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Retraining the brain and returning to work and health with IPAR

IPAR’s Rehabilitation Consultants play a vital role in supporting clients on their unique recovery journey following a workplace injury. A key part of this is integrating pain education and coaching into their services and empowering people with pain to return to work, health and daily life.

The below case study is an example of a good outcome achieved using an individualised pain coaching approach, including collaboration between the IPAR Rehabilitation Consultant, the client, and their treating Physiotherapist.

Sandra’s story

Sandra* sustained a lower back injury when she picked up a child during her role as an early childhood educator. Immediately following her injury, she was referred for an MRI in the absence of any neurological signs or symptoms, which demonstrated a mild lumbar disc prolapse. Sandra was subsequently provided with analgesia from her General Practitioner, certified to have no capacity for work and was issued a referral for Physiotherapy which she did not commence until nine weeks following her injury.

Sandra had been off work for 10 weeks and had only recently returned to work for four hours per week performing light administrative duties when she was referred to IPAR Rehabilitation.

At the time of referral, Sandra had developed significant unhelpful beliefs regarding her lower back. She believed that she would be unable to return to her pre-injury duties, demonstrated pain catastrophisation and fear of movement (especially flexion) as well as significant deconditioning. Sandra also experienced several aggravations of her symptoms in the early stages of her Physiotherapy when provided exercises and a walking program to complete at home.

Through the utilisation of IPAR’s Positivum™ Assessment (biopsychosocial screening tool) at the time of referral, the Rehabilitation Consultant identified unique recovery barriers including:

  • Low pain management

  • Low coping skills

  • Low self-confidence

  • Low health beliefs and recovery expectations

Retraining the brain

IPAR’s service commenced with a collaborative case conference with Sandra and her treating Physiotherapist to share the results from the Positivum™ Assessment. Together, they reviewed her current treatment plan and developed a recovery plan. They explored her understanding of her injury and completed an introduction to the simple pain resource available via YouTube: Understanding pain in under 5 minutes.

The recovery plan included eight weeks of pain and health coaching with the IPAR Rehabilitation Consultant and twice weekly Physiotherapy. Throughout this eight-week block, each coaching session with the IPAR Rehabilitation Consultant was concluded with Sandra writing down key take away messages and questions which were subsequently shared with her treating Physiotherapist.

Weeks one to two focused on the objective of increasing Sandra’s understanding of pain; specifically, that pain does not equal harm. These sessions included further exploration of Understanding pain in under 5 minutes and other resources such as the clip Why thing’s hurt. Sandra was also provided a podcast to listen to as homework on her days off, which explored 10 lower back pain facts and myths.

Week three to six focused on exploring the influence that thoughts, emotions and experiences have on pain. Sandra was introduced to the Explain Pain – Protectometer where Sandra mapped out her DIMs (Dangers in Me) and SIMs (Safety in Me) which was subsequently shared with her Physiotherapist.

The final two weeks explored the unique ability of the brain to be retrained and focused on proactive strategies Sandra can apply at work and home to improve her function and pain. Sandra consolidated her knowledge of the Protectometer and how to turn down her overprotection system.

Returning to work and daily life

Throughout the recovery plan Sandra was able to successfully graduate her treatment program from passive to active. She re-commenced previously feared movements including bending, twisting and lifting. Sandra also established and progressed a self-directed walking and exercise program with her family.

Sandra has since returned to modified classroom duties including bending and is continuing to work on increasing her physical capacity further to return to independent teaching. The Positivum™ Assessment was

re-administered following the health coaching program, and the resulting scores demonstrated a significant improvement in pain management, self-efficacy, coping skills and recovery expectations. It must be noted that Sandra’s progress was not linear and involved a few flare ups and setbacks along the way. However, Sandra was able to successful apply new skills learnt to manage these flare ups and continue to progress her return to work.

The IPAR Rehabilitation Consultant summarised the key contributors to the success of Sandra’s recovery plan:

  1. Consistent messaging and collaboration between the IPAR Rehabilitation Consultant and treating Physiotherapist.

  2. A treating practitioner (Physiotherapist) with a pro-occupational focus. Despite flare ups and setbacks, Sandra was encouraged by her Physiotherapist to remain at work with modifications.

  3. The importance of reflecting on the client’s understanding and documenting key take away messages at the end of each session.

  4. The use of simple pain education resources and tools including YouTube clips and Podcasts.

  5. The focus on harnessing Sandra’s SIMs (Safety In Me) to support her recovery and return to work journey.

The combination of the above points with the use of modern pain education to address individual barriers helped achieve a positive return to work outcome for Sandra.

If you would like to learn more about how IPAR Rehabilitation implements contemporary pain education to support clients return to work and health after injury, please reach out to Aaron Bowes on

*Name changed for privacy

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