This course is designed for physiotherapists who have some experience and knowledge of assessment and treatment of patients with primary symptoms of back and / or referred lower limb pain. Although my course Back Pain 101 is not a pre-requisite, it is recommended for recent graduates or undergraduates.
Back Pain 201 opens the door for lumbar spine and pelvic diagnostics and treatment selection based on a broad perspective that includes pathoanatomy, neurophysiology and the psychosocial dimensions by teaching you the essentials of a comprehensive clinical history and physical examination.
By the end of this course you will be able to confidently identify:
Mechanical discogenic pain.
Radicular syndromes.
Spinal stenosis.
Sacroiliac joint pain.
Hip and buttock pain sources.
This course builds on Back Pain 101, providing a structured assessment method that will be further expanded upon in the Back Pain 300 series.
This course is designed for physiotherapists who have graduated recently or are starting to learn management of back pain patients. Here you will learn practical hands-on assessment and management that goes beyond international guideline principles. The use of lectures and actual patient video, plus easy to use fillable forms for clinical notes, makes you ready to see patients presenting with a primary symptom of back pain. You also get a complimentary 60 day access to Quick Q&A online questionnaire service so you can identify patients with red flags and those with a high risk of experiencing persistent pain. You can then identify which patients you can manage yourself with good quality basic care and identify those patients who need more advanced knowledge/experience or referral for specialist advice or intervention.
Chapter 1: The Clinical History.
Two lessons, Fillable forms for clinical notes, and video case study of the history taking. You will need to use a form to complete as you watch the patient assessment video. This can be an online form from Quick Q&A (preferred and complimentary), a fillable Adobe form (downloaded from the course website), hard copy (Not recommended). You can use these forms when seeing your own patients in your own clinical environment. These forms are independent of practice management systems and may be printed and added to your practice clinical notes system. There is a quiz at the end of the chapter.
Chapter 2. The Physical examination.
Two lessons, video of assessment procedures: observation, a standard orthopaedic neurologic screening examination. Here you will learn to classify patients into meaningful flexion or extension protocol treatment categories: The red flag and StartBacK screening tool are used to narrow clearly identify the subset of patients the treatment protocols are suitable for and those patients for whom you should seek support for your management. Patients needing more advanced skills or specialist advice are identified early so you can refer them for further, more appropriate care and diagnostic workup. There is a Quiz at the end of the Chapter.
Chapter 3. Treatment.
Four lessons. Those patients with mild or moderate pain and with low or medium risk of persistent pain have been identified. Do the simple things well: an extension protocol, a flexion protocol, When to select which protocol. Learn the specifics of what advice to give, what exercises and posture instruction to recommend, what self-treatment works for most of these patients. Learn how to follow up, progress and discharge patients. Learn basic reporting for back pain patients
Learning outcomes:
Knowledge of prevalence and impact of back pain on the individual and society
Able to carry out an evidence based clinical histor
Able to select appropriate questionnaires to identify red flags
Use the StartBacK screening tool to assess psychosocial distress and risk of persistent pain.
Identify cases with possible radicular pain and/or radiculopathy
Able to identify that subgroup of patients suitable for basic level guideline care, and those patients who require more advanced or specialist level care
Able to do a standard physical examination that includes observation, differentiating between normal asymmetry and relevant deformity, neurologic screening for nerve root compression.
Able to select patients suitable for an extension protocol of exercise, posture adaption
Able to select patients suitable for a flexion protocol of exercise, posture adaption
Lean to follow up in a timely and appropriate manner.
Able to discharge patients in a timely and appropriate manner
Able to adequately document baseline, initial and follow up assessment/treatment findings in clinical notes.
This course presents case studies of three patients seen by Mark Laslett. All have over 2 years of persistent lumbosacral pain and all have had precious unsuccessful treatment. Two cases have clinical diagnoses that were available on the basis of the initial clinical assessment finding. The other case has a clinical diagnosis that is unconfirmed but unneeded for management.
Chapters
Introduction
Ian.54 year old salesman with 8 years of persistent central low back pain with daily severe immobilising twinges and intolerance to prolonged sitting.
Rosie.18 year old athlete with 2 years of dominant buttock pain interrupting professional basketball career.
Tom.32 year old electrician with 8 years of persistent unilateral low back pain causing him to change occupations three times.
Concluding commentary
The three cases have consented to the assessments and follow ups being videoed for educational purposes. In the clinical assessments video was running continuously and has been edited to remove unnecessary dialog. Captions and annotations added to improve detail and clarity.
