Emilio Louie Puentedura

Emilio Louie Puentedura
Baylor University | BU · Doctor of Physical Therapy Program

PT, DPT, PhD, OCS, FAAOMPT

About

120
Publications
152,516
Reads
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4,104
Citations
Introduction
After competing 10+ years at the University of Nevada Las Vegas, I am now a Clinical Professor in the new accelerated Doctor of Physical Therapy Program at Baylor University. I am board-certified Orthopaedic Clinical Specialist, Fellow in the American Academy of Orthopaedic and Manual Physical Therapists. Research agenda: investigating prescriptive and prognostic factors associated with a positive outcome with spinal manipulation, neurodynamics and pain neuroscience education (PNE).
Additional affiliations
October 2017 - present
Baylor University
Position
  • Professor
Description
  • Primary Faculty for Human Anatomy courses and Integrative Pain Sciences, and Secondary Faculty for Musculoskeletal Courses I and III for the lumbopelvic and cervicothoracic regions
June 2013 - present
Nova Southeastern University
Position
  • Professor (Associate)
July 2007 - December 2017
University of Nevada, Las Vegas
Position
  • Professor (Associate)
Education
May 2006 - December 2011
Nova Southeastern University
Field of study
  • Physical Theapy
January 2004 - December 2005
Northern Arizona University
Field of study
  • Musculoskeletal Physical Therapy
January 1983 - March 1984
La Trobe University
Field of study
  • Manipulative Therapy

