Lumbar Disc Pathologies: Osteopathic Assessment and Treatment Strategies

Mario Luis González, Pt-MSc -Eur Ost DO (Belgium-Spain), a well known European specialist in lumbar discopathy management, teaching his knoweldges and manipulative skills in Europe and South America,  invites you for the first time in Canada to enroll in this exclusive and exciting onsite but also online course.

OBJECTIVES, PURPOSE, RELEVANCE FOR THE PUBLIC TO WHOM THE COURSE IS REFLECTED

Low back pain and neuropathy of disc origin are pathologies of great recurrence in all medical, physiotherapy and osteopathic consultations.

Among the wide range of therapies available for this condition, osteopathy and its different models have proven to be clinically effective and can be an initial and long-term alternative to surgery.

This requires the therapist to be highly specialised in the specific diagnostic models and treatment strategies.

Being effective while being aware of contraindications when treating different types of low back pain is a major challenge.

Specific lumbar and disc biomechanics and kinematics, disc pathophysiology, and assessment strategies in the three planes of space will be described in order to tailor treatment according to local or global causal patterns.

In this module, we will focus on myofascial alterations in static and dynamic sagittal balance and present different work modalities, with specific HVLA, distraction and disc resorption techniques as well as myofascial, myotensive and visceral techniques.

The programme of this course will include a total of 21 hours of teaching, during which a manual clinical reasoning of the lumbar disc pathology will be developed and appropriate manipulative techniques will be shown.

This course is designed for osteopaths, physiotherapists (specialists), chiropractors.

This course will be available online via zoom, in real time! The course will be recorded for free viewing later to all!

TOTAL CEUs EARNED at the end of the course: 2 CEUs (21h) with a certificate issued at the end of the course to all participants (onsite and online).

Note: language will be French with English translation.

IMPORTANT! If you want to attend the course but you cannot be physically present, no worries, it will be possible to attend, from home, as you were there! Indeed, the 3-day course will be available, live, via zoom, and recorded for futher viewing (to all! Present or not)! You will be able to ask questions as you were there! If you are interested to participate remotely and If you might have question about that, please email us: admin@iosr-halifax.ca

The price for online participation remains the same and ticket is to be bought at the bottom of the page.

SKILLS THAT WILL BE ACQUIRED

At the end of the course the participant will be able to:

Theorical Introduction

• To update knowledge in relation to the physiology and biomechanics of the lumbar spine and pelvis.
• To understand the physiological processes that lead to disc deterioration.
• To enable the correct performance of clinical tests for the establishment of a differential diagnosis.
• Visualize and understand the symptomatology, multiple mechanisms, etiology and types of disc degeneration.
• Identification of Red Flags.
• Integrate the various postural and myofascial typologies and understand their osteopathic contributions to the degenerative processes.
• Recognise the biomechanical, spinal and supra-spinal effects that best explain the effects of manipulation.
• Integrate and recognize the various types of degenerative processes and their visualizations by images.

Practice

• Implement a simple and reproducible test plan and protocol
• Manual localization of the floors and segments of functional surgarges in the three planes of space
• Establish a local and/or global osteopathic/manual treatment strategy according to the etiology
• Integrate new and different evaluation tools in the pain processes of disc origin.
• To visit the classical approaches in a perspective centered on the refunctionalization of the vertebral axis.
• To afinner and reconceptualize the techniques of HVLA manipulations of the lumbar spine, giving importance to the correct focus of the gesture.
• To approach an osteopathic consultation with an acute or sub-acute patient with tranquillity and security.
• To know the medical and surgical possibilities if necessary.

Day 1 (8 hours: 9 AM to 11 AM; 11.15 AM to 13 PM; 14PM to 16PM; 16.15 to 18PM).

1. introduction

- Epidemiology

- Basic differential diagnosis

- Evidence-based clinical assessment of the lumbar spine

- Biopsychosocial assessment

- Sensitisation phenomenon

- Disc immune response and neuropathy

- Physiological inflammatory reaction

- Spontaneous regression of herniations.

- Effect of herniations on neural roots and radiculopathy

- Influence and relationship of posture on disc pathology.

+ Practice sessions

2. The intervertebral disc

- Macroscopic and microscopic structure of the healthy disc.

