Low Back PainAssessment and Management
Workshop-The Latest Developments from Australia-
Kotelawala Defence University IRCAugust 2015
Kusal Goonewardena (MaSpPhysio, GradCertSpPhysio, BaPhysio)Elite Athlete (APA) Sports PhysiotherapistHead of Sports MedicineElite Akademy Sports Physiotherapy Melbourne Australia
WHO I AM AND WHAT I DO…
One
15year CareerFounder/Director of 3 Sports Medicine
Clinics Australia
Over 50,000 Treatment Sessions in Sports Injuries & Performance
Melb Uni Sports Physio since 2002Head of Sports Medicine at Melb Uni
since 2008
Lecturer, Consultant Australia, China, Singapore, Sri
Lanka
Author
THE CHALLENGES OF TREATING LOW BACK PAIN
Two
The Most Common Types of Low Back Pain
Musculo-Ligamentous Strain/Sprain
Facet Joint Inflammation or
Stiffness Bulging Disc
The Most Common Types of Low Back Pain
Degenerative Disc Disease
SIJ Inflammation
The Most Common Types of Low Back Pain
MY STORY OF STRUGGLE AND FINDING A SYSTEM THAT WORKED
Three
3 Sessions or less
1. Reduce Pain
2. Correct Biomechanics
3. Exercises to Prevent Re-injury
Flowcharts
MY STORY OF FINDING A SOLUTION
Four
Why do I get Pain?
Why do I get Pain?
Why do I get Pain?
Why do I get Pain?
Solving Pain
The Performance Pyramid
The Ridgway Method
THE RESULTS WE HAVE ACHIEVED TO DATE
Five
Number of Sessions for Full Healing in Low Back Pain
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Results and Awards
THE MYTHS AND NEW TRENDS
Six
Myth
Pain is a feeling…NOPE!
Fixing your Pain ✔
75% of Low Back Pain caused by…Trend #1 - Neural tightness
75% of Low Back Pain caused by…Trend #2 and #3
75% of Low Back Pain caused by…Trend #4 - Gluteals
75% of Low Back Pain caused by…Trend #5 - Subscapularis
HERE’S THE STEP BY STEP GUIDE TO SOLVE LOW BACK PAIN
Seven
Elite Akademy Performance Pyramid™
1.What is it? 2. Where did it originate?
3. How does it work?
4. Why is it different?
5. What are the steps to learn?
6. What are the key areas to concentrate
on?
7. What should I do first and continue to
keep in mind?
Elite Akademy Performance Pyramid™
Outlines all the fundamentals required for success with musculoskeletal injuries in sport
Answers the Question, “What will you do to help me?” and “How will you help me?”
Process for comprehensive treatment and rehabilitationImproves objectivity, increases understanding (increase compliance)Increases awareness of what you do as a practitioner
1.What is it?
Elite Akademy Performance Pyramid™
1.What is it?
Elite Akademy Performance Pyramid™
• Originated in 2014 at Elite Akademy Sports Physiotherapy- University of Melbourne
• Founded by Kusal Goonewardena and his sports medicine team’s pursuit of
• ‘Making a Difference in 3 Sessions or Less’
2. Where did it originate?
Elite Akademy Performance Pyramid™
3. How does it work?
Each needs to improve by 85% for best outcome
Elite Akademy Performance Pyramid™
3. How does it work?
Any Pyramid is as strong as its base
Keep working from the bottom up to complete the Pyramid
Start on 1. Biomechanics then 2. Functional Range 3. Functional Core 4. Functional Core and finally 5. Strength and Conditioning
Elite Akademy Performance Pyramid™
EACH step of the process is measured
Same process is applicable for ANY athlete in - Rehabilitation, Prehabilitation, Performance Enhancement and Screening
Communication ‘Currency’ between players, coaches and other practitioners is the SAME
4. Why is it different?
Elite Akademy Performance Pyramid™
5. What are the steps to learn?
The 5 Fundamentals Step by Step
The Weighting Score on each
Elite Akademy Performance Pyramid™
1. Tests to Measure and Improve Biomechanics (Ridgway Method)
2. Tests to Measure, Improve Functional Range and Control(Ridgway Method)
3. Tests to Measure and Improve Functional Core (Clinical Pilates)
4. Tests to Measure and Improve Strength and Conditioning (Numerous!)
6. What are the key areas to concentrate
on?
Elite Akademy Performance Pyramid™
1. Master how to measure and Improve Biomechanics – The Base of the Performance Pyramid
2. Communicate the Performance Pyramid to Coaches, Athletes, Athlete’s Parents, Other Practitioners
3. Refer back to the Performance Pyramid when identifying ‘How Your Athlete Is Going?’
7. What should I do first and continue to
keep in mind?
Elite Akademy Performance Pyramid™
1.hat is it?