Publications

Publications (120)
Article
Objective To investigate the effects of working from home on musculoskeletal pain. Methods An e-survey of computer workers was conducted. Multinomial logistic regression modelling examined relationships between work location (work or home office desk, dining table, other), sitting posture (diagrams with descriptors), depressive symptoms (CESD -10)...
Article
Full-text available
In musculoskeletal and sports medicine, pain has traditionally been linked to tissue injury, often assuming a linear correlation between tissue damage and pain intensity. However, modern pain science has illuminated the complexity of the human pain experience, incorporating psychosocial elements, nervous system sensitization, immune responses, and...
Article
Background: Previous qualitative research has listed trust as a component of the therapeutic alliance in physical therapy. Objective: Quantitatively correlate trust and therapeutic alliance in physical therapy care for patients with chronic low back pain. The secondary aim was to investigate the relation of trust and therapeutic alliance with ou...
Article
OBJECTIVE: To compare the short- and intermediate-term effects of dry needling to manual therapy on pain, disability, function, and patient-perceived improvement in patients with mechanical neck pain. DESIGN: A single (therapist) blinded randomized controlled trial. METHODS: Seventy-eight patients (mean ± SD age, 50.74 ± 13.81) were randomly assign...
Article
Introduction Uncertainty exists regarding the best method for teaching thrust joint manipulation (TJM) to student physical therapists. The purpose of this study was to compare the effectiveness of Peyton's 4-step (P4) approach with the “see one, do one” (S1D1) approach for teaching students to perform a lumbar spine TJM task in an academic setting....
Article
OBJECTIVE: To create a consensus-based framework of manual therapy treatment approaches for the major mechanisms-based pain classifications established by the International Association for the Study of Pain (IASP) nociceptive, nociplastic, and neuropathic pain. DESIGN: The hybridized consensus survey included experts who participated in working gro...
Article
Purpose: The purpose of this study was to deliver pain neuroscience education (PNE) to participants in grades 3 to 8 to determine whether participants in these grades had positive shifts in pain knowledge and beliefs. Methods: Three hundred twenty participants, grades 3 to 8, received a 1-time, 30-minute PNE lecture. The Neurophysiology of Pain...
Article
Objective: The goals of this study were to establish whether mechanical pressure pain, short-term memory recall of a painful stimulus, or long-term memory of a prior painful lower extremity injury alters isometric muscle strength and whether there was a difference in responses between participants with and without a previous history of injury. De...
Article
Introduction: Enhancing the therapeutic alliance has been associated with improved outcomes for patients with chronic low back pain (CLBP). Qualitatively trust has been described to be part of the therapeutic alliance, but it has not been measured quantitatively within the physical therapy literature. Objective: Examine the relationship between...
Article
Introduction Pain neuroscience education (PNE) and graded exposure have not been explored in occupational settings for low back pain (LBP). Aim To pilot feasibility and assess preliminary effectiveness of PNE and graded exposure for LBP. Methods A pilot study where workers were randomized to either PNE and graded exposure or Pilates and postural...
Article
Full-text available
Background and Objective High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surroun...
Article
Objective: To understand the flexible work practices during the COVID-19 pandemic and their impact on work-related musculoskeletal disorders (MSD) and depression in frequent computer users. Methods: An e-survey determined the extent of workplace changes and MSD, and the relationships between them using descriptive-statistics and Chi-square tests...
Article
Introduction: Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement...
Article
Full-text available
Objectives Research suggests that attendance by physical therapists at continuing education (CE) targeting the management of low back pain (LBP) and neck pain does not result in positive impacts on clinical outcomes. The aim of this study was to determine if therapists attending a self-paced 3-hour online Pain Neuroscience Education (PNE) program w...
Article
Full-text available
Purpose: Memory has been identified as an important protective feature to prevent future injury, but its role has yet to be ascertained. The current study aimed to determine whether there was a difference in pressure pain threshold (PPT) responses between participants with a prior history of injury of lower extremity injury (PSI) and those without...
Article
Chronic spinal pain poses complex challenges for healthcare around the world and is in need of effective interventions. Pain Neuroscience Education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions and expectations about pain. PNE has shown promise in small, controlled trials...
Article
Introduction Thrust Joint Manipulation (TJM) is a widely used intervention in spinal care, however there are differences in its use between countries and spinal regions. This survey analyzes the frequency of use of TJM, examines the thoughts about the effectiveness of, and the perceptions of Dutch certified manual therapists regarding safety, comfo...
Article
Background: The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to a growth in evidence supporting use in practice. Yet adverse events (AE) have been documented following TTJM. Knowledge of current practice is therefore required to support further research. Purpose: To investigate TTJM knowledge and pre-TTJM e...
Article
Background Individuals with subacromial pain present with a variety of contributing impairments related to the movement problem. The scapular assistance test (SAT) and scapula reposition test (SRT) are proposed to identify shoulder pain related to abnormal scapular movement or position. It remains unknown if scapular movement related impairments ar...
Article
Objective To investigate the immediate changes in resting and contracted thickness of the transversus abdominis (TrA) muscle after application of thrust joint manipulation (TJM) vs sham manipulation in participants with low back pain. Methods A pretest–posttest randomized controlled trial design was performed. Consecutive subjects satisfying eligi...
Article
Full-text available
Chronic pain and the opioid epidemic need early, upstream interventions to aim at meaningful downstream behavioral changes. A recent pain neuroscience education (PNE) program was developed and tested for middle-school students to increase pain knowledge and promote healthier beliefs regarding pain. In this study, 668 seventh-grade middle-school stu...
Article
Full-text available
We describe the case of a 75-year-old female with chronic low back pain (CLBP), on opioids for more than 15 years. She presented with an acute episode of nausea, vomiting, abdominal pain, and shortness of breath. After a complete work-up, it was concluded that her presenting symptoms were likely due to her high levels of CLBP and high dose opioids....
Book
The modern clinician faces more challenges than ever before, including a worldwide pain epidemic and skepticism among critics about the efficacy of hands-on treatment. This book, written by four renowned physical therapists and pain neuroscientists, provides techniques that combine manual therapy and pain neuroscience to help practitioners meet the...
Article
Study design: Randomized clinical trial. Objectives: To determine the immediate and short-term effects of cervical spine high velocity low amplitude thrust (HVLAT) added to behavioral education, soft tissue mobilization, and a home exercise program (HEP) on reducing pain and dysfunction in individuals with a primary complaint of temporomandibula...
Article
Full-text available
Background: The use of pain neuroscience education (PNE) has been shown to be effective in reducing pain, improving function and lowering fear and catastrophisation. Pain neuroscience education utilises various stories and metaphors to help patients reconceptualise their pain experience. To date no individualised study has looked at which stories a...
Article
Objective: The aim of this study was to determine if a preoperative pain neuroscience education program would result in superior outcomes compared to usual preoperative education for total knee arthroplasty. Design: Controlled clinical trial with alternating allocation. Setting: Community-based hospital. Subjects: Consecutive sample of 120 p...
