Presenter(s): Susan Clinton, Raymond Butts, Kristina Koroyan
It is widely recognized that low back and pelvic pain have a concomitant dysfunction of the pelvic floor. This can be expressed symptomatically in urinary incontinence and urgency/frequency. Considering the staggering number of individuals with low back and pelvic pain, it is incumbent upon the orthopedic manual therapist to consider a larger and more integrative approach. The purpose of this course is to provide the audience a framework in the evidence-based diagnosis and treatment of pelvic floor dysfunction, including patient case discussions and an integrative lab component to highlight practical treatment interventions for the manual therapist.
Presenter(s): Katherine Gwyn, Pieter Kroon
The goal of the session will be to teach clinicians how to identify and successfully treat tendon problems. It will provide a solid framework of how to diagnose a tendon injury, identify what stage of pathology the tendon is in and treatment for each stage of pathology. It will focus on the hamstring tendon, gluteus medius tendon, patellar tendon and Achilles tendon and the unique factors that play a role in each area of the body. It will discuss movement impairments that can contribute to tendon break down in each area as well as other systemic and pharmacological factors that can contribute to placing the patient at a greater risk of developing a tendon pathology.
Presenter(s): Alison Grimaldi
Lateral hip pain associated with gluteal tendinopathy is a prevalent condition, particularly in post-menopausal women. It is associated with substantial impacts on sleep and weightbearing function with quality-of-life similar to that of end stage hip osteoarthritis. Diagnosis is often delayed, and first line management usually involves corticosteroid injection with little or no active intervention. A substantial body of evidence is now available that has elucidated likely pathoaetiology, diagnostic utility of clinical tests, and reported kinematic variations and impairments of the abductor musculotendinous complex in this population. Early recognition of the condition through appropriate differential diagnosis and diagnostic tests, when followed quickly with an active, evidence-based intervention is likely to optimise outcomes. High-quality RCT evidence has established that a specific load management education and exercise approach is highly effective and superior to corticosteroid injection or wait-and-see in both the short and long term.
Presenter(s): Gail Deyle, Chris Allen, Bryan Pickens
Knee osteoarthritis (knee OA) is a global epidemic. Physical therapists with strong orthopaedic manual physical therapy skills are well suited to provide lifestyle changing interventions for this challenging population. This exciting one-day interactive session starts with an introduction by Dr Gail Deyle who has served on a variety of national committees to develop knee OA clinical practice guidelines and has likely treated more knee OA patients under research conditions than any other physical therapist. This course is specifically designed to help physical therapy students and all physical therapists understand the complexities of knee OA including the precise clinical reasoning required to tailor physical therapy interventions to be effective and well tolerated despite widely variable patient presentations. Training for manual physical therapy examination and treatment will include the use of a manual force training device (loadpad® force sensor by Novel) that provides real time feedback to the learner to facilitate motor skill development. The inclusion of the objective feedback as well as the exceptional clinical and research experience of the faculty will help refine participant’s manual treatment skills. The readily visible and palpable arthritic knee provides an excellent model to increase understanding of the complexities of a wide spectrum of chronic and acute musculoskeletal disorders.
Presenter(s): Mark Bishop, Eric Chaconas, Ahmed Rashwan, Jason Hunt
Over 20 million Americans suffer from substance use disorder and many find themselves in a physical therapy clinic seeking care. Addiction to narcotics, prescription pain medication and alcohol are complex conditions often co-occurring with mental health disorders and chronic musculoskeletal pain. The physical rehabilitation process for an individual experiencing substance use disorder requires a unique approach within the biopsychosocial model of care. The purpose of this educational session is to describe current strategies to help patients recovering from chronic musculoskeletal pain and substance abuse disorder. An overview of the evidence pertaining to the neurophysiology of addiction and relation to pain conditions will be provided. Moreover, the evidence for exercise prescription, graded exposure, pain neuroscience education, and psychologically informed practice for the individual recovering from substance abuse disorder will be presented alongside practical examples of physical therapists currently practicing in the addiction recovery setting.
Presenter: Alison Grimaldi
Gluteal tendinopathy is one of the most prevalent lower limb tendinopathies presenting to general practice and imposes an impact on quality of life similar to severe hip osteoarthritis. The diagnosis is often delayed, and management may be limited to corticosteroid injection for a substantial period of time – a course often resulting in short term gain but frequent recurrence and gradual decline in local musculotendinous health, physical conditioning and activity levels. A substantial body of evidence has been published over the last few years that provide evidence-based strategies for identifying this condition, associated impairments and active management of the condition to achieve early diagnosis and optimal outcomes.
