Overview of Course

This unique two-day course highlights cutting edge research on low back disorders and also provides participants with an opportunity to apply these research principles in hands-on lab sessions.   The program for Day One consists of a keynote address by Deydre Tehan,  PT, PhD, OCS followed by lectures addressing muscle activation, proposed mechanisms for manipulation and principle of exercise for persons with low back disorders. A panel discussion will follow.  Panel will be composed of Deydre Teyhen, PT, PhD, OCS,  Kornelia Kulig, PhD, PT, FMAAOMPT & faculty from the USC Musculoskeletal Biomechanics Research Laboratory.
An integral part of the first day will be laboratory experiences in the cadaver laboratory, ultrasound and electromyography and exercise.  Day Two of the program will highlight the findings from recent best evidence to support the use of specific treatment and examination techniques for patients with lumbo-sacral disorders.  Participants will learn manual skills, movement task assessment and an exercise program to improve evaluation and treatment of patients with lumbo-sacral dysfunctions. 

*Participants have the option of registering for both days of the program or Day One or Day Two only.

Course Description for Part I, Day I

Update on Lumbar Spine 2010  is an annually updated course that provides a biomechanical and motor control framework for a sound exercise science based rehabilitation program for patients with low back disorders.  We will discuss the process of designing an intervention program that addresses the needs of individual patients.  Presentations will emphasize translating the current “best evidence” to practical clinical application. Lab sessions will give opportunities for exploration at the cadaveric level emphasizing the impact of loading on the spine.  Multiple modalities including the use of MRI and real time ultrasonography to illustrate activation of selected trunk musculature (transverse abdominus, multifidus) during commonly used clinical exercises.  Fine wire EMG application will be used across multiple exercises and their progressions.  Course attendees will have an opportunity to actively participate in each laboratory experience.

Course Objectives
At the end of the session, participants will be able to: 

• Discuss the current state of back care and the directions of relevant laboratory and clinical trial research.
• Discuss morphological characteristics of the back extensors associated with low back disorders.
• Discuss altered trunk muscle activation in persons with history low back disorders and its hypothetical consequences.
• Compare and contrast principles of exercise applied to healthy individuals and patients with low back disorders.
• Outline a standardized decision making process for prescribing a strength and muscular endurance program for patients with low back disorders.
• Integrate principles of exercise and motor control with rehabilitation of functional movements for patients with low back disorder.

Keynote Address:  Rehabilitative Ultrasound Imaging: Technology to Improve Assessment and Treatment of those with Musculoskeletal Conditions

Over the past decade, researchers have identified associations between neuromusculoskeletal disorders such as low back pain and underlying neuromuscular control deficits.2 However, reliable and valid non-invasive measurement strategies that could be employed in a clinical setting have been scarce. Evidence for the use of ultrasound imaging as a strategy to assist with these patient populations is growing. The use of ultrasound technology for medical applications began in the 1950s and it has proven to be an effective, safe, and relatively inexpensive tool for assessing morphologic characteristics and structural integrity of visceral organs and soft tissues. Specifically related to physical therapy practice, the use of ultrasound to assess muscle morphology and guide rehabilitation decision-making can be traced back to the late 1960s.6 Over the last decade there has been rapid development of this technique, with reliable and valid non-invasive measurement procedures that can be employed in a clinical setting.

The use of ultrasound imaging in the rehabilitation of neuromusculoskeletal disorders has been coined “rehabilitative ultrasound imaging” (RUSI). RUSI has been defined as “a procedure used by physical therapists to evaluate muscle and related soft tissue morphology and function during exercise and physical tasks…and is used to assist in the application of therapeutic interventions aimed at improving neuromuscular function.”4 RUSI has been advocated to improve the understanding of the relationship between motor control and function, determine which patients may benefit from a specific exercise treatment approach, enhance treatment efficacy via augmented feedback, and document the benefits of specific exercise treatment approaches. Early RUSI research has been promising.

This presentation will provide an overview of how RUSI has been applied in both clinical and research settings to assess underlying muscular dysfunction and exercise prescription for the abdominal wall,5 posterior spine,3 and pelvic floor,7 and the potential of RUSI as a biofeedback tool to help with rehabilitation.1
References

1. Henry SM, Teyhen DS. Ultrasound imaging as a feedback tool in the rehabilitation of trunk muscle dysfunction for people with low back pain. J Orthop Sports Phys Ther. 2007;37:627-634.
2. Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13:361-370.
3. Stokes M, Hides J, Elliott JM, Kiesel KB, Hodges P. Rehabilitative ultrasound imaging of the posterior paraspinal muscles. J Orthop Sports Phys Ther. 2007;37:581-595.
4. Teyhen D. Rehabilitative ultrasound imaging symposium San Antonio, TX, May 8-10, 2006. J Orthop Sports Phys Ther. 2006;36:A1-3.
5. Teyhen DS, Gill NW, Whittaker JL, Henry SM, Hides JA, Hodges P. Rehabilitative ultrasound imaging of the abdominal muscles. J Orthop Sports Phys Ther. 2007;37:450-466.
6. Whittaker JL, Teyhen DS, Elliott JM, et al. Rehabilitative ultrasound imaging: understanding the technology and its applications. J Orthop Sports Phys Ther. 2007;37:434-449.
7. Whittaker JL, Thompson JA, Teyhen DS, Hodges P. Rehabilitative ultrasound imaging of pelvic floor muscle function. J Orthop Sports Phys Ther. 2007;37:487-498.

Deydre Teyhen, PT, PhD, OCS is an Associate Professor, U.S. Army-Baylor University Doctoral Program in Physical Therapy and Director of the Center for Physical Therapy Research at Fort Sam Houston, TX.  Dr. Teyhen completed her PhD in Biomechanics from the University of Texas in 2004. She received a Master of Physical Therapy from the U.S. Army-Baylor University in 1995 and a Bachelor of Arts in Sports Science from Ohio Wesleyan University in 1993.  Dr. Teyhen’s professional experience and training have been primarily in orthopaedic physical therapy.  She is a board-certified Orthopaedic Clinical Specialist from the American Board of Physical Therapy Specialties, a certified Health Fitness Instructor from the American College of Sports Medicine, and a certified Health Promotion Director through the Cooper Institute.

Kornelia Kulig, PhD, PT, FMAAOMPT is an Associate Professor of Clinical Physical Therapy and Co-Director of the Musculoskeletal Biomechanics Research Laboratory at USC.  Her research explores tissue morphology, biomechanics, physiology, and pathology in relation to degenerative processes in connective tissues (tendon, disc) and accompanying muscle activation, and related signs, symptoms, and loss of function.  She is a Founding Member of the American Academy of Orthopedic Manual Physical Therapists.

 Instructional Level This course is designed for an Intermediate audience. 

Cost

Individual Registration for Part I or II only: $225, $425 for Parts I and II