COURSE CONTENT

The aim of this course is to review the facts, assessment, and treatment of low back pain in order to guide clinical physiotherapy practice. After completing this course, participants will be able to apply evidence-based evaluation and treatment of low back pain immediately.

The course provides an evidence-based pathoanatomical evaluation and testing approach.

It is designed to offer a pragmatic perspective on the evidence-based evaluation and treatment of acute and persistent low back pain. It is grounded in scientific evidence and a broad perspective, reviewing current knowledge, dispelling myths, addressing controversies, and offering a thought-provoking course. The ultimate goal is to promote a rational and balanced approach to the clinical management of low back pain.

The course context includes the biopsychosocial model, diagnostic classification, evidence-based pathoanatomical assessment and testing using likelihood ratios and selected clinical prediction rules, as well as a review of treatment guidelines. The course provides clinically relevant knowledge that will enhance current practice and strengthen clinical confidence in treating and educating individuals with low back pain. Both didactic and practical aspects are included, with lectures focused on practical application and minimal irrelevant theory.

COURSE OUTLINE

Section 1: Introduction
• Overview
• Causes of low back pain and “red flags”
• Basics of pain, pain system, biopsychosocial model
• Psychological factors
• Potential pain generators
• Risk factors
• Imaging – brief overview

Section 2: Assessment
• Screening assessment
• Subjective, historical, patient profile, observation context
• Statistics: 3-minute overview
• Key areas of evidence-based assessment: discogenic pain, nerve root and/or radiculopathy, facet joint, sacroiliac joint, lumbar spinal stenosis, hip joint, myofascial trigger points, others (inflammatory back pain, hamstring-related pain)

Section 3: Treatment
• Selective treatment
• Review of prescription medications and guidelines
• International guideline overview
• Pathoanatomical guideline overview
• Evidence-based approaches to low back pain treatment
• Education
• Exercise
• Myofascial trigger points and dry needling
• Clinical prediction rules for manipulation
• Methods: short discussion
• Cochrane reviews on low back pain: exercise, manual therapy, massage, dry needling, education, electrophysical modalities, psychosomatics, physiotherapy-related issues, prescription medications, interventional procedures, surgery

SAMPLE TOPICS DISCUSSED

• What is the definition of low back pain?
• What are acute, subacute, and persistent low back pain?
• What is the epidemiology and natural course of low back pain?
• What are common, unusual, and unmissable causes of low back pain?
• What is “low back pain classification”?
• What are the most frequent red flags, and are they reliable indicators?
• Why are pain mechanisms important in clinical practice and patient education?
• What is peripheral and central sensitization and pain modulation?
• Why is the biopsychosocial model and patient-centered care important?
• What are modifiable risk factors of low back pain, including in athletes?
• What role do comorbidities play?
• Imaging: why and when to image, and when not?
• What can be a potential source of low back pain/nociception?

Assessment-related questions:

• What are specificity, sensitivity, and likelihood ratio, and why do they matter?
• How reliable is diagnosing discogenic pain?
• How to differentiate discogenic pain from radiculopathy?
• What is pseudosciatica? Is the sacroiliac joint mobile, and are movement tests reliable?
• Do provocation tests matter for sacroiliac joint assessment?
• What is the active straight leg raise?
• What is spinal stenosis, and what are its features?
• How is the sacroiliac joint related to low back pain?
• How reliable is facet joint pain diagnosis? What do studies show? What are Revel’s criteria?
• Are myofascial trigger points important in low back pain?

Treatment-related questions:

• What are the main approaches to low back pain treatment?
• What is multimodal and multidimensional treatment, and active vs. passive treatment?
• How important is individualized treatment?
• Do patient expectations affect outcomes?
• What is the Hawthorne effect and why does it matter?
• What is the evidence for low back pain treatment?
• How do the 2016 NICE guidelines support a pragmatic approach?
• Are neuromuscular exercises important?
• What matters in internal vs. external exercise methods?
• What is comfort and threat, and why does it matter?
• What is the role of exercise in pain management?

LECTURER: DR. JOHNSON MCEVOY (BSc, MSc (Sports Physio), DPT, PT)
Dr. Johnson McEvoy has delivered lectures and led over a hundred courses in Ireland, the UK, Belgium, Spain, Portugal, Germany, Switzerland, and the USA. He has published extensively, including on Dry Needling (safety and clinical application). He graduated in 1993 with a degree in Physiotherapy from Trinity College Dublin, worked at the National Rehabilitation Hospital in Dublin, and later in the USA, gaining extensive experience in musculoskeletal rehabilitation.

After returning to Ireland in 1997, he opened his private practice in 2000 and worked with elite athletes at the National Coaching and Training Centre. From 2003 to 2017, he was the Head Physiotherapist of the Irish Amateur Boxing High-Performance Program across four Olympic cycles, including the Athens 2004 Olympic Games.

Since 2003, he has been teaching clinically relevant physiotherapy courses, including myofascial trigger point therapy, dry needling, and low back pain management. He also lectured for six years at the University of Limerick and continues to teach in various Irish university programs. In 2012, he chaired the development of the Irish Society of Chartered Physiotherapists’ Dry Needling guidelines.