Orthopaedic Physiotherapy Grand Rounds 19 - Beyond the Back: Differentiating and Treating Complex Leg Pain

Overview

This course delves into a clinical case study presented in Orthopaedic Division Grand Rounds 19. It features a detailed examination of a 23-year-old male presenting with an insidious onset of left leg pain and back discomfort. Through a systematic breakdown of the patient's subjective history, objective assessments, and subsequent treatment strategies, learners will explore the diagnostic process for radiating leg pain. The presentation highlights the clinical reasoning behind manual therapy and the interpretation of relevant imaging findings.  

Learning Objectives

Analyze subjective and objective clinical findings in young adult patients presenting with insidious left leg pain.  Evaluate the results of neurodynamic testing, specifically the Slump and Straight Leg Raise (SLR) tests, to inform clinical impressions.  Formulate a treatment plan utilizing manual therapy techniques targeting the lumbar spine and sacrum.  Interpret basic X-ray imaging results, including pedicle shortening and Schmorl's nodes, in the context of persistent back and leg discomfort.  

Audience

Physiotherapists, physical therapy students, orthopaedic specialists, and allied healthcare professionals seeking to enhance their clinical reasoning and manual therapy skills.

Why This Course Matters

Managing insidious leg and back pain requires a precise understanding of biomechanics, neurodynamics, and patient history. This case study bridges the gap between subjective patient complaints and objective clinical findings, providing healthcare professionals with practical insights into differential diagnosis and the application of targeted manual therapy to improve patient outcomes and facilitate a return to sport.

You can find all recorded Grand Round sessions from the Orthopaedic Division of the CPA here.

Case Presenter

Michael Monks, PT, BKin. (Hons), MSc. Kin., MSc. PT., CSEP-CEP, ACCDN

Originally from Newfoundland, Michael completed both his Bachelor of Kinesiology (honours) and Masters of Kinesiology at Memorial University in 2014 and 2016, respectively. During that time he also completed his Clinical Exercise Physiologist (CEP) certificate from the Canadian Society for Exercise Physiology (CSEP). In 2018 he completed his Masters of Science in Physiotherapy from Dalhousie University. Since finishing school, Michael has been working in the private sector and has been working towards obtaining his FCAMPT credential through the AIM system. He was the recipient of the Cliff Fowler Memorial Education Scholarship in 2023.

Panelists

Karen Decker, BScK, BScPT, Dip. Sport PT, Dip. Manipulative Therapy

Karen completed her Physiotherapy and Kinesiology degrees at Dalhousie University in 1991. She has attained the post-graduate specialization Diploma in Sport Physiotherapy and the Diploma of Manipulative Therapy. As a Sport Physiotherapist, Karen has worked with all levels of athletes in the clinic and on the field. She has attended seven Canada Games, three Olympics, the Commonwealth Games, the Pan American Games, and travelled internationally with Canada’s National Teams. She has been the Chief Therapist for many games including the 2011 Canada Games held in Halifax where she resides.

Audrey Long, BScPT, Dip MDT, Clinical Specialist MSK

Audrey graduated with a BScPT from WU in 1984. She attained her Diploma in Mechanical Diagnosis and Therapy (MDT) in 1993 and has been an Instructor with the McKenzie Institute Canada since 1997.  In order to keep herself well rounded she continue to enjoy attending non-MDT courses.  In 1996 she completed a Certificate in Adult Education from the University of Calgary. In 2012, Audrey received the designation Clinical Specialist in MSK.  Audrey has published extensively on MDT and continues to consult on MDT related projects.  Her paper “Does it matter which exercise” published in 2004 is considered one of the key MDT research papers. She is a Reviewer for the Journal of Manual and Manipulative Therapy and Physiotherapy Canada.  Audrey continues to work in Calgary in private practice 3 days a week.

Jill Robertson, BScPT, MScPT, FCAMPT, Clinical Specialist MSK

Jill Robertson has been a practicing physiotherapist for 37 years. She was a part-time academic instructor at Dalhousie University for 26 years.  Jill is an instructor and Lead Examiner for the Orthopaedic Division and a Clinical Specialist in Musculoskeletal Physiotherapy. She is a past Chair and Treasurer of the National Orthopaedic Division and the Canadian Academy of Manipulative Physiotherapy. Jill’s Master’s thesis measured the effects of manual therapy and exercise on hip active range of motion.