#PTonICE Podcast Episode 1979 - Reframing Rehab for Persistent Pain: Part 2
Jan 21, 2026
Dr. Justin Dunaway, a leading physical therapist and Total Spine division leader, shares his expertise on persistent pain management. He critiques the limitations of standard exercise protocols and highlights the need for customized interventions. Justin emphasizes the importance of balancing nervous system and tissue capacities to optimize rehabilitation. He discusses how clinician beliefs can influence patient outcomes and stresses the value of delivering early, reassuring narratives to combat fear and promote healing. Insights from his pain education course offer transformative strategies for patient care.
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Exercise Research Often Misses The Point
- Exercise isn't the problem in persistent pain; how we dose and research it is the issue.
- Standardized, low-dosage protocols often ignore intended stimulus and dosage specificity needed for effect.
Dose Nervous System Capacity Too
- Clinicians often fear provoking a flare and under-dose activity for persistent pain patients.
- We dose for tissue capacity but rarely for nervous system capacity, which limits progress.
Treat All Four Domains Early
- Include interventions across nervous system, tissue, cognition, and function from session one.
- Shift emphasis as nervous system capacity improves to address deconditioning and tissue capacity.