Orthopedic Manual Therapy

553 Pages·2010·19.32 MB·English

by  Chad E. Cook

Orthopedic Manual Therapy
An Evidence-Based Approach
Second Edition
Chad E. Cook, PT, PhD, MBA, OCS, FAAOMPT
Professor and Program Chair
Department of Physical Therapy
Walsh University
North Canton, OH
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Contents
Foreword vii Putting the Objective Physical Examination
Eric Hegedus Findings Together 50
Foreword viii Post-Examination Clinical Reasoning 50
Gregory S. Johnson Chapter Questions 51
Preface ix References 51
Acknowledgments xi
Contributors xiii • 4
Treatment and Re-Examination 55
Reviewers xiv
Chad E. Cook
• 1 Objectives 55
Orthopedic Manual Therapy 1
Chad E. Cook Treatment 55
Manual Therapy Techniques 56
Objectives 1
Fine-Tuning the Techniques 60
What Constitutes Orthopedic Manual
Therapy? 1 Re-Examination 62
The Science of Orthopedic Manual Chapter Questions 63
Therapy 2 References 63
Hierarchy of Evidence 8
Assigning Levels of Evidence 10 • 5
Manual Therapy of the Cervical
Chapter Questions 10
Spine 67
References 11
Chad E. Cook and Rogelio Coronado
• 2 Objectives 67
Orthopaedic Manual Therapy
Clinical Examination 67
Assessment 15
Observation 72
Chad E. Cook
Patient History 73
Objectives 15
Physical Examination 74
Clinical Decision Making Models 15
Treatment Techniques 90
Assessment Modifiers of Decision
General Techniques 92
Making 17
Targeted Specific Techniques 105
Clinical Reasoning 20
Treatment Outcomes 111
Decision Making in Manual Therapy 20
Chapter Questions 112
Assessment 28
Patient Cases 112
Chapter Questions 29
References 114
References 29
• 3 Orthopedic Manual Therapy Clinical • 6
Manual Therapy of the
Examination 35
Temporomandibular Joint 119
Chad E. Cook
Chad E. Cook
Objectives 35
Objectives 119
Determining Who is and Is not a Manual
Clinical Examination 119
Therapy Candidate 35
Patient History 120
Contraindications to Orthopedic Manual
Physical Examination 120
Therapy 36
Treatment Techniques 132
Detailed Elements of the Clinical Examina-
Treatment Outcomes 137
tion Process 39
Chapter Questions 138
The Physical Examination 44
iiiiii
iv Contents
Patient Cases 138 Clinical Examination 266
References 139 Physical Examination 268
Treatment Techniques 282
• 7 Manual Therapy of the Thoracic Spine Treatment Outcomes 292
143 Chapter Questions 294
Patient Cases 294
Chad E. Cook
References 296
Objectives 143
Clinical Examination 143 • 11
Manual Therapy of the Sacroiliac
Physical Examination 145
Joint and Pelvis 301
Treatment Techniques 159
Chad E. Cook
Treatment Outcomes 172
Objectives 301
Chapter Questions 172
Clinical Examination 301
Patient Cases 173
Observation 302
References 174
Patient History 303
Physical Examination 304
• 8 Manual Therapy of the Shoulder
Diagnosis and Treatment Decision
Complex 177
Making 318
Chad E. Cook Treatment Techniques 321
Objectives 177 Treatment Outcomes 331
Clinical Examination 177 Patient Cases 332
Observation 179 Chapter Questions 333
Patient History 179 References 334
Clinical Examination 180
• 12
Treatment Techniques 200 Manual Therapy of the Hip 337
Chad E. Cook and Christopher Fiander
Treatment Outcomes 211
Chapter Questions 212 Objectives 337
Patient Cases 212 Clinical Examination 337
References 214 Observation 338
Patient History 338
• 9 Manual Therapy of the Physical Examination 338
Elbow–Wrist–Hand 217 Special Clinical Tests 353
Treatment Techniques 354
Chad E. Cook and Amy Cook
Treatment Outcomes 367
Objectives 217
Chapter Questions 368
Clinical Examination 217
Patient Cases 368
Patient History 218
References 369
Physical Examination 219
Treatment Techniques 250 • 13
Manual Therapy of the
Treatment Outcomes 256
Knee 373
Chapter Questions 257
Chad E. Cook and Robert Fleming
Patient Cases 258
Objectives 373
References 259
Clinical Examination 373
Patient History 374
• 10 Manual Therapy of the Lumbar
Physical Examination 374
Spine 263
Special Clinical Tests 395
Chad E. Cook Treatment Techniques 396
Objectives 263 Treatment Outcomes 403
Clinical Examination 263 Chapter Questions 404
Contents v
Patient Cases 404 Clinical Special Tests 469
References 406 Treatment Techniques 469
Treatment Outcomes 473
• 14
Manual Therapy of the Foot Chapter Questions 475
and Ankle 409 Patient Cases 475
Ken Learman and Chad E. Cook References 476
Objectives 409
Clinical Examination 409 • 16 Soft-Tissue Mobilization 479
Observation 409 Megan Donaldson
Patient History 410 Objectives 479
Physical Examination 411 Soft-Tissue Mobilization 479
Special Clinical Tests 433 Clinical Examination 479
Treatment Techniques 433 Observation 480
Treatment Outcomes 442 Patient History 480
Chapter Questions 444 Physical Examination 481
Patient Cases 444 Special Clinical Tests 481
References 445 Treatment Techniques 493
General Techniques 503
• 15 Neurodynamics 449 Treatment Outcomes 512
Ken Learman and Chad E. Cook Chapter Questions 512
Objectives 449 Patient Cases 513
Clinical Examination 449 References 514
Observation 451
Patient History 451 Discussion of Cases Studies 517
Glossary 523
Physical Examination 452
Index 529
Clinical Use 467
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Foreword
As a clinician who first practiced physical therapy in the spine based on coupled motion and the necessity of mov-
early 1990s, I feel certain that I shared a belief of many oth- ing joints based on a convex/concave rule, while stead-
ers; that there was mainstream musculoskeletal physical fastly supporting other constructs with a scientific basis
therapy, and then there was “manual therapy.” Manual such as centralization or classification. Based on the
therapy was practiced by the apprentices of a handful of national and international success of the book, the
trailblazing gurus, each of whom taught their followers approach has been a needed and welcome approach.
