Body Image, Midline & Central Pain Presentations: Evidence Based Diagnosis & Rehabilitation

Body Schema, Midline & Central Pain Presentations:

Sensory motor & Primitive Reflex Development

Course Description

It is now clear that our virtual brain and body schema are involved in pain states. In some cases they can be a primary cause of the pain state. The brain needs to know what is happening in the body. It gets this information from sensory feedback. When this information is deficient the brain will change its behaviour to get this information. When it is absent or significantly inaccurate musculoskeletal symptoms can result.

We will cover how to assess for a disrupted body schema using a battery of tests. Evidence based treatments will be covered in detail. These involve specific sensory training and the neurodevelopmental process whereby we learn how our body schema. This is through the primitive reflexes that guide our movement and the sensory systems that are used during this process.

We will also cover an easy to use and highly accurate clinical prediction rule for the diagnosis of central sensitization. This was researched by using rate controlled thermal and pressure pain thresholds in six quadrants. These were compared to thirty-six variable (clinical assessment and self report measures) to develop the model. The understanding of the relationship between neurocognitive function, sensory motor function and neuroplasticity has created a number of evidence based rehabilitation strategies for central sensitization.

You will leave with a clear understanding of when to apply the clinical prediction rule, and assessment strategies for altered body schema, along with the appropriate subjective history, physical examination and outcome measures to use. You will be able to develop a rehabilitation program for clients with altered body schema and / or central sensitization and have appropriate progressions and problem solving strategies.

Why do people have whole limb pain or paresthesia? Get all their symptoms on one side of their bodies? Feel swelling when there isn’t any? Have one sided fatigue, heaviness or other bizarre musculoskeletal-like complaints?

There is growing evidence of an altered body schema. Unilateral neglect in stroke, phantom limb pain and Complex regional Pain Syndrome and dystonia are all likely versions of this.

Course Objectives:

  • Understand altered body schema, central sensitization and their role in pain states
  • Use a clinical prediction rule of self report and physical examination items to diagnose central sensitization
  • Be able to assess for altered body schema
  • Appreciate the role of the sensory system and the developmental process in body schema and pain
  • Develop a rehabilitation program for body schema disorders and central sensitization with appropriate starting points and progressions

What will you get from this course that you may not already have?

Body Schema
We will show you how to assess for body schema disorders and rehabilitation strategies which can be applied to a wide range of other conditions and clinical presentations. 

Clinical Prediction Rule for Diagnosis of Central Sensitization
Our evidence based clinical prediction rule will allow you to make a diagnosis of central sensitization with confidence.

Rehabilitation of Central Sensitization
We will provide you with new evidence based treatments. The understanding of the relationship between neurocognitive function, sensory motor function and neuroplasticity has created a number of rehabilitation strategies for central sensitization. 

Outcome and Timeframes
You will understand normal timeframes and how long it takes the central nervous system to change

Program & Pre-course Reading


Suggested pre-course reading
Revision of the Sub-classification course (if taken)

Acerra NE et al 2007 Stroke, complex regional pain syndrome and phantom limb pain: Can commonalities direct future management? J Rehabil Med 39: 109–114

Flor H et al 2001 Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. The Lancet. 357: 1763-1764

Gallace A, Torta DME, Moseley GL, Iannetti GD 2011 The analgesic effect of crossing the arms. Pain. In Press

Gibbons SGT 2011 Neurocognitive and sensorimotor deficits represent an important sub-classification for musculoskeletal disorders – Central Nervous System Coordination. Icelandic Physical Therapy Journal. 10-12
Available at

Grant M and Threlfo C 2002 EMDR in the Treatment of Chronic Pain. J Clin Psychol 58: 1505–1520

McCabe CS et al 2005 Simulating sensory–motor incongruence in healthy volunteers: implications for a cortical model of pain. Rheumatology. 44:509–516

Moseley GL, Zalucki NM, Wiech K 2008 Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. Pain. 137: 600–608

Norton JA et al 2008 Persistent mirror movements for over sixty years: The underlying mechanisms. Clinical Neurophysiology. 119: 80–87

Schneider J, Hofmann A, Rost C, Shapiro F 2008 EMDR in the Treatment of Chronic Phantom Limb Pain. Pain Medicine. 9: 76-82

