Spinal Stenosis: Contemporary Diagnosis and Therapy Management

Course Outline

1. Module 1: Introduction and Pathophysiology of Spinal Stenosis

   • Epidemiology and Clinical Significance

   • Anatomy and Pathoanatomy of the Stenotic Spine

   • Classification Systems: Central, Lateral, and Foraminal Stenosis

   • Neurogenic Claudication vs. Vascular Claudication: The Critical Differentiation

2. Module 2: Clinical Diagnosis and Differential Diagnosis

   • Patient History: Key Interview Questions and Symptom Mapping

   • Physical Therapy Examination: Subjective and Objective Measures

   • Diagnostic Imaging: Interpretation and Correlation with Clinical Findings

   • Outcome Measures and Functional Assessment Tools

3. Module 3: Evidence-Based Therapeutic Management

   • The Biopsychosocial Model in Lumbar Spinal Stenosis (LSS)

   • Core Principles: Flexion-Based Strategies and Centralization

   • Exercise Prescription: Strength, Flexibility, and Neuromotor Control

   • Manual Therapy and Modalities: Evidence and Application

   • Body Weight-Supported Treadmill Training (BWSTT) and Gait Retraining

4. Module 4: Occupational Therapy Interventions for Functional Independence

   • Activity Modification and Energy Conservation Techniques

   • Adaptive Equipment and Assistive Technology

   • Home and Work Environment Assessments

   • Pain Management and Cognitive-Behavioral Strategies

5. Module 5: Interdisciplinary Management and Surgical Considerations

   • Medical Management: Injections and Pharmacotherapy

   • Surgical Interventions: Decompression, Fusion, and Interspinous Spacers

   • Comparing Outcomes: Therapy vs. Surgery (Review of Key Trials)

   • The Role of Pre-Habilitation (Prehab) and Post-Surgical Rehabilitation

6. Module 6: Case Studies and Clinical Integration

   • Case Study 1: Conservative Management of Mild-Moderate LSS

   • Case Study 2: Multimodal Management of Severe LSS with Comorbidities

   • Case Study 3: Post-Surgical Rehabilitation Following Decompression

   • Case Study 4: The Chronic Pain Patient with Central Sensitization

7. Course Post-Test & Evaluation

Course Objectives

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

1. Differentiate between the pathoanatomical subtypes of spinal stenosis and their corresponding clinical presentations.

2. Accurately perform a differential diagnosis to distinguish neurogenic claudication from vascular claudication and other mimicking conditions.

3. Select and interpret appropriate patient-reported outcome measures (PROMs) and physical performance measures for individuals with spinal stenosis.

4. Design and implement an evidence-based, multimodal physical therapy plan of care centered on flexion-based exercises, neuromuscular re-education, and functional training.

5. Integrate occupational therapy interventions, including activity modification, energy conservation, and adaptive strategies, to enhance participation in daily activities.

6. Critically appraise the current evidence comparing the long-term outcomes of surgical versus non-surgical management for lumbar spinal stenosis.

7. Develop comprehensive rehabilitation protocols for patients both pre-operatively and post-operatively.

8. Apply clinical reasoning skills to complex case scenarios involving comorbidities and chronic pain.