Presenter: Joshua Cleland, PT, PhD, FAPTA
Manual therapy has been a foundational component of physical therapy for centuries, and a substantial body of knowledge suggests it can be beneficial for a variety of movement related conditions. Despite this, conflicting evidence, outdated paradigms and questionable scientific rigor has led to a heated debate within the world of manual therapy. While much of this debate has been useful and productive, there is a growing divide in our profession regarding the value of manual therapy. Dialogue and debate can lead to professional reflection and growth, but debate centered around personal bias and bad science can be destructive. It is challenging to participate in proper and productive debate, and our profession struggles to make sense of the emergence of new and sometimes conflicting evidence. Many times scientific findings, be they good, bad, or indifferent, get “lost in translation.” This leads to continued variation in physical therapist practice relative to the utilization of manual therapy. This lecture will briefly discuss the origins of manual therapy and present an objective summary of the evidence in support of its clinical effectiveness. Numerous debates from the past and present will be highlighted. Suggestions will be made to improve dialogue and debate within the manual therapy community and the impact this may have on the future of our profession.
Presenter: Lori Michener
Physical therapists are movement specialists. Assessing and optimizing movement is the foundation of physical therapy practice. In order to optimize movement, we need to identify movement deficits that require treatment. This is complex and limited by our ability to reliably assess movement, and identify thresholds of deficits that need treatment or amelioration to eliminate future problems. This session will discuss movement assessment examinations, the ability of movement assessments to determine deficits that require treatment, and the role of manual therapy for treatment of movement deficits.
Presenter(s): Nichole Volstad, Christina Gomez
Creatively transitioning concussion interventions into sport-specific exercises can be challenging. As rehabilitation progresses from simple tasks following injury into higher level activities, it is important to consider the demands on the vestibular, ocular, cervical, and proprioception systems for each sport. This interactive session will include lab experience and case study discussion to develop the attendee’s skill set in effectively and confidently creating a sport-specific concussion rehabilitation program from early rehabilitation to end-stage return to sport protocols. The labs and case studies will include manual techniques to immediately apply into practice and therapeutic exercises progressions for the involved systems.
Presenter(s): Mauricio Elizondo, Toko Nguyen
Session will discuss the prevalence of elbow injuries in the throwing athlete, biomechanical considerations that could affect elbow biomechanics, differential diagnosis in elbow injuries, and manual therapy/therapeutic exercise techniques to address appropriate impairments. The split can be 20 minute lecture, 25 minute lab.
Presenter(s): Ronald Schenk, Joseph Lorenzetti, Jane Borgehammar, Robert Robinson
Chronic pain affects over 25 million adults, with a significant proportion being attributable to disorders of the low back. The prevalence of low back pain (LBP) makes the condition a huge economic burden and a primary research priority. In contrast to attempts to make a pathoanatomical diagnosis, one way to identify and validate LBP subgroups is to base them on specific signs and symptoms identified with good inter-examiner reliability, followed by subgroup-specific interventions. Directional preference and centralization have been associated with favorable outcomes in LBP management and allow for a neuromusculoskeletal classification. An emerging evidence-based model of mechanical management, which may include end range forces, patient empowerment, and chronic pain subclassification, is showing favorable outcomes in the management of chronic LBP. Because centrally dominated pain is not all the same, this process requires classification of peripheral pain mechanisms.
Presenter(s): Josh Kidd, Cora Aytona, Chris Chase
When a patient presents to a clinician with an apparent musculoskeletal problem, the clinician will aim to direct intervention at the body part they perceive to be the source of the patient’s problem. Hence, a basic requisite for the successful local management of extremity problems is that the symptoms are emanating from the extremity itself. Clinicians interpret the patient’s history and examination to differentiate between a spinal source of symptoms and an extremity source. Even though this differentiation process is pivotal in guiding management, it is fraught with challenges. If pain of spinal origin is interpreted incorrectly as a local extremity problem, it can initiate a cascade of poor decision making and inappropriate management. The challenges of differentiating between the spinal and extremity source of pain are compounded by the high prevalence of incidental extremity imaging findings in the asymptomatic population. This may be further clouded by the poor psychometric properties of many extremity orthopedic tests and their propensity to be falsely positive in the presence of a spinal disorder. Perhaps most critically, there is no documented process that has been adequately tested and sufficiently demonstrated to differentiate a spinal versus an extremity source of symptoms. Indeed, many studies for extremity problems either make no mention of excluding the spine or the process appears cursory and based on assumptions rather than evidence. There is a ready acceptance that if there is pain elicited from extremity movement or if there is reduced range of extremity motion then the problem must reside either solely in the extremity or accompanying a separate spinal problem. This session will discuss the Mechanical Diagnosis and Therapy (MDT) system of musculoskeletal assessment and classification. It has acceptable reliability in trained clinicians for classifying low back pain and conflicting levels of reliability for classifying patients with neck and extremity pain. MDT has been used by clinicians in the differentiation of spinal and extremity symptoms. The MDT spinal vs extremity differentiation process is based predominantly upon the symptomatic and mechanical response to repeated end-range movements rather than on imaging or solely pain location. It is hypothesized, that by avoiding some of the pitfalls of the current differentiation process; by not basing decisions upon imaging, or using tests with poor psychometric properties, clinicians may gain a more accurate gauge of which symptoms are coming from the spine and which are not. This session will focus on the use of MDT as a differentiation process, to establish what proportion of patients presenting with primary extremity pain have a spinal source of their symptoms. Secondly; this session will examine if these spinal source extremity problems treated with MDT spinal interventions respond more or less favorably compared to extremity problems where the spine is not the source. It will include screening and non-thrust manipulation instruction to confirm or reject spinal involvement. The participant will leave this session with clinical tools they can implement immediately in any OMPT assessment.
