18.1: Low Back Pain and the Evidence for Effectiveness of Physical Therapy

Each monograph will be 18 to 24 pages in length and require 4 to 6 hours to complete. Course registrants will receive the entire course, along with the final examination, answer sheet, and registration form for continuing education units when they register. To receive continuing education credit, registrants must return the answer sheet and CEU form within 3 months, and must score 70% or higher on the 24-question multiple-choice examination. Registrants who successfully complete the examination will receive a certificate recognizing the contact hours earned. Only the person named on the registration form may obtain the contact hours.

This course provides the registrant with current clinical information needed to evaluate and treat patients who have low back pain. Primary emphasis is on integrating the science underlying the biology of lumbar pathology and applying evidence-based methodologies to achieve an effective outcome. Each author contributes a unique perspective and the series represents one of the most comprehensive works available.

Upon completion of this course the participant will be able to do the following:

1. Explain the influence of joint morphology on lumbar and sacral kinematics.
2. Explain the potential influence of anatomic variation in vertebral structure on the spinal column.
3. Understand the indications and uses of plain film radiography, magnetic resonance imaging, and computed tomographic imaging for evaluation of low back pain.
4. Describe frequently encountered plain film, magnetic resonance imaging, and computed tomography findings associated with low back pain.
5. Understand the nomenclature of radiology to enhance communication between referring physicians and physical therapists.
6. Integrate radiographic findings into the design and delivery of rehabilitation.
7. Recognize signs and symptoms of non-musculoskeletal causes of low back pain and identify signs and symptoms that necessitate medical referral.
8. Define and differentiate the origins of pain in the lumbar spine.
9. Discuss the diagnostic accuracy of commonly used assessment techniques for the lumbar spine.
10. Discuss the use of questionnaires and clinical prediction rules in the assessment of low back pain.
11. Understand the importance of early recognition of psychological factors when managing patients with low back pain.
12. Discuss the theoretical structure and clinical implications of the fear-avoidance model of musculoskeletal pain for patients with low back pain.
13. Identify psychological factors that should be screened for when managing patients with low back pain.
14. Identify potential future directions for psychological factors and musculoskeletal pain.
15. Appreciate the need for treatment-based classification of patients with low back pain.
16. Distinguish between classification-based treatment and traditional pathology-based diagnosis and treatment.
17. Understand the role of clinical prediction rules in the development of classification-based treatment strategies.
18. Select evidence-based interventions for patients with low back pain based on the classification subgroup.
19. Apply the current approved patient outcomes measures for lumbopelvic pain and recite the current minimally clinically important change scores for each measure.
20. Compare and contrast the different forms of lumbopelvic pain interventions (ie, modalities, exercise, manual therapy, traction, and back school) and the current levels of evidence associated for each in the care of lumbopelvic pain.

• Lumbar Anatomy and Physiology-Mark Bishop, PT, PhD
• Diagnostic Imaging in Physical Therapy Management of Low Back Pain-Ross E. Biederman, DPM
• Lumbar Examination and Assessment-John Jefferson, PT, MSc, CMT
• Psychological Screening and Management of the Patient with Low Back Pain-Steven Z. George, PT, PhD
• Low Back Treatment-based Classifications-Julie M. Fritz, PT, PhD, ATC and Joshua A. Cleland, PT, DPT, PhD, OCS, FAAOMPT
• Lumbar Interventions-Chad Cook, PT, PhD, MBA, OCS, FAAOMPT and Ken Learman, PT, PhD, OCS, COMT, FAAOMPT

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