Gerard Alvarez
Gerard Alvarez


Spine-related pain represents one of the top public health problems worldwide. From the old times, a huge variety of professionals have used Manual Therapy (MT) as an intervention to treat back and neck pain. Among those professionals, osteopaths have been historically considered experts in the treatment of back problems and the literature continuously report that back and neck pain is the main reason to consult an osteopath regardless the country. In fact, the best evidence supporting the effectiveness of osteopathy and MT has been obtained assessing their impact on patients with low back or neck pain. However, current  knowledge about neuroscience, pain mechanisms and the psychosocial dimension of back pain, has challenged the traditional osteopathic mechanistic view, especially in regard of those patients experiencing persistent pain. The original biomedical structural/postural model was questioned long ago along with those therapeutical approaches based on the same principles. Altogether has fostered the need to re-conceptualize what is the role of MTs in the treatment of spine-related problems and also the mechanisms and clinical situations that support the use of a hands-on structural approach to back and neck pain.

Based on a comprehensive literature search, this two-module course will present to the students the most updated information in regard of the main spine-related conditions. The focus will be place on clinical presentations and differential diagnosis in order to improve our clinical reasoning skills. Also, we will review

some structural hands-on techniques to be applied to those conditions within the context of a multimodal therapeutical perspective.

• To update the knowledge about potential sources and mechanisms of lumbopelvic and cervicothoracic pain.
• To establish the main strategies for the differential diagnosis of low back and neck pain and deepen into the clinical reasoning process to address these patients.
• A recall on safety elements, orthopedic and neurological examination and the role of palpation and manual testing.
• Refine and expand the manual technical repertoire on the lumbopelvic and cervicothoracic area with special emphasis on the structural approach.

The course will be delivered in a dynamic and interactive way alternating short theoretical presentations with hands-on related practice. The most updated evidence will be presented and discussed with the students and examples based on real clinical situations will also be provided.

  • Introduction:
    – Epidemiology of Neck Pain
    – Classification of Neck Pain (ICD /ICF) – Clinical guidelines
  •  Safety Considerations:
    – Red Flags
    – Vasculogenic considerations – Based on IFOMPT Framework
    – Cervical Instability
    – Congenital Syndromes (Basilar invagination)
  •  Neck pain with mobility deficits:
    – Biomechanical review (Upper and lower neck)
    – Cervical sources of Nociceptive pain – Referred patterns
    – Discogenic cervical pain
    – Facetogenic cervical pain
    – Myofascial cervical pain
  •  Neck pain with headache (Cervicogenic syndromes)
    – Differential Diagnosis
    – Cervicogenic headache:  Neurological basis, Diagnostic criteria, Clinical presentation, and physical
    – Tension-type headache: Clinical presentation, Diagnostic Criteria
    – Migrain:  Clinical presentations, Role of the cervical spine, Diagnostic Criteria
    – Occipital Neuralgia: Clinical presentation, Diagnostic Criteria
    – Cervicogenic dizziness:  Clinical presentation, Diagnostic Criteria
  •  Cervicodorsal pain and cervicothoracic syndromes:
    – Biomechanics and function of C/T junction
    – Potential impact of postural impairments
    – Non-vertebral elements of the C/T junction:  Ribs, Fascia, Stellate Ganglion
    – Thoracic Outlet Syndrome/s: Epidemiology, clinical presentations, Diagnostic criteria, Physical exam
  • Neck pain with radicular pain:
    – Neuropathic Pain: General considerations
    – Radicular Pain: Pathophysiology, Clinical presentation, Differential Diagnosis, Diagnostic Criteria, Physical exam
    – Cervical Myelopathy: Pathophysiology, Clinical presentation, Differential Diagnosis, Diagnostic Criteria
  •  Neck pain with movement coordination Impairments:
    – Whiplash and Whiplash Associated Disorders: Mechanical considerations, Sensorimotor impairment, Psychological factors, Clinical features, Role of TMs on WAD
  • Introduction:
    – Epidemiology of Low Back Pain (LBP)
    – Osteopathy and LBP – Quick look into the evidence
  •  Dimensions of LBP
    – Pain and disability driver management model (Tousignant-Laflamme et al. 2017)
  •  Diagnostic Screening and Safety
    – Diagnostic Triage – lessons from primary care
    – Red Flags – Clinical Guidelines
  •  Classification systems – Stratified Models of Care
    – STarT Back tool, Clinical Predictive rules, Cognitive Functional Therapy
    – Classifications model based on Pain mechanisms
    – Non-Specific LBP – Key clinical Points
  •  Nociceptive sources of low back pain:
    – Discogenic LBP: Pathophysiology, Clinical presentation, Physical exam
    – Sacro-Iliac LBP: Pathophysiology, Clinical presentation, Physical exam
    – Facetogenic LBP: Pathophysiology, Clinical presentation, Physical exam
    – Myofascial LBP: Pathophysiology, Clinical presentation, Physical exam
  •  Neuropathic sources of low back pain:
    – Compressive and non-compressive lumbar radicular pain: Diagnostic criteria, History taking, Clinical Presentation. Physical exam (including neurological examination)
    – Neurogenic claudication: Lumbar central and lateral stenosis: Clinical presentation, Diagnostic
    criteria: Spondylolisthesis: Clinical presentation, Diagnostic criteria
  •  Thoracolumbar junction and thoracolumbar syndrome/s:
    – Principles of the Sagittal Balance (Pierre Roussouly)
    – Biomechanics and function of T/L junction
    – Potential impact of postural impairments
    – Non-vertebral elements of the T/L junction: Thoracolumbar Fascia, autonomics
    – Thoracolumbar Syndrome (R. Maigne): Clinical presentations, Diagnostic criteria, Physical exam
  •  Nociplastic low back pain
    – Persistent Pain exemplified by CLBP
    – Clinical presentation, Yellow Flags, Treatment strategies
    – The role of MTs to treat Persistent LBP

Learning objectives

The main objective of this course is to train students to carry out a good clinical reasoning process for patients with lumbopelvic/cervicothoracic pain and revisit our structural approach under an evidence-informed point of view.

At the end of the course the student will be able to establish an appropriate an evidenced-informed differential diagnosis of the most common clinical spinerelated presentations and navigate through a complete and effective clinical reasoning. Also, the student will master a safe, diverse and effective structural
approach which combines articular and high-velocity techniques.


Dr. Gerard Alvarez is a clinician, teacher and researcher in the field of Osteopathy and Manual Medicine. Based in Barcelona, he works with patients experiencing musculoskeletal pain with special focus to spinal disorders.
Following a comprehensive evidence-informed approach, he has been teaching in several osteopathic and non-osteopathic institutions both in undergraduate and postgraduate level. As a researcher, Dr. Alvarez has broad interests in manual therapy-related topics and he is specially devoted to explore methodological strategies to improve Manual Therapy research. He is an active member of the Center for Osteopathic Medicine Collaboration (COME) and the Director of the Spain National Center (COME NACE-ES).

Gerard Alvarez - PhD MSc PT DO
Gerard Alvarez



3 days for each module - 2 Modules




40 h


Certificate of continuous professional development (CPD) issued by Medi-Cine Online Learning Academy. The CPD will be issued only upon completion of all modules.

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