A - prox control, strength, plyo - 20+ min sessions, > 30 min/wk - start in preseason, continue through season B - does not need balance or solely focus on balance

A - MT (thrust manip for acute lumbar/butt/thigh pain, thrust manip and nonthrust mob for subacute/chronic) - trunk coordination, strength, endurance ex (subacute and chronic post microdiscectomy) - centralization (acute with referred pain) - directional preference (acute, subacute, chronic with mobility issues) - progressive endurance ex (generalized pain) B - pt edu (not if it will incr perceived threat/fear) C - flex ex (combined with MT, strengthening, nerve mob, progressive walking - chronic with radiating) - LQ nerve mob (subacute and chronic with radiating) D - traction (mod evidence to not use with acute/subacute nonradicular or chronic; prelim evidence for nerve root compression with peripheralization or + CSLR - intermittent in prone)

CPGs Flashcards by Ketul Shah

Achilles Tendinitis Examination

walk, descend stairs, uni heel raise, SL hop, recreation
DF ROM, ST ROM, PF strength/endurance, static arch height, FF alignment, painful palpation

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Achilles Tendinitis Interventions

A - ECC loading
B - laser, ionto
C - stretching, orthoses (running), night splint NOT beneficial vs ECC
D - heel lift
F - MT, taping

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ACL Prevention

prox control, strength, plyo
20+ min sessions, > 30 min/wk
start in preseason, continue through season

B - does not need balance or solely focus on balance

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Adhesive Capsulitis

Risk Factors/Clinical Course

B - DM, thyroid, 40-65, female, had on contra side

C - 12-18 mo (mild/mod mob deficits and pain persist but min/no disability)

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Adhesive Capsulitis Interventions

A - injections with mob/stretching (more effective than mob/stretching alone)
B - pt edu, stretching
C - modalities (shortwave, US, estim with mob/stretchin), joint mob, MUA

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Ankle Sprain Risk Factors and Dx

hx of previous strains, no external use, no normal DF ROM, no proper warm up, no balance/prop program
level of function, lig lax, hemorrhage, pt tender, total ankle motion, swelling, pain

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Ankle Sprain/Instability Examination

A - swelling, ROM, talar translation and inversion, SL balance
B - SL hop tests for lateral, diagonal, directional movement/changes

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Ankle Instability Risk Factors and Classification

C - inc talar curvature, no external support, no balance/prop program after acute sprain
B - CAIT, instability from old lig injury, stability and movement coordination impairments

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Ankle Sprain/Instability Intervention - Acute/Protected Motion Phase

A - Early WBing with support, therex (severe sprain)
B - MT (drainage, active and passive STM and joint mob, A/P talar mob)

Physical Agents
A - cryo, US (don’t use)
C - diathermy
D - electro/laser

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Ankle Sprain/Instability Intervention - Progressive Loading/Sensorimotor Training Phase

A - MT (graded mob/manip, MWM for DF, prop, WBAT for sprain)

C - therex/theract (functional and SL balance), sport specific

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Carpal Tunnel Diagnosis

A - SWMT (2.83 or 3.22)
B - Katz, Phalen, TInel, carpal compression
D - UE neurodynamic tests, scratch-collapse test, test for vibration

B - cluster (3+ for accuracy)
> 45, wrist ratio index (> .67), CTQ-SSS > 19, shaking hands to relieve symptoms, sensory loss in thumb

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Carpal Tunnel Examination

Strength
A - don’t use lateral pinch or grip
C - grip, 3pt, tip pinch
D - tip, 3pt, APB MMT following surgery

Sensory
C - don’t use threshold or vibration in nonsurgical, phalen surgical
D - 2 pt discrimination, threshold after surgery

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Carpal Tunnel Intervention

B - orthoses (neutral wrist worn at night, short term and nonsurgical), agents (don’t use laser, ionto, magnets)

assistive technology
orthoses (day, symptomatic, full time when night only doesn’t work; during pregnancy/post partum)
- may add MCP joint immob or modify wrist position
agents (heat and diathermy for short term, don’t use US, phono for nonsurgical)
MT (short term)
therex (orthotic/stretching program if no thenar atrophy and normal 2pt)

agents (nonthermal US)
MT (neurodynamic mob)

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Knee Sprain Interventions

A - therex (WB/NWB, CON/ECC within 4-6wks after ACLR; 2-3x/week 6-10 mo), nm estim (6-8 wks), neuro re-ed
B - immed mob (within 1 wk), cyro, supervised rehab
C - CPM, early WBing (WBAT), knee bracing
D - patient preference knee brace
F - knee brace (acute PCL, severe MCL, PLC injuries)

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LBP Interventions

MT (thrust manip for acute lumbar/butt/thigh pain, thrust manip and nonthrust mob for subacute/chronic)
trunk coordination, strength, endurance ex (subacute and chronic post microdiscectomy)
centralization (acute with referred pain)
directional preference (acute, subacute, chronic with mobility issues)
progressive endurance ex (generalized pain)

