Lumbar Spine

Back Pain 300 Series: Advanced Diagnosis & Management

Access:150days 
Cost: $300 NZD | Payment plan available at checkout
Study Time: 31hrs (approx.)

CPD Certificates provided.

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The Back Pain 300 series of courses is a programme of study designed for physiotherapists, medical practitioners and other health care providers who have experience with managing people with persistent low back pain and referred lower limb pain. 

The Back Pain 300 Starter Pack includes Back Pain 300, and 301 courses that provide an overview of sources of causes of low back pain and introduces the concept of discogenic pain.

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Back Pain 201: Advanced Assessment

 

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Access: 60 days

Cost: $249 NZD

Study time: 10 hours approximately + self directed reading

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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.

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Back Pain 101: Basic Assessment & Treatment

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Cost: $160.00 NZD

Access: 60 days

Study time: 10 hours approx.

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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:

  1. Knowledge of prevalence and impact of back pain on the individual and society
  2. Able to carry out an evidence based clinical histor
  3. Able to select appropriate questionnaires to identify red flags
  4. Use the StartBacK screening tool to assess psychosocial distress and risk of persistent pain.
  5. Identify cases with possible radicular pain and/or radiculopathy
  6. Able to identify that subgroup of patients suitable for basic level guideline care, and those patients who require more advanced or specialist level care
  7. Able to do a standard physical examination that includes observation, differentiating between normal asymmetry and relevant deformity, neurologic screening for nerve root compression.
  8. Able to select patients suitable for an extension protocol of exercise, posture adaption
  9. Able to select patients suitable for a flexion protocol of exercise, posture adaption
  10. Lean to follow up in a timely and appropriate manner.
  11. Able to discharge patients in a timely and appropriate manner
  12. Able to adequately document baseline, initial and follow up assessment/treatment findings in clinical notes.   

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3 Case Studies of Persistent Lumbar Spine Pain

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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

  1. Introduction
  2. Ian. 54 year old salesman with 8 years of persistent central low back pain with daily severe immobilising twinges and intolerance to prolonged sitting.
  3. Rosie. 18 year old athlete with 2 years of dominant buttock pain interrupting professional basketball career.
  4. Tom. 32 year old electrician with 8 years of persistent unilateral low back pain causing him to change occupations three times.
  5. 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:

  1. The history, the physical examination and follow up consultations are presented as separate video presentations.
  2. Each case has depersonalized case notes in the form of letters, imaging, and reports. Follow ups are more 12 months.
  3. Reading case notes online and in the course manual.

Learning Outcomes:

  1. Demonstrate 3 different patho-anatomic subsets of non-specific low back pain may be identified by clinical assessment and clinical reasoning
  2. Demonstrate the clinical assessment used in the consultations
  3. Demonstrate appropriate use of and referral for confirmation by reference standard diagnostic procedures
  4. 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

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Is a Specific Diagnosis Possible for the Painful Lumbar Spine? Webinar

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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)

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