Learning activities:
The history, the physical examination and follow up consultations are presented as separate video presentations.
Each case has depersonalized case notes in the form of letters, imaging, and reports. Follow ups are more 12 months.
Reading case notes online and in the course manual.
Learning Outcomes:
Demonstrate 3 different patho-anatomic subsets of non-specific low back pain may be identified by clinical assessment and clinical reasoning
Demonstrate the clinical assessment used in the consultations
Demonstrate appropriate use of and referral for confirmation by reference standard diagnostic procedures
Demonstrate that clinical pathoanatomic diagnosis is necessary in persistent pain so that on-going management and appropriate treatment may be determined.
Study time: Three hours of video. 1-2 hours of reading case notes
This is a Prerecorded Webinar and includes a CPD Certificate at completion.
Access to Course: 30 Days
Cost: $30.00
Course includes:
Access to the recorded Webinar: 1 Hour
Resources: Manual
CPD Certificate
Listen to Dr Mark Laslett’s webinar discussing specific painful lumbar spine diagnoses like discogenic, facetogenic & SIJ pain. It is possible, necessary or desirable? Presentation is followed by Q&A session.
Here are questions to consider:
Is a specific diagnosis possible for back pain patients?
How do we know what the cause of back pain is?
Is a diagnosis necessary to guide management and treatment?
When is it necessary?
Does providing a diagnosis carry risks to the patient?
Is diagnosis based on imaging like MRI?
How do we use our assessment to arrive at a diagnosis?
What is the difference between a clinical diagnosis and a reference standard diagnosis?
A diagnosis has three parts (AMP) see graphic
Anatomical source of nociception
The Mediators of the pain experience and disability
The Pathology that causes the tissue to initiate nociception
How we know the cause of symptoms?
Clinical Diagnosis: the identification of source, cause and mediators of the pain experience using demographic information, history, physical examination and simple/cheap tests like X-rays or routine blood tests
Reference Standard Diagnosis: the best-known method of reaching a specific diagnosis. In addition to clinical diagnosis methods, this usually involves expensive and invasive diagnostic tests, like Hi-Tech Imaging or controlled anaesthetic blocks, plus a specialist interpretation of all the information.
What are the main sources of the painful lumbar spine? There are 5 basic categories
The anterior column: discogenic or vertebral body pain
The Lumbar facet joints
The sacroiliac joint
Central and foraminal stenoses
The posterior column other than the facet joint (spondylolisthesis & Baastrups disease)
Dr Mark Laslett is pleased to release the new educational programme Diagnosis of Persistent Low Back & Referred Lower Limb Pain. This programme allows considerable flexibility for post graduate students in planning continuing education and professional development. It is designed so you may balance study, work, lifestyle, as well as budget.
The Diagnosis of Persistent Low Back & Referred Lower Limb Pain Programme comprises eight courses. The first three are undertaken in order, then you may choose which course of 4 through 8 suits your interests, learning requirements and available time.
Program Objectives
Provide a selective overview of the sources and causes of low back and referred lower extremity pain and discuss their relationship to classification systems and national guidelines.
Provide a selective review of the evidence in support of the diagnostic accuracy of the clinical examination for causes of back and referred pain.
Provide the framework for evidence based-clinical reasoning as it applies to diagnosis of low back disorders. This includes the basis for “diagnosis by subtraction”.
Provide up-to-date, evidence-based diagnosis of discogenic, radicular, facetogenic, sacroiliac joint and other patho-anatomic pain syndromes.
Provide a standardized patient history protocol that supports clinical reasoning to a diagnosis and to patient management.
Provide simple methods of identifying important factors that confound both diagnosis and treatment, such as neuropathic pain, central sensitisation and illness behaviours.
Practice performance of key examination tests for nerve root compression and sacroiliac joint pain.
The first course in this program of instruction eases you into the online learning environment with videos on first activities that you need to complete: like downloading the course manual template, introducing yourself to the Course Forum, and downloading the PDFs of the first reading list.
There are three formal lessons that are essential in understanding the concept of diagnostic triage that is a central part of basic guideline management. The lessons are:
Pain drawings and their interpretation
Red Flag identification and what these mean
The basic neurologic screening examination that is a key part of the physical examination for all patients with back and referral of symptoms into the lower limb
There are two videos to watch. These are of a real patient with persistent low back pain. The first provides detail of the history taking process, and the second is the standard physical examination used throughout this program of instruction.
At the end there is a quiz to test your understanding of the material.
