2008 NAIOMT Annual
Conference & Symposium

Tim Flynn  PT, PhD, OCS, FAAOMPT - bio
“Management of Upper Thorax and Rib Cage in Upper Quarter Dysfunction”

Course Description:
Traditionally the cervical and lumbar spines have received greater attention than the thoracic spine in the research arena. While a few studies have advocated cervical spine thrust manipulation as an intervention appropriate for the care of patients with neck disorders, clinicians must consider the benefits relative to the potential risks, especially vertebral artery insult.1,2 The lack of evidence for pre-manipulative screening to identify which patients may be at risk has caused some authors to suggest that serious complications, although rare, are unpredictable and that the potential benefits of cervical spine thrust manipulation do not outweigh the inherent risks.3,4

Recent evidence has demonstrated that thrust techniques directed at the thoracic spine can have similar therapeutic benefits to cervical spine thrust manipulation in patients with mechanical neck pain5-7 and whiplash associated disorders8,9 while minimizing the risks. Additionally, a clinical prediction rule has been developed that accurately identifies patients with neck pain likely to exhibit a rapid and dramatic response to thoracic spine thrust manipulation.10 The ability to a priori identify patients with neck pain likely to experience a dramatic response with thoracic spine thrust manipulation while avoiding the potential risk associated with cervical spine thrust manipulation is useful for guiding clinical decision-making for individual patients. Preliminary evidence also exists for the use of a multimodal treatment strategy (including manual therapy directed at the thoracic spine) in the management of cervical radiculopathy11 and lateral epicondylalgia12 and upper quadrant pain syndromes.

This one day course will consist of lecture (20%) and lab sessions (80%). Lecture will consist of discussion surrounding current evidence related to the risks associated with cervical spine thrust procedures as well as the evidence supporting the effectiveness of thoracic spine thrust and non-thrust procedures for patients with presenting with a number of disorders. Lecture will also include the incorporation of clinical prediction rules into clinical practice to guide decision making regarding individual patients. The majority of the course will be devoted to hands-on demonstration and practice of both examination and thrust manipulation techniques directed at the upper thoracic spine and rib cage.  

Objectives:
Upon completion of this course the participants will be able to:

1. Describe the current best evidence for the use of manual therapy directed at the thoracic spine. 
2. Understand the benefits of using clinical prediction rules to guide decision making regarding individual patients.
3. Demonstrate evidence-based clinical examination skills.
4. Perform with moderate proficiency thrust manipulation to the upper thoracic spine and ribcage.

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Josh Cleland  PT, DPT, PhD, OCS, FAAOMPT - bio
“Thrust Manipulation in the Management of Low Back Pain”

Course Description:
The prevalence of low back pain (LBP) continues to rise and results in substantial pain and disability. However, certain physical therapy interventions and management strategies have demonstrated efficacy in the management of LBP.  In particular, manual therapy interventions have growing evidence supporting their use. Given the tremendous personal and financial burden associated with LBP it is imperative that physical therapists adopt the best practice initiatives in managing these disorders. This course will provide the current best evidence supporting the use of thrust manipulation in the management of LBP.

A clinical prediction rule (CPR) identifying patients with low back pain who are likely to respond rapidly and dramatically to thrust manipulation directed at the lumbopelvic spine has been developed and validated. The ability to a priori identify patients with LBP likely to experience a dramatic response is useful for guiding clinical decision-making for individual patients. This one day course will consist of lecture (20%) and lab sessions (80%). Lecture will consist of discussion surrounding current evidence related to the effectiveness of thrust manipulation in the management of LBP. Lecture will also include the incorporation of CPRs into clinical practice to guide decision making regarding individual patients. The majority of the course will be devoted to hands-on demonstration and participation of thrust manual therapy techniques directed at the lumbopelvic.  

Objectives:
Upon completion of this course the participants will be able to:

1. Describe the current best evidence for the use of thrust manipulation in the management of low back pain. 
2. Understand the benefits of using clinical prediction rules to guide decision making regarding individual patients.
3. Select and demonstrate thrust manipulation techniques and exercise interventions based on current best evidence.
4. Discuss strategies for changing practice behaviors and delivery of manual therapy services to a wider range of appropriate patients.

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Laurie McLaughlin  BSHcPT, MCPA, FCAMT - bio
“Manips for Chicks” or “Ergonomically Efficient Manipulation” (It’s not just for women)”

Course Description:
The idea for this course came from years of watching candidates come through the manual therapy exams attempting to do manipulations while they were at an ergonomic disadvantage. Many of the manipulation courses are taught by big men who can  accomplish these techniques with ease however not all manipulators are their size. As someone who is smaller in stature, I had to modify many manipulation techniques to be able to perform them in a manner that was safe not only for the patient but for me as well. This course will emphasize hands on practice of ‘ergonomically efficient’ spinal manipulation. Participants should have had some instruction in manipulation prior to taking this course.

