and “moves” necessary to reverse neurogenic mechanical nociceptive pain mechanisms.

Speaker biography

Annie O’Connor, MSPT, OCS, Cert. MDT is Founder and CEO of a World of Hurt, LLC a dedicated consulting, teaching, telehealth and research company for the application of Pain Mechanism Classification System into MSD & Neurological clinical practice. In addition, she is a Clinical Manager at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. Annie has co-authored 2019, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach 3e, Liebenson C (ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2020 and 2017, Therapeutic Exercise Chapter, Orthopedic Knowledge Update Spine 6 & 5, American Academy for Orthopedic Surgeons publisher. This chapter specifically is dedicated to helping Medical Doctors understand pain mechanism classification and the importance in therapeutic exercise selection. She has co-authored 2015 book “A World of Hurt: A Guide to Classifying Pain” and September 2016 Journal Article in JMMT “Validation of a pain mechanism classification system (PMCS) in physical therapy practice”. Both publications offer a research supported “paradigm shift” in managing Musculoskeletal Pain promoting effective and efficient outcomes with significant cost savings. She is an Orthopedic Clinical Specialist (OCS) of the American Physical Therapy Association and has a Certification in Mechanical Diagnosis and Therapy in the McKenzie Method (Cert. MDT). She teaches nationally and internationally the World of Hurt training courses, a six course training series designed for interdisciplinary application of the PMCS into clinical practice. She lectures nationally and internationally on musculoskeletal pain mechanism classification and intervention, neurodynamic evaluation and treatment, mechanical diagnosis and therapy of spine and extremities, kinetic chain evaluation, functional manual therapy and exercise prescription. She was instrumental in establishing the Pain Mechanism Classification System approach for musculoskeletal pain and neurological spasticity at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. She is a member of American Physical Therapy Association in the orthopedic section and canine special interest group, the North American Spine Society (NASS) serving on the Exercise Committee, and McKenzie Institute. She continues to treat orthopedic, neurological patients, and canines with pain to achieve the best life possible through her Chicago based private practice and the Shirley Ryan Ability Lab.

Melissa Watson, MSPT, Cert. MDT is Vice President of the World of Hurt, LLC and assistant instructor for the World of Hurt six training courses. She received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago Burr Ridge Outpatient Center with 17 years of clinical experience in neurological rehabilitation. Melissa is a Master Clinician and certified clinical instructor with the Shirley Ryan Ability Lab where she mentors other clinicians and students on their professional and clinical development. She is a recognized mentor in utilizing Pain Mechanism Classification System for Neurological Patients with MSD Pain and Spasticity. She is practicing clinically in the Day Rehabilitation setting with a research interest in musculoskeletal pain and applying both pain classification and MDT principles within the neurological population for spasticity. She is currently leading a Day Rehab Pain Group Committee where she is leads other Day Rehab clinicians on a research supported pain science education group that are focused on pain science education and active care treatment for patients with centrally dominated pain throughout 6 sites of care facilitating a standard for education through inpatient and outpatient clinicians in a large system of care. She certified in Mechanical Diagnosis and Treatment – McKenzie Method. She is an instructor of the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” and uses both sub grouping methods exclusively in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.

Course Objective(s)

At the conclusion of this course, participants should be able to:

1) Differentiate subjective and objective characteristics for peripheral neurogenic and central sensitivity pain mechanisms.

2) Differentiate subjective and objective characteristics for mechanical syndromes of the nervous system including neural entrapments, neural dysfunction and central sensitivity.

3) Prescribe patient education and exercise interventions for mechanical syndromes related to neural entrapments, neural dysfunction in spine, upper and lower extremities.

4) Perform passive repeated movement neurodynamic evaluation and treatment for common upper and lower extremity peripheral nerves.

Course Outline

Day 1 (7.0 CEU’s)

7:30 Registration

8:00 Course Introduction – [WoH: Forward xi]

8:20 Lecture: Pain Mechanism Classification System (PMCS) – Definitions, Research, & Clinical Practice Considerations [WoH: pg 19-23; 26-31; 35-38; 41-50; 52-55]

9:30 Interactive Workshop: Discussion how pain mechanism classification fits into your clinical practice? Role play foundational Pain Science Education topics.

9:45 Break

10:00 Lecture: Nerve Pain & Central Sensitization Subjective & Objective Characteristics [WoH: pg 106-115;119-122; 150-157; 188-194; 198-203]

11:00 Interactive Workshop: Paper Cases Classification Exercise

12:00 Lunch

1:00 Lecture: Neurodynamic Examination: Considerations & Clinical Patterns [WoH: pg 122-134; 102 - 103]

1:30 Interactive Workshop: Neurodynamic Tests: Lower, Upper and Spine [WoH: pg 158-166]

2:45 Break

3:00 Case Study: Video or Live Demonstration: PNPM 4:15 Debrief Day 1: Question / Answers – Open discussion

4:30 Adjourn

Day 2 (7.0 CEU’s)

7:30 Continental Breakfast

8:00 Interactive Workshop: Intervention: Trapped Nerve Spine - Directional Preference & Centralization Exercise

9:45 Break

10:00 Interactive Workshop: Intervention: Trapped Nerve Upper and Lower Body Entrapment Sites - Manual Therapy and Prescriptive Exercise [WoH: pg 130, 132-133]

12:00 Lunch

1:00 Lecture: Peripheral Neurogenic & Central Sensitization Intervention [WoH: pg 134-144; 185]

1:45 Interactive Workshop: Intervention: Neurodynamic Progressive Exercise

3:00 Break

3:15 Interactive Workshop: Intervention Pain Science Education [WoH: pg 206-208, 210-213 214- 215, 218]

4:00 Summary of Pain Mechanisms – Working Lamp Analogy: “5 Steps to a Pain Free Life”

4:15 Debrief Day 2: Question / Answers – Open discussion

4:30 Adjourn


Providence Northeast Rehabilitation

507 NE 47th Ave

Portland, OR 97213

World of Hurt: Peripheral Nerve


There is no pre-requisite for this course, but the World of Hurt overview course is recommended. 

Registration Information

Target Audience: This course will benefit Physical and Occupational Therapists, Chiropractors, Osteopaths, Physical Therapist Assistants, Occupational Therapy Assistants, Medical Doctors, Psychologists, Athletic Trainers, Massage Therapists, Personal Trainers and any other practitioners who are involved in treating musculoskeletal pain.  It is recommended participants be vaccinated for COVID when participating in continuing education courses. Masks will be required for the entirety of the course and additionally face shields will be required and provided during lab sessions. 

Registration Fee: The registration fee is $300 for Providence caregivers, $550 for all other registrants. A $25 early registration discount will be applied to all registration fees processed prior to August 27th, 2021.

The " a World of HURT: A Guide to Classifying Pain"  Book is recommended for this course.  If you need to purchase a book, please email Joanna.mullett@providence.org for information on how to purchase a book at the discounted price of $55.

There is not a pre-requisite for this course, but the World of Hurt Overview course is recommended prior to taking this course.

Refund Policy: Full refunds less a $25 administrative fee will be granted if cancellation is requested by September 3, 2021. No refunds will be made after that date unless the course is cancelled by Providence Rehabilitation Services, in which case full refunds will be issued.

Contact Hours: This course qualifies for 14.0 contact hours for Physical Therapists, Physical Therapy Assistants, Occupational Therapists, and Occupational Therapy Assistants in Oregon and Washington. Providence is also an approved provider for physical therapy continuing education in New York State. This course may be approved for other disciplines and states, please email rehab.courses@providence.org if you have questions regarding CEUs.