Presenter(s): Brandon Cruz, Kyle Feldman
Designed for students, new grads, and experienced clinicians who feel they lack the confidence and skill set with treating the extremities with joint based manipulations. 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.
Presenter(s): Mark Milligan, Jerry Durham
Physical Therapy practices will continue to see decreased reimbursement, decreased employee loyalty and a greater loss of patient impact if they do not understand their patient’s experience within their practice. The future of a successful manual physical therapy practice is in leveraging your team (all employees) to maximize the patient experience for greater patient outcomes. Your team includes front desk, back office, providers and aides. A coordinated TEAM will keep your practice running more smoothly as they will tie all the components of the patient experience together, from first phone call all the way through the completion of care and beyond! Your coordinated TEAM is your practices greatest asset for patient outcomes. This session will allow opportunities for the Orthopaedic Manual Physical Therapist to recognize how to maximize and leverage their patient relationships.
Presenter(s): Sara Cristello, Sara Baker, Bryan Tachibana, Ryan Vickers, Trent Harrison
Psychologically informed practice (PIP) for musculoskeletal pain is a biopsychosocial approach that addresses the behavioral aspects of pain, with the goal of reducing the number of individuals who may develop long-standing pain-related disability. Although it has been a utilized approach for several decades, there is growing interest and application more recently as a result of several factors, including its expanding evidence base and national priorities emphasizing non-pharmacologic pain management strategies.
Presenter(s): Alex Bengtsson
As physical therapists continue taking on more direct access patients, the responsibility to accurately screen for medical pathology and refer if needed grows correspondingly. The push for increased autonomy and expansion of the scope of practice, such as imaging rights, requires a strong basis in the literature to support physical therapists’ qualifications. While the strength of the supporting literature predominantly comes from large randomized controlled trials and systematic reviews, the potential cumulative impact of case studies and series should not be underestimated. Specifically, cases such as those involving differential diagnosis resulting in appropriate medical referral and treatment could be of high value to individual clinicians and the profession as a whole. This educational session will provide the learner with strategies to recognize uncommon pathologies, develop clinical and research questions and to translate these questions and corresponding findings into written abstracts.
Presenter(s): Charles Hazle, Robert Boyles
Do you trust your hands or the images? When should you trust one more than the other? When do your hands suggest to you imaging is indicated or not? How do you communicate with the radiologist? How do you integrate the imaging results into your understanding of the patient? Referral for imaging is increasingly becoming a component of physical therapist practice by virtue of physical therapist expertise with the clinical examination to drive decisions relating to imaging and evolving practice parameters. This session is directed at improving our understanding the correlation of manual examination procedures and diagnostic imaging of the spine. Common examination procedures and clinical presentations are presented for their relationship to the need for diagnostic imaging and for imaging results. Substantial evidence exists of this relationship with many patient care circumstances, but requires further consideration for full integration into daily decision making practices for both medical screening for serious disorders and for routine patient management. Attendees of this session will gain a better understanding the relationship of clinical examination of patients presenting with spinal disorders and diagnostic imaging. This includes imaging and examination correlates for instability, possible fractures, radiculopathies and myelopathies, mobility deficits, along with serious life/health-threatening disorders.
Presenter(s): Zaki Afzal, Laura Iglar
This breakout session will provide a framework that can lead to the effective development of entry-level clinicians guided by an OMPT. We will discuss learning styles, effective teaching/mentoring techniques, and managing different personalities in order to not only adequately teach manual therapy techniques but to develop a clinician that is hungry to improve.
Presenter(s): Dr. Amy Bullock, Dr. Kristina Koroyan
Innovative techniques utilizing a proposed 10-point semi-standardized electrical dry needling protocol shown to display positive effects in improving facial paralysis motor control.
Presenter(s): Stephanie Fournier, Elaine Lonnemann, Andrea Crunkhorn
Women are not new to leadership; think of Cleopatra, Queen Elizabeth, and Florence Kendall. But women are outnumbered by men in the most prestigious positions, from Capitol Hill to the board room. This session will examine the cause of women’s underrepresentation in leadership roles in Physical Therapy and suggests what we can do to change the status quo. This session will explore the unique challenges faced by women as they navigate various paths of leadership. The speakers will integrate current literature regarding challenges women in leadership roles face and highlight specific ways that the individual speakers have mastered those obstacles. Attendees will learn about the unique challenges that women face in leadership roles globally, in military and civilian sectors and discuss best practice models to overcome obstacles and lead with enriched understanding.
