Session Descriptions
Pre-Conference
Differential Diagnosis of the Upper and Lower Quarter and Axial Spine
This two-day lecture (30%) and laboratory (70%) workshop outlines the differential diagnostic process of the upper and lower quarter and the axial spine, and includes a battery of the currently validated tests and measured used to screen and diagnose musculoskeletal conditions. The learner is introduced to the language and measurement aspects of diagnostic accuracy.
Presenter: Chad Cook
Intramuscular Manual Therapy: Trigger Point Dry Needling — A Novel Approach to Relieve Muscle Pain, Restore Muscle Function
Intramuscular manual therapy is increasingly becoming the treatment of choice for trigger point deactivation and for treatment of segmental spinal dysfunction. Physical therapists worldwide are becoming educated and clinically trained in this technique through post-graduate workshops and even in entry-level programs. In the United States a growing number of states, the American Academy of Orthopaedic Manual Physical Therapists, and the American Physical Therapy Association have acknowledged that trigger point dry needling is within the scope of physical therapy practice. This pre-conference workshop will introduce clinical examination and treatment of myofascial trigger points with emphasis on Intramuscular manual therapy.
Presenters: Edo Zylstra/Tamer Issa
Manual Therapy for the Upper and Lower Quadrant: What Do I Need to Know?
This two-day course will include 15% lecture and 85% lab. The content will focus on incorporating evidence-based manual therapy interventions into the management of patients with upper and lower quadrant dysfunction. The focus will be on identifying patients who are appropriate candidates for either thrust or non-thrust manual therapy interventions directed at the spine and extremities. The course will cover techniques identified in the literature as being beneficial for decreasing pain and improving functional for a variety of upper and lower quadrant conditions. The first day of the course will focus on addressing impairments of the upper quadrant (cervicothoracic, shoulder, elbow, and wrist/hand) and the second day will focus on the lower quadrant (lumbopelvic, hip, knee, and foot/ankle). The majority of the course will be devoted to hands-on demonstration and class participation of the physical examination and appropriate application of thrust and non-thrust manual therapy techniques.
Presenter: Joshua Cleland
Orthopaedic Manual Physical Therapy Interventions for Osteoarthritis of the Hip and Knee: An Evidence-Based Approach
A progressive hands-on course with emphasis on the clinical skills related to manual examination and treatment of patients with osteoarthritis of the hip and knee. More than 50% of the course will be hands-on lab activities. The course presenters have been actively engaged in a line of research related to osteoarthritis for 15 years within the context of an academic fellowship program. Upon completion, participants will be familiar with the body of evidence related to manual physical therapy interventions for osteoarthritis of the hip and knee. They will be able to manually examine patients with hip and knee osteoarthritis and make precise intervention decisions that will increase the magnitude of response while simultaneously decreasing the risk of increased symptoms. Participants will be able to reinforce their clinical treatment with exercise programs designed by manual physical therapists based on current best evidence and targeted to relevant impairments identified through extensive manual examination and treatment of this population. The course faculty plan to provide an opportunity for each participant to graph the force and pressure of a knee treatment technique. This opportunity will be dependent on the functional status of this exclusive piece of intricate equipment at the time of the course.
Presenters: Gail Deyle/Skip Gill/Ben Hando/Dan Rhon
Tour
Center for the Intrepid Tour
Free tour with transportation provided. The Center for the Intrepid (CFI), designed for service members wounded in operations Iraqi Freedom and Enduring Freedom, is a four-story, 60,000 square foot facility that includes clinical space, a military performance lab with a gait lab and computer assisted rehabilitation environment, a pool, an indoor running track, a two-story climbing wall and prosthetic center. The Center provides amputees and those with severe extremity injuries the best opportunity to regain their ability to live and work productively. In addition to serving as a premier rehabilitation center, the CFI is actively involved in clinical research.
Practice Affairs Fund Event
Join your colleagues and support the
AAOMPT Practice Affairs Fund (PAF) at the same time! Spend an evening at the World's Greatest Rock 'n Roll Dueling Piano Show at Howl at the Moon Saloon within walking distance of the convention center and Grand Hyatt. Piano players will tickle the ivories and your funny bone all night long with the best music from the '60s to today! Audience participation is a must at this dueling piano bar. So be ready to clap, sing, dance and howl!
Legislative
Texas Physical Therapy Association (TPTA)
Registration fees for this pre-conference session will be donated to the Texas Physical Therapy Association (TPTA) Political Action Fund. Meet with TPTA's staff and learn about the issues facing the OMPT industry in Texas and what vital role you can play in making a difference.
