ID:
508854
Duration (hours):
16
CFU:
2
SSD:
SCIENZE INFERMIERISTICHE E TECNICHE NEURO-PSICHIATRICHE E RIABILITATIVE
Year:
2025
Overview
Date/time interval
Primo Semestre (01/10/2025 - 16/01/2026)
Syllabus
Course Objectives
Objectives
a) Assess the ability to identify and describe the causes of low back pain, distinguishing between specific and non-specific low back pain.
b) Verify the understanding of the indications and limitations of diagnostic techniques, such as magnetic resonance imaging (MRI), in the management of low back pain.
c) Evaluate the ability to apply evidence-based clinical recommendations in the management of low back pain.
d) Verify the understanding of spinal manipulation techniques and stabilization exercises, as well as the ability to select and justify the appropriate treatment.
e) Describe the benefits of stabilization exercises for a patient with lumbar instability.
f) Assess the awareness of the importance of psychological and social factors in the chronicity of low back pain.
g) Evaluate the ability to perform and interpret specific clinical tests for low back pain, such as the Prone Instability Test and the Beighton Ligamentous Laxity Scale.
h) Verify the ability to develop a personalized treatment plan based on the patient’s classification and clinical findings.
a) Assess the ability to identify and describe the causes of low back pain, distinguishing between specific and non-specific low back pain.
b) Verify the understanding of the indications and limitations of diagnostic techniques, such as magnetic resonance imaging (MRI), in the management of low back pain.
c) Evaluate the ability to apply evidence-based clinical recommendations in the management of low back pain.
d) Verify the understanding of spinal manipulation techniques and stabilization exercises, as well as the ability to select and justify the appropriate treatment.
e) Describe the benefits of stabilization exercises for a patient with lumbar instability.
f) Assess the awareness of the importance of psychological and social factors in the chronicity of low back pain.
g) Evaluate the ability to perform and interpret specific clinical tests for low back pain, such as the Prone Instability Test and the Beighton Ligamentous Laxity Scale.
h) Verify the ability to develop a personalized treatment plan based on the patient’s classification and clinical findings.
Course Prerequisites
Prerequisites:
Anatomy of the Spine: Understanding the structure of the spine, particularly the lumbar region, including the vertebrae, intervertebral discs, ligaments, and the main muscle groups involved.
Physiology of the Musculoskeletal System: Knowledge of the biomechanics of the spine, such as flexion, extension, and rotation movements, and how these movements affect the vertebral structure and surrounding tissues.
Anatomy of the Spine: Understanding the structure of the spine, particularly the lumbar region, including the vertebrae, intervertebral discs, ligaments, and the main muscle groups involved.
Physiology of the Musculoskeletal System: Knowledge of the biomechanics of the spine, such as flexion, extension, and rotation movements, and how these movements affect the vertebral structure and surrounding tissues.
Teaching Methods
a) Interactive Lecture
Description: The main concepts are presented through a structured lecture, but students are actively engaged through questions and discussions to stimulate interaction and learning.
b) Case Study Analysis
Description: Real or simulated clinical cases are used to allow students to apply theoretical knowledge to clinical practice, thereby bridging the gap between theory and practice.
c) Group Work
Description: Students are assigned group activities, such as researching scientific articles, presenting a specific topic, or creating a treatment plan, to promote collaboration and shared learning.
Description: The main concepts are presented through a structured lecture, but students are actively engaged through questions and discussions to stimulate interaction and learning.
b) Case Study Analysis
Description: Real or simulated clinical cases are used to allow students to apply theoretical knowledge to clinical practice, thereby bridging the gap between theory and practice.
c) Group Work
Description: Students are assigned group activities, such as researching scientific articles, presenting a specific topic, or creating a treatment plan, to promote collaboration and shared learning.
