Mechanical Low Back Pain: Differential Assessment and Management in the Absence of Imaging
A structured, evidence-based clinical examination that differentiates the most common mechanical low back presentations and links each to targeted management. A four hour online module followed by two full days of hands-on skills practice.
Designed for: Physiotherapists, athletic therapists, chiropractors, osteopathic manual practitioners and osteopaths.
A detailed overview of mechanical low back pain evaluation and management, featuring two days of supervised practice of key hands-on skills and corrective exercises.
Allied healthcare professionals already use special testing and corrective exercises for common musculoskeletal conditions. This course refines those skills into a structured, evidence-based clinical examination to differentiate the most common mechanical low back pain presentations. Targeted rehabilitation is then directed towards the relevant pain generating tissue or movements.
The course content includes clarification of painful pathophysiology of the lumbar spine, the use of movement testing, pattern recognition, related centralization/peripheralization phenomena and adopting a structured sense of clinical reasoning. This approach allows the clinician to guide management with confidence, without relying on imaging, and recognize when a patient needs referral to a physician.
What you take back to practice.
A structured mechanical examination
A consistent assessment sequence that differentiates disc herniation, far lateral disc herniation, stenosis, adherent nerve root, hypermobility, the sensitized segment and spondylolisthesis.
Refined special testing technique
Two full days of supervised practice with direct feedback and coaching on every test taught in the reading.
Management matched to the assessment
Practise exercises to reduce plastically deformed discs, understand directional preference and stabilization of hypermobile segments.
Red flag screening and referrals
Review red flag questions, neurological screening and special testing clusters for non-mechanical pain with referral to physicians.
Additional assessment skills
Leg length discrepancy testing and management, condition-specific palpation, and visceral and pelvic contributors.
Low-cost self-management resources
Evidence-based self-management resources for patients with mechanical low back pain who face barriers of cost, travel or wait-times.
Each teaching concept is referenced and graded by strength of evidence.
The pre-course reading cites more than 100 peer-reviewed and clinical sources. Each teaching point states the type of evidence behind it, so you can weigh it accordingly. Content was reviewed by a Scientific Planning Committee of family and sport medicine physicians.
Course content includes:
- Systematic reviews
- Meta-analyses
- Randomized controlled trials
- Clinical practice guidelines
- Expert opinion
- Emerging research
- Choosing Wisely Canada recommendations
Read the evidence. Learn the mechanical principles. Practise hands-on skills.
Pre-course reading
Ten educational modules, including a concept briefing, patient vignettes, and knowledge-check quizzes with answers and explanations. Mechanical concepts behind clinic tests are referenced to the peer-reviewed literature.
About 4 hours | self-paced, before the in-person courseTwo days of hands-on skills and management practice
Each segment of the clinical exam is demonstrated, then reproduced under supervision with direct feedback and coaching. Full assessments of the most common mechanical low back presentations are practised with feedback, along with the matching management techniques.
Two days | 8:30 am to 5:00 pm each dayPre-course reading modules
Essential physical examination skills from the reading content are practised in person, with direct coaching.
History and screening
Key history questions by presentation, red flag and neurological screening, Beighton score and hip screen.
Movement assessment
Lumbar range of motion, flexion hinge, extension restriction, palpation and instability testing.
Special tests
Quadrant and lateral translation, seated slump and straight leg raise.
Directional preference
Repeated prone extension and quadruped flexion to identify the movement that reduces symptoms.
Full assessments with feedback
Disc herniation, stenosis (bony change), stenosis with radiculopathy from plastic deformation, far lateral disc herniation and adherent nerve root.
Management practice
Reducing plastically deformed discs and stabilising hypermobile spinal segments, practised with direct coaching.
Persisting symptoms
Hypermobility, the sensitized segment and spondylolisthesis.
Additional assessment skills
Additional special tests, leg length discrepancy tests and management, and palpation specifics for each condition.
Visceral and pelvic involvement
Recognising visceral and pelvic floor contributions to low back pain, with a summary of the full approach.
A structured clinical examination you can use in your next clinic.
At the conclusion of this activity, participants will be able to:
Scope: adults presenting with mechanical low back pain without red or yellow flags. Aligned with Choosing Wisely Canada recommendations to avoid routine imaging when red flags are absent.
Physicians and rehabilitation clinicians, collaborating to improve patient care.
Family physician with a Certificate of Added Competence in Sport and Exercise Medicine. Co-owner and medical director of the Carleton Sport Medicine Clinic, with Olympic and Pan Am Games medical team experience.
Family physician with a Certificate of Added Competence in Sport and Exercise Medicine. Assistant Professor, Department of Family Medicine, University of Ottawa. Chief Medical Officer for Taekwondo Canada, with Olympic, Paralympic and Pan Am Games medical coverage.
Certified Athletic Therapist, Osteopathic Manual Practitioner and Registered Kinesiologist. Clinical focus on the assessment and management of mechanical spine pain and sciatica. Taught spine assessment skills to University of Ottawa Sport and Exercise Medicine Program fellows and family and sport medicine physicians since 2015. Worked with Rugby Canada, Athletics Canada and has World Championship and Commonwealth Games medical coverage.
Common questions.
How is the course structured?
The course runs in two parts, in order. Part 1 is the online pre-course reading: ten self-paced modules, about 4 hours in total, with concept briefings, patient vignettes and knowledge-check quizzes. It is completed before the in-person days. Part 2 is two in-person days, 8:30 am to 5:00 pm each day: each part of the clinical examination is demonstrated, then practised under supervision with direct feedback, followed by full assessments of common mechanical low back presentations and their matching management techniques.
Who is this course for?
Physiotherapists, athletic therapists, chiropractors, osteopathic manual practitioners and osteopaths who assess and manage adults with low back pain.
Are there prerequisites?
Yes. You must be a physiotherapist, athletic therapist, chiropractor, osteopathic manual practitioner or osteopath in good standing with your regulatory college or certifying association. You also need to complete the online pre-course reading before the in-person days.
What should I wear and bring?
Comfortable clothing that allows movement of the spine and hips. You will practise physical tests and perform clinical exams as both examiner and model patient on treatment tables, which we provide.
What if I have back pain or my physical limitations prevent me from completing a specific part of the course?
Our goal is to support your learning journey. If a specific course component is not physically accessible for you, we will work together to find an equitable alternative. This may include participating via observation, focusing on theoretical application, or issuing a certificate of completion tailored to the components you achieved. Please contact info@spinecourse.ca so we can discuss a supportive plan.
Is a certificate provided?
Yes. A certificate of completion is issued once both the online module and both in-person days are completed.
Do you offer group or clinic registration?
No. Clinicians should register individually. If you are a large clinic, facility or hospital (15+ clinicians) and would like this course delivered for your team, please email us at info@spinecourse.ca.
What is the refund policy?
Full refund, less a $75 administration fee, if you cancel at least 30 days before the in-person course. No refunds are issued within 30 days of the course. Instead, your fee can be transferred to a future course delivery at any location: free if requested at least 30 days before the course, or $75 within 30 days. Your registration can also be transferred to another eligible clinician for $75 with at least 7 days' written notice; the new attendee receives full access to the online pre-course modules, and the original registrant's access ends on the transfer date. If Mechanical Spine Pain Institute cancels a session, you will receive a full refund. See our Terms & Conditions for details.
Dates and registration
Course dates, locations and fees will be announced soon. Join the interest list below and we will email you when registration opens.
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Contact
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info@spinecourse.ca