- Irrigation and innervation of the disc

- Physiological characteristics of the disc

- Physiopathology of the disc and its modifications

- Relationship of the disc with the neural roots

- Discogenic pain and its difference with other nociceptive, referred and projected pain.

+Practice session

3. Lumbar and disc mechanics

- Physiological ranges of motion and lumbosacral segmental patterns

- Spinal and pelvic kinematics and biomechanics and impact on the disc.

- Biomechanics of the disc

- Static and dynamic sagittal rhythms and load distribution.

+Practice session

Final considerations and summary of the day

Day 2 (8 hours: 9 AM to 11 AM; 11.15 AM to 13 PM; 14PM to 16PM; 16.15 to 18PM).

4. Disc injury and degeneration

- Etiologies

- Physiopathology of lumbar disc degeneration

- Effect of compressive forces on the intervertebral disc

- Degeneration and aging.

- Types and updated nomenclature of disc disorders

+Practice session

5. Diagnosis - Assessment

- The clinical reasoning process of disc pathology.

- Discogenic pain and the difference with other nociceptive, referred and projected pain.

- Neuropathic pain and central sensitisation

- Clinical manifestations of neuropathic pain

- Neurological examination

- Global mobility test

- Analytical mobility test

- Ballistics of the hernia according to Lippincot and Gil Lavigne

- Volumes, pressures and rhythms in the sagittal plane

+Practice session

Final considerations and summary of the day

Day 3 (8 hours: 9 AM to 11 AM; 11.15 AM to 13 PM; 14PM to 16PM; 16.15 to 18PM).

6.  Polymodality of the treatment

- 3D strategies from global to local

- Reprogramming of dysfunctional breathing patterns

- Visceral-Vascular: nociceptive afferences on lumbar metamers.

- Reprogramming of sagittal myofascial patterns and synergies.

- 3D manipulative spinal treatment and its different classical modalities adapted to disc pathology.

- Importance of the nutritional and metabolic aspect.

- SOT and herniated discs

Practice session

7. Diagnosis and interpretation of disc disease by imaging and magnetic resonance imaging.

Final considerations and summary of the day. End of the course.

SELECTED READINGS

Licciardone JC, Schultz MJ, Amen B. Osteopathic Manipulation in the Management of Chronic Pain: Current Perspectives. J Pain Res. 2020;13:1839-1847 https://doi.org/10.2147/JPR.S183170

S Demaille-Wlodyka, M.-M Lefevre-Colau, S Poiraudeau, M Revel,

Sciatalgies et autres irradiations non discales,

EMC - Rhumatologie-Orthopédie,

Volume 1, Issue 2, 2004, Pages 117-129, ISSN 1762-4207,

https://doi.org/10.1016/j.emcrho.2003.12.004.

Sertac Kirnaz, Charisse Capadona, Taylor Wong, Jacob L. Goldberg, Branden Medary, Fabian Sommer, Lynn B. McGrath, Roger Härtl,

Fundamentals of Intervertebral Disc Degeneration,

World Neurosurgery,

Volume 157,2022,Pages 264-273,

ISSN 1878-8750,

https://doi.org/10.1016/j.wneu.2021.09.066.

Fulvio Dal Farra, Roberta Giulia Risio, Luca Vismara, Andrea Bergna,

Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis,

Complementary Therapies in Medicine,

Volume 56,2021,102616, ISSN 0965-2299,

https://doi.org/10.1016/j.ctim.2020.102616.

Iván Cosamalón-Gan, Tatiana Cosamalón-Gan, Giancarlo Mattos-Piaggio, Vega Villar-Suárez, José García-Cosamalón, José Antonio Vega-Álvarez,

Inflammation in the intervertebral disc herniation,

Neurocirugía (English Edition),

Volume 32, Issue 1, 2021,Pages 21-35, ISSN 2529-8496,

https://doi.org/10.1016/j.neucie.2020.04.001.

Annen M, Peterson C, Leemann S, Schmid C, Anklin B, Humphreys BK. Comparison of Outcomes in MRI Confirmed Lumbar Disc Herniation Patients With and Without Modic Changes Treated With High Velocity, Low Amplitude Spinal Manipulation. J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):200-9.

https://doi: 10.1016/j.jmpt.2016.02.012. Epub 2016 Apr 1. PMID: 27046146.