Utilizing Clinical Reasoning and Manual Therapy in the Management of Lumbo-pelvic Conditions

Course Title: Utilizing Clinical Reasoning and Manual Therapy in the Management of Lumbo-pelvic Conditions

CEU: 15 credits

Course Description

The emphasis of this course will be on applying evidence-based practice to clinical decision making strategies for the examination and management of patients with common musculoskeletal disorders of the lumbo-pelvic region. A systematic examination process will be presented that will guide the clinician to effectively categorize patients into treatment based classifications. To facilitate learning opportunities Lab time will be used to instruct and practice several diagnostic tests (to differentially diagnose lumbo-pelvic pathology) and manual therapy techniques (muscle energy techniques, thrust and non-thrust joint mobilizations). Patient education and therapeutic exercise will be presented which facilitate symptom management for patients. Other intervention strategies will be discussed that have been found to enhance treatment outcomes.

Objectives:

At the end of the presentation, participants will be able to:

• Critically evaluate the science of evaluation and treatment of the lumbo-pelvic region through the application of an algorithm-based approach.
• Perform a low back evaluation utilizing the principle of symptom reproduction through the application of stresses, special tests and clinical prediction rules.
• Demonstrate psychomotor competency of performing different special tests and manual therapy techniques of the lumbo-pelvic region to enhance outcomes of treatment.
• Formulate an opinion on the value of several different interventions of the lumbo-pelvic region according to the most recent literature
• Integrate effective therapeutic exercises in the intervention of individuals with lumbo-pelvic dysfunction.

Course Schedule:

Day One: 8:00 am-5:00 pm

8 am to 12 noon (15 minute break in the middle of the morning session)

• Introduction of treatment based classification and current clinical practice guidelines for management of low back pain (Lecture)
• Epidemiology/cost/tx effectiveness
• Treatment based classification principles
• Clinical practice guidelines
• Medical screening and examination of the lumbo-pelvic region (Lecture and lab)
• Medical screening and screening for red flags
• Examination techniques of the lumbo-pelvic region

12 noon to 1 pm – Lunch

1 pm to 5 pm (15 minute break in the middle of the morning session)

• Intervention strategies, including manual therapy and traction, for patients with low back pain with radiating/referred symptoms including those with spinal stenosis
• Discussion on current evidence regarding examination and intervention for patient who present with radiating/referred referred pain
• Instruction on centralization techniques of the lumbar spine and manual traction, positional traction
• Instruction in techniques to address pain associated with adverse neural tension.
• Instruction manual therapy techniques and other interventions to address back pain associated with spinal stenosis
• Instruction on self-management techniques
• Diagnostic and intervention strategies to address patients with low back pain associated with mobility deficits (Lecture)
• Wrap up and questions

Day Two: 8:00 am-5:00 pm

8 am to 12 noon (15 minute break in the middle of the morning session)

• Review material from day 1 including round robin practice sessions.
• Diagnostic and intervention strategies to address patients with low back pain associated with mobility deficits (cont) (Lecture and lab)     
  • Discussion on current evidence regarding manipulation and other manual therapy techniques
  • Instruction and practice on specific manipulation and mobilization techniques to address back pain associated with mobility deficits 
• Diagnostic and intervention strategies to address low back pain associated with sacroiliac joint dysfunction     
  • Discussion on current evidence regarding examination and intervention of the sacroiliac joint
  • Instruction and practice on special tests AND specific manipulation, mobilization and muscle energy techniques addressed to the SI joint
  • Instruction on self-management techniques 

12 noon to 1 pm – Lunch

1 pm to 5 pm (15 minute break in the middle of the morning session)

• Continue with intervention strategies for patients with pain associated with sacroiliac joint dysfunction
• Intervention strategies for patients with back pain associated with movement coordination impairments (spinal instability), including patients with spondylolisthesis/spondylolysis
• Discussion on current evidence regarding examination and intervention for patients who present with lumbar instability including spondylolisthesis
• Instruction on progression of stabilization exercises for the lumbo-pelvic region
• Instruction on self-management techniques
• Case presentations
• Round Robin Practice
• Wrap-up, discussion, review of overarching themes, completion of course evaluations.

Instructors:

Dr. Paul Reuteman PT, DPT, MHS, OCS, ATC is a Clinical Professor in the Program of Physical Therapy at the University of Wisconsin – La Crosse. His primary teaching responsibilities include musculoskeletal examination and intervention principles, clinical-decision making and clinical radiology. He maintains an active clinical practice at a private practice affiliated with Riverside Corporate Wellness in La Crosse. His credentials include being a board-certified Orthopedic Clinical Specialist from the ABPTS, is credentialed through the McKenzie Institute and is a board-certified Athletic Trainer from the NATA. Dr. Reuteman recently received the College of Health Sciences Professional Achievement Award from Marquette University and was named the Sports Medicine Teacher of the Year by the Gundersen Medical Foundation. Dr. Reuteman is the co-founder of Specialized Physical Therapy Education and is the Program Director and Instructor of their Orthopedic Residency Program. He also serves as faculty of Gundersen Health Care Sports Physical Therapy Residency Program in Onalaska, WI.