Smart KM, Blake C, Staines A, Doody C 2010 Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinician. Manual Therapy. 15: 80-87

Nijs J, Van Houdenhove B, Oostendorp RAB 2010 Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. Manual Therapy. 15:135-141

Wand BM, O’Connell NE, Di Pietro F, Bulsara M 2011 Managing chronic nonspecific low back pain with a sensorimotor retraining approach: exploratory multiple baseline study of 3 participants. Phys Ther. 91:535–546

Woolf CJ 2011 Central sensitization: Implications for the diagnosis and treatment of pain. Pain. In Press

Free articles available at:

Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity
Alban Latremoliere and Clifford J. Woolf
J Pain. Author manuscript; available in PMC 2010 September 1.
PMCID: PMC2750819
Published in final edited form as: J Pain. 2009 September; 10(9): 895–926. doi: 10.1016/j.jpain.2009.06.012.

Chronic non-specific low back pain – sub-groups or a single mechanism?
Benedict Martin Wand and Neil Edward O'Connell
BMC Musculoskelet Disord. 2008; 9: 11. Published online 2008 January 25. doi: 10.1186/1471-2474-9-11.
PMCID: PMC2266926

EMDR Effects on Pursuit Eye Movements
Zoi Kapoula, Qing Yang, Audrey Bonnet, Pauline Bourtoire, and Jean Sandretto
PLoS One. 2010; 5(5): e10762. Published online 2010 May 21. doi: 10.1371/journal.pone.0010762.
PMCID: PMC2874012

Treatment of chronic phantom limb pain using a trauma-focused psychological approach
C de Roos, AC Veenstra, Prof A de Jongh, ME den Hollander-Gijsman, NJA van der Wee, Prof FG Zitman, and YR van Rood
Pain Res Manag. 2010 Mar–Apr; 15(2): 65–71.
PMCID: PMC2886995

From Maps to Form to Space: Touch and the Body Schema
Jared Medina and H. Branch Coslett
Neuropsychologia. Author manuscript; available in PMC 2011 February 1.
PMCID: PMC2813960

Multisensory interactions follow the hands across the midline: Evidence from a non-spatial visual-tactile congruency task
Nicholas P. Holmes, Daniel Sanabria, Charles Spence, and Gemma A. Calvert
Brain Res. Author manuscript; available in PMC 2006 June 22.
PMCID: PMC1482253

DeSantana JM and Sluka KA 2008 Central Mechanisms in the Maintenance of Chronic Widespread Noninflammatory Muscle Pain. Curr Pain Headache Rep. 12(5): 338–343.

Meeus M and Nijs J 2007 Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol. 2007 April; 26(4): 465–473.

Roland Staud 2009 Abnormal Pain Modulation in Patients with Spatially Distributed Chronic Pain: Fibromyalgia. Rheum Dis Clin North Am. 35(2): 263–274.


Day 1
8:30 – 9:00 Overview of motor system changes with chronic pain & Sub-classification
9:00 – 10:00 Pain Mechanisms & Central Sensitization
10:00 – 10:30 Neurocognitive function, sensory motor function, neuroplasticity and relationship to central sensitization
10:30 – 10:45 Break
10:30 – 10:45 Development & clinical use of the Motor Control Abilities Questionnaire
11:00 – 12:00 Clinical Prediction Rule for Central Sensitization
12:00 – 1:00 Lunch
1:00 – 1:30 Fundamentals of exercise prescription
1:30 – 2:00 Graded Activity, Graded Exercise Therapy & Graded Exposure
2:00 – 3:15 Cognitive Behavioural Therapy: Principals
3:15 – 3:30 Break
3:30 – 4:30 Midline training
Day 2
8:30 – 9:30 Educational Strategies
9:30 – 10:00 Aerobic exercise & Functional Strengthening
10:00 – 10:15 Break
10:15 – 12:00 Sensory training
12:00 – 1:00 Lunch
1:00 – 2:00 Respiratory function & Breathing Retraining
2:00 – 3:00 Motor imagery, Mirror box, virtual reality
3:00 – 3:15 Break
3:15 – 3:30 Computer based training, EEG
3:30 – 4:00 Multidisciplinary team & communication


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