Toronto, September 26, 8-5 pm

1 Why Attend This Workshop?

Chronic musculoskeletal pain is among the most common presentations across clinical practice and one of the most common clinical conditions treated daily by kinesiologists, massage therapists, osteopaths, naturopaths, chiropractors, physicians, physiotherapists, dentists among others including students of this professions. Despite its prevalence, there are still many clinical observations that are not adequately explained using basic first principles of pain and neuromuscular physiology. Furthermore, current diagnostic and management strategies typically focus on addressing peripheral structural pathology, leaving clinicians without a mechanism-based rationale for many of the findings they observe and treat.

This workshop closes that gap. Drawing on the latest translational research in pain neuroscience, we present a contemporary neurophysiologic framework, grounded in first principles of neurobiology, that provides empirical evidence for these enigmatic clinical observations and, critically, translates this emerging science directly into practical diagnostic and therapeutic strategies you can apply in your practice immediately.

2 What Makes This Workshop Different?

This workshop synthesizes emerging basic science and clinical research to deliver a paradigm shift in how clinicians can understand, assess, and manage chronic musculoskeletal pain.

A coherent neurophysiologic framework that resolves clinical observations conventional models cannot explain
Direct translation of emerging research into practical, mechanism-based diagnostic and treatment strategies
Hands-on instruction in assessment techniques, including Quantitative Sensory Testing and segmental sensitization profiling, that can be incorporated into clinical practice immediately
Evidence-informed therapeutic approaches that target the underlying neurobiology, not just the symptomatic presentation

3 Foundations: The Neurobiology of Musculoskeletal Pain

A concise, clinically oriented overview of the fundamental neurobiology governing musculoskeletal pain. This section establishes the scientific foundation for the clinical framework developed throughout the workshop.

3.1.1 Key Topics

The unique neurobiology of muscle nociception and pain transduction
Peripheral and central sensitization: mechanisms and clinical significance
The integral role of viscerosomatic interactions in clinical presentation
Neurogenic inflammation and its emerging role in chronic pain states
Mechanisms of primary versus secondary hyperalgesia and how they manifest clinically
The dynamic interplay between muscle nociceptors, endogenous biochemicals, and the central nervous system

4 The Clinical Problem: Unresolved Observations and the Limits of Current Models

Clinicians regularly encounter findings in chronic musculoskeletal pain patients that do not fit within existing theoretical frameworks. This section identifies these common yet unexplained observations and critically examines where current models fall short, framing the clinical problem that the emerging science aims to resolve.

4.1.1 Key Topics

Clinical phenomena unexplained by conventional peripheral-structural models: widespread tenderness, remote (secondary) hyperalgesia, persistent myofascial trigger points (MTrPs)
Qualitative differences between true myofascial pain and musculoskeletal pain presentations.
The myofascial trigger point debate: primary pathology or secondary manifestation?
Limitations of the Integrated Hypothesis and prevailing conceptual frameworks
The clinical need for a diagnostic paradigm that reconciles observation with neurophysiologic principles

5 Emerging Science: Central Sensitization and Neurogenic Inflammation

The emerging translational research offers biologically plausible rationale for these clinical observations commonly observed in daily routine practice. This section presents the emerging science on the pathogenesis and pathophysiology of chronic musculoskeletal pain, with direct implications for clinical reasoning and decision-making.

5.1.1 Key Topics

The Neurogenic Hypothesis: a contemporary framework linking central sensitization and neurogenic inflammation to myofascial trigger point formation and clinical findings
The role of persistent nociceptive bombardment, wide dynamic range neurons, and dysfunctional descending pain modulation in the clinical manifestations of chronic myofascial pain
Translational evidence from animal models and human experimental studies
Segmental sensitization and somatovisceral interactions: explaining referred pain and allodynia

6 From Science to Clinic: Mechanism-Based Assessment and Diagnosis

Translating emerging science into practical clinical tools is a primary objective of this workshop. This section equips attendees with mechanism-based assessment strategies that can be incorporated into routine clinical examinations to identify and quantify central sensitization in their patients.

