Pre-Conference Sessions
Comprehensive management of neck pain- it’s time to pull it all together
Track: Clinical Skills
Presenters: Dana Tew, Brian Duncan, Jennifer Frerich, Toni Roddey
With conflicting recent evidence regarding the application and value of manual therapy in the management of persistent pain, OMPT’s are in the middle of a complex treatment paradigm debate. This course will assist clinicians in finding the balance of hands-on and hands-off approaches, as well as provide practical strategies for introducing active pain management. Participants will be guided through this 4-part “Monday morning applicable” course utilizing simultaneous application of manual therapy and pain neuroscience education, and the combined effects of motor control and higher-level cervical exercise. The course will provide didactic foundational knowledge of current pain science, manual therapy, and exercise, as well as lab time focused on improving psychomotor skills and exercise selection.
External-Focus Exergaming - Changing the Pain Game towards Transforming the Future
Track: Clinical Track
Presenters: Jan Dommerholt, Nathan Mayberry, Marc Sickel
The session will combine lectures and practical break-out sessions using high and low tech technologies. The main focus will be on experiencing external-focus exergaming.
Management of the Overhead Athlete: Bridging the Gap from Rehab to Performance
Track: Sports SIG
Presenters: Susan Falsone, Charles Thigpen, Ellen Shanely
Pain is a limiting factor for optimal performance for many athletes. When an athlete is injured, pain initially must be managed in order to properly return an athlete to sport. The Bridging the Gap from Rehab to Performance Continuum will be presented including several strategies for pain management, including but not limited to dry needling, cupping, kinesiology taping, manual therapy and movement interventions. Both scientific evidence and clinical experience will be shared in this hands on workshop.
Pain Science Manual Therapy: The Brain has a Body
Track: Clinical Decision Making
Presenters: Adriaan Louw, Louie Puentedura
With the increasing interest in pain science there has developed a potential clinical crossroad. For example, pain neuroscience education (PNE) is a cognitive intervention, purposefully shifting patients away from the traditional biomedical and anatomical models, which are prevalent in manual therapy. In fact, current PNE research deliberately avoids biomedical education as means to “undo” traditional pain models. With this purposeful shift, many clinicians are left with the question if manual therapy and pain science can cohabitate or are they mutually exclusive? This one day, lab intensive course, will delve into the cohabitation of pain science and various physical treatments such as mobilization, manipulation, soft tissue treatments, dry needling and exercise. Advances in the understanding of functional and structural changes in the brain shows manual treatments can be paired with pain science as means to remap cortical maps, alter nociceptive input into the central nervous system, facilitating descending inhibitory mechanisms, etc. Emerging PNE research has shown that a combination of physical treatment and PNE is superior to PNE-only approaches. Furthermore, PNE can in essence decrease sensitization, thus providing a window of opportunity to introduce physical treatments. The evaluation portion of the lab class will feature screening tools and tests to assess a hypervigilant nervous system and altered neuroplasticity associated with spinal pain. Treatment sessions will include a manual therapy-based PNE session explaining manual therapy from a pain perspective and using common manual techniques was ways to facilitate sensory discrimination, laterality retraining, localization and more. This hands-on one-day course is a MUST for manual therapists interested in seeing how pain science and manual therapy can work together to enhance outcomes in spinal pain.
Therapeutic Exercise Prescription In Orthopaedic Manual Therapy Practice: What Happens After Manual Therapy
Track: Clinical Track
Presenters: Bryan Dennison, Michael Leal, Brian Duncan
The Orthopaedic Manual Therapy (OMT) practitioner is a key player in the treatment of pain. Manual therapy has been shown to be an effective intervention for the treatment of musculoskeletal pain providing opportunities to improve patient function and self-reported disability. Additionally, a growing body of research is highlighting the ability of exercise to improve pain and function as well. Understanding and incorporating the emerging evidence for exercise interventions is necessary for OMT practitioners to continue demonstrating our current and future leadership roles as the musculoskeletal practitioners of choice.
This session will highlight the importance of therapeutic exercise prescription in OMT patient management. Lecture and lab teaching strategies will be used to assist the knowledge translation of the material presented in the course into immediate clinical practice. Course participants will have the opportunity to learn how to safely perform and teach various exercises for the upper and lower body, including the back squat and deadlift. Participants, working in groups, will design appropriate exercise programs including progressions for each program for various orthopedic conditions commonly encountered in the outpatient setting (spine, upper extremities, lower extremities) using traditional resistance training equipment, bands and body weight.
Using skillful hands and healing words to win the pain game with your patients: a multi-modal approach to manual therapy for the spine and extremities.
Track: Clinical Track
Presenters: Brian Power, Alec Kay
Integrating the most current evidence of pain science, this technique heavy course will provide the clinician with practical tools for optimizing outcomes using a blend of effective manual therapy and pain neuro education. Using language and education that emphasizes decreased sensitization and pain interpretation, HVLAT techniques will be blended with specific case scenarios to provide clinically applicable examples of language to decrease sensitization and facilitation of the nervous system and transform pain beliefs. We intend to make the material appropriate for PT students and include significant emphasis on precautions and safety with HVLAT techniques.