special techniques that could cure a patient with the skill- Never one to rest on success, Dr. Cook has created an
ful laying on of the hands. Many perceived that the skill almost wholesale revision. As the evidence for manual
set of these practitioners was closer to magic than science. therapy has changed and grown so have the teachings
In the early phases of manual therapy, most of the practi- and practice of the editor. Included are mobilization with
tioners did little to dispel this conception. movement techniques and a more detailed section on out-
Fortunately for manual therapy (and physical therapy), comes for each body region. The book includes two new
those gurus influenced a group of inquisitive physical ther- chapters on nervous system mobilization and soft tissue
apists that would fuel an explosion of research that has mobilization. Despite these inclusions, the second edition
added to a bourgeoning bolus of science to the art of man- is a more efficient yet a more comprehensive presentation
ual therapy. One of these physical therapists is Dr. Chad of manual therapy for every practitioner. The consistency
Cook, who is a voracious consumer and producer of the of the presentation of assessment and intervention proce-
science of manual therapy. Acomponent of this production dures, not to mention the decreased heft of the book,
was the first edition of Orthopedic Manual Therapy: An Evi- makes this version of Orthopedic Manual Therapy more
dence-Based Approach. user friendly for professors, clinicians, and students. This
The first edition took the science of manual therapy and is the one text on manual therapy that all should have in
presented that science in an eclectic format, which was their collection.
both easily digestible and clinically applicable. This book
debunked many of the myths associated with the manual Eric Hegedus, PT, DPT, MHSc, OCS
therapy examination and intervention, such as treating the Associate Professor, Duke University
vii
Foreword
Acquiring knowledge and developing clinical competency research and scientific knowledge specific to each region
are two of the greatest challenges facing orthopedic manual are analyzed and correlated to support the tests, tech-
therapists. Knowledge provides the solid foundation for evi- niques, and clinical reasoning presented. Each chapter
dence-enhanced practice and increasingly establishes the pa- provides the reader with an extensive bibliography to
rameters that define the scope of orthopedic physical therapy. facilitate further investigation and underscore the sup-
Clinical competency requires the succinct synthesis of porting evidence.
anatomy, physiology, and current research to serve as a Amajor strength of the text is the extensive and compre-
framework for the utilization and development of appropri- hensive technique section, which is representative of a wide
ate evaluation and treatment techniques. variety of manual therapy philosophies. This integrated
An orthopedic manual therapist cannot be complacent approach allows the therapist to compare and investigate
in the pursuit of knowledge. Regardless of the therapist’s the most appropriate method of intervention for each
governing regulations, all orthopedic manual therapists patient, rather than being directed into one specific system
must function as a direct access practitioner in the sense of or viewpoint. In addition, over 700 color pictures supple-
competency and responsibility. The rapidly evolving disci- ment this section, facilitating a more efficient understanding
pline of manual therapy dictates the aggressive pursuit of and application of the techniques presented.
