The Lumbar Spine

Low back pain can be difficult to treat. Management of chronic low back pain and leg pain requires a multifactorial approach. This course will not only help you to identify the underlying causative factors of LBP, but will also provide you with techniques that will enable you to assist patients to increase their active control of the passively unstable and associated areas in a way that will minimise symptom reoccurrences. Add an important modality to your tool box.

Low back pain (LBP) is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care.  In this short online course, we identify 10 common unhelpful beliefs about LBP and outline how they may influence behavioural and psychological responses to pain. We counter with 10 important facts about LBP, calling on clinicians to incorporate these into their interactions with patients. The infographic is designed for the public use.

*Fast track = fast track your learning with our short online courses

Objective Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). 

Summary/conclusion There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. 

Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. 

However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. 

We have identified effective, promising, or emerging solutions that could offer new directions.

Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. 

However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. 

We have identified effective, promising, or emerging solutions that could offer new directions.

As therapists, we often recommend exercise to reduce patients’ low-back pain, as well as increase their active range of motion and muscle strength. However, biokineticits face a challenge when recommending exercise to reduce low-back pain because the pain itself often inhibits the patient’s ability to exercise or perform activities of daily living. This situation becomes even more challenging if the prescribed exercise progam aggravates the individual’s low-back pain.  

This article discusses a method which provides for the effective treatment of low back pain by allowing patients to exercise pain free earlier in the rehabilitation process.  The method comprises a unique approach utilizing the following four components simultaneously from the onset of treatment: isometric muscle contraction (IMC); assisted active oscillatory movement; end-of-range passive stretch; and mindfulness.

Here’s a method that’s been proved to assist millions of people worldwide to reduce and eliminate musculoskeletal disorders - empowering patients to take control of their own symptoms and management, getting them pain free as quickly and cost effectively as possible.

It can also establish a patient’s directional preference and determine movements likely to help abolish the pain and restore function.

This three-part course, which must be taken together, is a must for any professional who treats back and neck pain.

Here’s a method that’s been proved to assist millions of people worldwide to reduce and eliminate musculoskeletal disorders - empowering patients to take control of their own symptoms and management, getting them pain free as quickly and cost effectively as possible. 

It can also establish a patient’s directional preference and determine movements likely to help abolish the pain and restore function. 

This three-part course, which must be taken together, is a must for any professional who treats back and neck pain.

Here’s a method that’s been proved to assist millions of people worldwide to reduce and eliminate musculoskeletal disorders - empowering patients to take control of their own symptoms and management, getting them pain free as quickly and cost effectively as possible. 

It can also establish a patient’s directional preference and determine movements likely to help abolish the pain and restore function. 

This three-part course, which must be taken together, is a must for any professional who treats back and neck pain.

What’s in a name?” Juliet asked. Well, when it comes to Low Back Pain, it could be quite significant. There are several classification schemes, each with its own philosophy and categorizing method that are used to subgroup low back pain (LBP) patients.

Physiotherapy derived schemes usually have a movement impairment focus, but the extent to which other biological, psychological, and social factors of pain are encompassed should also be considered.

Furthermore, within the prevailing ‘biological’ domain, the overlap of subgrouping strategies within the orthopaedic examination remains unexplored.

This course is designed to review the theoretical basis and content of physical movement classification schemes, determine their relative reliability and similarities/differences, and to consider the extent of incorporation of a bio-psycho-social framework within the schemes

What’s in a name?” Juliet asked. Well, when it comes to Low Back Pain, it could be quite significant. There are several classification schemes, each with its own philosophy and categorizing method that are used to subgroup low back pain (LBP) patients.

Physiotherapy derived schemes usually have a movement impairment focus, but the extent to which other biological, psychological, and social factors of pain are encompassed should also be considered.

Furthermore, within the prevailing ‘biological’ domain, the overlap of subgrouping strategies within the orthopaedic examination remains unexplored.

This course is designed to review the theoretical basis and content of physical movement classification schemes, determine their relative reliability and similarities/differences, and to consider the extent of incorporation of a bio-psycho-social framework within the schemes

Because low back pain can involve a multitude of factors, how you examine your LBP patients is critical. 

In part 1 of this course, we look at the factors that warrant consideration for their possible presence and role in a patient’s low back disorder.We also pay attention to non-musculoskeletal pathology, mechanical factors, ageing and degeneration, structural anomalies and muscle dysfunction. 