The second course in this instructional program gets into the nitty-gritty of diagnostic methodology within the clinic on the real patients we see every day. The focus here is on clinical diagnosis. That is, the diagnosis one can achieve in the clinic using the history and physical examination, and highly selective use of technology.
There are three formal lessons to complete. The lessons are:
Sources and causes of Low Back and Referred Lower Limb pain. This is a basic overview of known painful patho-anatomical categories of conditions. Basic knowledge is assumed of course but the idea is to provide a summary of basic categories for context and content needed for the next two lessons
The second lesson is Part 1 of the lesson on Diagnosis by Subtraction. Diagnosis by subtraction draws on the concepts of specificity & sensitivity to rule in and rule out different diagnostic categories.
The third lesson is Part 2 of the lesson on Diagnosis by subtraction. In this lesson you will see how expert clinicians reduce the pool of possible diagnostic conclusions to one, or a small number of diagnostic possibilities, so that treatment can be initiated or further diagnostic investigation planned.
There is one case study video to watch. This shows the centralization of pain graphically which is important, since centralisers are the largest subgroup within the back pain population.
You will also download the case notes of the patient seen in the introductory course and be encouraged to self test your own clinical reasoning skills using the details of this case and the learning from the three lectures on the principles of clinical diagnosis.
There is only one paper to download and read, and that is the 2017 paper of Petersen, Laslett & Juhl on the systematic reviews we carried out on the latest evidence on diagnosis and classification. You will need to read this thoroughly, because the course quiz will focus on that strongly.
At the end there is a quiz to test your understanding of the material.
Also you will be able to download the PDF forms I have used for clinical records. This documentation may be of use, or may not, but does give you a good idea of the sort of questionnaires I have patients complete, and notes I keep for all cases presenting in the clinic.
The third course in this program looks at radicular syndrome, that is, pain arising from irritation and/or compression of nerve roots, the dorsal root ganglion and dura mater.
This is the one condition that international guidelines agree may be diagnosed with some confidence using the history and physical examination. This perspective is a surgical one dating and unchanged from the 1980s. This is an outdated view in my opinion, and you will see as the program develops that we can do much better, given current evidence. However, for now, you must be thoroughly familiar with the standard orthopaedic perspective on radicular syndrome, the terms and concepts that are accepted internationally and the evidence supporting diagnosis, conservative care and surgical intervention.
There are four formal lessons to complete. The lessons are:
Introductory concepts of radicular syndrome. Here the distinctions between radicular syndrome, radicular pain and radiculopathy, are clarified using definitions and taxonomy from the international Association for the Study of Pain. The patho-anatomy and physiology of nerve root pain and impairment are covered also.
The second lesson looks specifically at disc herniation as the single biggest cause of radicular syndrome
The third lesson looks at discectomy, the indications for, and alternatives to discectomy. We look at complications following discectomy also.\
The fourth lesson looks at the adherent nerve root. This condition and its treatment was first described by Robin McKenzie. It is probably equivalent to the MRI finding of epidural scarring and occurs in adolescents who develop root compression from disc herniation, and following discectomy
There are three videos to watch.
The first is rare footage from the estate of Dr Stephen Kuslich who reported on the many hundreds of cases he operated on under progressive local anaesthesia on conscious patients. Very important work and fascinating.
The second video is a short video from Rob PT via Utube, on treatment options for adherent nerve root.
The third video shows a rare case where a neurologic deficit is to seen come and go depending on load.
You will also download published guidelines which are an example of accepted international standards for diagnosis and treatment of radicular syndrome.
There is a significant reading list and a quiz to test your understanding.
This is the last of the compulsory courses and completes the realm of what is known as diagnostic triage. The next course you do is entirely up to you. However, regardless of your prior experience, I strongly recommend that the next course you do is the one on mechanical discogenic pain. This course covers the single largest subgroup of the back pain population. That is, those having rapidly reversible and repeatable pain patterns and behaviours. There are several case study videos of the management of cases with acute and persistent deformities.
This course looks at the largest patho-anatomical subgroup in the back pain spectrum. These are patients whose symptoms can be made to centralise, and/or display a repeatable and reversible directional preference when examined using a standardized repeated movement assessment.
The fact that mechanical loading in one direction decreases or centralizes pain, and the opposite direction has the opposite effect, and that this behaviour is both repeatable and rapidly reversible, is what gives rise to the labelling of this group of patients as having mechanical pain.
We know from our own diagnostic accuracy research that only patients with confirmed discogenic pain behave in this way. That is, almost all cases who are categorized as centralisers or show a directional preference will have positive provocation discography, which is the accepted reference standard for discogenic pain.
