Physical Therapy Diagnosis and Management of Lumbar Spinal Instability: An Evidence-Based Approach, a Case Series

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Course Outline

Module 1: Introduction & The Problem of Low Back Pain

• The prevalence and impact of chronic low back pain (LBP).
• Critiquing common medical interventions: imaging, opioids, injections, and surgery.
• The need for evidence-based conservative management.
• Defining lumbar spinal instability (Panjabi's model).

Module 2: Evidence-Based Diagnosis of Lumbar Instability

• The challenge: Poor correlation between radiological findings and clinical symptoms.
• Introduction to the Passive Lumbar Extension (PLE) Test (Kasai et al., 2006).
• Critical appraisal of diagnostic tests: Understanding sensitivity, specificity, and likelihood ratios.
• Applying the PLE test in clinical practice: Procedure and interpretation.

Module 3: Differential Diagnosis & Outcome Measures

• The role of the Straight Leg Raise (SLR) and Slump tests in differential diagnosis.
• Selecting the best outcome instrument: A comparison of low back disability questionnaires.
• The rationale for selecting the Oswestry Disability Index (ODI).

Module 4: Evidence-Based Intervention

• Critical appraisal of the Celestini et al. (2005) randomized controlled trial.
• The efficacy of bracing + exercise vs. bracing alone.
• Detailed breakdown of the 8-component therapeutic exercise program for LSI.
• Practical application: Tailoring intensity and volume to the patient.

Module 5: Case Series Application & Clinical Integration

• Review of patient demographics and initial examination findings.
• Integrating the evidence: From evaluation to treatment planning.
• Analyzing patient outcomes using ODI and pain scales.
• Discussion on patient variability, limitations, and future research directions.

Course Objectives

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

1. Analyze the limitations of common medical and surgical interventions for chronic low back pain and advocate for evidence-based conservative care.
2. Apply the Passive Lumbar Extension (PLE) test, interpreting its results based on known sensitivity, specificity, and likelihood ratios to aid in diagnosing lumbar instability.
3. Differentiate between the diagnostic utility of the Slump test and the Straight Leg Raise test for patients with lumbar radiculopathy.
4. Justify the selection of the Oswestry Disability Index (ODI) as a primary outcome measure for patients with low back pain based on its psychometric properties.
5. Design an evidence-based treatment plan for a patient with lumbar spinal instability that incorporates a soft brace and a progressive, multi-faceted therapeutic exercise regimen.