Keynote Sessions
Don't Worry. We will Manage
Panelists: Joel Bialosky
Placebo is traditionally defined as inert. Paradoxically, placebo mechanisms such as expectation and conditioning are associated with robust analgesic effects. Interest is growing in the role placebo mechanisms play in clinically effective interventions for pain; however, this presents a dilemma for advanced post graduate training such as residency and fellowship programs. Specifically, what is the value of advanced training in interventions which may be dependent on placebo mechanisms? This presentation will discuss the role of placebo mechanisms in interventions for pain as well as argue for the benefits of advanced training. Treatment responses of patients in pain are highly variable across patients and depend upon numerous factors beyond the chosen intervention. Effective treatment of patients in pain is dependent upon the skilled management by well trained providers. Residency and fellowship programs certainly enhance the delivery of skilled interventions. Perhaps more importantly, residency and fellowship programs enhance contextual factors surrounding the provision of these interventions providing a framework for successful patient management.
Liars, Ex-Girlfriends and Statistics
Presenter: Chad Cook,
Interpretation of statistical analyses is often flawed, fraught with emotion, and riddled with bias. This lecture parallels the real world emotional biases associated with acceptance of liars and ex-partners with statistical analyses mis-assumptions. The objectives of the lecture are to support the premise that what appears to be fact in statistical terms is highly reflective of how the data were obtained, analyzed and interpreted.
Precision OMPT - Driving Transformation of Practice
Presenter: Allison Rushton
Using a focus to spinal pain, this session will analyse how we continue to transform our practice to achieve precision OMPT. It will integrate development of clinical reasoning through research findings into an analysis of how we need to develop our practice to meet the needs of individual patients. It recognises that patients are all different and that this is a challenge for practice and research, to afford pragmatic ways in which we can develop to further improve our effectiveness. It will enable a musculoskeletal physical therapist to analyse what they do well already and what aspects of their practice can be developed further. An understanding of the evidence is crucial to this development but the critical application of the evidence to our individual practice is not always easy. Some frameworks e.g. IFOMPT’s Cervical Artery Dysfunction framework assist this and will be discussed. It will explore how well we are driving transformation to end with some key take-home messages. Useful resources will be included throughout.
Crucial Conversations about Pain Panel
Panelists: Chad Cook, Joel Bialosky, Adriaan Louw, Allison Rushton, Louie Puentedura, Laura Finucane
Moderator: Dan Rhon
The topic leaders will be guided through a series of thought provoking questions to discuss the current state of knowledge about what is known about the interactions manual therapy and the pain experience. Future direction for pain and manual therapy research, translational practice strategies, and advocacy will be discussed by this expert panel.
PTI Talks
Back to the Future
Presenter: Adriaan Louw
If pain is 100% produced by the brain, why does AAOMPT exist? Why seemingly does all AAOMPT conferences end up as pain conferences? Does pain science negate the use and importance of manual therapy? This long overdue talk will discuss how the pain world may have it all wrong: Give the brain a helping hand...
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Presenter: Chad Cook
A Physical Therapist Looks at 50 From High Atop the Ivory Tower
Presenter: Joel Bialosky
This presentation will highlight the struggles of a physical therapist working in academia to reconcile the gap between the didactic training of physical therapy students and the reality of clinical care.
Breakout Sessions
A Case-Based approach to applying the evidence for managing patients with low back pain who have Movement Coordination Impairments
Track: Clinical Track
Presenters: Diane Dalton, Daniel Sieczkiewicz, Jonathan Raymond, Sorcha Martin, Jessica McManus, Dave Melchiorri
Recently, the Treatment Based Classification first described by DeLitto et. al. has undergone an update and a detailed description of the Movement Control group has been published. Development of Classification-Based Cognitive Functional Therapy has also continued by Peter O’Sullivan and colleagues. Evidence continues to emerge regarding neurophysiological changes that occur with persistent pain and classification approaches are developing regarding neuropathic, nociceptive or central sensitization pain. Additionally, if the goal is to improve motor control and alter maladaptive movement strategies, principles of motor learning should be followed when attempting to change movement patterns. Recent advances in knowledge have led to the development of the OPTIMAL theory of motor learning with an increase in external focus of attention. How do you integrate this information to determine the best approach for your individual patient? We will use case studies (including video) to illustrate the application of the current evidence into the management of low back pain for those who have impaired motor control and maladaptive movement strategies. We will provide some didactic information on the topics above, demonstrate application with cases and provide practice opportunities time for key assessment and treatment strategies.
Achieving the research component of IFOMPT Standards – ensuring research informed OMPT excellence
Track: IFOMPT
Presenters: IFOMPT Standards Committee
AAOMPT’s OMPT programs fulfill the IFOMPT Educational Standards that include Dimension 9 - Demonstration of a critical understanding and application of the process of research. OMPT students need to demonstrate achievement of this dimension through effectively executing a research project relevant to OMPT practice and neuro-musculoskeletal dysfunction, selecting appropriate data analysis procedures and disseminating the conclusions of the study. This can be challenging across a range of diverse OMPT programs. This workshop is targeted at those working with students in an educational or clinical environment. It will explore a range of strategies for programs to achieve the research project component of standards including systematic and narrative reviews, qualitative and quantitative approaches to case studies, pilot and feasibility studies, and exploratory studies using interviews or focus groups. Barriers and facilitators will be evaluated and addressed with practical solutions explored for key problems. Participants will have the opportunity to address personal objectives as part of the workshop.
Advanced Medical Screening for the Manual Therapist
Track: Clinical Track
Presenters: Cody Mansfield, Phil Toal
This session will describe advanced medical screening for the OMPT to implement into clinic immediately. The goal of this session will be to understand the importance of a general medical screen in an outpatient orthopedic physical therapy clinic, including the importance of taking vitals, and understanding the mechanisms of medications (opioids, blood pressure and hyperlipidemia medications) that can affect orthopedic conditions. We will review case examples where manual therapy interventions are contraindicated based on the general medical screen, and clinical situations where palpation of an abnormality can lead to a necessary referral to another medical provider. We will discuss in detail the flow of a medical screening examination, review an abdominal examination, and discuss how opioid use can be the cause of low back pain and gastrointestinal distress.