There are four formal lessons in this course:
Lesson one explores the biomechanics and patho-anatomy of the intervertebral disc as a baseline of understanding how it might be, that symptoms can be made to demonstrate this peculiar reversible and repeatable directional preference phenomenon.
Lesson 2 looks at the evidence and opinion regarding mechanical discogenic pain and how centralization has been observed and studied over the decades
Lesson 3 looks at case studies, mostly drawn from our own diagnostic accuracy research. Here we can see that not all discogenic pain cases centralize, and that discogenic pain is a broad category of painful patho-anatomy, with distinct subgroups of its own
Lesson 4 looks at the acquired deformities as distinct from the developmental ones like idiopathic scoliosis. Hypotheses and explanations for the lateral shift, acute lumbar kyphosis and acute fixed lordosis are discussed.
There is a 5th lecture which looks specifically at the diagnostic accuracy of directional preference, as distinct from centralization. This is not published in a journal, but was presented to a conference and revised to be put in the public domain.
There are several case study videos of management of the acute lateral shift, the acute kyphosis and acute fixed lumbar lordosis. There is one video of a fixed lumbar lordosis in a patient with more than 10 years of daily severe pain, that was rapidly reversible. He is being followed up still.
There is a quiz to complete so that you may test your understanding of this material.
*Prerequisite - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course.
This course investigates the non-mechanical causes of pain arising from the anterior column. The anterior column refers to all structures anterior to the spinal canal, such as the intervertebral disc, the vertebral endplates and the vertebral body. Understanding these potential causes of pain and being able to identify them in the clinic, depends to a large extent on the material in the course on mechanical discogenic pain. Somewhere between 25 and 75% of anterior column pain cases will be classified as mechanical based on the repeated movement assessment, so it is important that you are familiar with that clinical procedure. Do that course first if you are not confident with the procedure of the repeated movement assessment and the interpretation of patient responses.
Prior to research published in the 2000s, most anterior column pain was referred to as simply internal disc disruption, to distinguish these cases from those with disc protrusions and herniations causing radicular syndrome. These were the cases that were positive to controlled provocation discography. And of course there are those cases with high tech imaging evidence of overt discitis, osteomyelitis, fracture or neoplastic disease affecting the vertebral body. This course addresses those cases that are non-centralisers and show no evidence of repeatable, and rapidly reversible directional preference.
There are two main lessons in this course that refer specifically to anterior column infection
The first lesson looks at overt and aggressive anterior column infections presenting as discitis or osteomyelitis. These are often identified by the presence of red flags, but not always. It is important to remain aware that serious medical conditions do slip through the red flag screen. The case studies are those that I have seen myself in recent years.
The second lesson looks at the MRI finding of endplate changes referred to as Modic changes. Modic changes may be caused by a low grade, low virulence infection as proposed by Hanne Albert and co-workers, or may be non-responsive to a long course of antibiotics, which means that we simply don’t know whether this is a resistant infection or whether the Modic changes have some other cause. Of course, it must be noted that not all cases with Modic changes are symptomatic.
There is a third lesson that has a quite different focus. This topic is dear to my heart and concerns the sudden onset severe low back pain case that presents to the Emergency Department. A significant proportion of these cases do not have acute disc prolapses, fractures or infections, but have acute anterior column disorders that present with sudden onset deformities or annular tears. Best management of these cases involves the material from the course on mechanical discogenic pain.\
There are three case study videos in this course.
One presents with concerns about possible cauda equina symptoms.
There is a case study of management of an acute lateral shift where various management techniques are used that were not seen in the case study seen is the mechanical discogenic pain course.
There is another case study of anterior column pathology in a young man that is not reversible.
There is a video of my colleague Dr Charles Aprill discussing provocation discography and demonstrating the technique at three levels in the lumbar spine.
There is a short video demonstrating the movement of disc material during flexion and extension over a variety of age groups using cadaver specimens.
There is a quiz to test your understanding of the material.
*Prerequisite - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course.
This course focuses on pain arising from the sacroiliac region rather than the lumbar spine. Another term in common usage is pelvic girdle pain or PGP. PGP refers to the symptoms, whereas sacroiliac joint pain refers to pain whose nociceptive source is the sacroiliac joint. The great majority of patients classified as PGP have a sacroiliac joint source of pain. Lumbosacral pain and sacroiliac joint pain are often similar in location and behave in ways that are very similar.
