CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Parcours de soins pour les lombalgies
Date de la dernière mise à jour : février 2024
Diagnosis for Low Back Pain with Radiculopathy
Clinical Cornerstone:
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The goal is to identify the affected nerve root and determine the underlying cause to guide appropriate treatment.
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Diagnosis involves a thorough history and physical examination, focusing on neurological assessment. Imaging or diagnostic studies (e.g., MRI, electrodiagnostic studies) may be required when persistent, severe, or progressive neurological deficits are present.
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Definition: Involves the irritation or compression of a nerve root in the lumbar spine, manifesting as pain, numbness, or weakness radiating down the leg, often following a specific nerve distribution. Radicular pain, colloquially referred to as "sciatica", following a specific nerve distribution may be present.
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Prevalence: Less common than NSLBP but constitutes a significant portion of LBP cases.
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Risk Factors: Mechanical stress or injury, degenerative disc disease, lumbar disc herniation, and spinal stenosis. Occupations or activities involving heavy lifting, twisting, or bending.
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Pain Location: Typically originates in the lower back and radiates down the leg, potentially as far as the foot, often following a specific dermatomal pattern.
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Duration: Can be acute or chronic, with acute episodes potentially becoming recurrent or chronic if not managed appropriately.
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Signs and Symptoms:
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Sharp, shooting, or burning pain radiating down the leg, potentially associated with numbness, tingling, or weakness in the affected limb.
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Pain may be exacerbated by specific movements such as bending forward, lifting, coughing, sneezing or sitting.
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Physical Examination:
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Straight Leg Raise Test: Positive test can indicate nerve root irritation.
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Neurological Examination: May reveal sensory deficits, muscle weakness, and altered reflexes in the affected limb, corresponding to the involved nerve root.
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Neurodynamic Tests: May be utilized to assess nerve root involvement.
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Imaging: Imaging can be used to guide alternative treatment options. MRI or CT scans can help visualize a disc herniation that may be compressing the nerve root. Indications for imaging in the absence of trauma or red flags include: persistent or worsening back pain after four to six weeks of conservative care, progressive neurological symptoms.
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Electrodiagnostic Studies: Electromyography (EMG) and nerve conduction studies can be used to confirm the diagnosis and determine the severity of nerve involvement.
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Imaging studies (e.g., MRI, electrodiagnostic studies) may be required when persistent, severe, or progressive neurological deficits are present.
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Electrodiagnostic Studies: Electromyography (EMG) and nerve conduction studies can be used to confirm a diagnosis of specific low back pain with radiculopathy. Indications may include persistent, progressive, or profound radiculopathy signs.
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Response to Conservative Management: Can be variable, with some individuals responding well to conservative interventions like education, manual therapy, exercises, and medication, while others may require more interventional approaches, especially in the presence of persistent or severe neurological deficits.
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Psychosocial Factors: Important to explore and address psychosocial factors that may impact pain, disability, and recovery, such as fear of movement, beliefs about pain, and emotional well-being, ensuring a comprehensive management approach.
Conduct patient assessment
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Red flags present
Red flags present
Refer to appropriate emergency or healthcare provider
Diagnosis
Non-specific LBP or LBP with radiculopathy:
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Education
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Self-care
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Exercise
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Manual therapy
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Medicines
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Psychological therapy
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Social support
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Mind-body interventions
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Needling therapies, electrotherapies*
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Mobility assistive devices
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Multicomponent biopsychosocial care
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Topical ceyenne pepper
Additionally for LBP with radiculopathy:
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Medical/surgical consultations
Other specific LBP:
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Refer to appropriate emergency or healthcare provider
Follow-up
Follow-up
Major symptom/sign change
Goals not achieved
Re-evaluate
Adjust treatment and management plan or refer
References or links to primary sources
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Wong, J.J., Côté, P., Sutton, D.A., Randhawa, K., Yu, H., Varatharajan, S., Goldgrub, R., Nordin, M., Gross, D.P., Shearer, H.M., Carroll, L.J., Stern, P.J., Ameis, A., Southerst, D., Mior, S., Stupar, M., Varatharajan, T. and Taylor-Vaisey, A. (2017), Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain, 21: 201-216. https://doi.org/10.1002/ejp.931
Contact information for further inquiries or feedback
Disclaimer:
These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.