B
- pt edu (not if it will incr perceived threat/fear)

flex ex (combined with MT, strengthening, nerve mob, progressive walking - chronic with radiating)
LQ nerve mob (subacute and chronic with radiating)

D
- traction (mod evidence to not use with acute/subacute nonradicular or chronic; prelim evidence for nerve root compression with peripheralization or + CSLR - intermittent in prone)

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Knee Mensicus/Articular Cartilage Examination

B (meniscus) D (AC)
- modified stroke test for effusion, knee AROM, max vol isometric/isokinetic quad strength, jt line tenderness

B (meniscus) - max passive knee flex, McMurray’s, jt line tenderness

Knee Meniscus/Articular Cartilage Interventions

Progressive knee motion (B) - early A/PROM (both)

Progressive WBing
B - stepwise progressive (FWB by 6-8 wks, AC)
C - meniscus

Progressive RTP
C - early RTP meniscus
E - delay RTP (AC)

Supervised Rehab (B) - meniscus

Therex (B) - both post op

NM estim/biofeedback (B) - both post op

Neck Examination

Mobility - AROM, flex/rot test, c/t spine mob

Headache - AROM, flex/rot test, upper c spine mob

Radicular - neurodynamic testing, Spurling’s, distraction, Valsalva

Movement Coordination (includes WAD) - cranial cervical flex, neck flex endurance test

Neck Interventions Mobility

B
acute - thoracic manip, neck ROM, ST/UE strengthening
subacute - neck/shoulder girdle endurance
chronic - thoracic manip, cervical manip/mob, cervical/ST exercises

C
acute - cervical manip/mob
subacute - thoracic manip and cervical manip/mob
chronic - neck, shoulder girdle, trunk endurance; pt edu

Neck Interventions Movement Coordination

B, acute

edu (min use of collar, postural/mobility exercises)
reassure expected recovery is 2-3 mo
if slow recovery with persistent impairments (mobs with exercise)

C
acute - low risk of progressing to chronic (single session of edu/HEP, comprehensive ex program, TENS)
chronic - (edu, mob with submax ex program, TENS)

F
acute - monitor recovery status to identify delayed pts

Neck Interventions Headaches

B
acute - active mobility
subacute - cervical manip/mob
chronic - cervical/CT manip/mob with shoulder girdle, neck stretching, strengthening, endurance ex

C
acute/subacute - C1-C2 self SNAG

Neck Interventions Radiating

B, chronic

mechanical intermittent traction with stretching and strengthening, c/t spine mob/manip
edu

C
acute - mob/stab exercises, laser, short term collar use

NonOA Hip Pain Interventions

pt edu
MT (joint mob, STM)
therex and theract
neuro re-ed

Plantar Fasciitis Diagnosis

B
plantar medial heel pain (after period of inactivity, worsens with prolonged WBing)
heel pain with inc activity
painful palpation of prox insertion
(+) Windlass (-) Tarsal tunnel
limited A/PROM TC DF
abnormal FPI
high BMI in nonathletes

Plantar Fasciitis Interventions

A - manual therapy (joint mob, STM; tx for LE) - stretching (gastroc/soleus for short term, 1-4 wks; heel pad may inc benefits) - taping (antipronation for immed, up to 3 wks; elastic gastroc for short term (1 wk) - foot orthoses (prefab or custom to support med long arch and cushion heel) - night splint (1-3 mo program, if first step in AM pain) B - electro (ineffective for long term 1-6 mo; debatable for short term - ionto 2-4 wk) C - laser, phono, US (don't use), footwear (rocker-bottom with orthosis, shoe rotation during work week) E - edu for weight loss F - therex and neuro re-ed (control pro and attenuate forces during WBing), dry needling (don't use)

PFPS Diagnosis

A - reproduce of retro/peri pain during squat or loaded flex position (stairs) B - retro or peri pain, reproduction during squats, stairs, prolonged sitting, other flexed activities), exclusion of other ant knee pain pathologies C - patellar tilt test with hypomobility

PFPS Classification

F - no valid system, 4 proposed classification overuse/overload muscle performance deficits movement coordination deficits mobility impairments

PFPS Examination

B - squat, step down, SL squat C - patellar provocation, patellar mobility, foot position, thigh/hip strength, muscle length

PFPS Interventions

A - exercise (hip/knee combo) - foot orthoses (prefab with inc pro for short term pain relief, 6 wks; combo with ex, insufficient evidence for custom over prefab) - dry needling (don't use) - MT alone - don't use - combined interventions (foot orthoses, patellar tapine, patellar mobs, and/or stretching) B - patellar taping (w/ e for short term pain relief, 4 wks) - orthoses (don't use) - biofeedback (don't use electromyography, visual alignment cues) C - running gait retraining (adopt FF strike, inc cadence, dec peak hip abd) - acupuncture F - BFR (for limited painful ext) - pt edu