Ask an Expert: Complex Case Reasoning for Gluteal Pain and Lumbar Radiculopathy

Overview

This on-demand course is part of the Orthopaedic Division of the Canadian Physiotherapy Association's Ask an Expert series — a case-based format that gives physiotherapists direct access to an experienced orthopaedic clinician.

In this session, expert instructor Jill Robertson PT, MScPT, FCAMPT works through two complex real-world cases submitted by practicing clinicians, demonstrating how to reason through overlapping musculoskeletal and neurological presentations when the diagnosis isn't obvious. The session captures the kind of clinical thinking that rarely appears in textbooks: messy, multi-factorial, and rooted in decades of hands-on experience. Whether you're managing a post-oncology patient with persistent gluteal pain or a young tradesperson with a spine that defies a single treatment approach, this course models the diagnostic and therapeutic reasoning you need.

Learning Objectives

By the end of this course, participants will be able to:

1. Apply biomechanical testing — including hip internal and external rotation at 90° flexion — to differentiate between obturator internus, piriformis, and pudendal nerve involvement in complex gluteal pain presentations.
   
   
2. Explain how radiation-induced tissue changes can contribute to hypertonicity, neurovascular compromise, and pudendal neuralgia, and identify appropriate manual therapy and neuromuscular re-education strategies for this population.
   
   
3. Describe the clinical challenge of managing coexisting lumbar disc bulge and congenital spinal stenosis, and articulate a rationale for identifying a patient-specific neutral spine position.
   
   
4. Implement neurodynamic nerve gliding techniques (sliders) and ergonomic education strategies for patients with lumbar radiculopathy in physically demanding occupations.
   
   
5. Recognize the role of exercise dosage, sustained nerve tension limits, and frequent low-load movement in supporting disc nutrition and preventing radiculopathy flare-ups.

Audience

This on-demand course is designed for licensed physiotherapists and rehabilitation clinicians who regularly manage complex musculoskeletal and neurological presentations. It will be particularly relevant for clinicians working with post-oncology patients, those treating lumbar spine conditions, and any practitioner who wants to sharpen their differential diagnosis skills in cases where standard protocols don't cleanly apply. Orthopaedic Division members and those pursuing advanced musculoskeletal competency will find this course directly aligned with clinical practice at a specialist level.

Why This Course Matters

Gluteal pain with a history of pelvic radiation and lumbar radiculopathy in a patient with two competing spinal pathologies are exactly the kinds of cases that expose the limits of protocol-based practice. When a patient doesn't fit the textbook, clinicians need a clear framework for reasoning through competing diagnoses, managing conflicting treatment goals, and making confident decisions with incomplete information. This course doesn't just present answers — it walks through the clinical reasoning process in real time, including the false starts, differential considerations, and anatomical nuances that shape treatment choices. For physiotherapists who want to move beyond algorithmic care and develop the kind of adaptive clinical thinking that complex patients demand, this is the format that delivers it.

About the Presenter

Jill Robertson PT, MScPT, FCAMPT, Clinical Specialist MSK, Examiner Orthopaedic Division

Jill has been a practicing physiotherapist for 39 years and spent 30 years as a part-time academic instructor at Dalhousie University. She is an instructor and examiner for the Orthopaedic Division and a Clinical Specialist in Musculoskeletal Physiotherapy, and has served as past Chair of both the National Orthopaedic Division and the Canadian Academy of Manipulative and Musculoskeletal Physiotherapy. In 2025, Jill received the Golden Hands Award — one of the profession's most prestigious honours. She is a strong advocate for professional development that respects the time and financial realities of busy clinicians.