Keynote
Best Tests for Diagnosis of the Spine and Why It's Important
This keynote outlines the systemic process of differential diagnosis, the importance of a proper diagnosis in the initial stages of decision making, and notable errors and consequences of an improper diagnosis. Included are the required guidelines for defining an appropriately validated test for diagnsis and when and how these tests should be used in clinical practice. Lastly, the utility of current clinical tests for the spine will be evaluated and discussion of the value or lack of value for each will be presented.
Presenter: Chad Cook
Manual Therapy: If It Works, Why Isn't Everyone Doing It?
A substantial body of knowledge exists demonstrating the benefits of manual therapy for the management of a variety of conditions. However, it appears that the evidence is often lost in translation as there exists considerable variation in physical therapist practice. Specifically, manual therapy interventions are often underutilized potentially leading to suboptimal patient outcomes. Perhaps some of the reason for the underutilization may be related to lack of clarity surrounding the mechanisms of manual therapy. While traditional philosophies have relied on a biomechanical explanation for the observed effects, recent evidence suggests that a complex cascade of neurophysiological effects may be at work. This lecture will discuss recent evidence related to the mechanisms behind many of our manual therapy interventions. The lecture will continue by discussing possible education methods to enhance the incorporation of manual therapy into clinical practice. Finally, strategies to promote the utilization of manual therapy interventions in clinical practice will be discussed.
Presenter: Joshua Cleland
Patient Selection in the Era of Interventional Spine Care: Differentiating Acute and Chronic Pain
The diagnosis and management of lumbar spine problems has increasingly utilized health care resources with a significant increase in cost related to this common, yet complex diagnosis. However, outcomes have not improved as expenditures have soared. This lecture will address the essential issue of patient selection as it relates to treatment options for patients with lumbar spine problems.
Presenter: Stanley Herring
Research Day Keynote
Manual Therapy Responders: Is It All in Their Heads?
High-velocity low-amplitude thrust manipulation (HVLA) is an effective intervention for select individuals experiencing musculoskeletal pain. Despite the apparent effectiveness, the corresponding mechanisms are not established. Clinical practice often implies a predominantly biomechanical mechanism with the assessment of joint position and mobility directing the application of specific techniques intended to correct noted dysfunction. In contrast, recent pain literature suggests a central nervous system contribution to chronic musculoskeletal pain conditions separate from the peripheral injury. Neurophysiological responses associated with HVLA suggest inhibition of pain may result from a novel stimulus to the nervous system regardless of a biomechanical dysfunction and independent of the specificity of the technique. Subsequently, while clinical practice continues to emphasize a specific biomechanical mechanism of HVLA, centrally mediated neurophysiological responses may provide a more valid mechanistic model upon which to base our clinical practice and further study these interventions.
Presenter: Joel Bialosky
Break Out Sessions
Creating a Healthy Practice — Clinical Excellence Begins with a World Class Customer Experience
Would you like to drive your manual physical therapy practice towards success by learning how to create a world class customer experience for your patients and other customers so that they become raging fans? According to recently published research, patients access specialized health care services based on recommendations from their friends and other key ambassadors, not through online resources, published quality surveys, or radio/TV advertising. In this lively presentation attendees will gain key insight into making the experience of their patients the key driver of building their practice. Come join us to learn how to define it, teach it, measure it, live it, and reward it…the "it" being the customer experience!
Presenters: Timothy Flynn/John Childs
Entering the Online World: Boldly Go Where You've Rarely Gone Before
This session is for those physical therapists who love treating patients but know little about or are skeptical of the online world. However, as your work colleagues, your children, have learned to Google, Twitter, and generally leverage all the online information you feel the need to learn the basics. This session will help clinicians better understand the role that online resources have in the health care environment. Armed with basic terminology and fundamentals session participants will be better prepared to confidently explore and implement diverse technologies related to searching, organizing and sharing information.
Presenters: Tim Noteboom/Eric Robertson
Natural Alternatives to Long-Term NSAID Use
Studies show that long-term NSAID use has iatrogenic consequences on the musculoskeletal system, i.e., increases OA and interferes with tissue healing. Many patients are avoiding these long-term pharmaceutical interventions and looking at natural alternatives. We will discuss research on NSAID side effects; research on natural alternatives for pain and inflammation control; high sensitivity C-reactive protein (hs-CRP), a marker of dietary-related inflammation; and research supporting basic recommendations on eating habits that decrease inflammation. Awareness of research on diet, food, herbs and natural over-the-counter options can help PTs know what patients are doing and provide information for people to research options for a healthier future.
