Physical Therapy Management of Patients with Spinal Pain An Evidence-Based Approach

In this rapidly changing health care environment, a challenge today’s physical therapist faces is finding, evaluating, and implementing current best evidence into practicce, an integral part of health care professional educational programs. With that goal in mind, Physical Therapy Management of Patients With Spinal Pain: An Evidence-Based Approach provides a comprehensive research-based overview of the examination and physical therapy interventions of the spine.

Inside Physical Therapy Management of Patients With Spinal Pain, Drs. Deborah M. Stetts and J. Gray Carpenter evaluate the current evidence related to spinal pain and present it in a format that allows for an easy transition to the clinical environment. By providing effective clinical interventions, rather than relying on habits or tradition, patients benefit from an increased likelihood of improved quality of life with the least potential of personal and financial risk.

Some features include:
• Over 650 photographs, images, and tables
• Access to a supplemental video Web site with new book purchase
• Best practice for evaluating and treating the lumbar spine, thoracic spine, and cervical spine
• Comprehensive coverage of the clinical presentation of spine-related pathologies from evaluation to treatment

Each chapter outlines the history, physical examination, physical therapy diagnosis, evidence-based management guidelines, and case studies for each topic. Case studies will challenge the reader’s clinical reasoning skills with the use of current best evidence throughout the initial examination and subsequent treatment sessions.

Bonus!
Also included with Physical Therapy Management of Patients With Spinal Pain is access to a supplemental Web site containing more than 375 video demonstrations corresponding to the tests and measures, examination, evaluation, and intervention procedures covered within the text.

Physical Therapy Management of Patients With Spinal Pain: An Evidence-Based Approach is the go-to reference text and accompanying Web site for the physical therapy students, or clinicians who are reaching for best practice through providing the highest level of evidence-informed care in the evaluation and management of patients with spinal pain.

Deborah M. Stetts, PT, DPT is an associate professor in the Department of Physical Therapy at Elon University, NC, where she teaches professional students in the area of musculoskeletal management. Current research interests involve the use of real-time ultrasound imaging to examine abdominal muscle performance in select patient populations. Dr. Stetts is board certified in orthopedic physical therapy and a Fellow of the American Academy of Orthopedic and Manual Physical Therapists. She has over 23 years of service as a physical therapist in the United States Army working in a variety of clinical, academic, and administrative positions. Dr. Stetts completed her DPT from Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, in 2003; a master of physical therapy from the U.S. Army–Baylor University Graduate Program in Waco, TX in 1981; and a bachelor of science in health and physical education from Pennsylvania State University, State College, PA in 1976. She completed a residency in advanced orthopedic manual therapy at the Kaiser Physical Therapy Program, Hayward, CA, in 1990. Her professional experience and training have been primarily in orthopedic and manual physical therapy.

J. Gray Carpenter, PT, DPT, COMT graduated with a bachelor’s degree in physical therapy from East Carolina University, Greenville, NC in 1992 and completed his doctor of physical therapy from the University of North Carolina at Chapel Hill in 2006. Dr. Carpenter also completed the Certificate in Orthopedic Manual Therapy from Manual Concepts, Curtin University, Perth, Western Australia, in 2002. He became a board-certified specialist in orthopedics through the American Physical Therapy Association in 2008 and became a Fellow of the American Academy of Orthopedic and Manual Physical Therapists in 2009. During his career, Dr. Carpenter has primarily worked in outpatient orthopedic settings but has experience in several settings such as acute care, home health, inpatient rehab, and wound care. He currently works as a staff physical therapist at Alamance Regional Medical Center in Burlington, NC as well as serving as associate faculty at Elon University in the musculoskeletal module. Dr. Carpenter has been very active in the North Carolina Physical Therapy Association (NCPTA) and has held several positions with the NCPTA.