Presenter(s): Gregory Johnson
Will present the present evidence of the importance of the abdominal, thoracic and pharyngeal pressure systems on human posture and movement. The presentation will demonstrate how the management of impairments of these systems can enhance airway efficiency. Focus will be placed on the role of manual therapy for treatment of postural, movement and airways problems. Presentation will also demonstrate the role of manual therapy for the treatment of sleep apnea.
Presenter(s): Paul Sullivan
Biomechanics of the thumb, and the CMC joint in particular, and how biomechanical impairments affect tissue breakdown in the CMC joint. A solid framework of CMC assessment will be presented. Movement impairment syndromes of the hand will be discussed, and their influence as a causal factor of CMC osteoarthritis, pain, and loss of function. Rational treatment approaches to address deficits found will be discussed. Demonstrated examination and intervention techniques include joint mobilizations/manipulations, soft tissue mobilizations, and specific therapeutic exercises to address movement impairments identified in the evaluation.
Presenter(s): John Heick
Differential diagnosis is pivotal for physical therapists to comprehend and consider when evaluating a patient. Understanding this content enhances our profession’s ability to expand into primary care settings. This session will enhance engagement, understanding, and critical thinking through reflection of differential diagnosis principles. The session is geared towards educators, residency or fellowship directors interested in enhancing educational approaches and to share their educational approach with the audience that they feel is effective.
Presenter(s): Emily Slaven, Joel Coffman, Carl Stones, Maggie Stratton, Ed Jones
In this session, information about Generation Z, how they like to learn, and their expectations of higher education will be discussed. Based on student feedback and current evidence, options for best practice for learning and teaching manual therapy will be reviewed, including an innovative, online delivery model to explore and share manual therapy content. This student-driven and -created model will bring a new dimension to the teaching of manual therapy in DPT programs.
Presenter(s): Diane Dalton, Stephen Johnson
Recent studies have demonstrated the changes in the brain that occur due to chronic musculoskeletal pain, including reorganization of representation in the somatosensory and motor cortices. Novel treatments that directly target cortical reorganization are increasingly recommended for those with chronic musculoskeletal pain conditions. Implementing these treatments into care in the clinical setting can be challenging. The goal of improving cortical reorganization is not intuitive for physical therapists. Screening and examination techniques to aid in deciding when to include these techniques are not performed in usual care and they are time consuming. Explaining the techniques to patients is also challenging. Graded motor imagery (GMI) is a staged treatment that aims to engage and reorganize cortical networks without triggering the protective response of pain. Techniques include functional motor empathy, left-right judgment tasks, motor imagery and mirror therapy. This presentation will describe a brief overview of the decision process regarding when to include GMI into the care of an individual patient. This will include the classification of pain mechanisms into nociceptive, neuropathic, and central sensitization, and determining if motor and/or sensory representations are altered. Video and/ or live demonstration of GMI techniques including localization training, mirror therapy and explicit motor imagery will be included.
Presenter(s): Jodi Young, Amy McDevitt, Paul Mintken, Steve Karas, Alicia Emerson
This two part session will focus on the steps necessary to develop a quality abstract submission that will be competitive for acceptance, and how to incorporate, articulate and demonstrate a clinical reasoning process. Topics covered will include identifying your purpose, describing the problem, explaining your methods, describing your results, and generating a conclusion. Emphasis will be focused on clinical projects. Some focus will also be given on how to create and deliver an effective poster and/or platform session. The session will be a hands on working session and individuals will work in small groups (based on team based learning principles). Participants are expected to bring a clinical project or basic clinical research hypothesis with aims to the session so they can begin to develop their project ideas. Participants will also have the opportunity to meet in a 4:1 model with a facilitator to receive individualized feedback on their abstract or other basic clinical research projects.
Presenter(s): Kenneth Taylor, Erin Conrad
Current literature shows that alterations in sleep architecture from decreased sleep quality or quantity are significantly tied to musculoskeletal health outcomes. Related outcomes include adverse effects on tissue healing time, skeletal muscle insulin resistance, physical activity performance at all levels, musculoskeletal injury risk, risk of new-onset pain (not related to injury) and worsening of pain that is already present. Presenters will discuss the evidence behind these associated changes and provide evidence-based strategies for valid and reliable assessment of patient sleep quality/quantity. Presenters will then discuss strategies that can be utilized to help address sleep impairments, giving specific guidelines for the implementation of evidence-based interventions to address them.
