The RESOLVE Study: Cognitive Sensory Discrimination in Low Back Pain

Overview

This is the fourth course in the Weird and Wonderful Strategies that EVERY Physio Should Know to Effectively Treat LBP series, hosted by Carolyn Vandyken in collaboration with Embodia.

The RESOLVE trial (Bagg et al., JAMA, 2022) provides Level 1 evidence that graded sensorimotor retraining significantly reduces pain intensity in chronic LBP — and it does so via a rigorously controlled design that compared the intervention against sham procedures and attention control, not just usual care or a waiting list. Research shows that disrupted body perception occurs in up to 98% of people with chronic LBP (Wand et al., 2016) — yet most exercise prescription in clinical practice doesn't account for this at all.

In this course, Carolyn Vandyken unpacks the RESOLVE trial in full: its three-stage intervention model, the clinical tools used to identify and stratify sensorimotor dysregulation, and how to translate the evidence into practice. She also addresses what the study did not target — the psychosocial contributors to persistent pain — and equips clinicians with her SAD CLLIFSS framework: a structured, questionnaire-based approach to assessing and treating the full range of central sensitization phenotypes that commonly drive LBP.

Together, the RESOLVE protocol and the SAD CLLIFSS framework give clinicians a complete biopsychosocial toolkit — one that treats the biology of sensorimotor dysregulation and the psychological and social drivers that RESOLVE left on the table.

This course will change how you think about exercise prescription.

Learning Objectives

By the end of this course, participants will be able to:

1. Summarize the design, intervention, and key findings of the RESOLVE trial, and explain why its rigorous placebo control makes it clinically significant.
   
   
2. Explain sensorimotor dysregulation as a biological construct in chronic LBP and describe why it requires systematic assessment and targeted treatment.
   
   
3. Use the Fremantle Back Awareness Questionnaire (FreBAQ) to screen for and quantify sensorimotor dysregulation, and stratify patients into appropriate pre-movement treatment pathways based on their score relative to the median.
   
   
4. Apply Stage 1 neuroscience-informed pre-movement strategies — including graphesthesia training, the Recognise Back App, and global or targeted sensorimotor-rich movement (Qi Gong, Feldenkrais, Franklin method) — matched to a patient's clinical presentation.
   
   
5. Progress patients through Stage 2 (graded, precision-focused, feedback-enriched movement) and Stage 3 (function-first recovery with cardiovascular and strength progression), using calm breath, calm body, and calm mind as consistent guiding principles.
   
   
6. Use the SAD CLLIFSS framework and its associated validated measures — including the CSI, DASS-21, PCS, PSEQ-2, PANAS, IEQ, TSK, and Fremantle questionnaires — to identify the psychosocial drivers the RESOLVE protocol did not address, and select appropriate treatment strategies for each.

Audience

This course is for all physiotherapists and rehabilitation professionals who treat patients with chronic low back pain, including those in private outpatient, home care, and emergency settings. It is relevant to all orthopaedic clinicians, not just pelvic health specialists.

Why This Course Matters

Most physiotherapists treating chronic LBP are already doing something biopsychosocial — but without a structured framework, it's easy to address the factors you notice and miss the ones you don't. The RESOLVE trial gives clinicians a clear, evidence-based entry point: a three-stage sensorimotor retraining protocol that targets the biology of nociplastic pain in a way most exercise prescription simply doesn't. For patients who have plateaued, who can't seem to make lasting gains, or whose pain doesn't match their tissue state, this is precisely the kind of clinical reframe that changes outcomes.

But RESOLVE only gets you part of the way there. The trial deliberately narrowed its focus — and as a result, key psychosocial drivers of persistent pain (fear, catastrophization, low self-efficacy, shame, injustice, and others) were neither measured nor treated. This course doesn't let you stop at the biology. It asks the harder question: once you've addressed the sensorimotor system, what else is keeping this person stuck?

To answer that question, Carolyn Vandyken has developed the SAD CLLIFSS framework — a practical, questionnaire-driven clinical tool that maps the full landscape of central sensitization phenotypes, pairs each one with a validated outcome measure, and links each measure to evidence-informed treatment strategies. The SAD CLLIFSS flowchart is available as a downloadable resource included with this course. It is the kind of tool you will return to in clinical practice long after the course is done.

Together, RESOLVE and SAD CLLIFSS don't just make you a better LBP clinician. They make you a more complete one.