Y

Professional PT
Clinical Corner
Issue 1

December 2014

Welcome!!
Inside this issue:
Welcome!

Partnering with
MedBridge

In the Mind of ...

Open Letter

False Lateral Hip

Pain

2, 3

Technique Peek

Welcome to the first edition of

Professional PT Clinical Corner! We
will be publishing this newsletter on a
bi-monthly basis. The newsletter will
consist of upcoming events, article reviews, case studies and technique
peeks. Please feel free to submit anything that you feel would be helpful to
your fellow clinicians to continue to
learn and develop. Thank you!!
Your education team:
Rob Panariello, Tim Stump, Donis Gil
and Rob Shapiro

If you can't explain it

simply, you don't understand it well enough
Albert Einstein

Clinical Prediction 3
Rule for Ankle
Sprain

Points of Interest:
Student symposium
February 22, 2015
Lumbar Spine
Seminar coming in
May 2015
Kevin Wilk to return
Spring 2015
(tentative)
Look out for
In the Mind of ...
podcasts coming in
January 2015
Look for Technique
Peek Lecture in
January 2015

Professional PT Partners with MedBridge

The Clinical Education
Department is excited to
announce a new addition to all
full-time clinicians continuing
education benefits, starting
January 1, 2015.
MedBridge is an online
evidence-based continuing
education company which will
allow the clinician to learn from
experts in the field, educate
their patients with a state-ofthe-art patient library, and
provide patients with a clear
and concise HEP.
Every full-time PT/PTA/ATC will
have access to the site and will
be able to obtain and track their
CEUs from anywhere.

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2014

YPage 2

Professional PT Clinical Corner

In the Mind of ...

Caption describing picture or graphic.

Watch out for a new

podcast titled In the
Mind of which is a clinical
education department
sponsored program that
will be a recorded interview
lasting no more than 15-20
minutes. On a monthly
basis, we will pick a

clinician who possesses

expertise on a given

topic. The interview will be

focused on discovering the
thinking process of that
individual and how they
would approach patient care
in general, or for a specific
region. The goal of the
program is to assist other
clinicians in fine tuning their
clinical reasoning skills with
the help of a more
experienced clinician.

The first episode

will be available in
January 2015.

Open Letter from the Clinical Ed Department

The will to win, the

desire to succeed,
the urge to reach
your full potential...
these are the keys
that will unlock the
door to personal
excellence.
Confucius

We understand you have a

lot on your plate and we want
to help you continue to grow
and make sure you feel
confident in reaching out if
you need help or just want to
learn.
We are here to help and can
assist you in many ways such
as, but not limited to:
1. Providing feedback with
tough cases either via email,
Skype, or co-treating.

2. Setting up local study

groups in your area which
we will help run. All you
need to do is get a few of
your colleagues together
and reach out and tell us
when you are ready to start
to meet.
3. Bi monthly case study and
article review newsletters
4. Look out for a new podcast entitled "In the Mind
of...." This podcast will be an

interview based format and

will delve into the thinking
process of our more senior
clinicians (notice how I
didn't say old lol)
These a just a few ideas
and we are looking forward
to getting your feedback on
how we can help you become
a master clinician. Never stop
learning!
Thank you in advance for
helping make this a fun and
exciting process.

False Lateral Hip Pain

Robert Shapiro MA PT COMT
Dont forget about the
thoraco-lumbar junction
(TLJ) when treating patients
who are not responding to
what you may think is a hip
dysfunction. The TLJ includes
T10/11-T11/12 and T12/L1,
and is often the source of
lower back, groin and lateral
hip pain. The lumbar spine
has a limited amount of
rotation available especially
when combined with
extension while the thoracic
spine rotates freely. The TL
junction is a transitional zone
between the thoracic and
lumbar regions and will
therefore be a region that

is strained with rotational

activities. This is especially
true when the patient has
poor core control and
therefore put undue strain
through this region. False
lateral hip pain can be
caused by dysfunction at
the T12/L1 facet or by
entrapment of the cutaneous
branches from the T12 or L1.
The patient typically presents
with lateral hip pain which
can radiate toward the groin
and lateral thigh. Pain is
typically described as deep
and the patient may c/o a
sudden sharp pain in the

groin with quick movements

or with a sudden increase in
walking pace.
Examination to determine if
the pain is spinal origin will
consist of palpation for facet
tenderness and restricted
transverse pressure to the
involved spinal segments. A
positive test will reproduce
the patients lateral hip pain.
A pinch-rolling test can be
used to the skin overlying the
trochanter and will be painful
and thickened if the lateral
perforating branch of is involved. (See figure this
page.)
Continued on next page ...