6.1.1 Key Topics

A mechanism-based diagnostic approach grounded in neurophysiologic first principles
Quantitative Sensory Testing (QST): clinical assessment of allodynia, hyperalgesia, temporal summation, and wind-up
Physical examination techniques for spinal segmental sensitization across dermatomes, myotomes, and sclerotomes
Practical application and interpretation of brush allodynia, algometry, mechanical pain thresholds, and wind-up ratio
Diagnostic ultrasound: visualization of myofascial trigger points, elastography, and local blood flow assessment

7 Therapeutic Interventions: Targeting the Underlying Neurobiology

Effective treatment requires specifically targeting the mechanisms driving the clinical presentation, not merely the symptoms. This section presents evidence-informed therapeutic interventions grounded in the neurophysiologic framework developed throughout the workshop, with emphasis on practical techniques for immediate clinical application.

7.1.1 Key Topics

Designing treatment strategies that target central sensitization and neurogenic inflammation
Dry needling: peripheral and paraspinal techniques for segmental desensitization
Manual therapy, spinal manipulation, and trigger point release within a neurophysiologic framework
Electrical stimulation and therapeutic ultrasound as neuromodulatory interventions
Integrating mechanism-based strategies into a cohesive clinical management paradigm

8 Learning Objectives

By the end of this workshop, participants will be able to:

Explain the core neurobiology of muscle pain, including the dynamic interplay of nociceptors, endogenous biochemicals, peripheral and central sensitization, and neurogenic inflammation, and articulate why myofascial trigger points may represent a secondary effect (secondary hyperalgesia) rather than a cause (primary hyperalgesia) in chronic musculoskeletal pain.
Recognize clinical patterns mediated by central sensitization and neurogenic inflammation, including persistent nociceptive bombardment, wide-dynamic-range neuron wind-up, limbic involvement, dysfunctional descending inhibition, and somatovisceral referral, that current local-tissue models fail to explain.
Apply emerging translational research from animal and clinical studies to resolve previously enigmatic presentations of chronic myofascial pain, including segmental sensitization linked to remote spinal or visceral pathologic sources.
Perform objective, quantifiable assessments of central sensitization and spinal segmental sensitization using Quantitative Sensory Testing (QST) (brush allodynia, algometry, mechanical pain thresholds, wind-up ratio using weighted pinprick technique).
Design mechanism-based treatment plans targeting underlying neurophysiology, including peripheral and paraspinal dry needling, manual manipulation, trigger-point release, electrical stimulation, and therapeutic ultrasound, selected to desensitize involved segments, resolve chronic MTrPs, and interrupt neurogenic inflammation.
Integrate these concepts into daily clinical practice strategy through case-based discussion, developing contemporary neurophysiologic protocols that improve patient outcomes, support evidence-based documentation, and differentiate your clinical approach.

9 Who Should Attend

This workshop is designed for kinesiologists, massage therapists, osteopaths, naturopaths, chiropractors, physicians, physiotherapists, dentists, and other healthcare professionals / students who manage patients with chronic musculoskeletal pain and are seeking a deeper understanding of the neuroscience driving clinical presentation. Whether you are looking to refine your diagnostic approach, expand your therapeutic toolkit, or integrate the latest translational research into your practice, this workshop will deliver practical, actionable knowledge you can apply Monday morning in your practice.

Research Biography: Dr. John Z. Srbely

Dr. John Z. Srbely, HonBSc, DC, PhD, is an associate professor in the Department of Human Health Sciences within the College of Biological Science at the University of Guelph. He completed an Honours Bachelor of Science in Biochemistry at Laurentian University, graduated as a Doctor of Chiropractic from the Canadian Memorial Chiropractic College in 1992, and earned his PhD in biomechanics and neurophysiology from the University of Guelph in 2008. He also completed certification in clinical acupuncture in 2000.