Let’s look at each fundamental…
Elite Akademy Performance Pyramid™
Application of the Ridgway Method for best results
Objectively measure: Neural DynamicsMuscle ( Tight and Weak)Joint (Stiff and Lax)Behavioural
BIOMECHANICS36.0
Application of the Ridgway Method for best results
Objectively measure and Use of Technology here
Show Your Athlete their Deficits and Areas of Improvement
FUNCTIONAL RANGE28.0
Elite Akademy Performance Pyramid™
Application of the Ridgway Method for best results
Objectively look at the quality of movement
FUNCTIONAL CONTROL20.0
Elite Akademy Performance Pyramid™
Used at Elite Akademy Sports Physio – Uni of Melbourne:Clinical Pilates
Use current tests in individual sports or create tests for core assessment
FUNCTIONAL CORE12.0
Elite Akademy Performance Pyramid™
Individual Programs (Strength vs Endurance vs. Sports Specific)Personal trainers, Gym Instructors
Strength & Conditioning
4.0
Elite Akademy Performance Pyramid™
PRACTICAL SESSIONEight
Elite Akademy Performance Pyramid™
Application of the Ridgway Method for best results
Objectively measure: Neural DynamicsMuscle ( Tight and Weak)Joint (Stiff and Lax)Behavioural
BIOMECHANICS36.0
Neural Dynamic Testing
2. Where did it originate?
Neural Dynamic Testing
2. Where did it originate?
Neural Mobility - Treatment
2. Where did it originate?
Neural Mobility - Treatment
2. Where did it originate?
Neural Mobility - Treatment
2. Where did it originate?
Neural Mobility - Treatment
2. Where did it originate?
Neural Mobility - Treatment
2. Where did it originate?
Assessing where 75% of LBP Originates
2. Where did it originate?
Thoracic Spine
Assessing where 75% of LBP Originates
2. Where did it originate?
Gluteals
Assessing where 75% of LBP Originates
2. Where did it originate?
Lumbar Spine – Anterior Disc Approach
Assessing where 75% of LBP Originates
2. Where did it originate?
Subscapularis
Combine Treatment + Functional Test = Treatment Directional Test ‘TDT’
Results in Real Time
FUNCTIONAL RANGE28.0
Elite Akademy Performance Pyramid™
Combine Treatment + Functional Test = Treatment Directional Test ‘TDT’Results in Real Time
FUNCTIONAL CONTROL20.0
Elite Akademy Performance Pyramid™
Clinical Pilates
Use current tests in individual sports or create tests for core assessment
FUNCTIONAL CORE12.0
Elite Akademy Performance Pyramid™
Individual Programs (Strength vs Endurance vs. Sports Specific)Personal trainers, Gym Instructors
Strength & Conditioning
4.0
Elite Akademy Performance Pyramid™
Maintaining Your Gains
1. Posture - 3000 reps
2. Taping
3. Clinical Pilates
Live Client Demonstration
The Performance PyramidThe Ridgway Method
MEASURING PROGRESS AND REHABILITATION
Nine
Elite Akademy Performance Pyramid™ Scoring the Pyramid
FUNDAMENTAL % YOUR PERFORMANCE SCORE NORMAL VALUES
Biomechanics[36.0]
30.6 – 34.2
Functional Range [28.0] 23.8 – 26.6
Functional Control [20.0] 17.0 - 19.0
Functional Core [12.0] 10.2 – 11.4
Strength & Conditioning
[4.0] 3.4 – 3.8
Your Peak Performance
score: _____________Peak Performance 85.0
- 95.0
Elite Akademy Performance Pyramid™
Loading Tolerance
When your Peak Performance Score is >85.00 your Loading (intensity of training, competing) matches your Tolerance. Result
is no pain, no symptoms. The body is a well oiled machine.
Elite Akademy Performance Pyramid™
Loading Tolerance
7-14 DAYS
20%
Once your Peak Performance Score is >85.00 you can increase your Loading (training, intensity) by 20% over a
period of 7-14 days, and your body will be able to Tolerate it. For elite athletes, you can increase your Loading by
~30% over a period of 5-10 days. (I.e. you tolerate things faster).
Elite Akademy Performance Pyramid™
Loading Tolerance
>20%
PAIN/SYMPTOMS
If you increase your Loading by >20% the body finds it difficult to Tolerate this amount of change. When your
body's Tolerance does not match the Loading then pain/symptoms are the result.
Elite Akademy Performance Pyramid™
RECAPTen
What I want you to have achieved today
• Understand where 75% of low back pain comes from
• How to assess and treat Neural immobility, Lumbar Spine , The Thoracic Spine, The Gluteals and Subscapularis
• Understand Treatment Directional Tests (Real-Time Results)
• Learn preventative measures and rehab accelerators
• Objectively measure and communicate progress
WHAT TO DO NEXTEleven
Three things you should do now..
1. Assess Neural for every person
2. Assess Lx, Tx, Glutes and Subscap for every LBP sufferer
3. Use Performance Pyramid to map your progress
FAQ’sQ: Kusal will you be coming back for more lectures?A: Only if you want me to
Q: Do you have an online course I can do?A: Yes, we have created an Australian accredited online short Sports Physiotherapy course. Email me if you’re interested.
FAQ’sQ: Can I access Online Ridgway Method Training?A: Yes! Special PD video’s by Michael Ridgway for Sri Lankan Participants.
Click HERE to go directly there.
Or cut and paste this into your browserwww.ridgwaymethod.com/OnlineModules-SriLanka-pg29304.html
Any further Questions:[email protected]
Final ThoughtsOur Mission at Elite Akademy Sports Medicine…1. Help Practitioners Achieve their Best2. To help Athletes Achieve the Best Results, in the Shortest Period of Time.
We love What We Do and We love Sport. (And So Do I!)
Congratulations!
You have successfully completed the
Low Back Pain Assessment and Management
Workshop
Thank You!If you have any questions at all please do not hesitate to
send a note or call our clinic +613 8344 4948
My email address is: [email protected] twitter address is @kusalkumar
The Elite Akademy twitter address is @EliteAkademy
We share practitioner and athletes success stories and advice on our Facebook site
www.facebook.com/EliteAkademy
Lastly these slides have been uploaded to www.slideshare.net/KusalGoonewardena
Here’s Wishing You A Career and a Lifetime of Happiness!