Back Pain 201: Advanced Assessment

Access: 60 days
Cost: $249 NZD
Study time: 10 hours approximately + self directed reading

This course is designed for physiotherapists who have some experience and knowledge of assessment and treatment of patients with primary symptoms of back and / or referred lower limb pain. Although my course Back Pain 101 is not a pre-requisite, it is recommended for recent graduates or undergraduates. 

Back Pain 201 opens the door for lumbar spine and pelvic diagnostics and treatment selection based on a broad perspective that includes pathoanatomy, neurophysiology and the psychosocial dimensions by teaching you the essentials of a comprehensive clinical history and physical examination. 

By the end of this course you will be able to confidently identify:

  1. Mechanical discogenic pain.
  2. Radicular syndromes.
  3. Spinal stenosis.
  4. Sacroiliac joint pain.
  5. Hip and buttock pain sources. 

Course Structure:

Chapter 1: History and Screening

  • Red Flags
  • Pain Drawings
  • Advanced Clinical History
  • Psychosocial Screening Questionnaires
  • Observations of Lateral Shift & 
  • Advanced Neurological Examination

Chapter 2: Centralisation & Directional Preference

  • The concept of Centralisation
  • Directional Preference
  • Implementing Repeated Movement Testing

Chapter 3: Non-Lumbar Pain Sources

  • Sacroiliac Joint Pain & Instability Assessment
  • Hip and Buttock Pain Assessment

Chapter 4: Putting It All Together

  • Efficient physical examination sequence
  • Utility of advanced assessment

Learning outcomes:

  1. Able to identify red flag indicators of serious spinal pathology.
  2. Understand and interpret pain drawings.
  3. Make appropriate use of pre-screening health, pain, disability, sensitisation and psychosocial questionnaires.  
  4. Complete a detailed neurologic screening examination to identify radicular pain and radiculopathy.
  5. Understand the history and concepts of the centralisation and directional preference phenomena.
  6. Able to conduct a repeated movement / mechanical loading assessment to identify the subcategory for patients whose symptoms show directional preference or centralized.
  7. Able to carry out reliable and validated sacroiliac joint pain provocations tests and understand interpretation of patient responses.
  8. Able to carry out a standard orthopaedic medicine assessment for painful disorders of the hip and buttock structures.
  9. Implement a practical sequence of assessment and testing that is efficient and practical within normal clinical settings.
  10. Use clinical reasoning to interpret the clinical data derived from the advanced assessment.

This course builds on Back Pain 101,  providing a structured assessment method that will be further expanded upon in the Back Pain 300 series.

Course curriculum

  1. 1
    • Copyright Warning Notice

    • About you

    • Course Introduction from Mark Laslett

    • About Mark Laslett

    • Course Manual

  2. 2
    • References for Chapter 1

    • Using Questionnaires

    • Quick Q & A Link

    • Pain Drawings

    • Pain Drawing Quiz

    • Red Flags

    • Red Flag Quiz

    • Advanced Clinical History

    • Select Questionnaire System

    • Notes of the Clinical History

    • Observations

    • Observations quiz

    • Neurologic Screening Examination

    • Neurologic Screening examination quiz

  3. 3
    • References for Chapter 2

    • Centralisation: The Concept

    • The Test Movements

    • Practical Implementation

    • Centralization: A Case Study

    • Directional Preference

    • Case Study: Directional Preference to Extension

    • Case Study: Directional Preference to Flexion

    • Directional Preference to Side Gliding and Asymmetrical Extension

    • Chapter 2 Quiz. Centralisation & Directional Preference

  4. 4
    • References for Chapter 3

    • Sacroiliac Joint Assessment

    • SIJ testing: Pressure Variations

    • Hip Joint & Buttock Testing

    • Chapter 3 Quiz. Sacroiliac, Hip Joint & Buttock

  5. 5
    • References for Chapter 4

    • Notes of the Physical Examination

    • The Physical Examination Sequence

    • Physical Examination Quiz - assessment of Tom

    • Putting the pieces together

    • Using the Advanced Assessment

    • Self-Directed Reading Documentation

    • More Resources and Suggestions

    • Before You go...Course Evaluation



Dr Mark Laslett


Physiotherapy Specialist Musculoskeletal

After graduation as a physiotherapist in 1971, Mark owned and operated his own private practices in Auckland from 1972-2001, including a specialist Spine Care Clinic (1991-1997). He completed the Diploma in Manipulative Therapy in 1976 and the Diploma in Mechanical Diagnosis and Therapy in 1991. Mark moved to Christchurch in 2005 and has practiced as an independent musculoskeletal consultant for PhysioSouth Ltd since then.

Mark was a manipulative therapy instructor for the spine and upper and lower extremities for the NZ Manipulative Therapists Association 1980-1988 and was president 1988-89. He commenced teaching mobilization and manipulation workshops for the McKenzie Institute International as an international instructor in 1985 and added his own courses on the upper and lower extremities in 1990. Mark ceased active involvement in the McKenzie Institute in 1997. He has presented about 250 short courses in Scandinavia, Europe, North America and Australasia, and has presented at many international conferences with free papers and as keynote presenter. Most recently in 2013 he has completed a teaching tour of courses and conferences that included presentations in Finland, Germany, The Netherlands, Denmark, France and the USA.

His academic and research interest is in the theory and practice of diagnostics as distinct from therapeutics. He has over 40 publications, contributed chapters to two multi-author books and published his own text Mechanical Diagnosis and Therapy: The Upper Limb in 1996. See Reference List at end of this brief biography. Mark commenced doctoral studies at the University of Linköping, Sweden in 2001, successfully defending his thesis “Diagnostic accuracy of the clinical examination compared to available reference standards in chronic low back pain patients” in 2005. He became a Fellow of the New Zealand College of Physiotherapy in 2007 and served as a member of its Academic Board 2008-2014. He was a senior Research Fellow for AUT University from 2008-2012 supervising doctoral and Master’s research projects. He became the first physiotherapist to be registered as a clinical specialist in February 2014. Mark was made an honorary Life Member of Physiotherapy New Zealand in September 2014, and of the New Zealand Manipulative Physiotherapists Association in 2015. He continues to practice as a consultant clinician and remains active in clinical research.

Main areas of Interest:

Painful musculoskeletal disorders of the spine and extremities with special emphasis on persistent low back, neck and shoulder pain. Musculoskeletal diagnostics (as distinct from therapeutics) remains an ongoing research interest.

He is currently working with Dr Tom Petersen of Copenhagen on updating their lumbar spine classification system (2003) and with Dr Arianne Verhagen of Erasmus University in updating the systematic review of tests for lumbar radiculopathy. He is currently adjunct research fellow at AUT University on the basis of supervising a doctoral candidate whose research is based on the diagnostic accuracy of the clinical examination of the hip.