Article
Full-text available
Study Design: A prospective, single-arm, pre-postintervention study. Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP). Background: PNE has been shown to be an effective intervention for the treatment...
Article
Full-text available
Background: Subacromial pain syndrome (SPS) accounts for as much as 44% of shoulder pain encountered by physical therapists. Thoracic spine thrust manipulation (TSTM) is effective in the short term for improving pain and function in individuals with SPS, but its mechanisms remain elusive. Furthermore, it is unknown whether individuals with SPS res...
Article
When dealing with chronic pain, it is often not possible for clinicians to provide adequate answers to their patients about what might be wrong, and why they continue to have their pain. This has led to greater use of diagnostic “labels” for conditions such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, chronic Lyme disease, a...
Article
Full-text available
[Purpose] To establish a standardized sonographic approach to quantify anterior translation of the mandibular condyle during mouth opening by examining the reliability of image acquisition and processing, and to understand how anterior condylar translation contributes to mouth opening. [Participants and Methods] Twenty-eight participants without te...
Article
Full-text available
ABSTRACT Objectives: The perceived relative safety of thoracic thrust joint manipulation (TTJM) has contributed to evidence supporting its use. Yet, TTJM is not without risk, where transient side effects (SE) and severe adverse events (AE) have been documented. With evidence supporting the importance of prethrust examination in reducing AE in other...
Article
Background: Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspec...
Book
Evidence shows that patients who better understand their pain, and what pain truly is, experience less pain, have less fear, move better, exercise more and can regain hope. Pain Neuroscience Education is written by clinicians for clinicians, with all information presented in a way that is relevant and readily applicable to “real-world” clinical se...
Chapter
Comorbidities associated with orofacial pain There is evidence demonstrating that the presentation of chronic pain conditions such as low back pain, headache, and orofacial pain share common charac- teristics (De Leeuw & Klasser, 2013). Pain localization in these conditions often exhibits spreading pain into other areas. Orofacial pain has clear co...
Article
Full-text available
Study Design Case report. Background Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with centr...
Article
Full-text available
Pain neuroscience education (PNE) has gained considerable attention in research. Three systematic reviews have shown increasing efficacy of PNE decreasing pain, disability, pain catastrophization, movement restrictions, and healthcare utilization. In the development of any new therapeutic approach, it is proposed that there are three stages: develo...
Article
Full-text available
Objective The purpose of this study was to investigate changes in resting and/or contraction thickness of the transversus abdominis (TrA) muscle after dry needling (DN) of the lumbar multifidus (LM) in asymptomatic participants. Methods A randomized controlled laboratory trial with crossover design was performed. Forty-seven healthy individuals wh...
Article
Full-text available
Objective: To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear-avoidance and pain catastrophization in patients with shoulder pain. Design: Single-blind case series SETTING: Three outpatient physical therapy clinics PARTICIPANTS: Patients wi...
Article
Pain neuroscience education (PNE) is an educational strategy aimed at teaching people more about pain from a neurobiological and neurophysiological perspective. Current best-evidence provides strong support for PNE to positively influence pain ratings, dysfunctions, fear-avoidance and pain catastrophization, limitations in movement, pain knowledge,...
Article
Full-text available
Introduction: Myofascial pain is a common impairment treated with various manual interventions including spinal thrust manipulation and stretching; however, the comparative efficacy of each intervention is uncertain. Therefore, the purpose of this investigation was to evaluate thrust manipulation targeting the cervicothoracic junction compared to...
Article
Full-text available
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about th...
Article
Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk for adverse events. It would be valuable if patients at risk could be identified by specific characterist...
Article
Full-text available
Background: Results from a previous multicenter randomized controlled trial (RCT) on preoperative pain neuroscience education (PNE) for lumbar radiculopathy found no significant difference in patient reported outcomes between groups. However, patients who received PNE viewed their surgical experience more favorably and utilized significantly less h...
Article
Full-text available
Purpose: To determine the referral patterns, utilization and indications for postoperative physical therapy (PT) for lumbar radiculopathy. At least 50 % of patients following lumbar surgery (LS) for radiculopathy are referred for PT to address postoperative pain and disability. Very little is known regarding factors following LS that predict refer...
Article
Full-text available
Pain Neuroscience Education (PNE) has been shown to increase patient and healthcare provider knowledge of pain. To date, however, no study has examined if that knowledge is maintained over time. Patients suffering from chronic pain were invited to attend a free PNE lecture. Patients were required to complete intake demographics followed by two self...
Article
Objective To evaluate the evidence for the effectiveness of sham surgery in orthopedics by conducting a systematic review of literature. Methods Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect and Web of...
Article
Full-text available
Teaching people with chronic low back pain (CLBP) about the neurobiology and neurophysiology of their pain is referred to as pain neuroscience education (PNE). There is growing evidence that when PNE is provided to patients with chronic musculoskeletal pain, it can result in decreased pain, pain catastrophization, disability, and improved physical...
Article
Full-text available
Objective: Systematic review of randomized control trials (RCTs) for the effectiveness of pain neuroscience education (PNE) on pain, function, disability, psychosocial factors, movement, and healthcare utilization in individuals with chronic musculoskeletal (MSK) pain. Data sources: Systematic searches were conducted on 11 databases. Secondary s...
Article
Study design: Online survey study. Objective: To determine physical therapists' utilization of thrust joint manipulation (TJM) and their comfort level in using TJM between the cervical, thoracic, and lumbar regions of the spine. We hypothesized that physical therapists who use TJM would report regular use and comfort providing it to the thoracic...
Article
Full-text available
Chronic pain is incredibly complex, and so are decisions as to its treatment. During physical therapy care, pain neuroscience education (PNE) aims to help patients understand more about their pain from a biological and physiological perspective. Accompanying the growing evidence for the ability of PNE to reduce pain and disability in patients with...
Article
Full-text available
Objective: To determine if a 3-hour therapeutic neuroscience education session alters physical therapy student's knowledge of pain and effects their attitudes and beliefs regarding treating chronic pain. Methods: Seventy-seven entry-level doctoral physical therapy students participated in the study. Following consent, demographic data were obtai...
Article
Full-text available
Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single sour...
Article
Full-text available
Representational body maps are dynamically maintained in the brain and negatively influenced by neglect, decreased movement and pain. Graded motor imagery (GMI) utilizing various tactile and cognitive processes have shown efficacy in decreasing pain, disability and movement restrictions in musculoskeletal pain. Limited information is known about th...
Article
Full-text available
There appears to be very little in the research literature on the safety of thrust joint manipulation (TJM) when applied to the thoracic spine. To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AE) after receiving TJM to their thoracic spine. Case report...
Article
Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. A case series of 10 patients (female = 7) received pre...