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    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
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      • Segmental Mobility
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      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
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    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
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ACL Rupture, Reconstruction, and Rehabilitation

2/28/2013

0 Comments

 
At one time, a ruptured ACL was the equivalent of a "career-ender." Both conservative and surgical treatment were not advanced enough to return an athlete to pre-injury levels. While complete recovery is still not guaranteed today, the likelihood of returning as a high-level athlete is definitely possible. An obvious example is Adrian Peterson of the Minnesota Vikings. Having torn his ACL and MCL in the 2011 season, Peterson returned to nearly set a new NFL record in 2012. As the evidence surrounding rehabilitation following ACL reconstruction grows, we can improve the development of physical therapy based off what we know about tissue healing and functional achievements. That being said, there is still much to learn regarding this pathology and the most effective way of managing our patients.  CONTINUE READING...
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0 Comments

Final chance to Vote! 

2/25/2013

0 Comments

 
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Therapydia extended the voting deadline for Best PT Blog til 2/26 (tomorrow). The Student Physical Therapist was nominated as a top 5 finalist for the "Best Student Blog" category. If you enjoy reading our blog posts, please take 5 seconds to vote for us as your favorite student blog. 


Here is how to vote: 
1)Go to: http://www.therapydia.com/blog-awards
2) Scroll down to the bottom of the page and click "Vote Now" button. 
3) Vote for The Student Physical Therapist -James Heafner, Chris Fox, Brian Schwabe under Best Student Blog 

                                            Thanks for the support!

0 Comments

Spinal Manipulative Therapy for Acute Low Back Pain.

2/19/2013

4 Comments

 
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A 2013 Cochrane review was recently published regarding the effects of Spinal Manipulative Therapy (SMT) for acute low back pain. The review identified 20 randomized control trials with inclusion criteria being adults 18 or older with a mean duration of low back pain of six weeks or less & participants with or without radiating pain. In general the review found that SMT for the outcomes of pain and functional status had low to very low quality evidence. This suggests that there is no difference when treating a patient with SMT vs. another intervention. The conclusion stated that "SMT is no more effective for acute low back pain than inert interventions, sham SMT, or as adjunct therapy. SMT also seems to be no better than other recommended therapies." 

For someone who is entering an Orthopaedic Residency with a strong emphasis in manual therapy, this information was astounding. I have seen the short and long term benefits of manipulation and mobilization first-hand in the clinic. How could the evidence be so contradictory? When discussing this article with an OCS/ fellow trained manual therapist, he had the following comments to make: 

"This review like many others on manipulative therapy have similar pitfalls:
Operational definitions- Spinal manipulative therapy (SMT) includes every hands on intervention: thrust, non-thrust, mobs, etc. I thinking it would make for a more valid study to really try and separate the types of therapies out. Apples and oranges in my book.
SMT alone- we have known that SMT without exercise for low back and neck pain provides very minimal effect. Let’s move on from the thinking that SMT is a panacea and look at what actually happens in the clinic.
Minimal subgrouping of patients- classification of patients is vital. Any physical therapist can perform SMT, regardless of training or expertise.  Whether the patients are sub-grouped based off of a CPR, patient preference, or therapist experience/critical thinking, not all patients will respond from treatment types the same. After all LBP is a symptom and not a diagnosis.
Multiple low quality studies- there is still a void in the literature. Minimal high quality articles regarding SMT are performed by PT’s using the above qualifiers. Therefore, most RCT’s are really just comparing a bunch of low quality research and finding the same conclusions.
This study is helpful in that it adds to the body of literature. However, I don’t think it is clinically useful, because it does not adequately describe practice patterns. Humans are extremely complex and manual therapy will only be THE answer in a small subgroup of patients. Everyone else needs a uniquely tailored solution based on the biopsychosocial state, fitness level, and impairments."

I found all of these points to be true. Additionally, it allowed me to realize that I too often skim to the conclusion and results section of an article without fully interpreting the research process that goes into finding these results. Understanding the operational definitions and the quality of studies that were researched will alter the authors conclusive points and change your ability to translate this information into a practical clinical setting. The biggest battle which stands between us and our research is the complexity of the human being. We are all so unique. While 2 patients may present the same impairments, there are a myriad number of factors that will go into how they respond to your treatment session.  

Reference:
Rubinstein S, et al. "Spinal Manipulative Therapy for Acute Low Back Pain: An Update of the Cochrane Review." SPINE. 2013; 38.3: E158-E177.

