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  • Lian Yun-Perng, Physiotherapist

Top Down or Bottom Up Approach?

​Most of what we do in musculoskeletal rehabilitation involves the bottom up approach. What exactly is the bottom up approach? In my own terms, it is an approach that involves treating the peripheries to influence the CNS. For example, using STM, U/S or IFT to reduce pain or tone. On the other hand, the top down approach utilises the central nervous system to influence pain or tone. This approach is particularly effective for people with chronic pain. People with chronic pain can develop central sensitisation in which pain is only present in the CNS due to ? fear or brain adaptation. Therapeutic neuroscience education/ pain science education is an important tool to have as it is the only top down approach available freely. So which is more effective? Both approaches complement each other. Just as different keys fit different locks, the same goes to our treatment. When I treat a client that is full of fear that his/her body is tearing apart, I would first assure them that what they have heard from the Doctor or seen on the scan isn’t really that bad (Unless it is really that bad). So, my first treatment is just listening, re-assuring and some pain-ed! Next, I would calm their nerves down, eg. U/S, IFT, STM or repeated joint motions. Thanks for reading and stay tuned for more!

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Lian Yun-Perng  

UK Qualified Physiotherapist
Bachelor of Physiotherapy

Keele University, United Kingdom
Diploma in Physiotherapy

AIMST University, Malaysia

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