Collen-Francqui Chair 2024 | Professor Barbara Cagnie

Low back (LBP) and neck pain (NP) are amongst the top 5 chronic disorders in Belgium. Traditionally, there has been a widely accepted notion that the transition from acute to chronic LBP/NP follows a linear trajectory, where an injury leads to acute episodes, subacute stages, and progresses to a chronic pain condition. However, it appears that pain progression is much more complicated and individualized than this original unsupported assumption. In order to better understand and manage LBP/NP, we must examine the different pain trajectories so that clinicians can better identify and predict patient-needs and customize treatments for maximum efficacy.

The rate of transition from acute to chronic LBP/NP is about 35%. Secondary prevention requires an understanding of the risk factors involved in chronification, validated instruments to detect patients at risk, and validated clinical strategies addressing these risk factors with specific interventions. Evidence is provided that subgrouping patients regarding their risk for chronification and specifically tailored treatment (including education and exercise) is effective in the short and middle terms. Tertiary prevention aims to reduce the impact of chronic pain. The biopsychosocial model of pain led to the development of biopsychosocial (i.e multidisciplinary) treatment approaches. Although interdisciplinary treatment has been acknowledged as an appropriate answer to the comprehensive suffering of patients with LBP/NP worldwide, its evidence is controversially discussed. Conceptual frameworks and mechanism based treatment designs, and harmonized outcome assessment is needed to identify best treatment to specific groups of patients regarding their characteristics.

Patients with neck complaints can present themselves in different ways. There is evidence for different treatment strategies in the approach to these patients. Parallel reasoning, in which clinical patterns are identified based on different factors may enhance treatment success. A combined approach of education, hands-on and hands-off can be administered in each individual. However, the amount, content and order of these three modalities may differ between clinical patterns.

The clinical picture of Whiplash-associated disorders (WAD) and the recovery pathways are very variable. Although a spontaneous recovery within 3 months after the trauma is expected, up to 50% of patients develop persistent pain and disability. During this presentation, both peripheral and central mechanisms, that play a role in this injury will be discussed in more detail. Depending on the clinical picture and the phase of recovery, a targeted clinical examination and treatment plan will be presented.

Migraine, tension headache and cervicogenic headache are the headache types that most often occur in physiotherapy practice, largely due to their frequent association with neck pain. For therapeutic purposes, the challenge is to find the right treatment for each patient, using an evidence-based targeted approach. This lecture will provide an overview how to recognize the different types of headaches, which clinical tests are useful and what the possible treatment options are.

Work related neck disorders are common problems in office workers, especially among those who are intensive computer users. It is generally agreed that the etiology of work related neck disorders is multidimensional which is associated with, and influenced by, a complex array of individual, physical and psychosocial factors. Identifying risk factors in office workers provide key handles to target treatment.