4 Comments

Thoracic Outlet Syndrome (TOS)

2/13/2013

0 Comments

 
Thoracic Outlet Syndrome (TOS) is a pathology that is relatively common in the general population but often not symptomatic enough for individuals to seek treatment. Due to the various structures that pass through the thoracic outlet, there is a somewhat inconsistent pattern for the disorder, which makes it difficult to diagnose and treat. The Sports Physiotherapist does an excellent job breaking down the background, anatomy, clinical findings, examination and surgical/conservative management of the patients. Check out the article here!
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0 Comments

APTA Responds to Dr. Oz Show Regarding Segment on 'Cutting-Edge Solutions for Back Pain'

2/11/2013

0 Comments

 
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In a recent Dr. Oz episode, the television physician discusses "cutting edge" solutions for back pain. Some of these solutions include ultrasound, tiger balm patches, and bumpy balls to help relieve pain. As healthcare professionals, we know the limited evidence regarding these interventions alone. In response, Dr. Rockar, president of the APTA, wrote a letter to the produces of the Doctor Oz show. He discusses that "physical therapy treatment for back pain is on evidenced based exercises to improve strength and flexibility, manual therapy to improve the mobility of joints and soft tissues, and patient education on ways to enhance recovery, prevent and relieve pain, and avoid recurrence.  These avenues of care offer long-term solutions rather than temporary, intermittent relief."  

Unfortunately, Dr. Rockar's letter will not be seen by millions of viewers like Dr. Oz's episode. Therefore, it is our responsibility to pass this information along to our patients.

Read the full letter here.

Reference: 
"APTA Responds to Dr. Oz Show Regarding Segment on 'Cutting-Edge Solutions for Back Pain'" Letter to Dr. Oz Producers. 5 Feb. 2013. APTA Responds to Dr. Oz Show Regarding Segment on 'Cutting-Edge Solutions for Back Pain' N.p., 5 Feb. 2013. Web. 11 Feb. 2013.
0 Comments

Trochanteric Bursitis or Hip Abductor Tear?

2/7/2013

2 Comments

 
    I recently had a patient with a history of being diagnosed with "trochanteric bursitis." While her therapy at the time was not for the hip, the patient often complained of pain superoposterior to the greater trochanter. This pain could be reproduced with ambulation and palpation. Having learned of bursitis being misdiagnosed before, I decided to delve into the topic. Upon further discussion, I learned she had the hip pain for approximately 5 years following being diagnosed with bursitis. The patient reported that no MRI was ordered for her hip. She also presented with a positive uncompensated trendelenburg during gait, pain with active hip abduction, pain-free passive hip abduction. Upon review of the literature, it appears there could potentially be a large incidence of hip abductor tears being missed in these patients. This article discusses how the findings of patients with hip abductor tears are shown to be similar to the signs of those diagnosed with bursitis. With the load our hip musculature withstands throughout a lifetime and the potential excessive load due to compensating for other gait deviations, perhaps we should be taking a second look at our elderly patients with hip pain that do not seem to be progressing.
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2 Comments

Best Student Blog Nomination!

2/6/2013

1 Comment

 
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Therapydia is currently hosting the "PT Best Blog" Awards. The Student Physical Therapist was nominated as a top 5 finalist for the "Best Student Blog" category. If you enjoy reading our blog posts, please take a minute to vote for us as your favorite student blog. 


Here is how to vote: 
1)Go to: http://www.therapydia.com/blog-awards
2) Scroll down to the bottom of the page and click "Vote Now" button. 

                                            Thanks for the support!

1 Comment

Busting the Myth that patients need to have PAIN to see a Physical Therapist

2/4/2013

1 Comment

 
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While this post from Synergy Physio Blog is directed towards the consumer, as physical therapists it is important to remember that pain is not a requirement for physical therapy. We are Movement Analysis Specialists. We have the unique ability to detect movement dysfunction before pain and disability occur. If a client is having trouble with activities of daily living or struggling to perform a recreational hobby, they are a candidate for physical therapy. With our medical model changing to a "wellness model," we need to advocate to our patients that pain should not be the only indicator for a physical therapy evaluation. Additionally, we cannot let old age continue to be a simple answer to chronic pains and decreased function. Gross function should NOT decrease with age. We must educate our patients on the benefits physical therapy and the relationship to maintaining or increasing function versus simply reducing pain. 

1 Comment
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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test