Dr. Srbely’s research examines the neurophysiological and biomechanical mechanisms underlying chronic musculoskeletal pain. His work focuses particularly on myofascial pain, myofascial trigger points, osteoarthritis, fibromyalgia, degenerative spinal and joint disorders, central sensitization and neurogenic inflammation. Drawing on his extensive clinical experience as a chiropractor and acupuncturist, he combines basic and clinical research using both human and animal models.

A central objective of his research is to better understand whether myofascial trigger points are primary muscle injuries or secondary responses to changes within the nervous system. His research has contributed to the development of the neurogenic hypothesis of myofascial pain, which proposes that chronic joint or spinal pathology can produce neurologically mediated inflammation and sensitivity in connected muscles. This work may help improve the assessment and treatment of patients experiencing chronic back, neck, joint and myofascial pain.

Dr. Srbely’s laboratory also investigates diagnostic and assessment methods involving imaging, biological markers, quantitative sensory testing and electromyography. His therapeutic research has examined interventions such as dry needling, acupuncture, therapeutic ultrasound, manual therapy and spinal manipulation. From 2008 to 2013, he held a Canadian Chiropractic Research Foundation research position in spine mechanics and neurophysiology. He has also directed the University of Guelph’s Neuromuscular Health and Chronic Pain clinical-research facility

Dr. Jay P. Shah

Dr. Jay P. Shah, MD, is a physician specializing in physical medicine and rehabilitation, also known as a physiatrist. He serves as a senior staff physiatrist, clinical investigator and medical education coordinator in the Rehabilitation Medicine Department at the National Institutes of Health Clinical Center. He is also an affiliate professor in the Department of Bioengineering at George Mason University.

Dr. Shah earned his Bachelor of Arts from the University of California, Los Angeles and his medical degree from the Cayey School of Medicine. He completed his residency in Physical Medicine and Rehabilitation at New York Medical College and is certified by the American Board of Physical Medicine and Rehabilitation. His additional training includes the UCLA Medical Acupuncture Training Program and a fellowship in integrative medicine at the Arizona Center for Integrative Medicine.

Research in myofascial pain

Dr. Shah’s research focuses on the biological mechanisms underlying myofascial pain syndrome and myofascial trigger points. Trigger points are clinically identified as sensitive nodules within taut bands of skeletal muscle that can produce local pain, referred pain and restrictions in muscle function. His work examines how peripheral tissue abnormalities, inflammation and sensitization of the nervous system may contribute to persistent myofascial and musculoskeletal pain.

One of Dr. Shah’s most important research contributions has been the development and application of an in-vivo microanalytical technique for studying the biochemical environment of human skeletal muscle. Using this approach, his research group found that active trigger-point regions contained elevated concentrations of inflammatory mediators, neuropeptides, cytokines and other pain-associated substances compared with latent trigger points or normal muscle. Active trigger-point tissue was also associated with a more acidic local environment. These findings provided biological evidence that painful trigger points are associated with measurable physiological changes rather than being defined solely by palpation or patient symptoms.

Dr. Shah has also collaborated with biomedical engineers to apply ultrasound imaging, Doppler techniques and ultrasound elastography to the study of trigger points. This research has helped demonstrate differences in tissue stiffness, viscoelastic properties and blood-flow patterns within active trigger points and surrounding muscle tissue. These methods may eventually contribute to more objective approaches for identifying and monitoring myofascial pain disorders.

His clinical research evaluates non-pharmacological treatments including dry needling, acupuncture, electrical stimulation and other physical-medicine interventions. His studies have examined how dry needling may alter trigger-point characteristics, reduce pain and produce measurable changes in muscle tissue. Dr. Shah also teaches internationally on the evaluation and treatment of chronic myofascial and neuromusculoskeletal pain.

Dr. Shah’s contributions have been recognized with the Janet Travell Clinical Pain Management Award and the David G. Simons Award, honours associated with clinical pain management and advancements in the understanding of myofascial trigger point