Low Back Pain Assessment & Management workshop | KDU | International Research Council | August 2015

Low Back Pain
Assessment and Management
Workshop
-The Latest Developments from Australia-
Kotelawala Defence University IRC
August 2015
Kusal Goonewardena
(MaSpPhysio, GradCertSpPhysio, BaPhysio)
Elite Athlete (APA) Sports Physiotherapist
Head of Sports Medicine
Elite Akademy Sports Physiotherapy
Melbourne Australia

15year Career
Founder/Director of 3 Sports Medicine Clinics
Australia

Over 50,000 Treatment Sessions in Sports Injuries
& Performance

Melb Uni Sports Physio since 2002
Head of Sports Medicine at Melb Uni since 2008

Lecturer, Consultant
Australia, China, Singapore, Sri Lanka

THE CHALLENGES OF TREATING
LOW BACK PAIN
Two

TheMostCommonTypes of
LowBackPain
Musculo-Ligamentous Strain/Sprain
Facet Joint Inflammation or
StiffnessBulging Disc

TheMostCommonTypesof
LowBackPain
Degenerative Disc
Disease

SIJ Inflammation
TheMostCommonTypesof
LowBackPain

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

MY STORY OF FINDING A
SOLUTION
Four

THE RESULTS WE HAVE ACHIEVED
TO DATE
Five

Number of Sessions for Full
Healing in Low Back Pain
0
1
2
3
4
5
6
7
8
9
10
Old
New

Myth
Pain is a feeling…NOPE!

75%ofLowBackPaincausedby…
Trend#1-Neuraltightness

Trend#2and #3

Trend#4- Gluteals

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?

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 rehabilitation
Improves objectivity, increases understanding (increase
compliance)
Increases awareness of what you do as a practitioner
1.What is it?

1.What is it?

• 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?

3. How does it
work?
Each needs to
improve by 85%
for best outcome

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

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?

5. What are the
steps to learn?
The 5
Fundamentals
Step by Step
The Weighting
Score on each

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?

1. Master how to measure and Improve
Biomechanics – The Base of the Performance
Pyramid
1. Communicate the Performance Pyramid to
Coaches, Athletes, Athlete’s Parents, Other
Practitioners
2. 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?

1.hat is it?
Let’s look at each fundamental…

Application of the Ridgway Method for best results
Objectively measure:
Neural Dynamics
Muscle ( Tight and Weak)
Joint (Stiff and Lax)
Behavioural
BIOMECHANICS
36.0

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 RANGE
28.0

Application of the Ridgway Method for
best results
Objectively look at the quality of
movement
FUNCTIONAL CONTROL
20.0

Used at Elite Akademy Sports Physio – Uni of
Melbourne:
Clinical Pilates
Use current tests in individual sports or create
tests for core assessment
FUNCTIONAL CORE
12.0

Individual Programs (Strength vs Endurance
vs. Sports Specific)
Personal trainers, Gym Instructors
Strength &
Conditioning
4.0

Neural Dynamic Testing
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

2. Where did it
originate?
Gluteals

2. Where did it
originate?
Lumbar Spine – Anterior Disc Approach

2. Where did it
originate?
Subscapularis

Combine Treatment + Functional Test =
Treatment Directional Test ‘TDT’
Results in Real Time
FUNCTIONAL RANGE
28.0

Combine Treatment + Functional Test =
Treatment Directional Test ‘TDT’
Results in Real Time
FUNCTIONAL CONTROL
20.0

Clinical Pilates
Use current tests in individual sports or
create tests for core assessment
FUNCTIONAL CORE
12.0

Individual Programs
(Strength vs Endurance vs. Sports Specific)
Personal trainers, Gym Instructors
Strength &
Conditioning
4.0

Maintaining Your Gains
1. Posture - 3000 reps
1. Taping
1. Clinical Pilates

Live Client Demonstration
The Performance Pyramid
The Ridgway Method

MEASURING PROGRESS AND
REHABILITATION
Nine

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

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.

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).

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.

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

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’s
Q: 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’s
Q: 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 browser
www.ridgwaymethod.com/OnlineModules-
SriLanka-pg29304.html
Any further Questions:
michael@ridgwaymethod.com

Final Thoughts
Our Mission at Elite Akademy Sports
Medicine…
1. Help Practitioners Achieve their Best
2. 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: kusal@eliteakademy.com
My 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!

Low Back Pain Assessment & Management workshop | KDU | International Research Council | August 2015

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Low Back Pain Assessment & Management workshop | KDU | International Research Council | August 2015