Dedication
Acknowledgments
About the Authors
Preface
Foreword by Mary C. (Mary Kay) Hannah, PT, DPT

Chapter 1 Evidence-Based Practice in Physical Therapy
The Practice of Evidence-Based Physical Therapy
Critical Appraisal of Literature Related to Diagnostic Tests
A Case Study in Diagnosis Using the Critical Appraisal Criteria
Critical Appraisal of Literature Related to Intervention or Prevention
Effect Size and Confidence Intervals
A Case Study in Intervention Using the Critical Appraisal Criteria
Critical Appraisal of Literature Related to Outcomes and Prognosis

Chapter 2 Subjective Examination: A Patient’s History
Communication During the Patient Interview
Goals of the Subjective Examination
Content Areas of the Patient History
Pre-Examination Questionnaires
Patient Demographic Profile
Chief Complaint (In Your Own Words, Please Tell Me What Your Main Problem Is)
Completing the Body Chart or Symptom Diagram
Description and Assessment of Pain and Other Symptoms
History (Present or Current Episode)
History (Previous Episode[s] of Similar Problem)
Symptom Behavior
Review of Medical Screening Questionnaire
Patient Expectations and Goals
Interview Summary
Planning the Physical Examination

Chapter 3 Components of the Basic Neuromusculoskeletal Examination: Tests and Measures
Goals of the Physical Examination
Conducting the Physical Examination
Observation
Posture
Gait Screen
Balance Screen
Movement Testing
Neurological Examination
Muscle Length Tests
Muscle Performance
Special Tests
Neurodynamic Tests
Screening Tests for Regions Above and Below the Area of Symptoms
Palpation
Additional Studies
Evaluation
Diagnosis
Prognosis
Chapter 4 Evidence-Based Physical Therapy Practice for Low Back Pain
Diagnosis
Evaluation
Components of the Patient’s History (Subjective Examination)
Physical Examination of the Lumbopelvic Region (Includes Lower Thoracic Spine)
Diagnostic Classification and Matched Intervention
Chronic Low Back Pain Classification
Classification and Management of Chronic Low Back Pain
Interventional Therapies, Interdisciplinary Rehabilitation, Pharmacology, and Surgery
Patient Expectations and Patient Satisfaction
Pelvic Girdle Pain
Components of the Subjective Examination for Persons With Pelvic Girdle Pain
Components of the Physical Examination for Persons With Pelvic Girdle Pain
Evidence of Conservative Management of Pelvic Girdle Pain

Chapter 5 Evidence-Based Physical Therapy Practice for Thoracic Spinal Pain
Prevalence, Incidence, and Risk Factors
Classification of Thoracic Spinal Pain
History and Diagnostic Triage
Components of the History (Subjective Examination)
Components of the Physical Examination
Physical Examination of the Thoracic Region
Diagnostic Classification and Impairment-Based Management
Neurodynamics and the Thoracic Spine
Miscellaneous Disorders of the Thorax
Interventional Radiology and Surgical Management of Thoracic Disorders

Chapter 6 Evidence-Based Physical Therapy Practice for Neck Pain
Diagnosis
Classification Systems
General Overview of the Clinical Manifestations of Neck Pain
Evaluation
Components of the Patient’s History
Components of the Physical Examination
Considerations for Ligamentous Stability and Vertebral Artery Testing
Physical Examination of the Cervical Spine (Includes Upper Thoracic Spine)
Diagnostic Classification and Matched Intervention
Neck Pain With Headache Classification
Whiplash-Associated Disorders Classification
Surgical Management of Cervical Radiculopathy and Myelopathy
Postsurgical Rehabilitation

Appendix A Case Study for Limited Examination
Appendix B Case Study for Full Examination
Appendix C Case Study for Low Back Pain
Appendix D Case Study for Low Back Pain
Appendix E Case Study for Pelvic Girdle Pain
Appendix F Case Study for Thoracic Spinal Pain
Appendix G Case Study for Thoracic Spinal Pain
Appendix H Case Study for Cervical Pain
Appendix I Case Study for Cervical Pain
Index