Assessment Methods
The exam will be conducted orally. Each student will be asked 5 questions, with each question being evaluated on a scale from 0 to 6 points
Texts
a) Waddell, Gordon. The back pain revolution. Elsevier Health Sciences, 2004.
b) Hartvigsen, Jan, et al. "What low back pain is and why we need to pay attention." The Lancet 391.10137 (2018): 2356-2367.
c) McGill, S.M. Low back disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, IL, U.S.A., 2002. ISBN 0-7360-4241-5, Third Edition, 2016. Now also printed in Japanese, 2003 and in Chinese, 2009.
b) Hartvigsen, Jan, et al. "What low back pain is and why we need to pay attention." The Lancet 391.10137 (2018): 2356-2367.
c) McGill, S.M. Low back disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, IL, U.S.A., 2002. ISBN 0-7360-4241-5, Third Edition, 2016. Now also printed in Japanese, 2003 and in Chinese, 2009.
Contents
Introduction to Low Back Pain
Low back pain is one of the leading causes of disability worldwide, with a significant financial impact on healthcare and social support systems. This condition, which affects individuals of all ages, is particularly prevalent in low- and middle-income countries, where opportunities for job modification are limited, and informal employment is very common. While most episodes of low back pain are short-lived and do not lead to serious consequences, recurrent episodes are common, transforming low back pain into a chronic and complex condition influenced by psychological, social, and biomedical factors.
Classification of Low Back Pain
Low back pain can be categorized as acute or chronic. When symptoms last for less than six weeks, it is considered acute low back pain, whereas conditions persisting beyond this period are classified as chronic. It is important to note that approximately 90% of patients who consult a doctor for low back pain do not have an identifiable specific cause, and only a small percentage suffer from well-defined pathologies such as tumors, fractures, spinal infections, ankylosing spondylitis, spinal stenosis, or symptomatic disc herniations.
Psychological Factors and Diagnosis
Psychological factors, such as depression, can double the risk of developing low back pain. These factors often serve as better predictors of low back pain than MRI images. A thorough medical history and careful physical examination are crucial for correctly classifying the type of low back pain, taking into account psychosocial risk factors.
Use of Diagnostic Imaging
A crucial aspect of managing low back pain is the appropriate use of diagnostic imaging. It is recommended that doctors do not routinely request radiological tests for patients with nonspecific low back pain unless there are severe or progressive neurological deficits or there is suspicion of a serious underlying condition. There is no evidence that routine imaging improves treatment outcomes. In fact, the number of spinal surgeries is closely correlated with the number of MRIs performed.
Management of Low Back Pain
The management of low back pain should follow evidence-based guidelines. Patients are advised to stay active and engage in self-care, as low back pain is often a self-limiting condition. For those who do not benefit from self-care, non-pharmacological therapies such as manual therapy and the application of superficial heat for acute pain are recommended. Although physical exercise is generally beneficial, it does not seem to have a significant effect during the acute phase of low back pain.
Stabilization Exercises and Spinal Manipulations
Stabilization exercises are essential for improving muscle endurance and reducing low back pain. Among these, "bracing" and "hollowing" are particularly effective, with efforts ranging from 2-5% for light activities, such as walking, up to 50% for maximal lifts. Spinal manipulations can also be useful in treating acute low back pain, but they must be performed carefully to minimize associated risks.
Classification and Treatment of Acute Low Back Pain
A significant focus is placed on the classification and treatment of acute low back pain. A multi-step process is described to determine the most appropriate treatment based on the patient's symptoms. This includes specific exercises in extension or flexion, depending on signs of radicular compression and the centralization or peripheralization of pain. Additionally, the test for spondylolisthesis should be correctly performed and interpreted before engaging in extension exercises.
Evaluation Tests and Measurement Scales
Another relevant part concerns evaluation tests for hypomobility and internal hip rotation, as well as the importance of measurement scales such as the Beighton Ligamentous Laxity Scale (BLLS) and the Prone Instability Test. These tools are crucial for identifying patients with hypermobility and instability, who may benefit from stabilization exercises.
