1. Core Low Back Tool
Dr. Julia Alleyne BHSc(PT) MD MScCH Dip Sport Med CCFP(SEM) FCFP
Code Spine March 2018

2. Faculty / Presenter Disclosure Disclosure of Commercial Support
Faculty: Dr. Julia Alleyne
Relationships with commercial interests:
Grants/Research Support: None
Speakers Bureau/Honoraria: None
Consulting Fees: Centre for Effective Practice, Tool Development, Not for Profit Organization, Free tool
-Other: None
Disclosure of Commercial Support
This program has not received financial support.
Potential for conflict(s) of interest:
There is no payment or funding for this program.
All Tools are available at no cost through the public domains of many organizations who have endorsed the tool.
MSK CONNECT - WEEK 1

3. Primary Care Provider Dealing with complex and chronic LBP
Patient expectations for MRI & referrals
Psychosocial patient needs
Lack of patient educational resources
Lack of tools in guideline recommendations
Work related restrictions
Medication (Opioid Management)

4. Patient Barriers
Lack of understanding of rationale for investigations and specialist referral
Desire for funding for physiotherapy
Lack of self-management strategies
Request for more medications
Request for time off work
Lack of understanding of urgent symptoms versus pain
Lack of education on etiology of low back pain
Access to medical appointments

5. System Barriers Poor communication between providers
Lack of coordinated patient education material
Lack of web resources
Lack of consensus on guidelines
Lack of common approach between providers assessment and treatment

6. Gap Analysis of Current Guidelines
Includes: Continuum specific Key Messages Red Flags Yellow Flags Investigations Referrals Medications
American College of Physicians and was endorsed by the American Academy of Family Physicians. Towards Optimizing Practice, Alberta New Zealand Yellow Flags

7. Gap Analysis of Current Guidelines
Includes:
Continuum specific
Key Messages
Red Flags
Yellow Flags
Investigations
Referrals
Medications
Lacks
Approach to Assessment
Clinical Tools
Office Strategies
Patient Specific Approach

9. Give us one tool !

11. CORE LOW BACK TOOL

18. Range of Motion Identify Current Pain VAS Move Is your pain Better
Worse
Unchanged

19. Prone Extension Arms push up Buttock relax
May use pillow to support pelvis
5-10 Repetitions
Looking for pain improvement

20. Passive Hip Range of Motion

21. Passive Straight Leg Raise

22. Femoral Nerve Stretch

23. Myotomes Knee Extension Ankle Dorsiflexion Great Toe Extension
Great Toe Flexion

24. Complete your Neuro Deep Tendon Reflexes Dermatomal Sensation
Babinski Reflex

27. Evaluating Response to Treatment
Pain Improves
Reduce pain medication
Reinforce appropriate activity/exercise
Increase exercise /return to activities
Follow-up at patient’s discretion
Pain Unchanged
Re-assessment
Flags & Pattern
Review Activity/Exercise
Technique/ Dose
Pain Aggravation
Schedule recovery
Review Medication
Dosing/ Consistency/ Side Effects
Consider Rehab referral
Follow-up in 3-7 days to determine response
Pain Worsens
Flags & Pattern (Evolving or Combination)
Consider imaging/referral
Yellow Flags - ? CBT
Consider Non-Mechanical Low Back pain diagnosis
If above is negative, refer to Unchanged column

29. Reasons for referral to a spinal surgeon
Appropriate reasons for referral
Inappropriate reasons for referral

30. Comfort with Assessing & Managing LBP
Consistent increase in comfort as a predictor of behavior

31. Confidence in Assessing & Managing LBP
Consistent increase in confidence as a predictor of behavior
15%
18%
20%
22%

32. Saskatchewan Spine Pathway

33. BCMA Practice Support Program