An Anthology of Manual Therapy for the Lumbar Spine: One Therapist's Odyssey
Track: Master Clinician Series
Presenters: Michael Rogers
This breakout will provide the learner with a unique perspective of how various schools of thought and philosophy's were integrated into the instructor's practice. Case studies presented will provide examples of evaluation and treatment techniques currently employed by the instructor taken from several of the approaches discussed.
Appropriate load management throughout the continuum of tendon rehabilitation
Track: Clinical Track
Presenters: Pieter Kroon, Katie Gwyn
This presentation presents a structured and evidence based approach to evaluation and treatment of lower extremity tendon problems This breakout session will present best available evidence to treat lower extremity tendon problems. Demonstrated examination and intervention techniques include joint mobilizations/manipulations, and proper tendon loading exercises The following topics will be discussed: Anatomy, pathology and physiology of tendons Understanding tendon load Tendon pain and risk factors Assessment of tendon injuries Conservative management of tendon injuries
Beyond the Treatment Table: Implementing Pain Science Education into Clinical Practice for the Manual Therapist
Track: Translational Practice
Presenters: Mark Milligan
Pain science is the hottest topic in physical therapy and perhaps the medical community due to the opioid epidemic. We know that pain can persist absent of tissue damage and that the level of tissue damage does not elicit the same response between patients. The intention of pain education intends to provide patients with information that allows them better understanding and therefore improving their ability to manage and work with their pain. Due to the complex nature and multiple systems involved, many physical therapists struggle to integrate pain education into their treatment paradigm. This session will aim to enable physical therapists to integrate pain science and education into every aspect of their patient care, not just on the treatment table.
Breaking down the Cultural Component to the Pain Experience: A Hispanic Migrant OMPT clinic
Track: Educational Trends
Presenters: Mark Wilhelm, Megan Donaldson
Culture differences are evident in many aspects of life including the prevalence of illness and utilization of healthcare (Peacock 2008). These factors may influence healthcare utilization through differences in beliefs, behaviors, perceptions, and emotions. In the United Kingdom, back pain-related absence increased dramatically between 1979 and 1996 even though the prevalence of back pain did not increase. Subsequently, this trend has reversed, suggesting this trend was a cultural phenomenon. It has been suggested that people will cope with mild symptoms but will seek healthcare if the social environment changes and the current symptoms become viewed as problematic. There are 57.5 million Hispanics living within the United States, making people of Hispanic origin the nation's largest ethnic or racial minority. Hispanics constituted 17.8 percent of the nation's total population. The projected Hispanic population of the United States in 2060. According to this projection, the Hispanic population will constitute 28.6 percent of the nation’s population by that date. Although racial differences in pain prevalence and treatment have been investigated, little attention has been paid to ethnic differences in chronic pain. This is striking, given that Hispanics represent one of the fastest growing demographic groups in the United States. Moreover, Hispanic Americans are at increased risk of experiencing pain due to occupational exposure and have the lowest rates of health insurance of any racial/ethnic group. While Hispanics originate from diverse parts of the world, the majority of Hispanic Americans are of Mexican origin (63%). Given this burgeoning population, it is important that we better understand their pain experience and how it differs from other racial/ethnic groups. Mexican Americans experience pain in a unique way. Villarruel (1995) identified four common beliefs among Mexican Americans regarding pain. 1) Not only is pain a physical experience, it is also a personal, interpersonal, and spiritual experience where individuals feel the pain of others. 2) Pain is an accepted part of life that you have to live with. However, this acceptance of pain does not result in resignation, but instead indicates they can deal with the pain and it will resolve. 3) Enduring pain stoically and working despite the presence of pain is associated with pride. 4) Caring for others in pain and being cared for when in pain is essential to family and is an expected practice. Even for Mexican Americans at high levels of acculturation, many of these pain-associated beliefs were still present. The presence of cultural differences in regards to pain can create a unique and challenging environment in which to practice. Many of the migrant workers who have been seen in physical therapy have a more chronic nature due to their willingness to “tough it out” and belief that the pain will go away. Additionally, a suggestion of activity modification may not always be effective severe pain and limitations have not been influential enough to create activity modifications in themselves. Both the APTA and AAOMPT have multiple documents and policies mentioning cultural competence as an essential aspect of clinical practice as well as part of the entry level education. By facilitating student observation of utilizing OMPT in a pro-bono clinic for migrant workers, students gain an appreciation of cultural differences and how these differences may be navigated to improve the quality of life for an underserved population. This session will discuss the conceptual model of pain for Hispanic Americans and migrant Hispanics. We will discussion the key considerations in providing primary care in a pro-bono environment with Hispanic migrant workers experiencing pain. Last,we will utilize actual case scenarios to details specifics on pain education and manual therapy approaches may need to be altered to meet the unique cultural needs of these patients.
Boosting Your Mentorship Mentality: Using Structure in Your Sessions to Promote Lifelong Learning.