Presenter(s): Stacy Soappman
Not just for girls, this session is for anyone who wants to learn how to treat patients larger than themselves. Have you learned manipulation skills in class but struggle to integrate it into your clinical practice? Do you avoid using these techniques on your patients because it hurts your hands? Do you have difficulty performing manual therapy techniques or manipulations on patients larger than yourself? If you want to learn how to handle patients larger than yourself and do it with more efficiency and effectiveness then this is the course for you. This course will emphasize ergonomically efficient manipulation/manual therapy techniques. We will teach you that speed and body mechanics, not size, dictate how well you can manipulate and treat patients.
Presenter(s): Jodi Young, Amy McDevitt, Derek Vraa
Ask yourself these questions: Do you mentor Fellows or Residents? How did you learn to mentor? What is your mentoring style? In a time of data fatigue, cognitive load and a push for increased productivity in clinic, mentoring your residents and fellows must be both effective and efficient. One of the most critical elements of any post-professional physical therapy training program is mastering how to mentor. Having a quality, evidence based method and style of mentoring will optimize the training of your students to be adaptive and excel in a time of change. By providing mentees with the necessary skills, you will empower them to challenge their clinical reasoning thus advancing the quality of clinical care, musculoskeletal health and ultimately, the profession.
Presenter(s): Paul Ochoa, Emily Novoa
Presenter(s): Stephen Warfel II
We will discuss how to identify a patient that may have a possibility of OSA or UARS. These clients often require collaboration with other areas of medicine which we can co treat with for best possible outcomes. The journey through the airway will begin with description of the general anatomy. Then hone in on specific regions of the cranium and how they relate to each other, the mandible, an ultimately the respiratory cycle. Evaluation of the cranium will focus on specific landmarks which we will compare and contrast sides of the head in each plane.
Once we are familiar with the relevant anatomy and landmarks to evaluate, we will perform several functional tests to use as baseline. Before treating, we will discuss sequencing as this area requires finesse and communication to make changes. We will either perform some treatment techniques as a group, or I will pick an individual who would benefit and perform an example treatment. This will be up to the group to decide. There will be more techniques to perform in a patient demonstration as well as a better sense of sequence. Handout will provide manual contacts to use techniques at the clinic.
Presenter(s): Sorcha Martin, Elizabeth O'Shaughnessy
From 1999 to 2017 more than 700,000 people have died from a drug overdose and 68% of those drug overdose deaths in 2017 involved an opioid. The "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year. The impact of opioid misuse and abuse on individual person, their families and the health care system as a whole is substantial. This session will focus on current evidence in pain science, opioid pathophysiology, and the effects of opioid use on the central nervous system and how physical therapy intervention, including manual therapy and exercise can affect and optimize recovery for patients with persistent pain and opioid use. The need to revolutionize the role of the physical therapist as health care provider for individuals with opioid abuse will also be addressed.
Presenter(s): Dale Gerke, Scott Wallentine, Rich Maas
This course provides the participants with valuable examination, evaluation, diagnosis, and treatment strategies for patients with posterior hip microinstability. The demonstration will emphasize a clinical based examination for identification of posterior hip instability. The scientific and clinical rationale for rehabilitation strategies and progressions will be discussed. Participants can expect to learn innovative and creative treatment interventions. Case studies will be presented to facilitate effective recognition and treatment planning. Video examples of examination and treatment techniques will be presented and discussed throughout the presentation. The presentation will provide activities to encourage participants to integrate the information to enhance the quality care of their patients.
Presenter(s): Thomas Denninger
The rates of health sciences research publications is at an all time high and continues to accelerate. Despite attempts at creating access to research and attempts at clinical translation, rates of absorption and implementation continue to be extremely low, and decreasing. Not only is translation delayed, traditional estimates is that it takes 17 years for a research finding to become clinical practice, but most applicable discovery will never translate to practice. This occurs despite the possibility of decreased patient disability, lower need for dangerous opioid prescriptions, and massive health savings for a system rapidly going broke. From a physical therapists perspective we look outward and see underutilization of our services from a systems perspective, however, we need to also look internally and see that the care delivered within the four walls of a physical therapy clinic is highly variable, often ineffective, and far from guideline based. The production and publication of clinical practice guidelines throughout healthcare and specifically Orthopedic Physical Therapy has become common place. However, rates of implementation continue to be staggeringly low for a variety of reasons. This session will explore the challenges associated with the implementation of research into practice and specifically discuss strategies that have been used at a large national outpatient orthopedic and sports medicine company to decrease unwanted variability and improve patient outcomes. Changes in clinical behaviors, care parameters, and patient reported outcomes will be shared that are directly tied to the implementation of strategies to simplify and scale behaviors, knowledge, and the skills associated with high value care.
Presenter(s): Brian Swanson, Sean Riley
Current trends have moved OMPT towards the application of generic, one size fits all techniques and applications based on prognostic factors rather than specific examination findings. Current evidence suggests this approach may not be the best utilization of our skills. The use of specific and meaningful examination techniques, applied within a clinical reasoning framework and combined with purposeful communication techniques, are proposed as a means to refine the application of orthopedic manual physical therapy. This session will utilize a combination of lecture and lab to discuss and practice the use of provocation and alleviation testing as a means to determine patient-specific symptom behavior and to immediately transition to application of patient specific, meaningful treatment. Emphasis will be placed on effective communication strategies to improve patient understanding and buy-in that may be employed within this framework.