updated knowledge and skills. The second edition of The first edition of Orthopedic Manual Therapy immedi-
Orthopedic Manual Therapy: An Evidence-Based Approach ately became required reading for our Functional Manual
effectively presents the foundations of patient manage- Therapy Fellowship program in 2007. This text has pro-
ment, sound clinical reasoning, reflective practice, and vided the fellows in training with a comprehensive
problem solving, which assists in the management of the resource for information that guides the appropriate evalu-
unique challenge presented by each patient. Our patients ation, testing, and treatment of each patient, in addition to
require and deserve our ongoing commitment to excellence being the primary resource in studying for their examina-
and development of our knowledge of human behavior tions. I eagerly anticipate the release of the expanded and
and function to achieve optimum resolutions. enhanced version, bringing to our profession an up-to-date
Dr. Cook’s comprehensive, regional approach to the synopsis of relevant research and techniques for all ortho-
body allows the practicing therapist to synthesize current pedic patient populations. I am confident the second edi-
research, didactic knowledge, and clinical expertise in one tion of Orthopedic Manual Therapy: An Evidence-Based
resource. Chapters 1–4 provide detailed information per- Approach will continue to augment the advanced training
taining to orthopedic manual therapy assessment, evalua- of not only Manual Therapy Fellows and Residents, but all
tion, treatment, and contraindications. This carefully physical therapists dedicated to excellence in clinical man-
organized preamble to the regional technique section is agement and patient care. I am honored to write a Fore-
necessary reading for all physical therapists, regardless of word to such a high-quality and important text.
one’s area of specialty or experience. Atherapist’s ability
to recognize and appropriately address the orthopedic Gregory S. Johnson, PT
issues with any patient requires a knowledge base sup- Co-Founder, Institute of Physical Art, Inc.
ported by a comprehensive understanding of anatomy, President, Johnson and Johnson Physical Therapy, Inc.
pathology, and applicable research. The following 12 chap- Vice Chairman, Functional Manual Therapy Foundation
ters offer an in-depth, regional insight into the prevalence Program Director, FMT Fellowship
of musculoskeletal conditions supported by the relevant Program Administrator, FMT Orthopedic Residency
anatomy, biomechanics, clinical examination protocols, Secretary, FMT Certification Board
treatment techniques, and outcomes. Within this section, Associate Professor, Touro College
viii
Preface
It is with great pleasure that I present the second edition within- and between-session findings, and a brief discus-
of Orthopedic Manual Therapy: An Evidence-Based sion on classification. Gone from the second edition is the
Approach. As is appropriate for any text espousing evi- level of detail on special tests, which isn’t truly germane to
dence-based elements, I have updated and expanded the care provided by a manual therapist. In its place are the
accordingly. As I mentioned in the preface to the first edi- presentations of more home exercise activities for carry-
tion,1 literature describing and measuring “evidence- over of care and mobilization with movement techniques
based” care has grown significantly over the last decade.2 to further broaden the scope of the text.
The core components of evidence-based concepts were What remains a bastion of this text is its emphasis on the
developed in the 1970s and 1980s with the application of debunking of myths and its polarizing discussion on weak-
epidemiological principles of patient care.3,4 These epi- nesses of certain manual therapy approaches. The text still
demiological principles advocate that using evidence- exposes faulty philosophies, theories, and other clinical
based care allows clinicians to apply the current best provisos that are advocated and does so for the sake of sim-
evidence from research to the clinical care of the individ- plicity. Good manual therapy (provided with the appropri-
ual patient.3,5 The overwhelming collective evidence is ate motor training) should not be so complex that all
daunting and the ability of one textbook to capture all clinicians can’t use it. And if I’m wrong in my take of the
aspects is simply unattainable. evidence, then I do so in the spirit of simplicity and clinical
But it’s not as if we haven’t tried. The second edition has utility for all therapists.
enlisted the assistance of a number of new collaborators,
including Christopher Fiander, Amy Cook, Megan Donald- Chad E. Cook
son, and Roy Coronado. Ken Learman has contributed an Professor and Chair, Walsh University
additional chapter and Bob Fleming has returned to update
the knee chapter. In addition, two new chapters have been
added to expand the material within the textbook. Aneuro-
References
dynamics chapter (Chapter15) and a soft tissue mobiliza-
tion chapter (Chapter 16) should improve the
comprehensiveness of the text, which now covers all ele- 1. Cook C. Orthopedic manual therapy: An evidence-based
ments of manual therapy. Chapters5–16each have two or approach.Upper Saddle River, NJ; Prentice Hall: 2007.
three dedicated patient cases and we’ve included videos of 2. Cohen AM, Stavri PZ, Hersh WR. Acategorization and
selected techniques to improve the understanding and analysis of the criticisms of evidence based medicine. Int
carryoverto the clinic. Visit www.myhealthprofessionskit. J Med Informatics.2004;73:35–43.
com to view these videos. To further improve the text- 3. Sackett DL. The fall of clinical research and the rise of clin-
book’s ease of application in a clinical setting, we’ve placed ical practice research. Clin Invest Med.2000;23:331–333.
the anatomy and arthrological elements (with new illustra- 4. Buetow MA, Kenealy T. Evidence based medicine: the
tions) online at www.myhealthprofessionskit.com. need for new definition. J Evaluation Clin Pract. 2000;
The most notable difference from the first edition is the 6:85–92.
further emphasis on clinical decision making. Different 5. Sackett DL, Strauss SE, Richardson WS, Rosenberg W,
models of decision making are discussed as are clinical Haynes RB. Evidence-based medicine. In: How to practice
decision-making aids such as clinical prediction rules, and teach EBM.Edinburgh; Churchill Livingstone: 2000.
iiixxx