Track: Clinical Track
Presenters: Matthew Lee, Richard Hubler
Clinical mentoring in an OMPT post-graduate education program is one key for success, longevity and growth of the mentor and mentee. Effective mentoring is hallmarked by a structured relationship with the overarching goals of creating protégés and promoting lifelong connections. An effective mentor OMPT session showcases explicit structure and employs specific mentoring skills that go well beyond providing learner feedback. Yet, sub-optimal mentoring experiences are common in OMPT by both novice and seasoned faculty, because of unfamiliarity with the process and pragmatic tools of mentoring. This course will teach participants a practical structure to run a mentoring session and provide specific mentoring skills and clinical teaching strategies to maximize the results of a mentor session.
Bring the "Confidence Back" to Spinal Mobilization and Manipulation
Track: Clinical Track
Presenters: Kyle Feldman
Designed for students, new grads, and experienced clinicians who feel they lack the confidence with treating the spine with joint based treatment. Often when a therapist is not confident, they will seek alternative treatment approaches. This hands-on course is designed to work on improving body mechanics, feel, and leverage to increase confidence and desire to use joint mobilization’s in the clinic. Clinical pearls and simplicity of set up will be the emphasis. Attendees should come prepared with struggles and questions to work through.
Changing the Pain Game by Integrating Health Coaching in the Practice of Orthopaedic Manual Physical Therapy
Track: Educational Trends
Presenters: Myra Meekins
This breakout session will provide an overview of the scientific rationale for health coaching and its relevance in assisting clients with the management of pain. The session will focus on the identification, description, and application of health coaching techniques such as motivational interviewing, mindfulness, and principles of cognitive behavior therapy appropriate for patients with chronic pain conditions. Participants will practice coaching techniques and developing personal action plans for behavior change.
Changing the pain game for the OMPT: What are we missing?
Track: Clinical Decision making
Presenters: Beth Collier, Rhett Roberson, Joe Donnelly
So often the orthopaedic manual physical therapist can be distracted with trying to choose the best manual therapy intervention or technique to address a patient’s problem. We depend on the development of our clinical reasoning, clinical judgement and decision making which incorporates evidence-based medicine to make the best choices for our patients. Despite our logical consideration of what we know to be true, other contextual factors should play into our decision-making and often are missed. Likewise, many factors shape a patient’s pain experience that may be less obvious. This session will explore reflective strategies to identify personal perspective and contextual factors that influence clinical decision-making. These reflective and contextual strategies should be integrated within a comprehensive clinical reasoning strategy to manage patients with persistent pain.
Chronic Pain in the Older Adult: A Beast that OMPTs are Fit to Tame
Track: Clinical Decision making
Presenters: Daniel Chelette
The session will have both a lecture and lab component. The lecture will establish the problem of chronic pain in the older adult, how it develops, and its common presentation in the outpatient orthopedic realm. The roles of complex clinical reasoning, pain science education, and manual therapy will be discussed. The lab portion will involve attendees pairing up and collaborating on answering questions based upon two case scenarios involving older adults and chronic pain. The session will conclude with a reconvening of the whole group and group discussion regarding the case scenarios.
Ehlers-Danlos Syndrome (EDS), now what? Changing their pain game.
Track: Translational Practice
Presenters: Michelle Finnegan, Mary Beth Geiser, Lesli R. Bell
This session will briefly cover the wide range of Ehlers-Danlos Syndromes (EDS), but will emphasize characteristics of the hypermobility type (hEDS) since it is the most common. Screening strategies, assessment tools and specific useful questionnaires will be discussed to help educate physical therapists how to best care for this population. Speakers will use provide examples of how to blend current evidence, personal expertise and clinical reasoning to optimize orthopedic manual therapy treatment of patients with hEDS and provide participants with useful resources.
Evaluation and Treatment of Peripheral Nerve Entrapment as a Source of Hip Pain in Orthopedic Physical Therapy: Differential Diagnosis
Track: Clinical Track
Presenters: Katherine Gwyn, Pieter Kroon
This breakout session will present the current best available evidence on how to appropriately diagnose and treat complicated hip pain and how to assess for the involvement of peripheral nerve entrapment as the cause of pain. Demonstrated examination and intervention techniques include discussion of the peripheral nerves that can result in hip/pelvic girdle pain, neural tension testing and appropriate treatment techniques including nerve gliding, soft tissue work over the nerve and the use of dry needling. The following topics will be discussed: • Anatomy, pathology and physiology of peripheral nerves as they apply to the hip and pelvic girdle, including Ilioinguinal nerve, genitofemoral nerve, obturator nerve, cluneal nerves and sciatic nerve. • Possible causes of and risk factors for developing peripheral nerve entrapment. • Conservative therapeutic management of peripheral nerve entrapment.
Extension Rotation Syndrome of the Cervical Spine
Track: Educational Trends
Presenters: Tim Kruchowsky
This session will cover assessment, labeling and treatment of cervical extension rotation syndrome. This is by far the most common neck problem you will face. The identity of the physical therapist as a movement system practitioner will also be discussed.
Growing Pains in Mentoring: Timing and Structure of Important Conversations in the Mentoring Relationship
Track: Educational Trends
Presenters: Lauren Nielsen
This session will identify some tough topics that are often encountered in mentoring and identify potential solutions for both mentors and learners. The session will include reflective discussion on previous mentoring relationships from a recent fellowship graduate and the expert opinion of experienced mentors. The goal of the session to recognize that a successful mentoring relationship requires change and growth, and the way in which learning experiences and communication is structured can play large role in the happiness of both individuals. Current literature in leadership and communication will be used to provide immediately applicable techniques for handling a variety of mentoring situations, both positive and negative, from the perspective of the mentor and the learner. The bond between mentors and learners is essential for transforming the future of all parties involved as a direct and reciprocal relationship and it is important that we know how to foster it!
