Course outline:

The aim of this course is to review low back pain facts, assessment, and treatment for guiding clinical physiotherapy practice.

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Instantly applicable clinically relevant evidenced-informed assessment and treatment of low back pain.

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What tests what?

Evidenced-informed pathoanatomic assessment and testing...

 

The course centers on a pragmatic approach to the evidenced-based assessment and treatment of low back pain, both acute and persistent. An evidenced informed and broad-based focus will be employed, while reviewing current knowledge of LBP, breaking myths and addressing controversies and offering a thought-provoking course. The ultimate goal is to stimulate a rational and balanced approach to the clinical management of low back pain.

 

The context of the course includes the biopsychosocial model, diagnostic triage, evidenced-based pathoanatomic assessment and testing utilizing likelihood ratios and review of selected clinical prediction rules, and guideline treatment review. See course content breakdown.

 

The course will offer a clinically relevant knowledge base to complement current practice and build clinical confidence in the management and education of persons with low back pain. The course has a didactic and practical element. The lecture element is practical in application. The irrelevant theory is kept to a minimum.

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Section 1: Introduction

Introduction: an overview

Causes of low back pain & red flags

Pain basics, pain system, BioPyschoSocialmodel

Psychological factors

Potential pain generators

Risk factors

Imaging; brief mention

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Section 2: Assessment

Selective assessment

Subjective, history, patient profile

Examination considerations

Statistics: 3-minute overview

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Focussed areas - Evidenced-based assessment 

1. Discogenic

2. Nerve root/radiculopathy

3. Facet joint

4. Sacroiliac joint

5. Lumbar spine stenosis

6. Hip joint

7. Myofascial trigger points

8. Sundry (inflammatory back pain, hamstring versus referred pain)

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Section 3: Treatment

Selective treatment

Rx overview

Rx evidence overview into (see appendix)

Rx guideline overview – nice

International guideline review

Pathoanatomical guideline review

Low back pain treatment overview

Education

Exercise

Myofascial trigger points & DN

Manipulation clinic prediction rule

Modalities: brief discussion

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Appendix: Cochrane LBP reviews

1. Exercise

2. Manual therapy, massage & DN, etc

3. Education

4. Electrophysical agents

5. Psychological

6. Various relevant to physiotherapy

7. Drug RX

8. Interventional

9. Surgery

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Examples of questions addressed in this course

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1 General:

What is the definition of low back pain?

What is acute, sub-acute and persistent low back pain?

What is the epidemiology of LBP?

What is the natural course of low back pain?

What are the common, uncommon and not to be missed causes of low back pain?

What is “low back pain triage”?

What are the common red flags? Are they reliable indicators of disease?

What is the definition of pain?

Why are pain mechanisms important to clinical practice & pt education?

What are peripheral and central sensitization and pain modulation?

Why is the biopsychosocial model and patient-centered care important?

What are the potential psychological risk factors for persistent low back pain?

What are risk factors for low back pain and can they be modified?

What are the risk factors for athletic low back pain?

Are comorbidities important?

What is the problem with imaging and low back pain? Why image? Why not?

What can be a potential source of low back pain/nociception?

 

2 Assessment:

What is specificity and sensitivity and likelihood ratio? Why are these important?

Can discogenic pain be reliably diagnosed?

What is the difference between discogenic pain and radiculopathy? What are the differentiating features?

What is pseudosciatica?

Does the sacroiliac joint move and if so are movement tests reliable?

When the SIJ goes “out” where does it go? Lets clear up the controversy

Do pain provocation tests play a role in the assessment of the SIJ?

What is the active straight leg raise?

What is spinal stenosis? What are the presenting features?

How is the hip relevant to low back pain?

Can facet joint pain be reliably diagnosed? What do the tests tell us or not? What are Revel’s criteria?

Are myofascial trigger points relevant in LBP?

 

3 Treatment:

What are the main pillars of treatment for LBP?

What are multimodal and multidimensional and active and passive treatments?

Does individualized treatment approach really matter?

Do patient expectations play a role in treatment outcome?

What is the Hawthorne effect? How is it relevant? The problem with studies...?

What is the evidence for treatment of LBP?

What are the 2016 NICE guidelines and how can they assist in a pragmatic approach to low back pain?

Is neuromuscular training important?

What is important in internalization vs externalization of exercise approach?

What is comfort and threat? Why is this relevant?

What muscles are relevant terms of nociception and pain?

What role does exercise have in managing pain?