Excellence in Physical Medicine and Rehabilitation Education

Differential Diagnosis of Spinal Conditions




This course is an introduction to differential diagnosis of spinal conditions using Mechanical Thinking, Testing and Treatment.


At the end of the course participants will have the tools to differentiate between common mechanical spinal problems;

non-mechanical problems; hip; SIJ; shoulder, appreciation of the Biopsychosocial

social model and systemic problems.

They will also be able to apply simple manual techniques in a patient centered

assessment and treatment paradigm.



At the end of the course participants will be able to:



 Identify the common sources and mechanisms of symptom production.

 Understand the concept of non-innervated structure producing pain

and symptoms.

 Differentiate between treating symptom source and the mechanism of

symptom production.

 Understand the differences in the neuroanatomy of the cervical and

lumbar spine.

 Identify possible models for symptom production in

the spine.

 Understand the head joint cervical joint concept of biomechanics and

it’s importance and clinical application.

 Apply the Active / Inactive cycle during history and examination.

 Apply the DReMaR concept to treatment and management of clinical


Understand the new classification of Mechanical problems into

IDIOT, Mal –Adaptation, Re-arrangement and Trauma.

 Apply the principles of BIG PICTURE history and examination,

including the Intent/ Relevance cycle.

 Understand and apply the POOMM force progression model.

 Identify and utilse the key concepts of differentiation and hypothtico-

deductive reasoning.

 Understand the key concepts involved in shared decision making and


 Apply the basic principles of the biopsychosocial model

 Understand the different use of force and loading during treatment of

common spinal problems.

 Understand and apply active listening and understand receiving a history.

 Understand the value of patient centered force progression and application.

 Apply simple manipulation to the spine in a safe manner.

 Understand the contraindications to spinal mobilization and manipulation.




DAVID C. POULTER PT , B.Sc. Special Hon,  Dip MDT

David Poulter is a British trained Physical Therapist. He emigrated to Australia in 1986 where he ran a private practice specializing in treating musculoskeletal problems.

He obtained his Diploma in Mechanical Diagnosis and Therapy in 1992. On completion of his diploma course he moved to New Zealand to teach the McKenzie Institute International Diploma course.

David spent 3 years working alongside Robin McKenzie developing the diploma program.

In 1995 he moved the McKenzie Diploma course to Coon Rapids, Minnesota, to it’s new home at Two Rivers Center.

David was the McKenzie Institute International Director of Education from 1996-1998 inclusive.

He taught the diploma course from 1995-2000 at the Two Rivers clinic and for NovaCare after 1998. He was a Senior Faculty Member of the US McKenzie Institute from 1995-2000, and a senior faculty member of the McKenzie Institute International from 1992-2000.

After leaving the McKenzie Institute, David  developed and taught his own courses based on the “Patient Centered Model.”  He has presented his two main courses “Patients have all the Answers”, and “Telling isn’t Teaching” in Britain, Sweden, Denmark, Greece, Ireland and the USA. He also developed and presented nationally and internationally two courses on “Spinal Differentiation” and “Manual techniques in a Patient Centered Paradigm.”

David has presented at numerous MSK conferences in both the USA & internationally.

He specializes in treating Musculoskeletal issues, patient empowerment and self treatment. He has extensive experience in treating the conditions of the spine, shoulder, hip, knee, and post surgical rehabilitation.

David is currently working as a consultant through his own company MT3 .  During the COVID pandemic he has been teaching &  presenting online webinars. Recently he has co-developed a clinical mentoring program, with Evie MartinPT,  through Physios Online UK https://physiosonline.co.uk/