Headache and temporomandibular pain: Translating multidimensional health screening to leverage outcomes in OMPT
Track: Translational Practice
Presenters: Alicia Emerson, Garrett Naze, Stephen Shaffer, Carla Franck
Headaches and temporomandibular disorder (TMD) pain may involve complex and chronic conditions that significantly diminish quality of life. Epidemiological figures vary for prevalence and incidence, but the overall referral to physical therapy remains low for these conditions. Biomechanical etiologies are often the basis for diagnosis and treatment in orthopaedic manual physical therapy (OMPT). However, it is important to not overlook complex neurophysiological and psychological contributions such as stress, fear, and disrupted sleep because these variables may negatively impact health behaviors. Recent systematic reviews reported minimal high-equality research to support the efficacy and effectiveness of OMPT with these populations; only one systematic review reported outcomes other than jaw range of motion and pain. This research could be interpreted as support for the lack of referral to OMPT. These findings could be used to bolster the rationale to minimize headache / TMD pain assessment and intervention in educational programs. Further, they may explain recent findings that indicate OMPT fellowship training in TMD pain education is limited. However, emerging large-scale data from interprofessional research identify complex neurophysiological mechanisms in headache and TMD pain. If these biomarkers are not screened for, and addressed, then potential clinical reasoning errors in the dosing of OMPT interventions may adversely impact outcomes. Patients with headache/TMD pain demonstrate wide spread pain and sensitivity that require advanced clinical reasoning in management. As we strive to become frontline providers in pain management, supportive research is required when advocating for provider / patient awareness of OMPT interventions. In the first session, we will discuss how to clinically screen for aberrant neurophysiological processing, maladaptive psychological / cognitive beliefs, and ineffective health behaviors through questionnaires and simple clinical examination tools. We will provide simple, validated questionnaires to screen for maladaptive psychological, cognitive, and health beliefs such as depression and self-efficacy. We hope to challenge the audience to move beyond the biomechanical paradigm in headache and TMD pain. These findings will provide context for patient education on sleep, stress management, and minimizing fear avoidance beliefs and behaviors. The importance of elevated clinical reasoning required to incorporate these processes and guide OMPT intervention selection and prescription will be highlighted. In the second session, OMPT techniques will be demonstrated and practiced. OMPT intervention dosing will be discussed within the context of the aberrant pain processing and ineffective health behaviors. We will engage the audience with descriptive case studies, using these clinically relevant scenarios to highlight the research and clinical responses.
Hit the Pavement: Keys in Treating Knee Pain in Competitive Runners
Track: Clinical Track
Presenters: Toko Nguyen, Marie Charpentier
Evaluation and treatment of the competitive runner is a challenging area of practice in sports medicine and rehabilitation. There are many factors that must be addressed in order to successfully manage chronic knee joint issues in this population. These factors include mechanical joint dysfunctions, training load, and psychological factors competitive runners possess. This course will discuss some key strategies to return the competitive runner back to a high level of performance with intentional progressions of manual therapy, exercise prescription, and education. The course will include a strong lab component to demonstrate advanced manual therapy and proper exercise prescription.
Hot Topics in AAOMPT Practice Affairs: National and international implications for direction of a PTA addressing safety, efficacy and sustainability in OMPT practice
Track: Advocacy
Presenters: Jake Magel, Steve McDavitt, Elaine Lonnemann, Ken Olson
Historically there have been challenges in OMPT since the mid 90s in terms of how PTs co-treat with and educate PTAs in clinical practice. This session will briefly review the relevant history, APTA and AAOMPT positions and bring relevance to national and international implications in patient safety and efficacy and practice sustainability as it relates to orthopaedic manual physical therapist practice including the direction and supervision of the physical therapist assistant. This will be an interactive session will encourage discussion and debate among the attendees.
Integrating principles of self-management in the treatment of patients with musculoskeletal disorders
Track: Educational Trends
Presenters: Nathan Hutting
Self-management is defined as education and support provided by health professionals and/or lay leaders to increase patients' ability and self-confidence in managing their health and well-being. In self-management, patients are stimulated to be engaged in activities that protect and promote health, monitoring and managing the symptoms and signs of illness; managing the impact of illness on functioning, emotions and interpersonal relationships, and adhering to treatment regimes. It enables patients to make informed choices, to adopt new perspectives and generic skills that can be applied to new problems as they arise, and to practice new health behaviours. Patients who are able to make the lifestyle modifications and behavioural changes often report improved quality of life and clinical outcomes. However, patients need guidance and support to initiate and maintain these changes. Several self-management programs are available for patients with musculoskeletal disorders, including interventions for osteoarthritis, rheumatoid arthritis, osteoporosis, upper limb pain, fibromyalgia, knee pain, temporomandibular disorders, (chronic) low back pain, and various 'mixed' conditions. Some reviews suggest that self-management education alone is unlikely to improve clinical outcomes. Instead, it needs to be part of multifaceted interventions that also target clinicians, the environment, and wider health system issues. Self-management skills can be delivered effectively in many different ways, including facilitated groups, individual programs, telephone counselling programs and even self-instruction (Johnston et al., 2013). In the manual physical therapy setting, self-management techniques are likely to be most useful in assisting patients manage chronic pain and disability associated with long term and recurrent musculoskeletal conditions such as arthritis and back pain (Johnston et al., 2013). In the acute phase, the clinician promotes self-management by facilitating the patient to engage in pain relieving strategies and to learn the best way to manage their pain (Johnston et al., 2013). In the post-acute phase, the patient is actively engaged in activities to regain function appropriate for self-care and return-to- work and those activities which the patient nominates as important