This course focuses on the diagnosis of intra-articular sacroiliac pain and makes a clear distinction between that, and the concept of sacroiliac joint dysfunction. The two terms should never be used interchangeably at all. Sacroiliac joint pain is a verifiable and testable phenomenon that patients report, whereas sacroiliac joint dysfunction is an hypothesis regarding altered or pathological function regarding movement or position. Sacroiliac joint dysfunction is an unreliable and outdated diagnosis that has no place in modern musculoskeletal medicine. Intra-articular sacroiliac joint pain is a real issue that can be diagnosed clinically, and using controlled anaesthetic blocks. Sacroiliac joint pain may affect people of all ages, but is most common among women during and after pregnancy, young males and females affected by spondyloarthropathy, and those people suffering significant pelvic trauma.
There are two lessons in the course.
The first looks at the anatomy and biomechanics of the pelvis and sacroiliac joint to provide a solid understanding of movement, stability and the concepts of form and force closure.
The second lesson looks specifically at sacroiliac joint pain, how the clinical assessment is used to make the diagnosis, and how that compares to the reference standard of guided single and controlled intra-articular blocks. The published evidence underpinning this assessment is covered in detail.
There are several case study videos
A full assessment of a young woman with spondyloarthropathy.
The sacroiliac joint tests are described and shown in considerable detail so the variations in the direction and amount of pressure used is clear.
There is a link to a public domain lecture on the SIJ that is worth watching as well.
There is a significant reading list and a quiz to test your understanding of the material.
*Prerequisites - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course.Study time: 4hrs (approx.)
This course looks at those structures posterior to the vertebral body which includes the posterior column and spinal canal. I have included coverage of spinal stenosis in this course because patients with either symptomatic or asymptomatic spinal stenosis, often have symptomatic facet joint disorders concurrently. Separating these two issues requires some careful reasoning. The concepts of spinal stability and instability are included in this course too, because the facet joints and posterior column are key determinants in maintaining structural integrity and stability. The diagnoses of spondylolysis and spondylolisthesis are intertwined with discussion of the idea of spinal instability. Management strategies for these usually involve exercise therapies that, for better or worse, revolve around the notions or core strength and stability.
There are four formal lessons in this course.
The first covers the diagnosis of pain arising from the zygapophyseal, that is, the facet joint.
The second investigates spondylolysis and spondylolisthesis
The third reviews symptomatic and asymptomatic spinal stenosis
And the fourth looks at the notion of lumbar spinal instability
There are cases studies in the lessons and two full video case studies of patients with the clinical diagnosis of facet joint pain.
There is a significant reading list. You will be required to read fully, one of our own papers on the diagnostic accuracy of the clinical assessment in relation to diagnostic blocks of the facet joints. This is a complex paper that brings together many features of the different dimension of diagnostic accuracy research, compared to research into outcomes and therapeutic efficiency.
There are quizzes for each topic in this course to test your understanding of the material.
*Prerequisites - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course. Study time: 4hrs (approx.)
This course looks at two aspects of the back pain complexity. The first consideration is simply that back pain, leg pain and pelvic girdle pain are symptoms, not diagnoses. At best, they are the categories of symptom location. Back and leg pain may not arise from the lumbar spine or pelvis at all, and may be caused by some other condition that just refers pain in ways that masquerade as pain arising from spinal structures. This course looks at some of these. In particular, there is peripheral vascular disease affecting the proximal vessels that can look a lot like spinal stenosis. This is usually easy enough to tease out, but that requires a particular assessment and reasoning process.
Then there are the conditions affecting the hip and deep structures of the buttock, like gluteal tendinopathy or bursitis. These may produce symptoms that look a lot like pain referred from the lumbar spine. They too can be teased out from spinal problems with reasonable ease.
The second aspect of this course looks at confounders, rather than masqueraders. By this I mean, those non-nociceptive neurogenic and central nervous system activities, that seem to lower the threshold of pain perception to the point where the clinical picture is confused by hypersensitivity. Pain intensity seems quite disproportionate to any nociception – that’s if nociception is even still present. In patients with persistent pain, sensitization and neuropathic pain are often all mixed up with psycho-emotional distress and nociception. These complex cases can be hard to sort out. Determining what is nociceptive, neurogenic, psycho-emotional distress or cognitive error, is not an exact science by any means, and this course does not present all the relevant dimensions of this issue. That is a course on its own and I am not the best person to teach that. However, we do acknowledge the problem and offer a simple overview to make it clear, that in patients with persistent pain, diagnosis and management must be considered a bio-psycho-social program.