Future Implications and Treatment Improvements
Finally, there is a discussion on how to improve the effectiveness of acute low back pain treatment in the future. Currently, patient classification systems are often inadequate, as they are mainly based on pathologies rather than a clear description of symptoms and treatment responses. The adoption of more detailed classification systems could enhance treatment effectiveness, avoiding the randomness of treatment selection.
Low back pain is one of the leading causes of disability worldwide, with a significant financial impact on healthcare and social support systems. This condition, which affects individuals of all ages, is particularly prevalent in low- and middle-income countries, where opportunities for job modification are limited, and informal employment is very common. While most episodes of low back pain are short-lived and do not lead to serious consequences, recurrent episodes are common, transforming low back pain into a chronic and complex condition influenced by psychological, social, and biomedical factors.
Classification of Low Back Pain
Low back pain can be categorized as acute or chronic. When symptoms last for less than six weeks, it is considered acute low back pain, whereas conditions persisting beyond this period are classified as chronic. It is important to note that approximately 90% of patients who consult a doctor for low back pain do not have an identifiable specific cause, and only a small percentage suffer from well-defined pathologies such as tumors, fractures, spinal infections, ankylosing spondylitis, spinal stenosis, or symptomatic disc herniations.
Psychological Factors and Diagnosis
Psychological factors, such as depression, can double the risk of developing low back pain. These factors often serve as better predictors of low back pain than MRI images. A thorough medical history and careful physical examination are crucial for correctly classifying the type of low back pain, taking into account psychosocial risk factors.
Use of Diagnostic Imaging
A crucial aspect of managing low back pain is the appropriate use of diagnostic imaging. It is recommended that doctors do not routinely request radiological tests for patients with nonspecific low back pain unless there are severe or progressive neurological deficits or there is suspicion of a serious underlying condition. There is no evidence that routine imaging improves treatment outcomes. In fact, the number of spinal surgeries is closely correlated with the number of MRIs performed.
Management of Low Back Pain
The management of low back pain should follow evidence-based guidelines. Patients are advised to stay active and engage in self-care, as low back pain is often a self-limiting condition. For those who do not benefit from self-care, non-pharmacological therapies such as manual therapy and the application of superficial heat for acute pain are recommended. Although physical exercise is generally beneficial, it does not seem to have a significant effect during the acute phase of low back pain.
Stabilization Exercises and Spinal Manipulations
Stabilization exercises are essential for improving muscle endurance and reducing low back pain. Among these, "bracing" and "hollowing" are particularly effective, with efforts ranging from 2-5% for light activities, such as walking, up to 50% for maximal lifts. Spinal manipulations can also be useful in treating acute low back pain, but they must be performed carefully to minimize associated risks.
Classification and Treatment of Acute Low Back Pain
A significant focus is placed on the classification and treatment of acute low back pain. A multi-step process is described to determine the most appropriate treatment based on the patient's symptoms. This includes specific exercises in extension or flexion, depending on signs of radicular compression and the centralization or peripheralization of pain. Additionally, the test for spondylolisthesis should be correctly performed and interpreted before engaging in extension exercises.
Evaluation Tests and Measurement Scales
Another relevant part concerns evaluation tests for hypomobility and internal hip rotation, as well as the importance of measurement scales such as the Beighton Ligamentous Laxity Scale (BLLS) and the Prone Instability Test. These tools are crucial for identifying patients with hypermobility and instability, who may benefit from stabilization exercises.
Future Implications and Treatment Improvements
Finally, there is a discussion on how to improve the effectiveness of acute low back pain treatment in the future. Currently, patient classification systems are often inadequate, as they are mainly based on pathologies rather than a clear description of symptoms and treatment responses. The adoption of more detailed classification systems could enhance treatment effectiveness, avoiding the randomness of treatment selection.
Course Language
Italian
Degrees
Degrees
PHYSIOTHERAPY
Bachelor’s Degree
3 years
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