or relevant (Johnston et al., 2013). Self-management interventions can provide equal or better results compared to individual physical therapy (Toomey et al., 2015). Integrating self-management principles into routine care delivered by physical therapists may improve positive health behaviours and enable the patient to better manage the impact of their condition on their life (Hutting 2015; Hoon et al., 2015). However, there is evidence that clinicians do not always promote self-management in their patients (Cooper et al., 2009). Thus, additional training and knowledge is required to enhance the therapists' skills in the use of self-management principles in their treatment. Professional training for clinicians has a significant positive impact on their engagement in clinical self-management support and patient centeredness, as well as on their overall confidence to support self-management (Mudge et al., 2015). Therefore, training in self-management skills, which enables them to support patients, seems worthwhile for manual physical therapists (Hutting 2015). Manual physical therapists can play an important role in the delivery of self-management interventions for patients with chronic (musculoskeletal) disorders. This session will provide guidance in how manual physical therapists can integrate principles of self-management in their treatment of patients with musculoskeletal disorders. Behavioural change theories and techniques (Keogh et al., 2015; Hutting et al., 2015), effectiveness of self-management programs for several populations (Richardson et al., 2014; Hutting et al., 2015; Sheppard et al., 2015) development and evaluation of self-management programs (Johnston et al., 2014; Dufour et al., 2015; Hutting et al., 2016), and theoretical methods and practical strategies for self-management will be discussed (Johnston et al., 2013; Hutting et al., 2015). Moreover, implications for manual physical therapists will be presented and discussed with the audience. This session will provide the first step in training manual physical therapists in self-management skills to support patients with musculoskeletal disorders.
Integration of Movement and Manual Therapy for Painful Neck and Shoulder conditions.
Track: Clinical Track
Presenters: Mary Kate McDonnell, Patricia Zorn
The aims of this course are to enhance integration and knowledge of movement analysis with source specific testing. The use of multi-modal treatment strategies, including manual therapy and movement to improve orthopedic outcomes of the neck and shoulder patient will be presented. An experienced clinician who specializes in analysis of movement / posture and a fellowship trained manual therapist will present this session. An examination of the neck and shoulder will be presented which combines key tests valued by both movement specialists and manual therapists. Language for describing impairments will be defined and applied to case examples. A multi-modal treatment approach to address movement impairments will be described. A case study will highlight the clinical decision making process used by the two clinicians. The interpretation of clinical tests including testing for differential diagnosis in determining a diagnosis will be discussed. Treatment strategies for the individual in the case study will be described and will highlight the relationship between movement impairments and manual techniques to improve outcomes for the individual with pain conditions in the neck and shoulder.
Is the identification and treatment of pelvic conditions the missing link in your Orthopedic Manual Physical Therapy practice?
Track: Clinical Track
Presenters: Sara Cristello, Sara Brennan
The session will use a lecture format with an emphasis on case-based learning to illustrate a gap in traditional orthopedic manual therapy practice: a subgroup of low back pain patients walking into orthopedic practices that also have relevant pelvic conditions or impairments that are clinically linked to their lumbar complaints. An overview of the prevalence of pelvic conditions (i.e., chronic pelvic pain, pelvic organ prolapse, dyspareunia etc.) and low back pain will be presented to define the scope of the problem. The anatomical link between low back pain and pelvic conditions will be described. Description of patient cases will be utilized to illustrate how one might miss the relevant pelvic conditions when one is not properly screening for them. Finally the learner will leave with an understanding of key subjective and objective examination components to help them identify this subgroup of patients. Discussion related to orthopedic treatment, consultation, and/or referral to a Pelvic Floor Physical Therapist will also be discussed.
Kicking pain to the curb: Considering regional interdependence in the rehabilitation management of lower extremity injuries in the kicking athlete
Track: Clinical Track
Presenters: Christina Gomez, Lauren Hendrix, Nichole Volstad
There are hundreds of millions of kicking athletes in the world, yet the phases and musculoskeletal requirements of kicking are not well known. During this complex movement, the athlete must coordinate multiple regions of the body to perform an explosive action. After injury, the musculoskeletal system works in conjunction with neurophysiological, somatovisceral, and biopsychosocial responses to promote recovery. By considering the regional interdependence model, physical therapists can improve outcomes in these athletes. This session will combine the biomechanics of kicking and the regional interdependence model through an interactive lecture and discussion, with opportunity for question and answer. A lab portion will highlight specific manual therapy strategies to alter local and distal neuromuscular function and return the kicking athlete to sport.
Mentor & Mentee (M&Ms ... like the candy), digesting the importance of their interactions can transform any patient relationship
Track: Educational Trends
Presenters: IFOMPT Standards Committee
AAOMPT’s OMPT programs fulfill the IFOMPT Educational Standards that include the role of the OMT Physical Therapist as an expert clinician or clinical decision-maker. As experts, OMT Physical Therapists provide high quality, safe, patient centred care, drawing on their propositional knowledge, clinical skills and professional values. Mentored clinical practice (MCP) is an essential part of the OMT educational program to ensure that these qualities and skills are achieved. It provides a mechanism for promoting deeper learning and developing a broader knowledge base and skills required for higher level clinical reasoning and critical thinking in the clinical setting. This workshop is targeted at those working as mentors with students (mentee’s) in the clinical environment. It will explore a range of strategies for promoting learning and providing a practical approach to MCP. These include the mentor assisting the mentee’s (student’s) ability to transfer academic learning into clinical practice as well as reflective thinking of both the mentor and mentee. Mentorship is a critical tool for advancing patient care. Participants will have the opportunity to address personal objectives as part of the workshop.
