Toronto, September 27 – 7:30 AM to 5:15 PM

Schedule:

7:30 AM to 8:00 AM – sign in

8:00 AM to 10 AM – The Neurological Examination of Chronic Musculoskeletal Pain: Assessing Central Sensitization and Secondary Hyperalgesia

10:00 AM 10:15 AM – Break

10:15 AM – 12:15 PM Augmenting the Sensory Examination

12:15 PM – 1 PM LUNCH (not provided)

1:00 PM to 3 PM Augmenting the Cerebellar and Primitive reflex examinations

3:00 PM-3:15 PM Break

3:15-5:15 PM Dynamic Assessment & Management of Common Upper & Lower Limb Entrapment Neuropathies

8 AM to 10 AM

Doctors John Srbely and Jay P Shay

The Neurological Examination of Chronic Musculoskeletal Pain: Assessing Central Sensitization and Secondary Hyperalgesia

1 Why Attend This Workshop?

Chronic musculoskeletal pain frequently presents with clinical findings that cannot be adequately explained by local tissue injury or structural pathology alone. Patients may demonstrate disproportionate pain, widespread tenderness, remote hyperalgesia, allodynia, and persistent symptoms despite apparent tissue healing.

These findings may reflect altered nociceptive processing associated with central sensitization, segmental sensitization, impaired descending pain modulation, and neurogenic inflammation.

This focused two-hour workshop provides clinicians with a contemporary neurophysiological framework for recognizing these mechanisms and incorporating a structured sensory and neurological examination into routine clinical practice.

2 What Makes This Workshop Different?

This workshop moves beyond a strictly structural or tissue-based assessment of chronic musculoskeletal pain.

A clinically relevant framework linking central sensitization and neurogenic inflammation to chronic musculoskeletal pain
Practical differentiation of primary and secondary hyperalgesia
Focused examination procedures for detecting allodynia, hyperalgesia, and altered temporal processing
Assessment of spinal segmental sensitization across dermatomes, myotomes, and sclerotomes
Direct integration of neurological and sensory findings into clinical reasoning, treatment planning, and documentation

3 Workshop Format

3.1 Didactic Presentation: 90 Minutes

A clinically oriented overview of the mechanisms underlying central sensitization, neurogenic inflammation, and secondary hyperalgesia in chronic musculoskeletal pain.

3.2 Examination Demonstration: 30 Minutes

A practical demonstration of focused neurological and sensory examination procedures that can be incorporated into routine patient assessment.

4 The Clinical Problem: Limitations of Structural Models

Conventional musculoskeletal examinations frequently emphasize the identification of local tissue injury or structural pathology. Although essential, this approach may not adequately explain persistent, widespread, or disproportionate pain presentations.

4.1.1 Key Topics

Persistent pain despite apparent tissue healing
Widespread and remote tenderness
Pain extending beyond expected anatomical boundaries
Allodynia and secondary hyperalgesia
Discordance between structural findings, reported symptoms, and physical findings
The importance of evaluating both the nociceptive source and the state of the nervous system

5 Central Sensitization, Neurogenic Inflammation, and Secondary Hyperalgesia

Persistent nociceptive input may increase the responsiveness of spinal and supraspinal neurons, amplifying pain and expanding the distribution of sensory abnormalities. Neurogenic inflammation may provide a biological link between altered central nociceptive processing and persistent peripheral tissue findings. Distinguishing areas of primary vs. secondary hyperalgesia is therefore central to the mechanism-based examination of chronic musculoskeletal pain.

5.1.1 Key Topics

Persistent nociceptive bombardment
Increased dorsal horn, ventral horn, and intermediate horn excitability bilaterally
Wide-dynamic-range neurons, viscerosomatic interactions, and receptive-field expansion
Temporal summation and wind-up
Reduced inhibitory pain modulation
Segmental and widespread sensitization
Antidromic activation of primary afferent nociceptors and dorsal root reflexes
Release of substance P and calcitonin gene-related peptide
Vasodilation, plasma extravasation, and peripheral sensitization
Segmentally mediated neurogenic inflammatory responses
Relationships among spinal pathology, remote tenderness, and myofascial trigger points
Primary hyperalgesia at the site of tissue injury or inflammation
Secondary hyperalgesia beyond the primary site
Mechanical punctate hyperalgesia
Dynamic mechanical allodynia
Expansion of painful receptive fields
Segmental, regional, and widespread patterns of sensitivity

6 Focused Neurological and Sensory Examination

The practical component introduces a concise examination sequence for identifying findings consistent with central sensitization and secondary hyperalgesia.