Presenter: Krista J. Clark
Organizing the Web: Moving from Knowledge to Action
You may not live online, but you visit it frequently. You can go online to search for answerable questions and access the resulting search results, but you are not sure how efficient or effective your searches are. You have a Facebook account, but you are not sure about other social media that may help you connect with the best resources. You follow blogs and find Wikipedia helpful, but you are unsure of how to take the next step of using these resources in your clinical practice. This session will help you take your existing knowledge and help you take action as both a savy consumer and effective creator of technology solutions.
Presenters: Eric Robertson/Tim Noteboom
Orthopaedic Interventions for the Treatment of Oncology Related Movement Impairments at the Shoulder
With the scientific advancement of detection and intervention for those with breast cancer, it is estimated that there are now over two million people in the US who have survived this disease. The focus on patient care for surviving the disease must now also address improving the quality of the lives of the survivors. There is known potential for shoulder morbidity following treatment for breast cancer. In fact, within twelve months following surgery, 71% will develop secondary lymphedema and a minimum of 40% report pain and functional limitations that continue beyond five years post intervention. Emerging literature is providing kinematic data at the scapulothoracic region to assist with the development of treatment plans. This session will look in depth at the literary evidence available for the potential secondary shoulder impairments that survivors will incur and demonstrate the application of orthopedic interventions within the plan of care for restoration of more optimal movement patterns. Evidence will be examined on what impact orthopedic interventions have on the prevention of oncology related secondary impairments.
Presenters: Chris Sebelski/Marisa Perdomo
Patient Response Methods: Indications for Mobility, Stability, and Direction of Preference
This break out session is designed to guide clinicians in the analysis of movement dysfunction and in the application of a prescriptive program based on a case study. The session will also include an analysis of the literature regarding patient response methods of examinations and intervention and will include movement principles pertaining to the efficacy of the McKenzie, Maitland, and Sahrmann systems. As illustrated by a simulated case study, an integration of these approaches may be effective in improving patient function.
Presenters: Ronald Schenk/Jessie Mathers/Charles Sheets
Prognosis Following Acute Whiplash Associated Disorders (WAD): Development, Predictive Validity and Clinical Application of a New Clinical Tool
This session will be a 90 minute mixed format, part lecture and part group discussion, with opportunities for greater interaction during the case presentation. The session will allow for interpretation and clinical use of a new screening tool for use in acute WAD, highlighting the development and preliminary validation thereof. Other relevant outcome measures intended to capture the full biopsychosocial spectrum of influences on pain and disability will also be presented and discussed. We will be showing a video presentation and demonstrating the various aspects of a standardized physical assessment developed specifically for use in the assessment of acute whiplash. A clinical reasoning model will be applied to the case presentation encouraging an interactive learning experience for participants. Participants will be given a subjective examination of a whiplash patient and presenters will facilitate group discussion on relevant prognostic factors and how they may guide further evaluation and/or treatment. There will be an opportunity for "hands-on" application of the various examination tools used in the standardized physical assessment (digital algometers, sensory testing with monofilaments, cervical range of motion, key muscle testing and supine neck flexion test).
Presenters: Lenerdene Levesque/Hilary Reese/Dave Walton
Recent Evidence for the Use of Manual Therapy in the Management of Neck and Low Back Pain
Low back and neck pain continue to be a major societal burden. However, certain physical therapy interventions and management strategies have demonstrated efficacy in the management of mechanical spinal disorders. In particular, manual therapy interventions have growing evidence supporting their use in both neck and low back pain. Given the tremendous personal and financial burden associated with spinal disorders it is imperative that physical therapists adopt current best practice based on existing evidence in managing these conditions. This program provides the current, best evidence on thrust and non-thrust manipulation in the management of neck and low back pain and discusses how manual therapy procedures are integrated into total patient management.
Presenter: Joshua Cleland
Screening for Medical Conditions that May Present as Acute Low Back Pain: Are We Lowering the Red Flags Too Soon?