Objects in the Mirror are Less Painful Than They Appear
Track: Translational Practice
Presenters: Matthew Daugherty, David Kempfert, Amanda Grant
This educational session will be a 45-minute breakout session presentation the goal of translational knowledge strategies to impact clinical practice. Session presenters will provide background information on selected patient conditions an OMPT commonly manages in clinical practice. Next, session presenters will briefly review the current evidence-based interventions specifically utilizing mirror therapy to improve function and decrease pain for these patients. Lastly, the session presenters will engage the attendees through clinical case scenarios guiding participants through appropriate mirror interventions utilizing free KahootIT quiz website for improved attendee interaction.
Pain: Men and Women ARE Different.
Track: Translational Practice
Presenters: Mary Beth Geiser, Michelle Finnegan
This session will cover the evidence showing a basic overview of differences in pain perception, pain modulation and objective finding between men and women. Understanding key facts from both animal and human subjects will help clinicians better under these differences when treating clients of both genders.
Playing Chess not Checkers: Shared Strategies for Advocacy Wins in Florida from 2016 to the Present
Track: Advocacy
Presenters: Thomas Eberle, Mark Bishop
45 minute breakout session to discuss the SPECIFICS of a 5 year legislative strategy which is now paying annual dividends. Topics include choosing the best CEO and Lobbying Team, identifying legislators to assist our agenda, State Board strategies, general legislative strategies specific to our local challenges, identifying local experts to testify, and growing grassroots support.
Putting the Patient in Control: Patient Response, Progression of Forces and Thrust Manipulation
Track: Clinical Track
Presenters: Cora Aytona, Ronald Schenk
Participants will introduce the concepts of MDT clinical decision making regarding the application of manual physical therapy procedures based on a progression from patient generated to therapist generated forces. Analysis of the MDT peer-reviewed literature in regards to thrust and non-thrust manipulation and the indications and contraindications to manipulation will be discussed. Supervised practical sessions will promote the development of psychomotor skill in the application of MDT clinician procedures including thrust manipulation.
Putting Your Clinical Reasoning in Order: Effective Teaching and Learning Strategies for Physical Therapy Students and Educators.
Track: Educational Trends
Presenters: Evan Petersen, Matt Walk, Stephanie Thurmond
The development of clinical reasoning needs to be seen as part of a learner continuum and grounded in explicit teaching and learning strategies. Due to the variability in clinical reasoning for students in entry-level and even advanced level physical therapy programs, a systematic approach to introducing effective strategies and instructional tools is needed to improve this essential skill. Clinical reasoning is essential to understanding a patient’s pain and in determining the appropriate vigor and type of physical exam and intervention. This 2-part breakout session will highlight the use of several clinical reasoning strategies and tools that can facilitate the development of clinical decision-making. Attendees will learn to utilize these tools in the clinical and academic settings to improve clinical reasoning and effective decision-making.
Telehealth in Orthopedic Physical Therapy: Opportunities and Challenges
Track: Translational Practice
Presenters: Seth Peterson
The session will focus on the current state of telehealth research and regulation, particularly as it relates to implementation in an orthopedic physical therapy setting. This will include an overview of research methods juxtaposed with current practice and reimbursement. After presenting the state of the current research in telehealth, content will be used to demonstrate some of the barriers and opportunities that exist in implementing telehealth on a wider scale. Audience interaction will be via mobile phone polling to demonstrate the reliability of certain diagnostic and evaluative tests and how lighting and visual limitations can affect the outcome.
The Mindful Communicator
Track: Educational Trends
Presenters: Paul Mintken, Megan Donaldson
The purpose of this breakout is to provide knowledge and skills associated with higher order skills in expert communication such as motivational interviewing and mindfulness strategies. Patient education is a central component of physical therapy practice. Frequent, extended communication with patients enables practitioners to develop rapport and insight into contextual factors associated with health-related behaviors. Motivational interviewing (MI) is a style and spirit of interviewing. MI is an evidence-based, collaborative approach to patient education that incorporates goal setting, treatment planning, self-monitoring, and reassessment. MI techniques assist patients in recognizing discrepancies between their current behavior and personal values, and provide support for self-efficacy by reinforcing an individual's belief that he or she is capable of initiating and maintaining a healthy lifestyle. These characteristics place orthopaedic manual physical therapists in an optimal position to enhance health-related outcomes by reducing pain perceptions, improving function, and encouraging patients to play an active role in effective self-management.
Mindfulness makes us aware of what is happening in our bodies, our emotions, our minds, and in the world. Through mindfulness training, people learn to recognize and discriminate between components of experience, including thoughts, feelings, and sensations, and develop a non-reactive awareness of these. The benefits of mindfulness include higher brain function, decreased stress, anxiety and depression, improved immune function, lower pain levels, decreased heart rate and blood pressure, improved attention and focus, and enhanced neuroplasticity, just to name a few.
Effective communication techniques in a healthcare setting has been developed on the bases that physiotherapists are in a unique position as part of a multidisciplinary team in that they can have substantially more contact time with patients than other members of the team. The physiotherapist is well-positioned to develop a deeper patient-therapist relationship and in doing so educate and empower the patient of their physical condition and management. The interaction and relationship between the practitioner and patient begins during the medical interview. We will uniquely blend the evidence support of MI and mindfulness as part of the critical components of the subjective interview.
