A World of HURT: Peripheral Neurogenic Pain - Neural Entrapment to Neural Dysfunction Exercise Prescriptions

Course Description:

This course can be attended virtually or in-person.

This two-day course focuses information critical to the assessment and treatment of patients dominated by Nociceptive Pain Mechanisms involving the peripheral nerve. The Peripheral Neurogenic Pain Mechanism (PNPM) requires specific neurodynamic mechanical exercise prescriptions as well as pain neuro-immune science education about peripheral nerves and the pain alarm system. Outlining Chapter Five and Six of “A World of Hurt: A Guide to Classifying Pain,” pain clinicians will learn how to assess and classify neurogenic nociceptive pain mechanisms as either “trapped,” “tight,” or “sensitive” utilizing neurodynamic evaluation testing and clinical reasoning. This course assists identifying neural entrapments, dysfunctions and/or the beginning signs of central sensitivity in both the upper, lower body and spine. This pain neuro-immune science course provides interventions in patient education for neurogenic conditions and specific prescriptive neurodynamic exercises for each neurogenic mechanical problem. This course includes active manual therapy workshops for common cervical, thoracic, and lumbar spine directional preference and upper and lower body neural soft tissue entrapment site treatments. In addition, a workshop dedicated to both active neurodynamic exercise progression and passive neurodynamic testing and mobilization. Video, paper cases and live patient demonstrations (when available) will aid application to each clinician’s practice by understanding the importance of the specific “words” and “moves” necessary to reverse neurogenic mechanical nociceptive pain mechanisms.

Learning Objectives:

At the end of this course participants will be able to:

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

2. Differentiate subjective and objective characteristics for mechanical syndromes of the nervous system involving 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.

Agenda:  All course times are Pacific Standard Time.

Saturday October 11, 2025

7:30-8:00 Registration

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

8:15 Lecture: Pain Mechanism Classification System (PMCS) – Definitions, Research, & Clinical

Practice Considerations [WoH: pg 19-23; 26-31; 35-38; 41-50; 52-55]

9:15 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 (on your own)

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

Sunday October 12, 2025

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 (on your own)

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

Speakers:

Annie O’Connor, PT, 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 clinical practice. In addition, she is Clinical Account Director for Carelon Medical Benefits Management associated with Elevance Health Back and Joint Pain Program. 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 coauthored 2021 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 is the publisher and co-author of 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 research supported “paradigm shift” in treating 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 framework for musculoskeletal pain and neurological spasticity at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago for 35 years. 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.

Melissa Watson, MSPT, Cert. MDT received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan AbilityLab formerly known as the Rehabilitation Institute of Chicago Burr Ridge Outpatient & DayRehab Center with 21 years of clinical experience in neurological rehabilitation. Melissa is a Senior II Physical Therapist and certified clinical instructor 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 pain and spasticity. She is practicing clinically in the Day Rehabilitation setting with a research interest in 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 leads other Day Rehab clinicians on a pain science education group that is focused on pain science education and active care treatment for patients with centrally dominated pain throughout multiple sites of care. She is certified in Mechanical Diagnosis and Treatment – McKenzie Method. She is an assistant instructor of the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” and uses both subgrouping methods in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.

Registration information:

Registration is on a first-come, first-served basis.  Discounted rates for students and to audit/re-take the class.

Registration Fee: The registration fee is as follows: 

In-Person: $250 for students and re-takes, $450 for Providence employees, $600 for all other participants. A $25 early bird discount is available to participants who register prior to September 19, 2025.  Registration fees cover light continental breakfast, electronic certificate of attendance and electronic course handout. 

Virtual: $200 for students and re-takes, $425 for Providence employees, $550 for all other participants.  A $25 early bird discount is available to participants who register prior to September 19, 2025.  Virtual participants are required to be on camera during lab activities so that instructors can view their technique.  It is recommended that virtual participants have a partner they can practice the hands on techniques with during the class.   This can be another course participant, friend or family.

Registration fees cover electronic course handout, electronic certificate of attendance and link for virtual attendance.

Refund Policy: Full refunds less a $50 administrative fee will be granted if cancellation is requested by September 27, 2025. 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, Occupational Therapy Assistants, Speech Language Pathologists and Speech Language Pathology Assistants in Oregon, and Washington. Continuing education credit in additional states may be available.  Please email joanna.mullett@providence.org to determine if continuing educations credits can be submitted for your state.  Certificates of attendance will be issued to all participants completing the CEU requirements.

Lodging:

The Hilton Garden Inn near the course site is offering a discounted rate for course participants.  Reserve your room using this link:

Room Reservations