CPG

Question 1

What is level A evidence for adhesive capsulitis?(1)

Answer 1

1.Corticosteroid injection
Injection combined with mobility and stretching more effective in short term pain relief then stretching and mobility alone (4-6wks)

Question 2

What is level B evidence for adhesive capsulitis?(2)

Answer 2

1. Patient education
   Natural disease course, activity modification, match intensity of stretching with irritability
   2.Stretching-match to level of irritability

Question 3

What is level C evidence for adhesive capsulitis?(3)

Answer 3

1. Modalities-US,diathermy, e-stem combined with mobility and stretching
2. Joint mobilization’s-end range
3. Transitional manipulations-MUA

Question 4

What is level A evidence for interventions for cervical?(3)

Answer 4

1. Cervical mobilizations/manipulations-Combining cervical manipulation and mobilization with exercise is more effective in reducing neck pain, headache, and disability then manipulation and mobilization alone.
2. Coordination, strengthening, and endurance exercises
3. Patient education and counseling-

Question 5

What Patient education and counseling should be given for whiplash associated disorder?(2)

Answer 5

1. Educate the patient that early return to normal non-provocative pre accident activities is important
2. Provide reassurance to patient that good prognosis and fully recovery commonly occurs

Question 6

What is level B evidence for interventions for cervical?(2)

Answer 6

1. Upper quarter and nerve Mobilization

2. Traction-Mechanical Intermittent cervical traction

Question 7

What is level C evidence for interventions for cervical?(3)

Answer 7

1. Thoracic mobilizations\manipulations
2. stretching exercises
3. centralization procedures and exercises

Question 8

Which patient will likely experience favorable outcome with cervical mechanical traction?(5)

Answer 8

1. Age 55 or older.
2. • shoulder abduction test
3. • upper limb pension test A
4. Peripheralization of symptoms with Central PA testing (C4-C7)
5. +Neck distraction test

Question 9

Which patient will likely experience favorable outcome with cervical manipulation?(4)

Answer 9

1. Symptoms Duration less than 38 days.
2. Positive expectation that manipulation will help
3. Less than 10° difference in side to side rotation
4. Pain with spring testing (C3-7)

13.5x’s will help

Question 10

What is level A evidence for low back pain?(3)

Answer 10

1. Manual Therapy- consider utilizing thrust manipulations to reduce pain and disability in those with MOBILITY DEFICITS and ACUTE low back pain and back related buttock or thigh pain
2. Stabilization-Trunk coordination, strengthening, and endurance exercises to reduce low back pain and disability in patients with SUBACUTE and CHRONIC low back pain with movement coordination impairments and post-lumbar microdiscetomy
3. Directional Preference -(Research suggest that indications of CENTRALIZATION is a key predictor)

Question 11

What is level B evidence for low back pain?

Answer 11

Patient Education and Counseling: Patient education

1. Promotion of the understanding of the anatomical/structural strength inherent in the human spine
2. Neuroscience that explains pain perception
3. Overall favorable prognosis of low back pain
4. Use of active pain coping strategies that decrease fear and catastrophizing
5. Early resumption of normal or vocational activities, even when still experiencing pain
6. Importance of improvement in activity levels, not just pain relief.

Question 12

What level of evidence is there for Progressive Endurance Exercise and Fitness Activities?

Types of patients?(2)

Answer 12

Level A Evidence

1. moderate- to high-intensity exercise for patients with chronic low back pain without generalized pain
2. Incorporating progressive, low-intensity, submaximal fitness and endurance activities into the pain management and health promotion strategies for patients with chronic low back pain with generalized pain.

Question 13

What is level C evidence for low back pain?

Answer 13

1. Flexion Exercises Flexion has long been considered the standard of care for spinal stenosis, current evidence suggest combination of manual + exercise+ BW supported treadmill training is most effective intervention
2. Lower Quarter Nerve Mobilization Procedure Utilizing lower-quarter nerve mobilization procedures to reduce pain and disability in patients with subacute and chronic low back pain and radiating pain.

Question 14

Which postpartum patients will benefit form Stabilization exercises?(4)

Level of evidence?

Answer 14

1.Positive posterior pelvic pain provocation test
(AKA Thigh thrust test )
2.ASLR – difficulty reported
3.Modified trendelenburg test
4.Pain provocation W/ TTP of the long dorsal sacroiliac ligament or pubic symphysis

Level A

Question 15

Clinical criteria for knee OA?(6)

Answer 15

1. Age over 50
2. Bony enlargement
3. Bony tenderness
4. Crepitus
5. No warmth of joint
6. Morning stiffness

Question 16

What is level A evidence for plantar fasciitis?(5)

Answer 16

1. Manual therapy-Increased DF ROM and STM
2. Stretching-Plantar fascia and Gastrocnemius/soleus stretching
3. Taping-antipronation taping
4. Night splint-1- to 3-month period
5. Foot orthoses (prefab OR custom)-support the medial arch and/or provide cushion to the heel region