The Stubborn hip, why does pain persist post surgically? The influence of neurophysiological keys and the thorax in facilitating post-surgical recovery.
Track: Educational Trends
Presenters: Angela Gordon
Hip pain is increasingly on the rise amongst a variety of different patient populations from kids to runners to adult recreational athletes. Still there is question amongst surgeons as to why hip pain persists even after successful surgery to repair the acetabular labrum or correction of impingement syndromes. Neurophysiological components such as the thorax, breathing patterns, lumbopelvic alignment, knee and ankle conjunction rotation, and first ray loading all can have an impact on the successful rehabilitation of the hip. In this session, all the factors of the entire lower kinetic chain will be address and shown how to decrease hip pain. In turn, outcomes can improve for both physical therapy and surgery.
The Whole House: Understanding the Basement to the Roof. A Comprehensive Anatomical Approach to the Pelvis and Surrounding Structures
Track: Translational Practice
Presenters: Kelli Wilson
Gaining the whole picture of your patient referred for groin pain will evolve your practice and how you treat. This session will analyze the neuroanatomy of the anterior pelvic cavity and common pain presentations that come with particular nerve entrapments. Close examination of the autonomic nervous system and its input into organs within the pelvic cavity will give you a greater picture for treatment of your patient. There will also be discussion about vestibulodynia and how the pelvic floor can tie into anterior pelvic pain and hip pain. You will gain an understanding on the hormonal input to this region and how it can impact a person's pain presentation. Following this presentation, Orthopaedic Physical Therapists will gain a further understanding of anterior pelvic pain and how they tie into common orthopedic conditions.
Therapeutic Exercise Prescription In Orthopaedic Manual Therapy Practice: What Happens After Manual Therapy
Track: Clinical Track
Presenters: Bryan Dennison, Michael Leal, Brian Duncan
This session will highlight the importance of therapeutic exercise prescription in OMT patient management. We will use lecture, technique/exercise demonstration with participation from the attendees and group work utilizing case studies to assist with the knowledge translation of the material presented in the course into clinical practice.
Thoraco-Lumbar Junction Syndrome: Functional Anatomy & Manual Treatment
Track: Clinical Track
Presenters: Matthew Thomason, Kent Keyser
This course will present the relevant functional anatomy and biomechanics of the thoraco-lumbar junction, as it relates to typical and atypical painful presentations often encountered by the physical therapist. Mobilization and manipulative techniques will be presented to demonstrate a spectrum of simple-to-complex strategies to treat the thoraco-lumbar region.
Training, Tendinopathy, and Pain: The Reality of Every Endurance Athlete
Track: Clinical Track
Presenters: Lauren Nielsen, Christina Gomez, Darrin Staloch, Nichole Volstad
Injured endurance athletes face a unique set of challenges regarding maintaining training schedules while concurrently having to manage loads absorbed by the lower extremity. Physical therapists must recognize this dichotomy and intervene appropriately. In addition, the significant psychosocial component requiring intervention when rehabilitating an endurance athlete can be a barrier to decreasing their pain. The purpose of this interactive course is to interpret the differences found among different presentations of tendinopathy in the endurance athlete and provide clinical strategies to select appropriate intervention and activity modifications. The lab portion of this session with focus on manual intervention including addressing extrinsic soft tissue and intrinsic joint dysfunction to aid in management of symptoms and improvement of arthrokinematics to mitigate lower extremity load.
Using Retraction Extension under Traction to Reduce Acute Cervical Spine Radiculopathy
Track: Clinical Track
Presenters: Chris Chase
3. Parts 1. Description of case(s) where procedure offers quick and effective pain relief. 2. Instruction in how to perform the procedure including video demonstration. 3. Time to perform the procedure on Presenters who can give real time feedback about to perform procedure.
Using Video-augmented Movement Analysis to Improve your Clinical Decision-making
Track: Clinical Decision making
Presenters: Alison Chang, Craig Hensley
Physical therapists are regarded as experts in movement. Identifying patho-mechanics that may drive nociceptive input or overload tissues as well as monitoring movement pattern changes throughout the episode of care is critical for treatment success. Motion analysis can be a useful tool for clinicians to assess and optimize movement. Traditionally, movement has been analyzed using visual observation in the clinic or costly, equipment-intensive, time-consuming quantitative motion capture systems in a lab. Recently, there has been increasing development of video-enhanced motion-analysis apps available for smart phones and tablets that require little to no equipment at minimal to no cost. Analyzing movement coupled with a robust clinical reasoning process optimizes physical therapy effectiveness and efficiency and epitomizes our professional identity as experts in the movement system. This session will briefly provide an overview of video-enhanced movement analysis apps. A clinical reasoning process that systematically analyzes movement, identifies key movement patterns contributing to pain and tissue stress, and prioritizes movement training strategies and other treatment options will be discussed through four patient cases, including individuals with upper and lower quadrant complaints.
Why You Should Take a Closer Look at The Pectoralis Minor Muscle in Managing Subacromial Impingement Syndrome
Track: Clinical Track
Presenters: Lawrence Ramiscal
This presentation is a combination of lecture and laboratory sessions. It will highlight the role of pectoralis minor muscle (Pm) in scapular dysfunction leading to subacromial impingement syndrome (SAIS), provide an evidence-based assessment of a tight/short Pm, and present an impairment-based physical therapy management of SAIS with the focus of using a novel manual therapy technique effective in stretching the Pm.