The Lumbar Spine

Objective:  To validate the effectiveness of six exercise therapies in treating low back pain using Meta-analysis methods, and to propose optimal exercise duration, frequency, and cycle.

Conclusion:  All six exercise therapies effectively alleviated low back pain, with yoga showing the best results. The optimal exercise intervention protocol involved exercise duration not exceeding 30 min per session, frequency of more than 4 times per week, and cycle not exceeding 4 weeks. Additionally, exercise interventions exhibited the most significant improvements in Oswestry Disability Index scores for low back pain.

Non-specific low back pain is back pain without a known, specific cause. It accounts for about 95% of low back pain sufferers presenting to Physiotherapists and Biokineticists. 

It can result from issues like a muscle or ligament strain, or a problem with a disc or facet joint.  Poor posture, repetitive twisting or heavy lifting, weakness in core muscles, and long periods of sitting can contribute to the risk. 

This online course will describe an evidence-based approach to:

• Management of non-specific LBP

• Management of acutely severe LBP

• Management of subacute LBP

• Management of persistent LBP:  clinical sub-grouping approach (1 - 6) to:

1. Active extension pain patterns

2. Passive extension pain patterns

3. Flexion pain patterns

4. Lateral pain patterns

5. Rotational pain patterns

6. Multidirectional pain patterns

A variety of figures showing exercise and postural corrections is illustrated.

This online course will discuss:

- STRESS FRACTURE OF THE PARS INTERARTICULARIS/LUMBAR SPONDYLOLYSIS

• Terminology

• Clinical presentation

• Imaging

• Pathogenesis

• Management of lumbar spondylolysis

The key management goal for active spondylolytic bone stress injury are the resolution of symptoms, bone healing, return to pre-injury function and avoidance of recurrence.  All four goals are interrelated and bone healing is key to the process.  Conservative management can produce excellent critical and radiological outcomes, particularly in young athletic populations. 

- SPONDYLOLISTHESIS

• Clinical features

• Treatment

- ACUTE RADICULOPATHY +/- NERVE ROOT COMPRESSION

• Clinical features

• Treatment

- VERTEBRAL ENDPLATE OEDEMA

• Treatment

This article will cover the following topics:

• Management of lumbar bone stress injury (LBSI)

• Use of imaging

• Three phases of rehabilitation of LBSI

• Relevant case study

This online course focuses on 2 questions. First, does biomechanics in isolation have the potential to advance treatment of LBP? Second, how likely is it that such an approach would improve treatment strategies for LBP? This commentary is presented as a point-counterpoint discussion.

First, we present the view that biomechanics alone cannot lead to improved outcomes for LBP. 

Second, from among the various models that consider biomechanics, we select 3 that offer very different perspectives on how biomechanics may improve outcomes for LBP by guiding selection of clinical interventions.

Third, we present the counterpoint reaction of the authors of the biomechanical models to the presented debate. The overall objective is to foster discussion to encourage fruitful development in this field.

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.

And 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

1 Video
3 Ceu's Package, 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.