This course has 3 formal lessons:
Peripheral Vascular disease and Leriche Syndrome masquerading as spinal stenosis
Hip and buttock conditions that mimic pain referral from the spine
Central sensitization, neuropathic pain, the psychosocial dimension and Yellow Flags
Professor Tamar Pincus has an excellent series of short videos on the psychology of pain that are in the public domain. This is an outstanding resource and this course offers a link to one of these that I consider to be superb.
As this course is concerned with complex cases, there are several videoed case studies of patients I have seen in recent years.
There is one case of Leriche syndrome that was one of the clearest instances of peripheral vascular disease being managed unsuccessfully as a musculoskeletal problem. The disabling pain was rapidly and completely resolved with angioplasty once the correct diagnosis was made.
There is a case where I could not decide whether the patient had spinal stenosis or peripheral vascular disease. In fact that patient had something else entirely, and I missed the diagnosis.
There is another complex case where I still don’t know whether the patient has spinal stenosis or peripheral vascular disease.
*Prerequisites - First Activities and Introduction Course, Principles of Clinical Diagnosis Course and Radicular Syndrome Course.
Study time: 4hrs (approx.)
From course 3 onwards you should be considering how you may attend one of Workshop seminars that are arranged in various places throughout the world. While most of the content of this course can quite reasonably be explored online, there is no substitute for a face-to-face seminar environment for learning exactly how to do the sacroiliac joint tests or neurologic screening examination. Just how hard do you push when correcting a lateral shift deformity? Seeing patients being assessed on video is always less powerful that seeing patients in-the-flesh and in real time, which the seminar organisers can hopefully arrange as part of that course. Perhaps the most important part of a workshop seminar, is the opportunity to interact directly with the instructor, and with other colleagues in real time for a few days.
The second course in this instructional program gets into the nitty-gritty of diagnostic methodology within the clinic on the real patients we see every day. The focus here is on clinical diagnosis. That is, the diagnosis one can achieve in the clinic using the history and physical examination, and highly selective use of technology.
The third course in this program looks at radicular syndrome, that is, pain arising from irritation and/or compression of nerve roots, the dorsal root ganglion and dura mater.
This course looks at the largest patho-anatomical subgroup in the back pain spectrum. These are patients whose symptoms can be made to centralise, and/or display a repeatable and reversible directional preference when examined using a standardized repeated movement assessment.
This course investigates the non-mechanical causes of pain arising from the anterior column. The anterior column refers to all structures anterior to the spinal canal, such as the intervertebral disc, the vertebral endplates and the vertebral body. Understanding these potential causes of pain and being able to identify them in the clinic, depends to a large extent on the material in the course on mechanical discogenic pain. Somewhere between 25 and 75% of anterior column pain cases will be classified as mechanical based on the repeated movement assessment, so it is important that you are familiar with that clinical procedure. Do that course first if you are not confident with the procedure of the repeated movement assessment and the interpretation of patient responses.
This course focuses on pain arising from the sacroiliac region rather than the lumbar spine. Another term in common usage is pelvic girdle pain or PGP. PGP refers to the symptoms, whereas sacroiliac joint pain refers to pain whose nociceptive source is the sacroiliac joint. The great majority of patients classified as PGP have a sacroiliac joint source of pain. Lumbosacral pain and sacroiliac joint pain are often similar in location and behave in ways that are very similar.
This course looks at those structures posterior to the vertebral body which includes the posterior column and spinal canal. I have included coverage of spinal stenosis in this course because patients with either symptomatic or asymptomatic spinal stenosis, often have symptomatic facet joint disorders concurrently. Separating these two issues requires some careful reasoning. The concepts of spinal stability and instability are included in this course too, because the facet joints and posterior column are key determinants in maintaining structural integrity and stability. The diagnoses of spondylolysis and spondylolisthesis are intertwined with discussion of the idea of spinal instability. Management strategies for these usually involve exercise therapies that, for better or worse, revolve around the notions or core strength and stability.
This course looks at two aspects of the back pain complexity. The first consideration is simply that back pain, leg pain and pelvic girdle pain are symptoms, not diagnoses. At best, they are the categories of symptom location. Back and leg pain may not arise from the lumbar spine or pelvis at all, and may be caused by some other condition that just refers pain in ways that masquerade as pain arising from spinal structures. This course looks at some of these. In particular, there is peripheral vascular disease affecting the proximal vessels that can look a lot like spinal stenosis. This is usually easy enough to tease out, but that requires a particular assessment and reasoning process.