Presenter(s): Derek Vraa, Mary Beth Geiser
If you presently teach (or aspire to teach) musculoskeletal (MSK) content in a residency or fellowship program than this breakout session is for you! Find out what it takes to assess students along a continuum of MSK learning. Follow along as we take a group of hypothetical students (and their friends) through their separate OMPT residency or fellowship journeys. Come learn how small changes in rubrics, expectations and assessment tools can redefine the students’ MSK coursework experiences. In the end, it’s up to you to decide which of these students showed adequate skills to deserve an OMPT “nod”.
Presenter(s): Karen Dubrow
We will have a “round table” discussion of strategies with which to approach various insurance companies to negotiate as a group for higher reimbursement for specific codes. This is an exploratory session based on the experience of the presenter who has negotiated with BCBS of Texas, has been having discussions with various medical specialty groups made up of individual medical practices, and the experience of those who are attending. We will brainstorm on strategies to define OMPT for third party payers and the health care community. The session presenter will provide a platform of where to begin based on her experience negotiating, meeting with, and learning from a manager in the Network Management Department of Blue Cross Blue Shield of Texas. We will come away with a work group who will have an action plan to move this process forward. We will have defined roles which will increase our group membership to cover more activities.
Presenter(s): Larry Steinbeck, Brent Harper, Carl Heldman
Physical therapists are recognized as specialists in the identification and treatment of movement impairments for all populations. A growing body of literature supports the concept of regional interdependence, which incorporates kinetic chain biomechanics, neurophysiological mechanisms, and biopsychosocial considerations. Studies implicate fascia in musculoskeletal dysfunction, but not necessarily fascia’s tensile network. Utilizing a synthesis of information, alterations in the deep fascia can be identified and addressed through a biomechanical model based on regional interdependence and tri-planar assessment. Recent findings through anatomical dissection and histological studies show how innervated deep fascia influences proprioception and motor control through myotendinous insertions in a highly-organized pattern. This model provides participants a fresh perspective towards treatment of movement dysfunction and associated myofascial pain. Evidence for these concepts demonstrates a system for evaluating not just joint movement or strength in one or two segments, but assessing and treating the musculoskeletal system from a total body perspective.
Presenter(s): Bryan Pickens, Jon Umlauf, Chris Allen
Reflection facilitates deeper learning, gives meaning to clinical experiences and is a process through which our experience informs our practice and understanding of patients. The session will include a discussion of reflective writing and its role in the development of clinical reasoning skills, professional identity and lifelong learning. Participants will learn the theoretical pillars of reflective capacity as well as the components that make up effective reflective writing and how these facilitate the development of advanced clinical skills. The session will include examples of integrating reflective writing into fellowship training and clinical practice along with sample prompts. The presenters will share observations from experience using reflective writing and will instruct attendees on how guided written feedback about reflective writing narratives can promote a more in-depth reflective process.
Presenter(s): Brett Windsor
The US Healthcare system is rapidly transitioning from a fee for service arrangement towards a value-based framework. This transition is accompanied by the increasing demand for professions such as physical therapy to demonstrate effectiveness through positive patient outcomes. OMPT currently lacks an outcomes-focused definition of clinical expertise, a void which hinders the development of educational programs capable of inculcating and evaluating the various behaviors necessary for the production of positive patient outcomes. The objective of this session is to offer a progressive operational definition of the expert physical therapist. Our novel model of expertise relates to value-based health care by focusing on the achievement of positive clinical outcomes and their associated clinical attitudes and behaviors. Opportunities for OMPT within a value-based healthcare system are explored, and the historical perspectives of expertise within OMPT are reviewed. The attributes of capability, context and precision are introduced in view of their interrelationships to expertise and the development of consistent positive outcomes within orthopedic manual physical therapy. Expert physical therapists can meet the needs of their patients by producing positive patient outcomes. The interrelated dominions of clinical capability, context and precision are core attributes of clinical expertise, and should thus be the focus of educational programs aimed at increasing the likelihood of positive patient outcomes. Keywords: Expertise, clinical reasoning, capability, context, precision
Presenter(s): Josh Kidd, Chris Chase, Jane Borgehammar