Part 2 covers the objective examination of the lumbar spine and includes observation, interpretation and analysis of active movements, neurological testing, tension tests, manual segmental examination, muscular examination and the interpretation of the conclusion of the examination.

Because low back pain can involve a multitude of factors, how you examine your LBP patients is critical.

In part 1 of this course, we look at the factors that warrant consideration for their possible presence and role in a patient’s low back disorder.We also pay attention to non-musculoskeletal pathology, mechanical factors, ageing and degeneration, structural anomalies and muscle dysfunction.

Part 2 covers the objective examination of the lumbar spine and includes observation, interpretation and analysis of active movements, neurological testing, tension tests, manual segmental examination, muscular examination and the interpretation of the conclusion of the examination.

What role does the muscular system play in the control of activity throughout the body? What are the several causes for abnormal afferent input from the spine? What is the theory behind PNF?

Part 1 of this course provides the theoretical background to PNF. When discussing the use of PNF techniques for the treatment of patients with vertebral disorders, it is wise to consider the abnormal. Part 1 of this course will provide you with everything you need to know about PNF, including muscle physiology and function; neurophysiology and neuropathology of the neuromusculoskeletal system; and the effect of pain on muscle activity. It also provides a review of PNF techniques and their applications.

Part 2 helps you put what you have learned in part one into practice. It is fully illustrated with most of the PNF techniques for the cervical, thoracic and lumbar spine as well as peripheral joints. All figures contain detailed explanations for the use of each technique. It also covers the effect pain has on muscle activity and how PNF techniques address this problem.

What role does the muscular system play in the control of activity throughout the body? What are the several causes for abnormal afferent input from the spine? What is the theory behind PNF?

Part 1 of this course provides the theoretical background to PNF. When discussing the use of PNF techniques for the treatment of patients with vertebral disorders, it is wise to consider the abnormal. Part 1 of this course will provide you with everything you need to know about PNF, including muscle physiology and function; neurophysiology and neuropathology of the neuromusculoskeletal system; and the effect of pain on muscle activity. It also provides a review of PNF techniques and their applications.

Part 2 helps you put what you have learned in part one into practice. It is fully illustrated with most of the PNF techniques for the cervical, thoracic and lumbar spine as well as peripheral joints. All figures contain detailed explanations for the use of each technique. It also covers the effect pain has on muscle activity and how PNF techniques address this problem.

We all know that physical factors impact joint motion. But what factors influence the actual mechanics of the joint? Are they purely “mechanical”, or could something else be at play?

This course briefly outlines the assessment findings and the principles for management of the various factors that impact function of the SIJ. It also provides a comprehensive methodology for the effective management of pelvic pain and dysfunction.

We all know that physical factors impact joint motion. But what factors influence the actual mechanics of the joint? Are they purely “mechanical”, or could something else be at play?

This course briefly outlines the assessment findings and the principles for management of the various factors that impact function of the SIJ. It also provides a comprehensive methodology for the effective management of pelvic pain and dysfunction

Low back pain and leg pain, like love and marriage, usually go together like a horse and carriage. The key for the practitioner is to differentiate between the two in order to make an appropriate diagnosis and identify the underlying pathology.

This course introduces a systematic approach to assist with the diagnosis and classification of LBP patients in order to provide a more effective, appropriate treatment.

This illustrated on-line course covers the assessment, interpretation and treatment of the following short/tight muscles:

• Piriformis

• Quadrates lumborum

Arie Michaeli - MSc PT, MCMT
As therapists, we often recommend exercise to reduce patients’ low-back pain, as well as increase their active range of motion and muscle strength. However, physical therapists face a challenge when recommending exercise to reduce low-back pain because the pain itself often inhibits the patient’s ability to exercise or perform activities of daily living. This situation becomes even more challenging if the prescribed exercise program aggravates the individual’s low-back pain.

This video discusses a method which provides for the effective treatment of low back pain by allowing patients to exercise pain free earlier in the rehabilitation process.  The method comprises a unique approach utilizing the following four components simultaneously from the onset of treatment: isometric muscle contraction (IMC); assisted active oscillatory mobilization; end-of-range passive stretch; and mindfulness.