While the vast majority of patients with acute low back pain have signs and symptoms that may be attributed to mechanical dysfunction for which physical therapy is indicated, the possibility of a serious underlying medical condition presenting as a musculoskeletal condition should always be considered. The usefulness of screening for red flag symptoms, however, has recently been questioned since 80% of patients with acute low back pain will have 1 or more of the classic red flag symptoms present. More specifically, if nearly everyone with acute low back pain has a red flag, then the presence of a specific red flag will rarely help the clinician in deciding whether further medical evaluation and management is needed. Additionally, some authors argue that too great a focus on addressing red flag questions can distract the clinician from delivering key information and appropriate treatment to the patient. In light of these recent findings, how can physical therapists in today's practice settings appropriately screen for signs and symptoms of underlying medical conditions that can present as acute low back pain? This session will describe the relative risk of serious disease (e.g., fractures, visceral disorders, tumors, infections, inflammatory arthritic conditions) accompanying a complaint of acute low back pain and a medical screening process that can be immediately implemented by physical therapists that is designed for safe and efficient patient management. Emphasis will be placed on describing pertinent patient history and physical examination findings that may prompt the physical therapist to hypothesize and estimate the probability of medical conditions presenting as acute low back pain.
Presenters: Michael Ross/William Boissonnault
Tailored Home Exercise Programs as an Adjunct to Manual Therapy
The biomechanical and neurophysiological responses associated with manual therapy are short-term and the effect size is generally small. Carry over effects of the manual therapy intervention may be partially a consequence of the home exercise program prescribed by the treating clinician. This course presents a number of potential prescribed "tailored home exercise programs" that are designed as self-administered carry-over exercises by the patient. Probable neurophysiological and biomechanical consequences of each technique are discussed.
Presenters: Chad Cook/Phillip Sizer
The "4th Compartment" of the Knee — Orthopaedic Manual Physical Therapist Interventions for Proximal Tibio-Fibular Joint Dysfunctions
This lecture and lab session is intended to give the orthopaedic manual physical therapist an evidence-based foundation for the evaluation and treatment of proximal tibio-fibular joint (PTFJ) dysfunction. We will examine how impairments at this location may affect the knee/ankle complex. The PTFJ is generally underappreciated and is often overlooked in the examination and treatment of patients following knee and ankle injuries, or in patients with non-resolving or recalcitrant lateral knee pain. The format will be a lecture and hands-on lab. The presentation will include a discussion on anatomy, biomechanics, imaging, diagnosis, proposed mechanisms of orthopaedic manual physical therapy (OMPT) intervention for the PTFJ, manual therapy decision making using case examples, and an evidence review of current PTFJ research. The lab portion of the program will consist of specific joint mobilization/manipulation and other treatment techniques directed at primary PTFJ dysfunction.
Presenters: Kevin Harris/Skip Gill
Tips on How to Publish a Paper on Manual Therapy
This course outlines essential traits and components of a well-written impactful manuscript on manual therapy defined by the editor and deputy editors of the Journal of Manual and Manipulative Therapy. Learners should include individuals who are interested in publishing an abstract or paper.
Presenters: Chad Cook/Carol Courtney/Jean-Michel Brismée
Trigger Point Dry Needling/Intramuscular Manual Therapy: Advancing Clinical Practice Towards Vision 20/20
Trigger Point Dry Needling(TDN)/Intramuscular Manual Therapy(IMT) is a relatively new treatment technique quickly increasing in popularity in the United States as physical therapists, advancing their clinical practice, seek new, more effective and innovative ways to treat their patients with increased efficiency and improved outcomes. With Vision 20/20 quickly approaching, how will therapists continue to differentiate their practice to fit into the Doctoring profile that will be expected with this Profession's future goals and its involvement in the progression of medical/health care in this country.
Trigger will be defined and it's history of use will be described as it pertains to mainly the United States and what future role we can expect it to take in the next 10 years as we move towards Vision 20/20. Progression of the use of this technique in the US and abroad will be discussed. The research of this technique will be presented as to the current thought of its affects on the body but also the potential affects yet to be fully identified. Application to current diagnoses and types of injuries will be discussed. Discussion on insurance coverage, billing and how physical therapy is adapting to its ever expanding scope of practice, and how physical therapy should be consistently valued among third party payers and the public.
Presenters: Edo Zylstra/Tamer Issa
Student Sessions Part I and II
Examination and Treatment of Temporomandibular Disorders: An Evidence Based Manual Physical Therapy Approach
This breakout session will include description of the kinematics and functional anatomy of the temporomandibular joint (TMJ) and related structures, and the physical therapy examination, classification, and treatment of Temporomandibular disorders (TMD).
Presenters: Ken Olson/Eric Furto