Objectives:
Upon completion of this course the participants will be able to:
Understand the importance of body position in the delivery of effective thrust.
Perform localizing techniques to minimize the force necessary to achieve a successful manipulation
Demonstrate the use of increased speed and decreased force in the delivery of a thrust

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Peter Huijbregts  PT, DPT, OCS, FAAOMPT, FCAMT - bio
“Evidence-based practice: How it affects your ability to get a case report or literature review published”

Course Description:
Ever thought of adding to the peer-reviewed OMPT literature by way of a case report or literature review? What is stopping you: fear of rejection of your work? Every author becomes emotionally attached to his or her literary product after all the sacrifices required to get it written up. Or maybe you just do not know where to start, what format to use, where to find the data that seems required within the currently prevailing evidence-based paradigm? Maybe you do not quite know which data are in fact required? Or maybe the terms associated with this paradigm, such as, for instance, sensitivity, specificity, minimal detectable change, medical subject headings, methodological quality assessment tools, etc., are just something you never heard or paid no great attention to in your entry-level physical therapy training (making you no different from the presenter of this course, by the way). The intent of this course is to provide you a tutorial on what a case report or literature review should look like to have a good chance of being accepted for publication. In addition, this course will introduce (or reintroduce) you to concepts associated with the evidence-based practice paradigm allowing you to not only use these concepts and the associated skills more effectively when preparing a manuscript but also in day-to-day clinical practice.

Objectives:

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Erland Pettman PT, MCSP, MCPA, FCAMT, COMT - bio
‘An Evidenced Enhanced Course on the Biomechanics, Assessment and Manipulation of the Upper Cervical Spine”
(NOTE:This course will only be offered to those who have successfully passed the NAIOMT Level III Written Examination or its equivalent in fellow Institutes and Fellows of AAOMPT) 

At the conclusion of this course it is anticipated that the participants will be able to:

a)      Understand the biomechanics of the atlanto-occipital joint, atlanto-axial joint and the C2/3 joint.

b)      Understand the neuro-anatomical relationships of the upper three cervical segments and certain cranial nuclei.

c)      Understand the signs and symptoms that may be experienced by upper cervical joint biomechanical dysfunction.

d)      Perform, and interpret the findings of, a cranio-vertebral scanning examination including stress tests to the A/O, A/A and C2/3 joints.

e)      Perform passive motion testing to the upper three cervical joints.

f)        Perform passive and muscle-assisted mobilization techniques, including the use of locking techniques (where appropriate), for hypomobility of the upper three cervical joints.

g)      Understand the contra-indications and causes for concern when contemplating the use of high acceleration thrust techniques to the upper cervical joints.

h)      Discuss the issue of patient consent prior to performing any high velocity thrust technique.

i)        Set up and perform high acceleration thrust techniques to regain motion within the upper three cervical joints.

j)        Design an appropriate home exercise program to optimize the effect of the mobilization or high acceleration thrust technique performed on the patient.

Participants are reminded that the onus on safety is their shared responsibility. You will be required to fill out a disclaimer form that includes a confidential medical/physical information sheet. However, it should be emphasized that those participants who:

Have had recent or past cervical surgery, including cranial, cervical or thoracic stints

Have a history of chronic childhood respiratory dysfunction

Are pregnant (even if pregnancy is suspected)

Are known to have osteoporosis (or fit a major risk group for osteoporosis)

Have had recent (post 1 year) head or neck trauma

Have a history of high blood pressure

ANY regular medication, but especially steroids, aspirin or anti-coagulants

MUST make themselves known to the chief instructor. You must not allow yourself to be a model for any stress tests or ANY thrust techniques. If you are in doubt about your suitability to be a model please discuss this with your physician or the chief instructor of this course.

If you are unfamiliar with any of the above terminology or warnings, or their significance, then you should NOT be a participant on this course.

Participants are reminded that this is primarily a practical course and appropriate lab clothing will be expected.

Participants are advised not to perform, or have performed on them, any technique that is not expressly taught by the chief instructor.

An extensive course manual will be provided by the chief instructor. However, your course experience will be enhanced by attending with a copy of the chief instructors book ‘Manipulative Thrust Techniques. An evidence based approach’. This will be available at the symposium or can be ordered online at www.erlpettman.com .

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Gail Molloy - bio
Kathy Stupansky - bio
“Extremity (Peripheral) Joint Manipulation; upper and lower limbs”

Course Description: 
This course will teach the biomechanical examination and manual physical therapy intervention of selected joints of the upper and lower limb with emphasis on high velocity low amplitude mobilization/manipulation techniques (HVLAT/thrust).  Current literature and evidence will be reviewed to apply the intervention safely, efficiently and effectively to meet the patient/client needs.  The course will apply biomechanical and pathological theories and knowledge to the recognition and analysis of extremity joint conditions and movement dysfunctions benefiting from thrust techniques.

Objectives: