STEP 4 Lumbar and Thoracic Spine

STEP 4 Lumbar and Thoracic Spine
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STEP 4: Lumbar and Thoracic Spine

Scientific Therapeutic Exercise Progression (STEP), the premier exercise course series from the Ola Grimsby Institute. STEP is a curriculum that focuses on exercise rehabilitation for tissue repair (mechanotherapy), joint mobilization, motor control, coordination, endurance, strength training, and athletic function. Back exercise for low back pain has all types of evidence in the literature. Learn to assess mobility and motor control to design, dose, and progress and unique program for the individual patient. The trend of motor control training has been over-emphasized for every back patient, as not all patients have motor control impairment. Also, learn how to design back exercises to mobilize restricted segments (spinal stenosis), improve mobility in a restricted hip that sits underneath a hypermobile spine (regional dependencies), and release a ribcage for mobility and respiration. Movement specialists for back pain need to be able to test and integrate exercises for all muscles of the lumbar spine, not just the transverse abdominous and the multifidus. Physical therapists are the movement experts, it’s time we start acting like it. Advance your exercise knowledge with this exceptional course in this series. This course is taught by seasoned instructors that use this curriculum every day in the clinic.

STEP 4 covers exercise techniques for biomechanical and neurological conditions including motor control deficits of lumbar and thoracic dysfunction. Exercise concepts of dosage, design, and progression for rehabilitation of the lumbar and thoracic spine will be brought to life using case studies and clinical examples throughout the course. In addition to the current evidence in work physiology, the course offers a clinical approach to an individual, a highly specific dosed program to include: resistance (concentric, eccentric, isometric), repetitions, sets, rest, speed, range, and frequency with reference to functional qualities.

Course Cities and Dates

STEP4 Lumbar and Thoracic Spine (Des Plaines, Illinois) Oct 14-15, 2023
STEP4 Lumbar and Thoracic Spine (Anchorage, Alaska) April 22-23, 2023

Become Certified

All 6 STEP courses can be combined, along with online learning, projects, and examinations, to receive a Certification in Rehabilitative Exercise (CREx).

STEP Origins in MET

The origin of STEP is from the Norwegian school of MTT or MET (Medical Training Therapy / Medical Exercise Therapy). With over 50 years of clinical application, these courses are designed to teach the clinician to think—designing their own exercises, or modifying classic ones, to specifically address each impairment of the patient. Current principles in work physiology and clinical evidence guide the participants on a path to critical thinking that empowers the clinician to create, rather than reproduce. Don’t learn a list of exercises, learn how to design an unlimited list of movement-based solutions. Exercise to mobilize joints/fascia, resolve pain and muscle guarding, elevate abnormal movement patterns, and combine cervical programs with scapular and upper quarter training. Learn to answer questions for dosage on all variables associated with exercise prescription: resistance (concentric, eccentric, isometric), repetitions, sets, rest, speed, range, and frequency. This course integrates specific manual therapy principles in mobilization, stabilization, and prevention of injury in the cervical spine.



a deep understanding of research based movement reeducation, creating exercise, and dose treatment allowing you to build highly effective custom programs for each patient.  This class will free you from protocols and ruts of basic PT exercise that people can find themselves on the internet. You will learn to design combined exercises for the lumbar spine and pelvis and integrate regional dependent concepts honoring the bodies function as a whole system and not individual parts.


Highly individualized motor control programs for lumbar instability based on your newly acquired assessment skills. This new depth of understanding will expand your creative strategies to design patient specific back exercises and protocols for lumbar radiculopathy, lumbar instability, and hypomobility… the list is infinite as your eyes are open to treating the unique movement dysfunction.


your patient outcomes through a thorough understanding of motor control deficits, how to identify movement faults, and  treat the specific motor control issues individual to each patient.


appropriate dosing of exercise as it pertains to reps, sets, and resistance and how manipulate these features to achieve differing functional qualities to specifically address tissue repair (mechanotherapy), local circulation, motor learning, coordination, endurance and strength training, coordination, endurance, strength, power.


new paradigms of exercise progression that are ensconced in research and highly specific, augmenting healing to the tissue in lesion, coordinating neurological motor patterns in functional movements that  get your patient up and moving pain free quickly.


exercise set ups to correct motor control deficits and allow maximal stimulation to create positive cellular change

Course Schedule

Day One

8:00 Introductions

8:15 Lecture: STEP Intro, Models of Pathology and Clinical Histology

9:00 Lab 1: Lumbar OSR

9:30 Lecture: Biomechanical model for Mobilization Principles

10:00 Lab: AROM testing, Lab: Mobilizing exercises

11:00 Lecture: Neurophysiological Model

12:00 Lunch

1:00 Lecture : Lumbar Motor Control

1:30 Lab: Ls muscle and motor control testing testing

2:30 Lecture : Lumbar Motor Control continued

3:00 Break

4:00 Lecture/Lab: Work Physiology

5:00 Summary / Closing

Day Two

8:00 Q&A

8:30 Lecture/Lab: Mobilizing with Coupled Force locking

9:30 Lecture: Coaching Motor Control – Internal / External focus

11:00: Lab: External / Internal focus training Exercise Design-Line of Action

12:00 Lunch

1:00 Lab: Basic Planar Resistance

1:30 Lab: Line of Action in fiber line

2:00 Lecture: Exercise Progressions

2:30 Lab: Exercise Progressions

4:00 Case Study Group Work

5:00 Summary

STEP Book Series

This exceptional three textbook series edited by Ola Grimsby and Jim Rivard covers the scientific fundamentals related to manual therapy and exercise rehabilitation. As a foundational textbook series for the STEP curriculum, this book series will dramatically increase your knowledge base but also provide examples of decades in clinical practice of apply STEP and MET (medical exercise therapy) concepts.

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User Avatar Brian Matheson