To date there is limited evidence in identifying prognostic indicators for the painful shoulder. Traditional models include using pathoanatomical diagnostic labels. Despite the multitude of orthopedic tests and classifications, the pathophysiology of shoulder disorders is not well understood, and may be treated without consideration of the cervical spine as a source of pain. As a result, examination and interventions may be directed to the shoulder inappropriately, resulting in a misuse of clinical resources, and more importantly, a misdirection in the treatment for the individual seeking care. Taking into consideration the shortcomings of conventionally used examination procedures, a growing body of opinion favors implementing a different approach than the pathoanatomical model in the assessment and diagnosis of musculoskeletal disorders. This session will introduce different models of movement-based classification symptoms including; the Movement System Balance Model proposed by Dr. Shirley Sahrmann, the Shoulder Symptoms Modification Procedure developed by Jeremy Lewis and the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) as alternative methods that may fill the current care gap in the effective assessment and diagnosis of musculoskeletal disorders (and the shoulder joint in particular), leading practitioners toward better patient care. Several new peer-reviewed publications will be discussed that show the reliability and validity of MDT, including a recent longitudinal study published in the Journal of Manual and Manipulative Therapy examining the application of Mechanical Diagnosis and Therapy (MDT) in subjects with shoulder pain will provide supporting evidence for this presentation. In the longitudinal study, clinical data from a total of 105 patients were collected and no specific shoulder diagnoses were excluded as the intent was to classify all patients presenting with shoulder pain. An additional study published in Musculoskeletal Theory and Practice investigating the relationship between the results of three shoulder orthopedic special tests (Hawkins-Kennedy, Speed’s test, and Empty Can) and the MDT classification system to explore the possibility that MDT classification can affect the consistency of these special test. Lastly, literature will be discussed to support the use of MDT to clear the cervical spine in patients with isolated shoulder pain. After laying foundational knowledge of movement-based classification systems the participants will be instructed in the use of repeated end range movements of both the cervical spine and shoulder to classify patients accordingly. This will include a lab component focusing on psychomotor techniques used to confirm either cervical or shoulder origin and video to highlight the diagnostic process and the subgroup classification system to treat shoulder pain. At the conclusion of the session new emerging research will be presented regarding the prognostic indicator and clinical utility of the proposed treatment in the management of shoulder pain which emanates from the spine. The course participant will gain immediate incite and tools to include in their current treatment methods that will be clinically applicable
Presenter(s): Chris Dickerson, Mark Shepherd
Lecture-based presentation that will address the many ways in which sleep can impact musculoskeletal health, pain, mental health, and recovery. Discussion will include pragmatic tools that physical therapists can use to assess sleep quality and, when necessary, intervene to improve sleep quality from within an OMPT setting.
Presenter(s): Alan Fredendall, PT, DPT, CF-L2
This section will discuss utilizing exercise prescription and load dosage concepts such as rate of perceived exertion (RPE), heart rate variability (HRV), and repetitions-in-reserve (RiR) to improve outcomes with exercise in the clinic. The use of functional movements like the squat and deadlift will be discussed to treat pain and reduce future injury risk.
Presenter(s): Mark Milligan
Technology is healthcare is rapidly expanding to all areas of patient care. Telehealth is the use of electronic communication to remotely provide health care information and services. Telehealth has been shown to increase access to care, improve patient care outcomes, reduce costs, better utilize healthcare resources, and be highly satisfying to patients and healthcare consumers. Healthcare and healthcare delivery are being transformed by telehealth. The purpose of this course is to teach basic knowledge of telehealth and telehealth technologies while exploring issues surrounding physical therapy telehealth practice. This 90 minute introduction to telehealth will give attendees a basic understanding of telehealth including the different models of technology, options for use in practice, practice issues addressed by telehealth, options of types of platforms, and general rules and regulations. This course will enable the participant to understand and immediately integrate telehealth into clinical practice in multiple ways to ensure the best fit for their customer and patient population. The interface between technology and practice will be highlighted as attendees will be able to understand the many ways telehealth can improve their practice and patient experience and apply this knowledge into practice.
Presenter(s): Craig Hensley, Emmanuel Yung, Carol Courtney
Physical therapists are increasingly playing the role of front-line providers in healthcare. The orthopaedic manual physical therapist must have proficient medical screening and clinical reasoning skills to ensure appropriate patient management. Along with a thorough subjective exam, screening for non-musculoskeletal conditions via the abdomen exam can significantly aid in appropriate clinical decision making. The abdominal exam has long been a standard tool in medicine, however a recent study found that a majority of medical errors (63%) were due to failure to perform the standard abdominal examination. This resulted in missed or delayed diagnosis, unnecessary exposure to radiation, incorrect treatment, and other adverse consequences. This session will briefly discuss the importance of screening the abdominal region for non-musculoskeletal health conditions that may warrant referral to a physician, with emphasis on visceral and cardiac conditions. Evidence will be discussed regarding the sensitivity and specificity of the abdominal exam. An inductive reasoning approach will be used in demonstrating the abdominal exam followed by a practice session. Example cases where the abdominal exam played a critical role in determining appropriate management will be discussed.