6.1.1 Key Topics

Recognition of relevant pain history and symptom patterns
Mapping the primary painful and sensitized regions
Comparison with contralateral and remote reference sites
Assessment of light-touch and brush allodynia
Assessment of mechanical punctate hyperalgesia
Pressure pain threshold assessment
Evaluation of temporal summation/windup
Examination of dermatomal, myotomal, sclerotomal, and paraspinal sensitivity
Identification of localized, segmental, regional, and widespread patterns
Integration with the conventional neurological and musculoskeletal examination

No individual finding is diagnostic of central sensitization. Interpretation should be based on the convergence of the patient history, patient-reported outcomes, sensory examination, neurological findings, musculoskeletal assessment, and overall clinical presentation.

7 Two-Hour Schedule

0:00-0:10: Introduction, clinical context, and objectives

0:10-1:30: Limitations of structural models in chronic musculoskeletal pain; mechanisms and clinical manifestations of central sensitization; primary vs secondary hyperalgesia

1:30-1:55: Focused neurological and sensory examination demonstration

1:55-2:00: Conclusion, Q/A

8 Learning Objectives

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

Explain the fundamental mechanisms of central sensitization, including dorsal horn excitability, receptive-field expansion, temporal summation, wind-up, and impaired spinal segmental and descending pain inhibition.
Describe the mechanisms of neurogenic inflammation and explain how altered nociceptive activity may contribute to persistent peripheral tenderness and myofascial findings.
Differentiate primary hyperalgesia, secondary hyperalgesia, mechanical allodynia, and temporal summation.
Recognize historical and clinical features that raise suspicion of altered central nociceptive processing in patients with chronic musculoskeletal pain.
Perform a focused sensory examination using regional mapping, light-touch stimulation, punctate mechanical stimulation, pressure pain assessment, and side-to-side comparison.
Examine dermatomal, myotomal, sclerotomal, and paraspinal tissues for patterns consistent with spinal segmental sensitization.
Distinguish localized peripheral sensitization from segmental, regional, or widespread sensory amplification.
Integrate sensory findings with the conventional neurological and musculoskeletal examination without relying on any single test as a definitive measure of central sensitization.

9 Who Should Attend?

This workshop is designed for chiropractors, physicians, physiotherapists, osteopaths, athletic therapists, massage therapists, and other healthcare professionals who assess or manage patients with chronic musculoskeletal pain. It is particularly relevant for clinicians seeking to improve their recognition of centrally mediated pain mechanisms and strengthen the neurological and sensory components of their clinical examination.

Augmenting the Sensory Examination – Dr. Evelyn Lock

10:15 AM to 12:15 PM

Augmenting the Reflex & Cerebellar Examination – Dr. Ian Horseman

12:45 PM – 2:45 PM

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NERVES IN MOTION 3 PM to 5 PM – Dr. Joe Pelino

Dynamic Assessment & Management of Common Upper & Lower Limb Entrapment Neuropathies

DR. JOE PELINO, BSc, DC, DACBSP, ICSC

Founder, Gordie Howe™ Institute
“The Brain Trust For All Athletes & Their Fans.™”

2-HOUR PRACTICAL CLINICAL COURSE

COURSE OVERVIEW

Peripheral nerves do not function in isolation—and they are not static. They travel through and between muscles, fascia, connective tissue and anatomical tunnels while being exposed to changing tension, compression, movement and load.

MSK+ Neuro: Nerves in Motion presents Dr. Joe Pelino’s practical approach to the assessment and management of common upper- and lower-limb compression and entrapment neuropathies from a dynamic soft-tissue perspective.

The session combines focused neurological and musculoskeletal examination with palpation, movement, functional loading and dynamic soft-tissue assessment.

Drawing on decades of clinical experience, Dr. Pelino will demonstrate concepts developed through extensive clinical application of Anatomical Release Techniques Stress Relief Method (SRM) and, more recently, SONIK.health.

IDENTIFY → ASSESS → MOVE → TREAT → REASSESS → DECIDE

COURSE OBJECTIVES

Recognize common clinical presentations associated with upper- and lower-extremity peripheral nerve compression and entrapment.
Understand relevant functional anatomy and common anatomical locations where compression, irritation or restriction may occur.
Differentiate potential peripheral nerve involvement from muscular, fascial, joint and other musculoskeletal presentations.
Perform a focused neurological and MSK screening examination appropriate for suspected peripheral nerve involvement.
Examine peripheral nerves dynamically, considering movement, tissue tension, palpation, position and functional loading.
Identify muscles, fascia and other soft-tissue interfaces that may influence nerve mobility and mechanical sensitivity.
Apply clinically reasoned dynamic soft-tissue management strategies to appropriate presentations.
Integrate concepts derived from Anatomical Release Techniques, SRM and SONIK.health within a broader examination and management framework.
Immediately reassess relevant neurological, MSK, movement and functional findings following intervention.
Recognize findings requiring further investigation, diagnostic imaging, medical evaluation or neurological referral.

