At age 16 Leonard Van Gelder left traditional education to pursue his own IT company. Who would have thought that in the next 16 years he would become a martial artist, athletic trainer, physical therapist and physical therapy practice owner!
“I have always needed to motivate myself to learn. I also love to learn for a purpose.” Leonard did very well blazing his own path!
During martial arts training, he sustained injuries that led him to seek physical therapy. “I went to a course on movement and the speaker said he learned more from his physical therapist than from anyone else. So, at the age of 23, and without a high school diploma, I called Grand Valley State University’s physical therapy program and asked them how I could become a physical therapist,” said Leonard. “And to their credit, they did not disregard me but informed me of my options.” He graduated from the GVSU program and along the way earned an athletic training certification.
After graduation, Leonard focused on outpatient care and specifically on patients suffering from chronic pain. “I experienced chronic pain from martial arts injuries. Even during my undergraduate studies at Grand Valley, I followed the work of Louis Gifford, British Physical Therapist, who presented the mature organism model, and Adrian Low of the International Spine and Pain Institute.”
Over the past five years, Leonard worked at Generation Care where he helped with the development of a pain specialty division. “We set up a practice model that identified patients who would benefit from the biopsychosocial treatment model. In addition, we identified therapists who wanted to dig deeper into the Biopsychosocial treatment strategies,” he said.
Generation Care allowed the development of a pain treatment system. “As a team, we brought together ideas and trial treatment strategies with the goal of developing a best practice treatment model for the patient. I am very thankful to Generation Care for this valuable experience.”
The Biomedical Model vs the Biopsychosocial Model
“The biomedical model is traditionally how we approach all medical problems. This works great for Emergency Medicine. But chronic pain is months away from the original incident of injury. Chronic pain requires a different approach.”
Leonard’s a definition of the Biopsychosocial model is an evaluation that includes biomedical, psychology, and socio-environmental factors. Most of physical, occupational and speech therapy training focuses on the biomedical assessment. However, most educational programs do not cover the psychological or societal factor assessment. For example, research has shown that the patient needs to believe improvement can occur in order for healing to actually occur. Or, it is equally important to understand the patient’s social factors. For example, sitting upright may be interpreted as good posture in our culture but in others, it is interpreted as a form of torture depending on your social history.
Putting the Biopsychosocial Model to Work
“I had an athlete with shoulder pain at the end of a season. Medical imaging revealed no consistent results. My physical therapy special tests produced no definitive results. However, the patient reported social stressors – the expectations of friends and coaches were increasing and stress was affecting sleep, which negatively affected recovery. My patient also reported a decrease in confidence and focus.” Leonard continued, “the patient’s whole alarm system was on. She had physical pain, social stress and psychological stressors affecting performance. Small injuries in a heightened alarm system will not be able to calm down with just a biomedical approach.”
“The model recommends addressing the psychological and social stressors as well. You need to calm down the alarm system which includes a psychological and social approach to assist the patient. We identified the non-physical stressors involved in and affecting recovery and performance. We focused on effective strategies for responding to physical, psychological and social stress. Also, we added pacing strategies to decrease stress throughout the day. By addressing all the stress the patient was experiencing she was equipped to decrease the cumulative stress throughout the day.”
Combining the biomedical with the psychological, social and cultural influences of the patient is not an exact science. Leonard advocates we need to be comfortable with ambiguity and uncertainty. “As therapists, we need to be able to communicate confidence within our patients. We need to admit to the uncertainty. With the patient’s input, we will be able to develop a plan to help the patient.” I admitted to Leonard that until recently, I had been unfamiliar with the biopsychosocial model. “Currently there is a diversity of courses and approaches that you can use to help determine what works best for you as you work with patients experiencing chronic pain,” he said.
Dynamic Principles Education
Leonard has taken his focus, individual research, and continued education to develop Dynamic Principles Education. The focus is to provide a broad toolbox to help therapists re-conceptualize their understanding of pain and movement through current science while navigating the complexities of helping a whole person. You can find more information on his continuing education course here.
Leonard has not only been developing a continuing education course, but he has also started an outpatient clinic. “About six months ago,” Leonard explained, “it became clear that the next step I should take was to start an outpatient clinic. My clinic’s focus is on the patient who has been struggling with pain for a while.” During this time, he has mentored and persevered through filing for insurance network applications, designing his own clinic, obtaining funding, and designing a website.