Presenter(s): Catherine Patla, Tobi Baldwin, Amanda Grant
The diaphragm is the primary source of functional breathing. The diaphragm could be considered the power house engine for musculoskeletal health. Inappropriate function of the diaphragm leads to increased use of secondary muscles of breathing which then can lead to a myriad movement impairments. These abnormal movement impairments compromise musculoskeletal functioning. Evidence identifies the relationship of normal and abnormal functioning of the diaphragm to both upper and lower limb movements. Through both lecture and lab presentations, examination, evaluation and interventions are explored to enhance normal functioning of the diaphragm and the influence on movement patterns of the limbs. Clinical reasoning strategies are investigated with use of case examples. Clinical pearls are presented to facilitate immediate application of content to clinical use. Strategies are developed to promote active learning and participation for the patient. Lecture and lab sessions are utilized.
Presenter(s): Tim McGonigle
This two-part breakout session provides insight into the evolution of clinical education and practice and a detailed introduction to the model of the future. By clearly defining the fundamental elements of clinical practice, the evolution of past and current practice models as methods of addressing components of patient presentations is revealed and the threads between them easily seen. Proficient interface with the combination of factors contributing to each individual patient’s presentation requires a fully integrated practice model. Through a transition in focus from assessing components of a patient’s presentation to that of the interplay between the components, a foundation can be set for transforming clinical education and practice to their next evolutions. The system creates the perspective necessary for blending the rapidly expanding volume of clinically related knowledge with methods of streamlining assessment and intervention skills. Incorporation of all key variables potentially influencing a patient’s presentation facilitates the individualized care necessary to produce more optimal outcomes in the clinical setting. This transition in focus lays the groundwork for redirecting the initial sequence and content of orthopedic PT education. It will accelerate the acquisition of basic clinical proficiency in students and heighten the potential for development of expertise as clinicians mature in the profession. This model also provides the framework required by researchers to transition their work toward the much more meaningful Systems Thinking approach required when assessing interface with complex systems.
Presenter(s): Tamara Shelton, Dexter Upton, Caitlyn Lang, Sean Harris
In the midst of the rise in prevalence of chronic low back pain and the continued opioid crisis, Orthopedic Manual Therapists are put in a unique position to offer a safe and effective alternative to medication and in some cases, surgical intervention. It is vital to our healthcare system to determine more effective, evidence based approaches to triaging and managing spine patients non-operatively, pre-operatively and post operatively. Additionally, evidence continues to point toward the use of exercise to improve pain and function, but there are no established criteria for returning patients to their previous level of function especially for athletes. This session will explore a newly implemented, evidence based, end to end approach to spine patient management utilizing a multidisciplinary model within a large hospital system. Additionally, this session will propose a criterion based phased approach to the treatment of spine patients from the treatment table to the field/court. Course participants will participate in lecture and lab based learning to implement exercises from the various phases that they can implement immediately in the clinic.
Presenter(s): Jane Borgehammar, Ron Schenk, Cora Aytona
Lecture session to outline the evidence for the importance and role of therapeutic alliance to enhance OMPT principles of assessment, treatment with manual techniques, centralization, directional preference and neuromobilization through patient understanding of the findings and subsequent role they have managing their symptoms. Two video examples will be used to demonstrate effective and ineffective strategies to achieve therapeutic alliance in a clinical scenario.
Presenter(s): Marie Charpentier, Adeeb Khalfe
As clinicians that enjoy treating runners, we have sat through countless talks discussing the correction of dynamic knee valgus and running gait retraining. This knowledge can help get them back to running, but what about keeping them on the road long term? Or even better, improving their running performance? This talk will focus on the end stages of rehabilitating a runner, with emphasis on bridging the gap between running rehabilitation and running performance. We will explore exercise schemes beyond clamshells and 3 sets of 10 repetitions. At the conclusion of this talk, participants will be armed with the necessary knowledge to enhance their end stage running rehabilitation plans. As OMPT’s working with athletes, we can redefine musculoskeletal health by combining our manual therapy skills with performance based exercise prescription.
Presenter(s): Kristine Neelon, Benjamin Volkman, Courtney Bohne
Baseball players present in the physical therapy clinic mostly with shoulder and elbow injuries, which account for 17% and 22% respectively, of the injuries in Major League Baseball in 2015. The combined percentage of injuries in the lumbopelvic area accounted for 21%. Though less common clinically, these injuries still make up a significant component of the Injured List in baseball. Baseball throwing and hitting involve a high degree of rotation and movement coordination between the hips and thoracic spine in order to transfer the forces up to the upper extremity. Often times we see these athletes trying to focus on isolation strength movements in rehab and get back onto the field, when hitting and throwing aren’t isolation movements. They are highly dynamic and multiplanar movements and need to be rehabbed as such. In this course we will redefine how we provide functional treatment to rotational power athletes with low back pain, hamstring, groin, and oblique strains. Manual therapy intervention will involve proper soft tissue mobilization as well as joint manipulation to address impairments. Therapeutic exercise will be geared towards functional return to play progressions that can be used as a maintenance routine to prevent injury recurrence.