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2014

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Issue
1

False Lateral Hip Pain

(contd from page 2)

referral for injections.

Once these techniques
are performed the region needs to be
re-evaluated to
determine if this was
indeed the cause.

If the lateral hip pain is

determined to be of spinal
origin, the TLJ can be treated
by using muscle energy
techniques, mobilization or
spinal manipulation. If it was
determined that the lateral
hip pain was due to nerve
entrapment of the cutaneous
branches treatment can consist
of soft tissue mobilization,
myofascial release or possible

Next time you have a

patient with lateral hip
pain which does not
seem to clear with
localized treatment to

the hip dont forget to evaluate the TLJ as a possible

cause. Check out the Technique article for treating TLJ
dysfunction.
Maigne R. Diagnosis and
Treatment of Pain of
Vertebral Origin: a
manual medicine
approach. Baltimore:
Williams & Wilkins; 1996

Seated TL joint mobilization/

manipulation

Technique Peek: Thoraco-lumbar Junction Mobilization

Robert Shapiro MA PT COMT
Indications: Eg. T12/L1
dysfunction with limited
mobility into flexion and
rotation to the left .

right hypothenar eminence over

the T12 transverse process (on
the right,)

Technique: Flex patient until

you feel motion arrive at T12 on
the right , side bend the patient
to the left with combined left roTherapist position: Standing tation. When you get to the barrier of motion you can mobilize,
on the patients left side .
Reach across patient and grasp perform a muscle energy technique, or follow through with a
and stabilize the opposite
manipulation.
scapula just below the axilla.
Palpate T12/L1, place your
Refer to figure at right from
DO OMT
Patient position: Seated,
straddles over edges of table,
hands clasped behind neck

Clinical Prediction Rules: Ankle Sprain

Whitman, Julie M., et al.
"Predicting short-term response to
thrust and non thrust manipulation
and exercise in patients post
inversion ankle sprain." Journal of
Orthopedics & Sports Physical
Therapy 39.3 (2009): 188-200
Whitman et al developed a clinical
prediction rule that can be used to help
identify which patients would benefit
from manual therapy and general
mobility exercises after a lateral ankle
sprain.
The inclusion criterion for the study
was: Ages 18-60, primary report of
ankle pain, NPRS (pain scale) including
worst pain over the last past week
more than 3/10, Negative Ottawa Ankle

Rules (no need for x-ray).

Predictor Variables: Symptoms
worse with standing. Symptoms
worse in the evening. Navicular
drop > 5.0 m, Distal tibiofibular
joint hypomobility.
Interventions used: Manual
treatment.
Rear foot distraction thrust
manipulation, Proximal tibiofibular
P/A thrust manipulation, A/P
talocrural non-thrust manipulation.
Lateral glide of talocrural and
subtalar joints, Distal tibiofibular
A/P mobilization.
Exercises: Achilles stretch (WB
and NWB), Alphabet exercises

For internal use only. Not intended for external sharing or distribution.

Ankle self eversion mobilization,

Dorsiflexion self mobilization.
The presence of 3 or more
predictor variables creates a
moderate shift in the likelihood
that an individual with a lateral
ankle sprain, patients who meet
the inclusion criteria, will benefit
from manual therapy and exercise
within 2 visits (within 4-8 days).
75 percent of the subjects in this
study had a successful outcome.
Success was defined as a GROC
(Global Rating of Change) score
more than +5 (quite a bit better).
The GROC is a 15 point grading
scale ranging from -7 (a very
great deal worse) to +7 ( a very
great deal better).

Professional Physical Therapy 2014