2-HOUR COURSE SYLLABUS

PART 1 — THE NERVE IN MOTION

A concise introduction to looking beyond a static neurological examination and considering how peripheral nerves interact with the moving musculoskeletal system.

Peripheral nerve anatomy
Compression versus entrapment
Mechanical sensitivity and nerve mobility
Anatomical tunnels and soft-tissue interfaces
Repetitive and functional loading
Sport and occupational mechanisms
Neurological and MSK screening
Clinical reasoning, red flags and referral considerations

Core questions: Which nerve? Where? Why? During what movement? Against which tissue? Under what load?

PART 2 — UPPER LIMB ENTRAPMENT NEUROPATHIES

Practical assessment of common peripheral nerve presentations affecting the upper extremity.

Median nerve — arm, elbow, pronator region, forearm, carpal tunnel and hand.
Ulnar nerve — medial arm, cubital tunnel, flexor-pronator region, forearm, Guyon’s canal and hand.
Radial nerve — posterior arm, radial tunnel, supinator region, posterior interosseous nerve and superficial radial nerve.

Practical sequence: History → Neurological Screen → Palpation → Movement → Dynamic Soft-Tissue Assessment → Intervention → Reassessment

PART 3 — LOWER LIMB ENTRAPMENT NEUROPATHIES

Practical assessment of common peripheral nerve presentations involving the hip, thigh, knee, lower leg, ankle and foot.

Sciatic nerve — lumbopelvic relationship, gluteal region, deep hip structures, posterior thigh and hamstring interfaces.
Common fibular/peroneal nerve — distal thigh, lateral knee, fibular head, peroneal musculature and lower-leg interfaces.
Tibial nerve — posterior knee, calf, deep posterior compartment, tarsal tunnel and plantar foot.

Additional clinically relevant peripheral nerve presentations may be incorporated according to the patient or athlete presentation.

PART 4 — THE DYNAMIC SOFT-TISSUE PERSPECTIVE

Rather than viewing the nerve as an isolated structure, participants consider the relationship between the nerve and the tissues surrounding it. The examination asks what happens to symptoms and findings when nerve position, muscle, fascia, joint position, movement and functional load are changed.

Anatomical Release Techniques

Dynamic assessment and treatment of soft-tissue interfaces using clinician contact combined with patient- or clinician-directed movement.

Stress Relief Method (SRM)

Integration of soft-tissue assessment and management concepts within the overall mechanical presentation.

SONIK.health

Introduction to Dr. Pelino’s more recent incorporation of SONIK.health into his evolving approach to musculoskeletal and soft-tissue care.

These approaches are presented as components of a broader clinical reasoning process, rather than as substitutes for neurological diagnosis or appropriate referral.

PART 5 — TREAT → REASSESS → DECIDE

Intervention is followed by immediate reassessment. Participants compare relevant pre- and post-intervention findings.

Symptoms
Palpation findings
Range of motion
Neurological findings
Tissue sensitivity
Movement and strength
Functional loading
Sport-specific movement

CONTINUE → MODIFY → INVESTIGATE → IMAGE → REFER

THE DR. JOE PELINO CLINICAL PERSPECTIVE

Dr. Pelino’s teaching is grounded in decades of treating athletes and patients in environments where the clinician must combine anatomy, neurological assessment, hands-on examination, movement and immediate clinical decision-making.

His approach emphasizes that identifying the nerve is only the beginning. The clinician must understand the nerve, the anatomical interface, the movement, the load and the patient—and then determine whether changing the mechanical environment changes the clinical presentation.

FACULTY

DR. JOE PELINO — BSc, DC, DACBSP, ICSC

Dr. Joe Pelino is a sports chiropractor whose professional career has focused on musculoskeletal assessment, treatment, rehabilitation and athletic performance.

A substantial portion of his clinical career has involved the application of Active Release Techniques (former instructor) and dynamic soft-tissue assessment and treatment, subsequently incorporating SRM and, more recently, SONIK.health.

His professional sports medicine experience has included work associated with athletes and medical environments across the NHL, NHLPA, NBA, IRONMAN World Championship, Eroica and Race Across America (RAAM), among other professional, elite and endurance sporting environments.

Dr. Pelino brings this experience into a practical teaching format designed to help clinicians develop a more dynamic understanding of peripheral nerve and soft-tissue presentations.

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