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Orthopedic Manual Therapy PDF

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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 Pearson Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo LibraryofCongressCataloging-in-PublicationData Notice: Theauthorandthepublisherofthisvolumehavetakencarethattheinfor- Cook,Chad. mationandtechnicalrecommendationscontainedhereinarebasedonre- Orthopedicmanualtherapy:anevidencebasedapproach/ searchandexpertconsultationandareaccurateandcompatiblewiththe ChadE.Cook.—2nded. standardsgenerallyacceptedatthetimeofpublication.Nevertheless,as p.;cm. newinformationbecomesavailable,changesinclinicalandtechnical Includesbibliographicalreferencesandindex. practicesbecomenecessary.Thereaderisadvisedtocarefullyconsult ISBN-13:978-0-13-802173-3 manufacturers’instructionsandinformationmaterialforallsuppliesand ISBN-10:0-13-802173-2 equipmentbeforeuseandtoconsultwithahealthcareprofessionalas 1. Manipulation(Therapeutics)2. Orthopedics.3. necessary.Thisadviceisespeciallyimportantwhenusingnewsuppliesor Medicine, Physical. I.Title. equipmentforclinicalpurposes.Theauthorandpublisherdisclaimall [DNLM:1. Manipulation,Orthopedic—methods. WB535] responsibilityforanyliability,loss,injury,ordamageincurredasa RM724.C662012 consequence,directlyorindirectly,oftheuseandapplicationofanyof 615.8'2—dc22 thecontentsofthisvolume. 2010040563 Publisher:JulieLevinAlexander ManufacturingManager:IleneSanford AssistanttoPublisher:ReginaBruno ManufacturingBuyer:AlanFischer Editor-in-Chief:MarkCohen DesignDirector:JayneConte ExecutiveEditor:JohnGoucher ArtDirector:SuzanneBehnke AssociateEditor:MelissaKerian Photographer:AnitaAiken AssistantEditor:NicoleRagonese DirectorofMarketing:DavidGesell EditorialAssistant:RosalieHawley ExecutiveMarketingManager:KatrinBeacom MediaEditor:AmyPeltier MarketingSpecialist:MichaelSirinides MediaProductManager:LorenaCerisano Composition:Laserwords,India ManagingProductionEditor:PatrickWalsh Printer/Binder:Courier/Kendallville ProductionLiaison:ChristinaZingone CoverPrinter:Lehigh-PhoenixColor/Hagerstown ProductionEditor:PattyDonovan,Laserwords,Maine Copyright©2012,2007byPearsonEducation,Inc.,UpperSaddleRiver,NewJersey,07458. PublishingasPearson.Allrightsreserved.PrintedintheUnitedStatesofAmerica.ThispublicationisprotectedbyCopyrightandpermissionshouldbe obtainedfromthepublisherpriortoanyprohibitedreproduction,storageinaretrievalsystem,ortransmissioninanyformorbyanymeans,electronic, mechanical,photocopying,recording,orlikewise.Forinformationregardingpermission(s),writeto:RightsandPermissionsDepartment. Pearson®isaregisteredtrademarkofPearsonplc. 10 9 8 7 6 5 4 3 2 ISBN-10 0-13-802173-2 www.pearsonhighered.com ISBN-13 978-0-13-802173-3 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 This page intentionally left blank 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

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ORTHOPEDIC MANUAL THERAPY, 2nd edition is extensively updated and presents all modern foundations of orthopedic manual therapy, including patient management, clinical reasoning, reflective practice, and problem solving. Its comprehensive, regional approach to the body helps therapists synthesize new
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Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.