Mechanical Low Back Pain: Differential Diagnosis and Management in the Absence of Imaging
Evidence-based assessment and corrective exercise from the rehabilitation domain, adapted for primary care. A four hour online module followed by a full day of hands-on skills practice to clarify assessment and management of mechanical spine conditions.
Designed for: Family physicians, rural physicians and hospitalists.
Built to complement the four mechanical patterns used in Canadian low back pain pathways.
Rehabilitation-domain assessment skills, adapted for primary care.
Effective pattern recognition, special testing and corrective exercise prescription are used every day to manage complex and unresolving low back pain in the rehabilitation setting, yet they are not always part of primary care training. This course delivers that knowledge in a format tailored to physicians' clinical scope and practice.
The course content's central theme is that effective patient history taking and a structured, evidence-based physical examination allows the physician to recognize and manage common mechanical low back pain conditions without imaging, and to explain to patients why this approach serves them better than routine imaging. The skills are especially relevant for rural and remote practice, where access to imaging and rehabilitation services may be limited.
What you take back to practice.
Confidence without imaging
Classify mechanical low back pain and sciatica from a structured history and examination when imaging is delayed, unavailable or not indicated.
An efficient red flag and neurological screen
A time-efficient screen, including upper motor neuron signs, sacral sensation and the crossed straight leg raise, with clear thresholds for urgent referral.
Corrective exercise principles
How directional preference and stabilisation principles guide exercise selection for each mechanical presentation.
Plain-language patient communication
Plain-language phrasing to explain why imaging is not indicated for mechanical low back pain without red flags.
Low-cost self-management resources
Publicly accessible self-management resources for patients with mechanical low back pain who face cost or access barriers to physiotherapy.
Skills you use in your next clinic
Supervised practice with direct coaching and timed mock assessments, so the examination fits the pace of your practice.
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 courseHands-on skills and management practice
Each segment of the clinical exam is reproduced under supervision with direct feedback, self-reflection and coaching. Skills are then integrated into timed clinical mock scenarios using the most common mechanical low back presentations.
8:30 am to 5:00 pm | 7 hours of instructionPre-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 timed assessments
Twelve-minute assessments with feedback for disc herniation, stenosis (plastic deformation and bony change), far lateral disc herniation and adherent nerve root.
Persisting symptoms
Hypermobility, the sensitized segment and spondylolisthesis, plus visceral and pelvic contributors.
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. Serious pathology such as cauda equina, infection, fractures, malignancy and inflammatory conditions such as spondyloarthritis are covered in this course only for red flag screening and appropriate referral. This course does not give guidance on the diagnosis or treatment of these conditions. 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 day. Part 2 is one in-person day, 8:30 am to 5:00 pm, with 7 hours of instruction: a brief review of the reading, then supervised hands-on practice of every test covered online, then timed clinical scenarios.
Who is this course for?
Family physicians, rural physicians and hospitalists who assess and manage adults with low back pain.
Are there prerequisites?
Yes. You must be a licensed physician. You also need to complete the online pre-course reading before the in-person day.
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 the full in-person day are completed.
Do you offer group or clinic registration?
No. Physicians should register individually. If you are a large medical clinic, facility or hospital (15+ physicians) 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.
Join the interest list
Contact
-
info@spinecourse.ca
